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Review Sheet Flashcards

1
Q

Do Not Delegate:

A

“Do not delegate what you can EAT”

Evaluate
Assess
Teach

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2
Q

Difference between Addison’s and Cushing’s Disease:

A

Addison’s - Everything Hypo except HYPERKALEMIA

Cushing’s - Everything Hyper except HYPOKALEMIA

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3
Q

Assessment findings on Addison’s Disease:

A

HYPOnatremia

HYPOtension

HYPO Blood volume

HYPERkalemia

HYPOglycemia

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4
Q

Assessment findings on Cushing’s Disease:

A

HYPERnatremia

HYPERtension

HYPER Blood volume

HYPOkalemia

HYPERglycemia

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5
Q

No Pee - No K

A

Do not give Potassium without adequate urine output.

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6
Q

Limb positioning for better profusion:

A

EleVate Veins

DAngle Arteries

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7
Q

APGAR

A

A - Appearance (color pink, blue, or pale)

P - Pulse (>100, <100, absent)

G - Grimace (cough, grimace, no response)

A - Activity (flexed, flaccid, limp)

R - Respirations (strong cry, weak cry, absent)

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8
Q

TB precautions:

A

Airborne

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9
Q

Droplet precautions infections:

A

“SPIDERMAN”

Sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia, pertussis, influenza, diptheria, epiglottitis, rubella, mumps, meningitis, mycoplasma, adenovirus

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10
Q

Contact precaution infections:

A

“MRS. WEE”

multidrug resistant organism, respiratory infection, skin infection, wound infection, enteric infection (C. diff), eye infection (conjunctivitis)

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11
Q

Example of skin infections:

A

“VCHIPS”

varicella zoster, cutaneous diptheria, herpes simplex, impetigo, pediculosis, scabies

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12
Q

Signs and Symptoms of Air or Pulmonary Embolism:

A

Chest pain

Difficulty breathing

Tachycardia

Pale and cyanotic

Sense of impending doom

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13
Q

Nursing intervention for air or pulmonary embolism:

A

Turn patient to LEFT SIDE

LOWER head of the bed

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14
Q

Nursing intervention for woman in labor with unreassuring FHR:

A

Turn on LEFT SIDE

Give O2

Stop PITOCIN

INCREASE IV fluids

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15
Q

Nursing interventions for tube feeding with decreased LOC:

A

Position on RIGHT SIDE (promote gastric emptying)

Head of bed ELEVATED (prevent aspiration)

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16
Q

Patient positioning for epidural puncture:

A

Side-lying

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17
Q

Patient positioning following lumbar puncture:

A

Patient lies FLAT SUPINE (to prevent headache and leakage of CSF)

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18
Q

Patient positioning following oil-based Myelogram:

A

Patient lies FLAT SUPINE

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19
Q

Patient positioning following heat stroke:

A

Lie FLAT with LEGS ELEVATED

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20
Q

Patient positioning for continuous bladder irrigation (CBI):

A

Catheter is taped to the thigh, so LEG STRAIGHT. No other positioning restrictions

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21
Q

Nursing interventions following Myringotomy:

A

Position patient on side of AFFECTED EAR after surgery (allows for drainage of secretions)

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22
Q

Patient teaching following cataract surgery:

A

Patient to sleep on UNAFFECTED SIDE with a night shield for 1 - 4 weeks

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23
Q

Patient positioning following thyroidectomy:

A

Low or Semi-Fowler’s

Support head, neck, and shoulders

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24
Q

Patient positioning for infant with Spina Bifida:

A

Position PRONE (on abdomen) so that sac does not rupture

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25
Q

Patient teach and nursing interventions for patient following Total Hip Replacement:

A

Don’t sleep on operated side

Don’t flex hip more than 45-60 degrees

Don’t elevate HOB more than 45 degrees

Maintain hip abduction by separating thighs with pillows

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26
Q

Patient positioning for prolapsed cord:

A

Knee-to-chest or Trendelenburg

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27
Q

Patient positioning for infant with Cleft Lip following surgery:

A

Position on BACK or in infant seat to prevent trauma to suture line.

While feeding, hold in upright position.

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28
Q

Patient positioning following ulcer or gastric surgeries to prevent Dumping Syndrome:

A

Eat in reclined position

Lie down after meals for 20 - 30 minutes

Restrict fluids during meals

Low CHO and fiber

Offer small, frequent meals

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29
Q

Patient positioning following Above Knee Amputation:

A

ELEVATE LIMB for first 24 hours on pillows

Position PRONE daily to provide hip extension (prevent contractures)

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30
Q

Patient positioning following Below Knee Amputation:

A

FOOT OF BED ELEVATED for first 24 hours

Position PRONE daily to provide hip extension (prevents contractures)

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31
Q

Patient positioning for Detached Retina:

A

Area of detachment should be in the dependent position

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32
Q

Patient positioning for Administration of Enema:

A

Patient in LEFT SIDE LAYING (Sim’s) with knee flexed

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33
Q

Patient teaching during internal radiation therapy:

A

BEDREST while implant is in place

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34
Q

Signs and Symptoms of Autonomic Dysreflexia (Hyperreflexia):

A

Pounding headache

Profuse sweating

Nasal congestion

Goose flesh

Bradycardia

Hypertension

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35
Q

Patient positioning and nursing intervention for Autonomic Dysreflexia (Hyperreflexia):

A

Place client in SITTING POSITION (elevate HOB) first before any implementation

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36
Q

Nursing intervention and patient positioning for Head Injury:

A

ELEVATE HOB 30 degrees to decrease intracranial pressure

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37
Q

Nursing intervention for Peritoneal Dialysis with outflow is inadequate:

A

TURN patient from side-to-side before checking for kinks in tubing (according to Kaplan)

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38
Q

Nursing interventions following Lumbar Puncture:

A

AFTER procedure, the client should be placed in the SUPINE position for 4 - 12 hours as prescribed

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39
Q

Pain medication for PANCREATITIS:

A

DEMOROL

NOT Morphine Sulfate

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40
Q

Activity characteristics of Myasthenia Gravis:

A

WORSENS with exercise

IMPROVES with rest

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41
Q

Cholinergic Crisis (for Myasthenia Gravis):

A

Caused by excessive medication - stop giving Tensilon medication because you’re making it worse

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42
Q

Administration of medication for Head Injury:

A

MANNITOL (osmotic diuretic)

*Crystalizes at room temperature so always use a filter needle

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43
Q

Lab to check prior to Liver Biopsy:

A

Prothrombin Time

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44
Q

Blood Acid-Base for diarrhea and vomitus:

A

From the ASS - ASSidosis

From the mouth - Alkalosis

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45
Q

Clinical manifestations for Myxedema (severe hypothyroidism):

A

Slowed physical and mental function

Sensitivity to cold

Dry skin and hair

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46
Q

Clinical manifestations for Grave’s Disease (severe hyperthyroidism):

A

Accelerated physical and mental function

Sensitivity to heat

Fine or soft hair

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47
Q

Clinical manifestations of Thyroid Storm:

A

Increased temperature

Increased pulse

Hypertension

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48
Q

Patient positioning and nursing intervention following Tyroidectomy procedure:

A

Semi-Fowler’s position

Prevent neck flexion or hyperextension

Trach kit at bedside

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49
Q

Clinical manifestations of HYPO-parathyroid:

A

“CATS”

Convulsions

Arrhythmias

Tetany

Spasms and Stridor

*Due to decreased calcium

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50
Q

Clinical manifestations of HYPER-parathyroid:

