1
Q
What medication is contraindicated for individuals with Hemophillia? and why?
A
- NSAIDS (Ibuprofen, Aspirin)
- Inhibits platelet aggregation
2
Q
What is a long-term complication associated with hemophillia?
A
- Joint destruction (Hemathrosis)
-Most frequent sites of internal bleeding are the joint cavities
3
Q
RivaroXABAN, edoXABAN, and apiXABAN are all examples of what type of medication?
A
Factor Xa inhibitors - Anticoagulants
4
Q
Why are factor Xa inhibitors being prescribed more frequently than other oral anticoagulants such as warfarin?
A
- Lower risk of bleeding and require less ongoing monitoring
5
Q
What should clients’ avoid taking when prescribed factor Xa inhibitors ?
A
- NSAIDs (increase risk for uncontrolled bleeding)
- Garlic
- Ginger
6
Q
S/S of fluid & electrolyte imbalances (general)
A
- Tetany (intermittent muscle spasms)
- Prolonged QT intervals (arrhythmias)
- Paresthesia (numbness or tingling of the hands and lips)
- Hyperactive deep tendon reflexes
- Fatigue
- Confusion and irritability
- Diarrhea or constipation
- Headaches
- Muscle cramps
7
Q
S/S of hypocalcemia
A
- Serum calcium <9.0 mg/dl [2.25 mmol/L]
- often associated with decreased parathyroid hormone levels
- tingling lips
- Seizure activity
- Bronchospasm
- Muscle cramping
- Cardiac dysrhythmias
- Dry, scaly skin
- confusion or irritability
- brittle nails
8
Q
S/S of hypokalemia
A
- Serum potassium <3.5mEq/L [2.5 mmol/L]
- Constipation
- Heart palpitations
- Fatigue
- Muscle weakness and spasms
- Tingling and numbness
- Muscle twitches and/or cramps
- arrhythmias
9
Q
S/S of hyponatremia
A
- Serum sodium <135mEq/L [135mmol/L
- N/V
- Headache
- Confusion
- Fatigue
- Restlessness
- Muscle weakness, spasms, or cramps
- Seizures
- Coma
- Cardiac dysrhythmias
10
Q
Hypocalcemia is commonly caused after a thyroidectomy due to what?
A
Hypoparathyroidism - decreased parathyroid hormone levels
- Parathyroid hormone and calcium have a reciprocal relationship therefore when one increases or decreases so does the other.
11
Q
What is the chvostek or Trousseau sign used to look for?
A
- Hypocalcemia
12
Q
What is the Chvostek and Trousseau sign?
A
Chvostek sign - twitching of the facial muscles in response to tapping over the facial nerve
Trousseau sign - Carpopedal spasm which involves flexion of the wrist, thumb, and MCP joints induced by pressure applied to the arm by an inflated BP cuff
13
Q
What medication is used to increase calcium levels?
A
Calcium gluconate
& Vitamin D to increase calcium absorption in the intestines
14
Q
Clients with hypocalcemia should include which types of food in their diet?
A
- Foods high in calcium & vitamin D
Ex. tofu, banana, sardines, almonds, and dark green vegetables.
15
Q
Clinical manifestations of fetal alcohol syndrome
A
- Intellectual disability
- Developmental delay
- Distinct facial characteristics (indistinct philtrum (smooth space between lip and nose), thin upper lip, epicanthal folds, flat midface, short palpebral fissures)
16
Q
What type of isolation precaution should a client with C.diff, MRSA, VRE, or scabies be placed in ?
A
Contact precautions
17
Q
What are the infection-control measures for contact isolation?
A
- Hand hygiene ( soap and water for C.diff)
- Nonsterile gloves
- Gown
- Private room preferred
18
Q
Tenecteplase (TNK) - tPA injection is used for what?
A
- Used to manage intravascular clots
- Used when a blood clot in a heart artery causes an MI
- Ischemic stroke within 4.5 hours after the onset of stroke
19
Q
How is TNK given?
A
- IV
20
Q
Difference between TNK and tPA?
