NCLEX PREP
carbon monoxide levels of 21% to 40% result in
nausea, vomiting, dizziness, tinnitus, vertigo, confusion, drowsiness, pale to reddish-purple skin, and tachycardia;
dehiscence
open sutures ... call HCP
pt. receiving lipid emulsion .... the nurse must first assess if the patient has an allergy to
eggs egg yolk is used as emulsifier
Autografts
elevated and immobilize extremity for 3 to 7 days. This period of immobilization allows the autograft time to adhere to the wound bed.
assessment finding indicative of pancreatic injury
elevated serum amylase and lipase levels hypocalcemia
patients on chemotherapy who are anemic may recieve
epogen, procrit
drugs with "fil"
erectile dysfunction med
how often do you change IVs
every 3-4 days
sodium and chloride are primarily
extracellular ions
CKD
hypermagnesemia, hyperkalemia do not give any drugs with magnesium
continuous infusion of magnesium / what to assess for
hypotension, CNS depression
restlessness is the first indication of
hypoxia/shock
Tumor Lysis Syndrome & Electrolytes
imbalance! cell spills contents and alters electrolytes Hyperkalemia, hypocalcemia, hyperuricemia and hyperphosphatemia
thyroid storm
increased temp, pulse and HTN medical emergency associated with hyperthyroid
elevated ck-mb
indicated myocardial infarction
Strategy for Answering NCLEX Questions
1. ABCs - airway, breathing, circulation, safety 2. Pain 3. Education 4. Feelings
Normal Magnesium Levels
1.5-2.5 mEq/L
Sunscreen should be reapplied every
2 to 3 hours and after swimming or sweating;
Hypertonic fluids
3% NaCl
tuberculin skin test
4-10 weeks after initial exposure
When are trough levels taken?
30 minutes before medication administration
normal calcium levels
8.5-10.2
Normal calcium levels
8.5-10.5 mg/dL
Epiglottitis
A Medical Emergency Sudden onset of closing of airway Key sign is the that the child is drooling / can no longer swallow Prepare for intubation / hospitalization
When does quickening in pregnancy occur?
About 18-20 weeks 2 weeks earlier for multiparas
Furosemide
Action - increase excretion of water and electrolytes *Pay attention to potassium levels Hypokalemia can increase digoxin toxicity Side effects - hypotension, dry mouth, polyuria, dehydration, electrolyte imbalance Assessment - monitor renal panel do not use with other antihypertensives Pt. Teaching - increase salt substitutes and potassium containing foods
Dopamine Hydrochloride (Intropin)
Action: Sympathomimetic, vasopressor, inotropic agent Used for: Hemodynamic balance, shock, heart failure * is a vesicant and can cause tissue necrosis * must be inserted through a picc line Antidote = phentolamine
hepatitis B
B= blood and body fluids (hep c is the same) vaccine!
treatment for hypercalcemia
Calcitonin - "calci-tone-it-down" renal dialysis
carbon monoxide levels greater than 60%
death
SIADH is managed by
treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone.
S&S of serotonin syndrome
"HARM" H - hyperthermia A - agitation R - restlessness M - myoclonus
pericardial tap
treatment for cardiac tamponade
airbone precuations
"My Chix Hez TB" Measles Chickenpox Herpes Zoster TB
Droplet Precautions - which diseases
"Spiderman" S - scarlett fever P - pertussis I - influenza D - diphtheria E - epiglottitis R - rubella M - mumps A - adenovirus N - niceria meningitis
signs and symptoms of hypercalcemia
"Stones, bones, groans, psychiatric overtones." kidney stones, nausea/vomiting, constipation, fatigue, lethargy, decreased LOC
A patient being cared for in the critical care unit for pancreatitis and subsequent development of multiple organ dysfunction syndrome (MODS) is exhibiting gastrointestinal symptoms including bleeding. Which prescriptions does the nurse anticipate the healthcare provider will order to address the gastrointestinal issues? Select all that apply. Maalox Sucralfate Atorvastatin Loperamide Omeprazole
-Maalox -Sucralfate -Omeprazole Antacids like Maalox, proton pump inhibitors like omeprazole, and sucralfate are all indicated to treat issues related to injury to the gastric mucosa in MODS. Atorvastatin is a cholesterol-lowering agent and thus not indicated in this situation. Loperamide is an antidiarrheal and not appropriate based upon the information provided.
Pt. is on Digoxin and Loop Diuretic .....
* be wary of hypokalemia from loop diuretic ; it can cause digoxin toxicity
diverticulitis
*NPO Status at risk for peritonitis and obstruction
Esomeprazole (Nexium)
*caution C.DIFF Action: proton pump inhibitor Use: GERD, ulcers to decrease GI pain
Signs of hypermagnesemia
*think depression, low, slow Neurological depression respiratory depression bradycardia hypotension
Humira (adalimumab)
*think immunosuppression Action: Immunomodulator Uses: Ulcerative colitis, Chron's Rheumatoid Arthritis Nursing Assessment: Pt. needs to be tested for TB prior to use of drug Pt. is to receive no live vaccines while on drug Immunosupression Patient Teaching: Immunosupression Risk of Cancer No live vaccines
Actinic keratosis
, a premalignant lesion, appears as a small macule or papule with a dry, rough, adherent yellow or brown scale.
