question

Most common cause of hyperthyroidism

answer

Grave's Disease

question

S/S of thyroid storm

answer

hyperthermia, HTN, delirium, vomiting, abdominal pain, hyperglycemia, tachydysrhythmias

question

Antidote for Valium intoxication

answer

Flumazenil (Romazicon)

question

Valium, monitor for what?

answer

decreased respirations

question

Appropriate actions for bacterial meningitis

answer

droplet precautions, decrease environmental stimuli, maintain best rest w/ HOB at 30, seizure precautions, replace fluid and electrolytes

question

position crutches on affected or unaffected side when sitting or rising from chair?

answer

unaffected side 2-3 finger widths Crutches no weight bearing Tripod position weight on UNAFFECTED side. advance both crutches and affected extremity move unaffected forward (beyond crutches) advance both crutches then affected extremety continue sequence (steps equal length) Crutches with weight bearing move crutches forward about 1 step length move AFFECTED leg forward level with crutches move unaffected leg forward continue sequence (steps equal length)

question

Intervention for sprain

answer

(PRINCE) Protect, Rest, Ice, NSAIDs, Compress, Elevate

question

Airborne Precautions

answer

Used to protect against droplet infections smaller than 5 mcg (measles, varicella, pulmonary or laryngeal tuberculosis). Airborne precautions require: - A private room - Masks/ respiratory protection devices for caregivers and visitors -Negative pressure airflow exchange in the room of at least six exchanges per hour.

question

Droplet Precautions

answer

Protect against droplets larger than 5 mcg (streptococcal pharyngitis or pneumonia, scarlet fever, rubella, pertussis, mumps, mycoplasma, pneumonia, meingococcal pneumonia/sepsis, pneumonic plague). Droplet precautions require: - A private room or a room with other clients with the same infectious disease -Masks

question

Contact Precautions

answer

MRS WEE) Multidrug resistant organism, respiratory infection, skin infection (varicella, diphteria, shingle, impetigo, scabies), wound infection, enteric infection (c-diff), eye infection Protect visitors and caregivers against direct client/ environmental contact infections(respiratory syncytial virus, shigella, enteric diseases caused by micro-organisms, wound infections, herpes simplex, scabies, multi-resistant organisms). Contact precautions require: - A private room or a room with other clients with the same infection - Gloves and gowns worn by the caregivers and visitors. - Disposal fo infectious dressing material into a single, nonporous bag without touching the outside of the bag.

question

use of restraints

answer

provider must rewrite order every 24h, Toileting and ROM exercises and assessment of neurovascular and neurosensory status q2h, tie to bed frame (loose knots that are easily removed)

question

Care for Pt who has clostridium difficile

answer

contact precautions, encourage increased fluid intake, antiemetics, antimicrobial therapy

question

clinical manifestations of smallpox

answer

high fever, fatigue, sever headache, rash (starts centrally and spreads outward) that turns to pus-filled lesions, vomiting, delirium, excessive bleeding

question

sealed radiation implant

answer

pt in private room, nurse should wear dosimeter film badge, visitors limited to 30m visits and maintain distance of 6ft, visitors who are pregnant or under 16yrs. should not contact Pt, lead container in room, instruct pt to call nurse for assistance with elimination

question

Latent phase of labor

answer

1st part of the 1st stage of labor, lasts 4-6h, cervix 0-3cm, contractions irregular, mild to mod frequency 5-30m and duration of 30-45s, some dilation and effacement, pt talkative and eager Use slow/ deep breathing

question

Periodic FHR Changes

answer

Variable Cord Compression Move client Early Head Compression Identify progress Acceleration Other (Okay) No action needed Late Placental Insufficiency Execute action fast

question

equation for calculating due date

answer

1st day of last period + 1yr - 3 months + 7d = due date

question

grains per day

answer

6 oz whole grains (cereals , rice, pasta) 1 oz = one slice of bread, 1 cup cereal 1/2 cup cooked pasta

question

veggies per day

answer

2.5 cups (raw, cooked, or juice) broccoli, carrots dry beans and peas, corn, potatoes, tomatoes

question

fruits per day

answer

2 cups (1 small banana, orange, 1/4 cup dried apricots)

question

milk per day

answer

3 cups (2% milk, yogurt, cheese)

question

protein per day

answer

5.5oz (one small chicken breast 3 oz, one egg 1 oz, 1/4 cup dried cooked beans 1oz

