ATI - Review
Young infant - pain expected findings
-loud cry -rigid body or thrashing -local reflex withdrawal form pain stimulus -expressions of pain ( eyes tightly closed, mouth in a squarish shape, eyebrows lowered and drawn together) -lack of association between stimulus and pain
Adolescent
-more verbal expressions of pain with less protest -muscle tension with body control
General Renal considerations
-restrict sodium intake to maintain blood pressure -restrict potassium intake to prevent hyperkalemia -the recommended daily protein intake is 0.8 to 1.0g/kg/day of ideal body weight
Food high in oxalates
-spinach -rhubarb -beets -nuts, -chocolate, tea -wheat bran -strawberries Avoid megadoses of vitamin C, increase the amount of oxalate excreted
Schoo-age child
-stalling behavior -muscular rigidity -any behaviors of the toddler, but less intensen in the anticipatory phase and more intense in painful stimulus
A nurse is teaching a client who has a new prescription for imipramine (TCA) how to minimize anticholinergic effects. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) -void just before taking the medication -Increase the dietary intake of potassium -wear sunglasses when outside -Change positions slowly when getting up -Chew sugarless gum
-wear sunglasses when outside (photophobia.) -Chew sugarless gum (will help minimized the anticholigernic effect of dry mouth.)
Lithium Carbonate
-Lithium produced neurochemical charges in the brain, including serotonin receptor blockade. -There is evidence that lithium, decreases neuronal atrophy and/or increases neuronal growth.
A nurse is assessing an infant. Which of the following are findings of pain in an infant? (select all that apply) -Purse lips -Loud cry -Lowered eyebrows -Rigid body -Pushes away stimulus
-Loud cry -Rigid body
A change nurse is discussing mirtazapine (TCA) with a newly license nurse. Which of the following statements by the newly licensed nurse indicates understanding? "This medication increases the release of serotonin an norepinephrine." "I should tell the client about the likelihood of insomnia while taking this medication." 'This medication is contraindicated for clients who have an eating disorder." "Sexual dysfunction is a common adverse effect of this medication."
"This medication increases the release of serotonin an norepinephrine."
Alpha-blocking agents: tamsulosin BPH med
*Alpha-adrenergic receptor antagonist cause relaxation of the bladder outlet and prostate gland *These agents decrease pressure in the urethra, thereby re-establishing a stronger urine flow.
SSRI side effects
*BAD SSRI* B - Body weight increase; A - Anxiety/Agitation; D - Dizziness; Dry mouth S - Serotonin syndrome; S - Stimulated CNS; R - Reproductive/Sexual dysfunction I - Insomnia;
Dihydrotestosterone (DHT)- lowering medications: * 5-alpha reductase inhibitor (5-ARI), such as finasteride BPH med
*DHT-lowering medications decrease the production testosterone in the prostate gland. *Decreasing DHT often causes a decrease in the size of prostate
bening prostatic hyperplasia (BPH) Risk factors:
*Increased age *smocking, chronic alcohol use *sedentary lifestyle, obesitiy *Western diet *DM, heart disease
Tamsulosin Client education
*Tachycardia, syncope, and postural hypotension can occur. Change positions slowly *Concurrent use with cimetidine can potentiate the hypotensive effect
Finasteride (Proscar) client education
*it can take 6 month before effects of the medication are evident. *Impotence and decrease libido are possible adverse effects. *Report breast enlargement to the provider. *Teratogenic
A nurse is planning care for a child following a surgical procedure. Which of the following interventions should the nurse include in the plan of care? -Administer NSAIDs for pain greater than 7 on a scale of 0 to 10. -Administer intranasal analgestics PRN. -Administer IM analgestics for pain. -Administer IV analgesics on a schedule.
-Administer IV analgesics on a schedule. IV analgesics should be administered on a schedule to achieve optimal pain management.
A nurse is teaching a client about protein needs when on dialysis. Which of the following instructions should the nurse include in the teaching? (SATA) -Consume 35 kcal/kg of body weight to maintain body protein stores -Take phosphate binders when eating protein-rich foods -Increase biologic sources of proteins (eggs, milk and soy) -Increase protein intake by 50% of the recommended dietary allowance (RDA). -Consume daily protein intake in the morning
-Consume 35 kcal/kg of body weight to maintain body protein stores -Take phosphate binders when eating protein-rich foods -Increase biologic sources of proteins (eggs, milk and soy) -Increase protein intake by 50% of the recommended dietary allowance (RDA).
TB client teaching with meds
-Continue medication therapy for its full duration of 6 to 12 months, even up to 2 years for multiresistant TB -Continue follow-up care for 1 full year -Sputum samples are needed every 2 to 4 weeks to monitor therapy effectiveness. Clients are not longer considered infectious after 3 consecutive negative sputum cultures, and can resume work and social interactions.
