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Nursing Course - NYCLEX Prep > Entire Nursing Content- Remar > Flashcards

Entire Nursing Content- Remar Flashcards

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1
Q

What Blood Type is the Universal Donor?

A

o-

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2
Q

What blood type is the Universal recipient?

A

AB+

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3
Q

Antidote for Acetylsalicytic Acid? (Aspirin)

A

Activated Charcoal

Acetylsacitic acid increases the effects of Methotrexate (Chemo & Rheumatoid Arthritis Med)

Monitor H&H,INR & Renal Function

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4
Q

What test confirms Acid Reflex (GERD)?

A

Barium Swallow Fluoroscopy

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5
Q

What CD4 count indicate AIDS?

A

Less than 200

Zidovudine is the med of choice for AIDS

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6
Q

Digoxin…. HOLD HR<60

S/S of toxicity: Yellow spots, Nausea, Vomiting, ABD Pain

What do we treat with?

A

Digibind or Charcoal

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7
Q

Client has Bronzed Color Skin (hyperpigmentation), Lethargy, weakness, & weight loss.

What’s the diagnosis?

A

Addison’s Disease

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8
Q

Client had an amputation. Pain still felt at that location even though limb Is gone.

What kind of limb pain is it?

A

Phantom Limb Pain

Note: Post Op AMputattion, keep limb up 1st 24hrs, then PRONE Position twice daily to prevent flexion.

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9
Q

Client with aneurysm have severe pain, NV, tachycardia, decreased LOC and BP 60/30 & a Bruit is heart on auscultation .

What has occured?

A

Aneurysm RUPTURE

Avoid Straining, Lifting, Exerting
Take meds on schedule, report severe back/flank pain.

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10
Q

Client has localized tenderness @ McBurney’s point.

Diagnosis?

A

Appendicitis

NPO-No Opiods-No Heat-No Laxatives-No Enemas

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11
Q

Client with an spinal cord injury at T6 or above is known to have what condition?

A

Autonomic Dysreflexia

Can be caused by a full bladder or fecal impaction

Place client in High Fowlers, Check for bladder distention. Loosen restrictive clothing. Client need to void/have BM.

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12
Q

Crainial Nerve 7 is known as what medical condition?

A

Bells Palsy

“I have 7 Bells”

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13
Q

Client is straining to urinate, have decreased urine stream, and dribbling urine flow & feeling the need to go all the time.

Diagnosis?

A

BPH

Treat BPH with a TURP & monitor for bleeding/hemorrhage.
Post TURP to prevent blood clot, CBI continuous bladder irrigation.

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14
Q

Male Client with pale blue and cold hands and feet, which may tingle or be painful. Diagnosis?

A

Buerger’s Disease

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15
Q

Client with tooth decay, electrolyte imbalances , ulcers and cardiac arrythimias. They usually at normal weight but may also use enemas, drugs, diets & pills to try to lose weight. They often binge and purge.

Diagnosis?

A

Bulimia Nervosa

Supervise during meals
Assess suicidal potential
Establish diet plan
Antidepressants

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16
Q

What to CAUTION mean for cancer?

A

Change in bowel or bladder
Any sore that dont heal
Unusual bleeding/discharge
Thickening in breast
Indigestion
Obvious change in wart
Nagging cough or hoarseness

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17
Q

Internal/Sealed radiation

  • Most dangerous
    -Implant is inside
    -All body fluids are radioactive
    -If implant fall out, pick up with Long handle forceps/put in lead container.
    -Private room/bathroom. Limit visitors. rotate staff.sign at door/bedside.
    -To reduce nausea….admin Reglan (Metoclopramide)
A
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18
Q

Client have milky/white painless lens, blurred vision.

Diagnosis?

A

Cataracts

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19
Q

Client with Celiac Disease eat Rice & Corn. What foods must be avoided? (BROW)

A

Barley
Rye
Oats
Wheat

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20
Q

Agnosia is the inability to..

A

use objects correctly.

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21
Q

Client cant communicate properly is known as

A

Expressive Aphasia

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22
Q

Client taking Compazine Should be monitored for What type of extrapyramidal reactions? (DAT)

A

Dystonia
Tardy Dyskinesia
Akathisis

to decrease extrapyramidal effects admin… Benztropine

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23
Q

Client with buffalo hump, moon face, hirsutism, gained 20th, and lethargic

Diagnosis?

A

Cushings

Tx: Hypophysectomy or Adrenalectomy

then they will be on Life long Glucocorticoids

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24
Q

Client has abdominal pain, Diarrhea, Weight loss, and Potassium 2.0z This condition affects digestive tract from mouth to anus and can’t be cured with surgery. Dairy & High Fiber meals should be avoided.