question

nutrients for healthy nervous system

answer

B complex vitamins (thiamine, niacin, B6 & B12, Ca, and Na

question

Oils

answer

6 tsp (canola, corn, olive, nuts, olives and some fish)

question

Lab Results of an MI

answer

elevated troponin, CK-mb enzymes, elevated LDH

question

daily % calories from protein

answer

10%

question

daily % calories from carbs

answer

45-65%

question

daily % calories from fat

answer

20-35%

question

expected physiological changes of aging

answer

decreased EVERYTHING (skin turgor, wt, chest wall movement, senses, ht, subQ fat)

question

measures to prevent injury with osteoporosis

answer

Ca supplementation, adequate amounts of protein, mag, vit. K, Vit D, wt-bearing exercises, remove throw rugs, provide adequate lighting, clear walkways, mark thresholds, doorways and steps

question

African American women are at increased risk for what?

answer

cervical cancer

question

African Americans are at increased risk for what?

answer

heart disease and stroke

question

What populations are at greater risk for diabetes?

answer

American Indians, Alaskan natives, African Americans & Hispanics

question

Discharge teaching on breast engorgement

answer

Nonlactating Clients: avoid nipple stimulation & apply cold compresses 15m on and 45m off, cabbage leaves placed inside bra, pain meds, supportive bra. Lactating Clients: manually express some milk, frequent feeding or pumping, warm shower, beast massage, supportive bra, maternal meds after feed to avoid cross-over to breast milk.

question

to lose 1 lb of body fat per week, an adult must have an energy deficit of ____ cals/day

answer

500 or 3,500 cal/wk

question

Positive symptoms of schizophrenia

answer

hallucinations, delusions, alterations in speech, bizarre behavior

question

Negative symptoms of schizophrenia

answer

flat, blunt affect; algoia (poverty of thought/speech); avolition (lack of motivation); anhedonia (lack of pleasure/joy); anergia (lack of energy)

question

Nursing interventions for domestic partner abuse

answer

help Pt develop a safety plan, identify behaviors and situations that might trigger violence and provide information regarding safe places to live; encourage participation in support groups

question

Nursing interventions for Pt who is manic

answer

decrease stimulation, frequent rest periods, observe for escalating behavior, provide outlets for physical activity, provide portable nutritious food, use a calm, matter-of-fact approach, give concise explanations

question

Nursing interventions for alcohol withdrawal syndrome

answer

self-assess ones own feelings regarding abuses; use open-ended questions, close/one-on-one observation; low-stimulation enviro, encourage attendance of self-help groups

question

Nursing interventions for Pt with PTSD

answer

provide safety and comfort, remain w/ Pt through episode, give reassurance, group/family therapy is best, assist client to eval. coping mechanisms that work, assist Pt in determining triggers

question

Nursing interventions for dementia

answer

reinforce reality, orientation to Person Place Time, encourage reminiscence about happy times, talk about familiar things, minimize need for decision making and abstract thinking to avoid frustration

question

Ileostomy Care

answer

apply skin barriers to stoma, empty bag when it is 1/3 full, assess for fluid and electrolyte imbalances

question

Normal post-op output for an ileostomy is what?

answer

1 L/day; may be bile colored and liquid; normal to see small amounts of blood

question

Stoma appearance should normally look

answer

pink or red and moist/red and beefy

question

Steps in performing closed intermittent irrigation

answer

clamp catheter w/ injection port and extension tubing, cleanse port slowly inject syringe w/ irrigant into catheter remove syringe and unclamp allow irrigant to drain into drainage bag

question

Benefits of applying ice to extremity

answer

decreases inflammation, bleeding, fever, swelling, muscle spasms and pain

question

Kosher foods

answer

animals which chew cud and have split hooves (cattle, sheep, goats, & deer), seafood with fins and scales, NO PORK (hotdogs, sausage, gelatin), and no meats mixed with milk

question

Nutritional needs for Hepatic Encephalopathy

answer

high carb, high cal, low to mod fat, and low to mod protein; small, frequent meals; supplement w/ vitamins (B complex), folic acid, and iron

question

Nursing intrvetions for Pt receiving TPN

answer

monitor serum and urine glucose, monitor for "cracking" of solution, use sterile technique when changing central line, bag and tubing should be changed q24h

question

TPN fluid overload is evidenced by what?

