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Random Things to Remember Flashcards

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1
Q

Do you expect drooling with parkinson’s?

A

yes

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2
Q

Clonidine patches, can you just rip it off?

A

No- can cause withdrawal, rebound HTN. takes a long time for the medication patch to work

used to treat hypertension (mainly), also anxiety and ADHD by allowing blood vessels to relax

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3
Q

myasthenia gravis starts at the

A

head and goes down body– dysfunction

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4
Q

self catheterization is a ____ procedure

A

clean procedure. do not re-use single use catheters

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5
Q

nursing care immediate postpartum

A

First hour: Q15min checks
Second hour: Q30min checks
Third-fourth hours: Q1hr checks

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6
Q

lochia: definition & types & timing

A

lochia= endometrial sloughing
day 1-3: rubra- bloody with fleshy odor, may have clots
day 4-9: serosa- pink/brown with fleshy odor
day 10+: alba- yellow/white

*foul odor= abnormal and indicates infection!

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7
Q

4 Nursing assessments immediate postpartum

A
  1. lochia: color, volume, clots
  2. vital signs: BP, HR, RR
  3. fundus: position, firmness
  4. bladder: UO, may have urethral edema, urine retention
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8
Q

fundal positions

A

first 12 hours after birth: at or 1cm/finger breadth above the umbilicus

descend by one finger breadth each succeeding day

becomes pelvic organ again by day 10

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9
Q

Postpartum breast care for non-breast feeding mother

A

non-breast feeding mother: revolves around engorgement (swelling d/t milk, occurs 72-96 hours postpartum)

considerations:

  • non-opioid analgesics
  • tight fitting bra
  • home remedies can be used
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10
Q

postpartum breast care for breast feeding mother

A
  • avoid using soap on nipples to avoid drying out
  • use breast shields for inverted or sore nipples
  • wear well-fitting, non-binding bra for support/comfort
  • use breast pads for leakage
  • to prevent let down: press on nipples
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11
Q

5 Fetal Complications

A
  1. meconium stained amniotic fluid
  2. intrauterine growth restriction (IUGR)
  3. Neural Tube Defects
  4. Myelomeningocele
  5. TORCH infections
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12
Q

Meconium stained amniotic fluid

A
  • greenish colored amniotic fluid
  • when fetus becomes hypoxic, intestinal peristalsis increases and anal sphincter relaxes allowing meconium to be released into amniotic fluid
  • normal in breech deliveries
  • indicates problems with fetus
  • depending on when it is noted during pregnancy, severity of problems and types vary
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13
Q

intrauterine growth restriction

A
  • condition of inadequate fetal growth

- causes: various complications of pregnancy such as gestational HTN or poor nutrition

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14
Q

neural tube defects

A
  • defect in spinal cord ranging from anencephaly (underdeveloped brain and incomplete skull) to spina bifida (spinal cord fails to develop or close properly)
  • includes: spina bifida occulta, meningocele (protrusion of meninges through gap in spine d/t congenital defect, fluid sac, more minor complications), myelomeningocele (type of spina bifida, most severe)
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15
Q

myelomeningiocele

A
  • may be open or closed
  • indications: bulging, sac-like lesion at lumbosacral spine filled with spinal fluid, meninges, portion of spinal cord + nerves; hydrocephalus, paralysis of lower extremities, musculoskeletal deformities (club feet, kyphosis, scoliosis), neurogenic bladder and bowel

-interventions: prevent infection, assess neurological involvement, surgical repair 12-72 hours after birth, shunt for hydrocephalus or ABX may need attention prior to surgery.

nursing care: prevent local infection and trauma (careful handling), sterile moist dressings to sac, observe for CSF leaks, irritation, signs of infection, perineal care and other good skin care, maintain: warmth, nutrition, hydration, electrolyte balance; gentle ROM to ankles, knees and feet, involve parents, teach how to stimulate child at age-appropriate level and observe for complications

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16
Q

TORCH infections

A
  • group of maternal systemic infections that can cross the placenta or by ascending infection after rupture of membranes
  • infection early in pregancy may produce significant and devastating fetal deformities
  • later infection: overwhelming active systemic disease, CNS involvement causing severe neurological impairment or death of newborn

Infection types:

  • toxoplamosis
  • other: HIV, AIDS, HBV, HAV, human parovirus (spread via respiratory secretions), varicella zoster (chickenpox or shingles), gonorrhea, coxsackievirus
  • rubella
  • cytomegalovirus (CMV)
  • herpes simplex
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17
Q

vasectomy education

A

sterility not complete until proximal vas deferens is free of sperm (approximately 3 months). another method of birth control must be used until two sperm-free specimens are performed

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18
Q

Tracheosotmy- cuffed vs. fenestrated

A

surgical incision and tube inserted into trachea

Cuffed: balloon encircles trachea to form seal between outer cannula and trachea, used to permit mechanical ventilation and protect lower airways, should not exceed 20cm of water
-should be inflated: during and after eating, 1 hour after tube feedings, when client is unable to handle oral secretions, during mechanical ventilation and respiratory treatments

Fenestrated: tube with hole/window in bend of tube, permits air to flow around and through tube to upper aiway, permits talking, tube is plugged to wean client from tracheostomy tube
-tube can be removed if: spontaneous ventilation is adequate, pharyngeal and laryngeal gag reflexes are active, client can: swallow, move jaw, clench teeth; voluntary cough is effective in removing secretions without suctioning, care should be performed Q8hrs and PRN

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19
Q

tracheostomy suctioning nursing considerations

A
  • hyperoxygenate or deep breathe client
  • suction sube: insert suction catheter length of tracheostomy tube without suction, apply suction for 10 seconds, remove suction catheter, oxygenate client between suction passes, observe for signs of distress such as decrease in HR, document
  • indications for suctioning: noisy respirations, restlessness, increase HR and RR, presence of mucus in airway
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20
Q

tracheostomy cleaning nursing considerations

A

-remove old dressings, open sterile kit, put on sterile gloves, remove inner cannula, clean with hydrogen peroxide, rinse with sterile water and dry, reinsert into outer cannula, clean stoma with hydrogen peroxide then sterile water and dry, change ties as needed, apply new sterile dressing without cutting gauze pads

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21
Q

Types of fetal monitoring

A

electric external: monitors fetal HR to identify fetal distress and monitor uterine contractions

  • uses: external electronic techniques, ultrasound, tocodynamometer
  • tocodynamometer: used for estimating foce of uterine contractions, place over fundus (active contracting portion of uterus)

electronic internal:

  1. internal spinal electrode: electrode placed in presenting part, allows for continuous fetal data, requirements: amniotic membranes must be ruptured, cervix must be dilated at least 2cm, presenting part must be against cervix
  2. intrauterine pressure catheter: average pressure during contraction 50-85mmHg, monitors contractions- frequency, durations, intensity of contractions
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22
Q

