NCLEX Everything! Flashcards
Most common areas affected by scabies
hands and feet
Where should a portable shield be placed for a client with a radioactive implant?
on the hallway side of the client’s bed
not at the foot of the bed
what might you see if there is fecal impaction
oozing liquid stool. can be mistaked for uncontrolled diarrhea.
Interventions when a veteran is having a flashback
maintain a safe environment, protect self. client is in a war zone
What drink should be recommended for a client taking furosemide and digoxin?
Orange Juice- containes 496 mg of potassium
low potassim precipitates dig toxicity
When is glucagon normally used?
If client is a ketoacidosis or coma. They are usually unconscious
2 Types of Drugs that contain tyramine (MAOIs)
Phenelzine, Isocarboxazid,
Metronidazole
(Flagyl)
- *Indication** intra-abdominal infections, gynecoligical infections, septicemia, endocarditis, amebic liver abscess, peptic ulcer
- *Action** inhibits dna and protein synthesis in bacteria
- *Class** anti-infective, antiprotoxoals, antiulcer
- *Nursing Considerations** obtain cultures before therapy, monitor neruologic status, monitor intake and outpus and daily weights. May alter liver enzymes
What fluid and electrolyte imbalance happens with vomiting?
loss of acid in the stomach. Metabolic Alkalosis
Signs of Diabetes insipidus
- cracked lips due to dehydration
- large urine output
- low specific gravity as urine is not concentrated in the kidney
What is a sign of a fat embolism
petechiae
what is a good gift for a patient with parkinson diseaes?
warming tray for food. Keeps it hot and appealing for their slow eating process.
What drugs may lead to agranulocytosis
- Hyperthyroid drugs
- Propylthiorucil
- Methimazole
- Clozapine- 2nd gen antipsychotic
what type of precautions is pertussis
Droplet
tonsilittis, CF, and bronchitis are all standard.
Where is dorsalis pedis artery located
Insulin Long Acting
Detemir, Glargine, Levemir, Lantus
- *Indication** hyperglycemia with diabetes type 1 and type 2, ketoacidosis
- *Action** stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the livere, prevents breakdown of fat and protien
Detemir onset 3-4 hr, Peak 3-14hr
Glargine 3-4,, no peak
- *Class** lpancreatics, antidiabetics
- *Nursing Considerations** monitor body weight over time, may cause decreased inorganic phsophates, potassium and mag. Monitor B/S Q6, monitor A1C every 3-6 months
Why is pain med a priority for MI
pain wil increase oxygen demand
Hallmark Signs of Tensions Pneumothoraz
chest pain, muffled heart/lung sounds. medistinal shift, respiratory distress.
Why is it important to assess blood pressure for pt coming off spinal anasthesia?
blocakge of autonomic nervous system may still be presen and cause hypotension. Gradually elevate head of bed.
If pt is experiencing chest pain and nausea and dizziness what lab values should you request
CBC, Cardiac Enzymes. R/t MI or Angina
Tyramine rich foods
aged cheese, wine, tofu, chocolate, lunchmeats, fermented foods, caffeine
Why is a patient with hemophilia at risk for knee and joint deformities
most frequent site of bleeding is in the muscles and joints; repeated bleeding episodes causes changes in bones and muscles
When should PPIs (prazole) be given with regard to mealtime
on an empty stomach BEFORE meals
Signs of Autonomic Dysreflexia
- severe headache
- profuse sweating
- full bladder
- bradycardia
- hypertension
- goosepumps
- nasal congestion
best lab value to confirm diagnosis of MI
Troponin Levels
priority assessment post op
- respiratory highest priority (breathing)
- cardiac status (circulation)
- dressing
- positioning
- check the surgical notes
- monitor incision site
Priorities if a patient has fallen out of bed
- Obtain Vital Signs
- Assist client back to bed (if does not appear injured)
- Call HCP to report Incident
- Incident Report
What action is benefical to prevent hypercalcemia
walking as much as possible keeps the calcium in the bone
What level of training should be assigned to triage
you need at least one experienced RN, an inexperienced RN could be provided training.
This condition may be caused by gallstones, chronic alcohol use, infections, medications, and trauma.
Pancreatitis
tx with IV fluids, antibiotics, pain relievers
Atropine Overdose
Hot as a hare, mad as a hatter, red as a beet, dry as a bone
What are the 5 Stages of grief?
- Denial
- Anger
- Barganing
- Depression
- Acceptance
what is a common occurence with patients with hyperparathyroidism
urinary tract calcui- hematuria is a sign
parathyroid function: increase the concentration of plasma calcium by increasing the release of calcium and phosphate from bone matrix, increasing calcium reabsorption by the kidne
what are WBCs when patient is neutropenic
low
Why is carbazapine used for Trigeminal Neuraglia (tic durex)
for agonizing pain. Inhibits nerve impulses and reduces pain of the condition
Normal therapeutic range for PTT
1.5-2 times normal
Normal: 20-25
Upper: 32-39
A-S-T-H-M-A MGMT
- Albuterol (Adrenergic)
- Steroids
- Theophylline
- Hydration
- Mask
- Antibiotics
When is a patient in coma according to glascow scale
below 8. 15 is the best
Iodine
- *Indication** thyroidectomy, thyrotoxic crisis, radiation exposure
- *Action** inhibits release of thyroid hormones
- *Class** antithyroid agent
- *Nursing Considerations** GI bleed, diarrhea, hypothyroidism, goiter, monitor for hypersensitivity
when is phototherapy for an infant needed?
if bilirubin is greater than 15 mg/dL at 72 hours of age.
What type of pain delivery system is well suited for pts with cancer
SubQ
what could a multipara patient that is requesting to go to the bathroom to have a bowel movement mean?
imment birth, urgent. Do not allow to use the bathroom.
Who is the only employee from a health care organization that can be a lega withness of signing of an advance directive
clinical social worker
Which clients are at greates risk factor for respiratory depression while receiving opioids for analgesia?
elderly, opiate naive, pulmonary disease. Count the risk factors.
What does CSF have in meningitis
high protein, low glucose
What is the general rule with nutrition and renal patients?
decrease proteins because protein increases BUN
chvostek sign location
Lab Values for Metabolic Alkalosis
ph HIGH PCO2, HIGH, HCO3 High
Low Potassium
Why is morphine contraindicated in pancreatitis?
causes spasm of the spincter. Demerol should be given.
First action for chest pain (MI, Angina)
EKG, ST wave will have and issue
What can LVNs never do
assessments or evaluations. but can implement the tasks on the plan of care
What complication is at risk with Kawasaki Disease
Coronary artery aneurysm
Affects mucus membranes, lymph nodes and walls of the blood vessels. Can cause inflammation of the arteries, possible heart attack in child, fever lasting more than 2 weeks.
Methlergonovine
- *Indication** postpartum hemorrhage
- *Action** stimulates uterine muscles causing uterine contraction
- *Class** oxytocic, ergot alkaloids
- *Nursing Considerations** can cause hypertension, cramps, N/V, dyspnea. Monitor BP, HR and uterine response. Assess caclium levels
Lactulose
- *Indication** Constipation, portal systemic encephalopathy
- *Action** draws water into the stool and softens stool, inhibits ammonia passing into the colon
- *Class** osmotic laxative
- *Nursing Considerations** caution with DIabetes, may cause cramps ab distention and hyperglyciema, mental status, ammonial levels , avg 2-3 bowel movement per day
-sartan
ARBs
How high should a pregnant women let her heart rate go?
not above 140 bpm
Bucks traction is for
knee immobility
what type of exercises whould be recommended if a patient is in a cast
isometric exercises.
INR- international normalized Ratio
2 - 3 for standard warfarin therapy
3 - 4.5 for high dose warfarin therapy
Altepase
- Indication MI, Acute ischemis strok, occluded central lines
- Action converts plasminogen to plasmin, degrades fibrin in clots
- Class thrombolytic
- Nursing Considerations Intracranial hemorrhage, bleediing, anaphylaxis, HTN, neuro status
Possible SE of Imipramine (trycyclic antidepress)
sore throat, fever, increased fatigue, N/V, diarrhea
What type of precautions does a patient with mengiococal pneumonia have?
droplet
A harrington rod is used for scoliosis, what do you want to assess
neuro checks b/c of spine
What is assessment is necessary when oxytocin is given
palpate the uterus. Oxytocin stimulates the uterus to contract. Can lead to uterus rupture.
What is a common temporary side effect of Pepto Bismol (Bismuth Subsalicylate)
dark tint of the tongue
Paroxetine
- *Indication** major depressive disorder, OCD, anxiety, PTSD
- *Action** blocks reuptake of CNS
- *Class** antianxiety agent, antidepressant, SSRI
- *Nursing Considerations** neurleptic malignant syndrome, decrease effectiveness of digozin, increase bleeding with warfarin, suicidal thoughts
What could administering morphine do for a critical patient with a head injury
could mask signs of ICP
Examples of selective beta 1s
MEAANe
- Metroprolol
- Exmolol
- Acebutolol
- Atenolol
- Nebivolol
If you see a question with Who, What Where…?
consider the question that asks in a different way.
signs of hemolytic reaction
hypotension, back ache, low back pain, fever, dyspnea
Why should you be worried about a patient taking haloperidol with a fever?
neuroleptic malignant syndrome, lethal side effect
What is the nurse practitioner’s role in short words
perform physical examinations/recommends diagnostic testing
what does a myelogram test?
lumbar puncture with injection of contrast medium. allows visualization of the vertebral canal.
Haloperidol
Indication schisophrenia, mania, aggressive and agitated
Action alters effect of dopamine
Class antipsychotic, butryrophenones
Nursing EPS, caution in QT prolongation. seizures, constipation, dry mouth, agranulosytosis. Assess for hallucinations, Monitor hemodynamics, monitor neurleptic malignant syndrome. CBC with differential
the lower the glascow coma scale indicates
coma.
Maneuver used to asses carpal tunnel syndrome
Phallen’s maneuver. Put the back of hand together and bend both wrists at the same time. Produces parathesia of median nerve
for a forensic inviestigation why should material NOT be placed in a plastic bag?
should be paper, b/c bacteria could destroy DNA evidence if plastic bags are used.
what assessment is MOST important post op knee surgery
neurovascular checks every hour for 12 hours, then every 2-4 hours. Surery may interrupt blood supply to affected extremity and immediate intervention is required.
Med of choice for status epilepticus
valium
The assesssment of flattened neck veins when client is in supine position, goes with what nursing diagnosis
decreased cardiac output related to decreased plasma volume
which method of administration offers the client the longest duration of medication action?
rectal administration
What is the cause of late decelerations
placental insufficiency
Pancrelipase
- *Indication** pancreatic insufficiency, ductal obstruction
- *Action** replacement of pancreatic enzymes: lipase, amylase, protease
- *Class** digestive agent
- *Nursing Considerations** contraindicated in pig products, SOB, rash, assess nutritional status, monitor for steatorrhea, increase uric acid levels, take with meals
What does the nurse need to do after a cast is applied
elevate for first 24-48 hours to minimize swelling.
what are the most life threatening conditions after a cesarean birth?
fluid and electroylte imbalances. Hemorrhage and shock.
Vasopressin
- *Indication** MGMT of diabetes insipidius, Vt/VF, unresponsibe to initial shock, GI hemorrhage
- *Action** increases water permeability of the kidney collecting duct and distal convoluted tubule elading to water retention, also increases peripheral vascular resistance leading to increased BP
- *Class** antidiuretic hormone
- *Nursing Considerations** caution with HF, and CV disease, contraindicated in renal failure, hypersensitivity to pork. Monitor vitals. Monitor urine specific gravity & osmolality. Weight pt and assess for edema. Monitor electrolyte panel. DO NOT USE alcohol
what disease is associatd with glaucoma
diabetes
What should be done if a physician yells at a nurse in front of a client
nurse manager should request an immediate private meeting with HCP and staff nurse
-terol
bronchodilator
Nystatin
- *Indication** Candidiasis (thrush)
- *Action** causes leakge of funcal cell contents
- *Class** antifungal
- *Nursing Considerations** diarrhea, N/V, caution with dentures, assess mucus membranes
What foods should a patient with diverticulitis avoid?
corn, seeds, cucumber, tomatoes, strawberries, figs. These may block diverticula
How long should a client wait before brushing teeth after hypophysectomy
1-2 weeks to allow incision to heal
What type of drug is ethacyrnic acid
loop diuretic (potassium wasting)
How is most pain relieved in orthopedics
elevation, cold packs and analgesics (toherwise something is WRONG)
a push pull toy is good for which age group
18-21 months
HELLP
- Hemolysis
- Elevated
- Liver Function Tests
- Low
- Platelet Count
what position is a client placed for liver biopsy
supine with right arm behind their head
Hallmark signs of emphysema
carrel chest, chronic cough, SOB, wheezing, Weight loss
Best practice for confirming NG tube?
aspirating gastric contents and testing pH (should be below 5)
What is an important intervention to take if you are delivering an IV push medication?
time the med administration with a watch
T wave indicates
ventricular repolarization
Fluticasone (Flovent)
Indication prophylactic asthma treatmt
Action local anti-inflammatory
Class corticosteroid, inhalation, anti-asthmatic
Nursing watch for untreated infectios and suppressed immune function. Can cause headaches, insomnia, bronchospasm, nasal congestion, adrenal suppression. Monitor respiratory status, may lead to decreased bone density. Bronchodilators should be used BEFORE corticosteroids. Stop smoking
dunlap traction is for
skeletal or skin
Montelukast
- *Indication** prevent asthma, manage seasonal allergies, prevent exercise induced bronchoconstriction
- *Action** disrupts the effects of leukotrienes which effect airway edema.
- Class** allergy, cold, cough remedis, bronchodilator. Leukotriene antagonist*
- *Nursing Considerations** assess respiratory status, liver function, does not treat acute asthma
if a client is incontinent w/ frequent UTIs, what is an important intervention
intermitten catheterization for any residual urine volume. Bladder may not empty completely.
Primary clients for C. Difficile
hospitalized, receiving antibiotic therapy- Ampicillin, amoxicillin and cephalosporins (Cephalexin)
what type of socks are recommended for diabetic patient with foot problemts
cotton to absorb moisture
First signs of cystic fibrosis
meconium ileus at birth. Baby is inconsolable, does not eat, not passing meconium.
A client is in the third month of her first pregnancy. During the interview, she tells a nurse that she has several sex partners and is unsure of the identity of the baby’s father. Which of these nursing interventions is best at this time?
counsel the woman to consent to HIV screening
10 year old cognitive capabilities
able to think logically in the organization of facts
Guthrie Test
tests PKU, baby should have eaten source of protein first
classic symptoms of guilland barre
respiratory failure, flaccid paralysis, urinary retention
what position for shock, and why not trendelenburg
Elevate lower extremetities, trendenleburg puts too much pressure on throacic cavity which can increase workload on the heart. Lower extremeities iimproves circulation to the brain and vital organs.
- Atrial Fibrillation
- Irregular
- Heart Rate 60
- PRI- n/A
- QRS Interval 0.04 -0.06
what should you expect with perforated bowel
lead to peritonitis, expect surgery
What can a UAP help with
- ADLs
- hygiene
- feeding
- ambulation
- NO nursing judgment
What is a major side effect of INH
peripheral neuropathy
Dexamethasone
Indication cerebral edema, assess for cushing’s dissease
Action suppress inflammation and normal immune response. Used in inflammatory states
Class antiasthmatics, corticosteroids,
Nursing watch liver, avoid in untreated infections, may cause CNS alteration, peptic ulcers, cushings, weight gin, osteoporosis, decrease wound healing, elevated blood sugars, watch lipid and cholesterol
If a patient has and SCI injury at C-5, what is his sexual functioning
sexual functioning may be possible, depends on severity of the injury, age of the client.
What is the symptothermal method
non prescription birth control. Combines cervical mucus and basal body temperature.
what happen is a patient has low serum albumin
third spacing.Pretibilal edema. Albumin prevents plasma from leaking into interstitial fluid
tidine
H2 blocker
Normal Newborn Blood Pressure
50-75
MI & dysrhythmias go together like peas and carrots.
Where can you find standard of care?
institutional policy and procedure documents
when you are obtaining an assessment of a client with a headache, what should be your FIRST assessment
get a description in clients own words of the headache. Usually a symptom and not a disease, can be a result of neurolgical disease, caused by vasodilation or skeletal muscle tension
what is the first symptom of fat embolism
extreme confusion. Obtain blood gases.
What is an emergency situation for a patient with bulimia nervosea
a hoarse vois that is barely audibly. Indicates tracheosophageal fistula. Tear, laryngitis is a danger sign.
Propolol
- *Indication** anaesthia, induction, sedation
- *Action** hypnotic, produces amnesia
- *Class** general anesthetic
- *Nursing Considerations** caution with CVD, lipid disorder, increased ICP, apnea bradycardai, hypotension. Burnign pain at insertion site. Can turn urine green, assess respiraotry status and hemodynamic. Maintain patent airway. Assess level of sedation
A pt with BPH has a distended bladder due to acute urinary retention. What should nurse understand about care of this client
tx includes catheterization (starting w. smallest catheter size). Complete and rapid emptying of the bladder. Bladder irrigation is performed.
when a client is wearing bilateral eye patches, what is a necessary action to take
frequently touch the client while speaking to him.her
The most common healthcare associated infection
caused by staff
adverse reactions to atropine that should be reported to HCP
transient arrhythmias & paradoxical bradycardia.
For a client that received TURP, what is the purpose of continuous bladder irrgation
enables urine to keep flowing and prevent clots
what is a risk factor if membranes have ruptures for more than 24 hours after birth
infection
antihistamine eyedrops side effects
headache, burnig, rhinitis, sinusitis, blurred visions, pruritus,
What is the most important interventions with burn management
fluid replacement, hypoxia is alwasy the priority, hyperkalemia
What could be indicative of peripheral vascular disease
legs throbbing when going for a walk. Requires follow-up
What position should you place a client after a tonsillectomy?
prone or side lying with bed elevated.
What is the rule for UAPs for documentation
they cannot document what they cannot assess
What is fetor
breaths smells like ammonia
Why do daytime activities help clients that are immobilized in bed
it causes them to nap less during the day and provides relief from tension so they can relax at night
What is the first sign of worsening asthma
a fall in peak flow rates. Feeling tired, sneezing, stomach ache, poor appeptite, night time cough.
Swanz Ganz Catheter or Pulmonary Artery Catheter does what?
inserted into the the right side of the heart thru the groin or neck using conscious sedation (at the bedside). can measure different pressures in the heart and lungs.
What is Kawasaki disease, and what is the demographic?
boys younger than 5 and asian descent. Red eyes (conjuctivitis), rash on the body and genital area, strawberry tongue. Red skin on palms of hands. Last 2-12 wks without treatment
what is considered a positive PPD test
5mm or greater induration
Common findings in mitral valve regurgitation include
heart murmurs, SOB, fatigue, Paroxysmal noctural dyspnea
Coumadin Antidote
Vitamin K
Glucagon
Indication severe hypoglycemia, antidote for beta blockers and calcium channel blockers
Action stimulates production of glucose, relaxes GI tract
Class pancreatic, hormone
Nursing anaphylaxis, hypotensionn. Assess for hypoglycemia, neuro status. Monitor serum glucose. Teach pt signs of hypoglycemia
What can immunoglobulin therapy interfere with?
body’s ability to form appropriate amts of antibodies. Live attenuated immunizations should be delayed.
Medication Antidotes
If a patient with MS is having exacerbations what position should they be in
prone. May minimize spasms of the flexor muscles. If not relieved, contractures could occur and pressure ulcers
what is your most important assessment with gloerulonephritis
blood pressure.
first sign of pyloric stenosis in a baby
mild vomiting that progesses to projectile vomiting.
Meperidine
- *Indication** moderate to severe pain, sedation
- *Action** binds to opiate receptors in the CNS and alters perception of pain, while producing a general depression of the CNS
- *Class** opioid Analgesic
- *Nursing Considerations** altered mentation, hypotension, constipation, N/V. Assess BP, pulse and respriatory rate. Use caution if matient is receiving MAOIs. Narca is the antidote. Can cause seizures. May increase pancreatic enzyme levels. Assess bowel function
If a client is showing early signs of shock, what position
lower head of bed, place client on left side, air rises to right atrium
Do calcium channel blocker effect preload or afterload
afterload
What is the pathogen of peptic ulcer disease
heliobacter pylori
What is important to know for all anti-infective drugs
decrease effectiveness of oral contraceptives
HCO3
22-27 mm Hg
How do you know there is a therapeutic response for patient with edema
weight loss
what are the proper procedures when a neonate is hooked to a warming device
Continuous temperature monitoring using a probe
priority due to skin burns, brain damage
Left CVA impacts
speech
How much water must pt drink prior to ultrasound of urinary bladder
32 ounces
What is the rule for a pancreatitis client
keep stomach empty and dry. Kee client NPO, have NGT to suction, bed rest!
