ATI

Contraindication for sumatriptan

(Vasocontrictor) Angina pectoris, uncontrolled HTN, CAD, ischemic heart disease

Intradermal injection guidelines

- 0.5-5/8 in. length of needle - 25-27 gauge - 5 to 15 degree angle of needle - inner surface of forearm (hairless) - skin taut, look for wheal, no rubbing, no aspirating - 0.01 to 0.1 mL

Intramuscular injection guidelines

- 1-1.5 in. length of needle (1/2 inch for child, 2-3 inch for obese pt) - 20-25 gauge - 90 degree - Deltoid, ventrogluteal, vastus lateralis, rectus femoris (pediatrics), dorsogluteal - skin taut (unless limited muscle mass, then pinch), aspirate, remove needle and start over if blood appears in syringe -2-3 mL

Subcutaneous injection guidelines

- 3/8 to 5/8 in. length of needle (may need 1 inch for large patient) - 25-27 gauge - 45 to 90 degree - upper arm, thigh, abdomen, gluteal, scapula - pinch up tissue, no aspirating, no rubbing - Maximum 1.5 mL

Raloxifene

- Can lower the risk off breast cancer in menopausal pts - Should not take prior to periods of immobility

Findings from combining anesthetic agents with opioids

- Decrease RR - Low O2

Furosemide education

- Eat foods high in potassium - Report indications of hearing loss - Educate to rise slowly - Should be taken early in day - Check wt daily

Amiodarone Education

- Get liver enzyme tests periodically - Report development of jaundice - Side effects include optic neuropathy and optic neuritis - Can cause loss of appetite/constipation - Can cause CNS manifestations including confusion, hallucinations, dizziness, and insomnia

Hydrochlorothiazide side effect

- Hyperglycemia and other electrolyte imbalances

DKA symptoms

- Kussmaul breathing, increased serum potassium, decreased pH, hyperglycemia (>300 mg/dL)

Tamoxifen education

- Monitor calcium level for hypercalcemia (elevated BP and pulse) - Monitor for pulmonary embolus - Advise for potential of menstrual irregularities and hot flashes

Education about Warfarin

- Monitor intake of foods high in vitamin K ex. green leafy veggies, cabbage, broccoli, mayo, and canola - Oral contraceptives will decrease anticoagulant effects - Concurrent use of glucocorticoids should be avoided

Indications of fluid imbalance

- Oliguria - Cap refill > 5 seconds - Sunken eyes

Ketorolac side effects

- Oliguria (renal insufficiency, renal toxicity) - Dry mouth - Altered taste

Ciprofloxacin (and other fluoroquinolone) side effects

- Phototoxicity - Muscle weakness - N/V/D - Hepatotoxicity

Esomeprazole education

- Take 30 mins before meal - Side effects include headache, constipation, dry mouth, diarrhea

Sodium polystyrene sulfonate

- Treats hyperkalemia by excreting serum potassium

Corticosteroids Side Effects

- Truncal obesity (Cushing's syndrome - fluid retention, HTN, wt gain, fat redistribution - moon face, buffalo hump, susceptible to infection, hyperglycemia, osteoporosis, menstrual irregularities, thin fragile skin, hirsutism) - Osteoporosis - Susceptibility to infection

Digoxin Education

- Will cause heart to beat slower, contact provider if experiencing visual changes or excessive nausea

Normal specific gravity

1.010-1.030

How much should overweight women (BMI 26-29) gain during pregnancy?

15-25 pounds

How much weight should women with a normal BMI (19.8-26) gain during pregnancy?

25-35 pounds

How much should women who are below optimal weight (BMI < 19.8) gain during pregnancy?

28-40 pounds

How many additional calories should a pregnant patient consume?

300 calories a day more than pre-pregnancy 2,200 calories daily for most active women and teens 1,600 for sedentary women Protein: 60-80 g/day Iron: 18-30 g/day Folate: 400-600 g/day

How much weight should women carrying twins gain during pregnancy?

