NURSING NCLEX Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank, Exams of Nursing

Download NURSING NCLEX Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank and more Exams Nursing in PDF only on Docsity! NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Acetaminophen (Tylenol) is what type of drug? What is the maximum recommended dosage? What should you monitor? - AMSNonopioid Analgesics. Max dose: 4000 mg (4 g) in 24 hrs Monitor liver function Aldosterone attracts what? - AMSSodium aminoglycosides (mycins) - AMS Angiotensin II in the lungs is a potent? - AMSvasodialator At what pain level should an Opioid Analgesic be considered? - AMSPain level of 6 or greater. Opioids are used for moderate to severe pain. Define fluid volume excess: Hypervolemia - AMStoo much fluid in the vascular space (first). Vascular equals the vessels --> veins, arteries, capillaries, heart chambers, etc. DO NOT delegate what you can EAT - AMSE = evaluate A = assess T = teach EPI is always given in what type of syringe - AMSTB syringe HIV Nursing and Collaborative Management includes... - AMS- Monitor disease progression and immune function -Initiate and monitor (ART) antiretroviral therapy: to decrease viral load and increase T cell count -prevent development of opportunistic diseases -detect and treat opportunistic diseases -manage symptoms -prevent or decrease complications of treatment -prevent transmission of HIV How do you convert Centigrade to Fahrenheit - AMSC+40, multiply 9/5 and subtract 40 How do you convert Fahrenheit to Centigrade - AMSF+40, multiply 5/9 and subtract 40 How do you test for the Chvostek sign and what happens if there is a positive response? - AMSElicitation: Tapping on the face at a point just anterior to the ear and just below the zygomatic bone Postitive response: Twitching of the ipsilateral facial muscles, suggestive of neuromuscular excitability caused by hypocalcemia How do you test for the Trousseau's sign and what happens if there is a positive response? - AMSElicitation: Inflating a sphygmomanometer cuff above systolic blood pressure for several minutes Positive response: Muscular contraction including flexion of the wrist and metacarpophalangeal joints, hyperextension of the fingers, and flexion of the thumb on the palm, suggestive of neuromuscular excitability NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. caused by hypocalcemia How do you treat fluid volume deficits? - AMSStrict I&O Replace with isotonic fluids monitor Bp weight daily How does atrial natriuretic peptide (ANP) work? - AMSIt is the opposite of aldosterone, so it causes excretion of Nas and H2O How often is nitroglycerine administered and when should you not give it? - AMSup to 3 times (every 5 minutes) do not give when BO is less than 90/60 How should you address questions related to Maslow's Hierarchy of Needs - AMSAddress physiological needs first, followed by safety and security needs, love and belonging needs, self esteem needs and finally self actualization needs. *When a physiological need is not addressed in the question, look for the option that addresses safety. How would you treat fluid volume excess? - AMSGive Diuretics (Lasix), fluid restrictions, weigh daily, monitor K+ If a question is related to the nursing process, read the question to determine the step of the nursing process. What are the steps in the nursing process and what kind of question might be related to that step. - AMSAssessment question address the gathering and verification of data. Analysis questions require the nurse to: interpret data, collect additional information, identify and communicate nursing diagnoses and determine the health team's ability to meet the pts needs. Planning questions ask about determining, prioritizing, and modifying outcomes of care. Implementation questions reflect the management and organization of care and the assignment and delegation of tasks. Be prepared for questions on client teaching. Evaluation questions focus on comparing the actual outcomes of care with the expected outcomes and on communicating and documenting findings. If PVC's are left untreated what can it lead to? - AMSVentricular fibrillation Name 3 Invasive non-pharmacological pain relief techniques. - AMSNerve blocks Interruption of neural pathways Acupuncture Name 3 types of IV fluids - AMSIsotonic: 0.9% NS, LR, and D5w Hypotonic: 0.5% NS, 0.45% NS Hypertonic: d5 0.45% NS, D5LR, D5NS Name 4 types of Nonopioid Analgesics - AMS1. Acetaminophen: Tylenol 2. Salicylates: Aspirin, Trilisate 3. NSAIDS: ibuprofen, Indomethacin, Ketorolac, Diclofenac 4. COX-2 inhibitors: Celebrex Name 5 non-invasive non-pharmacological pain relief techniques (1st choice of pain relief) - AMSTen's NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What are the normal ranges for ABGs? (pH, pCO2, HCO3) - AMSpH (AC) 7.35-7.45 (AL) pCo2 (AL) 35 - 45 (AC) HCO3 (AC) 22 - 26 (AL) What are the normal ranges for ALP (alkaline phosphatase)? - AMS30-120 slightly increased in the elderly What are the normal ranges for BUN? What does BUN stand for? What is the ratio of BUN-creatinine? What does it indicate? - AMS10-20 blood urea nitrogen BUN-creatinine ratio of 20:1 indicates adequate kidney functioning What are the normal ranges for Ca+? What type of drug can increase calcium levels? What are two tests with positive results that are associated with hypocalcemia? How do you preform the two tests? - AMS9-10.5 for adults. slightly lower in the elder Use of thiazide diuretics can cause increased levels of calcium Positive Chvostek and Trousseau tests are associated with hypocalcemia. • Chvostek sign: contraction of ipsilateral facial muscles when the facial nerve is tapped just in front of the ear. • Trousseau sign: carpopedal spasm elicited by inflating a sphygmomanometer above systolic BP for 3 minutes. What are the normal ranges for Cl- - AMS98-106 is the normal range for chloride What are the normal ranges for Creatinine? What is the ratio of BUN-creatinine? What does it indicate? - AMSMale 0.6-1.2 Female 0.5-1.1 BUN-creatinine ratio of 20:1 indicates adequate kidney functioning What are the normal ranges for H&H? What are the nursing implications - AMSHemoglobin - Male 14-18 Female 12-16 Newborn 14-24 High altitude living increases value, slight decrease during pregnancy. Drug therapy can alter values. Hematocrit - Male 42-52 Female 37-47 Newborn 44-64 Prolonged stasis from vasoconstriction secondary to the tourniquet can alter values. Abnormalities in RBC size may alter Hct values What are the normal ranges for INR? What type of patients should have individualized values What should the values be for those patients? - AMS0.8-1.1 normal INR Individualized values for pts with: NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Afib and DVT between 2.0 and 3.0 mechanical heart valves between 3.0 to 4.0 What are the normal ranges for K+? What should you keep in mind when getting a specimen? - AMS3.5- 5 is normal range for potassium Exercise of the forearm with tourniquet in place may cause an increased level. Hemolysis of specimen can result in a falsely elevated value What are the normal ranges for Mg+? What may high magnesium levels indicate? What may low magnesium levels indicate? - AMS1.7-2.2 A high magnesium level may indicate: Addison disease Chronic renal failure, Dehydration, Diabetic acidosis Oliguria A low magnesium level may indicate: Alcoholism Chronic diarrhea, Delirium tremens, Hemodialysis Hepatic (liver) cirrhosis, Hyperaldosteronism Hypoparathyroidism, Pancreatitis, Too much insulin Toxemia of pregnancy, Ulcerative colitis What are the normal ranges for Na+? What should you consider when collecting a specimen? - AMS136- 145 is a normal sodium range Do Not collect from an arm with an infusing IV solution What are the normal ranges for PLATELETS? What may increase values? What may decrease values? What drugs decrease values? - AMSBoth Genders: 150000-400000 Living at high altitudes, exercising strenuously or taking oral contraceptives may increase values decreased values may be caused by hemorrhage, DIC, reduced production of platelets, infections, use of prosthetic heart valves, and drugs. Drugs that decrease platelets: acetaminophen, aspirin, chemotherapy, H2 blockers, INH, Levaquin, streptomycin, sulfonamides, thiazide diuretics. What are the normal ranges for PT? What is PT used to help regulate? What is the therapeutic range? - AMS11-12.5 is a normal PT range PT is used to help regulate Coumadin dosages. The therapeutic range: 1.5 to 2 times normal or control What are the normal ranges for PTT and aPTT? What do they help regulate? What is the therapeutic range? - AMSnormal range PTT: 60-70 normal range aPTT: 30-40 Both PTT and aPTT are used to help regulate heparin dosages. Therapeutic range is 1.5 to 2.5 times normal or control What are the normal ranges for RBC? What can increase levels What happens to levels during pregnancy? - AMSMales: 4.7-6.1 million NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Female: 4.2-5.4 million Exercise and high altitudes can cause an increase levels pregnancy usually lower values drug therapy can alter values Never draw a specimen from an arm with an infusing IV. What are the normal ranges for WBC? What can increase values? What can decrease values? How long does the postpartum period of pregnancy affect normal ranges? What range is normal during the postpartum period? - AMSBoth genders 5000-10000 Newborn 9000-30000 Anesthetics, stress, exercise, and convulsions can increased values. Drug therapy can decrease values. 24-28 hr postpartum: a count as high as 25000 is normal What are the symptoms of fluid volume excess? - AMSPeripheral edema periorbital edema elevated BP dyspnea ALOC What are the two main hormonal regulations related to fluid volume - AMSAldosterone (steroid, mineralocorticoid) Atrial Natriuretic Peptide (ANP) What can cause a fluid volume deficit - AMSInadequate fluid intake hemorrhage vomiting or diarrhea massive edema What can cause fluid volume excess: Hypervolemia - AMSHeart Failure (HF) where the heart is weak, CO is decreased, the kidneys have decreased perfusion and urinary output is decreased. **The volume stays in the vascular space! Renal Failure (RF) When the kidneys are not working. Medications: alka-seltzer, fleet enema's and IVF with Na. These medications have a lot of sodium causing water retention in the vascular space. What can cause fluid volume excess? - AMSCHF (most common) Renal failure cirrhosis overhydration What diseases are related to too much aldosterone? - AMSCushings and Hyperaldosteronism (Conn's) What does a low residue diet mean? - AMSLow fiber What does criminal law deal with? - AMSRights of individuals and society as defined by legislative laws NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What is required for informed consent to be valid? - AMSthe patient giving consent must be competent and of legal age. The consent is given voluntarily. The patient giving consent understands the procedure, risks/benefits, and alternative procedures. The patient has the right to have all questions answered satisfactorily. It is the duty of the HCP performing the procedure or treatment to obtain informed consent and to answer any questions the patient might have about the procedure. The RN is witnessing the signature not providing informed consent. What is the acronym S-BAR stand for? - AMSIt is a interdisciplinary communication strategy that promotes effective communication between caregivers S = situation - State the issue or problem B = background - provide history A = assessment - most recent VS and current findings R = recommendation - state what should be done What is the antidote for coumadin toxicty - AMSvitamin K What is the antidote for dgioxin - AMSdigibind What is the antidote for heparin toxicty - AMSprotamine sulfate What is the antidote for too much ammonia - AMSlactulose What is the drug of choice for alcohol withdraw - AMSLibrium What is the drug of choice to treat pain in pts who are narcotic addicts - AMSmethadone is an opioid analgesic used to detoxify and treat pain in narcotic addicts What is the medication of choice for a bipolar person - AMSlithium What is the medication of choice for Asystole - AMSatropine What is the medication of choice for CHF - AMSAce inhibitors What is the medication of choice for Status Epilepticus - AMSValium What is the medication of choice for SVT - AMSadenosine or adenocard What is the medication of choice for V tach - AMSlidocaine What is the medication used for anaphylactic shock - AMSEpinephrine What is the relationship of Ca+ and PO4? What is the relationship of Ca+ and pH? - AMScalcium and phosphorus have an inverse relationship: when calcium levels increase, phosphorus levels decrease, and vice versa. pH also affects the level of ionized calcium: As pH rises and blood becomes more alkalotic, calcium binds more easily with protein, causing the level of ionized calcium to drop. Conversely, when pH falls, causing acidosis, less calcium binds with protein, which raises the ionized calcium level NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What lab findings may be present with a fluid volume deficit? - AMSIncreased BUN Increased or normal creatinine Increased H/H Increased urine specific gravity What may be some Lab findings r/t fld volume excess - AMSEverything will be decreased Decreased: BUN, Hgb/Hct, serum osmolality, urine specific gravity and electrolytes What Nationalities have a high risk r/t the development of obesity and diabetes mellitus? - AMSBecause of their health and dietary practices, Native Americans, Latino Americans, Hispanic Americans, and African Americans have a high risk of obesity and diabetes mellitus. Asian Americans have a lower risk for obesity and diabetes mellitus. What routes of transmission are related to HIV exposure - AMS- unprotected sexual contact (most common) - exposure to blood through drug using equipment - perinatal transmission - most common for children - can occur during pregnancy, at the time of delivery, or after birth through breast feeding What should be avoided when a patient is neutropenic? - AMSNo live vaccines no fresh fruit no flowers What should be considered when communicating with a Chinese American? - AMSMost Chinese Americans maintain a formal distance with others, which is a form of respect. Many Chinese Americans are uncomfortable with face-to-face communications, especially when eye contact is direct. If the client turns away from the nurse during a conversation, the best action is to continue with the conversation. Walking around the client so that the nurse faces the client is in direct conflict with this cultural practice. The client may consider it a rude gesture if the nurse returns later to continue with the explanation. Telling the client about the importance of the instructions for the maintenance of health care may be viewed as degrading. What should the nurse do related to advanced medical directives (ADs) - AMSAssess the patients knowledge of advance directives. Integrate them into the patients plan of care Provide the patient with information about advanced directives or review ADs on admission. Have the knowledge that ADs can limit life-prolonging measures when there is little or no chance of recovery What should you know about HIV symptoms - AMS- 1 to 3 weeks; flu like symptoms - 8-10 years for diagnosis May begin with flu like symptoms in the earliest stage and advance to.. - severe weight loss - secondary infections - cancer -neurological disease What should you remember when someone is dealing with death and grief - AMS- Encourage expression of anger NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. - Do not take away the defense mechanism or coping mechanism the person uses in a crisis. - Customs surrounding death and dying vary among cultures. Make every attempt to understand and accommodate the family's cultural traditions when caring for a dying patient. What skills are needed for Supervision - AMSBe able to: give direction/guidance evaluate/monitor following up what type of communication and leadership is it if the person says "do it my way"? - AMSAggressive communication/authoritarian leader What type of communication and leadership is it if the person says "Lets consider the options available."