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NCLEX > ATI > Flashcards

ATI Flashcards

1
Q

Osteoporosis

A
  • Encourage weight-bearing exercises, including BRISK WALKING to prevent bone loss.
  • Cottage cheese is NOT a good source of calcium d/t PROCESSING
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2
Q

Infant development (8, 12, 13 months)

A

8 months: sit up unsupported
12 months: anterior fontanel closes
13 months: walk independently

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3
Q

Disseminated Intravascular Coagulation (DIC) expected findings

A

☑ bleeding at venipuncture site
☑ petechiae on chest & arms
☑ abdominal distension

RATIONALE: the formation of large amounts of microemboli in circulation depletes the body’s platelets and clotting factors, ∴ leading to uncontrollable bleeding at venipuncture site, petechiae, and abdominal cavity

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4
Q

Iron-rich foods

A

meat, fish, poultry, including BEEF LIVER

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5
Q

Anemia (aplastic, pernicious, sickle cell) manifestations

A
  1. Aplastic: decreased RBCs, WBCs, & platelets
    Manifestations: petechiae & ecchymosis
  2. Pernicious: body can’t ABSORB vitamin B12 d/t weak stomach lining or autoimmune condition.
    Manifestations: glossitis (smooth, beefy-red tongue) & weight loss (bc glossitis)
  3. Sickle Cell Anemia manifestations: Jaundice & enlarged liver & spleen
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6
Q

72 hr postop above the knee amputation (nursing actions)

A

☑ wrap residual limb w/ bandage 3x/day
☑ assist into prone position for 20-30 minQ 3-4 hrs to decrease r/f flexion contractures
☑ don’t elevate residual limb for 72 hrs after bc can lead to flexion contractures

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7
Q

impetigo contagiosa pnt education

A

☑ apply topical antibacterial ointment
☑ wash bed linens daily w/ HOT water
☑ wash hands before and after contact w/ area

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8
Q

ACTIVE labor pain relief (nonpharmacological)

A
  • assisting client into a warm shower stimulates release of endorphins
  • music is a distraction and relaxation in EARLY labor, NOT active
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9
Q

Leadership style for CPR situation

A

AUTOCRATIC!

RATIONALE: We need direct commands and someone to organize/take charge for CPR. Participative leadership AKA democratic is NOT good because that leader is a resource and facilitator and non-directive

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10
Q

Stomatitis (nursing actions)

A

What is it: swelling and sores inside mouth

DO: use a soft toothbrush, remove dentures except eating, rinse mouth w/ HYDROGEN PEROXIDE, warm saline, or baking soda Q2-3 hrs

DON’T: use lemon & glycerin swabs after meals bc they cause drying and irritation

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11
Q

Chronic kidney disease diet limitations

A

☑ limit fluid intake (to prevent hypervolemia)
☑ limit protein intake (to prevent build-up and uremia)
☑ increase calories (so body can use protein for protein synthesis instead of energy consumption)

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12
Q

Cycloplegia expected finding after administering atropine

A

expected finding: BLURRED VISION after administration of atropine d/t paralysis of ciliary muscle preventing near-vision focus

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13
Q

Cocaine intoxication expected findings

A

☑ dilated pupils
☑ increased BP
☑ increased temp

RATIONALE: stimulant! fight-or-flight!

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14
Q

late-stage CKD nutrients to increase

A

increase calcium because can develop hypocalcemia d/t decreased production of active vitamin D (Needed for calcium absorption)

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15
Q

Superior vena cava syndrome

A

What is it: Medical emergency! Partial occlusion of the superior vena cava → decreased blood flow through the vein

Earliest manifestation: FACIAL and UPPER EXTREMITY EDEMA

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16
Q

When to change tubing for TPN?

A

change IV tubing for TPN Q24 hrs

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17
Q

Brachytherapy

A
  • What is it: radioactive infusions or insertions into or near the tumor
  • put on bedrest while radioactive implant is in place to prevent dislodgment
  • there are no restrictions regarding contact with others
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18
Q

Newborn Vital Signs

A

RR: 30-60
HR: 110-160
BP: 60-80/40-50
T: 97.7-99.5

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19
Q

What to do when a client with an NG tube has nausea

A

FIRST: irrigate tube to determine patency. If tube isn’t patent, gastric pressure can’t decrease and increased pressure causes nausea!

DON’T clamp tube because that will worsen the nausea

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20
Q

Tension-building phase of cycle of violence

A

episodes of violence are often minor, and recipient might rationalize the episodes by taking blame

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21
Q

Car seat safety

A

☑ REAR-FACING until 2 Y/O

☑ place shoulder harness in the slows at level or slightly below the newborn’s shoulders

☑ place retainer clip at level of ARMPITS, NOT ABDOMEN

☑ position at 45 degree angle to prevent slumping and decrease r/f airway obstructions d/t weak neck muscles

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22
Q

Hydrotherapy

A
  • used for wound debrisment
  • client on a shower table, constant warm water, decreases f/t infection
  • use soft wash cloths or gauze to debride wounds
  • leave small blisters, cut open the large ones
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23
Q

nephrotic syndrome nursing care

A

provide skin care d/t edema and r/f infection

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24
Q

Transient Ischemia Attack (TIA)

A

What is it: a temporary disturbance in blood supply to the brain d/t atherosclerotic plaque in the carotid arteries and HTN ∴ limit sodium to control HTN and prevent future TIAs

When discharged, teach to monitor BP!

