NCLEX-RN PREPARATION | REVIEWER | SATA | PRIORITIZATION | DELEGATION |

NCLEX-RN PREPARATION | REVIEWER | SATA | PRIORITIZATION | DELEGATION |

5/25/2008

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1. CERVICAL CA

Risk Factors:

• African- American/ Native

women

• Behavior (Sexual promiscuity)

• Chronic instrumentation of cervix

• Disease –STD

• Early age of Sex

• High Parity

• Poor Hygiene

• Low economic status

• Multiple sexual partners

• Partner with Prostate CA

Sx:

• Post-coital bleeding

• Painful sex

• Menstrual irregularities

2. OVARIAN CA

Risk factors:

• Ovarian dysfunction

• Vaginal use of talcum powder

• Alcohol

• Race - White women & family

history

• Infertility

• Age - Peak=5th decade of life

• Nulliparity

• Genetic predisposition

3. DM FOOT CARE

• Meticulous care to feet

• Wash feet with warm water not hot &

dry

• Can use lotion but No lotion in

between toes

• Wear socks to keep feet warm

• Avoid thermal baths, heating pads

• Do not soak feet

• Inspect feet daily

• Do not treat corns, blisters

• Wear loose socks and no barefoot

• Change into clean cotton socks daily

• Break in new shoes gradually

• Use emery board

• Do not smoke

• Do not wear same pair of shoes 2

days in a row

• Check shoes for cracks before using

4. BLOOD TRANSFUSION

REACTION

• Transfusion Reactions

Hemolytic Reaction

Allergic Reaction

• Circulatory Overload

• Septicemia

• Iron Overload

• Hypocalcemia

• Disease Transmission

• Hyperkalemia

• Citrate Intoxication

5. HYPERTHYROIDISM

• Soft smooth skin & hair

• Mood swings

• HPN

• Diaphoresis

• Intolerance to heat

• PTU drug to block thyroid synthesis

6. LUNG CA

• Bronchogenic Carcinoma

• 1st leading cause of death

• From asbestos, bacterial invasion,

cigarette

• Sx: Nagging cough, hoarseness of

voice, dyspnea, diminished breath

sounds

7. SX OF PARKINSONS

• Tremors, akinesia, rigidity

• Weakness, “motorized propulsive

gait

• Slurred speech, dysphagia, drooling

• Monotonous speech

• Mask like expression

• Teach ambulation modification:

goose stepping walk (marching),

ROM exercises

• Meds—Artane, Cogentin, L-Dopa,

Parlodel, Sinemet, Symmetrel

• Activities should be scheduled for

late morning when energy level is

highest

• Encourage finger exercises.

• Promote family understanding of

disease intellect/sight/ hearing not

impaired,

8. ACUTE PANCREATITIS

• Abdominal Pain severe –acute sx

• Complication : Shock,Hypovolemia

• Limited fat & protein intake

9. CAST CARE

Don’t rest on hard surface

Don’t cover until dry 48+ hours

Handle with palms of hands not with

fingers

Keep above level of heart

Check for CSM

10. HYDROCEPHALUS

• Anterior fontanel bulges & nonpulsating

• Bones of head separated (cracked

pot sound)

• Check for sun-setting eyes

• D’ Increase ICP

• Evidence of Frontal Bossing

• Failure to thrive

• Irritability

• High-pitched cry

11. ESRD DIET

• Restricted protein intake

• Increase CHO

• Low K, P

• Restrict Na

12. NORMAL IN 8 MONTH OLD

CHILD

- can sit with out support

- can roll from front to back

- can hold a bottle

- closure of ant. fontanel

- can say mama and dada

- 2 teeth present

13. SUPERIOR VENA CAVA OCCLUSION

• Sx occur in the morning

• Edema of face, eyes & tightness of

shirt/ (Stoke’s sign)

• Late sx: edema of arms, hands,

dyspnea, erythema, epistaxis

14. ULCERATIVE COLITIS

Sx:

• Severe diarrhea with blood & mucus

• Abdominal tenderness & cramping

• Anorexia

• Wt. Loss

• Vit. K deficiency

• Anemia

• Dehydration

• Electrolyte imbalance

• Low residue & high protein diet

15. DILANTIN

• do not floss throughout the day

• do not use hard bristled

toothbrush

• Gingivitis S/E

16. ANAPHYLACTIC REACTION

(steps)

• Stop medication

• Maintain airway

• Notify MD

• Maintain IV access of 0.9 NSS

• Place in supine position with legs

elevated

• Monitor VS

• Administer prescribed

emergency drugs

17. BLADDER CA

Risk Factors:

• Hx of smoking

• Exposure to radiation

• Working in industrial Factory

18. S/S OF DKA

• Fruity breath Odor

• Oliguria

• Kusmaull'’s (deep & nonlabored)

19. SITE FOR IM INJECTION ADULT

• Deltoid

• Ventrogluteal

• Vastus Lateralis

• Gluteus Maximus

20. S/S OF BACTERIAL MENINGITIS

• N & V

• Seizures

• Stiff Neck

• Photophobia

• Positive Brudzinski sign

1. TB

• Waking up sweating at night

• Low grade fever

• Dull aching chest pain

• Cough streaked with blood

• Weight loss

• Anorexia

• Fatigue

22. LIVER CIRRHOSIS

• N & V

• Edema

• Ascites

23. PULMONARY EMBOLISM

Sx:

• Blood-tinged sputum

• Distended neck vein

• Chest Pain / Hypotension /

Cyanosis

• Cough / Shallow respirations

• Rales on auscultation

• Tachypnea / Tachycardia

24. COLON CA

Risk Factors:

