UPDATED NCLEX UWORLD (1720 QUESTIONS WITH CORRECT ANSWERS) 2024 REVISED EXAM GRADED 100% P, Exams of Nursing

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UPDATED NCLEX UWORLD (1720 QUESTIONS WITH CORRECT ANSWERS) 2024 REVISED EXAM GRADED 100% PASS . what medications interact with grapefruit? - Correct answer calcium channel blockers: diltiazem, nifedipine, verapamil, etc statins caffeine SSRIs be sure to practice math! - Correct answer stent placement using the femoral approach puts you at risk for retroperitoneal hemorrhage - Correct answer what are early signs of bleeding into the retroperitoneal space? - Correct answer hypotension, back pain, flank ecchymosis (grey turner sign), hematoma formation, diminshed distal pulses what is the grey-turner sign and what is it a sign of? - Correct answer bruising of the flanks and retroperitoneal hemorrhage and is a bluish color what are some physical signs of peripheral arterial disease? - Correct answer intermittent calf muscle pain?, rest pain, hair loss, decreased peripheral pulses, cool, dry, shiny skin, thick brittle nails, gangrene, ulcers (all of these are in the extremities) transplanted hearts are expected to be - Correct answer tachycardic like 90-110 what is the priority intervention for pain with sickle cell crisis and why? - Correct answer administer IV fluids to reduce blood viscosity and restore perfusion to areas affected by vasoocclusion what is the purpose of continuous bladder irrigation? - Correct answer it is perscribed after TURP to prevent obstruction of urine outflow by removing clotted blood from the bladder what is the nurses care of monitoring CBI? - Correct answer monitor quality of drainage, titrate the inflow rate, and manurally irrigating as needed characteristics of a basilar skull fracture - Correct answer periorbital hematomas (raccoon eyes), csf fluid rhinorrhea, and battle sign (behind the ear bruising) immediate client care for basilar skull fracture - Correct answer cervical spime immobilization, close neurologic monitoring, and support of ABCs vomiting with intake may mean - Correct answer viral or bacterial infection tympanosomty tubes are placed for - Correct answer recurrent otis medias nurse actions during a seizure - Correct answer assist them to lie down is standing/sitting, put them on side for patent airway, loosen tight clothing, give oxygen as needed, remove objects from immediate area, document time and duration of seizure (for tests are done later to see which type of seizure and maybe what exacerates it) never put anything in mouth or restrain them since musclec ontractions can occur during a seizure what are some early symptoms of ICP? - Correct answer altered LOC, headache, abnormal reathing, rise in bp, slow pulse, vomiting client who has a TIA is often placed on - Correct answer prophylactic antithrombotic treatment like aspirin or clopidogrel glascow coma scale ranges from - Correct answer 3-15; 3 being worst 15 being best condition (8 or below in a coma) what are the 3 components? - Correct answer eye opening motor response verbal response a client is not dead until warm and dead!!! - Correct answer nc sometimes a pt is so cold that a pulse cannot be felt intussusception causes intestinal obstruction - Correct answer ileum telescopes into cecum, pain obstruction, edema, compression of BVs, bowel ischemia, rectal bleeing (CURRANT JELLY stools) signs of intussusceotion - Correct answer inital periodic pain with legs drawn up to abdomen, pain is severe and progressive though, inconsolable crying, blood/mucousy stools "current jelly" how is it treated? - Correct answer an air enema guaifenesin (Mucinex) - Correct answer expecorant med that inc resp fluids and thins secretions to facilitate expectoration erythropoeitin Epogen - Correct answer stimulates bone marrow to make RBCs and combats the effects of chemo and used for kidney disease when is hemoccult done? - Correct answer when hidden (occult) blood is suspected due to dark and tarry stool treat intussusception with - Correct answer AIR ENEMA tetraology of fallot - Correct answer exacerbation can happen when infant or child cries, becomes upset, or is feeding you immediately place them in KNEE CHEST position hemolytic uremic syndrome - Correct answer life threatening complication of e. coli diarhea what are the signs? - Correct answer anemia (pallor), low platelets (petechiae and purpura, and acute kidney injury (low UO) cognitive behavioral therapy (CBT) 5 basic components - Correct answer education about pts disorder self observing and monitoring relaxation techniques cognitive restructuring behavioral strategies speicen collection from a foley is considered sterile and should not be delegated to uap - Correct answer a clients first and last name is not PHI privileged health info - Correct answer it is not a violation to cal them by their first and last names or have info heard inadvertently what happens if a client does not full undersnad infromed consent?q - Correct answer the nurse must contact the doctor. the nurse is not responsible for verifiying that the client understands how to stop epistaxis - Correct answer tilt the head forward and apply direct continuous pressure on the alaes (sides) for about 5-20 mins can also hold a cold washcloth to the bridge of nose for vasoconstriction keep child calm and quiet IV iodinated contrast used for ct scan can cause - Correct answer kidney injury metformin is discontinued on the day of IV iodine contrast exposure - Correct answer Amlodipine - Correct answer calcium channel blocker used to treat hypertension Gabapentin (Neurontin) - Correct answer used for neuropathic pain Phenytoin (Dilantin) - Correct answer antiseizure Glipizide - Correct answer oral sulfonylurea controls blood sugar Levofloxacin (Levaquin) - Correct answer antibiotic testicular self examination - Correct answer perform monthly and on same day perform while taking hot shower bc temps will relax scrotal tissue and make testis hang lower in scrotum use both hands to feel each testis separately palpate gently using thumb and first 2 fingers normal calcium level - Correct answer 8.6-10.2 review heart rhythms - Correct answer lactated ringers is often used for burns - Correct answer addisons disease= hyperpigmentation of the skin - Correct answer what is one of the earliest signs of ICP? - Correct answer change in respsonsiveness what are some expected symptoms in a TBI? - Correct answer low grade constant HA, slowness in thinking, memory problems, loss of balance, poor coordination, constant exhaustion, inc sensitivity to light, and heightened irritability all symtpoms that can last up to 6 weeks bacterial meningitis - Correct answer high fever change in loc nuchal rigidity meningeal signs (positive kernig and brudzinski signs)-- treat with antibiotics what is the kernig sign? - Correct answer patient lies supine, thigh is flexed at right angle, and it hurts to extend leg what is the brudzinski sign? - Correct answer bending of neck causes flexion of knee and hip what are these 3 signs indicative of? - Correct answer meningitis client identifiers - Correct answer first and last name medical record number DOB expected term newborn findings - Correct answer plantar creases up entire sole presence of babinski onset of tpe 2 diabetes - Correct answer after age 40 medicine healers are important part of native american culture - Correct answer be mindul of a patients spirtual needs. allow them to do rituals first thing to do if a pt is in ventricular tachycardia? - Correct answer assess them for a pulse (bc they can either have a pulse or not) how to treat unstable client in vtach with a pulse? - Correct answer synchronized cardioversion how to treat stable client in vtach with a pulse? - Correct answer antiarrythmic meds like amidorone when to initiate cpr and defibrillation with a client in VT? - Correct answer only if there is no pulse what is in the lpn scope of practice? - Correct answer monitor RN findings reinforce education routine procedures like catheterization most medication administrations ostomy care tube patency and enteral feeding specific assessments notify hcp if child temp is over 100.4 after immunizations - Correct answer what are common SE of immunizations? - Correct answer mild fever and soreness and redness at injection site anorexia/fussiness in the first 24 hours GP llb/llla receptor inhibitors (abciximab, etc) can cause serious BLEEDING - Correct answer careful monitoring of puncture site after percutaneous coronary intervention signs of internal bleeding and to watch carefully when GP llb/llla receptor inhibitors are given - Correct answer hypotension, tachycardia, changes in heart rhythm, blood in urine, abom/back pain, mental status changes, black tarry stools thrombocytopenia - Correct answer low platelet count; so this increases risk for bleeding what is SIADH? - Correct answer high antidiuretic hormone production leads to water retention increased total body water DILUTIONAL HYPONATREMIA -will see signs of fluid volume overload, changes in loc, weight gain w/o edema, hypertension, tachycardia -seizure precautions what can hyponatremia cause? - Correct answer SEIZURES, confusion, neurologic complications institute seizure precautions treatment of SIADH - Correct answer fluid restriction less than 1000 ml per day oral salt tablets to inc serum sodium hypertonic saline (3%) or NS IV and/or vasopresson receptor antagonists to decrease renal response to ADH so a pt with SIADH - Correct answer does not need extra fluid needs salt seizure precautions strict I/Os RACE for FIRES in a hospital - Correct answer R: rescue any pts in immediate danger and move them to safety A: alarm- sound alarm C: confine fire by closing all doors to all rooms E: extinguish fire with extinguisher what is asystole? - Correct answer complete absence of ventricular electrical activity in the heart. no ventricular contraction occurs client is pulseless, apneic, and unresponsive how to treat asystole? - Correct answer CPR initiate advanced cardiac life support give epinephrine and/or vasopressin place an airway hepatic encephalopathy - Correct answer sleep disturbances (early), lethargy, coma, mental status altered, not oriented to person place or time, asterixis- flapping tremor of hands, fetor hepaticus, elevated ammonia asterixis - Correct answer flapping tremors of