Anticholinergics
-Decrease the risk of bradycardia during surgery -Block the muscarinic response to acetylcholine by decrease salivation, perspiration, bowel motility and GI secretions. Atropine Glycopyrrolate
Implement actions that decrease ICP:
-Elevate HOB at least 30 to reduce ICP and promote venous drainage -Avoid extreme flexion, extension, or rotation of the head -Maintain a patient airway -Adm O2 as indicated to maintain PaO2 ≥ 60 mmHg
A nurse is preparing a toddler for an intravenous catheter insertion using atraumatic care. Which of the following actions should the nurse take? (select all that apply) -Explain the procedure using the child's favorite toy -Ask the parents to leave during the procedure -Perform the procedure with the child in his bed -Allow the child to make one choice regarding the procedure -Apply lidocaine and prilocaine cream to three potential insertion sites
-Explain the procedure using the child's favorite toy -Allow the child to make one choice regarding the procedure -Apply lidocaine and prilocaine cream to three potential insertion sites
Lithium carbonate complications:
-GI distress -Fine hand tremors -Polyuria, mild thirst -Weight gain -Renal toxicity -Goiter and hypothyroidism -Bradydysrhythmias, hypotension, and electrolyte imbalances.
Lithium Severe Toxicity
-Greater than 2.5mEq/L -rapid progression of manifestations leading to a coma and death Nursing actions: Hemodialysis can be warranted.
ICP can be increased by:
-Hypercarbia, which lead to cerebral vasodilation -Endotracheal or oral tracheal suctioning -Coughing -Extreme neck or hip flexion/extension -Maintaining the HOB at angle less than 30 -Increasing intra-abdominal pressure (restrictive clothing, Valsalva maneuver)
A nurse is caring for a client who has experienced a right-hemispheric stroke. The nurse should expect the client to have difficulty with which of the following? (SATA) -Impulse control -Moving the left side -Depth perception -Speaking -Situational awareness
-Impulse control -Moving the left side -Depth perception -Situational awareness
Democratic
-Includes the group when decisions are made. -Motivates by supporting staff achievements -Communication occurs up and down the chain of command
A nurse is caring for a postpartum client 8 hr after delivery. Which of the following factors places the client at risk for uterine atony? (select all that apply). -Magnesium sulfate infusion -Distended bladder -Oxytocin infusion -Prolonged labor -Small for gestational age newborn
-Magnesium sulfate infusion (Magnesium sulfate is a smooth muscle relaxant and can prevent adequate contraction of the uterus. -Distended bladder (After birth, clients can experience a decreased urge to void due to birth-induced trauma, increased bladder capacity, and anesthetics, which can result in a distended bladder. The distended bladder displaces the uterus and can prevent adequate contraction of the uterus) -Prolonged labor (Prolonged labor can stretch out the musculature of the uterus and cause fatigue, which prevents the uterus from contracting).
cane instructions
-Maintain two points of support on the ground at all times. -Keep the cane on the stronger side of the body. -Support body weight on both legs, move the cane forward 6 to 10 inches, then move the weaker leg forward toward the cane. -Next, advance the stronger leg past the cane
authoritative
-Makes decisions for the group -Motivates by coercion -Communication occurs down the chair of command, of from the highest management of level downward through other managers to employees. -Work output by staff is usually high: good for crisis situations and bureaucratic settings
A nurse is planning care for a client who has ESKD. Which of the following should the nurse include in the plan of care? (SATA) -Monitor the client's daily weight -Encourage the client to comply with fluid restrictions -Evaluate intake and output -Instruct the client on restricting calories from carbohydrates -Monitor for constipation
-Monitor the client's daily weight. -Encourage the client to comply with fluid restrictions -Evaluate intake and output -Monitor for constipation
A nurse is planning care for an infant who is experiencing pain. Which of the following interventions should the nurse include the plan of care?(select all that apply) -Offer a pacifier -Use guided imagery -Use swaddling -Initiate a behavioral contact -Encourage kangaroo care
-Ofer a pacifier -Encourage kangaroo care
Crutch instructions
-Once crutches are fitted do not adjust them. -UP with the good DOWN with the bad -Support body weight at the hands grips with elbows flexed at 20 to 30 degrees -Position crutches on unaffected side when sitting or rising from a chair.
A nurse is caring for a client who is taking phenelzine (MAO). For which of the following manifestations should the nurse monitor as an adverse effect of this medication? (Select all that apply.) -Elevated blood glucose level -Orthostatic hypotension -Priapism -Hypomania -Bruxism
-Orthostatic hypotension -Hypomania: Observe for a headache which Is an adverse effect of phenelzine.
TB meds
-PZA (Pyrazinamide) observe for hepatotoxicity. -Rifampin-possible orange urine (side effects: hepatitis, GI disturbance) -INH (Ionozide)-Can cause an elevation of hepatic enzymes and hepatitis. Neurotoxicity (tingling of the hands and feet). -Ethambutol (watch for changes in vision) Monitor when therapy is initiated and during the first 3 months.
A nurse manager is providing information to the nurses on the unit about ensuring client rights. Which of the following regulations outlines the rights of individuals in health care settings? -American Nurses Association Code of Ethics -HIPAA -Patient Self-Determination Act -Patient Care Partnership
-Patient Care Partnership The patient care partnership is a document that addresses client's rights when receiving care.
TB symptoms include
-Persistent cough -Fatigue -Night sweats -Purulent sputum
A nurse is caring for a client who has left homonymous hemianopsia. Which of the following is an appropriate nursing intervention? -Teach the client to scan to the right to see the object on the right side of the body -Place the bedside table on the right side of the bed -Orient the client to the food on the plate using the clock method -Place the wheelchair on the client's left side
-Place the bedside table on the right side of the bed The client is unable to visualize to the left midline of their body.
