NCLEX Review questions (Mark K)

What is the normal HR for a fetus?

-110-160 >>if lower, <110, then LION >>if higher, >160, document and take moms temp -low baseline variability is bad, want changes -late d-cells (HR slows near end of contraction) >>bad = LION -early d-cells (HR slow b/f contraction) - normal >>document it -variable d-cells (very bad, prolapsed core) >>push and position

When is the first time the fundus is palpable?

-12wks -this means if you're assessing a women and she says she's pregnant but you don't feel the fundus, she would be in the first trimester -fundus palpable at naval: 20-22wks **need to know this b/c the date of viability is 22-24wk (2nd tri) > > >aka if the fundus is NOT palpable above the fundus, then baby is not viable

How do you treat urinary incontinence during pregnancy and what trimester/s does it occur?

-1st and 3rd trimester >>baby is sitting on bladder -treat: void Q2 (until 6wks after delivery)

Nageles rule for calculating a due date

-1st day of the last menstrual period -Add 7 days -Subtract 3 months

Phenothiazines

-1st gen antipsychotics, Typical -all end in -zine -use: lg dose= antipsychotic, sm dose= antiemetic -action: decreae sympts, not a cure -major TRANQUILIZERS, "big guns" -use when nothing else works "we use -zines for the zany"

What trimester does morning sickness occur and how do we treat it?

-1st tri -give dry carbs b/f you get ut of bed

How often should a women come in for a doctor's visit during pregnancy?

-1x/month until 28th wk (into 3rd tri) -Every 2wks until wk 36 -every wk until delivery or at wk 42 = induction/c-section

If you have a laminectomy w/ fusion, how many incisions will the pt have?

-2, one at hip, one on spine -hip will have most pain -hip has most bleeding and drainage -both has risk of infection =hip is not great w/ healing, starting to use cadaver bones or synthetic **lam w/ fusion: takes a bone graft from iliac crest

How do you treat dyspnea during pregnancy and what trimester/s does it occur?

-2nd and 3rd tri -Tri-pod position (sit, lean forward, elbows on knees)

How do you treat back pain in pregnancy and what trimester/s does it occur?

-2nd and 3rd trimester -Pelvic tilt exercise

How much lochia an hour is normal?

-4-6ox in an hour -saturated in 15 min = excessive -rubra, serosa, alba

Describe the Active phase, in the first phase of labor

-5-7 cm dilated -Contractions are 3-5 min apart -Lasting 30-60 sec. -They are moderate

Describe the transitional phase, in the first phase of labor

-8-10 cm dilated -Contractions are 2-3 min apart -Lasting 60-90 seconds -They are strong

What is a delusion?

-A false fixed belief, idea or thought. -no sensory component. -If the question has "appear" in psych, it's a delusion

What is the treatment for superventricular arrythmias aka atrial arrythmias?

-A, B, C, D's -adnecard, adenosine -beta blockers -Ca+ channel blockers -digoxin

diabetes insipidus (DI)

-ADH is not secreted = loss of water -issue w/ the pituitary gland -s/x: polyuria, polydipsia = dehydration

Tx Protocol for Schizophrenia

-Obvious Foods. They are suspicious. If they are on antipsychotics, think FIBER. -Activity- With people to reinforce reality -Huge homicide/suicide risk. They are the biggest risk for other-direct violence

Warfarin

-PO only -takes 3-7 days to work -can take forever -antidote: vit K -contra in pregs

3 P's of nerve root compression (S/S) ?

-Pain -Paresis= muscle weakness -Parasthesia

What are the three types of delusions?

-Paranoid or Persecutory, -Grandiose -Somatic -Paranoid or Persecutory: False fixed belief that people are out to harm you (CIA, FBI). -Grandiose : False fixed belief that you are superior (God, the Pope). -Somatic: False fixed belief about a body part (X-ray vision).

Pathologic vs. Physiologic Jaundice

-Pathologic if occurs in 1st 24 hours of life, levels are increased by more than 5mg/dL/day and when the total serum bilirubin is 17mg/dL -Physiologic is occurance within 1st 3-4 days and resolves in 7-10 days

Lithium SE? (The 3 P's)

-Peeing -Pooping -Parasthesia **will not report these to a PCP, just make pt aware

A 3-6 yr old is in what Piaget stage?

-Pre-operational -Fantasy based, illogical, no reasoning -When: teach just before (morning of) -What: Teach what you are going to do -how:Learn through play

Patients that do NOT need interdisciplinary care

-Pt with multiple med surg diagnoses. Not the sickest or the most unstable people! Patients that do need interdisciplinary care = -Patients with multidimensional needs. For example, physical, intellectual, psychological, emotional, spiritual. >>or if they need rehab of any kind

After an amputation, for the first 24 hours, don't

-Put the leg under s pillow, might cause contractures

Treatment for low blood sugar in type I diabetes?

-Rapidly metabolizable carb (Juice, Pop, chewed candy) -or carb and protein/starch. -ideal combo of foods is sugar + starch/carb (MILK and peanut butter, or jam + crackers) If pt is unconscious: -NPO give Glucagon IM or -Dextrose IV. (home=glucagon, hosp= dextrose IV)

Erythema toxicum neonatorum is?

-Red papular rash on babys torso which is benign and disappears after a few day *normal

What do you teach patients taking phenothiazines to report?

-Report sore throat and any signs of infection. -Keep medicating, tell dr of SE -If toxic effect hold drug, tell dr

S/S of low blood sugar are?

-S/S of shock and being drunk... -clammy, weak -slurred speech, poor gait (staggering) -impaired judgement -delayed reaction time -liable emotions -low BP, tachycardia/tachypnea, cool, pale, clammy skin, mottled 1. Cerebral impairment (drunk) - slurred speech, judgement changes, staggering gait If it makes you look drunk, pick it. 2. Shock symptom = pale, cold, rapid + thready pulses, etc. **can cause brain damage -causes: too much insulin, not enough food, too much exercise

SE and route of aminoglycosides

-SE: ototoxic = hearing, tinnitus, vertigo/dizziness >>nephrotoxicity = watch creatinine (24hr clearance better indicator than serum creat) >>toxic to CN 8 (acoustic) -need to be given Q8 -IM or IV >>not absorbed if given PO -can give PO for hepatic encephalpathy and bowel surgery prep >>dissolves in gut and sterilizes it kill bacteria (including bacteria that create ammonia) -durgs for bowel prep are: >>neomycin and kanamycin "Who can sterilize my bowel? Neo Kan!"

What are the four types of functional psychosis?

-Schizophrenia -Schizoaffective disorder, -Major depression/mania (bipolar). (SCHIZO SCHIZO MAJOR MANIC) **these pts have the potential to learn reality -have normal jobs, chemicals just out of balance

clozapine

-Second-generation (atypical) antipsychotics -has zap (not zep like benzos) in it -use: sev. schitzophrenia -meant to replace the -zines and haldol >>doesn not have SE of A, B, C, D, E, F (can have some but very mild w/ the sympts) -disadvantage: SE of agranulocytosis >>traches bone marrow, decreases WBC's, increases infections

A 0-2 yr old is in what Paiget stage?

-Sensorimotor -When: total present thinking (no past or future) -What: Only teach what you do, while you do it -How: Tell them directly

Epsteins pearls are?

-Small,white epithelial cysts on babys gums. *normal

Patients taking Zoloft should NOT take what herb?

-St. John's wort -interaction = Serotonin Syndrome -SE: S-weating A-pprehension (sense of doom) D-izziness H-eadache

ONLY RN SCOPE (Don't delegate to LPN)

-Starting an IV -Hanging of mixing IV Meds -Evaluating IV Site or anything -Giving IV Push Meds -Giving an Blood Transfusion -Preforming Admission, discharge, transfer assessment, or any UNSTABLE patient -Plan of Care -Developing or Preforming Teaching -Taking Verbal Orders from MD

Stages of desensitization

-Talk about it -Look At Pictures -Be Environment with it -Interact/Experience it **first thing you do for pts w/ a phobia is: Let them avoid it for now.

What is the best toy for a 9-12 month old?

-Talking/speaking toy >>woody the cowboy, tickle-me-Elmo, see& saw barnyard toys -working on vocalization -purposeful activity w/ toys begins at 9 months (9months in womb, 9 months for purpose) >>ex: 7 months old can't build a tower w/ block b/c that's purposeful ***never pick answer w/ the following words if baby is <9months -build, stack, sort, make, construct

Post Op thyroidectomy risks 12-48 hrs for Total Thyroidectomy?

-Tetany ( they are stable at this point so don't pick airway or hemorrhage) "totals get tetany" **after 48hrs, primary is infection

What is Kernicterus?

-bilirubin in the brain (CSF, meninges, crosses BBB) -usually occurs around level 20 (can be fatal) -causes aseptic meningitis or aseptic encephilitis -s/x: opisthotonus (position baby assumes, hyperextended neck/back, needs immediate attention) Assessment: hyperextension d/t menigial irritation

What diseases do you need contact precautions for?

-c.diff -help A -staph infections -RSV -HSV/herpes -cholera

What are the 5 names of uppers?

-caffine -cocaine -PCP/LSD -methamphetamine -methylphenidate (adderal/ritilan) -s/x: euphoria, tachy, restlessness, irritability, borbaregmi, relfexes at 3-4, spastic, sz, suction needs to be ready

What does deconate mean?

-can be noted as a "D" after a drug -means long-acting -can work for wks-months -given IM for non-complaint clients >>can be court ordered

What are the indicators for benzo use?

