extras

Question 1

Vegans

Answer 1

• at risk of deficiency of vitamin B12 which is primarily supplied by animal products.

CHRONIC VITAMIN B12 DEFICINECY
- peripheral neuropathy (tingling and numbness
- neurological symptoms (gait and poor balance
- memory loss/dementia in cases of severe/prolonged deficiencies

INTERVENTION
- vitamin b12 fortified foods

Question 2

pulselessness and breathlessness

Answer 2

LOWEST PRIORITY
- at the scene of an unwitness accident because ppl like this are expected to die

HIGHEST PRIORITY
- at the scene of witnessed accident

BLACK TAG AT UNWITNESSED ACCIDENT
-pulselessness
- apnei
-breathlessness
-fixed & dilated pupils (even if breathing & have a pulse)

full thickness burns >60

Question 3

the MORE vital the organ, the HIGHER the priority. order of organ vitality

Answer 3

brain, lung, heart, liver, kidney, pancreas

DONT LOOK AT THE DIAGNOSIS!!!! GO WITH THE MODIFYING!!!

-23/m with CHF with potassium of 6.6 (C/D level) & no EKG changes heart
-chronic renal failure pt with a creatinine of 24.7 & pink frothy sputum (unstable) lung
-pt with cute hepatitis with jaundice (expected) & increased ammonia level (expected) who you
can’t arouse (unexpected) brain (HIGHEST PRIORITY!!!)

Question 4

Do NOT delegate the following to LPNs…

Answer 4

-start an IV.
-hang or mix IV meds
-push IV push meds… they CAN maintain & document the flow
-adminster blood or mess with central lines
-plan care (they CAN implement it)
-perform or develop teaching (they CAN reinforce it)
-take care of unstable pts
- DONT LET THEM DO THE FIRST OF ANYTHING!! he first of anything!

• can’t do the following assessments:
  admission, discharge, transfer or the first assessment after a change!

ex: Who should the LPN check? Who should the RN check?
-pt with angina pectoris with crushing substernal chest pain, admitted 3 days ago & is on
nitroglycerin: LPN
-pt who had a subtotal thyroid ectomy 2 days ago & is asking, “why are they washing elephants
in the parking lot?” RN (thyroid storm… symptom = delirium)

DONT LET LPN DO ANYTHING FOR A FIRST TIME!!!!

NEVER THE FIRST!!!!

Question 5

findings in pre term baby

Answer 5

INCREASED RISK OF PRETERM BABY
- infection (periodontal disease, UTI)
- cervical surgery such as cone biopsy
- tobacco and or illicit drug use
- mater age of ,17 or .35

PRE TERM LABOR
- before 34 weeks
- administer glucocorticoids to stimulate fetal lung maturation and promote suractant development
- no AROM cus the goal is to prolong the pregancy if possible
- administer antibiotics (penicillin) to prevent group B strep infections
- IV mag sulfate infusion for fetal neuroprotection if less than 32 weeks

FINDINGS ON A NEW BORN
- abundant lanugo on shoulders and back (preterm)
- vernix caseosa (protective white, chalky substance) = NORMAL
- smooth soles (deep creases in full term)
- flat areolae without palpable breast buds (palpable in full term)
- white pacthes on hard palate called epstein pearls
- smooth, pink skin with visible veins

NECROTIZING ENTEROCOLITIS =
- perforation of small and large bowels
- abdominal distention = abdominal girth and swelling
- erythema of the abdominal wall
- place supine WITH NO DIAPER
- frequent abdominal girth measurements are essential to assess for worsening distension

Question 6

UAP scope of practice

Answer 6

• ADL’s (baths, hygiene needs, brushing teeth; but NEVER the FIRST)
• obtain pulse ox reading
• ambulate and promote mobility of STABLE patients
• perform oral (NON STERILE) suctioning during oral care
• even though they clean, they should not be delegated to clean tracheostomy due to high risk of infection = only RN or LPN should perform tracheostomy care
• clients with tracheostomy that can eat = MAKE SURE TO DEFLATE THE CUFF BEFORE EATING
• collect and document vital signs
• turn and reposition STABLE PATIENTS

*Keep in mind: LPNs CAN do a lot of the things that RNs are
supposed to do in an extended care facility, because those pts are STABLE.

CLIENT DECLARED DEAD
- ALL CLIENT DEATHS ARE REPORTED TO LOCAL ORGAN PROCUREMENT SERVICES
- if a client is declared brainn dead, life support is continued until a decision for organ donation is reached so that organs and tissues continue to receive perfusion and oxygenation

POSTMORTEM CARE
- wash and straighten the body
- change lines and place a pad under the perineum to absorb stool and urine from relaxed spinchters
- place pillow under the head
- place dentures in mouth
- gently close eyes
- remove tubes, lines wtc

WHAT CAN CAUSE POSTMORTEM CARE TO BE DELAYED
- non natural deaths or associated with criminal activity

Question 7

How do you intervene with inappropriate behavior of staff?

Answer 7

ILLEGAL - tell supervisior
HARMFUL BUT NOT ILLEGAL - tell supervisor

NOT ILLEGAL BUT ANYONE IN DANGER?? - confront them and take over immediately. you dont want to tell supervisor first cus its delaying

NOT ILLEGAL BUT BAD BEHAVIOR, NOT HARMFUL BUT SIMPLY INAPPROPRIATE - talk to them at a later date

• ex: you are a LPN & suspect that a RN with whom you work is diverting narcotics for private sale
  and use… is it ILLEGAL? YES. what do you do? tell supervisor!

ex: you are a LPN & you walk by the room of an UAP who is giving perineal care to a patient &
the UAP is NOT wearing gloves… is it ILLEGAL? NO. is anyone in danger by the behavior? yes,
the UAP… what do you do? confront them & take over immediately!

ex: you are a LPN & notice that a RN goes home every day with bulging pockets… is it ILLEGAL?
YES (could be stealing). what do you do? tell supervisor!

ex: you are a LPN in the OR & you notice the surgeon during surgery contaminates the pinky of
his left hand? is it ILLEGAL? NO. is anyone in danger by the behavior? yes, the pt… what do
you do? confront them!

• you are a LPN & when giving report a RN always says “exasperation” instead of
  “exacerbation” when talking about a pt with COPD… is it ILLEGAL? NO. is anyone in danger by
  the behavior? NO… what do you do? talk to them about it at a later date!

ex: you are a LPN & you see a RN take & swallow a pill… confront them & ask “what was
that pill you just swallowed?” even if it’s a doctor! NCLEX wants you to go after them!!!
SAFETY!!!

Question 8

NUTRITION, WHAT MEAL WOULD BE BEST

Answer 8

when in doubt, pick chicken!! :) not fried chicken
- then pick fish NOT SHELLFISH\
- NEVER pick casseroles for a child
- NEVER mix meds in a child’s food = if you EVER mix meds in a person’s food; you must ask permission!

-Mtoddlers get FINGER foods (what can they eat on the run)
pre-schoolers (leave them alone; they eat when they are hungry) 1 meal = OKAY

Question 9

if you know what a drug does, but not the side effects - how do you proceed?!
*great guessing strategy: pick a side effect in the same body system where the drug is
working…

Answer 9

ex: GI drug… drowsiness, tachycardia, DIARRHEA?
ex: HEART drug… drowsiness, TACHYCARDIA, diarrhea?
ex: CNS drug… DROWSINESS, tachycardia, diarrhea?

Question 10

cognitive behavioral therapy (CBT)

Answer 10

• education about the clients SPECIFIC disorder
• self observation and monitoring
• physical control strategies = deep breathing exercises
• cognitive restructing = learning new ways
• behavioral strategies = focusing on the situations that causes anxiety

Question 11

PEDS: guessing

Answer 11

(growth & development)
always give the child more time (don’t rush their development!)

-when in doubt, call it NORMAL
-when in doubt, pick the OLDER age (at what age should a child ….) narrow down to two and pick the older age
-when in doubt, pick the EASIER task

IT ALL COMES TO NOT RUSHING THEM AND GIVING THEM MORE TIME!!!

Question 12

critical laboratory reuslts

Answer 12

• requires immediate intervention
• notify HCP as soon as possible
• do that before documenting it
• dont wait till the care provider is making rounds before telling them!
• CALL THEM IMMEDIATELY

DO NOT
- leave messages

Question 13

FIRST THING TO ASSESS MED SURG

Answer 13

1st thing to ASSESS = LOC
-not airway
*when you are in a CODE; you first ask the pt their name/are you okay?!

1st thing you DO = establish an airway

FIRST THING TO DO, ASSESS LOC
BEST THING TO DO: establish an airway

Question 14

if the question give you 4 right answers & asks you to pick the one with the HIGHEST
priority. how do you approach it

Answer 14

do the worst consequences game!
-take each option (A, B, C &D) “if I didn’t do this…”
-then choose the worst consequence!

ex: which of the following is the HIGHEST priority when caring for a suicidial pt?
if you don’t give him a tranqulizer… if you dont orient them to the unit… if you don’t put them
on suicide precautions… if you don’t introduce them to the staff…?

• what’s the worst between being aggitated, lost, dead or not knowing anyone?
  if you don’t put them on suicide precautions = dead!
• ex: what’s the worst without sips of water… what’s the worst without pain meds… what’s the
  worst if the side rails weren’t put up… what’s the worst without an abducter pillow (??) side
  rails!! fall/break!

Question 15

fall preventions in the elderly at home

Answer 15

ASSITING FALLING CLIENT
- step behind client with feet wide part
- move one foot back and extend front leg and let client slide down the extended leg
- lower client to the floor

RISK FACTORS
- age 65 and above
- the use of canes, walkers or crutches
- orthostatic vital signs (rise in pulse of 20 indicates syncope and falls)
- carbidopa/levodopa
- presence of IV therapy = **USE 5-15 DEGREE ANGLE ON INSERTION AS VEINS OF ELDERLY ARE MORE SUPERFICIAL

• use grab bars
• maintain a well-lit, clutter free environment
• regular vision exams
• wear rubber soled shoes, slippers and NON-SKID soles = WITHOUT LACES
• look forward when walking not down on at the feet
• rest crutches upside down(on the axilla pads when not in use to prevent them from falling
• keep crutch rubber tips dry
• use small backpack, fanny pack or shoulder bag to hold small personal items which will keep hands free when walking
• NO WHEELS OR TENNIS BALL ON WALKERS
• laxative is the number 1 abused drug in the elderly

Question 16

SYMPTOMS OF PH BEING UP (alkalosis)

Answer 16

• irritability
• hyper-reflexia (3&4)
• tachypnea
• tachycardia
• BORBORGYIM (increased bowel sounds)
• seizure ( suctioning )
• aspirate

BOWEL SOUNDS EVALUATION
BOWEL SOUNDS LESS THAN 5 PER MINUTES SHOULD BE EVALUATED

• BOWER SOUNDS SHOULD BE HIGH PITCHED

Question 17

=ASYMPTOMS OF PH BEING DOWN (ACIDOS)

Answer 17

remember when ph is down, every system shuts down

• hyporeflexia
• bradycardia
• lethargy (obtunded)
• paralytic ileus (decreased bowel sounds) = AVOID ANALGESICS
• coma
• respiratory arrest (ambu-bag/bag-valve mask

compensated vs uncompensated ABGs
- if ph is normal = compensated

• if ph is not within normal range = uncompensated

Question 18

what is kussmal breathing (MAC kussmal)

Answer 18

deep and labored breathing pattern asscoiated with severe METABOLIC DISORDER particulary DKA but also kidney failure

M: metabolic
AC: acidosis

cheyenne stokes: irregular respiration with periods of apnea

Question 19

RESPIRATORY RATE AND VENTILATION

Answer 19

ventilation is gas exchange

so if a patient with pneumonia is breathing is 50 bpm and their sp02 is 70, THEYRE STILL UNDERVETILATING = ACIDOSIS

