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RATIONALS Q AND A > MANAGEMANT OF CARE > Flashcards

MANAGEMANT OF CARE Flashcards

1
Q

What is the adverse reaction of captopril to the treatment of HTN?

A

hyperkalemia

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2
Q

Symptoms associated with **electrolyte abnormality?

A

dizziness and palpitations.

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3
Q

What is Kawasaki disease?

A

Vasculitis(INFLAMMATION OF THE VESSELS) that affects children.
KD can lead to long-term heart problems.

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4
Q

EARLY SYMPTOMS OF KAWASAKI DISEASE?

A

1. FEVER FOR 5 DAYS OR MORE
2. IRRITATION AND REDNESS OF THE EYES.
3. SWELLING OF THE HANDS AND FEET
4. RASH
5. INFLAMMATION OF THE THROAT, LIPS, MOUTH, AND SWOLLEN LYMPH GLANDS.

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5
Q

MEDICATION MANAGEMENT OF KD?

A

ASPIRIN ADN IV IMMUNOGLOBULIN THERAPY.

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6
Q

PAD?

A

PATENT DUCTUS ARTERIOUS

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7
Q

TOF?

A

TETRALOGY OF FALLOT

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8
Q

VSD?

A

VENTRICULAR SEPTAL DEFECT

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9
Q

POKER CHIP TOOL OR HURT TOOL

A

The poker chip tool, also known as the pieces of hurt tool, is a** self-reporting pain assessment tool** that uses four red poker chips** to quantify the child’s level of pain.

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10
Q

Visual analog ?

A

A visual analog scale involves a horizontal or vertical line with marked endpoints, such as no pain and worst pain.

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11
Q

AGE GROUP FOR POKER CHIP TOOL?

A

3-18 YEARS OF AGE.

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12
Q

AGE GROUP FOR VISUAL ANALOG?

A

5YEARS AND** OLDER**

This is not an appropriate a preschool .

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13
Q

NUMERIC PAIN SCALE?

A

A numeric pain scale involves a horizontal or vertical line with marked endpoints of 0 and 10, with 0 reflecting no pain and 10 reflecting the worst pain that can be experienced.

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14
Q

AGE GROUP FOR NUMERIC PAIN SCALE?

A

8 YEARS OF AGE AND OLDER **

This is not an appropriate pain rating scale for the nurse when assessing** a preschool client’s pain.**

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15
Q

OUCHER PAIN SACLE?

A

The Oucher pain rating scale is similar to the FACES scale in that facial expressions indicate increasing degrees of hurt.
**
However, six photographs are used instead of illustrations: “no hurt” is placed at the bottom of the arrangement, and “most hurt” is placed at the top.

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16
Q

AGE GROUP FOR THE OUCHER?

A

3 -12 YEARS.

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17
Q

FACES PAIN SCALE.

A

The FACES pain rating scale is a self-report tool typically used in pediatric clients.

This is an appropriate pain rating tool for the nurse to use to assess pain during the postoperative care period. The scale consists of six illustrations of faces arranged horizontally with expressions ranging from smiling (i.e., indicating no hurt) to crying with frowning (i.e., indicating hurts worst)

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18
Q

FACES SCALE AGE GROUP?

A

3 - 8 YEARS.

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19
Q

Which pain rating scales are appropriate for THE PRESCHOOL CLIENT WITH POSTOPERATIVE?

A

1. FACES
2. OUCHER
3.POKER CHIP TOOL

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20
Q

change fatigue.

A

the nurse experiences stress and exhaustion due to rapid and unrelenting changes in the work environment.

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21
Q

moral distress.

A

Moral distress happens when a nurse knows the ethical action to take but cannot take it due to certain constraints or restrictions.

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22
Q

medical futility.

A

Medical futility involves a treatment performed without any perceived benefit to the client.

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23
Q

Ethical dilemma.

A

In ethical dilemmas in nursing, the nurse must decide between competing choices and understand that either option holds consequences.

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24
Q

ICU psychosis

A
  1. ICU psychosis is a potential complication of a prolonged ICU stay, and it results in confusion and agitation.
  2. In general, ICU psychosis, or delirium, causes a decreased awareness of one’s surroundings.
  3. In addition to agitation and disorientation to time and place,
  4. ICU psychosis can cause a fluctuating level of consciousness, withdrawal, irritability, and hallucinations.
  5. Signs of ICU psychosis must be recognized and treated early, as this syndrome results in poor outcomes for critically ill clients.
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25
Q

a client who has a polymorphic ventricular tachycardia with a prolonged QT interval. Which medication should the nurse prepare to administer to this client?

A

Magnesium sulfate.
Intravenous (IV) magnesium sulfate is the first line of treatment to correct polymorphic ventricular tachycardia accompanied by a prolonged QT interval; therefore, the nurse prepares to administer this medication to the client.

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26
Q

VENTRICULAR TACHYCARDIA INITIAL ASSESSMENT BASED ON?

A

The **presence of a pulse **

The unstable client indicates that the VT can be treated with **synchronized cardioversion.

The presence of a pulse in a **stable **client indicates that the VT can be treated with antiarrhythmic medication.

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27
Q

WHAT ARE ANTIARRHYTHMIC MEDICATION?

A

1.AMIODARONE
2.PROCAINAMIDE
OR 3.SOTALOL.

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28
Q

WHAT ARE THE EXAMPLES OF FAST ACTING CARBOHYDRATE?

A
  1. Any commercial dextrose products
  2. Honey or syrup: One tablespoon (15 mL)
    3.Hard candy: Six pieces
  3. Low-fat milk: Eight ounces (240 mL)
  4. Regular carbonated beverage or fruit juice: Four ounces (120 mL)
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29
Q

Sensorimotor?

A

The infant and toddler, During the sensorimotor stage, expected cognitive development includes the following:
basic reflexes; coordination of more than one thought at a time
; the initiation of reason
and
anticipation of events

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30
Q

Preoperational?

A

preschool or early school-age are expected to be in the preoperational stage of cognitive development. During this stage, the child is expected
to have
1. increased language abilities
2. uderstanding of life events and relationships.