answer

weight gain > 1kg/day and edema

question

Interventions for chronic renal failure

answer

diet high in carbs and mod. fat, control protein intake, restrict Na, K, Ph, and Mg

question

Sleep promotion

answer

bedtime routine, min number of times pt is awakened, assist w/ personal hygiene or back rub, exercise 2hr before bed, limit fluids 2-4hr before bed

question

Intermittent tube feedings

answer

HOB @ 45 degrees feed and 1hr after feeding, admin. solution at room temp, formula is administered q4-6h in equal portions of 200-300mL over a 30m-60m time frame Flush 30mL every 4 hours

question

Bariatric surgeries Dietary planning

answer

limited to liquids or pureed foods for first 6wks, meal size shouldn't exceed 1c, vit & min supplements

question

Foods that can cause odor for ostomy

answer

fish, eggs, asparagus, garlic, beans, and dark green leafy veggies

question

Foods that can cause gas for ostomy pt

answer

dark green leafy veggies, beer, carbonated beverages, dairy products, and corn

question

What type of diet should a client who has dysphasia be on?

answer

Pureed or mechanical soft diet

question

Contraindications for the use of Isosorbide Mononitrate (IMDUR) For Angina

answer

Headache hypersensitivity to nitrates, traumatic head injury b/c med can increase ICP, use cautiously in Pt taking Hypotension: antiHTN meds or have renal or liver dysfucntion

question

If Pt develops reflex tachycardia from taking Imdur give what?

answer

metoprolol (Lopressor)

question

Atorvastatin (lipitor) purpose

answer

decrease manufacture of LDL and VLDL and increase HDLs; promotes vasodilation, decreased plaque site inflammation, and decreased risk of thromboembolism

question

S/E of Atorvastatin (Lipitor)

answer

Hepatotoxicity (liver fxn tests after 12wks then q6m); myopathy (obtain baseline CK levels); peripheral neuropathy (notify provider)

question

Teaching for Atorvastatin (Lipitor)

answer

don't take with grapefruit juice, take in evening

question

S/E of Metoclopramide (Reglan) For Heartburn (antiematic)

answer

EPS (bradykinesia, tremor, rigidy) (notify Ph, admin benadryl), hypotension, sedation, anticholinergic effects

question

Doxazosin (Cardura) For HTN and BPH

answer

venous & arterial dilation, smooth muscle relaxation of prostatic capsule and bladder neck

question

Teaching and S/E of Alpha Blockers Doxazosin (Cardura) or Prazosin (Minipress)

answer

1st dose orthostatic hypotension (syncope, dizzy or faint) take 1st dose at night and monitor BP 2hr after 1st dose, avoid activities requiring mental alertness for first 12-24h, instruct pt to change position slowly, take with food

question

Clozapine (Clozaril) Chlorpromazine (Neg and Pos s/s Schizophrenia) S/E What to do?

answer

neg and pos s/s of schizophrenia, relief of psychotic symptoms DRINK FLUIDS AVOID SUNLIGHT New onset diabetes/loss of glucose control (report s/s of increased thirst, urination, appetite), wt gain, hypercholesterolemia, orthostatic hypotension, anticholinergic effects, symptoms of agitation, dizziness, sedation, and sleep disruption, mild EPS such as tremor, risk for dyslipidemia, risk for fatal agranulocytosis (baseline & wkly monitor of WBC, notify of S/S of infection) Stop med for signs of neuroleptic malignant syndrome

question

Therapeutic effect of Levothyroxine (Synthroid)

answer

For Hypothyroidism: decreased TSH 0.3-3.0, normal T4 levels, absence of hypothyroidism symptoms (depression, wt gain, bradycardia, anorexia, cold intolerance, dry skin, menorrhagia); takes several wks to notice a therapeutic effect

question

Long-term adverse effects of Haloperidol (Haldol)

answer

Tardive dyskinesia (involuntary movements of tongue and face, lip smacking, involuntary movments of arms, legs, and trunk)

question

Effectiveness of Allopurinal (Zyloprim) is evidenced by

answer

Improvement in pain caused by gout attack (decreased joint swelling, redness), decreased number of gout attacks, decreased uric acid levels

question

Leukotrien Modifiers Montelukast (Singulair)

answer

suppress inflammation, bronchoconstriction, airway edema, and mucus production long-term therapy for asthma and to prevent exercise-induced bronchospasm Take once daily at bedtime