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25
Q

Hypoglycemia manifestations

A

diaphoresis, palpitations, shakiness

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26
Q

Pregnancy weight gain for BMI > 30

A

Limit weight gain to 11-20 lbs during pregnancy

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27
Q

Playing Development (Infants, Toddlers, Preschool, School-age)

A

Infants: solitary play
Toddlers: parallel play
Preschool: associative play
School-age: cooperative play

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28
Q

What vaccines to postpone with Kawasaki Disease (KD) if they are being treated with IV immune globulin

A
  • IV immune globulin treatment for KD has antibodies that can interfere w/ action of live-virus vaccines like measles, mumps, and rubella (MMR)
  • postpone MMR for 3-6 months!
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29
Q

PCA Pump

A
  • allows dosing Q6-8 min

- can use TENS while using PCA pump

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30
Q

Alternative restrains for confused and wandering clients

A

Use a rocking chair to expend some energy through rocking instead of wandering

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31
Q

What nutrient promotes wound healing?

A

Vitamin C!

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32
Q

Religious practices (Judaism/Jewish, Islamic, Hindu, Buddhist) for the dead

A

★ Jewish (Judaism): stay with body until burial

★ Islamic: body is washed and wrapped during ritual and buried ASAP following death

★ Hindu: place body w/ head facing North following death. CREMATION, not burial

★ Buddhist: male members prepare body

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33
Q

Cushing’s Syndrome

A

What is it: Over-secretion of glucocorticoids leading to muscle atrophy

Check for: urine specific gravity to assess for fluid volume overload and hyperglycemia because increase cortisol increases blood sugar

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34
Q

What to feed an infant with after surgical repair of cleft palate

A

After surgical repair, feed infant with a cup to prevent injury to suture line

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35
Q

Closed chest drainage system: when bubbling in water chamber stops

A
  • bubbling in water seal chamber STOPS when lung RE-EXPANDS

- Tidaling in water seal chamber is d/t INHALATION and EXHALATION

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36
Q

steps for gastric hemorrhage and going into shock

A
  1. ) ADMINISTER O2 via NONREBREATHER
  2. ) INITIATE IV therapy w/ large bore catheter to support circulation by expanding intravascular fluid volume
  3. ) INSERT NG tube to monitor rate of bleeding and prevent gastric dilation
  4. ) ADMINISTER RANITIDINE when no longer bleeding to prevent a stress ulcer
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37
Q

Zenker’s Diverticulum

A

What is it: AKA pharyngeal pouch, is herniation of the esophagus occurring through the cricopharyngeal muscle in the midline of the NECK

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38
Q

Autonomic Dysreflexia (AD)

A

What is it: an exaggerated response to stimuli in clients who have high level spinal injuries

If untreated: can lead to stroke, organ damage, or death

Manifestations: bradycardia, severe HA, flushing, and nasal congestion

Hallmark sign: sudden increase in BP

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39
Q

Granulating wound dressing

A

☑ hydrocolloid and transparent film dressing
☑ use 30mL - 60 mL syringe when irrigating

DON’T apply wet-to-dry dressing because can interrupt healing tissues when removed

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40
Q

Cushing’s Triad

A

What is it: bradycardia, severe HTN, widened pulse pressure

How: TBI ⇨ increased ICP ⇨ Cushing’s Triad

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41
Q

Kidney Transplant

A
  • lifelong immunosuppressive therapy for organ RECIPIENT

- HEMODIALYSIS needed after getting kidney from a DEAD DONOR

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42
Q

First thing to do in ER, client c/o chest pain 8/10

A

FIRST: administer morphine

RATIONALE: greatest risk is myocardial ischemia, ∴ use morphine to increased O2 supply and decreased O2 demand of the heart

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43
Q

PRIORITY ACTION after 1 hour after cardiac cath and there is a hematoma at insertion site and decreased pulse in affected extremity

A

apply firm pressure to insertion site to STOP BLEEDING

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44
Q

Diabetes and acute bronchitis

A

“take insulin even if you are unable to eat your regular diet”

Take insulin even when sick to PREVENT HYPERGLYCEMIA

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45
Q

Nonrebreather mask

A

highest concentration of O2 (80% - 95%), but client has to breathe unassisted. Give if pulse ox is low low

use ambubag for assisted breathing during CPR

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46
Q

Cirrhosis (bilirubin and albumin)

A

expect increased bilirubin and decreased albumin because albumin is formed in the liver

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47
Q

Gout pnt education

A
  • decrease intake of PURINE MEATS (organ meats and shellfish) to prevent precipitating an attack that causes pain and inflammation in joints
  • what to take for ACUTE ATTACK: take COLCHICINE, INDOMETHACIN, or corticosteroid
  • ALLOPURINOL: decreases uric acid after initial manifestations of acute attack have resolved
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48
Q

Specimen collection on wound

A
  • swab back and forth over clean areas in the BASE of the wound, NOT EDGES
  • cleanse wound w/ 0.9% sodium chloride irrigation to remove surface debris or old exudate
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49
Q

What to do before feeding a pnt w/ a gastrostomy tube

A
  • flushing w/ WATER, not 0.9% sodium chloride

- elevate HOB

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50
Q

What to avoid when using a fentanyl transdermal patch

A

Avoid using a heating pad on the area with the patch because heat will increase rate of absorption and lead to respiratory depression

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51
Q

Injury to the brain (cerebellum, hypothalamus, cerebral cortex)

A

difficulty w/ muscle coordination ⇨ CEREBELLUM

difficulty w/ sleeping ⇨ HYPOTHALAMUS

difficulty w/ expression ⇨ cerebral cortex

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52
Q

How to avoid insomnia

A

avoid watching TV in bed. Use bed only for sleeping and sex!

