NCLEX

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Ca Channel Blocker

(-ipine/-amil) vasodilate and adverse effects (2) may cause increased heart failure slows movement of calcium into smooth muscle

What signs/symptoms would the nurse expect to assess in a client diagnosed with multiple sclerosis (MS)?

1. Fatigue 3. Blurry vision 4. Leg weakness 6. Electric shock sensation when bending neck forward

Patient with bacterial meningitis will present with what symptoms

1. Positive Kernig's sign 2. Positive Brudzinski's sign 4. Photophobia 5. Severe headache 6. Nuchal rigidity

nurse is monitoring the client's heart rhythm. The monitor shows sinus tachycardia. What is expected with this assessment finding?

1. Regular rhythm 2. Rate of 101-200 3. P wave normal 5. QRS complex normal

Urine Specific Gravity

1.010-1.030 the higher it goes the more dehydration

Magnesium

1.3-2.1

Ammonia

10-80

The nurse is teaching a group of teenagers about decreasing the risk of developing skin cancer. What information should the nurse include?

2. A self-tanning product containing dihydroxyacetone (DHA) is safe to use. 3. Put on sunscreen every day, even on days when it is cloudy. SPF 15 or higher 4. Stay in the shade between 9 AM and 4 PM.

Total protein

6-8

Fasting glucose

70-110

Calcium

9-10.5

Chloride

98-106

Standard Precautions

A strict form of infection control that is based on the assumption that all blood and other body fluids are infectious.

The nurse is discussing information on adolescent obesity with parents of high-school students. What statement by the nurse is most comprehensive regarding obesity among teens?

Adolescent obesity is usually an inability to recognize signals of hunger or satiety.

Partially compensated

All values are abnormal

Adenosine

Antiarrhythmic converts SVT to sinus Stops the heart and restarts

Amiodarone

Antiarrhythmic used for v fib and v tach

Atropine

Antidysrhythmic agent. Increases firing of the sinoatrial node (SA) and conduction through the atrioventricular node (AV) of the heart, opposes the action of the vagus nerve by blocking acetylcholine receptor sites. Used for bradycardia and known exposure to chemical nerve agent (AtroPEN).

AST, ALT, ALP, GTTF

Blood tests that help identify liver disorders AST 0-35 ALP 30-120 ALT 4-36 GTTF Male 0-65 Female 0-48

alpha2 agonists

Clonidine Methyldopa contrindicated with anticoags

Hypertonic

D10W D50W D5NS D5LR

Amylase

Enzyme in saliva that breaks the chemical bonds in starches 30-220

What should you watch in feeding tube patients>

Feeding tube clients tend to get dehydrated, especially clients on bed rest, because bed rest induces diuresis! If the client is already having neurological signs, a grand-mal seizure may be next! Better take seizure precautions while awaiting the serum sodium results.

Mycophenolate

Immunosuppressant/ organ transplantation ***notify doctor if any signs of infection occur***

What type of breathing does a patient display with respiratory alkalosis

Kussmauls

Airborne precautions

MTV or My chicken hez tb measles, chickenpox (varicella) Herpes zoster/shingles TB

In any type of metabolic acidosis what is going to happen to the serum potassium level? Therefore, what is the major electrolyte imbalance that they will have, and what is the major side effect that they will have?

Metabolic acidosis increase the serum Potassium and that can cause ventricular tachycardia HEART ARRYTHMIA

What chemicals should come to mind when you think kidneys

PCo3 -bicarb

why do you have to worry about hypokalemia in the alkalotic patient? what life threatening complication can occur

Potassium goes down, low potassium leads to heart arrythmias

respiratory alkalosis causes

Primary cause: Hyperventilation (causes hypocapnia); Contributing Causes: Overventilation on a ventilator, Response to acidosis, Bacteremia, Thyrotoxicosis, Fever, Hepatic failure, Response to hypoxia, Hysteria

Early signs of hypoxia

RESTLESSNESS AGITATION TACHYCARDIA

If you have a client on a ventilator and the respiratory rate is set too high, will the client go into resp acidosis or alk?