the hands how is asterixis assessed? - Correct answer have pt extend the arms and dorsiflex the wrist what is the drug of choice for SVT? - Correct answer adenosine- administer it rapidly over 1-2 scds and flush after administer as close to heart as possible before the med, how is SVT usually treated? - Correct answer vagal maneuvers what is adenosine? - Correct answer an arrhythmic it treats irregular heartbeats what is the purpose of having a pt do a vagal maneuver? - Correct answer full weight bearing - Correct answer independent; no assistance needed unless they are uncooperative or they are a fall risk, which is 1 person standby partial weight bearing - Correct answer 1 person assist stand & pivot transfer with gait belt or motorized assist device if cooperative 2 person assist with full body sling if uncooperative no weight bearing - Correct answer motorized assist device if cooperative and they have upper body strength 2 person assist with full body sling if uncooperative and/or has no upper body strength clients should use as much of their own weight as possible - Correct answer what usually causes delayed PPH? - Correct answer retained placental fragments what are some risk factors for PPH? - Correct answer a hx of PPH uterine distension uterine fatigue high parity certain meds what do chvosteks/trousseaus signs indicate? - Correct answer hypocalcemia what to do first with an unrestrained pt invovled in a sudden deceleration accident during emergency trauma care? - Correct answer spinal precaustions are first!! before checking pulse AND opening their airway place cervical collar dementia characteristic - Correct answer slow onset family members usually notice first gradual progressive inability to remember recent events delerium signs - Correct answer fluctuating acute mental status changes inattention with disorganized thinking like hallucinations altered level of consciousness and the presence of infection can cause delerium what is a barium enema aka lower GI series? - Correct answer uses fluroscopy to visualize the colon outlined by contrast to detect abnormalities like polyps, ulcers, tumors, and diverticula preprocedure instructions for barium enema - Correct answer -take a cathartic (magnesium citrate, polythylene glycol) to empty stool from the colon -CLD day before procedure for bowel prep and to avoid dehydration. avoid red/purple liquids -NPO 8 hours before test -abdominal cramping may be felt during procedure postproceudre instructions for barium enema - Correct answer chalky white stool until barium passes take a laxative like milk of magnesia to help expel barium drink plenty of fluids to promote hydration and eat a high fiber diet make sure directions given from nurse to uap are specific and explicit - Correct answer GCS score of 8 or below is classified as what? - Correct answer a coma when you are 8, intubate - Correct answer Amyotrophic lateral sclerosis (ALS) typical symptoms - Correct answer limb weakness, dysarthria (difficulty speaking), and dysphagia what is trismus? - Correct answer LOCKJAW inablity to open the mouth due to a tonic contraction of the chewing muscles scarlett fever - Correct answer sandpaper skin rash and fever peritonsillar abcess? a collection of pus - Correct answer a serious complication that can reuslt from tonsilities symptoms include fever, sore throat, dysphagia, trismus, muffled voice, uvula deviation, pooling of saliva normal pH - Correct answer 7.35-7.45 paÓ - Correct answer 80-100 PaCÓ - Correct answer 35-45 HCǑ - Correct answer 22-26 Ó sat - Correct answer 95-99 ABG values that mean ARF are what? - Correct answer PaÓ less than or equal to 60 and PaCÓ greater than or equal to 50 what type of med is clopidogrel? - Correct answer antiplatelet and should be stopped 5-7 days before surgery NSAIDS should also be stopped 7 days before surgery to prevent excess bleeding - Correct answer ginko= bleeding - Correct answer what does foul smelling lochia suggest? - Correct answer endometrial infection what are other signs of endometrial infection? - Correct answer maternal fever, tachycardia, and uterine pain/tenderness WBC is usually elevated up to what during the first 24 hours postpartum? - Correct answer up to 30,000. temperature is also elevated pinworm infection - Correct answer anal itching thats worse at night how much folic acid do pregnant women need daily? - Correct answer min of 400 mcg what foods have folic acid? - Correct answer green leafy vegetables are an excellent source others are beans, rice, peanut butter, and fortified cereals what is topical capsaicin cream (Zostrix)? - Correct answer OTC analgesic that relived minor pain like osteoarthritis special instrution: wait 30 mins after massaging cream into hands before washing orthodox jews cant take capsules why? - Correct answer the gelatin is not kosher (fit to be consumed) what is the most accurate indicator of fluid loss or gain? - Correct answer daily weight what are some risk factors for respiratory depression? - Correct answer elderly underlying pul disease post surgery obesity who should get the flu vaccine? - Correct answer all pts 6 months old or greater unless pt has life threatening allergy to the vaccine or one of its ingredients symptoms of addisonian crisis - Correct answer sudden drop in bp, tachycardia, hypoglycemia, abdom pain, and weakness how to treat - Correct answer give IV hydrocortisone warfarin - Correct answer blocks the availibility of vitamin k and reduces risk of stroke venous thrombosis or PE what is the fluid of choice for the rapid correction of hypotension? - Correct answer 0.9 sodium chloride what is nitroglycerin used for? - Correct answer its a vasodilator that restores myocardial perfusion s/s of dig toxicity - Correct answer visual changes n/v confusion lethargy weakness cardac arrythmias take pulse and withold which med if less than 60? - Correct answer digoxin antihypertensives are held before dialysis - Correct answer never clamp a chest tube during transport of a pt. what may it cause? - Correct answer tension pneumothorax cuz the air has no way to escape what is parallel play that toddlers do? - Correct answer play alongside rather than with other children how to asisst a blind pt with walking? - Correct answer walk slightly ahead of them and to the side, and let them grab onto your elbow post op instructions for total hip replacement - Correct answer AVOID ADDUCTION and hip flexion client supine with hob elevated less than or equal to 45deg what are the steps to deliver a dose via a metered dose inhaler MDI? - Correct answer shake MDI and attach to spacer exhale completely place lips tightly around mouthpiece deliver one puff of med into spacer take a slow deep breath and hold it for 10 scds rinse mouth with water why is putting an IV in the arm of a mastectomy contraindicated? - Correct answer any trauma to the arm on the operative side can cause lymphedema with painful and lengthy swelling what are some reasons for venipuncture to be contraindicted un upper extremities? - Correct answer weakness paralysis infection av fistula or graft mastectomy what are the 2 clinical features of MDD - Correct answer depressed mood and loss of interest or pleasure why do opioids cause hypotension? - Correct answer they dilate peripheral BVs. if the pt stands it can cause orthostatic hypotension classic heart attack symptoms - Correct answer dizziness, sweating cold clammy skin, sob, n/v, ischemic chest pain, pain radiating to neck, jaw, left shoulder, arms, epigastrum symptoms of a pleural effusion - Correct answer dyspnea on exertion, non-productive cough, diminshed breath sounds, dullness to percussion, dec tactile fremitus how soon after a blood transfusion does an acute hemolytic reaction occur? - Correct answer 15 mins what are normal fetal heart tones? - Correct answer 110-160 what is nifedipine? - Correct answer calcium channel blocker antihypertensive. do not give if bp on the lower end range what side effects do beta adrenergics have? - Correct answer tremor or palpitations normal sodium value - Correct answer 135-145 if sodium is too low what could this lead to? - Correct answer altered mental status and seizures cystic fibrosis - Correct answer bronchodilators before chest physiotherapy diet high in fat calories and proteins pancreatic enzyme supplements with all meals and snacks recurrent respiratory infections what can determine if a person with heart problems can resume sexual activity? - Correct answer walking 1 block or climbing 2 flights of stairs without symptoms what is a major complication of RA? - Correct answer morning stiffness. how to fix? take a warm shower or bath characteristics of neuroleptic malignant syndrome - Correct answer fever, muscle rigidity, altered mental status, sweating, hypertension, and tachycardia what does torsades de pointes look like - Correct answer a strand of dna what is the first line of treatment for torsades de pointes? - Correct answer iv magnesium a porlonged QT interval is usually the result of electrolyte imbalances so what is usually the treatment? - Correct answer look for electrolyte in the answer what is the drug of choice for SVT? - Correct answer adenosine while talking with a delusional pt, focus on the pts feelings and reinforce reality - Correct answer for priority questions, anything with a new onset problem is usually first - Correct answer in therapeutic communication, dont choose "why" questions - Correct answer birth weight should double at 6 mo and triple at 12 mo - Correct answer when does the anterior fontanel close? - Correct answer 18 mon when does the posterior fontanel close? - Correct answer 2 months whatis typically seen in a retinoblastoma? - Correct answer absence of red reflex. the pupil reflects a white color what route is the best way to give burn victim meds? - Correct answer IV 14 gauge catheter - Correct answer fluids and drugs in prehospital or emergency setting or hypovolemic shock 18 gauge - Correct answer infusing blood or large amounts of fluids in adults drug for fibromyalgia - Correct answer duluxetene (cymbalta) it has both antidepressant and pain reliving affects its also perscribed for MDD what is fobromyalgia? - Correct answer abnormal cns pain transmission and processing incentive spirometer use - Correct answer piston rises with each deep inhalation why isit used> - Correct answer tp revent