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1
Q

primary dietary prescription for calcium nephrolithiasis (kidney stones)?

A

low calcium diet

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2
Q

for a client with nephrolithiasis (kidney stones) the diet should be _______ ash

A

acid

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3
Q

if kidney stone is calcium phosphate the diet must me low in ______ too

A

phosphorus

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4
Q

primary diet tx for uric acid nepholithiasis (kidney stone) is ___ ____

A

low purine

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5
Q

client with uric acid nepholithiasis (kidney stone) should have a diet low in ___

A

methionine

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6
Q

what is methionine?

A

precursor of the amino acid cystine

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7
Q

2 foods high in methionine

A

eggs & milk

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8
Q

clients with cystine nephrolithiasis (kidney stone) should have an _____ ash diet

A

alkaline

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9
Q

increased fluids over 3000cc/day is more effective in treating renal calculi than ANY dietary modification. T/F?

A

true —> want to flush tract then worry about diet

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10
Q

what is the common name for laryngotracheobronchitis (LTB)

A

croup

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11
Q

what is the typical temp elevation in croup?

A

low grade
usually below 38.8 but can be up to 40

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12
Q

are abx helpful for croup?

A

no

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13
Q

are abx helpful for epiglottitis?

A

yes

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14
Q

is croup viral or bacterial?

A

viral

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15
Q

which condition is croup most often confused with?

A

epiglottitis

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16
Q

can croup be managed at home?

A

yes

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17
Q

can epiglottitis be managed at home?

A

no, a 911 emergency

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18
Q

are sedatives used for kids with croup

A

no, this would mask signs of respiratory distress

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19
Q

what causes epiglottitis? Virus or bacteria?

A

H. Influenza. Bacteria

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20
Q

what is the best tx for croup

A

cool moist air

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21
Q

what should never be done to a child with epiglottitis?

A

never put anything in their mouth (tongue blade) as can lead to obstruction.

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22
Q

what are the typical signs and symptoms of croup?

A

barking cough, inspiratory stridor, laboured respiratory pattern

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23
Q

3 signs a child has epoglottitis instead of croup?

A

muffled voice, drooling, increased fever

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24
Q

when is croup bad enough to be evaluated by a doc?

A

when retractions and high pitched stridor are present

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25
Q

what lead level needs intervention

A

50-60mcg/dl

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26
Q

which which class of drug will a child with lead poisoning be treated?

A

chelating agents

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27
Q

what do chelating drugs do?

A

they increase the excretion of heavy metals

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28
Q

the most frequent cause of lead poisoning is…

A

ingestion of lead based paint chips

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29
Q

name 3 common chelating agents for lead poisoning

A

EDTA, desferal, BAL in oil

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30
Q

S&S of lead poisoning

A

drowsiness, clumsiness, ataxia, seizures, coma, respiratory arrest

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31
Q

symptoms of lead poisoning show up in the _____ system

A

neuro

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32
Q

leukaemia is cancer of the _____ forming tissues

A

blood

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33
Q

the type of cell that is most common and problematic in leukaemia is _____

A

immature WBC (B cells)

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34
Q

in leukaemia the RBC count is ….

A

low —> the bone marrow is going “wild” producing all the immature WBC - no energy or nutrients to make RBC

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35
Q

in leukaemia the platelet count is….

A

low —> the bone marrow is going “wild” producing all the immature WBC - no energy or nutrients to make platelets

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36
Q

in leukaemia, because RBC is low the pt will exhibit ____ and ____

A

pallor, fatigue

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37
Q

in leukaemia, because of the immature WBCs, the pt is at risk for ____

A

infection

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38
Q

in leukaemia, because of low platelets, the pt is at risk for ____, ____, ____, & _____

A

bruising, ecchymosis, bleeding, petechia

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39
Q

what causes lymph gland enlargement in leukaemia?

A

all the small immature WBC clog the lymph system

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40
Q

should you take a rectal temp on a child with leukaemia?

A

no

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41
Q

should you take and oral temp on a child with leukemia

A

yes, as long as they are over 4yrs, in remission, and have no sores in mouth

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42
Q

should the child with active leukaemia use straws, forks, cups?

A

no straws, no forks, yes cups

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43
Q

RNs priority in tx a child with newly diagnosed leukaemia is….

A

decrease risk of infection

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44
Q

when the leukaemia child’s platelets and WBCs are low, their activities should be ____

A

limited

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45
Q

when the platelets and WBCs are low the nurse should not insert a _____

A

suppository

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46
Q

are IM injections and IV sticks permitted on a child with leukemia

A

when labs are low IMs avoided and IVs limited
only done when absolutely necessary (to give chemo of measure blood counts)

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47
Q

why are kids on chemo also on allopurinol

A

to prevent uric acid kidney stones
when chemo kills cancer cells, purines and uric acid build up and could cause kidney stones

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48
Q

why do some kids with leukaemia have joint pains

A

immature WBCs infiltrate the joint and cause inflammation

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49
Q

why is a child with leukaemia at risk for neurological symptoms due to ICP

A

the immature WBCs infiltrate the brain and cause inflammation

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50
Q

what is alopecia?

