Cardiac/Pysch clinical, NCLEX Questions for test 5 w/ some Math & ABGs, NCLEX Questions Cardiac MI/ACS/Aangina/CAD, NCLEX Questions Adrenal, Test 4 extra meds, Added medication test 2

t/x of OCD

behavior therapy: expose to what they avoid response prevention; focus on delaying rituals

t/x of delirium tremors

benzo

causes of most first degree blocks

beta blockers, calcium channel blockers, digoxin

carotid rupture s/s

bleeding/pulsation at site, change in color, sternal or high epigastric distress - apply direct pressure

hep b

blood, blood products, hepatovax, can lead to liver cancer and chronic hep b

Body disturbance disorder

botox

tartive dyskinesia

can not be reversed

what can not be done in torsade de point

can not shock - must defibrillate

t/x of vtach with pulse

cardioversion

Cardioversion vs Defibrillation

cardioversion - with pt R wave defibrillation - high shock to heart to terminate VF

what to do if tube occluded by prolapsed cuff

change tubing

ART line

continous BP, no air in line, zero q4h, start of shift and after change

CPR with total laryngectomy

cover nose and mouth, bag via stoma

vfib t/x

defib, CPR, epi, amiodarone

pulseless vtach treatment

defibrillation

s/e of radiation for cancer t/x

delays healing - used for early glottic or intrinsic cancer

bipolar 2

depressed longer, hypomanic

body identity integrity disorder

desire to become an amputee

teaching for total laryngectomy

diminished taste and smell, need a smoke detector

cardiomyopathy

disease of the heart muscle

fibrioloytics

dissolve blood clots

bipolar s/s DIG FAST

distractibility, indiscretion, graniosity, flight of ideas, activity increase, sleep decreased, talkativeness

vasopressors

drugs used to increase blood pressure

assess trach infection

dry dressing, sterile technique when suctioning new, clean tech when healed

synchronized cardioversion

electrical shock that is synchronized with pts heartbeat (R wave)

paracentesis

elevate HOB, monitor BP and HR

what to do if tube occluded by water in vent tubing

empty water into reservoir bag

cardiomegaly

enlargement of the heart

pancrelipase (viokace)

enzyme replacement, give before or with meal, do not crush or chew, track progress by maintaining weight

Prinzmetal angina

episodic chest pain unrelated to exertion

what is used first - succinylocholine or etomidate

etomidate first, date before you succ

supraglottic cancer is what part of larynx

false vocal cords, epiglottis

agoraphobia

fear of leaving home

Hep A

fecal-oral - food/water workers commonly get this, havrix

hep e

fecal-oral, no vax, severe in preg women

Side effects of loop diuretics

frequent urination, blurry vision, headache, constipation, diarrhea

succinylocholine antidote

prostigmine

decreased albumin is related to

protein synthesis

social anxiety

provoked by certain social performances

addisons crisis

severe hypotension, high K, low BS, NA, dehydration

SSRI s/e

sexual dysfunction

trach hemorrhage s/s

swelling, trach ties getting tighter, active bleeding is bright red blood being suctioned

which vent is great for weaning

synchronized IMV

Example of fibrinolytic drug

tPA, ateplase

abnormal laryoscope findings

thickening or deformity, irregular mucous membrane, fixation of normally mobile laryngeal structures

common s/e of a fib

stroke

causes of PAC's

strong emotions, excessive alcohol, tobacco, caffeine, hypokalemia

what may occur with barotrauma

subq emphysema or crepitus and eventually tension pneumothorax

what do you do if tube is occluded by secretions

suction

severe anxiety

trouble thinking/reasoning, muscle tightening, increased VS

glottic cancer

true vocal cords, early symptom is voice change, slow metastasize

Typical dose of aspirin

typical dose of cardiac cases around 75-100 mg daily, can be increased to as high as 325 mg

what should be avoided with MAOI's

tyrimine foods (aged foods)

theophylline

used for COPD, caffeine affects drug, never IVP

adenosine

used for antiarrhythmias

atropine

used for bradycardia

Etomidate

used for intubation

t-piece trial

used for short period of intubation - 2 days

bronchodilators

used to open up airway

Dobutamine

used to raise blood pressure

algoria

vague response

if pt has low BP what anesthetic should be used

versed, instead of propofol

voice quality of partial/hemi laryngectomy

voice returns after 2-3 days, can have a normal convo

assist/control vent

pt triggers, but vent is in control

when can PEEP not be used

pts with highly compliant lungs - COPD, hypovolemia, low cardiac output

nutrition for intubated pts

pulmocare and nutrivent used with J tube for less risk of aspiration

how quickly does supraglottic cancer metastasize

rapidly

biome-fome cuff

red port ALWAYS left open

statins

reduce risk of heart attack/stroke

vasodilators

reduces blood pressure

Cluster A personality disorders (odd/eccentric)

paranoid, schizoid, schizotypal

benefit of PEEP

prevents atelectasis and reinflates collapsed alveoli

Side effects of fibrinolytic therapy

Bleeding, bruising, pulmonary edema, arterial embolism, DVT

What do ARBs treat?

Block the action of angiotensin II, pharmacologic effect is similar to ACE's

how many seconds is a big EKG box

0.20

Side effects of digoxin

Bradycardia, anorexia, n/v, fatigue, ARRHYTHMIAS

beta-blockers

-olol used to decrease HR and arrhythmias

calcium channel blockers

-pine used for hypertension and arrhythmias

ACE inhibitors

-pril used for hypertension

how many seconds is a little EKG box

0.04

normal QRS interval

0.06 - 0.10 sec 1 1/2- 3 small boxes

normal PR interval

0.12-0.20 seconds (3-5 small boxes)

PVC t/x

1 - monitor symptomic/more than 1 - beta blockers, antiarrhythmics

supraglottic laryngectomy

1 week temp trach, tube feeding 2-3 weeks

A client who had an MI asks the nurse why he is receiving morphine. Which benefits of morphine should the nurse explain to this client? (SELECT ALL THAT APPLY). 1.) Sedation 2.) Pain relief 3.) Diminished anxiety 4.) ↓ myocardial oxygen demand 5.) Vasoconstriction of peripheral vessels 6.) ↑ urinary output

1, 2, 3, 4. Morphine is to ↓ pain, myocardial O2 demand, and anxiety while causing sedation. Vasodilation and urinary retention are associated with the administration of morphine.

The nurse is caring for a patient with a digoxin level of 2.3 ng/dl. What symptoms should the nurse expect? (SELECT ALL THAT APPLY). 1.) Nausea 2.) Drowsiness 3.) Photophobia 4.) ↑ appetite 5.) ↑ energy level 6.) Seeing halos around bright objects.

1, 2, 3, 6. Digoxin is a cardiac glycoside used to manage & Tx heart failure. The therapeutic range is 0.8 ng/dl - 2.0 ng/dl. Signs of toxicity are GI disturbances, neurological abnormalities, facial pain, personality changes, and visual disturbances.

The nurse admits a client with a diagnosis of chronic adrenal insufficiency. Which assessment findings confirm this diagnosis? (SELECT ALL THAT APPLY). 1.) Hyponatremia 2.) Hyperkalemia 3.) Hyperglycemia 4.) Hypercalcemia 5.) Hypocalcemia

1, 2, 4. Adrenal insufficiency is manifested by hyponatremia, hyperkalemia, hypoglycemia, and hypercalcemia. BUN is generally increased.

