ARCHER and MARK K

You are working in the emergency department and are preparing to discharge a patient who came in with a magnesium level of 1.4 mEq/L. You are writing a list of foods you recommend that the patient consumes. Which foods would be appropriate for this list? A. Spinach B. Onions C. Mushrooms D. Salmon

A. Spinach D. Salmon

A patient reports feeling numbness of the throat and tongue after taking Benzonatate. Which of the following should the nurse instruct the patient?

A. Swallow the medication without chewing it The patient should be instructed to swallow the capsules without chewing, as the medication in the capsules will cause numbness of the throat and tongue. Benzonatate is a popular antitussive. It does not act on the cough center. Instead, benzonatate has an anesthetic-like effect on stretch receptors in the lung, which interrupts the cough "message."

The emergency department nurse is caring for a client with an abdominal aortic aneurysm at risk of rupturing. The nurse will anticipate the primary healthcare provider (PHCP) to prescribe A. esmolol. B. dexamethasone. C. heparin. D. pantoprazole.

A. esmolol. tight blood pressure control is essential

A cast has been applied to a childs arm and 3 hours later they state they cannot feel their fingers. What is the nurses most appropriate action? 1) Reassure client this is normal 2) Ask the client to clench his fist frequently 3)Remove cast immediately 4) Notify doctor

4) Notify doctor

a diabetic patient should get their A1c checked how often

90-120 days

disenfranchised grief

A situation in which certain people, although they are bereaved, are prevented from mourning publicly by cultural customs or social restrictions.

What is the priority nursing intervention for a newly admitted client with the possible nursing diagnosis of self care deficit: bathing and hygiene? (think nursing process)

A thorough assessment of the client in terms of self care strength and weaknesses

A nurse is administering furosemide to a pt. Which manifestations would be concerning for fluid volume deficit? A) Tachycardia B) Bradypnea C) Weight Gain D) Decreased Output E) Tenting of skin

A) Tachycardia D) Decreased Output E) Tenting of skin

A client has used a condescending tone towards the nurse, subsequently angering the nurse. Which response by the nurse would be most therapeutic? A. "That tone of voice makes me feel upset." B. "You make me angry when you talk like that." C. "Are you trying to upset me?" D. "Why do you use that tone of voice with me?"

A. "That tone of voice makes me feel upset." This response allows the nurse to provide feedback to the client without directly holding the client responsible for the nurse's reaction to the client's behavior.

When does preeclampsia usually occur?

After 20 weeks

milieu therapy

An emphasis of this therapy is the setting, the structure, and the emotional climate as important to the client's healing.

Which of the following special considerations should the nurse make when caring for a Hindu patient based on her religion? A. Provide all vegetarian meals. B. Handle the client's temple garments with care. C. Be sure the bathroom is equipped with a shower and not just a tub. D. Be aware that the patient will likely refuse blood transfusions. E. Arrange for female nursing staff to provide care for the client as much as possible. F. Be aware that the patient will likely refuse pain medication.

C. Be sure the bathroom is equipped with a shower and not just a tub. E. Arrange for female nursing staff to provide care for the client as much as possible

The nurse is instructing a client who is scheduled for electroconvulsive therapy (ECT). Which of the following statements by the client would require follow-up? A. "I can take my morning antidepressant with a sip of water." B. "I may feel a flushing sensation as the contrast dye is given." C. "I should be able to drive home after this procedure." D. "I will need one treatment for my depression to go into remission." E. "I may experience some confusion after this procedure."

B. "I may feel a flushing sensation as the contrast dye is given." C. "I should be able to drive home after this procedure." D. "I will need one treatment for my depression to go into remission. ECT is a safe therapy that induces seizures theorized to release monoamines, which may assist in treating psychiatric illnesses such as major depressive disorder and significant psychosis. Clients do not receive contrast dye ( Choice B) for this procedure; instead, this procedure involves no imaging and requires general anesthesia. Driving home after the procedure is prohibited because of the post-procedural confusion from general anesthesia and the ECT procedure itself ( Choice C). Clients may experience remission after several treatments, but one treatment is highly unlikely to bring remission ( Choice D). Instead, one session of ECT may bring some symptom improvement

A nurse is instructing a client about a newly prescribed medication, phenytoin. Which statements, if made by the client, indicate effective teaching? A. "If my gums get irritated and large, I can stop this medication." B. "I will need laboratory work to monitor the medication level." C. "It is okay for me to increase this medication if I have a seizure." D. "I should take this medication with low protein foods."

