Mark Klimek Yellow Yellow Book (KV) Study online at quizlet.com/_2p2yyy 1.
If the pH and the BiCarb are both in the same direction then it is?
Metabolc
2.
If the pH is up it is?
Alkalosis
3.
As the pH goes so goes my patient except for?
Potassium
4.
If the pH is down it is?
Acidosis
5.
If the pH is up my patient with show signs and symptoms of?
Increase... like tachycardia,diarrhea and borborygmi
6.
If the pH is down my patient will show signs and symtoms of?
Decrease... like decreased output, bradycardia and constipation
7.
If my pH is up my potassium (K+) is ?
Down
8.
If my pH is down my potassium (K+) is?
Up
9.
If my patient is overventilating I should choose?
Respiratory Alkalosis
10.
If my patient is underventilating I should choose?
Respiratory Acidosis
If my patient has prolonged gastric vomiting or suction I choose?
Metabolic Alkalosis
If it is not lung or prolonged vomiting or suctioning I choose?
Metabolic Acidosis
Kussmal Respirations
Metabolic Acidosis ( Remember MacKussmal
11.
12.
13.
14.
Before measuing ABGs you should check what?
Allen's test. Should be positive. Pt makes a fist and pressure is applied to the ulnar and the radial arteries Ulnar pressure is released and color should return in 7 seconds (means it's positive and OK to take ABG's).
15.
Definition of Compensation
PH is normal! It is never compensated if it is abnormal.
16.
If PH normal
look in the direction it is going. Closer to Acidic? (7.35) acidosis. Then look at Bicarb & figure out which is abnormal. If Bicarb is out of range, it's metabolic acidosis. If C02 is abnormal, it's Respiratory Acidosis :)
If your pt is acidotic and you need to pick a symptom
Pick the symptom where everything is DOWN. ( And vice Versa)
18.
If you don't know what causes an acid base balance, pick
Metabolic Acidosis
19.
If in doubt in ABGs, alway a lwayss pick
Headache, nausea, weakness & numbness+ tingling. It can be either up or down.
20.
High pressure alarms are triggered when?
They cannot push air in
21.
High pressure alarms are caused by what three types of obstructions?
Kinking, Water in dependant loops and mucus in the airway.
22.
If kinking in the tube is present you?
Unkink
23.
If water is present in the dependant loops you?
Open system and empty water.
24.
If mucus is present you?
Turn them, cough and have them deeo breath first. If ineffective you then suction.
25.
Don't suction unless
Coughing & deep brea breathing thing is deemed inappropriate.
17.
Ex: 2 degree Morbitz Type 2 BLOCK. <---Down direction
26.
In order to suction, you must be able to hear
Mucus in the lung
42.
What is the biggest problem in abuse?
Denial
27.. 27
Low pressure alarms are triggered when?
It is to easy to push air in.
43.
To treat denial you need to?
Confront them.
44.
Definition of Denial
Low pressure alarms are normally caused by?
Disconnection
Refusal to accept reality of their problem
45.
How do you confront?
29.. 29
If the tubing is disconnecte disconnected d you?
Reconnect
Point out the difference between what they say and what they do.
30.
If O2 sensor line is disconnect disconnected ed you?
Reconnect
46.
Loss and Grief
31.
In a vented client respiratory alkalosis means the vent setting may be too?
High
What is the one circumstance that you as a nurse would support denial?
47.. 47
Always go
Med surg first. Then Psych
48.
What is dependency?
32.
In a vented client respiratory acidosis means the vent may be too?
Low
When the abuser gets a significant other so make decisions for them or do thing for them.
33.
What do you do if the patients disconnected disconnect ed tube is on the floor?
Bag them, (call for help) get new tube and then reconnect.
49.. 49
What is codependency?
34.
First question to ask if the low pressure alarm sounds
Where is the tubing?!
When the significant other gets positive self esteem from doing things or making decisions for an abuser.
50.
Set limits and enforce them.
35.
HOLD
H- High Pressure O- Obstruction L- Low D- Disconnection Disconnectionss
To treat dependency/codependency you ?
36.
Never put anything in YOUR scope of practice
On anyone else
37.. 37
Make sure your answer is
PATIENT FOCUSED. PATIENT TAKE CARE OF YOUR PATIENT! Don't answer based on staff,, building, machine, staff etc. PATIENT FIRST.
28.
38.
What does wean mean?
Decrease Gradually
39.. 39
What do you do if the patients disconnected disconnect ed tube is on the chest?
Reconnect ... if its above the waist its ok.
Remember is PSYCH if you are asked to Prioritize, Don't forget
MASLOW! 1. Physiological 2. Safety 3. Comfort - Includes pain 4. Psychological 5. Social 6. Spiritual
40.
41.
When prioritizing, alwa always ys use Maslow + ABCs
For one patient. Don't if you have more than one patient.
Say NO and follow through. Agree in advance on what requests are allowed, then enforce the agreement.
Work on self esteem of the codependent. 51.
What is manipulation manipulation? ?
When the abuser gets the significant other fo do things for them that is not in the best interest of the significant other. This can be dangerous and harmful to the significant other.
52.
How do you treat manipulation?
Set limits and enforce.
53.
Why is manipulation easier to treat then dependency/codependency?
Because no one likes being manipulated.
54.
DABDA
D- Denial A- Anger B- Bargaining D- Depression A- Acceptance
55.
Psych Needs, In order
Denial Depend Manipulation
26.
In order to suction, you must be able to hear
Mucus in the lung
42.
What is the biggest problem in abuse?
Denial
27.. 27
Low pressure alarms are triggered when?
It is to easy to push air in.
43.
To treat denial you need to?
Confront them.
44.
Definition of Denial
Low pressure alarms are normally caused by?
Disconnection
Refusal to accept reality of their problem
45.
How do you confront?
29.. 29
If the tubing is disconnecte disconnected d you?
Reconnect
Point out the difference between what they say and what they do.
30.
If O2 sensor line is disconnect disconnected ed you?
Reconnect
46.
Loss and Grief
31.
In a vented client respiratory alkalosis means the vent setting may be too?
High
What is the one circumstance that you as a nurse would support denial?
47.. 47
Always go
Med surg first. Then Psych
48.
What is dependency?
32.
In a vented client respiratory acidosis means the vent may be too?
Low
When the abuser gets a significant other so make decisions for them or do thing for them.
33.
What do you do if the patients disconnected disconnect ed tube is on the floor?
Bag them, (call for help) get new tube and then reconnect.
49.. 49
What is codependency?
34.
First question to ask if the low pressure alarm sounds
Where is the tubing?!
When the significant other gets positive self esteem from doing things or making decisions for an abuser.
50.
Set limits and enforce them.
35.
HOLD
H- High Pressure O- Obstruction L- Low D- Disconnection Disconnectionss
To treat dependency/codependency you ?
36.
Never put anything in YOUR scope of practice
On anyone else
37.. 37
Make sure your answer is
PATIENT FOCUSED. PATIENT TAKE CARE OF YOUR PATIENT! Don't answer based on staff,, building, machine, staff etc. PATIENT FIRST.
28.
38.
What does wean mean?
Decrease Gradually
39.. 39
What do you do if the patients disconnected disconnect ed tube is on the chest?
Reconnect ... if its above the waist its ok.
Remember is PSYCH if you are asked to Prioritize, Don't forget
MASLOW! 1. Physiological 2. Safety 3. Comfort - Includes pain 4. Psychological 5. Social 6. Spiritual
40.
41.
When prioritizing, alwa always ys use Maslow + ABCs
For one patient. Don't if you have more than one patient.
Say NO and follow through. Agree in advance on what requests are allowed, then enforce the agreement.
Work on self esteem of the codependent. 51.
What is manipulation manipulation? ?
When the abuser gets the significant other fo do things for them that is not in the best interest of the significant other. This can be dangerous and harmful to the significant other.
52.
How do you treat manipulation?
Set limits and enforce.
53.
Why is manipulation easier to treat then dependency/codependency?
Because no one likes being manipulated.
54.
DABDA
D- Denial A- Anger B- Bargaining D- Depression A- Acceptance
55.
Psych Needs, In order
Denial Depend Manipulation
56.
To address a patient's psychological needs, they must be:
STABLE, safe, comfortable.
57.. 57
Pain
Never killed anyone. NOT the top priority, especially if there are physiologicall needs in the physiologica question that make the patient unstable.
58.
What is Wernickes (Korsakoffs) Syndrome?
Psychosis induced by vitamin B1 Psychosis (Thiamine) deficiency.
59.. 59
Symptom of Wernickes Korsakoffs syndrome?
Amnesia with confabula confabulation. tion. = Loss of memory with making up stories to fill in the gaps.
60.
Vitamin B1 helps breakdown?
Alcohol
61.
So without B1 what happens?
Alcohol isn't metabolized correctly goes to the brain and causes Wernickes
62.
Primary symptom of Wernickes?
Amnesia with confabula confabulation tion (making up stories) stories)..
63.
Is Wernickes preventable?
Yes- Take Vitamin B1
64.
Is Wernickes arrestable?
Yes- Take Vitamin B1
65.
Is Wernickes reversible?
No
66.
What is the goal of patients dementia/organic brain syndrome?
Maintain function, Never Improve.
67.
What is aversion therapy?
When you try and make the patient hate something.
68.
Antabuse onset and duration is?
2 weeks
69.. 69
Teach a patient taking Antabuse to avoid what?
Alochol
70.
On top of alcohol a patient taking Antabuse should also avoid what other 7 things?
Alcohol Aftershave, Cologne, Perfumes Insect Repellent Elixirs Vanilla Extract Vinaigrettes Handsanitizer Alcohol Prep Pads Vanilla Icing
71.
How long does it take for Antabuse to get out of the system so they can drink Alcohol again?
72.
What are Elixirs?
95% of liquids. If it is not an antibiotic, assume it is an elixir, so the patient can't have it if on antabuse. This rule applies for diabetics too (elixers also have sugar).
73.
What happens if a person on Antabuse ingests alcohol?
Nausea, Vomiting, & Possibly Death
74.
In Overdose VS Withdrawal, Ask yourself?
Is this drug an upper or a downer?
75.
What are the five uppers?
Caffeine, Cocaine, Methamphetamines, PCP/LSD and ADHD Meds, Bath Salts
76.. 76
Downers are?
Everything other then the five uppers. Heroin Ativan Valiumn Fetanyl
77.. 77
S/S of upper use?
Everything goes up Tachycardia Increased BP Irritability Fever Diarrhea +4 Reflexes Pupil Dilation Excitability Seizures Borborygmi ETC.
78.. 78
S/S of downer use?
Everything goes down Bradycardia Lethargy Constricted Pupils Hyporeflexia Flaccidity Respiratory Depression
79.. 79
Then ask yourself:
Are they talking about Overdose or Withdrawal?
80.
Overdose/Intoxication:
I have too much....
81.
Withdrawal:
I don't have enough...
82.
Overdose of a downer causes everything to go?
Down
83.
