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Galen Comprehensive Review > Comprehensive Review Material > Flashcards

Comprehensive Review Material Flashcards

1
Q

HGB normal range

A

12-18

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2
Q

HCT normal range

A

37-52

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3
Q

WBC normal range

A

5-10

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4
Q

PLT normal range

A

150-400
Monitor on Heparin, hold if <100, risk for HIT

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5
Q

PT normal range

A

11-12.5

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6
Q

PTT normal range

A

20-30

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7
Q

INR normal range

A

0.9-1.2
Monitor on Warfarin

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8
Q

NA normal range

A

135-145

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9
Q

K+ normal range

A

3.5-5

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10
Q

CL normal range

A

98-106

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11
Q

CA normal range

A

9-11

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12
Q

BUN normal range

A

10-20

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13
Q

CR normal range

A

0.5-1.2

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14
Q

BG normal range

A

70-110

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15
Q

ABGs normal ranges

A

pH 7.35-7.45
CO2 35-45
HCO3 22-28

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16
Q

Incident Reports: indicated for, where do they not go

A

Do not go in pt chart
Indicated for: adverse reactions, med errors, injury, lost/stolen items, pt fight c doctor

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17
Q

Airborne precautions

A

MTV: measles, TB, varicella

N95, private negative pressure room, door shut

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18
Q

Droplet precautions

A

Spiderman: sepsis, scarlet fever, strep, pneumonia, pertussis, influenza, diphtheria, rubella, epiglottitis, rubella, mumps, meningitis, adenovirus

Mask, private room or share c same organism, mask on pt when transporting

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19
Q

Contact precautions

A

c.diff, rsv, eye infections, wound or skin infections

Private room, gloves, gown when entering room

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20
Q

Donning PPE

A

Gown
Mask
Goggles
Gloves

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21
Q

Doffing PPE

A

Gown
Gloves
Mask
Wash hands

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22
Q

Live Vaccines & contraindications

A

mmr, varicella, flumist, rotavirus

Contraindicated: pregnancy, fever >101, immune compromised, low wbcs

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23
Q

RN scope of practice

A

EAT, PLAN CARE, DISCHARGE, BLOOD PRODUCTS, IV

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24
Q

LPN scope of practice

A

Reinforce teaching, reassess, past medical history, accucheck, wound vac, dressing change, trach care

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25
Q

UAP scope of practice

A

transport, I&O, vitals, ADLs, positioning

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26
Q

Consent: Before signing

A

Risks and benefits of surgery, alternative treatments, plan of care in layman’s
no consent = no treatment

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27
Q

Emergency but no consent form

A

Implied consent granted

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28
Q

Minors and consent

A

Parent or legal guardian gives consent, EXCEPT for mental or reproductive health or substance abuse

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29
Q

What chronic conditions require an interdisciplinary team approach?

A

Parkinson’s
Hip dysplasia @ 6months
Cystic Fibrosis
NAS baby c drug addicted mother

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30
Q

What foods are high in potassium?

A

Avdocadoes, strawberries, potatoes, tomatoes, bananas

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31
Q

What foods are high in calcium & what vitamin do you take with calcium?

A

Milk, yogurt, shellfish, salmon, dark leafy greens

Vitamin D

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32
Q

Mass Casualty: What conditions are tagged red?

A

Life threatening: Airway obstruction, shock, cardiac arrest, pulseless fracture

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33
Q

Mass Casualty: What conditions are tagged yellow?

A

Can be delayed: open fracture c pulse, closed fracture, deep lacerations, hypoglycemia

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34
Q

Mass Casualty: What conditions are tagged green?

A

Walking wounded: episodic illness

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35
Q

Mass Casualty: What conditions are tagged black?

A

Dead/Death expected: fixed+dilated pupils, grey matter exposed, burns 60%+ of body

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36
Q

Lung Sounds: Where are bronchiole sounds heard?

A

Around the trachea, 2nd and 3rd ICS

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37
Q

Lung Sounds: Where are bronchovesicular sounds heard?

A

Heard over major bronchi, between the scapulae

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38
Q

Lung Sounds: Where are vesicular sounds heard?

A

Over lung bases

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39
Q

A low pitched ventilator alarm indicates _____________?

A

Low = leak,
Something is disconnected, dislodged, cuff leaking

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40
Q

A high pitched ventilator alarm indicates _____________?

A

High = pressure increase
Kink in tubing

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41
Q

When a ventilator alarm goes off what is the first nursing action?

A

Assess the patient then check the tubing and the ventilator.

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42
Q

What indicates correct understandings when asked about proper suctioning for a client with a trach (4 concepts)?