? - AMSAssertive communication/democratic leader What type of communication and leadership is it if the persons says "Whatever...as long as you like me." - AMSPassive communication/laissez-faire leader What type of drug is Aspirin? - AMSNon opioid Analgesic Salicylates Choline magnesium trisaliclate (Trilisate) is another type of non opioid Analgesic salicylates What type of drug will affect afterload - AMSCalcium channel blockers When an opioid is prescribed in combination with a nonopioid analgesic, such as acetaminophen or a NSAID, what should you monitor? - AMSThe daily dose When blood volume gets low (vomiting, blood loss, etc.) what happens to the secretion of aldosterone and what happens because of it? - AMSAldosterone secretion increases which causes a retention of sodium and water which will make blood volume go up or increase. When can restraints be used? What must the nurse do if restraints are used? - AMSRestraints can be used only: to ensure the physcial safety of the patient or other residents, when less restrictive interventions are not successful, and must have a written order of a HCP. The nurse must follow agency policy and procedure to retrain any client, Documentation of the use of restraints and of follow-up assessments must detail the attempts to use less restrictive interventions. Liability for improper or unlawful restraint lies with the nurse and the healthcare facility. 30 min pulse checks, 2 hr ROM, one on one, When can the nurse NOT follow the healthcare provider's prescription and what must they do about it? - AMSNurses MUST follow the healthcare provider's prescription unless the nurse believes that it is in error; that it violates hospital policy; or that it is harmful to the patient. The nurse makes a formal report explaining the refusal. The nurse should file an incident (occurrence) report for any situation that may result in harm to the patient. When introducing foods to infants what should you teach the new parents? - AMSIntroduce one food at a time to help identify allergies. Progression of food should be "AS TOLERATED" The nursing assessment guides decisions about progression. NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Analysis questions require the nurse to: interpret data, collect additional information, identify and communicate nursing diagnoses and determine the health team's ability to meet the pts needs. Planning questions ask about determining, prioritizing, and modifying outcomes of care. Implementation questions reflect the management and organization of care and the assignment and delegation of tasks. Be prepared for questions on client teaching. Evaluation questions focus on comparing the actual outcomes of care with the expected outcomes and on communicating and documenting findings. If PVC's are left untreated what can it lead to? - AMSVentricular fibrillation Name 3 Invasive non-pharmacological pain relief techniques. - AMSNerve blocks Interruption of neural pathways Acupuncture Name 3 types of IV fluids - AMSIsotonic: 0.9% NS, LR, and D5w Hypotonic: 0.5% NS, 0.45% NS Hypertonic: d5 0.45% NS, D5LR, D5NS Name 4 types of Nonopioid Analgesics - AMS1. Acetaminophen: Tylenol 2. Salicylates: Aspirin, Trilisate 3. NSAIDS: ibuprofen, Indomethacin, Ketorolac, Diclofenac 4. COX-2 inhibitors: Celebrex Name 5 non-invasive non-pharmacological pain relief techniques (1st choice of pain relief) - AMSTen's heat and cold application message therapy relaxation techniques guided imagery biofeedback techniques Never IV push what electroylte - AMSK+ Nursing assessment r/t HIV - AMS-Positive result on enzyme-linked immunosorbed assay (ELISA) - CONFIRMED WITH WESTERN BLOT TEST -Polymerase chain reaction (PCR) - used with neonate - OraQuick In-Home HIV Test: positive result is only preliminary; it must be confirmed by a healthcare professional. **Ongoing assessment, interaction with the client, and client education and support are required.*** - NCLEX testing - never choose abstinence, choose educate! Related to mental Health, how long can an involuntary admission last? - AMS72 hours To much CO2 causes what? - AMSvasoconstriction What are low risk therapies - AMSLow-risk therapies are therapies that have no adverse effects and, when implementing care, can be used by the nurse who has training and experience in their use. Low-risk NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. therapies include meditation, relaxation techniques, imagery, music therapy, massage, touch, laughter and humor, and spiritual measures, such as prayer. What are nosocomial infections - AMSInfections acquired as a result of exposure to a microorganism in the hospital setting What are nurses responsible for related to the standards of care? - AMSNurses are responsible for performing procedures correctly and exercising professional judgment when implementing healthcare providers prescriptions. What are some examples of Non-opioid Analgesic pain medications - AMSAcetaminophen (Tylenol) Salicylates: - Aspirin - Choline magnesium trisalcylate (Trilisate) NSAIDs: - Ibuprofen - Indomethacin - Ketorolac - Diclofenac K Cyclooxygenase-2 (COX-2) inhibitors - Celecoxib What are some HIV Medications - AMSNucleoside reverse transcriptase inhibitors (NRTIs) -zidovudine (AZT, ZDV, Retrovir) -lamivudine -abacavir -emtricitabine Nucleotide reverse transcriptase inhibitor (NtRTI) - Tenofovir DF (Viread) What are some symptoms of fluid volume deficit - AMSweight loss oliguria (not enough urine) postural hypotension What are some types of Analgesics (used for moderate to severe pain)? - AMSMu agonists - Morphine - Hydromorphone - Methadone - Levorphanol - Fentanyl - Oxycodone - Codeine (Tylenol No.3) Mixed agonist-antagonists - Pentazocine -Butorphanol Partial agonists - Nuprenorphine -Buprenorphine plus naloxone Adjuvant drugs - used for neuropathic pain - Antiepileptic drugs, antidepressants, and anesthetics are prescribed alone or in combination with opioids for neuropathic pain, NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. - Corticosteroids What are the 3 categories of pain medications - AMS1. non-opioids: for mild pain or in combination for moderate pain 2. Opioids: for moderate to severe pain 3. Co-analgesic or adjuvant drugs (i.e. anticonvulsants, antidepressants) for neuropathic pain What are the 5 stages of grief - AMSDenial, anger, bargaining, depression, and acceptance What are the 7 Rights of medication administration? - AMS1. Right drug 2. right dose 3. Right route 4. Right time 5. Right patient 6. Right documentation 7. Right to refuse What are the five rights of delegation? - AMS1. right task 2. right circumstance 3. right person 4. right direction/communication 5. right supervision What are the goals of HIV drug therapy? - AMS-Reduce the viral load -maintain or raise the CD4+ T cell counts. T cell counts = Normal 800-1200 HIV 500 AIDS below 200 -Delay the development of HIV related symptoms and opportunistic diseases **compliance** What are the normal ranges for ABGs? (pH, pCO2, HCO3) - AMSpH (AC) 7.35-7.45 (AL) pCo2 (AL) 35 - 45 (AC) HCO3 (AC) 22 - 26 (AL) What are the normal ranges for ALP (alkaline phosphatase)? - AMS30-120 slightly increased in the elderly What are the normal ranges for BUN? What does BUN stand for? What is the ratio of BUN-creatinine? What does it indicate? - AMS10-20 blood urea nitrogen BUN-creatinine ratio of 20:1 indicates adequate kidney functioning What are the normal ranges for Ca+? What type of drug can increase calcium levels? What are two tests with positive results that are associated with hypocalcemia? How do you preform the two tests? - AMS9-10.5 for adults. slightly lower in the elder Use of thiazide diuretics can cause increased levels of calcium Positive Chvostek and Trousseau tests are associated with hypocalcemia. NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What are the two main hormonal regulations related to fluid volume - AMSAldosterone (steroid, mineralocorticoid) Atrial Natriuretic Peptide (ANP) What can cause a fluid volume deficit - AMSInadequate fluid intake hemorrhage vomiting or diarrhea massive edema What can cause fluid volume excess: Hypervolemia - AMSHeart Failure (HF) where the heart is weak, CO is decreased, the kidneys have decreased perfusion and urinary output is decreased. **The volume stays in the vascular space! Renal Failure (RF) When the kidneys are not working. Medications: alka-seltzer, fleet enema's and IVF with Na. These medications have a lot of sodium causing water retention in the vascular space. What can cause fluid volume excess? - AMSCHF (most common) Renal failure cirrhosis overhydration What diseases are related to too much aldosterone? - AMSCushings and Hyperaldosteronism (Conn's) What does a low residue diet mean? - AMSLow fiber What does criminal law deal with? - AMSRights of individuals and society as defined by legislative laws What does heparin prevent - AMSplatelet aggregation What does preload affect? - AMSThe amount of blood that goes to the R ventricle What drug is contraindicated in Pancreatitis? What pain medication should be used? - AMSDo not give Morphine for pancreatitis because it causes spasms of the Sphincter of Oddi, give Demerol instead. What happens when a patient has prednisone toxicity - AMSCushing's syndrome, buffalo hump, moon face, high glucose, hpertension What have NSAIDs (except aspirin) been linked to and what type of patient should not take NSAIDs? - AMSNSAIDs (except aspirin) have been linked to a higher risk for increased cardiovascular events, such as myocardial infarction, stroke, and heart failure. Patients who have just had heart surgery should not take NSAIDs. NSAIDs are very hard on the stomach. NO NSAIDs for Cardiac patient. What is a durable power of attorney for healthcare? - AMSThe person appoints a representative (healthcare proxy) to make healthcare decisions in a document What is a Mu agonist? - AMSThe so-called agonist-antagonist drugs have a relationship to the opioid receptors that includes activation and blockade. Some of these drugs activate one type of opioid receptor, known as the kappa receptor, while blocking another, the mu receptor NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What is a sign of a fat embolism and what medication would you give? - AMSpetechiae is a sign of a fat embolism. Treat with heparin What is afterload? - AMSthe resistance that blood has to overcome when leaving the heart What is civil law concerned with? - AMSProtection of the patients private rights What is documented in a living will? - AMSA person documents his or her wishes regarding future care in the event of terminal illness What is HIPPA and what does it require? - AMSHealth Insurance Portability and Accountability Act of 1996 established standards for the verbal, written and electronic exchange of private health information. HIPPA created patient rights to consent to use and disclose health information, to inspect and copy one's medical record, and to amend mistaken or incomplete information. HIPPA requires all hospitals and health agencies to have specific policies and procedures in place to ensure compliance with its standards. What is Hypercalcemia? What signs and symptoms may be present? and how do you treat it? - AMSHypercalcemia is a calcium level above 10.5 mEq/L Calcium affects the muscles, you may see muscle weakness, constipation, n/v, dysrhythmias, and behavioral changes. Limit vitamin D intake but push fluids. Avoid calcium-based antacids. Administer calcitonin to reduce calcium Renal dialysis may be required What is Hyperkalemia, what might you see with the patient and how do you treat it? - AMSHyperkalemia is a K+ level greater than 5 mEq/L You may see tall, tented T waves, bradycardia, muscle weakness. Treatment may include: - 10%-20% glucose with regular insulin - Kayexalate - renal dialysis may be required What is Hypernatremia? What symptoms might you see? How should you treat it? - AMSNa+ greater than 145 mEq/L May see: Pulmonary edema Neuro: seizures, thirst, fever. Do Not Use Ivs that contain sodium Restrict sodium diet Weigh daily What is Hypocalcemia, What might the patient exhibit? How will you treat it? - AMSHypocalcemia is a Ca2+ level of less than 8.5 meq/L It affects the muscles: You may see a + Trousseau's sign, + Chvostek's sign, diarrhea, numbness, and convulsions. Treatment may include: calcium supplements and vitamin D to absorb. If giving IV calcium, give it slowly. Teach patient to increase dietary calcium. NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What is Hyponatremia? Symptoms? and How should you treat it - AMSHyponatremia is a sodium (Na+) level less than 135 mEq/L, it creates Neuro/confusion and muscle cramps. Check blood pressure often, restrict fluids, and be cautious with IV fluid replacement. What is Important to remember about Hypokalemia - AMSHypokalemia is a K+ level less than 3.5 mEq/L. Affects the cardiac system: The patient may exhibit a rapid, thready pulse, flat T waves, fatigue, anorexia, and muscle cramps. Give IV potassium supplements with a max flow rate of 20 meq/hr. Encourage foods high in K+ (bananas, oranges, spinach, potatoes, milk, strawberries, apricots) What is in a LR IV fluid - AMSNS + electrolytes What is most important to remember about extracellular electrolyte balance? - AMSThat sodium Na+ maintains most abundant osmotic pressure. When either the ECF or the ICF changes in concentration, fluid shifts from the area of lesser concentration to the area of greater concentration. What is most important to remember about intracellular electrolyte balance? - AMSThat potassium K+ maintains osmotic pressure and if K+ is not in balance it may be life threatening. What is nursing malpractice? - AMSMalpractice is not always negligence. It is often referred to as professional negligence, it is a type of negligence. It is the failure to use that degree of care that a reasonable nurse would use under the same or similar circumstances. Malpractice is found when: *The nurse owed a duty to the patient *The nurse did NOT carry out the duty/breached that duty *The patient was at a high risk of injury * The nurse's failure to carry out that duty caused the patients injury What is nursing negligence - AMSNegligence is malpractice that is NOT intentional. It is the failure to exercise the proper degree of care required by the circumstances that a reasonably prudent person would exercise under the circumstances to avoid harming others. It is a careless act of omission or commission that results in injury to another. What is required for informed consent to be valid? - AMSthe patient giving consent must be competent and of legal age. The consent is given voluntarily. The patient giving consent understands the procedure, risks/benefits, and alternative procedures. The patient has the right to have all questions answered satisfactorily. It is the duty of the HCP performing the procedure or treatment to obtain informed consent and to answer any questions the patient might have about the procedure. The RN is witnessing the signature not providing informed consent. What is the acronym S-BAR stand for? - AMSIt is a interdisciplinary communication strategy that promotes effective communication between caregivers S = situation - State the issue or problem B = background - provide history A = assessment - most recent VS and current findings R = recommendation - state what should be done What is the antidote for coumadin toxicty - AMSvitamin K What is the antidote for dgioxin - AMSdigibind What is the antidote for heparin toxicty - AMSprotamine sulfate What is the antidote for too much ammonia - AMSlactulose NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Choline magnesium trisaliclate (Trilisate) is another type of non opioid Analgesic salicylates What type of drug will affect afterload - AMSCalcium channel blockers When an opioid is prescribed in combination with a nonopioid analgesic, such as acetaminophen or a NSAID, what should you monitor? - AMSThe daily dose When blood volume gets low (vomiting, blood loss, etc.) what happens to the secretion of aldosterone and what happens because of it? - AMSAldosterone secretion increases which causes a retention of sodium and water which will make blood volume go up or increase. When can restraints be used? What must the nurse do if restraints are used? - AMSRestraints can be used only: to ensure the physcial safety of the patient or other residents, when less restrictive interventions are not successful, and must have a written order of a HCP. The nurse must follow agency policy and procedure to retrain any client, Documentation of the use of restraints and of follow-up assessments must detail the attempts to use less restrictive interventions. Liability for improper or unlawful restraint lies with the nurse and the healthcare facility. 