final exam per allison's notes Flashcards
1
Q
what medicine is given for sinus bradycardia? what must you do before administering
A
IV atropine- assess to see if they are symptomatic
2
Q
what may be placed in the pt if they have sinus bradycardia?
A
transcutaneous pacemaker
3
Q
how do you treat sinus tachycardia?
A
correct causes first
4
Q
if your pt with sinus tachycardia has a fever, what do you do?
A
give them acetaminophen
5
Q
if your pt with sinus tachycardia is dehydrated, what do you do?
A
give them IV fluids
6
Q
what medicines can you give pts with sinus tachycardia?
A
calcium channel blockers and beta blockers
7
Q
how do calcium channel blockers lower the heart rate?
A
prevent calcium release and relax the heart muscle
8
Q
what are some examples of calcium channel blockers?
A
-pines, ditiazem, amioderone, verapamil
9
Q
what is important to remember about a fib?
A
no p wave, irregular rhythm, pattern
10
Q
someone with afib has an increased risk of
A
clots
11
Q
how would you control a high afib rate?
A
digoxin, beta blockers, calcium channel blockers
12
Q
what is a common antiarrhythmic medications?
A
amiodarone
13
Q
what are the procedures to treat afib?
A
cardioversion, ablation
14
Q
what do the waves look like on atrial flutter?
A
sawtooth
15
Q
describe the ECG of a pt with a flutter?
A
no p waves, irregular rhythm
16
Q
what medicines can be given for a flutter for rate control?
A
beta blocker, calcium channel blockers, digoxin
17
Q
what is superventricular tachycardia?
A
over 150 bpm
18
Q
describe the ecg of an ECG for someone with a flutter?
A
p wave may be hidden, regular rhythm, high rate
19
Q
what happens with the heart in SVT?
A
reduced cardiooutput
20
Q
what is the key to treating SVT?
A
slow the heart rate to identify the underlining rhythm
21
Q
what medicines are given for SVT?
A
adenosine, calcium channel blockers, beta-blockers, or amiodarone
22
Q
if your pt has a low heart rate, do not give ______-
A
beta blockers
23
Q
heparin increases the risk for
A
bleeding
24
Q
what is the drug of choice for stable angina?
A
sublingual nitrates
25
what is unstable angina? when does it occur?
it occurs at rest
26
Patient comes to ER with suspected ACS with chest pain unrelieved by rest and other clinical manifestations of MI. What do you do first?
nitroglycerin
27
what is the drug of choice of prinzmetal's angina?
calcium channel blockers (-dipine)
28
what are the post-procedure nursing interventions for heart-caths?
bed rest, bed no higher than 30 degrees, immobilize extremity access site, VS, pulses, bleeding assessment every 15 min 4 times, 30 min 4 times then 1 hours twice
29
what are common clinical manifestations of endocarditis?
osler's nodes, janeway lesions, splinter hemorrhage
30
what are osler's nodes?
painful/tender, red or purple pea sized lesions on fingertips
31
what are janeway lesions?
flat, painless, small red spots on the palms and soles
32
what are splinter hemorrhages?
black longitudinal streaks along fingernails
33
what are the ways to diagnose infective endocarditis?
blood cultures and echocardiogram
34
whats the primary diagnostic for endocarditis?
Blood cultures
35
what are the medications for infective endocarditis?
IV antibiotic therapy for 4-6 weeks
36
what will you hear with pericarditis?
pericardial friction rub
37
what test is done first for pericarditis?
ECG
38
what is the number one thing you need to treat with medications?
pain
39
what medicines can be given for pericarditis?
aspirin, NSAIDs, anti-inflammatories (colchicine)
40
what are the actions you should do for someone with pericarditis?
keep HOB elevated, administer medications as ordered, provide emotional support
41
what should you teach the pt with pericarditis?
avoid strenuous activites and distinguish between pericarditis and heart attack
42
what is a key sign and symptom of left sided heart failure?
paraoxysmal nocturnal dyspnea (SOB that wakes you during sleep)
43
what are the key signs and symptoms of right-sided heart failure?
peripheral edeman, abdominal ascites, hepatomegaly, JVD
44
left sided HF can eventually cause...
right sided hf
45
what is a sign and symptom of worsening heart failure?
confusion
46
what are signs and symptoms of pulmonary edema?
pink frothy sputum
47
what is the treatment for pulmonary edema?
o2, iv diuretics
48
what would you give to a pt with normal potassium, 58 BPM, hypotension and HF?
