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KLIMEK Flashcards

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1
Q

How is bleeding of abruptio placentae different from that in Placenta Previa?

A

Usually with pain in AP but not in PP, bleeding more voluminous in PP (the one that bleeds more has less pain; the one that bleeds less has more pain).

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2
Q

How often should the nurse check vital signs for unstable patients?

A

Q 15 minutes

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3
Q

How is an infant delivered when abruptio placentae is present?

A

C-section

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4
Q

Higher or lower risk incidence of fetal death with abruptio placentae compared with placenta previa?

A

Higher

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5
Q

Name the 5 criteria that are recorded on an APGAR scale?

A 
Cardiac status
Respiratory effort
Muscle tone
Neuromuscular Irritability (reflexes)
Color
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6
Q

On heart rate or cardiac status in APGAR, a 2 means that the HR is above …?

A

100 bmp

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7
Q

A high APGAR score of 2 is given for the respiratory effort if the newborn…?

A

Cries vigorously

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8
Q

To get an APGAR score of 1 for muscle tone, the newborn must place their extremities in…?

A

flexion

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9
Q

To get an APGAR score of 2 on neuromuscular reflex irritability the infant must…?

A

Cry

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10
Q

To score an APGAR of 2 on color the infant must look…?

A

Totally pink

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11
Q

Can you use cotton balls/washcloth to clean the eyes, nares or ears of an infant?

A

No, this is dangerous.

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12
Q

What is the #1 purpose of a tepid sponge bath?

A

Lower body temperature during fever

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13
Q

What body part do you begin bathing an infant?

A

eyes

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14
Q

Should you retract the foreskin of a 5-week-old male, uncircumcised infant to cleanse the area?

A

No, not until foreskin retracts naturally and without resistance- then it should be retracted, cleansed, and replaced.

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15
Q

T/F, you may use friction to remove vernix caseosa from an infants skin?

A

F, it causes bruising.

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16
Q

How many minutes should an infant breastfeed per side?

A

20 minutes

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17
Q

What side should breastfeeding begin?

A

Begin nursing on the side the baby finished last feeding.

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18
Q

How long can breastmilk be refrigerated?

A

24 hours

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19
Q

How long can breastmilk be frozen?

A

6 months

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20
Q

Which two nutrients is breastmilk lower in?

A

Fluoride and iron

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21
Q

Can a woman breastfeed on oral contraceptive?

A

Should not use OC during first 6 weeks after birth because the hormones may decrease milk supply. Estrogen is not recommended. Non-hormonal methods are recommended. Remember breastfeeding is unreliable contraceptive.

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22
Q

The infant fears what most when hospitalized?

A

Separation from love object

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23
Q

The toddler fears most what when hospitalized?

A

Separation from family

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24
Q

The toddler and preschooler will think that illness is caused by…?

A

Something they did wrong

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25
Q

Three types of ventilator obstruction and action?

A
  1. kinked tubing- unkink
  2. H2O in tubing- empty the H2O.
  3. Mucous- T(Turn)C(cough)DB(deep breathing)
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26
Q

what is psychosis induced by vitamin B1 (Thiamine) deficiency?

A

Wernicke’s Syndrome

Primary symptom: amnesia with confabulation.

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27
Q

Aversion therapy for alcohol dependancy?

A

Disulfiram/Naltrexone

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28
Q

Category A Bioterrorism agents (STAPHB)

A 
Small Pox
Tularemia
Anthrax
Plague
Hemorrhagic Fever
Botulism
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29
Q

what is xerostomia?

A

dry mouth

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30
Q

P Wave always refers to?

A

Atrial

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31
Q

QRS depolarizations always refers to?

A

Ventricular

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32
Q

In a pneumothorax, the chest tube removes…?

A

air

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33
Q

in a hemothorax, the chest tube reomves…?

A

blood

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34
Q

In a pneumohemothorax, the chest tube removes …?

A

air and blood

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35
Q

How many chest tubes (and where) for unilateral pneumothorax?

A

one, apical

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36
Q

How many chest tubes (and where) for bilateral pneumothorax?

A

2, apical

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37
Q

How many chest tubes (and where) for post-op chest surgery?

A

two, apical and basilar on operated side.

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38
Q

Rule of B’s related to ABG interpretations

A

If the pH and the Bicarb are Both in the same direction then it is metaBolic

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39
Q

Acid-Base Signs and Symptoms memorization

A

As the pH goes, so goes my patient. Except for potassium.

