NCLEX

Question 1

Maslow’s Hierarchy of Needs

Answer 1

(basic to complex)

• Physiologic (food, shelter, water, sleep, oxygen, sexual expression)
• Safety
• Love and Belonging
• Esteem and Recognition
• Self-Actualization

Question 2

Nursing Process

Answer 2

ADPIE

Assessment
Diagnosis (Analysis)
Plan
Implementation
Evaluation

Question 3

Tort

Answer 3

An act of involving injury or damage to another resulting in civil liability (i.e. victim can sue) instead of criminal liability.

Question 4

Negligence

Answer 4

• Form of unintentional Tort

- Performing an act that a reasonable and prudent person would not perform

Question 5

Malpractice

Answer 5

• Form of unintentional Tort
• Negligence by professional personnel that RESULTS IN INJURY

4 elements necessary:
Duty: obligation to use due care
Breach of Duty: failure to perform according to standard
Injury/Damages: failure to meet standard of care resulting in physical or mental injury or damage to client
Causation: A connection exists between conduct and resulting injury

Question 6

Intentional Torts

Answer 6

• Assault (mental or physical threat)
• Battery (actual and intentional touching)
• Invasion of privacy (false imprisonment, exposure of a patient, defamation)
• Fraud

Question 7

Surgical Permit

Answer 7

Written
Voluntary
Informed (explained to the client)

Question 8

Informed Consent

Answer 8

• Possible complications, risks, disfigurements
• Removal of any organs or parts of the body
• Benefits and expected results

Question 9

Consent for minors

Answer 9

Children 14-years-old must agree to procedure along with parent/guardian

Question 10

HIPAA

Answer 10

Health Insurance Portability and Accountability Act of 1996

• patient privacy
• non-compliance can result in civil and criminal liability

Question 11

Good Samaritan Act

Answer 11

Protects nurse when providing emergency care

Question 12

LEADERSHIP STYLES

Democratic
Authoritarian
Laissez-faire

Answer 12

Democratic (parcipative): Assertive

Authoritarian (autocratic): Aggressive

Laissez-faire (permissive): Passive

Question 13

5 Rights of Delegation

Answer 13

Right:
Task
Circumstance
Person
Direction/Communication
Supervision

Question 14

Lewin’s Change Theory

Answer 14

(Nurse Leaders/Managers as Change Agents)

Unfreezing- Initiation of a change
Moving- Motivation towards a change
Refreezing- Implementation of a change

Question 15

4 Core Competencies for Interprofessional Collaborative Practice

Answer 15

1. values/ethics for interprofessional practice
2. roles/responsibilities
3. interprofessional communication
4. teams and teamwork

Question 16

Ebola

Answer 16

• Risk in US low ,even when working in West African communities.
• Direct contact with blood or bodily fluids
• Contagious after symptoms start (fever, severe headache, muscle pain, diarrhea, vomit, unexplained bleeding).
• 21 day isolation
• Full PPE

Question 17

Zika Virus

Answer 17

• Microcehpaly in babies of mothers with Zika

- Remains in blood of infected person for 1 week

Question 18

Disaster Biologic/Chemical/Radiation Agents

Answer 18

Biologic agents:
Anthrax, Pneumonic Plague, Botulism, Smallpox, Inhalation tularemia, Viral hemorrhagic fever

Chemical agents:
Biotoxin agents (ricin)
Nerve agents (sarin)

Radiation

Question 19

Acute Respiratory Distress Syndrome

ARDS

Answer 19

• Unexpected, catastrophic pulmonary complication occurring in a person with no previous pulmonary problems. Morality rate ~50% (higher with hx or etoh).
• Characterized by hypoxemia (even on 100% oxygenation), decreased pulmonary compliance, dyspnea, non-cardiac-associated bilateral pulmonary edema, dense pulmonary infiltrates on radiography

-Interventions: Elevate HOB 30 degrees, assist with daily awakening, implement comprehensive oral hygiene program, implement a comprehensive mobilization program.

Question 20

What PaO2 value indicates respiratory failure in adults?

Answer 20

PaO2 <60 mm Hg

Question 21

What blood value indicates hypercapnia?

Answer 21

PCO2 >45 mm Hg

Question 22

Respiratory failure symptoms

Answer 22

• Dyspnea, hyperpnea, crackles (rales), wheezing, decreased breath sounds
• intercostal or substernal retractions
• cyanosis, pallor, molted skin
• increasing diminished breath sounds
• diffuse pulmonary infiltrates on chest radiography (white-out appearance)
• verbalized anxiety, restlessness, confusion, agitation

Question 23

Shock

Answer 23

• Widespread, serious reduction of tissue perfusion (lack of O2 and nutrients)
• Early signs= agitation and restlessness from cerebral hypoxia

Types: Hypovolemic (most common, early/severe below), Cardiogenic, Distributive, Obstructive.

EARLY: tachycardia, hypotension, weak periph pulses, restlessness/agitation/confusion, pale cool clammy skin, decreased urine output (<30 mL/hr)

SEVERE: organ dysfunction, renal failure, pleural effusion, resp distress… renal failure and/or death.

Question 24

Disseminated Intravascular Coagulation (DIC)

Answer 24

In disseminated intravascular coagulation, abnormal clumps of thickened blood (clots) form inside blood vessels. These abnormal clots use up the blood’s clotting factors, which can lead to massive bleeding in other places.

Prolonged PT, PTT
Decreased platelets
Increased FSPs

Obvious signs of bleeding, such as hematuria, hematoma at venipuncture sites, hemorrhage in conjunctiva, petichiae.

Treatment: Heparin

Question 25

HELLP Syndrome

Answer 25

(hemolysis, elevated liver enzymes, low platelet count) -Usually develops before the 37th week of pregnancy but can occur shortly after delivery. Many women are diagnosed with preeclampsia beforehand. Symptom Triad: Headache Nausea/Vomit URQ/Abd pain (distended liver) -Treatment usually requires delivery of the baby, even if the baby is premature.

Question 26

Resuscitation (emergency)

Answer 26

Adults /Children: CAB Chest compressions, airway, breathing) Newborns : ABC Airway, breathing, chest compressions 100 compressions/min 2 in/5 cm deep 1 rescuer: 30:2 (for all) 2 rescuers: children/neonate 15:2

Question 27

Cardiac arrest on bedside monitor?

Answer 27

Defibrillation

Question 28

1st drug in hospital for cardiac arrest?

Answer 28

Epinephrine Also for anaphylactic rxns and severe asthma

Question 29

- Chocking child or infant procedure? | - "blind sweep" of mouth in children or infants?

Answer 29

- Child: subdiaphragmatic abdominal thrusts (Heimlich maneuver) until object expelled or pt unresponsive. - Infant: repeat cycle of 5 back blows (slaps), 5 chest compressions until expelled or unresponsive. -NEVER! The object might be pushed farther down into the throat. Only go in if object can be seen.

Question 30

Fluid volume deficit

Answer 30

- H2O and electrolytes can be lost isotonically (serum levels would remain normal) - Dehydration - oliguria (concentrated urine), weight loss, postural hyptension, weak/rapid pulse, decreased skin turgor, dry mucous membranes - Elevated BUN and creatinine, increased osmolarity, elevated Hgb/Hct

Question 31

Fluid volume excess

Answer 31

- H2O and electrolytes can be retained isotonically - Water intoxication; retain water and Na decreases - HF, RF, Cirrhosis, excess NaCl ingestion, over-hydration with Na-containing fluid, poorly controlled IV therapy. - Attention loss, confusion, aphasia, altered LOC - Decreased BUN, Decreased Hgb/Hct, Decresed serum osmolality, Decreased urine osmolality and specific gravity - JVD and peripheral edema

Question 32

BUN

Answer 32

Blood urea nitrogen is a medical test that measures the amount of urea nitrogen found in blood. The liver produces urea in the urea cycle as a waste product of the digestion of protein. -Directly r/t metabolic function of the liver and excretory function of the kidneys

Question 33

Creatinine

Answer 33

- Chemical waste product from muscle metabolism, which fluctuates very little. - Kidney function (GFR) - Affected very little by dehydration, malnutrition, or hepatic function... better test for renal function than BUN.

Question 34

erythropoietin (EPO) What is it? How to admin if exogenous.

Answer 34

Hormone manufactured by kidneys. - promotes the formation of red blood cells by the bone marrow. - damaged kidney= less EPO=reduced oxygen Exogenous: IV or SUBQ HYPERTENSION MAJOR ADVERSE EFFECT! Contraindicated. Take BP beforehand Initiated when HGB <10 to alleviate sx of anemia and ned for blood transfusions. D/C therapy or reduce dose for HGB >11 to prevent thromboembolism.

Question 35

Standard precautions

Answer 35

- Wash hands, even if gloves have been worn - Wear gloves for touching blood or bodily fluids or any non-intact body surface - Wear gowns during any procedure that may produce splashes (ex. change client with diarrhea) - Masks and eye protection during any activity that might disperse droplets (suctioning) - Do not recap needles, dispose in puncture-resistant container - Use mouthpiece for resuscitation efforts

Question 36

CD4 T-cell count r/t HIV

Answer 36

CD4 T-cell count: describes # of infection-fighting lymphocytes a person has HIV infection destroys CD4 T-cells ad invades them and replicates Low <750/mm3 for infants Low <500/mm3 kids 1-5 <200 kids>5/adults <15% severely immunocompromised

Question 37

HIV

Answer 37

transmission: blood and bodily fluids (unprotected sex, sharing needles, infected blood products, breast milk, needle stick) Universal precaution: protection from blood and bodily fluids is the goal. Initiate barrier protection b/w caregiver and client (hand washing, gloves, gowns/masks, eye protection) Labs: Confirm with Western blot test ELISA can have false-positives

Question 38

PQRSTU

Answer 38

PAIN Provokes (what makes it worse/better?) Quality (dull, aching, sharp, stabbing, burning) Region (where and does it radiate anywhere?) Severity (pain scale) Timing (how long, how often, and when?) Understanding (what do they think causing pain)

Question 39

5 stages of grief

Answer 39

``` Denial Anger Bargaining Depression Acceptance ```

Question 40

Ginger

Answer 40

Treatment of nausea

Question 41

Garlic

Answer 41

decreases hyperlipidemia *no known interaction with statin medications* Also anti-platelet. Stop taking before surgery

Question 42

Ginseng

Answer 42

erectile dysfunction, reduce fatigue, enhance mental performance

Question 43

St. John's Wort

Answer 43

Treats depression Do not mix with other antidepressants (SSRI's and tricyclic antidepressants)

Question 44

Hydration

Answer 44

- thins out mucus trapped in bronchioles and alveoli- facilitates exporation - essential for client experiencing a fever - 300-400 mL fluid lost in lungs daily through exporation

Question 45

Increased temps cause...

Answer 45

increase in metabolism and demand for oxygen. Fever also causes dehydration because of excess fluid loss (diaphoresis)

Question 46

Blue bloater

Answer 46

Chronic bronchitis Use of accessory muscles to breath Leads to RSHF (cor pulmonale) Bilateral pedal edema JVD

Question 47

Pink puffer

Answer 47

Pulmonary emphysema ``` "floppy" alveoli increased CO2 retention (pink) pursed lip breathing (prolonged expiration) barrel chest from chest overinflation unproductive cough tripod position hyper-resonance upon lung auscultation thin in appearance leads to RSHF (cor pulmonale) ```

Question 48

COPD

Answer 48

Chronic Obstructive Pulmonary Disease Chronic bronchitis (blue bloater) and pulmonary emphysema (pink puffer) * **Tobacco * **Occupational exposure to chemicals and just (Carbon monoxide, coal, biomass fuels) NOT FACTORS: alcohol, poor nutrition, being overweight Too much inspired oxygen (NC, mask, etc) can decrease drive to breathe - Report S/S infection (fever, increased sputum, worsening dyspnea) - Get Flu and pneumococcal vaccine - Use albuterol, ipratropium if SOB emergency - eat frequent, small, high calorie meals because of increased energy/work for breathing - -too full puts pressure on diaphragm -May lead to polycythemia (increase RBCs). Body trying to compensate for chronic hypoxia.

Question 49

ABC vs CAB

Answer 49

ABC-prioritize nursing actions CAB- during CPR

Question 50

Tuberculosis Dx and Meds

Answer 50

TB test (mantoux) 10mm or greater in diameter 48-72 hrs after test If (+) and Asymptomatic-might be latent (cannot transmit). Will have normal CXR and neg sputum culture. NO CORTICOSTEROIDS for latentTB! (prednisone). Might convert to active TB Meds: RIPE * Rifampin/Rifapentine - Red/orange discoloration of body fluids/tissues - --could perm discolor dentures and contact lenses - Reduces effectiveness of contraceptives - Take with meals - Hepatotoxicity (have liver function test each month) * Isoniazid * Pyrazinamide * Ethambutol

Question 51

Intracellular and Extracellular ions

Answer 51

Intracellular: Potassium and Phosphate Extracellular: Sodium and Chloride

Question 52

uremia

Answer 52

a raised level in the blood of urea and other nitrogenous waste compounds that are normally eliminated by the kidneys. Protein should be restricted in CRF clients GFR used as protein consumption indicator

Question 53

Acute vs Chronic Renal Failure

Answer 53

Acute: often reversible, abrupt deterioration of kidney function Chronic: irreversible, slow deterioration of kidney function AEB increased BUN and creatinine. Dialysis eventually required

Question 54

Acute Renal Failure Types and Phases

Answer 54

Phases: *Oliguric- Decreased Output! Pt in FVE, K increases because not excreting urine=HYPERKALEMIC *Diuretic- Increased Output! Pf in FVD (potential shock), excreting a lot of K=HYPOKALMIC Recovery- Types: * Prerenal- interference with renal perfusion * Intrarenal- damage to renal parenchyma * Postrenal- obstruction in urinary tract from the tubules to the urethral meatus

Question 55

Digoxin

Answer 55

- Increases strength and contractility of the heart. - Increases CO - Increases Kidney perfusion * Decreases HR (Hold if HR <60 bpm) - -Apical pulse for 60 seconds * Excreted through kidney, MEASURE KIDNEY FUNCTION (BUN, creatinine) - Hypokalemia can lead to toxicity Normal level: 0.5-2 ng/mL Used in: a-fib (controls arrhythmia), CHF Toxicity: Early: anorexia, nausea, vomit Late: arrhythmia and vision changes (halo of light or anything else)

Question 56

Nitroglycerin

Answer 56

causes dilation of coronary arteries allowing more oxygen to heart muscle used for chest pain (1 every 5 min for 15 min) - Call EMS if unchanged or worse 5 min after first dose - Treats stable angina - Stored away from light and heat in original container - replace every 6 months after opening

Question 57

Atropine

Answer 57

increases heart rate by blocking vagal stimulation (suppresses HR) Treats brady!

Question 58

Myocardial infarction med admin

Answer 58

MONA | morphine, oxygen, nitroglycerin, aspirin

Question 59

Abdominal Aortic Aneurism What is it? S/S?

Answer 59

- An enlargement of the abdominal aorta - life-threatening if it bursts. - common in older men and smokers. - grows slowly, without symptoms. - Progress: some people may notice a pulsating feeling near the navel. PAIN IN THE BACK, belly, or side may be signs of impending rupture.

Question 60

Thrombophlebitis

Answer 60

A condition in which a blood clot in a vein causes inflammation and pain.

Question 61

Sodium warfarin

Answer 61

``` Coumadin Takes 48-72 hrs to take effect. Overlap with heparin common PT (Prothrombin time) 10-12 sec INR: 2-3 Antidote- Vitamin K ``` Uses: A fib to prevent clots and reduce stroke risk, DVT, PE, Mechanical heart valves (prevent clots on valves) Contraindicated in pregnancy

Question 62

Heparin

Answer 62

aPTT 30-45 sec | Antidote- protamine sulfate

Question 63

APGAR Score

Answer 63

``` Appearance Pulses Grimace Activity Reflex/Irritability ``` 0=absent 1=decreased 2=strongly positive 7 and above= normal 4-6=fairly low 3 and below= critically low

Question 64

Umbilical cord

Answer 64

AVA 2 arteries 1 vein

Question 65

Maternal hypotension intervention

Answer 65

Stop pitocin Turn on left side Admin oxygen If hypovolemia, push IV fluids

Question 66

Antianemica

Answer 66

increase RCB production

Question 67

Anticholinergic Side Effects

Answer 67

BLOCK ACETYLCHOLINE ``` Hot as a Hare Dry as a Bone Blind as a Bat Red as a Beet Mad as a Hatter (confusion) ```

Question 68

Antidiarrheals

Answer 68

Decreases gastric motility and reduce water in bowel

Question 69

Miotics

Answer 69

Constrict pupils

Question 70

Mydriatics

Answer 70

dilates pupils

Question 71

Rule of nines

Answer 71

Body surface area for burns ``` Head: 9% Arms: 18% (9% each) Back: 18% Legs: 36% (18% each) Genitalia: 1% ```

Question 72

Aluminum Hydroxide

Answer 72

Amphojel GERD and kidney stones Watch out for constipation

Question 73

Hydroxyzine

Answer 73

Vistrail Anxiety and itching Watch out for dry mouth

Question 74

Midazolam

Answer 74

Versed Conscious sedation Watch out for resp depression and hypotension

Question 75

Dopamine

Answer 75

Treats symptomatic hypotension, shock, low cardiac output. | Monitor for arrhythmias and BP

Question 76

CPR on pregnant woman

Answer 76

Chest compressions slightly higher on sternum Displace uterus (might be crushing vena cava) by placing towels/wedge under right hip

Question 77

Postpartum vaginal bleeding

Answer 77

Saturating 1 perineal pad <1 hr is excessive boggy fundus= uterine atony, full bladder keeps uterus from contracting (make sure bladder empty) Oxytocin- uterotonic if fundus massage fails

Question 78

Diabetes Insipidus

Answer 78

decrease ADH made (or distributed from) hypothalamus - increase in thirst likely (polydipsia) - high serum osmolality - low urine specific gravity - weight loss - possible dehydration treatment: desmopressin acetate

Question 79

Duchenne's MD

Answer 79

- frequent trips/falls at home - places hands on thighs to push up to stand (Gower Sign/Maneuver) - walks on tip toes and has disproportionately large calves - progressive replacement of muscle tissue with connective tissue

Question 80

glipizide

Answer 80

Type 2 diabetes treatment | oral sulfonylurea for blood sugar

Question 81

levofloxacin

Answer 81

antibiotic Other drugs/supplements canbind 98% of drug Take 2 hrs post other meds/supps

Question 82

Potassium chloride usually given with?

Answer 82

usually given with diuretic to prevent hypokalemia

Question 83

heparin flush

Answer 83

usually 2-3 mL of 10 or 100 units/mL vials

Question 84

Foods for Calcium, Vit D, and both

Answer 84

Calcium: cheese, ice cream, greens, almonds, soy, tofu Vitamin D: tuna, oily fish, cod liver oil, egg yolks BOTH: milk, yogurt, salmon, cereal

Question 85

Suction Artificial Airway

Answer 85

- hyperoxygenate beforehand - suction no more than 10-15 seconds - wait at least 1-2 min between passes - medium suction pressure for adults 100-120 mm Hg

Question 86

Normal Troponins

Answer 86

Trop I <0.5 Trop T <0.1 increased for MI

Question 87

Management of Cystic Fibrosis Resp/Diet

Answer 87

Autosomal recessive Thickened mucus and plugged ducts RESPIRATORY: - frequent respiratory/sinus infections - -blood-streaked sputum (hemoptysis) as result of damaged blood vessels common - -priority if pt has 90% O2 on RA - Chest physiotherapy performed AFTER bronchodilators and nebs - potential pneumothorax DIET: - pancreatic deficiency leads to decreased absorption of fat-soluble vits (ADEK) - pancreatic enzymes on ALL food (burning if touches lips, make sure on food) - need INCREASED CALORIC DIET (high protein, high fat) - -difficulty maintaining weight and growth - fecal retention common..may have steatorrhea (fatty and frothy) MISC: -infertility

Question 88

Scopolamine

Answer 88

- anticholinergic to prevent nausea/vomit with motion sickness - behind ear (dry, hairless) - 4 hours before travel - replace 72 hrs

Question 89

Depression med directions

Answer 89

DO NOT combine use of SSRI (-pram) with MAOI (-ine). - Risk of seratonin syndrome - do not start SSRI until 14 days after stopping MAOI

Question 90

INR

Answer 90

2-3 Risk of bleeding increases as INR rises. If INR high, DO NOT ADMINISTER ANTICOAGULANT (warfarin)

Question 91

Ventricular Tach on monitor | 1st action?

Answer 91

CHECK PULSE VT with and without pulse possible. With Pulse: check for clinical stability and O2 sat Stable? antiarrythmic meds Unstable (AMS, shock, hypotension, CP, acute HF)? synchronized cardioversion Without Pulse: CPR/Defib

Question 92

Oxytocin Infusion

Answer 92

- Assess uterine contraction pattern - Monitor I and O - Place IV oxytocin in electronic infusion pump - Connect to secondary line that's attached to the mainline in the PROXIMAL port. Prevents bolus and allows for sudden stop of infusion. - Continuous electronic FHR monitoring

Question 93

Post-op Chest Tube

Answer 93

Alert HCP if drainage: >3mL/kg/hr for 3 consecutive hrs OR >5-10 mL/kg for 1 hr Potential hemorrhage or cardiac tamponade

Question 94

Hypothermia post op?

Answer 94

Normal

Question 95

Infant I and O

Answer 95

1-2 mL/kg/hr

Question 96

isosorbide

Answer 96

-Actions identical to nitroglycerine -decreases cardiac workload by reducing preload and afterload -Can cause hypotension from vasodilation -Hold when systolic BP <90 (kidneys trouble with profusion at 80 mmHg)

Question 97

Basal Long-Acting Insulin

Answer 97

Glargine (Lantus) Detemir Once Daily Works up to 24 hrs Onset: 1-1.5 hrs

Question 98

Intermediate-Acting Insulin

Answer 98

NPH (Humulin N/Novolin N) ***CLOUDY (draw clear before cloudy) ***2x daily Onset: 1.5-4 hrs Duration: 12-18 hrs

Question 99

Short-Acting Insulin

Answer 99

Regular (R) Insulin ***Best for IV (DKA) Onset: 30min-1 hr Peak: 2-4 hrs Duration: 8 hrs

Question 100

Rapid-Acting Insulin

Answer 100

Lispro, Aspart, Glulisine ***Best for post-meal hyperglycemia Onset: <15 min Peak: 1-2 hrs Duration: 4-6 hrs

Question 101

Burns

Answer 101

Burn injuries cause cellular destruction, capillary leaking, and fluid shifts (emergent phase 24-72 hrs) Fluids are lost during the emergent phase (first 24-72 hours), resulting in hypovolemia and hyponatremia. The blood becomes more viscous and increased hematocrit and hemoglobin values result. Cellular damage releases potassium, which causes hyperkalemia.

Question 102

Halo external fixation device

Answer 102

``` cleaning- chlorahexadine or water Keep vest liner clean/dry Foam inserts under pressure points Small pillow when supine Keep correct-sized wrench for emergencies ``` ``` DO NOT: touch device frame when positioning patients adjust pins (HCP only) ```

Question 103

Hypothermia: The client is being rewarmed with blankets, and the IV fluids are being changed over to warmed fluids. What additional intervention is a priority?

Answer 103

Attach cardiac monitor After, get additional large bore IV and cover clients head to reduce heat loss (core takes priority over extremities)

Question 104

Bulimia nervosa

Answer 104

Binge eating followed by vomiting, excessive exercise, use of laxatives. Usually normal or just-above-normal weight. Anorexia- severe weight loss bulky clothing to hide excessive weight loss.

Question 105

Electroconvulsion Therapy

Answer 105

- induces generalized seizure, d/c any anti-convulsant medication - helps treat mood disorders (major depression and bipolar) and schizophrenia About: NPO 6-8 hrs, driving not permitted during treatment, temporary memory loss/confusion immediate side effect, anesthesia used during procedure

Question 106

EpiPen

Answer 106

Inject mid-outer thigh through clothing, hold there for 10 seconds

Question 107

Bipolar Mania

Answer 107

Hyperactivity Auditory hallucinations Risk-taking behaviors

Question 108

Lithium Toxicity

Answer 108

Normal: 0.6-1.2 >1.5 = toxicity Risk factors: - dehydration (1-2 L water daily) - decreased renal function (elderly) - diet low in sodium (YAY FOR SALT!) - drug-drug interaction (NO NSAIDS and thiazide diuretics) * **acetaminophen for pain relief Acute: GI symtoms Chronic: Neuro symptoms

Question 109

Licorice Root

Answer 109

- herb for GI disorders - when used with diuretics such as HCTZ, increased POTASSIUM LOSS - risk for hypokalemia -Pts using diuretics mostly include those with heart disease and/or hypertension

Question 110

PPV

Answer 110

Positive Pressure Ventilation - increased pressure/expansion in lungs compresses thoracic vessels - decreased venous return, ventricular preload, and cardiac output = HYPOTENSION - worse with hypovolemia and decreased venous tone (neuro or septic shock)

Question 111

Necrotizing Enterocolitis

Answer 111

``` Pre-term infants Life threatening Underdeveloped intestines/gut immunity Frequent abdominal girth measurements Supine and undiapered Avoid rectal temps (perforation) ```

Question 112

Acute diarrhea | Pediatric

Answer 112

- Oral rehydration therapy (even if vomiting) - Avoid BRAT diet - Assess frequency/amount of wet diapers, fluid intake, sunken eyes - Protect perineal skin breakdown using skin barrier cream

Question 113

Uterine Rupture

Answer 113

- Vaginal Birth After Cesarian (VBAC) at higher risk - 1st: abnormal FHR pattern (fetal decel & brady) * **constant pain, loss of fetal station, sudden stop of contractions Unrecognized UR: hemorrhage, hypovolemic, shock, maternal tachy

Question 114

Nephrotic Syndrome What is it? Who does it affect? Treatment

Answer 114

``` AID Affects kids 2-7 -proteinuria hypoalbuminemia (--fluid shift) -edema (eye, periph, ascites) -hyperlipidemia ``` Treatment: - Corticosteroids/immunosuppressants - Loss of appetite management (make foods fun/attractive) - Infection prevention (limit social interaction) - Low sodium diet while remission - fluid restriction in severe edema - recurrence rate high. Parent's need to check protein in urine daily, weight weekly. Record results!

Question 115

Latex allergy

Answer 115

lip swelling from bananas, kiwis, tomatoes, peaches, grapes or avocados latex balloons Or rash/Itching 3-4 days after exposure to latex product

Question 116

Isotretinoin

Answer 116

-Nodulistic Acne It's derived from vitamin A, so don't take extra! Priority: 2 forms birth control! More info: - increased ICP risk - AVOID tetracycline - photosensitivity (sunscreen) - blood donations discouraged - don't break capsules - dryness of eyes and mouth and skin common. - not for prig's (teratogenic)

Question 117

Using a Cane (regular and on Stairs)

Answer 117

Should be held on strong side! Ex. R-sided stroke = weak left side=hold in R hand UP: strong leg, cane, weak leg DOWN: cane, weak leg, strong leg Pt with total knee replacement can usually bear full weight by time of discharge

Question 118

Placenta Previa

Answer 118

-Abnormal implantation of placenta. Covers cervical os (opening) * Painless vaginal bleeding >20 wks - increased r/f hemorrhage RN: electronic fetal monitoring pad counts draw a type and screen large-bore IV DO NOT: vaginal/digital exam (even for dilation)

Question 119

Long term corticosteroid therapy

Answer 119

Hydrocortisone Primary drug for Addison's disease - never stop abruptly - notify HCP for s/s of infection - monitor blood glucose closely if diabetic - increase dose in times of stress - osteoporosis - muscle weakness - catracts - GI upset (take with food) DIET: high calcium (1500mg) high protein (1.5g/kg) Low fat, low simple CHO

Question 120

Brachytherapy

Answer 120

Internal radiation via implant - 30 min total time near pt during shift - dosimeter film badge required - no pregos or <18 near pt - 6 feet distance for all staff - door closed and radioactive sign outside - private room/bathroom - bedrest to prevent dislodgment of implant (24-72 hrs) - shield with lead with physical contact

Question 121

Anesthesia Pre-op Question

Answer 121

"Has anyone in your family had a bad reaction to anesthesia?" MALIGNANT HYPERTHERMIA * **muscle stiffness*** * **hypercapnia*** * **hyperthermia*** - rare, life-threatening INHERITED muscle abnormality - succinylcholine inhalation at start of anesthesia - increases Ca release in muscles - -rigidity, increased O2 demand, increased temp S/S: tachypnea, tachycardia, rigid jaw (general rigidity). Progresses to increased fever IV dantrolene is reversal agent! Slows metabolism Also cool client and treat hyperkalemia

Question 122

WBC count

Answer 122

4,000-11,000

Question 123

Chemotherapy Safety

Answer 123

- Low WBC (<4,000) likely - Reverse/Protective Isolation (pt wears mask) - Private room - -HEPA filtration or Pos Pressure AVOID: raw fruits/veggies, standing water, undercooked meat, HCP's with a cold Lowest WBC count (nadir) 7-10 days after initiation

Question 124

Endotracheal Suction

Answer 124

- sterile - hyperoxygenate beforehand - intermittent suctioning during withdrawal only, 10 seconds - 4 or 5 recover breaths or 1-2 min b/w passes

Question 125

Antiplatelet medications

Answer 125

prasugel (Effient) clopidogrel (Plavix) ticagrelor (Brilintal) post coronary intervention STOP 5-7 DAYS BEFORE SURGERY Also stop NSAIDS (aspirin, ibuprofen, naproxen, celecoxib) -Prolong bleeding time ``` Concerns: Ginkgo biloba Peptic ulcer disease Bleeding disorders Active bleeding IC hemorrhage ```

Question 126

IBS diet

Answer 126

Well tolerated foods: protein, breads, bland foods -increase fiber intake as tolerated (whole grains, nuts, legumes, fruits, veggies) ``` AVOID: GI irritants. Gassy foods (bagels, bananas, cabbage, onions), alcohol, caffeine, spicy foods, dairy, fatty foods ```

Question 127

IBD exacerbation and sulfasalazine Rx

Answer 127

Sulfasalazine topical GI anti-inflammatory and immunomodulatory agent. - Dehydration risk of IBD. - Sulfa crystalizes in kidneys if dehydrated. - Yellow-orange discoloration of skin and urine normal for med. - Photosensitivity - Folic acid deficiency PRIORITY FOLLOW-UP: Urine specific graviey of 1.035 Normal: 1.003-1.030 IBD: increased erythrocyte sedimentation rate, WBC, and c-reactive protein normal. Mild anemia normal for chronic inflammatory conditions.