Fetal heart rate: 6 types of changes observed

VEAL CHOP

A

VEAL CHOP

variable decelerations- cord compression
early decelerations- head compression
accelerations- okay
late decelerations- placental insufficiency

decreased variability
bradycardia

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23
Q

Fetal Heart Rate: Accelerations

A

increase in HR above baseline by 15 or more beats for 15 or more seconds for 2 minutes or less with return to baseline

indicates fetal well-being

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24
Q

Fetal Heart Rate: Early Decelerations

A
  • normal, benign, gradual decrease of fetal HR before uterine contraction peak with return to baseline by contraction end
  • caused by fetal head compression
  • nursing care: CTM
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25
Q

Fetal Heart Rate: Late Decelerations

A
  • begin after a contraction has been established (usually at or after peak of contraction)
  • continues after contraction is over, with a gradual return to baseline
    cause: uteroplacental insufficiency, supine hypotensive syndrome
  • fetal hypoxia and acidosis usually result

treatment: position client on LEFT side, give client oxygen, notify provider

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26
Q

Fetal Heart Rate: Variable Decelerations

A
  • transient UV-shaped reductions occurring at any time during the uterine contracting phase, decrease usually more than 15 bpm lasting 15 seconds, returns to baseline in less than 2 minutes from onset, indicates cord compression, may be relieved by client position change, ominous if: repetitive, prolonged, severe, slow return to baseline
  • treatment: administer oxygen, discontinue oxytocin
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27
Q

Fetal Heart Rate: Decreased Variability

A

variability in amplitude

  • classified: absent, minimal, moderate, marked variability
  • decreases caused by: fetal distress, fetal sleep, oxygen deprivation
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28
Q

Fetal Heart Rate: Bradycardia

A

heart rate less than 110-120 bpm
cause: fetal asphyxia, maternal hypotension, prolonged umbilical cord compression, fetal dysrhythmia
if accompanied by loss of variability, is considered ominous (=very bad)

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29
Q

Ileostomy nursing care & what foods to avoid & what not to take

A

surgical passage into end of ileum, remainder of large intestines removed. drainage is liquid stool containing proteolytic enzymes and bile salts, bad with pectin-based skin barrier must be worn at all times.

nursing care: empty pouch when 1/3 full, change pouch every 3-7 days during inactive period (before meals, bedtime), check skin for irritation, high-fiber and high-cellulose foods may cause diarrhea: popcorn, peanuts, coconut, Chinese vegetables, shrimp, rice, bran, corn, peas

do not take: enteric-coated medications, laxatives, enemas

report increase/decrease drainage to provider

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30
Q

thyroidectomy- complications & nursing care

A

excision of thyroid gland
complications: hemorrhage, respiratory distress, tetany d/t parathyroid injury, damage to laryngeal nerves

nursing care: check VS Q15min until stable then Q30min, check pain level, humidified air, cough/deep breathe Q30min-1hr, suction PRN, check dressing Q1hr then every 4 hours, monitor respirs, semi-fowlers, ice, speak Q2hours to check for change in tone or hoarseness, check for Chvostek and Trousseau signs (indicate tetany or decreased calcium), N/T extremities, keep at bedside: suction equipment, tracheostomy set, oxygen, suture removal kit, IV calcium

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31
Q

Increased ICP

A

causes: bleeding, tumors, edema

indications in adults: change in LOC, restlessness and confusion, pupil changes, motor changes, cardiac rate changes, HA, N/V, diploida (double vision)

indications in infants: tense, bulging fontanelle, separated cranial sutures, irritability, high-pitched cry, poor feeding

indications in children: HA, nausea, forceful vomiting, irritability and restlessness, drowsiness and lethargy

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32
Q

late signs of increased ICP

A

bradycardia, decreased response to commands, alterations in pupil size and reactivity, decorticate posturing, decerebrate posturing

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33
Q

increased ICP medications

A

osmotic diuretics, steroids, antiHTN, anticonvulsants, hyperventilation, surgery for decompression or shunt

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34
Q

Jewish (Kosher) Dietary Restrictions

A

-no meat or poultry at same meal as dairy, no using same utensils for meat and dairy, no pork products, no scavenger fish or fish with fins or scales, forequarters of other meats and poultry allowed

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35
Q

Varicella Zoster (Chickenpox) incubation period + nursing considerations

A

incubation period: 13-17 days

nursing considerations: isolation until vesicles crusted, communicable from 2 days before appearance of rash, avoid use of aspirin because of association with Reye syndrome, use acetaminophen, topical application of calamine lotion or baking soda baths

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36
Q

adequate fluid intake

A

1500-2000mL/day

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37
Q

dietary restrictions with gout

A

avoid meats rich in purines: organ meats, sardines, fish

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38
Q

opiate overdose- ____ pupils

A

constricted (pinpoint) pupils

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39
Q

cocaine overdose- ___pupils

A

dilated pupils

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40
Q

heroin overdose causes

A

respiratory depression, hyperpyrexia (very high fever), motor seizures, pinpoint pupils, etc.

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41
Q

renal arteriogram

A

injection of radiopaque contrast medium dye, uses femoral artery, allows visualization of renal arteries

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42
Q

infiltration

A

needles moves out of vein and fluid leaks into adjoining tissues

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43
Q

extravasation

A

when certain medications leak into adjoining tissue, reported to provider immediately

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44
Q

phlebitis

A

d/t presence of IV in susceptible clients, reported to provider immediately

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45
Q

air embolism

A

indications: CP, dyspnea, anxiety, tachycardia
prevention: place client supine when changing tubing, client perform Vasalva maneuver

if RN suspects air embolism: clamp catheter, place in left lateral trendelenberg position, notify provider, start oxygen therapy

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46
Q

Post-op care: VS checks

A

VS Q15 mins x4, Q30min x 2, Q1hr x2, then every hour or as needed

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47
Q

play therapy

A

children express themselves more easily in play than in verbal communication

choice in colors, toys, and interaction with toys is revealing as reflection of child’s situation in the family

nursing considerations: provide materials and toys, observe play, help child resolve problems through play

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48
Q

cast care

A

immediate cast care:
-avoid covering cast until dry, handle with palms, not fingertips (plantar cast), avoid resting cast on hard surfaces or sharp edges, keep affected limb elevated above heart on soft surface until dry, observe for blueness or paleness, pain, numbness on affected area

intermediate cast care:
-encourage client to perform prescribed exercises, report any break in cast or foul odor, inform client not to scratch skin underneath cast, avoid putting anything underneath cast

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49
Q

Schizophrenia, Schizoaffective d/o, catatonic schizophrenia

A

schizophrenia indications: inappropriate or no display of feelings, hypochondriasis and depersonalization, hallucinations, delusions, short attention span, regression, inability to meet survival needs

schizoaffective d/o:
observable bodily expression of emotions of a person. commonly used terms: flat, blunted, inappropriate, labile

catatonic schizophrenia:
pronounced decrease in amount of movement (hours)

