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
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
3
Q
A client reporting increased energy with little or no reduction of depression needs what?
A
Immediate assessment for suicide risk
4
Q
What needs to be done by the RN?
A
Clinical assessment
Initial patient education
Discharge education
Clinical judgement
Initiating blood transfusion
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)
6
Q
What is the scope of an UAP?
A
ADL
Hygiene
Linen change
Routine, stable VS
Documenting I&O
Positioning
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
8
Q
What are s/s of phlebitis?
A
erythema, edema, warmth, pain and palpable venous cord
9
Q
What are s/s of infiltration?
A
Edema
Coolness to the touch around the insertion site
May cause edema to dependent areas
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)
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
12
Q
What are the s/s of a transfusion reaction?
A
Chills
Fever
Low back pain
Flushing
Itching
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
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
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
16
Q
What is a cardiac tamponade? Treatment?
A
Fluid build up in the pericardial sac and compresses the heart
Emergency pericardiocentiusis is needed
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
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
19
Q
What does X-linked mean?
A
Carried by females and affects males
20
Q
What are the s/s of cataracts?
A
Blurred vision
Photosensitivity
Halo around eyes
21
Q
What are the s/s of macular degeneration?
A
Blurred vision
Blindness
Reduced mental vision
22
Q
What are the s/s of open angle glaucoma?
A
Blurred vision
Tunnel vision
Blindness
23
Q
What are stimulant meds used to treat? Examples?
A
ADHD
Methylphenidate (ritilin)
Amphetamines
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
25
What is developmental dysplasia of the hip? Treatment?
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
26
What are the instructions for a pavlik harness?
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
27
What is clonidine used for? How often should the patch be changed?
Antihypertensive agent
Changed every 7 days
28
What are the instruction regarding a clonidine patch?
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
29
What could occur as cirrhosis processes? What does this cause? What can be given for it?
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
30
What is intussusception? S/s? Diagnosis?
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
31
What should not be taken together d/t serotonin syndrome? What is serotonin syndrome symptoms?
SSRI and St Johns Worts
Shivering
Diarrhea
Muscle rigidity
Fever
Seizures
32
What are contraindications to the combined hormonal contraceptive methods?
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
33
What are barriers to self care?
Knowledge
Skills/supplies
Motivation (always assess the motivation of a patient to adhere to treatment)
34
What situations are implied consent used?
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
35
What is hydroxcloroquine? What is it used for? What are the SE?
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
36
What are the s/s of hypoglycemia?
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
37
What are the s/s of epiglottis? What is the most common cause?
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
38
What foods are rich in iron?
Meats
Shellfish - oysters, clams, shrimp
Eggs
Green leafy veggies
Dried fruits
Dried beans
Brown rice
Oatmeal
39
What should the nurse do for a patient with bacterial meningitis?
HOB 30 degrees
Implement seizure precautions d/t increased ICP
Ensure a restful environment
Droplet precautions
40
What are the absolute contraindications for thrombolytics?
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
41
What should you provide oral care with in a patient on a vent?
Chlorahexidine followed by endotracheal suctioning
42
If a patient overdoses on recreational drugs can it cause schizophrenia?
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
43
What is opxybutynin and what does it treat? What are the SE?
Anticholinergic used to treat overactive bladder
New onset constipation
Dry mouth
Flushing
Heat intolerance
Blurred vision
Drowsiness
44
What are proton pump inhibitors? What are they used for? ADR?
"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
45
What is metoclopromide? What is it used for? ADR?
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
46
What is the treatment for peptic ulcer disease?
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)
47
What are ACHES associated with contraceptive use?
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
48
What does small, rocky, hard stool mean?
Constipation
49
What does light clay colored stool mean?
Biliary obstruction
50
What does mucus or pus mean in stool?
Ulcerative colitis or infectious colitis
51
What does greasy, foamy, foul smelling stool mean?
Chronic pancreatitis
52
What does black tarry stool mean? Bright red bloody?
Black - upper GI bleed
Red - lower GI bleed
53
What does blood present on surface of stool/streaks mean?
Hemorrhoids
54
What are life threatening complications of chirrhosis? What symptoms would they have?