Benzodiazepines
-Reduce anxiety preoperative -Promote amnesia -Produce mild sedation (unconsciousness) with little-to-moderate respiratory depression with careful titration Diazepam Midazolam
Neuromuscular blocking agents
-Skeletal muscle relaxation for surgery -Airway placement -In conjunction with IV anesthetic agents (propofol, opioids, benzodiazepines) Succinylcholine Vecuronium
AKI classification
-Stage 1 (risk stage): Blood creatinine 1.5 to 1.9 times baseline and urine output less than 0.5mL/kg/hr for 6 hr or more -Stage 2 (injury stage): BC 2 to 2.9 times baseline and urine less than 0.5 mL/kg/hr for 12 hr or more. -Stage 3 (failure stage): BC 3 times baseline and urine output less than 0.3 mL/kg/hr for 12 hr or more
CKD Stages of
-Stage 1: minimal kidney damage when GFR (≥90mL/min) -Stage 2: mild kidney damage GFR (60 to 89 mL/min) -Stage 3: moderate kidney damage GFR ( 30 to 59 mL/min) -Stage 4: severe kidney damage GFR ( 15 to 29 mL/min) -Stage 5: kidney failure and end-stage renal disease w/little or no glomerular filtration (less than 15 mL/min)
Postrenal AKI
-Stone, tumor, bladder atony -Prostate hyperplasia, urethral stricture -Spinal cord disease or injury
Older Infant's Response to Pain
-Withdrawal from painful stimuli -Loud crying -Facial grimacing -Physical resistance
Tyramine containing foods
-avocados, -soybeans, figs, smoked meats, dried or cured fish, cheese, yeast products, beer, chanti wine, chocolate, caffeinated beverages
antiemetic
-decrease post anesthesia N/V -enhances gastric emptying (metoclopramide) -induces sedation (promethazine) -decrease the risk of aspiration
Anticholinergic effects
-dry mouth -constipation -photophobia -blurred vision -tachycardia -urinary hesitancy or retention
Toddler
-loud cry -Verbal expression of pain -trashing of extremities -attempt to push away or avoid stimulus -noncooperation -clinging to a significant person -behaviors occur in anticipation of painful stimulus
A nurse is caring for a client who is at 39 weeks of gestation and is in the active phase of labor. The nurse observes late decelarions in the fetal heart rate (FHR). Which of the following findings should the nurse identify as the cause of the late decelarations? a. utter-placental insufficiency b. fetal head compression c. fetal ventricular septal defect d. umbilical cord compression
a. utter-placental insufficiency A late deceleration in the FHR is a nonreassuring FHR pattern resulting from fetal hypoxemia due to insufficient placental perfusion. The nurse should reposition the client, initiate oxygen, and increase the infusion rate of IV fluid to enhance placental perfusion.
A nurse is caring for a client who has a closed-head injury with ICP ranging from 16 to 22 mmHg. Which of the following actions should the nurse take to decrease the potential for raising the client's ICP? (SATA) a. Suction the endotracheal tube frequently b. Decrease the noise level in the client's room c. Elevate the client's head on two pillows d. Administer a stool softener e. Keep the client well hydrated.
b and d b. Decrease the noise level in the client's room d. Administer a stool softener
A nurse is providing teaching to a client who has a new prescription for Amitriptyline (TCA). Which of the following statements by the client indicates an understanding of the teaching? a. "I can expect to experience diarrhea while taking this medication". b. "I may feel drowsy for a few weeks after starting this medication." c. "I cannot eat my favorite pizza with pepperoni while taking this medication." d. "This medication will help me lose weight that I have gained over the last year."
b. "I may feel drowsy for a few weeks after staring this medication." Sedation is an adverse effect of amitriptyline during the first few weeks of therapy.
A nurse is assessing a client who is 14 hr postpartum and has third-degree perineal laceration. The client's temp is 37.8 C (100 F), and her fundus is firm and slightly deviated to the right. The client reports a gush of blood when she ambulates and no bowel movement since delivery. Which of the following actions should the nurse take? a. Notify the provider about the elevated temperature. b. Assist the client to empty her bladder. c. Administer a bisacodyl suppository. d. Massage the client's fundus.
b. Assist the client to empty her bladder. When the client's fundus is deviated to the right or left it can indicate that her bladder is full. The nurse should assist the client to empty her bladder to prevent uterine atony and excessive lochia.
A nurse is caring for a client who is receiving magnesium sulfate by continuous IV infusion, Which of the following medications should the nurse have available at the client's bedside? a. Naloxone b. Calcium gluconate c. Protamine sulfate d. Atropine
b. Calcium gluconate The nurse should have calcium gluconate available to give to a client who is receiving magnesium sulfate by continuous IV infusion in case of magnesium sulfate toxicity. The nurse should monitor the client for a respiratory rate less than or equal to 12/min, muscle weakness, and depressed deep-tendon reflexes.
A nurse is caring for a client who has increased ICP and a new prescription for mannitol. For which of the following adverse effects should the nurse monitor? a. Hyperglycemia b. Hyponatremia c. Hypervolemia d. Oliguria
b. Hyponatremia Mannitol is a powerful osmotic direct. Adverse effects include electrolyte imbalances, such as hyponatremia.
A nurse is caring for a client who has oligohydramnios. Which of the following fetal anomalies should the nurse expect? a. atrial septal defect b. Renal genesis c. Spina bifida d. Hydrocephalus
b. Renal genesis Oligohydramnios is a volume of amniotic fluid less than 300 mL during the third trimester of pregnancy and occurs when there is a renal system dysfunction or obstructive uropathy. Absence of fetal kidneys will cause oligohydramnios.
