NCLEX-RN Test

Study Guide

Your NCLEX score is one of the most critical elements to your qualification to become a nurse, so it is naturally much too
important for you to take this test unprepared. The higher your NCLEX score,
the better your chances of passing the boards. Careful preparation, as described in this expert guide, along with hard
work, will dramatically enhance your probability of success. In fact, it is wise to apply this philosophy not only to your
board’s exam, but to other elements of your life as well, to raise you above the competition. Your NCLEX score is one of
the areas in the licensure process over which you have a substantial amount of control; this opportunity
should not be taken lightly. Hence, a rational, prepared approach to your NCLEX test as well as the rest of the licensure
process will contribute considerably to the likelihood of success. Keep in mind, that although it is possible to take the
NCLEX more than once, you should never take the test as an “experiment” just to see how well you do. It is of extreme
importance that you always be prepared to do your best when taking the NCLEX. For one thing, it is extremely
challenging to surmount a poor performance. If you are looking to take a “practice” run, look into review course,
professionally developed mock NCLEX examinations, and, of course, this guide.
This guide provides you with the professional instruction you require for understanding the traditional NCLEX test.
Covered are all aspects of the test and preparation procedures that you will require throughout the process. Upon
completion of this guide, you’ll have the confidence and knowledge you need for maximizing your performance on your
NCLEX test.

Testing and Analysis

It won’t take you long to discover that the NCLEX is unlike any test you’ve taken before, and it is probably unlike any test
you will ever take again in your academic career. The typical high school or college test is a knowledge-based test. The
NCLEX, however, is application- based.
What does this mean to you? It means that you’ll have to prepare yourself in a completely different way! You won’t simply
be reciting memorized facts as they were phrased in some textbook, and you won’t be applying any learned formulas to
specific problems that will be laid out. The NCLEX requires you to think in a thorough, quick and strategic manner...and
still be accurate, logical and wise. This test is designed to judge your abilities in the ways that the licensure boards feel is
vital to the success of first year nursing graduate. To some extent, you have already gradually obtained these abilities
over the length of your academic career. However, what you probably have not yet become familiar with is the capability
to use these abilities for the purpose of maximizing performance within the complex and profound environment of a
standardized, skills-based examination.
There are different strategies, mindsets and perspectives that you will be required to apply throughout the NCLEX. You’ll
need to be prepared to use your whole brain as far as thinking and assessment is
concerned, and you’ll need to do this in a timely manner. This is not something you can learn from taking a course or
reading a book, but itis something you can develop through practice and concentration.
The following chapters in this guidebook will lay out the format and style of the NCLEX as well as give you sample
questions and examples of the frame of mind you’ll be expected to take. If there is one skill that you take with you from
your preparation for the NCLEX, this should be it.

Introduction to the NCLEX

The purpose of the NCLEX is to establish a standard method of measurement for the skills that have been acquired by
nursing school graduates. These skills are considered critical to the healthcare profession. The principle behind the
NCLEX is similar to the SAT’s that are required for application to American colleges. Although these tests
are similar experiences in some respects, the NCLEX is a much more challenging and complex.
Fortunately, the NCLEX does not change very dramatically from year to year. What this means to you, is that it has
become possible for quality practice tests to be produced, and if you should take enough of these tests, in addition to
learning the correct strategies, you will be able to prepare for the test in an effective manner.

The NCLEX is not just a multiple-choice test. Fill in the blank questions and multiple right answer questions have been
added to the test. Although these types of questions are not the majority of
questions asked on the NCLEX. The main point is that the content has stayed the same. The nursing principles tested
prior to these changes are still the same. The content has remained relatively the same. If you understand the content
material of the exam, the type of testing question won’t matter.

The NCLEX Scoring Scale

The minimum number of questions asked on the NCLEX-RN exam is 75. The maximum number of questions is 265. The
exam is offered in CAT format which means the difficultly of the questions varies significantly. If you miss a question, the
computer will give you an easier question. If you get it right, then you will get harder questions.

Many NCLEX test takers freak out if computer shuts off after 75 questions, or if they have to take the maximum number of
questions. The main point is to be prepared to go the distance. Don’t be sprinter and concentrate for 100 questions and
then let your concentration begin to fade. Likewise, don’t stress on how many questions you have to take. You won’t know
the outcome until you get your scores, so don’t stress out.
Take some time for yourself and do something fun following the exam.
NCLEX Tips
1. Arrive early to the testing center.
2. Bring multiple forms of idea.
3. Wear layered clothing.
4. Get a good night’s sleep before the test. (Don’t cram)
5. Use a study partner when preparing for the exam.
6. Be familiar with the format of the exam.
7. Know your medical terminology.
8. Limit your distractions preparing for the exam.
9. Take time to unwind and reduce stress as you prepare.
10. Remember if you don’t pass, you can retake the exam.

General Strategies

Strategy 1: Understanding the Intimidation

The test writers will generally choose some material on the exam that will be completely foreign to most test takers. You
can’t expect all of the medical topics to be a topic with which you have a fair amount of
familiarity. If you do happen to come across a high number of topics/cases that you are extremely familiar with, consider
yourself lucky, but don’t plan on that happening.
Each case and scenario will be slightly different. Try and understand all of the material, while weeding out the distracter
information. The cases will also frequently be drawn from real world experiences.
Therefore, the passage that you will face on the test may almost seem out of context and as though it begins in the middle
of a medical process. You won’t have a nice title overhead explaining the general topic being covered but will immediately
be thrown into the middle of a strange format that you don’t recognize. Getting hit by strange sounding medical topics that
you don’t recognize, of which you may only have a small exposure, is just normal on the NCLEX. Just remember that the
questions themselves will contain all the information necessary to choose a correct answer.

Strategy 2: Finding your Optimal Pace Everyone reads and tests at a different rate. It will take practice to
determine what is the optimal rate at which you can read fast and yet absorb and comprehend the information. This is true
for both the flyover that you should initially conduct and then the subsequent reading you will have to do as you go
through and begin focusing on a specific question. However, on the flyover, you are looking for only a surface level
knowledge and are not trying to comprehend the minutia of details that will be contained in the question. Basically, skim
the question and then read the question slowly.

With practice, you will find the pace that you should maintain on the test while answering the questions. It should be a
comfortable rate. This is not a speed-reading test. If you have a good pace, and don’t spend too much time on any
question, you should have a sufficient amount of time to read the questions at a comfortable rate. The two extremes you
want to avoid are the dumbfounded mode, in which you are lip reading every word individually and mouthing each word
as though in a stupor, and the overwhelmed mode, where you are panicked and are buzzing back and forth through the
question in a frenzy and not comprehending anything.

You must find your own pace that is relaxed and focused, allowing you to have time for every question and give you
optimal comprehension. Note that you are looking for optimal comprehension, not maximum comprehension. If you spent
hours on each word and memorized the question, you would have maximum comprehension. That isn’t the goal though,
you want to optimize how much you comprehend with how much time you spend reading each question. Practice will
allow you to determine that optimal rate.

Strategy 3: Don’t be a Perfectionist

If you’re a perfectionist, this may be one of the hardest strategies, and yet one of the most important. The test you are
taking is timed, and you cannot afford to spend too much time on any one question.

If you are working on a question and you’ve got your answer split between two possible answer choices, and you’re going
back through the question and reading it over and over again in order to decide between the two answer choices, you can
be in one of the most minute on the problem, that you would be able to figure the right answer out and decide between the
two. Watch out! You can easily get so absorbed in that problem that you loose track of time, get off track and end up
spending the rest of the test playing catch up because of all the wasted time, which may leave you rattled and cause you
to miss even more questions that you would have otherwise.

Therefore, unless you will only be satisfied with a perfect score and your abilities are in the top .1% strata of test takers,
you should not go into the test with the mindset that you’ve got to get every question right. It is far better to accept that you
will have to guess on some questions and possibly get them wrong and still have time for every question, than to analyze
every question until you’re absolutely confident in your answer and then run out of time on the test.
Strategy 4: Factually Correct, but Actually Wrong
A favorite ploy of question writers is to write answer choices that are factually correct on their own, but fail to answer the
question, and so are actually wrong.When you are going through the answer choices and one jumps out for being
factually correct, watch out. Before you mark it as your answer choice, first make sure that you go back to the question
and confirm that the answer choice answers the question being asked.
Strategy 5: Extraneous Information
Some answer choices will seem to fit in and answer the question being asked. They might even be factually correct.
Everything seems to check out, so what could possibly be wrong?
Does the answer choice actually match the question, or is it based on extraneous information contained in the question.
Just because an answer choice seems right, don’t assume that you overlooked information while reading the question.
Your mind can easily play tricks on you and make you think that you read something or that you overlooked a phrase.
Unless you are behind on time, always go back to the question and make sure that the answer choice “checks out.”
Strategy 6: Avoiding Definites
Answer choices that make definite statements with no “wiggle room” are often wrong. Try to choose answer choices that
make less definite and more general statements that would likely be correct in a wider range of situations and aren’t
exclusive.
Example:
A. The nurse should follow universal contact precautions at all times in every case.
B. The nursing assistant completely demonstrated poor awareness of transfer safety.
C. Never allow new medications to be accessible on the unit.
D. Sometimes, the action taken by the aide was not well planned.
Without knowing anything about the question, answer choice D uses the term “sometimes,” which has wiggle room,
meaning there could have been a few strong points and weak points about the aide’s performance. All of the other answer
choices have a more definite sense about them, implying a more precise answer choice without wiggle room that is often
wrong.
Strategy 7: Using Common Sense
The questions on the test are not intended to be trick questions. Therefore, most of the answer choices will have a sense
of normalcy about them that may be fairly obvious and could be answered simply by using common sense.
While many of the topics will be ones that you are somewhat unfamiliar with, there will likely be numerous topics that you
have some prior indirect knowledge about that will help you answer the questions.

Strategy 8: Instincts are Right

When in doubt, go with your first instinct. This is an old test-taking trick that still works today. Oftentimes if something feels
right instinctively, it is right. Unfortunately, over analytical test takers will often convince themselves otherwise. Don’t fall
for that trap and try not to get too nitpicky about an answer choice. You shouldn’t have to twist the facts and create
hypothetical scenarios for an answer choice to be correct.

Strategy 9: No Fear
The depth and breadth of the NCLEX test can be a bit intimidating to a lot of people as it can deal with topics that have
never been encountered before and are highly technical. Don’t get bogged down by the information presented. Don’t try to
understand every facet of the nursing management process. You won’t have to write an essay about the topics
afterwards, so don’t memorize all of the minute details. Don’t get overwhelmed.
Strategy 10: Don’t Get Thrown Off by New
Information
Sometimes test writers will include completely new information in answer choices that are wrong. Test takers will get
thrown off by the new information and if it seems like it might be related, they could choose that answer choice incorrectly.
Make sure that you don’t get distracted by answer choices containing new information that doesn’t answer the question.

Example: Which conclusion is best supported?

A: Hyponatremia can cause the anxiety presented in this case.
Was anxiety even discussed in the question? If the answer is NO – then don’t consider this answer choice, it is wrong.
Strategy 11: Narrowing the Search
Whenever two answer choices are direct opposites, the correct answer choice is usually one of the two. It is hard for test
writers to resist making one of the wrong answer choices with the same wording, but changing one word to make it the
direct opposite in meaning. This can usually cue a test taker in that one of the two choices is correct.
Example:
A. Calcium is the primary mineral linked to osteoporosis treatment.
B. Potassium is the primary mineral linked to osteoporosis treatment.
These answer choices are direct opposites, meaning one of them is
likely correct. You can typically rule out the other two answer choices.

Strategy 12: You’re not Expected to be Einstein

The questions will contain the information that you need to know in order to answer them. You aren’t expected to be
Einstein or to know all related knowledge to the topic being discussed. Remember, these
questions may be about obscure topics that you’ve never heard of. If you would need to know a lot of outside knowledge
about a topic in order to choose a certain answer choice – it’s usually wrong.
Respiratory Conditions Tests:
Pulmonary Valve Stenosis CAT Scan
Causes: ABG
Congenital Pulmonary Function Test.
Endocarditis
Rheumatic Fever Treatment:
Mechanical ventilation
Symptoms: Bronchodilators
Fainting
SOB Respiratory Alkalosis: CO2 levels are reduced and pH is
Palpitations high.
Cyanosis Causes:
Poor weight gain Anxiety
Tests: Fever
Cardiac catheterization Hyperventilation
ECG
Chest-Xray Symtpoms:
Echocardiogram Dizziness
Numbness
Treatment:
Prostaglandins Tests:
Dieuretics ABG
Anti-arrhythmics Chest X-ray
Blood thinners Valvuloplasty Pulmonary function tests

ARDS- low oxygen levels caused by a Treatment:

build up of fluid in the lungs and Paper bag technique
inflammation of lung tissue. Increase carbon dioxide levels
Causes:
Trauma RSV (Respiratory synctial virus) - spread by contact,
Chemical inhalation virus can survive
Pneumonia for various time periods on different surfaces.
Septic shock
Symptoms:
Symptoms: Fever
Low BP SOB
Rapid breathing Cyanosis
SOB Wheezing
Nasal congestion
Tests: Croupy cough
ABG
CBC Tests:
Cultures ABG
Treatment: Chest X-ray
Echocardiogram
Auscultation Treatment:
Cyanosis Ribvirin
Chest X-ray Ventilator in severe cases
IV fluids
Mechanical Ventilation Bronchodilators
Treat the underlying condition
Monitor the Patient for: Monitor the patient for:
Pulmonary fibrosis Pneumonia
Multiple system organ failure Respiratory failure
Ventilator associated pneumonia Otitis Media
Acidosis Hyperventilation
Respiratory failure Causes:COPD
Panic Attacks
Respiratory Acidosis- Build-up of Carbon Stress
Dioxide in the lungs that Ketoacidosis
causes acid-base imbalances and the body Aspirin overdose
becomes acidic. Anxiety
Causes:
COPD Apnea: no spontaneous breathing.
Airway obstruction Causes:
Hypoventilation syndrome Obstructive sleep apnea
Severe scoliosis Seizures
Severe asthma Cardiac Arrhythmias
Symptoms: Brain injury
Chronic cough Nervous system dysfunction
Wheezing Drug overdose
SOB Prematurity
Confusion Bronchospasm
Fatigue Encephalitis
Choking
 Meningitis
Lung surgery Osteomyelitis
Causes:Cancer Alveolar proteinosis: A build-up of a phospholipid in the
Lung abscesses lungs were carbon dioxide and oxygen are transferred.
Atelectasis Causes:
Emphysema May be associated with infection
Pneumothorax Genetic disorder 30-50 yrs. Old
Tumors
Bronchiectasis Symptoms:
Weight loss
Pneumonia: viruses the primary cause in young children, Fatigue
bacteria the Cough
primary cause in adults. Bacteria: Streptococcus Fever
pneumoniae, SOB
Mycoplasma pneumoniae
pneumoniae (pneumococcus). Tests:
Chest X-ray
Types of pneumonia: Presence of crackles
Viral pneumonia CT scan
Walking pneumonia Bronchoscopy
Legionella pneumonia ABG- low O2 levels
CMV pneumonia Pulmonary Function tests
Aspiration pneumonia
Atypical pneumonia Treatment:
Legionella pneumonia Lung transplantation
Special lavage of the lungs
Symptoms:
Fever Pulmonary hypertension: elevated BP in the lung
Headache arteries
Ribvirin Causes:
SOB May be genetically linked
Cough More predominant in women

Chest pain Symptoms:

Tests: Fainting
Chest X-ray
Pulmonary perfusion scan Fatigue
CBC Chest Pain
Cultures of sputum SOB with activity
Presence of crackles LE edema
Weakness
Treatment:
Antibiotics if caused by a Tests:
bacterial infection Pulmonary arteriogram
Respiratory treatments Chest X-ray
Steroids ECG
IV fluids Pulmonary function tests
Vaccine treatments CT scan
Cardiac catheterization
Pulmonary actinomycosis –bacteria infection of the lungs Treatment:
caused by(propionibacteria or actinomyces) Manage symptoms
Causes: Diuretics
Microorganisms Calcium channel blockers
Symptoms: Heart/Lung Transplant if
Pleural effusions necessary
Facial lesions
Chest pain Pulmonary arteriovenous fistulas: a congenital defect
Cough were lung arteries and veins form improperly, and a
Weight loss fistula is formed creating poor oxygenation of blood.
Fever
Symptoms:
Tests: SOB with activity
CBC Presence of a murmur
Lung biopsy Cyanosis
Thoracentesis Clubbing
CT scan Paradoxical embolism
Bronchoscopy