B. "I will need laboratory work to monitor the medication level."

Before administering an as-needed opioid for pain, the nurse assesses the client. It is determined that the client is arousable but tired and is falling asleep during conversation. How would the nurse best document this assessment data? A. A #2 according to the Pasero sedation scale B. A #3 according to the Pasero sedation scale C. Comatose D. Stuporous

B. A #3 according to the Pasero sedation scale S: Asleep but easily aroused 1: Alert and awake 2: Sleepy but easily aroused 3: Arousable, but tired and falling asleep during conversations. This level is unacceptable. Monitor respiratory status closely until sedation level is #2 or lower. 4: Little or no response to physical stimulation. This level is unacceptable. Stop opioids and consider reversing with naloxone.

The nurse on the medical floor receives a report on four patients. Which patient should the nurse see first? A. A client with a pulmonary embolism that has dyspnea and a pCO2 of 30 mmHg, who is on anticoagulation. B. A client with atrial fibrillation on Warfarin with a history of prior rectal bleeding and an INR of 6.0. C. A client with congestive heart failure and brain natriuretic peptide of 640 pg/mL. D. A client with acute pancreatitis and serum calcium of 8.9 mg/dL.

B. A client with atrial fibrillation on Warfarin with a history of prior rectal bleeding and an INR of 6.0. While answering prioritization questions, it is essential to determine which findings are unexpected and which pose an immediate risk of complications to the client. The target international normalized ratio (INR) for atrial fibrillation is 2.0-3.0. A supra-therapeutic INR of 6.0 is too high for this patient and puts the patient at high risk for bleeding. Additionally, given his prior history of gastrointestinal bleeding, he is more prone to recurrent bleeding in the setting of coagulopathy. The nurse should hold warfarin, assess the patient for signs of bleeding and notify the physician of abnormal results to determine if vitamin K should be administered to counter the effects of warfarin.

The nurse is assisting the physician with a lumbar puncture to assess for meningitis. What should be the first nursing action of the nurse? A. Lay the client on his side. B. Ask the client to void. C. Obtain an advanced directive from the client. D. Withhold food and drinks from the client prior to the procedure.

B. Ask the client to void.

The nurse prepares a client for a positron emission tomography (PET) scan. Which laboratory data is necessary to obtain before this test? A. Urine specific gravity B. Liver function tests C. Blood glucose D. Creatinine kinase

C. Blood glucose the client is instructed to be nothing by mouth (NPO) four to six hours before the exam and have a glucose level below 150 mg/dL. The reasoning is that this exam primarily looks at cancerous tissue, which uses a substantial amount of glucose. If the radioisotope is metabolized in the body, similar to glucose, it will accumulate in the most active areas. Glucose greater than 150 mg/dL or less than 60 mg/dL will alter the results.

swallowing postures

Chin down/ chin tuck sitting up 90 degrees

The nurse is caring for a client who is experiencing psychosis. The client states, "You all are trying to kill me!" Which of the following responses would be most appropriate for the nurse to make to the client? A. "What you are experiencing is not real." B. "Are you hearing voices?" C. "You are safe here, please be calm." D. "What makes you think we are trying to kill you?"

D. "What makes you think we are trying to kill you?"

Sucralfate (Carafate) does what

Enhances mucosal protection and helps ulcer

up right sleeping position helps what GI issue

GERD

exophthalmos may be caused by

Graves' disease

Live vaccines

MMR and varicella

The nurse is caring for a client at the first prenatal visit. The primary healthcare provider (PHCP) has prescribed testing for syphilis. The nurse anticipates which laboratory testing?

Rapid Plasma Reagin (RPR) An RPR is a common screening test for syphilis infections. This test is often confirmed with a fluorescent treponemal antibody absorption (FTA-ABS) test.

Onychia

infected nail fold

A priority nursing intervention with PROM is to monitor for...

infection

The nurse is caring for a client with a suspected femoral artery occlusion. The nurse should take which action?

Notify the primary healthcare provider (PHCP) The essential action for a client with a femoral artery occlusion is to notify the PHCP or rapid response. This is a medical emergency! If untreated, this extremity may have to be amputated because of the interruption in distal perfusion.