Diagnosis?

A

Chrohns Disease
(inflammation of bowels)
can lead to colon cancer

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25
Q

Clients stool presents with Steatorrhea (greasy, foul smelling,pale stool) & Thick, Sticky mucous causing possible obstructions.

Diagnosis?

A

Cystic Fibrosis

admin Pancreatic Enzymes
Sweat Test Diagnose It >60
High Calorie High Protein Diet

Postural Drainage to clear mucous

Genetic counseling before having another child

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26
Q

Child Drooling, Lost Voice(Dysphonia), and Can’t Swallow (Dysphagia) & Must go to Hospital Immediately.

Diagnosis?

A

Epiglottis

Airway is Priority!!!

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27
Q

Client having Blurry And Tunnel Vision & Seeing Halos. (Due to increased intraocular pressure)

Diagnosis?

A

Glaucoma

Admin Miotics
(Pilocarpine or Timolo)

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28
Q

Child have increased Bilirubin levels & Jaundice Skin.

Hyperbilirubinemia

How do you treat it?

A

Phototherapy
-Keep 18” Under lights
- Only keep diaper on
-Cover Eyes
-Turn off lights q8hrs for 15mins
- Monitor Temp

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29
Q

Client with Uncontrolled Dance like Movements called Chorea, & impaired judgment & cognition.

Diagnoses?

A

Huntingtons Disease
(Inherited Disorder 30-50 y/o)

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30
Q

Client with 3-4 watery stools, Fatty (Steatorrhea) stools and anorexia & fistulas that’s associated with smoking.

Diagnosis?

A

Crohn’s Disease

NPO- Bowel Rest- Steroids

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31
Q

Non-smoking Client have BLOODY diarrhea, weight loss & requires surgery to remove colon.

Diagnosis?

A

Ulcerative Colitis

-Decrease Fiber, Increase Protein

-Admin Sulfasalazine

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32
Q

How often should Incentive Spirometry Be administered to the client?

A

10 Times per hour

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33
Q

At what age do influenza vaccine be administered?

A

6 months

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34
Q

At what age MMR & Varicella start to be given?

A

12 months

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35
Q

When is Hep B be administered?

A

@BIRTH, 2, & 6 months

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36
Q

Baby presents with bulging fontanelles & Increased vitals.
Seizure precautions should be implemented.

Diagnosis?

A

Increased Intracranial Pressure

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37
Q

Laminectomy

Post op: Log Roll Client

A
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38
Q

What is Lead Poisoning Treatment?

A

Chelating Agents via IM injections.

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39
Q

Client had a bite from a Tick. How long after the bite can they be tested for Lyme Disease?

A

4-6 weeks

Doxycycline for adults
Amoxicillin for children

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40
Q

To prevent Lymphedema the affected area should be elevated.

Diagnosis?

A

Mastectomy

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41
Q

Client has severe sudden attacks of tinnitus, unilateral hearing loss, dizziness and NV.

Diagnosis?

A

Meniere’s Syndrome

-Bed rest in quiet room
-Move head slowly
- Sedatives
-Low playing music to keep calm

-If surgery removal of labyrinth

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42
Q

Client has +Kernigs & Brudzinski’s Sign. Michal Rigidity, headache, NV

Diagnosis?

A

Meningitis

-Isolation
-Antibiotics
-initiate Seizure Precautions
-Monitor LOC

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43
Q

Blackish-Bluish Spots on infant is known as?

A

Mongolian Spots

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44
Q

A psychiatric disorder that causes a person to self inflict injury/harm to his/her body?

A

Munchausen

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45
Q

Client with autoimmune disease resulting in extreme fatigue and muscle weakness. Difficulty talking, Chewing, Weak muscle eyes, Visual disturbances, & Unsteady gait.

To diagnose it a Tensilon Test is used.

Diagnosis?

A

Myasthenia Gravis

If Muscle Strength is increased, They are Positive for MG.

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46
Q

What is the chest pain that is not relieved by rest or nitro? Client will have sudden crushing pain that radiates to Jaw, shoulders, back and lasting >30mins.

A

Myocardial Infarction

Meds: MONA

Morphine
O2
Nitroglycerin
Aspirin

Place Patient on Bed Rest

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47
Q

Chest Pain lasting 3-5 mins and is Relieved By Rest & Nitroglycerin is known as?

A

Angina

-Unstable angina occurs while client is resting

TX: Nitroglycerin 3 tabs up to 5 mins sublingual .
Low cholesterol diet
Exercise & Stop Smoking
Avoid if male client takes viagra (Sildenafil)

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48
Q

What is the number one complaint in client taking nitroglycerin?

