Uworld Flashcards
(233 cards)
1
Q
When do you deflate the cuff for a trach patient?
A
When the patient is improving, is determined not to be at risk of aspiration and is awake. Before the cuff is deflated, the patient is asked to cough if possible, to clear secretions that have built up above the cuff. In addition, suction is applied through the trach tube and then the mouth then the cuff is deflated.
2
Q
How should a patient be positioned when eating while having a trach partially deflated?
A
Sitting up right to reduce the risk of aspiration with the chin flexed toward the chest. Hyper flexio sitting up the rate to reduce the risk of aspiration with the chin flexed toward the chest. Hyperextension of the neck could increase the risk of aspiration.
3
Q
What is decerebrate posturing?
A
A sign of severe brain damage. During assessment, the nurse would observe arms and legs straight out, toes pointed down, in the head and neck arched back.
4
Q
What is sepsis neonatorum?
A
A medical emergency in which newborns show signs of infection through elevated temperature subtle changes such as; irritability, increased sleepiness and poor feeding.
Blood, urine, and cerebrospinal fluid cultures should be obtained immediately and a broad-spectrum antibiotic started.
5
Q
What is a hydrocele?
A
A fluid filled testicular mass that usually resolves before the first birthday and are not a medical emergency. It will present as a painless swollen testicle.
6
Q
Sepsis in a newborn is life-threatening. Newborns with fever, lethargy, and refusal to feed require a full septic workup. Broad-spectrum anabiotic’s should be started immediately after obtaining blood, urine, and cerebrospinal fluid’s cultures.
A
Remember this
7
Q
What is Cisplatin?
A
An antineoplastic medication that can cause renal toxicity. The healthcare provider needs to keep track of the renal function including laboratory values (BUN and creatinine), and urinary output
8
Q
What are the normal lab values for BUN?
A
Normal = 6-20 mg
9
Q
What are normal lab values for creatinine?
A
Normal = 0.6-1.3 mg
10
Q
What are the normal lab values for magnesium?
A
1.5 to 2.5 mEq/L
11
Q
What is a therapeutic magnesium level for a preeclamptic patient?
A
4-7 mEq/L this is necessary to prevent seizures
Normal = 1.5-2.5 mEq/L
12
Q
What are signs and symptoms of magnesium toxicity?
A
Magnesium toxicity causes central nervous system depression. which includes absent or decreased deep tendon reflexes as being One of the earliest signs of magnesium toxicity. Followed by decrease in urinary output, respiratory depression and cardiac arrest.
13
Q
What is used to treat magnesium toxicity?
A
Calcium gluconate
14
Q
What are some meds used for preeclampsia to lower blood pressure?
A
Typically used when BP is greater than 160/110
Hydralazine
Methyldopa
Labetalol
15
Q
What is capsaicin?
A
A topical analgesic used to relieve minor peripheral pain (osteoarthritis, neuralgia) with a regular use. Local irritation such as burning, stinging, and erythema is quite common. The patient should wait at least 30 minutes before washing the affected area to ensure adequate absorption.
16
Q
What is the normal CVP level?
A
2-8 mm Hg
17
Q
Which port do you use to measure the CVP?
A
The proximal PA catheter port because it’s lumen exits the right atrium
18
Q
What is Levetiracetam?
A
A medication often used to treat seizures and various settings. Often the preferred antiepileptic medication because of its minimal drug to drug interaction
19
Q
What is dexamethasone?
A
A corticosteroid used to treat cerebral edema associated with a brain injury/tumor by decreasing inflammation
20
Q
The best indication of moving air and a client with asthma is peak flow. How are results Categorized?
A
Green ( greater than or equal to 80% of personal best and good control)
Yellow (50% to 79% of personal best and caution)
Red (less than 50% of personal best, a medical alert)
21
Q
What is myasthenia gravis?
A
An auto immune disease in which antibodies attack acetylcholine receptors. This results in weakness in skeletal muscles, especially in the bull bar region that involves eye movement, swallowing/speaking, and breathing. These patients become more exhausted as the day progresses.
22
Q
What is a normal Glasgow coma scale score?
A
15 =normal
Head injury classification:
Mild 13-15
Moderate 9- 12
Severe less than or equal to 8
23
Q
What is the normal platelet count?
A
150,000-400,000/mm
24
Q
Why would a patient with oozing varices be considered unstable?
A
The varices are at risk for rupture and the patients ammonia levels could be increasing from digestion of the added protein via the blood oozing
25
What is esophageal atresia and tracheoesophageal fistula?
