NCLEX Review Flashcards
Stay with client for 1st ____ min of blood transfusion
15
Infuse blood within ____ hours
4
What type blood transfusion reaction manifests in pruritus, respiratory distress,urticaria, and flushing
allergic
What type of blood transfusion reaction manifests in flank pain, chest pain, fever, chills, tachycardia, and tachypnea
hemolytic
Erythropoietin is produced in the _________
kidneys
Pernicious anemia results from a deficiency in _____ usually caused by lack of the intrinsic factor in gastric juice
B12
Lead poisoning can cause _____________ anemia
hemolytic
Pain med of choice for sickle cell anemia
dilaudid
Dilute liquid ________ preparations in juice or water and administer with a plastic straw to avoid staining teeth
iron
Avoid antacids, coffee, tea, dairy products or whole grain breads for ___ after oral iron administration
1 hr
Massage after injecting iron. t/f
FALSE
Change needles between drawing up iron and injecting to prevent staining. t/f
TRUE
A 45 year old man’s lipid profile results are sent to the nurse practitioner. They are as follows total cholesterol= 287; HDL= 30’ LDL= 165; triglycerides =150. The nurse interprets these results as:
Abnormal: the total cholesterol and LDL levels are elevated, and the HDL is too low.
Increased fluids and laxatives may be prescribed after a swallow series to increase elimination of ________
barium
Give clear liquid diet and laxative day before procedure, NPO after midnight, and cleansing enema before a ________________ and _____________
barium enema study, colonoscopy
Have client lie on ______ side for 1-2 hours after a liver biopsy
Right
Assess placement of NG tube before each feeding and every ___ hours with continuous feeding
4
Always refeed residual of NG tube unless it exceeds ____ mL
100
TPN must be administered through a ___________ for rapid dilution and blood flow
central line
Maintain __________ technique during TPN dressing changes
aseptic
Change all TPN tubing and filters every ____ hours
24
Check blood glucose every __ hours for TPN
4
Methods to avoid ____________ include eating small frequent meals, avoiding liquids with meals, lying down after meals, and eating high-protein, high-fat, LOW-CARB meals
Dumping syndrome
Eat a _____ residue diet to prevent diverticulitis and a ____ residue diet to heal it - ALWAYS avoid ______
high, low, seeds
Ulcerative colitis
Bowel disease effecting large bowel, causing bleeding, pain, weight loss, and severe diarrhea
Crohn’s Disease
Bowel disease effecting small bowel, causing perianal involvement, fistulas, colicky pain, weight loss, and diarrhea
Hepatitis A
Virus transmitted by fecal-oral contact; often seen with contaminated water or shellfish
Hepatitis B
Virus transmitted through infected blood or unprotected sex - most common
Hepatitis C
Virus transmitted through blood transfusions, IV drug abuse, health care exposure
Appropriate immune serum globulin must be administered within ____ days of exposure to Hepatitis viruses
7-Feb
cirrhosis diet
This condition requires a high-calorie; low/no protein; low-fat; low-sodium diet
medication used to lower blood ammonia levels
lactulose
Murphy’s sign
Palpation of right subcostal area while client takes a deep breath - extreme pain indicates acute cholecystitis
Elevated serum amylase and lipase are seen with __________
pancreatitis
NPO with NG tube in place and TPN for moderate to severe cases occurs with ____________
pancreatitis
watch for sciatic nerve whene using what site
dorsogluteal
Potassium High sources include
bananas, peaches, melons, raisins, dried fruits, black licorice, nuts, salt substitutes, vegetables, and tomato, orange, and grape juices,
Which side effect of hydrochlorothiazide, a thizide diuretic should a diabetic patient be monitored for?
Increased hyperglycemia
An elderly white man with a long history of asthma has recently ben given a diagnosis of hypertension. Which class of antihypertensive agents should the nurse avoid for this client?