• Family HX

• Age above 50

• Jewish

• Male

25. DIGOXIN THERAPY

• Do not administer in infants if <

90 bpm

• Do not give to older children if

<70>

• Sx of toxicity to a child – N &V

26. S/S OF CAD

• Chest Pain

• Palpitations

• Dyspnea / Syncope

• Hemoptysis

• Excessive Fatigue

27. COPD

• Rhythmic, diaphragmatic

breathing

• If restless, perform purse-lip

breathing not more than 1

minute

• Perform deep breathing with

mouth held together during

expiration

28. SEEN IN 15 MONTH OLD CHILD

• Speaks 6 words

• Sits w/o support

• Builds a tower of 5 blocks

• Strong palmar grasp

29. CUSHING’S SYNDROME

• Osteoporosis

• Muscle wasting

• Hypertension

• Purple skin striations

• Moon face

• Truncal obesity

• Decreased resistance to infection

• Low Carbohydrate, Low Calorie,

High Protein, High K, Low sodium

• Monitor glucose level

• Check for color of stool, cortisol

increase secretion of gastric acid

– Peptic ulcer & GI bleeding

• C/I to Aspirin, increased bleeding

30. ADDISONS DISEASE

Fatigue

Weakness

Dehydration

Eternal tan

Decreased resistance to stress

Low Sodium

Low Blood Sugar

High Potassium

High protein, carbohydrate, Sodium,

Low potassium diet

Teach life-long hormone replacement

• Glucocorticoids (sugar) - Solu-

Medrol (succinate) to prevent

addisonian crisis

• Mineralocorticoids (salt) –

Florinef

6 A's of Addison's disease

1.) Avoid Stress

2.) Avoid Strenuous

3.) Avoid Individuals with Infection

4.) Avoid OTC meds

5.) A lifelong Glucocorticoids Therapy

6.) Always wear medic alert bracelet

Addisonian Crisis

• Hypotension

• Extreme weakness

• Nausea vomiting

• Abdominal pain /

• Severe hypoglycemia

• Dehydration

• Administer NaCl IV, vasopressors,

hydrocortisone

• Monitor VS /Absolute bedrest

31. PLACENTA PREVIA

• Check Hematocrit level

• External fetal monitor not internal

• No vaginal examination

• Assess for bleeding

• Improperly implanted placenta at

lower uterine

• Painless bright red, vaginal

bleeding

• Soft, relaxed, nontender uterus

• Fundal height greater than

expected

32. ABRUPTIO PLACENTA

• Premature separation of

placenta from uterine wall

• Painful dark red bleeding

• Uterine rigidity

• Severe abdominal pain

• Maternal shock

• Fetal distress

33. HEMODIALYSIS

• Palpate for a bruit or thrill

• Weigh client daily, before, during

& after

• Hold antihypertensive drugs b4

dialysis

• Check for thrill and bruit q 8 hours

• Don’t use extremity for BP, finger

stick

• Monitor vital signs, weight, breath

sounds

• Monitor for hemorrhage

34. PERITONEAL DIALYSIS

• Weight before and after treatment

• Monitor BP

• Monitor breath sounds

• Use sterile technique

• If problem w/ outflow, reposition

client

• Side effects: constipation

35. TYPE 1 IDDM

• Test blood glucose every 4 hrs if

no feeling well

• Eat fruit or cheese sandwich

before exercise

• Do not exercise if blood glucose

is >250mg/dl & urinary ketones

present

• Administer regular insulin 30

minutes before meals

36. COMPARTMENT SYNDROME

• Increased pain & swelling

• Pain with passive motion

• Loss of sensation

• Inability to move joints

• Pulselessness

37. CARDIAC CATHETERIZATION

• NPO 6-8 hrs. & no liquid for 4

hrs. prior to prevent vomiting &

aspiration

• Feel a flush, warm, fluttery

feeling, desire to cough,

palpitations in introduction of dye

• Shave & Clean insertion site with

antiseptic solution

38. PERNICIOUS ANEMIA

• Severe pallor

• Smooth, beefy red tongue

• Slight jaundice

• Paresthisias of hands & feet

• Disturbances with gait & balance

39. DUMPING SYNDROME

• Occurs 30 minutes after eating

• Abdominal fullness & cramping

• Diarrhea

• Tachycardia

• Perspiration

• Weakness / dizziness

• Borborygmi sound

40. TPN COMPLICATIONS

• Air Embolism

• Fluid Overload

• Hyperglycemia

• Hypoglycemia

• Infection

• Pneumothorax

41. DIC

• Bruising, purpura

• Presence of occult blood

• Low fibrinogen level, hct, platelet

• Increased PT, PTT

• Complication: RENAL FAILURE

42. PERIPHERAL ARTERIAL DISEASE

• Dry scaly skin on lower

extremities

• Rest Pain, at night

• Intermittent claudication/

• Thickened toenails

• Cold & gray-blue color of skin

• Decreased or absent peripheral

pulses

• Instruct pt. to walk to point of

claudication, stop & rest & walk

a little farther

43. THROMBOPHLEBITIS

• Avoid pressure behind legs

• Avoid prolonged sitting

• Avoid constrictive clothing

• Avoid crossing the legs

• Avoid massaging the legs

44. SYPHILIS

Painless chancre

fades after 6 weeks

Low grade fever

Copper-colored rash on palms and

soles of feet

Spread by contact of mucous

membranes

Treat with Penicillin G IM

If patient has penicillin allergy, will

use erythromycin for 10-15 days.

After treatment, patient must be

retested to make sure disease is gone

45. POLYCYTHEMIA VERA

• Increased RBC

• Leukocytosis / Thrombocytosis

• Angina

• Intermittent claudication

• Dyspnea /HPN

• Lethargy / Syncope / Paresthesia

46. PRIMARY HPN

Risk Factors:

• Aging

• Black race

• Chronic stress

• Family Hx

• Obesity

• Smoking

• Men

47. CHOLECYSTITIS

Sx:

• N & V

• Belching

• Indigestion

• Flatulence

• Epigastric pain that radiates to the

scapula 2 hrs. after eating fatty food

• Pain localized in RLQ

• Guarding, rigidity & rebound

tenderness

• Cannot take a deep breath when

fingers are pressed below hepatic

margin (Murphy’s Sign)

II. COMPUTATION

1. Dopamine

2. Dobutamine drip: Order is

2.5mcg/kg/min, patient weights 176 lbs.

Stock is 500mg in 500ml of NSS,

Compute for ml/hr?

Formula: Stock (mg) x 1000 mcg/mg

Quantity (ml)

Flow rate: Dose (mcg/kg/min) x wt (kg) x

60 min/hr

Concentration

(mcg/ml)

Answer: 12ml/hr

3. Md with IV order for patient 3,000ml in

24 hrs., get the rate at ml per hour.

Solution: 3000/24 = 125 ml/hr

4. Tablets : Dose of 20 mg per dose in

stock dose of 5 mg per tablet, how many

tablets?

Solution: 20/5 x 1 = 4 tablets

III. TOPICS

1. SAFETY INFECTION CONTROL

AIRBORNE : Hepa Filter Mask / N95

Particulate MASK

PTB

Measles / Rubella

Chicken Pox/

Varicella

SARS

Anthrax

CONTACT : GGG

(gown,gloves,goggles)

Conjunctivitis

Open wounds /drainage

Lesions

MRSA / VRSA /

CDAD

RSV/ VRE

DROPLET : Surgical Mask

Scarlett Fever

Diphtheria

Meningitis

Strep. Pharyngitis

Pneumonia

ENTERIC: Gown , Gloves

Diarrhea

Hep. A

Salmonella

Acute Gastroenteritis

Peptic H. Pylori

Shigella / Rotavirus Giardiasis /

Cryptosporidium Muris

PROTECTIVE:

Blood dyscrasias

Aplastic anemia

Leukemia

Major burns (50%)

Organ transplant

Aids

Multiple Myeloma

Prolong Steroid Therapy

Concepts:

1. Infection control:

a. clean with clean for

example patients with

CVA, DM, Cardio disease

2. Same precaution

techniques:

a. Universal precaution:

Hep B,D, AIDS

2. PRIORITIZATION

Remember the rule of stable vs.

unstable. Although you consider the

client unstable but if it expected in him,

this is stable. Example. Asthma with

wheezing- you consider this unstable.

ABC, unstable , first think EXPECTED

in asthma so this will be considered

stable.

3. DELEGATION

RN - Newly admitted, needs

assessment, pre op teaching and post

op, nsg. Judgment & discharge

planning ,IV meds, BT.

LPN-Can give meds except IV, sterile

techniques like wound dressing,

catheterization, insertion of NG tube,

remove sutures.Stable expected

outcome.

NA/ UAP/CN/ Senior nursing student

- All “-ing” ex bathing, reading v/s in

long term pt. Testing occult blood, BS,

monitoring, soap sud enema, testing

occult blood,

-Isolation precautions, basic hygiene

ADL, Input & Output, Finger stick with

gestational diabetes, urinalysis, TSB,

turning unconscious patient, change

perineal pad, assist in ambulation,

discharge tomorrow,

-Stable v/s, pulse oximetry, reading,

terminally ill because of comfort only

needed.

- Routinary Procedure

4. Patient Hx C/I for MRI :

• Mitral Valve Replacement

5. Glaucoma :

• Halos around light

6. U waves :

• Hypokalemia

7. Patient with arterial insufficiency

• Elevate the affected leg

8. Patient with Dumping Syndrome:

• Avoid cheese

9. Adverse Effect of Anti-metabolite 5FU

• Stomatitis

10. Obtaining sputum specimen from pt.

with tracheostomy:

• Instruct pt. to cough prior to

obtaining sputum

11. Post-hypophysectomy pt. Report if:

• Specific Gravity of 1.005

12. Diet for Hypothyroidism

• Low sodium, High K

13. Patient with CHF cor pulmonale S & S

• Jugular vein distention &

peripheral edema

14. Circumcision of a new infant:

• Diaper fasted loosely

15. Acute Pancreatitis

• Increase lipase/amylase

16. Short-term goal for anti-social patient

• Follow unit rules

17. Use of walker

• Partial weight bearing

• Stand in front, walk unto walker

18. Borderline patient

• Splitting

19. Neonates in nursery developed diarrhea

• Meconium stool study w/in 24

hrs.

20. Nsg. Action in pt. post cardiac

catherization

• Check pulse in lower

extremities

21. Diet for Diverticulitis

• Avoid high-fiber foods when

inflammation occurs, only low

residue

• Introduce soft high-fiber foods

when inflammation has

resolved

22. Low iron.WBC & albumin, what type?

• Nutritional deficit

(malnutrition)

23. What will you ask on pt for cardiac

stress test (Thallium stress test)?

• Is he on beta-blocker?