A

hair loss

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51
Q

if the platelet count is low, what drug should the child not take?

A

aspirin

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52
Q

is the alopecia from chemo permanent?

A

no, it will grow back

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53
Q

is the alopecia from radiation permanent

A

yes, the follicles are destroyed

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54
Q

what does ANC mean?

A

absolute neutrophil count

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55
Q

what is the ANC used for in leukaemia?

A

if ANC is <500 (0.5) then pt will be on protective isolation

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56
Q

which is used more commonly to decide if the pt should be on protective isolation? WBC or ANC?

A

ANC is more reliable and valid

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57
Q

by the end of the first 6 months of life an infants birthweight should be ___

A

double

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58
Q

by the end of the first year of life and infants birthweight should be ____

A

triple

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59
Q

ideal food fo infants is ____

A

breast milk

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60
Q

breast milk contains substances that increase immunity. T/F?

A

true

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61
Q

bottle-fed infants don’t bond well with their moms. T/F?

A

false

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62
Q

the one nutrient that commercial formulas are typically low in is ____

A

Fe (iron)

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63
Q

breast milk does not contain iron. T/F?

A

false - but it does not contain enough iron so they should be fed iron fortified cereal starting at 6 months

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64
Q

at what age should the infant be fed cows milks?

A

not before 12 months

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65
Q

what is the major problem with feeding an infant skim milk?

A

they don’t get enough calories and don’t grow
dehydration from excessive solute load and inability to concentrate urine

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66
Q

when should the infant be introduced to textured solid foods?

A

4-6 months

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67
Q

what is the first food that an infant should be introduced to?

A

iron fortified cereal

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68
Q

when forced to eat, the preschool child will ___

A

rebel

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69
Q

parents of preschool children should be taught that as long as the child eats ___ good nutritious meal per day, they should not make eating food and issue

A

one

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70
Q

refusal to eat is common in preschoolers. T/F?

A

true, but still offer a variety

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71
Q

youngsters develop food preferences by …

A

observing significant ppl in their environment

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72
Q

school aged kids grow at a slower rate than infants, toddlers, and adolescents. T/F?

A

true

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73
Q

what dietary strategy is most appropriate for the industrious school aged child?

A

wholesome snack because they are often too busy to eat

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74
Q

Girls in adolescence need more calories than adolescent boys T/F?

A

False, boys need more cals

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75
Q

Adolescents should take vitamin supplements T/F?

A

True

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76
Q

Mastitis and breast engorgement are more likely to occur in…

A

Primipara

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77
Q

Where does the organism that causes mastitis come from?

A

The INFANTS nose or mouth

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78
Q

Which organism most commonly causes mastitis

A

staph

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79
Q

Prolonged intervals between breast- feeding (dec/inc) the incidence of mastitis

A

increase

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80
Q

Cant too-tight bras lead to mastitis?

A

Yes, by preventing emptying of ducts

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81
Q

Mastitis usually occurs at least ___ days after delivery

A

10

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82
Q

Mastitis is accompanied with a fever over ___

A

38.8

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83
Q

When mastitis is present the breasts are ___, ____, and ____

A

hard, swollen, warm

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84
Q

If mastitis is caused by an organism , what causes breast engorgement

A

Temporary increase in vascular & lymph supply to the breast in preparation for milk production

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85
Q

If mastitis occurs 1+ weeks after delivery, when does breast engorgement occur?

A

2-5 days after delivery

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86
Q

Does breast engorgement interfere with nursing?

A

Yes, the infant has a difficult time latching on

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87
Q

What class of drugs is used to treat mastitis?

A

ATBs

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88
Q

ATBs are used to treat breast engorgement (T/F)?

A

false

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89
Q

application of (warm H2O compresses/ice packs) is the preferred tx for breast engorgement

A

Ice packs to dec swelling

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90
Q

The mother with mastitis should stop breast feeding (T/F)?

A

False. The mother must keep breast feeding. (Offer unaffected breast first).

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91
Q

If the mother has an open abscess on her breast, she must not breastfeed (T/F)?

A

true

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92
Q

For breast engorgement, the non- breastfeeding mother should be told to express milk (T/F)

A

No, that would increase milk production and would make the problem worse (warm compresses or a warm shower to let milk “leak” is okay - Ice is best

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93
Q

What is the best tx for breast engorgement?

A

Breast feeding - it will balance supply and demand

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94
Q

What is mastoiditis?

A

Inflammation / infection of the mastoid process

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95
Q

What is the most common cause of mastoiditis?

A

Chronic otitis media

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96
Q

What are the 4 S&S of mastoiditis?

A

Drainage from ear, high fever, HA, and ear pain, tenderness over mastoid process

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97
Q

What unusual post-op complication can result from mastoidectomy?

A

Facial nerve paralysis d/t accidental damage during surgery

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98
Q

What should you do to assess for facial nerve paralysis post-mastoidectomy?

A

Have the patient smile and wrinkle forehead

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99
Q

What is the medical tx of mastoiditis?

