review questions and material

Piaget's stages of cognitive development: Stage 4

Formal operational 11- adulthood

Ophthalmic use of fluroquinolones

burning of the eyes and a crusty discharge may occur

alpha 1 adrenergic blockers

doxazosin prazosin terazosin tamsulosin

antiemetic for pregnant women

doxylamine succinate (antihistamine) and pyridoxine (B vitamin)

common side effects of Allopurinol

drowsiness chills neuropathy N/V

Beck's Triad

hypotension, JVD, muffled heart sounds (PERICARDITIS) Distant heart sounds Distended JVD Decreased BP

antiemetic

meclizine metoclopramide HCL prochlorperazine promethazine ondansetron Uses

identity vs. role confusion

Erikson's stage during which teenagers and young adults search for and become their true selves Adolescence: 12-18 yrs

Presumptive

amenorrhea, fatigue, nausea and/or vomiting (morning sickness), breast changes, elevation of basal body temperature or skin changes.

Aminoglycosides

amikacin gentamicin tobramycin bactericidal for severe infections treat gram-negative aerobic bacilli. inhibit protein synthesis

Autonomy vs. Shame and Doubt

Erikson's stage in which a toddler learns to exercise will and to do things independently; failure to do so causes shame and doubt 18mo-3yr

Initiative vs Guilt

Erikson's third stage in which the child finds independence in planning, playing and other activities 3-5 yrs (preschool)

Monitor for what on Anticoagulants

GI bleed Bleedings: internal, external, bruising, espitaxis (use soft tooth brush and electric razor)

The nurse is caring for a male client admitted with a diagnosis of a spinal cord injury. The client asks the nurse how the injury will affect his ability to have sex. Which is the best response by the nurse? "Sexual intercourse may be possible." "Sexual functioning will not be impaired at all." "Normal sexual function is not possible." "There are drugs to help with achieving an erection."

"Sexual intercourse may be possible."

Medroxyprogesterone acetate contraindications and adverse effects

Contraindications: Pregnancy and hypersensitivity Fluid retention Thrombotic problems

ACE inhibitors use:

Control BP prevent CVA Heart failure kidney protectant for diabetic nephropathy

Age appropriate toys: Adolescent

Adolescents enjoy participating with peers during play. Toys may include music, sports, career training programs, books, movies and social events. Adolescents may be using social media and cell phones daily and should be taught about safe practices with this technology.

TPN for who?

Malabsorption syndrome Severe anorexia nervosa GI tract anomalies or obstruction Intractable, severe diarrhea Complicated surgery or trauma

Intermediate

NPH and Lente L 1-2 hours

bronchoscopy

NPO four hours before Might have sore throat Remain NPO till gag reflex returns

Ibuprofen

Advil Motrin

#1 risk factor for Sarcoidosis

African american

Right sided HF

Weight gain Jugular vein distention Bilateral, dependent peripheral edema Liver engorgement (hepatomegaly with abdominal pain, anorexia and nausea) Ascites

The nurse is providing discharge education to a client hospitalized for an acute exacerbation of rheumatoid arthritis. The nurse includes information focusing on conserving energy. Which statements by the client demonstrate the teaching has been effective? Select all that apply. "I will sit on a tall kitchen stool instead of standing when I am preparing meals." "On days of increased pain, I will stay in bed and relax instead of being active." "I will set priorities and complete the important tasks first." "I will schedule activities throughout the day instead of trying to complete everything in the morning." "If possible, I will delegate some things to my friends or family."

"I will sit on a tall kitchen stool instead of standing when I am preparing meals." "I will set priorities and complete the important tasks first." "I will schedule activities throughout the day instead of trying to complete everything in the morning." "If possible, I will delegate some things to my friends or family." Rheumatoid arthritis is a chronic, systemic, progressive autoimmune disease involving the joints. As the disease progresses, the client's joints will become increasingly inflamed and painful. An important topic to teach these clients focuses on maintaining consistent activity and energy conservation. Regular exercise is essential for clients with arthritis to prevent complications. The client should be as active as possible and not be immobile on days of increased pain. Regarding energy conservation, important concepts include pacing, prioritizing and delegating activity. The client should rest when possible.

The nurse is reinforcing foot care instructions for a client with a history of arterial insufficiency in the legs. Which client statement should the nurse identify as incorrect? "I will ask a family member to help inspect my feet." "I will use Epsom salt to remove any corns and calluses." "I should wear absorbent cotton socks." "I should not walk barefoot around my house."

"I will use Epsom salt to remove any corns and calluses."

5412 The parent of a 5-year-old child is concerned about an outbreak of measles in the community. The nurse understands that additional education about immunizations is needed when the parent makes which of the following statements? Select all that apply. "My child is unlikely to get measles because of their first vaccine at age one." "My child should receive a second dose of the measles vaccine now." "We should avoid playing with children with high fevers." "If a child develops a rash, the risk of spreading measles is gone." "My child should have passive immunity from the vaccine I had as a child."

"If a child develops a rash, the risk of spreading measles is gone." "My child should have passive immunity from the vaccine I had as a child." Rationale: Measles is a preventable communicable disease that was well controlled in the United States until recently. There have been outbreaks of measles in communities where children did not receive the vaccines. The Centers for Disease Control and Prevention (CDC) recommends immunization at around age one, with a booster between ages four and six. The child should be protected from the disease after the first vaccine. The period of time measles is communicable is from 3 to 5 days before the rash appears until about four days after the rash appears. In the first year of life, the child may have passive immunity from the mother. It is important to avoid being in confined spaces with any individual with a high fever.

A client is evaluated in the emergency department for an ankle sprain. Which discharge instructions should the nurse provide? Select all that apply. "Wrap your foot and ankle tightly with the elastic wrap and leave on overnight." "It is important to avoid standing or walking without crutches until after your follow-up visit." "To help decrease swelling, it is important to keep your ankle elevated when you are resting." "Rest your foot and ankle tonight but start strengthening exercises tomorrow morning." "You should apply an ice pack to your ankle for 20 to 30 minutes at a time, 3 to 4 times a day."

"It is important to avoid standing or walking without crutches until after your follow-up visit." "To help decrease swelling, it is important to keep your ankle elevated when you are resting." "You should apply an ice pack to your ankle for 20 to 30 minutes at a time, 3 to 4 times a day."

The daughter of a client with Alzheimer's disease asks the nurse, "Will the medication my mother is taking cure her dementia?" What is the best response by the nurse? "It will provide a steady improvement in memory." "It will help your mother live independently again." "It is used to halt the progression of Alzheimer's disease." "It will not improve dementia but can help control emotional responses."

"It will not improve dementia but can help control emotional responses."

The nurse is preparing a presentation focusing on the prevention of Lyme disease. Which statement by a participant would require further clarification by the nurse? "Lyme disease can spread to my brain if I don't seek treatment." "Lyme disease is caused by a virus similar to the flu." "I should wear light-colored clothing and long pants when gardening." "I will call the doctor if I see a rash that looks like a bull's eye."

"Lyme disease is caused by a virus similar to the flu." While the symptoms of Lyme disease are similar to influenza, Lyme disease is not caused by a virus. Lyme disease is caused by the spirochete, Borrelia burgdorferi, which is transmitted to humans by deer ticks

A client who is scheduled for a diagnostic mammography asks the nurse about the cancer risk from radiation exposure. Which response is most appropriate by the nurse? "A chest X-ray gives you more radiation exposure." "The radiation from mammography is equivalent to one hour of sun exposure." "This exam does not use radiation, and it is not dangerous." "You have nothing to worry about; it is less than tanning in the nude."

"The radiation from mammography is equivalent to one hour of sun exposure."

A client diagnosed with iron deficiency anemia is prescribed ferrous sulfate suspension orally. Which instruction would be most appropriate for the nurse to give to the client regarding this medication? 'Taking this medication will turn your urine dark orange in color." "You should use a straw when taking this medication." "You should take the medication with food to enhance absorption." "Diarrhea is a common side effect when taking this medication."

"You should use a straw when taking this medication."

Premixed insulins

% NPH and % regular Humulin 70/30 Novalin 70/30 Novolog 70/30 Humulin 50/50 Humalog 75/25 R before N Clear before CLOUDY

Wernicke's aphasia

("fluent" receptive aphasia): An inability to understand the meaning of spoken words and reading and writing is impaired; the client is able to speak but sentences do not make sense and contain nonexistent or incorrect words

Broca's aphasia

("non-fluent" or expressive aphasia): Speech is limited mainly to short utterances of less than four words; the client may understand speech and be able to read but has limited writing ability.

Anti-Alzheimer's Agents

*Anticholinesterase inhibitors* donepezil galantamine rivastigmine *NMDA (N-Methyl-D-aspartate)* receptor antagonists memantine hydrochloride

A client is admitted for hypovolemia associated with multiple draining wounds. Which is the best method for the nurse to use to evaluate the client's fluid balance? Presence of edema Daily weight Hourly urine output Skin turgor

*Daily weight* is the most easily obtained and accurate means of assessing a client's fluid volume status. Skin turgor varies considerably with age. Marked excess fluid volume may already be present before fluid moves into the interstitial space and causes edema. Although very important, hourly urine outputs do not take into account fluid intake or fluid loss through insensible loss, sweating or loss from the gastrointestinal (GI) tract or wounds

Anti seizure meds

*Hydantoins* phenytoin *Barbiturates and Barbiturate-like Drugs* phenobarbital *Benzodiazepines* clonazepam diazepam *Succinimides* ethosuximide *Gamma butyric acid (GABA) Inhibitors* valproic acid *Drugs that Treat Partial Seizures* carbamazepine gabapentin

teaching for CCB's

*NO GRAPE FRUIT* can lead to toxicity Syncope so change position slowly dont take OTC meds without talking to provider

Potassium rich foods

- Potato, cantaloupe, spinach, broccoli, orange, banana, avocados, tuna, beets, tomatoes, peas, mushrooms, pumpkin,

Magnesium rich foods

-Almonds -Peanut butter -Egg yolk -Soy -Whole-grain cereal -Dark-green veggies (APES-WyD?) & Nuts, legumes, grains

Calcium rich foods

-Collard greens -Dairy -Spinach -Tofu -Sesame Seeds -Almonds -Cereal -Broccoli -Bok Choy -Black beans -Turnip greens -Garlic -Pudding

Psuedoparkinsonism

-EPS -Sx: bradykinesia (slow movement), rigidity, shuffling gait, drooling, tremors dystonia akathasia muscle rigidity

NMS

-NMS is like S&M; -you get hot (hyperpyrexia) -stiff (increased muscle tone) -sweaty (diaphoresis) -BP, pulse, and respirations go up & -you start to drool

MI symptoms

-Persistent crushing chest pain Radiates to jaw, left shoulder and arm Impending doom

NSAIDS contraindications

-Pregnant women (due to closing of ductus arteriosus) -Peptic ulcer disease - Asthma - Methotrexate & Lithium (increased digoxin) -Increased bleeding with NSAIDS, salicylates, thrombolytics (monitor for bleeding esp GI bleeding) -Increased renal damage with ACE inhibitors** *Is an anti-inflammatory agent and antipyretic* *REPORT TINNITUS, TARRY STOOLS, BLURRED VISION* toxicity and GI bleed Discard nasal bottle after 24 hrs

Chest tube management

-Tidalling SHOULD occur: Ball in water seal chamber moves up and down with pt.'s inspiration and expiration, increase in water level with inspiration, a return to baseline level during exhalation -Bubbling in water seal chamber indicates AIR LEAK -Bubbling in suction chamber is NORMAL -NEVER CLAMP CHEST TUBE: Can increase positive pressure within the lungs and collapse the lungs even more -ONLY clamp chest tube if tube was severed, or if changing collection system or when removing chest tube to see if pt. can handle no chest tube in place -Ensure drainage system is BELOW the level of the chest -Reposition the patient every 1.5-2 hours (promotes drainage -Make sure the tubing is patent at all times

Lipase

0-160

The recommended protein intake is

0.8 grams per kilogram of the client's body weight per day.

Suction should be no longer than

10 seconds

Ammonia levels

15 to 45 mcg/dL Serum ammonia levels are used primarily to investigate the cause of changes in behavior and altered levels of consciousness due to severe liver disease. This test is also used to support a diagnosis of Reye's syndrome. Instruct the client to refrain from smoking for several days prior to the collection of the sample.

D.O.A.B.L.E

DIURETICS OXYGEN ACE INHIB BETA BLOCK LOW SODIUM EXERCISE AS TOL

antiacid meds administration

2 hours apart from other medicaitons

Albumin levels

3.5 to 5.5 g/dL

PPI administration

30 mins before meals

aPTT

30-40 seconds

Tylenol dosage max

4,000 mg per day

The nurse is caring for a client with orders for oxygen (O2) per nasal cannula at 5 L/min. Approximately what fraction of inspired oxygen (FiO2) is the client receiving? 21% 40% 36% 28%

40% Room air has an O2 concentration of approximately 21%. Supplemental O2 therapy is prescribed when the client's oxygenation needs are not met by room air. A nasal cannula can provide O2 at 0.5 to 6 L/min, corresponding to a FiO2 range of 25% to 40%. At 5 L/min, the client would be receiving approximately 40% O2. If the client's oxygenation needs are still not met, the O2 delivery system should be changed from a low-flow system like a nasal cannula to a high-flow system such as a nonrebreather mask.

Antimetabolites (Chemotherapy)

5-Fluorouracil (5-FU) (Adrucil), Methotrexate (Rheumatrex) Interfere with DNA and RNA growth by substituting for the normal building blocks of RNA and DNA. These agents damage cells during the S phase, when the cell's chromosomes are being copied. Methotrexate acts as a substitute for folic acid, which is needed for the synthesis of proteins and DNA USE FOR: Leukemias Breast cancer Ovarian cancer Intestinal tract cancer

Cardiac stress test

A cardiac exercise stress test is used to assess the heart's response to an increased workload caused by exercise or exertion. The client may walk on a treadmill or ride a stationary bicycle while connected to ECG monitoring. The client will exercise until a predetermined heart rate is reached, 20 minutes have elapsed, or the client starts to experience chest pain, fatigue, extreme dyspnea, vertigo or hypotension.The ECG is used to monitor for ventricular dysrhythmias, ST-segment depression or T-wave inversion that can indicate myocardial abnormalities related to coronary artery disease.' Nursing responsibilities for the client undergoing a stress test include: Ensuring that the client adheres to the pre-procedure diet restrictions, such as avoiding caffeine or caffeinated beverages Making sure the client remains NPO or only eats a light meal Instructing client to wear comfortable clothing and footwear

Low calcium diet

A client with hypercalcemia would be limited to 400 mg per day instead of the normal 800 mg. This diet restricts consumption of dried fruits and vegetables, as well as shellfish, cheese and nuts.

The nurse receives report on the following four clients. Which client should the nurse see first? A client who had an above the knee amputation and has a temperature of 101.3°F (38.5°C) A client with a stage 3 pressure ulcer who is due for a scheduled dressing change A client who had a hysterectomy performed 12 hours ago and is nauseous A client with acute urinary retention who has orders to insert an indwelling catheter

A client with acute urinary retention who has orders to insert an indwelling catheter The client with acute urinary retention should be seen first. The client needs to have an indwelling urinary catheter inserted to relieve bladder distention. If acute urinary retention is left untreated, then bladder damage, incontinence or kidney failure can result. The other client problems (e.g., nausea, fever and dressing change) are of lower importance.

Low purine diet

A low purine diet prevents uric acid stones and is used for clients with gout. This diet restricts glandular meats, fowl, anchovies, beer and wine

INR

A normal level is 1.0 in healthy adults.An expected level is 2 to 3 for clients with atrial fibrillation, deep venous thrombosis and pulmonary embolism. The expected level is 2.5 to 3.5 for clients with prosthetic heart valves.

