Nclex Review (8）--Uworld

Blood Thinners

1. Anticoagulants (Also known as Blood Thinners.) Commonly prescribed include: Rivaroxaban (Xarelto)（"zæ 肉头"） Dabigatran (Pradaxa) Apixaban (Eliquis) Heparin (various) Warfarin (Coumadin) Reason for Medication： 1. Helps to prevent harmful clots from forming in the blood vessels. 2. May prevent the clots from becoming larger and causing more serious problems. 3. Often prescribed to prevent first or recurrent stroke. 2. Antiplatelet Agents and Dual Antiplatelet Therapy (DAPT) Commonly prescribed include: Aspirin Clopidogrel (Plavix®) Dipyridamole Prasugrel (Effient)（"埃菲ent"） Ticagrelor (Brilinta)（"太kæ gre罗"）（"不予拎他"） Reason for Medication 1. Helps prevent clotting in patients who have had a heart attack, unstable angina, ischemic strokes, TIA (transient ischemic attacks, or "little strokes") and other forms of cardiovascular disease. 2. Usually prescribed preventively when plaque buildup is evident but there is not yet a major obstruction in the artery. 3. Certain patients will be prescribed aspirin combined with another antiplatelet drug - also known as dual antiplatelet therapy (DAPT).

The sequence of basic life support (BLS) for an unconscious, pulseless client includes:

1. Attempt to shake the client awake （ "Are you all right?" ） 2. Call for help （911 or bring the ACE, The emergency response system should be activated for all unresponsive clients. ) 3. Check for breathing and a pulse for 10 seconds 4. Begin chest compressions: (starting with chest compressions (circulation, airway, breathing [CAB] sequence) -- Chest compression rate should be 100-120/min. Chest compression depth should be 2-2.4 in (5-6 cm). 5. Notify the health care provider

sublingual nitroglycerin (NTG)

1. Headache and flushing are common side effects of NTG due to systemic vasodilation and do not warrant to DC （记） 2. Avoid fatal drug interactions: Concurrent use of erectile dysfunction drugs (sildenafil, tadalafil, vardenafil)(都是Vasodilator) or alpha blockers (terazosin, tamsulosin) is contraindicated due to potentially fatal hypotension （记） 3. (考）The nurse should instruct the client who is taking sublingual NTG to keep the tablets in a tightly capped, dark bottle away from heat and light. The client should be taught to take 1 tablet every 5 minutes (up to 3 tablets), but notify EMS if the pain does not improve or worsens 5 minutes after the first pill has been taken. These instructions should be reinforced at each appointment.

ACHES with contraceptives use

1. 详见附上的图片。

A child with school phobia

A child with a high level of school absenteeism has been determined to have school phobia. The nurse should remind the child's parent/caregiver to take which action? --ANS: Insist school attendance immediately, starting as a few hours a day.( 考） （A gradual approach may decrease the child's sensitization to the classroom.）

AE of aspirin

Aspirin and other NSAIDs inhibit platelet aggregation, resulting in GI bleeding complications. (eg.Coffee-ground emesis and black tarry stools (melena) , bruising, Tinnitus )(考）They also promote development of gastric ulcers with long-term use. Tinnitus (ringing in the ears) is the earliest sign of aspirin toxicity.

Bacterial meningitis

Bacterial meningitis occurs when infection causes inflammation in the meninges of the brain and spinal cord. This inflammation may lead to hydrocephalus and increased intracranial pressure (ICP). Due to the risk for severe complications from meningitis and increased ICP (eg, hearing loss, permanent brain damage, death), the priority of care is immediate antibiotic therapy（考）. Lumbar puncture (LP) with cerebrospinal fluid culture is performed to determine the causative organism.

Children with autism spectrum disorder (ASD) 自闭症

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

Dental avulsion

Dental avulsion 撕裂 (ie, tooth separated from the mouth) of a permanent tooth is a dental emergency. The priority nursing action is to rinse and reinsert the tooth into the gingival socket and hold it in place (eg, with a finger) until stabilized by a dentist (考). Reimplantation within 15 minutes of injury re-establishes blood supply, increasing the probability of tooth survival. If the tooth cannot be reinserted it should be kept moist by submerging it in commercially prepared solution (eg, Hanks Balanced Salt Solution), cold milk, sterile saline, or as a last resort—due to bacteria—saliva (eg, holding it under the tongue). The client should see a dentist immediately(记）. DO NOT: 1. Placing the tooth in water (a hypotonic solution) would lyse the cells, killing the tooth. 2. Scrubbing the root would damage it. The tooth should be gently rinsed with sterile saline or clean, running water. 3. Wrapping the tooth in sterile gauze would dry it out.