(if with radionuclide already,

Persantine, then invasive & shld.

avoid caffeine, calcium channel

blockers, b-blockers, theophylline)

24. Highest risk of accident

• 9 month infant eating grapes

& apricot

25. Pancrease in Cystic Fibrosis

• Give with meals, dilute in

applesauce

26. Client post-CVA, diet teaching

• Low salt, low fat

27. Client passing stones with calcium, diet

teaching:

• Should be acid-ash diet &

avoid oxalate rich & Ca rich

food such as tea, almonds,

rhubarbs beans, spinach,

cocoa, vegetables, fruits

• Give cranberries, prunes,

plums, tomatoes, cereals,

corn, legumes

I

28. Paget’s Disease

• Bowing of bones

29. Side Effect of Ansef (Cefazolin)

• Antibiotic (RTI,URTI)

• Diarrhea, Nausea

• Oral candidiasis

• Pancythopenia

30. Peptic ulcer disease

• Avoid stressful situation to

prevent exacerbation

31. Schilling’s Test

• For pernicious anemia

32. Prior To MUGA SCAN:

• Informed consent

• Allergy not a concern

33. Action of Aquamephyton

• Prevention of

hypoprothrobinemia

34. Action of Lipitor

• Anti-lipimec

35. Positioning of Hip Spica Cast in children

• Maintain flexion, abduction &

external rotation

36. Fear of 3 y/o child

• Injury (abandonment,

castration)

37. To prevent ureteral stones

• Increase

38. MDI

• Hold breath

39. Frostbite

• Soak in warm water

40. Normal respiratory changes in elderly

• Decreased cough reflex

41. Patient w/ DM & HPN, question if

• Given beta-blocker (causes

bronchospasm )

42. Maximum injection on 10 month old

infant

• 1 ml

43. Pt. with endometriosis takes Danocrine,

action of the drug?

• Suppress menstruation/

ovulation

44. Post NSD with epidural anesthesia with

bladder distension

• Offer bedpan

45. Apmhotericin B, side effect?

• Headache

• Hypokalemia

• Hypotension

46. PT. with angina unrelieved by 3

nitroglycerin

• Administer O2

47. Patient on Halo Vest

• Tape the wrench to the vest

(Torque screw)

48. Pre-menopausal syndrome

experiencing hot flashes

• Black Cohosh for menoposh

49. Abdominal Assessment

• Inspection

• Auscultation

• Percussion

• Palpation

50. Sclerotherapy

• Application of pressure dressing

for 12-48 hrs.

51. RSV

• Droplet precaution

52. SIADH

• Sodium 128 only (Normal:

135-145)

53. Dementia of Alzheimer Type

• Check what the pt. is taking

54. PEG

55. What medicine if given shld be

monitored for bleeding

• Indomethacin (NSAID)

56. GBS, priority nursing diagnosis

• Aspiration

57. Discharge teaching for Bell’s Palsy

• Provide eye care at bedtime

58. Sign of Scoliosis

• Asymmetry of the iliac crest

59. Normal for a 3 day old infant

• Describe normal tonic neck

reflex

60. Manifestation of Paranoid Schizophrenia

• Inappropriate anxiety with

delusion

61. Sign of Alcohol withdrawal

• Feeling of euphoria in 1st 24 hrs.

62. Activity for Alzheimer disease

• Reading magazine

63. Type 1 IDDM post renal test 48 hrs ago,

watch out for:

• Hematuria

64. Correct understanding of antidepressant

• Anti-depressant takes effect

after 1 week

65. DUROGESIC PATCH / FENTANYL

• For chronic pain lasts 3 days

• Maybe worn while bathing,

showering, swimming

• Apply to flat, nonirritated,

nonirradiated area like chest,

flank, upper arm, back

• Overdose : difficulty in breathing

66. Signs of increase ICP in pt. with close

head injury

• Increase systolic pressure &

weak bounding pulse

67. Positive outcome for Calcium Channel

blockers

• Decrease chest pain

68. Obsessive Compulsive Behavior

• To alleviate anxiety

69. Patient with back pain, proper body

mechanics

• Sit with knees higher than hips

70. What to check prior administration of

EPOETEN

• BP

• S/E : HPN, Seizures

71.

72. Patient with pancreatitis if developing

ascites would manifest:

• Cullen’s Sign (bluish

discoloration of abdomen or

peri-umbilical hematoma)

• Turner’s Sign (gray-blue

discoloration of flank)

• Shallow, rapid breathing

• Abdominal pain

• Dyspnea & difficulty eating

• Orthopnea

73. Digitalis + Lasix = Weight Loss

74. Side effect of Garamycin

• Ototoxicity

• Nephrotoxic

• Hypomagnesimea

• Muscular paralysis

• Hypersensitivity

75. Side Effect of Theophylline

• Tremors & tachycardia

• Insomnia

76. Nsg. Management for cleft palate infant

• Enlarged nipple for feeding

• Stimulate sucking

• Swallow

• Rest

• Burp frequently

77. Patient with expressive aphasia, best

communication:

• Use picture language

78. Diet for patient with colostomy

• DAT

• Low residue food 1-2 days postopt

• Avoid gas-forming foods

79. Patient allergic to Pseudoephedrine,

What is contraindicated?

• Patient taking Ma Huang

80. Patient with testicular cancer, correct

understanding?

• Testicular CA is painless

81. 1st intervention in prolapsed cord

• Positioning – knee

chest/trendelenberg

82. 2nd Stage of labor

• Cervical dilatation to delivery of

baby

83. Thiazide diuretic, what to watch out for?

• Potassium

84. Manic pt. taking lithium

• Watch out for sodium serum

85. Diet for patient with ileostomy

• Post opt 4 wks -- LOW FIBER

non-irritant diet to decrease fast

movement of liquid stool, after

can tolerate high fiber diet

already

• Foods that thicken stool like

boiled rice, low fat cheese

should be given

• Low fat diet

• Normal stool is liquid

86. G & D of a 2 y/o

• Combines 2 words

• Kicks a ball

• 50 word vocabulary

87. ALS

• Decreased sensation of touch

• Muscle weakness

• Excess glutamate

88. S/S of Kawasaki

• Desquamation of skin

• Joint pain

• Mucocutaneous lymph node

syndrome

89. Watch out for in lumbar puncture

• Increased ICP

• Brain Herniation

90. S/S of DVT

• Edema

• Calf or groin tenderness

• Pain with or w/o swelling

• + Homan’s Sign

• Warm skin

91. Developmental Milestone of 10 month

old

• Pincer grasp

92. Risk for breast CA

• 38 y/o female on oral

contraceptive

93. Need to consider anti-coagulant therapy

• If taking Gingko Biloba

94. Check 1st before tonsillectomy

• Bleeding time

95. Complication of CAST

• Compartment syndrome

• Fat embolism

• Shock

• Avascular necrosis

96. What should the nurse question?

• St. John’s Wort to a kidney

transplant

(C/I to anti-neoplastic drugs, lessen

effect)

97. Physician orders beta-blockers, for w/c

pt. should the nurse question the order:

• Patient on insulin

(B-blockers may mask signs of

hypoglycemia)

98. Patient hypersensitivity

• Give macrolides like

erythromycin,azithromycin

(Penicillin & Cephalosporins the same)

99. Patient with autonomic dysreflexia

• Pounding headache ,

piloerection

100. Pt. with carafate & antacids order,

select the schedule.

• Carafate 1 hr. before meals &

antacids after meals

101. Increasing pulse pressure

• Widening pulse pressure (late

sign)

• Decreased LOC, restlessness

(Early)

102. Pt. with Hemophilia & Leukemia

• Can lead to DIC

103. Effective teaching to DM patient

• Peak of NPH insulin 8 hrs.

104. Mg SO4 given to PIH pt. Nurse

should watch out for?

• Epigastric pain & headache

105. Pt. with calcium oxalate stones

• Diet with fig & wheat germs

106. Cancer & Sepsis can lead to DIC

• low platelet count

107. Pt. in labor with crusted popular

eruption, priority?

• Eye prophylaxis of the newborn

108. Heroin addicted mother in labor,

nursing action?