The nurse is providing care to an adult client in the postanesthesia care unit who is recovering from an emergency appendectomy. The client is sleepy, but arousable and reports zero pain on a numeric pain scale. Which assessment finding requires immediate action by the nurse? A temperature of 99.1°F (37.3°C ) A pulse oximetry reading of 92% A blood pressure of 100/60 mmHg A resting heart rate of 128 bpm

A resting heart rate of 128 bpm

Pericardial friction rub

A sign of pericardial inflammation, heard in infective endocarditis (IE), myocardial infarction (MI) and rheumatic fever (RF) Scratchy, grating or squeaking sound Listen using the bell of stethoscope over the left lateral sternal border to hear one systolic sound and two diastolic sounds

TEE

A transesophageal echocardiogram (TEE) examines cardiac structure and function with an ultrasound transducer placed immediately behind the heart in the esophagus or stomach. A TEE provides especially detailed views of posterior cardiac structures. Nursing responsibilities for the client undergoing a TEE include: Maintaining NPO status during the prescribed hours before the TEE Monitoring the client post TEE for the return of their gag reflex before allowing the client to resume oral intake Monitoring the client for respiratory depression related to procedural sedation Offering the client throat lozenges for residual throat discomfort

TB

ACID FAST Mycobacterium TB Fatigue, anorexia, wt loss, cough with purulent drainage, night sweats

Naproxen

Aleve

Aoritc Insufficiency causes

Aortic insufficiency may accompany *Marfan's syndrome*, ankylosing spondylitis, syphilis, essential hypertension or a defect of the ventricular septum.

While using a dry chest drainage system: Bubbling in the water seal chamber indicates

an air leak and should be reported to the health care provider (HCP).

APGAR

Activity, Pulse, Grimace (reflex irritability), Appearance Respiration. A score of 7 to 10 is normal. An infant score between 4 and 6 may indicate that the baby needs some resuscitation measures, including oxygen and careful monitoring. The nurse can simulate the baby by flicking the soles of the feet or rubbing the back. The nurse should be careful not to rub too vigorously. A total score of 3 to 4 indicates moderate depression and the newborn will need oxygen and possibly insertion of a feeding tube to decompress the stomach. A score of three or below indicates the newborn needs immediate resuscitation and lifesaving techniques.

Isotretinoin

Accutane NEED NEGATIVE PREG TEST BEFORE TAKING*

oseltamivir phosphate

Additional side effects include fatigue and cough. These medications have also been associated with orthostatic hypotension, insomnia and urinary retention.

blood transfusion

Administer by RN and check by additional RN NS only No medications Filter with tubing Baseline vitals Type and cross match before administration (only good for 72 hours) Use blood within 30 mins on floor and hang no longer than 4 hours *NEED PRESCRIPTION TO ADMIN* Flush lines after transfusion Slow admin at first 15 mins

The nurse is reviewing the medical record of a client with a new prescription for lovastatin for hyperlipidemia. Which finding requires the nurse to notify the health care provider immediately? Total cholesterol level of 320 mg/dL Serum creatinine level of 1.2 mg/dL Hemoglobin A1c level of 10.2% Alanine aminotransferase level of 90 U/L

Alanine aminotransferase level of 90 U/L Lovastatin is an HMG-CoA reductase inhibitor, commonly called a "statin," which is used for the treatment of hyperlipidemia and other cardiovascular diseases. Statins can be hepatotoxic and liver injury, as evidenced by elevations in serum transaminase levels, can develop. Normal alanine aminotransferase (ALT) levels range from 10 to 40 U/L. An ALT level of 90 is above normal and the nurse should notify the prescriber immediately. An elevated cholesterol level is an indication for treatment with lovastatin. The hemoglobin A1c level is also high but pertains to diabetes management, not the medication prescribed in this scenario. The creatinine level is normal.

ALT and AST

Alanine transaminase (ALT) will increase with liver disease/hepatitis. Normal levels are between 10 to 40 units. Aspartate aminotransferase (AST) will increase with liver disease/hepatitis. Normal levels are between 10 to 40 units.

TPN administration

All TPN solutions should be prepared by or under the supervision of a pharmacist Strict aseptic technique under a laminar airflow hood should be used during preparation Nothing should be added to the solution after it has been prepared In general, TPN solutions are good for 24 hours and must be refrigerated until 30 minutes before use Use a 0.22-micron filter with TPN solutions without lipids, a 1.2-micron filter for TPN solution with lipids Always use an infusion pump when administering TPN Use a dedicated line for the TPN - do not infuse other solutions with the TPN or administer intermittent IV medications including IV push meds through the same line with the TPN *Before starting a TPN infusion, the nurse must verify that the ingredients in the solution match what the HCP ordered.*

acarbose

Alpha-glucosidase Inhibitors: Side effects include abdominal pain, diarrhea, flatulence and rash.

Amylase

Amylase is typically ordered with a lipase test to help diagnose and monitor acute chronic pancreatitis. The client will restrict food for 1 to 2 hours before the test and avoid opiates for two hours before the test.A normal value is 23 to 85 u/dL.

MRI

An MRI is used for imaging the brain (soft tissues). Clients may feel claustrophobic inside the MRI unit. They must remove all metal prior to the test. MRI cannot be used on clients with metal implants.

Transfusion of blood

An informed consent for the blood transfusion has been signed. A type and crossmatch has been completed. The client has an appropriately sized IV catheter in place and patency has been verified. Positive identification is made by two nurses from the donor blood product to the recipient, i.e., client. If the transfusion cannot be started within 30 minutes from when the product was released from the blood bank, the nurse must return the blood product to the blood bank. Blood products should NEVER be stored on the nursing unit, even if it is a refrigerated location. The appropriate tubing is available and primed with 0.9% normal saline. Baseline vital signs are obtained before starting the transfusion. Vital signs are monitored at 15 minute intervals for the first 30 to 60 minutes of the transfusion.

types of pneumothorax

An open pneumothorax is when air enters the pleural space through a hole in the chest wall, e.g., a gunshot wound. A closed pneumothorax is when air enters the pleural space through a hole in the lung tissue (after a lung resection). A tension pneumothorax is a closed pneumothorax with rapid accumulation of air in the pleural space, which increases pressure: High pressure causes mediastinal and tracheal shift away from the affected side, compressing the heart and preventing adequate cardiac output. This condition can result in cardiopulmonary arrest.

Vancomycin

Avoid other Mycins* Nephrotoxic (bloody urine) Ototoxic (loss of hearing) Anaphylaxis *Monitor peak and trough* *SLOW INFUSION OVER 60 MINS* Monitor BUN and creatinine Report HA and dizziness, bloody urine, ringing in ear *Red man syndrome= rash on face, neck and torso with fast infusion. Slow infusion, administer benadryl

Biological agents with a high probability of mass dissemination or person-to-person transmission and high mortality rates include:

Anthrax (Bacillus anthracis) Botulism (Clostridium botulinumtoxin) Plague (Yersinia pestis) Smallpox (Variola major)

considerations for antivirals

Antiviral drugs work best when started within two days after the client becomes sick. They reduce the severity of symptoms and shorten the length of illness but they will not cure the disease. Prior to the first dose, baseline data should be obtained including any history of a hypersensitivity reaction to these medications, pregnancy status and renal function. Monitor for adverse reactions associated with antiviral agent use including headache, worsening infection, superinfections, and dizziness. Teach the client (or reinforce teaching) to report signs and symptoms of a superinfection, change positions slowly related to dizziness and possible hypotension, and to increase fluid intake. Clients being treated for sexually transmittable viruses should be instructed to avoid sexual contact while lesions are visible.

zanamirvir

Antiviral influenza treatment with zanamivir should be initiated within 48 hours of onset of symptoms, thus it is important to get treatment started as soon as possible. The medication won't cure the disease, it will only shorten the time frame that someone is sick and may reduce the severity of the illness. It is administered by oral inhalation. Antibiotics are not an appropriate treatment for the flu.

side effects and considerations with Filgrastim

Arthralgia, myalgia, HA, rash, and pain at injection = common Thrombocytopenia, splenomegally and rupture have also occured have regular CBC educate on signs of infection

The nurse is preparing to remove a client's nasogastric (NG) tube. Which action by the nurse will reduce the risk of aspiration during the removal? Ask the client to hold their breath while steadily pulling the tube out. Change the wall suction to high during the tube removal. Have the client swallow sips of water during the tube removal. Pre-oxygenate the client with 100% oxygen prior to removing the tube.

Ask the client to hold their breath while steadily pulling the tube out

Teaching for Medroxyprogesterone acetate

Assess PSA levels in men with prostate cancer. Monitor for thrombophlebitis. Report vaginal bleeding Teach signs of fluid retention. Monitor glucose if diabetic.

Macrolides used for

Azithromycin and clarithromycin are used as prophylaxis for endocarditis before dental procedures. Azithromycin is also used as prophylaxis for pulmonary exacerbations in clients with cystic fibrosis. Clarithromycin is used for prophylaxis in pertussis and Lyme disease.

BMP

BUN: 7 to 20 mg/dL CO2 (carbon dioxide): 20 to 29 mmol/L Creatinine: 0.8 to 1.4 mg/dL Glucose: 64 to 128 mg/dL Serum chloride: 101 to 111 mmol/L Serum potassium: 3.7 to 5.2 mEq/L Serum sodium: 136 to 144 mEq/L

Class II:

Beta Blockers brevibloc, propranolol

metformin

Biguanide Side effects include headache, weakness, dizziness, drowsiness, agitation, nausea, vomiting, diarrhea, lactic acidosis and flatulence. Metformin is typically taken twice per day with food to decrease GI symptoms. The tablets can be crushed as long as they are not extended release tablets. Be aware of signs of lactic acidosis (hyperventilation, fatigue, chills and sleepiness).

teaching for SERMS

Bone density test at baseline and throughout treatment. Take calcium supplements, Vitamin D if intake is inadequate. Increase exercise with weights. Report fever, acute migraine, emotional distress.

Signs of HTN in body (organ damage)

Brain: occipital headache, blurred vision, dizziness, transient ischemic attack (TIA) or stroke Eyes: retinal arteriole abnormalities, vision loss Heart: chest pain, palpitations, dyspnea or signs of HF; diagnostic tests showing left ventricle hypertrophy, ischemia or infarction Peripheral vascular: intermittent claudication, vascular bruit (Swishing sound in the larger arteries (carotid, aortic, femoral, and popliteal) that can be heard with a stethoscope or Doppler probe; may indicate narrowing of the artery and is usually associated with atherosclerotic disease. or aneurysm) Kidneys: elevated serum creatinine, urine tests positive for protein, kidney disease, including kidney failure

Clindamycin

Broad spectrum NOT FOR: Pregnancy, breast feeding, or liver damage patients Ineffective when taking: Erythromycin and Chloramphenicol Decreases effectiveness of Kaolin *treats MRSA* Adverse effects: *Stevens Johnson Syndrome*, Colitis, dermatitis Educate: TAKE WITH FOOD Complete all meds Take with full glass of water Report any symptoms of superinfection and extreme diarrhea

High protein diet is for

Burns Anemia Malabsorption Crohns Ulcerative colitis >60 g

contraindications for triptans

CAD, htn, hemiplegic or blindness as aura for their migraine Monitor the client for angina, blood pressure changes and renal or liver impairment. Teach clients (or reinforce teaching) to take these medications at the first sign of a migraine and to report any chest tightness or tingling of extremities to their HCP. These medications are not associated with the vascular and gastrointestinal effects of ergot derivatives that are also used as antimigraine therapy.

Cephalosporins

CAN CAUSE C. DIFF INFECTIONS** if abd cramping and diarrhea occurs call HCP

MI diagnostics

CK-MB rises 4 to 6° within 3 to 6 hours and peaks in 18 to 24 hours. The level returns to normal in 3 to 4 days. Lactate dehydrogenase (LDH) appears in 12 to 24 hours and peaks in 48 to 72 hours. This lasts 6 to 12 days. Troponin peaks in 4 to 12 hours and remains elevated for up to three weeks. (SPECIFIC TO MYOCARDIUM)

contraindications for Antipsychotics (Haloperidol, Chlorpromazine, Clozapine, Risperidone, Ziprasidone)

CNS depression Cardiac dysrhythmias Parkinsons Dementia pts BPH Glucoma Peptic ulcer disease Bowel obstruction 48 hrs before Myelography with dye Alcohol Sun exposure

lisdexamfetamine methylphenidate

CNS stimulant

Class IV:

Calcium Channel Blockers diltiazem, verapamil

ACE inhibitor drugs

Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Prinivil) Moexipril (Univasc), Ramipril (Altace) USED: Heart failure (decrease preload) and HTN / MI MOA: Suppress the Renin Angiotensin System (RAS). Prevents the conversion of Angiotensin I to Angiotensin II. This results in arterial dilation and increased stroke volume. ACE inhibitors block aldosterone so the client loses sodium and water and retains potassium

enalapril

Cardiovascular adverse reactions may occur, especially when given parenterally. When given parenterally, monitor blood pressure before and after administration, and the medication should be administered over 5 minutes.

ACE inhibitors & ARBS pregnancy category

Cat D (known defects and possibly death) * NEED NEG PREG TEST BEFORE STARTING*

Rheumatic Fever

Caused by: Strep A Pharyngitis Symptoms: sore throat, swollen joints, SOB, chills, fever (HIGH), chorea (emotional instability, muscle weakness with quick, uncoordinated jerky movements usually in the face, feet and hands), erythema marginatum (a ring-like or snake-shaped rash on the trunk or extremities), subcutaneous nodules or an elevated temperature up to 104°F (40°C). Diagnostics: + ASO

Pericarditis

Causes: bacteria, fungus, virus, SLE, inflammation, Dressler's syndrome, neoplastic disease (cancer) Signs: substernal burning, *pain when lying in supine position*, fever, chills, dysrhythmia, SOB Diagnostics: high WBC, High ESR, +blood culture, + ANA, ECG = ST seg elevation

Probabable findings

Chadwick's sign: increased vaginal vascularity contributes to bluish purple hue of the cervix, vagina and vulva Hegar's sign: increased vascularity and softening of uterine isthmus Goodell's sign: cervical softening caused by stimulation from estrogen and progesterone

Side effects of -prils

Cough Hypotension rash hyperkalemia loss of taste angioedema hepatotoxicity pancytopenia renal damage

education for Nitrates

Change position slowly after taking = hypotension Potency is lost approximately three months after opening the bottle. Keep a fresh supply of nitroglycerin on hand and store tablets in an airtight, dark glass bottle with a metal cap. If three sublingual tablets taken over a 15-minute period do not alleviate the chest pain, this may indicate a myocardial infarction and the client should call 911 immediately

The nurse is assessing a client with a hip fracture who has been in Buck's traction for 24 hours. Which nursing assessment is the priority? Monitoring the client's skin for breakdown around bony prominences. Auscultating the client's lung sounds. Assessing the client's level of pain. Checking the pulse, temperature and sensation of the client's lower extremities.

Checking the pulse, temperature and sensation of the client's lower extremities. Although all of the assessments are important, performing a neurovascular assessment is the priority assessment when caring for a client with a hip fracture. Complications from a fracture, such as acute compartment syndrome (ACS), venous thromboembolism (VTE) and ischemic necrosis, can be identified early with regular and frequent neurovascular checks. The nurse should assess the client's pedal pulses, color, temperature, sensation and capillary refill of the lower extremities. Any abnormal findings should be promptly communicated to the health care provider.

laxatives

Chemical Stimulant cascara senna bisacodyl Bulk Stimulant lactulose magnesium citrate polyethylene glycol psyllium Lubricant Mineral oil

Immediate (red)

Chest wounds Shock Open fractures 2/3 degree burns

Platinum Drugs (Chemotherapy)

Cisplatin USES: Advanced bladder cancer Metastatic testicular cancer Metastatic ovarian cancer MOA: Alkylates DNA, RNA; Inhibits enzymes that allow for the synthesis of amino acids in proteins; activity not cell-cycle-phase specific

Cardiac tamponade

Classic triad of signs: *Hypotension *Muffled heart sounds *Marked jugular vein distention (if there is no hypovolemia) Additional findings: Pulsus paradoxus is when the client's systolic blood pressure is greater than 10 mm/Hg, lower on inspiration than expiration. *Narrowed pulse pressure is the difference between systolic and diastolic blood pressure, an indicator of poor cardiac output. Tachypnea, tachycardia, restlessness*, lightheadedness or decreased level of consciousness - *this person requires emergency care!*

The nurse is reviewing the medical record of a client who is scheduled for a computerized tomography (CT) scan of the brain with contrast. For which information in the client's medical record should the nurse notify the health care provider? Select all that apply. Client takes anticonvulsant medication. Client is on hemodialysis. Client has a positive pregnancy test. Client has peripheral neuropathy. Client has an iodine allergy Client has a mechanical heart valve.

