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Kaplan NCLEX Review > Reduction Of Risk > Flashcards

Reduction Of Risk Flashcards

1
Q

Drug of choice for trigeminal neuralgia

A

Carbamazepine along with analgesics

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2
Q

Trigeminal neuralgia affects the ___th cranial nerve, and Bell’s Palsy affects the ___th cranial nerve

A

5; 7

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3
Q

What virus is associated with Bell’s Palsy?

A

HSV (antivirals frequently prescribed for this condition)

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4
Q

Bell’s Palsy nursing consideration

A

Teach client about eye protection, especially when sleeping (d/t inability to close eye)

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5
Q

Benign tumor of the 8th cranial nerve that is typically unilateral

A

Acoustic neuroma

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6
Q

S/S of acoustic neuroma

A
  • Unilateral, progressive sensorineural hearing loss
  • unilateral tinnitus
  • dizziness
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7
Q

Definitive treatment for acoustic neuroma

A

Posterior fossa craniotomy to excise the tumor
NOTE: if tumor >3 cm, there is a chance the client will have permanent hearing loss and experience facial paralysis

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8
Q

S/S of meningitis in infants

A

Bulging fontanels, shrill, high-pitched cry, refuse to food, vomiting and diarrhea

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9
Q

Early sign of increasing intracranial pressure

A

Diminished level of consciousness

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10
Q

The client with bacterial meningitis is at risk for developing

A

SIADH & dilutional hyponatremia

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11
Q

Meningitis prevention

A

Hib vaccination (infants), meningococcal vaccine

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12
Q

Intervention for nonpenetrating abrasion of the eye

A

Instruct patient to patch the affected eye to allow it to heal for 24 hours

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13
Q

Interventions for nonpenetrating contusion/blunt injury to the eye

A

Cold compress for edema and discomfort, prescribe analgesics

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14
Q

Intervention for penetrating eye wound

A

Cover the eye with dry, sterile patch immediately, do NOT attempt to remove penetrating/foreign object

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15
Q

Post-operative complication related to cataract surgery characterized by sudden, intense eye pain

A

Hemorrhage
NOTE: client should experience little to no pain post-operatively. Any pain should be relieved by analgesic

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16
Q

Cataract post-operative patient education

A

Wear night shield, sleep on unaffected side, avoid straining/heavy lifting

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17
Q

Retinal detachment post-op patient education

A
  • Avoid strenuous activity for 3 months
  • avoid work that is close up such as reading, writing, sewing for the first week
  • avoid stooping, straining
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18
Q

What are the 5 danger signs of glaucoma?

A
  1. Brow arching
  2. Halos around lights
  3. Blurring vision
  4. Diminished peripheral vision
  5. Headache or eye pain
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19
Q

Hearing loss characterized by a physical obstruction of sound wave transmission

A

Conductive

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20
Q

Permanent hearing loss resulting from inner ear damage

A

Sensorineural

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21
Q

Instilling ear drops in adults and children

A

Adult: pull ear up and back
Child 3 or younger: pull ear down and back

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22
Q

Three features of Meniere’s Disease

A

Tinnitus, sensorineural hearing loss, and vertigo

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23
Q

Ménière’s disease lifestyle modifications

A

Follow low-sodium diet <2000 mg/day, avoid alcohol, nicotine, and caffeine — These measures prevent endolymphatic fluid accumulation

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24
Q

Medications that can lead to diabetes

A

Corticosteroids, thiazides, phenytoin, and atypical antipsychotics such as clozapine

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25
Q

Normal fasting blood glucose

A

60-110 mg/dL

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26
Q

Normal HbA1c

A

4-6%

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27
Q

Describe the process of the oral glucose tolerance test (GTT)

A
  • client receives 75 g oral glucose loading dose
  • glucose levels assesses at timed intervals: fasting blood glucose should be between 60-100 mg/dL. At the 1 hour mark, glucose should be less than 200 mg/dL. At the 2 hour mark, glucose should be less than 140 mg/dL
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28
Q

