NCLEX Flashcards
Why do you not massage the injection site when given Haloperidol Deconoate?
Medication is irritating to subcutaneous tissue
What happens during a Non-stress test (pregnacy)
Fetal monitor is attached
Mom will push button when fetal movement is felt
Type of medication is Ketoconazole?
Antifungal med used for treatment of candidiasis
What signs of anxiety would indicate in injection of diazepam?
Restlessness
tachycardia
What is best practice for a pt that starts to present good behaviors?
Give the pt unsolicited attention
What type of food should a pt avoid to prevent dumping syndrome?
Carbs
Should a single use catheter be reused at home by pt doing self care?
No
Why is Ibuprofen contraindicated in pt with bleeding disorders?
NSAIDs increase bleeding by decreasing platelet aggregation.
What type of medication is Naproxen?
NSAID
What is the best medication to give a pt with a bleeding disorder for pain control?
Acetaminophen
What does the medication Sucralfate do?
Forms barrier on gastro mucosa (helps to increase absorption)
What happens to mom’s Dex after delivery?
Rapid drop
What does a placenta do related to mom’s insulin levels?
Placenta in an insulin antagonist and it will stop the insulin from counteracting the glucose in both mom’s and baby’s system
What type of medication is Famotidine and when should it be taken?
H2-Histamine blocker that reuces food-induced acid secretions
Take meds before bed
Is the outside of a bottle of sterile liquid considered sterile?
No
What is a side effect of Tetracycline HCL?
Photosensitivity
What is the first phase of rape recovery?
Disorganization: guilt, self-blame, shock, sobbing, insomnia, nightmares
What are normal symptoms of pt one month after major surgery?
Difficulty coping, frequent crying
What does the drug Glipizide do?
Stimulates pancreas to release insulin
What pt characteristic makes them more likely for developing Herpes Zoster?
Immunocompromised
What is a side effect of Terbutaline for a woman in labor?
Maternal Tachycardia
What is the drug Terbutaline used for in the OB setting?
Delay preterm labor
Why is it important to give prescribed insulin even when pt is feeling sick and not eating?
Illness can raise the dex level, so the insulin administration is still important.
At what age can in infant sit up and play peek-a-boo, and say mama and dada?
10 months
What is the peak timeframe for regular insulin?
1-5 hours
What do Kussmaul respiration and diaphoresis indicate related to blood sugar?
Hyperglycemia
What type of medication is Fluoxetine?
Energizing Antidepressant
What is a standard per hour urine output?
30ml/hour
What interventions are the priority to prevent respiratory complications for a woman post cesarean birth?
Early ambulation
Deep breathing
Coughing
What is the priority nursing problem for pt with placental abruption?
Reduced fluid volume (due to hemorrhage)
What are symptoms of Hyponatremia?
Headache
Apprehension
Cold/clammy skin
Confusion
Irritability
Paresthesia
Why does right sided heart failure cause polycythemia?
Lack of oxygen in blood, will cause marrow to make too many red blood cells
What cranial nerve deals with the motor activity of the facial muscles?
Facial nerve
What cranial nerve provides innervation for extraocular movements?
Oculomotor
What cranial nerve provides innervation to the chewing muscles and sensation to the facial muscles?
Trigeminal (V)
What is a likely post-op complication of a laproscopic cholecystectomy?
Referred shoulder pain due to CO2 that isn’t absorbed by the body
What lab value should be observed if a pt recieves Gemfibrozil?
AST/ liver labs
What are the first symptoms of an acute hemolytic reaction?
Back pain
chills
fever
What is the treatment plan for a pt with medication induced Cushing syndrome?
Gradual dosage reduction of the medication
What is the normal range of pre-albumin levels?
12-42mg/dL
What level of precautions are used for diapered or incontinent pt’s?
Contact precautions
What are four reasons for pt to get the flu vaccine?
65 or older
exposure to general public
Contact with young children
COPD
What type of medication is Benztropine?
Anti-parkinsonian
What are three post-op interventions that should be in place following a myelogram?
Encourage fluid intake
Lay flat for 2 hours
Monitor vital and neuro signs
Where should an IM dose of Prochlorperazine be administered?
Deep into a large muscle mass
What is amenorrhea?
Lack of menstrual period
(miss 3+ or haven’t had one by 15)
Why is Bromocriptine given?
Treat amenorrhea
Stop milk production
(Given because body is making too much prolactin)
When should Bromocriptine be taken?
With meals
What is the first priority following cesarean birth?
Monitor blood pressure
What is impetigo?
High infection superficial bacterial infection
What are symptoms of impetigo?
Honey-colored crusted lesion below nostril
What hormonal diagnosis results in high blood calcium levels?
Hyperparathyroidism
What is a normal contraction frequency?
Occurring every 2-5 minutes and lasting 45-60 seconds
What is L/S ratio?
Test to indicate fetal lung development
What is the normal range of L/S ratio?
2.0-2.5
(Under 2 indicates poor lung development)
What is a breathing strategy to use when pain during labor is becoming overwhelming?
Use shallow respirations
What is the most common complication following an MI?
Ventricular dysrhythmias
What is the ideal diet following surgery?
Increased:
calories
protien
Vitamin C
If you see “most concerned” in a question, what should you be looking for?
Complication
What is the drug Colchicine used for?
Treating acute gout
What is pt at risk for when taking Colchicine and Atorvastain?
Rhabdomyolysis
What is Atorvastatin?
Drug to lower cholesterol and triglycerides
How does Atorvastatin work?
Blocks enzyme needed to make cholesterol, and reduces amount in blood.
What is a common reason that a Sengstaken-Blakemore tube is used?
GI bleeding from esophageal varices
What is pyloric stenosis?
Condition where pyloric valve will not let food from stomach enter the intestines
What is an expected finding of an infant with pyloric stenosis?
Infant will be fussy and seem hungry all the time
What is the best way to assess a pt for fluid volume deficit?
Daily weight
What are expected assessment findings related to low RBC count?
Fatigue
Exertional dyspnea
Pallor
Dizziness
Malaise
Tachycardia
What are three activities expected of a 2 year old pt?
Participate in parallel play
Build a 6-7 block tower
Retrieves objects when asked to so
What is a way to minimized intenstinal cramping when administering tube feeds?
Give tube feeding liquid at room temperature
What type of medication is doxipen HCL?
Antidepressant
What are signs of OD of Doxipen HCL?
Dysrhythmias
Agitation
Why do you remove mask via elastic bands after treating pt on droplet precautions?
Front of mask is considered contaminated
What position should a pt be in when being prepped for liver biopsy?
Supine with Right arm raised above head
What position should a pt be in after a liver biopsy?
On right side with head slightly elevated
What type of drug is Isoniazid?
Anitbiotic used to treat Tuberculosis
What are two initial indications of hepatic dysfunction?
Fatigue
Dark Urine
What organ can Isoniazid damage?
Liver
What is a Myelomeningocele?
Neural Tube Defect where bones of spine do not completely form.
What is an early indication of fluid volume excess?
Change in character of respirations
What is a normal fasting dex?
70-99mg/dL
What is a normal measure of urine specific gravity?
1.003-1.030
What type of medication is Diclofenac?
NSAID
What are four interventions done to pt whose baby is having late decelerations while receiving oxytocin
Discontinue Oxytocin
Put pt on Left side
Apply Oxygen at 8 Lpm
Increase primary IV infusion rate
What would be an indication that treatment for hyperthyroidism is not working?
Anxiety
Extreme nervousness
What are three ways to help an older pt improve their nighttime rest?
Remind pt how to call for help
Postpone explanation of further tests
Identify bedtime routines
What is the normal level of Digoxin?
0.8 - 2ng/mL
What is Digoxin?
Helps treat disrhythmias
How can hospital staff help pt with AIDS from getting an infection?
Limit number of health care personnel caring for the pt
What level of precautions are needed for pt with Pertussis?
Droplet
Why are pts with Cushing syndrome prone to fluid overload?
Cushing syndrome causes both water and sodium retention
What is the top priority for a post-op pt after pain control?
Incentive spirometer use
What is the next step for a pt with a chest tube where the water has stopped fluctuating?
Prep pt for an X-ray
What postition should a pt be placed in who has opened an abdominal suture?
Low Fowler (HOB at 15 degrees)
What are: protienuria, elevated blood pressure, and pedal edema signs of?
Pre-eclampsia
How is intake from peritoneal dialysis measured?
Inflow-outflow
What is a priority action taken with a pt with a substance abuse issue, to create a good working relationship?
Meet individually with pt to discuss consequences of behavior and examine options
How is decreased peripheral edema an indication of favorable results from Levothyroxine?
Levothyroxine increases the metabolic processes of the body, and will allow tissue to clear excess fluid
What is a common source of infection for an child with frequent gastroenteritis?
Daycare
What is the correct order of a wet to dry dressing change?
- Remove dressing
- Dry skin around wound
- Moisten prescribed number of gauzes with prescribed amound of solution
- Apply gauzes as single layer
- Cover with dry dressings
What is the first step in an infant assessment?
Count RR for one minute prior to rousing infant
What instructions should be included for pt learning how to decrease back pain?
- Don’t bend at waist
- Don’t lift while standing on toes
- Place feet wide apart
- Don’t cross legs when sitting
What is the best solution for burn pt that has started showing adverse effects to prescribed morphine?
Explore alternative pain management techniques
What are the three P’s of Hyperglycemia?
- Polydipsia
- Polyphagia
- Polyuria
What is looked for with a Guthrie blood test?