Hemoglobin

Oxygen carrying pigment in red blood cells

diabetes, hormonal imbalances, vaginal, cervical, or rectal disorders, antihistamine, alcohol, tranquilizer, or illicit drug use, and cosmetic or chemical irritants to the genitals

can all cause dyspareunia

Macular degeneration causes

central vision loss

When water breaks it should be ______ and without _____

clear and without odor

Extreme______ is considered a nonallergenic trigger for an acute asthma attack.

cold

ventricular remodeling.

dilation and hypertrophy of the ventricles in the initial phases of heart failure, causing the ventricle to assume a spherical shape

According to the Celiac Disease Foundation, ____________ are among the most easily cross-contaminated food in restaurants

french fries

Angle-closure glaucoma is manifested by

headache and eye pain.

Hirschsprung disease

hereditary defect causing absence of enteric nervous system

suction control bubbling

intermittent bad need to increase suction, continuous is good

water seal should bubble _________

intermittently

Which flu vaccine is live?

intranasal

The initial treatment for a chemical burn is that it is

irrigated with a copious amount of water. This should occur before touching the burn to prevent further injury to the individual rendering care.

macular degeneration vision

loss of central vision

After a liver biopsy the patient should be positioned ....

on right side with pillow under biopsy site

dyspareunia

painful intercourse

Creatinine is a specific indicator of

renal function/failure. Although BUN is a measure of kidney function, patients without kidney disease who are dehydrated can show an elevation in BUN.

Preterm Premature Rupture of Membranes (PPROM)

rupture of membranes before 37 weeks

Premature Rupture of Membranes (PROM)

rupture of membranes before the onset of labor

Do hindus prefer shower or bath

shower or jug of water

Cushing triad

sign of increased ICP -Widening of pulse pressure, -Slowing HR -Slowing Respiration

The best source of reliable writing is

systemic review and meta-analysis studies

menarche

the first menstrual period

Impaired stereognosis is

the lack ability to identify an everyday object with tactile sensations and without visual cues

How do you get lyme disease

tick bites

The nurse should first validate the finding if it is

unusual, deviates from normal, and is unsupported by other data.

Enalapril is an ACE inhibitor and this drug class is indicated in the treatment of heart failure to prevent

ventricular remodeling.

The nurse is caring for a client that underwent a total knee arthroplasty the previous day. The nurse will include which intervention in the patient's care plan? A. Place the client on a continuous passive motion exerciser for 6-8 hours a day. B. Ask the client to dangle his feet on the bed for 5 minutes before standing up. C. Encourage weight bearing on the affected knee joint. D. Instruct the client to maintain a flexed knee while in bed.

A. Place the client on a continuous passive motion exerciser for 6-8 hours a day. This ensures that the knee is having its maximal range of motion, which is the goal for rehabilitation

The nurse observes a parent swaddling their infant with an unrepaired omphalocele. Which of the following statements would be appropriate? A. "Stop! You will kill your baby." B. "That is a nice, tight swaddle. It will help soothe your new baby." C. "May I help you? We will need to be careful with their intestines since we do not want the swaddle to push them back inside." D. "Swaddling is not allowed for these babies; please stop."

"May I help you? We will need to be careful with their intestines since we do not want the swaddle to push them back inside."

The average lithium level

0.6 mEq to 1.2 mEq/L. Any level over 1.5 mEq/L indicates a toxic serum lithium level

creatinine

0.6-1.2

Drug Levels: Phenytoin

10-20 mcg/mL.

Naegeles rule assumes ovulation is on day _____

14

BMI range

18-25

WHich should be included in care for kawasaki: 1. Contact precautions 2. 12-lead EKG 3. Soft foods and liquids 4. Fluid restrictions 5. Admin aspirin as prescribed

2. 12-lead EKG 3. Soft foods and liquids 5. Admin aspirin as prescribed

The nurse counsels a client about a newly inserted copper intrauterine device (IUD) for contraception. It would require follow-up if the client states which of the following? A. "This device may raise my risk for breast cancer." B. "I may continue to have bleeding and cramping." C. "I should perform weight-bearing exercises." D. "I will need my device replaced after 15 years." E. "This device may raise my risk for a stroke."

