NUR 301 OLD EXAM

• Pulmonary Embolism


  A sudden blockage in your pulmonary arteries, the blood vessels that send blood to your lungs
• Pulmonary Embolism


  • Dyspnea
  • Acute pleuritic chest pain
  • Tachypnea
  • Hemoptysis
  • Coughing
  • Dizziness
  • Heart palpitations
  • Leg pain or swelling
  • SOB
  • Diaphysis
  • fever
• Pneumonia


  Inflammatory reaction in the lung that produces exudates that interfere with the diffusion of oxygen and carbon dioxide
• Management of Pneumonia


  1. O2 therapy

  2. Antibiotics (send sputum & blood cultures first)

  3. Nebulizer/inhaler

  4. Antipyretics

  5. Nutritional support

  6. DVT prophylaxis

  7. Pneumococcal vaccine
• Thoracentesis


  Needle in the pleural space (lungs) to release excess fluid or air
• Management of Thoracentesis


  1. Monitor VS, o2 saturation, and breath sounds for several hours following the procedure

  2. Assess dressing over the puncture site
• Positioning for Thoracentesis


  • Sitting upright with arms resting on the table (bent forward)
• Symptoms and signs of angina

  • Pain
  • Weakness and numbness in arms, wrists, and hands
  • Shortness of breath
  • Pallor
  • Diaphoresis
  • Dizziness
  • Lightheadedness
  • Nausea and vomiting
• Management of angina


  • Nitroglycerin
  • Beta-Adrenergic Blocking Agents
  • Calcium channel blocker
  • Antiplatelet or anticoagulant- aspirin, adenosine, heparin, glycoprotein
  • Oxygen therapy
• Percutaneous Coronary Interventions


  • Assessment
  • Management
• Symptoms and signs of left-sided heart failure

  • Paroxysmal nocturnal dyspnea
  • Restlessness
  • Elevated pulmonary capillary wedge pressure
  • Confusion
  • Orthopnea
  • Tachycardia
  • Exertional dyspnea
  • Fatigue
  • Cyanosis
  • Pulmonary congestion (cough, crackles, wheezes, blood-tinged sputum, tachypnea)
• Symptoms and signs of right-sided heart failure

  • Fatigue
  • Increased peripheral venous pressure
  • Ascites
  • Enlarged liver & spleen
  • Distended jugular veins
  • Anorexia & complaints of GI distress
  • Weight gain
  • Dependent edema
• Management of heart failure

  • Lower sodium intake
  • Physical activity
  • Quit smoking/limit alcohol consumption
  • Manage stress
  • Get sleep
• ROME


  • Respiratory Acidosis - COPD
  • Respiratory Alkalosis - hyperventilation, anxiety, numbness and tingling of extremities
  • Metabolic Acidosis - nausea, vomiting, muscle twitching, slow to react, drowsiness, diabetic ketoacidosis, diarrhea, fistulas, need dialysis
  • Metabolic Alkalosis - nausea, prolonged vomiting (LOSS OF FLUIDS)
• Electrolyte levels

  • Sodium: 135-145 mEq/L
  • Potassium: 3.5-5 mEq/L
  • Magnesium: 1.6-2.6 mg/dL
  • Calcium: 8.2-10.2 mg/dL
• Other Values


  • BUN: 8-21 mg/dL
  • Creatinine: 0.5-1.2 mg/dL
  • Hemoglobin: Males 14-18 Females 12-16
  • Hematocrit: Males 43-49% Females 38-44%
• Symptoms


  • Hyponatremia: confusion, headache, dizziness, seizures, orthostatic hypotension, crackles, muscle cramps/weakness, edema and ascites
  • Hypernatremia: muscle weakness, muscle cramps, confusion, headache, hallucinations, lethargy, seizures, weight gain, edema, hypertension, bounding pulse
  • Hypokalemia: muscle pain, muscle weakness, constipation, abdominal distention, vomiting, bowel obstruction, flattened T waves, depressed ST segments or U waves
  • Hyperkalemia: muscle cramps, muscle twitching, muscle paralysis, abdominal cramps, and nausea, peaked T waves
  • Hypocalcemia: tetany (muscle spasms) + Chvostek sign + Trousseau
  • Hypercalcemia: Bones, stones, groans, thrones, and psychiatric overtones (memory loss and slowed speech)
  • Hypomagnesemia: seizures, confusion, tetany, increased tendon reflexes + Chvostek sign + Trousseau, cardiac arrhythmias
  • Hypermagnesemia: coma, drowsiness, lethargy, weakness, hypoactive reflexes, hypotension, flushing, cardiac arrhythmias, or cardiac arrest if the cardiovascular system is affected
• Syndrome of inappropriate Diuretic Hormone (SIADH)