Phenylketonuria
What is the treatment for an infant with a positive Phenylketonuria blood test?
Give reduced phenylalanine formula
What is the normal range of CVP?
2-8 mmHg
What type of drug is Risperidone?
Atypical antipsychotic used to treat schizophrenia and bipolar disorder
What are four teachings related to Risperidone?
- Weight gain is likely
- Temperature regulation is impaired
- Photosensitivity reactions likely
- Causes orthostatic hypotension
What is the first intervention following a vaginal delivery?
Check the lochia flow
What is the most important teaching about excercise related to osteoarthritis?
Do warm-ups prior to excercising
What is an appropriate weight gain during first trimester of pregnancy?
2-5 pounds
What are three pieces of information that should be relayed to a pt having a lumbar puncture?
- You will remain flat in bed for 8 hours after the test
- You may feel discomfort in you leg when the needle is inserted
- You can have analgesics after the procedure if you have a headache
How do you know that an NG tube is functioning effectively?
Hissing sound from the blue lumen tube
What is the priority to monitor in a pt recieving parenteral nutrition?
Blood glucose
How often should an ostomy bag be replaced and the stoma inspected?
Once per week
When in the assessment should a nurse inspect an infants ears?
Last
What kind of drug is Trihexphenidyl?
Antispasmodic (anti-parkinsonian)
What is a clear finding of pain relief?
Improved incentive spirometer results
What are two interventions that can be done related to breast soreness during pregnancy?
- Apply cool compresses to the sides of the breasts
- Wear a well fitting supportive bra
What PPE is requred for droplet precautions?
- gloves
- mask
What level of precautions are need for pt with rubella (German measles)
Droplet
What are two appropriate interventions for pt with bipolar who is currently in a manic phase?
- Distract with light physical activities
- Remind pt concisely about the rules
What kind of medication is Ditiazem?
Calcium Channel blocker
What are the theraputic effects of a Calcium channel blocker?
- Decreased BP
- Decreased HR
What is the most important action to help pt with pain relief?
Establish a trusting relationship with pt
What are Chelating agents used for?
Pt with metal poisoning (lead toxicity)
What is the total calorie recommendations for second trimester?
2200 calories /day
What can indicate overhydration but not a response to dehydration?
Daily weight
What is the correct post-op assessment order?
- Assess RR
- Assess HR
- Determine ability to respond to verbal stimuli
- Check dressing for evidence of bleeding
- Assess type and amount of IV fluids infusing
- Check medical record for surgical notes
What are three diet teachings related to a recent diagnosis of DM II?
- Plan conistent amounts of Macros each meal
- Plan regular times for meals and snacks
- Use fresh foods from all food groups
What are three activities that a pt with rheumatoid arthritis must be able to perform at home prior to discharge?
- Comb hair
- Brush teeth
- Eat independently
Why must a transdermal patch be removed prior to an MRI?
Transdermal patches have heat-conducting aluminized layers and may burn the skin
What type of medication is Chlorpromazine HCL?
Antipsychotic used to treat disorders like schizophrenia and manic-depression
When should post-op breathing be taught to pt?
Prior to procedure
What would neccesitate a repeat urinalysis for a pt with a suspected UTI
Lack of blood cells
When can a child with Hep A return to school?
Two weeks after the onset of jaundice
What is the most important consideration related to giving a PRN dose to a psychotic pt?
A less restrictive intervention failed
What intervention can be done to prevent pt from sliding down in bed while in Buck Traction?
Elevate head and foot of bed. (keeps the leg straight)
What is the correct way to palpate the abdomen for contractions?
Place palm on the fundus and press gently with fingertips
What are early S/S of an ectopic pregnancy?
- Colicky abdominal pain
- Shoulder tip pain
What are two indications of pain in an infant?
- Rubbing body part and crying
- Eyes closed tightly
What is the most concerning finding following a bronchoscopy?
Tachypnea
Why does hyperparathyroidism put pts at higher risk for Urinary Tract Calculi?
Increased Calcium levels
What is the onset time of inhaled albuterol?
5-15 minutes
What is the peak time of inhaled albuterol?
30-60 minutes
When should Sulcralfate be taken to have best results?
On an empty stomach
What is a Gauiac test looking for?
Fecal occult blood
What is the protocol for collecting a Gauiac test?
Collect samples over three days
What is an adverse effect of Isoniazid that needs to be addressed immediately?
Peripheral neuropathy
What type of medication is Fluticasone?
Glucocorticoid
Why do you need to flush your mouth after taking an inhaled glucocorticoid?
Reduce chance of getting candida infection
What are four discharge instructions that should be included with an MS pt?
- ambulate as tolerated every day
- avoid exposure to extreme temperatures
- Perform stretching and strengthening excercises daily
- Participate in social activities
What type of medication is metronidazole?
Antibiotic
What action is appropriate for a pt that is sleeping but is disorientated when aroused?
Raise side rails of bed
What are five teachings related to diabetic foot care?
- Never go barefoot
- Wash feet with warm water and soap daily
- Trim toenails straight across
- Avoid extreme temperatures
- Daily feet inspection
What is the best teaching method for a school-aged pt?
Interactive teaching (models, games, puzzels)
What type of medication is Tranylcypromine Sulfate?
MAOI
Why does a pt taking an MAOI need to follow a low Tyramine diet?
Risk of hypotensive crisis
What should be suspected with a pt receiving furosimide now complaining of muscle weakness and dizziness?
Dehydration and electrolyte imbalance
How is an abdominal wound with dehiscence treated?
Apply a sterile abdominal dressing soaked in sterile NS and cover with a sterile waterproof drape
Why is head circumference an important measurement following mylomeningocele repair?
High risk for hydrocephalus following surgery
What should an older adult with dementia be encouraged to do?
Talk about important past events
What is the first step for giving medications through an NG tube?
Check tube placement
What diagnosis does a positive sweat test indicate?
Cystic Fibrosis
What are three elements of a Cystic Fibrosis care plan?
- Administration of replacement enzymes
- Social Service referral
- Unrestricted fat diet
What macronutrient is not absorbed well in pt with CF?
Fat
What is Bismuth Subsalicylate?
Antacid (pepto bismol)
Why should PO medication be delayed if Bismuth Subsalicylate is given?
Medication will absorb PO meds
What are four actions that can help decrease milk production?
- Take acetaminophen
- Wear well supportive bra
- Apply cool packs to breasts
- Be patient as milk supply decreases
What are four indicators of early hepatic encephalopathy?
- Decreased attention span
- Impaired thought process
- Insomnia
- Sleep disturbances
What type of medication is Butorphanol Tartrate?
Synthetic opioid used for pain control
Which muscles are stronger: flexor/extensor?
Flexor
What does continuous bubbling in a chest tube water chamber indicate?
Air leak
What is Diabetes Insipidus?
Water metabolism disorder caused by antidiuretic hormone deficiency
What medication is given for treatment of Diabetes Insipidus?
Desmopressin (DDAVP)
Why should a pt with Diabetes Insipidus report weight gain to their healthcare provider?
Weight gain with DI may indicate that medication dosing may need to be adjusted
What are pt’s with Diabetes Insipidus at risk for?
Dehydration due to fluid loss
What sputum characteristics would indicate a theraputic response for a pt with pneumonia?
Color change from green to white
What nursing action is appropriate for a pt with significantly depressed T cells?
Remove any standing water left in equipment or containers
What is the expected result of IV Heparin therapy?
Prolonged aPPT of 1.5x the control
(Activated partial thromboplastin time)
What are the most important symptoms to relay for a pt with urinary calculi?
Change in location or character of pain
What are two common symptoms of type 1 diabetes?
- Execessive thirst
- Weight loss
What information should be on lab slip for a pt who had blood gases drawn?
If supplimental oxygen was used
What is a ballottement test?
Test looking for effusion (fluid) in the knee
What position should a pt’s legs be in for a ballottement test?
Straightened and supported on the bed
Where should a drainage evacuator be attached?
To pt clothing and below the level of the wound
What type of medication is Chlopidogrel?
Platelet aggregation inhibitor
What characteristic of morphine makes it a better drug choice than fentanyl for a pt with cardiac chest pain?
Vasodilation
What are the 5 “rights” of medication administration?
- Pt
- Drug
- Dose
- Route
- Time
What is the decision process for “Who do you see first”?
- Stable vs Unstable
- Unexpected vs. Expected
- ABCs
- Acute vs. Chronic
- Actual vs. Potential
Whose words is a chief complaint in?
Pt’s
What kind of pt can an LPN take?
Stable pt who do not need ongoing assessment, clinical judgment, or teaching
When should an AIDs pt cover their Karposi sarcoma?
If they are open
What position should an infant with a cleft lip and palate repair be placed in if they show signs of congestion and labored respirations?
On their side
(helps them adjust to breathing through their nose)
What is a Wilms tumor?
Most common kind of kidney cancer in children
What action should be avoided for a pt with a Wilms tumor?
Abdominal manipulation
(this can disseminate the cancer cells)
What is the normal measurement of an newborn head?
32 - 36.8cm
What is the average chest circumference of a newborn?
30 - 33cm
What is the best protocol for taking prenatal vitamins?
Take at bedtime with orange juice
(acid assists with iron absorption)
Can a pt vote if they are admitted to locked psych unit?
Yes via absentee ballot if they are registered to vote
What type of medication is Amphotericin B?
Strong antifungal used to treat serious fungal infections
What is hematocrit?
Percentage by volume of red cells in blood
Why is hematocrit elevated in burn pts?