Cancer Patients / when to notify HCP
- changes in bowel/bladder sore that doesnt heal unusual bleeding or discharge a new lump indigestion, difficulty swallowing changes in warts/moles nagging cough and hoarseness
Burns / critical thinking
- fluid resucitation / urinary output - infection / antibiotics - heat loss (hypothermia) / keep pt. warm
albumin infusions
- infuse albumin over 4 hours - large gauge catheter - monitor hemoglobin and hematocrit - assess for bleeding
QSEN / quality improvement competency states.
that a nurse should use data to monitor the outcomes of healthcare processes and uses improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems
Therapeutic range for digoxin
0.8- 2
isotonic fluids
0.9% NS, LR
kidneys normally excrete
1 mL/kg/hr of urine
pheochromocytoma
tumor of adrenal glands
granulocytes
type of WBC
hepatitis a
Ends in a vowel, comes from the bowel fecal-oral route
The eruption of permanent dentition may begin at
the age of five years
An oral temperature should be avoided if
the client has nasal congestion.
What things should never be delegated to a LPN?
1. blood transfusions 2. acute/unstable patients 3. they cannot be a charge nurse 4. they cannot make a care plan
4 components of malpractice
1. duty 2. breach of duty 3. injury 4. causation
supporting a patient who is interested in smoking cessation
1. set a date to stop smoking 2. Referrals to American Heart Association and American Lung Association for support 3. call patient every 3-5 days for optimal support
Normal magnesium levels
1.5-2.5 mEq/L
urinary bags should be changed when they are
1/3 of the way full
a patients parenteral nutrition bag is empty. what should the nurse hang in the meantime while she mixes another bag?
10% dextrose in water
treatment for hyperkalemia
10-20% glucose with insulin Kayexelate IV loop diuretics renal dialysis
normal fetal HR
110-160
PT (prothrombin time)
12 seconds PT and INR for coumadin
The nurse is evaluating the effectiveness of a continuous infusion of insulin for a patient diagnosed with multiple organ dysfunction syndrome (MODS). Which blood glucose value would indicate an acceptable level in this situation? 68 mg/dL 156 mg/dL 184 mg/dL 200 mg/dL
156
Nagele's Rule
1st day of last period + 7 days - 3 months
Decorticate posturing
Hands clenched in tightly to the "core" Indicates brain damage to the cerebral hemispheres
burn injury / diet
NPO high protein, high caloric, increase in Vitamin C.
Hypermagnesemia S&S
Neurological depression, respiratory depression, bradycardia, hypotension
Body systems to keep a close assessment on with Tertiary Syphilis
Neurovascular integumentary cardiovascular
Sustained Release Enteric Coated
Never crush!
Antacids Grapefruit Juice
Never mix them with other meds
does a patient with a PICC line need to restrict activity?
No
orthodox judaism / diet
No dairy-meat combinations Only fish that have scales and fins are allowed; meats that are allowed include animals that are vegetable eaters, cloven hoofed, and rituall
The client should be instructed to avoid sun exposure between
the hours of brightest sunlight: 10 a.m. and 4 p.m.
During an emergency birth the fetal head is crowning on the perineum. How should the nurse support the head as it is being delivered? 1 By applying suprapubic pressure 2 By placing a hand firmly against the perineum 3 By distributing the fingers evenly around the head 4 By maintaining pressure against the anterior fontanel
3 - distributing fingers evenly around head Distribution of the fingers around the head will prevent a rapid change in intracranial pressure while the head is being born and keeps the head from "popping out," which could result in maternal perineal trauma.
septic emboli secondary to meningitis
typically lodge in arterioles of extremities -look for finger/toe cyanosis
A client is to undergo a tuberculin test as part of her prenatal workup. Before administering the test, what information about the client should the nurse obtain? I 1 Whether she has had a previous tuberculin test 2 Whether the client is prone to respiratory diseases 3 Whether an earlier tuberculin test's result was positive 4 Whether the client's family has a history of tuberculosis
3 - whether the pt has had a positive test result in the past A tuberculin test should not be administered to a client with a previous positive result on a tuberculin test, because a severe reaction may occur at the test site in a previously sensitized individual. It is more important to know whether the test result was positive than whether a test was performed
Abdominal pain Intermittent tenesmus exacerbations of severe diarrhea
ulcerative colitis
Nursing Actions/Judgement for Dopamine Hydrochloride
the nurse is aware that: the drug is a vesicant and can cause necrosis it must be inserted through PICC line only
Maximum dosage of Acetaminophen
3250 mg in 24 hours
safe storage of blood cells
35 days check expiration date before administering
A hospitalized client tells the nurse that an instructional directive is being prepared and that the lawyer will be bringing the document to the hospital today for witness signatures. The client asks the nurse for assistance in obtaining a witness to the will. Which is the most appropriate response to the client? "I will sign as a witness to your signature." 2. "You will need to find a witness on your own." 3. "Whoever is available at the time will sign as a witness for you." 4. "I will call the nursing supervisor to seek assistance regarding your request."
