“wt ut, textbooks, questions Nursing review comprehensive Terms in this set (835) normal blood pressure 120/80 normal spo2 95-100 normal pulse 60-100 normal adult respirations 16-20 normal children respirations 16-30 glucose level 70-10 normal wbe '5000-10,000 normal platelets 150,000-4000,000 normal bun 10-20 creatinine 613 sodium 135-145 potassium 35-50 albumin calcium 86100 digoxin level 5-20 magnesium 16-26 Nursing review comprehensivehematocrit female 35-45 male 42-52 absence seizure last only a few seconds tonic clonic seizure protect airway protect pt from injury monitor duration of seizure activity status epileptic in er protect airway administer valuim(diazepam) place IV protect pt from injury main seizure drugs carbamazepine(tegretol) avoid grapefruit phenytoin(ditantin) extra growth on gums valproic(dapakote) affects wound healing if G1 symptoms occur while on seizure meds you should advice pt to take with food signs of depression in children pretends to be sick trouble in school pessimistic attitude TREATMENT FOR DEPRESSION antidepressants counseling psychotherapy should not take St johns wort while taking what meds antidepressants if'a pt is on TPN and it runs out with no more available at the time, the nurse should infuse 10% dextrose water at S4mi/hr best way to tellif ng tube is correctly Nursing review comprehensive chest x-rayproper use of inhaler during inhalation the pt should administer the medication after a procedure hispanics believe that they should drink hot things to restore balance blood transfusion are forbidden by jehovah witness when a pt has a hip replacement the nurse should place a pillow between legs while Lying to prevent hip dislocation giving meds through the NG tube the nurse should mix them individually if a pt is DNR and the nurse resesitates itis called battery miseries mean Pain when suction nasotracheal tube you should know what never suction longer then 15 seconds, if you get large amount of yellow secretions but past 15 secs, reoxygenate and then’ continue suctioning intramuscular injections in thin patients ventrogluteal should be given where landmark for ventrogluteal greater trochanter (hip) most effective way to use imagery sensory is to include as many images as possible progressive relaxation activity is accomplished by Ist-establish regular breathing pattern 2nd- tense muscle fully 3rd- relax muscle completely when should you teach a pt about how to use a PCA pump the day before surgery Nursing review comprehensiveveracity means truthfulness correct deep breathing exercise inhale through the nose, exhale slowly through mouth without pursed lips number one cause of bedsores prolonged bedrest what is the number | question t ask a pt before surgery have you had anything to eat since midnight when a pt gets anesthesia what is highest priority for nurse to do Position pt due to risk of perioperative-positioning injury why does a nurse call a time out before the surgery starts for final verification of procedure, site and right pt what do you expect to find after surgery hypoactive bowel sounds if you have a pt with tt hip replacement, p/o they have moderate sangvinous drainage nurse should observe area under hip (since gravity pulls) mark amount of drainage on dressing by circling it to help relieve anxiety for a pt who. has never been hospitalized the nurse should explain room environment to help prevent venous thromboembolism dorsal & plantar flex of feet lovenox injections (anticoaguiant) proper way to evaluate legs is use 2 pillows place I lengthwise under each calf if ptis experiencing right sided weakness place at 45* angle on tt side when a pt is starting to fall the nurse Nursing review comprehensive gently try to lower to the groundatelectasis can lead to pneumonia, to prevent atelectasis the pt should take 10 deep breaths per hour what Is atelectasis complete or partial collapse of the lung how would a nurse explain to a pt the correct way to deep breath place hands on abdomen above umbilicus, try to make your hands rise (shoulders should not rise) ‘what does braden scale assess Pressure ulcers way to prevent pressure ulcer reposition q2h , 60° side lying before giving a pt anew med what is most important question to ask if you are allergic to it ‘what helps to increase normal body flora buttermilk and yogurt what should you teach a pt with limited ambulation Isometric exercise of gluteal and quadriceps 5x Q2h while awake when a nurse is concern with the pt getting constipation due to lack of activity and poor diet what should the nurse do offer bedside commode, which allows pt independence and correct positioning for bowel action to improve spiritual needs of patient the nurse should place a sign on door to allow quiet time in A.M for prayer lack of sleep causes fatigue and pain how is quality of pain described dull, sharp, achy, stabbing pain intensity is measured by scale HO and faces for children guarding is known as Nursing review comprehensive ‘common response to an injured areaif'a pt is having pain and anxiely, itis important to determine what what is causing the an) before implimenting interventions the nurse should discuss it with the pt aspirin should be avoid in children, why it causes Raynards Syndrome for a sprained ankle the treatment should be place heating pad on, heat promotes muscle relation and relief of pain ‘what is important to remember about cold packs excessive direct exposure to skin can damage skin what causes the skin to become reddened from prolong exposure to ice