Drugs that are ototocxic?
- Loop diuretics
- Aminoglycoside Antibx (Gent)
- Aspirin
What is the highest schedule drug, not used in a clinical setting
Schedule I.
Potassium
3.5 - 5.0 mEq/L
what does an elevated d-dimer test indicate following aprution of placenta
concern for DIC. Notify HCP right away.
how can you tell if an infant is in pain
- increased pulse rate
- rubbing part of the body and crying
- eyes closed tightly, mouth opened
murphy’s sign
pain with palpation of gall bladder seen with cholecystitis
what is the primary purpose to turn cough and deep breath?
promote ventilation, and prevent respiratory acidosis
The bubbling in a water seal chest tube chamber indicates
lung has not yet re-expanded
Metered Dose Inhaler
What type of communication technique is best for patient with Wernicke’s Aphasi
non verbals, actions, movements, props. Wernicke have no understanding of language. They can speak, but it makes no sense
What type of breathing occurs with metabolic acidosis
deep rapid respirations, hyperpnea
How do you know if pt has toxic effects of aminophylline?
confusion, headache, flushing, tachycardia, seizure, palpitations, nervousness. Notify HCP.
A child with burn is at risk for dehydration, what finding would indicate decrease in status
increased hematocrit and decrease in urine volume
Fentanyl (Sublimaze)
Indication supplement to general anethseia, continuous IV infusion for purpose of analgesia
Action binds to opiate receptors in the CNS altering perception of pain, producing CNS depression
Class opioid analgesic
Nursing watch for ICP, head trauma and adrenal insufficiency. Avoid MAOIs. Can cause apnea, laryngospasm, decreased respiration, bradycardia, hypotension. Do not consume grapfruit juice. Monitor hemodynamics. Assess pain scale
What are signs of strabismus?
seeing double, might close one eye to see.
What is wander band used for
a sensor bracelet allows patients to roam around (dementia pt) trips an alarm system if they decide to leave.
What does crepitus mean?
air in sub q space (usually due to pneumothorax)
Order of operation for instilling eye drops
- Have client sit down, tilt head
- Pull tissue under eye downward
- hold dropper stabilize hand
- have client look up
- Close eye and move it around
- Press on lacrimal duct for 1 full minute
Bicarb
22-29 mEq/L
What is a common complication of nephrotic syndrome
venous thrombosis
major side effects with statin drugs include
must get liver function test and eye exams (will have eye lens opacities)
do not think of blood pressure with this drug
What is a good handoff report technique
- Introduction (yourself)
- Patient name, identifiers,
- Assessment, chief complaint, Vital signs/sx, Dx
- Situation (code status, recent changes, response to tx)
- Safety concerns (lab values, socioeconomic factors, allergies, falls
- Background (comorbidities, currend meds, family hx
- Actions (what did you do)
- Timing (level of urgency and explicit timing, priotixation actions
- Ownerhip (who is responsible)
- Next (blocking discharge, plan)
If a client is hallucinatying, why is it important to ask what they voices are saying?
must assess the nature of command hallucinations
Venturi Mask
- Most accurate oxygen delivery system
- helpful for adminstering low, constant O2 for COPD patients
*
What happens to nitrogen balance in burns, infections, injuries, fever or starvation
negative nitrogen balance. Protein is the body’s only source of nitrogen. Must be balanced by excretion of urea wastes.
What are signs of hypertensive crisis due to ingesting tyramines
headache, nasuea, tachycardia, vomitting.
early signs of hypoxemia
- increased HR
- Resltessness
- Irritability
- Nasal flaring
- cyanosis is a late sign
concentric training
muscle tense while shortening
If nurse makes a medication error, what are the appropriate actions to take?
- Monitor vital signs
- notify HCP
- Document the administration
- Notify nurse manager
what is usually the cause of a bladder infection
e.coli, not r/t glomerulonephritis (streptococcus)
what teaching should be recommended for clients with low back pain?
avoid standing for long periods of time
Fetal Attitude
the relationship of the fetall body part to one another
Fire Rescue plan, what does PRC stand for
Protect clients, Report the Fire, Contain the Fire
Common symptoms of measles
koplik spots
CHAIN OF COMMAND
ALWAYS FOLLOW THIS!
Signs ofr meningitis
Kerniq/Brudinski
What should you be concerned if observed after giving chlordiazepoxie
blurred vision, drowsiness. Anti-anxiety drug.
other SE’s include constipation, slurred speech, anorexia, polyuria, pancytopena, administer meals ro with milk to decrease GI irritation
-dil-
Vasodilator
What are signs of infection in elderly patients?
tachycardia, tachypnea, and confusion (not fever)
Sign of a big risk factor after CABG
chest tube drainage suddenly stops. Hallmark sign of cardiac tamponade
According to Erickson’s Stages, when does a client develop trust
birth - 18 months of age
Bryant’s traction
children
Write down the complications you expect with regard to days after surgery (i.e. 24-48 hours, 72 hours)
If pt has latex allergy, what else do you want to assess?
bananas, apricots, cherries, grapes, kiwis, passion fruit, avocados, chestunuts, tomatoes, peaches
What are signs of toxicity with aspirin
tinnusitis, headache, hyperventilation, diarrhea, confusion, diaphoresis.
What is the action behind morphine for MI
decreases blood return to the right side, and decreases peripheral resistance. Decreases pre load and afterload. Causes vasodilation
Erikson Stages thru Teenager
- 0-18 months– Trust vs Mistrust
- 18-3 years– autonomy vs shame/doubt
- 3-5 years– initiative vs guilt (preschooler)
- 5-13 years– industry vs inferiority
- 13-21 years– identity vs role confusion
Cortisone
Indication adrenal insufficiency, Addison’s Disease
Action suppress inflammation and normal immune response. Adrenal glands exrete steroid, cortisol, blood sugars, metabolism of fat, protein and carbohydrates. decreasing bone formation
Class antiasthmatic, corticosteroids
Nursing watch liver, avoid untreated infections, CNS alteration, peptic ulcers, Cushings, Weight, gain, osteoporosis, decrease wound healing
Methylphenidate
(ritalin)
- *Indication** ADHD, narcolepsy
- *Action** improves attention span
- *Class** CNS stimulatn,
- *Nursing Considerations** sudden death, hypertension, plapitations, anorexia, hyperactivity, insomnia. decreased effects of warfarin and phenytoin. Do not use with MAOIs. Do not consume caffeniated beverages. Monitor for dependence
What does a Swan-Ganz catheter do?
indirectly measures the pressure in the ventricles. Meausures the pulmonary artery wedge pressure.
What intervention is needed for an infant after a cleft lip repair
arm restrains to rpevent rubbing suture line
What do you want from a non stress test
it to be reactive
Why is Z-Track administration utilized
because IM technique is too irritating to the Sub Q tissues.
What is a common misconception with hemophilia A
bleeding all the time
what does stable eschar do for skin care?
serves as body’s natural cover
Hep A Precautions
wear gown and gloves during client contact
White Blood Cell Count
4500-11,000 cells/mm3
BUN
8-25 mg/dL
Norepinephrine
- *Indication** tx of severe hypotension and shock
- *Action** increase BP and COutput by stimulating alpha-adrenergic receptors in the blood vessels, demonstrates minor beta activity
- *Class** vasopressor
- *Nursing Considerations** monitor bp every couple minutes, can result in rebound hypotension due to tissue ischemia, monitor EKG and CVP if possible. Instruct pt to report headaches, dizziness, and chest pain
how do you know a woman is in the transition phase of labor?
asks to go to the bathroom. Increases pelvic pressure intense desire to urinate
What are the next steps if child has diarrhea and dehyrdation has stopped?
once rehydration has occured, start to introduce usual diet.
Other than hypertension and mental health. What can beta blockers be used for?
essential tremors
What should you NOT do after amputation
do not elevate after 24 hours. May result in flexion contracture. Expose to air.
What is the priority for cardia dysrthythmias
decreased cardiac output
how far apart should intake and output be from eachother?
200-300ml
what is the MOST importatn to consider when a client is immobile?
skin integrity
In poison control when should you NOt induce vomiting
if contains alkaline or acid agents. I.E. lye, houseehold cleaners, oven cleaner, furniture polish, metal cleaners, battery acids, petroleum products
can neutralize using activated charcoal
Lorazepam
- *Indication** anxiety, sedation
- *Action** general CNS depression
- *Class** anesthetic, antianxiety, sedative hypnotic, bonzo
- *Nursing Considerations** caution with COPD and sleep apnea, avoid alcohol use, antidote is Flumazenil, may cause cardiac arrest, bradycardia, hypotension, administer slowly and dilute to decrease complications
- arone
ex: Amiodarone
antiarrhythmic
If a client has a blood glucose of 175 and reports being hungry and thirsty what should you do?
administer Humulin R- Insulin (short acting, regular). Will work in 30 mintues, pt should wait to eat breaskfost so insulin can begin working
What is the most widely accepted test to examine the presence of tardive dyskinesia
Abnormal involuntary movement scale
SATA questions, what do you need to pay attention to
once a week, daily, once a month
ensure that the timing is appropriate.
What should you do if there is lots of water in a tracheostomy tubing?
empty the fluid, pt at risk for aspriation.
Client with Irritable Bowel Syndrome is having problems with fiber, what should you do
- increase fiber gradually 2 - 3 mg per day, help to reduce gas and bloating
- Dairy products can contribute to gas formation
- small frequent meals to reduce gas
goal is to reduce gas and bloating
What drug is used for autonomic dysreflexia
hydrazaline, fast acting antihypertensive.
Airborne precuations
mask, gloves
Atrial Flutter
250-350 bpm
Prothrombin Time (PT)
9.5 - 11.8 seconds
How often should self breast exams be performed
monthly
What is the most important intervention when body iimage is a factor
touch
Proper actions to take if you administer incorrect dose of medication
- record the dose of med administered
- perform an assessment on the client
- contact the physcian
- chart any adverse reaction
- submit the report to risk manager within 24 hours
Quadrigeminy
PVC after 3 normal QRS
How do you protect against extravasation in vesicant drugs for cancer?
aspirate positive blood return prior to use
femoral pulse is located..
What does justice mean?
fairness
Diazepam
Indication anxiety, pre-op sedation, conscious sedation, tx of seixures, insomnia, mgmt of alcohol withdrawal
Action depress the CNS
Class benzodiazepine, antianxiety, anticonvulsant, skeletal muscle relaxant
Nursing ccontraindicated in hepatic dysfunction, wathc renal impairment, dizziness, drowsiness, lethargy, hypotension, physical dependence, tolerance, caution with alcohol use
What is the preferred site for ABG
radial. Apply firm pressure 5 min prior. Leave oxygen on. Sample should be cold on ice to minimize chemical reaction
What is the primary purpose of a transitional care program
reduce readmissions to the hosptial
Cefaclor
Indication tx of respiratory tract infections, skin infections, otitis media
Action bacteriacidal, binds to bacterial cell wall causing cell death
Class cephalosporin 2nd generation, anti-infective
Nursing contraindicated cephalosporin and penicillin allergies, may lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at iv site, anaphalzis, assess infection and allergies, obtain cultures prior to therapy, monitor bowel function, can lead to super infection
what discomforts should be noted for a laparscopy exam
carbon dioxide is trapped in the abdomen and may cause shoulder pain
findings that indicate elder abuse
- over/undernourished,
- absence of needed dentures and glasses
- poor nutritional status
- dehydration
- urine burns
- excoriation
- pressure ulcers
- bruises
- battering (fractured hip can be osteoporosis)
How can you tell a patient is taking lithium
shaky hands
when does the potestorir fontanelle close?
6 to 8 weeks
what indicates cardiovascular fluid overload
rales and tachycardia
What is a milkwakee brace used for?
scoliosis 1-2 years, during periods of growth
What do insurance companies have a problem with when ordering supplies on discharge?
ordering extra suplies is considered stockpiling and they may refuse to pay the bill
what food should you avoid with chronic kidney disease
high potassium foods, risk for hyperkalemia
Common symptoms of cholera
rice watery stool
What is contraindicated for HEP B vaccine
anaphylactic rx to baker’s yeast
Classic findings of pulmonary stenosis
heaviy brathing, dyspnea, tachycardia, peripheral edema
Common symptoms of leprosy
lioning face
What is the most accurate procedure to rule out interstitial cystitis
cytoscopy procedure
VEAL CHOP
- Variable Cord Compression
- Early Head Compression
- Accelerations Okay
- Late Placental Insufficiency
Nursing Consideration with Fentanyl patch
- slowly absorped thru sub Q tissue, can take up to 12-24 hours before effective analgesia
- short acting opioid can be given for breathrough pain
- the pt can shower/bathe, but should not be exposed to hot tubs or heating pads. Speeds absorption of medication
- throw them away but folding in half, not by cutting in half
Amiodarone
- *Indication** ventricular arrthythmias, SVT, ACLS V-fib, Vtach
- *Action** prolongs action potential, inhibits adrenergic stimulation, decreases peripheral vascular resistance causing vasodilation
- *Class** Antiarrthymic Class III, Potassium channel blocker
- *Nursing Considerations** can cause ARDS, pulmonary toxicity, CHF, bradycardia, hypotension, increases dig levels, increases activity of warfarin, 2 RN check, monitor pulse daily and pt report abnormaility, avoid drinking grapefruit juice
Meniere’s syndrome makes client dizzy what intervention should nurse ensure
do not turn head
cullen’s sign
ecchymosis in umbilical area, seen with pancreatitis
Ketorolac (Toradol)
- *Indication** pain
- *Action** pain relif due to prostaglandin inhibition
- *Class** nonsteroidal antiinflammatory agent, non-opioid analgesics, pyrroziline carboxylic acid
- *Nursing Considerations** Steven Johnson Syndrome, anaphylaxis, drosiness, GI bleed, should not exceed 5 days of tx, increased bleeding risk with garlic, ginger and ginkgo, decrease HTN meds and diuretics
Olanzapine
- *Indication** schizophrenia, mania, depression, anorexia nervosa, N/V, r/t chemo
- *Action** antagonizes dopamine and serotnin
- *Class** antipsychotic, mood stabiilizer, thienbenzodiazioines
- *Nursing Considerations** do not use while breastfeeding, neurlyptic malignant syndrome, seizures, suicidial thoughts, inosmonia, tardive dyskinesia, aggranulocytosis, constipation, tremors, assess mental status, hemodynamics, Blood sugars, intake and output. liver function tests
When should you do an allen’s test?
prior to doing an abg to check for sufficient blood flow
negative test if color return in less than 7 seconds
Chancres, flu-like symptoms, hair loss, palmar rash signs of
syphyillis
Insulin (Short Acting)
- *Indication** hyperglycemia with diabetes type 1 and type 2, ketoacidosis
- *Action** stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the livere, prevents breakdown of fat and protien
- IV onset 1-2 hr, Peak 4-12 hr*
- *Class** lpancreatics, antidiabetics
- *Nursing Considerations** monitor body weight over time, may cause decreased inorganic phsophates, potassium and mag. Monitor B/S Q6, monitor A1C every 3-6 months
Responsibilities of UAP
- No scope of practice
- Non-invasive and non-sterile treatments
- bathing, transferring, ambulating, feeding, toileting, Vital signs
when is a very low calorie diet acceptable
an obese client (BMI greater than 30). Need professional monitoring.
What type of diet does a patient with preeclampsia need?
protein. Lie on the left side, adequite fluids. Protein restores osmotic pressure
What is the mneomonic for a client with celiacs
- Barley
- Rye
- Oats
- Wheat
What is BUN
Blood Urea Nitrogen. How much concentration, if highly concentration, kidneys are not functioning properly
Situations where Promethazine would be prescribed.
- going on a cruise
- preoperative sedation or surgery
- enhancing pain med after surgery due to sedation
anti-emetic, drowsiness
If a mother is RH negative and rbeastfeeding exclusively, what is a concern
hyperbilirubemia
How much radiation in mammography is it equivalent to?
one hour of sun exposure
what drugs are used for gout
colchicine, allopurinol, probenecid
how often should trach be cleaned
every 4 hours
S2 Auscultation
- closing of the aortic valve
- after short systolic pause, before long diastolic pause
- heard best over aorta, secon right interspace
- high pitched dull in quality
Hydralazine
Indication Hypertension
Action arterial vasodilator
Class anti hypertensive, vasodilator
Nursing tachycardia, sodium retention, dysrthymias, angina. Use caution with MAOIs. Monitor BP. Instruct pt on how to take BP
What are minors known as if they are married
emancipated minors through marriage, pregnancy, high school graduation, independet living or service in the military (have the legal capacity of an adult)
Sucralfate
- *Indication** GI ulcers, GI injury prevention form high dose aspirin, NSAID tx
- *Action** reacts with gastric acid to form a paste that dheres to ulcer
- *Class** antiulcer, GI protectant
- *Nursing Considerations** caution in renal failure, concurrent use of antacids may decrease the effect of sucralfate. Administer 30 min before or after. Adminsiter on empty stomch 1 hour before meals
Signs Symptoms of Buerger’s disease
vasculitis of blood vessels in upper and lower extremities. Digital sensitivity to cold
principle of safe assignments of nurse has never done a procedure before
change the assignment. Match the skills with the tasks.
CNS infection examples
meningiits, encephalitis
Oxytocin
- *Indication** labor induction, postpartum bleeding
- *Action** stimulates uterine smooth muscle
- *Class** hormone, oxytocics
- *Nursing Considerations** ICH in fetus, asphyxia in fetus, may cause coma and seizures in mother. Monitor blood pressure, assess maternal electrolytes. Uterine Tetany
what drug is given for myesthenia gravis
neostigmine. before eating will hep with chewing and swallowing.
What is a problem an infant could have if mother has diabetes?
hypoglycemia due to increased output of insulin
Terbutaline
- *Indication** asthma, COPD, preterm leabor
- *Action** prdouces bronchodilation
- *Nursing Considerations** nervousness, restlessness, tremors, assess respiratory status. monitor for hypoglycemia, may cause decreased potassium level.
Common symptoms of pneumonia
rusty sputum
Care after myelogram
- drink lots of clear liquids
- remain in bed for 8 hours, slightly elevated
- resume regular diet and meds
- avoid alcohol for 24 hours
- no strenuous activity for 48 hours.
What procedures should be implemented following a broncoscopy
semi-fowlers position, vitals q15. assess respiratory difficulty
What do you need to know about DIC
always secondary to something else
What is the maximum dose of IM injection for infants and toddlers
1mL
CABs in CPR stand for
compressions, airway, breathing
Trimethroprim/Sulfamethoxazole
- *Indication** bronchitis, UTI, diarrhea, pneumonia, multiple types of infection
- *Action** bacteriacidal by preventing metabolism of folic acid
- *Class** folat antagonist, antiinfective, antiprotozoal
- *Nursing Considerations** renal damage, steven johnson syndrome, agranulocytosis, aplastic anemia, phlebitis, drink 8-10 glasses of water
When you see coffee brown emesis what should you think
peptic ulcer
What is buck’s traction used for
to immobilize, position and align the lower extremity.
5-7 lbs is recommended for skin traction
Primary Nursing
- Primary nurse designs, implements and is accountable for nursing care of clients during entire stay on the unit
- continuity of care, not feasible with varying schedules
- greater nurse satisfaction, more personalized care, less turn over
- fewer negative outcomes for patients
Carbamazepine
Indication seizure, DM neruopathy, pain associated with trigeminal neuralgia
Action affects sodium channels in neurons leading to decreased synaptic transmission
Class anticonvulsant
Nursing interferes with oral contraceptives, do not use with MAOIs, suicidal thoughts, Steven Johnson syndrom, agranylocytosis, aplastic anemia, thrombocytopenia, No grapefruit juice, monitor CBC and platelets, monitor blood levels
What is penatmidine isethoionate used for and how do you know if it is affective?
prevent pneumocystitis, (AIDS), drug should decrease crackles and dyspnea.
What is the normal range for prothrombin time?
What is the normal range for Warfarin
10-14 seconds
20-28 seconds
Symptoms of Myasthenia Gravis
- muscle weakness that improves with rest
- ptosis- drooping eyelids
- impaired speech
- dysphagia
- double vision (diplopia)
Findings of Endocarditis
- Red spots on palms/soles (Janeway lesions)
- Red painful sores on fingetips and tes (Osler’s Nodes)
- fever, night sweats muscle aches.
Feeding an infant with a cleft lip
rubber tip syringe, prevent sucking on the tubing, Tend to swallow excessive amounts of air, require frequent bubbling.
