question

when preparing for a client brought in with possible acetaminophen overdose which medication should the nurse prepare?

answer

acetylcysteine

question

dimercaptrol

answer

heavy metal antagonist; used as chelating agent along with calcium disodium edentate to promote lead excretion in urine and stool in cases of lead poisoning

question

methimazole

answer

an antithyroid agent used in hyperthyroidism to inhibit synthesis of thyroid hormone by thyroid gland; may be used in treating thyroid storm

question

acetyolcysteine

answer

the specific antidote for acute acetaminophen poisoning; given orally every 4hours for 18 doses; all doses must be given; protects liver by preventing formation of metabolites of acetaminophen that are toxic to the liver

question

calcium gluconate

answer

used IV in hypermagnesemia to antagonize the cardiac depressant effects of the magnesium

question

acetaminophen

answer

antipyretic, nonopioid analgesic, inhibits prostaglandins that serve as pain and fever mediators, works mainly in the central nervous system - may cause liver and kidney failure - avoid alchol when taking

question

acetaminophen overdose signs and symptoms

answer

n/v, pallor hypothermia, slow-weak pulse; liver and kidney function decreased

question

maximum acetaminophen in one day

answer

4 grams

question

client recently diagnosed with agranulocytosis - which signs and symptoms should you expect

answer

sore throat, fever and weak rapid pulse

question

agranulocytosis

answer

decreased to absent granulocytic white blood cells (basophils, eosinophils, neutrophils)

question

examples of diseases that require airborne recautions

answer

measles (rubeola), TB, varicella (chickenpox), disseminated zoster (shingles)

question

which food is most likely to cause an allergy in a 6 month old infant: cereals, vegetables, fruits, eggs

answer

eggs

question

when to introduce solid food for a baby

answer

4-6 months

question

allergy

answer

hyper sensitivity caused by exposure to an allergen; caused by IgE antibodies

question

allergic rhinitis

answer

allergic reaction to an allergen resulting in watery rhinorrhea, nasal obstruction, sneezing, nasal pruritus

question

allergic desensitization

answer

used to treat allergy when the client is unable to avoid allergy, serial injections of one or mroe antigens are administered, start with a very small amount and the amount is increased gradually - client at risk for anaphylactic reaction; medication should always be administered in a healthcare provider's office, have epinephrine available and instruct the client to remain in office at least 30 mins for observation

question

eczema

answer

itchy red skin rash commonly seen in young children; may ooze serum and form a crust; often associated with allergic reaction to allergen, chemical or medication; treatment is avoidant of allergen, application of astringent solution, corticosteroid cream or antihistamine ; keep from scratching

question

which foods are the most likely cause of eczema

answer

milk, wheat and egg whites

question

what physiologic process causes the signs and symptoms (urticaria, swelling of lips, etc) of an allergic reaction

answer

release of histamines - histamine is short acting chemical mediator released during the primary phase of type I hypersenitivity; released during degranulation of IgE sensitized mast cells, increased capillary perme

question

Risk factors that put you at risk for a latex allergy

answer

allergies to pollen, grass, banana, kiwi, mulitple surgeries, client with spina bifida

question

epinephrine administration for anaphylactic shock

answer

administer aquesous epinephrine 1:1,000

question

general signs and symptoms of anemia

answer

pallor, SOB, tachycardia, pallor of skin, increased RR ; depth, dizziness, cold intolerance

question

definition of anemia

answer

decrease in red cells or hemoglobing content or altered hemoglobin function

question

causes of anemia

answer

decreased red cell production, blood loss, increased destruction of red cells or inadequate intake or excessive loss or iron

question

aplastic anemia

answer

all formed elements of the blood depressed, diagnosis through bone marrow biopsy, treatment is bone marrow transplant

question

megaloblastic anemia

answer

decrease in red blood cells that cause hemoglobin level to be lower than normal; deficiency of folic acid and vitamin B12 cause this