• Avoid withdrawal in active stage

109. Signs of Heroin intoxication?

• Euphoria

• Decrease response to pain

• Respiratory depression

• Apathy

110. Venorofaxen

111. Scarlett Fever isolation precaution

• Respiratory precaution

• droplet until 24 hrs. start of

treatment

112. Laryngectomy

• Avoid swimming, showering,

using aerosol sprays

• Teach client clean suction

technique

113. External irradiation therapy

• Time & distance shielding

114. Pt. with anorexia nervosa, signs

• Tachycardia

115. Brain injury

• Decorticate rigidity

116. Signs of renal failure

• Urine output less than 100ml/hr

117. Post-thyroidectomy patient, WOF

• Tingling sensation in the cheek

(complication)

118. Ventricular Fibrillation

• Do chest compression

119. Pt. in crutches, nurse should check

• Check armpits to see if there is

pressure secondary to crutch

(Pressure shld be on the hands not on

the axilla)

120. Influenza Vaccine indicated for:

• Anyone 50 y/o & above

annually

• Age 6 months & up with risk like

asthma

• Immunocompromised patients

• Pts with cardiac & pulmonary

disease

121. Herpes Simplex I & II

• 2 strains of herpes virus family

• HSV I – cold blisters / fever

blisters

• HSV II – in STD /Genital

Herpes/Shingles & varicella

zoster infection same with

chicken pox

122. Above the knee amputation, patient

shld

• Prevent internal or external

rotation of the limb

• Place sandbag or rolled towel

along side of thigh to prevent

rotation

123. HIV suspect patient

• Hairy tongue and leukoplakia

(Leukoplakia, pre-malignant lesion)

124. DVT on Heparin therapeutic goal

• Ambulate ASAP

( Prevent thrombus formation)

125. Esophageal varices, refer pt if

• Cold clammy skin ( sx of shock)

126. Pregnant 39 weeks, knows true

labor if

• Contractions from back going to

abdomen

127. Bipolar manic patients, what to do?

• Limit group activities

128. Multiple Myeloma, care

• Force fluid from 3 - 4 L/day to

offset hypercalcemia,

hyperurecemia

• Encourage ambulation to

prevent renal stones

129. Post pace maker transplant, correct

understanding

• Patient CAN USE electric

blankets, cell phones <3>

microwave ovens, metal

detectors

130. Patient taking garlic supplements

should take precaution when on aspirin

therapy

131. DKA patient, what to administer 1st?

• Start IV line 0.9 NaCl

132. Hearing aid, correct teaching:

• Turn off & remove battery when

not in use

• Avoid excessive wetting of

hearing aid, keep dry

• Ear mold is the only part that

may be washed w/ soap &

water

• Cannula is cleaned with small

pipe cleaner device or toothpick

133. PEEP

134. 18 day old infant, how to assess

trunk curvature

• Place in prone position & stroke

spinal colum, see if infant’s body

move towards the stimulated

area

135. Postural drainage, correct

understanding:

• Position—lung segment to be

drained is uppermost

• Drink a glass of water before PD

to loosen secretions

136. Sign of Abdominal Aortic Aneurysm

• Pulsation between umbilicus &

pubis

137. Echinacea

• To boost immune system

• Use only up to 8 weeks

138. Action of PILOCARPINE

• Increase outflow of aqueous

humor

• For OPEN ANGLE GLAUCOMA

139. Signs of acute angle glaucoma

• Eye pain / headache

140. Phenytoin for seizure. Watch out for:

• Gum Bleeding

141. Coumadin Therapy. Correct

understanding?

• Ask MD before taking OTC

drugs

142. Diet for hepatic encephalopathy

• Adequate caloric intake in form

of glucose

143. Side effect of TCA

• Urinary retention

144. HELLP

• Nausea

• Epigastric Pain

• Tx: FFP / Platelets

145. Drugs that can produced

Hyperglycemia

• Prednisone

146. Side effect of Haldol

• EPS, NMS

147. CA (Internal & External Radiation)

External Radiotherapy

• Leave markings on skin

• Avoid use of creams, lotions

• Only vitamin A&D =ointment)

• Check for redness, cracking

• Wear cotton clothing

• Administer antiemetics

• Do not pose any hazard to

anyone

Internal radiation

sealed source

• Lead container and longhandled

forceps in room

• Save all dressings, bed linen

until source removed

• Urine and feces not

radioactive

• Don’t stand close or in line

with source

• Patient on bed rest Cancer

Implementation:

Internal Radiation

• Time and distance important

• Private room sign on door

• Nurse wears dosimeter at all

times

• Limit visitors and time spent in

room

• Rotate staff

• Self-care when can do

Internal radiation

unsealed source

• All body fluids contaminated

• Greatest danger first 24-96

hours

148. LTB (Croup). Correct

understanding.

• Mother can be in the tent with

the child

149. Liver cirrhosis. What to assess

before nasotracheal suctioning?

• Platelet (risk for bleeding)

150. Adverse effect of 5FU (Fluoronacil)

• Antagonistic to iron – Anemia

151. Transition phase of labor

• Do short, shallow (PANT)

breathing

152. Mother (-), baby (+), Direct Coomb’s

test (-)

• Give Rhogram

153. Legionnaire’s disease

• Type of pneumonia

• Droplet precaution

• Sx: Fever, chills, cough, ataxia,

muscle aches, Diarrhea

• Middle age & older persons

• Treated with antibiotics ,

macrolides

154. Hepatitis C, Signs & sx

• Same with Hep B.

• Transmitted parenterally

• Common to drug users

• Major cause of post-transfusion

hepatitis

• Universal Precaution same with

Hep. B

155. Sx of Furosemide

• Decreased edema, abdominal

girth, BP & calcium

• Increased urinary output

156. Colchicines Toxicity

• Anti-gout drug

• Nausea & Diarrhea

• Vomiting

• Sore gums

• Metallic taste

157. TENS, how to explain procedure

• Use for chronic nerve pain

• Uses only electrodes

• Painless

• Non-invasive, passive modality

158. PROBENECID

• Treat gout /hyperurecemia

• Increase uric acid removal in

the urine

159. Meaning of death to a 5 y/o

• Magical thinking

• Death as temporary

160. Meaning of death to a 7 y/o

• Death as punishment

161. Meaning of death to 9 y/o

• Death as irreversible

162. Death to an adolescent

• Universal

163. Infant sounds

• 1 – 3 months = Cooing

• 4 -6 months = Babbling

• 6 -8 months – interest in sounds

• 9 -12 months = use of gestures

164. CEFTRIAXONE/ROCIPHEN

• Monitor tongue & oral cavity

165. EMG

• Stop all CNS meds 240 prior

procedure

• Skin prep on site

• To be stimulated with needles

166. Pt with uncomplicated cholelithiasis,

expect elevated?

• Alkaline Phosphotase

167. CANE

• COAL (cane opposite affected

leg)

168. Hep A, predisposing factor?

• From day care centers

169. Patient with Testicular CA

• Undescended testes

170. Diet teaching for Celiac Disease

(SPrue)

• Gluten free diet

• C/I wheat/rye/oats/barley)

• Give corn, rice, soybeans &

potatoes

171. Aspirin

172. Isoniazid (INH)

• S/E: peripheral neuropathy

(administer pyridoxine)

• Rash, urticaria

• Swelling of the face, lips, and

eyelids.

173. Rifampicin

• Hepatotoxic

174. Triage (External)-

• Treat first the stable before the

unstable.