They consist of a variety of congenital malformations that occurs when the esophagus and trachea do not properly separate or divide.
26
What are signs and symptoms of esophageal atresia and Tracheoesophageal Fistual?
Frothy saliva, coughing, choking, and drooling. Patient's may also develop apnea and cyanosis during feeding.
27
What is thiamine?
Vitamin B1
28
Why is it important for a patient with alcoholism to receive thiamine?
Alcoholics can have a thiamine deficiency which can result to Warnicke and cephalopathy
29
What is epistaxis?
Nosebleed.
30
What could a painful joint, fever, and limited range of motion and indicate?
Septic arthritis which is considered a surgical emergency.
31
What is epiglottitis?
This refers to information of the epiglottis, which may result in life-threatening upper respiratory obstruction.
32
What does abrupt onset of high-grade fever and a sore throat, followed by the 4 Ds: drooling, dysphonia, dysphasia, and distressed airway (inspiratory stridor) indicate?
(Hib) haemophilus influenza type B
| seen in children but the incidence has decreased dramatically with the widespread hib vaccination
33
What could a temperature of 102 and petechiae indicate in a child whose post valve replacement?
Endocarditis
34
What is hemophilia?
A hereditary bleeding disorder caused by a deficiency in coagulation proteins. Treatment consists of replacing the missing clotting factor and teaching the client about injury prevention including: avoiding medication such as ibuprofen and aspirin, avoiding intramuscular injections, avoiding contact sports and safety hazards, dental hygiene is necessary to prevent gum bleeding and a medic alert bracelets should be worn at all times.
35
What should patient education include for the patient with hemophilia?
injury prevention including: avoiding medication such as ibuprofen and aspirin, avoiding intramuscular injections, avoiding contact sports and safety hazards
dental hygiene is necessary to prevent gum bleeding and a medic alert bracelets should be worn at all times.
36
What is the normal lab value for sodium?
135-145 mg
37
What is glipizide?
An oral sulfonylurea used to control blood sugar, is prescribed once or twice a day 30 minutes before meals
38
What is levofloxacin?
An antibiotic used to treat urinary tract infection
39
What are normal lab values for potassium?
3.5-5.0 mEq
40
Widening of the QT interval can increase the risk of life-threatening torsades de pointes. Which medication is this most commonly seen with?
Haloperidol
Methadone
Ziprasidone
Erythromycin
41
What is nicardipine?
A potent calcium channel blocking vasodilator. The priority nursing intervention with IV administration is to monitor the hypotensive effects of this drug
42
What is digoxin
A cardiac glycosides given to infants and children in heart failure. It is given to increase myocardial contraction, which increases cardiac output and improves circulation and tissue perfusion.
43
When should you hold digoxin?
Pulse less than 90-110bpm for infants and young children
Pulse less than 70bpm for older children
44
What is methotrexate
In non-biologic disease modifying antirheumatic drug that is prescribed to treat rheumatoid arthritis. Adverse effects associated with this medication include bone marrow suppression, hepatotoxicity, and gastrointestinal irritation (nausea, vomiting, diarrhea)
45
What is the normal pH of the blood?
7.35-7.45
46
Would a blood pH of 7.25 be acidic or alkaline?
Acidic
47
What a blood pH of 7.58 be acidic or alkaline?
Alkaline
48
What is an acidic bicarbonate level of the blood?
Less than 22
49
What is an alkalosis bicarbonate level?
Greater than 26
50
What is the normal lab value for bicarbonate?
22 to 26
51
What is the normal lab value for PaCO2?
35 to 45
52
What is an acidotic level for PaCO2?
Greater than 45
53
What is an alkaline level for PaCO2?
Less than 35
54
What is misoprostol?
A synthetic prostaglandin that protects against gastric ulcers by reducing stomach acid and promoting mucus production and cell regeneration. It is often prescribed to prevent gastric ulcers in clients receiving long term nonsteroidal anti-inflammatory drugs
Also used for labor induction
Antacids, especially those that contain magnesium can increase the adverse effects of this medication.
55
What kind of assignments can the charge nurse give to a new graduate RN?
The new graduate RN should be given RN level responsibilities caring for STABLE clients who do not require specialized knowledge and performing skills taught in nursing school.
56
What is ataxia?
?
57
Initial teaching must be done by the RN, not the LPN. Providing client teaching for common medications is within the skill and knowledge set of a new graduate nurse.
.
58
What is Guillian barre syndrome?
A syndrome that results in bilateral, ascending paralysis. The ascent can be rapid and it is unknown at what level the clients body the ascension will stop. The client is unstable. A key concern is the paralysis ascending to the diaphragm and causing respiratory failure.