A

Systemic ATBs

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100
Q

What is the surgery for mastoiditis called?

A

Simple or radical mastoidectomy

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101
Q

Will a simple mastoidectomy worsen hearing?

A

No, a radical mastoidectomy may

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102
Q

Should the nurse change the post- mastoidectomy dressing?

A

No, reinforce it. Physician changes first post-op dressing

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103
Q

What is a common side effect of mastoidectomy?

A

Dizziness (vertigo)

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104
Q

What is a major nursing diagnosis post- mastoidectomy ?

A

safety

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105
Q

Define Menieres disease

A

An increase in endolymph in the inner ear causing severe vertigo

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106
Q

What’s the famous triad of S&S in Meniere’s?

A

Paroxysmal whirling vertigo - sensorineural hearing loss - tinnitus (ringing in the ears)

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107
Q

Does Meniere’s occur more in men or women?

A

WOMEN

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108
Q

What should the client with Meniere’s do if they have an attack?

A

bed rest

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109
Q

What safety measures should be followed with Meniere’s?

A

Side rails up x4, ambulate only with assistance

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110
Q

What age group in Meniere’s highest in?

A

40-60

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111
Q

What can prevent the attacks of Meniere’s?

A

Avoid sudden movements

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112
Q

What electrolyte is given to ppl with Meniere’s?

A

Ammonium chloride

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113
Q

What surgery is done for Meniere’s?

A

Labyrinthectomy

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114
Q

What disease often follows labyrinthectomy?

A

Bell’s palsy - facial paralysis, will go away in a few month

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115
Q

What is the activity order after labyrinthectomy?

A

Bed rest

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116
Q

When surgery is preformed for Meniere’s, what are the consequences?

A

Hearing is totally lost in surgical ear

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117
Q

What should the client avoid after labyrinthectomy?

A

Sudden movements and increase Na foods

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118
Q

What type of diet is the client with Meniere’s on?

A

low salt

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119
Q

What two classes of drugs are given in Meniere’s?

A

Antihistamines and diuretics (Diamox)

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120
Q

Meningitis is an inflammation of the ___ of the ___ and spinal ___

A

Linings, brain, cord

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121
Q

Meningitis can be caused by ___, ___, and ____.

A

Viruses, bacteria, and chemicals

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122
Q

The 4 most common organisms that cause meningitis are…

A

Pneumococcus, meningococcus, streptococcus, H. Influenza

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123
Q

Child with meningitis is most likely to be lethargic or irritable at first.

A

irritable

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124
Q

What visual S&S will the pt with meningitis have?

A

Photophobia (over-sensitivity to light)

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125
Q

What is the most common musculo- skeletal S&S of meningitis?

A

Stiff neck - nuchal rigidity

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126
Q

Will the pt with meningitis have a HA?

A

yes

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127
Q

Kernig’s sign is positive when there is pain in the ___ when attempting to straighten the leg with the ___ flexed

A

Knee; hip

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128
Q

What type of vomiting is present in meningitis?

A

projectile

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129
Q

What is the definitive diagnostic test for meningitis?

A

Lumbar puncture with culture of CSF

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130
Q

If the pt has meningitis, the CSF shows ___ pressure, ___ WBC, and ____ protein, ___ glucose

A

increased, increased, increased, decreased

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131
Q

On what type of isolation will the patient with meningitis be?

A

Contact and respiratory precaution

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132
Q

How long will the patient with meningitis be on these precautions?

A

Until they have been on an abx for 48h

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133
Q

The room of a pt with meningitis should be ___ and ___

A

dark and quiet

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134
Q

The client with meningitis can develop ___

A

Seizures

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135
Q

What is opisthotonos?

A

Arching of back (entire body) from hyperextension of the neck and ankles, d/t severe meningeal irritation

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136
Q

If a patient has opisthotonos, in what position would you place them?

A

Side-lying

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137
Q

Average duration of menstrual flow is ___. The normal range is ___ to ___ days.

A

5 days, 3-6

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138
Q

Average blood loss during menstruation is ____ cc

A

50-60cc

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139
Q

Name the two phases of the ovarian cycle

A

Follicular phase (first 14 days), luteal phase (second 14 days)

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140
Q

In the menstrual cycle, day 1 is the day on which…

A

Menstrual discharge begins

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141
Q

How long does an ovarian cycle last?

A

28 days

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142
Q

How many days after ovulation does menstruation begin?

A

14 days

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143
Q

What hormones are active during the follicular phase?

A

FSH and Estrogen

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144
Q

What is the major function of the luteal phase of the ovarian cycle?

A

To develop and maintain the corpus luteum which produces progesterone to maintain pregnancy until placenta is est.

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145
Q

If an ovum is fertilized during the luteal phase what hormone will be secreted?

A

HCG (human chorionic gonadotropin)

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146
Q

During menstruation, the average daily loss of iron is ___ mg.

A

0.5 to 1.0 mg

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147
Q

What occurs during the follicular phase of the ovarian cycle?

A

It accomplishes maturation of the graafian follicle which results in ovulation

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148
Q

What type of environmental modification is best for a migraine?