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31
Q

Concrete operational?

A

school-age client

1. logical thinking
2. incorporation of others’ perspectives,
3. the use of abstract thinking
4. deductive reasoning,
5. testing beliefs to establish values.

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32
Q

Formal operational?

A

The formal operational stage of development can occur anytime from late school-age to adolescence. During the formal operational stage, the client adopts -life guiding values or religious practices

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33
Q

PIAGET’S THEORY?

A

Piaget’s theory of cognitive development focuses not only on understanding how **pediatric clients acquire knowledge, **but also on understanding the nature of intelligence. Piaget believed that children take an active role in the learning process, making observations and learning about the world.

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34
Q

What are the major characteristics and developmental changes that occur during this stage of cognitive development?

A
  1. 1.Symbolic thinking and learning to use words and pictures to represent objects.
  2. Egocentrism is expected, and the child struggles to see things from the perspective of others.
  3. Enhanced language and thinking occur; however, the child tends to think concretely about things.
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35
Q

*** The nurse is providing education to the parents of a toddler newly diagnosed with type 1 diabetes mellitus (DM).
**
➤Which should be the **primary focus **of the teaching?

A
  • Learn how to maintain stable blood sugars.

The primary educational outcome for a pediatric client who is newly diagnosed with type 1 DM is to** ensure the child’s safety.**

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36
Q

A pediatric client is admitted for the treatment of **meningococcal meningitis. **

➤Which isolation precaution should be implemented?

A

Droplet

Droplet precautions are required for a child diagnosed with meningococcal meningitis, which causes central DI until the client has received 24 hours of the prescribed antimicrobial therapy to decrease the risk of spreading the infectious disease process to others.

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37
Q

Manifestations of hypoglycemia?

A

1. behavioral changes
2. confusion,
3. diaphoresis,
4.palpitations,
5.slurred speech,
6.tachycardia,
and 7.tremors**

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38
Q

signs and symptoms of hyperglycemia ?

A

1. blurred vision;
2. dry, flushed skin;
and
3. a fruity odor to the breath.

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39
Q

prolapsed stoma?

A

A prolapsed stoma is not an expected finding and can lead to ischemia if not addressed within a one-hour time frame; therefore, this finding requires priority action by the nurse, which includes practitioner notification for additional evaluation and treatment.

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40
Q

Behaviors associated with a hearing deficit includes?

A
  1. Acting inattentive and non-interactive
    2; appearing shy and timid; 3. having a monotone voice; 4. talking loudly;
    5 . delays in speech development
    6 . and withdrawn behavior.
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41
Q

Enucleation ?

A

Enucleation is the medical terminology for eye removal and this procedure is often required for the treatment of retinoblastoma.

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42
Q

Safety education for Enucleation?

A
  1. Routine eye checkups;
  2. **protection **from accidental injury;
    **3. Use safety goggles during sports
  3. prompt treatment of eye infections.
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43
Q

(SCD) ?

A

Sickle cell disease (SCD) is a group of inherited hemoglobinopathies in which the red blood cells (RBCs)** becomehard and sticky and look like a C-shapedfarm tool called a “sickle.

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44
Q

Complications associated with SCD?

A
  1. Impact average growth and development, causing delays when transitioning to puberty.

Delayed puberty is a common complication associated with SCD

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45
Q

A dye or contrast material is ?

A

A dye or contrast material is needed for some CT scans to help highlight the areas of the body being examined. The contrast material blocks X-rays and appears white on images thus helping emphasize blood vessels, intestines, or other structures

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46
Q

routes of contrast ?

A

oral or by the iv

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47
Q

side effect associated with the administration of contrast dye ?

A

A common side effect is NAUSEA.

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48
Q

allergy to contrast ?

A

An allergy to iodine or shellfish may experience anaphylaxis with the administration of dye; thus, it is important to monitor for this allergy prior to the implementation of this contrast material.

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49
Q

NOTHING PER ORAL IS REQUIRED FOR CONTRAST?

A

YES

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50
Q

POST PROCEDURE WITH CONTRAST NEEDS ENCOURAGEMENT IN FLUID INTAKE?

A

**YES, to facilitate the **excretion of contrast dye **to decrease the risk of kidney issues.

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51
Q

client who is allergic to milk
should be taught to avoid the following foods: ?

A

1. artificial butter flavor
2., casein
,3. ghee, **
4. lactalbumin,**
5.** nougat, **
6. pudding,
7. whey, and yogurt.

Some coffee whiteners, deli meats, hot dogs, and non-dairy products may also need to be avoided.

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52
Q

Clinical manifestations of a food allergy ?

A

1. Hives
,2. flushing,
3. facial swelling,
4. mouth and throat itching,
and 5. runny nose**
**
. Many children also have gastrointestinal (GI) reactions, including
1. abdominal pain,
2. diarrhea,
3. nausea, and vomiting.

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53
Q

The Avert Organization: Global Information and Resources on HIV and AIDS ?

A

The Avert Organization: Global Information and Resources on HIV and AIDS is geared towards health care professionals to provide information important to providing the best care possible to individuals with an HIV or AIDS diagnosis, this resource does not fund primary health care or other services for persons with HIV.

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54
Q

The Ryan White Comprehensive AIDS Resources Emergency Act?

A

The Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program is the largest federal program focused specifically on providing HIV care and treatment services to low-income individuals living with HIV who are uninsured or underserved thus, this is the resource the nurse includes in this child’s plan of care as it funds primary health care and other services that may be needed by this client due to the diagnosis of HIV.

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55
Q

The Elizabeth Glaser Pediatric AIDS Foundation.

A

The Elizabeth Glaser Pediatric AIDS Foundation is a nonprofit organization that is dedicated to preventing pediatric HIV infection and eliminating pediatric AIDS
through
advocacy,
research,
and prevention
and treatment programs. This resource, however, does not fund primary health care and other services for persons with HIV.

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56
Q

The Well Project: Women and HIV.

A

The Well Project is an organization that is committed to building agency and health literacy among women living with HIV by developing and providing access to culturally responsive, scientifically accurate, women-focused HIV information. It does not fund primary health care and other services for persons with HIV.

