Kaplan QBank 2 Flashcards
Why is it important for a pt on Chlorpromazine to brush their teeth 3x/day?
How long will it take for the meds to work?
What else is important to monitor / teach these pts (2)
Dry mouth is an adverse effect of the drug and so it is good to maintain oral hygiene
6 weeks
- Orthostatic Hypotension (change positions slowly)
- Leukopenia is a risk so the first 3 months they need lab work
Why does a newborn with hypothermia need to be rewarmed gradually?
To prevent apneic spells and acidosis
What type of blood transfusion reaction is one of the most dangerous?
Hemolytic reaction (chest, flank, abd and low back pain are s/s).
Also: hematuria, skin slushing, tachycada, tachypnea, hypotension, DIC–> shock/death
What is the tx for a hemolytic transfusion reaction?
Stop transfusion
Obtain urine spec
Maintian blood volume and renal perfusion with IV colloid solution
Tx for circulatory overload from blood transfusion reaction?
- Stop
- Position pt upright
- administer O2
What type of anti-hyptertensive med is contraindicated in pregnancy?
ACE-i
How should ACE-i be administered?
Empty stomach
_____ is a s/s of autonomic dysreflexia in a pt with a high-level SCI
headache
What is sensorineural hearing loss?
When a pt hears sound in the other ear when it is meant to be heard in the opposite ear. This can be seen in a Weber test with a vibrating tuning fork.
If you walk into a pt room and their NEWLY placed trach tube is displaced from their stoma, what action should the nurse take FIRST?
Open the airway using a hemostat to dilate the opening of the stoma.
A newly placed trach will not stay open without the tube because some swelling is expected due to the recent surgical procedure.
What is the target A1C for pts diagnosed with T2DM?
less than 7%
What are nml findings in the first 10 hrs PP?
- Elevated WBC (20,000-25,000 d/t inflammatory process)
- Elevated neutrophis
- Elevated temp to 100.4F d/t inflammation and dehydration
What s/s in a pt with bulemia would mean that they need immediate referral to HCP?
“hoarse voice that is barely audible”
Hight risk for tracheoesophageal fistula from esophageal tear
Laryngitis is a later sign
What is a special consideration when hanging IV nitroprusside?
It needs to be protected from light and should be shaded using aluminum foil or a dark bag cover
Light sensitive IV solitions (3)
Nitroprusside
Amphotericin B
Nitrogylcerin
Should alcohol be avoided completely in pts with HTN?
No – reduce alcohol consumption to: 2/day for men; 1/day for women
What dietary restirction should be advised in pts with respiratory failure?
Carbs
metabolism of carbs increases CO2 production
Fistula definition
abnormal passage between organs or between a hollow organ and skin. (Ex: fistula between vagina and rectum that might leak fluids or pus)
Diet for liver chirrhosis
Increased calories
Decrease fat
Increase carbs
Decrease sodium (d/t ascites)
Decrease fluids (d/t ascites)
PVCs indicate ______ electrolyte imbalance.
What can this lead to?
Hypokalemia
VT
What type of drinking device should infants avoid and why?
Avoid no-spill cups that require sucking because it doesn’t teach them how to drink from a cup and it allows juice and milk to be in constant contact with teeth increasing cavity risk
At what age can strained, purred or mashed meats be introduced?
10-12 m
What diseases can lead to hypocalcemia?
AKI - polyuric phase b/c calcium is excreted at a higher than normal rate
Acute pancreatitis
Thyroidectomy
s/s EARLY lithium tox
Nausea
Slurred speech
Fine hand tremors
Msk weakness
______ bili at 72 hrs of age and phototherapy is considered
15mg/dl or greater
______ bili at 72 hrs of age and phototherapy is considered
15mg/dl or greater
What is the process for a PET scan?
Radioisotope given, then pt waits 30-45 min so the substance can circulate to the brain, then the scan is performed.
2 hr procedure
Lower extremity numbness and weakness are symptoms of ______ which is common in kidney failure
Hypokalemia
What is Buerger disease?
Age/sex?
Cause?
S/s?
What should the nurse encourage?
Blood vessels swell, preventing blood flow –> clots –> pain, tissue damage, gangrene.