4 - in some states its illegal for employees to witness wills
A client at 12 weeks' gestation arrives in the prenatal clinic complaining of cramping and vaginal spotting. A pelvic examination reveals that the cervix is closed. Which probable diagnosis should the nurse expect? 1 Missed abortion 2 Inevitable abortion 3 Incomplete abortion 4 Threatened abortion
4 - threatened abortion Because the cervix is closed, this is considered a threatened abortion.
WBC Count
4,500 - 11,000
carbs, protein & fat percentages in diet
60% carbs 30% protein 10% fat
"Pril" Drugs
ACE inhibitors Used to treat hypertension Common side effects: hypotension hacking cough angioedema Important monitoring: - vital signs - WBC - potassium & creatinine - electrolytes
dawn effect
AM hyperglycemia growth-hormone is released at 3 am, which competes with insulin, causing high BS in AM
Somoji Effect
AM hyperglycemia sugars drop at night, and then sleep hormones (cortisol & epinephrine) bring it back up ... causing AM hyperglycemia treatment: snack before bedtime
rule of nines,
the percentage of total body surface area burned 9% for each arm (18% total for both arms) and 18% for the anterior trunk
nausea is indicative of
decreased bowel motility
Hyperaldosteronism
decreased potassium
Huntington's disease
degenerative disease of nervous system chorea - dancelike movements progression to dementia *risk for aspiration, pneumonia, self-care defecits, safety
Kubler-Ross stages of dying
denial, anger, bargaining, depression, acceptance
full thickness burn
dermal layer is destroyed. the tissues cannot repair themselves skin grafts needed
An MRI scan is used to
diagnose musculoskeletal disorders.
hepatic encephalopathy / common S&S
difficulty handwriting
The QSEN competency informatics involves
the use of information and technology to communicate, manage knowledge, and support decision-making
psoriasis
thickened skin reddish papules silvery-white scaly patches
liquid iron preparation / patient education
dilute it and drink thru a straw because it can stain tooth enamel take on an empty stomach acidic foods, however, improve absorption constipation is side effect
left lower quadrant pain fever
diverticulitis
Signs of Hyperkalemia
dizziness weakness cardiac irregularities muscle cramps diarrhea nausea
adrenal glands tumor symptoms
dizziness, sweating, palpitations
Chemotherapy / nursing guidelines
do not put thru a peripheral line
angle-closure glaucoma
do not take medications that dilate the pupils, it can precipitate intracranial pressure
external radiation therapy / patient teaching
do not use any irritating lotions, soaps on skin avoid sunlight fluid intake 2-3 L diet high in proteins, high in calories
Antibiotics used for Lyme Disease
doxycycline & amoxicillin
Medications for treatment of lyme disease
doxycycline & amoxicillin
chemotherapy / patient education
drink a lot of fluid to avoid uric crystallization
A patient diagnosed with multiple organ dysfunction syndrome (MODS) is severely dyspneic, tachycardic, hypotensive, confused, and disoriented. The patient's family asks the nurse why the patient is being prescribed amlodipine. Which response by the nurse is most appropriate? "Amlodipine is being used to reduce cerebral vasospasm." "The amlodipine is being used to treat low blood pressure." "Amlodipine is the drug of choice to increase oxygen delivery to the other organs." "The amlodipine will help your family member breathe easier and decrease the need for oxygen."
Amlodipine = Reduce cerebral vasospasm
Vancomycin (Vancocin)
Antibiotic , aminoglycoside class 10-40 (peak), 5-15 (trough) Side Effects: ototoxicity, flank pain, renal toxicity Most commonly used for MRSA and CDiff
Rifampin (Rifadin)/ classification & pt education
Antitubercular reduces effectiveness of birth control turns skin orange stains contact lenses
NSAID types
Aspirin Ibuprofen (motrin) ketorolac (toradol)
Antidote for cholinergic crisis
Atropine
Diet while on Isoniazid
Avoid Tyramine - red wine, tuna, hard cheese
Rapid transfusion of cool blood
BAD! places the client at risk for cardiac dysrhythmias. To prevent this, the nurse warms the blood with a blood-warming device.
breast exams
BSE staring at 20 years old comprehensive breast exam (CBE) done every 3 years, and then annually after mammograms yearly at age 40
microalbuminuria
earliest sign of diabetic nephropathy
COPD and renal function
COPD patients have decreased oxygen and increased carbon dioxide in their blood, creating respiratory acidosis this causes the kidneys to hold on to bicarbonate
signs and symptoms of increased ICP / infant
Change in consciousness, irritability, vomiting, (projectile) , headache, seizures, lethargy, feeding difficulties
hypotonic fluids
D5W 0.45% NaCl
Adverse Reaction on Isoniazid
Dark urine and yellow skin
The certified nursing assistant (CNA) reports that bright red blood has been found in the stool of a patient diagnosed with multiple organ dysfunction syndrome (MODS). The CNA asks the nurse about the cause of the blood in the stool. Which explanation by the nurse is most accurate? "Decreased oxygen to the gastric mucosa leads to breakdown." "Decreased gastric motility is common in MODS and can lead to blood in the stool." "Acid in the stomach is working overtime since the patient is receiving enteral feedings." "The medications used to treat MODS can cause many side effects, including blood in the stools."