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53
Q

Labor & bladder distention

A

in bladder distention, bladder FLUCTUATES like a balloon filled with water; suprapubic, round, bulging

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54
Q

Breathing patterns (Cheyne-Stokes, Kussmaul, Orthopnea, Paradoxical)

A

Cheyne-stokes ⇨ deep to shallow breaths followed by periods of apnea

Kussmaul ⇨ deep, rapid hyperventilation

Orthopnea ⇨ SOB in supine position

Paradoxical ⇨ (flail chest) chest wall contracts during inspiration and expands during expiration

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55
Q

Addison’s Disease diet

A

Requires diet w/ low potassium and high sodium, carbs and protein!

Good = turkey and cheese sandwich

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56
Q

Erikson’s Development (early childhood, adolescence, young adulthood, older adults)

A

Early adulthood ⇨ Initiative vs. guilt

Adolescence ⇨ identity vs. role confusion

Young adulthood ⇨ intimacy vs. isolation

Older adults ⇨ integrity vs despair

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57
Q

TB Test

A
  • Mantoux test determines if the client had an exposure to TB
  • X-ray or sputum test confirms if the client has active TB
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58
Q

Hormonal Therapy (TH) with estrogen and progestin

A
  • estrogen + progestin can be prescribed for menopause
  • short-term HT can assist with managing manifestations like urogenital atrophy
  • progestin can protect against estrogen-induced cancer of the uterus, but estrogen INCREASES r/f estrogen-induced BREAST CANCER
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59
Q

Thought-stopping

A
  • non pharmacological chronic pain management
  • repeat memorized facts about the painful event such as “the pain will be gone soon” or “I’ll be home by this time tomorrow”
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60
Q

Healing by secondary intention

A

Meaning: wound will be left open (instead of stitched up) to heal by itself and closing naturally

REPORT TO PROVIDER: halo or ring of erythema on surrounding skin, indicating underlying infection

  • Pink, shiny tissue w/ a grainy appearance = granulation tissues and indicates WOUND HEALING!
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61
Q

Moro Reflex

A

The legs move in a similar pattern of response to the arms. If the arms move up, the legs move up too!

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62
Q

Therapeutic response to a client who is concerned about how her partner will react to mastectomy

A

Right: “Would you like me to have a member of a breast cancer support group visit you? This is advocating!

Wrong: “This is a common concern…” This is a stereotypical remark and isn’t empowering or therapeutic

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63
Q

Manifestation of HTN

A

Epistaxis, HA, dizziness, facial flushing, fainting,

NOT exophthalmos, which is caused by hyperthyroid NOT HTN

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64
Q

Postpartum Diuresis

A

Weight loss of 5 lb from excess urination and perspiration of the remaining pregnancy-induced increase in blood volume after 12 hrs post partum

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65
Q

Toxoplasmosis

A

“Avoid gardening during pregnancy” because toxoplasmosis is a teratogenic infection to the fetus

Transmitted via contact with CAT FECES, which can be found in gardens, and via contact with UNCOOKED MEAT

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66
Q

Preventing dumping syndrome

A
  • Eliminate simple sugars (sugar, honey) and sugar alcohols (sorbitol, xylitol) from diet because they propel food through intestines faster
  • Drink BETWEEN, NOT WITH, meals about 1 hour after eating
  • Eat several smaller meals that have 1-2 foods, instead of less meals with much more food
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67
Q

Monitoring FHR during Labor

A

♡ 1st stage of Labor: monitor Q15 min

♡ 2nd stage of Labor: monitor Q5 min

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68
Q

Positive and Negative symptoms (schizophrenia)

A

Negative: absence of something that should be present (social discomfort)

Positive: impairments in memory, dysphoria, depression, hopelessness

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69
Q

Displacement defense mechanism

A

What is it: redirecting thoughts, feelings, and impulses from an object that causes to anxiety to a safer, more acceptable one

Example: Client redirecting anxiety about cancer diagnosis to the staff members who are providing care “This staff has been terrible and they haven’t been taking care of me!”

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70
Q

Burn patient care plan

A
  • initiate ROM exercises to maintain mobility and prevent contractures
  • ambulate frequently to promote mobility and improve ventilation
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71
Q

Conservative (noninvasive) Treatment for DVT

A
  • body goes through fibrinolysis that eventually dissolves the clot
  • heparin (anticoag.) PREVENTS future clot formation, NOT DISSOLVES the clot
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72
Q

purpose for gastric lavage

A

therapy for upper GI bleeding

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73
Q

MRI pnt education

A
  • client can have a mild sedative to help w/ clausterphobia and anxiety
  • have to lie still for 45-60 min
  • there is no radiation
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74
Q

Manifestations of…
Protein-calorie malnourishment
Vitamin C deficiency
Iron deficienacy

A

Protein-calorie: dry, brittle hair, edema (when albumin levels are low), and poor wound healing

Vitamin C: gingivitis

Iron: Spoon-shaped nails

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75
Q

interventions for manifestations of acute tubular necrosis (ATN) following a kidney transplant

A

☑ hemodialysis
☑ biopsy
☑ immunosuppression (essential after kidney tranplant!)

