NCLEX Study Guide 5

Take iron elixir with juice or water but never with...

milk

Kawasaki's leads to

cardiac problems

Dilantin TPR

D: 10-20

Theophyline TPR

T: 10-20

Acetaminophen TPR

A: 10-20

Digoxin TPR

0.5-2.0

Lithium TPR

0.5-1.5

Osteomyletitis is an infectious bone disease

Give blood cultures and antibiotics, then if necessary surgery to drain abscess

Nephrotic syndrome s/s edema + hypotension

Turn and reposition (risk for impaired skin integrity)

To access role relationship pattern focus on...

image and relationships with others

Renal impairment

serum creatinine elevated and urine clearance decreased

Norm. Serum creatinine

0.8-1.8 (men), 0.5-1.5 (women)

Norm. Urine clearance

85-135

Atropine Overdose

Hot as a Hare (Temp), Mad as a Hatter (LOC), Red as a Beet (flushed face) and Dry as a Bone (Thirsty)

Hemoglobin: Neonates

18-27

Hemoglobin: Neonates 3 m/o

10.6-16.5

Hemoglobin: Neonates 3 yrs

9.4-15.5

Hemoglobin: Neonates 10yrs

10.7-15.5

Glomerulonephritis

take vs q 4 hrs + daily weights

Age 4 to 5 yrs child needs

DPT/MMR/OPV

Cystic Fibrosis give diet...

low fat, high sodium, fat soluble vitamins A,D,E,K. Med:Aerosal bronchodilators, mucolytics and pancreatic enzymes

Airborne Precautions

measels, chicken pox and TB. private room, negatvie pressure w/ 6-12 air exchanges, Mask N95

Droplet Precautions

sepsis, scarlet fever, streptococcal pharyngitis, parovirus B19, pnuemonia, pertusis, influenza, diptheria, epiglottis, rubella, mumps, meningitis, mycoplasma and adenovirus. Door open, 3 ft distance, private room or cohort, mask

Contact Precautions

multidrug resistant organism; respiratory, skin, wound enteric and eye INFECTIONS

Zoloft (Selective Serotonin Reuptake Inhibitor (SSRI) It can treat depression, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), social anxiety disorder, and panic disorder) s/e

agitation, sleep disturb, and dry mouth

Clozapine (2nd gen antipsychotic/ atypical antipysch. It can treat schizophrenia. It can also lower the risk of suicidal behavior in patients with schizophrenia or schizoaffective disorder) s/e

agranulocytosis, tachycardia and siezures

Blood tests for MI

Myoglobin, CK and Troponin

Salt substitutes may contain

potassium

Placental abruptio

bleeding with pain, don't forget to monitor volume status (I&O)

An ill child regresses in

behavior

Meningeal irritation (A condition marked by headache, fever, and a stiff neck, which is caused when the meninges (three thin layers of tissue that cover and protect the brain and spinal cord) become irritated) S/s

nuchal rigidity, positive Brudzinski + Kernig signs and PHOTOPHOBIA too!

Babinski sign

toes curl great! toes fan bad

Glucose Tolerance Test

for pregnant women... result of 140 or highter needs further evaluation

Assessing extraocular eye movements check

cranial nerves 3, 4, and 6

Stomas

dusky stoma means poor blood supply, protruding means prolapsed, sharp pain + rigidity means peritonitis, mucus in ileal conduit is expected

Dilantin s/e (Anticonvulsant It can treat and prevent seizures)

rash (stop med), gingival hyperplasia (good hygiene) toxicity--\>poor gait + coordination, slurred speech, nausea, lethargy, and diplopia

Phenobarbital can be taken during pregnancy but not...

Dilatin is contraindicated

Incentive Spirometry

steps:1) Sit upright 2) Exhale 3) Insert mouthpiece 4) Inhale for 3 seconds, and then HOLD for 10 seconds

Aminoglycocide (treatment of severe infections of the abdomen and urinary tract, as well as bacteremia and endocarditis)

(__Mycin ; except erythromycine) Adverse Effects are bean shaped - Nephrotoxic to Kidneys and Ototoxic to Ears

MRSA-Methicillin-resistant Staphylococcus aureus

Contact precaution ONLY

VRSA-Vancomycin-Intermediate/Resistant Staphylococcus aureus

Contact AND airborne precaution (Private room, door closed, negative pressure)

LITHIUM

L-level of therapeutic affect is 0.5-1.5 I-indicate mania T-toxic level is 2-3 - N/V, diarrhea, tremors H-hyrdrate 2-3L of water/day I-increased UO and dry mouth U-uh oh; give Mannitol and Diamox if toxic s/s are present M-maintain Na intake of 2-3g/day

Sympathetic nervous system (SNS)

Increase in BP, HR and RR (dilated bronchioled), dilated pupils (blurred vision), Decreased GUT (urniary retention), GIT (constipation), Constricted blood vessels and Dry mouth.