question

Assessment of DI

answer

Decreased urine specific gravity and osmolality Hypernatremia Hypokalemia Increased urinary output Dehydration, weight loss and dry skin

question

Desmopressin (DDAVP) For Diabetes Insipidus

answer

promote absorption of water within the kidneys; cause vasoconstriction; tx of diabetes insipidus Effectiveness of DDAVP is evidenced by: reduction in the large volumes of urine output associated with diabetes insipidus to normal levels

question

Contraindications to MMR Immunization

answer

pregnancy, allergy to gelatin and neomycin, hx of thrombocytopenia, immunosuppression, recent blood transfusion; common cold NOT a contraindication

question

Administration of Enoxaparin (Lovenox) Anticoagulant

answer

subq q12h for 2-8d; use 20-22G needle to draw up; 25-26G needle to admin; admin in abdomen at least 2" away from umbilicus; apply pressure for 1-2m after injection; DON'T RUB

question

Teaching about iron supplements

answer

take with orange juice on empty stomach; may cause constipation, N/V/D, can turn stool a dark green/black color

question

Furosemide (Lasix) Purposes of Use

answer

block reabsorption of Na and chloride and prevent reabsorption of water; cause extensive diuresis Used for: pulmonary edema caused by HF, emergent need for rapid mobilization of fluid

question

S/E of Furosemide (Lasix)

answer

dehydration, hypoNa, hypoCl, hypoTN, hypoK OTOTOXICITY

question

Teaching on Lasix

answer

avoid admin late in day, report significant wt loss, lightheadedness, dizziness, GI distress, and general weakness, observe for signs of low Mg levels such as muscle twitching and tremors

question

Sedative/ Hypnotic Medications Eszopiclone (Lunesta) Temazepam (Restoril) Zolpidem tartrate (Ambien)

answer

Use cautiously with mental depression avoid with alcohol and medications with CNS depression S/E Dry mouth, decreased libido, respiratory depression

question

Opioids (relief and sedation)

answer

Duragesic, Dilaudud, Morphine, Demerol, Codeine, oxycodone

question

Opioid antagonist nalaxone (Narcan)

answer

used for respiratory depression

question

Ace Inhibitors (end in "pril")

answer

Used for: HTN, HF, MI, diabetic neuropathy Monitor potassium levels K+ persistent non-productive cough

question

SSRI (Duloxetine, Fluoxetine, Escitalopram, Fluvoxamine, Paroxetine, Sertraline) Teaching

answer

Avoid alcohol, do not discontinue abruptly, monitor for agitation, confusion and halluciations within the first 72 hours. S/E Weight gain, sexual dysfunction, fatigue, drowsiness May cause serotonin syndrome (2-72 hrs after start of treatment): tremors, agitation, confusion, anxiety and hallucinations

question

When should admin RhoGAM

answer

when mom is Rh-negative and had Rh-positive infant; admin w/n 28 weeks (3rd trimeter) and 72h after birth Spontaneous abortion, amneoscentesis

question

Does does Magnesium Sulfate do?

answer

relaxes smooth muscle of the uterus and inhibits uterine activity by suppressing contractions

question

What are s/s of Mag sulfate toxicity? What is the antidote for Mag Sulfate?

answer

loss of Deep Tendon Reflexes, urinary output < 30ml/hr, resp depression, pulmonary edema, and/or chest pain Calcium Gluconate to fix!

question

What are the contraindications for Mag sulfate?

answer

active vagninal bleeding, dilation of cervix is > 6cm, chorioamnionitis, > 34 wks gestation, acute fetal distress, severe pregnancy induced HTN or eclampsia

question

Indications to withhold Propranolol (inderal) Beta Blocker

answer

bradycardia, SOB, edema, fatigue, AV block, Pt has asthma

question

ANGINA Containdications for vasodilators Nitros

answer

CLIENTS WITH A HEAD INJURY Hypotensive risk with antihypertensive meds Erectile dysfunction meds (life threatening hypotension)

question

Uses for methadone (Dolophine)

answer

relief of mod to severe pain; sedation; reduction of bowel motility

question

Equation for calculating pulse pressure

answer

systolic - diastolic = pulse pressure 120-80=40

question

When should a trough level be scheduled for a once daily dosing of Gentamycin?

answer

1hr prior to next dose

question

When should a peak level be drawn for divided doses of Gentamycin?