• Emergent first before urgent. But

kung E.R. unstable muna

before stable. ABC

175. Spinal Cord Injury

176. Reflexes

177. LABORATORY VALUES

178. DIET

Clear liquid

No milk

No juice with pulp Full liquid

No jam

No fruit

No nuts

Low Fat /Cholesterol

Can eat lean meat

No avocado, milk, bacon, egg

yolks butter Sodium restricted

No cheese High roughage, high

fiber

No white bread without fiber

Low Residue Diet

Minimize intestinal activity

Buttered rice white processed food

No whole wheat corn bran

High Protein diet

Reestablish anabolism to raise

albumin levels

Egg, roast beef sandwich,

No junk food Renal

Keeps protein, potassium and

sodium low

No beans, no cereals, no citrus

fruits

Low Phenylalanine diet

Prevents brain damage from

imbalance of amino acids

Fats, fruits, jams allowed

No meats eggs bread

179. Lumbar puncture

180. Laminectomy

181. Myasthenia gravis

• Ptosis

182. Multiple sclerosis

• Fatigue / Ataxia /Vertigo

183. PCA

184. Influenza Vaccine, C/I?

• Allergy to eggs

185. Nephrotic syndrome

• PROTEINURIA – frothy urine

186. HERBAL MEDS

187. AUTONOMIC DYSREFLEXIA

• C6 injury

188. Primary, team, functional Nsg.

189. Consent and Advance Directives

190. Glasgow coma scale

191. Glomerulonephritis

• HEMATURIA

• cola/tea urine

Glomerulonephritis Assessment

• Fever, Chills

• Hematuria

• Proteinuria

• Edema

• Hypertension

• Abdominal or flank pain

• Occurs 10 days after beta

hemolytic streptococcal throat

infection

Implementation

• Antibiotics, corticosteroids

• Antihypertensives,

immunosuppressive agents

• Restrict sodium and water intake

• Bedrest

• I&O

• Daily weight

• High Calorie, Low protein

192. PEAK FLOW METER vs. METERED

DOE INHALER vs. INCENTIVE

SPIROMETER

193. Rheumatoid vs. Osteoporosis vs Gouty

194. Burn

Assessments

• Superficial partial thickness—pink to red,

painful

• Deep partial thickness—red to white,

blisters, painful

• Full thickness—charred, waxy, white,

painless

Wound Care for Burns

Never break blisters

Isotonic fluids (Lactated Ringer’s)

Closed method (Silvadene) covered

with dressings

Open method (Sulfamylon) that are not

covered with dressings

IV pain medication initially: not PO

takes too long, not IM circulation impaired

Medicate patient before wound care

Silver nitrate (warn patient skin will

turn black)

High calorie, High carbohydrate, High

protein diet

Vitamin B,C, and Iron

TPN maybe

Prevent contractures

195. Chest Tubes

1. Air-leak if bubbling in water-seal

chamber

(middle chamber)

2. Obstruction: “milk” tube in direction

of drainage

3. Removal of chest tube:

• Pt. does valsalva maneuver

• Clamp chest tube,

• Remove quickly

• Apply occlusive dressing

4. Dislodged

• Apply tented dressing

• Tube becomes disconnected

from drainage system, cut off

contaminated tip, insert

sterile connector

and reinsert

• Tube becomes disconnected

from drainage

system, immerse in 2cm of

water

Jackson-Pratt:

• Notify physician if drainage

increases or becomes bright

red

• Penrose: Expect drainage on

dressing

196. Cataract

Assessments

Distorted, blurred vision

Milky white pupil Cataracts

Postop: check for

hemorrhage

Check pupil—constricted

with lens implanted,

dilated without lens

Eye drops / Night shield

Sleep on unaffected side

197. Glaucoma

Abnormal increase in intraocular

pressure that leads to blindness

Blurred vision

Lights with halos

Decreased peripheral vision

Pain

Headache Glaucoma

Administer miotics (constrict

pupil) Carbonic

anhydrase inhibitors

Surgery

Avoid heavy lifting, straining of

stool

Mydriatics C/I with glaucoma.

198. Detached Retina

Flashes of light

Loss of vision

Particles moving in line of

vision confusion a Implementations

Bedrest, affected eye in dependent

position

Eye patched (one or both)

Surgery

Sedatives and tranquilizers

Avoid stooping, straining at stool,

strenuous activity

199. FLORINEF (fludrocortisones

acetate)

• For Addison’s Disease

• Given AM with meals, causes

PUD

• Causes Cushing-like syndrome

200. Traction

Buck’s Traction

Use to relieve muscle spasm of

leg and back

If used for muscles spasms only,

they can turn to either side.

If used for fracture treatment,

only can turn to unaffected side.

Use 8-20 lbs of weight, if used for

scoliosis will use 40 lbs of weight.

Elevate head of bed for counter

traction or foot bed

Place pillow below leg not under

heel or behind knee.

Russell’s Traction

Sling is used

Check for popliteal pulse

Place pillow below lower leg and

heel off the bed

Don’t turn from waist down

Lift patient, not the leg

Cervical Tongs

Never lift the weights

No pillow under head during

feedings

Balanced Suspension Traction

For femur realignment

Maintain weights hanging

free and not on floor

Maintain continuous pull

Halo Jacket

Maintain pin cleansing

201. Fractured Hip

Assessments

Leg shortened

Adducted

Externally rotated

Care after a total hip replacement

• Abduction pillows

• Crutch walking with 3-point gait

• Don’t sleep on operated side

• Don’t flex hip more than 45-60

degrees

• Don’t elevate head of the bed more

than 45 degrees

202. IV SIDE EFFECTS

Change tubing Q72 hours

Change bottle Q24 hours

Infiltration

• Assessment: cool skin, swelling,

pain, decrease in flow rate

• Implementation: discontinue IV,

warm compresses, elevate arm,

start new site proximal to

infiltrated site

IV Phlebitis, Thrombophlebitis

• Assessment—redness, warm,

tender, swelling, leukocytosis

• Implementation—discontinue IV,

warm moist compresses, start IV in

opposite extremity

Hematoma

• Assessment—ecchymosis,

swelling, leakage of blood

• Implementation—discontinue IV,

apply pressure, ice bag 24 hours,

restart IV in opposite extremity

IV Clotting

• Assessment—decreased flow rate,

back flow of blood into tubing

• Implementation—discontinue, do

not irrigate, do not milk, do not

increase rate of flow or hang

solution higher, do not aspirate

cannula, inject Urokinase, D/C and

start on other site.

203. Lung Sounds

204. Shock

205. NORMAL AGING PROCESS

206. Levin vs. Salem vs.

Sengstaken tube

Nasogastric Tubes:

• Levin-single—single-lumen, used for

decompression or tube feeding

• Salem sump—double-lumen, used for

decompression or tube feeding

• Sengstaken-Blakemore—triple-lumen,

used for bleeding esophageal varices

• Linton-Nachlas—4-lumen, used for

bleeding esophageal varices

• Keofeed/Dobhoff—soft silicone, used

for long-term feedings

• Cantor—single lumen with mercuryfilled

balloon and suction port

• Miller-Abbott—double-lumen with

mercury-filled balloon and suction port

• Harris—single lumen with mercuryfilled

balloon and suction port

NG tube placement:

“BEST WAY” to check is to aspirate for

gastric

contents and check for pH of aspirate

<4

Implementation of feeding:

• Check residual before intermittent

feeding, reinstall residual

• Check residual Q4 hours with

continuous feeding, reinstall residual

• Hold feeding if >50% residual from

previous hour (adults) or >25%

(children)

• Flush tube with water before and after

feeding

• Use pump to control rate of tube

feeding

• Administer fluid at room temperature

• Change bag Q8 hours for continuous

feeding

• Elevate head of bed while feeding is

running

• Check patency Q4 hours

• Good mouth care

NG Irrigation Tubing:

• Verify placement of tube

• Insert 30-50 cc of normal saline into

tube

• If feel resistance, change patient

position, check for kinks

• Withdraw solution or record amount as

input

NG removal:

• Clamp tube

• Remove tape

• Instruct patient to exhale

• Remove tube with smooth, continuous

pull

Intestinal Tubes (Cantor, Mill-Abbott,

Harris)

o After tube is in stomach, have patient

lie on right side, then back in Fowler’s

position, then left side

o Gravity helps to position tube

o Coil excess tube loosely on bed, do

not tape

o Position of tube verified by x-ray

o Measure drainage QShift

• Removal

o Clamp tube

o Remove tape

o Deflate balloon or aspirate contents of

intestinal tube balloon

o Instruct patient to exhale

o Remove 6” every 10 min. until reaches

the stomach, then remove completely

with smooth, continuous pull

T-Tube: 500-1000 cc/day, bloody first 2

hours

Penrose: expect drainage on dressing

207. Immunizations

208. PHEOCHROMOCYTOMA

• Persistent hypertension

• Hyperglycemia

• Pounding headache

• Palpitations

• Visual disturbances

• Histamine Test, Regitine Test, 24-

hour urine VMA test

• Avoid emotional and physical stress

• Encourage rest

• Avoid coffee and stimulating foods

• Postop care after adrenalectomy

209. Chron’s Disease

• Fever, cramp-like colicky pain

after meals

• Abdominal distention

• Diarrhea (semi-solid)