reflex vasodilation cold causes vasoconstriction control meds are called schedule IV analgesics and high potential for abuse after an incorrect med is given the nurse must notify Dr. of error in treatment purpose of an incident report is to find ways to prevent future errors IV obstruction is most often caused by pt movement,, occluding tine if nurse checks IV site and it is inflammed, lender, and dated 36 hrs ‘ago the nurse should remove and start in a different location phelebitis at IV site puts pt at risk for thrombus formation when a pts fluid intake is greater then their outout. this make a concern for Nursing review comprehensive ausculate for breath soundsif'a pt has swollen ankles with 4mm indention the nurse should document itas 1g edema present at feet and ankles if pt has abnormal breath sounds, bilateral pitting edema and jugular distention will cause the pt pulse to increase in rate and volume potassium should never be IV push foods high in potassium include baked potato, chicken, grapefruit when should dieurtics be taken In AM. with breakfast due to nocturia if pt has difficulty swallowing the nurse should assess for adventitous breath sounds, since pt at risk for aspiration pneumonia if pt gives copy of living will it should be placed in medical record and document its presence when a ptis deteriorating and disoriented itis important for nurse to determine from family if pt has a living will and power of attorney dying process begins the following Is done clean mouth with oral swabs 2 staff members provide care see cyanosis, motting of hands and feet signs of denial shock, numbness, disbelief why is transmucosal route of ‘oxycodone used rapid absorption decrease chance aspiration chest tubes have 2 chambers what are they water seal chamber (no bubbling) suction control chamber (bubbling) keep canister on ground what is GERD heartburn Nursing review comprehensivehow do you prevent GERD medication avoid chocolate avold tobacco smaller portion meals, chew gum after meals important info about histamine 2 blocker meds for Gerd & peptic ulcers may cause confusion dont smoke take with meals may cause black tongue what should you never give a pt in heart failure sodium bicarbonate (alka selzer) ‘What does sucralfate (carafate ) due for a pt with ulcers coats to protect from gastric juices (acid) Pepto should not be given to children why contains aspirin what must be monitored when given Reglan temperature cause it raises it causes lip smacking complications of peptic ulcers are bleeding ulcer perforation gastric obstruction when a pt has a seizure disorder what brings them on stress lack of sleep Pregnancy infection/flu what is aura, name an example of it when having a seizure it effects smell, taste and vision. Example: seeing floating lights epileptic cry is forced exhalation (tonic clonic) goiters are seen in what diseases hyperthyroidism hypothyroidism Graves dx Nursing review comprehensivewhen a pt is on thyroid replacement what two drugs do you have to adjust increase insulin decrease anticoagulants (always check vitals after given thyroid replacement drugs pt on thyroid replacement when should the nurse notify the dr. increase pulse 20 bpm from last week vomiting Irregular pulse rate pregnancy thyroid storm/crisis happens when infection trauma how long does it take to see 3 weeks improvement when started on thyroid suppressing drugs and what can they cause risk for infection hormones changes are caused by gonadrotropin releasing hormone ‘cause of hot flashes is what hormone follicle stimulating hormone (FSH) what is a great risk for pt on hormone replacement therapy when pt smokes blood clots what is Evalycemia normal fasting glucose 70-N10 when is glucagon active in the morning ‘what usually causes DM II obesity sedentary lifestyles ‘when is short acting insulin given, what color Is it before meals- clear intermediate acing insulin is what color cloudy (always draw up clear before cloudy) Nursing review comprehensiveInstructions when injecting insulin dont aspirate dont message after usually in abdomen signs of diabetic ketoacidosis fruity breath nausea abdomen pain remember children receiving adult glucophage should be given what type of doses how long should a pt not receive 48 hrs glucophage(Metformin) after an angiogram if anurse notices a hemovac drain full of sanguinous (bloody) drainage the nurse should empty drain measure amount notify surgeon check hemoglobin/hematocrit level what Is important about giving packed red blood cells only compatible with normal saline infuse within 2 hours infuse with NS when changing a dressing what should the nurse do first don sterile gloves before cleansing incision dehiscence is Unintentional opening of a wound prior to healing (pop a stitch) when a nurse notices a pt over or under reaching it is due to visual defect in depth perception 20 # feet from chart 40 larger the number = poorer vision how do you define characteristics of a problem Nursing review comprehensive cluster data and compare itwhen speaking with hard of hearing nurse should make eye contact, low pitch voice when a pl is being sent home but is at risk for falls the nurse should consult family about assessing pt home for risk of injury like throw rugs(even if they dont slide you can trip over edges active listening means giving your full attention when a pt becomes dependent on ‘others it causes. disturbed situational low self esteem when older adults lose ability to distinguish color which colors should you use to mark