Decreased oxygen leads to breakdown
Isoniazid (INH)
Drug for tuberculosis Pt. Teaching: ` Avoid foods containing tyramine - red wine, tuna, hard cheese Nursing Assessment: Adverse Reaction = dark urine, yellowish skin
Lithium may cause and is contraindicated in
Ebstein anomaly as a teratogenic effect. This drug is also contraindicated in breast-feeding clients
Luteal phase of menstrual cycle
Estrogen slowly decreases, and Progesterone increases
Snellen test
Example: 20/40 vision The person can see at 20 feet what a "normal" person can see at 40 feet
biophysical profile scores:
Fetal tone, fetal movement, amniotic fluid index, and fetal breathing movements
4 stages of labor
First Stage of Labor Contractions without cervix dilation of 10 cm Second Stage of Labor Cervix over 10 cm dilated Third Stage of Labor After the delivery of the baby until the delivery of the placenta Fourth Stage of Labor 1-4 hours after the delivery of the placenta
complementary and alternative medicine (CAM): which cause bleeding?
G's! Ginger, etc.
What's an early sign of digoxin toxicity?
GI Disturbance
follicular phase of menstrual cycle
General increase of estrogen, FSH, and LH triggering ovulation
nephrotic syndome / signs and symptoms / care
Generalized severe edema (Anasarca) Lethargy Anorexia Frothy urine Extremely elevated proteinuria supportive care
Patient is on narcotics/opioids with a respiratory rate less than 8
Give narcan Its assumed that if opioids are prescribed, narcan is a standing order
phlebitis scale
Grade 1 - erythema with or without pain. grade 2 - pain at the access site with erythema or edema. Grade 3- pain at the access site with erythema or edema, streak formation, and palpable cord. Grade 4 - pain at the access site with erythema or edema, streak formation, palpable cord more than one inch long, and purulent drainage.
osteoarthritis / patient education
exercise & eat right to achieve the correct BMI - reduce damage on joints
Bell's palsy
facial paralysis and weakness
signs and symptoms of hyperglycemia in older adults
fatigue, infection, neuropathy classic signs and symptoms are often absent in elderly
"Tidine" Drugs
Histamine 2 Antagonists Used for GERD, reflux, stomach ulcers - take med with meals - take antacids 1 hour before or after this drug *sulcrafate decreases medication effects monitor BUN
chvosteks sign
Hypocalcemia (facial muscle spasm upon tapping)
Potassium and Digoxin relationship
Hypokalemia can increase risk of dig toxicity
chronic alcoholism
Hypomagnesemia - give magnesium sulfate
A nurse is evaluating a patient admitted with sepsis who received large amounts of fluid resuscitation in the emergency room. Which is the priority for the nurse to evaluate concerning possible complications caused by large fluid volume administration? Hypothermia and coagulopathy Hypokalemia and hyperglycemia Reflex bradycardia and headache Cardiac stimulation and bronchodilation
Hypothermia and coagulopathy When large amounts of fluid are required, the nurse must assess the patient for two major complications: hypothermia and coagulopathy. Hypokalemia and hyperglycemia must be assessed when patients receive hydrocortisone. Reflex bradycardia and headache are side effects of phenylephrine. Cardiac stimulation and bronchodilation are intentionally induced with the use of epinephrine in anaphylactic shock.