A. "This device may raise my risk for breast cancer." C. "I should perform weight-bearing exercises." D. "I will need my device replaced after 15 years." E. "This device may raise my risk for a stroke." The copper intrauterine device is non-hormonal; therefore, it does not raise the risk of breast cancer. Unlike depot medroxyprogesterone, the IUD does not cause bone demineralization, so weight-bearing exercises are not a relevant teaching point for this type of contraception (where they would be for depot medroxyprogesterone). An increase in cardiovascular disease is not associated with the copper IUD as it is non-hormonal. The IUD is to be replaced every ten years (US FDA approved duration) - not fifteen. The most common adverse effect of the copper IUD is increased bleeding and cramping within the first six months after application. This may cause the client to discontinue the device.

You are providing education to the parents of a toddler suffering from gastroesophageal reflux disease (GERD). You know they understand your teaching when they make which of the following statements A. "We should feed him 6 small meals a day instead of a few big ones." B. "Making sure he is sitting upright while eating may help the reflux." C. "He should try to sleep on his left side so that his stomach can empty more easily." D. "There are no medications that can help with this disease so we will have to make lifestyle changes."

A. "We should feed him 6 small meals a day instead of a few big ones." B. "Making sure he is sitting upright while eating may help the reflux."

The nurse is reviewing dietary teaching with a client who has hypercalcemia. Which foods should the nurse recommend that the client avoid? A. Broccoli B. 2% milk C. Whole wheat pasta D. Bananas E. Seafood

A. Broccoli B. 2% milk E. Seafood

The nurse is caring for a client diagnosed with atrial fibrillation. The nurse should anticipate a prescription for which of the following medications? Select all that apply. A. Diltiazem B. Nitroglycerin C. Clonidine D. Atorvastatin E. Warfarin

A. Diltiazem E. Warfarin

The nurse is conducting a health screening at a local health fair. Which of the following should the nurse recognize as a risk factor for developing type II diabetes mellitus? Select all that apply. A. Gestational diabetes B. Metabolic syndrome C. Chronic corticosteroid use D. Gastric bypass surgery E. Obesity

A. Gestational diabetes B. Metabolic syndrome C. Chronic corticosteroid use E. Obesity

Which of the following does the nurse know are possible causes of constipation in the pediatric patient? A. Hirschsprung's disease B. Spina bifida C. Iron supplements D. Psychosocial factors

A. Hirschsprung's disease B. Spina bifida C. Iron supplements D. Psychosocial factors

While working in a pediatric cardiac unit, you are assigned to take care of an infant with tetralogy of Fallot. During report, you are told that the infant is having frequent 'tet spells'. To prepare for your shift, which medication do you ensure is readily available in case of a tet spell? A. Morphine sulfate B. Dexmedetomidine C. Fentanyl D. Atropine sulfate

A. Morphine sulfate Morphine sulfate is the drug of choice for use during tet spells. It helps to calm the child down while simultaneously reducing the infundibular spasm that causes right ventricular outflow obstruction and therefore the hypercyanotic tet spell.

The registered nurse (RN) is observing licensed practical/vocational nurses (LPN/VN) care for assigned clients. Which of the following actions by the LPN would require the RN to intervene? Select all that apply. A. Positions an unconscious client semi-Fowlers for oral care. B. Administers a bronchodilator to a client with chronic asthma. C. Irrigates an indwelling urinary catheter with 30 ml of sterile saline. D. Removes and reapplies weight to a client's skin traction every two hours. E. Administers intramuscular (IM) ketorolac to a client with osteoarthritis.

A. Positions an unconscious client semi-Fowlers for oral care. D. Removes and reapplies weight to a client's skin traction every two hours. An unconscious client should not be positioned semi-Fowler's for oral care. The client should be positioned on their side to prevent aspiration. When a client has skin traction, the weights should hang freely and not be removed unless prescribed by the physician. Intermittent removal and reapplication may be harmful to the client. Administering a bronchodilator to a client with chronic asthma, irrigating an indwelling urinary catheter, and administering intramuscular anti-inflammatory medications such as ketorolac is all within the scope of an LPN.

The nurse is caring for a client with systemic lupus erythematosus (SLE) in the acute phase of exacerbation. The nurse should focus on which aspect of nursing care? A. Prevention of additional infection B. Alleviate feelings of powerlessness C. Development of positive coping skills D. Provide social support

A. Prevention of additional infection Choice A is correct. During exacerbations, nursing care should be directed towards assessment and management of acute confusion, prevention of seizures, maintenance of skin integrity, prevention of new infection, evaluation of renal function, and management of impaired gas exchange.