59
What are the ranges for the Glasgow coma scale?
Head injury classification:
Mild 13-15
Moderate 9-12
Severe less than or equal to 8
Coma: does not open eyes, does not follow commands, and does not utter understandable words GCS 3-8
60
What are the requirements to be classified with the coma?
Does not open eyes, does not follow commands, and does not utter understandable words GCS 3-8
61
When delegating tasks remember that a UAP cannot handle a disgruntled visitor.
There may be a need for skilled communication to keep the situation from escalating. The visitor should be escorted off of the floor by either a nurse or security officer.
62
What is Agoraphobia?
Fear and anxiety about being in certain situations or physical spaces. The fear their experience is out of proportion to any actual danger. These individuals are also highly concerned about having trouble escaping or getting help in the event of a panic attack or panic symptoms.
A person with Agoraphobia may avoid open spaces, closed spaces, riding in public or private transportation, going outside the home, bridges/tunnels, and crowds
63
What is considered a normal capillary glucose for a neonate?
Greater than or equal to 40
Optimal equals 70-100
Glucose levels are decreased 1 hour after birth, then rise and stabilize within 2-3 hours.
64
What needs to be done immediately for a hypoglycemic neonate? (Less than 40 BG)
Feed immediately
65
What is the normal newborn respiratory rate?
30-60 breaths per minute
66
What is milia?
White papules
Clogged pores of newborns.
67
What is a classic sign of ventricular septal defect (VSD)?
A holosystolic murmur (heard during entire systole phase) at the left lower sternal border.
Although VSD is abnormal, most small VSDs close spontaneously within the 1st 6 months of life.
68
What are some classic signs of Down syndrome?
A singular transverse crease extending across the palm of a hand, small and low-set ears, flat nose bridge, protruding tongue, and hypotonia
69
What is hypotonia?
?
70
What are Epstein's pearls?
White, pearl like epithelial cysts on gum margins and the palate that'll usually disappear within a few weeks.
71
How should the umbilical chord look after birth?
Should be opaque or whitish blue with two arteries and one vein and covered with Wharton's jelly. The cord should be assessed for bleeding. It will become dry and darker within 24 hours and detached from the body within 2 weeks.
72
By when should the umbilical cord detach from a newborn?
Within 2 weeks
73
What is the difference in jaundice found in newborns within the first 24 hours and afterwards?
Initial sign With in the first 24 hours jaundice is pathological and usually relates to liver problems
Initial sign After the 1st 24 hours jaundice is referred to as physiological and is related to the increased amount of unconjugated bilirubin in the system.
74
What kind of diet does a patient with severe weight loss need?
High in calories AND protein
75
What is phenelzine?
A monoamine oxidase inhibitor. Used for patients with unipolar major depression.
Foods high in tyramine (aged cheese, yogurt, cured meats, fermented foods, broad beans, beer, red wine, chocolate, and avocados) need to be restricted to reduce the risk of hypertensive crisis
76
What type of diet should the patient on a MAOI have?
Avoid Foods high in tyramine (aged cheese, yogurt, cured meats, fermented foods, broad beans, beer, red wine, chocolate, and avocados)
They need to be restricted to reduce the risk of hypertensive crisis
77
What Foods are high in tyramine?
aged cheese, yogurt, cured meats, fermented foods, broad beans, beer, red wine, chocolate, and avocados
78
What are absence seizures?
Typically occurring in children, presentation is classic and includes: daydreaming episodes or brief (less than 10 seconds) staring spells, absence of a warning, absence of other forms of epileptic activity, unresponsiveness during the seizure, no memory of the seizure
79
What does tonic, clonic, and atonic mean?
Tonic is body stiffening
Clonic is muscle jerking
Atonic is loss of muscle tone or drop attack
80
What is Serosanguinous drainage
Pink drainage which would be expected 2 hours after surgery
81
Which of these medications would affect bleeding risk?
| Aspirin, clopidogrel, rivaroxaban, metoprolol, rosuvastatin, and lisinopril
Aspirin, clopidogrel, and rivaroxaban
82
How many milligrams is a baby aspirin?
81 mg
83
What class of medication is aspirin, clopidogrel, ticagrelor and prasugrel?
Antiplatelet agents
84
What class of medication is warfarin, rivaroxaban, and apixaban?
Anticoagulants
85
When documenting in narration there is no need to state a generic notation of "continue to monitor"
.
86
What is caude equina syndrome?