30 min pulse checks, 2 hr ROM, one on one, When can the nurse NOT follow the healthcare provider's prescription and what must they do about it? - AMSNurses MUST follow the healthcare provider's prescription unless the nurse believes that it is in error; that it violates hospital policy; or that it is harmful to the patient. The nurse makes a formal report explaining the refusal. The nurse should file an incident (occurrence) report for any situation that may result in harm to the patient. When introducing foods to infants what should you teach the new parents? - AMSIntroduce one food at a time to help identify allergies. Progression of food should be "AS TOLERATED" The nursing assessment guides decisions about progression. When selecting an NCLEX answer or determining the order of priority what should you remember or use and what is the exception? - AMSUse the ABC rule: Airway breathing, and circulation. The exception to the rule is with actual CPR, use C-A-B for CPR. Also remember safety first and acute before chronic. If the pt. is not in distress then you assess. If the pt is in distress then you should do something. If the pt has diaphorisis you should always do something. When should you draw a peak level? - AMS30-60 minutes after medication administration When should you draw a trough level? - AMS30-60 minutes before medication administration When should you use NS IV fluids - AMSUse NS when you are trying to replace volume (plasma) Where do Standards of Care originate? - AMSNurses are required to follow standards of care, which originate in the Nurse Practice Acts, state and federal laws, accreditation recommendations, the guidelines of professional organizations, and the written policies and procedures of the healthcare agency Where is aldosterone found - AMSin the adrenal glands Where is Atrial Natriuretic Peptide (ANP) found? - AMSIn the atria of the heart Where is insulin produced? - AMSbeta cells of pancreas NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Which disease is related to not enough aldosterone? - AMSAddisons: fluid volume is decreased Why should be be concerned about the patient receiving potassium and digoxin - AMSpotassium potentiates dig toxicity Acetaminophen (Tylenol) is what type of drug? What is the maximum recommended dosage? What should you monitor? - AMSNonopioid Analgesics. Max dose: 4000 mg (4 g) in 24 hrs Monitor liver function Aldosterone attracts what? - AMSSodium aminoglycosides (mycins) - AMS Angiotensin II in the lungs is a potent? - AMSvasodialator At what pain level should an Opioid Analgesic be considered? - AMSPain level of 6 or greater. Opioids are used for moderate to severe pain. Define fluid volume excess: Hypervolemia - AMStoo much fluid in the vascular space (first). Vascular equals the vessels --> veins, arteries, capillaries, heart chambers, etc. DO NOT delegate what you can EAT - AMSE = evaluate A = assess T = teach EPI is always given in what type of syringe - AMSTB syringe HIV Nursing and Collaborative Management includes... - AMS- Monitor disease progression and immune function -Initiate and monitor (ART) antiretroviral therapy: to decrease viral load and increase T cell count -prevent development of opportunistic diseases -detect and treat opportunistic diseases -manage symptoms -prevent or decrease complications of treatment -prevent transmission of HIV How do you convert Centigrade to Fahrenheit - AMSC+40, multiply 9/5 and subtract 40 How do you convert Fahrenheit to Centigrade - AMSF+40, multiply 5/9 and subtract 40 How do you test for the Chvostek sign and what happens if there is a positive response? - AMSElicitation: Tapping on the face at a point just anterior to the ear and just below the zygomatic bone Postitive response: Twitching of the ipsilateral facial muscles, suggestive of neuromuscular excitability caused by hypocalcemia How do you test for the Trousseau's sign and what happens if there is a positive response? - AMSElicitation: Inflating a sphygmomanometer cuff above NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. systolic blood pressure for several minutes Positive response: Muscular contraction including flexion of the wrist and metacarpophalangeal joints, hyperextension of the fingers, and flexion of the thumb on the palm, suggestive of neuromuscular excitability caused by hypocalcemia How do you treat fluid volume deficits? - AMSStrict I&O Replace with isotonic fluids monitor Bp weight daily How does atrial natriuretic peptide (ANP) work? - AMSIt is the opposite of aldosterone, so it causes excretion of Nas and H2O How often is nitroglycerine administered and when should you not give it? - AMSup to 3 times (every 5 minutes) do not give when BO is less than 90/60 How should you address questions related to Maslow's Hierarchy of Needs - AMSAddress physiological needs first, followed by safety and security needs, love and belonging needs, self esteem needs and finally self actualization needs. *When a physiological need is not addressed in the question, look for the option that addresses safety. How would you treat fluid volume excess? - AMSGive Diuretics (Lasix), fluid restrictions, weigh daily, monitor K+ If a question is related to the nursing process, read the question to determine the step of the nursing process. What are the steps in the nursing process and what kind of question might be related to that step. - AMSAssessment question address the gathering and verification of data. Analysis questions require the nurse to: interpret data, collect additional information, identify and communicate nursing diagnoses and determine the health team's ability to meet the pts needs. Planning questions ask about determining, prioritizing, and modifying outcomes of care. Implementation questions reflect the management and organization of care and the assignment and delegation of tasks. Be prepared for questions on client teaching. Evaluation questions focus on comparing the actual outcomes of care with the expected outcomes and on communicating and documenting findings. If PVC's are left untreated what can it lead to? - AMSVentricular fibrillation Name 3 Invasive non-pharmacological pain relief techniques. - AMSNerve blocks Interruption of neural pathways Acupuncture Name 3 types of IV fluids - AMSIsotonic: 0.9% NS, LR, and D5w Hypotonic: 0.5% NS, 0.45% NS Hypertonic: d5 0.45% NS, D5LR, D5NS Name 4 types of Nonopioid Analgesics - AMS1. Acetaminophen: Tylenol NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What are the goals of HIV drug therapy? - AMS-Reduce the viral load -maintain or raise the CD4+ T cell counts. T cell counts = Normal 800-1200 HIV 500 AIDS below 200 -Delay the development of HIV related symptoms and opportunistic diseases **compliance** What are the normal ranges for ABGs? (pH, pCO2, HCO3) - AMSpH (AC) 7.35-7.45 (AL) pCo2 (AL) 35 - 45 (AC) HCO3 (AC) 22 - 26 (AL) What are the normal ranges for ALP (alkaline phosphatase)? - AMS30-120 slightly increased in the elderly What are the normal ranges for BUN? What does BUN stand for? What is the ratio of BUN-creatinine? What does it indicate? - AMS10-20 blood urea nitrogen BUN-creatinine ratio of 20:1 indicates adequate kidney functioning What are the normal ranges for Ca+? What type of drug can increase calcium levels? What are two tests with positive results that are associated with hypocalcemia? How do you preform the two tests? - AMS9-10.5 for adults. slightly lower in the elder Use of thiazide diuretics can cause increased levels of calcium Positive Chvostek and Trousseau tests are associated with hypocalcemia. • Chvostek sign: contraction of ipsilateral facial muscles when the facial nerve is tapped just in front of the ear. • Trousseau sign: carpopedal spasm elicited by inflating a sphygmomanometer above systolic BP for 3 minutes. What are the normal ranges for Cl- - AMS98-106 is the normal range for chloride What are the normal ranges for Creatinine? What is the ratio of BUN-creatinine? What does it indicate? - AMSMale 0.6-1.2 Female 0.5-1.1 BUN-creatinine ratio of 20:1 indicates adequate kidney functioning What are the normal ranges for H&H? What are the nursing implications - AMSHemoglobin - Male 14-18 Female 12-16 Newborn 14-24 High altitude living increases value, slight decrease during pregnancy. Drug therapy can alter values. Hematocrit - Male 42-52 Female 37-47 Newborn 44-64 Prolonged stasis from vasoconstriction secondary to the tourniquet can alter values. Abnormalities in RBC size may alter Hct values NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What are the normal ranges for INR? What type of patients should have individualized values What should the values be for those patients? - AMS0.8-1.1 normal INR Individualized values for pts with: Afib and DVT between 2.0 and 3.0 mechanical heart valves between 3.0 to 4.0 What are the normal ranges for K+? What should you keep in mind when getting a specimen? - AMS3.5- 5 is normal range for potassium Exercise of the forearm with tourniquet in place may cause an increased level. Hemolysis of specimen can result in a falsely elevated value What are the normal ranges for Mg+? What may high magnesium levels indicate? What may low magnesium levels indicate? - AMS1.7-2.2 A high magnesium level may indicate: Addison disease Chronic renal failure, Dehydration, Diabetic acidosis Oliguria A low magnesium level may indicate: Alcoholism Chronic diarrhea, Delirium tremens, Hemodialysis Hepatic (liver) cirrhosis, Hyperaldosteronism Hypoparathyroidism, Pancreatitis, Too much insulin Toxemia of pregnancy, Ulcerative colitis What are the normal ranges for Na+? What should you consider when collecting a specimen? - AMS136- 145 is a normal sodium range Do Not collect from an arm with an infusing IV solution What are the normal ranges for PLATELETS? What may increase values? What may decrease values? What drugs decrease values? - AMSBoth Genders: 150000-400000 Living at high altitudes, exercising strenuously or taking oral contraceptives may increase values decreased values may be caused by hemorrhage, DIC, reduced production of platelets, infections, use of prosthetic heart valves, and drugs. Drugs that decrease platelets: acetaminophen, aspirin, chemotherapy, H2 blockers, INH, Levaquin, streptomycin, sulfonamides, thiazide diuretics. What are the normal ranges for PT? What is PT used to help regulate? What is the therapeutic range? - AMS11-12.5 is a normal PT range PT is used to help regulate Coumadin dosages. The therapeutic range: 1.5 to 2 times normal or control What are the normal ranges for PTT and aPTT? What do they help regulate? What is the therapeutic range? - AMSnormal range PTT: 60-70 normal range aPTT: 30-40 Both PTT and aPTT are used to help regulate heparin dosages. NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Therapeutic range is 1.5 to 2.5 times normal or control What are the normal ranges for RBC? What can increase levels What happens to levels during pregnancy? - AMSMales: 4.7-6.1 million Female: 4.2-5.4 million Exercise and high altitudes can cause an increase levels pregnancy usually lower values drug therapy can alter values Never draw a specimen from an arm with an infusing IV. What are the normal ranges for WBC? What can increase values? What can decrease values? How long does the postpartum period of pregnancy affect normal ranges? What range is normal during the postpartum period? - AMSBoth genders 5000-10000 Newborn 9000-30000 Anesthetics, stress, exercise, and convulsions can increased values. Drug therapy can decrease values. 24-28 hr postpartum: a count as high as 25000 is normal What are the symptoms of fluid volume excess? - AMSPeripheral edema periorbital edema elevated BP dyspnea ALOC What are the two main hormonal regulations related to fluid volume - AMSAldosterone (steroid, mineralocorticoid) Atrial Natriuretic Peptide (ANP) What can cause a fluid volume deficit - AMSInadequate fluid intake hemorrhage vomiting or diarrhea massive edema What can cause fluid volume excess: Hypervolemia - AMSHeart Failure (HF) where the heart is weak, CO is decreased, the kidneys have decreased perfusion and urinary output is decreased. **The volume stays in the vascular space! Renal Failure (RF) When the kidneys are not working. Medications: alka-seltzer, fleet enema's and IVF with Na. These medications have a lot of sodium causing water retention in the vascular space. What can cause fluid volume excess? - AMSCHF (most common) Renal failure cirrhosis overhydration NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What is nursing negligence - AMSNegligence is malpractice that is NOT intentional. It is the failure to exercise the proper degree of care required by the circumstances that a reasonably prudent person would exercise under the circumstances to avoid harming others. It is a careless act of omission or commission that results in injury to another. What is required for informed consent to be valid? - AMSthe patient giving consent must be competent and of legal age. The consent is given voluntarily. The patient giving consent understands the procedure, risks/benefits, and alternative procedures. The patient has the right to have all questions answered satisfactorily. It is the duty of the HCP performing the procedure or treatment to obtain informed consent and to answer any questions the patient might have about the procedure. The RN is witnessing the signature not providing informed consent. What is the acronym S-BAR stand for? - AMSIt is a interdisciplinary communication strategy that promotes effective communication between caregivers S = situation - State the issue or problem B = background - provide history A = assessment - most recent VS and current findings R = recommendation - state what should be done What is the antidote for coumadin toxicty - AMSvitamin K What is the antidote for dgioxin - AMSdigibind What is the antidote for heparin toxicty - AMSprotamine sulfate What is the antidote for too much ammonia - AMSlactulose What is the drug of choice for alcohol withdraw - AMSLibrium What is the drug of choice to treat pain in pts who are narcotic addicts - AMSmethadone is an opioid analgesic used to detoxify and treat pain in narcotic addicts What is the medication of choice for a bipolar person - AMSlithium What is the medication of choice for Asystole - AMSatropine What is the medication of choice for CHF - AMSAce inhibitors What is the medication of choice for Status Epilepticus - AMSValium What is the medication of choice for SVT - AMSadenosine or adenocard What is the medication of choice for V tach - AMSlidocaine What is the medication used for anaphylactic shock - AMSEpinephrine What is the relationship of Ca+ and PO4? What is the relationship of Ca+ and pH? - AMScalcium and phosphorus have an inverse relationship: when calcium levels increase, phosphorus levels decrease, and vice versa. pH also affects the level of ionized calcium: NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. As pH rises and blood becomes more alkalotic, calcium binds more easily with protein, causing the level of ionized calcium to drop. Conversely, when pH falls, causing acidosis, less calcium binds with protein, which raises the ionized calcium level What lab findings may be present with a fluid volume deficit? - AMSIncreased