Final Exam

What hormone is responsible for calcium resorption?

Parathyroid hormone (PTH)

What condition can occur post-thyroidectomy due to parathyroid removal or atrophy?

Hypocalcemia

What is Chvostek's sign?

Cheek tapping that leads to twitching in patients with hypocalcemia

What is Trousseau's sign?

Carpopedal spasms when a blood pressure cuff is inflated above systolic pressure for 3 minutes in a hypocalcemic patient

What are the normal sodium levels?

135-145 mEq/L

What conditions can cause fluid shifts between ICF and ECF?

Hyponatremia and hypernatremia

Why is sodium imbalance dangerous?

It can cause fluid shifts affecting the brain

What is a key nursing intervention for sodium imbalance?

Initiate seizure precautions

What are normal potassium levels?

3.5-5 mEq/L

What is a major cause of hyperkalemia?

Renal failure

What are additional causes of hyperkalemia?

Overreplacement, cell damage, acidosis, and use of spironolactone

What are causes of hypokalemia?

Diuretics (Thiazide and Loop), laxatives, NG tube drainage, poor intake, renal loss, GI loss, insulin administration, and alkalosis

What ECG changes are seen in hyperkalemia?

Peaked T waves, prolonged QRS, flattened P waves, blocks, PVCs, and arrhythmias

What ECG changes are seen in hypokalemia?

Flattened T waves, peaked P waves, PVCs, and arrhythmias

What is a crucial intervention in both hypo- and hyperkalemia?

Obtain ECG/EKG and report to MD/physician

Why does renal failure lead to hyperkalemia?

Because potassium is not adequately excreted through the kidneys

What do gallstones indicate?

Cholelithiasis

How can patients with gallstones manage symptoms?

Lifestyle modifications such as reducing fat intake

Which hepatitis types have vaccines?

Hepatitis A (HAV) and Hepatitis B (HBV)

Which hepatitis types can become chronic?

Hepatitis B (HBV), C (HCV), and D (HDV, only if HBV is present)

Is Hepatitis A acute or chronic?

Acute only

How is Hepatitis A transmitted?

Fecal-oral route

What is the vaccine schedule for Hepatitis A?

2 shots — 1st shot before travel, 2nd shot after 6 months

What is the post-exposure treatment for Hepatitis A?

Immune globulin (IVIG) within 2 weeks if unvaccinated

When are children recommended to get the Hepatitis A vaccine?

1-2 years old with second dose in 6 months

Is Hepatitis B acute or chronic?

Both acute and chronic

What are modes of transmission for Hepatitis B?

Blood and body fluids

- Sharing needles

- Sexual contact (semen, vaginal fluids)

- Perinatal (mother to baby at birth)

- Mucosal exposure (e.g., open wounds)

What is the Hepatitis B vaccine schedule?

3 doses at 0, 1 month, and 6 months

What is Twinrix?

A combination vaccine for Hepatitis A & B

Is there a vaccine for Hepatitis C?

No

Can Hepatitis C become chronic?

Yes — can lead to liver damage

What are the transmission routes for Hepatitis C?

Blood-to-blood

- Sharing needles

- Blood transfusions before 1992

- High-risk sexual contact

- Perinatal

- Occupational (needlesticks)

Is there a vaccine for Hepatitis D?

No direct vaccine

Can Hepatitis D become chronic?

Yes — but only if co-infected with Hepatitis B

How is Hepatitis D transmitted?

Bloodborne: IV drug use, sexual contact

What does HDV require to infect a person?

Co-infection with Hepatitis B

Is Hepatitis E acute or chronic?

Acute only

Is there a vaccine for Hepatitis E?

Not in the U.S. (available in China)

What is the most common mode of transmission for Hepatitis E?

Fecal-oral, especially via contaminated drinking water

Why is Hepatitis E serious during pregnancy?

It can cause fulminant hepatic failure and maternal death, especially in the third trimester

What is the post-exposure treatment for Hepatitis B?

HBIG antibodies ASAP (best within 24 hours), combined with the 1st dose of 3-dose HBV vaccine

What lab changes are associated with dehydration?

Increased hematocrit and hypernatremia due to hemoconcentration

What is ascites?

Accumulation of serous fluid in the peritoneal or abdominal cavity

What are signs of ascites?

Abdominal distention and weight gain

What condition commonly causes ascites?

Cirrhosis

How does cirrhosis lead to ascites?

↓ Albumin → ↓ oncotic pressure → fluid shifts out of blood vessels into peritoneum

What hormonal changes are associated with ascites?

↑ Aldosterone, ↑ Na reabsorption, ↑ H2O retention, due to RENIN activation

What causes hepatic encephalopathy?

Elevated blood ammonia levels affecting the CNS

What medication can prevent hepatic encephalopathy?

Neomycin (neomycin sulfate)

How does neomycin help in hepatic encephalopathy?

Decreases gut bacteria that form ammonia, lowering ammonia levels

What are symptoms of high ammonia levels?

Lethargy, confusion, decreased consciousness

What blood ammonia level is concerning in clinical practice?

60-80 µmol/L or higher

What is one main goal of paracentesis in treating ascites?

To relieve respiratory distress caused by pressure from excess abdominal fluid

What is steatorrhea and what condition is it associated with?

Fatty, frothy, smelly stool — seen in pancreatitis due to lack of lipase release

What are two main causes of acute pancreatitis?

Binge drinking and gallstones

What is Cullen's sign?

Periumbilical ecchymosis (bruising around the belly button)

What condition might show Cullen's sign?

Acute pancreatitis

Who is Cullen's sign named after?

