22447430 compiled-nclex-tips-and-questions[1]

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22447430 compiled-nclex-tips-and-questions[1]

  1. 1. HERBAL MEDSSt. Johns wort - antidepressant, photosensitive (C/Iin SULFA drugs)Garlic - antihypertensive (avoid aspirin)Ginseng - Anti stress (C/I in coumadin)Green tea - antioxidant (check if risk forcalculi-oxalates)Echinacea - immune stimulant (6-8 weeks only)(C/I inSANDIMMUNE-Immunosuppressant)Licorice - cough and coldGinger root - antinausea (C/I in Coumadin)Ginkgo - improves circulation (C/I in anticoagulant,headache side effect - check PT)Ma huang - bronchodilator, stimulant (Ephedra)Parent teaching: Use of Infant and Car SeatsWeight below 9 kg (20 lb):Use infant or convertible seat in back seat of car in backward-facing position.Keep infant reclined at a 45 degrees.Never place the infant in the front passenger seat.Fasten seat securely to car using car seat belt and following manufacturere instructions.Adjust harness to fit snugly at shoulders and legs.When using an infant seat, move to larger seat before the infants head reaches the top of shell.When using a convertable seat from birth, use one with a 5-point restraint.Birth-18 kg (40 lb)(Some seats are designed for infants from birht to 40 lbs, others are only designed forinfants up to 20 lb, therefore there are separate instructions for each type)When using a convertableseat, use reclined for rear-facing and upright for forward facing. (Infant remainsrear facing until they reach 20 lb as in the prior instructions)Follow manufacturer instructions for proper positions at specfied child weights for that product (Typciallythis is the "child must face rear until they reach 20 lb)When using a convertible seat, move to a high-backed child seat or booster seat when childs ears are abovethe seat.Always place the seat in the rear of the vehicle. (This is especially true with airbags as when they deploy in anaccident they will seriously injure or kill the child)Above 13.6 or 18 kg-27 or 36.3 kg (30 or 40 lb-60 or 80 lb) (Most instructions agree on the 40 lb & 40 inch-height minimum)Use booster seat fro children who have outgrown convertible/toddler seatsFollow manufacturere instructions for use and specfied child weights for the product (NCLEX questions willbe based on the standards published in nursing textbooks which are those included in this post)Use booster seat until the vehicle lap and shoulder belt fit correctlyHave all children 12 years and under ride in the rear seat, whether or not in a car seat.Air bags can seriously injure a child or cause death, when a child is in a car seat in the front passenger seat.Even when not in a car seat, and when the vehicle is not equipped with a passenger side air bag, the back seatis the safest for all children.From the textbook often used to write the NCLEX pediatric questions: (Ball & Bindler)Preschool childs need for autonomy and control can be met by allowing the child to choose which snacks topick or which finger to stick for glucose testing, or help the parent/caregiver gather necessary supplies.School-age children can learn to test blood glucose, administer insulin, and keep records. They should betaught how to select foods appropriate for dietary management and how to plan an exercise program. Theyneed to learn to recognize the signs and symptoms of hypoglycemia and hyperglycemia, and understand the
  2. 2. importance of carrying a rapidly absorbed sugar product.Adolescents should take on total responsibility for self-care. Although they understand explanations about thepotential complications of diabetes, they are present-time oreinted and may rebel against the dailyregimentation of insulin injections, blood glucose monitoring, and dietary management. Successful self-caredepends in part on the adolescents adjustment to the chronic nature of the disease and feelings of beingdifferent from peers.This same textbook defines:Preschool child, 3-6 years of ageSchool age child, 6-12 years of ageAdolescent, 12-18 years of agePrimary atypical pneumonia (Mycoplasma pneumonia) is characterized