Verapamil
- *Indication**hypertension, angina, SVT, migrain
- *Action** prevents tranport of calcium, leading to decreased contraction, decreases SA and AV node conduction
- *Class** antianginal, antiarrthymic, antihtn, vascular headache. CA blocker
- *Nursing Considerations** dont use with 2nd 3rd degree block. can cause anxiety, confusion, cough, dypsnea, CHF, bradycardia, hypotension, elevated liver enzymes, Steven’s Johnson sydrome. Hyperglycemia, gingival hyperplasia. grapefruit can increase effects. Can increase levels of diozin. assess angina.
pregnancy and type 1 insulin requirements
increase during pregnancy and decrease after delivery
Magnesium Sulfate
- *Indication** HTN, hypomagnesameia, preterm labor, torsade de pointes, asthma, anticonvulant with eclampsia
- *Action** magnesium plays a role in muscle excitability
- *Class** mineral/electrolytes
- *Nursing Considerations** caution with renal insufficiency, decreased respiratory rate, dysrthymias, hypotension, muscle weakness. Monitor EKG and repsiratory status. Monitor Mg levels. 2 practictioner check
Nursing considerattions with Vincristin (Oncovin)
- Used for ALL (Acute Lymphocytic Leukemia)
- IV use only
- Intrathetcal admin can be fatal
- Vesicant can cause local damage if extravasation occurs
- Tx includes warm compresses
- Peripheral neuropathy is a major side effect
- monitor for decreased hepatic functining b/c gets metabolized in the liver
Activity Lifestyle changes after MI
decrease physical activites. Need Cardiac Rehab
which is worse, inhaling a chemical or swallowing it?
inhaling. Immediate absorption and can impair oxygen exchange
what std is reportable
Gonorrhea
What is most valuable tool for school aged children and physical assessment
weight and heigh compared to standard tables
Cold vs Hot for pain
Cold for acute pain, heat for chornic pain (RA)
Why would a patient with hypertension have increased renin levels
increases serum aldosterone levels, increasing kidney reabsroption of soidum and water. Increases blood pressure
where are eye drops placed for a child?
in the conjuctival sac as the lower lid is pulled down
Foods to avoid if low WBCs
raw fruits and vegetables, undercooked meats, moldy cheeses, luch meat, salads things from the deli counter, brewed teas.
What needs to happen to prep a client for iv pyelogram
- clean out gi tract
- NPO 8-12 hours
- administer laxative the evening before
- enema morning of the test
Precautions to take with RSV
no contact lenses or pregnant nurses in rooms where ribavirin is being administered by hood, tent, etc.
What is a major side effect of terbutaline when used for women in labor?
tachycardia, withhold the medication. Fetus may have tachycardia and hypoglycemia. Minimal effects aon blood pressure thought.
Dobutamine
Indication short term mgmt of heart failure
Action positive inotropic effects, little effect on heart rate. Stimulates beta receptors in the heart
Class inotropic, adrenergic
Nursing hemodynapics, hypertension, increase HR, PVCs, skin reactions, beta blockers may negate therapeutic effects, montior CO, watch peripheral pulses, do not confuse with dopamine
What type of breathing occurs with pneumothorax?
rapid respirations/ tachypnea
Procedure for neutropenic precautions
- PPE
- private room
- visitor restriction
- no raw vegetable or fruits
- bathe daily
Heberden’s nodes are characteristic of
osteoarthritis nodules. Strongly inherited.
Metoclopramide
(Reglan)
- *Indication** prevention of N/V hiccups, migrains, gastric stasis
- *Action accelerates gastric emptying by stimulating motility**
- *Class** anti-emetic
- *Nursing Considerations** do not use with GI obstruction. Can cay extrapyramidal reaction, Neurolyptic malignant syndrome, Tardive dyskinesia, dysrithymias, BP alterations, hematologic alteration, facila movements, sedation. Can decrease effects of levodopa. Monitor liver function
-perone
antianxiety agent
Demerol contraindication
sickle cell crisis
Indications of Intenstinal obstruction
abdominal distention, chills fever (toxic megacolon), fitula formation
What are the 3 Ps of hyperglycemia?
Polyuria, polydipsia, polyphasia
he client is informed that the ultrasound suggests the baby is small for gestational age (SGA). An earlier ultrasound indicated normal growth. What causes this change?
maternal hypertension. Common cause of late pregnancy fetal growth restriction. Vasoconstriction reduces placental exchange of oxygen and nutrients.
Why is it important for a patient with an acute episode of pancreatitis to maintain bedrest
decreases the metabolic rate and the secretion of pancreatic enzymes; bathroom priveledges are not allowed.
by 6 months of age, what are the immunizations a child will have received?
- 3 doses of diptheria
- tetanus
- pertussis
Heparin
Indication venous trhomboembolism, prophylaxis and tx. Low dose used to ensure patency of IV catheters
Action increases the inhibitory effect of antithrombin on factor Xa
Class anticoagulant, antithrombotic
Nursing monitor signs of bleeding, platelet count, hyperkalemia, pt report signs of bleeding
liver biopsy prep
administer vit k, npo 6-12 before. Teach pt will need to hold breath for 5-10 secs, supine position, lateral with upper arms elevated. Post- position on rt side, frequent vs. Report severe ab pain stat. No heavy lifting for 1 wk
Guaifenesin (Robitussin)
Indication cough suppression
Action decreases viscosity of and mobilizes secretions
Class allergy, cold, cough remedy, expectorant
Nursing avoid OTC meds, assess lung sounds. Adequate fluid intake
Amoxicillin
- *Indication** skin ifections, respiratory infections, sinusitis, endocarditis prophylaxis, lime disease
- *Action** linhibits synthesis of bacterial cell wall leadting to cell death
- *Class** antiinfective, antiulcer, aminopenicillins
- *Nursing Considerations** contraindicated w/ penicillin allergy, seizures, rash anaphylaxis, excreted by kidneys-monitor renal albs, monitor pt for diarrhea, bloddy stool should be reported immediately
-cef
cephlosporin
When is handwashing a requirement?
- prior to eating
- after cleaning a wound
- after contact with inanimate object
- before having direct contact with a client
- C.Diff/soiled hands
what is a complication of impetigo
poststreptococcal glomerulonephritis, watch for periorbital edema.
Which adverse affect of ACE inhibitors need to be reported to the HCP
persistent cough, common reason to change to another medication.
(accumulation of bradykinin)
When does a pregnant women need to increase insulin dosage
during first 3 months of pregnancy
What medication is the only FDA approved med to treat PTSD
SSRIs
russells traction is for
femur or lower leg
What symptom from a diabetic patient should be reported immediately?
profusion perspiration, sx of hypoglycemia. (numbness and tingling are expected findings)
What is the reasoning of why an OCD patient performs rituals
to avoid severe levels of anxiety
what is a controversial seizure precaution
padded side railes, may embarras the client and family.
What are you worried about with neuroleptic malignant syndrome
very high temperature
What type of diet does a patient with chronic kidney disease need?
increase pasta and bready. Helps maintain energy requirements
Risk factors for CT scan with contrast
- history of asthma
- positive pregnancy
- Poor renal function
- Beta blockers
- heart, kidney, thyroid disease
What hormone causes a womens period to stop
progesterone
Epinephrine
Indication adrenalin, asthma, COPD exacerbations, allergic, cardiac arrest, anesthesia adjunct
Action both beta 1 and beta 2, alpha agonist properties. Bronchodilation, increases HR and BP
Class antiasthmatic, bronchodilator, vasopressor, adrenergic
Nursing angina, tachycardia, hytpertension, restlessness, nervouseness, hyperglycemia, MAOIs can lead to hypertensive crisis, do not use stimulants, hemodynamics, chest pain, adequate fluid intake, rinse after inhalation, beta blockers negate effects, increased blood sugar
Priority action for pt with preeclmapsia
have the client turn to the left side
What is the antidote for metformin
acetylcestein (24-48 hrs after contrast)
characteristics of hyperkalemia
muscle cramps, bradycardia, v,fib
What is important to note when planning debridement of a deep partilal thickness burn
need adequate time and emotional support
Warfarin
- *Indication** venous thrombosis, pumonary embolism, afib, myocardial infarction
- *Action** disrupts liver synthesis of Vitamin K dependent clotting
- *Class** anticoagulatn, coumarins
- *Nursing Considerations** contraindicated with bleeding, severe hypertension. Azole and anitfungals increase effects. Obtain full hx of supplements and herbsl. Large amounts of Vit K may antagonize effects of warfarin. Therapeutic level PT 1.3-1.5, INR 2.5-3.5/ No alcohol. Monitor bleeding times
-itis is always associated with
fever, inflammation, infection
Captopril
Indication hypertension
Action block angiotensin I to angiotensin II, Increases renin levels and decreases aldosterone. Vasodilation
Class ACE inhibitor, antihtn
Nursing neurtopenia, watch potassium, watch diuretics, 1 hr before meals, watch weight and fluid status, renal profile, monitor CBC
Proper technique for administering TPN thru Central Line
- Confirm the order
- check solution for cloudiness
- select and flusht the correct tubing and filter
- Thread IV tubing thru infusion pup
- use aseptic technique for handling injection cap
- connect to central line
- Set infusion pump at prescribed rate.
Med of choice for SVT
adenosine or adenocard
Butorphanol
Indication severe pain, labor pain, sedation
Action alters perception and response to pain by biding to opiate receptors in the CNS
Class opioid analgesic, agonists
Nursing caution with MAOIs, may cause confusion, hallucination, sedation, Monitor CNS depression, assess BP, pulse and respirations, aminister slowly through IV line
What should clients expect after transurethral resection of the prostate
3 way indwelling has a large diamtere, will continuously feel the urge to void for 24-48 hours
What does unstable chronic angina indicate
impending heart attack
Common symptoms of asthma
wheezon on expiration
How is anthrax spread
contact with infected animal hair and hides
standard precautions
Contact Precautions Mrs. WEE
- Multidrug resistant organism
- respiratory infections
- skin infections
- wound infection
- entereic infetion- c.diff
- eye infection- conjuctivitis
What could be a cause at home for a child to have an astma attack
new pillow
Drugs that alter electrolytes
- diuretics
- Thiazides- hold on to Ca & Uric Acid
- ACE- hyperkalemia
- Steroids- hypokalemia
Characterstics of hyponatremia
Nausea, confusion, muscle twitching, ICP, muscle cramps
When should you withold a calcium channel block (-dipine)
bradycardia
other than clearing the bowels, what else does IVP require
radiopaque dye, allergy to iodine can be life threatening
Fetal Lie
the relationship between the head to tailbone axis for both the fetus and the mother
Where is pain in diverticulitis
Left Lower Quadrant
Mannitol
- *Indication** increased ICP, oliguric renal failure, edema introcular pressure
- *Action** reeabsorption of water and electrolytes by increasing osmotic pressure excreted by the kidneys
- *Nursing Considerations** phlebitis at IV site. Dehydration, F/E imbalance. Monitor neuro status
How might restrains without consent or sufficient justification be interpreted?
false imprisonment
When is a child ready for toilet training
when myelinationf of the spinal cord is completed this is when voluntary control of sphincter muscles occurs. (between 18 and 24 months). Child has to be walking without holdingo n.
What will a patient experience with placenta previa
painless vaginal bleeding (painful bleeding indicated abruptio placenta)
Procedure for dressing change of burn
- administer morphine
- debride the wound of eschar using gauze
- obtain wound cultures
- apply silvadene ointment
- cover wound with sterile gauze dressing
In a math equation requiring dilution factor, what should you watch for as potential trick
don’t get confused by the quantitiy of diluent. only the final concentration directs your answer
what does percocet have with it?
oxycodone with acetaminophen
Infant milestones
Name an example of a hypotonic solution
0.45% sodium chloride
LPN/LVN and blood
cannot handle
Common cause of aortic stenosis
aging heart, or rheumatic fever
- Atrial Flutter
- Regular Rate
- QRS 0.06
Infectious Diseaseas that are droplet
rubella, meningitis
why should metformin be taken with meals?
to reduce side effects such as N/V, anorexia, ab cramps, fatigue.
What is a contraindication for receiving influenza vaccine
allergy to egg proteins b/c grown on egg embryos
precautions with a fistula
never take blood pressure or draw blood from arm with fistula
Fetal adaptions during labor
- engagement
- descent
- flexion
- internal rotation
- extension
- external rotation
- expulsion
What is lateral communication
between staff members i.e. coordinate activities
What can cause false positive result on fecal occult test
- eating red meat
- NSAIDS
- steroid use
- bleeding gums
Cardiopa/Levodopa
Indication parkinson’s disease
Action levodopa converts to dopamine and works as a neurotransmitter and carbidopa prevents destruction of levodopa
Class dopamine agonist, antiparkinson agent
Nursing orthostatic hypotension, dark urine, takes weeks to effect, no MAOIs, no with glaucoma/melanoma
Indomethacin
Indication inflammaotry disorders when pts do not respond to other meds.
Action decrease pain and inflammation by inhibiting prostaglandin synthesis
Class antirheumatic, ductus arteriosis patency, nonsteroidal antiinflammatory agent
Nursing monitor hepatitis and GI bleed, dizziness, drowsiness and headache. Assess for anaphylactic reaction. Aspirin may decrease effectiveness. Monitor renal labs. Shake supension before administration. Pt should wear sunscreen and protective clothing to protect against photosensitivity.
What is a major side effect to be noted with mag
decreased urine output, oliguria
What is the ONLY insulin that can be given IV push
short acting
Purpose of a tracheostomy
- when patient is unable to maintain airway
- unable to cough productively
- Permits Use of Positive Pressure Ventilation
- Prevents aspiration of secretions in unconcsious/paralyzed
Calcium Acetate
Indication hypocalcemia, menopausal osteoporosis, hypokalemia,
Action maintains cell membranes, muscle contraction, nerve impulses, blood formation and coagulation
Class antacids, minerl/electrolyte replacement
Nursing cardiac arrest and arrhythmias, phlebitis at insertion, hypotension, bradycardia, hypercalcemia, dig toxicity, watch parathyroid hormone
Alendronate
- *Indication** osteoporosis
- *Action** linhibits osteoclast activity leading to inhibition of resorption of bone
- *Class** bone resorption inhibitor, biphophnates
- *Nursing Considerations** take first thing in the morning w/ water 30 min prior to eating, assess calcium, may cause muscle pain
What is Creatinine
by product of muscle breakdown. our body tries to filter this out.
Why might you not put liquid medication down a gastrostomy tube?
may contain sorbitol. If client has an allrgy can cause diarrhea.
What are contraindications for a halo crown
skull fractures, chest trauma, obesity and avadanced age
on the nclex what is important to watch for if client has COPD or emphysema?
Should NOT increase oxygen.
primary goal of managed care is to..
reduce health care costs
Bubbling in a suction control chamber vs bubbling in water seal chamber?
Suction control bubbling is expected
Water seal, indicates air leak
notify HCP if draining is more than 100mL/hr
Common side effects of sulfonamides?
Urticaria/Rash
What is an example of behavioral therapy
using positive and negative reinforcement. Assertiveness trainsing and desensitiization.
good for phobias, sexual dysfunction, eating disorders, etc.
What is always an intervention when puncturing the spine
need fluids
Losartan (Cozaar)
- *Indication** HTN, DM neuropathy, CHF
- *Action** inhibits vasoconstrictive properties of angiotensin II
- *Class** angiotensin I receptor antagonist
- *Nursing Considerations** hypotension, tachycardia, angioedema, hyperkalemia. May increase digoxin levels. Asses BP and Heart rate. Assess fluids. Monitor dail weights with CHF. Monitor renal and liver.
PO2
80-100%
Diphemhydramine (Benadryl)
Indication allergy, anaphylaxis, sedation, motion sickness, antitussive
Action antagonizes effects of histamine, CNS depression
Class allergy, cold and cough, antihistamine, antitussive
Nursing drowsiness, anorexia, dry mouth, nausea, chest tightness, thick secreations, hypotension, blurred vision, headache, anticholinergic effects, monitor cough and lung sounds, avoid otc meds.
Trasmission based precaution for C.diff
contact precautions
Glipizide
Indication type 2 diabetes mellitus
Action stimulate release and sensitivity to insulin to lower blood glucose
Class anti-diabetic, sulfonylureas
Nursing aplastic anemias, hypoglycemia, photosensitivity, dizziness, drowiness, headache, diarrhea. Monitor CBC, assess for allergy to sulfonamides. Beta blockers may creat signs of hypoglycemia. Instruct patient on how to check blood sugars. Carry source of sugar in case of hypoglycemia
What are signs of ectoptic pregnanct
unilateral, dull abodminal pain
- Aystole
Major serious symptom of ectopic pregnancy
left lower quadrant pain
Hydrochlorothiazide
Indication hypertension, CHF, renal dysfunction, Cirrhosis, glucocorticoid therapy
Action selectively inhibits reuptake serotonin
Class anti hypertensive, diuretics, thiazide diuretic
Nursing dizziness, hypokalemia, hyponatremia, hypophosphatemia, hypomagnesemia, dehydration. hypokalemai can increase risk for dig toxicity. Monitor BP and I/Os. Monitor electrolyte levels. Take same time each day. How to take BP.
how should pain med be administered for a cancer patient with chronic pain
around the clock is more affective with cancer
What is an issue with infants who have a diabetic mother?
congential anomalies
What is the leading cause of skin breakdown?
decrease in tissue perfusion
Things the nurse CANNOT delegate
- assessment
- evaluation of client date
- nursing judgment
- teaching and evaluation
- nursing dx, or care planning
- admission/discharge
in a psychiatric unit, which client should you see first typically
auditory hallucination, make sure they are not telling the lcient o harm self or others
RACE stands for
Rescue, Alarm, Confine, Evacuate
What could a patient who is 27 weeks gestation with vaginal bleeding during intercourse.
could mean lots of things. could be placenta previa– more serious.
For a patient who is receiving chemotherapy, which laboratory result is of particular importance?
WBC, b/c chemo can decrease wbcs (neutropenia). Leaves the patient vulnerable to infection.
How can you tell the difference between Cerbro Spinal Fluid and other drainage?
Halo test, CSF will be + for glucose. When present there will be a halo around the blood spot
Med of choice for Vtach?
lidocaine
what pelvic inflammatory disease is frequently caused by what infectious disease
chlamydia and gonorrhea
Renal Encephalopathy signs pt with hemodlialysis
confusion irritability, elevated BUN and Creatnine
Gross Motor Skills
2-3 years
- balance on one foot for 3 seconds
- catch a ball
- pedals tricycle
when does discharge planning start?
upon admission
what is the most practical way to communicate with a patient that has a trach
yes/no question (nod, shake)
What is very important with pateitns with sickle cell disease
hydration and anlagesics
What is the most serious complication following gastric bypass surgery (bariatric surgery)
anastomotic leak. Monitor for back, shoulder, abdominal pain, restlessness, unexplained tachycardia, oliguria. Immediately report to surgeon. Do not manipulate NG tube. Elevate HOB.
what toxin needs to be monitored when giving nitroprusside
metabolism involved the production of cyanide.
Amitryptiline
- *Indication** depression, anxiety, insomnia
- *Action** increases effect of serotonin and norepinephrine in the CNS, exhibits antichoinergic effects
- *Class** Antidepressant, tricyclic
- *Nursing Considerations** contraindicated in MI, heart failure, glaucoma, risk for suicidal ideation, arrthythmias, hypotension EKG, alter BG levels, lethargy, do not use with MAOIs, take exactly as instructed, orthostatic hypotension, photosensitivity, may turn urine blue/green
How do you relieve flatus from a patient with an ostomy pouch
open the bottom of the pouch in privacy will cause odor.
Fluoxetine (Prozac)
Indication depressive disorder, PCD, bulimia, panic, bipolar, ADHD, DM neuropathy, obesity
Action inhibits reuptake of serotonin,
Class antidepressant, SSRI
Nursing contraindicated wtih MAOI, citallrpan use, may cause suididal thoughts, insomnia, diarrhea, nausea, serotonin syndrome, QT prolongation, monitor nutrition, good oral hygiene. 4-6 weeks for full affect to take place
Right CVA affects
impulsive behavior
What is the safe action for removing an NG tube
ask the client to hold breath until tube is completely out. Closes the epiglottis and helps prevent aspiration. When inserting it is easier of the pt swallows.
What is a major side effect of antineoplastic drugs
ototoxciity
Ranitidine
- *Indication** duodenal ulcers, GERD, heartburn esophagitis, GI bleed
- *Action** inhibits action of histamine in gastric pareital cells, decreases gastric acid secretion
- *Class** antiulcer agent, H2 blocker
- *Nursing Considerations** dysrthmias, agranulocytosis, aplastic anemia, confusion. Ab pain, monitor for blood in stool. monitor CBC
Digoxin
Indication CHF, Afib, Aflutter
Action ipositive inotropic effect, increases force of Myocardial contraction, prolongs refractiory period, decrease conduction through SA and AV nodes. Increases CO and slow Rate
Class antiarrhythmic, inotropics, digitalis glycosides
Nursing contraindicated with uncontrolled ventricular arrhthmias, hypokalemia increase risk for toxicity, hypercalcemia increase risk for toxic, caution with diuretic, watch for bradycardia, toxciity= vision changes, yellow green vision, montior pulse rate for 1 full minute
Interventions for patient with flail chest
- paradoxical respirations
- monitor vital signs for shock
- (Pler-evac is for pneumothorax)
- Very painful, need pain meds
- Turn Cough Deep Breath, lung expansion
- Monitor ABGs
- No need for surgery
eccentric training
muscle tenses while lengthening
Where my patient report pain if they have pancreatitis?
sharp pain in the epigastric area, above the belly button. Pt might report upper back pain, nurse needs to assess correct location regardless of how the client identifies it verbally.
