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SG exam 4 NUR112


differentiate between asthma and COPD COPD is chronic bronchitis and emphysema, affects the alveoli. the airways are always swollen. Asthma is airway obstruction caused by constriction of the bronchial smooth muscles surrounding the airways. Airways are only swollen during an attack.
What occurs pathophysiologically during asthma inflammation of the mucous membranes trigger the release of histamine and leukotrienes which causes the blood vessels to dilate, tissues swell and mucus increases and smooth muscle constricts
Why are different medication types used to treat asthma bronchodilators and anti-inflammatory drugs
What is a “rescue” inhaler? bronchodilators - beta2-adrenergic agonists, cholinergic antagonists and methylxanthines
What is a “maintenance” inhaler? anti-inflammatory durgs - corticosteroids, mast cell stabilizers and leukotriene inhibitors
Why would a maintenance inhaler like salmeterol not be the first line choice during an acute asthma attack? it does not act quickly, this medication has to build up over time, it will NOT stop an asthma attack
What teaching instructions are important to give patients with a dry powder inhaler for COPD? do not wash the inhaler or exhale into it, never shake the inhaler, pt may not smell, feel or taste anything when it is inhaled because there is no propellant
What teaching instructions are important for patients who are prescribed an inhaled bronchodilator and inhaled corticosteroids? use the bronchodilator first and wait at least 5 minutes before using the other inhaler
Why are blood levels drawn when a patient is prescribed theophylline? this is a systemic drug and can cause dangerous side effects if the levels are too high in the blood, SE=cardiac and CNS overstimulation
What assessments are important when administering bronchodialators? What are possible side affects for these drugs? assessment should include: asking whether or not the pt has experience using an inhaler, auscultate the lungs before and after to determine drug effectiveness, take vital signs including temp and mental status, check pt for tremors,
How do corticosteroids work with asthma or COPD? Why are they only used short term? What are their side effects? How do they improve breathing? corticosteroids decrease the production of chemicals that trigger inflammation, can prevent or reduce inflammation, enhances the effects of some broncodilators. Used only short-term due to systemic effects of steroids: adrenal gland suppression, can reduce immune response
What are commonly used antitussives? Be able to name several. How do they work? codeine and dextromethorphan, they work by raising the cough reflex threshhold
• Why are inhaled decongestants only used short term? used for less than 5 days due to rebound congestion
Why is Zofran usually given before meals for cancer patients? zofran blocks the receptors in the intestine and brain, two nausea pathways are blocked
How do osmotic laxatives work? cause fluid retention in the bowel which increases water content to soften stool
• Why are laxatives only recommended for short-term therapy? you can become dependent on them
• What’s the difference between H1 and H2 receptor blockers? Which is used to treat inflammation in the airways? Which is used to treat PUD/GERD? H1 (airways) is related to allergies and H2 (PUD/GERD)is related to stomach acid production.
How does sucralfate work to treat ulcers? forms a protective barrier over an ulcer, does not coat normal stomach lining, stops the effects of pepsin, inhibits H. pylori
How do the ‘-tidine” family of drugs work to treat PUD/GERD? H2 blockers. decrease stimulation of H2 receptors in gastric cells that secrete hydrochloric acid which decreases acid production
Be able to differentiate between PUD and GERD symptomology. What symptoms should the nurse report to the prescriber immediately? PUD= peptic ulcer disease - stomach, burning, gnawing pain between umbilicus and sternum GERD= gastroesophageal reflux disease - esophagus, dyspepsia (heartburn) immediately report to provider - signs of allergic reaction, confusion, black, tarry stools, dizziness or hallucinations
Why is metoclopramide prescribed in GERD? How does it work? promotility drug, given 30 minutes before meals, increases LES tone and speeds the emptying of the stomach.
• Why is omeprazole prescribed in GERD? How does it work? proton pump inhibitor, completely block the production of stomach acids and therefore acid reflux is decreased
How does synthroid work? replaces the natural hormone needed for proper metabolism
How do type I and type II diabetes differ? type 1 = beta cells- no production of insulin type 2 = decreased production of insulin and/or inability of insulin to bind with receptors, glucose still gets into cells so fat is not used for fuel and and ketones are not usually made
Why might a patient receive different types of insulin? to control their blood sugars they are usually given a short acting and long acting insulin together
What drug interactions might occur with insulin and anticoagulants? I can find no drug interactions with these classes. A complication of giving them together could be increased bleeding/bruising at injection site
What is a biguanide? Who gets biguanides? What ASE are important to monitor? it is an oral anti-diabetic drug - acts on liver to reduce the release of glucose from stored glycogen and increases sensitivity of insulin receptors. Big guys get biguanides. ASE: GI symptoms and HA, lactic acidosis
What lab values are important to monitor for miglitol? liver function tests, BUN, creatinine
Know the s/s of hypoglycemia? confusion, cool and clammy skin, tremors, headache, hunger, sweating
• What lab value indicates good control of diabetes? A1c 4% - 6%
What insulin is “clear”? rapid acting, short acting and detemir
What is “cloudy”? most intermediate acting including: NPH and the mixed ones (70-30, etc) EXCEPT detemir
Which do you administer first? you would draw into the syringe the clear and then the cloudy. I don't know if there is a preference to administering.
• Know which oral hypoglycemic promote insulin production and which promote more effective glucose metabolism at insulin receptor sites. release insulin: sulfonylureas and meglitinides increase sensitivity: biguanides and thiazolidinedione slows digestion: alpha-glucosidase
• Why are sulfonylurea oral hypoglycemic contraindicated with breast feeding? they cross into the breastmilk and affect the baby
What mineral is critical for making thyroid hormone? iodine
How do thyroid drugs affect diabetic processes? In diabetic patients with underlying coronary artery disease, L-thyroxine therapy may exacerbate angina by increasing myocardial contractility and heart rate.
What is exopthalmus? bulging eyes, think Grave's disease for NCLEX
Know propylthiouracil (PTU) indications, contraindications, side effects, drug interactions, etc. (e.g. don’t give with anticoagulants, etc.) thyroid hormone suppression, preparation for thyroidectomy, thyroid storm CI = pregnancy and BF, agranulocytosis, hepatitis, jaundice SE/ASE: HA, muscle and joint pain, lymph node enlargement, edema, bone marrow suppression, increased risk for infection, hepatoxic, kidney damage, enhance the action of anticoagulants especially warfarin
Know what lab tests and values would be important to assess with a patient on PTU and Coumadin (i.e. know your lab values for your coag panel—PT, PTT and INR expected values—what’s an abnormal INR?). PT - (aka INR) PTT - mean normal range est by lab INR - 0.8 - 1.2 therapeutic 2.0 - 3.0
Ordered theophylline 6 mg/kg four times daily for a pediatric patient who weighs 66 pounds. Theophylline comes in 60 mg/10 ml. How many ml do you give? 66 lb/2.2 = 30 kg 3 mg x 30 kg = 90 mg/dose 90mg/60mg x 10mL= 15 mL
Ordered synthroid 125 mcg PO daily. Have synthroid 250 mcg tab. How much do you give? 125 mcg/250 mcg = 1/2 tab
Ordered repaglinide 2 mg PO. Have repaglinide 0.5 mg tablets. How much do you give? 2 mg/ 0.5mg - 4 tabs
What assessments are important to perform prior to administering synthroid? check BP, HR and rhythm, double check med name and strength
What role does insulin play in glucose metabolism? insulin is an enzyme that binds to receptors and allows glucose to enter the cells
endocrine secretes hormones into blood stream
exocrine secretes enzymes via ducts, usually to outside environment
Created by: nursingTSJC2013



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