A

Headache

Other: Hypotension-tachycardia-syncope -dizziness

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49
Q

What is the aminoglycoside med given for GI tract before surgery to decrease bacteria and also given in clients with hepatic encephalopathy when ammonia levels are elevated?.

A

Neomycin Sulfate

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50
Q

Client just had an antipsychotic and have extreme fever, tachycardia, altered LOC, Seizures, Muscle Rigidity and elevated WBC or LFT.

What syndrome is they experiencing?

A

NMS

Neuroleptic Malignant Syndrome

Discontinue Med, Initiate Seizure Precautions, & admin Antipyretics to decrease fever.

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51
Q

To determine the length of the NG tube placed in the client, where do we measure? (from what to what?

A

Nose to the Earlobe to Xiphoid Process

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52
Q

To Aspirate for gastric content in client with NG Tube, the PH level should be less than?

A

4

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53
Q

S/S of NSAID (Aspirin) Toxicity?

A

Tinnitus

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54
Q

What is given to treat
Aspirin Toxicity?

A

Activated Charcoal or Sodium Bicarbonate

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55
Q

What is the Vitals in client with orthostatic hypotension?
(BP & HR)

A

BP decreased
HR increased

Check BP while client lying down, sitting up, & Standing.

Wait 5 mins between measurements.

Admin IVF

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56
Q

Client has heberden’s nodes on the joints of fingers, joint pain & stiffness that is relieved by rest.

Diagnosis?

A

Osteoarthritis

ED:
If exercising STOP if pain occur
Lose weight to help take stress off joints
Hot/Cold Therapy
Use assistive devices (canes, braces, etc.)

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57
Q

Client with Pancreatitis (Acute) have bluish-purplish bruising around the UMBILICUS. What is this sign called?

A

Cullen’s Sign

Note: Turner’s sign is grey/blue color of the FLANKS

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58
Q

Client is shuffling steps, loss of balance , Bradykinesia, tremors in hands/feet at rest.

Diagnosis?

A

Parkinsons

Assess Neuro status
Swallowing ability
Asst with ambulation
Encourage fluids
High Calories/Fiber
Low Protein

MED: Levodopa or Carbidopa-Levodopa

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59
Q

Client with hx of alcohol abuse presents with abdominal pain, NV, Board like abdomen.

Diagnosis?

A

Pancreatitis (Acute)

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60
Q

Client with Peptic Ulcer Disease c/o Pain with meals or after eating. What type of Ulcer is this?

A. Duodenal Ulcer
B. Gastric Ulcer

A

Gastric Ulcer

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61
Q

Client’s Legs is Hairless , cool, pale and have thick toe nails.

Diagnosis?

A

Peripheral Arterial Disease
“Dangle Legs”

ED: No smoke, No wear tight clothes, No Heat to Legs
Exercise & Inspect skin daily

Bypass surgery or angioplasty improves PAD

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62
Q

Client has a tumor that causes HTN, Sweating, Weight loss and Hyperglycemia.

Diagnosis ? (Begin with a Ph)

A

Pheochromocytoma

TX: Surgical removal of one of both adrenal glands
Post Op: Glucocorticoids

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63
Q

Client have streaks up the arm that are red, warm and painful.

Condition?

A

Phlebitis

Remove IV, Apply Warm towel, Assess for infection.

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64
Q

Pregnant older woman have bright red painless blood on her bed sheets.

Diagnosis?

A

Placenta Previa

TX: Bed Rest-C:section-Blood Transfusion- Frequent Vitals-Fetal Ultrasound-Fetal Heart Monitoring.

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65
Q

Pregnant have sudden painful bleeding with contractions & uterine tenderness that can cause Disseminated intravascular Coagulation (DIC).

(The placenta detaches itself from uterine wall)

Diagnosis?

A

Abruptio Placenta

TX: Bed Rest-C:section-Blood Transfusion- Frequent Vitals-Fetal Ultrasound-Fetal Heart Monitoring.

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66
Q

Rules of Nines..

What percentage is the Torso? (Front/Back)

A

36%

  • Each Arm: 9%
    -Each Leg: 18%
  • Perineum: 1%
  • Heck & Neck: 9%
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67
Q

Client has sharp pain on inspiration, SOB, Tachycardia and decreased breath sounds.

Fluid in pleural space is known as?

A

Pleural Effusion

TX: Thorancentesis
(Chest tube may be needed after)

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68
Q

Increase in RBC, Platelets & Leukocytes =Thick Blood, Increased clotting is known as ?

