General Flashcards
If BP is between 150/100 - 180/120 administer this medication sublingual
Nifedipine
Calcium channel blocker and Antihypertensive drug
It can treat high blood pressure and chest pain (angina).
S&S
Autonomic dysreflexia include…
Lower HR
High BP
Sweats at night
Nausea
Nasal stiffness
POUNDING HEADACHES
Higher fiber or low fiber prevents Constipation
High fiber
Which of the following are risk factors for DVT
- History of HTN
- 52 pack year smoker
- BMI 30
- High cholesterol
- THA (Total hip arthroplasty aka total hip replacement)
- Previous Cholecystectomy
- Bilateral hip osteoporosis
- History of DVT x2
- 52 pack year smoker
- BMI 30
- THA (Total hip arthroplasty aka total hip replacement)
- History of DVT x2
Orthopedic injuries increase risk of DVT.
SMOKING
OBESE
History of DVT
High cholesterol Doesn’t affect DVT
HTN Doesn’t affect DVT formation
Phycians Orders
Fondaparinux 7.5mg subQ q1d
Warfarin 5 mg PO
Oxygen NC 5L/min
Continous pulse Ox monitoring
Select if Nursing Action is:
Indicated or Contradicted
Monitor client platelets
Monitor clients aPTT (Activated Prothrombin Time)
Assess the client for bleeding/bruising
Monitor INR
Monitor hemocrit
Ensure Protamine Sulfate availability
Ensure Phytonadione (Vitamin K) availability
Indicated:
Monitor client platelets
(Fondaparinux affects platelets)
Assess the client for bleeding/bruising
Monitor INR (Warfarin affects pt & INR)
Monitor hemocrit (Measures internal bleeding)
Ensure Phytonadione (Vitamin K) availability (Antidote Warfarin)
Contradicted
Monitor clients aPTT (Activated Prothrombin Time) - Done for Heparin
Ensure Protamine Sulfate availability (Heparin’s Antidote)
Most common precipitating factor in a Type 1diabetic having a DKA incident
Infection/ insufficient Insulin Dose
____ is a protein fragment that’s produced when a blood clot breaks down, and is a byproduct of the blood clotting process.
Normal lab values are <0.50 mcg/mL
False positives include:
Being over 80 years old
Heart disease
High lipid or triglyceride levels
Liver disease
Pregnancy
Recent surgery or trauma
Stressful situations
D-dimer
Virchow Triad: Statis of blood, endothelial injury, hypercoagulability can all lead to…
Thrombus formation
Client with DKA & Covid 19
Anticipated or Contradicted/ Non-Helpful
O² per NC
0.45% Normal Saline Infusion
Insulin glargine bolus
Cont. Infusion of regular insulin diluted in NS
IV potassium
Continous Cardiac Monitor
Enoxaparin SQ daily
Tocilizumab & dexamethasone
Ceftriaxone
Anticipated
O² per NC
0.45% Normal Saline Infusion
Cont. Infusion of regular insulin diluted in NS
Continous Cardiac Monitor
Enoxaparin SQ daily
Tocilizumab (monoclonal antibody - used for covid 19 “inflammation” & dexamethasone (corticosteroids- treats inflammation)
Contradicted/ Not Helpful
Insulin glargine bolus (Need short acting insulin Not Long)
IV potassium
Ceftriaxone (Antibiotic) Covid is viral
Elevated _____ levels can indicate a recent heart attack or other injuries and conditions that affect the heart.
Other reasons for high levels:
Sepsis
Hypovolemia
Atrial fibrillation
Congestive heart failure
Pulmonary embolism
Myocarditis
Myocardial contusion
Renal failure
Cardiac angioplasty/stenting
Heart defibrillation or electrical cardioversion
Open heart surgery
Radiofrequency ablation of the heart
troponin
What type of test would be used for the following
Deep vein thrombosis (DVT), a blood clot that forms in a vein deep in your body. These clots usually affect the lower legs, but they can also happen in other parts of your body.
Pulmonary embolism (PE), a blockage in a lung artery. It usually happens when a blood clot in another part of your body breaks loose and travels to your lungs. DVT clots are a common cause of PE.