35-45 pounds

Normal HgA1C for diabetic

4-6%

Normal range for albumin

4.5-5.0 g/100mL

How much weight should women carrying triplets gain?

50 pounds

Normal fasting glucose range for diabetic

90-130 mg/dL

Normal HgA1C

<7%

Meds for Diabetes Insipidus

ADH Replacement Demopressin Acetate, ADH Stimulant Carbamazepine, Vasopressin

Atropine

Accelerates the HR by interfering with vagal impulses

Medications to treat glaucoma

Acetazolamide, Timolol maleate

What value should be monitored with TPN?

Albumin

Metformin is contraindicated with

Alcohol use disorder

Most important side effect to monitor with TCAs

Arrhythmias

Acyclovir nursing action

Assess for increase in creatinine

Where does the extra weight go during pregnancy?

Baby: 7-8 lbs Placenta: 1-2 lbs Amniotic fluid: 2 lbs Uterus: 2 lbs Maternal breast tissue: 2 lbs Maternal blood: 4 lbs Fluids in maternal tissue: 4 lbs Maternal fat and nutrient stores: 7 lbs

Syphilis medication

Benzathine penicillin G

Education for pt with rheumatoid arthritis receiving methotrexate

CBC should be monitored

What med should be given when a pt has Trousseau's sign?

Calcium glutinate

Nursing intervention when performing trach care

Change tracheostomy ties when soiled

Education for pts receiving ondansetron for chemo

Combinations of antiemetics are usually more effective than single-med therapy - serotonin antagonist (ondansetron) with corticosteroid (dexamethasone)

Therapeutic response to digoxin for MI

Decrease in pulmonary crackles

Water Deprivation Test

Dehydration is induced by withholding fluid. Urine output is measured and tested hourly. Test positive if kidneys are unable to concentrate urine

Education for patient with gout starting allopurinol

Drink 2-3 L of water to prevent kidney injury

Side effects of Acetazolamide

Electrolyte imbalance, respiratory acidosis, diarrhea, black tarry stools, nephrolithiasis, myopia, tinnitus, paresthesias, photosensitivity, anorexia, drowsiness

If a patient doesn't accept blood products what can be given

Epoetin Alfa

Med for maintenance of BP and sodium imbalance for pts with adrenocortical insufficiency

Fludrocortisone

What med should be given to counteract benzodiazepines?

Flumazenil

Foods appropriate for Chron's disease

Foods that are appropriate for clients with Crohn's Disease include: Tender, ground, well-cooked meat, eggs, fish, poultry, refined pasta and cereal, white rice and bread, canned or cooked vegetables without skin or seeds and juices without pulp.

Hypocalcemia signs

Fractures, seizures, Trousseau's sign (Hand finger spasms with sustained BP cuff inflation

Patient is in DKA what is most appropriate to administer?

Glucagon

Medication to help prevent N/V for chemo pts

Granisetron

What is didanosine used for?

HIV

When do you hold atenolol?

HR <50

Med that causes gingival hyperplasia

Haloperidol

Patient with digoxin sees objects with a yellowish tint and is nauseated

Hold the med and call provider

Important to monitor before giving lisinopril (side effect)

Hyperkalemia

Ginkgo with warfarin

Increases the effects - don't take ginkgo with warfarin

Potential adverse effect of glucocorticoids

Infection - watch for temperature of 100.5 degrees Fahrenheit

Vasopressin Test

Is positive when a SQ injection of vasopressin produces urine output with an increased specific gravity

Somatropin

Monitor child's height monthly, hypo/hyperglycemia

Anti-infective that inhibits bacteria growth

Moxifloxacin

Side effect of spironalactone

Muscle weakness - indications of hyperkalemia including dysrhymias

Medications associated with gastric irritation and peptic ulcers

NSAIDs such as naproxen - gastric irritation Corticosteroids - such as prednisone

PT & INR

PT: 11-12.5 seconds INR: 2-3 (norm: 0.8-1.1)

Antidote for Heparin

Protamine sulfate

Diabetes Insipidus

Results from a deficiency of ADH, secreted by the posterior pituitary gland that leads to a large quantity of diluted urine

First action when administering a medication that wasn't prescribed

Review possible side effects

How often should cromolyn be taken?