Ace-I
49
what should you teach your patient with heart failure?
avoid NSAIDS
50
white male comes in with BP of 158/92, what would you do?
smoking cessation and daily bp measurements
51
what is normal blood pressure?
120/80
52
what is an elevated blood pressure?
120-129/ 80
53
what is high blood pressure/hypertension stage 1?
130-139/ 80-89
54
what is hypertension stage 2
>140/>90
55
what is a hypertensive crisis?
>180/>120
56
what diet should someone with HTN be on?
DASH: fruit, vegetables, fat-free or low-fat milk, whole grains, fish, poultry, beans, seeds, and nuts, fat free cheddar cheese, greek yogurt
57
how do you know that antihypertensive medications are effective?
no signs and symptoms of TOD
58
what are the signs and symptoms of peripheral artery disease?
round/punched out arterial ulcers
59
what are the symptoms of critical limb ischemia?
tight, shiny, taut skin, arterial ulcer, no hair on legs
60
what is most effective for claudication in pts with peripheral artery disease?
walk until pain then rest
61
what is the first line treatment for PAD?
antiplatelets
62
what should you teach your patient with PAD?
don't cross legs, keep extremity dependent, inspect feet daily, DASH diet, no alcohol, no smoking, moderate exercise
63
what is used for DVT prophylaxis?
low molecular weight heparin
64
what would you give to a patient for pvd?
antiplatelets
65
what can be given to a patient who is at low risk of DVT after d/c from outpatient surgery?
low molecular weight heparin
66
what can be delegated to the UAP for pt with DVT?
elevate limbs
67
what do you need to monitor for when your pt is taking thiazide therapy?
low potassium
68
what is the most effective treatment for hypertension?
thiazide
69
what should you monitor for pts taking thiazides?
i and o
70
what do ace inhibitors end in?
"pril"
71
how do ace inhibitors work?
by blocking the formation of angiotensin II
72
what do angiotensin II receptor blockers (ARBS) end in?
"-sartan"
73
how do angiotensin II Receptor blockers (ARBS) work?
blocking the action of angiotensin 2
74
when would an angiotensin II receptor blocker be given?
if the pt can't handle the dry cough that ACE inhibitor gives
75
how do angiotensin Ii receptor blockers work?
decrease afterload
76
how long do angiotensin II receptors take to work?
3-6 weeks
77
when should you hold beta blockers?
if their bp is 90/60 or hr less than 60
78
what type of medicine can you NOT give with ACE-I?
angiotensin receptors
79
what medicine can you not give in HF?
calcium channel blockera
80
what are the risk factors for iron deficiency anemia?
very young or very old, women in reproductive years, poor diet, hemorrhage, chronic blood loss, GI problems, malabsorption
81
what are the clinial manifestations of iron-deficiency anemia?
pallor and glossitis
82
what are the signs and symptoms of phlebitis?
warmth, tenderness, hardness of vein
83
what do you do if your patient has phlebitis?
withdraw catheter, apply a warm, moist compress on the affected site
84
signs and symptoms of infiltration
swelling, burning, pain, coolness, blanching
85
what do you do if your patient is experiencing infiltration?
remove catheter
86
what can you not give via midline?
vesicant
87
what is the treatment of iron deficiency anemia?
increase iron intake
88
what are risk factors for vitamin b12 anemia?
surgery, excessive alcohol ingestion, smoking, autoimmune disorders, crohn's disease, celiac disease, strict vegetarians, long-term use of PPIs
89
what are the clinical manifestations of vitamin B12?