Monitor patient for:

Emphysema
Tests: Tests:
CT Scan Pulmonary function tests
Pulmonary arteriogram Lung biopsy
Low O2 Saturation levels Rule out other connective tissue
Elevated RBC’s diseases
CT scan
Treatment: Chest X-ray
Surgery
Embolization Treatment:
Lung transplantation
Pulmonary aspergilloma: fungal infection of the lung Corticosteroids
cavities causing abscesses. Anti-inflammatory drugs
Cause:
Fungus Aspergillus Monitor the patient for:
Symptoms:Wheezing Polycythemia
SOB Pulmonary Htn.
Chest pain Respiratory failure
Fever Cor pulmonarle
Cough
Tests: Pulmonary emboli: Blood clot of the pulmonary vessels
CT scan or blockage
Sputum culture due to fat droplets, tumors or parasites.
Serum precipitans Causes:
Chest X-ray DVT- most common
Bronchoscopy
Symptoms:
Treatment: SOB (rapid onset)
Surgery Chest pain
Antifungal medications Decreased BP
Skin color changes
Pulmonary edema: most commonly caused by Heart LE and pelvic pain
Failure, but maybe due to lung disorders. Sweating
Dizziness
Symptoms: Anxiety
Restless behavior Tachycardia
Anxiety Labored breathing
Wheezing Cough
Poor speech
SOB Tests:
Sweating Doppler US
Pale skin Chest X-ray
Drowning sensation Pulmonary angiogram

Tests: Pulmonary perfusion test

Murmurs may be present Plethysmography
Echocardiogram ABG
Presence of crackles Check O2 saturation
Low O2 Saturation levels
Treatment:
Treatment: Placement of an IVC filter
Diuretics Administer Oxygen
Oxygen Surgery
Treat the underlying cause Thrombolytic Therapy if clot
detected
Idiopathic pulmonary fibrosis: Thickening of lung tissue Monitor the patient for:
in the lower Shock
aspects of the lungs. Pulmonary hypertension
Causes: Hemorrhage
Response to an inflammatory Palpitations
agent Heart failure
Found in people ages 50-70.
Linked to smoking Tuberculosis- infection caused by Mycobaterium
tuberculosis.
Symptoms: Causes:
Cough Due to airborne exposure
SOB
Chest pain Symptoms:
Cyanosis Fever
Clubbing Chest pain
Cyanosis SOB
Weight Loss
Fatigue Tests:
Wheezing Bronchoscopy
Phlegm production Open Lung biopsy
Sputum cultures
Tests: Viral blood tests
Thoracentesis
Sputum cultures Treatment:
Presence of crackles Antiviral medications
TB skin test IV fluids
Chest X-ray
Bronchoscopy Monitor the patient for:
Liver failure
Treatment: Heart failure
Generally about 6 months Respiratory failure
Rifampin
Pyrazinamide Pneumothorax: a build-up of a gas in the pleural cavities.
Isoniazid Types:
Traumatic pneumothorax
Cytomegalovirus – can cause lung infections and is a Tension pneumothorax
herpes-type Spontaneous pneumothorax
virus. Secondary spontaneous
Causes: pneumothorax
More common in immunocompromised patients
Often associated with organ transplantation Symptoms:
SOB
Symptoms: Tachycardia
Fever Hypotension
SOB Anxiety
Fatigue Cyanosis
Loss of appetite Chest pain-sharp
Cough Fatigue
Joint pain
Tests:
Tests: ABG
CMV serology tests
ABG Chest X-ray
Blood cultures Poor breath sounds

Bronchoscopy Treatment:
Chest tube insertion
Treatment: Administration of oxygen
Antiviral medications
Oxygen therapy Circulatory System

Monitor the patient for: Functions

Kidney dysfunction
Infection The circulatory system serves:
Decreased WBC levels
Relapses (1) to conduct nutrients and oxygen to the tissues;
(2) to remove waste materials by transporting
Viral pneumonia – inflammation of the lungs caused by nitrogenous compounds to the kidneys and carbon
viral infection. dioxide
Causes: to the lungs;
Rhinovirus (3) to transport chemical messengers (hormones) to
Herpes simplex virus target organs and modulate and integrate the internal
Influenza milieu of the body;
Adenovirus (4) to transport agents which serve the body in allergic,
Hantavirus immune, and infectious responses;
CMV (5) to initiate clotting and thereby prevent blood loss;
RSV (6) to maintain body temperature;
(7) to produce, carry and contain blood;
Symptoms: (8) to transfer body reserves, specifically mineral salts,
Fatigue to areas of need.
Sore Throats
Nausea General Components and Structure
Joint pain
Headaches The circulatory system consists of the heart, blood
Muscular pain vessels, blood and lymphatics. It is a network of tubular
Cough structures through which blood travels to and from all the
SOB parts of the body. In vertebrates this is a completely
closed circuit system, as William Harvey (1628) once
demonstrated. The heart is a modified, specialized, Myocardium (middle coat; cardiac muscle)
powerful pumping blood vessel. Arteries, eventually Epicardium (external coat or visceral layer of
becoming arterioles, conduct blood to capillaries pericardium; epithelium and mostly connective tissue)
(essentially endothelial tubes), and venules, eventually Impulse conducting system
becoming veins, return blood from the capillary bed to Cardiac Nerves: Modification of the intrinsic rhythmicity
the heart. of the heart muscle is produced by cardiac nerves of the
Course of Circulation sympathetic and
parasympathetic nervous system. Stimulation of the
Systemic Route: sympathetic system increases the rate and force of the
heartbeat and dilates the coronary arteries. Stimulation
a. Arterial system. Blood is delivered by the pulmonary of the parasympathetic (vagus nerve) reduces the rate
veins (two and force of the heartbeat and constricts the coronary
from each lung) to the left atrium, passes through the circulation. Visceral afferent (sensory) fibers from the
bicuspid (mitral) valve into the left ventricle and then is heart end almost wholly in the first four segments of the
pumped into the ascending aorta; backflow here is thoracic spinal cord.
prevented by the aortic semilunar valves. The
aortic arch toward the right side gives rise to the Cardiac Cycle: Alternating contraction and relaxation is
brachiocephalic (innominate) artery which divides into repeated about 75 times per minute; the duration of one
the right subclavian and right common carotid arteries. cycle is about 0.8 second. Three phases succeed one
Next, arising from the arch is the common another during the cycle:
carotid artery, then the left subclavian artery. a) atrial systole: 0.1 second,
The subclavians supply the upper limbs. As the b) ventricular systole: 0.3 second,
subclavian arteries c) diastole: 0.4 second
leave the axilla (armpit) and enter the arm (brachium),
they are called brachial arteries. Below the elbow these The actual period of rest for each chamber is 0.7 second
main trunk lines divide into for the atria and 0.5 second for the ventricles, so in spite
ulnar and radial arteries, which supply the forearm and of its activity, the heart is at rest longer than at work.
eventually form a set of arterial arches in the hand which
give rise to common and proper digital arteries. The Blood is composed of cells (corpuscles) and a liquid
descending (dorsal) aorta continues intercellular ground substance called plasma. The
along the posterior aspect of the thorax giving rise to the average blood volume is 5 or 6 liters (7% of body
segmental intercostals arteries. After passage “through” weight). Plasma constitutes about 55% of blood volume,
(behind) the diaphragm it is called the abdominal aorta. cellular elements about 45%.

At the pelvic rim the abdominal aorta divides into the Plasma: Over 90% of plasma is water; the balance is
right and left common iliac arteries. These divide into the made up of plasma proteins and dissolved electrolytes,
internal iliacs, which supply the pelvic organs, and the hormones, antibodies, nutrients, and waste products.
external iliacs, which supply the lower limb. Plasma is isotonic (0.85% sodium chloride). Plasma
plays a vital role in respiration, circulation, coagulation,
b. Venous system. Veins are frequently multiple and temperature regulation, buffer activities and overall fluid
variations are common. They return blood originating in balance.
the capillaries of peripheral and distal body parts to the
heart. Cardiovascular Conditions
Cardiogenic Shock: heart is unable to meet the demands
Hepatic Portal System: Blood draining the alimentary of the body. This can be caused by conduction system
tract (intestines), pancreas, spleen and gall bladder does failure or heart muscle dysfunction.
not return directly to the systemic circulation, but is
relayed by the hepatic portal system of veins to and Symptoms of Shock:
through the liver. In the liver, absorbed foodstuffs and Rapid breathing
wastes are processed. After processing, the liver returns Rapid pulse
the blood via hepatic veins to the inferior vena cava and Anxiety
from there to the heart. Nervousness
Thready pulse
Pulmonary Circuit: Blood is oxygenated and depleted of Mottled skin color
metabolic products such as carbon dioxide in the lungs. Profuse sweating
Poor capilary refill
Lymphatic Drainage: A network of lymphatic capillaries
permeates Tests:
the body tissues. Lymph is a fluid similar in composition Nuclear Scans
to blood plasma, and tissue fluids not reabsorbed into Electrocardiogram
blood capillaries are transported via the lymphatic Echocardiogram
system eventually to join the venous system at the Electrocardiogram
junction of the left internal jugular and subclavian veins.
ABG
The Heart Chem-7
The heart is a highly specialized blood vessel which Chem-20
pumps 72 times per minute and propels about 4,000 Electrolytes
gallons (about 15,000 liters) of blood daily to the tissues. Cardiac Enzymes
It is composed of: Endocardium (lining coat; epithelium)
Treatment: Monitor patient for:
Amrinone Bleeding
Norepinephrine Stroke
Dobutamine Graft infection
IV fluids Irregular Heartbeats
PTCA Heart Attack
Extreme cases-pacemaker, IABP
Hypovolemic shock: Poor blood volume prevents the
Aortic insufficiency: Heart valve disease that prevents heart from
the aortic valve pumping enough blood to the body.
from closing completely. Backflow of blood into the left Causes:
ventricle. Trauma
Causes: Diarrhea
Rheumatic fever Burns
Congenital abnormalities GI Bleeding
Endocarditis
Marfan’s syndrome Cardiogenic shock: Enough blood is available, however
Ankylosing spondylitis the heart is
unable to move the blood in an effective manner.

Reiter’s syndrome Symptoms:

Symptoms: Anxiety
Fainting Weakness
Weakness Sweating
Bounding pulse Rapid pulse
Chest pain on occasion Confusion
SOB Clammy skin
Fatigue
Tests:
Tests: CBC
Palpation Echocardiogram
Increased pulse pressure and CT scan
diastolic pressure Endoscopy with GI bleeding
Pulmonary edema present Swan-Ganz catheterization
Treatment:
Auscultation Increase fluids via IV
Left heart cathereterization Avoid Hypothermia
Aortica angiography Epinephrine
Dopper US Norepinephrine
Echocardiogram Dobutamine
Treatment: Dopamine
Digoxin
Dieuretics Myocarditis: inflammation of the heart muscle.
Surgical aorta valve repair Causes:
Bacterial or Viral Infections
Monitor patient for:PE Polio, adenovirus, coxsackie virus
Left-sided heart failure
Endocarditis Symptoms:
Leg edema
Aortic aneurysm: Expansion of the blood vessel wall SOB
often identified in Viral symptoms
the thoracic region. Joint Pain
Causes: Syncope
Htn Heart attack (Pain)
Marfan’s syndrome Fever
Syphilis Unable to lie flat
Atherosclerosis (most common) Irregular heart beats
Trauma
Tests:
Symptoms: Chest X-ray
Possible back pain may be the only indicator Echocardiogram
ECG
Tests: WBC and RBC count
Aortogram Blood cultures
Chest CT
X-ray Treatment:
Treatment: Diuretics
Varies depending on location Pacemaker
Stent Antibiotics
Circulatory arrest Steroids
Surgery
Monitor the patient for:
Pericarditis Monitor the patient for:
Cardiomyopathy Constrictive pericarditis
A fib.
Heart valve infection: endocarditis (inflammation), Supraventricular tachycardia
probable valvular heart disease. Can be caused by fungi (SVT)
or bacteria.
Arrhythmias: Irregular heart beats and rhythms disorder
Symptoms:
Weakness Types:
Fever Bradycardia
Murmur Tachycardia
SOB Ventricular fibrillation
Night sweats Ectopic heart beat
Janeway lesions Ventricular tachycardia
Joint pain Wolff-Parkinson-white syndrome
Atrial fib.
Tests: Sick sinus syndrome
CBC Sinus Tachycardia
ESR Sinus Bradycardia
ECG
Blood cultures Symptoms:
Enlarged speen SOB
Presence of splinter Fainting
hemorrhages Palpitations
Dizziness
Treatment: Chest pain
IV antibiotics
Irregular pulse
Surgery may be indicated
Monitor the patient for: Tests:
Jaundice Coronary angiography
Arrhythmias ECG
CHF Echocardiogram
Glomerulonephritis Holter monitor
Emboli
Treatment:
Pericarditis: Inflammation of the pericardium. Defibrillation
Causes: Pacemaker
Viral- coxsackie, adenovirus, influenza, rubella viruses Medications
Bacterial (various microorganisms)
Fungi Monitor the patient for:
Often associated with TB, Kidney failure, AIDS, and Heart failure
autoimmune Stroke
disorders. Heart attack
Surgery Ischemia

Symptoms: Arteriosclerosis: hardening of the arteries.

Dry cough
Pleuritis Causes:
Fever Smoking
Anxiety Htn
Crackles Kidney disease
Pleural effusion CAD
LE swelling Stroke
Chest pain
Unable to lie down flat Symptoms:
Claudication pain
Tests: Cold feet
Auscultation Muscle acheness and pain in the
MRI scan legs
CT scan Hair loss on the legs
Echocardiogram (key test) Numbness in the extremities
ESR Weak distal pulse
Chest x-ray
Tests:
Blood cultures Doppler US
CBC Angiography

Treatment: IVSU
NSAIDS MRI test
Pericardiocentesis Poor ABI (Ankle brachial index)
Analgesics reading

Pericardiectomy Treatment:
Analgesics Class III is characterized by a marked limitation in
Vasodilation medications normal physical
Surgery if severe activity.
Ballon surgery Class IV is defined by symptoms at rest or with any
Stent placement physical activity.
Causes:
Monitor the patient for: CAD
Arterial emboli Valvular heart disease
Ulcers Cardiomyopathies
Impotence Endocarditis
Gas gangreene Extracardiac infection
Infection of the lower Pulmonary embolus
extremities
Symptoms:
Cardiomyopathy- poor hear pumping and weakness of Skin cold or cyanotic
the Wheezing
myocardium. Mitral valvular deficits
Lower extremity edema
Causes: Pulsus alternans
Htn Hypertension
Heart attacks Tachypnea
Viral infections
Heart Sounds:
Types: S1- tricuspid and mitral valve close
Alcoholic cardiomyopathy- due to alcohol consumption S2- pulmonary and aortic valve close
Dilated cardiomyopathy-left ventricle enlargement S3- ventricular filling complete
Hypertrophic cardiomyopathy-abnormal growth left S4-elevated atrial pressure (atrial kick)
ventricle
Ischemic cardiomyopathy- weakness of the myocardium Wave Review
due to heart
attacks. ST segment: ventricles depolarized
Peripartum cardiomyopathy- found in late pregnancy P wave: atrial depolarization
Restrictive cardiomyopathy-limited filling of the heart due PR segment: AV node conduction
to inability QRS complex: ventricular depolarization
to relax heart tissue. U wave: hypokalemia creates a U wave
T wave: ventricular repolarization
Symptoms:
Chest pain Wave Review Indepth:
SOB 1. P WAVE - small upward wave; indicates atrial
Fatigue depolarization
Ascites 2. QRS COMPLEX - initial downward deflection followed
LE swelling by large upright wave followed by small downward wave;
Fainting represents ventricular
Poor Appetite depolarization; masks atrial repolarization; enlarged R
Htn portion - enlarged ventricles; enlarged Q portion -
Palpitations probable heart attack.
3. T WAVE - dome shaped wave; indicates ventricular
Tests: repolarization; flat when insufficient oxygen; elevated
ECG with increased K levels
CBC 4. P - R INTERVAL - interval from beginning of P wave
to R wave; represents conduction time from initial atrial
Isoenzyme tests excitation to initial ventricular excitation; good diagnostic
Coronary Angigraphy tool; normally < 0.2sec.
Chest X-ray
MRI 5. S-T SEGMENT - time from end of S to beginning to T
Auscultation wave;represents time between end of spreading impulse
through ventricles and ventricular repolarization;
Treatment: elevated with heart attack; depressed when insufficient
Ace inhibitors oxygen.
Dieuretics 6. Q-T INTERVAL - time for singular depolarization and
Blood thinners repolarization of the ventricles. Conduction problems,
LVAD – Left Ventricular Assist myocardial damage or congenital heart defects can
Device prolong this.
Digoxin
Vasodilators