Routinely, usually 3-4 times per day, within 1 hr prior to physical activity (ideally 10-15 mins before)

Medications to avoid taking with glaucoma

Scopolamine, Methylphenidate, Diphenhydramine

What should be reported immediately when a patient is taking buproprion?

Seizures

What med should be given to tx metabolic acidosis?

Sodium bicarbonate

Monitor with Lithium

Sodium loss - diuretics should be questioned

How is mannitol administered?

Syringe, filter needle, IV filter tubing

What side effect should be monitored for with use of oral albuterol?

Tachycardia and dysrhythmias

Aluminum Hydroxide Gel

To bind phosphate in food and stop phosphate absorption

Patient with preterm labor is prescribed nifedipine. Why?

To relax muscles of uterus

Advice to pt when giving nitroglycerin to tx angina

To sit or lie down

Side effect that would indicate adverse reaction to gentamicin sulfate

Urinary output of 185 mL in 8 hr shift

Labs for Diabetes Insipidus

Urine - DILUTE - specific gravity: <1.005, decreased urine pH, Na, K Serum Chemistry - CONCENTRATED >300 Osm/L, increased Na and K Decreased ADH

Best site for 10 mg IM injection of morphine sulfate

Ventrogluteal

Antidote for Warfarin

Vitamin K

Side effects from Ipratropium

Xerostomia (anticholinergic effects)

A nurse is teaching parents how care for their newborn. Which of the following statements indicates a good understanding of how to use a bulb syringe to suction excess mucous from the infant's airway? Select one: a. "I should suction my baby's mouth before the nose." b. "I should compress the bulb syringe after I place it in my baby's mouth." c. "The bulb syringe should be sterilized after each use." d. "The bulb syringe should reach to the back of my baby's throat."

a. "I should suction my baby's mouth before the nose."

A nurse is reviewing a client's lab results. Which finding would lead the nurse to suspect the client is experiencing dehydration? Select one: a. Hematocrit 55% b. Serum sodium 130 mEq/L An increased serum sodium level (> 145 MEq/L) is anticipated in a client who is dehydrated. c. Urine specific gravity of 1.025 d. BUN 20mg/100mL

a. Hematocrit 55%

A client is admitted to the surgical unit after sustaining a compound fracture of the left femur. The client is alert and oriented with the following vital signs: T 99.4 F, P 88, R 20, B/P 94/58. The nurse notes a 4 cm. area of bright red blood on the pressure dressing on the left lower extremity. The client is receiving intravenous fluids of normal saline at 150 ml/hr. One hour after being admitted to the unit, the nurse finds the client confused and combative. Which of the following is the most likely cause of the change in the client's condition? Select one: a. Hypoxia related to fat embolism from the fractured bone. b. Fluid overload related to aggressive isotonic volume replacement c. Hypovolemic shock related to hemorrhage from the open wound d. Infectious process related to contamination of the open wound. Feedback

a. Hypoxia related to fat embolism from the fractured bone.

A nurse is orienting a newly licensed nurse to the operating room. Which of the following actions by the new nurse indicates a need for further education about surgical aseptic hand hygiene? Select one: a. Rinsing hands and arms while keeping them lower than elbows. b. Lathering hand and arms with soap to 5 cm (2 inches) above the elbows c. Cleaning under nails of both hands with a nail pick while under running water. d. Drying with a sterile towel moving from the hands to the elbows.

a. Rinsing hands and arms while keeping them lower than elbows.

