Exam 4: NUR253/ NUR 253 (NEW 2026/ 2027 Update) Concepts of Mental Health Nursing Guide| Questions & Answers| Grade A| 100% Correct (Accurate Solutions)- Galen

Exam 4: NUR253/ NUR 253 (NEW 2026/ 2027 Update) Concepts of Mental Health Nursing Guide| Questions & Answers| Grade A| 100% Correct (Accurate Solutions)- Galen Q. What are endocrine hormones? ANSWER Secreted directly into the blood stream by endocrine (ductless) glands Q. What do endocrine hormones regulate? ANSWER -Metabolism -Growth -Reproduction -Mood -Organ function Q. What are exocrine glands? ANSWER Secrete substances through ducts onto body surfaces or into body cavities Q. What are types of exocrine substances? ANSWER -Sweat -Mucus -Oil -Breast milk Q. What are the three thyroid hormones? ANSWER -Triiodothyronine (T3) -Thyroxine (T4) -Calcitonin Q. What are the cardiac impacts of thyroid hormones? ANSWER -Increase HR -Increase SV -Increase CO -Increase contractility Q. What are the respiratory impacts of thyroid hormones? ANSWER Stimulation of respiratory system Q. What are the skeletal muscle impacts of thyroid hormones? ANSWER Increased development of type II muscle fibers Q. What are type II muscle fibers? ANSWER "Fast-twitch" that create fast/powerful contractions Q. What are the metabolic impacts of thyroid hormones? ANSWER -Increase BMR -Increased energy expenditure -Nutrition utilization -Body heat production Q. What is a goiter? ANSWER Overgrowth of thyroid r/t excessive TSH Q. What disease is associated with hyperthyroidism? ANSWER Graves' disease Q. What is the priority assessment/treatment of a pt with thyrotoxicosis? ANSWER Airway Q. What organs does PTH target? ANSWER -Bones -Kidneys -Small intestine Q. What are clinical manifestations of hypoparathyroidism? ANSWER -Hypocalcemia -Numbness/tingling -Severe muscle cramps -Diarrhea -Tetany -Hypotension -ECG changes Q. What would labs look like in a pt with hyperparathyroidism? ANSWER -High PTH -High Ca -High ionized calcium -Low phosphorus Q. What type of white blood cell is elevated in a pt having an allergic reaction? ANSWER Eosinophils and basophils Q. What is type I (immediate) hypersensitivity? ANSWER Allergies Q. What is montelukast? ANSWER Leukotrine inhibitor Q. What is montelukast used for? ANSWER Asthma and allergies Q. What are EARLY signs of mild/moderate anaphylaxis? ANSWER -Dyspnea -Skin reactions -Anxiety -Heat flush -Angioedema -Bronchospasm -Hoarseness -Stridor -GI upset Q. What are signs of severe anaphylaxis? ANSWER -Airway closure -Circulatory collapse Q. What are antiretroviral medications? ANSWER Interfere with ability of HIV to reproduce Q. What is the expected outcome of antiretroviral medications? ANSWER -Decrease in viral load to "undetectable" levels -CD4+ count improvement Q. What type of white blood cell is elevated with chronic infections? ANSWER Monocytes Q. What type of white blood cell is elevated with acute infections? ANSWER Neutrophils Q. What are examples of a less drowsy antihistamine? ANSWER -Fexofenadine -Loratadine -Cetirizine Q. What body fluids do not carry HIV of a person who is HIV positive? ANSWER -Saliva -Tears -Sweat -Urine -Feces Q. What is the CD4 count of a CHRONIC ASYMPTOMATIC HIV patient? ANSWER 500 Q. What is the CD4 count of a CHRONIC SYMPTOMATIC HIV patient? ANSWER 200-499 Q. What is the CD4 count of an AIDS patient? ANSWER 200 Q. What are the symptoms of a CHRONIC ASYMPTOMATIC HIV patient? ANSWER None Q. What are the symptoms of a CHRONIC SYMPTOMATIC HIV patient? ANSWER -Frequent infections -Candidiasis (vaginal or oral) -Herpes simplex/zoster -Enlarged lymph nodes Q. What are signs/symptoms of a pt with a CD4 count 200? ANSWER Opportunistic infections: -Kaposi sarcoma -Pneumocystis pneumonia (PCP) If a patient were to experience anaphylaxis 10 minutes after beginning a new prescription of penicillin IV, what would the first action