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57
Q

Tinea corporis (i.e., ringworm)?

A

Not an actual worm (as the name implies) but is a fungal infection.

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58
Q

Tinea corporis spread through?

A

Tinea corporis (ringworm) COMMUNICABLE DISESASE. IT is very contagious. The condition can spread between humans and pets.

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59
Q

Treatment for tinea corporis (i.e., ringworm)?

A

terbinafine cream, an antifungal agent. 1% cream is used and rubbed on the affected areas.

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60
Q

IS ringworm is a life-threatening condition?

A

not a life-threatening condition but does cause itchy and uncomfortable skin

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61
Q

PREVENTION OF TINEA CORPORIS ?

A

1.HANDWASHING
2.ANTIFUNGAL CREAM.

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62
Q

what is Rubeola ?

A
  1. The measles virus causes rubeola.
  2. Rubeola first presents with prodromal symptoms (e.g., conjunctivitis, cough, coryza, fever) that last 2 to 4 days.
  3. These are followed by Kolpik spots and an erythematous maculopapular rash, which appears 3 to 4 days after the onset of the prodromal phase;
  4. the rash gradually proceeds from the head downward and outward.
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63
Q

What is filth disease?

A

The fifth disease typically has a prodromal phase that includes
1. a low-grade fever,
2. headache,
3. and mild upper respiratory system,
which progresses to the characteristic rash that occurs in three stages.

The rash for this viral infection begins with erythematous flushing, often described as a “slapped-cheek” appearance,

in addition to circumoral pallor, which then spreads to the trunk and outward, often sparing the child’s palms and soles.

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64
Q

Varicella zoster ?

A

A diagnosis of varicella zoster (i.e., chickenpox). A child with chickenpox may have prodromal symptoms 24 to 48 hours before the eruption of lesions to the scalp, face, trunk, and then extremities, which are initially pruritic, erythematous macules that evolve into papules and then form clear, fluid-filled vesicles.

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65
Q

fluid volume deficiency indicatives?

A

1. Oral mucosa is moist and pink
; 2. skin turgor is elastic and
3. urine output is at least 1 to 2 mL/kg/hr.

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66
Q

define Social isolation ?

A

the lack of social contacts and having few people to interact with regularly.

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67
Q

Rapid streptococcal antigen test ?

A

The rapid streptococcal antigen test is used to diagnose scarlet fever.
which is commonly referred to as throat culture.

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68
Q

what is scarlet fever ?

A

Scarlet fever is a complication of streptococcal group A infection**.

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69
Q

clinical manifestation of scarlet fever ?

A

The red, itchy, sunburn-like rash on the chest.

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70
Q

what is the treatment of scarlet fever?

A

antibiotics and analgesics to address the pain and discomfort.

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71
Q

Impaired tissue integrity caused by?

A

1. Hypersensitivity reactions,
2. infectious processes,
3. injury, or
4. mechanical factors.

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72
Q

Assessment of a nursing diagnosis of impaired skin integrity include ?

A

1. abrasions,
2. inflammation,
3. lacerations,
4. rashes, or
5. any disruption of the dermal layer of the skin.

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73
Q

What plan of care nurse includes a client with skin impairment?

A
  1. Assess the skin impairment every shift.
  2. Monitor for changes in color, warmth, or signs of infection.
  3. Understand the child’s skin care practices for education needs.
  4. **Customize the skin care regimen **based on the child’s condition.
  5. Use a **risk assessment tool **for immobilized children.
  6. Position the child to avoid further skin breakdown.
  7. Encourage proper nutritional intake for immune function and healing.
  8. Consult a wound and ostomy care nurse specialist.
  9. Provide** prescribed dressing changes and wound care**.
  10. Your role is crucial and empowering.
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74
Q

child abuse and neglect ?

A

The Centers for Disease Control and Prevention (CDC) defines child abuse and neglect (i.e., child maltreatment) as “any act or series of acts of commission or omission by a parent or other caregiver (e.g., clergy, coach, teacher) that results in harm, potential for harm, or threat of harm to a child.”

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75
Q

he nurse is assessing a** pediatric client with burn injuries consistent with child abuse from forced immersion.**

➤Which assessment finding supports this conclusion?

A

The child has a stocking pattern injury to the hand.
A stocking or glove pattern on the hands or feet (i.e., a circumferential ring appearing around the extremity) can result from a caregiver forcefully holding the child under extremely hot water, often as a form of punishment; therefore, this finding causes the nurse to child abuse-induced burn injury.

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76
Q

Caregiver education for prescribed medication for tinea capitis includes?

A
  1. Use selenium sulfide shampoo 2 to 3 times a week for **1 to 3 months (or as prescribed)
  2. and griseofulvin oral suspension for 1 to 3 months (or as prescribed).
  3. Griseofulvin may cause photosensitivityand should be taken withhigh-fat foods to enhance absorption
  4. Use of these medications includes taking them as prescribed and not discontinuing them early, even if itching and redness subside.
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77
Q

burn injury, the nurse obtains an in-depth history. Data that the nurse collects includes?

A

1. Elicit how the burn occurred, noting the date, time, and cause. **
2. Determine if smoke inhalation or an associated fall may have occurred.
3. Document the parent’s treatment of the child’s burn**.
4. Note the child’s recent health status, current medications, recent or chronic illness, and immunization status, particularly the date of the most recent tetanus vaccination.

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78
Q

Schizophrenia ?

A

Schizophrenia is a mental health disorder that affects an individual’s ability to behave, feel, and think clearly. The exact cause of schizophrenia is not known; however, it is believed to be caused by a combination of altered brain chemistry and structure in addition to environmental and genetic issues.

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79
Q

increases the risk for schizophrenia is?

A

substance use during adolescence and early adulthood.

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80
Q

Nursing interventions for clients with antisocial disorders include ?

A

setting firm limits

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81
Q

Enteral nutrition ?

A

Enteral nutrition via a tube is anticipated for a client who is severely malnourished and refusing to consume foods by mouth.

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82
Q

A self-care deficit can be causes?