Dehydration (fluid shift)
Increased viscosity
What is the drug Neostigmine Bromide used for?
Treatment of Myasthenia Gravis
What is an action to establish a normal urinary pattern?
Keep a record of daily fluid intake
What is the most common post-colonoscopy complications?
Bowel perforation
What is the most important sign to monitor for following a colonoscopy?
Increased abdominal pain
Is a fever over 103 degrees a contraindication for a DTaP vaccine?
Yes
What are Hand/ arm spasms following a blood pressure measure called?
Trousseau sign
What does a positive Trousseau sign indicate?
Tetany (which is a symptom of hypocalcemia)
At what age range does a child start to walk?
12-15 months
What is another name for Pyridoxine?
Vitamin B6
Why should apple juice be tried before orange juice in a diet evaluation?
Apple juice is a clear liquid
Orange juice is part of a full liquid diet
Should muscle twitching occur while a TENS unit is being used?
No (voltage is too high if twitching is occurring)
What is Cholestyramine used for?
Lowers blood Cholesterol levels
Why can Cholestyramine and Digoxin not be taken at the same time?
Cholestyramine interferes with absorption of Digoxin
(Take Dig before cholestyramine)
What is a healthy total plasma cholesterol level in an adult?
Under 200
Why does the last menstrual period information need to be obtained in a pt taking Phenytoin?
Phenytoin can cause birth defects
What is the first step if a chest tube system becomes disconnected from the drainage system?
Insert the tubing into a container of sterile water
What is the priority intervention for an infant after surgery?
Get parents to to touch infant (builds trust)
What are common characteristics of pt who have Hyperosmolar Hyperglycemic Syndrome (HHS)?
- Over 60
- Impaired thirst sensation or inability to replace fluids
- Taking beta blockers
What are three symptoms of NSAID toxicity?
- Ecchymosis of extremities (bruising)
- Hematemesis
- Flank pain
What is a positive Brudzinski reflex?
Flexion of hips and knees when head is bent forward to chest
(confirms meningeal irritation)
What liquid whould Ferrous Sulfate be given with?
Orange Juice (helps with absorption)
What are symptoms of Neuroleptic Malignant Syndrome?
- Generalized muscle rigidity
- tachycardia
- oliguria
- elevated temperature
What is the best way to improve pulmonary status in a pt with atelectasis?
Increase incentive spirometry use
What is assumed if a pt HR drops below the set rate on their pacemaker?
Pacemaker is malfunctioning
What are teachings related to pt with myasthenia gravis?
- No alcohol
- Avoid crowds
- Keep emotional extremes in check
- Avoid temperature extremes
- Spread work/activities throughout the day
- Thicker liquids are better
What direction is given to pt after nurse give Atropine sulfate eye drops?
Hold pressure on the inner canthus for 1 minute
What type of medication is Dexamethasone?
Corticosteroid
When should Dexamethasone be taken?
With meals
What is a good teaching for recently diagnosed pt with AIDS?
Take stool softeners and laxatives to reduce intestinal stasis and bacterial overgrowth
Why is morphine the higher priority than oxygen for a pt with cardiac chest pain?
Morphine will decrease the preload and afterload pressures
Why does prothrombin time need to be checked prior to a pt with Hep B getting surgery?
Hep B can cause a deficiency of clotting factors
What is the drug Theophylline used for?
treatment of COPD and Asthma
What effect can Beta Blockers have on Theophylline?
It can increase level because of the slowing of the metabolism (high risk for toxicity)
What can happen if pt takes Theophylline and Ciprofloxin?
Ciprofloxin slows the hepatic clearance of the drug and can lead to toxicity
Why is Theophylline contraindicated in pt with seizure disorder?
Theophylline can exacerbate the seizure disorder
What is an important intervention for a pt near end of life?
Regular turning (maintaining skin integrity)
What is a transsphenoidal hypophysectomy?
Procedure through the nose to remove pituitary or similar tumors
Why is urine specific gravity monitored after a Transsphenoidal Hypophysectomy?
If ADH from the pituitary is not curculating, pt is at risk for Diabetes Insipidus
What is Buergers disease?
Swelling of blood vessels in arms and legs
What should a pt with Buergers disease be doing daily?
Inspecting fingers and toes
What is the first step when palpating a pt with abdominal pain?
Have pt breathe slowly through mouth
What is the most important assessment following rupture of membranes?
Look for prolapsed cord
What are three actions taken for pt with suspected Salicylate overdose?
- Determine time when medication was taken
- Draw ABG
- Check temperature (Hyperthermia is a common reaction to salicylate overdose
Is a KVO fluid rate appropriate for a pt with sickle cell anemia?
No
What teachings should be included for pt taking Ciprofloxacin?
- Drink 12 cups of water/3 Liters per day
- Do not take anything with iron, calcium, zinc, magnesium 2 hours before or 6 hours after taking med
- Avoid exposure to the sun (photosensitivity reactions)
- Call HCP if you have diarrhea
What are four teachings given to pt to prevent urinary tract calculi?
- Drink at least 3000 (100oz) of water a day
- Eat low sodium diet (decreases calcium exretion)
- Increase fluid intake in hotter environments
- Limit coffee/caffeine intake
What medication is prescribed for pt with alcohol withdrawal?
Chlordiazepoxide
Why do burns cause hypokalemia?
Diuresis from fluid shifts
What are two signs of hypokalemia and when do they occur after a burn?
General muscle weakness and lethargy
(occurs three days after burn)
What is a normal A1C level?
Under 5.7%
(6%+ = diabetes)
What vitamin are Dark leafy vegetables and pork rich in?
Vitamin K
Why do pts taking Warfarin need to avoid vitamin K?
Vitamin K stops the anticoagulant effect of warfarin
What must be avoided in the diet of a pt taking Phenelzine Sulfate?
Tyramine (can cause hypertensive crisis)
What is the correct order for a pt to collect a clean catch urine specimen
Why is a pt instructed to not hold their breath during the insertion of a suppository?
Holding breath can cause rectal muscles to tighten
Why is the temperature of an older adult lower at baseline?
Decreased in basal metabolic rate
What elevation should the irrigation set be held above rectum when administering an enema?
12 inches above rectum, 18 inches above mattress
What action can a pt take that will allow for an assessment (palpation) of the thyroid?
Swallowing
Why is the best assessment for a pt in Buck traction checking if the elastic bandages are not too loose or too tight?
This will determine if circulation is being compromised
Where should an abductor pillow be secured?
Above and below the knee
What is metoclopramide used for?
Stimulates the motility of upper GI tract. It is used to treat the nausea of chemotherapy
(Do not take with possible hemorrhage of GI tract)
Is Prednisone indicated or contraindicated in presence of peptic ulcer?
Contraindicated
What type of medication is Famotidine?
H2 histamine receptor antagonist (antacid)
Treats reflux
What is the timeframe for onset of short-acting insulin?
30-60 minutes
What is the most important post-op activity for pt who had heart surgery?
Early ambulation/activity
What are four symptoms that indicate cocaine abuse?
- Paranoia
- Insomnia
- Rhinorrhea
- Tachycardia
What are two teachings related to an Intravenous Pyelogram?
- You may experience a hot feeling and/or flushed skin
- You will complete the bowel prep before this procedure
What finding indicates a complication with Cholecystitis?
Jaundice (possible stone in bile duct causing obstruction of bile flow)
What is the best intervention for maintaining bone mass?
Weight-bearing activities
Why should ear wash be warmed prior to irrigation?
Cold water can cause dizziness if it comes into contact with the tympanic memebrane
What is the normal Calcium range for a pt 1-18 years old?
4.8 - 5.5mg/dL
If there is stomach contents drain through the air tube of a double - lumen NG tube, what action is most appropriate?
Insert 30mL of air through the air vent
Why is difficulty with gas exchange a problem for pts with Acute Lymphocytic Leukemia?
ALL causes decreased: RBC, Hgb, Hct, platelets
What is Cimetidine used to treat?
Ulcers/GERD
(stops production of stomach acid)
When should Cimetidine be taken?
With meals and 1 hour before bed
Why type of medication is Aluminum Hydroxide?
Antacid
When should Aluminum Hydroxide be taken?
2 hours after meals and at bedtime
What type of medication interferes with Cimetidine absorption?
Antacids
When does the positive Babinski reflex disappear?
at 1 year of age
When does the extrusion reflex disappear?
Between 4-5 months old
What should a 6 month old infant’s eyes do when an object is dropped in front of them?
Follow the dropped object
What are teachings related to Hydrochlorothiazide?
- Can cause drowsiness
- Take with food
- Limit Sun exposure
What is a major sign of hypoparathyroidism?
Tetany
What type of medication is Prochlorperazine?
Treats N/V
(Compazine)
Why should aspirin be stopped prior to a pt having an occult blood test?
Bleeding from Aspirin could mask an actual GI bleed
What distraction activity is most appropriate for a pt with vaso-occlusive crisis?
Listening to music with headphones
Why should you dim the light in a room and minimize stimuli for a pt with Meningitis?
Decrease chances of motor seizures
What are teachings for a pt with a radium implant?
- Eat low residue diet to decrease bowel movements
- Have pt conserve energy
- Take anti-nausea medication
Why should ginger not be taken by a pt receiving heparin?
Ginger can extend clotting times
What type of diet should a pt with a spinal cord injury be on?
Adequate fluids
High fiber
What is the first action taken by a nurse for a pt following a bronchoscopy?
Touch back of throat to evaluate gag reflex
What type of pts can a nurse with shingles lesions NOT care for?