• positive pressure ventilation causes increased intrathoracic pressure and REDUCED venous return and REDUCED cardiac output = lead to hypotension

ACID BASES ARE NOT ABOUT THE RATE, ITS ABOUT THE SPO2

IF YOU BREATHING SLOW AND YOUR SPO2 IS HIGH = GOOD

IF YOURE BREATHING FAST AND THE SPO2 IS LOW = YOURE UNDERVENTILATING

Question 20

HIGH PRESSURE ALRAM ON VENTILATORS

Answer 20

triggered by INCREASED RESISTANT TO AIRFLOW. - the machine is pushing hard to GET AIR INTO THE LUNGS

• water in the ventilator circuit
• increased or thicker mucus or other secretions blocking the airway (caused by not enough humidity)
• bronchospasm
• coughing, gagging, or “fighting” the ventilator breath.
• respiratory alkalosis = hyperventilating

INTERVENTION
1. KINK IN TUBE: get kink out
2. WATER CONDENSING WITHIN THE TUBE: empty the tube
3. MUCUS SECRETIONS IN THE AIRWAY = change positions, turn, cough, deep breath, then suction suction as needed

HOW OFTEN YOU SUCTION PATIENT?/ WHEN NEEDED!!! especially after they are being turned, cough, deep breath

Question 21

LOW PRESSURE ALARM ON VENTILATORS

Answer 21

could indicate HYPOTENSION
- so first nursing action is to check the client for possible bleeding

• decreased resistance meaning TOO EASY FOR THE MACHINE TO PUSH AIR INTO THE LUNG = respiratory ACIDOSIS
• assess client vital signs if nothing is wrong with the ventilator

INTERVENTION
- disconnections of the main tubing or oxygen sensor tubing

OXYGEN AND SENSOR ON VENTILATOR
- TUBING: RECONNECT IT
- OXYGEN SENSOR TUBE: reconnect it UNLESS TUBE IS ON THE FLOOR

IF EVERYTHING IS RIGHT AND CAUSE CANT BE FOUND = assess the vital signs of the client

Respiratory alkalosis = ventilator setting may be too high.
Respiratory acidosis = ventilator setting may be too low.

Question 22

whats the number 1 problem in ALCOHOLISM or an abuse

Answer 22

DENIAL IS THE #1 PROBLEM IN ALL ABUSIVE SITUATIONS

they fail to accept the reality of a problem = accountability is a positive progress towards recovery
‘how do you treat denial?? = CONFRONTING IT

confronting using “i” never “YOU”

ABUSE = CONFRONT
LOSS = SUPPORT

Question 23

5 steps of loss and grief

Answer 23

DABDA
- denial
- anger
- bargaining
- depression
- acceptance

DON’T CONFRONT LOSS AND GRIEF, SUPPORT IT!!!

You have a pt that just hand a hand amputated & they say, “I can’t wait to get back to playing the
piano”… You say “Oh, how long have you played, etc? - you NEVER say “You can’t because you
only have 1 hand”

ABUSE = CONFRONT
LOSS = SUPPORT

Question 24

when a client arrives at the hospital and birth is imminent

Answer 24

the nurse should collect brief history by
- asking about medications and drug use
- how many babies they are expecting
- what color was their fluid when their water broke
- when is their due date

Question 25

motion sickness

Answer 25

• anticholinergic medications (diphenhydramine and scopolamine

SCOPOLAMINE PATCH
- apply over 4 hours before starting to travel
- hairless, clean and dry area BEHIND THE EARS
- replace every 72 hours as prescribed
- wash hand with soap and water after disposal to avoid accident contant with eyes
- keep reach out children and pets to avoid accidental ingestion

Question 26

2 psychological problem that abusers have

Answer 26

dependency = when the abuser get the significant other to do something.. “call my boss and tell him im sick” = abuser gets to keep abusing

codependency = when the person being abused calls the boss and tell him “hes sick, he cant come to work” and the person getting abused feels good about doing something positive like “i am a good wife for making the call for him”

person being abused keep getting positive self esteem out of it

how to treat this: SET LIMITS AND ENFORCE THEM.

TEACH THE PERSON BEING ABUSED TO SAY NO!!!

Question 27

Wernicke-Korsakoff Syndrome (WKS)

Answer 27

• all intoxicated clients should be given IV thiamine before being given IV glucose

neuro disorder caused by difficiency in vitamin B1 thiamine ASSOCIATED WITH ALCOHOLISM.
- irreversible about 70%

• wernicke = encephalopathy = ACUTE
• korsakoff = psychosis = CHRONIC

psychosis: lose of touch with reality

TREATMENT = THIAMINE/VITAMIN B1
- preventable & arrestable (stop it from getting worse)
VITAMIN B1 metabolizes glucose to produce energy for the brain

PREVENTABLE
ARRESTABLE
IRREVERSIBLE

PRIMARY SYMPTOM OF WKS
- amnesia with confabulation (making up stories: they believe the lie)

You have a pt who believes he is Ronald Regan’s National Security Officer… And they want to go
to a cabinet meeting… :/ WHAT DO YOU DO?!? Redirect!! (“well, why don’t you get a shower
and then we’ll go watch CNN and see what the news is in Washington D.C.”)

Question 28

upper drugs

Answer 28

• caffeine
• cocaine
• pcp/lsd = psychedelic hallucinogens
• methaphetamines (crystal meths)
• adderall

SING AND SYMPTOMS??? EVERYTHING GO UP = euphoria, tachycardia, restlessmess, irritability, diarrhea, reflexes (3/4). spatic/seizure (SUCTIONING)

CAUSES PUPIL DIALATION

Question 29

downers drug

Answer 29

• heroin
• alcohol
• marijuana etc

SIGN AND SYMPTOMS?? everything go down.

• lethargic, respiratory depression, bradycardia, reflexer 1/2 - AMBU-BAG

INHALANTS = slurred speech, loss of motor coordination and nausea

Question 30

too much downer or downer and intoxicated??

Answer 30

pick ↓ things!!

withdrawal on downer means THEY DONT HAVE ENOUGH DOWNER: TOO LITTLE

Question 30

overdose on cocaine, what would you expect to see

Answer 30

cocaine is an upper, overdose makes everything go up!!

ANTIDOTE: NALOXONE

irritability
- reflex 3/4, increased temp, borborygmi (increased bowel sounds)

COCAINE WITHDRAWAL
- dysphoric mood
- fatigue
- insomnia or hypersonic
- psychomotor agitation

Withdrawing from cocaine.. -Make sure the RR is above 12! Need NALOXONE!!!

Question 31

drug addiction in the newborn

Answer 31

always assume intoxication NOT WITHDRAWAL AT BIRTH

You are caring for an infant born to a equaline (pain killer) addicted mother… It is 24 hours after the birth… What do you expect to see.. = INTOXICATION

• difficult to console
• exaggerated startle reflex
• seizure risk (twitching, jitteriness)
• hyperactivity
• shrill high pitched

AFTER THE BABY IS 24 HOURS YOU CAN THEN ASSUME = WITHDRAWAL

restlessness is normal for the newborn

Question 32

alcohol withdrawals

Answer 32

MONITOR FOR (similar to HYPOcalcemia)
- MONITOR FOR HYPOGLYCEMIA since alcohol brings everyhting down
- tremors
- hyperactive reflexes
- C and T signs

• STABLE, NOT LIFE THREATENING

but only a small percentage goes in DELIRIUM TREMENS (unstable) which happens a couple days after

CARE
- regular diet
- semi-private anywhere
- up ad lib (they can go anywhere they wanna go)
- NO RESTRAINS

DELIRIUM TREMENS (severe form of alcohol withdrawal)
- dangerous to self and others

Question 33

reconstituting a powdered medication

Answer 33

1. hand hygiene
2. withdraw air from the POWDERED vial and
   inject that air into the liquid and withdraw the liquid (diluent)
3. inject diluent to the powdered vial
4. roll vial between palms of the hand
5. withdraw reconstituited medication from the vial
6. label syringe with medication name and dosage

Question 34

ABUSE

Answer 34

WHEN MORE LIKELY TO OCCUR
birth to 3 years. theyre the most vulnerable
- girls more likely

ELDERLY
cognitive impairment
- parkison’s disease
- alhezeimer disease

SUSPECTED CHILD ABUSE
- report any of the following injury FIRST
- long bone fracture (femur)
- avoid words like “excessive” and “suspicious” during interveiw because they sound judgemental

you are required to report your suspicions to the appropriate authorities
- report them as a nurse even if provider disagrees

AREAS OF ABUSE
- back, buttocks, inside of the thighs, and genitalia.

NEGLECTED CHILD SHOULD HE EVALUATED FOR

the definition of negligence is to fail to care for properly
- growth and development
- malnourishment
- poor hygiene
- physical appearance
- height and weight

Question 35

the cycle of violence

Answer 35

• tension building
• violence
• honeymoon phase

Question 36

Warning signs of violence

Answer 36

behavior changes, withdrawal, depression, agitation, hyperarousal, a new display of anger, noncompliance, sexualized behavior, bowel or bladder problems, sleep problems, and unexplained/curious injuries.

Question 37

in the cases of chemical injuries, what is the focus of urgent treatment??

Answer 37

decontamination

• the solution to pollution is dilution
• clothing is removed
• chemicals and powders are brushed off
• the burn is irrigated with copious amounts of water

immediately after a poison ivy exposure = advise client to thoroughly wash area

Question 38

strabismus

Answer 38

• misaligment of the eyes (one eye deviated inward or outward) = NOT ASSOCIATED WITH IOP

TREATMENT
- wearing a patch over the stronger eye to develop strength in the weaker eye
- if let untreated loss of visual acuity can occur

Question 38

PARANOID PERSONALITY DISORDER

Answer 38

• distruct and suspicion
• they believe peoples motives are malicious and assume others are out to exploit, harm or deceive them

Question 39

TAP DRUGS

Answer 39

trough
administer
peak

DO IT FOR a drug WITH NARROW THERAPETUIC WINDOW (what works/what kills)

small doses of narrow index can lead to LIFE THREATENING

FUROSEMIDE: THERAPEUTI: 10-120 DONT DO TAP

but will do it for digoxin and mag sulfate

Question 40

baby feeding bottle tooth decay

Answer 40

• bottles containing milk or sugary beverages should not be used as bed time pacifiers = leads to rapid dental caries in the developing teeth
• sucking a bottle for an extended periods can also push the jawline out of shape

DENTAL CARRIES
- AVOID fruit juice, simple sugars, sticky foods
- rinse mouth with water after meals

PROVIDING WATER IN BETWEEN MEALS FOR A CHILD = GOOD!
- it accustoms the child with the taste of water
- reduce risk of constipation and UTI
- helps child maintain healthy weight

Question 41

PEAK times after a drug is adminstered

Answer 41

depends on the route

• sublingual: 5-10 mins
• IV: 15-30 mins
• IM: 30-60 mins
• subQ: diabetes lectures

after PO: DON’T WORRY ABOUT IT

SITES FOR ID INJECTION
- inner forearm

SITES FOR SUBCUE INJ
- abdomen
- posterior upper arm
- thigh

SITES FOR IM INJECTION
- ventrogluteal = RECOMMENDED PLACE = FEWERE LESS BLOOD VESSEL AND NERVES
- deltoid
- vastus lateralis = KIDS

subcue can be 45 or 90

Question 42

v tach ekg strips

Answer 42

continuous BIG Ms like MCDONALDS SIGN

VT: WIDE QRS

SVT: SKINNY QRS

THIRD DEGREE HEART BLOCK
- also called complete heart block
- **decreased cardiact output (dizziness, syncope, mental status, heart failure, hypotension, brady)
- any of these symtptons is a high priority