Mostly males 20-40 yrs
Causes: tobacco
S/S:
- paresthesia
- Instep claudication
- absent pedal pulses
Encourage:
- Smoking cessation
- walk 30 min a day
- protect extremities from the cold
Tdap ages
2, 4, 6, 18 m
4-6 yrs
Who is responsible for explaining details of the surgery to a pt and answering questions related to the surgery? What about pt questions about anesthesia?
Surgeon
Anesthesia
What is impetigo?
Where is it usually found?
What does it look like?
What is a complication of this?
Tx?
Highly contagious skin infection (mostly in young children)
face, mouth, nares
Macules progressing to vesicles, erosions and then honey-colored crusts
Glomerulonephritis / cellulitis
Topical antibiotics
Oral antibiotics
Position of pt for enema?
Temp of solution
How far to insert tube?
Contraindications for enema? (3)
Left side
tepid
No more than 4 inches
Cardiac disease
Rectal prolapse
Prostate surgery
How fast is the lispro onset?
10-15 min
What is a safety risk with polypharmacy?
Medication and food interaction
IVIG expected adverse effect? (5)
HA
Fever and chills
Joint pains
Fatigue
Skin rash
When does glomerulonephritis occur?
10 days after a skin or throat infection (strep)
What is the nursing care for glomerulonephritis?
Diet?
Bed rest?
ABX
Corticosteroids
anti-HTN (b/c pt gets HTN)
Restrict Na+
Restrict H2O
Restrict high potassium foods
Bed rest
Tx / Nursing considerations for myexedema coma?
Maintain airway
Administer:
- Thyroid replacement
- Corticosteroids
- Glucose meds
Diet for hypothyroidism?
High protein
Low calories
Increased fluids
Meds for Hyperthyroidism?
Methimazole
Saturated solution of potassium iodine (SSKI)
Beta blockers
Radioactive iodine
s/s addisonian (Adrenal) crisis:
Hypotension
Cyanosis
Fever
Classic shock symptoms
HA
Abd pain
Nausea / diarhea
CONFUSION
What VS change should you watch for in a pt frequently getting Haldol?
BP (hypotension)
Changes in communication is seen in right or left sided hemiparesis?
Right
2 main s/s of peritonitis?
Abd pain
Cloudy peritoneal effluent
Nml BP newborn
80/45
60/40
Why is giving a narcotic like morphine contraindicated in pts with suspected subdural hematomas?
Because it can mask the s/s of IICP
Why is aspirin avoiding in the later stages of pregnancy?
increases the risk of intracranial bleeding for the fetus
Pulmonary symptoms are seen in pts with left or right sided HF?
Left
What should the position of a pt with a severe head injury be in bed?
HOB 30
Head midline
What is the purpose of moist to dry dressing changes?
Mechanical debridement (used with NECTROTIC wounds only)
The dressing should be moist when packed and dry when removed
Jaundice in the first 24 hrs after birth is caused by? (3)
Hemolytic disease
Sepsis
GDM / maternal infection
A pt with an ileostomy is at an increase risk of what two thing?
FVD
Ortho Hypo
What are 3 symptoms that are INITIALLY seen in pts with subdural hematomas?
Decreased LOC
Ipsilateral pupil dilation
HA
______ is a priority for any pt with a vaso-occlusive crisis
Hydration
Fluids help to “unblock” areas where cells have grouped together, preventing perfusion. After rehydration oxygenation is helpful.
Meds that most often lead to C Diff
Clindamycin
PCN
Cephs
Floroquinolines (Ciprofloxacin, Levofloxacin)
What type of common pain meds should NOT be given to pts with Hem A? What CAN you give?
NSAIDS (ex: Naproxen)
ASA
CAN give: Acetaminophen
Heartburn that radiates to the jaw is a s/s of ________
MI
______ is a proven risk factor associated with osteoarthritis. Why?
Smoking
Causes cartilage loss
When does the newborn anterior fontonelle close?
7-18 m
When engorgement occurs, should BF be increased or stay the same frequency?
Increase every 1.5-2 hrs
What is the initial presentation of Hodgkin’s lymphona?
enlarged single, firm, painless, moveable lymph node (usually in the cervical area)
- night sweats
- weight loss
- fatigue
- puritis
The presence of ______ in the stomach increases the risk for gastric cancer.
