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Kaplan/UWorld > UWorld > Flashcards

UWorld Flashcards

1
Q

SSRI drug names? What do they treat? Therapeutic effect?

A

Fluoxetine, sertraline, citalopram

Treats major depression and generalized anxiety

Therapeutic effect in 1-4 weeks

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2
Q

What are the SE of SSRI?

A

Loss of appetite, weight gain/loss
GI disturbances
HA, dizzy, insomnia, drowsiness
Sexual dysfunction
Risk of suicide especially in young adults during initial therapy or after dose changes

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3
Q

A client reporting increased energy with little or no reduction of depression needs what?

A

Immediate assessment for suicide risk

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4
Q

What needs to be done by the RN?

A

Clinical assessment
Initial patient education
Discharge education
Clinical judgement
Initiating blood transfusion

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5
Q

What is the scope of practice for an LPN/LVN?

A

Monitoring RN findings
Reinforcing education
Routine procedures
Most medications (PO, Tube)
Ostomy care
Tube patency and enteral feeding
Limited assessments (lungs, bowel sounds and neuro checks)

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6
Q

What is the scope of an UAP?

A

ADL
Hygiene
Linen change
Routine, stable VS
Documenting I&O
Positioning

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7
Q

What are the 5 rights of delegation?

A

Right task - within scope
Right circumstances - stable patient, resources available if needed
Right person - assess competency and have appropriate knowledge, skills, and ability
Right direction/communication - clear instructions
Right supervision/eval

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8
Q

What are s/s of phlebitis?

A

erythema, edema, warmth, pain and palpable venous cord

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9
Q

What are s/s of infiltration?

A

Edema
Coolness to the touch around the insertion site
May cause edema to dependent areas

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10
Q

What is Guillian-barre syndrome (GBS)?

A

Acute, immune mediated polyneuropathy that can

Ascending muscle paralysis and absence of reflexes

Neuromuscular respiratory failure is the most life threatening complication. Rate and depth should be monitored by serial bedside forced vital capacity (spirometry)

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11
Q

What are the SE of sulfa medications?

A

Crystalluria causing kidney injury (drink more water)
Photosensitivity and risk for sunburn
Folic acid deficiency
Agranulocytosis
SJS

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12
Q

What are the s/s of a transfusion reaction?

A

Chills
Fever
Low back pain
Flushing
Itching

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13
Q

What should the nurse do if the patient has a transfusion reaction?

A

Stop transfusion immediately and disconnect the tubing
Maintain IV access with normal saline using new tubing to prevent hypotension and vascular collapse
Notify HCP and blood bank
Monitor VS
Recheck labels, numbers, and blood type
Treat patient symptoms with provider orders
Collect blood and urine to evaluate for hemolysis
Return blood and tubing to blood bank
Complete paperwork

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14
Q

What should are airborne precautions?

A

N95 respirator
Negative pressure isolation room
As needed if contact with body fluid wear gloves, disposable gown and goggles/faceshield

TB, Varicella, herpes zoster, rubeola/measles

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15
Q

What are the s/s of a cardiac tamponade?

A

Narrowed pulse pressure
Hypotension
JVD
Muffled/distant heart tones
Pulsus paradoxus
Dyspnea
Tachypnea
Tachycardia

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16
Q

What is a cardiac tamponade? Treatment?

A

Fluid build up in the pericardial sac and compresses the heart

Emergency pericardiocentiusis is needed

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17
Q

What is the spleen apart of? If it is removed what occurs?

A

Spleen is a part of the immune system to filter/purify blood and remove microorganisms that cause infection

Lifelong complication if removed is overwhelming postsplenecotmy bacterial infection or rapid onset sepsis

Monitor for low grade fever, chills or HA

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18
Q

What is muscular dystrophy? s/s?

A

X-linked recessive disorder that causes a decrease in a protein needed for muscle stabilization. Lower extremities and pelvis are affected first

Calf muscle hypertrophy initially
Gower sign/maneuver (stands by hands pushing off of thighs)
Walk on tip toes
Frequent tripping and falling

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19
Q

What does X-linked mean?

A

Carried by females and affects males

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20
Q

What are the s/s of cataracts?

A

Blurred vision
Photosensitivity
Halo around eyes

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21
Q

What are the s/s of macular degeneration?

A

Blurred vision
Blindness
Reduced mental vision

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22
Q

What are the s/s of open angle glaucoma?

A

Blurred vision
Tunnel vision
Blindness

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23
Q

What are stimulant meds used to treat? Examples?

A

ADHD

Methylphenidate (ritilin)
Amphetamines

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24
Q

What are major problems with stimulant medications?

A

Decrease appetite and weight loss –> growth delays
HTN and tachycardia
Appearance of new vocal/motor tics
Excess brain stimulation –> restlessness and insomnia
Abuse potential

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25
Q

What is developmental dysplasia of the hip? Treatment?

A

Instability of hip joint. Treatment most successful if initiated in first 6 months

Pavlik harness to treat DDH early maintains hips slightly flexed and abducted. Worn for 3-5 months

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26
Q

What are the instructions for a pavlik harness?

A

Regularly assess skin
Dress in shirt and knee socks under harness
Avoid lotions and powders
Light massage the skin under strap to promote circulation
Only apply 1 diaper at a time
Apply diaper underneath the straps

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27
Q

What is clonidine used for? How often should the patch be changed?

A

Antihypertensive agent

Changed every 7 days

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28
Q

What are the instruction regarding a clonidine patch?

A

Apply patch to dry hairless area
Do not shave, have any cuts, scraps, calluses or scars
Wash hands before and after application
Wash area with soap and water
Rotate sites
Fold patch in half when discarding and keep out of reach of children and pets
Notify HCP if dizziness occurs or decrease HR but don’t remove patch w/o talking with HCP first

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29
Q

What could occur as cirrhosis processes? What does this cause? What can be given for it?

A

Cirrhosis can affect the biliary structures and function.

Pruritis can occur b/c bile ducts become obstructed and bile accumulate in body

Give choletyramine (bile acid sequesterant) to block the reabsorption of blue acid. Should be taken 1 hour after other meds because can affect absorption of other meds

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30
Q

What is intussusception? S/s? Diagnosis?

A

Intestine prolapses and telescopes into another part

Intermittent periodic pain
Legs drawn up
Pain is severe, progressive and inconsolable crying
Currant jelly stool

Contract enema
Air enema

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31
Q

What should not be taken together d/t serotonin syndrome? What is serotonin syndrome symptoms?

A

SSRI and St Johns Worts

Shivering
Diarrhea
Muscle rigidity
Fever
Seizures

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32
Q

What are contraindications to the combined hormonal contraceptive methods?

A

Active breast cancer
Migraines with aura
Uncontrolled HTN
Active hepatitis, cirrhosis, liver cancer
Age 35 and up and smokes 15 or more cigarettes/day
Ischemic heart disease or stroke
Less than 3 weeks PP
Prolonged immobilization
Thrombophilia
Venous thromboembolism

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33
Q

What are barriers to self care?

A

Knowledge
Skills/supplies
Motivation (always assess the motivation of a patient to adhere to treatment)

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34
Q

What situations are implied consent used?

