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ATI NCLEX Review > Incorrect/Need to Learn Concepts > Flashcards

Incorrect/Need to Learn Concepts Flashcards

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1
Q

Chlamydia

A

-Bacterial infection (STI)
-Causes: New partners, multiple partners, unprotected sex
-Complications: Pelvic Inflammatory Disease (PID), infertility, ectopic pregnancy, PROM, preterm pregnancy, postpartum endometriosis
-Screening: Yearly for all sexually active females <25 yrs + older females + pregnant pts screen @ 1st and 3rd trimester
-S/S: Penile discharge, dysuria, spotting, gray-white discharge
Diagnostic: Endocervical swab culture + urine culture
-Intervention: Doxycycline, Azithromycin (preg-safe), Erythromycin, barrier contraceptive, report to local health dept
-Rescreened for re-infection: 3-12m after tx

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2
Q

Triage Categories

A

-Emergent (RED): Life threatening injuries => immediate tx + HIGHEST priority
-Urgent (YELLOW): Serious + extensive injuries => not immediate threat + potential survival w/ DELAYED tx
-Non-urgent (GREEN): Less serious + less extensive injuries => no threat to life even w/ DELAYED tx
-Expected (BLACK): Potential for survival DOESN’T EXIST, even w/ tx => expected to DIE/FATAL + LOWEST PRIORITY

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3
Q

Fire Safety Evacuation

A

-Know location of exits, alarms, fire extinguishers, and O2 shut-off valves
-Make sure equipment doesn’t block fire doors
-Know evacuation plan for unit + facility
-RACE: Rescue, Alarm, Contain/Confine Fire, Extinguish
-PASS: Pull, Aim, Squeeze, Sweep

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4
Q

RACE

A

R: Rescue + protect clients in close proximity to the fire by moving them to a safer location (pts who are ambulatory can WALK independently to a safer location) HEALTHIEST/STABLE/AMBULATORY PT = HIGHEST PRIORITY
A: Alarm activated + then report the fire’s details and location
C: Contain/confine the fire by closing doors and windows + turning off any sources of O2/electrical devices (ventilate pts who are on life support w/ bag-valve mask)
E: Extinguish fire if possible w/ appropriate fire extinguisher

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5
Q

Incident Report

A

-Unusual occurrences (med error, falls, omission of prescription, needlestick, device malfunction)
-Complete incident report within 24 hrs
-Patient ID, time/place of incident, accurate account of event, who you notified, what action you took, signature
-DON’T reference/include incident report in client’s medical record/chart

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6
Q

Unintentional tort

A

-Negligence: nurse fails to implement safety measures for a client at risk for falls

-Malpractice: professional negligence; a nurse administers a large dose of med due to a calculation error (pt dies)

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7
Q

Quasi-intentional tort

A

-Breach of Confidentiality: a nurse releases a client’s med diagnosis to a member of the press

-Defamation of Character: a nurse tells a coworker that they believe the client has been unfaithful to their partner

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8
Q

Intentional tort

A

Assault: conduct of one person makes another person fearful + apprehensive; a nurse threatens to place an NG tube in a client who is refusing to eat

Battery: Intentional + wrongful physical contact w/ a person that involves an injury/offensive contact; a nurse restrains a client + administers an injection against their wishes

False imprisonment: a person confined/restrained against their will; a nurse uses restraints on a competent client to prevent their leaving the health care facility

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9
Q

Informed Consent

A

-Written permission for a procedure/tx + consent is informed
-Nurse witnesses client signing consent form + ensure the provider has obtained the form
-Implied consent: adhere to instructions the nurse provides
-Must have written consent for an invasive procedure/surgery
-Signed by competent adult (capable to understand the info)

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10
Q

DNR Legality

A

-Ordered by HCP
-“Allow natural death”
-Prescription in the client’s medical records
-HCP consults the client + family prior to administering DNR

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11
Q

Bleeding Dressing

A

-Hemorrhage control: apply DIRECT pressure to visible, significant external bleeding
-Drainage: Serous (CLEAR), Serosanguineous (PINK), Sanguineous (BRIGHT RED), Purulent (YELLOWISH-GREEN)
-Wet, saturated dressing should be REINFORCED by adding more dressing to the existing dressing
-FIRST dressing change is performed by surgeon

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12
Q

2 Point Crutch Gait

A

Partial weight is placed on the affected foot moving the crutch at the same time as the affected leg
OPPOSITE CRUTCH + FOOT MOVE AT SAME TIME

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13
Q

3 Point Crutch Gait

A

Weight is distributed on both crutches + then on the unaffected leg w/ the sequence being repeated (affected leg DOESN’T touch the ground)
CRUTCHES FIRST, THEN UNAFFECTED FOOT

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14
Q

4 Point Crutch Gait

A

Weight is evenly distributed, with each leg being moved alternately w/ the opposing crutch
R CRUCTH, L FOOT, L CRUTCH, R FOOT

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15
Q

Swing-thru Crutch Gait

A

Weight is placed on both legs, and crutches are place one stride in front and then legs swing to the crutches
CRUTCH, SWING BOTH LEGS TO CRUCTHES

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16
Q

Crutches/Canes Up + Down Stairs

A

GOOD = UP
BAD = DOWN

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17
Q

Pneumonia O2 sat

A

-Expected for pneumonia pt to have low reading
-Even though O2 Sat is within NORMAL range, REASSESS using another site before any other interventions are completed
-Low readings caused by mvmt, hypothermia, decreased peripheral blood flow, sunlight, decreased Hgb, edema, fingernail polish

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18
Q

Patient doesn’t recognize med

A

-Hold off on administering ANY med until verified against provider’s orders in client’s records
-Once complete, nurse can tell client w/ certainty that all meds were verified + answering any questions
-Prevent errors + build trust

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19
Q

Learning Barriers

A

-Self confidence
-Fear, anxiety, depression
-Physical discomfort, pain, fatigue
-Envmt distractions
-Sensory/perceptual deficits
-Psychomotor deficits

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20
Q

Spill kit (Chemotherapy)

