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CAT Tests Flashcards

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1
Q

what precautions are needed with MRSA pneumonia?

A

contact precautions- gloves, mask, gown, eyewear as appropriate whenever direct contact with body fluid is expected

limited to sputum in this example

most commonly spread through personnel’s hands

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2
Q

during a blood transfusion, if the temperature increases by less than 1 degree F, then you ______

A

CTM

not a febrile reaction

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3
Q

pursed-lip breathing allows for longer ______ to excrete CO2

A

longer

used for COPD patients

client purses lips so that expiration is 3x longer than inspiration

helps slow down breathing

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4
Q

normal serum sodium levels

A

136-145 mEq/L

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5
Q

insulin is excreted by the _______

A

KIDNEYS

in CKD, the kidneys function less efficiently and insulin remains in the circulation longer

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6
Q

In the NCLEX world, are you allowed to crush all pills and mix them together in water then administer them through an NG tube?

A

NO

each drug should be dissolved separately

flush with 15mL between meds reduces risk of obstruction and med incompatibility in NG tube

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7
Q

bluish skin over sacral and gluteal area of newborn is called

A

mongolian spots

common in infants of african american, native american, and mediterranean descent.

they disappear spontaneously during early years and are of no clinical significance

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8
Q

pink patches on nape of neck of an infant are

A

stork bites, telangiectases

gradually fade and are of no clinical significance

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9
Q

lateral recumbent position is best for

A

lumbar punctures

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10
Q

can you administer a pregnancy category A drug to a pregnant client?

A

yes, type A poses no risk to human fetus and can be safely administered

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11
Q

should arms be straight when using a walker?

should the bilateral leg weakened client push the two-wheeled walker first before taking first step?

A

no, slightly bent

yes
advance walker with good leg with one sided weakness, not bilateral

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12
Q

is the pneumococcal vaccine a one time dose given at 65?

A

yes

only given a second shot if the 1st dose was given at 60 (5 years prior)

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13
Q

how often do you need a tetanus booster at 65+

A

every 10 years

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14
Q

if a transfusion reaction occurs, do you obtain a urine specimen?

do you discard the blood bag and tubing?

do you run NS after?

do you notify blood bank?

A

yes, you check for presence of hemoglobin as a result of RBC hemolysis

you need to send the blood bag and tubing to the lab after the reaction

yes, run d/c blood tubing and connect NS infusion to maintain open IV line

yes, notify blood bank!

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15
Q

client has NG to suction after bowel obstruction… client is at risk for what acid base imbalance?

A

metabolic alkalosis d/t loss of acid in gastric fluid (suctioned out)

metabolic acidosis cause by excess acid in blood (renal failure, dehydration)

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16
Q

respiratory alkalosis- caused by CO2 ____ in blood and occurs with ____-ventilation

A

loss

hyperventilation

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17
Q

respiratory acidosis is caused by _____ CO2 in blood usually caused by ______ air movements in lungs

A

excess CO2

decreased air movement

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18
Q

ketorolac is an

A

NSAID

pain, anti-inflammatory

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19
Q

hypromorphone hydrochloride, codeine sulfate and hydrocodone are all

A

opioids and cause respiratory depression

codeine- weaker opioid, used for mild to moderate pain
hydrocodone- more potent opioid, used for severe pain

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20
Q

which abbreviations do you have to write out?

HS, SC, QD, Qid, PRN

A

HS, SC, QD can be confused

Qid and PRN are fine

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21
Q

ST depression of 2mm or more indicates

A

ischemia

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22
Q

QRS duration greater than 0.12 seconds may signify

A

PVCs

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23
Q

PR interval greater than 0.2 seconds indicates a

A

heart block

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24
Q

an ST segment elevation of 2mm or more indicates

A

MI

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25
Q

Is Raynaud phenomenon, HTN, joint pain and BUN=40 common in SLE?

A

yes, pallor in fingers is common

HTN is expected cardiac side effect, pericarditis is the most common cardiac finding

joint symptoms occur in 90% of SLE population

NO! BUN=40 is well above range of 10-20. also nephritis is the most common renal problem, this needs to be managed to prevent kidney failure

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26
Q

after a needle stick injury, the nurse must initially

A

wash with soap and water
then
notify manager ASAP

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27
Q

sharp, localized, unilateral chest pain is associated with

A

pneumothorax

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28
Q

severe substernal chest pain radiating down the left arm is associated with

A

MI

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29
Q

sharp, burning chest pain moving from one location to another is associated with

A

extreme anxiety or panic attack

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30
Q

can you give a suppository to an unconscious patient?