BUN Increased or normal creatinine Increased H/H Increased urine specific gravity What may be some Lab findings r/t fld volume excess - AMSEverything will be decreased Decreased: BUN, Hgb/Hct, serum osmolality, urine specific gravity and electrolytes What Nationalities have a high risk r/t the development of obesity and diabetes mellitus? - AMSBecause of their health and dietary practices, Native Americans, Latino Americans, Hispanic Americans, and African Americans have a high risk of obesity and diabetes mellitus. Asian Americans have a lower risk for obesity and diabetes mellitus. What routes of transmission are related to HIV exposure - AMS- unprotected sexual contact (most common) - exposure to blood through drug using equipment - perinatal transmission - most common for children - can occur during pregnancy, at the time of delivery, or after birth through breast feeding What should be avoided when a patient is neutropenic? - AMSNo live vaccines no fresh fruit no flowers What should be considered when communicating with a Chinese American? - AMSMost Chinese Americans maintain a formal distance with others, which is a form of respect. Many Chinese Americans are uncomfortable with face-to-face communications, especially when eye contact is direct. If the client turns away from the nurse during a conversation, the best action is to continue with the conversation. Walking around the client so that the nurse faces the client is in direct conflict with this cultural practice. The client may consider it a rude gesture if the nurse returns later to continue with the explanation. Telling the client about the importance of the instructions for the maintenance of health care may be viewed as degrading. What should the nurse do related to advanced medical directives (ADs) - AMSAssess the patients knowledge of advance directives. Integrate them into the patients plan of care Provide the patient with information about advanced directives or review ADs on admission. Have the knowledge that ADs can limit life-prolonging measures when there is little or no chance of recovery What should you know about HIV symptoms - AMS- 1 to 3 weeks; flu like symptoms - 8-10 years for diagnosis May begin with flu like symptoms in the earliest stage and advance to.. - severe weight loss - secondary infections NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. - cancer -neurological disease What should you remember when someone is dealing with death and grief - AMS- Encourage expression of anger - Do not take away the defense mechanism or coping mechanism the person uses in a crisis. - Customs surrounding death and dying vary among cultures. Make every attempt to understand and accommodate the family's cultural traditions when caring for a dying patient. What skills are needed for Supervision - AMSBe able to: give direction/guidance evaluate/monitor following up what type of communication and leadership is it if the person says "do it my way"? - AMSAggressive communication/authoritarian leader What type of communication and leadership is it if the person says "Lets consider the options available."? - AMSAssertive communication/democratic leader What type of communication and leadership is it if the persons says "Whatever...as long as you like me." - AMSPassive communication/laissez-faire leader What type of drug is Aspirin? - AMSNon opioid Analgesic Salicylates Choline magnesium trisaliclate (Trilisate) is another type of non opioid Analgesic salicylates What type of drug will affect afterload - AMSCalcium channel blockers When an opioid is prescribed in combination with a nonopioid analgesic, such as acetaminophen or a NSAID, what should you monitor? - AMSThe daily dose When blood volume gets low (vomiting, blood loss, etc.) what happens to the secretion of aldosterone and what happens because of it? - AMSAldosterone secretion increases which causes a retention of sodium and water which will make blood volume go up or increase. When can restraints be used? What must the nurse do if restraints are used? - AMSRestraints can be used only: to ensure the physcial safety of the patient or other residents, when less restrictive interventions are not successful, and must have a written order of a HCP. The nurse must follow agency policy and procedure to retrain any client, Documentation of the use of restraints and of follow-up assessments must detail the attempts to use less restrictive interventions. Liability for improper or unlawful restraint lies with the nurse and the healthcare facility. 30 min pulse checks, 2 hr ROM, one on one, When can the nurse NOT follow the healthcare provider's prescription and what must they do about it? - AMSNurses MUST follow the healthcare provider's prescription unless the nurse believes that it is in error; that it violates hospital policy; or that it is harmful to the patient. The nurse makes a formal report explaining the refusal. The nurse should file an incident (occurrence) report for any situation that may result in harm to the patient. NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. If a question is related to the nursing process, read the question to determine the step of the nursing process. What are the steps in the nursing process and what kind of question might be related to that step. - AMSAssessment question address the gathering and verification of data. Analysis questions require the nurse to: interpret data, collect additional information, identify and communicate nursing diagnoses and determine the health team's ability to meet the pts needs. Planning questions ask about determining, prioritizing, and modifying outcomes of care. Implementation questions reflect the management and organization of care and the assignment and delegation of tasks. Be prepared for questions on client teaching. Evaluation questions focus on comparing the actual outcomes of care with the expected outcomes and on communicating and documenting findings. If PVC's are left untreated what can it lead to? - AMSVentricular fibrillation Name 3 Invasive non-pharmacological pain relief techniques. - AMSNerve blocks Interruption of neural pathways Acupuncture Name 3 types of IV fluids - AMSIsotonic: 0.9% NS, LR, and D5w Hypotonic: 0.5% NS, 0.45% NS Hypertonic: d5 0.45% NS, D5LR, D5NS Name 4 types of Nonopioid Analgesics - AMS1. Acetaminophen: Tylenol 2. Salicylates: Aspirin, Trilisate 3. NSAIDS: ibuprofen, Indomethacin, Ketorolac, Diclofenac 4. COX-2 inhibitors: Celebrex Name 5 non-invasive non-pharmacological pain relief techniques (1st choice of pain relief) - AMSTen's heat and cold application message therapy relaxation techniques guided imagery biofeedback techniques Never IV push what electroylte - AMSK+ Nursing assessment r/t HIV - AMS-Positive result on enzyme-linked immunosorbed assay (ELISA) - CONFIRMED WITH WESTERN BLOT TEST -Polymerase chain reaction (PCR) - used with neonate - OraQuick In-Home HIV Test: positive result is only preliminary; it must be confirmed by a healthcare professional. **Ongoing assessment, interaction with the client, and client education and support are required.*** - NCLEX testing - never choose abstinence, choose educate! Related to mental Health, how long can an involuntary admission last? - AMS72 hours NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. To much CO2 causes what? - AMSvasoconstriction What are low risk therapies - AMSLow-risk therapies are therapies that have no adverse effects and, when implementing care, can be used by the nurse who has training and experience in their use. Low-risk therapies include meditation, relaxation techniques, imagery, music therapy, massage, touch, laughter and humor, and spiritual measures, such as prayer. What are nosocomial infections - AMSInfections acquired as a result of exposure to a microorganism in the hospital setting What are nurses responsible for related to the standards of care? - AMSNurses are responsible for performing procedures correctly and exercising professional judgment when implementing healthcare providers prescriptions. What are some examples of Non-opioid Analgesic pain medications - AMSAcetaminophen (Tylenol) Salicylates: - Aspirin - Choline magnesium trisalcylate (Trilisate) NSAIDs: - Ibuprofen - Indomethacin - Ketorolac - Diclofenac K Cyclooxygenase-2 (COX-2) inhibitors - Celecoxib What are some HIV Medications - AMSNucleoside reverse transcriptase inhibitors (NRTIs) -zidovudine (AZT, ZDV, Retrovir) -lamivudine -abacavir -emtricitabine Nucleotide reverse transcriptase inhibitor (NtRTI) - Tenofovir DF (Viread) What are some symptoms of fluid volume deficit - AMSweight loss oliguria (not enough urine) postural hypotension What are some types of Analgesics (used for moderate to severe pain)? - AMSMu agonists - Morphine - Hydromorphone - Methadone - Levorphanol - Fentanyl - Oxycodone - Codeine (Tylenol No.3) Mixed agonist-antagonists - Pentazocine -Butorphanol Partial agonists - Nuprenorphine -Buprenorphine plus naloxone NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Adjuvant drugs - used for neuropathic pain - Antiepileptic drugs, antidepressants, and anesthetics are prescribed alone or in combination with opioids for neuropathic pain, - Corticosteroids What are the 3 categories of pain medications - AMS1. non-opioids: for mild pain or in combination for moderate pain 2. Opioids: for moderate to severe pain 3. Co-analgesic or adjuvant drugs (i.e. anticonvulsants, antidepressants) for neuropathic pain What are the 5 stages of grief - AMSDenial, anger, bargaining, depression, and acceptance What are the 7 Rights of medication administration? - AMS1. Right drug 2. right dose 3. Right route 4. Right time 5. Right patient 6. Right documentation 7. Right to refuse What are the five rights of delegation? - AMS1. right task 2. right circumstance 3. right person 4. right direction/communication 5. right supervision What are the goals of HIV drug therapy? - AMS-Reduce the viral load -maintain or raise the CD4+ T cell counts. T cell counts = Normal 800-1200 HIV 500 AIDS below 200 -Delay the development of HIV related symptoms and opportunistic diseases **compliance** What are the normal ranges for ABGs? (pH, pCO2, HCO3) - AMSpH (AC) 7.35-7.45 (AL) pCo2 (AL) 35 - 45 (AC) HCO3 (AC) 22 - 26 (AL) What are the normal ranges for ALP (alkaline phosphatase)? - AMS30-120 slightly increased in the elderly What are the normal ranges for BUN? What does BUN stand for? What is the ratio of BUN-creatinine? What does it indicate? - AMS10-20 blood urea nitrogen BUN-creatinine ratio of 20:1 indicates adequate kidney functioning What are the normal ranges for Ca+? What type of drug can increase calcium levels? What are two tests with positive results that are associated with hypocalcemia? How do you preform the two tests? - AMS9-10.5 for adults. slightly lower in the elder NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. elevated BP dyspnea ALOC What are the two main hormonal regulations related to fluid volume - AMSAldosterone (steroid, mineralocorticoid) Atrial Natriuretic Peptide (ANP) What can cause a fluid volume deficit - AMSInadequate fluid intake hemorrhage vomiting or diarrhea massive edema What can cause fluid volume excess: Hypervolemia - AMSHeart Failure (HF) where the heart is weak, CO is decreased, the kidneys have decreased perfusion and urinary output is decreased. **The volume stays in the vascular space! Renal Failure (RF) When the kidneys are not working. Medications: alka-seltzer, fleet enema's and IVF with Na. These medications have a lot of sodium causing water retention in the vascular space. What can cause fluid volume excess? - AMSCHF (most common) Renal failure cirrhosis overhydration What diseases are related to too much aldosterone? - AMSCushings and Hyperaldosteronism (Conn's) What does a low residue diet mean? - AMSLow fiber What does criminal law deal with? - AMSRights of individuals and society as defined by legislative laws What does heparin prevent - AMSplatelet aggregation What does preload affect? - AMSThe amount of blood that goes to the R ventricle What drug is contraindicated in Pancreatitis? What pain medication should be used? - AMSDo not give Morphine for pancreatitis because it causes spasms of the Sphincter of Oddi, give Demerol instead. What happens when a patient has prednisone toxicity - AMSCushing's syndrome, buffalo hump, moon face, high glucose, hpertension What have NSAIDs (except aspirin) been linked to and what type of patient should not take NSAIDs? - AMSNSAIDs (except aspirin) have been linked to a higher risk for increased cardiovascular events, such as myocardial infarction, stroke, and heart failure. Patients who have just had heart surgery should not take NSAIDs. NSAIDs are very hard on the stomach. NO NSAIDs for Cardiac patient. What is a durable power of attorney for healthcare? - AMSThe person appoints a representative (healthcare proxy) to make healthcare decisions in a document NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What is a Mu agonist? - AMSThe so-called agonist-antagonist drugs have a relationship to the opioid receptors that includes activation and blockade. Some of these drugs activate one type of opioid receptor, known as the kappa receptor, while blocking another, the mu receptor What is a sign of a fat embolism and what medication would you give? - AMSpetechiae is a sign of a fat embolism. Treat with heparin What is afterload? - AMSthe resistance that blood has to overcome when leaving the heart What is civil law concerned with? - AMSProtection of the patients private rights What is documented in a living will? - AMSA person documents his or her wishes regarding future care in the event of terminal illness What is HIPPA and what does it require? - AMSHealth Insurance Portability and Accountability Act of 1996 established standards for the verbal, written and electronic exchange of private health information. HIPPA created patient rights to consent to use and disclose health information, to inspect and copy one's medical record, and to amend mistaken or incomplete information. HIPPA requires all hospitals and health agencies to have specific policies and procedures in place to ensure compliance with its standards. What is Hypercalcemia? What signs and symptoms may be present? and how do you treat it? - AMSHypercalcemia is a calcium level above 10.5 mEq/L Calcium affects the muscles, you may see muscle weakness, constipation, n/v, dysrhythmias, and behavioral changes. Limit vitamin D intake but push fluids. Avoid calcium-based antacids. Administer calcitonin to reduce calcium Renal dialysis may be required What is Hyperkalemia, what might you see with the patient and how do you treat it? - AMSHyperkalemia is a K+ level greater than 5 mEq/L You may see tall, tented T waves, bradycardia, muscle weakness. Treatment may include: - 10%-20% glucose with regular insulin - Kayexalate - renal dialysis may be required What is Hypernatremia? What symptoms might you see? How should you treat it? - AMSNa+ greater than 145 mEq/L May see: Pulmonary edema Neuro: seizures, thirst, fever. Do Not Use Ivs that contain sodium Restrict sodium diet Weigh daily What is Hypocalcemia, What might the patient exhibit? How will you treat it? - AMSHypocalcemia is a Ca2+ level of less than 8.5 meq/L It affects the muscles: You may see a + Trousseau's sign, + Chvostek's sign, diarrhea, numbness, and convulsions. NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Treatment may include: calcium supplements and vitamin D to absorb. If giving IV calcium, give it slowly. Teach patient to increase dietary calcium. What is Hyponatremia? Symptoms? and How should you treat it - AMSHyponatremia is a sodium (Na+) level less than 135 mEq/L, it creates Neuro/confusion and muscle cramps. Check blood pressure often, restrict fluids, and be cautious with IV fluid replacement. What is Important to remember about Hypokalemia - AMSHypokalemia is a K+ level less than 3.5 mEq/L. Affects the cardiac system: The patient may exhibit a rapid, thready pulse, flat T waves, fatigue, anorexia, and muscle cramps. Give IV potassium supplements with a max flow rate of 20 meq/hr. Encourage