Abnormal vital sigs and taking fish oil garlic and naproxen
all thos medication increase risk for bleeding. check color of bowel, bruising, frequency of medication use
arrett’s esophagus is a complication of this condition
GERD
if a client denies pain after surgery, how do you validate their pain
uses the faces pain scale. another assessment besides 1-10
If you notice a mass in the umbilica area, which assessment should you NOT perform?
palpate/percuss b/c risk of rupture. Auscultate, bruit would confirm an aneurysm
PPE for Contact Precautions
Gown, Gloves
Digoxin antidote
digiband
Contraindications for IPV (Inactivated polio vaccine)
anaphylactic rx to neomycin, streptomycin or polymyxin B
Even HIV are eligible for this
Phenazopyridine
- *Indication** urological pain
- *Action** analgesia to Urinary tract mucosa
- *Class** non opioid analgesic
- *Nursing Considerations** urine will turn red orange. headache, vertigo, heaptic toxicity, monitor renal function
What does an elevated ST segment mean?
client is having a heart attack. Get them to the cath lab for PCI in less than 90 minutes
worry about this client
What is the term when a nurse causes unintended harm to a patient?
Negligence
What is the most accurate way of determining proper NG tube placement?
measure hte pH of aspirated gastric contents
Spironolactone
- *Indication** potassium loss, hypertension, edema CHF
- *Action** inhibits sodium reabsorption while sparing potassium and hydrogen
- *Class** diuretic
- *Nursing Considerations** contraindicated with hyperkalemia, monitor I/O, BP, potassium and renal panel
deep partial thickness burns think
blisters are present
red, edema, pain!
Ferrous Sulfate
Indication prevention of iron deficiency anemia
Action iron is needed for hemoglobin, myoglobin and enzymes. It is transported to organs where it becomes part of iron stores
Class anti-anemic, iron supplement
Nursing seizures, hypotension, constipation, epigastric pain, diarrhea, skin staining, anaphylaxis. Asses nutrtional status, bowel function. Monitor hemoglobin, hematocrin. May cause eleved liver enzymes. Should take on an empty stomach to increase absorptio (vit c helps). Use z-track for IM injections.
anticoagulants/narcotics and LPNs
can be administered to stabled clients. But these are HIGH alert medications that should be given by RN to unstable client.
Gabapentine
Indication seizures, peripheral neuropathy, neuropathic pain, prevention of migraines
Action exact method of action is unknown
Class anticonvulsant, mood stabilizer
Nursing suicidal thoughts, confusion, depression, drowsiness, ataxia, facial edema, HTN. Monitor pt closely for changes in behavior and dpression. Asses seizure activity, pain. Take as prescribed
Client with a VTE should be on bed rest because
prevent pulmonary embolism. elevate legs, apply warm moist packs, monitor perippheral pulses, administer anticoagulants.
1 tblsp - how many mls
15 mls
Hallmark Signs of Severe Acute Respiratory Distress Syndrome
cough, difficulty breathing, fatigue, fever > 100.4, headache, myalgia.
compressions per breath for a 5 year old
same as adult 30/2
What is the main cause of glomerulonephriits?
strep. Treat my getting rid of strep
if you see the word immobilize 95% of the time think…
turn 2 hours, skin breakdown!
if a patient takes prednisone for adrenal insufficiency before surgery. What should you modify for the surgery
increase the dosae, because surgery increases the demand. Monitor vs, check for infection and bleeding
Right Sided Heart Failure
- dependent edema
- distended neck veins
- weight gain
Nursing Considerations regarding colestipol
antilipemic agent. Need Fat Soluble vitamins. Used for high cholestorerl and treat digitalis toxicity, biliary obstruction.
cause of GERD, location
lower esophageal sphincter.
What is the best indicator of dehydration
weight
What is the best indicator of an alcohol problem in a patient
tremors, elevated temp, nocturnal leg cramps, complaints of pain
Hydrocodone/Acetominiphen (Norco)
Indication moderate to severe pain
Action alters perception and reaction to pain by binding to opiate receptors in the CNS. Suppresses the cough reflex.
Class opioid analgesic, allergy, cold and cough remedy.
Nursing hypotension, monitor hemodynamics and respirations. May increase ICP. Narcan is the antidote for OD. Do not exceed 4g of acetominophen per day
What is Most important to note while a patient is having a seizure
observe the sequence and types of movements
Potassium antidote
insulin, NaHCO3, Kayexalate, Albuterol
what oral medication can be given to a type 2 diabetic
glipizide
What does downward communication mean?
used to relate organizationl policy such as position description and rules and regulations
symptoms of meningitis?
nuchal rigidity (neck), photophobia, DROPLET
Can CNAs collect urin specimens
yes
What drug should not be given with Lithium
diuretics (furosemide)
additional side effects include polyuria, polydipsia
Gastric vs Duodenal Ulcer
- G: laboring person, malnourished, pain AFTER eating. Food does NOT help. Vomiting does,
- D: Executives, well nourished. Pain after couple hours of eating. food helps
When is an electronic blood pressure machine contraindicated?
irregular HR, peripheral vascular disease, seizure, tremors, and shivering
What reason could a child have frequent bouts of gastroenteritis?
daycare, increased number children prone to infections
what happens to a patient taking cyclophasphamide for MS
develop alopecia 4-5weeks after starting treatment
SPIDERMAN acroydmn for droplet precautans
- Sepsis
- Scarlet fever
- Streptococcal pharyngitis
- parvovirus
- pneumonia
- pertussis
- influenza
- diptheria
- epiglottitis
- rubella
- mumps
- meningitis
- mycoplasma or menigeal pneumonia
- Adenovirus
if you see the word discharge for delegation its always the..
RN!!
how high should irrigation bag be held for an enema
12-18 inches
What is the patho behind MS
demyelination of spinal cord white matter. Can lead to parastesias. Difficulty swalling, impaired speech. Provide warm baths and packs. wide based walk. Bladder training.
Aspirin
- *Indication** rheumatoid arthritis, osteoarthritis, ischemic stroke and MI prophylaxis
- *Action** inhibits production of prstaglandins which leads to rreductiono fever and inflammation, decreases platelet aggregation leading to a decrease in ischemic diseases
- *Class** antipyretic, non opioid analgesic, salicylates
- *Nursing Considerations** bleeding, chronic alcohol use, Steven Johnson syndrome, laryngeal edema, anaphylaxis, increass risk for bleeding with warfarin, heparin, and clopdiogrel, increased risk for GI bleeding w. NSAID, liver function tests
what should you watch for with a patient that has myelonmeingocele?
elevated temp, irritability, lethargy. At risk to develop meningitis. Change dressing ever 2-4 hours using aseptic technique.
What happens to WBCs & RBCs with UTIs
- WBC: inflammation irritation of urethra
- RBC: bladder mucosa irritated and bleeding
what does theophylline do to digoxin toxicity?
increases risk, decreases effects of lithium and dilantin
How should you control a patient in a wheelchair in an elevator
back into the elevator, allows patient control
What is the safest laxative to administer?
Bulk-forming- Psyllium Hydrophilic mucilloid.
What could be a risk factor for malignant hyperthermia r/t general anesthetic
muscle cramps, or unexplained death of a relative with a febrile condition.
How long does an MRI procedure take
90 mintues
Prior to a CAT scan what is most important to assess?
problem client may have with enclosed spaces?
Propanolol
- *Indication** hypertension, angina, arrthymias, cardiomyopathy, alcohol withdrawal, anziety
- *Action** blocks Beta 1 & 2
- *Class** antianginal, antiarrthymic, antihypertensive, headache suppressant, beta blocker
- *Nursing Considerations** pulmonary edema, contraindicated with CHF, cardiogenic shock, bradycardia, heart block. Masks symptoms associated with diabetes mellitus. Advise physician if difficulty breathing
What is the drug of choice for frequent premature ventricular contractions?
lidocain
Metformin
- *Indication** mgmt of type II DM
- *Action** decreases glucose production inthe liver, decrease absorption, increases ellular insulin sensitivity
- *Class** antidiabetic, Biguanide
- *Nursing Considerations** do not use with renal dysfunction, metabolic acidosis. May cause diarrhea, N/V, lactic acidosis. D/C if acidotic.
Which age range is at increased risk for poisoning?
Toddlers age 1-3 years b/c increasing mobility
What will be elevated in glomerulonephritis?
Antistreptolysin (ASO)
Common EKG changes with Hypokalemia
- ST segment depression
- Inverted T waves
- Prominent U waves
- Heart Block
When are hemovac or jackson pratt’s removed after total kneww surgery
the morning after
Post op Thyroidectromy
- Have suction, oxygen, trach available
- monitor repsirations
- Semi Fowler’s position
- laryngeal nerve damage
- hypocalcemia
- thyroid storm
Avg circumference of the head for a neonate
32-36 cm
CABG
CABG intersted proximally and distally
Risk factor to look for with femoral politeal bypass graft
clammy skin, hypovolemic shock
Codeine
Indication mgmt of pain, diarrhea, cough suppressant
Action binds to opiate receptors in the CNS and alters perception of pain while producing genereal depression of CNS. Decreases cough reflex and GI motility
Class allergy, cold, cough remedy, antitussive, opioid analgesic, opioid agonist
Nursing alteration in mentation, hypotension, constipation, N/V, asses vitals before admin, caution with MAOIs
Why would you be concerned about a depressed client stating that “things are getting better”?
could be indirect suicide, nurse should clairfy pt’s statments
High density lipoproprotein (HDL)
30-70 mg/DL
What PPE do you need for herpes zoster
N95 Respirator, Gown, Gloves
spread thru airborne and contact
What is the most common airway injury associated with burns?
carbon monoxide poisoning
where is the fundus 12 hour after birth
1cm above the umbilicus. Descends 1-2 cm each day thereafter.
Causes of myocarditis
mononucleuosis, parvovirus (5th disease), HIV
Med of choice for aystole
atropine
Major Side Effects of digoxin
- nausea, vomiting, fatigue, bradycardia.*
(action: inhibits sodium potassium ATPase, which make more calcium available for contractile proteins and results in increased Cardiac output
Nitroprusside
- *Indication** hypertensive criss, cardiogenic shock
- *Action** peripheral vasodilation of arteries andv eins decreasing preload and afterload
- *Class** vasodilator, antihypertensive
- *Nursing Considerations** monitor HR, BP, EKG continuously. Cyanide toxciity. Sympathomimetics may decrease effectiveness, PAOP monitoring may help with MI and CHF
Pre-Op
A-M-P-L-E
- Allergies
- Medications
- Past Med Hx
- Last Meal
- Events surrounding injury
Labs for a patient with hyperosmolar hyperglycemic nonketotic state?
ABGs, CBC with idfferential, urinalaysis, glucose, BUN, electrolytes, chem profile, and creatnine. Rapid infusion of IV fluids
Where should weight be placed when using crutches?
hands and arms
What can oral contraceptive do to a mother that is breastfeeding
suppress milk production
Insulin Mixture
Humulin 70/30
- *Indication** hyperglycemia with diabetes type 1 and type 2, ketoacidosis
- *Action** stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the livere, prevents breakdown of fat and protien
- Lispro Mix 15-30 min , pk 2-3 hr*
- Aspart Mix 15 min, 1-4 hr*
- NPH reg 30 min, 4-8 hours*
- *Class** lpancreatics, antidiabetics
- *Nursing Considerations** monitor body weight over time, may cause decreased inorganic phsophates, potassium and mag. Monitor B/S Q6, monitor A1C every 3-6 months
proper cast care
- use palms of hands when handling
- elevated affected limb
- compare toes
- fan in the room- increase circulation in the room
- Turn every 2 hours
- Uncovered and exposed to air
What is a risk factyor with precipitous labor?
early postpartum hemorrhage. Amniotic fluid embolism.
Do you need to wear sterile gloves when removing a foley catheter?
No
What are pre-surgery procedures to ensure safety
- surgical site is marked by the surgeon
- client is asked to state his/her name and birthdate
- the client is asked to confrim the correct surgical site
Acyclovir
- *Indication** genital herpes, herpes zoster, chicken pox
- *Action** interferes w/ viral DNA synthesis
- *Class** antiviral, purine analogues
- *Nursing Considerations** seizures, renal failure, Steven Johnson syndrome, thrombotic pprpura syndrome, diarrhea, dizziness, nausea, renal panel during administration, assess lesions, use proper protection druing sexual intercourse
When you are reading answer choices for medication ORDERS .Make sure they state, dose, route, time,
what happens first in an infant .Walking or using phrases?
walking
Hematocrit
35-50%
-olone
steroid
If client states they are having vertigo, what is the priority action?
ensure they are sitting down to prevent falling (“are they in bed?”)
Beta 1 affects
heart
Requirements for 24 hr urine sampling
- container must be kept cool
- can help doctor confirm a diagnosis r/t kidneys
- how much creatnine clears thru kidneys
What is Crede Maneuver
used to help empty the bladder comletely. results in reduced risk for infection. Perform at the same time every day. Used for pts with spinal cord injury
How many times should the fetus move per hour during 3rd trimester?
3x per hour. If it doesn,t drink a glass of juice and then start a new count
If client wishes to die, who should be the one to report that to the family
the client, not the nurse. encourage pt to discuss with HCP and family.
What intervention is needed during transition phase of labor (after first stage)
use shallow respiration during the contractions. (pant)
What is seen with Wernicke’s syndrome?
a form of dementia due to thiamine deficiency. Diploplia or double vision
What are signs of Wilms tumor in an 2 year old?
urinary output less. Malignant tumor of the kidney. Increase girth
Symptoms of a Panic episode
- Palpitations
- Aabdominal distress
- Nausea
- Increased persiration
- Chest pain
What is a concerning observation with a COPD patient and oxygenation
client’s skin is pink within 20 minutes of delivery. Risk for oxygen induced hypoventilation.
Why type of solution is lactated ringers?
isotonic
where do you assess jaundice in a patient with dark skin
hard palate of the mouth
Infectious diseaseas that require contact precautions
meningitis, Varicella (Gown, Gloves)
What is the rooting reflex
touching or stroing cheek beside mouth causes baby to turn head to the side and suck (stops at 3-4 months
what drug is commonly used to treat migrain headaches
zolmitriptan
priority goal for a bowel obstruction
maintain fluid balance
vtach
semide
diuretic
Normal Central Venous Pressure?
2-8mm Hg
greater than 9 indicates fluid volume overload
Shilling Test
tests pernicious anemai, how well one absorbs vit b12
dietary restrictions for glomerulonephritis
limit sodium, potassium, fluids and protein
Azithromycin
- *Indication** URI, chronic bronchitis, lower respiratory infections, otitis media, skin infections, STIs, prevention of bacterial endocarditis, tx of CF
- *Action** inhibits bacterial protein synthesis
- *Class** atypical myobacterium antiinfective, macrolide
- *Nursing Considerations** pseydomembranous colitis, pain, diarrhea, nausea, Stevens Johnson Syndrome, Angioedema, increase risks for warafin toxicity, anaphylaxis, notify physician for diarrhea or blood in the stool, take meds exactly as prescribed.
What is considered keep vein open rate with iv’s
20ml.h
Sertraline
- *Indication** major depressive disorder, OCD, anxiety
- *Action** inhibits uptake of serotonin,
- *Class** antidepressant, SSRI
- *Nursing Considerations** dont use with MAOIs, neurolyptic malignant syndrome, suicidal thoughts, dry mouth, tremors, takes 1-4 weeks for therapy to be effective
Why does prostate disease increase the risk of UTIs in men
increased urinary retention
what is the leading cause of preventbale mental retardation
alcohol
Adrenal cortex is associated with
- Glucocorticoids- cotisol
- mineralocorticoids- aldosterone
Why is “play” important intervention
children have difficulty putting feelings into words
When should sucralfate be given with regard to meals?
empty stomach, 1 hour before meals
Order for removing PPE for client with airborne precautions
- Remove Gloves
- Take off Goggles
- Take Off Gown
- Remove N 95 Respirator
- Peform Hand Hygiene
Acetaminophen
- *Indication** pain, fever
- *Action** inhibits synthesis of prostaglandins
- *Class** lipid lowering agent
- *Nursing Considerations** do not exceed 4 g per day to limit risk for liver, renal and cardiac damage, OD can lead to hepatotoxicity, increase risk for bleeding w/ warfarin, alter blood glucose measurements
Positive Signs of pregnancy
- presence of fetus
- fetal heart tones, visualization of fetus, plpating fetal movements
Common in endocrine imbalances?
changes in energy level and fatigue
What is a sign and risk when infant is receiving ventriculoperiotneal shunt?
ICP, sign is irritability, bulging fontanel, high pitched cry, continual crying when held.. Variable pulse. Slow respirations
What action should you take if a piece of the PICC breaks when being removed?
place a tourniquet to prevent piece advancing into the right atrium. Then get an x-ray.
When does engagement of the fetus occur in pregnancy
2 weeks before birth
What does a continuous ambulatory eletrocardiography measure
cardiac activity during a 24 hour period. should not use an electric razor or hair dryyer. Should keep a log of all activities during monitoring
What is the consequence if a nurse attempts to resuscitate a client with a DNR
committing battery
Bilirubin Serum
0.3 - 1.2
what is the most accurate method for medication dosing with kids
BSA
Teaching for home sterile technique
- No need for sterile gloves, non sterile is fine
- Wash hands
- Not possible to keep wound covered at all times
- Use only one health care provides
- Make sure someone look at the wound at dressing change
- dressing discarded in a wrapped non sterile glove
Other things to note about a PKU test
- urine sample can be done 6 weeks of age
- positive test requires dietary control to prevent brain damage
Superficial partial thickness burn think
think red, No blisters, YES pain
What fetal heart rate pattern should the nurse expect prior to administration of morphine
decreased variability. CNS depressant
PCO2
35-45 mm HG
First Stage of Labor Active Phase
lasta 4 hours for primipara, discuss regional anasthesia
SaO2
96-100%
What can you expect with a patient who has leukemia
epitaxis b/c of low platelets
What is seen with korsakoff’s psychosis
confabulation- in order to fill memory gaps, client invents elaborate improbable happenings
what is normal intake in a day?
1500 - 3000 mL
Actions for nurse to take after administration of restraints
- explain rationale for restraints
- tie using quick release
- thorough assessment
- document which alternative interventions were attempted
What is an immediate response neede during a newborn assessment?
red reflex is absent in newborn’s eye. Opthalmic emergency. Notify HCP immediately
Where is the apical pulse heard? (apex/mitral area)
4-5th intercostal space midclavicular line
Procedure for child with ingestion of toxic substance
- Stabilize the child (ABCs)
- Start IV infusion (large bore needle)
- Obtain history of ingestion
- reverse or eliminate toxic substance
Jejunostomy vs gastric feedings
jejuno are given continuously to ensure absorption. Gastric are in a bolus every few hours.
MOST common cause of iron deficiency anemia
loss from the GI tract in adults.
What drugs are hepatotoxic?
- INH
- Acetominophen
- Statins
- Valproic Acid
- Antifungal Agents- “Azoles”
Newborn Apical Heart Rate Normal
110-160
what drug can be used in conjuction with levodopa
trihexphenidyl. helps counteract the spastic effects of parkinson’s
Airborne precaution PPE
Mask, N95 Mask
what are major fears of school age children
loss of control and separation from friends/peers
why is a pregnant woman anemic?
- blood volume increases
- iron utilization for fetal needs
- decreased gastric acidity
Divalproex
Indication seizures, manic episodes, prevention of headache
Action increases the level of GABA in CNS
Class anticonvulsant, vascular headache suppressants
Nursing suicidal thoughts, agitation, dizziness, insomnia, hepatotoxicity, pancreatitis, increase risk for bleeding w/ Warfarin, caution with MAOIs, monitor liver function
What is a risk if hematocrit increases by more than 4 points in a short span of time?
risk for hypertension and seizures. Watch this with epoetin
Patho behind COPD
baroreceptors that detect CO2 level re destroyed. O2 lever must be low b/c high O@ concentration blow pt stimulus for breathing
If patient sutures come out with dehissence what is the proper positioining
Low folwers, may be palced supine with hips and knees bent. Reduces stress on suture line
Hallmark signs of Myasthenia Gravis
drooping eye lid (ptosis), mouth weakness, difficulty chewing, swallowing or talking. Arm or Leg Weakness
If a patient in labor compains of being incontinent, what should you assess
pH of fluid; amiotic fluid is alkalitic, urine is acidic
Warning signs of Type 1 Diabetes in children
- fatigue
- frequent urination (bedwetting)
- unusual thirst
- extreme hunger
- weight loss
- dry skin
Math Conversions
Tetracycline
- *Indication** tx of infection, gonorrhea syphilis with penicillin alercy, chornic bronchitis
- *Action** bacteriostatic by inhibiting protein synthesis
- *Class** antiinfective
- *Nursing Considerations** caution with liver impairment. pseudomembranous colitis, diarrhea, N/V, photsensitivity. Increase effects of warfarin.