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50
Q

Normal newborn BP

A

60-80/40-50

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51
Q

normal BP child 1-4 years

A

90-99/60-65

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52
Q

normal BP child 5-12 years

A

100-110/56-60

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53
Q

normal adult BP

A

less than 120/less than 80

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54
Q

adult hypertension guidelines

A

elevated: 120-129/less than 80
HTN stage 1: 130-139/80-89
HTN stage 2: 140+/90+

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55
Q

CNS Stimulants (ADHD/Narcolepsy)

A

AE: insomnia, restlessness, palpitations, weight loss

amphetamine: used for narcolepsy, AE- hyperactivoty, dry mouth
dextroamphetamine: used for narcolepsy, short-term adjunt to exogenous obesity. AE: dry mouth, impotence. high abuse potential, dependence
methyphenidate: AE: tachycardia, growth suppression. Monitor: CBC, platelet count, BP

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56
Q

mood stabilizers

A

lithium and divalproex

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57
Q

lithium

A

mood stabilizer

AE: dizziness, hand tremors, impaired vision

normal ranges:
initial 1-1.5mEq/L or mmol/L
maintenance 0.8-1.2
toxicity: above 1.5

nursing considerations: monitor blood levels 2-3x/week when started, monthly when on maintenance

fluid intake of 2500-3000mL/day, adequate salt intake

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58
Q

divalproex

A

mood stabilizer for bipoloar, and antiseizure medication
rapid onset, safe
dosage: 750 (starting)-2500mg/day

AE: thrombocytopenia, pancreatitis, liver failure, GI upsets, weight gain

**teratogen- don’t take during pregnancy

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59
Q

dumping syndrome

A

rapid passage of food through stomach

indications: diaphoresis, diarrhea, hypotension
treatment: restrict fluids with meals, avoid stress after eating, lie down, eat smaller frequent meals, low carbohydrate and fiber diet

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60
Q

digoxin

A

cardiac glycoside
decreases HR, increases force of contraction

AE: bradycardia, anorexia, N/V, fatigue, dysrhythmias, diaphoresis

Nursing considerations:
know baseline VS, check for signs of toxicity especially fi taking furosemide concurrently: anorexia, N/V/D, confusion, visual disturbances, furosemide may cause hypokalemia, take apical pulse for 1 full minute noting rate and rhythm and quality, withhold medication and notify provider if rate below 60 bpm, observe K+ levels

therapeutic levels: 0.5-2.6 ng/mL (nmol/L)

Infants/children: therapeutic serum level 0.8-2 ng/mL, hold if apical pulse below 90 to 110 bpm in infants/young kids, 70 bpm in older kids.

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61
Q

ACE inhibitors

A

block conversion of ang I to ang II
dilates arteries and veins
decreases preload, afterload, cardiac workload

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62
Q

Addison’s disease is the deficiency of what hormones

A

adrenocortical

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63
Q

Addison’s disease info

A

causes: surgical removal of adrenal cortex, idiopathic destruction or by infections, inadequate pituitary ACTH
- sudden stopping of exogenous adrenocortical hormone therapy may cause secondary adrenal insufficiency
indications: weakness, hypoglycemia, hyponatremia, hyperkalemia, dehydration, hypotension, anorexia, GI symptoms, emaciation, DARK PIGMENTATION OF SKIN
treatment: hormone replacement

nursing responsibilities: monitor I&O balance of fluid and electrolytes, VS, WEIGHT

education: diet, medications, activity level

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64
Q

addisonian crisis (Adrenal Crisis)

A
  • acute adrenocortical insufficiency precipitated by stress, surgery, trauma, and infection
  • indications: hypotension, cyanosis, fever, classic shock symptoms, HA, ABD pain, N/V/D, confusion

nursing responsibilities: same as addison’s disease- monitor fluid and lytes, VS, weight, BP, educate about diet, medications, activity level

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65
Q

inflammatory bowel disease indications and recommended diet

A

indications: ABD pain, diarrhea, fluid imbalance, weight loss
diet: high protein, high calorie, low fat, low fiber

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66
Q

diarrhea is less severe in ____ than in ulcerative colitis

A

Chron’s disease

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67
Q

encouraging a laboring mom to pant-blow minimizes…

A

the urge to push

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68
Q

infant stools: meconium to transitional to formed

A

meconium- black and tarry, passed in 12-24 hours

transitional stools- thin, green-brown, part meconium and part fecal, day 2-3

formed- 1-2 pale yellow to light brown stools per day with formula feeding. loose golden yellow stools with sour milk odor with every breast feeding

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69
Q

fontanel closing times

A

anterior fontanel: closes by 18 months

posterior fontanel: closes by 8-12 weeks

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70
Q

babinski reflex

A

stroke sole of foot from heel upward across ball of foot causing toes to fan

reverts to usual adult response by 12 months

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71
Q

moro reflex

A

elicited by sudden disturbance in infant’s immediate environment
body stiffens, arms in tense extension followed by embrace gesture with thumb and index finger in a C formation
disappears after 3-4 months

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72
Q

rooting and sucking reflex

A

turns toward object touching/stroking cheek/mouth
opens mouth and sucks rhythmically when finger/nipple is inserted into mouth
usually disappears by 4-7 months

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73
Q

stepping reflex

A

makes stepping movements when held with toes touching a surface

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74
Q

tonic neck

A

when lying on back with head turned to one side, arm and leg outstretched to that side
disappears at 3-4 months

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75
Q

palmar and plantar grasp relfex

A

hand and toes grasp object placed in hand or at toes
palmar disappears at 3 months
plantar disappears at 8 months

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76
Q

truncal incurvation relex

A

body curves toward side of trunk stroked

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77
Q

extrusion

A

disappears at 4 months allowing for spoon feeding

*abnormal responses may indicate neurological damage

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78
Q

amputation complications and nursing responsibilities

A

complications: phantom limb pain, infection, hip contracture

nursing responsibilities:

  • prevent hip contracture by doing ROM, place client prone for 20-30min every 3-4 hours
  • don’t elevate residual limb on a pillow after the immediate postoperative period
  • inspect wound for inflammation after pressure dressing and drains are removed
  • change dressing DAILY until sutures are removed
  • wrap residual limb with an elastic bandage to shape the residual limb and keep the dressing in place
  • watch for signs of inadequate tissue perfusion
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79
Q

Adult Immunizations: Influenza

A

given yearly, preferably october to may
recommended for all people age 6months and older

contraindicated:
- previous anaphylactic reaction to vaccine or eggs
- had previous guillain-barre syndrome
- currently have a moderate or severe illness

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80
Q

Adult Immunizations: tetanus-diphtheria (TD) or tetanus-diphtheria-acellular pertussis (TDaP)

A

-tetanus and diphtheria toxoid (Td) administered to persons 7 years and older
-provides protection for 10 years
-tetanus toxoid- booster dose given in case of dirty wound
one TDaP and then TD every 10 years

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81
Q

Adult Immunizations: Chickenpox (Varicella)

