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1
Q

What are the different areas of heart auscultation and where are they?

A

Aortic- 2nd intercostal space, right star am border
Pulmonary-2nd ICS, left sterna border
Erbs-3rd ICS to left of eternal border
Tricuspid-5th ICS lower left eternal border
Mitral- 5th ICS at mid clavicular line

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2
Q

Regular insulin: onset, peak, duration, color. Can you use for IV?

A 
Onset: 1 hour
Peak: 2 hours
Duration: 5 hours
Color: clear 
Used most for IV
Most used for diabetic ketoacidosis
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3
Q

NPH: onset, peak, duration, color

A

Onset: 2 hours
Peak: 8-10 hours
Duration: 12-18
Color: Cloudy

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4
Q

Aspart/ Lispro: onset, peak, duration. When to give?

A

Onset: 15 mins
Peak: 30 mins
Duration: 3 hours
Give as they begin to EAT..not BEFORE eating, due to quick onset!

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5
Q

Lantis/Glargine: how often do you give?

Onset, peak and duration.

A

Give once a day. It’s so slow acting there isn’t a peak really. Basically no risk of hypoglycemia. Only insulin you can give at bedtime.
Onset: 2 hours
Peak: 3-9 hours
Duration: 24 hours

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6
Q

What organs are in the right upper quadrant?

A

https: //useruploads.socratic.org/T3lSvAloQDanS8xyz4hd_6ad3565c96eaccacfbcdcbb809a9be79.jpg
- liver
- gallbladder
- bile ducts
- transverse colon
- ascending colon

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7
Q

What organs are in the RLQ?

A

Appendix

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8
Q

What organs are in the LUQ

A
  • stomach
  • spleen
  • duodenum
  • pancreas
  • descending colon
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9
Q

What organs are in the LLQ?

A
  • small intestine
  • rectum
  • anus
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10
Q

Preeclampsia definition

A

New onset hypertension and proteinuria or end organ dysfunction after 20 weeks gestation

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11
Q

Preeclampsia: HTN perimeters

A

Systolic BP more than 140 or diastolic more than 90 on 2 occasions..at least 4 hrs apart
Or
Systolic BP more than 160 and diastolic more than 110 confirmed on repeat check

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12
Q

Preeclampsia: proteinuria numbers

A 
More than 300mg of protein in 24 hour urine collection
Or
Protein to creatinine ratio of 0.3
Or
Urine dipstick 1+
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13
Q

Preeclampsia: end-organ dysfunction complications

A

-thrombocytopenia= low platelet count (under 100,000). Normal platelet counts are between 150-400,000.
Or
Renal insufficiency (serum creatinine over 1.1 or doubling creatnine)
Or
Impaired liver function (ALT and AST twice normal range)
Or pulmonary edema

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14
Q

Thrombocytopenia s/s

A
  • easy and excessive bruising
  • petechiae
  • prolonged bleeding from cuts
  • bleeding from nose and gums
  • blood in urine or stool
  • heavy periods
  • fatigue
  • enlarged spleen
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15
Q

Intradermal lnjections: angle, site, gauge and needle length

A

15 degrees
Inner forearm
25-27 gauge
0.6-1.6cm

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16
Q

Subcutaneous injections: angle, site, gauge and needle length

A

45 or 90 degree angle
Abdomen, posterior upper arm, thigh
Needle gauge 25-27
Needle length 1-1.6

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17
Q

Intramuscular injections: angle, location, gauge and length

A

Angle= 90 degrees
Location= deltoid, Vastus lateralis, ventrogluteal
Gauge: 18-25
Length: 2.5-3.8cm

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18
Q

Signs and symptoms of hypoglycemia:

A

Think ‘drunk in shock’
Neuro: HA, blurred vision, dizziness, confusion, slurred speech, sleepiness, lightheaded
Gait: unsteady, staggered, shaking, fainting
Integumentary: diaphoresis, dry and tingling lips
Nausea and vomiting

19
Q

Signs and symptoms of DKA:

A

D=dehydration
K= kussmauls, ketones and elevated K
A= acidosis (metabolic), acetone breathe(fruity) and anorexia

20
Q

Creatinine: values, best indicator of? What level of import (A-D)

A

Value: 0.6-1.2 (same as lithium range)
Level: A
Only potentially important if they are getting dye procedure later

21
Q

INR: value, level of import, used for

A

Value: normal human INR is 0.9-1.2 but for people on Coumadin, want it to be between 2-3.
Level of import; any value above 4 is a C level!!

22
Q

What to do if pt has high INR?

A
  1. Hold Coumadin
  2. Assess for bleeding
  3. Prepare to give Vit K
  4. Call doc
23
Q

Potassium: values, What level of import (A-D). What to do if potassium is low?