• Anorexia, N & V

210. PIH, APGAR

211. EVISTA

212. SAW PALMETTO

213. CIALIS

214. SANDIMMUNE,

215. CELESTONE

216. PNST, CST, COLONOSCOPY,

ARTERIOGRAPHY,

217. CPR, CARDIOVERSION

Defibrillation

• Start CPR first

• 1st attempt – 200 joules

• 2nd attempt – 200 to 300 joules

• 3rd attempt – 360 joules

• Check monitor between shocks for

rhythm

Cardioversion

• Elective procedure, Informed Consent

• Valium IV

• Synchronizer on

• 25-360 joules

• Check monitor between rhythm

CPR

Shake, shout, summon help, open airway,

look, listen, feel for signs of breathing, pinch

nose, give 2 full breaths (if no rise,

reposition)

Adults 12/min check carotid, chest

compressions

80-100/min 1.5 inches

Infants 20/min check brachial pulse, chest

compression

100/min ½ - 1 inch

15:2 Adult 4 cycles

Infant 20 cycles

Reassess pulse and breathing

Continue CPR until:

• Victim responds

• Someone else takes over

• Victim is transferred

• Rescuer is unable to continue

218. POSITIONING

Therapeutic Positions

Supine—avoids hip flexion

Dorsal recumbent—supine with knees

flexed

Prone—extension of hip

joint(after amputation)

Side lateral—drainage of oral secretions

Knee-chest—visualization of rectal area

Sim’s—decreases abdominal tension (side

lying with legs bent)

Fowler’s—increases venous return,

lung expansion

High Fowler’s—60-90

Fowler’s—45-60

Semi-Fowler’s—30-45

Low Fowler’s—15-30

Modified Trendelenburg—used for shock;

Feet elevated 20 degrees, knees straight,

trunk flat, head slightly elevated

Elevation of extremity—increases blood

to extremity and venous return

Lithotomy—used for vaginal exam

219. Cushing what will you expect?

a. Na of 142 b. ph 7.41 c. K of 3.1

220. ff statements is correct for

malpractice?

a. a nurse giving Celebrex to an RA pt

who has an allergy to aspirin

b. a nurse telling the pt not to take

zafirlukast during an asthma attack ( C/I

DURING ASTHMA ATTACK USE AS

PROPHYLAXIS FOR & TX FOR CHRONIC

BRONCHIAL ASTHMA)

221. Diet for Addison’s?

a. high calcium

222. A pt with pneumonia will go to

radiology for x-ray?

• pt will wear a surgical mask while

traveling in the hallway.

223. a pt with pneumonia safety

precaution?

• wear mask while bathing the pt.

224. sealed radiation what will be the

safety to the nurse?

a. limit exposure for 30mins close

contact to pt during shift

b. giving the radiation bandage/band to

the nurse for the next shift

225. Lipitor what will be the concern?

a. muscle

weakness/pain –

b. adverse effect:

myalgia &

rhabdomyositis

226. Break confidentiality?

• nurses talking in the hallway

227. Gastrochisis?

• put soaked gauze with nss to

abdomen

228. Clostridium deficille? private rm

229. suctioning pt needs further

teaching?

• my wife have shortness of breath

during my suctioning.

230. sickle cell crisis what is your

concern?

• i still have joint pain even though

im taking analgesic daily

231. dysphagia pt how to feed?

• put head of bed to 60degrees

before feeding

232. total knee replacement immdtly post

op what is the correct statement?

• ill put an abduction pillow

233. Tapazole?

• with meals

234. a 28yrs old pt 35wks pregnant is

having internal bleeding was rushed to

ED, what does the nurse do first?

• fhr external monitoring

235. a pt taking captopril what will check

or concern?

im having cough at night

236. Jewish orthodox dead?

• dont leave body alone, should be

with relatives

237. Reglan?

• take 30mins before meals

238. Maoi- C/I?

• chicken bullion and cheese

239. what food to give to a child?

• Crackers

240. food rich in Ca?

• broccoli

241. fracture of arm what position?

• place pillow under arm

242. pt is constipated what health

teaching?

• increase intake of fruits and

veggies

243. Arcabose is given to px health tx?

• helps pancreas to release insulin

244. px with myasthenia gravis what will

you monitor?

• k

245. 3 month old baby. parents plan to

buy/purchase an electronic door that

sings open when there is weight. what is

the health tx?

• delay purchase of electronic

device

246. pt taking nardil has stopped taking

the drug for 5 days and began taking

chocolate and cheeseburger. he

suddenly feels severe headache and

goes to er.

• pt is reacting to the food recently

taking

247. sickle cell crisis advice to give to

teenager?

• lessen physical activity

Sickle Cell Anemia

• Pain /Swelling/Fever

• Sclera jaundiced

• Cardiac murmurs / Tachycardia

• Check for signs of infection (prevent

crisis)

• Check joint areas for pain and

swelling

• Encourage fluids

• Provide analgesics with PCA pump c

crisis

248. how are you going to irrigate

ileostomy?

• with nss

249. px taking iron supplement, what

statement by px shld you be cautioned?

• will crush the tablet before i drink

it

250. Position after liver biopsy?

• sidelying on rt side with pillow

under right side of ribs

251. LYME’S DISEASE

Multi-system infection caused by

a tick bite. There are three stages.

Stage 1

Erythematous papule develops

into lesion with clear center

(Bull’s-eye)

Regional lymphadenopathy

Flu-like symptoms (fever,

headache, conjunctivitis)

Can develop over 1 to several

months

Stage 2

Develop after 1 to 6 months if

disease untreated.

Cardiac conduction defects

Neurologic disorders (Bell’s

palsy, temporary paralysis)

Stage 3

Develops after 1 to several months,

if reached at this stage may

persist for several years.

Arthralgias

Enlarged, inflamed joints

Teaching

Cover exposed areas when

in wooded areas

Check exposed areas for

presence of ticks

Antibiotics 3-4 weeks

Stage 1 use Doxicillin

IV penicillin with later

stages

252. Huntington's dse

253. Osteoporosis

254. NST

255. Early deceleration

256. Vanillylmandelic acid

1. used to diagnose

pheochromocytoma which is a

tumor in the adrenal gland.

24-hour urine collection. Save all the

urine in 24 hours..

257. Which is the wrong statement in

Addison’s disease?

• Administer potassium.

258. Stress management-- Instruct the

patient to imagine that he is in the

beach-- this is correct. this is guided

imagery wherein the patient imagines or

fantasizes to reduce stress. pls.

259. Multiple sclerosis-- low bed position-

-- think safety

260. Herpes zoster/shingles

• will the pt experience acute pain?

YES

261. What is the purpose of swimming in

arthritis?

262. Mycoplasma pneumonia-- what

precaution? DROPLET

263. How many ml is 1/2 banana?

264. Tamoxifen- inhibit estrogen

production

265. Total thyroidectomy d/c teaching?

• Monitor pulse rate and temp

266. 3rd degree burn

267. Digoxin +Quinidine?

268. IDDM advice lifestyle change?

a. Avoid strenuous ex

b. Increase insulin dose if involved to

sports

269. which among the ff psych meds is

incorrect statement?

• White wine is not ok with maoi, red

wine is ok

270. Earliest sign of magnesium sulfate

toxicity

271. Receptive aphasia? Picture board

272. SEROQUEL?

273. Internal disaster drill?

274. external disaster drill

275. what is normal for a 2 days old

baby?

276. enhance effect of Coumadin

277. Schizo pt- lalabas? Wear long

sleeves

278. Do not take garlic if you are

receiving aspirin. It increases the

antiplatelet effect!

279. Rattle snake bite

280. Car safety in children less than 20

lbs.

281. LASIX SIGNS THAT IT IS

WORKING = DECREASE

PERIPHERAL EDEMA,

282. PT WITH GLOMENOLEPHRITIS

URINE RESULT

• BLOOD

283. Dilantin detoxified by liver.

284. The nurse cares for a client

receiving IV antibiotics every 8 hours for

the past 4 days. The antibiotic is

mixed in D5W. The nurse determines

that a post-infusion phlebitis has

occurred if which of the

following is observed? .