A
  1. Suctioning is always PRN,
  2. position semi to high Fowler
  3. hyperoxygenate
  4. suction 10-15 sec interval, 2-3 times
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43
Q

What is a contraindication for blood transfusions and what can you give to help?

A

febrile pt , premeditate c Tylenol + Benadryl

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44
Q

When is a transcutaneous pacemaker indicated?

A

Emergency situations only
Significant discomfort for client

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45
Q

What should you educate a client about related to their permanent pacemaker?

A

Don’t raise arms for two weeks
Phone on opposite side of pacemaker
Don’t submerge in water (initially)

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46
Q

Important nursing considerations before cardiac cath?

A

Check pt creatinine (0.5-1.2)
if over 2 kidneys not working = no cardiac cath, can’t excrete contrast

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47
Q

Important nursing considerations after cardiac cath?

A

Assess peripheral pulses (q15min/hr, q30min/hr, q1hr for 4 hours)
Bed rest 2-6 hours
Bleeding risk- apply pressure 15 min

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48
Q

What are the expected signs and symptoms of cardiac tamponade? (4)

A

Muffled heart sounds, JVD, hypotension, pulsus paradoxis

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49
Q

What are 3 signs of Impending rupture of a AAA?

A

Different BP in each arm
Sudden onset hypotension
Severe lower back pain

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50
Q

A client is following a low cholesterol diet and their LDLs are high and HDLs are low what is the nursing action?

A

Call PCP- low cholesterol diet indicates adherence, so LDLs should be low and HDLs should be high

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51
Q

What foods should a client avoid if they are prescribed a low cholesterol diet? (5)

A

Organ meats
Butter
Egg yolks
Fatty meats
Whole milk

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52
Q

What foods should a client consume if they are prescribed a low cholesterol diet? (5)

A

Walnuts
Salmon
Olive oil
Shellfish
Fruits + veggies

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53
Q

What indicates a correct understanding of NG tube insertion? (3)

A

Consent needed
Measure bridge of nose, around ear down to xyphoid process (mark)
Pt look up then insert

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54
Q

What are two important nursing interventions to consider when a client has an NG tube?

A

Disconnect from suction to auscultate bowel sounds
Perform oral care

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55
Q

What are 6 nursing considerations related to tube feeds?

A

No food coloring/dyes in tube
Check placement c pH <4
Keep schedule, do not increase rate if behind
If patient has to lie flat TURN OFF (prevent aspiration)
Check residual before feeding
Sit upright 1 hr after feed (prevent aspiration)

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56
Q

What are important nursing considerations when removing an NG tube?

A

Client sit in high fowler
Client take a deep breath + hold, quickly remove tube

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57
Q

What are four expected s/s associated with Crohn’s disease?

A

RLQ pain worse with eating
Steatorrhea
Wt loss
No blood in stool

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58
Q

What kinds of diets are indicated for a client with Crohn’s disease?

A

High calorie + High protein
Low fiber
(NO dairy, grains, raw fruits + veggies)

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59
Q

What are three expected s/s associated with Ulcerative Colitis?

A

20-40 liquid bloody stools/day
Abdominal distention
High pitched bowel sounds

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60
Q

A client with ulcerative colitis has been on a low residue diet with high calories and protein and fluids have been increased, they are having <10 liquid bloody stools/day what is the nursing action?

A

Send client home on prednisone

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61
Q

A high fiber diet is indicated for diverticul____?

A

DiverticulOSIS = pouch herniations
Increase fiber to get rid of waste so it doesn’t sit, get stuck in pouches

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62
Q

A low fiber diet is indicated for diverticul____?

A

DiverticulITIS = inflammation of intestine
Low fiber to decrease intestinal stimulation, irritation
-litis = low fiber

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63
Q

What are five expected s/s associated with IBS?

A

Bloating
Abdominal pain
Mucus in stool
Erratic bowel pattern
Diffuse abdominal tenderness

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64
Q

What medication would be a contraindication with IBS?

A

Loperamide - antidiarrheal

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65
Q

What are expected s/s associated with PUD [peptic ulcer disease]?

A

Dull gnawing pain
Decrease H+H ( blood transfusion maybe required)

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66
Q

What are the treatment options for PUD?

A

Place NG tube (coffee ground = old blood, bright red = active bleed)
Triple therapy: 2 antibiotics + one PPI

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67
Q

Cirrhosis is ___________ ____________ of the _________.

A

Irreversible
Scarring
Liver

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68
Q

Jaundice, enlarged liver and weight loss indicate what stage of Cirrhosis?

A

Early stage: increase protein

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69
Q

Splenomegaly, esophageal varices, clay colored stool, small modular liver indicate what stage of cirrhosis?