A client is started on steroid therapy after an adrenalectomy. Which information is MOST important to share with this client? (SELECT ALL THAT APPLY) 1.) Take the prescribed dose daily, and do not miss a dose 2.) Notify your healthcare provider if you experience increased urination 3.) Discontinue steroid therapy after two weeks 4.) Take this medication for the rest of your life 5.) Take two doses if you miss a dose

1, 2, 4. Steroid therapy following an adrenalectomy will continue for the rest of the client's life. It is important to take the dose daily, and not miss a dose. The client should be warned about the potential side effects such as hyperglycemia, which could manifest as symptoms such as increased urination. Clients should take the medication as soon as they remember missed dose, but not double the dose the next day.

Which statements are true regarding lung cancer tumor staging? (Select all that apply) 1.) Staging describes the severity of the cancer 2.) Staging helps the health care provider plan appropriate treatment 3.) Staging systems don't change over time 4.) Surgical biopsy with cytologic cell examination is the only data collection method used to perform staging 5.) Staging helps to determine whether the cancer has spread to distant areas of the body

1, 2, 5, staging describes the extent and severity of the cancer, and helps the health care provider determine the most appropriate therapy. Staging systems continue to improve as cancer is better understood. Multiple data collections methods such as laboratory results, physical examinations, and imaging results are used to determine the stage of cancer.

The nurse is admitting a client suspected of having Addison's disease. An initial serum chemistry test is done. What findings should the nurse expect to find? 1.) Hyponatremia and Hyperkalemia 2.) Hypernatremia and Hypokalemia 3.) Hyperglycemia and Hypernatremia 4.) Hypercalcemia and Hyperglycemia

1, Addison's disease is characterized by hyponatremia, hyperkalemia, hypoglycemia. Serum calcium is is not usually affected to a significant degree.

preicteric phase

1-3 weeks before jaundice, GI symptoms, anorexia, n/v, mild RUQ pain

Which condition would place a client at the greatest risk for cardiogenic shock? 1.) Acute MI 2.) CAD 3.) Decreased Hgb level 4.) Hypotension

1. 15% of clients with Acute MI will also experience cardiogenic shock. CAD causes MI. Decreased Hgb level is a result of bleeding. Hypotension is a result of reduced CO from cardiogenic shock.

Which class of drug is most commonly prescribed to increase CO? 1.) Beta-adrenergic agonist 2.) Angiotensin-converting enzyme inhibitor 3.) Loop diuretic 4.) Beta blocker

1. A beta-adrenergic agonist such as dobutamine is a direct-acting inotropic agent that primarily increases CO. Angiotensin-converting enzyme inhibitor directly ↓BP, Loop diuretics don't have an effect on contractility or tissue perfusion. BB ↓HR & BP

The nurse is caring for a client admitted with Addisonian Crisis. Which outcome is the priority? 1.) Preventing irreversible shock 2.) Preventing infection 3.) Relieving anxiety 4.) Lowering blood pressure

1. A client with Addisonian crisis has an uncontrolled loss of Na in the urine, and impaired mineralocorticoid function, which results in loss of extracellular fluid, low blood volume, and possible irreversible shock. Infection is not a priority in this life threatening scenario. Relieving anxiety is appropriate for after the client has been stabilized. The Client would have hypotension with Addisonian crisis so we would not want to lower the blood pressure we want to raise it.

The nurse understands that the most common symptom in a client w/ AAA is? 1.) Abdominal pain 2.) Diaphoresis 3.) Headache 4.) Upper back pain

1. Abdominal pain in a client with an AAA results from the disruption of normal circulation in the abdominal region. Diaphoresis and headache are not associated with an AAA. Lower back pain usually signifies expansion & impending rupture of the aneurysm.

The nurse is caring for a client admitted with joint pain and weakness the client describes a gradual coarsening of facial features and enlargement of hands and feet over the past year what assessment is appropriate for this client? 1.) Growth hormone levels 2.) cortisol levels 3.) Thyroid hormones 4.) insulin levels

1. Acromegaly is marked by the coarsening of facial features and soft tissue and swelling of hands and feet. The cause is overproduction of growth hormones. cortisol levels are increased in Cushing syndrome which causes thin extremities truffle obesity and moon face. Thyroid hormones are not related to these symptoms. Insulin changes do not produce this client's symptoms.

What should the nurse assess in a female client with anterior pituitary hypofunction? 1.) Date of last menstrual period 2.) weight gain 3.) changes in urinary output 4.) chest pain

1. Amenorrhea is a sign of decreased FSH which is one of the anterior pituitary hormones. Weight gain is associated with Cushing's syndrome. Urinary output is related to posterior pituitary function. And chest pain is not related to hormone levels.

A client who was involved in an MVA is admitted to the hospital with the diagnosis of pneumothorax. A chest tube is inserted and attached to chest drainage system. The nurse notes almost constant bubbling the water seal chamber. Converse is aware that the bubbling is most likely the result of: 1.) Air leaks 2.) Adequate suction 3.) Inadequate suction 4.) Kinked chest tubes

1. Bubbling in the water seal Chamber of a chest drainage system stems from an air leak. In pneumothorax, an air leak can occur as air is pulled from the pleural space. Bubbling doesn't normally occur with either adequate or inadequate suction. Kinked chest tube can stop the suction and any pre-existing bubbling in the water seal chamber.

With a client diagnosed with Cushing's syndrome what is the priority nursing assessment? 1.) Serum Glucose 2.) Daily wt. 3.) Urinary output 4.) Abdominal girth

1. Cushing's syndrome results in an ↑ secretion of of cortisol from the adrenal cortex. Glucose metabolism is profoundly affected by hypercortisolism.

The nurse is admitting a client newly diagnosed with Cushing's syndrome. The nurse expects to find what S/Sx in the initial assessment? 1.) "Moon face" & truncal obesity 2.) Wt. loss & heat intolerance 3.) Changes in skin texture & low body heat 4.) Polyuria & dehydration

1. Overproduction of adrenocortical hormone results in redistribution of fat, resulting in the manifestations of "moon face", truncal Obesity, "buffalo hump".

A nurse reinforces the teaching plan for a client who has recently been diagnosed with squamous cell carcinoma of the left lung. What is the most appropriate information for the nurse to give this client? 1.) you have a slow growing cancer that rarely spreads 2.) in terms of prognosis you may only have a few months to live 3.) squamous cell cancer is very rapid growing cancer 4.) the cancer has generally metastasized by the time diagnosis is made

1. squamous cell carcinoma is a slow growing rarely metastasizing type of cancer. It has the most optimistic prognosis of all lung cancer types.

OCD t/x meds

1. SSRI (fluvoamine) 2. SNRI (venlafaxine) 3. second gen antipsychotic (risperidone, olanzepine)

While palpating a client's abdomen, the nurse notes a pulsating abdominal mass. How should the nurse interpret this assessment? 1.) Abdominal aortic aneurysm 2.) Enlarged spleen 3.) Gastric distention 4.) Gastritis

1. The presence of a pulsating mass in the abdomen is an abnormal finding, and usually indicates an outpouching in a weakened vessel. However, can be a normal finding on a thin person. Enlarged spleen, Gastric distention, Gastritis do not cause pulsation.