A

This is an emergency
Treatment is required to protect the patients health
It is impractical to obtain consent
It is believed that the patient would want treatment if able to consent

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35
Q

What is hydroxcloroquine? What is it used for? What are the SE?

A

Antimalarial drug used to reduce fatigue and treat skin and arthritic pain in patients with lupus

Retinal toxicity and visual disturbances so ophthalmologic exam every 6-12 months

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36
Q

What are the s/s of hypoglycemia?

A

Sweating and pallor
Irritability and anxiety
Tremors and weakness
Tachycardia and palpitations
Drowsiness
Hunger
Restlessness

Immediate danger of lethargy, seizures, coma if brain becomes depleted of glucose

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37
Q

What are the s/s of epiglottis? What is the most common cause?

A

Rapid onset of a high grade fever and sore throat, drooling, dysphonia, dysphagia, distressed airway (inspiratory stridor), tripod position

Haemophilus influenza B (Hib) so important to get vaccinated

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38
Q

What foods are rich in iron?

A

Meats
Shellfish - oysters, clams, shrimp
Eggs
Green leafy veggies
Dried fruits
Dried beans
Brown rice
Oatmeal

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39
Q

What should the nurse do for a patient with bacterial meningitis?

A

HOB 30 degrees
Implement seizure precautions d/t increased ICP
Ensure a restful environment
Droplet precautions

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40
Q

What are the absolute contraindications for thrombolytics?

A

Prior intracranial hemorrhage
Stuctural cerebrovascular lesion (arteriovenous malformation, aneurysm)
Ischemic stroke within 3 months
Suspected aortic dissection
Active bleeding
Significant head trauma within 3 months

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41
Q

What should you provide oral care with in a patient on a vent?

A

Chlorahexidine followed by endotracheal suctioning

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42
Q

If a patient overdoses on recreational drugs can it cause schizophrenia?

A

It can trigger it because it causes an imbalance in neurotransmitters which can lead to an acute psychotic episode but in rare cases it can lead to schizophrenia if genetically predisposed

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43
Q

What is opxybutynin and what does it treat? What are the SE?

A

Anticholinergic used to treat overactive bladder

New onset constipation
Dry mouth
Flushing
Heat intolerance
Blurred vision
Drowsiness

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44
Q

What are proton pump inhibitors? What are they used for? ADR?

A

“prazole” used to suppress gastric acid secretions in conditions like GERD and treatment/prevention of peptic ulcer disease

Malabsorption of calcium, iron, mg, and B12
Increases risk of infection - C-diff
Osteoporosis
CKD

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45
Q

What is metoclopromide? What is it used for? ADR?

A

Used for treatment of delayed gastric emptying, GERD and antiemetic

Associated with extrapyramidal adverse effects including tardive dyskinesia especially when used long term in older adults so watch/call if protruding/twisting of tongue, lip smacking, puffing of cheeks, chewing movements, frowning or blinking eyes, twisting fingers, twisted/rotated neck

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46
Q

What is the treatment for peptic ulcer disease?

A

Avoid spicy food, acidic foods and black pepper
Avoid substances that stimulate acid secretion and delay healing like anti-inflam drugs, alcohol, caffeine, chocolate, tabacco
Reduce stress and get sufficient rest
Take the triple drug therapy (7-14 days of omeprazole, amoxicillin, and clarithromycin)

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47
Q

What are ACHES associated with contraceptive use?

A

Abdominal pain - ischemic bowel
Chest pain - pulmonary embolism/MI
Headaches - stroke
Eye problems - retinal blood vessel ischemia
Severe leg pain. - DVT

ALL due to increased risk for blood clots

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48
Q

What does small, rocky, hard stool mean?

A

Constipation

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49
Q

What does light clay colored stool mean?

A

Biliary obstruction

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50
Q

What does mucus or pus mean in stool?

A

Ulcerative colitis or infectious colitis

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51
Q

What does greasy, foamy, foul smelling stool mean?

A

Chronic pancreatitis

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52
Q

What does black tarry stool mean? Bright red bloody?

A

Black - upper GI bleed

Red - lower GI bleed

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53
Q

What does blood present on surface of stool/streaks mean?

A

Hemorrhoids

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54
Q

What are life threatening complications of chirrhosis? What symptoms would they have?

A

Upper GI bleed or bleeding esophageal varicies

Black tarry stool

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55
Q

Hepatitis B is transmitted by?

A

Blood
Semen
Vaginal discharge

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56
Q

What does a Fib look like? Which procedure is it common after? Treatment?

A

Absence of P wave with fibrilatory waves and irregular rhythm

Common after CABG

Treat with antiarrythmic meds like beta blockers and digoxin

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57
Q

What should be the care after a CABG?

A

Covering the patient with a warm blanket and increase room temp and warm IV fluids d/t hypothermia on bypass

Monitor patients blood pressure via an arterial line

Notify HCP if chest tube drainage is >100mL/hr (could indicate hemorrhage

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58
Q

What is a life threatening complication that could occur after esophagogastroduodenoscopy? S/S?

A

Perforation - notify HCP immediately if pt gets a fever

Sudden temp spike
Increasing pain/tenderness
Restlessness
Tachycardia
Tachypnea

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59
Q

What is a hyper cyanotic episode associated with? What should you do?

A

Tetralogy of fallot

Knee-chest position to increase blood to get back to heart
Supplemental O2
Decrease stimuli

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60
Q

What are sulfonylurea medications? What are major SE of them?

A

Glyburide, glipizide, glimepiride

Hypotension
Weight gain
Serious sunburns

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61
Q

What is chronic venous insufficiency? S/S?

A

Veins of lower extremities fail to move blood causing increase venous pressure and the increase pressure pushes fluid out of the vascular space into tissues and enzymes break down RBC

Brownish skin discoloration
Chronic edmea
Tissue hardens and appears leathery
Skin is highly prone to break down and ulcerations especially inside the ankle

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62
Q

When do fat embolisms commonly occur? S/S

A

Fracture of long bones and pelvis

Altered mental status if in brain
Resp distress if in lungs
Hallmark sign is petechiae from small vessel clotting across the chest, axilla, and soft palate

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63
Q

What are omphalocele and gastroschisis?

A

Congenital defects of the abdominal wall

Omphalocele - bowel covered by peritoneal sac herniates through abd wall
Gastroschisis - bowel herniates through wall w/o sac

Immediately after birth cover herniated bowel with non-adherent dressing like plastic bowel bag and saline-soaked gauze to prevent fluid loss and protect the bowel

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64
Q

What should you monitor with omphalocele and gastroschisis?

A

Temperature stability
Infection
Fluid loss
Initiate IV access for antibiotics and fluids

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65
Q

What is acute post infectious glomerulonephiritis? S/S?

A

Immune reaction that occurs 2-3 weeks following a skin or UPI

Gross hematuria (tea/cola colored)
Edmea (periorbital/generalized)
HTN
Protein, blood and red blood cell casts in urine
Increase serum creatinine and ASO/strepoenzyme test

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66
Q

What teaching should be included about impetigo?

