Notes for Nclex

Mannitol

, an osmotic diuretic, increases the intravascular volume that must be excreted by the kidneys. The client's urine output should be monitored hourly to determine the client's response to therapy

Level One: Pre-Conventional/Premoral Morality

- The child's behavior is motivated by anticipation of pleasure or pain. Stage 1: Punishment and Obedience Orientation Egocentrism Inability to consider the perspectives of others Stage 2: Naively Egocentric Orientation This stage values the right action, is that which is instrumental in satisfying the self's needs and occasionally others'. In other words, children in this stage view morally right action as that which increases their personal rewards.

Tropoinin T levels and tropoinin I level

0.1-0.2, below 0.6

6 months- 1 year head circum grows?

0.5 cm

4-6 months head circum grows?

1 cm

piagets theory

1. sensorimotor 2. preoperational 3. concrete operations 4. formal

TB results positive

10mm or larger for adults

formal

11-up egocentric thought Think more logically than ever before and can see new logical relationships Analyze situations and engage in problem solving More creative due to the ability to think abstractly Increased concern for moral and social issues

what week can you feel fetal movement?

14-18 weeks

birth- 3 months head circum grows?

2 cm

what age can use spoon and cup?

2 yrs

preoperational stage

2-7 using symbols and mental images thinks past, present, future Object permanence becomes more established There's still an egocentric view of the world Use of language increases Increased magical thinking and imagination (animism) Perceptions rule thinking and reasoning Short attention span Thinking is non-logical The child has a better concept of time as he or she approaches school age nursing consideration Children in this stage of development learn best if they are actively involved in the learning process. They relate well to imfprmation about what they will see and feel, which is why visual and tactile learning works well. However, children have many fears, especially separation from a parent or caregiver (which peaks around 2-3 years). Illness and hospitalization frightens toddlers and preschoolers because they lack the cognitive ability to grasp these experiences. Although older children are capable of some reasoning, they will use fantasy and magical thinking in their attempt to understand illness. Younger or preoperational children think everyone sees the world as they do.

what age can use a fork?

3-4 years

treatment for scabies

5% permethin lotion

concrete operations

7-11 think of action before doing it classify, order, sort facts Thinking shifts from total egocentrism, but egocentric thinking still predominates The conscience develops Perception no longer dominates reasoning; cause-and-effect relationships are recognized Understands basic concepts of numbers, classifications and other concrete ideas The attention span increases Mental actions are reversible and problem-solving occurs by trial and error nursing consideration: School age children can use reasoning but it is limited to their own experience. They understand cause and effect and can think creatively. A concern for moral and social issues begins to develop and there is less egocentric thinking.

how long after the last dose will the nurse schedule to have a client's blood drawn to evaluate the serum lithium level?

8-12hrs

what age does mastery of concept of conservation of volume?

9-12years old

identity vs. role confusion

Adolescence (12-18 years) Exploring independence and developing a sense of self.

Generativity vs. Stagnation

Adulthood (40-64 years) Building careers and family.

Aldendronate

Alendronate therapy may cause esophageal ulcers; therefore the nurse instructs client A, who is on alendronate therapy, to remain upright for 30 minutes after medication administration to prevent esophageal ulcers. Standing upright for 30 minutes after medication administration will allow the drug to move drug quickly in the stomach.

atomoxetine

Atomoxetine is a nonstimulant second-line drug used to treat attention deficit hyperactivity disorder (ADHD)

what treats chlamdyia infection? what treats syphilis?

Azithromycin is used to treat a chlamydia infection. Pencillin G treats syphillis.

Barbiturates?

Barbiturates are used to treat epilepsy and are the most common causative agents of toxic epidermal necrolysis (TEN). Diffused redness and large blisters on the buccal mucosa are the clinical signs of TEN.

cardiac tamponade?

Cardiac tamponade is accompanied by distant, muffled heart sounds and prominent neck vessels.

cardiogenic shock?dissecting aortic aneurysms?

Cardiogenic shock occurs with severe damage (more than 40%) to the left ventricle. Classic signs include hypotension, a rapid pulse that becomes weaker, decreased urine output, and cool, clammy skin. Respiratory rate increases as the body develops metabolic acidosis from shock. Dissecting aortic aneurysms usually are accompanied by back pain.

Clomiphene? Tolvaptan and conivaptan?Metyrapone?