H. Pylori –> PUD
A Braden scale of ____ or less indicates an at risk status
18 or less
Steps for lowering high K+ in CKD pts
- IV Calcium Gluconate (tx for dysrrhythmias ONLY)
- IV 50% Dex and Reg Insulin
- Kayexalate (polystyrene sulfonate)
- Dialysis
NSAIDS or Acetaminophen leads to Kidney injury?
NSAIDS
In pts with CKD, what meds should be avoided?
NSAIDS
Milk of Mag (Antacid)
ABX: Vancomycin, Gentamicin
CT contrast dye
Diet for CKD
Low Phosphorous (AVOID: yogurt, puddings, milk)
Low Na+
Low K+ (Apples are a low potassium fruit!)
Low protein (less workload on the kidneys)
All kidney disease pts should be LOW protein diet, EXCEPT….
Nephrotic syndrome
PT normal
9.5 - 12
Normal BUN
What would an elevated BUN indicate?
10-20
Decreased renal perfusion
S/s cataracts (3)
Blurred vision
Photosensitivity
Halos around lights
S/s macular degeneration (3)
Blurred vision
Blindness
Reduced central vision
S/s open angle glaucoma (3)
blurred vision
Tunnel vision
Blindness
After a cataract surgery, pts shouldn’t lift more than ___ lbs.
What should their pain level immedicately post op be?
15
Minimal pain, severe pain should be reported
Which cranial nerve should be tested first in a pt with difficulty seeing?
CN II
In newborns, is there a decrease in PVR or increase and why?
Decrease
Blood –> lungs, closing the fetal shunts –> increases blood flow to the pulmonary vessels –> decreased PVR
Pt is 6 w pregnant and has LLQ pain and vaginal spotting, what do you suspect?
Ectopic pregnancy –> death if not addressed
In the active phase of labor, how long are ctx?
40 - 60 seconds
When in labor are copious amounts of bloody show seen?
Transition phase
At what age should a baby have a social smile?
2 m
MRSA= ______ precautions
contact
S/s of morphine withdrawal (3)
Diarrhea
HTN (rebound HTN from hypotension that occurs with morphine)
Emesis
The nurse reviews medications prescribed for a client recovering from surgery. Which prescription causes the nurse the most concern?
1. Diphenhydramine 50 mg PO at bedtime, as needed. 2. Furosemide 40 mg IV q.d. 3. Morphine sulfate 2 mg IV every hour, as needed, for pain. 4. Oxygen at 2 L/min via nasal cannula.
Furosemide
The Institute for Safe Medication Practices reports that the abbreviation “q.d.” can be mistaken for q.i.d., especially if the period after the “q” or the tail of the “q” is misunderstood as an “I”; therefore, they recommend that the word “daily” be used instead. For example, furosemide 40 mg IV daily.
An adolescent client is brought to the hospital with a head injury requiring emergency surgery. The client’s parents are out of the country. The client is staying with the paternal grandparents. The nurse identifies which source as legal consent for surgery?
1. The parents by phone. 2. The attending surgeon. 3. The paternal grandparents. 4. The hospital lawyer.
- Any grandparent can give consent for a minor grandchild in an emergency, if the parents are not present.
How far away from the umbilicus should SQ injections be give?
at least 2 inches
The nurse provides care for a newborn who is recovering from necrotizing enterocolitis (NEC). Which intervention does the nurse include in the newborn’s plan of care?
1. Feed the newborn fresh breast milk. 2. Use droplet transmission precautions. 3. Assess rectal temperature frequently. 4. Place the newborn in a prone position.
- The use of fresh breast milk is the preference for the newborn who is recovering from NEC. It is the preferred enteral nutrient because it confers some passive immunity (IgA), macrophages, and lysozymes. Also, breast milk is more easily digested than formula.
The nurse provides care to clients on a progressive care unit. Which client does the nurse see first?
1. The client with abdominal incision dehiscence and foul-odor to the wound. 2. The client with a new tracheostomy with a speaking valve caused by respiratory arrest after a heroin overdose. 3. The client with a blood pressure of 86/44 mm Hg receiving intravenous antibiotics for urosepsis. 4. The client with a blood glucose of 215 mg/dL receiving treatment for diabetic ketoacidosis.