A

2 doses if not had as a child

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82
Q

Adult Immunizations: Human papillomavirus (HPV)

A

3 doses before age 26

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83
Q

Adult Immunizations: shingles (herpes zoster)

A

shingrix
age 50 and older
2 doses 2-6 months apart

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84
Q

Adult Immunizations: measles, mumps and rubella (MMR)

A

2-3 doses before age 55

AE: fever, allergic rxn, arthritis, arthralgia, encephalitis, burning, stinging pain at injection site

nursing considerations: administer SQ, do NOT receive if pregnant or immunosuppressed, may receive as separate injections if unusual reaction occurs

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85
Q

Adult Immunizations: Pneumococcal

A

administered to immunize against streptococcus pneumoniae

first vaccination recommended:

  • clients under 65 years if: chronic lung disease, cardiovascular disease, DM, spleen disorders, immunocompromised status
  • residents of nursing homes
  • clients 65+
  • cigarette smokers

re-vaccination recommended:

  • clients over 65 if vaccinated more than 5 years previously
  • less than 65 with initial vaccination
  • clients 19-64 if: chronic kidney problems, immunocompromised
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86
Q

Adult Immunizations: meningococcal

A

1 dose depending on lifestyle

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87
Q

Adult Immunizations: HAV

A

2 doses depending on lifestyle

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88
Q

Adult Immunizations: HBV

A

indicated for: adults at risk for exposure to blood or blood-containing body fluids, hemodialysis clients, household contacts, sex partners of HBV clients, international travelers, injecting drug users, gay men, sluts, STDs, all unvaccinated adolescents

given in 3 doses, with second dose 1-2 months after the first dose, and third dose 4-6 months after the first dose

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89
Q

Adult Immunizations: polio

A
  • adults traveling to certain parts of the world
  • laboratory workers who might handle polio virus
  • healthcare workers who treat polio clients
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90
Q

post prostatectomy care and education

A

bladder irrigation, high oral fluid intake 2-3 liters, frequent ambulation, stool softners, catheter care, avoid caffeine, kegal exercises to prevent dribbling or incontinency, avoid long periods of sitting or strenuous activities for several weeks.

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91
Q

preparation for procedures with children- different fears with various age groups

A

toddlers: fear of separation, strangers, changes in environment. teach parents to expect regression
preschooler: fears mutilation, allow child to play with equipment, encourage expression of feelings (anger)

school-age: fears loss of control, explain procedure in simple terms, allow choices when possible

adolescent: fears loss of independence, being different from peers, alterations in body image. explain procedure, involve in therapies, expect resistance, express understanding of concerns, point out strengths.

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92
Q

alzheimers disease results in

A

cerebral atrophy, decline in intellectual/cognitive functioning, motor and sensory functioning, affect

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93
Q

alcoholism nursing considerations

A

monitor VS frequently, allow to “sleep it off”, protect airway from aspiration, assess: need for IV glucose, injuries, signs of withdrawal, chronic alcohol dependence

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94
Q

alcoholism withdrawal indications

A

occurs 4-6 hours after last drink

tremors, agitation, anxiety, insomnia, mild tachycardia, HTN

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95
Q

alcoholism delirium tremens

A

indications: tremors, anxiety, panic, disorientation, hallucination, vomiting, tonic-clonic seizures (first 48 hours after withdrawal)

alcoholic hallucinations: occur 48 hours after last drink
indications: auditory, visual, tactile (in absence of other psychotic behavior)

nursing responsibilities: sedation PRN, monitor VS, seizure precautions, quiet and well-lighted environment, alcohol provides calories but no nutriton

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96
Q

Blood administration + transfusion reactions

A

19 gauge needle and standard blood filter

start infusion slowly during first 15 minutes and stay with client, check for reactions

infuse over 2-4 hours

transfusion reaction: usually in first 15 minutes. stop the blood, restart saline, notify provider, provide supportive care

types of reactions:

  • allergic (hypersensitivity to donor antibodies): uticaria, pruritis, fever, anaphylactic shock
  • hemolytic (imcompatibility): N/V, lower back pain, hypotension, hematuria
  • febrile (antibodies to donor platelets or leukocytes): fever, chills, nausea, HA, flushing, tachycardia
  • bacterial (contaminated blood products): tachycardia, hypotension, fever, chills, shock

*also watch for circulatory overload: cough, dyspnea, pulmonary congestion, tachycardia, HA, sudden anxiety, HTN, JVD

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97
Q

adverse effect of multiple FFP transfusions

A

hypocalcemia

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98
Q

newborn cord care

A

clean and dry, open to air until falls off (7-14 days after delivery), no tub baths until healed, stump requires care 3-5 days after cord falls off

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99
Q

newborn hearing assessment

A

newborn should respond to loud noise by the moro reflex

2-3 mo: should turn head side to side when sound is made at that level of ear
3-4mo: able to locate sound by turning head and looking in that direction
6-8mo: responds to own name
1 year: knows several words and their meanings

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100
Q

black cohosh

A

commonly used to treat menstrual and menopausal symptoms

considerations: women at risk for breast cancer should avoid

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101
Q

garlic

A

actions: anti-microbial, lipidemic, thrombotic, tumor, inflammatory
uses: reduction cholesterol and HTN, prevention atherosclerosis, cancer, stroke, MI, prevention and tx of colds and flu

AE: flatulence, heartburn, halitosis, irritation of mouth, esophagus and stomach, allergic rxn.

considerations: don’t administer with GERD/PUD, cautious with antiplatelet/coag patients (increase bleeding), caution with anti-DM medictions (cause hypoglycemia), caution with HTN/HLD meds, cyclosporines or hormonal contraceptives, don’t administer to clients with lily family allergy

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102
Q

ginger

A

uses: N/V, indigestion, gas, anorexia
AE: minor heartburn, dermatitis
considerations: contraindicated with gallstones, potentiate action of antiplatelet and anticoag meds and increase bleeding, hypoglycemia with antiDM meds

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103
Q

ginkgo biloba

A

enhances cerebral and peripheral blood circulation, antidepressant

uses: dementia, STML, vertigo, PVD, depression, sexual dysfuntion

AE: GA, GI upset, contact dermatitis, dizziness

considerations: potentiate meds that prevent clotting and MAO inhibitors, decrease anticonvulsant effectiveness, interfere with DM management (close glucose monitoring and change pharm dependence)

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104
Q

licorice

A

made from glycyrrhiza glabra root, dried

large amounts cause: salt retention, potassium excretion, HTN

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105
Q

St. Johns wort

A

antidepressant

action: SSRI, antifundal, viral, inflammatory, bacterial
uses: depression, OCD, skin inflammation, burns, wound/injury

a lot of interactions

AE: HTN, diarrhea, flatulence, serotonin syndrome, hypoglycemia, dizziness, ABD pain, phototoxicity, neuropathy, restlessness, sleep disturbances, dry mouth, allergic skin reaction

nursing responsibilities: monitor depression S&S and suicidal tendencies

client education: take as directed, discuss with provider, use sunscreen and protective clothing, take for 4-6 weeks, if no change, talk to provider

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106
Q

is clumsiness expected during adolescent growth and development?