Clomiphene is used to trigger ovulation for women with gonadotropin deficiency. Tolvaptan and conivaptan are used to treat syndrome of inappropriate antidiuretic hormone. Metyrapone is used to treat Cushing's syndrom

diabetes inipidus

Diabetes insipidus is characterized by hyposecretion of antidiuretic hormone, and the kidney tubules fail to reabsorb water. Polydipsia and polyuria are classic symptoms of diabetes insipidus. The urine is pale, and the specific gravity is low. Anorexia and weight loss occur.

A pregnant client has labor pains. However, the nurse finds that the client's cervix is not dilated. Which drug should be administered to the client to promote labor?

Dinoprostone induces cervical ripening. This action helps in the induction of labor at term. Oxytocin enhances labor when uterine contractions are weak and ineffective.

Autonomy vs. Shame and Doubt

Early Childhood (18 months-3 years) Children develop a greater sense of personal control (i.e. toilet training).

Intimacy vs. Isolation

Early adulthood (18-40 years) Exploring personal relationships is important, especially love relationships.

A lactating woman has developed thromboembolism. Which drug should be prescribed if she wishes to continue breast-feeding?

Heparin is the drug of choice to treat thromboembolism in a lactating woman because it is not absorbed in the breast milk

Type 1 reaction

IgE medicated histamine ex. allergies

Trust vs. Mistrust

Infancy (birth-18 months) The development of trust is based on the dependability and quality of the infant's caregivers (i.e.: being fed).

Isotrentinoin

Isotretinoin, 13-cis-retinoic acid (Accutane), is used to treat severe cystic acne that has not responded to other treatments.

Meperidine

Meperidine is a strong analgesic that when taken concurrently with MAOIs may result in excessive elevation of the temperature.

methimazole and propylthiouracil

Methimazole and propylthiouracil inhibit the synthesis of thyroid hormones and are used to treat hyperthyroidism.

Nitro action?

Nitroglycerin reduces cardiac workload by decreasing the preload of the heart by its vasodilating effect.

Integrity vs. Despair

Older adult (65 years to death) Reminiscing and reflecting on one's life

PQRSTU

P- wht makes it better or worse Q-quality R- rate S- loaction T- constant? U - how it affects you

hormone that is osteoclastic?

PTH- bone resorption

Initiative vs. Guilt

Preschool (3-5 years) Children begin to assert their power and control over the world through direct play and other social interaction (i.e.: independence).

hep A relapses

Relapses are common; they occur after too early ambulation and too much physical activity. Fatigue is a cardinal symptom; if the client tires at rest, a return to work must be delayed. The client does not stay contagious for six months.

Rifampin (Rifadin)

Rifampin causes body fluids, such as sweat, tears, and urine, to turn orange. treats TB

Industry vs. Inferiority

School age (6-11 years) Through social interactions, children begin to develop a sense of pride in their accomplishments.

sibutramine? Orlistat? Metformin?

Sibutramine is an appetite suppressant used to treat obesity. Orlistat is a lipase inhibitor that has been approved for children 12 years and older. y intracranial tumors. Metformin is prescribed to obese clients with insulin resistance and hyperinsulinemia.

Level Three: Post-Conventional Morality

Stage 5: Social Contract Orientation Norms of right and wrong are defined in terms of laws or institutionalized rules which seem to have a rational basis. When conflict arises between individual needs and law or contract, though sympathetic to individual needs, the individual believes the law or contract must prevail because of its greater functional rationality for society, the majority will and overall welfare. Stage 6: Universal Ethical Principle Orientation Orientation not only toward existing social rules, but also towards the conscience as a directing agent, mutual trust and respect, and principles of moral choice involving logical universalities and consistency. Action is controlled by internalized ideals that exert a pressure to act accordingly regardless of the reactions of others in the immediate environment. If one acts otherwise, self-condemnation and guilt result.

superior vena cava syndrome

Superior vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms. Cyanosis and mental status changes are late signs.

Parkland formula?

The Parkland (Baxter) formula for estimating fluid requirements is 4 mL × kilograms of body mass × percent total body surface area. Half of this total is administered in the first 8 hours after the burn.

Level Two: Conventional/Role Conformity

The child behaves appropriately in order to please others. Stage 3: Good Boy-Nice Girl Orientation Orientation to approval, to pleasing and helping others Relativism of values to each other's needs and perspectives Naive egalitarianism, orientation to exchange and reciprocity Stage 4: Law and Order Orientation Orientation to "doing duty" and to showing respect for authority and maintaining the given social order for its own sake Regard for the earned expectations of others Differentiates actions out of a sense of obligation to rules, from actions springing from generally nice or natural motives

Hypothalamus secretes? Anterior pituitary gland?