-can be used as pre-op for anesthesia -used as muscle relaxant -used for alcohol w/drawal -good for sz -help pt relax when on vent and fighting it, calms them down **all benzos should only be used for 6wks or less >>work quickly

How do you determine if mom or fetus is priority in an emergency situation using fundal height as the metric

-can't palpate fundus = 1st tri, mom is priority -fundus at naval = 2nd tri, mom is priority -fundus above belly button = 3rd tri, baby priority

What is the Pre-op cervical laminectomy's most important assessment?

-cervical spinal cord innervates: diaphragm and arms -1st breathing (rate and rhythm) -2nd arm/hand and motor sensory/function

What post-op complication do you watch for with a laminectomy? (cervical, thoracic, lumbar)

-cervical: pneumonia= b/c can't get deep/good breaths -thoracic: pneumonia or ileus -lumbar: urinary retention, issues w/ legs **typically no chest tubes after

If in doubt, what OB answer is always best to pick?

-check fetal HR

Does a thoracentisis or a chest tube have a higher risk of infection?

-chest tube -a thoracentisis is an in and out procedure so there is decreased risk d

What are some example of phenothiazines?

-chlorpromazine -fluphenazine -promazine

If you have an elevated lab and you don't know what it is, pick?

-dehydration -labs are always elevated w/ that -may not be the right answer but it's better than a shot in the dark

What are 3 things to know about mobilization after spinal surgery?

-do not dangle legs (go from lying down to standing) -do not sit for longer than 30min >>question up in chair TID, meal okay but only short time allowed -may walk, stand, and lie down w/out restriction >>sitting is only issue

If there is intermittent bubbling in the water seal chamber for the chest tube what do you do?

-document it -this is good, if it is continuously bubbling then there is a leak, this we need to investigate further and fix

What are 3 types of loose associations that psychotics can make?

-flight of ideas -word salad -neologism -flight of ideas: go from thought to though, make phrases, make sense/coherent, but phases together don't make sense -word salad: babble odd sounds and word, doesn't make sense -neologism: making up words

SIADH

-fluid overload. (crackles, Edema, etc.) -DO: Fluid restrictions + sodium supplements -low output, high specific gravity (norms: 1.010-1.030) **OD: once/day (QOD: every other day) (QD: everyday, daily)

What is the treatment for v-fib and asystole?

-for v-fib, you d-fib -asystole: first use epi then atropine

Dumping syndrome

-gastric emptying syndrome -Post-op gastric surgery complication in which gastric contents dump too quickly into the duodenum -Gastric contents moving in the RIGHT DIRECTION at INCORRECT RATE.

Hiatal hernia

-gastric emptying syndrome -reguritation of acid into esophagus, because upper stomach herniates upward through diaphragm -Gastric contents move in -WRONG DIRECTION at CORRECT RATE.

Heparin

-give IV or subQ -work immediately, but cannot be on it for longer than 3 wks (except for lovenox) -anitidote: protamine sulfate -check aPTT -can have if pregnant

What is the onset, peak, and duration of long-acting insulin (glargine)?

-onset: 3-4 hrs -peak: none -duration: 12-24hrs -do not mix w/ other insulins -give at bedtime (other insulins shouldn't be given at bedtime, only give R then if insulin is sky high, glargine can be given regularly) -mealtime is not relevant

What is the onset, peak, and duration of short-acting insulin (regular)?

-onset: 30-60min -peak: 1-5 hrs -duration: 6-10 hrs **clear solution (can be given w/ other insulins), can also be given IV (Rapid and Run, "rapid-acting, run IV") -give 20-30 min ac meals (b/f meals)

What are the 5 D's for priority labs?

-pH in 6's -K+ in 6's -CO2 in 60's -O2 in 60's -Platelets <40K

Fetal presenation

-park of baby that enters birth canal first -most common is LOA, then ROA

Hyperbilirubinemia in the newborn

-patho present at birth -physiologic jaundice appears after 24 hours of age and disappears at about one week.

What is appropriate interest at the adolescent age (13-20)?

-peer group association in huge -don't do much, let them hang out -don't let them hang if: >>Contagious >>Immunosupressed >>Fresh post-op <12 hr

examples of MAOI's

-phenelzine -tranylcypromine -isocarboxazid **antidepressant

How do you walk w/ a walker?

-pic them up, set them down, walk to them -move slowly -no belongings should be tied to walker but if they are must be tied to side not front (will tip over_ **no tennis balls or wheels allowed for boards

The long-term complication of DM are related to what 2 things?

-poor tissue perfusion -peripheral neuropathy ex: -renal failure -retinopathy -poor healing -decreased peripheral feeling -loss of bowel and bladder control

What are the 3 things that result in an unwitnesses accident that lead to a black tag?

-pulselessness -breathlessness -fixed and dilated pupils (even if they're breathing)

What is the treatment for a hiatel hernia?

-raise HOB (increases emptying) -increase liquids (passes food easily) -increase carbs (digests quickly) > > > low protein "hi-atel hernia, everything needs to be high"

What are considered Abn or abnormal psych disorders?

-really abnormal personality disorders -antisocial -borderline -narcissistic **can use functional protocol, good to set limits w/ these pts

What does station mean during labor/pregnancy?

-refers to where the baby's presenting part (normally the head) is in relation to mothers ischeal spines. -if baby is above ischeal spine then given a - number, if they are below they are given a + number. + numbers are positive news - numbers are negative news. **ischeal spines are the smallest diameter of the pelvis, if baby can't fit = c-section **engagement is station "0" **if mom is at a neg number for a long time, could mean the baby can't fit -if below for a long time then may need to induce labor

Fetal lie

-relation of long axis (spine) of the fetus to long axis (spine) of mother -vertical lie/parallel: compatible for vag delivery -transverse/perpendicular: not good (c-section needed)

How do you know which crutch gate to use for which illness?

-remember "even for even and odd for odd" -if weakness is evenly distributed then need to use a two or four point gate **2 point gait for mild 4 point gait for severe -if weakness is only in one limb, you can use a three-point gate (or amputee) **4 point gate: Fresh Post Op

laminectomy

-removal of the vertebral spinous processes (not entire vert) -relieves nerve root compression ( cut away bone to give you space) **key thing to pay attention to w/ these questions is paying attention to the location of the laminectomy can be: -cervical: neck -thoracic: upper back -lumbar: lower back

Name some 2nd gen antipsychotics

-risperidone -olanzapine -ziprasidone -paliperidone

General guessing rules

-rule out absolutes -if 2 answers are same thing, neither is righ -if 2 answers are opposite, one is probs righ -umbrella strategy, wich answer is more global (aka answer that covers all the other answers) -if ? give you 4 right anwers and ask for priority need (don't use other rules) = play worst consequences game -when stuck b/t 2 answers look at question seseme street rule -oly use when you have zer idea what answer is "right answers tend to be different than the other"

When can psychotic delirium occur?

-sepsis -UTI -ICU sensory deprivation -thyroid storm -post-op psychosis -high on uppers or w/drawal from dowers (DT's) -this is a temporary, sudden, dramatic, secondary loss of reality, usually due to chemical imbalance body

How do you assess the intensity of a contraction?

-shows strength of contractions -Palpate with one hand over fundus and with fingertips (pads of fingers)

Described the care of someone going through alcohol withdrawal?

-stable pt, not harmful to others -regular diet -semi-private rm -up ad lib -no restraints -give anti-HTN meds -give vit B1

Whats the purpose in contractions in each stage of labor?

-stage 1: dilate and efface woman -stage 2: push baby out -stage 3: push placenta out -stage 4: contract uterus, prevent bleeding

What are two tocolytics?

-stop labor -terbutaline -mag sulfate -terbutaline: SE of maternal tachycardia -mag sulfate: SE decrease systems >>if reflexes are +2 w/ 12 or less RR titrate down

Whenever a lab is out of range and something needs to be done, what order of interventions do you need to put in place?

-stop the thing/hold: meds, IV, etc -assess, focused on area w/ prob -prepare to _________(whatever will help) -call PCP or whoever is needed **sometimes there's nothing to hold or prepare so jump to next step

What is the first thing you need to look at on an insulin bottle besides the name?

-the expiration date -if not date listed, then 30 days after opening it is the new expiration date (need to write it on bottle) **insulin does not need to be refrigerated (especially once its open, do need to teach pts to refridgerate their insulin at home)

Lithium therapeutic and toxicity levels?

-therapeutic: 0.6-1.2 -toxic: >2 -Use: Mania

Lanoxin (digoxin) therapeutic and toxic levels?

-therapeutic: 1-2 -toxic: >2 **so if you get 2 as an answer option you should pick it as being toxic to play it safe -use: CHF, Atrial arrhythmia

Aminophylline therapeutic and toxic levels?

-therapeutic: 10-20 -toxic: >20 (Antispasmotic used for asthma) **same class as theophyllline

Phenytoin therapeutic and toxic levels?

-therapeutic: 10-20 -toxic: >20 **Anticonvulsant, used to prevent sz

If the pH is under 6 you?

-this is a class D, very important to call PCP and assess pt -hyperkalemia is biggest concern here, watch cardiac

What is the Pre-op thoracic laminectomy's most important assessment?

-thoracic innervates: cough and bowels (abd muscles and bowel muscles) -1st cough (uses abdominal muscles) -2nd bowel sounds **check both b/f surg (If you can't contract these muscles, you can't cough)

Postpartum, what are we assessing for when we do an extremity check, and how do we assess it?

-thrombophlebitis -Pulses -Edema -S/S of thrombophlebitis- bilateral calf circumference is best way to check. If they are equal its ok if not its positive for whichever calf is bigger) **holman's sign is not best answer

Post Op Thyroidectomy risks 1st 12 hrs? (total or sub)

-top priority is airway -watch for edema -second priority is hemorrhage

Lithium

-treats mania in bipolar -stabilizes nerve cell membranes unlike other psych drugs that deal w/ neurotransmitters

What are the Lithium toxic SE?

