NCLEX Saunders Review Day 1

Symptoms of Silicosis include: 1.Fatigue 2.Malaise 3.Anorexia 4.Weight gain 5.Dyspnea at rest

1,2,3 Malaise, extreme fatigue, anorexia, weight loss, and dyspnea on exertion (not at rest) would occur in a client with silicosis.

Signs and symptoms of alkalosis include: 1.Tetany 2.Lethargy 3.Tingling 4.Confusion 5.Numbness 6.Restlessness

1,3,5,6 A client's reaction to alkalosis causes tingling and numbness of the fingers, restlessness, and tetany caused by irritability of the central nervous system (CNS) results. If the severity of alkalosis increases, convulsions and coma may occur.

When should nateglinide be taken

1-30 minutes before meals

Normal right atrial pressure (RAP)

1-8

What is impetigo?

A contagious bacterial infection of the skin caused by β-hemolytic streptococci or staphylococci, or both. Impetigo is most common during hot, humid summer months. Impetigo may begin in an area of broken skin, such as an insect bite or atopic dermatitis. Impetigo is extremely contagious. Lesions usually are located around the mouth and nose, but may be present on the hands and extremities.

Clanging

A form of rhyming that is not comprehensible; a client whose speech features clanging seems to be caught up in the sound of the words.

What is a hypophysectomy?

A hypophysectomy is the surgical removal of the pituitary gland to treat cancerous or benign tumors.

A client calls the nurse at the clinic and reports that ever since the vein ligation and stripping procedure was performed, she has been experiencing a sensation as though the affected leg is falling asleep. Why should the nurse advise the client to contact the HCP?

A sensation of pins and needles or feeling as though the surgical limb is falling asleep may indicate temporary or permanent nerve damage after surgery. The saphenous vein and the saphenous nerve run close together, and damage to the nerve will produce paresthesias.

Early indication and resolution of a fat emboli?

An altered mental state is an early indication of fat emboli; therefore, clear mentation is a good indicator that a fat embolus is resolving.

Nateglinide

Anti-diabetic medication.It can treat type 2 diabetes. When used along with proper diet and exercise, it helps control blood sugar.

Ketoconazole. Which interventions should the nurse include when teaching the client about the medication? 1. Avoid alcohol 2.Restrict fluid intake. 3.Avoid exposure to the sun. 4.Prepare for periodic liver function studies. 5.Administer the medication with an antacid. 6.Administer the medication on an empty stomach.

Antifungal, 1,3,4 Ketoconazole is an antifungal medication. There is no reason for the client to restrict fluid intake; in fact, this could be harmful to the client. The medication is hepatotoxic, and the nurse monitors liver function. It is administered with food (not on an empty stomach) and antacids are avoided for 2 hours after taking the medication to ensure absorption. The client is also instructed to avoid alcohol. In addition, the client is instructed to avoid exposure to the sun because the medication increases photosensitivity.

Hydroxychloroquine sulfate

Antimalarial medication used to prevent or treat malaria. It is also used to treat symptoms of rheumatoid arthritis ans discoid and systemic lupus erythematosus. Ocular toxicity is an adverse effect with the use of hydroxychloroquine sulfate. An eye examination should be performed when medication therapy is started and after 6 months of therapy.

The nurse caring for a child who has sustained a head injury in an automobile crash is monitoring the child for signs of increased intracranial pressure (ICP). For which early sign of increased ICP should the nurse monitor?

Changes in level of consciousness

Silicosis

Chronic lung fibrosis that results from the long-term inhalation of silica dust.

Nikolsky's sign

Epidermal blistering and sloughing precipitated by lateral finger pressure, commonly is present in pemphigus vulgaris.

IV administration of cyclosporine

For IV administration of cyclosporine, 1 mL of concentrate is diluted in 20 to 100 mL of 0.9% sodium chloride or 5% dextrose. The solution should be protected from light. The initial dose is 5 to 6 mg/kg (one third of the oral dose) administered over a 2- to 6-hour infusion.

Acetylsalicylic acid occasional side effects

Gastrointestinal distress such as cramping Mild nausea Heartburn Abdominal distention

Leflunomide

Immunomodulatory agent and has an antiinflammatory action. The medication provides symptomatic relief of rheumatoid arthritis.

azathioprine

Immunosuppressant generally used with renal transplant recipients can cause neutropenia and thrombocytopenia. Inhibits the proliferation of B and T lymphocytes Used as an adjunct to cyclosporine and glucocorticoids to help suppress transplant rejection

Cyclosporine

Immunosuppressant medication used to prevent rejection following allogeneic organ transplantation. Usually administered with a glucocorticoid and another immunosupressant. Most common side effects are nephrotoxicity, infection, hypertension and hirsutism.