Upper GI bleed or bleeding esophageal varicies
Black tarry stool
55
Hepatitis B is transmitted by?
Blood
Semen
Vaginal discharge
56
What does a Fib look like? Which procedure is it common after? Treatment?
Absence of P wave with fibrilatory waves and irregular rhythm
Common after CABG
Treat with antiarrythmic meds like beta blockers and digoxin
57
What should be the care after a CABG?
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
58
What is a life threatening complication that could occur after esophagogastroduodenoscopy? S/S?
Perforation - notify HCP immediately if pt gets a fever
Sudden temp spike
Increasing pain/tenderness
Restlessness
Tachycardia
Tachypnea
59
What is a hyper cyanotic episode associated with? What should you do?
Tetralogy of fallot
Knee-chest position to increase blood to get back to heart
Supplemental O2
Decrease stimuli
60
What are sulfonylurea medications? What are major SE of them?
Glyburide, glipizide, glimepiride
Hypotension
Weight gain
Serious sunburns
61
What is chronic venous insufficiency? S/S?
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
62
When do fat embolisms commonly occur? S/S
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
63
What are omphalocele and gastroschisis?
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
64
What should you monitor with omphalocele and gastroschisis?
Temperature stability
Infection
Fluid loss
Initiate IV access for antibiotics and fluids
65
What is acute post infectious glomerulonephiritis? S/S?
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
66
What teaching should be included about impetigo?
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
67
S/S of increased ICP?
Change in LOC
projectile vomitting
Ataxia
Ipsilateral/unilateral pupil dilation
Seizures
HA
68
What are Statin drugs used for? ADR?
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
69
What should you do if you can flush a central line?
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
70
What is included in the DASH diet?
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
71
What is included in the DASH diet?
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
72
What are s/s of lithium toxicity?
GI - N/V and diarrhea
Neuro - ataxia, sluggishness, confusion, agitation, neuromuscular excitability (tremors)
73
What are the S/S of impetigo? Caused by? Treat? Complication?
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
74
How do you avoid lithium toxicity? Can you take lithium and NSAIDS together?
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
75
What are the risks with polyhydramnios? What could increase risk of pt having this?
Umbilical cord prolapse
PP hemorrhage - overdistention of uterus leading to muscle poorly contracting after birth
Patient with DM
76
What is tines capitis? Transmitted? Treatment?
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
77
What should you treat you patient about their AV fistula?
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
78
What is HELLP?
Hemolyiss
Elevated liver enzymes
Low platelets
Occurs after 20 weeks and presents as elevated liver enzymes, RUQ pain, malaise, nausea, decrease platelets
79
What interventions should be included for a patient with HELLP?
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
80
What are the S/S of a TCA overdose?
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)
81
What is the home care for CF?
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
82
What is allergic contact dermatitis?
TV hypersensitivity reaction that manifests are pruritic painful, erythematous rash in the area that is exposed to the irritant
83
What is impetigo?
Highly contagious bacterial infection of the skin that manifests as erythematous fluid-fluid lesion on exposed areas. Honey colored crust can form
84
What does a myxedema coma look like? What is the treatment?
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
85
When does mild withdrawal occur in AWS? S/S?
6-24 hours
Anxiety, insomnia, tremors, diaphoresis, palpitations, GI upset, intact orientation
86
When does seizures occur in AWS? Type?
12-48
Single or multiple generalized tonic clonic
87
When does alcohol hallucinations occur in AWS? S/S?
12-48 hours
Visual, auditory, or tactile
88
When does delirium tremens occur? S/S?
28-96 hours after last drink
Confusion, agitation, fever, tachycardia, HTN, diaphoresis, hallucinations
89
What should the nurse monitor for with a patient with guillian-barre syndrome?
Abdominal distension (d/t decrease bowel movement)
Blood pressure variability (d/t autonomic dysreflexia)
Decreased RR and depth
Difficulty swallowing
Urinary retention
90
Is HDL or LDL good cholesterol?
HDL is good cholesterol
91
What is Hirschsprung disease? S/S?
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
92
What is Tiotropium? How is it administered?