A nurse is admitting a client who is in labor and experiencing moderate bright red vaginal bleeding. Which of the following actions should the nurse take? a. perform a vaginal examination to determine cervical dilation b. obtain blood samples for baseline laboratory values. c. place a spiral electrode on the fetal presenting part d. prepare the client for a transvaginal ultrasound
b. obtain blood samples for baseline laboratory values. The nurse should obtain samples of the client's blood for baseline testing of hemoglobin and hematocrit levels.
Saw Palmetto uses
benign prostatic hyperplasia
A nurse is assessing a client who is postpartum following a vacuum-assisted birth. For which of the following findings should the nurse monitor to identify a cervical laceration. a. Continuous lochia flow and a flaccid uterus b. Report of increasing pain and pressure in the perineal are c. A slow trickle of bright vaginal bleeding and a firm fundus d. A gush of rubra lochia when the nurse massages the uterus
c. A slow trickle of bright vaginal bleeding and a firm fundus The nurse should monitor for bright red bleeding as a slow trickle, oozing or outright bleeding,and a firm fundus to identify a cervical laceration.
A nurse is assessing a 12-hour-old newborn and notes a respiratory rate of 44/min with shallow respirations and periods of apnea lasting up to 10 seconds. Which of the following actions should the nurse take? a. Perform chest percussion. b. Place the newborn in a prone position. c. Continue routine monitoring. d. Request a prescription for supplemental oxygen.
c. Continue routine monitoring. The nurse should continue routine monitoring because the newborn's assessments findings indicate he is adapting to extrauterine life.
A nurse is caring for a client who is in the latent phase of labor and is receiving oxytocin via continuous IV infusion. The nurse notes the client is having contractions every 2 min which last 100 to 110 seconds and that the fetal heart rate (FHR) is reassuring. Which of the following actions should the nurse take? a. Decrease the infusion rate of the maintenance IV fluid b. Administer oxygen via nonrebreather mask. c. Decrease the dose of oxytocin by half. d. Administer terbutaline 0.25 mg subcutaneously
c. Decrease the dose of oxytocin by half. The nurse should decrease the dose of oxytocin by half because the client is experiencing uterine tachysystole.
A nurse is planning care for a newborn who is receiving phototherapy for an elevated bilirubin level. Which of the following actions should the nurse take? a. Offer the newborn glucose water between feedings. b. Keep the newborn's eye patches on during feedings. c. Apply barrier ointment to the newborn's perianal region. d. Use a photometer to monitor the lamp's energy.
d. Use a photometer to monitor the lamp's energy. The nurse should monitor the lamp's energy throughout the therapy to ensure the newborn is receiving the appropriate amount to be effective.
Chronic Kidney Disease (CKD)
Progressive, IRREVERSIBLE loss of kidney function Defined as presence of GFR<60ml/min. for 3 mos. or more Kidney disease is staged based upon decreasing GFR Final stage of CKD is end stage renal disease (ESRD) ESRD requires dialysis or renal transplant
hypertensive crisis
Resulting from intake of dietary tyramine: severe hypertension as a result of intensive vasoconstriction and stimulant of the heart. -headache -n/v -increase heart rate/BP -diaphoresis -change in LOC
SNRI side effects
Side effects: stimulant effects (tachycardia, ↑ BP), nausea, constipation, sedation, and if suddenly stopped can cause SNRI discontinuation syndrome (flulike symptoms and electric-like shocks) • Both medications can result in persistent pulmonary hypertension (PPHN)
BPH (I-PSS) Expected findings
The International Prostate Symptom Score (I-PSS) is an assessment tool used to determine the severity of manifestations and their effect on client's quality of life. *The client rates the severity of lower urinary tract manifestations using a 0 to 5 scale and also rates the quality of life as affected by urinary tract manifestations.
A nurse is assessing a newborn 1 hr after birth. Which of the following assessment findings should the nurse report to the provider? a. Jaundice of the sclera b. Respiratory rate 50/min c. Acrocyanosis d. Blood glucose 60 mg/dL
a. Jaundice of the sclera If the newborn has jaundice within the first 24 hr of life, this can indicate a potential pathological process such as hemolytic disease. Pathologic jaundice can result in high levels of bilirubin that can cause damage to the neonatal brain.
A nurse is completing discharge teaching about diet and fluid restrictions to a client who has calcium oxalate-based kidney stone. Which of the following instructions should the nurse include in the teaching? a. Reduce intake of spinach b. Decrease broccoli intake c. Increase intake of vitamin C supplements d. Limit consumption of purine substances
a. Reduce intake of spinach.
A nurse is teaching a client who has stage 2 chronic kidney disease about dietary management. Which of the following information should the nurse include in the instructions? a. Restrict protein intake b. maintain a high-phosphorous diet c. increase intake of foods high in potassium d. limit dairy products to 1 cup/day
a. Restrict protein intake Restricting protein intake decreases the risk for proteinuria and decreases the workload on the kidney.
A nurse is assessing a newborn who was born at 39 weeks gestation. Which of the following findings should the nurse expect? a. Symmetric rib cage b. Dry, wrinkled skin c. Vernix over the entire body d. Lanugo abundant on the back
a. Symmetric rib cage A newborn who is born at 39 weeks of gestation is full-term and should have a symmetric rib cage.