A patient is being intubated in the trauma bay after falling from a 20-ft deer stand. The doctor instructs the nurse to prepare intubation drugs. Which drug should the nurse administer first? A. Propofol B. Vecuronium C. Succinylcholine D. Rocuronium

A. Propofol Propofol is a sedative agent, which needs to be administered first before a paralytic agent.

The nurse is assisting a client with their insulin pump. The nurse understands which insulin is commonly loaded into the pump?

A. Rapid acting

A patient with a chest tube drainage system has just been admitted to the unit. The nurse notes that the fluid in the water seal column is not fluctuating. The nurse knows that the best explanation of fluctuation cessation is that: A. There may be fibrin clots in the tubing B. The lung is collapsing C. There has been an increase in intrapleural pressure D. The tubing may have become dislodged from the chest

A. There may be fibrin clots in the tubing Choice A is correct. Fibrin clots from the lungs sometimes become lodged in the chest tube system resulting in the cessation of fluctuations in the water seal column. This may also occur when the lung becomes fully expanded.

The nurse is preparing to measure the fundal height of a client at 16 gestational weeks. The nurse should prepare the client for this assessment by instructing the client to

A. lay in a side-lying position with the knees bent.

The nurse is discussing about the functions of the parathyroid hormone (PTH) with a student. Which of the following statements would be correct for the nurse to make? A. moves calcium from bones to the bloodstream. B. promotes renal tubular reabsorption of calcium. C. controls bodily functions such as metabolism and heart rate. D. promotes renal tubular reabsorption of phosphorus. E. causes the retention of sodium and the excretion of potassium.

A. moves calcium from bones to the bloodstream. B. promotes renal tubular reabsorption of calcium.

The nurse is performing a physical assessment on a client with infective endocarditis (IE). The nurse observes flat, reddened non-tender maculae on the hands and feet. The nurse understands that these are

B. Janeway lesions.

The nurse is implementing orders for a client undergoing a barium enema. Aside from the radiology department, which hospital department should be notified of the procedure?

B. The dietary department.

The nurse is assessing a client diagnosed with a pneumothorax with a water seal chest tube placed three hours ago. The nurse observes no tidaling in the water seal chamber. The nurse should take which action? A. Auscultate the client's lung sounds B. Assess the tubing for any kinks C. Instruct the client to cough and deep breathe D. Check the amount of water in the suction control chamber

B. Assess the tubing for any kinks . Tidaling in the water seal chamber along with intermittent bubbling, is expected for a client with a pneumothorax. If tidaling and intermittent bubbling have stopped, it could indicate a positive finding such as the resolution of the pneumothorax. Considering that this client had this device placed three hours ago, a resolution is unlikely. The more likely finding is that a portion of the tubing is kinked or obstructed which has stopped the tidaling in the water seal chamber.

The nurse reviews the assessment data for a child with acute glomerulonephritis (AGN). Which of the following would be an expected finding? A. Urine specific gravity of 1.004. B. Hematuria C. Urinary incontinence D. Hypotension

B. Hematuria Urinalysis shows red blood cells (hematuria) and protein (proteinuria) in a client with AGN. In addition to hematuria, one of the characteristic findings of AGN is the presence of red blood cell casts.

The nurse is caring for several geriatric clients. Which of the following should the nurse include in the teaching plan for older clients with altered immune responses? Select all that apply. A. It is normal to run a slightly higher than normal temperature. B. If arthritis pain begins to bother you, the doctor can prescribe something for pain. C. I'd like to talk to you about ways to manage stress. D. It is very important to eat a well-balanced diet.

B. If arthritis pain begins to bother you, the doctor can prescribe something for pain. C. I'd like to talk to you about ways to manage stress. D. It is very important to eat a well-balanced diet. *Pain can lower immune system due to stress response

Select the sensory impairment that is accurately paired with one of its possible causes or a method for assessing it. A. Impaired gustatory sensation: Using the Grady Scale B. Impaired tactile sensation: Diabetes C. Impaired auditory sensation: Using the Braden Scale D. Impaired Stereognosia: Alzheimer's disease E. Impaired Proprioception: Morse Scale

B. Impaired tactile sensation: Diabetes D. Impaired Stereognosia: Alzheimer's disease

A neonate is suspected of having a tracheoesophageal fistula. Which symptom would the nurse observe from the neonate? A. Hypersensitive gag reflex B. Dry mouth C. Cyanosis D. Decreased level of consciousness

C. Cyanosis Cyanosis is a notable symptom in a neonate with a tracheoesophageal fistula. The cyanosis often results from a laryngospasm (a protective mechanism that the body has to prevent aspiration into the trachea).