A disorder that results from injury to the Lumbosacral nerve roots (L4-L5) causing motor and sensory deficit's. The main symptoms are severe lower back pain, inability to walk, saddle anesthesia (Motor weakness/loss of sensation to inner thighs and buttocks), and bowel and bladder incontinence.
This is a medical emergency. Treatment requires urgent reduction of pressure on the spinal nerves to prevent permanent damage.
87
What is cholecystitis?
Inflammation of the gallbladder
88
What is Meniere disease?
An inner ear disorder. Expected symptoms include episodic vertigo, tinnitus, and muffled hearing.
89
What is used to treat an acute attack of meniere disease?
Antihistamines, anticholinergics, and benzodiazepines
90
What are clinical manifestations of anorexia nervosa?
Extreme weight loss, amenorrhea, bradycardia, cold intolerance, dry skin, and lanugo. Life-threatening complications, such as cardiac arrhythmias associated with hypokalemia, may develop.
91
What is methylphenidate?
Classified as a stimulant, and children with ADHD it improves attention, decreases distractibility, helps maintain focus on an activity, and improves listening skills.
92
In a disaster setting, clients of different age groups can be placed in the same room together so long as both are stable and noninfectious. Even if this is not socially acceptable.
.
93
By around age 4, clients with sickle cell disease have some level of immunosuppression as their spleens are dysfunctional due to infarctions from the sickling episodes.
.
94
Rapid volume replacement requires a large bore IV access, which peripheral IV access would suffice?
16 or 18 gauge catheter should be initiated
95
How does placental abruption usually present itself?
Abdominal pain and dark red vaginal bleeding. The main concerns are maternal blood loss resulting in hypertension and shock and fetal compromise. Maternal stabilization and expedited birth or indicated.
96
What is Reynauds phenomenon?
Usually triggered by cold exposure, during a typical episode digital arteries (most often in the fingers) constrict and Blood flow is impaired. This causes the skin to turn pale and then blue and to feel numb and cold. As blood flow returns to the affected digits, the skin turns red and I throbbing or tingling sensation is often felt. This is an expected finding;episodes usually resolve 15 to 20 minutes once the trigger has been removed. (Ex: rewarming fingers)
97
Bed rest is no longer required for a client with DVT unless what?
The client is having severe edema or leg pain.
98
Developmental milestones of Toddlers: which age group walks first steps independently, crawls upstairs, uses two finger pincer grasp, hits two objects together, says 3 to 5 words, uses nonverbal gestures (waving goodbye), May have separation anxiety, and searches for hidden objects.
12 months
99
Developmental milestones of Toddlers: which age group walks up and down stairs with help, throws a ball overhand, jumps in place, builds 3 to 4 block tower, turns 2-3 book pages, scribbles, uses cup and spoon, 10+ word vocabulary, identifies common objects, has temper tantrum's, understands ownership ("mine"), imitates others.
18 months
100
Developmental milestones of Toddlers: which age group walks up and down stairs alone one step at a time, runs without falling, kicks ball, builds 6 to 7 block tower, turns one book page, draws a line, 300+ word vocabulary, 2 to 3 word phrases, states own name, begins parallel play, begins to gain independence from parents.
Two years old
101
Developmental milestones of Toddlers: which age group walks up stairs with alternating feet, pedals a tricycle, jumps forward, draws a circle, feed self without help, grips a crayon with fingers instead of first, 3 to 4 word sentences, asks "why" questions, states own age, begins associative play, toilet trained except wiping.
Three years old
102
Developmental milestones of preschoolers: which age group walks upstairs with alternating feet, pedals a tricycle, jumps forward, draws a circle, feeds self without help, grips a crayon with fingers instead of first, three or four words sentences, asks "why" questions, states own age, begins associative play, toilet trained except wiping.
Three years old
103
Developmental milestones of preschoolers: which age group walks downstairs with alternating feet, balances on 1 foot, catches a ball, draws a square, cuts with scissors, ties a simple knot, names 2+ colors, likes telling stories, begins imaginative/group play, recognizes analogies, often focused on self.
Four years old
104
Developmental milestones of preschoolers: which age group skips, walks backward, uses a jump rope, draws a triangle, tie shoelaces, prints letters and numbers or words, counts to 10, speaks full sentences, names coins and days of the week, independently dresses and bathe, identifies real from pretend.
Five years old
105
What is the therapeutic magnesium level necessary for a preeclamptic client to prevent seizures?
4-7 mEq
106
Why is magnesium sulfate given to preeclampsia-eclampsia syndrome patients?