as:Select all that apply:O 1 Most common cause of pneumonia in childrenO 2 incidence in children between the ages of 5 and 12O 3 Occurs primarily in summerO 4 more prevalent in crowded living conditionsO 5 caused by Borelia burdorferiThe correct answers are:1, 2 & 4It occurs primarily in the fall and winter monthsThe causative organism is M. pneumoniaeM. pneumoniae is a common cause of mild pneumonia . Various studies suggest that it causes a higherpercentage of pneumonia in school-aged children.People at highest risk for mycoplasma pneumonia include those living or working in crowded areas such asschools and homeless shelters, although many people who contract mycoplasma pneumonia have noidentifiable risk factor.SymptomsThe symptoms are generally mild and appear over a period of one to three weeks. They may progress to moresevere symptoms in some people.Common symptoms include the following:HeadacheFever (may be high)ChillsExcessive sweatingCoughUsually dryUsually without phlegm or bloodChest painSore throatLess frequently seen symptoms include the following:Skin lesions or rashEye pain or sorenessMuscle aches and joint stiffnessNeck lumpRapid respiratory rateEar painSigns and testsA physical examination may reveal enlarged lymph nodes and inflammation of the eardrum. An examinationof the chest with a stethoscope (auscultation) reveals crackles.These tests help confirm the diagnosis:Blood tests for antibodies to mycoplasmaSputum cultureChest x-ray
  3. 3. TreatmentAntibiotics may be prescribed for more serious symptoms related to mycoplasma pneumonia. Home careincludes rest and a high-protein diet with adequate fluids.Expectations (prognosis)Most people recover completely even without antibiotics, although antibiotics may speed recovery. Inuntreated adults, cough and weakness can persist for up to a month.EPOGEN - EPOETIN ALFA RECOMBINANTPossible Test Item:A client with chronic renal failure on dialysis is to receive EPOGEN. Which of the followingsymptoms would warrant the nurse to hold the administration of this human recombinant?Select all that apply:O 1 the client has feverO 2 the client has hypertensionO 3 heart rate 72/minuteO 4 respiratory rate is 19O 5 the client is paleO 6 client has body malaiseThe correct answers: 1 & 2CNS side effect: Pyrexia, withhold the drugCVS side effect: Hypertension, withhold the drug.EPOGEN - recent question in the NCLEX-RNEPOGEN - epoetin alfa recombinantClassificationErytrhopoietin, human recombinant1. normally synthesized in the kidney and stimulates RBC production2. will elevate and maintain RBC level, decreasing the need for BTUses:Treatment of anemia associated with Chronic Renal Failure in adultsC/I: uncontrolled hypertensionSide effects:CV - hypertensionCNS - pyrexiaComplication: PolycythemiaWhat to monitor before and after:BP. TEMP & HEMATOCRITwater.1)a young patient most likely to get lead poisining if?a. he is drinking from a ceramic pitcher.b. father referinshes old furniture at their home> ANSWER is B. probably if he refurbishes an old furniture at home.. that is, if the furniture has oldpaint on it and during 60s paints have lead content on it (heavy metals) and if you need to removethat, chips from the old paint may be taken by a kid that leads to Pb poisoning2) a TB pt understands that he can reduce the risk of spreading his disease if he states?a. i wont sleep in same room w/ my wife for 1-2 monthsb. i will stay away from pregnant women and childrenc. i will use plastic utensil when i eat****>> if the patient is already taking anti-TB drugs, it will only be 2 weeks of chemotherapy andthat (+) PTB will no longer be communicable.. and 1-2 months is long!CHildren are more susceptible to acquire Primary complex and pregnant women are susceptible andalmost vulnerable to all type of illnesses.. There is no need for the patient to separate their utensilssince PTB is airborne and not by contact in terms of transmission.. so i go for B answer.3) 4 years old with salmonella what u should do?a. private roomb. isolationc. place in a room with 4 year old with cellulitisd. keep door closed at all times.