A

yes

bypasses need to swallow medication

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31
Q

is external radiation excreted in the client’s bodily fluids?

A

NO

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32
Q

severe hypothermia, what is the most important concern?

A

assess cardiac monitor for dysrhythmias (ventricular)

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33
Q 
which vital sign is out of range for a post-op anesthesia client?
SpO2 85%
BP 90/60
HR 58bpm
Temp 100.4F
A

SpO2 85%

all others are in normal range for post-op client

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34
Q

the tongue extrusion reflex is a

A

natural reflex for an infant who is not developmentally ready for solid foods

disappears around 4-6 months when solid food can be safely introduced into the diet

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35
Q

what is autologous blood transfusion?

A

when you donate blood pre-surgery to be transfused post-surgery

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36
Q

which of the following conditions would prevent an autologous transfusion?

acute infection
cancer diagnosis
AB negative blood type
hemoglobin= 8.9
unstable angina
A

acute infection- risk of bacterial contamination in blood

cancer diagnosis- risk of spreading malignant cells

Hg= 8.9 indicates anemia

unstable angina- C/I as loss of blood via the donation may precipitate an MI

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37
Q

cor pulmonale is another term for

A

right sided HF

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38
Q

what is a sign of cor pulmonale?

A

JVD

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39
Q

white frothy sputum is a sign of

A

left sided HF

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40
Q

finger clubbing is a sign of

A

chronic hypoxemia

seen in COPD

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41
Q

a client violently vomits in a nurse’s face, what does the nurse do?

A
  1. wash face with copious amounts of soap and water
  2. inform manager
  3. go to employee health services, start prophylactic treatment
  4. inform client that they will need to be tested for blood-borne infections
  5. fill out incident report detailing what happened
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42
Q

false labor

A

contractions are irregular and do not increase in frequency, duration, and intensity

feels like menstrual cramps

no bloody show

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43
Q

in true labor, walking _____ contractions

A

intensifies

brings about cervical effacement and dilation

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44
Q

Rights of Delegation

  • right supervision
  • right person
  • right circumstance
  • right direction
  • right communication
A
  • right supervision: appropriate monitoring and intervention if needed, follow up
  • right person: has experience and knows what to do
  • right circumstance: using the appropriate client and setting to determine if the delegated task is appropriate. NAP and LPN should not be caring for an unstable client
  • right direction: giving clear, concise direction of the delegated task
  • right communication: clear directions
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45
Q

promethazine, ondansetron, and scopolamine are all drugs to help with

A

N/V

promethazine: antihistamine. AE: sedation, dry mouth
ondansetron: serotonin antagonist. none of AE as promethazine
scopolamine: anticholinergic used for motion sickness and N/V

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46
Q

meperidine and hydromorphone are

A

opioid analgesic for severe pain management

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47
Q

alendronate is a drug to treat

A

osteoporosis

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48
Q

alendronate should be taken

A

on an empty stomach with a full glass of water to prevent acid reflux

can take anytime throughout the day

client must remain upright for 30 minutes after taking it to prevent esophagitis

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49
Q

if a patient has heart burn they should eat ____ frequent meals to prevent over distention of the stomach

A

MORE

should also not eat 2-3 hours before bed, weight loss helps, lifting head of bed helps

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50
Q

insulin glargine is a ____-acting insulin

A

long

onset 1-1.5 hours
lasts 24 hours

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51
Q

when transitioning a DKA client from a short acting insulin drip to insulin glargine, you should keep the regular insulin running for ______ hours after administering the glargine

A

1-2 hours

prevents hyperglycemia by allowing the long acting to kick in before stopping the short acting insulin

when a DKA client is making this transition, they are stable

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52
Q

in SLE, we educate clients to wear _____

A

sunscreen

prevents rashes and photosensitivity

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53
Q

in SLE patients, especially adolescent females, a ____ rich diet is recommended for those taking corticosteroids

A

Ca+2

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54
Q

the priority nursing diagnosis for a client in a sickle cell crisis is ineffective ________

A

ineffective peripheral tissue perfusion

cerebral tissue perfusion is a concern but not the highest priority

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55
Q

when does the Babinski reflex disappear?