Blood transfusion- sign of allergies in order:

1)Flank pain 2)Frequent swallowing 3)Rashes 4)Fever 5)Chills

Thrombocytopenia -Bleeding precautions!

1)Soft bristled toothbrush 2)No insertion of anything! (c/i suppositories, douche) 26 3)No IM meds as much as possible!

Iron deficiency anemia - easily fatigued

1)Fe PO - give with Vitamin C or on an empty stomach 2)Fe via IM- Inferon via Ztrack

Pernicious Anemia

Red, Beffy tongue; will take Vit.B12 for life!

Burn 1st degree

Red and Painful

Burn 2nd degreee

Blisters

Burn 3rd degree

No pain b/c of blocked and burned nerves

Meniere's Disease (An inner ear disorder that causes episodes of vertigo (spinning))

Admin diuretics to decrease endolymph in the cochlea, restrict Na, lay on affected ear when in bed. Triad: 1)Vertigo 2)Tinnitus 3)N/V

Gastric Ulcer pain

occurs 30 minutes to 90 minutes after eating, not at night, and doesn't go away with food

What is an intraosseous infusion?

In pediatric life-threatening emergencies, when iv access cannot be obtained, an osseous (bone) needle is hand-drilled into a bone (usually the tibia), where crystalloids, colloids, blood products and drugs can be administered into the marrow. It is a temporary, life-saving measure, and I have seen it once! (Gruesome.) When venous access is achieved it can be d/c’d. One medication that cannot be administered by intraosseous infusion is isoproterenol, a beta agonist.

During sickle cell crisis there are two interventions to prioritize

fluids and pain relief

With glomerulonephritis you should consider blood pressure to be your most important assessment parameter. Dietary restrictions you can expect include

fluids, protein, sodium, and potassium

congenital cardiac defects result in hypoxia which the body attempts to compensate for (influx of immature rbc’s) Labs supporting this would show

increased hematocrit, hemoglobin, and rbc count

School-age kids (5 and up) are old enough, and should have

an explanation of what will happen a week before surgery such as tonsillectomy

If you gave a toddler a choice about taking medicine and he says no, you should

leave the room and come back in five minutes, because to a toddler it is another episode. Next time, don’t ask

The first sign of pyloric stenosis in a baby is

mild vomiting that progresses to projectile vomiting. Later you may be able to palpate a mass, the baby will seem hungry often, and may spit up after feedings.

We know Kawasaki disease causes a heart problem, but what specifically?

Coronary artery aneurysms d/t the inflammation of blood vessels.

A child with a ventriculoperitoneal shunt will have a small upper-abdominal incision

This is where the shunt is guided into the abdominal cavity, and tunneled under the skin up to the ventricles. You should watch for abdominal distention, since fluid from the ventricles will be redirected to the peritoneum. You should also watch for signs of increasing intracranial pressure, such as irritability, bulging fontanels, and high-pitched cry in an infant. In a toddler watch lack of appetite and headache. Careful on a bed position question! Bed-position after shunt placement is flat, so fluid doesn’t reduce too rapidly. If you see s/s of increasing icp, then raise the hob to 15-30 degrees

What could cause bronchopulmonary dysplasia?

Dysplasia means abnormality or alteration. Mechanical ventilation can cause it. Premature newborns with immature lungs are ventilated and over time it damages the lungs. Other causes could be infection, pneumonia, or other conditions that cause inflammation or scarring.