A

1 cognitive functioning
2; fatigue;
3 muscular,
4 neuromuscular,
5 skeletal impairments;
6 pain;
7 and weakness.

A client who is unable to bathe, dress, or feed his or her self is identified as having a self-care deficit.

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83
Q

Which fracture should always be investigated to rule out the possibility of abuse particularly in pediatric clients who are less than 2 years of age?

A

1. humerus fracture
2, rib fracture
3. spiral femur fracture.

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84
Q

NALOXONE ?

A

This medication is an opioid antagonist

meaning that it binds to opioid receptors and can block and reverse the effects when respiratory depression occurs.

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85
Q

hydromorphone (Dilaudid)

A

Opioid analgesics for the treatment of severe pain.

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86
Q

A common side effect associated with the administration of opioid analgesics?

A

Pruritus, or itchiness, peristalsis.

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87
Q

WHAT IS ASD ?

A

Autism spectrum disorder (ASD) is a developmental and neurological disorder which affects how the individual communicates, interacts, and understands.

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88
Q

Risk factors **for the development of ASD include ?

A

1. male gender
2. , family history,
3. prematurity,
4. and parental age

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89
Q

WHAT IS Myelomeningocele ?

A

Myelomeningocele is neural tube defect which presents with a pouch outside of the body in the lumbar region that contains the newborn’s spinal fluid, nerves, and spinal cord.

90
Q

Which interventions are appropriate to include in the diagnosis of a considerable myelomeningocele?

A
  1. Place the child in a prone position,
  2. assess head circumference at frequent intervals,
  3. and place a sterile, moist dressing on the myelomeningocele until surgical correction is performed.
91
Q

VP SHUNT ?

A

VENTRICULOPERITONEAL SHUNT

92
Q

COMPLICATIONS OF VP?

A

increased intracranial pressure (ICP), a potentially life-threatening condition

93
Q

CLINICAL MANIFESTTION OF HYDEOCEPHALUS**?

A

1. Vomiting,
2. headache,
3. visual changes,
4. and alterations in level of consciousness (LOC).

94
Q

Reye syndrome ?

A

an extremely rare disease process, primarily affects pediatric clients younger than 15 years of age** who are recovering from a viral illness**

95
Q

Symptoms OF REYE SYNDROME ?

A

1. changes in level of consciousness **
2.(e.g., confusion, irritability, lethargy)
3., .hyperreflexia, *
3. and* vomiting.***
4. While the exact cause is unknown,

Studies have found that it is a reaction triggered by using salicylates or salicylate-containing products to treat symptoms of a viral infection.

96
Q

RVS ?

A

Respiratory syncytial virus

97
Q

RVS TRANSMITTED BY?

A

(RSV) may be transmitted by the droplet route; however, it is primarily spread by direct contact with infectious respiratory secretions; thus,

contact precautions are required.

98
Q

CPT ?

A

Chest physiotherapy

99
Q

HFCWO ?

A

high-frequency chest wall oscillation

100
Q

HFCWO vest

A

This vest inflates and deflates quickly causing vibration which loosens and mobilizes respiratory secretions into the large airways. Once the secretions are loosened the client is able to cough and clear secretions from the airways. This therapy is performed several times each day and as needed.

101
Q

FBAO

A

foreign body airway obstruction (FBAO) due to the small size of their airways

102
Q

Clinical manifestations indicative of FOREGIN BODY AIRWAY OBSTRUCTION include

A

* coughing,
* cyanosis,
* dry heaving,
* inability to speak.

103
Q

MDI

A

metered dose inhaler (MDI)

104
Q

Proper administration of a medication with an MDI must include the following steps:

A
  1. Shake the MDI
    ; 2. Attach the to the spacer;
    3.Exhale completely
  2. Place the lips around the mouthpiece tightly;
  3. Deliver the medication into the spacer with** a single puff when taking a deep and slow breath;**
  4. Hold your breath for 10 seconds
    ; 7. Rinse the mouth** with water to remove leftover medication** from the mucous membranes;
  5. Spit the water out to ensure that no medication is swallowed.
105
Q

CF ?

A

Cystic fibrosis(CF) results in thickened mucus that hinders the respiratory cilia and cough reflex from clearing respiratory secretions.

106
Q

Symptoms that indicate substance use

A

1. Pupil constriction
2. “track” marks (i.e., discoloration around the veins in the arms);
3. and warm, flushed skin.

107
Q

AGN ?

A

acute glomerulonephritis

108
Q

behavioral management strategies.

A

therapeutic techniques that are implemented to alter the client’s behavior by changing one or more aspects of the environment

109
Q

Retinoblastoma ?

A

malignant tumor of the retina which produces a white glow rather than the normal red reflex. This white glow is referred to as leukocoria. This is a serious condition which will result in enucleation of the affected eye to prevent the spread of cancer to other parts of the body.

110
Q

Strabismus.

A

condition where both eyes do not move in the same direction simultaneously. The condition is associated with nerve damage or dysfunction of the muscles controlling eye movement

111
Q

Bilateral exophthalmos.

A

Bilateral exophthalmos is associated with Graves disease or hyperthyroidism.

112
Q

AOM ?

A

Acute otitis media (AOM) is an infection of the inner ear caused by a** virus or bacteria.** Medical treatment includes antibiotics, including a 10-day course of azithromycin. If symptoms do not improve within 72 hours, the healthcare provider should be consulted.

113
Q

**The nurse is administering antimicrobial drops for a two-year-old client diagnosed with acute otitis media (AOM).

➤What is the proper technique for administration?

A

Pulling the pinna of the child’s ear down and back.

To straighten the ear canal for a child under 3 years of age, the nurse pulls the pinna down and back to facilitate proper administration of otic medication. Once the child reaches 3 years of age, the pinna is pulled up and back.

114
Q

IELEUS

A

A TEMPORARY ARREST OF INTESTINAL PERISTALASIS.

115
Q

OPIOID ANALGESICS INCREASE THE RSIK OF WHAT IN THE POST OP PT?

