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CMSRN Exam Questions And 100% Correct
Answers A+ Graded
Examples of third spacing - ANSWER Ascites, edema, burn
Dilutional Hyponatremia - ANSWER Excessive fluid intake Edema, confusion, weight gain Treatment: decrease fluid intake "swells, rings tight"
True Hyponatremia - ANSWER Loss of fluid and Na Weight loss, DRY, hypotensive, tachy, DEHYDRATED Tx: replace both sodium and water
Hypernatremia Causes - ANSWER Fevern unresponsive to traditional interventions, Na IV fluids, DI, tube feeds
Hypernatremia Symptoms - ANSWER DRY, thirst, tachy, oliguria(compensating)
Hypernatremia treatment - ANSWER Decrease Na and replace fluids
Cl - ANSWER Acts like Na Buffer to maintain pH
Hyperkalemia Causes - ANSWER Cell wall destruction Increased intake
K sparing diuretics Renal failure Acidosis
Hyperkalemia symptoms - ANSWER Irritable muscles Dysrhythmias Hyperactive bowels/bladder- diarrhea, frequency, urgency
Hyperkalemia tx - ANSWER Limit intake Kayexalate Ca gluconate IV glucose Dialysis
Hypokalemia Causes - ANSWER Vomiting Diarrhea NG suction Decreased PO Burns K wasting diuretics
Hypokalemia Symptoms - ANSWER Muscle flaccidity- not there to stimulate Weakness Constipation Alkalosis-resps Shallow Resps Cardiac arrest
Hypocalcemia Causes - ANSWER Decrease PO of Ca and Vitamin D Increased Phosphate Renal disease Alcoholism Pregnancy POST PARATHYROIDECTOMY
Hypocalcemia Symptoms - ANSWER Tetany Trousseaus- BP cuff Chvostek's- facial nerve "Pins and needles, lips burning, numbness"
Hypocalcemia Tx - ANSWER Increase Ca and vitamin D intake TUMS- phosphate binding antacid IV Ca Gluconate
Phosphate - ANSWER Bone/teeth strength Metabolism of carbs, fats, proteins Acid base balance
INVERSE W/ CA Ex: hypophos looks like hypercal
Magnesium - ANSWER metabolism of carbohydrates and proteins and fats muscle contraction If levels off- torsades DO NOT GIVE TO PATIENTS WITH RENAL IMPAIRMENT
Isotonic Solutions - ANSWER Volume expander- cell stays same size NS, LR
Hypertonic Solutions - ANSWER Cells Shrink- fluid leaves cell and goes to vascular space Correctional fluid D5LR D5NS Traumas, surgeries Never for dehydrated its
Hypotonic Solutions - ANSWER Cell Swells Dehydrated pts 1/2 NS or 1/4 NS
Gallbladder location - ANSWER RUQ
Appendix location - ANSWER RLQ
Stomach location - ANSWER LUQ
Bowel pain location - ANSWER LLQ
GERD Symptoms - ANSWER Dyspepsia Heartburn Hoarse voice
Ulcerative Colitis - ANSWER Left colon Starts at rectum and ascends Bloody diarrhea Shallow ulcers
Diet for inflammatory bowel disease - ANSWER low residue low fiber low fat low processed high protein and carbs
IBD treatment - ANSWER Immodium- if C.Diff not present Steroids Sulfasalazine Cyclosporin
Pancreatitis Causes - ANSWER Biliary tract disease Obstruction- gallstones Viral infection ETOH
Pancreatitis signs and symptoms - ANSWER Pain N/V Abd distension Fever Hypoactive or silent bowel sounds Grey Turner sign
Elevated pancreatic enzymes
Treatment of pancreatitis - ANSWER Rest the pancreas- NPO Pain control Fluid and electrolyte replacement Nutrition support- maybe TPN Surgery
Liver functions - ANSWER Antibody production Coagulation- prothrombin, fibrinogen, albumin Glucose metabolism Bile salt formation Detox of noxious agents- excretion
Hepatitis A - ANSWER Fecal oral
Hepatitis B - ANSWER Body fluids- drug use, sexual intercourse
Hepatitis C - ANSWER BLOOD TRANSMISSION WITH TRANSFUSION IS RARE Drug use, sexual intercourse High correlation with hepatitis C and liver cancer
Hepatitis Stages - ANSWER Prodromal -1 wk- 10 days -malaise, fever, anorexia Icteric -Liver unable to convert bilirubin to bile- jaundice