A

2 years

dorsiflexion and fanning of toes when bottom of foot is stroked

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56
Q

internal radiation

A

people should not be in the room without a dosimeter badge to monitor radiation exposure

trash may be too radioactive to service like other trash

family should only come for 30 minutes, minimal risk

pregnant individuals are at most risk- teratogenic-related abnormalities

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57
Q

venous ______ are a serious complication of venous insuffiency

A

venous ulcerations

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58
Q

when you see apathy and depression in a withdrawal patient, that is likely from a _____ withdrawal

A

stimulant

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59
Q

legumes, grains and fish should be encouraged for a ____ deficient diet

A

Vitamin B1 deficient

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60
Q

tomatoes, potatoes and fruit juice is appropriate for a vitamin __ deficient patient

A

C

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61
Q

leafy vegetables, eggs, and cheese is appropriate for a vitamin ___ deficient patient

A

K

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62
Q

liver, sweet potatoes, and carrots are appropriate for a vitamin ___ deficient patient

A

A

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63
Q

exenatide stimulates the pancreas to secrete ______ when blood sugar levels are high

A

insulin

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64
Q

exenatide should be administered

A

twice a day within 1 hours before the morning and evening meals

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65
Q

_____ precautions are implemented when caring for a client with measles for up to 4 days after the onset of rash

A

airborne

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66
Q

_______ precautions are used for clients with diphtheria, rubella, streptococcal pharyngitis, pertussis, mumps

A

droplet

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67
Q

c-diff requires _____ precautions

A

contact

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68
Q

hypocalcemia results from blood transfusions containing _____

A

citrate

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69
Q

citrate from blood transfusions causes _____ cell membrane permeability leading to increased neuromuscular excitability, which may result in

A

increased

numbness or tingling in ears, nose, fingers and toes d/t citrate causing hypocalcemia

if severe, laryngospasm, seizures, and cardiac arrest may occur

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70
Q

hypercalcemia causes _____ neuromuscular excitability

S&S?

A

decreased

S&S: fatigue, hypoactive deep tendon reflexes, decreased muscle strength and tone, bone pain, decreased GI motility

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71
Q

hyponatremia results in fluid shifts into cerebral spaces causing ______

A

cerebral edema

can results in seizure, coma, respiratory arrest

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72
Q

hypernatremia causes fluid to shift ____ of the intracellular fluid resulting in cellular _____

A

out
dehydration

cerebral vessels shrink and tear, resulting in cerebral hemorrhage

S&S: lethargy, irritability on stimulation, high pitched cry

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73
Q

hypocalcemia is anticipated with ______ processes

A

alkalotic

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74
Q

serum potassium levels are often _____ in metabolic acidosis

A

HIGH

as pH drops, excess H ions enter RBCs causing K+ to leave the cells, resulting in hyperkalemia

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75
Q

a client who is fatigue, dry skin, poorly healing wound likely is experiencing

A

malnutrition

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76
Q

starvation can lead to metabolic _______

A

acidosis

low bicarb levels

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77
Q

cyanosis of the tongue, jaundiced skin and slow capillary refill are common with what patients?

A

sickle cell

cyanosis of tongue- poor profusion
jaundices- rapid breakdown of RBCs
slow cap refill- poor capillary profusion

*slurred speech is not common- indicates stroke!

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78
Q

BNP normal value

A

<100

elevated BNP indicates congestive HF

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79
Q

sedimentation rate: normal values

A

Men under 50: <15 mm/h
Men over 50: <20 mm/h
Females under 50: <25 mm/h
Females over 50: <30 mm/h

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80
Q

elevated sedimentation rate indicates

A

inflammatory process going on

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81
Q

elevated CRP indicates

A

inflammation, tissue injury, infection, atherosclerosis

82
Q

CRP normal value

A

1 mg/L

83
Q

INR warfarin therapeutic range

A

2.5-3.5 seconds

84
Q

elevated INR indicates high risk of _____

A

bleeding

takes longer for blood to clot

85
Q

the term station in OB means

A

the relationship between the presenting fetal parts to the ischial spines

86
Q

placing a client recovering from an above the knee amputation in a ____ position prevents the development of hip contractures

A

prone

30 minutes, 3-4x/day

elevating the limb on a pillow for 2 hours and sitting in a chair for greater than an hour both encourage the development of hip contractures

87
Q

can NAPs bladder scan even with nurse supervision

A

NOT IN THE NCLEX WORLD!

88
Q

Contractions occurring at 2-4 minute intervals lasting 50-60 seconds are seen in the ____ phase of labor

A

active

89
Q

contractions occurring at 5-30 minute intervals and lasting 10-30 seconds are seen in the _____ phase of labor

A

latent

90
Q

contractions occurring at regular 2-3 minute intervals and lasting 1-2 minutes are seen in the _____ phase of labor

A

transition

91
Q

the nurse should ___ document in a note that an incident report was completed

A

should NOT

92
Q

is massaging the injection site appropriate after a SQ injection?