sore, red, beefy, shiny tongue, peripheral neuropathy, altered mental status, visual changes
90
what is the medical management of vitamin b12 anemia
parenteral or intranasal administration of cobalamin
91
folic acid deficiency has an increased risk for
bleeding
92
what are foods high in folate for folic acid deficiency?
green leafy vegetables, beans, legumes, nuts, bran, yeast, liver, wheat
93
what are the clinical manifestations of sickle cell anemia?
pallor, pain and swelling in joints, jaundice, gallstones, typical patient is asymptomatic except during sickling episodes
94
what is the first priority if a patient is in sickle cell crisis?
get pain meds and iv fluids
95
what is a sickle cell crisis?
severe, painful, acute exacerbation of RBC sickling causing a vaso-occlusive crisis
96
what is the treatment for sickle cell anemia?
administer oxygen, provide aggressive iv hydration, administer pain medication and antipyretics, provide supportive measures
97
what should you teach your patient with sickle cell anemia?
avoid cold temperatures, high altitutde, dehydration, overexertion
98
what are the clinical manifestations of aplastic anemia?
pallor, tachycardia, dizziness, SOB, fatigue, susceptibilty to infections, bleeding
99
a cancer patient with radiation may have
aplastic anemia
100
when you are verifying the patient for a blood transfusion, who should be there
two rns
101
if a pt is having a blood reaction what should you do?
stop the infusion
102
T OR F: never leave a transfusion reaction pt alone
T
103
if there is a transfusion reaction, what should you do?
stay with pt for 15 min and assess vs q5min
104
foods high in vitamin D
fish and eggs
105
what are the steps to give packed red blood cells?
check hcp order, get consent, get iv materials, get the blood bag supplies, start blood
106
what are the signs and symptoms of adrenal cortical insufficiency?
dark/bronze hyperpigmentation, weight loss, hypotension, tachycardia, hypoglycemia
107
what are the signs and symptoms of adrenal cortex hyperfunction?
hyperglycemia, fluid retention, decreased muscle mass, thin/easily bruised skin, delayed wound healing, deepend voice, amenorrhea
108
what should you teach patients that are taking corticosteroids?
monitor for hyperglycemia,, prescribe GI prophylactic meds, don't stop abrubtly, long-term use can cause cushing's disease, causes immunosuppression
109
what are the signs and symptoms of hypothyroidism?
myxedema (moon face), obesity, amenorrhea, intolerance to colds, fatigue, anorexia, goiter
110
what medicine should you give someone with hypothyroidism/hasimotos?
levothyroxine
111
what is there to remember about patient teachings regarding levothyroxine?
make sure the medicine always looks the same, take in the morning at the same time every day, therapy will be lifelong, take on an empty stomach
112
what are the signs and symptoms of hyperthyroidism?
hyperthermia/heat intolerance, weight loss, weakness, elevated heart rate, exophthalmos, goiter
113
what are the medicines given to someone with hyperthyroidism?
propylthiourcail, methimazole, lithium carbonate
114
what should you monitor post thyroidectomy?
respiratory rate/airway compromise
115
what are signs and symptoms of hypoparathyroidism?
tingling around the mouth, muscle cramps, spasms, tetany, positive chvostek's and positive trousseaus
116
what are the signs and symptoms of hyperparathyroidism?
bone pain, low back pain, constipation, lethargy
117
what are the things you should do for your pt with hyperparathyroidism?
administer fureosemide and oral phosphates and calcium binders, and use a lift sheet
118
what diagnostics reveal someone has diabetes mellitus?
HgbA1c>6.5%; fasting blood glucose >126mg/dL; >200mg/dL
119
what are the signs and symptoms of type 1 diabetes?
polyuria, polydipsia, polyphagia, fatigue, weight loss, ketones in blood and urine
120
what is the onset of lispro?
15-30 min
121
what does peak mean regarding insulin?
when the pt is at highest risk of hypoglycemia
122
is it ok to mix insulin with long acting?
no
123
if someone is using an insulin pump, when should they monitor glucose?
