NCLEX study questions
Congenital hypothyroidism is _______ TSH and low ___
Increased; low T4
S3 and S4 are
abnormal
First drug in line for treatment of C-Diff
Metronidazole (flagyl)
What type of medication is contraindicated in patients with HF?
NSAIDs
Nursing considerations for Thiazide Diuretics
Obtain baseline vital signs, give with meals to decrease GI upset, replace K+ if lower than 3.5, avoid giving patients with gout, Monitor renal function
Nursing considerations for loop diuretics
Obtain baseline vitals, administer furosemide SLOWY, replace K+ if less than .5
-tadine (antiviral) Examples; drug class
amantadine; rimantadine antiviral; anti influenza A
Pre-schooler (3 to 5 years): Theorist Freud, type of development and stage
Psychosocial Phallic
JVD, hepatosplenomegaly, splenomegaly, ascites, edema, increased abdominal girth are all signs of
RIGHT sided heart failure
Hodgekins lymphoma would show a presence of what cells
Reedsternberg cells
Which type of insulin is available by IV?
Regular insulin (short acting )
What is the most commonly used DMARD
Rheumatrex
St Johns Wort should be avoided when taking what type of medications?
SSRI's
-cillin Examples; drug class
amoxicillin; ampicillin; dicloxacillin penicillin antibiotic
digoxin toxicity signs and symptoms
anorexia, visual symptoms, nausea vomiting, diarrhea, fatigue, weakness, confusion
Action of spironolactone
antagonizes aldosterone which increases absorption of sodium, excretion of Na+ and H2O, NOT K+
What medications help with the "death rattle"
anticholinergic medications such as a transdermal scopolamine or atropine sublingual drops effectively treat this symptom by drying up excess secretions
What class of meds should not be given while an epidural catheter is in place?
anticoagulants
What is metoclopramide?
antiemetic medication that treats nausea, vomiting, and gastroparesis by increasing GI motility and promoting stomach emptying
Beers criteria for drugs that can be harmful to the elderly include:
antipsychotics, anticholinergics, antihistamiens, antihypertensives, benzodiazepines, diuretics, opioids, and sliding insulin scales
S2 (DUB) is what
aortic and pulmonic valve closure
Carvedilol is what and used for what purpose
a beta blocker; used to improve cardiac output and slow the progression of heart failure
-statin Examples; drug class; special things to remember
atorvastatin; lovastatin; simvistatin; pitavastatin HMG-CoA reductase inhibitor; statins obtain baseline cholesterol levels and notify MD if there are muscle aches or pains, anorexia, GI disturbances, avoid alcohol should be taken with evening meals or at bedtime baseline liver enzymes should be obtained
Hep B is transmitted through...
body fluids; sexual contact and infected blood
-bital Examples and drug class
butabarbital; phenobarbital; barbituate (sedative)
What is used to lower serum phosphorous levels
calcium acetate
Pericarditis can lead to...
cardiac tamponade
-mustine Examples; drug class; special things to remember
carmustine; estramustine; lomustine alkylating agent (antineoplastic)
left side of the heart
carries oxygenated blood from the lungs to the body
a 4 year old should be able to
catch a ball 50% of the time copy or draw a square hop on one foot
cef- ceph- Examples; drug class; important things to remember
cefaclor; cefprozil; cephalexin cephalosporin antibiotic check for PCN allergy due to cross sensitivity
Clients with an allergy to penicillin antibiotics, can possibly experience a cross sensitivity to
cephalosporin antibiotics
HIV, HPV, and multiparity are risk factors for
cervical cancer
Angina pectoris is
chest pain that is caused by myocardial ischemia; chest pain with activity, shortness of breath, fatigue
Pain in the right quadrant that radiates to the right shoulder would be indicative of
cholecystitis
Before an MRI the nurse needs to assess for
claustrophobia Metal Pacemaker
What does intermediate acting insulin look like
cloudy
sign of right to left shunt?
clubbing fingertips
-zepam -zolam Examples; drug class; important things to know
conazepam; diazepam; lorazepam; alprazolam; estazolam; midazolam benzodiazepine commonly administered with haloperidol Flumazenil is the antidote
-tinib Examples; drug class;
crizotinib; dasatinib; erlotinib; getitinib antineoplastic
parin; -parin
dalteparin; enoxaparin; heparin; antithrombotic; anticoagulant should be withheld if significant thrombocytopenia, enoxaparin requires CBC monitoring but not coagulation studies, do not give with epidural catheter in place
-nacin Examples; drug class;
darifenacin; solifenacin muscarinic antagonist (anticholinergic)
infarction =
death
a low pulse pressure can indicate
decreased cardiac output (patient with heart failure)
Peripheral vascular disease is where
deoxygenated blood cant get back to the heart. Pooling of oxygenated blood in the extremities
What is desmopressin used to treat?
diabetes insipidus
NSAIDs decrease effectiveness of
diuretics and drugs that control blood pressure
Grade 3 murmur sounds like
easily heard
what is Hyperopia?
farsightedness-can see far but not close
The nurse is gathering subjective and objective data from a client with a diagnosis of suspected rheumatoid arthritis (RA). The nurse would expect to note which early signs and symptoms of RA? Select all that apply. 1.Fatigue 2.Weight gain 3.Restlessness 4.Morning stiffness 5.Pain with movement only
fatigue, morning stiffness
A client is admitted to the hospital emergency department after receiving a burn injury in a house fire. The skin on the client's trunk is tan, dry, and hard. It is edematous but not very painful. The nurse determines that this client's burn should be classified as which type?
full thickness
After a bronchoscopy absence of ____ ______ is normal for 2 hours post op
gag reflex
What are the adrenal cortex hormones
glucocorticoids, mineralocorticoids, sex hormones
In type 1 diabetes the cells are starved of _______ since there is no ______ to bring it to the cells
glucose; insulin
onset for type 2 diabetes is
gradual
calcium channel blockers + _________ _____ = severe hypotension
grapefruit juice
What foods are rich in vitamin K?
green, leafy veggies and liver
What is pediculosis capitis?
head lice
BNP is ___ in HF
high
After a patient takes a single puff from their MDI, what should they do?
hold it for 10 seconds rinse mouth out with water to remove any leftover medication and spit out water to ensure medication is not swallowed
Side effects of spironolactone
hyperkalemia, diarrhea, gastritis, drowsiness, erectile dysfunction, gynecomastia
Tumor lysis syndrome is a emergency that causes
hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia
Purpose of spironolactone
hypertension, edema, hypokalemia, hyperaldosteronism, cross sex hormonal therapy, spironolactone inhibits testosterone
Endocrine glands 8
hypothalamus; pancreas; pituitary; adreanal; thyroid; ovaries; parathyroid; testes
S/S of a thyroid storm
increased temp; tachycardia; hypertension; nausea/vomiting/diarrhea; agitation/anxiety; delirium/seizures or coma
Oseltamivir (Tamiflu) can be given to clients with symptoms of ______ within the last 48-72 hours
influenza
Action of thiazide diuretics
inhibit reabsorption of NA+ and Cl-; excretion of Na+, Cl- and H20
Action of loop diuretics
inhibit reabsorption of Sodium and Chloride, acts on 3 sites to increase reabsorption
Treatment for malignant hyperthermia
initiate IV dantrolene ASAP; cool the client and treat high potassium levels;
Theophylline is what type of med and what is it used for
it is a methylxanthine, used for long term control of chronic asthma
Azathioprine is contraindicated if _______is present
leukopenia
What is malignant hyperthermia?
life threatening hypermetabolic condition triggered by certain drugs used for general anesthesia
adrenalectomy requires
lifelong glucocorticoid replacement
what is bumetanide?
loop diuretic
Ejection Fraction is ___ in most types of HF
low
Serotonin syndrome is characterized by
mental status change; autonomic dysregulation; neuromuscular hyperactivity
pain assessment scale for ages 5 years and older
numeric scale
Treatment for hyperparathyroidism
parathyroidectomy; administer phosphates, calcitonin and IV oral biphosphonates;
interventions for a thyroid storm
patent airway; non salicylate antipyretics; anti thyroid medications; cooling blanket
liver cirrhosis leads to
portal hypertension and splenomegaly
Digoxin and ________ levels should be assessed with the administration of Digoxin
potassium
Addisonian crisis S/S
profound fatigue; dehydration...shock!; renal failure; vascular collapse; hyponatremia; hyperkalemia
Second degree AV block looks like
progressive lengthening of PR interval until QRS is dropped (long long drop now you got a Wenckebach)
Adolescents (12 to 18 years): Theorist Freud, type of development and stage
psychosocial genital
Why do you push furosemide slowly
rapid administration can cause permanent hearing loss
How should high doses of furosemide be administered and why?
slowly to prevent ototoxicity
What is indicated for someone with dumping syndrom?
small frequent meals consumption of protein and fat at each meal-avoid concentrated sugars restrict lactose intake Consume liquids 1 hr before or after eating instead of with meals
What is the major electrolyte in extracellular fluid?
sodium
bicarbonate replacement therapy
sodium bicarbonate
Medications for hypertensive crisis
sodium nitroprusside labetalol diazoxide fenoldopam trimethaphan
What is the K+ sparing diuretic
spironolactone
Baseline liver enzymes are obtained for clients taking _____ and _____
statins and isoniazid (for TB)
post cardiac catheterization how should the client be positioned and for how long?
supine with affected extremity flat for 2-6 hours
cardiac afterload is clinically measured by
systolic blood pressure
Trachea deviation from midline is a sign of
tension pneumothorax
Parathyroid hormone (PTH) controls what
the levels of calcium in the blood
PR interval is what
the movement of electrical activity from atria to ventricles
What is the SVR
the resistance it takes to push blood through the circulatory system to create blood flow
When someone is AV paced (atrioventricular) where are the pacemaker spikes on an EKG?
there is one prior to the P wave and the second prior to the QRS complex
Why are NSAIDs contraindicated in patients with HF?
they contribute to sodium retention
In a patient with a pleural effusion what should the nurse anticiapte?
thoracentesis
what is chlorpromazine used for
to control shivering in a hyperthermic state
What are HMG CoA reductase inhibitors (statins) used for
to treat primary hypercholesterolemia, for prevention of coronary events, for protection against MI and stroke for clients with diabetes, and to help increase HDL levels in clients with primary hypercholesterolemia
Hyperthyroidism S/S (too much thyroid hormone gives you ENERGY)
too much energy; nervous; irritable; attention span; increased appetite; weight loss; hot; exopthalmos (bulging eyes); enlarged thyroid; goiter; increased BP and pulse
What is the name for a polymorphic ventricular tachycardia
torsades de point
TEF stands for
transesophageal fistula
Drugs in the ACE inhibitor class are used for
treating heart failure, hypertension, MI, diabetic or non diabetic nephropathy
If a clients MAP falls below 65 what are you worried about
underperfusion
Babinkski sign can indicate
upper motor neuron lesion
In individuals affected with gout, the body either produces too much ____ _____ or is unable to excrete enough ____ ____ and it builds up
uric acid
allopurinol prevents what
uric acid production
Levofloxacin is a fluoroquinolone antibiotic prescribed for
urinary tract infections
Uses for Azathioprine
used to prevent organ rejection in people who have received a kidney transplant, also used to treat rheumatoid arthritis. This is an immunosuppressant.