A

no

93
Q

hypercalcemia –> nurse should encourage

A

movement
increase fiber to prevent constipation
fluids (at least 3L/day) to prevent exacerbation, especially fluids with Na in it
administer zoledronate

94
Q

zoledronate is a biphosphonate drug that inhibits the action of osteoclasts and therefore _______ serum Ca+2 levels

A

reduces

95
Q

rhabdomyolysis results in ____ breakdown and can lead to ________ putting the kidneys at risk for an AKI

A

muscle breakdown

myoglobinuria

need to keep the client hydrated and a UO of 200-300 mL/hr

96
Q

creatinine kinase vs. creatinine

A

creatinine kinase- evaluates muscle function

creatinine- evaluates renal function

97
Q

amylase is released by the

A

pancreas

monitored in pancreatitis

98
Q

relief of severe ABD pain radiating to the back by sitting forward with knees bent is seen in a client with

A

acute pancreatitis

99
Q

scabicide should be applied to the

A

neck and down

not on the face or scalp

100
Q

cushings triad for increased ICP S&S

A

HTN (widened pulse pressure)
bradycardia
bradypnea (irregular)

*opposite of shock

other S&S: weakness, lethargy, HA, vomiting, blurred vision, changes in behavior

101
Q

in _____ patients, the sclera and buccal mucosa will be yellow in color

A

hepatitis

102
Q

a AKI patient is at risk for_______

A

hyperkalemia

103
Q

AKI patients should avoid: potatoes, raisins, bananas because they are high in

A

potassium

104
Q

pasta is a good source of caloric needs and energy for patients with an

A

AKI

low in K+ and meeds needs

105
Q

acute osteomyelitis

A

bone pain, redness, swelling

ABX tx at home

106
Q

elevated BNP indicates

A

congestive heart failure
released from ventricles when not performing well

<100 normal

excess fluid volume r/t increased venous pressure and decreased renal perfusion secondary to heart failure

107
Q

thyroid crisis post op thyroidectomy

A

first 12 hours post-op

S&S of hyperthyroidism are exaggerated

S&S: N/V, severe tachycardia, severe HTN, hyperthermia up to 106F

108
Q

S&S of hypothyroidism- expected findings

A

cold intolerance, constipation, depression

109
Q

cataracts cause vision to appear

A

cloudy

110
Q

glaucoma causes a gradual loss of

A

peripheral vision

111
Q

with a , ______ ________ there is a sudden loss of partial or complete vision in one eye

A

detached retina

112
Q

change in central vision described as blurry or distorted describes

A

macular degeneration

113
Q

maternal ______ with possible reduction in placental perfusion is most likely to occur within the fist 15 minutes after initiating an epidural or injection of intermittent boluses

A

hypotension

114
Q

formoterol is a long-acting

A

bronchodilator

115
Q

imipramine

A

tricyclic antidepressant

increase serotonin in brain

take at night to prevent daytime drowsiness and aid in sleep

116
Q

masks and oxygen concentration

A

partial rebreather mask delivers 60-90% oxygen

venturi mask delivers high flow oxygen (40%)

non-rebreather mask delivers 60-90% oxygen

simple face mask doesn’t provide a precise percentage of oxygen

117
Q

what is a common complication of oxygen therapy in very low birth weight preterm newborns?

A

visual impairment or blindness d/t injury of developing retinal blood vessels is sometimes precipitated by high levels of oxygen

118
Q

what kind of exercises do you want for osteoporosis therapy

A

weight-bearing

119
Q

medicare uses a fixed reimbursement amount based on assigned

A

diagnosis-related groups, regardless of patient’s length of stay or use of services

diagnosis-related group reimbursement group is based on case severity, rural/urban/regional costs, and teaching costs, not national averages

120
Q

hypotension with a narrow pulse pressure is a clinical manifestation associated with

A

cardiogenic shock

ex: 100/88

121
Q

how to prevent tumor lysis syndrome

A

administer high rate of fluids and sodium bicarbonate to prevent effects of tumor lysis syndrome (hyperkalemia, hyperuricemia, cardiac failure, renal failure)

122
Q

eschar is

A

a thick, leathery coating caused by acid or heat exposure

123
Q

liquefaction necrosis indicates

A

chemical burn process is continuing

124
Q

intact blisters indicate a ______-________ thermal injury

A

partial thickness

125
Q

primary open angle glaucoma is

A

painless

ophthalmic drops are prescribed and clients need to know how to use them

check meds they take to see if any increase intraocular pressure

126
Q

constipation prevention

A

exercise 3x/week
avoid caffeine, tea, cola
drink 3 quarts fluids/day
consume 20-30g fiber/day