A

Late stage

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70
Q

Restlessness, coma, stupor and asterixis indicate what stage of cirrhosis?

A

End stage
Asterixis (hand flapping)

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71
Q

Moon face, trunchal obesity, irritability, buffalo hump, striae, hyperglycemia, hypernatremia, and hypokalemia indicate what endocrine disorder?

A

Cushing’s- excessive aldosterone/ over secretion

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72
Q

What diet is indicated for a client with cushing’s?

A

High calcium
Low sugar
Low salt

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73
Q

A client with Cushing’s is d/c with a new prescription for prednisone what is the next nursing action?

A

Question prescription, Cushings is caused by over steroid use, prednisone is a steroid

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74
Q

A client presents to the ED with bronze pigmentation, anorexia, salt craving, fatigue, what condition is associated with these signs and symptoms?

A

Addison’s- under secretion/ adrenalectomy, stress bomb, do not adapt to stress
Add a -sone = tx
Everything low + slow EXCEPT K+ & Ca+

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75
Q

What nursing considerations are important for Addison’s Disease? (4)

A

Fluid status- hydration
Check blood sugar frequently - prevent hypoglycemia
Assess cardiac function (hyperkalemia)
Monitor for adverse effects of tx (-sones) = s/s of Cushing’s

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76
Q

What three things can bring on Addisonian Crisis and what does a crisis look like (4)?

A

Bring on crisis: stress- surgery, infection, trauma
Looks like: Low Na+, Low Glucose, Low BP, High K+ (shock)

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77
Q

Insulin drips can quickly (increase/decrease) K+ levels and are indicated for _____________? What other treatment options are indicated?

A

Quickly Decrease K+ levels
Indicated for Addisonian crisis
Other tx: IV fluid, D5W + NS, IV steroids

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78
Q

Excessive ADH (vasopressin), r/t small cell lung cancer, bounding pulses, severe HTN, hyponatremia, changes in LOC, concentrated/decreased UO are associated with what condition?

A

SIADH - soaked inside(low liquidy labs), sticky concentrated urine, Low blood osmolality

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79
Q

What are five important nursing considerations for a client with SIADH?

A

Restrict fluids (500-1000ml/24hr)
Seizure precautions (Na+ <135), HA = early sign
Monitor I&O (strict c daily wt)
Give/ eat salt (IV 3% NaCl + furosemide if Na+ normal & HF indicated)
Tolvaptin (ADH antagonist- promote water loss s losing Na+)

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80
Q

Diabetes Insipidus (DI) is suspected if a client present with what five s/s?

A

Polydipsia
Polyphagia
Oliguria
Tachycardia
Hypernatremia
-DI = dry inside, diuresing (high diluted UO), decreased BP, dry skin

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81
Q

What is a priority assessment finding in a client with DI?

A

Headache (HA) indicates low sodium <135 = seizures = DEATH
Tx: desmopressin decreases urine output

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82
Q

What is a priority nursing action if pheochromocytoma is suspected?

A

DO NOT palpate or percuss the abdomen
(BP in same arm, no caffeine, no smoking, tumor releases catacholimines= fight/flight

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83
Q

A client presents to the ED with HA, HTN, Hyperhydrosis, Hypermetabolism, and Hyperglycemia, what condition is most closely associated with these signs and symptoms?

A

Pheochromocytoma
S/S: 5 H’s
Tx: alpha adrenergic blockers (decrease blood pressure)

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84
Q

What are five expected signs and symptoms associated with Diabetic Keto Acidosis (DKA)?

A

BG >300, metabolic acidosis, kussmaul’s respirations, fruity breath, (+) positive ketones
Tx: regular insulin IV drip
GI upset: metoclopramide/ reglan

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85
Q

What are four important nursing interventions in the management of DKA?

A

Insulin bolus ( tx high BG) (increase BG 50- 75/hr)
Assess vitals q15 minutes until stable
Assess LOC and BG qhr until stable then q4h
Monitor for s/s of dehydration & hypokalemia = DEATH IN DKA
-(UO has to be at least 30 mL/ hr to give potassium)

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86
Q

A client presents to the ED with BG > 600, no ketones in urine, severe dehydration, and hypokalemia what condition can be suspected?

A

HHS: decreased urination, monitor hydration, neuro checks (seizures)
Tx: fluids, 1/2 NS, insulin (decrease 50-70ml/hr)

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87
Q

What is a priority nursing action to consider when a patient presents with HHS?

A

Ensure they stay hydrated!!!

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88
Q

A client presents with numbness and tingling of the lower extremities and upon initial assessment has decreased tendon reflexes, what condition is this client experiencing and what can be done about it?