A

-Spill is an envmt hazard + chemotherapy is a carcinogen & teratogen to anyone who handles it in a unprotected manner
-Small spill => use chemotherapy spill kit (goggles, mask, protective clothing, shoe covers, absorbent pads, detergent cleansers, and chemotherapy waste disposal bag
-Large spill=> contact OSHA

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21
Q

Ergonomics for transferring patients

A

-Lifting is a high-risk activity (postural stressors)
-Manual lifting client’s full weight is BAD
-Use client-handling equipment
-Lift w/ legs not back
-Lift from close proximity

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22
Q

Amyl Nitrate

A

-Antidote for cyanide poisoning
-Cyanide poisoning is an AE for nitroprusside
-S/S: HA, dizziness, anxiety, SOB, bitter almond breath

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23
Q

Amputation Positioning

A

-First 24hrs = ELEVATED on pillow (above heart level)
-After 24hrs = DEPENDENT/DANGLING

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24
Q

Blood Pressure Electronic Device

A

-For pts who require frequent evaluation
-Can have inaccurate readings
-Hypotension or movement

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25
Q

Contact Infections

A

RSV, Hep A, E. coli, Shigella, Herpes simplex, Impetigo, Scabies, MRSA, VRE

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26
Q

Droplet Infections

A

Strep, Pneumonia, Hib, Scarlet fever, Rubella, Pertussis, Mumps, Meningococcal pneumonia

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27
Q

Airborne Infections

A

Measles, TB, Varicella

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28
Q

Biliary Atresia

A

-Blockage in the tubes (ducts) that carry bile from liver to gallbladder (underdeveloped liver)
-Cause increase bilirubin (buildup)
-Common in infants
-S/S: Jaundice, dark urine, clay-colored stools, weight loss, irritability

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29
Q

NG Tube Suction

A

-For decompression/relieve abd distension
-Assess lab results (electrolytes & Hct)
-Monitor potassium levels (HYPO)
-Cause metabolic acidosis (low obstruction) or metabolic alkalosis (high obstruction)

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30
Q

Ciprofloxacin

A

-Fluoroquinolone; broad-spectrum antimicrobial
-For urinary tract, respiratory, GI tract infections
-Anthrax prevention
-Complications: GI discomfort, Achilles tendon rupture, supra-infection, phototoxicity

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31
Q

ABG Specimen Care

A

-Preprocedure: Perform Allen’s test
-Intraprocedure: Perform arterial puncture, collect + cap specimen into basin of ice water, transport to lab ASAP
-Postprocedure: Hold direct pressure over the site for 5min, monitor for bleeding, document

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32
Q

Leukemia

A

-Causes increase of immature WBCs w/ neoplastic characteristics (AML/ANLL)
-Common in childhood
-Decreased PLTs (PLT transfusion)
-Low-grade fever, anorexia, HA, fatigue
-Bone marrow aspiration (needle biopsy)

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33
Q

Magnesium Sulfate

A

-Tocolytic; CNS depressant + relaxes smooth muscles (neuromuscular)
-Stops labor
-Prevent seizures (preeclampsia)
-Cause maternal hypocalcemia + transient hypotension
-Causes fetal nonreactive NST + reduced FHR variability
-Monitor DTR
-Antidote: Calcium gluconate

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34
Q

Hypoxia

A

-Decrease in tissue oxygenation
-Early: Tachypnea, Tachycardia, Restlessness, Pallor, Hypertension
-Late: Bradypnea, Bradycardia, Cyanotic, decreased LOC, Hypotension
-Position in semi-fowlers/fowlers, O2 therapy, promote turning/coughing/deep breathing/using incentive spirometer/suctioning

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35
Q

Abruptio Placentae

A

-Premature separation of placenta from uterus
-After 20 wks gestation
-Cause maternal death
-Vaginal bleeding (Dark red) => hypovolemic shock
-Sharp abd pain
-Tender rigid uterus
-IV fluids, blood products, continuous monitoring

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36
Q

Placenta Previa

A

-Placenta implants in lower segment of uterus/over cervical os
-Bleeding during 3rd trimester
-Painless vaginal bleeding
-Fetus in breech, oblique, transverse
-Decreased UO
-REST + don’t insert anything into vagina

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37
Q

Paranoid Personality Disorder

A

-Distrust
-Suspiciousness

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38
Q

Schizoid Personality Disorder

A

-Emotional detachment
-Disinterest in close relationships
-Indifference to praise/criticism
-Uncooperative

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39
Q

Schizotypal Personality Disorder

A

-Eccentric personality
-Magical thinking
-Perceptual distortions

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40
Q

Antisocial Personality Disorder

A

-Disregard for others
-Lack empathy
-Criminality
-Deceitful
-Sense of entitlement
-Seductive/charming

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41
Q

Borderline Personality Disorder

A

-Instability
-Splitting behavior
-Manipulation
-Impulsiveness
-Suicidal

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42
Q

Histrionic Personality Disoder

A

-Emotional attention-seeking behavior
-Center of attention
-Seductive/flirtatious

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43
Q

Narcissistic Personality Disorder

A

-Arrogance
-Grandiose views
-Need consistent admiration
-Lack empathy
-Sensitive to criticism

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44
Q

Avoidant Personality Disorder

A

-Social inhibition/avoidance
-Extreme fear of rejection
-Anxious in social situations

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45
Q

Dependent Personality Disorder

A

-Extreme dependency in close relationships
-Fear of abandonment
-Cannot make own decisions

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46
Q

Obsessive-Compulsive Personality Disorder

A

-Indecisiveness
-Perfectionism
-No control over life

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47
Q

EXPECTED Lithium Toxicity (<1.5 mEq/L)

A

-N/V/D
-Thirst
-Polyuria
-Fine hand tremors
-Slurred speech
-Muscle weakness
(Improve over time)

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48
Q

EARLY Lithium Toxicity (1.5-2.0 mEq/L)

A

-GI distress (ongoing)
-N/V/D
-Confusion
-Coarse hand tremors
-Sedation
(Withhold med, notify HCP, promote excretion)

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49
Q

ADVANCED Lithium Toxicity (2.0-2.5 mEq/L)

