NCLEX

Dyscrasia

any abnormal condition of the blood (anemia, leukopenia, etc.) that can result from carbamazepine these exhibit flu-like symptoms such as sore throat, fever, fatigue, pallor

Diplopia

double vision A S/S of Multiple Sclerosis

Cullen's sign

ecchymosis in umbilical area, seen with pancreatitis

Common Niacin SE

flushing of the face and neck for about an hour Teach this SE to pt before they take it

Somatic Delusions

focus on preoccupations regarding health and organ function "The doctor said I'm fine, but I really have lung cancer."

When should the nurse follow up after administering morphine?

follow-up 30 minutes after the morphine is administered to assess the effectiveness of the pain medication

Loop Diuretics examples

furosemide - Lasix bumetanide - Bumex

Long acting insulin

glargine, detemir, degludec Once/day

Acanthosis nigricans

is a skin condition that occurs with obesity and diabetes and appears as velvet-like patches of darkened, thick skin These areas typically occur around the back of the neck and in the groin and armpits

Dextrose 5% in water (D5W) is an _________ fluid. It helps correct dehydration.

isotonic

Ataxia

lack of muscle coordination a S/S of Multiple Sclerosis

Advanced directives are legal documents that include ________ & ___________.

living wills & health care proxies (durable powers of attorney for health care or medical power or attorney)

Glargine and detemir are ________ acting insulins

long

SE of loperamide

loperamide causes an anticholinergic effect of urinary retention

Statins do what?

lower cholesterol

Palivizumab

monoclonal antibody that binds to RSV Provides immunity in pediatric patients at high risk for RSV

after meals

pc

Low levels of ___________ increases risk for digitalis toxicity

potassium

How should oral potassium be taken?

potassium is an erosive substance that can cause esophagitis take with plenty of water and remain sitting upright for ≥30 minutes after ingestion potassium should be taken during or immediately following meals to prevent gastric upset

Interventions to promote safety and reduce the risk of falling when using axillary crutches in the home

resting crutches upside down on the axilla pads when not in use looking forward when walking maintaining a clutter-free environment using a small bag to hold personal items wearing sturdy rubber-soled shoes

Symptoms of meperidine toxicity

restless irritable confused hallucinations "bugs on walls"

MAOI examples

selegiline isocarboxazid phenelzine tranylcypromine It's not PHENE (funny) but SELEne ISO TRANY. Oh Me, Oh My (MAOI)

Verapamil

calcium channel blocker Slows SA node -> delays AV node conduction Slows ventricular rate

Chlorthalidone

thiazide diuretic

Clinical manifestations of Cushings syndrome

thin fragile skin ecchymosis weakness

Loop diuretics

Furosemide Torsemide Bumetanide

What drug categories is diphenhydramine?

Anticholinergic! And antihistamine of course

What is an intervention for a pt with cariogenic shock and a PAWP of 24 mmHg?

Furosemide (Lasix) to decrease left ventricular preload

Patients with which allergy should not take celecoxib?

Sulfa allergy Celecoxib contains a sulfur molecule

COX-2 inhibitors are contraindicated in patients allergic to what?

Sulfa drugs Aspirin NSAIDs

How do beta blockers work?

block Sympathetic NS reduce O2 demand slow HR lower BP

SE of thiazide diuretics

hyperkalemia - manifests as muscle cramps

How long does a pt need to take Warfarin after mechanical valve replacement?

Anticoagulant therapy (warfarin) will be needed for life after a mechanical valve replacement to prevent thromboembolic events (stroke) and valve thrombosis

PPIs

"-prazole" Omeprazole Pantoprazole Esomeprazole Work better than H2 blockers

Chronic hyperglycemia can cause microvascular damage in the retina, leading to diabetic retinopathy, the most common cause of new blindness in adults. Which vision problem is an emergency?

"Half my vision looks like it is being blocked by a curtain!" This statement indicates a retinal detachment requiring emergency management A partial retinal detachment may be painless and cause symptoms such as a curtain blocking part of the visual field, floaters or lines, and sudden flashes of light An unrepaired complete retinal detachment can cause blindness

Delusions of Grandeur

"I need to get to Washington for my meeting with the president."

Nihilistic Delusions

"It doesn't matter if I take my medicine. I'm already dead." Belief that a major catastrophe will occur

Trismus

"Lockjaw"

Superior mesenteric artery syndrome

"cast syndrome" A rare complication of an overly tight cast that involves compression of the duodenum by the SMA Immobilization of clients in body casts decreases peristalsis and may cause a paralytic ileus (bowel obstruction)

How do loop diuretics affect potassium?

"potassium-wasting" diuretics may cause hypokalemia

Benztropine is used for

(Cogentin) is used in the treatment of extrapyramidal side effects associated with antipsychotic medications or metoclopramide

Antifungals

-azole Ketoconazole Itraconazole Voriconazole

Analgesics

-caine Lidocaine Benzocaine Bupivacaine Novocaine blocks sodium channels numb things (calm things down, reduce pain)

metabolic alkalosis compensation

-compensatory hypoventilation to retain CO2 and decrease pH -may cause hypoxemia

Protease Inhibitors

-navir Ritonavir Treat HIV and Hep C

Macrolides

-thromycin "throw mice" Azithromycin - Zpack for URI Clarithromycin Erythromycin

H2 Receptor Blockers

-tidine Cimetidine Famotidine reduce acid

Antivirals

-vir Acyclovir Valganciclovir Cidofovir Tenofovir

SSRIs

-xetine Paroxetine Fluoxetine Sertraline Citalopram

Benzodiazepines

-zepam -zolam Diazepam Alprazolam Midazolam Triazolam

alpha blockers

-zosin

Digoxin therapeutic range

0.5 - 2.0 ng/mL

Normal Cr - NCLEX level

0.6 - 1.3

Normal Creatinine male

0.6 - 1.3 male

Normal Creatinine

0.6-1.3 mg/dL

Normal INR

0.75-1.25

When should calcium channel blockers be administered?

1 hour before meals OR 2 hours after meals

Healthy infants gain about ____ ounce(s) per day or _____ lb(s) per week for the first 3 months

1 ounce per day 0.5 lb per week

What should you do if a child collapses, is apneic, and has a pulse of 60 or less?

1) 2 rescue breaths 2) If pulse still slow, begin compressions 3) If pulse returns to > 60, go back to just breaths

Tx for Magnesium Toxicity

1) Immediately D/C magnesium infusion 2) Administer antidote: IV Calcium Gluconate bolus 3) Prepare for actions to prevent respiratory or cardiac arrest

You see VTach on the monitor. What 2 things do you need to assess about it to determine treatment?

1) Is there a pulse? 2) If there is a pulse, is the pt stable or unstable? Signs of instability include hypotension, altered mental status, signs of shock, chest pain, and acute heart failure

Process of changing a negative-pressure wound therapy dressing

1) Medications are administered preprocedure to prevent discomfort - 30 mins prior 2) After wound cleansing, a skin protectant is applied around the wound to prevent breakdown and promote an air-tight seal 3) A sterile foam dressing is cut to fit the wound shape and size and is placed in the wound bed - edges should extend beyond the size of the wound - do not cut foam directly over wound site b/c pieces will fall into wound 4) Then a vacuum-assisted closure (VAC) unit is connected to create negative pressure 5) The foam dressing should compress when the device is turned on, indicating a proper seal and functioning equipment

Examples of pregnant clients who should NOT be given opioid agonist-antagonist medications

1) Mom at 3cm dilation who wants to ambulate - opioids could prolong her labor and make her dizzy during her walk 2) Mom in active labor with recent heroin use - risk for maternal and/or fetal withdrawal symptoms 3) Mom at 9cm with urge to push - opioids cross placenta and could cause respiratory depression in baby who will likely be born soon

Drugs that can cause orthostatic hypotension

1) Most antihypertensive medications, particularly sympathetic blockers such as beta blockers (metoprolol) and alpha blockers (terazosin) 2) Antipsychotic medications (olanzapine, risperidone) and antidepressants (SSRIs) 3) Volume-depleting medications such as diuretics (furosemide, hydrochlorothiazide) 4) Vasodilator medications (nitroglycerine, hydralazine) 5) Narcotics (morphine)

Asthma exacerbation treatment:

1) O2 to maintain sat >90% 2) High-dose inhaled short-acting beta agonist (SABA) (albuterol) and anticholinergic agent (ipratropium) nebulizer treatments every 20 minutes 3) Systemic corticosteroids - IV methylprednisolone (Solu-Medrol)

How often should a rescue inhaler be taken apart and washed?

1-2 times/week

Dextrose 10% in water (D 10W), dextrose 5% in lactated Ringer's (D 5LR), and dextrose 5% in 0.9% sodium chloride (D 5NS; D 50.9% NaCl) are ____________ solutions.

hypertonic

Evaluation of kidney function is essential for clients taking medications that are excreted renally or can worsen renal injury. These include 3 major classes/drugs:

1. ACE inhibitors (lisinopril, enalapril) 2. Aminoglycosides (gentamicin) 3. Digoxin

Acceptable blood product alternatives for Jehovah's Witnesses include

Non-blood volume expanders (saline, lactated Ringer's, dextran, hetastarch) Albumin-free erythropoietin (epoetin alfa)

Treatment for an acute asthma attack:

1. Oxygen to maintain saturation >90% 2. High-dose inhaled short-acting beta agonist (albuterol or levalbuterol) and anticholinergic agent (ipratropium) nebulizer treatments every 20 mins 3. Systemic corticosteroids (Solu-Medrol) to control the underlying inflammation - note that these will take some time to show an effect

Can children take fluoroquinolones?

Nope

Can LPNs administer blood?

Nope!

Normal magnesium levels

1.5 - 2.5

The ostomy bag is emptied when it becomes ____________ full.

1/3 full Leaking and skin irritation may occur if the appliance becomes too heavy and pulls away from the skin

Children under the age of ____ should automatically be upgraded to 1 level higher than the triaged urgency of their medical issues.

10

Maximum infusion rate of KCl through a PIV is __ mEq/hr and the maximum concentration is __ mEq/L

10 40

HR for 1-year-old

100 - 160

Normal newborn HR

110-160 when awake and calm 80/min during rest 180/min when crying or agitated

Normal Hgb

13.2 - 17.3

Normal Hgb for male and female

13.2-17.3 male 11.7-15.5 female

Normal platelet count

150,000-400,000 cells/mm3

Houses built before ______ have a high probability of containing lead-based paint.

1978 Active renovations can significantly increase the amount of lead released into the home environment, causing lead poisoning (neurological and motor impairment)

IV hydromorphone should be injected over how many minutes?

2 - 3 mins, either diluted with 5ml NS or undiluted

How many arteries and veins are in the umblical cord?

2 arteries and 1 vein

a normal umbilical cord has ___ arteries, ___ veins

2 arteries, 1 vein AVA

Normal CVP

2-8 mmHg

Why is it bad to give escitalopram to a pt who stopped phenelzine yesterday?

SSRIs (escitalopram) cannot be combined with (MAOIs) (phenelzine) as there is a risk of serotonin syndrome MAOI effects persist long after dosing stops An MAOI should be withdrawn at least 14 days before starting an SSRI

A pt with depression who takes herbal supplements should be educated about which supplement?

SSRIs and St John's wort increase serotonin levels in the brain Pts taking both products concurrently are at risk for potentially life-threatening serotonin syndrome (agitation, confusion, tachycardia, diaphoresis, tremors, hyperreflexia)

Histrionic personality disorder

Self-dramatizing, exaggerated, shallow Attention-seeking, needs to be the center of attention Overly friendly and seductive, attempts to keep others engaged Demands immediate gratification and has little tolerance for frustration

opioid-induced constipation is treated with simultaneous use of _______________ and ________________

Senna (stimulant) AND Docusate (stool softener)

Introjection

Taking in and "swallowing" the values and standards of others Sharing the political views of your favorite famous actor

Permanent effect of long-term phenothiazine administration?

Tardive dyskinesia is a permanent extrapyramidal symptom

Warfarin is usually administered for __ - __ months following PE to prevent further thrombus formation.

3 - 6 months

tPA must be administered within _____ of onset of clinical stroke symptoms.

3 to 4.5 hr window from onset

A common side effect of tiotropium and other anticholinergics (ipratropium, benztropine) is

Xerostomia (dry mouth) due to the blockade of muscarinic receptors of the salivary glands, which inhibits salivation Sugar-free candies or gum may be used to alleviate dry mouth and throat

Can a UAP provide perineal care around an indwelling urinary catheter and reapply SCDs?

Yes

Do you shake an albuterol canister prior to inhalation?

Yes

Does varicella zoster require use of an N95 respirator?

Yes

Is it ok to mix NPH with regular insulin or lispro?

Yes

Is it ok to administer Levofloxacin to a pt who has anaphylactic reactions to penicillins?

Yes! Levofloxacin, a fluoroquinolone antibiotic prescribed to treat UTIs, has no known cross-sensitivity to penicillin

Normal albumin levels

3.5-5

A normal respiratory rate for an infant

30-60/min

Normal Hct male

39% - 50% male

Undiluted morphine IV push should be administered slowly over how many minutes?

4 - 5 mins

A therapeutic magnesium level of ____ - ____ mEq/L is necessary to prevent seizures in a preeclamptic client.

4 - 7

How long until SSRIs start working?

4-6 weeks

Autonomic dysreflexia is an acute, life-threatening response to noxious stimuli, which clients with spinal cord injuries above _____ are unable to feel.

Above T6 Signs and symptoms include hypertension, bradycardia, a pounding headache, diaphoresis, and nausea It is essential that the nurse assess for and remove noxious stimuli to prevent a stroke Noxious stimuli may include: Bladder distention (obstructed urinary catheter, neurogenic bladder) Fecal impaction Tight clothing (shoelaces, waistbands)

Which drug is tPA?

Alteplase

Beta blockers can mask symptoms of ________________

hypoglycemia

Is it ok to administer IV morphine to a pt with who just underwent nephrolithotripsy who has not had a BM in 2 days?

Yes! Although opioids (morphine) can cause constipation, symptoms can be managed with pharmacologic (docusate sodium, sennoside) and nonpharmacologic interventions (increased activity, increased fiber and fluid intake) Percutaneous nephrolithotripsy breaks and removes kidney stones, and can lead to severe pain - therefore, pain medication is appropriate

The nurse should administer atenolol for any HR greater than _____.

60

A normal blood glucose range for an infant

40-60 mg/dL within the first 24 hours after delivery A blood glucose level < 40 indicates hypoglycemia

Ketorolac (Toradol)

a highly potent NSAID

Phlebostatic axis is located where?

4th ICS, at the midway point of the AP diameter (½ AP) of the chest wall

Normal BUN

6 - 20 male

Stranger anxiety begins at what age?

6 months

How long does drug therapy last for a pt with TB?

6 months or longer

Normal PaO2

80-100

If pt is obese, administer SQ at a ____-degree angle!

90

Normal infant HR

90-160

A normal temperature range for an infant

97.7-99.7 F (36.5-37.6 C)

An individual with a CD4 lymphocyte percentage < ____% is considered to be severely immunocompromised.

< 15%

Low platelet count is not considered an urgent need until it is at < __________.

< 50,000

Secondary Postpartum Hemorrhage (PPH)

>24 hours but <6 weeks postpartum Usually results from uterine subinvolution (does not return to original size), retained placental fragments/membranes, or uterine infection (Option 1) Postpartum fatigue is common due to the adjustments needed to provide newborn care or may be related to postpartum anemia. Follow-up is necessary, but it is not the most concerning statement. (Option 2) Bright red bleeding with defecation is associated with hemorrhoids, a common finding in pregnancy. Hemorrhoids usually begin to shrink following birth. (Option 4) Physiologic fluid retention in pregnancy may cause medial nerve compression (ie, carpal tunnel syndrome), an expected discomfort of pregnancy marked by a tingling or burning sensation of the hands. Educational objective:Secondary or delayed postpartum hemorrhage (PPH) occurs >24 hours but <6 weeks postpartum. Reports of increased vaginal bleeding, soaking a pad in <1-2 hours, reverting from lochia serosa back to lochia rubra, or passing several/large clots are concerning findings associated with secondary PPH.

When should children be screened for elevated blood lead levels?

A BLL screening is recommended between ages 1 and 2, or up to age 6 if the child was not previously screened

What is a priority when caring a pt after a carotid endarterectomy?

A carotid endarterectomy is a surgical procedure that removes atherosclerotic plaque from the carotid artery Blood pressure is closely monitored during the first 24 hrs postop Hypertension may strain the surgical site and trigger hematoma formation, which can cause hemorrhage or airway obstruction *SBP is maintained at 100-150 mmHg to ensure adequate cerebral perfusion and avoidance of hemorrhage or strain

Misoprostol (Cytotec)

A cervical ripening agent In addition to ripening the cervix, prostaglandins (misoprostol, dinoprostone) can stimulate frequent contractions It is given PO or vaginally, OR rectally in case of PPH

How should a parent handle a child with school phobia?

A child with school phobia needs to return to the classroom immediately Insisting on school attendance, along with other supportive interventions, will help the child make a faster adjustment

Solifenacin

A cholinergic antagonist prescribed to treat symptoms associated with an overactive bladder (urge incontinence, frequency) Common expected adverse effects include dry mouth and constipation Can cause dizziness and blurred vision

Expected lab finding in an infant with pyloric stenosis

A hematocrit of 57% (0.57) is elevated and indicative of hemoconcentration caused by dehydration Elevated BUN is also a sign of dehydration

Which diet should a patient follow when taking mebendazole?

A high-fat diet increases the absorption of mebendazole, which boosts the effectiveness of the medication in eliminating the pinworms

Impetigo

A highly contagious bacterial skin infection, most commonly occurring in children during hot, humid weather Itchy, burning, red pustules that rupture to form honey-colored crusts When treated with antibiotic ointmentand/or oral antibiotics, lesions are no longer contagious after 24-48 hours and typically heal within a week

Fat embolism syndrome (FES)

A life-threatening condition that has no specific treatment When a long bone is fractured, pressure within the bone marrow leads to release of fat globules into the bloodstream These combine with platelets (fat embolus) and can travel to the brain, lungs, and kidneys

Signs of bleeding into retroperitoneal space

A client who undergoes percutaneous coronary intervention (PCI) and intracoronary stent placement using the femoral approach is at increased risk for retroperitoneal hemorrhage Administration of antithrombotic drugs before, during, and after PCI can exacerbate potentially life-threatening bleeding from the femoral artery S/S: Hypotension, back pain, flank ecchymosis (Grey-Turner sign), hematoma formation, and diminished distal pulses can be early signs of bleeding into the retroperitoneal space and require immediate intervention/evaluation (notify health care provider, serial CBCs, abdominal CT)

Psychomotor retardation

A clinical finding in some pts diagnosed with major depressive disorder The key features include: 1) Decreased movement 2) Inability or decreased ability to talk 3) Impaired cognitive function 4) Lack of facial expression 5) Downcast gaze

Psychogenic dystonia

A psychogenic movement disorder characterized by involuntary muscle contractions that cause slow, repetitive movements such as twisting and abnormal postures

Carbidopa/levodopa can affect urine how?

A common medication used to manage symptoms of Parkinson disease, can cause a harmless darkening of urine color (brown, black)

Bronchiolitis

A common viral illness of childhood that is usually caused by RSV Treatment: supportive care; most children can be managed in the home environment Breastfeeding should be continued and additional fluids offered if there is a risk of dehydration due to frequent coughing and vomiting Parents should be instructed to use saline nose drops and then suction the nares with a bulb syringe to remove secretions prior to feedings and at bedtime NO meds

Dextromethorphan

A cough suppressant Antitussive

Tetralogy of Fallot (TOF)

A cyanotic cardiac defect that causes chronic hypoxemia due to decreased pulmonary blood flow and circulation of poorly oxygenated blood To compensate for prolonged tissue hypoxia, erythropoietin production increases to produce additional oxygen-carrying RBCs Increased RBCs result in increased circulatory viscosity or polycythemia (hgb >22 g/dL or hct >65%) Polycythemia increases the risk for blood clotting (thrombus formation), which can cause stroke

Cystic fibrosis (CF)

A defective protein responsible for transporting Na+ and Cl- causes exocrine gland secretions to be thicker and stickier than normal Viscous respiratory secretions accumulate, resulting in impaired airway clearance and a chronic cough Eventually develop chronic lung disease, which predisposes them to recurrent respiratory infection Pancreatic enzyme secretion, needed for digestion and absorption of nutrients, is also impaired because thick secretions block pancreatic ducts Pt needs supplemental enzymes with all meals and snacks Requires multiple vitamins and a diet high in carbohydrates, protein, and fat to help meet nutritional requirements for growth Sweat gland abnormalities prevent Na+ and Cl- reabsorption, causing increased salt loss, dehydration, and hyponatremia during times of significant perspiration - parents should increase the child's salt intake and fluids during hot weather, exercise, or fever Pts should incorporate chest physiotherapy (percussion, vibration, postural drainage) into their daily routine to improve mucus clearance and lung function Encourage physical activity as tolerated, which helps to thin secretions and remove them from airways and improves muscle strength and lung capacity

Atrial fibrillation

A disorganization of electrical activity in the atria due to multiple ectopic foci It results in loss of effective atrial contraction and places the client at risk for embolic stroke due to thrombi formed in the atria from stasis of blood During atrial fibrillation, the atrial rate may be increased to 350-600/mi The ventricular response (pulse rate) can vary The higher the ventricular rate, the more likely the client will have symptoms of decreased CO (hypotension) *Ventricular rate control is a priority in clients with atrial fibrillation

What needle is used to withdraw medication from a glass ampule?