things red,orange and yellow to assess pt ability to discriminate sensation the nurse should touch extremities with different objects and ask pt to describe what they are fling if pt comes out of surgery and is. confused the nurse should address pt by name, they them where they are and the time ( keep bathroom light on to help ID surroundings) chronic middle ear infections can cause hearing loss paraplegia means paralysis of lower half of body when nurse notices reddish area on sacrum the nurse should evaluate it by document length time of redness apply light pressure to check for blanching measure diameter What is rubor and where is it usually seen redness (usually seen area lower then heart mainly legs) reactive hyperemia is when tissue is relieved of pressure to relief pressure on sacrum the pt Nursing review comprehensive 30° lateral inclined positionwhat is treatment for stage | pressure ulcer place transparent film on it infection leads to sepsis skin is acicity ifit losses acid what will happen increase water (maceration) overgrowth bad bacteria (staph & candida) pt has herpes zoster (shingles) the nurse should cover with non inherit bandage ‘what is dermatomal pattern rash that does not cross areas purulent means pus if pt has diarrhea the nurse needs to protect skin by applying moisture repellent ointment a written schedule in a pt room does not do what violate pt rights irrigating a wound on a pt with MRSA the nurse should wear gloves, gown, googles, face mask what is used to measure wound tunneling sterile tip cotton applicator what does wet to dry dressings do they mechanically debride the tissue the antibiotic ZYVOX should be handled how never shake, turn bottle upside down then right side up 3-5X ‘when pt has rash and itching the pt should be given antihystimine what diagnostic test is used to test Nursing review comprehensive peak and troughif pt ulcer has granulation tissue filing the treatment should be to continue hydrocolloid dressings sleep med Restoril (temazepam) is a hypnotic drug ( will make respirations and $PO2 decrease while steeping) nocturia causes sleep deprivation sleep interventions monitor food/beverage intake if cant sleep after 30 mins, get up and do a quiet activity Effleurage is what and helps what light touch with slow movement over back to aids in sleep obstructive steep apnea is lack of airflow through mouth/nose for a period of 10 seconds or more narcolepsy is dysfunction to regulate sleep/wake states, causes excessive day sleep ‘Apt with steep apnea in the hospital it is important to continue monitoring must be in room by nurses station ‘a pt has obstructive sleep apnea and the nurse notices his SPO2 is at 84% the nurse should gentle awaken pt to increase oxygen saturation if a pt has a increase in WBCs it tells the nurse to check what temperature to assess for a fever kids in summer tend to stay up later and sleep until noon because many adolescents start developing this type of pattern as they develop their independence how is bladder training for incontinence done remind pt to void q2hr while awake technique for inserting condom Nursing review comprehensive clean & dry penis return foreskin to normal positionwhat can cause difficulty inserting a foley ina male enlarged prostate gland technique to irrigate catheter clamp distal tubing first use normal saline use aseptic technique sign of respiratory problem is cyanosis of fingertips signs of activity intolerance stopping and talking in halls readjusting clothes how do you assess for residual urine use Ix straight catheter skin tenting is a sign of fluid volume deficit (dehydration) after inserting catheter in a male what should the nurse do inflate balloon with 10ml of sterile water primary cause of Gl ulcers is gastric infection what is signs of peptic ulcer disease burning, gnawing pain from sternum to umbilicus meds avoid caffeine, alcohol, smoking treatment for peptic ulcers avoid NSAIDS avoid Stress, Tounce = how many ml 30 15 grains = how many grams acute closed angle is a medical emergency eye drop Travoprost (travatan) can darken eye color Nursing review comprehensivebefore the nurse administers the eye ‘drop Timoptic (timolol) the nurse should ask the pt what if they have cataracts if they have asthma if they have heart condition eye drops that can cause risk for falls are Timotot carbachol (can cause systemic side effects if gets on skin whip off immediately) Apraclondine (iodine) eye drops for glaucoma precautions include dont give to anyone on MAO inhibitor wear sunglasses if pt on IV meds long term through implanted infusion port the nurse should insert huber-point needle in port if pt has anxiety it is important for nurse to ask pt what nutritional history.. sugar, caffeine and alcohol intake agenogram is genetic and family history pt with myasthenia gravis ( weakness fatigue of muscles that ‘causes difficult swallowing) should have snacks that are semi sotid, with pudding h calories and protein like before flushing an NG tube the nurse should first check placement neuro cognitive function is controlled by what part of brain frontal tobe when a pl with NG tube has a violent ‘cough the nurse should clear tube with 30mt of air check pH of fluid for placement name 4 types drug orders prn standing stat one time single dose Nursing review comprehensiveif the anti anxiety med benzodiazepines are give to older adults what must nurse monitor respirations, wean off slowly (withdraw symptoms can be life threatening) adverse effects of antipsychotic meds