Overdose of an upper causes everything to go?
Up
2 weeks
Withdrawal of an upper causes everything to go?
Down
85.
Withdrawal of a downer causes everything to go?
Up
86.
Upper withdrawal looks like
Downer Overdose
87.
Downer Withdrawal looks like
Upper overdose
88.
At birth if the mother was addicted to a substance always assume the newborn is?
Overdosed
89.
If 24 hours after birth assume the baby is in?
Withdrawal
90.
Every alcoholic goes through what withing 24 hours after cessation?
Alcohol Withdrawal syndrome
What is Alcohol Withdrawal Syndrome?
Hyper irritability state less than 24 hours after the first drink
92.
After 72 hours of alochol withdrawal a small minority may get?
93. 94.
84.
91.
95.
96.
97.
98.
101.
All aminoglycosides end in?
"mycin" Vancomycin
102.
For Aminoglycosides, think:
A Mean Old Mycin
103.
Aminoglycosides treat?
Big gun antibiotics. Treat serious, life threatening, resistant infections
104.
If it has "thro" in it you?
Throw it out...Zithromycin. It treats a minor infection
105.
Toxic effects of aminoglycosides?
Ototoxicity Nephrotoxicity Cranial nerve 8 (vestibulocochlear nerve) which senses sound.
106.
The one Aminoglycoside that doesn't end in Mycin?
Amikacin
107.
What is another word for aminoglycoside?
Glycopeptide
Delirium Tremens
108.
Monitor what with aminoglycoside use?
Hearing, balance, tinnitus & creatinine (best indicator of renal function)
Can Delirium Tremens kill you?
Yes
109.
Best indicator of aminoglycoside toxicity?
Ototoxicity (Ears)
Can Alcohol Withdrawal Syndrome kill you?
No 110.
Frequency of administration for aminoglycosides?
Q8H
Are patients with Alcohol Withdrawal Syndrome a danger to themselves or others?
No 111.
Aminoglycoside route of administration?
Im or IV
Are patients with Delirium Tremens a danger to themselves or others?
Yes
112.
Aminoglycosides are given PO for what two reasons?
Hepatic Encephalopathy and Pre-op bowel surgery.
113.
N/I for Delirium Tremens?
Private room near nurses station NPO/Clear liquids Restricted bed rest Restraints, tranquilizer, multivitamin (B1 Vitamin/Thiamine) Antihypertensive.
What is Hepatic Encephalopathy also called?
Liver Coma, AmmoniaInduced Encephalopathy
114.
If fluid resuscitation is used in shock, there will be
Increased Urine Output
115.
Neomycin and Kanmycin are used for what?
Bowel sterilzation? Can also be given for C.Diff
116.
Who can sterilize my bowel?
"Neo" "Kan"
117.
If you give aminoglycosides PO, do you have to worry about side effects?
No
118.
Hepatic Encephalopathy is caused by?
High ammonia levels
119.
What raises ammonia levels the most?
Ecoli in the gut
120.
Why do you draw TAP levels?
Narrow therapeutic Window
N/I for Alcohol Withdrawal Syndrome?
Semi-private room anywhere Regular diet Up and ad-lib, no restraint Tranquilizer Multivitamin (B1/Thiamine) Antihypertensive.
99.
A two point restraint is?
One arm and the opposite leg.
121.
When do you draw a trough level?
30 minutes before the next scheduled dose.
100.
N/I for restraints?
Check Q15min Rotate sites Q2H
122.
When do you draw a sublingual peak level?
5-10 minutes after it is dissolved.
123.
When do you draw a IV peak level?
15-30 minutes after dose is finished.
124.
When do you draw a IM peak level?
30-60 minutes after given
125.
If you must pick a time to draw the peak, pick the highest amount of time without going over the limits
So for IV, Pick 30 Minutes, not 15.
126.
Category A Bio terrorism Agents
Most Lethal
127.
What are the Category A Bio terrorism Agents?
Smallpox Tularemia Anthrax Plague Hemorrhagic Fever, Such as Ebola Botulism
138.
3 H's of Plague
Blood Everywhere. H- emoptysis - Coughing up blood H-ematemesis - Blood in Vomitus H-ematochezia - Bright red blood in the diarrhea
139.
Plague patients die by
DIC and respiratory Distress
140.
Hemorrhagic Illnesses (Like Ebola)
Petechiae and ecchymoses = Pinpoint Hemorrhage, especially on Chest & Bruising
141.
Botulism is
Ingested - Most Lethal Dies from Respiratory Arrest
142.
3 Major Symptoms of Botulism
Descending Paralysis (Starts in face and goes down) Fever But is Alert
128.
Category B
A big, long list.
143.
Gullian Barre
Ascending Paralysis
129.
Category C. Not very Lethal
Hanta Virus Nipeh Virus
144.
Chemical Agents
Mustard Gas, Cyanide, and Phosgine Chlorine
130.
Small Pox Early Detection Symptom
Rash that starts around the mouth
145.
Mustard Gas The Chemical Agent causes
Blisters
146.
Cyanide The Chemical Agent Causes
Respiratory Arrest.
147.
What do you use to treat Cyanide Poisoning?
Sodium Thiosulfate IV
148.
What does Phosgine Chloride Cause
Choking
149.
Sarin, the Nerve Agent, Causes
Massive Cholinergic parasympathic response
150.
Cholinergic, Parasympathetic effects cause?
B-ronchorrhea B-ronchospasm S-Salivation L-acrimating U-rinating Constantly D-iaphoretic + Diarrhea G-I distress E-mesis
151.
Ebola (Hemorrhagic Fever) Precautions
Standard, Contact, and Droplet
131.
132.
133.
Small pox
Tularemia
Anthrax spreads by
Inhalation. Pt on AIRBORNE Precautions Dies from Septicemia. No treatment Inhalation Chest Symptoms Dies from RESPIRATORY FAILURE Treat with Streptomycin Inhalation (AIRBORNE PRECAUTIONS)
134.
Anthrax looks like
Respiratory FLU
135.
Anthrax death occurs from?
Respiratory Failure
136.
Treat Anthrax with
Cipro, Penicillin, Streptomycin
137.
Plague spreads by
Inhalation
152.
All chemical agents require only soap and water except for Sarin, which requires
A WEAK Bleach
153.
What do you do in a Chemical Attack?
Decontaminate + Treat
What is the Nurse's role in Chemical Decontamination?
Put clothes in Biohazard bag that gets burned Put them in a Government Issued suit They may need to be housed for a while
154.
155.
Biochemical Attack, what do you do?
Quarrentine
156.
Calcium Channel Blockers are like what for the heart?
Valium
157.
Calcium Channel Blockers
Negative Ino, Chrono, Dromo
158.
Calcium Channel Blockers treat what? (the 6 A's)
Antihypertensive, AntiAnginal, Anti Atrial Arrythmia and SVTS
159.
Calcium Channel Blocker side effects? (the 2 H's)
Headache and Hypotension Also Bradycardia
160.
Calcium Channel Blockers treat what Arrhythmias starting with?
A, as well as SVT
161.
What causes angina?
Chest pain due to decreased O2 supply and demand issues.
162.
What do Anti-Anginal Medications do?
Decrease O2 demand on the Heart, allowing more O2 to chest (dilate)
168.
Asystole
TX: Epinephrine (Think Heart Stimulant) 169.
Atrail Flutter is?
170.
Atrial Flutter
Rapid P-wave repolarizations in a saw tooth pattern.
Pharmacological therapy, such as beta blockers, antiarrhythmics, or calcium-channel blockers, need frequent monitoring of EKG rhythm strips, heart sounds, and apical pulse rate. (Unlikely to ask this) 171.
Atrial- Fib is?
172.
Atrial Fibrillation
Chaotic QRS depolarizations
Chaotic Between QRS, but QRS is still PRESENT. HR Has to be Irregular. Treatment: Heparin. IMMEDIATELY. 173.
What do you do if the Afib is unwitnessed?
1. Heparin First 2. Cardioversion 3. ADENOsine 8 second Push- Watch for the pt to go into Asystole BETA Blocker CALCIum Channel Blockers DIGitalis (Lanoxin)
174.
V-fib is?
Chaotic QRS depolarizations
175.
Ventricular Fibrillation
163.
90% of Calcium Channel Blockers end in?
"dipine" and "zem"
164.
When giving a Calcium Channel Blocker you hold and notify if?
Systolic is 100 or lower.
165.
"QRS" refers to?
Ventricular
166.
"P" refers to?
Atrail
176.
V-tach is?
167.
Asystole is?
A lack of QRS repolarizations
177.
Ventricular Tachycardia
TX: Shock therapy. you DE-FIB. Wide bizarre QRS's
Treatment: Lidocaine & amniodarone
178.
SVT Subventricular Tachycardia
Narrow QRS. Treatment: A-denosine 8 second Push- Watch for the pt to go into Asystole B-eta Blocker C- Calcium Channel Blockers D- igitalis (Lanoxin) 179.
PVC is?
180.
PVC
Periodic wide, bizarre QRS's
PVC is the deviation in the picture from the normal QRS. Treatment is Lidocaine & Aminodorone 181.
182.
Be concerned about PVC's if? ( rule of 6's)
188.
PVC's fall on what wave of the previous beat?
T wave
189.
When prioritizing lethal arrhythmias, if one happened 6 minutes ago and the other happened 15 minutes ago, which do you choose?
Always choose the closest to the 8 minute mark. After 8 minutes the survival rate is LOW.
190.
To treat PVC's you give?
Lidocaine/Amnioderone
191.
To treat V-tach you give? (If it starts with V you use..)
Lidocaine/Amnioderone
192.
To treat supraventricular arrythmias you give?
Adeno Beta Calci Dig (Lonoxin)
193.
Supra means?
Above
194.
To treat V-fib you ?
Defibrillate ... For V-fib you D-fib
195.
To treat AsystolE you give?
CPR Epinephrine (atropine no longer given) Oxygen
196.
If asked how to treat A-fib first you?
Give Heparin then ABCD.... Heparin is instant Warfarin and Plavix take time.
197.
What is the purpose of Chest Tubes?
To re-establish negative pressure in the pleural space
198.
Pneumothorax removes
Air
199.
Hemothorax removes
Blood
200.
Pneumohemothorax
Air and Blood
201.
An Apical chest tube is placed?
High (for air) A for air
202.
A Basilar chest tube is placed?
Low (for blood) B for blood
203.
Chest tubes after a surgery or trauma assumes it's a?
Unilateral Pneumohemothorax
204.
Does a pneumonectomy get a chest tube?
No..removes the pleural space
205.
Patient Positioning after Chest Surgery
Chest Tube Up, good side down
206.
Patient Positioning after Chest Surgery
Operative side (Good lung up) Or Back (Supine)
207.
What 4 things do you do if the water seal breaks on a chest tube?
Clamp it 1st!! Cut broken device off of tube Put the tube in water (NS) Unclamp.
More then 6 per minute, 6 in a row
What are the 2 lethal arrythmias?