be? 1. Stop infusion 2. Administer NS for IV patency What is a blood smear? Shows presence of abnormal/immature WBCs when done in addition to CBC with differential How is HIV transmitted? -Blood -Semen -Vaginal fluid -Breast milk via blood or mucous membrane Aside from hay fever, what are other common allergens? -Food -Meds -Insect bites -Contrast dye What kind of allergy is latex? Type IV What is the number 1 priority treatment for a pt experiencing anaphylaxis? Epinephrine How is epinephrine administered to a pt experiencing anaphylaxis? IM q5-15mins then IV if unresponsive What are lab considerations for antiretroviral therapy (ART)? Renal and liver function What are unexpected outcomes of ART? Treatment failure -CD4 remains low -Viral load remains detectable What are the common causes of ART failures? -Missed doses -Missed appointments -Virus resistance Prior to an allergy skin test, which medication classes should not be administered as it will interfere with the results? -Glucocorticoids -H1 antihistamines -H2 (ranitidine) -NSAIDS How long should contraindicated medication classes be held prior to an allergy test? 5 days What is the normal CD4 count? 500-1500 What is stage 1 HIV? CD4 500 What is stage 2 HIV? CD4 200-499 What is stage 3 HIV? AIDS: CD4 200 How many ART medications will be used and from how many classes? Minimum 3 from 2 classes What is the acute stage of HIV infection Weeks-month after exposure What are characteristics of the acute stage of an HIV infection? -VERY HIGH viral load -Rapid CD4 killing What are symptoms of the acute stage of an HIV infection? Flu-like symptoms for a few weeks Will the patient test positive immediately after exposure? No, takes a few weeks to detect the HIV antibodies What is a "window period?" Time between infection and seroconversion What are routine screening recommendations for people aged 15-65 who do not have high risk for HIV? Offer opt-out screening for everyone in this age group What IV medications may be administered for a pt experiencing anaphylaxis? -Antihistamines -Corticosteroids What inhalation medication may be administered via nebulizer in a pt experiencing anaphylaxis? Short acting beta adrenergic agonist (i.e. albuterol) What is the expected outcome of albuterol nebulization in a pt experiencing anaphylaxis? Decreased wheezing What are considered "high-risk" behaviors that may warrant more frequent HIV testing? -IV drugs -Unprotected sex -Multiple sex partners -Community with greater than 1% HIV prevenlence How often should "high-risk" people be tested for HIV? Yearly What medication is pre-exposure prophylaxis (PrEP) for HIV negative partners? Truvada What medications make up Truvada? -Tenofovir -Emtricitabine How often should Truvada be taken? Daily What are types of opportunistic infections diagnostic of AIDS? -Pneumocystis pneumonia (PCP) -Candidiasis outside of the moth (esophagus, pulmonary) -Mycobacterium tuberculosis (TB) -Wasting syndrome -Herpes simplex -Bronchitis -Pneumonitis -Esophagitis -Cervical cancer -Kaposi sarcoma -Cryptococcal meningitis -Cytomegalovirus (CMV) retinitis (with loss of vision) -Lymphoma (Burkitt's, immunoblastic, or brain) -Histoplasmosis -Mycobacterium avium complex -Toxoplasmosis of brain -Encephalopathy -Cryptosporidiosis (Intestinal) Which medication is given preventatively for patients with AIDs to prevent opportunistic infections? Prophylaxis (sulfamethoxazole-trimethoprim) What is cirrhosis? Scarring of the liver that impedes blood supply and causes portal HTN What can result from portal HTN? -Peripheral edema -Blood shunting around liver -Esophageal varices -Hemorrhoids -Veins on abd What is a result of blood shunting around the liver? -Increased bleeding risk (hepatic impairment) -Ammonia elevation (hepatic encephalopathy) What are risk factors of cirrhosis? -Viruses -Alcohol -Biliary disease -Accumulation of fat in liver cells -Nonalcoholic fatty liver disease (NAFLD) -Nonalcoholic steatohepatitis (NASH) What virus most commonly causes cirrhosis? Hepatitis C What is Laënnec's cirrhosis? Cirrhosis caused by alcohol Why is someone with cirrhosis at increased risk of bleeding? 