A

Neuropathy- thickening of capillary basement membrane- ischemia and nerve death can result

Tx: gabapentin, cymbalta

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89
Q

What are three important nursing considerations to discuss when doing education on diabetic foot care?

A

Wash and inspect both feet DAILY c mirror
Always wear shoes
Use lotion NONE BETWEEN TOES

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90
Q

What is an early indicator a client is experiencing hardening of the glomeruli or nephropathy?

A

Early indicator: Microalbuminemia
(Avoid nephrotoxic substances i.e: gentamycin, contrast dye

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91
Q

What is epilepsy?

A

Chronic seizure activity

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92
Q

A generalized seizure affects the entire brain and includes _________ seizures which is stiffening and lasts 30 seconds to several minutes, and _________ seizures which is muscle contraction and relaxation (jerking).

A

Tonic , Clonic

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93
Q

A nurse has just arrived for her shift and witnesses her client fall to the floor. The client stiffens their body followed by rhythmic jerking motions, what kind of seizure did the nurse witness?

A

Tonic-Clonic; client becomes immediately unconscious

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94
Q

A ________ seizure is one where a client stays conscious, an aura may occur, and may experience [autonomic changes].

A

Partial
[change in heart rate, skin flushing, epigastric discomfort

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95
Q

What are important nursing considerations when implementing seizure precautions? (5)

A

O2, suction, airway at bedside
Iv access
Nothing in mouth, loosen restrictive clothing
Pt on side
Bed in lowest position

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96
Q

What is the priority nursing intervention when a client experiences a seizure?

A

Maintain patent airway

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97
Q

Benzodiazepines (-lams and -pams) are used to treat ________ seizure activity, while phenytoin is used for ________ seizure activity.

A

Acute: Diazepam and lorazepam (flumazenil is antidote)
Chronic: Phenytoin (oral hygiene to prevent gingival hyperplasia)

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98
Q

What is important to educate to a client with a new prescription for carbamazepine?

A

Use other forms of birth control

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99
Q

A client presents to the ED with symptoms of ICP (increased intracranial pressure) what does the nurse expect to observe? (5)

A

Change in LOC
Restlessness
HA
Sensory changes
Stupor

*Normal ICP: 10-15

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100
Q

A client presents with bradycardia, cheyne-stokes respirations and widened pulse pressure (Severe HTN) what is the client experiencing?

A

Cushing’s Triad= EMERGENCY brain stem compression
Late sign of ICP

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101
Q

What are important nursing interventions to implement when dealing with a client who has ICP? (5)

A

HOB 30,
neck neutral, log roll,
no shivering/control fever (increases ICP),
no cluster care,
decrease stimuli

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102
Q

What are key features of Multiple Sclerosis (MS)? (6)

A

Muscle weakness
Dysphagia - difficulty swallowing
Nystagmus - uncontrolled eye movement
Tinnitus - ear ringing
Diplopia - double vision
Vertigo

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103
Q

A client with MS is being discharged home what should be included in the discharge teaching? (4)

A

Avoid hot tubs + hot showers
Watch feet while walking
Walk c feet slightly apart
Use assistive devices

MS- autoimmune, periods of exacerbation + remission

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104
Q

A nurse is caring for a client diagnosed with MS what medications should the nurse expect the PCP to order?

A

Interferon - sub q inj, immunomodulator/ antiviral effect
Prednisone - glucocorticoid/ anti inflammatory

105
Q

Pyridostigmine is a drug used in the treatment of Myasthenia Gravis, what is important to educate about this drug?

A

effectiveness = increase in strength
Do not miss a dose = crisis
*anticholinesterase- take 30-60 min before food to increase muscle strength for chewing/swallowing

106
Q

Myasthenia Gravis is an autoimmune disorder characterized by ptosis (drooping eyelid), dysphagia and fatigue with symptoms worse later in the day, what are six important nursing interventions to implement in the care for this client?

A

Support Airway
CPT
Avoid sedatives
Falls risk
HOB up 30 - prevent aspiration
Activities early in day

107
Q

A client presents with muscle weakness that starts in the lower extremities and spreads proximally, what condition is this client experiencing?

A

Guillian-Barre- inflammatory disease of peripheral nervous system, symmetrical temporary paralysis, begins in lower extremities and ascends bilaterally (goes up body)

108
Q

A nurse has been assigned a client with a diagnosis of Guillian-Barre what nursing interventions should the nurse implement?

A

Monitor for DVT and pressure ulcers
Prevent paralytic ileus c tube feeds/ TPN

109
Q

What is a complication of a spinal cord injury?