A

-Tinnitus
-Blurred vision
-Ataxia/Seizures
-Severe hypotension
-Respiratory complications
(Whole bowel irrigation)

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50
Q

SEVERE Lithium Toxicity (>2.5 mEq/L)

A

-Oliguria
-Seizures
-Coma/Death
(Hemodialysis)

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51
Q

Erikson (Infant)

A

-Trust vs. Mistrust
-Birth to 1 year
-Delayed gratification
-Meet needs

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52
Q

Erikson (Toddlers)

A

-Autonomy vs. Shame vs. Doubt
-1 to 3 years
-Independence (do everything themselves)
-Negativism
-Ritualism

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53
Q

Erikson (Pre-schooler Children)

A

-Initiative vs. Guilt
-3 to 6 years
-Energetic
-Guilt from misbehaving/unable to accomplish task
-Guide to attempt activities within capabilities
-Set limits

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54
Q

Erikson (School-Age Children)

A

-Industry vs. Inferiority
-6 to 12 years
-Develop skills + knowledge (contribute to society)
-Sense of accomplishment
-Cooperate + compete w/ others
-Challenge w/ tasks
-Create system (rewarding)

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55
Q

Erikson (Adolescents)

A

-Identity vs. Role Confusion
-12 to 20 years
-Try different roles + experiences
-Sense of personal identity
-Unique individuals
-Group identity (social influences)

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56
Q

Colporrhaphy

A

-Surgery to fix weakness of vaginal walls
-Anterior (Cystocele) or Posterior (Rectocele)
-Pelvic muscles are shortened or tightened
-Increase bladder support or reduce rectal protrusion into the vaginal canal

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57
Q

Post-Op Colporrhaphy

A

-Administer PCA, antimicrobials, stool softeners
-Apply warm compress to abd
-Frequent sitz baths
-Low-residue diet
-Avoid straining at all (tighten/support pelvic muscles when straining)
-Avoid strenuous activity, sex for 6wks, carrying >5lbs

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58
Q

Post-Op Open Radical Prostatectomy

A

-Monitor I+O
-Check dressing, incision, and drainage
-Encourage client to void (urge)
-Dribbling is expected
-Administer stool softener (no straining)
-Administer abx (infection)
-Increase fiber
-Avoid tub baths
-Encourage fluid intake
-Do perineal exercises

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59
Q

Intermittent Tube Feeding Intervention

A

-For non-critical, home tube feedings, or rehab clients
-Tube placement verified by radiography
-Measure tube each shift/prior to feeding
-Verify presence of bowel sounds
-Maintain patency by flushing w/ warm water
-Check gastric residual volume before feeding
-Prevent aspiration

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60
Q

Indwelling Catheter Perineal Care

A

-Avoid inadvertently advancing cath into bladder
-Monitor for infections

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61
Q

Determine Strength for Ambulation

A

-Client should be able to move affected extremity in active motion
-Assess client’s plantar flex the feet against resistance (most appropriate)

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62
Q

Buck’s Traction

A

-Uses pulling force to promote + maintain alignment of injured area
-Preoperatively for hip fractures in immobilized adults
-Decrease muscle spasms + pain
-Immobilize extremity prior to surgery
-Weights free hanging attached to rope to client’s skin (not on floor)
-Avoid lifting/removing weights
-Monitor skin integrity
-Prevent wrinkling of traction bandage

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63
Q

Ileostomy Diet

A

-Liquid only + slowly advance based upon client’s tolerance
-High in fluids + low fiber
-Avoid foods that cause gas, stomal blockage, odorous
-Increase calories + protein intake

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64
Q

Growth + Development (Infant)

A

-Lose 5-10% birth weight in first few days (regained by 2nd wk) => increase 1.5lbs/month
-Palpable fontanels (A: closes 2-3m & P: closes 12-18m)
-Startling, sucking, palmar grasping, positive Babinski, respond to visual stimuli, mimic smile
-Cry = communication > vocalize “oohs + aahs” > laugh + squeals
-6 to 8 teeth erupt by end of year (teething)
-Object permanence @ 9m
-Solitary play

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65
Q

Contractions

A

-Braxton Hicks (false): painless, irregular, relieved by walking
-True: increase in intensity + frequency w/ regularity
-To subside: change position/walk around
-At least 3 contractions/10 min
-Duration: 40-60 sec/each
-Oxytocin: induces uterine contractions
-BAD => contractions > 90 secs or occurring more frequently than q 2 min

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66
Q

Abnormal Infant Symptoms

A

-Decreased UO
-Lethargic
-No response to voice
-Excessive crying > 3hrs

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67
Q

Nonpharmacological Comfort Measures for Pre-schooler

A

-Encourage child to watch favorite cartoon on TV
-Distraction > progressive relaxation
-Magical thinking, animism, centration (focus on one thing)
-Play w/ favorite toy/watch favorite cartoon to ease fears

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68
Q

Chronic Renal Failure Diet

A

-Low-protein, low-phosphorus, low-potassium, low-sodium
-Restrict fluids
-Limit phosphorus intake (meat, PB, dried beans, cola, chocolate, beer)
-Limit dairy products
-High biologic value protein recommended (eggs, soy, fish)

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69
Q

Restful Sleep

A

-Drinking hot milk
-Take bath before going to bed
-Go to bed and get up @ same time each day
-Don’t take naps during day
-No TV until falling asleep

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70
Q

Crohn’s Diet

A

-Low residue
-High protein
-High calorie w/ vitamins + mineral supplements
-IV fluids
-Enteral nutrition (exacerbation)
-Avoid nicotine/substances that cause diarrhea
-Ex: eggs, cooked ground meat, fish, poultry, white rice, cooked veggies w/o skin, pasta

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71
Q

Dumping Syndrome Interventions

A

-Avoid consuming milk, sweets, and sugars
-Eat small, frequent meals during the day
-Eliminate liquids w/ meals & one hour before + after meals

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72
Q

Guillain-Barre Syndrome Mobility Assessment

A

-Assess bowel sounds/frequency of stools
-Observe skin color over sacral, heels, scapulae areas
-Performing ROM of joints