A

Avoid linen sharing or personal items
Keep patients fingernails short d/t scratching
Soak the lesions and then remove the crusts with antiseptic soap and water and then coat with prescribed antibiotic using a cotton application

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67
Q

S/S of increased ICP?

A

Change in LOC
projectile vomitting
Ataxia
Ipsilateral/unilateral pupil dilation
Seizures
HA

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68
Q

What are Statin drugs used for? ADR?

A

Lower cholesterol and reduce risk of atherosclerosis and coronary artery disease

Myopathy with generalized weakness and muscle aches

If muscle aches occur should get a creatine kinase level b/c will be significant elevated if myopathy is occurring

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69
Q

What should you do if you can flush a central line?

A

Reposition the patient b/c catheter tip may be resting against a valve or kinked
Assess IV for any external clamps, kink and precipitate
If neither of those work then do not flush again b/c could dislodge a clot and contact HCP who might order med to dissolve clot

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70
Q

What is included in the DASH diet?

A

Including fresh fruits and vegging and whole grains
choosing fat free or low fat dairy products
Choosing meats lower in cholesterol such as fish/poultry and alternate protein sources like beans
Limiting intake of sweets, foods high in sodium, and sugary beverages to an occasional treat

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71
Q

What is included in the DASH diet?

A

Including fresh fruits and vegging and whole grains
choosing fat free or low fat dairy products
Choosing meats lower in cholesterol such as fish/poultry and alternate protein sources like beans
Limiting intake of sweets, foods high in sodium, and sugary beverages to an occasional treat

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72
Q

What are s/s of lithium toxicity?

A

GI - N/V and diarrhea
Neuro - ataxia, sluggishness, confusion, agitation, neuromuscular excitability (tremors)

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73
Q

What are the S/S of impetigo? Caused by? Treat? Complication?

A

Pustules/vasicles with honey crusted lesions
Most commonly on face/etremities

Caused by staph and group A strep

topical antibiotics if localized and oral antibiotics if extensive

Poststreptococcal glomerularnephrtitis

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74
Q

How do you avoid lithium toxicity? Can you take lithium and NSAIDS together?

A

Drink at least 8-12 cups of water a day b/c lithium increased urination which could cause dehydration and lead to lithium toxicity
Receive routine blood tests (therapeutic 0.6-1.2 and toxic is over 2)

No, NSAIDS can increase renal absorption of lithium

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75
Q

What are the risks with polyhydramnios? What could increase risk of pt having this?

A

Umbilical cord prolapse
PP hemorrhage - overdistention of uterus leading to muscle poorly contracting after birth

Patient with DM

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76
Q

What is tines capitis? Transmitted? Treatment?

A

Fungal infection of scalp transmitted via direct contact such as bedding, hairbrush

1% selenium shampoo several times each week and anti fungal medication (Griseofulin) for weeks to months and should no be discontinued early to ensure keratin is shed completely

Griseofulin will absorb best when taken after food high in fat

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77
Q

What should you treat you patient about their AV fistula?

A

Avoid sleeping on the arm with AVF
Avoid creams/lotions on the site
Avoid lifting heavy objects on side with AVF but performing mild exercises like squeezing ball helps increase strength
Feel for a vibration
Avoid restrictive jewelry to prevent thrombosis
Monitor/report any immediate signs of infection/bleeding after dialysis

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78
Q

What is HELLP?

A

Hemolyiss
Elevated liver enzymes
Low platelets

Occurs after 20 weeks and presents as elevated liver enzymes, RUQ pain, malaise, nausea, decrease platelets

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79
Q

What interventions should be included for a patient with HELLP?

A

Preparing patient for birth
Initiating mg sulfate for seizure prophylaxis
AnhiHTN meds PRN ofr stroke
Evaluate deep tendon reflexes -Hyperreflexia and clonus (pre-e) hyporeflexia (mg toxicity)
Monitor clotting factors and monitor for DIC

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80
Q

What are the S/S of a TCA overdose?

A

Mental status changes like drowsy, delirium, coma
Seizures
Resp depression
Tachycardia
Hypotension
Prolonged PR/QT/QRS
Arrythmias
Anticholinergic ( dry mouth, blurred vision, dilated pupils, urinary retention, hyperthermia)

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81
Q

What is the home care for CF?

A

Regular exercise
Annual flu vaccine
Breathing exercises
Lifelong vitamin supplements
Pancrelipase capsules to enhance absorption of food in GI tract. Capsule may be opened and sprinkles on applesauce or acidic soft food if cant be swallowed whole

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82
Q

What is allergic contact dermatitis?

A

TV hypersensitivity reaction that manifests are pruritic painful, erythematous rash in the area that is exposed to the irritant

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83
Q

What is impetigo?

A

Highly contagious bacterial infection of the skin that manifests as erythematous fluid-fluid lesion on exposed areas. Honey colored crust can form

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84
Q

What does a myxedema coma look like? What is the treatment?

A

Everything goes down (hypothermia, hypoventilation, bradycardia, hyper/hypotension with narrow pulse pressure, decreased mental status, non pitting edema, hyponatremia and hypoglycemia)

Pts with slow shallow breathing or low O2 require emergency intubation

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85
Q

When does mild withdrawal occur in AWS? S/S?

A

6-24 hours

Anxiety, insomnia, tremors, diaphoresis, palpitations, GI upset, intact orientation

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86
Q

When does seizures occur in AWS? Type?

A

12-48

Single or multiple generalized tonic clonic

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87
Q

When does alcohol hallucinations occur in AWS? S/S?

A

12-48 hours

Visual, auditory, or tactile

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88
Q

When does delirium tremens occur? S/S?

A

28-96 hours after last drink

Confusion, agitation, fever, tachycardia, HTN, diaphoresis, hallucinations

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89
Q

What should the nurse monitor for with a patient with guillian-barre syndrome?

A

Abdominal distension (d/t decrease bowel movement)
Blood pressure variability (d/t autonomic dysreflexia)
Decreased RR and depth
Difficulty swallowing
Urinary retention

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90
Q

Is HDL or LDL good cholesterol?

A

HDL is good cholesterol

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91
Q

What is Hirschsprung disease? S/S?

A

Lack of nerve innervation in the distal large intestine relating in inability to relax internal anal sphincter

Distended abdomen
Feeding intolerance
Vomitting green bile
Absence of meconium passage

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92
Q

What is Tiotropium? How is it administered?

A

Long acting anticholinergic used to control COPD

Administered via capsule inhaler so patient will place capsule in inhaler and it will poke a small hole to be inhaled. DO NOT swallow the capsule

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93
Q

What is phenytoin used for? Special admin?

A

Anticonvulsant used to treat seizures

Absorbed slowly and requires steady absorption so pause tube feedings if given via tube

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94
Q

What medication is used to treat supra ventricular tachycardia?

A

Adenosine

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95
Q

What medication is used to treat tachyarrythmias?

A

Metoprolol/beta blocker

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96
Q

What is Torsades de pointes? What treats it?

A

Polymorphic ventricular tachycardia that has QRS complexes that change size and shape in a twisting pattern usually d/t a prolonged QT interval caused by hypomagnesemia

Treat my giving IV Mg

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97
Q

What is the protocol for giving CPR to an infant?