are seizures neuroleptic malignant syndrome(reaction to drug fever,change mental statusmuscle stiffness what is alzheimers plaque between brain cells caused by age unable to perform simple task drooling- too high of dose of meds when should you take alzheimers med Donepezil (Aricept) at bedtime pin rolling is a sign of parkinsons ox pt on tokapone (tasmar) for parkinsons should go to er if their urine turns dark parkinsons or depression should be warned to stay out the sun if aptis having an enema and begins abdominal cramping the nurse should lower enema bag roll clamp to stopenema until cramping subsides how would you assess orthostatic vitals sign changes take in laying,sitting &standing assess in supine for changes that occur from sitting to standing when taking orthostatic vitals after recording the Ist B/P the nurse should check radial pulse rate fluid volume deficit often causes tachycardia (rapid) orthostatic hin most important data to collect when assessina fluid volume is, Nursing review comprehensive body weightin elderly fluid volume deficit is caused by decreased hepatic blood flow morphine causes respiratory depression ‘what is done in post anesthesia phase pain management post anesthesia precautions a pt with rheumatoid arthritis should perform exercise how slow and smooth cchest pain and tearing feeling in chest are signs of what dissecting aaa rt sided cardiac failure is due to back up circulation of rt ventricle lt sided cardiac failure is due to pulmonary congestion from back up of circulation in tt ventricle somatization is pain unrelieved by medication psychogenic amnesia is sudden inability to recall certain events psychogenic fugue is pt leaves home, unable to recall their identity or their past depersonalization is fear of going crazy dependent personali allowing people to make decisions for you antisocial means unable to confirm to social norms histrionic personality means dramatic,flamboyant, center of attention what does hypothalmus do regulates body temp, appetite, maintain wakeful state Nursing review comprehensive‘occupational therapist helps with fine motor movement from the provisions of self care when a pt has dysphagia (di swallowing) the nurse should to what to make swallowing easier ficulty signs of altered nutrition Pale conjunctival sac lips dry & cracked skin over sternum tents when pinched if a pt has shallow respirations to get ‘an accurate count the nurse should place hand on chest to determine the need for anasal cannula you should measure oxygen saturation when assessing breath sounds you should have pt do what take deep breath in through mouth anew peg tube is inserted how long should a nurse wait to begin feeding supplements 24 hours orthopnea is difficulty breathing while lying flat if spo2 is below 95 what does that indicate Impaired gas exchange signs of hypoxia (oxygen deficiency) are fatigue restlessness what should nurse do when SPO2 drops first reposition finger clip assess for respiratory distress encourage pl to cough & deep breath tenacious means consistency Nursing review comprehensiveto obtain sputum sample the nurse should have pt cough deeply from chest and s; antitussives do what reduce cough vesicular breath sounds are normal where in peripheral lung fields abdomen assessment inspect A-ausculate P- percussion P- palpate what Is most important when assessing bowel sounds listen up to 5 minutes normal bowel sounds are 5-35 x per minute hypoactive bowel sounds are heard after 5 minutes of listening what do laxatives do causes movement of intestines that push bowel contents, docusate (surfak) is a stool softner which does what changes consistency of stool before administering a rectal suppository the nurse should check for what rectal bleeding what does making a pt take slow deep breaths do when administering a suppository relaxes the anal sphincter to reduce discomfort, vagal nerve stimulation will decrease pulse rate due to slowing the heart rate how are telephone orders handled Nursing review comprehensive administer as prescribed get dr signature the next dayif renal transplant pt on cyclosporine they should not receive immunizations or flu vaccine if pt is on warfarin and notices blood tinged urine they should call dr. Immediately OCD depression what does paxil treat anxiety ticlopidine (ticlid) is an antiplatlet how with food should it be taken pt with Aids taking Raltegravir, adverse effect is temperature 101.2 baclofen (muscle relaxer) can make the pt drowsy Adverse effect of betopic eye drops for glaucoma is increased pulse rate what should HIV pt have done before starting Retrovir a complete blood cell count pt taking lithium carbonate for bipolar ‘or manic depression should be advised to maintain fluid intake 2-3 L (day have a normal serum lithium of 641.2 what do thrombolytics do dissolve thrombi that already exist what are symptoms of toxic serum Lithium level vomiting, diarrhea slurred speech ataxia ((oss of body movements) twitching Dantrium is used to manage hypermetabolism caused from what malignant hyperthermia Nursing review comprehensivewhat should a cancer pt report immeditety if receiving chemo with tuorpuracit stomal diarrhea (swelling & sores in mouth) what does the drug Arava relieve joint pain and arthritis, ‘what will Avodart therapy do decrease the obstruction of the outflow of urine through urethrea what drug should not be mixed with warfarin mitomycin when irrigation an ear what should the warm to 98.6 nurse do to the solution when pt prescribed the eye drops