The nurse notes an order to change the client's chest drainage system from suction to gravity drainage. What is the most appropriate action by the nurse? 1.) Detached to from the suction port to provide a vent 2.) Clamp the client's drainage tube 3.) Question the health care provider's order 4.) Turn off the suction source and leave the tubing connected

1. When the suction source is turned off, the drainage system should be open to the atmosphere so intrapleural air can escape from the system. Detaching the tube from the suction port provides an exit vent for air and reduces the risk of tension pneumothorax.

general adaptive system (GAS)

1. alarm 2. resistance 3. exhaustion

A client who underwent femoral-popliteal bypass surgery, is scheduled to return from the PAC unit. Which staff member should receive this client? 1.) RN w/ 1 year of experience 2.) LPN w/ 5 years of experience 3.) Nursing assistant w/ 15 years of experience 4.) Charge nurse w/ 10 years of experience

1. this is because the client requires, frequent neurovascular assessments, so a RN should receive them. AN LPN does not have the education to complete this action. The Nursing assistant does not have the necessary assessment skills. The Charge needs to be able to direct the care of other pts.

cardiac workup

EKG, locate ischemia, echo, cardiac enzymes, cardiac cath

A client with pneumonia is ordered azithromycin 500mg IV daily. The medication is premixed by the pharmacy in a 50ml bag of solution to be infused over 30min. The IV delivers at 15gtts/ml. What drip rate should the infusion pump be set at? (Round to a whole number) _____________gtts/min

15gtts 50ml -------- X --------- = 25gtts/min 1 ml 30min

The nurse is assessing a patient with substernal chest pain. Which symptoms reported support a Dx of stable angina pectoris rather than a possible MI? (SELECT ALL THAT APPLY) 1.) "The pain began while I was watching tv." 2.) "The pain goes up and down my left arm." 3.) "The pain lasts less than 5 minutes." 4.) "The pain started when I ate breakfast and continued all morning." 5.)" One nitroglycerine relieved the pain."

2, 3, 5. Stable angina pectoris is a temporary imbalance of supply and demand of oxygen for cardiac muscle. Substernal pain may radiate to the arm, it is precipitated by stress, is relieved by rest or nitroglycerine and lasts 2-5 minutes

A client is experiencing the classic S/Sx of acute coronary artery disease. What is the nurse's priority intervention? 1.) Remain with the client to reduce anxiety 2.) Apply supplemental oxygen 3.) Administer sublingual nitroglycerine 4.) Educate the client about his symptoms

2, Enhancing myocardial oxygenation is the priority when a client exhibits S/Sx of cardiac compromise. Without adequate oxygen, the myocardium suffers damage.

Which potential complication should the nurse instruct a client with Cushing's syndrome about? 1.) Dehydration 2.) Infections 3.) Breathing difficulty 4.) Acute pain

2, High levels of corticosteroids cause reduced inflammatory and immune response., putting the client at an increased risk of infections. Na & H2O is retained with Cushing's syndrome resulting in fluid overload. Breathing difficulty & Acute pain are not generally associated with Cushing's syndrome.

Which findings should the nurse expect to find in a patient with Addison's disease? 1.) Weight gain & loss of skin pigment 2.) Fatigue & muscle weakness 3.) Hypertension & hyponatremia 4.) Increased appetite & hypokalemia

2, Manifestations of adrenal insufficiency or Addison's disease include fatigue, muscle weakness, weight loss, hyperpigmentation, hyperkalemia, hyponatremia, decreased appetite and hypotension.

Central Venous Pressure (CVP)

2-6 mmHg norm

icteric phase

2-6 weeks, jaundice, increased RUQ pain, pruritus, brown foamy urine, light brown stool, assess sclera and skin

When auscultating the abdomen of a client with an AAA, the nurse hears a bruit. How should the nurse interpret this finding? 1.) Normal finding 2.) Reflects a partial arterial occlusion 3.) Indicates a collection of fluid in the lungs 4.) Shows an inflammation of the pericardial surface

2. A bruit is a vascular sound that reflects partial arterial occlusion. This is not a normal finding. Fluid in the lungs is called crackles. Inflammation of the pericardial surface causes friction rub.

A client is at risk of developing cardiogenic shock. Which is a presenting symptom of this condition? 1.) ↓ HR 2.) ↓ Cardiac index 3.) ↓ BP 4.) ↓ Cerebral blood flow

2. A client's Cardiac index is used to identify if their CO is meeting the client's needs. Cardiac index, BP, and Cerebral blood flow are less useful in determining the risk of cardiogenic shock.

A nurse teaches a client with acute coronary syndrome about coronary blood flow. Which statement, made by the nurse is correct? 1.) Most of the blood flow to the coronary arteries is supplied during inspiration 2.) Most of the blood to the coronary arteries is supplied during diastole 3.) Blood flow to the coronary arteries is related to breathing patterns 4.) coronary arteries receive most of their blood flow from systole

2. Although the coronary arteries receive a minute portion of blood from systole, most of the blood flow is supplied to the coronary arteries during diastole.

A client is scheduled for testing to Dx an AAA. What is the most definitive test for this condition? 1.) Abdominal x-ray 2.) Aortogram 3.) CT scan 4.) Ultrasound

2. An aortogram accurately and directly depicts the vasculature, and clearly delineates the vessels and abnormalities. An X-ray will only show the AAA if it is calcified. CT scan and ultrasound don't give a direct view of the vessels therefor don't yield as an accurate Dx.

The nurse is performing an admission assessment with an AAA. For which comorbidity should the nurse assess? 1.) Diabetes Mellitus 2.) HTN 3.) Peripheral vascular disease 4.) Syphilis

2. HTN causes continuous pressure on vessel wall --> weakened walls --> an aneurysm. DM is not directly related. Peripheral vascular disease is loosely linked to aneurysms. Only 1% of clients with syphilis experience an aneurysm.

The nurse is caring for client with DI. What is the nurse's priority intervention? 1.) Watching for signs and symptoms of septic shock 2.) Maintaining adequate hydration 3.) Checking weight every three days 4.) Monitoring urine for specific gravity over 1.030

2. Maintaining fluid intake is essential and the client with DI. The client is at risk for developing hypovolemic shock because of increased urine output. Weight should be measured daily to monitor fluid balance. Urine specific gravity should be monitored for low osmolarity generally less than 1.005, due to the body's inability to concentrate urine.

A client is involved in an MVA. Upon admission to the emergency department, the client's heart rate was 130 BPM, with shallow respirations of 32 breaths/min, a blood pressure of 90/60 mmHg. The breath sounds were diminished on the right side, and paradoxical chest wall movement appears on the right side. A chest X-ray reveals in pneumothorax with multiple rib fractures. What diagnosis would the nurse anticipate for this client? 1.) Tension Pneumothorax 2.) Flail chest 3.) Ruptured diaphragm 4.) Massive hemothorax

2. Next for bed fractures in paradoxical chest pain comment would confirm a diagnosis of flail chest. Diaphragm shift would have bowel sounds in the middle chest. Tension pneumothorax would have severe respiratory distress. A massive hemothorax would have signs and symptoms of shock.