The hormones that are secreted by the hypothalamus include prolactin-inhibiting hormone and corticotropin-releasing hormone. Growth hormone, follicle-stimulating hormone, and melanocyte-stimulating hormone are hormones secreted by the anterior pituitary gland.

resuscitation/emergent phase of burns?

The resuscitation/emergent phase begins at the time of injury and ends with the restoration of capillary permeability, usually at 48 to 72 hours following the injury. During the resuscitation/emergent phase, the hematocrit level increases to above normal because of hemoconcentration from the large fluid shifts. Hematocrit levels of 50% to 55% are expected during the first 24 hours after injury, with return to normal by 36 hours after injury. low urine output. Pulse rates are typically higher than normal, and the blood pressure is decreased as a result of the large fluid shifts.

zanamivir

Zanamivir is used with caution in clients who have asthma or chronic obstructive pulmonary disease (COPD) and in older adults.

12 weeks preggo where should the fundus be palpated

above symphy publis

lamivudine treats?

antiviral slows and replication of HIV and decrease progression. it is used for proph treatment for exposed health care.

20 weeks preggo where should fundus be palpated

at umbilicus

natural killer

attack mutated cells

Foods high and low in potassium

banana, canteulope, kiwi, oranges cherris, berris, grapefruit, peaches,apples, pineapples

16 weeks preggo where should fundus be palpated

between symphy publis and umbilicus

sensorimotor stage

birth-2y, construct an understanding of the world by coordinating sensory experiences w physical/motor actions (understands environment) Children use the skills and abilities they were born with (such as sucking, grasping and listening) to learn about the environment Reflexes are used to achieve equilibrium Repetitive acts help establish patterns of behavior Active experimentation is used The concept of object permanence begins (learning that an object still exists even when it is out of sight) There's an egocentric view of the world

hormone that is ostoblastic?

calcitonin- breakdown

Calicum supplements

calcium supplements, is advised to take one-third of the daily dose at bedtime as calcium is most readily utilized by the body when the client is fasting and immobile. osteoporosis

Air embolism S/S

chest pain , dyspena, increase HR and drop BP and loud churning over pericardium

what is the bacteria that causes cervicitis?

chlamydia trachomatis

treatment for bedbugs

chlorocyclohexane

type 2 reaction

complement lysis mediator injury ex. good pastures, blood transmission, gravis

infiltration s/s

coolness, pallor, swelling

rhonhi

course over large airways

normal age changes?

decrease HR, visual acuity, short term memory increase chances UTI, awakening at night

IgD

diff B lymphocytes

treatment for tick bites

doxcycline

cataract surgery post op care

dressing removed at the end of day need to wear metal or plasic eye cover for proction need to lay on opposite side when sleep need to wear glass during the day no warm pack unless HCP says uses stool softners

meningities precautions

droplet for least 24 hrs after antibiotics and private room.

early and late sign of ICP

early- nausea late- alternation of pupils, cushing tirad, bradycarda, decrease loc

what age can use knife and pour own drink?

end of preschool.

helper t cells

enhance immunity

early deceleration

followed by return to baseline normal

GTPAL?

g- number of births T- full term longer 37 weeks P-before 37 weeks A- abortions or miscarriages L- living children

Kohlberg stages of moral development

has 6 stages in sequantial fashion but not everyone reaches 5 or 6. -progress in relationships to cognitive dev make judgement over period of time

pertussis and treatment?

high contagious infection of the resp tract and need anitbitoics.

what is the bacteria that causes genital warts?

human papilomavirus

type 3

immune complex with neutrophil ex lupus, tissue death

cyclosporine

immunosuppresnt no vaccinations report decrease urine and cloudy urine need dental check up every 3 months for givigual hyperplasia self check for BP

azathioprine

immunosupressant take for life do not miss more then one dose need to tell HCP

station measurements

measured from ischial spine showing part. - is above + is below

gynecoid pelvis

most favorable for labor easier

anthropoid pelvis

narrow public arch

TPN (total parenteral nutrition) via infusion pump

need to change bag every 24 hours even if there is some in it. because it has high glucose and can cause bacteria growth at room temperature. need to check glucose every 4-6 hours for increase glucose. when changing the tubing the patient should use the valsalva maneuver to prevent air embolism.

cyclophosphamide

need to watch for painful urination because of cystitis. need to increase fluids to prevent this.

what is the bacteria that causes Gonorrhea?