foods high in K+ (bananas, oranges, spinach, potatoes, milk, strawberries, apricots) What is in a LR IV fluid - AMSNS + electrolytes What is most important to remember about extracellular electrolyte balance? - AMSThat sodium Na+ maintains most abundant osmotic pressure. When either the ECF or the ICF changes in concentration, fluid shifts from the area of lesser concentration to the area of greater concentration. What is most important to remember about intracellular electrolyte balance? - AMSThat potassium K+ maintains osmotic pressure and if K+ is not in balance it may be life threatening. What is nursing malpractice? - AMSMalpractice is not always negligence. It is often referred to as professional negligence, it is a type of negligence. It is the failure to use that degree of care that a reasonable nurse would use under the same or similar circumstances. Malpractice is found when: *The nurse owed a duty to the patient *The nurse did NOT carry out the duty/breached that duty *The patient was at a high risk of injury * The nurse's failure to carry out that duty caused the patients injury What is nursing negligence - AMSNegligence is malpractice that is NOT intentional. It is the failure to exercise the proper degree of care required by the circumstances that a reasonably prudent person would exercise under the circumstances to avoid harming others. It is a careless act of omission or commission that results in injury to another. What is required for informed consent to be valid? - AMSthe patient giving consent must be competent and of legal age. The consent is given voluntarily. The patient giving consent understands the procedure, risks/benefits, and alternative procedures. The patient has the right to have all questions answered satisfactorily. It is the duty of the HCP performing the procedure or treatment to obtain informed consent and to answer any questions the patient might have about the procedure. The RN is witnessing the signature not providing informed consent. What is the acronym S-BAR stand for? - AMSIt is a interdisciplinary communication strategy that promotes effective communication between caregivers S = situation - State the issue or problem B = background - provide history A = assessment - most recent VS and current findings R = recommendation - state what should be done What is the antidote for coumadin toxicty - AMSvitamin K What is the antidote for dgioxin - AMSdigibind NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What type of drug is Aspirin? - AMSNon opioid Analgesic Salicylates Choline magnesium trisaliclate (Trilisate) is another type of non opioid Analgesic salicylates What type of drug will affect afterload - AMSCalcium channel blockers When an opioid is prescribed in combination with a nonopioid analgesic, such as acetaminophen or a NSAID, what should you monitor? - AMSThe daily dose When blood volume gets low (vomiting, blood loss, etc.) what happens to the secretion of aldosterone and what happens because of it? - AMSAldosterone secretion increases which causes a retention of sodium and water which will make blood volume go up or increase. When can restraints be used? What must the nurse do if restraints are used? - AMSRestraints can be used only: to ensure the physcial safety of the patient or other residents, when less restrictive interventions are not successful, and must have a written order of a HCP. The nurse must follow agency policy and procedure to retrain any client, Documentation of the use of restraints and of follow-up assessments must detail the attempts to use less restrictive interventions. Liability for improper or unlawful restraint lies with the nurse and the healthcare facility. 30 min pulse checks, 2 hr ROM, one on one, When can the nurse NOT follow the healthcare provider's prescription and what must they do about it? - AMSNurses MUST follow the healthcare provider's prescription unless the nurse believes that it is in error; that it violates hospital policy; or that it is harmful to the patient. The nurse makes a formal report explaining the refusal. The nurse should file an incident (occurrence) report for any situation that may result in harm to the patient. When introducing foods to infants what should you teach the new parents? - AMSIntroduce one food at a time to help identify allergies. Progression of food should be "AS TOLERATED" The nursing assessment guides decisions about progression. When selecting an NCLEX answer or determining the order of priority what should you remember or use and what is the exception? - AMSUse the ABC rule: Airway breathing, and circulation. The exception to the rule is with actual CPR, use C-A-B for CPR. Also remember safety first and acute before chronic. If the pt. is not in distress then you assess. If the pt is in distress then you should do something. If the pt has diaphorisis you should always do something. When should you draw a peak level? - AMS30-60 minutes after medication administration When should you draw a trough level? - AMS30-60 minutes before medication administration When should you use NS IV fluids - AMSUse NS when you are trying to replace volume (plasma) Where do Standards of Care originate? - AMSNurses are required to follow standards of care, which originate in the Nurse Practice Acts, state and federal laws, accreditation recommendations, the guidelines of professional organizations, and the written policies and procedures of the healthcare agency Where is aldosterone found - AMSin the adrenal glands Where is Atrial Natriuretic Peptide (ANP) found? - AMSIn the atria of the heart NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Where is insulin produced? - AMSbeta cells of pancreas Which disease is related to not enough aldosterone? - AMSAddisons: fluid volume is decreased Why should be be concerned about the patient receiving potassium and digoxin - AMSpotassium potentiates dig toxicity Acetaminophen (Tylenol) is what type of drug? What is the maximum recommended dosage? What should you monitor? - AMSNonopioid Analgesics. Max dose: 4000 mg (4 g) in 24 hrs Monitor liver function Aldosterone attracts what? - AMSSodium aminoglycosides (mycins) - AMS Angiotensin II in the lungs is a potent? - AMSvasodialator At what pain level should an Opioid Analgesic be considered? - AMSPain level of 6 or greater. Opioids are used for moderate to severe pain. Define fluid volume excess: Hypervolemia - AMStoo much fluid in the vascular space (first). Vascular equals the vessels --> veins, arteries, capillaries, heart chambers, etc. DO NOT delegate what you can EAT - AMSE = evaluate A = assess T = teach EPI is always given in what type of syringe - AMSTB syringe HIV Nursing and Collaborative Management includes... - AMS- Monitor disease progression and immune function -Initiate and monitor (ART) antiretroviral therapy: to decrease viral load and increase T cell count -prevent development of opportunistic diseases -detect and treat opportunistic diseases -manage symptoms -prevent or decrease complications of treatment -prevent transmission of HIV How do you convert Centigrade to Fahrenheit - AMSC+40, multiply 9/5 and subtract 40 How do you convert Fahrenheit to Centigrade - AMSF+40, multiply 5/9 and subtract 40 How do you test for the Chvostek sign and what happens if there is a positive response? - AMSElicitation: Tapping on the face at a point just anterior to the ear and just below the zygomatic bone Postitive response: Twitching of the ipsilateral facial muscles, suggestive of neuromuscular excitability caused by hypocalcemia NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. How do you test for the Trousseau's sign and what happens if there is a positive response? - AMSElicitation: Inflating a sphygmomanometer cuff above systolic blood pressure for several minutes Positive response: Muscular contraction including flexion of the wrist and metacarpophalangeal joints, hyperextension of the fingers, and flexion of the thumb on the palm, suggestive of neuromuscular excitability caused by hypocalcemia How do you treat fluid volume deficits? - AMSStrict I&O Replace with isotonic fluids monitor Bp weight daily How does atrial natriuretic peptide (ANP) work? - AMSIt is the opposite of aldosterone, so it causes excretion of Nas and H2O How often is nitroglycerine administered and when should you not give it? - AMSup to 3 times (every 5 minutes) do not give when BO is less than 90/60 How should you address questions related to Maslow's Hierarchy of Needs - AMSAddress physiological needs first, followed by safety and security needs, love and belonging needs, self esteem needs and finally self actualization needs. *When a physiological need is not addressed in the question, look for the option that addresses safety. How would you treat fluid volume excess? - AMSGive Diuretics (Lasix), fluid restrictions, weigh daily, monitor K+ If a question is related to the nursing process, read the question to determine the step of the nursing process. What are the steps in the nursing process and what kind of question might be related to that step. - AMSAssessment question address the gathering and verification of data. Analysis questions require the nurse to: interpret data, collect additional information, identify and communicate nursing diagnoses and determine the health team's ability to meet the pts needs. Planning questions ask about determining, prioritizing, and modifying outcomes of care. Implementation questions reflect the management and organization of care and the assignment and delegation of tasks. Be prepared for questions on client teaching. Evaluation questions focus on comparing the actual outcomes of care with the expected outcomes and on communicating and documenting findings. If PVC's are left untreated what can it lead to? - AMSVentricular fibrillation Name 3 Invasive non-pharmacological pain relief techniques. - AMSNerve blocks Interruption of neural pathways Acupuncture Name 3 types of IV fluids - AMSIsotonic: 0.9% NS, LR, and D5w Hypotonic: 0.5% NS, 0.45% NS NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. 4. right direction/communication 5. right supervision What are the goals of HIV drug therapy? - AMS-Reduce the viral load -maintain or raise the CD4+ T cell counts. T cell counts = Normal 800-1200 HIV 500 AIDS below 200 -Delay the development of HIV related symptoms and opportunistic diseases **compliance** What are the normal ranges for ABGs? (pH, pCO2, HCO3) - AMSpH (AC) 7.35-7.45 (AL) pCo2 (AL) 35 - 45 (AC) HCO3 (AC) 22 - 26 (AL) What are the normal ranges for ALP (alkaline phosphatase)? - AMS30-120 slightly increased in the elderly What are the normal ranges for BUN? What does BUN stand for? What is the ratio of BUN-creatinine? What does it indicate? - AMS10-20 blood urea nitrogen BUN-creatinine ratio of 20:1 indicates adequate kidney functioning What are the normal ranges for Ca+? What type of drug can increase calcium levels? What are two tests with positive results that are associated with hypocalcemia? How do you preform the two tests? - AMS9-10.5 for adults. slightly lower in the elder Use of thiazide diuretics can cause increased levels of calcium Positive Chvostek and Trousseau tests are associated with hypocalcemia. • Chvostek sign: contraction of ipsilateral facial muscles when the facial nerve is tapped just in front of the ear. • Trousseau sign: carpopedal spasm elicited by inflating a sphygmomanometer above systolic BP for 3 minutes. What are the normal ranges for Cl- - AMS98-106 is the normal range for chloride What are the normal ranges for Creatinine? What is the ratio of BUN-creatinine? What does it indicate? - AMSMale 0.6-1.2 Female 0.5-1.1 BUN-creatinine ratio of 20:1 indicates adequate kidney functioning What are the normal ranges for H&H? What are the nursing implications - AMSHemoglobin - Male 14-18 Female 12-16 Newborn 14-24 High altitude living increases value, slight decrease during pregnancy. Drug therapy can alter values. Hematocrit - Male 42-52 Female 37-47 Newborn 44-64 NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Prolonged stasis from vasoconstriction secondary to the tourniquet can alter values. Abnormalities in RBC size may alter Hct values What are the normal ranges for INR? What type of patients should have individualized values What should the values be for those patients? - AMS0.8-1.1 normal INR Individualized values for pts with: Afib and DVT between 2.0 and 3.0 mechanical heart valves between 3.0 to 4.0 What are the normal ranges for K+? What should you keep in mind when getting a specimen? - AMS3.5- 5 is normal range for potassium Exercise of the forearm with tourniquet in place may cause an increased level. Hemolysis of specimen can result in a falsely elevated value What are the normal ranges for Mg+? What may high magnesium levels indicate? What may low magnesium levels indicate? - AMS1.7-2.2 A high magnesium level may indicate: Addison disease Chronic renal failure, Dehydration, Diabetic acidosis Oliguria A low magnesium level may indicate: Alcoholism Chronic diarrhea, Delirium tremens, Hemodialysis Hepatic (liver) cirrhosis, Hyperaldosteronism Hypoparathyroidism, Pancreatitis, Too much insulin Toxemia of pregnancy, Ulcerative colitis What are the normal ranges for Na+? What should you consider when collecting a specimen? - AMS136- 145 is a normal sodium range Do Not collect from an arm with an infusing IV solution What are the normal ranges for PLATELETS? What may increase values? What may decrease values? What drugs decrease values? - AMSBoth Genders: 150000-400000 Living at high altitudes, exercising strenuously or taking oral contraceptives may increase values decreased values may be caused by hemorrhage, DIC, reduced production of platelets, infections, use of prosthetic heart valves, and drugs. Drugs that decrease platelets: acetaminophen, aspirin, chemotherapy, H2 blockers, INH, Levaquin, streptomycin, sulfonamides, thiazide diuretics. What are the normal ranges for PT? What is PT used to help regulate? What is the therapeutic range? - AMS11-12.5 is a normal PT range PT is used to help regulate Coumadin dosages. The therapeutic range: 1.5 to 2 times normal or control NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What are the normal ranges for PTT and aPTT? What do they help regulate? What is the therapeutic range? - AMSnormal range PTT: 60-70 normal range aPTT: 30-40 Both PTT and aPTT are used to help regulate heparin dosages. Therapeutic range is 1.5 to 2.5 times normal or control What are the normal ranges for RBC? What can increase levels What happens to levels during pregnancy? - AMSMales: 4.7-6.1 million Female: 4.2-5.4 million Exercise and high altitudes can cause an increase levels pregnancy usually lower values drug therapy can alter values Never draw a specimen from an arm with an infusing IV. What are the normal ranges for WBC? What can increase values? What can decrease values? How long does the postpartum period of pregnancy affect normal ranges? What range is normal during the postpartum period? - AMSBoth genders 5000-10000 Newborn 9000-30000 Anesthetics, stress, exercise, and convulsions can increased values. Drug therapy can decrease values. 