General Bullets #3 Flashcards Preview

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Flashcards in General Bullets #3 Deck (201):
1

While a client is receiving heparin, the nurse should monitor the:

partial thromboplastin time.

2

Urinary frequency, incontinence, or both can occur after __________________________. Incontinence may be manifested as:

catheter removal; dribbling

3

When teaching a client about colostomy care, the nurse should instruct the client to hang the irrigation reservoir 18"-22" above the stoma, insert the catheter ______ into the stoma, irrigate the stoma with ________ of water at room temperature of _____________ once a day, clean the area around the stoma with soap and water before applying a new bag, and use a protective skin covering such as a Stomahesive wafer, karaya paste, or karaya ring, around the stoma.

2-4"
17-34 oz.
105-110 degree

4

The first sign of Hodgkin's disease is painless, superficial ______________, typically found under one arm or on one side of the neck in the cervical chain.

lymphadenopathy

5

Cyanotic skin ____________, but pigmented skin does not.

blanches

6

A client with a ________________ is most likely to report pain during or shortly after eating.

gastric ulcer

7

Widening pulse pressure is a sign of:

increasing ICP

8

In a burn victim, a primary goal of wound care is to prevent contamination by:

microorganisms.

9

To prevent _______________________ in a client who has had hip nailing, the nurse places trochanter rolls from the knee to the ankle of the affected leg.

external rotation

10

Severe hip pain following the insertion of a hip prosthesis indicates dislodgement. The nurse should assess for :

shortening of the leg
external rotation
absence of reflexes

11

______________ is a pathological, parrot like repetition of another person's words or phrases.

Echolalia

12

According to psychoanalytic theory, the _______ is the part of the psyche that controls internal demands and interacts with the outside world at the conscious, preconscious, and unconscious levels.

ego

13

According to psychoanalytic theory, the __________ is the part of the psyche that's composed morals, values, and ethics. It continually evaluates thoughts and actions, rewarding the good and punishing the bad.

superego (supercop of the unconscious)

14

According to psychoanalytic theory, the ________ is the part of the psyche that contains instinctual drives.

id (remember "I" for instinctual and "d" for drive)

15

According to Erikson, from birth to age 12 months, the child is in the _____________________ stage of psychosocial development.

trust-versus-mistrust

16

Pregnancy-induced hypertension (preeclampsia) is an increase in BP of __________ over baseline or BP of _________ on two occasions at least 6 hours apart accompanied by edema and albuminuria after 20 weeks' gestation.

30/15
140/95

17

Positive signs of pregnancy include:

ultrasound evidence
fetal heart tones
fetal movement felt by examiner (after 4 mos.)

18

______________ is softening of the cervix.

Goodell's sign

19

____________ is softening of the lower segment of the uterus.

Hegar's sign

20

Quickening, a presumptive sign of pregnancy, occurs between _________________ weeks' gestation.

16 and 19

21

__________ ceases during pregnancy.

ovulation

22

Any _______________ during pregnancy should be considered a complication until proven otherwise.

vaginal bleeding

23

At 12 weeks' gestation, the fundus should be at the tope of the:

symphysis pubis

24

______________ are small, irregular, red spots with minute, bluish white centers that appear on the buccal mucosa of clients with measles (rubeola).

Koplik's spots

25

As much as 75% of renal function is lost before ______ and __________ levels rise above normal.

BUN
serum creatinine

26

When compensatory efforts are present in acid-base balance, partial pressure of arterial carbon dioxide and bicarbonate always point in the :

same direction

27

Polyuria is urine output of ____________ with 24 hours in an adult.

2,500 mL or more

28

The presenting sign of ____________ is chest pain that is usually unilateral and related to respiratory movement and may be described as "stabbing" or "knifelike."

pleuritis

29

If a client can't void, the first nursing action should be _________________ to assess for bladder distention.

bladder palpation

30

If a client has a gastric drainage tube in place, the nurse should expect the physician to order:

potassium chloride.