Congestive Heart Failure:

Class I describes a patient who is not limited with normal
physical
activity by symptoms.
Class II occurs when ordinary physical activity results in
fatigue, dyspnea, or other symptoms.
Arrhythmias Review ECG Changes with MI
Supraventricular Tachyarrhythmias T Wave inversion
Atrial fibrillation – Abnormal QRS rhythm and poor P ST Segment Elevation
wave appearance. (>300bpm.) Abnormal Q waves
Sinus Tachycardia- Elevated ventricular rhythum/rate. ECG Changes with Digitalis
Paroxysmal atrial tachycardia- Abnormal P wave, Inverts T wave
Normal QRS complex QT segment shorter
Atrial flutter- Irregular P Wave development. (250-350
bpm.) Depresses ST segment
Paroxysmal supraventricular tachycardia- Elevated bpm ECG Changes with Quinidine
(160-250) Inverts T wave
Multifocal atrial tachycardia- bpm (>105). Various P QT segment longer
wave appearances. QRS segment longer
ECG Changes with Potassium
Ventricular Tachyarrhythmias
Ventricular Tachycardia- Presence of 3 or greater PVC’s Hyperkalemia- Lowers P wave, Increases width of QRS
(150- complex
200bpm), possible abrupt onset. Possibly due to an Hypokalemia- Lowers T wave, causes a U wave
ischemic ventricle. ECG Changes with Calcium
No P waves present. Hypercalcemia-Makes a longer QRS segment
Hypocalcemia- Increases time of QT interval
(PVC)- Premature Ventricular Contraction- In many
cases no P wave
followed by a large QRS complex that is premature, Endocrine Review
followed by a compensatory pause. Hypothyroidism: Poor production of thyroid hormone:
Primary- Thyroid cannot meet the demands of the
Ventricular fibrillation- Completely abnormal ventricular pituitary gland.
rate and rhythum requiring emergency intervention. No Secondary- No stimulation of the thyroid by the pituitary
effective cardiac output. gland.
Causes:
Bradyarrhythmias Surgical thyroid removal
Irradiation
AV block (primary, secondary (I,II) Tertiary Congenital defects
Primary- >.02 PR interval Hashimoto’s thyroiditis (key)
Secondary (Mobitz I) – PR interval Increase
Secondary (Mobitz II) – PR interval (no change) Symptoms:
Tertiary- most severe, No signal between ventricles and Constipation
atria noted on Weight gain
ECG. Probable use of Atrophine indicated. Pacemaker Weakness
required. Fatigue
Poor taste
Right Bundle Branch Block (RBBB)/Left Bundle Branch Hoarse vocal sounds
Block (LBBB) Joint pain
Sinus Bradycardia- <60 bpm, with presence of a Muscle weakness
standard P wave. Poor speech
Color changes
Cardiac Failure Review Depression
Right Sided Heart Failure
A. Right Upper Quadrant Pain Tests:
B. Right Ventricular heave Decreased BP and HR
C. Tricuspid Murmur Chest X-ray
D. Weight gain Elevated liver enzymes,
E. Nausea prolactin, and cholesterol
F. Elevated Right Atrial pressure Decreased T4 levels and serum
G. Elevated Central Venous pressure sodium levels
H. Peripheral edema Presence of anemia
I. Ascites Low temperature
J. Anorexia Poor reflexes
K. Hepatomegaly
Treatment:
Left Sided Heart Failure Increase thyroid hormone levels
A. Left Ventricular Heave Levothyroxine
B. Confusion
C. Paroxysmal noturnal dyspnea Monitor the patient for:
D. DOE Hyperthyroidism symptoms
E. Fatigue following treatment
F. S3 gallop Heart disease
G. Crackles Miscarriage
H. Tachycardia Myxedema coma if untreated
I. Cough
J. Mitral Murmur
K. Diaphoresis
L. Orthopnea
Hyperthyroidism: excessive production of thyroid Primary/Secondary Hyperaldosteronism
hormone. Primary Hyperaldosteronism: problem within the adrenal
gland
Causes: causing excessive production of aldosterone.
Iodine overdose Secondary Hyperaldosteronism: problem found
Thyroid hormone overdose elsewhere causing
Graves’ disease (key) excessive production of aldosterone.
Tumors affecting the
reproductive system Causes:
Primary:
Symptoms: Tumor affecting the adrenal
Skin color changes gland
Weight loss Possibly due to HBP
Anxiety Secondary:
Possible goiter Nephrotic syndrome
Nausea Heart failure
Exophthalmos Cirrhosis
Diarrhea Htn

Hair loss Symptoms:

Elevated BP Paralysis
Fatigue Fatigue
Sweating Numbness sensations
Htn
Tests: Weakness
Elevated Systolic pressure noted
T3/T4 (free) levels increased Tests:
TSH levels reduced Increased urinary aldosterone

Treatment: Abnormal ECG readings

Radioactive iodine Decreased potassium levels
Surgery Decreased renin levels
Beta-blockers
Antithyroid drugs Treatment:
Primary: Surgery
Congenital adrenal hyperplasia: Excessive production of Secondary: Diet/Drugs
androgen and
low levels of aldosterone and cortisol. (Geneticially Cushing’s syndrome: Abnormal production of ACTH
inherited disorder). which in turn
Different forms of this disorder that affect males and causes elevated cortisol levels.
females
differently. Causes:
Corticosteroids prolonged use
Causes: Adrenal gland enzyme deficit causes cortisol Tumors
and aldosterone
to not be produced. Causing male sex characteristics to Symptoms:
be expressed Muscle weakness
prematurely in boys and found in girls. Central obesity distribution
Back pain
Thirst
Symptoms: Skin color changes
Boys: Bone and joint pain
Small testes development Htn
Enlarged penis development Headaches
Strong musculature appearance Frequent urination
Girls: Moon face
Abnormal hair growth Weight gain
Low toned voice Acne
Abnormal genitalia
Lack of menstruation Tests:
Dexamethasone suppression
Tests: test
Cortisol level check
Salt levels MRI- check for tumors
Low levels of cotisol
Low levels of aldosterone Treatment:
Increased 17-OH progesterone Surgery to remove tumor
Increased 17-ketosteroids in Monitor corticosteroid levels
urine
Monitor the patient for:
Treatment: Kidney stones
Reconstructive surgery Htn
Hydrocoristone Bone fractures
Dexamethasone DM
Infections
 T3/T4 increased
Diabetic ketoacidosis: increased levels of ketones due to Increased HR
a lack of
glucose. Lymphocyte concentration noted
with biopsy
Causes: Insufficient insulin causing ketone production
which end up in Treatment:
the urine. More common in type I vs. type 2 DM. Varies depending on symptoms.
(Beta blockers may be used.)
Symptoms:
Low BP Monitor the patient for:
Abdominal pain Autoimmune thyroditis
Headaches Hashimoto’s thyroiditis
Rapid breathing Goiter
Loss of appetite Stuma lymphomatosoma
Nausea
Fruit breath smell Graves’ disease: most commonly linked to
Mental deficits hyperthyroidism, and is an
autoimmune disease. Exophthalmos may be noted
Tests: (protruding
Elevated glucose levels eyeballs). Excessive production of thyroid hormones.

Increased amylase and Symptoms:

potassium levels Elevated appetite
Ketones in urine Anxiety
Check BP Menstrual changes
Fatigue
Treatment: Poor temperature tolerance
Insulin Diplopia
IV fluids Exophthalmos

Monitor the patient for: Tests:

Renal failure Elevated HR
MI Increased T3/T4 levels
Coma Serum TSH levels are decreased
Goiter
T3/T4 Review
Both are stimulated by TSH release from the Pituitary Treatment:
gland Beta-blockers
T4 control basal metabolic rate Surgery
T4 becomes T3 within cells. (T3) Active form. Prednisone
T3 radioimmunoassay- Check T3 levels Radioactive iodine
Hyperthyroidism- T3 increased, T4 normal- (in many
cases) Monitor the patient for:
Fatigue
Medications that increase levels of T4: CHF
Methadone Depression
Oral contraceptives
Estrogen Hypothyroidism (over-
correction)
Cloffibrate
Type I diabetes (Juvenile onset diabetes)
Medications that decrease levels of T4:
Lithium Causes: Poor insulin production from the beta cells of
Propranolol the pancreas.
Interferon alpha Excessive levels of glucose in the blood stream that
Anabolic steroids cannot be used
Methiamazole due to the lack of insulin. Moreover, the patient
continues to
Lymphocytic thyroiditis: Hyperthyroidism leading to experience hunger, due to the cells not getting the fuel
hypothyroidism that they need.
and then normal levels. After 7-10 years the beta cells are completely destroyed
Causes: Lymphocytes permeate the thyroid gland in many
causing cases.
hyperthyroidism initially.

Symptoms: Symptoms:
Fatigue Weight loss
Menstrual changes Vomiting
Weight loss Nausea
Poor temperature tolerance Abdominal pain
Muscle weakness Frequent urination
Hyperthyroidism symptoms Elevated thirst

Tests: Tests:
Fasting glucose test PVD
Insulin test Htn
Urine analysis
Diabetes Risk Factors:
Treatment:
Insulin Bad diet
Htn
Relieve the diabetic ketoacidosis Weight distribution around the waist/overweight.
symptoms Certain minority groups
Foot ulcer prevention History of diabetes in your family
Poor exercise program
Monitor for infection: Elevated triglyceride levels
Monitor for hypoglycemia
.Microbiology Review
conditions if type I is over- Characteristics of Bacteria Types
corrected.
Rickettsias- gram-negative bacteria, small
Glucagon may need to be Rickettsia rickettsii
administered if hypoglycemia
conditions are severe. Spirochetes- spiral shape, no flagella, slender
Monitor the patient for ketone Lyme disease, Treponema pallidum-syphilis
build-up if type I untreated.
Get the eyes checked- once a Gram positive cocci- Hold color with Gram stain, ovoid or
year spherical
shape
Staphlyococcus aureus, Streptococcus pneumoniae
Type II diabetes
Gram negative cocci- Loose color with Gram stain,
The body does not respond appropriately to the insulin spherical or oval
that is present. shape
Insulin resistance is present in Type II diabetes. Results
in Neisseria meningidis (meningococcus), Neisseria
hyperglycemia. gonorrhoeae (gonococcus)

Risk factors for Type II Mycoplasmas- Mycoplasma pneumoniae

Diabetes:
Obesity Acid-fast bacilli- Hold color with staining even when
Limited exercise individuals stained with acid
Race-Minorities have a higher in most
distribution cases. Mycobacterium leprae, Mycobacterium
Elevated Cholesterol levels tuberculosis
Htn
Acitinomycetes- Stained positive with a gram stain,
Symptoms: narrow filaments
Blurred vision Nocardia, Actinomyces israelii
Fatigue
Elevated appetite Gram positive- Rod shaped, hold color with gram stain
Frequent urination
Thirst Clostridium tetani, Bacillus anthracis
Note: A person may have Type
II and be symptom free. Gram negative- Do not hold color with gram stain, also
rod shaped.
Tests: Pseudomonas aeruginosa, Escherichia coli, Klebsiella
Random blood glucose test. pneumoniae
Oral glucose tolerance test
Diseases and Acid Fast Bacilli Review
Fasting glucose test.
Disease Bacteria Primary Medication
Treatment: Tuberculosis, renal
Tlazamide and meningeal
Glimepiride infections
Control diet
Increase exercise levels Mycobacterium
Repaglidine/Nateglinide tuberculosis
Glycosylated hemoglobin
BUN/ECG Isoniazid + rifampin +
Frequent blood sugar testing pyrazinamide
Acarbose
Diabetic Ulcer prevention Leprosy Mycobacterium leprae Dapsone + rifampin

Monitor the patient for: Diseases and Spirochetes Review

Neuropathy
CAD Disease Bacteria Primary Medication
Increased cholesterol Lyme Disease Borrelia burgdorferi Tetracycline
Retinopathy Meningitis Leptospira Penicillin G
Syphilis Treponema pallidum Penicillin G Pharyngitis Corynebacterium
diphtheriae
Diseases and Actinomycetes Review
Penicillin G
Disease Bacteria Primary Medication
Cervicofacial, and Meningitis,
other lesions Bacteremia

Actinomyces israelii Penicillin G Listeria

monocytogenes
Diseases and Gram-Negative Bacilli Review
Ampicillin
Disease Bacteria Primary Medication
Meningitis Flavobacterium Anthrax / pneumonia Bacillus anthracis Penicillin G
meningosepticum Endocarditis Corynebacterium

Vancomycin species

UTI’s Bacteremia Escherichia coli Ampicillin+/- Penicillin

aminoglycoside G/Vancomycin

Gingivitis, Genital Diseases and Cocci Review

infections, ulcerative
pharyngitis Disease Bacteria Primary Medication
Genital infections,
Fusobacterium arthritis-dermatitis
nucleatum syndrome

Penicillin G Neisseria gonorrhoeae Ampicillin, Amoxicillin

Abscesses Bacteroides species Clindamycin/Penicillin Meningitis,

Hospital acquired Bacteremia
infections
Neisseria meningitidis Penicillin G
Acinetobacter Aminoglycoside
Endocarditis,
Abscesses, Bacteremia
Endocarditis
Streptococcus
Bacteroides fragilis Clindamycin, (viridans group)
metronidazole
Gentamicin
Legionnaires’ Disease Legionella
pneumonphila Bacteremia, brain and
other absesses
Erythromycin
Streptococcus
UTI’s Proteus mirabilis Ampicillin/Amoxicillin (anaerobic species)
Pneumonia, UTI’s,
Bacteremia Penicillin G

Pseudomonas Endocarditis,
aeruginosa Bacteremia

Penicillin-Broad Streptococcus
agalactiae
Bacteremia,
Endocarditis Ampicillin

Streptobacillus Pneumonia,
moniliformis Osteomyelitis,

Penicillin G Staphyloccus aureus Penicillin

G/Vancomycin
Pneumonia, UTI Klebsiella pneumoniae Cephalosporin
Bacteremia, Wound
infections abscesses
UTI’s, Endocarditis Streptococcus faecalis Ampicillin,
Pasteurella multocida Penicillin G Penicillin G
Pneumonia, sinusitis,
Diseases and Gram-Positive Bacilli Review otitis, Arthritis

Disease Bacteria Primary Medication Streptococcus

Gas Gangrene Clostridium Penicillin G pneumoniae
Tetanus Clostridium tetani Penicillin G
Penicillin G or V TNF-α Promotes the activation of neutrophils and is
produced by
Cellulitis, Scarlet macrophages.
fever, bacteremia TNF-βProduced by T lymphocytes and encourages the
activation of
Streptococcus neutrophils
pyogenes γ-interferon (Activates macrophages and is produced by
helper T cells.)
Penicillin G or V

Bacteremia, Controlled Substance Categories

endocarditis
Schedule I Highest potential abuse, used
Streptococcus bovis Penicillin G mostly for research. (heroin,
peyote, marijuana)
DNA Virus Review
Schedule II High potential abuse, but used for
DNA Virus Infection therapeutic purposes (opioids,
Adenovirus Eye and Respiratory infections amphetamines and barbiturates)
Hepatitis B Hepatitis B Schedule III Mild to moderate physical
Cytomegalovirus Cytomegalic inclusion disease dependence or strong
Epstein-Barr Infectious mononucleosis psychological dependence on
Herpes Types 1 and 2 Local infections oral and genital both. (opioids such as codeine,
Varicella-zoster Chickenpox, herpes zoster hydrocodone that are combined
Smallpox Smallpox with other non-opoid drugs)
Schedule IV Limited potential for abuse and
RNA Virus Review physical and/or psychological
dependence (benzodiazepines,
RNA Virus Infection and some low potency opioids)
Human respiratory virus Respiratory tract infection Schedule V Lowest abuse potential of
Hepatitis A virus Hepatitis A controlled substances. Used in
Influenza virus A-C Influenza
Measles virus Measles cough medications and anti-
Mumps virus Mumps diarrheal preps.