Question 128

SBAR

Answer 128

Situation Background Assessment Recommendation/Request

Question 129

Uterine Infection

Answer 129

Postpartum Endometritis ``` foul-smelling lochia fever chills tachycardia uterine tenderness ``` Serum lab draw for blood culture and sensitivity needed prior to antibiotic administration

Question 130

Constipation

Answer 130

Common- pregos and pts taking ferrous sulfate (iron) supps ``` High fiber diet (nuts, seeds, fruits, veggies) High fluid intake Regular exercise Bulk-forming fiber supplements Avoid caffeine (b/c it's a diuretic) ```

Question 131

Otitis media

Answer 131

infants and kids <2 Often follows respiratory infection such as flu or RSV ``` Risk factors: Tobacco exposure Regular pacifier use (after 6mo) Drinking from bottle while lying down Lack immunizations (pneumococcal series) ```

Question 132

Otitis externa

Answer 132

excess water in ears from bathing or swimming "Swimmers ear" Damage due to foreign body in ear also increases risk

Question 133

Neuro Assessment Needed if...

Answer 133

``` Nuchal rigidity (stiff neck, won't bend down) -meningitis ``` Fixed dilated pupils: -increased ICP Normal: 3-5mm New limb drift- stroke NORMAL ASSESS: positive doll's eye (oculocephalic reflex) -intact brainstem Absent adult Babinski reflex -toes point down w/ stimulation on sole for negative. Normal to fan toes (+ reflex) in infants up to 1 yr.

Question 134

Tetralogy of Fallot (TOF)

Answer 134

4 defects: Ventricular Septal defect, Stenotic Pulmonary Valve, Overriding Aorta (from R/L V's), Right Ventricular Hypertrophy - Cyanotic cardiac defect - Infants w/ TOF normally maintain O2Sat of 64-85% until surgically corrected - Increased HGB (polycythemia) result of compensation for hypoxia. DANGEROUS b/c increases blood viscosity. - Stroke or thromoembolism - Must stay hydrated Knee-to-chest position to relieve pain. Normal Infant HGB: 12.5-20.4

Question 135

Rapid Response Team

Answer 135

``` HR <40 or >130 SBP <90 Resp rate <8 or >28 O2Sat <90 w/ oxygen Urine output <50 mL/4hrs LOC change for 10 min ```

Question 136

Glascow Coma Scale | GCS

Answer 136

``` High number is good! Highest= 15 -Eye opening response (1-4) -Verbal Response (1-5) -Motor Response (1-6) ``` ``` 15- normal 13-14 mild 9-12 moderate head injury <8 severe "WHEN YOU ARE 8, YOU INTUBATE" 3 deep coma or brain death ```

Question 137

ADHD

Answer 137

3 core sx: hyperactivity impulsiveness inattention Other: - impaired social skills - low self-esteem - increased risk for depression, anxiety, learning disability, substance abuse - academic or work failure

Question 138

Tension pneumothorax

Answer 138

- progressive build up of air in pleural space - d/t lung laceration - no more pressure holding lungs in place, everything pulled to the opposite side! TRACHEAL DEVIATION! -emergency large bore needle decompression followed by chest tube placement to relieve pressure on mediastinal structures

Question 139

Somatic Symptom Disorder (SSD)

Answer 139

psych disorder stress related unexplained physical sx RN: redirect somatic complains to unrelated neutral topics -limit time discussing physical symptoms - recognize secondary gains (increased attention, freedom from responsibilities) - recognize factors that intensify sx (stress) - incorporate coping strategies

Question 140

Black cohosh

Answer 140

Herbal supp Menopausal hot flashes Side effects: thickening of uterine lining, liver toxicity

Question 141

Post cataract surgery

Answer 141

AVOID anything that increases intraoccular pressure: - bending - lifting >5 lbs - sneezing/coughing - rubbing eye - straining during BM Normal: itching, photophobia, mild pain several days post-op

Question 142

Misoprostol

Answer 142

- Synthetic prostaglandin - protects against gastric ulcers by decreasing stomach acid and increasing mucus production - usually prescribed to pts on long-term NSAID therapy to avoid ulcers

Question 143

Hepatic Encephalopathy

Answer 143

-temporary worstenig of brain function in ppl with end-stage liver disease -inadequate detox of ammonia from blood Sx: - factor hepaticus (must, sweet breath) - lethargy - confusion - slurred speech - coma - asterixis (flapping tremor) - constipation (need 2 BM's daily on lactulose)

Question 144

Bacterial meningitis

Answer 144

Most critical intervention: start antibiotic therapy! Initiate sz precautions IF necessary, but still start therapy first. Cause will be determined by LP and blood cultures Complications: hearing loss, permanent brain damage, etc.

Question 145

Monoamine oxidase inhibitors (MAOIs)

Answer 145

Antidepressants common: isocarboxazid, phenelzine, tranylcypromine - increased risk for SI - avoid tyramine containing foods (cheese, overripe fruit, liquor, fermented foods) can cause hypertensive crisis - sleep dysfunction - nausea/constipation

Question 146

Collect Sputum Speciment

Answer 146

1. rinse mouth with water 2. wit on side of bed 3. inhale deeply several times 4. cough deeply to raise enough sputum (4-10mL) 5. expectorate into STERILE specimen container

Question 147

mal de ojo

Answer 147

``` "Evil Eye" Latin American -caused by stranger admires child -kids vomit, fever, cry -"cure" by admirer touching the child while speaking to the child or immedately afterwards ```

Question 148

Rheumatoid arthritis | morning stiffness and pain reduction

Answer 148

Take warm shower or bath upon waking. Heat decreases stiffness and promotes muscle relaxation and mobility - ROM exercises daily to maintain joint flexibility - Moist heat packs to stiff joints - Ice packs to painful joints - Frequent rest - Sleep in flat, neutral position to keep joints straight

Question 149

Codeine adverse effects

Answer 149

- constipation (drink 8 glasses water, increase fiber, laxatives if needed) - nausea/vomiting (take meds with food) - orthostatic hypotension (sit at side of bed before standing) - dizziness

Question 150

Higher Suicide Risk

Answer 150

SAD PERSONS Sex (men>women) Age (teens, young adults) Depression (hopelessness) ``` Prior attempt Ethanol/drug use Rational thinking loss (hearing voices) Support system loss (living alone) Organized plan No significant other Sickness (terminal) ```

Question 151

Phlebostatic Axis

Answer 151

4th IC space, mid-axillary line (close to V6) Used as reference for placement of transducer when measuring continuous arterial BP, CVP, central line, Swan-Ganz cath, etc

Question 152

Triple Lumen Catheter Central Venous Catheter

Answer 152

Administers fluids, meds (non-compatible ok), parenteral nutrition, and used for hemodynamic monitoring (ex. CVP) CVC=central venous cath -inserted by HCP in 'central' vein (subclavian, internal jugular, femoral) Priority: check placement with chest x-ray! Make sure tip is in lower-third of superior vena cava Blue: IV fluids/CVP White: TPN Red: Blood (do not flush with saline if hemolytic rxn)

Question 153

decompensated heart failure with frothy pink sputum

Answer 153

``` Administer diuretic (ex. furosemide) STAT. -pulmonary edema needs to be resolved ```

Question 154

Allen Test

Answer 154

Done before arterial cath placed. -Have pt make fist -Occlude radial and ulnar arteries using firm pressure -Instruct pt to open fist (palm will show pallor) -Release pressure on ulnar artery -Palm pink in 15 sec = patent ulnar artery

Question 155

Check arterial cath

Answer 155

``` color capillary refil sensation temperature movement ``` Compare 2 sides or from baseline assessments

Question 156

Possible abdominal aortic aneurism (AAA) repair complications

Answer 156

Pulses can be absent 4-12 hrs post-op d/t vasospasm. If PEDAL PULSES DECREASE from baseline with cool, or mottled extremity 2 days post op, potential ARTERIAL OR GRAFT OCCLUSION/LEAKAGE Dangerous!!! Graft leakage: - ecchymosis of scrotum, penis, or perineum - increased abdominal girth - report of groin, pelvis, or back pain - tachycardia - weak/absent peripheral pulses - decreasing hob - decreased urinary output

Question 157

Preterm birth risks

Answer 157

- Infection (periodontal disease, UTI) - #1 risk factor: Hx of spontaneous preterm birth - previous cervical sx (ex. cone biopsy- weakens cervical support) - tobacco and/or illicit drug use - age <17 and >35 - malnutrition - non-hispanic black women

Question 158

von Willebrand disease

Answer 158

- Genetic bleeding disorder - decreased vWF, needed for coagulation Pt Teaching: - med bracelet! - Avoid NSAIDS - Avoid high-risk activities (contact sports) - keep nasal mucosa moist - maintain gum integrity (soft bristled toothbrush) - notify HCP s/s bleeding (severe joint pain/swelling, headache after injury, blood in urine/stool, uncontrollable nosebleed)

Question 159

Opiod intoxicatoin

Answer 159

Decreased respiratory rate (<12/min) Decreased mental status Constricted (miotic) pupils (may not be in every pt) Decreased/absent bowel sounds ***Naloxone (Narcan) reverses CNS and respiratory depression Pruritus and nausea common/expected Admin histamine blockers if needed

Question 160

Newborn Safety

Answer 160

- Rear-facing carseat in back seat - rolled blankets or car seat inserts may be used to support trunk if small baby - supine position while sleeping - sleep in crib in clothing, such as a sleep sack (baby warm without head covered) - remove loose bedding and other objects from crib - crib slats no more than 2.25 inches apart

Question 161

Benzodiazepines

Answer 161

Anti-anxiety meds alprazolam lorazepan clonazepan diazepan Take at bedtime

Question 162

Catheter size based on fluid

Answer 162

BLOOD or Somewhat stable adult client needing a lot of fluid: 18-gauge EMERGENCY: large bore, 14-gauge General IV fluids and meds: 20-22 Children and Geriatrics w/ fragile veins: 24

Question 163

Leukopenia and Neutropenia

Answer 163

Leukopenia: Reduced WBC count (normal 4,000-11,000) ***aka: agranulocytosis Neutropenia: Reduced absolute neutrophil count (normal 2200-7700) Neutropenic precautions: - private room - strict handwashing - avoid exposure to sick ppl - avoid all fresh fruits, veggies, flowers - all equipment used disinfected Neutropenia from cancer treatment puts pt at high risk for infection and sepsis (hypotension, elevated lactic acid)

Question 164

Pinprick fail

Answer 164

peripheral neuropathy

Question 165

Loss of hair on LE

Answer 165

poor perfusion likely they also have poor wound healing

Question 166

Rheumatic Fever

Answer 166

2-3 weeks after streptococcus pharyngitis Major: J<3NES Joints, Heart, Nodules, Erythema, Sydenham chorea Minor: Fever, arthralgias, increased sed rate/c-reactive protein, prolonged PR interval 2 major OR 1 major + 2 minor (+ preceding strep)

Question 167

Feeding Tube

Answer 167

- Crush, dissolve, and deliver each med separately - Determine if med in liquid form - Flush tube with sterile water before and after med admin

Question 168

Chicken Pox

Answer 168

- Varicella - Vesicular lesions * **Airborne spread secretions*** - -put mask on child if in ER until placed in isolation negative airflow room - Most contagious 1-2 days before the rash until shortly after onset (until crusted over) *Herpes zoster (shingles) caused by same virus. Airborne and contact precautions.

Question 169

(-) vs (+) air pressure room

Answer 169

Positive: pushes air out of room by increasing rate of flow. Used for immunosuppressed clients to prevent normal environment from entering. Negative: ventilation system that removes more exhaust air form the room that air allowed into the room. Prevents infection from spreading out into the environment. Used for airborne spread of disease.

Question 170

Infective endocarditis

Answer 170

Vegetation over valves. Can break off and embolize. Life threatening! -prophylactic antibiotics before for high-risk procedures (ex. dental work) - Call HCP or 911 if any sign of embolization: * slurred speech * ONE-SIDED weakness/paralysis/pain * painful/cold extremity - IV antibiotics for several (4-6) weeks post discharge - Report persistent fever S/S may include: Myalgia (muscle pain), chills, fever, joint pain, anorexia, petechiae, osler node (fingers), splinter hemorrhage (nail bed)

Question 171

Post op: | radical prostatectomy

Answer 171

Avoid any rectal interventions such as straining, suppositories or enemas! Prevent stress on suture lines/surgical areas. Encourage fluid intake, ambulation (DVT), cleaning indwelling cath w/ warm water and soap.

Question 172

Erb's Point (cardiology)

Answer 172

3rd intercostal space Left sternal border Best place to hear S2

Question 173

Bruit

Answer 173

Bell of stethoscope | Swish/buzzing sounds: turbulent blood flow in a narrowed blood vessel or aneurism

Question 174

TPN discharge plan

Answer 174

- change tubing q24h - immediately report red or drainage at insertion site - monitor temp - capillary glucose tests

Question 175

RACE

Answer 175

RESCUE anyone in immediate danger ALARM- activate a pull station alarm box CONFINE fire by closing doors, windows, and shutting off main O2 supply EXTINGUISH or EVACUATE

Question 176

line infiltration

Answer 176

I.V. fluid or meds leak into surrounding tissues lumen dislodged or displaced from lumen of the vein Usually a place of flexion or person with brittle veins

Question 177

Injury patterns of non-accidental traumas | Pediatrics

Answer 177

- Coup-contrecoup (shaking baby, head flopping) - Subdural and epidural hematomas - retinal hemorrhage - frenulum tears and gingival lesions - linear-type immersion burns - long bone fractures (humerus, femur) - burns the shape of household items - repeated injuries at different stages of healing - lapsed time between injury and care sought - inconsistency b/w injury and caregiver explanation - shaken baby syndrome

Question 178

Shaken baby syndrome

Answer 178

Irritability or lethargy Poor feeding Emesis (vomit) Seizures

Question 179

Advanced directives

Answer 179

clients choices for medical care at the end of life, including resus status AD>family wishes

Question 180

Second degree Type 2 Heart block

Answer 180

Not every P wave has QRS complex (can be ratio) Check PR interval Need transcutaneous pacemaker -stop potential cardiac arrest

Question 181

Adenosine

Answer 181

SVT | creates transient heartblock

Question 182

Warts and HPV Teaching

Answer 182

- warts can be treated but can return - High risk HPV strains (16/18) increase risk of cervical, oral, and genital cancers - Vaccine <26 years of age, more effective before sexually active - PAPs start at 21 years old EVEN IF sexually active - barrier methods reduce risk, but don't prevent transmission

Question 183

TB Test

Answer 183

Mantoux test PPD (purified protein derivative) Airborne bleb 48-72 hours >5mm induration Considered POSITIVE if: -HIV, organ transplant, recent contact with person with TB, immunosuppressed >10mm induration Considered POSITIVE if: -recent arrival (<5 yrs) from high prevalent country, healthcare employees, mild immunosuppression, kids <4 yrs, comorbidities (basically unhealthy) >15mm induration Considered POSITIVE if: person is healthy Redness without induration (raised hard area) is NEGATIVE. Bacillus Calmette-Guerin vaccine increase TB resistance in increased risk pts. Can produce false positive.

Question 184

After positive TB test

Answer 184

Further test: chest x-ray if not symptomatic Active TB: isolation and airborne N95 mask If pt transferred, they just need to wear surgical mask

Question 185

Dabigatran (Pradaxa)

Answer 185

thrombin inhibitor anticoagulant Uses: atrial fibrillation, pulmonary embolus, DVT Increased risk for: bleeding and hemorrhage

Question 186

Phenytoin (Dilantin)

Answer 186

Anti-seizure medication Therapeutic range: 10-20mcg/mL Stop enteral feedings (1-2 hr), antacids, and calcium before taking. *Early Toxicity: horizontal nystagmus Gait unsteadiness *Later: slurred speech, lethargy, confusion, coma ``` Gingival hyperplasia (puffy gums)- expected side effect -Need good oral hygiene ``` Developing rash??? CALL DOC! Could be start of Steven-Johnson Syndrome Other risks: - increased body hair - folic acid depletion - osteoporosis

Question 187

Invalid Consent

Answer 187

If client still has questions indicating incomplete undersatnding

Question 188

Restraints

Answer 188

Hourly neurovascular checks Release for skin check and ROM q2h Offer fluid, toilet, nutrition q2h

Question 189

Prioritize Nurse Dx

Answer 189

Maslow's Hierarchy of Needs

Question 190

Parent refuse meds or treatment

Answer 190

Open ended question Assess parent knowledge first --condition --necessity of treatment

Question 191

Respiratory syncytial virus (RSV)

Answer 191

- affects ciliated cells of respiratory tract - excess mucus - rhinorrhea (runny nose) - fever, cough, lethargy, irritability, decreased feeding Severe: tachypnea, dyspnea, poor oxygen exchange Treatment: supplemental oxygen, suction, increase HOB, antipyretics, IV fluids, Palivizumab injection Contact isolation, droplet within 3 ft of pt. Transmission: DIRECT CONTACT WITH RESPIRATORY SECRETIONS.

Question 192

Increased ICP Treatment

Answer 192

HOB >30 degrees Head and body midline (promote venous return) Stool softeners (prevent straining) Calm environment (quiet) Suction only when needed (no more than 10 sec) Treat fever aggressively to decrease metabolic demands

Question 193

Best CPR outcomes

Answer 193

defib early increases outcomes! Chest clean and dry Remove any medication patches before applying AED pads

Question 194

Early Decelerations in Contraction Stress Test

Answer 194

Baby and Mom have symmetrical reactions Onset, peak, and finish the same. Cause: compression of head during contraction, results in vagal stimulation resulting in slowing fetal HR. No intervention necessary

Question 195

Late Decelerations in Contraction Stress Test

Answer 195

Baby onset at peak of Mom contraction. Baby delayed compared to contraction. Cause: Uteroplacental insufficiency, fetus has decreased oxygen reserves, maternal supine hypotension, placenta previa, abruptio placentae Treatment: reposition mom, IV bolus, stop pitocin, give oxygen ***Needs further testing

Question 196

Variable Decelerations in Contraction Stress Test

Answer 196

``` Random decrease (>15bpm for >15 sec) in fetal HR not associated with contraction. R/T umbilical cord compression. ``` Change maternal position, check for prolapse, decrease or turn off pitocin, admin O2, prepare amnioinfusion ***Needs further testing

Question 197

oligohydromnios What is it? Complications?

Answer 197

deficiency in amniotic fluid Complications: -pulmonary hypoplasia, might need resuscitation after birth -umbilical cord compression, continuous fetal monitoring for variable decelerations

Question 198

Prenatal Fetal Abnormalities | *Infections*

Answer 198

``` TORCH Toxoplasmosis Other (parvo/varicella-zoster) Rubella Cytomegalovirus Herpes ```

Question 199

Chest Pain | Treatment if MI

Answer 199

CP=potential MI... MI sx: CP, diaphoresis, dyspnea, anxiety ``` Treatment: ABC's 12 lead, cardiac markers, electrolytes Apply O2 Insert 2 large-bore IV's and administer medications (nitro, morphine, etc) ```

Question 200

IV Potassium

Answer 200

Heart monitor Monitor IV frequently (K=tissue necrosis) Max inf rate - 10 mEq/hr (PIV) Max concentration 40 mEq/L Assess renal function beforehand (potential K toxicity)

Question 201

Petichiae

Answer 201

- reddish/purple pin points on skin - r/t bleeding of capillaries from blood vessel injury or bleeding disorders Dark skin patients: conjunctivae of eyes or buccal mucosae

Question 202

Jaundice

Answer 202

Increased bilirubin | Dark skinned pts- check sclera, palms, and soles

Question 203

Administer intermittent enteral feeding

Answer 203

- HOB 30-45 degrees before and 30-60 min after - Assess tube placement - Assess bowel function (sounds and residual volume...return residual to stomach) - Flush tube 30mL - Administer feeding Abd cramps? too fast or too cold

Question 204

Abruptio Placentae

Answer 204

bleeding, abdominal pain, uterine tenderness, increased uterine resting tone

Question 205

Cushing Triad

Answer 205

Cause: INCREASED ICP -Irregular respirations (Cheyne-Stokes) -Bradycardia. -Systolic hypertension with widening pulse pressure (difference b/w systolic and diastolic)

Question 206

High Potassium Foods

Answer 206

``` Rainbow colors! Red- strawberry, tomato (NO APPLE) Oranges- oranges, cantaloupe, carrots, apricot Yellow- banana, potato Green- avocado, kiwi Blue from blue sea-fish Violet-raisins ```

Question 207

Low Potassium Foods

Answer 207

Asparagus, green beans, apples, apple sauce, green peppers, peas, grapes, grapefruit, peaches, pears, pineapple, cottage cheese, chicken, turkey, shrimp, tuna, eggs, bread, pasta, white flour, rice

Question 208

Pre-eclampsia

Answer 208

New onset hypertension AND proteinuria or end-organ dysfunction AFTER 20 WEEKS GESTATION S&S: headache, visual changes, edema (normal for all pregos) HTN: >140/>90 on 2 occassions or 4 hrs apart OR >160/>110 confirmed on repeat Proteinuria: >300mg (0.3g) protein in 24-hr urine collection OR protein to creatine ration 0.3 OR urine dipstick +1 ``` End Organ Dysfunction: Thrombocytopenia (<100,000) Renal insufficiency (Creatinine >1.1) Impaired liver function (2x normal AST and ALT) ***Normal AST 10-40/L ALT 7-56/L) Pulmonary Edema Cerebral or Visual Sx ```

Question 209

Ostomy Care

Answer 209

- Change appliance 5-10 days - Drink plenty of fluids - Appliance needs to fit well (if loose, digestive enzymes on skin and will be irritated) - Empty when 1/3 full - Decrease intake of gas forming foods (onions, beans, broccoli, cauliflower)

Question 210

Urosepsis

Answer 210

Bloodstream infection originating from urinary tract Treatment: - Fluid - IV broad spectrum antibiotics (valsartan) - Blood/urine culture (ideally before antibiotics) - Heart monitor (potential hyperkalemia and sepsis)

Question 211

Hyperkalemia | Avoid which meds?

Answer 211

Ace inhibitors (-pril) and ARBS (-sartan). Used for htn secondary to renal disease. Can worsen hyperkalemia Don't consume salt substitutes- high in K

Question 212

Risperidone

Answer 212

Use: Schizophrenia, bipolar, other mental disorders Other atypical antipsychotics: quetiapine, olanzapine Common S&S: - Extrapyramidal Sx: akathesia (restlessness, fidget), parkinsonism (tremors, shuffling) *may be mistaken for agitation so watch closely - Anticholinergic effects (dry mouth, constipation) - Sedating Effects - Change position frequently to prevent ortho hypotension - weight gain Serious S&S: -Fever and Muscle rigidity: Neuroplastic malignant syndrome (potentially fatal)

Question 213

Tardive Dyskinesia

Answer 213

repetitive, involuntary movements, such as grimacing and eye blinking Cause: long-term use of neuroleptic drugs, which are used to treat psychiatric conditions.

Question 214

3 P's of Diabetes

Answer 214

Polydipsia (thirsty) Polyuria (>200mL/hr-increase in dilute urine) Polyphagia (increased appetite)

Question 215

Hyperglycemia

Answer 215

``` Polydipsia (thirsty) Polyuria (excess dilute urine) Polyphasia (hungry) Headaches Blurred Vision ``` TPN increases glucose, hyperglycemia = risk

Question 216

Seizure activity RN interventions

Answer 216

Assist to safe position, protect head, clear area Loosen tight clothing Administer O2 if cyanotic Document time and duration of sz

Question 217

Bruising behind ear

Answer 217

AKA: Battle Sign Follows head trauma =basilar skull fracture ***Most common cause of traumatic death in kids Other S/S: Blood behind tympanic membrane, periorbital hematomas (raccoon eyes), CSF leak from nose and ears

Question 218

Aldosterone

Answer 218

adrenal glands mineralcorticoid RETAINS SODIUM AND WATER Too much? fluid overload Cushings Hyperaldosteronism (Conns) Not enough? Lose Na and H2O Fluid volume deficit Addison's Disease (ADD Steroids) Decreased Na/H20--increase K Increased Na/H2O--decreased K

Question 219

ADH

Answer 219

Anti-Diuretic Hormone Pituitary RETAIN WATER WATER WATER!!! ``` Too much? Retain H2O in vascular space Fluid volume excess SAIDH- decrease urine output because ADH too high *dilute blood concentrated urine Decreased specific gravity and Na ``` *D*iabetes Insipidus- not enough ADH D=Diuresis!!! still putting out dilute urine NEEDS EXOGENOUS ADH *urine diluteblood concentrated Head trauma? Watch urine output. Potential ADH issue

Question 220

Thyrioid Hormones

Answer 220

T3 - needs dietary iodine T4 - needs dietary iodine Calcitonin

Question 221

Calcitonin

Answer 221

Decreases serum Calcium by driving it INTO THE BONES

Question 222

Hyperthyroid

Answer 222

GRAVES DISEASE nervous, sweaty, hot, wt loss, decreased attention span, increased appetite, fast GI, increased BP, increased size in thyroid (GOITER) *exophthalmos=bulging eyes from fluid buildup behind eye. irreversible Meds: antithyroid propylthioracil/PTU, tapozole Goal? EUTHYROID Must TAPER and D/C meds!

Question 223

Lugol's Iodine

Answer 223

Pre-op Decreases vascularity to decrease bleeding Use straw!!! Why do we use straws? STAINS TEETH

Question 224

Beta-blockers

Answer 224

Treatment for heart failure and hypertension -olol Decrease HR and BP (get apical pulse before admin! <50, contact HCP) Also decreases ANXIETY Good for Graves MASKS HYPOGLYCEMIA- don't give to diabetics or pts with asthma

Question 225

Radioactive Iodine

Answer 225

Decreases thyroid Becomes Hypothyroid For 24 hrs: don't go near babies or kiss anyone

Question 226

Thyroidectomy

Answer 226

``` Teach how to support neck interlace fingers behind neck to support All personal items very close No tension on sutures Report any complaint of pressure near neck ``` Raise HOB to decrease edema around neck Check for bleeding and pooling behind neck HOARSENESS = Laryngeal nerve damage could lead to vocal cord paralysis=trach Keep trach set at bedside (hypocalcemia and swelling/vocal cord paralysis)

Question 227

Parathyroid Removal?

Answer 227

There are 4 on Thyroid. Very possible to remove them during thyroidectomy Parathyroid makes PTH-- PTH: increases serum Calcium by taking calcium from bones and bringing it to the blood. CALCIUM ACTS AS SEDATIVE No calcium? rigid, tightness, spasms

Question 228

Hypothyroidism

Answer 228

No Energy/Myxedema Babies with hypo: Sleepy, "well-behaved", barely cries, gaining weight Adult: fatigue, slow GI, increase weight, constantly cold, slow/slurred speech, no expression. Don't use heating pad! They might not be able to feel it. Often confused with depression. Treatment? Synthroid FOREVER. Increased Energy, HR, BP. Tent to have CAD- don't konw why Watch for CP and rhythm changes

Question 229

Parathyroid

Answer 229

CALCIUM CONTROL ***Calcium = sedative Secretes PTH- pull calcium from bone to blood Increased PTH- Increased serum calcium- decreased serum phosphate Decreased PTH- Decreased serum calcium- Increased serum phosphate Hyperparathyroidism=hypercalcemia=hypophosphatemia

Question 230

IV Calcium

Answer 230

Pt needs to be on heart monitor Decreases rate Widens QRS- any widening STOP IV INFUSION

Question 231

Hyperphosphatemia treatement

Answer 231

Amphojel Binds phosphorus- makes phosphorus "invisible" and decreases the serum value Leads to increase calcium

Question 232

Adrenal Gland Components

Answer 232

Medulla: Epi and Norepi Cortex: Steroids (glucocorticoids, mineralocorticoids, sex hormones)

Question 233

Pheocromocytoma

Answer 233

Benign tumors releasing norepi and epi in boluses (not same amount continuously) Increases HR and BP VMA test (Vanillylmandelic Acid Test) 24-hr urine (discard first void, collect rest for 24 hr) Stay calm throughout the day... no exercise, stress, etc. May alter results Surgery to remove tumors

Question 234

Steroids

Answer 234

From Adrenal Cortex | Glucocorticoids, mineralocorticoids, sex hormones

Question 235

Glucocorticoids

Answer 235

protein catabolism Exogenous=decreased muscle gluconeogenesis- inhibits insulin (CORTISOL!) immunosuppression- decreases inflammation, slows healing Maintains cardiac response to chatecholamines

Question 236

Addison's Disease

Answer 236

Adrenal Cortex INSUFFICIENTY ADD-ison's Disease= ADD STEROIDS Decreased aldosterone (decrease in Na/H2O, increased K) fluid volume loss- muscle weakness, decreased bowel sounds, nausea, GI upset, anorexia, hypotension, POTENTIAL SHOCK * Hyperpigmentation (bronze skin) * Hypoglycemia * **Steroids increase blood sugar * **No steroids- decreased blood sugar Measure I and O, BP, wt -- fluid loss and med adjustment RN Dx: fluid volume deficit Treatment: mineralcorticoid= FLORINEF (aldosterone) Addison's Crisis? extreme fluid loss, potential shock and vascular collapse

Question 237

Cushing Syndrome

Answer 237

Disease: developed endogenously- body making too many steroids Syndrome: exogenous administration of steroids TOO MANY STEROIDS!!! Exogenous glucocorticoids, minerocorticoids, sex hormones S/S: - hyperglycemia - hypertension - weight gain (truncal, buffalo hump, moon face) - pink/purple stretch marks on abd, arms - thinning skin, bruise easily - muscle atrophy/weakness - slow healing of cuts - acne MEN: decreased libido, ED, decreased fertility WOMEN: hirsutism (thicker facial and body hair) irregular/absent menstrual period Test: 24-hr urine

Question 238

Prednisone

Answer 238

Glucocorticoid replacement Decreases serum Calcium by making you excrete it through GI tract, pulls calcium from bones * Calcium will look normal, but it's due to it being taken from bones * **Brittle bones!!! long term use increase K, decrease Na, increase protein, increase calcium

Question 239

Insulin Function

Answer 239

moves sugar and potassium out of vascular space into cells. Without insulin- CELLS STARVING Body will breakdown fat and form ketones --ketones:acids, leads to metabolic acidosis Insulin needs increase when pt with diabetes is sick! illness + DM = DKA

Question 240

Hyperglycemic Hyperosmolar Nonketotic Coma

Answer 240

HHNK ***TYPE 2 DIABETES NON-KETOTIC (no ketones b/c pancreas still makes tiny bit of insulin that gets some sugar into cells) Often confused with DKA IS NOT ACIDOTIC!!!! --Make enough insulin to not breakdown bodyfat (make ketones), but still extremely hyperglycemic

Question 241

Diabetic Ketoacidosis

Answer 241

DKA ***TYPE 1 DIABETES! Usually first sign someone has type 1 diabetes -Not enough (or zero) insulin, increased blood sugar, 3 P's, fat breakdown leads to ACIDOSIS, leads to KUSSMAUL'S respirations (blow off excess CO2), decreased LOC from messed up pH. S/S: polyuria abdominal pain nausea/vomit Treatment: - IV insulin (d/c when glucose <200, then D5W) - fluid resuscitation - hourly BG monitoring - Hypokalemia results as resolution, so admin K even when normokalemic (3.5-5) ***leads to metabolic acidosis. Can LEAD TO DEATH.

Question 242

Pregnancy Trimester Lengths

Answer 242

Trimester 1: 1-13 weeks Trimester 2: 14-27 weeks Trimester 3: 28-40 weeks

Question 243

3 Types of Pregnancy Signs

Answer 243

PRESUMPTIVE: amenorrhea (progesterone increase, not hcg), nausea, vomit, frequency (urinary), breast tenderness PROBABLE: positive pregnancy test, hegars sign (soft uterus), goodells sign (soft vag cervix), braxton hix, pigment changes (dark line down abd), facial melasma, stretch marks POSITIVE: fetal heart beat at 10-12 weeks fetalscope at 17-20 weeks fetal movement *felt by examiner* *ultrasound*

Question 244

Gravidity

Answer 244

of times pregnant Duration means nothing here gravida 5 with no kids is possible!

Question 245

Parity

Answer 245

``` # that reach viability viability= 20 week minimum!!! ```

Question 246

TPAL

Answer 246

Term (>=37 weeks) Pre-mature (20-36 weeks) Abortions (<20 weeks) Living If G in front=Gravidity If M at end= Multiple

Question 247

Naegele's Rule

Answer 247

Calculate Due Date 1st day LMP + 7 Days - 3 Months + 1 year Only accurate +/- 1-2 weeks

Question 248

Pregnancy Caloric Needs and Weight Gain

Answer 248

400 mcg/day FOLIC ACID prior to pregnancy (neural tube defects such as spinabifida) 1st trimester: 300kcal protein increase to 60g/day Normal for pt to gain ~4 lbs 2nd trimester: 1 lb weight gain per week 3rd trimester: 1 lb weight gain per week

Question 249

Normal 1st Trimester S/S

Answer 249

nausea vomiting frequency (a lot of urination) breast tenderness (all parts of pregnancy) Drink water before topical ultrasound to push uterus to abd surface. Not necessary for transvaginal ultrasound. VOID if an ultrasound is for a procedure

Question 250

Normal 2nd Trimester S/S

Answer 250

``` NO nausea/vomit NO frequency breast tenderness quickening (fetal movement around 16-20 wks) FHR should be 120-160 ```

Question 251

Normal 3rd Trimester S/S

Answer 251

- frequency back again! - nasal stuffiness - fullness in ears - edema - Leukorrhea (whitish, mucoid vaginal discharge) increases throughout pregnancy FHR 130-160 NOT NORMAL: - copious thin/water leaking (might be amniotic fluid) - dysuria - cloudy urine - flank pain

Question 252

Common Pregnancy Discomforts

Answer 252

``` fatigue hemorrhoids varicose veins heartburn indigestion swelling nausea ankle edema (elevate) constipated (fiber, fluids, walk) nasal congestion (saline nasal spray) ```

Question 253

Prego blood pressure rule

Answer 253

+30/+15 of baseline!