Question 43

v fib ekg strip

Answer 43

continuos lower case m

no pattern

Question 44

a fib ekg strip

Answer 44

looks like normal sinus rhythym but with “v fib” in the middle

Question 45

ankylosing spondylitis

Answer 45

MANIFESTATIONS
- low back pain and stiffness
- similar to excess scoliosis where head is pointing down
- worse in morning and improve as the day progresses

INTERVENTION
- promote extension of the spine with proper posture
- daily stretching, swimming
- manage pain with moist heat and NSAIDS
- take immunosuppressant and antiinflammatory

TREATMENT
- NSAID

Question 46

what does the QRS on ekg explain

Answer 46

ventricular depolarization

Question 47

what class of drugs inhibits gastric acid secretion

Answer 47

ends in - TIDINE
- PRAZOLE

renally excreted and REQUIRES DOSAGE ADJUSTMENT FOR PATIENTS WITH RENAL PROBLEM

Question 48

PVC on ekg

Answer 48

low priority
- periodic bizzare wide QRS

6 pvc in a min, fall on a t wave = moderate piroity

they never reach high priority

Question 49

treatments for ventricular arrhythmias

Answer 49

use lidocaine

NEW: amiodarone

Question 50

what is the purpose of a chest tube

Answer 50

re-establish negative pressure in the pleural space

• negative pressure is needed for air exchange because it makes things stick together
• pneumothorax (air in pleural space = positive pressure.. put chest tube in to re-establish negative pressure!) PNEUMOTHORAX = collapsed lungs (hyperresonant)
• hemothorax (blood= positive pressure.. put chest tube in to re-establish negative pressure!)
• pneumohemo (air & blood = positive pressure.. put chest tube in to re-establish negative
  pressure)

deviated trachea is a medical emergency MANIFESTATION of pneumothorax and its a high priority

WHEN CHEST DRAINAGE STOPS ABRUPTLY
- auscultate the lungs to determine if its because the lung has re-expanded
- have client cough and deep breathe
- reposition client (if they been on one position for too long, maya accumulate drainage

Question 51

patient on hemothorax, what FINDINDS do you report

Answer 51

in questions like this, first identify what type of chest tube it is. in this case, the question is hemo so blood.

what do you expect from a hemo chest tube: drain blood

PAY ATTENTION TO THE DISEASE IT WAS PLACED

you’ll report the chest tube not draining

if you flip it to phenumothorax, then youll report no bumbling

Question 52

locations of chest tube

Answer 52

Apical = chest tube is way up high ( done to removed AIR cus air rises)

Basilar: chest tube is placed at the bottom to remove BLOOD

so if they say your apical is draining 300 ml per hour?? BAD

• apical tube is not bubbling = BAD
• basillar tube is draining 300 ml?? GOOD

traumatic pneumothorax, priority is covering wound place with 3 side tapes

Question 53

what chest tube would you use for a unilateral pneumohemo

Answer 53

apical for the pneumo

basilar for the hemo (blood)

bilateral pneumo??? = 2 apical chest tubes cus apical is AIR

chest trauma? =always assume its unilateral unless specified

IF YOU HEARD CRACKLING SENSATION UNDER THE SKIN (crepitus) AROUND WHERE CHEST TUGE IS INSERTED = NOTIFY HCP THATS EMPHYSEMA
subcutaneous emphysema
- air leaked into tissue surrounding the chest tube insertion site
- marked by crackling sensation when palpating the skin

Question 54

what chest tube will you need for post op right pneunonectomy?

Answer 54

NO CHEST TUBE WHY??

pneunonectomy is the removal of the lungs so theres no pleural space therefore you dont need any chest tube to restablish the negative pressure

Question 55

what should you do when the water seal breaks on a chest tube

Answer 55

CLAMP IT so that positive pressure don’t get in the pleural space (DON’T CLAMP MORE THAN 15 SECONDS WITHOUT DR ORDER

2. CUT IT AWAY FROM THE BROKEN DEVICE
3. (SUBMERGE) STICK THAT TUBE UNDER STERILE WATER
4. UNCLAMP IT

FIRST: CLAMP
BEST THING TO DO IF IT BREAKS?? = SUBMERGE BECAUSE IT RESTABLISHES WATER SEAL

Question 56

A PERSON WITH V FIB ON A MONITOR, YOU RUN IN A ROOM THEY ARE NOT RESPONDING WITH NO PULSE. FIRST AND BEST THING TO DO?

Answer 56

FIRST: place a backboard

BEST: begin chest compression

Question 57

What do you do if the chest tube gets pulled out?

Answer 57

FIRST: takes a gloved hand and cover the hole

BEST: cover the incision site with vaseline gauze!! = TAPED 3 SIDES! NEVER 4

NEVER REINSERT CHEST TUBE = it’s not the RNs job

WHEN DOCTOR IS REMOVING CHEST TUBE = instruct patient to take TAKE A BREATHE IN, HOLD IT AND BEAR DOWN = VALSALVA MANEUVER. post procedure chest x ray is needed

Question 57

hearing impairment in children

Answer 57

• appears shy, timid and WITHDRAWN
• avoids social interaction
• inattentive
• monotone loud speech

Question 58

WATER SEAL CHAMBER ON CHEST TUBE

Answer 58

• contains water which prevents air from flowing INTO the client
• up and down is seen with inspiration and expiration = normal
• intermittent is normal during coughs

continuous bubbling = bad =indicates leaky

LPN CAN DO THIS
*If something is sealed, should you have a continous bubbling? NO

IF THE WATER SEAL IS NOT FLUCTUATION, then there may be fit in clots in the tubing = also happens when the lungs is fully expanded

• REPORT drainage of 100 or more an hour from chest tube

Question 59

colostomy

Answer 59

• irrigate daily ONLY FOR DESCENDING COLOSTOMY
• wear a colostomy pouch over the stoma to collect feces from the stoma
• clarify enteric coated medications with HCP poorly absorbed
• tenderness surrounding colostomy may be normal immediately after surgery due to manipulation
• paleness, grey tinged may indicate inadequate blood flow
• REGULAR DIET but prevent excess gas by not consuming brocolli and cauliflower. ADHERE TO LOW FIBER DIETS TOO
• pink is normal purple is necrosis and requires immediate intervention

BOWEL IRRIGATION = CLAMP WHEN IT CRAMP (but leave cone in place)
- fill container with 500-1000 lukewarm water, flush irrigation tubing and reclamp
- instruct to sit on toilet, irrigation container 18-24 inches above the stoma
- never use enema to irrigate a colostomy, a cone tipped applicator is used

Question 60

dietary fiber

Answer 60

• prevents constipation
• decreases risk of colorectal cancer
• promotes weight loss
• improves blood glucose control
• decreases serum cholesterol levels
• reduces risk of coronary artery disease and stroke

Question 61

Rules for clamping a tube:

Answer 61

1. do NOT clamp longer than 15 seconds without a doctor’s
   order….

What happens if you break the water seal? CLAMP it! How long do you have to get it
under water? 15 seconds, or you gotta unclamp..

• Have sterile water bottles nearby! Use rubber
  tip double clamps…

CLAMPING = cases intrathoracic pressure

Question 62

TROUBLE HEART DEFECTS

Answer 62

• shunts blood from right to left (cyanoitc = B)
• R comes before L in the letter trouble
• needs surgery, delayed growth,
• decreased life expectancy
  -needs more time in the
• hospital/pediatric cardiologist

EXAMPLES OF TROUBLE DEFECTS
all starts with T EXCEPT: left ventricular hypoplastic syndrome

• tetrology of fallot
• truncus arteriosus
• transposition on the great vessels
• transposition on the great arteries = initiate ALPROSTADIL infusion
• tricuspid atresia
• total anomalous pulmonary venous return
  (TAPV),

ALL HEART DEFECTS WHETHER TROUBLE OR NO TROUBLE HAS
- 1. all have murmur why? = because of the shunt of the blood
- 2. they all have an echo done

Question 63

NO TROUBLE HEART DEFECTS

Answer 63

shunts blood from Left to Right (pink)

• doesn’t need surgery
• normal growth
• normal life expectancy
• only 24-36 hours in the hospital/pediatrician/NP

EXAMPLES OF NO TROUBLE DEFECTS
- ventricular septal defect = harsh systolic murmur
- patent ductus arteriosis = loud machine like murmur
- patent foramen ovale
- atrial septal defect = systolic murmur/ fixed split second
- pulmonic stenosis = systolic ejection

• coaractation of the aorta = weak lower and strong upper extremities

ASD and VSD = down syndrome

**MANIFESTATION OF NO TROUBLE HEART DEFECTS (L-R SHUNT)
- heart murmur
- poor weight gain
- diaphoresis with exertion
- signs of heart failure

normal ejection fraction 55-70

ALL HEART DEFECTS WHETHER TROUBLE OR NO TROUBLE HAS
- 1. all have murmur why? = because of the shunt of the blood
- 2. they all have an echo done

Question 64

tetralogy of fallot (TOF)

Answer 64

4 DEFECT OF TOF HEMO AND HEMAT INCREASES
VarieD PictureS Of A RancH
- VD (ventricular defect)
- PS (pulmonary stenosis)
- OA (over-riding aorta)
- RH (right hypertrophy)

• clients with this experiences chronic hypoxemia due to decreased pulm blod flow and curculation of pooorly oxygenated blood, as a result, RBC increases(polycethemia) and results in increased blood viscosity = report elevated hemo or HEMATOCRIT
• polycethemia is treated with phlebotomy

propranolol and sodium bicarbonate may be used much later if necessary

INTERVENTION
- mag sulfate and morphine sulfate for TET SPELLS but first put infant in KNEE CHEST POSTION (like mother holding child on chest

Question 65

Allen test

Answer 65

• preffered way of obtaining arterial blood gas sample
• determines adequacy of ulnar artery blood flood, circulation to the extremity
• patency of ulnar artery

STEPS
- instruct client to make a fist and occlude radial and ulnar arteries using firm pressure
- instruct the client to open the fist; palm will exhibit pallor
- release pressure on the ULNAR ARTERY. palm should turn pink in 15 seconds indicating patency of the ulnar artery

Question 66

delusions vs illusion

Answer 66

they both psychosis but

DELUSIONS:
- false fixed idea or belief: NO SENSORY
COMPONENT (3 TYPES: grandiose, paranoid, somatic (x ray vision)

ILLUSIONS
- a sensory experience
- misinterpretation of reality

Question 67

types of nursing

Answer 67

FUNCTIONAL NURSING: involves assigning each nurse with a specific task to perform for the shift. = FOCUSES ON TASK

TEAM NURSING: involves a group of nurses or STAFF being assigned to a limited number or group of patients.
- involves RN LPN UAP

PRIMARY NURSING: requires a nurse to provide care for the same patients during hospital stay

benchmarking: when a nurse manager compares best practices from other hospitals to improve unit performance

Question 68

what is diabetes mellitus

Answer 68

error of glucose metabolism

• your body cannot metabolize gluocose well
• polydipsia - excess thirst
• poluria
• sometimes its a lack of insulin
• sometimes the cell has become resistance to insulin

MONITOR EYES AND KIDNEY FUNCTIONS

TWO PROBLEMS DIABETIC PATIENTS ALWAYS HAVE
- hyperglycemia
- dehydration = polyuria

Question 69

type 2 diabetes treatment

Answer 69

DOA
- diet (most important)
- oral hypoglycemic ( metformin )
- activity

DIETS MODIFICATIONS TYPE 2
- caloric restriction: 1200 calories, 1800
- 6 small meals a day