A

yes

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107
Q

MS patients fatigue early so…

A

they want to get to the point of their statements before they get tired, use images if they can’t use words, eye contact and facing who talking to etc.

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108
Q

gastrostomy tube

A

rotate G tube 360 degrees 1x/day to prevent skin breakdown and don’t want it to get stuck against the skin

check for slight in and out movement- detects if it is not embedded in stomach wall

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109
Q

diabetic ketoacidosis- you want to start ____ first

A

FLUIDS

they are fluid depleted and need to fix their volume status and then insulin (then after insulin causes potassium to shift into the cells from the bloodstream, then replace potassium)

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110
Q

RA can cause

A

anemia

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111
Q

any heat source _____ rate of absorption of medication through skin

A

increases

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112
Q

signs of hemolytic reaction

A

hypotension
low back pain
fever

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113
Q

signs of fluid overload

A

severe SOB

wet breath sounds

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114
Q

urticaria is a sign of a ____ reaction

A

anaphylactic

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115
Q

____ increase risk for dumping syndrome

A

carbohydrates

*avoid them

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116
Q

patients with dumping syndrome should:

A

eat smaller meals for frequently
lie down after eating (decrease GI motility)
avoid drinking fluids meals with meals (1 hour before and after)

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117
Q

Meniere’s disease requires a low ____ diet to prevent vertigo

A

sodium

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118
Q

Meniere’s disease: patients will be prescribed

A

antihistamines
antiemetics
antivertigo
diuretics

119
Q

is it expected to see bubbling in water seal chamber after insertion of chest tube on patient with a pneumothorax?

A

yes however the bubbling should NOT be continuous

120
Q

with a pneumothorax, we expect ___ to exit the lungs, not fluid

A

AIR

121
Q

when a client with a chest tube coughs, fluctuations is expected in the ____ chamber

A

water-sealed chamber

not the suction controlled chamber

122
Q

how many cm of water should be in the water sealed chamber?

A

2cm

123
Q

what position should a client be in for a tracheostomy suctioning

A

semi-fowlers

124
Q

calcium channel blockers and beta blockers are first line treatment for

A

afib

digoxin is not a first line treatment

125
Q

if you observe continuous bubbling in water seal chamber of a chest tube, you should be concerned of an

A

air leak

126
Q

in the beginning of dialysis treatment, clients may experience

A

headaches, nausea, fatigue may occur after hemodialysis d/t disequilibrium syndrome

127
Q

lanolin is contraindicated when breast feeding

A

yes

used for cracked nipples

128
Q

babies can suck on one nipple for _____ minutes at a time

A

15-45 min

129
Q

ventilated patients prevention of VAP, overall care

A

brush teeth Q8
Q2 turns
pantoprazole- prevent GI ulcers

130
Q

normal magnesium levels

A

1.3-2.3 mg/dL

131
Q

normal digoxin levels

A

0.5-2ng/mL

132
Q

croup is an

A

upper airway infection blocking breathing and has a distinctive barking cough

133
Q

unemancipated minors may receive/consent to what types of medical treatment without parental consent?

A

pregnancy, STD, substance abuse, mental health

*need to know why the minor is seeking treatment

134
Q

herpes zoster is

A

shingles

135
Q

can a person who was not vaccinated for chicken pox get infected with chicken pox after exposure to someone with shingles?

A

yes

136
Q

how often to older adult patients need to get their eyes checked?

A

every 1-2 years

137
Q

you need consent by proxy (spouse) if the client is confused

A

yes

138
Q

AIDS client has drenched sheets with perspiration can indicate they have

A

tuberculosis

139
Q

dawn phenomena

A

hyperglycemia in the morning

treat by adjusting: evening diet, bedtime snack, insulin dose* (order 3 additional units of intermediate acting insulin at 2200), and exercise to prevent early morning hyperglycemia

  • do not eliminate evening snack, just adjust it. don’t reduce diet
  • do not order an additional 10 units of short acting insulin at 2000 because it would peak in 1-5 hours which would not prevent the hyperglycemia
140
Q

when a client returns from an abdominal surgery, you first want to assess if they can…

A

lift their head off the pillow

if they can’t, they likely have remaining effects of neuromuscular agents in their system and their ability to deep breath will likely be affected.

assess this before asking the client to cough and deep breathe

141
Q

use ____ to prepare a toddler for surgery

A

puppets/dolls

no books/pictures of surgery. use simple terms of what the child will see, hear, taste, smell and feel. do not use timing

142
Q

how to prepare a school age child for surgery

A

draw a picture of the eye to explain what will happen

read an age-appropriate illustrated book about eye surgery

143
Q

placenta previa is _____ vaginal bleeding

A

painless

no N/V, not related to activity

144
Q

who is most at risk for developing herpes zoster?

  • 19 yr old with tibia fracture
  • 50 yr old with diabetic foot ulcer
  • 62 yr old with transplant rejection
  • 84 yr old with COPD
A

-62 yr old with transplant rejection

the only one who is immunocompromised

145
Q

do not massage Haldol into the injection site because…

A

it is very irritating to the SQ tissue

needs to be administered deep IM in a large muscle mass in a single dose using a 2 inch 21 gauge needle

146
Q

____ exercises are key for RA patients to reduce swelling, increase circulation and diminish stiffness and preserve joint motility

A

ROM exercises (also heat application)

massaging joints will prob cause pain.

147
Q

post cholecystectomy stab site (type of incision) care-

observe saturated dressing with dark green-yellow drainage

A

remove dressing and replace with more absorbent dressing

expected drainage and not indicating infection. it will continue to drain until the wound seals. keep the wound clean and change dressing as needed. dehiscence usually doesn’t occur with this type of wound

148
Q

procainamide is used to treat

A

PVCs or atrial tachycardia

AE: severe hypotension and bradycardia

149
Q

the client is prescribed regular insulin before breakfast. the client is nauseated with a blood glucose of 74. what does the nurse do?

A

administer insulin on time

encourage eating food on breakfast tray. recheck glucose in 30-60min, and it should be monitored anyways every 3-4 hours because hyperglycemia can occur in illness. sip 8-12oz/hour if tolerated to decrease risk of dehydration, or substitute solid foods if liquids aren’t tolerated.

because blood glucose increases during illness, insulin or oral hypo-glycemic agents must be given on time even though the client cannot eat

if the client is given orange juice, it may cause vomiting at this time.