Client is on hemodialysis. Client has a positive pregnancy test. Client has an iodine allergy

propanolol administration

Clients will take the medication with a full glass of water at the same time each day. The medication should not be opened, chewed or crushed. Clients should not concurrently use an antacid that contains aluminum; it may decrease the medication's absorption

Trach care

Clients with a new tracheostomy may have *bloody secretions* for a few days after the procedure or after a complete tube change. A tracheostomy obturator should be available at the bedside at all times. *Fungal Infections can develop under moist tracheostomy dressings.* Ask another member of the Interdisciplinary Team (IDT) such as another nurse or respiratory therapist, to assist with care of a new tracheostomy to prevent accidental dislodgement.

Steven Johnson Syndrome medications

Clindamycin Phenobarbital Carbamazepine. Lamotrigine (Lamictal) the "oxicam" class of anti-inflammatory drugs (including meloxicam and piroxicam) Phenytoin. Sulfamethocazole and other sulfa antibiotics

Antipsychotics (ATYPICAL)

Clozapine Risperidone Ziprasidone HCL

lisdexamfetamine methylphenidate should be avoided with

Contraindications of CNS stimulants include a history of hypersensitivity reaction, heart defects or cardiac problems. CNS stimulants should not be prescribed to clients with anxiety, tension and glaucoma; these effects can be exacerbated by the CNS effects of these medication.Caution should be used when administering these medications to clients with a history of seizures (as they may lower the seizure threshold), to those with a history of substance dependence, or to clients with hypertension.

Codine/Acetaminophen

Codeine is an opioid analgesic and antitussive (cough suppressant). For analgesic use, codeine is formulated alone and in combination with non-opioid analgesics (either aspirin or acetaminophen). Because codeine and non-opioid analgesics relieve pain by different mechanisms, the combination can produce greater pain relief than either agent alone. Opioids such as codeine slow down the function of the central nervous system. This can affect involuntary movements in the body, such as peristalsis. As the movement of food through the intestinal tract is slowed down, the walls of the intestine absorb more fluid. With less fluid in the intestines, stool becomes hard and constipation develops. The other side effects are not usually seen with codeine.

A community health clinic nurse is interviewing a client who is experiencing lightheadedness. The client reports a history of arthritis and is taking ibuprofen for the pain. The client is pale with a blood pressure of 88/40 mmHg. The client's pulse is 114 bpm, the respiratory rate is 22 breaths per minute, and the oral temperature is 98.2°F (36.7 °C). Which additional information should the nurse solicit from the client? Select all that apply. Color of bowel movements Frequency and amount of ibuprofen used Presence of photophobia Presence of bruises Presence of tingling or numbness in the extremities

Color of bowel movements Frequency and amount of ibuprofen used Presence of bruises

Piaget's stages of cognitive development: Stage 3

Concrete Operational 7-11

Topotecan & Irinotecan adverse effects and contraindications

Contraindications: Pregnancy and breast feeding, bone marrow suppression Adverse: Leukopenia Hypersensitivity Neurotoxicity Loss of DTRs Bone marrow suppression

The nurse is caring for a client who is confused and has repeatedly attempted to pull out their intravenous lines and feeding tube. The nurse receives an order from the health care provider (HCP) to apply soft wrist restraints. Which actions by the nurse are appropriate? Select all that apply. Conduct a thorough physical assessment of the client. Tie the wrist restraints using quick-release knots. Explain the rationale for the use of restraints to the client. Call the HCP every 48 hours for a new restraint order. Release the restraints and provide care every four hours. Document that alternative interventions were attempted.

Conduct a thorough physical assessment of the client. Tie the wrist restraints using quick-release knots. Explain the rationale for the use of restraints to the client. Document that alternative interventions were attempted Restraints should only be used as a last resort. If necessary, the least restrictive device should be used to restrain a client. Situations that require the use of restraints include when clients interfere with treatment (e.g., enteral feedings, intravenous infusions, etc.). Every two hours, restraints must be removed to assess skin integrity, allow for range of motion and assess neurovascular status. Even though the client may be confused, the nurse must still explain the reason for applying restraints. Wrist restraints should be tied to a stationary part of the bed with a quick-release knot. A new restraint order must be written by the HCP every 24 hours. Prior to applying restraints, the nurse must conduct a thorough assessment of the client and document the events leading to the use of the restraint. The nurse should also document which alternatives to restraints were tried and the client's response to those measures

Contraindications and adverse effects for SERMS

Contra: Pregnancy and breastfeeding Adverse: Thrombotic events

Cardiac enzyme tests

Creatinine kinase (CK) lab results are used to diagnose an acute myocardial infarction (MI). CK is detected in the blood within 3 to 5 hours post MI. The presence of Murakami (MM) bands indicate skeletal muscle damage and the presence of myocardial B and R (CK-MB) bands indicate heart muscle damage. Troponin is a regulatory protein found in striated muscle. Troponin levels are elevated 4 to 8 hours after a heart attack. This test is used to diagnose a heart attack and to assess the degree of damage to the heart muscle. There are two different cardiac-specific isoforms: troponin I and troponin T.

Contraindications for -sins

Cross sensitivity to quinazolines Not for: constipation, GI obstruction, ileus or liver impairment *contraindicated for clients that have undergone cataract or glaucoma surgery and should be used with caution in clients that have a history of angina or orthostatic hypotension.*

Chemotherapy: Alkylating Agents

Cyclophosphamide interrupts ability of proper binding of DNA and RNA needed for division FOR: Breast cancer, Leukemia, Lyphoma, Hodgkins Disease, Myeloma

The nurse is reviewing the medical record of an inpatient client and notes a positive stool occult blood test. The nurse recognizes which factors may have contributed to this positive result? Select all that apply. Daily consumption of red meat Current naproxen sodium use Recent invasive dental procedure Hemiparesis Current corticosteroid use Amblyopia

Daily consumption of red meat Current naproxen sodium use Recent invasive dental procedure Current corticosteroid use

Rimantacine HCL (Flumadine) Oseltamivir phosophate (Tamiflu) Acyclovir (Zovirax)

Decreases the effect of Phenytoin (Dilantin) Increases nephro and neurotoxicity of aminoglycosides Teach proper hydration while taking medications Report changes in urine output or signs of bleeding Report CNS changes and safety related to orthostatic hypotension Monitor Vital signs and urine output closely Monitor CBC, BUN, creatinine and liver enzymes Increase fluid intake to 1500-2000 mL per day Assess gums for bleeding

Trust vs. Mistrust

Erikson's first stage during the first year of life, infants learn to trust when they are cared for in a consistent warm manner Birth - 18 months

What medication should a patient avoid if they have BPH?

Diphenhydramine is a first generation histamine1 receptor antagonist or antihistamine, commonly used for relief from symptoms of mild to moderate allergic disorders. H1 blockers have anticholinergic effects or atropine-like responses and can cause urinary hesitancy or retention. A client with BPH is already at risk for urinary retention and should not receive an antihistamine such as diphenhydramine without clarification from the HCP first.

Complications for blood transfusion

Disconnect the blood product and blood tubing (do not discard!) but maintain a patent IV line with saline solution Obtain vital signs and monitor the client closely for any respiratory difficulties Notify the blood bank and HCP immediately Send the saved blood product and tubing to the blood bank Monitor urine output Obtain blood and urine specimen per policy and/or HCP orders

If the alarm continues to sound and the client develops distress:

Disconnect the client from the ventilator. Use a manual resuscitation (ambu) bag to ventilate the client. Call for help immediately.

Suctioning and Chest Physiotherapy

Do not apply suction for longer than 10 seconds. Hyperoxygenate prior to and immediately after suctioning. Administer prescribed bronchodilator medication before chest physiotherapy.

Clonidine teaching and interactions

Do not give with Beta Blockers - accentuates bradycardia and rebound hypertension of therapy discontinuation. Monitor HR and BP before admin Monitor liver enzymes Daily weights and I&O for Pulmonary HTN (watch for dyspnea) *Orthostatic hypotension* = might have syncope *Do not stop taking abruptly* Teach client how to take BP

Cervical bioposy or Colposcopy

Do not have sex, use tampon, take vaginal meds, douche or swim 3 days before proceedure

Tetracycline / Doxycycline

Do not take with antiacids (calcium based) or calcium products = decreased absorption *PHOTOSENSITIVE* Hyperglycemia, nephro and hepatotoxic = labs and I&O Teach whether medication prescribed should be taken with food or without and time frame for best absorption. Avoid sun and use sunglasses Do not take with milk products, iron or antacids Take liquid forms via straw to prevent staining of teeth** Not for young children

Opioids indications Codine Morphine Fentanyl Dilauded Hydrcodone Hydromorphone

Do not use with other CNS depressants like Antiseizure meds or mood stabilizers, alcohol, antidepressants, St. johns wort. kava kava Causes resp depression, orthostatic hypotension, increased cranial pressure Monitor bowel sounds Drink 8-10 cups per day High fiber diet DO NOT CRUSH EXTENDED RELEASE TABLETS* used in MI's (morphine)

Contraindications for Macrolides

Do not use with: statins, and ergotamine for lingual ischemia Renal impairment and liver disease Prolonged QT - when used with CCB or other QT prolongation meds

Chemotherapy: Anthracyclines

Doxorubicin y altering the DNA inside cancer cells to keep them from growing and multiplying. anti-tumor antibiotics that interfere with enzymes involved in DNA replication. These drugs work in all phases of the cell cycle. They are widely used for a variety of cancers. Breast cancer Ovarian cancer Lung cancer Bladder cancer Leukemia

The nurse is caring for the neonate immediately following a vaginal delivery. Which interventions will promote temperature regulation in the neonate? Select all that apply. Dry the newborn off with warm towels. Wrap the newborn in blankets and use warmed caps on the newborn. Bathe the newborn to remove contaminants from the delivery. Place the newborn under a radiant warmer. Encourage skin-to-skin contact with the mother.

Dry the newborn off with warm towels. Wrap the newborn in blankets and use warmed caps on the newborn. Place the newborn under a radiant warmer. Encourage skin-to-skin contact with the mother.

The nurse is caring for a client who is recovering from a right total hip arthroplasty. The client reports a sudden onset of chest pain and difficulty breathing. What action should the nurse take first? Elevate the head of the bed. Auscultate the client's lung fields. Notify the health care provider. Obtain the client's vital signs.

Elevate the head of the bed.

Industry vs. Inferiority

Erikson's stage between 6 and 11 years, when the child learns to be productive School age: 6-11yr

The nurse working on a surgical unit is caring for a client who had surgery earlier today. The client's blood pressure is 80/51 mmHg and the heart rate is 128 bpm. Which intervention should the nurse implement first? Increase the rate of the IV fluid infusion. Check the surgical dressing for bleeding. Apply supplemental oxygen therapy. Ensure the client has a patent airway.

Ensure the client has a patent airway

Double check these mediations with 2 nurses:

Epi, NE, Phenylephrine Propanolol, metoprolol, Labetalol Warfarin, Heparin, Lovenox Fondaparinux, Apixaban, Rivaroxaban Argatroban, Bivalirudin, Dabigatran etexilate Alteplase, Reteplase, Tenecteplase Eptifibatide Sterile Water Dialysis Hypoglycemics, Insulin Digoxin, Milrinone (Primacor) Liposomal Amphotericin B (antifungal) Epoprostenol, Nitroprusside sodium Magnesium Sulfate Methotrexate Oxytocin Promethazine Vasopressin

Doxorubicin (Adriamycin) adverse effects and education

Esophagitis Thrombocytoepenia Cardiotoxic *GIVE THRU LARGE BORE IV NEEDLE* Monitor for extravasation= Ice pack and call HCP and Dexrazoxan Assess HR before admin *Drug turns urine pink or red* Report signs of infection or bleeding Isolation precautions and do not visit anyone with respiratory infections

The nurse is assessing a client during the first stage of labor. Which action is correct when evaluating the characteristics of uterine contractions? Place a hand on the abdomen below the umbilicus and palpate uterine tone with fingertips. Evaluate intensity by pressing fingertips into the uterine fundus. Assess uterine contractions every 30 minutes throughout the first stage of labor. Determine frequency by timing the end of one contraction until the end of the next contraction.

Evaluate intensity by pressing fingertips into the uterine fundus The characteristics of uterine contractions include frequency, duration and intensity. The frequency of contractions is measured from the beginning of one contraction to the beginning of the next contraction. Duration is how long each contraction lasts from beginning to end. Intensity refers to the strength of the contraction, which is determined by pressing down on the fundus with the fingertips to see if the fundus can be dented. If the fundus can be indented with fingertips in the peak of a contraction, the contraction is deemed mild. It is best practice to time several consecutive contractions before charting frequency or duration.

Considerations for manitol

Extravasation (leakage) of mannitol can cause edema and skin necrosis. Monitor blood pressure, intake and output, and electrolyte levels. Mannitol may crystallize; use a filter needle to withdraw mannitol from the vial, and an in-line filter with continuous IV infusion. Teach the client (or reinforce teaching) to report any chest pain, breathing difficulty, or pain at the IV site to the nurse. The client should also change position slowly to decrease dizziness.

Primary HTN causes

Family history of hypertension within the client's immediate family, including mother, father, sister or brother Race: African Americans, Hispanics and Native Americans are more susceptible Stress levels Obesity: the client is 20% or more above their ideal weight A diet high in sodium Use of tobacco Sedentary life and lack of exercise Older age

Left sided HF

Fatigue and activity intolerance Cough (often initially dry) Mild weight gain that leads to early pulmonary symptoms Shortness of breath/orthopnea Paroxysmal nocturnal dyspnea Tachypnea Crackles Third heart sound Cardiac cachexia and muscle weakness in the advanced stage Acute pulmonary edema: Frothy sputum (may be blood-tinged) Restlessness, irritability, hostility, agitation and anxiety Prominent crackles throughout lung fields Diaphoresis Cyanosis

Metronidazole (Flagyl)

For: H-pylori, UTI, Septicemia, meningitis *avoid alcohol 48 hrs from taking medication (not even mouth wash) *Dark urine is expected and metallic taste Monitor: CCB for bone marrow suppression, UOP and color, ECG and LOC Proper hand washing with bowel movements and cleansing mouth (can cause infections)

Contact precautions

Gastrointestinal infections, e.g., foodborne illness such as norovirus or Clostridium difficile (C. diff.) Diarrhea of unknown origin Skin infections or infestations, e.g., impetigo, scabies Presence of, or colonization with, multidrug-resistant bacteria, e.g. methicillin-resistant Staphylococcus aureus (MRSA) Gown, gloves, mask, eye protection

Iron def anemia symptoms

Generalized weakness and fatigue Light-headedness and inability to concentrate Palpitations Dyspnea on exertion Pallor Tachycardia Dry, brittle, ridged nails Glossitis Angular stomatitis

Penicillins

Give separately from aminoglycosides: May inactivate medication. May cause anaphylaxis meals or 2-3 hours after meals). Report sore throat, fever, fatigue, diarrhea as they may indicate superinfection. Admini with water

Clonidine contraindications

Glaucoma Cardiogenic shock Dysrhythmias

Sulfonylureas

Glimepiride Glipizide Glyburide Chlorpropamide

Galantamine and rivastigmine side effects

HA insomnia pain dizziness anorexia diarrhea HTN cough

Pregnancy test looks at

HCG Positive = HCG >25

AZT (zidovudine) Antiviral

HIV, Hep B, Epstein Barr Bone marrow depression with antineoplastics = Decreased platelets and granulocytes GI and insomnia is common and disappears 3-4 wks into treatment *Report signs of infection: sores in mouth, fever, etc* No OTC meds (tylenol, aspirin)

-statins MOA

HMG- CoA Reductase Inhibitor agents reduce LDL cholesterol by inhibiting the HMG-CoA reductase enzyme in the liver that is responsible for the synthesis of cholesterol. This reduces LDL levels and slightly increases the cardioprotective high density lipoprotein (HDL) levels. This drug may cause atheroma formations to shrink. Contraindications

OTC cold medications are contraindicated for who

HTN CV problems

Antipsychotics (TYPICAL)

Haloperidol Chlorpromazine

The nurse is collecting data on a client who is complaining of drowsiness and an inability to concentrate. Which statements by the client's spouse indicate the client might be suffering from obstructive sleep apnea? Select all that apply. "He is very irritable and tired, even when he has slept 12 hours the night before." "He snores really loud during the night. I have to sleep in the other bedroom." "He falls asleep anytime he sits down" "He stops breathing sometimes at night." "He says he feels short of breath when lying flat." "His legs are usually swollen at the end of the day." "He seems to snore less when he sleeps in a chair."