Magnesium sulfate - admin consideration
Administration Consideration Have calcium gluconate available to reverse effects. Adverse Reaction May include hypotension, flushing, heart block and respiratory paralysis. IV_Facts Dilute and give slowly, no greater than 150 mg/ minute. Nursing Consideration Monitor fluids, electrolytes, respirations and vital signs.
Oxytocin - admn consideration
Administration Consideration Have magnesium sulfate available for myometrium relaxation. Adverse Reaction Rare but severe reactions include subarachnoid hemorrhage, seizure, coma, hypertension and abruptio placenta. IV_Facts Do not bolus. Dilute and give through an infusion pump.
A nursing is caring for a client who is at 37 weeks of gestation and is undergoing a non stress test. The fetal heart rate (FHR) is 130/min without accelerations for the past 10 min. Which of the following actions should the nurse take? a. Use vibroacustic stimulation on the client's abdomen for 3 seconds b. Report the nonreactive test result to the provider immediately c. Request a prescription for an internal fetal scalp electrode d. Auscultate the FHR with a Droppler transducer.
a. Use vibroacustic stimulation on the client's abdomen for 3 seconds The nurse should use a vibroacoustic stimulator on the client's abdomen to elicit fetal activity because the fetus is most likely sleeping. Fetal movement should cause accelerations in the FHR.
Warfarin (Coumadin)
Anticoagulant PT (1.5 to 2.5 times the control level of 11 to 12.5 seconds) and INR of 2 to 3.
Heparin
Anticoagulant aPTT (1.5 to 2.5 times the control level of 30 to 40 seconds).
Phenytoin (Dilantin)
Anticonvulsant
Serotonin Syndrome
Can begin 2 to 72 hr after the start of treatment, and it can be lethal. -mental confusion, diffuculty concentration -abdominal pain -diarrhea -fever -anxiety -hallucinations -hyperreflexia Treatment: cyproheptadine (5-HT2 receptor antagonist).
Prerenal AKI
Cause is "before" Glomerular Apparatus; MOST COMMON AKI *Reduced renal artery blood flow Hypotension, Hypo-perfusion, Cardiogenic Shock, Sepsis, Shock
Oxytocin
Class exogenous hormone, oxytocic Indications Used to stimulate uterine contractions for induction of labor, augmentation of labor, assessment of fetal status, abortion, and for control of postpartum hemorrhage.
Magnesium sulfate
Class mineral, electrolyte Indications Used for hypomagnesemia, seizures, ventricular arrhythmias and to prevent seizures in preeclamptic women.
BPH Expected finds cont:
Clients with BPH typically report urinary frequency, urgency, hesitancy, or incontinence; incomplete emptying of the bladder; dribbling post-voiding; nocturne; diminish force of urinary stream; straining with urination; and hematuria. If BPH persists, back flow of urine into the ureters and kidney can lead to kidney damage.
azotemia (uremia)
Condition of increased amounts of nitrogenous waste products in the blood
amyotrophic lateral sclerosis (ALS)
Condition of progressive deterioration of motor nerve cells resulting in total loss of voluntary muscle control. Symptoms advance from muscle weakness in the arms and legs, to the muscles of speech, swallowing, and breathing, to total paralysis and death; also known as Lou Gehrig disease
Opiods (narcotics)
Depress the medulla oblongata and can cause respiratory depression. Uses: -Sedation -Analgestics to relieve preoperative and postoperative pain Fentanyl Sufentnail Alfentanil
Multiple Sclerosis (MS)
Disease of the central nervous system characterized by the demyelination (deterioration of the myelin sheath) of nerve fibers, with episodes of neurologic dysfunction (exacerbation) followed by recovery (remission)
Lithium interactions
Diuretics NSAIDs Anticholinergics (antihistamines, tricyclic antidepressants)
Tricyclic Antidepressants (TCAs)
Drugs that inhibit the reuptake of norepinephrine and serotonin by the presynaptic neurons in the central nervous system, increasing the amount of time they are available to the postsynaptic receptors. Amitriptyline (Elavil) Imipramine (Tofranil) Nortriptyline (Pamelor)
Ethacrynic acid (mechanism, use, toxicity)
Essentially same action as furosemide. -Use: diuresis in patients allergic to sulfa drugs. -Toxicity: similar to furosemide; can cause hyperuricemia; never use to treat gout
A nurse is completing a pain assessment on an infant. Which of the following pain scales should the nurse use? -Faces -FLACC -Oucher -Non-communincating children's pain checklist
FLACC The FLACC pain assessment scale is recommended for infants and children between 2 months and 7 years of age.
A nurse is caring for a client who believes she might be pregnant. Which of he following findings should the nurse identity as a positive sign of pregnancy? a. palpable fetal movement b. Chadwick's sign c. positive pregnancy test d. amenorrhea
a. palpable fetal movement Palpable fetal movements are a positive sign of pregnancy. Quickening, the client's report of fetal movement, is a presumptive sign of pregnancy.
Foods high in phosphorus
Fish *Organ meats* *Nuts* Pork, beef, and chicken Whole-grain breads and cereals Milk products
Saw Palmetto Interactions
Insoluble in water Interferes with iron absorption Estrogen replacement therapy Oral contraceptives Might slow blood clotting.