TYPE 2 DIABETES MEDICATIONS
- metformin (hold 24 hours after surgery with die)
- THIAZOLIDINEDIONES = carries low risk for hypoglycemia like metformin
- increased risk of cardiovascular events

when taking thiazolidediones, MONITOR AND REPORT myocardial infarction and bladder cancer
- bladder cancer = painless hematuria = primary cause is smoking and occupational exposure as second

METFORMIN
- risk of hypoglycemia is minimal cus it does not increase insulin secretion even when meals are skipped
- SHOULD BE HELD 24 hours after a surgery that involved a contrast dye = CAN CAUSE RENAL FAILURE

OTHER NAMES FOR TYPE 2 DIABETES
- non insulin dependent, non ketosis prone
- hyperosmolar hyperglycemic state

Question 70

sign and symptoms of type 2 diabetes

Answer 70

• polyuria (increased urine)
• polydipsia (increased thirst)
• polyphagia (technically means swallowing a lot but in the context of diabetes, increased eating)
  can lead to retinal detachment

LOW URINE GRAVITY AND OSMOLALITY
HIGH SERUM OSMOLALITY

HYPEROSMOLAR HYPERGLYCEMIC STATE
- TURN IT TO DEHYDRATION ANYTIME YOU SEE HYPERGLYCEMIC HYPEROSMOLAR = HYDRATE HYDRATE HYDRATE
- sugar levels >600
- complication of TYPE 2 diabetes
- older age
- abdominal pain less commoin
- severe hyperglycemia happens more slowly and is often not noted until neuro manifestations occur
- osmotic diuresis
- more ppl die from hyperglycemic hyperosmolar but DKA is higher priority in the emergency

Question 71

vitamin D and calcium

Answer 71

recommended to take calcium supplements with vitamin d

same way you take iron supplements with vitamin c
- take iron pills on empty stomach
- use straw for oral suspension to avoid staining teeth

Question 72

west nile virus

Answer 72

• mosquito borne disease (encephalitis)
• occurs mainly in summer during humid weathers

INTERVENTION
- insect repellent
- wear long sleeved, long pants and light colors
- avoid outdoor activities at dawn and dusk when mosquitoes are most active

Question 73

INSULIN EXPIRATION DATE

Answer 73

manufacturer’s expiration date is only good when the
bottle is closed…

• after it’s open; it expires in 30 days!) make sure you write the date on the
  bottle with EXP!
• You should teach patients to refridgerate their insulin at home, but it doesn’t need to be
  refridgerated in the hospital.

Question 74

effects of exercise on insulin

Answer 74

it potentiates insulin = does the same thing as insulin
- think of exercise as another shot of insulin

EXAMPLE:
- the patient exercised = they got another shot of insulin
- the patient is going to play soccer this afternoon = the patient is going to get another shot of insulin

MORE EXERCISE = MORE INSULIN SO THEY ACTUALLY NEED LESS SHOT OF INUSLIN NOW

LESS EXERCISE = NEED MORE INSULIN

Question 75

SICK DAYS OF DAIBETICS

Answer 75

• when a diabetic is sick, their GLUCOSE ALWAYS GO UP EVEN WHEN THEYRE NOT EATING THATS WHY THEY STILL HAVE TO TAKE INSULIN
• still take insulin, even if they’re not eating
• take sips of water; they get dehydrated fast
• stay active as possiblme

Question 76

indwelling catheter

Answer 76

• betadine is included in the indwelling cather so ASK PATIENT IF THEY ALLERGIC TO IT, if yes switch it

secured lower stomach, upper thigh

NOSOCOMIAL INFECTIONS
- acquired at the hospital
- most common is UTI followed by surgical site infections, pneumonia and bloodstream infections

Question 77

TYPES OF THOUGHTS DISTURBANCES IN PSYCH

Answer 77

• tangential = wandering thought but never seems to get to get to the MAIN POINT
• word salad = mix of words and/or phrases having no meaning EXCEPT TO THE CLIENT = most extreme form of disturbed speech
• associative looseness = rapid shifting with no connection (topic and ideas are not connected). jumping from one topic to another with no association

Question 78

optimal fetal position for a vaginal birth

Answer 78

• ROA = right occiput anterior
• LOA = left occiput anterior
• baby front facing the posterior of the mother

FETAL STATIONS
- relationship of the fetal presenting part to the mothers ischial spine (narrowest part of the pelvis)
- if the baby cannot fit there, it cannot be born vaginally
- negative station: presenting part is above the tight squeeze

positive station +4+3,+4,+3 = baby presenting part is below/already made it through the tight squeeze

+4+3,+4,+3 can the baby be porn vaginally?? yes cus the baby already made it through the ischial spine

EFFACEMENT
- thinning of the cervix 100%

• so a woman begin labor thick and 0 cm and ends labor in fully dilated and efface (10 cm and 100%)

laminaria is used to efface the cervix

FETAL PRESENTING PART
the part of the baby that enters the birth canal first

Question 79

sign and symptoms of hyperkalemia

Answer 79

kalemias do the SAME AS THE PREFIX, except for heart rate and urine output
peaked T waves
HYPER
- brain: irritability, restlessness, agitation…
- lungs: tychpnea
- heart: low heart rate (bradycardia)
- urine: oliguria
- bowel: diarhhea, borborygmi
- muscles: spasticity
- reflexes: +3/+4
- ADDISON

clonus = muscle spasm

• narrow t waves
• end stage renal failure
• dka

Question 80

sign and symptoms of HYPOKALEMIA

Answer 80

kalemias do the SAME AS THE PREFIX, except for heart rate and urine output

HYPO
- brain: lethergy
- lungs: bradypnea
- heart: tachycardia
- urine: polyuria
- bowel: constipation
- muscles: flaccidity, muscle cramps
- reflexes: 1/2

-Cushings: immonosuppressed (needs PRIVATE room) (aldosterone; retain sodium & water;
low on potassium)

Question 81

extubation

Answer 81

• immediately place on humidified oxygen and monitor for aspiration, airway obstruction, respiratory distress
• remain NPO until swallowing fucntions has been evaluated
• provide routine oral care as well as instructions on deep breathing and use of incentive spirometer
• side lying prevents aspiration pneumonia
• flex neck (chin to chest when swallowing)

Question 82

sign and symptoms of hypercalcemia

Answer 82

HYPER and its the oppsite of it so everything is DOWN

brain: lethergy
lungs: bradypnea
heart: bradycardia
urine: oliguria
bowel: constipation
muscles: flaccidity
reflexes: 1/2

• what do you administer: phosphorus, calcitonin, IV biphosphonates

Question 83

sign and symptoms of hypocalcemia

Answer 83

EVERYTHING GOES UP

brain: irritability, restlessness, agitation…
lungs: tachypnea
heart: tachycardia
urine: polyuria
bowel: diarhhea

Question 84

insensible fluid loss

Answer 84

fluid loss that is outside the norm that the patient is usually not aware

• insensible fluid loss occurs to every patient through the skin and the lungs

DOEST NOT INCLUDE VOMITING AND DIARRHEA cus the patient is away

INSENSIBLE = tachy ( with each breath, small amount of fluid is lost in the air and since the patient is not ware = ITS INSENSIBLE

Question 85

sign and symptoms of hypermagnessium

Answer 85

1.3-2.1

oppsoite of prefix

brain: lethergy
lungs: bradypnea
heart: bradycardia
urine: oliguria
bowel: constipation
muscles: flaccidity
reflexes: 1/2
somnolence = excessive drowisness

treatment: calcium gluconate

Question 86

sign and symptoms of hypomagnesium

Answer 86

opposite of refix

HYPOmagnesium:
brain: irritability, restlessness, agitation…
lungs: tachypnea
heart: tachycardia
urine: polyuria
bowel: diarhhea
muscles: spasms
reflexes: +3/+4

Question 87

sodium electrolytes

Answer 87

• HYPERnatremia: DEHYDRATION DKA DI… HHNK?
• HYPOnatremia: OVERLOAD Fluid volume excess SIADH

NUMBNESS & TINGLING (paresthesia) = earliest sign of any electrolyte disorder
“circumoral” = numb & tingling lips
UNIVERSAL sign of any electrolyte disorder = MUSCLE weakness (paresis)

• SODIUM CONTROLS AND MANAGES CIRCULATING BLOOD VOLUME

HYPERNATREMIA MANIFESTATIONS
FRIED and SALTY

Fever (low grade)
Restlessness & agitation
Increased fluid retention
Edema: peripheral and pitting
Dry mouth

Skin flushed
Altered LOC & confusion
Low urinary output
Thirst
Elevated blood pressure
Decreased energy

DEHYDRATED PATIENTS SHOUKD AVOUD
- sugar
- caffeine
- sodium

Question 88

how do we lower potassium

Answer 88

FASTEST WAY but temporary fix - **Give D5W with REGULAR insulin BUT CALCIUM GLUCONATE IS GIVEN FIRST TO PREVENT FURTHER DYSRYHTMIA AND STABILIZE THE PATIENT
- insulin and dextrose drives potassium into the cell and OUT OF BLOOD

• D50 and regular insulin in SEVERE HYPERKALEMIA (>7.0)

PERMANENT WAY but slow - sodium polystyrene (Kayexalate) = it switches the potassium with sodium) = switching from a life threatening
imbalance (HYPERkalemia) for a non-life threatening imbalance (HYPERnatremia) = JUST HYDRATE AFTER THIS!!
hydrate!!*
- CLIENTS RECEIVING SODIUM POLYSTYRENE MUST HAVE NORMAL BOWEL FUNCTIONS TO AVOID THE RISK OF INTESTINAL NECROSIS = access for constipation, impacttion and recent bowel patterns

Question 89

atopic dermatitis (eczema)

Answer 89

GOAL IS TO REDCUE
- itching
- erythema
- dry skin

INTERVENTION
- reduce itching
- apply emollient soon after birth
- give oral antihistamine before bed to relieve itching which is worse at night
- keep child nails short and trimmed
- long sleeves should be worn at night in soft clothing like cotton
- rough fabrics can cause itching and sweating

Question 90

when installing an IV and after the second attempt you still don’t get it, what do you do?

Answer 90

ask a second nurse to attempt to start the IV

Question 91

electro convulsive treatment (ECT)

Answer 91

• highly effective in treating severe depression especially in thosr HIGHLY SUICIDAL
• also used in clients that does not respond to medications

DUIRNG ECT
- pulses of electrical energy is sent through electrodes applied to the scalp = can cause brief convulsion
- general anesthesia and a skeletal muscles relaxant is adminstered to prevent SEIZURE and musculoskeletal injury
- medication is given with ECT for imporved outcomes

SIDE EFFECTS
- the patient is not supoosed to feel anything from the procedure but confusion and memory loss are COMMON SIDE EFFECT

ELECTROENCEPHALOGRAM (EEG) = used to diagnose prescence of seizure disorder
- wash hair with shampoo before the procedure to remove oils and other hair care products not painful and avoid caffeine
- no pain is felt and no sedation is needed

Question 92

thyroid storm/crisis

Answer 92

medical emergency from partial/ subtotal thyroidectomy

MANIFESTATIONS
- super HIGH temps (105 & >)
- extremely HIGH BP’s *ex: 210/180 (stroke
category)
- severe TACHYCARDIA (ex: 180-200)
- PSYCHOTIC DELIRIUM

INTERVENTION = bring temp DOWN and oxygen UP SEQUENCE: oxygen, cooling blanket
- ice packs
- cooling blanket = best
- never leave patient alone by themseleves
- OXYGEN PER MASK AT 10L PER MINUTE

DO NOT USE ACETAMINOPHEN= it works in the hypothalamus and isn’t going to work at
this time

Question 93

iloestomy

Answer 93

LOW FIBER DIET

• connects small intestine to the external abdomen
• stools from the small intestine bypasses the colon and exit through the ileostomy = results in liquid stools

REPORT
- abdominal bloating
- nausea vomiting
- decreased stool
- these symptoms indicate bowel obstruction or obstructed ileostomy