A
- TNK is modified with higher attraction to clots, which results in less unintended bleeding in other areas of the brain compared to tPA
- TNK has a longer half-life
21
Q
What type of insulin is Lantus –> Glargine
A
- Long-acting
22
Q
What is the peak time of long-acting insulin & when should it be given?
A
- No peak because it is slowly absorbed
- Given at bedtime
23
Q
What side should someone using a cane hold it on?
A
- Hold cane on strong/unaffected side
24
Q
How do you measure for crutches?
A
- correct length if 2-3 fingers space between the top of the crutch pad and the axilla
- Hand grip: at wrist level when arms are hanging and approx 30 degrees of elbow flexion when using
25
How do you walk up and down stairs with crutches?
- Up with the good, down with the bad
ie: first good leg goes up then bad leg vs Going down the bad leg goes down first with crutches
- Crutches move with the bad leg
26
What is the purpose of a small-volume cleansing enema?
Works by pulling fluid into the internal lumen, which softens stool to promote defecation
27
What type of fluid is used in a small-volume cleansing enema?
100-200ml of hypertonic solution (sodium phosphate) --> to draw fluid towards solute to soften stool within the bowel.
28
Large- volume enemas use what fluid?
Tap water >500 ml of water (hypotonic solution) into the colon
29
What do Lipase inhibitors do?
prevent the breakdown and absorption of fats from the intestines
- prescribed for clients with obesity who have difficulty losing weight
- Should be taken with or within 1 hour of meals that contain fat, if meal does not contain fat then the dose may be skipped
30
A client with a C3 spinal cord injury has a headache and nausea. The clients' BP is 170/100 mm Hg. How should the nurse respond initially?
A. Administer PRN analgesic medication
B. Administer PRN hypertensive medication
C. Lower the head of the bed
D. Palpate the client's bladder
D
31
What is autonomic dysreflexia?
An acute life-threatening response to noxious (Harmful) stimuli, which clients with spinal cord injuries above T6 are unable to feel.
32
S/S of Autonomic dysreflexia
- Hypertension
- Bradycardia
- A pounding headache
- Diaphoresis
- Nausea
33
Noxious stimuli may include:
- Bladder distention eg. obstructed urinary catheter, neurogenic bladder
- Fecal impaction
- Tight clothing eg. shoelaces, waistbands
34
What is intussusception?
Occurs when a segment of the intestine prolapses and then telescopes into an adjacent segment.
35
S/S of intussusception
- Vomiting
- Stool changes (red, jelly-like stools)
- acute episodes of abdominal pain
- sausage-shaped mass palpated in the right upper quadrant
- Right lower quadrant often feels empty to palpation
36
The nurse should be MOST concerned about a child with intussusception developing... what (2)
- Bowel ischemia
- Perforation
37
What are the anticipated nursing interventions for a child with intussusception
- Administer IV fluids
- Preparing the client for an air enema
- Maintaining client on NPO status to decrease peristalsis and promote bowel rest.
- NG MAY also be indicated, depending on severity of obstruction
38
What is the recommended needle length for an IM injection ?
1-1.5 inch (2.5 to 3.8 cm) needle is used to reach the proper muscle space
39
What is amyotrophic lateral sclerosis (ALS)?
Characterized as a progressive loss of motor neurons in the brain stem and spinal cord
40
S/S of ALS
- Spasticity
- Muscle weakness
- Atrophy
* neurons involved in swallowing & resp function are eventually impaired leading to aspiration, respiratory failure and death
41
Erythropoietin therapy increases the risk for...
- HTN
- Stroke
- MI
- Blood clots
- Heart failure
due to thickened blood related to the higher concentration of RBCs
42
Features of metabolic syndrome include..