- The client with urosepsis has low blood pressure, which could indicate poor organ perfusion. This client should be seen first by the nurse.
The nurse provides care to clients on a progressive care unit. Which client does the nurse see first?
1. The client with abdominal incision dehiscence and foul-odor to the wound. 2. The client with a new tracheostomy with a speaking valve caused by respiratory arrest after a heroin overdose. 3. The client with a blood pressure of 86/44 mm Hg receiving intravenous antibiotics for urosepsis. 4. The client with a blood glucose of 215 mg/dL receiving treatment for diabetic ketoacidosis.
- The client with urosepsis has low blood pressure, which could indicate poor organ perfusion. This client should be seen first by the nurse.
What should the head of a pt be for decreasing aspiration risk?
Raised 60-90 degrees and tilt slightly forward
The nurse provides care for a client diagnosed with anemia caused by chronic kidney disease. The nurse teaches the client about epoetin therapy. Which statement by the client indicates that teaching was effective?
1. "I will regularly monitor my blood pressure." 2. "I will shake the medication before administration." 3. "I will avoid taking iron supplements." 4. "I will avoid drinking orange juice or eating citrus fruits."
- Most clients with chronic kidney disease have hypertension. Blood pressure may further rise with epoetin, especially when hemoglobin rises in the early part of therapy. Therefore it is important for the client to regularly monitor blood pressure.
What type of BP do pts with CKD typically have?
HTN
The nurse provides care to a client with a tracheostomy. Which nursing action performed before the client eats poses a risk to the client?
1. Deflate the tracheostomy cuff. 2. Provide thin liquids. 3. Suction the tracheostomy. 4. Raise the head of the bed.
Correct = 2
1) Deflating the tracheostomy cuff prior to giving the client solid food makes it easier to swallow.
2) CORRECT — The client is given thickened, rather than thin, liquids to reduce the risk of aspiration.
NML red blood cell count
4.4 x 106 cells/uL
The nurse manager creates a discharge teaching form for clients with acquired immunodeficiency syndrome (AIDS). Which statement will the manager include on this form? (Select all that apply.)
1. Avoid children who have just gotten a live vaccine. 2. A condom is necessary during sexual activity. 3. Contact sports, such as football, must be avoided. 4. Drug paraphernalia must not be shared with others. 5. Sexual activity must be restricted to a single partner.
1, 2, 4
1) CORRECT — The client with AIDS is immunocompromised. Children who have just received a live vaccine and children who have not been vaccinated pose a risk.
2) CORRECT — The use of a barrier method during sexual activity is the only way to prevent transmission of the virus to the partner.
3) Avoiding contact sports is unnecessary unless the specific type of sport causes frequent bleeding injuries. If the client feels well enough to participate, engaging in sports may also increase social interaction and well-being.
4) CORRECT — Drug paraphernalia such as needles, syringes, and straws can transfer the virus that causes AIDS to people who share these devices with infected individuals.
5) It is advisable to restrict partners, but the use of condoms during sexual activity is the primary way to prevent transmission to others and the acquisition of an additional sexually transmitted infection.
The nurse provides pain management teaching to an older adult client diagnosed with osteoarthritis (OA). Which medication does the nurse discuss as the initial treatment of choice for OA pain?
1. Morphine. 2. Acetaminophen. 3. Ibuprofen. 4. Cyclobenzaprine.
- Acetaminophen first, if that doesn’t work, NSAIDs
What are two complications from a CVAD insertion?
Air embolism
Pneumothorax
While assessing an adolescent for a sore throat and fatigue, the nurse notes multiple wounds in different levels of healing on both of the client’s arms. Which action will the nurse take first?
1. Inquire as to how the wounds occurred. 2. Ask about a history of sexual abuse. 3. Assess the wounds for healing and signs of infection. 4. Report the findings to the nursing supervisor.
- CORRECT — Physiological needs are a priority. The wounds need to be assessed for signs of infection and evidence of healing.
The adult children of a client recovering from stem cell transplantation bring a bag of home-prepared food for the client, including a salad with toppings. Which statement does the nurse make before the family enters the client’s room?
1. “I’m sure this food from home is going make the client feel better.” 2. “There’s nothing like a fresh salad to help with vitamins and minerals!” 3. “I know your parent likes blue cheese, but it cannot be eaten at this time.” 4. “Be sure all fresh vegetables are washed before taking them into your parent’s room.”