127
Q

diarrhea, HTN, emesis are side effects of

A

opioid withdrawal

-rebound effects

128
Q

diverticular disease dietary recommendations

A

high fiber, 8 8 ounces of water/day, limit red meat, low fat diet to reduce risk of constipation

avoid alcohol- irritate GI tract lining

diverticula are little pouches that form in the colon. when they become inflamed, it is diverticulitis

129
Q

type 2 diabetes drugs: metformin, glipizide, repaglinide, miglitol

A

Metformin, a biguanide, controls blood glucose levels in type 2 diabetes by inhibiting glucose production in the liver and increasing insulin sensitivity in body tissues.

Glipizide, a second-generation sulfonylurea, controls blood glucose levels in type 2 diabetes by stimulating pancreatic beta cells to secrete insulin.

Repaglinide, a meglitinide, controls blood glucose levels in type 2 diabetes by stimulating pancreatic insulin secretion.

Miglitol, an alpha-glucosidase inhibitor, controls blood glucose levels in type 2 diabetes by delaying absorption of complex carbohydrates in the intestine. This delays carbohydrate digestion after meals slowing glucose entry into the systemic circulation.

130
Q

lead poisoning screening

A

begins at 12 months for low risk clients, repeat at 24 months

high risk infants screened at 6 months

131
Q

magnesium sulfate is used for

A

electrolyte replacement or anticonvulsant

not an analgesic!

132
Q

early signs of peanut allergy

A

urticaria (red, itchy welts on skin), wheezing, dyspnea

133
Q

hiatal hernia mimics symptoms of

A

gastric reflux

bulging of top of stomach above the diaphragm

134
Q

CT bubbling in the control chamber

A

The third compartment, the suction control chamber, applies suction to the chest drainage system. Bubbling is an expected finding. If no bubbling is seen in the suction control chamber, (1) there is no suction, (2) suction is not high enough, or (3) the pleural air leak is so large that suction is not high enough to evacuate it.

135
Q

adenosine adm for SVT

A

1-3 second injection + 20cc NS flush

136
Q

magnesium IV is given for

A

torsades de pointes

137
Q

what drug can be used after epi in a cardiac arrest with a patient with V fib or V tach?

A

amiodarone

antiarrhythmic

138
Q

atropine is only used in

A

symptomatic bradycardia

139
Q

side effects of anticholinergic medications

A

pupil dilation/blurred vision, xerostomia/dry mouth, constipation/reduced bowel tone and motility, urinary hesitancy and retention

does not cause paresthesia (pins & needles sensation)

140
Q

should insulin glargine be mixed with other insulins?

A

no, needs to be a separate injection because it is long acting

141
Q

contrast is toxic to what organ

A

kidneys

inform provider before cardiac cath if creatinine clearance is decreased

142
Q

risk factors for fetal macrosomia

A

maternal obesity, gestational diabetes

fat baby

143
Q

severe hypokalemia and use of oxycodone may cause paralytic ileus resulting in

A

absent bowel sounds

adverse reaction of oxycodone

144
Q

fast acting insulin

A

clear

  1. rapid acting insulin: lispro, aspart, glulisine
  2. short acting insulin: regular insulin (still considered fast though)

rapid acting insulin:
onset: 10-30min
peak: 0.5-4 hours
duration 3-6 hours or less

time of adverse reaction: mid morning

need to eat with 5-15 mins of administation

145
Q

regular insulin (short acting)

A

clear

only type of insulin used in pumps and administered IV

can be mixed with intermediate acting insulins, just not long-acting.

draw up: “clear before cloudy” –> draw up regular insulin first then NPH

onset: 30-60 min (if adm IV- onset 10-30 min)
peak: 2-5 hours
duration: 6-10 hours

client needs to eat within 20-30minutes of injection time

146
Q

intermediate acting insulin

A

cloudy (contains protein that prevents body from breaking it down right away)

draw up: “clear before cloudy” –> draw up regular insulin first then NPH

NPH (cloudy), insulin detemir (clear)

onset: 1-2/3-4 hours
peak: 6-14/12-24hours
duration: 16 hours, 18-24 hours

time of adverse reaction: early evening

administered once/day and can be given after meals

147
Q

S&S hypoglycemia

A

nervousness, tremors, confusion, sweating, tachycardia

148
Q

slow-acting (long-acting) insulins

A

glargine, insulin detemir (intermediate to long-acting)

onset: 3-4 hours
peak: no peak/6-8 hours
duration: 24 hours/varies, 6-24 hours

cannot be mixed with other insulins

both clear solutions

given HS (at bedtime)