• reddened, warm area noted around

insertion site or on path of vein;

discontinue IV, apply warm, moist

compresses, restart IV at new

site

285. How long should a client with

tuberculosis be on medication?

• 6-9 Months

286. What are symptoms of hepatitis?

Inflammation of Liver

Jaundice

Anorexia

RUQ pain

Clay-colored stools, tea-colored urine

Pruritis (bile salts eliminated through

skin)

Elevated ALT, AST

Prolonged PT (liver involvement with

clotting factor)

287. What is the transmission of

Hepatitis A?

Fecal/Oral

Consume contaminated food or water

Travelers to developing countries at

risk

Clients with hepatitis A should not

prepare food for

others

288. What is the transmission of

Hepatitis B?

Parenteral/Sexual contact

Blood or body fluids

At risk individuals are the one’s that

abuse IV drugs,

dialysis, healthcare workers

Vaccine developed

289. What is the transmission of

Hepatitis C?

Blood or body fluids

Can become chronic disease

290. Seen in patients with hemophilia

• (unable to clot)

291. What is the transmission of Delta

Hepatitis?

• Co-infects with hepatitis B

292. Where to put 4 y/o child in a car

• Booster seat

293. Toddler

• Playing side by side w/o sharing pf

toys

294. Lantus understanding

• I will avoid OTC with chromium

295. What nursing care are

recommended for Hepatitis?

Rest (mainly for liver)

Contact and standard precautions

Low-fat, High-Calorie, and High

Protein diet (needed for organ

healing)

No alcoholic beverages

Medications (Vitamin K, Aqua-

Mephyton for bleeding problems, Antiemetic

– no compazine, use Tigan or

(Dramamine).

Corticosteroids to decrease

inflammatory response, and antihistamines,

will use lotions or

baths than systemic ones.

296. Intermiettent claudication

intervention

• Lower the legs

297. Femoral fracture, indicate

complication

• Petechiae

298. Sickle cell crisis

• Increased reticulocyte count

299. Multiple Sclerosis

• Baclofen

300. Post-arthroscopy, notify md

• Painful knee

301. Osteoporosis history taking at risk

• Taking wine or beer

302. Wilm’s Tumor

• Flank pain

303. Fosamax

• 30 minutes before meals

304. Cotrimoxazole

• Yellow sclera

305. Tegretol

• With meals

306. Colchicine

• With meals

307. Valium

• Monitor liver function

308. Antivert

• 1 hour before travel

309. Mannitol, effective?

• Increase awareness

310. Orinase

• 30 minutes before meals

311. Diabeta (Glipizide)

• 30 minutes before meals

312. Metformin HCL

• Take with food to decrease GI upset

313. Gantrisin

• Drink 2-3 L for the whole day

314. Amaryl (Glimiperide)

• With or w/o breakfast

315. Start to assess radial pulse

• 2 y/o

316. Discharge teaching for postcholecystectomy

client.

• Reporting of complication (pale

stool & dark urine)

317. Diagnostic test for Renal Failure

• Monitor BUN, Creatinine, electrolyte

• Monitor for acidosis

318. Complications of TURP

• Sterility may or may not occur

• Bleeding is normal, moniot for

hemorrhage

• Bladder spasms common postopt,

ant-spasmodics are

prescribed

319. Drug therapy for Rheumatoid

Arthritis

• Salicylates

• Gold salts

IV. DRUGS

Ethacrynic Acid (Edecrin)—are considered

loop diuretics and are potassium wasting;

encourage client to increase intake of

potassium-rich foods. Orange

Juice/Bananas, etc.

Aminophylline (Truphylline)—is a

xanthine bronchodilator; major side effects:

palpitations, nervousness, rapid pulse,

dysrhythmias, nausea, and vomiting.

Toxic effects: confusion, headache,

flushing, tachycardia, and seizure.

Morphine Sulfate—decreases blood return

to the right side of the heart, and decrease

peripheral resistance. In other words,

decreases preload and afterload

pressures and cardiac workload; causes

vasodilation and pooling of fluid in

extremities; provides relief from anxiety.

Inotropin (Dopamine)—vasoactive

medication are given IV to restore BP in

hypotensive states; Increases blood return

to the right side of the heart, and increase

peripheral resistance;

S/E: headache, severe hypertension,

dysrhythmias; check BP q2 minutes until

stabilized, then q5 minutes

TPN—hang no longer than 24 hours; IV

tubing and

filters every 24 hours; site of catheter

changed every 4 weeks.

Fluoxetine (Prozac)—a selective serotonin

reuptake inhibitor (SSRI) used to treat

depression and obsessive compulsive

disorder.

S/E: postural hypotension, dry mouth, rapid

heartbeat, anorexia, weight loss, severe

headache. If dose is missed, omit dose &

instruct client to return to regular dosing

schedule.

Propanolol (inderal)—a beta-adrenergic

blocker used as antihypertensive;

S/E: bronchospasm, bradycardia,

depression. Take pulse before

administration & gradually decrease when

discontinuing. Do not give to asthmatic pts

Glipizide (Glucotrol)—an oral

hypoglycemic that decreases blood sugar by

stimulating insulin release from the beta

cells of the pancreas; may cause aplastic

anemia and photosensitivity.

Prednisone (Deltasone)—a corticosteroid.

Side effects: hyperglycemia

Bethanechol (Urecholine)—a cholinergic

or parasympathomimetic used to treat

functional urinary retention; mimics action of

acetylcholine.

Ventricular Tachycardia—causes chest

pain, dizziness, and fainting.

1 grain = 60mg

Levothyroxine (Synthroid)

—thyroid preparation should be

administered at breakfast to prevent

insomnia.

Carbamazepine (Tegretol)

—interferes with action of hormonal

contraceptives. Side effects:

photosensitivity.

Aluminum Hydroxide (Amphojel)

—an antacid; neutralizes hydrochloric acid

and reduces pepsin activity; take one hour

before and hour of sleep. Antacids most

effective after digestion has started, but prior

to the emptying of the stomach.

Isoniazid (INH)—S/E: peripheral

neuropathy (administer pyridoxine), rash,

urticaria & swelling of the face, lips, and

eyelids.

Pyridoxine (Vitamin B6, Beesix,

Doxine)—required for amino acid,

carbohydrate & lipid metabolism. Used in

the transport of amino acids, formation of

neurotransmitters & sythesis of heme.

Prevention of neuropathy.

Carbamazepine (Tegretol)—prevention of

seizures & relief of pain in trigeminal

neuralgia. Trigeminal neuralgia is an

agonizing pain result in severe depression &

suicide.

Clonidine (Catapres-TTS)—is a centrally

acting alpha-adrenergic used to treat HPN

S/E: drowsiness, sedation, orthostatic

hypotension, heart failure. If patch used be

cautious around microwaves results in

burns, heat will increase medication

absorption leading to toxicity.

Phlebitis—tenderness, redness; remove iv,

apply warm soaks to decrease inflammation,

swelling, and discomfort.

Autologous blood—may give blood 5

weeks before surgery; can give 2 to 4 units

of blood; may have to take iron pills

Carbidopa/Levodopa (Sinemet)—used to

treat symptoms of Parkinson’s disease.

Take immediately before meals and highprotein

meals may impair effectiveness of

medication. Reduces rigidity and

bradykinesis & facilitates client’s mobility.

Doxycycline (Vibramycin)—a tetracycline

that is taken at regular intervals but not

within 1 hour of bedtime because it may

cause esophageal irritation. Use another

method of birth control, do not take antacids

within 1-3 hours of taking medication, and

may cause photosensitivity.

Albuterol (Proventil)—a bronchodilator.

Side effects: tremors, headache,

hyperactivity, tachycardia. Use first before

steroid medication so opens up bronchioles

for steroid to get in. Wait one minute

between puffs of the inhalers for best effect.

Beclomethasone (Vanceril)—a steroid

medication. S/E: fungal infections, dry

mouth, throat,infections.

Insulin

—NPH Onset: 1.5 hours Peak: 4-12 hours

Regular Onset: 0.5 hours Peak: 2.5-5 hours

Topiramate (Topamax)—is an

anticonvulsant. Should drink 2000-3000ml of

fluid daily to prevent kidney stones.