answer

30m after admin of med or infusion has finished

question

When should a trough level be drawn for divided doses of Gentamycin?

answer

right before next dose

question

S/S of dehydration

answer

hyperthermia, tachycardia, thready pulse, hypoTN, orthostatic hypotension, decreased CVP, tachypnea, dizziness, cool clammy skin, diaphoresis, sunken eyeballs

question

S/S for overhydration

answer

tachycardia, bounding pulse, HTN, tachypnea, increased CVP, confusion, muscle weakness, wt gain, ascites, dyspnea, crackles

question

S/S of hyponatremia

answer

hypothermia, tachycardia, rapid thready pulse, hypoTN, ortho hypo, headache, confusion, decreased DTRs, hyperactive bowel sounds

question

S/S of hypernatremia

answer

hyperthermia, tachycardia, rapid thready pulse, ortho hypo, restlessness, irritability, muscle twitching, reduced to absent DTRs, hyperactive bowel sounds

question

S/S of hypokalemia

answer

hyperthermia, weak irregular pusle, hypoTN, resp. distress, muscle cramping, hypoactive DTRs, PVCs, bradycardia, decreased motility

question

S/S of hyperkalemia

answer

slow, irregular pulse; hypoTN, restlessness, irritability, weakness with ascending flaccid paralysis, N/V/D, hyperactive bowel sounds

question

S/S of hypocalcemia

answer

muscle twitches/tetany, hyperactive DTRs, positive Chvostek's sign (tapping on the facial nerve triggering facial twitching), positive Trousseau's sign (hand/finger spasms with sustained blood pressure cuff inflation), seizures

question

S/S of hypomagnesaemia

answer

hyperactive DTRs, muscle tetany, positive Chvostek's and Trousseau's signs, hypoactive bowel sounds, paralytic ileus

question

Complications following a hypophysectomy (removal of pituitary gland)

answer

monitor for bleeding and nasal drainage for possible CSF leak (assess drainage for glucose or halo sign); assess neurological condition every hour for first 24h and every 4h after

question

Nursing Interventions for preventing delays in healing

answer

encourage an intake of 2-3L of fluid/d, increase protein, keep serum albumin levels above 3.5

question

Meds for Sinus Tachycardia

answer

amiodarone, adenosine, and verapmil; synchronized cardioversion

question

S/S of hyperglycemia

answer

BG > 250, thirst, freq. urination, hunger; warm, dry flushed skin; weakness; malaise; rapid, weak pulse; hypoTN, deep rapid respirations

question

Complication of pericarditis

answer

cardiac tamponade (hypoTN, muffled heart sounds, JVD, paradoxical pulse)

question

Pericarditis commonly follows a

answer

respiratory infection

question

S/S of pericarditis

answer

chest pressure/pain, friction rub, SOB, pain relieved when sitting and leaning forward

question

Fasting blood glucose

answer

post pone admin of antidiabetic med until after levels are drawn; ensure pt has fasted for 8hr prior to blood draw

question

Oral glucose tolerance test

answer

fasting blood glucose level drawn at start then pt consumes a specified amount of glucose. Blood glucose levels drawn every 30m for 2hrs; instruct client to consume balanced diet for 3d prior then fast 10-12hr

question

Glycosylate hemoglobin (HgA1c)

answer

best indicator for average blood glucose level for the past 120d; normal range is 4-6%, diabetic range is 6.5-8%

question

Evaluating proper placement of NG tube

answer

aspirate to collect gastric contents and test pH (4 or less) before feeding. Hold if residual is >100 mL, X-Ray Injecting air into tube to listen over abdomen is NOT an acceptable practice

question

IV Urography Procedure

answer

used to detect obstruction, assess for a parenchymal mass, and assess size of kidney Before procedure check allergy to iodine and check creatinine levels because dye can cause renal failure.

question

Complications of chest tube insertion

answer

air leaks - monitor the water seal chamber for continuous bubbling (air leak); tension pneumothorax - sucking chest wounds, prolonged clamping of the tubing, kinks in the tubing, or obstruction may cause this Tidaling in water seal chamber is normal!