Disseminated intravascular coagulation (DIC), a condition that causes too many blood clots to form. They can form throughout the body, causing organ damage and other serious health issues. DIC may be caused by inflammation, infection, or cancer.
Stroke, which can happen when blood flow to a part of the brain is blocked
D-dimer test - for blood clotting disorders
Serious disorder, proteins that control blood clotting become overactive.
Causes
When you are injured, proteins in the blood that form blood clots travel to the injury site to help stop bleeding.
If these proteins become abnormally active throughout the body, you could develop _____.
The underlying cause is usually due to inflammation, infection, or cancer.
Test to diagnose?
Treatments?
Disseminated intravascular coagulation (DIC)
Diagnose:
CBC
Partial thromboplastin time(PTT)
Prothrombin time(PT)
Fibrinogen blood test
D-dimer
Treatments:
No specific treatment for DIC.
Supportive treatments may include:
Plasma transfusions
This test looks at the heart & blood vessel functioning…
Maybe used for diagnosis of
Congenital heart disease: Heart defects that are present at birth
Coronary artery disease: Can be evaluated and treated
Heart failure: Can help determine the causes
Heart valve diseases: Such as aortic stenosis and mitral regurgitation
Pulmonary hypertension: High blood pressure in the lungs
Cardiac Catheterization
Following Cardiac Catheterization
Which nursing interventions SATA
- Assess SOB
- Keep both extremities straight
- Encourage activy as tolerates
- Apply soft knee brace to left leg
- Supine posistion
- Monitor mental status changes
- Monitor VS q15min initially
- Assess insertion site for bloody drainage/ hematoma
- Apply SCD to both lower extremities
- Assess circulation, sensation, and motion of affected extremity.
Indicated:
- Assess SOB
- Apply soft knee brace to left leg
(Helps to keep leg straight) - Supine posistion
(HOB <30°) - Monitor mental status changes
- Monitor VS q15min initially
- Assess insertion site for bloody drainage/ hematoma
- Assess circulation, sensation, and motion of affected extremity.
Not indicated:
- Keep both extremities straight
(Only affected leg, 2 - 6 hrs after procedure) - Encourage activy as tolerates
(Activity is avoided directly after) - Apply SCD to both lower extremities (Increases risk of bleeding at insertion site)
___ mg aspirin is prescribed post MI
81
Nitroglycerin maybe taken in doses 0.3 - 0.6 sublingual every __ minutes as needed up to ___ times
5 minutes/ 3 times
Post MI
If BP increases more than ___ BPM of their normal they should stop exercise
20
BUN & Creatinine levels both associated with kidney function.
Which one is the most reliable test for kidney impairment
Creatinine
Measure the creatinine (waste product of muscle use) that is filtered by the kidneys.
BUN (Blood urine nitrogen - by product of breakdown of protein)
BUN is better at measuring dehydration. High is dry >20
Procedure administering a small amount of fluid over a short period of time to assess their cardiac preload reserve.
The goal is to replace volume while reducing the risk of fluid overload.
The test can help clinicians determine if a patient is a candidate to receive fluids and improve their outcome
Fluid challenge test
Empyema is
a collection of pus in a natural anatomical cavity, most often the pleural cavity.
Complete the follow for the medication Ceftriaxone
Actions to take (2)
Check for allergies to penicillin
Access fluid retention
Monitor for seizures
Avoid NSAIDS
Assess for Dysrhthmias
Drug Classification (1)
Penicillin
Carbapenem
Cephlosporin
Monobactam
Parameters to Monitor (2)
Ox Sat
VS
Wound drainage
Breath Sounds
Serum Potassium
BOWTIE QUESTION
Action to take
Penicillin allergy
Avoid NSAIDS
Drug Classification
Cephlosporins
Parameters to Monitor
VS
Wound drainage
Ceftriaxone can cause bleeding issues.
Apixaban is this type of medication prescribed for A fib.
Anticoagulant
Profuse scalp hair, dry cracked skin without lanugo, long thin body
Are characteristics of what?
Post term newborn
Acrocyanosis is a(n) (abnormal/ normal) fidning in Newborns with peripheral cyanosis around hands, feet, and mouth.