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73
Q

Pneumonia Prevention

A

-Ambulate regularly (daily)
-Use humidifier
-Reassure client during resp. distress
-Well-rounded diet

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74
Q

Advanced Directive Legality

A

-Do NOT share client’s wishes to ALL family members
-Document in medical chart
-Confirm if current
-Provide written information to client

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75
Q

Prioritizing Care Mgmt

A

-Prepare written list
-Postpone items that do not have immediate deadlines

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76
Q

Digoxin Toxicity Expected Findings

A

-Bradycardia
-Yellow vision/Halos
-Tinnitus

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77
Q

Ileostomy Stomal Swelling Intervention

A

-Moisten towels applied to abd (facilitate draining)
-Abd massage (promote drainage)
-Drink hot tea (facilitate drainage)

78
Q

Hearing Impaired Interventions,

A

-Provide client w/ written instructions
-Turn off TV + close door (background sounds)
-Include client’s spouse in teaching session

79
Q

Action for Bladder Irrigation

A

-Closed intermittent irrigation: use soap + water w/ washcloth + gloves @ insertion site
-Cleanse catheter 3x/day + after pooping
-Check patency of catheter
-If obstructed, turn off CBI + irrigate w/ 50 mL irrigation solution or contact surgeon

80
Q

Administering Intermittent Enteral Feedings (G-Tube)

A

-If using syringe, hold high for formula to empty gradually via gravity
-Fill syringe w/ 40-50 mL

81
Q

Promote Sleep

A

-Exercise regularly at least 2hrs before bedtime
-Establish bedtime routine + regular sleep pattern
-Limit alcohol, caffeine, nicotine (4hrs before bed)
-Engage in muscle relaxation (stressed)

82
Q

Prevent Pressure Injuries (Positioning)

A

-HOB @ or below 30 degrees (or flat)
-Relieve pressure on sacrum, buttocks, and heels

83
Q

Progressive Relaxation

A

-Promotes relaxation using breathing techniques while TENSING + RELAXING specific muscle groups

84
Q

Complicated Grief (Delayed/Inhibited)

A

-Delayed/Inhibited
-Doesn’t demonstrate expected behaviors of normal grief
-Cultural expectations can influence
-Remain denial for long time
-Inability to progress through stages (trigger grief response after extended period of time)

85
Q

Complicated Grief (Distorted/Exaggerated)

A

-Somatic manifestations (exaggerated)
-Unable to perform activities of daily living
-Remain in anger stage (project to themselves or others)
-Develop clinical depression

86
Q

Complicated Grief (Chronic/Prolonged)

A

-Maladaptive
-Difficult to identify
-Remain denial (unable to accept reality)
-Inability to perform ADLs

87
Q

Complicated Grief (Disenfranchised)

A

-Cannot be publicly shared or not socially accepted —-Ex: suicide/abortion

88
Q

Normal Grief

A

-Uncomplicated
-Anger, Resentment, Withdrawal, Hopelessness, Guilt
-Changes to acceptance (overtime)
-Acceptance achieved by 6 months after loss
-Somatic manifestations: chest pain, palpitations, HA, nausea, changes in sleep pattern, fatigue

89
Q

Anticipatory Grief

A

-“Letting go” of person BEFORE loss
-Have opportunity to grieve before actual loss

90
Q

Complicated Grief

A

-Difficult progression through expected stages of grief
-Prolonged + more severe manifestations
-Suicidal ideation, intense guilt, lower-self esteem
-Somatic complaints

91
Q

Alzheimer’s Disease + Anxiety Communication

A

-Encourage reminiscence about happy times
-Talk about familiar things (memories)
-Break instructions + activities into short time frame
-Limit # of choices
-Minimize need for decision making
-Approach slowly + from front (address by name)
-Encourage family visitation
-Calm, reassuring voice
-Reinforce reality, orientation to time/place/person
-Establish eye contact

92
Q

Assessing Peripheral Pulse w/ US Stethoscope

A

-Using bell to listen to low-pitched sounds (unexpected heart sounds or bruits)

93
Q

Interpreting Cardiovascular Assessment

A

-Carotid Artery: over carotid pulses for bruits

94
Q

Teaching Health Promotion Priority

A

-Nursing Process: ADPIE
-Assess client’s ability to make health decisions
-Health literacy + health beliefs
-Determine additional info is needed PRIOR to calling HCP/making decision (DATA COLLECTING)

95
Q

Newly Licensed Nurse Requires Intervention

A

D/Cing IV therapy:
-Check prescription
-Prepare equipment
-Perform hand hygiene/don gloves
-Clamp tubing
-Remove tape + dressing + stabilize
-Apply sterile gauze over site
-Withdraw catheter (pull straight back)
-Elevate extremity + apply pressure from 2-3 min
-Examine site, apply gauze + tape
-Document removal

96
Q

Moving Client UP in Bed

A

-Widen base of support
-Pull object toward center of gravity
-PUSH: move front foot forward
-PULL: move rear leg back to promote stability
-Face direction of mvmt
-Use own body as counterweight
-Sliding, rolling, pushing require less energy than lifting
-Avoid twisting spine/bending your back

97
Q

Removing PPE

A

-Clinical judgment needed
-Set priorities
-Gloves and gowns worn by the caregivers + visitors (contact precautions)
-REMOVE: Glove, Gown, Goggles, Mask
-DON: Gown, Mask, Goggles, Gloves

98
Q

Items that Trigger Allergic Reactions

A

-Fruits (Kiwi/banana) => LATEX
-Eggs/Soybean oil => PROPOFOL
-Shellfish => IODINE
-Let client + ALL members of health care team know about allergy
-Use latex-free gloves/equipment/supplies
-Use nitrile gloves
-Schedule surgery FIRST!