INTERVENTION = LOW FIBER DIETS
- it helps prevent obstruction of the narrow lumen of the stoma
- client should be advised to chew food thoroughly

AVOID
- popcorn
- brown rice
- multigrain bread
- fruits with seeds like strawberry, olives
- after the ileostomy heals, introduce fiber foods one at a time

Question 94

Defense mechanisms

Answer 94

• regression: a teenager experiences episodes of wetting bed after being bullied
• sublimation: channeling energy from unacceptable things to acceptable actions
• repression: after going through something traumatic, person cannot remember details of the event (keeping thoughts in the unconcious
• rationalization: using excuses to justify soemthing
• projecting: unconsciously placing one own thoughts or feelings onto someone else
• reaction formation: expressing opposite feelings of ones true feeling (parent becoming over protective of unwanted child)
• introjection: a person who never liked working out dates. a personal trainer and now goes to the gym everyday
  -displacement: angry with the boss at work, comes home and yells at the spouse**
• transference: you are just like my mother, bothering me with all these questions

PSYCH TERMS
- splitting: inability to view both positive and negative aspects of others as part of a whole
- histrionic: likes to be center of attention, exagerrated emotional expression
- schizoid personality: social detachment and inability to express emotion
- agraphobia = intense fear and axiety about being in certain situations or spaces (train, crowds, outside the home alone, enclosed space)
- so you either view someone as either a wonderful person or horrible person
- factitious disorder: serious mental disorder in which someone deceives others by appearing sick
resilience: protective factor that is strengthened by practicing positive coping skills such ass deep breathing, journaling, muscle relaxation

DELUISIONS
- nihilistic: it doesnt matter if i take this med, im already dead
- somatic: the doctor said im fine but i have lung cancer
- reference: believe that songs, newspaper articles and other events are personal and significant to them

ILLUSIONS
- falsed sensory
- misinterpretation of reality

Question 95

amyotrophic lateral sclerosis (ALS or Lou Gehrigs diseas)

Answer 95

• progressive neuro loss of motor neurons
• glutamate excess

MANIFESTATIONS
- difficulty breathing
- limb/ muscle weakness
- dysarthria = difficulty speaking = greatest priority
- dysphagia
- RESPIRATORY

NO CURE but RILUZOLE IS THE ONLY MEDICATION APPROVED FOR ALS TREATMENT = slows down disease progression

TREATMENTS FOCUSES ON
- resp function
- adequate nutrition = they have difficulty eating
- quality

Question 96

TORCH INFECTIONS

Answer 96

• group of infections that causes fetal abnormalities
• Toxoplasmosis
• Other (parvirus, varicella)
• Rubella
• Cytomegalovirus
• Herpes simplex virus

gonorrhea and chlamydia are leadin causes of pelvic inflammatory disease

Question 97

SAFETY considerations when selecting toy for a child

Answer 97

• NO SMALL TOYS for children UNDER 4 years (could put in mouth/aspirate)

-NO METAL (die-cast) TOYS, if OXYGEN is in use.. (sparks!)

-BEWARE of FOMITES (NON-living object that harbors micro-organisms)

What toys are the worst for FOMITES = Stuffed animals cus its hard to clean

What toy is the best for FOMITES? Hard plastic toys/you can disinfect it!

*BEST toy for an IMMUNSUPPRESSED child? HARD PLASTIC action figure!

Question 98

from birth to 6 months of age, what toy is age appropriate

Answer 98

best toy: musical mobile = stimulates motor sensory

2nd best toy = something soft (so they dont hurt themselves) large (so they dont choke)

they can’t sit up and reach for the musical mobiles yet

6-9 MONTHS WORST
- musical mobile, WHY? they can sit up/reach up and then can stranglate themselves

but musical mobile is the best for birth to 6 months

Question 99

toddlers (1-3) style of play

Answer 99

PARALLEL PLAY = PLAY ON THEIR OWN but still around eachother
- they play next to each other and are happy to be in the presence of peers but they do not play directly with one another
- not interacting
- independent don’t wanna play with anybody

• stacking blocks
• acitivitiws such as playing with dolls, toys cars, pushing and pulling large toys, smearing paint, digging in sand box

BEST TOY: push/pull toys
- work on GROSS MOTOR = running,
jumping

• imitates

NORMAL OBSERVATIONS
- temper tantrums is their way of relieivng stress =use time outs and offer quiet environments
- they experience phenomenal growth of language skills
- they say “no” to express their independence
- picky about their food choices so expose them to new foods repeatedly
- avoid forcing foods on them = poor eating habits in the future
- offer food 15 minutes after play periods = promotes better eating habits

NO FINGER DEXTERITY YET = cant color, use scissors
- molding clay

= “Finger painting”?? yes, because
they can use their HAND!
= Finger painting = HAND painting

Question 100

adolescents kids are characterized by

Answer 100

• Peer Group Association (hang out with their friends)

Question (pertaining to Nursing): Do you let 5-8 adolescents hang out in a room together?
YES!! UNLESS these 3 things:
- if anyone is fresh post-op (less than 12 hours out of
surgery)
- if anyone is immunosuppressed
- if anyone has a contagious disease.

Question 101

LAMINECTOMY

Answer 101

• also known as decompression surgery
  why do we do this?? = RELIEVE NERVE ROOT COMPRESSION
• ENLARGES YOUR SPINAL CANAL TO RELIEVE PRESSURE ON THE SPINAL CORD OR NERVES
• 3 LOCATIONS = cervical (neck), thoracic (upper back) & lumbar (lower back)

Question 102

S/S of nerve root compression

Answer 102

3 PS

• pain
  -paresthesia (numbness & tingling)
  -paresis (muscle weakness)

Question 103

MOST IMPORTANT thing to pay attention in any SPINAL question

Answer 103

THE LOCATION = cervical, thoracic and lumbar

• cervical; diaphragm… #1 answer = check out their breathing… #2 answer = check out the
  function of their arms & hands.
• thoracic; cough & bowels… #1 answer = check how well they cough
• lumbar; bladder & legs… #1 answer = is their bladder distended or empty… #2 answer =
  how is the function of their legs

Question 104

what is the most important pre op assesment for a cervical laminectomy

Answer 104

1 BREATHING

• cervical spinal cord intervates diaphragmn and arms so two things to check for

#2 the functions of the arms and hands

COMPLICATION
- trouble breathing = pneumonia

Question 105

what is the most important pre op assesment for a thoracic laminectomy

Answer 105

1 = cough mechanisms = check how well they cough

#2 = bowels

thoracic spinal cord intervates the abdomen and gut

ONLY LAMIECTONY WE CAN USE A CHEST TUBE FOR

COMPLICATIONS
- thoracic = trouble coughing = PNEUMONIA
- paralytic ILEUS (because bowels wont work)

Question 106

what is the most important pre op assesment for a lumbar laminectomy

Answer 106

1 bladder = is their bladder distended or empty

#2 legs = functions of their legs

COMPLICATIONS
- lumbar = URINARY RETENTION
- problems with the legs

Question 107

3 things to mobilizing patients who just had a spinal cord surgery or LAMIECTOMY

Answer 107

• do NOT dangle them (sit on the edge of the bed)
• do NOT sit for longer than 30 minutes
• they may walk, stand & lie down without restriction

Question 107

3 things to mobilizing patients who just had a spinal cord surgery or LAMIECTOMY

Answer 107

• do NOT dangle them (sit on the edge of the bed)
• do NOT sit for longer than 30 minutes
• they may walk, stand & lie down without restriction

Question 108

Laminectomy with FUSION

Answer 108

they take a bone graft from the iliac crest

• If you remove the disc, you have to get bone from somwhere = so there isn’t bone on bone (grinding)!

= So, there will be 2 incisions; spine & hip; the most pain will be at the hip

IF YOU REMOVE DISK, GOTTA DO A FUSION!!!! get the brone from somewhere = commonly on the hip

spine & hip; the most pain will be at the hip

• most bleeding and drainage = at the hip = will have JP drain
• highest risk for infection?? BOTH the spine and hips
• highest risk of rejection?? THE Spine

Surgeons are using bones from cadavers quite a bit to lower infection rates..

Question 109

discharge teaching for lamiectomy

Answer 109

TEMPORARY
- do NOT sit longer than 30 minutes (6 weeks)
- lie flat & log roll (6 weeks)
- NO driving (6 weeks)
- do NOT anything more than 5 lbs; gallon of milk (6 weeks)

IF YOU HAVE TO GUESS WHEN SOMETHING SHOULD BE RESTRCITED AND YOU DONT KNOW?? = ALWAYS PICK 6 WEEKS

Remember: MOST IMPORTANT thing to pay attention to
in any NEURO question = LOCATION!

PERMANENT
-NEVER pick up object by bending at the waist; lift with the knees!!

• CERVICAL LAMIECTOMY can NEVER lift anything over your head (for life!)

-NO mountain biking, jerky moving ride (rollercoasters), horseback riding, etc.

Question 110

if a patient has a high potassium levels whats the protocol

Answer 110

• HOLD all potassium
• ASSESS the heart
• Prepare to administer (kayexalate, D5W & regular insulin)
• CALL DOC

Remember: if the potassium is = or > than 6 = deadly serious; pt
could DIE, in like the next 2 minutes.
SO WHAT DO YOU DO??

HOLD all potassium
ASSESS the heart
PREPARE (kayexalate, D5W & regular
insulin)
CALL doc STAT!!! get everyone involved & YOU stay with your PT

HAVE OTHER PPL INVOLVED CUS EVERYHTING GOTTA BE DONE STAT or they could die in the next two minutes

Question 111

ph levels and what to do with low pH

Answer 111

7.35 - 7.45
- pH in the 6 is a HIGH PRIORITY

what to do?? (remember: hold,assess,prepare,call) but in this case, nothing to hold and give so…

• ASSESS vital signs cus pH going down means patient is going down. get these first before calling the doctor cus they’ll ask for it = is he breathing? is he alive?
• CALL doc and get them there STAT

Question 112

if they give you an elevated blood value and you have no idea whats going on and they ask for what would you assess them??

Answer 112

DEHYDRATION is a good answer.

ALL BLOOD VALUES GO UP WHEN YOU DEHYDRATED

Question 113

OPIOIDS

Answer 113

SIDE EFFECTS
- itching and nausea are expected adverse effects
- can lead to hypotension
- teaching about constipation is essential. to prevent long term complications
- CLIENT FALLING ASLEEP IN MIDDLE OF TAKING INDICATES OVERSEDATION AND REQUIRES INTERVENTION

INTERVENTION
- defecate when urge is felt
- drink 2-3 L a day
- high fiber diet
- exercise

MED: use of a stool softer(docusate) and a stimulant (senna) SIMULTANEOUSLY

when a person is in pain, pick UP things

MATERNITY
- opiods are safe for clients who will give birth 2-4 hours after amdnistration so that the effects wear off before birth
- best for clients in active labor with well established contraction cus opiods may slow labor progression in the latent phase
- avoid in clients who are close to giving birth such as already feeling the urge to push

AVOID MORPHINE IN
- people with head injury cus it can lead to increase ICP

Question 114

when a pt is HYPOXIC: which rate increases first? respiratory rate or heart rate?