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76
Q

Play with a 4 month old infant (tactile, kinetic, auditory, visual,)

A

tactile: splashing in bath tub
kinetic: gentle bouncing on parent’s lap
auditory: rattle
visual: put a toy in hand

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77
Q

Play with a 9-12 month old (kinetic, auditory, visual)

A

kinetic: pull-push toy
auditory: making animal sounds
visual: board book with large pictures

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78
Q

Airborne Precaution (AirS MTV)

A

AirS: shingles (herpes zoster)
M: Measles (rubella)
T: TB
V: Varicella (chicken pox uncrusted lesions = contact)

PPE: N95, gloves, gown, goggles
Isolation: negative pressure room

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79
Q

Contact Precaution (DORMS)

A

D: Diarrheal → c. diff, e. coli, rotavirus
O: Other → conjunctivitis, salmonella
R: Respiratory → RSV, adenovirus, parainfluenza
M: Multidrug Resistant → MRSA, VRF
S: Skin wound → scabes, lice, herpes, varicella (uncrusted chicken pox), shingles

PPE: gown, gloves, private room

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80
Q

Droplet Precaution (SPIDERMAN)

A 
S: Sepsis - streptococcal pharyngitis
P: Pneumonia/ pertussis
I: Influenza
D: Diphtheria
E: Epiglotitis
R: Rubella

M: Mumps/ meningitis, meningeal pneumonia
A: Adenovirus
N: Neisseria meningitis

PPE: mask, gloves, gown, goggles, private room

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81
Q

What med can be administered with Lithium?

A

Valproic acid because it also treats bipolar disorder.

NOT

  • ibuprofen (↑ kidney absorption of Lithium)
  • haloperidol (↑ r/f extrapyramidal ADRs and tardive dyskinesia)
  • hydrochlorothiazide (promotes sodium loss → lithium toxicity)
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82
Q

Infant reflexes end date (stepping, moro, extrusion, babinski)

A

4 weeks: stepping
3 months: moro
4 months: extrusion
1 year: babinski

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83
Q

Rh(D) immune globulin

A
  • administer to client who is pregnant and is Rh-negative at 28 weeks gestation
  • administer if pregnant client has Rh-negative blood to prevent maternal antibody production due to having a Rh-positive newborn
  • administer following a mismatched blood transfusion
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84
Q

Triage during mass casualty event: head injury with fixed dilated pupils

A

BLACK TAG

Nonreactive dilated pupils = poor prognostic sign and indicates severely increased ICP

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85
Q

Dinoprostone vaginal insert pouch

A

What is it: Put in vagina and gives off prostaglandin which body makes to start labor

Pnt edu: lie on back for at least 2 hours without getting up

86
Q

Arthroscopy

A

What is it: helps with diagnosing musculoskeletal disorders like rheumatoid arthritis, osteoarthritis, and internal joint injuries

After: keep leg elevated 12-24 hr to decrease pain and swelling. Have short-term activity restrictions

87
Q

Adjustment Disorder

A

What is it: Response to a stressful death, treated with antidepressant meds

Manifestations: guilt, depression, anxiety, anger, social withdrawal

Example: “I could have done something to prevent his death”

88
Q

Ventricular Septal Defect (VSD)

A

What is it: a hole in the septal wall between the ventricles. When the oxygenated blood goes to the left ventricle to be pumped out the aorta, some exits thought the septal hole and mixes in with the deoxygenated blood in the right ventricle, so mixed blood goes to body and lungs and the heart and lungs work harder

Expected Finding: murmur at left sternal border

89
Q

Renal Biopsy pnt edu

A

need to be on bedrest supine with a back roll for support 2-24 hours after procedure to decrease r/f bleeding

90
Q

safest IM injection site for adults

A

Ventrogluteal because has thick gluteal muscles and no major nerves or blood vessels

91
Q

Thrombocytopenia care plan

A

measure abdominal girth DAILY to monitor for manifestations of internal bleeding

92
Q

Manifestations of…
Respiratory Obstruction
Tension pneumothorax
Flail chest

A

Respiratory Obstruction: intercostal retractions, high-pitch inspiratory (stridor), call RRT! Caused by laryngospasm and edema

Tension pneumothorax: tracheal deviation, distended neck veins, absent breath sounds on 1 side

Flail chest: paradoxical chest movement, dyspnea, and cyanosis

93
Q

Urine specific gravity

A

1.005 to 1.030

94
Q

Expected findings for isotonic dehydration

A

increased hematocrit d/t hemoconcentration caused by decreased plasma fluid volume

95
Q

Types of enemas (oil retention, carminative, hypertonic, sodium polystyrene sulfate)

A

Oil retention ⇨ SOFTEN stool before removing fecal impaction

Carminative ⇨ expel FLATUS

Hypertonic ⇨ CLEANSE bowels (prep for surgery)

Sodium polystyrene sulfate ⇨ give to client who has high potassium

96
Q

A client has hemophilia and reports pain and swelling in a joint following an injury. What is the nursing action?

A

Prepare for replacement of the missing clotting factor.

What is hemophilia: hereditary bleeding disorder in which blood clots slowly and abnormal bleeding occurs d/t deficiency in most common clotting factors, factor VIII (hemophilia A). AGGRESSIVE FACTOR REPLACEMENT is initiated to prevent hemarthosis, which can lead to long-term loss of ROM

97
Q

Hypertonic uterine dysfunction + 3 cm dilation (full = 10cm) Nursing actions

A
  • offer hydrotherapy to relax

- therapeutic rest measures should be initiated to relieve pain and prevent early exhaustion

98
Q

1 oz = x mL

1 pint = x mL

A

1 oz = 30 mL

1 pint = 480 mL

99
Q

ABG withdrawal from radial artery nursing action

A

perform Allen’s Test before obtaining specimen by ensuring that circulation to the hand is adequate from the ulnar artery in case the radial artery is injured (the radial artery is the most common site for ABG withdrawal)

100
Q

Genital herpes self-management

A
  • apply warm compress to the lesions to relieve discomfort

- AVOID sexual activity when lesions are present

101
Q

weight gain (1 lb body fat = x calories)

A

3,500 calories

102
Q

infant nutrition

A

allow infant to try finger foods, like crackers, after SIX months

103
Q

toddler development

A

toddlers maintain bowel and bladder control during daytime by 30 months (2.5 years)

104
Q

Baby feedings

A
  • feed baby 8-12 times/day or Q2-3 hours

- after 1st week of life, baby should have 6-9 heavy wet diapers per day

105
Q

Acute angle-closure glaucoma manifestations

A

severe eye pain, halos around lights, blurred vision, HA, brow pain, N/V

106
Q

what to administer for 12 hr postop & preventing DVT (enoxaparin, warfarin, or aspirin?)

