Mark Klimek NCLEX Review 2

Mark Klimek NCLEX Review 2 Acidosis: Ph goes down: everything goes down except ____ goes up. Hyporeflexia, lethergy, _____, etc. "As Ph goes down so goes my pt" Respiratory ____ can occur - ANS potassium, bradycardia, arrest Alkalosis: ph goes up: everything goes _____ except potassium goes down. Can cease and ______. - ANS up, aspirate Kusmals: "Mac Kusmal" (someones name) MAC= metabolic ______ - ANS acidosis ABG's: first thing you ask- Is it lung? Overventilating: ______. Underventilating: acidosis. Ventilation= gas exchange not respiratory ____. Ventilation= ______ - ANS alkalosis, rate, SAO2 ABG's: if not lung its ______. Prolonged vomiting, or gastric ____= metabolic alkalosis. "Alk, alk" noise when vomiting. If ph and bicarb are in same direction its _____ - ANS metabolic, suctioning, metabolic Ph: 7.35-7.45. Bicarb (HCO3): ____-28. PACO2: 35-____ - ANS 22, 45 Ventilators: high pressure alarm: when needs to pump ____. Could have a kink or ____. Low pressure alarm: could have _____. Respiratory alkalosis: ventilator setting too _____ - ANS more, blockage, disconnection, high Denial treatment- _____ (for abuse) Don't say "you" say "I" Ex: I'm having trouble interpreting this. Loss and grief: DABDA- denial, ____, bargaining, depression, acceptance. Treatment- ______ - ANS confrontation, anger, support Dependency: abuser gets significant other to do things for them or make _____ for them. Co-dependency: when significant other derives _____ self esteem for doing things for abuser - ANS decisions, positive Dependency treatment: teach co-dependent person to say ____ and that they're a good person. Manipulation: the nature of the act is _____ or harmful. Treatment- set _____ and enforce them - ANS no, dangerous, limits Wernicke's encephalopathy and Korsakoff's (psychosis) usually together, induced by vit _____ or thyamin deficiency. Extreme psychotic symptoms. Go _____, amnesia, confabulation. Usually permanent. Can't learn _____ - ANS B1, insane, reality Wernickes, Korsakoff: Need B1 to metabolize alcohol so if not metabolized then goes to _____. Treatment: redirection. Is preventable and ______ - ANS brain, irreversible Antibuse and Revia (disulfiram): when drink ____ makes pt really sick. Onset ____ weeks. No mouthwash, aftershave, extracts, Nyquill etc. - ANS alcohol, 2 Uppers: caffeine, coaine, pcp/lsd, meth, _____. Everything goes up- uphoria, restlessness, hyperreflexia +3, +4, ____, etc. Could arrest and cease. Need _____. - ANS adderall, diarrhea, suction Downers: everything goes down. Every drug not an upper is downer. Drowsiness, _____, etc. Can go into respiratory ____. - ANS lethargy, arrest Withdrawal from upper: not enough upper makes everything go ____. Not enough downer makes everything go ___. Boroborigmy: increased bowel sounds - ANS down, up Ex: pt withdrawing from cocaine: Respirations 12, difficult to ____, etc. Need ____ - ANS arouse, narcan Drug addiction in newborn: always assume intoxication not _____ at birth. After ____ hrs it can be withdrawal - ANS withdrawal, 24 When alcohol pts ____ drinking alcohol within 24 hrs= withdrawal symptoms. Within ____ hrs= delirium tremors. Alcohol withdrawal syndrome- not life threatening. Not dangerous. Regular diet, up ad lib, no _____ - ANS stop, 72, restaints Delirium tremors: can be _____, unstable. NPO or clear ____, private room near nurses station. restricted bed ____, must be restrained. Very dangerous. Both Al with syndrom and delir trem get antihypertensive, tranquilizers and vit ____ - ANS fatal, liquids, rest, B1 Aminoglycosides (antibiotics): don's use unless _____ else works. "A mean old mycin" ALL END IN _____. Treat infections that are: serious, life threatening, resistant, gram _____. - ANS nothing, MYCIN, negative Aminoglycosides: 3 drugs that end in mycin that are not these: arythromycin, ______ and clarithromycin. If it has "thro" in it, than throw it _____. - ANS zithromycin, out Aminoglycosides: "mycin"- mice, mice have big ears. Ears- _____. Monitor pts hearing, ringing, dizziness. When you draw an ear connect it it looks like a ____- nephrotoxic, monitor ____ (best indicator of renal function), also a #8 fits in the ear drawing- cranial nerve ____ (hearing) and administer q8h - ANS ototoxic, kidney, creatinin, 8 Aminoglycosides: Give IM and ____, Not oral. Doesn't absorb! Hepatic encephalopathy- give oral aminoglycosides since it kills ____ in gut and reduces amonia levels- won't hurt ____ since it doesn't absorb. - ANS IV, bacteria, liver Pre-op bowel surgery: give aminoglycoside _____ route to sterilize the bowel. PO kills bacteria in gut and doesn't get _____, or hurt liver. "Who can sterilize my bowels?" "Neo Can!" ______ and canimycin. - ANS po, absorbed, Neomycin Trough level: drug at ____. Peak level: drug at _____. "TAP" levels: T- check trough level, A- administer drug, P- draw ____. Draw when drug has a _____ therapeutic window - ANS lowest, highest, peak, narrow Draw trough 30 min before next ____. Draw peak: sublingual 5-10 min after drugs is _____. IV 15-30 min after drug is finished. IM 30-____ min - ANS Dose, dissolved, 60 Calcium channel blockers: Are like ____ for your heart. Cardiac _____. Treat: AAA & AS A. Antihypertensives, anti _____, anti atrial arrhythmias. - ANS Valium, depressants, anginas Calcium channel blockers: s/e- headache, _____. End in "dipine" "Dipping into