Beta Blockers
Your patient is receiving unfractionatedheparin. In addition to the PTT, which laboratory value must be monitored?
Platelets
Which drug counteracts heparin?
Protamine sulfate
CD4 count less than _______ indicates AIDs
200
chronic inflammatory disease involving vascular and connective tissue of multiple organs causing butterfly rash on cheeks and across nose, polyarthralgia, anemia, fever, malaise, weight loss, Raynaud’s
Lupus
Which birth control method is contraindicated for patients with Lupus?
IUD
The shock phase of a burn victim occurs for ___ -____ hours - this is when massive edema, protein and fluid loss, and increase in potassium occurs
24-48
For burn victims, give half of total fluids in first ___ hours
8
Sodium High sources include
table salt, processed foods, baking soda, MSG
Calcium High sources include
dairy products, sardines, salmon, tofu, soy,and nuts
Magnesium High sources include
fruits, peas, nuts, pumpkin seeds, sunflower seeds, spinach, salmon, halibut, black and navy beans
Administration of glucose and insulin facilitate entry into cells
Potassium
Kayexalate can be given for excess of this electrolyte
Potassium
Never give this electrolyte by bolus IV or PO - Must be diluted and infused at no greater than 40 mEq/L
Potassium
Use ___ instead of tap water for irrigation or enemas in the presence of hyponatremia
NS
In the presence of surplus _________, signs include edema, hypertonicity, dry sticky mucous membranes, elevated temperature, flushed skin, and thirst
Sodium
Proportions in body are always inversely related to phosphorus proportions
Calcium
May be deficient in hypoparathyroidism or removal of thyroid
Calcium
Calcium Deficiency causes
tetany, cramps, tingling, numbness, hyperactive reflexes, cardiac arrhythmias, and Chvostek and Trousseau’s signs
This vitamin facilitates absorption of calcium
D
Deficiency of this can be related to alcoholism
magnesium
Do not administer antacids containing ______________ to renal failure patients
magnesium
Post-renal biopsy, patient must remain in a _______ position and be on bed rest for ___ hours
supine, 24
Antibiotics of choice for UTIs
sulfonamides
Type of acute renal failure resulting in inflammation of the kidney’s that is thought to be related to strep infection
glomerulonephritis
This type of acute renal failure usually occurs in children and has a good prognosis
glomerulonephritis
Reduce dietary protein and sodium and increase calories for ____________________
glomerulonephritis
acute renal failure Symptoms include
sudden onset of oliguria, edema, elevated BUN, creatinine, potassium, decreased protein and calcium, phosphate, decreased specific gravity, acidosis, heart failure
Diet for _________ renal failure is low-protein, low-potassium, low sodium, low phosphate, high-carb,, with vitamin and calcium supplements with fluid restriction
Chronic
Never clamp a nephrostomy tube. t/f
TRUE
Medications which promote urinary flow
alpha-blockers
If fluid intake is encouraged, this usually means at least ___________mL per day
3,000
TURP syndrome
Hyponatremia, confusion, brady./tachycardia, hypo/hypertension, N/V, or visual changes resulting from absorption of irrigating fluids through prostate tissue during surgery
Urge incotinence
Type of incontinence in which patient cannot hold urine when stimulus to void occurs
Functional incotinence
Type of incontinence when the patient cannot physically get to the bathroom or doesn’t know to
Stress Incotinence
Type of incontinence when pressure such as coughing, straining, or laughing causes urine to escape
Decorticate
Abnormal posturing indicated by rigidity, flexion of arms, clenched fists, extended legs
Decerebrate
Abnormal body posturing indicated by rigid extension of arms and legs, downward pointing of toes, and backward arching of head
__ or less on the Glasgow coma Scale indicates that the patient is in a coma
7
After a lumbar puncture, it is correct to position the patient flat for 20-60 minutes. T/F
TRUE
The first sign of increased ICP is altered _____
LOC