A

Check brachial pulse for no longer than 10 seconds
If unwitnessed collapse by a single rescuer, the rescuer should give 2 minutes of CPR before getting AED
Chest compressions should be given at a depth of 1/3 anterior/posterior chest
Infant compression using 2 fingers or 2 thumbs on the sternum just below nipple line
Single rescuer 30:2, Double rescuer 15:2

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98
Q

After knee arthroplasty what should the nurse do to prevent contracture?

A

Place a pillow under the leg or heal

DO NOT place the pillow under the knee because it causes flexion increasing risk of contracture

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99
Q

What are a risk of ACE inhibitors and ARBs?

A

Can potentiate hyperkalemia

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100
Q

What kind of drug is benztropine? What is it used to treat?

A

Anticholinergic/antiparkinson med

Used to treat EPS which are a serious ADR of some antipsychotic medications

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101
Q

What is the care for a coronary arteriogram?

A

Not eating or drinking anything 6-12 hours prior
Warn pt that they may feel warm/flushed d/t contrast
Hemostatsis must be obtained so usually arterial line with femoral artery so pt needs to lay flat for several hours

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102
Q

What are risks of thiazide diuretics? What herbal remedy should not be used with them? What should be encouraged with thiazides?

A

Hypokalemia and hyponatremia

Should not be used with licorice root (used for GI like ulcer, heartburn. colitis) because can increase potassium loss

Encourage foods with potassium

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103
Q

What increases an infants risk for otitis media?

A

Exposure to tobacco
Using a pacifier
Drinking a bottle when lying down

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104
Q

What is sodium polystyrene sulfonate? what does it treat and how? What are pts at risk for?

A

Kayxelate

Treats hyperkalemia by exchanging potassium for sodium in the intestines and then potassium is excreted in the stool

If patents do NOT have normal bowel function (Post surgery, constipation, fecal impaction) then there is a risk for intestinal necrosis
All patients at risk for fluid volume overload because excess sodium absorbed

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105
Q

What is myopia? S/S?

A

Nearsidedness - cant see object far away

Hold object close to the face
Squint to see clearly
HA
Dizzy
School performance can be affected

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106
Q

What is misoprostol? What is it used for?

A

Cytotec - synthetic prostaglandin to protect against gastric ulcers by reducing stomach acid and promoting mucus production and cell regeneration

Used to prevent ulcers in patients getting long term NSAIDS

Antacids especially with mg should not be used with this because increased ADR like dehydration and diarrhea

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107
Q

What is the treatment of frostbite?

A

Remove jewelry and clothing to prevent constriction
DO NOT massage rub or squeeze area
Immerse affected area in warm water preferably in a whirlpool
Avoid heavy blankets/clothing to prevent tissue sloughing
Provide pain management since rewarming is painful
As thaws can get edema and blisters so elevate in area
Keep wound open after whirlpool to dry then apply loose nonadherant sterile dressing
Monitor for s/s of compartment syndrome

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108
Q

What is cranial nerve I? How is it tested?

A

Olfactory nerve

Tested by having patient recognize an odor

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109
Q

What is cranial nerve III? How do you test it?

A

motor nerve of the eye

Tested by tracking an object

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110
Q

What is cranial nerve II? How do you test it?

A

Sensory nerve

Testing field of vision for the clients ability to see objects in the field
Bring your fingers in from the side to the middle until patient can see them

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111
Q

What is cranial nerve VII? How do you test?

A

Facial nerve

Tested by using facial movements like scrunching eyebrows, smiling, frown, show teeth

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112
Q

What is projection?

A

Attributing uncomfortable thoughts/behaviors to someone/something

calling the sidewalk stupid after tripping

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113
Q

What is regression?

A

Behaving as if much younger to avoid uncomfortable thoughts/behaviors

Moving back to parents to avoid responsibilities

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114
Q

What is repression?

A

Unintentionally blocking uncomfortable tohught/behaviors form consciousness

Being unaware of a past traumatic experience

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115
Q

What is displacement?

A

Redirecting uncomfortable thoughts/behaviors from it original source to another person/object

Punching a pillow when angry at parents

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116
Q

What is sublimation?

A

Transforming unpleasant thoughts/behaviors into pleasant thoughts/behaviors

Attending a boxing class as a way to channel ones anger

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117
Q

What is reaction formation?

A

Behaving in a manner opposite of unpleasant thoughts/behaviors

Expressing love for a person one despises

118
Q

What are s/s of colorectal cancer?

A

Blood in the stool
Abd discomfort
Anemia
Change in bowel habits
Unexplained weight loss

119
Q

What are SE of opioids?

A

Sedation
Resp depression
Hypotension
Constipation

120
Q

What is narcissistic personality disorder?

A

Reccurt pattern of grandiosity, the need for admiration, and lack of empathy

Superiority, arrogance, hypersensitive to criticism

121
Q

What is a possible complication of an amnioinfusion?

A

Uterine over distension

Monitor baseline resting tone and if elevated and there is minimal to absent fluid return then pause infusion and notify HCP

122
Q

Muscle relaxer example

A

Cyclobenaprine

123
Q

NSAIDS

A

ibuprofen
naproxen
celecoxib

124
Q

Neuropathic pain reliever examples

A

Gabapentin
Pregabalin

125
Q

SSRI example

A

Fluoxetine
Duloxetine

126
Q

Tricyclic antidepressant examples

A

Amitriptyline

127
Q

What are 2 teaching points about the storage of nitro tablets?

A

Need to be stored at room temp/avoid temp extremes
Light resistant bottle

128
Q

S/S for neurogenic shock?

A

Vascular dilation with decreased venous return to the heart d/t loss of innervation from spine (usually cervical or T6 and higher)

Hypotension, bradycardia, pink and dry skin

129
Q

What helps to relieve pain in PAD?

A

Dangling limbs over side of bed because allows gravity to maximize blood flow

130
Q

What is a common practice in patients with raynauds syndrome?

A

Immersing hands in warm water to decrease vasospasm

131
Q

What are some causes of secondary amenorrhea?

A

Pituitary tumors - suppress LH and FSH
Low body weight
POCO
Excessive exercise

132
Q

When on warfarin, what common foods increase risk of bleeding?

A

Ginger
Garlic
Ginkgo biloba

133
Q

What is the only treatment for syphilis when pregnant? What if allergic?

A

IM penicillin

If allergic, nurse should do penicillin desensitization

134
Q

What is malignant hyperthermia? S/S? Treatment?

A

Rare life threatening muscle abnormality triggered general anesthesia

Excessive release of calcium from muscles –> muscle contraction and rigidity

Hypercapnia, muscle rigidity, rigid jaw, increase HR & RR, hyperthermia

Notify HCP immediately for treatment - dantrolene, cooling blanket, fluids

135
Q

What are expected findings are general anesthesia?

A

Pin point pupils

Hypothermia

136
Q

What are s/s of inflammatory breast cancer?

A

red warm tissue that has an orange peel pitting appearance

Very concerned because this is a very aggressive form of cancer

137
Q

What is a side effect of carbamazepine?

A

Agranulocytosis

Look of sore throat

138
Q

What is a good drug to treat C. diff with?