Question 254

Danger Signs in Pregnancy

Answer 254

Usually 3rd trimester: - sudden gush of fluid - Bleeding - Persistent Vomit - Severe Headache - Abd Pain - Increased Temp - Edema - No fetal movement

Question 255

Leopold's Maneuver

Answer 255

Palpate abdomen to feel for head, back, and buttox. WHY? Fetal back is where you listen to FHR. VOID FIRST! Uterus should be midline Do Leopold's Maneuver between contractions. Won't feel baby during contractions, just tightened muscles

Question 256

Labor S/S

Answer 256

- Lightening (fetal head dropping into pelvis) 2 weeks before. - Mom will feel less congested - Increased urinary frequency - Engagement- largest presenting part of fetus (head) at pelvic inlet at zero station. - Sudden burst of energy (nesting) - Stronger braxton hicks contractions - Rupture of membranes - Soft cervix - some women get diarrhea

Question 257

Contractions that indicate it's time for the hospital!

Answer 257

5 minutes apart OR when membranes rupture **potential prolapsed cord, which is life-threatening

Question 258

Non-Stress Test

Answer 258

>=2 increases of 15 bpm with fetal movement Each increase should last 15 seconds 20 minute test Healthy baby result: REACTIVE! accelerations are present If HR does not increase, baby won't be able to handle labor and delivery Get ready for NST: - monitor - whenever mom feels baby move, mom punches button

Question 259

Contraction Stress Test

Answer 259

"Oxytocin Challenge Test" *Only for high risk pregnancies! (pre-eclampsia, maternal diabetes, etc.) Usually after 28 weeks because contractions being induced. Results only good for 1 week. Determines if baby can handle UTERINE CONTRACTIONS. Contractions decrease blood floor to baby=potential hypoxia Ideal Result: NEGATIVE!!! no late decels!!! Bad Result: Late decelerations. Deliver that baby!

Question 260

True Labor

Answer 260

Regular contractions Increase in frequency/duration with contractions ***Discomfort in BACK, radiates to abdomen ***INCREASED pain WITH ACTIVITY -bloody show does not indicate true labor. Occurs a few days before onset.

Question 261

False Labor

Answer 261

Irregular contractions * **Lower Abdominal and Groin pain * **DECREASED pain WITH ACTIVITY (Braxton Hicks)

Question 262

Epidural Anesthesia

Answer 262

Position: left side, legs flexed, not a ton of back arch - Usually no headache b/c not in spinal fluid * Most common complication: HYPOTENSION - -IV fluids (NS or LR), change position, lie on side to decrease vena cava compression, change sides every hour

Question 263

Pitocin

Answer 263

Oxytocin 1-to-1 care (for NCLEX) Never lay prego SUPINE! Complications: * Fetal brady- turn on left side * Hypertonic labor- contractions that won't stop can kill baby (no oxygen getting to baby during contractions) * Uterine Rupture: VBAC at high risk!!! C-section scar may rupture. Complete UR: through uterine wall into peritoneal cavity. Sudden sharp/shooting pain, Absent fetal heart tones Incomplete UR: through uterine wall, not peritoneal cavity, internal bleeding, possible late decels, hypotonic with contractions Late Decels with Pitocin? TURN OFF!!! Left side, oxygen 8-10 non-rebreather, bolus LR, call HCP

Question 264

Postpartum Hemorrhage Causes and S/S

Answer 264

Causes: uterine atony (no tone), bleeding, lacerations, retained fragments, forceps delivery Early: >500cc in 1st 24 hrs Late: 24hrs-6wks High HR (should be 50-70 for 6-10 days post) Excessive Vaginal Bleeding (>1 pad/hr) Decreasing blood pressure (should be stable post) *Retained placenta or any products may lead to hemorrhage *Check firmness of fundus. If not going back to normal (involution) worry about hemorrhage! Should be near umbilicus

Question 265

Lochia and Clots

Answer 265

Postpartum Rubra (dark red) 3-4 days Serossa (pinkish brown) 4-10 days Alba (whitish yellow) 10-28 days/up to 6 wks Pt teaching: report any foul smelling lochia! endometritis Clots: no larger than nickel Diurese for 1st 24 hours post partum Inspect legs for DVTs

Question 266

Postpartum Perineal Care

Answer 266

If episiotomy, tearing, or surgery: - intermittent ice packs 6-12 hrs to decrease edema - warm water rinses - sits baths 2x/day

Question 267

Breastfeeding

Answer 267

Initiate ASAP after birth (bonding and uterine contractions) Breast pump if mom can't be near baby in 1st hr Increase kcal by 500 8-10 glasses fluid/day (need more fluid/milk) --if not, potential plugged duct and leads to mastitis Do not clean breasts with soap, only warm water. Soap=drying Breast pads needed. Wet breasts decrease skin integrity

Question 268

Post-partum infection

Answer 268

``` Within 10 days of birth -E.coli -betahemolytic strep Will need cultures and antibiotics. If taking antibiotics while breastfeeding, take immediately after feeding baby ``` Teach proper hygiene: front to back and hand washing

Question 269

Mastitis

Answer 269

``` Bacteria: Staphylococcus Usually 2-4 weeks Cause: not breastfeeding properly! Need to EMPTY breast with each feeding. Stagnant milk=inflammation ``` Treatment: Still want to BF? Empty affected breast as often as possible (BF and/or pump), hot shower to help breasts leak, always offer affected breast 1st, penicillin (take immediately after feeding). Analgesics (ibuprofen) Don't want to continue BF: cooling breasts! Cooling breasts helps decrease milk supply and constrict vessels

Question 270

Newborn Care

Answer 270

``` Suction Clamp/Cut Cord Maintain Temp APGAR (minutes 1 and 5) ***At least 8-10 **Most babies 9 because of purple hands/feet (acrocyanosis) ``` AquaMEPHYTON- Vit K shot in vastus lateralus *needs clotting factors! Will make own after eating for a week Erythromycin- eye ointment

Question 271

Baby Umbilical Cord Care

Answer 271

``` dries and falls off 10-14 days Starts to dry in about 24 hrs Turns black 2-3 days Fold diaper below cord NO IMMERSION until it falls off report any s/s infection wet=moist=bacteria=infection ```

Question 272

Baby Hypoglycemia

Answer 272

Not getting enough glucose from mom High Risk: LGA, SGA, Preterm, mom was diabetic Sugar bottle!

Question 273

Jaundice

Answer 273

Pathologic Jaundice: 1st 24 hrs--ABO or Rh incompatible Physiologic Jaundice: after 24 hrs hemolysis of excess RBC's releasing bilirubin immature liver

Question 274

Rh Sensitization

Answer 274

People either have or don't have Rh factor in blood. Rh Negative- if body exposed, will make antibodies (Rh sensitization). Ex. Mom (-) and Baby (+), mom treats (+) like foreign body to her (-) blood. Blood may come in contact when placenta separates at birth, during miscarriage, amniocentesis, trauma to abd. Treatment: RH IMMUNOGLOBULIN (stops body from making antibodies). Given at 28 weeks. *RhoGAM given after birth (within 72 hrs) Destroys fetal cells in moms blood. If not treated, first baby unaffected but next pregnancy could lead to complications. Mom's blood will destroy baby blood (erythroblastosis). Baby won't have blood (anemic, hypoxic), won't grow. Baby: direct test in cord Mom: indirect test

Question 275

Decerebrate Posture

Answer 275

"Extensors predominate" * **Indicates severe head/brain injury*** - arms and legs straight out - toes pointed down - head/neck arched back Arms opposite of decorticate posture (flexed)

Question 276

Hypothermia

Answer 276

weak and thready pulse because of cold should be normalized when warm CLIENT NOT DEAD UNTIL WARM AND DEAD may need prolonged resus

Question 277

Near-Drowning

Answer 277

-hypothermia common (warm IV fluids, blankets, air) -weak thready pulses common (may need prolonged resus) -wheezing on auscultation STILL BREATHING! ---bronchospasm crackles=aspirated fluid- could lead to resp distress syndrome ED management: - advanced airway (intube and/or mech vent) - aggressive O2 - establish IV access and IV fluids (warm if hypo) - cardiac monitor for arrhythmias and fluid imbalances *do not turn frequently- cause Vfib

Question 278

Renal Calculi Plan of Care

Answer 278

analgesia for pain increase fluid intake assist with ambulation (promotes clearance) strain urine for stones (for analysis)

Question 279

Uterine Contractions | 1st stage labor

Answer 279

``` 45-80 seconds (NOT more than 90 seconds) 2-5 every 10 min, no more than every 2 min Strength: measure at peak, 25-50mmHg --NOT more than 80 mmHg Resting Tone: measure b/w contractions avg 10mmHg (NOT more than 20mmHg) ``` ***Increase in values indicate uteroplacental insufficiency

Question 280

Phalen's Maneuver

Answer 280

back of hands together and elbows flexed Testing for carpel tunnel syndrome

Question 281

Heel-to-Shin test

Answer 281

Assess cerebellar function

Question 282

Romber test

Answer 282

eyes closed, feet together Testing vestibular function (perception of head in space) proprioception (perception of body in space) vision

Question 283

IV Oxytocin Complications and RN action

Answer 283

increased contractions, increased resting tone, increased FHR with decreased variability ``` Stop infusion Reposition client to side-lying Admin oxygen by facemask Notify HCP Record/Document findings ```

Question 284

Teletherapy

Answer 284

(external beam of radiation) - Proetect skin from infection (no rubbing, itching, scrubbing, wear loose clothing) - Cleans with lukewarm water and mild soap - Only cream/lotion HCP approved - Avoid extremes in temp (head pads, ice packs)

Question 285

Concussion

Answer 285

Minor TBI - brief disruption in LOC - amnesia regarding event (retrograde amnesia) - headache

Question 286

TBI

Answer 286

* not concussion! More serious* - worsening headache, vomiting, sleepiness, confusion (all indicate increased ICP) - Visual changes - Weakness or numbness

Question 287

SIADH

Answer 287

Syndrome of Inappropriate ADH Increased ADH secretion increased serum osmolarity, decreased serum Na decreased urine output increased urine specific gravity (concentrated) OPPOSITE: Diabetes insipidus ``` Treatment: fluid restriction (<1000) oral salt tabs hypertonic saline (at first) vasopressin receptor antagonists Strict I/O Neuro checks ```

Question 288

Severe Preeclampsia

Answer 288

IV Mg prescribed (depresses CNS) ``` Plan of Care: Check Deep tendon reflexes Calcium gluconate as reversal agent Seizure precautions!--- -Decrease environmental stimuli -Dim lighting -Pillow to protect head -Side-lying position -O2 and Suction available -Bed in low position -Loosened clothing ```

Question 289

SIRS

Answer 289

Systemic inflammatory response syndrome d/t trauma, ischemia, infection (i.e. sepsis) or other distributive shock process causing system infectoin 2 of the following: Temp >100.4 or <96.8 HR >90 Resp >28 OR pCO2 <32mmHg WBC >12,000 OR <4000 OR >10% band

Question 290

Peritonitis - causes - RN action

Answer 290

common and serious complication of peritoneal dialysis - Also potentially occurs with diverticulitis- * pain in other quadrants of abdomen, rigidity, guarding, rebound tenderness* 1st: cloudy peritoneal effluent Later: low grade fever, chills, rebound tenderness, abdominal pain RN: collect peritoneal effluent from drainage bag for culture and sensitivity. May need antibiotics. Do not place in high-fowlers... will increase abd pain

Question 291

Ischemic Stroke

Answer 291

Most common presentation: sudden onset of numbness/weakness of arm and/or leg Kids with sickle cell at high risk (relative to other peds)

Question 292

Intussusception

Answer 292

One portion of intestine prolapses and telescopes into another portion - "currant jelly" stools due to blood/mucus - sausage-shakped mass in RUQ - screaming - knees drawn up to chest

Question 293

Hemophilia

Answer 293

Primarily males Lack of clotting factors Desmopressin (DDAVP) stimulates release of clot factor VIII *Pts with hemophilia A need factor VIII administered after potential bleeding injury before any other treatment. Long term complication: JOINT DESTRUCTION Teach injury prevention Avoid contact sports Avoid aspirin and ibuprofen (platelet inhibition) Avoid IM inj, SQ preferred Dental hygiene to prevent gum bleeding, soft toothbrush -MedicAlert bracelet

Question 294

Hepatic Encephalopathy

Answer 294

Too much ammonia! Liver not functioning to remove toxins from blood. - Axterixis (flapping of hands) - Fetor Hepaticus (musty, sweet breath) - Increased ammonia levels - Sleep disturbances/irritability - AMS/lethargy - slurred speech

Question 295

Theophylline

Answer 295

``` Bronchodilator Low therapeutic index Avoid caffeine Monitor drug levels o avoid toxicity: --anorexia, nausea, vomit, restlessness, insomnia Dose based on PEAK drug levels --measured 30 min post-dose ```

Question 296

Gluconeogenesis

Answer 296

Stress induced hyperglycemia >140 Glucose target to void hypoglycemia is 140-180 Occurs in ICU pts when they are unable to fight off infection. NOT always diabetic!!! 80% ICU pts with hyperglycemia not diabetic, but under physical stress

Question 297

Gingko Biloba

Answer 297

Taken to relieve symptoms of intermittent claudation | cramping in leg from exercise r/t obstructed arteries

Question 298

Cold Injury Action from Home

Answer 298

Rewarm in warm water (104 degrees) to promote blood flow and oxygenation See HCP do NOT rewarm and refreeze=death (think of chicken) do not massage affected area!

Question 299

S3 sound

Answer 299

Normal in young adults and athletes Indicates congestive heart failure in older adults The third heart sound is caused by a sudden deceleration of blood flow into the left ventricle from the left atrium. Heart with bell of stethoscope at apex

Question 300

Breast self exam

Answer 300

Not sub for routine exams! Regular periods: 5-7 days after menstruation Post-menopause OR irregular menses: choose same day monthly Oral Contraceptives- when new pack started

Question 301

Post-op Prostatectomy | Concerning S/S

Answer 301

Contact HCP for the following: | bleeding, passage of clots, decreased urinary stream, urinary retention, S/S UTI

Question 302

NSAIDS

Answer 302

``` ibuprofen aspirin celecoxib naproxen ketorolac indomethacin ``` ---used for analgesic, anti-inflammatory, antipyretic Toxicity: Nephrotoxic and ototoxic TINNITUS OD? tachy, hypotension (secondary to blood loss/dehydration from nausea and vomiting) INCREASE risk of thrombotic events in clients with CAD

Question 303

Acetaminophen

Answer 303

Tylenol Fever reducer Pain relief

Question 304

Nitrate Medication Function

Answer 304

prevents angina | Vasodilate peripheral vessels and decrease cardiac workload and coronary artery workload

Question 305

Hepatitis C

Answer 305

Virus Pts usually have chronic infection Expected finding: ALT and AST (liver enzymes) >2-3x normal!

Question 306

Ventilator Associated Pneumonia

Answer 306

Second most common Healthcare Acquired Illness purulent sputum, (+) sputum culture leukocytes 12,000 fever (>100.4) new onset or progressive pulmonary infiltrates on chest x-ray suggesting pneumonia

Question 307

Continuous Subcutaneous Insulin Infusion

Answer 307

- Fewer swings in blood glucose levels and hypoglycemic events - still admin bolus before carbs - check blood sugar at least 4x/day (4-8 common) - --Fasting, pre-meal, 2 hrs post meal, bedtime, 3am - Open-loop cannot respond to change in glucose levels Some closed loop with continuous BG monitoring! Still need daily calibration

Question 308

Breast cancer | Breast lumps

Answer 308

Mobile lumps usually ok! Inflammatory breast cancer: red, warm, and has orange peel (peau d'orange) pitting appearance. Breast mass may or may not be present. Cancer in lymph glands in affected side armpit

Question 309

Calcium needs for 1-3 year olds

Answer 309

500 mg/day leafy dark greens calcium fortified juice and cereal Vitamin D increases Ca absorption - direct sunlight - fish oil, egg yolk, Vit D cereal

Question 310

Airborne Infections

Answer 310

Most contagious! Priority for isolation questions. - Measles (Rubeola) - TB - Varicella - Severe acute respiratory syndrome ***N95 Respirators!!! +gowns and gloves ***Negataive airflow room

Question 311

Droplet Infections

Answer 311

2nd most contagious - Viral Influenza (flu) -*and contact* - Meningitis (Neisseria meningitidis) - Pertussis (whooping cough) - Rubella - Strep group A - Surgical mask for routine care - Private room - As needed: gloves, gown, goggles/face shield (wound care, suctioning)

Question 312

Contact Infections

Answer 312

MRSA (bathe with moistened cloths with chlorhexadine) | Scabies

Question 313

Annual Flu Vaccine

Answer 313

Recommended for EVERYONE >6 months whose not allergic to ingredients

Question 314

Prevent VAP

Answer 314

minimize mechanical irritation and bacterial access to the lungs - sealed endotrach tube cuff >20cm H20 (15mmHg) - routine oral hygiene with chlorhexidine - elevate HOB - avoid gastric over distension - minimize sedation, extubate ASAP - only suction when clinically indicated! not on schedule

Question 315

Alcohol Intoxication Intervention

Answer 315

``` IV thiamin (Vit B1) followed by IV glucose -prevents Wernicke encephalopathy ```

Question 316

Alcohol Abuse Recovery

Answer 316

Should: -show accountability -understand/express consequences -use insight to face reality -use coping skills and non-chemical alternatives. -Encouraged to set goals for personal growth. -Abstain from any/all alcohol consumption

Question 317

Fetal Ultrasound Timeline

Answer 317

7 wks- fetal heart tones 8wks- major organ systems in place/function in simple ways 12 wks- sex can be determined by genitalia if in good position 16-20 wks fetal movements felt

Question 318

Ophthalic Ointment Admin

Answer 318

1) Hand hygiene 2) Tilt head back, pull down lower lid, and look up 3) Squeeze thin strip onto lower lid from inner to outer edge 4) Close eyes gently for 2-3 min after application

Question 319

Suspected Meningococcal Meningitis Nursing Care

Answer 319

Safety: Droplet precautions and NPO status (for somnolence) Comfort: minimize stimuli, raise HOB slightly, remove pillows Droplet precautions continue 24 hrs after initiation of antibiotic therapy

Question 320

Loop diuretics

Answer 320

-Furosemide (IV may cause ototoxicity, 4mg/min only) -Torsemide -Bumetanide *used for CHF or renal insufficiency "everything wasting" -INCLUDING K!!!

Question 321

Angiotensin II Receptor Blockers | ARBS

Answer 321

-sartan Losartan, valsargan, candesartan ANTI-HYPERTENSIVE Uses: clients who cannot take ACE inhibitors (-pril). ***No dry cough!!! Heart failure, MI, DM neuropathy, stroke prevention Block angiotensin 2 action. ***Angioedema can be severe and affect breathing! *WILL NOT affect fluid status of client with acute HR.

Question 322

Beta Blockers

Answer 322

-lols Metoprolol, bisoprolol, carvedilol ANTI-HYPERTENSIVE Decreases HR (control of tachyrhythmias), less force, therefore decreases BP * *MASKS HYPOGLYCEMIA= NO diabetics * **CONSTRICTS SOME SMOOTH MUSCLE=NO Asthmatics Potential withdrawal

Question 323

Ace Inhibitors

Answer 323

-pril lisinopril, captopril, enalapril ANTI-HYPERTENSIVE First line for hypertension, especially in diabetics. * **Protective in kidneys * -Decreases peripheral vascular resistance WITHOUT increasing HR, CO, or contractility. -DRY COUGH -ANGIOEDEMA -Temporary increase in creatinine -HYPERKALEMIA (decrease aldosterone secretion=loss of H2O and Na) *Measure K before administration --avoid K sparing diuretics (spirinolactone, amiloride, triamterene) NO PREGO'S!!! Check BP prior to admin. Commonly given to pts post-MI to prevent vent. remodeling (hypertrophy) Asians (specifically Chinese) high risk for COUGH. Black people- high risk for cough and angioedema

Question 324

Migrane

Answer 324

unilateral pulsating headache | sensitivity to light

Question 325

Hypertensive encephalopathy

Answer 325

Medical Emergency - caused by sudden elevation in BP (hypertensive crisis) - leads to cerebral edema/increased ICP -look for hx of htn, vision issues, epistaxis S/S: severe headache, VISUAL IMPAIRMENT, anxiety, confusion, EPISTAXIS, sz, coma

Question 326

Trismus

Answer 326

inability to open mouth due to a tonic contraction of muscles used for chewing - may indicate peritonsillar or retropharyngeal abscess - maintaining adequate airway essential

Question 327

C. Difficile Medication

Answer 327

``` Metronidazole (Flagyl) anti-infective drug COMMON FOR VAG INFECTIONS Metallic taste/dry mouth (ok for pregos, dark urine expected) ``` if severe: oral vanco IV vanco ineffective Antibiotics reduce normal bacteria in body, alows other bacteria (like C.Diff) to take over. Grows in intestinal tract. Causes diarrhea.

Question 328

Proton Pump Inhibitors

Answer 328

-zole omeprazole, pantoprazole Reduce stomach acid production Take before meals Assoc w/ development of C.diff

Question 329

Asthmaticus

Answer 329

Acute exacerbation of asthma that remains unresponsive to initial treatment of bronchodilators

Question 330

Parkland Formula

Answer 330

Equation needed for IV resus after burns (4mL * wt in kg * percentage of body burned) = 24 hr requirement. 1/2 given first 8 hrs! Convert to L if needed

Question 331

Dilutional Hyponatrma

Answer 331

Na <135 Caused by excess total body water in clients with heart failure Diuretics and fluid/salt restriction

Question 332

Kawasaki Disease

Answer 332

aka: mucocutaneous lymph node syndrome *systemic vasculitis* Crucial when at home: -Monitor for fever every 6 hrs for first 48 hrs post last fever >5 days fever, bilateral non-exudative, conjunctivitis, mucositis, cervical lymphadenopathy, rash, extreme swelling, GALLOP heart rhythm, decreased UO IV Immunoglobulin used to prevent HEART DISEASE. Aspirin also used. Primary goal: CORONARY DISEASE PREVENTION

Question 333

Tricyclic antidepressants

Answer 333

amitriptyline, nortriptyline, desiprmine, imipramine Common for neuropathic pain Side effects: orthostatic hypotension, dizzy, constipation, urinary retention, confusion, photosensitivity Pt Teaching: change positions slowly

Question 334

Urinary Cath Care to Prevent UTIs

Answer 334

- routine hand hygiene - Clean perineal area with soap and water routinely - Keep bag below bladder and off ground - keep cath and tubing free of kinds - use sterile technique when collecting specimens - encourage fluid intake if not contraindicated Do NOT routinely irrigate Rt use of antiseptic cleansers NOT shown to prevent infection

Question 335

Heparin and platelets

Answer 335

Normally: heparin prevents clotting and does not affect the platelets (components of the blood that help form blood clots) Immune system response sometimes causes HEPARIN INDUCED THROMBOCYTOPENIA (decreased platelets) When pt on heparin look for and report on: -decrease of >=50% from baseline OR -below 150,000

Question 336

Advanced Directives

Answer 336

- Copies in med record, with pt, and healthcare proxies - Two witnesses required, should not be healthcare proxies listed on doc - Does not need to be notarized - Clients wishes, not a medical order - -not a DNR form!

Question 337

Preconception Care

Answer 337

- 400 mcg Folic Acid - avoid alcohol, smoking, tobacco - dental appt in case of periodontal disease (assoc with adverse pregnancy outcomes) - rubella vaccine 4 wks prior to pregnancy - normal BMI (18.5-24.9)

Question 338

Osteomalacia

Answer 338

REVERSIBLE bone disorder - caused by vitamin D deficiency - weak, soft, and painful bones - fall precautions - encourage light to moderate activity - increase calcium, phosphorus, vitamin D - Take OTC Vit D

Question 339

Enoxaparin

Answer 339

low-molecular-weight heparin Right or left side of the abdomen At least 2 INCHES FROM THE UMBILICUS

Question 340

Acute Pancreatitis

Answer 340

- life threatening - abd pain radiating to back - rise in pancreatic enzymes (amylase, lipase) -Can be caused by endoscopic retrograde cholangiopancreatography (ERCP)

Question 341

Aortic Disection

Answer 341

Intimal layer tears, blood between inner (intima) and middle (media) layers. Ascending: Chest pain radiating to back Descending: Back pain, abdominal pain - Frequently abrupt onset - "worst ever" "tearing" "ripping" pain - hypertension contributing factor Treatment: LOWER BP! SURGERY

Question 342

Septic Shock

Answer 342

Infectious agent from localized infection source (UTI, wound) enters bloodstream. - Fever OR hypotherma (>100.4 <96.8) - Hypotension (systolic <90 or MAP <65) - Prolonged Cap Refill - Tachycardia - WBC >12,000 or immature neutrophils (bands) >10% - Decreased mental status - Decreased CVP (below 2)

Question 343

Systemic inflammatory response syndrome and Sepsis

Answer 343

SIRS: - inflammatory response - -fever, tachycardia, tachypnea Sepsis: SIRS + infectious source identified (pneumonia, UTI, etc) Septic Shock: Sepsis + HYPOTENSION DESPITE ADEQUATE IV FLUIDS MODS: Septic Shock + Multiple organ system damage (acute resp distress syndrome, AKI, low platelets)

Question 344

Transurethral resection of prostate

Answer 344

TURP continuous bladder irrigation for 24-36 hrs to flush small clots and prevent obstruction -reddish-pink drainage expected

Question 345

Obstructive sleep apnea

Answer 345

``` Apnea (>10 sec) Diminished airflow (hypopnea) ``` Findings in Pt: Night- repeated periods of apnea, loud snoring, interrupted sleep Day- morning headaches, irritability, excessive sleepiness

Question 346

Botulism

Answer 346

- muscle paralysis - found in soil and contaminates food - improperly canned or stored food! - kids under 1 yr get it from honey Manifestations: - descending flaccid paralysis (start from face) - dysphagia - constipation (smooth muscle paralysis)

Question 347

Sprained ankle treatment

Answer 347

"RICE" Rest 24-48 hrs Ice 10-15 min every hr for 24-48 hrs Compress Elevate 24-48 hrs Analgesia (NSAID) every 6 hrs prn Exercise rehab program when pain subsides

Question 348

Peritoneal dialysys

Answer 348

-Cath in peritoneal cavity, dialysate (dialysis fluid) infused, tubing clamped for 20-30 min (dwell phase), unclamped to allow dialysate to drain via gravity Insufficient flow usually from constipation blocking catheter holes! - admin stool softeners as prescribed - maintain bag below abdomen - check tubing for kinks - reposition pt (side-lying) - assist with ambulation

Question 349

Peak flow meter

Answer 349

Measures peak expiratory flow rate -for moderate to severe asthma Exhale as quickly and forcibly as possible through mouthpiece of device to obtain reading - move indicator to 0 before using - use after short-acting bronchodilator rescue MDI to check response

Question 350

Tetracycline

Answer 350

tetracycline, dosycycline, minocycline - Take on empty stomach - Avoid antacids or dairy products (2 hrs after antacid) - Take with full glass of water - Photosensitivity - Reduces effectiveness of oral contraceptives (like rifampin) Do not take at bedtime- assoc with esophageal irritation

Question 351

RN action for | Abdominal wound evisceration

Answer 351

- Remain calm and stay with pt - Have someone notify HCP immediately and get sterile supplies - Low-Fowlers position (<20 degrees) and knees slightly flexed - Assess vital signs for shock (repeat every 15 min) - Cover with sterile dressings saturated in NS - Document - Immediately NPO in case of surgery

Question 352

Quadriplegia

Answer 352

aka: tetraplegia Lower limbs completely paralyzed Upper limbs completely or partially paralyzed C-spine injury Airway and oxygenation priority

Question 353

Therapeutic vs. Non-therapeutic Communication

Answer 353

Therapeutic: reflecting, open-ended questions, suggesting strategies or resources Non-Therapeutic: minimization, automatic responses, and leaving clients who have strong emotions

Question 354

TPN

Answer 354

- Make sure CVC is in place with chest x-ray!!! - Filters used to remove precipitate and microorganisms - Hypertonic solution (>10% glucose) used, increases risk for infection - 0.22 micron filter used for non-lipid TPN - 1.2 micron filter used with lipids - Baseline blood glucose and finger-sticks every 6 hrs - -- Desired 140-180 for hospitalized adult clients - Hyperglycemia is risk, also in enteral feedings

Question 355

Torsades de Pointes

Answer 355

Caused by widened QT from Hypomagnesemia First line treatment: IV MAGNESIUM Defib may be necessary Meds that can cause TdP: heloperidol (Haldol), methadone, ziprasidone, erythromycin

Question 356

TB intradermal injection

Answer 356

- Use a 27-gauge 1/4 inch needle with a 1 mL tuberculin syringe - Administer injection on inner forearm at a 10-degree angle with bevel up - Make a wheal (bleb) - Avoid rubbing site after injection

Question 357

Newborn of diabetic mother

Answer 357

Risk for hypoglycemia and hypocalcemia. Hypo in newborn <40 Symptoms: JITTERINESS, IRRITABILITY, hypotonia, apnea, lethargy, tamp instability Transitional time (first 6 hrs post birth) increased risk for hypoglycemia as fetus produces insulin in response to mom's glucose.