150
Q

infant cannot sit up unsupported and say a few words until

A

8 months

12 months: can say 3-5 words

151
Q

battery is

A

harmful or offensive touching of another person

152
Q

unless court ordered, clients have a right to ____ medication, even if psychotic

A

refuse

153
Q

adverse effects of haldol

A

galactorrhea- excessive or spontaneous flow of milk
lactation
gynecomastia- excessive growth of male mammary glands

154
Q

what intervention prevents infection in partial thickness burns

A

removing clothing and covering client with clean sheet

don’t use any soaps or ointments in an emergency situation

155
Q

intermittent peritoneal dialysis (IPD) expected & unexpected side effects:

A

expected AE: pain during inflow of diasylate, blood-tinged fluid around the intra-abdominal catheter (d/t SQ bleeding) common during the first few exchanges. Also constipation (inactivity, decreased nutrition, medications –> high fiber diet & stool softners to prevent)

unexpected/abnormal AE: cloudy diasylate outflow –> indicated peritonitis. will also see: N/V, anorexia, ABD pain, tenderness and rigidity

*warm diasylate solution with heat pads to reduce pain caused by cold solution

156
Q

when going through with a behavior modification plan, make sure that all team members

A

understand and comply with the plan

157
Q

plebitis

A

reddened area or red steaks at the site and up length of vein

158
Q

strabismus

A

visual axes are not parallel, so the brain receives two images

*child closes one eye to see a poster on the wall

159
Q

refractive error (myopia= near sightedness)

A

able to see objects at close range

child places head close to the table when drawing
child rubs eyes frequently

160
Q

cataracts or peripheral vision problems

A

child is unable to see objects in peripheral vision

161
Q

nystagmus

A

when eye makes uncontrolled, repetitive movements

can result in reduced vision and depth perception, and affect balance and coordination

162
Q

zidovudine is used for

A

HIV

*write out schedule of when to take medicine

163
Q

when obtaining a history on a psych client, you want data addressing a

A

psychosocial approach, including a family system assessment

not just a mental status exam

164
Q

damage to the parathyroid gland after a thyroidectomy could result in

A

tetany

keep calcium gluconate IV set up for administration if needed

165
Q

post thyroidectomy, you need:

A

calcium gluconate IV- treat possible tetany from possible parathyriod damage

for airway: tracheostomy set up, suction equipment

166
Q

_____ levels are the best indicators of long term nutritional status

A

albumin

167
Q

normal albumin levels

A

3.4-5.4 g/dL

168
Q

restraints

we must obtain permission from the ___ for restraints.

if the client is deemed incompetent, permission is obtained from the _______ ________

A

client

legal guardian

169
Q

confusion, cold & clammy skin, elevated pulse, mental confusion, fine hand tremors are signs of

A

hypoglycemia

170
Q

normal blood glucose

A

70-110 mg/dL

171
Q

lethargy, hot & dry skin, rapid & deep respirations are signs of

A

hyperglycemia

*treatment for severe hyerglycemia: IV fluids, IV insulin, then later IV potassium after insulin causes it to decrease (shift into cells from bloodstream)

172
Q

perphenazine is an antipsychotic med used to treat

& AE

A

schizophrenia

extra pyramidal AE: neck stiffness and arched at angle, muscle spasms

*give benztropine= antiparkinsonian agent to counteract the EPS

173
Q

benztropine

A

antiparkinsonian agent to counteract muscle spasms/rigidity

174
Q

promazine & thiothixene

A

older antipsychotic meds to treat schizophrenia

175
Q

after a scleral bucking procedure, what assessment data is important

A

N/V presence

could increase intraocular pressure

176
Q

ewald tube

A

large, orogastric tube designed for rapid lavage

insertion often causes gagging and vomiting, suction equipment must be immediately available to reduce risk of aspiration

177
Q

SDH + cerebral edema S&S initially

A

decreasing LOC (as pressure increases, LOC decreases), ipsilateral pupil dilation (dilation same side as hematoma) , HA (1st Sx)

late sign of high ICP: tonic/clonic seizures

late sign of brainstem damage: decerebrate posturing

178
Q

cesarian vs general surgery medications

A

cesarian- similar sedation + hypnotics, decreased narcotics because it crosses the placental barrier causing neonatal respiratory depression

179
Q

client with history of oliguria, HTN, peripheral edema, BUN=25, K+=4

what foods should the client restrict?

what foods should the client eat?

A

protein

decreasing protein intake can decrease production of urea nitrogen. metabolic wastes cannot be excreted by kidneys

client should eat fats & carbs because they decrease nonprotein nitrogen production. magnesium should also not be restricted.

180
Q

transfusions: order of priority

itching, HA, vomiting, JVD

A
  1. vomiting- acute hemolytic rxn
  2. JVD- fluid overload
  3. itching- allergic rxn
  4. HA- febrile rxn
181
Q

hemolytic transfusion rxn

A

most dangerous

N/V, lower back pain, hematuria

tx: stop blood, obtain urine specimen, maintain blood volume and kidney perfusion

182
Q

JVD- circulatory overload tx with transfusion

A

adjust rate of infusion of blood, place in upright position, oxygen and possibly diuretics

183
Q

itching with transfusion

A

allergic rxn

sx: urticaria, pruritis, fever
tx: stop infusion, give antihistamine, restart transfusion slowly

184
Q

urticaria =

A

hives

185
Q

pruritis=

A

itching

186
Q

transfusion- HA

A

febrile rxn

sx: fever, chills, nausea, HA
tx: stop infusion, administer antipyretics

187
Q

nitroglycerin can cause

A

hypotension

vasodilator

avoid quick changes in position

188
Q

infant hip dysplasia

A

see limited abduction,
folds and creases will be longer and deeper on affected side,
decrease in limb length,
may or may not see internal rotation

189
Q

normal BUN

A

10-20 mg/dL under 60 years old

190
Q

acetaminophen can cause ____ damage

A

liver

191
Q

normal liver enzyme levels

A

AST: 1-36 units/L
ALT: 1-45 units/L

192
Q

normal WBC

A

5,000-10,000/mm^3

193
Q

____ can cause fetal hemorrhage, don’t use during pregnancy

A

aspirin

194
Q

most effective way of deep breathing and coughing to dilate airway and expand lung surface area after abdominal surgery

A

take three deep breaths, hold incision, and then cough

195
Q

famotidine should be given when?