1. Shunted blood around liver decreases filtering an work of liver 2. Vitamin K decreases causing coagulopathy and increases bleeding risk What are some physical assessment findings that indicate bleeding as a result of cirrhosis? -Petechiae -Ecchymosis What lab values should be monitored in a pt with cirrhosis? -PT -INT -PTT -Platelets What are nursing interventions prior to a paracentesis? -VS -Abd girth -Bowel sounds -IV access -PT VOIDS What are nursing interventions after a paracentesis? -VS q15m for 1-2h -Abd girth (compare) -Monitor for complications What complications can arise from a paracentesis? -Hematuria (punctured bladder) -Severe abd pain (peritonitis/bleeding) -Bleeding from site -Change in bowel sounds (peritonitis) -Fever (peritonitis) What are s/s of thyroid storm? -Tachycardia -HTN -Fever -Tremors -Tachypnea -Seizures What can tachycardia and HTN lead to in thyroid storm? CHF What can tachypnea lead to in thyroid storm? Respiratory failure What precedes seizures in thyroid storm? -Restlessness -Confusion What causes thyroid storm? Poorly managed hyperthyroidism What are some interventions for thyroid storm? -Airway management -Fluid recitation -Cooling blanket -Acetaminophen -Calm environment What precautions should someone be on when they have thyroid storm? Seizure What is the most likely cause of abdominal distention in a patient with cirrhosis? Ascites What is the skin color change anticipated with a patient with cirrhosis? Jaundice (yellow) What causes skin color change in a cirrhosis pt? Elevated bilirubin What are signs of bleeding after a liver biopsy? -Tachycardia -Hypotension -Decreased LOC What is the activity level immediately after a liver biopsy? Bedrest How long should someone be on bedrest after a liver biopsy? Several hours What are some positioning considerations post liver biopsy? -Sandbag over site -Lying R side What is one medication that helps prevent varices from bleeding by decreasing portal hypertension? Beta-blockers When should you hold beta blockers if a patient has varices? Active hemorrhaging What is banding of varices? Bands prevent bleeding of varices What is sclerotherapy? An agent is injected to sclerose varices to dry it up What is a sengstaken-blakemore tube? Tube that applies pressure to compress varices with pressure in the stomach and esophagus Sodium restriction should be maintained to what level to decrease ascites and peripheral edema with cirrhosis? 2g/d What are expected outcomes of lactulose? -2-3 stools/day -Decreased ammonia leading to neurologic improvement What other medication is used to treat hepatic encephalopathy? Neomycin How does neomycin treat hepatic encephalopathy? -Decrease ammonia -Increase neurologic improvement What is primary hypothyroidism? Hyposecretetion of T3/T4 What is secondary hypothyroidism? The pituitary does not release enough TSH What is tertiary hypothyroidism? Hypothalamus does not release enough thyrotropin-releasing hormone (TRH) What are risk factors for hypothyroidism? -Autoimmune disease -Thyroid surgery -Radioactive iodine therapy -Iodine/tyrosine deficiencies -Pituitary damage -Hypothalamus damage -Thyroid cancer -Congenital disorder of thyroid What is the most common cause of hypothyroidism? Hashimoto's thyroiditis What causes Hashimoto's thyroiditis? Antibodies destroy thyroid tissue and replace it with fibrous tissue What is the point of levothyroxine? Replace thyroid hormone What labs should be monitored when pt is on levothyroxine therapy? -TSH -T3 -T4 When should levothyroxine be used cautiously? Cardiac history because it can