monitor 8/P (Betaxolol) the nurse should Zyrtec (antihistamine) causes drowsiness what is the therapeutic serum level of 10-20 Theo-24 Myambutol used to treat TB, what is adverse side effect of it visual disturbances what does nebulizer do thins respiratory secretions Benzonatate (tessalon) is an antusssive which calms cough Intal is prescribed for asthma the purpose of this drug is suppress an allergic reaction pt who have a stroke and has dysphagia Gifficulty swallowing) they should be given Nursing review comprehensive thickened food nectar, apple sauce oatmealIns and wears if pt on droplet precat glasses how should nurse place mask secure surgical face mask over bridge of clients nose under the glasses if a ptis anxious while the nurse is going over discharge information including prescriptions the nurse should write them down after placing pt in restraints the nurse should check capillary refill describe stage Il pressure ulcer shallow open ulcer with pink wound bed what is a natural laxative warm prune juice you are going to bathe a pt with hepatitis A and hepatic encepholapathy the nurse should wear gloves because Hep A is very contagious what is proper way to break ampule place gauze over it then break if a hospice pt has diminished blink reflex the nurse should check to see if corneas are dry if aptis having an allergic reaction with anaphylaxis the nurse should give diphenhydramine if a pt is on Naproxen (anti- inflammatory) and after 3 weeks no relief what should happen next another type of nonsteroidal anti-inflammatory will be prescribed decrease of lean body mass in older adults effects distribution of medications when a ptis taking digoxin for congestive heart failure the nurse must monitor Nursing review comprehensive potassium levelwhen should a trough level be taken to be administered immediately before next dose what are signs of thyroid hormone toxicity tachycardia chest pain salicylate (aspirin) toxicity can cause tinnitus (ringing in ears) the pt should notify dr immediately ‘what instructions should you give a female who is prescribed Flagyl for trichomonas increase fluid intake avoid alcohol use condoms til treatment is complete sexval partner treated at same time take with food what are the expected side effects for nitrates used to treat angina orthostatic hypotension (make sure to tell pt not to get up to quickly) sublingual nitroglcerin treats acute anginal attacks (chest pain) when a ptis prescribed niacin (niaspan) for hyperlipedema the must known to expect flushing of face and neck Ifa pt had a liver transplant and is taking cyclosporine they should report what to their dr. hand tremors when pt taking spironolactone (aldactone) for heart failure itis important that they refrain from what eating foods high in potassium since this is a potassium sparing drug what can an overdose of tylenol cause liver damage and abdomen pain hypokalemia affects myocardial contractility and places pt at risk for dysrythmias digoxin is given for onset of wnat supraventricular tachycardia Nursing review comprehensivept admitted to er with acute status asthmaticus, they should be given meds in what order albuterol salmeterol prednisone gentamicin when pts on ARC-C for chemo the nurse should assess oral mucosa for ulcerations an adverse effect of ampicillin for a sinus infection is a rash narcan is a narcotic antagonist that reverses respiratory distress what should you advise a pt to do when taking Fosomax for ‘osteoporosis take med walk 30 mins eat breakfast what should be monitored when a pt pt/inr is taking Warfarin which route has greatest first pass oral effect when taking opioids the pt should not benzos take restlessness ‘demerot through IV should be irritability decreased if what symptoms of confused toxicity is present says bugs are crawling on them the emergency drug dobutamine treats what heart failure how long before departure should a pt apply tranderm scop patch for motion sickness Nursing review comprehensive hours,heparin is prescribed for prevention of blood clots ‘what ids the treatment for tumor induced spinal cord compression decadron ppt with parkinsons dx taking carbidopa-tevodopa will have less tremors before initiating the PCA pump the nurse must assess rate and depth of respirations vitamin C increases the absorption of iron tinnitus is a sign of system toxicity when should sun screen be applied 30 min before exposure to sun absorption of corticosteroid cream for eczema is higher on what parts of the body scalp, axilla, face, neck, perineum (anus area), genitalia myleran which treats leukemia can increase uric acid level when giving potassium the nurse should know always use pump always dilute with normal saline monitor for phelbitis monitor urine output topical burn cream sulfamylon can cause hyperventilation what must be checked when apt is receiving isotretinon for acne triglycerides (do not take with vitamin A) to determine BSA you must get pts what Nursing review comprehensive height and weightbleomycin the cancer drug effects what organ lungs when pts are prescribed antineoplastic meds they need to check with dr before receiving what Immunizations the cancer drug for ovarian cancer Vincasar effects pheripheral neuropathy pts with breast cancer are given tomoxifen, what is its primary action competively binds to estrogen receptors on tumors and other tissue targets (increases calcium,cholestrol and triglyceride levels) signs of IV extravasation redness swelling slow infusion with extravasation the nurse should stop