The nurse is caring for a AAA Pre-Op client. The nurse understands that this client is most at risk for? 1.) HTN 2.) Aneurysm rupture 3.) Cardiac arrhythmias 4.) Diminished pedal pulses

2. Rupture of the aneurysm is a life-threatening emergency and is the greatest concern for this client. HTN should be avoided because it can ---> to rupture. Cardiac arrhythmias are not directly linked to an aneurysm. Diminished pedal pulses are a sign of poor circulation to the lower extremities, and are associated with an aneurysm but are not life-threatening.

The nurse assessing a client with an AAA is most concerned when the client presents with: 1.) Lower back pain, ↑BP, ↓ RBCs, ↑WBCs 2.) Severe lower back pain, ↓BP, ↓RBCs, ↑WBCs 3.) Severe lower back pain, ↓BP, ↓RBCs, ↓WBCs 4.) Intermittent lower back pain, ↓BP, ↓RBCs, ↑WBCs

2. Severe lower back pain indicates a rupture, secondary to pressure being applied within the abdominal cavity. When there is a rupture, the pain will continue until the rupture is fixed. BP & RBCs are decreased because from the blood loss d/t aneurysm rupture. WBCs increases because they migrate to the site of the injury.

The nurse is planning care for a patient with Addison's disease. What outcome is appropriate for the nurse to include in this patients care plan? 1.) Fluid intake of less than 1000ml a day 2.) Participating in daily relaxation techniques 3.) Ambulating in the hall 5-6 times per day 4.) Choosing low sodium foods

2. Stress can precipitate an Hypotensive crisis w/ a patient w/ Addison's disease. So therefore a client has to learn ways to identify and cope with stressors.

The nurse is preparing a client for chest tube insertion in the upper right chest. What is the priority role of the nurse? 1.) A nurse isn't required. 2.) Preparing the chest tube drainage system. 3.) Bringing the chest X-ray to the client's room. 4.) Inserting the chest tube

2. The nurse must anticipate that a drainage system will be required, and the system readied prior to chest tube for immediate connection following insertion. The chest X-ray need not be brought into the client's room. A train provider will insert the chest tube.

A patient who experienced an MI tells the nurse that he is fearful of dying. Which statement by the nurse will help to validate this patient's feelings? 1.) "Tell me more about your fear of dying." 2.) "It must be very frightening to be told that you have had an MI." 3.) "Facing death would certainly be a frightening experience for me." 4.) "Please be assured that we are doing everything possible to prevent you from dying."

2. The nurse should validate this patient's feelings by acknowledging his fear. This provides the patient with a sense of being understood, and demonstrates empathy.

Which information should the nurse include in the teaching plan of a patient diagnosed with Cushing's syndrome? 1.) ↑ dietary sodium 2.) Physical changes are disease related 3.) ↑ fluid intake is important 4.) Restrict dietary protein

2. The patient may have disturbed body image related to fat redistribution, "moon face", truncal Obesity, "buffalo hump", acne, striae, hirsutism. So explaining theses physical changes can help to address theses feelings. Patients w/ Cushing's syndrome should ↑ protein, ↓ sodium intake, and fluids are often restricted.

A client, scheduled to have a ventilation-perfusion scan, asks good nurse to explain the tests. The nurse tells the client that the test will help diagnose a pulmonary embolism and provide information about: 1.) Amount of pleural surface and oxygenation present 2.) Extent of occlusion in amount of perfusion loss 3.) Location and size of pulmonary embolism 4.) Presence of perfusion and atelectasis abnormalities

2. The ventilation perfusion scan will provide information on the extent of occlusion caused by the pulmonary embolism in the amount of column tissue involved in an area not refused. It does not address the amount of coral surface and oxygenation present, the size of pulmonary emboli, or the presence of perfusion and atelectasis abnormalities.

idoventricular rhythm

20-40 bpm

non sustained vtach

3 beats - 30 seconds

A client with reports of acute chest pain radiating down the left arm was admitted to the telemetry unit. Which lab studies should the nurse order to evaluate myocardial damage? (SELECT ALL THAT APPLY) 1.) Hgb & Hct 2.) Serum glucose 3.) Creatinine phosphokinase (CK-MB) 4.) Troponin T & troponin I 5.) Myoglobin 6.) BUN

3, 4, 5. Levels of CK-MB, troponin T, and troponin I rise because of cellular damage. Myoglobin elevation is an early indicator of myocardial damage.

A nurse is monitoring a client for manifestations of cardiac tamponade. Which finding would support this dx? (SELECT ALL THAT APPLY). 1.) Bradycardia 2.) Hypertension 3.) Restlessness 4.) Muffled heart sounds 5.) Widened pulse pressure 6.) Distended neck veins

3, 4, 6. Cardiac tamponade is a medical emergency. Symptoms of cardiac tamponade include elevated venous pressure, distended neck veins, Kussmaul's sign, hypotension, narrowed pulse pressure, tachycardia, dyspnea, anxiety, cyanosis of the lips & nails, and muffled heart sounds.

A client diagnosed with Addison's disease is concerned about dark areas of skin around his knees and elbows. The nurse's best response would be: 1.) "This finding is not related to Addison's disease. I will refer you to a dermatologist." 2.) "This skin change is related to your medication therapy, and should subside in a few weeks." 3.) "This is related to hormonal changes caused by Addison's disease." 4.) "This change is related to sun exposure and should not be a concern."

3, Addison's disease causes melanin stimulating hormone (MSH) levels to elevate as the pituitary gland is stimulated. This results in areas of increased pigmentation. There is no damage to the skin so therefore there is no reason to see a dermatologist.

Bradydysrhythmias

HR below 60

A client with a Hx of cardiac problems is concerned that he may incur a MI. What sign would alert the nurse that this client may be developing this acute condition? 1.) Hoarseness 2.) Pink, foamy sputum 3.) Indigestion 4.) Swelling of the feet and ankles

3. A sensation, often described as heartburn, is commonly associated with an impending MI.

A client, scheduled for a pneumonectomy asked the nurse how the thoracic cavity will be filled. What is the nurse's best response: 1.) The space remains filled with air only 2.) The surgeon fills the space with a gel 3.) Serous fluid fills the space and consolidate the region 4.) The lung tissue from the remaining lung grows in this space

3. And then immediate postoperative period air and serous fluid fill the space. Eventually the area consolidates, preventing extensive mediastinal shift of the heart and remaining lung. Air can't be left in the space. There's gel that can be placed in the pleural space. The tissue from the other lung can't cross the mediastinum, although it temporary mediastinal shift exists until the space is filled.

A client who is 48hr post MI is most at risk for developing? 1.) Cardiogenic shock 2.) Heart failure 3.) Arrhythmias 4.) Pericarditis

3. Arrhythmias, caused by oxygen deprivation to the myocardium, is the most common complication of MI.

A client with an AAA is admitted to a step-down unit. The nurse should intervene Immediately if this client experiences: 1.) A migraine-like headache 2.) Cramping in the legs 3.) Sudden, severe back pain 4.) Diaphoresis

3. If expansion and impending of an AAA is suspected, the nurse should assess for acute & severe pain in the back or lower abdomen, which may radiate to the groin. No other options indicate a change in client's status.