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
93
What is phenytoin used for? Special admin?
Anticonvulsant used to treat seizures
Absorbed slowly and requires steady absorption so pause tube feedings if given via tube
94
What medication is used to treat supra ventricular tachycardia?
Adenosine
95
What medication is used to treat tachyarrythmias?
Metoprolol/beta blocker
96
What is Torsades de pointes? What treats it?
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
97
What is the protocol for giving CPR to an infant?
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
98
After knee arthroplasty what should the nurse do to prevent contracture?
Place a pillow under the leg or heal
DO NOT place the pillow under the knee because it causes flexion increasing risk of contracture
99
What are a risk of ACE inhibitors and ARBs?
Can potentiate hyperkalemia
100
What kind of drug is benztropine? What is it used to treat?
Anticholinergic/antiparkinson med
Used to treat EPS which are a serious ADR of some antipsychotic medications
101
What is the care for a coronary arteriogram?
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
102
What are risks of thiazide diuretics? What herbal remedy should not be used with them? What should be encouraged with thiazides?
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
103
What increases an infants risk for otitis media?
Exposure to tobacco
Using a pacifier
Drinking a bottle when lying down
104
What is sodium polystyrene sulfonate? what does it treat and how? What are pts at risk for?
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
105
What is myopia? S/S?
Nearsidedness - cant see object far away
Hold object close to the face
Squint to see clearly
HA
Dizzy
School performance can be affected
106
What is misoprostol? What is it used for?
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
107
What is the treatment of frostbite?
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
108
What is cranial nerve I? How is it tested?
Olfactory nerve
Tested by having patient recognize an odor
109
What is cranial nerve III? How do you test it?
motor nerve of the eye
Tested by tracking an object
110
What is cranial nerve II? How do you test it?
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
111
What is cranial nerve VII? How do you test?
Facial nerve
Tested by using facial movements like scrunching eyebrows, smiling, frown, show teeth
112
What is projection?
Attributing uncomfortable thoughts/behaviors to someone/something
calling the sidewalk stupid after tripping
113
What is regression?
Behaving as if much younger to avoid uncomfortable thoughts/behaviors
Moving back to parents to avoid responsibilities
114
What is repression?
Unintentionally blocking uncomfortable tohught/behaviors form consciousness
Being unaware of a past traumatic experience
115
What is displacement?
Redirecting uncomfortable thoughts/behaviors from it original source to another person/object
Punching a pillow when angry at parents
116
What is sublimation?
Transforming unpleasant thoughts/behaviors into pleasant thoughts/behaviors
Attending a boxing class as a way to channel ones anger
117
What is reaction formation?
Behaving in a manner opposite of unpleasant thoughts/behaviors
Expressing love for a person one despises
118
What are s/s of colorectal cancer?
Blood in the stool
Abd discomfort
Anemia
Change in bowel habits
Unexplained weight loss
119
What are SE of opioids?
Sedation
Resp depression
Hypotension
Constipation
120
What is narcissistic personality disorder?
Reccurt pattern of grandiosity, the need for admiration, and lack of empathy
Superiority, arrogance, hypersensitive to criticism
121
What is a possible complication of an amnioinfusion?
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
Muscle relaxer example
Cyclobenaprine
123
NSAIDS
ibuprofen
naproxen
celecoxib
124
Neuropathic pain reliever examples
Gabapentin
Pregabalin
125
SSRI example
Fluoxetine
Duloxetine
126
Tricyclic antidepressant examples
Amitriptyline
127
What are 2 teaching points about the storage of nitro tablets?
Need to be stored at room temp/avoid temp extremes
Light resistant bottle
128
S/S for neurogenic shock?
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
What helps to relieve pain in PAD?
Dangling limbs over side of bed because allows gravity to maximize blood flow
130
What is a common practice in patients with raynauds syndrome?
Immersing hands in warm water to decrease vasospasm
131
What are some causes of secondary amenorrhea?
Pituitary tumors - suppress LH and FSH
Low body weight
POCO
Excessive exercise
132
When on warfarin, what common foods increase risk of bleeding?