A-systole and V-Fib (Pic if V-Fib, Asystole is Flat Lining) 183.
184.
185.
186.
187.
What are the 4 potentially life threatening arrythmias?
V-tach, A-fib, A-flutter and PVC
What are the 6 arrythmias you are tested over on the NCLEX?
V-fib, A-fib, A-flutter, PVC, A-systole and V-tach
What are the 6 arrythmias for NCLEX in order for prioritization?
A-systole, V-fib, V-tach, A-fib, A-flutter and PVC
When talking about arrythmias the word "chaotic" means?
Fibrillation
When talking about arrythmias the word 'bizarre" means?
Tachy
What do you do if you kick over the collection bottle?
Set it back up Tell the patient to take some deep breaths
What is the BEST thing to do if the water seal breaks?
Put it in water (NS). (the first= clamp it)
What 4 things do you do if a chest tube comes out?
Cover hole with a gloved hand Put on a vaseline gauze dressing, Put on sterile dressing and then tape on 3 sides.
How many chest tubes (and where) for a Unilateral Pneumohemothorax ?
2 chest tubes, One side (Unilateral) one apical (for air/pneumo) and one basal (for blood-hemo)
How many chest tubes (and where) for bilateral Pneumothorax?
Bilateral- chest tubes on both sides Pneumo- (air) Apical = 2 apical chest tubes (one on each side)
How many chest tubes (And Where) for postop chest surgery?
Unilateral, pneumohemo (2 chest tubes, one side, apical and basal) Assume Chest trauma is a gunshot wound.
Straight Catheter is to a foley catheter
Like a Thoracentesis is to a Chest Tube :) (meaning less invasive, less infection risk)
How long can you clamp a chest tube?
No longer then 15 seconds without a doctors order.
What do you use to clamp a chest tube and why?
Rubber tipped double clamps. Rubber because it won't pierce the tube and double because were nurses and if one is good two is better.
Is bubbling in the water seal continuously good?
No it is bad. You need to find the air leak, tape it, report it and then record it.
218.
Is bubbling in the water seal intermittently good?
Yes it should tidal on inhalation
219.
Is bubbling in the suction control chamber intermittently good?
No it is bad. You need to dial up the suction, report and record.
Is bubbling in the suction control chanber continuously good?
Yes
When picking answers, narrow it down to two, then ask yourself
If i did this, but not this, what would be the outcome? Is it better?
208.
209.
210.
211.
212.
213.
214.
215.
216.
217.
220.
221.
222.
In routine care, do you ever clamp a chest tube?
No. In an emergency, you can.
223.
When picking answers ask yourself ?
Which one is MOST important to leave undone. More so than the others.
224.
All congenital heart defects that are trouble start with a ?
"T"
225.
Which exception to the rule of congenital heart defects doesn't start with a T?
Left Ventricular Hypoplastic Syndrome
226.
What defects have right to left shunts and are cyanotic?
Trouble defects
227.
What defects have left to right shunts and are acyanotic?
Not trouble defects
228.
All congenital heart defects have what?
Murmur and an echocardiogram done
229.
What are the four defects of Tetrology of Fellot?
Ventricular Defect, Pulmonic Stenosis, Overriding Aorta and Right Hypertrophy
230.
What is the saying to help remember the four defects of Tetrology of Fellot?
VarieD PictureS Of A RancH
231.
1 fingerwidth is how many cm's?
1
232.
How to measure crutches
2-3 cm/fingerwidths below anterior AXILLARY FOLD to a point lateral and slightly in front of the foot
233.
When measuring crutches, don't pick
any foot landmark like a "toe" or "heel"
234.
When the handgrip of a crutch is properly in place the elbow felxion should be?
30*
235.
If crutch is not 30*, what will happen?
Nerve Damage
236.
Crutches should be how many fingerwidths below the armpit?
2-3
237.
Describe a 2 point gait?
1. one crutch and opposite foot together 2. Other crutch and other foor together. 2 points 2gether and the same time.
238.
239.
Describe a 3 point gait?
Describe a 4 point gait?
1. Move two crutches and bad leg together. 2. Move good foot. Move all three together and then the good leg.
253.
A non psychotic person has
insight and is reality based
254.
A psychotic person has
No Insight and is Not reality based
255.
Not all psych patients are
Psychotic. Show this in your answers!
NOTHING moves together 1. Right crutch 2. Left foot. 3. Left crutch. 4. Right foot. It moves one at a time so 1,2,3,4 and 1,2,3,4, and 1,2,3,4
256.
7 Hallucinatory Words
Look See Listen Hear Feel Taste Smell
257.
If the question has "appear" in psych, it is
A delusion ( a belief)
240.
Describe swing through?
Traditional crutching
241.
Who uses Swing Through?
Amputees, non weight bearing (sprain/break)
258.
What is a delusion?
A false fixed belief, idea or thought. This has no sensory component.
242.
Use the even numbered gaits when weakness is?
Evenly distributed (bilateral)
259.
What are the three types of delusions?
Paranoid or Persecutory, Grandiose and Somatic
260.
What is a paranoid delusion?
False fixed belief that people are out to harm you (CIA, FBI).
261.
What is a grandiose delusion?
False fixed belief that you are superior (God, the Pope).
262.
What is a somatic delusion?
False fixed belief about a body part (X-ray vision).
263.
What is a hallucination?
False, fixed sensory experience.
264.
Five types of hallucinations?
Auditory, visual, tactile (feel) olfactory gustatory (taste)
265.
Most common type of hallucination?
Auditory (Especially Command)
266.
What is an illusion?
Misinterpretation of reality. It is a sensory experience.
267.
How can you diffirentiate between illusions and hallucinations?
Illusion: Sensory response to something in reality [the news (reality) is talking TO them (illusion)]
Remember, Even for Even, Odd for Odd 243.
When using the even gaits what one is for severe and what one for mild problems?
2 point gait for mild 4 point gait for severe.
244.
4 point gait for what?
Fresh Post Op
245.
If the question says "systemic disease" when it comes to crutches
Assume it impacts both legs
246.
Use the odd numbered gait when?
The problem is affecting one leg (unilateral)
247.
When going up the stairs or down the stairs with crutched remember?
UP with the GOOD and DOWN with the BAD
Crutches always move with what leg?
The bad leg.
249.
What side do you hold the cane?
Strong side.
250.
What side do you advance the cane with?
The weak side for a wide base support. Step with opposites
251.
For walkers remember you?
Pick it up, set it down and walk to it.
248.
252.
Remember for walkers that you
Always push, never pull NO tennis balls on legs If you put something on the walker, make it the side not front
Hallucination: Sensory response but nothing in reality pertains 268.
Don't treat all Psych patients
The same/like they are psychotic
269.
Example of an illusion?
The clock on the wall is a bomb (the clock is real, but the belief isn't)
270.
What are the four types of functional psychosis?
Schizophrenia Schizoaffective disorder, Major depression/mania (bipolar). (SCHIZO SCHIZO MAJOR MANIC)
271.
Functional Psychotics have WHAT
The potential to learn reality
If a functional psychotic is having a delusion or illusion you?
Acknowledge the feeling ( I see you are upset), Present reality (but we have no spiders in the room) Set a limit ( we're not going to talk about that lets talk about something else) Enforce the limit ( I see you're to ill to talk about reality).
272.
Follow with : We have medication to treat those symptoms 273.
NEVER set limits on
Feelings
274.
Present reality
Positively
275.
Example of presenting reality positively:
Tell them what they CAN do instead of what they CAN'T do.
5 examples of psychosis of dementia?
Alzheimers, dementia, organic brain syndrome, wernickes seniality.
277.
When deciding whether to redirect or reassure
Functional Psychotic (Schizophrenia) or Non Functional (Dementia)
278.
Re directing is NOT
Orders Distraction Doing a physical action
279.
Re-direction IS
Taking what a patient is fixating on and that they are expressing inappropriately, and you get them to express it appropriately
276.
280.
For patients with OCD, you
Negotiate a balance
281.
If a patient has psychotic depression
No reality. Won't get dressed because they believe they are a prisoner in Iran.
282.
What do you do if a patient with psychosis of dementia is having a hallucination or illusion?
Acknowledge their feelings Redirect them. DON'T Challenge them.
283.
Examples of Psychosis of dementia:
Alzheimer's Disease, Senility, Organic Brain Syndrome/Post Stroke Dementia, Lewy Body Disease, Parkinson's, Wereneke's
284.
Patients with Psychosis of Dementia
Cannot learn reality because they have brain damage
285.
What causes Psychotic Delirium?
Chemical Imbalance (electrolyte Imbalance), Sepsis, UTI.
286.
Is Psychotic Delirium permanent?
No. Assure them its temporary. A dramatic, episodic onset of skewed reality d/t acute illness.
287.
What is flight of ideas?
Jump from word to word. (This room is big, I liked the movie BIG when they were on the piano, Elvis could play the piano).
288.
What is word salad?
Jump from word to word. Bob, Car, Sleep, Foot etc..
289.
What is neologisms?
Make up new words.
290.
If a patient is psychotic, should you force them to do things?
NO. They will become violent.
291.
What is a narrowed self concept?
When they refuse to leave the room or get dressed. (DON'T force them to do it) Respond by saying " I see you are uncomfortable, when you are ready, you can do it"
292.
What is ideas of reference?
When they think everything is about them. (Everyone is talking about me)
293.
Type I diabetes (IJK)?
Insulin dependant Juvenile onset Ketosis prone ( makes ketones)
294.
Type II diabetes?
Non insulin dependant Adult onset Non ketosis prone
295.
Diabetes S/S?
Polyuria, Polydypsia and polyphagia (hunger)
296.
What is diabetes mellitus ?
An error in glucose metabolism
297.
What is diabetes Insipidus?
Not enough ADH, pituitary gland
298.
How do you treat type I diabetes? (DIE)
Diet 3 Insulin 1 Exercise 2
299.
How do you treat type II diabetes? (DOA)
Diet 1 Oral hypoglycemic 3 Activity 2 (Obesity Reduction)
300.
In a tonsellectomy, what days are most important post op?
Days 6-8, biggest risk for bleeding.
301.
Diabetes is also what?
Dehydration
302.
AC
Before Meals
303.
TID
3 times a day
304.
QD
Every day/daily
305.
OD
Once a day
306.
QOD
Every other day
307.
QID/QDS
4 times daily
308.
SIADH is
fluid overload. (crackles, Edema, etc.) DO: Fluid restrictions + sodium supplements
322.
As a rule in shock
Anything that is a pressure goes down Anything that is a RATE goes up
323.
When a client is sick what does it do to there blood sugar?
It increases d/t stress
324.
Teach diabetics who are sick to?
Take insulin, Stay hydrated Stay as active as possible.
325.
What are the 4 types of insulin?
Humalog (log rolls down hill FAST) Regular, (RN, R then N) NPH (iNNNtermediate) Lantus/Levemir (glargine) L for LOONG
326.
Regular insulins all have what in them?
R
327.