-tremors -metallic taste -severe diarrhea #1 intervention is to increase fluids (need normal Na+ **low Na+ = Li more toxic **high Na+ = Li won't work > > >need to monitor Na+ levels

What does a low pressure alarm on a ventilator mean?

-triggered by decreased resistance >>causes: -disconnections (tubing is disconnected or sesory tubing is disconnected)

What does a high pressure alarm on a ventilator mean?

-triggered by increased resistance to air flow >>due to obstructions: -kinks in tubing = unkink -water condensation in tube = empty tube -mucus sections in airway = change positions; turn, cough, deep breathe, if those don't work then suction

If a pt has a congenital heart defect that is TRouBLe, what can some of the side effects be?

-trouble defects shunt from R to L and are cyanotic b/c of this -growth and development is slowed -life expectancy is decreased -stress, grief, financial issues -apnea monitor, long hospital stays -exercise intolerance -etc **all congenital heart defect kids, trouble or not have: a murmur and need an EKG

Haloperidol

-typical, first gen antipsychotic -similar to thorazine -has a deconate form SE: A-nticholinergic SE (dry mouth) B-lurred vision C-onstipation D-rowsiness E-xtra paramital syndrome (EPS) F-otosensitivity (photosensitivity) aG-granulocytosis (↓ WBC =immunosup)

What is Addison's Disease?

-under-secretion of the adrenal cortex -s/x: hyperpigmentation, hyperK+, hypoNa+, hypoglycemia, dehydrated easily -pts can't respond to stress, small amounts of stress can put them into crisis/shock **side note: all diseases that stim from issues w/ the adrenal cortex all start w/ "a" or "c"

Described the care of someone going through DT's

-unstable, danger to self and others -NPO (sz risk/aspiration risk) -private Rm near nurses station -must be restrained >>vest or 2-point locked leathers, arm and leg) -give anti-HTN meds -give vit B1

What are the 4 defects of Tretrology of Fallot?

-ventricular defect (R to L shunt) -pulmonic stenosis -overriding aorta -right hypertrophy

If a pt is taking sertraline, what other medication would it be imparitive to stop taking?

-warfarin -can cause a pt to bleed out -warfarin would need to be decreased and you need to watch for bleeding

If a baby is >24hrs old and has a mother who is addicted to drugs, what can we assume about the baby?

-we would assume intoxication NOT w/drawals from birth to 24hrs -after 24hrs, baby will have w/drawal

What is co-dependency?

-when self-esteem is gain or lost from doing things for others -needs to be addressed in alcohol dependence -teach person to set limits and enforce them, must say "no" and then feel good about themselves saying it **manipulation is getting another person to do something for them that is not good for that person

When does alcohol withdrawal and delirium tremons occur?

-withdrawal= 24hrs stopping drinking -DT's = 72 hrs, not all people get this >>life-threatening

Which patient would be see between a pt with angina pectoris with unstable BP or the pt with an MI with stable vital signs?

-you would see the angina pectoris b/c of the unstable BP, the pt being unstable is the unstable phrase and that breaks the tie on who you should see first

In a tie never pick ___________ If the symptom involves nerve or skeletal pick__________ For any other symptom pick___________

...magnesium ....calcemia. ....potassium.

1st trimester weight gain?

1 lb a month -1-3lbs total **3-5lbs also acceptable 0-12wks is first tri

2nd/3rd trimester weight gain?

1 lb/week 13-26 wks is 2nd tri >27 wks 3rd tri

How do you lower K+ in the body? (2 ways)

1) D5W w/ Insulin R (insulin pulls the K+ from the blood and pulls it in the cell with glucose) >>fastest way to lower K+, but only temp b/c K+ leaks out of cells 2) Kayexalate >>goes through mouth into gut or into rectum (enema) >>full of Na+ trades Na+ for K+ to get K+ excreted (leads to hypernatremia so we give them fluids to re-hydrate them) >>takes a long time but it's permanent **need to give them both!! "K-exits-late"

What is the order of events you need to complete if the water-seal on the chest tube breaks?

1) clamp it (so nothing gets in) 2) cut it away from the broken device 3) stick tube in sterile water 4) unclamp it **best thing is sterile water **if chest tube gets pulled out then need to cover chest hole with petroleum gauze

In the second stage of labor what is the order of effects in birth? (order is important)

1) deliver head 2)suction mouth, then nose (alphabetical order) 3) check for nuchal cord 4) deliver shoulders and body **baby must have ID band on b/f leaving unit for post-partum

Contractions should be no longer then ____ and no closer then_____.

90 sec and 2 minutes > = uterine tetany & hyperstimulation =decreased 02 to baby

Your pt has respiratory acidosis your pt has: (select all that apply) a) +1 reflexes b) diarrhea c) a dynamic ileus d) spasm e) urinary retention f) paraxysmol atrial tachycardia e) 2nd degree, mobitz, type 2 heart block g) hypokalemia

a) +1 reflexes c) a dynamic ileus e) urinary retention g) 2nd degree, mobitz, type 2 heart block

Pregnancy Categories

A- Safe B- Problems in Animals, Not Humans C- Caution, if benefits outweigh the risks you can use it X- NEVER.

The SE for phenothiazines are? (ABCDEFG)

A-nticholinergic SE (dry mouth) B-lurred vision C-onstipation D-rowsiness E-xtra paramital syndrome (EPS) F-otosensitivity (photosensitivity) aG-granulocytosis (↓ WBC =immunosup) ***don't call PCP for adverse effects, just toxic ones -need to have ND of safety, risk for falls b/c blurred vision and dizziness

MAOI SE?

A-nticholinergic effects B-lured vision C-onstipation D-rowsiness

Benzo SE? (ABCD)

A-nticholinergic effects B-lured vision C-onstipation D-rowsiness **#1 ND for benzos is safety

Tricyclic SE? (ABCDE)

A-nticholinergic effects B-lured vision C-onstipation D-rowsiness E-uphoria (happy)

What are the 2 lethal arrythmias?

A-systole and V-Fib -lethal b/c little to no CO

acetylsalicylic acid

AKA aspirin - one of the most widely used analgesics, anti-inflammatories, and antipyretics -associated with a lot of GI problems - should be avoided by athletes in contact sports b/c it prolongs blood clotting

Plague is not longer commutable when?

After 48 hours of treatment

For a prioritization question what 2 pieces of information do not matter?

Age and gender

What type of precautions does SARS have?

Airborne Private room-door closed Mask Gloves Gown Handwashing Special filter respirator masks Pt wears a mask when leaving room Disposable/dedicated supplies Negative airflow room

What are the TRouBLe congenital heart defects?

All of them start w/ a "T" -tetralogy of fallot -truncus arteriosus -transposition of vessels -tricuspid atresia **shunts R to L and cyanotic

For Empathy Questions

Always pick the answer that reflects the patient's FEELINGS, *Not* Actions, or the nurses feelings.

Who uses Swing Through technique on crutches?

Amputees, non weight bearing (sprain/break)

As a rule in shock

Anything that is a pressure goes down Anything that is a RATE goes up

With an Epidural, give what after delivery?

Fluid Bolus to combat hypotension because they are a FALL RISK

What two drugs can increase blood sugar?

Glucagon and Epinephrine

Type 2 diabetes will do what when in acute illness?

Go to type 1 and need insulin **do not freeze insulin, denatures it

What 4 things are always considered unstable?

Hemorrhage Hypoglycemia Fevers over 104* Pulselessness and breathlessness

What lab is the best indicator for long term blood sugar maintenance?

Hgb A1C (glycosated hemoglobin) -want it to be <6 and lower -out of control is >8 -diagnostic level is 6.5 <7 is an ideal sign of CONTROLLED diabetes

Hyperthyroidism (AKA graves disease) is the same as saying?

Hypermetabolism

What interventions do you do for all other OB complications? (LION)

If Pitosin is running stop this first then LION L-eft side position I-ncrease IV O-2 N-otify doctor **use w/ hyptension eclampsia, toxiema, uterine rupture

Don't be tempted to answer a question based on your ___ instead of your____

Ignorance instead Knowledge (if you've never heard of it, DON'T PICK IT)

What do you do if another staff member is placing the patient in physical or psychological harm?

Intervene and take over. >tell supervisor after but pt safety is priority here

Which illness would have the nursing diagnosis of "fluid volume deficit"? Select all that apply a) diabetes mellitus b) diabetes insipidus c) SIADH

a) diabetes mellitus b) diabetes insipidus **SIADH will have fluid volume access b/c high ADH = retention of fluid, low urine output

Describe a 4 point gait?

NOTHING moves together 1. Right crutch 2. Left foot. 3. Left crutch. 4. Right foot. It moves one at a time so 1,2,3,4 and 1,2,3,4, and 1,2,3,4

For patients with OCD, you

Negotiate a balance

You have a multigravida who is at 8 cm requesting her IM pain medication, would you give it to her? a) no b) yes c) consult a physician

No, b/c the mom is at 8cm and she has delivered other babies her delivery could be faster -IM peaks at 30-60 minutes **do not give pain meds if they will peak when baby is bone

Stop beta blockers & calcium channel blockers if

Patient had MI or suspected MI

Priorities, in Order

Physiological, Safety, Comfort(Includes Pain), Psychological, Social, Spiritual (Maslow's)

If ICP is increased

Pressure goes UP Rate goes DOWN (Opposite of hypoglycemia)

Droplet precations have what 6 things?