Mantoux test
Intradermal test to determine tuberculin sensitivity based on a positive reaction where the area around the test site becomes red and swollen
Intrarenal AKI
Intrarenal causes of AKI include conditions that cause direct damage to the kidney tissues resulting in impaired nephron function. The damage usually results from prolonged ischemia, nephrotoxins (NSAIDS, aminoglycosides, vancomycin, IV contrast, or hemolytic incompatibility), hemoglobin released from hemolyzed RBCs, or myoglobin released from necrotic muscle cells. Acute tubular necrosis is the most common intrarenal cause of AKI and is primarily the result of ischemia, nephrotoxins or sepsis. Nephrotoxic agents cause necrosis and tubular cells slough off and plug the tubules.
transurethral incision of the prostate gland (TUIP)
Involve incisiones into the prostate to relieve constriction.of the urethra. Tissue is not removed with this procedure It is minimal invasive and typically performed in a outpatient setting
Cerclage
Involves pursestring suturing of a cervical os in an attempt to prevent miscarriage due to incompetent cervix. The term "incompetent cervix" refers to the premature dilation of a weak cervix. This occurs most frequently in the fourth or fifth month of pregnancy.
Acute Kidney Injury (AKI)
Manifestations include: a decrease urination, decrease sensation in the extremities, swelling of the lower extremities, and flank pain. It is characterized by rising blood levels of urea and other nitrogenous wastes
end-stage kidney disease (ESKD)
Manifestations include: fatigue, decrease alertness, anemia, decreased urination, headache, and weight loss.
Increased Intracranial Pressure (ICP)
Monitor by placing a screw, catheter, or sensor through a burr hole into the ventricle or the subarachnoid, epidural or subdural space. Expected reference range is 10 to 15 mmHg.
nephrotic syndrome (nephrosis)
Most pronounced manifestations are edema and high proteinuria. Other manifestations include hypoalbuminemia, hyperlipidemia and blood hyper coagulation.
Hypertensive crisis treatment
Nitroprusside or phentolamine (antagonizes alpha) -Provide continuous cardia monitoring and respiraron support as indicated
Leadership and Management
Nurses act in both leadership and management roles. A. A leader is an individual who influences people to accomplish goals. B. A manager is an individual who works to accomplish the goals of the organization. C. A nurse manager acts to achieve the goals of safe, effective client care within the overall goals of a health care facility.
Oligohydramnios
Oligohydramnios is a complication of pregnancy, defined as a volume of amniotic fluid being less than 300 mL during the third trimester of pregnancy. Usually when there is a decreased amount of amniotic fluid there is a amniotic fluid leak or fetal renal dysfunction or obstructive uropathy.
Mannitol (Osmitrol)
Osmotic diuretics. Pull fluid back into the vascular and extravascular space by increasing serum osmolality to promote osmotic changes. Used to prevent renal failure related to hypovolemia. Decrease intracranial pressure related to cerebral edema. Decrease intraocular pressure.
MAOIs
Phenelzine (Nardil) Tranylcypromine (Parnate)
Physical changes - postpartum
Physiological changes consist in uterine involution; lochia flow; cervical involution; decrease vaginal distention; alteration in ovarian function and menstruation; and cardiovascular, urinayy tract, breast and GI tract changes.
Prostatic stent
Place to keep the urethra patent, especially if client is a poor candidate for surgery
polyhydramnios
Polyhydramnios is the presence of excessive amniotic fluid surrounding the unborn infant. It occurs when the fetus fails, for any number of reasons, to swallow and absorb amniotic fluid in normal amount. Polyhydramnios is associated with gastrointestinal fetal malformations and neurologic disorders. Two examples of these are tracheoesophageal fistula and anencephaly. Treatment involve amniocentesis and bedrest.
AKI: types of failure
Prerenal: occurs as as a result of volume depletion and prolonged reduction of blood flow to the kidneys, which leads to ischemia of the nephrons Intrarenal: occurs as result of direct damage to the kidney from lack of oxygen, indicating damage to the glomeruli, nephrons, or tubules Postrenal: occurs as result of bilateral obstruction of structures leaving the kidney
Postpartum physiological adaptations
The main goal during the immediate postpartum period is to prevent postpartum hemorrhage. Includes at least the first 2 hr after birth.
BPH Lab test
Urinalysis and culture: WBCs elevated, hematuria, and bacteria present with UTI CBC: WBCs elevated if systemic infection is present, RBCs possible decreased due to hematuria BUN and creatinine: elevated, indicating kidney damage. Prostate-specific antigen: To rule out prostate cancer. Culture and sensitivity of prostatic fluid: Can be performed if fluid is expressed during digital rectal examination.
SNRIs
Venlafaxine (Effexor) Duloxetine (Cymbalta)
The right cerebral hemisphere is responsable for:
Visual and spatial awareness and proprioception. -Altered perception of deficits (overstimation of abilities) -Unilateral neglect syndrome (ignore left side of the body -Loss of depth perception -Poor impulse control and judgement -Left hemiplegia or hemiparesis -Visual changes
Laissez-faire
a policy or attitude of letting things take their own course, without interfering.
