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NCLEX Review Deck > M.K. Review > Flashcards

M.K. Review Flashcards

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1
Q

What are the nursing considerations after a hemiarthroplasty?

A

Abduct leg using abduction splints / wedge or 2-3 pillows between legs

Flex hip no more than 90 degrees

Elevate HOB no more than 45 degrees

Prevent complications r/t immboility with early ambulatory

Use fracture bed pan/ elevate toilet seat to prevent 90 degree flex ion.

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2
Q

Steps for CPR

A
  1. Check for unresposiveness
  2. Call for help
  3. Check breathing / pulse
  4. Initiate CPR (30 compressions, followed by 2 rescue breaths)
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3
Q

Zolpidem is also known as ______. ADRS:
Monitor for ______

A

Ambien

Worsen depression / sleep driving / side effects increase with prolonged use

Monitor for suicidal thoughts / behavior

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4
Q

Nursing considerations: Lithium

A

Check serum levels 2x/week during treatment - q2-3 months on maintenance

Draw blood AM prior to dose

Take with meals to avoid GI upset

Encourage 10-12 glasses of water / day and MODERATE (6-10g/day) salt intake

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5
Q

Target serum lithium levels: treatment and maintenance

How long until onset of therapeutic effects?

A

0.5 - 1.5 mEQ/L

0.6 - 1.2 mEq/L

1-2 weeks

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6
Q

Early signs of Alzheimers

A

Short term memory loss
Forgetful
Cannot retain new information
Loss of concentration
Physical appearance / personal hygiene
Night time confusion

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7
Q

Later signs of Alzheimers

A

Loss of judgement
Communication difficulties
Memory loss
Language difficulties
Personality Changes
Night time wandering
Decreased motor functioning

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8
Q

Nursing considerations for Alzheimers

A
  • Safety (bathroom assist every 2-4 hrs to prevent falls)

Exercise programs to delay mobility issues

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9
Q

Meds for Alzheimers

A

Cholinesterase Inhibitor Meds (improve cholinergic transmission)
- Donepezil
- Galatamine
- Rivastigmine

ADRs: livery toxicity + GI upset

NMDA:
- Memantine

ADRs: sleepiness and confusion + GI upset

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10
Q

Why is otittis media more common in children?

A

Shorter eustachian tube + more narrow

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11
Q

Tx for RA

A

NSAIDs or Salicylates

Corticosteroids

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12
Q

Meds for gout + ADRs

A

Colchicine
Probenecid
Allopurinol

Agranulocytosis
Aplastic anemia
GI upset
Renal calculi

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13
Q

Side effects of antihistamines

A

Drowsiness

Dry mouth

GI upset

Bronchospasm (contraindicated with acute asthma attack / hx of asthma)

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14
Q

What should you do with a pt who has Wernicke’s?

How can you keep it from getting worse?

Is it reversible? Do they have to stop drinking?

A

Redirect them - DON’T confront them or present reality

B1 or Thiamine

Yes reversible, don’t have to stop drinking

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15
Q

Two drugs for alcohol aversion therapy

A

Disulfiram

Naltrexone

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16
Q

What pt ed for Disulfirum or Naltrexon?

A

Takes 2 weeks to get into the system

Avoid alcohol products including:
- Mouthwash
- Aftershave
- Perfumes/cologne
- Insect repellant
- Alcohol hand sanitizer

*** they can have red wine vinaigrette

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17
Q

Should you assume intoxication or withdrawl at birth in a newborn?

A

Intoxication

** baby needs 24 hrs to be in withdrawal

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18
Q

S/s of newborn withdrawing

A

Difficult to console

Exaggerated startle reflex

Seizure risk

Shrill high pitch cry

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19
Q

At ____ hrs a pt withdraws from alcohol. At ___ hrs they can have DT.

A

24

72

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20
Q

Nursing considerations DT

3 meds

A

NPO/clear liquids

Private room near nurses station

Strict bed rest / need bed pans and urinals

Vest or 2 point locked leathers (opposite arm and leg) - rotate q2h

Meds:
- Anti-HTN
- Tranquilizer
- B1

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21
Q

Which type of meds are ototoxic ?

A

Amnioglycocides - mycin

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22
Q

Your pt is getting an amino-glycoside, what should you monitor for?

A

Hearing, tinnitus, vertigo/dizziness

Nephrotoxicity

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23
Q

How are aminoglycosides administered?

A

q8h

Route: IM or IV - DON”T GIVE PO for infection

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24
Q

What two meds can be used to sterilize the bowel?

A

Neo can! NEOmycin and CANomycin

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25
Q

When should the trough of a med be drawn that’s IV/SL/IM/SQ/PO?

A

30 min prior to the next dose

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26
Q

When does an IV med peak?

IM?

A

15-30 min AFTER drug is finished

30-60 min AFTER drug finished

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27
Q

What do CCB’s do for your heat?

How do they work?

A

calm your heart - weaken, slow down, depress the heart (cardiac depressant)

Negative inotrope

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28
Q

What do CCB’s treat? What does it NOT treat?