Pregnant women
preterm newborns
immuncompromised clients
What vegetable should be taken out of diet if pt has diverticular disease?
tomatoes
What chemical should be avoided by pt with Graves Disease?
Caffeine
Why do pts with Bell palsy need to use artificial tears?
Eyelid does not close completely and blink reflex is diminished
What are three interventions for pt with abdominal gas pain?
- Ambulate pt frequently
- Position pt on right side
- Provide Bisacodyl suppositories PRN
What are four classic signs of meningitis in an infant?
- Fever
- Poor feeding
- Irritability
- Bulging Fontanel
What type of pt can a UAP take care of?
Pt who is stable with standard/unchanging procedures
What is involved with the “right person” area of delgation?
Ensuring that the correct personnel is chosen to complete the assigned task
What is an indication that bleeding is no longer occurring in a patient with GI bleeding and who has an NG tube?
Lack of coffee ground emisis or blood in the NG suction
What type of medication is Promethazine?
aka Phenergan
antihistamine, antipsychotic, sedative and antiemetic
What kind of medication is Scopolamine?
Anticholinergic agent used to treat motion sickness, N/V
What does an elevated Erythrocyte Sedimentation rate indicate?
Inflammatory process
What is a normal Erythrocyte sedimentation rate in men both under and over 50 y/o?
<15mm/H
<20mm/H
What is a normal Erythrocyte sedimentation rate in women both under and over 50 y/o?
<25mm/h
<30mm/h
What does an elevated Brain Natriuretic peptide level indicate?
Congestive Heart Failure
What is a normal value of Brain Natriuretic Peptide?
<100pg/mL
What does an elevated C-reactive protien level indicate? (4)
- Inflammation
- tissue injury
- infection
- atherosclerosis
What is a normal C-reactive protein level?
<1mg/L
What does International normalized ratio level monitor?
Effectiveness of Warfarin
What is a normal range of INR?
2 - 3.5
What are three risk factors for sleep apnea?
- Obesity
- Short neck
- Smoking
What level of precautions are needed for a pt with Meningococcal Menigitis?
Droplet precautions
What actions should be taken if pt vomits in nurses face?
- Report to employee health for lab testing
- Complete an incident report or other variance documentation
- Inform pt that they will be tested for blood-borne infections
What are three S/S of Acute Leukemia?
- Petechiae
- Orthostatic Hypotension
- Joint Pain
Who can give consent for a surgery of a pediatric ward of the state?
Foster parent
What are three core measure needs for a pt recovering from an ischemic stroke?
- Provide a prescription for a statin medication at discharge
- Provide and document stroke education prior to discharge
- Prevent venous thromboembolism
What are three factors that will increase an older pt chances of falling?
- Glare from bright lights
- Medication interactions
- Previous Falls
What are three teachings related to a pt with asthma and who has been prescribed a corticosteroid?
- Use spacer with all inhalers
- Use peak flow meter as ordered
- Keep home dry and dust free
What are two actions that will be taken during the second/entry phase of the home visit?
- Determine nursing diagnoses
- Establish desired outcomes for pt
What teachings about skin cancer prevention are appropriate?
- Avoid sun exposure between 1100-1500
- Wear opaque clothing and a hat when outside
- Keep a “body map” of skin spots for a baseline
What complication of an enema will present with abdominal distention and rigidity?
Bowel perforation
What are examples of side effects from an anticholinergic medication?
- pupil dilation
- blurred vision
- dry mouth
- urinary hesitancy and retention
- constipation
what is a normal serum phosphate range?
3 - 4.5mg/dL
What depth does a vaginal suppository need to be inserted to be effective?
2 inches
What are three early manifestations of a peanut allergy?
- Urticaria
- Wheezing
- Dyspnea
What is the best action by pt to prevent consipation?
Exercise 3x per week
What is a TIPS procedure?
Putting a stent to connect portal vein to adjacent blood vessels with lower pressure
Why is a pt who recently had a TIPS procedure at risk for bleeding?
Altered clotting factors due to liver dysfunction
What is a symptoms related to blood pressure that indicates pt is developing cardiogenic shock?
Hypotension with a narrow pulse pressure
What is medicare reimbursement based on?
Based on assigned diagnosis-related group regardless of length of stay or use of services
What are four expected interventions for a pt with Diabetic Ketoacidosis?
- Short acting IV insulin
- Isotonic IV fluids
- Hourly intake and output
- Finger dex checks every hour
What are interventions that can be done for a pt with chronic insomnia?
- Participate in calming activities before bed
- Avoid negative associations with inability to sleep
- Get out of bed and try a relaxing activity to induce relaxation
- Use essential oils with relaxation properties
What should be done if purulent drainage at the insertion site of a PIV is noted?
Save the catheter to send to lab for a culture
What type of medication is Formoterol?
Long-acting bronchodilator
What is the normal range of PaO2?
85-95
What is a theraputic level of Phenytoin?
25 or below
(over 25 is toxic)
What are teachings related to a pt with hiatal hernia?
- Avoid chocolate and carbonated drinks
- Stay in an upright position after meals
- Elevate the head of the bed six inches
Can a pt adjust their home O2 rate?
No, O2 is a drug and needs to be changed by a provider
Should Insulin Glargine be mixed with any other insulin?
No
What is Cushing’s Triad?
A set of vital signs that are indicative of increased ICP
What are the elements of Cushing’s Triad?
- Bradycardia
- Irregular Respirations
- Widened pulse pressure
What does chronic pain increase the risk of in an older pt?
Depression
What are three teachings for parents of a newborn with a circumcised penis?
Wash area by squeezing warm water over it
Avoid wipes that contain alcohol
Report any redness, bleeding, or drainage
What type of medication is Amikacin?
Aminoglycoside Antibiotic
What type of medication is Spironolactone?
Potassium-sparing diuretic
What is a side effect of Aminoglycoside?
Ototoxicity
(tinnitus, vertigo)
What is the priority assessment for pt getting epidural anesthesia?
Blood pressure
What must be true related to right task of deligation?
Task must be within scope of practice for designee
What is the best technique to teach pt for lung secretions?
Huff cough
What complication can occur in a preterm newborn that is very low birth weight and who is recieving oxygen therapy?
Retinopathy of prematurity
(can cause blindness)
What is the best post-op intervention for a pt with an autograft placement on lower extremity?
Elevate and immobilize the grafted extremity
What are postmortem activities that would be completed by staff?
- Close eyes
- Leave dentures in place
- Arms placed at side
- whole body cleaning/bed bath
- Stop all infusions
What nursing action would preceed a prosthetic fitting for a pt with a leg amputation?
Wrap residual limb with a bandage
Psyllium is a safe laxative. How does it work?
Psyllium is a fiber that increases the water retention within the stool which stimulates peristalsis
What are two potential problems with regular ingestion of Docusate Sodium?
- Laxative dependency
- Impaired absorption of fat-soluble vitamins
What are potential problems with regular ingestion of Magnesium Hydroxide?
Saline laxative that works by drawing water into the intestine from surrounding tissues
- Electrolyte balance
- Dehydration
- Laxative dependence
What part of the body can be used to assess for presence of cyanosis on a dark-skinned pt?
Palms of hands
Why do older adults have hyponatremia more often?
Increased levels of antidiuretic hormone and atrial natriuretic peptide combined with decrease in renin and aldosterone lead to decreased sodium reabsorption and increased water retention by kidneys
Should family of deceased pt’s be given chance to help with body prep?
yes
What causes transfusion-related acute lung injury?
Reaction of anti-leukocyte antibodies between donor and recipient
How can a Transfusion-related actue lung injury be prevented in a pt that requires a transfusion?
Request for Leukocyte-reduced red blood cells to be used for the transfusion
What does a pt taking an MAOI have to avoid?
Tyramine
Are store-bought sauces and dips usually high in tyramine?
yes
What is the best way to ensure continuity of care when pt is discharged from hospital?
Communicate with primary health care provider
What are four ways to assess Gait and lower limb mobility of a pt with a knee replacement?
- Walk across the room and back
- Walk heel to toe across the room
- Close eyes then stand with feet together with arms resting at side
- Close eyes and stand on one foot
- Run the heel down the shin of the opposite leg toward the foot
What is required of care staff for a pt that was bit by a dog outside of medical treatment?
Report bite to health department
Does a pt with hemiplegia and dysphagia need to avoid peanut butter?
Yes
What rate of rewarming should be used for a pt receiving therapeutic hypothermia?
Rewarm at a rate of 0.45 degrees F per hour
What is the best action to help a pt in a long-term care facility reports not getting enough sleep?
Have pt keep a sleep diary and rate sleep quality for a week
What are four findings that indicate potential complication due to immobility?
- Lower leg edema
- Crackles auscultated in lung bases
- Muscle atrophy
- Nonblanchable skin erythema
Why does aging lower pain tolerance?
Diminished adaptive capacity
What type of medication is Acyclovir?
Antiviral medication used to decrease pain and slow disease progression
What type of pt does Dupuytren’s contracture occur in?
Men over 50 of Scandinavian or Celtic descent
Occurs most often in conjucture iwth: diabetes, gout, arthritis, alcoholism
Can Finasteride, Levetiracetam, potassium chloride be crushed into an NG tube?
no
Why are Aminoglycosides contraindicated in pts with kidney impairment?
Aminoglycosides are nephrotoxic and toxic levels are reached rapidly
Why are Aminoglycosides contraindicated in a pt recieving Warfarin?