How do you design an effective behavioral modification program?
observe client’s behavior at regular intervals. Frequency, amount, time, precipitating factors. All must be collected FIRST
example- patient screams constantly
How is Hep A transmitted
fecal oral route, or someone w/ virus hands food without washing hands. Or drinking contaminated water, eating raw shellfish from polluted water
What lab value indicate chronic kidney disease
BUN & Creatinine will be HIGH
what foods prevent stool odor
cranberry juice, buttermilk, parsley, yogurt
How do jewish people prefer to handle end f life care
control of pain is most important.
signs a man is carrying gonnorrhea
has a drip. urethritis and epididmytits. Women are asymptomatic
Each square in EKG represents how many seconds
0.04 seconds
What is MDS
Minimum Data Set. Standardized assessment of all residents in Medicare or Medicaid certified facilities. Completed for any individual staying more than 14 days. Does not measure outcomes.
Antidote for Magnesium Sulfate
Calcium Gluconate
action of nitroglycerin for MI
decreases preload by dliating the vessels
Gross Motor Skills 1-2 years
- kicking a ball
- jumping on 2 feet
- walking upstairs
- running
Going up stairs with crutches
STEP UP
- good leg goes up first
- then crustches and the bad leg
Going down
down with the bad
Antidote for Benzodiazepines
Flumazenil
Benzotropine
Indication Parkinson’s Disease
Action anticholinergic to reduce rigidity and tremors
Class antiparkinson, anticholinergic
Nursing arrthymias, hypotension, palpitations, tachycardia, constipation, dry mouth, assess extrapyramidal symptoms, good oral hygiene
early sign of diabetic nephropathy
albumin in the urine
precipitous labor risks
fetal hypoxia
Causes of Pericardities
infection, heart attack, injury to the chest esophagus or heart (MI)
potential complication of central venous pressure line
pneumothorax, b/c of proximitys of central veins and lung cavity
Prochlorperazine is given to a client after cataract surgery. Why is it given?
to prevent pressure on the suture line created by nausea and vomiting
Altorvastatin
- *Indication** high cholesterol
- *Action** lowers LDL, increase HDL, inhibits HMG-CoA reductase in liver and cholesterol formation
- *Class** lipid lowering agent
- *Nursing Considerations** contraindicated with liver disease,may cayse rhabdomyolysis, renal function, monitor cholesterol, report muscle weakness
what should be restricted for a child healing from clet palate repair
straws, tongue depressors, thermometers, small smoons, for about 6 weeks.
where is the pulmonic area located?
Remember the med that is given for cirrhoiss and ascites mgmt?
albumin
if a diabetes patient feels nervous and hungry after jogging, what should you recommend?
eat a snack before the run to prevent hypoglycemia caused by insulin intake and exercise
Morphine
- *Indication** pain, pulmonary edemia, MI
- *Action** binds to opiate receptors in the CNS and alters perception of pain. Decreases cough reflex and GI motility
- *Class** opioid analgesic,
- *Nursing Considerations** hypotension, constipation, N/V, BP, pulse, RR. Caution with pt receiving MAOIs
What form of delivery is preferred with preterm infants
cesarean
what is a concern with a drainage evacuator
rapid re-inflation indicates air leak. Check plug for a secure fit
According to Erickson theroy of personality development. Where is a child at if they are learning rules and how to play with others
industry vs inferiority
how to caclulate EKG bpm
1500 small boxes equal 1 minute. Count small boxes then divide by 1500.
What might excessive protein do to a patient with osteoporosis
may increase calcium loss in the urine
Afib, No Pwave, & Irregular
300-650 bpm
What indicates child has swallowed something corrosive
irritation of tissues. Mout would be burning and throat pain.
what i the most important action for CPR
compress the chest hard and fast (100 compressions pe rminute)
What is the best technique when staff need to adjust to change?
avoidance conflict mgmt technique. Allow staff time and space to adapt.
Non Stress Test
Non Stress is NOT Good
should be reactive
Sucking Reflex
slowly relaced by voluntary sucking by 2 months of age.
Side effects of MAOIs
hypertension and slurred speech
-sporin
immunosuppresants
What is the first principle of safe assignments?
match skills with the task. New nurses should not be assigned task for which they are not competent
What is the role of the MDS coordinator
interacts with health care staff to coordinate care processes of client assessment and care planning. Usually an RN
How should an Addison’s patient prevent a crisis in hot weather
increase salt intake
Gross Motor Skills
3-6 years
- gallop
- hops 5 times consecutively
- sit ups/pushups
- skips
What is the extrusion reflex
touch or depress the tongue and it is forced outward. Stops by 4 months of age
what is a senstaken blakemore tube used for
inserted thru the nose/mouth. MGMT of GI hemorrhage due to esophageal varices.
What does folic acid treat? SATA
- pregnancy
- liver disease
- alcoholism
- intenstinal obstruction
Drugs to be given with food?
NSAIDS
what is polyartertis nodosa, and how has treatment changed
inflammation of small arteris causing diminished blood. Treatment with cortisone now results in 90% remission rate.
Where is edema
in the interstitial space
What my an elderly patient with a hearing deficit exhibit
suspicious of others, because pt can’t communicate well with other people.
When does the posterior fontanelle close?
by 3 months of age.
what is the most helpful tool in determing a client with bulimia’s eating habits?
food/feeling/thought/action journal.
If a patient pulls out a central line what is the proper procedures to take
- left side trendelenburg position increases likelihood that air will pass into the right atrium then dispirsed by the pulmonary artery
Common symptoms of empysema
barrel chest
For a toddler, why should you allow them to play with equipment before your assessment
allows child to become familiar, decreases fear. Uses the senses
Practice Partnerships
partners work together on same schedule with same group of clients
Insulite (Intermediate Acting)
NPH, Humulin N, Novolin N
- *Indication** hyperglycemia with diabetes type 1 and type 2, ketoacidosis
- *Action** stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the livere, prevents breakdown of fat and protien
IV onset 10-30min, Peak 15-30min
- subQ 30-60 min, peak 2-4 hours*
- *Class** lpancreatics, antidiabetics
- *Nursing Considerations** monitor body weight over time, may cause decreased inorganic phsophates, potassium and mag. Monitor B/S Q6, monitor A1C every 3-6 months
- Ventricular Tachycardia
- HR 160
- Regular Rate
What is the septum
a wall between the ventricles, there should be no opening
Post Op Tracheostomy position
Elevate HOB and turn to one side until consciousness returns
what does atropine do to secretions
reduces them
What intervention is MOST important after the first 18 hours of amputation
elevate residual limb on a pillow, then prone
Albuterol and Beclomethasone for asthma
- Albuterol is used to treat asthma attacks. As needed
- Beclomethasone is an ant-inflammatory to prevent attacks. Qday.
Nal-
narcotic agonist/antagonist
People at high risk for reaction to contrast
- history of asthma
- positive pregnancy test
- high BUN
- Past reactions
- Heart, kidney, thyroid disease
- Beta blocker
- Metformin
What is the 3rd stage of labor
placental separation and expulsions. Lasts 5-30 minutes
myxedema coma is hot or cold
COLD
What type of syringe is epinephrine given in?
tb syringe
Why can’t a CNA shave a client after surgery
they probably have taken anticoagulants only an electric shaver can be used.
Pediculosis capitis, signs
whitish oval specks sticking to the hair shaft. (Head lice)
Gentamicin
Indication Tx of gram negative infection when penicillin is ineffective
Action sinhibits bacterial protein sysnthesis
Class aminoglycoside, anti=infective
Nursing causes tinnitus hearing loss, do not administer with penicillin. Caution in renal impairment. Assess for infection. Obtain cultures prior to therapy. Monitor liver function tests. Monitor blood levels of drug
Why should patient drink water prior to transabdominal pelvic ultrasound?
provides a less obstructed view by pushing the uterus away from the pubic symphysis, and pushing the intestine out of the pelvis
Where is the mitral area
5th ICS, midclavicular line. Apex of the Heart. Asucultate S1
What should you NOT include in the chart in general
incident reports, abbreviations
drug of choice for acute asthma
theophylline
Why do you worry if a heart failure patient is coughing pink tinged sputum
indicates fluid in the lungs. Could be life threatening. Need to administer cardiac lgycosides, diureteics, and record I/Os with oxygen therapy
How do you calculate MAP
(diastolic BP x2 + systolic BP)/3
should be between 70-90
What is the cause of early decelerations
head compression
How should RN treat newly admitted client
- the priority
- needs to assess
Malabsorption syndrome and Wernicke-Korsakoff syndrome are associated with which disorder
Chronic Alcoholism
malabsorb fat, nitrogen, sodium, water, thiamine, folic acid and vitamin b12. Wernicke’s is caused by a lack of thiamine.
what type of precaution requires that you stand 3 ft away?
droplet. Influenza
Peak of regular insulin
2-4 hours
onset 30-60 minutes
First Stage of labor Latent Phase
lasts 8 hours for primipara, 4-5 hours for multipara
Normal Newborn Respiration
30-60
Albuterol
Indication bronchodilator prevent airway obstruction in asthma and COPD
Action binds to Beta 2 adrenergic receptors in the airway leading to relaxation of smooth muscles in the airways
Class bronchodilator/adrenergic
Nursing Considerations may decrease effectiveness of beta blockers, caution w heart disase, diabetes, galucoma, seizure disorder, bronchospasms, chest pain, palpitations, decrease digoxin levels
what symptom would lead you to believe the parathyroid gland has been damaged
numbness in the fingers, parasthesia
Where is jaundice seen best on asian americans
the hard palate
Steroid Side Effects
6S’s
- Sugar
- Soggy Bones
- Sick
- Sad
- Salt
- Sex
what is the patho behind a patient who is pale
shunting of blood from skin and mucous membranes to the heart and brain (vital organs)
Antidote for tylenol
acetycysteine
At what age is a child able to jump with both feet and stand on one foot
3 years old
Diagonal communication
staff from different levels work together on a project
Postpartum assessment, BUBBLEHE
- Breasts
- Uterus
- Bowels
- Bladder
- Lochia
- Episiotomy/C-section incision
- Homans
- Emotional Status
Quetiapine
- *Indication** schizophrenia, depressive disorder, mania
- *Action** dopamine and serotonin antagonist
- *Class** antipsychotic, mood stabilizer
- *Nursing Considerations** neuroleptic malignant seziures, dizziness, palpitations, weight gain, anorexia, dont use with CNS depressants. Weight frequently, Monitor liver function test and CBC, may increase cholesterol
Where is the Right Middle Lobe located?
right anterior chest between fourth and 6th ntercostal space
What vegetarian foods are rich in
cereals and dried froot
-pril
ACE inhibitor
clinical manifestation of neuroblastoma
abdominal mass and weakness, fever, weight loss.
How soon should activated charcoal be administered after toxin has been ingested?
within 1 hour
What findings might you expect with an intestinal obstruction?
- nausea/vomiting
- No stool, at all
- ab distention
What drugs can lead to bleeding
- NSAIDS
- Anticoagulatns
- Thrombolytics
- Aspirin
S3 sounds in CHF vs MI
normal in CHF, not normal in MI
How is varicella spread
airborne, remove client immediately
What is the wound care for an open fracture
cover it with anything sterile or clean
What is Dupuytren contracture?
a slow progressive contracture of palmar fascia cusing flexion of the fourth and fifth fingers. Inherited autosomal dominant trait. Often in men 50 years of age of scandinavian or celtic descent. Associated with diabets, gout, arthritis, alcoholism, age.
What can aspirin do to children
cause reye’s syndrome (encephalopathy
diet for a patient with ulcerative collitits.
Has inflammation. High calorie, high protein, low residue diet. Cooked carrots, baked fish, white flour, applesauce.
How many words does a toddler of 2 years have?
300 word vocab
what do you need to remember to look for with ICP
widening pulse pressure. High systolic, low diastolic. think concussion and other things.
What is raynaud’s phenonemon
cold temperatures or strong emotions cause blood vessel spasms. Block blood flow to fingers, toes, ears and nose
Why is a client with pancreatitis critical and a priority?
symptoms of acute gastritis, vomiting blood etc.
What is a serious condition to be noted with an injury from T1-T6?
decreased respiratory reserve. Observe respiratory function first.
Calcium Carbonate
Indication severe pain, labor pain, sedation
Action alters perception and response to pain by biding to opiate receptors in the CNS
Class opioid analgesic, agonists
Nursing caution with MAOIs, may cause confusion, hallucination, sedation, Monitor CNS depression, assess BP, pulse and respirations, aminister slowly through IV line
what does a hip protector do for patients with osteoporosis
prevent hip fractures, if patient happens to fall.
where do you palpate pulse during CPR on an adult
medial edge of sternocleidomastoid muscle in the neck (carotid)
when should baby apnea be report to HCP
after 15 seconds
Chlorpromazine
Indication second line tx for schizo, N/V, pre-op sedation, acute intermittent prphyria, headache, bipolar
Action anticholinergic activity, alters effects of dopamine in CNS
Class phenothiazine, antisychotic, antiemetic
Nursing neuroliptic malignant syndrome, sedation, tardive dyskinesia, hyoptension, agranulocytosis, asses mental status prior to tx, monitor BP, monitor CBC and liver function, do not skip dose
Gross Motor Skills
Birth - 1 year
- belly crawling by 8-9 months
- independent walking 12-15 months
how many mililiters per ounce
30mL
Procedure for patient who is lethargic and slow to respond
- Attempt to elicit a response by physically shaking
- quick neurological assessment
- call rapid response team
- remain with pt, send another staff member to get list of medications and chart
Pregnant women has nausea, what should you suggest to relieve this?
eat dry carbohydrates 30 min before getting out of bed. Remain in bed until the feeling of nausea subsides. Fluids, milk tea
Droplet Precaution requirements
Mask, goggles
During a health history of a patient receiving surgical treatment for obesity. What sould be reported to the surgeon?
history of body dysmorphic disorder. Corrective surgery can exacerbate this disorder.
What position would you use to dilate vessels (For PN administration)
Supine, head low turned away from insertion site.
Montelukast is used for chronic or acute asthma?
Chronic. Takes several weeks to take effect.
Toddler’s healthy eating habits
- finger foods
- need carbohydrates for enegy
How can over training in exercise increase risk with osteoporosi
can decrease estrogen levels in women and may increase risk
what can a baby do when in prone position between 1 and 3 months
lift the head 45 degrees
What is a risk factor with sepsis
Disseminated intravascular coagulation. Blood at a venipuncture site and around an iv catheter
What interventions should be included after a myelogram?
- hydration
- lie flat for several hours
- monitor vital and neurological signs
- bed rest for several hours
why is applying lip balm prohibited in the hosptial
due to blood born patheogen expsure
What is a risk when the membranes rupture
increased risk fo cord prolaspe if head is at a minus level
ICP vs shock
- are opposites
- ICP increased BP, decreased pulse, decrease resp
- shock- decreased BP, increased pulse, increase resp
Why is tumor lysis syndrome an emergency
potential for renal failure. Will have electrolyte imbalances.
When do you test a child for lead poisioning
12 months of age
What position relieves low back pain
flexed knees, relieves pressure on sciatic nerve
Insulin Rapid Acting
novolog, humalog, apidra,, aspart, lispro, glulisine
- *Indication** hyperglycemia with diabetes type 1 and type 2, ketoacidosis
- *Action** stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the livere, prevents breakdown of fat and protien
IAspart 1-20 min , 1-3 hr
glulisine 15 min 1 hr
lispro 15 min 1-1.5 hr
- *Class** lpancreatics, antidiabetics
- *Nursing Considerations** monitor body weight over time, may cause decreased inorganic phsophates, potassium and mag. Monitor B/S Q6, monitor A1C every 3-6 months
What type of diet should a patient with chronic kidney disease take?
High protein
What intervention or advice does the nurse implement after instilling eye drop medication?
apply pressure for about minute to decrease systemic absorption of the medication
Conductive hearing loss vs Sensorineural
- Conductive- otitis media, swimmer’s ear, ear wax. Can be corrected
- Sensorineural- permanent
what is the best form of communication for a 3 year old?
simple explanations. short concnrete terms
When you think of a probable sign of pregnancy what should you think
“probably” positive urine test, chadwicks sign
Critical lab values for tumor lysis syndrome
- high K
- Low Caclium
- High Uric Acid
- High BUN
- acute kidney injury, seizures, cardiac dysththmias.
What should nurse recommend with client that has chronic constipation?
increase intake of cereals, fresh fruits, vegetables. Bul-forming foods.
What is upward communications?
staff meetings
What drug allergy is a cross sensitivity with aspirin
tartazine
What teaching should be provided for RA with inflammation and physical activity?
when inflammation is severe, decrease the number of repetitions of exercise
Special care for celiacs patients’ diet
HIGH calorie, High protien (veggies are not enought)
What is important to inform an MS patient when starting an exercise program?
exercise is beneficial, but must be HYDRATED!
What is your main concern if your liver is sick
bleeding
What is a keyword to consider with a public health nurse
groups rather than invidivuals
IM pain med administration consideration
- assess for response to therapy 30 minutes after admin
- avoid with hypothermia and vasoconstriction
How do you know if IV pump is not functioning
calculate how much is left, more than expected amount would be left in the container
physiology of the first stage of labor
sheddying of the cervix until it is 9 cm dilated.
What do you want from a contraction stress test
you want it to be negative
what is the maintenance dose range for digoxin
0.125 - 0.5mg
how shal prenatal vitamins be taken
with orange juice at bed time (acidic helps absorb iron
when should you NOT cluster cares?
patient with ICP, sensitive to sudden or noxious stimuli
What is withdrawing from heroin similar to?
flu like sympomts. runny nose, yawning, joint pain.
What interventions of very important with Promethazine Hydrochloride?
absolute patency of the vein, extravasation will cause necrosis.
Furosemide (Lasix)
Indication edema, hypertension
Action prevention reabsorption of sodium and chloride in kidneys, increase excretion of water, sodium, chloride, magnesium and potassium
Class diuretic, loop
Nursing caution with liver disease. Can cause hypotension, dry mouth, excessive urination, dehydration, electrolyte, metabolic alkalosis. Hypokalemia may lead to increase risk of digoxin toxicity. Monitor renal panel. Caution with antihypertensives. Causes arthritic symptoms. Do not take wih aminoglycosides due to ototoxicity.
Why is Vitamin B 6 given for TB patients?
prevents side effects of peripheral neuropathy, dizziness, and ataxia
Findings of pinworm
infection which includes intense perianal itching.
HIV precautions
standard, just wear gloves.
What is a priority for a client with cushing’s sydnrome
respirations, fluid overload CHF and sodium/water retention
-pamil
vasodilator
Phenytoin
- *Indication** tonic clonic seizures, dysrthymia, neuropathic pain
- *Action** interferes with ion transport, shortens action adn decreases automaticity
- *Class** antidysrthmia, anticonvulsant, hydanotin
- *Nursing Considerations** ataxia, suicidal thoughts, EPS, hypotension, tachy cardia, gingival hyperplasia, enteral feedings may decrease absorption, monitor for hypersensitivity, assess seizures, therapeutic level is 1-20 mcg/ml
What do you do if a chest tube is accidentally pulled out?
- tape down sterile vaseline gauze ( 3 sides)
- Call the HCP
feeding an infant with TEF
enlarge the hole in the nipple of the formula. Feed on a 3 hr scedule, Feed soon after awakening, to avoid infant crying
What is the only fuel source that neurons cannot store
glucose. Only fuel used by brain cells
Infectious diseases that are airborne?
TB, Rubeola, Varicella, measles, herpes zoster
what client would you be concerned about giving TPN fat emulsion?
fractured femur b/c at risk for fat embolism
Signs of False Labor
- Irregular contractions
- Diminish with activity
- Contractions get weaker
- Felt in the front of the abdomen or pelvic region
- membranes in tact, no cervical changes
What is the cause of essential (primary) hytpertension
idiopathic
Oral PAIN med admin consideratations
- contraindicated with N/V
- assess response 1 hour after administration
- may require additional analgesic
Peak action of rapid acting insuling
60 min after administration
Bisocodyl
Indication constipation, bowel regimen
Action stimulates peristalsis leads to fluid accumulation in the colon
Class laxative, stimulant laxative
Nursing hypokalemia, ab pain, use caution w/ milk, abdominal distention & bowel function, drink 1500-2000 ml/day during therapy, monitor F&E, take as ordered
Celecoxib
Indication Osteoarthritis, rheumatoid arthritis, acute pain
Action decrease pain and inflammation by inhibiting synthesis of prostaglandins
Class antirrheumatics/NSAID
Nursing watch cardiovascular disease, increase risk for MI, CVA, thrombosis, GI bleeding, steven johnson synddrome, dermatitis, notify provider for new onset of abdominal pain or black stool
-Alol
combined alpha and beta blockers
to assess for patency in a dialysis fistula or graft, the nurse should..