atelectasis in post op clients how many breaths are recommended? - Correct answer 5-10 breaths per session every hour while awake process for breathing from an incentive spiromeyer - Correct answer sit in high folwers or sitting seal lips tightly to prevent air leakage inhale deeply hold breath for 2-3 seconds exhale slowly breathe normal for several breaths before repeating the process cough at the end of the session what is a serious side effect of statin drugs? - Correct answer muscle aches and weakness if mypopaty is present, what will ve very elevated? - Correct answer creatinine kinase side effect of clcium channel blcokers? - Correct answer headaches what is radioactive iodine used for? - Correct answer to destroy the thyroid gland in pts with hyperthyrpid disorders like graves disease. this makes them permanently hypothyroid which makes them take lifelong thyroid supplements the use of radioactive iodine is contraindicated in - Correct answer a pregnant client. all females should be tested before lyme disease - Correct answer initial symptoms: flu like ha, fever, myalgia, fatigue, bulls eye rash. give antibiotics to prevent it from spreading to heart brain or joints any condition that causes a decrease in RR is at risk for reveloping - Correct answer respiratory acidosis respiratory acidosis - Correct answer low ph and high pacó metabolic acidosis - Correct answer low ph and low hcǒ respiratory alkalosis - Correct answer high ph and low pacó metabolic alkalosis - Correct answer high ph and low hcǒ hypoventilating can cause a buildup of carbon dioxide in the blood and can lead to - Correct answer respiratory acidosis delusions of reference - Correct answer cts believe songs nespaper articles the radio and other things are personal and significant to them somatic delusion - Correct answer of having some physical defect or disease persecutory (paranoid) delusion - Correct answer the belief of being treated in a malicious way what is creatinine clearance> - Correct answer a measure of glomerular function and an indicator for renal disease progression it is a 24 HOUR URINE COLLECTION. the test must be started again if all urine in the 24 hours period is not collected when the test begins, the first urine is taken and thrown away what is palliative care? - Correct answer manages symptoms, provide psychosial support, coordinate care to relieve suffering and improve quality of life for cts with serious illnesses classic symptoms of a rotator cuff injury - Correct answer shoulder pain & weakness, sever pain on arm abduction what is a saline lock? - Correct answer the cap that goes onto an iv insertion catheter. it allows you the ability to stop giving iv fluids and then start again at a later time without having to do another venipuncture patient with the flu precautions - Correct answer droplet be in 3 ft when coughing or sneezing place mask on pt when transporting what is the purpose of unfractioned heparin? - Correct answer to slow the time it takes the blood to clot thereby keeping the current clot from getting bigger and preventing new ones from forming homonymous hemianopsia - Correct answer loss in half of the visual field on the same side oxytocin - Correct answer induction or augmentation of labor should be given by an electronic infusion pump requires frequent mother/fetal assessment adverse affects: maternal hypotension and water intoxication what are some seizure triggers? - Correct answer excess caffeine, alcohol, sleep deprivation, and stress phenytoin - Correct answer gingival hyperplasia dont give nsaids with nasal polyps - Correct answer dont give beta blockers to asthma patient - Correct answer treat asthma with - Correct answer albuterol. SE: n/v, insomnia, palpitations, tremor proton pump inhibitors can increase the risk of - Correct answer C-diff common proton pump inhibitors PPIs - Correct answer Prazoles: omeprazole, lansoprazole, etc heparin is measured thru what levels? - Correct answer PTT normal wbcs - Correct answer 4,000-11,000 a pt with heparin should have a ptt of 1.5-2 times the normal range which is 25-35 scds - Correct answer what is the causitive agent of fifth disease? - Correct answer human parvovirus fifth disease - Correct answer "slapped face" distinct red rash on cheeks its on communicable before the onset of symptoms spreads via respiratory PKU - Correct answer low phenylalanine diet specal infant formula no meat eggs or dairy warning signs of cancer - Correct answer CAUTION what do rales (crackles) indicate? - Correct answer fluid in the lungs proper nasal spray administration - Correct answer high fowlers and head bowed slightly forward occlude one nostril and put it in open one point tip toward side and away from center spray while inhaling deeply normal platelets - Correct answer 150,000-400,000 how to close a hemovac - Correct answer compress to create negative suction pressure and APPLY PLUG BEFORE RELEASING THE PRESSURE most important to monitor bulemic pts when? - Correct answer cystic fibrosis - Correct answer chest physiotherapy- to remove secretions that cause ineffective airway clearance CF is genetic HIGH fat HIGH calorie diet liberal fluid intake when would you see dry shiny hairless skin? - Correct answer peripheral atherosclerotic arterial disease wilms tumor is on the - Correct answer kidney presents as abnormal bulging on one side of child's abdomen DO NOT PALPATE ABDOMEN process for a burn at home - Correct answer soak in cool water to stop buring process remove clothing around burn cover with a clean dry cloth dont put any meds or anything on the wound post surgical pts are usually perscrbed which prn med to help from the opioid drugs they were on - Correct answer naloxone (Narcan) but it wears off in 1-2 hours so be prepared to give more than once monitor RR and give oxygen cushings triad - Correct answer bradycardia, slowed RR, widened pulse pressure what is the normal pulse rate for a 1 year old - Correct answer 100-160 hypokalemia can cause - Correct answer heart arrythmias and muscle cramps and weakness what do you closely monitor when giving furosemide? - Correct answer blood pressure potassium BUN creatinine what type of medication is clopidogrel? - Correct answer antiplatelet "look, listen, feel" approach - Correct answer ppl with long bone or pelvic fractures are at risk for developing what? - Correct answer fat embolism what patients are considered immunosuppressed? - Correct answer on steroids/chemo, HIV pos, new post op, multiple chronic co morbidities, splenectomy, diabetes, very young/elderly what kind of precautions do you need for open lesions from shingles? - Correct answer both contact and airborne precautions and a negative airflow room symptom of macular degeneration - Correct answer loss of central field of vision seeing small flashes of light is a sign of - Correct answer retinal detachment when are pancreativ supplements taken? - Correct answer with or judt before every meal what will chronic pancreatitis show in stool - Correct answer greasy, foamy, foul-smelling, fatty how about biliary obstruction - Correct answer light gray clay colored RA causes bilateral symmetrical pain insmall joints of hands wrists and feet - Correct answer displacement - Correct answer angry at boss and comes home yelling at wife warfarin - Correct answer monthly INR spironolactone - Correct answer potassium sparing diuretic liver dysfunction abnormalities - Correct answer low albumin, high ammonia, elevated INR/PT, increased bilirubin, low platelets symptoms of malignant hyperthermia - Correct answer tachycardia, tachypnea, rigid jaw, high fever. it is triggered by drugs used for anesthesia give them IV DANTROLENE PTSD patients tend to - Correct answer blame themselves. make sure to tell them it wasnt their fault how to use the peak flow meter for asthma - Correct answer exhale quickly and forcibly thru the mouthpiece nursing care for acute pancreatitis - Correct answer NPO IV opioids IV fluids NG tube for suction what puts a patient at risk for preterm labor? - Correct answer infection like periodontal disease symptoms of active tuberculosis - Correct answer cough, ,fever/chills, malaise, weight loss, night sweats, anorexia, fatigue positive T skin test abnormal chest xray can transmit latent TB infection - Correct answer positive TST, neg chest xray, asymptomatic, cant transmit steroids can convert latent to active TB - Correct answer what is an amniotomy? - Correct answer artificial rupture of the membranes what should the nurse do during an amniotomy? - Correct answer assess FHR before and after, note characteristics of amniotic fluid, assist client to an upright position after the procedure symptoms of anaphylaxis - Correct answer oral/airway swelling dizziness tachycardic stridor/hoarseness wheezing rash pruritis flushing n/v abdom pain treatment of anaphylaxis - Correct answer IM epinephrine before starting on statin drugs, what must be checked? - Correct answer liver function tests bc they can cause hepatotoxicity what can statins cause? - Correct answer muscle aches and can lead to rhabdomyolysis aphasia - Correct answer inability to express thoughts and comprehend language what does a pt with Marfan syndrome look like - Correct answer tall and thin. they often have heart abnormalities so contact sports are dicouraged so no contact sports with Marfan syndrome - Correct answer what is the Bishop score? - Correct answer assesses and rates cervical favorability and readiness for induction of labor. a score above 8 is good carbidopa-levodopa - Correct answer treats parkinson's- improves spontaneos activity seen with this disease what does a person see with glaucoma eye - Correct answer tunnel vision what does a sacral dimple on a newborn signify? - Correct answer spina bifida what is a normal newborn HR - Correct answer 110-160 what type of drug is clopidogrel, prasugrel, and ticagrelor - Correct answer antiplatelet prior to an EEG which diagnoses seizures: - Correct answer non caffeine, stimulants or depressants wash hair what is Duchenne muscular dystrophy? - Correct answer childhood form of MD x linked recessive lacks protein called dystrophin for proper muscle stabliizing mucles of proximal lower extremities are affected first they do the gower sign to help them stand remove clutter to prevent falls what is the gower sign? - Correct answer uses ones hands to rise