A

Dark, quiet, environment

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149
Q

The long term tx of migraine focuses upon…

A

Assessing things that bring on stress and then planning to avoid them

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150
Q

What type of pain is typical of migraines?

A

throbbing

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151
Q

Are migraines more or less common in men?

A

less

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152
Q

Besides pain, ppl with migraines complain of what other S&S?

A

N&V, and visual disturbances

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153
Q

What are the processes occurring in migraines?

A

Reflex constriction then dilation of cerebral arteries

154
Q

Where is the pain of migraines most likely located?

A

Temporal, supraorbital

155
Q

Name a drug given to tx migraine?

A

Sansert (methsergide), Cafergot (prophylaxis: Imipramine)

156
Q

Are migraine HAs usually unilateral or bilateral?

A

Unilateral

157
Q

When Inderal is given in migraine headache, is it used to prevent or treat an attack?

A

To prevent. It does not treat

158
Q

MS is a progressive ____ disease of the CNS.

A

Demyelinating

159
Q

Myelin promotes ___, ___ ___ of nerve impulses.

A

Fast, smooth conduction

160
Q

With demyelination the nerve impulses become ___ and ____.

A

Slow, uncoordinated

161
Q

MS affects men more than women (T/F)

A

False, affects women more than men

162
Q

What age group usually gets MS?

A

20-40

163
Q

MS usually occurs in (hot/cool) climates

A

cool

164
Q

What is the 1st sign of MS?

A

Blurred or double vision

165
Q

MS can lead to urinary incontinence (T/F)

A

true

166
Q

MS can lead to impotence in males (T/F)

A

true

167
Q

Patients with MS should be taught to walk with a ___ -___ gait

A

wide based

168
Q

Why are Adrenocorticotropic Hormone (ACTH) and prednisone given during acute MS?

A

To dec. edema in the demyelination process

169
Q

For acute exacerbations of MS ___ per IV is often used

A

ACTH (Corticotropin)

170
Q

What drug can be given to treat urinary retention in MS?

A

Urecholine, Bethanocol

171
Q

Will the muscles of MS clients be spastic or flaccid

A

spastic

172
Q

What 3 drugs can be given for muscle spasms?

A

Valium, Baclofen (Lioresal), Dantrium

173
Q

Baclofen causes (constipation/ diarrhea)

A

Constipation

174
Q

Dantrium causes (constipation/ diarrhea)

A

Diarrhea (Hint: the D’s go together, Dantrium and Diarrhea)

175
Q

Patients with MS should have (inc/restricted) fluids

A

Increased to dilute urine and reduce incidence of UTI

176
Q

The diet of a patient with MS should be ___ -ash

A

acid

177
Q

What major sense is affected most in MS (besides vision)?

A

Tactile (touch) - they burn themselves easily

178
Q

Which will bring on a MS exacerbation: over-heating or chilling?

A

Both will; but they tend to do better in cool weather (summer will always be a bad time for MS patients)

179
Q

In Myasthenia Gravis (MG) there is a disturbance in transmission of impulses at the ___ ____.

A

Neuromuscular junction

180
Q

The #1 sign of MG is ____ ____ ___

A

Severe muscle weakness

181
Q

What is the unique adj. given to describe the early signs of MG?

A

The early signs (difficulty swallowing, visual problems) are referred to as BULBAR signs.

182
Q

MG affects men more than women (T/F)

A

False, affects women more than men

183
Q

When women get MG they are usually old or young?

A

OLD

184
Q

What neurotransmitter is problematic in MG?

A

Acetycholine

185
Q

What class of drug is used to tx MG?

A

Anticholinesterases

186
Q

What ending do anticholinesterases have?

A

-stigmine

187
Q

Are anticholinesterases sympathetic or parasympathetic?

A

parasympathetic

188
Q

Anticholinesterases will have (sympathetic/cholinergic) side effects

A

Cholinergic (they will mimic the parasympathetic nervous system)

189
Q

What surgery CAN be done for MG?

A

Thymectomy (removal of thymus)

190
Q

The severe muscle weakness of MG gets better with exercises (T/F)

A

False, it is worse with activity

191
Q

What will the facial appearance of a patient with MG look like?

A

Mask-like with a snarling smile (called a myasthenic smile)

192
Q

If a patient has MG, what will be the results of the Tensilon Test?

A

The patient will show a dramatic sudden increase in muscle strength

193
Q

Besides the Tensilon Test, what other diagnostic tests confirm a diagnosis of MG?

A

Electromylogram (EMG)

194
Q

What is the most important thing to remember about giving Mestinon and other anticholinesterases?

A

They must be given EXACTLY ON TIME; at home, they might need to set an alarm

195
Q

Do you give anticholinesterases with or without food?

A

With food, about 1/2 hour ac; giving ac helps strengthen muscles of swallowing

196
Q

What type of diet should the pt with MG be on?

A

soft

197
Q

What equipment should be at the bedside of an MG patient?