A filter needle must be used when withdrawing medication from a glass ampule to prevent aspiration and injection of glass shards After the medication is withdrawn, the filter needle is discarded and an injection needle (eg, 20-gauge, 1-in [2.5-cm] needle) is attached to the syringe

Methotrexate

A folate antimetabolite, antineoplastic, immunosuppressant drug used to treat various malignancies and as a nonbiologic disease-modifying antirheumatic drug used to treat rheumatoid arthritis and psoriasis Pt education: Obtain routine killed (inactivated) vaccines (influenza, pneumococcal) and avoiding crowds and persons with known infections Live vaccines (herpes zoster) are contraindicated Alcohol should be avoided in clients taking methotrexate as it is hepatotoxic Photosensitivity (tetracycline, thiazide diuretics, and sulfonamides) and nephrotoxicity (common with aminoglycosides, vancomycin, and nonsteroidal anti-inflammatory drugs) can occur

What should you do if the patient's ventilator is alarming, you have check all the connections, and the O2 sat is dropping?

A low tidal volume alarm indicates that the volume of air the ventilator is delivering is lower than the set volume. This is most often due to a disconnection, loose connection, or leak in the circuit. The nurse should troubleshoot the most common causes of the alarm, but if the client's condition is deteriorating clinically (eg, decreasing oxygen saturation), then the nurse should: Disconnect the ventilator and manually ventilate the client's lungs with a resuscitation bag device at 10-15 L/min oxygen until the ventilator alarm state can be resolved. Then call the RT!

Autonomic dysreflexia (autonomic hyperreflexia)

A massive, uncompensated cardiovascular reaction by the sympathetic nervous system (SNS) in a spinal injury at T6 or higher Due to the injury, the parasympathetic nervous system cannot counteract the SNS stimulation below the injury Classic triggers are distended bladder or rectum

Which pt should be seen first? 1) Cancer pt on chemo with new onset back pain and weak legs 2) Cancer pt on chemo with persistent vomiting and K+ of 3.4

A new-onset finding is more concerning than chronic or expected findings There is a risk of spinal cord compression from a metastatic tumor in the epidural space The classic symptoms are localized, persistent back pain; motor weakness; and sensory changes (numbness, paresthesia) Neurologic changes are a priority because the symptoms are subtle and time sensitive for permanent negative outcomes Bone is a common site for metastasis due to its vascularity (The 3.4 K+ is barely low and vomiting is expected for a chemo pt)

Albuterol (Proventil)

a short-acting beta agonist a rescue drug to relieve symptoms (eg, wheezing, breathlessness, chest tightness) associated with asthma

Functional nursing

A nursing care pattern focusing on tasks and jobs; each nursing team member has certain tasks and jobs to do

McBurney point

A point halfway between the anterior superior iliac spine and the umbilicus on the pt's right side The area of pain and rebound tenderness in patients suffering from acute appendicitis

Hirschsprung's disease

A portion of the colon has no innervation and must be removed. Some children require a temporary colostomy.

Nicardipine

A prototype of nifedipine and is a potent calcium channel blocking vasodilator It takes effect within 1 minute of IV administration It is essential to monitor that the BP is not being lowered too quickly or too slowly Must be discontinued if hypotension or reflex tachycardia occurs

What do you do if a chest tube becomes dislodged?

A sterile occlusive dressing (petrolatum gauze) must immediately be placed over the insertion site until the HCP can assess the client and insert a new chest tube *If such dressings are not immediately available, the nurse should cover the insertion site with something clean and occlusive gloved hand) to prevent air from entering the pleural cavity After the chest tube insertion site is covered, the client should be assessed

Nitrazine pH test strip

A strip inserted into the vagina that can differentiate between amniotic fluid, which is alkaline, and vaginal fluid, which is acidic A blue-green, blue-gray, or deep blue color indicates a positive result and probable rupture of membranes A yellow, olive-yellow, or olive green color indicates a negative result and suggests that membranes are intact

Bishop score

A system for the assessment and rating of cervical favorability and readiness for induction of labor The cervix is scored (0-3) on consistency, position, dilation, effacement, and station of the fetal presenting part A higher Bishop score indicates an increased likelihood of successful induction that results in vaginal birth For nulliparous women, a score ≥6-8 usually indicates that induction will be successful

Systolic murmur in a pregnant woman

A systolic murmur (swooshing sound heard during S1) is a common finding in pregnancy It results from increased total body volume (flow murmur) and usually resolves after birth

Middle East respiratory syndrome (MERS)

A viral respiratory illness caused by the coronavirus (MERS-CoV) Symptoms include fever, cough, and SOB that often worsen and cause death in many of those afflicted How the virus spreads is not fully understood, but it is thought to spread via respiratory secretions PPE: standard, contact, and airborne precautions with eye protection when caring for clients with MERS - includes an N95 respirator

Regular insulin

best for IV use for diabetic ketoacidosis Short-acting Peak: 2-5 hours

Which antihypertensive medication class is helpful in diabetics?

ACE Inhibitors

Captopril is an ___________ that also causes ______________.

ACE inhibitor hyperkalemia

Angioedema and dry, hacking cough are adverse effects of which class of medications?

ACE inhibitors (enalapril, lisinopril, captopril) and occurs more commonly in African American clients

Which antihypertensives can worsen hyperkalemia?

ACEs and ARBs

Desmopressin

ADH agonist used to treat Diabetes Insipidus Monitored for UO, urine specific gravity, and serum Na+ (to avoid hyponatremia due to excess DDAVP)

Losartan is an ____________ that causes _____________.

ARB hyperkalemia

Behavioral management for agitated clients with Alzheimer disease includes:

Acknowledging client feelings Reassuring safety Distracting Redirecting to other activities

Colchicine is used to treat

Acute attack of gout because it decreases the inflammation and pain associated with deposition of uric acid crystals in the joints

Pain and tenderness in the epigastric or right upper quadrant of the abdomen that is referred to the right scapula is associated with

Acute cholecystitis May also experience indigestion, nausea, vomiting, restlessness, and diaphoresis

Sucralfate

An oral medication that forms a protective layer in the GI mucosa, which provides a physical barrier against stomach acids and enzymes It does not neutralize or reduce acid production but is prescribed to treat and prevent both stomach and duodenal ulcers Sucralfate is generally prescribed 1 hour before meals and at bedtime and, for effective results, is taken on an empty stomach with a glass of water Sucralfate forms a better protective layer at a low pH level - therefore, antacids or other acid-reducing medications (PPIs, H2 blockers) should be avoided within 30 minutes of taking sucralfate Sucralfate should be taken 1 hour before meals to protect the stomach Sucralfate binds with many medications (digoxin, warfarin, phenytoin), reducing their bioavailability and effectiveness - therefore, all other medications are generally taken ≥ 1-2 hours before or after taking sucralfate Constipation is a common side effect of sucralfate

NPH insulin is ____ acting

intermediate

Adalimumab

Adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade) are common tumor necrosis factor inhibitor, biologic disease-modifying antirheumatic drugs Major adverse effects include immunosuppression and infection

Which medication is administered for SVT and how is it administered?

Adenosine! Rapid IV push! The half-life is <5 seconds, so adenosine should be administered rapidly as a 6-mg bolus IV over 1-2 seconds followed by a 20-mL saline flush. Repeat boluses of 12 mg may be given twice if the rapid rhythm persists The injection site should be as close to the heart as possible (antecubital area)

The nurse should anticipate the following interventions for clients in Preterm Labor before 34 weeks gestation:

Administer IM antenatal glucocorticoids (betamethasone, dexamethasone) to stimulate fetal lung maturation and promote surfactant development Administering IVantibiotics (penicillin) to prevent group B Streptococcus infection in the newborn if preterm birth occurs Initiating an IV magnesium sulfate infusion for fetal neuroprotection if at <32 weeks gestation Giving tocolytic medications (nifedipine, indomethacin) to suppress uterine activity, which allows antenatal glucocorticoids time to have a therapeutic effect Monitoring pertinent laboratory results, including cultures for vaginal or urinary tract infection and group B Streptococcus, if obtained Place on continuous fetal monitoring

Amnioinfusion

Administered through an intrauterine pressure catheter to relieve variable decelerations, not late decelerations Variable decelerations are usually caused by cord compression secondary to loss of amniotic fluid (after rupture of membranes, because of oligohydramnios)

The priority in treatment of hyperkalemia with ECG changes (peaked T waves) is

Administration of IV calcium gluconate to immediately prevent life-threatening dysrhythmias Then IV regular insulin with dextrose, sodium polystyrene sulfonate, and/or hemodialysis may be implemented IV regular insulin temporarily corrects hyperkalemia by shifting potassium into the cells - dextrose is administered concurrently to prevent hypoglycemia

Mannitol

An osmotic diuretic used to treat cerebral edema (increased ICP) and acute glaucoma When administered, mannitol causes an increase in plasma oncotic pressure (similar to excess glucose) that draws free water from the extravascular space into the intravascular space, creating a volume expansion This fluid, along with the drug, is excreted through the kidneys, thereby reducing cerebral edema and intracranial pressure However, if a higher dose of mannitol is given or it accumulates (as in kidney disease), fluid overload that may cause life-threatening pulmonary edema results An early sensitive indicator of fluid overload is new onset of crackles auscultated in the lungs

When should infants no longer have head lag?

After age 4-6 months Head lag remaining after age 6 months is an abnormal finding often associated with cerebral palsy or autism

Beta agonists

Albuterol Terbutaline

Rapid-acting asthma medications

Albuterol and Ipratropium

Who should get the influenza vaccination?

All pts age ≥6 months should receive the influenza vaccine annually unless the client has a life-threatening allergy to the vaccine or one of its ingredients Especially vaccinate the following people: - Clients with chronic conditions (asthma, HF, cancer) may experience exacerbation of symptoms if infected - Immunocompromised clients (HIV) have decreased ability to fight infection - Health care workers and caretakers are at greater risk for acquiring and transmitting infection to other clients - Healthy children age 6-23 months and clients age ≥65 are at greatest risk for serious, flu-related complications (pneumonia, dehydration) - Pregnant clients are at increased risk for premature labor/delivery or influenza complications due to pregnancy-related physiologic changes

Benzodiazepines for acute anxiety include

Alprazolam Lorazepam

Buretrol

Also known as a volume control device, may be used to reduce risk for fluid overload or medication overdose May also be used for intermittent medications that need to be further diluted and given over a specific time.

In children with cystic fibrosis, which medications may be given before meals with enzymes to reduce gastric acidity and prevent enzyme destruction?

Aluminum hydroxide and magnesium hydroxide

How does Amantadine work for pts with Parkinson's?

Amantadine is a dopamine-releasing agent It increases the amount of dopamine present in the CNS

Zolpidem

Ambien Insomnia Hypnotic

Tricyclic antidepressants

Amitriptyline nortriptyline moxapine

Which medication is prescribed for neuropathic pain to reduce opioid use?

Amitriptyline tricyclic antidepressant

ALS

Amyotrophic lateral sclerosis, also known as Lou Gehrig disease, is a debilitating, progressive neurodegenerative disease with no cure Clients develop fatigue and muscle weakness that progresses to paralysis, dysphagia, difficulty speaking, and respiratory failure Most clients diagnosed with ALS survive only 3-5 years

Suspect a chest tube air leak when ...

An air leak would cause bubbling in the air leak gauge or water seal chamber NOT in the suction control chamber Gentle, continuous bubbling in the suction control chamber of a chest tube drainage unit indicates the presence of suction in the system and is an expected finding

Unilateral neglect

An alteration in sensory perception that causes clients to ignore input from the affected side, leading to performing actions only on one side (eg, eating food on only the right side of the plate) Teaching clients to turn the head to fully scan the environment reduces the tendency to neglect one side

Tobramycin

An aminoglycoside antibiotic drug used to treat serious gram-negative bacterial infections

Amphotericin B

An antifungal used to treat systemic fungal infections Commonly associated with severe adverse effects, including hypotension, fever, chills, and nephrotoxicity Do not administer at the same time as blood products

Signs of child abuse

Shaken baby syndrome (irritability or lethargy, poor feeding, emesis, seizures) Burns in the shape of household items (iron, spatula), from cigarettes, or from immersion in scalding liquid Repeated injuries in varied stages of healing (bruises, burns, fractures) Injuries to genitalia Lapsed time between the injury and the time when care is sought Inconsistency between the injury and the caregiver's explanation of the injury (client's developmental age, mechanism of injury)

Myasthenia gravis

An autoimmune disease manifesting mainly as muscle weakness and ptosis The muscle weakness increases with activity, and by the end of the day, ptosis is present Pts with myasthenia crisis can have respiratory failure

Benztropine

Anticholinergic Medication treats the extrapyramidal symptoms associated with chlorpromazine

Postpartum endometritis

An infection of the endometrium Characterized by fever, chills, tachycardia, uterine tenderness, and purulent lochia

Dopamine

An inotrope used to treat hypotension due to bradycardia

Radiofrequency catheter ablation

An invasive procedure that may be used to treat clients with recurrent episodes of SVT A catheter is inserted through a large artery or vein (femoral) and threaded to the heart After cardiac catheterization, clients must remain supine with the head of the bed at ≤30 degrees and the affected extremity straight to prevent bleeding from the catheter insertion site Any level of chest pain after ablation should be reported immediately to the health care provider (even 2/10 pain)

Nursing care for Renal Calculi

Analgesics administered at regularly scheduled intervals Rehydration of up to 3 L/day unless contraindicated by other comorbidities Ambulation to facilitate the passage of calculi Strain all urine obtained - stones are analyzed for composition in lab Monitored heat therapy on flank is ok but no massage

At what Hgb level is epoetin administered to a pt with CKD?

Anemia associated with chronic kidney disease is treated with recombinant human erythropoietin (Epogen/Procrit, epoetin) Therapy is initiated when Hgb is < 10 g/dL Therapy should be discontinued or the dose reduced for hemoglobin >11 g/dL to prevent venous thromboembolism and adverse cardiovascular outcomes from blood thickened by high concentrations of RBCs

MRI is contraindicated in pts with:

Aneurysm clips Metallic implants such as Implantable Cardioverter Defibrillators (ICDs) Pacemakers, electronic devices Hearing aids Shrapnel

What is the difference between antacids and H2 antagonists?

Antacids do not affect healing or prevent the recurrence of ulcers; they merely provide symptomatic relief

Difference between H2 blockers and antacids

Antacids neutralize gastric acid to keep pH at 3.5 or above H2 Blockers decrease the production of gastric secretions (-tidines)

Tamoxifen

Anti-estrogenic drug used to decrease the occurrence of certain breast cancers

How do you treat stable VTach with a pulse?

Antiarrhythmic medications (amiodarone, procainamide, sotalol)

Adenosine

Antiarrhythmic used to treat supraventricular tachycardia (SVT)

Should you administer pain meds/antipyretics or antibiotics first?

Antibiotics

Ezetimibe

Antihyperlipidemic

Clonidine class

Antihypertensive (and analgesic)

Which class of antineoplastic chemotherapy agents resembles the essential elements required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function and replication?

Antimetabolites exert their action by inhibiting the enzymes necessary for cellular function and replication.

Cisplatin

Antineoplastic medication that can cause renal toxicity Check UO, BUN, and Cr

Carbidopa/levodopa

Antiparkinson medication May cause dizziness, involuntary movements, and orthostatic hypotension, further increasing the risk for falls

Clopidogrel (Plavix)

Antiplatelet agent

Phenytoin

Antiseizure medication

Baclofen

Antispasmodic drug commonly prescribed to clients with multiple sclerosis to relieve uncomfortable spasms and muscular pain Dizziness when attempting to stand or changing positions (orthostatic hypotension) is a common adverse effect

What could trigger a low-pressure limit alarm in a pt with a ventilator?

Any condition that decreases airway resistance (tubing disconnect, extubation, endotracheal or tracheostomy tube cuff leak) can trigger the low-pressure limit alarm

What do you do if a 5 minute APGAR is <7?

Apgar scoring is repeated every 5 minutes for up to 20 minutes if the 5-minute Apgar score is <7 Scores <7 indicate difficulty transitioning and may require further interventions (oxygen, suctioning) in addition to typical supportive measures (stimulating, drying, warming)

Interventions for a client with a suspected cervical spine injury are ...

Application of a rigid hard collar Placing the client on a firm surface Logrolling the client during movement and transfers Continued assessment of need for an advanced airway

Labor Pain intervention for fetus in Right Occiput Posterior (ROP) position

Applying counter-pressure to the sacrum during contractions

What should you check before giving a patient a cephalosporin?

Are they allergic to penicillin??

Why is careful handling required for hypothermic pts?

As the core temperature decreases, the cold myocardium becomes extremely irritable Frequent turning could cause spontaneous VFib and should not be performed during the acute stage of hypothermia Continuous cardiac monitoring should be initiated

ADHD medications

Stimulants such as methylphenidate (Ritalin) and amphetamines (dextroamphetamine, lisdexamfetamine)

Priority assessment prior to administering Kayexalate

Assess abdomen and review EMR for frequency of stools In clients without normal bowel function (post surgery, constipation, fecal impaction), there is a risk for intestinal necrosis During sodium polystyrene sulfonate therapy, severe hypokalemia (palpitations, lethargy, cramping) can develop - frequent monitoring of electrolyte status is required Because potassium exchanges with sodium content of the resin, excess sodium absorption could put clients at risk of developing volume overload (water follows sodium) - the client should be monitored for signs of fluid overload (crackles, JVD, edema) and have daily weights and I&O assessment

Hypercyanotic episodes occur in infants with which disease?

Associated with Tetralogy of Fallot The knee-chest position increases systemic vascular resistance in the lower extremities and can help

How long must a patient remain at the healthcare center after receiving an allergy shot?

At least 30 mins to assess for anaphylaxis

Is it ok to apply a heating pad on a pts abdomen if they have appendicitis?

Avoid applying heat to the abdomen as this increases appendiceal swelling and the risk of appendix perforation

Teaching plan for isoniazid (INH)

Avoid intake of alcohol and limit use of other hepatotoxic agents (acetaminophen) Take pyridoxine (vitamin B6) if prescribed to prevent neuropathy Avoid aluminum-containing antacids (aluminum hydroxide (Maalox)) within 1 hour of taking INH Report changes in vision (blurred vision, vision loss) Report scleral and skin jaundice, vomiting, dark urine, fatigue, numbness, tingling of extremities

What type of diet is required for a patient taking MAOIs? Why?

Avoid tyramine-containing foods (eg, cheese, overripe fruit, liquor, beef/chicken liver, fermented products) due to risk of hypertensive crisis

At what platelet count should you avoid IM injections and venipuncture?

Avoiding intramuscular injections and minimizing venipunctures is most important when the platelet count is below 50,000/mm3, as these can cause prolonged bleeding

Expected SE of methotrexate

Stomatitis

When a foreign body becomes accidentally embedded in a pt's eye, what should the nurse do?

BOTH eyes should be shielded to prevent eye movement and additional injury The nurse should immediately refer the client to an ophthalmologist for further evaluation and treatment

Which 4 proteins have gluten in them?

Barley Rye Oats Wheat mnemonic: BROW

Which medication class should the nurse monitor apical rate and assess for decreased BP?

Beta Blockers

Carvedilol

Beta blocker used to improve cardiac output and slow the progression of heart failure

Why is wheezing a bad sign after a pt receives a beta blocker?

Beta blockers cause P to decrease secondary to a decrease in HR. Bronchoconstriction may occur due to the effect on the beta2 receptors. The presence of wheezing in a client taking propranolol may indicate that bronchoconstriction or bronchospasm is occurring. The nurse should assess for any history of asthma or respiratory problems with this client and notify the health care provider (HCP).

Hirschsprung Disease s/s

Bilious green vomiting Abdominal distension Failure to pass meconium Tight anal sphincter

Potential complications for a pt with a total thyroidectomy

Bleeding (throat compression) Hypocalcemia (if parathyroids were removed inadvertently)

Where should you check the pulse of an unresponsive infant <1 year old?

Brachial artery

Adverse effects of beta-blockers include

Bradycardia Bronchospasm Depression Decreased libido with erectile dysfunction

Abciximab

Glycoprotein (GP) IIb/IIIa receptor inhibitors (abciximab, eptifibatide, tirofiban) are used as platelet inhibitors to prevent the occlusion of treated coronary arteries during percutaneous coronary intervention procedures and prevent acute ischemic complications GP IIb/IIIa receptor inhibitors can cause serious bleeding Glycoprotein IIb/IIIa receptor inhibitors (eg, abciximab, eptifibatide, tirofiban) inhibit platelet aggregation and increase bleeding risk Serious thrombocytopenia can occur within few hours, further increasing bleeding risk

Why are H2 antagonists taken at bedtime?