A

Fatigue

Muscle weakness

Renal calculi

Back and joint pain

*Due to increased calcium

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51
Q

HYPO-parathyroid diet:

A

High Calcium

Low Phosphorus

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52
Q

HYPER-parathyroid diet:

A

Low Calcium

High Phosphorus

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53
Q

Clinical manifestations of HYPO-volemia:

A

Increased temperature

Rapid/weak pulse

Increased respirations

HYPO-tension

Anxiety

Urine specific gravity >1.030

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54
Q

Clinical manifestations of HYPER-volemia:

A

Bounding pulse

Shortness of breath

Dyspnea

Crackles

Peripheral edema

HYPTER-tension

Urine specific gravity s position

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55
Q

Clinical manifestations of Diabetes Insipidus:

A

Decreased ADH - Fluid loss

Excessive urine output and thirst

Dehydration

Weakness

*Administer PITRESSIN

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56
Q

Clinical manifestations of SIADH (Syndrome of Inappropriate ADH):

A

Increased ADH - Fluid retention

Change in LOC

Decreased deep-tendon reflexes

Tachycardia

Nausea/Vomiting

Headache

*Administer DECLOMYCIN and DIURETICS

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57
Q

Clinical manifestations of HYPO-kalemia:

A

Muscle weakness

Dysrrhythmias

*Increase K (raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery)

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58
Q

Clinical manifestations of HYPER-kalemia:

A

“MURDER”

Muscle weakness

Urine (oliguria/anuria)

Respiratory depression

Decreased cardiac contractility

ECG changes

Reflexes

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59
Q

Clinical manifestations of HYPO-natremia:

A

Nausea

Muscle cramps

Increased ICP

Muscular twitching

Convulsions

*Administer osmotic diuretics and fluids

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60
Q

Clinical manifestations of HYPER-natremia:

A

Increased temperature

Weakness

Disorientation/Delusions

Hypotension

Tachycardia

*Administer HYPO-tonic solution

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61
Q

Clinical manifestations of HYPO-calcemia

A

“CATS”

Convulsions

Arrhythmias

Tetany

Spasms and Stridor

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62
Q

Clinical manifestations of HYPER-calcemia:

A

Muscle weakness

Lack of coodination

Abdominal pain

Confusion

Absent deep-tendon reflexes

Sedative effect on CNS

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63
Q

Clinical manifestations of HYPO-Mg:

A

Tremors

Tetany

Seizures

Dysrrhythmias

Depression

Confusion

Dysphagia

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64
Q

Clinical manifestations of HYPER-Mg:

A

Depresses the CNS

Hypotension

Facial flushing

Muscle weakness

Absent deep tendon reflexes

Shallow respirations

*EMERGENCY SITUATION

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65
Q

Clinical manifestations of Addison’s Disease:

A

HYPO-Na
HYPER-K
HYPO-glycemia

Dark pigmentation

Decreased resistance to stress and fractures

Alopecia

Weight loss

GI Distress

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66
Q

Clinical manifestations of Cushing’s Disease:

A

HYPER-Na
HYPO-K
HYPER-glycemia
HYPER-tension

Prone to infection

Muscle wasting

Weakness

Edema

Hirsutism

Moonface/Buffalo hump

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67
Q

Clinical manifestations of Addisonian Crisis:

A

Nausea/Vomiting

Confusion

Abdominal pain

Extreme weakness

HYPO-glycemia

Dehydration

Decreased BP

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68
Q

Clinical manifestations of Pheochromocytoma:

A

Hypersecretion of Epinepherine and Norepinepherine

Persistent HTN

Increased HR

HYPER-glycemia

Diaphoresis

Tremor

Pounding headache

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69
Q

Nursing interventions for Pheochromocytoma:

A

Avoid stress

Frequent bathing and rest breaks

Avoid cold and stimulating foods

*Requires surgery to remove tumor

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70
Q

Dangerous disease for fetus when pregnant:

A

“Don’t get pregnant with a German”

German measles (Rubella)

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71
Q

Sequence for drawing up Regular and NPH insulin together:

A

“RN”

1) Regular insulin
2) NPH

Air NPH, air regular, draw regular, draw NPH.

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72
Q

Tetralogy of Fallot:

A

“HOPS”

Hypertrophy of Right Ventricle
Overriding Aorta
Pulmonary Stenosis
Septal Defect

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73
Q

MAOIs used as Antidepressants:

A

“Pirates say AR!”

pARnate
mARplan
nARdil

“PANAMA”

PA-rnate
NA-rdil
MA-rplan

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74
Q

Nursing interventions for Autonomic Dysreflexia (hyperreflexia):

A

Elevate HOB to 90 degrees

Loosen restrictive clothing

Assess for bladder distention and bowel impaction (trigger)

Administer hypertensive medications (prevent stroke, MI, seizure)

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75
Q

Nursing interventions for Digoxin:

A

Check pulse (hold for <60)

Check Dig levels and Potassium levels

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76
Q

Adverse effect of Amphojel:

A

Constipation

*For treatment of GERD and kidney stones

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77
Q

Vistaril:

A

Treatment of anxiety and itching

*Watch for dry mouth, commonly given preoperatively

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78
Q

Versed:

A

Given for conscious sedation

*Watch for respiratory depression and hypotension

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79
Q

Sinemet:

A

Treatment for Parkinsons

Adverse effects:
Sweat, saliva, and urine may turn reddish brown occasionally. Causes drowsiness.

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80
Q

Artane:

A

Treatment of Parkinsons

Also has sedative effect

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81
Q

Cogentin:

A

Treatment of Parkinsons and Extrapyramidal effects of other drugs

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82
Q

Tigan:

A

Treatment of post-operative nausea and vomiting associated with gastroenteritis

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83
Q

Timolol (Timoptic):

A

Treatment of glaucoma

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84
Q

Bactrim:

A

Antibiotic

Don’t take if allergic to Sulfa drugs.

Diarrhea is common side effect, drink plenty of fluids

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85
Q

Common medications for GOUT:

A

Probenecid (Benemid)

Colchicine

Allopurinol (Zyloprim)

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86
Q

Apresoline (hydralazine):

A

Treatment of hypertension or CHF

Report flu-like symptoms. Rise slowly from sitting/lying position. Take medication with meals.

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87
Q

Bentyl:

A

Treatment of irritable bowel syndrome

Assess for anticholinergic side effects.

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88
Q

Calan (Verapamil):

A

Calcium channel blocker for treatment of hypertension and angina.

Assess for constipation.

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89
Q

Carafate:

A

Treatment of duodenal ulcers.

Works by coating the ulcer so take before meals.

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90
Q

Theophylline:

A

Treatment of asthma and COPD.

Therapeutic drug level 10-20.

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91
Q

Mucomyst:

A

Antidote to tylenol and administered orally.

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92
Q

Diamox:

A

Treatment of glaucoma and high-altitude sickness.

Don’t take if allergic to sulfa drugs.

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93
Q

Indocin:

A

NSAID treatment of arthritis (osteo, rheumatoid, gouty), bursitis, and tendonitis.

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94
Q

Synthroid:

A

Treatment of HYPO-thyroidism.

May take several weeks to for therapeutic effects. Notify physician of chest pain. Take in the AM on an empty stomach. Could cause HYPER-thyroidism.

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95
Q

Librium:

A

Treatment of alcohol withdrawal.

Don’t take with alcohol, can cause serious nausea and vomiting.