Question 358

Penicillin Allergy | also avoid...

Answer 358

Cephalexin any cephalosporin Start with cef- or ceph-

Question 359

H1 receptor antagonists

Answer 359

Fexofenadine Cetrizine Levocetrizine Loratadine Decrease inflammatory response by blocking histamine receptors. -Given during type I hypersensitivity rxn (allergic rhinitis, conjunctivitis, hives)

Question 360

Asthma and nasal polyps

Answer 360

sensitivity to NSAIDs

Question 361

Sumatriptan

Answer 361

Selective serotonin agonist - Treat migraine headaches - Triptan drugs constrict cranial blood vessels to help migraine Contraindicated in CAD and uncontrolled hypertension b/c of vasoconstriction and increased angina risk

Question 362

Plagiocephaly

Answer 362

flat head syndrome in infants - alternate head positions - minimize time against firm surface (eg. carseat) - tummy time for 30-60 min/day - placing toys on opposite of favored/affected side to encourage head turning

Question 363

Ampule medication withdrawl

Answer 363

- Blunt filter needle to prevent aspiration of glass | - Filter needle can be discarded and an injection needle can be attache (IM: 20-gauge, 1 in needle)

Question 364

Expected finding in atrial septal defect

Answer 364

Murmur (systolic) with a fixed split second heart sound

Question 365

Cardiac Tamponade

Answer 365

``` LETHAL! Fluid in pericardial space -Decreases cardiac output *Increases CVP b/c of external pressure *Decreases BP b/c of hemorrhage ``` MUFFLED/DISTANT HEART TONES - narrowed pulse pressure - distended neck veins - paradoxical pulse (pulsus paradoxus): when BP >10mmHg on expiration than on inspiration - reduced LV cavity space - dyspnea/tachypnea - tachycardia TREATMENT: Pericardiocentesis: needle to draw out blood

Question 366

Coarctation of the Aorta

Answer 366

-Narrow aorta Difference between upper and lower extremities: UPPER- increased BP, strong brachial/radial pulses, well-developed LOWER: decreased BP, weak/absent femoral pulses, underdeveloped, claudation (ischemic pain)

Question 367

Anaphylactic Shock Management

Answer 367

Call for help! 1. Ensure patent airway, admin O2 2. Remove insect stinger 3. IM epi. Repeat dose every 5-15 min 4. Elevate legs 5. IV fluids 6. Bronchodilator (albuterol) 7. Antihistamine (diphenydramine for pruritius) 8. Corticosteroids (methylprednisolone for swelling) 9. Cricothyrotomy (tracheostomy with severe laryngeal edema)

Question 368

Skeletal Traction tasks for UAP

Answer 368

- Assist with active and passive ROM - Notify RN of sensation changes - Remind pt to use incentive spirometer - maintain proper use of pneumatic compression devices - remind client to move frequently using overhead trapeze

Question 369

Toxic epidermal necrolysis

Answer 369

- acute skin disorder, most commonly associated with a medication reaction, that results in widespread erythema, blistering, epidermal shedding, keratoconjunctivitis, and skin erosion - severe form of Stevens-Johnson syndrome. - MAJOR CAUSE OF DEATH: sepsis!! Infection=critical. - sterile wound care - reverse isolation and strict sterile techniques - monitor for infection - vital signs and output monitored for hypovolemia - hypothermia prevention (85 degree room temp) - pain management - eye care

Question 370

PTSD

Answer 370

- Increased anxiety - reliving event - feeling detached from others 3 categories of Sx: 1. Reexperiencing the event 2. Avoiding reminders of the trauma 3. Increased anxiety and emotional arousal NO auditory hallucinations, changing emotions, delusions, or lethargy

Question 371

Pica

Answer 371

compulsive craving for non-food substances Often r/t iron deficiency anemia CHECK hgb and Hcg levels for anemia

Question 372

Thoracentesis

Answer 372

- Treat pleural effusion - Needle between ribs into pleural space to drain fluid - complications: pneumothorax (needle into lungs and deflates), bleeding (less common) In case of pneumothorax watch: level of alertness, resp rate, resp effort, O2 sat, and lung sounds. Chest X-ray before and after Tension pneumo= trach deviation and cardiac compromise

Question 373

Tachysystole

Answer 373

>=5 contractions in 10 minutes Do not increase uterotonic drugs (oxygocin)! Might compromise fetal oxygen. Decrease or d/c oxytocin

Question 374

Reye Syndrome

Answer 374

Encephalopathy/cerebral edema Acute fatty liver failure Kids cannot have: Salicylate!!! -Bismuth subsalicylate (pepto Bismol) -Aspirin ...especially during a viral infection (influenza, varicella) OR pt with Kawasaki disease ``` increased serum ammonia fever lethargy acute encephalopathy altered hepatic function ```

Question 375

Meds kids can have

Answer 375

- Acetaminophen every 4 hrs for fever | - Ibuprofen every 6 hrs for body aches

Question 376

Delirium

Answer 376

``` "Acute cognitive dysfunction" Manifestations in a critically ill pt who was previously A and O: -Acute onset -Impaired consciousness -Fluctuates -Reversible -global impairment (place and time) -short-term memory loss -increased lethargy ``` Predisposing factors in hospitalized its: - advanced age - neuro issue (stroke, dementia) - polypharmacy - infection/comorbidities - acid-base imbalance - impaired mobility - surgery (post-op) - untreated pain

Question 377

Dementia

Answer 377

Gradual (months to years), consciousness intact, progressively worse, irreversible, remote memory spared

Question 378

Depression

Answer 378

Gradual (months), consciousness intact, EPISODIC, reversible, moderately impared focus/concentration

Question 379

Psychosis

Answer 379

No acute onset. Usually oriented but have auditory (not visual) hallucinations -Symptoms, not disorder (ex. schizophrenia symptom)

Question 380

Fifth disease

Answer 380

PARVOVIRUS B-18 "slapped face" erythema infectiosum One of TORCH infections. Can cause spontaneous abortion/ fetal abnormalities Viral illness human parvo! School-aged kids (people pups) -communicable only prior to symptom onset --cover mouth and nose when coughing/sneezing Rash on cheeks Joint pain (ibuprofen ok!) Recover within 7-10 days Isolation not usually required

Question 381

Acute blood loss

Answer 381

Medical emergency! - Supine position (lower HOB) to maintain perfusion to the brain and other vital organs - Follow this with interventions (IV access/fluids, vitals, hgb/hct)

Question 382

Laparoscopic cholecystecomy | Post-op Nursing

Answer 382

-Surgical removal of gallbladder - focuses on prevention of respiratory complications. - Place in the SIMS POSITION to facilitate movement of carbon dioxide (CO2) utilized during surgery to fill the abdominal cavity.

Question 383

Flumazenil

Answer 383

Antidose for a benzo OD Benzo endings: - azepam - azolam

Question 384

Nitroprusside

Answer 384

NITRO=VASODILATION Potent vasodilator used in hypertensive urgencies RN action: Check BP

Question 385

Raynaud's phenomenon

Answer 385

Usually triggered by cold exposure - digital arteries constrict and blood flow impaired - red, numb, tingling, throbbing, and cold - episodes 15-20 in

Question 386

Physical Restraints

Answer 386

Limb (ankle, writs) Belt - involuntary - not temporary for medical procedure (ex. elbow restraint <30 min for blood draw on toddler)

Question 387

Post op bleeding

Answer 387

- Serosanguineous (pink) drainage expected - Saturated dressing with sanguineous (bright red) indicates excessive blood loss - -posible hemorrhage - -report immediately to HCP

Question 388

Digoxin

Answer 388

Lanoxin Cardiac glycoside for heart failure and a-fib -positive inotropic effects (increases cardiac output) -negative chronotropic effects (decreases heart rate) -Range 0.5-2.0 *Prior to admin check pulse (<60) hold med Report: Cardiac Sx Visual changes (scotomas, blindness, color vision) GI changes (nausea, vomit) neuro manifestations (lethargy, fatigue, weakness, confusion)

Question 389

Chest Tube sections

Answer 389

Left to Right: A: Suction Regulation SUCTION CONTROL CHAMBERr: amount of suction applied Continuous, gentle bubbling Water Seal Chamber (middle) BUBBLING IS BAD HERE! C (low part): Air leak gauge. Bubbling indicates air leak. B (tall 2 balls): Should see inspiration and expiration *tidaling* D: Collection Chamber Collect drainage from client (serosanguinous). Not bright red1

Question 390

Strong Antibiotics and Risks

Answer 390

Vancomycin Gentamicin (aminoglycosides) Nephrotoxic Ototoxic Constantly check kidney and hearing function Vanco: red man syndrome- upper body flushing Trough level: 10-20 mg/L

Question 391

Statin and Fibrate Complications

Answer 391

Statin: atorvastatin, rosuvastatin Fibrates: gemifibrozil, fenofibrate Muscle aching and cramping. Statins: take at night or before bed - most cholesterol synthesized during fasting state, so statins needed in system at that time - Contraindicated for severe liver or muscle injury

Question 392

Methotrexate

Answer 392

-Treats cancer, RA, psoriasis (malignancies) - Immunosuppressant - --increased risk for infection - Decreases RBC - --bone marrow suppression - teratogenic NO PREGOS! - Hepatotoxic, avoid alcohol!

Question 393

CVP

Answer 393

- Central venous pressure - Right Ventricular Preload (volume in V at end of diastole) Normal: 2-8 mmHg Increased indicates fluid volume overload: - periph edema - increased dilute urine output - acute rapid wt gain - JVD - S3 heart sound in adults - tachypnea, dyspnea, crackles in lungs - bounding periph pulses Low CVP: deficient fluid volume: dry mucous membranes, hypotension

Question 394

Nicardipine

Answer 394

Cardene Potent Calcium Channel Blocking Vasodilator Priority RN intervention is to monitor hypotensive effects of drug

Question 395

Acute stroke presentation

Answer 395

requires "permissive hypertension" during the first 24-48 hours to allow for adequate perfusion through the damaged cerebral tissues.

Question 396

Guillain-Barre Syndrome

Answer 396

``` Rare disorder Immune system attacks nerves Ascending paralysis -weakness -ataxia -bilateral paresthesis progressing to paralysis ``` Progresses rapidly or over 2-3 wks

Question 397

Active labor

Answer 397

``` "transition: 8-10 cm Bloody show Urge to push (Ferguson reflex) Coach through breathing techniques and AVOID PUSHING until fully dilated to prevent cervical tauma ```

Question 398

ACE inhibitors and ARBs

Answer 398

- prils - sartans ***May potentiate hyperkalemia*** ACE- decrease aldosterone (promotes Na retention and K excretion)

Question 399

Lactulose

Answer 399

Cirrhosis and hepatic encephalopathy - Promotes excretion of ammonia via fecal elimination (2-3 soft stools/day) - decreases intestinal absorption of ammonia -given with juice, milk, or water OR rectally via enema -can be given on empty stomach for more rapid effect

Question 400

Orthostatic BP Procedure

Answer 400

1. Have the client lie down for at least 5 minutes 2. Measure BP and HR 3. Have the client stand 4. Repeat BP and HR measurements after standing at 1- and 3-minute intervals

Question 401

Greasy, foamy, foul-smelling, fatty stool

Answer 401

chronic pancreatitis

Question 402

Light gray "clay-colored" stool

Answer 402

Bilary obstruction

Question 403

Small, dry, rocky hard masses for stool

Answer 403

constipation

Question 404

Black tarry stool

Answer 404

"coffee ground stool" aka: MELENA Upper GI bleeding NSAID overuse

Question 405

Bright red bloody stool

Answer 405

Lower GI bleeding

Question 406

Blood present on surface of stool

Answer 406

hemorrhoids

Question 407

Diabetic foot care

Answer 407

Keep clean, dry, and free from irritation 1. wash feet daily warm water mild soap 2. inspect for abrasions, cuts, sores 3. to prevent injury, use cotton or lambs wool to separate overlapping toes, but nails straight across and file along cures of toes, do not go barefoot, mild food powder for moisture, absorbent socks with aligned seams 4. avoid OTC products on abrasions 5. do not sit with legs crossed, exercise daily 6. report any issues/infections immediately

Question 408

Cast Care

Answer 408

Nothing placed down cast! No lotion. No powder. Use cool hairdryer to help itching. S/S of infection (sores, purulent drainage, foul odors) and persistent itching report to HCP. Frequent neurovascular checks if pt has vascular impairment (changes in extremity color, temp, pulse) or periph neuro impair (loss of sensory or motor function)

Question 409

Alcohol Withdrawl

Answer 409

-always screen for heavy use of alcohol or benzodiazepines as withdrawal is potentially life-threatening and avoidable. Mild 6-12 hrs: anxiety, insomnia, tremors, diaphoresis, palpitations, GI upset, intact orientation Seizures 12-48 hrs: single or generalized tonic-clonic Hallucinations 12-48 hrs: visual, auditory, or tactile, intact orientation, stable VSs Delirium tremens 48-96 hrs: confusion, agitation, fever, tachycardia, hypertension, and diaphoresis, hallucinations DT's can be prevented with benzo administration Benzo's used to help with withdrawl. -epam

Question 410

Features Assoc with Hip Fracture

Answer 410

``` Ecchymosis/tenderness Groin and hip pain with weight bearing **Muscle spasm*** for protection and stabilization Shortening Abduction or adduction of the affected External rotation ```

Question 411

PTSD

Answer 411

Re-experiencing the traumatic event: Examples include intrusive memories, flashbacks, recurring nightmares, and feelings of intense distress/loss of control or strong physical reactions to event reminders (eg, rapid, pounding heart; gastrointestinal distress; diaphoresis) Avoiding reminders of the trauma: Examples include avoidance of activities, places, thoughts, or other triggers that could serve as reminders; feeling detached and emotionally numb; loss of interest in life; inability to set goals; and amnesia about important details of the event Increased anxiety and emotional arousal Examples include insomnia, irritability, outbursts of rage, persistent anger and/or fear, difficulty concentrating, hypervigilance, and exaggerated startle response Persons with PTSD are typically restless and hypervigilant and have trouble falling or staying asleep.

Question 412

Breastfeeding

Answer 412

on demand, whenever infant displays hunger (crying rooting reflex) 8-12x/day 15-20 min/breast for newborns "tummy to tummy" at nipple level Common positions are clutch hold, cradle, cross cradle, and side-lying nipple and part of areola Incorrect latch: insert a finger to break the suction prior to moving infant

Question 413

pudendal nerve block

Answer 413

Used when too late for epidural! Late Second Stage of Labor - infiltrates local anesthesia (ie, lidocaine) into the areas surrounding the pudendal nerves that innervate the lower vagina, perineum, and vulva. - least maternal/newborn side effects - It does not relieve contraction pain but does relieve perineal pressure when administered in the late second stage of labor

Question 414

Otitis Media vs Otitis Externa

Answer 414

Otitis Media: - usually kids <2 after resp infection - high fever, ear pain, irritability/restlessness, loss of appetite, and pulling on the affected ear - bulging red tympanic membranes Otitis Externa: - swimmers ear - infection of outer ear - severe pain experienced with direct pressure on tragus (anterior flap Rose has pierced) and pinna (whole outer ear) - normal tympanic membrane, infection in external ear canal,

Question 415

Meniere disease

Answer 415

AKA: endolymphatic hydrops * **excess fluid in inner ear - vertigo attacks (minimize with quiet, dark room and avoiding sudden head movements, turn off TV) - tinnitus - hearing loss - aural fullness

Question 416

ALT/AST test indications

Answer 416

LIVER INJURY! - HEPATITIS/other hepatic disorders - Viral hep - excess alcohol intake - OTC meds (acetaminiphen), -certain herbal and dietary supplements (green tea extract, kava, comfrey) - IV illicit drug use (increases risk for hep B/C)

Question 417

Target range for glucose control in pts receiving nutritional support

Answer 417

140-180 Hypoglycemia (serum glucose <70 mg/dL [3.9 mmol/L]) can be due to slowing the rate of the infusion. Although it occurs less frequently in clients receiving total parenteral nutrition (TPN) than hyperglycemia (serum glucose >180 mg/dL [10.0 mmol/L]) does, hypoglycemia can lead to life-threatening complications (eg, seizures, nervous system dysfunction).

Question 418

Otalgia

Answer 418

Ear Pain Normal after adenotonsillectomy due to irritation of the 9th cranial nerve (glossopharyngeal) in the throat.

Question 419

Hypertensive Crisis

Answer 419

Elevation in blood pressure (BP) >180 mm Hg systolic and/or >120 mm Hg diastolic ***evidence of organ damage (eg, kidney damage, retinopathy). RN: Prioritize Neurological Assessment b/c of stroke risk Goal: slowly lower BP using IV antihypertensive medications (eg, vasodilators) to limit end-organ damage.

Question 420

Clodine

Answer 420

Very potent antihypertensive Abrupt D/C can result in serious rebound hypertensive crisis ``` Other common side effects: 3 D's Dizziness Drowsiness Dry mouth ```

Question 421

Isoniazid (INH)

Answer 421

-is a first-line latent tuberculosis (TB) drug Adverse Side effects: HEPATOTOXICITY (jaundice, anorexia) PERIPH NEUROPATHY (interferes with Vit B6 aka pyridoxine) ``` Avoid alcohol Avoid other hepatotoxic agents (acetaminophen) Take pyridoxine (Vit b6) Avoid aluminum-containing antacids (Maalox) Report vision changes ``` Report S/S of severe adverse effects: Hepatoxicity (jaundice, vomiting, dark urine, fatigue) Peripheral neuropathy (numbness, tingling of extremities)

Question 422

Dumping syndrome

Answer 422

- complication of the surgically reduced gastric capacity (ex. Billroth II, gastrojejunostomy). - rapid emptying of hypertonic gastric contents into the duodenum and small intestine. - abdominal pain, diarrhea, nausea, vomiting, dizziness, sweating, palpitations (tachy), hypotension. ``` Dietary changes to delay gastric emptying: Small frequent meals Foods high in protein and fat Drink fluids between means Avoid high carbs (dry foods with low carbs ok) Diet high in fiber East slowly Avoid sitting up after a meal ```

Question 423

Baby Ultrasound Timeline

Answer 423

7 wks- fetal heart tones 8 wks- major organ systems in place (function in simple ways) 12 wks- sex if in good position 16-20 - quickening (fetal movement)

Question 424

Near Drowning ED

Answer 424

- advanced airway management (intub/MV as needed) - agressive O2 - Establish IV access/IV fluids (warm if hypothermic) - Monitor heart arrhythmia and fluid imbalances Frequent turning-cause Vfib

Question 425

Baseline glucose for hospitalized adult

Answer 425

140-180 >180 hyperglycemia <70 hypoglycemia <100 should be avoided

Question 426

Torsades de Pointes

Answer 426

widened QT HYPOMAGNESEMIA Treat with IV Mg and maybe defib

Question 427

Compartment Syndrome

Answer 427

post-op/post fracture reduction Neurovascular checks performed 1st *****If pain NOT RELIEVED by pain meds or is out of proportion to injury notify HCP***** -Pain with passive motion Early S/S: pain, numbness, unrelieved pain by meds, diminished/absent pulses, pallor, coolness, cyanosis Put extremity LEVEL WITH HEART (not above) Do NOT apply heat/ice

Question 428

Sodium Polystyrene Sulfonate

Answer 428

Kayexalate Retention enema Given to pts with increased K levels Resin in SPS replaces Na for K

Question 429

Barium enema

Answer 429

Contains contrast for colon in fluoroscopic x-ray Pre-procedure: - Take cathartic (mg citrate, polyethylene glycol) to empty stool from colon - Clear liquid diet day before (no red/purple liquids) - No eating/drinking 8 hrs before procedure - May have abdominal cramps during procedure Post-procedure: - White stools after procedure - Take laxative - Plenty of fluids and fiber ***Retention of barium can cause fecal impaction or bowel obstruction resulting in BOWEL PERFORATION AND PERITONITIS! Constipation is a big deal.

Question 430

Fleet enema

Answer 430

Hypertonic solution, pulls H2O from bowel, softens stool, then defecation

Question 431

Neomycin enema

Answer 431

Medicated | Decreases bacteria before colon surgery

Question 432

SLE

Answer 432

positive antinuclear antibody titer (>1:40) elevated erythrocyte sed rate (normal <30 mm/hr) Lupus nephritis (treat ASAP to preserve kidneys) --increased serum creatinine >1.3 Increased BUN ``` Butterfly (malar) rash Photosensitivity Rash anywere exposed to sunlight Weight loss Fever/increased infection Raynaud's phenomenon (cool/numb parts in certain situations. Think of holding snowball) ```

Question 433

Polycythemia Vera

Answer 433

- Excess amt RBC, WBC, and platelets produced - Bone marrow disorder - Increased risk for clots b/c of increased volume, vascular stasis of blood ***Periodic phlebotomy to remove 300-500mL blood through venipuncture*** Pt should report swelling, redness, or tenderness in leg Follow up immediately Stroke also complication

Question 434

Mitral Valve Regurgitation

Answer 434

LV pumps blood through aorta and some backflows into LA -Decreased CO -Dilation of LA -Pulmonary edema -Often asymptomatic -Report any new sx of heart failure ***dyspnea, orthopnea, weight gain, cough, fatigue) HEART FAILURE REQUIRES IMMEDIATE INTERVENTION

Question 435

Heart Failure | Diastolic and Systolic

Answer 435

Diastolic: Heart can't fill (stiff thick chambers/impaired relaxation) Systolic Heart can't pump (reduced Ejection Fraction)

Question 436

Cervical Cancer Risks

Answer 436

HPV and anything that increases risk to get HPV - sex before 18 - multiple partners - immunosuppression - oral contraceptives - STDs - Tobacco use

Question 437

Kernig's Sign

Answer 437

``` (+)=MENINGEAL PAIN pt supine flex pts hip and knee try extending leg at knee (+)= back pain and resistance to straightening Bilateral = even more (+) ```

Question 438

Brudzinski's Sign

Answer 438

``` (+) MENINGEAL IRRITATION pt supine put hand behind pts head lift head (flexing towards chest) (+)= INVOLUNTARY FLEXION OF HIPS AND KNEES ```

Question 439

Otalgia

Answer 439

Ear Pain

Question 440

Hypertensive Crisis

Answer 440

>180 and/or >120mmHg + organ dysfunction Goal: slowly lower BP using IV antihypertensives

Question 441

Amlodipine

Answer 441

Calcium channel blocker Used for HTN Slows HR Relieves CP

Question 442

Hemianopsia

Answer 442

Only portion of visual field from each eye R-sided CVA may have L-sided hemianopsia Turn head to left to see more of visual field

Question 443

Tiotropium

Answer 443

``` and Umeclidinium Inhaled steroids Powder via special inhaler -long acting 23-hr anticholinergic med Rinse mouth out afterwards ``` do NOT decrease inflammation, but RELAX airway by blocking parasympathetic bronchoconstriction

Question 444

Ipratopium

Answer 444

Short acting anticholinergic used as a RESCUE for COPD/ASTHMA do NOT decrease inflammation, but RELAX airway by blocking parasympathetic bronchoconstriction

Question 445

Epiglottitis

Answer 445

aka: supraglottitis Sudden-onset medical emergency due to Haemophilus influenza. -Soar throat -Fever w/ toxic appearance + 4 D's: -dysphonia (muffled voice) -DROOLING -dysphagia (difficulty swallowing) -distressed rest effort -leaning forward -RN action: tripod position -will need intubation or surgical airway PREVENTABLE!!! Cause: Haemophilus influenza type B (HiB) standard 2- and 4-month vaccine Rarely seen in vaccinated kids

Question 446

Ethambutol

Answer 446

``` TB drug OCULAR TOXICITY (vision loss/double vision/blurred vision) ``` Loss of red-green discrimination Monitor eyes regularly (baseline eye exam)

Question 447

Sucralfate

Answer 447

Antacid | Take before meals to decrease irritation of ulcers

Question 448

Coombs Test

Answer 448

Screens for Rh sensitization Indirect Coombs Test: mom Direct Coombs Test: baby Rh (-) mom will get screened if any TRAUMA occurred that may cause bleeding. Rh immune globulin (RhoGAM) given to ALL Rh (-) pregos at 28 weeks and within 72 hrs of birth as well as post maternal trauma NOT EFFECTIVE once sensitization has ccured

Question 449

Serum alpha-fetoprotein

Answer 449

Screen for neural tube defects

Question 450

Rubella

Answer 450

German Measles red rash Droplet (sneeze, cough, mucus/saliva contact) Mom to baby by pregnancy, labor, nursing MMR VACCINE!!! Measles, mumps, rubella

Question 451

Meningitis

Answer 451

fever, severe headache, nausea/vomiting, nuchal rigidity, photophobia, AMS, increased ICP - W/ sepsis or hypotension? FLUID! - vasopressors (constrict blood vessels) epi, norepi - Labs/cultures - Empiric antibiotics (within 30 min admission) - Head CT BEFORE LP (increased ICP or mass lesions lead to brain herniation) - assist with LP

Question 452

Cranial Nerves

Answer 452

On Old Olympus Towering Tops A Finn And German Viewed Some Hops I-Olfactory-Smell II-Optic-visual III-Oculomotor- pupils constrict/extraoccular movement IV-Trochlear- extraoccular/down and inward V-Trigeminal-face sensation, biting, chewing VI-Abducens- Extraoccular/ lateral movement VII-Facial- Close eyes and smile VIII-Acoustic- Hearing/Romberg IX-Glassopharyngeal-Gag reflex X-Vagus-"AH" uvular and palate movement XI-Spinal Accessory -Turn head and shrug shoulders XII-Hypoglossal-stick tongue out

Question 453

Metabolic Syndrome

Answer 453

>= 3 health factors Increase risk for Stroke, DM, and CVD - Abdominal Obesity (>40M, >35W) - Increased Triglycerides (>150) R Hypertriglyceredemia drug treatment - Decreased HDL (<40M, <50W) - HTN (>=130/85) OR hypertensive drug treatment - Fasting blood glucose >=100 OR hyperglycemia treatment

Question 454

Lumbar Puncture

Answer 454

``` Spinal Tap Increase fluids lie flat for 4 hrs (prone or supine) Headache common Continued leaking fluids- site not sealed! Blood patch needed ```

Question 455

Ankylosing Spondylitis

Answer 455

Inflammation disease Hunch/curved spine - posture, daily stretching, swimming or racquet sports - stop smoking/breathing exercises - pain: moist heat and NSAIDS - immunosuppressant and anti-inflammatory meds - rest during flare ups - sleep on back with FIRM mattress to decrease spinal flexion

Question 456

Cleft Palate

Answer 456

Risks: aspiration, malnutrition Inability to create suction Feeding: - upright - bottle/nip away from CP - special bottle (nip always filled) "cross-cute" and preemie nips (no sucking needed) - burp often - feed slowly 20-30 min - feed 3-4 hrs

Question 457

Beck Triad

Answer 457

Cardiac Tamponade Hypotension Muffled heart sounds Distended neck veins Pulsus Paradoxus: large decrease in stroke volume, SBP, and wave amplitude during inspiration "Normal" SBP fall: 10 mmHg Normally BP rises with inspiration and falls with expiration

Question 458

Acid-fast Bacilli Smear and Culture

Answer 458

Confirms TB after positive TB test and Chest x-radiograph Sterile sputum 3 consecutive mornings

Question 459

Chronic Arterial Insufficiency

Answer 459

*Oxygenated Blood Not Getting To Tissue* Pain: Intermittent claudation (progresses to rest pain) Pulses: Decreased or maybe absent Color: Pale when elevated, red with lowering of leg Temp: Cool Edema: Absent or mild Skin Changes: thin, shiny, loss of hair over food/toes, nail thickening Ulceration: If present will involve toes or areas of trauma on feet (painful) Gangrene: May develop Compression: Not used

Question 460

Chronic Venous Insufficiency

Answer 460

* Blood Getting To Tissue, Can't Get Away!* - -Not oxygenation problem (don't choose give 2L NC) Pain: None to aching pain depending on dependency of area Pulses: Normal (may be difficult to palpate d/t edema) Color: Normal (may see petechiae or brown pigmentation w/ chronic condition) Temp: Normal Edema: Present Skin Changes: Brown pigmentation around ankles, possible thickening of skin, scarring may develop Ulceration: If present will be on sides of ankles Gangrene: Does not develop Compression: Used (need fluid to get back!)