  • Stop urination (low urine output)
  • Sticky & thick urine, high SG
  • Soaked inside & liquidity labs (hypo osmolality (low) and hyponatremia)
  • Sodium low
  • Seizures (headaches)
  • Severely high BP
  • Stop all fluids + give salt + diuretics
  • LABS ARE LOW AND LIQUIDY
• Diabetes Insipidus

  • Diurese "drain" fluid (high urine output)
  • Diluted urine (low SG)
  • Dry inside "high and dry" labs (hyperosmolarity and hypernatremia)
  • Drinking a lot "thirsty"
  • Dehydrated (dry mucosa & skin)
  • Decreased BP
  • Desmopressin "vasopressin" (decrease urine output)
  • Headaches
  • LAB ARE HIGH AND DRY
• Diabetic Ketoacidosis

  • polyuria, polydipsia, polyphagia, electrolyte imbalances (1st hyperkalemia, 2nd hypokalemia), hypotension
  • D Dry & high sugar
  • K ketones & Kussmaul respirations (fruit breathe)
  • A abdominal pain
  • A acidosis metabolic (pH <7.35)
• Management of Diabetic Ketoacidosis

  1. Rehydration (up to 6-12 L, VS, respiratory, cardio, and neuro assessment, I&Os)

  2. Electrolyte correction (monitor K levels add K)

  3. Acidosis (inulin administration)
• Hypoglycemia

  • Blood sugar <63 mg/dL
  • Can be caused by too much insulin or oral hypoglycemic agent, too little food, or excessive activity
• Signs and symptoms of Hypoglycemia

  • cool, clammy, confused, pale, sweating, drowsy, palpations, seizures
• Chronic renal failure

  • HTN, HF, pulmonary edema, LOC, agitation, confusion, n/v, ammonia breath, anorexia, pruritus, anemia, seizure, coma
  • Decreased GFR
• Acute renal failure

  • HTN, edema, pulmonary edema, JVD, anorexia, nausea, constipation or diarrhea, dysrhythmias
  • Elevated BUN and creatinine, hypocalcemia, increase in everything else
• Management of Chronic renal failure

  1. Treat electrolyte abnormalities (hyperkalemia, hypocalcemia, hypernatremia)

  2. Monitor for renal osteodystrophy

  3. Renal diet: low sodium, protein, and potassium

  4. Treat complications

  5. Renal transplant: acute rejection (>3 months and requires antirejection meds)

  6. Renal replacement therapies
• Management of Acute renal failure

  1. Eliminate the underlying cause

  2. Maintain fluid balance (daily weight/I&Os)

  3. Avoid fluid excess (respiratory status, VS, give loop or osmotic diuretics)

  4. Provide renal replacement therapy (short-term hemodialysis or peritoneal dialysis)

  5. Treat electrolyte abnormalities (Potassium: Kayexalate, insulin, calcium gluconate

  6. Acidosis: bicarbonate)
• Causes of Acute Renal Failure

  • Prerenal: Hypoperfusion
  • Hypotension
  • HF or reduced CO
  • GI loss
  • Intrarenal: Nephrotoxins (ABX (vancomycin) or contrast dye)
  • Glomerulonephritis
  • Rhabdomyolysis
  • Postrenal: Kidney stones
  • BPH
  • Tumors
  • Biliary stasis
• Duodenal ulcer

  • 80%-hypersecretion of stomach acid
  • Epigastric pain aggravated by fasting, pain improves with food or antacids (pain 2-3 hours after eating)
  • Often awaken at night
  • Vomiting is uncommon
  • Hemorrhage is less common
• Gastric ulcer

  • 15%- normal or hyposecretion of acid
  • Relieved by vomiting and is not relieved by eating
  • Pain in the stomach (pain 30-60 min after meals)
  • epigastric pain with food intake
  • vomiting helps
  • hemorrhage is more common
• Short-term post-op complications of the obese client

  • pulmonary embolism
  • hemorrhage
  • infection
  • anastomosis leak (tachycardia, hypotension, fever, abdominal pain)
• Long-term post-op complications of the obese client

  • hernia
  • intestinal obstruction
  • band slippage
  • malnutrition
  • vitamin deficiency (b12)
  • GERD