  4. 4. *** the (+) salmonella kid may be placed in a private room. Salmonella is transmitted by Enteric..therefore Enteric precaution is needed and handwashing is very important and gown and gloves,diaper or bedpan in necessary. Option B, and D are all for pulmonary tuberculosis precautions. Isuppose, the answer is A. place in a private room.4) wot herb would help with vomiting?a. ginkob. ginsing.c. ginger rootd. echinacea****> ginger root is good for nausea.. most especially in morning sickness but in moderation forpregnant women... Option C is the answer5) allergic to sulfa wot not to take?a. ma huangb. echunacea....I think the answer is... geez, i forgot..i think its Echinacea..let me check again ok..6) mother called a nurse from home stating that her child having chicken pox..which of the followingstatements by the mother needs immidiate follow up?a. father of the child with liver failureb. sibling with anemiac. child just had tonsillectomyd. child has intermittent low grade feverI think the answer is C. the child that just had tonsillectomy. i think the child isimmunocompromised. and varicella (Chicken pox) is a viral one.. we all know that tonsils are one ofthe lymph defenses we have against any infection.. Im not really sure with this answer.7) clientwith allergy to sudafed ..which of the statments is correct?a. i will take valerianb. i will take ma huangc. i will take echinacea for acute viral inf.d. i will take black cohosh**valerian root is for cystitis and fungal infections; ma huang is for (I forgot!!),echinacea is forimmune booster but not to be taken with patients with progressive systemic disorders such as AIDS,PTB, HIV, etc. black cohosh is for menopause.*** dont you think that Echinacea is the correct option??8)food processinga. frozen food can be defrost for up to six hoursb. frozen food which has been defrost can be return back to fridge.c. cook perishible food should cover and coold. frozen food should be defrost by hot waterusually, frozen food must be thawed at cool tap water for freshness. not in the microwave because itcan be cooked outside and raw inside, not in the hotwater with same principle. so i believe, thawingit FOR UP TO 6 HOURS would be ok. returning thawed food back at fridge is ok but it is unsafesince salmonella can start thriving in.. Answer is OPTION A.9) child in a mist tent and the parents brought him a car toy...the child was clutching the toy and thenurse refused to let him play for wot reason?a. it will get contaminated with bacteriab. it will accumalate moisturec. it could cause a fire** The answer is OPTION C. Usually car toy have friction on it for the wheels to run.. Oxygensupports combustion.. and if friction is present together with oxygen (in a mist tent) then, fire couldcommence.11) a mother reported tht her son is throwing up each time she feeds him wot would be the bestquestion u ask?a. did u warm up the formulab. wot kind of formula did u give himc. does ur son feel hungry each time he throws upd. does r son have a jelly like stool***>>> CORRECT OPTION is D.. Does your son have jelly like stool.. jelly like or currant likestool is a cardinal sign of Intussusception/ Telescoping or invagination of the large intestines in theIleoceccal area..
  5. 5. 12) a patient had AIDS the nurse should advise?a. cook ur meat very wellb. not to eat in the same table with familyc. avoid crowds***>> if you have AIDS, u are immunocompromised.. therefore you are prone to infection..neutropenic precaution is advised and one that is a must is Avoiding Crowds.. Correct option is C.Seasonal Affective Disorder (SAD) may affect over 10 million Americans.The typical symptoms of SAD include depression, lack of energy, increased need for sleep, a cravingfor sweets and weight gain. Symptoms begin in the fall, peak in the winter and usually resolve in thespring. Some individuals experience great bursts of energy and creativity in the spring or earlysummer.Susceptible individuals who work in buildings without windows may experience SAD-typesymptoms at any time of year. Some people with SAD have mild or occasionally severe periods ofmania during the spring or summer. If the symptoms are mild, no treatment may be necessary. Ifthey are problematic, then a mood stabilizer such as Lithium might be considered. There is a smallergroup of individuals who suffer from summer depression.SAD is recognized in the DSM-IV (The American Psychiatric Associations diagnostic manual) as asubtype of major depressive episode.Some individuals who work long hours inside office buildings with few windows may