Patient Teaching on Diet when on Furosemide
Increase salt substitutes and potassium containing foods Diuretics make you pee a lot; you pee out electrolytes, so they need to be restored
cushings triad
Increased BP Decreased Pulse Altered Respirations indicative of increased ICP
Digoxin
Increases heart contractility, slows ventricles 0.8 - 2 Assess pulses for a full minute if < 60 bpm, hold dose check Digitalis and potassium levels common side effects: bradycardia nausea, vomiting fatigue Life threatening side effects dysryhthmias Early sign of toxicity is GI Disturbance
Decerebrate posturing
Indicates brain damage to the brain stem arms straight to side
what to be cautious for when a patient is on parenteral nutrition
Infection / elevated temperature hypervolemia / weight changes
Carbon monoxide levels between 11% and 20% result in
flushing, headache, decreased visual activity, decreased cerebral functioning, and slight breathlessness;
When answering questions about: The symptoms and how they relate to an illness
Look for expected vs unexpected values Answer is likely the unexpected value
"Statin" Drugs
Lower cholesterol *do not drink grapefruit juice *take at night *liver enzyme checks *risk of rhabdomyolysis coca colored urine unexplained muscle soreness/weakness --> report to HCP
What are statin drugs given for
Lowering the risk of cardio-vascular disease High cholesterol
contact precautions
MRS. WEE M - MRSA R - respiratory infection, RSV S - skin infections W - wound infections E - Enteric Infections (Gut) E - Eye Infections
HELLP syndrome / signs and symptoms
Malaise, Right upper quadrant pain, epigastric pain, nausea and vomiting hemolysis, elevated liver enzymes, low platelets
A patient in neurogenic shock is receiving phenylephrine. Which nursing actions are appropriate when caring for this patient? Monitoring for signs of dyspnea and pulmonary edema Monitoring for signs of hypokalemia and hyperglycemia Monitoring for signs of reflex bradycardia and restlessness Monitoring for signs of hypothyroidism and Addison's disease
Monitor for reflex bradycardia and restlessness
A patient being cared for in the critical care unit following a fall from a ladder which caused a severe fracture of the left tibia, several rib fractures, and splenic bruising is being assessed by the nurse. The family reports that the patient seems confused and has become agitated. The nurse notes that the patient's oxygen saturation is decreasing, respiratory rate is 30, blood pressure is 86/50 mm Hg, and capillary refill is greater than 3 seconds. What does the nurse suspect may be occurring with this patient? Neurogenic shock Obstructive shock Rupture of the spleen Multiple organ dysfunction syndrome
Multiple Organ Dysfunction Syndrome Decreasing oxygen saturation, systolic blood pressure, tachypnea, and delayed capillary refill in a critically ill patient can indicate development of multiple organ dysfunction syndrome (MODS), which can occur in critically ill patients. Neurogenic and obstructive shock can precede the development of MODS. Neurogenic shock is characterized by hypotension, bradycardia, and an inability to regulate body temperature. Obstructive shock is characterized by jugular venous distention and pulsus paradoxus. A ruptured spleen is characterized by abdominal pain, hypotension, and signs of shock.
Never give antipsychotics to
Parkinson's patients
Famotidine
Pepcid used for GI
APGAR Score
Performed at 1 and 5 minutes Airway, pulse, grimace, activity, respirations score of 0-2 for each category 2 is a strong score - good indicator 0 - absent 1 - slight 2 - present *babies with a score 0-3 need immediate medical attention * babies with score 4-6 are on 5 minute watches
Antidote to Dopamine Hydrochloride
Phentolamine
A client at 42 weeks' gestation is admitted for a nonstress test. The nurse concludes that this test is being done because of what possible complication related to a prolonged pregnancy? 1 Polyhydramnios 2 Placental insufficiency 3 Postpartum infection 4 Subclinical gestational diabetes
Placental Insufficiency Placental function peaks at 37 weeks and declines slowly thereafter; therefore continuation of the pregnancy past term (42 weeks) places the fetus at risk because of placental insufficiency
Risks of prolonged pregnancy
Placental insufficiency oligohydraminos (decreased amniotic fluid)
bacterial meningitis / sign, diagnosis & care
Positive Brudzinski Sign (when you flex the neck the legs flex) / Nuchal rigidity Officially diagnosed with a lumbar puncture Antibiotics and supportive care provided
The nurse is teaching a group of nursing assistive personnel about nutritional support for patients diagnosed with multiple organ dysfunction syndrome (MODS). Which statement by the nurse reflects the overall goal of nutritional support in patients with MODS? "The overall goal of nutritional support in MODS is to preserve organ function." "Nutritional support in MODS is intended to increase the metabolic rate and support healing." "Blood glucose can rise during MODS, so nutritional support is used to maintain acceptable glucose levels." "During MODS, caloric expenditure greatly exceeds intake, so the goal of nutritional support is to equalize intake and expenditure."
Preserve organ function
adverse reaction of vancomycin
Redman's syndrome
foods with high potassium
fruits (cantaloupe, strawberries) and nuts leafy veggies potatoes mushrooms tomatoes carrots meat raisins
Drugs for HIV
Reverse transcriptase inhibitors Protease Inhibitors Integrase Inhibitors antivirals with "vir" in name
Piaget's Theories
Sensorimotor stage, a child develops an action pattern for dealing with the environment. Preoperational stage), a child develops egocentrism in that they see objects and persons from only his or her point of view. also demonstrate animism, in which they personify objects. Concrete operations stage), a child is able to describe a process without actually doing it. Formal operations stage), a child demonstrates feelings and behavior characterized by self-consciousness.
evisceration
The displacement of organs outside of the body
The nurse is taking the health history of a client who has been admitted for repair of a cystocele and rectocele. Which signs or symptoms would the nurse expect the client to report? 1 White vaginal discharge and itching 2 Sporadic bleeding and abdominal pain 3 Increased temperature and intractable diarrhea 4 Stress incontinence and low abdominal pressure
Stress Incontinence and low abdominal pressure As the uterus drops, the vaginal wall relaxes. When the bladder herniates into the vagina (cystocele) and the rectal wall herniates into the vagina (rectocele), the individual feels pressure or pain in the lower back and/or pelvis. When there is an increase in intraabdominal pressure in the presence of a cystocele, incontinence results.