question

Pt teaching for external radiation therapy

answer

gently wash skin over the irradiated area w/ mild soap and water, DON'T remove radiation tattoos, DON'T apply powders or lotions, wear soft clothing over irradiated area, avoid tight clothing, DON'T expose area to sun or heat

question

Infectious Mononucleosis

answer

Spread? saliva Transmission Precautions? Standard Contact Incubation Time? 4-6 Weeks S/S: fever, soar throat, swollen lymph glands, increased WBC, atypical lymphocytes, splenomegaly, enlarged liver Complication: ruptured spleen

question

Nursing Interventions for Pt who has HSV-2

answer

monitor fetal well-being, fetal consequences include miscarriage, preterm labor, and intrauterine growth restriction, obtain cultures, possible c section if lesions present during labor

question

Early S/S of cold stress in infant

answer

auxiliary temp < 97.7, increased resp. rate, increased HR, mottled skin

question

Late S/S of cold stress in infant

answer

apneic periods, bradycardia, acrocyanosis, decreased activity

question

Indications for use of cardioversion

answer

Atrial dysrhythmias, SVT, vent. tachy w/ pusle & tx of choice for pt who are symptomatic

question

S/S of Hypoglycemia

answer

shakiness, diaphoresis, anxiety, nervousness, chills, nausea, headache, weakness, confusion

question

Tx for Hypoglycemia

answer

4oz OJ or 2 oz grape juice or 8 oz milk recheck BG in 15m if still low (<70) give 15g more carbs recheck BG in 15m, if w/n norm limits eat 1g protein (peanut butter, cheese)

question

Nursing Interventions for increased ICP

answer

Keep HOB at 30 degrees, avoid extreme flexion, extension, or rotation of the head and maintain in midline neutral position; keep body aligned avoid hip flextion/extension; minimize endotracheal or oral suctioning; instruct pt to avoid coughing or blowing nose

question

S/S of Bacterial Vaginosis

answer

vaginal odor, discharge, dysuria

question

Nursing Interventions for Boggy Uterus Postpartum

answer

massage first then administer oxytocin

question

what acid-base imbalances w/ a pt with chronic emphysema most likely have?

answer

resp. acidosis and compensatory metabolic alkalosis

question

Respiratory Syncytial Virus Transmission Precautions

answer

Contact Precautions PPE: Gloves, Gown (mask and goggles as needed) Private Room Gloves and gown by visitors Disposal of infectious dressing material into nonporous bag Dedicated equipment to room or disinfect Droplet Precautions PPE: Mask when 3 feet of the client Private room Keep door closed In Baby: Maintain normal body temperature

question

Care at Birth

answer

Vital signs should be checked on admission/birth and every 30 min x 2, every 1 hr x 2, and then every 8 hr. Weight should be checked daily at the same time, using the same scale. Inspect the newborn's umbilical cord. Observe for any bleeding from the cord, and ensure that the cord is clamped securely to prevent hemorrhage. In the first 6 to 8 hr of life as body systems stabilize and pass through periods of adjustment, observe for periods of reactivity. First period of reactivity - The newborn is alert, exhibits exploring activity, makes sucking sounds, and has a rapid heart rate and respiratory rate. Heart rate may be as high as 160 to 180/min, but will stabilize at a baseline of 100 to 120/min during a period that lasts 15 to 30 min after birth. Period of relative inactivity - The newborn will become quiet and begin to rest and sleep. The heart rate and respirations will decrease, and this period will last from 30 min to 2 hr after birth. Second period of reactivity - The newborn reawakens, becomes responsive again, and often gags and chokes on mucus that has accumulated in his mouth. This period usually occurs 2 to 8 hr after birth and may last 10 min to several hours.

question

Intervening to Promote Bonding

answer

Facilitate the bonding process by placing the infant skin-to-skin in the en face position with the client immediately after birth. Promote rooming-in as a quiet and private environment that enhances the family bonding process. Promote early initiation of breastfeeding, and encourage the client to recognize infant readiness cues. Offer assistance as needed. Teaching the client about infant care facilitates bonding as the client's confidence improves. Encourage the parents to bond with their infant through cuddling, bathing, feeding, diapering, and inspection. Provide frequent praise, support, and reassurance to the client as she moves toward independence in caring for her infant and adjusting to her maternal role. Encourage the client/parents to express their feelings, fears, and anxieties about caring for their infant

question

Combination Oral Contraceptives Contradictions

answer

1. Are smokers and over the age of 35. 2. Have a history of thrombophlebitis and cardiovascular events. 3. Have a family history or risk factors for breast cancer. 4. Are experiencing abnormal vaginal bleeding. 5. Use cautiously in clients who have hypertension, diabetes mellitus, gall bladder disease, uterine leiomyoma, seizures, and migraine headaches