A

before meals or at bedtime to treat gastric/duodenal ulcers

H2 blocker- decreases food-induces acid secretion

196
Q

Right sided HF

A

peripheral edema (fluid accumulation, decreased heart pumping), distended neck veins (fluid overload, HF), anorexia (malaise), polycythemia (increased RBC as compensation for decreased oxygenation

197
Q

acute gout diet restrictions

A

low-purine diet

avoid: red and organ meats, shellfish and oily fish with bones

198
Q

the healthcare provider may begin treatment without written consent if contacting the ______ is not possible

A

next of kin

199
Q

cranial nerve III

A

oculomotor

provides innervation for extraoccular movement

200
Q

cranial nerve V

A

trigeminal

provides sensation to facial muscles

201
Q

cranial nerve VII

A

facial

provides motor activity to the facial muscles

202
Q

cranial nerve XI

A

spinal accessory

provides innervation to the trapezius and sternocleidomastoid muscles

203
Q

normal response 1 month after mastectomy for breast cancer

A

“i have been having difficulty coping with the surgery and cry frequently”

integration into normal life is not normal for this stage

204
Q

cytomegalovirus (CMV) precautions

A

standard precautions
eyewear worn whenever there is risk of slash or splatter

no need for private room

herpes strain

205
Q

glipizide is indicated for

A

type two diabetic tx- produce minimal amounts of insulin, oral medication

stimulates pancreas to release insulin in response to hyperglycemia (wouldn’t work for type 1)

206
Q

hepatitis A precautions

A

contact precautions

requires single patient room

207
Q

nonstress test

A

noninvasive test to evaluate the response of fetal heart rate to the stress of fetal movement

the response will be reflected on the fetal monitor

instruct client to push a button when a fetal movement is felt

208
Q

S&S of neuroleptic malignant syndrome

A

pallor, tachycardia, HTN or hypotension, diaphoresis, fever, convulsions, loss of bladder control, respiratory distress, severe muscle stiffness, tiredness

identify early, notify provider, administer emergency care as needed

209
Q

any suspected child abuse, report it to

A

child protection agency

210
Q

pertinent assessment for a client receiving magnesium sulfate for pre-eclampsia

A

assess respirations and urine output

have calcium gluconate available as an antidote

211
Q

safe oxytocin administration

A

palpate uterus frequently

oxytocin stimulates uterus to contract

prolonged tetanic contraction can lead to a ruptured uterus

212
Q

promethazine

A

H1 blocker

antiemetic

213
Q

ranitidine

A

H2 histamine antagonist

reduces acid production in stomach, prevents stress ulcers

214
Q

morphine sulfate

A

narcotic analgesic
causes CNS and respiratory depression
contraindicated in head injury because it masks signs of increased ICP

215
Q

pediatric lumbar puncture: nurse must appropriately _____ the child

A

restrain

prevent trauma during procedure

216
Q

kussmaul respirations are a sign of

A

hyperglycemia

217
Q

diaphoresis and trembling are signs of ____

A

hypoglycemia

218
Q

regular insulin peaks in

A

1-5 hours

give skim milk

219
Q

fluoxetine HCl

A

energizing antidepressant

as client begins to demonstrate a positive response, the client has increased energy level, and is able to participate more in milieu (social environments)

220
Q

why can you not suddenly withdraw from steroids

A

the client may die of acute adrenal insufficiency

221
Q

priority action for a client with a vasoocclusive crisis

A

provide adequate hydration

oxygen is not priority

222
Q

what pain medication is best for a client with hemophilia A

A

acetaminophen

aspirin, ibuprofen and naproxen (NSAIDs) increase bleeding times by decreasing platelet aggregation
*contraindicated for persons with bleeding disorders

223
Q

Kaposi sarcoma are seen in patients with

A

AIDS

dark lesions on the skin, brown/purple/red patches or nodules

clean with mild soap daily and pat dry. want to eliminate risk for secondary skin infection

224
Q

sucralfate and digoxin

A

sucralfate gets best results on an empty stomach. take one hour before breakfast then digoxin one hour after breakfast

medications should be separated by 2 hours for max absorption. sucralfate forms a barrier on the GI mucosa, preventing absorption of other medications

225
Q

sucralfate treats

A

GI ulcers- forms a covering over them

226
Q

digoxin treats

A

HF and chronic afib

cardiac glycoside

227
Q

4 month infant response to increased ICP

A

high pitched cry (first signs)

posterior fontanelles should be closed by 3 months (wouldn’t see bulging at 4 mo)

228
Q

when does stormy behavior start in kids?

A

age 11

229
Q

school-aged child: parenting

should advise parents to

A

give child responsibilities around the house

allows them to develop feelings of competence and self-esteem through their industry

230
Q

symptoms of hyponatremia

A

HA, apprehension, lethargy, muscle twitching, convulsions, diarrhea, fingerprinting of skin

231
Q

symptoms of hypernatremia

A

sticky mucous membranes, decreased urinary output (oliguria), firm & rubbery tissues, restlessness, weakness, coma, tachycardia, flushed skin, fever

232
Q

heroin withdrawal

A

narcotic withdrawal is very similar to flu sx

runny nose, yawning, fever, muscle and joint pain, diarrhea

233
Q

cocaine withdrawal

A

severe cravings, depression, fatigue, hypersomnia

234
Q

amphetamine withdrawal

A

depression, disturbed sleep, restlessness, disorientation

235
Q

barbiturate withdrawal

A

N/V, tachycardia, coarse tremors, seizures

236
Q

gemfibrozil

A

lipid lowering agent prescribed for high triglyceride levels

AE: ABD pain, cholelithiasis

take 30 minutes before breakfast and dinner

can affect liver function- monitor AST

237
Q

ESR is used to monitor

A

inflammation

normal range 0-20

238
Q

creatinine assesses ______

normal Cr levels

A

kidney function

0.7-1.4 mg/dL

239
Q

myelogram + post interventions

A

diagnostic imaging test using contrast dye and XR/CT to look for problems in the spinal canal

interventions: encourage oral intake to flush out dye, HOB 30-40, monitor vital/neuro signs, bedrest 24 hours

240
Q

MS + labor

A

anticipate giving lower pain medications d/t decreased pain perception

241
Q

trochanter rolls can be used on outer aspect of thigh to

A

hold hip in neutral position and leg in normal alignment. the entire weight of leg cannot be held by props placed below knee

242
Q

sudden decrease in NG output and patient is nauseated, first you

A

aspirate the gastric contents with a syringe to ensure the NG tube is in the right place- the pH of the contents should be 0-4. if the tube is not in the right place, gastric secretions could build up causing nausea.

after confirming its in the right place, then irrigate the tube with NS

243
Q

terbutaline action and maternal/fetal AE

A

tocolytic: anti-contraction medication to delay preterm labor for up to 48 hours

can also be used as a reliever inhaler for asthma management

maternal AE: maternal tachycardia (hold med if tachy), nervousness, tremors, HA, pulmonary edema

fetal AE: tachycardia, hypoglycemia

terbutaline is preferred over ritodrine because it has minimal effects on blood pressure

244
Q

continuous ambulatory peritoneal dialysis (CAPD) encourages a high ___ diet and daily ____ measurements

A

protein

weight (at the same time of day)

245
Q

at what age can a child grasp for a toy out of reach?

A

6 months

246
Q

esophageal speech after a total layrngectomy is when the client

A

swallows air and then eructates (belching from stomach) it while forming words with the mouth

247
Q

how does a client with a tracheostomy speak

A

places a finger over the tracheostomy, forcing air up through the vocal cords

248
Q

most asthma attacks are a result of inhaled ______

A

allergens

avoid allergens!!