Private room- door can be open Gloves Mask- #1 in this group Handwashing Pt wears mask when leaving room Disposable/dedicated equipment

How do you treat prolapsed cord? 911!! OB emergency

Push and position -Push head up and in -poistion knee-chest (hands and knees) >Or elevate hips on pillows >Don't put the patient on their left side. >Cover the cord in moist saline

How do you treat painful back labor?

Push and position -position: mom into knee-to-chest (baby probably an a posterior position ie LOP -push: use fist to push into sacrum

What is the best toy for a toddler (1-3 yr.)?

Push/pull toy=wagon, stroller, lawn mower -working on gross motor (running, jumping) >>if it takes finger dexterity, don't pick for toddlers -start to do parallel play: play alongside but not w/

How often do you monitor vitals during labor?

Q15min until the 2hr mark after placental delivery. Then Q1H.

The best psych answers

Reflect the feelings the patient feels and not the words they said Reflect Are open ended (not yes/no questions ) Don't have "I, me, we, us" Shortest answers are better Why questions are not as good

What are the S/S of serotonin syndrome?

S-weating A-pprehension (sense of doom) D-izziness H-eadache

If you know what a particular drug does pick a SE in the ______ body system.

Same >>Ex: you know its a heart med, pick something like tachycardia If you have no idea what a drug is check to see if it is ___. If it is, pick a _______ SE. >>>PO, GI

S/S of Hyperthyroidism?

Same as hypermetabolism... agitated, nervous, diarrhea, heat Intolerant, ^HR, ^BP, thin, hyperactive etc. Remember RUN yourself in the GRAVE

Hypothyroidism S/S?

Same as hypometabolism ie, -tired, -sluggish -Cold intolerant -obese -decreased hr, rr aka myxedema **DO NOT sedate these pts, can cause coma -if pt is ordered NPO b/f surgery question it >>they need their oral thyroid meds b/c they're more susceptible to never waking up from anesthesia

Elderly patients on Haldol

Should be 2.5 mg (half of the regular dose of 5)

What are the 4 stages of labor?

Stage 1: Labor (LAT) >>Latent phase >>active " " >>transition " " Stage 2: Delivery of Baby Stage 3: Delivery of Placenta Stage 4: Recovery (2 hrs long)

On nclex, when drying hands

Swipe ONE swipe per paper towel then throw it away and get another one **when putting on sterile gloves, put on dominant hand first

Do not give what type of pain medication to a women in labor if the medication is likely to peak when the baby is born?

Systemic- AKA IV, IM and oral

What order do we draw peak and trough levels?

TAP levels -T: draw trough -A: admin drug -P: draw peak **look at route not drug to know when to draw

In what order to you take your PPE off?

Take off in alphabetical order -gloves, goggles, gown, mask Put in on in opposite order except mask is 2nd -gown, mask, goggles, gloves

If another staff member is doing something illegal you?

Tell the supervisor. -answer's not to intervene or wait until later date

What is the rule for Natremias and fluid balance?

The one with the E =dehydration HypErnatremia has s/s of dehydration the one with the O = overload HypOnatremia has s/s of fluid overload.

When do you draw trough and peak levels for sublinguial, IV, IM, SubQ, and PO meds?

Trough: -draw all 30 min b/f next dose Peak: -sublinguial: 5-10min after drug has dissolved -IV: 15-30 min after drug has finished -IM: 30-60 min after given -subQ "see DM meds" -PO: too variable

After week 12 you can subtract 9 to get appropriate weight gain. (Think 9months)

Week 12 = 3 lbs 13 = 4 lbs 14 = 5 lbs 15 = 6 lbs 16 = 7 lbs 17 = 8 lbs eg. week 14-9= 5lbs 28-9= 23 lbs

All psych medications cause what?

Weight changes and low BP.

You have a prima gravida at 5cm who wants her IV push pain medication, will you give it to her or not? a) no b) yes c) consult a physician

Yes, b/c the mom is at 5cm and since it is her first baby she will tend to deliver at a slower rate -IV meds peak 15-30 min after they're given **do not give pain meds if they will peak when baby is bone

If you see the words "During the therapeutic interview" "While implementing the care plan" "While working on the care plan goals" "During treatment sessions" "During therapy" "In your weekly session" "Three days after admission"

You are in the working phase, also known as the "therapeutic phase" Do: Be very focused, directive, "tough" In some ways these answers will seem stern and slightly unfriendly. Enforce proper communication.

Rule out these words in psych

"Suggest that" "Advise the patient to" "Tell the patient to" "If I were you, I would..." "You should do" "You ought to" "You should NOT do" "Don't do" "Recommend that"

How do you use crutches when going up the stairs?

"Up w/ the good, down w/ the bad" -lead w/ good ft when goin up stairs, crutches go second -lead w/ bad ft when going down stairs **crutches always move w/ bad leg

Boards try to trick you with the words

"bile stained " and "vomitus" in acid base. It is NOT from the stomach, it is from the intestine, so it means metabolic acidosis.

Describe the Latent phase, in the first phase of labor

-0-4 cm dilated -Contractions 5-30 min apart -Lasting 15-30 sec. -mild

Type II diabetics need how many calories a day?

-1,200-1,800 -recommended to have in 6 small feedings/day

In a neonate, what is considered Elevated bilirubin level and a toxic bilirubin level?

-10-20 ->20 is considered toxic -14-15 is when hospitalizations occur **adult normal is 12 or less

You're caring for a newborn that is 24hrs old. The mom is addicted and actively taking Quaaludes, what responses do you expect to see from the newborn? Select all that apply a) difficult to console b) low core body temp c) exaggerated startle reflex d) respiratory depression e) sz risk f) shrill high-pitched cry

a) difficult to console c) exaggerated startle reflex e) sz risk f) shrill high-pitched cry

Your pt has diarrhea, what caused it? a) hyperkalemia b) hypokalemia c) hypocalcemia d) hypomagnesemia

a) hyperkalemia **if a tie and its not muscle or nerves then its always K+

You have a type 2 DM, what is the best dietary route to take? a) restrict their calories b) divide their food into 6 feeding/day

a) restrict their calories **both are needed but since this is a "best" question this is the best option

In what position should you put an opisthotonus baby? a) side b) prone c) supine d) head elevated (sitting)

a) side **opisthotonus is a hyperextention of the neck and back and can occur when an elevated bilirubin passes the BBB of a baby --important to report immediately as its a sign of impending kernicterus

What crutch gate would you use for: (answer each question w/ two-point, three-point, four-point, or swing through) a) Pt w/ early stages of rheumatoid arthritis? b) Left-above the knee amputation c) first day post-op right knee replacement, partial weight-bearing allowed d) advanced stages of ALS (amylotrophic lateral sclerosis) e) left hip replacement second day post-op non-weight bearing f) bilateral total knee replacement, first day post-op, weight-bearing allowed g) bilateral total knee replacement, three weeks post op

a) two-point >>both legs affected, early on in illness b) swing through c) three point d) four-point e) swing through f) four-point g) two-point

S/S of Cushing's Syndrome?

over secretion of adrenal cortex. -Think of the Cush Man... Moon face-steroids buffalo hump thin legs and bones striae (stretch marks), male breasts, hirstusism high glucose Immunosuppressed/infection bruising Gaining h20 Infection Irritability Weak bones Wasting, thin extremities (atrophy of muscles) Bruises Easily Moon Face Acne Losing K Buffalo Hump Striae/Stretch Marks Breasts in Men Trunkal Obesity Hair on face

You are caring for a pt with a lumbar oligodendrocytoma, what is the number one problem? a) airway b) ileus c) cardiac arrhythmia d) urinary retention

d) urinary retention -the illness does not determine the answer, the location does, don't worry about what the big word means

What are the nursing considerations for a pt after receiving radioactive iodine and PTU?

radioactive iodine -need room to self for 24hrs -need to be care w/ urine, flush several times, radiation in urine PTU -cancer drug used for thyroid -leads to immunosuppression >>need to monitor WBC's "Puts Thyroid Under"

What products would a pt need to avoid if taking naltrexone or disulfiram?

used for aversion therapy of alcohol -mouthwash, aftershave, perfumes/colonges, insect repellents, over the counter meds that end in -elixer, alcohol-based hand sanitizers, uncooked icings, vanilla extract ***do NOT pick red wine vinaigrette, they can have that

Of the following pts, who is the highest priority? A pt with CHF, pt w/ COPD, pt w/ appendicitis, a pt who is 2-hrs post op after a cholesystectomy, or a pt who is post-op day 2 after open heart surgery? a) CHF b) COPD d) appendicitis e) 2-hrs post-op cholesystectomy f) post-op day 2, open heart

e) 2-hrs post-op cholesystectomy -pts who are "fresh" post-op are always priority -"fresh" would be 12 hrs or less post-op

How often do you suction pts? a) every 2 hrs b) every 15 min c) every hour d) every 4 hours e) none of the above

e) none of the above -suction as needed only -suctioning is a double edge sword, the more your suction the more secretions are produced

PSYCH do not receive______ do not give _______ keep the pt ________ about it Use _______ when communicating Put self in client's _______ choose answer that reflects

gifts advise talking the feelings of the client shoes Don't fucus on words said, but feelings (empathy questions have a quote in them)

Addisons Disease treatment?

glucocorticoids - -think blood sugar monitoring and immunosuppression

Benzodiazepines

have -zep in middle of name (not always actually, all end in -pam or -lam -antianxiety med, minor tranqs -lorazepam (ativan) -diazepam (valium) -clorazepam -alprazolam (Xanex) -flurazepam

BUN norm? if BUN is elevated what do you need to check for?