Regular insulin onset?
1 hour
328.
Regular insulin peak?
2 hours
Type II diabetics need how many calories a day?
1,200-1,800
310.
#1 Priority in Type 1 diabetes
Medication (insulin)
329.
Regular insulin duration?
4 hours
311.
#1 Priority in type 2 =
Diet + Exercise (NEED TO LOSE WEIGHT)
330.
NPH insulin all have a what in them?
N
331.
NPH onset?
6 hours
332.
NPH peak?
8-10 hours
333.
NPH duration?
12 hours
309.
Type II diabetics need how many feedings a day?
6 small meals
313.
Type 2 diabetes will do what when in acute illness?
Go to type 1 and need insulin
334.
NPH is not so fast and
...not in the bag (IV)
314.
The peak in insulin is a risk for what?
Biggest risk for HYPOGLYCEMIA
335.
Regular insulin is
...rapid and runs IV
336.
With humalog when do you give it?
With meals
Which Insulins and peaks for hypoglycemia?
Humalog: 30 minutes after dose Regular: 2 hours after dose NPH: 6 hours after dose
337.
Humalog onset?
15 minutes
338.
Humalog peak?
30 minutes
339.
Humalog duration?
3 hours
340.
What is the only insulin safe to give at bedtime?
Lantus/Glargine Duration 12-24hrs No peak
312.
315.
316.
Freezing insulin does what?
De natures it
317.
What two drugs can increase blood sugar?
Glucagon and Epinephrine
341.
Which insulin works the fastest?
Humalog
318.
If client exercises more they need?
Less insulin and a snack
342.
What are the three reasons that cause low blood sugar in type I diabetes?
319.
Replace the word exercise with?
Another shot of insulin
too much insulin (#1) too much exercise not enough food
320.
Best answer for a type 2 diabetic?
Calorie Restriction 343.
What is the biggest danger with low blood sugar?
Brain damage
If client exercises less they need?
More insulin
321.
344.
345.
346.
S/S of low blood sugar are?
For Hypoglycemia, Pick signs and symptoms of
If ICP is increased
S/S of shock and being drunk... clammy, weak, slurred speech, poor gait etc. 1. Cerebral impairment (drunk) - slurred speech, judgement changes, staggering gait If it makes you look drunk, pick it. 2. Shock symptom = pale, cold, rapid + thready pulses, etc. Pressure goes UP Rate goes DOWN (Opposite of hypoglycemia)
347.
Treatment for low blood sugar in type I diabetes?
Rapidly metabolizable carb (Juice, Pop, chewed candy) or carb and protein/carb and starch. (MILK, or jam + crackers)
348.
If a diabetic is unconscious
NPO give Glucagon IM or Dextrose IV.
349.
Examples of rapidly metabolizing carbs?
Juice, hard candy, icing, honey, syrup
350.
Diabetic Ketoacidosis (AKA high blood sugar in Type I diabetes) is caused by what 3 things?
Too much food Not enough insulin Not enough exercise
What is the #1 cause of DKA?
Viral upper respiratory infection within last 2 weeks.
351.
352.
So if you suspect DKA, what should you ask?
Have you had a cold lately?
353.
DKA S/S?
D-ehydration K-etones in urine/blood, Kussmauls and K+ A-cidosis, Acetone breath, Anorexia d/t nausea
354.
DKA treatment?
High IV flow rate (150200hr) with insulin R in prescribed mixture (Rehydrate and push K back into cell, Oxygenate)
355.
Treatment for low blood sugar in Type II is the same as Type I low blood sugar treatment.
...
356.
High blood sugar in type II aka hyperosmolar, hyperglycemic, non-ketotic coma (HHNK) is the same as?
Dehydration
357.
HHNK S/S?
Same as dehydration
358.
Treatment for HHNK is?
Rehydrate but no insulin in the bag (type II has insulin still) Insulin in the bag with type I diabetes d/t burned fat = ketones=acidic
359.
Diabetes complications, in order of priority:
1.Hypoglycemia 2.DKA 3.HHNC
360.
If you don't know if a blood glucose is high or low, pick
Low If you give candy to a hyperglycaemic they're condition won't change If you give candy to hypoglycaemic you'll save their life
361.
What are the two long term problems from diabetes?
Peripheral neuropathy Poor tissue perfusion.
362.
What lab is the best indicator for long term blood sugar maintenance?
HGBA1C (glycosated hemoglobin) <7 is an ideal sign of CONTROLLED diabetes
363.
What is the H1AC diagnosis level?
Greater to or equal to 6.5
364.
Lithium therapeutic level?
0.6-1.2
365.
Lithium toxic level?
over 2.0
366.
Lanoxin (digoxin) therapeutic level?
1-2
367.
Lanoxin (digoxin) toxic level?
Over 2.0
368.
Aminophylline therapeutic level? (Antispasmotic)
10-20
369.
Aminophylline toxic level?
Over 20
370.
Dilantin therapeutic level?
10-20
371.
Dilantin toxic level?
Over 20
372.
Elevated bilirubin level?
10-20 neonate only
373.
Toxic bilirubin level?
Over 20 neonate only
374.
Dilantin is an?
Anticonvulsant
375.
Aminophylline is an?
Airway antispasmotic
376.
Lanoxin(digoxin) is for?
CHF, Atrial arrhythmia
377.
Lithium decreases?
Mania
378.
What is Kernicterus?
When bilirubin is over 20 and in the CSF(cerebrospinal fluid) and brain
389.
Kalemias do the same as the prefix except for the what?
The HR and urine output. (opposite) eg HyperK= BRADY, tachypnea, diarrhea HypoK= TACHY, lethargy, POLYurea, ilius
390.
Calcemias do the opposite of the prefix plus all what?
BP changes eg: Hypocalcemia FAST everything (Low bp) Hypercalcemia: SLOW everything (high BP)
391.
So hypocalemia.. pick symptoms consistent with what?
UP... Plus BP changes
392.
So hypokalemia... pick symptoms consistent with what?
Down... and UP HR and UP Urine Output
393.
What is Chvosteks sign?
Push the cheek and it spasms (low calcium)
394.
What is Trousseaus sign?
BP cuff inflated and causes a carpal spasm. (Low calcium)
395.
Magnesemias do the opposite of the prefix plus all what?
BP changes Calcium and Mag have inverse relationship
396.
Calcium below what is a medical emergency?
6.0 N=8.2-10.3?
397.
In a tie never pick ___________ If the symptom involves nerve or skeletal pick__________ For any other symptom pick___________
...magnesium ....calcemia. ....potassium.
398.
What is the rule for Natremias?
The one with the E =dehydration HypErnatremia has s/s of dehydration
Assessment: hyperextension d/t menigial irritation 379.
What is Opisthotonos?
POSITION of hyperextension seen with kernicterus. ANY EXTENSION, Even slight extension of the neck! DO: Place on there side if present.
380.
381.
382.
If kernicterus and opisthotonos are occuring you?
Hiatal hernia is?
Definition of Hiatal Hernia?
Turn baby on their side Call doctor Draw bilirubin level Increase the IV rate and start billirubin lights. Stomach herniates into esophagus Gastric contents move in WRONG DIRECTION at the CORRECT RATE. Reguritation of acid into the esophagus, because upper stomach herniates upward through the diaphragm
383.
Definition of dumping syndrome?
Post-op gastric surgery complication in which gastric contents dump too quickly into the duodenum
384.
Dumping syndrome is?
Gastric contents moving in the RIGHT DIRECTION and the INCORRECT RATE.
385.
S/S of hiatal hernia are?
GERD upon lying after meals
386.
S/S of dumping syndrome are?
DRUNK + SHOCK + ABD DISTRESS Acute abdominal distress= gas, ^bs, cramping, bloat Drunk=staggered gait, slurred speech Shock= cold, pale, hypotension, tachy
387.
388.
3 treatments for hiatal hernia is?
High fowlers during and 1hr after meals Increase fluids with meals Increased carbs
3 treatments for dumping syndrome?
Lay flat on side during and 1hr after meals Decrease fluids during meals(drink between meals) Decrease carbs (aka ^ protein diet)
the one with the O = overload HypOnatremia has s/s of fluid overload. 399.
Earliest sign of an electrolyte overload is?
Numbnesss and tingling (AKA parasthesia)
400.
Universal s/s of an electrolyte imbalance is?
Muscle weakness (AKA paresis)
401.
Nere push what electrolyte?
K+
402.
To decrease K+ you give?
D5W with Insulin R (insulin pulls the K+ from the blood and pulls it in the cell with glucose. this buys time but doesnt solve the problem)
403.
Kayexelate does what?
Gets rid of K+
413.
With a Total Thyroidectomy what do they need for life?
Hormone replacement (Synthroid)
414.
What are you at risk for following a Total Thyroidectomy?
Hypocalcemia- taking parathyroid with sx (parathyroid regulates calcium)
415.
For a Sub-total Thyroid storm Thyroidectomy you are at risk for what?
416.
S/S of a Thyroid storm are?
The same as graves disease but incredibly higher. Exp: HR 180, Temp 108*, psychotic delirium.
417.
Thyroid storm treatment?
High flow O2, 5 ice packs= 2 under each arm, 2 groin, 1 back of neck. OR cooling blanket
418.
First thing to do in thyroid storm is?
Ice pack Then cooling blanket
419.
Post Op Thyroidectomy risks 1st 12 hrs?
Hemorrhage and airway. After 1st 12hrs assume they are stable.
420.
Never pick infection within
48 hours after surgery
421.
Get cooling blankets to shut off
One degree higher than what the doctor wants
422.
Post Op thyroidectomy risks 12-48 hrs for Total Thyroidectomy?
Tetany ( they are stable at this point so don't pick airway or hemorrhage)
slow and late= K-exits-late 404.
How much K+ can you have per liter of IV fluid?
40 mEq If higher, clarify order.
405.
In electrolyte questions, pay attention to:
Cause & effect questions. WHICH one are they asking?
What two words mean the same thing as immunosuppresion?
Agranulocytosis and neutropenia.
407.
Hyperthyroidism (AKA graves disease) is the same as saying?
Hypermetabolism
408.
Anesthesia (total loss) is to paresthesia (partial loss) as
Paralysis (total loss) is to paresis (partial loss)
S/S of Hyperthyroidism?
Same as hypermetabolism... agitated, nervous, diarrhea, heat Intolerant, ^HR, ^BP, thin, hyperactive etc.
423.
Post Op thyroidectomy risks 12-48 hrs for Sub-total Thyroidectomy?
Thyroid storm (this can cause brain damage ..too febrile)
424.
Hypothyroidism is the same as saying?
Hypometabolism
425.
Hypothyroidism S/S?
Same as hypometabolism ie, tired, sluggish Cold intolerant obese decreased hr, p, rr
426.
What is the name of the disease for hypothyroidism?
Myexedema
427.
Treatment for hypothyroidism?
Hormone supplement
406.
409.
410.
Remember RUN yourself in the GRAVE
...
411.