Gynomastia is irreversible or reversible?
usually reversible after spironolactone therapy has stoppped
_________ is usually administered for 3-6 months following PE to prevent further thrombus formation
warfarin
Systolic HF is
weakened heart muscle, the ventricle does not EJECT properly
-statins should be taken
with evening meals or at bed time
How is an unstable ( hypotensive) patient in ventricular tachycardia with a pulse, treated?
with synchronized cardioversion
Is levothyroxine safe during pregnancy?
yes
Drugs for all types of seizures except petit mal-CaPhe mnemonic
CArbamazepine; PHEnytoin/phenobarbital
BNP is a good indicator of what?
CHF
If an infant is grunting during feeding we should be concerned about ?
CHF
Thrombolytic Agents are? (ghostbusters hint)
CLOT BUSTERS! they work quickly to restore circulation, as such they increase risk for bleeding
Memory trick: CO ZY RE D stands for what
CO (contract) ZY (systole) RE (relax) D (diastole)
Replacement therapy for calcium
Calcium citrate Calcium carbonate or calcium acetate
What should be on hand to counteract toxicity when giving magnesium sulfate via IV?
Calcium gluconate
A client admitted to the hospital is taking capecitabine for breast cancer. The nurse should monitor the client for which symptom that is a side or adverse effect of the medication? 1.Dyspnea 2.Dizziness 3.Headache 4.Constipation
Dyspnea
Pneumonic for Left Sided HF..... DROWNING.... means what
Dyspnea, Rales, Orthopnea, Weakness, Nocturnal paroxysmal dyspnea, Increased HR, Nagging cough (frothy, blood tinged sputum), Gaining weight (2-3lbs a day)
Side effects of osmotic diuretic
Edema, blurred vision, nausea vomiting diarrhea, urinary retention
What is expected in SLE (systemic lupus erythematosus) especially during a flare up?
Elevated ESR, Mild leukopenia, thrombocytopenia, butterlfy rash across nose and cheeks,
Urine specific gravity measures
Elevated levels of urea and other nitrogen compounds in the blood.
A postpartum client is diagnosed with cystitis. The nurse should plan for which priority action in the care of the client? 1.Providing sitz baths 2.Encouraging fluid intake 3.Placing ice on the perineum 4.Monitoring hemoglobin and hematocrit levels
Encouraging fluid intake
What med is given during a thyroid storm to reduce the synthesis of the thyroid hormone?
Lugol solution
Left sided heart failure is associated with (L)
Lungs
SSRIs cannot be paired with what? As there is risk of serotonin syndrome
MAOIs
Contact precautions mnemonic- MRS WEE
MRSA RSV Skin infections Wound infections Enteric infections (C diff) Eye infections
Magnesium replacement therapy consists of
Magnesium sulfate Magnesium gluconate or magnesium hydroxide
-triptan Examples; drug class; important things to know
almotriptan; eletriptan; rizatriptan; sumatriptan; antimigraine; selective 5-HT receptor agonist sumatriptan is contraindicated in clients with coronary artery disease and uncontrolled hypertension
-setron Examples; drug class; special things to remember
alosetron; dolasetron; ondanestron Antiemetic and antinauseant May cause seritonin syndrome
-phylline Examples; drug class; special things to remember
aminophylline; dyphylline; oxitriphylline; theophylline xanthine derivative (bronchodilator) it can cause seizures and life threatening arrhythmias; signs of toxicity: headache, insomnia, nausea, vomiting; cimetidine and ciprofloxacin can dramatically increase serum theophylline levels, and should not be used in these clients
-tyline Examples; drug class; important things to know
amitriptyline; nortriptyline; protriptyline tricyclic antidepressant; has neuropathic pain relieving effects anticholinergic effects
-pine Examples; drug class; special things to remember
amlodapine; felodipine; nifedipine calcium channel blocker no grapefruit juice (causes severe hypotension), side effects are dizziness, flushing, headache, peripheral edema and constipation
stroke volume is what
amount of blood pumped out of the ventricle with each beat or contraction
What is a thyroid storm
an acute life threatening emergency with uncontrollable hyperthyroidism
autonomic dysreflexia is what
an acute life threatening response to noxious stimuli (bladder distention, tight clothing) in clients with spinal cord injuries above T6
Sjogrens syndrome is
an autoimmune disease that cause dry eyes and mouth. Use artificial tears, vaginal lubricant. frequent dental exams, lukewarm showers with mild soap and avoid decongestants
Type 1 diabetes is caused by
an autoimmune response
Clients with any form of prosthetic material in their heart valves or who have unrepaired cyanotic congenital heart defects or a prior history of Innefective endocarditis should take what prior to dental procedures?
antibiotics
Atropine is a __________ agent
anticholinergic
what is foscarnet and what do you need to monitor in patients receiving it?
antiviral med that is very toxic to the kidneys; serum creatinine level is monitored 2-3 times weekly
priority action when you have a patient with a sucking chest wound
apply a sterile occlusive dressing taped on 3 sides (petroleum gauze)
When using the nursing process always remember to _____ first
assess
How do female, elderly, and diabetic patients present differently for a myocardial infarction
associated symptoms with no chest pain (diaphoresis, nausea, fatigue, dyspnea, epigastric burning or gas)
Defribrillation is not effective for the treatment of...
asystole or PEA (pulseless electrical activity)
When giving insulin in the abdomen where should it be given
at least 2 inches away from the belly button
-olol Examples; drug class; special things to remember
atenolol; metoprolol; nadolol; propranolol beta blocker can worsen bronchoconstriction; bad with asthma, only good in CHRONIC HF; side effects: bradycardia, bronchospasm, hypertension, depression, impotence
common statin medications
atorvastatin simvistatin lovastatin pravastatin
In PQRST (ecg) the P is what
atrial contraction; DE-polarization; DE-compressing
grade 6 murmur sounds like
audible without the stethoscope directly on the chest wall
prefix -afil. examples; drug class; important things to know
avanafil; sildenafil; tadalafil; phospho-diesterase inhibitor (PDE) no grapefruit juice; cannot take with nitro!
nitroglycerin needs to be stored...
away from light and heat
-mycin -micin Examples; drug class; special things to remember
azithromycin; clarithromycin; clindamycin; erythromycin antibiotic; antibacterial therapeutic range of vanco is 10-20 mg/L; creatinine levels should be monitored, nephrotoxicity and ototoxicity biggest complications; infuse over at least 60 minutes, draw trough levels prior if given IV, can cause prolonged QT interval
Common sites for insulin administration
back of arms; thighs; abdomen;
Left sided heart failure causes fluid to...
back up into the lungs=pulmonary symptoms
Grade 1 murmur sounds like
barely audible
-pril Examples; drug class; special things to remember
benazepril; captopril; enalapril; lisinopril; moexipril ACE inhibitor drugs of choice in diabetic clients with hypertension or proteinuria common side effect is cough, contraindicated during pregnancy, monitor kidney function
two most common classes of bronchodilators are
beta 2 adrenergicagonists; methylxanthines
Treatment for A Fib
beta blockers; calcium channel blockers; digoxin; amiodarone; anticoagulant therapy to prevent clots; Cardioversion
prefix's : -one cort- -onide pred- examples; drug class; important things to know
betamethasone; dexamethasone; clocortolone; fludrocortisone; hydrocortisone; budesonide; desonide; corticosteroid side effect: hyperglycemia, worsen HTN, assess for infection
Normal ranges of pulse pressure
between 40 and 60 mm Hg
ACE inhibitors do what
block the production of angiotensin II which results in vasodilation, sodium and water excretion, and potassium retention
What is polycythemia vera?
bone marrow produced too many RBCs
Hypervolemia signs and symptoms
bounding pulse SOB dyspnea rales/crackles peripheral edema HTN Urine specific gravity <1.010 (low) Place patient in semi fowlers
The ____ artery is used to detect a pulse in an unresponsive client age <1 year
brachial
Nulliparity is a risk factor for....
breast cancer
-fenac -profen Examples; drug class; special things to remember
bromfenac; diclofenac; nepafenac fenoprofen; ibuprofen; ketoprofen (naproxen/ketorolac as well) NSAID should be avoided in those with kidney disease; decreases the effectiveness of diuretics and drugs that control BP; NSAIDS can lead to GI toxicity, kidney injury, hypertension, heart failure and bleeding risk!; Aspirin toxicity can lead to bruising, tinnitus, black tarry stool, hypotension, treat with activated charcoal before sodium bicarb
-iramine Examples; drug class; special things to remember
brompheniramine; chlorpheniramine; pheniramine antihistamine avoid if glaucoma or urinary retention
Methylxanthines cause what
bronchial smooth muscle relaxation resulting in bronchodilation
Nitroprusside may be slightly what color?
brown, however solutions that ae dark blue, red or green should be discarded
-caine Examples; drug class; important things to remember
bupivacaine; lidocaine; mepivacaine local anesthetic signs of toxicity: slurred or difficult speech, altered CNS, muscle twitching, seizures
-sartan Examples; drug class; special things to remember
candesartan; irbesartan; losartan; olmesartan; valsartan angiotensin II receptor antagonist; ARB; recommended for clients unable to tolerate ACE inhibitors contraindicated in prenancy
What would you be worried about with rapidly decreasing chest tube drainage?
cardiac tamponade
Cyloplegics are drugs that
cause paralysis of the ciliary muscle (plegic like paraplegic/paralysis)
Norepinephrine does what to the vessels/heart?
causes vasoconstriction and improves heart contractility/output in hypovolemic shock
-thiazide Examples; drug class; special things to remember
chlorothiazide; hydrochloro-thiazide; methyclothiazide thiazide diuretic consume foods high in potassium, take with food to prevent GI upset, watch weight Good to give with potassium sparing diuretic because it reduces likelihood of hyperkalemia; side effects: hypokalemia, hyponatremia, hyperuricemia, hyperglycemia. interacts with lithium!