Grapefruit juice can cause significant interactions with drugs

Grapefruit juice can cause significant interactions with drugs such as calcium channel blockers and sildenafil（"修电脑fil"）（见上方 erectile dysfunction drugs ） . Grapefruit might interact with some "statins" including lovastatin (Mevacor), simvastatin (Zocor), and atorvastatin (Lipitor). （statins used to lower cholesterol, are broken down by enzymes. Grapefruit juice can block the action of these enzymes, increasing the amount of drug in the body and may cause more side effects.）

Muslim clients

Important aspects of care for Muslim clients include accommodating the following client needs: Facing Kaaba（卡巴） in the holy city of Mecca['mekə]麦加 for prayer, modesty （羞怯）considerations, adherence to dietary practices (halal （"her loud"）伊斯兰清真食品or kosher['kəʊʃə]犹太食品 meals and possibly fasting during Ramadan[,ræmə'dæn; 斋月), and involvement of family. Kaaba： 克尔白（指建于麦加清真寺内的方形石造殿堂，内有供教徒膜拜的黑色圣石，等于Caaba） Mecca：. 麦加（沙特阿拉伯一座城市） Ramadan：斋月（伊斯兰教历的九月，等于Ramazan）the ninth month of the Muslim year, during which strict fasting is observed from sunrise to sunset.

cystic fibrosis (CF)

In CF, unusually thick mucus obstructs the pancreatic ducts, preventing pancreatic enzymes (amylase淀粉酶, trypsin胰蛋白酶, and lipase脂肪酶) from reaching the small intestine. The result is malabsorption of carbohydrates, fats, and proteins; the inability to absorb fat-soluble vitamins (A, D, E, and K) is of particular concern. Gastrointestinal signs and symptoms of CF include flatulence, abdominal cramping, ongoing diarrhea, and/or steatorrhea( [,sti:ətə'ri:ə 四弟呀 特read呀)脂肪泻. Nutritional therapy includes the administration pancreatic enzyme supplements with or just before every meal or snack (记). These enzymes are enteric-coated beads designed to dissolve only in an alkaline environment similar to that of the small intestine. They must not be mixed with a substance that would cause them to dissolve prior to reaching the jejunum. Capsule contents may be sprinkled on applesauce, yogurt, or acidic, soft, room-temperature foods with pH <4.5. Capsules should be swallowed whole and not crushed or chewed（考）; chewing the capsules could cause irritation of the oral mucosa. Excessive intake of pancreatic enzymes can result in fibrosing colonopathy结肠病 (记).

latex allergy

Indications that the client may have a latex allergy include certain food allergies (eg, bananas, avocados, tomatoes， chestnuts, kiwis, potatoes, peaches, grapes, and apricots), lips swelling when blowing up balloons, and a history of multiple exposures (eg, self-catheterization for a neurogenic bladder, multiple surgeries [as seen in clients with spina bifida]). 73% of clients with spina bifida have a sensitivity to latex.

type 1 diabetes mellitus: exercise should be postponed until ketones are absent and blood glucose is 100-250 mg/dL

Ketonuria indicates that the body is unable to metabolize carbohydrates for energy. Exercise increases metabolic demand and ketogenesis, which may lead to ketoacidosis. Therefore, exercise should be postponed until ketones are absent and blood glucose is 100-250 mg/dL (≥5.55-13.88 mmol/L).

Methotrexate

Methotrexate is a nonbiologic disease-modifying antirheumatic drug used to treat rheumatoid arthritis. The major adverse effects associated with its use include：请记住以下的： bone marrow suppression, hepatotoxicity, and gastrointestinal irritation. Methotrexate can cause bone marrow suppression resulting in anemia, leukopenia, and thrombocytopenia. Leukopenia and its immunosuppressant effects can increase susceptibility to infection. 请记住以下的：Clients should be educated about obtaining routine killed (inactivated) vaccines (eg, influenza, pneumococcal) and avoiding crowds and persons with known infections. Live vaccines (eg, herpes zoster) are contraindicated in clients receiving immunosuppressants, such as methotrexate.

Nocturnal enuresis 夜尿

Nocturnal enuresis, or involuntary bed-wetting at night. The nurse reinforces teaching: Avoid the use of Pull-Ups and diapers at bedtime(考）. Use enuresis alarms (attached to the child's underwear), which waken the child when voiding begins (考）

Osteogenesis imperfecta 成骨不全症(玻璃娃娃）

Osteogenesis imperfecta (brittle bone disease) is a rare genetic condition resulting in fragile bones and frequent fractures. The nurse should use careful handling (eg, checking blood pressure manually, distributing pressure when lifting the infant, using supportive devices) to minimize additional fractures and prevent molding of soft bones (eg, skull). The nurse's priority for a client with OI is careful handling to minimize additional fractures. Care of the infant with OI includes: 1. Checking blood pressure manually to avoid cuff over-tightening, which may occur with automatic blood pressure cuffs (Option 3) 2. Lifting the infant by slipping a hand under the broadest areas of the body (eg, back, buttocks) so the pressure is distributed（not lift by arms or ankles) 3. Repositioning the infant frequently using supportive devices and gel padding to avoid molding of the soft bones of the skull