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40
Q

Causes of Acid Base imbalance

A

First ask yourself, “is it lung?”
If yes, then it is respiratory

Then ask yourself “Are they over or under ventilating”
If over- alkalosis
If under- acidosis

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41
Q

What symptom is associated with metabolic alkalosis

A

prolonged vomiting or suction

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42
Q

High pressure alarms in ventilators are caused by…

A

Increased resistance to air flow (obstructions)

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43
Q

What are obstructions in ventilators that cause high pressure alarms?

A

Kinked tubing
H2O in tubing - empty the H2O
Mucous- Turn, Cough, Deep Breathe (must do TCDB before suctioning)

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44
Q

What are low pressure alarms in ventilators caused by?

A

decreased resistance to air flow, can be caused by disconnections of the tubing. Reconnect the tubing. If tube falls on floor, call resp + ambu pt. If tube falls on pt chest, clean + reconnect.

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45
Q

Respiratory Alkalosis means ventilator settings may be too …

A

High (hyperventilation)

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46
Q

Respiratory Alkalosis means ventilator settings may be too…

A

Low (hypoventilation)

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47
Q

How to treat denial

A

Confront it by pointing out to the person the difference between what they say and what they do. In contrast, support the denial of loss and grief.

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48
Q

When the abuser get the significant other to do things for them or make decisions for them.

A

Dependancy

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49
Q

When the significant other derives positive self-esteem from doing things for or making decisions for the abuser.

A

Codependency

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50
Q

Psychosis induced by Vitamin B1 (Thiamine) deficiency.

A

Wernicke’s Syndrome

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51
Q

Primary symptoms of Wernicke’s Syndrome

A

Amnesia with confabulation (making up stories that client believes)

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52
Q

Is Wernicke’s Syndrome reversabile?

A

No

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53
Q

Things to know about Disulfiram and Naltrexone

A

Aversion therapy to alcohol
Onset and duration- 2 weeks
Avoid all forms of alcohol such as vanilla extract, insect repellants, aftershaves, perfumes, vinaigrettes.

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54
Q

Things to know about Delirium Tremens

A 
Patients with DT's are dangerous to themselves and others. 
NPO
Take Thiamine or multivitamin
Bed rest or activity restriction
Antihypertensives and antidepressants
Restraints, 2pt leather
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55
Q

Aminoglycosides treat …

A

mean ol infections

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56
Q

Aminoglycoside Toxicity effects

A

Ototoxicity

Nephrotoxicity

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57
Q

Do not give Aminoglycosides PO except in these two cases:

A 
Hepatic Encephalopathy (liver coma)
Pre-op bowel surgery

Aminoglycosides act as a bowel sterilizer.

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58
Q

Things to know about smallpox:

A

Airborne precautions

Dies from septicemia, no treatment

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59
Q

Things to know about Anthrax

A

Looks like resp flu
Dies from resp failure
Treat with Cipro, PCN, and Streptomycin

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60
Q

Three H’s of the Plague

A

Hemoptysis
Hematemesis
Hematochezia

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61
Q

3 major symptoms of Botulism

A

Descending paralysis
Fever
Alertness

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62
Q

Sarin- Nerve Agent, what is 2B’s and SLUDGE?

A 
Bronchoconstriction
Bronchorrhea- massive amounts of sputum
Salivation
Lacrimation
Urination
Diaphoresis and Diarrhea
GI Upset
Emesis
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63
Q

Calcium Channel Blockers are like…

A

Valium for your heart (calming and relaxing)

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64
Q

How do Calcium Channel Blockers treat?

A

Antihypertensives
Antiangina
Anti Atrial Arrthmial

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65
Q

Ending of Calcium Channel Blockers

A

-zem, -dipine, Isoptin

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66
Q

QRS Depolarization always refers to…

A

Ventricular

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67
Q

P Wave always refers to …

A

Atrial

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68
Q

Be concerned about PVC’s if…?

A

More than 6 per minute
More than 6 in a row
PVC falls on T-wave of previous beat

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69
Q

Treatment for PVC and V Tach

A

Lidocaine & Amidarone

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70
Q

Treatment for Supra-ventricular arrthymias

A

Adenosine - must slam it IV push
Beta Blockers
CCB’s
Digitalis or Digoxin

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71
Q

What do you do if a water seal breaks on a chest tube?

A

First - clamp tube, cut, submerge, unclamp

Best- Submerge end of tube

72
Q

What do you do if a chest tube comes out?

A

First- cover with vaseline gauze, DSD + tape.