A

CONSTIPATION

116
Q

ECCHYMOSIS

A

BLEEDING OR BRUSING

117
Q

The adverse reactions associated with the use of aspirin include the following:

A

* Bruising/bleeding
* (e.g., The presence of dark melena in the stool; Increased ecchymosis noted on the extremities);
* dark urine
* ; difficulty hearing
* ; jaundice;
* kidney issues
* ; lethargy;
* persistent or severe nausea/vomiting,
and tinnitus.

118
Q

A client who has received ** IV morphine for chest pain** should be reassessed within

A

15 minutes of administration.

119
Q

Acetaminophen

A

a nonopioid analgesic that is** used to treat mild to moderate pain**

120
Q

NSAIDs

A

**NSAIDs are used to treat fever, inflammation, and pain. **They block the formation of thromboxane A2, which produces a system-wide bleeding tendency by causing platelet aggregation and prolonging bleeding time

. The** risk of GI bleeding is increased **due to the presence of acid in the lumen of the stomach

; therefore, the nurse should question a client’s prescription for ibuprofen, an NSAID.

121
Q

PVC

A

Premature ventricular contractions (PVCs) are extra, abnormal beats which begin in the ventricles and disrupt the normal heart rhythm. This causes the client to feel as though their heart is skipping a beat or they are having palpitations and is common if the client has excessive caffeine intake or stress.

122
Q

(PMI). The nurse should place the stethoscope at which location?

A

The PMI is where the apical pulse is best auscultated. It is located just left of the midclavicular line at the 5th intercostal space (ICS).

If the PMI is located below the 5th ICS, the client may have a diagnosis of cardiomegaly, or an enlarged heart.

122
Q

PMI

A

POINT OF MAXIMAL IMPULSE OR APICAL PULSE.

123
Q

TO ASSESS JUGULAR VEIN DISTENTION CLIENT POSITION SHOULD BE ?

A

the client is placed upright at a 45 degree angle.

123
Q

Palpating both carotid arteries simultaneously for equal quality.

A

The carotid arteries should never be palpated simultaneously as this would significantly decrease cerebral circulation.

123
Q

the bell of the stethoscope to auscultate

A

best for auscultating low pitched sounds such as murmurs

124
Q

Troponin.

A

Troponins are a group of proteins that are found in cardiac and skeletal muscles. Troponins are released into the bloodstream when cardiac muscle is damaged. Therefore, troponin is the most specific indicator that a client has experienced an MI. This laboratory data will be elevated within hours of an MI and remain elevated for approximately 14 days.

124
Q

AICD

A

automated internal cardiac defibrillator **

An AICD is placed in clients who are at risk for life-threatening dysrhythmias. AICDs sense deadly dysrhythmias such as ventricular fibrillation and pulseless ventricular tachycardia and deliver a life-saving shock.

124
Q

WARFARIN ANTAGONIST

A

VIT K

124
Q

Nitroglycerin sublingual tablets

A

given to clients to use at home in case angina or myocardial infarction-type symptoms are experienced. The nurse should teach the client how to properly use this medication to enhance safety. Instructions should include the following: Use of up to 3 pills (1 under the tongue every 5 minutes if chest pain does not subside)

124
Q

Client education post-AICD **placement

A

avoid lifting the affected arm, informing clients that when the AICD fires it may cause temporary pain/discomfort,
and that driving is allowed when approved by the healthcare provider (HCP).
a shock from an AICD is painful and the client should be informed of this.

124
Q

POTASSIUM RICH FOOD

A

RAISINS
APRICORT

125
Q

Foods that are rich in vitamin K include

A
  1. **kale,
  2. green tea,
    3 sauerkraut,
    4 and turnip greens**.
126
Q

STORAGE OF NITROGLYCERIN?

A

store nitroglycerin in a cool, dry, dark place

127
Q

COMMON SIDE EFFECTS OF NITROGLYCERIN

A

HEADACHE

128
Q

Dabigatran

A

reduce CLOT FORMATION and STROKE in clients in long-term ATRIAL fibrillation AF

128
Q

Important education for DABIGATRAN includes the following

A

implementing bleeding precautions; reporting any excessive bleeding (e.g.,** bleeding gums, blood in urine or stool);**

keeping the medication in its original packaging or pill container

; **taking the medication whole, with a full glass of water or food;

and n**ot stopping the medication unless directed **to do so by the healthcare provider.

The nurse provides education and then evaluates the client’s understanding using the “teach-back” method.

129
Q

medication is likely the cause of the client’s bradycardia

A

Beta blockers such as labetalol decrease blood pressure and heart rate which can lead to hypotension and bradycardia.
This medication blocks the effects of the sympathetic nervous system on the body.
This means it blocks the usual increased heart rate and blood pressure associated with** fight or flight.**
Understanding beta blockers can help the nurse understanding the effects on the heart.

130
Q

A known adverse reaction associated with the prescribed desmopressin (prescribed to treat DI) is

A

dilutional hyponatremia due to water intoxication. This adverse reaction manifests with headache.

131
Q

glyburide.

A

Sulfonylureas are a category of oral hypoglycemic medications used alone or in combination with other oral hypoglycemics to control blood glucose in **type 2 diabetes. **This drug works by stimulating the pancreas to increase release of insulin.

132
Q

common side-effects of SULFONYLUREAS

A

Hypoglycemia and increased weight gain

Beta blocker blood pressure medications should be avoided

since it can mask hypoglycemia in clients with diabetes. The major adverse effect of this drug is how it affects the heart. It is important to monitor for any cardiac changes in a client taking this medication.

133
Q

Simethicone

A

an anti flatulent medication used for clients reporting symptoms of bloating and gas. Chronic use of this medication could be an indicator of an underlying disease process;

134
Q

esomeprazole

A

Proton pump inhibitors (PPIs), such as esomeprazole, reduce acid production in the stomachThis medication is prescribed for clients who are diagnosed with GERD and peptic ulcer disease (PUD) for symptom relief; however, stomach acid protects the client from gastrointestinal (GI) infection, including gastritis.

135
Q

PUD

A

Peptic ulcer disease (PUD) is commonly caused by nonsteroidal anti-inflammatory drug (NSAID) use and a bacteria called Helicobacter pylori (H pylori).