A

Suction apparatus (for meals), Tracheostomy/ endotube (for ventilation)

198
Q

Name the two types of crises that a MG pt can have

A

Cholinergic (too much Mestinon); Myasthenic (not enough Mestinon)

199
Q

The #1 danger in Myasthenic and Cholinergic crisis is ___ ___.

A

Respiratory arrest

200
Q

What words will the client use to describe the pain of an MI?

A

Crushing, heavy, squeezing, radiating to left arm, neck, jaw, shoulder

201
Q

What is an MI?

A

Either a clot, spasm, or plaque, that blocks the coronary arteries causing loss of blood supply to the heart and myocardial cell death

202
Q

What is the #1 S&S of an MI?

A

Severe chest pain unrelieved by rest and nitroglycerine

203
Q

Males are more likely to get an MI than females (T/F)

A

true

204
Q

Death d/t MI occurs within ___ hour of symptom onset in 50% of all patients

A

1

205
Q

What pain medication is given for the pain of a MI (give three)?

A

Morphine, Demerol, Nitroglycerine

206
Q

What is the reason for giving post MI patients ASA?

A

To prevent platelets from forming clots in the coronary arteries

207
Q

Name a new drug with anti-platelet activity

A

plavix

208
Q

The 3 most common complications after MI are ___, ___, and ____.

A

Cardiogenic shock, arrhythmia, CHF

209
Q

What will the activity order be for the post- MI client?

A

Bed rest with bedside commode

210
Q

What is the most common arrhythmia after an MI?

A

PVCs

211
Q

What cardiac enzymes indicate an MI?

A

Elevated CPK, LDH, SGOT

212
Q

What serum protein rises soonest after myocardial cell injury?

A

troponin

213
Q

Do people without cell damage have troponin in their blood?

A

No, troponin is only present when myocardial cells are damaged

214
Q

How soon after cell damage does troponin increase?

A

As soon as 3 hours (can remain elevated for 7 days)

215
Q

When will the client with an MI be allowed to engage in sexual activities after an MI?

A

6 weeks after discharge

216
Q

Will fluid resuscitaion (administering large amounts of IV fluid) treat cardiogenic shock?

A

No, you must use cardiac drugs (giving IVs and blood will not help this kind of shock)

217
Q

Will the client with an MI be nauseated?… diaphoretic?

A

yes, yes

218
Q

What will the extremities of the client with an MI feel like?

A

cold, clammy

219
Q

What is the permanent EKG change seen post MI?

A

ST wave changes

220
Q

Of CPK and LDH which rises earliest?

A

CPK

221
Q

What drug will be used to treat PVCs of MI?

A

Lidocaine

222
Q

Will the client with an MI need 100% O2 for their entire stay in the hospital?

A

No, just moderate flow (42% or 3-6L for first 48h)

223
Q

Vegetables highest in Na are ___

A

canned veggies

224
Q

fruit highest in Na is___

A

tomato sauce

225
Q

fresh meats are ___ in Na

A

low

226
Q

canned meats are ___ in Na

A

very hight

227
Q

smoked foods are ___ in Na

A

very high

228
Q

fruits are ___ in Na

A

low

229
Q

fruits are ___ in Na

A

low

230
Q

veggies are ___ in Na

A

low

231
Q

which are higher in Na? veggies or fruits

A

fruits

232
Q

breads/cereal are ___ in Na

A

moderately high

233
Q

processed meats and cheese are ___ in Na

A

very high

234
Q

margarine is much lower in Na than butter. T/F?

A

true

235
Q

an NG tube is inserted into the ___ via the ___

A

stomach, nares

236
Q

When an NG tube is being used for decompression what is happening?

A

The stomach is being emptied of its contents by suction

237
Q

NG tubes are used to pump the stomach of drug overdose clients (T/F)

A

true

238
Q

What does gavage mean?

A

Feed a client with a tube

239
Q

What does lavage mean?

A

To continuously irrigate the stomach via NG tube

240
Q

When an NG tube is used to stop gastric hemorrhage, it is irrigated with ____

A

iced tap water

241
Q

How long do you irrigate an NG with iced tap water when the stomach is bleeding?

A

Until the irrigating solution comes back out clear

242
Q

What is the maximum suction level used to decompress the GI tract via a NG?

A

25 mmHg

243
Q

Why are salem sump tubes best suited for safe gastric suctioning?

A

Because they have vents that prevent damage to the gastric mucosa

244
Q

When a NG tube is in for a long time it must be replaced every ___ to ___ weeks

A

2-3 weeks

245
Q

People with a NG tube will breathe through their ___

A

Mouth (mouth care is important)

246
Q

The best way that the nurse can check if the NG is in the stomach is…

A

To aspirate gastric contents; auscultating the gastric air bubble is the second best way

247
Q

Before you put anything down the NG you must do what?

A

You must check the see if the NG placement is in the stomach

248
Q

In what position should the client be when a NG is being inserted?

A

Sitting up with head slightly extended until the tube reaches the back of the throat then have them mildly flex the neck to push the tube in all the way

249
Q

How do you determine how far to put an NG tube in?