Tacrolimus

Immunosuppressant used for prevention of rejection following liver or kidney transplantation. Adverse effects include nephrotoxicity, neurotoxicity, GI effects, hypertension, hyperkalemia, hyperglycemia, hirsutism, and gum hyperplasia

In extensive burn injuries (greater than 25% of total body surface area), the edema occurs in both burned and unburned areas as a result of

Increase in capillary permeability and hypoproteinemia. Edema also may be caused by the volume and oncotic pressure effects of the large fluid resuscitation volumes required.

efavirenz

Nonncleoside reverse transcriptase inhibitors (NNRTIs) can cause rash, dizziness, confusion, difficulty concentrating, dreams, and encephalopathy

etravirine

Nonncleoside reverse transcriptase inhibitors (NNRTIs) can cause rash, gastrointestinal distrubences, HA, HTN, and peripheral neuropathy

delavirdine

Nonncleoside reverse transcriptase inhibitors (NNRTIs) can cause rash, liver function changes and pruritis

nevirapine

Nonncleoside reverse transcriptase inhibitors (NNRTIs) can cause rash, stevens johnson syndrome, hepatitis, and increase transaminase levels

Emitricitabine Emtricitabine/tenofovir

Nucleoside-nucleotide reverse transcriptase inhibitor (NRTIs) Can cause headache, diarrhea, rash, hyperpigmentation of the palms and soles, lactic acidosis, and severe hepatomegaly. Lactic acidosis and severe hepatomegaly

Abacavir Abacavir/Lamivudine

Nucleoside-nucleotide reverse transcriptase inhibitor (NRTIs) Can cause nausea and hypersensitivity reaction. Lactic acidosis and severe hepatomegaly

Didanosine

Nucleoside-nucleotide reverse transcriptase inhibitor (NRTIs) Can cause nausea, diarrhea, peripheral neuropathy, hepatotoxicity and pancreatitis

stavudine

Nucleoside-nucleotide reverse transcriptase inhibitor (NRTIs) Used to manage HIV in clients who do not respond to or who cannot tolerate conventional therapy can cause peripheral neuropathy (monitor gait and parethesia)and pancreatitis

lamivudine/zidovudine

Nucleoside-nucleotide reverse transcriptase inhibitor (NRTIs) can cause anemia and neutropenia and lactic acidosis with hepatomegaly

tenofovir

Nucleoside-nucleotide reverse transcriptase inhibitor (NRTIs) can cause nausea and vomiting

zidovudine

Nucleoside-nucleotide reverse transcriptase inhibitor (NRTIs) can cause nausea, vomiting, anemia, leukopenia, myopathy, fatigue and HA given at 14 weeks gestation, IV during labor, and for 6 weeks to the neonate after birth

Lamivudine

Nucleoside-nucleotide reverse transcriptase inhibitor (NRTIs) causes anemia and nasal congestion

lamivudine/zidovudine/abacavir

Nucleoside-nucleotide reverse transcriptase inhibitor (NRTIs) hypersensitivity, anemia and neutropenia and lactic acidosis with hepatomegaly

HIV and AIDS medications

Nucleoside-nucleotide reverse transcriptase inhibitors (NRTIs) Nonncleoside reverse transcriptase inhibitors (NNRTIs) Protease Inhibitors (PIs) Fusion Inhibitors

Flight of ideas

Overproductive speech, characterized by the client's quickly switching from one subject to another.

Amoxicillin

Penicillin. Frequent minor side effects include gastrointestinal disturbances, headache, and oral or vaginal candidiasis (perineal itching). A less common but more harmful effect that can occur include superinfection, such as potentially fatal antibiotic-associated colitis, which results from altered bacterial balance. Symptoms and signs include abdominal cramps, severe watery diarrhea, and fever.

Indications for intravenous metoclopramide include:

Postoperative nausea and vomiting, facilitation of small bowel intubation, and facilitation of radiological exams of the gastrointestinal tract.

The nurse caring for a client diagnosed with schizophrenia should include which interventions in the plan of care to assist in managing the client's concrete thinking?

Present verbal instructions regarding expectations in single, simple commands.

Tangential speech

Refers to an inappropriate response to a statement in which the content of the statement is disregarded.

A client who is receiving therapy with a hypothermia blanket starts to shiver. The nurse raises the blanket temperature and monitors the client. After 15 minutes the client's temperature has not increased, and the client is still shivering. What should the nurse do next?

Remove the hypothermia blanket and notify the client's health care provider. Shivering increases oxygen consumption and vasoconstriction which can cause injury.

Assessment findings in a child with hepatitis include:

Right upper quadrant tenderness Hepatomegaly Pale and clay-colored stool Urine will be dark and frothy Jaundice

Loose associations "Glass breaks if you throw stones or shoot at it with a gun. My cousin shoots guns at the police all the time at target practice. People who live in glass houses shouldn't throw stones."

Speech patterns in which there is a lack of a logical relationship between thoughts and ideas; this causes speech and thought to seem inexact, vague, unfocused, and diffuse.