He is very irritable and tired, even when he has slept 12 hours the night before." "He snores really loud during the night. I have to sleep in the other bedroom." "He falls asleep anytime he sits down" "He stops breathing sometimes at night." "He seems to snore less when he sleeps in a chair."

Normals for Nitrates

Head ache (take tylenol) GI upset reflex tachy postural hypotension= educate**

ARB's are for

Heart failure BP ppl who can't take prils MI

Acetaminophen (Tylenol) (things to remember

Hepatotoxic Hypothrombinemia (with Warfarin) Caution with breastfeeding and pregnancy Decrease barbiturates monitor BUN and creatinine ACETYLCYSTINE = ANTIDOTE 4 Grams max a day Not antiinflammatory but is antipyretic

carbidopa and levodopa levodopa rasagiline contraindications

History of a angle closure glaucoma. Additionally, these medications have been linked to melanoma in clients with a history of suspicious skin lesions. Caution should be used when administering these agents to clients that have a history of cardiac conditions, asthma and psychiatric disorders

Nasal cleaning techniques

Hot showers Nasal saline irrigation Steam inhalation Increase oral fluids to thin mucus

Positive findings

Human chorionic gonadotropin (hCG) is secreted by the fertilized ovum after placental implantation and can be measured in the blood to confirm pregnancy.Home pregnancy tests detect hCG in urine.

Virchows triad

Hypercoagulability Venous stasis Endothelial damage

Teaching for ACE inhibitors

Hyperkalemia can result if taken in combination with potassium-sparing (Aldactone) diuretics or eating salt substitutes- monitor K+ levels Initiate safety precautions?? Rise slowly from lying / sitting to standing = orthostatic hypotension

Hypophosphatemia

Hypophosphatemia refers to a below-normal concentration of phosphorus in the ECF (serum phosphate less than 2.5 mg/dL). The most common causes of hypophosphatemia are depletion of phosphorus because of insufficient intestinal absorption, hypercalcemia, transcompartmental shifts and increased renal losses. Lack of parathyroid hormone (PTH) after removal of the parathyroid gland leads to decreased blood levels of calcium (hypocalcemia) and increased levels of blood phosphorus (hyperphosphatemia), not hypophosphatemia. *Nuts are high in organic phosphorus and considered good snack foods. Meats and dairy products are high in phosphate* and a lack of intake of those foods can lead to a low serum phosphorus level.

Cefalozolins

INCREASE INR and PT = increased bleeding Nephrotoxic (BUN and creatinine) Anaphylaxis (allergies to penicillins) Superinfections= mouth ulcers and anal discharge Take probiotics with medications

ESR

INFLAMMATION In men aged 49 or younger, normal values are at or below 15 mm/h.In men aged 50 or older, normal values are at or below 20 mm/hr. In women aged 49 or younger, normal values are at or below 25 mm/h.In women aged 50 or older, normal values are at or below 30 mm/h.

Restraints

If a client can easily remove the device, it does not qualify as a physical restraint. A provider order for restraints can never be written in advance for "what if" situations or "as needed" (i.e., PRN). Always attempt to use the least restrictive form of restraint and/or safety device. Never apply or use a restraint (chemical, physical or seclusion) to punish a client Chemical: These include medications such as anxiolytics, sedatives, opioids and paralytics. Physical: These include mechanical devices or equipment that limit the client from moving or from moving an extremity. A chair with an attached tray that prevents the client from getting up is considered a restraint. Raising all bed rails can be considered a form of restraint; however, one raised side rail that the client uses to move in and out of bed would not be considered a restraint. Seclusion: A locked room or area away from other clients that the client cannot leave. This is primarily used with clients in behavioral health settings who are at risk for violent behavior and only after all other interventions have failed

Contraindications for Anticoagulants (Heparin, Warfarin, Enoxaparin)

If a client has an underlying coagulation disorder, peptic ulcer disease, malignancy, recent surgery or active bleeding, they should not be taking an anticoagulant. If a client is pregnant or lactating, she should not receive warfarin. Heparin and heparin-like agents should be used cautiously in clients receiving epidural analgesia.

Triage Categories

Immediate, Delayed, Minimal, Expectant

The nurse is performing the following actions immediately after the delivery of a newborn. Indicate the correct sequence of actions by dragging and dropping the options below into the correct order.

Immediately following delivery, the nurse should place the newborn on a radiant warmer and dry, assess and wrap the newborn in warmed blankets. Assessing the airway and respirations is the first action. Next, if indicated, the baby should be suctioned. Then the heart rate is assessed. After these initial assessments, the newborn should be placed on the mother's chest to provide skin-to-skin contact. The nurse should then place identification bands on both mother and baby. Proper identification occurs in the birthing suite before anyone leaves the room. Intramuscular administration of vitamin K is recommended for the newborn, but this can be done after the initial assessments and proper identification.

Cyclosporine and Tacrolimus mycophenolate mofetil

Immunosuppressants

A client reports to the nurse the passage of hard dry stools at least twice a week. Which of these actions should the nurse suggest that the client take first to improve their bowel function? Increase daily fiber intake to at least 20 grams. Use a chemical laxative as needed. Increase physical activity. Avoid binding foods, such as cheese.

Increase daily fiber intake to at least 20 grams.

Teaching for Leuprolide and Goserelin

Increased antineoplastic action with megestrol. Black cohosh may interfere with treatment. Assess for increased bone pain. Monitor for allergic reaction Notify prescriber if menstruation continues - menstruation should stop. Bone pain should disappear after 1 week. Monitor weight. Report weight gain of > 2 lbs (0.9 kg)/day. How to administer SubQ/IM medication.

Paclitaxel (Taxol) teaching points

Increased bleeding risk with NSAIDS, anticoagulants Monitor ECG for SVT Monitor for hypotension and paresthesia Premedicate with antiemetics VS during first Monitor for IV site (extravasation) need ICE pack Report signs of infection: fever, sore throat, flulike symptoms. Report signs of anemia: fatigue, headache, faintness, SOB, irritability. Report bleeding. Bleeding precautions. Avoid vaccinations

Teaching for Topotecan and Irinotecan

Increased bleeding risk with NSAIDS, anticoagulants, platelet inhibitors Monitor IV site for extravasation: Apply ice pack. Notify MD. Assess liver and renal function studies. Increase fluid intake to 2-3 L/day unless contraindicated. Rinse mouth 3-4 times/day with water; Brush teeth with soft toothbrush for stomatitis. Teach that total alopecia may occur. Hair grows back but is different in color and texture. Avoid foods with citric acid or hot and rough texture if stomatitis is present. Avoid vaccines, toxoids. Report signs of anemia: fatigue, headache, faintness, SOB, irritability

Doxorubicin (Adriamycin) interactions and contraindications

Increased risk of cardiac toxicity with CCB's Green tea = increases effects Garlic and St Johns Wort decrease effects Pregnancy Severe Cardiac disease

Macrolide antibiotics (thromycins)

Increases the plasma levels of theophylline, carbamazepine, and warfarin. Conversely, plasma levels of erythromycin can be reduced when used with verapamil, diltiazem, HIV protease inhibitors and azole antifungal drugs. Contraindicated with astemizole, cisapride, pimozide or terfenadine.

Age appropriate toys: Infant:

Infants tend to play alone or with caregivers. Toys which are appropriate include: music boxes, rattles, mirrors, teething toys, mobiles or large blocks. Infants may enjoy playing pat-a-cake or peek-a-boo with a caregiver.

Infant sleep

Infants typically develop a sleep pattern around 3 to 4 months of age. Infants should be placed on their back for sleep. To decrease the risk for SIDS, cribs should be clear of pillows, toys and blankets. By 12 months, the child can typically sleep through the night with a few day-time naps. To encourage sleep, a bedtime routine should be established

Droplet precautions

Influenza Meningococcal meningitis Mumps Rubella (German measles) Diphtheria Pertussis (Whooping cough) Infections caused by drug-resistant Streptococcus pneumonia Surgical mask 6 ft distance gown and gloves when providing care

Fluroquinolones (-floxacins)

Interactions: Antacids, minerals and multivitamins interfere with absorption. Concurrent use with amiodarone, disopyramide. Erythromycin, some antipsychotics and tricyclic antidepressants increases risk of *torsade de pointes* in susceptible individuals. Concurrent use with corticosteroids may increase risk of tendon rupture= SPONTANEOUS RUPTURE OF ACHILLES Phototoxic and cardiotoxic do not take on empty stomach Notify primary healthcare provider of swelling of the face and throat, swallowing problems, shortness of breath, rapid heartbeat, tingling of fingers or toes, itching or hives. Stop taking the medicine immediately if swelling in tendon occurs. Avoid being in direct sunlight and use a sunscreen; do not use tanning beds. Do not take antacids that contain aluminum, calcium or magnesium

Teaching for Cisplatin

Interactions: ASA, NSAIDS, Alcohol increase bleeding risk. Bumetanide, furosemide increase ototoxicity risk. Loop diuretics increase nephrotoxicity risk. Monitor IV site for extravasation: *Sodium Thiosulfate*. Cold compresses. Monitor CBC, platelet count weekly. *Hold drug for WBC < 4000 or platelet <100,000.* Monitor BUN, creatinine. Monitor for signs of anaphylaxis. Monitor temperature q4h Monitor for bleeding. Increase fluid intake to 2-3 L/d to prevent calculi and promote elimination of medication. Report s/s of infection. Report s/s of anemia. Report bleeding, bruising, petechiae Bleeding precautions. Report decreased urine output/flank pain. Do not receive vaccinations during treatment

The home health nurse is performing a daily dressing change on a client who has a diabetic ulcer. Which intervention is most important for the nurse to implement to meet the goal of wound healing? Schedule regular visits to monitor wound healing. Arrange for a referral to a diabetic educator. Involve the client in making heath care decisions. Evaluate the client's understanding of appropriate foot care.

Involve the client in making heath care decisions

SJS and TEN

Involves 10-30% of body surface (over 30% is just TEN) Within 1 to 3 weeks after the start of the offending drug, clients develop a prodrome of malaise, fever, headache, cough and keratoconjunctivitis. Then macules appear suddenly, often in a target configuration, usually on the face, neck and upper trunk. These macules simultaneously appear elsewhere on the body, coalesce into large flaccid bullae and slough over a period of 1 to 3 days. Nails and eyebrows may be lost along with epithelium. The palms and soles may be involved. Skin, mucosal and eye pain are common. In some cases, diffuse erythema is the first skin abnormality of toxic epidermal necrolysis.In severe cases of toxic epidermal necrolysis, large sheets of epithelium slide off the entire body at pressure points (Nikolsky sign), exposing weepy, painful and erythematous skin. Painful oral crusts and erosions, keratoconjunctivitis and genital problems (e.g., urethritis, phimosis) accompany skin sloughing in up to 90% of cases. Bronchial epithelium may also slough, causing cough and dyspnea.

symptoms of MI in women

Jaw, neck, arm, back or shoulder discomfort Chest pain mild or absent Dyspnea Indigestion Nausea Look for distress in client Fatigue Flu like symptoms

Considerations for carbidopa and levodopa levodopa rasagiline

LIVER FUNCTION** tolerance can be met baseline HR, and BP, as well as glucoma assessment

The nurse enters a toddler's hospital room to administer an oral medication. When the nurse asks the child, "Are you ready to take your medicine?" the child's response is an immediate, "No!" Which action would be appropriate by the nurse? Ask another nurse to hold the child while giving the medication. Leave the room and return five minutes later to try to give the medication. Explain to the child that the medicine must be taken now. Notify the health care provider and request a parenteral form of the medication.

Leave the room and return five minutes later to try to give the medication. During toddlerhood, a child will begin to display negativism. This negativism is an effort to develop a sense of control and autonomy. By asking the child if they were ready to take the medication, the nurse gave the child a choice. However, toddlers do not have an accurate sense of time, so leaving the room and coming back later is another episode to the toddler and the child's response may be more positive. The other actions are not appropriate at this time.

Intermittent claudication

Leg pain that occurs with walking due to the increased oxygen demands of the leg muscles. Clients will walk a certain distance before discomfort, such as cramping or burning muscular pain, starts, forcing them to stop. The pain stops with rest, hence the term "intermittent claudication". When the client resumes walking, they can walk the same distance before it returns. As the disease progresses, they can walk only shorter and shorter distances before pain recurs. Ultimately it may occur even while at rest. Claudication is a hallmark symptom of peripheral arterial disease. (leg pain with exercise, relieved by rest) Smoking cessation

Gonadotropin-Releasing Hormone

Leuprolide and Goserelin USE: Advanced Breast cancer Prostate cancer Suppress the secretion of follicle-stimulating hormone and luteinizing hormone from the pituitary gland. Initially an increase in testosterone levels is seen. However, with continued use the pituitary gland becomes insensitive to this stimulation, leading to a reduction in the production of androgens and estrogens..

HbA1C ranges

Levels of 5.7% to 6.4% indicate increased risk for development of diabetes. Levels greater than 6.5% indicate diabetes. Levels greater than 8% indicate poor diabetes control and need for better adherence to prescribed regimen, dietary modifications or changes in therapy. % = ave glucose 5%= 100 6%=135 7%=170 8%=190 9%= 215 10%=250 11%=280

Rapid acting Insulins

Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra) (Snack in 15 mins) so admin 10-15 before meals

Lithium should not be taken with

Lithium generally should not be taken with diuretics, especially a loop diuretic such as furosemide. The use of a diuretic will narrow the safe range for the lithium and adding a diuretic can lead to lithium toxicity. Additionally, side effects of lithium are polyuria and polydipsia. The nurse should clarify the order before administering lithium and furosemide together. Finasteride, amlodipine or insulin typically do not interact with lithium.

A client has been taking isoniazid and rifampin for several months. Which laboratory test should the nurse monitor with this client? Creatinine clearance Sputum culture Cardiac enzymes Liver enzymes

Liver enzymes INH and rifampin are used to treat tuberculosis and both are hepatotoxic. Isoniazid can cause hepatocellular injury and multilobular necrosis and is believed to result from the production of a toxic isoniazid metabolite. Rifampin is also toxic to the liver, posing a risk of jaundice and even hepatitis. Asymptomatic elevation of liver enzymes occurs in about 14% of patients. Hepatotoxicity is most likely in people who abuse alcohol and in clients with pre-existing liver disease. These individuals should be monitored closely for signs of liver dysfunction. Tests of liver function (serum aminotransferase levels) should be made before treatment and every 2 to 4 weeks thereafter. The other lab tests are not specific to the medications the client is taking.

bumetanide is what type of drug

Loop diuretic

prolonged QT causes

Macrolides quinidine, procainamide amiodarone and ilbutide

The nurse is assessing a client in her third trimester of pregnancy. The recent ultrasound suggests the baby is small for the gestational age. However, an earlier ultrasound indicated normal growth. The nurse understands that this change is most likely associated with which problem? Chromosomal abnormalities Maternal hypertension Sexually transmitted infection Exposure to teratogens

Maternal hypertension

Anthelmintics

Mebendazole (Vermox) Ivermectin (Stromectol) Pyrantel pamoate (Pin-X) used to treat worm infections, pin worms, tape worms, hook worms, trichinosis and parasites not for pregnant women Effectiveness decreased by some anticonvulsants. Increased absorption with high fat meal. Might see intestinal blockage from dead parasites Entire family and close contacts must be treated to prevent reinfestation Proper handwashing and hygiene with bowel movements Monitor stools for presence of worms/parasites Monitor CBC, BUN, Creatinie and liver enzymes during treatment Teach proper hygiene and cleansing of clothes and linens to prevent reinfestation. Infected person should sleep alone until treatment complete. Teach to wear shoes when out doors Teach proper cleansing of fresh fruits and vegetables

-sins MOA

Mechanism of Action Alpha1 blockers work by inhibiting the alpha1 receptor sites, which causes decreased vascular muscle tone and vasodilation. This leads to a decreased blood pressure and relaxation of the prostate and bladder neck in (BHP) clients. Alpha1 blockers are metabolized in the liver and excreted in the feces, bile or urine.