8-20 -check for dehydration

Tx Protocol for Bipolar

-Mania - Very high calorie, Finger Foods (on the go) -Needs Gross Motor Activity -Let them sleep whenever they can -Not usually self destructive

What is the onset, peak, and duration of intermediate insulin? (NPH, insulin detemir)

-onset: 1-2 hrs -peak: 6-14 hrs (10) -duration: 12-16 hrs -cloudy (suspension), no IV drip "N" is Not in the bag

If a functional psychotic is having a delusion or illusion, how do you respond?

-Acknowledge feeling ( I see you are upset), -Present reality (but we have no spiders in the room) -Set a limit ( we're not going to talk about that lets talk about something else) -Enforce the limit ( I see you're to ill to talk about reality). >>don't punish them or take things away, just end the conversation "I see your too sick to have a conversation, so we're done talking now" **Tell them what they CAN do instead of what they CAN'T do. Follow with : We have medication to treat those symptoms

What are the four rules of prioritization?

-Acute < chronic -Fresh post-op(12hr.) < medical or other surgical. -Unstable < stable -more vital the organ the higher the priority(use only as a tie breaker)

What makes a patient unstable? (7)

-Acute illness -Post-op less than 12 hr -General anesthesia -Changed assessment -Phrase "newly admitted" or "newly diagnosed" -Labs C & D -Unexpected S/S

Cushings Syndrome treatment?

-Adrenalectomy -Biliateral Adrenectomy = addison's= need to take steriods=effects of steroids can give cushing-like s/s

What are some examples of pts w/ psychosis of dementia

-Alzheimers -dementia -organic brain syndrome -senility -after a stroke >>anything that says dementia or senility **these pts have actual brain damage

adenosine

-Antiarrhythmic -Use: atrial arrhythmias -need to use IV push in 8 seconds -pt can go into asytole but should come out of it

If Hgb is under 8 you should do what?

-Assess bleeding -Prepare for blood admin -Call doctor (norms: 12-18) **if >18 assess for dehydration

If CO2 is the 50's what should you do?

-Assess respiratory status -Do pursed lip breathing (^ exhale time) -DON't give O2 if the above isn't working call the doctor! (call resp therapist first) **need to prepare to intubate and ventilate ***class D

If the potassium is below 3.5 you?

-Assess the heart -Prepare to give potassium -Call the doctor

Calcemias do the opposite of the prefix plus all what?

-BP changes -eg: Hypocalcemia FAST everything (Low bp) -Hypercalcemia: SLOW everything (high BP) -hyperCa+: lethargy, bradycardia, flaccid muscles, +1 reflexes, constipation, bradypnea -hypoCa+: irritability, +4 reflexes, sz, clonus, tachycardia, spasm, chvostek's and Trousseau's sign **muscles and nerves are must important when looking at Ca+ issues

Magnesemias do the opposite of the prefix plus all what?

-BP changes (boards won't test this) -Calcium and Mag have inverse relationship

Name 2 muscle relaxants

-Baclofen -cyclobenzaprine (flexeril) -SE: fatigue and muscle weakness -Teach: don't drink, don't drive, don't operate heave machinery, Don't care for children under 12

Hemangiomas in newborns is?

-Benign tumor of the capillaries.

Mongolian spots are?

-Bluish/black macules appearing over the buttocks and or thighs of darker skinned neonates. *normal

cephalohematoma vs caput succedaneum

-Cephalohematoma: Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines. -caput succedaneum: Edematous swelling on scalp caused by pressure during birth. This swelling may cross suture line. It usually disappears in a few day.

The ACE of spades answer for nutrition is to either pick ____ or _____.

-Chicken or Fish -never pick cassoroles for kids -never mix meds in kids food -toddlers: finger food -preschoolers: leave them alone, 1 meal/day okay >>eat similar things, eat less, all okay, they eat when they're hungry

What makes a patient stable? (7)

-Chronic illness -Over 12 hr post op -Local or regional anesthesia -Unchanged assessment -Phrase "to be discharged" -Lab values A or B -Typical S/S for the disease they have or what they are receiving treatment for.

A 7-11 yr old is in what Piaget stage?

-Concrete operation (think of a 7-11 with concrete around it) -Rule oriented (can't abstract) -when: teach days ahead -what: Teach what to do +skills -how: Be age appropriate, use demonstrations

What is the best toy for a 6-9 month old?

-Cover/uncover toy, eg. jack in box, pop up pals, books w/ windows, playing peek-a-boo >>if not avail pik lg, hard toy (wood or plastic) -kids working on object permanence

School age (7-11 yr.) is characterized by the 3 C's, what are they?

-Creative (no coloring book, use blank paper) -Collecting -Competitive -Creative: let them do it/make it, don't do it for them (legos, transformers, blank paper) -Collecting: always collecting something -Competitive: like to play games w/ winner and a loser

S/S of dumping syndrome

-DRUNK + SHOCK + ABD DISTRESS -Drunk=staggered gait, slurred speech, delayed reaction time, etc -Shock= cold, pale, hypotension, tachy -Acute abdominal distress= gas, cramping, bloat, diarrhea, guarding/protecting, borbarigmi, tenderness -staggering gate -delayed reaction time -emotionally liable -impaired judgement -cool, clammy skin -hypotension -tachypnea -tachycardia -cramping -pain -guarding/protecting -borbarigmi -diarrhea -bloating/distention -tenderness -doubling over

What is a hallucination and what are the 5 types of hallucinations?

-Def: False, fixed sensory experience. Types -Auditory -visual -tactile (feel) -olfactory -gustatory (taste) **experiences things that aren't there **in order of commonality

What is an illusion and how can you differentiate between illusions and hallucinations?

-Def: Misinterpretation of reality, sensory experience. Illusion: Sensory response to something in reality [the news (reality) is talking TO them (illusion)] **something is actually there, the pt is just confused about it Hallucination: Sensory response but nothing in reality pertains

What is the best toy for a 0-6 month old?

-Musical mobile (get rid of this at 6 months or when the child is sitting up to prevent choking) -kids are sensory motors, need to stim -if musical mobiles not there, pick big, soft toy

Tx Protocol for Anxiety Disorder

-No special diet, more anxious = more allergies -Activity absorbs anxiety -Self destructive behavior is not an issue.

High blood sugar in type II aka hyperosmolar, hyperglycemic, non-ketotic coma (HHNK) is the same as?

-Dehydration -s/x are the same as dehydration (skin hot, flushed, dry) -ND: fluid vol. deficit -#1 intervention: giving fluids -outcomes: increase output, moist mucus membranes Treatment: Rehydrate but no insulin in the bag **so would be more pertinent to give a pt w/ DKA insulin -more pts die from HHNK than DKA, but DKA is priority when you get into the ER (this is b/c DKA is more easily recognized and treated and HHNK pts wait longer to come in b/c s/s are not as acute) >>DKA would die first if no treatment is provided

Milia in newborns is?

-Distended sebacious glands which appear as tiny white spots on babys face. *normal

What are the Permanent restrictions for a laminectomy pt?

-Do not lift by bending at the waist -No crazy activities... jerky rides, horseback riding -Cervical: can never Lift objects above the head

What is the Discharge teaching for a laminectomy that only applies for a temporary amount of time?

-Don't sit for longer then 30 minutes for 6 weeks -Lie flat and log roll for 6 weeks -No driving for 6 weeks -Do not lift more then 5 lb. (gallon of milk) for 6 weeks **if in doubt, just pick 6wks for recovery times

Positive signs of pregnancy?

-Fetal skeleton on X-ray -Fetal presence on ultrasound -Auscultation of FHR (heart at week 8, most likely at 10 and should be heard by 12) -Examiner palpates fetal movement Need to be careful about how things are phrased on NCLEX, look for "first, most likely, should by" ex: Hearing fetal HR -when would you FIRST hear HR? =8wks (early) -when would you MOST LIKELY hear HR? = 10wks (mid-point) -when SHOULD YOU hear HR by? =12wks (end of range)

What two things should you work on with a preschooler (3-6 yr.) ?

-Fine motor (fingers) and Balance (dance, gymnastics) >>tricycles, tumbling, ice-skating -co-operative play: play w/ each other in groups -highly imaginative: like to pretend

The uterus should be like what after delivery?

-Firm not boggy -Fundal height= days postpartum (3days= 3cm below naval) >>height = cm below naval same as days after birth, day of birth will be at naval -Midline- if not catheterize

If the WBC is low you should?

-Follow strict hand washing -Shower BID with antimicrobial soap -Avoid crowds -Private room -No fresh flowers or potted plants -Low bacteria diet- no raw fruits/veggies, no undercooked meat. -No water drinking if its been sitting for longer then 15 minutes. -Vitals Q4H -Check WBC daily -Avoid reusable plates/silverware etc,

A 12-15 yr old is in what Piaget stage?

-Formal operations -Can abstract, understand cause and effect -Can be taught like adults -can manage their own care >>first time child can manage their own care is age 12

How do you assess frequency and duration of contractions?

-Frequency: Beginning of one contraction to the beginning of another. -Duration: Beginning to end of contraction

s/x of hiatel hernia?

-GERD(gastric, esophageal, reflux disease) upon lying after meals -aka heartburn, indigestion **have to lie down after eating to have symptoms or it is not GERD

Violent Clients

-Goal is to de-escalate. -Walk with a pacing patient. Say "I see you are upset" -Need 5 people to control a person. 1 person charge.

What are 3 things that effect stomach emptying time?