Change in LOC, N/V, pupil changes, diplopia, widening pulse pressure, bradycardia, Cheyne-Stokes respirations, and elevated temperature are signs of _______________
elevated ICP
With elevated ICP, keep HOB at ___-___ degrees and head in ________ position
30-45, neutral
Opiates and sedatives are contraindicated for ___________, but ___________ may be used if uncontrolled
elevated ICP, barbituates
This med can only be administered with NS and has side effects of ataxia, diplopia, hirsuitism, and gum hypertrophy
Phenytoin
medication of choice for status epilepticus
Ativan
autonomic dysreflexia
Life threatening syndrome of sudden, severe hypertension in response to noxious stimuli below cord damage such as bowel/bladder distension, pressure ulcers or points, and pain or spasms
multiple sclerosis
Chronic, progressive disease of the CNS, characterized by small patches of demyelination in the brain and spinal cord
Parkinson’s Manifestations include
bradykinesia, rigidity, resting tremor, expressionless fixed gaze, drooling, slurred speech, constipation
myasthenia gravis
Disorder affecting neuromuscular transmission of voluntary muscle causing extreme muscular weakness, increased by fatigue
Guillain-Barre Syndrome
Ascending, reversible paralysis cause by acute inflammatory disease of peripheral nerves
presbycusis
progressive disorder associated with aging in which the patient loses the ability to hear sounds at high frequencies
presbyopia
farsightedness associated with aging
Meniere’s Disease
Disorder of the inner ear that causes vertigo, tinnitus, hearing loss, and pressure in the ear due to increased fluid
Risk for _________ is an area for concern with patients with Meniere’s disease
Falls
It is important to take precautions against increasing _______ after a cataract surgery - severe pain should be reported immediately
ICP
Patients with glaucoma should avoid all ______________ medications
anticholinergic
Infant birth weight doubles by ____ months and triples by ____ months
6, 12
The posterior fontanel closes by ___ months
2
The anterior fontanel closes by __-___ months
18-Dec
Age of child in months minus 6 equals number of ______
teeth
Solids can be introduced into an infants diet around __-___ months
6-Apr
Infant can sit alone by __ months
7,8
Infant can pull self to feet by ___ months
9
Use a semi-reclining infant car seat that faces rear until ___ lbs
20
Forward facing seats for children weighing __-___ lbs
40-80
Sensorimotor Cognitive stage
12-14 months - objects are cause of action; separation anxiety
Preoperational Cognitive stage
2-7 years - egocentric in though and behavior; concrete, tangible thinking; vivid imagination (magical thinking, peak age for fears)
Play of the toddler
parallel
Play of the Preschooler
cooperative
Concrete Cognitive stage
7-11 years - classifies and sorts; enjoys collecting; concrete logic and problem solving; less egocentric; inductive thinking
formal operations Cognitive stage
11+ years - abstract thinking; ability to hypothesize
Ortalani’s sign
Audible click that can be heard with congenital hip dysplasia as the examiner slips the femoral head forward
_________ is used during an acute asthma attack, ________ is used daily for chronic asthma
albuterol, salmeterol
Overdose of ________ can cause tinnitus, hyperpyrexia, seizures, bleeding, and hyperventilation
aspirin
Overdose of _______ can cause liver necrosis in 2-5 days, N/V, Right upper gastric pain; coagulation abnormalities
tylenol
Consumption of _________- can cause developmental regression, impaired growth
lead
chelation therapy
Treatment for lead poisoning (or other heavy metals)
Activated charcoal and gastric lavage are treatment for ______________ and _______________ - do NOT induce emesis
hydrocarbons, corrosives
rheumatic fever
Inflammatory disease affecting the heart, joints, and CNS 2-6 weeks after a upper respiratory strep infection
Wilm’s tumor
renal cancer usually in children around age 3 - Do NOT palpate abdomen
nephrotic syndrome
renal disorder in very young children with increased permeability of the glomerular membrane to protein