A 
Value: 3.5-5
If potassium is low, it’s a level C and you would:
1. Nothing to hold
2. Assess heart
3. Prepare to administer potassium
4. Call doc
24
Q

What to do if potassium is between 5.4 and 5.9 and level severity (A-D)

A

Severity C if between 5.4-5.9

  1. Hold all potassium
  2. Assess heart
  3. Prepare to admin polystyrene sulfonate (kayexelate), D5W and reg insulin
  4. Call doc
25
Q

What to do if potassium is over 6? And severity level.

A

Level D..deadly!
Do everything indicated for potassium between 5.4 and 5.9 but need multiple ppl and needs to be STAT. Cannot leave your pt!

26
Q

Blood pH: range, severity etc

A

pH: 7.35-7.45
Would only be a D if it’s actually 6..
NB- as pH goes down, so does your pt. So check vitals!
If pH is 6..get v/s and call doc, skip everything else!

27
Q

BUN: range, issue level

A

BUN: 8-25

If BUN is elevated, not a big deal, just assess for dehydration

28
Q

Hemoglobin: range, severity, what to do

A

Range: 12-18

  • If hemoglobin is between 8-11, severity level B: assess for anemia, bleeding and malnutrition
  • If hemoglobin is below an 8..it’s a level C (must do something):
    1. Nothing to stop
    2. Assess 4 bleeding
    3. Prepare to admin blood
    4. Call doc
29
Q

Bicarbonate: range, severity

A

Range: 22-26

Level A..no one cares

30
Q

Co2 from arterial blood gas: range, severity, what to do

A

PaCo2 level: 35-45 (same as pH but without the 7.)
Co2 that high (in 50s): level C (will have dyspnea)
1. Nothing to hold
2. Assess resp
3. Pursed lip breathing (prolong exhalation to get rid of CO2)
4. Mostly above will do the trick so don’t need to call doc

If I’m the 60’s: (level D) criteria for respiratory failure.

  1. Nothing to hold
  2. Assess resp
  3. Prepare to intubation and ventilation
  4. Then call resp and then call doc
31
Q

Hematocrit: value, severity, what to do

A

Value: 36-54 (or 3x hemoglobin)
Elevated: level B
Assess for dehydration but not a big deal

32
Q

PaO2: value, severity and what to do

A 
Value: 75-100
If low but still in 70s= C!
1. Nothing to DC
2. Assess respiration’s
3. Give 02
33
Q

What to do is PaO2 is in 60s:

A

Level D! Resp failure

  1. Dc nothing
  2. Give 02
  3. Assess resp
  4. Prepare to ventilate and intimate
  5. Call doc!
34
Q

O2 sats: range, severity level, what to do

A

Range: 93-100
Anything less than 93= C
NB- when you have anemic pt, may look falsely ok on Sa02 but actually not be doing well, need to look at other things.
Contrast dye may also give falsely ok results

35
Q

BNP: value, level, what to do, best indicator of?

A 
Value: 
-less than 100= normal
-more than 400=high
Best indicator of congestive HF
Elevated= B, don’t need to call doc, just watch for CHF
36
Q

Sodium (Na): range, rating, etc

A

Range: 135-145
Mostly level B
If sodium high= assess for dehydration
Is sodium low= assess for fluid vol overload
If question asks about abnormal Na and change in LOC, becomes priority C

37
Q

WBC: different ranges for this, ANC and CD4, severity etc

A 
WBC range: 5000-10000
ANC (absolute neutrophil count)= needs to be more than 500!
CD4= 
*below 200=AIDS
*above 200=HIV 
All issues involving low WBC are a C level 
1. Nothing to Dc
2. Assess for infxn 
3. Place on neutropenia precautions
38
Q

Platelets: value, severity etc

A

trigger value for thrombocytopenia
Range: 150-400
Level C
Thrombocytopenia precautions!

39
Q

Calcium; normal range, issues, s/s of hypocalcemia

A 
Normal range: 9-10.5
S/s of hypo: 
-tachycardia
-htn
-irritable
-jittery
-tremor
-paresthesia (pins and needles) feeling..happens around face too! 
-chevostek sign is twitchy facial muscles
-trousseau sign: corpopedal spasm
40
Q

DKA protocol:

A
  1. IV for dehydration and fluid resuscitation
  2. iv insulin when serum glucose is 250 (can disc when it’s 200 w resolution of acidosis and ketosis)
  3. Blood glucose checks hourly
  4. Potassium admin as client gets better (even if potassium is normal)
41
Q

Normal newborn HR:

A

Between 120-160

42
Q

Normal newborn RR:

A

30-60

43
Q

Red blood cells (normal range)

A

3.6-5 million

44
Q

Magnesium normal range and what it does

A

1.7-2.2

Effects muscle contractility, with heart rhythms and with nerve function

HG NCLEX Review (3 decks)

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