A

Autonomic Dysreflexia: severe HA, change in HR, hyperhydrosis, High BP
*severe HA is first sign

110
Q

A secondary injury after a spinal cord injury may result from swelling, hemorrhage, ischemia or inflammation, what medication class will a nurse expect to be prescribed to prevent the secondary injury?

A

Glucocorticoids

111
Q

A client understands cast care if they do what at home? (4)

A

Ice cast for 1-2 days after it’s put on
Never put anything inside cast
Use a hair dryer cool setting to “scratch” an itch
Bag over cast in shower, no fully submerging

112
Q

What interventions are associated with the compensatory
stage of shock?

A

Promote safety
Monitor tissue perfusion

113
Q

Preventing complications and promoting rest are associated with what stage of shock?

A

Progressive

114
Q

A client in the irreversible stage of shock will need what interventions?

A

Fluid replacement
Nutrition support

115
Q

What is shock?

A

Imbalance between oxygen supply + demand (cellular level) = poor perfusion
-Cardiogenic- pump (heart) stops working
-Hypovolemic- decreased body volume (dehydration/ hemorrhage)
-Distributive- blood volume pools, not enough reaches heart (septic, anaphylactic, neurogenic)
-obstructive-physical block of blood flow

116
Q

What is sepsis?

A

Pathogens enter bloodstream, dx: lactate >4, low urine output, hypotension, high cardiac output, neutropenic fever

117
Q

What do you do within three hours of a sepsis bundle? (4)

A

Obtain serum lactate,
cultures,
give broad spectrum antibiotics,
aggressive fluid resuscitation

118
Q

What do you do within six hours of a sepsis bundle?

A

Administer Vasopressors if MAP <65
Reassess intravascular volume status/ tissue perfusion
-CVP goal: 8-12
-ScvO2 goal: >70%
-bedside echo

119
Q

A client diagnosed with neutropenia would need what medication and why?

A

Filgrastim to increase white blood cells

120
Q

Neutropenic precautions include doing what?

A

Private room
Strict hand washing
No fresh flowers, raw fruits/veggies
No live vaccines
Avoid large crowds

121
Q

A client receiving internal radiation or brachytherapy has to follow strict rules, list some.

A

Nurses and visitors only allowed 30min/day
No one under 18 or pregnant allowed in room
Patient cannot ambulate
If it falls out, pick up with mitt + tongs- call pcp
Nurse must wear dosimeter in room, take off when going home.

122
Q

What is important to educate about external radiation?

A

Don’t wash off radiation pen marks
Mild soap + water + hand (no washcloths)
Can have visitors
Avoid sun exposure for 1 year (sunscreen + long sleeves)
Keep follow up appointments

123
Q

A medical emergency known as DIC happens secondary to sepsis, trauma, placental abruption or cancer, what important nursing interventions should be in place for a client with DIC? (4)

A

Maintain fluid balance
FFP + Platelets if needed
Bleeding precautions
Monitor Organ function: mods is a complication of DIC

124
Q

A client is receiving Kayexalate, allopurinol, furosemide and is on dialysis. Their presenting symptoms were AKI, dysrhythmias and seizures, what condition does this client have?

A

Tumor Lysis Syndrome- EMERGENCY, release of tumor contents into body, rapid electrolyte imbalances

125
Q

Amenorrhea, Nausea, and quickening are all _______________ signs of pregnancy.

(presumptive, probable, or positive)

A

Presumptive

126
Q

Hegar’s sign (softening of lower uterus), positive pregnancy test, Chadwick’s sign (blue purple color), Braxton Hick’s are all _____________ signs of pregnancy.

(presumptive, probable, positive)

A

Probable

127
Q

Fetal heart tones, visualization by ultrasound, movement felt by examiner and delivery of fetus are all ____________ signs of pregnancy.

(presumptive, probable, positive)

A

Positive

128
Q

A Rhogam shot is indicated in pregnancy when a mother has (-/+) blood and the baby has (-/+) blood, given IM @ ____wks and ___-___hrs after delivery, fill in the bank.

A

(-) mother & (+) baby
@28wks and 48-72hrs after delivery
** cannot be done by an LPN**

129
Q

What are the three priority nursing interventions immediately post delivery for the newborn?

A

Clear airway
Dry baby
Obtain Apgar within 1 AND 5 minutes- 2= normal, up to 10 points total

130
Q

This type of screening is mandatory 24 hours after delivery because the condition being screened for causes mental disability?