Thomas Stephen Cullen, the physician who described it

What is fluid volume deficit (FVD) also called?

Hypovolemia

What causes fluid volume deficit?

- Hemorrhage

- Vomiting/diarrhea

- Diuretics

- Excessive sweating (diaphoresis)

- Third-spacing (e.g., ascites, burns)

- Inadequate fluid intake

What are signs and symptoms of FVD (Fluid volume deficit)?

- Dry mucous membranes, dry skin

- Poor skin turgor

- Hypotension (↓ BP)

- Tachycardia (↑ HR)

- Weight loss

- Oliguria

- Dark, concentrated urine

- Sunken eyes, flat neck veins

- Confusion, dizziness, fatigue

What are the lab findings in FVD (Fluid volume deficit)?

- ↑ Hematocrit

- ↑ BUN

- ↑ Urine specific gravity

- ↑ Serum osmolality

- Hemoconcentration

What are nursing interventions for FVD (Fluid volume deficit)?

- Monitor daily weight & I/O

- Assess vital signs frequently

- Encourage oral fluids if safe

- Administer IV fluids (e.g., NS or LR)

- Fall precautions (orthostatic hypotension risk)

FVD = DRY: ↓ BP, ↑ HR, dry mouth, low urine output

What is fluid volume excess (FVE) also called?

Hypervolemia

What causes fluid volume excess?

- Heart failure

- Renal failure

- Cirrhosis

- Excessive IV fluids

- Hyperaldosteronism

- Long-term corticosteroid use

What are signs and symptoms of FVE (Fluid volume excess)?

- Edema (peripheral/generalized)

- Jugular vein distention (JVD)

- Bounding pulses

- Hypertension

- Crackles in lungs

- Dyspnea, orthopnea

- Weight gain

- Ascites (if liver-related)

What are the lab findings in FVE (Fluid volume excess)?

- ↓ Hematocrit

- ↓ BUN

- ↓ Urine specific gravity (diluted)

- ↓ Serum osmolality

- Hemodilution

What are nursing interventions for FVE (Fluid volume excess)?

- Restrict fluids and sodium

- Monitor daily weight & I/O

- Administer diuretics (e.g., furosemide)

- Elevate HOB if dyspneic

- Monitor respiratory status

- Assess for edema and skin integrity

FVE = WET: ↑ BP, edema, crackles, JVD

What causes jaundice?

Functional liver cell damage and bile duct compression from connective tissue overgrowth

What happens when the liver can't conjugate bilirubin?

Bilirubin enters the bloodstream and urine (dark urine), and stools become clay-colored

How does jaundice appear in the body?

- Yellowing of the sclera and skin

- Dark urine

- Clay-colored stools

How should nurses assess for jaundice?

Inspect sclera and skin, and monitor stool and urine color

What is Homan's sign?

Pain in the calf upon dorsiflexion of the foot, indicating possible DVT

What are symptoms of DVT?

- Calf tenderness

- Lower leg swelling

- Warmth

- Redness

What is Virchow's Triad?

Venostasis, hypercoagulability, and vessel wall injury/inflammation

What is RICE used for?

Soft tissue injury treatment: Rest, Ice, Compression, Elevation

What is a T-tube used for post-cholecystectomy?

To help with bile drainage

What position should hip replacement patients avoid?

Flexion angle > 90°, such as sitting in a low chair

What lab change occurs during the emergent burn phase?

Hemoconcentration → ↑ hematocrit levels

What is the priority concern with large burns (>30% BSA)?

Massive fluid loss

What might coughing during the immediate postburn phase indicate?

Inhalation injury — a major predictor of mortality

What causes GERD pathophysiologically?

Relaxation of the lower esophageal sphincter (LES)

What is a complication of chronic untreated GERD?

Barrett's epithelium → increased risk of esophageal cancer

How does pregnancy contribute to GERD?

Progesterone relaxes LES and enlarged uterus increases abdominal pressure

What patient education is important when taking antacids?

Take other medications at least 2 hours apart due to potential absorption issues

Why is escharotomy performed in burn patients?

To relieve pressure and prevent compartment syndrome in circumferential burns

What is the best route for pain management after burns?

Intravenous (IV) for rapid therapeutic effect

What is compartment syndrome?

Increased pressure in a muscle compartment impairs circulation and nerve function

What are the 6 P's of compartment syndrome?

Pain, pallor, paralysis, paresthesia, pulselessness (late sign), poikilothermia

What symptom of compartment syndrome requires immediate attention?

Pain unrelieved by medication

How should casts be handled to prevent skin ulcers?

Move with palms, not fingertips, during drying phase

What are compensatory signs of severe anemia?

Tachycardia and dyspnea due to low oxygen-carrying capacity

What are pagophagia and pica signs of?

Iron deficiency anemia

What is the focus of hospice care?

Comfort and quality of life for patients with life expectancy under 6 months

What should patients receiving radiation therapy be taught?

Monitor skin for breakdown and avoid sun exposure or trauma to treated areas

What is the pathophysiology of Type 1 DM?

Autoimmune destruction of pancreatic beta cells → no insulin production

What is the typical onset of Type 1 DM?

Childhood or adolescence (can occur at any age)

What are key features of Type 1 DM?

Thin body type, rapid onset, insulin-dependent, ketone production, DKA risk

What are symptoms of Type 1 DM?

Polyuria, polydipsia, polyphagia, weight loss, fatigue, ketonuria

What is the pathophysiology of Type 2 DM?

Insulin resistance + impaired insulin secretion; beta-cell function declines