Late signs of increased ICP include:

Tachycardia leading to bradycardia, apnea, systolic hypertension, widening pulse pressure, and posturing.

What complication can occur following a hypophysectomy?

Temporary diabetes insipidus can result from antidiuretic hormone deficiency. This deficiency is related to surgical manipulation. The nurse should assess urine specific gravity and notify the health care provider if the result is less than 1.005.

Can cause permanent staining of the teeth, a straw should be used, and the mouth should be rinsed after administration. The medication should be administered 1 hour before or 2 hours after the consumption of milk. Diluting the medication with water is unnecessary.

Tetracycline

CK is a cellular enzyme that can be fractionated into 3 isoenzymes.

The MM band reflects CK from skeletal muscle. This band would be elevated in skeletal muscle disease. The MB band reflects CK from myocardial muscle. The BB band reflects CK from the brain.

Why would treatment by chemotherapy and radiation resolve SIADH in a client with carcinoma of the lung?

The immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal.

Antiviral medications used to treat cytomegalovirus retinitis, herpes simplex and varicella-zoster virus

acyclovir foscarnet ganciclovir valacyclovir

Anti-fungals used to treat candidiasis and cryptococcal meningitis:

amphotericin B fluconazole itraconazole ketoconazole vorioconazole

Anti-infective and anti-inflammatory used to treat opportunistic infections such as pneumocystis jiroveci pneumonia

atovaquone, metronidazole, pentamidine isethionate sulfasalazine

Macrolide antibiotic. The usual pharmacological treatment for urethral, cervical, or rectal chlamydial infections. Often prescribed when compliance may be a problem because only one dose is needed. Take 1 hour before meals. Best to take the medication with water on an empty stomach.

azithromycin

Binds with CCR5 and blocks viral entry, most common side and adverse effects are cough, dizziness, pyrexia, rash, abdominal pain, musculoskeletal symptoms, upper respiratory tract infections, liver injury and cardiovascular events

chemokine receptor 5 antagonist: maraviroc

Standard treatment for HIV (HAART)

consists of using 3-4 meds in regimens known as highly active antiretroviral therapy, not curative, delays or reverses the loss of immune function, preserve health and prolong life

Enfuvirtide

fusion inhibitor can cause skin irritation at the injection site, fatigue, nausea, insomnia, and peripheral neuropathy

Nucleoside-nucleotide reverse transcriptase inhibitors (NRTIs) and Nonncleoside reverse transcriptase inhibitors (NNRTIs) work by:

inhibiting the activity of reverse transcriptase

Fusion inhibitors work by:

inhibiting the binding of HIV to cells

Stops HIV replication and is used in combination with other antiretroviral medications, common side and adverse effects include nausea, diarrhea, fatigue, HA and itching

integrase inhibitor: raltegravir

PIs work by:

interfering with the activity of the enzyme protease

When taking an antifungal medications which interventions should the nurse include when administering this medication: (4)

monitor liver function, administer with food, avoid alcohol, avoid sun exposure

foscarnet

nephrotoxicity, hypocalcemia, used to treat cytomegalovirus retinitis

Aminoglycosides adverse effects

ototoxicity and nephrotoxicity, confusion, disorientation, palpitations or dysrhythmias

Oral metoclopramide is given for:

paralytic ileus, diabetic gastroparesis, and gastroesophageal reflux disease.

indinavir

protease inhibitor can cause nausea diarrhea, hyperbilirubinemia, nephritis, and kidney stones

atazanavir

protease inhibitor can cause nausea, HA, infection, vomiting, diarrhea, drowsiness, insomnia, fever, hyperglycemia, hyperlipidemia, and increased bleeding in clients with hemophilia

lopinavir/ritonavir

protease inhibitor can cause nausea, diarrhea, altered taste sensations, circumoral paresthesia and hepatitis

saquinavir

protease inhibitor can cause nausea, diarrhea, photosensitivity and HA

nelfinavir

protease inhibitor can cause nausea, flatulence, and diarrhea

fosamprenavir

protease inhibitor can cause nausea, vomiting, HA, altered taste sensations, perioral paresthesia, rashes and altered liver function

ritonavir

protease inhibitor can cause nausea,vomiting, diarrhea, altered taste sensations, circumoral paresthesia, hepatitis, and increased triglyceride levels

tipranavir

protease inhibitor hepatotoxicity, nausea, vomiting, diarrhea, HA, fatigue

Anti-infective used to treat toxoplasma encephalitis

sulfamethoxazole/trimethoprim

methotrexate

used for its immunosuppresant action to treat autoimmune disorders, can cause hepatic fibrosis, cirrhosis, bone marrow suppression, ulcerative stomatitis, and renal damage

cyclophsophamide

used for its immunosuppressant action to treat autoimmune disorders can cause neutropenia and hemorrhagic cystitis