experiencesymptoms all year round. Some very sensitive individuals may note changes in mood during longstretches of cloudy weather.A sign of improvement from dehydration would be a decreased urine specific gravity and adecreased/decreasing hematocrit. So the SG of 1.015 and a Hct of 46% would be the answer. It is thebest answer of the two you had in you question.The normal urine SG is 1.003-1.035 (Usually between 1.010-1.025 with normal hydration andvolume) (different texts give a slightly different range).SG 1.025-1.030+ (concentrated urine)SG 1.001-1.010 (dilute urine)SG 1.001-1.018 in infants under 2 years of ageSpecific gravity is a measurement of the kidneys ability to concentrate urine. The range of urinesSG depends on the state of hydration and varies with urine volume and the load of solids to beexcreted under standardized conditions; when fluid intake is restricted or increased, SG measures theconcentrating and diluting functions of the kidney. Loss of these functions is an indication of renaldysfunction.SG values usually vary inversely with amounts of urine excreated (decrease in urine volume =increase in specific gravity). However in some conditions this is not the case. For example:a. Diabetes: increased urine volume, increased SG (High amount of glucose in urine)b. Hypertension: normal volume, decreased SGc. Early chronic renal disease: increased volume, decreased SGHematocrit: Percentage of packed red cells in a volume of whole blood. The hematocrit will beincreased in dehydration.Source: A Manual of Laboratory & Diagnostic Tests (Frances Fischbach)digitalis toxicity includes..N - nauseaA - anorexiaV - vomitingD - diarrheaA - abdominal painkasma na changes sa vision..Digitalis toxicity is the result of the body accumulating more digitalis than it can tolerate at that time.Patient will complain visual change in color, and loss of appetite.From RAG book and memory notebookDrugs which can cause URINE DISCOLORATIONAdriamycyn------ ReddishRifabutin--------- Red orange
  6. 6. Rifampicin------- Red orangeBactrim---------- Red orangeRobaxin--------- Brown, Black or GreenishAzulfidine------ Orange yellowFlagyl------------ BrownishDilantin---------- Pink tingedAnti Psychotic-- Pinkish to Red brownEarly signs of hypoxia:R-restlessnessA-anxietyT-TachycardiaLate signs of hypoxia:B-bradycardiaE-extreme restlessnessD-dyspneaIn pedia-F-feeding difficultyI-inspiratory stridorN-nares flareE-expiratory gruntingS-sternal retractionsRespiratory PatternsKussmaul- fruity acetone breath odorCheyne-stokes- near death breathing patternCRUTCH WALKING UP STAIRSGood goes to heaven, Bad goes to hellCYSTITIS-Inflamation of the urinary bladderManifestations:Urgency and frequencyLab data:Culture and sensitivity tests reveal the presence of bacteremiaUsually E.ColiPREVENTING CYSTITIS>Drink 8-10 glasses of fluid per day>Women should wipe from front to back>Urinate after intercourse>Avoid vaginal deodorants and bubble baths>Avoid silk underwear, cotton underwear is preferred>Maintain acid ash diet (cheese,cranberry,prunes and plums1.Which of the following statements made by a patient reflects a need for further teaching?a. I drink a lot of fluidsb. I usually go nonstop driving for 8 hours on weekends--- answerc. I should avoid bubble bathsd. I love drinking citrus juices2. Which of goal of nursing care takes priority for a female client with cystitis?a. increasing urine alkalinityb. maintaining a balanced fluid I & Oc. Providing instructions on perineal hygiene--- answerd. screening urine for sedimentationMuskuloskeletal Anatomical tipsTENDONS- connect muscle to boneLIGAMENTS- connect bone to boneCUSHING SYNDROMEHypersecretion of Glucocorticoids by the adrenal glandsManifestations:central type or truncal obesity with thin extremetiesmoonfacebuffalo humphirsutismLab data:Elevated serum cortisol levels
  7. 7. Hypernatremia,hyperglycemia,hypertensionHypokalemiaIntervention:High potassium, Low sodium dietLifelong administration of glucocorticoid synthesis inhibitorsEg. MitotaneInform that there will be poor wound healingSample question:When assessing a 40-year old patient with cushing’s syndrome, the nurse should expect the person todemonstrate:A lability of mood---- answerB ectomorphism with a moon faceC a decrease in the growth of facial hairD an increase resistance to bruising and bleedingEYE ABBREVIATIONSOU- both eyesOR- right eyeOS- left eyeLEVELS OF CONSCIOUSNESSA------ ALERTV------ VERBAL STIMULIP------ PAINFUL STIMULIU----- UNRESPONSIVEREASONS FOR UNCONSCIOUSNESS(SKIN COLOR)RED----- Stroke or increase BPWHITE---- Shock or HemorrhageBLUE--- Respiratory or Cardiac ArrestCIRCULATION ASSESSMENT- 5PsPainPallorPulseParesthesiaParalysisCHOLINERGIC CRISISS- SalivationL-LacrimationU-UrinationD-DefecationGEADLsB-BathingA-AmbulationT-ToiletingT-TransfersE-EatingD-DressingInstrumental ADLsS-shoppingC-cooking, cleaningU-using telephone /transportationM-managing money and medicationsC caneO opposite