Magnesium sulfate is a central nervous system depressant used to prevent/control seizure activity in preeclampsia/eclampsia clients
107
What is hydralazine, methyldopa, or labetalol used for in the pre-eclampsia patient?
To lower blood pressures of greater than 160/110
108
Which medications are used to suppress uterine contractions in preterm labor, allowing pregnancy to be prolonged for 2 to 7 days so that corticosteroid administration can improve fetal lung maturity?
Tocolytic drugs such as: terbutaline, magnesium sulfate, indomethacin and nifedipine
109
Which rectal temperatures would be considered a red flag in a neonate patient?
Rectal temperature greater than 100.4 Fahrenheit or less than 96.8 Fahrenheit
110
What is a normal lab value for PaO2?
80 to 100 MMHG
111
When asked by a client about results or dying, respond by ASSESSING the clients understanding of the situation and/or feelings about the topic using therapeutic communication skills.
.
112
A lower IV catheter gauge corresponds to a larger bore IV catheter.
.
113
What is a 14 gauge IV catheter typically used for?
Administering fluids and drugs in an emergency or prehospital setting or for hypovolemic shock.
114
What size IV is needed for blood transfusions?
18 gauge
115
What is the normal serum potassium level?
3.5-5.0 mEq
116
What is a normal BNP level?
Less than 100 pg/mL
117
What BNP would you expect to find with the patient who is in heart failure?
A level greater than 100 pg/mL due to the stretching of the heart
118
What is the normal sodium value?
135 to 145 mEq
119
What is Leopold maneuver?
Used as a systematic approach to palpating the pregnant abdomen to identify fetal presentation.
120
What is used for shoulder dystocia in an unborn child?
The McRoberts maneuver and/or suprapubic pressure which helps to dislodge an impacted anterior shoulder from under the clients pubic bone
121
Which position should a pregnant client be placed in when the nurse visualizes a loop of umbilical cord protruding from the vagina?
Position the client on hands and knees
122
What are some late stage manifestations of hepatitis B?
Jaundice, weight loss, clay colored stools, thrombocytopenia
123
How is the hepatitis B and transmitted?
Transmission occurs through parenteral or sexual contact with body fluids such as blood, semen, or vaginal secretions
Remember the pneumonic B is for body fluid
124
When titrating IV nitroglycerin the nurse should pay close attention to the systolic blood pressure, what values would indicate for the nurse to stop the infusion?
When the systolic blood pressure drops more than 30 points below the patient's baseline or when the systolic blood pressure falls below 90
125
What is a gastroduodenostomy?
A technique that removes 2/3 of the stomach which is used to treat stomach cancer and peptic ulcer disease that does not respond to more conservative treatment.
126
What is dumping syndrome?
Where the patient experiences abdominal pain, diarrhea, nausea, hypertension/tachycardia 15 to 30 minutes after meals during early onset. During late onset The patient experiences dizziness/confusion, fatigue, diaphoresis, syncope or seizures (in severe cases) 2 to 3 hours after meals.
This patient needs to have small/frequent meals, replace simple sugars with complex carbohydrates and incorporate high fiber and protein rich foods.
127
Why should the Gastroduodenostomy patient avoid high carbohydrate meals?
These meals can cause dumping syndrome and may lead to hypoglycemia
128
Varicella-zoster vaccine, measles-mumps-rubella, Rotavirus, and yellow fever are all examples of which kind of vaccine?
Live vaccines which generally should not be given to severely immunocompromised children (corticosteroid therapy, chemotherapy, aids)
129
What is methylprednisolone?
A corticosteroid. The nurse needs to frequently monitor this patient's blood glucose.
130
For the client with COPD exacerbation, what is important for the nurse to monitor for and report to the healthcare provider if noted?
Monitor mental status frequently and report changes such as restlessness, decreased level of consciousness, somnolence, difficult arousal, and confusion
131
What is digoxin?
A cardiac glycosides that increases cardiac contractility but slows the heart rate and conduction. It is used in heart failure to increase cardiac output and atrial fibrillation to reduce the heart rate.
Excreted almost exclusively by the kidneys
132
Which lab values are measurements of kidney function?
BUN and creatinine
133
What are the normal lab values for creatinine?
0.6-1.3 mg/dL
134
Before the administration of digoxin be sure to Measure the apical heart rate for a full minute. It is safe to administer the drug when the apical heart rate is greater than or equal to 60 bpm
.
135
What is fluoxetine?
An antidepressant drug that is a selective serotonin reuptake inhibitor
136
What is red man syndrome?