-pramine Examples; drug class; special things to remember
clomipramine; desipramine; imipramine; trimipramine tricyclic antidepressant; anticholinergic drugs do not give with St johns wort; side effects: dizziness from orthostatic hypotension, drowsiness, dry mouth, constipation, photosensitivity, urinary retention and blurred vision
Adolescents (12 to 18 years): Theorist Piaget, type of development and stage
cognitive formal operations
Scleroderma is caused by
collagen overproduction
within 24 hours postpartum what should appear?
colostrum
Antineoplastics are used to
combat cancerous cells
occasional PVCs are ____
common
Signs of botulism in pediatrics are
constipation, difficulty feeding, decreased head control, diminished deep tendon reflexes
The presence of an air leak in your clients chest tube is indicated by
continuous bubbling of fluid at the base of the water seal chamber
In clients receiving IV vancomycin, what labs should be closely monitored?
creatinine levels, for signs of nephrotoxicity
-tadine Examples; drug class; (antihistamine)
cyproheptadine; desloratadine; loratadine antihistamine
S/S of hypoparathyroidism
decreased calcium; increased phosphorous; numbness and tingling; muscle cramps; tetany; hypotension; anxiety, irritability and depression; positive trousseaus; chvosteks sign
Signs and symptoms of a pleural effusion
decreased or absent breath sounds decreased tactile fremitus dullness on percussion chest pain during inspiration dyspnea
low Cardiac output = ?
decreased perfusion to the body; decrease LOC; lungs sound wet due to backflow; shortness of breath; skin will be cold and clammy;decrease urinary output
0.45% NS is a hypotonic fluid that _________ circulatory volume ------> use in hypertonic dehydration (e.g., excessive perspiration)
decreases
-cycline Examples; drug class; special things to to remember
demeclocycline; doxycycline; minocycline; tetracycline tetracycline antibiotic teratogenic, should be taken with water, before or after meals, no dairy with it, use additional birth control, photosensitivity
Right side of the heart pumps
deoxygenated blood to the lungs
Common posterior pituitary hormones/antidiuretic hormones
desmopressin; vasopressin
-trel Examples; drug class;
desogestrel; etonogestrel; levonorgestrel female hormone (progestin)
Treatment for CKD
dialysis; kidney transplant
Mydriatics are drugs that
dilate the pupil
Organic nitrates (nitroglycerine) does what
dilates veins and prevents spasms of coronary arteries
______ __________ can occur from fluid volume excess due to reduced renal blood flow
dilutional hyponatremia
Third degree AV block is
disassociation of atrial and ventricular contraction, meaning the P waves are not associated with QRS complexes on EKG
Cushings syndrome is (pneumonic: they "have a cushion")
disorder of the arenal cortex, too many steroids
Prefix: -rubicin Examples; drug class
docorubicin; epirubicin; idarubicin antineoplastic; cytotoxic agent (chemotherapy drugs/anticancer drugs)
serotonin agonists examples (tron to the rescue!)
dolasetron ondanestron (zofran) tropisetron
Newborns ________ their birth weight at 5 to 6 months of age and ______ it by 1 year.
double; triple
grade 4 murmur sounds like
easily heard and associated with a palpable thrill
classic symptoms of nephrotic syndrome
edema, hyperlipidemia, proteinuria
Treatment for PVD
elevate Veins, mediation like aspirin or clopidogrel/cholesterol lowering drugs "statins", surgery such as an angioplasty, CABG, endarterectomy
treatment for cardiac tamponade
emergency pericardiocentesis
A major complication of chronic alcohol abuse is _________, related to...
encephalopathy; poor thiamine absorption
Adrenal medulla hormones
epinephrine and norepinephrine
What can be elevated in a patient with IBD? (inflammatory bowel disease)
erythrocyte sedimentation rate, C reactive protein, white blood cells
-prazole Examples; drug class; special things to remember
esomeprazole; omeprazole; rabeprazole proton pump inhibitor long term effects; decreased bone density, risk of cdiff and pneumonia
When taking bisphosphonates, you should drink extra water and be upright for 30 minutes after, to prevent ________
esophagitis
continuous infusing bag should be changed
every 24 hours
The nurse has been assigned to the care of 4 adult clients who are receiving continuous intravenous (IV) infusions. How often should the nurse plan to check the IV infusions and IV sites of these clients?
every hour
Grade 2 murmur sounds like
faint but immediately audible
S/S of Addisons disease
fatigue; nausea/vomiting/diarrhea; anorexia; hypotension;confusion; decreased sodium and water; increased potassium; hyperpigmentation of the skin; Vitiligo
patho of CAD
fatty plaques develop called atherosclerosis and there is restriction of blood flow to the heart
Hepatitis A is spread through which route
fecal-oral
symptoms associated with hypothyroidism
feeling cold; loss of body hair; persistent lethargy; puffy face
a burn that is dry with blanchable redness; epidermis only is what type of burn?
first degree (superficial)
-nazole Examples; drug class; special things to remember
fluconazole; ketoconazole; miconazole; terconazole antifungal treats vaginal candidiasis
Treatment of HHS
fluid replacement; correction of electrolyte imbalances; possible insulin administration
Elevated CVP (central venous pressure) can indicate what?
fluid volume overload or RIGHT ventricular failure
Management for diverticulitis
focuses on bowel rest, NPO, NG suction, bed rest and drug therapy (IV antibiotics, analgesics)
When taking phenelzine (MAOI) what foods need to be avoided?
foods high in tyramine (aged cheese, cured meats, fermented foods, alcohol, chocolate, avocados)
Why are atrial pacemakers normally placed?
for sinoatrial node dysfunction, such as atrial fibrillation, bradycardia, and heart blocks
-semide Examples; drug class; special things to remember
furosemide; torsemide loop diuretic encourage foods high in potassium; report weight loss, lightheadedness, dizziness, GI distress, watch for orthostatic hypotension, hypokalemia; give slowly when given IV to prevent ototoxicity; the nurse should question the bumetanide prescription as the client with heart failure has hypokalemia and is already at increased risk for life threatening cardiac dysrhythmias
In a child with Kawasaki disease, it is priority to monitor for...
gallop heart rhythm, and decreased urine output- you are monitoring for HF and risk of developing coronary aneurysms
-micin Examples; drug class; special things to remember
gentamicin aminoglycoside monitor kidney function and hearing; muscle cramping may occur with infusion
Adenosine is administered how?
given rapidly over 1-2 seconds
In emergent phase after a burn (first 24-72 hours) what will labs look like?
hematocrit and hemoglobin elevated due to hypovolemia, hyponatremia, hyperkalemia
The two main anticoagulant medications
heparin and coumadin
What type of diet may prevent diverticulitis and diverticulosis?
high fiber
Rapid insulin types
humalog; novolog; apidra
Thiazide diuretics 3 of them
hydochlorothiazide, chlorothiazide, methyclothothiazide
A side effect of corticosteroid therapy is
hyperglycemia
S/S of HHS
hyperglycemia
Purpose of thiazide diuretics
hypertension, heart failure, renal disease, cirrhosis, edema, corticosteroids, estrogen therapy
Purpose of loop diuretics
hypertension, heart failure, renal disease, edema, pulmonary edema
Clients with SIADH often require what repletion to increase serum sodium levels
hypertonic saline
What may indicate hypovolemic shock?
hypotension, tachycardia, and decreased CVP (normal: 2-8 mm Hg)
-ridone Examples; drug class; special things to remember
iloperidone; paliperidone; risperidone atypical antipsychotic benztropine is used in the treatment of extrapyramidal side effects associated with antipsychotic medications; neuroleptic malignant syndrome usually presents with mental status changes, fever, muscle rigidity, and autonomic instability after starting antipsychotic medications; photosensitivity is a side effect
What is hemophilia?
impaired clot formation and increased risk for uncontrollable bleeding
Type 1 diabetes is usually diagnosed when
in childhood
A chest tube is placed where?
in the pleural space
How is symptomatic bradycardia treated?
initially with IV atropine, if ineffective an infusion of dopamine or epinephrine may be considered
During removal of a chest tube what do you do/instruct client to do?
instruct client to perform Valsalva maneuver and cover site with a sterile airtight petroleum jelly gauze/occlusive dressing; post procedural xray after
IV albumin increases ___________ fluid volume and may be used to prevent hypotension associated with paracentesis
intravascular
Epoetin alfa (helps your body make more rbc's) is administered by which route
intravenous or subcutaneous route
What would be the replacement for sodium
isotonic IV therapy of .9%NS or lactated ringer
What can nitroglycerin do to your blood pressure?
it can cause hypotension
amiodarone is used to treat what
it is an antidysrhythmic that is used to treat ventricular dysrhythmias
What does rapid insulin look like
it is clear
5-FU (fluourouracil) is used for
it is one of the oldest chemotherapy drugs and is used against a variety of cancers- WARNING HAZARDOUS DRUG
how does desmopressin work?
it mimicks the effects of naturally occurring ADH which increases renal water absorption and concentrates urine
Common causes of HIGH pressure limit alarm for mechanical ventilator:
kinked tubing water in tubing secretions in tube biting tongue increased airway resistance (bronchospasm, excessive secretions) decreased lung compliance (pneumothorax, atelectasis, pulmonary edema)
What is the fluid of choice for burn injuries, to prevent hypovolemic shock?
lactated ringer
-vudine Examples; drug class;
lamivudine; stavudine; telbivudine; zidovudine antiviral; nucleoside analogues
S4 is what
late diastole and high atrial pressure (forcing blood into a stiff ventricle)
Clients allergic to bananas, apricots, cherries, grapes, kiwis, passion fruit, avocado, and/or peaches may experience an allergy to...
latex
if the EF is 55% the heart is pumping out 55% of whats inside of....
left ventricle
Furosemide can be used to decrease ____ _______ _____ in cardiogenic shock
left ventricular preload
What would be considered a narrow pulse pressure?
less than 440 mm Hg
Signs and symptoms of CKD
lethargy, altered LOC, confusion, seizures, hypertension, Fluid volume excess, heart failure, anorexia, nausea vomiting ,ammonia breath, impaired immune and inflammatory response, anemia, increased risk for bleeding, amenorrhea
clinical manifestations of congenital hypothyroidism in pediatrics
lethargy, enlarged fontanelle, protruding tongue, umbilical hernia, poor feeding, constipation, dry skin, jaundice, hoarse cry, difficult to awaken
Thyroid medications
levothyroxine
When you think "statins" we need to remember to protect...
liver and muscles STAT Monitor liver function tests after 12 weeks and then every 6 months and avoid alcohol risk of myopathy and peripheral neuropathy. CK levels will be monitored periodically
What insulin CANNOT be mixed with any other insulin
long acting
Haloperidol and _______ are commonly administered together to depress the central nervous system and decrease aggressive behaviors
lorazepam
Placentia previa is what
low implantation of the placenta
ischemia =
low o2
What does bicarbonate do for the body?
maintains blood pH to prevent metabolic acidosis
deficiency of B12 can lead to
megaloblastic anemia
Acute glomerulonephritis interventions
monitor daily intake and output; daily weight; fix the cause! (strep); bed rest; diuretics; antihypertensive meds; fluid restrictions; sodium restrictions; decrease in protein; provide a lot of carbs! (stop the breakdown of protein)
what do you need to monitor for when a patient is taking theophylline
monitor serum levels for toxicity (>20mcg/ml)
10 month old client should be able to
move from lying down to sitting position
S/S of cushings syndrome
muscle wasting; moon face; buffalo hump; truncal obesity with thin extremities; weight gain; hirsutism; increased glucose, increased sodium, decreased potassium, decreased calcium, hypertension
-olone Examples; drug class;
nandrolone; oxandrolone; oxymethalone anabolic steroid
What is Myopia?