A

Metronidazole
Oral vancomycin

139
Q

Can you give codeine/sedatives to a patient with respiratory problems?

A

No

It is also a cough suppressant so suppressing the cough causes a build up of secretions leading to rest difficulty. Also sedatives depress the respiratory center so should be avoided

140
Q

What is intrahepatic cholestatsis of pregnancy?

A

Liver disorder that manifests as itching but no rash usually on hands and feet that gets worse at night.

Increases risk of fetal demise

141
Q

What are the manifestations of neonatal abstinence syndrome?

A

Neuro: irritability, hypertonia, jittery movement, seizures
GI: vomitting, diarrhea, feeding intolerance
Autonomic: sweating, sneezing, pupillary dilation

142
Q

What should you treat a patient with unilateral weakness from a stoke?

A

Avoid unilateral neglect by teaching to patient to turn head to fully scan the environment

Right sided CVA are usually more impulsive and unaware of deficits

143
Q

What is a concern regarding actue glomrulonephritis?

A

Severe HTN form fluid volume excess

144
Q

What is pheochromocytoma? Treat?

A

Neuroendocrine tumor that arises in the adrenal medulla and secretes excess catecholamines (Epi, NE, dopamine) –> HTN, HA, sweating tachycardia

AntiHTN meds, 24 hour urine, CT/MRI to localize tumor, surgical removal

145
Q

Feedings with cleft palate?

A

Infant upright position
Special bottles/nipples
Burped more often b/c swallow a lot of air
Feeding slow over 20-30 minutes
Feeding every 3-4 more
Point down and away form cleft

146
Q

If a patient has a low neutrophil count d/t chemo what should they avoid at home?

A

Gardening

Fresh flowers and pants

Soil contains pathogens

147
Q

How do you check for a retinoblastoma?

A

Most common intraoccular childhood malignancy

Absent red reflex, instead a white glow of the pupil because light is reflecting off of the tumor

148
Q

When a patient comes to the PACU after getting a pace maker what is the first thing you should do?

A

Get the patient on the cardiac monitor

149
Q

CPR on an adult

A

Chest compressions at 100-120/min
Depth of 2-2.4 inches
Pads are on right upper chest and left lateral chest
Compressions passed every 2 minutes for 10 seconds to check pulse
Manual breaths given 2 breaths to 30 compressions without advanced airway or once every 6 seconds with advanced airway without stopping compressions

150
Q

Methotrexate? ADR?

A

Antirheumatic med

ADR: bone marrow suppression, hepatotoxicity, and GI (n/v, diarrhea)

Bone marrow suppression –> leukopenia, anemia and thrombocytopenia
Bleeding and high risk for infection

151
Q

Following cataracts surgery what is to be expected?

A

Remain blurry for several hours but improve over the next few days

152
Q

What medications are tetragenic?

A

Phenytoin
Lithium
Valporate
Isotretinoin
Methotrexate
ACE inhibitors
Warfarin
Doxycycline (impair bone mineralization and discolor permanent teeth)

153
Q

What is cranial nerve IX? What if it is damaged?

A

involved in gag reflex and ability to swallow

Supraglottic swallow is taught

Inhale deeply, hold breath tightly to close vocal cords, put food in mouth and swallow while holding breath, cough to dispel any food from cords, swallow a second time before breathing

154
Q

What are atypical symptoms of an MI found in women, elderly, and patients w/ hx of DM?

A

N/V
Belching
Indigestion
Diaphoresis
Dizziness
Fatigue

155
Q

What is conversion disorder?

A

Neuro symptoms brought on my psychosocial stress w/o a clear cause

Medically unexplainable but can lead to significant neuro dysfunction like paralysis and blindness

Distinctive feature is la belle indifference - lack of emotional response to varying deficits

156
Q

If a patient has a possible spinal cord injury what should you do to get an airway?

A

Jaw thrust maneuver while on a backboard

DO NOT use head-tilt-chin-lift because manipulates the neck

157
Q

Nonmalefinence means.. Benefience means…

A

Do not harm

Promote good

158
Q

Pregnant healthcare workers should not be exposed to which infections?

A

Toxoplasmosis
Other (Varicella, Parvo)
Rubella
Cytomegalovirus
Herpes simplex

159
Q

When is a ventriculoperitoneal shunt placed? What is a complication that could occur?

A

Treat hydrocephalus placed at 3-4 months

Blockage and infection

Blockage –> signs of increased ICP such as cushings tired (Bradycardia, slowed RR, Widened pulse pressure)

160
Q

At what age is ibuprofen contraindicated?

A

Less than 6 months d/t GI and renal health risks

161
Q

What is dicyclolmine? When is it contraindicated?

A

Anticholinergic/antispasmodic for patients to manage hyper motility with IBS

Contraindicated in patients with paralytic ileus

162
Q

What helps to prevent stress ulcers in critically ill patients?

A

Hypoxemia –> blood shunted to vital organs –> increase risk of stress ulcer

Early initiation of enteral feeding help to preserve gut mucosa, limit movement of bacteria form intestine to bloodstream and prevent stress ulcers

163
Q

Before giving a loop diuretic like furosemide, what should you assess?

A

Blood pressure
BUN/creatinine
Potassium

164
Q

What could occur when large amounts of albuterol are given?

A

Loses selectivity –> beta 1 receptors activated –> promoting cardiac stimulation

Stimulation of SNS –> palpitations, tachycardia, insomnia, mild tremor, N/V

165
Q

In a patient with acute pancreatitis, what would you expect their blood glucose to be?

A

Increased d/t pancreas not releasing enough insulin

166
Q

If a patient has acute pancreatitis what should you monitor closely for?

A

manifestations of infection because pancreatic tissue can easily become necrotic and infected –> abscess/sepsis

167
Q

What is acute cholecystitis? S/S?

A

Inflammation of the gallbladder

Severe pain after eating
Epigastric pain

168
Q

What is acute pancreatitis? S/S?

A

inflammation of pancreas commonly caused by chronic alcohol or gallstones

Severe pain after eating
Epigastric pain
Relieved by leaning forward

169
Q

How long should you wait in between passes for suctioning?

A

1-2 minutes

170
Q

What is theophylline? What should be avoided?

A

Bronchdilator with a low therapeutic index
Toxicity >20mcg/mL (seizures and arrhythmia)

Cimetidine and ciprofloxacin (dramatically increase theophylline levels)
Caffeine

171
Q

What is the newborn at risk for if mom has diabetes?

A

Hypoglycemia
Polycythemia (increase RBC production d/t poor placental perfusion)
Birth injury
Fetal macrosomia

172
Q

What teaching should be given for isoniazid?

A

Avoid alcohol b/c hepatotoxic
Take pyridoxine (vitamin B6) to prevent neuropathies
Avoid aluminum containing antacids within 1 hour of taking
Report changes in visions
Report s/s of hepatotoxicity and neuropathy

173
Q

What occurs with rifampin that you should educate about?

A

Red-orange urine, saliva, sweat, tears that is normal

174
Q

What things should you know about collecting a 24-hour urine?