Blocks hydrochloric acid secreted at time H2 antagonists act on the parietal cells to inhibit gastric secretion. Some gastric secretion occurs all the time, even when the stomach is empty, unless medications are taken to inhibit this action

Guillan-Barre Syndrome

Body produces auto-antibodies that cause demyelination of nerves leading to muscle paralysis and weakness S/S: ascending muscle paralysis and absence of reflexes

The major adverse effects associated with methotrexate include

Bone marrow suppression Hepatotoxicity Congenital abnormalities and fetal death So get flu shot, don't drink alcohol, and don't get pregnant

Peak of NPH

Both insulin NPH, an intermediate-acting insulin, and insulin detemir, a long-acting insulin, have peak effect timesthat may cause hypoglycemia at 5-6 hours later

What should the nurse assess before administering atropine?

Bowel sounds (should have 3 - 35 sounds/min) Anticholinergic drugs, such as atropine, have antispasmodic and antisecretory properties, which relax the gastrointestinal tract, and are therefore contraindicated in a client with intestinal atony

Which type of inhaler is used first?

Bronchodilator before corticosteroid

Theophylline

Bronchodilator used to treat asthma and COPD

Battle sign

Bruising behind an ear over the mastoid process that may indicate a basilar skull fracture

Dehiscence

Bursting open of a wound, especially a surgical abdominal wound

Which analgesic should the nurse anticipate administering for a patient with pain during the active stage of labor?

Butorphanol is a mixed agonist-antagonist analgesic resulting in good analgesia but with less respiratory depression, nausea, and vomiting compared with opioid agonist analgesics

Opioid agonist-antagonist medications used in labor include:

Butorphanol tartrate (Stadol) and nalbuphine hydrochloride (Nubain) Maternal adverse effects include sedation, dizziness, and nausea Butorphanol tartrate crosses the placental barrier, peaking in 30-60 minutes; its duration of action is approximately 2-4 hours If given near the time of birth, there is a risk for newborn respiratory depression, which may require naloxone (Narcan) to reverse the effects

Can a 3-month old recognize faces?

By age 3 months, the infant recognizes familiar items and faces Any 3-month-old who does not respond to familiar faces may have visual impairment or an underlying neurological disorder (eg, autism)

Pt education for carbamazepine

Carbamazepine is associated with agranulocytosis (leukopenia) and infection risk Clients should be advised to report any fever or sore throat

NPH

intermediate acting insulin Duration: 12-18 hours Twice a day

Labetalol and Carvedilol are contraindicated in which 4 patients?

COPD Asthma HF Heart Block

Gerd triggers

Caffeine, alcohol, nicotine, high-fat foods, chocolate, spicy foods, peppermint, and carbonated beverages

Avoid grapefruit juice with this class of antihypertensive medication

Calcium Channel Blocker

Amlodipine

Calcium channel blocker commonly used to treat hypertension

Potential complications of alcohol withdrawal

Can develop into delirium tremens or seizures If this happens, pts need frequent doses of benzodiazepines (lorazepam, diazepam) and aggressive supportive care

Why is widening of the QT interval dangerous and which medications can cause this to happen?

Can increase the risk of life-threatening Torsades de Pointes Most commonly seen with: Haloperidol (Haldol) Methadone Ziprasidone (Geodon) Erythromycin

Isoniazid interacts with which drugs?

alcohol Antabuse phenytoin - increases levels

Pacemaker failure to capture

Causes bradycardia and hypotension Pacemaker malfunction may be caused by a failing battery, malpositioned lead wires, or fibrosis at the tip of lead wire(s) preventing adequate voltage for depolarization If this happens and the pt is symptomatic, the nurse's priority is to use transcutaneous pacemaker pads to normalize the HR, stabilize BP, and adequately perfuse organs until the permanent pacemaker is repaired or replaced Administer analgesia and/or sedation as prescribed as transcutaneous pacing is very uncomfortable for the client The health care provider needs to be notified, but the nurse should first use the transcutaneous pacemaker to stabilize the client

When the mechanical ventilator high-pressure limit alarm sounds (high PIP), the nurse should assess for ...

Causes of increased airway resistance in the: 1) Patient (bronchospasm) 2) Artificial airway (excessive secretions, biting the endotracheal tube) AND/OR 3) Ventilator system (eg, kinked tubing) Also check for causes of decreased lung compliance (pneumothorax)

What is the black box warning for Celecoxib?

Celecoxib (Celebrex), a COX-2 inhibitor, has a black box warning for increased risk of cardiovascular complications. MI symptoms!!

Amyotrophic lateral sclerosis (ALS) becomes emergent at which point?

Characterized by the progressive loss of motor neurons in the brainstem and spinal cord Clients have spasticity, muscle weakness, and atrophy *Neurons involved in swallowing and respiratory function are eventually impaired, leading to aspiration, respiratory failure, and death Care of clients with ALS focuses on maintaining respiratory function, adequate nutrition, and quality of life There is no cure, and death usually occurs within 5 years of diagnosis The client with ALS and worsening ability to speak (dysarthria) may also have dysphagia and respiratory distress - seeing this pt first is a priority!

Nursing Implications for Calcium Channel Blockers

Check BP and pulse routinely Limit caffeine consumption Take medications before meals No grapefruit juice! It causes hypotension High fat meals elevate serum levels - cause hypotension

In which room should a child with autism be placed on the unit?

Children with autism spectrum disorder (ASD) often exhibit sensory processing problems; they may be hyper- or hypo-sensitive to sounds, lights, movement, touch, taste, and smells A calming environment with minimal stimulation should be provided; a private room away from the nurses' station is the best location The nurse can also facilitate a calming environment by: Using a quiet or monotone voice when speaking to the child Using eye contact and gestures carefully Moving slowly Limiting visual clutter Maintaining minimal lighting Providing the child with a single object to focus on

Addison's disease

Chronic adrenal insufficiency occurs when the adrenal glands do not produce adequate amounts of steroid hormones (mineralocorticoids, glucocorticoids, androgens) S/S: - Weight loss - Muscle weakness - Low BP - Hypoglycemia - Hyperpigmented skin (skin folds, buccal area, palmar crease) - Loss of libido - Decreased axillary and pubic hair are common due to lower levels of androgens Hyperpigmented skin is a characteristic universal finding; this results from increased adrenocorticotropic hormone which is due to a decrease in cortisol negative feedback Tx: - Replacement therapy with oral mineralocorticoids and corticosteroids

Fibromyalgia

Chronic, nonspecific pain disorder Causes fatigue, sleep disturbances, emotional distress (eg, anxiety, depression), and even mild cognitive impairments (eg, forgetfulness, difficulty concentrating)

neurogenic shock

Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation A form of distributive shock Causes a disruption in the function of the sympathetic, but not parasympathetic, nervous system Bradycardia, a characteristic manifestation of neurogenic shock, occurs as a result of this alteration in neural activity between the 2 systems Warm dry skin is present (not cool, clammy)

Loratadine

Claritin is an antihistamine

When cleanse a female pt with iodine swabs prior to insertion of a Foley, do you clean the meatus or labia first?

Cleanse the labia majora first, then the labia minora, and lastly the urinary meatus

phenothiazines

all end in 'zine Ex: Thorazine, Compazine, they are major tranquilizers so think safety

Pt education to prevent SE of codeine

Codeine is both an opioid for pain and an antitussive. SE: - Constipation - N/V - Orthostatic hypotension - Dizziness Interventions: - Increasing fluid intake and bulk in the diet - Laxatives - Taking the medication with food - Changing position slowly

Avoid giving Methylergonovine [Methergine] to which pts?

Contraindicated for clients with high BP such as preeclampsia or preexisting hypertension Why? Because Methergine acts by vasoconstriction Could lead to stroke or seizure if given to pt with high BP!

Guaifenesin is prescribed for which pts?

Clients with acute URIs or chronic bronchitis (inflammation of the upper airways) may be prescribed guaifenesin (Musinex) to loosen and improve the expectoration of mucus Clients with chronic bronchitis typically develop rhonchi (sonorous wheezes), which are continuous, low-pitched adventitious breath sounds that resemble moaning or snoring

What should you do if a pt with an allergy to amoxicillin, ciprofloxacin, and sulfa drugs is prescribed IV cefazolin?

Clients with an allergy to penicillin antibiotics (amoxicillin, ampicillin) can possibly experience a cross-sensitivity reaction to cephalosporin antibiotics (cefazolin, cephalexin, ceftriaxone) The nurse should obtain more information about this client's reported allergies, as reactions range from mild to severe The nurse should then clarify the prescription with the health care provider (HCP) prior to administration

What should you do if a pt with borderline personality disorder ask for you to be their only nurse?

Clients with borderline personality disorder, in an attempt to prevent abandonment and control their environment, may flatter and cling to one staff member while making derogatory remarks about others The best nursing action is to rotate staff members assigned to care for the client

Phosphodiesterase inhibitors used in erectile dysfunction (tadalafil, sildenafil, vardenafil)

Contraindicated with the use of nitrates Both have similar mechanisms and cause vascular smooth muscle dilation Combined use can result in severe hypotension

What age group partakes in cooperative play?

Cooperative play is common in school-age children (age 6-12) These children play with one another with a specific goal , often within a rigid set of rules

Hypothermia treatment

Core temp <95 F (35 C) and the body is unable to compensate for heat loss Cold myocardium --> extremely irritable --> prone to dysrhythmias The client should be handled gently as spontaneous VFib could develop when moved or touched Therefore, placing the client on a cardiac monitor is a high priority The nurse should anticipate defibrillation in these clients

Why would a pt with liver disease need albumin?

Clients with severe liver disease can develop hypoalbuminemia because the liver manufactures albumin, and damaged hepatocytes are unable to synthesize it

RN Scope of Practice

Clinical assessment Initial client education Discharge education Clinical judgment Initiating blood transfusion

RN scope of practice

Clinical assessment Initial client education Discharge education Clinical judgment Initiating blood transfusion

Escitalopram

Lexapro SSRI Antidepressant

What type of drug is isocarboxazid?

Commonly used MAOIs include isocarboxazid, phenelzine, and tranylcypromine These first-generation antidepressants are used only for resistant depression due to serious adverse affects

3rd degree Heart Block

Complete heart block occurs when electrical conduction from the atria to the ventricles is blocked, causing decreased CO (dizziness, syncope, mental status changes, heart failure, hypotension, bradycardia) The client with third-degree AV block is a high priority, as the client may decompensate to cardiogenic shock and even periods of asystole Treatment: atropine and temporary pacing (transcutaneous) until a permanent pacemaker can be placed Clients with third-degree atrioventricular (AV) block should be assessed immediately due to the potential for life-threatening consequences (eg, shock, syncope, asystole) caused by decreased CO and severe bradycardia The client with third-degree AV block requires a permanent pacemaker

Common SE of famotidine

Confusion "I haven't been thinking clearly"

Hypospadias

Congenital defect in which the urethral opening is on the underside of the penis Typically corrected around age 6-12 months by surgically redirecting the urethra to the penis tip Circumcision is delayed so the foreskin can be used to reconstruct the urethra Postoperatively, absence of UO for over an hour indicates that a kink or obstruction may have occurred and requires immediate follow-up

Important age-related considerations for the older adult receiving IV therapy include:

Consideration of renal and cardiac function to prevent hypervolemia Use of an infusion pump for control Close monitoring of the site for infiltration and infection Measures to prevent skin tears Use of small-bore (24-26 gauge) IV catheters and correct technique (5-15-degree angle) for insertion of an IV into fragile veins

Hemolytic uremic syndrome

Life-threatening complication of E. coli diarrhea and results in red cell hemolysis, low platelets, and acute kidney injury (low UO) Hemolysis results in anemia (pallor), and low platelets manifest as petechiae or purpura

What question do you ask patients taking SSRIs when they are new to taking them?

Do you have suicidal thoughts? SSRIs can give them enough energy to carry out their plan

Oxybutynin (Ditropan)

an anticholinergic used to treat overactive bladder

Elevated hct can indicate

Dehydration - thicker blood

Which foods should a pregnant woman avoid consuming?

Deli meats and hot dogs (unless steaming hot) - risk for listeriosis Liver - too much Vitamin A Unpasteurized milk products Unwashed fruits and vegetables Raw fish Fish high in mercury such as swordfish

What do Benzos do?

Depress respirations Depress CNS - sleep, sedation (Versed - midazolam)

How can the RN help a patient with myasthenia gravis respond to their symptoms?

Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms Patients should be taught to recognize signs of overmedication and undermedication with cholinesterase inhibitors so that they can modify the dosage themselves based on a prescribed sliding scale

Which drug is used as a palliative treatment to manage symptoms of compression from tumor growth?

Dexamethasone

Nursing care when administering IV vancomycin

Draw the prescribed trough level prior to administration - therapeutic vancomycin levels range from 10-20 mg/L for hemodynamically stable clients Adverse effects of vancomycin toxicity include nephrotoxicity (elevated creatinine levels) and ototoxicity (hearing loss, vertigo, tinnitus) Infuse medication over at least 60 minutes (≤10 mg/min) - faster rates increase the likelihood of complications Monitor blood pressure during the infusion - hypotension is a possible adverse effect Red man syndrome is a nonallergic histamine reaction characterized by sudden onset of severe hypotension, flushing, and/or maculopapular rash of the face, neck, chest, and upper extremities Monitor for anaphylaxis Observe IV site every 30 minutes for pain, redness, or swelling - Vancomycin is a vesicant and may cause thrombophlebitis or, if extravasation occurs, tissue necrosis Administration using a central venous catheter is preferred; however, a peripheral IV may be used for short-term therapy

Mixing regular and NPH insulin

Draw up regular insulin first RN- regular before NPH

High doses of Vitamin C can cause what?

Diarrhea

Most common side effect of Quinidine

Diarrhea

Which drug is used in the ED to treat status epilepticus?

Diazepam

Dicyclomine

Dicyclomine (Bentyl) is an anticholinergic/antispasmodic drug prescribed to manage symptoms of intestinal hypermotility in clients with irritable bowel syndrome (IBS) Dicyclomine is contraindicated in clients with paralytic ileus as it decreases intestinal motility and would exacerbate the condition

How does nitroglycerine work?

Dilates coronary arteries so more O2 can get to heart

Which medication would you give to a pt with Afib, a HR of 140, and a BP of 120/80?

Diltiazem (a calcium channel blocker) is the priority as its purpose is to decrease the ventricular response rate to <100/min Other medications such as beta blockers (metoprolol) or digoxin may also be used to control the ventricular rate Anticoagulants (rivaroxaban [Xarelto], dabigatran [Pradaxa], apixaban [Eliquis], and warfarin) are used for long-term prevention of atrial thrombus and embolic complications

Medications used for AFib

Diltiazem (calcium channel blockers) Metoprolol Digoxin Goal of meds: reduction in ventricular rate OR Antiarrhythmic medications such as amiodarone or ibutilide will be used for conversion to sinus rhythm AND Anticoagulants are used to prevent embolic complications

Babinski reflex disappears at what age?

Disappears between ages 1 - 2

Diverticulitis

Diverticula are saclike protrusions or outpouchings of the intestinal mucosa of the large intestine caused by increased intraluminal pressure (chronic constipation) The left (descending, sigmoid) colon is the most common area for diverticula to develop When these diverticula become inflamed (diverticulitis), the client may experience acute pain (usually in the left lower quadrant) and systemic signs of infection (eg, fever, tachycardia, nausea, leukocytosis)

Pain in the left lower quadrant is associated with

Diverticulitis (often in the sigmoid colon) Other signs and symptoms include a palpable, tender abdominal mass and systemic symptoms of infection (fever, increased C-reactive protein, and leukocytosis with a left shift)

Pancreatic enzymes for CF education

Do NOT give with milk It is ok to open capsule and sprinkle on applesauce for children Do NOT chew capsule though

Is loss of mucous plug a sign of true labor?

During pregnancy, a collection of secretions forms a "mucous plug" in the cervical canal, acting as a protective barrier Although the client may notice expulsion of the mucous plug in the days preceding labor, it is not necessarily a sign of labor

CPR in Pregnancy, 3rd trimester

During pregnancy, the heart is displaced toward the left because the growing uterus pushes upward on the diaphragm, particularly in the third trimester To accommodate this displacement, the hands should be placed on the sternum slightly higher than usual for chest compressions In addition, a gravid uterus can significantly compress the client's vena cava and aorta - the uterus should be manually displaced to the client's left to reduce this pressure - the nurse can also place a rolled blanket or wedge under the right hip to displace the uterus - pt should NOT be fully supine If ROSC does not occur after 4 minutes of CPR, emergency cesarean section is usually initiated - delivery should occur within 5 minutes of initiating CPR

How fast should infants grow per week during the first 6 months? During age 6-12 months?

During the first 6 months, infants should grow 5-7 oz a week From age 6-12 months, infants should grow 3-5 oz a week

What should you do if you suspect a PE?

Elevate the head of the bed Administer oxygen Assess the pt Notify HCP

What type of BUN/Cr values would you expect for a dehydrated pt?

Elevated BUN (eg: 40) and normal Cr (eg: 1)

Nursing interventions to control ICP include:

Elevating the head of the bed to 30 degrees with the head/neck in a neutral position to reduce venous congestion Administering stool softeners to reduce the risk of straining (Valsalva maneuver) Managing pain well while monitoring sedation Managing fever (cool sponges, ice, antipyretics) while preventing shivering Maintaining a calm environment with minimal noise (alarms, television, hall noise) Ensuring adequate oxygenation Hyperventilating and preoxygenating the client before suctioning - reducing CO2 (a potent cerebral vasodilator) by hyperventilation induces vasoconstriction and reduces ICP Limit performing interventions unless absolutely necessary and AVOID performing interventions in clusters The nurse should suction a maximum of 10 seconds and only as necessary to remove secretions. Prolonged suctioning increases ICP

Hyperresonance to percussion should make you think of what diagnosis?

Emphysema floppy lung, distended alveoli

Should PPIs be given on an empty or full stomach?

Empty

LMWHs

Enoxaparin Dalteparin Tinzaparin

What lab value can you assess for therapeutic affect of corticosteroids used to treat RA?

Erythrocyte sedimentation rate (ESR) This is indicative of active inflammation

Why does positive pressure ventilation lead to fluid/Na+ retention?

Fluid and/or Na+ retention usually occurs about 48-72 hours after initiation of PPV due to: (1) increased intrathoracic pressure and decreased CO that stimulate the kidneys to release renin (2) physiologic stress that leads to the release of ADH and cortisol (3) breathing through the ventilator's closed circuitry, which decreases insensible loss associated with respiration

Benzo reversal agent

Flumazenil (Romazicon)

Scleroderma

an autoimmune disorder in which the connective tissues become thickened and hardened, causing the skin to become hard and swollen

Schizoid personality disorder

Exhibit social detachment and an inability to express emotion Do not enjoy close relationships and prefer to be aloof and isolated

Phlebostatic axis

External anatomical point on the chest at the level of the atria of the heart (fourth intercostal space at the midaxillary line or midway point of the anterior posterior diameter of the chest) It is used as a reference point for correct placement of the zeroing point of the transducer when measuring continual arterial BP, CVP using a central line, and/or cardiopulmonary pressures via a pulmonary artery (Swan-Ganz) catheter If the zeroing stopcock is placed below this level, falsely high readings occur; if it is too high, falsely low readings are obtained

Stage 4 pressure ulcer

Full-thickness skin loss with visible tendon, muscle, or bone Slough or eschar (scabbing, dead tissue) may be present Undermining and tunneling may be present

4 loop diuretics

Furosemide Ethacrynic acid Bumetanide Torsemide

FLACC scale

Face, Legs, Activity, Cry, and Consolability Can be used to assess pain in the child who is nonverbal This includes assessment for: Facial grimacing Leg movement, tension, or bending up toward the chest Activity, including squirming, arching, jerking Crying or moaning Difficulty consoling or comforting the child

Rivaroxaban

Factor Xa inhibitors (rivaroxaban [Xarelto], edoxaban, apixaban) are anticoagulants used to prevent and treat venous thromboembolism They have a lower risk of bleeding and require less ongoing monitoring than Warfarin does (eg, PT/INR) Education: - Avoid taking over-the-counter medications or supplements that increase bleeding risk, such as NSAIDs (aspirin), garlic, and ginger - Unlike warfarin, factor Xa inhibitors are not affected by vitamin K, which is found in many green, leafy vegetables - Routine monitoring of clotting times (PT/INR, PTT) is unnecessary for clients prescribed factor Xa inhibitors

Is fentanyl safe for a pt with a codeine allergy?

Fentanyl is appropriate in postoperative clients with moderate to severe pain, even those with a history of allergies to codeine Both drugs have opiate agonist effects but are chemically different - Codeine is a derivative of natural opiates (morphine), whereas fentanyl is completely synthetic

S/S of Neuroleptic Malignant Syndrome (NMS)

Fever Muscular rigidity Altered mental status Autonomic dysfunction (sweating, hypertension, tachycardia)

Clinical manifestations of bacterial meningitis in infants age < 2 include:

Fever or possible hypothermia Irritability, frequent seizures High-pitched cry Poor feeding and vomiting Nuchal rigidity (stiff neck) Bulging fontanelle is possible One of the most common acute complications of bacterial meningitis in children is hydrocephalus

Filgrastim

Filgrastim (Neupogen) and pegfilgrastim (Neulasta) stimulate neutrophil production and are given prophylactically or if the client has an infection and more neutrophils are needed to fight it

Factor Xa Inhibitor

Fondaparinux

If your pt who overdosed on cocaine has a creatine kinase level of 30,000, what would you recommend to the HCP?