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96
Q

Oncovin (Vincristine):

A

Treatment of leukemia.

Given by IV ONLY.

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97
Q

Kwell:

A

Treatment of scabies and lice.

Scabies - apply lotion once and leave on for 8-12 hours.

Lice - use the shampoo and leave on for 4 minutes with hair uncovered then rinse with warm water and comb with a fine tooth comb.

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98
Q

Premarin:

A

Estrogen replacement for treatment after menopause.

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99
Q

Dilantin:

A

Treatment of seizures.

Therapeutic drug level is 10 - 20.

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100
Q

Navane:

A

Treatment of schizophrenia.

Assess for Extrapyramidal Symptoms.

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101
Q

Ritalin:

A

Treatment of ADHD.

Assess for heart related side effects and report immediately. Child may need a drug holiday because it stunts growth.

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102
Q

Dopamine (Intropine):

A

Treatment of HYPO-tension, shock, low cardiac output, poor perfusion to vital organs.

Monitor EKG (for arrhythmias) and blood pressure.

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103
Q

Fetal heart rate (FHR) patterns in OB:

A

“VEAL CHOP”

VC - Variable decels; Cord compression
EH - Early decels; Head compression
AO - Accelerations; OK! No problem
LP - Late decels; Placental insufficiency (can’t fill)

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104
Q

Nursing intervention for pregnant mother for cord compression:

A

Place mother in TRENDELENBERG because this removes pressure of the presenting part off the cord.

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105
Q

Nursing intervention for cord prolapse:

A

Cover the cord with sterile saline gauze to prevent drying of the cord and to minimize infection.

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106
Q

Nursing intervention for LATE DECELERATIONS:

A

Position mother on LEFT SIDE to allow more blood flow to the placenta.

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107
Q

Nursing intervention for any kind of bad fetal heart rate pattern:

A

Give O2, often by mask.

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108
Q

For pregnancy, HYPO-tension, BRADY-pnea, BRADY-cardia:

A

Major risks and are emergencies.

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109
Q

Priority nursing actions when pregnant mother or fetus shows signs of distress:

A

NEVER check the monitor or a machine as a first action.

ALWAYS assess the patient first, whether it’s the mother or the child.

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110
Q

Baby presentation and sound locations:

A

Posterior - sounds heard at sides.

Anterior - closer to midline, between umbilicus

Breech - high up in the fundus near the umbilicus

Vertex - a little bit above the symphysis pubis

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111
Q

Nursing interventions for ventilator alarms:

A

“HOLD”

HO - High; Obstruction
LD - Low; Disconnection

High Pressure Alarm - Obstruction due to increased secretions, kink, patient coughs gags or bites.

Low Pressure Alarm - Disconnection or leak in ventilator or in patient’s airway cuff. Patient stops spontaneously breathing.

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112
Q

Clinical manifestations and blood sugars:

A

HYPER-glycemia; “Hot and dry, sugar high”

HYPO-glycemia; “Cold and clammy, need some candy”

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113
Q

ICP and shock have opposite vital signs:

A

ICP - increased BP, decreased pulse, decreased respirations.

Shock - decreased BP, increased pulse, increased respirations.

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114
Q

Cor Pulmonale:

A

Right sided heart failure caused by left ventricular failure. Occurs with bronchitis or emphysema.

Presents with edema and JVD.

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115
Q

Clinical manifestations of heroin withdrawal in neonates:

A

Irritable

Poor sucking

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116
Q

Dietary restrictions for Jews:

A

No milk and meat together.

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117
Q

How to obtain pulse on an infant:

A

Brachial pulse

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118
Q

Dietary sources of Potassium:

A

Bananas, potatoes, citrus fruits.

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119
Q

Why would patient with leukemia have epistaxis:

A

Low platelet count.

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120
Q

Best way to warm a newborn:

A

Skin-to-skin contact, with a blanket covering mom.

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121
Q

Priority nursing action when patient comes in active labor:

A

Listen to FHR or FHT.

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122
Q

Treatment for phobic disorders:

A

Systemic desensitization.

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123
Q

Technique for answer selection:

A

Choose ASSESSMENT over intervention, except in an emergency or distress situation.

Discard absolute answers; always, never, must, etc.

Priority to answers that deal with patient’s bodies, not the machines/equipment.

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124
Q

General feeding guidelines:

A

Small, frequent feedings are better than fewer, large ones.

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125
Q

Restricted from Unlicensed Assistive Personnel:

A

Assessment

Teachings

Medications

Evaluations

Unstable patients

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126
Q

LVN/LPN vs RN:

A

LVN/LPN cannot handle blood.

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127
Q

Adverse effects of Aminoglycosides (like Vancomycin):

A

Nephrotoxicity

Ototoxicity

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128
Q

Technique for answer selection with family involved:

A

Family option can be ruled out UNLESS it’s a child.

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129
Q

Patient treatment in emergency triage situation:

A

Patient with greatest chance of survival are treated first.

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130
Q

Cardinal sign of ARDS:

A

Acute Respiratory Distress Syndrome - fluids in alveoli, results in HYPO-xemia (low oxygen levels in tissues).

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131
Q

Organs of concern with pH regulation:

A

Lungs

Kidneys

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132
Q

Location of fluid with edema:

A

INTERSTITIAL SPACE

Not cardiovascular space.

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133
Q

Best indicator of dehydration:

A

Weight

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134
Q

Consequence of Aspirin to children:

A

Reye’s Syndrome (encephalopathy)

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135
Q

Hot/Cold remedies for Acute and Chronic pain:

A

COLD - aCute pain (sprain)

HOT - chronic (rheumatoid arthritis)

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136
Q

Poor answer selection for distressed patient:

A

Medication administration

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137
Q

Clinical manifestations of pneumonia:

A

Fever and chills are usually present.

For elderly, confusion is often present.

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138
Q

Priority nursing interventions before administration of antibiotics:

A

Check for allergies (especially PCN)

C/S done before first dose

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139
Q

Common respiratory diseases:

A

COPD is chronic

Pneumonia is acute

Emphysema and bronchitis are both COPD.

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140
Q

Administration of Epinephrine:

A

Always given in TB syringe.

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141
Q

Clinical manifestations of Prednisone Toxicity:

A

Cushing’s syndrome.

Buffalo hump, moon face, HYPER-glycemia, HYPER-tension.

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142
Q

Four options of cancer management:

A

Chemo

Radiation

Surgery

Allow to die with dignity

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143
Q

Neutropenic precautions:

A

No live vaccines

No fresh fruits

No flowers

No (possibly) infectious visitors

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144
Q

Chest tube drainage placement:

A

Pleural space

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145
Q

Difference between angina and MI:

A

Angina - low oxygen to heart tissues, no damaged tissue.

MI - dead heart tissue.

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146
Q

Mevacor:

A

Anticholesterol medication.

Must be given with evening meals if once per day.

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147
Q

Nitroglycerine protocol:

A

Administered q5 minutes 3 times. If chest pain does not stop, go to hospital. Hold for BP < 90/60.

Unstable angina is not relieved by nitro.

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148
Q

Effect of Angiotensin II in the lungs:

A

Potent vasodilator.