Respiratory syncytial virus Respiratory tract infection in Dose Response- the relationship between dose and the
children body’s
Poliovirus Poliomyelitis response is called a dose-response curve (DRC).
Rhinovirus types 1-89 Cold
Human immunodeficiency
Virus AIDS Potency- relates to the dosage required to produce a
certain response.
Rabies virus Rabies A more potent drug requires a lower dosage than does a
Alphavirus Encephalitis less potent
Rubella virus Rubella drug to produce a given effect.

Immunoglobulin isotypes Efficacy- usually refers to maximum efficacy. Maximum

efficacy is
IgA– can be located in secretions and prevents viral and plateau (or maximum response), but may not be
bacterial achievable clinically
attachment to membranes. due to undesirable side effects. In general, the
IgD- can be located on B cells steepness of the curve
IgE-main mediator of mast cells with allergen exposure. dictates the range of doses that are useful
IgG- primarily found in secondary responses. Does cross therapeutically.
placenta and
destroys viruses/bacteria. LD50/ED50 -- Quantal dose response curve is the
IgM- primarily found in first response. Located on B cells relationship between
the dose of the drug and the occurrence of a certain
Cytokines Review response.

IL-1 Primarily stimulate of fever response. Helps activate Therapeutic index (TI)- the ratio of the median effective
B and T dose (ED50)
cells. Produced by macrophages. and the toxic dose (TD50) is a predictor of the safety of a
IL-2 Aids in the development of Cytotoxic T cells and drug. This
helper cells. ratio is called the therapeutic index. Note:
Produced by helper T cells. Acetominophin has TI of
IL-3 Aids in the development of bone marrow stem cells. 27. Meperidine (DEMEROL) has a TI of 8.
Produced by T-cells.
IL-4 Aids in the growth of B cells. Produced by helper T-
cells. Aids in Pharmacology
the production of IgG and IgE
IL-5 Promotes the growth of eosinophils. Produced by Drug Suffix Example Action
helper T-cells. -azepam Diazepam Benzodiazepine
Also promotes IgA production. -azine Chlorpromazine Phenothiazine
IL-8 Neutrophil factor -azole Ketoconazole Anti-fungal
-barbital Secobarbital Barbiturate
-cillin Methicillin Penicillin Cardiac glycosides:
-cycline Tetracycline Antibiotic Digoxin
Dieuretics:
-ipramine Amitriptyline Tricyclic Anti- Loop Dieuretics
depressant Hydrocholorothiazide

-navir Saquinavir Protease Inhibitor K+ Sparing Dieuretics

-olol Timolol Beta Antagonist Spironolactone
-oxin Digoxin Cardiac glycoside Triamterene
-phylline Theophylline Methylxanthine Amiloride
-pril Enalapril ACE Inhibitor
-terol Albuterol Beta 2 Agonist
-tidine Ranitidine H2 Antagonist CNS Pharmacology
-trophin Somatotrophin Pituitary Hormone
-zosin Doxazosin Alpha 1 Antagonist Sympathomimetics:
Dopamine
Cardiovascular Pharmacology Dobutamine
Epinephrine
Antiarrhythmics- Na+ channel blockers (Class I) Norephinephrine
Isoproterenol
Class IA
Procainamide Cholinomimetics:
Disopyramide Carbachol
Amiodarone Neostigmine
Quinidine Pyridostigmine
Echothiophate
Class IB Bethanechol
Mexiletine
Lidocaine Cholinoreceptor blockers:
Tocainide Hexamethonium-Nicotinic
blocker
Class IC Atropine-Muscarinic blocker
Flecainide
Encainide Beta blockers:
Propafenone Atenolol
Nadolol
Antiarrhythmics (Beta blockers) (Class II) Propranolol
Metroprolol Metoprolol
Atenolol Pindolol
Propranolol Labetalol
Timolol
Esmolol Tricyclic Antidepressants:
Doxepine
Antiarrhythmics (K+Channel blockers) (ClassIII) Imipramine
Sotaolol Amitriptyline
Amiodarone Nortriptyline
Bretylium Amitriptyline
Ibutilide
Parkinson’s Treatment:
Antiarrhythmics (Ca2+ channel blockers) (Class IV) L-dopa
Diltiazem Amantadine
Verapamil Bromocriptine

Vasodilators: Verapamil Benzodiazepindes:

Iorazepam
Minoxidil Triazolam
Hydralazine Oxazepam
Diazepam
Calcium Channel Blockers:
Verapamil Opiod Analgesics:
Diltiazem Heroin
Nifedipine Methadone
Morphine
Sympathoplegics: Codeine
Beta blockers Dextromethorphan
Clonidine Meperidine
Reserpine
Guanethidine MAO Inhibitors:
Prazosin
Tranylcypromine
ACE Inhibitors: Phenelzine
Lisinopril
Enalapril Seroton specific Re-uptake
Captopril inhibitors:
Paroxetine Alteplase
Sertraline
Fluoxetine Cox 2 Inhibitors:
Citalopram Rofecoxib
Celecoxib
Epilepsy Treatment:
Valproic acid NSAID’s:
Phenobarbital Naproxen
Benzodiazepines Indomethacin
Gabapentin Ibuprofen
Ethosuximide
Carbamazepine Diabetic Treatment:
Sulfonylureas:
Barbiturates: Chlorpropamide
Pentobarbital
Thiopental Tolbutamide
Phenobarbital Glyburide
Secobarbital
Insulin- Key
IV Anethestics:
Midazolam Metformin
Ketamine
Morphine Glitazones:
Rosiglitazone
Fentanyl Troglitazone
Propofol Pioglitazone
Thiopental
Asthma Treatment:
Local Anesthetics:
Tetracaine Corticosteroids:
Procaine Prednisone
Lidocaine Beclomethasone

Neuroleptics (Antipsychotic Antileukotrienes:

drugs) Zafirlukast
Chlorpromazine Zileuton
Thioridazine
Clozapine Beta 2 agonists:
Fluphenazine Salmeterol
Haloperidol Albuterol

Alpha 1 Selective blockers: Nonselective Beta agonists:

Terazosin Isoproterenolol
Prazosin
Doxazosin Muscarinic agonists:
Alpha 2 Selective blockers: Ipratropium
Yohimbine
H2 blockers:
Glaucoma Treatment: Famotidine
Prostaglandins Nizatidine
Dieuretics Cimetidine
Alpha agonists Ranitidine
Beta Blockers
Anti-Microbial Drugs
Cholinomimetics
Tetracyclines:
Cancer Treatment Drugs: Tetracycline
Etoposide Doxycycline
Nitrosoureas Minocycline
Cisplatin Demeclocycline
Doxorubicin
Incristine Macrolides:
Paclitaxel Carithormycin
Erythromycin
Methotrexate Azithromycin
6 – mercaptopurine Aminoglycosides:
Busulfan Amikacin
5 – fluorouracil Gentamicin
Lomustine Neomycin
Carmustine Tobramycin
Streptomycin
Throbolytics:
Urokinase Protein Synthesis Inhibitors:
Anistreplase Chloramphenicol
Streptokinase Aminoglycosides
Tetracyclines 1000 grams 1 (kg)
1 tablespoon (T) 15 (ml)
TB Medications: 1 teaspoon (tsp) 5 (ml)
Isoniazid 20 drops 1 (ml)
Rifampin 2.2 (lb) 1 (kg)
Ethambutol 1 (lb) 453.6 (gm)
Pyrazinamide 1 (oz) 30 (gm)
Ethambutol 1 (ml) 1 (cc)
1 (dl) 100 (ml)
Fluoroquinolones:
Ciprofloxacin Solid Conversions
Sparfloxacin Apothecary Avoirdupois
Enaxacin 2.7 (lb) 2.2 (lb)
Nalidixic acid 1.33 (lb) 1 (lb)
Norfloxacin 480 (gr) 1 (ounce)
Mortifloxacin 15 (gr) 15.4 (gr)
1 (gr) 1 (gr)
Sulfonamides:
Sulfadiazine Liquid Conversions
Sulfisoxazole Household Metric Apothecary
Sulfamethoxazole 1 drop .06 (ml) 1 minim
Malaria Treatment: 1⁄4 teaspoon 1 (ml) 15 or 16 minims
Chlorquine 1 teaspoon 4 or 5 (ml) 1 fluid dram
Quinine 1 tablespoon 15 (ml) 4 fluid dram
Mefloquine 2 tablespoons 30 (ml) 1 fluid ounce
1 cup 250 (ml) 8 fluid ounces
Additional Mentionable Anti-viral Drugs: 1 pint 500 (ml) 16 fluid ounces
Acyclovir 1 quart 1000 (ml) 32 fluid ounces
Amatadine
Ribavirin Metric - (Apothecaries’)
Zanamivir 1/100 grain .6 (mg)
Ganciclovir 1/60 grain 1 (mg)
1/30 grain 2 (mg)
HIV Treatment: 1/20 grain 3 (mg)
Zidovudine (AZT) 1/15 grain 4 (mg)
Nevirapine 1/10 grain 6 (mg)
Didanosine 1/6 grain 10 (mg)
1/5 grain 12 (mg)
Protease Inhibitors-(HIV) 1/3 grain 20 (mg)
Saquinavir 3/8 grain 25 (mg)
Retinonavir 1⁄2 grain 30 (mg)
Nelfinavir 1 grain 60 (mg)
1 1⁄2 grains 100 (mg)
Measurement Equivalents 5 grains 300 (mg)
10 grains 600 (mg)
Weights Conversion Table

.1 mg 1/600 grain Drug Distribution

.2 mg 1/300 grain
.5 mg 1/120 grain Bioavailability dependant on several things:
1 mg 1/60 grain 1. Route of administration
10 mg 1/6 grain 2. The drug’s ability to cross membranes
30 mg 1⁄2 grain 3. The drug’s binding to plasma proteins and intracellular
60 mg 1 grain components
300 mg 5 grains
1 gm 15 grains Membrane Review:
4 gm 60 grains
15 gm 4 drams 1. Membranes separate the body in components
30 gm 1 ounce 2. The ability of membranes to act as barriers is related
to its
Volume Conversion Table structure
3. Lipid Soluable compounds (many drugs) pass through
Household Metric Apothecary by
1 quart 1000 ml 1 quart becoming dissolved in the lipid bylayer.
1 pint 500 ml 1 pint 4. Glucose, H20, electrolytes can’t pass on their own.
2 tablespoons 30 ml 1 ounce They use
1 tablespoons 15 ml 4 fluid drams pores.
1 teaspoon 5 ml 1 fluid dram 5. In excitable tissues, the pores open and close.
15 drops 1ml 15 minims 6. Movement occurs by:
a. passive diffusion
Common Conversions b. active transport
1 meter 1000 (mm) c. facilitated diffusion
1 meter 100 (cm) d. endocytosis
.001 milligram 1 (mcg)
1 gram 1000(mg) Passive Diffusion Review:
 4. Must assume the fetus is subjected to all drugs taken
1. No energy expended. by the
2. Weak acids and bases need to be in non-ionized form mother to some extent.
(no net
charge). 92
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90
Copyright © StudyGuideZone.com. All rights reserved. Biotransformation of Drugs

3. Drugs can also move between cell junctions. BBB is Biotransformation refers to chemically altering the
exception. original drug
4. Must be lipid soluable to pass through pores. structure. “Metabolite” refers to the altered version.
5. Osmosis is a special case of diffusion Biotransformation metabolites are generally more polar
a. A drug dissolved in H2O will move with the water by than the
“bulk original drug. The kidney will excrete polar compounds,
flow” but reabsorb
b. Usually limited to movement through gap junctions non-polar compounds.
because size too large for pores.
Enzymatic reactions are either Phase I or Phase II
Active Transport Review: reactions:
Phase I include:
1. Requires energy and requires a transport protein 1. hydrolysis rxns – split the original compound into
2. Drugs must be similar to some endogenous separate
substance. parts
3. Can carry substances against a gradient 2. reduction rxns – either remove O2 or add H
4. Some drugs may exert their effect by increasing or 3. oxidation rxns- adds an O2 molecule and removes a
decreasing transport proteins. H
molecule. These are the most predominant reactions for
Facilitated Diffusion Review: biotransforming drugs
1. Requires transport protein
2. Does not require energy Phase I reactions are generally more polar and usually
3. Very few drugs move this way inactive-some
exceptions.
Endocytosis:
Phase II reactions are called conjugation rxns.
1. Drug gets engulfed by cell via invagination 1. Lead to the formation of a covalent bond between the
2. Very few drugs move this way and only in certain drug
cells. and another compound such as glucaronic acid, amino
acids
Regulation of distribution determined by: or acetate.
1. Lipid permeability 2. Products are highly polar and generally inactive-
2. Blood flow morphine is
exception.
91 3. Products are rapidly excreted in urine and feces
Copyright © StudyGuideZone.com. All rights reserved. because
poorly reabsorbed by kidney and intestine.
3. Binding to plasma proteins 4. There is also a phenomenon known as entrohepatic
4. Binding to subcellular components recirculation – can result in re-entry of the parent drug
back
Volume of Distribution (Vd) - is a calculation of where the
drug is 93
distributed. Copyright © StudyGuideZone.com. All rights reserved.

Vd = amount of drug given (mg) into the circulation and leads to delayed elimination and
concentration in plasma (mg/ml) prolonged effect of the drug.

Calculate the Vd and compare to the total amount of Most metabolism takes place in the liver- 1st pass
body H20 in a significant.
person. Kidney, skin, GI, and lugs have significant metabolic
-if Vd = total amount of body (approx. 42) is uniformly capacity.
distributed Phase I reactions take place mostly in endoplasmic
-if Vd is less than 42 – retained in plasma and probably reticulum
bound to (ER). Phase II reactions take place mostly in cytosol.
plasma proteins
-if Vd is more than 42 – concentrated in tissues Cytochrome P450 mono-oxygenase enzymes are the
major
This is not a “real value” but tells you where the drug is catalyst in Phase I. The Cyt 450 system is a series of
being enzymes
distributed. that are heme containing proteins. The catalyze
oxidation/reduction reactions- which make compounds
Placental Transfer of Drugs more +
1. Some drugs cause congenital anomalies or -. These metabolites are subjected to conjugation
2. Cross placenta by simple diffusion reactions
3. Must be polar or lipid-insoluable Not to Enter and then excreted.
Biotransformation Factors: The time required to remove half of the drug is called t
1⁄2. T1/2 is
1. Induction- certain drugs induce synthesis of addition constant in 1st order kinetics.
Cyt 450
enzymes In 1st order kinetics the:
2. Inhibition- certain drugs inhibit Cyt 450 enzymes
3. Genetic Polymorphism-slow vs. fast metabolizers Rate of elimination = concentration of drug in plasma
4. Disease- impaired liver function, decreased hepatic (mg/ml) x Cl
blood flow (ml/hr). When the systems for drug elimination become
5. Age/Gender-rate of phase I/II reactions slow in saturated,
infants, now have zero order elimination. Zero order elimination
females may have reduced ability to metabolize certain means that
compounds? the elimination rate is constant over time, regardless of
the
Drug Elimination concentration of drug in the system.

1. Renal elimination The aim is to maintain a steady-state concentration of a

a. Drugs get filtered and if not reabsorbed, gets excreted drug within a
in known therapeutic range. Steady state is achieved when
urine the rate of
b. Renal excretion involves: glomerular filtration, active elimination = rate of availability.
tubular secretion, and passive tubular reabsorption.
Availability = amount of drug in plasma
2. Elimination by other routes. amount of drug given
a. Lungs mostly volatile compounds
b. Bile/fecal excretion Rate of Elimination = Cl x concentration in plasma
c. Saliva, sweat, tears, breast milk
d. Hair, skin Time to reach steady state depends on dosing interval
and elimination
95 t 1⁄2 . If you want to achieve steady state more rapidly, a
Copyright © StudyGuideZone.com. All rights reserved. loading
dose can be given followed by a maintenance dose.
General Pharmacokinetics Review
Loading dose (mg) = target concentration (mg/ml) x Vd
Clinical Pharmacokinetics attempts to quantify the (ml)
relationship
between dose and effect. Primary parameters that Maintenance dose = amount given must equal amount
dictate dosage eliminated
include: within dosing time.
1. Clearance
2. Volume of Distribution 97
3. Bioavailability Copyright © StudyGuideZone.com. All rights reserved.