Forced saline diuresis with IV fluids (to prevent blockage of the renal tubules with myoglobin) is necessary to prevent permanent kidney damage

Where should you place the pulse ox in a pt with decreased peripheral tissue perfusion who is also receiving vasopressors?

Forehead

Vaginal hematoma

Formed when trauma to the tissues of the perineum occurs during delivery More likely to occur following a forceps- or vacuum-assisted birth or an episiotomy S/S: - Persistent, severe vaginal pain or a feeling of fullness - Uterus is firm and at the midline on palpation - If the hematoma is large, the hemoglobin level and vital signs can change significantly

How is Alendronate best absorbed?

Fosamax is best absorbed when taken 30 mins before breakfast. Patient should remain upright for these 30 mins.

Stage 3 pressure ulcer

Full-thickness skin loss SQ fat is visible but not tendon, muscle, or bone Tunneling may be present

Which type of contrast is used for MRIs?

Gadolinium contrast NOT providing-iodine (Betadine)

Which oral supplements cause an increased risk of bleeding and should be discontinued prior to surgery?

Garlic Ginger Ginkgo biloba Ginseng Feverfew

Burning pain in the upper abdomen can be due to

Gastric or duodenal ulcers If the ulcers are located posteriorly, the client may experience back pain

Complications of alcoholic cirrhosis

Gastritis Clotting abnormalities (thrombocytopenia, coagulation disorders) Esophageal varices that increase the risk for hemorrhage (coffee ground emesis from oxidized blood)

Blood transfusion tubing

Gauge 20 or bigger (18 is preferred)

Aminoglycosides

Gentamicin Neomycin Amikacin Tobramycin Streptomycin GNATS

LGA risk factors

Gestational diabetes Excessive gestational weight gain or elevated prepregnancy BMI History of a prior newborn who was LGA Postterm gestation Genetics (male sex, maternal birth weight, ethnicity)

PPE removal order

Gloves Eyes Gown Mask

Patient education for HIV antiviral medication zidovudine

Go to clinic for blood counts every 2 weeks Bone marrow depression with granulocytopenia is a severe and common adverse effect of zidovudine

PPE donning order

Gown Mask Goggles Gloves

Adverse reactions to Nitroglycerine or Isosorbide

HA Dizziness, weakness Hypotension Nausea

digoxin uses

HF Afib

What should you do before splitting a medication in half?

Hand hygiene Do not need gloves though

Antisocial personality disorder

Have a pattern of disregard for and violation of the rights of others Manipulate others for personal gain and lack empathy

S/S of myopia in children

Headaches, dizziness, and the need to squint the eyes to see clearly Fften need to hold objects near their face or sit near objects to see clearly Decreased school performance from eye strain "nearsightedness"

Beta agonists are usually prescribed for which condition?

Heart failure They increase CO by increasing HR and BP

Dobutamine is used for which condition?

Heart failure - emergency cardiac decompensation

Leopold maneuvers

Help determine fetal presentation and involve systematic palpation of the client's abdomen These maneuvers assist the nurse in locating the fetal back for optimal placement of the ultrasound transducer for external fetal heart monitoring

What is an adverse effect of erythropoietin administration and what should the nurse do to prevent this from occurring?

Hypertension is a major adverse effect of erythropoietin administration Therefore, uncontrolled hypertension is a contraindication to recombinant erythropoietin therapy BP should be well controlled prior to administering erythropoietin - the nurse should always check BP prior to administration Erythropoietin is administered intravenously or in any SQ area, NOT IM Adequate stores of iron, vitamin B12, and folic acid are required for the erythropoietin to work

Initial goal during management of hypertensive crisis

Hypertensive crisis may require continuous infusion of an IV vasodilator (nitroprusside sodium) BP should be lowered slowly to prevent organ damage *The initial goal is to lower MAP by 25% or less or to maintain MAP of 110-115 mm Hg MAP = (2 x DBP + SBP) / 3

Common adverse reaction of cyclophosphamide

Hemorrhagic cystitis Teach patient to assess urine for hematuria (chemotherapy drug)

Your PACU pt who just had surgery under anesthesia has a temp of 94F (34.4C). Should you notify the provider?

Hypothermia (<95 F [35 C]) is common in the immediate postoperative period due to anesthetic-induced vasodilation, decreased basal metabolic rate, and a cool environment This can be managed by the nurse Hyperthermia (fever) is also common due to the blood products and trauma from surgery However, stiffness/rigidity in the presence of elevated temperature is more concerning and could be malignant hyperthermia

Beclomethasone (Beconase)

an inhaled corticosteroid normally used as a long-term, first-line drug to control chronic airway inflammation fluticasone is also an inhaled corticosteroid

Two serious adverse effects of INH use are ____________ and _________________.

Hepatotoxicity and peripheral neuropathy

When obtaining blood from a client for labs, follow these rules:

Insert the needle at 15-degree angle Limit attempts to 2 Avoid the side of a mastectomy A capillary specimen should be obtained at the side of the finger pad Never draw a specimen above an IV infusion

How are glaucoma eye drops administered?

Instruct client to close the eyelid and move the eye around Then apply pressure to the lacrimal duct for 30-60 seconds if medication has systemic effects (beta blocker, timolol maleate - this will distribute the medication, prevent overflow into the lacrimal duct, and reduce possible systemic absorption

Clients with hypertension should be instructed not to take potentially high-risk over-the-counter (OTC) medications such as:

High-sodium antacids Appetite suppressants Cold and sinus preparations Many cold and sinus medications contain phenylephrine or pseudoephedrine These sympathomimetic decongestants activate alpha-1 adrenergic receptors, producing vasoconstriction The resulting decreased nasal blood flow relieves nasal congestion These agents can cause dangerous hypertensive crisis!!!

Clonidine

Highly potent antihypertensive

Developmental dysplasia of the hip (DDH)

Hip abnormalities ranging from mild dysplasia of the hip joint to full dislocation of the femoral head Manifestations in infants age <2-3 months include: - Extra inguinal or thigh folds - Laxity of the hip joint on the affected side If DDH is not treated, these signs disappear after age 2-3 months due to the development of muscle contractures After age 3 months, limited hip abduction and limb shortening on the affected side are evident A pelvic tilt is noted once the child learns to walk

Food choices for infants nearing 1 year of age

Honey should not be offered to children age <12 months because their immature gut systems are susceptible to Clostridium botulinum (botulism) infection Common allergenic foods (eggs, fish, peanuts) may be introduced along with other foods starting at age 4-6 months Infants should be transitioned to whole milk, not low-fat milk, at age 12 months At age 8-10 months, start offering small finger foods, such as crackers or cut-up pieces of nutritious foods

Insulin aspart onset

Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes

Which vasodilator is used to treat HTN?

Hydralazine

___________________ is administered in the setting of critically elevated blood pressure.

Hydralazine (Apresoline)

At what maternal BP would you anticipate intervening with a BP medication and which medications would you recommend?

Hydralazine (Apresoline) and/or labetalol are used to lower blood pressure if needed when > 160/110 mm Hg Remember, HTN is a sign of preeclampsia!

Thiazide diuretics

Hydrochlorothiazide (HCTZ) Chlorthalidone Metolazone

_________________- may develop when a potassium-sparing diuretic or angiotensin-converting enzyme inhibitor increases the ___________ level.

Hyperkalemia potassium

Stage 1 pressure ulcer

Intact skin with nonblanchable redness

Potential complications for a pt with acute pancreatitis

Hypocalcemia ARDS May need aggressive supportive care (pain management, IV fluids)

What is a side effect of terbutaline?

Hypoglycemia may occur in the neonate because a side effect of terbutaline sulfate is increased maternal serum glucose levels

Adverse effects of Thiazides and Loop diuretics

Hypokalemia Hyperuricemia Glucose intolerance

Which lab value would cause you to hold bumetanide?

Hypokalemia Loop diuretics (eg, bumetanide, furosemide, torsemide) can cause hypokalemia (K < 3.5)

_____________ can be caused by antidepressants and NSAIDs.

Hyponatremia

What electrolyte imbalance are infants at risk for if their formula is diluted with excess water?

Hyponatremia secondary to water intoxication, which can present with neurological symptoms (eg, lethargy, irritability, seizures)

Adverse reactions of Calcium Channel Blockers

Hypotension HA, dizziness Edema Nausea Constipation Tachycardia HF Dry cough

What should you do if your pt with alcoholic cirrhosis has hypotension, tachycardia, and coffee ground emesis?

Hypotension and tachycardia in the presence of blood loss can indicate hypovolemia Assess for signs of hypovolemia and call HCP to report changes in baseline Esophagogastroduodenoscopy is necessary to determine the bleeding site

SE of Calcium Channel Blockers

Hypotension, syncope, dizziness, fatigue Hypokalemia

Serious adverse effect of ticarcillin

Hypothrombinemia and decreased platelet adhesion, which can result in the presence of petechiae

Swelling around the eyes and face occurs in which 3 conditions?

Hypothyroidism Cushings disease nephrotic syndrome

What does a paCO2 > 45 and normal paO2 indicate?

Hypoventilation Instruct pt to use incentive spirometer

A pt undergoing ET intubation received IV sedation and succinylcholine. Pt becomes flushed and profusely diaphoretic and has a rigid jaw. Which medication should the nurse prepare to administer?

IV dantrolene

IV morphine peaks in ___ minutes and has a duration of ___ - ____ hours.

IV morphine peaks in 20 minutes and has a duration of 3-4 hours.

How should you administer IV pain meds to a pt in labor?

IV narcotics administered to laboring women can cause fetal sedation and subsequent respiratory depression at birth Administering IV narcotics at the PEAK OF CONTRACTIONS reduces the amount of narcotic that crosses the placental barrier and affects the fetus

IV opioids are safest for clients who will give birth in ______ hours

IV opioids are safest for clients who will give birth 2-4 hours after administration so that the opioid effect has time to wear off before the birth - could cause respiratory depression in baby at birth IV opioids are also best for clients in active labor or those with a well-established contraction pattern because opioid administration may slow labor progression in the latent phase

Is ibuprofen or acetaminophen an NSAID?

Ibuprofen (Advil) Acetaminophen (Tylenol) is an analgesic and antipyretic

Agoraphobia

Intense anxiety about being in a situation from which there may be difficulty escaping in the event of a panic attack May avoid open spaces, closed spaces, riding in public or private transportation, going outside the home, bridges/tunnels, and crowds

How serious is it if a pt with a PCA reports burning at the IV site?

If the IV line infiltrates the SQ tissue or the catheter becomes occluded, the PCA drug can back up into the primary tubing each time a dose is administered, resulting in inadequate pain control In addition, burning can indicate phlebitis, which causes vessel wall injury and can lead to thrombophlebitis

"Unstageable" pressure ulcer

If the base is covered by necrotic tissue or eschar

Pt gave birth by c-section 5 hours ago and is requesting pain meds. The client appears restless, has a heart rate of 110/min, and admits to recent onset of anxiety. What do you suspect?

If unrecognized, DVT may progress to pulmonary embolism (PE), often characterized by: Anxiety/restlessness Pleuritic chest pain/tightness Shortness of breath Tachycardia Hypoxemia Hemoptysis

Ectopic pregnancy

If untreated, continued growth can lead to fallopian tube rupture, resulting in hemorrhage and hemodynamic compromise Intra-abdominal bleeding can lead to referred shoulder pain, a classic sign of diaphragm irritation Ruptured ectopic pregnancy requires emergency surgical intervention and hemodynamic support (eg, IV fluids, blood transfusion)

Infective Endocarditis compilations

In IE, the vegetations over the valves can break off and embolize to various organs, resulting in life-threatening complications - stroke, loss of limb, infarction IE clients typically require intravenous antibiotics for 4-6 weeks Splinter hemorrhages can occur and may be caused by vessel damage from swelling of the blood vessels (vasculitis) or tiny clots that damage the small capillaries (microemboli)

"mal de ojo"

In Latin American culture, an illness called "mal de ojo" ("evil eye") is believed to be caused when a stranger or someone perceived as powerful admires or compliments a child The mal de ojo curse can be broken if the admirer touches the child while speaking to the child or immediately afterward Mexican American mothers may worry when strangers compliment their babies without touching them

Important patient teaching for Acyclovir for herpes

Increase daily fluids to 2000 to 4000 mL/day Increasing fluid intake during treatment prevents precipitation of the drug in the renal tubules, which could lead to obstructive problems that impair kidney function Acute glomerulonephritis is a possible complication of acyclovir therapy

What diet change should you recommend in a pt taking antipsychotic medications?

Increase intake of raw fruits and vegetables to prevent constipation

How do cholinesterase inhibitors work?

Increase the availability of acetylcholine at cholinergic synapses, which aids in neuronal transmission and assists in memory formation

Vaginal bBirth after Cesarean (VBAC) - potential complications

Increased risk for uterine rupture The first sign of uterine rupture is usually abnormal fetal heart rate (FHR) patterns - usually decelerations followed by fetal bradycardia with decreased variability Constant abdominal pain Loss of fetal station Sudden cessation of uterine contractions Hemorrhage, hypovolemic shock, and maternal tachycardia may occur if severe rupture occurs unrecognized

ECT patient education

Induces a generalized seizure in an anesthetized client Prior to the procedure, the client should be NPO and not take anticonvulsant medications (such as valproic acid - Depakote) Temporary confusion and memory loss are common after the procedure Clients should be instructed not to drive during the course of ECT treatment

What intervention is indicated in all pts who are comatose or do not follow commands after cardiac arrest resuscitation?

Inducing therapeutic hypothermia within 6 hrs of arrest and maintaining it for 24 hours has been shown to decrease mortality rates and improve neurologic outcomes 89.6-93.2 F (32-34 C) for 24 hrs before rewarming The nurse must closely assess the cardiac monitor (bradycardia is common), core body temperature, BP (mean arterial pressure to be kept >80 mm Hg), and skin for thermal injury The nurse must also apply neuroprotective strategies such as keeping the head of the bed elevated to 30 degrees

Infants should double in birth weight by age ____ months and triple in birth weight by age ____ months.

Infants should double in birth weight by age 6 months and triple in birth weight by age 12 months At birth, head circumference is slightly more than chest circumference, but these equalize by age 12 months

Lactational mastitis

Infection and inflammation of breast tissue may result from inadequate milk duct drainage or poor breastfeeding techniqu Manifestations include fever, muscle aches, and breast pain and inflammation (warmth, redness, edema)

S/S of infection in neonates

Infectious manifestations are often subtle in neonates (fever can be the only symptom) May have hypothermia, lethargy, poor feeding, or decreased UO *Rectal temperature >100.4 F (38.0 C) or <96.8 F (36.0 C) is a "red flag" in a neonate

Pudendal nerve block

Infiltrates local anesthesia (lidocaine) into the areas surrounding the pudendal nerves that innervate the lower vagina, perineum, and vulva When birth is imminent, a pudendal block provides the best pain relief with the least maternal/newborn side effects and could be administered quickly by the HCP It does not relieve contraction pain but does relieve perineal pressure when administered in the late second stage of labor

Extravasation

Infiltration of a drug into the tissue surrounding the vein Norepinephrine (Levophed) is a vasoconstrictor and vesicant that can cause skin breakdown and/or necrosis if absorbed into the tissue Pain, blanching, swelling, and redness are signs of extravasation Norepinephrine should be infused through a central line when possible

Epiglottitis

Inflammation of the epiglottis that may result in life-threatening airway obstruction Symptoms begin with abrupt onset of high-grade fever and a severe sore throat, followed by the 4 Ds: drooling, dysphonia, dysphagia, and distressed airway (inspiratory stridor) Children are typically toxic-appearing and may be "tripoding" (sitting up and leaning forward) with inspiratory stridor

Inflizimab, adalimumab, & etanercept

Infliximab, adalimumab, and etanercept are tumor necrosis factor (TNF) inhibitors that suppress the inflammatory response in autoimmune diseases such as RA, Crohn disease, and psoriasis Due to the immunosuppressive action of TNF inhibitors, clients taking these drugs are at increased risk for infection - a client with current, recent, or chronic infection should not take a TNF inhibitor

Rifampin

Inhibits RNA polymerase of tubercle bacillus

Ethambutol

Inhibits RNA synthesis of tubercle bacillus Bacteriostatic for tubercle bacillus Used as a substitute for Rifampin or Isoniazid if toxicity occurs

Patients with an allergy to Atropine may also be allergic to which medication?

Ipratropium

What is the drug of choice for treatment of patients with a positive skin test for tuberculosis?

Isoniazid

24-hr urine collection procedure

It is common practice to start a 24-hour urine collection test at the time of the client's first voiding in the morning To start the collection period, the nurse asks the client to void and discards this specimen (it is not added to the collection container) If any urine is discarded by accident during the test period, the procedure must be restarted All produced urine should be placed in the same container and kept cool (on ice)

What is the difference between pathological jaundice and physiological jaundice?

Jaundice within the first 24 hours is pathological - it is usually related to problems of the liver Jaundice after 24 hours is referred to as physiological jaundice and is related to the increased amount of unconjugated bilirubin in the system

Which lab should be monitored in pts taking calcium channel blockers?

K+

Which lab should the nurse assess before administering a neuromuscular blocking agent?

K+ Low potassium levels enhance the effects of neuromuscular blocking agents

Which vaccines should be delayed for a 12-month-old child being treated for Kawasaki disease with IV immunoglobulin?

Kawasaki disease is treated with aspirin and IVIG to prevent coronary artery aneurysms Antibodies acquired from the IVIG therapy will remain in the body for up to 11 months and may interfere with the desired immune response to live vaccines Therefore, live vaccines (eg, varicella, MMR) should be delayed for 11 months after IVIG administration as this therapy may decrease the child's ability to produce the appropriate amount of antibodies to provide lifelong immunity Hib, Hep B, and PVC are NOT live vaccines

Levetiracetam

Keppra is often used to treat seizures It has minimal drug-drug interactions compared to phenytoin and is often the preferred antiepileptic medication

Combined Alpha/Beta Blockers

Labetalol Carvedilol

Which hair abnormality is seen in extreme cases of anorexia?

Lanugo (fine terminal hair) can be seen in extreme cases

What would an increased CVP, increased PAWP, and coarse crackles indicate?

Left-sided heart failure treat with loop diuretic - furosemide

SE of Beta Blockers

Lethargy Impotence HF Bradycardia Hallucinations Wheezing

Guidelines for Pt Care during Brachytherapy

Limit staff time spent in the room to 30 minutes per shift - cluster care Instruct the client to remain on bedrest to prevent dislodgement of the implant Staff must wear a dosimeter film badge No individuals who are pregnant or under age 18 may be in the room All staff and visitors must maintaining a distance of at least 6 feet Assign the client to a private room with a private bath Keep the door to the room closed Ensure that a sign stating, "Caution, Radioactive Material" is affixed to the door All staff providing nursing care that requires physical contact must wear a lead apron

Short-acting insulin

Lispro Aspart Glulisine Best for post-meal hyperglycemia Peak: 0.5-3 hours

Glipizide

oral hypoglycemic enhances pancreatic production of insulin as long as there is some beta cell function present

When you give statins, what should we monitor?

Liver function tests!

Chronic pain treatment

Long-acting controlled-release opioid drugs for chronic pain require regularly scheduled dosing to maintain a therapeutic drug level. Immediate-release opioids may be required for breakthrough pain. Long-term opioid use leads to tolerance and physical dependence; higher doses are eventually required for therapeutic effect.

Cor pulmonale is treated with...

Long-term, low-flow oxygen Bronchodilators Diuretics

Bumetanide

Loop diuretic Prescribed for clients with HF to promote diuresis

ARBs

Losartan Valsartan

SE of methylphenidate in children

Loss of appetite with resulting weight loss Parents and caregivers should be instructed to weigh the child with ADHD at least weekly due to the risk of temporary interruption of growth and development It is very important to compare weight/height measures from one well-child checkup to the next If weight loss becomes a serious problem, methylphenidate can be given after meals; however, before meals is preferable Another SE is increased BP and tachycardia - these should be monitored before and after starting tx

Enoxaparin

Lovenox Low molecular weight heparin Administer at least 2 inches to the left or right of the umbilicus - pinch skin - 90 degree angle injection

If a pt has a temp of 100.4 F (38 C) and cough, should you report this to the surgeon before the pts procedure?

Low-grade temperature and cough could indicate the presence of an infection, and the nurse should report these findings to the HCP as soon as possible before surgery The administration of anesthesia in a client with a fever and cough can exacerbate an unknown viral or bacterial condition, increase the risk for postoperative pneumonia, and interfere with the postoperative healing process

Clinical manifestations of ectopic pregnancy

Lower-quadrant abdominal pain on one side Mild to moderate vaginal bleeding Missed or delayed menses Signs of subsequent hypovolemic (hemorrhagic) shock from ruptured ectopic pregnancy: Dizziness, hypotension, and tachycardi Free intraperitoneal blood pooling under the diaphragm can cause referred shoulder pain Peritoneal signs (eg, tenderness, rigidity, low-grade fever) may develop subsequently

What is the main side effect for a patient staring to take an MAOI?