-HOB -water content of meal -carb content of meal **these can be altered for treatment of hiatel hernia and dumping syndrome to speed up or slow down emptying -hiatel hernia: want stomach to empty faster b/c if faster emptying = nothing in there = no reflux -dumping syndrome: want stomach to empty slower

What is the treatment for dumping syndrome?

-HOB flat (turn to side to eat) -decrease fluids (can have b/f or after meals, not during) -decrease carbs > > >high protein (takes longer to digest) "when everything is low the stomach empties slow"

When a pt is hypoxic, which rate increases first? RR or HR?

-HR, then RR -hear tries to compensate by increases blood O2 to body, when it can't RR picks up

How is a women's Hgb effected during pregnancy?

-Hgb decreases w/ pregnancy -can be as low as 10 & 11 and still be okay >>gets lower as preg progresses

Tx Protocol for Depression

-High Calorie, FIBER FOODS. -Activities that are w/ others, but not interactive. -Like Parallel Play. -Dangers: Suicide. If They suggest it, be direct and ask them if they have a plan

If the potassium is high (5.4-5.9 high but still within the 5's) you?

-Hold potassium if in the IV -Assess the heart -Prepare to give D5W with insulin -Call the doctor if K+ is a >6 then: -Stop what you're doing and assess -If negative effects present you call rapid response. -If no negative effects you do the same as "high but within the 5's) **class D

What needles should you use for an IM and a subQ injection?

-IM: 21 G, 1 inch (looks like an "I") -subQ: 25 G, 5/8th inch (5 looks like an S)

When a client is sick what does it do to there blood sugar?

-It increases d/t stress tell pt to: -Take insulin -Stay hydrated -Stay as active as possible.

What is the first thing you assess in a Med-Surg situation?

-L.O.C. -first thing you do is establish airway

If you don't know the drug, monitor

-Liver Enzymes -Then Creatinine -Then WBC

During the third stage of labor and delivery (placental delivery) you do what two things?

-Make sure it's intact( can 1)hemorrhage 2) infection) -Check for three vessels (2 arteries, 1 vein)AVA

Kalemias do the same as the prefix except for the what?

-The HR and urine output. (opposite) Ex: -HyperK= BRADY, tachypnea, diarrhea -HypoK= TACHY, lethargy, POLYurea, ilius ***just the HR is affect by this rule, everything else applies For example: -in hyperK+, the pt experiences bradycardia BUT there is still a peaked T wave and ST's are elevated -in hypoK+, the pt will have tachycardia, but will also still have a U wave (which dips below the line, aka goes down) **the heart is the most important when looking at K+ problems

Post Op thyroidectomy risks 12-48 hrs for Sub-total Thyroidectomy?

-Thyroid storm (this can cause brain damage ..too febrile) "subs get storm" **after 48hrs, primary is infection

For a Sub-total Thyroidectomy you are at risk for what?

-Thyroid storm -s/x: same as graves disease but incredibly higher. -super high temps (>105) -extremely high BP's (stroke level high, >200's) -severe tachycardia (180's) -psychotically delirious **med emergency, can lead to brain damage ****these pts do not need life-long thyroid replacement >>have a decreased risk for hypocalcemia

Lithium toxicity

-Tremors -Metallic taste -neuro symptoms besides parenthesia >>high Na+ = Li doesn't work as well >>low Na+ = Li works too well = toxic

If kernicterus and opisthotonos are occuring you?

-Turn baby on their side -Call doctor -Draw bilirubin level -Increase the IV rate and start billirubin lights.

What are the 4 things you do 4 times an hour for the 4th stage of labor?

-VS- check for S/S of shock -Fundus- if boggy, massage. If displaced,void/cath -Perineal pad- excessive lochia= pad saturated >>if sat in 15 min = hemorrhage = emergency -Roll on side and check pad for bleeding.

WBC norm, Absolute neutrophil count (ANC) norm, and CD4 norm

-WBC: 5,000-11,000 -ANC: <500 -CD4: <200 -elevated WBC: Leukocytosis -low WBC: Leukopenia >Neutropenia >Agranulocytosis >Immunosupression >Bone marrow supression

What is a narrowed self concept?

-When pt's who are psychotic refuses to leave room or get dressed. (DON'T force them to do it) Respond by saying " I see you are uncomfortable, when you are ready, you can do it" -where they're at and what they're wearing defines who they are, making them leave or change would not be helpful **if a pt is not psychotic and is just depressed (not major depression), then you make choices for them

What is ideas of reference?

-When they think everything is about them. (Everyone is talking about me) **if someone is out in the hall talking they think what are those people saying about me?

If has psychosis of dementia and is having a delusion or illusion, how do you respond?

-acknoledge feeling -redirect them (change from something they cannot do to something they can do) **don't present reality or set limits re-directing is NOT: -Orders, Distraction, Doing a physical action re-directing is: -Taking what a patient is fixating on and that they are expressing inappropriately, and you get them to express it appropriately

What is the #1 cause of DKA?

-acute Viral upper respiratory infection within last 2 weeks. -need to ask pt if they've been sick if you suspect DKA -stress of illness increases the BS

ziprasidone

-aka Geodon -Second-generation (atypical) anti-psychotics -BLACKBOX warning b/c heart issues >>prolongs QT interval, can cause sudden cardiac arrest -don't' use w/ pts w/ heart probs

Sertraline

-aka Zoloft -SSRI -can cause insomnia but you CAN give it at bedtime **big thing that's tested is the fact it has a lot of drug interactions >>>sertraline interferes w/ the system of breaking down drugs in the liver = increased risk for drug toxicity > > >this means you may need to lower the dose of other drugs that are being taken as to not OD pt

Dinoprostone

-aka cervidil -prostaglandin that helps relax cervical muscles -causes Effacement which leads to contractions.

meperidine

-aka demerol -narcotic for mod-sev pain

Fluoxetine

-aka prozac -SSRI, antidepressant -SE: A-nticholinergic effects B-lured vision C-onstipation D-rowsiness E-uphoria (happy) teaching: -causes insomnia: give b/f noon, NOT at bedtime >>usually given 2x/day (2nd dose at noon) -when changing dosage for adolescents/young adults watch for increasing risk of suicide

What are the probably & presumptive signs of preg?

-all urine and blood tests (could be false) -Chadwicks, Goodell, Hegar signs (occur in alphabetical order, need to know this!) -chadwicks: Cervical change to cyanosis (blue hue) -Goodells's: cervical softening -Hegars: uterine softening

Examples of TCA's

-amitriptyline -imipramine -nortriptyline -protriptyline -clomipramine -desipramine -doxepin -amoxapine **mood elevator for depression

What 2 things can falsely elevate an SpO2?

-anemia (need to look at other indicators, pt can be much sicker than what reading says) -if pt just had a dye test (increases color in blood, makes it look like there's more RBC's)

Where are the heart sounds heart?

-aortic: 2nd intercostal space, R sternal border -pulmonic: 2nd intercostal space, L sternal border -tricuspid: 4th intercostal space, L sternal border -mitral: 5th intercostal space, midclavicular line

how long is Acrocyanosis present in a baby usually?

-appears intermittently over the 1st 7-10 days **Nevus/Nevi = birthmark

What are the two neonatal lung medications?

-betamethasone -beractant (like surfactant) -betamethasone: give to mom, b/f birth, IM >>watch mom's glucose, will rise w/ this -beractant: increases surfactant production, give to baby after birth, transtracheal (blown into trachea), given after babies born

Describe aminoglycosides

-big guns of antibiotics, treats serious, resistant, life-threatening infections (TB, spetic peritonitis, pyloenonephritis) -all end in -mycin except for those w/ "thro" in them (erythromycin, azithromycin, clarithromycin) >>"throw out the thros" -Amikacin, only aminoglycoside that doesn't follow the rules ex: adriamycin, clindomycin

What is the truest most valid sign of labor is?

-onset of regular, progressive contractions Terms: -dilation: opening of cervix, 0-10 cm (4inchs) -effacement: thinning of cervix, 0-100% (thick is 100%)

What pt teaching needs to be completed for pts on MAOI's?

-has a lot of drug interactions so do not take any OTC meds -to prevent acute, severe HTN crisis, must avoid tyramines in foods ex: -f/v: salad BAR= bananas, avocado, raisins (any dried fruit -grains: fine -meats: organ meats, preserved (smoked, dried, cured, pickeld), no processed meats (hot dogs, etc) -dairy: can only have cottage and motz cheese (aged is bad), NO yogurt -no alcohol, caffeine, or chocolate (not even soy sauce) AGED & FERMENTED Cheese Sour cream Yogart Soy sause cured meats beer/wine smoked fish

How do you walk w/ a cane?

-hold can on STRONG side -advance it w/ the bad leg at the same time to widen the base

In DKA what are 2 possible electrolyte imbalances?

-hyperkalemia and hypernatremia (dehydration) -ND for hypoNa+: fluid volume excess (would be the same w/ SIADH) **DI & HHNK = hyperNa+

What are you at risk for following a Total Thyroidectomy?

-hypocalcemia -s/x: tenany, spasm, HTN, tachycardia >>first sign is parasthesias >>watch chevostek's and trousseau's **pts will need life-long thryoid replacement aka, levothyroxine

hypomania vs mania

-hypomania: Manic but can function -manic: can't function in society

A student nurse runs to you and says they ran 1L of IV into the pt in 10 min b/c they forgot to clamp it, what electrolyte imbalance to you expect to see?

-hyponatremia **would be put on fluid restriction, has fluid overload

What are the 2 most common causes of increasing HR in caridac care?

-hypoxia and dehydration **give O2 and fluids

What is the relationship between overdosing and withdrawaling on uppers and downers?