A

PKU screening
Educate breastfeeding moms to avoid aspartame

131
Q

A nurse is educating a new mother on umbilical cord care what should be included in the teaching? (4)

A

Let it fall off on its own 10-14 days
Keep dry
No baths until it falls off
Tuck diaper under

132
Q

A client brings her newborn son in to the ED with complaints of a milky white discharge covering the top of his penis. The mother is frantic and thinks someone is abusing her son, she says she’s being doing all the correct things like squeezing warm water over the area and applying petroleum jelly. What should the nurse tell the client?

A

The milky white covering is normal and expected after a circumcision, you are doing a great job. I see no signs or symptoms of sexual abuse.

133
Q

A client brings her newborn into urgent care with a runny nose, hasn’t been feeding well, and exhibits a high pitched cry, what is this baby experiencing?

A

Withdrawal

134
Q

Normal HR ranges:
Newborn: 110-170
Infant: 90-160
Toddler: ___-___
Preschooler: 75-120
School age: 70-100
Adolescents+: 60-100

A

Toddler Normal HR : 80-140

135
Q

A client that is 0-2 years old that uses language for demands and cataloguing and develops object permanence is in what stage for Piaget?

A

Sensorimotor

136
Q

A client that is 2-7 years old and uses imagination and intuition but still have trouble with abstract thoughts are in what stage for Piaget?

A

Preoperational

137
Q

A client that is 7-11 years old, can understand concepts as concrete situations and understand time, space and quantity are in what stage for Piaget?

A

Concrete operational

138
Q

A client that is 11 years old and older who has developed theoretical and hypothetical thinking, and can strategize and plan are in what stage for Piaget?

A

Formal operational

139
Q

A client experiencing photophobia, nuchal rigidity, positive kernig and brudizinskis signs are most likely experiencing what?

A

Meningitis- organism enters blood stream+ crosses the brain barrier
- viral or bacterial meningococcal (most common): streptococcus
- preventable with vaccine 1st dose 11-12 years old and 2nd @ 16 years old

140
Q

Discussing the terms of termination, building rapport and trust and defining the roles of the relationship are associated with what phase of the nurse patient relationship?

(Orientation/Working/Termination)

A

Orientation phase

141
Q

Promoting problem solving skills, promoting alternate adaptive behaviors and overcoming resistance behaviors is associated with what phase of the nurse patient relationship?

(Orientation/Working/Termination)

A

Working phase

142
Q

Summarizing the goals achieved, and discussing new coping strategies is associated with what phase of the nurse patient relationship?

(Orientation/Working/Termination)

A

Termination phase

143
Q

What are behaviors associated with increased risk for suicide?

A

Recent break up- losing wt
Loss of partner- failure to socialize
Getting rid of personal belongings

144
Q

What is the priority when a med error occurs?

A

Assess the patient FIRST

-then call pcp, fill out incident report

145
Q

Medication wasting requires ______ nurse check and you must waste the medication ________ administration.

A

2 nurse check
Waste BEFORE administration

146
Q

What do you draw first, the peak or the trough?

A

Trough first (right before next dose) then peak (30 minutes after administration)

147
Q

Digoxin normal range 0.5-2
Toxic >2
What are the s/s of digoxin toxicity and what is the priority?

A

N/V and vision changes
Priority: obtain vitals

*apical pulse 1 full minute, eat foods high in potassium, report irregular pulses

148
Q

Lithium normal range: 0.5-1.5
Toxic: when dehydrated
What are s/s of toxicity?

A

Loc change, vision changes, hand tremors
*avoid exercise, diuretics, tea, cola, coffee, excess salt (no nsaids=salt)

149
Q

Enoxaparin/ lovenox is a low molecular weight heparin administered 2 inches above the umbilicus. What other important nursing interventions should be done with this drug?

A

Do not expel the air bubble, retain it
Do not massage or aspirate site
Rotate sites

150
Q

What is the purpose of kayexalate?

A

Lowers potassium via bowel movements

151
Q

What is Nitro?

A

Vasodilator, HA expected

152
Q

Caution a penicillin allergy with what drug?

A

Ceftriazone

153
Q

Furosemide adverse reaction will cause what to happen?

A

Tinnitus - report to pcp

154
Q

Epoetin alpha is effective if

A

Hgb increases

*tx anemia: low RBCs

155
Q

This type of care is done concurrently with treatment but is non-curative, it focuses on improving quality of life.

A

Palliative care

156
Q

This type of care focuses on comfort at end of life, no antibiotics, no life saving procedures.