Aminoglycosides can kill normal gut flora which will reduce the amount of vitamin K available
What is the most common causes of ARDS?
Aspiration
How should a fat emulsion be infused in a pt getting parenteral nutrition?
Fat emulsions need to be infused through a separate peripheral or central line with a Y-connector
What are three characteristics of iron deficiency anemia?
- May occur with removal of duodenum (loss of absorption abiity)
- Associated with chronic blood loss
- Most common type of anemia
What can a nurse ask a pt to do when removing a central venous access device?
Ask pt to hold breath during removal (valsalva maneuver increases intrathoracic pressure and prevents air from entering through the opening of the skin)
What is the most important assessment finding in a pt after they have had a thyroidectomy?
Numbness in fingers (first indication of hypocalcemia)
What is part of the post-op care plan for a pt that has had surgical repair of detached retina of one eye?
Cover the operative eye, and limit the movement of both eyes
What should be suspected if a child presents with headache, vomiting, and wants to be in a quiet, darkened room?
Possible bacterial Meningitis
What three factors suggest that pt may have Heparin Induced Thrombocytopenia?
- Heparin use for more than 5 days
- Platelet count decreased by 50%
- Erythema (superficial skin reddening)
What can facial and periorbital edema indicate in a pt receiving chemotherapy?
Superior vena cava syndrome (tumor near the superior vena cava cause increased pressure which leads to breathing and circulation deficits
What are four indications that a pt is in anaphylactic shock?
- Hypotension
- Oliguria
- Stridor
- Restlessness
What are two most common causes of hypercalcemia?
- Malignancies (malignant neoplasm)
- Hyperparathyroidism
What are the steps for discharging a pt to a long-term care facility?
What is a common lab finding in pts that are malnourished or are diagnosed with anorexia nervosa?
Hypophosphatemia
What IV fluid is given to start wean a pt from TPN?
10% dextrose in water
What is the correct order for performing a swallow study (bedside)?
What is an expected finding related to mastoiditis?
Tympanic membrane that is red, dull, and thick
What is the priority for a pt returning after an open cholecystectomy?
Assess pain level
What is a result of bone destruction by tumors?
Hypercalcemia
Why is fluid intake critical with ciprofloxacin?
Prevents crystalluria and renal calculus formation
What type of medication is Sulindac?
NSAID
When is a fetal lie measured as positive values?
When baby (presenting part) is below the pelvic brim
What are two things that can prevent new tracheostomy dislodgement?
- Wait 24 hours to change trache ties
- Suction tube when there is a moist cough or hypoxia
Why is activity limited in a pt with sickle cell anemia who is in a vaso-occlusive crisis?
Reduction of activity will reduce oxygen demands and reduce sickling
What are four examples of good care related to a new cast applied to a pt?
- Handle cast using palms
- Elevate limb to level of the heart
- compare toes of casted and non-casted leg
- Put a fan in pt room
Why is an upper GI fluoroscopy a time sensitive test?
Barium radiography can interfere with other tests (x-ray, ultrasound, proctoscopy, colonoscopy)
Where is early jaundice best observed in pt of Asian descent?
Posterior hard palate
What position should a pt who had a supratentorial craniotomy be placed in following surgery?
- Semi-fowlers
- Head midline
- Minimal hip flexion
Why will a pt with regular respiratory treatments be at risk for hypervolemia?
Inhalation and absorption of excessive amounts of water vapor through the lung tissue
Why is a warming tray for food a good gift for a pt with Parkinson disease?
The ability to keep food warmer and more appealing will help a pt with this condition who will be slower eating
What is the correct order for using a standard walker?
How often should a pt with DM I inspect their feet?
Daily
What is the correct order for placing pt on a continuous passive motion machine after knee replacement?
Why is strenuous activity discouraged before or during a creatinine clearance test?
Creatinine is a waste product of muscle breakdown and exercise will affect the results
What type of pain relievers should be given to a pt following a retina repair?
Non-narcotic (decrease constipation)
What is the highest priority for a pt with new dx of myasthenia gravis?
Assist with mealtime (risk of choking and aspiration)
What is the daily expected output from a T-tube following an open cholecystectomy?
400ml (1.5 cups)
What expected medical history would be present in a pt with Hypoparathyroidism?
- Carpal spasms
- History of convulsions
- Muscle irritability
Why is an abductor pillow placed on a pt with hip replacement?
Prevent dislocation of the hip while turning
What type of medication is Alteplase?
Thrombolytic medication, used to treat acute ischemic stroke, acute ST-elevation myocardial infarction, pulmonary embolism associated with low blood pressure, and blocked central venous catheter
Why should Alteplase be used with caution in presence of known or suspected infection?
Could release a localized infection into the systemic circulation
What type of diet should a pt with severe liver disease be on?
Low protein
High Carb
Where should meds be stored to prevent a toddler from getting to them?
Locked cabinet
What are three interventions for a pt with orthostatic hypotension?
- Conserve energy
- Increase fluid intake
- Rise slowly
Why should pts with a laryngectomy avoid direct exposure to cold air?
Potential tracheal spasm
What is the first step step to deal with autonomic dysreflexia?
Put pt in a sitting position (first step to reduce ICP)
According to NCLEX what are two “truths” about gun safety?
Guns in home increase the risk for adolescent suicide
Family and acquaintances are a common source of guns for adolescents
What is the correct order for donning a prosthetic device?
What is an early sign of chronic kidney disease
Polyuria
What is the correct steps for attaching a pulse oximeter?
What are three things that can help pt with ileostomy to promote elimination?
- Drink warm fluids
- Massage around the stoma
- Take a warm shower or bath
Is supplimental O2 provided to pt with history of stroke regardless of current O2 status?
yes
What is the max allowable amount of drainage from a post-op drain?
200mL after the first hour and 100mL in susequent hours
What diet should be suggested to an adolescent female?
High Calcium: supports growth and help prevent osteoporosis in later years
What Braden score indicates a mild risk for a pressure injury?
15-18
What Braden score indicates a moderate risk for a pressure injury?
13-14
What Braden score indicates a high risk for a pressure injury?
10-12
Leg Spasms and peripheral neropathy are caused by too little of what mineral?
Calcium
How can acute kidney injury lead to hypocalcemia?
The early phase of the process will be the polyuric phase. Calcium is excreted at a high amount which leads to hypocalcemia.
How can a pt be at risk for hypocalcemia following removal of the thyroid gland?
Possible damage to the parathyroid gland puts pt at risk for hypocalcemia
What is the preparation for the Lower GI series test?
- Clear liquid/low-residue diet for 2 days
- NPO after midnight before test
- Enemas and laxatives
What is a normal BUN level?
10-20mg/dL
What does an elevated serum anti-streptolysin O titer indicate?
Glomerulonephritis
What is a normal total serum bilirubin level?
14 and below
What is a normal infant respiratory rate?
25-55
What is the correct direction of movement when using a doppler on a pt with peripheral arterial disease?
Distal to proximal
Is the incidence of psoriasis higher or lower in darker-skinned races
lower
What do the symptoms: conjunctivitis, cough, truncal blisters indicate?
Stevens-Johnson syndrome
aka. Toxic epidermal necrosis
What type of medication is Hydrochlorothiazide?
Non-potassium sparing diuretic
What is most important step when creating a teaching plan for a pt with previous CVA?
Ask pt to discuss perception of health status
What are four signs of vitamin B12 deficiency?
- Fatigue
- Constipation
- Sore tongue
- Diarrhea
What assessment must be done before, during, and after a paracentesis?
Blood pressure
How far should a visitor be from a radiation source?
6 feet
What is the correct order for dealing with choking pt?
When does racemic epinephrine reach its peak effect?
2 hours after administration
What are teachings related to a pt being on an insulin pump?
- Troubleshooting issues can help prevent DKA
- Change tubing every 2-3 days
- Always have a backup way to administer insulin
- Pump settings must be kept with pt
What are symptoms of an allergic reaction?
- Rhinitis
- Angioedema
- Bronchospasm
- Shock
What is the first action if a PICC catheter has broken off inside a pt?
Apply a tourniquet to the upper arm
What system status is assessed by a CD4+ test?
Immune system
What are four interventions that can be done to reduce risk for pressure injury?
- Pt pt on an air mattress
- HOB at less than 30 degrees
- Put pillows under calves
- Instruct pt to use the overhead trapeze bar
What is another name for Struvite calculi?
infection calculi
(they form in response to ammonia)
Why is joint pain a concern with a hemophilia pt?
Joints are frequent sites of bleeding
What should the dialysate characteristics be in a pt on CAPD?
Clear and straw colored
What is the first step in establishing a plan for safe movement in pt home?
Assess pt ability to balance and transfer
At what height is a booster seat no longer needed in a car?
4’ 9’’
What is the medication Propylthiouracil used for?
Inhibit the production of thyroid hormone
Why are ACE inhibitors stopped once pregnancy is detected?
They can impair fetal renal function and can cause fetal death
What is the ideal height for a bladder irrigation bag?
60cm
What nursing intervention can prevent pt from experiencing complications associated with TURP procedure?
Teach pt how to stop and start urine stream
What type of medication is Nifedipine?
Calcium channel blocker used as an antihypertensive
can cause bradycardia
When are pts with total hip replacement often discharged?
Post-op day 2-3
What are symptoms of a transfusion-related acute lung injury?
- fever
- chills
- hypotension
- tachypnea
- frothy sputum
- dyspnea
- hypoxemia
- resporatory failure
What are signs of Lithium toxicity?