infusion notify dr apply ice or heat Prepare antidote when pt with breast cancer is taking cyclophosphamide it is important to teach them: increase fluid 2000-3000m\/day do not take with food do not increase potassium pt with non hodgkins is receiving Daunoxome the adverse side effect of this drug is crackles in lungs byette is for what type of DM only type lll viagra should never be taken if a pt is taking nitroglycerin pt taking methimazole (tapazole) for Nursing review comprehensive take with foodwhat does pancrelipase therapy do reduce stealorrhea (fatty stools) carafate is a gastric protectant and should be taken Thr before meals and at bedtime chronic use of NSAIDs cause constipation gastric mucosal injury helicobacter pylori infection is treated how with2 antibacterial meds (ills bacteria) | proton pump inhibitor nexium or prevacid (decreases acid production) histamin receptors that treat heartburn are axid zantac pepcid tagament Questran is used to lower cholestrol but taste awful nurse should advice to take with flavor products mucinex needs to be taken with a full glass of water with opioid overdose the nurse should naloxone hydrochloride have resuscitation equipment available benadryl should be taken with food or milk pt taking accolate for bronchial asthma should have which tabs monitored Lt terbutaline for bronchitis should be used in caution if pt has what conditions DM (it increases blood sugar) seizures hypertension hyperthyroidism decrease heart function isoniazi¢ therapy is hepatotoxic what sign should be reported immediately jaundice Nursing review comprehensivetheophyline is a bronchodilator pt be taught to limit what foods coffee pop chocolate pt complains of dizziness after receiving procainamide for cardiac dysrythmia the nurse should first ausculate apical pulse and get B/P normal APTT 60-80 sec hydrochlorothiazide is a thiazide hypokalemia diuretic sulfa based what should nurse hyeralycemia monitor sulfa alleray the diuretic bumetanide if given for heart failure how do you know itis working increase urine output what is antidote for heparin protamine sulfate pt with BPH has a cold and is unable to void nurse should check to see if pt on decongestive because it can cause urinary retention ppt with UTI is taking Macrodantin reports cough, chills, fever, and difficulty breathing what should nurse do stop medication because pt Is experiencing pulmonary reaction urechotine is given for urinary retention itis important for nurse to monitor for Urinary strictures bradycardia (SIGN OF OVERDOSE) sign of toxicity from oxybutynin chloride used for neurogenic bladder is restlessness what would you see in a cholinergic crisis Nursing review comprehensive temporary worsening conditionwhat does miotic meds for glaucoma do constricts pupil and decreases eye pressure when given cipro thru IV how tong should it be infused slowly over 60 min pt with chronic renal disease is given Epoetin to reverse anemia what lab valve tells you itis working hematocrit between 30-33 % lasix is a diuretic which decreases electrolytes what should be monitored potassium, sodium chloride herb feverfew effects blood clotting pt on zithromax for chlamydia should notify dr if yellow sclera (eyes) pt has GERD taking prevacid for lwk report no change nurse should advise it takes several weeks to work radioactive iodine is taseless, colorless administered by dr. monitor for thyroid storm iron should be taken before breakfast with vitamin © pt has schizophrenia taking Risperdal fever should notify dr of following sweating symptoms tachycardia allopurinol is an anti-gout med that decrease uric acid placing ear drops in kids ear the nurse should Nursing review comprehensive pull down and backrelrovir slows what down but doesnt HIV cure it when pt has a clot their INR must be 23 what pt on Etanercept for rheumatoid wec arthritis what labs should be platlets monitored rt sided heart failure causes edema Ut sided heart failure causes crackles why is lactated ringers used MVA and burn pts. to build blood volume up quickly aspirin and non steroidal anti inflammatory drugs interact with what herbal med ginkgo DDAVP given internasally itis important to teach pt take at bed time causes runny nose what does glucocorticoid therapy do to skin bruises easily if skin is thin, tears easity when should nurse hold digoxin if apical pulse less then 60, masklike expression and infrequent blinking are signs of Parkinsons when pt has pen rose drain before choosing room the nurse should find ‘out what. if they have an infection what is earliest sign of diabetic nephropathy in pt with DM microalbuminuria Nursing review comprehensivepts with alcohol related liver disease should not take sedatives like phenobarbitol number | cause COPD smoking ‘when pt has scleraderma and needs to be placed in a room what type room would nurse choose one that stays warm signs pacemaker failure dizzines change in puise most important priority for a pt admitted with kidney stones is strain urine parkinson pts sometimes feel rooted, frozen in | spot chest tube not draining what is first check for kinks priority when pt with tumor lysis syndrome is, glucose receiving IV infusion with insulin the potassium nurse should monitor pt wth NG tube starts coughing moderate amount white sputum the nurse should stop tube feed sign of aspiration pls that have total laryngectomy should carry a medical alert card stating that they are a total neck breather nausea, vomiting and dehydration can BUN increase which lab value pt