Diagnostic criteria for diabetes

A
  • HbA1c >/= 6.5%
  • fasting blood glucose >/= 126 mg/dL
  • 2 hour OGTT >/= 200 mg/dL
  • “classic symptoms” + random plasma glucose > 200 mg/dL
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29
Q

Diabetic sick day rules

A
  • Take insulin as ordered
  • Check blood glucoses q3-4h. If glucose > 240 mg/dL, check for urine ketones
  • Notify HCP if vomiting, diarrhea, or fever
  • Consume liquids every 30 min to 1 hr to prevent further dehydration
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30
Q

How often should diabetics check their glucose throughout the day?

A

If the client takes insulin, instruct them to check their glucose every 2-4 hrs. Check at least 2-3 times per week if managing Type II diabetes with oral hypoglycemics or lifestyle modifications

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31
Q

Hypoglycemia is classified as blood glucose less than ___-___ mg/dL

A

50-60

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32
Q

Intervention for conscious hypoglycemic client

A
  • Administer oral liquids with 10-15 g of glucose (skim milk ideal, 4 oz juice)
  • Hard candies
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33
Q

Interventions for unconscious hypoglycemic client

A
  • administer dextrose 50% IV, 1 mg glucagon IM/SQ
  • follow up with carbohydrates in 15 min
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34
Q

Dietary modifications for gout

A

Low-purine diet avoiding fish, organ meats, beef, pork, lamb, seafood, beer, and breads

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35
Q

What medications should be avoided by the client with gout?

A

Aspirin and diuretics

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36
Q

Diet for renal failure

A

High calorie, low-protein diet with restrictions on fluid, sodium, potassium, and phosphorus

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37
Q

Cystic fibrosis diet

A

High protein, high calorie diet with pancreatic enzyme replacement

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38
Q

Appendicitis nursing considerations

A
  • No heating pads, laxatives, or enemas
  • hold analgesics until diagnosis is confirmed
  • keep client NPO
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39
Q

Diet for cholecystitis/cholelithiasis

A
  • smaller, more frequent meals
  • low fat, high fiber diet
40
Q

Diet for Crohn’s Disease and Ulcerative Colitis

A
  • high protein, high calorie, low fat, low fiber
  • parenteral nutrition my be required for bowel rest during exacerbations
41
Q

Foods to avoid for Crohn’s Disease

A

Cocoa, chocolate, citrus juices, cold or carbonated drinks, nuts, seeds, popcorn, or alcohol

42
Q

Characteristics of duodenal ulcers

A
  • occur in the first 1-2 cm of the duodenum
  • more common in males 30-60 years old
  • pain 2-3 hours after eating and at night; described as burning, cramping, or painful pressure
  • food intake and antacids relieve pan
43
Q

Characteristics of gastric ulcers

A
  • can occur anywhere within the stomach, but predominantly seen in the antrum
  • common in both males and females 50 years and older
  • pain 30 min to 1 hr after meals
  • pain worsens with ingestion of food
  • hematemesis
44
Q

GI ulcer dietary modifications

A
  • eat 3 meals/day
  • avoid coffee, alcohol, caffeine, milk/cream
  • avoid foods at extreme temps (either really hot or cold)
45
Q

Antacids should be administered _________ before/after meals

A

1 hour

46
Q

When should H2 Blockers be administered?

A

With meals

47
Q

When should anticholinergics be administered?

A

30 min before meals

48
Q

When should cytoprotective agents (sucralfate) be administered?

A

1 hour before meals

49
Q

When should PPIs be administered?

A

At bedtime

50
Q

Diet for dumping syndrome

A

Low carb, low fiber

51
Q

What electrolyte imbalance is the client with an intestinal obstruction located higher in the GI tract likely to experience? Lower in the GI tract?