Filing incidence report

Medication administration errors (even if the error did not reach the client) Any time a client makes a complaint Medical device malfunction Any time a client, staff member or visitor is injured or involved in a situation with the potential for injury When a client leaves the health care facility against medical advice (AMA) Loss or theft of a client's or visitor's property

Progestins

Medroxyprogesterone acetate (Depo-Provera), Megestrol acetate (Megace) Used for: Breast cancer Endometrial carcinoma Renal cancer Stimulate appetite MOA: Act by shrinking the cancer tissues. Thought to bring about cell death

Antineoplastics

Methotrexate Tamoxifen (Anti cancer drugs) These medications are used to treat various solid tumors, lymphomas and leukemias, with the goal of limiting growth by decreasing numbers or size in order to allow the natural immune system to respond. They are also prescribed for some autoimmune disorders, such as rheumatoid arthritis.

What should not be given the first year of birth?

Milk and juice No water before 4 months

Minimal (green)

Minor burns or fractures or bleeds

Teaching and interventions for Tamoxifene

Monitor CBC, platelet count weekly. Monitor for allergic reactions. Avoid use of St. John's wart, dong qui, black cohosh. Use nonhormonal contraception during and for 2 months after discontinuing treatment. Notify prescriber of signs of stroke. Increase fluids to 2 liters/day unless contraindicated. Protect from sun.

Teaching and Side effects of Methotrexate

Monitor IV site for extravasation: Apply ice pack. Notify MD. Avoid direct skin contact with medication. Administer antiemetic 30-60 minutes before therapy I&O Monitor blood counts. Encourage mouth rinses every 2 hours with normal saline Report signs of infection Examine mouth daily/ report signs of stomatitis Do not visit anyone with a respiratory infection Use sunscreen when outdoors Maintain protective precautions Good oral care with soft toothbrush Encourage small, frequent meals. Encourage cool, bland foods.

muscle relaxant considerations cyclobenzaprine baclofen

Monitor clients for cardiac dysrhythmias, excessive CNS depression and confusion. Teach the client (or reinforce teaching) to avoid using other CNS depressants such as alcohol while on this medication., The client should avoid activities that require mental alertness until the reaction to these medications is known. Clients should also be urged to ask for assistance with walking, due to the dizziness and weakness associated with these medications.

monitor for what in SSRI's

Monitor clients for hypersensitivity reactions, hyponatremia and weight changes. Teach the client (or reinforce teaching) to report any suicidal or homicidal ideations. Let clients know that therapeutic effects may take up to 4 weeks of use, and that they should avoid alcohol. Due to its short half-life and few drug interactions, sertraline is the drug of choice for treating depression in the elderly. Conversely, due to its long half-life, fluoxetine is a better choice for children. Citalopram, escitalopram, fluoxetine, and sertraline can increase the effects of digoxin, warfarin, and diazepam. Increased risk of suicide

Education points for antihistamines

Monitor for dizziness, drowsiness, and dry mucus membranes Educate that medication might be sedative so avoid driving or preforming high risk activities do not take with other CNS depressants like alcohol or benzos have adequate oral fluid intake or have hard candy to alleviate dry mouth

education for Allopurinol

Monitor the client for hypersensitivity reactions including fever, rash, and decreased liver/kidney function. Teach the client (or reinforce teaching) to: Take the medication after meals and drink enough water to produce 2 liters of urine a day. Adhere to a low purine diet to prevent uric acid. Report any abnormal bleeding and bruising. During the first months of use, an increase in gout "flare ups" may occur. The client should contact their HCP for recommendations to treat this pain, but should not discontinue use.

cyclobenzaprine baclofen uses

Muscle relaxants are used to treat spasticity associated with spinal cord diseases (such as cerebral palsy, multiple sclerosis) or lesions. They also relieve symptoms of acute painful musculoskeletal conditions. These medications should be used in conjunction with other modalities to reduce muscle spasms and pain, including rest, heat, or physical therapy.

Side effects of Methotrexate and Tamoxifen

N/V, diarrhea, altered taste, alopecia, ulceration of stomach *BONE MARROW SUPPRESSION* -> leukopenia, anemia and thrombocytopenia (likely to catch diseases) Increase in uric acid Abnormal vag bleeding *Methotrexate WILL terminate pregnancy* Nonproductive dry cough may be the first sign of pulmonary toxicity* Vision chnages are seen with Tamo

IV fluid used when administering blood products

NORMAL SALINE ONLY

Leuprolide and Goserelin contraindications and adverse effects

NOT FOR: pregnant or breast feeding women Seizures MI PE Dysrhythmias GI bleeding NORMALS: hot flashes, memory loss, depression and alopecia

Celecoxib (Celebrex)

NSAID

How can you identify your patient?

Name Date of birth MR number NOT Room number

The nurse is caring for a client who received thrombolytic therapy for an acute myocardial infarction (MI). Which information is most important for the nurse to communicate to the health care provider (HCP)? A decrease in ST-segment elevation on the ECG No change in the client's reported level of chest pain An increase in troponin levels from baseline A large bruise at the client's IV insertion site

No change in the client's reported level of chest pain Continued chest pain suggests myocardial ischemia and that the thrombolytic therapy is not effective. Other coronary interventions may be needed, such as a stent. Bruising is a possible side effect of thrombolytic therapy and should be monitored, but it is not more important to report than the unrelieved chest pain. The decrease of the ST-segment elevation indicates that perfusion is returning to the injured myocardium. An increase in troponin levels is expected with reperfusion and is related to the release of cardiac biomarkers into the circulation as the blocked vessel reopens.

Tetraogenic category A

No risk to fetus trhu studies

Tetraogenic category C

No studies

Tetraogenic category B

No studies but no apparent risk

SERMs (selective estrogen receptor modulators)

Raloxifene Toremifene USES: Breast cancer prophylaxis in postmenopausal women MOA: Act like antiestrogens to slow tumor growth, but have fewer side effects than tamoxifen.

Mask provides the highest amount of oxygen and how many liters can it deliver per minute?

Nonrebreather 15

Bilirubin

Normal levels: Total bilirubin: 0.3 to 1.0 mg/dL Indirect bilirubin: 0.2 to 0.8 mg/dL Direct bilirubin: 0.1 to 0.3 mg/dL

Normal thyroid pannel results

Normal values (adults):Thyroxine (T4) Total: 4 to 12 mcg/dLThyroxine (T4) Free: 0.8 to 2.8 mcg/dLThyroid-Stimulating Hormone (TSH): 0.3 to 5 μU/mL

DEXA scan ranges and indications

Normal: < 1 SD below normal (> -1.0)Osteopenia: 1.0 to 2.5 SD below normal (-1 to -2.5)Osteoporosis: >2.5 SD below normal (< -2.5)

Contraindications for fluoroquinolones

Not for <18 yrs old ACHILLES TENDON RUPTURE Diabetes Renal impairment Rheumatoid arthritis Prolonged QT Myasthenia gravis

Considerations for cephalosporins

Not for penicillin allergies Renal impairment GI ulcers

Cyclophosphamide Contraindications and adverse effects

Not for pregnant women or liver/kidney disease Garlic, ginko, ginseng and kava kava = ^^ INR and PT Echinacea= decrease immunosuppressants Monitor IV site for extravasation: Cold compresses Assess need for IV hydration. The client should be well hydrated (2L/day) to prevent hemorrhagic cystitis. Observe for s/s of hematuria. Monitor BUN and creatinine Avoid direct skin, eye, and mucus membrane contact with drug Take medication early in the day to prevent accumulation of drug in the bladder. Report signs of infection. Do not visit anyone who has a respiratory infection Emphasize protective precautions. Teach importance of birth control while receiving therapy

Specific side effect of ethambutol, rifampin, and isoniazid

ORANGE BODY FLUIDS: stain clothes and contact lenses; DO NOT STOP MEDS

What symptoms might a pt experiance with rapid infusion of loop diuretics?

OTOTOXICITY = ringing of ear - slow infusion rate

Tonsillectomy interventions post op

Observe for hemorrhage (BP and HR, LOC, *frequent swallowing*) Air way obstruction Elevate HOB and turn head to the side Ice collar Mouth washes and pain meds Full liquid diet 48-72 hrs post op

The nurse is caring for a client who is experiencing excessive bleeding after receiving unfractionated heparin sodium. Which orders should the nurse anticipate from the health care provider? Select all that apply. Change to enoxaparin Obtain PT and INR Administer protamine sulfate Administer Vit K Obtain aPPT

Obtain aPPT Administer protamine sulfate

Specimen Collection

Obtain all specimens wearing the appropriate personal protective equipment (PPE) and following standard precautions. Seal all specimen containers tightly and place in a sealable, leak-proof biohazard pouch during transport to the lab. *Specimens should be delivered to the laboratory as quickly as possible. Do not allow specimens to sit at room temperature.*

When is flu seaseon

Oct 1 - March 31

Codine

Opioid Analgesic

Clindamycin is used for

Oral and skin infections (PO and topical) Abdominal infections and anaerobic respiratory infections, aerobic gram positive coverage

MI treatment OH BATMAN!

Oxygen Heparin Betablocker Aspirin Throbolytics Morphine ACE in hibitors Nitro

Raynauds phenomenon

PROTECT FROM STRESS AND COLD

Plant Alkaloids - Mitotic Inhibitors (Chemotherapy)

Paclitaxel

A nurse is participating in a care conference for a postoperative client who has been reporting frequent, unrelieved acute pain. Which statements suggest that the nurse understands the principles of effective pain management? Select all that apply. Pain can be treated with pharmacologic and/or nonpharmacologic therapies. Pain exists when and where the client says it exists. Clients from Eastern cultures usually require less pain medication. Postoperative pain should only be assessed by the health care provider. Family members can influence a client's response to pain. Pain is an emotional response to tissue inflammation or damage.

Pain can be treated with pharmacologic and/or nonpharmacologic therapies. Pain exists when and where the client says it exists. Family members can influence a client's response to pain.

Signs of aortic insufficiency

Pectus Excavatum Dilation of aorta Arachnodactyly orthopnea anginal pain not relieved by nitro pulsating nail beds Quinckes sign: root of nail flushs and then pales when pressed (pulsates) HF signs: JVD+. edema, distention, ascities wide Pulse pressure = Low Diastolic and high systolic *high pitched at left sternal border DIASTOLIC murmur*- lean forward Austin flint murmur*= rumbling Left vent hypertrophy Increase afterload** ^LEDV Syncope Apical impulse is displaced down and laterally

A client is admitted to the hospital with endocarditis. The nurse understands that which risk factors can lead to the development of endocarditis? (Select all that apply.) Atrial fibrillation with use of warfarin Treatment of substance use disorder with methadone Placement of an arteriovenous fistula for hemodialysis Oral abscess with tooth extraction Placement of a central venous access device History of aortic valve replacement

Placement of an arteriovenous fistula for hemodialysis Oral abscess with tooth extraction Placement of a central venous access device History of aortic valve replacement

Collapsed lung type

Pneumothorax A pleural effusion is when fluid (transudate or exudate) is found in the pleural space. It is treated with a thoracentesis or a chest tube. A hemothorax is when blood is in the pleural space. It is treated with a thoracentesis or a chest tube. Empyema is when purulent drainage is found in the pleural space. It is usually a complication of pneumonia, and is treated with a chest tube and antibiotics.

Lumbar puncture considerations

Position the client on one side in a fetal position with their knees close to their chest, or leaning forward while sitting. Explain that a local anesthetic will be injected at the puncture site. Let the client know that they will feel a stinging sensation and pressure as the spinal needle is inserted. After the LP, instruct the client to lay flat for several hours to minimize headache, which can occur due to the removal of CSF. Encourage the client to drink additional fluids to help replenish the CSF. Administer analgesics as ordered for headache pain. Apply a sterile dressing to the site and perform a neuro-sensory assessment every 15 to 30 minutes until the client is considered stabl

The nurse in a pediatric office is speaking with the parents of a 3-year-old child. The parents ask the nurse about normal growth and development. The nurse knows that which finding may be indicative of abnormal childhood development? Use of four-word sentences Positive Babinski reflex Presence of a pincer grasp Presence of all primary teeth

Positive Babinski reflex The nurse must have an adequate understanding of normal physical development in children. The Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe moves upward or toward the top surface of the foot. The other toes fan out. This reflex is normal in children up to two years old. It disappears as the child gets older. A positive Babinski reflex in a 3-year-old child indicates the need for a neurological follow-up. Pincer grasp describes the ability for a child to grasp objects between their index finger and thumb and should be established by 10 months. By three years, children should have all of their primary teeth and the ability to speak in 3 to 4 word sentences.

High risk meds: PINCH

Potassium Insulin Narcotics Chemo Heparin

Class III:

Potassium Channel Blockers amiodarone, ibutilide

Piaget's stages of cognitive development: Stage 2

Pre-operational 2- 7

Paclitaxel (Taxol) adverse effects and contraindications

Pregnancy SVT Neutropenia Leukopenia Thrombocytopenia Anemia Tissue necrosis Pulmonary edema

5-Fluorouracil & Methotrexate contraindications and adverse effects

Pregnancy Severe infection Bone marrow suppression Thrombocytopenia Hemorrhage Renal failure Extravasation

Tamoxifen contraindications and adverse effects

Pregnancy & Breastfeeding Increases the risk of bleeding and uterine cancer, stroke, PE, thrombocytopenia NORMAL SIDE EFFECTS: Masculine secondary sexual characteristics. Hot flashes Irregular menses Fatigue Headaches Impotence Decreased interest in sexual activity.

Contraindications for ACE inhibitors

Pregnancy (fetal cardiac defects) Renovascular hypertension (renal failure)

Who should not take antiulcer meds?

Pregnant and lactating women electrolyte disorders Kidney disease

Age appropriate toys: Preschool

Preschoolers enjoy group play without rigid rules. During this category, play should focus on activities which encourage physical, social and cognitive development. Toys may include tricycles, wagons, paints, crayons, puzzles, books, and balls. Play may be imaginative and dramatic. Some preschoolers create imaginary friends in this stage. Preschoolers enjoy make-believe and pretend. Media time should be limited to 2 hours a day.

Meloxicam and Ketorolac

Prescription NSAIDS

Considerations for -sins

Prior to the first dose, obtain baseline data. Important baseline data includes blood pressure, pulse, fluid volume status and weight. Important laboratory results include BUN and creatinine. Administer the first dose of the medication at bedtime to prevent a syncopal episode, which is a risk with Alpha1 blockers. The client should be considered at an increased risk for falls. Monitor the client's blood pressure, pulse, fluid volume status, weight, gastrointestinal function, muscle strength and liver function. Teach the client (or reinforce teaching) to change positions slowly to prevent orthostatic hypotension, how to monitor and record blood pressure and pulse, when to notify the health care provider, and to consult the HCP prior to discontinuing the medication. If appropriate, instruct and encourage the client to make lifestyle changes to decrease blood pressure and increase effectiveness of the medication. Important lifestyle changes include managing weight, increasing activity level and changing unhealthy dietary practices (low sodium).