the calcium ____. Also varapamil and cardizim. Monitor bp- if systolic is under ____ don't give. - ANS Hypotension, channel, 100 Normal sinus rhythm: p wave before every QRS. Vfib looks like ____ line. V tach- jagged, Sharp peaks, a ____. Saw tooth- A ____ - ANS Squiggly, pattern, flutter QRST: ventricular _____ - ANS ... Draw trough 30 min before next ____. Draw peak: sublingual 5-10 min after drugs is _____. IV 15-30 min after drug is finished. IM 30-____ min - ANS Dose, dissolved, 60 Calcium channel blockers: Are like ____ for your heart. Cardiac _____. Treat: AAA & AAA. Antihypertensives, anti _____, anti atrial arrhythmias. - ANS Valium, depressants, anginas Calcium channel blockers: s/e- headache, _____. End in "dipine" "Dipping into the calcium ____. Also varapamil and cardizim. Monitor bp- if systolic is under ____ don't give. - ANS Hypotension, channel, 100 Normal sinus rhythm: p wave before every QRS. Vfib looks like ____ line. V tach- jagged, Sharp peaks, a ____. Saw tooth- A ____ - ANS Squiggly, pattern, flutter QRST: ventricular _____. P wave = atrial. A lack of QRS segment= _____. Bizzar in question= tachycardia. - ANS polarization, astystole PVC: more than ___ pvc's per minute or more than 6 PVC's in a row or if the PVC falls on the T wave of the ____ beat= change priority from low to _____ priority - ANS 6, previous, moderate Asytole: _____ priority. V fib: high priority. Both have no cardiac ____ which equals no brain perfusion. Patient dead in ____ minutes. - ANS high, output, 8 V tach: potentially life threatening, has _____ output. Ventricular: treat with ____ and amioderone. - ANS cardiac, lidocaine Atrial: treat with ABCD. Treatment: A- _____ (IV push, FAST) B- beta blockers, C- calcium channel blockers, D- _____ (lanoxin, digoxin) "Adeno-______- calcium- Didge" - ANS adenocard, digoxin, beta V fib: you D fib (defibrillation). Asystole treatment: epinephrine first then _____. - ANS atropine Chest tube: creates _____ pressure in pleural space, this is good and lets lung ____ while chest wall moves. - ANS negative, expand Chest tube questions: look at reason for why it was placed and _____. Pneumothorax: tube removes ____. Hemothorax: removes blood. Apical: up high, removes air. ____: bottom, removes blood - ANS location, air, Basilar Chest tubes: surgery- always assume bilateral. If drain container comes open: 1st ____, 2nd cut broken container off, 3rd put end of tube under ____ water, then unclamp. Use rubber tipped double clamps. - ANS clamp, sterile Chest tubes: if tube comes out: 1st put gloved ____ over hole on patient. 2nd cover hole with vaseline ____. - ANS finger, gauze Chest tube: intermittent bubbling in water seal is ____, just document it. Continuous bubbling in water seal is bad, it means a ____. Like buying a bottle of pop- don't want broken ____ - ANS good, leak, seal Chest tube: intermittent bubbling in suction control is ____, means suction is not high enough in container- turn suction ___. Never clamp a tube longer than ____ seconds without doctor order - ANS bad, up, 15 Congenital heart defects: either trouble or no trouble. Remember TROUBLE- use consanants. T- trouble, R- right, B- ____, L- left. "Trouble, blue, shunts blood right to ____" - ANS blue, left Congenital heart defects: Trouble defects start with "T". No trouble: _____ life expectancy, can go home, etc. All congenital heart defects have a ____ whether trouble or not. Get echocardiograms. - ANS Normal, murmur Tetrology of fallot (trouble): "varied pictures of a ranch" use the first and ___ letter of each word. VD: ventricular defect, PS: pulmonary ____, OA: overriding _____, RH: right hypertrophy - ANS last, stenosis, aorta Contact precautions: for anything interic- _____, oral. C-diff, Hep A (anus) and ____ infections, herpes. RSV is a droplet but kids touch everything so its ____. - ANS fecal, staph, contact Contact precautions: Private room or cohart- same disease same ____. Gloves, ____, handwashing, dedicated equipment, disposable ____. - ANS room, gown, supplies Droplet precautions: ____, H flu. Private room. Mask, gloves, handwashing. Pt wear ____ when leaving room, dedicated equipment, disposable supplies. - ANS meningitis, mask Airborne precautions: measles, ____, rubella, TB and ____ (chicken pox). Private room, mask, gloves, handwashing. - ANS mumps, varicella Special filter mask for ____, negative air room. Always take PPE off in _____ order- Gloves, goggles, gown, mask. OFF ALPHABETICAL. On in _____ alphabetical for G's but mask is ____- Gown, mask, goggles, gloves (GMGG) - ANS TB, alphebetical, reverse, second Pediatric dose: always _____ by 2.2. Crutches: length of crutch- 2 to ____ finger-widths below the anterior ____ fold to a point lateral or slightly in front of the ____. Hand grip- elbow will be about ___ degrees - ANS divide, 3, axillary, foot, 30 Crutch gaits: 2 point gait- move a foot and ____ crutch together, moving two together. 3 point- move two ____ and bad leg together. 