A

Administer ENOXAPARIN bc it is a low-molecular-weight heparin

Not warfarin because it has a delayed onset and it is for long-term prophylaxis

Not aspirin because it suppresses platelet aggregation, not anticoagulant

107
Q

Complete vs incomplete proteins

A

Complete: eggs, soybeans, yogurt

Incomplete: lentils, veggies, gains, nuts, seeds (missing 1+ essential amino acids)

108
Q

when a pregnant client needs a biophysical profile

A
  • when a non-stress test is nonreactive

- when there are < 10 kicks in 12 hours (the minimum number of kicks in 12 hrs is 10 kicks)

109
Q

schizophrenia symptoms (cognitive, affective, negative)

A
  • cognitive: impaired memory, impaired concentration, impaired judgement
  • affective: feelings of hopelessness; mood or emotional responses dissonant w/ behavior “I just feel so hopeless”
  • negative: absence of normal behaviors r/t motivation or interest (inability to experience joy) “I no longer enjoy the activities i used to love”
110
Q

Binge-eating disorder

A
  • expected abdominal pain

- repeated episodes of binging w/o using compensatory behaviors such as laxatives

111
Q

Tracheal stenosis

A

What is is: abnormal narrowing of the trachea d/t inflammation and scarring that follows intubation

Manifestations: increased coughing/ inability to cough up secretions/ difficulty talking or breathing

112
Q

Burn lab values during resuscitation phase (sodium, hemoglobin, albumin, potassium)

A

Resuscitation phase: replacement of fluids

Sodium: ↓ because it is trapped in interstitial space

Albumin: ↓

Hemoglobin: ↑ d/t loss of fluid volume

Potassium: ↑

113
Q

End-stage liver failure expected labs (PT, lactate dehydrogenase, ammonia, albumin)

A

Prothrombin time: ↑ d/t inadequate supply of clotting factors, ∴ prolonged PT

Lactate dehydrogenase: ↑ = liver cell destruction

Ammonia: ↑

Albumin: ↓

114
Q

DVT Treatment

A
  • continuous heparin therapy
  • can take acetaminophen, NOT ASPIRIN
  • warm, moist heat & elevation for comfort
115
Q

Communication problems

Receptive Aphasia, Expressive Aphasia, Dysarthria

A

Receptive Aphasia: unable to understand words or sentences they hear

Expressive Aphasia: cannot name simple objects or formulate sentences or phrases

Dysarthria: difficulty articulating correctly d/t weakness or paralysis of muscles that produce speech

116
Q

Effective uterine contractions

A

should occur every 2-3 minutes

117
Q

Prevention

A

Primary: vaccines / education to healthy people that are in danger of getting ill; seatbelts, bike helmets

Secondary: preventing illness from getting severe via regular exams and screenings (mammograms)

118
Q

Who can take oral contraceptives?

A

Yes: 4 weeks after childbirth

No: smoking, anticonvulsants & systemic anti-fungals, anti-HIV protease inhibitors, anti TB meds

119
Q

Tympanostomy tubes

A
  • allow drainage from and ventilation to middle ear

- fall out on their own within 6-12 months

120
Q

Nursing actions for fever

A
  • keep bed linen dry to maximize heat loss

- do not ice groin because this leads to shivering and increased energy expenditure

121
Q

Postop urinary diversion to treat bladder cancer

A

Nursing care: change collection pouch in early morning when urine output is low

Expect no delay in urinary output after surgery

122
Q

gross motor mobility of a 3/yo

A

stand on 1 foot for a few seconds

123
Q

Nursing actions for 8 hrs postpartum hemorrhage

A

☑ massage the fundus to expel clots and help uterus contract
☑ administer 10 L/min O2 via nonrebreather face masks
☑ add oxytocin to IV fluids
☑ insert indwelling urinary catheter to monitor urinary output and perfusion to kidney
☑ place in lateral position w/ legs elevated 30 degrees

124
Q

When to discontinue Swaddling

A

D/C swaddling once baby is able to roll over (~2 months) because rolling over can tighten the swaddle and keep baby from breathing properly

125
Q

Polyhydramnios

A

What is it: presence of excessive amniotic fluid surrounding unborn fetus

Expected: GI malformations and neuro disorders

126
Q

Female Structures (graafian follicle, fallopian tube, corpus luteum)

A

Graafian follicle: expels mature ovum

Fallopian tube: where egg moves from ovaries to uterus

Corpus luteum: structure within the ovary that produces the progesterone needed to establish and maintain pregnancy

127
Q

Vacuum-assisted birth

A

inform the client that caput succedaneum (swelling of scalp d/t suction) resolves in a few days

128
Q

Otosclerosis (sclerosis of the ossicles)

A

Overgrowth of the tissue of the bones in the middle ear, which can cause tinnitus and conductive hearing loss

129
Q

Diet when client has acute diverticulitis active inflammation

A

Low fiber (white bread, low-fat milk, yogurt w/ active cultures, poached eggs, and canned soft fruit)

130
Q

Borderline Personality Disorder

A
  • Splitting is a common defense mechanism in which the client plays one staff member against another. First, they cling towards a certain staff member and then abruptly complains about them to another staff.
  • Underlying cause of splitting: fear of abandonment and inability to accept both + and - feelings. ∴ the client demonstrates only + or - feelings towards others.
131
Q

Alcohol withdrawal manifestations

A

6-8 hrs after cessation: “the shakes” and HTN

12-24 hrs after cessation: generalized and tonic-clonic seizures

Within the 1st 72 hrs: delirium tremens

132
Q

Antacids

A

Take antacids 1 hr apart from other meds because antacids increase gastric pH and interferes with absorption of various meds

133
Q

Types of grief (acute, anticipatory, delayed, disenfranchised)

A

Acute: have somatic and psychological manifestations of distress like waking up early/inability to sleep well + profound sadness

Anticipatory: an expected response before an actual loss. Client might be preoccupied w/ impending loss, make extensive funeral arrangements, etc.