99
Q

Using Gait Belt (Ambulation)

A

-Complete fall-risk assessment (Romberg test)
-Instruct orthostatic hypotension pt => AVOID getting up too fast, sit on side of bed for few seconds before standing/walking

100
Q

Evaluating ABGs

A

-Use tic-tac-toe method
-pH: low, PaCO2: high, HCO3: normal => respiratory acidosis
-pH: low, PaCO2: normal, HCO3: low => metabolic acidosis
-pH: high, PaCO2: low, HCO3: normal => respiratory alkalosis
-pH: high, PaCO2: normal, HCO3: high => metabolic alkalosis

101
Q

ABG: Uncompensated vs Compensated

A

-Uncompensated: pH is outside expected range & either HCO3 or PaCO2 is outside expected range
-Partially compensated: pH, HCO3, and PaCO2 are outside the expected range
-Fully compensated: pH is within expected range, but PaCO2 + HCO3 are both outside the expected range
-Look at pH to see if its <7.40 (acidosis) or >7.40 (alkalosis)

102
Q

Mechanical Ventilation Interventions

A

-Maintain patent airway + monitor respiratory status q hour
-Oxygenate before suctioning
-Assess + document sputum
-Continuous ECG
-Perform oral care q 2 hrs
-Wear PPE (gown, gloves, mask)
-Position HOB at least 30 degrees
-Administer enteral/parenteral feedings +confirm NG tube placement
-Prevent aspiration

103
Q

Fever Intervention

A

-Antipyretics (aspirin, acetaminophen, ibuprofen) to reduce fever + discomfort)
-NO aspirin for children + adolescents who have VIRAL illness (Reye’s Syndrome)
-Prevent shivering (increase energy demand)
-Offer blankets during chills + remove when warm
-Provide oral hygiene + dry clothing
-Provide fluids + rest

104
Q

Focused Assessment of Sensory Functions

A

-Babinski Reflex (Plantar Reflex)
-Positive BAD in adults, but GOOD in newborns
-BAD => vertigo, hemiparesis, cranial nerve dysfunction, papilledema

105
Q

Calculating Infusion Flow Rate

A

-For electronic infusion pumps (mL/hr) and manual IV tubing (gtt/min)
-Electronic pumps => x mL/hr = given mL/given hrs
-Convert minutes to hours
-Manual tubing => x gtt/min = (given mL/given mins) * (given gtt/mL)

106
Q

Central Venous Access Device Care

A

-Wipe all ports w/ alcohol or antiseptic swab before connecting IV lines or inserting syringe to prevent infections
-Never disconnect tubing/reposition client
-Change IV sites q 72 hrs
-Remove catheters as soon as no need for them (clarify with HCP)
-Don’t label IV bags w/ ink

107
Q

Client Confidentiality

A

-Nurses must NOT disclose clients’ information to unauthorized individuals or family members who request it in person/over phone
-Code system to identify individuals who can receive info
-Unauthorized individuals should ask client permission for medical information DIRECTLY

108
Q

Diarrhea Priority Action

A

-F+E disturbances (metabolic acidosis) => excessive loss of HCO3
-Monitor for dehydration (weak, rapid pulse; hypotension, poor skin turgor, high temp)
-Monitor for hypernatremia + hypokalemia
-Replace F+E (IV fluids => rehydration therapy)
-Safety risk priority

109
Q

Transferring Client from Bed to Stretch

A

-Evaluate need for additional staff/assistive devices
-Ex: transfer belt, hydraulic lift, sliding board
-Determine client’s ability to help w/ transfer
-Ex: balance, muscle strength, endurance, use of trapeze bar

110
Q

Antianginals

A

-Nitroglycerin or BB
-Relieve chest pain + prevent MIs + improve blood flow (decreasing O2 demand)
-Dilate blood vessels
-Determine cause active/rest
-Continuous ECG monitoring + cardiac labs (check effectiveness)
-Complications: orthostatic hypotension

111
Q

Anticoagulants

A

-Prevent clotting (DVT, PE, MI, stroke)
-Heparin (IV), Enoxaparin (IM), Warfarin (PO)
-Need frequent blood tests
-Check therapeutic levels + clotting times (aPTT, PT, INR, PLT)
-Manage Vit K levels (warfarin)
-NO 5 G’s => garlic, ginseng, gingko biloba, glucosamine, ginger!
-Complications: Chest pain, altered LOC, coughing blood, increased risk of bleeding (GI)
-Use electric razor, soft toothbrushes, no contact sports, don’t blow nose too hard, avoid alcohol

112
Q

Antirheumatics

A

-Treat rheumatoid arthritis (decrease inflammation + pain)
-Prevent further joint deformities
-DMARDs (methotrexate, sulfasalazine, hydroxychloroquine) + etanercept
-Complication: infection, hepatotoxicity, hyperglycemia, F+E imbalance, HTN, osteoporosis, glaucoma

113
Q

Antituberculosis

A

-Treat TB and decrease risk of transmission
-Combo tx: RIPE (Rifampin, Isoniazid, Pyrazinamide, Ethambutol)
-Give with active/suspected TB
-Check sputum culture for clearance + CXR (3 consecutive negatives)
-Expect: orange-tinged body fluids
-“RIPE orange”
-Taken 6-12 m
-Complications: GI upset, peripheral neuropathy, hepatoxicity, hyperglycemia
-Antidote: Vit B6
-Monitor liver functions + avoid alcohol

114
Q

Antimicrobial

A

-Decrease-prevent post-op infections/further systemic infections (PROPHYLACTIC)
-Penicillin, Cephalosporin, Tetracyclines, Aminoglycosides, Macrolides, Fluoroquinolones
-Monitor WBCs
-Complications: GI upset, nausea, allergic reaction, thrush

115
Q

Glucorticoids

A

-Treat allergies, anti-inflammatory, control metabolism
-Prednisone + dexamethasone
-Affect thyroid function
-High doses => reduce conversion of active T4 to T3
-Complications: hyperglycemia, immunosuppression, infection, weight gain,
-Monitor blood sugar +administer insulin

116
Q

Opioids Analgesics

A

-Pain relief (moderate to severe)
-Highly addictive
-Morphine sulfate, oxycodone, hydrocodone, codeine, methadone, fentanyl
-Complete pain assessment q 2 hrs (effectiveness)
-Complication: constipation, overdose, tolerance, depression, sedation
-Give stool softeners