question

Left Sided Heart Failure

answer

Dyspnea, orthopnea (shortness of breath while lying down), nocturnal dyspnea Fatigue Displaced apical pulse (hypertrophy) S3 heart sound (gallop) Pulmonary congestion (dyspnea, cough, bibasilar crackles) Frothy sputum (can be blood-tinged) Altered mental status Manifestations of organ failure, such as oliguria (decrease in urine output

question

Right Sided Heart Failure

answer

Jugular vein distention Ascending dependent edema (legs, ankles, sacrum) Abdominal distention, ascites Fatigue, weakness Nausea and anorexia Polyuria at rest (nocturnal) Liver enlargement (hepatomegaly) and tenderness Weight gain Cardiomyopathy (leading to heart failure)

question

Compartment Syndrome

answer

1. Compartment syndrome (ACS) is assessed by using the five P's (pain, paralysis, paresthesia, pallor, and pulselessness). 2. Increased pain unrelieved with elevation or by pain medication. 3. Intense pain when passively moved. 4. Paresthesia or numbness, burning, and tingling are early signs. 5. Paralysis, motor weakness, or inability to move the extremity indicate major nerve damage and are late signs. 6. Color of tissue is pale (pallor), and nail beds are cyanotic. 7. Pulselessness is a late sign of compartment syndrome. 8. Palpated muscles are hard and swollen from edema. 9. If untreated, tissue necrosis can result. Neuromuscular damage occurs within 4 to 6 hr. Surgical treatment is a fasciotomy.

question

Vitamin to prevent neural defects

answer

Folate is a B-vitamin found in spinach and leafy green vegetables, dried beans, liver, and citrus fruits. In vitamin supplements and fortified foods such as breakfast cereal, it is usually found in the form "folic acid."

question

Disposing of insulin syringes at home

answer

Coffee container on a high shelf

question

Status Epilepticus Meds

answer

Lorazepam (Ativan) Drug of choice Diazepam (Valium) Phenytoin (Dilantin) (IV Slowly) Fosphenytoin (Cerebyx)

question

Brachytherapy (Radiation)

answer

Radiation source is within the client who emits radiation and is a hazard to those around for a period of time.

question

Varicella/ Chickenpox

answer

Direct contact and airborne precautions. 2-3 week incubation. Contagious until all lesions have scabbed. Pregnant women should not be in contact.

question

Amount of calcium needed daily

answer

1,000-1,200 mg a day. 600 mg at a time.

question

Refeeding Syndrome

answer

Potassium, magnesium, and phosphate move intracellularly during enteral nutrition, electrolyte disturbances can result. Patients who are severely malnourished are at high risk for refeeding syndrome and require careful management of fluid and electrolytes when tube-fed. For patients who are severely ill or malnourished, provide feedings at 50% of estimated requirements and increase gradually over 24 to 48 hours if careful monitoring does not suggest clinical or biochemical abnormalities. Circulatory collapse that occurs when a client's completely compromised cardiac system is overwhelmed by a replenished vascular system after normal fluid intake resumes.

question

Anorexia Abnormal Lab Values

answer

1. Hypokalemia 2. Serum Albumin less than 3.5 (malnutrition) 3. Anemia and leukopenia with lymphocytosis 4. Possible impaired liver function, shown by increased enzyme levels 5. Possible elevated cholesterol 6. Abnormal thyroid function tests. 7. Elevated carotene levels, which cause skin to appear yellow. 8. Decreased bone density 9. Abnormal blood glucose level 10. ECG changes

question

Cranial nerve XI (Spinal accessory)

answer

Function of the nerve: Motor - Turning head, shrugging shoulders System: Head and neck

question

Mother's Tests at 12 weeks

answer

Ultrasound chorionic villi sampling NT Down Syndrome

question

Amniocentesis

answer

Performed at 14-16 weeks assess fetal lung maturity and well being Rh-negative mothers get Rhogam Complications are bleeding, contractions, signs and symptoms of infection

question

peripherally inserted central catheter (PICC)

answer

catheter used for long-term intravenous access and inserted in the basilic or cephalic vein just above or below the antecubital space with the tip of the catheter resting in the superior vena cava Needs an informed consent

question

How to access a venous access port (port a cath)

answer

don a mask-use surgical asepsis- don sterile glove -prime access cap, extension tubing and non coring needle with pre filled NS syringe -cleanse the site with chlorahexadine for 30 seconds -immoblize the device with non dominant hand forming a U with index and thumb -insert non-coring, non-barbed (Huber) needle with dominant hand in a 90 degree angle Most facilities' policies allow access to the implanted port with the same needle for 7 days.