Clearance-measure of the body’s ability to eliminate a If given at intervals shorter than elimination time =
drug. Clearance toxicity.
is an expression of the volume of plasma which is If given at intervals longer than elimination time =
cleared of the drug ineffective dose.
per unit time (ml/hr) not the concentration of the drug
cleared. Pharmacodynamic Terms

Clearance = flow (ml/min) x amount of drug removed 1. Agonist – has affinity and efficacy
from the 2. Partial agonist – has affinity and partial efficacy
blood (mg/ml) 3. Antagonist – has affinity, no efficacy
Amount of drug going in to kidney 4. Additive effects- !+1 = 2
(mg/ml) 5. Synergistic effects- 1+1 = 3
6. Affinity – attraction between drug and (X)
Or 7. Specificity- attraction between drug and specific (X)
8. Potentiation- one drug enhances the effect of another
Cl = flow x [C]in – [C]out (amount removed) drug
[C] in (amount in blood) Ex. Aspirin bumps T3/T4 off plasma proteins- more free
T3/T4
The systems of drug elimination are not usually
saturated so drug Autonomic Nervous System Receptors
elimination is dependent on the concentration of drug in
the plasma. 1. Cholinergic Receptors – Ach binds both – prefers
This means the higher the concentration of the drug, the Muscarinic
faster the
blood is cleared. When this is true this is called 1st order a. Nicotinic-preferentially binds nicotine. Found at
kinetics. In ganglion
on post synaptic fiber. Found in both SNS and PNS.
96 Drugs
Copyright © StudyGuideZone.com. All rights reserved. that bind to nicotinic receptors affect both systems.

1st order kinetics a constant faction of the drug is b. Muscarinic- preferentially binds muscarine. Found on
eliminated/unit time. target tissue in PNS and located on sweat gland in SNS.
 Kidney failure
2. Adrenergic Receptors: Metastasis
Various Organ system failures
Alpha- found NE excited target tissue and also inhibited Liver failure
further release of NE from nerve. (constricted VSM)
Beta- found that NE and EPI equally potent in heart but Cerebral palsy: Cerebrum injury causing multiple nerve
EPI 50x more potent function
deficits.
Specific Pediatric Conditions
Types:
Wilm’s tumor: kidney tumor found in children. Cause: Spastic CP 50%
unknown/possible genetic link. Tumor will spread to
other regions. Dyskinetic CP 20%
Sometimes children will be born with aniridia. Do not Mixed CP
exert pressure
over the abdomen. Ataxic CP

Symptoms: Symptoms:
Fever Poor respiration status
Vomiting Mental retardation
Fatigue Spasticity
Irregular urine coloration Speech and language deficits
Abdominal pain Delayed motor and sensory
Constipation development
Abdominal mass Seizures
Increased BP Joint contractions

Tests: Tests:
Sensory and Motor Skill testing
BUN Check for spasticity
Creatinine CT scan/MRI
Analysis of the urine EEG
X-ray
CT Scan Treatment:
Family history of cancer PT/OT/ST
CBC Surgery
Seizure medications
Treatment: Spasticity reducing medication
Surgery
Chemotherapy Croup: trouble breathing in infants and children that can
be caused by
Radiation bacteria, viruses, allergies or foreign objects. Primarily,
caused by
Neuroblastoma: tumor in children that starts from viruses.
nervous tissue.
Capable of spreading rapidly. Cause unknown. Symptoms:
Labored breathing
Symptoms: Symptoms increased at night.
Abdominal mass Noisy cough
Skin color changes Stridor
Fatigue
Tachycardia Tests:
Motor paralysis X-rays
Anxiety
Diarrhea Breaths sounds check
Random eye movements
Bone and joint pain Treatment:
Labored breathing Acetaminophen
Steroid medications
Tests: Intubation
Bone scan Nebulizers
CBC
MIBG scan Monitor the patient for:
Respiratory arrest
Catecholamines tests Atelectasis
X-ray
CT scan Dehydration
MRI Epiglottitis

Treatment: Kawasaki disease: a disease that affects young children

Radiation primarily.
Chemotherapy Unknown origin probable autoimmune disease. Attacks
Surgery the heart,
blood vessels, and lymph nodes.
Monitor the patient for:
Symptoms: Limited infant feeding
Fever Clubbing
Joint pain SOB
Swollen lymph nodes
Peripheral edema Tests:
Rashes Chest X-ray
Papillae on the tongue
Chapped/Red lips EKG
Echocardiogram
Tests: Heart Catheterization
CBC CBC
Presence of pyuria Heart Murmur
Chest X-ray
Treatment:
ECGH Surgery
ESR Small meals
Urine Analysis Limit child’s anxiety

Treatment: Monitor the patient for:

Gamma globulin
Salicylate treatment Seizures
Poor overall development
Monitor the patient for: Cyanois
Coronary aneurysm
MI Atrial septal defect- congenital opening between the
Vasculitis atria.

Pyloric stenosis: a narrowing of the opening between the Symptoms:

intestine and Dyspnea
stomach. Most common in infants. May have genetic Reoccurring infections
factors (respiratory)
SOB
Symptoms: Palpitations
Diarrhea
Abdominal pain Tests:
Catheterization
Belching Echocardiography
Vomiting ECG
Weight loss MRI
Irregular heart rhythm/sounds
102
Copyright © StudyGuideZone.com. All rights reserved. Treatment:
Surgery
Tests: Antibiotics
Abdomen distended
Barium X-ray Monitor the patient for:
US Heart failure
Electrolyte imbalance A fib.
Pulmonary Htn.
Treatment: Endocarditis
Surgery
IV fluids
Ventricular septal defect- opening between the ventricles
Vaccinations of the heart.
Attenuated – Varicella, MMR
Inactivated – Influenza Symptoms:
Toxoid – Tetanus/Diptheria Poor weight gain
Biosynthetic – Hib conjugate vaccine Labored breathing
Profuse sweating
SOB
Tetralogy of Fallot- 4 heart defects that are congenital. Poor color
Poorly Irregular heart beat
oxygenated blood is pumped to the body’s tissues. Respiratory infections
reoccurring
4 factors:
Right ventricular hypertrophy Tests:
Ventricular septal defect Ausculatation
Aorta from both ventricles Echocardiogram
Stenosis of the pulmonic outflow ECG
tract
Chest X-ray
Symptoms: Treatment:
Poor weight gain Digoxin
Cyanosis Surgery
Death Digitalis
 Glioblastoma Multiform-50% of all primary tumors, linked
Monitor the patient for: to
Endocarditis specific genetic mutations
Pulmonary Htn. Secondary Tumors
Aortic insufficiency Metastatic carcinomas
Limited growth and
development Scale –degree of anaplasia: differentiation of mature
Arrhythmias (good) vs.
CHF immature cells (bad)
Grade I: up to 25% anaplasia
Patent ductus arteriosus: open blood vessel (ductus Grade II: 26-50% anaplasia
ateriosus) that Grade III: 51-75% anaplasia
does not close after birth. Grade IV: 76-100% anaplasia

Symptoms: Primary Tumor Effect:

SOB 1. Headaches
Limited feeding 2. Vomiting
1. Seizures
Tests: 2. Neurological problems
ECG 3. Dementia
Echocardiogram 4. Drowsiness
Heart murmur
Chest X-ray Secondary Tumor Effect:
1. Direct compression/necrosis
Treatment: 2. Herniation of brain tissue
Surgery 3. Increase ICP
Indomethacin Noteworthy Tumor Markers
Decrease fluid volumes
1. AFP
Monitor the patient for: 2. Alkaline phosphatase
Surgical complications 3. β-hCG
Endocarditis 4. CA-125
Heart failure 5. PSA

Aortic coarctation: aorta becomes narrow at some point Define the following terms:
due to a birth
defect

Symptoms: Basal cell carcinoma:

Headache Chondrosarcoma:
Hypertension with activity Ewing’s sarcoma:
Nose bleeding Giant cell tumor:
Fainting Melaonoma:
SOB Meningioma:
Oligodendroglioma:
Tests: Pituitary ademona:
Check BP Schwannoma:
Doppler US Squamous cell carcinoma:
Chest CT
MRI Leukemia Review
ECG Know the following four types of leukemias.
Chest X-ray ALL- acute lymphocytic leukemia
Cardiac catheterization AML- acute myelocytic leukemia
CLL- chronic lymphocytic leukemia
Treatment: CML- chronic myeloid leukemia
Surgery

Monitor the patient for: GI Review

Stroke Zollinger-Ellison syndrome: Tumors of the pancreas that
Heart failure cause upper
Aortic aneurysm GI inflammation. The tumors secrete gastrin causing
Htn high levels of
CAD stomach acid.
Endocarditis
Aortic dissection Symptoms:
Diarrhea
Tumor Review Vomiting
Abdominal pain
Primary Tumors
Neuromas-80-90% of brain tumors, named for what part Tests:
of Abdominal CT
nerve cell affected. + Calcium Infusion Test
Meningiomas - outside of arachnoidal tissue, usually + Secretin Stimulation Test
benign
and slow growing Elevated gastrin levels
Tumors in the pancreas Symptoms:
Nausea
Treatment: Jaundice
Ranitidine
Cimetidine Depression
Lansoprazole Back pain
Omeprazole Indigestion
Surgery Abdominal pain
Weight loss
Wilson’s disease: High levels of copper in various
tissues throughout Tests:
the body. (Genetically linked- Autosomal recessive). CT scan
Biopsy
Key organs affected are: Abdominal US
Eyes Liver function test
Brain
Liver Treatment:
Kidneys Surgery
Chemotherapy
Symptoms: Radiation
Gait disturbances Whipple procedure
Jaundice
Tremors Hepatitis A: Viral infection that causes liver swelling.
Abdominal pain/distention
Dementia Symptoms:
Speech problems Fatigue
Muscle weakness Nausea
Spenomegaly Fever
Confusion Itching
Dementia Vomiting

Tests: Tests:
Various lab tests:
Bilirubin/PT/ SGOT increased Increased liver enzymes
Albumin/Uric acid production Presence of IgG and IgM
decreased antibodies
MRI Enlarged liver
Genetic testing
Low levels of serum copper Treatment:
Copper is found in the tissues Rest
Kayser-Fleisher Rings in the eye Proper diet low in fatty foods

Treatment: Hepatitis B: Sexually transmitted disease, also

Pyridoxine transmitted with body
Low copper diet fluids and some individual may be symptom free but still
be carriers.
Corticosteroids
Penicillamine Symptoms:
Jaundice
Monitor the patient for: Dark Urine
Cirrhosis Malaise
Muscle weakness
Joint pain/stiffness Joint pain
Anemia Fever
Fever Fatigue
Hepatitis
Tests:
Pancreatitis: Inflammation of the pancreas Decreased albumin levels
Symptoms: + antibodies and antigen
Fever Increased levels of
Vomiting transaminase
Nausea
Chills Treatment:
Anxiety Monitor for changes in the liver.
Jaundice Recombinant alpha interferon in
Sweating some cases.
Transplant necessary if liver
Tests: failure occurs.
X-ray
CT scan Hepatitis C
Various Lab tests
Symptoms:
Pancreatic Cancer: cancer of the pancreas. Higher rates Fatigue
in men. Vomiting
Urine color changes (dark)
Jaundice Colonoscopy
Abdominal pain
CT Scan
Tests: Sigmoidoscopy
ELISA assay
Increased levels of liver Intestinal obstruction: Can a paralytic ileus/false
enzymes obstruction
No Hep. A or B antibodies (children) or a mechanical obstruction:

Treatment: Types of mechanical

Interferon alpha obstruction:
Ribavirin Tumors
Volvulus
Gastritis: can be caused by various sources (bacteria, Impacted condition
viruses, bile Hernia
reflux or autoimmune diseases). Inflammation of the
stomach lining. Symptoms:
Constipation
Symptoms: Vomiting
Loss of appetite
Hiccups Diarrhea
Nausea Breath
Vomiting blood Abdominal swelling
Abdominal pain Abdominal pain

Tests: Tests:
EGC Barium enema
X-Ray CT scan
CT scan Upper/Lower GI series
Poor bowel sounds
Ulcers
Peptic Ulcers-ulcer in the duodenum or stomach Carcinoid Syndrome: symptoms caused by cardinoid
Gastric Ulcers- ulcer in the stomach tumors. Linked
Duodenum Ulcer-ulcer in the duodenum to increased secretion of Serotonin.

Bacteria: Helicobacter pylori- often associated with ulcer Symptoms:

formation. Flush appearance
Wheezing
Symptoms: Diarrhea
Weight loss Onset of niacin deficiency
Chest pain Abdominal pain
Heartburn Decreased BP
Vomiting
Indigestion Tests:
Fatigue
5-HIAA test
Tests: Increased levels of
EGD Chromogranin A and Serotonin
CT scan
Stool guaiac MRI
GI X-rays
Treatment:
Treatment: Surgery
Bismuth Sandostatin
Famotidine
Sucralfate
Cimetidine Chemotherapy
Omeprazole Multivitamins
Antibiotics Octreotide
Interferon
Diverticulitis – abnormal pouch formation that becomes
inflamed in the Monitor the patient for:
intestinal wall. Low BP
Right Sided Heart Failure
Symptoms:
Fever Hiatal Hernia: Stomach sticks into the chest through the
Diarrhea diaphragm.
Nausea Can cause reflux symptoms.

Vomiting Symptoms:
Constipation Chest pain
Heartburn
Tests: Poor swallow
Barium enema
WBC count Tests:
EGD
Barium Swallow X-ray. Eye, Ear, and Mouth Review

Treatment: Disorders of the Eye

Weight loss
Surgical repair Diabetic retinopathy:
Medications for reflux Blood vessels in the retina are affected. Can lead to
blindness if
(GERD) -Gastroesophageal reflux disease untreated. Two primary stages (Proliferative and
Nonproliferative.
Symptoms: Retina may experience bleeding in nonproliferative
Nausea stage. During the
Vomiting proliferative stage damage begins moving towards the
Frequent coughing center of the
Hoarseness
Belching eye and there is an increase in bleeding. Any damage
Chest pain caused is non-
Anatacid relief reversible. Only further damage can be prevented.
Sore Throat
Strabismus:
Tests:
Barium swallow Eyes are moving in different stages. The axes of the
Bernstein test eyes are not
Stool guaiac parallel. Normally, treated with an eyepatch; however,
Endoscopy eye drops are
now used in many cases. Atropine drops are placed in
Treatment: the stronger
Weight loss eye for correction purposes. Surgery may be necessary
Antacids in some cases.
Proton pump inhibitors Suture surgery will reduce the pull of certain eye
muscles.
Limit fat and caffeine
Histamine H2 blockers Macular Degeneration:

Monitor the patient for: Impaired central vision caused by destruction of the
macula, which is
Chronic pulmonary disease the center part of the retina. Limited vision straight
Barrett’s esophagus ahead. More
Esophagus inflammation common in people over 60. Can be characterized as dry
Bronchospasms or wet types.
Wet type more common. Vitamin C, Zinc, and Vitamin E
Ulcerative colitis: chronic inflammation of the rectum and may help
large slow progression.
intestine.