Delayed: unable to accept the reality of a loss. Client remains in denial and can’t express sorrow and loss

Disenfranchised: can’t openly acknowledge the loss because of societal or religious norms

134
Q

Digestive proteins (pepsin, amylase, lipase)

A

Pepsin: breaks down PROTEINS
Amylase: breaks down STARCHES into GLUCOSE
Lipase: breaks down TRIGLYCERIDES into MONOGLYCERIDES

135
Q

Fetus in occipital brow presentation

A

What is it: this presentation increases diameter of the presenting part, which may prevent the fetal head from descending into the pelvis

Can cause PROLONGED LABOR, forceps- or vacuum- assisted birth, or a C-section

136
Q

Post-streptococcal glomerulonephritis

A

Expect hematuria, normal potassium, and increased BP

137
Q

Priority finding for 13 weeks and has hyperemesis gravidarum

A

Priority: Ketones 2+

Rationale: the greatest risk is malnutrition → risk to developing fetus. Ketonuria indicates that the client is breaking down FAT and PROTEIN STORES for energy, and can’t give fetus essential nutrients

NOT priority: hypotension, dehydration, hyponatremia

138
Q

Expected findings for newborns

A
  • acrocyanosis: within 24-48 hrs after birth
  • erythema toxicum: macular, papular, vesicular rash on torso; within 24-72 hrs after birth
  • blood sugar >40 mg/dL
  • NOT axillary temp 96.9F because r/f cold stress which can decrease pulmonary perfusion
139
Q

How to decrease allergen exposure

A

apply a hypoallergenic mattress cover

140
Q

How to prevent the onset of Raynaud’s disease

A

Smoking cessation

141
Q

mL to tbsp

A

1 tbsp = 15 mL

142
Q

HELLP Syndrome

A

This syndrome is a severe form of preeclampsia (3 manifestations)

HELLP = hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP)

143
Q

Neonatal Abstinence Syndrome

A

Usually exhibits hyperactivity within the CNS

144
Q

Nursing action for infant with unrepaired myelomeningocele

A
  • palpate the abdomen for bladder distention d/t possibility of incomplete emptying
  • a neurogenic bladder is a common complication
145
Q

Bile (gallbladder, liver, intestines, bile duct)

A
  • gallbladder STORES bile
  • liver MAKES bile for digestion
  • GI tract ELIMINATES bile
  • small amount of bile continuously enters the duodenum
  • bile duct is a series of thin tubes that carry bile from the gallbladder into the small intestine to help digest the fats in food
146
Q

Commercial formula for newborn

A

Cow’s milk-based formula is recommended for healthy newborns because it is similar to human breast milk.

Conditions that need alternative formula W/O milk: galactosemia

147
Q

Labor Terms (lightening, quickening, effacement)

A

Lightening: engagement of fetal head into pelvis. Breathing becomes easier, but urination is more frequent

Quickening: 1st fetal movement

Effacement: thinning of cervical tissue

148
Q

VEAL CHOP (fetal accelerations and decelerations)

A

V: variable decels C: cord compression
E: early decels H: head compression
A: acceleration O: okay
L: late decels P: placental insufficiency

149
Q

amnioinfusion

A

prepare an amnioinfusion to decrease cord compression

150
Q

Leuk- (-openia, -emia, -ocyosis, -oplakia)

A

Leukopenia: decreased WBC

Leukemia: uncontrolled production of blast cells or immature WBC in bone marrow (cancer)

Leukocytosis: increased circulating WBC in response to WBC exiting from the blood vessels in response to inflammation

Leukoplakia: thick white patches in mucosa of the mouth (precancerous, seen in heavy smokers)

151
Q

Disease manifestations (varicella, measles, fifth disease, tetanus)

A

Varicella (chicken pox): maculopapular rash → vesicles on erythemous bases, which will eventually rupture and crust over

Measles: Koplik spots (a transient cephalocaudal rash of maculopapular eruptions of upper trunk and face) → spreads to lower body

Fifth disease: begins w/ bright red cheeks, “slapped-cheek,” then a rash appears on the extremities and trunk. The rash fades centrally, giving a lacy (reticulated) look

Tetanus: lockjaw and muscle rigidity. DTap vaccine prevents

152
Q

Defense mechanisms (compensation, conversion, projection)

A

Compensation: coveres/blocks a problem.
Example: blocks anxiety by drinking alcohol (maladaptive); avoid anxiety by working hard to excel in some way (adaptive)

Conversion: unconscious transformation of anxiety into physical manifestations w/no organic cause

Projection: unknowing rejection of emotionally unacceptable feelings by attributing those feelings to others

153
Q

ADHD parent education

A

“ignore your child’s attention-seeking behaviors that are not dangerous” so the child will learn the the behavior does not get the desired response and does the behavior less.