A nurse has administered the first DTaP (diphtheria toxoid, tetanus and pertussis) immunization to a two-month-old infant. For which of the following symptoms should the nurse teach the parents to seek immediate medical attention? Select one: a. The baby is crying inconsolably for more than three hours b. The baby develops swelling or redness at the injection site c. The baby develops a localized or generalized rash d. The baby has an axillary temperature of 100.4o F. (38o C)

a. The baby is crying inconsolably for more than three hours

aPTT PTT

aPTT: 60-80 seconds (1.5-2.5x the normal value of 30-40 seconds) PTT: 60-70 seconds

A nurse is caring for a client when the IV infusion pump malfunctions and delivers 1 Liter of IV fluid over 2 hours. Which intervention is the priority? Select one: a. Monitor urine output. b. Fill out an incident report. c. Report the defective equipment. d. Document the amount of fluid infused.

b. Fill out an incident report

A nurse is teaching lifestyle modifications to a client diagnosed with hypertension. Which of the following statements made by the client indicates a need for further teaching? Select one: a. "We have a glass of wine a couple of times a week with dinner." b. "Losing weight is so hard, but so far I am losing 2 pounds a week." c. "I will substitute mushrooms for the bacon in my daily omelets." d. "I don't like to walk, but I do aerobics and work out at the gym during the week."

c. "I will substitute mushrooms for the bacon in my daily omelets."

A nurse is caring for a client following a right below the knee amputation. Which of the following should the nurse include in the plan of care to prevent infection? Select one: a. Encourage the client to lie prone for 20-30 minutes several times a day. b. Encourage the client to lie supine for 20-30 minutes several times a day. c. Position the affected limb in a dependent position. d. Position the affected limb elevated on a pillow.

c. Position the affected limb in a dependent position.

A newly-licensed nurse is preparing the surgical suite for a client who has a latex allergy. Which action demonstrates a need for further education? Select one: a. Placing monitoring devices in stockinet. b. Using glass syringes. c. Scheduling the case late in the day. d. Covering IV tubing ports with tape.

c. Scheduling the case late in the day

A nurse is caring for a client with Addison's disease. Which of the following diets should the nurse teach the client to follow? Select one: a. Low Sodium, high potassium and decreased fluids. b. High Sodium, low calcium and increased fluids. c. Low Sodium, high calcium and decreased fluids. d. High Sodium, low potassium and increased fluids.

d. High Sodium, low potassium and increased fluids.

A client has just returned to the surgical unit after an open cholestectomy. A nurse notes the abdominal dressing is saturated with sanguineous drainage. Which of the following is the most appropriate intervention? Select one: a. Remove the dressing to assess the incision. b. Document the assessment findings. c. Outline the drainage size with a marker. d. Reinforce the dressing with additional gauze.

d. Reinforce the dressing with additional gauze.

A nurse is caring for a client with a diagnosis of sepsis with a temperature of 40.8 C (105.5 F). The provider has ordered a cooling blanket. Which intervention is appropriate to delegate to an Unlicensed Assistive Personnel (UAP)? a. Obtain a fan for the client's use b. Assess the client's skin for any reddened c. Bathe the client to keep the skin damp d. Report shivering by the client

d. Report shivering by the client

When the nurse takes morning medications to a client, the client states "I've never seen that one before." Which of the following is the most appropriate action for the nurse to take? Select one: a. Recheck the medication with the medication administration record (MAR). b. Tell the client that the medication must be new and to go ahead and take it. c. Administer the rest of the medications and recheck the one that was questioned. d. Return to the nurse's station and check all medications against provider orders

d. Return to the nurse's station and check all medications against provider orders

A nurse correctly understands which of the following characteristics is a possible developmental delay for a 3-month-old client? Select one: a. The infant is unable to point to objects b. The infant is unable to sit with support c. The infant demonstrates stranger anxiety d. The infant does not raise his head when placed on his abdomen

d. The infant does not raise his head when placed on his abdomen