MAOIs and other antidepressants are associated with increased risk of suicidal ideation during the first few weeks of treatment Clients taking MAOIs need to avoid tyramine-containing foods due to risk of hypertensive crisis

Neomycin enema

Medicated enema that reduces the number of bacteria in the intestine in preparation for colon surgery

Atypical (second-generation) antipsychotic medications

Pisperidone Quetiapine Olanzapine Used in the treatment of schizophrenia, bipolar disorder, and other mental health disorders SE: - Extrapyramidal symptoms (EPS) include akathisia (restlessness, fidgeting) and Parkinsonism (tremors, shuffling gait) - Fever and muscle rigidity may indicate neuroleptic malignant syndrome, a potentially fatal condition requiring emergent intervention - Clients may experience anticholinergic effects (dry mouth, constipation - Clients should change positions slowly to prevent orthostatic hypotension - Sedating effects (drowsiness, hypersomnia) are common *The HCP may prescribe medications to treat EPS (benzodiazepines, diphenhydramine)

Interventions for Malignant Hyperthermia

MH requires emergent treatment with IV dantrolene to reverse the process by slowing metabolism Apply cooling blankets to reduce temperature Treat high potassium levels

Magnesium toxicity occurs at what level?

Magnesium toxicity may occur when magnesium levels are > 7 mEq/L. Causes CNS depression and blocks neuromuscular transmission

Nursing interventions after Extubation

Place pt immediately on warm humidified oxygen High Fowler position Monitored for aspiration, airway obstruction, and respiratory distress NPO until swallowing function has been evaluate Routine oral care Coughing, deep breathing, and use of incentive spirometry to prevent atelectasis

Expected (normal) findings for a term newborn include

Plantar creases up the sole of the foot Babinski reflex - disappears at 1 year old - the toes hyperextend and fan out when the lateral surface of the sole is stroked in an upward motion Epstein's pearls - white, pearl-like epithelial cysts on gum margins and the palate - they are benign and usually disappear within a few weeks Cord with 2 arteries and 1 vein

Frequent eye exams are required for pts taking which two medications?

Plaquenil Ethambutol

What can trismus indicate in children with tonsillitis?

May indicate a serious complication of tonsillitis, a peritonsillar or retropharyngeal abscess Other features of the abscess include a "hot potato" or muffled voice, pooling of saliva, and deviation of the uvula to one side This abscess can occlude the airway, making it a medical emergency Surgical intervention (tonsillectomy or incision and drainage) is often required In the meantime, maintaining an adequate airway is essential

Which infections require airborne precautions with negative pressure isolation?

Measles Tuberculosis Varicella zoster (chicken pox) infections (airing MTV)

Preschoolers partake in what type of play?

Preschoolers (age 3-6) enjoy associative play, in which they engage in similar activities or play with the same or similar items, but the play is unorganized without specific goals or rules They often borrow items from each other without directing each other's play Preschoolers also enjoy play involving motor activities and imaginative, pretend play

IV loop diuretic SE

ototoxicity

When is LMWH indicated?

Prevention of DVT

Which drug should not be given on the day a pt receives IV contrast with iodine?

Metformin Can resume 48 hrs after iodine contrast

How is muscle strength graded?

Normal muscle strength is 5 on a scale of 0-5 Weakened muscle strength would be a 2+ and means only able to move laterally, not able to lift up against gravity)

Which beta blocker is appropriate for a pt with asthma?

Metoprolol Other beta blockers cause bronchoconstriction

What is the first line drug to treat C. diff?

Metronidazole (Flagyl) is the first-line anti-infective drug used to treat infectious diarrhea caused by Clostridium difficile Note: Leukocytosis is expected with this bacterial infection

Discharge teaching for pt taking enoxaparin after ortho surgery

Mild pain, bruising, irritation, or redness of the skin at the injection site is common - do NOT rub the site with the hand Using an ice cube on the injection site can provide relief Avoid taking ASA, NSAIDs, and herbal supplements (Ginkgo biloba, vitamin E) without HCP approval as these can increase the risk of bleeding Monitor complete blood count to assess for thrombocytopenia (NO need for regular coag studies - PT, INR)

Head injury classification based on GCS

Mild: GCS 13-15 Moderate: GCS 9-12 Severe: GCS ≤8 (coma)

What happens if your patient takes flouroquinolones and drinks milk or takes antacids?

Milk or antacids inactivate flouroquinolones

LPN/LVN Scope of Practice

Monitoring RN findings Reinforcing education Routine procedures (catheterization) Most medication administrations Ostomy care Tube patency & enteral feeding Specific assessments* (lung sounds, bowel sounds, neurovascular checks)

A patient with Inflammatory Bowel Disease is at risk for which adverse reaction if taking morphine?

Morphine slows peristalsis Therefore, the patient is at risk for: Toxic megacolon & paralytic ileus

Why would an Orthodox Jew not want to take a medication in capsule form?

Most capsules are coated in gelatin, a substance made from the collagen of animals, which is generally considered nonkosher. The nurse should first ask the pharmacist if an equivalent, gelatin-free form of the medication (tablets) is available

Are penicillin derivates and cephalosporins safe for pregnant and breastfeeding women?

Most penicillin derivates (ampicillin, amoxicillin) and cephalosporins (cephalexin, ceftriaxone) are generally considered safe for use by women who are pregnant or lactating

What should you do if you suspect heat exhaustion?

Move pt to cooler temperatures and provided a cool sports drink, a electrolyte-containing beverage (Gatorade), or water The priority is to lower the body temperature to prevent heat stroke, a potentially fatal condition associated with mental status changes (indicating brain damage) and additional organ damage (kidney injury, rhabdomyolysis) If the temp continues to rise after moving to cooler temperatures, ice packs placed on the axilla and groin may help to dissipate heat; further medical help may be necessary Assessment can be continued once the pt has been moved to a cooler environment and provided with hydration - alcohol consumption may compound heat exhaustion but does not change initial management of the client

Guaifenesin

Mucinex is an expectorant used to facilitate mobilization of mucus

Cyclobenzaprine

Muscle relaxant given to treat pain associated with muscle spasm Commonly given for a pt with an open fracture Carisoprodol or methocarbamol can also be prescribed

Why do patients taking carbamazepine for seizures need weekly blood tests?

Myelosuppression is a risk factor

S/S of emergent bowel obstruction

N/V Abdominal pain Bloating Decreased stool output If left untreated, bowel obstruction can lead to electrolyte disturbances, dehydration, bowel perforation and infection (peritonitis), and/or tissue necrosis

SE of Isoniazid

N/V abdominal pain hepatotoxicity - metabolized by liver, excreted by kidneys neurotoxicity - crosses blood-brain barrier

Colchicine toxicity

N/V/D abdominal pain

Does Digoxin help with angina?

NO Digoxin increases the strength and contraction of the heart

Patient education for metronidazole

NO alcohol - causes a disulfiram-like reaction (like Antabuse) Treat partner concurrently Use a barrier method for sex or abstinence during treatment

Can kids take tetracyclines?

NO! Prevents calcium absorption

Does tPA (Alteplase) cause a bleeding risk?

NO, only alters coagulation at the site of the thrombus, NOT systemically

Kosher laws

No pork, shellfish, or fish without scales Separation of meat/poultry from dairy When meat or poultry is consumed, at least 3-6 hours must pass before a dairy product is consumed Certain foods, including fresh fruits and vegetables, grains, tea, and coffee, are considered neutral and can be consumed at any time

In an emergent situation, is a 22 gauge IV sufficient?

No probably need a 16 or 18 gauge incase bolus IV or blood products are needed

Celecoxib

NSAID

Ketorolac

NSAID that is administered PO, IV, or IM for short-term relief of mild to moderate pain

Which 2 classes of medications can cause problems for pts with asthma?

NSAIDs and beta blockers have the potential to cause problems for clients with asthma About 10%-20% of asthmatics are sensitive to Ibuprofen (Motrin) and aspirin and can experience severe bronchospasm after ingestion

Acronym to determine the need for spinal immobilization during triage

NSAIDs: N - Neurological examination. Focal deficits include numbness and decreased strength S - Significant traumatic mechanism of injury A - Alertness. The client may be disoriented or have an altered level of consciousness I - Intoxication. The client could have impaired decision-making ability or lack awareness of pain D - Distracting injury. Another significant injury could distract the client from spinal pain S - Spinal examination. Point tenderness over the spine or neck pain on movement (if there is no midline tenderness) may be present Note: there is no direct correlation of multiple sclerosis (autoimmune progressive nerve demyelinization) with the need for spinal immobilization

A pt with CKD should restrict intake of which electrolytes?

Na and K Avoid salt substitutes (they contain K) Likely should take Ca supplements due to hypocalcemia

Should you hold Warfarin in a pt with a PE and an INR of 2.5?

No! Give it! The effect of warfarin (Coumadin) is monitored by the INR The therapeutic range of INR is 2 - 3

Your pt has a STAT order for an anticoagulant and has an epidural for continuous anesthesia. Do you give the anticoagulant?

No, anticoagulants are not given while an epidural catheter is in place

Should a pt with asthma be on a beta blocker?

No, contraindicated

Should you report bilateral crackles in an infant born 30 mins ago?

No, it is normal to auscultate crackles in an infant during the first hour of life This is because fluid is still being pushed out of and absorbed by the lungs

Should you remove dentures during postmortem care?

No, leave them in to maintain face shape If not in at death, put them in

Which drugs reverse the effect of pancuronium bromide?

Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the respiratory muscle paralysis caused by pancuronium bromide

The nurse is caring for a client who was just resuscitated following an out-of-hospital cardiac arrest. The client does not follow commands and remains comatose. What intervention does the nurse anticipate being added to the client's plan of care?

Neurologic injury is the most common cause of mortality in clients who have had cardiac arrest, particularly VFib or pulseless VTach *Inducing therapeutic hypothermia in these clients within 6 hours of arrest and maintaining it for 24 hours has been shown to decrease mortality rates and improve neurologic outcomes It is indicated in all clients who are comatose or do not follow commands after resuscitation

Most serious complication of Guillan-Barre syndrome

Neuromuscular respiratory failure The rate and depth of the respirations should be monitored

Risk factors for suicide

Never married, divorced, separated Elderly white man Psychiatric disorders, prior suicide attempts Hopelessness Living alone Unemployed or unskilled Physical illness Family history of suicide, family discord Access to firearms Substance abuse, impulsivity

Preeclampsia definition

New-onset hypertension (≥140/90 mmHg) PLUS proteinuria and/or signs of end-organ damage after 20 weeks gestation Although edema is not a diagnostic criterion for preeclampsia, it is a common manifestation of the disease process

Which MI medication decreases preload and afterload?

Nitroglycerin The vasodilation reduces preload and the reduced contractility reduces afterload

Can you mix long acting insulin with other insulins?

No No mixing glargine or detemir

Should a sexually active woman < age 21 have a Pap smear?

No Not until 21, regardless of sexual activity

Would you be concerned about a pt with WBC of 12,000 2 days postop ortho surgery?

No Postoperative leukocytosis (>11,000) is common in the first 48 hours after orthopedic surgery from normal inflammatory immune responses

Is it concerning for a pregnant woman at 39 weeks to have brown mucoid vaginal discharge?

No Vaginal discharge increases at the end of pregnancy and may become mucoid and blood-tinged (pink/brownish) in the days preceding labor This assessment finding may be a sign of approaching labor

Serum carboxyhemoglobin

Normal values are <5% in nonsmokers and slightly higher (<10%) in smokers The diagnosis of CO poisoning is often missed in the emergency department because symptoms are nonspecific (HA, dizziness, fatigue, nausea, dyspnea) with a normal O2 sat Tx: Immediate administration of 100% oxygen to correct hypoxemia and eliminate toxic CO from the blood

At what age do infants begin playing interactive games such as peek-a-boo?

Not until age 10-12 months

Concerning SE in pts taking furosemide

Nurses caring for clients receiving potassium-wasting diuretics (eg, furosemide) should monitor for and report signs of hypokalemia (eg, muscle cramps), as unmanaged hypokalemia may result in lethal complications

OD on tricyclic antidepressants (TCAs) effects

OD is especially concerning for a tricyclic antidepressant (TCA) due to the effect this can have on the cardiovascular and central nervous systems (eg, dysrhythmias, seizures) TCA use for depression is an uncommon second-line treatment, but the drug class is used for neuropathic pain and sometimes enuresis

Otitis media vs otitis externa

OM typically occurs in infants and children under age 2, sometimes following a respiratory tract infection Infants with exposure to tobacco smoke are at risk for OM OM risk is also higher with activities such as using a pacifier or drinking from a bottle when lying down as these allow fluid to pool in the mouth and then reach the eustachian tubes Key preventive measures include eliminating exposure to smoke, obtaining routine immunizations to prevent infection, and reducing or eliminating use of a pacifier after age 6 months vs. Otitis externa is "swimmers ear" and can be caused by water in the ears

Which medication is given to children with cystic fibrosis to help with nutrition requirements?

Pancreatic enzyme replacement with pancrelipase

When are PVCs considered dangerous?

Occasional PVCs in the normal heart are not significant PVCs in the client with CAD or MI indicate ventricular irritability and may lead to life-threatening dysrhythmia such as VTach!!!

Late decelerations

Occur after the onset of a uterine contraction and continue beyond its end The lowest point (nadir) occurs near the end of the contraction before the fetal heart rate gradually returns to baseline Late decelerations occur when fetal oxygenation is compromised (uteroplacental insufficiency, uterine tachysystole, hypotension)

Diabetes insipidus

Occurs due to insufficient production/suppression of antidiuretic hormone (ADH) Tx: Fuids should be replaced orally/intravenously to prevent dehydration ADH replacement with vasopressin can be used to treat DI, however, it also has vasoconstrictive properties so desmopressin (DDAVP), an analog without vasopressor activity, is preferred

Sickle cell crisis

Occurs when inadequate oxygenation or hydration exacerbates sickling and causes RBCs to clump together in the capillaries (vasoocclusion) Adequate oxygenation and hydration may reverse the acute sickling response The priority intervention is the administration of IV fluids to reduce blood viscosity and restore perfusion to the areas previously affected by vasoocclusion

Rhabdomyolysis

Occurs when muscle tissue is damaged and myoglobin is released into the blood, usually after an injury from overexertion, dehydration, severe vasoconstriction (eg, cocaine use), heat stroke, or trauma AKI can occur when myoglobin overwhelms the kidneys' filtration ability As myoglobin is excreted, the urine becomes very dark and is described as being a cola-brown color Severely elevated creatine kinase levels, typically >15,000 U/L (>250 µkat/L), are observed with severe muscle damage and can be a precursor to kidney injury

Placental abruption

Occurs when the placenta separates prematurely from the uterine wall, causing hemorrhage beneath the placenta Abruptions are classified as partial, complete, or marginal and may be overt (visible vaginal bleeding) or concealed (bleeding behind placenta) Risk factors include abdominal trauma, hypertension, cocaine use, history of previous abruption, and PPROM Nursing Interventions: Tachysystole, with or without fetal distress, is often present, and continuous fetal monitoring is necessary A type and crossmatch should be drawn as treatment may include blood transfusion In severe cases, emergent cesarean birth is indicated Maternal vital signs should be assessed frequently for signs of shock Abruption may require rapid volume replacement with IV fluid and blood products, requiring large-bore IV access - peripheral IV access with a 16- or 18-gauge catheter should be initiated

How should a post-op pneumonectomy client be positioned in bed?

On the affected side With the complete removal of the lung in a pneumonectomy, the client should be positioned on the surgical side to promote adequate expansion and ventilation of the remaining lung

Antiemetics

Ondansetron Granisetron Prochlorperazine Promethazine Metoclopramide Haloperidol Diphenhydramine

2 things about Oral Care for ventilated pts on the NCLEX that differs from how you normally do it

Oral care is every 2 hrs Only suction ETT when indicated, not every time you do oral care

Oral iron should be taken how?

Oral iron is better absorbed on an empty stomach and with vitamin C

SE of Rifampin

Orange urine, stains contact lenses hepatitis fever GI disturbance peripheral neuropathy suppresses effect of birth control pills

Bisthmuth Subsalicylate should not be combined with

Other salicylates, such as Aspirin Bisthmuth subsalicylate is Pepto Bismol

Anticholinergic drugs

Oxybutynin (Ditropan) Tiotropium Ipratropium (Atrovent) Benztropine (Cogentin) Scopolamine Diphenhydramine

High PEEP is dangerous because

PEEP of 10 - 20 can cause overdistension of the alveoli and cause them to rupture --> barotrauma of the lung --> air can escape and cause pneumothorax or subcutaneous emphysema

Proton pump inhibitors side effects

PPIs like omeprazole, are associated with increased risk of pneumonia, Cdiff, and calcium malabsorption (osteoporosis)

Warfarin therapeutic range

PT 1.5 - 2.5 x normal INR 2:3

Vitamin K foods should be reduced when taking which medication?

PT and INR are decreased when a vitamin K antagonist warfarin (Coumadin) is taken with vitamin K-rich foods such as green, leafy veggies

Warfarin labs

PT/INR

What labs do you assess in a pt on heparin?

PTT Hgb, Hct Platelets

Heparin therapeutic range

PTT 1.5 - 2.5 x normal

How does Propylthiouracil work?

PTU inhibits synthesis of T3 and T4 by the thyroid

Factors to prevent SIDS

Pacifier use Room sharing without bed sharing Smoking cessation Breastfeeding Up-to-date immunizations Firm sleep surface

How is Pancuronium eliminated?

Pancuronium is eliminated via the kidneys, so a client with renal failure is at risk for prolonged muscle relaxation

A full bladder is a concern with which procedure?

Paracentesis when a trocar needle is inserted into the abdomen to drain ascites

What age group partakes in parallel play?

Parallel play is more common in toddlers During parallel play, these children play next to each other and are happy to be in the presence of peers, but they do not play directly with one another

Carbidopa-levodopa

Parkinson disease is characterized by decreased dopamine levels, uncontrolled acetylcholine, and formation of abnormal protein clusters (Lewy bodies) in the brain Carbidopa-levodopa is a combination antiparkinsonian medication used to reduce physical symptoms by increasing dopamine levels in the brain

Stage 2 pressure ulcer

Partial-thickness skin loss (abrasion, blister, or shallow crater) involving the dermis or epidermis The wound bed is red or pink and may be shiny or dry

When should the peak level be drawn for Gentamicin?

Peak drug serum levels are achieved 30 minutes after the IV administration of aminoglycosides

Famotidine

Pepcid H2 antagonist

Preventing VAP in sedated pts

Performing scheduled daily sedation vacations and maintaining appropriate client sedation levels Elevating the head of the bed 30-45 degrees (ie, semi-Fowler position) Providing oral care with antiseptic solutions (eg, chlorhexidine mouthwash) and suctioning subglottic secretions Practicing strict hand hygiene

Is prophylactic treatment of family members recommended for pertussis or RSV bronchiolitis?

Pertussis

SE of griseofulvin

Photosensitivity Teach to wear sunscreen

What is a common adverse effect of haloperidol?

Photosensitivity is a common adverse effect of haloperidol (Haldol); therefore, the use of sunglasses and sunscreen should be included in the discharge teaching for this client

Somatization

Physical symptoms that cannot be explained by a medical condition or disease

Priority before administering radioactive iodine to a female adult patient with Grave's disease

RAI destroys the thyroid gland, making clients permanently hypothyroid and requiring life-long thyroid supplements In female clients, a non-pregnant status should be confirmed with a valid pregnancy test prior to administering RAI RAI is contraindicated in pregnancy and may cause harm to a fetus At some point, educate about S/S of hypothyroidism

Where is the gallbladder located?

RUQ

Causes of hirsutism

Polycystic ovary syndrome Cushing's syndrome

Would oligohydramnios or polyhydramnios pose a risk for postpartum hemorrhage?

Polyhydramnios is a risk factor for postpartum hemorrhage due to overdistension of the uterus

Torsades de pointes

Polymorphic VTach characterized by QRS complexes that change size and shape in a characteristic twisting pattern

PEEP

Positive end-expiratory pressure - pressure given at the end of expiration during mechanical ventilation Keeps alveoli open so they can participate in gas exchange Usually PEEP is kept at 5 High PEEP is used in pts with ARDS

What type of change in VS when standing would indicate a risk for falls?

Positive orthostatic vital signs (eg, rise in pulse of ≥20/min) indicate increased risk of syncope and falls

Adverse effect associated with positive pressure ventilation (via facemask, ETT, NC, etc)

Positive pressure applied to the lungs compresses the thoracic vessels and increases intrathoracic pressure during inspiration This leads to reduced venous return, ventricular preload, and CO, which results in HYPOTENSION

Your post cholecystectomy pt reports increased nausea. What do you do?

Postoperative pts are at an increased risk for vomit aspiration due to nausea and an altered LOC (caused by anesthesia) These pts should be placed on their side and should receive antiemetics to prevent potential airway and breathing complications

Postpartum vaginal bleeding that saturates a perineal pad in < ____ hr(s) is considered excessive.

Postpartum vaginal bleeding that saturates a perineal pad in <1 hour is considered excessive.

What is the purpose of combining spironolactone with HCTZ?