Symptoms: Esotropia:
Weight loss
Appearance of cross-eyed gaze or internal strabismus.
Jaundice
Diarrhea Exotropia:
Abdominal pain
Fever External strabismus or divergent gaze.
Joint pain
GI bleeding Conjunctivitis:

Tests: Inflammation of the conjuctiva, that can be caused by

Barium edema viruses or
ESR bacteria. Also known as pink eye. If viral source can be
CRP highly
Colonoscopy contagious. Antibiotic eye drops and warm cloths to the
eye helpful
Treatment: treatment. Conjunctivitis can also be caused by
Corticosteroids chemicals or allergic
Mesalamine reactions. Re-occurring conjunctivitis can indicate a
Surgery larger underlying
Ostomy disease process.
Azathioprine
Glaucoma:
Monitor the patient for:
Ankylosing spondylitis An increase in fluid pressure in the eye leading to
Liver disease possible optic nerve
Carcinoma damage. More common in African-Americans. Minimal
Pyoderma gangrenosum onset
Hemorrhage symptoms, often picked to late. Certain drugs may
Perforated colon decrease the
amount of fluid entering the eye. Two major types of
glaucoma are May be caused by an ear infection and is known as
open-angle glaucoma and \angle-closure glaucoma. inflammation of the
mastoid.
Disorders of the Mouth
Meniere's disease:
Acute pharyngitis:
Inner ear disorder. Causes unknown. Episodic rotational
Often the cause of sore throats, inflammation of the vertigo,
pharynx. Tinnitus, Hearing loss, and Ringing in the ears are key
symptoms.
Acute tonsillitis: Dazide is the primary medication for Meniere’s disease.
Low salt diet
Viral or Bacterial infection that causes inflammation of and surgery are also other treatment options. Diagnosis
the tonsils. is a rule-out
diagnosis.
Aphthous ulcer:
Labyrinthitis:
Also known as a canker sore. A sensitive ulcer in the
lining of the Vertigo associated with nausea and malaise. Related to
mouth. 1 in 5 people have these ulcers. Cause is bacterial and
unknown in many viral infections. Inflammation of the labyrinth in the inner
cases. ear.

Acute Epiglottitis Otitis externa:

Usually caused by a bacterial infection. Swimmer’s ear.
Inflammation of the epiglotitis that may lead to blockage Infection of
of the the skin with the outer ear canal that progress to the ear
respiratory system and death if not treated. Often drum.
caused by Itching, Drainage and Pain are the key symptoms.
numerous bacteria. Intubation may be required and Suctioning of the
speed is critical in ear canal may be necessary. Most common ear drops
treatment. IV antibiotics will help reverse this condition in (Volsol, Cipro,
most cases. Cortisporin).
Common symptoms are high fever and sore throat.

Oral candidiasis: Obstetrics/Gynecology

This is a yeast infection of the throat and mouth by Amniocentesis: Removal of some fluid surrounding the
Candida albicans. fetus for
analysis. Fetus location is identified by US prior to the
Oral leukoplakia: procedure.
A patch or spot in the mouth that can become Results may take a month.
cancerous.
Used to check for:
Parotitis: Spina bifida
Rh compatibility
A feature of mumps and inflammation of the parotid Immature lungs
glands. Down syndrome

122 Chorionic villus sampling: Removal of placental tissue

Copyright © StudyGuideZone.com. All rights reserved. for analysis
from the uterus during early pregnancy. US helps guide
Disorders of the Ear the procedure.
1-2 weeks get the results. Can be performed earlier than
Otitis media: amniocentesis.

Most common caused by the bacteria (H.flu) and Used to check for:
Streptococcus Tay-Sachs disease
pneumoniae in about 85% of cases. 15% of cases viral Down syndrome
related. More Other disorders
common in bottlefeeding babies. Can be caused by
upper respiratory Monitor the patient for:
infections. Ear drums can rupture in severe cases. A Infection
myringotomy Miscarriage
may be performed in severe cases to relieve pus in the Bleeding
middle ear.
125
Barotitis: Copyright © StudyGuideZone.com. All rights reserved.

Atmospheric pressures causing middle ear dysfunction. Preeclampsia: presence of protein in the urine, and
Any change in increased BP
altitude causes problems. during pregnancy. Found in 8% of pregnancies.

Mastoiditis: Symptoms:
Abnormal Rapid Weight gain Oligohydramnios: Low levels of amniotic fluid that can
Headaches cause: fetal
Peripheral edema abnormalities, ruptured membranes and fetus disorders.
Nausea
Anxiety Polyhydamnios: High levels of amniotic fluid that can
Htn cause:
Low urination frequency gestational diabetes and congenital defects.

Tests: Polyhydaminos Causes:

Proteinuria Beckwith-Wiedemann syndrome
BP check Hydrops fetalis
Weight gain analysis Multiple fetus development
Thrombocytopenia Anencephaly
Evidence of edema Esophageal atresia
Gastroschisis
Treatment:
Deliver the baby Sheehan’s syndrome: hypopituitarism caused by uterine
Bed rest hemorrhage
Medications during childbirth. The pituitary gland is unable to function
due to
Induced labor may occur with blood loss.
the following criteria:
Eclampsia
HELLP syndrome Symptoms:
High serum creatinine levels Amenorrhea
Prolonged elevated diastolic Fatigue
blood pressure >100mmHg Unable to breast-feed baby
Thrombocytopenia Anxiety
Abnormal fetal growth Decreased BP
Hair loss
Eclampsia: seizures occurring during pregnancy,
symptoms of pre- Tests:
eclampsia have worsened. Factors that cause eclampsia CT scan of Pituitary gland
vs. pre- Check pituitary hormone levels
eclampsia relatively unknown.
Treatment:
Symptoms: Weight gain sudden Hormone therapy

Seizures Breast infections/Mastitis: Infection or inflammation due

Trauma to bacterial
Abdominal pain infections. (S. aureus).
Pre-eclampsia
Symptoms:
Tests: Fever
Check liver function tests Nipple pain/discharge
Check BP Breast pain
Proteinuria presence Swelling of the breast
Apnea
Tests:
Treatment: Physical examination
Magnesium sulfate

Bedrest Antibiotics
BP medications Moist heat

Induced labor may occur with Breast pump

the following criteria:
Atrophic vaginitis- low estrogen levels cause
Eclampsia inflammation of the
HELLP syndrome vagina. Most common after menopause.
High serum creatinine levels
Prolonged elevated diastolic Symptoms:
blood pressure >100mmHg Pain with intercourse
Thrombocytopenia Itching pain
Abnormal fetal growth Vaginal discharge
Vaginal irritation after
Amniotic fluid- greatest at 34 weeks gestation. intercourse

Functions: Tests:
Allows normal lung development Pelvic examination
Freedom for movement
Fetus temperature regulation Treatment:
Trauma prevention Hormone therapy
Vaginal lubricant
Cervicitis: infection, foreign bodies,or chemicals that Extreme shock
causes
inflammation of the cervix. Heart failure

Symptoms: Hirsutism: development of dark areas of hair in women

Pain with intercourse that are
Vaginal discharge uncommon.
Pelvic pain
Vaginal pain Causes:
Cushing’s syndrome
Tests: Congenital adrenal hyperplasia
Pelvic examination Hyperthecosis
PCOS
STD tests High Androgen levels
Pap smear Certain medications

Treatment: Treatment:
Laser therapy Laser treatment
Antibiotics/antifungals Birth control medications
Cryosurgery Electrolysis
Bleaching
Pelvic inflammatory disease: infection of the fallopian
tubes, uterus or Dysmenorrhea: painful menses.
ovaries caused by STD’s in the majority of cases.
Symptoms:
Symptoms: Constipation
Vaginal discharge Nausea
Fever Vomiting
Pain with intercourse Diarrhea
Fever
Nausea Tests:
Urination painful Determine if normal
LBP dysmenorhea is occurring.
No menstruation Pain relief
Anti-inflammatory medications
Tests:
Pelvic exam Endometriosis: abnormal tissue growth outside the
Laparoscopy uterus.
ESR
WBC count Symptoms: Spotting
Pregnancy test
Cultures for infection 131
Copyright © StudyGuideZone.com. All rights reserved.
Treatment:
Antibiotics Infertility
Surgery LBP
Periods (painful)
Toxic shock syndrome: infection of (S. aureus) that Sexual intercourse painful
causes organ
disorders and shock. Tests:
Pelvic US
Symptoms: Laparoscopy
Seizures
Headaches Pelvic exam.
Hypotension
Fatigue Treatment:
Multiple organ involvement Progesterone treatment
Fever Pain management
Nausea Surgery
Vomiting Hormone treatment
Synarel treatment
Tests:
Check BP Stress Incontinence: A laugh, sneeze or activity that
Multiple organ involvement causes
involuntary urination. Urethral sphincter dysfunction.
Treatment:
Dialysis- if kidneys fail Tests:
BP medications Rectal exam
IV fluids X-rays
Antibiotics Pad test
Urine analysis
Monitor the patient for: PVR test
Kidney failure Cystoscopy
Pelvic exam
Liver failure
Treatment: May cause hair loss.
Surgery
Medications Pityriasis rosea:
(pseudoephedrine/phenylpropan
olamine)/Estrogen A mild to moderate rash that starts as a single pink patch
Pelvic floor re-training and then
Fluid intake changes numerous patches begin to appear on the skin. This may
lead to
Urge incontinence- urine loss caused by bladder itching. Found primarily in ages 10-35 years old.
contraction.
134
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Frequent urination
Abdominal pain/distention Psoriasis:

Tests: An autoimmune disease mediated by T lymphocytes that

can lead to
Pelvic exam arthritis. Generally, treated with UV light, tar soap and
X-rays topical steroid
Cystoscopy cream. A reddish rash that can be found in numerous
EMG locations.
Pad test
Stevens-Johnson syndrome:
Urinary stress test
PVR test An allergic reaction that can include rashes, and involve
Genital exam-men the inside of
the mouth. May be due to drug sensitivity. Can lead to
Treatment: uveitis and
Surgery keratitis. Other factors related to SJS include:
pneumonia, fever,
Medications-(tolterodine, myalgia and hepatitis. SJS can be extremely similar to
propatheline, imipramine, varicella zoster
tolterodine, terbutaline) and pemphigus vulgaris conditions. There may also be
Biofeedback training the presence of
Kegel strengthening herpes virus or Mycoplasma pneumoniae.

Dermatology Review Bullous pemphigoid:

Eruptions of the skin caused by the accumulation of
Atopic Dermatitis: antibodies in the
basement membrane of the skin. Treated with cortisone
Scaling, Itching, Redness and Excoriation. Possible creams or
lichenification in internally. Skin biopsy offers definitive diagnosis.
chronic cases. Most common in young children around Acne vulgaris:
the elbow and Oil glands become inflamed, plugged or red. May be
knees. Adults are more common in neck and knees. May treated in
be moderate to severe cases with anti-inflammatory
associated with an allergic disorder, hay fever, or medications or
asthma. creams.

Contact Dermatitis: Rosacea:

A redness that covers the middle part of the face. Blood
Itchy, weepy reaction with a foreign substance (Poison vessels in the
Ivy) or lotions. face dilate. Most common in adults 30-50 years old.
Skin becomes red. Unable to be
cured, only treated. May cause long term skin damage is
Diaper Rash: left
Inflammatory reaction in the region covered by a diaper. untreated. Antibiotics are often prescribed.
This may
include chemical allergies, sweat, yeast, or friction
irritation.
Ermatitis stasis: Seborrheic keratosis:
Decreased blood flow the lower legs resulting in a skin
irritation, The development of skin “tags” or the barnacles of old
possible ulcer formation. age. Usually
Onychomycosis: found in people over 30 years old. Appear to be tabs
Fungal infection related to the fingernails or toenails. growing in
Often caused by groups or individually on your skin. Can be treated with
Trichophyton rubrum. Scrapping,
Freezing or Electrosurgery.
Lichen planus:
Actinic keratosis:
Treated with topical corticosteroids. The presence of A site that can become cancerous, usually small and
pink or purple rough on the skin
spots on the legs and arms. Lesions are itchy, flat and that has been exposed to the sun a lot. Usually treated
polygonal. with
cryosurgery and photodynamic therapy. affected will also turn white. Primarily identified in ages
10-30.
Scabies: Several genetic factors involved. May be associated with
other more
Caused by the human itch mite: Sarcaptes scabies, and severe autoimmune disorders.
identified by
presence of raised, red bumps that are itchy. Closer Axial Skeleton
identification with
a visual aid will show streaks in the skin created by the The axial skeleton consists of 80 bones forming the
mite. trunk (spine and
thorax) and skull.
Molluscum contagiosum:
Vertebral Column: The main trunk of the body is
Considered a STD. Small downgrowths called supported by the
molluscum bodies that spine, or vertebral column, which is composed of 26
include the presence of soft tumors in the skin caused by bones, some of
a virus. which are formed by the fusion of a few bones. The
Contagious. vertebral column
from superior to inferior consists of 7 cervical (neck), 12
Herpes zoster: thoracic and
5 lumbar vertebrae, as well as a sacrum, formed by
Infection caused by the varicella-zoster virus. Can cause fusion of 5 sacral
chickenpox vertebrae, and a coccyx, formed by fusion of 4
and then shingles in later years. The virus infects the coccygeal vertebrae.
dosal root
ganglia of nerves and can cause intense itching. Ribs and Sternum: The axial skeleton also contains 12
pairs of ribs
St. Anthony’s Fire: attached posteriorly to the thoracic vertebrae and
anteriorly either
Claviceps purpurea (fungus) can cause intense pain in directly or via cartilage to the sternum (breastbone). The
the extremities ribs and
by causing blood vessels to constrict. Fungus produces sternum form the thoracic cage, which protects the heart
ergotamines. and lungs.
Seven pairs of ribs articulate with the sternum (fixed ribs)
Impetigo: directly,
and three do so via cartilage; the two most inferior pairs
A skin infection caused by Staph or Streptococcus that do not attach
causes itchy, anteriorly and are referred to as floating ribs.
red skin and pustules. Treated with topical antibiotics
and primarily Skull: The skull consists of 22 bones fused together to
affects children. form a rigid
structure which houses and protects organs such as the
Acanthosis nigricans: brain, auditory
apparatus and eyes. The bones of the skull form the
The presence of dark velvety patches of skin around the face and cranium
armpit, back, (brain case) and consist of 6 single bones (occipital,
neck and groin. Can occur with multiple diseases. Has frontal, ethmoid,
been linked to sphenoid, vomer and mandible) and 8 paired bones
patients with insulin dysfunction. (parietal,
temporal, maxillary, palatine, zygomatic, lacrimal, inferior
Hidradenitis suppurativa: concha and
nasal). The lower jaw or mandible is the only movable
The presence of numerous abscess in the groin and bone of the
armpit region. skull (head); it articulates with the temporal bones.

Melasma: Other Parts: Other bones considered part of the axial

skeleton are
137 the middle ear bones (ossicles) and the small U-shaped
Copyright © StudyGuideZone.com. All rights reserved. hyoid bone
that is suspended in a portion of the neck by muscles
“Mask of Pregnancy” Changes in the pigmentation of and ligaments.
women that are
pregnant. Occurs in 50% of all pregnancies. Appendicular Skeleton

Urticaria: The appendicular skeleton forms the major internal

support of the
Elevated itchy areas that are linked to allergic reactions. appendages—the upper and lower extremities (limbs).
May be
accompanied with edema and may blanch with touch. Pectoral Girdle and Upper Extremities: The arms are
“Hives” attached to
and suspended from the axial skeleton via the shoulder
Vitiligo: (pectoral)
girdle. The latter is composed of two clavicles
Loss of melanocytes resulting in skin turning white. Hair (collarbones) and two
in regions
scapulae (shoulder blades). The clavicles articulate with Compact Bone. Compact bone lies within the
the sternum; periosteum, forms the
the two sternoclavicular joints are the only sites of outer region of bones, and appears dense due to its
articulation compact
between the trunk and upper extremity. organization. The living osteocytes and calcified matrix
are arranged in
Each upper limb from distal to proximal (closest to the layers, or lamellae. Lamellae may be circularly arranged
body) consists surrounding a
central canal, the Haversian canal, which contains small
Each upper limb from distal to proximal (closest to the blood vessels.
body) consists
of hand, wrist, forearm and arm (upper arm). The hand Spongy Bone. Spongy bone consists of bars, spicules or
consists of 5 trabeculae,
digits (fingers) and 5 metacarpal bones. Each digit is which forms a lattice meshwork. Spongy bone is found
composed of at the ends of
three bones called phalanges, except the thumb which long bones and the inner layer of flat, irregular and short
has only two bones. The
bones. trabeculae consist of osteocytes embedded in calcified
matrix, which in
Pelvic Girdle and Lower Extremities: The lower definitive bone has a lamellar nature. The spaces
extremities, or between the
legs, are attached to the axial skeleton via the pelvic or trabeculae contain bone marrow.
hip girdle.
Each of the two coxal, or hip bones comprising the pelvic Bone Cells: The cells of bone are osteocytes,
girdle is osteoblasts, and
formed by the fusion of three bones—illium, pubis, and osteoclasts. Osteocytes are found singly in lacunae
ischium. The coxal bones attach the lower limbs to the (spaces) within the
trunk by articulating with the calcified matrix and communicate with each other via
sacrum. small canals in
the bone known as canaliculi. The latter contain
THE HUMAN SKELETAL SYSTEM osteocyte cell
processes. The osteocytes in compact and spongy bone
Part of the Skeleton Number of Bones are similar in
Axial Skeleton structure and function.
Skull
Ossicles (malleus, incus and stapes) Osteoblasts are cells which form bone matrix,
Vertebral column surrounding themselves
Ribs with it, and thus are transformed into osteocytes. They
Sternum arise from
Hyoid undifferentiated cells, such as mesenchymal cells. They
are cuboidal
Appendicular Skeleton cells which line the trabeculae of immature or developing
Upper extremities spongy bone.
Lower extremities
Osteoclasts are cells found during bone development
80 and remodeling.
22 They are multinucleated cells lying in cavities, Howship’s
6 lacunae, on
26 the surface of the bone tissue being resorbed.
24 Osteoclasts remove the
1 existing calcified matrix releasing the inorganic or
1 organic components.