A

Measure from the tip of the nose to the back of the ear then to the xiphoid process

250
Q

In what position should the client be during a continuous NG tube feeding?

A

HOB must be elevated 30 degrees (semi- fowler’s would be acceptable)

251
Q

Is nephrotic syndrome a disease?

A

No, it is not a specific disease, it is a group of S&S that can result from many diseases

252
Q

Is there any hematuria in nephrosis?

A

No, there is no hematuria in the -oses, but there is hematuria in the -itis’s

253
Q

What are the dietary modifications for nephrosis ?

A

High carbs, moderate proteins, low sodium

254
Q

What is #1 nursing dx in nephrosis?

A

Alteration in fluid volume, excess

255
Q

What are the 2 pathophysiologic processes in nephrotic syndrome?

A

Glomerular inflammation, loss of protein

256
Q

What S&S are MOST common in nephrosis?

A

Generalized severe edema

257
Q

What 2 classes of drugs are given for nephrosis?

A

steroids, diuretics

258
Q

Is bed rest common in treating nephrosis?

A

it is occasionally done, but not nearly as common as in acute glomerulo-nephritis, it is usually is most appropriate when edema is severe

259
Q

In nephrotic syndrome, the BP will be most likely (hypotensive / hypertensive)

A

Hypertensive: remember in acute glomerulonephritis, the BP is hypertensive as well

260
Q

In nephrotic syndrome, the urine is (frothy/very dark or tea-colored)?

A

Frothy. Remember in AGN, it is tea-colored

261
Q

Is scrotal edema common in nephrosis?

A

yes

262
Q

What is done for scrotal edema?

A

Elevate the scrotum on a scrotal sling and apply ice

263
Q

Name the 3 sub-scales in the Glasgow coma scale (GCS)

A

Best eye opening (E), Best verbal response (V), and best motor response (M)

264
Q

Whats max score on GCS?

A

15

265
Q

What is the minimum score on the GCS?

A

3

266
Q

A score equal to or below ____ on the GCS is considered coma

A

7

267
Q

Pupillary reaction test cranial nerve ___

A

3

268
Q

A respiratory pattern in which there is alternation between apnea and hyperventilation is known as..

A

Cheyenne-Stokes

269
Q

A value of 20/80 on visual acuity means that the patient can see at ___ feet what normal people see at ___ feet

A

20, 80

270
Q

Babiniski’s reflex is tested by stroking the ___

A

Bottom lateral surface of the foot

271
Q

It is always pathologic if a Babinski is negative (T/F)

A

False, non-walking infants normally have a positive Babinski, walking infants, toddlers, and all other people should normally have a negative Babinski

272
Q

When a Babinski is positive the ___ ___ ___ flexes and the other ___ fan out

A

Great toe dorsiflexes, toes

273
Q

In decorticate posturing, the legs are ____ and the neck and arms are ___ and ___ rotated

A

extended, flexed, internally

274
Q

In decerebrate posturing, the legs are ___ and the arms, neck and back are ____

A

Extended, extended (pronated)

275
Q

A score of 4 for a reflex means that it is ____

A

hyperactive

276
Q

Cerebellar function is evaluated by testing for ____, ____, ____, ____

A

Posture, gait, balance, coordination (ie Romberg’s sign)

277
Q

assault

A

A threat or an attempt to make bodily contact with another person without that person’s consent

278
Q

battery

A

An assault that is carried out

279
Q

Common law

A

Law resulting from court division that is then followed when other cases involving similar circumstances arise

280
Q

malpractice

A

An act of negligence- commonly used when speaking of negligent acts committed by a person working in a certain profession, such as medicine or nursing

281
Q

ethics

A

A system that defines actions with respect to their being judged right or wrong

282
Q

false imprinsonment

A

Unjustifiable restraint or prevention of the movement of a person without proper consent

283
Q

misdemeanour

A

A wrong of less seriousness than a felony

284
Q

good samaritan law

A

Law that gives certain persons legal protection when giving aid to someone in an emergency

285
Q

felony

A

A wrong of serious nature

286
Q

negligence

A

Performing an act that a reasonable and comparable person under similar circumstances would not do, or failing to perform an act that a reasonable and comparable person under similar circumstances would do

287
Q

invasion of privacy

A

A wrongful act that violates the right of a person to be let alone

288
Q

liable

A

Being accountable, responsible, or answerable for an act

289
Q

libel

A

A written untruthful statement about a person that subjects him/her to ridicule or contempt

290
Q

slander

A

A spoken untruthful statement about a person that subjects him/him to ridicule or contempt

291
Q

How could a nurse be convicted of assault?

A

If the client perceives that the nurse intends to do a procedure without consent or justification

292
Q

How could a nurse be convicted of battery?

A

If the nurse willfully touched a client in any manner that is wrong in some way

293
Q

If a nurse uses restraints to keep a client, who is a danger to himself, in bed, the nurse is likely to be convicted of false imprisonment (T/F)

A

False, you can detain/restrain a person against their will if they are: 1) a threat to self; 2) a threat to others

294
Q

In order to legally sign as a witness to informed consent, the nurse must have been present when the physician and client discussed the procedure (T/F)

A

False. You are only witnessing that the patient was the one who signed the consent

295
Q

It is NOT necessary for the nurse to determine if the client understands what the physician is said in order to witness an informed consent

A

True. You are only witnessing a signature

296
Q

Can a patient legally sign an informed consent after they have received the premedication analgesic for a procedure?