Best- vaseline gauze

73
Q

Continuous bubbling in water seal chamber

A

bad- means leak

74
Q

Continuous bubbling in suction control chamber

A

good

75
Q

Intermittent bubbling in water seal chamber

A

good

76
Q

Intermittent bubbling in suction control chamber

A

bad- turn off suction

77
Q

Trouble pneumonic for congenital heart diseases

A

TRouBLe
T- diseases that start with T will be trouble
R->L = shunt right to left
B- blue, cyanotic

78
Q

All CHD kids will have these two things…

A
  1. Murmur

2. At least 1 ecchocardiogram

79
Q

Four defects of Tetralogy of fallot - VardieD PictureS Of A RancH

A

Ventricular Defect
Pulmonary Stenosis
Overriding Aorta
Right Hypertrophy

80
Q

What side do you hold a cane on?

A

Strong side

81
Q

What is a somatic delusion?

A

False, fixed belief about a body part. Ex- x-ray eyes, hollow body, male pregnancy.

82
Q

What is a gustatory hallucination

A

Hallucination of taste

83
Q

Difference between illusions and hallucinations?

A

With illusions there is a referent in reality.

84
Q

Four steps to dealing with clients with functional psychosis? (ex- Schizophrenis, schizoaffective, major depression, and manic phase)

A

Acknowledge feelings
Present reality
Set a limit
Enforce the limit

85
Q

Two steps to dealing with clients who suffer from psychosis of dementia? (Alzheimers, senility, Wernickes. post-stroke psychosis)

A

Acknowledge the feeling
Redirect- take what the client is fixated on, that they are expressing inappropriately and get them to express the fixation appropriately.

86
Q

What is psychotic delirium?

A

This is a temporary, episodic, dramatic, sudden onset loss of reality due to a chemical imbalance.

Acknowledge the feeling and reassure the client.

87
Q

What is flight of ideas?

A

stringing phrases together

88
Q

What is word salad?

A

string words together

89
Q

What are neologisms?

A

making up words

90
Q

What is ideas of reference?

A

When the client believes to be the center of the universe and causes everything.

91
Q

Rule of refrigeration of insulin

A

Refrigeration of unopen insulin is required, optimal after opening.

92
Q

Treatment of low blood sugar in a type 1 diabetic

A

15/15X3

Give 15 gm of glucose
wait 15 minutes, if glucose is under 100…
Give 15 gm more of glucose
wait 15 minutes, if glucose is still under 100…
Give 15 gm more of glucose
If still under 100, call HCP

If unconscious, give glucagon or IV D50

93
Q

1 cause of high blood glucose in type 2 diabetic

A

acute viral upper respiratory infection within the last week.

94
Q

S/S of high blood glucose in type 2 diabetic (DKA)

A

Dehydration
Ketones, kussmal, high K+
Acidosis, acetone (fruity breath), anorexia w/nausea

95
Q

What is high blood sugar in a type 1 diabetic ?

A

HHNK (Hyperosmolar, hyperglycemic, non-ketotic coma)

Treat like dehydration

96
Q

Diabetic A1C target

A

below 7

97
Q

Non-diabetic A1C target

A

below 6

98
Q

Prediabetic A1C

A

6.3-7

99
Q

Bilirubin elevated range

A

10-20

100
Q

Bilirubin toxic level

A

Above 20

101
Q

What is Kernicterus?

A

Bilirubin in CSF, baby dies quickly.

102
Q

What is Opisthotonos

A

Hyperextension seen with Kernicterus. Lie on side.

103
Q

What is a Hiatal Hernia?

A

Regurgitation of acid into esophagus because upper stomach herniates upward through the diaphragm.

Gastric contents move in the wrong direction, at the correct rate.

104
Q

What is dumping syndrome

A

Complication of post-op gastric surgery in which gastric contents dump into the duodenum too quickly.

Gastric contents move in the correct direction at the wrong rate.

105
Q

Treatment of Hiatal Hernia Vs. Dumping syndrome

A

Hiatal Hernia- High fowlers 1 hr after eating, High fluids with meals, High carb
Dumping Syndrome- Low fowlers 1 hr after eating, low fluids with meals, low carbs and high protein

106
Q

Sentence to memorize with Kalemias

A

Kalemias do the same as the prefix, except HR and urine output

107
Q

Sentence to memorize with Calcemias

A

Calcemias do the opposite the prefix, no exceptions. Does anything to BP.

108
Q

Two signs associated with low calcium

A

Chvosteks sign

Trousseaus sign- BP cuff makes clients arm spasm

109
Q

Sentence to memorize with Magnesemias

A

Magnesemias do the same as the prefix & do anything to BP.