with decreased blood supply will dark urine have the following symptoms absent/weak pedal pulses Nursing review comprehensivedigoxin toxicity signs nausea vomiting anorexia headache if atornado warning is in effect what should nurse do move all pts/visitors to hall and close all doors neurogenic bladder = infection what Is normal to see in urine in the slight protein ria (pus) elderly Byuria (ous) bacteruria what will you see in a pt with CKD hypOcalcemia when pt is DM and needs surgery but has to be NPO how should nurse. handle insulin regular subQ per sliding scale how does a nurse check for pulmonary embolism listen to lung sounds confusion signs of pneumonia in elderly is . tachycardia where is elderly center of gravity torso pt on lasixs for cardiac disease you Uwave will see a change in what wave on ECG pts that have angle closure glaucoma dilate pupils should not take medications that what is highest priority for older pt admitted with new onset of cardiac dyrhythmia risk of injury 6/t confusion syncope (dizziness) Nursing review comprehensivemycostatin is an antifungal for infection in the mouth how should pt take hold in mouth for a few seconds before swallowing reason for oral care for a pt scheduled for esophagogastromy due to esphageal cancer is prevent infection pt with small bowel obstruction develops fever the nurse should notify dr maybe peritonitis pulmonary embolisms are a risk for people who had the following? signs abdomen surgeries pale grabs chest diaphoretic (sweating) ‘when suctioning a trach you should hyperventilate insert tl you feel resistance or pt coughs pt with genital herpes the nurse should teach annual pap take antiviral meds use condoms warm sitz bath for itching pt has ileostomy and is being discharged nurse should get him to attend ostomy support group schedule II opioids can decrease what oz 2vitals signs respiration what causes jaundice that increases alcoholism amylase and lipase obstructive cholelithiasis ifa pt with acute diverticulitis has 2 hard and rigid abdomen and increase WBCs the nurse should notify dr may be peritonitis which is a medical emergency when should trach cuff be inflated just before feeding to block to block trach and prevent food from entering trach Nursing review comprehensiveif a pt goes into ventricular fibrillation which Is life threatening the nurse should immediately start CPR when a pt has flail chest the nurse should encourage pt to cough and deep breath to prevent atelectasis if a NG tube has no drainage in 2 hrs and pt feeling nauseated the nurse should Ist reposition on side pt with gun shot wound bleeding heavy to maintain B/P the nurse shout place in supine position ( face up,flat on back) when you have alist of pts which one should always be assessed first pt on morphine because it causes respiratory depression pt with CHF and AFib has ventricularectopy what should nurse do increase 02 flow to promote 02 to myocardium pt with cirrhosis develops ascites and ‘edema the nurse should restrict salt restrict fluid intake when should ileostomy bags be changed when seal is broken if chest tube has tidaling the nurse should notify dr before removal Diabetic pt with gangrene on foot, the nurses goal is to prevent infection staffing needs determined by average daily census basilar skull fractures place pt at high risk for Infection to the brain nurse Nursing review comprehensive temperaturecorrect hand placement for CPR just above xiphoid on lower 3rd sternum Roferan A and Ribavirin for hepatitis C both can cause severe depression if ICU pt has clear breath sounds but distended jugular vein, muffled heart sounds the nurse should prepare pt for pericardial tap what can help reduce the risk for cancer switch to skim milk. pt with Huntingtons disease is at high risk for aspiration how should oral care be performed with as little fluid as possible what are the signs of hyperglycemia in older adults infection fatigue sensory changes pt with an Av shunt has no thrill or bruit and is scheduled for dialysis the nurse should notify dr immediately sign it may be obstructed fa ptis having PVCs the nurse should Increase 02 flow pt with radioactive seed implants to treat cancer must follow what exposure precautions pt with cushings syndrome must have what monitored by nurse daily glucose because this disease leads to DM ‘what is first indication of neurological deterioration change or decrease in LOC Nursing review comprehensivept comes into er with acute diverticulitis the nurse should immediately place on NPO because they are at risk for peritonitis intestinal obstruction (may need surgery) pt has high B/P and on meds, the nurse takes the B/P and it is normal what should nurse due with medication that is due now administer them because they are achieving the desired outcome early signs of shock are skin pale,cool, moist, restless, pt ust diagnosed with Hepatitis B the nurse should determine if all employees had their Hep B vaccination ‘apt that is a chronic alcoholic will effect what lab value they will have hypOmagnesium what should nurse teach pt at risk for ‘osteoporosis avold smoking & alcohol weight bearing exercise home safe plan to prevent falls foods to help decrease obesity fruits & veggies lean meat fish whole grain low fat dairy to treat a pt with uncontrolled AFIB IS By SYNCHRONIZED CARDIOVERSION potassium should never be given if urine output is what 20 respi acicic (lots gastric acid) alkalosis too lil gastric acid) with tumor lysis what should be glucose monitored potassium when