question

pernicious anemia

answer

red cells that are large, have abnormally shaped nuclei, contain normal amounts of hemoglobin - caused by decreased intrinsic factor that causes decreased absorption of vitamin b12 in the gastric mucosa, chronic gastric inflammation, surgical removal of the stomach or bowel

question

intrinsic fator

answer

formed in the parietal cells and is required for absorption of vitamin B12

question

Schilling Test

answer

laboratory test used to diagnose pernicious anemia, which is caused by vitamin B12 deficiency; client fasts for 12 hours, then is given small dose of radioactive vitamin B12 in water to drink, followed by large nonradioactive dose IM; 24-hour urine specimen collected and measured for radioactivity; in pernicious anemia, ability to absorb vitamin B12 is reduced, so excretion of radioactive material in urine is reduced; normal is over 10% of dose exceted in 24 hours

question

good foods for iron deficiency anemia

answer

need a good source of iron as well as vitamin C to enhance the iron sources found in plants - liver and onions, spinach, rice pudding with raisins, chicken, dark meat, liver, oysters, egg yolks, carrots, apricots, raisins, leafy greans, flanks steak, green leafy vegetables, prunes ; tomatoes (vit c)

question

pernicious anemia treatment

answer

parenteral vitamin B12 - vit B12 cannot be absorbed in pernicious anemia due to the lack of an intrinsic factor therefore it must be given parenterally

question

food sources of vitamin B12

answer

red meats such as liver

question

why does ferrous gluconate need to be diluted and increase fluid intake when taking

answer

undiluted iron stains teeth and causes constipation - should always be taken after meals, through a straw, and diluted well to decrease Gi upset and staining of teeth

question

heparin

answer

anticoagulant; used for short term therapy, given IV or subQ; action: inactivbates thrombin and prevents conversion of fibrinogen to fibrin; dosage is adjusted according to partial thromboplatin time (PTT), therapeutic range is 1.5-2 times nromal value

question

antagonist of warfarin

answer

vitamin K

question

lab used to evaluate warfarin

answer

prothrombin time

question

diphenhydramine hydrochloride

answer

antihistamine; blocks the effects of histmaine on bronchioles, GI tract and blood vessels, thereby preventing or decreasing symptoms of allergic response

question

nursing responsibilities for administering blood

answer

two RNs must check the health care providers order, blood expiration date, identify client, check for allergies, check for previous blood reactions, use 19 gauge needle and standard blood filter, starting infusion slowly during first 15 min (no faster than 5 mL/min for the first 15 min) and staying with client, take VS before/after 15 mins/ and every hour or per protocol, infuse over 2-4 hours

question

transfusion reaction

answer

immunogenic or nonimmunogenic response to blood produces; may cause reactions in all major body systems; symptoms and specific treatments vary according to causes; general standard procedures include stop the blood, restart the saline, notify provider, provide supportive care

question

signs of allergic reaction to blood products

answer

hypersensitivity to donor antibodies; urticaria, pruritus, fever, anaphylactic shock

question

hemolytic reaction to blood

answer

incompatibility; nausea, vomiting, pain in lower back, hypotension, hematuria

question

febrile reaction to blood products

answer

antibodies to donor platelets or leukocytez; fever, chills, nausea, headache, flushing, tachycardia

question

bacterial reaction to blood products

answer

contaminated blood products; tachycardia, hypotension, fever, chills, shock

question

circulatory overload due to blood administration

answer

cough, dyspnea, pulmonary congestion, tachycardia, HA, sudden anxiety hypertension, distended neck veins

question

when do transfusion reactions usually occur

answer

within first 50 mL of transfusion, which is usually within the first 15 minutes so nurse should remain with client during that time

question

fresh frozen plasma

answer

plasma volume exdpander, uncoagulated plasma separated from RBCs, high in coagulation factors V, VIII, and IX; action: increase plasma volume; use: treat post surgical hemorrhage and shock, replace a specfici factor when that factor is not available individually for infusion