The nurse is asking auscultating the lungs of a client following chest tube insertion. What assessment finding would indicate correct chest tube placement? 1.) Bronchial sounds heard at both bases 2.) Vesicular sounds heard over the upper lung fields 3.) Bronchovesicular sounds heard over both lung fields 4.) Crackles heard on the affected side

3. If the tube is inserted correctly, normal bronchovesicular breath sounds should be heard in the client's oxygenation status should improve. A chest X-ray should be done to ensure re-expansion and all other sounds are abnormal.

A client's BP is 126/80mmHg. How would the nurse interpret this client's MAP and organ perfusion? 1.) Organs are in danger of ischemia and perfusion pressure is critically low 2.) Organs are at risk of insufficient perfusion and perfusion pressure is borderline low 3.) Perfusion pressure is adequate to meet organs' perfusion needs 4.) Perfusion pressure minimally meets the organ's

3. MAP= 126mmHg + 2(80 mmHg) ----------------------------- 3 286mmHg ----------- = 95mmHg 3 Normal MAP is 70-110, therefore the organs are being adequately perfused

The nurse is educating a patient about the long-term management of CAD. What information should the nurse include? 1.) The need to have cardiac cath. done every year 2.) The use of coronary artery bypass surgery as a preventative measure 3.) Daily PO aspirin to prevent blood clots 4.) The need to have a percutaneous coronary intervention with routine cardiac cath.

3. PO aspirin would be the initial long-term Tx for CAD to prevent coronary blood clots.

A nurse is providing education to a patient with Addison's disease. What should be included in the nurse's teaching? 1.) Low-sodium diet 2.) Decrease fluid intake 3.) Wear a Medic-Alert bracelet 4.) Taking daily cortisone on an empty stomach

3. Patients with Addison's disease should wear an aler bracelet to inform health care providers of possible Addisonian crisis.

A nurse is caring for a client with hypovolemic shock. Which findings should the nurse expect to assess? 1.) BP 132/85, HR 116, Urinary Output of 45ml/hr, and warm skin 2.) BP 149/92, HR 59, Urinary Output of 57ml/hr, and cold skin 3.) BP 87/58, HR 123, Urinary Output of 20ml/hr, and clammy skin 4.) BP 91/62, HR 99, Urinary Output of 35ml/hr, and pale skin

3. S/Sx of hypovolemic shock would include altered LOC, oliguria, hypotension, tachycardia, tachypnea, cool, pale, and clammy skin.

The nurse is assessing the abdomen of a client with a possible abdominal aneurysm. Where should the nurse palpate to determine this condition? 1.) Right upper quadrant 2.) Directly over the umbilicus 3.) Middle lower abdomen to the left of the midline 4.) Middle lower abdomen to the right of the midline

3. The aorta lies directly left of the umbilicus therefore, the rest of the locations are inappropriate for palpation.

The nurse anticipates that the priority Tx for a client with a spontaneous pneumothorax is: 1.) Antibiotics 2.) Bronchodilators 3.) Chest tube insertion 4.) Hyperbaric chamber

3. The only way to re expand a lung is to place a chest tube so air in the pleural space can be removed in the long re expanded. And I biotics and bronchodilators would have no effect on lung reexpansion, nor would placing the client in a hyperbaric chamber.

A client's ABG results are pH: 7.16, PaCO2: 80mmHg, HCO3: 24 mEq/L, and SaO2: 81%. Based on these values this client is showing signs of? 1.) Metabolic Acidosis 2.) Metabolic Alkalosis 3.) Respiratory Acidosis 4.) Respiratory Alkalosis

3. pH= Acid 7.35-7.45 Alk PaCO2 = Alk 35-45 Acid HCO3 = Acid 22-26 Alk SaO2= 80-100

A client tells the nurse that his chest tube has been accidentally. What is the most appropriate action by the nurse? 1.) position the client on the left side 2.) Position the client on the right side 3.) Apply in occlusive dressing over the site 4.) Reinsert the chest tube that fell out

3. to prevent this client from sucking air into the pleural space and causing a pneumothorax and occlusive dressing should be applied over the hole. The health care provider should be called, and the client checked for signs of respiratory distress. Positioning the client on either the left or right side won't make a difference. The old tube should not be reinserted because it's not sterile.

A client w/ symptoms of acute asthma is ordered IV aminophylline 350mg in 100ml to be administered over 30min. The nurse has vials of the medications are labeled 250mg/5ml. How many ml of fluid was the ordered dose? (Round to a whole number) ________ml

350mg 5ml -------- X --------- = 7ml 1 250mg

What is an appropriate treatment measure for a client with Addisonian Crisis? 1.) IV fluid replacement 2.) IV corticosteroids 3.) Blood glucose management 4.) All and the above

4, All of these answers are first-line treatment measures during Addisonian Crisis

A client with SOB has decreased to absent breath sounds from the apex to the base of the lung on the right side. How would the nurse interpret this finding? 1.) Acute asthma 2.) Chronic bronchitis 3.) Pneumonia 4.) Spontaneous pneumothorax

4. A Spontaneous pneumothorax occurs when the client's lung collapses causing an acute decrease in lung function. A sudden collapse will cause chest pain and SOB. Wheezes will be heard with asthma. Ronchi will be heard with bronchitis. Pneumonia will have bronchial breath sounds.

A nurse is planning care of a client with cardiogenic shock. What is the priority outcome for this client? 1.) Correct hypoxia 2.) Prevent infraction 3.) Correct metabolic acidosis 4.) Increase myocardial O2 supply

4. A balance between O2 supply and demand must be maintained. The demand for O2 increases during shock therefore requiring more oxygen. Without more O2 the effects of shock will increase. Increasing O2 will correct metabolic acidosis, and hypoxia. Infraction normally causes the shock state, therefore preventing isn't appropriate.

The nurse is caring for a post operative client who has undergone surgical removal of the pituitary gland and has now developed diabetes insipidus. The nurse should assess for: 1.) hypertension and bradycardia 2.) Glucosuria and weight gain 3.) Fluid overload and hyponatremia 4.) Severe dehydration and hypernatremia

4. A client with diabetes insipidus excretes high volumes of urine, even without fluid replacement. Limiting fluid intake will cause severe dehydration and hypernatremia. A client undergoing a fluid deprivation test may experience tachycardia and hypotension. Weight loss, and normal urine glucose levels are common in client w/ DI. Fluid overload and hypernatremia are signs and of syndrome inappropriate antidiuretic hormone (SIADH).

The nurse is assessing a client that was given an opioid analgesic. What ABG value would indicate that this client is at risk for respiratory failure. 1.) PaCO2 15 mmHg 2.) PaCO2 30 mmHg 3.) PaCO2 40 mmHg 4.) PaCO2 80 mmHg

4. An ABG of 80 mmHg would indicate retained CO2. To have Respiratory arrest there is an inefficient ventilation and the retention of CO2.

A patient was just admitted to the ED for evaluation of a possible MI. Which diagnostic intervention would be the nurse's priority intervention? 1.) Cardiac catheterization 2.) Cardiac enzymes 3.) Echocardiogram 4.) Electrocardiogram (ECG)

4. An ECG is the quickest, most accurate, and most widely used tool to determine the location of MI.

The nurse is aware that a client with Cushing's syndrome is at risk for: 1.) Hypoglycemia& dehydration 2.) Hypotension & hyperkalemia & hyperglycemia 3.) Hyponatremia & dehydration 4.) Hypertension & heart failure

4. An ↑ mineralocorticoid activity w/ Cushing's syndrome results in a retention of NA & H2O, which commonly contributes to HTN and heart failure.