A

Polycythemia Vera

TX: Phlebotomy
(blood draws several times a year)

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69
Q

What is presbycusis?

A

Hearing Loss

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70
Q

When is RhoGam shot given in Pregnant Woman?

A

Given is Mom is RH- & Baby is RH+.

given 28 weeks gestation and within 72 hrs after delivery.

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71
Q

Antidote for Magnesium Sulfate?

A

Calcium Gluconate

72
Q

How many arteries and veins do the umbilical cord have?

A

2 Arteries, 1 Vein

73
Q

RhoGam is given to pregnant clients when the mom is _________ and the baby is ________?

A

Mom RH-
Baby RH+

74
Q

Meds to Treat Pre-Term Labor

“I-N-M-T”

A

“Its Not My Time”

Indomethacin (NSAID)
Nifedipine (Ca Channel Blocker)
Magnesium Sulfate
Terbutaline (Watch for Increased HR)

75
Q

To determine Fetal Heart Rate:

“VEAL CHOP”

What do Late Decelerations indicate?

A

Placental Insufficiency (BAD SIGN)

76
Q

To determine Fetal Heart Rate:

“VEAL CHOP”

What do Variable Decelerations indicate?

A

Cord Compressions

77
Q

To determine Fetal Heart Rate:

“VEAL CHOP”

What do Early Decelerations indicate?

A

Head Compressions

78
Q

To determine Fetal Heart Rate:

“VEAL CHOP”

What do Accelerations indicate?

A

Oxygenation is OK

79
Q

Interventions for Pregnant client having fetal distress?

“LION”?

A

Left Side Lying
IVFs
Oxygen via facemask
Notify Hcp

80
Q

Interventions for Client have Group B Strep?

(SEPSIS!!!)

A

IVFs

81
Q

Client have blurred vision, see floaters, black spots and flashes of light.

Diagnosis?

A

Retinal Detachment

  • Cover both eyes with patches
  • No coughing, sneezing, strict Bed rest, Elevate HOB
  • Surgery to reattach retina
82
Q

Client presents with fatigue, weight loss, and low grade fever. The ESR will be elevated and Joints BILATERALLLY will be affected.

Diagnosis?

A

Rheumatoid Arthritis

-Encourage client to exercise
- Take showers in am

83
Q

Med of Choice for Scabies?

A

Permethrin 5%

84
Q

Client with Shingles have itching vesicals grouped together on top of red rash that’s painful, fever and feeling malaise. What type of precautions should be placed on?

A

Respiratory Isolation

  • Rash will be unilateral
  • Cool compresses
85
Q

When should TPN tubing be changed?

A

Daily

  • Change the TPN bag q24hr
  • If TPN not avail, hang 10ths % Dextrose Water
86
Q

If the client is NOT on ventilator but has a trach, How should the Cuff Be?
Deflated or Inflated?

A

DEFLATED!
(Dont Block Airway)

87
Q

If client coughing strongly and trach becomes dislodged , interventions?

A

Keep Airway Opened by reinserting obturator or grabbing retention sutures.

Give O2

88
Q

Client have a productive cough, night sweats, chills, low grade fever & weight loss with a Mantoux (PPD) test is >10. Diagnosis?

A

TB

-airborne precautions
-Negative pressure room (6 Fresh air exchanges per hour
- Vitamin B6 will be depleted
-Avoid Alcohol to prevent Hepatoxicity

89
Q

Client have 20 Bloody Diarrhea Stools per day, abdominal pain, Weight loss and NV

Diagnosis?

A

Ulcerative Colitis

  • removal od large intestine/rectum
    -Post OP: Ileostomy
    Low Fiber diet/avoid fiber; Fat greasy foods to decrease diarrhea—avoid alcohol & caffeine, Increase Fluid intake
90
Q

Which vitamin is important in Blood Clotting?

A

Vitamin K (Green, Leafy Veggies)

91
Q

Which vitamin is important in Eye Sight?

A

Vitamin A (Oranges, dark green, leafy veggies)

92
Q

Which vitamin is important in Pernicious Anemia?

A

Deficiency in Vitamin B12
(Client will have paresthesia in hands and feet)

93
Q

Which vitamin should be taken with iron?

A

Vitamin C

94
Q

Child presents with hepatomegaly, acidosis, hypoglycemia and delayed growth.
(Liver glycogen disease)

Diagnosis?

A

Von Gierke’s Disease

  • Frequent Meals
    -Allopurinol for gout
    -Liver transplant
95
Q

Genetic Defect that causes copper buildup that the body is unable to remove?