2 point mild problem, 4 point- _____ problem - ANS opposite, crutches, severe Crutch gaits: 4 point- move everything _____. Swing through- for non- _____ bearing. "even for even, odd for odd" Use even numbered when have an even number of ____ messed up - ANS separately, weight, legs Crutches and stairs- up with the good, ____ with the bad. Hold cane on ____ side. Advance cane and bad leg at same time. Walkers- pick them up and set them down, then ____ to them. - ANS down, strong, walk Non-psychotic: insight is ____ based, need good therapeutic communication, recognize their problem. Psychotic: no insight, don't think they have a ____, not reality based - ANS reality, problem Paranoid delusion: believe people are out are out to ____ them. Grandios delusion: believe they are _____. Somatic delusion: false belief about _____ part - ANS harm, superior, body Hallucinations: sensory, most common is ____- voices telling them to hurt self. Illusion: sensory, a referent in reality- something to which a person ____- actually something there - ANS auditory, refers Functional psychotic: ___ function in ADL's. "skeezo skeezo major manics" Schizophrenia, schizo effective disorder, major ____, manic - ANS can, depression Psychosis of dementia: brain is _____. Functional psychotic: has potential to learn ____. If not psychotic pick best _____ communication as answer - ANS damaged, reality, therapeutic Teach reality: 1st acknowledge ____. 2nd present reality, 3rd set a limit. Last ____ the limit. Ex: presenting reality- "I know that you see that demon but I don't see that demon" Setting a limit- "we're not gonna talk about that" - ANS feelings, enforce Can't learn reality: 1st acknowledge feelings, 2nd _____. Dementia: you can do reality orientation, ______ do PRESENTING REALITY. - ANS re-direction, CANNOT Psychotic delirium: temporary sudden dramatic secondary ____ of reality. From meds or _____ imbalances. Acknowledge feelings and re-_____ that its temporary. - ANS loss, chemical, assure Flight of ideas: ideas all other the place, phrases are coherent but not tightly ____. By themselves they are coherent but together ____ coherent. - ANS connected, not Word salad: babble random words. Neologism: making ____ words. Narrowed self concept: psychotic refused to ____ room or change clothes. Believe clothes define who they are. - ANS up, leave Ideas of reference: think people are ____ about them. - ANS talking If your not interrupting patients meal to give Lispro your doing it ____. Do not give it before, only with meals - ANS wrong Diabetes: don't metabolize glucose. Insipidus: polyuria, polyphagia, polydipsia,- leading to _____ due to low adh - ANS dehydration SIADH is opposite of diabetes insipidus. Retain ____ and not thirsty. If urine output goes down, specific gravity goes ____. - ANS fluid, up Diabetes melitus type 1: insulin ____, ketosis prone. If don't get treatment could DIE. D-diet, I- _____, E- exercise. - ANS dependent, insulin Diabetes type 2: treatment: DOA, D- diet, O- oral hypoglycemic A- _____. Diet is most important, _____ restriction- best answer. Need ___ small meals a day. - ANS activity, calorie, 6 Regular insulin: big "R" on bottle. Onset ____ hour, peak 2 hrs, duration 4 hrs. Its _____ so its a solution, can IV drip. Rapid short acting. R-rapid and ____ (in IV) - ANS 1, clear, run NPH insulin: intermediate acting. Onset 6 hrs, peak ____ to 10 hrs, duration 12 hrs. Cloudy so its a _____, No IV drip. N= not fast acting and not hung (in IV) - ANS 8, suspension Lispro and Humalog insulin: FAST ACTING. Onset ___ min, peaks 30 mins, duration 3 hrs. Give with ____. - ANS 15, meals Lantis and Glargine insulin: _____ acting. So slowly absorbed has no peak. Little risk for hypoglycemia. Can give at ____. Duration 12- _____ hrs - ANS long, bedtime, 24 Insulin: peak= when pt can get hypoglycemia. Check expiration dates. Minute its opened expiration date is ____ days after- write on bottle when opened and date or when _____ - ANS 30, expired Exercise does the same thing as ____. In questions- replace exercise with insulin. Ex: pt went to store and exercised- Pt went to store and got another shot of insulin. More exercise ____ insulin, less exercise more insulin - ANS insulin, less Diabetics: need to eat carbs before exercise. When sick GLUCOSE GOES ____. Need to take insulin even though not ____. Take sips of water to prevent dehydration, stay active as possible - ANS UP, eating Complications of diabetes: low sugar (glucose)- hypoglycemic shock. Causes: not enough food or too much ____ and too much exercise. - ANS insulin Hypoglycemic shock s/s: "drunk in shock" slurred speech, staggering gait, poor ____, delayed reaction time, labile mood (all over place), ____, loud. Shock- low blood pressure, tachycardia, tachypnea, cold, ____, clammy skin - ANS judgement, obnoxious, pale Hypoglycemic shock treatment: rapidly metabolized ____- sugar, starch or protein. Ex: fruit juice, pop, candy, ____, honey, icing, jelly, crackers, cheese. If unconscious give ____ IM or IV dextrose - ANS carbs, milk, glucogon DKA: high glucose. In type ___ diabetic. Diabetic coma can occur. Causes: too much ____, not enough exercise, not enough medication - ANS 1, food DKA: treatment- regular insulin, IV. #1 cause: acute viral upper ____ infections within the last 2 weeks. After recovery they start going ____. - ANS respiratory, downhill DKA s/s: 1 D, 3 K's, 3 A's: D- dehydration. K- _____ (in blood). K- kusmauls (deep rapid breathing) K- high K (potassium) A- ____ (due to nausea), A- acidotic (metabolic) A- acetone ____ - ANS ketones, anorexia, breath HHNS: high glucose in type 2 diabetic. ___- ketonic. Symptom: ____. - ANS Non, dehydration Diabetes long term complications: Poor tissue ____ and peripheral neuropathy. Ex: eye damage, hurting ____ because can't feel pain, gang green - ANS perfusion, self HA1C: best test for glucose. Need to be 6 or lower. 