Adjust activity based on level of child’s attention

ADRs of ADHD meds: decreased appetite and weight loss

154
Q

Heberden’s nodes

A

hard, bony lumps or nodules in the finger joints

155
Q

Systemic Scleroderma

A

Sclerodroma: chronic disease that can cause thickening, hardening, or tightening of the skin, blood vessels, and internal organs

Patho: body produces and deposits too much collagen → thickening and hardening, including skin and extremities

Localized scleroderma: mainly affects the skin

Systemic scleroderma: can affect internal organs

Manifestations: skin changes, Raynaud’s, arthritis, muscle weakness, dry mucous membranes, contractures develop with advanced s.s. unless clients do ROM and muscle-strengthening

156
Q

Hematocrit levels during dehydration

A

They increase.

When a person does not drink enough, their plasma levels drop, while the number of RBCs packed in it stays the same and this increases the proportion of red blood cells in their blood volume.

157
Q

celcius to farenheit

A

F = (C x 9/5) + 32

158
Q

A client is at risk for a latex allergy if they are allergic to these foods…

A

avocados, bananas, chestnuts, mangos, kiwi, pineapple, and passion fruit

(abc MK, pp)

159
Q

manifestations for client w/ ADHD and addicted to amphetamines

A

will eat excessively, exhaustion, depression, prolonged sleep, craving amphetamines

160
Q

Dialysis Disequilibrium Syndrome (DSS)

A

What is it: CNS disorder that can develop in clients who are new to dialysis d/t the rapid removal of solutes and changes in blood pH

Manifestations: HA, N/V, decreased LOC, seizures, and restlessness

161
Q

Lithium

A

Expected: hand tremors (will subside), nausea (will subside), weight gain (diet and exercise will help

Toxicity Manifestation: poor motor coordination

162
Q

APGAR

A

A: appearance
0 = blue/pale
1 = pink body; blue extremities
2 = pink

P: pulse
0 = absent
1 = < 100
2 = > 100

G: grimace (reflex irritability)
0 = floppy
1 = minimal response to stimulation
2 = prompt response to stimulation

A: activity (muscle tone)
0 = absent
1 = flexed arms and legs
2 = active

R: respiration
0 = absent
1 = slow and irregular
2 = vigorous cry

163
Q

Administering a cleansing enema

A
  • insert tip of tubing 7-10 cm (3-4 in) along rectal wall to prevent dislodging of the tube and avoid injury to rectal mucosa
  • position on the left side in sims’ position to allow solution to flow downward into sigmoid colon and rectum and promote retention of the enema
164
Q

rheumatoid arthritis meds

A

Daily management: celecoxib (NSAID)

Short term treatment d/t ADRs or severe R.A.: prednisone (corticosteroid)

165
Q

Pravastatin

A

the only statin that isn’t affected by CYP3A4 inhibitors ∴ you CAN drink grapefruit juice with this med

166
Q

ADHD meds side effects

A

stimulants

Will see weight loss, tachycardia, HTN

167
Q

Caring for a client with recent stroke and history of GERD. What is this client at risk for?

A

Aspiration pneumonia

Rationale: GERD → gastric reflex from stomach to lower esophagus. When regurgitation occurs, client is at high risk for PNEUMONIA d/t aspiration of gastric contents in airway.
Recent stroke increases risk for dysphagia.

168
Q

Esophageal varices

A

What is it: enlarged veins in the esophagus develop when blood flow to the liver is blocked. They often occur in people with advanced liver disease.

169
Q

duodenal ulcer disease

A

ulcers in duodenum, not esophagus, and are r/t stress, COPD, pancreatic disease, and chronic renal failure

170
Q

Administering otic antibiotics

A

holder dropper 1 cm (0.5 in) above the ear canal during administration

171
Q

spinal anesthesia hypotension ADR

A

nursing action: position client in a head-down position to rapidly promote venous return to the heart and increase BP

172
Q

nicotine gum ADRs

A

throat irritation, aching jaw muscles, dyspepsia

173
Q

an expected view of death from a preschooler

A

a preschooler typically views death as temporary and interchangeable with life

174
Q

basic needs of older adult clients

A
  • caloric needs are decreased because metabolic rate decreases by 10%
  • deep sleep is decreased because they spend less time in stages of deep sleep, but this can delay healing
175
Q

Diaphragm

A

What is it: a flexible rubber cup that is filled with spermicide and inserted over the cervix before sex

Prescription fitted by a provider

Replace Q2 years

176
Q

mucolytic drugs for bronchitis

A

such as hypertonic saline solution or acetylcysteine

ADR: bronchospasm because it can irritate the airways by producing a cough and thinning mucus secretions

177
Q

Otitis media manifestations

A

low-pitched (NOT high) sound in ear, feeling of fullness, ear pain, cracking sound when yawning or swallowing, mild dizziness

178
Q

Foot care for patient with diabetes

A
  • test water temp with wrist because client may have peripheral nerve damage from diabetes
  • trim toenails straight across, NOT round the edges because can create in ingrown toenail
179
Q

Nursing actions for extravasation of tissues surrounding IV

A
  1. ) stop infusion
  2. ) elevate extremity
  3. ) notify provider
  4. ) remove IV line last because treatment may include infusion of antidote through IV line, ∴ don’t remove until prescription is initiated
180
Q

Toddler should be able to

A

remove their own shoes

181
Q

IV problems and manifestations (infiltration, infection, phlebitis, not intact)

A
  • infiltration: taut skin around IV catheter site that is cool to touch. Stop IV, elevate extremity, warm moist or cold compress
  • infection: redness at IV catheter entry site. Remove IV, clean site with alcohol, start IV in a different location
  • phlebitis: palpable cord along the vein d/t inflammation of inner layer of the vein. Discontinue infusion and start a new IV in a different location
  • Not intact: bleeding at insertion site. See if IV is intact and if the catheter is in the vein. If still bleeding, start a new IV in a different location
182
Q

Removing sutures from a client’s laceration

A

“I will clip each suture close to the skin and pull it through from the other side” so it doesn’t disrupt the wound-healing process

183
Q

Indication of an acute INTRAVASCULAR hemolytic reaction

A

sudden oliguria because this reaction causes AKI

184
Q

Late decelerations nursing action

A
  • place client in a left lateral position to improve blood flow to the uterus because late decels = placental insufficiency (veaL choP) = decreased fetal oxygenation.
  • 8-10 L/min nonrebreather mask
185
Q

A kid has strabismus. How to prevent amblyopia?