esophageal atresia
THREE C's: coughing, choking, cyanosis esophagus is not fully developed correct with surgery
Involution
The involution process is the return of the uterus to a nonpregnant state after birth; it begins immediately after expulsion of the placenta and contraction of the uterine smooth muscle. This process progresses rapidly during the first few days after birth.
levothyroxine
given for hypothyroid
Stations of Labor
The ischial spines are used as landmarks in relation to the fetus's head, because they reflect the progression of labor; 0 station - presenting part is at the ischial spines. When the head enters the vagina it is below the ischial spines and its position is designated with positive numbers (+1 to +4). When the presenting part is floating, the fetus is at -5 station. A position above the ischial spines is designated by a minus number (-1 to -4).
Internal radiation / guidelines for patient care
Time Distance Space
EKG abnormalities in hypokalemia
U waves flattened or abnormal T waves ST segment depression
Which should the nurse evaluate when performing an assessment of end organ function on a patient who received fluid volume resuscitation for septic shock? Select all that apply. Visual acuity Oral mucosa Urine output Bowel sounds Peripheral pulses Neurologic function
Urine output Peripheral pulses Neuro function
Enelapril
Vasotec Used for hypertension, CHF
Warfarin Antidote
Vitamin K
pneumovax vaccine
given once in a lifetime to those > 65 or with history of illness
measles (rubeola) / signs and symptoms
White spots in the mouth (Koplik spots) and rash, combined with increased mucus secretions (coryza),
When to call HCP
You have assessed, identified the problem, planned, implemented, and evaluating that the action is not working/improving pt condition
superior mesenteric artery syndrome
a complication of spine surgery caused by mechanical changes in the position of the child's abdominal contents emesis and abdominal distention postoperative vomiting
Nitroglycerin
given to suppress angina and vasoconstriction
Clinical manifestations of ovarian cancer include
abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately general severe pain.
antidote to acetaminophen
acetylcysteine
serum phosphate primarily affects
activates vitamins, enzymes, energy cell growth acid base balance calcium homeostasis
medication to treat PSVT
adenosine
severe hypomagnesemia and hypocalcemia present / nursing action
administer IV magnesium
calcium channel blockers
amlodipine diltiazem nifedipine verapamil
Goodpasture syndrome is
an autoimmune disorder associated with the client's kidney.
A melanoma is
an irregularly shaped pigmented papule or plaque with a red-, white-, or blue-toned color. highly metastatic
The chest tube insertion site is covered with
an occlusive (airtight) dressing to prevent air from entering the pleural space.
Ethambutol
antiTB drug need vision checks before starting & monthly after often on drug for 1-2 years
Drugs with "vir" stem
antivirals used for HIV
type II Diabetics & allergies
any allergies to sulfa drugs? most antihyperglycemic drugs are sulfonylureas
Basal cell carcinoma
appears as a pearly papule with a central crater and rolled waxy border. Exposure to ultraviolet sunlight is a major risk factor.
Pain at McBurney's point Nausea
appendicitis
Trousseau's sign
arm/carpal spasm that indicates hypocalcemia
Best time to get a trough drug level
as close as possible to right before next administration of drug
HPV Pap smear
assesses cervical health done every 3 years ages 21-29 every 5 years ages 30-65
if a client has an internal pacemaker but is in clear distress .....
assume the pacemaker is malfunctioning & shock the client per policy
tracheostomy tube is dislodged
attempt to reinsert by spreading stoma and inserting replacement tube cover with sterile dressing on three sides if disconnects from water seal- place in sterile water
Hashimoto
autoimmune disease of thyroid - causing hypothyroidism
reducing risk of disease transmission and complications in blood transfusions
autologous blood donation ask a family member to donate
internal radiation / special precautions
goal is to keep internal radiation applicator in place - pt. is on bed rest with minimal turning, bathing, HOB raising Monitor VS every 4 hours report temp > 100 no sex for 7-10 days after removal of applicator
gram-negative bacteria
harder to treat with antibiotics - resistance
A nurse administrator's function is
to prepare the budget, staffing, strategic planning of programs and services, employee evaluations, and employee development.
asian american / diet
believe that health correlates with yin (cold) and yang (hot) energies during a fever - eat yin foods
herpes zoster diagnosis is confirmed by
blood culture
calcium primarily affects...
bones enzyme activation skeletal and cardiac muscle contraction nerve impulse transmission blood clotting
cardiac tamponade
buildup of fluid in pericardial sac, life-threatening because it makes heart pump very weak
absense of thrill/bruit over AV shunt
call HCP
St. John's Wort
can cause serotonin syndrome
sodium primarily affects...