31

___________ shouldn't be given to infants younger than age 1 because it has low linoleic acid content and its protein is difficult for infants to digest.

Cow's milk

32

An increased pulse rate is one of the first indications of _________________. It occurs because the heart attempts to compensate for a decreased oxygen supply to the tissues by pumping more blood.

respiratory difficulty

33

If jaundice is suspected in a neonate, the nurse should examine the infant under __________________. If that is unavailable, the nurse should examine the infant under a ___________.

natural window light
white light

34

Denial is a ________________ used by a client who denies the reality of an event or condition.

defense mechanism

35

The three phases of a uterine contraction are:

increment
acme
decrement

36

The client who uses a cane should carry it on the _________________ and advance it at the same time as the ________________.

unaffected side
affected side

37

To fit a supine client for crutches, the nurse should measure from the ____________ to the _______ and add ______ to that measurement.

axilla
sole
2"

38

The intensity of a labor contraction can be assessed by the _______________ of the uterine wall at the contraction's peak.

indentability

39

Labor contractions are graded as _______, __________, or ____________.

mild (somewhat tense)
moderate (moderately tense)
strong (boardlike)

40

____________, the mask of pregnancy, is pigmentation of a circumscribed area of skin (usually over the bridge of the nose and cheeks) that occurs in some pregnant women.

Chloasma or melasma

41

The gynecoid pelvis is most ideal for delivery. Other types include:

platypelloid (flat)
anthropoid (apelike)
android (malelike)

42

Pregnant women should be advised that there is no safe level of _______________.

alcohol intake

43

In an adult, a hemoglobin level below ________ suggests iron deficiency anemia and the need for further evaluation.

11 mg/dL

44

The normal partial pressure for oxygen in arterial blood is ________ (plus or minus 5 mm Hg).

95 mm Hg

45

Vitamin C deficiency is characterized by:

brittle bones
pinpoint peripheral hemorrhages
friable gums with loosened teeth

46

Clinical manifestations of pulmonary embolism are variable, but common signs include:

increased RR
tachycardia
hemoptysis

47

In a psychiatric setting, ______________ is used to reduce overwhelming environmental stimulation, protect the client from self-injury or injury to others, and prevent damage to hospital property.

seclusion

48

Seclusion is used for clients who don't respond to less restrictive interventions. Seclusion controls _______________ until the client can assume self-control and helps the client to regain self-control.

external behavior

49

__________________, such as aged cheese, chicken liver, avocados, bananas, meat tenderizer, salami, bologna, Chianti wine, and beer may cause severe hypertension in a client who takes a ______________.

Tyramine-rich food
monoamine oxidase inhibitor

50

A client who takes a monoamine oxidase inhibitor should be weighed ___________ and monitored for _____________.

bi-weekly
suicidal tendencies

51

If the client who takes a monoamine oxidase inhibitor has ___________, _____________, or severe _______________, the nurse should withhold the drug and notify the physician.

palpitations
headaches
orthostatic hypotension

52

Normally, the intraocular pressure is ___________. It can be measured with a _________________ tonometer.

12-20 mm Hg
Schiotz

53

The frequency of uterine contractions, which is measured in minutes, is timed from the ___________ of one contraction to the ______________ of the next.

beginning

54

In early _________________, blood pressure may be normal, but RR & HR are rapid. The client may report ________ and may have _________ and piloerection.

hemorrhagic shock
thirst
clammy skin

55

_______________ begins with the nurse's first encounter with the client and continues throughout the client's stay.

Assessment

56

The nurse obtains assessment data through the:

health history
physical examination
review of diagnostic studies

57

Cool, moist, pale skin, as occurs in shock, results from diversion of blood from the skin to the __________.

major organs

58

Capillary refill indicates ______________, which decreases in shock, thereby lengthening refill time. Normal capillary refill time is _______.

perfusion

59

Except for clients with renal failure, urine output of

dehydration

60

The appropriate needle size for insulin injection is ______ and ______ long.