149
Q

combination insulin

A

short and intermediate acting
pre-mixed NPH + regular with percentages of each

pre-filled syringes, mixed solutions that you just draw up

onset: 0.5 hours or sooner for 75% short acting
peak: 2-12 hours
duration: 20-24 hours

150
Q

insulin precautions- what medications increase and decrease insulin needs

A

thiazide diuretics, glucocorticoids/cortisone, thyroid meds, estrogen elevate glucose levels –> increased insulin needs

tricyclic antidepressants, MAO inhibitors, aspirin, anticoagulants –> decrease insulin needs

illness and stress increase glucose and therefore insulin needs are increased

151
Q

oral hypoglycemics

A

T2DM

used in conjunction with insulin as well if needed (if diet-controlled is insufficient)
-when T2DM under stress/illness/trauma/surgery, increased insulin needs and need to be on a sliding scale insulin

S&S: hypoglycemia, GI upset, skin reactions

considerations: take before breakfast (with food if severe GI upset), avoid alcohol (metformin- life threatening lactic acidosis or sulfonylureas- significant GI distress, HA)

-sulfonylureas: glyburide, glipizide, glimepiride
works by increasing secretion of insulin and increasing body’s sensitivity to insulin

-biguinide: metformin
works by decreasing hepatic production of glucose/decrease intestinal glucose absorption
*contrast and alcohol can cause severe lactic acidosis when on metformin
*severe diarrhea needs to let provider know

-alpha-glucosidase inhibitors: Acarbose, Miglitol
works by preventing absorption of carbs in intestines

-thiazolidinediones: Pioglitazone, Rosiglitazone

-incretin modifiers or mimics
work by increasing insulin secretion and decreasing glucagon secretion

152
Q

normal wedge pressure

A

4-12 mmHg

153
Q

what do you do with elevated wedge pressure?

A

diuresis

154
Q

normal 12 hour newborn assessment findings

A

acrocyanosis (blue hands and sometimes feet) for up to 24 hours
cyanosis Apgar score of “1” and color should return after blanched

apneic periods < 20 seconds

tachypnea (greater than 60 breaths/min)

155
Q

signs of newborn respiratory disress

A

nasal flaring, retractions, cyanosis, grunting, seesawing (abdomen lifts and chest sinks –> indicates airway obstruction)

156
Q

post-term neonate assessment findings

A

skin cracked and peeling

absent vernix (white, cheesy substance protecting the baby’s skin in womb)

deep plantar creases

157
Q

preterm neonate (<34 weeks gestation) assessment findings

A

little ear cartilage and remains folded

thick covering of vernix (white, cheesy substance protecting the baby’s skin in womb)

few creases on foot

lanugo present (fine, soft hair covering body)

158
Q

full-term neonate assessment findings

A

full term newborn- ear returns to normal position immediately

some peeling and cracking of skin mainly in areas with creases

little vernix except small amount in creases (white, cheesy substance protecting the baby’s skin in womb)

lanugo (fine, soft hair covering body) may be present- usually sheds by 32-36 weeks. small amount may be present on upper back and shoulders, ears or side of forehead

159
Q

70% of digoxin is excreted in the

A

kidneys

monitor for renal failure

Cr=7 indicates digitalis toxicity (same thing as digoxin toxicity)

160
Q

weakness, acute pain, joint swelling, cyanosis/jaundice are S&S of

A

sickle cell crisis

weakness- pain/anemia
cyanosis-hypoxia
jaundice- RBC destruction
swelling of joints- blood vessel occlusion at joint

priapism (persistent erection) can occur in men

161
Q

eating with a tracheostomy

A

deflate the trach cuff before giving solid foods helps the client swallow

client should have thickened fluids rather than thin fluids to reduce risk of aspiration

162
Q

tracheostomies should only have an inflated cuff when

A

used for mechanical ventilation and the client is at risk of aspiration of saliva/fluids

if speech pathology approves to eat, then deflate cuff and provide solid foods/thickened liquids

163
Q

foods high in vitamin K such as spinach, broccoli, and beef antagonize the effects of

A

warfarin

however, the intake of vitamin K must be consistent until the INR ration is therapeutic

164
Q

left lateral recumbent position is best for

A

inserting a rectal tube

follows normal curvature of the rectum and sigmoid colon

165
Q

what fluids would you anticipate giving a client with hypernatremia?