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149
Q

Antidote for Heparin:

A

Protamine Sulfate

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150
Q

Antidote for Coumadin:

A

Vitamin K

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151
Q

Antidote for Ammonia:

A

Lactulose

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152
Q

Antidote for Acetaminophen (Tylenol):

A

n-Acetylcysteine (Mucomyst)

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153
Q

Antidote for iron toxicity:

A

Deferoxamine

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154
Q

Antidote for Digitoxin (digoxin) toxicity:

A

Digibind

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155
Q

Antidote for alcohol withdrawal:

A

Librium

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156
Q

Opiod analgesic used to detoxify and treat pain in narcotic addicts:

A

Methadone

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157
Q

Lab results for Coumadin:

A

PT and PTT are elevated.

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158
Q

Effects of dysrrhythmias on cardiac output:

A

Decreased.

Dopamine increases BP.

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159
Q

Medication for V-Tachycardia:

A

Lidocaine

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160
Q

Medication for SVT (Supraventricular Tachycardia):

A

Adenosine or Adenocard

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161
Q

Medication for Asystole:

A

Atropine

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162
Q

Medication for CHF (Congestive Heart Failure):

A

ACE Inhibitor

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163
Q

Medication for Anaphylaxis:

A

Epinephrine

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164
Q

Medication for Status Epilepticus:

A

Valium

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165
Q

Medication for BiPolar Disorder:

A

Lithium

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166
Q

Amiodorone:

A

Effective in both ventricular and atrial complications.

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167
Q

Protonix:

A

Given prophylactically to prevent stress ulcers.

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168
Q

Priority nursing assessment following Endoscopy:

A

Check gag reflex.

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169
Q

Location of administration of TPN:

A

Total Parenteral Nutrition is given in the Subclavian Line.

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170
Q

Low residue diet:

A

Low fiber

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171
Q

Diverticulitis:

A

Inflammation of the diverticulum in the colon.

Pain in the LLQ.

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172
Q

Appendicitis:

A

Inflammation of the appendix.

Rebound tenderness and pain the LRQ.

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173
Q

Where is insulin produced?

A

Beta cells of the Pancreas

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174
Q

Contraindicated medication for Pancreatitis:

A

Morphine; causes spasms of the Sphincter of Oddi.

Demerol should be given.

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175
Q

Signs observed in HYPO-calcemia:

A

Trousseau

Tchovoski

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176
Q

Medication regiment for chronic pancreatitis:

A

Pancreatic enzymes given with meals.

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177
Q

Medication treatment for Addison’s disease:

A

Mineral corticoids

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178
Q

Diabetic Ketoacidosis (DKA):

A

Condition where the body is breaking down fat instead of sugar for energy. By-products are ketones, which are acidic, that causes the pH to drop.

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179
Q

Clinical manifestation of Fat Embolism:

A

Petechiae; treat with Heparin.

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180
Q

Expected physician orders following knee total replacement surgery:

A

Continuous Passive Motion Machine

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181
Q

Consequence of glaucoma:

A

Loss of peripheral vision

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182
Q

Clinical manifestation of cataracts:

A

Cloudy, blurry vision.

Treat by lens-removal surgery.

183
Q

Effect of CO2 on vascular system:

A

CO2 causes vasoconstriction

184
Q

Multiple Sclerosis:

A

Myelin sheath destruction, disruption in nerve impulse conduction.

185
Q

Myasthenia Gravis:

A

Decrease in receptor sites for acetylcholine.

Since smallest concentration of ACTH receptors are in cranial nerves, expect fatigue and weakness in eye, mastication, and pharyngeal muscles.

186
Q

Tensilon Test:

A

Given if muscles are tense in Myasthenia Gravis.

187
Q

Guillain-Barre Syndrome:

A

Ascending Paralysis (from the feet up).

Monitor for respiratory distress.

188
Q

Clinical manifestations of Parkinson’s Disease:

A

“RAT”

Rigidity
Akinesia (loss of muscle movement)
Tremors

Treat with Levodopa

189
Q

Transient Ischemic Attack (TIA):

A

Mini stroke with no dead brain tissue.

190
Q

Cerebrovascular Accident (CVA):

A

Stroke with dead brain tissue.

191
Q

Hodgkin’s disease:

A

Cancer of lymph and curable in early stages.

192
Q

Rule of NINES for burns:

A

Head and Neck = 9%

Each Upper Extremity = 9%

Each Lower Extremity = 18%

Front Trunk = 18%

Back Trunk = 18%

Genitalia = 1%

193
Q

Birth weight by age:

A

Doubles by 6 months

Triples by 12 months

194
Q

First signs of Cystic Fibrosis (in new borns):

A

Meconium ileus at birth.

Baby is inconsolable, does not eat, and not passing meconium.

195
Q

Consequence of Rheumatic Fever:

A

Cardiac valve malfunctions.

196
Q

Cerebral Palsy:

A

Poor muscle control due to birth injuries and/or decreased oxygen to brain tissues.

197
Q

Consequence of Dilantin Levels too high:

A

Gingival hyperplasia

198
Q

Assessment in children for Meningitis:

A

Kernig’s Sign

Brudzinski’s Sign

199
Q

Presentation of Wilm’s Tumor:

A

Usually encapsulated above the kidneys causing flank pain.

200
Q

Hemophilia and genetics:

A

X-linked trait.

Mother (carrier) passes disease to son.

201
Q

Consequence of elevated Phenylalanine:

A

Affects brain function

202
Q

Eclampsia:

A

Results in seizure

203
Q

Why does mother receive RhoGam:

A

When mother is Rh- to protect the next baby.

204
Q

When do fontanelles close?

A

Anterior - by 18 months

Posterior - by 6 - 8 weeks

205
Q

Pathological jaundice:

A

Occurs before 24 hours and lasts 7 days.

206
Q

Physiological jaundice:

A

Occurs after 24 hours.

207
Q

Placenta Previa:

A

There is no pain, there is bleeding.

208
Q

Abrupto Placentae:

A

There is pain, but no bleeding.

209
Q

Bethamethasone (Celestone):

A

Surfactant medication to aid in lung expansion.

210
Q

Dystocia:

A

Baby can not make it down to the canal:

211
Q

Pitocin:

A

Medication used for uterine stimulation.

212
Q

Magnesium Sulfate:

A

Used to halt preterm labor.

Contraindicated if deep-tendon reflexes are ineffective. If patient experiences seizures during magnesium sulfate administration, get baby out (emergency)!

213
Q

Five interventions for psych patients:

A

Safety

Set Limits

Establish Trusting Relationship

Medication Administration

Least Restrictive Methods (Environment)

214
Q

How long before you see effects of SSRI (Antidepressants)?

A

About 3 weeks to reach therapeutic effects.

215
Q

Nursing interventions for Hallucinations vs. Delusions:

A

Hallucinations - Redirect the patient

Delusions - Distract the patient

216
Q

Adverse effects of Thorazine (Haldol):

A

Antipsychotic medication. Can lead to EPS (extrapyramidal side effects).

217
Q

Characteristic od Alzheimer’s Disease:

A

Chronic, progressive, degenerative cognitive disorder that accounts for >60% of all dementias.

218
Q

Clinical manifestation of HYPER-thyroidism:

A

“Michael Jackson in Thriller!”

Skinny, nervous, bulging eyes, up all night, tachycardia.

219
Q

Medication used to decrease secretions:

220
Q

Antiemetic used to reduce nausea:

221
Q

Commonly used tranquilizer given to reduce anxiety before surgery:

222
Q

Pain control medication contraindicated for sickle cell crisis:

223
Q

Method for Fe (iron) injections:

A

Z-track, so it doesn’t leak into SQ tissues.