- Increased waist circumference
- Increase BP
- Increased triglycerides
- Decreased HDL
- Increased fasting blood glucose
We Better Think High Glucose
Waist cir, BP, Triglycerides, HDL, glucose
43
Metabolic syndrome, IE:
Insulin resistance syndrome
44
Cyanotic congenital heart defects: (6)
-Ebstein anomaly
- Tetralogy of fallot
- Tricuspid atresia
- transposition of the great vessels
- Truncus arteriosus
- Total anomalous pulmonary venous return
45
Noncyanotic congenital heart defects: (4)
- Atrial septal defect
- Ventricular septal defect
- Patent ductus arteriosus
- Coarctation of the aorta
46
A cyanotic congenital heart defect specifically tetralogy of fallot is characterized by the presence of 4 defects:
- Ventricular septal defects (opening between left & right ventricle which allows mixing of oxygenated and unoxygenated blood)
- Pulmonary stenosis
- Overriding aorta
- Rt ventricular hypertrophy
47
Major adverse effects of beta-blockers
- Bradycardia
-Bronchospasm
- Hypotension
- Depression
- Erectile dysfunction
48
Major adverse effects of ACE inhibitors
- Dry cough
- Hypotension
- Reflex tachycardia
- Hyperkalemia
- Angioedema
49
Major adverse effects of sulfonylureas
- Hypoglycemia ie: diaphoresis, headache, hunger, tachycardia, confusion
50
Major adverse effects of Thyroid replacement
- Symptoms of hyperthyroidism ie: Diarrhea, weight loss, palpitations, tachycardia, sweating and heat intolerence
51
What type of medication are sulfonylureas?
Hypoglycemic agent used to treat type 2 diabetes
52
Contraindications for taking vancomycin
- Intestinal disorders
- Kidney disease
- Hearing problems
- If you are receiving Iv antibiotics
53
When do you check the vancomycin through levels?
before the 4th dose
54
What class of medication is captopril
ACE inhibitor
55
what is captopril used to treat?
- Hypertension
- Congestive heart failure
- also used to treat kidney disease (nephropathy) caused by diabetes in patients with type 1 diabetes and retinopathy (eye disease)
56
What class of medication is prednisone?
Glucocorticoid - corticosteroid medication
57
Prednisone is used to treat what conditions?
- Allergic disorders
- Skin conditions
- Ulcerative colitis
- Arthritis
- Lupus
- Psoriasis
- Breathing disorders
58
You should avoid taking prednisone if you...
- Have a fungal infection or are taking oral fungal medication
59
Long-term steroid use can lead to..
Osteoporosis
60
Side effects of prednisone
- blurred vision, eye pain, or seeing halos around lights;
- Edema
- rapid weight gain,
- feeling short of breath;
- severe depression, feelings of extreme happiness or sadness,
- changes in personality or behavior
- seizure (convulsions);
- bloody or tarry stools
-coughing up blood;
- pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate);
- Hypokalemia (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling);
- dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).
61
What are the four seizure phases, in order
- Prodormal
- Aural
- Ictal
- Postictal
62
Cranial nerve mnemonic
oh - olfactory
oh- optic
oh - oculomotor
To - Trochlear
Touch - Trigeminal
And- Abducens
Feel - Facial
Very - vestibulocochlear
Good - Glossopharyngeal (gag reflex)
Velvet - Vagus
Ah - Spinal accessory & Hypoglossal
63
Height increases of a newborn to 12 months
increases by 1 inch per month in the first 6 months and has a 50% increase by 12 months
64
Weight increases of a newborn to 12 months
Weight doubled by 5 to 6 months and tripled by 12 months
65
The anterior fontanel should be closed by
18 months
66
The posterior fontanel should be closed by
4 months
67
Newborn vitals
RR - 30-60
HR - 120 - 160
Temp 36 - 37.2
BP - 80-90 - 40-50
68
1 year old infant vitals
RR - 20 - 40
HR - 90 -130
Temp - 36 - 37.2
BP - 90/56
69
Toodler vital signs
RR - 20 - 30
Temp 36.4 - 37
HR - 80 - 120
BP - 92 - 55
70
What does the placenta do?
provides for exchange of nutrients and waste products between the fetus and mother
71
How many veins and arteries does the umbilical cord have?
two arteries, one vein
72
What does gravida refer too?
a pregnant woman
73
What does nulligravida mean?