A

Dark jug with special powder
Empty bladder and discard it so that the start time is exactly 24 hours
Keep cold in fridge or cooled ice chest

175
Q

What is metabolic syndrome

A

Presence of 3 or more health factors
“We Better Think High Glucose”

Waist circumference increased
Blood pressure increased
Triglycerides increased
HDL decreased
Glucose increased

176
Q

If they have had a transplant of any kind what do you report to the doctors immediately?

A

WBC increase because these patients are on immunosuppressants so they are very susceptible to and infection

177
Q

In post op patients, what is a major priority? Why?

A

Antiemetic medication in those who are N/V because they are at high risk for aspiration d/t their altered LOC

178
Q

What medications should be avoided in older adults?

A

Anticholinergic (first gen antihistamines, GI antispasmodics)
Cardiovascular (Alpha-1 blockers, Alpha 2 agonists, antiarrythmics)
CNS ( TCA, Antipsychs, barbiturates, benzos)
Endocrine (sulfonylureas, sliding scale insulin)
Pain (non-selective NSAIDs, muscle relaxers)

179
Q

If a diabetic patient drinks alcohol, what can it cause?

A

Hypoglycemia so priority is to monitor blood glucose

180
Q

What indicates that the body is no longer compensating for shock?

A

Cool clammy skin

181
Q

What goes on with the spleen in sickle cell?

A

Generally have a small spleen d/t repeated splenic infarctions

Acute splenic sequestration crisis - large number or sickle cells get trapped in the spleen causing splenomegaly

Life threatening because blood pools in the spleen –> hypovolemia and shock

182
Q

Which medications are known to cause orthostatic hypotension?

A

AntiHTN
Antipsy and antidepressants
Diuretics
Vasodilators
Narcotics

183
Q

What is neurogenic shock?

A

Overactive PNS –> relaxes smooth muscles and decreased HR and contractility d/t disruption in the SNS from spinal injury in thoracic or cervical

Bradycardia, massive vasodilation, pooling of blood in venous circulation

184
Q

What is fondaparinux? What can it not be used with?

A

Unfractionated heparin

Cant be used with epidural/spinal blockers d/t risk for bleeding/spinal hematoma –> severe back pain and paralysis

185
Q

What is an antithyroid medication?

A

Methimazole

186
Q

What toxicity can furosemide cause?

A

Ototoxicity with administered in high doses to those with compromised renal function

Administration rate should not exceed 4mg/min

187
Q

If patient is worried about N/V with opioids what do you tell them?

A

Expected SE but tolerance builds quickly so persistent N/V is rare

188
Q

What are the contraindications to using cytotec/misprostol?

A

Receiving another med to ripen/stimulate contractions
Hx of uterine surgery d/t uterine rupture risk
Abnormal fetal HR or uterine tachysystole

189
Q

What are the clinical manifestations of bacterial meningitis for those under 2?

A

Fever or hypothermia
High pitched cry
Poor feeding and vomitting
Nuchal rigidity
Buldging fontanels

190
Q

If a patient has a dust mite allergy what should you instruct them to do?

A

Wash their bed linens in very hot water 1-2 times a week and vacuum that mattress often

191
Q

Are sudden changes in a patient with dementia a concern?

A

Yes, behavioral changes such as agitation, aggression, resistance to care often result from patients inability to identify a stressor such as pain or problems with elimination

192
Q

What are s/s of trichomoniasis?

A

Thin frothy yellow green vaginal discharge
Vulvovaginal erythema
inflmmation
Puritis
Dyspareunia
Bleeding after intercourse
Urinary pain and frequency

193
Q

Can an LPN preform sterile procedure

A

Yes if there is an established prescription plan

194
Q

After repair of a abdominal aneurysm what needs to be monitored closely?

A

Renal perfusion status

Hypotension, dehydration, blood loss, clmaping during surgery can all lead to decreased renal perfusion and kidney injury

Monitor BUN, creatinine, and UOP

** diminished lung bases are common after abd surgery because hurts to breathe deep

195
Q

What is isotretinoin?

A

Acne medication derived from vitamin A only used for severe or cystic acne

risk for SJS and cause birth defects if become pregnant

Required to be on 2 forms of contraception

Avoid taking vitamin A supplements because –> vitamin A toxicity –> IICP, GI upset, liver damage, changes to skin and nails

196
Q

What should be done after a mastectomy?

A

Elevate the air to help restore functioning and prevent lymphedema
Hand/arm exercises gradually implemented
Semi fowlers postion
Sign over HOB starting non BP or venipuncture in that arm

197
Q

What are the rules on taking calcium?

A

Best absorbed if not taken in excess/over 500mg per dose. For doses larger than this split them up
Taken within an hour of eating b/c food increases absorption
Constipation is a SE

198
Q

If a patient is having anaphylactic shock, what should you do?

A

Administer Epi IM
If not change in 5-15 minutes administer and additional dose of Epidural
Bronchodilator
Inflammatory mediators

199
Q

What is catatonia in a psychomotor disorder?

A

Absence of or excessive involuntary movemetns

Withdrawn - unresponsive to environment and remain in a fixed position and silent

Excited - hyperactivity –> exhaustion so need more food and low stimulating enviorment

In both patients are unable to meet their needs

200
Q

What is PKU?

A

Inborn genetic error inn metabolism of phenylalanine

Low phenylalanine diet is prescribed

Avoiding milk. eggs, meat
Special prepared formula
Encouraging fruits and veggies

201
Q

What medication should be given for death rattle? Why?

A

This is when a patient that is dying can no longer control their secretions and atropine drops should be given because it is an anticholinergic med that drys the mouth/secretions

202
Q

For a patient that has decreased LOC what is a good position for them?

A

side lying because they may not be able to protect their airway from aspiration

203
Q

What are examples of TCA?

A

amitriptyline, nortriptyline, desiparamine, imipramine

204
Q

When giving a patient contracts what medication should not be given?

A

Metformin for 24-72 hours before and after because risk of lactic acidosis

205
Q

What is an Allens test?

A

used to determine if the ulnar artery is patent

Occulde both ulcer and radial artery to see if hand goes white, unocclude and see if hand pinks up

206
Q

What foods should be avoided while using warfarin?

A

Vitamin K high foods

Leafy greens, liver

207
Q

What is testicular torsion? Emergency?

A

Blood flow to testis has stopped –> testicle rotates and twists the spermatic cord causing venous drainage obstuction that leads to swelling and severe pain. Arterial blood supply is interrupted –> testicular ischemia and necrosis

Diagnosed with ultrasound

Short time frame tha tit can be treated so it an emergency

208
Q

What are characteristics of borderline personality disorder?

A

impulsitivity
emotional dysregulation
unstable relationships and self image
Manipulative behavior
Splitting - everything is good or everything is bad

IMPORTANT to set boundaries and reinforce unit guidelines

209
Q

What herbal supplements should be avoided with benzos?

A

Kava and valerian root because both used for anxiety, insomnia and depression so could increase CNS depression
Kava could lead to hepatotoxicity
Melatonin could cause increase drowsiness and CNS depression

210
Q

What id common and what is a concern with a bronchoscopy?

A

Common - blood tinged sputum d/t inflammation

Concern - hemopytosis of bright red blood can indicate hemorrhage

211
Q

What are the s/s of an anaphylactic reaction?