8 and ___ out of control. "7 no ____, 8 see the gate" (of heaven) - ANS above, heaven Lithium: 0.6-1.2. ____ is toxic. Lanoxin (digoxin): treats A fib and congestive HF, range ____-2, toxic level is 2. - ANS 2, 1 Aminophylline: airway antispasmotic. When bronchodilator _____ work give a phylline then bronchodilator. Range: 10-20. ____ is toxic - ANS doesn't 20 Dilantin (phenytoin) for _____. Range: 10-20, 20 is toxic. Billirubin: newborn- range 10-20 and ____ is toxic. Level 10 or above need to come to hospital. Billirubin in _____- kernicterus. - ANS seizures, 20, brain Lithium and lanoxin: go _____= 2 (toxic levels) all others go high= _____ (toxic level) - ANS low, 20 Hiatal hernia: regurgitation of acid into esophagus, upper part of ____ herniates into diaphragm. Dumping syndrome: gastric contents dump ____ quickly into duodenum - ANS stomach, too Hiatal hernia s/s: GERD only when lay down after ____. Dumping syndrome s/s: shock and "drunk": staggering, slurred ____ etc. Also, abd cramping, _____, boriborigmy. Decreased cerebral blood flow, all blood is going to the ___. - ANS eating, speech, diarrhea, gut Hiatal hernia treatment: you want the stomach to empty _____ so it doesn't regurgitate. Dumping syndrome treatment: want stomach to empty _____. - ANS faster, slower Hiatal hernia: elevate HOB, high _____- to go through stomach faster, high carbs- digested fast. Dumping syndrome: HOB ____, lay on side to eat, low fluids- 1 to 2 hrs before or after ____, low carbs - ANS fluids, flat, meals Hiatal hernia: "everything high". Dumping syndrome: "when you wanna go slow make everything ____." High carbs= low ____ - ANS low, protein Kalemias: do the _____ except for the heart rate and urine output. Hyperkalemia s/s: irritability, hyperactive, loud, aggitated, ____ heart rate, elevated ST, diarrhea, spasticity +3 +4 ____, low urine output - ANS SAME, low, reflexes Hypokalemia s/s: bradypnea, tachycardia, polyuria, flaccid, +1 reflexes. (+2 is normal), _____, lethargy, decreased _____, constipation - ANS weakness, LOC Obtunded: almost _____. Calcemias do the _____ - ANS comatose, opposite Hypercalcemia: bradycardia, constipation, decreased ____, flaccid muscles +1 reflexes, bradypnea. Hypocalcemia: +3 +4 reflexes, tachycardia, ____, hyperactive, Chevosteck and trousseaus sign - ANS LOC, diarrhea Chevosteck sign: rub ____ go into spasm. Trousseaus sign: hand spasm when put BP ____ on. Gay French Guy named Trousseo doing gay wrist flick. - ANS cheek, cuff Magnesemias do the _____. In a tie don't pick magnesemias. Skeletal muscle or nerve= _____. Heart = potassium. - ANS opposite, calcium Hypernatremia= dehydration. Hyponatremia= fluid _____. Earliest sign of electrolyte disorder is numbness and ____(parasthesia). Circumoral parasthesia: numbess, tingling around _____ - ANS overload, tingling, lips Potassium imbalance treatment: never push potassium ____. Not more than 40 K. Give D5W with regular ____, quick fix- drives potassium into the ____ out of the blood. Also kayexalate (mouth or rectum) - ANS IV, insulin, cell Potassium imbalance treatment: Kayexalate: is full of ____ (if high sodium, potassium goes down) lasts longer but takes longer to achieve effects. "K exits late" D5W, Regular insulin: "K enters ____" - ANS sodium, early Thyroidism= metabolism. Hyperthyroidism: hyperactivity, ___ intolerance, cold tolerance, weight ____, exopthalmous, high pulse and BP, skinny. This is graves disease - ANS heat, loss Graves disease (hyperthyroidism): " your gonna run yourself into the grave" Treatment: radioactive ____, PTU (proplethyouricil) and ______ - ANS iodine, thyroidectomy Grave disease (hyperthyroidism): radioactive iodine- pt by themselves for ___ hrs, careful with urine (if spill call hazmat). PTU- "puts thyroid under", S/e: _____. - ANS 24, immunosuppresion Total thyroidectomy: lifelong ____ replacement. At risk for hypocalcemia- impossible to spare ____ during procedure - ANS hormone, parathyroid Sub total thyroidectomy: thyroid ____. S/s: temp 105 and above, extremely high ____, severe tachycardias, psychotic delerium, _____- can cause brain damage - ANS storm, BP, hypoxia Sub total thyroidectomy/ thyroid storm treatment: get temp down- ice and ____ blanket. O2 at 10 liters. ____ with patient, wait till come out of it. - ANS cooling, stay Thyroidectomy post op: first ___ hrs top priority is airway, second is hemorrhage. 12-48 hrs after: totals can get ____ (larangeal) due to low calcium. Sub totals (partial): can get ____. - ANS 12, tetany, storms Never pick infection before ____ hrs post op, as an answer. Deonate = long acting. - ANS 72 Hypothyroidism (myxedema): s/s: cold intolerance, heat _____, flat affect, tired over weight, low ___ and pulse, longer thinking times, slow. - ANS tolerance, BP Hypothyrothyroidism: another name is _____. Treatment: thyroid hormone- ____, levothyroxin. Do not ____, can put into a coma ie ambien. Do Not hold thyroid ____ before surgery. - ANS myxedema, synthroid, sedate, med Adrenal cortex: disorders begin with "A" or "C". Addison's: ____ secretion of adrenal cortex. S/S: hyperpigmented, don't adapt to ____. If don't have adequate adrenal cortex when in stress can go into ____ - ANS under, stress, shock Addison's treatment: _____ (glucocorticoids), end in "sone". Need to "add a son (sone)" - ANS steroids Cushings syndrome: if you have a cushy couch or cushy tushy you have ____ much. Over secretion of adrenal cortex. Treatment: ____ - ANS too, adrenalectomy Cushings s/s: are also side effects of steroids. Moon face, gynocomastia, striae, ____, atrophy, high ____ sugar, full of sodium and water, _____ hump, hirsutism, immunosuppression. (draw moon man) - ANS bruises, blood, buffalo No small toys for children under ___ yrs old. No metal (diecast) toys if O2 is in use- can spark. Stuffed animals harbor ____- non living object that harbors bacteria - ANS 4, fomites Hard plastic toys don't harbor ____, easy to clean. 