Woman who has never been pregnant
74
What is parity/para referring too?
Para is the number of births (not the number of fetuses eg. twins) carried past 20 weeks of gestation, whether or not the fetus was born alive
75
What is quickening?
The first perception of fetal movement by the mother may occur at the 16th to 20th week gestation
76
What is chadwick's sign?
Violet coloration of the mucous membranes of the cervix, vagina, and vulva that occurs at about week 6
77
What is ballottement?
Rebounding of the fetus against the examiner's fingers on palpation
78
Hyperemesis gravidarum is what?
unmanageable N/V during the first trimester that causes disturbances in nutrition, fluids and electrolyte balance.
79
Interventions for hyperemesis gravidarum
- Initiate measures to alleviate N/V such as medications, if unsuccessful IV fluids, electrolytes, and TPN may be necessary
- Monitor vitals, I & O, weight and calorie count
- Monitor labs for electrolyte imbalances.
- Monitor urine for ketones
- Monitor fetal HR
- Encourage small portions of food, easily digestible carbs such as rice, and pasta
- Encourage intake of liquids between meals
- Encourage client to sit upright after meals
80
Define a placental abruption
Premature separation of the placenta from the uterine wall after 20th week of gestation and before the fetus is delivered.
81
Assessment findings of a placental abruption
- Dark red vaginal bleeding
-Uterine pain or tenderness or both ( usually during and between contractions if in labour)
- Uterine ridgity
- severe abdo pain
- signs of fetal distress
- signs of maternal shock if bleeding is excessive
82
Interventions for placental abruption
- monitor fetal and maternal vitals
- Assess for excessive bleeding, abdo pain, and increase in fundal height
- have client maintain bed rest; administer O2, IV fluids, and blood products as prescribed,
- Place the client in Trendelenburg position if indicated to decrease the pressure of the fetus on the placenta or place the client in a lateral position with the head of the bed flat if hypovolemic shock occurs
- Monitor and report any uterine activity
- Prepare for delivery of the fetus ASAP, vaginal delivery preferable if the fetus is healthy and stable.
- Monitor for signs of DIC in the postpartum period.
83
Define a tubal (ectopic) pregnancy
Implantation of the fertilized ovum outside of the uterine cavity - most common location is the ampulla of the fallopian tube
84
Assessment of an ectopic/tubal pregnancy
- missed period
- abdo pain
- vaginal spotting to bleeding that is dark red or brown
- Rupture: increased pain, referred shoulder pain, signs of shock
85
Interventions for an ectopic pregnancy
- Obtain assessment data and vital signs
- monitor bleeding and initiate measures to prevent rupture and shock
- methotrexate, a folic acid antagonist may be prescribed to inhibit cell division in the developing embryo
- prepare client for laparotomy and removal of the pregnancy and tube if necessary or repair of tube.
- Administer antibiotics; Rh immune globulin is prescribed for Rh - women.
86
Define postpartum hemorrhage
Any amount of blood loss resulting in hemodynamic instability. Bleeding greater than 1000ml or more after birth, or a 10% drop in Hgb and hematocrit from admission postdelivery.
PPH can occur early or late postpartum
87
Assessment of PPH
- Persistent significant bleeding; perineal pad is soaked within 15 mins
- Restlessness, increased pulse rate, decrease in BP, cool and clammy skin, ashen or grey in color
- Complaints of weakness, lightheadedness, dyspnea
88
Priority nursing actions for PPH
- Notify the OB (stay with client ask another nurse to notify OB)
- If uterus is boggy, massage firmly to cause it to contract
- elevate clients legs to atleast 30 degree angle.
- Administer O2 by nonrebreather face mask at 8 to 10 L/min
- Monitor vitals frequently
- Administer uterotonic medications (eg. Oxytocin (pitocin) , protaglandins) as prescribed for increased uterine tone
- Provide additional IV of ringers or NS (client should have two patent IVs)
- Administer blood products as prescribed via large-bore IV
- Insert cath to monitor perfusion of kidneys
- adminster emergency medications as prescribed
- Prepare for possible surgery
NCLEX
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