question

platelet transfusion

answer

transfusion of only the platelet component of the blood; used when blood clotting is problematic

question

packed red blood cells

answer

red blood cells that have ben separated from the plasma; used for blood replacement when red blood cells are needed but not the fluid (plasma); transfused like other blood prodcuts

question

celecoxib

answer

a NSAID used for arthritis, dysmenorrhea, and acute pain; avoid using if client is allergic to aspirin due to possible cross hypersensitigiy; first ass the client's statement of having an allergy; inhibits prostaglandin synthesis and producest anti inflammatory, analgesic, and antipyretic effects - use cautiously in patients with significant liver impairment and avoid in the third trimester of pregnancy

question

what does someone with a penicillin allergy have a crossallergy with

answer

cephalosporins

question

cephalosporin

answer

group of antibiotics; used for bacterial infection; action: binds to bacterial wall membrane leading to death - monitor kidney and hepatic function

question

oatmeal baths

answer

colloidal oatmeal baths are applied to red, irritated and oozing skin to relieve itching and soothe the skin; rash can cause severe, intense itching with tingling, burning sensations

question

dermatitis

answer

inflammatory rash with itching and redness; causes: exposure to an allergen, irritant, venous stasis, habitual scratching, dry skin, photosensitivity; treatment: find and avoid causative agent, upon exposure to causative agent was well with soap and water to remove, topical corticosteroid ointment or cream, systemic corticosteroids, antistamins, topical immunomodulators

question

Disseminated Intravascular Coagulation

answer

sever life-threatening disorder of the coagulation system in the body, with overstimulation of the system being the issue; it begins as extensive clotting throughout the small blood vessels of the body, which provokes an excessive outpouring of fibrinolytic activity to lyse the clots; clotting factors are then so consumed that generalized hemorrhage occurs; both the clotting and the fibrinolysis can occur simultaneously; the initial clotting may be provoked by a wide variety of conditions, most often sepsis or infection, but also others such as tissue damage, neoplasms, snakebites, extensive surgery, severe trauma; treatment consist of correcting the precipitating cause, replacing clotting factors and platelets, and controlling the manifestations of both the thrombosis and the hemorrhage

question

signs and symptoms of DIC

answer

bleeding from surgical or invasive procedures, bleeding fums, petechiae, ecchymoses, epistaxis, tachycardia, hypotension

question

nursing considerations for DIC

answer

assess for bleeding, assess for indications of shock, monitor prothrombin time (PT), partial thromboplastin time (PTT), platelet count, fibrinogen levels, clotting times, avoid injections if possible, apply pressure to bleeding sites, administer blood components

question

romiplostin

answer

a thrombopoietin receptor agonist; it is used with clients being treated for immune thrombocytopenia (ITP)

question

DIC and its relationship to oxygen

answer

microclots in the pulmonary vasculature of clients with DIC are likely to interfere with normal gas exchange; initially, clients may hyperventilate to overcome deficiencies; as the disorder persists, hyperventilation is no longer sufficient to meet the client's oxygen demands; oxygen is given to decrease cardiac and pulmonary workloads, thereby relieving dyspnea; dosage varies individually; heparin therapy may also be ordered, but its use remains controversial

question

busulfan

answer

antineoplastic, alkylating agent most commonly used in the treatment of chronic myelogenous leukemia for clients who are no longer responsive to radiation therapy or to previously tried antineoplastics

question

Infection Precautions: Droplet

answer

used with pathogens transmitted by infectious droplets, involves contact of conjunctiva or mucous membranes of nose or mouth; happens during coughing, sneezing, talking, etc. - patient needs private room or mate with same disease, door may remain open, remain three feet away from visitors, place mask on client when being transferred, proper PPE (mask, shield, gloves, gown)

question

gastrectomy

answer

surgical excision of all or (more commonly) part of the stomach for treatment of an ulcer or removal of a malignancy; after partial excision, remainder of stomach is joined to duodenum or jejunum; after total removal of stomach, esophagus is joined to jejunum