A

Anti-HTN

Anti-angina

Anti-atrial-arrhythmia

(treats everything atrial)

DOES NOT treat SVT

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29
Q

Side effects of CCBs (2)

When should it be held?

A

HA

Hypotension

If systolic is below 100, hold

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30
Q

Names of CCBs

A

“dipine”

Verapamil

Cardizem

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31
Q

V-fib will look like

A

chaotic squigly line. NO PATTERN.

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32
Q

What will V-tach look like?

A

Sharp peak and jags

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33
Q

QRS depolarization, the answer ill always be ______

P wave, the answer will always be ________

Lack of P wave, answer will always be ______

Lack of QRS, the answer will be ______

A

Ventricular

Atrial

Ventricular

Asystole

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34
Q

A flutter looks like

A

Saw tooth

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35
Q

Chaotic is always a word to describe _______ (heart)

Bizarre is always the word used for _____ (heart)

A

Fibrillation

Bizarre

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36
Q

What is the different between low priority and moderate priority PVCs?

A

LOW:
- Premature ventricular contraction (PVC)
- A bunch of PVC’s is like a short run of V-Tach

Moderate Priority:
- If more than 6 PVC’s in a minute or row and/or if PVC falls on the T wave of
the previous beat. They never are high priority!

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37
Q

What meds are given for SVTs?

A

ABCD’s

Adenosine

Beta Blockers

CCBs

Digoxin / Digitalis (Lanoxin)

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38
Q

What would you give adenosine for? What should you warn the pt about?

How fast to push it?

A

SVT

Asystole

Push in 8 seconds (two nurses, one pushes quickly the other flushes quickly)

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39
Q

Your pt is in asystole, what meds are given?

A

Epi and Atropine (in that order)

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40
Q

What is the purpose of chest tubes?

What are the 2 locations for them? And why these places?

When would both locations be used?

A

To reestablish negative pressure in the pleural space

Apical - removes Air
Basilar (bottom of lungs) - removes blood

For Pneumohemothorax

41
Q

What should you do if you knock out a closed chest drainage device like a pneumovac or pleurevac

A

Set it back up and have the pt take deep breaths – not emergency

42
Q

Steps to follow if the water seal on a chest drainage device breaks?

What is FIRST? What is BEST?

A
  1. Clamp
  2. Cut away
  3. Submerge in sterile water
  4. Unclamp because you need to reestablish the water seal
43
Q

What is FIRST and BEST if a chest tube dislodges?

A

First = cover hole with gloved hand
Best = cover with vaseline gauze

44
Q

You are looking at a chest tube water chamber and there is intermittent bubbling; what does this mean?

A

Good ! Document

45
Q

You are looking at a chest tube water chamber and there is continuous bubbling; what does this mean?

A

Bad - tape it (sign of leak)

46
Q

You are looking at a chest tube suction control chamber and there is continuous bubbling; what does this mean?

A

Good! - document

47
Q

You are looking at a chest tube suction control chamber and there is intermittent bubbling; what does this mean?

A

Bad - suction isn’t high enough

48
Q

Never clamp a chesttube for longer than _____ secs w/o a Dr order

A

15

49
Q

What is TOF? Will you see cyanosis?

A

Ventricular defect

Pulmonary Stenosis

Overriding Aorta

Right Hypertrophy

YES– R to L = cyanosis

50
Q

For droplet precautions, do you need a gown?

A

No

51
Q

Measles, Mumps, Rubella, TB, and Varicella = ______ precautions

Meningitis, H-flu = _______ precautions

A

Airborne

Droplet

52
Q

Order for taking off PPE (doffing)

A

Gloves
Goggles
Gown
Mask

(Alphabetical order)

53
Q

Order for donning PPE

A

Gown
Mask
Goggles
Gloves

54
Q

Angle of elbow flexion for crutches?

A

30 degrees

55
Q

Which side do you hold the cane?

A

Strong side

56
Q

Describe to a pt how to use a walker?

A

Pick it up, set it down, walk into it

57
Q

What is a somatic delusion?

A

False belief about your body (ex: X ray vision)

58
Q

Difference between Paranoid and Persecutory deliusion?

A

Paranoid = people are out to harm you

Persecutory = people are treating you maliciously

59
Q

Most common type of hallucination =

A

Auditory (then visual, then tactile)

60
Q

Difference between illusion and hallucination

A

Illusion = something is there, but its misinterpreted

Hallucination = nothing is there

61
Q

Neologism =
Word salad =

A

Making up imaginary words

Random words

62
Q

Narrow self concept

A

When a functional psychotic refuses to leave their room or change their clothing

63
Q

Ideas of reference

A

pt thinks that everyone is talking about them

64
Q

Aminophylline: Therapeutic lvl _______

A

10-20

65
Q

________ Occurs when bilirubin gets around 20 in newborns

A

20

66
Q

__________- Position baby goes in when they have kernicterus. What does this position look like?

A

Opisthotonus

Hyperextension from irritated meninges

67
Q

TX hiatal hernia

A

 High position HOB
 High fluids, high carbs.
 Everything needs to be high, except protein (low)

68
Q

Dumping syndrome usually occurs after ____. What happens?