224
Q

Mnemonic for Cranial Nerves:

A 
Oh - I - Olfactory
Oh - II - Optic
Oh - III - Oculomotor
To - IV - Trochlear
Touch - V - Trigeminal
And - VI - Abducens
Feel - VII - Facial
A - VIII - Auditory
Girls - IX - Glossopharyngeal
Vagina - X - Vagus
And - XI - Accessory
Hymen - XII - Hypoglossal
225
Q

Clinical manifestations for HYPER-natremia (greater than 145):

A

“SALT”

S - skin flushed
A - agitation
L - low grade fever
T - thirst

226
Q

Significance with APGAR values:

A

8 - 10; Patient is OK

0 - 3; Resuscitate

227
Q

Clinical manifestations of HYPO-xia:

A

Restless

Anxious

Cyanotic

Tachycardia

Tachypnea

228
Q

Mnemonic for Addisons and Cushing’s Syndrome:

A

ADDison’s - need to ADD hormone

CUSHINg’s - have extra CUSHIN of hormone

229
Q

Nursing interventions and medical management of Dumping Syndrome:

A

Increase fat and protein intake

Small frequent meals

Lie down after meals (to decrease peristalsis)

Wait 1 hour after meals to drink

230
Q

Precautions for Herpes Zoster:

A

Disseminated HZ - Airborne Precautions

Localized HZ - Contact Precautions

231
Q

Fat soluble Vitamins:

232
Q

Drugs to give with food:

A

NSAIDS

Corticosteroids

Bipolar drugs

Cephalosporins

Sulfonamides

233
Q

Treatment of choice for Status Epilepticus:

234
Q

Sequence for bronchodilator in conjunction with glucocorticoid inhaler:

A

Bronchodilator first to open the passage way.

Then Glucocorticoid.

Then rinse mouth since Glucocorticoid is a steroid inhaler.

235
Q

Considerations for Theophylline:

A

Increases the risk of Digoxin toxicity.

Decreases the effects of Lithium and Dilantin.

236
Q

Intal:

A

IN-tal is an inhaler used to treat allergy induced asthma. May cause bronchospasm. Think IN-to the asthmatic lung.

237
Q

Adverse effects of Isoniazid:

A

Peripheral neuritis

238
Q

Treatment of peptic ulcers caused by H. pylori:

A

Flagyl

Prilosec

Biaxin

*Treatment kills bacteria and stops production of stomach acid, but does not heal the ulcer.

239
Q

Correct use of a Diaphragm contraceptive:

A

Must stay in place for at least 6 hours after intercourse.

They are also fitted and so must be refitted if you lose or gain a significant amount of weight.

240
Q

Best time to take Growth Hormone:

241
Q

Best time to take Steroids:

242
Q

Best time to take Diuretics:

243
Q

Best time to take Aricept:

244
Q

Best time to take Carafate (Sulcrafate):

A

Before meals. It’s a mucosal barrier.

Watch for constipation.

245
Q

Best time to take Tagamet:

A

With meals. H2 medication.

*Interacts with a lot of things and screws with elderly, so watch out!

246
Q

Consequence of long-term use of Amphogel:

A

Binds to phosphates, increases Ca in circulation by robbing the bones.

Leads to increased Ca resorption from bones and WEAKENS BONES.

247
Q

Medical management for Glaucoma:

A

Increased intraocular pressure (greater than the normal 22 mmHg).

Give miotics to constrict iris (PILOCARPINE).

ATROPINE is contraindicated.

248
Q

Non-dairy sources of Calcium:

A

Rhubarb

Sardines

Collard Greens

249
Q

Nursing intervention for irritated skin with plaster casts:

A

Petal the rough edges with tape.

250
Q

Patient positioning to relieve lower back pain:

A

Bend knees

251
Q

Allopurinol:

A

Flushes uric acid out of the system.

252
Q

Adverse effects of INH:

A

Peripheral neuritis, take Vitamin B6 to prevent.

*Also hepatotoxic.

253
Q

Adverse effects of Rifampin:

A

Red orange tears and urine.

Contraceptives won’t work.

254
Q

Adverse effects of Ethambutol:

A

Messes with your Eyes.

255
Q

Procedure for administration of eye drops:

A

Apply to conjunctival sac.

Apply pressure to nasolacrimal duct/inner canthus, to prevent systemic leakage.

256
Q

Considerations when administering Kayexalate:

A

Worry about dehydration.

257
Q

Why is yogurt contraindicated for immunosuppressed patients?

A

Yogurt contains live cultures.

258
Q

Nursing intervention for treatment of itching under cast area:

A

Cool air via blow dryer

Ice pack for 10-15 minutes

*NEVER use Q-tip or anything to scratch the area.

259
Q

Murphy’s Sign:

A

Pain with palpation of gall bladder area seen with CHOLECYSTITIS.

260
Q

Cullen’s Sign:

A

Ecchymosis in umbilical area seen with PANCREATITIS.

261
Q

Turner’s Sign:

A

Flank grayish blue seen with PANCREATITIS.

262
Q

McBurney’s Point:

A

Pain in LRQ seen with APPENDICITIS.

263
Q

Guthrie Test:

A

Tests for PKU in infants; baby should eat a source of protein first.

264
Q

Shilling Test:

A

Test for PERNICIOUS ANEMIA; how well one absorbs Vitamin B12.

265
Q

Allen’s Test:

A

Occlude both wrist arteries until hand blanches.

Release Ulnar artery.

If hand pinks up then good and can carry on with ABG/radial stick.

266
Q

Permissible observations during Peritoneal Dialysis:

A

Abdominal cramps

Blood tinged outflow

Leakage around the site

*CLOUDY outflow never normal!

267
Q

Indications of yellow amniotic fluid with particles:

A

Meconium stained

268
Q

Rhogam administration schedule:

A

Given at 28 weeks gestation.

Again 72 hours post-partum.

*Only given to Coomb’s negative and Rh- mother, by IM injection.

269
Q

Order of Assessment:

A 
NON-ABDOMINAL:
Inspection
Palpation
Percussion
Auscultation
ABDOMINAL & CHILDREN:
Inspection
Auscultation
Percussion
Palpation
270
Q

Related to Latex allergy:

A 
Bananas
Apricots
Cherries
Grapes
Kiwis
Passion Fruit
Avocados
Chestnuts
Tomatoes
Peaches
271
Q

Tensilon:

A

Used to confirm diagnosis of Myasthenia Gravis.

272
Q

Amyotrophic Lateral Sclerosis (ALS):

A

Degenerative condition of motor neurons for both upper and lower motor neuron systems.

273
Q

Transesophageal Fistula (TEF):

A

Esophagus doesn’t fully develop. This is a surgical emergency.

274
Q

The 3 C’s of TEF in the newborn:

A

Choking

Coughing

Cyanosis

275
Q

How is MMR vaccine administered?

A

Given SQ, not IM.

276
Q

Greek tradition with newborn baby:

A

Put an amulet or other protective charm around the baby’s neck to avoid the “evil eye” or envy of others.

277
Q

Children and relation to time:

A

4 year old kids cannot interpret TIME. They need to be explained in relationship to a known COMMON EVENT.

“Mom will be back after supper”

278
Q

Contraindication for Hepatitis B vaccine:

A

Anaphylactic reaction to baker’s yeast.

279
Q

Assessment question before administering vaccine:

A

Allergy to eggs.

280
Q

What to monitor while on Nitroprusside:

A

Monitor thiocynate (cyanide) levels.

Normal value should be 1 is heading toward toxicity.