A

5% dextrose (D5W)

NS and LR have sodium in it. D5W dilutes excess serum sodium

166
Q

tPA requirements

A

normal platelet range (150-400)

GI/urinary bleeding within last 21 days, prior intercranial hemorrhage, is a contraindication

IV tPA can be administered within 3-4.5 hours from symptom onset
interarterial tPA infusion can be administered for up to 6 hours after onset of stroke symptoms

intracranial surgery, stroke or serious head injury in previous 3 months is a contraindication

167
Q

suction pressure for newborn

A

60-100 mmHg

advance catheter 3-5 inches into nose

168
Q

psyllium is a

A

bulk forming laxative prescribed to help prevent bowel contents from accumulating in the diverticulum

169
Q

side effects of prednisone

A

hunger, potassium depletion, weight gain, hyperglycemia, HTN

170
Q

no raw fruit or vegetables, or cheese may be brought into a

A

protective isolation room (neutropenic precautions)

171
Q

steroid inhalers (beclomethasone)

A

rinse mouth after using to prevent thrush

use a spacer to prevent bronchospasm

use albuterol first before using steroid inhaler

172
Q

cystectomy

A

removal of bladder and urine drains into ileal conduit

173
Q

clopidogrel is an

A

antiplatelet drug

174
Q

SOB during pregnancy could indicate

A

respiratory tract infection or cardiac disease

175
Q

chlordiazepoxide is used in alcohol withdrawal to prevent

A

anticonvulsant

seizures, brain injury, and delirium tremors

176
Q

fluoxetine and citalopram

A

SSRI
antidepressant
stabilize mood and anxiety

177
Q

disulfiram can be used in acute alcohol withdrawal after the initial detoxification in order to remain

A

abstinence

178
Q

phenytoin is an

A

anticonvulsant

179
Q

newborn findings: smooth and transparent skin, abundant lanugo on back, slow recoil of pinnae, absent plantar creases indicate the newborn is ________ and should monitor the baby for _______

A

pre-term (<32 weeks gestational age)

respiratory distress syndrome d/t immature lungs and insufficient surfactant

180
Q

bread, vegetables and legumes are high in

A

fiber

181
Q

S&S of acute leukemia

A 
petechiae
orthostatic hypotension
joint pain
weight loss
tachycardia
182
Q

hypoglycemic agents

A

reverse severe hypoglycemia (insulin reaction)

glucagon- stimulates liver to change glycogen to glucose

S&S: N/V, hypotension, bronchospasms

IM/SQ. IV

onset: 15 mins, can repeat in additional 15 mins

administer additional carbohydrates after giving glucagon to prevent subsequent hypoglycemic reactions

183
Q

who’s at risk for chronic kidney injury (intrarenal)

A

ischemia, toxic medications (ABX, iodine contrast media, chemotherapy), muscle trauma (breakdown), transfusion reactions, SLE, glomerulonephritis, DM

postrenal= obstruction

184
Q

problems that result from CKD

A

azotemia (nitrogen waste increase) and resulting uremia (S&S renal failure) then ESRD (cannot sustain life without intervention)

kidneys can no longer concentrate urine, causing a fixed urine specific gravity (doesn’t adjust to the needs of the body), increase BUN, increase serum Creatinine, decrease urinary output

S&S: fluid volume overload, metabolic acidosis (decreasing mental and cardiac function, kussmaul respirations- trying to blow off CO2) , hyperkalemia, HYPERphosphatemia, HYPOcalcemia (increases risk of bone fracture), hypermagnesemia, , hyponatremia (early)/hypernatremia (later), stomatitis, N/V, PUD, HTN, HF, pericarditis (d/t increased metabolic byproducts), HLD, anema (decreased erythropoeitin), pruritis, uremic frost (whitis color) oozing through skin- toxic to skin, increased WBC with infection, decreased RBC,

185
Q

implementations for CKD

A

epoetin alfa (human erythropoeitin to increase RBC production), iron preparations (for anemia), Vitamin D and phosphate binder medications (aluminum hydroxide), peritoneal/hemodialysis

protein is restricted depending on severity and if dialysis is used

sodium, phosphorus and potassium are restricted and vary based on urinary output

immunocompromised!

changes in bone structure and possible alterations in neurological function

antihistamines for itching, avoid drying soaps, uremic frost- frequent cool wash cloths or rinses to get rid of it

186
Q

AKI

A

reversible if caught soon enough, but could become chronic

S&S: rise in serum creatinine and decrease urinary output

187
Q

who’s at risk for developing an AKI?