117
Q

Atropine

A

-Increases HR by interfering w/ vagal impulses
-Increasing work + oxygen demand
-Treats bradycardia + manage digoxin toxicity & dysrhythmias
-ACh effects => blurry vision, dry mouth, urinary retention, constipation, dilated pupils
-“PINE” = like a pine tree goes UP
-For unresponsive patients

118
Q

DigOxin

A

-Decrease electrical conduction thru AV node + decrease automaticity in the SA node
-Increase myocardial contraction
-For: HF, A-Fib, A-flutter, paroxysmal SVT
-Complication: digoxin toxicity + hyPOkalemia + arrhythmias
-DON’T give to pregnant, Vtach/Vfib pt
-Contraindication: CCB, antidysrhythmic, diuretic, corticosteroids, antacids
-Take apical pulse BEFORE giving (BAD < 60bpm)

119
Q

Digoxin Toxicity Intervention

A

-Hold drug + call HCP
-Eat high-potassium diet (hyPOkalemia)
-Administer @ same time daily
-Monitor digoxin + potassium levels
-Antidote: Digiband
-Educate on complications
-Administer potassium IV/PO (hyPOkalemia)

120
Q

Nifedipine

A

-CCB + tocolytic
-For decreased BP and relaxing smooth muscles (uterine + blood vessels)
-For angina pectoris, HTN, cardiac dysrhythmias, stop labor/contractions
-Monitor for tachycardia, lightheadedness, swelling
-Complications: orthostatic hyPOtension, peripheral edema, reflex tachycardia, HA
-NOT for cardiac pts
-NO grapefruit juice, BB, Mg Sulfate

121
Q

DKA: Insulin HyPOglycemia Tx

A

-Frequent blood glucose level checks HOURLY
-Administer glucose (conscious) => snack, OJ, milk, glucose tablets, candy
-Administer IV glucose, IM glucagon, D50 (not conscious)
-Wear medical bracelet
-Always have snack of glucose on you

122
Q

Captopril Interventions

A

-ACh effects (REPORT)
-Dry cough: notify HCP to d/c, encourage increasing fluids, consume candy
-HyPERkalemia: monitor, low-potassium diet
-Altered taste: notify HCP
-Angioedema: epinephrine + d/c
-Take 1 hr before meals (with or without food)
-Rise slowly

123
Q

TPN Effectiveness

A

-Albumin levels 5.0 g/1 mL (4.5-5.0 g/100 mL)
-Gaining up to 1 kg/day
-Increase in prealbumin levels (15-36 mg/dL)
-BUN within expected level (7-20)
-Monitor electrolytes, CBC, BUN, glucose, albumin

124
Q

Type 1 DM Lab Interpretation

A

-Fasting plasma glucose for diabetic (90-130 mg/dL)
-HbA1C level (4-6%)
-HbA1C is long-term glycemic control indicator for 3 months
-Fasting plasma glucose is short-term

125
Q

Digoxin Abnormal Labs

A

-HyPOkalemia (<3.5)
-Digoxin levels (>2.0)

126
Q

Nitroglycerin Nursing Care

A

-NOT for anemic, close-angle glaucoma, traumatic head injury pts
-Administer before activities
-Encourage pt to sit/lie down!
-Store in cool, dark places
-Don’t crush/chew
-Shave + dry area, remove old patch, remove @ night, rotate sites (patch)
-Measure dose + wear gloves (ointment)
-Continuous cardiac + BP monitoring
-Call 911 + administer second tablet, if first one doesn’t work (wait 5 min to take third)
-Don’t stop abruptly!

127
Q

Penicillin Injection Safety

A

-Assess for allergies to penicillin or cephalosporins
-HARMFUL => infants, older adults, pregnant, acutely ill
-Hand hygiene
-Check for up to date immunization status
-Test sensitivity
-Monitor kidney functions/labs
-Sit still for 30 min after injection (reduce anaphylactic reaction)

128
Q

Imipramine HCl Toxicity

A

-Tricyclic Antidepressant
-“Inhibit my PEEING”
-Orthostatic hyPOtension
-ACh effects
-Sedation
-Excessive sweating
-Dysrhythmias/Arrythmias (overdose/toxicity)
-Confusion/Seizures

129
Q

Digoxin Effectiveness

A

-Normal cardiac status + potassium/digoxin levels
-HF is controlled
-Absence of cardiac dysrhythmias
-Decrease pulmonary crackles (from left HF + pulmonary edema)

130
Q

Lisinopril Assessment (BEFORE)

A

-ACE inhibitor
-Check BP before administration
-Check serum electrolytes (HYPERkalemia)
-Check lithium
-Stop using NSAIDs
-Stop taking diuretics 2-3 days before

131
Q

Angioedema vs Peripheral Edema

A

-Angioedema: severe allergic reaction => swelling underneath skin of face, oropharynx, neck, tongue
-Peripheral edema: swelling of leg tissue from fluid retention

132
Q

Gentamicin Sulfate A/E

A

-Harmful to fetus
-Ototoxicity
-Nephrotoxicity (low UO)
-Muscle weakness
-Hypersensitivity

133
Q

Fluoxetine (SSRI) Priorities

A

-Take in the morning (prevent insomnia)
-Take same time DAILY
-Take as prescribed (DON’T abruptly stop)
-S/E: ACh effect, blurry vision, constipation, drowsiness, euphoria, weight changes, sexual dysfunction
-Monitor for Serotonin Syndrome (SADHEAD)
-Administer w/ food
-Takes up to 4 wks to work
-No St. John’s wort, MAOIs, TCAs

134
Q

Methylprednisolone Sodium Succinate IV S/E

A

-Infection (fever/sore throat)
-Hyperglycemia
-Bone loss
-Muscle weakness
-Peptic Ulcer Disease (PUD)
-Hypokalemia
-Weight gain
-Insomnia

135
Q

Mannitol Supplies

A

-Continuous IV infusion
-Syringe
-Filter needle
-IV filter tubing
-Alcohol wipes
-Potassium supplements (hypokalemia)

136
Q

Jehovah’s Witness Culture

A

-No blood transfusions
-Avoid foods having or preparing with blood
-Burial or cremation
-Epoetin Alfa: growth factor for anemic pts or to increase erythrocyte counts in clients who will undergo elective surgery (appropriate)
-Allowed to use albumin, growth factors, immunoglobulins, and clotting factors