Graves disease treatment options are? (3)
1.Radiation with I131 (radioactive iodine) (1st 24hrs be alone and flush the toilet alot. Urine is very dangerous/radioactive) 2. PTU(drug- Puts Thyroid Under) worry about immunosuppresion. 3. Surgical removal.
412.
What are the two types of Thyroidectomys?
Total and Sub-total.
428.
If asked a question and your patient is critical remember to always STAY with the patient!!
...
429.
Do you sedate a patient with hypothyroidism?
No you could put them into a coma.
430.
If a patient with hypothyroidism is NPO for surgery you still give them what?
Hormone replacement medication.
431.
What is Addison's Disease?
Under secretion of the adrenal hormones
437.
CUSHMAN! draw him!
Gaining h20 Infection Irritability Weak bones Wasting, thin extremities Bruises Easily Moon Face Acne Losing K Buffalo Hump Striae/Stretch Marks Breasts in Men Trunkal Obesity Hair on face
( Normal- Stress= ^glucose, ^BP= perfusion Addison's-No adrenaline + stress= v glucose, v bp=shock) 432.
S/S of Addison's Disease?
Hyperpigmentation Do not adapt to stress. Also becomes dehydrated easily
433.
Addisons Disease treatment?
glucocorticoids think blood sugar monitoring and immunosuppression
434.
With Addison's Disease you ADD what?
ADD-A-SONE
435.
Cushing Syndrome is the oversecretion of?
The adrenal cortex.
436.
S/S of Cushing's Syndrome?
Think of the Cush Man... Moon face-steroids buffalo hump thin legs and bones striae (stretch marks), male breasts, hirstusism high glucose Immunosuppressed/infection bruising
438.
Cushings Syndrome treatment?
Adrenalectomy Biliateral Adrenectomy is always worse
439.
Hep A
Anus to mouth
440.
Hep B
Blood
441.
Pts with Adrenal cortex diseases must have
Med alert bracelet
442.
Symptoms of cushings are side effects of what?
SONES.
443.
Contact precautions are used for what 4 types of diseases?
RSV (babies) Herpies zoster, Staph infections and Enteric (bowel) infections (cdiff, collera)
444.
RSV
Spread by droplet, but they are on contact precautions (Only affect infants)
445.
Contact precautions have what 5 things?
Private room - door can be open Gloves Gown- if giving direct care Handwashing Disposable supplies Dedicated equipment
446.
447.
448.
449.
Droplet precautions are for what 2 diseases?
Droplet precations have what 6 things?
Airborne precautions are for what 4 diseases? Airborne precautions have what 9 things?
All meningitis and all influenza Pertusis, Diptheria, Mumps, All Meningitis Private room- door can be open Gloves Mask- #1 in this group Handwashing Pt wears mask when leaving room Disposable/dedicated equipment SARS (Severe Acute Respiratory Syndrome), TB, Measles and Varicella Private room-door closed Mask Gloves Gown Handwashing Special filter respirator masks Pt wears a mask when leaving room Disposable/dedicated supplies Negative airflow room
459.
What do you use in handwashing?
Soap and water
460.
When do you wash your hands?
Before and after gloves, entering and exiting a room and after you soil your hands.
461.
What position are your hands in for scrubbing?
Elbows below hands.
462.
What is the length for hand scrubbing?
3-7 minutes
463.
What do you use for hand scrubbing?
Cleaning agent must have the prefix "chlor"
464.
Can the sink have handles for scrubbing?
No
465.
When do you use scrubbing?
Immunosuppresion, surgery, transplant, chemo, HIV
466.
Dry yours hands from...?
Cleanest to least clean
467.
You can use alcohol based solution when?
Before and after gloves, entering and leaving a room
468.
how to sterile glove
Glove Dominant Hand First Grasp Outside of the cuff Touch only the inside of the glove surface Do not roll the cuff Fingers inside of the second glove cuff Only touch the outside of the glove with your first gloved hand
450.
PPE contains?
Gloves, gown, gogles and mask unless told otherwise.
451.
Proper order for donning PPE?
1. gown 2. mask 3. goggles 4. gloves
469.
Remember with sterile gloving
Only touch the OUTSIDE of the surface glove Glove to Glove Skin to Skin
452.
Where do you remove PPE?
In the room.
470.
453.
Where do you put on PPE?
Outside the room.
On nclex, when drying hands
Swipe ONE swipe per paper towel then throw it away and get another one
454.
Proper order for removing PPE?
1. gloves 2. goggles 3. gown 4. mask
471.
What can't children under four have?
Small toys
472.
If a child has O2 is use what type of toys can't be used?
Metal
473.
Beware of Foamites
Nonliving object that harbors microorganisms
474.
What is the best toy for a 0-6 month old?
Musical mobile (get rid of this at 6 months or when the child is sitting up)
475.
What toy is good for an immunosuppressed patient?
Action figure. Can't harbor microorganisms
In airborne precautions it is ok to remove what piece of PPE outside of the room?
Mask
What position are your hands for handwashing?
Hands below elbow
457.
How long do you wash for handwashing?
15 seconds
458.
Can the faucet have handles for handwashing?
Yes
455.
456.
476.
What three things should you ask yourself when choosing appropriate toys for kids?
Is it safe Is it appropriate Is it feasible
477.
Remember: 9 Months in the womb
9 months until purposeful activity
478.
What is the 2nd best toy for a 0-6 month old?
Anything soft and large
479.
What is the best toy for a 6-9 month old?
Cover/uncover toy eg. jack in box
492.
Allow adolescents to be in each others rooms unless?
Contagious Immunosupressed Fresh post-op <12 hr
493.
If you're being questioned over a drag and drop and you're given an option that would require a doctors order assume that you have that order. But if an option is to call the doctor, you call first then give.
...
494.
Best indicator of kidney function?
Creatnine
What is the second best toy for a 6-9 month old?
Anything large that they can't swallow.
495.
Creatinine norm?
0.6-1.2
496.
INR monitors?
Coumadin/Warafin therapy
What is the best toy for a 9-12 month old?
Talking toy.
497.
INR therapeutic level?
2-3
498.
If the INR is over 4 you?
482.
What is the second best toy for a 9-12 month old?
Anything that is purposeful (play with blocks)
483.
What 5 words should you avoid when answering a question about toys for a child under 9 months old?
Build Make Construct Sort Stack
Hold all Coumadin/Warafin Assess bleeding Prepare to give K+ Call doctor
499.
Potassium norm?
3.5-5.3
500.
If the potassium is below 3.5 you?
What is the best toy for a toddler (1-3 yr.)?
Push/pull toy wagon, stroller
Assess the heart Prepare to give potassium Call the doctor
501.
485.
What should you work on with a toddler (1-3 yr.) ?
Gross motor eg. run, jump NOT finger dexterity <- fine motor
If the potassium is high (5.4-5.9 high but still within the 5's) you?
Hold potassium if in the IV Assess the heart Prepare to give D5W with insulin Call the doctor
486.
What is toddler (1-3 yr.) play characterized by?
Parallel play (with another child but alone)
502.
If the potassium is over 6 you?
487.
What two things should you work on with a preschooler (3-6 yr.) ?
Fine motor (fingers) Balance (dance, gymnastics)
488.
What sort of play do preschoolers (3-6 yr.) prefer?
Pretend play
Stop what you're doing and assess If negative effects present you call rapid response. If no negative effects you do the same as "high but within the 5's)
503.
pH norm?
7.35-7.45
489.
What is preschooler (3-6 yr.) play characterized by?
Co-operative play (together) Everybody wins
504.
If the pH is under 6 you?
Assess vital signs Call the doctor ASAP
School age (7-11 yr.) is characterized by the 3 C's, what are they?
Creative (no coloring book, use blank paper) Collecting Competitive
505.
BUN norm?
8-30
506.
If the BUN is elevated check for?
Dehydration
480.
481.
484.
490.
491.
Adolescents (12-18 yr.) "play" is?
Peer associated
507.
How should you prioritize labs?
Which level will do the most harm to the body and NOT the disease it's associated with.
530.
Absolute neutrophil count (ANC) norm?
500
531.
CD4 norm?
>200 (below that=aids)
532.
If the WBC count is high this is called?
Leukocytosis
533.
If the WBC is low it is called?
Leukopenia Neutropenia Agranulocytosis Immunosupression Bone marrow supression
534.
If the WBC is low you should?
Follow strict handwashing Shower BID with antimicrobial soap Avoid crowds Private room No fresh flowers or potted plants Low bacteria diet- no raw fruits/veggies, no undercooked meat. No water drinking if its been sitting for longer then 15 minutes. Vitals Q4H Check WBC daily Avoid reusable plates/silverware etc,
If you have a lab thats high and you don't know why pick?
Dehydration
509.
Hgb norm?
12-18
510.
Hgb under 8 you?
Assess bleeding Prepare blood Call doctor
511.
Elevated Hemoglobin?
Dehydration
512.
Bicarb (HCO3) norm?
22-26
513.
CO2 norm?
35-45
514.
CO2 is the 50's you?
Assess respiratory status Do pursed lip breathing ^ exhale time DON't give O2 if the above isn't working call the doctor!
515.
Severe Acidosis means what?
Hyperkalemia! Biggest priority
516.
CO2 in the 60's (respiratory failure) you?
Assess respiratory status Do pursed lip breathing Prepare for intubation Call respiratory therapy Call the doctor
517.
Hct norm?
36-54
518.
PO2 norm?
78-100
535.
Platelets norm?
150,000-400,000
519.
PO2 70-77 you?
Assess respiratory status Give O2
536.
If platelets are below 90,000 you?
520.
PO2 below 60 you?
Assess respiratory status Give O2 Prepare for intubation Call respiratory therapy Call the doctor
Check for bleeding Place on bleeding precautions (thrombolytic precautions)
537.
If platelets are below 40,000 you?
Prepare platelet transfusion Call the doctor
538.
RBC norm?
4-6
539.
What is a lamina? Reason for laminectomy?
Vertebral spins process (bumpy bones at back of neck) To treat nerve root compression.
540.
3 P's of nerve root compression (S/S) ?
Pain Paresis= muscle weakness Parasthesia
541.
Knowing the location of a laminectomy is key to getting the ? right.
...
542.
Cervical =
Neck
543.
Thoracic =
Upper back
544.
Lumbar =
Lower back
508.
521.
O2 sat norm?
93-100
522.
O2 sat below 93 you?
Assess respiratory status Give O2
523.
BNP norm?
<100
524.
BNP is a good indicator of what?
CHF
525.
What is the best indicator of CHF?
ANF
526.
ANF and BNP=
CHF
527.
Sodium norm?
135-145
528.
Sodium is ok if abnormal unless what occurs?
Change in LOC
WBC norm?
5,000-11,000
529.
545.
Pre-op cervical laminectomy's most important assessment is?
1st breathing (rate and rhythm) 2nd arm and motor sensory
546.
Pre-op thoracic laminectomy's most important assessment is?