Question 461

Cardiac Output

Answer 461

Amt of blood pumped by the heart per minute HR x SV (bpm x amt per beat)

Question 462

Preload

Answer 462

End Diastolic Volume Stretches R or LV CVP=measurement (2-8 normal)

Question 463

Afterload

Answer 463

Pressure in aorta and peripheral arteries that LV has to pump against during systole (systolic pressure)

Question 464

Fibrinolytics

Answer 464

Dissolve clot blocking blood flow to heart Decrease size of infarction Streptokinase (a lot of peopel allergic) Tenecteplase (1x psh) Aletplase (stroke too!) Reteplase Heart: 6-8 hrs!!! Complication? Bleeding ``` Contraindications: Brain tumor (IC neoplasm), IC bleed, suspected aortic dissection, internal bleeding ``` Stroke: 3 hrs

Question 465

5 P's

Answer 465

``` Neurovascular Check: Pain Pallor *Pulselessness (mark before procedure) Paresthesia (tingling, burning, etc.) Paralysis ```

Question 466

CHF

Answer 466

Coronary Heart Failure Blood not moving forward (cardiomyopathy, valvular disease, endocarditis, acute MI, htn) Left sided: THINK LUNGS! pulm cong, dyspnea, S3 sound, restless, blood-tinged sputum, crackles, Displaced PMI, paroxysmal nocturnal dyspnea (sense of SOB that wakes up pt) Right Sided: "Cor Pulmonate" Think Venous system enlarged organs, pitting edema, wt gain, distended neck veins (JVD), ascites NO NSAIDS! Cause sodium retention.

Question 467

Diagnose CHF

Answer 467

Swan Ganz catheter Central line cath -measures pressures inside of the heart Not pumping? increased heart pressure will show with increased Swan reading Other Tests: High BNP (peptide released when Vent stretched) Chest X-ray- enlarged heart, pulm edema Echo- EF, measures pressure

Question 468

Systolic HF vs Diastolic HF

Answer 468

Systolic: Heart can't contract/eject Diastolic: Ventricles can't relax and fill

Question 469

Spironolactone

Answer 469

Aldactone Diuretic May be given to decrease aldosterone (salt and water) levels When H2O and Na decrease, K increases!!! K-SPARING!!!!!!!

Question 470

Artery vs Vein | Elevate extremity?

Answer 470

Elevate Veins Dangle Arteries Artery issues/occlusions prevent blood from getting to tissue. Elevation makes that worse Veins can't get fluid away from tissue, elevate to move fluid along

Question 471

Buerger's Disease

Answer 471

``` Arterial Disease Men inflammation of veins and arteries (mainly arteries) --Cuts off O2 Usually LE's (toes) ``` Cause? Heavy smoking, getting too cold, intense emotions Treat: stop smoking, avoid cold, hydrate, wear shoes that fit well, maybe surgery, avoid trauma to feet

Question 472

Raynaud's Disease

Answer 472

``` Arterial Disease Female=Fingers! Vasoconstriction of vessels. Get's upset/cold/smokes and her fingers (both hands) turn white, then blue, then red PAINFUL and can ulcertae ``` Avoid cause: ex. if hands hurt when reaching into the freezer, wear gloves

Question 473

Echolalia

Answer 473

Repeating word or phrase over and over "echo" one of many schizo symptoms

Question 474

Neologism

Answer 474

Make up new words with no real meaning "neo-logic" one of many schizo symptoms RN: seek clarification!" "I don't understand" Do not reinforce behavior

Question 475

Korsakoff's Syndrome

Answer 475

Common in alcoholism *Thiamin/Niacin (V Vits) deficiencies Disoriented to time Confabulate (make up something to fill in gaps) --memory disturbance

Question 476

Wernickes Syndrome

Answer 476

Common in alcoholism Thiamin (Vit B1) deficiency labile emotions moody tires easily ok at first, ten soemthing sets them off

Question 477

Antabuse

Answer 477

Deterrent to alcohol - -any type of alcohol will cause effect - -couph syrups, aftershave, colognes,e tc

Question 478

Hemothorax

Answer 478

Blood in pleural cavity NOT pneumothorax= air in pleural cavity

Question 479

Crutches on Stairs

Answer 479

UP: "Up with the Good" Strong leg, weak leg, crutches DOWN: "Down with the Bad" Crutch, bad, then good

Question 480

Walking with Walker

Answer 480

Pick up, put in front, walk into walker Sliding? Hazard if pt's walker has rubber stoppers. They need tennis balls to make sliding safer

Question 481

D-Dimer

Answer 481

Blood test Will increase with pulmonary embolism *Indicates if clot located ANYWHERE in body, not just lungs

Question 482

hemoptysis

Answer 482

coughing up blood

Question 483

Fractures: S/S Complications

Answer 483

Continuos pain, unnatural movement, muscle spasms, possible deformity, crepitus (bones grating together), shortening of extremity (r/t muscle spasms), swelling, discoloration Complications: Shock, Compartment Syndrome, Fat Embolus (usually long tone fx, pelvic fx, crushing injury)

Question 484

Fat Embolus S/S

Answer 484

Depends on where emboli travels: - petechia or rash over chest - dyspnea - confusion - conjunctival hemorrhage - "snow storm" chest x-ray (fat in lungs) Usually long bone fracture First 36 hrs post injury

Question 485

Traction

Answer 485

- Pulling on part of body - Decreases muscle spasms, reduces (realigns) bones, immobilizes - Should be continuous *never relieve traction w/o order!* - Weights hand freely - Ropes move freely - Knots should be secure Skin Traction: tape material stuck to skin and weights pull against it. Skin not penetrated! Bucks, Russell's ``` Skeletal Traction: applied direclty to bones w/ pins and/or wires. Used when PROLONGED traction needed Steinman Pins (through the knee), Gardner-Wells Tons, Halo Vest ```

Question 486

Skin Traction Types

Answer 486

BUCKS--mostly hip fx - Weights hang off end of bed - 1 pulley and food being pulled horizontally towards end of bed - Supine or semi-fowlers (20-30 degrees) RUSSELL'S- moslty femoral fx - 3 pulleys - -1 above knee to pull leg upward while also being pulled by 2nd pulley towards end of bed

Question 487

Post-Op Amputation

Answer 487

-Tourniquet at bedside in case of hemorrhage Elevate on pillow first 24 hours --after that, elevate food of bed! (don't want contractures) -Want to prevent hip flextion!!! BKA=2 possible contractures (hip/knee) --put pt in PRONE POSITION to extend hip.knee Phantom Pain- diversional activity and pain meds Rehabilitation: - Stump shaping for prosthesis-cone shape - Massaging stump increases circulation and decreases tenderness - "Toughen" Stump: press into soft pillow, then firm pillow, then the bed, then the chair

Question 488

Hemodialysis

Answer 488

- Machine acts as glomerulus - If pt allergic to HEPARIN, can't be hemodialyzed - --unless another solution with anti-clot property can be used (ex. sodium citrate. - Pts with unstable cardiovascular system can't tolerate hemodialysis - Done 3-4x/week - Avoid K, high Na, and Phosphorus in diet - Eat more protein - Learn how much fuid allowed to drink

Question 489

Glomerulonephritis

Answer 489

- Inflammatory rxn in GLOMERULES (kidney filter) - Usually caused by STREP - sore throat, malaise, headache, Proteinuria, increased BUN/Creatinine, facial edema, decreased UO, anemia -Increase Carbs to increase energy! Dn't want protein to break down and make Urea that can't be excreeted

Question 490

Nephrotic Syndrome

Answer 490

*Inflammatory response in glomerulus ANY INFLAMMATION! (NSAIDS, heroin, Hodgkins, bacteria, viral, allergic rxn, DM, SLE) *big holes=protein leaking into urine *hypoalbunemic - can't hold onto fluid in vessels-THIRD SPACING! *Full-body edema (ANASARCA) *No fluid in vessels=kidney response to increase fluid-(renin-angiotensin system kicks in and produces aldosterone) *retention of Na and H2O Bed rest (to diurese) Prednisone- decrease inflammation (now immunosuppressed) ***Increase protein! ONE KIDNEY DISEASE YOU CAN INCREASE PROTEIN Lasix and Albumin infusion

Question 491

Meds that could cause intra-renal damage

Answer 491

"MYCINS", loop diuretics | -use with caution in clients with renal damage

Question 492

Peritoneal Dialysis

Answer 492

- Dialysate WARMED (vasodilation) and infused into peritoneal cavity by gravity through catheter - 2000-2500 mL stays in for ordered amt of time (dwell time) - Bag lowered and fluid along with toxins drained Effluent/drainage/fluid:Should be clear, straw-colored Cloudy=infection! -WHO? Pts who can't take hemodialysis like cardiovascular pts - Fluid not coming out? Reposition or turn from side to side - Diet: increased fiber and protein 2 Types of Peritoneal Dialysis - Continuous Ambulatory Peritoneal Dialysis (4x/day, 7 days/week, need strong client with no disc disease, arthritis, or colosomy) - Continuous Cycle Peritoneal Dialysis (night time only)

Question 493

Continuous Renal Replacement Therapy

Answer 493

Usually ICU setting - kidney filter utilized - Hemodialysis more aggressive - -300mL of blood in hemo machine, only 80mL in CRRT machine - Better for unstable pts whose CV status can't handle hemodialysis

Question 494

Ultrafiltration

Answer 494

Only pulling off water for pts only retaining water | May be utilized with peritoneal dialysis or hemodialysis

Question 495

Kidney Stones

Answer 495

Renal calculi, urolithiasis Don't Kill You! Pain WBC's in urine Hematuria (not inough to throw you in shock) RN Action: Urine specimen ASAP and check for RBC's Treatment: - Ketolorac (Toradol), Hydromorphone (Dilaudid), Promrthazine (Phenegran), Ondansetron (Zofran) - Increase fluids - Strain urine -EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) Will CRUSH stone!

Question 496

Cups of milk for 14 month old daily?

Answer 496

2-3 cups

Question 497

School age child daily caloric intake?

Answer 497

1600 avg | based on weight

Question 498

FLACC assessment

Answer 498

Pain assessment 2 months - 7 months ``` Face Legs Activity Crying Consollability 0=no pain 10=worst pain ```

Question 499

Wong Baker Pain Rating Scale

Answer 499

Faces :) | >=3 Years

Question 500

Numeric Scale for children of what age?

Answer 500

>=5 Years old

Question 501

Pediatrics | Observable signs for respiratory dysfunction

Answer 501

``` Accessory muscle use Flaring nostrils (nares) Circumoral pallor Sternal retractions Pallor Cap refill >3 ```

Question 502

Respiratory Syncytical Virus

Answer 502

RSV - Acute viral infection affecting bronchioles - Affects children 2 months-2 years - Begins with simple URI and then progresses - nasal discharge, nonproductive paroxysmal cough, tachypnea and flaring nares, wheezing

Question 503

Asthma | S/S and Dx

Answer 503

Cough, SOB, audible wheezing, prolonged EXPIRATORY WHEEZING, restlessness, cyanosis, tripot posiiton Identify triggers!!! Infants: Reactive Airway Disease (RAD) - Chronic cough, no infection - Pulmonary Function Test - Spironmetry function >5 years old - Peak expiratory flow rate (PEFR) (age, race, height gender dependent)

Question 504

Asthma Treatment

Answer 504

GENERAL: - Chest physiotherapy (percussion, vibration, squeezing of chest and then breathing exercise- ex. blowing a pin wheel) - allerg shots - small frequent meals - cold air, breath through nose - encourage fluids to thin secretions (not cold- bronchospasm) ACUTE: - humidified O2 - epi Sq or Tebutaline Sq - Rescue meds: IV corticosteroids, prednisone, Solu-medrol * *Beta 2 agonists: Albuterol, Metaproterenol, Terbutaline - -After neb treatment, kid will get worse before better. Airway opens and they will wheeze * *Bronchodilator: Salmetrol, aminophaline, theophylline LONG TERM CONTROL (preventer meds) -corticosteroids (inhaled by MDI or neb, po) 0MDI's -Beta 2 agonist ***MDI at any age with correct spacer

Question 505

Hirschprung's Disease

Answer 505

Piece of intestines=no nerves No nerves = no peristalsis in that location AKA: aganglionic MEGA COLON that results in mechanical obstruction along bowel. -Sigmoid Colon S/S- Constipation, abdominal distention, ribbon-like/foul smelling stools Clinical Features: - bilious vomiting - abd distension - failure to pass meconium - failure of internal anal sphincter to relax - difficulty feeding ``` Fatal complication: ENTEROCOLITIS -fever/lethargy -explosive foul-smelling diarrhea -rapidly worsening abdominal distention ```

Question 506

Pyloric Stenosis

Answer 506

Obstruction of gastric outlet. - Results in projectile vomiting d/t pressure, usually after feeding. - Immediately hungry again. - Olive shaped mass in epigastrium region (near umbilicus) - -Enlarged pyloris's! Vomiting=dehydration - metabolic alkalosis - hypokalemia - hemoconcentration (high hct) RN Intervention for infant pt? hydration d/t vomiting, intake and output, daily weight, urine specific gravity Surgery neeeded PS vs GER? GER results in spitting formula with gastric juice (reflux)

Question 507

Esopageal Atresia

Answer 507

- Esophagus ends in a blind pouch - Saliva can't make it to stomach - frothy mucus/cyanosis - suction airway! ***No meconium because they never swallowed any amniotic fluid! Fed with G-tube (straight into stomach)

Question 508

Tracheoesophageal Fistula

Answer 508

``` Opening b/w trachea and esophagus 3 C's: Coughing Chocking Cyanosis ``` - Potential for aspiration - Pre-op, place infant on back with head and shoulders elevated to let secretions pool in lower esophagus. -Common for moms with GI tract issues to have POLYHYDRAMIOS b/c baby never swallows amniotic fluid

Question 509

Leukemia

Answer 509

- Most common form of childhood cancer - cancer of blood forming tissue - proliferation of immature WBC's (immunosuppressed) - -SO many WBC's no room for platelets or RBC's (thrombocytopenia and anemia) ALL (acute lymphoid leukemia) +better prognosis AML (acute myeloid leukemia)

Question 510

Wilms tumor

Answer 510

Nephroblastoma Found: KIDNEY or abdominal mass -Swelling or non-tender mass on one side of abdomen -abdominal pain, nausea/vomit Wilms: DO NOT PALPAT ABDOMEN -Gentle care with bathing or moving pt

Question 511

Fontanelle Closure Times

Answer 511

Anterior: 7-18 months Posterior: 1-3 months

Question 512

Rheumatic Fever

Answer 512

-Inflammatory disease that occurs after an infection -Group A B hemolitic streptococcus Strep LOVES the heart and kidneys Clinical manifestation: carditis! Penicillin G or Erythromycin

Question 513

Kawasaki Disease

Answer 513

Widespread inflammation of small and medium sized blood vessels. -Coronary arteries most susceptible! Treatment: High dose of IV Immune G Salicylate (ASA therapy)-aspirin Bed rest

Question 514

RN assessment of kids with cardiac dysfunction

Answer 514

- Nutritional status (failure to thrive, poor eight gain, fatigue with feeding, poor feeding habits) - Color, chest deformities, unusual pulsations, resp effort, clubbing of fingers - Behaviors (knee-chest position or squatting seen in some types of herat disease) - Excessive sweating during feeding

Question 515

CHF | Pediatric Pts

Answer 515

-Usually due to congenital heart defects Early S/S: increased pulse at rest/with slight exertion increased RR Scalp sweating (infants) Fatigue Sudden weight gain (>=1 lb/day is FLUID!) --fluid retention, think heart problems first! ``` Tx: Listen to lungs!! Control room temp Decrease heart workload (sit-up, rest, decrease stimuli) Cool, humidified oxygen Uninterrupted sleep Feed q3hr --20 min feedings Digoxin --Infants, hold if P<110, Children hold if P<70 --Normal dig level 0.8-2 Ace inhibitors- watch for cough! Lasix ```

Question 516

Patent Ductus Arteriosus

Answer 516

Hold between pulmonary Artery and Aorta. Normal for fetus (O2 from placenta, not lungs). Should close after delivery. MACHINERY LIKE MURMUR

Question 517

Coarctation of Aorta

Answer 517

Narrowing of Aorta - Difficulty for LV to pump - -Left sided HF Dx? Big difference in pulses and BP in UE's and LE's Upper extremities much higher!

Question 518

Tetrology of Fallot

Answer 518

PROVe Pulmonary Stenosis RV Hypertrophy Overriding aorta Ventricular Septal Defect

Question 519

Transposition of the Great Vessels

Answer 519

Aorta Connected to the RA and RV Pulmonary Artery connected to the LA and LV 2 separate sets of circulation. Surgery required

Question 520

Tonsillectomy

Answer 520

- Post op position: Side lying HOB elevated OR prone - Don't give red or brown fluids (don't want anything confused with blood) - hemorrhage? Frequent swallowing - Hemorrhage risk for 10 days - no milk - avoid coughing, clearing throat, blowing nose - avoid oral mouth rinses, gargling, vigorous tooth brushing ``` Common complains post-op? Sore throat Slight ear pain Low grade fever (normal) --spike=infection Bad breath (old blood) ```

Question 521

Intussusception

Answer 521

Sudden onset/episodes of pain | Currant jelly stool (maroon=blood and mucus)

Question 522

Delegation

Answer 522

Designating tasks to others, but RN retains accountability

Question 523

3 Rules of LPN Delegation

Answer 523

1. Only nursing care in stable situations 2. Orders not subject to change (do not delegate complex tasks) 3. Selected tasks in unstable situations - Monitor pain and admin pain meds - Titrate oxygen based on unit protocols - Reinforce education - Routine procedures (catheterization) - Ostomy care - Tube potency and enteral feedings - specific assessments - Monitor RN findings

Question 524

UAP Delegation

Answer 524

Non-complex tasks: * **Allowed to pick up/return blood from blood bank! - I and O - Routine Vitals (not blood, dopamine, mag sulfate, nitro) * before and after blood transfusion ok - Basic Communication - CPR (make sure doing it correctly) - ID Risks - Feeding pt (except stroke) - Oral care (even on trach pt) - ROM exercises - Must teach to report back to RN on task/pt condition * NOT PAIN - CAN escort family to waiting area - CAN report observations - CAN empty, measure and record output from surgical drain - NOTHING THAT STARTS WITH "MONITOR" - CAN transport client to morgue

Question 525

Ulcerative Colitis

Answer 525

Large intestine mucosal irritation -bloody diarrhea - high calorie/high protein diet - multivitamins w/ calcium - >=2 L water/day - Journal/Avoid dietary triggers - Avoid caffeine, alcohol, tobacco

Question 526

Acute Pancreatitis Symptom Relief and Prevent Complications

Answer 526

NPO: food increases release of pancreatic enzymes. -Use NG tube to suction gastric secretions Pain: IV opioids Fluid: aggressive IV fluid replacement to prevent hypovolemic shock Positioning: flex trunk (Semi-fowlers) to decrease pressure on abdomen OR side-lying with head elevated to 45 degrees

Question 527

Prevent Dumping Syndrome

Answer 527

Multiple small meals Low CHO diet Do not consume fluids and food at the same time (at least 30 min apart)

Question 528

Narcissistic Personality Disorder

Answer 528

Fragile/Damaged Ego Exhibit: grandiosity, need for admiration, lack of empathy Project: superiority, uniqueness, independence (all hides emptiness) Why? Need to regulate/maintain fragile self-esteem

Question 529

Anemia in Pregnancy | Based on Trimester

Answer 529

1: Hgb <11 2: Hgb <10.5 3: Hgb <11

Question 530

Circumcision Home Care

Answer 530

- Wash hands before - Warm water, NO soap q4h - Petroleum Jelly at diaper changes (q4h, 3-5 days) - Yellow exudate normal (2-3 days) - Expect 4-6 wet diapers first 24hrs - Bleeding size of quarter ok About procedure: - was a sterile procedure in hospital - Restrained in wrapped blanket or on special board to prevent injury - sucrose solution offered for pain Infection: red, odor, discharge

Question 531

Mg Toxicity | Pre-eclampsia pt

Answer 531

Normal (non-prego) range 1.5-2.5 mEq/L Therapeutic Mg level in pre-eclampsia pt to prevent sz: 4-7 mEq/L Absent/diminished DTRs (normal=2+) Respiratory depression <30mL/hr UO cardiac arrest D/C infusion Calcium glutinate (antidote) ONLY if cardiorespiratory compromise

Question 532

SIDS Prevention

Answer 532

- Less than 1 yr supine to sleep - Firm sleep surface - Do not share bed with caregivers - Avoid soft objects (stuffed animals, heavy blankets, pillows). Thin tucked blanket ok - Avoid bumper crib pads - Smoke-free environment - Use pacifier when placing infant to sleep (>1 month) - Breastfeeding and keeping up infant immunizations

Question 533

Ventricular Septal Defect

Answer 533

many newborns asymptomatic acyanotic defect HARSH SYSTOLIC MURMUR (systole and diastole)

Question 534

Cystic Fibrosis Features

Answer 534

- meconium ileum (thick meconium/blockage at birth) - Sinusitis - Barrel Chest - Pneumonia/bronchiectasis - Cachexia (weakening/wasting of body d/t chronic illness) - Biliary cirrhosis - Pancreatic exocrine insufficiency - CF-related diabetes - Digital clubbing - Inspissated (thicken/congeal) stools - Absent vas deferens (infertile men)

Question 535

Alpha-Adrenergic Blockers Function, Use, Side Effects

Answer 535

``` -ZOSIN (terazosin, prazosin, doxazosin) Relaxes smooth -bladder neck, prostate gland -peripheral vasculature ``` Uses: BPH Hypertension Side effects: Orthostatic hypotension, falls/syncope, dizziness, ED Misc: - Take at bedtime to avoid orthostatic hypotension - Do not take with -ENAFIL meds (sildenfail, vardenafil) - --also smooth muscle relaxing

Question 536

Radiation Poisoning

Answer 536

Like chemo, affects rapidly proliferating cells first: Oral mucosa GI tract Bone marrow ``` Phases: Prodromal Latent Manifest Recovery/Death ```

Question 537

Neurogenic Shock

Answer 537

Disruptive (vasodilatory) Shock Affect sympathetic nervous system (SNS), not parasympathetic nervous system (PNS) MASSIVE VASODILATION - hypotension - bradycardia - warm skin, not cool/clammy

Question 538

Opioid Use Teaching

Answer 538

Common side effects: - pruritus (antihistamines) - flushing - hypotension (fluids, rise slowly) - nausea (antiemetics) - constipation (no developed tolerance) ``` Constipation expected long-term side effect: defecate when urge felt, 2-3L water daily, high-fiber diet, exercise), stool softener (Decussate) stool stimulant (Senna) ```

Question 539

Common Selective Serotonin Retake Inhibitors SSRI's

Answer 539

``` citalopram (Celexa) escitalopram (Lexapro) fluoxetine (Prozac) fluvoxamine (Luvox) paroxetine (Paxil) sertraline (Zoloft) ```

Question 540

Common Monoamine Oxidase Inhibitors MAOI's

Answer 540

selegiline (Emsam) isocarboxazid (Parplan) phenelzine (Nardil) tranylcypromine (Parnate)

Question 541

Candida Albicans

Answer 541

*Oropharyngeal candidiasis/moniliasis* ``` Fungal infection oral candidiasis (thrush) ``` White patches on oral mucosa, palate, tongue Non-removable and tend to bleed when touched At risk? - Infants - Pts with dentures - immunosuppressed its (ex, taking corticosteroids, chemo/radiation, AIDS) Treatment: Anti fungal (nystatin) Oral hygiene

Question 542

Atrial Fibrillation Treatment Goals

Answer 542

Ventricular HR <100 Diltiazem (Ca Blocker) Metoprolol Digoxin If you want to change rhythm to NSR: amiodarone or ibutilide

Question 543

Clonidine Patch

Answer 543

- change and rotate sites every 7 days - dry hairless area on upper chest/arm - no shaving before patch (razor burn) - discard by folding sticky sides together - 1 patch at a time - DO NOT stop using abruptly

Question 544

Proof of repercussion after STEMI

Answer 544

Return of ST segment to baseline - thrombolytic therapy can stop infarction process in STEMI - given first 12 hrs of symptom onset

Question 545

Infant Increased ICP S/S

Answer 545

fever vomit high-pitched cry irritability bulging fontanelle "sunset eyes" Prominent scalp veins Increased head circumference Potential bacterial meningitis

Question 546

Dislodged Tracheostomy Tube | RN Action

Answer 546

-If mature (>7 days), insert new trach with obturator. - If unable to: cover w/ sterile occlusive dressing (3 sides) - ventilate w/ bag-valve mask over nose/mouth

Question 547

IV Potassium Chloride | KCl

Answer 547

Central Venous Access Device (PICC, CVC): Concentration: 20-40 mEq/100mL Max Rate: 40 mEq/hr Peripheral: Concentration: 10 mEq/100mL - KCl irritates vein - May slow infusion rate to decrease discomfort.

Question 548

Transfusion Reaction | RN Interventions

Answer 548

1. D/C immediately 2. Maintain IV access w/ NS and new tubing (prevent hypotension and vascular collapse) 3. Notify HCP and blood bank 4. Monitor Vitals 5. Recheck labels, #'s, blood type 6. Treat clients Sx based on HCP Rx 7. Collect blood/urine specimens to evaluate for hemolysis 8. Return blood/tubing set to blood bank 9. Documentation/paperwork

Question 549

Autonomic dysreflexia

Answer 549

aka. Hyperreflexia Spinal cord injuries >=T6 Exaggerated sympathetic nervous system response HYPERTENSIVE EMERGENCY (uncontrolled HTN) -Can lead to stroke or MI Manifestations: - acute onset of throbbing headache - nausea, and blurred vision - hypertension and bradycardia - diaphoresis and skin flushing above the level of the injury Triggers: Bladder distension Rectum distension Pressure Ulcers Treatment: Check BP, Check bladder (cath), digital rectal exam, remove constrict clothing

Question 550

Need for Cerebral Spine Stabilization

Answer 550

NSAIDS N=neuro exam (numbness, decreased strength) S=significant traumatic mechanism of injury A=alertness I=intoxication (decreased pain awareness) D=distracting injury (not paying attention to spine) S= spinal exam (midline or point tenderness spine/neck)

Question 551

Diabetic client wants to fast for religious reasons. | RN Action?

Answer 551

Assess for risk of adverse events! - Clinical stability (comorbidities) - glycemic control (hyper/hypo-glycemic episodes, medication regimen, knowledge, ability to self-monitor BG during fast)

Question 552

Acute Pericarditis

Answer 552

Inflamed layers of pericardium rubbing against heart causing pain. - ST Elevation in ALL EKG leads! (MI localized to leads being effected) - CARDIAC TAMPONADE LETHAL COMPLICATION - Worse with deep breathing/supine - sit up and lean forward (fowlers or high fowlers)

Question 553

Cholecystitis

Answer 553

Gallbladder inflammation -Vomiting? NPO! If in any major pain, NPO to decrease gall bladder stimulation. -Low-grade fever, chills, nausea, vomit, anorexia -RUQ pain (Murphy's sign) radiating to R shoulder or scapula -Then deal with pain, fluid imbalance, and gastric decompression (NG Tube) -FATTY FOODS 1-3 hrs pre-onset ``` Interventions: Sims position Deep breathing Ambulation Analgesics ```

Question 554

Paralytic ileus

Answer 554

Temporary paralysis of portion of bowel. Affects peristalsis and bowel motility S/S: abdominal discomfort, distention, nausea/vomiting. Risk Factors: Abdominal surgery, perioperative meds (opioids, anesthesia, analgesics), immobility (stroke) Treatment: - NPO - NG tube wall suction to decompress stomach - F/E replacement to correct losses from NG suction - Antiemetics (ondansetron, promethazine)

Question 555

Epinephrine and Norepinephrine | vessel action

Answer 555

Adrenal Medulla Fight/Flight Hormones Acts directly on smooth muscles of blood vessels to CONSTRICT them Norepi medication is a vasoconstrictor and vesicant that can cause tissue necrosis

Question 556

What to avoid during therapeutic communication

Answer 556

"WHY" questions. Viewed as critical, judgmental, and intrusive. Voicing doubt ok.

Question 557

Herbal supplements that increase risk for bleeding

Answer 557

- Gingko biloba (memory, claudation) - Garlic - Ginseng (improved mental performance) - Ginger - Feverfew

Question 558

Intrapartum fetal HR monitoring mneumonic

Answer 558

VEAL CHOP Variable-Cord compression Early- Head compression Accelerations- OK Late- Placental insufficiency

Question 559

Rotavirus

Answer 559

Contagious Virus Leading cause of diarrhea in kids <5. -Dehydration major risk! Fecal-oral Vaccination for kids less than 8 months old. Contact w/ food, toys, diaper, and hands *Hand washing 8

Question 560

Heatstroke

Answer 560

- Temp >104F - Hot, dry skin - Hemodynamic instability (tachycardia, hypotension) - AMS/neuro symptoms (confusion, lethargy, coma Risk for permanent near injury or death directly related to duration. ABC's and rapid cooling: -cool water immersion -cool IV fluids Antipyretics INEFFECTIVE b/c unrelated to inflammatory process.

Question 561

IV Potassium Chloride | KCl

Answer 561

Concentration: 40 mEq/L Infusion Rate Max: Central Line- 40 mEq/hr Peripheral Line- 10 mEq/hr Pain at peripheral site, slow IV infusion rate

Question 562

Vitamin K Food

Answer 562

Do not eat with warfarin! Greens! green leafy veggies, cauliflower, broccoli, cabbage, lettuce, spinach, brussel sprouts

Question 563

Do not eat with warfarin...

Answer 563

High vitamin K foods | Green tea, grapefruit juice, cranberry juice

Question 564

Frostbite Treatment

Answer 564

- Do NOT massage/rub/squeeze - Immerse in warm water (98.6-102.2) - analgesia - remove clothing/jewelry - NO heavy blankets/clothing to prevent tissue sloughing - While thawing, area may become edematous (ELEVATE) and blister - Keep wounds open immediately after a water bath and allow them to dry before applying loose, non adherent, sterile dressings - Monitor s/s compartment syndrome

Question 565

Post-up naloxone RN Action after: 1 dose given, 1 hr later decreased respiratory rate and low arousability

Answer 565

- Administer oxygen - Assess respiratory rate - Notify HCP - Prepare 2nd dose! Naloxone has shorter half life than most opioids. Wears off 1-2 hours.

Question 566

Clozapine Use? Adverse effects?

Answer 566

-Atypical antipsychotic -Treatment-resistant Schizophrenia -AGRANULOCYTOSIS! =Increased risk for infection (fever, sore throat, etc) ``` Monitor WBC (>3,500) count and ANC (>2000) *Monitor WBC and ANC weekly* ``` Metabolic Syndrome - weight gain - hyperglycemia - dyslipidema -drooling, hypersalivation Seizures

Question 567

Glucocorticoid side effects

Answer 567

* Prednisone * Methylprednisolone * Dexamethasone Side effects: - increase in blood sugar - fluid retention/increased hypertension - stop suddenly can lead to adrenal crisis

Question 568

1 oz converted to mL

Answer 568

1oz = 30mL

Question 569

Caput succedaneum

Answer 569

CS=crosses suture Edema/hematoma above periosteum that CROSSES suture lines feels "spongy" and closes suture *Resolves within first week Expected finding

Question 570

Cephalohematoma

Answer 570

Subperiosteal bleed that DOES NOT CROSS suture lines Expected finding

Question 571

Crutches Safety

Answer 571

- Clutter free (rugs) - Look forward - Use small backpack/bag to hold items to keep hands free - Rubber/non-skid soled slippers/shoes - Keep rubber tips dry

Question 572

Measuring/Assessing JVD

Answer 572

- Bed at 45 degrees (semi-fowlers) | - Pulsation of neck veins

Question 573

Refeeding Syndrome

Answer 573

Declines in PPM Phosphorous (2.4-4.4) Potassium (3.5-5) Magnesium (1.5-2.5) Food=insulin=shift into cell. Hypophosphatemia= muscleweakness= resp failure Other: fluid overload, Na retention, hyperglycemia, thiamine deficiency Actions to prevent refeeding syndrome include the following: - Obtaining baseline electrolytes - Initiating nutrition support cautiously with hypocaloric feedings - Closely monitoring electrolytes - Increasing caloric intake gradually

Question 574

Splenectomy lifelong risk for...

Answer 574

RAPID SEPSIS! Even low-grade fever should be taken seriously with these clients. A lot of vaccines: pneumococcus, meningococcus, haemophilus influenzae type B

Question 575

Cellulitis

Answer 575

Common skin bacterial infection IV antibiotics in clients with DM

Question 576

RN Plan of Care for | Pertussis Infection

Answer 576

- Droplet precautions - Monitor signs airway obstruction - Small amounts of fluid frequently - Oral antibiotics - Supportive measures (humidified oxygen) - cough >2 wks - >1 wk paroxysms of cough, inspiratory whooping sound, and posttussive vomiting

Question 577

Acute appendicitis

Answer 577

Appendix - ABDOMINAL pain (belly button to RLQ) - POINT of McBurney's (most pain, b/w belly button and hip bone) - POOR appetite - ELEVATED temp - NAUSEA/vomiting - DESIRE to be in fetal position/relieve pain - INCREASED WBC, inability to pass gas or have BM - rebound tenderness RLQ -Surgery required in first 24 hrs

Question 578

Vaso-occlusive Crisis

Answer 578

Pain crisis in Sickle Cell Disease Elevated reticulocytes Elevated bilirubin Anemia NOT RELATED: rbc's, high k.

Question 579

Psoriasis Look Management

Answer 579

Chronic autoimmune disease-rapid turnover of epidermal cells. - silver plaques on reddened skin - NO CURE Manage: - avoid triggers (stress, trauma, infection) - topical therapy (corticosteroids, moisturizers) - phototherapy/sunlight - systemic medications, cytotoxic (methotrexate) and biologic (infliximab) agents

Question 580

Post-op Chest Tube | Drainage

Answer 580

- Excessive drainage (>100 mL/hr) - Air/fluid in chest (diminished breath sounds) - pain - infection at drainage site - Excess drainage of frank red blood = hemorrhage must be managed immediately - Assess every hr for first 8 hrs - Then every 8 hours until removed

Question 581

Cyclobenzaprine

Answer 581

Flexural Common centrally acting muscle relaxant: For muscle spasticity, muscle rigidity, acute/chronic muscle pain/injury. Metabolized by LIVER. Toxicity with liver disease (hepatitis) and increased CNS depression

Question 582

Cognitive Behavioral Therapy

Answer 582

Maladaptive reactions to stress, anxiety, and conflict: CBT has 5 basic components: - Education about disorder - Self-observation and monitoring -anxiety, identify triggers, and assess the severity - Physical control strategies – deep breathing and muscle relaxation exercises - Cognitive restructuring – learning new ways to reframe thinking patterns - Behavioral strategies – focusing on situations that cause anxiety and practicing new coping behaviors, desensitization to anxiety-provoking situations or events NOT: interpersonal psychotherapy, NOT psychodynamic therapy

Question 583

Calcium Channel Blockers

Answer 583

-dipine Very Nice Drugs Verapamil, Nifedipine, Diltiazem Blocks Ca access to cells causing: * Decreased heart contractility/rate * Decreased demand for oxygen * Decreases PVR * Relaxation of vascular smooth muscles Uses: angina, HTN, dysrhythmias (verapamil, dilt) ``` Adverse effects: Dizziness Peripheral edema Constipation Orthostatic hypotension ```

Question 584

Dental avulsion

Answer 584

Tooth separated from mouth. If permanent tooth- DENTAL EMERGENCY! Re-implantation in 15 min reestablishes blood supply. Tooth might survive. Can put tooth in: cold milk, sterile saline, Hanks balanced salt solution. NOT hypotonic solution!

Question 585

Hypoglycemia S/S

Answer 585