0-6 months old: best toy is a mobile or something ____. 6-9 months: teaching object permanance, best toy- ____ uncover toys. Ex: jack in box, window books - ANS bacteria, soft, cover 9-12 months old: ____ toys are best, purposeful activity. Never pick answers with these words before 9 months old: ____, sort, stack, make, construct. - ANS speaking, build Toddlers 1-3 yrs old: push ____ toys. Gross motor skills- running, walking. No finger dexterity objects ie ____, scissors. Parallel play: play along side not with - ANS pull, pencils Preschoolers: finger dexterity and ____. Cooperative play, ____ play. School age: 3 C's- creative (legos), _____, competitive (don't like losing). Adolescents: _____ and friends are main focus - ANS balance, pretend, collective, socializing Lamenectomy: removal of spinous ____ of vertebrae. To relieve nerve root ____. S/s: pain, prastesias, paresis- muscle weakness. Location in any neuro problem will determine symptoms and ____ - ANS processes, compression, treatment Cervical vertebrae/neuro damage: affects diaphragm and ____. Monitor respirations. Thoracic: monitor cough and ____. Lumbar monitor bladder and ____. - ANS arms, bowels, legs Post op lamenectomy: log ___. any spinal cord injury pick log roll as an answer. Do not let ___ dangle. Do not let sit for longer than ____ min. May walk, stand, and lie down ____ restrictions - ANS roll, feet, 30, without Lamenectomy post op complications: Cervical- trouble breathing _____, ie pneumonia. Thoracic- pneumonia and ____. Lumbar- urinary retention and leg problems - ANS deeply, ileus Whenever you don't know how long something restricted pick ____ weeks. Lamenectomy with fusion: bone ___ from ileac crest. - ANS 6, graft Lamenectomy discharge teaching: do not ___ longer than 30 min. Lie flat or log roll. No _____ or lifting more than 5 lbs all of these for ___ weeks. - ANS sit, driving, 6 Lamenectomy permanent restrictions: NEVER lift object by bending at ___. Cervical- no allowed to lift anything over ____. No off trail biking, carnival rides, jerking motions, etc. - ANS waist, head Creatinine: 0.6-1.2, not a priority. INR: coumadin level, 2-____. 4 or less is high priority. Hold med, ____ pt, prepare to give (antidote-vit k), then ____ doctor - ANS 3, assess, call Potassium: 3.5-5. Low or high potassium is high priority but if it get to ___ or more its highest priority - ANS 6 PH: 7.35-7.45. Ph in 6's= highest priority. Assess ____, and call doc asap. BUN: 8-____. If high assess for ____ - ANS vitals, 25, dehydration Hemoglobin: 12-____. If its 8-11 its low priority. If below 8 its ____ priority- assess for bleeding - ANS 18, high Bicarb: 22-26. Not a priority. Co2: 35-____. In 50's= high priority- have pt do pursed ____ breathing (gets rid of Co2) In ____= highest priority- respiratory failure, prepare to intubate and ventilate. - ANS 45, lip, 60's Hematocrit: 36-____. Is hemoglobin x3, Ex: 12x3=36, 18x3=54. High= low priority, monitor pt for ____. - ANS 54, dehydration Po2: ____-100. In 70's= high priority, assess respirations, give o2. When hypoxic heart rate goes up ___ then when heart can no longer compensate respiratory rate goes up. In 60's= highest priority- respiratory ____ - ANS 78, first, failure Sao2: o2 sat. 93-100. Less than 93= high priority. Anemia falsely ____ o2 sat. ____ procedure in last 48 hrs falsely elevates it. - ANS elevates, dye BNP (brain naturetic peptide): best indicator of congestive ____ failure. Sodium: 135-145. If abnormal= low priority. If sodium abnormal and pt has decreased ____= high priority. - ANS heart, LOC WBC: total wbc 5,000- 11,000. ANC (absolute neurophil count): needs to be above ___. CD4: needs to be above ___- if below= AIDS, if above = ____. All WBC labs below levels= high priority - ANS 500, 200, HIV Neutropenic precautions: don't drink ____ been sitting longer than 15 mins- no pitchers. ____ bottles of water good for 1 hr, unopened good for 4 hrs. - ANS water, opened Platelets: below ____= high priority. Below 40,000= highest priority. RBC's: 4-___ million. Abnormal= low priority - ANS 90,000, 6 All psych drugs cause low bp and ____ changes. Phenothiazines: "we use zines for the zanny" In large doses= anti-psychotics. In small doses= anti-____. They are major ____, the "big guns" - ANS weight, emetics, tranquilizers Phenothiazines s/e: ABCDEFG. A-anticholingergic, dry mouth. B- _____ vision. C- constipation. D- drowsiness. E- ____. F- Fotosensitivity. G- agranulocytosis. At risk for ___ - ANS blurred, EPS, injury NSSRI's: ____ elevators. Ex: elevil, toprodil, avotil, desoril. Elevil- elevate. S/E: anticholingergic, blurred vision, constipation, drowsiness, ____. Take for 2-___ weeks to achieve full effects. - ANS mood, euphoria, 