A

prerenal: dehydration, decreased CO (decreased perfusion of kidneys secondary to CO), renal artery narrowing, shock (shunting blood away from the kidneys)
intrarenal: ischemia, toxic medications (ABX, iodine contrast media, chemotherapy), muscle trauma (breakdown), transfusion reactions, SLE, glomerulonephritis, DM
postrenal: blockage causing urine to backup into the kidneys causing injury –> BPH, prostate cancer, urinary calculi, renal tumors, renal trauma, hydronephrosis

188
Q

Problems that can occur from an AKI

A

HF, HTN, pericardial effusion, anemia, hyperkalemia, hypocalcemia, hyperphosphatemia, hypermagnesemia, UTIs, respiratory infections

189
Q

3 stages of renal failure

A

oliguric phase
diuretic phase
end stage (ESRD, or recovery)

190
Q

oliguric phase of AKI (1/3)

A 
HTN, edema, weight gain (increased blood volume)
oliguria (< 400mL/day) within one week of onset (longer this occurs, more damage can occur), 
metabolic acidosis (bicarbonate is not reabsorbed- may see decreased mental function and bradycardia as a result), hyperkalemia (weakness, ECG changes), hypermagnesemia (bradycardia, hypotension, decreased muscle weakness), lethargy and fatigue progress to more serious symptoms
191
Q

diuretic phase of AKI (2/3)

A

increase in urinary output (up to 5L/day) with very dilute urine- can’t concentrate urine anymore so it lets it all go

hyponatremia (confusion, muscle weakness, hypotension, decreased pedal pulses)

clients can recover from this phase and fluids/electrolytes will slowly return to normal

192
Q

urinalysis

A

URINALYSIS

  • urine specimen (voided, clean-catch or midstream, catheterized, 24-hour urine)
  • color, clarity (cloudy= infection or sediment)
  • specific gravity (1.01-1.03), pH (4.6-8)- infection, A/B balance, diet can affect pH
  • hyperglycemia –> glucose in urine
  • ketones seen only in acidotic or fasting states
  • proteins seen in small amounts normally. increased amounts with kidney disease or preeclampsia
  • RBC- small amounts normal, large amounts indicate urinary calculi, infection, or trauma
  • WBC- very small amounts normally, large amounts indicate infection or inflammation
  • bacteria- normally <1000 colonies/mL. if increases= UTI, C&S needs to be completed
193
Q

urine culture and sensitivity

A

used to determine if bacteria is present in the urine

  • identifies number and types of pathogens
  • sensitivity tests (which ABX is effective against a particular pathogen)
  • midstream or clean catch or catheterized specimen
  • early AM specimen (most concentrated)
  • transport to laboratory

do not start ABX until culture is taken!

194
Q

cystometrogram (CMG)

A
  • evaluates sensory and muscle
  • function of bladder
  • fluid instilled into bladder
  • sensation evaluated
  • pressure inside bladder measured
  • risk for UTI
195
Q

creatinine clearance

A
  • 24 hour urine specimen
  • void at beginning of collection (then it starts after the first void)
  • collect urine at end of collection period
  • serum creatinine level is taken after the specimen collection to measure the creatinine clearance
  • calculated value
  • normal values
    women: 85-125mL/min
    men: 95-140mL/min (more muscle and form more creatinine)
196
Q

cytoscopy

A
  • bladder examined
  • biopsies
  • urinary calculi
  • bladder catheter insertion
  • anesthetic
  • post procedure: urine characteristics, frequency, ABX, contact if bright red urine or abnormal
197
Q

IV pyelography

A
  • evaluation of kidneys, ureters, bladder
  • IV injection of contrast media
  • prior to procedure: bowel prep, iodine or shellfish allergies, assess renal function (can’t do this if kidneys are too damage), want to know if client is on metformin
  • procedure: salty taste in mouth, warm feeling during dye injection (normal)
  • post-procedure: increase oral intake (want to flush out contrast ASAP), assess for allergic reaction
198
Q

respiratory acidosis has a high _____

A

PCO2

199
Q

metabolic acidosis has a low ______

A

HCO3

200
Q

respiratory alkalosis has a low _____

A

PCO2

201
Q

metabolic alkalosis has a high ______

A

HCO3

202
Q

digoxin

A

increases contractility of heart to increase CO

HR decreases, heart is less stretched and BP may decrease d/t less sympathetic stimulation

decrease SA node automaticity, decrease AV node conduction, increase ventricular automaticity –> HR decreases
*adverse effect: increased risk of ventricular dysrhythmias

second line tx for HF d/t toxicity and

NCLEX Preparation (5 decks)

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