``` BG <70 Epi released! Trembling/Shakiness Palpitations Anxiety/arousal Restlessness Diaphoresis/pallor ``` ``` Prolonged Hypoglycemia: neuro symptoms! confusion seizures coma ```

Question 586

Receptive Aphasia | Intervention

Answer 586

Impairment or loss of language comprehension (speech, reading) - Ask short, simple, "yes" "no" questions - Use gestures or pictures to demonstrate activities - Remain patient and calm, allowing pt to understand each instruction - eye contact do NOT: raise voice. Hearing isn't the issue

Question 587

Peptic Ulcer Disease Treatment | *Types of Ulcers

Answer 587

"Triple Drug Therapy" 14 days Amoxicillin, Clarithromycin, Omeprazole -Avoid triggers -Stop smoking, drinking Duodenal Ulcers: Pain 2-3 hrs post meals Food might decrease pain Gastric Ulcers: aPain 30 min- 1 hr after meals Eating increases pain Stress ulcers- Cushing's ulcers (brain injury), Curling's Ulcer (extensive burns)

Question 588

Emergency Drugs to LEAN on

Answer 588

Lidocaine (V-arrhythmias, MI's) Epinephrine Atropine (treats brady) Narcan (opioid reversal)

Question 589

IDEA for slow HR and BP

Answer 589

Isoproternol- relaxes BV and increases cardiac pump efficiency Dopamine- Increases pump strength Epinephrine- constricts peripheral BVs to shunt blood to heart and brain Atropine- anticholinergic- treats symptomatic brady

Question 590

ABCDE for atrial arrhythmias

Answer 590

``` Anticoagulants Beta Blockers (slow HR) Ca Channel Blockers (slow HR, contractility, smooth muscle relaxation) Digoxin (stronger HR) Electrocardioversion ```

Question 591

Anticholinergic drugs

Answer 591

Cause decrease in parasympathetic effects! S/S-Same as sympathetic fight/flight ``` Decreased smooth muscle spasms Decreased digestion Pupil dilation Increased secretions Increased HR Airway relax ``` Atropine, Ipratropium, Benztropine, Scopolamine, Oxybutynin Uses: AV blocks, mydriasis for retinal exams, Increased HR for symptomatic bradycardia

Question 592

Death Rattle

Answer 592

Actively dying Unable to manage airway/clear secretions Give anticholinergics to dry secretions! Atropine drops Scopolamine patch

Question 593

Small Bowel Obstruction S/S Treatment

Answer 593

- rapid onset nausea/vomit - colicky, intermittent abd pain - distension ``` Treatment: NPO NG tube IV fluids Pain treatment ```

Question 594

Large Bowel Obstruction | S/S

Answer 594

- gradual onset of symptoms - cramping/abd pain - distension - ABSOLUTE constipation - lack of flatus

Question 595

Meds Pregos CANNOT have

Answer 595

Ace inhibitors doxycycline isotretinoin (accutane) NSAIDS (aspirin, ibuprofen-Motrin/Advil) Thalidomide

Question 596

Fondaparinux

Answer 596

Unfractioned heparin Do not give until >6 hrs post op -same rule for LMW heparin

Question 597

Sjogren's Syndrome

Answer 597

- Auto immune disorder - WBC's attack moisture-producing exocrine glands - Salivary gland decrease: Xerostomia (dry mouth) - Lacrimal gland decrease: Xerophthalmia (dry eyes) Dry skin (itchiness, rash), throat/bronchi (dry cough) * **Avoid decongestants! Further dryness * Avoid oral irritants (coffee, alcohol, nicotine, acidic drinks) Treatment: eye drops, SF candy, lubricant, frequent dental exams, lukewarm showers/mild soap, avoid decongestants (oxymetazoline, phenylephrine, pseudo ephedrine)

Question 598

Dislodged CVC | RN action

Answer 598

- Oxygen non-rebreather - Occlusive dressing - Monitor VS/Resp effort - Notify HCP - Left Lateral Trendelenburg

Question 599

Inserting NG Tube for gastric decompression

Answer 599

1. Hand hygiene and apply clean gloves (not sterile) 2. Pt in high Fowler's position 3. Assess nares and oral cavity and select naris 4. Measure (nose, ear, typhoid) and mark the tube 5. Curve 4-6" tube around index finger and release 6. Lubricate end of tube with water-soluble jelly 7. Instruct client to extend neck back slightly 8. Gently insert tube just past nasopharynx, aiming tip downward 9. Rotate tube slightly if resistance is met, allowing rest periods for client 10. Continue insertion until just above oropharynx 11. Ask client to flex head forward and swallow small sips of water (or dry if NPO) 12. Advance tube to marked point 13. Verify tube placement and anchor - use agency policy and procedure to verify placement by anchoring tube in place and obtaining an abdominal x-ray. - Aspirating gastric contents and testing the pH may also give an indication of placement (pH should be 5.5 or below). - Auscultation of inserted air is acceptable for confirming tube placement initially, but is not definitive as it is not an evidence-based method. - Nothing may be administered through the tube until x-ray confirmation is obtained, or this may cause aspiration.

Question 600

Gastric Lavage

Answer 600

- Use large-bore (36-42 french) orogastric tube - Removes ingested toxins/irrigates stomach - Intubation/suction supplies ready in case of emergency - pt on their side or with head of bed elevated - initiate within 1 hr of OD Activated charcoal admin is standard treatment for OD, but ineffective for lithium, iron, alcohol

Question 601

PTSD communication

Answer 601

They believe they are responsible/to blame. Will experience guilt/shame. Convey that what happened was not their fault.

Question 602

Disulfiram

Answer 602

Antabuse Aversion therapy-alcohol abstinence If alcohol consumed, pt may experience headache, intense nausea/vomit, flushed skin, sweating, dyspnea, confusion, tacky, hypotension). Large amount can be FATAL Hidden alcohols in: - liquid cold/cough meds - aftershave, lotions, colognes, mouthwashes - foods such as sauces, vinegars, flavor extracts Abstain from alcohol for 2 weeks after last dose b/c run could still occur Wear med bracelet to let others know you're on disulfiram therapy

Question 603

Cryptorchidism

Answer 603

undescended testicle -If at birth, not concerning. Most descend spontaneously by age 6 months

Question 604

Concerning fetal abnormalities at birth

Answer 604

Cranial nerve abnormalities. Ex. ptosis (drooping of eyelid below level of pupil) Normal: rales (crackles) for a few hrs after birth. Dull percussion over bladder (full bladder)

Question 605

HELLP Syndrome

Answer 605

Severe form of preeclampsia: Hemolysis Elevated Liver enzymes Low Platelet count ``` Presentation: (sometimes non-specific) RUQ pain nausea vomit malaise ``` If not treated immediately could lead to placental abruption, stroke, and death

Question 606

Cystitis

Answer 606

- Most commonly acquired UTI (e.coli) - Lower UT - Bladder (mucosa) inflammation! S/S: - burning urination (dysuria) - urinary frequency - urinary urgency - hematuria - suprapubic discomfort

Question 607

Pyelonephritis

Answer 607

``` Kidney infection (e.coli)! Can ascend from bladder. -nausea -vomit -FEVER WITH CHILLS -FLANK PAIN EXTENDING TOWARDS UMBILICUS (costovertebral angle tenderness) ```

Question 608

Huff coughing Why? How?

Answer 608

COPD -need to learn to expectorate mucus without high-pressure coughs (incapable) 1. Position upright 2. Inhale through the nose using abdominal breathing and prolong the exhalation through pursed lips for 3 breaths – deflates excess air from lungs 3. Hold breath for 2–3 seconds following an inhalation, keeping the throat open 4. Deeply inhale and, while leaning forward, force the breath out gently using the abdominal muscles while making a "ha" sound (huff cough); repeat 2 more times (eg, "ha, ha, ha") – keeps airways open while moving secretions up and out of the lungs. 5. Inhale deeply using abdominal breathing and give one forced huff cough – the last, increased force ("ha") usually results in mucus being expectorated from the larger airways.

Question 609

Transplant patients highly...

Answer 609

IMMUNOSUPPRESSED! On strong immunosuppressant meds. Infection can be rapidly progressing and be FATAL. Low grade feel is a priority.

Question 610

Thiazolidinediones

Answer 610

rosiGLITAZONE pioGLITAZONE *Treat type 2 diabetes* increase insulin sensitivity - Can worsen heart failure by causing fluid retention - Risk:bladder cancer - risk: heart events (MI) -low risk for hypoglycemia NO retinopathy risk related to the med.

Question 611

Coronary Arteriogram

Answer 611

Angiogram -invasive diagnostic study coronary arteries, heart chambers, function - NPO 6-12 hrs before - warm and flushed when dye injected - may have to lie flat for several hours to ensure hemostatis in artery that was cannulated for procedure. - NOT general anesthesia - can usually go home that day

Question 612

Neonatal heel stick

Answer 612

- medial or lateral side of outer aspect of heel - warm heel for several minutes with warm towel - sucrose and nonnutritive sucking - cleanse with alcohol - automatic lancet Acceptable alternate method: venipuncture (draw blood from vein) - less painful - fewer punctures for more larger sample

Question 613

Fecal incontinence | Types

Answer 613

aka. encopresis, soiling >4 years old Functional: retentive - constipated for days, painful stool, repeat cycle (think of parents that only feed their kids candy) - reward system to encourage child's involvement in treatment Psychosocial (non retentive)- cannot control feces

Question 614

Adverse events Error types

Answer 614

-Injuries caused by medical management, NOT client's underlying condition. Error types: - diagnostic - treatment - preventive - other (failure to communicate, equipment failure system failure

Question 615

Cerebral aneurysms

Answer 615

Asymptomatic bless they rupture "silent killers" "The worst headache of my life"

Question 616

Long bone fractures

Answer 616

Femur Humorous Tibia POTENTIAL FAT EMBOLUS! Travel to lungs, skin, and brain AMS= blocked blood vessels in brain! Lungs=respiratory distress Hallmark sign: PETECHIA-pin sized red/purple spots small vessels clotting. Chest, axillae, soft palate

Question 617

Hyperkalemia Med Admin

Answer 617

If peaked T waves: 1) calcium glutinate 2) insulin/dextrose If no peaked T waves, start insulin/dextrose

Question 618

Levetiracetam

Answer 618

Keppra Anticonvulsant for seizure disorders Depresses CNS: drowsiness, somnolence, fatigue AS CLIENTS ADJUST to meds -Typically improves in 4-6 wks Risks needing immediate attention: - increased anxiety, depression, SI - Stevens-Johnson syndrome (blistering skin)

Question 619

Driving for patients with seizures

Answer 619

Avoid driving or operating heavy machinery until they have permission from their HCP Usually requirements from department of transportation (sz free for certain period of time)

Question 620

Stevens-Johnson syndrome

Answer 620

Rare, but life-threatening blistering reaction of skin. MEDICAL EMERGENCY! 1. flu-like symptoms 2. painful rash 3. blistering Other: fever, malaise, coughing, eye redness, itching, mouth ulcer, sensitivity to light, sore throat, selling, peeling, rash of purplish or red spots

Question 621

Acanthosis nigricans

Answer 621

- Skin condition - Usually obesity and diabetes Velvet-like patches of darkened, thick skin Usually around back of neck, groin, and armpits

Question 622

Respiratory Depression r/t Opioid use for Analgesia | RISK FACTORS

Answer 622

- the elderly - underlying pulmonary disease - hx of snoring (w or w/o apnea) - obesity - smoking (>20-pack-year hx) - the opiate naive - 24 hrs post-op

Question 623

When to see HCP for diarrhea

Answer 623

>48 hrs OR accompanied by fever or bloody stools Diarrhea usually self-limiting (48hrs)

Question 624

aPTT time

Answer 624

30-40 seconds If on anticoag therapy: 46-70 seconds

Question 625

LPN Scope

Answer 625

- Monitoring RN findings - Reinforce education - Routine sterile procedures (eg. catheterization) - Most med admin - Ostomy care - Tube potency and enteral feeding - focused assessments - collection of specimens - Stable clients -measure stockings or devices/choose appropriate device

Question 626

Medically emancipated minor

Answer 626

Minors can provide own consent. - Emergency care - STI - Substance abuse - Prego care - Contraception Regular Emancipated minor: homeless, parent, married, military, financially independent, HS grad

Question 627

Reaction Formation

Answer 627

Behaving in a manner or expressing a feeling opposite of ones true feelings Ex. A parent who is resentful of an "unplanned" child become overprotective

Question 628

Sublimation

Answer 628

Transforming unacceptable thoughts or needs into acceptable actions. Ex. Aggressive person becomes star boxer.

Question 629

Drugs to lower Ventricular Rate

Answer 629

DILTiazem MetroprOLOL DIGoxin

Question 630

Target BP and HbA1c for Diabetic Pts

Answer 630

<140/90 | <7%

Question 631

Expected findings in pneumonia

Answer 631

``` fever chills fatigue crackles sputum production ```

Question 632

DVT Risk Factors

Answer 632

- Trauma - Major Surgery - Prolonged immobilization - Oral contraceptives - Underlying malignancy - Smoking - Old age - Obesity and varicose veins - Myeloproliferative disorders (increased blood viscosity)

Question 633

Retinoblastoma

Answer 633

Retinal Tumor -usually dx kids <2 White "glow" of one or both pupil(s) (leukocornia) -white instead of red in photos Strabismus 2nd most common sign -misalignment of the eyes

Question 634

IV Opioid Analgesics Admin and Side Effects

Answer 634

Hydromorphone/Morphine -SLOWLY Over 2-3 minutes Sedation Resp depression Hypotension Constipation REASSESS during opioid's peak effect! 15-30 min for hydromorphone

Question 635

Sedation Level Scale

Answer 635

S-sleepy 1- awake, alert 2-slightly drowsy, easy to arouse 3- falls asleep during conversation (unacceptable) 4-somnolent (stop sedation, maybe use naloxone)

Question 636

Iron Supplement

Answer 636

NO MILK Better on empty stomach Vitamin C increases absorption (citrus fruits/juices)

Question 637

Warning signs of cancer

Answer 637

CAUTION - Change in bowel or bladder habits - A sore that does not heal - Unusual bleeding/discharge - Thickening or lump - Ingestion or difficulty swallowing - Obvious change in wart/mole - Nagging cough/hoarseness

Question 638

Acceptable Residual Urine

Answer 638

<100mL Report amounts >100mL to HCP

Question 639

Parkinson's Disease

Answer 639

- Trembling of extremities - Resting tremor - Stooped posture - Rigidity - Masked facial expression - Forward tilt of trunk - Reduced arm swinging - Slightly flexed hips/knees - Shuffling, short gait

Question 640

Serotonin Syndrome

Answer 640

* Potentially lethal * OD Antidepressants - Mental status change (anxiety, agitation, disorientation) - Autonomic dysregulation (hyperthermia, diaphoresis, tachy/htn, mydriasis) - Neuromuscular hyperactivity (tremor, muscle rigidity, clonus, hyperfreflexia, diarrhea, hyperactive bowel)

Question 641

Peripheral Artery Disease

Answer 641

``` Risk Factors: Smoking DM Hyperlipidemia Smoking ``` Pain in LE's with movement/exercise d/t ischemia At rest, might experience burning, aching, numbness

Question 642

Saw palmetto

Answer 642

Natural Herb: | BPH

Question 643

Hawthorn extract

Answer 643

Natural Herb: Heart failure approved in Germany

Question 644

Major depressive disorder | 2 key clinical features

Answer 644

aka: unipolar depression 1. Depressed Mood 2. Loss of interest or pleasure (anhedonia) 1 sx above for >=2 weeks ``` Other: SIGECAPS Sleep (up/down) Interest deficit (anhedonia) Guilt Energy deficit Concentration deficit Appetite (up/down) Psychomotor retardation/agitation Suicidality ```

Question 645

Testicular torsion

Answer 645

Emergency Condition Stopped blood flow to testis (scrotum), hehe :D - Testicle rotates/twists the spermatic cord - swelling/severe pain - testicular ischemia and necrosis - Small treatment window! 4-6 hrs - -use ultrasound to dx - Emergency surgery Potential testicle death!

Question 646

Severe asthma exacerbation characteristics and treatment

Answer 646

- Tachycardia >120 - Tachypnea >30 - O2 Sat <90RA - Accessory muscle use - Peak expiatory flow - <40% predicted or best (<150 L/min) 1. Oxygen 2. High-dose inhaled short acting beta agonist (ALBUTEROL) and anticholinergic agent (IPRATROPIUM) neb treatment q20min 3. Systemic corticosteroids (Solu-Medrol)

Question 647

Wound Culture procedure

Answer 647

1. Hand hygiene, gloves, remove old dressing, d/c gloves 2. hands again, STERILE gloves, assess wound. Cleanse with normal saline. Remove gloves 3. hands again, CLEAN gloves, swab from center to outer margin. AVOID contact with skin at wound edge. 4. swab in STERILE specimen container. 5. Apply topical med, BACITRACIN, after culture. Apply new dressing 6. remove gloves, hand hygiene, label specimen, document

Question 648

Gout What is it? Suggested lifestyle mods.

Answer 648

hyperuricemia Urate crystal deposits (aka, TOPHI) in joints Modifications: - weight loss - Increased fluids - LOW-PURINE DIET * **avoid organ meats * **avoid certain seafood (sardines/shellfish) - Limit alcohol, especially beer - Healthy, Low-fat diet - Low-fat dairy products goos source of protein :)

Question 649

Normal ICP ICP while doing RN interventions on pt with brain injury

Answer 649

Normal: 7-15 mmHg Max for working on pt with brain injury: 25mmHg Should return to baseline within a few minutes

Question 650

RN interventions to control ICP

Answer 650

- HOB 30 degrees, maintain neutral alignment - Stool softeners - manage pain well - calm environment - adequate O2 - Hyperventilate and pre oxygenate before suction - avoid clustering care

Question 651

Hypoxic client: | Post op care after general anesthesia

Answer 651

Obese person probably has obstruction (use of accessory muscles, snoring, decreased O2, cyanosis) Head tilt and chin lift to open occluded airway

Question 652

RN interventions for a newborn immediately after delivery

Answer 652

1. Standard precautions (gloves) 2. Maintain clear airway *pharynx first, nares second* 3. Thermoregulation (97.5-99) 4. IM vitamin K injection in vastus laterals within 6 hrs (mid anterior lateral thigh) 7. Ophthalmic ointment for gonorrhoeae legally required (within 1 hr) 8. Initial bath! Remove blood, bodily fluids, or meconium. Leave vernix caseosa (waxy white coating)

Question 653

Suspected urinary retention

Answer 653

Opioids, anticholinergic meds, tricyclic antidepressants Increase bladder sphincter tone and/or relax bladder muscle RN intervention: palpate suprapubic area

Question 654

Shock Continuum: Stages of Shock

Answer 654

I. Initial - inadequate O2 to supply the demand. - Anaerobic metabolism. - No recognizable S/S II. Compensatory ex. urinary retention to maintain fluid volume. - Tachycardia to maintain cardiac output and O2 demand. III. Progressive - Failure of compensatory - cold and clammy skin IV. Irreversible

Question 655

Normal urine output

Answer 655

0.5-1 mL/kg/hr OR >30mL/hr

Question 656

ALS

Answer 656

Amyotrophic Lateral Sclerosis -progressive loss of motor neurons in brainstem and spinal cord ONLY MED: RILUZOLE *slows progression* Prolongs life 3-6 months Client Care Focus: Respiratory function, adequate nutrition, quality of life *Dysarthria=worsening ability to speak. May also have dysphagia and rest distress No cure Death usually in 5 years

Question 657

External Fixation

Answer 657

Stabilizes bone with inserted metal pins through skin into bone. Metal pins attached to rod outside of skin. ``` S/S infection: low-grade fever drainage pain redness swelling ***immediate treatment ``` Could lead to osteomyelitis!!!

Question 658

Chronic subdural hematoma

Answer 658

- Bleeding into subdural space. - Can occur several weeks to months following a mild head trauma - Elderly on anticoags are at high risk. - Elderly also at risk because of falls. ``` Manifestations: headache gait disturbance memory loss decreased LOC ``` *Investigate Immediately!*

Question 659

Expected findings in neonate 1-3 hrs post-delivery

Answer 659

-Blood glucose above 40, but below 70. (normal 70-100) -Resp rate 30-60 Might be sightly irregular, diaphragmatic, and shallow -Milia (white papule) on nose and chin. Resolve without treatment within several weeks Abnormal: -holosystolic murmur=VSD

Question 660

Down Syndrome

Answer 660

Trisomy 21 single transverse crease across palm small and low-set ears flat nose bridge protruding tongue hypotonia (floppy muscle tone) at birth

Question 661

Total joint replacement surgery contraindications

Answer 661

Recent/current infection ex. burning on urination Report to HCP immediately

Question 662

Cirrhotic Liver | Blood Test Values

Answer 662

-Elevated bilirubin (jaundice) -Elevated PT INR, aPTT (Liver makes coagulation factors) - Ammonia (usually converted to urea in liver and excreted by kidney). - increases and crosses blood-brain barrier leading to *hepatic encephalopathy* -Decreased albumin Liver unable to synthesize protein (albumin) -Decreased sodium With 3rd spacing r/t low albumin, kidney tries to conserve sodium and water. Na gets diluted!

Question 663

Endotracheal tube suctioning

Answer 663

1. gloves 2. suction oropharynx/oral care 3. wall suction <120 mmHg 4. hyper oxygenate 5. advance cath until resistance met 6. remove with intermittent suction <10 seconds 7. evaluate tolerance. Repeat 1-2 times 8. resume oxygenation/vent settings

Question 664

Risk factors and symptoms for pelvic inflammatory disease (PID)

Answer 664

*leading cause of ectopic pregnancy and infertility* - Multiple sexual partners - Hx of chlamydia or gonorrhea - Hx of PID - Partner with STI - Lack of consistent barrier contraception use (no condoms) - Age 15-25 Symptoms: - pelvic/lower and pain -menstrual irregularities - increased menstrual cramps - painful intercourse - fever - abnormal vag discharge

Question 665

Prevent Post-Op Pneumonia

Answer 665

- Adequate pain control - Ambulate within 8 hrs if possible - Coughing with splinting q1hr - Deep breathing/incentive spirometer every hr - Fowler's position (45-60 degrees) - Turn/reposition q2hr - Swab mouth with chlorhexidine swabs q12hr - hand hygiene!

Question 666

TB associated S/S

Answer 666

Tb in any location: - Night sweats - Low grade fever - Anorexia and Weight loss - Fatigue Pulmonary TB: - cough - purulent or blood-tinged sputum - SOB

Question 667

Splenic sequestration crisis

Answer 667

Finding: rapidly enlarging spleen Life Threatening! Leads to hypovolemia (hypotensive) shock. Occurs when a large number of "sickled" cells get trapped in spleen causing splenomegaly.

Question 668

Vegan Diet Complications

Answer 668

Risk for Low: * Protein * Calories * Calcium (vitamins will be needed) * Vitamin D * Iron (fortified cereals. increase absorption with Vit C) * Vitamin B12 (cobalamin) - only in animal proteins At risk for megaloblastic anemia and neurological manifestations Cobalamin (Vit B12) deficiency affects entire nervous system from peripheral nerves to spinal cord and brain. "hands and feet get tingly sensation"

Question 669

Progestin-only Pills | POPs

Answer 669

- oral contraction - thicken cervical mucus (hinders sperm motility) - thins endometrium (hinders implantation) - Same time everyday - >=3 hrs late, barrier method advised until pill correctly taken for 2 days - additional POP taken if diarrhea or vomit occurs within 3 hrs of last dose - No inactive pills in POP pack. No break from hormone to menstruate - breakthrough bleeding commonly reported - Low cardiovascular risk profile, so lower risk for clots

Question 670

Therapeutic hypothermia

Answer 670

-Cardiac arrest -Comatose OR -Do not follow commands after resuscitation - Neurologic injury most common cause of death in V-fib and pulseless V-tach. * *this improves neurologic outcomes and decreases mortality - induce within 6 hrs of arrest - maintain for 24 hrs - 89.6-93.2 degrees - cooling blankets; ice placed in groin, axillae, sides of neck; cold IV fluids

Question 671

Carboxyhemoglobin Level

Answer 671

Carbon monoxide Normal: <5% Smokers: <10% Pulse oximeter can't detect difference between O2 and CO. CO poisoning: headache, dizzy, fatigue, nausea, dyspnea

Question 672

Colorectal Cancer S/S

Answer 672

- blood in stool - abd discomfort - anemia d/t intestinal bleeding - change in bowel habits - unexplained weight loss >50 routine colorectal cancer screening

Question 673

Seizure manifestation Phases

Answer 673

1. prodromal phase: warning signs 2. aural phase: visual/sensory changes 3. Ictal phase: SEIZURE! 4. Postictal pose: confusion/recovery

Question 674

Pleural Effusion What is it? S/S

Answer 674

Abnormal collection of fluid (>15mL) in pleural space. Prevents lung from fully expanding resulting in: -Atelectasis (collapsed/partially collapsed) -Decreased lung volume -ineffective gas exchange ``` S/S Dyspnea Pain with respiration’s Diminished breath sounds Dullness to perfusion over affected area ```

Question 675

Erratic plethysmograph waveform. | First action?

Answer 675

Check/Asses the patient's O2/perfusion status and assess for motion artifact.

Question 676

Bacterial meningitis care

Answer 676

- Droplet isolation (surgical mask, private room, pt masked during transport) - Reduced stimulus (quiet, dimly lit, coo temp) - HOB 10-30 degrees - Seizure precautions (padded bed rails, O2 and suction at bedside)

Question 677

Pincer Grasp Age

Answer 677

- Thumb and forefinger movement * *develops at 8-10 months** Can pick up small finger foods

Question 678

When to introduce allergenic foods to babies

Answer 678

4-6 months of age Examples? Eggs, fish, peanut products

Question 679

Agoraphobia

Answer 679

fear and anxiety about being in (or anticipating) certain situations or physical spaces. Examples: - Outside the home alone - In a crowd or standing in line - Traveling in a bus, train, car, ship, or airplane - On a bridge or in a tunnel - Open spaces (eg, parking lots, marketplaces) - Enclosed spaces (eg, theaters, concert halls, stores)

Question 680

Renal Calculi Pain

Answer 680

Excruciating, sharp, and stabbing Unable to find comfortable position Pain radiates down to groin as stone travels

Question 681

ATK amputation post op

Answer 681

Above-the-knee amputation - Residual limb should not be elevated! * Figure eight compression bandage* - Prone 30 min 3-4x/day - abductor pillow - no bending at hip more than 90 degrees - no crossing legs

Question 682

When to hold insulin

Answer 682

Possibly when client is NPO Glucose below 70 mg/dL

Question 683

Alzheimer's Safety Mods

Answer 683

- Arrange furniture to allow for free movement - Frequently used items in easy reach - Lock on stairwells/doors that lead outside (above or below eye level) - motion sensor/alarm when someone tries to exit - Stop sign on door exits - childproof doorknob covers - Label doors to bathroom - Provide nightlight to prevent falls, aid in orientation, and decrease illusions

Question 684

Vaginal hematoma Cause S/S

Answer 684

- formed when trauma to perineum (forceps, vacuum, episiotomy) - persistent, severe vaginal pain - feeling of fullness - Uterine funds firm/midline - Unchanged vaginal bleeding

Question 685

Post-mortem care

Answer 685

- Family participation ok - maintain standard/isolation precautions until TOD - Remove tubes/dressings (unless autopsy or organ harvest pending) - Straighten and wash the body - Change the linens - Leave dentures in place or replace them - Fold towel under chin to keep jaw closed - Pad under perineum (leaking stool/urine) - Place a pillow under the head (prevent blood from pooling and discoloring) - Remove equipment and soiled linens from the room - Give client's belongings to a family member or sent with the body

Question 686

Don PPE Order

Answer 686

Hand hygiene Gown Mask or Respirator Goggles or Face Shield Gloves

Question 687

Frontal Lobe Parietal Lobe Occipital Lobe Temporal Lobe Medulla Oblongata

Answer 687

Frontal: personality and behavior Damage=Broca/expressive aphasia Parietal: somatic and sensory input Occipital: Vision Temporal: Auditory input and past experiences Damage to left side =Wernicke/receptive aphasia Medulla Oblongata: rate and depth of respirations

Question 688

Normal aPTT Anticoagulant Therapeutic aPTT

Answer 688

25-35 seconds 1.5-2x greater if on heparin 46-70 seconds

Question 689

Pleural Effusion What is it? S/S

Answer 689

An abnormal collection of fluid (>15mL) in the pleural space. Prevents full lung expansion resulting in: -Decreased lung volume -atelectasis -ineffective gas exchange S/S - dyspnea - pain w/ respirations - diminished breath sounds - dullness to percussion (over affected area)

Question 690

Nasal Spray Admin

Answer 690

1. High Fowler's position with head slightly tilted forward 2. Insert the nasal spray nozzle into an open nostril, occluding the other nostril with a finger 3. Point the nasal spray tip toward the side and away from the center of the nose 4. Spray the medication into the nose while inhaling deeply 5. Remove the nozzle from the nose and breathe through the mouth 6. Repeat the above steps for the other nostril 7. Blot a runny nose with a facial tissue, but avoid blowing the nose for several minutes after instillation

Question 691

3 signs of worsening asthma attack.