Potassium-sparing diuretics (spironolactone, amiloride, triamterene eplerenone) are generally very weak diuretics and antihypertensives *However, they are useful when combined with thiazide diuretics to reduce potassium (K+) loss Thiazide diuretics can cause hypokalemia when used as monotherapy

Addisonian crisis

Precipitated by physical or emotional stress, or sudden withdrawal of hormone S/S: N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP

Factors that protect against suicide

Pregnancy Parenthood Religion & participation in religious activities Social support/family connectedness

A BMI of 25 to 29.9 is considered

overweight

Allen's test

Prior to drawing an ABG from the radial artery, you must occlude both ulnar and radial artery until hand blanches - then release ulnar - if the hand pinks up in <15 secs, ulnar artery is good and you can carry on with ABG/radial stick as planned

Should you flush an NG tube with 30 ml of water prior to or after administering enteral feeding?

Prior!

A pt is 2 days post-op gastric bypass surgery. The pt is experiencing nausea and is dry heaving. Is this pt's condition a priority and what should you do?

Priority because vomiting/dry heaving increase the risk for wound dehiscence and eviscerating - Obese clients who have undergone extensive abdominal surgery are especially vulnerable!! Administer an antiemetic medication as soon as possible to prevent wound dehiscence and evisceration, which would be a medical emergency!

Shock continuum

Progressive stage of shock Initial --> Compensatory --> Progressive --> Irreversible

____________, used for anesthesia and sedation, includes egg lecithin and soybean oil as inactive ingredients. Therefore, patients who have an egg or soy allergy should not receive this medication.

Propofol

Beta Blockers

Propranolol Metoprolol Atenolol

Certain individuals should receive prophylactic antibiotics prior to dental procedures to prevent infective endocarditis (IE). These include the following:

Prosthetic heart valve or prosthetic material used to repair heart valve Previous history of IE Some forms of congenital heart disease Cardiac transplantation recipients who develop heart valve disease

Heparin antagonist

Protamine sulfate

Administration of misoprostol is contraindicated if:

Pt is receiving another uterotonic simultaneously (oxytocin) Pt has a history of uterine surgery (cesarean birth) Pt has an abnormal fetal heart rate pattern or uterine tachysystole (>5 contractions in 10 min)

Risperidone

Pts with bipolar disorder often need antipsychotic medication (risperidone, haloperidol) to control acute psychosis and lithium for long-term maintenance therapy

Who should NOT take anticholinergics (antihistamines included!)?

Pts with urinary retention, such as BPH diagnosis Bowel obstruction pts Glaucoma pts

How do you administer ear drops to a child <3 years old?

Pull the pinna downward and straight back

A child with tonisllitis is pulling at his ears. Is this a serious finding?

Pulling at the ears is a common symptom in children with otitis media An ear infection frequently accompanies tonsillitis in children and is easily treated with antibiotics This is not a serious finding

Complications of Oligohydramnios

Pulmonary hypoplasia - due to the lack of normal alveolar distension by aspirated amniotic fluid Umbilical cord compression - continuous fetal monitoring should be applied to monitor for variable decelerations

Abdominal aortic aneurysm S/S

Pulsatile mass in the periumbilical area slightly to the left of the midline Bruit may be auscultated over the site Back/abdominal pain due to compression of nearby anatomical sites or nerve compression from an expanding/rupturing AAA Rupture of an abdominal aneurysm can quickly cause exsanguination and death

When should Levothyroxine be held?

Pulse > 100bpm

Adverse effect of Erythromycin

QT prolongation (over 0.4 sec)

Scopolamine

anticholinergic used to prevent nausea and vomiting from motion sickness used as an adjunct to anesthesia to control secretions

Nursing care for suspected Autonomic Dysreflexia

Raise the HOB Treat the cause - such as a kink in the Foley (bladder or rectal distension is a common cause)

Peak of Lispro

Rapid-acting insulins (lispro, aspart) take peak effect in 30 minutes to 3 hours E.g.: Pts who receive rapid-acting insulin at 11:30 AM would be most at risk for hypoglycemia from 12:00-2:30 PM

Most common adverse effect of penicillins

Rash - indicates potentially impending anaphylaxis

Cardiogenic shock s/s

Reduced CO (hypotension, narrow pulse pressure), Pulmonary edema (tachypnea, bibasilar crackles, decreased O2 sat) caused by blood "backing up" into the pulmonary capillaries To compensate, catecholamines (epinephrine) and vasopressin are released by the adrenal glands to increase CO IV fluids should not be bolused in cardiogenic shock as this will suddenly increase circulating volume and cardiac workload, which may precipitate pulmonary edema Nitroglycerin can worsen hypotension and should not be given either - other pain medications (morphine) may be given for chest pain if blood pressure is low

Peak of Regular Insulin

Regular insulin is a short-acting insulin that reaches the peak effect within 2-5 hours after SQ administration E.g.: Pts who receive regular insulin subcutaneously at 11:30 AM are at highest risk for hypoglycemia between 1:30 PM and 4:30 PM

Which type of insulin can be administered IVP?

Regular insulin is the only insulin that can be administered via IV push SQ injection is the indicated route for NPH insulin administration; it should never be administered via IV push

Fleet enema

Relieves constipation by infusing a hypertonic solution into the bowel, pulling fluid into the colon and causing distention and then defecation

Neck dissection

Removal of cancerous lymph nodes around the neck

Which antitubercular drug often causes red-orange urine?

Rifampin often causes a red-orange discoloration of body fluids (urine, sweat, saliva, tears)

Where are defibrillator pads placed?

Right upper chest, just below the clavicle Left lateral chest, near the anterior axillary line below the nipple line

Is left or right sided heart failure more critical?

Right-sided heart failure (peripheral edema) is not as dangerous as left-sided heart failure (pulmonary edema)

ALS medical management

Riluzole (Rilutek) is the only medication approved for ALS treatmen Riluzole, a glutamate antagonist, is thought to slow neuron degeneration by decreasing the production and activity of the neurotransmitter glutamate in the brain and spinal cor In some clients, riluzole may slow disease progression and prolong survival by 3-6 months

Methylphenidate

Ritalin is a CNS stimulant used to treat ADHD and narcolepsy

New Oral Anticoagulants (NOACs)

Rivaroxaban (Xaralto) Dabigatran Apixaban

How does Syndrome of Inappropriate Antidiuretic Hormone (SIADH) secretion affect Na+ levels? What is an appropriate IV solution for this pt?

SIADH secretion results in water retention and dilutional hyponatremia Pts with SIADH often require hypertonic saline 3% for sodium repletion to increase serum sodium levels

Heparin route

SQ or IV

MAOIs should not be combined with

SSRIs Concurrent use of MAOIs with SSRIs (escitalopram, citalopram, sertraline) may precipitate life-threatening adverse reactions (serotonin syndrome, neuroleptic malignant syndrome, hypertensive crisis) If a client's prescribed medication regimen will change to or from an MAOI, the existing medication should be tapered and discontinued, followed by a 2-week "washout" period without either medication

What is a good activity for a hospitalized 10-year-old child to promote growth and development?

School-age children deal with the conflict of industry versus inferiority Learning is a priority and completing school work provides a sense of accomplishment and satisfaction Parents should provide hospitalized school-age children with missed school work on a regular basis

What type of drainage is expected 2 hours post-op?

Serosanguineous (pink) drainage is expected after a surgical procedure, but a dressing saturated with sanguineous (bright red) drainage indicates excessive blood loss with possible hemorrhage; it should be reported immediately to the health care provider for evaluation Treatment with a pressure dressing to provide hemostasis, cauterization of a bleeding vessel, or fluid replacement may be necessary

Patient education for Levothyroxine

Several medications impair the absorption of levothyroxine (Synthroid): antacids, calcium, and iron preparations Pts with hypothyroidism should be instructed to take levothyroxine on an empty stomach, preferably in the morning, separately from other medications Levothyroxine dosing is adjusted based on blood tests for thyroid-stimulating hormone or other thyroid hormone levels Thyroid supplementation with levothyroxine usually requires lifelong therapy Levothyroxine has a long half-life, so dosing is once daily

S/S of Autonomic Dysreflexia

Severe hypertension Throbbing headache Marked diaphoresis above the level of injury Bradycardia Piloerection (goose bumps) Flushing This is an emergency condition requiring immediate intervention

Myxedema coma

Severe hypothyroidism causing decreased LOC (lethargy, stupor) that may progress to a coma S/S: Hypothermia Bradycardia Hypotension Hypoventilation Will likely require emergency endotracheal intubation and mechanical ventilation Clients with myxedema coma require thyroid hormone replacement with IV levothyroxine to correct the hypothyroid state but only after respiratory status is secured

SE of SSRIs

Sexual SE - Zoloft (sertraline) = No Loft Serotonin syndrome

Hepatitis B is transmitted through

Sexual contact and infected blood (drug use, accidental needle stick, perinatal mother-to-child infection)

How is nystatin administered for oral candidiasis?

Shake suspension well before dosing Assist the client in removing and soaking dentures Assess the affected area frequently Educate the client to swish the medication in the mouth before swallowing

Epstein pearls

Small, white cysts found on the hard palate of newborns These cysts are considered common findings, and they disappear a few weeks after birth

Burn care at home

Soak area briefly in cool water to stop the burning process Remove any clothing or jewelry around the burn to avoid constriction as edema develops - only a HCP may remove clothing that is stuck to the burned area Cover with a clean, dry cloth to prevent contamination, further trauma, and hypothermia Medications should not be applied to a burn until prescribed No ice, ointments, creams, or butter should be placed on the open skin

Which medication is administered to reverse QRS prolongation from a tricyclic antidepressant overdose?

Sodium bicarbonate

Which medication is used to treat mild to moderate hyperkalemia?

Sodium polystyrene sulfonate (Kayexalate) Potassium is exchanged for sodium in the intestines and excreted in the stool, thereby lowering the serum potassium

What medication should not be taken with tetracycline?

Sucralfate is used to treat duodenal ulcers and will bind with tetracycline hydrochloride, inhibiting this antibiotic's absorption

When suctioning a newborn, should you suction the pharynx or nasal passages first?

Suction the pharynx first followed by the nasal passages to prevent aspiration if the newborn gasps with nasal suctioning

What age group partakes in solitary play?

Solitary play is common in infants Children at this stage are focused on their own activity and will play alone in the presence of others

What is the priority action for a pt that has been impaled with a sharp object?

Stabilization of the object is the first priority to prevent it from moving during initial client assessment Exception to the rule: First responders may remove the impaled object if it obstructs the airway and prevents effective cardiopulmonary resuscitation

Scarlet Fever

Streptococcus pyogenes S/S: Fever Soar throat and erythema Strawberry tongue Sandpaper rash - red sunburn-like rash with small bumpy feeling Dx: Rapid streptococcal antigen test Throat culture may be needed Tx: Penicillin such as amoxicillin

Does Streptokinase or Urokinase have a side effect of allergic reactions?

Streptokinase

Which fibrinolytic drugs can cause bleeding complications?

Streptokinase Urokinase Assess for bleeding at puncture sites Do not administer heparin or anticoagulants with these drugs!

Fibrinolytic agents

Streptokinase Urokinase Alteplase

Contraindications for tPA

Stroke or head trauma within the past 3 months Thrombocytopenia (platelet count < 100,000 and/or coagulation disorders Uncontrolled hypertension Major surgery in past 2 weeks Onset of symptoms > 4.5 hrs ago

Calculating EDB

Subtract 3 months and add 7 days from LMP

Rhythms that are ideal for synchronized cardioversion are:

Supraventricular tachycardia (SVT) Ventricular tachycardia with a pulse Atrial fibrillation with rapid ventricular response If the defibrillator is not synchronized with the R wave in a client with a pulse, the shock may be delivered on the T wave and can cause a lethal arrhythmia (Vfib)

Dopamine (Intropin)

Sympathomimetic inotropic medication used to improve hemodynamic status in clients with shock and heart failure Enhances CO by increasing myocardial contractility, increasing HR, and elevating BP through vasoconstriction Renal perfusion is also improved, resulting in increased UO

Fibromyalgia treatment

Symptom management: Muscle relaxers (cyclobenzaprine) Narcotic analgesics (tramadol, hydrocodone) NSAIDs (ibuprofen, naproxen, celecoxib) Neuropathic pain relievers (pregabalin, gabapentin) Antidepressants such as SSRIs (fluoxetine, duloxetine) and tricyclic antidepressants (amitriptyline).

Major side effects of angiotensin-converting enzyme (ACE) inhibitors include:

Symptomatic hypotension Intractable cough Hyperkalemia Angioedema (allergic reaction involving edema of the face and airways) Temporary increase in serum creatinine

How do you treat unstable VTach with a pulse?

Synchronized cardioversion

Instructions for proper NTG administration include:

Tablets are heat and light sensitive: They should be kept in a dark bottle and capped tightly Take up to 3 pills in a 15-minute period: Take 1 pill every 5 minutes (up to 3 doses) EMS should be called if pain does not improve or worsens 5 minutes after the first tablet has been taken Avoid fatal drug interactions: concurrent use of erectile dysfunction drugs (sildenafil, tadalafil, vardenafil) or alpha blockers (terazosin, tamsulosin) is contraindicated due to potentially fatal hypotension Headache may occur: headache and flushing are common side effects of NTG due to systemic vasodilation and do not warrant medication discontinuation

Symptoms of hypokalemia

Tachycardia Dry mouth, thirst Weakness, drowsiness, lethargy Muscle aches

Signs of malignant hyperthermia

Tachypnea, tachycardia, and a rigid jaw or generalized rigidity As the condition progresses, the client develops a high fever Muscle tissue is broken down, leading to hyperkalemia, cardiac dysrhythmias, and myoglobinuria

Dabigatran

anticoagulant, thrombin inhibitor risk for bleeding

Which vaccines can a pregnant woman received at 30 weeks gestation?

Tdap, influenza vaccine (NOT nasal spray) Pregnant women have suppressed immune systems and are at increased risk for illness and subsequent complications Some viruses (eg, rubella, varicella) can cause severe birth defects Inactivated vaccines contain a "killed" version of the virus and pose no risk of causing illness from the vaccine. Some vaccines contain weakened (ie, attenuated) live virus and pose a slight theoretical risk of contracting the illness from the vaccine. For this reason, women should not receive live virus vaccines during pregnancy or become pregnant within 4 weeks of receiving such a vaccine The tetanus, diphtheria, and pertussis (Tdap) vaccine is recommended for all pregnant women between the beginning of the 27th and the end of the 36th week of gestation as it provides the newborn with passive immunity against pertussis (whooping cough) During influenza season (October-March), it is safe and recommended for pregnant women to receive the injectable inactivated influenza vaccine regardless of trimester The influenza nasal spray; measles, mumps, and rubella (MMR) vaccine; and varicella vaccine contain live viruses and are contraindicated in pregnancy

COX-2 inhibitors are not safe for which patient populations?

Teenagers 3rd trimester of Pregnancy - premature closure of ductus arteriosus

Right sided stroke

Tend to be impulsive and unaware of deficits Teaching the client's family to expect disinhibition and emotional outbursts helps family members cope with the behavioral changes and reduces frustration during interactions

What is the first sign of puberty in boys?

Testicular enlargement, including scrotal changes This typically occurs at age 9½-14

Common SEs of Clonidine

The 3 Ds: Dizziness Drowsiness Dry mouth

Fluoxetine is an ________________ that leads to _______________.

antidepressant hyponatremia

Negative-pressure wound therapy

The application of negative pressure to a wound to enhance bacteria and exudate removal Negative pressure promotes healing by stimulating cell growth and vessel perfusion in the wound bed

A child with tonsillitis develops a sandpaper-like rash. Is this a serious finding?

The most common bacterial cause of tonsillitis is group A streptococcal infection Group A strep can also result in scarlet fever, which manifests as fine sandpaper-like skin rash and fever Antibiotics will effectively treat this condition, and it is not life-threatening

Ethambutol adverse effect

The client must have baseline and periodic eye examinations during therapy as optic neuritis is a potentially reversible adverse effect The client is instructed to report signs of decreased visual acuity and loss of color (red-green) discrimination

Monitor these labs when a pt is taking Isoniazid

The client receiving isoniazid is at risk for the development of hepatitis; therefore, liver function test results should be monitored

What should the nurse do to help a pt who gave birth vaginally 2 hrs ago, has a boggy fundus deviated to the right, and has saturated a pad in 20 mins?

The client should be assisted to void to correct the bladder distension The nurse should then perform fundal massage An oxytocin infusion should be initiated if initial attempts to control postpartum bleeding (relief of bladder distention and fundal massage) have failed - the usual postpartum oxytocin IV dosage is 125-200 milliunits/min A complete blood count is needed to determine hematocrit and hemoglobin levels following excessive postpartum bleeding Oxygen delivery at 10 L/min via a nonrebreather facemask may be initiated if the client becomes symptomatic following excessive blood loss - however, the first priority is to control the bleeding

A pt with COPD and worsening leg edema likely has which heart condition?

The client with COPD and peripheral edema may have cor pulmonale, or right-sided heart failure, from vasoconstriction of the pulmonary vessels

Which client should be seen first? 1. Asthma, SOB, high-pitched expiratory wheezing 2. HF, SOB, pink frothy sputum

The client with HF who is SOB and coughing up pink frothy sputum has developed acute pulmonary edema (fluid filling the alveoli), a potentially life-threatening condition - this client's status has deteriorated from baseline, is potentially the most hemodynamically unstable, and should be assessed first This client with shortness of breath and high-pitched expiratory wheezing is experiencing expected clinical manifestations of asthma and is the second most unstable client at this time

What color should the stoma be post-op?

The colostomy stoma should be beefy red in the immediate postoperative period. Any discoloration to the stoma could indicate decreased blood supply to the area; the nurse should notify the HCP. Any paleness or graying of the stoma indicates decreased blood supply to that area.

When is a toddler ready for toilet training?

The degree of readiness progresses relative to development of neuromuscular maturity with voluntary control of the anal and urethral sphincters occurring at age 18-24 months Bowel training is less complex than bladder training; bladder training requires more self-awareness and self-discipline from the child and is usually achieved at age 2½-3½ years

When should Lovastatin be taken

The enzyme that helps metabolize cholesterol is activated at night, so this medication should be taken with the evening meal

In a pt with autonomic dysreflexia with symptoms of HTN, bradycardia, and HA, should you lower or raise the HOB?

The head of the bed should be raised to lower the blood pressure

How fast can IVPB KCL be administered?

The infusion rate should not exceed 10 mEq/hr. Therefore, IVPB KCL must be given via an infusion pump so the rate can be regulated. IV KCL should be diluted and never given in a concentrated amount. Furthermore, too rapid infusion can cause cardiac arrest. The charge nurse would need to intervene if the new nurse was attempting to administer IVPB KCL via gravity infusion instead of a pump.

Placenta accreta

direct implantation into myometrium without intervening decidua -> will need a C-section, high risk for bleeding, may need hysterectomy

Glyburide pt education

The major adverse effects of sulfonylurea medications (glyburide, glipizide, glimepiride) are: Hypoglycemia & Weight gain Pts taking glyburide should be taught to use sunscreen and protective clothing as serious sunburns can occur Avoid alcohol because it lower blood sugar and can cause hypoglycemia

If parents of a child with epiglottis are wondering how they could have prevented this from happening, what should you say?

The majority of cases of epiglottitis are caused by Haemophilus influenza type B (HiB), which is covered under the standard vaccinations given during the 2- and 4-month visits Epiglottitis is rarely seen in vaccinated children

Characteristics of an Extreme Preemie around 28 weeks

The newborn at 28 weeks gestation has: Abundant lanugo - fine hair on back that disappears at 36 weeks Flat areolae without palpable breast buds Smooth, pink skin with visible veins

How can the nurse prevent fat emboli from forming in a pt with a fractured femur?

The nurse should minimize movement of the injured extremity to reduce the risk for fat emboli

Plan of Care for LGA baby

The nurse should prioritize assessment of birth injuries and hypoglycemia!!! - Assess the newborn for birth-related injuries (eg, cephalohematoma, clavicular fracture, lacerations) and review the birth record to determine if an operative vaginal birth occurred (eg, forceps) - Discuss the need for possible feeding supplementation (eg, breastmilk, formula) if the newborn is hypoglycemic - Assist the mother to feed the newborn soon after birth and every 2-3 hours thereafter to prevent hypoglycemia - Obtain a capillary blood glucose before feeding to assess for hypoglycemia, and notify the health care provider when a capillary BG reading is <40-45 mg/dL

Postoperative cognitive dysfunction (POCD)

The nurse should teach the client that possible memory impairment and problems with concentration, language comprehension, social integration, and emotional lability are common following major surgery Symptoms typically resolve after 4-6 weeks or when healing is complete

Which meds should not be combined with Lithium?

Thiazide diuretics NSAIDs Antidepressants They can all cause elevated lithium levels, which increases the risk of toxicity Remember Lithium range: 0.6-1.2

What adverse effect should a patient taking hydrochlorothiazide report?

Thiazide diuretics, such as HCTZ, cause potassium wasting in the urine, so the client should be instructed to report fatigue and muscle weakness, which are characteristic of hypokalemia

How do administer ear drops to an adult or child years or older?

The pinna is pulled upward and back to straighten the external ear canal

When does the posterior fontanel close?

The posterior fontanel is a membrane-filled space between the parietal and occipital bones and normally closes by age 2 months

The posterior fontanelle fuses by age ____ months, and the anterior fontanelle fuses by age ____ months.