  8. 8. A affectedL legIN CASE OF ABDOMINAL TENDERNESSInspect, auscultate, percuss, palpateCUSHINGS (Hypersecretion of Adrenal Cortex Hormones)C = Check VS, particularly BPU = Urinary output & weight monitoringS = Stress ManagementH = High CHON dietI = Infection precautionN = Na+ restrictionG = Glucose & Electrolytes MonitoringS = Spousal supportADDISONS (Hyposecretion of Adrenal Cortex Hormones)Always Remember the 6 As of Addisons disease1.) Avoid Stress2.) Avoid Strenuous3.) Avoid Individuals with Infection4.) Avoid OTC meds5.) A lifelong Glucocorticoids Therapy6.) Always wear medic alert braceletIF RESPIRATORY DEPRESSION OR OVERSEDATION IS SUSPECTED:1. CEASE the PCA2. CEASE all other infusions that could be contributing to sedation3. Attempt to rouse the patient4. Call 777 [MET team] if appropriate5. If apnoeic: administer bag & mask ventilation with 100% oxygen6. If breathing: maintain airway, monitor oxygen saturations and administer oxygen via face mask at8L/min7. Check circulation. If pulseless: commence chest compressions8. Prepare naloxone for possible administration9. Call CPMS for urgent reviewAllergic: caused by sensitivity to foreign proteins.Clinical Manifestations: Urticaria, flushing, itching, no fever.Treatment: Administer antihistamines as directed.If manifestations mild and transient, transfusion may resume.Prevention: Treat prophylactically with antihistamines.Acute hemolytic: caused by infusion of ABO-incompatible red blood cells.Clinical manifestations: Chills, fever, low back pain, flushing, tachycardia, hemoglobinuria,hypotension, vascular collapse, bleeding, acute renal failure, shock, cardiac arrest, death.Management: Discontinue transfusion, removing/changing IV tubing down to IV catheter.Send blood samples for serologic testing, and send urine samples to lab. Send blood tubing tolab/blood bank.Maintain blood pressure.Give diuretics as prescribed to maintain urine flow.Insert indwelling catheter or measure hourly output.Dialysis may be needed.Prevention: Meticulously verify recipent from sample collection to transfusion.Anaphylactic reaction: caused by infusion of IgA proteins to IgA-deficient recipient who hasdeveloped anti-IgA-antibodies.Clinical Manifestations: Anxiety, urticaria, wheezing progressing to cyanosis, shock, and possible
  9. 9. cardiac arrest.Treatment: Do not transfuse additional RBC.Initiate CPR if indicated.Have epinephrine ready for injection (0.4 ml of a 1:1000 solution SCPrevention: Give blood composnents from IgA-deficient donors or remove all plasma by washing.Hirschsprung’s diagnosed with rectal biopsy looking for absence of ganglionic cells. Cardinal signin infants is failure to pass meconium, and later the classic ribbon-like and foul smelling stools.Intussusception common in kids with CF. Obstruction may cause fecal emesis, currant jelly-likestools (blood and mucus). A barium enema may be used to hydrostatically reduce the telescoping.Resolution is obvious, with onset of bowel movements.With omphalocele and gastroschisis (herniation of abdominal contents) dress with loose salinedressing covered with plastic wrap, and keep eye on temp. Kid can lose heat quickly.After a hydrocele repair provide ice bags and scrotal support.No phenylalanine with a kid positive for PKU (no meat, no dairy, no aspartame).Second voided urine most accurate when testing for ketones and glucose.Never give potassium if the patient is oliguric or anuric.Nephrotic syndrome is characterized by massive proteinuria (looks dark and frothy) caused byglomerular damage. Corticosteroids are the mainstay. Generalized edema common.A positive Western blot in a child <18 months (presence of HIV antibodies) indicates only that themother is infected. Two or more positive p24 antigen tests will confirm HIV in kids <18 months.The p24 can be used at any age.For HIV kids avoid OPV and Varicella vaccinations (live), but give Pneumococcal and influenza.MMR is avoided only if the kid is severely immunocompromised. Parents should wear gloves forcare, not kiss kids on the mouth, and not share eating utensils.Hypotension and vasoconstricting meds may alter the accuracy of o2 sats.An antacid should be given to a mechanically ventilated patient