A nurse is caring for a client who is at 14 weeks of gestation and has hyperemesis gravidarum. The nurse should identify that which of the following are at risk factors for the client? (SATA) a. Diabetes b. Multifetal pregnancy c. Materna age ≥ 40 d. Gestational trophoblastic disease e. Oligohydramnios
a, b, and d a. Diabetes b. Multifetal pregnancy d. Gestational trophoblastic disease
A nurse is administering magnesium sulfate IV for seizure prophylaxis to a client who has severe preeclampsia. Which of the following indicates magnesium sulfate toxicity? (SATA) a. respirations less than 12/min b. urinary output less than 25 mL/hr c. Hyperreflexic deep-tendon reflexes d. Decreased LOC e. Flushing and sweating
a, b, and d a. respirations less than 12/min b. urinary output less than 25 mL/hr d. Decreased LOC
A nurse in the critical care unit is completing an admission assessment of a client who has a gunshot wound in the head. Which of the following assessment findings are indicative of increased ICP? (SATA) a. Headache b. Dilated pupils c. Tachycardia d. Decorticate posturing e. Hypotension
a, b, and d a. Headache b. Dilated pupils d. Decorticate posturing
A nurse is assessing a 2-day-old newborn and notes an egg-shaped, edematous, bluish discoloration that does not cross the suture line. Which of the following pieces of information should the nurse provide to the mother when she inquires about the finding? a. "This will resolve within 3 to 6 weeks without treatment." b. "This will resolve on its own within 3 to 4 days." c. "The provider might drain this area with a syringe." d. "This is expected at birth so you don't need to worry about it."
a. "This will resolve within 3 to 6 weeks without treatment." This discoloration is a cephalhematoma, resulting from a collection of blood between the skull and periosteum, that will resolve within 2 to 6 weeks.
A nurse is caring for a newborn who is premature at 30 weeks of gestation. Which of the following findings should the nurse expect? a. Abundant lanugo b. Good flexion c. Heel creases covering the bottom of feet d. Dry, parchment-like skin
a. Abundant lanugo Newborns who are premature have abundant lanugo, fine hair, especially over their back. A full-term newborn typically has minimal lanugo present only on the shoulders, pinnas, and forehead
A nurse is caring for a client who is at 32 weeks of gestation and is experiencing preterm labor. Which of the following medications should the nurse plan to administer? a. Betamethasone b. Misoprostol c. Methylergonovine d. Poractant alfa
a. Betamethasone The nurse should plan to administer betamethasone IM, a glucocorticoid, to stimulate fetal lung maturity and thereby prevent respiratory depression.
A nurse is teaching a client who is at 13 weeks of gestation about the treatment of incompetent cervix with cervial cerclage. Which of the following statements by the client indicates an understanding of the teaching? a. I am sad that I won't be able to get pregnant again b. I can resume having sex as soon as feel up to it c. I should go to the hospital if I think I may be in labor d. I should expect bright red bleeding while the cerclage is in place.
c. I should go to the hospital if I think I may be in labor Cervical cerclage prevents premature opening of the cervix during pregnancy. The client should immediately go to a facility for evaluation if she experiences any manifestations of labor while the cerclage is in place. If the client experiences preterm uterine contractions she might require tocolytic therapy.
A nurse is assessing the reflexes of a new born to assess neurological maturity. Which of the following reflexes is the the nurse assessing when she quickly and gently turns the newborn's head to the side? a. Rooting b. Moro c. Tonic neck d. Babinski
c. Tonic neck To elicit the tonic neck reflex, the nurse should quickly and gently turn the newborn's head to one side when he is sleeping or falling asleep. The newborn's arm and leg should extend outward to the same side that the nurse turned his head while the opposite arm and leg flex. This reflex persists for about 3 to 4 months.
A nurse is assessing a client who is at 35 weeks of gestation and is receiving magnesium sulfate via continuous IV infusion for severe pre-eclampsia. Which of the following findings should the nurse report to the provider? a. Deep tendon reflexes 2+ b. Blood pressure 150/96 mmHg c. Urinary output 20 ml/hr d. Respiratory rate 16/min
c. Urinary output 20 ml/hr The nurse should report a urinary output of 20 mL/hr because this can indicate inadequate renal perfusion, increasing the risk of magnesium sulfate toxicity. A decrease in urinary output can also indicate a decrease in renal perfusion secondary to a worsening of the client's pre-eclampsia.
A nurse is caring for a client who is at 35 weeks of gestation and has severe pre-eclampasia. Which of the following assessment provides the most accurate information regarding the client's fluid and electrolyte status? a. blood pressure b. intake and output c. daily weight d. severity of edema
c. daily weight Evidence-based practice indicates that daily weight is the most accurate assessment to determine a client's fluid and electrolyte statu
A nurse is caring for a client who is in active labor and has meconium staining of the amniotic fluid. The nurse notes a reassuring FHR tracing from the external fetal monitor. Which of the following actions should the nurse take? a. prepare the client for an ultrasound examination b. prepare the client for an emergency cesarean birth c. prepare equipment needed for newborn resuscitation d. perform endotracheal suctioning as soon as the fetal head is delivered.
c. prepare equipment needed for newborn resuscitation The nurse should ensure that all supplies and equipment needed for resuscitation of the newborn are readily available for every delivery. Endotracheal suctioning is recommended in cases of meconium staining only if the newborn has poor respiratory effort, decreased muscle tone, and bradycardia after delivery.
A nurse is teaching a client who has multiple sclerosis and a new prescription for baclofen. Which of the following statements should the nurse include in the teaching? a. "This medication will help you with your tremors." b. "This medication will help you with your bladder function." c. "This medication can cause your skin to bruise easily." d. "This medication can cause you to experience dizziness."
d. "This medication can cause you to experience dizziness." Baclofen is an antispasmodic medication that is given to clients who have MS to treat muscle spasms.