A

wear an eye patch on the stronger/unaffected eye (to strengthen the weak eye muscle on affected eye)

186
Q

ALZ Disease

A

Expect personality changes and confusion that develops SLOWLY

187
Q

hypercalcemia manifestations

A

depressed deep-tendon reflexes, N/V, bone pain, lethargy, weakness

NOT muscle tremors (hypo)

** it’s kinda like hypercalcemia = depressed symptoms (opposite)

188
Q

Allergy contraindications to vaccines

A

allergy to EGGS, don’t take INFLUENZA vaccine

allergy to GELATIN or NEOMYCIN, don’t take VARICELLA vaccine

189
Q

using a nonpunitive approach

A

verbal reminder

190
Q

Concept to discuss in Termination phase in a nurse-patient relationship

A

Loss

Rationale: loss is an expected feeling for both client and nurse. Must end relationship w/o guilt or anxiety

191
Q

Pericarditis

A

What is it: swelling and irritation of thin, saclike tissue surrounding the heart.

Manifestations: dyspnea, hiccups, nonproductive cough… can indicate HF from pericardial compression d/t constrictive pericarditis or cardiac tamponade

  • chest pain increases w/ deep inspiration d/t increased pressure on pericardial sac
  • chest pain decreases when sit upright or lean forward bc will relieve pressure
192
Q

Ways to decrease flatus and odor

A

Eat crackers, toast, and yogurt because they can help decrease flatus, which contributes to odor

193
Q

Successful surgery for bile duct obstruction

A

clay-colored stool (obstruction) → yellowish-brown stool (successful surgery)

194
Q

Cons of ORAL glucocorticoids for kids

A

Chronic use of oral glucocorticoids in high doses can → decreased linear growth

While inhaled glucocorticoids go directly to the local target area (airways) → decreased r/f adrenal suppression

195
Q

Fat embolism syndrome

A

Manifestations: neuro changes, petechial rash, and hypoxemia occur when fat globules occlude small blood vessels

Risk factors: multiple fractures and a long bone fracture, male clients

196
Q

Nurse to intervene in AP’s actions when turning patient to the right side

A

when AP places a pillow under right arm. The AP shouldn’t do this. Place pillow under LEFT arm to prevent internal rotation of the L shoulder

197
Q

Placenta problems (abruptio placentae and placenta previa)

A

Abruptio placentae: premature separation of placenta from the uterus
Expect: persistent uterine contractions, board-like abdomen, and DARK red vaginal bleeding

Placenta previa: placenta is covering the cervix (outlet of uterus)
Expect: a relaxed uterus and BRIGHT red vaginal bleeding

198
Q

Foods to eat if client has uric acid calculi

A

YES: citrus fruits
NO: food w/ purine (chicken, organ meats, red wine)

199
Q

Plasma infusion nursing actions

A

☑ enter plasma product # into client’s medical record

☑ transfuse fresh frozen plasma immediately to maintain integrity of the clotting factors

☑ admin. each unit over 30-60 min. Slow infusion rate if the client shows indication of fluid overload

200
Q

What to do if IV pump for TPN is unavailable

A

Use manual drip tubing to give dextrose 10% in water at the same rate

DON’T admin TPN using a manual drip tubing because it increases r/f hyperglycemia!

201
Q

Pressure injury (stage II and III)

A

Stage II: partial-thickness skin loss or blister

Stage III: visible subcutaneous tissue

202
Q

Significant head trauma and agonal breathing (gasping for air)

A

Black tag!

203
Q

Disaster management plan

A

includes prevention, preparedness, response, recovery)

Response: perform a rapid needs assessment

Recovery: conduct home visits, identify lack of safe shelter or clean water and any other potential hazards

204
Q

Colostomy care

A
  • activate the adhesive in the skin barrier by holding it in place over the stoma for 30 seconds
  • cut the skin barrier opening no more than 0.3 cm (0.13 in) larger than the stoma
205
Q

tunneled central venous catheter w/o a pressure-sensitive valve

A
  • flush catheter daily w/ heparin when not using it regularly
  • keep the catheter clamped when not in use to prevent blood backflow.
206
Q

Nursing actions for early decels at 39 weeks, 2nd stage labor

A

continue to monitor FHR

Rationale: this is an expected finding for progression of labor

207
Q

multiple sclerosis manifestation

A

nystagmus (involuntary eye movements and muscle spasticity)

208
Q

trach care order

A
  1. Remove inner cannula
  2. Remove soiled dressing
  3. Clean stoma with 0.9% sodium chloride
  4. Change trach collar
209
Q

How to clean vomit on a reusable BP cuff

A

place BP cuff in a labeled bag and send for decontamination NOT chlorine bleach (blood spills)

210
Q

Reporting to local health department

A

chlamydia, syphilis, gonorrhea, chancroid, and HIV/AIDS

do NOT tell hospital chaplain the pnt’s diagnosis d/t HIPAA

211
Q

obstructive sleep apnea complication

A
  • hypoxia → HTN
  • HF
  • dysrhythmias

NCLEX (5 decks)

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