question

prevention measures for dumping syndromes

answer

restrict fluids with meals, lie down after eating, eat smaller more frequent meals, maintain a diet low in carbohydrates and fiber and high in protein and fat

question

Primary Presenting Symptoms of Acute Glomerulonephritis

answer

microscopic or macroscopic (gross) heamturia - red blood cells and protein plugs or casts resulting from glomerular damage cause the urine to be cola-colored; blood in the urine is a critical feature of acute glomerulonephritis

question

Glomerulonephritis

answer

damage to glomeruli caused by an immunologic reaction that results in proliferative and inflammatory changes within the glomerular structure; caused by beta-hemolytic streptococcal infection elsewhere in the body, occurs 10 days after skin or throat infection; indications include fever, chills, hematuria, red cell casts, proteinuria, weakness, pallor, dyspnea, weight gain, lung rales, fluid overload, generalized and/or facial and perioorbital edema, moderate to severe hypertension, oliguria with fixed specific gravity

question

what does hematocrit measure?

answer

ratio of red blood cells to fluid volume

question

what does hemoglobin measure

answer

the oxygen carrying capacity of the blood

question

hemophilia

answer

hereditary bleeding disorder caused by deficiency of a clotting factor;

question

what should the nurse assess a schoole aged child diagnosed with heomophilia for

answer

the child's ability to perform range of motion activity - as the child moves the joints, the range of motion will be limited by pain from hemorrhage within the joint cavaties; this is usually see in the knees, elbows, and ankles; passive range of motion risks injuring the joint with forced movement

question

hemophilia A

answer

deficiency of clotting factor VIII; most common

question

hemophilia signs

answer

prolonged internal or external bleeding, easy bruising, joint pain with bleeding, pallor

question

nursing responsibilities for hemophilia

answer

avoid IM injections, administer analgesics for joint pain, administer factor replacement therapy as ordered, instruct in active range of motion after bleeding episodes, teachy to avoid contact sports, engage in swimming or golf

question

how is the hemophilia trait carried

answer

it is an X-linked recessive trait found primarily in males - rarely shows in females, since their second sex chromosome is also an X

question

antagonist to heparin

answer

protamine sulfate

question

Human Immunodeficiency Virus

answer

virus that causes immunodeficiency that can lead to acquired immunodefiency symdrome (AIDs); transmitted via blood and body fluids

question

signs and symptoms of HIV

answer

early stages of infection - asymptomatic, later as immune system deteriorate - opportunist infections

question

medical treatment for HIV

answer

antiretroviral medications, organism-specific medications, chemotherapy, antidepressants, nutritional support

question

Acquired Immune Deficiency Syndrome

answer

Syndrom distinguished by serious deficits in cellular immune function; causes opportunistic infections such as pneumocystitis jiroveci pneumonia, candida albicans stomatitis and esophagitis, cytomegalovirus, Kaposi's sarcoma, etc.

question

indications of AIDS

answer

include gradually worsening chest tightness, SOB, persistent, dry, nonproductive cough, dyspnea, tachypnea, fever, progressiv hypoxemia, cyanosis

question

nursing care for AIDS

answer

high protein, high calorie diet, monitor VS, chest sounds, suction and maintain oxygen, monitor for oral infections

question

what lab cells are associated with AIDS

answer

decreased T cell or CD4 cell count

question

AIDS and Laundry

answer

keep laundry in a plastic bag

question

western blot test

answer

looks at certain proteins - detects the HIV virus

question

what syndrome does AIDS put you more at risk for

answer

Kaposi Sarcoma - vascular malignancy associated with depressed immune status; possible etiology herpes virus; involves skin surface, especially face and thorax; similar appearance to ecchymosis or purpura

question

function of the spleen

answer

nonimmunologic ; immunologic functions; considered part of the lymphatic system and has functions of immunologic defense, such as routinely cleansing the blood of microorganisms by macrophages and producing leukocyte, monocytes and lymphocytes which respond to blood-borne antigens; removal of the spleen or diminished function from infection or injury greatly increases the risk for bacterial infections