A

No. The patient would be considered to be under the influence of a mind-altering drug. The consent would be invalid

297
Q

Name 3 groups of ppl who cannot give legal consent

A

Minor, unconscious client (even under influence of CNS drugs), mentally ill

298
Q

In an emergency situation, when client and family cannot give consent, consent is assumed and tx proceeds (T/F)

A

true

299
Q

The legality of no code or slow code orders is well-est. in the courts

A

False- no definitive policy in the courts exists at this time- dealt with on a case-by- case basis

300
Q

Anxiety-producing thoughts are called ____

A

obsessions

301
Q

Repetitive actions designed to reduce anxiety are called _____

A

Compulsions - such as washing hands over and over, dusting furniture 3 hour per day, refusing to turn your back to anyone

302
Q

Which defense mechanism is most closely associated with OCD

A

displacement

303
Q

Should you allow an OCD person to perform their compulsive behavior?

A

Yes, give them time to do their ritual and try to set a limit and redirect

304
Q

Should you ever make an OCD person stop their compulsive behavior?

A

No, they will become very anxious

305
Q

Is the patient with OCD neurotic or psychotic?

A

Neurotic- they know reality

306
Q

Should you confront the OCD patient with the absurdity of their behavior?

A

No, just say things like “You washed your hands for so long you must have been very anxious.”

307
Q

What should you do if an obsessive- complusive person is always late due to their rituals?

A

Get them started earlier - for ex. if they wash their hands for 1/2 hour before meals and are always late for breakfast, just get them started 1/2 hour earlier

308
Q

What are the two typer of oral contraceptives?

A

Progestin only & combination progesterone and estrogen

309
Q

How many days of the menstrual cycle do you take the progestin only pill?

A

all 28 days

310
Q

How many days of the menstrual cycle do you take the combo pill?

A

You take it on days 5-24, but not on days 24-28 and 1-4 (8 days off)

311
Q

How log before surgery must you d/c PO contraceptives

A

one week before surgery

312
Q

If a woman forgets to take the pill one day, what should she do?

A

Take it as soon as she remembers it, and take next pill at regular time.

313
Q

What if a woman forgets to take the pill for two days in a row? What should she do?

A

Take 2 pills a day for 2 days in a row and then resume normal schedule

314
Q

What should a woman do if she forgets to take her pill for 3 days or more?

A

Throw away pack & start new pack same day. Use back-up contraceptive method for 7 days

315
Q

If a woman doesn’t stop oral contraceptives one week before surgery she is at risk for developing ___

A

thrombophlebitis

316
Q

People who smoke more than ___ cigs per day should not be on an oral contraceptive

A

15, bc if you smoke you have constriction of vessels and this potentates the chances that a woman on oral contraceptives will get thrombophlebitis

317
Q

If a woman on oral contraceptives misses a period, should she still take pills?

A

Yes, however, if 2 missed periods occur, stop and have a pregnancy test.

318
Q

Will breakthrough bleeding, N&V, and breast tenderness go away when a woman is on oral contraceptives?

A

yes after about 3-6 months of tx

319
Q

Osteoarthritis is a ____ disease of the ___

A

degenerative, joint

320
Q

Osteoarthritis is most commonly caused by the wear and tear of life (T/F)

A

true

321
Q

The most common symptom of osteoarthritis is ____ _____

A

joint pain

322
Q

What 2 joints are most commonly affected in osteoarthritis?

A

knee and hip

323
Q

To control the pain of osteoarthritis one should use heat or cold?

A

heat

324
Q

What 3 meds are used in osteoarthritis?

A

Aspirin, NSAIDs, steroids

325
Q

What do you observe on the fingers of the client with osteoarthritis?

A

Heberden’s nodes

326
Q

Are Heberden’s nodes painful?

A

Not in the beginning, can be later as swelling occurs

327
Q

Are rest periods and ROM exercises appropriate in the care of osteoarthritis?

A

Yes, rest is probably the most effective thing they can do.

328
Q

The pain of osteoarthritis is usually better or worse with rest? With activity?

A

Better with rest, worse with activity

329
Q

What age group gets osteoarthritis?

A

60-80 years old

330
Q

Osteoarthritis is more common in females (T/F)

A

False, it occurs in equal frequency

331
Q

For cervical osteoarthritis the client should wear..

A

A cervical collar

332
Q

What is arthroplasty?

A

joint replacement

333
Q

What is arthrodesis?

A

jont fusion

334
Q

What is otosclerosis?

A

Overgrowth of the spongy bone in the middle ear that doesn’t allow the bones of the middle ear to vibrate

335
Q

What will the client with otosclerosis complain of besides hearing loss?