A

Wilson’s Disease

  • Avoid food High in Copper: Lamb, shellfish, vegetable juice, nectarines, dried beans, chocolate, multivitamins
96
Q

How to Don (Put on) PPE? (GMGG)

A

Gown-Mask-Goggles-Gloves

97
Q

How to DOFF (Remove) PPE? (GGGM)

A

Gloves-Googles-Gown-Mask
(remove the dirtiest first)

98
Q

What infections are treated w/Standard Precautions ? (SHH…)

A

Shingles-HIV-Hepatitis
Hand Hygiene & PPE

99
Q

Client with MRSA , C-Diff or Scabies should be placed on what type of Precautions )

A

Contact Precautions (DORMS)

  • Private room w/sign on door. Cohort is fine
  • Upon entrance/Exit wash hands with soap & water. Use disposable gowns, etc.
  • Keep Stethoscope , BP cuff etc. In
100
Q

Client with Influenza B, Pertussis: Whooping Cough, Strept Group A, Epiglottis, Meningitis, should be placed on what type of Precautions )?

A

Droplet Precautions (SPIDERMAN)

101
Q

Client with shingles, measles, TB (suspected or confirmed), Varicella or chicken pox should be placed on what type of Precautions?

A

Airborne/Respiratory Precautions

  • N95 Mask & Neg Pressure Room (6-12 air exchanges)
    -Close the door when exiting
  • Varicella is not contagious when all lesions are dried & crusted
102
Q

What type of Precautions Used for EBOLA?

A

ALL PRECAUTIONS!!

Standard- Contact- Airbourne

103
Q

How long should a Judaism (Jew) wait to receive dairy product after meat/poultry is consumed?

A

3-6hrs

  • No Pork/Shellfish/Fish without Scales
    -Dont admin oral drugs that contain Gelatin (gummies & Capsules)
104
Q

Jehovah’s Witness DONT accept blood transfusions. What do they accept instead of blood?

A

Erythropoeitin (Poetin alfa) & IV iron

  • If child is in danger– Admin the Blood! Save the child!
    –Hemorrhaging: admin IVF & NSS 1st
105
Q

What religion of client who is Lacto Ovo. Vegetarian ?

A

Hinduism

  • No Types of Meat
  • Avoid Dairy
    -No Circumcision
    -Can get Mechanical Valve Replacement
106
Q

When should a urine culture be collected ?

A

Early in the am after waking

107
Q

Urine specimen should not be taken from the bag. Use aseptic technique to transfer specimen from the collection port.

True or False?

A

True

108
Q

What position should the client be placed in for a Enema?

A

Sims

  • Hang enema bag no more than 12” in above rectum
    -Retain for 5-10 mins
    -Abdominal Cramping = Slow the Rate!
109
Q

Blood Transfusion should be transfused within how many hours?

A

4 hours

  • Get blood from blood bank, verify product with type & Crossmatch & 2 client identifiers with another nurse at patient’s bedside. Make sure its compatible
  • Stays with patient first 15mins and get vitals
    UAP can get vitals after the initial 15 mins
110
Q

What type of Burn?
No blisters, Pink/Red
Tender, May be painful, Epidermis

A. Full Thickness
B. Partial Thickness (2nd Degree)
C. Superficial (First degree)

A

Superficial (first degree)

111
Q

What type of Burn?
Skin is Raw Red, Moist, Painful and May Blister

A. Full Thickness
B. Partial Thickness (2nd degree)
C. Superficial (first degree)

A

Partial Thickness (Second degree)

112
Q

What type of Burn?
Skin is black/brown/yellow/pearly white and leathery. Blood vessels and bones may be seen… little to no pain.

A. Full Thickness
B. Partial Thickness
C. Superficial (First Degree)

A

Full Thickness

113
Q

What is done in Emergency Burn Care ?

A

Fluids Immediately!
Elevate Extremities

114
Q
A
115
Q

What is the Parkland Formula for Burns?

(Calculates the fluid replacement needed in first 24hrs after a burn injury)

A

4ml X Body Weight X BSA

  • 1/2 of total volume is given in the first 8 hours
  • 1/2 of total volume is given over the next 16hrs
  • Only partial thickness and full thickness burns are included in calculation
116
Q

How often is the Porcine (Pig) Valve replacement is replaced?

A

Every 15 years

  • No Muslims, No Jews, 7th day adventist
  • Bovine (Cow) is replaced q15yrs
    -Prosthetic (Mechanical) is NOT replaced.
  • we worried about rejection of valves
117
Q

Client with MUFFLED HEART sounds, JVD, Decreased BP, Increased HR & Drop in systolic BP of 10 points. (Beck’s Triad)

Diagnosis?