AC, 2 hours after eating, and HS
124
you should monitor blood glucose more freqently when...
acute or ongoing illnesses
125
what are the signs and symptoms of type 2 diabetes?
polyuria, polydipsia, polyphagia, fatigue, overweight, poor wound healing, recurring infections, visual disturbances
126
what is the first line of medicine for type 2 DM?
metformin
127
what is important to remember about metformin?
use with caution in renal insuffiency and discontinue 2 days before iv contrast procedure
128
what medicines do you give someone with type 2 DM?
metformin, glyburide, jardiance
129
what are side effects of sulfonylureas (glyburide, glipizide)?
hypoglycemia
130
how do SGLT-2 inhibitors (jardiance) work?
reduce glucose reabsorption
131
what are side effects of jardiance
genital yeast infection and increased uti risk
132
when is someone considered hypoglycemia?
glucose <65
133
what are the signs and symptoms of hypoglycemia?
shaky, irritable, anxious, hunger, slurred speech, sleepy
134
what rule should you follow if your hypoglycemic patient is conscious?
rule of 15= check BG, give oral glucose, check again 15 min later and then again in 15 min later
135
what are complications of long term hyperglycemia?
diabetic peripheral neuropathy, autonomic neuropathy
136
what is diabetic peripheral neuropathy
numbness, tingling, or pain
137
what is diabetic autonomic neuropathy?
gastroparesis
138
in the water seal chamber of a chest tube, if you see continuous gentle bubbling is this good or bad?
bad
139
what should you see in the water seal chamber of a chest tube?
tidaling when breathing
140
when tidaling ceases in the water seal chamber, what does this mean?
the pneumothorax is healed
141
when should you notify HCP regarding fluid drainage?
>100 mL/hr
142
what should you do before a chest tube removal?
premedicate 30-60 minutes before
143
what should you ask the pt to perform during removal of a chest tube?
valsalva maneuver
144
what is the most effective long term control med of asthma?
fluticasone
145
how often are long term control meds used?
daily
146
what are the rescue medications of an asthma attack?
albuterol
147
what is an axample of an anticholinergic? what are side effects?
ipratropium; dry mouth
148
how to use a metered dose inhaler?
remove cap and shake inhaler, breathe out gently, put mouthpiece in mouth, push canister down, and inhale slow and deep, hold the breath for 10 seconds or as long as possible, breathe out slowly, wait 1 minute then repeat steps 2-4
149
how do you use a peak flow meter?
exhale as quickly and forcibly as possible
150
how often do you repeat the peak flow meter?
3 times and record the highest of the three
151
when should you measure the peak flow?
the same time every day
152
when do you take a peak flow?
during an asthma attack and every day
153
what is emphysema?
injury to alveoli, destruction of lung tissue
154
what are the signs and symptoms of emphysema?
pink/reddish complexion, puffing when breathing, pursed-lip breathing, increased chest, no chronic cough, tripoding
155
what are the nursing interventions of copd?
position in semi fowlers and provide small frequent meals
156
what should you teach your patients?
pursed lip breathing
157
who is more likely to get sick at a hospital?
a patient with chronic COPD
158
what medicine should you give a patient with pneumonia to open up their airway?
albuterol
159
what should you teach your patient to do that has pneumonia?
incentive spirometer, turn cough, deep breathe every hour, early ambulation
160
does a person with latent TB have to be worried about spreading it?
no
161
person with latent tb cannot transmit the TB to others but it may become...
an active infection
162
what are the symptoms of tuberculosis?
weight loss, night sweats, low grade fever, hemoptysis (rusty, blood streaked sputum)
163
what medicines are given for the treatment of tuberculosis?
"RIPE" rifampin, isoniazid, pyrazinamide, ethambutol
164
what are side effects of rifampin?
causes tears/saliva/urine to turn a reddish-brown color
165
there is an increased risk of developing _______ when taking rifampin that is an emergency
SJS (painful rash that causes blisters and tissue necrosis)
166
what precautions are patients with tuberculosis on?
airbone
167
describe airborne precautions
private negative air pressure room, gloves, gown, N95 mask
168
if a patient with tuberculosis needs to be transported, what should they have?
a mask
169
patients with tuberculosis may have to undergo what type of therapy? what does this do?