136
Q

Cystic fibrosis (CF)

A

chronic disease process that can affect all of the organs of the body. It most often causes problems with breathing and digestion.

137
Q

CVS

A

chorionic villus sampling (CVS)

138
Q

Amniocentesis

A

An amniocentesis is performed during the second trimester of pregnancy, between 15 and 20 weeks’ gestation. **When this procedure is performed, a thin needle is inserted into the client’s abdomen to obtain a small sample of amniotic fluid for testing.

139
Q

TAVR

A

Transcatheter Aortic Valve Replacement

140
Q

Brachytherapy

A

Brachytherapy kills cancer cells while causing minimal damage to healthy nearby tissue;

When brachytherapy is initiated for prostate cancer, the client is instructed to avoid intercourse for two weeks due to the partner’s risk of exposure to radiation. After two weeks, a condom will need to be used to avoid an implant seed from traveling through the ejaculate.

141
Q

Cisplatin

A

Cisplatin is an alkylating chemotherapeutic agent.This medicationtargets rapidly dividing cells; however, it cannot differentiate between bad and good cells. This lack of differentiation causes side effects that can negatively impact the client’s health. An example of rapidly dividing good cells includes parietal cells in the gastrointestinal system; therefore, nausea and vomiting are common and can lead to malnutrition and dehydration. The priority targeted health screening assessment for this client is a nutrition assessment.

142
Q

Methotrexate

A

Methotrexate is an immunosuppressant medication that is prescribed for the therapeutic management of autoimmune disorders, including Rheumatoid arthritis

143
Q

Interferon

A

an immunomodulator medication that is prescribed for the treatment of cancer and certain viral illnesses. This medication is administered by IM injection

144
Q

side effects, of Interferon

A

Edema, redness, and pain at the injection site. Additionally, this medication is associated with flu-like symptoms **

(e.g., chills, muscle aches) which is often addressed with acetaminophen

145
Q

To decrease discomfort associated with the IM administration of interferon,

A

evidence-based practice (EBP) guidelines support the application of a warm compress to the site prior to injection.

146
Q

cyclosporine

A

Immunosuppressant medications suppress bone marrow function, increasing the risk for leukopenia (i.e., decreased white blood cell [WBC] production) and/or thrombocytopenia (i.e., decreased platelet production). Leukopenia increases the client’s risk for infection, while thrombocytopenia increases the client’s risk for bleeding. Additionally, the prescribed cyclosporine can also cause hypercholesterolemia, hyperglycemia, and hypertension; therefore, monitoring the client’s blood pressure, serum cholesterol, and glucose levels in the provision of client care.

147
Q

Infliximab

A

blocks the action of a protein in the body called tumor necrosis factor-alpha (TNF-alpha) thus decreasing inflammation that is often the cause for symptoms associated with Crohn disease.

148
Q

side effects of infliximab

A

this medication is hepatotoxic; therefore, can increase the risk for liver failure. Clay-colored stools is a finding that warrants HCP notification for additional evaluation as this is a symptom associated with poor liver function.

149
Q

isoniazid (INH) side effect

A

Peripheral neuropathy.*

S**ymptoms of peripheral neuropathy include

ataxia, tingling, and numbness. T

This adverse reaction is caused by the medication’s interference with the absorption of vitamin

150
Q

CAM

A

complementary and alternative medicine

151
Q

Bromelain

A

Bromelain is a CAM health care practice that may be utilized to enhance the effectiveness of the prescribed penicillin;

152
Q

Guar gum

A

Homeopathic supplement that is often utilized for the treatment of constipation.

153
Q

Penicillin i

A

Penicillin is a beta-lactam antibiotic that kills bacteria **and is used to treat a variety of infections, including pneumonia.

154
Q

Metronidazole

A

a nitroimidazole antimicrobial medication that is prescribed for the treatment of trichomoniasis, a sexually transmitted infection (STI).

155
Q

side effects and adverse reactions associated with the Metronidazole

A

changes to the color of urine and a **metallic taste in the mouth. The use of alcohol is associated with psychosis, a specific adverse reaction that can occur when taken during or up to three days** after completion of the prescribed medication;

156
Q

Bismuth subsalicylate

A

This medication is aspirin based and,
contraindicated for pediatric clients who
< 18 years of age due to the risk for Reye syndrome.

157
Q

Trimethoprim-sulfamethoxazole

A

Sulfonamide is an
antimicrobial medication prescribed for the treatment of bacterial infections.

The medication often causes increased sun sensitivity and is not safe to use while pregnant

158
Q

Atazanavir (ATV)

A

Antiretroviral medication used in the treatment of HIV.

159
Q

Hidradenitis suppurativa

A

****a chronic skin condition that causes
* inflammation and infection of the sweat glands*
,
sulting in painful pea- to marble-sized lesions under the skin
Treatment may include painful incision, drainage, and triamcinolone injections;
ongoing pharmacotherapy often includes topical and oral clindamycin. **The disease process and treatment are often painful

160
Q

Which instructions address the side effect of alterations in taste?

A

avoid metallic utensils and replace them with those

made of plastic or wood.

161
Q

Pediculus capitis (i.e., head lice)

A

**A parasitic insect that can be found on the eyebrows, eyelashes, and scalp hair of infected individuals. **

This infection is** communicable** and thus requires treatment with OTC permethrin shampoo, a scabicide, or pediculicide, which kills live insects.
The medication, however, does not kill unhatched eggs (i.e., nites); therefore, reapplication may be necessary.

162
Q

The management of this integumentary disorder? Pediculus capitis

A

I will apply the shampoo to my hair, scalp, behind my ears, and the back of my neck. I will leave it in place for 10 minutes and then rinse.”

163
Q

Scabies

A

contagious,
pruritic skin condItion

caused by mites that burrow into the integument that is treated with topical permethrin.

164
Q

Symptoms of scabies

A

Erythema,
bumps,
and severe pruritus (i.e., itching).

When symptoms are noted, prompt pharmacotherapy is essential to decrease the spread of this communicable skin disorder to others in the household.