- auscultate for a bruit and
- palpate for a thrill (you feel this)
what is the first assessment that should be made prior to vaginal delivery?
check for lochia flow
Common reasons older adults get readmitted to the hospital
- inadequate primary care
- poor care coordination
- poo skilled nursing facility
- poor communication among providers
- family preferences
What solution should be used to clean around the pins in skeletal traction?
saline or sterile water (not alcohol or iodine which can cause corrosion)
EKG reading with MI
- ST elevation
- T wave inversion
- pathological Q-wave
What are symptoms of irritable bowel syndrome
alternating diarrhea and constipation
Tx for Tachycardia
beta blockers, antipyretics, analgesics, fluid (dehydrated),
how often should glucose be checked with TPN
q 6 - 8 hours
-conazole
systemic antifungal
Hemoglobin A1c Failure Diabetic control
7 - 8%
Procedures for after a newborn is delivered
- Asses infant’s airway and breating
- perform bulb suctioning if excessive mucus
- assess infants heart rate
- place id bands on mother and infant
- administer vit k
Signs of Lithium Toxicity
Diarrhea, oversedation, ataxia, tinnitus, slurred speech, muscle weakness.
What is cocaine withdrawal like?
severe cravings, depression, fatigue, hypersomnia
What does obtundation mean
greatly reduced level of consciousness
Left sided heart failure signs
CHOP
- Cough
- Hemoptysis
- Orthopnea
- Pulmonary Congestion (Crackles/Rales)
Lamotrigine
- *Indication** Seizures r/t epilepsy, bipolar
- *Action** inibits sodium transport in neurons
- *Class** anticonvulsant
- *Nursing Considerations** suicidal thoughts, dizziness, behavior changes, N/V, photosensitivity, rahs, Steven Johnsons, caution with oral contraceptiv, assess mental status,
What is amphteamine withdrawal like?
depression, disturbed sleep, disoriented.
-mycin
antibiotic
how often should you check a doppler reading after femoropopliteal bypass graft?
every HOUR
Why is oil in a bathrub a risk factor?
oil makes it slippery and risk for falls
Complications with cold stress
metabolic acidosis, hypoglycemia, reduced partial pressure of oxygen in arterial blood
What do you do if outer cannula of trach gets expelled?
ventilate the chest using a manual resuscitation bag
Prioriy procedures for patient with pneumonia and sepsis
- Oxygen administration
- Blood & Sputum (prior to admin of antibx)
- IV initiation of normal saline
- Administer antibiotics
- Fingerstick before each meal
Symptoms of Cardiogenic shock
oliguria, jugular vein distention, crackles in bilateral bases, pitting sacral edema, weight gain
What kind of drug is indomethacin and why should it not be given to a patient with PUD
Nonsteroidal anti-inflammatory, GI. Nausea, vomiting, discomfort NEC.
What is placenta previa
placenta is abnormally implanted in the lower uterine segment. No vaginal exams, IVs to restore blood volume.
-thiazide
diuretics
What will the lab values be that are potentially life threatening in a patient with osteogenic sarcoma?
hypercalcemia.
Radium Implant Care
- applicator should be checked q8hrs
- low residue diet, bowel movements can dislodge implant
- STRICT bed rest
- High fluid intake
- Conserve energy
- anti-nausea medications
What is a common adverse effect of ethambutol?
optic neuritis. Reduces visual activity. This is concerning
What ethnicity is more at risk for pancreatic cancer?
African Americans, males, smokers
Propylthiouracil (PTU)
- *Indication** HYPERthyroidism
- *Action** inhibits thyroid hormones
- *Class** antithyroid agent
- *Nursing Considerations** hepatoxicity, N/V, agranulocytosis, WBC and liver function tests, weight patient frequently, lekopenia, jaundice. Take with meals
What does RACE stand for
Rescue clients, Activate fire alarm, Contain fire, Extinguis flames
why does a patient with hyperthyroidism have increased irritability
mental confusion is a symptom of hyperthyroidism.
What is the biological response modifier for cancer therapy
stimulates bodys defense mecahnism. flu-like sx are common
risks for taking benzos for depression
should be used as a last resort, can cause dependencies
-pam, -lams
What electrolyte imbalance is important to monitor in a patient with Addisons’s disease
hyperkalemia- dysrthythmias
Rheumatic Fever Microbiology
Group A Hemolytic Streptococcus. C-Reactive Serum.
- have you had any sore throats*
- this contributes to Heart Failure*
What drogs are nephrotoxic?
- cyclosporine
- Aminoglycoside Antibiotics (Gentamycin)
- NSAIDS
- Antiviral agnes such as Acyclovir
what is intermittent claudication
pain felt in the calves when patient walks see in arterial insufficiency
Famotidine (Pepcid)
Indication short term active ulcer, GERD, heartburn, indigestion, prevetion of GI bleed, over use of NSAIDS
Action blocks action of histamine located in gastric pareital cells, inhibits gastric acid secretion
Class antiulcer agent, H2 antagonist
Nursing dysrthmias, agranulocytosis, aplastic anemias, asses ab pain and occult blood, monitor CBC, instruct pt to increase fluid and fiber intake to prevent constipation
What tool is most important to have available for acute hypoparathyroidism?
a tracheostomy set. due to risk of laryngospasm
Patho behind ketoacidosis
body is breaking down fat instead of sugar for energy. Fats leave ketones that cause pH to decrease
How is Legionnaire’s disease spread
found in warm, stagnant hot water tanks.
early sign of intenstinal obstruction
hyperactive bowel sounds
What is a classic symptom of hiatal hernia?
reports awakening at night with heartburn. reflux.
What is a symptom of curling’s ulcer after a burn?
gashtic pH less than 5, 24 hours after severe burn
What happens if a patient fails to rotate sites for insulin injections
poor absoprtion, which increases blood sugar
What type of breathing occurs with drug overdose
respiratory depression
What is an important assessment with continuous ambulatory peritoneal dialysis
checking weight to check volume status
How can you determine if anorexic patient has met the goal of balanced nutrition?
menstrual period has returned and is regular (FSH), (LH)
When a patient has a spinal cord injury what is the biggest risk
immobility. place client on pressure reducing support surface.
Why should a toxic shock patient be assigned to the RN
staph infection that cause vomiting. Critical to avoid invovlement with other organ systems.
What can cause mitral valve regurgitation
any disease or porblem that weakens the valve or heart tissue.
Epoetin
Indication anemia
Action stimulates erythropoesis,
Class anti-anemic, hormones
Nursing contraindicated in albumin sensitivity, seizures, CHF, MI, CVA, HTN, monitor BP, assess dialysis shunts, monitor bleeding times, seizure precautions, do not shake vial
Levetiracetam
Keppra
- *Indication** seizures
- *Action** decreases everity and incidence of seizures
- *Class** anticonvulsant
- *Nursing Considerations** suicidal thoughts, dizziness, weakness. Alters RBC, WBC and liver function. Somnolence. Infuse over 15 min
what is an intervention if someone is having a seizure in a public setting
protect from head injury.
Nifedipine
- *Indication** HTN, angina, migranes, CHF
- *Action** blocks calcium transport, inhibits contraction causing sytemic vasodilation
- *Class** antianginal, antihypertensive, CA blocker
- *Nursing Considerations** no grapefruit juice, dysrthymias, elevated liver function tests, gingival hyperplasia, monitor BP and pulse
Broca’s Area affects expressive aphasia or receptive aphasia?
Expressive Aphasia
What is the most common and life threatening metabolic complication of renal failure?
hyperkalemia
Metoprolol
- *Indication** HTN, angina, prevention of MI, heart failure management. Migrain prophylaxis
- *Action** blocks the stimulation of beta1, receptors in the SNS does not effect beta 2,
- *Class** antianginal, antihypertensive, beta blocker
- *Nursing Considerations** monitor hemodynamics, may lead to bradycardia, pulmonary edema, assess I&Os and monitor signs of CHF
This GI issue Pain localizes to the right upper quadrant, but may radiate to the right shoulder or scapula
Cholecystitis
When is the safest time to offer analgesia during labor?
dilation is between 4-7 cm
-pezil
acetycholinesterase inhibitor
anti-alzheimer agent
Responsibilities of LPN/VN
- implementation of a plan
- assessing abnormal/normal
- reinforce information given by RN
- care for stable clients with predictable condition
When it comes to prioritization of burn patients, which area of the body is a prioirty
facial burns–> airway inflammation and swelling
Positioning for pregnant woman
left side lying, prolasped cord (reverse trendelenburg)
What is herpes zoster (shingles)
a reactivation of latent varicella (chickenpox), increased frequency among adults with weakened immune system. Contagious to those who have not had chickenpox or immunosuppressed
Precautions for client with croup
Contact
What does the CDC indicate for any client having SARS (Severe Acute Respiratory Distress Syndrome)
rapid implementation of standard, contact and airborne precautions. If negative pressure room is not available, droplet precautions should be initiated until client can be moved.
Myxedema is associated with what disorder?
hypothyroidism
Does Amytryptaline contain tyramine?
no
Signs of True Labor
- contractions regular pace,
- continue despite change of position
- start in the lower back and move to the front of the abdomen
- effacement and dilation
Ventricular Fibrillation
Isoniazide
INH
- *Indication** tuberculosis
- *Action** inhibits synthesis of mycobacterial cell wall
- *Class** antitubercular
- *Nursing Considerations** jaundice, peripheral neropathy, seizures, hepatitis, avoid tyramine, monitor liver function
what does priapism mean?
painful erection lasting longer than 6 hous
Clindamycin
Indication skin infections, respiratory tract infections, septicemia, intraabdominal infections, osteomyelitis
Action inhibits protein synthesis
Class antiinfective
Nursing arrhthmias, pseudomemrbanous colitis, diarrhea, phlebitis, watch bowel function, cultrues prior to therapy, monitor liver function, monitor cbc
What is the most common cause of diverticular disease
eating a low fiber diet
what is important to note if a client is taking diphenhydramine and codeine
causes drowsiness. Allow client to remain in bed 3-4 hours
dont use statistics with clients it is non therapeutic
Buck’s Traction Care
- remove foam boot 3x per day to inspect skin
- turn client to unaffected side
- back care every 2 hours to prevent pressure sores
- dorsiflex the foot on the affected leg. Asses function of peroneal nerve
- elevate the foot of the client’s bed to provide counter traction
Methylpredinosone
- *Indication** inflammation, allergy, autoimune disorders, prevent organ rejection
- *Action** isuppress inflammation and normal immune response. Increase B/S, immune suppression, metabolism of fat, protein and carbohydrates. Decrease Bone formation
- *Class** antiasthmatics, corticosteroids
- *Nursing Considerations** monitor liver profile, avoid active untreated infections. CNS alterations. Peptic ulcers. Cushings. Weight gain, osteoporosis, Decrease wound healing. Elevate blood sugars. Increase cholesterol and lipid values.
what factors conrtibute to insulin resistance seen in Type 2 Diabetes
increase in waist circumference (apple shape). Can develop atherosclerosis
what are signs of fractured hip
external rotation, shortening adduction
Acute bacterial, viral gastroenteritis infections
salmonella, gastroentereitis, viral hepatitis, C. difficile
What happens when medication are administered sub lingually or rectally and metabolism
avoids the first pass effect.
when dealing wth a patient with MI- MONA is the acroynm. however what should you do first
administer oxygen (if there is shortness of breath)
remember- 1 thing and walk away
Respiratory Opposite Metabolic Equal
What lab value is an increased risk for dig toxicity
hypokalemia
what does naloxone do?
reverses effects of repsiratory depression due to opiod use. Must be taken immediately as directed. STAT
What complaint is concerning regarding heart failure
trouble catching breath. dyspnea may become worse with exertion. pulmonary edema. Symptoms of LEFT SIDED heart failure take PRIORIT
Gout Diet
low purine. Organ meats, anchovies, mushrooms, spinach, dried beans, peas.
drawing up insulin acronym
NICOLE RICHIE RN
Air into NPH then Air into Regular, draum up regular then draup up NPH
what is a bulge test?
confirms presence of fluid in the knee. Client’s leg should be extended
what does a low blood sugar level in a diabete patient represent?
decreased food intake, too much insulin
What should you not do prior to administration of an IM injection?
massage the site
How do you replace fluid loss
24 hr loss + 500 mls
What preventive care should a patient with open angle glaucoma do?
periodic tonometer readings (1-2 times a year.
specific gravity
1.010 - 1.030. Low specific gravity indicates DI.
when you see phenelzine sulfate what should you think?
Tyramine!!
what happens in stage IV parkinson’s
immobile, need ROM to prevent contractures.
what is the most important instruction for nurse to give for client receiving barium enema?
crucial you take slow deep breaths through your mouth. Must retain barium, slow deep breaths will ease the discomfort
What is the algorithm for safe client handling and repositioning in bed
- Use 2-3 Caregivers for a client that can partially assist & weights less tah 200 lbs
- Use a friction reducing device
- Move bed into flat position at comfortable height for caregivers
what is important to have readily available when performing plasmapheresis
warm blankets to prevent chills and hypothermia. Similar to hemodialysis. Removes antibodies that may be causing symptoms
P wave indicates
atrial depolarization
When you see the word thrombophlebitis, what should you think
embolism DVT/VTE
prazole
antiulcer agent
pain the the lower extremeities not relieved by rest indicates
peripheral arterial disease. Leg will be cold to touch.
Ibuprofen
Indication mild to moderate pain, inflammatory states
Action decreases pain and inflammation by inhibiting rostaglandins
Class antypyretic, antirheumatics, nonopioid analgesic
Nursing GI bleeding, hepatitis, Stevens Johnson Syndrome. Monitor for headache N/V, constipation. Therapy should be D/Ced after first sign of rash. Monitor renal and liver labs. Avoid alcohol
Tricupsid Area Location
fifthe intercostal space lower left sternal border
What medications should you hold before dialysis
- any blood pressure meication
- water soluble vitamin
- antibiotics
Why should you question if child has had a skin infection or throat infection r/t glomerulonephritis
ususally occurs 10 days. after an infection. Symptoms include, fever chills, hypertension, flank pain.
what is a fatal complication of penatmidine
hypoglycemia.
-pressin
vasoconstrictor
What does a depresset ST segment indicate
myocardial infarction. Less worrisome than elevated
isometric training
contraction when muscle tenses while NOT changing length. (pushing against an immoveable object)
What kind of drug is Acetazolamide?
sulfonamide
Therapeutic range for lithium
0.8 - 1.2 mEq/L
Typical symptoms of a client with Hyperosmolar Nonketotic State
- blood glucose above 600 mg/dL
- profound dehydration
- No ketones
- alkalosis
Clopidogrel (plavix)
Indication atherosclerotic events, MI, CVA, PVD, acute coronary syndrome
Action inhibits platelet aggregration
Class antiplatelet, platelet aggregation inhibitor
Nursing GI bleed, neutropenia, hypercholesterolemia, increase risk for bleeding, monitor CBS and platelet count, discontinue 5-7 days before surgery
what do you worry about if an anorexic patient stops their menses
osteoporosis
If a medication ends in these letter, what should you do?
CR, CD, LA, SR, XL, XR, XT
Do not crush
Appropriate actions for the scope of practice for LPN/LVN
ausclate breath sounds, administer med via MDI, check oxygen saturation, dressing changes.
How many doses of Hep B are administered?
total of 3 doses given.
3rd dose- 3-4 months after 2nd dose.
Second dose given 1-2 months after 1st.
-vir, vir-
antiviral
What is one thing you worry about with fractures
compartment syndrome
What is the priority action prior to getting a sputum sample
oral hygiene without the use of mouthwash (alchol can alter the spututm . Then pt should take deep breaths and cough
What is compartment syndrome?
muscles become swollen and hard. Pain is not relieved with pain meds. Loosen do not remove cast
if a child has a cold can you still give immunizations?
yes
What causes nausea during first trimester?
elevation of estrogen, progesterone and hCG
Patient education regarding thumb sucking
usually subsides after 24 months of age. Most prevalent when child is hungry or tired.
What do you need to know about ARDS?
fluid in the alveoli
what is cushings ulcers
r/t brain injury
how should a patient after a mastectomy of the right breast be positioned after surgery
semi fowler’s with right arm elevated. enhances circulation and prevents edema
If it is an emergency how are patients handled in terms of priority
patients with a greater chance to live
Which organ is most susceptible to damage during a hypertensive crisis
the brain due to rupture of cerebral blood vessels. Monitor neuro.
What is the treatment time with a halo vest?
12 weeks
cephalexin is given after surgery, what food should be given to icnrease intestinal flora
probiotics, yogurt acidophilus
What lab values indicate protein/malnutrtion
cholesterol, hemoglobin, Total Lymphocyte Count
What should you be worried about if client has a halo traction device?
It hurts when chewing. may indicate skull pins have slipped into temporal plate. NOTIFY HCP.
What pain medication can induce asthma attacks
aspirin
Sodium
135 - 145 mEq/L
What to know about epiglottitis
- Between 2-8 years of age
- bacterial form of croup
- caused by H.Influenzae (should receive Hib vaccine)
- Winter
- inspiratory stridor
- do not attemtp to visualize posterior pharanyx (temp in tmouth etc)
- can occulde the airway
- cool mist to decrease swelling
what is the patho behind a headache
pressure of meninge-sensitivity to light, neck stiffness. (manifestation will decrease as blood is reabsorbed and vasospasm decreases)
- Adol -aldol
ex: Tramadol
Analgesic
Bismuth Subsalicylate
Indication diarrhea, heartburn, indigestion, H.pylori ulcer
Action stimulates absoprtion of f/e’s in intestinal wall, reduction of hypermotility of stomach and binds to toxins
Class antidiarrheal, antiulcer, adsorbant
Nursing contraindicated in aspirin, hypersensitivity, increase risk for impaction with geratric and pediatric patients, monitor liver profile, bismuth may intere fere with radiologic exams
What does the nurse challenge rule refer to?
assertively voice concerns at least 2 times to ensure that it has been heard. If not heard contact supervisor or the attending physician.
What are signs of epiglottitis
sitting upright ot breathe better, tongue protrusion, drooling
What is a reasonable long term goal with a patient with rheumatic carditis?
The client climbs one flight of stairs with normal heart rate
ADLS!!!
most common complication following an MI
dysrhythmias
where do you place the tuning forks for a rinne test?
behind the ear
Clinical Findings with Basilar Skull Fracture
- facial numbness
- brusing around both eyes (Racoon eyes)
- hearing loss
- bursing behind the ear, battle’s sign
What does a cisternography assess
ciculation of cerbrospinal fluid within the skull or subarachnoid spaces
Steps to using a peak flow meter
- move the indicator to the bottom of the numbered scale
- stand up
- take deep breath
- place in mouth and close lis around it
- blow out hard and fast
- record number achieved on the indicator
- Repeat 2x more (3 attempts
what to note with native american patients
will not arrive on time, are present oriented and do not live by a clock
how can you tell if a client is experiencing circulatory overload
change in character of respirations
dyspnea, cough, edema, hemoptysis
Levothyroxine
- *Indication** thyroid hormone replacement in hypothyroidism
- *Action** replaces thyroid hormone increasing metabolism, promotes gluconeogensis, stimulates protein synthesis, restores normal hormone balance ans uppresses thyroid cancer
- *Class** thyroid prep, hormone
- *Nursing Considerations** assess pulse, monior dyrthymias, chest pain, monitor TSH levels, OD is presents as hyperthyroidsm, start with low doses and increase as indicated, therapy is lifelong. Take directly after breast feeding, increases the effects of warfarin.
what is most important to assess when using cognitivie therapy approach
language. used in thought speech or writing. indicator of patient’s automatic thoughts.
priority action for a trauma client
neurologic assessment
What endocrine disorder leads to dry scaly skin, muscle cramps, tingling of the lips, fingers and toes
Hypoparathyroidism
Lithium
- *Indication** mania
- *Action** alters cation transport and neurotransmitter reuptake
- *Class** mood stabilizer
- *Nursing Considerations** do not administer with NSAIDS, monitor drug blood levels frequently. May cause seizures dyrthymias, EKG changes, fatiuge, confusion, nausea, anorexia, hypothyroidism tremors. ACE inhibitors may increase serum levels. Instruct patient to maintain adequate fluid intake. Therapeutic level 0.5-1.5 mEq/L
What is the common cause of old age related drug absorption
decrease in lean body mass and increase in body fat.
where should the nurse be positioned when assisting client with CANE
stand slightly behind the client on the strong side
what are signs of catatonic schizophrenia?
sudden loss of animation and tendency to remain motionless in a steretyped position “waxy flexibility”
What does a scheduled I drug mean
very addictive (heroin, LSD)
what is finasteride used for
BPH, decreases male testosterone and libido
Can a LPN perform a dressing change?
yes
what can happen when phenylanine increase
brain problems occur
What side of the body should a CANE be held?
the unaffected side
Erb’s point is located where
3rd left iintercostal space left of the sternum.