cardiac contraction skeletal muscle contraction osmolality nerve impulse transmission
jugular vein distention and muffled heart sounds
cardiac tamponade
NSAIDs are linked to a higher risk for
cardiovascular events, MI, stroke, heart failure GI problems clients who have had heart surgery should not take NSAIDs
Inevitable abortion
cervix is dilated
PEG Tube Placement
check placement q 4 hours; before every feeding aspirate stomach contents for pH & residual volume
immunosuppressant medications
common side effect is bone marrow suppression ... indicated by hemoglobin levels
hematuria
common symptom of bladder cancer
addisons and cushings are related to
cortisol levels
what are the most common types of cancer
men - prostate women - breast
ulcerative colitis / at risk populations
more common among jewish americans
tornado warning
move all clients into hallway; close doors to rooms
Beurger's Disease
to stop smoking vessel disease, decreased circulation to extremities
diabetes insipidus
decreased antidiuretic hormone
Cholinergic drugs and bladder control
help improve bladder muscle tone and promote emptying
resuscitation/emergent phase of burn injury
hematocrit level increases d/t hemoconcentration from the large fluid shifts Expected in first 24 hours; resolves by 36 hours Low urine output
rectocele
hernia of the rectum into the vagina
Cystocele
hernia of the urinary bladder into vagina
basilar skull fracture
high risk for infection because meninges are left exposed
S&S of lithium toxicity
high temperature muscular rigidity altered mental status tachycardia irregular pulse, dysrhythmias diaphoretic
4 L of oxygen
humidification
signs and symptoms of hyponatremia
hyperactive bowel sounds
thiazide diuretics cause what electrolyte imbalane
hypercalcemia
multiple myeloma & calcium
hypercalcemia increase water intake to 3-4 L to promote calcium excretion
bubbling in the water-seal chamber
indicates a leak in the drainage system
critical thinking for when a patient has a fever
infection increased metabolic demand and O2 consumption dehydration, fluid loss, diaphoresis
common symptom of neurogenic bladder
infection, due to urinary stasis
most aggressive form of breast cancer
inflammatory with peau d'orange
tracheostomy cuff and feedings
inflate just before feeding to block off trachea remain inflated during feeding
when to return blood to blood bank?
inspect the unit of blood for leaks, abnormal color, clots, and bubbles and returns the unit to the blood bank if clots are noted.
potassium and phosphate are primarily
intracellular ions
Squamous cell carcinoma
is a firm, nodular lesion topped with a crust or a central area of ulceration.
A vesicovaginal fistula
is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina.
Omaha system
is a standardized terminology recognized by ANA to support nursing practices. It includes codes for entering the data obtained from a problem rating scale in the EHR
if the question mentions the clients age ....
it's relative to the answer!!
chinese americans / nonverbal communication
its common for them to avoid eye contact and face to face interactions keep speaking to them normally
safest approach of opening airway for a client with suspected spinal injury
jaw-thrust
opportunistic infections in AIDS
kaposis sarcoma candidiasis non-hodgkins lymphoma mycobacterium complex
A pregnant patient is hospitalized with severe hemorrhage. The nurse expects what laboratory results? Select all that apply. Increased lactate levels Increased sodium levels Decreased hematocrit levels Decreased blood glucose levels Increased natriuretic peptide levels
lactate & hematocrit
client populations at high risk for obesity and DM
latino american man native american man hispanic american man african american woman
Diaphragm (birth control)
leave in the cervix for up to 6 hours after sex to prevent pregnancy do not leave in longer than 8 hours
if you suspect a client has an air embolus ... place them in this position
left side lying, reverse trendelenburg
Normal amount of chest tube drainage per hour
less than 70 mls per hour
poisonous flower
lily
Pt. on tylenol ... monitor
liver and renal function
Glaucoma
loss of peripheral vision treatment: beta blockers
diet for cirrhosis
low fat fluid restriction
diet management for inflammatory bowel disease
low residue diet
what is the deadliest cancer
lung cancer
diagnostic test for sarcoidosis
lung tissue biopsy
HELLP syndrome / treatment
magnesium sulfate
Wilms tumor
malignant kidney tumor do not palpate abdomen
Medical Reserve Corps (MRC)
may help staff hospitals or community health settings that face shortages and provide first aid stations or special-need shelters.
bone fractures / fat emboli
medical emergency! sudden change in mentation is warning sign
ectopic pregnancy / nursing interventions
medical emergency! Notify HCP ultrasound vitals to assess for shock surgery
ventricular ectopy
multiple PVCs caused by decreased oxygenation to myocardium apply oxygen!