Normal
Maybe seen first few hours
Interment 7 - 10 days
Transient tachypnea of the newborn (TTN), also known as “wet lungs” or type II respiratory distress syndrome
Benign respiratory condition that can affect newborns shortly after birth.
It’s caused by 1.______
To compensate, the baby breathes faster, leading to a respiratory rate of more than 2. _____ breaths per minute, also known as tachypnea.
a delay in the clearance of fetal lung fluid, which makes it harder for the baby to take in oxygen.
- 60
Meconium aspiration syndrome (MAS) is a medical condition that occurs when a newborn has trouble breathing because meconium, their first stool, gets into their lungs.
Meconium is a thick, sticky, dark green substance made of cells, fats, protein, and intestinal secretions.
Symptoms include
Bluish skin color in the infant
Breathing problems
Dark, greenish staining or streaking of the amniotic fluid or the obvious presence of meconium in the amniotic fluid
Limpness in infant at birth
Causes of MAS
Interventions of MAS
Causes:
A pregnancy that goes past the due date
Difficult or long labor
Certain health issues experienced by the mother, such as hypertension or diabetes
An infection
Interventions:
Immediate suction of airway
Antibiotics to treat infection
Breathing machine to keep the lungs inflated
Use of a warmer to maintain body temperature
Tapping on the chest to loosen secretions
Which would you assign an LPN?
Client with emphysema scheduled for discharge
Client in traction for treatment of fractured Femur
Client low back pain scheduled for a myelogram (imaging that looks at the spine)
Client newly diagnosed type 1 diabetes
Traction for fractured Femur.
Most stable
3 yr old child doesn’t have ID band on. Before giving medicine the nurse should
- Ask parents child’s name
- Ask child to say name
- Have coworker ID child
- Hold medication until ID bracelet is obtained
Ask parents
Allows proper ID & give meds timely
Clients BP is 190/100
What action should the LPN take?
- Report BP to RN
- Wait 20 minutes & retake
- Use different cuff and retake
- Posistion supine with feet elevated
- Report findings
There is no Evidence in the question that an error was made with the cuff useage
Client ask about going to Cafe to get lunch. LPN tell client that they are not allowed to do so. Client becomes verbally abusive
Which approach is most effective
- Tell client to speak softly to avoid distrubing other clients
- Ask client what they want and deliver it to their room
- Calmly but firmly escort client back to their room
- Assigns UAP to accompany client to the Cafe.
- Calmly but firmly escort client back to their room
Nurses Must Not Reinforce Abusive behavior
Clients needs consistent & clearly defined expectations & limits
HCP is casting infant for talipes equinovarus. Which instruction is most important?
- Offer age-appopriate toys
- Visit clinic frequently for cast adjustments
- Give analgesics PRN
- Check circulation in the casted extremity.
Bonus: What is talipes equinovarus
- Check circulation frequently
Club foot. (Painless & usually respondes well to treatment
Which Subjetive data is important to a diagnosis of glomerulonephritis?
- Sore throat 10 days ago
- Family history of chronic glomerulonephritis
- Renal calculus 2 years ago
- Renal trauma several years ago
Sore throat 10 days ago.
Acute glomerulonephritis caused by A Streptococcus
10 days after strep throat / Scarlett fever
21 days after Streptococcus A skin infection
2nd & 3rd degree burns
HCP prescribed silver sulfasalazine cream application
Best method to apply the cream
- Sterlie dressing soaked in saline
- Sterile tongue depressor
- Sterile gloved hand
- Sterile cotton tipped applicator
- Sterile gloved hand.
Causes least trauma
Which observation indicates that a client with Anorexia Nervosa is improving?
- Eats all food on meal tray
- Ask friends to bring special foods
- Weighs self daily
- Has gained weight
- Has gained weight
Most objective outcome measure
Client right mastectomy & Axillary lymph nodes dissection.
Which statements indicate further teaching is necessary
- I will wear gloves & long sleeves while gardening
- The risk of my arm swelling will decrease 1 year after surgery
- I will sleep with my right arm on a small flat pillow elevated
- If my right arm begins to feel heavy I will contact my HCP
- I will need to wear a compression bandage for life.