nearsightedness-reduced visual acuity when viewing objects at a distance
-zodone Examples; drug class; important things to know
nefazodone, trazodone, vilazodone antidepressant
Management for airborne precautions
neg pressure room, private room, mask, n-95 for TB
unstable angina is not relieved by
nitroglycerin
Hypothyroidism S/S (not enough ENERGY)
no energy; fatigue; no expressions; weight gain; cold; amenorrhea; slurred
pain assessment scale used for ages 3-18 years
non communicating childrens pain checklist
peak of long acting insulin
none
Emergency Trauma Assessment (ABCDEFGHI)
o A - airway à clear airway, stabilize cervical spine o B - breathing à give oxygen, prepare to intubate o C - circulation à check pulse, HR, control bleeding o D - disability à check level of consciousness, assess using GCS o E - exposure à remove clothing, prevent heat loss o F - full set of vitals/focused interventions à monitor ECG, place tubes and drains o G - give comfort à assess and treat pain o H - head-to-toe assessment/history à SAMPLE - Signs/Symptoms, Allergies Medications, Past health history, Last meal, Events preceding o I - inspect posterior à logroll & palpate
Warning signs of cancer (CAUTION)
o Change in bowel or bladder habits o A sore that does not heal o Unusual bleeding or discharge from a body orifice o Thickening or a lump in the breast or elsewhere o Indigestion or difficulty in swallowing that does not go away o Obvious change in a wart or mole o Nagging cough or hoarseness
Home interventions to reduce the incidence of tet spells include (Tetralogy of Fallot) :
o Providing a calm environment, particularly on waking o Soothing and quieting the infant when crying or distressed o Offering a pacifier o Swaddling or holding the infant during procedures or times of stress o Providing frequent smaller feedings to reduce frustration due to hunger and limit sucking fatigue
In the case of an air embolism, which is rare, and a life threatening complication of CVC insertion/removal, what would you do?
occlusive dressing, administer oxygen, left Trendelenburg, monitor
Petechiae on African American clients is best detected where?
on the buccal mucosae and the conjuctivae of the eye
When is Type 2 diabetes usually diagnosed
onset is as an adult
What do antiresorptive meds help treat
osteoporosis
pain assessment scale used for 3-13 years of age
oucher
What is Homans sign?
pain in the calf with dorsiflexion
A client has undergone abdominal perineal resection for a bowel tumor. The nurse interprets that the client's colostomy is beginning to function if which sign is noted? 1.Absent bowel sounds 2.The passage of flatus 3.Blood drainage from the colostomy 4.The client's ability to tolerate food
passage of flatus
When doing CPR on a pregnant patient how should it be done?
perform compressions slightly higher on the sternum and displace the uterus to the clients left side (turn client slightly on side)
What is the antidote drug used to treat a norepinephrine extravasation
phentolamine
Gait disturbance (ataxia) is commonly seen with _________ toxicity
phenytoin
Anal itching and disturbed sleep is indicative of what in children?
pinworms
-glitazone Examples; drug class; special things to remember
piogloitazone; rosiglitazone; troglitazone antidiabetic; thiazolidine can worsen HF
Antiplatelets prevent
platelet aggregation= increases clients risk for bleeding
Signs and symptoms of pericarditis
pleuritic chest pain that is sharp and aggravated during inspiration and coughing, ST segment elevation in almost all leads and friction rub is common
Generally speaking, heart failure patients may need which supplement
potassium
Concurrent use with _______ or _______ can cause hyperkalemia
potassium sparing diuretics or ACE inhibitors
NEVER give ______ IV push
potassium. It can cause fatal hyperkalemia
abruptio placenta is what
premature separation of the placenta
What is recommended before suctioning a mechanically ventilated patient?
preoxygenate with 100% oxygen for 30 seconds before
what is the CVP
pressure in the superior vena cava. Shows how much pressure from the blood is returned to the right atrium from the superior vena cava
Biphosphonates are a class of drugs that do what
prevent the loss of bone density, used to treat osteoporosis and similar disease
Biphosphonates do what
prevent the loss of bone mass
Management for droplet precautions
private room, mask
Angiotensin II receptor blockers (ARBS) do what
produce vasodilation by blocking the action of the angiotensin II
To compensate for chronically low oxygen levels in a client with COPD, the body does what.
produces more RBCs to carry needed oxygen to cells which leads to polycythemia and NO supplemental iron
What is an expected adverse effect of using beta blocker drugs for a first degree AV Block? (EKG)
prolonged PR interval
Dopamine agonists examples
promethazine compazine metoclopramide (reglan)
Glucocorticoids and NSAIDs do what in the treatment of RA
provide symptom relief from inflammation and pain
Toddler (12 months to 3 years) Erickson theorist, type of development and stage
psychosocial Autonomy vs shame
Pre-schooler (3 to 5 years): Theorist Erickson, type of development and stage
psychosocial Initiative vs guilt
School-aged (5 to 12 years): Theorist Erickson, type of development and stage
psychosocial industry vs inferiority
School-aged (5 to 12 years): Theorist Freud, type of development and stage
psychosocial latency
Infant (birth to 1 year) Freud theorist, type of development and stage
psychosocial oral
Infant (birth to 1 year) Erickson theorist, type of development and stage
psychosocial trust vs mistrust
A client diagnosed with thrombophlebitis 1 day ago suddenly complains of chest pain and shortness of breath and is visibly anxious. Which complication should the nurse immediately assess the client for? 1.Pneumonia 2.Pulmonary edema 3.Pulmonary embolism 4.Myocardial infarction
pulmonary embolism
upper tract UTI is called
pylonephritis
Signs of HF in children
rapid breathing rate, rapid heart rate at rest, dyspnea, activity intolerance (especially during feeding in infants), pale, cool extremities; weight gain, reduction in wet diapers, puffiness around the eyes
drug therapy for glaucoma is directed at
reducing elevated IOP (intraoccular pressure)
Treatment for pericarditis
relieve pain by putting patient in Fowlers position, NSAIDs+colchicine
scleroderma can lead to
renal crisis which causes malignant hyperthermia
Excessive alcohol ingestion + benzodiazepines ---->
respiratory acidosis
A serious complication of statins is
rhabdomyolysis
Streptokinase (Streptase) needs to be given when
right away!! must be administered within 4-6 hours of onset of symptoms
What medication is used to slow progression of ALS?
riluzole
Lab values of significance in TLS include
rising blood uric acid, potassium, and phosphate levels with decreasing calcium levels
"worst headache of my life" could indicate what?
ruptured cerebral aneurysm
-gliptin Examples; drug class;
saxagliptin; linagliptin; sitagliptin antidiabetic; inhibitor of the DPP-4 enzyme
Implement ______ precautions during calcium administration
seizure
What is phenytoin used for?
seizures
Droplet mnemonic- SPIDERMAn
sepsis scarlet fever strep pertussis pneumonia parvovirus influenza Diphtheria Epiglottis Rubella Mumps Adenovirus
Nephrotic syndrome results in
serum proteins leaking into the urine
Fosamax has been associated with
severe esophagitis and ulcers of the esophagus
a 7 month old client should be able to
sit with minimal support and bear their full weight while standing with caregiver support
DMARDs do what
slow joint degeneration and progression of rheumatoid arthritis
-lactone Examples; drug class; special things to remember
spironolactone potassium sparing diuretic initiate cardiac monitoring for serum potassium great than 5, do not give with K+ supplement, teach to avoid salt subs that have K+, maintain adequate fluids
diastolic HF is
stiff and non compliant heart muscle, the ventricle does not FILL properly
Nephrolithiasis is
stones in kidneys
ureterolithiasis is what
stones in the ureter
If a chest tube disconnects from chest drainage system and cannot be reattached quickly, what do you do?
submerge the distal end of the chest tube 1-2 in below the surface of a 250mL bottle of sterile water or saline solution
sulfa- Examples; drug class; special things to remember
sulfacetamide; sulfadiazine; sulfamethoxazole; sulfasalazine antibiotic; anti-infective; anti-inflammatory yellow orange discoloration of the clients skin and urine is an expected side effect; dehydration is a concern due to risk of crystal formation in kidney; also cause photosensitivity, folic acid deficiency, steven johnson syndrome (stop taking immediately if any rash occurs)
Signs and symptoms of a Left to right shunt (pediatrics)
tachypnea/tachycardia, diaphoresis, heart murmur, signs of CHF, poor weight gain
Treatment for 3rd degree AV block
temporary or permanent pacing is necessary
Bronchodilators are used to treat
the SYMPTOMS of asthma that result from inflammation of the bronchial passages, but they do not treat the inflammation
Calcium channel blockers cafuse vasodilation as a result of...
the blocking of calcium channels in blood vessels
Type 2 diabetes what is happening in the body
the body does not produce enough insulin or produces "bad" insulin that does not work properly
S1 (LUB) is what
the tricuspid and mitral valve closure
Anti parkinson or antiparkinsonian medications, work how?
they increase dopamine activity or reduce acetylcholine activity in the brain. They do not halt the progression of the disease they offer symptomatic relief
How do the meds for hypertensive crisis work?
they provide direct vasodilation of veins and arteries and rapid reduction of BP
______ diuretics are good to give with potassium sparing diuretics because it reduces the likelihood of ______
thiazide; hyperkalemia
Hirschsprung disease in infants signs and symptoms
thin, ribbon like stools, bilious vomiting, foul smelling, diarrhea, abdominal distention, failure to pass meconium
splenomegaly leads to
thrombocytopenia
What should be done before a radioactive iodine uptake test?
thyroid meds should be help 5-7 days before, pregnancy test performed, NPO 2-4 hours prior, remove dentures and jewelry/metal around the neck, drink plenty of fluids after
ST segment is
time between ventricular depolarization and repolarization (ventricular contraction)
QT interval is
time it takes for ventricles to depolarize, contract, and repolarize
Common uses of antagonists
treatment of opioid overdose, reversal of effects of opioids (Naloxone)
What should you try before giving adenosine?
vagal maneuver
What is a fistula
vascular access for HD where they join an artery to a vein
Posterior pituitary hormones/anti diuretic hormone causes what
vaso constriction due to the contraction of the vascular smooth muscle
during the QRS what is happening
ventricle contraction; DE polarization; DE compressing
T wave is what
ventricles; RE-laxing; RE-polarizing; RE-filling with blood
Symptoms of menieres disease
vertigo tinnitus nausea vomiting dizziness
12 month old clients should be able to
walk first steps independently crawl up stairs uses 2 finger pincer grasp hits two objects together says 3-5 words uses non verbal gestures searches for hidden objects may have separation anxiety
18 month old client should be able to
walk up/down stairs with help throws a ball overhand jump in place builds a tower of 3-4 blocks turns 2-3 pages at a time scribbles uses cup and spoon 10+ word vocabulary identifies common objects temper tantrums understands ownership imitates others
3 year old client should be able to
walk upstairs while alternating feet pedals a tricycle jumps forward draws circle feeds self grips crayon with fingers instead of fist 3-4 word sentences asks why questions states own age begins associative play toilet trained except wiping
What is something you need to prioritize as a nurse with a patient who has catatonic schizophrenia?
watch for fluid volume deficit
Syndrome of inappropriate antidiuretic hormone (SIADH) secretion results in
water retention and dilutional hyponatremia
Peripheral Arterial Disease (think bAd) is where
there is a narrow artery where oxygenated blood cannot get to the distal extremities. Ischemia and necrosis of extremities
grade 5 murmur sounds like
very loud, heard with a stethoscope lightly on chest
Complication of Type 2 Diabetes
Hyperosmolar hyperglycemic state (HHS)
Most antibiotics will increase what lab value
INR by causing vitamin K deficiency
-dronate Examples; drug class; special things to remember
alendronate; etidronate; ibandronate biphosphonate; bone resorption inhibitor Drink extra water and be upright for 30 mins after taking
-floxacin Examples; drug class; special things to remember
besifloxacin; ciprofloxacin; levofloxacin; fluoroquinolone antibiotic (treat UTI) can increase theophylline levels so do not use concurrently
best GCS score and worst
best 15; worst is 3
what should the nurse implement pre electroconvulsive therapy?