Antiulcer meds

Proton Pump Inhibitors (PPIs) lansoprazole omeprazole Histamine-2 Antagonists (H-2 Receptor Blockers) cimetidine famotidine Antacids sodium bicarbonate Gastrointestinal Protectant Sucralfate

Tetraogenic category D

Risk to fetus exists but benefits outweigh the risk

Sickle cell disease interventions

Push oral fluids Administer an isotonic IV solution, such as normal saline, at a high rate Administer O2 Pharmacological interventions include: Analgesics (opioids tend to be most effective, especially during a sickle cell crisis) Antibiotics (prophylaxis with penicillin is recommended) Folic acid High dose IV steroids TEACHING: Drink at least 3 to 4 liters of liquids every day. Avoid alcoholic beverages. Avoid smoking cigarettes or using tobacco in any form. Contact their primary HCP at the first sign of illness or infection. Receive an influenza vaccination each year. Avoid temperature extremes of hot or cold. Be sure to wear socks and gloves when going outside on cold days. Avoid planes with unpressurized passenger cabins . Avoid travel to high altitudes. Avoid strenuous physical activities. Engage in mild, low-impact exercise at least three times a week when not in crisis.

low protein diet for

Pyelonephritis Uremia Kidney failure <40 g a day

R.A.C.E

R: Remove and rescue patients A: Activate fire alarm C: Contain fire E: Extinguish

HF education

REAL R:Report wt gain (+2lbs in a day or 5+ in a week), worsening dyspnea or fatigue E: Exercise is important: LOW AND SLOW A: Adhere to meds L:Low sodium diet

Salicylates/Aspirin contraindication

REYE'S SYNDROME: progressive encephalopathy and hepatotoxicity (avoid giving aspirin to child with Flu or virus) Do not crush enteric coated pills

-statins side effects

RHABDO: watch for muscle pain and decreased UOP cataracts respiratory infection

risk factors for DVT

Reduced blood flow (e.g., immobility, bed rest, stroke, paralysis) Increased venous pressure (e.g., pregnancy, venous stenosis) Mechanical injury to vein (e.g., peripherally inserted venous catheters, IV drug use) Increased blood viscosity (e.g., polycythemia, dehydration, thrombocytosis) Acquired (e.g., oral estrogens such as used for birth control, smoking) Old age

Short / Regular acting insulins

Regular (Humulin R, Novolin R), Actrapid 30-60 mins before meals

Aminoglycosides Tobramycin Gentamycin Neomycin Amikacin Streptomycin

Renal damage, Tinnitus, Pregnancy Increase risk of ototoxicity with loop diuretics (Furosemide)- baseline hearing test needed MONITOR: Trough and peak BUN and creatinine *INCREASE FLUIDS 1500-200* and watch daily weight

Secondary HTN

Renal disease (e.g., renal artery stenosis, glomerulonephritis or end-stage kidney disease) Drugs: Stimulants such as ephedrine-type decongestants and cocaine Certain immunosuppressants such as cyclosporine Hormonal contraceptives Excessive alcohol consumption Cushing's syndrome, which causes increased levels of the stress hormone cortisol Pregnancy-related hormones Neurologic disorders (e.g., brain tumors, traumatic brain injury) Coarctation of the aorta (congenital aortic narrowing)

Contraindications for aminoglycosides

Renal or hepatic disease hearing loss herpes infection myesthenia gravis Parkinsons disease breast feeding pregnancy due to congenital defects

The nurse performs a heel stick for a blood glucose check on a 1-hour-old, full-term newborn who weighed 9 pounds (4.1 kg) at birth. The serum glucose reading is 45 mg/dL. Which action should the nurse take? Ask another nurse to perform a second blood glucose check. Start an IV infusion of 5% dextrose. Check the pulse oximetry reading. Repeat the test in two hours.

Repeat the test in two hours After birth, the infant's glucose supply from the placenta is no longer available, and the newborn's glucose levels will decline. Hypoglycemia is a frequent problem encountered in newborns. However, a serum glucose of 45 mg/dL is within the expected newborn range of 40 to 90 mg/dL. Newborns who weigh more than 8.8 pounds (4 kg), are large for their gestational age or have a gestational age of fewer than 37 weeks are considered at risk for hypoglycemia. Due to the weight of this newborn, a repeat blood glucose test is indicated. The other actions are not appropriate for this infant.

Treatment for Hemophilia A

Replacement of clotting factor 8 (VIII) Desmopressin* (aids blood clotting) Pressure to bleeding, elevation, ice, rest, immobilize area Prophylactically treat before surgeries

Use of Antihistamines

Rhinitis urticaria angioedema allergic reactions also off lable for insomina, N/V, and motion sickness & parkinson like reactions with antipsychotics

5 rights of patient medication administration

Right client Right Drug Right dose Right route Right time

Trimethoprim/ Sulfamethoxazole (Bactrim, Septra) Sulfisoxazole (Gantrisin)

Risk of thrombocytopenia with thiazide diuretics; hyperkalemia with other diuretics Nephrotoxicity Hyperkalemia *Stevens-Johnson syndrome* Anaphylaxis Increase fluids to 2000-3000 mL per day Assess I&O, BUN and creatinine regularly Monitor Vital signs closely Assess for early signs of anemia or superinfections Drink lots of fluid daily when taking medications Take 1 hour before or 2 hours after meals Wear sunglasses and avoid direct sunlight Report any excess bruising or bleeding

The nurse is developing a plan of care for a client with chronic obstructive pulmonary disease (COPD). Which interventions should the nurse include in the plan? Select all that apply. Schedule the client for an annual influenza vaccination. nstruct the client on the pursed-lip breathing technique to reduce carbon dioxide (CO2) retention. Educate the client about relaxation techniques to help with their anxiety. Instruct the client to engage in high-intensity aerobic exercise to increase activity tolerance. Provide high-protein, high-calorie meals to help maintain adequate nutrition.

Schedule the client for an annual influenza vaccination. nstruct the client on the pursed-lip breathing technique to reduce carbon dioxide (CO2) retention. Educate the client about relaxation techniques to help with their anxiety. Provide high-protein, high-calorie meals to help maintain adequate nutrition. Diaphragmatic (abdominal) and pursed-lip breathing help manage dyspneic episodes that occur with COPD. Breathing through pursed lips creates mild resistance, which prolongs exhalation and increases airway pressure. This technique delays airway compression and reduces air trapping prevalent with COPD. Clients with COPD tend to become anxious during acute dyspneic episodes. The nurse will help the client manage dyspneic episodes and panic attacks through the use of progressive relaxation, hypnosis therapy and biofeedback. For some clients, anxiolytics may be needed. Pneumonia is a common complication of COPD and the client should receive the yearly influenza vaccine. Clients with COPD tend to feel too full to eat, and have poor appetite and meal-related dyspnea. The work of breathing raises the client's calorie and protein needs, which can lead to protein-calorie malnutrition. It is important to urge the client to eat small, frequent meals of high-calorie, high-protein foods. Exercise for conditioning and pulmonary rehabilitation can improve function and activity tolerance in clients with COPD. Each client's exercise program should be personalized to the client's limitations. The simplest plan is to have the client walk daily at a self-paced rate, until symptoms limit further walking. High-intensity aerobic exercise would not be appropriate for the client with COPD.

Age appropriate toys: School age

School-age children participate in cooperative play. They may join a club or team and focus on structure and rules in play. In addition, solitary activities may be enjoyed. Toys may include: board games, jump ropes, books, bicycles, crafts or sports. Though children may learn from educational media, caution should be taken with media, television, gaming and internet exposure.

Piaget's stages of cognitive development: Stage 1

Sensorimotor Birth -2 years

valacyclovir HCL

Side effects include diarrhea, abdominal cramps, rash and fatigue.

sitagliptin

Side effects include pancreatitis, kidney problems, upper respiratory infection, headache, rhinitis and sore throat. Clients should take the medication immediately prior to meals and contact their HCP if they experience symptoms of pancreatitis, such as persistent abdominal pain, with or without vomiting.

acyclovir s/e

Side effects include peripheral neuropathy, thrombocytopenia purpura and liver damage.

thrombophelbitis

Signs: Pain Swelling Redness and warmth around the insertion site or the path of the vein Fever Leukocytosis Interventions: Discontinue IV Apply warm compress Elevate the extremity

Clotting at iv site

Signs: Decrease IV flow rate or infusion pump alarming Back flow of blood into tubing Interventions: Discontinue IV Do not attempt to flush or irrigate the IV Do not aspirate clot from cannula

Phlebitis

Signs: Reddened, warm area around the insertion site or the path of the vein Tenderness and swelling Interventions: Discontinue IV Apply warm, moist compresses

Infiltration

Signs:Edema Pain Coolness around insertion site Infusion pump alarm Interventions: Discontinue IV Apply warm compresses Apply sterile dressing Elevate arm Monitor for compartment syndrome Evaluate neurovascular status of extremity distal to infiltration

During a routine visit, the nurse is evaluating developmental milestones for a 7-month-old child. Which of these developmental activities should the child be able to perform? Drinks from a cup Sits leaning on hands for support Says several words Uses a neat pincer grasp

Sits leaning on hands for support

cyclobenzaprine baclofen

Skeletal muscle relaxant Muscle relaxant medications act centrally on the brain stem to inhibit neuronal transmission. They are typically classified by their pharmacologic properties as either anti-spasticity or antispasmodic agents. Most skeletal muscle relaxants are metabolized in the liver and all are excreted in the urine. Baclofen is not metabolized by the body.

Class I: antiarrhythmic

Sodium Channel Blockers Ia: quinidine, procainamide (hypotension and TORSADES) Ib: lidocaine (drowsiness and confusion, seizures and resp arrest) Ic: flecainide, propafenone (dizzy, altered taste, EKG changes) agents all block the cardiac sodium channels to slow conduction in the atria, ventricles, and His-Purkinje system. Class Ia delay repolarization, whereas Class Ib accelerate repolarization.

Specimens should be sent to lab

Specimens should be delivered to the laboratory as quickly as possible. Do not allow specimens to sit at room temperature

A client who is receiving a blood transfusion suddenly reports having a severe headache and low back pain. Which actions should the nurse take? Select all that apply. Stop the blood transfusion. Notify the rapid response team. Provide emotional support to the client. Complete an incident/occurrence report. Obtain a urine specimen as soon as possible. Flush the IV line with 30 mL of normal saline.

Stop the blood transfusion. Complete an incident/occurrence report. Obtain a urine specimen as soon as possible. Clients who are receiving a blood transfusion can develop any one of these transfusion reactions: febrile, hemolytic, allergic or bacterial reactions, circulatory overload or transfusion-associated graft-versus-host disease (TA-GVHD). The client in this scenario appears to be experiencing a hemolytic reaction, which is caused by blood type or Rh incompatibility. Interventions for this type of reaction should include immediately stopping the transfusion and removing the blood tubing. The nurse should not flush the contents of the blood transfusion tubing, which would allow more of the reaction-causing blood to enter the client. Instead, a second, new IV access is preferred, especially for the fluid resuscitation the client will most likely require. Because of the high risk of kidney failure with this type of reaction, a urine sample is collected. This situation will also require an incident report to be completed and the blood bank needs to receive all of the original blood product and tubing for analysis and to figure out how this reaction happened. The client might feel anxious and the nurse should provide emotional support. Notifying the rapid response team (RRT) is not indicated at this time.

Tetraogenic category X

Studies show that risk is greater than benefit

COnsiderations for Fluoroquinolones

Superinfections, colitis, diarrhea Prior to the first dose, obtain baseline data including obtaining a culture and sensitivity test, reviewing for a history of hypersensitivity reactions, impaired renal function or liver function, and an EKG to rule out prolonged QT intervals. During and after the first dose, monitor the clients for hypersensitivity reactions including rash, pruritus and flushing. Oral ciprofloxacin and levofloxacin should be administered with a glass of water one hour before or two hours after meals, antacids or iron supplements. During fluoroquinolone use, monitor for muscle weakness or tendon swelling, serum glucose, gastric upset and photosensitivity. Teach the client (or reinforce teaching) to maintain hydration and report diarrhea, bloody stools, muscle weakness or tendon swelling to their HCP, and to complete the full course of antibiotics regardless of symptom improvement.

Antifungals

Systemic Antifungal Azole Agents clotrimazole Local Antifungal Azole agents fluconazole Other antifungals amphotericin B

MOA of antifungals

Systemic and local antifungal azole agents work by binding to sterols on the fungus or by interfering with cellular replication. This leads to both a fungicidal (fungal cell death) and fungistatic (inhibiting growth) effect

AntiEstrogen Hormone therapy

Tamoxifen This male hormone (androgen) promotes regression of tumors by competing with estradiol at estrogen receptor sites. Decreases DNA synthesis. Reduces risk of breast cancer in postmenopausal women. USE: Palliative treatment of advanced breast cancer positive lymph nodes in postmenopausal women

education for Tolteradine

Teach the client (or reinforce teaching) to avoid alcohol while taking these medications, avoid activities that require alertness until the side effects of these medications are known, and to treat dry mouth with sugarless candy and adequate hydration. The client should avoid strenuous activity and overheating as the sweating abilities of the exocrine glands will be decreased.

D.A.S.H diet

The Dietary Approaches to Stop Hypertension (D.A.S.H.) diet is used to help lower blood pressure but may also offer protection against osteoporosis, cancer, stroke, diabetes and heart disease. The standard D.A.S.H. diet limits sodium to 2300 mg/day and a lower D.A.S.H. diet restricts sodium to 1500 mg/day. The D.A.S.H. diet is also low in saturated fat, cholesterol and total fat.

The nurse is caring for a client who is admitted with pneumonia and has orders for a sputum culture. The nurse observes the unlicensed assistive person (UAP) assisting the client in collecting a sputum specimen. Which action by the UAP would require the nurse to intervene? The UAP lowers the head of the bed to stimulate coughing. The UAP asks the client to spit 5 mL of saliva into the cup. The UAP asks the client to take several deep breaths then cough. The UAP asks the client to rinse their mouth with water prior to sputum collection.

The UAP asks the client to spit 5 mL of saliva into the cup. It is important that the proper sputum collection procedure is followed to obtain accurate laboratory and microbiology results. The client should rinse their mouth with water before expectorating the sputum to decrease contamination by particles in the oropharynx. The client should be asked to take several deep breaths then cough. If the client is unable to produce a sputum specimen, coughing can be stimulated by lowering the head of the bed. The client should expectorate a sputum specimen directly into the sterile collection container. The sputum specimen should be representative of pulmonary secretions, not saliva. The client should be reminded not to use antiseptic mouthwash before sputum collection

PAD symptoms

The affected limb will present with: Waxy, hairless, cool, pale or cyanotic skin Weak or absent pulses ParesthesiaAbnormal or unusual nerve sensations, such as tingling and burning. Non-healing wounds

lisinopril

The client can take lisinopril without regard to food. Tablets may be crushed to aid in swallowing.

The health care provider (HCP) of a client with opioid-induced constipation prescribed the administration of a bisphosphate enema. After reviewing the client's medical record, the nurse recognizes which contraindications for giving the enema? Select all that apply. The client has a history of substance use disorder (SUD). The client has a history of syncopal episodes. The client has a history of hemorrhoidectomy. The client has a history of thrombocytopenia purpura The client has a history of hyperkalemia. The client has a history of hepatitis A

The client has a history of syncopal episodes. The client has a history of hemorrhoidectomy. The client has a history of thrombocytopenia purpura An enema can cause a vasovagal response and a temporary decrease in heart rate and blood pressure, causing syncope. Because the client already has a history of syncopal episodes, the nurse should clarify the order with the HCP first. The client's history of hemorrhoidectomy implies that hemorrhoids could be present, even if none are externally visible. If internal hemorrhoids are present, inserting the enema may cause bleeding and discomfort. Therefore, the nurse should clarify the order with the HCP first. Clients with thrombocytopenia (low platelet count) may begin bleeding from the rectum due to the mechanical trauma of the enema and should be given stool softeners and laxatives instead. The other conditions do not represent contraindications for receiving an enema.

The nurse is caring for a client with schizophrenia, who has an order for haloperidol 5 mg PO every four hours as needed. Which behaviors justify the use of this chemical restraint? Select all that apply. The client is crying after a difficult family meeting. The client is refusing to participate in unit group activities. The client is expressing paranoid delusions. The client is verbalizing a plan to harm another client. The client is experiencing command hallucinations.

The client is expressing paranoid delusions. The client is verbalizing a plan to harm another client. The client is experiencing command hallucinations. Command hallucinations and paranoid delusions can be frightening or dangerous, potentially causing a client to act aggressively. It is important to intervene before a client acts on a plan to harm another person. An antipsychotic medication, such as haloperidol, will help control and manage symptoms and behaviors associated with schizophrenia. A chemical restraint should be used in an extreme or emergent situation. A client has the right to refuse to participate in activities. Verbal intervention, such as offering to speak with the client 1:1, would be appropriate if the client is upset and crying.

5450 The nurse observes a client using crutches. Which of the following actions by the client would require the nurse to intervene? Select all that apply. The client has a spare pair of crutches and rubber tips. The client is using crutches that have a broken rubber tip. While using a three-point gait, the client is bearing weight on both legs. The client is resting their axillae or armpits on top of the crutches. The handgrips of the crutches are even with the client's hips.

The client is using crutches that have a broken rubber tip. While using a three-point gait, the client is bearing weight on both legs. The client is resting their axillae or armpits on top of the crutches. Rationale: When clients use crutches, their hands should rest on the handgrips of the crutches. The client's weight should not be resting on their axillae, as this could lead to damage of the axillary nerve.Clients should check the integrity of their crutches, including the rubber tips. The crutches should be in good working order and not broken or worn down.Clients should have a spare pair of crutches, including rubber tips.A three-point crutch gait is used for people who only have one weight-bearing leg.

captopril

The client should take medication on an empty stomach one hour before meals or two hours after meals. Tablets may be crushed to aid in swallowing. Let the client know that they may experience a loss of taste for 2-3 months. The nurse should monitor nutritional intake.