Ginger
Garlic
Ginkgo biloba
133
What is the only treatment for syphilis when pregnant? What if allergic?
IM penicillin
If allergic, nurse should do penicillin desensitization
134
What is malignant hyperthermia? S/S? Treatment?
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
What are expected findings are general anesthesia?
Pin point pupils
Hypothermia
136
What are s/s of inflammatory breast cancer?
red warm tissue that has an orange peel pitting appearance
Very concerned because this is a very aggressive form of cancer
137
What is a side effect of carbamazepine?
Agranulocytosis
Look of sore throat
138
What is a good drug to treat C. diff with?
Metronidazole
Oral vancomycin
139
Can you give codeine/sedatives to a patient with respiratory problems?
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
What is intrahepatic cholestatsis of pregnancy?
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
What are the manifestations of neonatal abstinence syndrome?
Neuro: irritability, hypertonia, jittery movement, seizures
GI: vomitting, diarrhea, feeding intolerance
Autonomic: sweating, sneezing, pupillary dilation
142
What should you treat a patient with unilateral weakness from a stoke?
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
What is a concern regarding actue glomrulonephritis?
Severe HTN form fluid volume excess
144
What is pheochromocytoma? Treat?
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
Feedings with cleft palate?
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
If a patient has a low neutrophil count d/t chemo what should they avoid at home?
Gardening
Fresh flowers and pants
Soil contains pathogens
147
How do you check for a retinoblastoma?
Most common intraoccular childhood malignancy
Absent red reflex, instead a white glow of the pupil because light is reflecting off of the tumor
148
When a patient comes to the PACU after getting a pace maker what is the first thing you should do?
Get the patient on the cardiac monitor
149
CPR on an adult
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
Methotrexate? ADR?
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
Following cataracts surgery what is to be expected?
Remain blurry for several hours but improve over the next few days
152
What medications are tetragenic?
Phenytoin
Lithium
Valporate
Isotretinoin
Methotrexate
ACE inhibitors
Warfarin
Doxycycline (impair bone mineralization and discolor permanent teeth)
153
What is cranial nerve IX? What if it is damaged?
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
What are atypical symptoms of an MI found in women, elderly, and patients w/ hx of DM?
N/V
Belching
Indigestion
Diaphoresis
Dizziness
Fatigue
155
What is conversion disorder?
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
If a patient has a possible spinal cord injury what should you do to get an airway?
Jaw thrust maneuver while on a backboard
DO NOT use head-tilt-chin-lift because manipulates the neck
157
Nonmalefinence means.. Benefience means...
Do not harm
Promote good
158
Pregnant healthcare workers should not be exposed to which infections?
Toxoplasmosis
Other (Varicella, Parvo)
Rubella
Cytomegalovirus
Herpes simplex
159
When is a ventriculoperitoneal shunt placed? What is a complication that could occur?
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
At what age is ibuprofen contraindicated?
Less than 6 months d/t GI and renal health risks
161
What is dicyclolmine? When is it contraindicated?
Anticholinergic/antispasmodic for patients to manage hyper motility with IBS
Contraindicated in patients with paralytic ileus
162
What helps to prevent stress ulcers in critically ill patients?
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
Before giving a loop diuretic like furosemide, what should you assess?
Blood pressure
BUN/creatinine
Potassium
164
What could occur when large amounts of albuterol are given?
Loses selectivity --> beta 1 receptors activated --> promoting cardiac stimulation
Stimulation of SNS --> palpitations, tachycardia, insomnia, mild tremor, N/V
165
In a patient with acute pancreatitis, what would you expect their blood glucose to be?
Increased d/t pancreas not releasing enough insulin
166
If a patient has acute pancreatitis what should you monitor closely for?
manifestations of infection because pancreatic tissue can easily become necrotic and infected --> abscess/sepsis
167
What is acute cholecystitis? S/S?
Inflammation of the gallbladder
Severe pain after eating
Epigastric pain
168
What is acute pancreatitis? S/S?
inflammation of pancreas commonly caused by chronic alcohol or gallstones
Severe pain after eating
Epigastric pain
Relieved by leaning forward
169
How long should you wait in between passes for suctioning?