increase metabolic rate When should the provider be notified when on levothyroxine therapy with a cardiac history? -Chest pain -SOB -Swelling How long will a pt be on levothyroxine? Life What medications can interact with a pt on levothyroxine? -Sedatives -Narcotics How should levothyroxine be administered? -Morning -Empty stomach -Full glass of H2O If, upon palpation, the thyroid is thought to be enlarged, what physical assessment should the nurse perform to validate this finding? Thyroid bruit What are the manifestations of hypothyroidism? -Lethargy -Weight gain -Cold intolerance -Myxedema -Constipation -Abd distension -Dry hair/nails/skin -Hyperlipidemia -Low libido -Heavy menses Why do patients with thyroid disorders can suffer calcium imbalances? -Calcitonin dysfunction -Potential parathyroid damage from thyroidectomy What is myxedema coma? Life threatening condition that occurs if hypothyroidism is not treated What can precipitate myxedema coma? -Infection -Stroke -Trauma -Meds What is the mortality rate of myxedema coma? High What are s/s of myxedema coma? -Hypoxia -Fluid/electrolyte imbalance -Hypothermia -BRADYCARDIA -HYPOTENSION What are the most common medications for hyperthyroidism? -Methimazole -Propylthiouracil What are pt teaching points for methimazole and propylthiouracil (PTU)? -Inhibits thyroid hormone synthesis -Daily weights -TSH/T4/T3 levels need to be monitored -Do not use (PTU) in 2nd/3rd trimester -Monitor for s/s of hypothyroidism What medication can be given short term preoperatively to decrease blood flow and decrease thyroid hormone production? Iodine What can be given to pts to decrease HR and palpitations r/t hyperthyroidism? Beta blockers What is the most common cause of hyperthyroidism? Graves' disease What are manifestations of hyperthyroidism? -EVERYTHING IS HIGH -Thyroid bruit -Hair loss -Light/absent menses -Heat intolerance -Goiter -Exophthalmos What is primary hyperthyroidism? Thyroid hypersecretes T3/T4 What is secondary hyperthyroidism? Pituitary releases too much TSH What is tertiary hyperthyroisim? Hypothalamus hypersecretes TRH What is goiter? Enlarged thyroid What can cause goiter? Iodine deficiency What medications can cause goiter? -Lithium -Phenytoin -Rifampin How many periods of reactivity are there? 2 How long does the first reactivity period last? 30 minutes after birth During the first reactivity period, how much does the HR increase? 160-180 What happens to the resp. during the first reactivity period? irregular What happens to the motor activity during the first reactivity period? decrease followed by 60-100 min of sleep When is the second period of reactivity? 4-8 hrs after birth What happens during the second period of reactivity? tachycardia, tachypnea, and meconium passes Normal newborn HR: 120-160 Mongolian spots: type of birthmark What do you need to do with mongolian spots if they are seen on an infant? document Acrocyanosis: blue in hands and feet How long is acrocyanosis considered normal? for first 12 hrs after birth Moro reflex: Infant reflex where a baby will startle in response to a loud sound or sudden movement Babinski reflex: stroke foot and toes fan out convection cool ambient air pulls heat from body What can prevent convention heat loss? hat Evaporation: loss of heat when liquid is converted to vapor What is something that can prevent evaporation heat loss? drying after delivery and after bath conduction: loss of heat from body surface to cooler surface in direct contact What is something that can prevent conduction heat loss? place in prewarmed bed and skin to skin with mom radiation: loss of heat from body surface to cooler solid surface NOT in direct contact What is something that can prevent radiation heat loss? avoid drafts Where is meconium formed? during fetal life in amniotic fluid When does meconium pass? 12-24 hrs after bith RBC after birth: increase initially then drop back down WBC after birth: 12000 Platelets after birth: How much fluid requirement does a newborn need during day 1-2? 