blood tests and an electrocardiogram
In a client with heart failure related fluid overload, what will you assess first?
breath sounds
What do you immediately report to HCP while taking care of a bronchoscopy patient post op?
bright red blood (blood tinged sputum is normal)
Right Sided HF is
fluid backing up into the venous system
0.9% NS or lactated ringers are isotonic fluids that _______ circulatory volume ----> used in hypovolemic shock
increase
Action of mannitol
increase the thickness of the filtrate so water cannot be absorbed; excretion of Na+ and Cl-
BNP is secreted when there is ___ pressure in the ventricle
increased
S/S of pheochromocytoma
increased BP; increased HR; palpitations; tremors; flushing/diaphoretic; headache; pain in the chest or abdomen; hyperglycemia
S/S of HYPERparathyroidism
increased Calcium; decreased phosphorous; fatigue and muscle weakness; skeletal pain; pathological fractures from the bone deformities; kidney stones; weight loss/anorexia; constipation; hypertension; cardiac dysrhythmias
bradycardia in an infant can be a sign of
increased ICP
Symptoms of hypovolemia
increased temp rapid/weak pulse increase respirations hypotension anxiety Urine specific gravity >1.030 (high)
Ventricular paced rhythms have a pacer spike where?
just before the QRS complex
The nurse is caring for a client diagnosed with tuberculosis (TB). Which assessments, if made by the nurse, are consistent with the usual clinical presentation of TB? Select all that apply. 1.Cough 2.Dyspnea 3.Weight gain 4.High-grade fever 5.Chills and night sweats
cough, dyspnea, high grade fever
Lower tract UTI is called
cystitis or urethritis
Treatment of UTIs
hydration, antibiotics, phenazopyridine
The nurse is instructing a client who is taking levothyroxine and tells the client that full therapeutic benefits will be seen when? 1.Immediately 2.In 1 to 3 weeks 3.Within 24 hours 4.Within 3 to 5 days
in 1-3 weeks
Findings indicative of multiple myeloma are
increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level.
BUN is what
normal waste product resulting from breakdown of proteins. high levels can indicate a problem and be toxic to the body
A client in her second trimester of pregnancy is seen at the health care clinic. The nurse collects data from the client and notes that the fetal heart rate is 90 beats/minute. Which nursing action is appropriate?
notify pcp because it is bradycardia
intradermal injection should be given at what angle
15 degree angle
What is a normal MAP
70-105
PaO2 values
75-100
Duration of intermediate acting insulin
8-24 hours
Systemic vascular resistance (SVR) values
800-1200 dynes/sec/cm
What is the treatment for a client that is symptomatic with a 2nd degree AV block?
Atropine and temporary pacing
The generic names of ACE inhibitors end in...
"pril" Captopril enalapril lisinopril
PR interval
.12-.2
uric acid values
.18-.48
ionized calcium values
1.03-1.23
urea values
1.2-3
When should the lab have the peak level specimen drawn for a peak vancomycin level?
1.5 hours after completion of the scheduled infusion
Magnesium values
1.5-2
posterior fontanelle fuses by age
2 months
IV hydromorphone is administered over
2-3 mins
peak of short acting insulin
2-4 hrs
CVP values
2-8 mmHg
bleeding time values
2-9 min
An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period? 1.Test the urine for protein. 2.Reposition the infant frequently. 3.Provide a stimulating environment. 4.Assess blood pressure every 15 minutes.
2. reposition the infant frequently
The nurse is conducting a health screening clinic and is preparing to test the visual acuity of a client using a Snellen chart. The nurse educates the client about the procedure. Which statement by the client indicates that the teaching has been effective? 1."Stand 10 ft (3 meters) from the chart and cover 1 eye." 2."Stand 20 ft (6 meters) from the chart and cover 1 eye." 3."Stand 30 ft (9 meters) from the chart and read the largest line on the chart." 4."Stand 40 ft (12 meters) from the chart and read the largest line on the chart."
2."Stand 20 ft (6 meters) from the chart and cover 1 eye."
Cardiac index values
2.5-4 L/min/m2
hematocrit values
40%-52%
What is pheochromocytoma?
A rare condition characterized by an adrenal medulla tumor that produces excessive catecholamines (epinephrine, norepinephrine)
A burn where both the epidermis and dermis are damaged, and there are blisters and shiny fluid filled vesicles, would be classified as?
A second degree (partial thickness burn)
Do not give muscle relaxants with presence of...
hepatic disease
What type of meds are contraindicated during pregnancy?
ACE inhibitors (-pril) ; ARBs (-sartan)
Sodium nitroprusside is a medication used in the management of
ACUTE decompensated heart failure, ACUTE hypertension
What drugs can worsen CO2 retention in a COPD exacerbation?
AVOID morphine and benzodiazepines
Pneumonic ARTS for peripheral arterial disease stands for
Absent pulses, Round red sores, Toes and feet pale or black, Sharp calf pain. GANGRENE may develop
A client is taking lansoprazole. The nurse anticipates that the primary health care provider will advise the client to take which product if needed for a headache? 1.Naproxen 2.Ibuprofen 3.Acetaminophen 4.Acetylsalicylic acid
Acetaminophen
What is the antidote for acetaminophen
Acetylcysteine (Mucomyst)
Clients Who Require Dialysis: AEIOU (The Vowels)
Acid base imbalance Electrolyte imbalances Intoxication Overload of fluids Uremic symptoms
A client who suffered a severe head injury has had vigorous treatment to control cerebral edema. Brain death has been determined. The nurse prepares to carry out which measure to maintain viability of the kidneys before organ donation?
Administering IV fluids
Treatment for Cushings disease
Adrenalectomy, avoid infection, administer chemotherapeutic agents if adrenal tumor is present
What does the term "vasodilators" refer to
drugs that improve oxygenation of tissues by dilating or opening up the body's vascular system
When should all women be able to report feeling the fetus move?
After 20 weeks
A client has a prescription for magnesium citrate to prevent constipation after undergoing barium studies of the gastrointestinal tract. How should the nurse administer the magnesium citrate? 1.With fruit juice only 2.At room temperature 3.With a full glass of water 4.After it is chilled in the refrigerator
After it is chilled in the refrigerator
Shortness of breath causes mnemonic - 4A's+4P's
Airway obstruction Angina Anxiety Asthma Pneumonia Pneumothorax Pulmonary Edema Pulmonary embolus
Complications of using iodine contrast for a cardiac catheterization
Allergic reaction (shellfish) contrast nephropathy (creatinine >1.3 mg/dL should not receive contrast unless absolutely necessary) Lactic acidosis (metformin should be discontinued 4-48 hours prior)
Teach client with gout to avoid the following
Anchovies Sardine in oil fish roe herring yeast organ meats
Anti- parkinsonian drugs include- A Cat Does Like Milk
Anticholinergic agents COMT inhibitors; an enzyme involved in degrading neurotransmitters Dopamine Agonists Levodopa MAO-B inhibitors
What is an antiresorptive med
Antiresorptive medications are designed to slow bone removal and/or improve bone mass
Heart sounds mnemonic- All People Enjoy the Movies
Aortic Pulmonic Erbs point Tricuspid Mitral
Antiplatelet meds to know
Aspirin Plavix Pentoxifylline
Which is the primary goal of crisis intervention therapy? 1.Introduce new, effective coping methods to the client. 2.Assess the client to identify the causative stressors. 3.Establish a sustainable therapeutic nurse-client relationship. 4.Assist the client in returning to the level of pre crisis functioning
Assist the client in returning to the level of pre crisis functioning
PPI's are well tolerated by most clients but can cause what if taken too long?
B-12 deficiency
S3 is what
early diastole in rapid ventricle filling
on an ECG, if someone has an Atrial Pacemaker, where will the pacer spike be?
BEFORE the P wave, followed by the QRS complex
Treatment for a patient that is in Ventricular Fibrillation
CPR, defribrillation, epinephrine, vasopressin, amiodarone
what lab would a nurse monitor for a patient on phenytoin?
CBC
Cane walking mnemonic- COAL
Cane Opposite Affected Leg
What is the one ACE inhibitor affected by food
Captopril; this med should be taken at least 1 hour before meals
School-aged (5 to 12 years): Theorist Piaget, type of development and stage
Cognitive Concrete operations
Infant (birth to 1 year) Piaget theorist, type of development and stage
Cognitive Sensorimotor
Pre-schooler (3 to 5 years): Theorist Piaget, type of development and stage
Cognitive preoperational
Hypocalcemia signs and symptoms mnemonic- CATS
Convulsions Arrhythmias Tetany Stridor and spasms
4Cs of TEF
Coughing Choking Cyanosis Continuous drooling
COUMADIN mnemonic
Coumadin interferes with coagulation factors by antagonizing vitamin K Oral administration is typically used Use is contraindicated in clients with low platelet counts or uncontrolled bleeding Mephyton (vitamin K) is the antidote for coumadin Advise clients to avoid food high in vitamin K Doses are typically once daily INR and PT are monitored for clients on coumadin No coumadin for pregnant women!
Cleft lip pneumonic for post op care (CLEFTLIP)
Crying, minimize Logan bow Elbow restraints Feed with Brecht feeder Teach feeding techniques; two months of age (average age at repair) Liquid (sterile water), rinse after feeding Impaired feeding (no sucking) Position-never on abdomen
In a client with pancreatitis you will see positive ____ and ____ signs
Cullen's and Turner's signs
What is the most common community aquired UTI?
Cystitis
hypotonic fluids
D5W 0.45% NaCl
complication of type 1 diabetes
DKA
What medications help treat Rheumatoid Arthritis
DMARDs, glucocorticoids, and NSAIDs
What is the action of Proton Pump Inhibitors
Decrease stomach acid by inhibiting those gastric proton pumps that make the acid-they stop the acid at the pump!
Side effects of Thiazide diuretic
Decreased hypokalemia, decreased hypotension, decreased hyponatremia, decreased libido, increased hyperglycemia, increased photosensitivity, dehydration, azotemia
Treat pancreatitis with which pain medication?
Demerol! NO morphine! (morphine causes spasm of the sphincter of oddi)
Treatment for type 2 diabetes
Diet and exercise; oral hypoglycemia agents (metformin); possibly insulin
Antidote for Digoxin/digitoxin
Digoxin immune Fab (Digibind)
Epiglottitis 3D's
Drooling Dysphonia Dysphagia
Before a CT scan the nurse needs to
assess for allergies
What food must be avoided when taking MAOI's?
Food high in Tyramines
Theophylline toxicity looks like...
GI distress and restlessness dysrhythmias and seizures
Complication of severe preeclampsia mnemonic (HELLP)
Hemolysis Elevated Liver enzymes Low Platelet count
What is the most common form of congenital heart defect?