281
Q

Precautions for SARS (Severe Acute Respiratory Syndrome):

A

Airborne + Contact precautions

282
Q

Hepatitis A precautions:

A

Contact precautions

283
Q

Common infections that require Standard Precautions:

A

Tetanus

Hepatitis B

HIV

284
Q

William’s Position:

A

Semi-Fowler’s with knees flexed to relieve lower back pain.

285
Q

Physical signs of a fractured hip:

A

External rotation

Shortening

Adduction

286
Q

Clinical manifestations of a fat embolism:

A

Blood tinged sputum (related to inflammation)

Respiratory alkalosis

Hypocalcemia

Increased serum lipids

“Snow Storm” effect on CXR

287
Q

Complications of mechanical ventilation:

A

Pneumothorax

Ulcers

288
Q

Clinical manifestations of Paget’s Disease:

A

Tinnitus

Bone pain

Enlargement of bone

Thickened bones

289
Q

Contraindicated with administration of Allopurinol:

A

NO VITAMIN C!

290
Q

Acid Ash Diet:

A

Cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread.

291
Q

Alkaline Ash Diet:

A

Milk, veggies, rhubarb, salmon.

292
Q

Side effect of thyroid hormones:

A

Insomnia; with increased metabolic rate, your body is “too busy to sleep”.

*With HYPO-throidism patients may report somnolence; decreased metabolic rate, the body becomes slow and sleepy.

293
Q

Medical management and medication for Strabismus:

A

Botox.

Patch GOOD EYE so that the weaker eye can get stronger.

294
Q

O2 administration requirement for COPD patient:

A

2 L/min vis nasal cannula MAXIMUM.

295
Q

Medication to reverse the effects of Pancuronium:

A

Neostigmine

Atropine

(Anticholinergics)

296
Q

Assessment before administration of Asparginase:

A

Test for hypersensitivity

297
Q

Dietary teaching while taking Vermox:

A

High-fat diet increases absorption.

298
Q

Glucose threshold for kidney:

299
Q

Anxiety related to children:

A

Stranger anxiety - 7 to 9 months old

Separation anxiety - peaks at toddlerhood

300
Q

Tardive Dyskinesia:

A

Involuntary movement of the tongue, face, and extremities. May happen after prolonged use of antipsychotics.

Effects are irreversible.

301
Q

Akathisia:

A

Motor restlessness, feels the need to keep going.

Treat with anti-Parkinsons medications. Can be mistaken for agitation.

302
Q

Procedure for drawing ABGs:

A

Put the blood in a heparinized tube.

No bubbles.

Put on ice immediately.

Label indicating what type of air (O2, room).

303
Q

Patient preparation before Pulmonary Function Test (PFT):

A

Bronchodilators and smoking are with-held for 4 hours.

304
Q

Patient positioning for lung biopsy:

A

Side-laying with arms raised up on pillows over bedside table.

Patient to hold breath mid-experation.

CXR done immediately after to check for complications of pneumothorax, apply sterile dressing.

305
Q

Medical management for lumbar puncture:

A

Patient positioned in lateral recumbent fetal position.

Keep patient flat for 2-3 hours after with a sterile dressing over wound.

Frequent Nero assessments.

306
Q

Considerations for Dexedrine:

A

Medication used for treatment of ADHD.

May alter insulin needs.

Avoid taking with MAOIs, and take medication in the morning (possible side effect is insomnia).

307
Q

Cytovene:

A

Used for treatment of retinitis caused by cytomegalovirus.

Patient will need regular eye exams.

Report dizziness, confusion, or seizures immediately.

308
Q

INH:

A

Used in the treatment and prevention of TB.

Do not mix with Dilantin.

Can cause Phenytonin toxicity.

Monitor LFT’s.

Give with Vitamin B6.

HYPO-tension will occur initially then resolve.

309
Q

Preferred anti-psychotic in the elderly:

A

Haldol

*Has high-risk extrapyramidal side effects (dystonia, tardive dyskinesia, tightening of jaw, stiff neck, swollen tongue, swollen airway). Monitor for early signs of reaction and give IM Benadryl.

310
Q

First line antipsychotic in children:

A

Risperdal

*Doses over 6mg can cause tardive dyskinesia.

311
Q

Levadopa:

A

Treatment of Parkinsons.

Contraindicated for patients with glaucoma, and should avoid B6.

312
Q

Sinemet:

A

Treatment of Parkinsons.

Contraindicated with MAOI’s.

313
Q

Hydroxyurea:

A

Treatment of Sickle Cell.

*Report GI symptoms immediately, as it could indicate toxicity.

314
Q

Zocor:

A

Treatment of Hyperlipidemia.

Take on an empty stomach to enhance absorption. Report any unexplained muscle pain, especially fever.

315
Q

Decorticate vs. Decerebrit:

A

Decorticate - fists towards core (at sternum)

Decerebrit - fists outward

316
Q

Progression of Multiple Sclerosis disease:

A

Chronic, progressive disease with demyelinating lesions in the CNS which affect the white matter of the brain and spinal cord.

Signs & Symptoms
Motor: limb weakness, paralysis, slow speech
Sensory: numbness, tingling, tinnitus
Cerebral: nystagmus, ataxia, dysphagia, dysarthria

317
Q

Huntington’s Chorea:

A

50% genetic, autosomal dominant disorder.

Signs & Symptoms
Chorea - writhing, twisting, movements of face, limbs, and body.
Gait deteriorates to no ambulation.
No cure just palliative care.

318
Q

Definitive diagnosis for Abdominal Aortic Aneurysm (AAA):

319
Q

Patient contraindicated for Kayexalate:

A

HYPO-active bowel sounds

320
Q

Uremic fetor:

A

Smell urine on the breath.

321
Q

Hirschsprung’s Disease:

A

Bile present - lower obstruction

No bile present - upper obstruction

Presents with ribbon like stools

322
Q

Patient teaching before fecal occult stool blood test:

A

Cantaloupe causes a false positive.

No fish.

No red meat.

323
Q

HYPO-spadias:

A

Abnormality in which urethral meatus is located on the ventral (back) surface of the penis, anywhere from the corona to the perineum.

HYPO - lower surface of penis.

324
Q

EPI-spadias:

A

Opening of the urethra on the dorsal (front) surface of the penis.

EPI - top surface of penis.

325
Q

Physical manifestations of Fetal Alcohol Syndrome (FAS):

A

Upturned nose

Flat nasal bridge

Thin upper lip

SGA

326
Q

IM administration sites for infants and children:

A

18 months - Ventrogluteal

Children - Deltoid and gluteus maximus

327
Q

Patient teaching for Cane walking:

A

“COAL”

C - Cane
O - Opposite
A - Affected
L - Leg

328
Q

Procedure for Thoracentesis:

A

Take vital signs

Shave area around needle insertion

Position patient with arms on pillow over bed table or side laying

No more than 1,000 CCs at one time

After procedure listen for bilateral breath sounds, check vital signs, check for leakage, and apply sterile dressing

329
Q

Patient preparation for cardiac catheterization:

A

NPO 8-12 hours

Empty bladder

Patient may have desire to cough with dye injection

After procedure take vital signs and keep leg straight on bed rest for 6 - 8 hours.