1-2 minutes
170
What is theophylline? What should be avoided?
Bronchdilator with a low therapeutic index
Toxicity >20mcg/mL (seizures and arrhythmia)
Cimetidine and ciprofloxacin (dramatically increase theophylline levels)
Caffeine
171
What is the newborn at risk for if mom has diabetes?
Hypoglycemia
Polycythemia (increase RBC production d/t poor placental perfusion)
Birth injury
Fetal macrosomia
172
What teaching should be given for isoniazid?
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
What occurs with rifampin that you should educate about?
Red-orange urine, saliva, sweat, tears that is normal
174
What things should you know about collecting a 24-hour urine?
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
What is metabolic syndrome
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
If they have had a transplant of any kind what do you report to the doctors immediately?
WBC increase because these patients are on immunosuppressants so they are very susceptible to and infection
177
In post op patients, what is a major priority? Why?
Antiemetic medication in those who are N/V because they are at high risk for aspiration d/t their altered LOC
178
What medications should be avoided in older adults?
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
If a diabetic patient drinks alcohol, what can it cause?
Hypoglycemia so priority is to monitor blood glucose
180
What indicates that the body is no longer compensating for shock?
Cool clammy skin
181
What goes on with the spleen in sickle cell?
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
Which medications are known to cause orthostatic hypotension?
AntiHTN
Antipsy and antidepressants
Diuretics
Vasodilators
Narcotics
183
What is neurogenic shock?
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
What is fondaparinux? What can it not be used with?
Unfractionated heparin
Cant be used with epidural/spinal blockers d/t risk for bleeding/spinal hematoma --> severe back pain and paralysis
185
What is an antithyroid medication?
Methimazole
186
What toxicity can furosemide cause?
Ototoxicity with administered in high doses to those with compromised renal function
Administration rate should not exceed 4mg/min
187
If patient is worried about N/V with opioids what do you tell them?
Expected SE but tolerance builds quickly so persistent N/V is rare
188
What are the contraindications to using cytotec/misprostol?
Receiving another med to ripen/stimulate contractions
Hx of uterine surgery d/t uterine rupture risk
Abnormal fetal HR or uterine tachysystole
189
What are the clinical manifestations of bacterial meningitis for those under 2?
Fever or hypothermia
High pitched cry
Poor feeding and vomitting
Nuchal rigidity
Buldging fontanels
190
If a patient has a dust mite allergy what should you instruct them to do?
Wash their bed linens in very hot water 1-2 times a week and vacuum that mattress often
191
Are sudden changes in a patient with dementia a concern?
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
What are s/s of trichomoniasis?
Thin frothy yellow green vaginal discharge
Vulvovaginal erythema
inflmmation
Puritis
Dyspareunia
Bleeding after intercourse
Urinary pain and frequency
193
Can an LPN preform sterile procedure
Yes if there is an established prescription plan
194
After repair of a abdominal aneurysm what needs to be monitored closely?
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
What is isotretinoin?
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
What should be done after a mastectomy?
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
What are the rules on taking calcium?
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
If a patient is having anaphylactic shock, what should you do?
Administer Epi IM
If not change in 5-15 minutes administer and additional dose of Epidural
Bronchodilator
Inflammatory mediators
199
What is catatonia in a psychomotor disorder?
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
What is PKU?
Inborn genetic error inn metabolism of phenylalanine
Low phenylalanine diet is prescribed
Avoiding milk. eggs, meat
Special prepared formula
Encouraging fruits and veggies
201
What medication should be given for death rattle? Why?
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
For a patient that has decreased LOC what is a good position for them?
side lying because they may not be able to protect their airway from aspiration
203
What are examples of TCA?
amitriptyline, nortriptyline, desiparamine, imipramine
204
When giving a patient contracts what medication should not be given?
Metformin for 24-72 hours before and after because risk of lactic acidosis
205
What is an Allens test?
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
What foods should be avoided while using warfarin?
Vitamin K high foods
Leafy greens, liver
207
What is testicular torsion? Emergency?
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
What are characteristics of borderline personality disorder?
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
What herbal supplements should be avoided with benzos?