A CT scan is used to detect
musculoskeletal problems, primarily in the vertebral column and joints
Getamycin adverse reaction
nephrotoxicity, ototoxicity
vancomycin
nephrotoxicity, phlebitis
patients on chemotherapy who are neutropenic may recieve
neupogen or neulasta
symptom in the early stage of renal insufficiency
nocturia
Hypoparathyroidism
numbness, tingling, cramps in extremities caused by hypocalcemia
When volume of blood loss is greater than 30%
start infusion of blood product
cystic fibrosis / signs and symptoms
steatorrhea malabsorption, poor weight gain
decreased fetal HR variability / nursing actions
stop oxytocin oxytocin can cause forceful contractions and decreased oxygenation to the placenta, leading to decreased variability
kidney stone
strain all urine most important encourage urine
chest tube / there should be slow, steady bubbling in the
suction control chamber
Nurse Practice Act
supervision and delegation
Hirschsprung disease
suspected in newborns who do not pass meconium within 24 hours distended abdomen
Dobutamine
symoathimometic drug increases HR
phlebitis / nursing actions
take out IV apply warm packs to the site notify HCP restart IV in another vein document
testicular exam
testicular self exam done monthly starting at puberty
Colorectal cancer screening
testing Done every 5 years starting at age 50 or colonoscopy done every 10 years
two main causes of pancreatitis
obstructive cholelithiaitis and alcoholism
Aging on renal system and older adults
older adults have more protein and glucose in their urine than adults higher urine specific gravity
Trigeminal Neuralgia
paroxysms of pain, similar to electric shock on the face
mechanical ventilation and skeletal muscles
patients often need a skeletal muscle relaxer while on mechanical ventilation risk for impaired communication
asthma and morphine
patients should not be on morphine with asthma morphine is a histamine-releasing opioid
EKG abnormalities in hyperkalemia
peaked t wave widened QRS
escharotomy
performed to relieve the compartment syndrome that can occur when edema forms under nondistensible eschar in a circumferential third-degree burn. The escharotomy releases the tourniquet-like compression around the arm. Escharotomies are performed through avascular eschar to subcutaneous fat.
chest tube disconnects from water seal chamber
place in a bottle of sterile water
signs and symptoms of hypocalcemia
positive chvosteks sign numbness and tingling around mouth hyperactive reflexes twitching, cramping tetany laryngospasms dysrhythmias
hypocalcemia / EKG
prolonged QT and ST
Antidote for Heparin
protamine sulfate
acute renal disease / diet
protein-restricted, high-calorie, fluid-controlled, sodium and potassium controlled.
diet management for gastric ulcer
reduce high fiber, high roughage foods and spicy foods
Insulin by IV route
regular insulin only IV
potassium primarily affects...
resting membrane potential of skeletal, cardiac and smooth muscle overall muscle function regulates cell metabolism of carbs and proteins
earliest sign of hypoxia
restlessness and confusion
Multiple sclerosis and bladder control
retention is common teach pt. self catheterization to prevent distention
If there's separation of emulsion product, froth accumulation or fat globules in a bag of fat emulsion lipids ... the nurse should
return the bag to the pharmacy
five rights of delegation
right task right circumstance right person right direction/communication right supervision/evaluation
corticosteroids
risk for infection
bulimia nervosa / sign
russell's sign - calluses on back of hand
multiple sclerosis / client education
schedule rest periods
liver damage and sedatives
sedatives (like phenobarbitol) are contraindicated with liver damage
carbon monoxide levels of 41% to 60% result in
seizure and coma;
Which types of shock may cause reduced urinary output in a patient? Select all that apply. Septic shock Obstructive shock Neurogenic shock Cardiogenic shock Hypovolemic shock Anaphylactic shock
septic hypovolemic cardiogenic obstructive
Professional Standards Review Organizations (PSROs)
set up by federal gov't to review quality, quantity and cost of healthcare
small bowel obstruction
severe fluid and electrolyte imbalances
ectopic pregnancy / signs and symptoms
sharp abdominal pain vaginal bleeding transferred shoulder pain
postmenopausal vaginal bleeding
sign of endometrial cancer
magnesium primarily affects
skeletal muscle contraction carbohydrate metabolism and ATP cell growth & energy
cellulitis
skin infection of dermis and hypodermis
whispered pectoriloquy
sound is not easily transmitted through lung tissue if louder/clear - pneumonia absent/diminished - air ... pneumothorax, emphysema
Numbness and tingling of the lower extremities could be a sign of
spinal cord compression
The Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS) is a
standardized survey developed to measure client perceptions of their hospital experience. The survey asks 27 questions about the client's hospital experience. The survey is taken by clients who were discharged from the hospital between 48 hours and six weeks ago.
When volume of blood loss is less than 30%
start crystalloid fluids
A patient is receiving 5% human serum albumin. The nurse should monitor for which complications associated with the infusion? Select all that apply. Urticaria Bleeding Hyponatremia Fluid overload Hyperchloremic acidosis
urticaria fluid overload
nystatin suspension
used for fungal infections of the mouth pt. should swish in mouth for 2 minutes, then swallow
fresh-frozen plasma
used for volume expansion as a result of fluid and blood loss
Abnormal bleeding, often resulting in hypermenorrhea, is associated with
uterine cancer.
HELLP syndrome
variant of severe preeclampsia Hemolysis Elevated liver enzymes Low Platelets
chest tube / the suction control chamber should be filled with
water to the 20 cm line
chest tube / there should be tidaling (rising and falling) in the
water-seal chamber
Fat emulsion (lipids)
white, opaque solution administered intravenously during parenteral nutrition therapy to prevent fatty acid deficiency
Digoxin and Heart rate
withold med if heart rate is less than 60
aPTT (activated partial thromboplastin time)
~60-90 seconds a measure of clotting time; used to monitor unfractionated heparin