It is essential to maintain nasal patency with children < 1 yr. because

they are obligatory nasal breathers

MMR and Varicella immunizations date

15 months

testis or cryptorchidism is a known risk factor for testicular cancer later in life...intervention

Start teaching boys testicular self exam around 12, because most cases occur during adolescence

No aspirin with kids b/c it is associated with Reye’s Syndrome (A rare but serious condition that causes confusion, swelling in the brain, and liver damage), and also no nsaids such as ibuprofen...instead give

Give Tylenol

CSF in meningitis will have

high protein, and low glucose

No nasotracheal suctioning with

head injury or skull fracture

Feed upright to avoid

otitis media

Pull pinna down and back for kids < 3 yrs. when instilling

eardrops

Kids with RSV

no contact lenses or pregnant nurses in rooms where ribavirin is being administered by hoot, tent, etc.

Positioning with pneumonia

lay on the affected side to splint and reduce pain. But if you are trying to reduce congestion the sick lung goes up

A positive ppd (Mantoux test is a tool for screening for tuberculosis) confirms

confirms infections, not just exposure

A sputum test will confirm

active disease

Coughing w/o other s/s is suggestive of

asthma. Speaking of asthma, watch out if your wheezer stops wheezing. It could mean he is worsening.

You better pick ‘do vitals’ before administering that

dig. (apical pulse for one full minute).

Tet spells (tetralogy of fallot-activities that change the pressure in your baby's heart and increase the flow of oxygen-poor blood to their body) treated with

morphine

Group-a strep precedes rheumatic fever

Chorea is part of this sickness (grimacing, sudden body movements, etc.) and it embarrasses kids. They have joint pain. Watch for elevated antistreptolysin O to be elevated. Tx Penicillin!

Don’t pick cough over tachycardia for signs of

chf in an infant

No milk (as well as fresh fruit or veggies) on

neutropenic precautions

Tylenol poisoning

liver failure possible for about 4 days. Close observation required during this time-frame, as well as tx with Mucomyst.

Radioactive iodine

The key word here is flush. Flush substance out of body w/3-4 liters/day for 2 days, and flush the toilet twice after using for 2 days. Limit contact w/patient to 30 minutes/day. No pregnant visitors/nurses, and no kids.

The main hypersensitivity reaction seen with antiplatelet drugs is

bronchospasm (anaphylaxis)

Common sites for metastasis (cancer cells break away from the original (primary) tumor, travel through the blood or lymph system, and form a new tumor in other organs or tissues of the body) include the

liver, brain, lung, bone, and lymph

Orthostasis (A form of low blood pressure that happens when standing up from sitting or lying down)is verified by a drop in

drop in blood pressure with increasing heart rate

Bence Jones protein in the urine confirms

multiple myeloma

Don’t fall for ‘reestablishing a normal bowel pattern’ as a priority with small bowel obstruction b/c

the patient can’t take in oral fluids ‘maintaining fluid balance’ comes first

Pernicious anemia s/s

pallor, tachycardia, and sore red tongue

With flecainide (Tambocor), an antiarrythmic, limit fluids and sodium intake, because

sodium increases water retention which could lead to heart failure

Basophils release histamine during

during an allergic response

Adenosine (Antiarrhythmic It can treat irregular heartbeats (arrhythmias). It can also be used during a heart stress test)

treatment of choice for paroxysmal atrial tachycardia

Iatragenic means it was caused by

treatment, procedure, or medication

G-tube and J-tube feedings are usually given as

continuous feedings

Four side-rails up

can be considered a form of restraint. Even in LTC facility when a client is a fall risk, keep lower rails down, and one side of bed against the wall, lowest position, wheels locked.

Your cancer patient is getting radiation. What should you be most concerned about? Skin irritation?

No. Infection kills cancer patients most because of the leukopenia caused by radiation.

A breast cancer patient treated with Tamoxifen should report changes in

visual acuity, because the adverse effect could be irreversible

Pneumovax 23

gets administered post splenectomy to prevent pneumococcal sepsis

Let’s say every answer in front of you is an abnormal value. If potassium is there...

you can bet it is a problem they want you to identify, because values outside of normal can be life threatening. Normal potassium is 3.5-5.0. Even a bun of 50 doesn’t override a potassium of 3.0 in a renal patient in priority.

You better be making sure that patient on Dig and Lasix is getting enough

potassium, because low potassium potentiates Dig and can cause dysrrhythmias.

You will ask every new admission if he has

an advance directive ( legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes), and if not you will explain it, and he will have the option to sign or not