neisseria gonorrhoe

multiple myeloma findings?

neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia(need alot of fluids) caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level.

what can you NOT do after an amputation below the knee?

no elevation for 24hrs because it can lead to hip contracture.

celliac disease

no wheat, oat, RYE can eat rice, corn, millet

chest tube

normal- fluctuation of water level. increase during inhale and decreased during exhale abnormal- no fluctuation=obstruction or suction is not working. Air leak- excessive bubbling decrease suction- excessive bubbling in suction chamber.

mastectomy post care

normal- have numbness at site and inner arm from armpit to elbow. goes away to months to year.

menierers diease

over production and defective absorption of endolomph. increase volume and pressure within membranes diet: low sodium, caffeine, sugar, alcohol

PE care

oxygen, assess BP, morphine, IV started, heparin

placenta previa

painless vaginal bleeding soft nontender uterus

dark color skin places

petechia- oral muscosa juandice- sclera cyanosis- palms and soles

rubeloa care

photophobia need stay away bright lights warm baths and sunlight make itching worse need rest

IgM

plasma primary immune response

IGE, IGg

plasma, interstiial fluid ex. allergic

ticlipidine hydro

platelet aggravtion to decrease thrombotic stroke with patients with signs no aspirin

lactulose treats?

port encapthy removes annomia and laxative removes annomia out of blood and expells it in poop.

methyllergonovine is used for?

postpartum hemmorahge casues vasoconstriction of the uterus. it is avoided for women with cardiovasular disease and hypertension. need to check BP

furesmide need to check what electrolyte?

potassium because it lowers it.

hypocalemia ECG

prolong QT interval or ST

hypokalemia ECG signs

proment U wave inverted t waves ST depression

tonsillectomy post op position?

prone or side for drainage

mild preeclampsia s/s to report

protein in urine weight gain 1 pd per week or edema 3 or less fetal movments pr hour

what do you do when chest tube dislodges?

put on sterile glove and cover site and then call for HCP.

Raloxifene?

raloxifene, is advised to have a liver function test (LFT) done as this drug may increase LFT values or worsen hepatic disease. osteoporisis

what is truvade used for?

reduce the risk for HIV

plasma cells

response specfic antigens

What is leflunomide used for?

rheumatoid arthritis immunomodulatory and noninflammatory - it decrease joint pain

duodenal ucler pain

right epigastrum worse at eating 90- 3 hrs awaken at night due to pain

cytotoxic t cells

selectivity, non self cells

Incentive Spirometry steps?

semi fowlers mouth over mouthpiece inhale slowly and constant at reach max inhale need to hold 2-3 sec and exhale slowly

Hypercalcemia ECG

short ST wide t wave

anterior fontanel

soft, flat and diamond shape top of head

negales rule

substract 3 months and add 7 days and ad one year to last menstrual day.

type 4

t cyctoxic cells involved ex. contact dermatitis, delayed graft rejection, sarcoidosis

IGA

tears, saliva, breastmilk protects body

cerebellum vs cerebrum

the cerebellum is involved in the synergistic control of muscle action. The cerebrum is responsible for the level of consciousness and voluntary motor function.

Etanercept? Infliximab?

the nurse should teach a client who is receiving etanercept therapy to report signs of site reaction, as they are very painful. The nurse should teach a client who is receiving infliximab therapy to report chest pain. The nurse should teach a client who is receiving infliximab therapy to report difficulty in breathing during intravenous infusion; etanercept is given subcutaneously. Rheumatoid arthritis

bacavir is used for?

treat HIV

android pelvis

unfavorable because narrow pelvic planes

gastric ulcer pain

upper epigastrum and left midline worse after meal 30-60 minutes not awaken

what do you do if umblicial cord is protruding?

upward pressure with gloved hand then warm solution towel.

abruptio placentae s/s

vaginal bleeding abd pain mild to severe uterine tenderness

when do you stop Oxytococin?

when you have non reassuring FHR and uterine hypertonicity. need to stop infusion, side lying, oxygen and HCP

leg cramps in pregancy

where the uteurs is enlarges and compressed the release of calcium and increase phosphous. when thromb is ruled out then can use heat and dorsiflex of foot. doc can prescribe calcium with meals.

platypelliod pelvis

wide pelvis, shorter diameter

36 weeks preggo where should the fundus be palpated

xiphoid process

zoledronic acid?

zoledronic acid, is instructed to have a dental examination before drug administration as this drug can cause jaw or maxillary osteonecrosis if oral hygiene is poor. osteoprosis