A

Buzzing or ringing in the ears (tinnitus)

336
Q

Do ppl have a loss of hearing with otosclerosis?

A

yes

337
Q

What is a corrective surgery for otosclerosis called?

A

Stapedectomy - removing the stapes bone and replacing it with a micro prosthesis

338
Q

Should side rails be up after stapedectomy?

A

Yes, client may feel dizzy

339
Q

What should the client avoid post- stapedectomy?

A

Coughing, sneezing, blowing nose, swimming, showers, flying

340
Q

What warning should you give the client about getting up after stapedectomy?

A

get up slowly

341
Q

What should the client expect regarding hearing post-stapedectomy?

A

An initial decrease with the benefits of surgery noticeable in 6 weeks

342
Q

What should the client do if he must sneeze after a stapedectomy?

A

Open his mouth, this de-pressurizes the middle ear

343
Q

What type of hearing loss is associated with otosclerosis?

A

conductive

344
Q

Which sex has a higher incidence of otosclerosis?

A

women

345
Q

Do hearing aids help hearing in otosclerosis?

A

yes

346
Q

What will be the results of the Rinne test in otosclerosis?

A

Bone conduction will be better than air conduction

347
Q

Is stapedectomy done under general or local anesthesia?

A

local

348
Q

If the client complains of dec. hearing after stapedectomy what would you say?

A

It is normal d/t edema. The hearing will start to improve within 6 weeks

349
Q

Which side will the client be allowed to lie upon post-stapedectomy

A

Depends on MD: operative side promotes drainage, un- operative side prevents graft dislodgment. Dont make a big deal of position post-op

350
Q

What 2 drugs are commonly given post- stapedectomy

A

Codeine/Demerol for pain, Dramamine for dizziness

351
Q

Cysts on the ovaries are usually malignant (T/F)?

A

false, usually benign

352
Q

What is the #1 reasons why MD’s remove ovarian cysts?

A

Remove before they transform into malignant

353
Q

Do small ovarian cysts cause S&S?

A

no, only large ones

354
Q

Common signs of large ovarian cysts are..

A

Low back pain, pelvic pain, abnormal bleeding

355
Q

What does torsion of an ovarian cyst mean?

A

Twisting of cyst with interruption of its blood supply

356
Q

What is the big danger from torsion?

A

Necrosis and rupture of ovary

357
Q

What other disorders resemble rupture of ovarian cysts?

A

Appendicitis, rupture of a fallopian tube pregnancy

358
Q

What affect do oral contraceptives have on ovarian cysts?

A

They cause it to stop growing and decrease in size

359
Q

What are the 3 most common signs of ovarian cyst rupture?

A

Pain, abd distention, abd rigidity

360
Q

Compare signs of non-ruptured ovarian cysts with the signs of a ruptured ovarian cyst

A

Non-ruptured= low back pain, dull pelvic pain, abnormal uterine bleeding esp. with mensturation
Ruptured: acute pain, abd distention, and abd rigidity

361
Q

After surgery to remove an ovarian cyst the woman can return to normal activities between ___ to ___ weeks

A

4-6 wks

362
Q

How soon after removal of an ovarian cyst can a woman resume sexual intercourse?

A

4-6 wks

363
Q

Should a woman douche after surgery to remove an ovarian cyst?

A

No, it is not good to douche on a regular basis, it destroys the natural protective vaginal flora

364
Q

What does lightening mean?

A

When the fetal head descends into the pelvis

365
Q

When does fetal head descent occur in pregnancy?

A

2-3 weeks before birth for primipara

366
Q

What is the most common positive effect of lightening?

A

After it occurs the woman can breathe much easier

367
Q

Name the 2 earliest signs that a woman is likely in labor

A

Low back pain and show (blood-tinged mucous plug has passed)

368
Q

What is the most RELIABLE or VALID indication that a woman is in labor?

A

The onset of regular contractions that result in progressive dilatation/effacement of the cervix

369
Q

What are the 2 processes that occur to the cervix during labor?

A

effacement and dilation

370
Q

What is the meaning of cervical effacement?

A

the cervix thins

371
Q

Into how many stages is labor and delivery divided?

A

4

372
Q

What is accomplished during the first stage of L&D?

A

full effacement and dilation

373
Q

How long is the first stage of labor and delivery for a primagravida? For a multigravida?

A

12 hours, 6 hours

374
Q

The 2nd stage of L&B accomplishes..

A

delivery of an infant

375
Q

The 2nd stage of L&D begins with ___ and ends with ___ of the ___

A

Full dilation, delivery, infant

376
Q

The 2nd stage of labor and delivery lasts ___ hours for a primagravida and ___ hours for a multigravida

A

1.5, 5

377
Q

The 3rd stage of L&D accomplishes…

A

expulsion of placenta

378
Q

The 3rd stage of the L&D lasts…

A

<1hr

379
Q

What occurs during the 4th stage of L&D?

A

recovery

380
Q

When does 4th stage of L&D end?

A

2 hrs after expulsion of placenta

381
Q

What is the average blood loss during labor?

A

500 cc

NCLEX Blue Book (2 decks)

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