The posterior fontanelle fuses by age 2 months, and the anterior fontanelle fuses by age 18 months.

How should you position a patient after a liver biopsy? How long should they stay in the position?

The pt must lie on the right side for a minimum of 2-4 hours to splint the incision site (the liver is on the right side of the body) The liver is a "heavy" organ and can "fall on itself" to tamponade any bleeding The client stays on bed rest for 12-14 hours

Category X drugs

There is a risk for teratogenesis in the first trimester Must use reliable birth control if taking a drug in this category (e.g. Accutane)

Why is it important to drink plenty of water when taking sulfa drugs?

They can crystalize in the urine

What should you educate your pt about drowsiness related to clonidine?

This SE will go away after a few weeks of taking the drug

Techniques for feeding pts with dysphagia

Tilting the neck slightly to assist with laryngeal elevation and closure of the epiglottis Modification of food consistency (pureed, mechanically altered, soft) - don't want it too thin Thickened liquids Having the client sit upright at a 90-degree angle Placing food on the stronger side of the mouth to aid in bolus formation Avoid straws for drinking liquids - might cause increased swallowing difficulty and choking

Prior to oral surgery, it is necessary to report findings such as

Those that will place a client at risk for the development of endocarditis (presence of prosthetic valves, history of congenital heart disease) and bleeding (elevated INR)

Is it ok for a pt with glaucoma to take diphenhydramine?

Those with glaucoma or urinary retention should avoid anticholinergic drugs

Alteplase

Thrombolytic agents (alteplase, tenecteplase, reteplase) place clients at risk for bleeding Therefore, they are contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension They are often prescribed to resolve acute thrombotic events (ischemic stroke, myocardial infarction, massive pulmonary embolism) BP must be below 180/110 mm Hg !!!!

NSAIDs increase the risk of

Thrombotic events (MI, stroke), especially in clients with cardiovascular disease (coronary artery disease)

Lyme disease

Tick-borne disease caused by Borrelia ring-shaped rash tx: antibiotics

What is a S/S of aminoglycoside toxicity?

Tinnitis - ring of the ears Because aminoglycosides are ototoxic (and nephrotoxic!)

Tinnitus is a SE of which drugs

Tinnitus (ringing in the ears) is an uncommon SE of NSAID (naproxen) use Tinnitus is commonly associated with toxicity related to salicylate-containing NSAIDs (aspirin) or aminoglycosides (gentamicin, neomycin, tobramycin)

What is atropine used for in the OR?

To decrease oral secretions

A pt is receiving a heparin infusion and you have orders to administer Warfarin at the same time. Why? What do you do?

Warfarin begins to take effect in 48-72 hours and then takes several more days to achieve a maximum effect Therefore, an overlap of a parenteral anticoagulant like heparin with warfarin is required The typical overlap is 5 days or until the INR reaches the therapeutic level Warfarin requires an overlap of therapy with unfractionated heparin infusion or low-molecular-weight heparin (eg, enoxaparin, dalteparin) for several days until the INR is in the therapeutic range for the client's condition. Remember: Anticoagulants like heparin and warfarin will not break down or dissolve clots. They inhibit any further clot formation and keep the current clot from getting larger. Thrombolytics, such as tissue plasminogen activator, do break down clots.

When are NOACs used?

To prevent stroke/embolism in patients with atrial fibrillation Prevent VTE in orthopedic surgery

Which medication is administered for AFib?

To slow the heart rate, an IV infusion of the calcium channel blocker diltiazem is prescribed This requires continual cardiac monitoring!!

Topical capsaicin cream

Topical capsaicin cream (Zostrix) is an over-the-counter analgesic that effectively relieves minor pain (osteoarthritis, neuralgia)

First line medication for Torsades de pointes

Torsades de pointes is usually due to a prolonged QT interval (more than half the RR interval), which is the result of electrolyte imbalances, especially hypomagnesemia, or some medications The first-line treatment is IV magnesium Treatment may also include defibrillation and discontinuation of any QT-prolonging medications

TORCH infections

Toxoplasmosis Other (parvovirus B19/varicella-zoster virus) Rubella Cytomegalovirus Herpes

Which route provides the most continuous analgesia for cancer pain?

Transdermal drug administration of an analgesic provides around-the-clock, controlled release of the medication that is absorbed through intact skin into the bloodstream to provide continuous pain relief

Justice

Treating every pt equally regardless of gender, sexual orientation, religion, ethnicity, disease, or social standing

Position Air Embolism

Trendelenburg on the Left Side!

Oral Metronidazole pt education

Trichomoniasis is a sexually transmitted infection that may cause a frothy, malodorous, yellow-green vaginal discharge Appropriate teaching for clients undergoing treatment with oral metronidazole includes: - Avoidance of alcohol - Treatment of sexual partners - Abstinence from sexual activity until the symptoms resolve (about 1 week after treatment) - Awareness of possible side effects (dark-colored urine, metallic taste, GI upset)

Amitriptyline

Tricyclic antidepressant Also treats nerve pain, so may be used to treat fibromyalgia

Medication for Trigeminal Neuralgia

Trigeminal neuralgia is sudden, sharp pain along the distribution of the trigeminal nerve The symptoms are usually unilateral and primarily in the maxillary and mandibular branches Clients may experience chronic pain with periods of less severe pain, or "cluster attacks" of pain between long periods without pain - pain is severe, intense, burning, or electric shock-like Triggers can include washing the face, chewing food, brushing teeth, yawning, or talking *The drug of choice is carbamazepine - it is a seizure medication but is highly effective for neuropathic pain

Tumor lysis syndrome (TLS)

Tumor lysis syndrome occurs due to rapid lysis of cells and the resulting release of intracellular potassium and phosphorus into serum Phosphorus binds to calcium, leading to hypocalcemia The breakdown of cellular nucleic acids causes severe hyperuricemia IV hydration and hypouricemic medications (allopurinol) are prescribed to promote purine excretion and prevent acute kidney injury

A pt with a goiter should avoid which food?

Turnips

Who can witness an advance directive?

Two witnesses are required for completion of the advance directive form The witnesses canNOT be health care providers involved in the care of the client OR individuals named as health care proxies in the document

Subdural hematoma

Typically is a slow venous bleed so symptoms appear 24-48 hours after head trauma occurs S/S: similar to those of increased ICP, including change in LOC, projectile vomiting, ataxia, ipsilateral (unilateral) pupil dilation, & seizures Brain herniation can occur if the condition is not recognized and treated

When should you hold erythropoietin?

Uncontrolled HTN Hgb > 11

Fondaparinux

Unfractionated heparin Anticoagulant commonly used for DVT and PE prophylaxis after hip/knee replacement or abdominal surgery Fondaparinux is not administered until MORE THAN 6 hrs after any surgery Anticoagulants are NOT given while an epidural catheter is in place

Typical characteristics of child abusers

Unrealistic expectations of the child's performance, behavior, and/or accomplishments; overly critical of the child Confusion between punishment and discipline; having a stern, authoritative approach to discipline Having to cope with ongoing stress and crises such as poverty, violence, illness, lack of social support, and isolation Low self-esteem A history of substance abuse Punitive treatment and/or abuse as a child Lack of parenting skills, inexperience, minimal knowledge about child care and child development, and young parental age Resentment or rejection of the child Low tolerance for frustration and poor impulse control Attempts to conceal the child's injury or being evasive about an injury; shows little concern about the child's injury

UAPs cannot reposition which pts?

Unstable clients and spinal cord stabilization require the presence of a nurse for repositioning or moving - includes pts with cervical collar or a recent hip replacement Other repositioning info: Use a gait/transfer belt to transfer a partially weight-bearing client to a chair Use 2 or more caregivers to reposition clients who are uncooperative or unable to assist (comatose, medicated) Use a full-body sling lift to move/transfer nonparticipating clients Use 2-3 caregivers to move cooperative clients weighing less than 200 lb Use 3 or more caregivers to move cooperative clients weighing more than 200 lb

How to care for a newly circumcised baby

Use only warm water for cleaning and avoid soap and alcohol-based wipes After 24 hours, a yellow exudate forms as part of the normal healing process; it should not be removed Pain is expected Diapers should be changed when soiled or at least every 4 hours to keep the area clean and assess for evidence of infection or bleeding Petroleum gauze or ointment should be applied at every diaper change (unless Plastibell used) to prevent sticking

Black cohosh

Used for treatment of menopausal symptoms The main side effect is liver injury

Memantine

Used to ease the symptoms of moderate to severe Alzheimer disease, thereby improving the quality of life for clients and caregivers It may improve: Cognition - memory, thinking, language ADLs Behavioral problems - agitation, depression, hallucinations

Lithium is used to treat which conditions and what range is therapeutic?

Used to treat bipolar affective disorders Therapeutic serum range of 0.6-1.2 mEq/L Levels >1.5 mEq/L are considered toxic

Barium enema

Uses contrast medium (barium) administered rectally to visualize the colon using fluoroscopic x-ray

Ways to prevent lead exposure in the home

Vacuuming spreads lead dust in the air, which increases inhalation exposure, so instead hard surfaces should be wet-dusted or mopped at least weekly Hot tap water dissolves lead from older pipes; therefore, cold water should be used for consumption if lead plumbing is present - taps should be flushed for several minutes to clear out contaminated water before use The home environment should be assessed for lead sources Hand-washing, especially before eating, is important to remove lead residue

What should a pt practice before a cardiac catheterization?

Valsalva's maneuver and coughing These tasks will need to be performed during the procedure

Live vaccines

Varicella-zoster vaccine (chicken pox) Measles-mumps-rubella (MMR) Rotavirus Yellow fever Influenza if administered intranasal

Vesicular skin lesions on an infant could be which 2 things?

Varicella-zoster virus (chickenpox) OR Staphylococcus aureus (impetigo) These lesions are not associated with a fungal infection

Calcium Channel Blockers

Verapamil Nifedipine Diltiazem Amlodipine

Warfarin antagonist

Vitamin K

Normal WBC and neutrophil count

WBC 4,000 - 11,000 Neutrophils 2,200 - 7,700

Capasaicin cream pt education

Wait at least 30 mins after massaging the cream into the hands before washing to ensure adequate absorption The client should avoid contact with mucous membranes (eg, nose, mouth, eyes) or skin that is not intact, as capsaicin is a component of hot peppers and can cause burning The application of heat with capsaicin is contraindicated as heat causes vasodilation, which increases medication absorption and can possibly lead to a chemical burn Local irritation (burning, stinging, erythema) is quite common and usually subsides within the first week of regular use - if the client experiences persistent pain, redness, or blistering, the cream should be discontinued and the HCP notified Topical capsaicin is often used concurrently with acetaminophen or NSAIDs (naproxen, celecoxib) to effectively treat osteoarthritis pain. Capsaicin should be used regularly (3-4 times daily) for long periods (weeks to months) to achieve the desired effect

Which foods should pts starting to take Warfarin not eat too much of eat inconsistent amounts of?

Warfarin (Coumadin) is a vitamin K antagonist used to prevent blood clots in clients with atrial fibrillation, artificial heart valves, or a history of thrombosis *Excessive intake of vitamin K-rich foods (broccoli, spinach, liver) can decrease the anticoagulant effects of warfarin therapy

Furosemide is a _____________ that causes _____________ and ______________

diuretic hypokalemia and hypomagnesemia

Pertussis

Whooping cough is a very contagious communicable disease caused by the Bordetella pertussis bacteria Droplet isolation Tx: Antibiotics Humidified oxygen Adequate fluids will help loosen the thick mucus Suction as needed is important in infants Respiratory status should be monitored for obstruction Position pt on the left side to prevent aspiration if vomiting occurs No cough suppressants

What is the priority treatment for an injured child with hemophilia A who hit their head?

When intracranial or another form of bleeding is suspected, administration of factor VIII is a priority as the client's body cannot form a clot without it. Then after this, you can get a CT scan.

When should isosorbide or nitroglycerine be held?

When the SBP < 90 mmHg

Shoulder dystocia

When the fetal head delivers but the anterior (top) shoulder becomes wedged behind or under the mother's symphysis pubis Shoulder dystocia lasting ≥5 minutes is correlated with almost certain fetal asphyxia resulting from prolonged compression of the umbilical cord

SE of Phenazopyridine to tell your pts

Will turn urine an orange-red color

When should a parent take their child for their first dental visit?

Within 6 months of first tooth eruption OR by the first birthday

Recent major surgery within the past ___ days is a contraindication as tPA dissolves all clots in the body and may therefore disrupt the surgical site

Within the past 14 days

Evisceration

Wound separation with protrusion of organs

Alprazolam

Xanax An anxiolytic

What are some important preconception education topics?

achieving a normal weight (BMI 18.5-24.9) check rubella immunity & get updated vaccinations folic acid supplementation regular dental care avoidance of alcohol, smoking, and illicit drugs

ac

before meals

How could ACE inhibitors affect potassium levels?

cause hyperkalemia

Psoriasis

chronic skin condition producing red lesions covered with silvery scales autoimmune tx: corticosteroids, methotrexate, phototherapy, avoid stress triggers

Signs of TRUE labor

contractions are regular with increasing frequency, duration, and intensity discomfort radiates from back to abdomen contractions do not decrease with rest cervix progressively effaces and dilates

Acyclovir SE

crystalline neuropathy in kidneys

Corticosteroids ___________ the potassium level.

decrease

What is the benefit of combined alpha/beta blockers?

decrease BP without affecting HR

How do Calcium Channel Blockers work?

decreases SA/AV node conduction

PO Penicillin G should be taken when?

empty stomach

Which Loop diuretic is NOT a sulfa drug?

ethacrynic acid

How often should a corticosteroid inhaler be taken apart and washed?

every day

Pediculosis capitis

head lice

HHNK

hyperglycemic hyperosmolar non ketotic coma - essentially DKA without the ketoacidosis - blood gluclose levels rise without the right amount of insulin

Anticholinergic Pt Education

increase intake of fluids and bulk-forming foods to prevent dry mouth and constipation avoid locations/activities that may lead to hyperthermia do not drive until you know how the medication affects you (commonly causes sedation)

How do renal labs change in older age (age 80)?

increased protein in urine is expected serum glucose increase is expected specific gravity declines

NSAIDs examples

indomethacin ibuprofen naproxen ketorolac

Patients with myxedema are dangerously hypersensitive to which classes of medications?

narcotics barbiturates (phenobarbital for sleep) anesthetics these meds are contraindicated in this patient!

Pyloric stenosis S/S

narrowing of the opening of the stomach to the duodenum S/S: Projectile nonbilious vomiting followed by hunger - "hungry vomiter" An olive-shaped RUQ mass Weight loss Dehydration Electrolyte imbalance (metabolic alkalosis)

isosorbide dinitrate (Imdur) can cause which SE?

nitrates cause vasodilation which can cause HAs Acetaminophen can be administered prn to control the HAs

1st degree heart block

prolonged PR interval usually asymptomatic

A diet rich in ____________ and vitamin ___ helps with calcium-supplement absorption

protein vitamin D

Adverse reactions of ACE Inhibitors

proteinuria neutropenia cough

Cushing's triad

r/t increased ICP 1) Systolic HTN with widening pulse pressure 2) Bradycardia 3) Bradypnea

Lispro and aspart insulins are _________ acting

rapid

McRoberts maneuver

sharp flexion of the maternal hips that decreases the inclination of the pelvis increasing the AP diameter of the free anterior shoulder Used for shoulder dystocia

Herpes zoster

shingles

Manifestations of Addisonian Crisis are similar to s/s of what condition?

shock Hypotension, rapid weak pulse, rapid RR

Regular insulin is _________ acting

short

edrophonium

temporarily reduces muscle weakness to test for myasthenia gravis

Which medications can cause pill-induced esophagitis?

tetracyclines (eg, doxycycline) bisphosphonates ("dronates": alendronate, ibandronate, pamidronate, risedronate) potassium

Dysarthria

the inability to use speech that is distinct and connected because of a loss of muscle control after damage to the peripheral or central nervous system

Imipramine

tricyclic antidepressant

Eardrops are administered with the ear positioned ____________ and ___________ for patients > 3 years.

upward and outward

Acyclovir is used to treat which two conditions?

varicella zoster - shingles herpes

Nitroprusside sodium

vasodilator used to decrease BP in HTN

Signs of digitalis toxicity

vomiting!!! anorexia abdominal pain Lipitor can cause digitalis toxicity!

Transverse myelitis

(Spinal cord inflammation) usually results from a recent viral infection Classic symptoms include paralysis, urinary retention, and bowel incontinence

Delusions of Control

"Don't drink the tap water. That's how the government controls us."

Persecutory (paranoid) delusion

"Those martians are trying to poison me with that tap water."

Drugs that can cause Neuroleptic Malignant Syndrome (NMS)

"Typical" antipsychotics: haloperidol, fluphenazine Newer "atypical" antipsychotic drugs: clozapine, risperidone, olanzapine

Rosuvastatin

(Crestor) is a strong statin drug that can cut LDL drastically and reduce total cholesterol and triglycerides A serious complication associated with statin medication is rhabdomyolysis The client should immediately report any signs of muscle aches or weakness to the HCP Other SE: insomnia, headache, abdominal discomfort

Phentolamine

(Regitine) is the antidote drug used to treat a norepinephrine (Levophed) extravasation

Tinea capitis

(Ringworm of the scalp) is a contagious fungal infection that lives on the surface of the scalp, resulting in scaly, pruritic, erythematous, circular patches with hair loss Treatment may include 1% selenium sulfide shampoo applied several times each week in combination with an antifungalmedication (griseofulvin oral suspension) that the client must take for several weeks to months The client will best absorb griseofulvin (suspension, microsized tablets) when taken after/with high-fat foods (ice cream) Photosensitivity is a common SE of griseofulvin

Colchicine

antiinflammatory to treat acute gouty arthritis Take WITHOUT food

A white pupil

(leukocoria, or cat's-eye reflex) is one of the first signs of retinoblastoma, an intraocular malignancy of the retina Other symptoms include an absent red reflex, asymmetric or of a differing color in the affected eye, and fixed strabismus (constant deviation of one eye from the other)

Tricyclic antidepressants side effects

*TCAs* T - Thrombocytopenia C - Cardiac [arrhythmia, MI, stroke] A - Anticholinergic [urinary retention, constipation] S - Seizures *TEACHING* -take at bedtime because of sedative effect -stay out of sun

S/S of colorectal cancer

- Blood in the stool (positive occult blood, melena) - Abdominal discomfort and/or mass (not common) - Anemia due to intestinal bleeding - Change in bowel habits (diarrhea, constipation) - Unexplained weight loss due to impaired nutrition from altered intestinal absorption

Epinephrine auto-injectors patient education

- Administer injection at a 90-degree angle into the outer thigh - Hold the auto-injector in place for 10 seconds to ensure delivery of the entire dose - Seek immediate medical care after an injection because anaphylactic reactions may resume when the effects of the epinephrine subside (ie, 10-20 minutes) - Expect to experience tachycardia, palpitations, and/or dizziness after administration - Store EAIs at room temperature in a dark place to prevent inactivation by heat or light, or device failure from cold

Nursing interventions for clients with acute viral hepatitis include:

- Alternate periods of rest and activity to reduce metabolic demands and avoid fatigue - Avoid hepatotoxins (alcohol, acetaminophen) - Medications metabolized in the liver (appetite stimulants, antipruritics, analgesics, sedatives) should be used cautiously to allow hepatocytes to heal - Encourage low fat, small, frequent meals to decrease nausea and promote intake in clients with anorexia - anorexia is lowest in the morning - promote eating a larger breakfast - Provide oral care and avoid extremes in food temperature to increase appetite - Promote water consumption (3L/day) and diets adequate in carbohydrates and calories Diets high in fat should be avoided as liver bile production, which is needed for fat digestion, may be impaired - encourage protein and carbohydrate intake to assist with liver healing

Causes of lithium toxicity

- Dehydration - Diet low in Na+ - Drug-drug interactions (NSAIDs and thiazide diuretics) - Decreased renal function (elderly clients) Lithium is cleared renally. Even a mild change in kidney function can cause serious lithium toxicity - therefore, drugs that decrease renal blood flow (NSAIDs) should be avoided. Acetaminophen would be a better choice for pain relief Pts should NEVER restrict their Na+ or H2O intake while taking lithium

Clients taking long-term corticosteroid replacement should be taught the following:

- Do not discontinue glucocorticoid therapy abruptly - Report any signs and symptoms of infection to the HCP immediately - Stay attuned to signs and symptoms of stress and increase dose of corticosteroid during times of stress - A side effect of corticosteroid therapy is hyperglycemia - Corticosteroids are catabolic to bone (osteoporosis) and muscle (muscle weakness - a diet high in calcium (at least 1500 mg/day) and protein (1.5 g/kg/day) but low in fat and simple carbohydrates is recommended - Cataracts are a side effect of corticosteroids, particularly glucocorticoid therapy. - make an appointment with an optometrist yearly to assess for cataracts - Corticosteroid medications can cause gastric irritation and should not be taken on an empty stomach

Nursing interventions for shoulder dystocia

- Documenting the exact time of events (birth of fetal head, shoulder dystocia maneuvers) - Verbalizing passing time to guide decision-making by the HCP ("two minutes have passed") - Performing maneuvers to relieve shoulder impaction (McRoberts maneuver, suprapubic pressure) - Requesting additional help from staff NO forceps

Pts classified as "Expectant" during disaster triage

- Full-thickness burns over > 60% BSA - Severe neuro trauma - Apnea - Pulsenesses

When reconstituting a powdered medication for parenteral administration, the nurse should follow these steps in this order:

- Perform hand hygiene and don clean gloves prior to handling medication - Cleanse the vial top with alcohol and let it dry to prevent possible microbial contamination - Withdraw an amount of air from the vial equal to the prescribed amount of diluent to create negative pressure that will be equalized when the diluent is injected into the vial - Inject the appropriate diluent (sterile saline, sterile water) into the vial - Roll the vial between the palms of the hands to gently mix the solution - Withdraw the reconstituted medication from the vial into a sterile syringe for administration - Verify the dosage by checking the prepared medication against the medication administration record and medication label - Label the syringe with the medication name and dose

Mastitis tx

- Staphylococcus aureus is the most common causative organism and requires antibiotic treatment (dicloxacillin, cephalexin) - Continue breastfeeding frequently (every 2-3 hr) to ensure adequate milk drainage - Ensure proper breastfeeding technique (alternate newborn feeding positions, proper latch) - Apply warm compresses and massage the breast to facilitate complete emptying - Cool compresses can also be used between breastfeeding as needed for comfort - Ensure adequate rest, nutrition, and hydration - Relieve pain and inflammation with analgesics compatible with breastfeeding (acetaminophen, ibuprofen) - Wash hands before and after feeding

How should you manage norepinephrine extravasation through a peripheral IV?