A condition that can occur with rapid IV vancomycin administration. It is characterized by flushing, erythema, and pruritus, typically on the face neck and chest. Muscle pain, spasm's, dyspnea, and hypotension may also occur.
137
What are signs of anaphylaxis?
Flushing, hypotension, hives, angioedema (lip swelling), wheezing, and respiratory distress
138
For the client on IV vancomycin who's exhibiting signs of anaphylaxis what should the nurse do?
Stop the infusion immediately and treat with intramuscular epinephrine.
139
What must be done for the patient who is in supraventricular tachycardia and has been unresponsive to drug therapy?
Cardioversion.
To perform safe cardioversion, the synchronizer button must be activated prior to discharging the unit. The synchronizer function allows the unit to sense the clients rhythm and not deliver a shock during a vulnerable time (T wave) that could cause the client to go into a more lethal rhythm.
140
During cardioversion when is the shock delivered?
During the R wave of the QRS complex
141
What is theophylline?
A bronchodilator
Avoid caffeinated products
Avoid toxicity by monitoring drug levels 30 minutes after does given and periodically afterwards to adjust
Signs of a toxicity that should be reported or anorexia, nausea, vomiting, restlessness, and insomnia
142
Methylphenidate, dextroamphetamine and lisdexamfetamine are examples of which type of medicine?
Stimulants which are used as first-line agent's in the treatment of ADHD.
Given in divided doses two or three times daily, usually 30 to 45 minutes before meals.
As a stimulant, it may interfere with the sleep and should be given no later than 6 PM
143
Contrary to popular myth, sugar does not increase hyperactivity. Although an additive free diet may be a healthy approach for children, eliminating additives or food coloring's does not decrease the symptoms of ADHD
.
144
How long does a patient need to be off MAOIs before starting therapy with an SSRI?
14 days these medications cannot be administered concurrently
145
Why can't SSRIs be combined with MAOIs?
There is a risk of serotonin syndrome (diaphoresis, tachycardia, agitation, autonomic instability and hypertensive, diarrhea and hyperactive bowel sounds, hyperreflexia, clonus, tremor, and mydriasis)
146
What is the therapeutic range for INR?
2 to 3
147
What is dysarthria?
Worsening ability to speak
148
What are the normal lab values for BUN?
6-20 mg/dL
149
What is the normal range for hemoglobin in a one-month-old?
12.5-20.5 g/dL
150
What is a normal BNP level?
Less than 100
151
What is enoxaparin?
An anticoagulant. Assess the CBC frequently when administering this medication
152
At what level would you see digoxin toxicity?
Greater than 2 ng/mL
153
What is pertussis?
Whooping cough
Is very contagious communicable disease.
Patients need oral antibiotics, droplet precautions, and supported measures such as humidified oxygen and oral fluids.
154
What patients would be put into a negative pressure isolation room?
Individuals with measles, tuberculosis, and varicella zoster (chickenpox) infections
155
How often are thyroid levels checked after initiating levothyroxine treatment?
Every 4 to 6 weeks
Relief of symptoms could begin approximately 3 to 4 weeks after beginning therapy
Full therapeutic effect may take up to eight weeks after initiation
156
What are delusions of reference in the schizophrenic patient?
They cause the clients to feel as if songs, newspaper articles, and other events are personal to them
157
What is nitroprusside?
A highly potent vasodilator for both venous and arteriolar
Venous dilation reduces preload
Arterial dilation reduces afterload
Nitroprusside is most commonly used in hypertensive emergencies and for conditions in which blood pressure control is of utmost importance (aortic dissection, acute hypertensive heart failure)
158
What does supine mean?
On back
159
What does prone mean?
On belly
160
What is the most helpful way to alleviate a patient's back pain during labor pains with a fetal occiput posterior position?
Applying counterpressure to the client's sacrum during contractions
161
What is the occiput?
Back of the fetus head
162
What is a normal ejection fraction for Cardiac output?
55%-70%
163
What is Cushing's Triad?
Hypertension, bradycardia, and irregular respirations
Used for assessing signs of increased intracranial pressure
164
What are risk factors for respiratory depression related to opioid use for analgesia?
The elderly, those with underlying pulmonary disease, history of snoring (with or without sleep apnea), obesity, smoking more than 20 pack year history, the opiate naïve, especially if treated for acute pain, and post surgery 24 hours
165
What is the antidote for benzodiazepines?
Flumazenil
166
What is the antidote for opioids?
Naloxone
167
What is the antidote for norepinephrine extravasation?
Phentolamine
168
Children who developed reye syndrome often have had a recent what?