from sqaut to a chair x linked recessive - Correct answer carried by females and affects males what is methotrexate? - Correct answer antineoplastic, immunosuppressant to treat malignancies when is digoxin held in kids? - Correct answer pulse less than 90 ARBs and ACE inhibitors are contraindicated in - Correct answer pregnancy what does elevated cvp mean - Correct answer right vent failure or fluid overload c diff room needs - Correct answer single rubella titer is contrain in - Correct answer pregnancy mass casualty goal - Correct answer greatest good for greatest # of ppl furosemide can cause what - Correct answer ototoxicity lithium toxicity - Correct answer GI side effects mainly client self determination act - Correct answer clients must be given info about their rights to identify written directions about the care that they wish to get in the enent they become incapacitated and are unabe to make healthcare decisions.asked about advance directive on admission 2 types of advance directives - Correct answer instructional directive - Correct answer lists medical treatment the client wants to omit or refuse if they become unable to make decision durable power of attorney - Correct answer health care proxy chosen by client to make health care decision on clients behalf id client can no longer make decisons informed consent is not needed for an unconscious adult comes into the er why? - Correct answer bc delyaing treatmnt could causes injury or death to the pt intractible diarrhea - Correct answer chronic, diarrhea that is hard to control influenza is transmitted how? - Correct answer droplet what does a dnr exactly mean to withhold? - Correct answer CPR and other lifesaving measures what is Tofranil? - Correct answer trycyclic antidepressant what is osteoporosis - Correct answer low bone density stage 1 ulcer - Correct answer intact skin non-blanchable with localized rednes stage 2 - Correct answer blister, abrasion, shallow open ulcer red pink wound with no sloughing stage 3 - Correct answer full thickness skin loss with visible sub q fat stage 4 - Correct answer full thickness skin loss exposed muscle tendon or bone unstageable - Correct answer full thickness skin loss ulcer base covered by slough and eschar that needs to be removed to stage which long acting insulins can you not mix? - Correct answer glargine and detemir what does lead poisoning cause? - Correct answer neurological and motor impairment if a chest tube gets dislodged, immediately cover with something sterile or clean if you dont have sterile. what are we trying to prevent here? - Correct answer air from getting into the pleural cavity what is happening in ventricular trigeminy? - Correct answer PVCs are occuring every third heartbeat its dangerous when someone is throwing PVCs why? - Correct answer they could go into a lethal dsrythmia what is the battle sign? - Correct answer bruising behind the ear what could this indicate? - Correct answer skull fracture that could cause brain injury if not treated risperidone- what class and what is it used to treat? - Correct answer antipsychotic used to treat schizophrenia and bipolar what are some potential side effects of antipsychotic meds? - Correct answer -extrapyramidal symptoms like akathisia, parkinsonism (tremor, rigidity, etc) -anticholinergic effects -orthostatic hypotension -sedating effects -tardive dyskinesia -neuroleptic malignant syndrome what is akathisia? - Correct answer restlessness with inability to sit still tardive dyskinesia - Correct answer involuntary movements like face tongue trunk that you cant control neuroleptic malignant syndrome - Correct answer fever, muscle rigidity, altered mental status anticholinergic effects - Correct answer dry mouth and constipation what are some meds that treat EPS? - Correct answer benzos like "pam" drugs and benadryl blood products should not be left at room temp for more than 30 minutes before being given - Correct answer if patient has hyperkalemia, what drugs should they not have - Correct answer ace inhibitors and angiontension 2 how often should ostomy bags be changed? - Correct answer every 5-10 days when should an ostomy bag be emptied? (when it is how full?) - Correct answer when it is 1/3 full lithium toxicity symptoms - Correct answer acute: GI disturbances: nausea, vomiting, diarrhea neuro finding can occur later chronic- neurologic ataxia, confusion, tremors nitroglycerin is why type of drug? - Correct answer antianginal vasodilator that may cause a headache what are wheezes? - Correct answer continuous, high pitched musical adventitious sounds caused by air movement through narrow bronchi and bronchioles placental abruption - Correct answer the placenta prematurely detaches from the uterine wall what are the priorities of care for suspected placenta abrupto? - Correct answer monitor mom for fluid status and fetal heart tones bc it can cause maternal hemorrhage and/or fetal oxygen supply interruption what are some symptoms of placental abruption? - Correct answer frequent contractions, abdom pain, dark red vaginal bleeding placenta previa - Correct answer when the placenta covers the opening of the mothers uterus it usually presents with painless vaginal bleeding what does an ST elevation indicate? - Correct answer myocardial infarction bc one or more of the coronary arteries that supply blood to the myocardium are occluded what are some causes of the low pressure limit on a ventilator? - Correct answer loss of airway (exubation), endotracheal or tracheostomy cuff leak, or tubing disconnect, all of which impair airway and ventilation what number is the normal, expected deep tendon reflex? - Correct answer 2+ presence of neurological change in pregnant women may indicate what? - Correct answer worsening preeclampsia what is clonus? - Correct answer cause is neurological; it is rhythmic muscle spasms how to assess for clonus? - Correct answer nurse dorsiflexes the foot with one hand and supports the leg/ankle with the other. when positive clonus is shown, rhythmic jerking beats of the foot are present as the foot is released reactive nonstress test vs nonreactive nonstress test - Correct answer reactive nonstress test you have a baseline of 110-160/min, moderate variability and 2 or more accelerations in 20 mins and nonreactive does not meet criteria for reactivity is reactive nonstress test positive or negative? - Correct answer POSITIVE where to look for certain things in dark skinned patients - Correct answer jaundice? - Correct answer palms of hands and soles of feet petechiae? - Correct answer buccal mucosae and conjunctivae of the eyes cyanosis? - Correct answer nail beds of fingers/toes s/s of myocardial infarction - Correct answer chest pain, diaphoresis, dyspnea, anxiety TORCH infections cause what? - Correct answer fetal abnormalities what does TORCH stand for? - Correct answer Toxoplasmosis Other (parvo/varicella/zoster) Rubella Cytomegalovirus Herpes simplex virus late or variable deceleration indicate what in pregnancy? - Correct answer not good and need further teaching nursing interventions that decrease ICP? - Correct answer HOB at 30 degrees keep head and body midline give stool softeners suction only when necessary provide a calm environment with dimmed lights treat fever symptoms of RSV in infants - Correct answer excessive mucous production, rhinorrhea, fever, cough, lethargy, irritability, poor feeding RSV interventions - Correct answer give oxygen elevate HOB airway suction give antipyretics IV fluids CONTACT AND DROPLET isolation bipolar pt comes in and is experiencing acute mania. what is the priority? - Correct answer NOT risk prone behavior bc physiological needs like food take priority (remember maslows). so imbalanced nutrition would be the priority MEMORIZE MASLOWS - Correct answer PSILOVEYOU Pysiological, Safety, Self actualization, Love and beloning, Self esteem having a patient bring their meds to each appointment is the appropriate thing to do - Correct answer botulism is what and caused from? - Correct answer GI absorption of toxin produced by clostridium botulinum from improperly canned or stored food. found in soil and can grow in food. look out for swollen/bulging cans what does botulism cause? - Correct answer muslce paralysis children under what age should not be given honey? - Correct answer 1 year serious form of preeclampsia condition called HELLP stands for what? - Correct answer Hemolysis, Elevated Liver enzymes, Low platelets- delivery right away females prescribed Accutane must have what - Correct answer -2 negative pregnancy tests before starting -must use 2 forms of contraception -enroll in a risk management program to make sure these are both being followed through loop diuretics like Furosemide can cause what? - Correct answer hypokalemia what is an example of potassium sparing diuretics? - Correct answer Spironolactone (Aldactone) it is normal for children to regress while hospitalized - Correct answer signs of Epiglottitis - Correct answer sore throat, dyshagia, drooling, respiratory distress, and sitting up/leaning forward AN EMERGENCY- PREPARE FOR EMERGENCY AIRWAY- INTUBATION/TRACHEOSTOMY signs of croup - Correct answer upper respiratory tract symptoms, hoarseness, barking cough, stridor, respiratory distress urinary retention is an expected side effect of opioids - Correct answer majority cases of epiglottitis are caused by what? - Correct answer HiB. if kids are vaccinated, this is rarely seen most cases of epiglottitis are prevented by what? - Correct answer standard immunizations with a balloon tamponade tube, what should always be kept at the bedside? - Correct answer scissors most frequet sites of bleeding in a hemophiliac are where? - Correct answer the joints contraindication meds for heart failure - Correct answer NSAIDS UAPS can assist with passive and active ROM exercises that they were taught by the nurse or PT - Correct answer Thiozolidinediones like rosiglitazone and pioglitazone treat type 2 diabetes. these drugs can worsen what condition? - Correct answer heart failure when you think hyperkalemia, think what? - Correct answer CARDIAC PROBLEMS what can cause pseudohyperkalemia? - Correct answer hemolysis or clotting during the blood draw normal labor symptoms - Correct answer intermittent pain with contractions, small amount of blood-tinged mucus "bloody show" placental abruption symptoms - Correct answer sudden-onset vaginal bleeding, abdominal pain, frequent uterine contractions placenta previa symptoms - Correct answer painless vaginal bleeding, ultrasound shows placenta covering cervical os after a med error happens, what should you always do first? - Correct answer assess the patient when on crutches, lok forward when walking an not down at feet - Correct answer what ABG values indicate ARF? - Correct answer low PaO2 and high PaCo2 how to fix ARF immediately? - Correct answer high concentrations of O2 always try least restrictive before using restraint. nclex wants you to know this so most likely the answer is not going to be apply restraint. - Correct answer remember the 5Ps to compartment syndrome - Correct answer paresthesia, pain, pressure, palor, pulselessness what can cause atelectasis after surgery? - Correct answer retained secretuons a patient with a total knee arthroplasty should be what by discharge? - Correct answer fully weight beaaring left side heart failure symptoms - Correct answer pulmonary edema, dyspnea, orthopnea, crackles right side heart failure - Correct answer JVD, hepatomegaly, splenomegaly, ascites, edema what does the peak mean when giving insulin? - Correct answer when the insulin works to its maximum to lower the blood sugar rapid acting insulin peak (aspart, lispro, glulisine) - Correct answer 30mins-3 hours short acting (regular) insulin peak - Correct answer 2-5 hrs intermediate acting (NPH) - Correct answer in 4 hours long acting (detemir, glargine) - Correct answer 4-9 hrs *memorize that insulin paper i have - Correct answer always report bright red blood to hcp, dark blood is ok - Correct answer how to give morphine iv push - Correct answer dilure and give slowly over 3-5 mins abdominal surgery and other procedures with bowel manipulation caise what for the bowels for the first 24-48 hours? - Correct answer absent bowel sounds how are bowel sounds determined absent - Correct answer nurse listens for 2-5 mins in each quadrant differences btwn SIRS, septic shock, and mods - Correct answer order of progression from sirs to mods - Correct answer SIRS--> sepsis -- > septic shock --> MODS when can fetal sex be determined? - Correct answer end of 12 weeks what is polycythemia? - Correct answer too many RBCs target therapy for polycythemia - Correct answer phlebotomy to remove some of those RBCs what is monitored carefully after an abdominal aortic aneuryim repair? - Correct answer renal status so things like BUN, creatinine, and urinry output skin cancer neumonic ABCDE what does it stand for? - Correct answer Assymetry Border irregularity COlor changes Diameter more than a pencil eraser Evolving or changing in any way if a patient has a chest tube and all of the sudden the rainage stops, what are some interventions? - Correct answer -lung sounds (bc maybe the lungs have re expanded and there is no more drainage) -reposition patient -get them to cough and deep breathe milking chest tubes - Correct answer generally contraindicated bc it messes with the pressure changes in the pleural space care of anorexic patient - Correct answer -determine pt daily calorie requirement -monitor weight at same time every day with same scale, same amount of clothes on -limit exercise initialy bc they are obsessed -reflecting with the patient on triggers -dont encourage a log of food bc this contributes to patient's obsession with food after a thyroidectomy, there shouldnt be swelling of the neck or increased pain. what could this indicate? - Correct answer hematoma formation or increased tissue inflammation which affect airway patency. this patient shoudl be seen first hepatic encephalopathy symtpoms - Correct answer compliction of ESRD build up ammonia in the blood lethary, confusion, slurred speech, can lead to coma watch for asterixis- flapping hand tremors what med is given for encephalopathy? - Correct answer Lactulose bc it gets rid of the ammonia stress ulcers can develop in critically ill patients so what helps with this? - Correct answer enterel feedings asthma - Correct answer frequent cough at night how long hsould an acceleration last on a fetal heart strip? - Correct answer 15 min above the baseline lasting for at least 15 scds-- means fetal ovement is moderate variability considred normal? - Correct answer yes and is 6- 25/min late or variable decelerations are BAD- inadequate fetal oxygenation - Correct answer what is the Allen's test? - Correct answer determines patency of the ulnar artery. pt makes a fist and radial and ulnar arteries are occluded. pt opens fist and pallor is shown on hand from non blood flow. nurse releases pressure on arteries and blood flow is returned to hand. allens test should be positive and if negative, another artery should be used before ABGs are taken, what test must be performed? - Correct answer the Allen's test can UAPs transfer a dead client to the morgue? - Correct answer yes cardinal physical sign of Parvo aka fifth disease is what? - Correct answer slapped cheek rash. spread person to person esp with respiratory secretions remember with bulemia, which gland is swollen? - Correct answer parotid gland what types of drugs are used to treat ADHD? - Correct answer stimulants like Ritalin and Adderall what is the trade nae for methylphenidate? - Correct answer Ritalin what are some side effetcs of stimulants? - Correct answer -decreased appetite and weight loss -hypertension and tachicardia -restlessness or insomnia -vocal/motor tics -addiction/misuse potential if on oxytocin for induced labor and having more than 5 contractions in 10 minutesk what shuould the nurse do? - Correct answer stop the infusion what to do if patient is on oxytocin and late decels, fetal bradycardia, tachycardia, and decreased variability happen, what does the nurse do in order? - Correct answer -stop the oxcytocin right away -put pt in side lying position -give oxygen (10L via face mask) -IV fluid bolus -maybe give terbutaline -notify HCP -document things that UAP are alloqed to do - Correct answer passive/active ROM exercises, transport body to the morgue, pick up something from pharmacy burning at the IV site can indicate and lead to what? - Correct answer can indicate phlebitis which can lead to thrombophlebitis (blood clot) pca pumps have a running IV line attached to deliver a flush each time a dose of the pca is delivered, this is to make sure the patient gets all of the pain med and thus has adequate pain control - Correct answer when is the only time that procedures can be performed without getting informed consent first? - Correct answer lifesaving procedures what is tiotropium (Spiriva) and what/how is it used for? - Correct answer long acting, 24 hour, anticholinergic inhaled med used to control COPD. given using capsule-inhaler system where the capsule is placed in the device and a buttom is pressed to put a hole in the capsule and the powder is dispered thru the inhaler. it should not be used as a rescue med for example if someone has trouble breathing, thats where you woulld use the short acting like albuterol important teaching for tiotropium - Correct answer do not take the capsule orally even though it comes in a capsule and look slike you do. the buttom must also be pushed on the inhaler for the med to be dispersed Ipratropium - Correct answer is the short acting anticholinerguc used as a rescue med for COPD and asthma is a child is having sepration anxiwty in the hospital, what are some things nurses can do to reduce the anxiety - Correct answer have parent leave familiar objecs in room, dont leave them alone when upset, establish daily schedule thats familira to the one at home, give child time to play many people use St. John's wort to tret what? - Correct answer depression what meds does St. John's wort interact with - Correct answer antidepressants like SSRIs, SNRIs, MAOIs can increase side effects and lead to serotonin syndrome from too much serotonin symptoms of serotonin syndrome - Correct answer mild (shivering and diarrhea) sever (muscle rigidity, fever, seizures) also tachycardia and hypertension also agitation/restlessness patient care for acute manic episode - Correct answer -reduce environment stimuli -calm quiet low lit -limiting person contact -ONE on ONE- not group activities -structured scheudle of activities to keep focus -physical activities one on one to relieve energy -high protein high calorie finger foods -SET LIMITS before a lumbar puncture teaching - Correct answer empty bladder lateral recumbent (fetal position) or sitting pain may be felt radiating down leg but should be temporary after a LP teaching - Correct answer lie flat with no pillow for atleat 4 hours incrase fluid intake what does normal CSF look like/contain? - Correct answer colorless and odorless a little protein, glucose, minimal wbcs, no rbcs, and no microorganisms digoxin function - Correct answer increases cardiac contractility but slows heart rate EXCRETED BY THE KIDNEY when is digoxin used? - Correct answer in heart failure to increase cardiac output and in afib to reduce the heart rate what labs to check before giving digoxin? - Correct answer BUN and creatinine bc this drug is mostly excreted by the kidney who to watch for while taking digoxin? - Correct answer elderly and those with kidney injury bc they ave decreased kidney function and digoxin can build up so they must be monitored frequently early signs of dig toxicity - Correct answer nausea and vomiting late signs of dig toxicty - Correct answer arrhythmias dince dig lowers the heart rate, it is important tpo check what before giving? - Correct answer the heart rate. make sure it is above 60 bpm Fluoxetine (Prozac) - Correct answer antidepressant SSRI containdications to thrombolytics - Correct answer -previous brain bleed -ischemic stroke or head trauma within 3 mo -active bleeding -cerebral aneurysm all thrombolytics lyse the pathologic clot (one whats causing the MI) and may lyse other clots so bleeding is a complication having chest pain typical of acute MI for 6 hours or less and no absolute contraindications you can then be given what - Correct answer thrombolytic therapy watch ALS patients for swallowing and respiratory difficulty - Correct answer what is dysarthria? - Correct answer worsening ability to speak- can lead to respiratory distress meds should be stored specfcaly how when hiding from