330
Q

Patient preparation for Cerebral Angiography:

A

Keep well hydrated

Lie flat

Site shaved

After procedure keep flat for 12 - 14 hours, check site, vitals, and force fluids

331
Q

Nursing interventions post-procedure for Lumbar puncture:

A

Neuro assessment q15-30 minutes until stable

Lay flat for 2 - 3 hours

Encourage fluids

Oral analgesics for headache

Observe dressing site

332
Q

Patient preparation for EEG:

A

No sleep the night before

Meals not with-held

No stimulants for 24hours before

Tranquilizer and stimulant meds held 24 - 48 hours before

May be asked to hyperventilate 3-4 minutes and watch a bright flashing light

333
Q

Laproscopic procedure:

A

CO2 used to enhance visual field

General anesthesia used

Patient on FOLEY CATH

After procedure walk patient to decrease CO2 build up used for procedure

334
Q

Nursing considerations for Sengstaken Blakemore Tube:

A

Used for treatment of esophageal varices

Keep scissors at bedside

335
Q

Classic signs and symptoms of PTB:

A

Low-grade afternoon fever

336
Q

Classic signs and symptoms of Pneumonia:

A

Rusty sputum

337
Q

Classic signs and symptoms of Asthma:

A

Wheezing on expiration

338
Q

Classic signs and symptoms of Emphysema:

A

Barrel chest

339
Q

Classic signs and symptoms of Kawasaki Syndrome:

A

Strawberry tongue

340
Q

Classic signs and symptoms of Pernicious Anemia:

A

Beefy red tongue

341
Q

Classic signs and symptoms of Downs Syndrome:

A

Protruding tongue

342
Q

Classic signs and symptoms of Cholera:

A

Rice watery stool

343
Q

Classic signs and symptoms of Malaria:

A

Stepladder like fever with chills

344
Q

Classic signs and symptoms of Typhoid:

A

Rose spots in abdomen

345
Q

Classic signs and symptoms of Diptheria:

A

Pseudo membrane formation

346
Q

Classic signs and symptoms of Measles:

A

Koplik’s spots

347
Q

Classic signs and symptoms of Systemic Lupus Erthymatosus (SLE):

A

Butterfly rashes

348
Q

Classic signs and symptoms of Liver Cirrhosis:

A

Spider-like varices

349
Q

Classic signs and symptoms of Leprosy:

A

Lioning face

350
Q

Classic signs and symptoms of Bulimia:

A

Chipmunk face

351
Q

Classic signs and symptoms of Appendicitis:

A

Rebound tenderness

352
Q

Classic signs and symptoms of Dengue:

A

Petechiae or positive Herman’s sign

353
Q

Classic signs and symptoms of Meningitis:

A

Positive Kernig’s sign (leg flex then leg pain on extension)

Positive Brudzinski sign (neck flex causes lower leg flexion)

354
Q

Classic signs and symptoms of Tetany:

A

HYPO-calcemia

Positive Trousseau’s sign (carpopedal spasm)

Chvostek sign (facial spasm)

355
Q

Classic signs and symptoms of Tetanus:

A

Risus sardonicus

356
Q

Classic signs and symptoms of Pancreatitis:

A

Cullen’s sign (ecchymosis of umbilicus)

Positive Grey turners spots

357
Q

Classic signs and symptoms of Pyloric Stenosis:

A

Olive-like mass

358
Q

Classic signs and symptoms of Patent Ductus Arteriosus (PDA):

A

Machine-like murmur

359
Q

Classic signs and symptoms of Addison’s Disease:

A

Bronze-like skin pigmentation

360
Q

Classic signs and symptoms of Cushing’s Syndrome:

A

Moon face appearance

Buffalo hump

361
Q

Classic signs and symptoms of HYPER-thyroidism (Grave’s Disease):

A

Exopthalmus

362
Q

Classic signs and symptoms of Intussusception:

A

Currant jelly stools

Dance sign (empty portion of LRQ)

363
Q

Classic signs and symptoms of Multiple Sclerosis:

A

Charcot’s Triad (IAN)

364
Q

Classic signs and symptoms of Myasthenia Gravis:

A

DESCENDING muscle weakness

365
Q

Classic signs and symptoms of Guillian Barre Syndrome:

A

ASCENDING muscle weakness

366
Q

Classic signs and symptoms of Deep Vein Thrombosis (DVT):

A

Positive Homan’s sign

367
Q

Classic signs and symptoms of Chicken Pox:

A

Vesicular rash (dew drop on rose petal)

368
Q

Classic signs and symptoms of Angina:

A

Crushing stabbing pain relieved by Nitroglycerin

369
Q

Classic signs and symptoms of Myocardial Infarction:

A

Crushing stabbing pain which radiates to left shoulder, neck, arms and unrelieved by Nitroglycerin

370
Q

Classic signs and symptoms of Laryngotracheobronchitis (LTB):

A

Inspiratory stridor

371
Q

Classic signs and symptoms of Tracheoesophageal Fistula (TEF):

A

4C’s

Coughing
Choking
Cyanosis
Continuous drooling

372
Q

Classic signs and symptoms of Epiglotitis:

A

3D’s

Drooling
Dysphonia
Dysphagia

373
Q

Classic signs and symptoms of Hodgekin’s Lymphoma:

A

Painless, progressive enlargement of spleen and lymph tissues. Presents with Reed-Sternberg cells.

374
Q

Classic signs and symptoms of Infectious Mononucleosis (MONO):

A

Sore throat

Cervical lymph adenopathy

Fever

375
Q

Classic signs and symptoms of Parkinson’s:

A

Pill-rolling tremors

376
Q

Classic signs and symptoms of Cystic Fibrosis:

A

Salty skin

377
Q

Classic signs and symptoms of Diabetes Mellitus (DM):

A

Polyuria

Polydipsia

Polyphagia

378
Q

Classic signs and symptoms of Diabetic Ketoacidosis (DKA):

A

Kussmaul’s breathing (rapid deep breaths)

379
Q

Classic signs and symptoms of Bladder Cancer:

A

Painless hematuria

380
Q

Classic signs and symptoms of Benign Prostatic Hypertrophy (BPH):

A

Reduced size and force of urine stream

381
Q

Classic signs and symptoms of Retinal Detachment:

A

Visual floaters, flashes of light, curtain vision

382
Q

Classic signs and symptoms of Glaucoma:

A

Painful vision loss

Tunnel vision

Halo vision

(Loss of peripheral vision)

383
Q

Classic signs and symptoms of Cataract:

A

Painless vision loss

Opacity of lens blurs vision

384
Q

Classic signs and symptoms of Retino Blastoma:

A

Cat’s eye reflex (grayish discoloration of pupil)

385
Q

Classic signs and symptoms of Acromegaly:

A

Coarse facial features

386
Q

Classic signs and symptoms of Duchennes’s Muscular Dystrophy:

A

Gower’s sign (use of hands to push one’s self from the floor, making like a table shape)

387
Q

Classic signs and symptoms of Gastroesophageal Reflux Disease (GERD):

A

Barrett’s esophagus (erosion of the lower portion of the esophageal mucosa)

388
Q

Classic signs and symptoms of Hepatic Encephalopathy:

A

Flapping tremors

389
Q

Classic signs and symptoms of Hydrocephalus:

A

Bossing sign (prominent forehead)

390
Q

Classic signs and symptoms of Increased ICP:

A

Cushing’s Triad

HYPER-tension
BRADY-pnea
BRADY-cardia

391
Q

Classic signs and symptoms of Shock:

A

HYPO-tension

TACHY-pnea

TACHY-cardia

392
Q

Classic signs and symptoms of Meniere’s Disease:

A

Vertigo

Tinnitus

393
Q

Classic signs and symptoms of Cystitis:

A

Burning upon urination

394
Q

Classic signs and symptoms of Ulcerative Colitis:

A

Recurrent bloody diarrhea

395
Q

Classic signs and symptoms of HYPO-calcemia:

A

Positive Chvostek & Trosseau’s signs

396
Q

Classic signs and symptoms of Lyme Disease:

A

Bull’s-eye rash

397
Q

Therapeutic levels of Dilantin:

398
Q

Therapeutic levels of Theophyline:

399
Q

Therapeutic levels of Acetaminophen:

400
Q

Therapeutic levels of Lithium:

401
Q

Therapeutic levels of Digoxin:

402
Q

Osteomyelitis:

A

Infectious bone disease.