Side effects: orthostatic hypotension, ocular

symptoms, blindness, and decrease effects

of hormonal contraceptives.

Propranolol (Inderal)—a beta-blocker that

takes up beta-adrenergic receptor sites,

which prevents adrenaline from causing

symptoms and glycogenolysis.

Inderal may mask symptoms of

Hypoglycemia, removing the body’s early

warning system.

Phenazopyridine (Pyridium)—acts on

urinary tract mucosa to produce analgesic or

local anesthetic effects.

Side effects: bright orange urine,

yellowish discoloration of skin or sclera

indicates drug accumulation due to renal

impairment.

Trimethoprim-sulfamethoxazole

(Bactrim)—most common

side effect mild to moderate rash (urticaria)

Aminoglycosides are ototoxic.

Butorphanol Tartrate (Stadol)—analgesic

used for moderate to severe pain; Side

effects include change in BP, bradycardia,

respiratory depression.

Infant normal resting heart rate:

120-140

Salt substitutes contain potassium

When directing a UAP, the nurse must

communicate clearly about each delegated

task with specific instructions on what must

be reported. Because the RN is responsible

for all care-related decisions, only

implementation tasks should be assigned

because they do not require independent

judgment.

When applying the nursing process,

assessment is the first step in providing

care. The 5 "Ps" of vascular impairment can

be used as a guide (pain, pulse, pallor,

paresthesia, paralysis)

Rash and blood dyscrasias are side effects

of anti-psychotic drugs. A history of severe

depression is a contraindication to the use of

neuroleptics.

The nurse instructs the client taking

dexamethasone (Decadron) to take it with

food or milk because Decadron increases

the production of hydrochloric acid, which

may cause gastrointestinal ulcers.

The protest phase of separation anxiety is a

normal response for a child this age (2 yearold

hospitalized child). In toddlers, ages 1 to

3, separation anxiety is at its peak

Signs of tardive dyskinesia include

smacking lips, grinding of teeth and "fly

catching" tongue movements.

Verapamil, Bretylium, and Amiodarone

increases serum dig levels, possibly causing

Digitalis Toxicity

Signs/Symptoms of Digital Toxicity: f1st

sx include abdominal pain, anorexia,

nausea, vomiting, visual disturbances,

bradycardia, and other arrhythmias. In

infants and small children, the 1st sx of

overdose are usually cardiac arrhythmias.

Left-Side CHF

• Dyspnea, orthopnea

• Cough

• Pulmonary edema

• Weakness/Changes in mental status

Right-Side CHF

• Dependent edema

• Liver enlargement

• Abdominal pain/Nausea/Bloating

• Coolness of extremities

CHF Implementations

• Administer digoxin, diuretics

• Low-sodium, low-calorie, low-residue diet

• Oxygen therapy

• Daily weight

• Teach about medications and diet

Herbs: Toxicities and Drug Interactions

1. Chamomile

Uses: Chamomile is often used in the form of a tea as

a sedative.

Reactions: Allergic reactions can occur, particularly

in persons allergic to ragweed. Reported reactions

include abdominal cramps, tongue thickness, tightness

in the throat, swelling of the lips, throat and eyes,

itching all over the body, hives, and blockage of the

breathing passages. Close monitoring is recommended

for patients who are taking medications to prevent

blood clotting (anticoagulants) such as warfarin.

2. Echinacea

Uses: Largely because white blood cells in the

laboratory can be stimulated to eat particles,

Echinacea has been touted to be able to boost the

body's ability to fight off infection.

S/E : unpleasant tastel, liver toxicity.

C/I: ketaconazole, leflunomide (Arava), methotrexate

(Rheumatrex), isoniazide (Nizoral).

3. St. John's Wort

Uses: depression, anxiety, and sleep

disorders. It is technically known as Hypericum

perforatum.

S/E: sun sensitivity which causes burning of the skin.

Leave nerve changes in sunburned areas.

C/I: tetracycline/Achromycin, sulfa- containing

medications, piroxicam (Feldend).

S/E: headaches, dizziness, sweating, and

agitation when used in combination with serotonin

reuptake inhibitor medications such as fluoxetine

(Prozac) and paroxetine (Paxil).

4. Garlic

Uses: lower blood pressure and

cholesterol

S/E: Allergic reactions, skin inflammation, and

stomach upset , Bad breath . decrease normal blood

clotting and should be used with caution in patients

taking medications to prevent blood clotting

(anticoagulants) such as warfarin /Coumadin.

5. Feverfew

Uses: Most commonly used for migraine headaches.

Reactions: Feverfew can cause allergic reactions,

especially in persons who are allergic to chamomile,

ragweed, or yarrow. Nonsteroidal anti-inflammatory

drugs (NSAIDs such as ibuprofen (Advil), naproxen

(Aleve) or Motrin) can reduce the effect of feverfew.

A condition called "postfeverfew syndrome" features

symptoms including headaches, nervousness, stiffness,

joint pain, tiredness, and nervousness. Feverfew can

impair the action of the normal blood clotting element

(platelets). It should be avoided in patients taking

medications to prevent blood clotting (anticoagulants)

such as warfarin (Coumadin).

Ginko Biloba

Uses: This herb is very popular as a treatment for

dementia (a progressive brain dysfunction) and to

improve thinking.

Reactions: Mild stomach upset and headache have been

reported. Ginko seems to have blood thinning

properties. Therefore, it is not recommended to be

taken with aspirin, nonsteroidal anti-inflammatory

drugs (Advil), naproxen (Aleve) or Motrin), or

medications to prevent blood clotting (anticoagulants)

such as warfarin (Coumadin). Ginko should be avoided

in patients with epilepsy taking seizure medicines,

such as phenytoin (Dilantin), carbamazepine

(Tegretol), and phenobarbital.

Ginseng

Uses: Ginseng has been used to stimulate the adrenal

gland, and thereby increase energy. It also may have

some beneficial effect on reducing blood sugar .in

patients with diabetes mellitus. (Dr. Miller

emphasized that there is substantial variation in the

chemical components of substances branded as

"Ginseng.")

Reactions: Ginseng can cause elevation in blood

pressure, headache, vomiting, insomnia, and nose

bleeding. Ginseng can also cause falsely abnormal

blood tests for digoxin level. It is unclear whether

ginseng may affect female hormones. Its use in

pregnancy is not recommended. Ginseng may affect the

action of the normal blood clotting element

(platelets). It should be avoided in patients taking

aspirin, nonsteroidal antiinflammatory drugs (such as

ibuprofen (Advil), naproxen (Aleve) or Motrin), or

medications to prevent blood clotting (anticoagulants)

such as warfarin (Coumadin). Ginseng may also cause

headaches, tremors, nervousness, and sleeplessness. It

should be avoided in persons with manic disorder and

psychosis.

Ginger

Uses: Ginger has been used as a treatment for nausea

and bowel spasms.

Reactions: Ginger may lead to blood thinning. It is

not recommended to be taken with medications that

prevent blood clotting (anticoagulants) such as

warfarin (Coumadin).

Saw Palmetto

Uses: Saw palmetto has been most commonly used for

enlargement of the prostate gland. Saw palmetto has

also been touted as a diuretic and urinary antiseptic to

prevent bladder

infections.

Reactions: This herb may affect the action of the sex

hormone testosterone, thereby reducing sexual drive or

performance. Dr. Miller states that "While no

drug-herb interactions have been documented to date,

it would be prudent to avoid concomitant use with

other hormonal therapies (e.g., estrogen replacement

therapy and oral contraceptives...")

Black Cohosh

Claims, Benefits: A natural way to treat menopausal

symptoms.

Bottom Line: Little is known about its benefits and

its risks.

A child with celiac disease mustn’t consume foods

containing gluten and therefore should avoid prepared

puddings, commercially prepared ice cream, malted

milk, and all food and beverages containing wheat,

rye, oats, or barley.

The infant of a diabetic mother may be slightly

hyperglycemic immediately after birth because of the

high glucose levels that cross the placenta from

mother to fetus. During pregnancy, the fetal pancreas

secretes increased levels of insulin in response to

this increases glucose amount that crosses the

placenta from the mother. However, durin