A

Cardiac Tamponade

TX: Pericardiocentesis (Will increase BP)

  • Cardiac Tamponade comes with acute pericarditis
118
Q

Client BP 90/40, HR 92, having chest pain that RADIATES Midscapular or Upper Back…

Diagnosis?

A

Aortic Dissection (Emergency)

  • We FOA Hemorrhage (which is why BP decreases)
    TX: IVF & Beta Blockers
119
Q

Client has precordial chest pain that radiates to the back.

Diagnosis?

A

Acute Pericarditis

  • Ask “Recent Upper Respiratory Infection”
120
Q

Client with bilateral edema , Brown discoloration, ulcers around ankle and upward.

Diagnosis?

A

Venous Insufficiency

TX: SCD twice daily- Ulnar Boot (hip)

  • No pillows behind the knees
121
Q

Client with DVT (Vein issue) have unilateral edema, the right calf larger than the left calf and have warmth erythema.

How should the legs be positioned?

A

Elevate Legs!

-Risk for PE- Dont massage site!
-Warm compresses
-Heparin
-Early ambulate

122
Q

IV Drug user with nail bed hemorrhage, B-Splinter fingernails., Right sided HF symptoms & Triscupid Regurgitation.

Diagnoses?

A

Bacterial Endocarditis

  • Antiembolism Stockings
  • PE risk!
  • IV Antibiotics
    -NO hard flossing
    -Assess for Petechiae
  • Valve Replacement : Warfarin for Life
123
Q

Child has Conjunctivitis, Red Rash, Aneurysm, Seizures, Strawberry Tongue, Hands/Feet peeling (desquamation)

Diagnosis?

A

Kawasaki Disease

  • Report Fever Immediately
    -Monitor the heart
    -IV immuniglobin & Aspirin to prevent aneurysm
    -No Live vaccines
124
Q

Client have a fever of 105, Red Hot Joints, chorea, swelling in joints & subcutaneous nodules.

Diagnosis? (A-R-F)

A

Acute Rheumatic Fever

TX: Penicillin IM Monthly
DO cardiac Checks
Valve Replacement

125
Q

Client is cyanotic, diaphoretic and tachypneic

Diagnosis?

(Air-….E)

A

Air Embolism

TX: Occlusine Dressing
100% O2 nonrebreather
Left Lateral Position

126
Q

Client with severe SOB & Orthopnea, Tachycardia, tachypnea, Large amount of blood tinged, frothy sputum , cold clammy skin, cyanotic, wheezing, crackles and gurgling respirations

Diagnosis? P…. E

A

Pulmonary Edema

  • HIGH FOWLERS
  • O2-Check lung sounds- IV access- Diuretic-Morphine-Foley Cath
  • Intubate and mech vent if needed
127
Q

Where is Friction Rub heard at during auscultation?

A

ERB’s

128
Q

S/S of Spironolactone ? (K+ sparing)

A

Gynecomastia (male breast tissue)

  • Sulfa Patients can have

Other K+ Sparing: SAMA

Spironolactone
Aldactone
Milirone
Amiloride

129
Q

Patient gained weight over last few weeks.
Admin a Loop Diuretic: -IDE

BumetanIDE
TorsemIDE
FurosemIDE

What is the signs/symptoms of Loop Diuretic?
OOHH DANG

A

Orthostatic Hypotension
Ototoxcity
HYPOKALEMIA
HYPOmagnesium (Tremors)

Dehydration
Allery: Sulfa drugs (SAT)
Nephrotoxicity
Gout (uric acid build up)

  • Check potassium levels prior to admin
    -CHeck BUN & Creatinine levels
  • BUN (6-20)
  • Creatinine (0.6-1.3) ….FOA 2.0 or around
130
Q

Chest Tube System

If the drainage system cracks or break what should the nurse do?

A

Remove the broken or cracked system and replace with new system.

  • The chest tube is inserted into a bottle of sterile water.
  • Keep a clamp at bedside, in case it needs to be changed (dont clamp without hcp order)
  • Maintain the drainage system (CHEST TUBE/BOTTLE WATER at level of chest
131
Q

Chest Tube System

what do continuous vigorous bubbling indicate?

A

Air Leak!

132
Q

If fluctuations if the chest tube system stop, what to do?

A

Change position of resident
Check for kinks & occlusions

133
Q

If there is No fluctuations on the chest tube, what do that mean?

A

Lungs Re-Expanded

134
Q

Continuous/Gentle Bubbling on the chest tube system indicates?