A

Hospice
Focus on energy conservation, suction, pain meds as needed, sitter ( so they don’t die alone), nutrition megestrol acetate (appetite stimulant)

*question dr sending pt home on hospice with picc line

157
Q

Hospice criteria:

A

<6 months to live
Progressive, irreversible illness

158
Q

Priority patients:

Kid c laceration falling asleep
Patient temp of 105- private room
Constipated taking loperamide
Creatinine of 2 scheduled for cardiac cath
Pt c JVD and crackles

A

Unstable, acute, new onset, altered loc,

159
Q

Priority patients:

Starting IV sodium and potassium level 2.9
Multiple compound fractures reporting chest pain
Graves disease and high temp
Thoracentesis elevated hr 95-110
Burns UO 45mL/2 hrs
Pain on deep inspiration

A

Unstable, acute, new onset, altered loc,

160
Q

Gushing laceration

A

Apply pressure (stop bleed FIRST) then get IV access

161
Q

AAA pt c severe lower back pain

A

Prepare for surgery

162
Q

Hypovolemic shock- increased HR

A

Give O2

163
Q

Cardiogenic shock, what do you do first?

A

Fix BP first

164
Q

Blood transfusion contraindication

A

Can’t hang if pt is febrile

165
Q

Desmopressin

A

Decreases UO

166
Q

Insulin drip, what do you do before you administer?

A

Waste first 50 units

167
Q

Metformin

A

Hold 24 hours prior and 48 hours after contrast dye CT
Assess shellfish allergy (iodine)

168
Q

D/C heparin

A

6 hours prior to sx

169
Q

Alendronate for osteoporosis

A

Take c full glass of water on empty stomach, sit upright for 30 minutes after

170
Q

PTU (propylthiouracil) medication for Graves Disease, what is important about it?

A

Dont stop abruptly

171
Q

Amlodipine

A

Calcium channel blocker

172
Q

Lisinopril

A

Adverse reaction - dry cough
Avoid spironolactone (K+ already high and increases)
Don’t take while pregnant

173
Q

Clozapine (antipsychotic)

A

Report flu like symptoms

174
Q

Aripiprazole (abilify)

A

Report agranulocytosis low wbc

175
Q

Clopidogrel (prevent thrombus)

A

D/C 7 days prior to sx

176
Q

Valsartan (ARB) and ACE -prils important consideration

A

Monitor K+ and renal function
Avoid spironolactone

177
Q

Haloperidol (antipsychotic)

A

Causes urinary retention

178
Q

Ciproflaxacin

A

Report deep tendon pain

179
Q

Belladonna and opium

A

Suppository for bladder spasms

180
Q

Sodium polystyrene (kayexalate) mechanism of action?

A

Decrease potassium in hyperkalemia via bowel movement

181
Q

Baclofen and Diphenhydramine are prescribed for a client what is the next nursing action?

A

Call pcp, these meds cannot be taken together

182
Q

What considerations are important to know about TPN?

A

Change tubing every 24 hours, 2 nurse check, runs out Hang D10, change dressing if wet or soiled

183
Q

Change lipids

A

Every 12 hours

184
Q

Residual < 250 for tube feed

A

Notify pcp

185
Q

Check peg tube

A

Every 12 hours, rotate 360 every day

186
Q

Prostate exam

A

Over 45 yearly (increase c age)
Digital and PSA yearly

187
Q

Testicular Exam

A

Monthly after shower, index finger and thumb gently roll

188
Q

HPV vaccine

A

9-26 years old BEFORE sexually active

189
Q

Pneumonia vaccine

A

Over 65, immunocompromised, hx, over populated living condition

190
Q

Postictal after seizure

A

Last 5-30 min
Sleepy and confused NOT PRIORITY

191
Q

Dysphagia

A

Do not give juicy fruits or soft fruits

192
Q

Ischemic stroke

A

TPA within 4 hours of onset

193
Q

Hemorrhagic Stroke: what medication is contraindicated?

A

TPA -DO NOT GIVE (increases bleeding)

194
Q

Stroke diet

A

Soft puréed food, thickened liquids
No juicy fruits

195
Q

Menieres disease (older adults fluid buildup causes vertigo)

A

DO NOT increase fluids
RESTRICT sodium
Ear feels full

196
Q

Skeletal traction, what indicates rejection?