Viral infection, especially varicella (chickenpox) or influenza.
The risk for developing reye syndrome increases if aspirin therapy is used to treat the fever associated with veriCella or influenza
169
What are the clinical manifestations of reye syndrome?
Lethargy, fever, acute encephalopathy(shown with vomiting and a severely altered level of consciousness, it can rapidly progressed to seizures and or coma), and altered hepatic function. Elevated serum ammonia levels are expected laboratory findings.
170
What are the normal serum magnesium levels?
1.5-2.5
171
What is torsades de pointes?
Ventricular tachycardia coupled with a prolonged QT interval
It is a lethal cardiac arrhythmia
Can be caused by hypomagnesemia
172
Hypomagnesemia relates to torsades de pointes
Assess for widening(prolonged) QT intervals
.
173
Atrial fibrillation is usually associated with an underlying heart disease and is rarely immediately life-threatening
.
174
Atrial flutter is characterized by saw tooth shaped flutter waves. It is associated with underlying heart disease such as mitral valve disorders, cardiomyopathy, and cor pulmonal
.
175
Mobitz 2 (second-degree atrioventricular block type 2) is often associated with conduction system disease or drug toxicity such as beta blockers, and calcium channel blockers
.
176
Clients on radiation therapy need to maintain frequent oral hygiene due to the drain effects of the mucosa
Before and after meals and at bedtime
Use a soft toothbrush and rinse with baking soda solution
177
What is Guillian-barre syndrome?
An ascending symmetrical Paralysis. It can move upward rapidly or relatively slowly over days and weeks. Respiratory compromise is the worst complication.
178
What is graves disease associated with?
Hyperthyroidism
Thyroid storm is a life-threatening complication that is shown with fever, altered mentation, and excess autonomic activity such as severe hypertension and Tachycardia
179
What is acanthosis nigricans?
The dark skin on the back of the neck or in the groin and armpits
180
What is hirsutism?
Male like hair growth in women
181
Which parasitic infestation is presented with intestinal bleeding and anemia?
Hookworms
182
What is adenosine?
The first line drug of choice for the treatment of paroxysmal supraventricular tachycardia (HR greater than 150bpm)
Must be administered RAPIDLY as a 6mg bolus IV over 1-2 seconds followed by a 20mL Saline flush. A repeat of 12mg may be given twice if the rapid rhythm persists.
The injection site should be as close to the heart as possible such as the antecubital area.
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What is guaifenesin?
Mucinex
An expectorant medication that increases respiratory fluids and thins secretions
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Ibuprofen is an anti-inflammatory
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What is levofloxacin?
An antibiotic that is used for therapy for hospitalized patients with community acquired streptococcal pneumonia
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What is a gluten-free diet for?
Pts with celiac disease who cannot tolerate barley, rye, oats, or wheat (BROW)
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What is enoxaparin?
Lovenox
Low-molecular-weight heparin anticoagulant administered for prophylaxis of deep venous thrombosis in hospitalized pts.
Bleeding and thrombocytopenia (platelet count less than 150,000) are possible complications
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What is thrombocytopenia?
Platelet count less than 150,000
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What is the normal creatinine level?
0.6-1.3
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What is the normal potassium level?
3.5-5.0
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What is the normal sodium levels?
135-145
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What is the normal white blood cell range?
4,000-11,000
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What is pericardial effusion?
Build up of fluid in the pericardium
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What is a Cardiac tamponade?
A serious complication of pericardial effusion (build up of fluid in the pericardium), develops as the effusion increases and volume and results in compression of the heart.
S/s: -hypotension with narrowed pulse pressure
- Muffled or distant heart tones
- jugular venous distention
- pulsus paradoxus
- dyspnea, tachypnea
- tachycardia
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What are signs and symptoms of a cardiac Tamponade? (compression on the heart from fluid in the pericardium)
- hypotension with narrowed pulse pressure
- Muffled or distant heart tones
- jugular venous distention
- pulsus paradoxus
- dyspnea, tachypnea
- tachycardia
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What does the parietal lobe of the brain integrate?
Somatic and sensory input.
Injury could result in a deficit with sensation.
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What does the frontal lobe of the brain control?
High order processing, such as executive function and personality.
Injury often results in behavioral changes
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What does the temporal lobe of the brain integrate?
Visual and auditory input, and past experiences.
Injury results in client not understanding verbal or written language
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What does the occipital lobe of the brain control?
Registers visual images.
Injury could result in a deficit with vision
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What is sildenafil?
Viagra, a phosphodiesterase inhibitor.