A

Vasodilation –> hypotension, tissue edema, HA
Upper airway edema –> stridor and hoarseness
Bronchospasm –> wheezing
Urtiarial rash, puritus, flushing
N/V, abd pain

212
Q

What is NMS?

A

potentially life threatening ADR to antipsychotics like haloperidol

S/S: change in mental status, severe hyperthermia, muscle rigidity, autonomic dysfunction (tachycardia, fluctuating BP and diaphoresis)

213
Q

What is azathioprine? What should you watch for?

A

Immunosuppressant

Causes bone marrow suppression –> increased risk for infection

214
Q

What position should be used for a lumbar puncture?

A

Side lying with head, back, knees flexed. Pillow can be placed in between or behind the head

215
Q

What position do you use for an air embolism?

A

Trendelenburg position on the left side so air can rise to the right atrium and HCP needs to be notified immediately

216
Q

At what age do babies roll from prone to supine? Supine to prone?

A

Prone to supine at 6 months

Supine to prone comes shortly after

217
Q

What are some ADR of NSAIDs

A

CV: heart attack, stroke, high BP. HF all from fluid retention
Peptic ulcers
Kidney disease

218
Q

When do you give Rogam?

A

When mom is Rh negative

Regularly given at 28 weeks and within 72 hours after birth

219
Q

What should be avoided after cataract surgery?

A

Activities that increase intraocular pressure such as bending, lifting more than 5 pounds, sneezing, coughing, rubbing/placing pressure on eyes, straining during a BM

220
Q

What is serotonin syndrome?

A

Excess of serotonin –> mental status changes like anxiety, restlessness, agitation and autonomic dysregulation like diaphoresis, tachycardia, HTN, hyperthermia

Monitor for clonus and temp in these patients

221
Q

What are you listening for in a patient with acute pericarditis?

A

Muffled or distant heart tones, hypotension, JVD are all signs that it has progresses to a cardiac tmaponade and requires an emergency pericardiocentesis to prevent cardiac arrest

222
Q

What does VSD place a patient at risk for?

A

CHF and pulmonary HTN because there is left to right shunting that leads to excess blood flow to the lungs

Grunting or increased respiratory exertion means to lead to CHF

223
Q

What puts a patient at increased risk for having a pre term birth?

A

Infection (periodontal disease, UTI)
History of preterm birth
Cervical surgery like a cone biopsy
Tabacco/drug use

224
Q

If you patient is hypothermic what should you avoid doing?

A

Avoid moving them too much because the hypothermic myocardial tissue is easily excitable so it could lead to spontaneous V-fib

225
Q

What is another word for atopic dermatitis?

A

Eczema

226
Q

What patient teaching should be included for a patent prescribed phenytoin?

A

Use a soft bristle tooth brush and regular dentist visits because it can cause gingival hyperplasia

Folic acid can help decrease this as well

227
Q

When getting a thoracentesis, what is the best position for the patient?

A

sitting in a upright position on the side of the bed and leaning forward over a bedside table with arms supported by pillows

228
Q

Where is the pain with acute pancreatitis?

A

left upper quadrant or midepigastric that radiates to the back

Pain improves with leaning forward and worsens when lying flat

Pain often proceeds or is made worse by a high fat meal

229
Q

What two medications get rid of uric acid?

A

rasburicase and allopurinol

230
Q

What increases a patient’s risk for respiratory depression on opioids?

A

Concurrent use of the sedation meds
Hx of smoking
Obesity
Opioid naive status
Advances age over 65
Hx of pulmonary disease
Recent surgery

231
Q

What are common SE of metronidazole?

A

Metallic taste
GI upset
Dark colored urine

232
Q

What could a low pressure alarm on an arterial line mean?

A

Hypotension

A-line carry risk fro bleeding and hemorrhage to occur at the connection sites of the tubing and catheter

233
Q

When taking a potassium pill, what instructions should be included?

A

Drink with plenty of water and sit upright for at least 30 minutes to prevent the tablet form being lodged into the esophagus or reflex from the stomach

234
Q

What occurs in a acute hemolytic reaction?

A

usually cause by mismatched blood

Fever and chills
Flank/back pain
Dark red urine
Tachycardia
Hypotension

235
Q

What occurs in an anaphylactic transfusion rx?

A

seconds to minutes after initiation d/t massive histamine release

Respiratory - wheezing, dyspnea
Hives and flushing
Abd pain
Angioedema
Hypotension

236
Q

What occurs in a febrile non hemolytic transfusi0on rx?

A

most common and caused by cytokine release form leukocytes in donor blood

Fever
Cills
Malaise

237
Q

What should be assessed in a severe HTN crisis?

A

Prioritize neuro assessment because could have hypertensive encephalopathy (HA, N/V, confusion, seizure) and poses high risk for end organ damage (hemorrhagic stroke, kidney disease, HF, papilledema)

238
Q

What should a patient of tamoxifen report to HCP?

A

if they are having irregular or excessive menstraul bleeding or if they are having any bleeding postmenopause

This could be a sign of endometrial cancer

239
Q

What is the toxic level of theophylline? S/S?

A

> 20mcg/ml

CNS stimulation - HA, insomnia, seizures
GI - N/V
Cardiac toxicity - arrythmia

240
Q

What does the occipital lobe do?

A

registers visual images

Injury to this will affect vision

241
Q

What does the frontal lobe do?

A

Controls high order processing such as functioning and personality

Injury results in behavioral changes

242
Q

What does the temporal lobe do?

A

Integrates visual and auditory input and past experiences

243
Q

What does the parietal lobe do?

A

integrates somatic and sensory input

244
Q

What can indicate a patient is experiencing rhabdo? What can it lead to?

A

Severely elevated creatinine kinase typically >5000 are observed with severe muscle damage

Can lead to kidney injury

Treat with saline diuresis and IV fluids to prevent permanent kidney damage

245
Q

What blood type is the universal recipient?

A

AB can receive A, B, AB, or O blood

Rh negative can only get Rh negative blood
Rh positive can get either positive or negative

246
Q

What is an oropharyngeal airway (OPA)?

A

Artificial airway to prevent tongue displacement and tracheal obstruction for patient that is sedated or unconscious

NEVER tape it down because when patient wakes up the device stimulates the gag reflex and causes choking and aspiration if cannot remove easily

247
Q

A patient who is in menopause should make what changes? What are they at risk for?

A

Dietary calcium with green leafy veggies and dairy
Engaging in weight-bearing exercise for bones
Monitor cholesterol level (HDL, LDL, triglycerides) b/c increase LDL –> CAD
Seek dietitian assistant to maintain a healthy weight
Seek support with emotional symptoms

Increased risk for osteoporosis and coronary artery disease

248
Q

Dysarthia

A

Worsening ability to speak

Noticable pauses between syllables and unusual emphasis on syllable

Seen in patients with sclerosis

249
Q

What is cyclobenzaprine?

A

Centrally acting skeletal muscle relaxant

Metabolized by the liver so liver disease –> toxicity and increased CNS depression

250
Q

What is an aortic dissection?