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Does Port need flushing?

answer

-open ended= require heparin flushing -valved= does not require heparin

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Vancomycin Precautions

answer

Causes: Ototoxicity and nephrotoxicity Monitor creatinine and BUN Peak and Trough Levels Therapeutic Range 20-40 mcg/dL Infusion reactions (rash, flushing, tachycardia, hypotension) Thrombophlebitis DON'T TAKE WITH LOOP DIURETICS (OTOTOXICITY)

question

Who Cannot Give Consent

answer

kids less than 18 intoxicated- blood alcohol level of .08 client with a dose of morphine

question

a nurse is caring for a client with a hx of agression, the client is playing cards and throws them at other patients- what should you do

answer

ask the client how he is feeling (therapeutic cmcn) not take the cards away (this will increase aggression) explaining unit rules will not help either

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Cocaine/Amphetamines

answer

Dilated pupils, tachycardia, elevated BP, impaired judgement, grandiosity, paranoia with delusions

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Opiates (Heroin, fentanyl)

answer

Constricted pupils, decreased respirations, decreased BP, initial euphoria followed by dysphoria

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Dialysis Teaching

answer

Pt needs to report: muscle cramps, headache, nausea, or dizziness (hypotension)

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Total Gastrectomy

answer

is total removal of the stomach; long term complication include dumping syndrome- undigested food rapidly enters the duodenum or jejunum usually 5-30 minutes after eating, epigastric pain with cramping, loud hyperactive bowel sounds- managed primarily with smaller and more frequent meals- no liquids with meals- increase in protein and fats- reduce carbs; Anemia may also be problem after gastric surgery due to decreased iron absorption; intrinsic factor is also lost so B12 cant be absorbed; folic acid deficiency, poor absorption of nutrients

question

Gastrectomy Medications Needed

answer

Vitamin B12 is absorbed in the stomach and must be supplemented with regular injections by patients who underwent a total gastrectomy. Absorption may be impaired in those who still have part of their stomach, so it is necessary to have B12 levels checked periodically. Supplementation with folate, iron, and calcium may also be necessary to correct deficiencies caused by the surgery.

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Purpose of Telemetry

answer

Detects the ability of cardiac cells to generate a spontaneous and repetitive electrical impulse through the heart muscle

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Gestational Hypertension

answer

20 weeks of pregnancy

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Seizure Precautions

answer

Rescue equipment at bedside Establish IV Site Position seizing pt to ground, stay with them Protect Head If in bed, pad side-rails Side lie with head flexed and slightly forward Loosen restrictive clothing Document time, behavior, aura, etc. Report seizure to the provider

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In Case of Fire

answer

Rescue Pull Alarm Aim Contain Squeeze Extinguish Sweep

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Bacterial Meningitis sign of ICP

answer

Nuchal Ridgidy, Kernig's Sign Sign of ICP: Memory Loss

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To Promote Wound Healing

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Protein and Vit A

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Digoxin Toxicity

answer

Diarrhea, Nausea and Muscle Weakness 0.8-2.0

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Theophyline Toxicity

answer

Hypotension, Albuminuria, Tachycardia and Anorexia 10-20

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Valporic Acid for Seizure Control

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Hepatotoxic, report jaundice

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Warfarin

answer

Do not take with acetaminophen report dark stools

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Signs of Peritonitis

answer

Rigid, Board Like Abdomen Absent Bowel Sounds Fever High WBCs

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Rheumatoid Arthritis

answer

Use cold to edematous joints

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Suctioning Airway

answer

Use surgical asepsis No more than three consecutive times When resistance is met, retract 1-2cm

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Dumping Syndrome

answer

No liquids or carbs!

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Right CVA

answer

Minimizes problems Short attention span Impaired judgement and time Impulsive

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Left CVA

answer

Impaired speech and comprehension Slow and depressed

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HGB

answer

12-18

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Hit

answer

37%-52%

question

gtt

answer

Volume/time * gtt = gtt 1 min 100ml/20min * 10gtt 50 gtt 1 min If given hours multiply by 60

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