suctioning a pt what pressure 80-120 mmhg should be used WHAT IS ROUSSEAU SIGN CARPAL SPASMS (INDICATES HYPOGLYCEMIA) what can a neurogenic bladder cause infection cause the urine is stagnate what is cardiac tamponade collection of fluid in pericardial sac signs of cardiac tamponade jugular vein distention muffied heart sounds decreased cardiac output what is treatment for cardiac tamponade pericardial tap cushings dx is hypersecretions of glucocorticoids in adrenal cortex pt with cushings monitor what glucose levels Nursing review comprehensivept with head trauma has a sudden unilateral pupil dilation and its nonreactive the nurse should call dr immediately sign of increase intercranial pressure common side effect for methotrexate (mexate) which is a immunosuppressant IS BONE MARROW DEPRESSION what is sign of trigeminal neuralgia sudden stabbing pain over lip, and chin area tidalig in a chest tube canister shows unresolved pneumothorax (collapsed lung) pt on ventilator taking Vecuronium impaired communication (because relaxes muscles) barrel chest signs emphysema rail bed clubbing fatigue morphine shouldnt be given to pts asthma diagnosed with signs cystic fibrosis steatorrhea ( fatty feces) foul smelting stools delayed growth wt loss pulmonary congestion after a cleft lip repair what position should pt be placed upright to prevent aspiration what is juvenile rheumatoid arthritis joint inflammation that impaired mobility symptoms of meningitis headache fever what stage are children age 4 to 5 initiative vs guilt Nursing review comprehensive‘what should be taught to pt dx with encopresis no dairy ho mineral oll, inctease fluids increase fiber when is intercostal retractions noticeable on inspiration apt with down syndrome (trisomy 21) usually also have heart disease systolic murmur ‘what is a indicator of congenital heart defect diminished femoral pulses normal tympatic membrane in ear is pearly grey not bulging moves when puff air blown on it ‘what Is initial symptom in a infant with HIV persistent coughing pt with polycythemia (abnormal increased amount hemoglobin) the nurse should hydrate to decrease the abnormal high number RBCs and reduce risk DVT classic sign of pyloric stenosis is, projectile vomiting ‘common symptoms of leukemia pallor bone pain due to leukemia invading bones how long should milwaukee brace (used for scoliosis) be worn 23 hours a day what is #1 priority when inserting NG. tube into infant monitor heart rate if pt having a hypercyanotic spell the Nursing review comprehensive place in knee chest position to restore hemodynamicwhat age group are possessive with 2 year olds thelr toys what age group are aggressive and 4 year olds loves to tell stories celiac crisis is severe diarrhea what should nurse check Ist mucus membranes skin turgor acquired plastic anemi caused from is usually certain drugs anterior fontanel closes when posterior closes 12-18 months 2 months signs of mag sulfate toxicity are urine output <100mt ind h respirations <12 absent DTR (deep tendon reflex) infant with hydrocephalus the nurse should reposition head frequently because it grows at abnormally quick rate ‘what is subinvolution retained placental fragments how do u collect urine from 6 month old place urine collection device on perineum what are worsening signs of preeclampsia blurred vision headache pt with possible ectopic pregnancy the nurse should monitor apical pulse because indicator of hypOvolemic shock what should nurse know about impetigo Nursing review comprehensive appears hands & face contagious common humid weather ‘may show up in broken skin(bug bites)how should pt be positioned after imperforated anus surgery prone or side lying with legs flexed ‘what can cause glomerulonephritis strep ask pt if they have had a sore throat ‘where is the best place to check for jaundice nail beds what is evitable abortion one that can not be prevented septic abortion is has odor, fever , and bleeding 2nd stage of labor is complete cervix dilation to birth ‘when pts at home with preeclampsia the home nurse must monitor for fetal movement if infant has TB how long with they have to take Rifampin (ritadin) 9 months Priority problem for a child with severe edema from nephrotic syndrome risk for skin breakdown partum d fatigue signs post partum depression fans post partum asp tiredness PROPER PPE FOR MEASLES AND MASK RUBEOLA, Gloves ‘when using ventilation bag on child what is the rate 40-60breaths/min symptoms respiratory distress syndrome: Nursing review comprehensive tachypnea (rapid breathing) nasal flaring cyanosis retractionsnormal respirations for infant 30-60breaths/min if breast infant has hyperbilirubinemia(too much bilirubin in blood) what should be done Increase frequency of breastfeeding pt with preeclampsia at 34 wis is receiving mag sulfate what does nurse need to assess signs of labor appropriate family centered care techniques allow allow for parents to make choices provides time for partner to ask questions sign & symptoms of mastitis breast tenderness ‘warmth in breast redness pie shaped flu like symptoms positive signs pregnancy fhe visualization of fetus fetal movement 14 yo in ICU for spinal cord injury, nursing care should include monitor B/P monitor respirations administer corticosteroids homeless women at high risk for TB Anemia chlamydia alcoholism hypOthermia what is included in a health hx review of systems sexual hx. nutritional assessment family hx. advantages of fibercast versus plaster cast drys faster Nursing review comprehensive