25g
1/2"

61

Residual urine is urine that remains in the bladder after _________. The amount of residual urine is normally ________.

voiding
50-100 mL

62

In elderly clients, the most common fracture is:

hip fracture

63

_____________- weakens the bones, predisposing elderly clients to fracture, which usually results from a fall.

Osteoporosis

64

Molting and tenting of the skin are signs of severe ____________; intravenous fluids are required to rehydrate.

dehydration

65

Before _____________, the nurse should ask the client whether he's allergic to the dye, shellfish, or iodine and advise him to take nothing by mouth __________ before the procedure.

angiography
8 hours

66

During myelography, ~__________ of CSF is removed for laboratory studies and an equal amount of contrast media is injected.

10-15 mL

67

Vitamin K is administered to neonates to prevent hemorrhagic disorders because a neonate's ___________ can't synthesize Vitamin K.

intestine

68

After ________________, the puncture site is covered with a pressure dressing and the affected part is immobilized for _____________ to decrease the risk of bleeding.

angiography
8 hours

69

If a water-based medium was used during myelography, the client remains on bed rest for _________, with the head of the bed elevated ______________.

6-8 hours
30-45 degrees

70

If an oil-based medium was used, the client remains _____ in bed for ____________.

flat
6-24 hours

71

The level of ____________ is determined by estimating the maximum viable tissue (tissue with adequate circulation) needed to develop a functional stump.

amputation

72

Before internal fetal monitoring can be performed, a pregnant client's cervix must be dilated at least _____, the amniotic membranes must be ruptured, and the fetus's presenting part (scalp or buttocks) must be at station ______ or lower, so that a small electrode can be attached.

2 cm
-1

73

Fetal alcohol syndrome presents in the first 24 hours of life and produces:

lethargy
seizures
poor suckling reflex
abdominal distention
respiratory difficulty

74

Variability is any change in the ______ from its normal rate of _______________.

FHR
120-160 bpm

75

_________ is increased FHR.

Acceleration

76

_________ is decreased FHR.

Deceleration

77

Heparin sodium is included in the ________ used for renal dialysis.

dialysate

78

In a neonate, the symptoms of heroin withdrawal may begin ____________ to _______ after birth.

several hours
4 days

79

In a neonate, the cardinal signs of narcotic withdrawal include:

coarse flapping tremors
sleepiness
restlessness
prolonged, persistent, high-pitched cry
irritability

80

The nurse should count a neonate's respirations for __________.

1 full minute

81

Paroxysmal nocturnal dyspnea may indicate:

heart failure

82

A client who takes a cardiac glycoside, such as ____________, should consume a diet that includes high-potassium foods.

digoxin

83

The nurse should limit tracheobronchial suctioning to _______ and should make only ______ passes. The client should be hyperventilated between each pass.

10-15 seconds
two

84

Before performing tracheobronchial suctioning, the nurse should ventilate and oxygenate the client _______ with a resuscitation bag and _______ oxygen. This procedure is called __________.

5-6 times
100%
bagging

85

Signs and symptoms of pneumothorax include:

tachypnea
restlessness
hypotension
tracheal deviation

86

The cardinal sign of toxic shock syndrome is rapid onset of a

high fever.

87

A key sign of peptic ulcer is ___________ hematemesis, which can be bright red or dark red, with the consistency of coffee grounds.

hematemesis

88

Signs and symptoms of a perforated peptic ulcer include:

sudden, severe upper abdominal pain
vomiting
extremely tender, rigid (boardlike) abdomen

89

_____________ is a common adverse reaction to aluminum hydroxide.

Constipation

90

For the first 24 hours after a __________, the client should use a bedside commode and then progress to walking to the toilet, bathing, and taking short walks.

myocardial infarction

91

After a myocardial infarction, the client should avoid ________ and add a new activity daily, as tolerated without dyspnea.

overexertion

92

In a client with a recent MI, frothy, blood-tinged sputum suggests:

pulmonary edema

93

In a client who has acquired immunodeficiency syndrome, the primary purpose of the drugs is to prevent

secondary infections

94

In a client with AIDS, suppression of the immune system increases the risk of opportunistic infections, such as:

cytomegalovirus
Pneumocystis carinii pneumonia
thrush

95

A client with AIDS may have rapid weight loss, a sign of

wasting syndrome.