Blood cultures and deliver antibiotics. If necessary, surgery to drain abscess.

403
Q

Nephrotic syndrome:

A

Presents with edema and HYPO-tension.

Turn and reposition patient; risk for impaired skin integrity.

404
Q

Normal serum Creatinine levels:

A

Men = 0.8-1.8

Women = 0.5-1.5

405
Q

Medical interventions for Cystic Fibrosis:

A

Low fat, high sodium, fat-soluble Vitamins (ADEK) diet.

Aerosol bronchodilators.

Mucolytics and pancreatic enzymes.

406
Q

Side effects of Zoloft:

A

Agitation, sleep disturbance, and dry mouth.

407
Q

Side effects of Clozapine:

A

Agranulocytosis, tachycardia, and seizures.

408
Q

Blood tests for Myocardial Infarction:

A

Myoglobin

CK

Troponin

409
Q

Considerations for use of salt substitutes:

A

May contain Potassium

410
Q

Assessment of Stomas:

A

Dusky - poor blood supply

Protruding - prolapsed

Sharp pain - peritonitis

Rigidity - peritonitis

Mucus in ileal conduit is expected

411
Q

Side effects of Dilantin:

A

Rash (stop meds)

Gingival hyperplasia

412
Q

Clinical manifestations of Dilantin toxicity:

A

Poor gait and coordination

Slurred speech

Nausea

Lethargy

Diplopia

413
Q

Anti-seizure medications during pregnancy:

A

Phenobarbital is Ok.

Dilantin is contraindicated.

414
Q

Steps for Incentive Spirometry:

A

1) Sit upright
2) Exhale
3) Insert mouthpiece
4) Inhale for 3 seconds
5) Hold for 10 seconds

415
Q

Signs of allergy during blood transfusion:

A

1) Flank pain
2) Frequent swallowing
3) Rashes
4) Fever
5) Chills

416
Q

Precautions for Thrombocytopenia:

A

Bleeding precautions

Soft tooth brush

Nothing inserted (douche, etc.)

Minimize IM medications

417
Q

Treatment for Iron Deficiency Anemia:

A

Iron PO with Vitamin C on an empty stomach

Iron IM - Inferon via Z-track

418
Q

Clinical manifestations of Burns:

A

1st Degree - red and painful

2nd Degree - blister and painful

3rd Degree - painless due to blocked and burned nerves

419
Q

Triad for Meniere’s Disease:

A

Vertigo

Tinnitus

Nausea & Vomiting

420
Q

Pattern of pain associated with Gastric Ulcer:

A

Occurs 30 - 90 minutes after eating

Doesn’t occur at night

Doesn’t go away with food

421
Q

Priority nursing interventions during Sickle Cell Crisis:

A

FLUID administration

PAIN relief

422
Q

Most important nursing assessment for Glomerulonephritis:

A

Blood pressure

423
Q

Clinical manifestations of Pyloric Stenosis:

A

Mild vomiting that progresses to projectile vomiting

424
Q

Cardiac consequence of Kawasaki Disease:

A

Coronary artery aneurysms; due to the inflammation of blood vessels

425
Q

When are MMR and Varicella immunizations given?

A

15 months of age

426
Q

Contraindicated procedure for head injuries or skull fracture:

A

Nasotracheal suctioning

427
Q

Most common sites for metastasis:

A

Liver

Brain

Lungs

Bone

Lymph

428
Q

Nursing priority for small bowel obstruction:

A

Maintaining fluid balance comes first because patient will be on oral fluid restrictions.

Reestablishing a normal bowel pattern is not a priority.

429
Q

What is released during an allergic response?

A

Basophils release histamine

430
Q

Iatragenic:

A

Caused by treatment, procedure, or medication

431
Q

Four-side rails up:

A

Considered a restraint and requires a doctors’ orders.

432
Q

Priority nursing concern for cancer patient receiving radiation:

A

Infection as leukopenia is caused by radiation and the patient is now immunocompromised.

433
Q

Potassium and blood chemistries:

A

Alkalosis - al-K-a-LO-sis - Potassium is LOW

434
Q

Priority vital sign to check with HIGH potassium:

A

Pulse; dysrhythmias are imminent.

435
Q

Medication consideration for Myasthenia Gravis and eating:

A

Neostigmine is given 45 minutes before meals to help with chewing and swallowing.

436
Q

Priority nursing intervention for Pulmonary Embolism (PE):

A

Oxygen (O2)

437
Q

Action of Atropine:

A

Blocks acetylcholine (reduces secretions)

438
Q

Diagnosis of Hirschsprung’s Disease:

A

Rectal biopsy reveals absence of ganglionic cells. No innervation of intestinal muscles.

Cardinal sign in infants is failure to pass meconium and later classic ribbon-like and foul smelling stools.

439
Q

Indication by low magnesium and high creatinine:

A

Signals renal failure

440
Q

Highest priority with Rheumatoid Arthritis (RA):

A

Usually pain

441
Q

Priority nursing assessment with Status Epilepticus:

A

Level of consciousness

442
Q

Priority nursing assessment for Addison’s patient:

A

Blood pressure; disease can result in Addisonian crisis presenting with severe HYPO-tension.

443
Q

Most accurate method for medication dosing for kids:

444
Q

Action when observing nurse making mistake:

A

Talk to person first

Then talk to management

445
Q

Reportable (communicable) diseases:

A

TB

Gonorrhea

446
Q

Action of Vasopressin:

A

Vasoconstriction

Vaso-press-in

447
Q

You have delegated care of a patient in restraints to a nursing assistant. How often should the nursing assistant assess skin integrity for this patient?

A

Every 30 minutes

448
Q

You enter a patients room and find the patient not breathing, no pulse, and unresponsive. You have called for help. What is the next step?

A
  1. ) Open airway

2. ) Begin chest compressions

449
Q

The most appropriate place to check the pulse on a 1-month-old infant is:

450
Q

A patient with COPD would most likely develop which acid-base imbalance?

A

Respiratory acidosis

451
Q

Kussmaul respirations:

A

Abnormally deep, regular and increased respirations.

452
Q

You are assisting the physician with removal of a chest tube. The nurse should instruct the patient to:

A

The nurse should instruct the patient to perform the Valsalva’s maneuver (take a deep breathe, exhale and bear down). Then the tube would be quickly removed and an airtight dressing placed. An alternative would be to ask the patient to take a deep breathe and hold the breath while the tube is removed.

453
Q

Stridor:

A

The physician will need to be notified if the patient develops stridor. Stridor is a high-pitched, coarse sound heard over the trachea. This is an indication of airway edema, which puts the patient at risk for airway blockage.

454
Q

Croup:

A

Worse symptoms at night that improve during the day. Usually, a child develops croup after several days of respiratory infection. Croup begins with a harsh, brassy cough, sore throat and inspiratory stridor. The patient may develop a low grade fever, but in some cases the fever will get as high as 104 degrees.

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