126 Bone Matrix: Matrix of compact and spongy bone

64 consists of
62 collagenous fibers and ground substance which
constitute the organic
Characteristics of Bone component of bone. Matrix also consists of inorganic
material which is
Bone is a specialized type of connective tissue about 65% of the dry weight of bone. Approximately 85%
consisting of cells of the
(osteocytes) embedded in a calcified matrix which gives inorganic component consists of calcium phosphate in a
bone its crystalline
characteristic hard and rigid nature. Bones are encased form (hydroxyapatite crystals). Glycoproteins are the
by a main
periosteum, a connective tissue sheath. All bone has a components of the ground substance.
central marrow
cavity. Bone marrow fills the marrow cavity or smaller MAJOR TYPES OF HUMAN BONES
marrow spaces, Type of Bone Characteristics Examples
depending on the type of bone. Long bones

Types of Bone: There are two types of bone in the Short bones
skeleton: compact
bone and spongy (cancellous) bone. Flat bones
Irregular bones Elbow and knee,
interphalangeal
Sesamoid joints

Width less than length Radius and ulna,

atlas and axis (first
Length and width and second cervical
close to equal in size vertebrae)

Thin flat shape Between tarsal

bones and carpal
Multifaceted shape bones

Small bones located in

tendons of muscles
Permits motion in two planes
Humerus, radius, which are at right angles to
ulna, femur, tibia each other (rotation is not
possible)
Carpal and tarsal
bones Metacarop-
phalangeal joints,
Scapulae, ribs,
sternum, bones of temporomandibular
cranium (occipital,
frontal, parietal) Adjacent bones at a joint are connected by fibrous
connective tissue
Vertebrae, sphenoid, bands known as ligaments. They are strong bands which
ethmoid support the
joint and may also act to limit the degree of motion
Joints occurring at a
The bones of the skeoeton articulate with each other at joint.
joints, which
are variable in structure and function. Some joints are Musculoskeletal Conditions
immovable,
such as the sutures between the bones of the cranium. Legg-Calve-Perthes disease: poor blood supply to the
Others are superior aspect
slightly movable joints; examples are the intervertebral of the femur. Most common in boys ages 4-10. The
joints and the femur ball
pubic symphysis (joint between the two pubic bones of flattens out and deteriorates. 4x higher incidence in boys
the coxal + Bony
bones). cresent sign.

TYPES OF JOINTS Symptoms:

Hip and Knee pain
Joint Type Characteristic Example Limited AROM and PROM
Ball and socket Pain with gait and unequal leg
length.
Hinge (ginglymus)
Tests:
Rotating or pivot X-ray Hip

Plane or gliding Test ROM of hip

Condylar Treatment:
(condyloid) Surgery
Physical therapy
Permits all types of Brace
movement (abduction, Bedrest
adduction, flexion,
extension, circumduction); it Developmental dysplasia of the hip: abnormal
is considered a universal development of the hip
joint. joint found that is congenital.

Permits motion in one plane Symptoms:

only Fat rolls asymmetrical
Abnormal leg length
Rotation is only motion AROM limited
permitted
Tests:
Permits sliding motion US

Hips and shoulder X-ray of hips

joints AROM testing of hips
Treatment: Protective clothing
Cast Cytotoxic drugs
Surgery Hydroxychloroquine
Physical Therapy
Slipped capital femoral epiphysis: 2x greater incidence in Monitor the patient for:
males, most Seizures
common hip disorder in adolescents. The ball of the Infection
femur separates Hemolytic anemia
from the femur along the epiphysis. Myocarditis
Infection
Symptoms: Renal failure
Hip pain
Gait dysfunction Scleroderma: connective tissue disease that is diffuse.
Knee pain
Abnormal Hip AROM Symptoms:
Wheezing
Tests:
X-ray Heartburn
Palpation of the hips Raynaud’s phenomenon
Treatment:
Surgery Skin thickness changes
Weight loss
Polymyalgia Rheumatica- hip or shoulder pain disorder Joint pain
in people SOB
greater than 50 years old. Hair loss
Bloating
Symptoms:
Shoulder pain Tests:
Hip pain Monitor skin changes
Fever
Anemia Chest x-ray
Fatigue Antinuclear antibody test
ESR increased
Tests:
Monitor the patient for:
ESR increased Renal failure
CPK Heart failure
Hemoglobin low Pulmonary fibrosis

Treatment: Rheumatoid Arthritis: inflammatory autoimmune disease

Pain management that affects
Corticosteroids various tissues and joints.

Systemic lupus serythemtosus: autoimmune disorder Symptoms:

that affects Fever
joints, skin and various organ systems. Chronic and Fatigue
inflammatory. 9x Joint pain and swelling
more common in females. ROM decreased
Hand/Feet deformities
Symptoms: Numbness
Butterfly rash Skin color changes
Weight loss
Fever Tests:
Hair loss Rheumatoid factor tests
Abdominal pain C-reactive protein
Mouth sores
Fatigue Synovial fluid exam
Seizures X-rays of involved joints
Arthritis ESR increased
Nausea
Joint pain Treatment:
Psychosis Physical therapy
Moist heat
Tests: Anti-inflammatory drugs
CBC Corticosteroids
Chest X-ray Anti-malarial drugs
ANA test Cox-2 inhibitors
Splinting
Skin rash observation
Coombs’ test Juvenile Rheumatoid Arthritis: inflammatory disease that
Urine analysis occurs in
Test for various antibodies children.

Treatment: Types:
NSAIDS Pauciarticular JRA- 50%
Polyarticular JRA- 40% symptoms
Systemic JRA- 10%
Tests:
Symptoms: X-ray
Painful joints
Eye inflammation Passive testing of joints
Fever
Rash Treatment:
Temperature changes (joints) Physical therapy
Poor AROM Cox 2 inhibitors
NSAIDS
Tests: Joint injections
ANA test Aquatic exercises
Surgery
HLA antigen test
CBC Gout: uric acid development in the joints causing
Physical exam of joints arthritis.
X-rays of joints
Eye exam Stages:
RA factor test Asymptomatic
Acute
Treatment: Intercritical
Physical therapy Chronic
Corticosteroids
NSAIDS Symptoms:
Infliximab Joint edema
Hydrochloroquine
Methotrexate Fever
Lower extremity and/or upper
Paget’s disease: abnormal bone development that extremity joint pain
follows bone
destruction. Tests:
Uric acid in the urine
Symptoms:
Joint pain Synovial biopsy
Bow legged appearance Synovial analysis
Hearing loss
Neck and back pain Monitor the patient for:
Headaches Kidney stones
Kidney disorders
Sharp bone pain
Fibromyalgia: joint, muscle and soft tissue pain in
Tests: numerous
Increased alkaline phophatase locations. Presence of tender points and soft tissue pain.
levels
Symptoms:
X-rays- abnormal bone Fatigue
development. Body aches
Bone scan Poor exercise capacity
Muscle/Joint pain
Treatment:
NSAIDS Tests:
Calcitonin Rule-out diagnosis.
Plicamycin
Etidronate Treatment:
Anti-depressants
Tiludronate Physical therapy
Surgery Stress Management
Massage
Monitor the patient for: Support group
Spinal deformities
Hear loss Duchenne muscular dystrophy: Genetically X-linked
Paraplegia recessive type of
Heart failure
Fractures muscular dystrophy that starts in the lower extremities.
Dystrophin-
Osteoarthritis: chronic condition affecting the joint protein dysfunction.
cartilage that may
result in bone spurs being formed in the joints. Symptoms:
Falls
Symptoms: Fatigue
Join pain Muscle weakness
Morning stiffness Gait dysfunction
Limited AROM Scoliosis
Weight bearing increases
Joint contractures Biopsy
Bone scan
Tests:
CPK levels increased Treatment:
Cardiac testing Chemotherapy
EMG Surgery

Muscle biopsy testing

Sample Questions
Treatment:
Physical therapy 1. A nurse is reviewing a patient’s medication during shift
Braces change.
Mobility assistance Which of the following medication would be
contraindicated if the
Monitor the patient for: patient were pregnant? Note: More than one answer
Contractures may be correct.
Pneumonia
Respiratory failure A: Coumadin
CHF B: Finasteride
Cardiomyopathy C: Celebrex
Limited mobility D: Catapress
E: Habitrol
Ankylosing spondylitis: Vertebrae of the spine fuse. F: Clofazimine

Symptoms: 2. A nurse is reviewing a patient’s PMH. The history

Limited AROM indicates
Back and neck pain photosensitive reactions to medications. Which of the
Joint edema following drugs
Fever Weight loss has not been associated with photosensitive reactions?
Note: More
Tests: than one answer may be correct.
X-ray spine
CBC A: Cipro
B: Sulfonamide
ESR test C: Noroxin
NSAIDS D: Bactrim
Surgery E: Accutane
HLA-B27 antigen test F: Nitrodur

Monitor the patient for: 3. A patient tells you that her urine is starting to look
Pulmonary fibrosis discolored. If
Aortic valve stenosis you believe this change is due to medication, which of
Uveitis the following
patient’s medication does not cause urine discoloration?
Compartment syndrome: impaired blood flow and nerve
dysfunction A: Sulfasalazine
caused by nerve and blood vessel compression. B: Levodopa
C: Phenolphthalein
Symptoms: D: Aspirin
Severe pain
Weakness 4. You are responsible for reviewing the nursing unit’s
Skin color changes refrigerator. If
you found the following drug in the refrigerator it should
Tests: be removed
from the refrigerator’s contents?
Muscular length testing
A: Corgard
Treatment: B: Humulin (injection)
Surgery C: Urokinase
Physical Therapy D: Epogen (injection)

5. A 34 year old female has recently been diagnosed

Osteosarcoma: bone tumor that is malignant and found with an
in autoimmune disease. She has also recently discovered
adolescents. that she is
pregnant. Which of the following is the only
Symptoms: immunoglobulin that will
Bone pain provide protection to the fetus in the womb?
Fractures
Swelling A: IgA
B: IgD
Tests: C: IgE
CT scan D: IgG

X-ray
6. A second year nursing student has just suffered a should a nurse most closely monitor for during acute
needlestick while management of
working with a patient that is positive for AIDS. Which of this patient?
the following
is the most important action that nursing student should A: Onset of pulmonary edema
take? B: Metabolic alkalosis
C: Respiratory alkalosis
A: Immediately see a social worker D: Parkinson’s disease type symptoms

156 158
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B: Start prophylactic AZT treatment 13. A fifty-year-old blind and deaf patient has been
C: Start prophylactic Pentamide treatment admitted to your
D: Seek counseling floor. As the charge nurse your primary responsibility for
this patient
7. A thirty five year old male has been an insulin- is?
dependent diabetic
for five years and now is unable to urinate. Which of the A: Let others know about the patient’s deficits
following B: Communicate with your supervisor your concerns
would you most likely suspect? about the
patient’s deficits.
A: Atherosclerosis C: Continuously update the patient on the social
B: Diabetic nephropathy environment.
C: Autonomic neuropathy D: Provide a secure environment for the patient.
D: Somatic neuropathy
14. A patient is getting discharged from a SNF facility.
8. You are taking the history of a 14 year old girl who The patient
has a (BMI) of has a history of severe COPD and PVD. The patient is
18. The girl reports inability to eat, induced vomiting and primarily
severe concerned about their ability to breath easily. Which of
constipation. Which of the following would you most the following
likely suspect? would be the best instruction for this patient?

A: Multiple sclerosis A: Deep breathing techniques to increase O2 levels.

B: Anorexia nervosa B: Cough regularly and deeply to clear airway passages.
C: Bulimia C: Cough following bronchodilator utilization
D: Systemic sclerosis D: Decrease CO2 levels by increase oxygen take output
during meals.
9. A 24 year old female is admitted to the ER for
confusion. This 15. A nurse is caring for an infant that has recently been
patient has a history of a myeloma diagnosis, diagnosed
constipation, intense with a congenital heart defect. Which of the following
abdominal pain, and polyuria. Which of the following clinical signs
would you most would most likely be present?
likely suspect?
A: Slow pulse rate
A: Diverticulosis B: Weight gain
B: Hypercalcaemia C: Decreased systolic pressure
D: Irregular WBC lab values
C: Hypocalcaemia
D: Irritable bowel syndrome 159
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10. Rho gam is most often used to treat____ mothers
that have a 16. A mother has recently been informed that her child
____ infant. has Down’s
syndrome. You will be assigned to care for the child at
A: RH positive, RH positive shift change.
B: RH positive, RH negative Which of the following characteristics is not associated
C: RH negative, RH positive with Down’s
D: RH negative, RH negative syndrome?

11. A new mother has some questions about (PKU). A: Simian crease
Which of the B: Brachycephaly
following statements made by a nurse is not correct C: Oily skin
regarding PKU? D: Hypotonicity

A: A Guthrie test can check the necessary lab values. 17. A patient has recently experienced a (MI) within the
B: The urine has a high concentration of phenylpyruvic last 4 hours.
acid Which of the following medications would most like be
C: Mental deficits are often present with PKU. administered?
D: The effects of PKU are reversible.
A: Streptokinase
12. A patient has taken an overdose of aspirin. Which of B: Atropine
the following C: Acetaminophen
D: Coumadin
A: Trust vs. mistrust
18. A patient asks a nurse, “My doctor recommended I B: Initiative vs. guilt
increase my C: Autonomy vs. shame
intake of folic acid. What type of foods contain folic D: Intimacy vs. isolation
acids?”
25. A nurse is making rounds taking vital signs. Which of
A: Green vegetables and liver the following
B: Yellow vegetables and red meat vital signs is abnormal?
C: Carrots
D: Milk A: 11 year old male – 90 b.p.m, 22 resp/min. , 100/70
mm Hg
19. A nurse is putting together a presentation on B: 13 year old female – 105 b.p.m., 22 resp/min., 105/60
meningitis. Which mm Hg
of the following microorganisms has noted been linked to C: 5 year old male- 102 b.p.m, 24 resp/min., 90/65 mm
meningitis in Hg
humans? D: 6 year old female- 100 b.p.m., 26 resp/min., 90/70mm
Hg
160
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Copyright © StudyGuideZone.com. All rights reserved.
A: S. pneumonia
B: H. influenza 26. When you are taking a patient’s history, she tells you
C: N. meningitis she has
D: Cl. difficile been depressed and is dealing with an anxiety disorder.
Which of the
20. A nurse is administering blood to a patient who has a following medications would the patient most likely be
low taking?
hemoglobin count. The patient asks how long to RBC’s
last in my A: Elavil
body? The correct response is. B: Calcitonin
C: Pergolide
A: The life span of RBC is 45 days. D: Verapamil
B: The life span of RBC is 60 days.
C: The life span of RBC is 90 days. 27. Which of the following conditions would a nurse not
D: The life span of RBC is 120 days. administer
erythromycin?
21. A 65 year old man has been admitted to the hospital
for spinal A: Campylobacterial infection
stenosis surgery. When does the discharge training and B: Legionnaire’s disease
planning C: Pneumonia
begin for this patient? D: Multiple Sclerosis

A: Following surgery 28. A patient’s chart indicates a history of hyperkalemia.