- diarrhea
- oversedation
- ataxia
- tinnitus
- slurred speech
- muscle weakness/twitching
What is the peak and duration of action time of Aspart insulin?
Peak: 1-3 hours after admin
Duration: 3-5 hours
What are four methods to determine patency of AV fistula?
- Auscultate to detect a bruit
- Palpate pulses distal to the site
- Observe capillary refill in fingers distal to site
- Check for altered sensation
What is the best diet for a pt on Lithium?
Regular sodium intake
adequate fluid intake
What precautions are needed when dealing with a pt with disseminated herpes zoster?
Contact and airborne isolation
What are two interventions for a pt with dementia that is pocketing food in the mouth?
- feed pt in smaller portions
- allow family to bring the pt’s favorite food in
What is another name for cholelithiasis?
gall stones
What are three risk factors for gall stones?
- obesity
- multiple pregnancies
- age (20-60)
Can an LPN irrigate an NG tube?
yes
What can an absent red reflex indicate in an infant?
Suppression of optic nerve function that can lead to blindness
What is the medication Permethrin used to treat?
Lice
What are teaching points related to Permethrin?
- Leave cream on hair for 10 minutes before rinsing it out
- Use cream once per week
- Redness and skin irritation are potential adverse effects of permethrin
- Check family members as condition is easily spread
- Itching should stop after use of the medication
What type of pt will benefit from having a case manager assigned to their care plan team?
Case management are used to help pts with chronic or long-term can and conditions
ie. new dx of COPD or kid with Type 1 diabetic ketoacidosis
What is the medication Phenazopyridine used for?
Provides a topical analgesic effect on the urinary tract mucosa. It’s used a lot for pt’s with UTIs
What is a side effect of Phenazopyridine?
Turns urine orange or red
What are three actions that can be done related to sputum collection?
- Use a suction catheter if needed
- Offer oral care before collection
- send specimen to lab immediately
How many large squares are in a six second strip?
30
What are five findings consistant with diabetic ketoacidosis?
- Poor skin turgor
- polyruia
- elevated dex
- tachycardia
- orthostatic hypotension
What are four priority assessments for a pt with preeclampsia and being treated with magnesium sulfate?
- Look for facial edema
- Measuring blood pressure
- Eliciting deep tendon reflexes
- Counting respiratory rate
Why would a pt with fractured rib and/or in buck traction with a fractured hip be at risk for pneumonia?
Both conditions cause shallow breathing and decreased lung expansion
What does the push-pause technique do?
Causes turbulence within the catheter lumen and removes debris
Is a UAP allowed to implement bladder training measures?
yes
What should be limited in a diet for a pt with Chronic kidney failure?
- Sodium
- Phosphorus
- Potassium
What are three factors that can increase pt risk for having a latex allergy?
- Allergy to avocado
- undergone multiple surgeries
- works in health care
What is the normal range of Magnesium?
1.3 - 2.1
What are three teachings related to an above the knee amputation recovery?
- Phantom limb pain is common
- Maintain prone position several times daily
- Antiseizure meds may help with phantom limb pain
What is a risk factor for hypermagnesemia?
Renal failure
Why does hypoalbuminemia cause edema?
hypoalbuminemia causes fluids to shift from the vascular area to tissue which causes edema
What type of medication is Hydralazine hydrochloride?
Fast acting antihypertensive
What can both Levothyroxine and Methylprednisone increase in body?
stored glucose
When should levothyroxine be taken?
In the morning on an empty stomach
What chemical should be avoided when taking Ciprofloxacin?
caffeine
Why should a pt with paralysis not be moved by their affected arm?
Chance of dislocation
What is the result of not rotating insulin injection sites?
Increased glucose levels due to poor absorption of insulin
What kind of hearing loss is present if a pt has sound lateralize to their right ear during a Weber test?
Sensorineural loss
What type of insulin is Detemir?
long acting
What is the duration of Insulin Detemir?
5.7 - 24 hours
What effect to Alzheimer medications have?
Helps control symptoms, not the disease
What usually causes fat embolism syndrome?
Long bone fracture and repair
What is another name for plumbism?
lead toxicity
What are three manifestations of pt that needs glucose?
- incoherence
- diaphoresis
- palpitations
What should not be done during pursed lip breathing?
hold breath
What does pain that radiates from procedure site indicate?
bleeding
What type of medication is Celecoxib?
NSAID
What are two interventions for a pt post-op from a colon resection?
- Assess stoma every 4 hours
- Provide emotional support to pt
What is a tonometer reading used for?
Assessing intraoculoar pressure
(Glaucoma)
normal intraocular presure is 10 - 21mmHg
What are four teachings related to Chlorpromazine?
- Maintain good oral hygiene
- It may take 6 weeks for medication to work
- Risk of leukopenia in first 3 months means you need regular blood work during this time
- Change positions slowly
What is a bad breath sound for a pt with chronic asthma?
absence of wheezing
What type of diet should a pt on furosemide eat?
high in potassium
What household activity should a pt avoid while recovering from cataract surgery?
Vacuuming
What position should a pt with Crohn disease be in to reduce discomfort?
Lying supine with legs straight
What are four non-pharm pain management strategies for a school-age pt following an appendectomy?
- assume comfortable position
- show pt how to do progressive relaxation
- use distractions
- teach rhythmic breathing
Why is a hemoglobin of 13 a concern if a pt is recieving epoetin therapy?
If the pt is recieving epoetin therapy and their hemoglobin is above 12 there is an increased risk of thromboembolic event
What is a regular level of hematocrit?
35 - 47
What is an adhesion?
Band of scar tissue that forms between organs following surgery.
These can mimic the symptoms of an intestinal obstruction
What is the first test that would be done for a pt with acute onset of seizures?
Electroencephalogram
Does a nursing manager review incidents and liabilities?
no
What are four teachings related to acute pancreatitis recovery?
- Avoid alcohol
- drink plenty of water
- limit caffeine
- avoid strict dieting (rapid weight loss can cause another attack)
What is Paget disease?
Disease that disrupts the replacement of old bone tissue with new bone tissue
What are three findings that are expected with Paget disease?
- Elevated serum alkaline phosphatase
- pathologic fracture
- Abnormal remodeling and resorption of bone
What are four instructions for a pt doing a holter monitor study?
- trigger event marker when pain or other symptoms occur
- use a regular toothbrush instead of an electric one
- keep a diary of activities
- immediately report fast heart rate or difficulty breathing
Can a UAP perform hourly rounding during a blood transfusion?
yes
Should a podiatrist cut the toenails of a pt with DM?
yes
How long does a pt have to be NPO prior to a pharm stress test?
3 hours
What is the antidote for magnesium toxicity?
calcium gluconate
What are cataracts?
Partial or total opacity of normally transparent cystalline lens due to lack of hydration in the eye
What is Meniere disease?
Inner ear problem that leads to tinnitis, vertigo, and dizziness
made worse by high sodium intake
What diet change can help pt maintain energy level without compromising the heart or the kidneys?
whole grain pasta and breads
Why should a pt with bilateral casts on upper extremities be referred for home health?
bilateral casts pose a high fall risk
Anterior and posterior pain in neck is referred from what?
Liver damage
Can a nurse get a mid-surgery update for a family?
yes
What type of medication is Triamterene?
Diuretics
What type of medication is Dabigatran?
Anticoagulants
What are five teachings related to Gabapentin?
- Used for neuropathic pain
- May cause drowsiness
- Taken in three divided doses
- Used as an anti-convulsant med
- Prescribed for postherpetic Neuralgia
When giving meds through an estabolished line what action should be taken ensure a good administration?
time medication with a watch
What is a Volkmann contracture?
Compartment syndrome caused by obstruction of arterial blood flow to forearm and hand
Can a pt with an implanted port swim?
yes, once the port incision is fully healed
What is a temperature criteria for SIRS?
Anything over 101 degrees
What is an indication that prescribed Lactulose treatment is going well?
Pt has increased energy and mental clartity
What are two electrolyte imbalances most likely to be suffered by a pt who consumes etoh daily?
- hypomagnesmia
- hypocalcemia
What is a positive Chvostek sign?
muscle twitching when stimulating facial nerve
What is a positive Chvostek sign?
muscle twitching when stimulating facial nerve
What are two actions that can be done for a pt with a history of opioid abuse after a hysterectomy?
- Determine what type of amount of opioids the pt used previously
- Administer opioids around the clock
What is the correct order of tasks to implement if a pt starts to have a transfusion reaction?
What type of medication is Atomoxetine?
used as part of a total treatment program to increase the ability to pay attention and decrease impulsiveness and hyperactivity in children and adults with ADHD.
What are teachings related to Atomoxetine?
- Low risk of dependence with this medication
- Can be taken with or without food
- Record child’s weight weekly
- Offer fresh fruits and vegetables to prevent constipation
- Suicidal ideation is an adverse effect of atomoxetine
What is the safest seat for an infant in a car seat?
back and center
What type of cleaner should be used on dentures?
non toothpaste gentle cleaner
What type of stools are expected for a pt taking ferrous sulfate?
black stools
What does ataxia indicate?
poor muscle control that causes clumsy voluntary movements
Dysfunction of the cerebellum
What are two indications that a pt has cognitive deficits post stroke?
- Poor judgment
- Memory deficits
Why is a preme neonate with NG feedings need pressure injury prevention?
Preterm neonates do not have the fat stores to protect from skin breakdown
What does a 4+ deep tendon reflex indicate?
Hyperactive responses indicate central nervous system irritability
How often should a tpn bag be changed?