Otitis media (OM) in children

Otitis media (OM) is inflammation or infection of the middle ear. The eustachian tubes in infants and young children are short, wide, and fairly horizontal, which results in ineffective draining of respiratory secretions and a potential for recurrent infections. Established family patterns that can play a role in recurrent OM should be assessed and include: 1. Recurring exposure to tobacco smoke（考） 2. Regular pacifier use, particularly after age 6 months（考）（Continuous sucking on a pacifier causes the auditory tubes to become abnormally open, which allows secretions from the throat to seep into the middle ear.） 3. Drinking from a bottle while lying down（考） 4. Lack of immunizations, particularly the pneumococcal vaccine series（考） NOT: Excess water in the ears from bathing or swimming ,Damage due to a foreign body in the ear .contribute to otitis externa外耳炎, also known as swimmer's ear.Fluid to the middle ear enters from the mouth through the eustachian tubes.

ccare the client with indwelling urinary catheter

Perineal hygiene is performed using soap and water only at every shift and as needed. Routine use of antiseptic cleansers has not been shown to prevent infection and may lead to the development of drug-resistant bacteria(考）.

SBAR（详见附页图）

SBAR (situation, background, assessment, recommendation/read-back) is an established reporting format used to communicate with the health care provider (HCP). Use of SBAR ensures that the HCP receives the necessary information to make a clinical judgment regarding treatment or need for immediate assessment.

Sumatriptan --triptan曲坦类药 Use：migraine and cluster headaches.

Sumatriptan relieves migraines by constricting cranial blood vessels. Sumatriptan is contraindicated in clients with coronary artery disease and uncontrolled hypertension （考）because the vasoconstrictive effects can cause hypertensive urgency, angina, decreased cardiac perfusion, and acute myocardial infarction.

Thoracentesis

Thoracentesis is commonly used to treat pleural effusion胸腔积液. Following thoracentesis, the nurse should monitor for signs of pneumothorax（记）, including level of alertness, respiratory rate, respiratory effort, oxygen saturation, and lung sounds. 注： Infection would be a later complication (occurring a few days after the procedure), so monitoring temperature is not required during the initial postprocedure period.

Meds should be held prior to dialysis.

Unless otherwise indicated by the health care provider, antihypertensives and other blood pressure-lowering medications (eg, furosemide), antibiotics, digoxin, and water-soluble vitamins (B, C, and folic acid) should be held prior to dialysis.

Wound cultures

Wound cultures identify microorganisms to aid in prescribing appropriate antibiotics and are obtained as follows: 1. Perform hand hygiene, and apply clean gloves. Remove the old dressing. Remove and discard gloves. 2. Perform hand hygiene, and apply sterile gloves. Assess the wound bed. Cleanse the wound bed and surrounding skin with normal saline (eg, flushing, swabbing with gauze) to remove drainage and debris (Option 2). Remove and discard gloves. 3. Perform hand hygiene, and apply clean gloves. Gently swab the wound bed with a sterile swab, from the wound center toward the outer margin (Options 4 and 5). Avoid contact with skin at the wound edge as it can contaminate the specimen with skin flora. 4. Place the swab in a sterile specimen container; avoid touching the swab to the outside of the container. 5. Apply prescribed topical medication (eg, bacitracin "bæ 细崔神" ointment) after obtaining cultures to prevent interference with microorganism identification (Option 1). Apply new dressing. 6. Remove and discard gloves, and perform hand hygiene. Label the specimen, and document the procedure.

borderline personality disorder (BPD)

a psychological disorder characterized by a prolonged disturbance of personality accompanied by mood swings, unstable personal relationships, identity problems, threats of self-destructive behavior, fears of abandonment, and impulsivity。 Individuals with borderline personality disorder (BPD) live in fear of rejection and abandonment. To avoid being abandoned, they use manipulation and control, often unconsciously, to prevent a person from leaving. The manipulative behavior may be of a positive nature, such as the use of flattery, or a negative nature, such as distancing from the other person. An individual with BPD may also engage in self harm or suicidal behaviors in an attempt to gain attention and keep that person from leaving. Nursing Intervention: The best nursing action is to rotate staff members assigned to care for the client(考）.This will help diminish the current dependence on a particular individual and help the client learn to relate to more than one person

spinal fusion 脊柱融合术

a technique to immobilize part of the spine by joining together two or more vertebrae

myelomeningocele 脊髓脊膜膨出 in a newborn

most severe form of spina bifida in which the spinal cord and meninges protrude through the spine. The newborn with a myelomeningocele is at risk for infection. Covering the myelomeningocele with a sterile, moist dressing is indicated to decrease the risk of infection at the site(考）. The infant should be placed on the abdomen (prone) with the face turned to the side（记）.

oral contraceptive pills (OCPs)

要记住:Clients who are prescribed oral estrogen contraceptives (with or without progestin) have an increased risk for developing blood clots. Clients should be educated on warning signs to report to the health care provider (eg, severe leg pain, vision loss) versus common side effects (eg, breast tenderness, spotting).