A

Its working correctly in the suction control chamber

135
Q

Client have dull lung sounds that could be caused by trauma, cirrhosis, infection or burns.

Diagnosis?(Pleural …..E)

A

Pleural Effusion

TX: Thorancentesis

136
Q

Med treated for THRUSH?

A

Nystantin (Swish & Swallow)

137
Q

Client with Atelectasis (Collapse of Lung).

Treatment?

A

Ambulate CLient
Incentive Spirometer

138
Q

Client with pleuritic chest pain, crackles, wheezes, sputum, increased tactile remits, dullness to percussion.

Diagnosis?

A

Pneumonia

TX: Incentive Spirometer
Antibiotics, supportive measures , annual flu shot, pneumococcal vac & smoking cessation

139
Q

Client presents with a seal like barking cough, running nose and stridor.

Diagnoses?

A

LaryngoTracheoBronchitis

TX: Open airway- supportive measures to decrease swelling (before we have to intubate them)

140
Q

Client with Muffled voice, deviated Uvula, fever, and pooling of saliva & Increased Neutrophils.

Diagnosis? (What type of absess?)

A

Peritonsillar Absess

TX: Incision & Drainage
ABX (Antibiotic therapy)

141
Q

Client have cold symptoms, with difficulty breathing and wheezing due to what condition that is mostly caused by RSV?

A

Bronchiolitis

  • NO Antibiotics
  • Supportive Measures ONLY
    -If Severe: Mechanical Vent
142
Q

Client with a Violent Cough “Whooping Cough”
lasting >2 weeks.

Diagnosis?

A

Pertussis

TX: High Fowlers
Every close contact with patient must be treated

143
Q

Client weighs 165lbs and is 5’ 9” tall

What is the BMI?

A

24.4

-165
-69”

Divide weight (Lbs) by Height (Inches) squared
Multiply by 703
Round to one decimal place

(165lbs/69”/69”) X 703 =

144
Q

Client has hemoptysis, hoarseness, unintentional weight loss, chest pain, wheezing and a cough.

Diagnosis?

A

LUNG CANCER

-Airway is Priority
- Fowlers-O2-Chemo-Radiation-Chest Tube-Ambulate
- Incentive Spirometer

145
Q

Client have Swelling, Pain and Coolness at IV site.

What is this called?

A

IV Infiltration

-Remove IV immediately
- Elevate Extremity
- warm or cool compress
-dont rub to avoid development of hematoma

146
Q

Obese client who had abdominal surgery has opened wound edges and the bowels or other abdominal contents is visible. (protruding of internal organs)

Diagnosis?

A

Wound Evisceratiion

-Call for help & stay with client
- Place client in LOW FOWLERS w/knees bent
- Cover wound with sterile normal saline dressing & keep the dressing moist
- Vitals & monitor closely for shock
- Prepare client for surgery

147
Q

The separation of wound edges at the suture line is known as?

A

Wound dehiscence

148
Q

Client with cerebral palsy uses a crutch gait that allows weight bearing and one foot placed in front of the other.

Which crutch gait is being used?

A

Four-Point Gait

-Right crutch then left foot. Left crutch , right foot)

149
Q

Crutch gait used for no weight bearing status or partial weight bearing status?

A

3 point gate

(Both crutches and foot of affected extremity advanced together, followed by the foot of unaffected extremity)

150
Q

The crutch on the affected side and the unaffected foot are advanced at the same time is known as which crutch gait?

A

2 point gate

151
Q

CRUTCH SAFETY

  • Look forward NOT down when walking
  • Use Backpack to carry any items (Hands Free)
  • Keep rubber tips of crutches dry
    -Elbows flexed at 90 degrees
  • Proper fitting of sling
A
152
Q

When walking up the stairs with crutches, what leg is advanced first?

A

The “Good Leg”

Think of it as Good Going Up to Heaven

(When going downstairs, use the affected leg 1st)

153
Q

The Cane should be on which side of the body?

A

STRONGER Side

-Hold cane on stronger side and move cane before moving weaker leg ALWAYS

154
Q

How should you walk downstairs with a CANE?

A

Cane 1st
weaker leg, then stronger leg

155
Q

How should you walk upstairs with a CANE?

A

Stronger leg first
Cane then weaker leg

156
Q
A
157
Q

How do you mix Insulin?

“Nicole - Ritchie-RN”

A

NPH (intermediate- put air in 1st)

then Regular (air into)

draw Regular
then draw NPH

158
Q

3 Main s/s of Diabetes? (Ps)

A

PolyUria
Polydipsia (Thirsty)
PolyPhasia (Hungry)

159
Q

Unconscious Hypoglycemic Diabetic Resident Unable to Swallow.