Mechanical ventilation Salicylate OD
Causes of respiratory acidosis - ANSWER Hypoventilation Opioid OD Cardiac arrest Pulmonary disease Musculoskeletal disorders- nonambulatory pts Head trauma
Causes of metabolic alkalosis - ANSWER Diuretics Cushing's r/t corticosteroid therapy Excessive antacids NG suction Vomiting
Causes of metabolic acidosis - ANSWER DKA Renal failure Poisoning Diarrhea
Chronic bronchitis - ANSWER Chronic, productive cough SOB Airway remodeling Mucus production- increased infection risk "healthy glow" healthy weight Local crackles
Tachypneic Expiratory wheezes Hacking, rasping
Empysema - ANSWER Little sputum Barrel chest Accessory muscle use Weight loss- decrease appetite from WOB Very hypoxic Tachypneic Fine crackles
Considerations for COPDers - ANSWER No more than 2 L O2- will eliminate drive to breathe if over oxygenated- drive to breathe is high CO2 and low O Teach pursed lip breathing High protein High cal Live at 86%-88%
TB risk factors - ANSWER Immunosuppressed Jail, overcrowded living conditions Prolonged contact with those already infected
TB signs and symptoms - ANSWER Persistent, productive cough with hemoptysis Night sweats Fever/Chills Chest pain Anorexia/weight loss
Chest pain Actue SOB Impending doom/anxiety
Virchow's Triad - ANSWER Risk factors for clots Vessel wall damage Venous stasis Hypercoaguable state
PE treatment - ANSWER High flow oxygen TPA if large clot Heparin drip and simultaneously giving warfarin May need surgical intervention
Hodgkin's lymphoma - ANSWER Peak yrs 25- 90% cure rate if caught early First symptom- Painless enlarged lymph node then night sweats and fatigue Reed Sternberg cells Tx: chemo, radiation, surgery for staging
Non Hodgkins Lymphoma - ANSWER Peak years 50- Poor cure rate First symptom- enlarged, painless lymph node then fatigue and night sweats No hallmark diagnostic Treatment- chemo, radiation, surgery for staging
Deep Tissue Injury - ANSWER Looks intact
Purple or maroon due to pressure or shear
Stage I - ANSWER In tact skin Nonblanchable usually over bony prominence
Stage II - ANSWER Partial thickness, loss of dermis
Stage III - ANSWER Full thickness
Stage IV - ANSWER Full thickness with exposed bone, tendon etc
Unstageable - ANSWER Covered with eschar cannot see base of wound
Cardiac output - ANSWER Amount of blood leaving the heart per min
Stroke volume - ANSWER Amount of blood leaving the ventricles with each contraction
S3 - ANSWER Ventricular gallop Indicative of pulmonary edema
S4 - ANSWER Atrial gallop
Nitro - ANSWER Chest pain Q5 min 3 times- unrelieved go to ER Sublingual Light sensitive
Systolic murmur Fatigue Activity intolerance
Right ventricular failure - ANSWER "R is rest of body" JVD Dependent edema Hepatomegaly Abd distention Fatigue Activity intolerance
BB - ANSWER "lol" Decreases workload of the heart by decreasing BP and HR
ACE Inhibitors - ANSWER "pril" decrease afterload and preload in heart failure Prevents action of angiotensin two which causes vasoconstriction- med relaxes vessels
Angioedema, Cough, HYPERK
ARBS - ANSWER "Sartan" Decrease preload and afterload Prevent the binding of angiotension- resulting in vasodilation
Digoxin - ANSWER Increases contractility Watch for toxicity- halos, GI upset
Range- .6-1.
PAD - ANSWER Lack of oxygen to tissues Loss of hair, extremities pale and cool
PVD - ANSWER Inability to remove waste products Edema, wounds won't heal
Ca channel blockers - ANSWER "pine" Decreases force of contraction- blocks Ca
Cardiogenic Shock - ANSWER Severe cardiac dysfunction Decrease in CO Decrease in tissue perfusion and elimination of waste Causes: MI, Tamponade, Cardiomyopathy