Answer 691

1. pulses paradoxes - Drop of bp on inspiration 2. silent chest - airway is so closed there's no wheezing! 3. increasing CO2 despite tachypnea - not getting anything out of lungs Intubate and Ventilate!

Question 692

Normal Newborn Serum Glucose

Answer 692

40-60 mg/dL hypoglycemia=jitteriness or tremors FEED THAT BABY ASAP! If you give baby glucose, huge amount of insulin released and rebound hypoglycemia would occur.

Question 693

Left-to-Right-Sided heart shunt

Answer 693

Cause blood to shunt from high pressure LEFT to low pressure RIGHT *patent ductus arterioles, atrial septal defect, VSD* Results in pulmonary connection (increased work breathing, decreased lung compliance). * ACYANOTIC DEFECTS - tachypnea - tachycardia, even at rest - diaphoresis during feeding/exertion - heart murmur - signs of congestive heart failure - increased metabolic rate/poor wt gain

Question 694

Right-to-Left-Sided defects

Answer 694

CYANOTIC DEFECTS Impede pulmonary blood flow - TOF - Transposition of the great vessels -need immediate attention after birth

Question 695

Aphasia | 2 types

Answer 695

Impaired communication r/t neuro condition 1. Receptive aphasia: - impaired comprehension of speech and writing 2. Expressive aphasia: - difficulty with word choice Dysarthria- weakness of muscles used for speech Pronunciation/articulation affected (mumble, lisp)

Question 696

Apraxia

Answer 696

Loss of ability to perform learned movements

Question 697

Scleroderma

Answer 697

Overproduction of collagen causing tightening and hardening of skin and connective tissue. * Progressive with no cure* - renal crisis - malignant htn

Question 698

Sepsis neonatorum

Answer 698

Medical Emergency Baby Sepsis - Increased sleepiness (lethargy) - Poor feeding - Increased/decreased temp Full septic workup. -Broad-spectrum antibiotics immediately after blood, urine, and CSF

Question 699

Tinea Corporis

Answer 699

Ring Worm aka: dermatophytosis Fungal infection Transmitted from 1 person to another or from animal to humans

Question 700

Methylphenidate administration

Answer 700

For ADHD - 30-45 min before meals - Dose start low and titrate up - 2-3 doses daily - Monitor closely - Last dose NO LATER than 1800

Question 701

Obstructive sleep apnea Symptoms Interventions

Answer 701

Symptoms: sleep disturbance, snoring, morning headache, daytime sleepiness, difficulty concentrating, forgetfulness, mood changes, depression Interventions: - Continuous positive airway pressure device - Limit alcohol intake - Weight loss/exercise - Avoid sedating medications (bento's, antihistamines, opiates, sedating antidepressants) DO NOT: - nap during the day - eat before bed - take sedatives

Question 702

Creatinine clearance test

Answer 702

24-hour urine collection Blood draw

Question 703

Laryngeal stridor What is it? RN action?

Answer 703

high-pitched, vibratory, harsh sound on inspiration or expiration INDICATES PARTIAL AIRWAY OBSTRUCTION! RN action: - suction devices - oxygen - tracheosomy tray ready

Question 704

Potassium-sparing diuretics used with thiazides. Alone outcome Together outcome

Answer 704

K-sparing: spironolactone, amiloride, triamterene eplerenone -Generally weak diuretics and antihypertensives - Useful when combined with thiazide to reduce K loss! - Normal K (3.5-5.0) indicates spironolactone effective in preventing hypokalemia

Question 705

Laryngotracheitis

Answer 705

Croup ``` URTI Hoarseness BARKING COUGH (seal-like) Stridor Respiratory distress ``` Parainfluenza virus

Question 706

Left sided heart failure symptoms

Answer 706

Pulmonary congestion - Displaced PMI - S3 sound - Dyspnea - Orthopnea (SOB when lying flat) - PND (paroxysmal nocturnal dyspnea) - Crackles

Question 707

Right sided heart failure symptoms

Answer 707

Systemic venous congestion - JVD - Hepatomegaly - Splenomegaly - Ascites - Edema

Question 708

Mixing insulins Intermediate-acting Short-acting

Answer 708

1. clean tops of vials with alcohol swabs 2. Inject air into NPH without touching needle to solution 3. Remove and then inject air into regular 4. Invert regular vial and withdraw regular solution into syringe 5. Insert needle into NPH insulin vial and withdraw solution *Remember: RN Regular before NPH (clear before cloudy)

Question 709

Duloxetine | 2 uses

Answer 709

SNRI (serotonin-norepinephrine reuptake inhibitor) 1. Antidepressant 2. Pain-relieving effects - Used to relieve chronic pain that interferes with normal sleep patterns in fibromyalgia - Diabetic neuropathy

Question 710

Mannitol

Answer 710

Osmitrol Osmotic diuretic -used to treat cerebral edema and acute glaucoma Draws fluid from intravascular space to extravascular space. If dose too high or accumulates (in kidney disease), fluid overload may cause: pulmonary edema ``` Monitor: serum osmolarity I and O serum electrolytes kidney function ```

Question 711

Macular degeneration What is it? S/S?

Answer 711

progressive incurable disease of eye where central portion of retina (macula) deteriorates with age. Blurred, waves, or loss of vision in central field of vision. -Peripheral vision remains intact

Question 712

Abstinence Syndroms in neonate

Answer 712

-Most commonly seen with opioid use in mother -Autonomic NS symptoms: stuffy nose, sneezing, yawning, sweating, tachycardia, tachypnea **Swaddle and keep nasal passages clear -CNS symptoms: irritability, high-pitched crying, restlessness, abnormal sleep pattern, hypertonic/hyperactive primitive reflexes **Medication and protect skin -GI symptoms: poor feeding, vomiting, diarrhea **small, frequent feedings

Question 713

Tumor lysis syndrome

Answer 713

Potential compilation of chemo Increased serum: Potassium Phosphorus Uric Acid Decreased serum: Calcium Electrolyte imbalances can lead to: AKI Dysrhythmias (vfib) - IV fluids - Allopurinol blocks nucleic acid catabolism to prevent hyperuricemia * **Also used for chronic gout and uric acid calculi

Question 714

Topical Capsaicin What is is? How to use

Answer 714

OTC analgesic for minor pain (osteoarthritis, neuralgia) Component of peppers that's HOT!!! Instructions: - Wait at least 30 min after massaging cream into hands before washing to ensure adequate absorption. - Avoid contact with mucous membranes (nose, mouth, eyes) or skin not intact. - No heat added! vasodilation, increased absorption, chemical burn - Local irritation common in first week of use. - Often used concurrently with Tylenol or NSAIDs for OA pain - Use 3-4x/day for long periods

Question 715

ARDS

Answer 715

Acute respiratory distress syndrome Damage to areolar-capillary membrane, blood-gas barrier - alveoli collapse and fluid leaks into alveolar space - impairs gas exchange

Question 716

Neurotic malignant syndrome What is it? Treatment?

Answer 716

Rare, life-threatening reaction d/t antipsychotics (usually typical like haloperidol, fluphenazine, but also atypical). Characteristics: - Fever - Muscular rigidity - AMS - Autonomic dysfunction (sweating, htn, tachycardia) Intervention: DISCONTINUE ANTIPSYCHOTIC AND NOTIFY HCP.

Question 717

28 week gestation assessment findings

Answer 717

- Lanugo (find downy hair) on back and shoulders * *begins disappearing around 36 wks gestation -smooth, pink skin with visible veins - areolae may be barely visible with no raised breast buds * *palpable raised (5-10mm) in newborns close to term - fine wrinkles and few creases on sole of foot * *deep creases on entire sole of full-term

Question 718

Prior to dialysis treatment, nurse should...

Answer 718

- assess fluid status (weight, BP, peripheral edema, lung/heart sounds) - vascular access (arteriovenous fistula, arteriovenous grafts) - vital signs - last post-dialysis wt and current pre-dialysis weight to determine fluid removed (ultrafiltration) AFTER connected to dialysis, IV heparin added to blood. NOT before, so no subcutaneous heparin

Question 719

Incident/Occurrence Reports

Answer 719

Document events that pose unanticipated actual or potential risk to the health or safety of a client, visitor, or employee. Form of QUALITY IMPROVEMENT. Not in health record. Examples: Assault and Injury- physical, verbal, sexual assault, client falls with or without injury, staff and visitor falls with or without treatment Treatment and intervention- failure to obtain or intervene upon results of dx procedure, inadequate dx and monitoring, delay/omission of meds/therapies, hospital equipment failure

Question 720

Minimal variability on fetal heart strip meaning

Answer 720

<=5 bpm - Potential CNS depressants (opioid analgesics, narcotics, alcohol, illicit drugs) - temporary fetal sleep - prematurity - fetal hypoxia

Question 721

Febrile seizure management

Answer 721

1. Antipyretics acetaminophen and ibuprofen (>6 months) 2. cool, damn compresses to forehead, increase air circulation, loose clothing 3. call 911 for sz >5 min

Question 722

New onset dependent edema risks

Answer 722

Huge deal in the elderly! Could be due to heart failure. Need to assess for lung tackles and increased body weight

Question 723

Neurological impairments from stroke. Nurse teaching

Answer 723

- unilateral weakness/neglect on affected side - impulsiveness - aphasia RN teaching: * *Improve visual perception-- - turn head to affected side - scan environment * *Overcome unilateral weakness-- - dressing affected side first Right sided CVA: impulsive and unaware of deficits. May have outbursts.

Question 724

Scabies

Answer 724

Sarcoptes scabiei mite Person-to-person (nursing homes, day cares, prisons) Intense itching, especially at night - Pregnant female burrows (burrow track) into dead layer of skin, lays eggs and feces. * *30-60 day incubation period - Treat all persons who have had contact with infested child during that time - >2 months can receive one-time treatment with scabicide cream (1% permethrin) - -apply everywhere below head - Itching will continue for several weeks after proper treatment given -scabies don't survive >2-3 days away from human skin. Disinfect clothes, linens, stuffed animals by placing in plastic bag for minimum 3 days OR machine wash hot, dry on hottest ***fumigation of living area not needed Hand hygiene: soap and water, not gel

Question 725

Constipation prevention

Answer 725

20-30 g of fiber daily 2-3 L fluids daily (avoid caffeine) Exercise 3x/week Healthy bowel regimen (avoid delaying defecation if urge felt) Avoid laxatives and enemas unless prescribed. Overuse=dependency

Question 726

Status epilepticus

Answer 726

Life threatening Pt seizing >=5 min Grunting and dazed appearance RN PRIORITY: 1. STOP SZ if adequate airway/breathing IV benzos (diazepam, lorazepam) OR rectal diazepam if IV unavailable VP shunt at higher risk for sz

Question 727

RN assisting with lumbar puncture

Answer 727

1. Verify informed consent 2. Gather the lumbar puncture tray and needed supplies 3. Explain the procedure to older child and adult 4. Have client empty the bladder 5. Place client in the appropriate position (eg, side-lying with knees drawn up and head flexed or sitting up and bent forward over a bedside table) 6. Assist the client in maintaining the proper position (hold the client if necessary) 7. Provide a distraction and reassure the client throughout the procedure 8. Label specimen containers as they are collected 9. Apply a bandage to the insertion site 10. Deliver specimens to the laboratory

Question 728

Pharmacologic Nuclear Stress Test Instructions

Answer 728

- No eating, drinking, or smoking on day of test (NPO 4 hrs) - avoid caffeine 24 hrs pretest - avoid decaffeinated products 24 hrs pretest (trace amounts) - No theophylline 24-48 hrs pretest - Ask HCP about diabetes med adjustment for test in case of hypoglycemia - Do not take following meds: * nitrates (nitroglycerine or isosorbide) * dipyridamole * beta blockers

Question 729

Ruptured ectopic pregnancy | Clinical Features

Answer 729

- Unilateral abdominal pain - Hypotension (dizziness, tachycardia) - Referred shoulder pain * **Life threatening hemorrhage Symptoms of ectopic pregnancy: - amenorrhea followed by vaginal spotting or bleeding - palpable adnexal mass on pelvic exam

Question 730

Clomiphene

Answer 730

Clomid Infertility in women -Stimulates ovulation Orally for 5 days Start 3-5 days into menses Ovulation 5-9 days after medication complete Frequent sexual intercourse every other day for 1 week. -5 days after med complete is best chance for conception Risks/Side Effects: multiple gestation Mood swings, nausea, hot flashes, headaches

Question 731

Common causes SIADH

Answer 731

CNS disruption -stroke, infection, trauma, neurosurgery Malignancies -small cell lung carcinoma Drugs -desmopressin, carbamazepine Pulmonary disorders -pneumonia

Question 732

Exophthalmos plan of care

Answer 732

Bulging eyes from Graves disease (hyperthyroid) - artificial tears to moisten conjunctiva - if eyelids don't close during sleep, sightly tape them shut - dark glasses to prevent irritation - smoking cessation - raised HOB to drain fluid from area - restrict salt intake - intraocular muscle exercises to maintain flexibility - regularly visit ophthalmologist

Question 733

Hepatitis A transmission

Answer 733

Fecal-oral route Wash hands after bowel movements and before eating most important Needle sharing and unprotected sex discouraged. Its >=1 yr should receive vaccine

Question 734

Chlamydia

Answer 734

Most common STI ``` Most asymptomatic. Sx: -spotting after sex -dysuria -abnormal vag discharge ``` All sexually active women <25 and any client >=25 are served annually for chlamydia and gonorrhea. Can lead to PID and infertility. After treatment (1 dose azithromycin, 7 days doxycycline) abstain from sex for 7 days

Question 735

Newborn abnormalities to report to HCP

Answer 735

Jaundice Not voiding or passing meconium in first 24 hrs Nasal flaring, chest wall retractions, and grating with respirations

Question 736

Normal for newborns

Answer 736

Desquamation (peeling skin), especially post-term babies Head circumference 12.5-14.5 in

Question 737

Cardidopa-Levodopa

Answer 737

Treats bradykinesia (slow movement) in Parkinson's Disease - may also help tremor and muscle rigidity - do not stop suddenly!!! Akinetic crisis

Question 738

Drugs | Increase memory in Alzheimers

Answer 738

Donepezil | Rivagtigmine

Question 739

TSH

Answer 739

Thyroid stimulating hormone. Released when not enough thyroid (T3/T4) is circulating

Question 740

Iron deficiency anemia | Treatment

Answer 740

Foods: leafy green veggies, red meats, poultry, dried fruit, fortified cereal) Oral supplement: - between meals - give with citrus (Vit C) - place med in back of mouth (can temporarily stain teeth) - Don't give with milk (Ca reduced absorption) - No more than 1 month supply on hand - black or green tarry stools expected

Question 741

Delirium S/S

Answer 741

- Acute mental status change that fluctuate - Inattention with disorganized thinking - -hallucinations - Altered LOC - abrupt onset (Unlike dementia: slow onset, normal attention) Risk factors: older age, prior cognitive impairment, infection, severe illness, comorbidities, dehydration, psychotropic med use, alcoholism, vision impairment, pain

Question 742

How to stop epistaxis

Answer 742

Nose bleed - Lean forward - Apply direct, continuous pressure to nose for 5-10 minutes - Pressure below nasal bone (nasal alae/Kiesselbach pleases) - ice or cold cloth for vasoconstriction - keep child quiet and calm Avoid local trauma and maintain hydration of mucosa with saline nasal spray or humidifier

Question 743

Folic Acid Dietary Sources

Answer 743

Excellent (100+mcg/0.5cup): * fortified breakfast cereal * fortified grain products (cereals, bread, pasta) * Green leafy veggies * cooked dried beans * liver (consumed more for iron) Good (40-100 mcg/0.5 cup): - broccoli - spinach - green peas - beets - fortified spaghetti, pasta - rice ``` Other (40-100mcg/serving): tomato juice (3/4 cup) 1 orange 1 oz sunflower seeds 1 Tbsp PB enriched bread (1 slice) ```

Question 744

Antihistamines

Answer 744

diphenhydramine (Benadryl) loratadine (Claritin) promethazine (Phenegran) Don't take 2 weeks before allergy test

Question 745

Sulfa drugs

Answer 745

Sulfasalazine Trimethoprim Sulfamethoxazole Treat bacterial infections or ulcerative colitis Contraindications: hypersensitivity Pregnancy/breastfeeding Assess for allergies to sulfa drugs and sulfonylurea meds (such as glyburide) Side effects: - Crystalluria potential adverse effect - Drink at least 2-3 L water/day - Photosensitivity - Folic acid deficiency (megaloblastic anemia) - Agranulocytosis (leukopenia) - SJS

Question 746

Kosher Dietary Laws

Answer 746

Orthodox Jews NO: pork shellfish fish without scales When meat/poultry consumed, 3-6 hrs must pass before dairy consumed. Neutral foods to eat anytime: fresh fruits/veggies, grains, tea, and coffee

Question 747

Biphosphonates

Answer 747

Used to treat osteoporosis and other bone loss diseases (Pagets disease) Osteoblast=create Osteoclast=destroy *Encourage apoptosis of osteoclasts to slow rate of bone loss Alendronate, risedronate, zoledronic

Question 748

Abdominal assessment

Answer 748

Stand to RIGHT side Inspect Auscultate Percuss Palpate

Question 749

dysthymia

Answer 749

persistent depressive disorder

Question 750

Bell's Palsy

Answer 750

Peripheral, unilateral facial paralysis *Inflamed cranial nere VII - Inability to completely close eye on affected side - Flat nasolabial fold - Asymmetric smile/frown - Altered tear production - loss of taste on anterior 2/3 of tongue Teaching: * Apply patch or tape to affected eye at night * Artificial tears during the day * Chew on good side * Maintain meticulous oral hygiene * soft diet recommended

Question 751

Hepatitis B | Transmission

Answer 751

Viral disease of liver characterized by inflammation, necrosis, and cirrhosis. Blood Semen Vaginal secretions (B: Body fluids) unprotected sex IV illicit drug use Early sx: malaise, nausea, vomit, bad pain. Can lead to: jaundice, wt loss, clay-colored stools, thrombocytopenia

Question 752

1x pneumococcal vaccination

Answer 752

Does not prevent community-acquired pneumonia >=65 should receive 2 pneumococcal vaccinations 1 yr apart. (PCV13 and PPSV23) Revaccination q5years for those immunocompromised, splenectomy, and >65

Question 753

Pulmonary Embolism Assessment Findings

Answer 753

``` CP Hypoxemia Tachypnea Pleuritic chest pain Tachycardia Anxiety/apprehension ``` Massive PE: syncpope hemodynamic instability

Question 754

Pregnant with Genital Herpes

Answer 754

- Report to HCP ASAP - Can be transmitted to infant in utero (congenital HSV), perinatally, or postnatally - Neonatal HSV serious morbidity (permanent near sequelae) and mortality - immediate antiviral therapy (ACYCLOVIE) initiated to treat active infection. - C-section if active lesions

Question 755

Live vaccines

Answer 755

Varicella MMR Influenza NASAL SPRAY Wait in immunocompromised and post Kawasaki treatment (IV immunoglobulin)

Question 756

Why diluting formula is no bueno

Answer 756

-Immature renal systems with low GFR can't excrete excess water. - Potential water intoxication! - Hyponatremia - --irritability, lethargy, and in severe cases, hypothermia an sz.

Question 757

Peritonitis characterized by...

Answer 757

Fever Abdominal rigidity Guarding Rebound tenderness Potentially fatal

Question 758

Tyramine foods

Answer 758

Cannot be eating with MAOI's ``` aged cheese yogurt cured meats fermented foods broad beans beer red wine chocolate avocados ```

Question 759

Findings with pneumonia

Answer 759

``` Crackles Dyspnea Pleuritic CP Bronchial breath sounds in perish lung fields Unequal chest expansion Dullness ```

Question 760

Hyperresonance

Answer 760

Asthma attack Emphysema Pneumothorax

Question 761

Amniotomy About? RN action

Answer 761

Artificial rupture of membranes Augment or induce labor Risk of umbilical cord prolapse -can lead to fetal bradycardia d/t cord compression RN action: - note amniotic fluid color, amount, odor * should be clear/colorless without foul odor - Monitor temp q2hr (increased risk for infection) - Assess FHR before and after procedure

Question 762

Cystoscopy What is is? Complications include...

Answer 762

-scope inserted through urethra into bladder while in lithotomy position Complications: Urinary retention Hemorrhage Infection Notify HCP if: - bright red blood when urinating - blood clots - inability to urinate - fever >100.4 and chills - abdominal pain unrelieved by analgesia Expected up to 48 hrs post cystoscopy: - Pink-tinged urine - frequency - dysuria Drink 4-6 glasses water/day, avoid alcohol and caffeine (24-48 hrs) because they irritate bladder Mild analgesic and warm tub/sitz bath ok

Question 763

What to consider when deciding appropriate method to transfer client safely

Answer 763

1. Can client bear weight? 2. Is client cooperative? Yes and Yes? transfer independently with standby assistance for safety.

Question 764

Hiatal Hernia | RN actions

Answer 764

Part of stomach pushed through portion of diaphragm. (Paraesophageal/Rolling hernia Medical Emergency) - Elevate HOB 30 degrees (4-6 inch blocks under bed at home) - Instruct client to avoid tobacco and caffeine - Offer small, frequent, low fat meals - Teach client to avoid lifting/straining - weight loss Do not wear girdle or tight clothing! Might increase intra-abdominal pressure

Question 765

Rheumatoid arthritis

Answer 765

- Symmetrical pain and swelling the tonically affects small joints of hands and feet - morning joint stiffness that lasts from 60 minutes to several hours - elevated ESR and rheumatoid factor levels

Question 766

Osteoarthritis

Answer 766

Asymmetrical pain in the weight bearing joints - Crepitus, especially over knee joints - morning stiffness subsides within 30 min - Atrophy of muscles that support joint - Decreased ROM

Question 767

Menopause teaching | post age 51

Answer 767

At risk for osteoporosis and heart disease. - Bisphosphonates (alendronate, risedronate, ibadronate) decrease bone resorption to slow decreasing bone density * take on empty stomach with full glass of water * sit upright for 30 minutes -calcium and Vit D needed (food and supplements) - HRT can improve bone mass but can lead to thrombotic complication and some cancers. * only used for disabling hot flashes * watch out for unilateral leg swelling -postmenopausal bleeding or abnormal premenopausal bleeding most common sx of endometrial cancer. Requires follow up!

Question 768

Foods for pregos to avoid

Answer 768

due to bacteria (Listeria, toxoplasmosis)contamination - unpasteurized milk products - unwashed fruits/veggies - deli meat - hot dogs (unless headed until steaming hot) - raw fish/meat -fish high in mercury (shark, swordfish, mackerel, tilefish)

Question 769

Small bowel follow-through

Answer 769

X-rays of small intestine to examine anatomy and function. Barium ingested, x-ra taken every 15-60 minutes to visualize barium as it passes through. - Fast 8 hours prior - Test 60-120 minutes - Drink a lot of fluids post-procedure - Chalky stools 24-72 hours post

Question 770

Interior vena cava filter What is it? Teaching

Answer 770

Metallic filter that traps blood clots from LE and prevents them from becoming PE's. Discharge teaching: - Regular physical exercise - Alert HCP's before body scans (metal object) - Avoid crossing legs to promote venous return - Leg pain, numbness, or swelling needs to be reported - Report s/s of PE (CP, SOB)

Question 771

-floxacin | Risk

Answer 771

Ciprofloxacin, levofloxacin, moxifloxacin, nofloxacin, ofloxacin TENDINITIS AND TENDON RUPTURE! Most commonly Achilles tendon. Black box warning about the risk. First sign? tendon pain or swelling - stop med - abstain from moving affected area - contact HCP

Question 772

When speaking to a client with hearing impairment

Answer 772

room lights on directly face the client speak at a normal volume toward the least-affected ear ensure that any hearing aids are functional and in place Hearing impairment signs may be posted to promote safety.

Question 773

Catatonia

Answer 773

Might be with schizophrenia 2 of the following for dx of catatonia: - immobility - remaining mute - bizarre postures - extreme negativism (resists instructions) - waxy flexibility (limbs stay in same spot someone else moved for them) - staring - stereotyped movements, prominent mannerisms, grimacing Unable to meet basic needs. At risk for dehydration and malnutrition

Question 774

Inactivated vaccines

Answer 774

OK for pregnancy Tdap (tetanus, diphtheria, pertussis) 27th and 36th week of gestation Inactivated influenza vaccine - -NOT NASAL SPRAY - -any trimester (Oct-Mar)

Question 775

Who not to treat during disaster (black tag worthy)

Answer 775

- Pulselessness - Apnea - Severe neuro trama (ex. fixed dilated pupils) - Full-thickness burns >60% BSA

Question 776

Pavlik harness

Answer 776

- For developmental dysplasia of the hip (DDH) - hips slightly flexed and abducted - worn 3-5 months - straps assessed q1-2weeks by HCP - parents should not alter strap placement - assess skin 2-3x/day - shirt and knee socks under harness - diapers underneath straps - leave on at all times - lightly massage under straps daily to promote circulation

Question 777

Stages of Labor

Answer 777

1: Latent (0-5cm) Active (6-10cm) 2: 10cm-birth 3: Birth-expulsion of placenta 4: 1-4 hrs post birth, maternal physiologic readjustment

Question 778

Labor meds | How far along before meds?

Answer 778

- systemic analgesia given during active phase (at least 4-5cm) - 4 cm in multipara -contractions should be well established (~3-4 min) - butorphanol - nalbuphine * bolus IV push over peak of 2 contractions to decrease amount going to fetus - ceiling effect, only 3 doses given because more won't help - don't use in opioid-dependent client (precipitate withdrawal)

Question 779

Thyroid storm What is is? S/S?

Answer 779

Hyperthyroidism Excessive secretion of TH Life-threatening! - fever - tachycardia - cardiac dysrhythmias (eg, atrial fibrillation) - nausea - vomiting - diarrhea - altered mental status. Client management: - reduce fever - hydrate - prevent cardiac compromise (HF)

Question 780

Acceptable pulse ox for normal, healthy nonsmoking adult

Answer 780

95-100% 90% is LOW and indicates inadequate depth or rate

Question 781

Radioactive iodine uptake test

Answer 781

-Scan done at 2, 6, 24 hrs to assess absorbing iodine (narrow dx to Graves) RN considerations: - notify HCP if other iodine contrast used - Thyroid meds held for 5-7 days prior - prego test for premenopausal women Pt education: - NPO 4 hrs pre - Eat 1-2 hrs post swallowing iodine - Remove dentures and jewelry/metal around neck - Increase fluids post-test to clear iodine - You'll be awake! No discomfort - Do not breastfeed right afterwards

Question 782

Wound irrigation

Answer 782

- Analgesis 30-60 min before - Gown, mask w/ face shield, sterile gloves - 30-60mL sterile irrigation syringe - 18-19 gauge needle or angiocatheter - hold 1 inch above area - Continuous pressure until drainage clear - dry surrounding wound area to prevent skin breakdown - clean from least to most contaminated area (prevents recontamination)

Question 783

Signs of imminent birth

Answer 783

Precipitous birth is <3 hrs of labor involuntary pushing/breaking down with contractions grunting report of sensations of having BM *If pt arrives in second-stage of labor (i.e.,pushing) nurse needs to apply gloves and observe perineum for crowning

Question 784

Interventions to prevent abdominal wound dihiscence

Answer 784

- stool softeners - antiemetics (prevent nausea/vomit) - abdominal binder - tight glycemic control - splint abdomen when coughing/moving

Question 785

Nursing interventions for clients with acute viral hepatitis

Answer 785

- alternate rest/activity - avoid hepatotoxins (alcohol, acetaminophen) - use caution with meds metabolized in liver - low fat (impaired bile production), small, frequent meals to decrease nausea - larger breakfast (anorexia lowest in am) - oral care - avoid extremes in food temp - promote water consumption - do not share razors or toothbrushes - condoms for sex

Question 786

Ineffective coping in labor

Answer 786

- crying, sweating, hyperventilating - tenseness; tremulous voice - thrashing, wincing, writhing - inability to focus/concentrate - clawing, biting, screaming - panicked activity with contractions

Question 787

Highest risk for MRSA

Answer 787

- older adults - suppressed immunity (chronic illness) - long hx of antibiotic use - invasive tubes or lines (hemodialysis, vent pts) ***pts in ICU***

Question 788

High retention of CO2 level in COPD (hypercapnia respiratory failure) RN intervention

Answer 788

Bilevel positive airway pressure (BIPAP) machine -(+) pressure and expel CO2 from lungs

Question 789

Blood pressure after ischemic stroke

Answer 789

Usually elevated as compensatory mechanism "Permissive HTN" Usually autocorrects within 24-48 hrs Only requires treatment for extreme HTN >220 OR >120

Question 790

Major complication with | joint replacement surgery

Answer 790

Infection!!! Especially obese people ---also at risk for post-op pneumonia (impaired pulmonary function, sleep apnea, hypoventilation)

Question 791

Normal infant - respiratory rate - temperature - blood glucose

Answer 791

30-60/min 97.7-99.7 40-60 (within first 24 hrs)

Question 792

Myasthenia crisis

Answer 792

Exacerbation of myasthenia graves (AID) Caused by: - infection - undermedication (pyridostigmine) - stress Characterized by: - oropharyngeal and respiratory muscle weakness - respiratory failure ***IMMEDIATE INTERVENTION***

Question 793

Trigeminal neuralgia Pain/Triggers Drug of choice/Side-effects Client self-care

Answer 793

Sudden, sharp (usually unilateral) pain along mandible or maxillary zone. ``` Drug: carbamazepine -seizure med -highly effective for neuropathic pain -associated with agranulocytosis (leukopenia) and infection risk ***Report any fever/sore throat*** ``` Pt care: - oral care: small, soft-bristled toothbrush or warm mouth wash - lukewarm water - avoid food temp extremes - room moderate temperature - avoid rubbing/favial massage (cotton pads to wash face if needed) - soft diet, high calorie content - chew on unaffected side of mouth

Question 794

pneumonectomy post op patient position

Answer 794

Client should be positioned on surgical side We want maximum expansion of the REMAINING LUNG!

Question 795

Percutaneous Nephrolithotripsy What is it? Complication?

