QUIZ 1-2 Flashcards
Which situation requires the nurse to complete an incident report?
1.A visitor having symptoms of illness; **
2 accidental omission of prescribed therapies; **
3 **circumstances that lead to injury or a risk for client injury;
4 medication administration errors; **
5 needlestick injuries
6 and client fall
Hypokalemia
Low potassium levels in the body can be **caused by an adrenal gland disorder, **a prolonged bout of diarrhea or vomiting, chronic laxative abuse, diuretics, or a low magnesium level.
Symptoms OF HYPOKALEMIA
weakness,
cramps,
twitching,
and abnormal heart rhythms.
NORMAL POTASSIUM LEVEL
3.5-5.0 mEq/L
CAN WE CRUSH POTASSIUM TABLET?
NO
Should not crush the medication as this releases all the medication at once and can increase the chances of adverse reactions.
CAN WE BREAK THE POTASSIUM PILL INTO HALF?
YES
SMART
* S-specific*
*
* M-measurable,
* A-achievable,
*
* R-relevant,
*
* T-time-bound.
Anaphylaxis
A potentially life-threatening condition that is caused by a hypersensitivity reaction to an antigen.
epinephrine ROUTE
administered by intramuscular (IM)
SIGNS AND SYMPTOMS OF INFECTION?
1. WARMTH
2. REDNESS
3. INFLAMMATION
4. PURULENT OR FOUL-SMELLING
5. DRAINAGE
6. FEVER
Clients with pressure ulcers need specialized care
skin maintenance,
wound management,
adequate nutrition,
pain control,
and pressure relief.
signs and symptoms of an infected pressure injury
1** Fever**
2 Foul-smelling drainage
3 Wound redness
4 Wound warm to touch
5 Edema
3 supplies
that are appropriate for the nurse to administer a pneumonia vaccine to a client
-
3 mL syringe
Since the pneumonia vaccine is 0.5 milliliters, a 3 mL syringe would be appropriate to prepare for its administration.
2.* 2 x 2 alcohol prep pad*
The nurse should obtain a 2 x 2 alcohol prep pad to clean the injection site before administration of the pneumonia vaccine. The alcohol prep pad reduces germs and bacteria in the injection area.
-
23 gauge, 1 ½ inch safety needle
A 23-gauge, 1 ½ inch safety needle is correct for the administration of the pneumonia vaccine to an obese adult client.
Preventative strategies to decrease the risk for pressure injury include
-
DO NOT drag or pull the client up in bed, as this causes shearing to occur;
2 DO NOT massage bony prominences; -
Monitor nutritional status,
including serum albumin levels; 4. Provide prompt care for clients who are incontinent of bowel and/or bladder;
5 Reposition clients every 2 hours using appropriate assistive devices; - use** barrier creams to moisturize, protect, and reduce irritation** of the client’s skin;
7 use foam padding or wedges to decrease pressure on the client’s bony prominences.
. Common risk factors associated with the development of pressure injury include*
- Advanced age;
- Altered levels of consciousness **(LOC); **
-
Comorbidities (e.g., HIV)
; 4.** Immobility; ** - Incontinence; **
6. Infection; ** - Use of medical devices;
- Poor oxygenation and perfusion (e.g., dopamine infusion);
- Poor nutrition (e.g., low serum albumin level);
- Unintentional weight loss.
Albuterol
A short-acting bronchodilator relaxes and expands air passages in the lungs, thus helping the client breathe easier.
Side effects of this medication may include** shakiness, tachycardia, irritation, and headache; therefore, it is vital to monitor the client after the treatment.**
Oxybutynin
very effective for clients with an overactive bladder.
Methylergonovine
rapid and strong uterine and vascular contraction.
It is rarely given IV, however, because of the risk of stroke caused by the sudden vasoconstriction.
How to administer oral medications to an infant.
****a reclining position **
give medication.
2 Use a measuring syringe to administer the medication slowly.
Venlafaxine
serotonin and norepinephrine reuptake inhibitor (SNRI) prescribed for depression. venlafaxine can take 2-4 weeks to decrease symptoms of depression.
Cyclosporine
An immunosuppressant medication that is prescribed to clients after organ transplantation decreases the risk of rejections. As with all immunosuppressants, the medication can result in leukopenia and thrombocytopenia, thus increasing the risk of infection and bleeding.
Methotrexate
is an immunosuppressant medication used to treat rheumatoid arthritis (RA) and psoriasis. As an immunosuppressant, this medication weakens the immune system, thus increasing the client’s risk for infection.
Thready pulse
A fast and thready pulse is a finding that indicates continued dehydration; t
Brisk capillary refill
an assessment finding that indicates resolution of dehydration
Dry mucous membranes
a finding that indicates continued dehydration;
Acetaminophen
Acetaminophen is an OTC analgesic that can be safely administered during pregnancy to address fever, headache, and muscle and joint pain.
Naproxen sodium
Nonsteroidal anti-inflammatory drugs (NSAIDs), including naproxen sodium, increase the risk for spontaneous abortion during the first trimester of pregnancy;
tamsulosin
Tamsulosin is given to relax the smooth muscles involved in urination, promoting the ability to urinate and empty the bladder. The blockage of alpha-adrenergic receptors also contributes to orthostatic .
proper steps during mixing he insulin in the multi use vials
- The nurse should clean the vials, place the amount of air (in units) into the NPH (cloudy) insulin,
2 . then place air into the Regular (clear) insulin. Immediately, without removing the needle, the nurse should pull back the amount of insulin units into the syringe (have another nurse check this)
3, pierce the NPH vial and withdraw the NPH insulin units into the syringe.
4 Another nurse should verify that the NPH insulin dosage is correct by confirming that the total is the sum of the two insulins (Regular insulin units + NPH insulin units = Total in the syringe).
NEWBORN IM INJ GAUGE ?
A 22 gauge needle is appropriate for the administration of IM injection for the newborn client
IM INJ SITES FOR NEWBORN
**The vastus lateralis **
is the muscle of choice for administering IM injections to
newborns and infants.
Tuberculin syringe: Accurate measurement of medication that is** less than 1 mL.**
ibuprofen 800 mg 2 hours prior to surgery.
Ibuprofen, along with other nonsteroidal anti-inflammatory drugs (NSAIDs), are often held for 7 days before surgical procedures to decrease the client’s risk for bleeding; therefore, this prescription requires HCP clarification.
cyclosporine after liver transplantation.
Immunosuppressant medications suppress bone marrow function increasing the risk for leukopenia (i.e., decreased white blood cell [WBC] production) and/or thrombocytopenia (i.e., decreased platelet production). Leukopenia increases the client’s risk for infection while thrombocytopenia increases the client’s risk for bleeding. Additionally, the prescribed cyclosporine can also cause hypercholesterolemia, hyperglycemia, and hypertension; therefore, monitoring the client’s blood pressure and serum cholesterol and glucose levels in the provision of client care.
Psyllium
a bulk-forming agent for constipation.