MOA of Furosemide and Bumetanide

These medications work in the ascending loop of Henle where magnesium and calcium are reabsorbed. Disrupted reabsorption causes increased urine production, which lowers blood volume and results in lowered blood pressure. They also cause the veins to dilate, which lowers blood pressure mechanically. These medications result in copious amounts of sodium-rich urine.

Thorocentesis

The client will be asked to sit at the side of the bed and lean forward. A local anesthetic is used prior to the needle insertion. The client may feel some pain as their lungs fill with air and expand against the chest wall. The client may need to cough, feel light-headed and/or short of breath during or after the procedure. No more than 1,000 mL should be removed at one time.The nurse will monitor breath sounds and vital signs frequently. They should also monitor for leakage of fluid at the puncture site. A sterile dressing will be applied after the test and a chest X-ray may be ordered.

Breast feed infants need

Vit D and Iron after 4 months

The nurse is preparing to enter a disaster scene to assist with triaging victims. What assessment priorities should the nurse adhere to? Select all that apply. The nurse requires disaster certification before performing triage during a disaster. The nurse should allocate resources to those victims with the strongest probability of survival. The nurse must consult a qualified health care provider prior to making client resource decisions. The nurse should assess clients by considering their airway, breathing, circulation and neurological function. The nurse should consider the age of a victim before allocating any resources

The nurse should allocate resources to those victims with the strongest probability of survival. The nurse should assess clients by considering their airway, breathing, circulation and neurological function.

Benadryl side effects

anticholinergic effects drowsiness

Steriod considerations Glucocorticoids methylprednisolone prednisolone dexamethasone betamethasone Mineralocorticoids cortisone fludrocortisone hydrocortisone

The nurse should monitor sodium and potassium levels, as well as for any signs of infection. Clients with diabetes may need increases in their insulin dosages due to the effects of these medications. Due to immunosuppression, clients taking corticosteroids should not receive a "live" vaccine. They should call their primary care practitioner if they are exposed to chicken pox or measles, since these conditions can be fatal in people who are using a steroid. Teach the client (or reinforce teaching) to take the prescribed dose in the morning, maintain a low sodium, higher potassium diet and to avoid grapefruit

Second trimester

The nurse will stress the importance of keeping all scheduled appointments (usually monthly during the second trimester), maintaining a healthy lifestyle and following the recommended diet, along with taking prescribed vitamins and supplements. The nurse should reinforce teaching and prepare the pregnant client for the following lab tests and procedures, as applicable. Urinalysis to monitor for presence of protein and glucose Alpha-fetoprotein (AFP) screening, performed at 16 to 18 weeks to test for chromosomal and congenital malformations and neural tube defects Gestational diabetes screening (usually performed at 24 to 28 weeks) Oral Glucose Tolerance Testing (OGTT) Screening for hepatitis B and HIV, if the client is considered high risk for exposure A tuberculin test if the client is considered high risk for having or having been exposed to tuberculosis (TB) AmniocentesisAmniocentesis is the surgical insertion of a needle through the abdominal wall and into the uterus to obtain a sample of amniotic fluid for testing purposes. Risks of amniocentesis include amnionitis, spontaneous abortion, preterm labor or premature rupture of membranes. might be performed at 15 to 18 weeks Rh-factor incompatibilityRhesus (Rh) factor is an inherited protein found on the surface of red blood cells. If the protein is present, the client is considered Rh positive (Rh+). Rh+ is the most common blood type. Having a Rh negative (Rh-) blood type usually does not affect a person's health. However, it can affect a client's pregnancy. A pregnant client needs special care if the mother is Rh- and the baby is Rh+, which is known as Rh incompatibility. screening

CHEST TUBE

The water-seal chamber should be filled with sterile water to the level specified by the manufacturer. The water-seal chamber is used to monitor for air leaks. The severity of the air leak is indicated by the amount of bubbling, noted by numbers at the bottom of the water-seal chamber. Intermittent bubbling that corresponds to respirations indicates an air leak from the pleural space. This should resolve as the lung re-expands. If bubbling in the water-seal chamber is continuous, there may be a leak in the system. Notify the HCP who inserted and is managing the chest tube. When there are only small air leaks present, the HCP may decide to only monitor the client. Watch for tidaling, i.e., normal fluctuations in the water-seal chamber with respiratory effort. The water level should increase during inspiration and decrease with expiration. If tidaling doesn't occur, check to see if the tubing is kinked or clamped. Also, tidaling should not occur with complete lung expansion or with mediastinal tubes, because the respirations don't affect tubes outside the pleural space. Assess the color of drainage in the drainage tubing and collection chamber. At regular intervals (per facility policy), document the amount of drainage and its characteristics in the client's electronic health record (EHR). Alert the HCP if you see sudden fluctuations or changes in chest-tube output, especially a sudden increase from previous drainage. Also report changes in drainage character, especially bright red blood or free-flowing red drainage, which could indicate hemorrhage.

pioglitazone

Thiazolidinediones Side effects include cold symptoms, headache, sinusitis, respiratory infection, muscle pain and tooth disorder. Clients should take the medication at the same time every day. Teach clients that they will need to have their liver enzymes checked and have regular eye exams for macular edema. Pioglitazone may increase the risk of bone fractures and can exacerbate heart failure. In 2011, the FDA issued an alert that clients who have been on the medication for over a year have an elevated risk of bladder cancer.

Luteninizing (LH)

This test is used to help determine the reason for the cessation of menstrual period, the loss of sex drive or infertility. This test is a blood draw.For women of childbearing age, the test may need to be done midway through the menstrual cycle, when LH levels peak.

TRACTION CONSIDERATIONS

To ensure proper functioning, inspect traction equipment at least every 8 to 12 hours for loosening, fraying and proper positioning of all ropes, knots and pulleys. Traction weights should not be allowed to rest on the floor. Implement pressure-reduction measures to reduce the risk of pressure-related skin breakdown, since clients with skeletal traction are often fully or partially immobilized. Perform pin site care according to facility protocol or as prescribed by the HCP. Notify the HCP if the client reports severe pain from muscle spasms as this may indicate that the weights are too heavy or that the client needs realignment. WEIGHTS SHOULD ALWAYS HANG FREELY (not on ground)

Age appropriate toys: Toddler

Toddlers tend to play alongside other children without interacting together. Toys which are appropriate include: push-pull toys, blocks, thick crayons, finger paints, puzzles, dolls, trucks and dress-up clothes. Play should be active and screen time should be limited to 1 hour a day.

Plant Alkaloids - Topoisomerase Inhibitor

Topotecan (Hycamtin), Irinotecan (Camptosar, CPT-11) USES: Leukemia Lung cancer Ovarian cancer GI cancer MOA: These drugs interfere with enzymes called topoisomerases, which help separate the strands of DNA so they can be copied during the S phase. (Enzymes are proteins that cause chemical reactions in living cells.)

Ketoralac

Toradol

Lipid Profile pannel

Total cholesterol: 150-200 LDL: 160 (without cardiac risk) HDL: Men 35 to 70 mg/dL (0.91 to 1.8 mmol/L) Women 35 to 85 mg/dL (0.91 to 2.2 mmol/L) Triglycerides: 100-200

A soft wrist restraint can be applied before a doctor's order is given, but the nurse must contact the HCP immediately after the restraint is applied to obtain the order. (True or False)

True

Diabetes pt have a higher risk for MI (T/F)

True

True or false The nurse is responsible for implementing interventions that promote airway clearance and reduce the risk of respiratory complications.

True

allopurinol

Urate-Lowering Drugs (Antigout Agents)

The nurse in a health clinic is reviewing recommended nutritional therapy with a client who has a history of emphysema. Which action should the nurse emphasize to the client? Drink lots of liquids with meals. Perform exercises to enhance appetite. Use oxygen during meals. Use the rescue inhaler prior to meals.

Use oxygen during meals.

Leuprolide and Goserelin

Used for: Advanced Breast cancer Prostate cancer MOA: Suppress the secretion of follicle-stimulating hormone and luteinizing hormone from the pituitary gland. Initially an increase in testosterone levels is seen. However, with continued use the pituitary gland becomes insensitive to this stimulation, leading to a reduction in the production of androgens and estrogens..

Airborne precautions

Varicella (chicken pox) Tuberculosis Measles (rubella) N95

The oncology nurse is preparing to administer the initial dose of vincristine to a child diagnosed with acute lymphocytic leukemia. Which interventions should the nurse include in the plan of care? Select all that apply. Verify blood return before, during and after intravenous administration. Select the appropriate catheter for intrathecal administration. Apply pressure to the injection site if extravasation occurs. Monitor liver function tests regularly. Monitor for numbness or tingling in the fingers and toes.

Verify blood return before, during and after intravenous administration. Monitor liver function tests regularly. Monitor for numbness or tingling in the fingers and toes.

pharyngitis

Viral, bacterial (beta hemolytic) or fungal (candidiasis) Throat pain worsens upon swallowing Increase fluids but avoid fruit jucies and sodas *TAKE ALL ANTIBIOTICS TO REDUCE RISK OF RHEUMATIC FEVER and APSGN*

Water soluble vitamins include:

Vitamin C B-complex vitamins (thiamin, riboflavin, niacin, pantothenic acid, biotin, B6, folate, B12) Cannot be stored in the body Require daily intake Pose little risk of toxicity because the body will eliminate excess

Fat soluble vitamins include:

Vitamins A, D, E and K Act as coenzymes for chemical reactions required for various body functions (e.g., nerve function, energy and protein metabolism, normal vision and skin health) Are stored primarily in the liver and adipose tissues Are absorbed by the body from the intestinal tract

The nurse is caring for a client diagnosed with gastroenteritis, caused by a Salmonella infection. Which intervention should the nurse implement to prevent transmission of this infection? Isolate the client in a single room without a roommate. Wear two pairs of gloves when changing linens. Wash hands with soap and water after client contact. Place the client on contact precautions.

Wash hands with soap and water after client contact. Salmonella is a bacteria and one of the primary causes of foodborne illnesses such as gastroenteritis. Bacteria transmission usually occurs through ingestion of the organisms via contaminated foods and the oral-fecal route. The Centers for Disease Control and Prevention (CDC) recommends using standard precautions for this infection; therefore, the best way to prevent spread of the infection is to perform handwashing before and after client contact, using soap and water

A common temporary side effect of bismuth subsalicylate is

a dark tint of the tongue or stool. Do not confuse this with black and tarry stools, which are a sign of bleeding in the intestinal tract.

IM peds injections

With smaller children the nurse may need to have another person available to assist with holding the child. Nurses should consider the needle length and size in relation to the medication administration. Vastus lateralis: this is the preferred location for infants and toddlers. With infants give 0.5 mL per leg while older children may have up to 2 mL. Ventrogluteal: this route may have less reactions or pain than the vastus lateralis. Administer 0.5 mL for infants and up to 2 mL for older children. Deltoid: this route has a faster absorption than the other routes. Since the muscle is small, nurses should not use this site for infants and small children. Administer 0.5-1 mL per arm.

Endocarditis

Worried about emboli and valvular vegetation Cause: Staph A and Streptococcus from strep throat, IV drug use, RF, hemodialysis Manifestations: murmur, fever, chills, arthralgia, fatigue, stroke symptoms, petechia, splinter hemorrhage under nails, oslers nodes, janeways lesions Intervention: IV antibiotics 6 wks or until neg sputum culture

Hemophilia A

X linked recessive prolonged bleeding in muscles and joints (hemarthrosis)

Common side effects of Cephalosporins

Yeast infections Diarrhea Abd cramping Fever Arthralgia

Chronic bronchitis

a chronic inflammatory response in the bronchioles of the lung D/t smoking

Sinus bradycardia is defined as

a heart rate of less than 60 beats per minutes with a regular rhythm that originates from the sinoatrial (SA) node. Typically, clients who develop sinus bradycardia are asymptomatic. If a client develops symptomatic bradycardia, they can present with hypotension, shortness of breath, chest pain, syncope or syncopal episodes and altered mentation. To avoid a vasovagal response (i.e., the slowing of the heart rate caused by bearing down when trying to defecate) and the risk for another syncopal episode, it is important to ensure that the client's bowel movements are soft and easily expelled. The client should also be instructed to avoid holding their breath or bearing down (Valsalva maneuver). The other interventions are not appropriate or required for this client

BNP

a hormone found in the left ventricle and helps diagnose and evaluate the client's for heart failure (HF). It is used for prognosis and to monitor therapy of clients with HF. Normal range is < (less than) 100 pg/mL.

Mycophenolate mofetil is

a medication used to prevent transplant organ rejection. Absorption of this medication can be decreased by antacids that contain magnesium and aluminum hydroxides such as milk of magnesia. Accordingly, mycophenolate mofetil should not be given simultaneously with these drugs. Taking acetaminophen (Tylenol) for minor pain is acceptable, as long as the client remains within the FDA-recommended maximum daily dose of 3,900 mg. A sore throat and chills can be early symptoms of an infection in immunosuppressed clients, so the client should notify their HCP. Taking the drug on an empty stomach will facilitate complete absorption and is recommended.

EEG

a painless test that measures electrical activity in the brain and checks for seizure activity. Prior to the test, the client should avoid caffeine intake and prescription medications that affect the nervous system. A series of cup-like electrodes are attached to the scalp. The client is exposed to a variety of external stimuli, e.g., bright or flashing lights or noises, and is asked to open and close their eyes and/or change their breathing patterns. The client usually reclines in a chair or on a bed during the test and it may take up to an hour. If the EEG is taken during sleep, it can take around three hours. After the test, the nurse will remove electrode paste from the scalp and hair, administer any medications that were held and observe for seizure activity in seizure-prone clients.

CRP

a protein produced by the liver. CRP levels rise with inflammation throughout the body. CRP may help determine the risk of future cardiac events in clients who have had a heart attack. CRP is a simple blood draw and no client preparation is required.

Subsalicylate can cause what in children

a serious and sometimes fatal condition called Reye's syndrome in children. Do not give bismuth subsalicylate to children or teens. (like aspirin)

Schedule II drugs

a type of drug with medicinal uses that is highly addictive and only available with a prescription OPIOIDS, Benzos

Clonidine, Methyldopa

alpha 2 agonist used for: HTN and opioid with drawal MOA: Decreases the release of norepinephrine from sympathetic nerves and decreases peripheral adrenergic receptor activation. Produce vasodilation which decreases blood pressure

benzodiazepines

alprazolam chlordiazepoxide diazepam lorazepam

antivirals

acyclovir oseltamivir phosphate valacyclovir HCL

Other Antidysrhythmic Agents

adenosine (may cause asystole or severe bradycardia for a temporary time) digoxinA

Anticholinesterase inhibitors work by

affecting the chemical neurotransmitter, acetylcholine. Acetylcholine is broken down by the enzyme, acetylcholinesterase (cholinesterase). These agents prevent the breakdown of acetylcholine by blocking the activity of acetylcholinesterase. Anticholinesterase inhibitors are metabolized by the liver eliminated in the urine and feces

hay fever

allergic rhinitis

clients taking cyclobenzaprine may experience

anticholinergic effects such as dry mouth and urinary retention. While taking this medication, antidepressants should be used with caution due to the increased risk of serotonin syndrome, excessive CNS depression, and hyperpyretic crisis

Antiplatelet agents

aspirin clopidogrel dipyridamole

If an alarm sounds while caring for a client on a ventilator, what should the nurse do?

assess the client first

HTN diagnosis

average of three or more blood pressure readings, taken two minutes apart, during three or more visits, not including the initial screening visit.

considerations for macrolides

base line EKG, BUN and creatinine and liver enzymes Dont need food

avoid when taking -prils

being pregnant breast feeding potassium supplements

cholestyramine

bile acid sequestrant

antidiarrheals

bismuth subsalicylate loperamide diphenoxylate-atropine

Bronchodilators or steriods first?

bronchodilators

Delayed (yellow)

second priority need treatment and transport but can be delayed multiple injuries to bones or joints, back injuries stable abd wounds eye and CNS injury

medication for magnesium toxicity

calcium gluconate

Antiparkinsonism agents

carbidopa and levodopa levodopa rasagiline

Hyperbaric oxygen therapy increases the dissociation of

carbon monoxide from the hemoglobin molecule.