A

Tear in the inner lining of the aorta that allows blood to surge bt/n layers of the arterial wall –> separating and weakening of the aortic wall

Acute onset of excruciating sharp or ripping chest pain that radiates to the back

Requires surgery but before surgery, IV beta blocker to decrease risk of rupture

251
Q

How do you tell a patient with dysphagia to swallow?

A

Chin slightly downward toward the neck

252
Q

What should the nurse do if a patient needs tuve feedings and phenytoin?

A

Pause the tube feed for 1-2 hours because it decreases the absorption of phenytoin

253
Q

What is agoraphobia?

A

Intense fear and anxiety about being in certain situations or spaces

254
Q

What are the s/s of a PDA?

A

Loud machine like systolic and diastolic murmur

255
Q

What should occur prioir to a patient getting an EEG?

A

Hair sohuld be washed to remove oils and hair products
Avoid caffeine, stimulants, CNS depressants
Not painful

256
Q

What is partisans disease treated with? Avoid when?

A

Anticholinergics (benzotopine and trihexyphenidyl) to treat tremor

Avoid anticholinergics if patient has BPH or glaucoma because they can lead to urinary retention and acute glaucoma episode

257
Q

How does a cervical cap work?

A

Use with spermicide and placed over the cervix before intercourse. Must remain in place at least 6 hours after intercourse but no more than 48. Can insert several hours prior to intercourse

Do not use during menses because increase risk for TSS

258
Q

What is marfan syndrome?

A

Autosomal dominant that affects CT of the body –> cardiovascular, MSK, and ocular issues (mainly abnormalities of the aorta including aneurysms and tears) so contact sports should be avoided

Very tall and thin with disproportionate long arms, legs, and fingers

259
Q

How long does it take to have relief of symptoms after levothyroxine is begun?

A

3-4 weeks

Hormones will be rechecked after 4-6 weeks and it can take up to 8 weeks to see full effect

260
Q

What are the s/s of acute pericarditis?

A

Recent viral infection
Pleuritic chest pain worsened with inspiration and coughing but better with sitting up and leaning forward
Pericardial friction rub

Treated with NSAID, ASA, ir colchicine

261
Q

What is aplastic anemia? Treatment?

A

Blood disorder where bone marrow fails to produce adequate amount of new blood cells –> decrease RBC, WBC, platelets

Prepare for bone marrow biopsy
Type and screen
Monitor for infection and bleeding

262
Q

What is cushings triad? What is it r/t?

A

Irregular respirations
Bradycardia
Widening pulse pressure

Increased ICP

263
Q

What does iodide treat?

A

rapidly reduced thyroid hormones in patients with severe hyperthyroidism

264
Q

What is the drug of choice for SVT? What should be tried first?

A

Adenosine and should be given with an IV that is as close as possible to the heart

Should try vagal maneuvers first such as bearing down becuas eincreased the intra-thoracic pressure and stimulates the vagus nerve –> PSNS –> slowed rhythm

265
Q

What is the antidote for benzo?

A

Flumazenil

266
Q

What is an inguinal hernia?

A

Intraperitoneal contents protrude out of a weakened area in the abdominal wall

267
Q

What teaching should occur regarding bisphosphonates? Drug name?

A

Alendronate

Full glass of water and remain upright for 30-60 minutes
Do not take with a meal
Do not crush or split the pill
Do not administer with a calcium supplement

268
Q

What complications should a nurse monitor for in a patient with is receiving chemo and external beam radiation?

A

Tumor lysis syndrome
Superior vena cava syndrome

269
Q

What is infant botulism?

A

Food poisoning that occurs after consuming clostridium botulinum –> Life threatening paralysis

No honey for at least 1 year

Constipation, difficulty feeding, decrease head control, diminished DTR

270
Q

What is histrionic personality disorder?

A

self-dramatizing, exaggerating
Attention seeking
Overly friendly and seductive
Immediate gratification and little tolerance for frustration

271
Q

What does desmopressin treat?

A

diabetes insipidus

Mimics natural ADH –> increase water resorption and concentrates urine

Patients taking this should be monitored for water intoxication/hyponatremia adn severe hyponatremia can lead to seizure

272
Q

How should you look in the ear for infants and toddlers?

A

Pull the pinna down and back

273
Q

What are H1 receptor antagonists? What do they treat?

A

Loratadine, fexofenadine, levocetrizine

Decrease inflammatory response by blocking histamine receptors

Treats allergic rhinitis, allergic conjunctivitis, and hives

274
Q

What is macular degeneration?

A

progressive incurabel disease of eye where the central portion of the retina begin to deteriorate

Vision loss in thr central field of vision

275
Q

Can codeine be taken with food?

A

Yes, decreased GI irritation

276
Q

Is it a concern if herpes zoster is still painful after 3 months?

A

Yes, herpes zoster causes transient pain d/t hemorrhagic inflammation but typically fades. if it remains then it indicates posttherpetic neuralgia –> pain that is triggered by light touch

277
Q

How do you help a patient that is legally blind walk?

A

Sighted-guide technique - walking slightly ahead with the pateint holding the elbow

278
Q

What is sjogrens syndrome?

A

autoimmune disorder –> inflammation of the exocrine gland resulting in decreased produciton of tears and saliva –> dry eyes and mouth –> corneal ulcers, dental caries, and oral thrush

Treatment focuses on alleviating symptoms with artificial saliva and tears

279
Q

Where would a patients pain be located with appendicitis?

A

lower abdomen above right hip

280
Q

What is an abnormal troponin level?

A

0.7 indicates cardiac muscle damage

281
Q

After a patient experience an intrauterine fetal demise, what are they at risk for?

A

DIC

Should get baseline lab tests such as coat, platelets, and fibrinogen

282
Q

What are marcolides? ADR?

A

Antibiotics - azithromycin, erythromycin, clarithromycin

QT prolongation and hepatotoxicity

283
Q

In the emergent phase of burns first 24-72 hours, what electrolyte imbalance are patients at risk for?

A

Hyperkalemia

284
Q

What type of lymph node is not of concern?

A

Soft, mobile localized <2cm lymph node and no systemic symptoms

285
Q

What time of lymph node is concerning?

A

Firm or hard, immobile, >2cm lymph node that is generalized or supraclavicular and there are systemic s/s

286
Q

What is TTP? Treatment?

A

Platelet disorder –> decreased platelets d/t platelet consumption –> bleeding, petechiae, purpura

Life-threatening and requires emergency plasmapheresis to remove components of blood that cause the micro thrombi and supplies a plasma enzyme that will help reverse plasma aggregation

287
Q

What is the main priority to patients newly diagnosed with quadriplegia?

A

Respiratory status b/c impaired functioning and at risk for atelectasis and PNA

Usually a concern in cervical or high thoracic spine injuries

288
Q

What should patients with PNC allergy avoid?

A

Cephalosporins (Cephalexin)

289
Q

A patient with nasal polyps should not have which med?

A

NSAIDs

290
Q

What is pulsus paradoxus? How do you measure it?

A

Sign of cardiac tamponade and is a exaggerated fall in SBP >10mmhg with inspiration

Note the korotkoff sound during both inspiration and expiration and determine the difference

Kaplan/UWorld (2 decks)

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