A nurse is teaching a client about lung cancer. The nurse determines that teaching was effective when the client states that which is the primary cause of lung cancer? 1.) genetics 2.) occupational exposures 3.) pipe smoking 4.) cigarette smoking

4. As many as 90% of clients feeling sated with one cancer smoke cigarettes. Cigarette smoke contains several organ-specific carcinogens. There may be a genetic predisposition for the development of lung cancer. Occupational hazards, such as pollutants, can cause cancer. Pipe smokers inhale less often than cigarette smokers and 10 to develop cancers of the lip and mouth.

A nurse is caring for a client diagnosed with diabetes insipidus. Which laboratory value is the most important for the nurse to monitor? 1.) Glucose 2.) Hemoglobin 3.) Creatinine 4.) Sodium

4. Diabetes insipidus occurs as a result of decreased release of ADH, which disturbs fluid and electrolyte balance, especially sodium. Twice daily posting Meyer for hypernatremia

A client receives midazolam, 2mg IV, as sedation before bronchoscopy. 5 minutes after administration his respiratory rate drops to 4 breaths/minute. What is the nurse's most appropriate action? 1.) Administer naloxone 2.) Administer protamine sulfate 3.) Administer phentolamine 4.) Administer flumazenil

4. Flumazenil reverses the effects of benzodiazepines such as midazolam. Naloxone is used to reverse opioids such as morphine. Protamine sulfate reverses the effects of heparin. Vital told me is injected into the tissues to reverse the damage effects of dopamine infiltration.

The nurse is caring for a client who has had a chest tube inserted for the treatment of pneumothorax. Which assessment finding best indicates to the nurse that the chest tube is no longer needed? 1.) There's minimal damage from the chest tube 2.) ABG results are within normal range 3.) the client states he is not experiencing dyspnea 4.) no fluctuation in the water seal chamber occurs when no suction is applied

4. One indication of lung re-expansion is the cessation of fluctuation in the water seal chamber when suction isn't applied. Drainage should be minimal before chest tube is removed. An ABG analysis may be done to ensure proper oxygenation but isn't necessary if other clinical assessment criteria are met. A chest tube isn't removed until the client's lung has adequately free expanded and remains expanded.

A client's ABG analysis reveals a pH: 7.81, PaCO2: 73mmHg, PaO2 of 82mmHg, HCO3 of 24 mEq/L. How would the nurse interpret these values? 1.) Metabolic acidosis 2.) respiratory alkalosis 3.) metabolic alkalosis 4.) respiratory acidosis

4. pH= Acid 7.35-7.45 Alk PaCO2 = Alk 35-45 Acid HCO3 = Acid 22-26 Alk SaO2= 80-100

What is the nurse's most important tool for monitoring the severity of the shock state? 1.) ART line 2.) Indwelling urinary catheter 3.) ECG monitor 4.) Pulmonary artery catheter

4. Pulmonary artery catheter will give accurate pressure measurements within the heart, that help determine the course of Tx. ART line, Indwelling urinary catheter, and ECG monitor will provide valuable information related to the shock state but aren't the most important tools.

A nurse is obtaining assessment data from a client with possible lung cancer. The nurse is most concerned if the client exhibits which symptom? 1.) Dizziness 2.) generalized weakness 3.) hypotension 4.) recurrent plural effusions

4. Recurring episodes of pleural effusions can be caused by a tumor and should be investigated. Dizziness, generalized weakness, and hypotension art typically considered warning signs, but may occur in advanced stages of cancer.

A nurse is caring for a client who has just returned to the unit following a lobectomy here during assessment, the nurse is aware that the lobectomy site: 1.) remains empty. 2.) Is filled with gel by the surgeon 3.) Is filled with serous fluid 4.) Is filled by overexpansion of the remaining lobes

4. The remaining load or lobes over expand slightly to fill the space previously occupied by the tissue that has been remove. The diaphragm is carried higher on the operative side to further reduce the empty space. The surgeon doesn't use gel to fill the space. Serous fluid overproduction would compress the remaining lobes and diminish their function possibly causing a mediastinal shift.

A client, diagnosed with a large benign lung tumor asked the nurse how it will be treated. What is the nurse's best response: 1.) The tumor is treated with only radiation therapy 2.) The tumor is treated with chemotherapy only 3.) The tumor is left alone unless symptoms are present 4.) The tumor is removed with the least possible amount of tissue

4. The tumor is removed to prevent further compression of lung tissue as the benign tumor grows. If the tumor can't be removed, then radiation or chemotherapy may be used to reduce the size of the growth.

Following a motor vehicle collision, a client has a chest tube inserted in the left upper chest. The two begins to drain dark red fluid. What does the nurse determine? 1.) The chest tube was inserted improperly 2.) This is an expected result for this client 3.) An artery was nicked when the chest tube was placed 4.) The client is experiencing a hemothorax

4. This client has a hemothorax, in which blood collection causes a lung to collapse. The placement of a chest tube will drain blood from the space and re expand the lung. And intercostal artery can be next during chest tube insertion, but the risk is minimal if the provider placing the tube is specifically trained. The initial chest X-ray would confirm the presence of blood, or air in the pleural space.

A client displays signs associated with a possible aneurysm rupture. What is the priority nursing intervention? 1.) Administer prescribed Antihypertensives 2.) Prepare the client for an aortogram 3.) Administered Beta-adrenergic blockers 4.) Prepare client for surgical intervention

4. When the vessel ruptures, prompt surgery is required for its repair. Antihypertensives & Beta-adrenergic Blockers can help prevent aneurysm rupture by controlling HTN. An aortogram is used for the Dx of an aneurysm.

The nurse is admitting a client newly diagnosed with Cushing's syndrome. What Lab values would the nurse expect to find? 1.) ↓ sodium & ↓ glucose 2.) ↓ cortisol & ↓ glucose 3.) ↑ cortisol & ↓ sodium 4.) ↑ cortisol & ↑ sodium

4. ↑ glucose, sodium, and cortisol are found with patients who have Cushing's syndrome.

The nurse is assessing a client who is displaying the earliest sign of shock. What is the finding that the nurse would report? 1.) Cyanosis 2.) ↓ Urine output 3.) Heart sound present at S4 4.) Altered LOC

4. ↓ CO --> ↓ cerebral blood flow --> restlessness, agitation, confusion. Cyanosis, S4 heart sound, and ↓ urinary output are all later signs of shock.

Junctional Rhythm

40-60 bpm - no p wave or inverted

major depressive disorder s/s

5 or more symptoms within 2 week period - inability to problem solve, weight change, sleep change, eating change

how long should you wait between switching antidepressants and why

5-6 weeks to wash out, can cause serotonin syndrome

normal ejection fraction

50-70%

hep c

90-95% blood transfusions, no vax, liver cancer, cirrhosis

Side effects of fibrates

Abdominal pain, headache, nausea, constipation, CK elevates, abnormal LFT's

How to administer loop diuretics

Administer furosemide IVP slowly and watch for signs of ototoxicity. Do not admin concurrently with aminoglycoside antibiotics

Examples of potassium sparing diuretics

Amiloride, spironolactone, triamterene

Examples of calcium channel blockers that lower blood pressure only

Amlodipine, felodipine, isradipine, nicardipine, nifedipine

What do beta blockers do in relation to blood pressure in heart rate?