3) CORRECT – No blue cheese may be brought into a protective isolation room because it may harbor bacteria and fungi.
4) No fresh raw fruit or vegetables, regardless of when they were washed, may be brought into a protective isolation room because they may harbor bacteria and fungi.
The nurse provides care for a client who is experiencing withdrawal from long-term alcohol use. The nurse prepares to administer medications to the client. Which medication does the nurse administer first?
1. Atenolol. 2. Chlordiazepoxide. 3. Fluoxetine. 4. Disulfiram.
- The client who has acute alcohol withdrawal is at greatest risk for seizures; therefore, the first medication the nurse should give is chlordiazepoxide to prevent seizures, brain injury, and delirium tremors.
*** Long acting type of Benzo
Apneic periods <________ seconds are a normal finding for a newborn.
< 20
The parent of a school-age child diagnosed with type 1 diabetes mellitus reports that the child has been sick and has ketones in the urine. Which instruction will the nurse provide to the parent?
1. Hold the next dose of insulin. 2. Administer an additional dose of regular insulin. 3. Encourage the child to drink calorie-free liquids. 4. Seek medical attention for additional assessment and treatment.
- If ketones are present, liquids are needed to aid in clearing them from the kidneys. No-calorie liquids should be encouraged to resolve the problem.
The nurse cares a client who is prescribed digoxin. Which lab finding does the nurse identify as putting the client at risk for digitalis toxicity?
1. Creatinine level of 7 mg/dL (238.6 umol/L). 2. Serum potassium level of 8 mEq/L (3.8 mmol/L). 3. Serum calcium level of 8.5 mg/dL (1.2 mmol/L). 4. Cholesterol level of 240 mg/dL (6.2 mmol/L).
1) CORRECT — Seventy percent of digoxin is excreted via the kidney. An elevated creatinine level increases the client’s risk for digitalis toxicity. The normal range for serum creatinine is 0.6 to 1.3 mg/dL (53 to 115 umol/L).
2) An elevated serum potassium level (as noted here) is not at risk for digitalis toxicity. The normal range for serum potassium is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). The client experiencing hypokalemia, not hyperkalemia, is at increased risk for digitalis toxicity.
Hyper or hypokalemia places a pt at risk for digoxin toxicity?
Hypokalemia
The nurse assesses the coping skills of a client receiving chemotherapy after a mastectomy for breast cancer. Which client statement indicates effective coping?
1. "I am glad the nausea and vomiting are subsiding." 2. "I do not need as much pain medication as was prescribed." 3. "I made an appointment to get fitted for prosthesis." 4. "I will begin the next round of chemotherapy next week."
- Making an appointment for a prosthesis is planning for the future. When a person is under stress and believes something can be done about the problem, the person is using problem-focused coping. People facing life-changing experiences need to maintain hope. Hope is the anticipation of a continued good or an improvement or the lessening of something unpleasant. Hope energizes and comforts people as they face personal challenges, and it enhances their coping skills.
The nurse teaches a parent measures to reduce her school-age client’s fever. Which information does the nurse include?
1. Sponge the skin with cold water. 2. Give aspirin for a fever of 100.4° F (38° C) or higher. 3. Cover with warm blankets. 4. Apply clothing lightly.
1) Tepid water should be used to prevent shivering
2) Aspirin and aspirin-containing products are not recommended for a child under 19 years of age with a fever because of a possible risk for Reye syndrome.
3) Warm blankets should be avoided with a fever. Evaporative heat loss is needed.
4) CORRECT - Clothing should be applied lightly to allow for evaporative heat loss.
Upon arriving to the operating room suite, a client tells the nurse that no one provided a paper for the client to sign that gives permission to complete the surgery. Which action will the nurse take first?
1. Explain the surgical procedure to the client. 2. Ask the client to sign the consent form now. 3. Determine if preoperative medications were given to the client. 4. Notify the health care provider that a consent form has not been signed.
3) CORRECT – Before taking any action, the nurse needs to learn if the client has received preoperative medications that would affect the client’s decision-making ability.
4) Notifying the health care provider would occur after determining if the client has already received preoperative medications.