A

Metabolic alkalosis; metabolic acidosis

52
Q

Tracheoesopageal fistula and esophageal atresia post-op nursing consideration

A

Provide infants with nonnutritive sucking (pacifier) to prevent feeding aversion and difficulty with PO feeding

53
Q

Assessment of Hirschsprung Disease

A
  • failure of newborn to pass meconium within 48 hours
  • poor feeding
  • foul smelling, ribbon-like stools
  • visible peristalsis
54
Q

Hallmark symptoms of pyloric stenosis

A
  • eagerness to feed and weight loss
  • projectile vomiting
  • palpable olive-shaped tumor in epigastrium
  • visible peristaltic waves
55
Q

Impetigo characteristics

A
  • bacterial skin infection
  • pruritic, reddish macula becomes vesicle then crusts. Crust is thick and honey-colored**
  • commonly seen on face
56
Q

Untreated impetigo can lead to the development of

A

Acute glomerulonephritis

57
Q

Herpes zoster characteristics

A
  • vesicular eruption in a linear distribution along a nerve root or dermatome
  • painful, pruritic
  • usually unilateral on face, thorax, trunk
58
Q

Herpes zoster prevention

A

Herpes zoster/shingles vaccine at age 60 and over

59
Q

Tinea characteristics

A

erythematous, ring-like lesions with central clearing

60
Q

Psoriasis characteristics

A
  • thick, itchy, erythematous papules/plaques
  • silvery, white scales
  • symmetrical distribution commonly occurring on the scalp, knees, and/or elbows
  • NOT contagious
61
Q

Eczema (atopic dermatitis) patient teaching

A
  • elimination diet: milk, eggs, wheat, citrus
  • wear cotton clothing
  • avoid harsh, overly drying soaps
  • use emollient lotions
  • keep nails short and clean
62
Q

Systemic Lupus Erythematosus (SLE) diagnostic indicators

A
  • rheumatoid factor
  • ANA
  • decreased C3 and C4 complement levels
  • increased immunoglobulin levels
  • increased anti-DNA levels
  • increased CRP
63
Q

How frequently should client vital signs be monitored postoperatively?

A

Every 15 min x 4, every 30 min x2, every hour x2, then as needed

64
Q

Normal WBCC for adults and children

A

Adults: 5,000-10,000
Children: 5,000-13,000

65
Q

Normal RBC for men and women

A

Men: 4.6-6. Million
Women: 4.2-5.4 million

66
Q

Normal Hgb for men and women

A

Men: 13-18 g/dL
Women: 12-16 g/dL

67
Q

Normal Hct for men and women

A

Men: 42-52%
Women: 35-47%

68
Q

Normal platelet count

A

150,000-450,000 mm3

69
Q

T-Tube drain characteristics

A
  • placed after gallbladder surgery in the common bile duct
  • drainage: initially 500-1,000 mL/day, bright red blood that transitions to darker color
  • nursing consideration: keep drainage bag below waist
70
Q

When should suction surgical drains be emptied?

A

When full or every 8 hours

71
Q

Stomach/Esophagus Endoscopy considerations

A
  • instruct client that they will be sedated during the procedure
  • NPO for at least 8 hrs
  • expect numbness after the procedure; keep NPO until gag reflex returns
  • expect sore throat for 3-4 days; use warm, saline gargle to address discomfort
72
Q

Sigmoidoscopy considerations

A
  • clear liquid diet before procedure; administer laxative night before exam; enema or suppository morning of exam
  • NPO after midnight
  • client will be positioned on tilt table; encourage client to take deep breaths during insertion of scope; may have urge to defecate during this part of the procedure
73
Q

Post-upper GI Series Barium Swallow patient education

A
  • increase fluid intake (barium can be constipating)
  • laxatives may be administered to prevent constipation
  • stool may be light-colored/white from barium for up to 72 hrs
74
Q

Client preparation for paracentesis

A
  • obtain baseline vitals and weight client
  • position client in semi-fowler’s or sitting upright on edge of bed
  • empty bladder (prevents injury/perforation of bladder)
75
Q

How high should enema irrigation be set above the rectum?