165
Q

scabies treatment with permethrin lotion

A

The medication is applied at bedtime as the lotion must remain in place for 8 to 12 hours to kill the mites

166
Q

Prednisone

A

Prednisone is a
corticosteroid
medication used to treat inflammation that causes symptoms associated with RA.
**
It is commonly prescribed to clients when nonsteroidal anti-inflammatory drug (NSAID) therapy does not adequately address the client’s pain and inflammation.

167
Q

side effects and adverse reactions that must be monitored

A

Increased blood glucose,
bone loss,
peptic ulcer disease (PUD), infection,
insomnia,
anxiety,
irritation,
fungal/yeast infection, and cataracts, eye care professional every 6 months

168
Q

Rheumatoid arthritis (RA

A

Rheumatoid arthritis (RA) is a

chronic, autoimmune disease process that leads to inflammation of the joints and surrounding tissues
**.
Prednisone is commonly prescribed to clients who are diagnosed with RA if nonsteroidal anti-inflammatory drug (NSAID) therapy is not adequate to address pain and inflammation.

169
Q

Side effects and adverse reactions of prednisone

A

1.* Increased blood glucose levels
2 bone loss,
3 peptic ulcer disease (PUD)
4 Infection,
5 insomnia,
6 anxiety,
7 irritation
8 fungal/yeast inf*ection,
9 cataracts. **

Clients with pre-existing type 2 DM should have serial serum glucose levels monitored for the duration of therapy.

170
Q

DMD

A

Duchenne muscular dystrophy (DMD) is an inherited condition that has progressive deterioration of the muscles. The muscles become very weak resulting in the following:
increased incidence of falling; difficulty getting up from a sitting position; and impaired gait.

171
Q

THERAPY FOR DMD

A

Corticosteroid therapy is the standard of care for clients who are diagnosed with DMD

that aims to slow disease progression and control symptoms through potent anti-inflammatory action.
The client who is diagnosed with DMD often has learning difficulties and eventually is unable to walk. This places increasing stress on caregivers and puts them at risk for physical and compassion fatigue.
The nurse should continue supporting caregivers and monitor for the need for resources.

172
Q

Which instruction should the nurse include to reduce the client’s risk for adrenal insufficiency?who is diagnosed with osteoarthritis about prescribed dexamethasone.

A

“Do not stop taking the medication abruptly.”
Glucocorticoid medications, including dexamethasone, have several side effects, including the risk of adrenal insufficiency.

173
Q

Dexamethasone

A

Glucocorticoid medication is used to decrease inflammation in the body.

This medication is often prescribed for osteoarthritis, a type of arthritis that only affects the joints, usually in the hands, hips, knees, lower back, and neck.

Glucocorticoids must be taken as prescribed and should not be abruptly discontinued due to the risk of adrenal insufficiency,

**which results in fatigue, nausea, darkening of the skin, and dizziness upon standing. **
To avoid this complication, the medication is tapered.

174
Q

Baclofen

A

This medication enhances GABA, a neurotransmitter that induces muscle relaxation.

Baclofen should never be abruptly stopped but tapered.

It is excreted by the kidneys, so a history of renal impairment often necessitates lower dosages for client safety.
To determine renal function, the nurse anticipates that the practitioner will prescribe a **serum creatinine level.

175
Q

useful for the treatment WITH Baclofen

A

clonus (i.e., involuntary, rhythmic muscle spasms caused by a lesion in the brain)

flexor muscle spasms (e.g., hip flexors, hamstrings),
and associated pain.

176
Q

HYDROMORPHONE

A

opioid analgesics

ANTIDOTE: naloxone.

177
Q

Multiple sclerosis (MS)

A

Multiple sclerosis(MS) is an autoimmune disorderthat affects the central nervous system (CNS), primarily the brain; however, it can also affect the spinal cord.
**
There are several types of MS; the main type is relapsing-remitting.

There is no cure for MS, only treatment.

One of the medications used to reduce the frequency and severity of exacerbations is interferon beta, an immunomodulator that suppresses the immune system

178
Q

Gabapentin

A

**anticonvulsant medication

that is supported by evidence-based practice (EBP) guidelines for the
**
*treatment of peripheral neuropathy.

It works on the neurotransmitter gamma-aminobutyric acid (GABA) and is classified as a controlled substance.

179
Q

GABAPENTIN SIDE EFFECTS

A

Gabapentin is a central nervous system (CNS) depressant and can cause
Drowsiness,
** driving and operating hazardous machinery is not recommended** until clients know how the medication will affect them;*

additionally,
no medication that causes CNS depression should be abruptly discontinued without counsel from the health care provider (HCP)

180
Q

nurse includes information related to safe administration, side effects, and adverse reactions that require HCP notification,

FOR prescribed
trazodone extended-release (ER) for major depressive disorder

A

1 do not break, crush, or chew this medication;
2 do not make missed doses of the medication;
3 take this medication at the same time every day;
4 drowsiness is a common side of this medication;
5 and if a client experiences confusion or hallucinations, it is essential to notify the HCP.
After the teaching, the nurse evaluates the client’s understanding using the “teach-back” to enhance safety with this medication prescription.

181
Q

Isocarboxazid

A

A monoamine oxidase inhibitor (MAOI) is an

antidepressant medication used to treat depression, panic disorders, and social disorders.

182
Q

FOOD CONTAINING TYRAMINE?

A

1. SMOKED SALMON
2. SALAMI
3. REDWINE
4. PICKLED PIG FEET
5.smoked cheese,
6 beer,
7 chocolate,
8 smoked or pickled meats.

183
Q

Therapeutic lithium levels are

A

0.6-1.2 mEq/L

Lithium levels above 2.0 mEq/L can cause severe toxicity.

184
Q

HRT

A

Hormone replacement therapy

185
Q

BLACK COHOSH

A

Herbal remedies, such as black cohosh, may be effective for treating hot flashes that occur during menopause.

186
Q

the teaching ON IUD

A

IUDs do not protect against sexually transmitted infections (STIs), so a barrier device is required.