Resp Alk they are expelling to much C02

Hyponatremia signs and symptoms

SALT Stupor/coma Anorexia Lethargy Tendon reflexes decreased LOSS Limp muscles Orthostatic hypotension Seizures/headache Stomach cramps

What measures renal function

Serum creatinine (0.6-1.2 male, 0.5-1.1 female) BUN 10-20 Creatinine clearance (90-139 male, 80-125 female)

Brudzinski's sign

Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.

Temp conversion

Temp x 1.8 + 32 cel to fah Temp x 1.8-32 fah to cel

Reverse Trendelenburg's position

The head of the bed is raised and the foot of the bed is lowered

The nurse is caring for a client taking digoxin. Which electrolyte imbalance should be of most concern?

The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity could occur

pernicious anemia

Vitamin B12 deficiency symptoms include -smooth red tongue -burning in feet -lightheaded dyspnea upon exertion

airborne, droplet, contact

What are the three types of transmission-based precautions?

WBC

White blood cells 5,000-10,000

Kernig's sign

a diagnostic sign for meningitis marked by the person's inability to extend the leg completely when the thigh is flexed upon the abdomen and the person is sitting or lying down

aPTT

activated partial thromboplastin time 30-40 seconds

Ketones

chemical substances that the body produces when it does not have enough insulin in the blood 0----very bad

A1C

glycosylated hemoglobin 4.5-7....higher is poor diabetes management

What is the most important vital to monitor post MI

heart rate

HcT

hematocrit-percentage of erythrocytes in a volume of blood Female 37%-47% Male 42%-52%

What kind of diet should a patient with hypothyroidism be on?

high fiber, these patients will have constipation

Metabolic Alkalosis

high pH, high HCO3

LDL

low-density lipoprotein-bad l/s 130

What organ compensates for a metabolic imbalance?

lung

In respiratory alkalosis or acidosis what is the problem

lungs

What chemicals should you think of with the lungs

pH and Co2

What are the major acid/base chemicals? What organs control each

pH and PCo2 controlled by the lungs-acids HCo3 controlled by the kidneys-bicarb-base

Uncompensated

pH and one other value are abnormal.

Compensated

pH is normal

Homan's sign

pain in *calf upon dorsiflexion* of foot and may indicated thrombophlebitis

What organ does not like when the pH is messed up>

the kidneys, means the lungs aren't working

DASH diet

whole grains, fruits, veggies, low fat no high sugars, no high fat or high salt items

Total bilirubin

0.1-1.0

Discharge teaching for a mild concussion

1. Concussion symptoms may last anywhere from hours and days to weeks and months. 2. Return to the emergency department for worsening headache. 4. Avoid physical activities until released from care. 5. Awaken the client every two hours.

BUN

10-20

ACE inhibitor drugs

Captopril (Capoten), Enalapril (Vasotec), Enalaprilat (Vasotec IV), Fosinopril (Monopril), Lisinopril (Prinivil) produces vasodilation to decrease BP can cause angioedema used to treat hypertension, HF, MI

HgB

Hemoglobin and tells % of RBC's Female 12-16 Male 14-18

when someone is in respiratory alkalosis, what organ is going to compensate? with what chemicals are they going to compensate?

Kidneys will compensate with bicarb (hco3)

Respiratory Alkalosis

high pH, low CO2

dorsal recumbent position

the back-lying or supine position

Burn Fluid needs

weight in kilograms X fluid per hour (2-4ml) x total percentage burned 1/2 in first 8 hours, 1/2 over next 16 hrs Day 2: Half of Day 1 example: Patient weights 70 kilograms and has 40% of their body burned, the doctor has ordered 4ml IV solution, what is the total to be given in 24 hrs 70kg X 4ml=280 280 X 40(percentage burned)=11200 total in first 24 hours

Kawasaki disease

(inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms. signs and symptoms strawberry tongue high persistent fever erythema on palms and souls enlarged cervical lymph nodes The nurse should recognize strawberry tongue, high and persistent fever, enlarged cervical lymph nodes, and redness of the palms of the hands and soles of the feet as signs of Kawasaki disease. Kawasaki disease is an autoimmune disease in which the medium-sized blood vessels throughout the body become inflamed. Many organ systems, mainly those including the blood vessels, skin, mucous membranes, and lymph nodes, are affected. The most prominent signs are a high and persistent fever that is not responsive to normal treatment with acetaminophen or ibuprofen, extreme irritability, and the presence of a "strawberry tongue" caused by necrotizing microvasculitis.