137
Q

Duodenal Ulcer w/ Status Asthmaticus Wrong Med

A

-Prednisone (increase incident of peptic ulcers)
-Naproxen (gastric irritation)

138
Q

Corticosteroids A/E

A

-Susceptibility to infection
-Truncal obesity (Cushing’s)
-Osteoporosis

139
Q

Digoxin Education

A

-Slows heart rate
-Contact HCP if experiencing visual changes
-Digoxin level test @ beginning of drug therapy
-Takes 1-2 wks to work
-Monitor levels routinely
-Contact if experiencing excessive nausea (toxicity)

140
Q

Glaucoma (Meds to Avoid)

A

-Scopolamine ( ACh effects)
-Diphenhydramine (ACh effects)
-Methylphenidate (ACh effects)
-All cause blurry vision + dilated pupils

141
Q

PCA (Morphine sulfate) interaction

A

-Decreased respiration (Respiratory depression)
-Decreased SpO2
-Excessive sedation
-Shallow respirations

142
Q

Warfarin Education

A

-Concurrent use of glucocorticoids should be avoided (increase anticoagulant effect)
-Oral contraceptives will decrease anticoagulant effects
-Intake of Vit K should be monitored

143
Q

DKA expected S/S

A

-Decreased serum pH (<7.35)
-Kussmaul breathing
-Fruity breath
-Increased serum potassium (>5.3)

144
Q

Older Adult Fluid Imbalance

A

-Oliguria (decreased urine production)
-Sunken eyes
-Capillary refill > 5 sec
-Tenting of skin over sternum, collar bone, forehead

145
Q

Methotrexate Education

A

-Monitor CBC (decrease WBC, liver functions, and kidney functions)
-Check for infection (sore throat)
-Monitor temperature (fever)
-Hepatotoxicity (jaundice)
-GI ulcers (toxicity)

146
Q

Allopurinol

A

-For chronic gout/gout attacks
-Complications: hypersensitivity, kidney injury, hepatitis, GI distress, increase in gout attacks
-Slows metabolism of warfarin (bleeding)
-Take w/ food or after meals (decrease GI upset)
-Avoid alcohol + high purine foods
-Drink 2-3 L of fluids/day (prevent kidney injurt)

147
Q

Antilipemic Agents

A

-Lower LDL cholesterol levels/triglycerides + raise HDL cholesterol levels
-Prevent coronary events (CAD) + strokes
-Include lifestyle modifications
-Check cholesterol, liver, and kidney function levels
-Complications: Hepatotoxicity + myopathy
-Avoid alcohol
-Take w/ low-fat, low-cholesterol diet & regular exercise

148
Q

Statins

A

-Rosuvastatin/Lovastatin/Atorvastatin (-statin)
-Check baseline cholesterol levels + CK levels
-Report anorexia, GI upset, jaundice, muscle pain
-NOT for pregnant people
-DON’T take Fibrates
-Administer in evening

149
Q

Cholesterol Absorption Inhibitor

A

-Ezetimibe
-Report liver + muscle issues
-NO bile acid sequestrants/statins/fibrates
-Administer 1 hr before/after bile sequestrants

150
Q

Bile-Acid Sequestrants

A

-Colestipol/Colesevelam
-Complications: Constipation, bowel obstruction, pancreatitis
-Decrease oral contraceptive effect
-Administer 1 hr before or after meds that interact w/ them
-Increase fiber + fluids
-Administer vitamin supplements

151
Q

Fibrates

A

-Gemfibrozil/Fenofibrate
-Complications: GI upset, Gallstones, Myopathy, Hepatotoxicity
-Report RUQ pain, fat intolerance, bloating
-NO warfarin + statins
-Take 30 min before breakfast + dinner
-Monitor for biliary disease

152
Q

Nicotinic Acid

A

-Niacin
-Monitor BUN + creatinine
-Advise to take aspirin 30 min before/dose

153
Q

Gingko Biloba

A

-Mild GI upset, HA, lightheadedness, caution w/ seizure pt
-Lower seizure threshold
-Interfere w/ coagulation (risk of bleeding)

154
Q

St. John’s Wort

A

-Dry mouth, constipation, GI upset, skin rash (sun-exposure)
-Decrease contraceptive, warfarin, digoxin, CCB, steroids, HIV, cancer drug effects
-Risk for bleeding

155
Q

Ginseng

A

-Nervousness, agitation, insomnia, diarrhea, HA, heart palpitation
-No MAOIs
-Interrupt heart med effects
-Risk of bleeding (anticoagulants)

156
Q

Garlic

A

-GI upset
-Risk for bleeding
-Hypoglycemic effect

157
Q

Echinacea

A

-Bitter taste, mild GI upset, fever
-Chronic use decreases TB drug effects
-Risk of bleeding

158
Q

Saw Palmetto

A

-Mild GI upset + interrupt detection for cancer marker
-Additive effects w/ finasteride

159
Q

Kava Kava

A

-Dry flaky skin, jaundice, liver damage
-Sedation when taken w/ CNS depressants

160
Q

Black Cohosh

A

-GI upset, lightheadedness, rash, weight gain
-Increase antihypertensive drug effects
-Hypoglycemia

161
Q

Valerian

A

-Drowsiness, lightheadedness, depression, risk of physical dependence
-CNS depression

162
Q

Feverfew

A

-Agitation, tiredness, insomnia, HA, joint discomfort
-Risk of bleeding (NSAID, heparin, warfarin)

163
Q

Ganciclovir

A

-Treat + prevent cytomegalovirus (CMV), HIV/AIDS, organ transplant, immunocompromised
-DON’T give pregnant pt
-Obtain CBC + PLT (suppress bone marrow)
-Administer w/ food (N/D)
-Administer IV slowly
-Increase fluid intake

164
Q

Near Miss Medication Error

A

-Must file an incident report
-Notify HCP of all errors
-Implement corrective measures ASAP