Why might a patient be asked to bear down during a central venous catheter insertion?
IV pressure must exceed astmospheric pressure to prevent air from entering the catheter and traveling to the heart and lungs
What is the priority action to take is a patient is experiencing anaphylaxis?
give epinephrine. Other interventions, oxygen via nonrebreather, albuterol to decrease airway narrowing.
Foods that should be avoided for a stool specimen
oranges, cauliflower, broccoli, steak, radishes, aspirin
log roll
What lab values can indicate pre-eclampsia
Magnesium will be low, Creatnine will be high
Which muscle should client exercise after lumbar puncture
abdominal, supporrts the lumbar spine
The registered nurse primary responsibility with regard to education
risk factors
- Atrial Pacemaker
- Regular Rate
- PRI 0.20
- QRS 0.09-0.10
- HR 60
What does it mean if the chest tube is placed in the upper anterior chest?
removal of AIR. Because air rises
What do variable decellerations in a fetus represent
prolapsed cord, reposition client, apply oxygen and notify HCP
how should conversation be directed for patient in a long term care facility with dementia?
encouraged to talk about life and important things in the past b/c of memory loss
How do you decrease pain with an acute gout attack.
partial weight bearing while ambulating. would relieve weight pressure and stress. may use a cane.
Why should an RN care for a client with an excision of a malignant melanoma?
may require a wide escision that requires nurse to anticipate the need for analgesic meds, psch supprt, assessment, teachning and nursing judgment
What is the most accuarete oxygen delivery method
venture mask mixes RA with 100% oxgyen max of 55%
Smallpox causative agent
variola virus
Characteristic vital signs of Heart Failure
tachycardia and increased respirations (do not look at BP)
What is the biggest concern with first time dosing effect
orthostatic hypotension
characteristics of hypokalemia
muscle weakness, parasthesias, fatigue, N/V, dysrhythmias.
Naegeles Rule for confirmng pregnancy date
first day of last period + 7 days - 3 months + 1 year
Example: June 10th is first day of last period = March 17 due date
For a pre op patient what comes first, remain in bed or administer medicatin?
remain in bed, then admin med.
In relation to the heart what direction do veins go?
towards the heart, they have valves.
A client with diabetic neuropathy reports a burning, electrical-type pain in the lower extremities that is worse at night and not responding to nonsteroidal anti-inflammatory drugs. Which medication will you advocate for first?
Gabapentin
Hemoglobin
12-15
When doing an abdominal assessment, what quardant do you start in?
Right Lower Quadrant
Naproxen
- *Indication** pain dimennorhea, fever, inflammation
- *Action** inhibits prostaglandins
- *Class** NSAID, antipyretic
- *Nursing Considerations** GI bleeding, increase risk for stroke and MI, Steven Johnson Syndrome, should remain upright 30 min after administration
Acronym OLD Cart for Pain scale
- Onset
- Location
- Duration
- Characteristics
- Attributes
- Related findings
- therapy and timing
What should you do for a school nurse that finds a patient with a contagious illness
call parents to send the child home
Why do you give lactated ringers for a women in labor receiving an epidural?
replaces electrolytes lost in the labor process and adds volume to expand the vascular bed to reduce hypotension
what type of defense mechanisms does a pt with conversion reaction use?
repression. Instinctive drives and their accompanying anxiety are rpressed and converted into physal symptoms
what is the most dangerous type of transfusion reaction
hemolytic. Nausea, vomiting, pain in lower back, hematuria.
what can patient do after surgical colostomy is established
can resume ALL activities as normal
what type of insulin is given for a patient with diabetic ketoacidosis
short acting
What is important to watch for if pt is taking phenlzine sulfate?
tyramine rich foods
Explain Use of a Partial/Non Rebreather Mask
- short term thereapy
- 60-90%, 10-15L/min
Charge nurse has received a call from ambulance of a multiple car accident with multiple casualties. What action should nurse take first
- notify supervisor and request additional staff
- prep the trauma room
Levofloxacin
- *Indication** UTI, gonorrhea, respiratory infection, bronchitis, pneumonia, skin and bone infection
- *Action** inhibits DNA synthesis in bacteria. Antiinfective
- *Class** fluoroquinolone
- *Nursing Considerations** contraindicated in allergies. May cause QT prolongation, avoid use with other drugs that can cause QT prolongation. Seizures, dyrthymias, pseudomembranous colitis, anaphylaxis, Steven Johnson. Decreased of phenytoin. Monitor renal panel. Asses for infection, obtain cultures prior to therapy, monitor liver function tests.
What does it mean if the chest tube in in the lower chest?
fluid drainage.
What does a boggy uterus deviated to the right indicate?
full bladder and needs to void
If a toddler does not want to take medication, what is the correct method or intervention to take?
leave the room and return five minutes later and give the medicine. Nurse must comply with child’s choise to build trust. Toddlers to not have an accurate sense of time.
What is the glabellar reflex
tap the bridge of ose and baby will close both eyes
Barb
Barbituric Acid derivatives
When creating a teaching plan for a client, what is most important to determine
the client’s perception of health status
What should you do if one of the lumens has increased resistance
secure the luer lock and notify HCP (streptokinase can dissolve it). If that doesnt work that is is labeld as “clotted off”
Steps to take if infant has allergy to cow’s milk
try soy based formula, If that doeesn’t rok try predigested formulats.
What lab value is an increased risk for lithium toxicity
hyponatremia
Iron Antidote
Deferoxamine
Where is the Rinne Test administered using tuning forks?
against the mastoid bone. Normal= air conduction is longer than bone conduction.
Abnormal= the reverse
Salmeterol
- *Indication** reversible airway obstruction, exercise induced asthma
- *Action** bronchodilation through stimualtion of beta 2 adrenergic receptor
- *Class** bronchodilator, adrenergic
- *Nursing Considerations** avoid excessive use, headache, palpitations, tachycardia ab pain, paradoxical bronchospasm. decrease effectiveness of betablockers. Assess respiratory status. May increase glucose levels
Normal range for neonate blood sugar
40-90
depending on weight of newborn, may need blood sugar checks q 2 hours
What is the priority action of a radiation implant has become dislodged
use a pair of forcepts to place the radiation source in a lead container.
Therapeutic interventions for knee replacement
continuous passive motion machine
what is most important to assess when giving a patient dopamine
their weight in kg. That is how it is administered, via pump titrated.
What is essential when starting a infusion of dopamine
patency of iv line. Extravasation can slough the surrounding skin and tissue
a “Reassigned RN” is considered on the same level as..
an LPN/LVN. assign stable client with an expected outcome
What is a priority for a patient with diabetes to call the health care provider for?
if they have an open reddened wound on the heel. Can lead to gangrene or limb loss. Death caused by sepsis.
what medication should client avoid if having urinary incontinence
antihistamines due to anticholinergic action. Can cause urinary retention
what is buspirone used for?
episodie or acute anxiety, minimial abuse potential and not as many SEs with alcohol use.
hydropmorphone/Dilaudid
Indication moderate to severe pain
Action alters perception and reaction to pain by binding to opiate receptors in the CNS. Suppresses the cough reflex.
Class opioid analgesic, allergy cold and cough remedy, antitussive
Nursing assess BP, respirations and pulse before and druing admin. CNS depression. Narcan is the antidote for OD. Caution with MAOIs. May be used as an antitussive. Dilue with NS prior to administration and to administer slowly to decrease CNS depression
Creatnine
0.6 - 1.3 mg/dL
-aril
Antiviral
What does coconut oil contain
caprylic acid, no scientfici evidence says it is safe and effective for cognitivie decline
What does veracity mean
telling the truth
What is the most common cause of SIADH
Lung Cancer. Confusion, weight gain, urin output 15ml/hr
a disease that causes inflammation and sores (ulcers) in the lining of the rectum and colon (large intestine)
Ulcerative colitis
what promotes acidic urine to reduce riks of UTI
- cranberry juice
- tomato juice
- bouillon
- prune juice
citrus promotes alkaline urine, avoid excessive milk and carbonated beverages.
What 4 things does the nurse practice act define?
scope of practice, nursing titles, qualification for licensure, actions taken if nurse does not follow the law.
Does an RN have a legal duty to provide Good Samaritan care at a traffic accident?
No, not legally required
Heparin Antidote
Protamine Sulfate
Examples of urniraty tract infections
cystitis, pyelonephritis
Atenolol
- *Indication** hypertension, angina, prevention of MI
- *Action** blocks the stimulation of beta 1 receptors in the SNS w/ minimal effect on beta 2
- *Class** antianginal, antihypertensive, beta blocker
- *Nursing Considerations** monitor hemodynamic parameters, bradycardia, CHF, pulmonary edema, Masks symptoms associated with diabete mellitus, advise to change positions slowly to prevent orthostatic hypotension, instruct pt on how to take BP
Turner’s sign
flank grayish blue (turn around to see your flanks) pancreatitis
When should a women in labor go to the hosptial
when contractions are 5 minutes apart or when membranes rupture
Escitalopram (Lexapro)
Indication major depressive disorder, anxiety, PTSD, social phobia
Action selectively inhibits reuptake serotonin
Class antidepressant, SSRI
Nursing contraindicated wtih MAOI, citallrpan use, may cause suididal thoughts, insomnia, diarrhea, nausea, serotonin syndrome, QT prolongation, sexual dysfunction, 406 weeks for full affect to take place
what technique is bet when caring for a TPN patient
sterile technique because prone to infection.
-Zoin
Alpha adrenergic blocker
-pidem
hynotic/sedative
Omeprazole
- *Indication** GERD, ulcers, Zollinger syndrome, reduce risk of GI bleed in ill patients, heart burn
- *Action** prevents the transport of H ions into gastric lumen by binding to gastric parietal cells.
- *Class** antiulcer agent, ppi
- *Nursing Considerations** capsules should be swallowed whole, report black tarry stools
Left Sided Heart Failure
- Dyspnea
- S3
- Dry non productive cough
Risk factors for prostate cancer?
age, race, employment
Probable changes in pregnancy
- Chadwicks Sign- vaginal vascularity- blue cervix
- Hepgar’s Sign- uterine vascularity
- Goodell’s sign- cervical softening from estrogen and progesterone
Priority action for client with hypovolemia
- increase IV rate
- elevate lower extremities
- assess surgical dressing for bleeding
- reassess vital signs
Why is protonix given prophylactically
to prevent stress ulcers
What form of medication is best for a client on suicide precautions
liquid
What can excessive diarrhea do to ABGs?
What about excessive vomiting?
d: lead to metabolic acidosis.
v: metabolic alkalosis
Why should you not use the skin fold technique for elder patient to asess hydration
elasticity of skin in this area is affected by aging, gives an inaccurate assessment
Addison’s disease and symptoms of hyponatremia
muscle cramps, fatigue, hypotension
Preparation for stangulated intestinal obstruction
- NG tube for decompression
- Ab radiography
- IV fluids
- IV borad spectrum antibx
- NO pain meds, could mask sx
-azosin
alpha blockers
It is most important for the nurse to observe which condition when a patient had Addison’s disease
dysrthymias. Increased retention of potassium
What is the first intervention to decrease phantom pain?
diversional activity
What is Miconazole cream used for?
vulvovaginal candidiasis, use cream every day even while menstruating
Fetal station means
the relationship between the presenting part of the baby with the mother’s pelvis
How is an acute glomerulonephritis patient treated?
treated with antiinfective, diuretics, antihyptertensives. Short term medication management.
if you see an answer choice that says “reassess in 15 minutes” what should you think
wrong answer
Cephalexin (Keflex)
Indication skin infections, pneumonia, UTI, otitis media
Action bactericidal
Class antiinfective, cephalosporin 1st generation
Nursing contraindication with penacillin allergy, seizures, pseudomembranous colitis, diarrhea, phlebitis at iv site, anaphalaxis, obtain cultures prior to therapy, monitor bowel function, may lead to super infection, may cause elevated liver enzymes
What is the best technique for improving patient outcomes
involve the client in making healthcare decisions. More motivated to adhere to recommendations when involved in the process
Midazolam
- *Indication** Sedation, conscious sedation, anesthesia, status epilepticus
- *Action** CNS depressant, mediated by GABA
- *Class** Benzo, antianziety, sedative
- *Nursing Considerations** assess level of sedation 2-6 hours following. Monitor BP, Pulse, Respirs, IV administratiaon, Antidote is Flumazenil
GI infections
staph food poisoning, botulism
Procainamide
- *Indication** ventricular and atrial dysthrythmias, PAC, PVC, Vtach, post cardioversion
- *Action** decreases excitibility and slows conduction velocity
- *Class** antidysrthmia
- *Nursing Considerations** ventricular dyrhythmias, seizures, aysystole, heart block. widening of QRS complex. hypotensions must be supine. can cause drug induced lupus syndrome
What does the mitral valve control?
flow between the left atrium and left ventricle (Atrioventricular Valve)
what is a risk factor with basal cell carcinoma
sun exposure
What foods contain tyramine?
cheese, beer, red wine, yogurt, liver, onions, fish
Why is a sedative/antianxiety contraindicated if client is exhibiting signs of alcohol withdrawal
med will lower client’s seizure threshold and BP, serious medical consequences.
What are early findings of shock?
Increase RR, Inc HR, Oxygen is the most critical intervention
What drug should be given before a cardioversion procedure
benzo- sedative
which vaccines come later in life
mmr and varicella (15 months)
Diet for crohn’s disease
increased protien increase calorie. Low fat, Low Residue (fiber)
Amiodipine
Indication HTN, Angina
Action blocks transport of calcium into muscle cells inhibiting excitation and contraction
Class antiHTN, CA channel blocker
Nursing Considerations gingival hyperplasia, grapefruit juice may increase drug level, BP and pulse prior to therapy, monitor I/Os, assess signs of CHF, teach patient how to take BP
Why are statins administered in the evening
because cholesterol synthesis increases at night
what is 90-90 traction used for?
femur or tibia fracture. Hip and kneww is flexed 90 degrees.
TB treatment
medication is taken daily with monthly visits to the clinic
Contracture- the result of a stiffness or constriction in your muscles, joints, tendons, ligaments, or skin that restricts normal movement.
What is barbituate withdrawal like?
N/V Tachycardia, course tremors, seizures
What does mottling of the skin, acrocyanois and irregular respirations represent
cod stress.
positioning for appendectomy
elevate HOB 30-45 degress. Reduce stress on suture line.
what is cushing triad
r/t icp (htn, brady cardia, irr respers)
Drawing up insulin
- Clear (regular) before Cloudy (NPH)
- put air in NPH first
What are the 5 steps for reading and ekg
- Are there any P waves?
- Are there any QRS?
- Measure PR Interval
- Rate
- Rhythmn
which type of client is most at risk to develop uritary tract calculi
vegetarian. High calcium foods (soy, tofu, etc) increase risk.
What indicates hepatic dysfunction in patient with TB
fatigue and dark urine
Ampicillin
- *Indication** skin infections, soft tissue infections, otitis media, sinusitis, respiratory infection, GU infections, meningitis, septicemia
- *Action** bactericidal, broader spectrum than penicillins, binds to cell wall leading to bacterial cell death
- *Class** antiinfective
- *Nursing Considerations** super infection fury overgrowth on tongue, vaginal itching, loose and foul smelling stool, pt should not use with oral contracetive, liver function, can cause seizures, diarrhea, anaphylaxes super infection
When is it NOT the time to have client Turn Cough and Deep Breathe
immediately after srugery
For a patient with emphysema what does an oxygen flow that is too high, what is the respiratory rate
DECREASED
what non pharm mgmt helps phantom pain
activity helps reduce frequency and degree
emergency dressing for a patient with an open pneumothorax
cover the wound loosely to allow air to escape but not renter the pleural space.
Ztrack vs SubQ administration
Ztrack is 90degrees, SubQ is 45-90.
most common cause of mitral valve problems
history of rheumatic fever or carditis
What patient is good to put next to a depressed patient
another depressed paitent or someone who’s condition is more stable. Matching roommates ages as closely as possible
What is an early manifestation of spinal cord compression related to a tumor
back pain 95% of patients.
Total Client Care Case Method
- RN is responsible for ALL aspects of care
- May be seen in Critical care or PACU
what does percodan have with it?
oxycodon with aspirin
Why should doxycycline not be taking before bed?
can cause esophageal irritation. Nurse should find out time pt goees to bed.
Pathophysiology of Pernicious Anemia
parietal cells of stomach fail to excrete intrinsic factor which is necessary for absorption of vitamin B12
sx: sore tongue(beefy red), anorexia, nausea, vomiting, diarrhea, abdominal pain
What is the policy for using restraints
nurse should assess continue use every 4 hours. Order needs to be rewritten every 24 hours
For a patient receiving the chemotherapeutic drug vincristine (Oncovin), which side effects should be reported to the physician?
parasthesia
n/v, fatigue, anroxia are common side effects for ALL chemo drugs
What should you think with a women who is tachycardic and postpartum
hemorrhage
Cyclosporine
Indication prevent rejection in transplantation, treatment of RA, MGMT of ulcerative colitits
Action inhibits normal immune response,
Class apolypeptides,immunosuppresants, antirheumatics (DMARD)
Nursing cseizures, tremors HTN, hepatoxicity, diarrhea, N/V, gingival hyperplasia, increase immune suppression, avoid grapefruit juice, renal panel, liver enzymes, lifelong therapy required for transplant patients, teach how to take bp
Common symptoms of ulcerative colitis
recurrent bloddy diarrhea
Findings with a child with pyloric stenosis
fussy, seems hungry all the time. BEcomes lethargic, dehydrated and malnourished.
Where do you support a fracture
above and below the site
What defense mechanism is attributing to other one’s feelings, impulses, thoughts or wishes?
projection (blaming/scapegoating)
what factor can increase risk of vasooclusive sickle cell crisis in a patient with sickle cell disease
cold temp, infection, fluid volume deficity, high altitudes, stress
What does CO2 do to vessels
vasoconstriction
What is a priority for a patient after orchiectomy?
removll of testis for prostate cancer. PAIN MGMT
Guthrie Bacterial Inhibition test (PKU)
- Can be done after 6 weeks of age
- Mandatory in the U.S.
- identifies an inherited disease
- Best results occur after baby has been breast feeding or drinking formula for 2 full days
- Test is delays if baby is less than 5 lbs
- positive test require dietary control for prevention of brain damage
Insulin before surgery
hold morning dose of NP and Short Acting. Can cause them to become hypoglycemic during surgery
Atropine
- *Indication** decreases oral and respiratory secretions, treats sinus bradycardia and heart block, treatment of brochospasm
- *Action** anticholinergic inhibits the effects of PNS, acetycholine. Increases HR, bronchodilation decreased GI and respiratory secretions
- *Class** antiarrthmic, anticholinergic, antimuscarinic
- *Nursing Considerations** avoid acute hemorrhage, tachycardia, and angle closure glaucoma, monitor tachycardia and palpitations, may cause urinary retention, constipation
5Ps Factors affecting Pregnancy
- Passageway bony pelvis, soft tissues
- Passenger (fetus)
- Power (uterine contractions, bearing down)
- Position of laboring woman
- Psyche of birth
What is the casative agent for the plague
yersinia pestis. Deteriorating pneumonia, fever, chest pain, bloody or watery sputum.