1st cough (uses abdominal muscles) 2nd bowel sounds (If you can't contract these muscles, you can't cough)
547.
Pre-op lumbar laminectomy's most important assessment is?
1st voiding ( when was last time, can they) 2nd leg motor and sensory.
559.
Discharge teaching for a laminectomy?
Don't sit for longer then 30 minutes for 6 weeks Ly flat and log roll for 6 weeks No driving for 6 weeks Do not lift more then 5 lb. for 6 weeks
560.
Permanent restrictions for a laminectomy?
Do not lift by bending at the waist No crazy activities... jerky rides, horseback riding
561.
For a cervical laminectomy they can never?
Lift objects above the head.
562.
Nageles rule for calculating a due date is?
1st day of the last menstrual period Add 7 days Subtract 3 months
548.
The rule of ABC"s doesnt work in what area of health?
Neuro
549.
What is the #1 post-op answer for the NCLEX?
Log roll the patient
563.
Normal weight gain for pregnancy?
28 + or - 3 lb
550.
Activity requirements/restrictions Q8H after laminectomy surgery?
Do NOT dangle (AKA sit on the side of bed) May stand, walk and lay without restrictions Don't sit longer than 30 minutes
564.
1st trimester weight gain?
1 lb a month x 3 months
551.
What post-op complication do you watch for with a cervical laminectomy?
Pneumonia/Atelectesis (breathing issues)
552.
What post-op complication do you watch for with a thoracic laminectomy?
Decreased cough= Aspiration > pneumonia Decreased GI= ilius
553.
What post-op complication do you watch for with a lumbar laminectomy?
Urinary retention
554.
For a laminectomy what incision site is more painful?
Hip site
555.
For a laminectomy what incision has the most drainage/bleeding?
Hip site
556.
For a laminectomy what incision site has the highest risk for infection?
50/50 equal
557.
If being asked about a surgery and the length of time for restrictions your default answer should be?
6 weeks
Surgeons are using cadaver from bone banks. Why?
Because they only do one incision Quicker heel time
558.
565. 2nd/3rd
trimester weight
1 lb a week x 6 months
gain? 566.
After week 12 you can subtract 9 to get appropriate weight gain. (Think 9months)
Week 12 = 3 lbs 13 = 4 lbs 14 = 5 lbs 15 = 6 lbs 16 = 7 lbs 17 = 8 lbs eg. week 14-9= 5lbs 28-9= 23 lbs
567.
Fundal height is not palpable until week?
12
568.
The fundus is palpable at the naval at week?
20-22
569.
If the fundus is not above the naval the baby is not?
Viable
570.
Positive signs of pregnancy?
Fetal skeleton on X-ray Fetal presence on ultrasound Auscultation of FHR (heart at week 8, most likely at 10 and should be heard by 12) Examiner palpates fetal movement
571.
Probable/presumptive signs of pregnancy are?
All urine and blood tests
572.
What is Chadwicks sign?
Cervical change to cyanosis (blue hue)
573.
What is Goodells sign?
Cervical softening
574.
What is Hegars sign?
Softening moves from the cervix to the uterus.
575.
Good prenatal care = dr apt _______ times a month until week 28
once a month
576.
Good prenatal care= dr apt ________ a month weeks 28-36
Twice a month
577.
Good prenatal care= dr apt ______ times a month weeks 36 to birth
4 times a month
578.
Is it normal to be slightly anemic during pregnancy?
Yes
579.
Normal Hgb level in women is?
12-16
580.
Hgb level in first trimester?
Can fall to 11 and it is normal.
591.
Station is?
This refers to the baby's presenting part (normally the head) to the mothers ischeal spine. So if the baby is above the ischeal spine they are given a - number, if they are below they are given a + number. + numbers are positive news - numbers are negative news.
592.
Engagement is?
Station 0
593.
Lie is?
Relationship between the spine of the baby and the spine of the mom. Vertical (parallel) is ok, Tranverse (perpindicular) is bad.
594.
Transverse Lie?
C- Section!
581.
Hgb level in second trimester?
Can fall to 10.5 and is normal.
595.
Presentation is?
The part of the body that enters the birth canal first.
582.
Hgb level in the third trimester?
Can fall to 10 and is normal.
596.
The first stage of labor is?
The labor part.
583.
How do you treat morning sickness? (1st trimester)
Dry carb
597.
The second stage of labor is?
Delivery of the baby.
584.
How do you treat urninary incontinence during pregnancy? (1st and 3rd trimester)
Void Q2H
598.
The third stage of labor is?
Delivery of the placenta.
599.
How do you treat dyspnea during pregnancy? (2nd and 3rd trimester)
Tri-pod position (sit, lean forward, elbows on knees)
The fourth stage of labor is?
Recovery (1st 2 hours after the placenta is delivered)
600.
Q15min until the 2hr mark after placental delivery. Then Q1H.
How do you treat back pain in pregnancy? (2nd and 3rd trimester)
Pelvic tilt exercise
How often do you monitor during labor?
601.
3
Always teach a pregnant women to pee how often from day of pregnancy to 6 weeks post partum?
Q2H
The first stage of labor has how many phases?
602.
Latent, Active and Transition
Truest most valid sign of labor is?
Regular contractions
What are the three phases of labor?
603.
Latent phase is?
0-4 cm dilated Contractions are 5-30min apart Lasting 15-30 sec. They are mild
604.
Active phase is? ONLY MEMORIZE THIS (The other phases can be figured out)
5-7 cm dilated Contractions are 3-5 min apart Lasting 30-60 sec. They are moderate
605.
Transition phase is?
8-10 cm dilated Contractions are 2-3 min apart Lasting 60-90 seconds They are strong
606.
Contractions should be no longer then ____ and no closer then_____.
90 sec and 2 minutes > = uterine tetany & hyperstimulation =decreased 02 to baby
585.
586.
587.
588.
589.
Dilation is?
Opening of the cervix (0-10)
590.
Effacement is?
Thinning of the cervix (0-100%)
607.
How do you assess frequency of contractions?
Beginning of one contraction to the beginning of another.
608.
How do you assess duration of a contraction?
Beginning to end of contraction
609.
How do you assess the intensity of a contraction?
Palpate with one hand over fundus and with the fingertips.
610.
How do you treat painful back labor?
Knee to chest position You use your fist and press on the patients sacrum.
611.
How do you treat prolapsed cord? 911!! OB emergency
Push head back in knee-chest (hands and knees) or Trendelenburg Or elevate hips on pillows Don't put the patient on their left side. Cover the cord in moist saline
612.
613.
What interventions do you do for all other OB complications? (LION)
VEAL CHOP
If Pitosin is running stop this first then LION L-eft side position I-ncrease IV O-2 N-otify doctor V- Variable CCord Comphression E- Early Decels H- Head Compression A- Accelerations O - OK L-Late Decels P Placenta
614.
Do not give what type of pain medication to a women in labor if the medication is likely to peak when the baby is born?
Systemic- AKA IV, IM and oral
615.
Low fetal heart rate is ?
Bad LION if hr under 110
616.
High fetal heart rate?
160 This is ok Take mom's temp
617.
Low baseline variability? (aka heart rate not changing)
Bad LION
618.
High baseline variability?
HR changing a lot. This is ok.
619.
Late decelerations?
Bad (placental insufficiency) LION
620.
Early decelerations?
Head pressed on. This is ok.
621.
Variable decelerations?
HR up or down, cord compression = VERY BAD Prolapsed cord= push head up, change mom position
622.
ACE of spades answer for OB?
Check fetal HR
623.
If in OB its low or late you?
LION
624.
If variable its?
Very bad and you push and position.
625.
The second stage of labor and delivery is all about?
Order
626.
So what do you do and in what order for the second stage?
Deliver the head Suction 1st the mouth then the nose Check for nuchle cord (cord around neck) Deliver shoulders and body ID band
627.
During the third stage of labor and delivery (placental delivery) you do what two things?
Make sure it's intact( can 1)hemorrhage 2) infection) Check for three vessels (2 arteries, 1 vein)AVA
628.
What are the 4 things you do 4 times an hour for the 4th stage of labor?
VS- check for S/S of shock Fundus- if boggy, massage. If displaced,void/cath Perineal padexcessive lochia= pad saturated Q15min 911 Roll on side and check the pad for bleeding.
The uterus should be like what after delivery?
Firm not boggy Fundal height= days postpartum (3days= 3cm below naval) Midline- if not catheterize
630.
Lochia color rubra?
Red- rub it red
631.
Lochia color serosa?
pink- rose pink
632.
Lochia color alba?
White- albino white
633.
Moderate lochia is?
4-6 inches on pad in one hour
634.
Excessive lochia is?
Saturated pad in 15 minutes
635.
Extremity assessment post partum should check?
Pulses Edema S/S of thrombophlebitis- bilateral calf circumference is the best way to check. If they are equal its ok if not its positive for whichever calf is bigger)
629.
Nevus/Nevi is?
The generic term for a birthmark.
What 2 newborn variations are you most likely to be tested on for the NCLEX?
Cephalohematoma and Caput Succedaneum
649.
Tocolytics do what to labor?
Stop it
650.
What are the two tocolytics?
Trobutaline= increases moms hr Nifediopine= ccb= decreases hr bp Magsulfate= decreases hr, bp, refleces, rr, loc (watch RR and watch Reflexes)
651.
SE for Terbutaline?
Maternal tachycardia This drug is not good if a heart issue is already present.
652.
SE of Nifedipine?
Headache and Hypotension (H&H)
653.
Oxytocics do what to labor?
Start it
647. 648.
636.
Post partum assessment should include what?
Uterus Lochia Extremities
654.
What are the two oxytocic's?
Pitocin=Oxytocin Cervidil= Prostaglandin Methergine
637.
Milia is?
Distended sebacious glands which appear as tiny white spots on babys face.
655.
Oxytocics used for PP Hemorrhage:
Pitocin, Methergine
656.
SE of Pitocin?
Can cause hyperstimulation (contractions longer than 90 sec. and closer then 2 min.)If FHR is less then 110 stop it, if FHR is normal you slow it. Used also for PP Hemorrhage.
638.
Epsteins pearls are?
Small,white epithelial cysts on babys gums.
639.
Mongolian spots are?
Bluish/black macules appearing over the buttocks and or thighs of darker skinned neonates.
640.
Erythema toxicum neonatorum is?
Red papular rash on babys torso which is benign and disappears after a few days.
657.
With an Epidural, give what after delivery?
Fluid Bolus to combat hypotension because they are a FALL RISK
641.
Hemangiomas is?
Benign tumor of the capillaries.
658.
Liquid meds in math calculations
Round
642.
Cephalohematoma is?
Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines.
659.
SE of Cervidil?
Effacement which leads to contractions.
660.
What are the two neonatal lung medications?
Betamethasone Survanta
661.
How do you give Betamethasone?
To the mom Before delivery IM
662.
SE of Betamethasone?
^ in glucose so monitor blood sugar
663.
How do you give Survanta?
To the baby After delivery By inhalation
664.