w/ an ng tube if the ph of theaspirate is <5.0. Aspirate should be checked at least every 12 hrs.Ambient air (room air) contains 21% oxygen.The first sign of ARDS is increased respirations. Later comes dyspnea, retractions, air hunger,cyanosis.Normal PCWP is 8-13. Readings of 18-20 are considered high.First sign of PE (pulmonary embolism) is sudden chest pain, followed by dyspnea and tachypnea.High potassium is expected with carbon dioxide narcosis (hydrogen floods the cell forcingpotassium out). Carbon dioxide narcosis causes increased intracranial pressure.Pulmonary sarcoidosis leads to right sided heart failure.An NG tube can be irrigated with cola, and should be taught to family when a client is going homewith an NG tube.Q&As found in the NCLEX FORUMQuestion # 1 (Multiple Choice) History and exam indicates your 77 year oldfemale patient has digitalis toxicity. Which drugs are contraindicated in this
  10. 10. case? Plz provide your rationale.A) lidocaine and atropineB) adenosine and amiodaroneC) magnesium sulfate and sodium bicarbonateD) bretylium and verapamilAnswer::A) lidocaine and atropine-Dont affect dig level/dig toxicity.B) adenosine and amiodarone-Amiodarone, increases serum dig levels, possiblycausing dig toxicity. Adenosine doesnt affect dig toxicity. Only one of thesemeds is contraindicated in dig levels/toxitiy.C) magnesium sulfate and sodium bicarbonate. Neither drug affects dig levelsD) bretylium and verapamil-BEST ANSWER: Verapamil, increases serum dig levels,possibly causing dig toxicity. Bretylium aggravates dig toxicity and digoxintoxic arrhytmias are exacerbated by bretylium. This answer has two meds that areshould not be given to dig toxic patients.Question # 2(Multiple Choice) Regarding abruptio placentaeA) Blood loss is confined within the amniotic sacB) Internal bleeding is generally minimal.C) Blood loss may be concealed between the uterine wall and the placentaD) There is always excessive external vagina bleedingwhats the correct one? I just dont agree with c.Answer::C. is the best answer because it does describe placenta previa, most correctly.Placenta previa is premature separation of the placenta, and the blood loss canbe either apparent or concealed. If the edges of the placenta remain attached tothe uterus then there will be no apparent loss of blood. However the woman isstill have significant internal bleeding.A. is incorect because it does not describe A.P.B. is incorrect because blood loss is usually significant, not minimal.D. is incorrect because blood loss can be hidden.Question # 3 (Multiple Choice) The geriatric patient suffering from organic
  11. 11. brain syndrome or dementia may not be able to make a rational decisionsregarding emergency care. In these situations, you may use ____to permit you tolegally render careA) Good Samaritan LawsB) Standards of CareC) Implied ConsentD) Informed Consentc is given as correct. why?Answer:: Implied consent means that the patient most likely has been found indistress and it is assumed that person wants to live. Therefore, you are withinthe law to treat a person who is unable to make a decision about his/her carewho is in an emergency situation.Above answer to your question explains why C is the best answer. Let me pointout a test taking tip to further support how you would choose this answer on anexam, like NCLEX. First look at your question and identify, the key words, i.e.what the question is asking. This question is asking which law will permit youto deliver care in an emergency situation, when the patient is unable to giveconsent. Now define each of the possible reponses.A) Good Samaritan Laws-This law is to protect the individual that intervene toprovide care in an emergency from litigation. In other words, if a nurse stopsat an accident scene and provides care, the nurse will not be held liable fortheir actions, if the care was provided in good faith according to practicestandards. Therefore this is not the answer.B) Standards of Care-These are established guidelines for the nurse/health careprovider that outline safe and effective nursing care/interventions for givendiagnoses, etc. So, again this is not the answer to the question.C) Implied Consent-Best answer, the patient cant verbalize consent, due totheir OBS/dementia, but they need emergency care. Because care is required thenconsent to provide life saving care is implied. The same principle applies whengiving emergency care to unconscious patients. You cant wait for them to tellyou it is OK, to save their life, the law allows you to intervene. This isimplied consent.