60-80 mL/kg How much fluid requirement does a newborn need during day 3-7? 100-150 mL/kg How much fluid requirement does a newborn need during day 8-30? 120-180 mL/kg vernix caesosa: greasy deposit covering baby at birth Do we remove the vernix caesosa? NO what does the vernix caesosa do? protects the skin When do you do an APGAR score? 1 and 5 minutes sometimes at 10 minutes Apgar appearance aPgar pulse apGar grimace apgAr activity apgaR respiration APGAR: 0-3: critically low APGAR: 4-6: below normal APGAR: 7+: normal What is the purpose of eye ointment? to prevent infection from chlamydia, gonorrhea, and STI's What are three things as a nurse that we should do for a baby receiving phototherapy? eye protectant, turning, skincare, and protect scrotum on boys circumcision care: check bleeding, vaseline on top after each dipper change, and prevent infection discharge after circumcision: must have voided and minimal bleeding purpose of APGAR scoring: to see how the baby is doing out of woumb AGA criteria: must be between 10-90 percentile Preterm: before 37 weeks late preterm: 34-36 weeks term: 38-42 week postterm: after 42 weeks postmature: after 42 weeks with placental insuficiency Newborn screening PKU, sicklecell disease, and galactosemia How to promote safety in the hospital to the baby: device in place so no one can steal and handwashing What are four feeding cues to teach the mother? hand to mouth, sucking motion, rooting, and mouthing What are some benefits of breastfeeding? nutritionally superior, promoting growth factors, and nutrients more easily absorbed How can you tell if breastfeeding is effective? baby has 10-12 wet dippers a day If a woman is breastfeeding, how can you decrease engorgement? breastfeed more frequently If a woman is not breastfeeding, how can we decrease engorgement? cabbage leaves and cold bottle feeding education: how to mix, burping, and when to feed What are three reasons mom should bottle feed? AIDs, cancer treatment, or illicit drugs When should breastfeeding mother wake their baby to feed? every 4 hrs removal of infant from breast: finger in mouth, release suction What two hormones are associated with breast feeding? ocytocin and prolactin What does oxytocin do for breastfeeding? release milk What does prolactin do for breastfeeding? milk production colostrum: clear, yellow fluid Should the mother feed colostrum to the baby? yes What is colostrum high in that the mother should give it to baby? nutrients and antibodies When does a baby produc surfactant? at 32 weeks What kind of babies will need surfactant therapy? preterm What does a bowel movement inutero cause a risk for? aspiration which then causes risk for sepsis When does a bowl movement inutero usually occur? in term and postterm Kangaroo care: skin to skin What do prolonged rupture of membranes cause an increase risk in the baby? infection How do you assess for infection of the fetus when ther eis prolonged rupture of membranes? temp What causes fetal alcohol syndrome? a mother who drinks every day or at least 3 times a week Symptoms of FAS: small head, developmental delays, bit eyes, and SGA Pathologic jaundice: result of underlying disease Pathologic jaundice appears: after 24 hrs Pathologic jaundice dissapears: after 7 days Physiologic jaundice: increase bilirubin production due o RBC decrease lifespan and liver immaturity When do you see signs of jaundice for physiologic? after 24 hrs What are four non pharmacological pain measures for baby? swaddling, holding, swing, and swetties S/S of mastitis: red, warm, fever, and pie shaped area storage of breast milk: roomtemp: 2-4 hrs storage of breast milk: fridge: 72 hrs storage of breast milk: freezer: 6 months