110
Q

What is the earliest sign of an electrolyte disorder?

A

Numbness and tingling (parathesia)

111
Q

What is the universal sign of electrolyte imbalance?

A

Muscle weakness

112
Q

Can you push K+ IV?

A

Never, can stop heart and cause death

113
Q

What to do to decrease K+ ?

A 
Give D5 and regular insulin (2 different IV's) 
Sodium Polystyrene (Kayexalate, "K exits Late" Takes a long time to exchange electrolytes and digest out of the body)
114
Q

What is PTU?

A

Propylthyroid uracil- treatment for hyperthyroidism

PutsThyroidUnder

115
Q

Treatment of Addisons Disease?

A

Steroids (glucocorticoids + mineralcorticoids)

116
Q

The proper order in which you apply PPE?

A

Gown
Mask
Goggles
Gloves

117
Q

Proper order in which you remove PPE?

A

Gloves
Goggles
Gown
Mask

118
Q

Synonyms for low WBC

A

Leukopenia
Neutropenia
Agranulocytosis
Immunosuppression

119
Q

Neutropenic Precautions

A 
Strict handwashing
shower with antimicrobial soap
Avoid crowds
Limit number of staff
Limit visitors to healthy adults
No fresh flowers or plants
Low bacteria diet (no raw fruits, veggies or undercooked meats)
Do not drink standing water (more than 15 minutes)
vitals Q4
Check WBC daily
Avoid indwelling catheter use
Use disposable eating utensils
120
Q

Synonym for low platelet count

A

Thrombocytopenia

121
Q

Thrombocytopenic (bleeding) protocol

A 
No unnecessary venipuncture
Injections or IV should use a small gauge catheter
No electric razor
No hard foods
No flossing or toothbrush
Blow nose gently
No rectal temp, enema, or suppository
No aspirin
No contact sports
No walking in care feet
No tight clothes or shoes
Use stool softener, no straining
Notify MD of blood in urine or stool.
122
Q

Reasons for Laminectomy

A

To treat nerve root compression

123
Q

S/S of nerve root compression (3P’s)

A

Pain
Parathesia
Paresis (muscle weakness)

124
Q

Most important assessment of a post-op Cervical Laminectomy

A

U. Extremities + breathing function

125
Q

Most important assessment of a post-op Thoracic Laminectomy

A

couch mechanism + bowel function

126
Q

Most important assessment of a post-op Lumbar Laminectomy

A

bladder + lower extremities

127
Q

1 spinal post-op answer on NCLEX?

A

log roll (move pt w/o moving spine)

128
Q

Specific “activity”/mobilization strategy for spinal post-op

A

do not dangle pt (sit on edge of bed)
No restriction on walking, standing, and lying down
Limit sitting to 30 minutes

129
Q

Post op complication for all spinal surgery types

A

Cervical - Pneumonia
Thoracic - Pneumonia or constipation or paralytic ileus
Lumbar - bladder retention

130
Q

How long is a “restriction?”

A

6 weeks

131
Q

Permanent restrictions for laminectomy clients

A

Lift by bending waist
Cervical laminectomy- lift objects above the head
No horseback riding, off-trail biking, jerky amusement park rides, etc.

132
Q

Nagele’s Rule

A

Take the FIRST day of the LMP
Subtract 3 months
Add 7 days

133
Q

Weight gain during pregnancy

A

Total weight gain= 28 Ibs, +/- 3 Ibs
1st tri- 1 Ib/month
2nd & 3rd tri- 1 Ib/week
*gestation week -9 = ideal weight

134
Q

At what week of pregnancy is the fundus palpable?

A

12

135
Q

What week does the fundus reach the umbilical level?

A

20-22

136
Q

Probable/Presumptive signs of pregnancy

A 
All urine + blood tests
Chadwicks sign (cyanotic cervical color)
Goodells sign (Cervix softens)
Hegars Sign (uterus softens)
137
Q

Pattern of office visits during pregnancy

A

Once a month til week 28
Once every 2 week until week 36
Every week until delivery

138
Q

How to battle morning sickness

A

Dry carbohydrate upon awakening, before leaving bed in the morning
High protein snack before bed

139
Q

what to do with a prolapsed cord during labor?

A

Push head off cord

Position knee-chest or trendelenburg or elevate hips

140
Q

Interventions for all complications of labor and delivery (LIONPIT)?