Answer 114

HEART RATE will speed up first and when the heart can no longer compensate for it, the respiratory rate go up

• if you ever work CORONARY care, what are the 2 most common causes of episodic
  tachycardia in heart pt’s? HYPOXIA & DEHYDRATION

Question 115

when you need to
INTUBATE/VENTILATE a patient

Answer 115

When the O2 & the CO2 are both in the 60’s

NROMAL
pO2 is 78-100
pCO2 is 35-45

pO2 in 70s
78-100 = this the oxygen from ABG not the pulse ox
- if its low but still in the 70s
- ASSESS for respiratory status
- PREPARE to give oxygen ( yes you can do this without an order )
- 9/10 it’ll correct it and wont need to call the DOC

pO2 in 60s
nothing to hold so

• ASSESS respiratory status
• PREPARE to intubate and ventilate
• CALL respiratory and call the DOC

most reliable method for confirming placement is intubation is to observe for CO2 exhalation using a CO2 detector= CHEST RADIOGRAPH

you can put oxygen on them at that time and its not gonna solve the problem but it’ll make them a little calm
- ex: (click & drag question) = THROW on O2, ASSESS, PREPARE to intubate/ventilate & then call
respiratory/doc..

CO2 IN 60s
- medical emergency = RESPIRATORY FAILURE

remember hold,assess,prepare and call

so what to do??

• ASSESS respiratory status
• PREPARE for INTUBATION/VENTILATE
• CALL respiratory
  therapy first, then CALL the doc. (YOU stay with YOUR pt!!!)

Question 116

dehiscence

Answer 116

• wound healing complication = wound separates

COLLECTING WOUND CULTURES
- apply bacitracin ointment after collecting wound culture
- cleanse the wound gently by flushing it with normal saline

HOW TO PREVENT DEHISCENCE AND PROMOTE WOUND HEALING

• post op nausea and vomiting should be treated asap to prevent dehiscnese and evisceration
• heaving (retching) and nausea is a priority
• stool softners (docusate) to prevent straining and constipation and easy passage of stools
• antiemetics to prevent the straining that occurs during vomitting
• abdominal binder to support the incision during cough, moving
• ensure client has effective pain relief before performing coughing exercises
• monitor blood sugar levels to promote wound healing
• splinting the abdomen by holding a pillow or folded blanket against the wound when coughing and moving
• incorportate adequate calories and protein intake

EVICERATIONS
- put them in low fowler position with knees bent/flexed = LESSENS ABDOMINAL TENSION on the suture line to prevent further evisceration

LOW FOWLER POSITION RELAXES AND REDUCES ABDOMINAL MUSCLES TENSION

Question 117

platelets counts

Answer 117

140k-450k
- less is thrombocytopenia
- more is thrombocytosis

• platelet count BELOW 90,000 is a priority BUT…
• platelet count BELOW 40,000 is HIGHEST PRIORITY
• platelets are essential for proper blood coagulation
• decreased platelets = more bleeding

Question 118

who gets placed on neutropenic precautions

Answer 118

filgrastime is prescribed to stimulate neutrophil production or when client has infection and more neutrophils are needed to fight it
- wbc below 5000 (normal 5-11K)
- ANC below 500 (normal 1500)
- CD4 below 200 (normal 500-1500)

CD4 count: needs to be above 200 = when below 200, this is when HIV goes into AIDS

what to do for such patients??

• ASSESS for signs of infection & place them on NEUTROPENIC precautions!

NEUTROPENIC PRECAUTIONS
- private room
mask on when leaving their room
- strict handwashing
- avoid exposure to people who are sick
avoid all fresh fruits, vegetables and FLOWERS
- ensure that all equipments has been disinfected

EVEN A LOW GRADE FEVER SHOULD BE REPORTED IN THESE POPULATION

Question 119

tricyclic antidepressants

Answer 119

• mood elevators, used for neuropathic pain
• amiTRIPTYLINE = neuropathatic pain relieving effects
• norTRIPTYLINE
• IMIPRAMINE (Tofranil)
• imipramine can be prescribed for nocturnal enuresis (bed wetting)

TAKE NOTE
- photosensitivity
- anticholinergic effects
- cardio vascuslar effects (hypotension)

MONITOR SUICIDAL IDEATIONS IN CLINETS TAKING ANTIDEPRESSANTS

SIDE EFFECTS
A = anticholinergic (dry mouth)
B = blurred vision
C = constipation
D = drowsiness
E = euphoria

The pt must take these for 2-4 weeks before they see beneficial effects!

Question 119

neuroleptic malignant syndrome NMS

Answer 119

• often seen in typical antipsychotic drugs (haloperidol, fluphenazine)

MANIFESTATIONS
- high fever (pyrexia) 106-108
- muscle rigidity
- increased muscle enzymes

• NMS can also cause anxiety & tremors; just like EPS (like Parkinsons)

Make sure that the dose for an ELDERLY pt is HALF the adult dose

TREATMENT
- discontinuation the antipsychotic medication and notify HCP
- supportive care

DIFFERENCE BETWEEN NMS AND EPS
TEMPERATURE (if 102 and above call RAPID RESPONSER)

extrapyramidal symptoms (EPS) = - treated by BENZTROPINE
- side effect (NO big deal)
- anticholinergic used to treat extrapyramidal symptoms
- side effects = dystonia (abnor muscle movem) and parkinson symptoms

NMS = medical EMERGENCY; pt could die (HUGE big deal!

Question 119

Circadian rhythm

Answer 119

24-hour biological clock that is primarily one that functions best with daytime wakefulness/activit
- melatonin helps the body adjust to new surroundings

Question 120

whaen you are on sertraline, what happens with other drugs.

Answer 120

• it interferes with the cytochrome p450 system (in the liver) responsible for breaking down and deactivating the
  drugs in the liver = other drugs do not get metabolized

SO

• if you have a patient on sertraline & other drugs, then the other drug doses need to be lowered
• watch for interactions with ST. JOHN’s WART (can get serotonin syndrome; SADH: sweat,
  apprehensive (impending sense of doom!!), dizzy & headache)

LIVER DISEASE = MILK IS GOOD FOR IT

Question 121

average typical weight gain for pregnancy

Answer 121

28 pounds +/- 3

so 25-31

ESTIMATED DUE DATE
last menstrual period + 7 days MINUS 3 months

Question 122

in the first trimester, how much weight is gained

Answer 122

1 pound each month

1st trimester is 3 months so that means she gains 3 pounds the whole first trimester.

so if they give you a woman who had a sig amount of weight gain in the first semester= BAD

2ND TO 3RD TRIMESTER = she gains 1 pound every week!

CALCULATING IDEAL WEIGHT: weeks of gestation - 9

a woman is in her 28th week she has gained 22 pounds, what is your impression
- take the gestational and substract by 9.

so 28-9 = 19 pounds she shouldve gain. she gained 22 pounds which is 3 more than she shouldve = ASSESS HER

3 pounds off = ASSESS HER
4 pounds off = TROUBLE

a woman is in her 31st week she has gained 15 pounds, what is your impression
- take the gestational and subract by 9 (31-9) = 22

• she should’ve gained 22 pounds but she gained 15 so the baby mustve died

Question 123

fundal height

Answer 123

it starts from the symphysis pubis and make its way towards the xiphoid process as the week progresses
- after 20 weeks the fundal height correlates to the weeks of gestation

fundus = upper part of the uterus NOT PALPABLE UNTIL WEEK 12 (first trimester) = mother the priority

\WHEN DO YOU PALPATE THE FUNDUS

2nd trimester: the fundus is at the umbilicus (the belly button) = 20-22 WEEK OF GESTATION = mother the priority

3rd semeter: fundus is above the umbilicus = BABY THE PRIORITY

why is that important for the nurse to kno = fundal height can be used to determine lenght of pregnancy = AFTER 20 WEEKS

FUNDAL HEIGHT POSTPARTUM
- fundal height = days
postpartum

MAKE SURE ITS MIDLINE
- 4th postpartum day: 4 below on the 4th day..

Question 123

signs of pregnancy

Answer 123

during pregnancy, intense itching of the hands and feet that worsens at night but no rash is a priority = liver disorder called intrahepatic cholestasis or pregnancy

POSITIVE
- fetal skeleton on x ray
- fetal presence on ultrasound
- auscultation of a fetal heart rate
- when the examiner palpate (NOT MOM)

PROBABLE
CHADWICK
- cervical color change to cyanosis (blue) = ALL STARTS WITH C

GODDELL= cerivcal softening

HEGAR = uterine softening

all urine and blood pregnancy tests (a lot are false positive cus it just means you have the hormones = DOESNT CONFIRM PREGNANCY

ballotement test: used to detect solid objects surrounded by fluid in the

BRAXTON HICKS
- tighthening in your abdomen that comes and go
- NOT REAL CONTRACTIONS OF LABOR

Question 124

most OB information has a range where it occurs. range for quickening, fetal heart etc cus every woman is diff

Answer 124

• CAREFULLY read your question as follows. using FETAL HEART as an example in this

1. when would you FIRST ausculate a fetal heart = 8 weeks
2. when would you MOST LIKELY = 10 weeks
3. when should you BY = 12 weeks

• when they say FIRST = pick the earliest part of the range
• when they say MOST LIKELY = pick midpoint of the range
• when they say SOULD BY = pick the end of the range

Question 125

when does quickening happen?

Answer 125

16-20 week its a range question so use the range approach

FIRST FEEL IT = 16 weeks
MOST LIKELY FEEL IT = 18 week
WHEN SHOULD YOU BY? = by 20 week

Question 126

pattern of office visits for a pregnant mom

Answer 126

• once a month until week 28 (first, second and little bit into 3rd trimester)
• at 28 weeks, come in every 2 weeks until week 36
• at 36 come in every week until delivery or week 42

when a womman comes in for her 12 week check up, when should she be scheduled to come in again
- 16 weeks why? once every month until 28 weeks

when a womman comes in for her 30 week check up, when should she be scheduled to come in again at
- 32 week why? = every 2 weeks from 28th week to 36 weeks

when a womman comes in for her 37 week check up, when should she be scheduled to come in again at
- 38 weeks why? she comes in every week from week 36 to birth

Question 127

hemoglobin levels in pregnancy

Answer 127

hemoglobin levels will fall due to INCREASE IN PLASMA
normal for woman is 12-16

• first trimester can fall to 11 and be perfectly normal
• 2nd trimester, it can drop to 10.5 and be normal
• 3rd semester, it can drop all the way to 10 and be normal

if less than 9, assess them for symptoms of anemia

Question 128

how do you deal with morning sickness during pregancy

Answer 128

• treat with carbs BEFORE YOU GET OUT OF BED not for breakfast
• FOODS OR DRINKS CONTAINING GINGER
• vitamin b6
• drink small sips of liquids throughout the day rather than large amounts with meals
• nausea and vomiting is related to high levels of estrogen and hCG

HYPEREMESIS GRAVIDARUM
- hypokalemia/hyponatremia
- ketonuria
- hemoconcentration
- metabolic alkalosis
- increased urine specific gravity

GIVE VITAMIN B9(folate) prior to pregnancy to prevent neural defects

Question 129

how do you deal with urinary incontinence during pregancy

Answer 129

1st and 3rd trimester problem

• how to treat it? = VOID EVERY2 HOURS
• you don’t get it during 2nd trimester because at that time, the baby is up high not on the bladder

INCONTINENCE IN GEENRAL
- having them void every 2 hours is key over kegel exercises
- kegel exercises takes 6 weeks

Question 130

difficulties during pregnancy

Answer 130

DIFFICULTY BREATHING = TEACH THEM TRIPOD POSITION
2nd and 3rd trismetser problem

BACK PAIN
- PELVIC TILT EXERCISE (lying supine and raising pelvic)
- place leg on stool

BACK PAIN DURING LABORING
- position then push
- what position: KNEE CHEST
- what do you push: put your fist and push inside her sacrum, that applies counterpressure that relieves pains

Question 131

penicillin allergy

Answer 131

• may experice cross sensitivity to cephalosporin (cefazolin, cephalexin, ceftrixone) antibiotics = DRUG MOLECULES ARE STRUCTURALLY SIMILAR

cefazolin(bone penetrating) is usually given before and after surgery to prevent infection