Hypernatremia signs and symptoms

-thirst -elevated temp. -swollen dry tongue; sticky mucous membranes -hallucinations -lethargy -restlessness -irritability -seizures -pulmonary edema -twitching -nausea -vomiting -anorexia -increased pulse -increased BP

Which interventions should the nurse include for a client with sickle cell crisis who is experiencing pain?

. Massage affected areas gently. Support and elevate swollen joints. Monitor pain level by looking for BP, respiratory, and heart rate elevation. 6. Administer Normal Saline (NS) at 125 mL/hour. Apply warm, moist compresses to affected joints or other painful areas. Avoid use of ice or cold compresses. Warmth causes vasodilation and increases circulation to hypoxic areas. Cold causes vasoconstriction and compounds the crisis. The sickle cell client should not be kept from eating or drinking. Hydration is an important component of therapy. Dehydration promotes sickling process.

what are miotics

. Miotics are medications that cause pupillary constriction such as pilocarpine. The action of miotics are to increase aqueous fluid outflow by contracting ciliary muscle and causing miosis (constriction of the pupil) and opening of the trabecular network.

hypotonic solution

0.45% NS, 2.5% dextrose in 0.45% saline (d2.545%NS)

Creatinine

0.6-1.2

Isotonic

0.9% NS LR D5W

An alcoholic client has agreed to take disulfiram 250 mg PO daily. The nurse recognizes that education has been successful when the client makes which statements?

1. "If I decide to stop taking disulfiram, I should not ingest any alcohol for at least 2 weeks or I will have a reaction." 2. "I must read labels carefully so that I know that alcohol is not an ingredient." 4. "This medication is not a cure. I still need to attend therapy sessions." 5. "I should avoid eating a lot of chocolate while on this medication."

PT

11-12.5 seconds

Sodium

135-145

Platelets

150,000-400,000

Infant Milestones

2 months - holds up head 4 months - rolls from abdomen to back 7 months - sits alone 9 months - crawls 8 - 15 months - standing with support & walking neonate - palmer grasp reflex teething at 6 months

What is the minimal length of therapy time for TB

3 months of medication

Phosphorus

3-4.5

What should the nurse include when teaching a client diagnosed with Grave's disease who is scheduled to receive radioactive iodine?

3. Radioactive iodine will leave the body in urine and saliva within a few days. 4. You cannot receive radioactive iodine if you are pregnant.

Albumin

3.5-5

Potassium

3.5-5

What is a good technique to assess lung sounds in a 3 yr old with asthma

Assessing lung sounds requires a client to inhale and exhale while the nurse auscultates. The most efficient method is to have the child participate in a game that requires breathing in and out. Blowing a cotton ball across a table is an appropriate activity which can be easily understood by a 3 year old child and mimics a game that will encourage participation.

A client wishing to stop smoking receives a prescription for bupropion from the healthcare provider. What educational points should the nurse include regarding this medication?

Bupropion is an antidepressant medication prescribed for major depressive disorders and seasonal affective disorder. Bupropion is used to help people stop smoking by reducing cravings and other withdrawal effects. This medication can cause a false positive drug screening test so the client should inform the laboratory personnel that the client is taking bupropion. Nicotine patches or gum may be prescribed to further support smoking cessation treatment as bupropion is a nicotine free prescription. The client can continue to smoke for about 1 week after starting the medicine. A date to quit smoking during the second week of treatment is determined. The recommended length of bupropion therapy is seven to twelve weeks. Dont drink can cause seizures Common side effect is decreased sex drive

What developmental milestone does the nurse expect to see in an 18 month old toddler?

By the age of 18 months, the nurse would expect the baby to say and shake the head "no", point to a body part, drink from a cup, and point to what they want.