Left to right shunt
Hyperthyroidism means ___TSH and ____ T3 and T4
Low; High
Osmotic Diuretic (1)
Mannitol
Toddler (12 months to 3 years) Freud theorist, type of development and stage
Psychosocial Anal
Adolescents (12 to 18 years): Theorist Erickson, type of development and stage
Psychosocial Identify vs role confusion
Right sided heart failure is associated with (R)
Rest of body
Early signs of hypoxia- RAT
Restlessness anxiety tachycardia/tachypnea
What is a normal BNP?
<100 pg/mL
The target blood pressure for a client with diabetes is what
<140/90 mm Hg
a weight gain of 1kg is equal to _____ mL of retained fluid
1,000 mL
onset of intermediate acting insulin
1-2 hours
onset of long acting insulin
1-2 hours
The nurse is caring for a pediatric client who just arrived at the emergency department with an extremity fracture. The nurse uses the 5 "Ps" to assess the extent of the client's injury. What are some of the 5 "Ps"? Select all that apply. 1.Pallor 2.Pain and point of tenderness 3.Paralysis distal to the fracture site 4.Pulses proximal to the fracture site 5.Sensation distal to the fracture site
1.Pallor 2.Pain and point of tenderness 3.Paralysis distal to the fracture site 5.Sensation distal to the fracture site
Free T4 values
10-20
5 areas of auscultating the heart ( All People Enjoy Time Magazine)
Aortic; Pulmonic; ERBs point; Tricuspid; Mitral
Standard testing for visual acuity is at _____ ft. However for children it is a recommended ___ ft.
20 feet; 10 feet
aPTT values
20-40 sec
Suction above ____ cm H20 is generally not indicated when dealing with a chest tube
20cm
bicarb values HcO3
22-26
symptoms of hypothyroidism typically begin to improve approximately ___-____ weeks after initiating levothyroxine?
3-4 weeks. Full therapeutic may take up to 8 weeks
Duration of rapid acting insulin
3-5 hours
The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL (3.4 mmol/L)? Select all that apply. 1.Administer regular insulin. 2.Encourage the child to ambulate. 3.Give the child a teaspoon of honey. 4.Provide electrolyte replacement therapy intravenously. 5.Wait 30 minutes and confirm the blood glucose reading. 6.Prepare to administer glucagon subcutaneously if unconsciousness occurs.
3. Give the child a teaspoon of honey 6. Prepare to administer glucagon subcutaneously if unconsciousness occurs
The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. Which statement by the student indicates an understanding of the ductus venosus? 1."It connects the pulmonary artery to the aorta." 2."It is an opening between the right and left atria." 3."It connects the umbilical vein to the inferior vena cava." 4."It connects the umbilical artery to the inferior vena cava."
3. It connects the umbilical vein to the inferior vena cava
RNs DO NOT delegate what they can EAT
Evaluate Assess Teach
WBC values
4-10x
peak of intermediate acting insulin
4-12 hours
Second line of medication for gout (hint: gout is in the med name)
Colchicine (Colgout)
How do you treat Kawasaki disease
IVIG and aspirin
A burn that involves fascia muscle, and/or bone tissue. Would be classified as what type of burn?
Fourth degree (full thickness)
Troponin levels
Less than 0.5 ng/mL
troponin values
0-0.4
Free T3 values
0.2-0.5
The optimal therapeutic range for digoxin is
0.5 to 2.0 ng/mL
TSH values
0.5-5
creatinine values
0.8-1.3
INR values
0.9-1.2
-dazole Examples; drug class; special things to remember
albendazole; metronidazole; tinidazole anthelmintic; antibiotic; antibacterial metallic taste in mouth, treats Cdiff and trichomoniasis
What is Fifth Disease?
a viral illness caused by human parvovirus, that affects mainly school age children
-zosin Examples; drug class; Important things to know
aFDA1fuzosin; doxazosin; prazosin; terazosin alpha blocker; treats BPH orthostatic hypotension is a side effect
How long is influenza contagious?
about a week
Onset for type 1 diabetes is
abrupt
What should be given with nitroglycerine?
acetaminophen or aspirin because headache is common
-lamide Examples; drug class;
acetazolamide; methazolamide; brinzolamide carbonic anhydrase inhibitor
In type 1 diabetes, when the cells break down protein and fat into energy causing ketones to build up what does this cause?
acidosis
Too much Co2 means
acidosis; too much Co2 being retained
tretin-; tretin; -tretin Examples; drug class; important things to know
acitretin; aliretinoin; isotretinoin; tretinoin retinoid; dermatologic agent; form of vitamin A teratogenic, clients need to avoid tetracycline, excess sun, and vitamin A supplements
Treatment in client with aspirin toxicity
activated charcoal, IV sodium bicarbonate.
Sudden onset of unrelenting, severe pain in the left upper quadrant or mid epigastric area of the abdomen that often radiates to the back is most likely indicative of
acute pancreatitis
Examples of ARBs
"sartans" losartan, candesartan, valsartan
Generic names for the inhaled form of beta 2 agonists end in
"terol"
Ejection fraction is
% of blood expelled from the left ventricle with every contraction
QRS intervals
.6-0.12
isotonic fluids
.9% NS, lactated ringer, plasmolyte
How many fingers should you be able to fit under a trach tie?
1 finger should fit under the tie
Steps for mixing regular and NPH insulin
1. inject air into NPH insulin 2. Inject air into regular insulin 3. Draw up dose of regular insulin 4. Draw up dose of NPH insulin
The nurse has reviewed with the preoperative client the procedure for the administration of an enema. Which statement by the client would indicate the need for further instruction? 1."The enema will be given while I am sitting on the toilet." 2."I should try and hold the fluid as long as possible after it is run in." 3."I know that there will be some cramping after the enema solution is run in." 4."I should tell the nurse if cramping occurs when the fluid is running in."
1."The enema will be given while I am sitting on the toilet."
A hospitalized client is diagnosed with type 1 diabetes mellitus. The nurse plans care for the client, understanding that which factors are likely causes of the beta cell destruction that accompanies this disorder? Select all that apply. 1.Viruses 2.Genetic factors 3.Autoimmune factors 4.Human leukocyte antigen (HLA) 5.Primary failure of glucagon secretion
1.Viruses 2.Genetic factors 3.Autoimmune factors 4.Human leukocyte antigen (HLA)
Administer potassium no faster than...
10 mEq/L per IV
Therapeutic range of vancomycin in pediatrics is
10-20 mg/L
In meningitis the HOB shou0ld be elevated between ___-____ degrees
10-30 degrees
Normal pulse range for a 1-year-old
100-160/min
anterior fontanelle fuses by age
18 months
secondary tubing should be changed every _____ hours if not attached to the primary IV infusion set
24
duration of long acting insulin
24 hours
Changing the inner cannula of the trach is not indicated until....
24 hours after insertion
What is the therapeutic INR for a patient with a mechanical heart valve is
2.5-3.5
The nurse is inserting an indwelling urinary catheter into a client. As the catheter is inserted into the urethra, urine begins to flow into the tubing. What action should the nurse take next? 1.Immediately inflate the balloon. 2.Insert the catheter 2.5 to 5 cm and inflate the balloon. 3.Withdraw the catheter about 1 inch and inflate the balloon. 4.Insert the catheter until resistance is met and inflate the balloon.
2.Insert the catheter 2.5 to 5 cm and inflate the balloon.
The nurse should hold warfarin and contact health care provider if the INR is > than....
3.5
potassium values
3.5-5
to increase ICP the HOB should be raised to
30 degrees
peak of rapid insulin
30 mins-3 hours
onset of short acting insulin
30-60 minutes
Types of beta 2 agonists (the brand names of some drugs in this class provide a hint because they contain the words "vent" or "breth")
albuterol (proVENT; VENTolin) formoterol salmeterol (sereVENT) Terbutaline (BRETHine)
The nurse prepares to administer a phytonadione (vitamin K) injection to a newborn, and the mother asks the nurse why her infant needs the injection. What best response should the nurse provide? 1."Your newborn needs the medicine to develop immunity." 2."The medicine will protect your newborn from being jaundiced." 3."Newborns have sterile bowels, and the medicine promotes the growth of bacteria in the bowel." 4."Newborns are deficient in vitamin K, and this injection prevents your newborn from bleeding."
4."Newborns are deficient in vitamin K, and this injection prevents your newborn from bleeding."
A client in cardiogenic shock has a pulmonary artery catheter (Swan-Ganz type) placed. The nurse would interpret which cardiac output (CO) and pulmonary capillary wedge pressure (PCWP) readings as indicating that the client is most unstable? 1.CO 5 L/min, PCWP low 2.CO 3 L/min, PCWP low 3.CO 4 L/min, PCWP high 4.CO 3 L/min, PCWP high
4.CO 3 L/min, PCWP high
Subcutaneous injections should be given at what angle
45 degree
onset of rapid insulin
5-30 mins
new foods should be given to infants how many days apart to assess for food allergies?
5-7 days
duration of short acting insulin
5-7 hours
what is recommended dose of calcium for ages 1-3
500 mg
what is a normal PAWP? (pulmonary artery wedge pressure)
6-12 mm Hg
What is the recommended initial treatment of peptic ulcer disease related to H pylori?
7-14 days of omeprazole, amoxicillin and clarithromycin
intramuscular injection should be given at what angle
90 degree angle
In a massively enlarged spleen, the spleen can hold more than ___% of the total platelet mass in the body
90% (which is why splenomegaly leads to thrombocytopenia)
Primary IV tubing should be changed every
96 hours
An individual with a CD4 lymphocyte percentage of _____% is considered to be severely immunocompromised
<15%
In pediatrics, drainage from a chest tube >____ mL/kg/hr for 3 consecutive hours or >____-____ mL/kg/hr should be reported immediately to a provider
>3mL/kg/hr ; >5-10mL/kg/hr
episodes of bleeding rarely occur with a platelet count greater than...
>50,000
Systolic blood pressure should be >____mm Hg to ensure renal perfusion
>90 mm Hg
-terol Examples; drug class; special things to remember
albuterol; arformoterol; formoterol; beta agonist; bronchodilator SABAs (short acting beta agonist), tremor is a common side effect
Example of a biphosphonate?
alendronate (fosamax)
too little Co2 means
alkalosis
Third line of medication for Gout (hint: PURINE is in the name of the med)
Allopurinol
S/S of hypovolemic shock
Altered mental status, tachycardia with thready pulse, narrowing pulse pressure, cool clammy skin, oliguria, tachypnea, urine output <0.5mL/kg/hr despite fluid replacement (bad)
Newborn assessment components—"APGAR"
Appearance Pulse Grimace Activity Respiratory effort
Permethrin is prescribed for a child with a diagnosis of scabies. The nurse should give which instruction to the parents regarding the use of this treatment? 1.Apply the lotion to areas of the rash only. 2.Apply the lotion and leave it on for 6 hours. 3.Avoid putting clothes on the child over the lotion. 4.Apply the lotion to cool, dry skin at least 30 minutes after bathing.
Apply the lotion to cool, dry skin at least 30 minutes after bathing.