ARDS

causes: sepsis, pancreatitis, blood transfusion, burns, trauma Need PEEP and fluid restriction Complications: malnutrition, deep vein thrombosis (DVT), HAIs, disseminated intravascular coagulation (DIC), skin breakdown, inadequate nutrition, gastrointestinal (GI) hemorrhage and pneumothorax.

when is mannitol used

cerebral edema glaucoma prophylaxis for AKI in kidney transplant (swollen head balloons, and eye cups spilling water)

SSRI's

citalopram escitalopram fluoxetine paroxetine sertraline

AFB smear

collect in AM rinse with water

TCA antidepressants (doxepin, imipramine, amitriptyline)

contraindicated in clients that have a history of a hypersensitivity reaction to a TCA medication, a history of recent myocardial infarction or current MAOI use. Pregnancy and lactation are contraindicated for TCA use due to fetal abnormalities. TCAs should be used with caution in clients with a history of glaucoma, enlarged prostate, cardiovascular problems, history of seizures, liver impairment or renal impairment. *INCREASED RISK OF SUICIDAL IDEATION* TCAs should be avoided for 24 hours after myelography due to the drug-to-drug interaction with the dyes used in these exams.

Sildenafil

contraindicated when used with Nitrates (hypotension) If pt has a heart attack and takes this, Nitro will NOT be given notify provider for an erection that lasts longer than 4 hours

Cisplatin contraindications and adverse effects

contraindications: Pregnancy Breastfeeding Preexisting hearing impairment Bone marrow suppression adverse effects: Extravasation Bone marrow depression Renal toxicity Bleeding Ototoxicity Seizures

INHALED STEROIDS (need to know)

dont use with active resp infection wash mouth out after use

Pulsus paradoxus is a

decrease in systolic blood pressure (SBP) during inspiration that is exaggerated in cardiac tamponade. Pulsus paradoxus exists when there is a difference greater than 10 mm Hg between when Korotkoff sounds are heard during expiration and when they are heard throughout the respiratory cycle. The other methods described would not be useful in determining the presence of pulsus paradoxus.

NDMA receptor antagonists work by

decreasing the effects of glutamine, the principal excitatory neurotransmitter in the brain, which is involved in the processing, storage and retrieval of information. Memantine hydrochloride undergoes minimal metabolism and is excreted in the urine unchanged.

Cullen's sign and Grey Turner's sign

ecchymosis in umbilical area, seen with pancreatitis Lateral brusing (PANCREATITIS)

education for varicose veins

elevating the affected leg. The nurse will teach the client (or reinforce teaching) not to cross their legs, to avoid prolonged sitting or standing and to elevate their legs as much as possible.

Macrolides

erythromycin, clarithromycin, azithromycin

TB treatment

ests used to diagnose latent or active TB include: Interferon gamma release assays (IGRA, QuantiFERON-TB or T-Spot.TB) (blood) Nucleic acid amplification test (NAAT) (sputum) Gold standard for diagnosis: TB culture (can take 2 to 6 weeks to obtain results) (sputum) Alternative test: acid-fast bacilli (AFB) smear (any body fluid, most often sputum) Long-term (6 to 24 months) antimicrobial therapy with at least two antitubercular drugs (isoniazid, rifampin, ethambutol and/or other antiinfectives). high carb high protein diet, small frequent meals Might need directly observed therapy

Antitubercular agents

ethambutol, rifampin, and isoniazid Antitubercular agents work by acting on the DNA and/or RNA of the mycobacterium, which leads to a lack of growth, replication and eventually bacterial death. These agents are often used in combination with other agents in this class to increase effectiveness and reduce the risk of the emergence of resistant strands. These agents are metabolized in the liver and excreted in the urine. NO ALCOHOL and monthly liver tests COMPLIANCE ISSUES - pts have to take for a VERY long time

Cluster headache

excruciating stabbing or burning sensations located in the eye or cheek ONE SIDED PAIN- comes in episodes over weeks or months Start in hypothalamus

While using a wet chest drainage system, gentle bubbling in suction control chamber is A. indicative of air leak b. expected and indicates that there is suction. c. shows the tube got disconnected d. is a sign to call the HCP

expected and indicates that there is suction.

Drugs that cross placenta easily

fat soluble

oxybutynin tolteradine use

for bladder hyperactivity including symptoms of urgency, frequency, nocturia and incontinence. ANTICHOLINERGIC EFFECTS**

triptans

for migraines Triptans are medications that work as selective serotonin receptor agonists; they cause a vasoconstriction in cranial nerves that has been associated with migraine and cluster headache pain relief. These medications are not used for prevention of migraine headaches. These medications are primarily metabolized in the liver and excreted in the urine. They cross the placenta and have shown toxic effects to the fetus in clinical animal studies. They also enter breast milk.

Alendronate

for osteoporosis hypocalcemia and esophageal cancer is possible

Long acting insulin

glargine, detemir, Ultralente

Fluoroquinolones agents are used to treat

gram-negative and gram-positive bacteria that infect primarily the lower respiratory system, skin and soft tissues, urinary tract and sexually transmitted diseases. Levofloxacin has been found to be effective against inhalation anthrax infections.

Complication of thyroidectomy

hemorrhage vocal chord paralysis

Vicodin

hydrocodone/acetaminophen

Antihistamines

hydroxyzine diphenhydramine Second Generation (non-sedating) cetirizine HCL fexofenadine loratadine

Herpes Zoster (shingles) disseminated needs what precautions

implement both contact and airborne precautions until lesions are dry and crusted.

Budesonide

inhaled steroid

Zafirlukast and Montelukast

inhaled steroid

Mannitol is NOT for

intracranial bleeding liver failure anuria pulmonary edema severe dehydration renal impairment

Filgrastim

treats leukopenia

Notify the HCP if drainage from Dry chest tube

is more than 100 mL/hour, if it becomes bright red or the amount suddenly increases.

Peritonsillar abscess

is often caused by a group A β-hemolytic Streptococci infection, especially if the infection was not treated with antibiotics or if treatment was delayed. Signs: drooling, unable to swallow, tonsil enlargement, muffled voive, high fever, chills, facial swelling adn ^ WBC

Therapeutic hypothermia

is typically used after a cardiopulmonary arrest.

Bupropion (Zyban)

is used as a nicotine-free method used to aid with smoking cessation. It should be started slowly and the dosage increased, but it should not be given for more than 12 weeks. Bupropion, when marketed as Wellbutrin, is used to treat depression. Side effects of bupropion are the same for either brand and include weight loss and insomnia. An alternative smoking cessation aid, varenicline, is associated with abnormal dreams and nightmares. Bupropion is not used for the treatment of hallucinations.

Chelation therapy

is used for poisoning with mercury or lead.

Expectant (black)

last priority dead or minimal chance of survival cardiac arrest or open head injury brain stem injury

Galantamine and rivastigmine should not be used in clients with

low body weight, due to the side effect of anorexia.

Cholinergic crisis with dozepil

manifested by severe nausea, diaphoresis, bradycardia, hypotension, increased salivation, muscle weakness, seizures, respiratory depression and cardiac arrest. The antidote for an anticholinergic inhibitor overdose is *atropine sulfate* given IV.

Solid foods

may be introduced between 4 to 6 months of age. Solid foods should be introduced once a week to evaluate for allergic reactions Honey should not be given in the first year. Weaning should be gradual, replacing one feeding at a time with the night-time feeding the last to be discontinued. Infants should not go to bed with bottles or cups.

Evisceration

means the total separation of the wound's incision edges and protrusion of internal organs, such as intestines, through the open wound.Evisceration is a surgical emergency and the nurse must notify the surgeon immediately. The client will most likely need to return to the operating room. The nurse should make the client NPO and cover the eviscerated matter with sterile, saline soaked gauze.

chelating agents

molecules that attract or bind with other molecules and are therefore useful in either preventing or promoting movement of substances from place to place Potassium iodine: helps radioactive iodine in thyroid Prussian blue : for cesium and thallium

anticholinergics are contraindicated in what

narrow angle glaucoma and urinary retention

A paracentesis is a

needle aspiration of fluid from the abdominal cavity used for diagnostic examination of the ascetic fluid and the treatment of ascites.This procedure can be done at the bedside. The client will be in a semi-Fowler's position. The nurse will instruct the client to empty the bladder prior to the procedure to decrease the risk of accidental puncture.Post-procedure, the nurse will monitor the client for worsening abdominal pain, abdominal rigidity and rebound tenderness that can be indicative of peritonitis.

Montelukast may increase the risk of

neuropsychiatric events including hallucination, aggression, anxiousness, suicidal behavior and tremors. The client will notify the provider if they experience these symptoms as well as any wheezing or respiratory distress.

Considerations for antifungals

no for pregnancy no for bad liver or with alcohol no for children

contraindications for sulfonamides

not for pregnant or breastfeeding: kernicterus renal/hepatic dysfunction and asthma *PHOTOSENSTIVE!!!*

contraindications for oxybutynin tolteradine

not good with other anticholinergic like drugs no with antihistamines

-tidine administration

once a day in the morning either with meal or on empty stomach

mannitol

osmotic diuretic

Black box warning for aminoglycosides

ototoxicity and nephrotoxicity

antispasmodic drugs

oxybutynin tolteradine

tension headache

pain is like a band squeezing the head temples or back of the head

Nitrates are contraindicated for clients who

recently taken: Sildenafil, tadalafil (severe hypotension) anemia cerebral trauma hemorrhage renal or hepatic problems

Atherosclerosis arises when

plaque (fat, cholesterol and other substances) accumulates inside arterial walls. The plaque limits blood flow through arteries and can eventually lead to tissue and organ ischemia. Atherosclerosis can develop in any artery in the body. Smoking contributes to the development of atherosclerosis by damaging artery walls and triggering vasoconstriction. A family history of heart disease (mother) is a risk factor for the development of atherosclerosis. Diabetes and elevated low-density lipoprotein (LDL) cholesterol levels are closely tied to the development of atherosclerosis. The target LDL level for a client is less than 100 mg/dL. The client's current alcohol consumption is within current daily recommendations of no more than 1 to 2 drinks per day. The D.A.S.H. diet is rich in fruits, vegetables, whole grains and legumes, which can reduce the development and progression of atherosclerosis.

Cyclosporine and Tacrolimus uses

prevent transplant rejection

Acid ash diet

prevents kidney stone formation. The restrictions include carbonated beverages, dried fruits, banana, figs, chocolate, nuts, olives and pickles.

MOA of Manitol

produce a rapid loss of sodium and water by inhibiting their reabsorption in the kidney tubules and the loop of Henle, thus increasing plasma osmolality. This increases the diffusion of water from the intraocular, intracranial and cerebrospinal fluids.

Mitral valve stenosis, regurg

rheumatic heart disease is #1 cause (also IE, MI) manifestations: cough, orthopnea, might see left sided HF (blood pooling in lungs)

CT scan

scan of the brain is used to detect hemorrhage, stroke, skull fractures and tumors. If contrast dye is used with the scan, informed content must be obtained. The test is painless, but the client must remain immobile during the exam, which can cause anxiety and may be challenging for clients with dementia, delirium or claustrophobia An extreme or irrational fear of confined places. .If contrast dye is used, the client may experience a flushed, warm face and/or a metallic taste during the injection. The nurse will assess for allergic responses to the dye such as rash, itching, angioedema or urticaria. After the CT scan, the nurse will encourage the client to intake fluids to facilitate elimination of the contrast material.

zolpidem zaleplon eszopiclone

sedative hypnotics short-term treatment of insomnia. Sedative-hypnotics work by binding to benzodiazepine receptors in the central nervous system and increasing the inhibitory effect of gamma-aminobutyric acid (GABA). These medications have been associated with withdrawal symptoms. Teach the client (or reinforce teaching) to avoid using alcohol or other CNS depressants during usage and to take these medications when 6-8 hours of sleep is possible (just prior to bedtime).

Theophylline toxicity

serum levels greater than 20 mcg/ml. The client may begin to exhibit headache, gastrointestinal upset. At levels higher than 30 mcg/ml dysrhythmias, seizures, or death may occur. . Draw peak serum theophylline levels 15-30 minutes after an administering IV loading dose. Ensure that diazepam is readily available to treat seizures.

phenytoin s/e

severe liver toxicity, nystagmus and diplopia, rash, gingival hyperplasia, and or hirsutism.

Migrane

severe, recurring, unilateral, vascular headache Quick onset with aura: visual onset Pain worsens and resolves in 72 hours more than once a month

administration guidelines for Alendronate

sit up 30 mins after taking this med do not give with food, antiacids, calcium or iron take calcium and vit D supplement

Ipratropium should not be given to

soy or peanut allergy

What medications effects PTH

steroids, isoniazid, lithium, rifampin, anticonvulsants and phosphates.

Sulfonamides

sulfamethoxazole- trimethoprim (bactrim)

Sputum ciulture

take in the morning prior to test: RINSE MOUTH WITH WATER do not brush teeth or use mouth wash

Baclofen contraindications

take it with food and that discontinuing the use of baclofen abruptly can cause severe adverse reactions. not for pts in recovery from MI, dysrythmias, heart failure increased urinary frequency and seizures

ramipril

the client can take ramipril without regard to food. The contents of the capsule can be mixed with water, juice or applesauce to aid in swallowing.

Emphysema

the walls of the alveoli enlarge and lose elasticity, trapping air and decreasing capacity for vital gas exchange due to alpha-1 antitrypsin deficiency or smoking

contraindications CCB

they are contraindicated in clients that have hypotension or are having an acute MI. Clients with symptomatic heart failure and heart block should not use these medications as decreasing the cardiac output will worsen these conditions. Hepatotoxic

When clients experience a persistent cough with ACE inhibitors:

they often discontinue their use of ACE Inhibitors. Remind the client to consult with their HCP before they discontinue this medication and that many over-the-counter cough, cold and allergy medications may exacerbate hypertension.

Doxazosin use

to control blood pressure or treat the symptoms associated with benign prostatic hyperplasia (BPH).

lisdexamfetamine methylphenidate use

treat ADD decrease appetite and promote wt loss alleviate sleep disorders Mechanism of Action These medications increase physical activity (energy), mental alertness and attention span by acting on the reticular activating system (RAS) and stimulating catecholamines. This has a contradictory effect of calming hyperactivity that is thought to be related to an immature RAS. However, the exact mechanism of action is not known. These medications are metabolized in the liver and excreted in the urine. *TAKE IN THE AM WITH FOOD TO STIMULATE APPETITE*

Sulfonamides used for

treat urinary tract infections, ulcerative colitis, Crohn's disease, some types of bacterial pneumonia and shigellosis. They are also effective in treating some protozoal infections, otitis media and toxoplasmosis.

Erythropoetin Alfa

treats anemia and good in End stage kidney disease

Paclitaxel (Taxol)

used for: Breast cancer Lung cancer Myelomas Lymphomas Leukemias IV ONLY MOA: Mitotic inhibitors are often plant alkaloids and other compounds derived from natural products. They work by stopping mitosis in the M phase of the cell cycle but can damage cells in all phases by keeping enzymes from making proteins needed for cell reproduction.

Fluconazole may affect

warfarin levels and increase prothrombin time. It has also been linked to a reduced metabolism of tolbutamide, glyburide and glipizide. Glucose levels should be monitored in clients with a history of diabetes or hyperglycemia.

donepezil galantamine rivastigmine should not be used when

with COPD, asthma, bradycardia, bladder obstruction or ulcer diseases

sodium rich foods

• baking mixes (pancakes, muffins) • barbecue sauce • buttermilk • butter/margarine • canned chili • canned seafood • canned soups • canned spaghetti sauce • cured meats • dry onion soup mix • "fast" foods • frozen dinners • macaroni and cheese • microwave dinners • Parmesan cheese • pickles • potato salad • pretzels, potato chips • salad dressings (prepared) • salt • sauerkraut • tomato ketchup Seafood Cheese BRead

Low cholesterol

✓✓✓✓✓ A low cholesterol diet is used for cardiovascular disease and those with high serum cholesterol levels. The normal amount of cholesterol intake is 250 to 300 mg/day. Diet restrictions include eggs, beef, liver, lobster and ice cream.

low residue diet

✓✓✓✓✓✓✓ A low residual diet is used for conditions such as diarrhea and acute diverticulitis. Clients are asked to reduce their intake of canned fruit, refined carbohydrates and fruits/vegetables. Foods that are high in refined carbohydrates are usually low in fibe