96

Between the ages of ___________, a child begins to show emotions, such as affection, jealousy, and anger.

10-12 months

97

Chlorpromazine (thorazine) is used to treat neonates who are addicted to

opioids

98

The nurse should use ____________ to protect an infant with eczema, a scalp vein infusion, or who's recovering from cleft lip repair or eye surgery.

elbow restraints

99

The nurse should provide a dark, quiet environment for a neonate who's experiencing ___________.

opioid withdrawal

100

Difficulty ___________ is a common complaint of a client who has just undergone a thyroidectomy.

swallowing

101

If the body doesn't use glucose for energy, it metabolizes fat and produces:

ketones.

102

In infants ages _________ months, separation from the mother evokes a more intense response than any other stimulus.

6-12

103

Because __________ mask symptoms of infection, they should be administered to children with extreme caution.

steroids

104

Steroids should be administered with ________ to a child.

food

105

Approximately 20% of clients with ______________________ have residual deficits, such as mild motor weakness or diminished lower extremity reflexes.

Guillan-Barre syndrome

106

In children, signs and symptoms of leukemia include:

fatigue, anorexia, low-grade fever, and decreased WBC, RBC & platelet counts

107

In children with leukemia, the most common causes of death include:

hemorrhage
infection

108

In a child, anemia is the first sign of :

lead poisoning

109

A ______________ frame is commonly used to immobilize a child who has a spica cast.

Bradford

110

In a premature neonate, signs of respiratory distress include:

nostril flaring
substernal retractions
inspiratory grunting

111

Hypertension and hypokalemia are the most significant clinical manifestations of primary:

hyperaldosteronism

112

In a child age _____, having and frequently speaking to an imaginary friend are normal behaviors.

3

113

By age _______, an infant with normal motor development should be able to lift and control his head.

3-4 months

114

Head lag is common in infants younger than:

3 months

115

________ is candidiasis (Candida albicans) of the oral mucous membranes.

Thrush

116

Thrush is characterized by aphthae, or small _______, in the mouth.

ulcers

117

Common causes of child abuse are:

poor impulse control by the parents
lack of knowledge of growth and development

118

Allopurinal (Zyloprim) is used in children with leukemia to prevent accumulation of:

uric acid

119

Allopurinal =

Zyloprim

120

Before administering any "as needed" pain medication, the nurse should ask the client to indicate:

the location of the pain

121

At age ___ months, an infant should begin to receive solid foods one at a time and ____ week apart.

6
1

122

After percutaneous aspiration of the bladder, the client's first void is usually ________; urine containing ___________ should be reported to the physician.

pink
frank blood

123

A urine culture that grows more than ____________ colonies of bacteria per milliliter of urine indicates infection.

100,000

124

The most appropriate toy for a toddler age 18 months is one that helps to develop

motor coordination

125

When administering an _____________ to an infant, the nurse should ask another nurse (not the parent) to divert the child's attention and assist as needed.

injection

126

Respiratory distress syndrome (hyaline membrane disease) develops in premature infants because their pulmonary alveoli lack:

surfactant

127

A client who's undergoing dialysis should take a vitamin supplement and eat food that are:

high in calories
but low in protein, sodium and potassium

128

The nurse should lower her profile to communicate at eye level with a

child.

129

An infant who has phenylketonuria should be fed a ________________ formula and should have plasma phenylalanine levels monitored frequently.

low-pheylalanine

130

When caring for an infant who has had six to eight episodes of diarrhea a day for 4 days, the nurse should assess for

electrolyte imbalance

131

The nurse may offer finger foods to a child age ____ who has a poor appetite.