Concurrent use of nitrate drugs (commonly prescribed to treat unstable angina) is contraindicated as it can cause life-threatening hypotension
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Which client is more likely to develop serotonin syndrome?
The client taking more than one or an overdose of antidepressant medication that increases serotonin levels
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What are the clinical manifestations of thyroid storm?
A rapid increase in temperature, heart rate, and blood pressure in response to stress.
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Clients with diabetes mellitus, hypertension, and tobacco use are at risk for peripheral ARTERIAL disease.
.
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Vascular ulcers appear with edema and large amounts of exudate.
.
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Therapeutic hypothermia is indicated in nonresponsive, Comatose patients after resuscitation within six hours of arrest.
.
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What is the normal range for the MAP?
70-105mm Hg
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How do you calculate the MAP?
Systolic BP + (diastolic blood pressure x2) /3
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When would you see tracheal deviation?
This is a symptom of a tension pneumothorax
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What is lactuloses purpose in the patient with cirrhosis who has encephalopathy?
A laxative used to trap and expel ammonia in the stool.
Elevated ammonia levels cause mental confusion so lactulose improves the mental status
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Aldosterone is metabolized by the liver
.
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Hyperaldosteronism causes hypokalemia
Hypokalemia can also result from diuretics used to treat fluid retention
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What is the med that is given to help with ascites in cirrhosis?
Diuretics such as spironolactone and furosemide
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What are signs and symptoms of heart failure from impaired myocardial contactility?
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Tachycardia
Pale, cool extremities
Weak peripheral pulses
Decreased BP
Decreased urinary output
Activity intolerance, weakness/fatigue
Loss of appetite
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What are signs and symptoms of heart failure from pulmonary congestion?
Dyspnea
Tachypnea
Orthopnea
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What are signs and symptoms of heart failure from systemic venous congestion?
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Hepatomegaly
Peripheral edema (periorbital in children)
Neck vein distention
Weight gain
Ascites
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What is hirschsprung disease?
It occurs when a child is born with some sections of the distal large intestines missing nerve cells; this renders the internal anal sphincter unable to relax.
Newborns exhibit symptoms of distal intestinal obstruction, distended abdomen, and will not pass meconium within the expected 24-48 hours. They will have difficulty feeding and often vomit green bile (bilious vomiting)
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When are newborns expected to pass the meconium?
24 to 48 hours after birth
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What does a tuft of hair on the lower back signify on a newborn?
Spina bifida
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Folic acid intake during pregnancy decreases the risk of spina bifida in newborns
.
220
Map of 110-115??
.
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A child with moderate intellectual disability:
Has academic skills at about the second grade level and may be able to work in a sheltered workshop; performs self-care activities with some supervision; participates and simple activities; May have limited speech capabilities
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Hypotonia, or decreased muscle tone, (which is not a normal finding in newborns) may be related to hypoxia, down syndrome, or a muscular/neurological disorder
.
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A normal umbilical cord has 2 arteries and 1 vein
The presence of a single umbilical artery is sometimes associated with congenital defects, particularly of the kidneys and heart.
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Acrocyanosis is cyanosis of the hands and feet that results from poor peripheral blood perfusion as an initial mechanism to reduce heat loss and stabilize temperature in newborns.
This is a normal finding the first day of life and/or up to seven days after birth if the infant becomes cold
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A UAP cannot collect a urine specimen for culture and sensitivity from a client with a Foley catheter
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A UAP's scope of practice includes:
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Activities of daily living,
Hygiene,
Linen change,
Routine, stable vital signs,
Documenting input/output,
Positioning
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A LPN's scope of practice includes:
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Monitoring RN findings,
Reinforcing education,
Routine procedures (catheterization),
Most medication administration,
Ostomy care,
Tube patency and enteral feeding,
Specific assessments
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Endotracheal suctioning should be performed only when clinically indicated and not on a scheduled basis.
.
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Neuroleptic malignant syndrome is a life threatening reaction to antipsychotic medications that presents with what?
Fever, muscular rigidity, altered mental status, and autonomic dysfunction (e.g.: sweating hypertension, tachycardia)
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Haloperidol, fluphenazine, clozapine, risperidone and olanzapine are examples of which type of drug?
Antipsychotics
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Pyloric stenosis in infants can lead to progressive dehydration.
.
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1 gram of weight is equal to 1 milliliter of fluid.
.
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What are the normal values for an adult male?
Hematocrit?
Hemoglobin?
Hematocrit: 39%-50%
Hemoglobin: 13.2-17.3 g/dL