What to administer?

A

IV Dextrose

160
Q

Diabetes Insipidus

“Pissing A lot, So Dry inside”

Caused by Lithium or Lung Disease

Client will have Polyuria & Polydipsia, Dehydration & increased NA

What is the Treatment for DI?

A

Desmopressin & IVF

Note: if too much decompression, can lead to water intoxication. (can lead to seizures, neuro damage or death)

161
Q

SIADH

“Soaked Inside”

client will have fluid retention, crackles, JVD, and decreased urinary output

Interventions?

A

Fluid Restriction
Seizure Precautions
Neuro checks
Strict monitoring of I&O
3% NaCl
Demeclocine

162
Q

What is the Treatment for ALL GI disorders? (NIPPA)

A

NPO
IVF
Pain Meds (PRN)
-Prazoles
Anti-Emetic (PRN) (Ondansetron-Metoclopramide)

163
Q

Client is Screaming & Drawing the knees up to chest crying with abdominal pain. Bilious Vomit, A mass that is Sausage Shaped Mass & Current Jelly Stools .

Diagnosis?

A

Intussuception

164
Q

Client Have olive shaped mass & projectile vomiting.

Diagnosis?

A

Pyloric Stenosis

TX: NIPPA

165
Q

Baby refuse meals and had no meconium for 24-48hrs. Bilious Vomit. Toxic Megacolon.

Diagnosis?

A

Hirschsprung’s Disease

TX: NIPPA
stool softener is contraindicated

166
Q

Child is Coughing, Choking & Cyanotic. Drooling, with a Distended Abdomen.

Diagnosis?

A

Tracheoesophageal Fistula with Esophageal Atresia

TX: NIPPA

167
Q

Client taking NSAIDs develops blood in stool/vomit, Heartburn, NV and Anemia.

Diagnosis?

A

Gastritis

TX: NIPPA- BUN & Creatinine
Misoprostol - Vitamin B12

168
Q

Client with joint pain upon awakening, ulnar deviation, morning sickness & tissue swelling & instructed to take a warm shower/bath upon awakening.

Diagnoses ?

A

Rheumatoid Arthritis

TX: MIM

  • Methotrexate
    -Isoniazid
  • Metronidazole

(If prescribed Methotrexate, STOP if pregnant & double folic acid dose. Can terminate pregnancies)

169
Q

Client presents with a molar butterfly rash, arthritis, ulcers and renal issues.

Diagnoses ?

A

Lupus

Treated with immunosuppressants (PAM)

-Prednisone
-Azothioprine
-Methotrexate

170
Q

OBESE Client presents with inflammation of Big Toe (Podagia), swelling of joints, & dysuria.

Diagnosis?

A

GOUT

  • Avoid or decrease organ meats
    -Avoid or decrease ETOH
    -Dont Smoke
    -MED: Colchicine
    -: MED: Allopurinol…Prevent build up of Purines

RF: Obesity, Organ meats, DM, ETOH, Poor Diet, Sardines, Increased BUN/Creatinine.

171
Q

Client wit drooping eyelids, double vision, difficulty with breathing & swallowing with hoarse voice and trouble talking. Weakness & fatigue.

Diagnosis?

A

Myasthenia Gravis

  • Eat small foods/meal to protect airway
    -Flu vaccine >6 mos year old & pneumonia Vaccine
    MED: Pyridostigmine (take before meals)
172
Q

Indications of Dialysis in client with acute kidney injury? (AEIOU)

A
  • Acid (Metabolic)
    -Electrolyte Imbalance (K+)
    -Intoxication Overdose
    -Overload of Fluid
    -Uremia (encepholopy-Pericarditis)

**Restrict Na & K+
**INcrease Phosphophus: Yogurt, cheese, etc.

173
Q

Nursing Interventions for Hemodialysis?

A

HOLD MEDS until client return

Before & After Dialysis:
- Check Vitals
-Monitor BUN/Creatinine
-Check weight & last Dialysis weight
-Check thrill /Brui in AV Fistula
- Monitor for Bleeding (Heparin is added to bag)

174
Q

What is the concern in Client with Peritoneal Dialysis?

A

Infection is the concern

-Use STERILE procedures when spiking & attaching bag with effluent

  • Drainage bag below abdomen
  • If fluid is Cloudy- FOA!! (Infection) – Peritonitis
175
Q

Client is guarding of abdomen, abdomen is hard and rigid with rebound tenderness.

Diagnosis?

A

Peritonitis

** Do a culture and sensitivity 1st!

Nursing Course - NYCLEX Prep (1 decks)

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