Humulin 70/30 is what?
70% N insulin (intermediate) 30% R insulin (short rapid)
643.
Caput Succedaneum is?
Edematous swelling on the scalp caused by pressure during birth. This swelling may cross suture line. It usually disappears in a few day.
Hyperbilirubinemia is?
Normal, physiologic jaundice appears after 24 hours of age and disappears at about one week.
645.
Vernix caseosa is?
Whitish, cheese like substance which covers the skin on an unborn baby.
646.
Acrocyanosis is?
Normal cyanosis of the babys hands and feet which appears intermittently over the 1st 7-10 days.
644.
665.
When drawing up insulins its?
RN (regular then N) draw what you are RN)
666.
If your are pressurizing for drawing up insulin you?
Draw what you are backwards. NR----> RN
667.
For injections an IM needle must be?
A 1 in both gauge and length. If not, pick the CLOSEST.
668.
For injections SUBQ needles must have?
A 5 in both gauge and length.
669.
What routes can you give Heparin?
IV or SUBQ
670.
How quickly does Heparin work?
ASAP
671.
Heparin does not
Thin blood/dissolve clots. It prevents clots from happening
672.
What do you monitor if on Heparin?
PTT
673.
Antidote for Heparin is?
Protamine Sulfate
674.
Heparin is what pregnancy class?
C
675.
How can Coumadin be given?
Oral only
676.
For Heparin, Ask:
How long have they been on it?
677.
How long does it take for Coumadin to work?
3-5 days
678.
What do you monitor in Coumadin?
Pt-INR(this is only for Coumadin)q
679.
What is the antidote for Coumadin?
Vitamin K
680.
What pregnancy class is Coumadin?
X
681.
Switching from Heparin to Coumadin must?
Be 14 days after heparin (5 days before coumadin) or there is a risk for DIC.
682.
Clot busters end in what?
Ase
683.
All K+ wasting diuretics end in?
X... If it ends in X its X's out K+ everything else it K+ sparing diuretics.
684.
Generic for Baclofen(this will be on the NCLEX)
Lioresil or Flexeril -muscle relaxant/antispasmotic
685.
What is Baclofen(Lioresil, Flexeril)?
Muscle relaxer
686.
Baclofen(Lioresil, Flexeril) SE?
Muscle weakness and drowsiness
687.
What should you teach a patient taking Baclofen(Lioresil, Flexeril)?
Don't drive/ operate machinery Don't drink alcohol Don't care for children under 12 Causes muscle weakness Causes Drowsiness
688.
What is the saying that can be used to help remember Baclofen(Lioresil,Flexiril)?
When you're on Baclofen you're on your back loafin.
689.
Pregnancy Categories
A- Safe B- Problems in Animals, Not Humans C- Caution, if benefits outweigh the risks you can use it X- NEVER.
690.
A 0-2 yr old is in what Paiget stage?
Sensory motor total present thinking Only teach what you do, while you do it Tell them directly
691.
A 3-6 yr old is in what Piaget stage?
Pre-operational Fantasy based teach just before (morning of) Teach what you are going to do Learn through play
692.
A 7-11 yr old is in what Piaget stage?
Concrete operation (think of a 7-11 with concrete around it) Rule oriented (can't abstract) teach days ahead Teach what to do +skills Be age appropriate, use demonstrations
693.
A 12-15 yr old is in what Piaget stage?
Formal operations Can abstract Can be taught like adults can manage their own care
694.
Piagets sensory motor stage is characterized by?
Present oriented Only think about what they SENSE or are DOING now.
695.
As a nurse when, what and how do you teach a child in sensorimotor stage?
Teach when you're doing it What you're doing to them Do it verbally
696.
Piagets pre-operational stage is characterized by?
Fantasy oriented Illogical No rules
697.
Teaching 0-2 years old?
Teach them as it happens, verbally tell them what you're doing as you do it
698.
Teaching 3-6 year olds?
Teach them the day of, Don't let them sleep on it. Tell them what you're going to do - future tense. USE PLAY. Picture book, dolls, play with equipment
699.
Teaching, 7-11 year olds?
Teach days before. Teach them what you're going to plus skills (they can draw up insulin) Don't use play. Use Age Appropriate audio + visual materials
700.
Teaching 12-15 year olds?
Teach them like an adult! They can think abstractly.
701.
As a nurse when, what and how do you teach a child in the preoperational stage?
Teach the day of- to avoid nightmares What you're going to do Do this through play
702.
Piagets concrete operations stage is characterized by?
Rule oriented Live and die by the rules Cannot abstract
703.
As a nurse when, what and how do you teach a child in the concrete operations stage?
Teach them ahead of time What you're going to do Use visual and audio and use age appropriate reading
704.
At what Piaget stage can you teach a skill like how to draw up insulin?
Concrete operations
705.
Piagets formal operations stage can be taught like?
An adult
706.
Stage 1 Pressure Ulcer
Non Blanching Redness 707.
Stage 2 Pressure Ulcer
Skin no longer intact, fleshy pink base with a break in skin integrity This is where Blistering is 708.
Stage 3 Pressure Ulcer
Yellow fatty tissue seen at the base 709.
Stage 4 Pressure Ulcer
Bright Red Muscle or Bone is seen 710.
Milia
Distended sebaceous glands which appear as tiny white spots on the baby's face. NORMAL.
711.
Epstein's Pearls
715.
Cephalohematoma
Small, white epithelial cysts on the baby's spots 712.
Swelling caused by bleeding between the osteum and the periosteum of the skull. This swelling does not cross the suture lines.
Mongolian Spots 716.
Blue-ish black macules appearing over the buttocks and/or thighs of darker skinned neonates 713.
Caput Succedaneum
Crosses the suture lines 717.
Hyperbilirubinemia
Erhythema Toxicum Neonatorum
Normal, Physiologic Jaundice 718.
Vernix Caseosa
Red papular rash on the baby's torso which is benign and disappears after a few days 714.
Hemangiomas
White wax like substance that covers the skin of an unborn baby
Benign tumor of the capillaries
719.
Acrocyanosis
726.
For a prioritization question what 2 pieces of information do not matter?
Age and gender
727.
What are the four rules of prioritization?
Acute < chronic Fresh post-op(12hr.) < medical or other surgical. Unstable < stable The more vital the organ the higher the priority(use only as a tie breaker)
728.
What is the best rule out of all 4 for prioritization?
#4
729.
What makes a patient stable? (7)
Chronic illness Over 12 hr post op Local or regional anesthesia Unchanged assessment Phrase "to be discharged" Lab values A or B Typical S/S for the disease they have or what they are receiving treatment for.
730.
What makes a patient unstable? (7)
Acute illness Post-op less than 12 hr General anesthesia Changed assessment Phrase "newly admitted" or "newly diagnosed" Labs C & D Unexpected S/S
731.
What 4 things are always considered unstable?
Hemorrhage Hypoglycemia Fevers over 104* Pulselessness and breathlessness
732.
The more VITAL the ORGAN
The HIGHER the priority
733.
What are the main 6 organs in prioritized order?
1. Brain 2. Lung 3. Heart 4. Liver 5. Kidney 6. Pancreas
734.
What do you not delegate to a family member?
Safety responsibilities-" can you watch your dad really fast while I grab something."
735.
Family can only do what you ____ them for the patient?
Teach
normal cyanosis of the baby's hands and feet. Appears intermittently over the first 7-10 days 720.
Nevus/Nevi
Normal Birthmark 721.
Pulse Points
722.
If S1 is louder in a heart sound
It's in the tricuspid
723.
If S2 is louder is the heart sound
It's Aortic
724.
For prioritization the question will give what 4 pieces of information?
Age Gender Disease Modifying phrase
For a prioritization question the most important information is?
The modifying phrase
725.
736.
737.
ONLY RN SCOPE (Don't delegate to LPN)
Do not Delegate to an UAP
Starting an IV Hanging of mixing IV Meds Evaluating IV Site or anything Giving IV Push Meds Giving an Blood Transfusion Preforming Admission, discharge, transfer assessment, or any UNSTABLE patient Plan of Care Developing or Preforming Teaching Taking Verbal Orders from MD Chart about a Patient (They may document what they DID) Assessment Meds/IV. They MAY apply topical lotions/creams Treatments, except for Soap Suds Enema
746.
Phenothiazines end in?
"zine"
747.
Large doses of phenothiazines are ?
Anti-psychotic
748.
Small doses of phenothiazines are?
Antiemetics
749.
Major doses of phenothiazines are?
Tranquilizers..... BIG GUNS.
750.
The SE for phenothiazines are? (ABCDEFG)
A-nticholinergic SE B-lurred vision C-onstipation D-rowsiness E-xtra paramital syndrome F-otosensitivity aG-granulocytosis
751.
What do you teach patients taking phenothiazines?
Report sore throat and any signs of infection. Keep medicating, tell dr of SE If toxic effect hold drug, tell dr
752.
What is the #1 nursing diagnosis for a patient taking phenothiazines?
Risk for injury --Keep pt Safe
753.
If a drug has the word _____ behind it, it means long IM form for noncompliance?
Deconoate
754.
Deconoate means?
Long IM form given to noncompliant patients.
755.
Tranquilizers work?
ASAP
756.
Antidepressants work?
In 2-4 weeks
757.
Tranquilizers shouldn't be taken?
Long
758.
Antidepressants can be taken?
Long
759.
What are the four Tricyclic antidepressants you need to know?
Elavil Tofranil Aventyl Desyrel
760.
Tricyclic SE? (Elavil starts with E so they go through E ABCDE)
A-nticholinergic effects B-lured vision C-onstipation D-rowsiness E-uphoria (happy)
761.
Tricyclic's do what to the mood?
Elevates it elavil- elevates
762.
Benzodiazepines are ?
Antianxiety meds.
763.
Benzodiazepines are considered minor __________?
Tranquilizers
764.
Benzo's have what in the name?
"zep"
You MAY delegate ADLs. 738.
Perfect Glasgow Coma Score?
15
739.
If another staff member is doing something illegal you?
Tell the supervisor.
What do you do if another staff member is placing the patient in physical or psychological harm?
Intervene and take over.
741.
What do you do if a staff members behavior is legal, not harmful but just inappropriate?
Counsel them later at a better time.
742.
PSYCH do not receive______ do not give _______ keep the pt ________ about it Use _______ when communicating Put self in client's _______ choose answer that reflects
gifts advise talking the feelings of the client shoes Don't fucus on words said, but feelings (empathy questions have a quote in them)
743.
All psych medications cause what?
Weight changes and low BP.
744.
What group of drugs is the most commonly tested on the NCLEX?
Psychotropic
What are phenothiazines?
Psychotropic drugs
740.
745.
765.
Must not take Benzo's for longer than?
6 weeks
778.
Prozac is?
An SSRI
766.
Benzo's can also be used for what 5 other reasons?
1. Anesthesia induction 2. Muscle relaxant 3. Alcohol withdrawal 4. Seizures 5. Facilitates mechanical ventilation
779.