question

thymus function

answer

the thymus is an endoccrine organ responsible for development of T lymphocytes, which when mature are called T-cells that have cytotoxic properties and can destroy "target" cells; T-helper cells and T-suppressor cells also exist

question

liver function

answer

primarily involved with hematopoiesis; it does have routine blood-cleansing functions as well, but not particular to mounting an immunologic defense

question

28

answer

review for children vaccines

question

MMR vaccine

answer

measles, mumps, rubella

question

adverse effect of the MMR vaccine

answer

arthritis - others include rash and fever

question

incubation period

answer

the time between when a person gets infected and when actual symptoms appear

question

lymphadenopathy

answer

an enlargement of lymph nodes in the body to the point where they are palpable; the nodes function as a filter of foreign materialo such as bacteria and also aid in the circulation of lymphocytes sucha s T-cells; these lymphocytes fight infection and increase in number when infection is present

question

grams to kilograms

answer

1,000 g = 1 kg

question

pounds to kilograms

answer

2.2 pounds = 1 kilogram

question

microgram to milligram

answer

1,000 mcg = 1 mg

question

Bell's Palsy

answer

facial paralysis, usually 3-5 weeks in length, involving the 7th cranial nerve (facial); cause is unkown but viruses and inflammatory diseases can predispose to it; symptoms include distortion of one side of the face, inability to close the eye, lacrimation; treatment includes comfort measures, facial muscle exercises, prevention of corneal abrasion

question

multiple sclerosis

answer

progressive disorder of nerve impulse transmission characterized by demyelination of white matter throughout brain and spinal cord; periods of exacerbation and remission; intellect intact; leads to paraplegia or complete paralysis; indications include paresthesias or abnormal sensations in extremities, vision changes, incoordination, bowel and bladder dysfunction, spascticity, intention tremors, chewing and swallowing difficulties, impaired speech, emotional instability, sexual dysfunction

question

atorvastatin

answer

antihyperlipidemic, HMG-CoA inhibitor, used to lower serum cholesterol low density lipoproteins and increase serum high density lipoproteins and to lower triglyceride levels; adverse effects: headache, abdominal pain, rash, myalgia, rhabdomyolysis; nursing considerations: monitor for muscle pain, tenderness, or weakness; advise client to take medication at same time each day; monitor liver function tests

question

neutropenic precautions

answer

used for clients at increased risk for incetions, such as immunosuppressed with neutrophil count uner 500 mm; private room scrupulously cleaned; meticulous handwashing and use of personal protective equipment by all; restriction of visitors; no fresh fruit or vegetables; avoid invasive procedures, such as catheterization, unless essential

question

sickle cell disease

answer

hereditary severe chronic condition in which abnormal hemoglobin distorts erythrocytes, increases their fragility, and causes them to become sickled in shape and rigid; anemia occurs; periods of exacerbation called vasoocclusive crises occur; indications are systemic and include anemia, possible groth retardation and delayed sexual maturity, pain (often in the joints), swelling, jaundice, priapism, impaired kidney function, cardiac murmurs, altered pulmonary function, increased susceptibility to infection

question

interventions for sickle cell disease

answer

rest, oxygen IV fluids and electrolytes, sedation, analgesia, possible transfusion

question

thrombocytopenia

answer

platelet count below 20,000 mm - excessive destructions of polatelets

question

atelectasis

answer

collapsed or airless lung condition; indications icnlude dyspnea, cyanosis, cough, tachycardia, pleuritic chest pain

question

flail chest

answer

abnormality of the chest wall occurring when two or mroe ribs fracture which creates a segment of rib that is not attached or on either end; these fractures cause chest wall to become unstable and respond paradoxically; flail area moves in with inspiraiton and out with expiration; immediate respiratory failure may result and mechanical bentilation may be required with the use of high inspiratory pressures