children? - Correct answer out of sight up in a cabinet and locked what should the nurse do if the chest tube becomes separated from drainage tubing and is not contaminated? - Correct answer wipe the end with antiseptic immediately reconnect it, and secure with tape what about if a chest tube separates from the drainage tube and becomes contaminated? - Correct answer submerge the distal end 1-2 cm below the surface of sterile water to create a water seal so that air does not get in. keep bottle of sterile water, clamps, and antiseptic wipes at the bedside clamping a chest tube should not happen for longer than a minuteand only if perscribed by the HCP - Correct answer characteristics of herpes zoster - Correct answer unilateral linear pattern of fluid filled blisters patients report pain and itching the varicella zoster virus can cause what 2 things? - Correct answer chicken pox and shingles relation of varicella/chicken pox/herpes zoster - Correct answer varicella causes chickenpox in childhood and then the virus goes dormant. what are some iron rich foods? - Correct answer meats- beef, lamb, liver chicken, pork shellfish- oysters, clams, shrimp eggs, green leafy veggies, broccoli, dried fruits, dried beans, brown rice, oatmeal eating foods rich in vitamin c like citrus fruits potatoes and tomatoes and also orange juice can enhance the absorption of iron a nurse should listen to breath sounds of a client with heart failure related fluid overload bc they are likely to have dyspnea, orthopnea, and rales/crackles - Correct answer fall risks - Correct answer 65 or above the use of assistive ambulatory devices like canes or crutches orthostasis taking sedatives or antiparkinson med like Sinemet (carvidopa/levidopa) potassium sparing diuretics and ACE inhibitors cause hyperkalemia - Correct answer indicatrs of increased ICP - Correct answer change in LOC (often the first sign), cushings triad, and pupillary changes) if spine injury is suspected, do not use the head tilt chin lift method as this could damage the spine further. what do you use instead? - Correct answer jaw thrust maneuver with any suspicion of spinal injury in a trauma, always use the jaw manuever - Correct answer given what meds in hypovolemic shock (besides fluids) ? - Correct answer norepinephrine and dopamine what type of fluids would someone need while in hypovolemic shock? - Correct answer isotonic like normal saline and lactated ringers in cystic fibrosis, pancreatic ducts are blocked in the GI tract due to thick secretions that clog them. therefore they are deficient in what type of enxymes? - Correct answer pancreatic enzymes that are given with meals cystic fibrosis diet - Correct answer high calorie, high fat, high protein kidney disorders diet - Correct answer low phosphate heart failure, ascites, hypertension diet - Correct answer low sodium (fluid overload states) antisocial personality disorder - Correct answer they disregard rules, hx of irresponsible behavior, and blame others for their actions. SET LIMITS with them make them aware of the rules and acceptable behaviors in pregnancy, pts are considered anemic when hemoglobin drops below what? - Correct answer <11 the elderly should avoid which type of drugs - Correct answer sulfonylureas- can cause prolonged hypoglycemia what is the Beers criteria? - Correct answer lists potentially inappropriate drugs thar lead to adverse effects in the elderly Naegele's rule - Correct answer add 9 months and 7 days to LMP conception occurs around the time of ovulation and is about 14 days frmo the beginning of the LMP - Correct answer in Arab culture, a man is not allowed to be alone with a woman other than his wife - Correct answer ulcerative colitis - Correct answer inflammation/ulcerations in the large intestines causing urgent, frequent, bloody diarrhea, abdom pain, anorexia, and anemia clients with alcoholism are commonly deficeint in which vitamin? - Correct answer thiamine what can thiamine deficiency lead to? - Correct answer Wernicke encephalopathy what should all intoxicated patients be given? - Correct answer IV thiamine before or with IV glucose signs of phenytoin toxicity - Correct answer ataxia, nystagmus, slurred speech, decreased mentation what type of device would be placed in a client with sudden kidney failure requiring immediate dialysis? - Correct answer central venous catheter how to deliver a dose via a metered dose inhaler? - Correct answer - shake MDI and attach to spacer -exhale completely -place lips tightly around the mouthpiece -deliver a single puff of med into spacer -take a slow deep breath and hold for 10 scds -rinse mouth with water after dose acute hemolytic reaction - Correct answer develops within the first 15 mins s/s are: chills, feverm lower back pain, tachycardia, tachypnea, and hypotension Nifedipine (Procardia) is what? - Correct answer calcium channel blocker antihypertensive- dont give if hypotensive infants should not be throwing up green vomit, this could indicate what? - Correct answer bowel obstruction when should statin drugs be taken? - Correct answer evening meal or at bedtime positioning for paracentesis - Correct answer upright semi or high fowler inferior vena cava filter is placed where and does what? - Correct answer in the femoral vein and catches blood clots from the legs from going to the lungs bile - Correct answer made in liver and helps aid in digestion why is throwing up green vomit an emergency? - Correct answer his is indicitaive of bile ad coule mean its a bowel obstruction what does frosstbite a ctually men - Correct answer ice crystals form n the intracellular spaces causing peripheral vasoconstriction and reduced blood flow superficial frostbite looks: mottled, blue, or waxy yellow deeper frostibite looks: white heard and unable to sense touch leads to gangrene treatment of frostbite - Correct answer remove clothing/jewelry to prevent vasoconstriction do not massage rub or squeeze he affeected area immerse affected areas in warm water provide analgesia- rewarming is painful elevate affected areas let areas become dry then put loose nonadherent dressings what does lactulose do? - Correct answer decrease intestinal ammonia absorption in pts with liver disease and hepatic encephalopathy what should a client be having daily as a result of taking lactulose? - Correct answer 2-3soft stools per day TIPS procedure is used for what? - Correct answer esophageal varices what is spironolactone and what is it used in? - Correct answer potassium sparing diuretic used in liver failure, ascites, and edema to promote diuresis EpiPen delivery - Correct answer can be delivered through clothing in the out thigh hold for 10 scds so all med goes in then massage the thigh for 10 more scds when is IV epinephrine indicated? - Correct answer profound hypotension or when a pt does not repsond to IM epinephrine and fluid resuscitation should bulemic patients be allowed to keep a doof diary in the hospotal? - Correct answer yes, to keep track of the amount and type of food the client has eaten the deluvery if oxytocin - Correct answer given through an infusion pump into a proximal port (not distal) monitor FHR and uterine contraction pattern at least every 15 mins monitor intake and output continuous FHR monitoring be careful for giving too much oxytocin why - Correct answer can lead to uterine tachysystole, decreased placental perfusion, and fetal distress. this is why its given via an infusion pump so there are no med errors why do we monitor intake and output during oxytocin infusion? - Correct answer can lead to water intoxication metoprolol - Correct answer slows the HR and lowers the BP review heart strips and which meds to be given/actions to take when patients are in certain heart rhythms - Correct answer hydrocdone/aceteminophen oral tablet is typically used for what type of pain? - Correct answer moderate morphine is typically used for what type of pain? - Correct answer severe remember when measuring fundal height, that after 20 weeks it correlates with number of weeks pregnant. so if you are 24 weeks pregnant, the fundal height should be 24cm above the pubis sympysis - Correct answer what is quickening? - Correct answer the awareness of fetal movement when should quickening happen? - Correct answer 18-20 weeks in first time baby havers and sooner for previous moms first trimester in weeks - Correct answer 1-12 weeks second trimester in weeks - Correct answer 13-26 weeks third trimester in weeks - Correct answer 27 weeks to end of pregnancy how to calculate MAP? - Correct answer 2xdiastolic + systolic all divided by 3 proton pump inhibitors examples - Correct answer pantoprazole and omeprazole given for GERD, ulcer treatment and prophylaxis IV proton pump inhibitors are given for - Correct answer gastric ulcer bleeding what antibiotic is used for cdiff? - Correct answer vancomycin what are lab results that support a vaso-occlusive crisis (pain crisis) in sickle cell patients? - Correct answer elevated reticulocytes elevated bilirubin anemia high reticulocytes inicate what - Correct answer bone marrow is producing RBCs fast what are mongolian spots and are they normal? - Correct answer they are bluish discoloration of the skin on newborns seen on darker skinned newborns on the back or butt. they isllay fade over 1-2 yrs of life. nurse shouls measure and document bc they look like bruises. they are normal rememebr that when delegating, the nurse can only ask for specific assessments f someting like if there are blood clot in the urine or how mich urine is there, they can not ask the UAP to describe what the urine looks like bc this involves assessment - Correct answer the RN can ask the UAP to apply the restraints but the RN cannot ask the UAP to verify if they are on correctly. that is the RNs job - Correct answer childhood of someone with NPD - Correct answer sense of inferiority, poor self esteem, and self criticism what does this cause them to do? - Correct answer try to regulate their self esteem people with narcissistic personality disorder try to maintain what? - Correct answer self esteem what are adverse affects of methotrexate? - Correct answer bone marrow suppression, hepatotoxicity, and GI irritation what does thromboycytopenia (low platelets) present as? - Correct answer petechiae, purpura, or bleeding bone marrow suppression can lead to what? - Correct answer