Beta blockers lower BOTH blood pressure and heart rate

amiodarone

Antiarrhythmic

lidocaine

Antiarrhythmic

pt can not do what with total laryngectomy

CAN NOT TALK

asystole t/x

CPR, IV/IO, epi 1 mg every 3-5 min, H&T's

Examples of bile acid sequestrants

Cholestyramine, colestipol, colesevelam

Side effects of calcium channel blockers

Constipation, dizziness, palpitations, fatigue, headache, nausea, rash, flushing, swelling in feet and lower legs

self soothing behaviors

Dermatillomania (skin-picking) Onychophagia (nail biting) Trichotillomania (hair pulling)

maturational crisis

Developmental events requiring role change - wedding, birth, retirement

Examples of positive inotropes

Digoxin

Cardiac Glycosides

Digoxin increase force of the heart

Examples of calcium channel blockers that lower blood pressure and heart rate

Diltiazem and verapamil

Side effects of nitrates

Dizziness, headache, flushing/redness of face and neck, n/v, hypotension, arrhythmia

Parameters for digoxin

Do not give if hr is below 60

Side effects of ARB's

Dry cough, dizziness, fatigue, upset stomach, headache, edema, diarrhea

Side effects of ACE inhibitors

Dry cough, dizziness, headache, fatigue, stomach upset, angioedema

Side effects of beta blockers

Fatigue, weight gain, cold hands and feet, dizziness, depression, nausea, hypotension, trouble sleeping

Example of fibrates

Fenofibrate

Side effects of nicotinic acid

Flushing/redness of the skin on the face and neck, itching, headache, dizziness, diarrhea

Side effects of thiazide diuretics

Frequent urination, diarrhea, loss of appetite, headache, hair loss, muscle spasms, constipation

Examples of loop diuretics

Furosemide, torsemide, ethacrynic acid, bumetanide

vtach

HR 170 or higher

Side effects of potassium sparing diuretics

Headache, heartburn, loss of appetite, n/v, diarrhea

Side effects of bile acid sequestrants

Heartburn, gas and bloating, diarrhea, nausea, muscle aches and pain

Examples of thiazide diuretics

Hydrochlorothiazide, metolazone chlorothiazide

What do statins treat?

Hypercholesterolemia and hypertriglyceridemia. prevention of heart attacks and strokes.

H & T's

Hypovolemia Hypoxia Hypo/Hyperkalemia Hypothermia Hydrogen Ion (acidosis) Toxin Tamponade Tension pneumo Thrombosis

Use of positive inotropes

Increase contractility of the heart

Malingering Disorder

Intentionally pretending to be sick or injured to avoid work or responsibility

What do ACE inhibitors treat?

Interfere with production of angiotensin 2 resulting is vasodilation, reduced blood volume, and prevention of its effects in the heart and blood vessels. In HF they reduce afterload and improve cardiac output and renal blood flow.

Examples of ACE inhibitors

Lisinopril, captopril, benazepril, enalapril, ramipril

Fibrinolytic therapy

Medications are used to break us a clot that could be dangerous/life threatening.

Examples of beta blockers

Metoprolol, carvedilol, propranolol

What do bile acid sequestrants do?

Reduce LDL cholesterol levels. Prevents cardiac events.

total laryngectomy nutrition

NG tube (do not resinsert if misplace), oral feeding 10-14 days, thick fluids, good oral care, monitor weight, no swallowing

post op laryngoscope

NPO until gag reflex returns (1-2 hr), observe for resp difficulties, pain, swelling, apprehension, expectorating blood

pancreatitis diet

NPO, then clear, full, low fat, high CHO

crystalloid solutions

NS, LR, D5

Side effects of aspirin

Nausea, vomiting, stomach pain, heartburn

Examples of nitrates

Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate

Obessions vs Compulsions

Obsessions - intrusive, persistent uncontrollable thoughts, urges or images Compulsions- impulse to repeat certain behaviors or mental acts to avoid distress (what gives temp relief)

second degree heart block mobitz 1 wenckebach

P gets further and further from QRS

Use of aspirin

Platelet aggregation inhibitor, also can treat acute coronary syndrome, acute thromboembolic stroke

What do potassium sparing diuretics do?

Prevent sodium reabsorption, prevents excretion of potassium and decreased retention of water preventing hypokalemia. Used in the management and treatment of hypertension and HF

agnosia

inability to recognize objects

Administration of bile acid sequestrants

Take with meals, high fiber diet, and plenty of water.

What do fibrates treat?

They treat hypertriglyceridemia and hypercholesteremia by inhibiting triglyceride synthesis.

What do beta blockers treat?

Treat hypertension, angina, heart failure, and cardiovascular event prevention/protection.

What do calcium channel blockers treat?

Treat hypertension, heart failure, and angina by inhibiting calcium ion reflux into vascular smooth muscle and myocardium

What does nicotinic acid treat?

Treats hypercholesterolemia, hypertriglyceridemia, and high-density lipoprotein deficiency by activating the nicotinic acid receptor.

situational crisis

Unanticipated Death, divorce, termination of a job, illness

What do loop diuretics treat?

Used in the management and treatment of fluid overload conditions such as HF, nephrotic syndrome, or cirrhosis, and hypertension. Promote potassium excretio

What do thiazide diuretics treat

Used in the management and treatment of hypertension and heart failure. Promote potassium excretion

What do nitrates treat?

Vasodilator used to treat and manage angina and other cardiovascular diseases

Cluster C personality disorders (anxious, fearful)

avoidant, dependent, obsessive-compulsive

aphasia

inability to speak

conversion disorder risk factors

abuse, recent stressful event, female, comorbid psychiatric disorders

encephalopathy stage 3 stuporous

abusive when aroused, difficult to arouse, rigidity

delirium

acute, can be reversed, treat underlying cause - ativan and haldol to sedate if causing harm

what do you do if tube is occluded by pt bitting ET tube

add bite block

how to address hallucinations

address directly, do not agree, assess for paranoia

encephalopathy stage 2 impending

agitation, asterixis, fetor hepaticus (smell of old urine)

delirium tremors

alcohol withdraw, shaking, vomiting, increase pulse, sweating, AMS (need to be hospliatized), 24-48 hr peak after no alcohol

Etiology of acute pancreatitis

alcohol, cholecystitis (gallstones), post op complications

synchronized IMV

allows for spontaneous breathing by pt, but if pt fails, minimum # of breathes are given

what should be kept in sight with trach

ambu bag and mask

What labs increase with pancreatitis

amylase, lipase, WBC, bilirubin, glucose

Cluster B personality disorders (dramatic, emotional, erratic)

antisocial, borderline, histrionic, narcissistic

t/x generalized anxiety disorder

anxious longer than 6 months - buspirone, SSRI

5 p wave questions

are they there? occurring regularly? one p for every QRS? are they smooth, round, and upright? do they all look similar?