DOT direct observation therapy; it ensures medication adherence by the RN watching the patient take the pill
170
when do you know a patient with tuberculosis is noninfectious?
2 consectuive negative AFB smears over 3 days from early morning specimen
171
what should you monitor for with a patient with an 02 delivery system?
skin breakdown around nose and ears
172
what is the flow rate for COPD patient for nasal cannula?
1-2 L/min
173
what should you teach your patient who has oxygen therapy at their home?
no smoking, keep oxygen 6 ft away from flame or heat sources, check electrical equipment in the same room, keep fire extinguisher at home, keep tanks upright, do not change settings of o2 tank, if power fails call 911, assess for skin breakdown around the nose/ears and oral/nasal cavity for dryness/irritation
174
what is the treatment for SVT?
adenosine
175
what should you monitor for your pt if they are on heparin?
pt, ptt
176
what is the drug of choice for prinzmetal's/varian angina?
calcium channel blockers
177
what is most sensitive to heart damage?
troponin
178
invasive procedure in which a catheter is advanced through an artery to check for blockages
heart cath
179
if your patient is having a MI, what is the order that should be used for pharmalogical treatment?
morphine, oxygen, nitroglycerin, aspriin
180
if your pt is experiencing phlebitis, what should you do?
stop the infusion first and then discontinue the IV
181
what is an adverse reaction for ace inhibitors?
angioedema
182
before you give digoxin, what should you do?
monitor hr
183
a patient with HF should be on what type of diet?
low sodium
184
what is the most common side effect of an ace inhibitor?
dry cough
185
what are the clinical manifestations of peripheral artery disease?
intermittent claudication (muscle pain, numbness)
186
what test is used for a DVT?
D dimer (tests for probability of pt getting a DVT
187
what is the menumonic for sickle cell anemia?
HOPS (hydrate, oxygen, pain control, support
188
if your pt is experiencing hypoglycemia and they are unconscious what do you do?
IV- 25-50 mL of 50% dextrose and if they have no IV then 1 mg IM glucagon
189
what medications are given to pts with hyperthyroidism?
propylthiouracil and methimazole
190
what is a common symptom of hypoparathyroidism?
positive chvostek and trousseau sign
191
what are the common signs and symptoms of cushing's disease in females?
breast atrophy, vocal changes, amenorrhea, hair on chin and chest
192
if your pt with asthma has absent or diminished breath sounds what does this mean?
it is an emergency
193
what are the emergency medications given to someone with asthma?
albuterol and levoalbuterol
194
what is the key prevention measure from COPD getting worse?
smoking cessation
195
what is a size effect of pyrazinamide?
painful joints
196
what should you teach your patient to report if they are taking ethambutol?
visual changes/disturbances
197
what should you teach your pt to do for pneumonia?
pulmonary hygeien (early mobility, incentive spirometer, turn, cough, and deep breathe
198
what do you do if the chest tube becomes disconnected from the drainage system?
immediately submerge the end of the chest tube in sterile water
199
if the chest tube becomes dislodged from the chest, what should you do?
apply a vaseline gauze dressing and notify hcp
200
what do you need to get before administering anti-rheumatic medications?
baseline liver and renal functions
201
what should you teach your patients who are taking leflunomide?
use birth control during the time of treatment and up to 2 years after it is stopped
202
what are the triggering factors of lupus?
pregnancy, exposure to sunlight, illness, major surgery, silica dust, medication allergies
203
when is HIV considered AIDS?
CD4+ count is less than 200
204
what are the clinical manifestations of HIV?
skin lesions, night sweats, enlarged lymph nodes
205
if a pt participates in high risk behaviors, they should be screened every...
3-6 months
206
what are the manifestations of anaphylaxis?
dyspnea, SOB, wheezes/crackles, hives
207
what is the number one treatment for anaphylaxis?
epipen
208
when a pt is undergoing brachytherapy, what should you teach men to do?
wear a condon
209