anemia, thrombocytopenia, and leukopenia what should someone take methotrexate with to help with adverse affects? - Correct answer folic acid supplement separation anxiety in babies - Correct answer 6 mo- about 3 years. this is a normal reaction macrolide antibiotics like azithromycin, erythromycin, and clarithromycin can cause what? 2 things - Correct answer -a prolonged QT interval which can lead to torsades de pointes and sudden death -also hepatotoxicity what drug used to treat skin and athritic manisfestaions of Lupus - Correct answer Hydroxychloroquine. when taking, make sure to have an eye appt every 6-12 mo take with food at 6 mo what should baby weigh? - Correct answer double birth weight at 1 year of age, what should an infant weigh? - Correct answer triple their birth weight when does tooth eruption occur in infants? - Correct answer 6-10 months quick formula to calculate number of teeth in the first 2 years of life? - Correct answer age of child in months- 6= expected number of teeth at 12 months, heat and chest circumference are equal - Correct answer what is the best indicator of treatment effectiveness of antibiotics? - Correct answer WBC count avoid IM/venipncture when the platelet count is below what? - Correct answer 50,000 UAP can carry blood products to and from the blood bank - Correct answer heart failure patient having trouble breathing, what to do first? - Correct answer elevate HOB always remember inspection is always done first, then listening, then palpating - Correct answer a normal kidney is not usually palpable, if it is it could indicate disease - Correct answer what drug is given with furosemide to prevent electrolyte imbalances? - Correct answer potassium chloride in a heart failure patient, the nurse should question a maintenance IV line of fluids bc these ots dont need excess fluid, they need fluid removed - Correct answer heart failure patients should be on a what type of diet? - Correct answer low salt what does excess salt cause? - Correct answer retention of water what will excess salt in diet do to BP? - Correct answer higher BP what is myopia? - Correct answer nearsightedness, have trouble seeing objects at a distance what are some hings that happen with myopia? - Correct answer headache, dizziness, poor school performac,e eye rubbing, frequent blinking.squinting when viewing bjects from afar what is strabismus? - Correct answer cross eyes eyes dont look in the same directon at once closing one eye when viewing objects is a sign avoid sex with active herpes lesions and can still be contracted if lesions are not present so use condoms - Correct answer what is Levetiracetam (Keppra) used for? - Correct answer treats seizures the preferred antiepileptic med what is Dexamethasone? - Correct answer corticosteroudoid that reduced inflammation and cerebral edema with brain injury and tumors APETOMAN - Correct answer APETM aortic, pulmonary, erbs point, tricuspid valve, mitral valve valve locations - Correct answer erbs point - Correct answer 3rd ICS tricuspid - Correct answer 5th ICS pulmonic - Correct answer 2nd ICS aortic - Correct answer 2nd ICS mitral AKA apex - Correct answer 5th ICS at midclavicular line what to check labs wise when giving ace inhibitors? - Correct answer BUN/creatinine, potassium, blood pressure what will a child with epiglottitis present like? - Correct answer sitting in tripod position, be drooling, restless, anxious epiglottis- what is it? - Correct answer severe inflammatory obstruction caused by H. influenzae medical emergency!! symptoms progress fast from being asymptomatic to an occluded airway have emergency intubation available what are signs of perforation? - Correct answer abdominal pain (with shoulder tip pain), positive rebound tenderness, gaurding, abdominal distension, boardlike/rigid abdomen elevate HOB or put pt on side use large bore what is the standard treatment for overdose? - Correct answer charcoal (but its inneffective for lithium, iron, and alcohol) infant formula teaching - Correct answer -keep parts of bottles as clean as possible -wash the top of can before opening -keep unused prepared formula or cans in refrigerator after opening but discard after 48 hours -but throw away formula that infant left in bottle -never microwave but instead can be placed in pan of hot water to warm it, then test temp on inner wrist. should be lukewarm -never add water to formula to stretch it what is a magnetic resonance cholangiopancreatography - Correct answer noninvasive diagnostic to see biliary, hepatic, and pancreativ ducts via MRI. contrast (IV gadolinium) given before contraindications of the procedure that should be assessed by nurse beforehand: -any metal/electrical implants -any allergic reaction to contrast -pregnancy- the conrast crosses the placenta nursing care for NG tube feeding - Correct answer -elevate HOB during and after -check gastric residual every 4 hours with continuous feeding or before each intermittent feeding/medication giving -flush tube before and after bolus feedings -aspirate but return contents to stomach -check for excessive residual volume -start feeding after getting residual volume <100 ml -gastric ph should be acidic <5 basically what 2 things do you do before and after wach feeding or medication giving thru an ng tube? - Correct answer check placement and flush tube with sterile water what must be done after ng tube placement? - Correct answer xray to confirm location kidney and liver biopsy what to watch out for - Correct answer bleeding before/after a kidney biopsy - Correct answer -discontinue all antiplatelet and blood thinners one week before -type and cross match in case blood is needed -place in prone position -monitor vitals q15 after for first hour -place patient on procedure side to put pressure -bed rest for 24 hrs what is partial thromboplastin time (PTT)? - Correct answer the time it takes your blod to clot what does an elevated PTT mean? - Correct answer it is taking your blood way too long to clot therefore this is a problem bc you could bleed out- there may be a coagulation factor deficiency therapeutic PTT - Correct answer 1.5-2 times normal reference of 25-35 scds so normal is about 37-70 scds right?? if you times them liver cirrhsis patients will have low platelets - Correct answer Aripiprazole (abillify) - Correct answer antipsychotic for dementia what combination durgs are normally used to treat heart failure? - Correct answer ace inhibitor and lasix calcium carbonate drug is what? - Correct answer calcium supplement why should you not give a baby a bottle of milk or other sugary substance to go to bed? - Correct answer tooth decay cauda equina, amedical emergency - Correct answer injury to L4-L5 causing motor/sensory deficits from pressure on spinal nerves acute spinal/lower back pain and bowel/bladder incontinence its a medical emergency to prevent permanent damage acute cholecystitis may present with shoulder pain - Correct answer what is Meniere disease - Correct answer inner ear disorder vertigo, tinnitis, and muffled hearing if a patient being discarged is a DNR, make sure they ave a bracelet - Correct answer mastitis - Correct answer caused by staph frequent feeding and appropriate latching to prevent what is given to hyerkalemic patients to stabilize the myocardium? - Correct answer calcium gluconate after calcium gluconate, what 3 things are given to actually decrease the potassium in a hyperkalemic patient? - Correct answer IV regular insulin w/ dextrose, sodium polystyrene sulfonate, and hemodialiysis what is the strongest risk factor for late onset Alzeimers? - Correct answer advancing age what do you do if a tooth falls put - Correct answer tooth death can occur in one hour so put the tooth in milk and get help CF kids have thick secretios and lifelong respiratory infections - Correct answer in leukemia, bone marrow activity is depressed and so what does this result in - Correct answer blood cancer *infection low RBC production= *anemia decreased making of platelets= *bleeding what should be checked before giving erythropoietin? - Correct answer blood pressure in continuous bladder irrigation, what should the urine look like? - Correct answer light pink with no clots bladder spasms are expected in bacterial meningitis, what is the priority of care? - Correct answer immediate antibiotics LP with csf is done to find causative organism continuous bublling in a chest tube inicates what - Correct answer an air leak in the chest tube system section C orienting client to the bedside unit is the job or RN or UAP? - Correct answer RN signs of DIC - Correct answer frank external bleeding like venipuncture site bleeding and internal bleeding like petechiae, ecchymosis, hematuria, and bloody stools, also respiratory distress from bleeding into the lungs what to do? replace clotting factors fresh frozen plasma and platelets what modifications to take when giving cpr to a pregnant patient? - Correct answer place them on left side and compress slightly higher on the sternum a pregnant client in the supine is never really good because it compresse the aorta and vena cava - Correct answer normal urine output in mg/hr and mg/kg/hr - Correct answer 30 ml/hr 0.5-1 ml/kg/hr cold clammy skin is a sigh of hypoperfusion in shock - Correct answer Trousseua and Chvosteks are signs of what - Correct answer hyocalcemia what is the trousseau sign - Correct answer blood pressure cuff is inflated and the wrist spasms what is the chvostek sign - Correct answer facial twitch after tapping nerve on side of head hepatitis is diagnosed when liver enzymes are 2-3 times the normal value - Correct answer during a thyrpidectomy, the parathyrpid glands may be accidentally removed bc they are very small in size - Correct answer hypocalcemia can result in - Correct answer tetany, laryngeal stridor, seizures, and cardiac dsyrthmias people taking corticosteroids are immunocompromised and are prone to getting infections - Correct answer local reactions like swelling and erythma, minor illness, exposure o an infectuos source, and allergies to nonvaccine compnents are not contraindications to immunization - Correct answer what is ebola - Correct answer viral hemorrhagic fever extremelt contagious high mortality rate standard, contact, airborne, and droplet precautions so for ppl entering room: impermeable gown/coveralls, N95 respirator, full face