INTERVENTION
the nurse must first assess the type of reaction a client had to penecillin drugs when instructed to give a cephalosporin

CLIENTS WITH PENICILLIN ALLERGY SHOULD BE DESENSITIZE TO RECEIVE APPROPRIATE TREATMENT

CEPHALOSPORINS
- contraindicated for clients with history of anaphylactic reactions to penicillin
- BUT CAN BE GIVEN WITH A HISTORY OF MILD ALLERGIC REACTION LIKE A RASH

TETRACYCLINES has cycline in name
- DONT TAKE WITH FOOD, JUST FULL GLASS OF WATER
- AVOID IN PREGNANCY
- take on empty stomach. 1 hour before or 2 hours after food
- avoid antacid and diary products
- DON’T TAKE AT BEDTIME
- use sunblock (photosensitivity)
- use additional contraceptive techniques

PROLONGED HIGH DOSE OF ANTIBIOTICS LEADAS TO ORAL CANDIDIASIS

Question 132

what is fetal lie

Answer 132

the relationship between the spine of the mother and the spine of the baby

• basically position of the baby
• mom spine and baby spine parallel = GOOD baby is coming out

SUPINE HYPOTENSION IN PREGNACY/ AORTOCAVAL COMPRESION
- when mom is laying supine, it causes the uterine to fall on the aorta and vena cava
- treatment is elevation and support = moves the uterus to the side

Question 133

four stages of labor and delivery

Answer 133

stage 1 = labor (phases: latent, active, transition)
stage 2 = delivery of the baby
stage 3 = delivery of the placenta
stage 4 = recovery (last for 2 hours)

POSTPARTUM
- 2 hours after the delivery of the placenta NOT WHEN THE BABY COMES OUT
- first 8 hours of postpartum, orthostatic hypotension is regular = instruct client to get out of bed slowly and ask for help when ambulating

STAGE ONE: LATENT LABOR
- dilate 0-4 centimeters
- frequency 5-30 minutes apart
- last 15 to 30 seconds
- intensity = MILD

STAGE ONE: ACTIVE LABOR
- dilation 5-7 cm
- frequency: every 3 to 5 minutes
- last 30-60 seconds
- intensity: MODERATE (our word not mom)
memorize this then anything below will be latent and anything above will be transition

STAGE ONE: TRANSITION LABOR
- dilation 8-10 cm
- frequency 2-3 minutes
- last: 60-90 seconds
- intensity: STRONG
EXPECTED MANIFESTATIONS OF TRANSITION LABOR
- perineal/rectal pressure
- nausea and even vomiting
- trembling/shivering
- increased pain and fear
- irritability and self doubt
PROVIDE EMOTIONAL SUPPORT = provide encouragement and coaching in breathing tecniques

contractions should not be longer than 90 seconds or closer than every 2 minutes

HOW DO YOU KNO A WOMAN IS IN TROUBLE DURING LABOR
- when contractions are longer than 90 seconds and closer than every 2 minutes = WE DO NOT WANNA SEE THAT
- ITS CALLED UTERINE TETANY

ASSESSMENT OF CONTRATCIONS
- if client arrives at the hospital in second stage labor, the nurse rapidly assesses whether birth is imminent = apply gloves and assess perineal to determine if birth is imminet before applying other measures

PECIPITOUS BIRTH = when labor lasts less than 3 hours from contraction onset

STRENTH OF CONTRACTIONS = 25-50 mm hg
- intensity = purely subjective
25-50 mm hg
- should not exceed 80mm hg
RESTING TONE
- average 10 mm Hg should not exceed 20 mm hg

Question 134

intervention for all other complications of labor and birth (eclampsia, maternal hypotension, uterine rupture)

Answer 134

treat with LION

• Left Side
• IV (increased IV)
• O2
• Notify physician

if client expericnes nausea and lightheadness, it may inidcate hypotension but first you need to confirm before implementing LION

LPNs can do all those except increase the IV

you use LION method for any complication with the exception of PAINFUL BACK AND PROLAPSED CORD

in OB crisis, if pitocin is runnin, STOP IT. if it states pit is running, then you do that first before LION

AFTER RUPTURE OF MEMBRANE: PRIORITIZE ASSESSING THE FETAL STATUS VIA ASSESSMENT OF FETAL HEART TONES
- nitrazine paper is used to measure the ph of the fluid

Question 135

delivery of the baby in order

Answer 135

1. deliver the HEAD
2. suction the mouth then the nose..
3. check for a nuchal cord (around the neck)
4. deliver the shoulders & the body
5. the baby MUST have an ID band on before it leaves the delivery area

DELIVERY OF THE PLACENTA
- make sure it is INTACT
- make sure the cord has 3 vessels (AVA; 2 arteries & 1 vein)

Question 136

what do you do in the stage 4 (recovery)

Answer 136

stage 1 = labor (phases: latent, active, transition)
stage 2 = delivery of the baby
stage 3 = delivery of the placenta
stage 4 = recovery (last for 2 hours)

recovery = 2 hours after the placenta comes out

you do 4 things, 4 times per hour so basically ever 15 minutes

1. VITALS signs = assessing for sign and symptoms of shock (BP go down, rates go up, pale, cold and clammy)
2. check the FUNDUS = boggy massage it till it’s firm/// displaced = catheratize it = HAVE THEM EMPTY BLADDER FIRST
   - full bladder than cause fundus to be displaced
3. check the PADS = if she’s bleeding excessively, she will saturate a pad in 15 mins or less. has to be 100% saturated
4. ROLL her over = check for bleeding

Question 137

conductive hearing vs sensorineural hearing loss

Answer 137

WEBBER TEST
- tuning fork
- conductive hearing loss: louder in affected ear
-sensoriurineal hearing loss: louder in unaffected ear

CONDUCTIVE: caused by obstruction in the ear including excessive cerumen, water, foreign body

rinne test = CONDUCTION

SENSORINEURAL: caused by prolonged exposure to noise, ototoxic substances (amninoglycosides), diabetes mellitus, presbycusis (age-related hearing loss)

EAR IRRIGATION (impacted cerumen)
- assess the cleint for fever, ear infection or tympanic membrane injury = those symptoms are contraindications
- place client in sitting position with head tilted towards the affected ear
- place towel and an emesis basin under the affected ear
- straighten ear canal by pulling up and back the pinna
- gently irrigate the ear canal with a slow, steady flow of solution
stop immediately of the client experinces severe nausea, or dizziness

PINNA
- up and back for 3 years and older
- down and back for less than 3
have clients lay prone or supine with head turned to the appropriate side

Question 138

postpartum assessments

Answer 138

every 4-8 hours depends on if they stable or not
BUBBLE HEAD (3 big things are Fundus, Lochia and Extremity check)

• B: breast
  **Uterine fundus = needs to be FIRM
  if boggy = massage
  if not midline or displaced = catheratize them. have them empty bladder first
• Bladder
• Bowel
• Lochia = rubra (1st = red)
• Episiotomy (incision)
• Hemoglobin/hematocrit
• Extremity check = looking for thrombophlebitis = bilateral calf circumference
  measurements
• Affect
• Discomfort

LOCHIA
RUBRA = red
SEROSA (rose) = pink
ALBA (albino) = white
- 4-6 inches on pad = okay
saturate a pad 15 mins or less = bad

Question 139

fecal impecation

Answer 139

patient usually passes only liquid stool becuase thats the only thing that gets to pass through the impecation site

PERFORATED BOWEL = RIGID BOARD LIKE ABDOMEN = PERITONITIS = MEDICAL EMERGENCY AND IS THE HIGHEST PRIORITY

peritonitis = elevated wbc

Question 140

tocolytics vrs oxitocity drugs

Answer 140

TOCOLYTICS (terbutaline and mag sulfate) = STOPS LABOR

• terbutaline = cause maternal tachycardia (speeds moms heart rate)
• magesium sulfate = stops labor (fetal contractions) HYPERmagnesium and we know magnesiums do the oppsoite of the prefix so ehat happens?? LOWERS heartrate, BP, reflexes, respiratory rate & LOC

OXITOCITY (oxytocin and methylergonovine) = stimulates and strethens labor
- oxytocin = it can cause uterine hyperstimulation longer than 90 seconds and closer than every 2 minute
- methergine = can cause HBPso its contraindicated in clients with high blood pressure

OXYTOCIN
- administered through a secondary IV line
- proximal port (distal is distance towards down, proximal is going up)
- electronic fusion pump
- initiated at the lowest dose and titrated until contractions are 2-3 minutes and last for 80-90 seconds
- prevents hypotension

UTERINE STIMULATION FROM OXYTOCIN INCREASES THE RISK OF
- placental abruption
- uterine rupture
- abnormal or indeterminate fetal heart rate patterns
- uterine tachysystole
- postpartum hemorrhage

Question 141

true vs false labor

Answer 141

TRUE LABOR
- regular contractions, frequency, duration and intensity increase over time
-discomfort begins in LOWER BACK and RADIATES TO ABDOMEN with contractions
- contractions increase despite comfort measures

FALSE LABOR
- braxton hick
- tightening in your abdomen that comes and go
- expulsion of mucous plug in days preceding labor is NOT A SIGN OF LABOR

Question 142

FETAL LUNG MATURING Meds

Answer 142

• betamethasone = STEROID
• survanta/beractant = surfactant

they are both given to make the baby lung mature faster

BETAMETHASONE
- it’s a steroid given to the MOTHER.
- its given IM
- it is given BEFORE the baby is born

SURVANTA/BERACTANT
- it is given to the BABY
- it is given trans-tracheal (blown through the trachea:nebulizer)
- it is given AFTER the baby is born

Question 143

drawing up insulin rules

Answer 143

• CLEAR before CLOUDY

boards uses
Clear = R
Cloudy = N

HUMALIN 70/30
- an insulin that combines the short action of regular human insulin (Humulin R) and intermediate of Humulin N

N = 70%
R = 30%

N is in the Numertaor

MIXING INSULIN IN SAME SYRINGE = NRRN
- Add air to cloudy (intermediate-acting) insulin. N
- Add air to clear (short-acting) insulin. R AND FLIP
- Withdraw clear (short-acting) insulin first. R
- then cloudy (intermediate-acting) insulin

Question 144

injections and what needles to use

Answer 144

When choosing sizes: the clue is in the abbreviation! Look at the first letter & then go find
those #’s!!