4 Benzodiazepines: anti- _____. Mild tranquilizers. "zep" in name. "Zzzzz"= sleep (tranquilized). Ex: diazepam- valium, lorazepam. Works ___ but shouldn't be on for longer than 2-____ weeks - ANS anxiety, quickly, 4 Benzodiazepines: "zeps" Indications: mild tranquilizers, post- op to ____ so much anesthesia, muscle relaxer, ____ withdrawal, seizures, help people relax when fighting ____. Side effects: ABCD (see phenothiazines) - ANS reduce, alcohol, ventilator MAOI's: anti-____. Beggining of names are Mar, Nar and Par- brand names. Pt must avoid tyramine ____. - ANS depressants, food Tyramine foods: "BAR" B- bananas, A- ____, R- raisins (or dried fruit). Also, aged ____, yogurt, alcohol, ____ - ANS avocado, cheese, chocolate Lithium: for bi-polar disorder. Decreases ____. S/e: peeing, pooping, parasthesia, ____, metallic taste, severe diarrhea. - ANS mania, tremors Lithium: #1 intervention is ___ intake. Need normal sodium for lithium. - ANS fluid Prozac: s/e: ABCDE. Causes ____- do not give at bedtime. Adolescents and young adults watch for ____ ideation when change dose - ANS insomnia, suicidal Haldol: is a deconate (long acting) S/e: ABCDE. Can cause NMS- neuroleptic ____ syndrome, high fever, medical emergency. - ANS malignant Cholozaril (clozapine): for severe schizophrenia. S/e: _____. Geodone: prolongs QT interval and can cause cardiac ____ - ANS agranulocytosis, arrest Zapines: new major _____. Zoloft (sertraline): ____. Do not take St Johns ___ with this- can cause seritonin syndrome. On coumadin with SSRI's- increased ____ Zeps, Zines and Zaps= tranquilizers - ANS SSRI, wort, bleeding St johns wart (not with SSRI's) can increase drug ____ cause it doesn't allow meds to be broken ____. Seritonin syndrome s/e: "SAD head" S- sweating, A- apprehension, D- ____, head ache. - ANS toxicity, down, drowsiness Woman's due date: 1st day of ____ menstrual period, add 7 days and 1 yr and subtract ___ months. - ANS last, 3 Pregnancy weight gain: total- ___ pounds, plus or minus 3. ___ trimester: 1 lb a month- 3 months so gain 3 lbs. 2nd and third trimester: 1 lb a ___ - ANS 28, first, week Calculate ideal pregnancy weight gain: take week of gestation and subtract ___. Fundal height: NOT _____ until week 12. At umbilicus at ___-22 weeks - ANS 9, palpable, 20 Positive signs of pregnancy: fetal skeleton on ____, fetal presence on ultrasound, auscultation of fetal heart ____-hear it between 8-12 weeks. Examiner ____ fetus - ANS xray, rate, palpates Probable and presumptive signs of pregnancy: are maybes. All ____ and blood tests. Positive pregnancy test is ___ a positive sign of pregnancy. - ANS urine, not Chadwick, goodell and hegar signs occur in ____ order. Chadwick sign: cervical color turns blue- from ____. - ANS alphebetical, cyanosis Goodell sign: cervical ____. Hegar sign: ____ softening. During pregnancy Hemoglobin will fall- thats ____. Morning sickness: dry carbohydrates before get out of ___. - ANS softening, uterine, normal, bed Pregnancy: urinary incontinence- 1st and ____ trimester, Not 2nd because the baby is up ___ of bladder. Need to void every ___ hrs - ANS 3rd, high, 2 Pregnancy: difficulty breathing- 2nd and 3rd trimester. Teach _____ position- flat with arms on table, leaning forward. Back pain- 2nd and 3rd trimester. Treatment- pelvic ___ exercises to tilt pelvic forward. - ANS tripod, tilt Truest, most positive sign of labor: the onset of _____ progressive contractions. Effacement: thinning of cervix, up to ____%. Station: fetal presenting part in relation to ischial ____ - ANS regular, 100, spines Pregnancy: positive station- presenting part is ____ ischial spines. Negative station- part is above spines. 0 station- part is at ischial spines. ___: the position of babys spine to mothers spine - ANS below, Lie Transverse lie: babys spine is diagonal to moms. Presentation: part of baby that enters birth ____ first. ROA and LOA most ____ - ANS canal, common Stages of labor: stage 1: labor, phases- Latent, ____, transition. Stage 2: delivery of ____. Stage 3: delivery of placenta. Stage 4: recovery, lasts ___ hrs - ANS active, baby, 2 Labor: Stage 1: dilate and efface. Stage 2: purpose of contractions- push baby ____. Stage 4: contractions to stop ____. - ANS out, bleeding Labor: Active phase: dilate 5-7 cm, every ___-5 min, lasts ____-60 sec. *Memorize this phase only, anything less=latent, anything more= transition. - ANS 3, 30 Contractions should not be ____ than 90 seconds or closer than every ___ minutes. If they are than can= problems. Can be a sign of uterine ____ or uterine hyperstimulation- would need to turn down or stop ____ - ANS longer, 2, tetany, pitocin Timing contractions: frequency: begining of one to beginning of next. Duration: beginning to ____ of one contraction. Intensity: the ____ of contraction. Teach to palpate with one hand over ____ with pad of fingers - ANS end, strength, fundus Painful back labor: position her in knee ____- on hands and knees with butt up. Push your hand into sacrum. Prolapse cord: push the head up off ___, put her in knee chest position. - ANS chest, cord If its not back pain or prolapse cord treat with: LION. L- turn on ____ side. I- increase IV. O- oxygen. N- notify ___. - ANS left, doctor In an OB crisis if pitocin is running ____ it. Do not give pain meds to woman in labor if baby is likely to be ____ when the med peaks - ANS stop, born Low