A nurse is caring for a client whose last menstrual period (LMP) began July 8. Using Nagele's rule, the nurse should identify the client's estimated date of birth (EBD) as which of the following? a. October 1 b. April 1 c. October 15 d. April 15
d. April 15 Using Nagele's rule, the nurse determines the EDB by counting back 3 months from the first day of the LMP and adding 7 days.
A nurse is providing teaching to the parents of a newborn about bottle feeding. Which of the following instructions should the nurse include in the teaching? a. Dilute ready-to-feed formula if the newborn is gaining weight too quickly. b. Prop the bottle with a blanket for the last feeding of the day. c. Discard unused refrigerated formula after 72 hr. d. Boil water for powdered formula for 1 to 2 min.
d. Boil water for powdered formula for 1 to 2 min. The parents should run tap water for 2 min and then boil it for 1 to 2 min before mixing it with the formula to decrease the risk of contamination.
A nurse is administering a rubella immunization to a client who is 2 days postpartum. Which of the following statements indicates to the nurse the clients needs further instruction? a. I can continue to breastfeed b. I will still need to have my provider perform a rubella titer check with my next pregnancy c. I cannot receive the rubella immunization during my pregnancy d. I can conceive any time I wan after 10 days
d. I can conceive any time I wan after 10 days A client who receives a rubella immunization should not conceive for at least 1 month after receiving the rubella immunization to prevent injury to the fetus.
A nurse is providing teaching to a client who is planning to breastfeed a newborn. Which of the following statements by the client indicates an understanding of the teaching? a. I must drink milk everyday in order to assure a good quality breast milk b. drinking lost of fluids will increase my breast milk production c. after the first few weeks, my nipples will toughen up and breastfeeding won't hurt anymore d. It is normal for my baby to sometimes feed every hour for several hours in a row
d. It is normal for my baby to sometimes feed every hour for several hours in a row Cluster feeding is an expected finding for newborns who are breastfeeding. The mother should follow her newborn's cues and feed her 8 to 12 times per day.
A nurse is assessing a newborn for congenital hip dysplasia. Which of the following findings should the nurse expect? a. Legs that are shorter than the arms b. Temperature of one leg differing from that of the other c. Symmetrical gluteal folds d. Limited abduction of one hip
d. Limited abduction of one hip A newborn who has congenital hip dysplasia can have limited abduction because the head of the femur might have slipped out of the acetabulum.
A nurse is caring for a client who is in the latent phase of labor and is experiencing low back pain. Which of the following actions should the nurse take? a. instruct the client to pant during contractions b. position the client supine with legs elevated c. encourage the client to soak in a warm bath d. apply pressure to the client's sacral area during contractions
d. apply pressure to the client's sacral area during contractions The nurse should provide counter pressure to the sacral area with a palm or a firm object, such as a tennis ball, during contractions. Counterpressure lifts the fetal head away from the sacral nerves, which decreases pain.
A nurse is providing teaching to a client who is at 8 weeks of gestation about manifestation to report to the provider during pregnancy. Which of the following information should the nurse include in the teaching? a. nausea upon awakening b. leg cramps when sleeping c. increase in white vaginal discharge d. blurred or double vision
d. blurred or double vision A client who is pregnant should report experiencing blurred or double vision as these could be a manifestation of gestation hypertension or pre-eclampsia.
A nurse is teaching a client who is at 12 weeks of gestation and has human immunodeficiency virus (HIV). Which of the following statements should the nurse include in the teaching? a. breastfeed your newborn to provide passive immunity b. abstain from sexual intercourse throughout the pregnancy c. you will be in isolation after delivery d. you should continue to take zidovudine throughout the pregnancy
d. you should continue to take zidovudine throughout the pregnancy The nurse should inform the client that taking prescription antiviral medication every day decreases the risk of transmission of HIV to her newborn.
The left cerebral hemisphere is responsible for:
language, mathematics skills, and analytic thinking. -Expressive and receptive aphasia (inability to speak and understand language) -Agnosia (unable to recognize familiar objects) -Alexia (reading difficulty) -Agraphia (writing difficulty) -Right extremity hemiplegia -Slow, cautious behavior -Depression, anger, and quick to become frustated -Visual changes (hemianopsia [loos of visual died in one or both eyes]).
Lithium toxicity
lithium level: 1.5 to 2.0 mEg/L -mental confusion -sedation -poor coordination, -n/v, diarrhea lithium level 2.0 to 2.5 mEq/L -extreme polyuria or dilute urine, -tinnitus -giddiness -jerking movements -blurred vision -ataxia, seizures -severe hypotension and stupor leading to coma -death from respiratory complications
transurethral needle ablation (TUNA)
low radiofrequency energy shrinks the prostate
Atypical Antidepressants
miscellaneous group of drugs with antidepressant effects but only mild side effects. Bupropion (Wellbutrin)
transurethral resection of the prostate (TURP)
procedure of removing all or part of the prostate by the insertion of a resectoscope into the urethra
Cushing's triad
r/t ICP (HTN, bradycardia, irritability, sleep, widening pulse pressure)
SSRIs
selective serotonin reuptake inhibitors -Fluoxetine, paroxetine, sertraline, citalopram.
transurethral microwave thermotherapy (TUMT)
treatment that eliminates excess tissue present in benign prostatic hyperplasia by using heat generated by microwave