24-28 hr postpartum: a count as high as 25000 is normal What are the symptoms of fluid volume excess? - AMSPeripheral edema periorbital edema elevated BP dyspnea ALOC What are the two main hormonal regulations related to fluid volume - AMSAldosterone (steroid, mineralocorticoid) Atrial Natriuretic Peptide (ANP) What can cause a fluid volume deficit - AMSInadequate fluid intake hemorrhage vomiting or diarrhea massive edema What can cause fluid volume excess: Hypervolemia - AMSHeart Failure (HF) where the heart is weak, CO is decreased, the kidneys have decreased perfusion and urinary output is decreased. **The volume stays in the vascular space! Renal Failure (RF) When the kidneys are not working. Medications: alka-seltzer, fleet enema's and IVF with Na. These medications have a lot of sodium causing water retention in the vascular space. What can cause fluid volume excess? - AMSCHF (most common) NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. *The nurse did NOT carry out the duty/breached that duty *The patient was at a high risk of injury * The nurse's failure to carry out that duty caused the patients injury What is nursing negligence - AMSNegligence is malpractice that is NOT intentional. It is the failure to exercise the proper degree of care required by the circumstances that a reasonably prudent person would exercise under the circumstances to avoid harming others. It is a careless act of omission or commission that results in injury to another. What is required for informed consent to be valid? - AMSthe patient giving consent must be competent and of legal age. The consent is given voluntarily. The patient giving consent understands the procedure, risks/benefits, and alternative procedures. The patient has the right to have all questions answered satisfactorily. It is the duty of the HCP performing the procedure or treatment to obtain informed consent and to answer any questions the patient might have about the procedure. The RN is witnessing the signature not providing informed consent. What is the acronym S-BAR stand for? - AMSIt is a interdisciplinary communication strategy that promotes effective communication between caregivers S = situation - State the issue or problem B = background - provide history A = assessment - most recent VS and current findings R = recommendation - state what should be done What is the antidote for coumadin toxicty - AMSvitamin K What is the antidote for dgioxin - AMSdigibind What is the antidote for heparin toxicty - AMSprotamine sulfate What is the antidote for too much ammonia - AMSlactulose What is the drug of choice for alcohol withdraw - AMSLibrium What is the drug of choice to treat pain in pts who are narcotic addicts - AMSmethadone is an opioid analgesic used to detoxify and treat pain in narcotic addicts What is the medication of choice for a bipolar person - AMSlithium What is the medication of choice for Asystole - AMSatropine What is the medication of choice for CHF - AMSAce inhibitors What is the medication of choice for Status Epilepticus - AMSValium What is the medication of choice for SVT - AMSadenosine or adenocard What is the medication of choice for V tach - AMSlidocaine What is the medication used for anaphylactic shock - AMSEpinephrine What is the relationship of Ca+ and PO4? NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What is the relationship of Ca+ and pH? - AMScalcium and phosphorus have an inverse relationship: when calcium levels increase, phosphorus levels decrease, and vice versa. pH also affects the level of ionized calcium: As pH rises and blood becomes more alkalotic, calcium binds more easily with protein, causing the level of ionized calcium to drop. Conversely, when pH falls, causing acidosis, less calcium binds with protein, which raises the ionized calcium level What lab findings may be present with a fluid volume deficit? - AMSIncreased BUN Increased or normal creatinine Increased H/H Increased urine specific gravity What may be some Lab findings r/t fld volume excess - AMSEverything will be decreased Decreased: BUN, Hgb/Hct, serum osmolality, urine specific gravity and electrolytes What Nationalities have a high risk r/t the development of obesity and diabetes mellitus? - AMSBecause of their health and dietary practices, Native Americans, Latino Americans, Hispanic Americans, and African Americans have a high risk of obesity and diabetes mellitus. Asian Americans have a lower risk for obesity and diabetes mellitus. What routes of transmission are related to HIV exposure - AMS- unprotected sexual contact (most common) - exposure to blood through drug using equipment - perinatal transmission - most common for children - can occur during pregnancy, at the time of delivery, or after birth through breast feeding What should be avoided when a patient is neutropenic? - AMSNo live vaccines no fresh fruit no flowers What should be considered when communicating with a Chinese American? - AMSMost Chinese Americans maintain a formal distance with others, which is a form of respect. Many Chinese Americans are uncomfortable with face-to-face communications, especially when eye contact is direct. If the client turns away from the nurse during a conversation, the best action is to continue with the conversation. Walking around the client so that the nurse faces the client is in direct conflict with this cultural practice. The client may consider it a rude gesture if the nurse returns later to continue with the explanation. Telling the client about the importance of the instructions for the maintenance of health care may be viewed as degrading. What should the nurse do related to advanced medical directives (ADs) - AMSAssess the patients knowledge of advance directives. Integrate them into the patients plan of care Provide the patient with information about advanced directives or review ADs on admission. Have the knowledge that ADs can limit life-prolonging measures when there is little or no chance of recovery What should you know about HIV symptoms - AMS- 1 to 3 weeks; flu like symptoms NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. - 8-10 years for diagnosis May begin with flu like symptoms in the earliest stage and advance to.. - severe weight loss - secondary infections - cancer -neurological disease What should you remember when someone is dealing with death and grief - AMS- Encourage expression of anger - Do not take away the defense mechanism or coping mechanism the person uses in a crisis. - Customs surrounding death and dying vary among cultures. Make every attempt to understand and accommodate the family's cultural traditions when caring for a dying patient. What skills are needed for Supervision - AMSBe able to: give direction/guidance evaluate/monitor following up what type of communication and leadership is it if the person says "do it my way"? - AMSAggressive communication/authoritarian leader What type of communication and leadership is it if the person says "Lets consider the options available."? - AMSAssertive communication/democratic leader What type of communication and leadership is it if the persons says "Whatever...as long as you like me." - AMSPassive communication/laissez-faire leader What type of drug is Aspirin? - AMSNon opioid Analgesic Salicylates Choline magnesium trisaliclate (Trilisate) is another type of non opioid Analgesic salicylates What type of drug will affect afterload - AMSCalcium channel blockers When an opioid is prescribed in combination with a nonopioid analgesic, such as acetaminophen or a NSAID, what should you monitor? - AMSThe daily dose When blood volume gets low (vomiting, blood loss, etc.) what happens to the secretion of aldosterone and what happens because of it? - AMSAldosterone secretion increases which causes a retention of sodium and water which will make blood volume go up or increase. When can restraints be used? What must the nurse do if restraints are used? - AMSRestraints can be used only: to ensure the physcial safety of the patient or other residents, when less restrictive interventions are not successful, and must have a written order of a HCP. The nurse must follow agency policy and procedure to retrain any client, Documentation of the use of restraints and of follow-up assessments must detail the attempts to use less restrictive interventions. Liability for improper or unlawful restraint lies with the nurse and the healthcare facility. 30 min pulse checks, 2 hr ROM, one on one, When can the nurse NOT follow the healthcare provider's prescription and what must they do about it? - AMSNurses MUST follow the healthcare provider's prescription unless the nurse believes that it is in NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. caused by hypocalcemia How do you treat fluid volume deficits? - AMSStrict I&O Replace with isotonic fluids monitor Bp weight daily How does atrial natriuretic peptide (ANP) work? - AMSIt is the opposite of aldosterone, so it causes excretion of Nas and H2O How often is nitroglycerine administered and when should you not give it? - AMSup to 3 times (every 5 minutes) do not give when BO is less than 90/60 How should you address questions related to Maslow's Hierarchy of Needs - AMSAddress physiological needs first, followed by safety and security needs, love and belonging needs, self esteem needs and finally self actualization needs. *When a physiological need is not addressed in the question, look for the option that addresses safety. How would you treat fluid volume excess? - AMSGive Diuretics (Lasix), fluid restrictions, weigh daily, monitor K+ If a question is related to the nursing process, read the question to determine the step of the nursing process. What are the steps in the nursing process and what kind of question might be related to that step. - AMSAssessment question address the gathering and verification of data. Analysis questions require the nurse to: interpret data, collect additional information, identify and communicate nursing diagnoses and determine the health team's ability to meet the pts needs. Planning questions ask about determining, prioritizing, and modifying outcomes of care. Implementation questions reflect the management and organization of care and the assignment and delegation of tasks. Be prepared for questions on client teaching. Evaluation questions focus on comparing the actual outcomes of care with the expected outcomes and on communicating and documenting findings. If PVC's are left untreated what can it lead to? - AMSVentricular fibrillation Name 3 Invasive non-pharmacological pain relief techniques. - AMSNerve blocks Interruption of neural pathways Acupuncture Name 3 types of IV fluids - AMSIsotonic: 0.9% NS, LR, and D5w Hypotonic: 0.5% NS, 0.45% NS Hypertonic: d5 0.45% NS, D5LR, D5NS Name 4 types of Nonopioid Analgesics - AMS1. Acetaminophen: Tylenol 2. Salicylates: Aspirin, Trilisate 3. NSAIDS: ibuprofen, Indomethacin, Ketorolac, Diclofenac 4. COX-2 inhibitors: Celebrex Name 5 non-invasive non-pharmacological pain relief techniques (1st choice of pain relief) - AMSTen's NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. heat and cold application message therapy relaxation techniques guided imagery biofeedback techniques Never IV push what electroylte - AMSK+ Nursing assessment r/t HIV - AMS-Positive result on enzyme-linked immunosorbed assay (ELISA) - CONFIRMED WITH WESTERN BLOT TEST -Polymerase chain reaction (PCR) - used with neonate - OraQuick In-Home HIV Test: positive result is only preliminary; it must be confirmed by a healthcare professional. **Ongoing assessment, interaction with the client, and client education and support are required.*** - NCLEX testing - never choose abstinence, choose educate! Related to mental Health, how long can an involuntary admission last? - AMS72 hours To much CO2 causes what? - AMSvasoconstriction What are low risk therapies - AMSLow-risk therapies are therapies that have no adverse effects and, when implementing care, can be used by the nurse who has training and experience in their use. Low-risk therapies include meditation, relaxation techniques, imagery, music therapy, massage, touch, laughter and humor, and spiritual measures, such as prayer. What are nosocomial infections - AMSInfections acquired as a result of exposure to a microorganism in the hospital setting What are nurses responsible for related to the standards of care? - AMSNurses are responsible for performing procedures correctly and exercising professional judgment when implementing healthcare providers prescriptions. What are some examples of Non-opioid Analgesic pain medications - AMSAcetaminophen (Tylenol) Salicylates: - Aspirin - Choline magnesium trisalcylate (Trilisate) NSAIDs: - Ibuprofen - Indomethacin - Ketorolac - Diclofenac K Cyclooxygenase-2 (COX-2) inhibitors - Celecoxib What are some HIV Medications - AMSNucleoside reverse transcriptase inhibitors (NRTIs) -zidovudine (AZT, ZDV, Retrovir) -lamivudine -abacavir -emtricitabine Nucleotide reverse transcriptase inhibitor (NtRTI) NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. - Tenofovir DF (Viread) What are some symptoms of fluid volume deficit - AMSweight loss oliguria (not enough urine) postural hypotension What are some types of Analgesics (used for moderate to severe pain)? - AMSMu agonists - Morphine - Hydromorphone - Methadone - Levorphanol - Fentanyl - Oxycodone - Codeine (Tylenol No.3) Mixed agonist-antagonists - Pentazocine -Butorphanol Partial agonists - Nuprenorphine -Buprenorphine plus naloxone Adjuvant drugs - used for neuropathic pain - Antiepileptic drugs, antidepressants, and anesthetics are prescribed alone or in combination with opioids for neuropathic pain, - Corticosteroids What are the 3 categories of pain medications - AMS1. non-opioids: for mild pain or in combination for moderate pain 2. Opioids: for moderate to severe pain 3. Co-analgesic or adjuvant drugs (i.e. anticonvulsants, antidepressants) for neuropathic pain What are the 5 stages of grief - AMSDenial, anger, bargaining, depression, and acceptance What are the 7 Rights of medication administration? - AMS1. Right drug 2. right dose 3. Right route 4. Right time 5. Right patient 6. Right documentation 7. Right to refuse What are the five rights of delegation? - AMS1. right task 2. right circumstance 3. right person 4. right direction/communication 5. right supervision What are the goals of HIV drug therapy? - AMS-Reduce the viral load -maintain or raise the CD4+ T cell counts. T cell counts = Normal 800-1200 HIV 500 AIDS below 200 -Delay the development of HIV related symptoms and opportunistic diseases **compliance** NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Female: 4.2-5.4 million Exercise and high altitudes can cause an increase levels pregnancy usually lower values drug therapy can alter values Never draw a specimen from an arm with an infusing IV. What are the normal ranges for WBC? What can increase values? What can decrease values? How long does the postpartum period of pregnancy affect normal ranges? What range is normal during the postpartum period? - AMSBoth genders 5000-10000 Newborn 9000-30000 Anesthetics, stress, exercise, and convulsions can increased values. Drug therapy can decrease values. 