-if you overdose on an upper = everything goes up -w/drawal on an upper = everything goes down -if you overdose on a downer = everything goes down -if you w/drawal on an upper = everything goes up **watch for sz w/ upper overdose or w/drawal of downer **resp depression w/ upper w/drawal or downer overdose

How quickly do tranquilizers take effect?

-immediately, but pt should not be on them long-term -antidepressants can take 2-4wks to work, but pt can be on them permanently **pts generally start w/ a tranq and antidepressant at the same time and then once antiD starts working, tranq is stopped

What is the Pre-op lumbar laminectomy's most important assessment?

-innervates bladder and legs -1st bladder/voiding (last time they voided, distention) -2nd leg motor and sensory function

3 questions you need to ask when picking a child's toy or play activity? safety considerations?

-is it safe? -is it age appropriate? -is it feasible? Safety considerations -no sm toys for children <4 -no metal toys if O2 is in use (no dye-casts) -beware of fomites (stuff animals), hard plastic can be disinfected so better ***if kid immunosuppressed, need to pick hard plastic toy

What is the treatment for ventricular dysrhythmias?

-lidocaine and amiodarone

Calcium Channel Blockers

-like Valium for your heart, calm it -Use: A, AA, AAA (antihypertensives, antianginals, anti-atrial-arythmias) -SE: H&H (headache and hypotension) -ex: anything that ends in -dipine "-dipinng your toe in the channel" >>plus verapamil and cardizem/diltiazem (can be given cont. IV drip) -need to measure BP b/f giving (causes hypotension) -need to titrate drip if BP low

What are 3 examples of rapid-acting insulin?

-lispro** (humalog) -aspart -glulisine

What s/x do all psych drugs cause?

-low BP and weight changes, usually gain

What are the toxytocic's?

-maternity durgs that stim and strengthen labor -oxytocin -Methylergonovine -oxytocin: Can cause hyperstimulation (contractions longer than 90 sec. and closer then 2 min., then stop pit) -methylergonovine: SE causes high BP (contracts blood vessels and uterus

What diseases do you need airborne precautions for?

-measles -TB -Rubella -varicella (chicken pox)

What diseases do you need droplet precautions for?

-meningitis -h.flu -influenza -mumps -pertusis -diptheria **mask, gloves, disposable/dedicated equipment

What 2 drugs are used for alcohol abuse treatment?

-naltrexone (Revia) -disulfiram (Antabuse) -used for aversion therapy, pt feels deathly ill if drinks and takes these meds -onset: 2 wks for onset and duration (must be off for 2wks b/f being able to drink)

Thyroid storm treatment?

-need to get temp down and O2 up >temp decrease: icepacks first, best way is cooling blanket >O2 up: O2 per mask, high-flow (10L) **no meds, self-limiting condition, try to control symptoms

If there is intermittent bubbling in the suction control chamber for the chest tube what do you do?

-need to turn up suction, bubbling should be continuous in this chamber

IF an older pt is taking haloperidol, what do we need to watch out for?

-neuroleptic malignant syndrome (NMS) -potentially fatal hyperprexia (fever) >>temps of 106-108 (>102-105) SE: anxeity and tremors w/ EPS >>need to distinguish from EPS by the anxiety and high fever **cut dose in half for older adults to prevent this >>risk goes up if you're white as well

What are 2 things you need to know for administering K+? (high K+ stops your hear)

-never push K+ IV -not more than 40 L at a times

If a pt is post-op from a pneumonectomy, how many chest tubes will they have?

-none, a penumonectomy is a total removal of the lung -if there's a lobe-ectomy there can be a unilateral tube placement **regular chest surgery, you should assume that there is a unilateral placement

For Peds when in doubt call it?

-normal -pick older pt -pick easier task **give kid more time to develop, don't rush G&D

What is the earliest sign of an electrolyte imbalance?

-numbness and tingling aka parasthesia **circumoral parathesia (numb, tingling lips) -the universal sign of an electrolyte imbalance is muscle weakness (paresis)

What is the onset, peak, and duration of rapid acting insulin (lispro)?

-onset: 15-30 min -peak: 30-2.5 hrs -duration: 3-6 hrs **pt should eat w/in 5-15 min after injection

Humulin 70/30 is what?

70% N insulin (intermediate) 30% R insulin (short rapid) order to draw up: RN (regular then N) draw what you are RN)

Hct norm?

36-54 **triple Hgb to get these #'s

What are the main 6 organs in prioritized order?

1. Brain 2. Lung 3. Heart 4. Liver 5. Kidney 6. Pancreas **The more VITAL the ORGAN, The HIGHER the priority

Describe a 3 point gait?

1. Move two crutches and bad leg together. 2. Move good foot. Move all three together and then the good leg.

RBC norm?

4-6

Describe a 2 point gait?

1. one crutch and opposite foot together 2. Other crutch and other foor together. Move 1 crutch and opposite ft together at same time

Graves disease treatment options are? (3)

1.Radiation with radioactive iodine 2. PTU(drug- Puts Thyroid Under) 3. Surgical removal.

Hgb norm?

12-18 **this is overall, NCLEX isn't going to care about the male/female results

When does quickening occur?

16-20wks

How often do you have to draw a WBC for a patient taking a second generation tranquilizer?

1x a week for 1 month 1x a month for 6 months 1Q6 months for life

INR therapeutic level?

2-3 -test w/ Coumadin/Warafin therapy -if INR is >4 >>Hold all Coumadin/Warafin >>Assess bleeding >>Prepare to give K+ >>Call doctor

How to measure crutches?

2-3 cm/fingerwidths below anterior AXILLARY FOLD to a point lateral and slightly in front of the foot

Normal weight gain for pregnancy?

28 + or - 3 lb

What is the length for hand scrubbing?

3-7 minutes **for scrubbing need to use a Cleaning agent w/ prefix "chlor" -sink cannot have handles use scrubbing if: -Immunosuppresion, surgery, transplant, chemo, HIV

When the handgrip of a crutch is properly in place the elbow felxion should be?

30*

What postpartum assessments should you do Q4-8?

BUBBLEHEAD B-breasts U-Uterine fundus* B-bladder B-bowel L-lochia* E-episeotomy H-Hgb, Hct E-extremity check* A-affection (emotion) D-discomforts *important to check for (fundus, lochia, check legs for thrombophlbitis

Sodium is ok if abnormal unless what occurs?

Change in LOC

Do not Delegate to an UAP

Chart about a Patient (They may document what they DID) Assessment Meds/IV. They MAY apply topical lotions/creams Treatments, except for Soap Suds Enema You MAY delegate ADLs.

Nursing implementations for restraints?

Check Q15min Rotate sites Q2H

Ruptured membranes

Check for prolapsed cord

If you see the words "During the initial interview" "Upon admitting the patient" "On admission" "At your first few meetings with" "While assessing" "On the day of admission" "While FORMULATING nursing diagnoses"

Correct answers should be: Tolerant Accepting Explorative Probing "Nosy" Be warm and fuzzy This is the introductory phase. You would not set limits

What do you do if a staff members behavior is legal, not harmful but just inappropriate?

Counsel them later at a better time. >>intervening could make it worse at the time, pick more appropriate time to address

Best indicator of kidney function? give normal level

Creatnine 0.6-1.2

What are the s/x and treatment of DKA?

D-ehydration K-etones in urine/blood, Kussmauls and K+ A-cidosis (metabolic), Acetone breath (fruity), Anorexia d/t nausea -High IV flow rate (fast rate) (150-200hr) with insulin R in prescribed mixture (Rehydrate and push K back into cell, Oxygenate) **can have ketones in your urine and not have DKA, but if you have ketones in your blood you have confirmed DKA

Stages of Grief (Kubler-Ross)

DABDA -Denial -Anger -Bargaining -Depression -Acceptance

In a tonsellectomy, what days are most important post op?

Days 6-8, biggest risk for bleeding.

If a patient is on drug A for 10 yrs. and the doctor adds drug B which drug dose needs to be lowered?

Drug A

Pt just had gastric surgery...acting drunk and in shock with ABDOMINAL distress... Think?

Dumping syndrome! Low everything! **Pt has chest pain when lying down and indigestion = hiatel hernia

What the first thing you need to ask when looking at a psych question?

Is this person psychotic or not? -non-psychotics: have insight and is reality based >>pts can be emotionally ill or distressed by they know they have a problem and what they smell, hear, taste, etc is real >>if a pt is not psychotic, then use good therapeutic communication -psychotic pt is not reality-based -they may think they're sick/ be able to state their diagnosis but doesn't mean they have insite **do NOT pick a therapeutic answer for these pts

In a patient with suspected shock, how should you position them?

Legs elevated

If client exercises more they need?

Less insulin and a snack Best answer for a type 2 diabetic? -Calorie Restriction

What is the #1 post-op answer for the NCLEX?