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
What id common and what is a concern with a bronchoscopy?
Common - blood tinged sputum d/t inflammation
Concern - hemopytosis of bright red blood can indicate hemorrhage
211
What are the s/s of an anaphylactic reaction?
Vasodilation --> hypotension, tissue edema, HA
Upper airway edema --> stridor and hoarseness
Bronchospasm --> wheezing
Urtiarial rash, puritus, flushing
N/V, abd pain
212
What is NMS?
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
What is azathioprine? What should you watch for?
Immunosuppressant
Causes bone marrow suppression --> increased risk for infection
214
What position should be used for a lumbar puncture?
Side lying with head, back, knees flexed. Pillow can be placed in between or behind the head
215
What position do you use for an air embolism?
Trendelenburg position on the left side so air can rise to the right atrium and HCP needs to be notified immediately
216
At what age do babies roll from prone to supine? Supine to prone?
Prone to supine at 6 months
Supine to prone comes shortly after
217
What are some ADR of NSAIDs
CV: heart attack, stroke, high BP. HF all from fluid retention
Peptic ulcers
Kidney disease
218
When do you give Rogam?
When mom is Rh negative
Regularly given at 28 weeks and within 72 hours after birth
219
What should be avoided after cataract surgery?
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
What is serotonin syndrome?
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
What are you listening for in a patient with acute pericarditis?
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
What does VSD place a patient at risk for?
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
What puts a patient at increased risk for having a pre term birth?
Infection (periodontal disease, UTI)
History of preterm birth
Cervical surgery like a cone biopsy
Tabacco/drug use
224
If you patient is hypothermic what should you avoid doing?
Avoid moving them too much because the hypothermic myocardial tissue is easily excitable so it could lead to spontaneous V-fib
225
What is another word for atopic dermatitis?
Eczema
226
What patient teaching should be included for a patent prescribed phenytoin?
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
When getting a thoracentesis, what is the best position for the patient?
sitting in a upright position on the side of the bed and leaning forward over a bedside table with arms supported by pillows
228
Where is the pain with acute pancreatitis?
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
What two medications get rid of uric acid?
rasburicase and allopurinol
230
What increases a patient's risk for respiratory depression on opioids?
Concurrent use of the sedation meds
Hx of smoking
Obesity
Opioid naive status
Advances age over 65
Hx of pulmonary disease
Recent surgery
231
What are common SE of metronidazole?
Metallic taste
GI upset
Dark colored urine
232
What could a low pressure alarm on an arterial line mean?
Hypotension
A-line carry risk fro bleeding and hemorrhage to occur at the connection sites of the tubing and catheter
233
When taking a potassium pill, what instructions should be included?
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
What occurs in a acute hemolytic reaction?
usually cause by mismatched blood
Fever and chills
Flank/back pain
Dark red urine
Tachycardia
Hypotension
235
What occurs in an anaphylactic transfusion rx?
seconds to minutes after initiation d/t massive histamine release
Respiratory - wheezing, dyspnea
Hives and flushing
Abd pain
Angioedema
Hypotension
236
What occurs in a febrile non hemolytic transfusi0on rx?
most common and caused by cytokine release form leukocytes in donor blood
Fever
Cills
Malaise
237
What should be assessed in a severe HTN crisis?
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
What should a patient of tamoxifen report to HCP?
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
What is the toxic level of theophylline? S/S?
>20mcg/ml
CNS stimulation - HA, insomnia, seizures
GI - N/V
Cardiac toxicity - arrythmia
240
What does the occipital lobe do?
registers visual images
Injury to this will affect vision
241
What does the frontal lobe do?
Controls high order processing such as functioning and personality
Injury results in behavioral changes
242
What does the temporal lobe do?
Integrates visual and auditory input and past experiences
243
What does the parietal lobe do?
integrates somatic and sensory input
244
What can indicate a patient is experiencing rhabdo? What can it lead to?
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
What blood type is the universal recipient?
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
What is an oropharyngeal airway (OPA)?
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
A patient who is in menopause should make what changes? What are they at risk for?