Prozac has the same side effects as Elavil?
ABCDE
780.
Prozac causes what?
Insomnia
781.
When should you give Prozac?
Before 12 noon.
782.
If Prozac is BID give at what times?
6A and 12N
783.
When changing the dose of Prozac for a young adult you must monitor for?
Suicide
784.
If you don't know what a drug is and you are being asked which lab is important.... you need to remember?
ALT A L-iver T-est
785.
What is the average dose of Haldol?
5 mg
786.
Haldol has the SE?
ABCDEFG
787.
Elderly patients need to take what amount of Haldol?
Half the regular amount.
788.
If an elderly patient OD's on Haldol what are they at risk for?
NMS Neuroleptic Malignant Syndrome
789.
Hyperprexia is?
Fever- really bad fever
790.
NMS has what associated with it?
Hyperprexia
791.
Clozaril(Clozapine) is what?
A second generation tranquilizer
792.
Most second generation tranquilizers have what in them?
"zap"
793.
How often do you have to draw a WBC for a patient taking a second generation tranquilizer?
1 a week for 1 month 1 a month for 6 months 1Q6 months for life
794.
Clozaril(Clozapine) is used to treat?
Severe schizophrenia
795.
If a question has a drug with "zap " in it, the answer is probably?
Infection related
796.
Clozaril(Clozapine) has what SE?
Agranulocytosis
797.
Zoloft(Sertraline) is a?
SSRI
798.
Can Zoloft be taken in the evening?
Yes
799.
Does Zoloft cause insomnia?
Yes
800.
Zoloft decreases metabolism and can cause?
Toxic drug levels
801.
What should you monitor with Zoloft use?
Other drugs levels
767.
Benzo SE? (ABCD)
A-nticholinergic effects B-lured vision C-onstipation D-rowsiness
768.
What is the #1 nursing diagnosis for Benzo's?
Safety
769.
MAOI's treat?
Depression
770.
MAOI's are the?
Mar-plan Nar-dil Par-nate
771.
MAOI SE?
A-nticholinergic effects B-lured vision C-onstipation Drowsiness
772.
773.
774.
To avoid a severe hypertensive crisis patients taking MAOI's must avoid all foods with?
Tyramine
a list of Tyramine foods
AGED & FERMENTED Cheese Sour cream Yogart Soy sause cured meats beer/wine smoked fish
Lithium SE? (The 3 P's)
Peeing Pooping Parasthesia
775.
Lithium toxic SE?
Metallic taste Severe diarrhea
776.
Number 1 intervention for Lithium toxicity?
Keep them hydrated If sweating give sodium as well as fluids
777.
While on Lithium you must monitor the level as well as what?
Sodium
802.
Patients taking Zoloft should NOT take what?
St. John's wort
803.
St. John's wort and Zoloft use can cause?
Serotonin Syndrome
804.
What are the S/S of serotonin syndrome?
S-weating A-pprehension (sense of doom) D-izziness H-eadache
805.
806.
807.
If a patient is on drug A for 10 yrs. and the doctor adds drug B which drug dose needs to be lowered?
Drug A
Tx Protocol for Depression
High Calorie, FIBER FOODS. Activities that are with others, but not interactive. Like Parallel Play. Dangers: Suicide. If They suggest it, be direct and ask them if they have a plan
Tx Protocol for Schizophrenia
Obvious Foods. They are suspicious. If they are on antipsychotics, think FIBER. Activity- With people to reinforce reality Huge homicide/suicide risk. They are the biggest risk for otherdirect violence
808.
Tx Protocol for Bipolar
Mania - Very high calorie, Finger Foods (on the go) Needs Gross Motor Activity Let them sleep whenever they can Not usually self destructive
809.
Tx Protocol for Anxiety Disorder
No special diet, more anxious = more allergies Activity absorbs anxiety Self destructive behavior is not an issue.
810.
Hypomania
Manic but can function
811.
Manic
Can't function in society
812.
Stages of desensitization
Talk about it Look At Pictures Be Environment with it Interact/Experience it
813.
For a phobia, the first thing you do is
Let them avoid it for now.
814.
Violent Clients
Goal is to de-escalate. Walk with a pacing patient. Say "I see you are upset" Need 5 people to control a person. 1 person charge.
815.
For Empathy Questions
Always pick the answer that reflects the patient's FEELINGS, Not Actions, or the nurses feelings.
816.
Abdomen Organ Landmarks
817.
Heart Ausculation Landmarks
818.
The ACE of spades answer for nutrition is to either pick ____ or _____.
Chicken Fish
819.
Never choose _______ as a food for children.
Casserol
820.
For a toddler pick ______ food.
Finger
821.
For a preschooler ____ meal a day is ok!!!
1 (they aren't growing as fast)
If you know what a particular drug does pick a SE in the ______ body system.
Same
823.
If you have no idea what a drug is check to see if it is ___. If it is, pick a _______ SE.
PO GI
824.
Ace of Spades answer for OB?
Check the FHR.
825.
What is the first thing you assess in a Med-Surg situation?
L.O.C. = Bob, Bob, Bob are you ok????
826.
What is the first thing you do in a Med-Surg situation?
Airway
For Peds when in doubt call it?
Normal
For Peds when in doubt pick?
The older age.
829.
For Peds when in doubt pick the?
Easier task for the child.
830.
In Peds always give?
More time
831.
Empathy question have?
A quote in the question and a quote in the answer.
832.
In psych choose the answer that reflects the _______ and not the _______ they said.
Feelings Words
833.
Warfarin, watch for?
Bleeding
834.
When you get a select all that apply question, do NOT ask
What list do I remember?
835.
When you get a select all that apply question, ask yourself:
836.
When you get a select-all that apply question, ask yourself:
822.
827.
828.
837.
838.
Do not use the following words in your thought process: Boards love to make an answer
Never select an answer on a SATA
Based on another answer you chose. Base it on the QUESTION.
840.
Watch for opposite answers...The list will often contain a __ concept going in the ___direction.
Correct Concept in the Wrong Direction. READ CAREFULLY!
841.
Make sure to decide if the question is asking what ___ the phenomenon OR what ___ from it.
Causes the phenomenon or results from it. These are often the totally opposite answer.
842.
Rule out
Absolutes. Like "Always" or "Never"
843.
If two answers say the same thing
Neither is right "tachycardia", "racing heart"
844.
If two answers are opposite
One of them is probably right
845.
Pick the answer that is more
Global. (Umbrella Answer) For example, "Initiate suicide precautions" instead of "Remove belt", "medicate", "supervision", ect.
846.
Don't be tempted to answer a question based on your ___ instead of your____
Ignorance instead Knowledge (if you've never heard of it, DON'T PICK IT)
847.
If you don't know a drug in the question...
Cross it out, ignore it. Look at the route or other info about it. Like "IVPB" and base your answer on what you DO know about THAT!
848.
If you don't know an answer
You do know the answer. Use your common sense!
What principle do I know that could guide me to make my selection?
849.
If an answer seems right
It probably is. Right answers are different from wrong answers just because they are right!
What does this disease/drug/procedure do to the BODY? For example, hypocalcemia makes the body responses go UP.
850.
Only change an answer
If you have a rationale and can answer as to why THAT answer is superior to one you originally chose
851.
Every psych patient is a
Med-surg patient first
852.
In order to pick a psych answer, the patient must be
Stable, Safe, and comfortable
853.
Priorities, in Order
Physiological, Safety, Comfort(Includes Pain), Psychological, Social, Spiritual (Maslow's)
Maybe, If, Possibly, Might, Could. They lead to OVERSELECTION! Right, but in the wrong direction. For example, Hyperkalemia when it should be HypOkalemia
839.
854.
Boards try to trick you with the words
"bile stained " and "vomitus" in acid base. It is NOT from the stomach, it is from the intestine, so it means metabolic acidosis.
855.
Patients that do NOT need interdisciplinary care
Pt with multiple med surg diagnoses. Not the sickest or the most unstable people!
856.
Patients that do need interdisciplinary care
Patients with multidimensional needs. For example, physical, intellectual, psychological, emotional, spiritual.
869.
Wheezes are heard, what would you give?
Bronchodilator
870.
Theophylline
Long acting bronchodilator
871.
Should you massage a pressure sore if it won't blanch?
NO
872.
Lithium toxicity
Tremors, Metallic taste, neuro symptoms besides parenthesia
873.
High sodium levels in lithium
Decrease the effectiveness
874.
Low sodium levels in lithium
Prolong lithiums half life
875.
If you don't know the drug, monitor
Liver Enzymes Then Creatinine Then WBC
Patients who need rehabilitation
Needs interdisciplinary Care Automatically
Tie breakers when deciding which patient needs interdisciplinary care more
Patient who's current treatment is ineffective, or the patient who is preparing for discharge
876.
Elderly patients on Haldol
Should be 2.5 mg (half of the regular dose of 5)
859.
Best indicator of CHF
ANF (ANF+BNP=CHF)
877.
Legs elevated
860.
Plague is not longer commutable when?
After 48 hours of treatment
In a patient with suspected shock, how should you position them?
861.
Stop beta blockers & calcium channel blockers if
Patient had MI or suspected MI
878.
Nursing diagnoses must
Support the assessment data in the question
879.
Unsuitable for age group
If a diabetic is unconscious
If in hospital, give dextrose IV If at home, give Glucagon
When intervening in daycare, look for task that is
880.
Low bowel surgery
Low residue diet
Pt just had gastric surgery...acting drunk and in shock with ABDOMINAL distress... Think?
Dumping syndrome! Low everything!
881.
Ruptured membranes
Check for prolapsed cord
882.
Antacids should not be given?
With meals. They interfere with absorption With other meds. They stop other med absorption
Pt has chest pain when lying down and indigestion
Hiatal Hernia
883.
After an amputation, for the first 24 hours, don't
Put the leg under s pillow, might cause contractures
865.
Cushing's patients with an adrenalectomy need what?
A "SONE" because they are more like an addison's pt now
884.
866.
All adrenal cortex disorders start with?
A or C
Whenever a time is mentioned after a medication is given, like "a pt received morphine. One half hour later, the patient wants to ambulate"
Think about the peak times of the medication and if there are any safety risks involved! Don't ambulate if a medication is likely to peak!
867.
Prolapsed cord / Variable decelerations, do you turn them on their left side?
NO! Knee to chest position, tredelenburg, or elevate hips on pillows.
885.
In the pre interaction phase the nurse will?
Explore his/own feelings about...
886.
If you see the words "During the initial interview" "Upon admitting the patient" "On admission" "At your first few meetings with" "While assessing" "On the day of admission" "While FORMULATING nursing diagnoses"
Correct answers should be: Tolerant Accepting Explorative Probing "Nosy" Be warm and fuzzy This is the introductory phase. You would not set limits
857.
858.
862.
863.
864.
Also cover chord in moist saline 868.
Pressurizing insulin
Draw up whole dose of air Put air into N (equal to liquid amount ordered) Put air into R Draw up R Draw up N