Log roll the patient

Theophylline

Long acting bronchodilator

Low bowel surgery

Low residue diet

Pts with Adrenal cortex diseases must have

Med alert bracelet

What pt can you delegate to an LPN? a) pt w/ angina pectoralis w/ crushing substernal pain who is on nitroglycerin b) pt w/ subtotal thyroidectomy complete two days ago, who says, "why are they washing elephants in the parking lot"

a)pt w/ angina pectoralis w/ crushing substernal pain who is on nitroglycerin -substernal pain is expected w/ angina -in subtotal thyroidectomy, a complication is thyroid storm, a symptom of storm is delirium, this is not an expected outcome for the pt so an RN would need to assess

Weirnicke-Korsakoff syndrome

alcohol induced, lack of vit B1 -Weirnicke: encephalopathy -Korsakoff: psycosis induced by vit B1 or thiamine deficiency -SE: amesia w/ confabulation (making up stories to fill in areas they forgot and believing them) Preventable, arrestable, irreversible -preventable w/ taking vit B1 or stop drinking -arrestable: stop it from getting worse by doing above -irreversible: 70% will die **don't confront or present reality w/ these pts, they have brain damage, need to redirect

PO2 70-77 you? And if it drops further, PO2 below 60, what do you do?

at 70-77 -Assess respiratory status, Give O2 <60: -Assess respiratory status -Give O2 -Prepare for intubation -Call respiratory therapy -Call the doctor (norms: 78-100)

IF you give your pt an (N) or intermediate acting insulin at 7am, when would you check for hypoglycemia? a) 9am b) 3pm c) 6pm d) 7pm

b) 3pm **peak is 8-10 hours for intermediate insulin so peak would be from 3-5 pm or "late afternoon"

If your pt is on a PCA pump, what acid-base imbalance will cause you to take them off of it? a) respiratory alkalosis b) metabolic alkalosis c) respiratory acidosis d) metabolic acidosis

c) respiratory acidosis -PCA pumps depress respirations = underventilation

Who is the highest priority patient? a) 16-yr-old female w/ meningococcal meningitis who has had a temp of 103.8 since admission 3 days ago b) 66-yr-old male w/ irritable bowel syndrome who spike a temp of 100.3 this afternoon

b) 66-yr-old male w/ irritable bowel syndrome who spike a temp of 100.3 this afternoon **the pt w/ meningitis has had a stable temperature over a few days, the other pt w/ IBS has had a change in status and a fever would not be expected with an IBS pt

If your male pt comes in with hyper-emesis what acid-base imbalance would he have? a) respiratory alkalosis b) metabolic alkalosis c) respiratory acidosis d) metabolic acidosis

b) metabolic alkalosis -vomiting or suctioning = met alkalosis -losing acid

The ER nurse gets a call from an EMT reporting a patient with an overdose on cocaine, what would you expect to see? Select all that apply a) respiration rate <12 b) reflexes (+4) c) borburigmi d) irritability e) difficult to arouse f) increased temp

b) reflexes (+4) c) borburigmi d) irritability f) increased temp -too much upper, makes things go up

You suspect a another nurse is diverting narcotics away from the hospital for sale, what do you do? a) confront the nurse and take over her pts b) report the behavior to the supervisor c) ignore the behavior d) talk to the individual at a later date

b) report the behavior to the supervisor -if true, this is illegal and should be reported to a higher up

If platelets are low, what do you do?

below 90,000 -Check for bleeding -Place on bleeding precautions (thrombolytic precautions) below 40,000 -Prepare platelet transfusion -Call the doctor **class D -norms 150,000-400,000

A young boy with type one diabetes comes into the E.R. with a blood glucose of 800, what is the best question to ask his parents to determine the cause of the DKA? a) Has your child be involved in high activity today? b) Did your child have an extra dose of insulin today? c) Has your child had an URI in the last two weeks? d) Did your child skip a meal today?

c) Has your child had an URI in the last two weeks? **(A) is correct but not the BEST answer, the most common cause of DKA is upper respiratory infection --the stress of the illness causes the body to break down fats, leading to ketones --need to confirm with ketones in the blood, ketonuria can be present without DKA so this is not diagnostic

A woman comes into the doctors off advising she had a positive reading on a pregnancy test. Her last menstrual period was June 10th-June 15th. Calculate her due date. a) March 22nd b) February 10th c) March 17th c) May 17th

c) March 17th -add 7 days to the first day of the last menstrual cycle, then subtract 3 months

Your pt has hypothyroidism, what pre-op order would you question? a) penicillin b) insulin c) ambien

c) ambien **pt should not be given sedation medications, can lead to myxedema coma --their whole body is slowed b/c decreased coma

Which patient would you see first, a pt w/ COPD, pt w/ CHF, or pt w/ appendicitis? a) COPD b) CHF c) appendicitis

c) appendicitis -acute will always been chronic conditions when choosing prioritization

When you give a Calcium channel Blocker, what vital sign do you need to measure before you give it? a) temperature b) respirations c) blood pressure d) SpO2

c) blood pressure -Ca+ blockers are like Valium to the heart, it slows it down and creates vasodilation leading to hypotension

You have a pt with chest-tubes in for a hemothorax, what would you report to the provider? a) chest-tube is not bubbling b) chest-tube drained 800mL in first 10hrs c) chest-tube is not draining d) chest-tube is intermittently bubbling

c) chest-tube is not training -supposed to be draining blood if it was a pneumothorax it could be a or b -supposed to bubble with pneumothorx b/c air should drain and not supposed to be draining

The doctor says wean off vent in the a.m. tomorrow, the 6am ABG's show respiratory acidosis, what would you do? a) follow the order b) call respiratory therapy c) hold the order, call the doctor d) begin to decrease the settings

c) hold the order, call the doctor -the pt is under-ventilating b/c has respiratory acidosis so we don't want to take the pt off the vent -if pt had respiratory alkalosis then pt could be on the ventilator "B" is a bad answer b/c you should never defer responsibility

A pt underwent a lumbar laminectomy 10 hours ago, whats the number one problem you could expect? a) airway b) breathing c) circulation d) urinary retention

d) urinary retention -complications of laminectomies all depend on the location, if a lumbar lam then need to look for issues with the bladder and the legs >>cervical: breathing and arms >>thoracic: cough and bowels

A pt has pneumonia present in 4 lobes, they have a RR of 52, and a SpO2 of 78. What acid-base imbalance is the patient exhibiting? a) respiratory alkalosis b) metabolic alkalosis c) respiratory acidosis d) metabolic acidosis

c) respiratory acidosis -the rate is less important than the gas exchange, if the SpO2 is 78 then gas exchange is not good and shows acidosis -they are under ventilating, under = acidosis -not about rate about SaO2 or SpO2

A women is in her 28th week, she has gained 22lbs, what is your impression a) she has average WG b) she's underweight c) she's overweight d) need an assessment to gather more information

c) she's overweight >>she should have gained 19 lbs -to calculate weight gain, you take the number of weeks gestation and subtract 9, that will give you the number of lbs supposed to be gained **a women gains 3 lbs in the first tri and 1 lb/wk in the second and third *****if the weight is 1-2 lbs off then that's okay, say w/in range

You are caring for a pt whose lab value for K+ came back as a 6.1. Arrange the order of actions you would take from first to last. a) assess heart rhythm/rate b) prepare Kayxolate and D5W w/ insulin c) stop K+ drip d) call physician

c) stop K+ drip a) assess heart rhythm/rate b) prepare Kayxolate and D5W w/ insulin d) call physician **this is a critically high lab value, if it is critical you cannot leave the bedside of the pt, you must get other people involved to move stat to correct the imbalance b/c death is impending

You are caring for a pt whose lab value for INR came back as a 4.5. Arrange the order of actions you would take from first to last. a) assess for bleeding b) call physician c) stop Warfarin/coumadin d) prepare vitamin K antidote

c) stop Warfarin/coumadin a) assess for bleeding d) prepare vitamin K antidote b) call physician **if actions need to be taken for a lab value you always: >>hold, assess, prepare, call >>Normal value for INR: 2-3

If a high-pressure ventilator alarm is going off, what order of events would you follow? a) reposition pt, turn, cough, deep breath b) provide suctioning c) empty any water out of the tubing d) check for kinks/unkink tubing

d) check for kinks/unkink tubing c) empty any water out of the tubing a) reposition pt, turn, cough, deep breath b) provide suctioning **suction only if all else fails, always check for kinks in tubing first, then see if there's any condensation in the tubing if so empty, then turn pt and then them to cough/deep breath, then and only then do you suction

Your Pt has hyperkalemia, select all that apply: a) dynamic ileus b) obtundant c) +1 reflex d) clonus e) u wave f) depressed ST g) polyuria h) bradycardia

d) clonus h) bradycardia **-kalemias do the same as the prefix except for the HR and urine output ---U wave starts on the baseline and goes down, its a sign of cardiac depression (if you don't know what it is on a select all apply then don't pick it)

If an infant comes in with diarrhea, what acid-base imbalance is anticipated? a) respiratory alkalosis b) metabolic alkalosis c) respiratory acidosis d) metabolic acidosis

d) metabolic acidosis -diarrhea is not vomiting or suctioning so it is not alkalosis -diarrhea leads to dehydration = acidosis

If a male pt comes in with prolonged hyper-emesis that has lead to dehydration what acid-base imbalance would they have? a) respiratory alkalosis b) metabolic alkalosis c) respiratory acidosis d) metabolic acidosis

d) metabolic acidosis -even though the pt is vomiting, they are now dehydrated which is the main take away from the question, dehydration = acidosis

If a pt has third degree (full thickness) burns over 60% of their body in the first phase, what acid-base imbalance do you expect to see? a) respiratory alkalosis b) metabolic alkalosis c) respiratory acidosis d) metabolic acidosis

d) metabolic acidosis -not a lung issue -not due to vomiting or suctioning

If your pt is in kidney failure, what acid-base imbalance do you expect to see? a) respiratory alkalosis b) metabolic alkalosis c) respiratory acidosis d) metabolic acidosis

d) metabolic acidosis -not a lung issue -not due to vomiting or suctioning

A 49yr old alcoholic gets her 17yr old daughter to the store to buy alcohol for her, is this okay? a.) yes, its for her mom who is sick b.) no, its dependence c) yes, only if an adult is present d) no, its manipulation

d) no, its manipulation -b/c a 17 yr old buying alcohol is illegal which is harmful to her = manipulation -if a spouse was asked, that is w/in age, the act would be dependency