3

132

When in a mist tent (Croupette), a child may require

soft restraints

133

In a client who has COPD, the most effective ways to reduce thick secretions are to

increase fluid intake to 2,500 mL/day
encourage ambulation

134

The nurse shouldn't administer a drug to a child at ____________ unless it's specifically prescribed because it may stimulate the child.

bedtime

135

Medulloblastoma, the most common brain tumor in children, is characteristically found in the

cerebellum

136

Clubbing of the digits and a barrel chest may develop in a client who has

COPD

137

In a client who's undergoing dialysis, desired outcomes are :

normal weight
normal serum albumin level (3.5-5.5 mg/dL)
adequate protein intake (1.2-1.5g/kg of body wt daily)

138

Intermittent peritoneal dialysis consists of ____ cycles per night.

6

139

Isoetharine (Bronkosol) can be administered with a handheld nebulizer or by

intermittent positive-pressure breathing

140

Isoetharine =

Bronkosol

141

_______________ decreases body secretions and is used before surgery such as tonsillectomy.

Atropine sulfate

142

Continuous ambulatory peritoneal dialysis requires ____ exchanges per day, 7 days a week, for a total of 168 hours per week.

4

143

The classic adverse reactions to antihistamines are

dry mouth
drowsiness
blurred vision

144

Because of the risk of ______________, a client who has received a general anesthetic can't take anything by mouth until active bowel sounds are heard in all abdominal quadrants.

paralytic ileus

145

_______________ believe that they shouldn't receive blood components donated by other people but can receive an organ transplant if the donor organ has had the blood removed.

Jehovah's Witnesses

146

The level of alpha-fetoprotein, a tumor marker, is elevated in clients who have

testicular germ cell cancer

147

Clinical manifestations of orchitis caused by bacteria or mumps include

high temp
chills
sudden pain in involved testis

148

The level of prostate-specific antigen is elevated in clients with

BPH
or prostate CA

149

The level of prostatic acid phosphatase is elevated in clients with advanced

stages of prostate CA

150

Phenylephrine (Neo-Synephrine) a mydriatic, is instilled in a client's eye to __________ the eye.

dilate

151

Phenylephrine =

Neo-synephrine

152

To test ___________, the nurse should ask the client to cover each eye separately and to read the eye chart with glasses and without, as appropriate.

visual acuity

153

To promote fluid drainage and relieve edema in a client with epididymitis, the nurse should elevate the scrotum on a

scrotal bridge

154

Fluorescein staining is commonly used to asses ________________ because it outlines superficial epithelial defects

corneal abrasions

155

____________ is loss of near vision as a result of the loss of elasticity of the crystalline lens.

Presbyopia

156

When providing _____________ for an unconscious client, to minimize the risk of aspiration, the nurse should position the client on his side.

oral care

157

During assessment of distance vision, the client should stand ______ from the chart.

20'

158

A sign of acute appendicitis, __________________ is tenderness at ___________ (about 2" from the right anterior superior iliac spine on a line between the spine and the umbilicus)

McBurney's sign
McBurney's point

159

The diagnosis of _____________ is based on clinical findings of two or more cognitive deficits, progressive worsening of memory, and the results of a neuropsychological test.

Alzheimer's disease

160

Signs and symptoms of ____________ include rectal bleeding, change in bowel habits, intestinal obstruction, abdominal pain, weight loss, anorexia, nausea & vomiting.

colon cancer

161

To help calm a child who's frightened of a mist tent, the nurse may suggest that a parent

lie with the child in the tent

162

Symptoms of prostatitis include

frequent urination
dysuria

163

The male sperm contributes an __________ chromosome, the female ovum contributes an ____.

X or Y
X

164

Fertilization produces a total of ___ chromosomes, including an XY combination (male) or an XX combination (female).

46

165

A _________ is a painless, ulcerative lesion that develops during the primary stage of syphilis.

chancre

166

During the __________ stage of syphilis, spirochetes invade the internal organs and cause permanent damage.

tertiary

167

Normal room humidity is _____.