The emergency department (ED) nurse is triaging a client who reports recent international travel to West Africa and has signs and symptoms of conjunctival injection, fever, rash, vomiting, and blood in their stool. The nurse is concerned that this client may have A. pulmonary tuberculosis. B. encephalitis. C. Ebola virus disease. D. inhalation anthrax.

C. Ebola virus disease.

The nurse is giving a lecture on the complications of positive pressure ventilation. Which should be included as a potential cause of alveolar hypoventilation? A. Incorrect respiratory rate in ventilator settings. B. Air leakage from endotracheal tube. C. Excessive lung secretions. D. High tidal volume in ventilator settings.

C. Excessive lung secretions.

You are providing education to an HIV+ mother about what she will need to do for her baby after he is born. Which of the following teaching points are appropriate? Select all A. Follow exclusive breastfeeding to ensure your infant receives proper nutrition. B. Ensure your infant receives all vaccines on time. C. Monitor your infant closely for signs of HIV for at least 18 months. D. Keep track of your baby's weight gain and notify the pediatrician if he doesn't gain weight as expected.

C. Monitor your infant closely for signs of HIV for at least 18 months. D. Keep track of your baby's weight gain and notify the pediatrician if he doesn't gain weight as expected. *B is usually good advice but in the case of an HIV+ mother, it is not correct. No live vaccinations should be administered to an infant until it is confirmed they are HIV negative. This includes MMR (measles, mumps, rubella), smallpox, chickenpox, rotavirus, and yellow fever vaccines. All other vaccines can be administered on schedule.

Symptoms of Kawasaki disease

Characterized by: fever, conjunctivitis, rash, redness and swelling of hands/feet, chapped lips

A G3P3 client in labor tells the nurse, "I would like to breastfeed, but my breasts got so engorged last time. I could not take it. Do I have to go through that again?" Which of the following responses is most appropriate? A. "Keeping your baby on an every 4-hours schedule would help slow the milk production and lessen the engorgement." B. "You can feed your baby formula milk until your milk comes in. This will reduce stimulation and prevent engorgement." C. "You can take Parlodil to stop your milk production and prevent engorgement." D. "You need to feed your baby as soon as possible. Also, feeding your baby often would prevent breast engorgement."

D. "You need to feed your baby as soon as possible. Also, feeding your baby often would prevent breast engorgement." Immediate and frequent breastfeeding is the key to decreasing breast engorgement in breastfeeding women. Also, the first step in treating engorgement is encouraging the mother to immediately breastfeed and continue to do so every 2 hours.

What statement about contractures secondary to immobility is accurate? A. Contractures cannot be prevented because of muscular spasticity. B. Contractures cannot be prevented because of muscular tension. C. Extension contractures are the most commonly occurring contracture. D. Flexion contractures are the most commonly occurring contracture.

D. Flexion contractures are the most commonly occurring contracture.

SPIDERMAN - Droplet

Sepsis, scarlet fevel, strep Parvovivrus B19, pneumonia, pertussis Influenza Diptheria Epiglittitis Rubella Mumps, mycoplasma, meningitis, meningeal pneumonia An Adenovirus

Which theoretical model helps in explaining the cyclical and progressive nature of domestic and spousal abuse?

The cycle of violence

Kawasaki disease

Usually below 5 yo In males Can cause inflammation of coronary arteries, leading to aneurysms

preeclampsia

abnormal condition associated with pregnancy, marked by high blood pressure, proteinuria, edema, and headache

Naegele's Rule

add 7 days to first day of LMP, subtract 3 months, and add 1 year

a diabetic patient should get their eyes checked how often

annually

the client should be positioned upright 30-60 minutes after meal to prevent...

aspiration

Celiac disease should avoid sources of gluten such as

barley, rye, oats, and wheat.

thelarche

beginning of breast development

diltiazem

calcium channel blocker