What is Total Lymphocyte count used for?
to assess immune function and is below 1500 when pt is malnourished (protein)
As the charge nurse evaluating a new nurse, what is the first priority for evaluating work?
good performance is always reinforced first
First Stage of Labor Transitional Phase lasts for
10-15 minutes
What intervention is crucial for pt with NG tube
frewuent oral care (ice chips/mints could be contradindicated)
Early vs Late signs of opiate withdrawal
- Early: diaphoresis
- Late: ab cramps, nausea, fever
Alprazolam
- *Indication** anxiety, panic disorder, PMS, insomnia, mania, psychosis
- *Action** CNS anxiolytic effect, CNS depression
- *Class** anti anxiety agent, benzo
- *Nursing Considerations** caution w/ sleep apnea, renal dysfunction, hepatic dysfunction, drowsiness, lethargy, physical dependence, tolerance effect, flumazenil is the antidote, grapefruit juice may increase blood levels
P-I-S-O
Regarding Cells
Potassium Inside
Sodium Outside (the cell)
What happens after a T-Tube removal?
expect that a stab wound will continue to drain until the wound seals. Nurse should continue to change the dressing and ensure it is clean and dry
what is indicative of PCP intoxication
aggressive behaviors, blank stare, rigis muscles, nystagmus. unpredictable outbursts.
trochanter roll
what should be done to prepare for an EEG test to monitor seizure activity
needs to be sleep deprives in order for one part of the test to be most effectively carried out
What should you do if a patient is presenting with symptoms of air embolism?
turn to the left side and lower the head of bed. allows air to enter the right atrium and pulmonary artery. Remain in position for 20-30 min
what is the purpose of iodine after a subtotal thyroidectomy
reduces vascularity and size of the thyroid. Will reduce post op hemorrhage.
what do you need to ensure before administration of spinal anastesia
fluids beforehand to prevent hypotension after
Which type of insulin has the longest duration of action
glargine
Enalapril
Indication hypertension, MGMT of CHF
Action iblock conversion of angiotensin I to angiotensin II, increases renin levels and decrease aldosterone, vasodilation
Class ACE inhibitor, antihypertensive
Nursing neutropenia, caution with potassium, watch diuretic therapy, admin 1 hour before meals, monitor BP, monitor weight and fluid status, monitor renal profile, monitor CBC
What is the best way to schedule medication for a client with constant pain?
around the clock
what part of the hand do you palpate the uterus with during labor
fingertips
Why does a patient with herpes zoster need a private room?
airborne, and contact.
Nalpuphine
- *Indication** pain, analgesia during labor, sedation before surgery, supplement of balance anesthesia
- *Action** alters perception and response to pain, causes CNS depression
- *Class** opioid analgesic
- *Nursing Considerations** caution with head trauma, dizziness, headache, N/V, respiraotry depression. Do not use with MAOIs, assess pain, hemodynamics, can elevate pancreatic enzymes. NARCAN antidote
how often does a continuous tube feeding need to be changed?
every 4 hours
What is charcot’s join
degenerative condition. Joint instability, and hpermobility. Along with numbness and tingling. Tx includes casting for 12 weeks. No weight bearing acivity
Beta 2 means
2 lungs- constrict bronchi lead to increase in blood glucose concentration
Why should you question an IM order of thrombolytic therapy
im injection and risk of bleeding
How do you reduce risk of lead contamination in tap water
let water run for 2 minutes
Cimetidine
Indication duodenal ulcers, CERG, heartburn, Zollinger Ellison syndrome, GI bleeding in crit patients
Action iinhibits action of histamine leading to inhibition of gastric acid secretion
Class H2 antagonist, antiulcer agent
Nursing increases serum levels of warfarin, respiratory infection, watch dysryhthmias, agranulocytosis, aplastic anemia, monitor CBC, increase fluid and fiber intake to decrease constipation
Glucose
70-110 mg/dL
What is being lost with nephrotic syndrome
lots of protein, more edems.
This is the exception to the rule, increase protein because they are losing too much
How is Scope of Practice determines
Stat’es nurse practice act
Med of choice for CHF
ace inhibitor
Where is pain in appendicits
Right Lower quadrant
Loperamide (Imodium)
- *Indication** Acute diarrhea, decrease drainage post ileostomy
- *Action** inhibits peristalsis, reduces volumje of feces wwhil increasing the bulk and viscoscituy
- *Class** antidiarrheal
- *Nursing Considerations** can lead to constipation, asses bowel function, assess fluid and elctrolyte levels
What drug is given if client is having continuous tonic clonic seizures
diazepam. IV
how do you count twins in terms of gravita and para
gravita 2, para 1
what is helpful for a paitent having discomfort with peripheral arterial insufficinecy
apply a heating pad to your abdomen once a day. Causes reflex vasodilation of extremetieis without direct heat on extremities.
What does a fluid challenge consist of?
bolus of 250 mls or greater with normal saline and watch foley for urine output
what drug is used to treat tourette syndrome?
Haloperidol
Why does a client lie in prone position prior to amputation
stretch hip flexor muscles.
Russells sign is observed with this disorder
bulimia nervosa
will have scraped or raw areas on the knuckles.
Prep for client receiving ECT
should not eat or drink 8 hours prior. Due to general anasthesia.
When a client is immunosuppressed, what type of precautions do you put them on
neutropenic
What do you need to monitor when administering dopamine
vital signs all.
what is minimal change disease?
a kidney disorder that can lead to nephrotic syndrome. Tx corticosteroids. Child might bot be ablte to fight infection. Surgical patient is considered “clean”
How should you always begin your assessment?
with observation
1 tsp - how many mls
5ml
why is a cardiac monitor attached to a patient with an acute MI
to detect life threatening changes in the heart rhythm
Bright flashes of light; blurred vision; “floaters” in the eye
Retinal detachment
right sided hf signs
anorexia, nausea, ab discomfort, peripheral edema
what is methotrexate used for
cancer, rheumatoid arthritis, immunosuppressant, psoriasis
what signifies worsening of asthma
diminished breath sounds, indicates severe obstruction
the primary focus of the nclex-rn
assessment of minimum competency
If the dose of med exceeds 1 ml For infants receiving an IM injection. How should it be administered?
2 separate doses
Streptokinase
- *Indication** pulmonary embolism, DVT, occluded lines, arterial thrombus
- *Action** converts plasminogen to plasmin which degenerates fiibrin clots
- *Class** thrombolytic, plaminogen activator
- *Nursing Considerations** contraindicated with active bleeding, hypersensitivity, bronchospasm, ICH, hypotension,. Begin therapy as soon as possible, Monitor VS continuously. Avoid invasive procedures
How long before anginal client can resume sexual activity
1 week
when should the nurse hold morphine
when the client appears leathargic, decreased respirations
Functioning Nursing
- RN gives medications and UAP gives bed baths for one group of clients
- Needs are broken down into tasks
when you see the word “deep injection” think
z-track method to prevent tissues from irritation.
what does a percutaneous transluminal coronary angioplasty do
open blocked coronary arteries. It is performed druing cardiac catherization.
Ondansetron
- *Indication** Nausea and vomiting
- *Action** blocks effects of serotonin on vagal nerve and CNS
- *Class** antiemetic, 5-HT3 antagonist
- *Nursing Considerations** headache, constipation, diaarrhea, dry mouth. EPS symptoms, monitor liver function tests. Administer slowly over 2-5 minutes
Best position for a patient with Unilateral Hemiplegia
prone with feet dangling (counteracts foot drop).
if tolerated.
what do you watch for with addisonian crisis
stress mgmt, severe hypotension
what should you never do to a iv bag?
write with a permanent marker, can penetrate the solution. Use a label as a barrier
what drug should be given to a bay to minimize side effects from DPaT immunization?
antipyretics for discomfort, irritability and fever.
General Guide for serving size for children
one tables spoon per year of age.
Procedures with a patheint with bronchiolitis to RSV
- Assess for respiratory distress
- promote tissue ogyenation
- institute droplet isolation precautions
- administer medication
- promote desired fluid intake
- provide family teaching
what should be recommended to a patient before a pap smear
no intercourse 24 hours before the test. No douching can affect appearance fof cells.
what is the recovery time for heptatits?
Type A is not infectious, within a week may return to school
Pantoprazole
- *Indication** GERD, heartburn
- *Action** decreases accumulation of acid in the stomach
- *Class** antiulcer agent, ppi
- *Nursing Considerations** hyperglycemia, abdominal pain, decreases absroption of certain drugs, may increase bleeding with warfarin, assess for occult blood.
After a liver biopsy what position
on right side, for several hours.
Vancomycin
- *Indication** life threatening infection
- *Action** bacetericidal, antiinfective
- *Class** antianginal, antihypertensive, beta blocker
- *Nursing Considerations** ototoxicity, N/V, nephrotoxicity, anaphylaxis, red man syndrome,. Monitor BP
When is Intraocular pressure increased?
in the early morning
Signs of Chronic Kidney Disease
Ecchymoses, hyperpigmentation, pruritus
Hallmark Signs of tonsillitis
viral or bacterial. Difficulty swallowing, ear pain, fever/chills, headache, sore throat
Clinical indicators for suctioning
- course breath sounds
- noisy breathing
- increased/decreased pulse
- increased/decreased respiration
- prolonged expeiratory breath sounds
What is the main finding of pericardities
sharp, stabbing pain in the center or left side of chest.
What is always a concern with mysathenia gravis
airway
Non-diabetic Hemoglobin A1c
4% - 5.9%
Diphenoxylate/Atropine
Indication tx of diarrhea
Action inhibits GI motility via anticholinergic effects
Class antidiarrheal, anticholinergic
Nursing contraindicated with angle closure glaucoma, dehydration, r/t opioids watch patients allergic to opioids, SE- constipation, tachycardia, dizziness, ilues, monitor liver, do not double dose
garlic and diabetes
can have a hypoglycemic effect. Can potentiate action of diabetic drugs.
why does a patient with addison’s disease need more sodium during time of stress
decrease in aldosterone, sodium intake should be increased
what could epigastric pain during pregnancy indicate?
impending convulsion
S1 Auscultation
- closing of the mitral valve.
- heard best at apex
- after long diastolic pause, before short systolic pause
Actions to take with sudden drop in BP and pulse
- Simultanously check apical and radial pulse manually
- Assess for chest pain, dyspnea, low oxygen sat, restlessness
- nofity HCP
- anticipate EKG, oxygen admin, and mergency pacing
In application of the principles of pain treatment, what is the first consideration?
Client perception must be accepted. Their belief is always first priority.
What other treatment options are there for an Afib clinet that does not respond to antiarrhythmics or cardioversion?
radiofrequency catheter ablation. After ablation pt will need to take anticoagulatns
if the client is disoriented, how should the bed be positioned
elevate the side rails
Regarding room assignments what is a post-op paitent considered in terms of infection control
“clean”, should be with a patient that is clean as well.
Methadone
- *Indication** withdrawal symptoms, pain
- *Action** binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS. Decrease in the cough reflex and GI motility
- *Class** opioid analgesic
- *Nursing Consideration** caution with MAOIs may cause QT prolongation, hypotension, respiratory depression, dependence, confusion, sedation. Assess pain, vital signs, bowel function. May increase pancreatic enzyme levels. Assess withdrawal symptoms
ratio of compressions to breaths for an adult
30 compressions, 2 breaths
What does a Miller-Abbott Tube do?
intenstinal decompression, used to treat paralytic ileus. Removes fluid and gas from small intestine
when is propanolol contraindicated?
uncompensated heart failure or pulmonary edema
Bethanechol
- cholinergic or parasympathomimetic*
- How are they used for neurogentic bladder*
mimics action of acetylcholine
Who should nurse manager consult with regarding bad behavior by a nurse?
human resources to determine procedures for documenting and reporting behavior
talipes equinares
another name for clubfoot
What is the appropriate dressing for a stage II pressure ulcer
Hydrocolloid or foam dressing (duoderm). Eliminate answer choices that have the word “dry” in them
Opioids antidote
naloxone
Presumptive Signs of Pregnancy
subjective/objective reported by women
amenorrhea, fatigue, N/V, breast changes, elevation of basal body temperature, skin changes.
findings can be caused by conditions other than pregancy
When does the second stage of labor occur?
Complete dilation through birth (30-50 minutes for primipara)
How are symptoms of meniere’s disease controlled
adhering to a low sodium diet
onset of NPH and when hypoglyemica reaction may occur
within 2-4 hours
Procedural order for administeral total parenteral nutrition through Central Line
- Check solution ofr cloudiness or sediment
- select & flush the correct tubing and filter
- thread the IV tubing thru an infusion pump
- use aseptic tech when handling injection cap
- connect the tubing to the central line
- set infusion pump at prescribed rate
How many wet diapers per day for infants and newborns?
6-8 wet diapers
How is metformin used for Type 2 Diabetes
it lowers the amount of glucose absorbed from food, lowers the amount of glucose produced by the liver and increases body’s response to insulin
Promethazine
- *Indication** allergic reactions, N/V, sedation
- *Action** blocks the effects of histamine, antiemetic effect. anticholinergic, CNS depression
- *Class** antiemetic, antihistamine, sedative, phenothiazine
- *Nursing Considerations** IV administration can cause tissue damage, hypertension impaired liver function. Neuroleptic malignant syndrome, confusion, sedation
when you see the word watery diarrhea what should you think
life threatenting. Bowel perforation or obstruction
QRS complex indicates
ventricular depolarization
Erythromycin
Indication in place of peniccillin, upper and lower respiratory tract infections, otitis media, skin infections, pertussis, syphilis, rheumatic fever
Action suppress bacterial protein synthesis, bacteriostatic
Class antiinfective, macrolide
Nursing QT prolongation, ventricular arrhythmias, diarrhea, liver function
Partial Thromboplastin Time (PTT)
20-36 seconds
Who establihed the Standards of Practice
the nursing profession (ANA)
immediately before transporting a client to a surgical area, the nurse should take which action?
check their bands
What is internal radiation therapy (Brachytherapy)
- Radioactive source is inside the clinet.
- Radiation IS being emitted
- All pt swill emit radiation are a threat to tohters.
- Nursing assignments should be rotated daily,
Dopamine
Indication improve blood pressure, cardiac output and urine output
Action small dose result in renal vasodilation, medium cardiac stimulation by acting on beta 1 receptors, large dose stimulate alpha receptors leading to vasoconstriction increase SVR
Class inotropic, vasopresser
Nursing cmonitor BP, HR, EKG, CVP, PAOP, titrate to obtain appropriate BP, irritation may occur at IV site, beta blockers may counteract therapeutic effects
Which diseases is carbamazepine administered?
diabetic neuropathy, trigeminal neuralgia
take with meals, photosensitivity.
what specific gravity indicates fluid volume deficit
HIGH
(1.010-1.030)
-tricin
antibiotics
What is an early sign of diminished oxygenation
increasing pulse rate, compensatory mechanism.
Diltiazem
Indication HTN, angina, SVT, Afib, Aflutter
Action inhibits calcium transport resulting in inhibition of excitation and contraction, leads to vasodilation and decreased bp
Class antianginals, antiarrhythmics, antihtn, Calcium Channel Blocker
Nursing contraindicated in 2nd and 3rd av block, dysrythmias, CHF, bradycardia, peripheral edema, ginigval hyperplasia, increases dig levels, no grapefruit juice, monitor EKG, ortho hypotension, monitor potassium, teach how to take BP
Buproprion
Indication depression, smoking cessation, ADHD
Class antidepressant, smoking deterrents, aminoketones
Nursing seizures, suicidal thoughts, do not take w/ MAOI, renal/liver impairment, assess mental status, avoid alcohol
wheezing upon inspiration as a toddler. What should you think?
choking on a piece of meat, aspirating
What should you think when a patient states ““I went to the bathroom and my urine looked very red but it didn’t hurt when I went.””
painless gross hematuria. Urgent associated with bladder cancer or kidney problems.
Team Nursing
- Most common delivery system
- team of nursing personnel provides total care to a group of clients
what might suggest overdosage of thyroid medication
nervousness and difficulty sleeping
Signs and Symptoms of hantavirus pumonary syndrome
thrombocytopenia, hematuria, hematemesis, bleeding gums, melena
Fetal Presentation
portion of the fetus that enters the pelvic inlet first (cephalic, breech, shoulder)
In relation to the heart, what direction do arteries go?
away from the heart
how does a 7 year old view death
as a punishment
What should you do after a straight catheter is inserted
clamp the catheter after 300-500 mls because rapid decompression can result in bladder wall damage
Enoxaparin
Indication prevention of VTE, DVT, and PE
Action iprevents thrombus formation by potentiating the inhibitory effect of antithrombin on factor Xa
Class anticoagulant, antighrombotic
Nursing contraindicated in pork hypersensitivity, onitor signs of bleeding, admin in SUBQ tissues, do not eject air bubble prior to injection, do not aspirate or massage site
What types of food can prevent kidney stones
high calcium, dairy products
Cholesterol Total
140-199 mg/dL
Expected findings with ECT therapy
headache, difficulty with short terma d long term memory, confusion
Rifampin
- *Indication** TB
- *Action** inhibits RNA synthesis
- *Class** antitubercular, rifamycin
- *Nursing Considerations** can turn body fluids red. N/V, confusion. Assess lung sounds and sputum, evaluate renal and liver tests, instruct patient not to skip or double dose
Expected findings with inflammatory bowel disease
persistent diarrhea, ab pain, blood mucus in the stools
how does a client with placenta previa deliver?
C-section.
ACE Inhibitor consideration
- *Indication** hypertension, CHF
- *Action** block convfersion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation
- *Nursing Considerations** caution with potasssium supplements and potassium sparing diuretics. Caution with diuretic therapy, Administire 1 hour before meals, Monitor BP often. Monitor weight and fluid status. Monitor renal profile. Monitor liver function tests
correct action for DVT prevention
prevent pressure at the back of the knees
-azepam
Antianxiety
Hypophysectomy is…
he surgical removal of the hypophysis (pituitary gland). It is most commonly performed to treat tumors, especially craniopharyngioma tumors. Sometimes it is used to treat Cushing’s syndrome due to pituitary adenoma.
What is the proper procedure after inhaling a glucocorticoid
rinse the mouth every time to decrease risk fo candida infection
How long does infant have babinski reflex
12 months
Why is age a risk factor for cancer?
increased incidence in the immunosuppressed
What does an elevated D-dimer test indicate?
pulmonary embolism
DIC
how do you know if levothyroxine is working
increased urine output, increases metabolic processes, including glomerular filtration.
nutritional needs while lactating vs during pregnancy
more calories are needed. But same amount of protein and calcium.
What does chest pain during a treadmill stress test indicate?
MI, stop the test to avoid ischemia.
how many mL is a popsicle
20mL
each gram of a diaper is equivalent to
1 mL
1 cup of ice chips is equivalent to..
1/2 of cup= 4 oz. (120 mL)
what type of exercise for cast
isometric
what candy can decrease serum potassium levels
black licorice
what is the most important intervention for venous stasis ulcer
nutrtional therapy
what does brudinski’s sign look like with meningitis
severe stiff neck causes flexion of hips and knees with passive flexion of the neck.
food that are rich in iron
red meat, fish, egg yolks, legumes, whole grains, nuts, dried fruits.
what’s important to establish for a client that is paranoid
trust
if you see bilateral ankle edema, what should you think
right sided heart failure, or venous insufficiency
unilateral swelling could mean deep vein thrombosis
what can happen to older patients when givent cimetidine (H2 blocker)
can become confused.
what might you expect with an infant with tetraology of fallot
- may be cyanotic at birth that progresses over the first year of life
- becomes pulmonic stenosis
- murmur is present
dry powder capsule
think of it like a cigarette. Inhale fast and deep. Hold for 10 seconds, then breath out. Rinse mouth afterwards
High specific gravity=
poor hydration
Pyridostigmine Nursing Considerations
- for Myasthenia gravis to help with swallowing. Should be given 30-60 min before meals.
- MG will have more muscle weakness in the evening. Regain strength with rest.
What nursing considerations for ceflasporin
- GI upset, give with food. All other antibx on an empty stomach
- can cause false positive for proteinuria and glucose
When should antacids be given
1-2 hours after eating
Parkland formula
4mL * Kg * BSA Burned = Total Volume Necessary
how do you know altepase is successful in patient with MI
reduction of ST segment, indicates a return in blood flow to the injured myocardium
What drug can cause renal failure if given with contrast media?
metformin
what is the test of choice to determine placenta previa
transvaginal ultrasound
What is a cisternography done for?
assess CSF circulation
Abnormal drainage from Peritoneal Dialysis
- Brown- bowel perforation
- Cloudy- infection
- bloody- perforation
when to notify HCP about chest tubes
- drainage on dressing
- drainage volume > 100mL/hr
- emphysema
what is concerning about nausea and vomiting
- increase intraocular pressure and ICP
- Increased Cardiac Workload
What is the shick test
diptheria toxin
How much water should patient drink prior to ultrasound of the abdominal cavity?
- 32 oz, 60 minutes prior
- cannot void until after exam
what is delirium tremens?
severe alcohol withdrawal. Impaired cognition or agitation. Confusion, disorientation, agitation, hallucinations, diaphoresis, fever, tachycardia, HTN
visitation and addisonian crisis
limit visitors can cause stress
Pinna is down and back for what age group?
3 years and younger
what is an appropriate method to ensure compliance to drug regimen?
direct observation
(ex: family member’s observing client)
What does SR mean?
sustaned release. Should be be crushed or fed thru gastonomy tube.
What helps a patient TCDB after surgery
pain medications
what is asthma?
airway becomes narrowed. Obstructing airflow in response to triggers. Not a disease but an inflammatory disorder.
Wernicks vs. Broca
- W: receptive aphasia
- B: expressive aphasia
Indicators of ICP
changesin respiration, more sensitive than blood pressure and pulse
Posterior Pituitary Gland produces
ADH and oxytocin
what endocrine disorder can be associated with kidney stones?
Hyperparathyroid due to hypercalcemia