165
Q

Oxybutynin A/E

A

-ACh effects: constipation, dry mouth, blurred vision, photophobia, dry eyes, tachycardia, anhydrosis
-Anhydrosis: decrease ability to produce sweat to cool body => avoid activities that cause overheating (hyperthermia)

166
Q

Neonatal Abstinence Syndrome S/E

A

-Maternal substance use during pregnancy consist of use of alcohol/drugs
-CNS: high-pitched cry, hyperactivity, increased DTR, convulsions, tremors
-Metabolic/Resp: nasal congestion w/ flaring, frequent yawning, apnea/tachypnea, high temp
-GI: poor feeding, projectile vomiting, diarrhea, constant sucking

167
Q

Raloxifene Client Teaching

A

-Chemotherapy agent used to treat/prevent breast cancer
-Stop growth of breast cancer cells (estrogen-dependent) => blocks estrogen receptors
-Oral
-Complications: endometrial cancer, hypercalcemia, N/V, thromboembolic events, hot flashes, vaginal discharge/bleeding
-DON’T give to pt taking anticoagulants and SSRIs

168
Q

Digoxin Contraindications

A

-Digoxin slows down AV conduction
-DON’T give to pts w/ ventricular rhythm disturbances (V-fib, V-tach, second- or third-degree heart block), hypokalemic, partial AV block, advanced HF, impaired kidneys

169
Q

Promethazine Client Teaching

A

-Antihistamine (1st gen H1 antagonist)
-Causes sedation, ACh effects, GI discomfort, acute toxicity, seizures, respiratory depression
-Take @ night
-Avoid activities that involve alertness + alcohol/CNS depressants
-Increase fluid intake (2-3 L) + eat w/ meals

170
Q

Metformin Contraindication

A

-Severe infection (WBCs)
-Shock
-Kidney impairment (check creatinine levels)
-Hypoxic condition (O2 saturation)
-Alcohol use disorder

171
Q

Procainamide Action

A

-Antidysrhythmic med
-Sodium Channel Blocker: slows cardiac conduction velocity => delay
-For SVT, V-tach, A-flutter/fib

172
Q

Neostigmine A/E

A

-For Parkinson’s + MG
-REVERSABLE
-Cholinergic crisis: excessive stimulation, resp. depression, paralysis
-Excessive muscarinic stimulation: increased GI motility/secretions, diaphoresis, increased salivation, bradycardia, urinary urgency

173
Q

Exenatide

A

-Antidiabetic med (supplemental glucose control)
-For Type 2 DM
-SQ (thigh, abd, upper arm)
-Complications: GI upset + pancreatitis

174
Q

Levodopa/Carbidopa A/E

A

-N/V/Drowsiness
-Dyskinesias (antidote: amantadine)
-Orthostatic HyPOtension
-Psychosis (clozapine)
-Sweat/urine discoloration (harmless)
-Activation of malignant melanoma

175
Q

Hydromorphone Toxicity

A

-Antidote: naloxone (opioid antagonist)
-Resp. depression, coma, + pinpoint pupils
-Provide mechanical ventilation

176
Q

Epoetin Alfa Effectiveness Labs

A

-H+H (weekly or 2x/week)
-Iron

177
Q

Dextroamphetamine A/E

A

-CNS stimulation (insomnia + overstimulation)
-Mania/aggressiveness
-Dysrhythmias
-Psychosis (hallucinations + paranoia)
-Physical tolerance/withdrawal (TAPER OFF)
-Toxicity (dizziness, palpations, HTN, seizures)

178
Q

Zidovudine Client Teaching

A

-Antiretroviral med (HIV)
-Cause suppressed bone marrow (neutropenia) + liver disease

179
Q

Pregabalin Contraindication

A

-Benzodiazepines
-Alcohol
-Opioids
-Intensify depressive effects (AVOID)
-Avoid activities that require alertness

180
Q

Meperidine Priority

A

-Opioid: resp. depression, sedation
-Check ABCs
-Report if RR <12/min (WITHHOLD + Notify HCP)
-Administer SLOWLY
-Double-check dosage w/ another nurse

181
Q

Isoflurane (General Anesthesia) Priority

A
  • Check ABCs (sedation + anesthetic effects)
    -HyPOtension can occur (lower HOB, administer IV fluid + monitor BP)
    -Encourage pt to urinate BEFORE administering
    -Bed is in low position
182
Q

Unsafe Abx for Preschooler

A

-Tetracycline: yellow/brown tooth discoloration + hypoplasia of enamel
-Avoid giving to children < 8yrs + pregnant pt

183
Q

Hydrochlorothiazide A/E

A

-Hyperglycemia (monitor BG)
-Dehydration/HyPOnatremia
-HyPOkalemia
-Hyperuricemia
-HyPOmagnesemia

184
Q

Self-Administering Enoxaparin

A

-Self inject SQ @ 45-90 degrees
-20G or 22G needle
-2 inches from umbilicus
-DON’T aspirate

185
Q

Atenolol A/E

A

-BB 1 (ONLY HEART)
-Orthostatic HyPOtension (sit/lie down + change positions slowly)
-Lightheadedness
-Bradycardia
-AV Block

186
Q

Atenolol Assessments Prior

A

-Monitor pulse (< 50/min = HOLD + notify)
-Check BG (hypoglycemia)
-Monitor BP (orthostatic hyPOtension)

187
Q

Oxytocin A/E

A

-Uterine tachysystole: more intense, longer, and more frequent contractions
-Uterine rupture: rupture/tear of uterus + internal bleeding
-Abruptio placentae: displacement of the placenta that causes sharp pain, vaginal bleeding

188
Q

Mannitol Complications

A

-Rebound ICP
-F+E imbalances (hypovolemia + hyper/hyponatremia)

189
Q

Acute Respiratory Failure (ARF)

A

-Occurs when one of the gas exchange functions FAIL => inadequate gas exchange
-Acid-base imbalance (uncompensated resp. acidosis) -Ventilation-perfusion mismatch
-Hypoxemic vs. Hypercapnic
-V/S: decreased O2 Sat, increased RR
-Symptoms: lethargic

190
Q

Hypoxemic vs. Hypercapnic

A

ATI NCLEX Review (1 decks)

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