B: Upon admit Which of the
C: Within 48 hours of discharge following would you not expect to see with this patient if
D: Preoperative discussion this condition
were acute?
22. A child is 5 years old and has been recently admitted
into the A: Decreased HR
hospital. According to Erickson which of the following B: Paresthesias
stages is the C: Muscle weakness of the extremities
child in? D: Migranes

A: Trust vs. mistrust 29. A patient’s chart indicates a history of ketoacidosis.

B: Initiative vs. guilt Which of the
C: Autonomy vs. shame following would you not expect to see with this patient if
D: Intimacy vs. isolation this condition
were acute?
23. A toddler is 16 months old and has been recently
admitted into A: Vomiting
the hospital. According to Erickson which of the following B: Extreme Thirst
stages is the C: Weight gain
toddler in? D: Acetone breath smell

A: Trust vs. mistrust 30. A patient’s chart indicates a history of meningitis.

B: Initiative vs. guilt Which of the
C: Autonomy vs. shame following would you not expect to see with this patient if
D: Intimacy vs. isolation this condition
were acute?
24. A young adult is 20 years old and has been recently
admitted into A: Increased appetite
the hospital. According to Erickson which of the following B: Vomiting
stages is the C: Fever
adult in? D: Poor tolerance of light
 37. A mother is inquiring about her child’s ability to potty
31. A nurse if reviewing a patient’s chart and notices that train.
the patient Which of the following factors is the most important
suffers from conjunctivitis. Which of the following aspect of toilet
microorganisms is training?
related to this condition?
A: The age of the child
A: Yersinia pestis B: The child ability to understand instruction.
B: Helicobacter pyroli C: The overall mental and physical abilities of the child.
C: Vibrio cholera D: Frequent attempts with positive reinforcement.
D: Hemophilus aegyptius

32. A nurse if reviewing a patient’s chart and notices that 38. A parent calls the pediatric clinic and is frantic about
the patient the bottle of
suffers from Lyme disease. Which of the following cleaning fluid her child drank 20 minutes. Which of the
microorganisms is following is the
related to this condition? most important instruction the nurse can give the
parent?
A: Borrelia burgdorferi
B: Streptococcus pyrogens A: This too shall pass.
C: Bacilus anthracis B: Take the child immediately to the ER
D: Enterococcus faecalis C: Contact the Poison Control Center quickly
D: Give the child syrup of ipecac
33. A fragile 87 year-old female has recently been
admitted to the 39. A nurse is administering a shot of Vitamin K to a 30
hospital with increased confusion and falls over last 2 day-old
weeks. She is infant. Which of the following target areas is the most
also noted to have a mild left hemiparesis. Which of the appropriate?
following
tests is most likely to be performed? A: Gluteus maximus
B: Gluteus minimus
A: FBC (full blood count) C: Vastus lateralis
B: ECG (electrocardiogram) D: Vastus medialis
C: Thyroid function tests
D: CT scan 40. A nurse has just started her rounds delivering
medication. A new
34. A 84 year-old male has been loosing mobility and patient on her rounds is a 4 year-old boy who is non-
gaining weight verbal. This child
over the last 2 months. The patient also has the heater does not have on any identification. What should the
running in his nurse do?
house 24 hours a day, even on warm days. Which of the
following A: Contact the provider
tests is most likely to be performed? B: Ask the child to write their name on paper.
C: Ask a co-worker about the identification of the child.
A: FBC (full blood count) D: Ask the father who is in the room the child’s name.
B: ECG (electrocardiogram)
C: Thyroid function tests
D: CT scan

35. A 20 year-old female attending college is found

unconscious in her
dorm room. She has a fever and a noticeable rash. She
has just been
admitted to the hospital. Which of the following tests is 41. A nurse is observing a child’s motor, sensory and
most likely to speech
be performed first? development. The child is 7 months old. Which of the
following tasks
A: Blood sugar check would generally not be observed?
B: CT scan A: Child recognizes tone of voice.
C: Blood cultures B: Child exhibits fear of strangers.
D: Arterial blood gases C: Child pulls to stand and occasionally bounces.
D: Child plays patty-cake and imitates.

36. A 28 year old male has been found wandering 42. A nurse is observing a child’s motor, sensory and
around in a speech
confused pattern. The male is sweaty and pale. Which of development. The child is 5 months old. Which of the
the following tasks
following tests is most likely to be performed first? would generally not be observed?
A: Child sits with support.
A: Blood sugar check B: Child laughs out loud.
B: CT scan C: Child shifts weight side to side in prone.
C: Blood cultures D: Child transfers objects between hands.
D: Arterial blood gases
43. A nurse is caring for an adult that has recently been
diagnosed
with renal failure. Which of the following clinical signs the following drugs is considered a loop dieuretic that
would most could be used to
likely not be present? treat CHF symptoms?
A: Hypotension
B: Heart failure A: Ciprofloxacin
C: Dizziness B: Lepirudin
D: Memory loss C: Naproxen
D: Bumex
44. A nurse is caring for an adult that has recently been
diagnosed 170
with hypokalemia. Which of the following clinical signs Copyright © StudyGuideZone.com. All rights reserved.
would most
likely not be present? 51. A patient has recently been diagnosed with polio and
A: Leg cramps has
B: Respiratory distress questions about the diagnosis. Which of the following
C: Confusion systems is most
D: Flaccid paralysis affected by polio?

45. A nurse is caring for an adult that has recently been A: PNS
diagnosed B: CNS
with metabolic acidosis. Which of the following clinical C: Urinary system
signs would D: Cardiac system
most likely not be present?
A: Weakness 52. A nurse is educating a patient about right-sided heart
B: Dysrhythmias deficits.
C: Dry skin Which of the following clinical signs is not associated
D: Malaise with right-sided
heart deficits?
46. A nurse is caring for an adult that has recently been
diagnosed A: Orthopnea
with metabolic alkalosis. Which of the following clinical B: Dependent edema
signs would C: Ascites
most likely not be present? D: Nocturia
A: Vomiting
B: Diarrhea 53. A nurse is reviewing a patient’s medication. Which of
C: Agitation the
D: Hyperventilation following is considered a potassium sparing dieuretic?

47. A nurse is caring for an adult that has recently been A: Esidrix
diagnosed B: Lasix
with respiratory acidosis. Which of the following clinical C: Aldactone
signs would D: Edecrin
most likely not be present?
A: CO2 Retention 54. A nurse is reviewing a patient’s medication. The
B: Dyspnea patient is taking
C: Headaches Digoxin. Which of the following is not an effect of
Digoxin?

D: Tachypnea 171
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48. A nurse is caring for an adult that has recently been
diagnosed A: Depressed HR
with respiratory alkalosis. Which of the following clinical B: Increased CO
signs would C: Increased venous pressure
most likely not be present? D: Increased contractility of cardiac muscle

A: Anxiety attacks 55. A patient has been instructed by the doctor to reduce
B: Dizziness their intake
C: Hyperventilation cyanosis of Potassium. Which types of foods should not worry
D: Blurred vision about avoiding?

49. A nurse is reviewing a patient’s medication list. The A: Bananas

drug B: Tomatoes
Pentoxifylline is present on the list. Which of the C: Orange juice
following conditions D: Apples
is commonly treated with this medication?
56. A patient’s chart indicates the patient is suffering
A: COPD from Digoxin
B: CAD toxicity. Which of the following clinical signs is not
C: PVD associated with
D: MS digoxin toxicity?

50. A patient has been on long-term management for A: Ventricular bigeminy

CHF. Which of B: Anorexia
C: Normal ventricular rhythm
D: Nausea B: Lithium .6 – 1.2 mEq/L
C: Digoxin .5 – 1.6 ng/ml
57. A fourteen year old male has just been admitted to D: Valproic acid 40 – 100 mcg/ml
your floor. He
has a history of central abdominal pain that has moved 64. Which of the following normal blood therapeutic
to the right concentrations is
iliac fossa region. He also has tenderness over the abnormal?
region and a fever.
Which of the following would you most likely suspect? A: Digitoxin 09 – 25 mcg/ml
B: Vancomycin 05 – 15 mcg/ml
A: Appendicitis
B: Acute pancreatitis 174
Copyright © StudyGuideZone.com. All rights reserved.
172
Copyright © StudyGuideZone.com. All rights reserved. C: Primidone 02 – 14 mcg/ml
D: Theophylline 10 – 20 mcg/ml
C: Ulcerative colitis
D: Cholecystitis 65. Which of the following normal blood therapeutic
concentrations is
58. A thirteen-year old male has a tender lump area in abnormal?
his left groin.
His abdomen is distended and he has been vomiting for A: Phenytoin 10 – 20 mcg/ml
the past 24 B: Quinidine 02 – 06 mcg/ml
hours. Which of the following would you most like C: Haloperidol 05 – 20 ng/ml
suspect? D: Carbamazepine 5 – 25 mcg/ml
Answer Key
A: Ulcerative colitis
B: Biliary colic 1. (A) and (B) are both contraindicated with pregnancy.
C: Acute gastroenteritis
D: Strangulated hernia 2. (F) All of the others have can cause photosensitivity
reactions.
59. Which of the following is the key risk factor for
development of 3. (D) All of the others can cause urine discoloration.
Parkinson’s disease dementia?
4. (A) Corgard could be removed from the refigerator.
A: History of strokes
B: Acute headaches history 5. (D) IgG is the only immunoglobulin that can cross the
C: Edward’s syndrome placental
D: Use of phenothiazines barrier.

60. A father notifies your clinic that his son’s homeroom 6. (B) AZT treatment is the most critical innervention.
teacher has
just been diagnosed with meningitis and his son spent 7. (C) Autonomic neuropathy can cause inability to
the day with the urinate.
teacher in detention yesterday. Which of the following
would be the 8. (B) All of the clinical signs and systems point to a
most likely innervention? condition of
anorexia nervosa.
A: Isolation of the son
B: Treatment of the son with Aciclovir 175
C: Treatment of the son with Rifampicin Copyright © StudyGuideZone.com. All rights reserved.
D: Reassure the father
9. (B) Hypercalcaemia can cause polyuria, severe
61. A patient has recently been diagnosed with abdominal pain,
hyponatremia. Which and confusion.
of the following is not associated with hyponatremia?
10. (C) Rho gam prevents the production of anti-RH
A: Muscle twitching antibodies in the mother that has a Rh positive fetus.
B: Anxiety
C: Cyanosis 11. (D) The effects of PKU stay with the infant
D: Sticky mucous membranes throughout
their life.
62. A patient has recently been diagnosed with
hypernatremia. Which 12. (D) Aspirin overdose can lead to metabolic acidosis
of the following is not associated with hypernatremia? and
cause pulmonary edema development.
A: Hypotension
B: Tachycardia 13. (D) This patient’s safety is your primary concern.
C: Pitting edema
D: Weight gain 14. (C) The bronchodilator will allow a more productive
cough.
63. Which of the following normal blood therapeutic
concentrations is 15. (B) Weight gain is associated with CHF and
abnormal? congenital
A: Phenobarbital 10-40 mcg/ml heart deficits.
16. (C) The skin would be dry and not oily. 39. (C) Vastus lateralis is the most appropriate location.

17. (A) Streptokinase is a clot busting drug and the best 40. (D) In this case you are able to determine the name
choice in this situation. of
the child by the father’s statement, moreover you should
18. (A) Green vegetables and liver are a great source of not
folic withhold the medication from the child following
acid. identification.

19. (D) Cl. difficile has not been linked to meningitis. 41. (D) These skills generally develop between 10-15
months.
176
Copyright © StudyGuideZone.com. All rights reserved. 178
Copyright © StudyGuideZone.com. All rights reserved.
20. (D) RBC’s last for 120 days in the body.
42. (D) Transferring objects between hands is a 8-9
21. (B) Discharge education begins upon admit. month
skill.
22. (B) Initiative vs. guilt- 3-6 years old
43. (A) Hypertension is often related renal failure.
23. (A) Trust vs. Mistrust- 12-18 months old
44. (D) Flaccid paralysis is an indication of
24. (D) Intimacy vs. isolation- 18-35 years old Hyperkalemia.

25. (B) HR and Respirations are slightly increased. BP is 45. (B) Dysrhythmias are associated with metabolic
down. alkalosis.

26. (A) Elavil is a tricyclic antidepressant. 46. (D) Hyperventilation occurs with metabolic acidosis.
Hypoventilation occurs with metabolic alkalosis.
27. (D) Erythromycin is used to treat conditions A-C.
47. (D) Tachypnea is associated with respiratory
28. (D) Answer choices A-C were symptoms of acute alkalosis.
hyperkalemia.
48. (C) Hyperventilation cyanosis is associated with
29. (C) Weight loss would be expected. respiratory
acidosis.
30. (A) Loss of appetite would be expected.
49. (C) This drug is a hemorheological agent that helps
31. (D) Choice A is linked to Plague, Choice B is linked blood
to viscosity.
peptic ulcers, Choice C is linked to Cholera.
50. (D) Bumex is considered a loop dieuretic.
177
Copyright © StudyGuideZone.com. All rights reserved. 51. (B) Polio is caused by a virus that attacks the CNS.

32. (A) Choice B is linked to Rheumatic fever, Choice C 52. (A) Orthopnea is a left- sided heart failure clinical
is symptom.
linked to Anthrax, Choice D is linked to Endocarditis.

33. (D) A CT scan would be performed for further 53. (C) Aldactone (Spironolactone) is considered a
investigation potassium
of the hemiparesis. sparing diuretic.

34. (C) Weight gain and poor temperature tolerance 54. (C) Digoxin decreases venous pressure.
indicate
something may be wrong with the thyroid function. 55. (D) All the others are high in potassium.

35. (C) Blood cultures would be performed to investigate 56. (C) Ventricular rhythm may be premature with
the Digoxin
fever and rash symptoms. toxicity.

36. (A) With a history of diabetes, the first response 57. (A) Appendicitis is most likely indicated in this case.
should be
to check blood sugar levels. 58. (D) A hernia is the most likely indicated in this case.

37. (C) Age is not the greatest factor in potty training. 59. (D) Penothiazines are considered a risk factor for
The Parkinson’s disease dementia.
overall mental and physical abilities of the child is the
most 60. (C) Rifampicin would be used in this case.
important factor.
61. (D) Stick mucuous membranes are associated with
38. (C) The poison control center will have an exact plan hypernatremia.
of
action for this child.
62. (A) Hypotension would be associated with agraphia, acalculia
hyponatremia.
Temporal lobe Contralateral homonymous upper
63. (C) The normal ranges for Digoxin is .7 – 1.4 ng/ml. quadrantanopsia, partial complex
seizures
64. (C) The normal ranges of Primidone is 04 –12
mcg/ml. Paracentral lobe Urgency of micturition,

180 incontinence, progressive spastic

Copyright © StudyGuideZone.com. All rights reserved. paraparesis
Third Ventricle Hydrocephalus
65. (C) The normal ranges of Carbamazepine is 10 – 20 Fourth Ventricle Hydrocephalus, progressive
mcg/ml. spastic hemiparesis

Optic Chiasm Bitemporal hemianopsia, optic atrophy

Occipital Lobe Homonymous hemianopsia, partial
seizures with limited visual Uncus Partial complex seizures
phenomena Superior temporal gyrus Receptive dysphasia
Prefrontal area Apathy, poor attention span, lossof
Thalamus Contralateral thalamus pain, judgement, release
contralateral hemisensory loss phenomena, distractible
Pineal gland Early hydrocephalus, papillary Orbital surface frontal lobe Paroxysmal atrial tachycardia
abnormalities, Parinaud’s Hypothalmus Amenorrhea, cachexia,
syndrome
hypopituitarism, hypothyrodism,
Internal capsule Hemisensory loss, homonymous impotence, diencephalic
hemianopsia, contralateral autonomic seizures
hemiplegia

Basal ganglia Contralateral dystonia,

Contralateral choreoathetosis
Pons Diplopia, internal strabismus, VI
and VII involvement, contralateral
hemisensory and hemiparesis
loss, issilateral cerebellar ataxia

Broca’s area Motor dysphasia

Precentral gyrus Jacksonian seizures, generalized
seizures, hemiparesis
Superficial parietal lobe Receptive dysphasia
Cerebellar hemisphere Ipsilateral cerebellar ataxia with
hypotonia, dysmetria, intention
tremor, nystagmus to side of lesion

Midbrain Loss of upward gaze, III

involvement, ipsilateral cerebellar

signs, diplopia

Angular gyrus Finger agnosia, allochiria,