Antihypertensives Drugs

Calcium Channel Blocker ACE inhibitor Beta Blockers Vasodilators Alpha2 Agonists

A client is admitted for management of ulcerative colitis. What sign/symptom would be of immediate concern to the nurse?

Guarding is a completely involuntary response of the muscles. In other words, you have no control over it. It's a sign that your body is trying to protect itself from pain. It can be a symptom of a very serious and even life-threatening medical condition.

In respiratory acidosis, what happens to the Co2 level in you blood? What is causing the increase?

Increases due to slow shallow breathing

A client with a suprapubic catheter is admitted for surgery and requires a catheter change before that procedure. What is the most important action for the nurse to take prior to changing this catheter?

It is important to maintain the same catheter size as the one currently in use since the surgical opening does not increase in size like a urethral opening. If the balloon is too small, urine can leak through the opening. If the balloon is too big, urine will not drain properly, leaving residual and the potential for infection.

A client with an acute exacerbation of systemic lupus erythematosus (SLE) is hospitalized with incapacitating fatigue and fever. A urinalysis reveals proteinuria and hematuria. The primary healthcare provider prescribes corticosteroids. During the acute phase of the client's illness, what is most important for the nurse to do?

Look at the clues in the stem. Proteinuria and hematuria. When you see proteinuria what do you need to worry about? The kidneys! Protein is a great big molecule. The only way for protein to be seen in the urine is if there are holes in the glomerulus. So the kidneys are being damaged. Thus, the nurse knows that the biggest problem to "worry" about here is renal failure. The best methods for monitoring fluid status and renal status for a client are to monitor I and O and daily weights. (Also, remember that one weight doesn't mean anything. The hematuria indicates that there has already been glomerular damage.)

In respiratory acidosis, what organ is not working correctly and what organ is going to compensate?

Lungs are not working and the kidneys will compensate

timolol maleate eyedrops for glaucoma

This medication decreases the production of aqueous humor

A new mother asks the clinic nurse why her baby should receive recommended vaccinations. What is the best response by the nurse concerning vaccinations?

Vaccines are suspensions of antigen preparations intended to produce a human immune response to protect the person from future encounters with the organism. Vaccinations will help your baby produce antibodies against disease causing organisms."

Anaphylaxis reactions

angioedema dyspnea

What vital do you monitor with hypovolemic shock

apical pulse

side effect of amiodarone

ataxia

Urine pH

average 6.0; range 4.6-8.0

what is the immediate treatment for respiratory alkalosis

breathing into a brown paper bag, get the Co2 back into the lungs

Beta Blockers

decrease heart rate and dilate arteries by blocking beta receptors, decrease the release of renin from the kidneys caution in asthma patients lol endings

When someone gets very acidotic, what happens to the LOC

decreases, they become sleepy and lethargic

What is the only way to lower Co2 in the body

exhaling

What should the nurse who is educating about the most common initial visual changes associated with glaucoma inform the client?

f glaucoma is not diagnosed and treated early, an individual starts to lose peripheral vision, or the area of vision outside the central field of sight. People who have glaucoma experience tunnel vision and cannot see objects to the side, near the head, or by their feet. Central vision can be lost later if the disease progresses.

FVD

fluid volume deficit -weight loss -dry mucous membranes -increased HR, RR -thready pulse -cap refill is less then 3 seconds -orthostatic hypotension -poor skin turgor -oliguria -decreased CVP -FLAT NECK VEINS

FVE

fluid volume excess -cough/dyspnea -increased BP -tachypnea -tachycardia -weight increased -bounding pulses -pitting edema -JVD -increased CVP

HDL

high-density lipoprotein-good male 40-160 female 35-135

What is the only way that you can have a build up of Co2 in your body?

improper exhalation

Ataxia

inability to perform coordinated movements

Diverticulitis

inflammation of the diverticula

Peramivir

influenza treatment It is an inhibitor of the influenza virus and is indicated for the treatment of acute influenza in clients over the age of 2 years who have been symptomatic for no more than 2 days. The dose of this medication needs to be decreased if the creatinine clearance of a client is less than 50 mL/min, so the nurse must know the prescribe creatine clearance level of this client prior to administering peramivir.