A

Loose screws = rejection

197
Q

Bucks traction

A

Weights hang freely
Pincare q 12 hours
MD required for weight change

198
Q

FHR 140 no variability

A

Call MD
Assess mom
Fetal compromise

199
Q

FHR over 170

A

Mom on lateral side

200
Q

Self breast exam

A

7-10 days after period ends, same day each month, 2,3,4 finger in circular motions

201
Q

Postpartum hemorrhage

A

Soaking 1 or more pads every 15 minutes
Massage fundus until firm

202
Q

Cervical cancer risk

A

Smoking

203
Q

Umbilical cord falls off at 5 days

A

Problem call pcp

204
Q

Child abuse

A

Generalized bruising on child over 4
Under 4 (ten-4 rule)

205
Q

5 Year old activity

A

Doll and coloring book

206
Q

Hirschsprungs

A

Ribbon like stool

207
Q

Suction control chamber

A

Gentle bubbling should be present

208
Q

Chest tube disconnects

A

Put into sterile water

209
Q

CKD pt c CR of 3

A

NOT PRIORITY
EXPECTED FINDING

210
Q

Dialysis patient

A

Can drink
Problem if bag runs out before scheduled time

211
Q

Expected c dialysis

A

N/V

212
Q

Live donor kidney transplant

A

Instant urine output

213
Q

Cadaver donor kidney transplant

A

1 week for urine output, pt needs dialysis until then

214
Q

Kidney rejection

A

Elevated temp, CR, BUN, WBC, HR, <30 mL/hr

215
Q

SIADH expected

A

Low sodium c bounding pulses, high BP

216
Q

SIADH AVOID

A

HCTZ and do not raise hob over 10

217
Q

Addisonian crisis

A

Monitor BG less than 60

218
Q

TURP expected

A

Pink drainage
Gross or bloody- irrigate
Irrigation wide open c red return notify PCP monitor h&h

219
Q

Acute glomerulonephritis

A

Risk of fluid over load
CRACKLES = EMERGENCY

220
Q

Metabolic Acidosis

A

DKA, diarrhea, renal failure

221
Q

Metabolic alkalosis

A

Vomit or NG suction

222
Q

Respiratory alkalosis

A

Hyperventilation

223
Q

HHS PRIORITY

A

Fluid volume deficit , HYDRATE

224
Q

DM BG less than 100 or over 240

A

Do not exercise

225
Q

Colostomy

A

Beefy red is expected, dull call pcp
Eat yogurt

226
Q

Dumping syndrome diet

A

Increase protein, low carb
Lay flat
No fluids between meals

227
Q

Celiac disease s/s

A

Diarrhea, steatorrhea, decreased weight, migraines

Gluten allergy

228
Q

NG tube assessment

A

Disconnect before auscultation of bowel

229
Q

Clean catch urine

A

Dominant hand holds cup
Non dominant hand spreads labia

230
Q

PUD

A

Bright red blood = active bleed
Coffee grounds = old blood
Type and cross

231
Q

Crohns

A

RLQ PAIN, NO BLOOD, AVOID DAIRY, NUTS , RAW FOODS

232
Q

Appendicitis

A

RLQ pain , if pain stops = EMERGENCY

233
Q

GERD NURSING INTERVENTIONS

A

Sit up 30 minutes after, no carbonation or spicy foods, avoid tight clothes,
Heartburn give PPI (-zole)
Wedge pillow

234
Q

Spina bifida + multiple sx

A

Increase risk for latex allergies

235
Q

Scabies

A

Wash/dry HOT, OINTMENT NECK DOWN 8-14 hrs

236
Q

Delegate to LPN

A

Get blood sugar

237
Q

Stroke pt becomes restless

A

See first

238
Q

Hypothermia

A

Rewarm trunk before extremities

239
Q

Peritoneal dialysis

A

Cloudy= infection

240
Q

Pyloric stenosis

A

Projectile vomiting in infant

241
Q

Kidney transplant 1 week ago

A

BP decreases = good

242
Q

HDL high pt on correct diet

A

Genetics

243
Q

Crying baby c cleft palate

A

Swaddle, hold close and rock

244
Q

Lateral violence

A

Bullying NOT SEXUAL HARASSMENT

245
Q

PVC

A

Check peripheral pulses

246
Q

Report temp 1 degree change

A

Kidney transplant, Graves’ disease

247
Q

Child c WBC of 3.9

A

No vaccine

248
Q

No honey

A

Before 1 years old

249
Q

Delegate vitals signs after biopsy to

A

PCA

250
Q

Atherosclerosis what food is contraindicated for this disease process?

A

NO EGGS

251
Q

Sickle cell

A

Avoid high altitudes

252
Q

Radiation materials stay in room (v/s machine)

A

Further teaching

253
Q

Blood transfusion everything stops next

A

Run NS

254
Q

Post mortem

A

Lines out before autopsy

255
Q

Gi bleed c black tarry stool caused by?

A

H pylori ulcer

256
Q

Hold Sippy cup

A

12 mos at 14 mos is concerning if still can’t hold it

257
Q

Social smile

A

2-3 months

258
Q

Outside agency

A

Stage three pressure ulcer
14 year old pregnant

259
Q

Hypovolemic shock

A

Pulse increase HR 80-100

Galen Comprehensive Review (2 decks)

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