24-28 hr postpartum: a count as high as 25000 is normal What are the symptoms of fluid volume excess? - AMSPeripheral edema periorbital edema elevated BP dyspnea ALOC What are the two main hormonal regulations related to fluid volume - AMSAldosterone (steroid, mineralocorticoid) Atrial Natriuretic Peptide (ANP) What can cause a fluid volume deficit - AMSInadequate fluid intake hemorrhage vomiting or diarrhea massive edema What can cause fluid volume excess: Hypervolemia - AMSHeart Failure (HF) where the heart is weak, CO is decreased, the kidneys have decreased perfusion and urinary output is decreased. **The volume stays in the vascular space! Renal Failure (RF) When the kidneys are not working. Medications: alka-seltzer, fleet enema's and IVF with Na. These medications have a lot of sodium causing water retention in the vascular space. What can cause fluid volume excess? - AMSCHF (most common) Renal failure cirrhosis overhydration What diseases are related to too much aldosterone? - AMSCushings and Hyperaldosteronism (Conn's) What does a low residue diet mean? - AMSLow fiber What does criminal law deal with? - AMSRights of individuals and society as defined by legislative laws NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What does heparin prevent - AMSplatelet aggregation What does preload affect? - AMSThe amount of blood that goes to the R ventricle What drug is contraindicated in Pancreatitis? What pain medication should be used? - AMSDo not give Morphine for pancreatitis because it causes spasms of the Sphincter of Oddi, give Demerol instead. What happens when a patient has prednisone toxicity - AMSCushing's syndrome, buffalo hump, moon face, high glucose, hpertension What have NSAIDs (except aspirin) been linked to and what type of patient should not take NSAIDs? - AMSNSAIDs (except aspirin) have been linked to a higher risk for increased cardiovascular events, such as myocardial infarction, stroke, and heart failure. Patients who have just had heart surgery should not take NSAIDs. NSAIDs are very hard on the stomach. NO NSAIDs for Cardiac patient. What is a durable power of attorney for healthcare? - AMSThe person appoints a representative (healthcare proxy) to make healthcare decisions in a document What is a Mu agonist? - AMSThe so-called agonist-antagonist drugs have a relationship to the opioid receptors that includes activation and blockade. Some of these drugs activate one type of opioid receptor, known as the kappa receptor, while blocking another, the mu receptor What is a sign of a fat embolism and what medication would you give? - AMSpetechiae is a sign of a fat embolism. Treat with heparin What is afterload? - AMSthe resistance that blood has to overcome when leaving the heart What is civil law concerned with? - AMSProtection of the patients private rights What is documented in a living will? - AMSA person documents his or her wishes regarding future care in the event of terminal illness What is HIPPA and what does it require? - AMSHealth Insurance Portability and Accountability Act of 1996 established standards for the verbal, written and electronic exchange of private health information. HIPPA created patient rights to consent to use and disclose health information, to inspect and copy one's medical record, and to amend mistaken or incomplete information. HIPPA requires all hospitals and health agencies to have specific policies and procedures in place to ensure compliance with its standards. What is Hypercalcemia? What signs and symptoms may be present? and how do you treat it? - AMSHypercalcemia is a calcium level above 10.5 mEq/L Calcium affects the muscles, you may see muscle weakness, constipation, n/v, dysrhythmias, and behavioral changes. Limit vitamin D intake but push fluids. Avoid calcium-based antacids. Administer calcitonin to reduce calcium Renal dialysis may be required What is Hyperkalemia, what might you see with the patient and how do you treat it? - AMSHyperkalemia is a K+ level greater than 5 mEq/L You may see tall, tented T waves, bradycardia, muscle weakness. NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Treatment may include: - 10%-20% glucose with regular insulin - Kayexalate - renal dialysis may be required What is Hypernatremia? What symptoms might you see? How should you treat it? - AMSNa+ greater than 145 mEq/L May see: Pulmonary edema Neuro: seizures, thirst, fever. Do Not Use Ivs that contain sodium Restrict sodium diet Weigh daily What is Hypocalcemia, What might the patient exhibit? How will you treat it? - AMSHypocalcemia is a Ca2+ level of less than 8.5 meq/L It affects the muscles: You may see a + Trousseau's sign, + Chvostek's sign, diarrhea, numbness, and convulsions. Treatment may include: calcium supplements and vitamin D to absorb. If giving IV calcium, give it slowly. Teach patient to increase dietary calcium. What is Hyponatremia? Symptoms? and How should you treat it - AMSHyponatremia is a sodium (Na+) level less than 135 mEq/L, it creates Neuro/confusion and muscle cramps. Check blood pressure often, restrict fluids, and be cautious with IV fluid replacement. What is Important to remember about Hypokalemia - AMSHypokalemia is a K+ level less than 3.5 mEq/L. Affects the cardiac system: The patient may exhibit a rapid, thready pulse, flat T waves, fatigue, anorexia, and muscle cramps. Give IV potassium supplements with a max flow rate of 20 meq/hr. Encourage foods high in K+ (bananas, oranges, spinach, potatoes, milk, strawberries, apricots) What is in a LR IV fluid - AMSNS + electrolytes What is most important to remember about extracellular electrolyte balance? - AMSThat sodium Na+ maintains most abundant osmotic pressure. When either the ECF or the ICF changes in concentration, fluid shifts from the area of lesser concentration to the area of greater concentration. What is most important to remember about intracellular electrolyte balance? - AMSThat potassium K+ maintains osmotic pressure and if K+ is not in balance it may be life threatening. What is nursing malpractice? - AMSMalpractice is not always negligence. It is often referred to as professional negligence, it is a type of negligence. It is the failure to use that degree of care that a reasonable nurse would use under the same or similar circumstances. Malpractice is found when: *The nurse owed a duty to the patient *The nurse did NOT carry out the duty/breached that duty *The patient was at a high risk of injury * The nurse's failure to carry out that duty caused the patients injury What is nursing negligence - AMSNegligence is malpractice that is NOT intentional. It is the failure to exercise the proper degree of care required by the circumstances that a reasonably prudent person would exercise under the circumstances to avoid harming others. It is a careless act of omission or commission that results in injury to another. NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. - Do not take away the defense mechanism or coping mechanism the person uses in a crisis. - Customs surrounding death and dying vary among cultures. Make every attempt to understand and accommodate the family's cultural traditions when caring for a dying patient. What skills are needed for Supervision - AMSBe able to: give direction/guidance evaluate/monitor following up what type of communication and leadership is it if the person says "do it my way"? - AMSAggressive communication/authoritarian leader What type of communication and leadership is it if the person says "Lets consider the options available."? - AMSAssertive communication/democratic leader What type of communication and leadership is it if the persons says "Whatever...as long as you like me." - AMSPassive communication/laissez-faire leader What type of drug is Aspirin? - AMSNon opioid Analgesic Salicylates Choline magnesium trisaliclate (Trilisate) is another type of non opioid Analgesic salicylates What type of drug will affect afterload - AMSCalcium channel blockers When an opioid is prescribed in combination with a nonopioid analgesic, such as acetaminophen or a NSAID, what should you monitor? - AMSThe daily dose When blood volume gets low (vomiting, blood loss, etc.) what happens to the secretion of aldosterone and what happens because of it? - AMSAldosterone secretion increases which causes a retention of sodium and water which will make blood volume go up or increase. When can restraints be used? What must the nurse do if restraints are used? - AMSRestraints can be used only: to ensure the physcial safety of the patient or other residents, when less restrictive interventions are not successful, and must have a written order of a HCP. The nurse must follow agency policy and procedure to retrain any client, Documentation of the use of restraints and of follow-up assessments must detail the attempts to use less restrictive interventions. Liability for improper or unlawful restraint lies with the nurse and the healthcare facility. 30 min pulse checks, 2 hr ROM, one on one, When can the nurse NOT follow the healthcare provider's prescription and what must they do about it? - AMSNurses MUST follow the healthcare provider's prescription unless the nurse believes that it is in error; that it violates hospital policy; or that it is harmful to the patient. The nurse makes a formal report explaining the refusal. The nurse should file an incident (occurrence) report for any situation that may result in harm to the patient. When introducing foods to infants what should you teach the new parents? - AMSIntroduce one food at a time to help identify allergies. Progression of food should be "AS TOLERATED" The nursing assessment guides decisions about progression. NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. When selecting an NCLEX answer or determining the order of priority what should you remember or use and what is the exception? - AMSUse the ABC rule: Airway breathing, and circulation. The exception to the rule is with actual CPR, use C-A-B for CPR. Also remember safety first and acute before chronic. If the pt. is not in distress then you assess. If the pt is in distress then you should do something. If the pt has diaphorisis you should always do something. When should you draw a peak level? - AMS30-60 minutes after medication administration When should you draw a trough level? - AMS30-60 minutes before medication administration When should you use NS IV fluids - AMSUse NS when you are trying to replace volume (plasma) Where do Standards of Care originate? - AMSNurses are required to follow standards of care, which originate in the Nurse Practice Acts, state and federal laws, accreditation recommendations, the guidelines of professional organizations, and the written policies and procedures of the healthcare agency Where is aldosterone found - AMSin the adrenal glands Where is Atrial Natriuretic Peptide (ANP) found? - AMSIn the atria of the heart Where is insulin produced? - AMSbeta cells of pancreas Which disease is related to not enough aldosterone? - AMSAddisons: fluid volume is decreased Why should be be concerned about the patient receiving potassium and digoxin - AMSpotassium potentiates dig toxicity NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Acetaminophen (Tylenol) is what type of drug? What is the maximum recommended dosage? What should you monitor? - AMSNonopioid Analgesics. Max dose: 4000 mg (4 g) in 24 hrs Monitor liver function Aldosterone attracts what? - AMSSodium aminoglycosides (mycins) - AMS Angiotensin II in the lungs is a potent? - AMSvasodialator At what pain level should an Opioid Analgesic be considered? - AMSPain level of 6 or greater. Opioids are used for moderate to severe pain. Define fluid volume excess: Hypervolemia - AMStoo much fluid in the vascular space (first). Vascular equals the vessels --> veins, arteries, capillaries, heart chambers, etc. DO NOT delegate what you can EAT - AMSE = evaluate A = assess T = teach EPI is always given in what type of syringe - AMSTB syringe HIV Nursing and Collaborative Management includes... - AMS- Monitor disease progression and immune function -Initiate and monitor (ART) antiretroviral therapy: to decrease viral load and increase T cell count -prevent development of opportunistic diseases -detect and treat opportunistic diseases -manage symptoms -prevent or decrease complications of treatment -prevent transmission of HIV How do you convert Centigrade to Fahrenheit - AMSC+40, multiply 9/5 and subtract 40 How do you convert Fahrenheit to Centigrade - AMSF+40, multiply 5/9 and subtract 40 How do you test for the Chvostek sign and what happens if there is a positive response? - AMSElicitation: Tapping on the face at a point just anterior to the ear and just below the zygomatic bone Postitive response: Twitching of the ipsilateral facial NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. To much CO2 causes what? - AMSvasoconstriction What are low risk therapies - AMSLow-risk therapies are therapies that have no adverse effects and, when implementing care, can be used by the nurse who has training and experience in their use. Low-risk therapies include meditation, relaxation techniques, imagery, music therapy, massage, touch, laughter and humor, and spiritual measures, such as prayer. What are nosocomial infections - AMSInfections acquired as a result of exposure to a microorganism in the hospital setting What are nurses responsible for related to the standards of care? - AMSNurses are responsible for performing procedures correctly and exercising professional judgment when implementing healthcare providers prescriptions. What are some examples of Non-opioid Analgesic pain medications - AMSAcetaminophen (Tylenol) Salicylates: - Aspirin - Choline magnesium trisalcylate (Trilisate) NSAIDs: - Ibuprofen - Indomethacin - Ketorolac - Diclofenac K Cyclooxygenase-2 (COX-2) inhibitors - Celecoxib What are some HIV Medications - AMSNucleoside reverse transcriptase inhibitors (NRTIs) -zidovudine (AZT, ZDV, Retrovir) -lamivudine -abacavir -emtricitabine Nucleotide reverse transcriptase inhibitor (NtRTI) - Tenofovir DF (Viread) What are some symptoms of fluid volume deficit - AMSweight loss oliguria (not enough urine) postural hypotension What are some types of Analgesics (used for moderate to severe pain)? - AMSMu agonists NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. - Morphine - Hydromorphone - Methadone - Levorphanol - Fentanyl - Oxycodone - Codeine (Tylenol No.3) Mixed agonist-antagonists - Pentazocine -Butorphanol Partial agonists - Nuprenorphine -Buprenorphine plus naloxone Adjuvant drugs - used for neuropathic pain - Antiepileptic drugs, antidepressants, and anesthetics are prescribed alone or in combination with opioids for neuropathic pain, - Corticosteroids What are the 3 categories of pain medications - AMS1. non-opioids: for mild pain or in combination for moderate pain 2. Opioids: for moderate to severe pain 3. Co-analgesic or adjuvant drugs (i.e. anticonvulsants, antidepressants) for neuropathic pain What are the 5 stages of grief - AMSDenial, anger, bargaining, depression, and acceptance What are the 7 Rights of medication administration? - AMS1. Right drug 2. right dose 3. Right route 4. Right time 5. Right patient 6. Right documentation 7. Right to refuse What are the five rights of delegation? - AMS1. right task 2. right circumstance 3. right person 4. right direction/communication 5. right supervision What are the goals of HIV drug therapy? - AMS-Reduce the viral load -maintain or raise the CD4+ T cell counts. T cell counts = NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Normal 800-1200 HIV 500 AIDS below 200 -Delay the development of HIV related symptoms and opportunistic diseases **compliance** What are the normal ranges for ABGs? (pH, pCO2, HCO3) - AMSpH (AC) 7.35-7.45 (AL) pCo2 (AL) 35 - 45 (AC) HCO3 (AC) 22 - 26 (AL) What are the normal ranges for ALP (alkaline phosphatase)? - AMS30-120 slightly increased in the elderly What are the normal ranges for BUN? What does BUN stand for? What is the ratio of BUN-creatinine? What does it indicate? - AMS10-20 blood urea nitrogen BUN-creatinine ratio of 20:1 indicates adequate kidney functioning What are the normal ranges for Ca+? What type of drug can increase calcium levels? What are two tests with positive results that are associated with hypocalcemia? How do you preform the two tests? - AMS9-10.5 for adults. slightly lower in the elder Use of thiazide diuretics can cause increased levels of calcium Positive Chvostek and Trousseau tests are associated with hypocalcemia. • Chvostek sign: contraction of ipsilateral facial muscles when the facial nerve is tapped just in front of the ear. • Trousseau sign: carpopedal spasm elicited by inflating a sphygmomanometer above systolic BP for 3 minutes. What are the normal ranges for Cl- - AMS98-106 is the normal range for chloride What are the normal ranges for Creatinine? What is the ratio of BUN-creatinine? What does it indicate? - AMSMale 0.6-1.2 Female 0.5-1.1 BUN-creatinine ratio of 20:1 indicates adequate kidney functioning What are the normal ranges for H&H? What are the nursing implications - AMSHemoglobin - Male 14-18 Female 12-16 Newborn 14-24 NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. elevated BP dyspnea ALOC What are the two main hormonal regulations related to fluid volume - AMSAldosterone (steroid, mineralocorticoid) Atrial Natriuretic Peptide (ANP) What can cause a fluid volume deficit - AMSInadequate fluid intake hemorrhage vomiting or diarrhea massive edema What can cause fluid volume excess: Hypervolemia - AMSHeart Failure (HF) where the heart is weak, CO is decreased, the kidneys have decreased perfusion and urinary output is decreased. **The volume stays in the vascular space! Renal Failure (RF) When the kidneys are not working. Medications: alka-seltzer, fleet enema's and IVF with Na. These medications have a lot of sodium causing water retention in the vascular space. What can cause fluid volume excess? - AMSCHF (most common) Renal failure cirrhosis overhydration