A 
Left side
IV Increase
Oxygen (mask 8-10L)
Notify HCP
Pitocin Off
141
Q

Fetal Monitoring Patterns

A 
Low Fetal heart rate- LIONPIT
FHR Accelerations- document
Low Baseline Variability (Bad)- LIONPIT
High Baseline Variability- document
Late Decels- LIONPIT
Early Decelerations- document
Variable Decelerations- Very Bad- prolapsed cord intervention
142
Q

Second Stage of Labor and delivery steps

A

Deliver the whole baby
Suction the Mouth then the Nose
Check for cord around the neck
Make sure an ID band is on the baby before it leaves the mothers side.

143
Q

How to know if the fundal height is correct

A

The day of postpartum +/- 1.

144
Q

Tiny white spots on babys face

A

Milia

145
Q

small, white epithelial cysts on babys gums

A

Epsteins Pearls

146
Q

bluish black macules appearing over the buttocks and/or thigh of darker -skinned neonates

A

Mongolian Spots

147
Q

red popular rash on babys torso which is benign and disappears after a few weeks.

A

Erythema Toxicum Neonatorum

148
Q

benign tumor of capillaries in babies

A

Hamangimas

149
Q

swelling caused by bleeding between the osteum and periosteum of the skull. Does not cross suture lines in babies.

A

Cephalohematoma

150
Q

edematous swelling on scalp caused by pressure during birth. this swelling may cross suture lines. usually disappears in a few days.

A

Caput Succedaneum

151
Q

generic term for a birth mark

A

Nevus/Nevi

152
Q

Size of gauge and length of IM needles

A

21G

1.5 in

153
Q

Size of gauge and length of SubQ needles

A

25G

5/8 in

154
Q

If the order read 50 units of 70/30 (Humulin/Novolog),how much N and R would you give?

A

50 x .70= 35N

20 x .30= 15R

155
Q

Facts about Heparin

A 
Works immediately
Given IV and SubQ
Antidote- Protamine Sulfate 
Lab- PTT
Safe for pregnancy
156
Q

Facts about Warfarin

A 
Takes days to work
Only PO
Antidot- Vitamin K
Lab- PT
Not safe for pregnancy
157
Q

K+ sparing diuretics have what ending?

A

-tone

158
Q

K+ wasting diuretics have what ending?

A
  • dine
  • mide
  • zide
159
Q

What is a xenograft?

A

Tissue graft from animal, not a permanent fix.

160
Q

What is a homo & allograft?

A

tissue from other people

161
Q

When does the termination phase in care of psych clients begin?

A

On admission

162
Q

Diet of a client with depression

A

High fiber and fluids

Prepare everything for client

163
Q

Activity of client with depression

A

Group activity w/o interaction

164
Q

Watch for what in the safety of a client with depression?

A

Self-destructive behavior

165
Q

Diet of a client with schizophrenia

A

high fiber and fluids

prepare nothing

166
Q

Activity of client with schizophrenia

A

Group activity with interaction to learn reality. Ex- boardgames, behavior group, cards, ect

167
Q

Watch for what in the safety of a client with schizophrenia

A

Watch other directed behavior, they hate manics

168
Q

Diet of a client with mania

A

High protein + fiber

169
Q

Activity of client with mania

A

Gross Motor + no competition. Ex- punching bag, tredmill, self sports

170
Q

Activity of client with anxiety

A

Gross motor with competition, action eats anxiety.

171
Q

How to deal with violent clients?

A
  1. Requires 5 trained staff
  2. Give them a chance to deescalate
  3. Only one person talks during procedure
172
Q

Ace of Spades answers for Psych

A

Best- “The nurse will examine own feelings about…”

Next- “Establish a trust relationship”

173
Q

Ace of Spades answers for Nuturition

A 
In a tie, either pic chicken or fish
Never pick casseroles for children
Never mix medications in children's food
Toddlers need finger foods
Preschoolers- Leave them alone! One meal a day is okay.
174
Q

Ace of Spades answers for Pharmacology

A

Most commonly tested area in pharm is s/s
If you know what a particular drug does, choose side effects in the same body system where the drug is working.
If you have no clue what the drug does, look to see if its PO. If so, pick GI side effects.
Never tell a child medicine is candy.

175
Q

Ace of Spades answers for OB

A

Check FHR

176
Q

Ace of Spades answers for Med-Surg

A

What is the first thing you assess in a med-surg situation? LOC
What is the first thing you do in a med-surg situation? Check airway.

177
Q

Ace of Spades answers for Pediatrics

A

Three rules on growth and development. They are based on the principal: always give the child more time.

When in doubt call it normal.
When in doubt, pick the older age.
When in doubt, pick the easier task.

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