IM: 21g & 1” (the “I” in IM looks like a 1) = VASTUS LATERALIS MUSCLE ( newborns and infants)

SUBQ = 25g & 5/8” (the “S” in subq looks like a 5

for infants do not on the gluteal cus they dont have enough muscle there yet

MEDICATION FROM AN AMPULE
- use filter needles to prevent aspiration and injection of glass shards
- after the filter needle is discarded, 20 gauge, 1 inch is attached to the syringe

INTRADERMAL = 5-15 DEGREE ANGLE
- apply firm pressure to the injection site to prevent bleeding
- dont massage site

SUBCUTANEOUS
- 90 degree angle if 2 inches of subcue tissue can be grasped (obese people)
- DO NOT EXPEL THE AIR BUBBLE PRIOR TO ADMINISTRATION IN PREFILLED SYRINGES
- 45 degrees if only 1 inch of subcue tissue can be grasped

INTRAMUSCULAR
- preffered site ventrogluteal due to fewer large blood vessels and nerves
- position patient supine, prone or side lying with the knee and hip flexed
- flexing the knee and hip reduces muslce tension and improve access and promote client comfort

Question 145

HEPARIN

Answer 145

• VTE, DVT = does not dissolve clots
• HEPARIN is given IV or sub Q
• works immediately
• CANNOT BE GIVEN LONGER THAN 3 WEEKS except enoxaparin (lovenox)
• lab test monitors PTT ( heparin = 7 letters, count on hand 3 fingers left (PTT)
• CAN BE GIVEN TO PREGNANT WOMAN

ANTIDOTE = PROTAMINE SULFATE

CONTRAINDICATION
- should be discontinued before surgery
- clients with hemorrhagic stroke
- epidural and recent spinal injury

CAN BE USED WITH WARFARIN UNTIL WARFARIN EFFECT QUICKS IN

Question 146

seizure precautions

Answer 146

stay with the client, note time the seizure began and how long it last

• during active activity = call for additional help
• prepare for suctioning
• turn client to the side = first thing to do
• padding the side rails
• loosen clothing around the neck and chest to promote ventilation**

Question 147

myocardial infaction/ischemia

Answer 147

normal troponin is <0.5

MANIFESTATIONS
- dizziness
- SOB
- nausea vomiting

PAIN RADIATION
- neck
- jaw
- left shoulders
- arms, epigastrium
pain radiating to any of these could indicate MI

Question 148

cyclobenzaprine (flexeril) and baclofen teachings and side eefects

Answer 148

• muscle relaxant
• muscle relaxants are contraindicated in people with hepatitis because they are metabolized by the liver

Sign and Symptoms
- fatigue/drowsiness
- muscle weakness

3 THINGS YOU TEACHING
- DON’T drink
- drive or operate heavy machinery

Question 149

newborns

Answer 149

GROWTH IN NEWBORN
- 1ST 6 MONTHS = weight doubles
- BYn12 MONTHS = weight triples

VITALS
- respiratory rate = 30-60
- pulse = up to 160/min

cryptorchidism is normal until 6 months

• the nurse must prioritize any responding to perceived or reported threat to security to prevent infant abduction
• milia = white pinpoint paupules on newborn face = NORMAL
• bilateral crackles in lungs are normal during first hour of life = FLUID IS STILL BEING PUSHED OUT AND ABSORBED BY LUNGS

waitin to introdcue newborns to common allergenic foods leads risk of allergies

• glucose levels in newborns are decreased FIRST HOUR of birth then rise and stabilize within 2-3 hours = level of 40 or more is considered normal
• first 3-4 days, weight loss approx 5-6% birth weight is expected due to fluid excretion (respirations, urine, stool)
• weight loss usually ceases around 5 days of life in healhty newborns and retun to birth weight 7-14 days
• weight loss of 7 or more indicate the need. for BREASTFEEDING SUPPORT and FORMULAR SUPPLEMENTATON and require evaluation

BOTTLE FEEDING
- leftover milk in the bottle should be discarded after feeding cus it has mixed with the childs saliva and can foster bacterial growth
- unused prepared formula should be kept in the fridge and discarded after 48 hours
- dont heat formula cus it can great hot spots in the milk and burn the child

after 6 months, infants should not exhibit head lag when raised from a supine to seated position = can indicate autism and cerebral palsy

FONTANELS
- anterior = diamond shaped and soft in the middle
- posterior = triangular shaped separeted by sutures
posterior and occipital closes by 2 months so should not be palpable after that

skull cannot expand after the fontannels close at 18 months so anything taking up more space in the skull can cause ICP

EXPECTED
- cracked and peeling of the skin around day 3 = sign of physical maturity (DESQUAMATION)
- undescended testicles
- crackles and rales in lungs are expected immediately after birth
- average head circumference is 13-14 inches

ATOPIC DERMATITIS = eczema
- itching
erythema
- dry skin
red crusted scaly lesions in infants = prevent scratching (cutting fingers short)

DIET
- feed every 2-3 hours (breastmilk is easily digested)
- breastmilk is recommended from birth to at least 6 months old
- avoid introduction of artificial nipples and supplemental formular unless MEDICALLY NECESSARY.

Question 150

SPLENECTOMY

Answer 150

• leads to high lifelong risk of rapid sepsis
• they need vaccination against several organisms
  even a low grade fever should be taken serious in these clients

Question 151

HALLUCINATIONS:

Answer 151

false fixed sensory (hear, feel, taste, smell, see). most common hallucination: AUDITORY (voices telling you to kill yourself) , then visual, then tactile, gustatory (taste), olfactory (smell)

AUDITORY HALLUCINATIONS MANAGEMENT
- increasing the amount of external auditory stimulation in the environment have them watch tv, listen to music through headphones to make it easier to ignore internal sounds from hallucinations

clients who are alone and hearing these voiced requires IMMEDIATE INTERVENTION

priority over spouse of a client that has just called that client is suicidal. why?? client is not alone, spouse can intervene

Question 152

hodgkin lymphoma

Answer 152

malignant cancer of the lymphatic system

EXPECTED MANIFESTATIONS
- painless enlarged lymph nodes
- fatigue
- fever
- itching
- weight loss and - drenching night sweats

Question 153

PRIOTIZING, STABLE, UNSTABLE

Answer 153

1. ACUTE BEATS CHRONIC! Acutely ill person is a higher priority than a chonincally ill patient
   = COPD (chronic), CHF (chronic) & appendicitis (acute: HIGHEST priority!)
2. fresh post op (12 hours) beats medical or other surgical
   = COPD, CHF, acute appendecitis, 2 HOUR POST OP FOR CHOLECYSTECTOMY (fresh post op:
   HIGHEST priority!), 2nd day post of coronary artery bypass graft?

STABLE

-stable
-chronic illness
-post op greater than 12 hours
-local or regional anesthesia
-lab abnormalities of an A or B level
-“ready for discharge”, “to be discharged”, “admitted longer than 24 hours ago”
-unchanged assessments (nothing new/different)
-experiencing the typical expected sign & symptoms of the disease with which they were
diagnosed

UNSTABLE
-unstable
-acute illness
-post op less than 12 hours
-general anesthesia (only in the first 12 hours)
-lab abnormalities of an C or D level
-“not ready for discharge”, “newly admitted”, “newly diagnosed”, “admitted less than 24 hours
ago”
-changing or changed assessments (something new/different)
-experiencing unexpected sign & symptoms of the disease with which they were diagnosis

ALWAYS UNSTABLE WHETHER EXPECTED OR NOT
- hemmorhage = coffee ground emesis from iodized blood can idicate hemorrhage
- HIGH fevers (over 104) seizures
- HYPOglycemia (low blood glucose)
- pulselessness or breathlessness
*tachycardia is an early sign of internal hemorrhage**

Question 154

vegetables high in fiber and good for constipation.

Answer 154

broccoli
leafy greens
brussle sprouts
brown rice
whole grain bread
nuts and seeds

Question 155

clear liquid diets

Answer 155

pedialyte
ice chips
tea without cream
juice
black coffee
sports drink
plain jello
water
water based or pulp free fruit popsicle
basic broth

when is clear liquid diet preferred
clear liquid diet should always be the first to be ordered after a procedure

best for patients who have not had oral intake for some time as well as for the first time a patient eats after complete bowel rest

BRAT DIET
- bananas, rice, applesauce and toast = does not provide sufficient protein or energy

SOFT DIET
- when the person has difficulty swallowing and needs food which are much easier to eat
- peanut butter

HOW TO OPTIMIZE NUTRITIONAL INTAKE IN COPD
- drink fluids between meals not before or during
- small frequent meals high in calories and protein
- oral hygiene before meals due to their mouth breathing leading to dry mouth
- avoid exercise an hour before or an hour after

LACTOSE INTOLERANCE
- can still eat cheese and yoghurt if it dont make you sick
- take calcium and vitamin D supps
- lactase enzyme supplement should be taken with meals containing diary

Question 156

informed consent

Answer 156

STAT medications should be given immediately and ONLY ONCE! = new prescription is required to be repeated
- not needed for barium enema

• INFORMED CONSENT IS WAIVED IN LIFE THREATENING INCIDENTS WHEN THE CLIENT IT UNCONSCIOUS = referred to as implied concent
• CANNOT BE OBTAINED FROM PSYCH PATIENTS COGNITIVELY IMPAIRED ( get it from a family member )

Question 157

CHRONS DISEASE

Answer 157

asymptomatic so if they feel pain and diarrhea = NEEDS INTERVENTION = TREATMENT IS TUMOR NECROSIS FACTORS

inflammatory bowel disease treatments
- lasoprazole
- metronidazole
- sulfasalazine

Question 158

when an employee gets injured

Answer 158

urine is obtained to determine whether during the time of injury the employer was under the influence of alcohol or drug

Question 159

patients confined to wheelchair

Answer 159

should he be given a pressure relieving cushion BEFORE being educated to move buttocks every 2 hours

what to do first? give cushion

Question 160

advanced directive/ care planing

Answer 160

legal documents INCLUDES

living will: describes the type of life sustaining treatments such as CPR, intubation, mechanical ventilation, feeding tube) that the client want intiated if unable to make decisions

• health care proxy (durable power of attorney for healthcare or medical power of attorney) = person who can advocate for the client as needed during times when client cannot make health care decisions for themselves

even if client has a DNR, giving oxygen by NASAL CANNULA is still allowed

TO LEAVE AGAINST MEDICAL ADVICE
- client has to be legally competent to make an educated decision to stop treatment
- parents do not have the right to place their minor child in life threatening position. that is child abuse or neglect so as a nurse, notify the hospital adminstration about the situation if the paretns are refusing treatment for the child in life saving treatment

CANNOT LEAVE AGAINST MEDICAL ADVICE
- altered conciousness
- mental illness (danger to self or others)
- chemical influcneces such as drugs or alcohol

only patients that are concious and competent can sign out against medical advice

Question 161

cerebrovascular accident CVA

Answer 161

also known as a stroke

• affects the opposite extremities of where the injury has occurred in the brain

right sided CVA = left sided paralysis

left sided CVA = right sided paralysis

most important modiafiable risk factor of stroke is HYPERTENSION. over smoking

• when transfering stroke patient, use transfer belt

FAST ASSESSMENT
- facial drooping
- arm weakness or drift
- speech difficulties
- time

Question 162

glucose testing

Answer 162

always recheck and validate the results and confirm accuracy before you decide to administer glucose

fasting blood glucose
- less than 100 is good
diabetic: 125 and up (less than 140)

Question 163

Mean arterial pressure (MAP)

Answer 163

70-100 but >60 is adequate to perfuse the vital organs

lower MAP is treated by nonrepinephrine = this increase vascular tone

• MAP = systolic + 2(diastolic ) divided by 3

Question 164

toxic shock syndrome (TSS)

Answer 164

accumulation of bacterials produced by microorganism

example using tampons, cervical caps and diaphgrams cus they lead to the build up of organisms

Question 165

latext allergies

Answer 165

• more common in healthcare workers and hospitalized patients than the general population
• avoid oil based hand creams

FRUITS TO AVOID = rubber-like textures
- bananas
- kiwis
- avocados
- tomatoes

strawberry??

Question 166

osteomyelitis

Answer 166

most common cause : S AUREUS

• bone pain
• fever
• swelling

REQUIRES ANTIBIOTIC 6-12 WEEKS

Question 167

hepatitis patients

Answer 167

• check with doctor before taking any medication because it might be a hepatoxic medication and will complicate delivery
• AVOID MUSCLE RELXANTS ALSO CUS THEY ARE METABOLIZED BY THE LIVER

PERCUTANEOUS KIDNEY BIOPSY
- uncontrolled hypertension is a contraindication
- post procedure bleeding
- after a liver biopsy, client should be placed in RIGHT SIDE LYING POSITION because the liver is located on the right side

Question 168

migraine

Answer 168

• unilateral pulsating headache

INTERVENTION
- pain and environmental management

Question 169

Antisocial personality disorder

Answer 169

• disregard rules
• irresponsible behaviors
• blame others for their behavior
• uses numerous excuses and justifications to avoid responsibility

NURSING INTEREVNTION
- set firm limits by letting them know rules and acceptable behaviors
- make them take responsibility for their behaviors for not following rules