question

pleurisy

answer

inflammation of the pleura

question

pneumothorax

answer

lung collapse caused by accumulation of air or fluid in the pleural cavity; indications include pleuritic pain, tachypnea, diminieshed breath sounds; treatment includes chest tubes

question

what to avoid with thrombocytopenia

answer

soft toothbrush, avoid contact sports, dental floss, ASA, NSAIDs, feverfew, ginger, ginkgo, garlic, kava, and corticosteroids

question

prednisone

answer

short acting synthetic steroid; action: suppress severe inflammation or immune response, decrease release of inflammatory mediators (leukotrienes, histamine, prostaglandins), decrease infiltration of inflammatory cells (eosinophils, leukocytes), decrease edema and hyperactivity of airways and mucous production

question

adverse effects of prednisone

answer

hyperglycemia, peptic ulcers, muscle wasting, fluid retention, hypokalemia, moon face, depression euphoria, ostoporosis, thromboemboism, weight gain, increased risk of infection, fluid and electrolyte disturbances, buffalo hump, increased intracranial pressure, anorexia, nausea, acne, delayed wound heaing, vomiting, psychoses, restlessness, joint avascular necrosis, etc.

question

prednisone and stress

answer

may require a higher dose of prednisone

question

lyme disease

answer

inflammatory disorder caused by a spirochete, spread by tick bites; symptoms include flat, slightly raised red lesion, fever, fatigue, chills, muscle pain, progresses to joint pain, persisten fatigue, headache, and stiff neck; treatment/nursing considerations include antibiotic therapy, instructing that medication may be required up to 1 month, NSAIDs to treat arthritic symptoms, teaching importance of maintaining consistent schedule of NSAIDs, teach about transmission and prevention

question

acyclovir

answer

antiviral used to treat recurrent genital herpes, localized cutaneous herpes zoster, and varicella

question

zidovudine

answer

antiretroviral used to treat HIV inection; adverse effects include anemia, HA, anorexia, diarrhea, nausea, Gi pain, paresthesia, dizzines, insomnia, agranulocytosis, insomnia

question

what can cause a sickle cell disease crisis

answer

decreased oxygenation - ex: upper respiratory infection

question

clindamycin

answer

anti-infective; action: inhibits protein synthesis at the 50S ribosom; use: treatment of susceptible organisms; AE: superinfection, GI upset, allergic reaction, etx.

question

azathiprine

answer

used to suppress immune function

question

signs and symptoms of rubeola

answer

rash, runny nose, sneezing and coughing, kpoliks spots on buccal mucosa

question

rubeola - measles

answer

communical viral disease of childhood, transmitted by direct contact

question

pruritus

answer

severe intesne itching

question

psoriasis

answer

chronic, noninfectious inflammatory disase of the skin; indications include chronic recurent thick, itchy, erythematous papules/ plaques covered with silvery white sclaes with symmetrical distribution, commonly found on scalp knees, sacrum, elbows, and behind ears

question

polycythemia vera

answer

excess in red blood cells; can be secondary to conditions that stimulate erythopoiesis, such as decreased oxygen tension in blood; treatment is to remove enough blood to deplete iron stores, avoid foods and multivitamins containing iron

question

phenazopyridine

answer

urinary tract analgesic; action: analgesic/anesthetic effect of urinary tract mucosa; use: pain and/or burning and/or frequency and/or urgency caused by irritation or infection of urinary tract mucosa; AE: HA, vertigo, nausea, hepatotoxiciy, CKD, rash, brigh reddish orange urine

question

aspirin and kids

answer

can cause reye's syndrome

question

systemic lupus erythematosis

answer

chronic systemic inflammatory autoimmune collagen vascular disease of mulitple body systems; indications include arthritis (synovitis), joint swelling, tendernes, and pain on movement, butterfly rash across bridge of nose and cheeks, polymyositis, oral ulcers, pericarditis, pleural effusion, etc.

question

sickle cells disease and genetics

answer

it is an autosomal recessive disorder

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