30-60%

168

In TPN, ____________ is the most reliable indicator of a positive response to therapy.

weight gain

169

The nurse may administer an IV fat emulsion through a central or peripheral catheter, but shouldn't use an ___________ because the fat particles are too large to pass through the pores.

in-line filter

170

A positive Homan's sign may indicate

thrombophlebitis

171

If a client who has a prostatectomy is using a ________________, instruct him to wash and dry his penis before applying the clamp.

Cunningham clamp

172

A Cunningham clamp should be applied ______________ and removed every 4 hours to empty bladder to prevent infection.

horizontally

173

______________ is the loss of train of thought because of a defect in mental processing.

Thought blocking

174

A Bradford frame is used for ___________ of a child, such as a client with extensive burns or meningocele.

long-term immobilization

175

During delivery, ________________ is safest for the mother and baby. This includes a pudendal block of the perineal tissue.

local anesthesia

176

If a woman has signs of UTI during menopause, she should be instructed to

drink 6-8 glasses of water per day
urinate before and after intercourse
perform Kegel exercises

177

_____________ causes fissures at the angles of the mouth and may indicate a Vitamin B12, riboflavin, or iron deficiency.

Cheilosis

178

Tetany may result from ______________ caused by hypoparathyroidism.

Hypocalcemia

179

Dietary fiber (roughage), which is derived from ____________, supplies bulk, maintains intestinal motility, and helps to establish regular bowel movements.

cellulose

180

Alcohol is metabolized primarily in the _______. Smaller amounts are metabolized in the kidneys and lungs.

liver

181

A client who has cervical cancer may experience vaginal bleeding for 1-3 months after

intracavitary radiation

182

___________ is the accumulation of fluid, containing large amounts of protein and electrolytes, in the abdominal cavity.

Ascites

183

Ascites is commonly caused by

cirrhosis

184

To measure ascites, use a centimeter tape and measure at the _________________ or the ___________.

superior iliac crest
umbilicus

185

Normal pulmonary artery pressure is

10-25 mmHg

186

Normal pulmonary artery wedge pressure is

5-12 mmHg

187

After cardiac catheterization, the site is monitored for bleeding and hematoma formation, pulses distal to the site are palpated every _______ minutes for an hour, and the client is maintained on bed rest with the extremity extended for ____ hours.

15
8

188

The third stage of labor begins after the neonate's birth and ends with

expulsion of the placenta

189

In full-term neonates, skin creases appear over two-thirds of the neonate's feet. Preterm neonates have heel creases that cover less than ____________ of the feet.

two-thirds

190

The _____________ stage of labor (postpartum stabilization) lasts up to 4 hours after the placenta is delivered. This time is needed to stabilize the mother's physical and emotional state after the stress of childbirth.

fourth

191

At 20 weeks' gestation, the fundus is at the level of the

umbilicus

192

At 36 week's gestation, the fundus is at the lower border of the

rib cage

193

A premature neonate is one born before the end of the

37th week of gestation

194

The ___________ isoenzyme level increases 4-8 hours after a MI, peaks at 12-24 hours and returns to normal in 3 days.

CK-MB

195

Phase I (orientation phase) of nurse-client relationship:

nurse obtains initial history
nurse & client agree to a contract

196

Phase II (working phase) of nurse-client relationship:

client discusses his problems
behavioral changes occur
self-defeating behavior is resolved/reduced

197

Phase III (termination or resolution phase) of nurse-client relationship

nurse terminates therapeutic relationship
and gives client positive feedback

198

___________________ is a leading cause of maternal death in the U.S.

Gestational hypertension

199

A _________________ is a woman who has had three or more consecutive spontaneous abortions.

habitual aborter

200

____________________ occurs when bleeding is present without cervical dilation.

Threatened abortion

201

A ________________ occurs when all products of conception are expelled.

complete abortion