hep d

associated with hep b, HBIG vax, chronic hep, cirrhosis, fulminant hep

Examples of statins

atorvastatin, simvastatin, rosuvastatin, pravastatin, and lovastatin

serotonin syndrome s/s

autonomic instability, hypertension, diarrhea, agitation

if a pt needs mechanical ventilation, what must be used

cuffed tube

trouble breathing with sengstaken-blakemore

cut balloon ports and pull out

high amonia = what type of diet

decrease pts protein in diet

Neuroleptic Malignant Syndrome s/s

fever, muscle rigidity, AMS, autonomic dysfunction, seen after 1st dose or shortly after starting meds

Neuroleptic Malignant Syndrome

fever, muscle rigidity, altered mental status

panic anxiety

fight, flight, or freeze response; pupils dilate

communication with pt that have personality disorder

firm, supportive, limit setting, assertive

somatic disorder risk factors

first relative, decreased serotonin or endorphins, depressive personality or anxiety disorder, childhood trauma. abuse/neglect, female 16-25

negative symptoms (normal) schizophrenia

flat affect, algoria, anergia, anhedonia, avolition

alterations in speech - flight of ideas, neoglisms, echolalia

flight of ideas - each sentence is different neoglisms - made up words echolalia - repeating words

pulmonary edema

fluid in the lungs

BIG sign of suicide

giving their things away

s/s of pancreatitis

grey turners (flank bruise), cullings sign (belly bruise), 3rd spacing

positive symptoms (not normal) schizophrenia

hallucinations, delusions, altered speech, bizarre behavior

first generation antipsychotics for positive symptoms

haloperidol, prolixin, depot injection q4weeks

stable angina

happens on excertion, less than 10 min

s/s of panic disorder

have to have 4 or more, palpations, sweating, tremors, SOB, chest pain, nausea, sense of suffocation, dizziness, hot flashes, paresthesia, abdominal distress

rheumatic heart disease

heart disease caused by rheumatic fever (infection)

Digoxin use

heart failure, atrial fibrillation

Sodium Bicarbonate

heartburn, indigestion

bleeding s/s total laryngectomy

hemopytsis, neck swelling, expectoration of blood, excessive JP drainage

whats the risk of putting a pt on peep with highly compliant lungs

high risk of barotrauma (ruptured lung)

t/x of vessel erosion

hyper inflate cuff, prepare for surgery, check VS

hyperactive adrenal cortex

hyperfunction increased BS, NA, BP, WBC decreased potassium, Ca truncal obesity, thin extremities, osteoporosis, fat deposits, bruises, petechiae

addisons disease

hypofunction increase potassium low NA, BS, BP, Cl weight loss, body hair changes, weakness, dehydration

s/s of decreased CO

hypotension, fatigue/weakness, EKG changes, edema, dizziness, reduced urine output, cold clammy skin, AMS

apraxia

impaired motor functioning

Prolonged PT is associated with

impaired vitamin K

epinephrine

improve breathing, stimulate heart, raise BP

Anhedonia

inability to experience pleasure

digitalis

increase blood pressure

Fluid resuscitation

increase cardiac output and organ perfusion

pancreatitis complication -abscess s/s

increased WBC, fever,

how to keep airway clear with vents

increased secretions are normal when new, clean every shift, use fluids/humidification to keep secretions thin

isuprel

increases heart rate

endocarditis

inflammation of middle of heart, t/x antibiotics

Huntington's disease

inherited, dementia eventually

reward seeking behavior

kleptomania (stealing) oniomania (buying) hoarding pyromania (fire setting)

anergia

lack of energy

avolition

lack of motivation

encephalopathy t/x

lactulose, eliminate protein

what should be observe for with extubation

laryngeal spasms - wheezing

Post OP total Laryngectomy

laryngectomy tube, suctioning need, NG tube, avoid swallowing, deep breathing, avoid coughing

sustained vtach

lasting more than 30 seconds

post icteric phase

lasts 2-12 weeks, jaundice subsides, malaise and weakness continues for 9 month - 1 yr, stool, urine, appetite, labs improve

procaimade

life threatening arrhythmias

diagnosis of cirrhosis

liver function test, liver biopsy

first degree block

long PR interval

first sign of supraglottic cancer

lump in throat, pain/burning while drinking

bipolar 1

manic longer, not as depressed

epi

massage after, causes vasoconstriction leading to hypertensive crisis

electroconvulsive therapy (ECT) s/e

memory loss

nursing care hepititis

monitor possible bleeding - bruising, bleeding, check H&H

mild anxiety

motivates

Side effects of statins

muscle pain and damage, liver damage, increased blood sugar or diaberes, neurological side effects

what must be ready if succinylcholine is used

must be ready to intubate

third degree heart block

no P to QRS relationship

levophed

norepinephrine treat low blood pressure

encephalopathy stage 1 prodromal

normal LOC, periods of lethargy

medication considerations

older adults start with lowest dose, do not stop abruptly, follow up care if important

obturator

only used for insertion of trach

narcan

opioid reversal, IV most effective, last 2-5 min then pt can experience decreased resp again

cyclic antidepressant s/e

orthostatic hypotension and cardiac dysrhythmias

brady treatment

oxygen, atropine, pacing, dopamine, epi

t/x for MI

oxygen, nitrate, aspirin, morphine

Second Degree Heart Block (Mobitz II)

p wave but not QRS

etiology of cardiac tamponade

pericardial effusion, trauma, cardiac rupture, hemorrhage

moderate anxiety

physcial display

subglottic cancer

portion below vocal cords, mostly asymptomic until growth affects airway

lithium is dangerous for who

pregnant women, crosses placenta - stop when pregnant or breast feeding

IV antiplatelet drugs

prevent blood clots

treatment for pleasantly confused delirium pt

reorient if not causing harm

interventions major depressive disorder

repeat what they say as a question, ask direct questions, safety first

factitious disorder (munchausen)

report physcial or psychological s/s for attention

what can occur with underventiliation

resp acidosis

what can occur with overventiliation

resp alkalosis leading to low calcium and potassium producing cardiac arrhythmias and neuromuscular irritability

second gen antipsychotics t/x for postive and negative symptoms

risperidone, clozapine

cuffed trach tube

seals airway, prevents aspiration

t/x of anxiety

short term anxiolytics (xanax, valum, liprium, clonipine), cognitive behavorial therapy

ET tube movement

should be at lipline, if moved, can make diminished lung sounds - want chest xray, assess breath sounds

change occurring with radical neck dissection

shoulder droop

sodium channel blockers

slows HR

cirrhosis s/s

spider angiomas, testicular atrophy, gynecomastia, pectoral or axillary alopecia, palmar erhythema

portal hypotension

splenomegaly, esophageal varies, caput medusae, ascites

pulmonary prep

stop smoking, cough and deep breath, sternal splinting, incentive spirometry, explain ET tube and vent

done before cardiac surgery

stop smoking, treat infection, treat CHF, optimize renal function, blood sugar management, pulm function test, vascular mapping

tardive dyskinesia

tongue rolling, smacking tongue

Magnesium Sulfate

treat and prevent low magnesium

nitrates

treat angina

potassium channel blockers

treat antiarrhytmias

dopamine

treat low BP, low cardiac output, and improve kidney flow

Colloid solutions

treat patients with shock

tachy t/x

treat underlying cause

PAC t/x

treat underlying causes

risk factor anxiety

women, younger than 45, divorced or separated, poverty

chronic pancreatitis s/s

wt loss, n/v, anorexia, diarrhea, steattorrhea