249
Q

metronidazole is used for

A

anti-infective

treatment of intestinal amebiasis (parasitic infection), trichomoniasis, inflammatory bowel disease

250
Q

ketoconazole is used for

A

treatment of candidiasis

S&S: mouth pain, difficulty swallowing, white discharge in back of throat

251
Q

trimethoprim-sulfamethoxazole is used to treat

A

Pneumocystis pneumonia (PCP)

S&S: dyspnea, tachypnea, persistent dry cough, fever, fatigue

252
Q

rifampin is used to treat…?

commonly used in a cocktail with isoniazid and ethambutol

A

tuberculosis

S&S: fever, chills, night sweats, weight loss, anorexia

cocktail prevents resistant strains

253
Q

client has a sprained ankle- where should he hold the cane?

A

left hand

advance cane 6-10 inches with body weight on both legs

254
Q

acute phase of rape trauma syndrome- nurse’s initial priority is for the client to

A

begin expressing reactions and feelings about the assault before leaving the ED- gain some acceptance and perspective. Help the client begin dealing with this.

255
Q

what is the duration of warfarin

A

2-5 days

256
Q

lupus (SLE) & pregnancy

A

client should wait two years after diagnosis to conceive

client should be in remission for at least 5 months prior to conceiving

257
Q

fixed and dilated pupil represents

A

neurological emergency

258
Q

tetracycline

A

ABX

take on empty stomach
AE: photosensitivity

259
Q

pregnant client urine test positive for glucose and acetone is a sign of

A

gestational diabetes

hazard of placental insufficiency

260
Q

How to collect a pinworm specimen from child?

A

collect early in the morning with scotch tape touched to the child’s anus

pinworms crawl outside the anus in the early monring to lay their eggs

261
Q

atropine sulfate is used for

A

bradycardia

antidysrhythmic

262
Q

isoproterenol is used for

A

heart blocks, ventricular dysrhythmias

antidysrhythmic

263
Q

verapamil is a

A

antihypertensive

calcium channel blocker

264
Q

lidocaine is used with cardiac patients for

A

frequent PVCs occurring in excess of 6-10 per minute; for coupled PVCs or for a consecutive series of PVCs that may result in VT

265
Q

myxedema

A

slowing of all body functions

severely advanced hypothyroidism

S&S: lethargy, confusion/non-responsiveness, feeling cold, low body temp, swelling of body (especially face, tongue, lower legs), difficulty breathing

266
Q

abruptio placenta is when

A

the placenta prematurely separates from the uterus leading to hemorrhage

fluid volume deficit is the major nursing concern

267
Q

when client is confused, first check their

A

oxygen levels

268
Q

prochlorperazine is an

A

antiemetic

given deep IM in a large muscle mass

can lead to hypotension

269
Q

butorphanol is an

A

opioid analgesic

given deep IM in a large muscle mass

can cause hypotension and respiratory depression

270
Q

Addison’s disease- patients need to be educated on _____ replacement

A

steroid

adrenal insufficiency- low cortisol and aldosterone

271
Q

angioplasty is

A

surgical repair or unblocking of blood vessel, especially coronary artery

272
Q

you should empty a colostomy bag when it is ___ full to prevent leakage

A

1/3

about 6+ times per day

273
Q

HF patients should limit their sodium intake to ___ grams/day

A

2

274
Q

HF patients should avoid what medications at home?

A

NSAIDs

cause sodium and fluid retention

275
Q

if you observe other healthcare workers talking about a patient and violating HIPAA, you

A

contact the manager

don’t need to confront the employees, go up chain of command

276
Q

milieu therapy

A

psych therapy for behavior and personality disorder treatments- good to provide consistent set of activities and responsibilities for each client to allow them to develop healthy social behaviors. recreating a home environment may be detrimental to the client as it could trigger problematic behaviors

277
Q

insulin glulisine peaks at

A

60-90 minutes after SQ injection

short-acting

278
Q

when priming an insulin infusion with NS first, how much fluid should you discard?

A

50mL
insulin sticks to tubing and the initial concentration could have a decreased concentration of insulin. most institutions recommend priming tubing with NS first then switching to an insulin bag

279
Q

when determining the patency of an AV fistula, you should assess:

A

auscultate to detect bruit
palpate pulses distal to site
observe capillary refill to fingers distal to site
check for altered sensation

tenderness- indicates infection

280
Q

positive contraction stress test signifies

A

late decelerations following at least 50% of contractions indicating uteroplacental insufficiency

281
Q

why do you instruct pregnant women to lay on their sides?

A

don’t want to lay on back (supine) because it can cause vena cava syndrome

laying on side promotes good cardiac output by taking weight of the uterus off the vena cava and increases blood return to the heart

282
Q

client presents for r/o CVA (sudden HA and loss of consciousness) what is more important to tell provider: history of a fib or client takes warfarin daily?

A

history of a fib

CVA could be caused by an embolus, and afib accounts fo 17% of all CVAs

hemorrhagic stroke- resulting from warfarin toxicity, tends to have symptoms with more subtle progression

283
Q

polio vaccine- oral vs IM

A

oral- live attenuated
weakened organisms that produce an immune response but not illness. although, people can shed the virus and spread disease to immunosuppressed individuals

IM- inactivated (or killed) poliovirus and causes an immune response but incapable of reproducing and causing infection

284
Q

when a bipolar client is in a manic state, you expect to see

A

agitation, grandiose delusions, euphoria, concentration problems, more extreme levels of behavior

285
Q

sputum collection

A

use suction if client cannot cough effectively

don’t have the client cough into the container because it could contain saliva not sputum. advise to deep breathe then COUGH to provide the sample

offer oral care before to prevent contamination of the sputum with oral microbes

send specimen to lab immediately

obtain specimen in the morning

286
Q

tingling sensation in the face and arm could indicate a

A

stroke

287
Q

headache, fever and neck stiffness could indicate

A

meningitis

288
Q

stages 1, 2, 3 of alcohol withdrawal syndrome (AWS)

A

stage 1 (initial 24 hours): mild tremors begin in first 5-8 hours

stage 2 (1-3 days)- grand mal seizures, hallucinations

stage 3 (3-4 days)- fever, HTN, delirium, drenching sweats, severe tremors

289
Q

firm, painless and moveable adenopathy in cervical area is characteristic of

A

Hodgkin’s lymphoma

290
Q

when can solid foods be introduced to an infant?

A

6 months

291
Q

how long can breastmilk be stored in the freezer?

A

6 months

292
Q

renal failure and HF, what to avoid?

A

salt substitutes (renal, high in potassium and not excreted well)

high chicken and fish- high protein breaks down to urea and nitrogen which is not excreted by compromised kidneys. just have normal protein intake.

only 1-2 L of water intake for HF and RF patients

*encourage increased whole grain pasta and breads- maintain energy requirements and doesn’t compromise kidneys or heart

293
Q

when taking lithium, which lab value do you not want to be low?

A

sodium

low sodium causes the body to compensate by retaining lithium, causing lithium toxicity

NCLEX Preparation (5 decks)

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