Nursing 3100 Final Exam Questions With Correct Answers

How do antiemetics work? (i.e. what is the physiology of nausea? what and where are the receptors locate?) - Answer Antiemetics block the CTZ (chemoreceptor trigger zone) which suppresses nausea and vomitting. These receptors are located near the medulla, outside the Blood Brain Barrier When should antiemetics be given? - Answer At least 1 hour before symptoms List at least 4 classes of antiemetic agents. State their mechanism and potential side effects. - Answer - anticholinergic: inhibits vagal transmission - antihistamine: anticholinergic properties and block H1 receptors on CTZ - dopamine receptor blockers: block receptors in CTZ - serotonin receptor blockers: block receptors in stomach and CTZ What is the effect of isopropyl alcohol on preventing post-op nausea? - Answer It works as aromatherapy What would be the laxative of choice for each of the following? A patient recoverin from acute myocardial infarction (MI). A patient with a slow transit time. A patient who requires bowel preparation before surgery. - Answer Myocardial Infarction: stool softener (Colace) because it avoids arrhythmia and valsalva's maneuver Slow transit time: fiber and bulk forming laxative which decreases the stool transit time Bowel Preparation before surgery: increase doses of hyperosmotic laxatives which are fast working What are the possible side effects of stimulant laxatives, hyperosmotic laxatives, saline cathartics, and bulk-forming laxatives? - Answer stimulant laxatives: can't be administered with antacids -- causes premature dissolution in the stomach, GI distress, cathartic habit, patients could become dependent hyperosmotic laxatives: electrolyte imbalance saline cathartics: suppresses bowel reflex causing you to lose electrolytes bulk-forming laxatives: increase dose gradually to avoid discomfort When should diarrhea be treated? - Answer at onset of symptoms What are the causes of diarrhea? - Answer - infection - viral - bacteria - absorption issues - stress alters the motility of feces - irritable bowel syndrome - sorbital containing medications - enteral feedings What is ORT (oral rehydration therapy)? When should it be used? - Answer Replaces water and electrolytes in patients with diarrhea. It should be used at the onset of diarrhea. What is the BRAT diet? When should it be used and when should it not be used? - Answer Bananas, rice, applesauce, tea/toast. It should be used for diarrhea right after ORT and not used in pediatric patients What is the most important therapy for diarrhea? - Answer ORT Under what circumstances should medication be used for chronic diarrhea? What is the drug of choice (DOC)? Why? - Answer It should be used when the diarrhea is chronic (longer than a few days). The drug of choice is calcium polycarbophil (Equalactin) because it absorbs excess water. What is the significance of "coffee-ground" emesis? Green emesis (think about bile)? Bright red emesis? - Answer Coffee-ground emesis: is from the stomach because it has been siting in a more acidic environment Green emesis: excessive bile Bright red emesis: blood from above the stomach What is melena? Hematochezia? What causes each? - Answer Melena: black, sticky, foul smelling stools caused by chronic bleed in stomach Hematochezia: fresh blood from rectum caused by polups and hemorrhoids What are common causes of abdominal pain? - Answer - distention What is torsion -- volvulus? Intussusception? Inguinal hernia? Adhesions? Peritonitis? - Answer - torsion volvulus: twisting; blocks blood supply to intestine - intussusception: colon folds in on itself - inguinal hernia: when a portion of the small intestine enters the inguinal canal - adhesions: scar tissue on the intestine - peritonitis: inlammation of the peritoneal cavity Indicate the significance of a plate abdominal x-ray in a patient with suspected abdominal obstruction. - Answer it allows you to see the diaphragm; see if there is air which would indicate a tear Differentiate between mechanical and nonmechanical bowel obstructions. - Answer Mechanical: - Extrinsic (tumors, torsion, fibrosis, hernia, intussusception) - Intrinsic (tumors, gallstones, foreign bodies, fiber Nonmechanical: - intraabdominal (reflex inhibition of peristalsis, trauma or inflammation, bowel ischemia - extraabdominal (spine or pelvic fracture, metabolic, Rx) Identify the risk factors that an abdominal surgical patient has that can contribute to the development of an ileus. List some other (nonsurgical) causes of paralytic ileus. - Answer - anesthesia - a blockage - a non mechanical obstruction - cathartic habit other: - trauma to the GI tract