Every 24 hours
What are four teachings for a pt with weakness and paralysis of the seventh cranial nerve after a viral infection
- Give eye drops as needed
- Wear scarf over face when its windy (cold and drafts can induce pain these pts)
- Give acetaminophen PRN (mild analgesic can reduce pain from Bell palsy)
- Prednisolone is prescribed within 72 hours of symptom onset (early corticosteroid treatment in a pt with Bell palsy reduce the length and severity of the disease)
What is the first action that should be done after a HIPAA violation?
Contact the unit manager
What is appropriate diet for a pt with level 1 dysphagia?
Pureed foods without texture
What kind of medication is Aminophylline?
Aminophylline belongs to a group of medicines known as bronchodilators. Bronchodilators are medicines that relax the muscles in the bronchial tubes (air passages) of the lungs. They relieve cough, wheezing, shortness of breath, and troubled breathing by increasing the flow of air through the bronchial tubes.
Will the rash on the face associated with systemic lupus erythematosus go away?
no
What is the minimum SPF suncreen when when exposed to direct sunlight?
SPF 30
What are four teachings related to Hydralazine?
- Tell HCP if you lose your appetite (anorexia a a possible adverse effect)
- Take medication with food to increase bioavailability of med
- Tell HCP before taking OTC meds
- Sit on edge of bed prior to standing (orthostatic hypotension is a probable adverse effect)
What is the treatment goal for a pt getting hormone therapy diagnosed with prostate cancer?
Suppress circulating androgens
How often should a pt in restraints be offered food?
Every 2 hours
How often should skin integrity be monitored for a pt in restraints?
Every 30 minutes
What is the normal coagulation time?
2 - 8 minutes
What are three dermatologic complications related to high-dose corticosteroids?
- Delayed wound healing
- Erythematous plaques on legs
- Decreased subcutaneous fat over extremities
What are four sleep changes that occur due to aging?
- Total sleep time is shorter
- Stage 4 (deep) sleep is substantially decreased
- Physical problems and medication can affect sleep
- Older adults have more difficulty falling asleep
What is Multiple myeloma?
Neoplastic condition that involves overproduction of plasma cells with bone an marrow destruction as a result
What are three teachings related to ergonomics in the workplace?
- Ergonomics increase comfort and decreases potential injries to employees
- Ergonomics is concerned with decreasing strain on joints and muscles in the workplace
- Ergonomic issues should be reporrted to employee health department
How long should an IV port be scrubbed for?
30 - 60 seconds
What is the Crede maneuver?
The Credé maneuver is a technique used to void urine from the bladder of an individual who, due to disease, cannot do so without aid. The Credé maneuver is executed by exerting manual pressure on the abdomen at the location of the bladder, just below the navel.
What are four early symptoms of dumping syndrome?
- Weakness
- Tachycardia
- Profuse sweating
- Pallor
What is a positive result for a Guaiac test?
Blue color change
What can provide a false negative result in a Guaiac test?
Vitamin C
What is the normal range of Lactic acid?
0.5 - 2.2
What type of medication is Cisplatin
Cisplatin injection is used to treat advanced cancer of the bladder, ovaries, or testicles. Cisplatin is an antineoplastic agent (cancer medicine). It interferes with the growth of cancer cells, which are eventually destroyed by the body.
What does activated partial thromboplastin time measure?
The effectiveness of Heparin
What two values must be monitored in a pt taking Clopidogrel?
Hemoglobin and Hematocrit
A drop in either of these values can indicate bleeding
What four interventions should be done with a pt that has had a gynecologic fistula repair?
- Maintain urinary catheter
- Warm sitz baths
- Perineal hygiene
- Increase oral fluids
What type of medication is Gentamicin?
Aminoglycoside antibiotic
What should be avoided when bathing a newborn?
Cream, lotions, and powders can cause skin irritation or repiratory irritation if inhaled
Does diabetes predispose a pt to have regular Candida infections?
yes
What are three indications that a pt receiving peritoneal dialysis has peritonitis?
- Abdominal pain
- Rebound tenderness
- Cloudy dialysate return
What is an expected assessment finding for a pt with Hypermagnesemia?
normal range (1.3 - 2.1)
Repetitive involuntary movements
How often does a hemofilter for CRRT need to be changed?
Every 24 - 48 hours
What are three teachings related to Herpes zoster?
- Herpes Zoster follows dermatomes on one-half of the body (one side of face will hurt)
- This pain may linger for months
- Don’t scratch to avoid a secondary bacterial infection
What effect does Tetracycline have on oral contraceptive pills?
Decreases their efficacy. Pt should look into barrier protection
If pt is using a walker, is it better to lift it or push it forward?
lift it
What abnormal direction should be given to pt following a Billroth II (gastrojejunostomy) procedure?
Pt should lay down after meal to slow gastric emptying
How long does a pt need to be NPO prior to colonoscopy?
2 - 4 hours
Is weakness associated with hypercalcemia or hypocalcemia?
hypercalcemia
What is Cushing syndrome?
Result of body producing too much Cortisol for too long
What are some manifestations of Cushing syndrome?
- Sodium retention (hypernatremia)
- Hypertension
- Hyperglycemia
- Hypokalemia
- Metabolic alkalosis
When does testing for Lyme disease occur?
1 to 2 months after the initial tick bite
Why is Diphenhydramine contraindicated for pt with closed-angle glaucoma?
anti-cholinergic effects will increase intraocular pressure
What are common anticholinergic effects?
Stops parasympathetic nervous system from working
- Urine retention
- Gastric bleeding
- Constipation
- Tachycardia
What is a late effect of chemotherapy and radiation treatments?
Secondary malignancies
What action should be taken for pt getting continuous enteral feedings, and recieving medication through their NG tube?
Clamp tube for 30 minutes after giving medications
What can safely dry a wet cast?
Hair dryer set to low heat
What type of medication is Meloxicam?
NSAID
What is the max infusion rate of Potassium Chloride?
10 mEq/hour
What are four meds that should not be taken with St. John’s wort?
- Digoxin
- Nifedipine
- Simvastatin
- Escitalopram
What type of medication is Sitagliptin?
Stimulates pancreas to release insulin
stops liver from producing sugar
What diet is appropriate for a pt diagnosed with malnutrition?
High calories
High protein
What vitamin does Metformin interfere with the absorption of?
B 12
What is the primary concern in a pt with diarrhea?
dehydration
What are the two most common causes of acute pancreatitis?
Gallstone migration
Alcohol abuse
What does Fluorescein angiography measure?
Circulation in the retina
When is Bicarb given?
If pH is 7 or below
What type of medication is Pioglitazone?
Pioglitazone is used with proper diet and exercise to treat high blood sugar levels caused by type 2 diabetes. It may be used alone or with other medicines such as insulin, metformin, or sulfonylurea agents. Pioglitazone works by helping your body use insulin better.
What is the best diet for a pt experiencing ulcerative colitis exacerbation?
Low-residue
* seedless vegetables
* refined grains
* cheese/milk
* meats
Why is a pt with in internal radiation implant restricted from ambulation
Possibility of dislodging the implant or getting radiation burns from a distended bladder. Pt will have an indwelling catheter to void.
what finding is consistant with the acute stage of HIV?
Temporary decrease in CD4+ T cells
What are three interventions that can help an older man with difficulty voiding?
- Stand while voiding
- Press on the pubic area when trying to void
- Have pt drink 2 liters of fluid each day
Should Dexamethasone be taken with a meal?
Yes with Breakfast
How is Alprostadil (for ED) administered?
Fine needle in side of penis
What type of medication is Verapamil?
Calcium channel blocker
Why are Calcium channel blockers avoided in pt with heart failure?
CCB are negative inotropes and can cause severe bradycardia
When should Trimethoprim/sulfamethoxazole be taken?
On an empty stomach and 1 hour before or 2 hours after meals
What can anticonvulsants cause deficiencies in ?
folate
vitamin D
What type of pressure injury is a foam dressing appropriate for?
Stage 1
What type of pressure injury is a hydrocolloid dressing appropriate for?
Stage 3
What is Azotemia?
Buildup of nitrogenous waste products in bloodstream
Look for elevated BUN and creatinine
What are four findings during the oliguric phase of acute kidney injury
- Azotemia
- Pruritus
- Nausea
- elevated potassium
What organ’s function needs to be watched when taking a statin?
Liver
What three meds are contraindicated with a pt having dementia?
Divalproex sodium
Risperidone
Lorazepam
Is long acting insulin cloudy or clear?
cloudy
What medications should be avoided in a pt already taking furosemide and aspirin?
Vancomycin: risk of ototoxicity
Digoxin: risk for digoxin toxicity
What is the priority action for a pt getting debridement of a burn?
Plan a time to perform the dressing change
Can Digoxin and Ampicillin be administered IV push?
yes
How much is a typical Enoxaparin dose?
less than 1 mL
What are two substitute solutions that can be given if a new bag of PN is not ready for Central line administration?
D10W
D20W
What type of medication is Vincreistine?
chemotherapy
What is the correct order for safe blood administration?
What is the correct order for a newborn bath?
What does uterine cramping indicate?
Placenta separation
What foods should be avoided in pt with latex allergy
- avocado
- apple
- banana
- carrot
- celery
- chestnut
- kiwi
- melon
- papaya
- raw potato
- tomato
What can create an outflow problem in a pt doing ambulatory peritoneal dialysis?
full colon
What is the timeframe of peak effect for Warfarin Sodium?