It is important to keep all appointments with the HCP and voice any concerns.

** Anticipate a decrease in mental flow and cramping.
*
Check the string position each week for the first four weeks after insertion and contact the HCP if changes are noted.

Once the information is presented, the nurse must evaluate the client’s understanding using the “teach-back” method to determine if additional education is required.

187
Q

Tubal ligation

A

a permanent form of contraception

188
Q

contraceptive options that are effective, yet not permanent.

A

1. monophasic oral birth control pills
2. , intrauterine devices (IUDs),
3 a levonorgestrel implant
4. medroxyprogesterone injections.

189
Q

intrauterine device (IUD)

A

a small t-shaped plastic device that is inserted into the uterus during an office visit to** decrease the likelihood of an unwanted pregnancy. **This form of birth control is 99% effective and **lasts 3 to 6 years. **Some IUDs contain hormones, such as progestin to enhance effectiveness. Clients are taught to monitor the length of the IUD string on a regular basis. If the string is longer, shorter, or missing, the IUD is likely displaced which decreases its effectiveness; therefore, these findings should be reported to the client’s practitioner.

190
Q

Intranasal phenylephrine

A

Intranasal phenylephrine is a short-acting sympathomimetic (i.e., alpha-adrenergic agonist) decongestant. This medication causes vasoconstriction of the blood vessels in the nasal passages thereby relieving nasal congestion and pressure.

190
Q

adverse reaction associated with Intranasal phenylephrine **

A

Rebound congestion

(i.e., constant nasal congestion that develops from the** overuse of decongestant nasal sprays)**Use this nasal spray for no more than five days

191
Q

Asthma

A

Respiratory condition

that causes the

airways to become inflamed, narrow, and swell, and produce extra mucus, which causes breathing difficulties.

192
Q

Theophylline

A

Theophylline is a methylxanthine medication that dilates and relaxes the smooth muscles of the bronchi.

This maintenance mediation has a narrow therapeutic index: 10-20 mcg/mL.
**
Symptoms indicative of increased theophylline levels include nausea, vomiting, diarrhea, insomnia, and restlessness.

Toxic levels of theophylline occur if the client’s serum drug level is greater than 30 mcg/mL and may cause cardiac dysrhythmia (e.g., ventricular fibrillation) and seizure activity.

193
Q

Glucocorticoids

A

he most effective anti-asthma medication

194
Q

Clients who are prescribed long-term glucocorticoid therapy, NEEDS?

A

dual-energy X-ray absorptiometry (DEXA) scans (i.e., bone density scans) to monitor the client for bone loss and osteoporosis.

195
Q

acetylcysteine via nebulizer

A

is likely to cause bronchoconstriction

196
Q

COPD O2 NORMAL RANGE ?

A

88-92%

197
Q

COPD

A

Chronic obstructive pulmonary disease (COPD) is a group of lung diseases (e.g., chronic bronchitis, emphysema) that block airflow and make it difficult to breathe.

198
Q

MEDICAL MANAGEMENT OF COPD

A

**pharmacotherapy, including beclomethasone, an intranasal glucocorticoid that reduces inflammation in the lungs; additionally, low flow supplemental oxygen is administered as high flow oxygen removes the client’s hypoxic (i.e., low level of oxygen) respiratory drive resulting in hypoventilation, higher carbon dioxide levels, apnea (i.e., pauses in breathing), and ultimately respiratory failure.

199
Q

A major adverse reaction to erythropoietin alfa

A

HTN and hemoglobin prior to administration to decrease the risk for thromboembolism.

200
Q

Tamsulosin

A

Tamsulosin is prescribed for males and females to help the ureters and bladder relax and be able to urinate more freely, thereby helping*** kidney stones move and be eliminated more easily. *This medication is an alpha blocker and most often used for clients having urinary retention related to benign prostatic hyperplasia ( BPH).

201
Q

Oxybutynin

A

Oxybutynin is an antimuscarinic muscle relaxing medication or an anticholinergic. This medication is used for an overactive bladder **that causes urinary retention. It helps the person feel in more control of their bladder. Therefore, it should not be taken by a person who has difficulty emptying their bladder or has urinary retention.

202
Q

Finasteride

A

Finasteride is a 5-alpha-reductase inhibitor and is used to decrease the size of the prostate, which allows the prostate to be able to pass more urine which allows the bladder to empty more fully.

202
Q

Tolterodine

A

Tolterodine is a** bladder relaxant** that allows the bladder to hold more so the client has more control over their bladder emptying. This medicine is used for incontinence issues (loss of bladder control) and urination frequency.

203
Q

Phenazopyridine

A

Phenazopyridine treatment for a client to treat pain associated with urinary tract infection and other urinary tract pain.

204
Q

nitrofurantoin

A

used for urinary tract infections because it has few side effects in other body systems, it is associated with clostridium difficile-associated diarrhea.**

205
Q

Eltrombopag

A

Eltrombopag would increase platelets or thrombocytes in the body.

205
Q

Epoetin alfa is

A

Synthetic erythropoietin lacks this hormone. Therefore, this includes kidney failure and chemotherapy. The healthy kidney normally produces erythropoietin is used in clients with severe anemia caused by many conditions,. The hormone is released into the bloodstream to stimulate RBC production in the bone marrow. All clients with kidney failure are anemic due to lack of this hormone, therefore it is a necessary part of treatment to maintain optimal health. Symptoms of anemia include shortness of breath, fatigue, and pale skin and mucous membranes.

206
Q

Filgrastim

A

Filgrastim injection would increase white blood cells (WBCs) in the body.

207
Q
A
207
Q

Finasteride

A

Finasteride alters testosterone which is the mechanism of action to shrink the prostate glandHowever, it can be absorbed through theskin through contact with the pill which means that caregivers who administer the medication also absorb the medication. The alteration in testosterone can result in abnormalities in a developing male fetus, so females who may not even realize they are pregnant are at riskFinasteride is also contained in the semen of clients taking the medication, so precautions should be used if their sexual partners are of childbearing age. These are important teaching points for clients taking this medication.

RATIONALS Q AND A (17 decks)

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