shield, dooubled gloves, boot covers, apron no current meds or vaccines to prevent prevention is key there is a strict glove removal process when degloving -client shold have airbonr isolation room, strict ppe use, restrict visitors, and log of ppl who enter room what is transferrence? - Correct answer a client unconscioulsy transfers feelings and behaviors related to a person in the clients past onto the nurse examples: a client states that the nurse reminds them of their sister what is countertransferrence? - Correct answer the nurse unknowingly displaces feelings and behaviors in the nurses past onto the client assessing a sleeping infant - Correct answer auscultate first the palpate/percuss from head to toe then traumatic procedures like eyes, ears, mouth then moro reflex (this is the last step) what is the moro reflex? - Correct answer the startle reflex where the nurse holds the baby and lets it "drop" in her hands and the baby's legs and arms move up in a startle motion/crying most important thing to do t preent stroke in a patient with a ton of risk factors and hyoertension - Correct answer make sure they take antihypertensives SIADH - Correct answer too much ADH is produced causing water retention, increased total body water, and dilutional hyponatremia -can be caused by some central nerve disorders -ADH can sometimes be secreted by lung cancer cells what is peak expiratpry flow? - Correct answer airflow out of the lungs what are symptoms of an asthma exacerbation? - Correct answer wheezing, coughing, chest tightness, dyspnea, retractions. cough may be the earliest sign if a client complains about a staff member mistreating them ,what is the first thing the nurse does? - Correct answer ask patient to describe what happened so the nurse can assess then choose a chourse of action what is the priority when giving 2 neds at the smae time? - Correct answer checking for drug compatibility what is the pavlik harness used to treat - Correct answer DDH in kids. it keeps kids legs bent and spread apart care of infant wearing pavlik hanress - Correct answer assess skin 2-3 times daily put shirt and socks under harness put diapers underneath straps leave harness on at all times adjusting of straps should onlt be done by HCP, not nurse or parent if there is a radiation contamination, see the victims farthest away from the source first - Correct answer in postmortem care, it is ok to let family members assist with care - Correct answer chlorhexidine gives antimicrobial effect really quick (like 30 scds) - Correct answer excessive hari may be clipped but not shaved when trying to start an IV. sjaving can cause abrasions which can introduce pathogens - Correct answer elbow sling placement - Correct answer 90 deg hand abve elbow bottom of sling ends in middle of palm with fingers visible do not take ace inhibitors if pregnant or planning to become - Correct answer when dealing wtih a cf patient, airway and o2 sat are the priorities bc a pneuothorax can develope and the only sign may be a drop in o2 sat - Correct answer a little facts about cystic fibrosis - Correct answer -sticky thick respiratory secretions -chronic cough -at risk for recurrent lung infections -reduced pulse ox but 90% requires immediate intervetion -can cough up blood sputum -lose weight -fecal retenion/impaction metaboli syndrome- what s it? - Correct answer insulin resistance syndrome what are the criteria? - Correct answer 3 or more of the following: increased waist circumference high bp 130/85 triglyceride level over 150 HDL below 40 or 50 fasting glucose levels above 100 mnemonic: We Better Think High Glucose LDL (bad) cholesterol level is ok if below 100 - Correct answer normal triglyceride is below 150 - Correct answer best fluid solution to give after a burn - Correct answer lactated ringers bc it most closely resembles blood than all of the others a patient with SIADH is going to need fluid restrictions - Correct answer what to wear to ptrotect yourself from mosquites - Correct answer long sleeve, long pants, and light colors after thyroidectomy watch out for what - Correct answer respirtory distress from neck compressing the ariway stridor is noisy breathing - Correct answer 2 major purposes of amniotic fluid - Correct answer to prevent cord compression and promote lung development where is amniotic fluid produced? - Correct answer fetal kidney what causes oligohydramnios? - Correct answer low amniotic fluid volume caused by fetal kidney anomalies or leaking fluid through the vagina oligohydramnios requires more personnel in tht eroom for delivery - Correct answer oligohydramnios increases the risk for what? - Correct answer umbilical cord compression and pulmonary hypoplasia so needs additional personnel and continuous fetal monitoring what is an external fiaxtor - Correct answer metal device with metal scerws placed into a bone to stabilize it. there is an adjustable external rod *infection with pins is a complication. antibiotics must be started right away to prevent osteomyelitis -nurse gives sterile pin care with 1/2strength hydrogen peroxide and NSS OR chlorhexidine -neurovascular assessment afterwards -with an external fixator early ambulation is key with device in place nursing interventions for pin care - Correct answer regular assessmnt to make sure pins arent loose or showing signs of infection, notify HCP if either neuro checks clean with hydro perx/saline or chlorhexidine UTI and the elderly - Correct answer confusion may be a sign of a UTI, but still be addressed to R/O other possible causes what is presbyopia? - Correct answer decrease in ability to see objects close up elderly tend to have lower body temps. 100.2 is febrile - Correct answer in all of these conditions, breath sounds are either decreased or absent AND decreased fremitus - Correct answer pleural effusion, pneumothorax, emphysema, atelectasis what is a pleural effusion? - Correct answer abnomral collection of fluid >15-20 mls in the pleural space btwn parietal and visceral preventing th lung ffrom expanding ffully results in: dec lung volume, atelactasis, and ineffective gas exchange wheezing indicates what in a respiratory issue? - Correct answer an obstructive process like asthma, copd what is fremitus? - Correct answer palpable vibration on the chest wall when talking what is Midalozam (Versed)? - Correct answer a benzo used for conscious sedation. commonly siven with an opioid necrotizing enterocolitis - Correct answer mostly preterm infants from underdeveloped intetestin/gut immunity so bacteria is introduced into bowel and get worse fast bc compromised immunity inflammation and ischemic necrosis of the intetsine pogression causes bowel congestion and gangrenous with gas forming inside bowel wall nursing interventions for necrotizing enterocolitis - Correct answer measure abdominal girth daily NPO NG suction to decompress stomach/intestines parenteral hydration IV antibiotics place supine to avpid pressure on the abdomen avoid rectal temps in case perforation Marfan syndrome need to avoid what - Correct answer contact sports why? - Correct answer heart problems raising the HOB causes BP to do what? - Correct answer decrease hypovolemic shhock patient should never be places in high fowlers - Correct answer norepinephrine (Levophed) - Correct answer vasopresser used to increase stroke volume, CO, and MAP what is normal MAP - Correct answer 60 or more different stages/phages of kidney disease - Correct answer bladder spasms are exptedt after a prostatectomy with a catheter - Correct answer laser lithotripsy - Correct answer breaks down stones. burning on urination and hematuria are expected SE autonomic dyreflexia can happen in someone with a SCI at or above T6 - Correct answer autonomic dysrefexia (hyperreflexia) - Correct answer throbbing headache from uncontrolled hypertension nausea blurred vision sweating and skin flushing above level of injury what are common triggers of this? - Correct answer bladder or rectum distention. treat the trigger nurses should ask clients what they think caused illness as a way to assess their undersandings and beliefs of it - Correct answer albuterol - Correct answer short term rescue inhaler that treats reversible airway obstruction a/w asthma if not effective, use an inhaled corticosteroid side effects of albuterol - Correct answer insomnia, n/v, palpitations (from tachycardia), and tremor IV potassium chloride 5-10 m/hr is recommended to correct hypoakalemia - Correct answer potassium is never given via which 3 routes? - Correct answer IV push, intramuscular, or subq what is expected during IV infusion of KCL? - Correct answer irritation and discomfort at the site bc KCL irritates the vein if there is discomfort when infusing KCL, what should the nurse do? - Correct answer slow the rate. dont stop it bc they need their potassium replacement if 20-40 of KCL are needed to be given, use a CVAD rather than a peripheral vein - Correct answer how are orthostatic vitals taken? - Correct answer supine, sitting, then standing with 2 minutes btewn each position change orthostatic vitals are present when what happens to systolic/diastolic BP? - Correct answer systolic drops at least 20 diastolic drops at least 10 pulse usually rises about 20 in dehydrationm you get hypotension and tachycardic - Correct answer what to dw tih client with positive orthstatic vitals?` - Correct answer dnt complete if feel dizzy/weak give fluids examples of isotonic solutions? - Correct answer normal saline lactated ringers look up fluid types in saunders - Correct answer IUDs can cause heavy bleeding- normal finding - Correct answer ovarian cancer - Correct answer subtle symptoms at first which contribute to more deaths than any other gynecologic cancer lack of screening and vague symptoms may not be diagnosed until advanced stage ovarian cancer symptoms - Correct answer ABDOMINAL BLOATING PELVIC PAIN OR PRESSURE early satiety abdominal, back, or leg pain urinary urgency/frequency gi disturbances how do toddlers play? - Correct answer parallel play- right alongside eachother but not with eachother dealing with a patient with hearing loss or deaf - Correct answer visibly gain their attention before speaking directly face the client put up hearing impairment sign on hob or door keep lightd on so speakers face is well lit direct speach to least affected ear if partial hearing loss