A school nurse is teaching an athletic coach how to prevent dehydration in athletes during football practice. Which action by the coach during football practice would indicate that further teaching is needed? 1. Weighs athletes before, during, and after football practice 2.Asks the athletes to take a salt tablet before football practice 3.Schedules fluid breaks every 30 minutes throughout practice 4.Tells the athletes to drink 16 oz of fluid per pound lost during practice
Asks the athletes to take a salt tablet before football practice
Nursing considerations for spironolactone
Avoid eating foods high in potassium, avoid salt substitutes and potassium supplements, monitor K+levels
What is an effective therapy as treatment to decrease CO2 levels in patients with hypercapnic respiratory failure?
BIPAP
Late signs of hypoxia- BED
Bradycardia Extreme restlessness Dyspnea
nine point postpartum assessment mnemmonic- BUBBLEHER
Breasts Uterus Bladder Bowel Function Lochia Episiotomy Hemorrhoids Emotional Status Respiratory System
Toddler (12 months to 3 years) Piaget theorist, type of development and stage
Cognitive Sensorimotor transition to preoperational
Shock signs and symptoms mnemonic- CHORD ITEM
Cold clammy skin Hypotension Oliguria Rapid shallow breathing Drowsiness confusion Irritability Tachycardia Elevated or reduced central venous pressure Multi organ damage
What is Leucovorin and how does it work when given with fluorouracil? (chemo drug)
Leucovorin, when given in combination with chemo drugs can enhance the binding of the fluorouracil to an enzyme inside of the cancer cells. As a result it may stay in the cancer cell longer and exert its anti cancer effect on the cells
What therapy can be used for a vancomycin resistant enterococcus infection?
Linezolid therapy.
Treatment of CAD
Lipid lowering medications like statins, diet, physical activity, smoking cessation, stress management ,coronary stent, angioplasty, CABG
diagnosis of CAD consists of
Lipoprotein profile; LDL, HDL, Total cholesterol, triglycerides, assess ECG for changes in ST segments or T waves
In someone with type 1 diabetes do they produce insulin?
NO
What is contraindicated when transporting a patient with a chest tube?
NO CLAMPING THE CHEST TUBE. This can lead to a tension pneumothorax
Patho of HHS
NO acidosis present! Simply high amounts of glucose in the blood
A patient with COPD should have no more than ____ Liters Nasal Cannula
NO more than 2 liters!
Intermediate acting insulin types
NPH Humilin N; Novolin NPH
Side effects of ACE inhibitors
Orthostatic hypotension, hyperkalemia, cough, angioedema
Treatment for PAD
Dangle arteries, perform daily skin care with moisturizer, stop smoking, avoid tight clothing, no heating pads, medications such as vasodilators/antiplatelets
Side effects of loop diuretics
Decrease Hypokalemia, decrease hypotension, decrease hyponatremia, increase hyperglycemia, increase photosensitivity, dehydration
Antihistamines examples
Diphenhydramine (benadryl) Dimenhydrinate (dramamine) Meclozine
To prevent Reye syndrome in infants, which of the following instructions should be given to parents?
Do not administer any product containing aspirin or salicylates to a child with a viral infection
What medication is used to treat symptomatic hypotension?
Dopamine
Pain assessment tool for 2 months-7 years
FLACC
pain assessment tool for ages 3 and older
Faces
-mab Examples; drug class; special things to remember
adalimumab; daclizumab; infliximab monoclonal antibody rule out TB prior to therapy, report elevated WBC; the nurse should monitor the clients blood counts, blood pressure, and heart rate and rhythm, as well as watch for signs of bleeding
what is important when evaluating a fistula
Feel the thrill; hear the bruit
A mnemonic to assist you in performing assessments on a pregnant client admitted to the medical surgical unit-FETUS
Fetal heart tones every shift Emotional support Temperature Uterine contractions Sensations of fetal movement (ask about movement)
Signs of septic shock
Fever OR hypothermia, hypotension, prolonged cap refill, tachycardia, WBC count >12,000/mm3
3 Loop Diuretics
Furosemide, Bumex, Demadex
Long acting insulin types
Glargine (lantus); Detemir (levemir)
What is a common medication given for insulin overdose
Glucagon
Classic signs of muscular dystrophy in infants
Gower sign/maneuver, enlarged calves, walking on tiptoes, frequent tripping and falling
management for contact precautions
Gown, gloves, goggles, private room
What drink needs to be avoided when taking a Calcium channel blocker
Grapefruit juice; this can lead to toxicity
GTPAL
Gravida Term Preterm Abortions Living children
What is a critical Troponin
Greater than 1.5 ng/mL
__________________ is a cause of glomerulonephritis
Group A β-hemolytic streptococcal infection
Metabolic acidosis (from the ass- diarrhea) K+ is...
HIGH
HDL you want ___ levels
HIGH levels, this is happy cholesterol
What is the first line of drug used for PSVT (paroxismal supraventricular tachycardia)
adenosine
HEPARIN mnemonic
Heparin sodium prevents thrombin from converting fibrinogen to fibrin. administered IV or SQ Enoxaparin is a low molecular weight heparin, same action as heparin but has a longer half life Protamine sulfate is the antidote for heparin Administer heparin when there is a likelihood of clot formation (MI, DVT) Risk for bleeding is the major side effect Instruct clients to avoid corticosteroid use, salicylates, NSAIDS, green leafy vegetables and foods high in vitamin K Normal activated partial thromboplastin time is 20-36 seconds, but it should be 1.5-2 times the normal value while on heparin
Treatment for Type 1 diabetes
INSULIN ONLY! Oral hypoglycemic agents will NOT work for this pt
Treatment for hypoparathyroidism
IV calcium; phosphorous biding drugs;
Live vaccines should be delayed for up to 11 months after _____ administration
IVIG
After administering a clot buster, what should you administer and why?
administer beta blockers to decrease myocardial oxygen consumption and reduce the incidence and severity of reperfusion arrhythmias
The nurse is describing cardiovascular system changes that occur during pregnancy to a client. Which findings are normal for a client in the second trimester?
Increase in pulse rate increase in red blood cell production
Order of assessment with abdomen
Inspect AUSCULTATE percuss palpate
Order of assessment
Inspection Palpation percussion auscultation
What is IVIG
Intravenous immune globulin- this is a product made up of antibodies that can be given intravenously
How do you calculate a pulse pressure?
It is the difference between the systolic blood pressure and the diastolic blood pressure. Example: systolic 110/diastolic 80 then the pulse pressure would be 30 mm Hg
Hypokalemia signs and symptoms- 6Ls
Lethargy Leg cramps Limp muscles Low shallow respirations Lethal cardiac dysrhythmias Lots of urine
What is sumatriptan and how does it work?
It relieves migraines by constricting dilated cranial blood vessels
What is the treatment for hyperkalemia >5.0 mEq/L
Kayexalate
What medication is often used to treat seizures in various settings?
Keppra
a client with meningitis would have a positive _____ sign
Kernigs sign
Signs and symptoms of DKA
Ketosis and acidosis; hyperglycemia; dehydration; kussmaul respirations; acid breath"fruity breath"
a client with measles would have what kind of spots
Koplik's spots
Cardiomegaly, displaced PMI, S3 sound, pulmonary edema, dyspnea, orthopnea, PND, crackles, frothy sputum and confusion are all symptoms of
LEFT sided heart failure
Metabolic Alkalosis (from the mouth-vomitus) K+ is....
LOW
During acute diverticulitis what diet is prescribed
LOW fiber diet
LDL you want ___ levels
LOW levels, this is bad cholesterol
You want your LDL ______ and your HDL ______
LOW; HIGH
_________ medications should be discontinued two weeks prior to ECT (electroconversion Therapy)
Lithium, MAOIs and all seizure threshold medications
Treatment for menieres disease
administer diuretics to decrease endolymph in cochlea restrict sodium lay on affected ear when in bed
Treatment for Addisons disease
administer glucocorticoid and/or mineralocorticoid; diet high in protein and carbs
`Endocrine system functions
Maintenance and regulation; energy metabolism; response to stress and injury; reproduction; growth and development; fluid, electrolyte and acid base balance; reproduction
Airborne precautions mnemonic- My Chicken Hez TB
Measles Chicken pox Herpes zoster TB
What is a known side effect of Flagyl
Metallic taste in the mouth
Extended use and/or high doses of this drug may lead to the development of Tardive Dyskinesia
Metclopramide
Anti thyroid medications
Methimazole or PTU; iodine compounds; radioactive iodine therapy; thyroidectomy
Congestive heart failure treatment mnemonic- MADD DOG
Morphine aminophylline digoxin dopamine diuretics oxygen gasses (ABGs)
immediate treatment for myocardial infarction (MONA)
Morphine, Oxygen, Nitroglycerin, Aspirin
signs of cardiac tamponade
Muffled or distant heart tones, hypotension, JVD
Hyperkalemia mnemonic MURDER
Muscle weakness Urine Respiratory depression Decreased cardiac contractility ECG changes (peaked T waves) Reflexes
Do you massage the site of inflammation in a patient with a DVT?
NO
Acute pancreatitis interventions
NPO status/NG tube inserted to suction out gastric secretions; pain management IV opioids; IV fluids to prevent hypovolemic shock; semi fowlers or side lying with HOB 45 degrees
First line of medication for gout
NSAIDs and prednisone is first to treat pain and inflammation of gout attacks
Common PPI's (think of the pump in your stomach churning out the acid- Zole is the nice guy who shuts off the pump)
Omeprazole (Losec), Iansoprazole, pantoprozole
Nursing considerations for osmotic diuretics
Only administered IV, may crystalize (check solution before admin), Perform neuro assessment and LOC (if using for cerebral edema)
________ _________ is common with ACE inhibitors and alpha-blockers (-zosin)
Orthostatic hypotension
Phenytoin adverse effects- mnemonic PHENYTOIN
P-interactions Hirsutism Enlarged gums Nystagmus Yellow-browning of skin Teratogenicity Osteomalacia Interference with B metabolism (anemia) Neuropathies: vertigo, ataxia, headache
Arterial occlusion: 4 P's
Pain pulselessness pallor paresthesia
Treatment for hemopilia
administer supplemental IV clotting factors (factor VIII, Factor IX)
Treatment of pheochromocytoma
adrenalectomy (if a tumor is present), tell the patient to not smoke, drink caffeine or change position suddenly; administer anti hypertensives; promote rest and calm environment; diet high in calories. vitamins, and minerals
In a patient with placenta previa what do you immediately do
Place the woman immediately on bed rest in a side lying position
What method can be used to elicit Trosseau's sign?
Placing BP cuff on the arm, inflating to a pressure greater than systolic BP, holding in place for 3 minutes. This will induce a spasm of the muscles in the hand and forearm when hypocalcemia is present
When will there be an intermittent air leak with bubbling in water seal chamber?
Pneumothorax
Signs and symptoms of Type 1 and Type 2 diabetes. 3 P's
Polyuria (excessive peeing), polydipsia (excessive thirst), polyphagia (excessive hunger)
What do you give for potassium replacement therapy?
Potassium chloride
Dystocia general aspects (4P's)
Powers Passageway Passenger Psych
A patient with latent TB should NOT begin treatment with ________ because it increases risk for conversion into active TB
Prednisone
The nurse is caring for a child with hemophilia and is reviewing the results that were sent from the laboratory. Which result should the nurse expect in this child? 1.Shortened prothrombin time (PT) 2.Prolonged PT 3.Shortened partial thromboplastin time (PTT) 4.Prolonged PTT
Prolonged PTT
Short acting insulin types
Regular insulin
What is the only insulin that can be delivered IV Push?