Answer 795

- Nephroscope breaks/remove large kidney stones - Leave temporary tube to prevent obstruction by stone fragments - Tube potency critical! - No drainage??? - GENTLE IRRIGATION! - sterile NS, aseptic technique

Question 796

Rhabdomyolysis: Cause Complication Immediate Treatment

Answer 796

Muscle fibers released into blood b/t of muscle injury - exercise - heat stroke - physical trauma Acute renal failure -elevated myoglobin overwhelm kidneys -Rapid IV fluid resuscitation to flush damaging myoglobin S/S of rhabdo: - dark, sometimes bloody urine - oliguria - fatigue

Question 797

Clang associations

Answer 797

Schizophrenia Rhyming words in meaningless, illogical manner "the pike likes to hike and Mike fed the bike near the tyke"

Question 798

Perseveration

Answer 798

Schizophrenia Repeating same words/phrases in response to different questions

Question 799

Pursed-lip breathing technique

Answer 799

Inhale for 2 seconds through nose, keeping mouth closed Exhale for 4 second through pursed lips COPD pts

Question 800

Cranial nerve IX

Answer 800

Glossopharyngeal gag reflex ability to swallow phonation taste SWALLOW PRECAUTIONS Possibly damaged during laryngectomy If so, client needs to learn supraglottic swallow

Question 801

Cranial Nerve VIII

Answer 801

Vestibulocochlear Hearing and equilibrium Impairment: loss of hearing, dizziness, vertigo, fall risk

Question 802

Bishop Score

Answer 802

Cervical favorability and readiness for induction of labor 10=highest score >8 in nulliparous women successful induction and subsequent vaginal birth Consistency (0-2): firm, medium, soft Position (0-2): Posterior, mid-position, anterior Dilation: 0, 1-2, 3-4, >5 (0-3) Effacement: 0-30#, 40-50%, 60-70%, >80% (0-3) Station: -3; -2; -1,0; +1, +2 (0-3)

Question 803

Most accurate indicator of fluid loss or gain

Answer 803

daily weight | in acutely ill clients

Question 804

MMR Vaccine

Answer 804

12-15 months Can be given earlier within 72 hours of initial measles exposure. If administered within 6 days, post-exposure prophylaxis IF they receive it early, they will need to be revaccinated 12-15 months and again 4-6 yrs

Question 805

Hypothyroidism symptoms

Answer 805

Bradycardia Wt gain, constipation Fatigue, muscle aches, joint pains Lethargy, apathy, forgetfulness, depression No period, always menstruating; infertility, decreased libido Cold intolerance, dry and thick skin, brittle nails and hair, hair loss, facial and generalized edema Anemia (pallor)

Question 806

Sequence of BLS for unconscious, pulseless pt

Answer 806

1. Verify response (are you ok?, shake awake) 2. Call for help-emergency response team activated for all unresponsive clients 3. check for breathing/pulse or 10 seconds 4. begin chest compressions 5. notify the HCP

Question 807

Histrionic personality disorder

Answer 807

Center of attention Exaggerate emotional expression Little tolerance for frustration Attention-seeking Overly-friently/seductive, attempts to keep others engaged Demands immediate gratification

Question 808

Antisocial personality disorder

Answer 808

Disregard for and violate the rights of others Manipulate others for personal gain and lack empathy

Question 809

Metoclopramide Use? Normal side effects? Emergency side effects?

Answer 809

Use: delayed gastric emptying, GERD, antiemetic, nausea, vomit, GASTROPARESIS Promotes GI motility and stomach emptying. NORMAL side effects: sedation, fatigue, resteless, headache, sleepy, dry mouth, constipation, diarrhea ``` EMERGENCY Side effects? Similar to antipsychotic drugs, extrapyramidal adverse effects... -TARDIVE DYSKINESIA (uncontrollable movements, sucking/smacking lips) -protruding/twisting tongue -lip smacking -chewing movement -frowning or blinking of eyes -twisting fingers -twistied or rotated neck (torticollis) ```

Question 810

Tumor necrosis factor inhibitor drugs: - Names - Uses - What to check before admin - Complications

Answer 810

Adalimumab Etanercept Infliximab Also used for rheumatoid arthritis Need baseline Tuberculin Skin Test (TST) beforehand. Latent TB must be treated before imitation of TNF drugs Complications: Cause immunosuppression and infection Elevated WBC is NO BUENO!

Question 811

What does liver do/produce

Answer 811

Clotting factors (with Vit K) Breaks down old or damaged blood cells Bile production/excretion Synthesis of albumin Excretion of bilirubin, cholesterol, hormones, and drugs

Question 812

Patient positioning with pneumonia

Answer 812

GOOD LUNG DOWN

Question 813

Liver failure/dysfunction lab abnormalities

Answer 813

* Low serum albumin (edema) * High ammonia (hepatic encephalopathy, asterixis, coma, confusion) * Elevated INR/long PT (bruising, bleeding) * Increased bilirubin (jaundice, itching, scleral icterus) * Low platelets (petechiae, spontaneous bleeding)

Question 814

Prolapsed umbilical cord positions

Answer 814

Hands and knees (knee-chest position) Trendelenburg

Question 815

Multiple sclerosis What is it? S/S? Pt interventions

Answer 815

Progressive, demyelinating disease of CNS. S/S: muscle weakness, spasticity, incoordination, loss of balance, fatigue Risk for fall/injury Interventions: - Stretch, strengthen, ROM - Walk with feet apart (increase base support), improves steadiness and gait - Assistive devices (cane, walker) usually required as progression occurs -wheelchairs only i gait training unsuccessful. Independence as long as possible.

Question 816

Phentolamine What does it do? What does it treat?

Answer 816

Antihypertensive drug Vasodilator BP Pheochromocytoma

Question 817

Gastroduodenostomy What is it? Client teaching RN intervention

Answer 817

AKA: Billroth I Removes distal 2/3 of stomach Teaching: - frequent, low carb, moderate protein, moderate fat meals - no drinking with meals (dumping syndrome) - turn, cough, deep breath while splinting RN: - elevate HOB - do NOT manipulate or flush post op NG tube - might cause hemorrhage or gastric perforation

Question 818

African american disease risks

Answer 818

HTN Cervical cancer Ischemic stroke (RF: htn,DM, sickle cell)

Question 819

Broca Aphasia

Answer 819

Expressive aphasia frontal lobe damage Speech sparse and nonfluent Comprehension relatively preserved Client frustrated while attempting to speak Limited to short phrases that require effort. Usually omit smaller words ("and", "is", "the")

Question 820

Wernicke Aphasia

Answer 820

Receptive aphasia temporal lobe damage Inability to comprehend the spoken and/or written word Long meaningless speech pattern

Question 821

Orthodox Jew postmortem care

Answer 821

1. Sheet over face (dead disrespected if effects of death seen on face) ``` 2. Autopsies not permitted UNLESS -required by law -pt provided consent before death -hereditary disease and it would help save others ``` Believe body belongs to Go and that a complete burial is required to enter heaven. If autopsy required, all organs and fluids returned to it before burial. 3. family member always with them

Question 822

Arterial angiogram

Answer 822

Arteriography Catheter inserted and dye injected to make blood vessels visible by x-ray. -assesses for occlusions (embolism), injuries, aneurysms, abnormalties Frequent neuromuscular checks of affected extremity (temp, distal pulses, color, cap refill, sensation, movement).

Question 823

Cranial Nerve V

Answer 823

Trigeminal ``` Chewing SWALLOW PRECAUTIONS (if damaged) ```

Question 824

Swallowing affected by which cranial nerves?

Answer 824

IX (glossopharyngeal) X (vagus)

Question 825

Indications of contaminated blood

Answer 825

- Green, black, white, or dusky discoloration - accumulations of air - evidence of clotting or presence of inclusions - malodor

Question 826

Cyclosporine

Answer 826

Immunosuppressant RA Psoriasis Prevent transplant rejection RISK FOR INFECTION Takes 1-2 months for full effect of therapy Secondary malignancies (skin cancer, lymphoma) increased in these pts - increases hair growth - gingival hyperplasia - hypertension - nephrotoxicity - avoid grapefruit juice

Question 827

peristomal care

Answer 827

- cleanse skin with ild soap and water - ensure ostomy appliance fits well - trim appliance opening 1/8 inch larger than stoma so it "hugs" stoma without toughing stoma tissue

Question 828

Ileostomy

Answer 828

- Formed from small intestine to bypass colon - incontinence of liquid stools - change appliance every 5-10 days - empty at 1/3 full - encouraged to increase fluid intake (dehydration, hypokalemia, and dehydration risk)

Question 829

Verapamil

Answer 829

Calcium channel blocker Sometimes used for the prevention of migraines.

Question 830

Septic arthritis

Answer 830

infectious arthritis - Fever - Joint swelling with effusion - Limited range of motion - Moderate to severe pain Possible irreversible joint damage NOT numbness below in the extremity (not a nerve problem)

Question 831

Decrease risk of pressure injuries in sedated infants

Answer 831

- HOB 30 degrees - Moisture barrier to any vulnerable areas - Reposition pulse ox q4h NO baby powder NO donut pillows

Question 832

``` Alateen vs. Al-anon vs. ACOA ```

Answer 832

Alateen: support to adolescent children of alcoholics Al-anon: help for spouses, significant others, family and friends to share personal experiences and coping strategies ACOA: adult children of alcoholics For adults who grew up in dysfunctional homes d/t alcoholism

Question 833

Rabies: Risks Post-exposure prophylaxis

Answer 833

Dog/Bat Affects CNS Viral encephalitis Death r/t cardiovascular and respiratory collapse 1. Immediate wound care (scrub with povidone-iodine or soap and water) 2. admin tetanus toxoid vaccine (if not current) 3. Admin human rabies immunoglobulin INTO proximal wound area. Passive immunity. 4. Admin human rabies vaccine IM. Active immunity. Shot on day of exposure and 3, 7, 14 days post-exposure.

Question 834

Superior vena cava syndrome

Answer 834

Tumor obstructing SVC ``` Facial edema Facial plethora (fullness, red complexion) ``` Venous distension distal to obstruction

Question 835

Decorticate posturing

Answer 835

Flexion posturing - Arms rigidly flexed at elbow - Hands raised to chest - Legs extended Suggests worsening cerebral impairment (increased ICP). May be reversible with proper interventions

Question 836

hemiparesis | hemiplegia

Answer 836

Paralysis of one side of body

Question 837

Removing PPE

Answer 837

Gloves Goggles/face shield Gown Mask/Respirator Remove in alphabetical order

Question 838

Compression of oculomotor nerve III

Answer 838

Fixed dilated pupils Indicates increased ICP

Question 839

Otorrhea

Answer 839

CSF leaking from ear -possible skull fx NOT directly related to increased ICP

Question 840

Names of random anticoagulants Not heparin, LMWH, or warfarin

Answer 840

apixaban rivaroxaban edoxaban

Question 841

Meds/electrolyte imbalances that prolong QT and may precipitated torsades

Answer 841

``` Antiarrhythmics: sotalol amiodarone (fib, SVT, arrest, etc.) ibutilide dofetilide ``` Macrolide antibiotics: -mycins Electrolyte abnormalities: hypomagnesemia hypokalemia

Question 842

Fetal tachycardia: Causes RN intervention

Answer 842

``` Causes: -fetal hypoxia -acidosis -infection -maternal fever -maternal dehydration -maternal hypotension -drug side effects (terbutaline, bronchodilators, decongestants) ``` RN action: - take maternal temp - take maternal BP - review med administration record - increase IV fluid rate if hypotension

Question 843

Culture sensitivity testing for infants

Answer 843

Urine needed Sterile technique -Sterile cath for infants and toddlers who are not toiled trained

Question 844

Varicose Veins Treatment Potential complications

Answer 844

``` TREATMENT -weight loss -3 E's: Elevation Exercise Elastic compression hose ``` COMPLICATIONS * Chronic Venous Insufficiency* - Warm, thick, indurated skin - bronze/brown pigmentation of skin - edema - ulcer

Question 845

Monitor tube feeding for complications/intolerance

Answer 845

*BOWEL MOVEMENTS: Diarrhea -too concentrated/hyperosmolar or too rapid FLUID STATUS - rapid weight gain, periph edema - Too dilute or excess water flushes DELAYED GASTRIC EMPTYING - Nausea/Vomiting - high gastric residuals

Question 846

How to position pt if unable to hear heart sounds

Answer 846

Aortic/Pulmonic areas: Sit up and Lean forward Mitral area: Lie down on left side

Question 847

Dissociative identity disorder What is it? Treatment goal? RN intervention?

Answer 847

2 or more identities, response to abuse/trauma. - might not be aware - gaps in memory/"lost time" GOAL: to integrate ID's into 1 personality safely RN: - trust with each id - encourage journaling and dissociation triggers - listen for expressions of self-harm - teach grounding techniques to hinder dissociation - Allow recall of memory at own pace DO NOT force client to recall memories.

Question 848

OCD | Initial nursing care

Answer 848

- help pt identify anxiety triggers - positive feedback when non ritualistic - nonjudgmental and empathetic - reflective communication - cognitive-behavioral therapy (eg, thought stopping)

Question 849

Hyper/Hypo | Calcium

Answer 849

Calcium acts as diuretic and sedative Hyper: constipation and polyuria Hypo: neuromuscular excitability -tremors, hyperactive reflexes, sz

Question 850

Hyper/Hypo | Potassium

Answer 850

Hyper: peaked T-waves, muscle twitches, cramps, paresthesis, decreased bb, diarrhea Hypo: weakness, fatigue, confusion, irritable, thready pulse, low intestinal motility

Question 851

Benztropine | Use

Answer 851

Anticholinergic med for some EXTRAPYRAMIDAL SX , which are associated with some antipsychotic meds. Pseudoparkinsonism: symptoms resembling PD (mask like face, shuffling gait, rigidity, rest tremor, bradykinesia) Dystonia: Abnormal muscle movements of face, neck, trunk by sustained muscular contractions

Question 852

Pharyngitis cause Interventions

Answer 852

Group A B-hemolytic Streptococcus bacterial throat infection -Could cause renal or cardiac complications if not treated Interventions: - Antibiotics!!! * kid can return to school 24 hrs post if afebrile * throw away toothbrush 24 hrs post - test siblings age <3 - complete all antibiotics

Question 853

Active TB combined therapy Drugs Length of therapy

Answer 853

Isoniazid - hepatotoxicy - peripheral neuropathy Rifampin - hepatotoxicity - red urine, sweat, tears (no contact lenses) - Decrease oral contraceptive effectiveness - increased metabolism of hypoglycemia and warfarin Ethambutol -occular toxicity (frequent eye exams) Pyrazinamide LOT: 6-9 months

Question 854

placenta accreta

Answer 854

Most morbid cause of retained placenta Adheres to myometrium Attempted separation=life-threatining hemorrhage

Question 855

Barotrauma

Answer 855

Potential complication of high levels of PEEP (10-20 cm H2O) -abrupt pressure change - RUPTURED ALVEOLI! * pneumothorax and/or subcutaneous emphysema

Question 856

Reduce risk of aspiration in pt with tracheostomy

Answer 856

- cuff makes it hard to swallow/talk - cuff deflated when client improving - client sit upright with chin flexed towards chest - monitor for wet/garbled-sounding voice - monitor for fever

Question 857

Furosemide

Answer 857

Lassie K-depleting loop diuretic

Question 858

Shingles

Answer 858

Herpes zoster Open lesions- AIR AND CONTACT PRECAUTIONS Disseminated shingles: CONTACT AIRBORNE NEGATIVE-AIRFLOW ROOM Localized shingles: standard precautions for clients with intact immune system and covered/contained lesions

Question 859

Cranial Nerve XI

Answer 859

Spinal accessory Shoulder muscles

Question 860

Hyperemesis gravidarum

Answer 860

Persistent nausea an vomiting ``` Dehydration Concentrated urine Hypokalemia Hyponatremia Ketonuria (body breaking down fat for energy) ```

Question 861

Emergency contraception

Answer 861

Within 5 days Efficacy reduced after 3 days

Question 862

CF diet

Answer 862

High calorie High protein High fat

Question 863

Bronchial breath sounds

Answer 863

normally heard over trachea -harsh, high-pitched If heard over lung periphery, indicates pneumonia (consolidation)

Question 864

Borborygmi

Answer 864

Loud, gurgling bowel sounds. Potentially gastroenteritis, diarrhea, and early phase of mechanical obstruction

Question 865

Normal muscle strength

Answer 865

5=NORMAL! Active motion against full resistance 4=active motion against some resistance 3=active motion against gravity 2=only able to move laterally, not against gravity 1=slight flicker of contraction 0=paralysis

Question 866

Transverse myelitis

Answer 866

spinal cord inflammation S/S paralysis urinary retention bowel incontinence

Question 867

Midazolam Use Antidote

Answer 867

Conscious sedation for endoscopic procedures Antidote: Flumazenil

Question 868

Acute angle-closure glaucoma VS Open-angle glaucoma

Answer 868

``` Acute-angle: Medical emergency Increased IC pressure Permanent blindness S/S: -severe pain -reduced CENTRAL -vision -blurred vision -ocular redness -halos around lights ``` Open: gradual loss of peripheral vision difficulty adjusting to light Develops slowly, not emergent Eye redness from increased pressure

Question 869

Asthma its cannot use which meds?

Answer 869

Beta blockers NSAIDS (ibuprofen, aspirin)

Question 870

Guaifenesin

Answer 870

aka: Mucinex expectorant to mobilize mucus

Question 871

Loratadine

Answer 871

aka: Claritin antihistamine

Question 872

``` Clear Liquids vs. Full liquids vs. Soft Diet ```

Answer 872

Clear: clear broth, jello, popsicles, clear fruit juice (apple, grape), carbonated beverages (sprite, ginger ale), coffee, tea Full: strained/blended cream soups, custards, puddings, cooked cereals (oatmeal, grits), all fruit juices, ice cream, frozen yogurt, sherbet, milkshakes Soft: soups, flaky fish, PB, scrambled eggs, mashed potatoes

Question 873

Bariatric surgery post-op

Answer 873

-NG tubes contraindicated (don't mess with surgery site!) * **Clear liquid diet for 48-72 hrs to promote healing * Full liquids after that. * Low-carb (sugar-free) liquids to decrease dumping syndrome - Low fowler's position for meal times to slow gastric emptying - Morphine and PCA used for pain management

Question 874

Phenylketonuria What is it? treatment?

Answer 874

- Genetic - Lack enzyme phenylalanine, used to convert then to tyrosine. - Unconverted then accumulates, leads to irreversible near damage TREATMENT: Low-phenalalinine diet (safe serum level 2-6 mg/dL for clients <12) -Lifetime dietary restriction -special formulas ended -Eliminate high-phen foods (meat, eggs, milk) -encourage consumption of natural foods w/ low phen (fruits/veggies)

Question 875

Fluticasone/salmeterol

Answer 875

fluticasone=corticosteroid salmeterol=bronchodilator Long-term control of asthma, not rescue inhaler - after inhalation, rinse mouth with water without swallowing - avoid smoking - receive normal vaccines

Question 876

Rescue asthma meds

Answer 876

albuterol | ipratoprium

Question 877

Azathioprine

Answer 877

immunosuppressant can cause bone marrow depression increased risk for infection Leukopenia severe adverse effect

Question 878

Rheumatoid Arthritis | What is it?

Answer 878

-Chronic, relapsing autoimmune disorder -Inflammation of synovial joints -fibrosis/stiffening of synovial membranes -contracture of ligaments -joint remodeling =weakness/deformity *joint deformity can be prevented with drugs and joint protection -ROM exercises to prevent loss of function and prevent contracture PREVENT DISEASE PROGRESSION: - joint protection (body aligners/immobilizers at to keep joints straight rest) - Medications * **methotrexate (anti rheumatic drug) * **take as prescribed regardless of symptoms - ROM exercises, stay active

Question 879

OA vs RA

Answer 879

OA: - degenerative cartilage loss - Morning stiffness less than 30 min - asymmetrical - heberden's node - localized joints, 1 or a few joints RA: - autoimmune - inflamed synovium - (late)extra-articular (joint) involvement... deformities - symmetrical - Morning stiffness more than 30 min

Question 880

Nystatin

Answer 880

Treats oral candidiasis (thrush) Available in powders, suspensions, creams, ointments, lozenges Oral suspension used for oral candidiasis. * Swish in mouth for several minutes * SWALLOW - ointments for skin - lozenges need to be dissolved in mouth

Question 881

Myasthenia Gravis What is is? S/S? Treatment?

Answer 881

Autoimmune disease -Decrease acetylcholine receptors S/S: * *EYES, SPEAKING, SWALLOWING, BREATHING*** - ptosis/diplopia - bulbar signs (difficulty speaking/wallowing) - difficulty breathing * stronger in the morning, weaker with the day's activity - skeletal muscle, NOT CNS (so bladder/bowel control ok) Treatment: - anticholinesterase BEFORE MEALS (AC) * pyridostigmine* - Annual flu vaccine - Pneumonia vaccine - Semi-solid foods (over solid foods)

Question 882

Cholinergic actions vs Anticholinergic actions

Answer 882

Cholinergic: - Pupil constriction (mitosis) - Decreases HR - Causes urination Anticholinergic: - Pupil dilation (mydriasis) - Increases HR - Causes urinary retention

Question 883

Nitrazine test What for? Results?

Answer 883

Determines if membranes ruptured (labor) Negative: yellow, olive-yellow, olive green (pH5-6) *membranes intact* Positive: blue-green, blue-gray, deep blue (pH6.5-7.5) *membranes ruptured* FALSE POSITIVES: Semen Blood

Question 884

Thrombolytic agents Use Contraindications

Answer 884

-PLASE anteplase, tenecteplase, reteplase Resolve acute thrombotic events (ischemic stroke, MI, massive PE) Contraindication: - uncontrolled hen (>180/110) - active bleeding - recent trauma - aneurysm - hx of hemorrhagic stroke

Question 885

Penicillin derivatives and cephalosporins safe for pregos?

Answer 885

MOST, YES! ampicillin amoxicillin cqphalexin ceftriaxone

Question 886

Fundal height based on weeks pregnant

Answer 886

12: just above symphysis pubis 20-22: reaches umbilicus 36: approaches xiphoid process 38-40: engagement occurs, starts to drop At 20 weeks, fundal height measured in centimeters Pubic bone=0cm Measuring tape over belly towards breasts

Question 887

Chest physiotherapy

Answer 887

Cystic fibrosis AFTER bronchodilators and neb BEFORE meals

Question 888

Newborn respirations

Answer 888

Rate:30-60 Periodic pauses lasting <20 seconds

Question 889

Myopia

Answer 889

nearsightedness (can't see objects far away) - headaches - dizziness - low school performance - rubbing ees - frequent blinking/squinting Biconcave lenses or laser sx

Question 890

Stabismus

Answer 890

What Jamie Eason's kid has! One eye drifts *malalignment* Kids will close one eye when viewing objects

Question 891

Veracity

Answer 891

Telling the truth

Question 892

Fidelity

Answer 892

Loyalty Keeping promises Fulfilling commitments (accountability)

Question 893

Justice

Answer 893

equal treatment for all

Question 894

Drugs most commonly associated with orthostatic hypotension

Answer 894

1. antihypertensives (Beta blockers, alpha blockers-terazosin) 2. antipsychotics and antidepressants (olanzapine, risperidone, SSRI's) 3. diuretics 4. vasodilators (nitro's hydrazine) 5. narcotics

Question 895

Retinal detachment symptoms

Answer 895

Painless loss of vision "like a curtain" coming across field of vision Light flashes Floaters Gnat/hairnet appearance in vision field EMERGENT EVALUATION!!! Untreated-blindness

Question 896

Age for heimlich maneuver

Answer 896

Over 1 Fore tin body aspiration Upward abdominal thrusts

Question 897

Gold standard to assess early ventilation failure

Answer 897

Serial Bedside Forced Vital Capacity | spirometry

Question 898

Eosilophils

Answer 898

1-2% | Elevated in allergies and asthma

Question 899

Lymphocytes

Answer 899

Elevated with viral and hematologic malignancies

Question 900

Neutrophils

Answer 900

55-70% | Elevated in infection

Question 901

Stages of Change Model

Answer 901

Pre contemplation: "no problem" Contemplation: understand change needed, but is it worth it? Preparation: established goals Action: active steps towards new behavior Maintenance: Prevent relapse Termination: change achieved

Question 902

American Diabetic Association Meal Planning

Answer 902

``` High fiber (whole grains, legumes, fruits, veggies, low-fat dairy) Low glycemic index Monounsaturated fats (no burgers) Reduce sodium Limit sucrose Limit alcohol ```

Question 903

Rapid response team criteria

Answer 903

Acute change in the following: - Hr <40 or >130 - SBP <90 - Resp rate <8 or >28 - O2 sat <90% - Urine output <50/4hrs - Level of consciousness

Question 904

Coup-countrecoup

Answer 904

Body in motion suddenly stops (ex. car slamming into wall) Frontal lobe: executive function, memory, SPEECH (Broca are), and voluntary movement Occipital lobe: vision

Question 905

Phenazopyridine

Answer 905

Urinary analgesic For UTI's Will turn urine (and other bodily fluids) bright red-orange

Question 906

Pyrosis What is it? Lifestyle changes to treat

Answer 906

Heartburn Common in pregnancy Esophageal sphincter relaxation - Elevate HOB - Sit upright after meals - less fluid while eating - Small, frequent meals - Avoid tight clothes - Eliminate dietary triggers (fried/fatty food, caffeine, citrus, chocolate, spicy foods, tomatoes, carbonated drinks, peppermint) Dairy isn't typically a problem :)

Question 907

Presbyopia

Answer 907

Farsightedness Loss of elasticity of lends Old age

Question 908

Vancomycin Used for? Lab checks? Risks?

Answer 908

MRSA, C.Diff BUN (12-20) Creatinine (1-1.5) Serum trough level monitored before 4th dose. 15-20 mg/L ideal1 NEPHROTOXICITY!

Question 909

Maintain gastric suction using Salem Sump Tube

Answer 909

NG Tube - Semi-fowlers position - Mouth care q4h - Turn off suction during auscultation - Inspect drainage system for patency - Keep air vent (blue pigtail) open and above level of clients stomach NO RESIDUAL! It's on suction!

Question 910

Mononucleosis What is it? Sx? Treatment?

Answer 910

Epstein-Barr VIRUS Fatigue, sore throat, fever, swollen lymph nodes, splenomegaly, hepatomegaly NO ANTIBIOTICS! IT'S A VIRUS!!! Treatment: manage symptoms :( hydration, rest, pain control, reduce fever Saline gargles or anesthetic troches (lozenges) Avoid contact sports b/c of splenomegaly.

Question 911

Sulfonylurea medications Names Use Adverse effects

Answer 911

glyburide glipizide glimepiride Type 2 diabetes Increase insulin release from beta cells in pancreas Side effects: Hypoglycemia Weight Gain Extra info: Avoid alcohol d/t risk of severe hypoglycemia Glyburide: sunburn easily

Question 912

Liver Biopsy

Answer 912

-Check its PT/INR and PTT -Type and crossmatch blood type *bleeding risk! Lie supine Right arm under head Exhale and hold during insertion Needle b/w 6th-9th ribs Lie on right side 2-4 hrs Bed rest 12-14 hrs

Question 913

Normal vs Abnormal Lymph Node findings

Answer 913

***NORMAL*** Usually non palpable ``` Small (0.5-1cm) Mobile Firm Contender ALL NORMAL! ``` Could be from recent trauma, inflammation ***ABNORMAL*** tender, enlarged hard, fixed- potential malignancy

Question 914

Sucralfate

Answer 914

Protective layer in GI mucosa! | Empty stomach May bind with other meds take 1-2 hrs away from sucralfate Potential constipation

Question 915

Sarin

Answer 915

Biological weapon Nerve Agent Excess acetylcholine Mitosis, rhinorrhea, copious secretions, SOB, flaccid paralysis Treat: suction support ventilation

Question 916

Botulism

Answer 916

Neurologic symptoms Symmetrical descending paralysis Cranial nerve palsies (ptosis diplopia, dysphagia, dysphonia)

Question 917

Pessary

Answer 917

Vaginal device to support prolapsed bladder - No surgery - Fitted for proper size - Can still have sex - Its can insert/remove themselves - Increased vag discharge normal, if odorous let HCP know

Question 918

Myxedema coma Cause? S/S Treatment

Answer 918

Complication of hypothyroidism Lethargy, mental sluggishness, eventually coma state ``` S/S: Hypothermia Bradycardia Hypotension Decreased MS ``` Resp distress (low o2, increased resp) prepare for respiratory support (intubate, ventilate) Other treatment: IVP levothyroxine

Question 919

Hypospadias

Answer 919

Abnormal urethral opening Under penis Hourly output monitored post-op

Question 920

Radioactive iodine | First week post-procedure

Answer 920

Treats hyperthyroid - destroys/damages thyroid - DELAYED RESPONSE! Takes up to 3 months to work 1 week precautions: - Continue other meds because of delayed response - avoid prego's and kids - no breastfeeding - no sharing utensils - no using bare hands to handle other people's food - isolate laundry/wash separately - use separate toilet, flush 2-3x after each use - DRINK FLUIDS - wash hands thoroughly - sleep in separate bed - don't sit near others for a long time (train, flight)

Question 921

Which meds require Liver Enzyme monitoring?

Answer 921

Statins | Isoniazid (for TB)

Question 922

Bowel Irrigation for colostomy

Answer 922

1. fill irrigation container with 500-1000 mL lukewarm water, flush tubing, reclamp, hang on hook or IV pole. 2. Sit on toilet place the irrigation sleeve over the stoma, extend the sleeve into the toilet, and place the irrigation container approximately 18-24 inches above the stoma. 3. Lubricate cone-tipped irrigator, insert cone and attached catheter gently into the stoma, and hold in place 4. Slowly open the roller clamp, allowing irrigation solution to flow for 5-10 minutes 5. Clamp the tubing if cramping occurs, until it subsides 6. Once the desired amount of solution is instilled, the cone is removed and feces is allowed to drain through the sleeve into the toilet

Question 923

Anaphylactic rxn to IV meds

Answer 923

1. stop the infusion 2. ensure airway patency and administer oxygen 3. give epinephrine and initiate IV fluids 4. administer adjunctive therapies (antihistamines, bronchodilators, corticosteroids) 5. Monitor vital sign changes

Question 924

Pulsus Paradoxus

Answer 924

Why? Cardiac tamponade Difference between pressure heart at first korotkoff sound during expiration and inspiration. Difference <10 normal Difference >10 = cardiac tamponade!

Question 925

Korotkoff sound

Answer 925

Sounds of blood flow during BP evaluation

Question 926

S/S of anaphylaxis

Answer 926

CV: Vasodilation -hypotension, edema Tachycardia ``` RESP: Upper airway edema -stridor, hoarseness Bronchospasm -wheezing ``` CUTANEOUS: -urticarial rash, pruritus, flushing GI: Nausea, vomit, abd pain Shock: dizzy, LOC NOT FEVER

Question 927

Colles Fracture

Answer 927

Distal radius fracture Wrist fracture Makes hand/arm look like up-side-down fork