A

Gastric surgery

 The gastric contents dump too quickly into the duodenum.

69
Q

s/s of dumping syndrome?

A

 Drunk: Staggering gait, slurred speech, delayed reaction time, emotional labile

 Shock: Hypotension, pail cold clammy skin, tachycardia

 Acute abdominal distress

70
Q

TX for dumping syndrome

A

 Low position (HOB flat)

 Turn to side with head down

 Low fluids (1-2hrs before or after meals, not with the meals), Low carbs.

 If you want the stomach to empty slow, everything is low. Except protein

71
Q

For which is protein low: Dumping syndrome or hiatal hernia?

A

Hiatal hernia

72
Q

Which has tachycardia: Hypo or hyperkalemia?

A

Hypokalemia

73
Q

What will the EKG of hyperkalemia look like?

A

Tall p waves

Elevated ST waves

74
Q

s/sof hyperkalemia: agitation or lethargy?

Tachycardia or bradycardia?

Spastic / hyperreflexia or hyporeflexia and relaxed?

Diarrhea or constipation?

A

Agitation

bradycardia, tall p

diarrhea

spastic muscles,
hyperreflexia

75
Q

Hypercalcemia s/s

A

bradycardia

bradypnea

flaccid muscles

hypoactive reflexes

lethargy

constipation

76
Q

Seizures are a risk with hypo or hypercalcemia?

A

Hypocalcemia

77
Q

Hyper or hyponatremia lead to hot flushed skin?

A

Hypernatremia

78
Q

Hypo or hypernatremia leads to fluid restriction and give lasix

A

Hyponatremia (overload fluids)

79
Q

Earliest sign of any electrolyte imbalance is _________

A

numbness/tingling aka Paresthesia

80
Q

Never give more than ____of K+ per liter of IV fluid

A

40

81
Q

What is the FASTEST way to lower K+, what is a slower effective PERMANENT way?

A

D5W and insulin to push K+ back into the cell from the blood

Kayexalate (enema or oral) - trades Na+ for K+ and you poop it out

82
Q

Hyperthyroidism is also known as ______

A

Graves disease

83
Q

3 types of tx for hyperthyroidism

A
  1. Radioactive iodine
  2. PTU
  3. Thyroidectomy
84
Q

How long after getting radioactive iodine for graves does a pt need to isolate?

A

24 hrs

85
Q

When would a pt take PTU? What should you monitor on it?

A

Hyperthyroidism or cancer

WBC monitor

86
Q

subtotal thyroidectomies are at risk for ______. What would this look like?

A

Thyroid storm / thyrotoxicosis

Very high fever 105+
Very high BP (stroke)
Tachy
Psychotically delirious (brain damage)

87
Q

What is the FIRST, BEST and overall treatment for thyroid storm?

A

FIRST: Ice pack
BEST: cooling blanket

O2 mask @10 L
2 staff, 1 pt
No meds (pt comes out of it on their own)

88
Q

Your pt had a total thyroidectomy. What will they need lifelong replacement of?

A

Calcium (risk for hypocalcemia)

89
Q

Your pt just had a total thyroidectomy and they are 12-48 hrs pot op. what should you watch for?

A

Tetany r/t hypocalcemia (have a airway on hand)

90
Q

Your pt just had a partial / subtotal thyroidectomy and they are 12-48 hrs pot op. what should you watch for?

A

Thyroid storm

91
Q

What type of pt can you not sedate and why?

A

Hypothyroidism – go into myexedema coma

92
Q

S/s of addisons

A

Hyper pigmented (very tan)

Unable to adapt to stress - can go into shock with too much stress

Hypoglycemia

Hypotension

93
Q

Tx for Addisons

A

Steroids (-sones)

94
Q

Tx for cushings

A

Adrenalectomy

95
Q

What types of toys should you NOT select for toddlers (1-3 yrs)?

What type of play for this age?

A

Finger dexterity: cut, use pencils, color (including finger painting)

Parallel

96
Q

At what age do children play together?

A

Preschool

97
Q

What are the 3 C’s of play for school aged kids?

A

Create (drawing, legos)

Compete (play games they can win)

Collect (pokeman cards, beanie babies, etc)

98
Q

What is the purpose of a laminectomy? What is this surgery?

A

Relieves nerve root compression

Removal of vertebral spinal processes

99
Q

After any spinal surgery, what are the 4 temporary restrictions for 6 weeks?

What are FOREVER restrictions?

A
  1. No sitting longer than 30 min
  2. Lie flat / log roll
  3. No driving
  4. Do not lift more than 5 lbs (a gallon of milk)
  • Don’t lift objects by bending at the waist
  • cervical laminectomy - never lift above their head
  • no horseback riding, no jerking, 6 flags

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