fetal heart rate: below ___ do LION- this is bad. High fetal heart rate: above ____- not bad, monitor it and take moms temp, probably has ____ - ANS 110, 160, fever Low fetal baseline variability: fetal heart rate stays the same- BAD, do ____. High baseline variability: fetal heart rate always ____- not bad - ANS LION, changing Late decelerations: heart rate slows down near the end or after _____- BAD. Do LION. Early decels: fetal heart rate slows ____ or at beginning of contraction- not bad - ANS contraction, before Variable decels: VERY BAD. Prolapse ____- push baby head up, put mom in knee chest position. Fetal HR tracings that begin with letter "L" do ____, they are bad - ANS cord, LION VEAL CHOP- write vertical, next to each other. V- variable= ____ compression. E- Early decel= H- head compression. A- acceleration (high fetal HR)= O-___. L- Late decels= P-_____ insufficiency - ANS cord, OK, placental IN OB: check fetal heart ____ is answer that always wins. Delivery (stage 2): Goes alphabetical order- head, then ____, then nose. Then check for nuchal ___, deliver shoulders, then body - ANS rate, mouth, cord OB: baby must have ID band on ____ leaves delivery area. Placental delivery (stage 3): make sure its ___ there, check for 3 vessel cord. "AVA"- two arteries one ____ - ANS before, all, vein Labor: Recovery (4th stage): first ___ hrs after placenta delivered. 4 things every 4 hrs in 4th stage: Vitals (look for signs of shock), Check fundus, Check ____, and Roll (to check bleeding under) - ANS 2, roll Labor 4th stage: Boggy fundus: massage. Displaced fundus: _____. Check perineal pad: if bleeding excessively will saturate 100% of pad in ___ minutes or less. Roll her over and check for bleeding - ANS catheterize, 15 Postpartum assessment: "BUBBLE HEAD": B- breasts, U- uterine fundus- check ____ and firmness, B- bladder, B- bowel. L- ____. E- episiotomy, H- hemoglobin, hematocrit, E- ____ check, A- affect (emotion), D- discomforts - ANS height, lochia, extremity Postpartum: lochia- "real slimey accumulation" R- rubra, red color. S- ____- "rosa- rosey cheecks", pink. A- alba, (albino) ____ color - ANS serosa, white Newborn complications: ____ succidana "CS= crosses suture" Cephalo hematoma doesn't ____ sutures. Physiologic jaundice appears after ___ hrs - ANS Caput, cross, 24 OB meds: Tocolytics- stop labor Ex: turbutaline, and ____ sulfate. Turbutaline: ____ maternal heart rate - ANS magnesium, increases Magnesium sulfate: hypermagnesemia- does opposite, everything goes ____- heart rate, BP, Respirations, ____ and reflexes. Want +2 reflexes, if +1 need to ____ magnesium down, if + 3 need to increase it. - ANS down, loc, slow Oxytoxics: stimulate ____. Ex: pitocin and _____. Pitocin- can cause uterine hyperstimulation, is longer than ___ seconds and closer than 2 minutes. - ANS labor, methergine, 90 Methergine: causes high ___. Mag- "magnum ____ shot lowers bp" Meth- "methamphetamine raises BP" - ANS BP, 45 Fetal lung meturing meds: betamethasone- given to ___, IM, before baby is born. Servanta- surfactant- given to neonate, trans tracheal (blown into trachea), after baby is ____ - ANS mother, born Humulin 70 D30: 70% N, 30% ____. Top # Numerator- N (NPH) 70/30. Drawing up insulin: want to be RN= regular first then ____. - ANS regular, NPH Insulin: injecting air: into N first then ___ (drawing up is opposite-RN) Injections: "I" looks like a 1 (one) so pick answer that has ___ 1's. Ex: 21 gauge 1 inch ( has two ones) - ANS R, two Sub Q: "S" looks like a "5" so pick answer with two ___'s in it. Ex: 25 guage 5/8 inch. Heparin: given ___ or sub q. Coumadin: given PO ONLY. - ANS 5, IV Heparin: works immediatly, cannot be given for longer than ___ weeks (except lovenox). Antidote- protamine sulfate. Lab test- ___. Can be given to ____ women. - ANS 3, PTT, pregnant Coumadin: PO only, takes a few ____ to a week to work. Can be given for rest of ___. Antidote- vitamin K. Lab test- ___ (INR). Not given to pregnant women. - ANS days, life, PT PTT: draw two lines on TT and it makes an "H" for heparin. Diuretics: any diuretic ending in letter __ exes out potassium= wastes potassium. And Diurill included. Diurill sounds like "die you will" when your dying- ____ away. - ANS x, wasting Diuretics: Semides end in X. Ex: fourosemide- ____. Baclofen: muscle relaxer. S/e- fatigue, muscle ____. Don't drink, don't ___, don't operate heavy machinery. "Back loafin' " Flexeril: muscle relaxer - ANS lasix, weakness, drive Piaget: stages of thinking: 0-2 yrs old- sensory ____. Present oriented. Teach them ____ you to it. Teach what you are doing, verbally - ANS motor, while Piaget: 3-6 yrs- preoperational. _____, teach shortly before or after. Teach what you are ____ to do. Use ____ - ANS imaginative, going, play Piaget: 7-11- ____ operations. Rule oriented, teach ___ ahead. Teach what your going to do plus ____, with age appropriate reading and demonstration. - ANS concrete, days, skills Piaget: 12-15 yrs old: formal operations. ____ thinking, teach like an ____. They can manage care. - ANS Abstract, adult Psych: Don't give or except gifts. Don't give _____ or guarantees in psych. Pick answers that keeps pt ____. Don't pick refer to social services even if appropriate. - ANS advice, talking Psych: Don't use slang- they take everything ____. Empathy: nurse excepts the pts ____. Never say "I know how you feel" Empathy questions always have a ___ in question part. - ANS literally, feelings, quote Empathy: Do not choose answer that reflects their ____, choose one that reflects what pt FELT. Ex: "your killers, you killed my mom" she feels scared, pick answer about her being scared. - ANS words Prioritization: questions will always have age, gender, ____ and modifying phrase. Don't need age and gender. - ANS diagnosis Rules for prioritization: ACUTE BEATS CHRONIC. Fresh post op- up to ___ hrs after beats medical or other surgical. 