- Stop the infusion immediately and disconnect the IV tubing - Use a syringe to aspirate the drug from the IV catheter; remove the IV catheter while aspirating - Elevate the extremity above the heart to reduce edema - Notify the health care provider and obtain a prescription for the antidote phentolamine (Regitine), a vasodilator that is injected subcutaneously to counteract the effects of some adrenergic agonists (eg, norepinephrine, dopamine)

Cervical lacerations should be suspected if

- The uterine fundus is firm and midline on palpation despite continued vaginal bleeding - The bleeding can be minimal to frank hemorrhage - Severe pain or a feeling of fullness is not associated with cervical lacerations

To care for and decrease transmission of impetigo, interventions include:

- Wash hands before and after touching the infected area - Isolating the infected person's clothing and linens and washing them in hot water - Keeping the infected person's fingernails short and clean to prevent bacteria from collecting under them and to deter scratching - Avoiding close contact with others for 24-48 hours after initiation of antibiotic therapy - Keeping the infected area covered with gauze when in contact with others

S/S of third spacing

- decreased UO with adequate intake - tachycardia - hypovolemia - increased weight - pitting edema, ascites

Fluoroquinolones

- floxacin Ciprofloxacin Levofloxacin Moxifloxacin

Common side effects of anticholinergics

- new-onset constipation - dry mouth - flushing - heat intolerance - blurred vision - drowsiness

Pt Education for Transdermal Scopolamine

- placed on a hairless, clean, dry area behind the ear - apply patch ≥4 hours before starting travel - replace patch q72 hours - remove and discard old patch before placing a new one - dispose of the old patch out of reach of children and pets - wash hands with soap and water after handling patch

What size needle is used for IM injections?

1 to 1.5 in

The maximum rate for infusion of IV potassium chloride through a peripheral vein is ____ mEq/hr, and the maximum rate through a central vein is ____ mEq/hr.

10 mEq/hr 40 mEq/hr

Theophyline therapeutic range

10 to 20 mcg/mL Hold dose and call provider if higher than 20

Withhold digoxin in an infant with a HR less than _______ bpm.

100 And contact HCP

A neonate's resting pulse is _____ /min

110-160/min

Ovulation begins ____ days before the start of the menstrual period

14

1 tbsp = ? mL

15 mL

A client with an acute stroke presentation requires "permissive hypertension" during the first 24-48 hours to allow for adequate perfusion through the damaged cerebral tissues. However, the blood-brain barrier is no longer intact once the blood pressure is > _____/_____ mm Hg. Therefore, "mild" lowering is required, usually to a systolic pressure that is not below _____ mm Hg.

220/120 170

Normal aPTT

25-35 seconds

Therapeutic aPTT

46-70 seconds 1.5-2 times normal aPTT value

Colostomies appliance should be changed every __ - __ days.

5 - 10

Normal BUN in children

5-18 mg/dL

Normal pulmonary artery wedge pressure

6-12 mmHg

Asymptomatic hypoglycemia in newborns with blood glucose (BG) <____ mg/dL if age 4-24 hours or <____ mg/dL if age < 4 hours should be initially treated with ____________.

< 35 <25 Feeding !!! Feeding the newborn is a simple, noninvasive method of increasing and stabilizing BG

Low CD4 counts are defined as:

< 750 for infants 12 months or younger <500 for children between age 1-5 years <200 for children age >5 years and adults

Oliguria is defined as < _____ mL/kg/hr

<0.5 mL/kg/hr

Normal BNP

<100 pg/mL BNP is secreted from the ventricles in response to the increased ventricular stretch Elevated BNP is expected in a client with heart failure

What is SVT?

> 150 bpm

After how many days postpartum should lochia change from rubra to serosa?

> 3-4 days postpartum - progressive change in lochia from lochia rubra (dark-red vaginal bleeding) to lochia serosa (pink or brown discharge)

Facility policy may advise holding enteral feeding for high GRVs > ____ mL to minimize aspiration risk.

> 500 ml

Newborns who are large for gestational age (LGA) are diagnosed after birth by plotting their birth weight and gestational age on a growth chart; weight must be at least ____ percentile and is commonly > _______.

> 90th percentile > 8lbs 13oz (4000g)

What is considered a severely high creatine kinase level?

>15,000 U/L

UAP Scope of Practice

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

UAP Scope of practice

ADLs Hygiene Linen change Routine, stable VS Documenting input/output Positioning

Which antihypertensive medication class can cause hepatitis and renal failure?

ARBs - Losartan

What class of medication is recommended for a pt who has a reaction to ACE inhibitors?

ARBs such as valsartan or losartan

Phenazopyridine

AZO UTI pain relief

Insulin is absorbed more quickly when injected into the ______________.

Abdomen

Pica

Abnormal, compulsive craving for and consumption of substances normally not considered nutritionally valuable or edible Common substances include ice, cornstarch, chalk, clay, dirt, and paper Many women only have pica when they are pregnant Often accompanied by iron deficiency anemia due to insufficient nutritional intake or impaired iron absorption

Most important pt teaching about Clonidine

Abrupt discontinuation can result in serious rebound hypertension due to the rapid surge of catecholamine secretion that was suppressed during therapy Clonidine should be tapered over 2-4 days Abrupt withdrawal of beta blockers can also result in rebound hypertension and in precipitation of angina, myocardial infarction, or sudden death

Tolterodine and Oxybutynin

Anticholinergic meds to treat overreactive bladder reduce bladder spasms

When should a vaccine be held in children?

Assess for allergies to vaccine components (neomycin, gelatin, yeast) Screen for an allergy to latex (lips swelling from contact with bananas, kiwis, or latex balloons) Severely immunocompromised children (corticosteroid therapy, chemotherapy, AIDS) generally should not receive live vaccines (varicella-zoster vaccine, measles-mumps-rubella, rotavirus, yellow fever) Passive immunization may be the only option for children with severe immunosuppression or those unable to mount an antibody immune response It is OK to give vaccines to kids with a cold (even with a fever), hx of local swelling/erythema from previous vaccination, current antibiotics

What should you do first if an intubated pt has a drop in O2 sat?

Auscultate breath sounds bilaterally If the tube becomes displaced in the hypopharynx, hypoxemia can result Confirming the presence of equal breath sounds bilaterally via auscultation is an important initial nursing intervention Once placement is confirmed, you can give 100% O2 and suction tube

Which vitamin should be given along with isoniazid (INH) therapy?

B6 (pyridoxine) INH interferes with the action of vitamin B6 resulting in peripheral neuropathy; it manifests as ataxia and paresthesia Individuals who are most predisposed to becoming neurotoxic from taking INH include older adults, those who are malnourished, diabetic clients, pregnant or breastfeeding clients, alcoholics, children, those with liver or renal disease, and HIV-positive individuals

Nurses should screen clients for and immediately report warning signs of cancer, which can be remembered with the mnemonic CAUTION:

Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge from a body orifice Thickening or a lump in the breast or elsewhere Indigestion or difficulty in swallowing that does not go away Obvious change in a wart or mole Nagging cough or hoarseness

sublimation (defense mechanism)

Channeling socially unacceptable impulses into constructive, even admirable, behavior Using boxing to channel aggression

What time of day should a patient take corticosteroids?

Daily doses of long-term corticosteroid therapy should be administered in the morning to coincide with the body's normal secretion of cortisol Patients receiving long-term corticosteroids need to increase their intake of calcium, which generally means an increase in dairy products Corticosteroids can often cause GI distress and should be administered with meals

What should you monitor in a pt on hydralazine?

Daily weights, I&Os BP, pulse Adverse reactions: fluid retention, tachycardia

What could cause a false low on a pulse ox?

Dark fingernail polish or artificial acrylic nails Hypotension and low cardiac output (HF) Vasoconstriction (hypothermia, vasopressor medications) Peripheral arterial disease

Vitamin K foods

Dark green vegetables ( Spinach, Brussels sprouts, broccoli) Green tea

Side effects of ADHD medications (stimulants)

Decreased appetite and weight loss - can lead to growth delays Cardiovascular effects - hypertension and tachycardia Appearance of new or exacerbation of vocal/motor tics Excess brain stimulation - restlessness, insomnia Abuse potential - misuse, diversion, addiction

Reaction formation

Defense mechanism by which people behave in a way opposite to what their true but anxiety-provoking feelings would dictate

How should pts with Type 1 diabetes change their disease management when they are sick?

Do NOT discontinue insulin usage during an illness, even if unable to eat Encouraging fluids Monitoring glucose more frequently Check ketone levels in urine

What is a benefit of oral anticoagulants, such as Rivaroxaban?

Do not require monitoring like Warfarin does

Cholinesterase inhibitors

Donepezil Rivastigmine Galantamine

Methotrexate - always do this before administering to a patient with RA

Double-checking the prescription with another RN because death can occur from an overdose It is administered weekly and in low doses for RA and should not be confused with administration of the drug as a chemotherapeutic agent

Priority intervention during a "Tet Spell"

During a hypercyanotic episode, or "tet spell," which is an exacerbation of tetralogy of Fallot that can happen when a child cries, becomes upset, or is feeding, the child should first be placed in a KNEE-TO-CHEST position Flexion of the legs provides relief of dyspnea as this angle improves oxygenation by reducing the volume of blood that is shunted through the overriding aorta and the ventricular septal defect After placing infant in knee-to-chest position, check VS. Morphine or O2 can be administered if this does not help

Dependent personality disorder

Fear separation and tend to be indecisive and unable to take the initiative They are often preoccupied with the thought of being left to fend for themselves and want others to assume responsibility for all major decision making

Erythema toxicum neonatarum

Firm, white or yellow papules or pustules surrounded by erythema This idiopathic rash, which closely resembles flea bites, appears in the first few days after birth and resolves within 5-7 days The rash requires no treatment

What should you do if a feeding tube becomes clogged?

First attempt to unclog the tube by using a large-barrel syringe to flush and aspirate warm water in a back-and-forth motion through the tube A digestive enzyme solution may help if warm water flushing is not effective

SE of taking glucocorticoids with NSAIDs or ASA

Glucocorticoids (prednisone), when taken in combination with aspirin or NSAIDs such as naproxen, can increase the risk of GI ulceration and bleeding

Education for a new mom who choses NOT to breastfeed

Ice packs to breasts for 15-20 minutes every 3-4 hours to reduce blood flow and swelling Applying chilled, fresh cabbage leaves to breasts Taking an anti-inflammatory analgesic (eg, ibuprofen) as directed to reduce pain Maintaining firm breast support (eg, supportive bra, breast binder)

Herpes simplex virus in a pregnant woman

Immediate antiviral therapy (acyclovir) should be initiated to treat the active infection Vaginal birth is not recommended in the presence of active lesions

Your patient's baby is having late decelerations. What do you do?

Immediate steps to correct late decelerations include: 1) Stop oxytocin if it is being administered 2) Reposition the client to the left/right side 3) Administer O2 by face mask 4) Administer an IV bolus of isotonic fluid (LR, NS) as needed 5) If late decelerations persist or variability is absent or minimal, the nurse should prepare for emergency delivery

Azathioprine

Immunosuppressant drug that can cause bone marrow depression and increase the risk for infection It is prescribed to treat autoimmune conditions such as inflammatory bowel diseases (Crohn disease) and to prevent organ transplant rejection

receptive aphasia (Wernicke's aphasia)

Impairment of verbal and written language comprehension Visual aids and hand gestures may be more effective means of communication

Pt education about Carbidopa-levodopa

Implement fall precautions (changing positions slowly, removing rugs), as orthostatic hypotension is a common side effect Carbidopa-levodopa takes several weeks to reach its maximum effectiveness Harmless discoloration (red, brown, black) of secretions (urine, perspiration, saliva) may occur Avoid high-protein meals, which interfere with the absorption Dyskinesia (facial or eyelid twitching, tongue protrusion, facial grimacing) may indicate overdose or toxicity of carbidopa-levodopa and should be reported immediately to the health care provider Carbidopa-levodopa often decreases, but does not eliminate, tremor and rigidity

Isoniazid (INH)

Interferes with DNA metabolism of tubercle bacillus

Sodium polystyrene sulfonate retention enema

Kayexalate Retention enema administered to clients with high serum K+ levels Kayexalate can also be given orally and is much more effective

What do you do if while changing the tubing of your pts central line, he starts gasping for air and writhing?

Likely an Air Embolism! Leakage of more than 500 mL of air into a central venous catheter is potentially fatal An air embolism in the small pulmonary capillaries obstructs blood circulation A central venous catheter leaks air rapidly at 100 mL/sec This client requires immediate intervention to prevent further complications (cardiac arrest, death) Priority interventions for active or suspected air embolism are as follows: 1) Clamp the catheter to prevent more air from embolizing into the venous circulation 2) Place the pt in Trendelenburg position on the left side, causing any existing air to rise and become trapped in the right atrium 3) Administer oxygen if necessary to relieve dyspnea 4) Notify the HCP or call an RRT to provide further resuscitation measures 5) Stay with the pt to provide reassurance and monitoring as the air trapped in the right atrium is slowly absorbed into the bloodstream over the course of a few hours

S/S of Magnesium Toxicity

Mild: nausea, flushing, HA, hyporeflexia Moderate: areflexia (patella reflex 0/4), hypocalcemia, somnolence Severe: respiratory paralysis, cardiac arrest Absent or decreased deep tendon reflexes (DTRs) are the earliest sign of magnesium toxicity DTRs, scored on a scale of 0 to 4+, should be frequently assessed during magnesium sulfate infusion Normal findings are 2+ Also, UO < 30 mL/hr is a sign that magnesium toxicity may be likely, as magnesium is excreted through the urine

Milrinone

Milrinone (Primacor) is a phosphodiesterase-3 inhibitor given via IV infusion to increase contractility and promote vasodilation. Milrinone, an inotropic agent, is often prescribed to clients with heart failure unresponsive to other pharmacologic therapies. The medication is usually infused over 48-72 hours in a hospital setting; however, home infusion through a central line is becoming more common as a palliative measure for end-stage heart failure. Milrinone infusion requires central venous access (eg, peripherally inserted central catheter) as the medication is a vesicant and can cause extravasation if infused through a peripheral IV line.

Meperidine use during labor can result in

Minimal variability FHR - but this is ok as long as accelerations/early decelerations are present and HR is not bradycardic - continue to monitor to see if FHR will return to moderate variability after the opioid wears off in 2-4hrs Opioid medications administered during pregnancy cross the placenta, resulting in minimal variability FHR patterns and neonatal respiratory depression after birth

LPN/LVN Scope of practice

Monitoring RN findings Reinforcing education Routine procedures (eg, catheterization) Most medication administrations Ostomy care Tube patency & enteral feeding Specific assessments* - lung sounds, bowel sounds, neurovascular checks

2nd degree type 2 AV block

More P waves than QRS complexes Can rapidly deteriorate to complete heart block (third-degree AV block), which is life-threatening The nurse should quickly obtain a transcutaneous pacemaker, assess the client for symptoms (bradycardia, hypotension, syncope), and be prepared to pace the client if symptoms occur

Can calcium channel blockers be crushed?

No, swallow whole

When should methylphenidate (Ritalin) be administered to a child diagnosed with ADHD?

Offer the child the medication with breakfast and after the child eats lunch. This helps prevent the effects of appetite suppression (a SE of methylphenidate) Doses should be spaced at 6-hour intervals

Pavlik harness education

Regularly assess skin for redness or breakdown under the straps Dress the child in a shirt and knee socks under the harness to protect the skin Avoid lotions and powders to prevent irritation and excess moisture Lightly massage the skin under the straps every day to promote circulation Only apply 1 diaper at a time as wearing ≥2 diapers increases risk of incorrect hip placement Apply diapers underneath the straps to keep harness clean and dry

How should you care for a pt with frostbite?

Remove items that can cause constriction or sloughing Do NOT massage or rub the injured area Provide warm water soaks and analgesia Elevating injured areas to prevent edema as blood returns to extremities Apply loose, nonadherent, sterile dressings - NOT occlusive dressings Monitor for compartment syndrome.

What type of labs would you expect to see in a pt with renal failure and osteodystrophy?

Renal failure -> kidneys fail to activate Vitamin D -> impaired calcium absorption -> serum calcium decreases -> stimulates release of PTH -> resorption of calcium and phosphate from the bones -> hypocalcemia, hyperphosphatemia, & hyperkalemia Renal failure also causes anemia

What labs should you check in a pt on an ACE inhibitor?

Renal tests

if a nurse suspects child abuse, is it a priority to document or report first?

Report

Pt teaching for Ethambutol

Requires monthly vision check May have to take for 1-2 years

PKU screening

Requires that the newborn has ingested adequate amounts (2-3 days) of milk proteins to detect metabolism errors, which result in abnormal phenyaline in the newborns blood and predisposes the infant to mental retardation

What are we concerned about with Benzos?

Respiratory depression!

Theophylline toxicity S/S

Restlessness Anorexia N/V Insomnia Tachycardia, arrhythmias Seizures

Signs of antimetabolite toxicity

Stomatitis Mucosal ulcerations Occurs because chemo affects all rapidly growing cells

S/S of a moderate to severe asthma exacerbation

Tachycardia (>120/min) Tachypnea (>30/min) Saturation <90% on RA Use of accessory muscles to breathe moderate to severe asthma exacerbations

How to perform a testicular self-exam

Testicular cancer is the most common form of cancer in men age 15-35 When diagnosed early, it is highly curable Clients at high risk for developing a tumor (history of undescended testis) are encouraged to perform a monthly TSE Instructions for a TSE include: Perform TSE monthly on the same day (easy to remember) Perform TSE while taking a warm shower or bath as warm temperatures will relax the scrotal tissue and make the testis hang lower in the scrotum Use both hands to feel each testis separately Palpate each testicle gently, using the thumb and first 2 fingers Check that the testicle is normally egg-shaped and movable with a smooth surface Report these findings to HCP: Painless, hardened lump on testes Scrotal swelling or heaviness Dull ache in pelvis or scrotum *Note: It is normal for one testicle to be slightly larger or hang lower than the other

What is oxytocin used for?

Uterotonic drugs (oxytocin [Pitocin]) are used to induce or augment labor and to stop postpartum hemorrhage by promoting uterine contractions Oxytocin must be administered via infusion pump and requires continuous electronic fetal monitoring as it is a high-alert medication The nurse assesses and documents the fetal heart rate and contraction pattern every 15 minutes during the first stage of labor with oxytocin Most oxytocin protocols dictate gradual titration to achieve contractions every 2-3 minutes Tachysystole (ie, ≥5 contractions in 10 minutes) is a potential adverse effect of oxytocin Treatment of tachysystole may include decreasing or stopping oxytocin infusion and administering IV fluid bolus and/or tocolytic drugs (terbutaline)

Is a bite block used during ECT?

Yes, the jaw muscles can contract when the current is applied

Can as UAP collect a urine specimen?

Yes, unless the pt has a Foley catheter because this is a sterile procedure The UAP and even pts themselves may collect a clean-catch or midstream urine specimen

Calcium acetate (PhosLo)

a phosphate binder used to treat hyperphosphatemia (normal phosphorous: 2.4-4.4 mg/dL) in clients with chronic kidney disease Calcium acetate lowers the serum phosphorous level by binding to dietary phosphate and excreting it in feces

A pt who is experiencing asthma should administer inhalers in which order?

albuterol first to open the airways and then the corticosteroid to provide better delivery of the medication

What happens after administering adenosine rapid IVP?

brief period of asystole due to adenosine slowing impulse conduction through the AV node The pt should be monitored for flushing, dizziness, chest pain, or palpitations during and after administration

What color is it ok for dobutamine solution to be?

brown

Pts should not eat grapefruit or drink grapefruit juice while taking _________________ due to the possible development of severe _____________.

calcium channel blockers severe hypotension