Regular insulin
Right Sided HF pneumonic...SWELLING....stands for
Swelling of legs and hands, Weight gain, Edema (pitting), Large neck veins (JVD), Lethargy/fatigue, Irregular heart rate, Nocturia, Girth (ascites)
S__ heart sound in children is normal when reflecting rapid filling of the left ventricle
S3
Electrical conduction of the heart pneumonic Send A Big Bounding Pulse stands for
SA node; AV node; Bundle of His; Bundle Branches; Purkinje fibers
St johns wort interferes with many prescription medications, such as...when taken with these meds it can cause....
SSRIs; MAOIs or tricyclic antidepressants; when taken with these, it can cause serotonin syndrome
Patients with spinal cord injuries at _____ or above have autonomic dysreflexia/hyperreflexia
T-7 or above
If a client is taking a beta 2 agonist and inhaled glucocorticoid concurrently, how should they be taken?
Take the beta 2 agonist first to promote bronchodilation which will enhance absorption of the glucocorticoid
Heart murmur causes mnemonic- SPASM
Stenosis of a valve Partial obstruction aneurysms septal defect mitral regurgitation
____________ can intensify the effects of warfarin, phenytoin, and sulfonylurea-type oral hypoglycemics (e.g., glipizide, glyburide)
Sulfonamides
Preterm infant anticipated problems mnemonic: TRIES
Temperature regulation (poor) Resistance to infections (poor) Immature liver Elimination problems Sensory perceptual functions
What is a Mantoux test used for? What is indicative of a positive Mantoux test?
This is a skin test used to detect infection by TB. A positive mantoux test is >15mm unless they are less than 4 years old or are a recent immigrant then it is >10
The clinic nurse is preparing to perform a Romberg test on a client being seen in the clinic. The nurse would perform this test for the purpose of determining which status? 1.The client's ability to ambulate 2.The intactness of the tympanic membrane 3.The intactness of the retinal structure of the eye 4.The functional status of the vestibular apparatus in the inner ear
The functional status of the vestibular apparatus in the inner ear
what entails care of a halo external fixation device?
The nurse should clean pin sites with sterile solution to prevent infection, reduce pressure on the halo device (pillow under head), keep vest clean and dry, avoid holding the device frame while moving the client
A burn where the dermis is destroyed and possibly involves subcutaneous tissue, where the skin is dry and inelastic with waxy white leathery, or a charred black color...would be what type of burn?
Third degree (full thickness)
Infections during pregnancy mnemonic (TORCH)
Toxoplasmosis Other (hepatitis B, Syphilis, group B beta strep) Rubella Cytomegalovirus Herpes simplex virus
How to treat tumor lysis syndrome
Treat with aggressive hydration, correction of electrolyte abnormalities
Purpose of osmotic diuretic
Treatment of cerebral edema, decrease intraocular pressure
The nursery room nurse is assessing a newborn infant who was born to a mother who abuses alcohol. Which assessment finding should the nurse expect to note? Select all that apply. 1.Tremors 2.Lethargy 3.Irritability 4.Poor feeding 5.Higher-than-normal birth weight 6.A greater-than-normal appetite when feeding
Tremors Irritability Poor Feeding
Normal values for Troponin I and troponin T
Troponin I <0.5ng/mL and Troponin T should be <0.1ng/mL
LOW pressure limit alarm on mechanical ventilator, causes:
Tube disconnect or leak Loss of airway (total or partial extubation or decannulation)
Thiazolidinediones and pioglitazone are used to treat ________ and can worsen what?
Type 2 diabetes; can worsen heart failure
Drugs for petit mal seizures- ValEt mnemonic
Valproic acid; Ethosuximide
VEAL CHOP
Variable decels-Cord compression (change in mothers position helps) Early decels- Head compression Accelerations- O2 (baby is well oxygenation this is good) Late decels-Placental utero insufficiency (this is bad and means there is decreased perfusion of blood/oxygen/nutrients to the baby)
Who is at highest risk of Megaloblastic anemia?
Vegans
VEINY pneumonic for Peripheral vascular diseased stands for
Very big pulses=warm legs; Edema (blood pooling), Irregularly shaped sores, No intense pain, Yellow and brown ankles
What breath sounds are normal to find when auscultating?
Vesicular breath sounds
Nitroglycerine with concurrent use of _______ can lead to life threatening hypotension
Viagra
The nurse is conducting a dietary assessment on a client who is on a vegan diet. The nurse provides dietary teaching and should focus on foods high in which vitamin that may be lacking in a vegan diet?
Vitamin B12
Megaloblastic anemia is caused by
Vitamin B12 or folic acid deficiency
2 year old client should be able to
Walks up/down stairs alone, 1 step at a time o Builds 6-7 block tower o Turn 1 page at a time o Draw a line o 300+ vocabulary o 2-3-word phrases o States own name o Begins parallel play o Begins to gain independence from parents
The nurse is developing a plan of care for a client in Buck's traction. The plan of care should include assessing the client for which finding indicating a complication associated with the use of this type of traction? 1.Hypotension 2.Weak pedal pulses 3.Redness at the pin sites 4.Drainage at the pin sites
Weak pedal pulses
The school nurse is performing pediculosis capitis (head lice) assessments. Which assessment finding indicates that a child has a "positive" head check? 1.Maculopapular lesions behind the ears 2.Lesions in the scalp that extend to the hairline or neck 3.White flaky particles throughout the entire scalp region 4.White sacs attached to the hair shafts in the occipital area
White sacs attached to the hair shafts in the occipital area
What is a sucking chest wound
a SCW happens when an injury causes a hole to open in your chest (stabbing, gunshot)
what is a left to right shunt?
a back leak of blood from the systemic to the pulmonary circulation. This causes the pulmonary flow to be larger than the systemic
A halo external fixation device stabilizes what
a cervical or high thoracic fracture
Addisons disease is (pneumonic: we need to ADD some)
a disorder of the adrenal cortex, not enough steroids
Define orthostatic hypotension
a drop in systolic BP of >20 mm Hg or in diastolic BP of >10mm Hg
After barium xray what should be given to the client?
a laxative to help expel barium. Retained barium can lead to fecal impaction
Autonomic dysreflexia/hyperreflexia is what
a life threatening inhibited sympathetic response of the nervous system to a noxious stimulus
Isosorbide dinitrate (isordil) is what
a long acting nitrate medication prescribed to prevent angina in clients with CAD
What is an antiemetic
a medication used in treatment and/or prevention of nausea/vomiting
All macrolide antibiotics (azithromycin, erythromycin, clarithromycin) can cause...
a prolonged QT interval
hypomagnesemia can lead to...
a prolonged QT interval, which leads to VTACH which can lead to torsades de point
A client with a documented exposure to tuberculosis is on medication therapy with isoniazid. The nurse is monitoring laboratory results and determines that which laboratory value indicates the need for follow-up? 1.Platelet count 325,000 mm3 (325 × 109/L) 2.Serum creatinine 1.0 mg/dL (88.3 mcmol/L) 3.Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) 4.Aspartate aminotransferase (AST) 55 U/L (55 U/L)
Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L)
The nurse has provided home care instructions to a client with a history of cardiac disease who has just been told that she is pregnant. Which statement, if made by the client, indicates a need for further instruction? 1."It is best that I rest lying on my side to promote blood return to the heart." 2."I need to avoid excessive weight gain to prevent increased demands on my heart." 3."I need to try to avoid stressful situations because stress increases the workload on the heart." 4."During the pregnancy, I need to avoid contact with other individuals as much as possible to prevent infection."
"During the pregnancy, I need to avoid contact with other individuals as much as possible to prevent infection."
What is Chadwick's sign?
Blue-tint to the cervix
Phosphate values
0.8-1.5
The nurse is providing instructions to the mother of a child with croup regarding treatment measures if an acute spasmodic episode occurs. Which statement made by the mother indicates a need for further teaching? 1."I should place a steam vaporizer in my child's room." 2."I will take my child out into the cool, humid night air." 3."I could place a cool-mist humidifier in my child's room." 4."I will have my child inhale the steam from warm running water."
1."I should place a steam vaporizer in my child's room."
Which interventions are essential to perform when a central venous site is suspected of being infected? Select all that apply. 1.Prepare to administer antibiotics. 2.Notify the primary health care provider (PHCP). 3.Inform the client that blood cultures will need to be obtained. 4.Document the occurrence, the actions taken, and the client's response. 5.Continue to use the central venous catheter until another one is placed.
1.Prepare to administer antibiotics. 2.Notify the primary health care provider (PHCP). 3.Inform the client that blood cultures will need to be obtained. 4.Document the occurrence, the actions taken, and the client's response.
The nurse is caring for a client who has undergone a radical neck dissection and creation of a tracheostomy because of laryngeal cancer and is providing discharge instructions to the client. Which should be included in the instructions? Select all that apply.
1.Protect the stoma from water. 2.Use a humidifier if dryness is a problem. 3.Keep powders and sprays away from the stoma site.5.Apply a thin layer of non-oil-based ointment to the skin around the stoma to prevent cracking.
a normal PT range is
11-12.5 seconds
PTT values
11-14 sec
RBC distribution (RDW) values
11.5-14.5
Hemoglobin for men and women values
13-17 men, 12-15 women
sodium values
135-145
Ammonia values
15-50
platelet values
150-400
Hypertonic fluids
3% NS, 5% NS, 5% albumin, 25% albumin, mannitol
paCO2 values
38-42
normal Cardiac output
4-7 L/min
Normal Cardiac output
4-8 L/min
Normal EF
50%-70%
total calcium levels in a term infant younger than a week
7-12
BUN values
8-21
normal apical pulse for an infant
90-130 bpm
SaO2 values
94-100
chloride values
95-105
The nurse is assisting a primary health care provider (PHCP) during the examination of an infant with developmental hip dysplasia. The PHCP performs the Ortolani maneuver. The nurse determines that the infant exhibits a positive response to this maneuver if which finding is noted? 1.A shrill cry from the infant 2.Asymmetry of the affected hip 3.Reduced range of motion in the right and left hip 4.A palpable click during abduction of the affected hip
A palpable click during abduction of the affected hip
large blood vessel that supplies the anterior wall of the left ventricle
Left anterior descending artery (LAD)
cardiac afterload is what
Pressure that the left ventricle has to pump against
what is cardiac preload
amount of blood returned to the right side of the heart at the end of diastole
A decreased PT may be noted in
arterial occlusion, deep vein thrombosis, edema, myocardial infarction, peripheral vascular disease, and pulmonary embolism
Difference between hemodialysis and peritoneal dialysis
hemodialysis is 3x a week outside the body; peritoneal is inside the body performed at the bedside or operating room
what is agnosia
inability to interpret sensations and hence to recognize things, typically as a result of brain damage.
The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. 1.Tremors 2.Anorexia 3.Irritability 4.Nervousness 5.Hot, dry skin 6.Muscle cramps
tremors, irritability, nervousness