What diseases are related to too much aldosterone? - AMSCushings and Hyperaldosteronism (Conn's) What does a low residue diet mean? - AMSLow fiber What does criminal law deal with? - AMSRights of individuals and society as defined by legislative laws What does heparin prevent - AMSplatelet aggregation What does preload affect? - AMSThe amount of blood that goes to the R ventricle What drug is contraindicated in Pancreatitis? What pain medication should be used? - AMSDo not give Morphine for pancreatitis because it causes spasms of the Sphincter of Oddi, give Demerol instead. NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What happens when a patient has prednisone toxicity - AMSCushing's syndrome, buffalo hump, moon face, high glucose, hpertension What have NSAIDs (except aspirin) been linked to and what type of patient should not take NSAIDs? - AMSNSAIDs (except aspirin) have been linked to a higher risk for increased cardiovascular events, such as myocardial infarction, stroke, and heart failure. Patients who have just had heart surgery should not take NSAIDs. NSAIDs are very hard on the stomach. NO NSAIDs for Cardiac patient. What is a durable power of attorney for healthcare? - AMSThe person appoints a representative (healthcare proxy) to make healthcare decisions in a document What is a Mu agonist? - AMSThe so-called agonist-antagonist drugs have a relationship to the opioid receptors that includes activation and blockade. Some of these drugs activate one type of opioid receptor, known as the kappa receptor, while blocking another, the mu receptor What is a sign of a fat embolism and what medication would you give? - AMSpetechiae is a sign of a fat embolism. Treat with heparin What is afterload? - AMSthe resistance that blood has to overcome when leaving the heart What is civil law concerned with? - AMSProtection of the patients private rights What is documented in a living will? - AMSA person documents his or her wishes regarding future care in the event of terminal illness What is HIPPA and what does it require? - AMSHealth Insurance Portability and Accountability Act of 1996 established standards for the verbal, written and electronic exchange of private health information. HIPPA created patient rights to consent to use and disclose health information, to inspect and copy one's medical record, and to amend mistaken or incomplete information. HIPPA requires all hospitals and health agencies to have specific policies and procedures in place to ensure compliance with its standards. What is Hypercalcemia? What signs and symptoms may be present? and how do you treat it? - AMSHypercalcemia is a calcium level above 10.5 mEq/L Calcium affects the muscles, you may see muscle weakness, constipation, n/v, dysrhythmias, and behavioral changes. Limit vitamin D intake but push fluids. Avoid calcium-based antacids. Administer calcitonin to reduce calcium NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Renal dialysis may be required What is Hyperkalemia, what might you see with the patient and how do you treat it? - AMSHyperkalemia is a K+ level greater than 5 mEq/L You may see tall, tented T waves, bradycardia, muscle weakness. Treatment may include: - 10%-20% glucose with regular insulin - Kayexalate - renal dialysis may be required What is Hypernatremia? What symptoms might you see? How should you treat it? - AMSNa+ greater than 145 mEq/L May see: Pulmonary edema Neuro: seizures, thirst, fever. Do Not Use Ivs that contain sodium Restrict sodium diet Weigh daily What is Hypocalcemia, What might the patient exhibit? How will you treat it? - AMSHypocalcemia is a Ca2+ level of less than 8.5 meq/L It affects the muscles: You may see a + Trousseau's sign, + Chvostek's sign, diarrhea, numbness, and convulsions. Treatment may include: calcium supplements and vitamin D to absorb. If giving IV calcium, give it slowly. Teach patient to increase dietary calcium. What is Hyponatremia? Symptoms? and How should you treat it - AMSHyponatremia is a sodium (Na+) level less than 135 mEq/L, it creates Neuro/confusion and muscle cramps. Check blood pressure often, restrict fluids, and be cautious with IV fluid replacement. What is Important to remember about Hypokalemia - AMSHypokalemia is a K+ level less than 3.5 mEq/L. Affects the cardiac system: The patient may exhibit a rapid, thready pulse, flat T waves, fatigue, anorexia, and muscle cramps. Give IV potassium supplements with a max flow rate of 20 meq/hr. Encourage foods high in K+ (bananas, oranges, spinach, potatoes, milk, strawberries, apricots) What is in a LR IV fluid - AMSNS + electrolytes What is most important to remember about extracellular electrolyte balance? - AMSThat sodium Na+ maintains most abundant osmotic pressure. When either the ECF or the ICF changes in concentration, fluid shifts from the area of lesser concentration to the area of greater concentration. NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. What routes of transmission are related to HIV exposure - AMS- unprotected sexual contact (most common) - exposure to blood through drug using equipment - perinatal transmission - most common for children - can occur during pregnancy, at the time of delivery, or after birth through breast feeding What should be avoided when a patient is neutropenic? - AMSNo live vaccines no fresh fruit no flowers What should be considered when communicating with a Chinese American? - AMSMost Chinese Americans maintain a formal distance with others, which is a form of respect. Many Chinese Americans are uncomfortable with face-to-face communications, especially when eye contact is direct. If the client turns away from the nurse during a conversation, the best action is to continue with the conversation. Walking around the client so that the nurse faces the client is in direct conflict with this cultural practice. The client may consider it a rude gesture if the nurse returns later to continue with the explanation. Telling the client about the importance of the instructions for the maintenance of health care may be viewed as degrading. What should the nurse do related to advanced medical directives (ADs) - AMSAssess the patients knowledge of advance directives. Integrate them into the patients plan of care Provide the patient with information about advanced directives or review ADs on admission. Have the knowledge that ADs can limit life-prolonging measures when there is little or no chance of recovery What should you know about HIV symptoms - AMS- 1 to 3 weeks; flu like symptoms - 8-10 years for diagnosis May begin with flu like symptoms in the earliest stage and advance to.. - severe weight loss - secondary infections - cancer -neurological disease What should you remember when someone is dealing with death and grief - AMS- Encourage expression of anger - Do not take away the defense mechanism or coping mechanism the person uses in a crisis. NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. - Customs surrounding death and dying vary among cultures. Make every attempt to understand and accommodate the family's cultural traditions when caring for a dying patient. What skills are needed for Supervision - AMSBe able to: give direction/guidance evaluate/monitor following up what type of communication and leadership is it if the person says "do it my way"? - AMSAggressive communication/authoritarian leader What type of communication and leadership is it if the person says "Lets consider the options available."? - AMSAssertive communication/democratic leader What type of communication and leadership is it if the persons says "Whatever...as long as you like me." - AMSPassive communication/laissez-faire leader What type of drug is Aspirin? - AMSNon opioid Analgesic Salicylates Choline magnesium trisaliclate (Trilisate) is another type of non opioid Analgesic salicylates What type of drug will affect afterload - AMSCalcium channel blockers When an opioid is prescribed in combination with a nonopioid analgesic, such as acetaminophen or a NSAID, what should you monitor? - AMSThe daily dose When blood volume gets low (vomiting, blood loss, etc.) what happens to the secretion of aldosterone and what happens because of it? - AMSAldosterone secretion increases which causes a retention of sodium and water which will make blood volume go up or increase. When can restraints be used? What must the nurse do if restraints are used? - AMSRestraints can be used only: to ensure the physcial safety of the patient or other residents, when less restrictive interventions are not successful, and must have a written order of a HCP. The nurse must follow agency policy and procedure to retrain any client, Documentation of the use of restraints and of follow-up assessments must detail the attempts to use less restrictive interventions. Liability for improper or unlawful restraint lies with the nurse and the healthcare facility. 30 min pulse checks, 2 hr ROM, one on one, NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. When can the nurse NOT follow the healthcare provider's prescription and what must they do about it? - AMSNurses MUST follow the healthcare provider's prescription unless the nurse believes that it is in error; that it violates hospital policy; or that it is harmful to the patient. The nurse makes a formal report explaining the refusal. The nurse should file an incident (occurrence) report for any situation that may result in harm to the patient. When introducing foods to infants what should you teach the new parents? - AMSIntroduce one food at a time to help identify allergies. Progression of food should be "AS TOLERATED" The nursing assessment guides decisions about progression. When selecting an NCLEX answer or determining the order of priority what should you remember or use and what is the exception? - AMSUse the ABC rule: Airway breathing, and circulation. The exception to the rule is with actual CPR, use C-A-B for CPR. Also remember safety first and acute before chronic. If the pt. is not in distress then you assess. If the pt is in distress then you should do something. If the pt has diaphorisis you should always do something. When should you draw a peak level? - AMS30-60 minutes after medication administration When should you draw a trough level? - AMS30-60 minutes before medication administration When should you use NS IV fluids - AMSUse NS when you are trying to replace volume (plasma) Where do Standards of Care originate? - AMSNurses are required to follow standards of care, which originate in the Nurse Practice Acts, state and federal laws, accreditation recommendations, the guidelines of professional organizations, and the written policies and procedures of the healthcare agency Where is aldosterone found - AMSin the adrenal glands Where is Atrial Natriuretic Peptide (ANP) found? - AMSIn the atria of the heart Where is insulin produced? - AMSbeta cells of pancreas Which disease is related to not enough aldosterone? - AMSAddisons: fluid volume is decreased NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. muscles, suggestive of neuromuscular excitability caused by hypocalcemia How do you test for the Trousseau's sign and what happens if there is a positive response? - AMSElicitation: Inflating a sphygmomanometer cuff above systolic blood pressure for several minutes Positive response: Muscular contraction including flexion of the wrist and metacarpophalangeal joints, hyperextension of the fingers, and flexion of the thumb on the palm, suggestive of neuromuscular excitability caused by hypocalcemia How do you treat fluid volume deficits? - AMSStrict I&O Replace with isotonic fluids monitor Bp weight daily How does atrial natriuretic peptide (ANP) work? - AMSIt is the opposite of aldosterone, so it causes excretion of Nas and H2O How often is nitroglycerine administered and when should you not give it? - AMSup to 3 times (every 5 minutes) do not give when BO is less than 90/60 How should you address questions related to Maslow's Hierarchy of Needs - AMSAddress physiological needs first, followed by safety and security needs, love and belonging needs, self esteem needs and finally self actualization needs. *When a physiological need is not addressed in the question, look for the option that addresses safety. How would you treat fluid volume excess? - AMSGive Diuretics (Lasix), fluid restrictions, weigh daily, monitor K+ If a question is related to the nursing process, read the question to determine the step of the nursing process. What are the steps in the nursing process and what kind of question might be related to that step. - AMSAssessment question address the gathering and verification of data. Analysis questions require the nurse to: interpret data, collect additional information, identify and communicate nursing diagnoses and determine the health team's ability to meet the pts needs. Planning questions ask about determining, prioritizing, and modifying outcomes of care. NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. Implementation questions reflect the management and organization of care and the assignment and delegation of tasks. Be prepared for questions on client teaching. Evaluation questions focus on comparing the actual outcomes of care with the expected outcomes and on communicating and documenting findings. If PVC's are left untreated what can it lead to? - AMSVentricular fibrillation Name 3 Invasive non-pharmacological pain relief techniques. - AMSNerve blocks Interruption of neural pathways Acupuncture Name 3 types of IV fluids - AMSIsotonic: 0.9% NS, LR, and D5w Hypotonic: 0.5% NS, 0.45% NS Hypertonic: d5 0.45% NS, D5LR, D5NS Name 4 types of Nonopioid Analgesics - AMS1. Acetaminophen: Tylenol 2. Salicylates: Aspirin, Trilisate 3. NSAIDS: ibuprofen, Indomethacin, Ketorolac, Diclofenac 4. COX-2 inhibitors: Celebrex Name 5 non-invasive non-pharmacological pain relief techniques (1st choice of pain relief) - AMSTen's heat and cold application message therapy relaxation techniques guided imagery biofeedback techniques Never IV push what electroylte - AMSK+ Nursing assessment r/t HIV - AMS-Positive result on enzyme-linked immunosorbed assay (ELISA) - CONFIRMED WITH WESTERN BLOT TEST -Polymerase chain reaction (PCR) - used with neonate - OraQuick In-Home HIV Test: positive result is only preliminary; it must be confirmed by a healthcare professional. **Ongoing assessment, interaction with the client, and client education and support are required.*** - NCLEX testing - never choose abstinence, choose educate! Related to mental Health, how long can an involuntary admission last? - AMS72 hours NURSING NCLEX: Respiratory, Neuro, GI, Ortho Cardio GI, Endocrine, Integumentary (Test Bank) Latest 2023/2024, A+ Guide. To much CO2 causes what? - AMSvasoconstriction What are low risk therapies - AMSLow-risk therapies are therapies that have no adverse effects and, when implementing care, can be used by the nurse who has training and experience in their use. Low-risk therapies include meditation, relaxation techniques, imagery, music therapy, massage, touch, laughter and humor, and spiritual measures, such as prayer. What are nosocomial infections - AMSInfections acquired as a result of exposure to a microorganism in the hospital setting What are nurses responsible for related to the standards of care? - AMSNurses are responsible for performing procedures correctly and exercising professional judgment when implementing healthcare providers prescriptions. What are some examples of Non-opioid Analgesic pain medications - AMSAcetaminophen (Tylenol) Salicylates: - Aspirin - Choline magnesium trisalcylate (Trilisate) NSAIDs: - Ibuprofen - Indomethacin - Ketorolac - Diclofenac K Cyclooxygenase-2 (COX-2) inhibitors - Celecoxib What are some HIV Medications - AMSNucleoside reverse transcriptase inhibitors (NRTIs) -zidovudine (AZT, ZDV, Retrovir) -lamivudine -abacavir -emtricitabine Nucleotide reverse transcriptase inhibitor (NtRTI) - Tenofovir DF (Viread) What are some symptoms of fluid volume deficit - AMSweight loss oliguria (not enough urine) postural hypotension What are some types of Analgesics (used for moderate to severe pain)? - AMSMu agonists