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CEN STUDY QUESTIONS AND ANSWERS
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CEN STUDY QUESTIONS AND ANSWERS
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CEN STUDY QUESTIONS AND ANSWERS"Adrenergic" is associated with the ______ system - answer- Sympathetic
"Cholinergic" is associated with the ______ system - answer- Parasympathetic
Activation of the RAAS system leads to...? - answer- Increased water and sodium
reabsorption (decreased UO)
Beta-one receptors stimulate the...? - answer- Heart
Beta-two receptors stimulate the...? - answer- Lungs
What is hematologic factors are high in renal failure? - answer- The 3 Ps!
Potassium
Phosphorous
Positive Ions (Acidosis)
(Sodium and calcium are low)
Potassium is closely related with what electrolyte? - answer- Mg
Magnesium is closely related with what electrolyte? - answer- K+
Calcium is inversely related to? - answer- Phosphate and potassium
Phosphate is inversely related to?
closely related to? - answer- Inverse: Calcium
Direct: Potassium
What medication do we never give in thyroid storm? - answer- ASA
What are the s/s of hyponatremia? - answer- swelling, confusion, apathy, sense of
doom, *muscle cramps*
What are we worried about when correcting hyponatremia? - answer- Correcting
sodium too rapidly can cause central pontine myelinolysis (flaccid paralysis, dysarthria,
dysphagia, hypotension)
What are the s/s of hypernatremia? - answer- AMS (fatigue, lethargy, confusion, coma),
weakness, diarrhea
(think of how you feel after eating McDonalds^^^)
,What are the early s/s of hyperkalemia? - answer- muscular excitability, irritability,
N/V/D
What are the late s/s hyperkalemia? - answer- *fatigue*, weakness, distal limb
paresthesia, tetany, respiratory depression, ascending paralysis
What are the cardiovascular s/s of hyperkalemia? - answer- 1. Peaked T wave
2. Elongated PR interval
3. Absent P wave
4. Enlarging QRS complex
5. Sin wave (very bad sign)
How do we treat hyperkalemia? - answer- 1. Stabilize cardiac membrane with CaCl or
Ca Gluconate
2. Shift potassium into the cells with high dose albuterol (15-25mg) and Insulin 10units
IV push with 100mL of 50% dextrose IV push
3. Remove potassium from the cells (HD, NS and furosemide, Ion exchange resin like
kayexalate)
What are the s/s of hypokalemia? - answer- Frequently asymptomatic. Weakness,
hyporeflexia, latent tetany, paralysis to the lower extremities, respiratory failure,
paresthesia. Prominent U wave on the ECG causing a "camel-hump" appearance to the
T-wave, ST depression
**treat hypokalemia with magnesium too since they often coincideWhat are the
precipitants of lithium toxicity? - answer- *Dehydration
Concurrent use of diuretics or NSAIDs
Hyponatremia/renal impairment
What are the early and late signs of lithium toxicity? - answer- Early:
-Marked tremor
-Anorexia, nausea, vomiting, diarrhea
-Lethargy
Late:
-Restlessness, muscle twitching
-Abnormal muscle movements and incoordination
-Seizures
How do we treat lithium toxicity? - answer- IV fluids
Hemodialysis
What is dystonia? - answer- Disordered muscle tonicity seen with antipsychotic
medications
,What is oculogyric crisis? - answer- Deviation of the eyes in all directions seen with
antipsychotic medications
What is blepharospasm? - answer- Spasm of the eyelid muscles causing forced eyelid
closure seen with antipsychotic medications
What is torticollis? - answer- Spasm of the neck muscles with twisting of the neck to one
side seen with antipsychotic medications
What is tortipelvic crisis? - answer- Forced spasm of the trunk and pelvic muscles
causing bizarre body postures seen with antipsychotic medications
What is buccolingual crisis? - answer- Spasm of the face, jaw, pharynx muscles,
producing trismus, tongue protrusion, grimacing, and difficulty speaking seen with
antipsychotic medications
What is opisthotonos? - answer- Spasm of the paravertebral muscles forcing the trunk
and neck into hyperextension seen with antipsychotic medications
What is akathisia? - answer- An urge to move about constantly and an inability to sit still
seen with antipsychotic medications
What is neuroleptic malignant syndrome? - answer- It is a life-threatening condition that
can be caused by antipsychotic agents. It is characterized by severe fever, muscle
rigidity, altered mental status, cardiovascular instability
What is serotonin syndrome? - answer- - occurs w/ any drug which increases serotonin
(SSRIs, antidepressants, opioids, CNS stimulants, psychedelics such as MDMA or LSD,
or certain herbal medications including St. John's Wort, syrian rue, panax ginseng,
nutmeg, or yohimbe)
- hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea,
seizures
What is the treatment for serotonin syndrome? - answer- DC agent
Agressive cooling
Reduce rigidity (bromocriptine [parlodene] or dantrolene [Dantrium])
What are suspicious bruises that are signs of abuse? - answer- -Bruises on back, chest,
forearm, face (cheek or nose), protected areas (ears, cheeks, lateral chest), other
concerning sites: thigh, calf, abdominal wall, genitals.
-Crescent shaped (pinching)
-Oval shaped (biting 0 adulte canine teeth are 1 to 1.6 inches apart)
-Bruises in various stages of healing
, What are the triad of injuries for shaken baby syndrome? - answer- -Subdural
hemorrhage
-Retinal hemorrhage
-Decreased LOC
Early ICP: Vomiting, lethargy
Late ICP: Unconsciousness, seizures, abnormal posturing, fixed and dilated pupils, full
fontanels
What is the medication treatment/dosing for bradycardia? - answer- 0.5mg Atropine Q3-
5 min PRN
Do not give less than 0.5mg/dose
(Unlikely to be effective after cardiac transplantation or with heart blocks)
What are the s/s of hypermagnesemia? - answer- Neuromuscular depression,
decreased DTR, constipation, N/V, fatigue, tall T waves, depressed ST segmants
How do we treat hypermagnesemia? - answer- 1. Reduce serum mag (fluids and loop
diuretics)
2. Reduce ingestion of magnesium (dark leafy greens, nuts, seeds, fish, beans, whole
grains, avocados, yogurt, bananas, dried fruit, dark chocolate
3. Dialysis (give calcium while awaiting dialysis)
What are the s/s of hypomagnesemia? - answer- Mild to moderate is usually
asymptomatic
Severely low causes *neuromuscular excitability*: tetanic contractions, perioral or finger
paresthesia, positive Chvostek's sign, positive trousseaus's sign, seizures. Prolonged
PR interval, widened QRS complex
What are the s/s of hypocalcemia? - answer- *The same as hyperphosphatemia*
Neuromuscular excitability (positive Chvosteks and trousseaus), shortened ST
segment, and widened T wave
How do we treat hypocalcemia? - answer- 1-2 amps of 10% calcium gluconate mixed
with D5W over 10-20 minutes
(Remember potassium rises with low calcium!)
How do we treat hyperphosphatemia? - answer- Limit phosphate intake, give oral
phosphate binding agents such as aluminum hydroxide (antacids), increased excretion
(IV fluids, diuretics)
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