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
Dysarthia
Worsening ability to speak
Noticable pauses between syllables and unusual emphasis on syllable
Seen in patients with sclerosis
249
What is cyclobenzaprine?
Centrally acting skeletal muscle relaxant
Metabolized by the liver so liver disease --> toxicity and increased CNS depression
250
What is an aortic dissection?
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
How do you tell a patient with dysphagia to swallow?
Chin slightly downward toward the neck
252
What should the nurse do if a patient needs tuve feedings and phenytoin?
Pause the tube feed for 1-2 hours because it decreases the absorption of phenytoin
253
What is agoraphobia?
Intense fear and anxiety about being in certain situations or spaces
254
What are the s/s of a PDA?
Loud machine like systolic and diastolic murmur
255
What should occur prioir to a patient getting an EEG?
Hair sohuld be washed to remove oils and hair products
Avoid caffeine, stimulants, CNS depressants
Not painful
256
What is partisans disease treated with? Avoid when?
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
How does a cervical cap work?
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
What is marfan syndrome?
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
How long does it take to have relief of symptoms after levothyroxine is begun?
3-4 weeks
Hormones will be rechecked after 4-6 weeks and it can take up to 8 weeks to see full effect
260
What are the s/s of acute pericarditis?
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
What is aplastic anemia? Treatment?
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
What is cushings triad? What is it r/t?
Irregular respirations
Bradycardia
Widening pulse pressure
Increased ICP
263
What does iodide treat?
rapidly reduced thyroid hormones in patients with severe hyperthyroidism
264
What is the drug of choice for SVT? What should be tried first?
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
What is the antidote for benzo?
Flumazenil
266
What is an inguinal hernia?
Intraperitoneal contents protrude out of a weakened area in the abdominal wall
267
What teaching should occur regarding bisphosphonates? Drug name?
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
What complications should a nurse monitor for in a patient with is receiving chemo and external beam radiation?
Tumor lysis syndrome
Superior vena cava syndrome
269
What is infant botulism?
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
What is histrionic personality disorder?
self-dramatizing, exaggerating
Attention seeking
Overly friendly and seductive
Immediate gratification and little tolerance for frustration
271
What does desmopressin treat?
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
How should you look in the ear for infants and toddlers?
Pull the pinna down and back
273
What are H1 receptor antagonists? What do they treat?
Loratadine, fexofenadine, levocetrizine
Decrease inflammatory response by blocking histamine receptors
Treats allergic rhinitis, allergic conjunctivitis, and hives
274
What is macular degeneration?
progressive incurabel disease of eye where the central portion of the retina begin to deteriorate
Vision loss in thr central field of vision
275
Can codeine be taken with food?
Yes, decreased GI irritation
276
Is it a concern if herpes zoster is still painful after 3 months?
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
How do you help a patient that is legally blind walk?
Sighted-guide technique - walking slightly ahead with the pateint holding the elbow
278
What is sjogrens syndrome?
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
Where would a patients pain be located with appendicitis?
lower abdomen above right hip
280
What is an abnormal troponin level?
0.7 indicates cardiac muscle damage
281
After a patient experience an intrauterine fetal demise, what are they at risk for?
DIC
Should get baseline lab tests such as coat, platelets, and fibrinogen
282
What are marcolides? ADR?
Antibiotics - azithromycin, erythromycin, clarithromycin
QT prolongation and hepatotoxicity
283
In the emergent phase of burns first 24-72 hours, what electrolyte imbalance are patients at risk for?
Hyperkalemia
284
What type of lymph node is not of concern?
Soft, mobile localized <2cm lymph node and no systemic symptoms
285
What time of lymph node is concerning?
Firm or hard, immobile, >2cm lymph node that is generalized or supraclavicular and there are systemic s/s
286
What is TTP? Treatment?
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
What is the main priority to patients newly diagnosed with quadriplegia?
Respiratory status b/c impaired functioning and at risk for atelectasis and PNA
Usually a concern in cervical or high thoracic spine injuries
288
What should patients with PNC allergy avoid?
Cephalosporins (Cephalexin)
289
A patient with nasal polyps should not have which med?
NSAIDs
290
What is pulsus paradoxus? How do you measure it?
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