Following statements require more Teaching for lymphedema
- The risk of my arm swelling will decrease 1 year after surgery
(The risk will always be the same) - I will sleep with my right arm on a small flat pillow elevated
(Must be elevated above head) - I will need to wear a compression bandage for life. (Compression bandages are used for Acute lymphedema Not Everyday)
Site to give IM injections on infants
Middle 3rd of anterior thigh
TB client
Appropriate/ Not Appropriate
- Single room
- Shoe & hair covering
- N95 respirator
- Keep door closed
- Reinforce cough etiquet
- Allow client to leave room if wearing isolation gown
Appropriate
- Single room
- N95 respirator
- Keep door closed
- Surgical mask within 3 to 6 feet
- Reinforce cough etiquet
Not Appropriate
- Shoe & hair covering
- Surgical mask within 3 to 6 feet
(Droplet Precautions = Surgical Mask ie. Flu, pertussis, Pneumonia, meningitis) - Allow client to leave room if wearing isolation gown
(If medically necessary may leave with Standard Isolation Maks / Surgical Mask)
TB client
Which statements indicate understanding upon discharge
- I will get my phlegm checked for TB, so I know how I’m doing
- My TB is better so now I don’t have to worry my friends about getting screened
- Public health nurse may need to visit me and ensure I take my meds correctly
- I will spend quality time alone outdoors and distance myself from crowded social activities
- I can cut back on meds once I feel better
- Taking my medicine is the best way to prevent spreading TB
- I will get my phlegm checked for TB, so I know how I’m doing
(Sputum for Acid Fast Bacillus culture- obtained at frequent intervals) - Public health nurse may need to visit me and ensure I take my meds correctly
(Notifying Public Health Dept is Required)
- I will spend quality time alone outdoors and distance myself from crowded social activities
- Taking my medicine is the best way to prevent spreading TB
Needs more Teaching
- My TB is better so now I don’t have to worry my friends about getting screened
- I can cut back on meds once I feel better
Parkinson client has Hand Tremors, Slurred Speech & Family reports Depression
What is the priority care for this client
- Place clock & calender within clients view in room
- Encourage ROM exercise
- Ask Family about their favorite TV shows
- Assist client to sit at edge of bed before ambulation
Assist client to sit at edge of bed before ambulation
Priority of care physical & safety > psychological
After a cystogram is burning / blood in urine a normal finding?
Yes, first 2 days
Avoid alcohol for 2 days also
How do ID a confused patient with no wrist band
- Have roommate ID them
- Have client state full name
- Ask another LPN to help
- Look up photo of client in medical records
Look up photo of client in medical records
According to nursing text books this is the correct answer
Agitated & confused client is given morphine & lorazapam Preop.
Which precaution should you take
- Ask security to stay with client
- Ask UAP to stay with client
- Leave client alone until meds take affect
- Restrain client with help of coworker
- UAP stays with them.
Perfect World scenario.
Image what would be done in a text book & Not IRL
Client doesn’t want to breast feed new born.
Which statement demonstrates Lack of Understanding
- I’ll pump my breast and use warm packs to relieve pain.
- I’ll wear a tight bra and apply ice packs to relieve engorgement discomfort
- I’ll take prescribed pain meds when I have pain or discomfort
- I’ll take prescribed pills to stop milk production.
- Pumping breast will stimulate milk production.
Client after motor vehicle accident being treated with balanced suspension skeletal traction using a Thomas splint and Pearson’s attachment.
Client reports terrible pain in left thigh. What does LPN do first
- Determine traction weights and ropes are aligned and hanging free.
- Ask client to describe pain
- Check the Thomas splint and Pearson’s attachment for proper positioning.
- Explain that pain in affected leg is expected
- Ask client to describe pain
Always evaluate CLIENT FIRST then Equipment Second
Pain is always abnormal and needs to be investigated
A fib client is prescribed 5,000 u heprin q12h SQ.
What is normal pTT range?
What is Therapeutic pTT range?
Normal 20 - 45 sec
Therapeutic = 1.5 - 2 × (Normal pTT)
30 - 90
Protamine = Antidote for heparin