3 to 4 days
What is the best pt indication of pain (or not)?
non-verbal cues
What type of drug is Indomethacin?
NSAID
What is the preferred drug to decrease blood pressure while protecting the kidneys?
Captopril
What age can a baby sit up with support?
6 months old
What breath sounds are described as high-pitched whistling sound?
wheezes
What group of people have the highest risk of lung cancer?
African Americans
What are developmental milestones that are met in order?
Can a UAP re-delegate tasks to another UAP?
No
What immunizations are scheduled for a two month old?
- Rotavirus
- DTaP
- Hib (influenzae)
- Inactivated poliovirus
How often should SCDs be removed?
At least once every 8 hours
Why is a pt taking Osteoporosis meds a contraindication to receiving ECT therapy?
Osteoporosis placed pt at risk for injury during muscle contractions that happen with ECT
Where is the fundus located 6-12 hours after delivery?
Near level of the umbilicus
What is the correct order for inserting an indwelling catheter?
What is the first treatment for a cluster headache?
Give 100% o2
What is a normal value of hemoglobin?
12 - 16
Why is it important to assess the nature of the command hallucinations?
there is a chance the hallucinations could be telling a pt to hurt themselves or others
What immunizations can be given to pregnant woman?
- Tetanus
- Hep B
- Influenza
- Pertussis
What immunizations cannot be given to a pregnant woman?
- Measles
- Mumps
- Rubella
- Varicella
- Smallpox
Is trimethoprim/sulfamethoxazole safe during pregnancy?
no
What are two factors that increase potential for fetal macrosomia?
- Gestational diabetes
- Maternal obesity
What are two dangers of warming an infant too fast?
- Apneic spells
- acidosis
Metformin is contraindicated in pt with history of what?
Lactic acidosis
Why is an elevated temperature concerning in a pt with Cushing Syndrome?
Cushing syndrome puts pt at increased risk of infection
What are 3 examples of primary health prevention?
- Health education programs
- Immunizations
- physical/nutritional fitness activities
What does a sputum that grows acid-fast bacillus indicate?
possible pulmonary tuberculosis
When is furosemide dangerous related to sodium levels?
If sodium is under 125, do not give
What change occurs in a newborn after birth related to the left atrium?
pressure increases
Why should Rh(D) immune globulin be given to a pt having an ectopic pregnancy?
Ectopic pregnancy can expose pt to fetal blood which can result in mom developing antibodies against Rh positive blood
What is a good Lithium level?
Levels below 1.5 are non-toxic
What part of stethoscope is used to listen to heart sounds?
diaphram
A newborn with a HR of 100 gets what Apgar score?
2
What is a normal Ejection Fraction?
55 - 65%
What is Presbycusis?
age related hearing loss
What is a characteristic of pts with presbycusis?
Respond better to low-pitched sounds.
difficulty hearing high pitched sounds
A pt diagnosed with bulimia nervosa that has laryngitis is in danger for what?
Tracheoesophageal fistula from esophageal tear secondary to forceful vomiting
What test is used to determine the size and composition of the thyroid gland?
Ultrasound
Why is lidocaine dangerous for a pt in complete heart block?
Lidocaine reduces ventricular irritability, but in complete heart block it could actually stop the heart completely
What are two outcomes that can result from Pancreatic cancer?
- Severe anorexia
- Dramatic weight loss
What is the consiquence of too much fluid intake in pt with liver cirrhosis?
ascites
What electrolyte imbalance can NSAIDs cause?
Sodium retention (and therefore water retention)
What is a cardinal sign of fecal impaction?
continuous oozxing of liquid stool
What are risk factors for schizophrenia?
- first-degree relatives with schizophrenia
- autoimmune disorders
- older age of father
- comorbid disorders: substance abuse, DM, disordered water balance
What are three expected findings in mom 10 hours after giving birth?
- elevated WBC count
- elevated neutophils
- low grade fever
What diet should be followed by a pt with Cushing syndrome?
- High protein
- High potassium
- Low carb
- low sodium
- low calorie
What is the concern with beta blockers in a pt with type 2 diabetes?
beta blockers can mask symptoms of hypoglycemia
What IV fluid is used to infuse blood products?
normal saline
What are two possible complications related to long term antiretroviral therapy use?
- Hyperlipidemia
- cardiovascular disease
What type of medication is Imipramine?
Tricyclic antidepressant
What is the priority nursing intervention for a pt with a high fever?
give oral fluids frequently
When is the reagent placed on the specimen for a fecal occult blood test?
after it is applied to the testing card
What three drugs can grapefruit juice increase the serum levels of?
- atorvastatin
- buspirone
- nifedipine
How long are contractions in the active phase of labor?
40 - 60 seconds
What symptoms should be expected for pt with alcohol withdrawal syndrome that had their last drink 4 days ago?
- Fever
- hypertension
- delirium
- drenching sweats
- severe tremors
What are the criteria for mild preeclampsia related to blood pressure?
> 140/90
but
< 160/110
What is a normal ALT level?
10 - 40U/L
What diet is appropriate for a pt with cholecystitis?
- High protein
- low carb
- low fat
What is the first task done with a pt reporting a severe headache 30 minutes after a lumbar puncture?
assess the puncture site
What is Rotavirus?
GI infection that causes acute diarrhea
need contact precautions
What is indicated by a positive contraction stress test?
late decels following 50% of contractions
When will a child start to demonstrate a social smile?
2 months
What two actions should a nurse getting a blood pressure take?
- Release pressure 2-3mmHg per second
- wrap cuff 2.5cm (1 inch) below the AC area
Are furosemide and milrinone compatible?
no, must be administered through separate IV lines
What is the goal of teriary health prevention?
Prevent disability and complications of a condition
What are Reticulocytes?
Immature red blood cells
Why are reticulocytes counts increased in sickle cell pts?
RBCs have short live spans due to their misshapen appearence
What type of medication is Clonidine?
Sedative and antihypertensive
can cause constipation
Why are isoniazid, rifampin, and ethambutol given to treat TB?
multiple meds help to reduse resistant strains
What are five health screenings that should be done by older adult males?
- Stool DNA test every 3 years
- Digital rectal examination every year
- Test for DM every 3 years
- Prostate-specific antigen test every 2 years
- Low dose CT scan every year if 30-year smoker
What do Ginseng and Ibuprofen do related to oral anti-diabetic meds?
increase the hypoglycemic effect
What is the small box method for calculating EKG heartrate?
1500/ number of small boxes between R waves
What drug is given during a pharm stress test?
synthetic sympathomimetic
What must be done to Phenytoin prior to administration?
it comes as a suspension and must be shaken
What is Rubeola, and what level of precautions are needed for the disease?
red measles
airborne precautions
What level of precautions are needed for Rotavirus?
contact: gown, non-sterile gloves
How can an immunocompromised pt be protected from contact with Varicella zoster?
Give varicella immunoglobulin
What assessment confirms the diagnosis of Kaposi sarcoma?
punch biopsy of cutaneous lesions
What are three desired effects of digoxin?
- clear breath sounds
- normal sinus rhythm
- easy work of breathing
What mask is needed when dealing with pt that has pulmonary tuberculosis?
n-95
What type of medication is Doxazosin?
Anti-hypertensive
Are antimicrobials (antibiotics) given with dialysate solution?
No, they are held until after the procedure
What is the first action taken when a pt receiving enteral nutrition reports nausea?
Check residuals (level of gastric empying)
If they are high it means you are not digesting food
What temperature should dialysate solution be before infusing?
body temperature
When should a statin be taken to have the greatest effect?
at night when cholesterol synthesis is highest
What is an expected age related electrolyte change?
hyponatremia
What are three sources of oxalate?
- Spinach
- Rhubarb
- Black Tea
What type of medication is Fluphenazine decanoate?
Psychotherapeutic used in management of psychotic disorders.
Given through IM or SQ injection every 1 to 6 weeks
Why are carbs limited in pt with respiratory failure?
carb metabolism causes increased CO2 production
What do Divalproex sodium, Risperidone, and Lorazepam have in common related to a pt with dementia?
They are contraindicated due to increased risk of mortality when given with other sedatives/antipsychotics
What size catheter should be used for cathing a man?
16 - 18 French
What diet should a pt with an exacerbation of ulcerative colitis eat?
low residue
What are expected findings in a pt with hyperglycemic hyperosmolar syndrome?
- Dex greater than 600mg/dL
- pH greater than 7.3
- Bicarb greater than 18
- Urine ketones are absent to small
What are three findings that will prompt the stopping of oxytocin?
- Contractions lasting longer than 90 seconds (indicates uterine hyperstimulation)
- maternal Nausea and vomiting are adverse effects of oxytocin
- Late decels indicate fetal distress
What position should a pt with Crohn disease avoid in order to reduce the discomfort from the diagnosis?
Lie supine with legs straight
What are four benefits of pulmonary rehabilitation?
- Improved exercise capacity
- decreased anxiety
- decreased depression
- decreased hospitalizations
How often should insulin glargine be given?
once per day, it is long-acting
What is the max daily dosage of acetaminophen?
4 grams per day
What type of breathing should be done by pt during CVC placement?
Pt should perform valsalva maneuver rather than breathing deeply
What type of diuretic is Furosemide?
Non-potassium sparing
loop
What are typical results of taking Thiazide diuretics?
- hyponatremia
- elevated calcium
- metabolic alkalosis
What is a normal prothrombin time?
9.5 - 12 seconds
What is Lactulose prescribed for?
Hepatic encephalopathy
It reduces ammonia levels in blood