INR

international normalized ratio 0.8-1.1

What happens to the bicarb level in in resp alkalosis

it increases

If you have a patient in met acidosis what is going to happen to their respiratory rate and why

it is going to decrease and become shallow bc the kidneys are trying to help the lungs

What is going to happen to the bicarb level (HCO3) in respiratory acidosis

it will increase because it is trying to fight off to Co2

HIV patients can suffer from

kaposi sarcoma, encephalopathy, pulmonary candidiasis prevent spreading by disinfecting with bleach

what are ketones and how do they affect the blood

ketones are fat cells that break down into acid in the blood

In metabolic acidosis or alkalosis what is the problem

kidneys

in metabolic acidosis what organ is the problem and what chemicals are altered

kidneys-hco3

Total serum cholesterol

less than 200 mg/dL

If you have a client who is in acidosis do you want to retain Co2 or lose it

lose it

How does vomiting or NG tube suction cause met alkalosis

losing too many electrolytes

Respiratory Acidosis

low pH, high CO2

Metabolic Acidosis

low pH, low HCO3

Gout diet

low purine diet no alcohol no sodas eat fish monitor BMI smoking doesnt impact

Vasodilators

medications that cause dilation of blood vessels Rapidly drop BP

ABG numbers pH PaCO2 HCO3

pH 7.35-7.45 PaCO2 45-35 HCO3 22-26

In a metabolic problem what chemicals will be altered

pH and C02 bc the lungs are helping the kidneys

Lipase

pancreatic enzyme necessary to digest fats 0-160

Orthopnic position

patient is bent over a bedside table or in high fowlers

Torsades des Pointes

prolonged QT interval profound hypomagnesemia- treat with IV magnesium

What patient care should be included with a cirrhosis patient?

q2 turns keep in semi fowler position monitor the color of urine and stool monitor creatinine levels keep on a low salt diet, not low calorie

RBC

red blood cell Female 4.2-5.4 Male 4.7-6.1

what happens to the pH in met acid

retains to much hydrogen and excretes to much base

Droplet precautions

spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia, pertussis, influenza, diptheria, epiglottitis, rubella, mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus (Private room and mask)

When a patient has a high level of Co2 in their blood, what is going to happen to the oxygen level of their blood

the 02 is going to down

pulse pressure

the difference between systolic and diastolic blood pressure

Who compensates when you are in metabolic acidosis or alkalosis

the lungs

If a patient is in respiratory acidosis what is the primary thing that has to be done

the lungs need to be fixed, fix the Co2 level

In metabolic alkalosis, which organ is going to compensate

the lungs will compensate because the kidneys are not functioning properly

Sims position

the patient is lying on the left side with the right knee and thigh drawn up with the left arm placed along the back

Why do antacids cause metabolic alkalosis

they are bicarbonates

How can a anorexic or bulimic patient go into met acidosis

they are breaking down fat and protein and it is turning into ketones

In respiratory acidosis, howw is the patient breathing? And how does this affect the Co2 level in the blood?

they are breathing slowly and shallow and increases the Co2 in the blood

How can diarrhea cause metabolic acidosis?

too much acid, the GI tract is base

Uricemia

uric acid in blood excessive uric acid is GOUT

Can Co2 be a chemical that makes you sick and be a chemical that makes you compensate?

yes

can bicarb and hydrogen be chemicals that make you sick and be chemicals that make you compensate

yes

respiratory acidosis causes

• Depression of the respiratory center. (1) Head injuries. (2) Oversedation with sedatives and/or narcotics. • Conditions affecting pulmonary function. (1) COPD (2) Pneumonia. (3) Atelectasis. • Conditions that interfere with chest wall excursion. (1) Thoracic trauma: flail chest. (2) Diseases affecting innervation of thoracic muscle (Guillain-Barré syndrome, myasthenia gravis, polio). (3) Mechanical hypoventilation.

Acute MI symptoms

• chest pain (smothering) • neck, jaw, arm, back • nausea, vomiting, sweating, shortness of breath • syncope or aborted SCD • heart failure symptoms (LV dysfunction) • silent MI Women and Older adults with diabetes often report no pain


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