2 hr post op ___. UNSTABLE BEATS STABLE. - ANS 12, highest Stable: ready for discharge, admitted longer than ___ hrs ago, unchanged assessment, chronic illness, post op ___ than 12 hrs, local or regional anesthesia - ANS 24, longer Stable: pt experiencing typical ____ signs and symptoms of the disease with which they were diagnosed. Unstable: ____ signs and symptoms - ANS expected, unexpected Unstable: acute illness, post op less than ___ hrs, general anesthesia, Newly ____- less than 24 hrs ago newly diagnosed, ____ assessment - ANS 12, admitted, changed Things always unstable regardless of whether its expected or not: hemorrhage, high fevers over ____, hypoglycemia, pulselessness or ____ - ANS 105, breathlessness 3 things for black tags in un-witnessed accident: pulselessness, breathlessness, ____ dilated pupils. Unless there when happened, unwitnessed at scene of death= ____ priority - ANS fixed, lowest Tie breaker only: the more vital the ____ the higher the priority- organ of the modifying phrase. Order of organ vitality: Brain, ___, heart, liver, ____, pancrease - ANS organ, lung, kidney Do Not delegate these to LPN: starting an ___, hanging or mixing IV meds. IV ____ meds, administer blood or mess with central lines, No care planning, perform or develop ____ (can re-inforce), take care of unstable pts, can't do the ___ of anything. - ANS IV, push, teaching, first LPN cannot do these assessments: admission, ____, transfer, first assessment after there's been a ____ - ANS discharge, change Do not delegate these to an AID (UAP): charting about the pt- can chart what they did. Give ____- except for topical OTC skin barriers. Assessments- except vitals and ____. Treatments- except ____. Cannot evaluate - ANS meds, accuchecks, enemas Aids/ UAP's can do: ADL's but never the ____. Do Not delegate ____ responsibilities to family - ANS first, safety Inappropriate behavior from staff: are they doing anything illegal? if yes- tell ____. Is anyone in physical or psychological harm? if yes- ____ and take over. Is this legal, not harmful but simply inappropriate? if yes- talk later on with them. Never choose ____ it - ANS supervisor, confront, ignore Organ locations: liver- RUQ, gall bladder- RUQ, Spleen- ____, pancreas- LUQ, Appendix- ____ - ANS LUQ, RLQ Heart sounds: Aortic- 2nd intercoastal space, right side, Pulmonic- ____ intercoastal space on left side, Tricuspid- 4th intercoastal space, Mitral (apical)- ____ intercoastal space, left side - ANS 2nd, 5th Psych questions: best answer- nurse will examine her ___ feeling about it. Also, establishing ____ relationship - ANS own, trust Nutrition: In a tie pick ____ (not fried), if not an answer then pick fish (not shellfish). Never pick casserole for ____. Never mix meds in childrens food. - ANS chicken, children Nutrition: Toddlers- ____ foods even if not healthiest answer. Preschoolers- 1 meal a day is ____, leave them alone - ANS finger, ok Pharmacology: if you know what a med does but don't know s/e: pick side effect in same ____ system where the drugs working. Ex: GI drug- choose diarrhea - ANS body Pharmacology: if you have no clue what the drug even is: If its po pick ____ side effect. Never tell children meds are ____. - ANS GI, candy Med surge: first thing you assess- _____. First thing you do- establish an _____. - ANS LOC, airway Peds: always give child more time (to grow and develop), don't rush. When in doubt- call it ___. Ex: 6 yr old can't read- call it normal. When in doubt pick the ____ task. Ex 6 month old rolling over or sitting up- rolling over is easier to do - ANS normal, easier General guessing: rule out absolutes. If two answers say the ____ thing neither one is right. If two answers are ____, one of them is probably right. - ANS same, opposite General guessing: When want to answer all of the above- choose an answer that ____ all others. - ANS covers Pt med question: take each option and ask "if I didn't do this what's worse that could happen" choose the ____ outcome. Ex: which is highest priority for suicidal pt? Give tranquilizer, orientate to unit, put on suicide precautions, introduce to staff. If no suicide precautions they could die so best answer. - ANS ... When stuck between two answers go ____ and read question. When you don't know what something is- Re- read question ____ what it is you don't know. - ANS back, without Sesame street rule: only when NO other way. Right answer tends to be ____ than others. Wrong answers are similiar. When something really ____ right it probably is- go with your gut - ANS different, feels Aneurysm: monitor ____- hypertension could cause it to enlarge or rupture - ANS Bp Aneurysm: monitor ____- hypertension could cause it to enlarge or rupture - ANS Bp Bruit: swooshing sound. AAA: hear a bruit over peri _____ area - ANS umbilical Non reactive non stress test is ____ good. Reactive= reassuring - ANS Not