A

No more than 18 in (45 cm)

76
Q

How deep should enema rectal tube be inserted in an adult?

A

No more than 3-4 inches (7.5-10 cm)

77
Q

Enemas should NOT be administered if

A

Client is experiencing abdominal pain, N/V, or is suspected to have appendicitis

78
Q

NG tube measurement

A

Measure from the tip of the nose to the earlobe, and down to the bottom of the xiphoid process

79
Q

NG tube placement confirmation

A
  • X-Ray (definitive)
  • aspirate for gastric contents (gastric pH </= 4)
80
Q

Hold enteral feeding if NG tube residual exceeds ___ mL

A

100
NOTE: indicates delayed gastric emptying. Report to HCP

81
Q

The nurse should instill ___-___ mL of water before and after each dose of medication and each tube feeding, after checking residual, and every 4-6 hours with continuous feeding

A

15-30

82
Q

How often should enteral feeding bags be changed?

A

Every 24-72 hrs

83
Q

How is removal of an intestinal tube different than an NG tube?

A

Unlike removing an NT tube in one swift, continuous motion, the intestinal tube must be removed 6 inches every 10 min (small segments at a time) until you reach the stomach, THEN you remove it completely with smooth, continuous pull

84
Q

Liver biopsy client preparation

A
  • Administer vitamin K (d/t risk for bleeding)
  • NPO 6 hours prior to procedure
  • medicate with sedative
  • position client supine or laterally with arms elevated
  • instruct client to exhale and hold breath for 5-10 seconds during needle insertion
85
Q

Post-liver biopsy nursing care

A
  • position client on right side for 2-3 hours
  • gradually elevate HOB, 30 degrees first hour, 45 degrees second 2 hours
  • bed rest for 24 hours
  • client should anticipate experiencing mild local pain that can radiate to the right shoulder
  • instruct client to avoid activities that increase intra-abdominal pressure for at least one week
86
Q

Post-lumbar puncture considerations

A
  • client should be positioned flat in bed for 4-12 hours
  • encourage fluids to prevent headache
87
Q

EEG client preparation

A
  • hold tranquilizers, stimulant meds, and stimulants (cigarettes, caffeine) for 24-48 hours prior to procedure
  • client may be asked to hyperventilate during procedure or watch bright flashing lights (increases likelihood of seizure activity)
  • client may be instructed to be sleep deprived
88
Q

Post-laparoscopy considerations

A
  • quick recovery; client can get out of bed after procedure
  • client can resume regular diet
  • client may experience shoulder/back pain (d/t CO2 introduced during procedure)
89
Q

Central Venous Pressure (CVP) normal reading

A

2-6 mm Hg

90
Q

Elevated CVP reading

A

> 6 mm Hg
NOTE: this indicates hypervolemia or poor cardiac contractility

91
Q

Low CVP reading

A

< 2 mm Hg
NOTE: this indicates hypovolemia

92
Q

Prevention of air embolism in the client with a central venous line

A

Instruct the client to hold their breath/perform valsalva maneuver when tubing is inserted, withdrawn, or changed

93
Q

In which position should the nurse place the client to ensure accurate CVP measurements?

A

Supine with the HOB elevated no more than 45 degrees and the zero (0) point of the manometer level with the phlebostatic axis

94
Q

Bronchoscopy patient preparation

A
  • NPO 6 hours prior
  • premedicate w/ diazepam, midazolam, atropine (decreases gastric secretions)
  • advise patient they may have a sore throat after procedure
95
Q

Post-bronchoscopy considerations

A
  • instruct client to sit or lie on their side to prevent aspiration
  • keep NPO until return of gag reflex
96
Q

Thoracentesis procedure considerations

A
  • instruct the client to remain still, avoid coughing and talking
  • do not aspirate more than 1000 mL at one time
97
Q

Cardiac catheterization post-procedure consideration

A

Keep affected leg straight for 6-8 hours

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