  12. 12. D) Informed Consent-This is when the physician describes the procedure that isto be preformed. Included in this explanation is the benefits and risksassociated with the procedure. The patient is INFORMED about the procedure andthen they give their consent. Again, this is not the best answer.Try this technique when answering NCLEX-like questions, and you will find thatyou will get more correct.Question:1.)a person is holding their neck what do you do?a.)ask them can they cough.b.)immediately perform the heimlich maneuver. I got confused because Iknow are suppose to ask the person can they talk.2.) an elderly client has alzheimers and wanders through out the day. To protecthis safety what is the best thing to do?a.) put alarms on all the doors.b.) inform all the staff to reorient the client.c.) have the security guards to check on him.d.) family to sit with him.3.)When teaching a pt.about urinary catheter. What is most important?a.)wear sterile gloves.b.)clean the urethra with betadine.4.)A woman is coming in for a pap smear what is most import to follow up onbefore the pap smear is performed.a)I just started menstruating and it is very heavy.b) my last pap smear was abnormal.C)I never had sex before.d)I forgot this choice.Answer:These are some thoughts and rationales for the possible best answers to yourquestions.1.)a person is holding their neck what do you do?a.) ask them can they cough. BEST ANSWER, because you need to confirm/rule out anobstructed airway. If the patient can cough, then they are encouraged to do so.If they cant speak or cough (no airway movement/obstructed airway) then youbegin the sequence for removing an airway obstruction, in this case it would be
  13. 13. for a conscious patient.b.)immediately perform the heimlich maneuver. NOT THE BEST CHOICE, because youneed to confirm whether or not the patient is able to move air effectivelybefore performing this maneuver. Therefore to rule out an obstructe airway youneed to select an answer that will establish if the patient can speak, cough orsome other indicator of air movement.I got confused because I know are suppose to ask the person can they talk. Thiscorrect, but as you know from taking the NCLEX, the answer you want is neverthere. What you have to do is select the answer that best matches/fits theprinciples for the answer you would expect to find. You ask if the patient canspeak to confirm/rule out airway movement. Asking if they can cough willaccomplish the same thing.2.) an elderly client has alzheimers and wanders through out the day. to protecthis safety what is the best thing to do? Key words in this question are WANDERS,Alzheimers patient, and to protect HIS SAFETY.a.) put alarms on all the doors. BEST ANSWER, this is for the patients SAFETY,because Alzhiemers patients wander and if they were to leave the healthcarefacility their safety would be compromised significantly. The alarms willimmediately alert all staff and the patient can be returned to the unitimmediately.b.) inform all the staff to reorient the client. NO, remember the question isasking about safety. Reoriented an Alzheimer’s patient is appropriate nursingcare, but they have no short term memory, so this will not ensure that they willremain on the unit. They can (and will ) still wander.c.) have the security guards to check on him. NO, this is both extreme and it is"passing the buck". On the NCLEX it is up to nursing to solve nursingproblems. The patient could be injured or leave the unit between checks by thesecurity guards.d.) family to sit with him. NO, this is "passing the buck" and putting anotherburden on a family that is already in crisis due to the fact they have a familymember with Alzheimers disease.
  14. 14. 3.)When teaching a pt.about urinary catheter. What is most important? Bothanswer dont match the principles of home care for a client with a catheter, soit would be interesting to know what the other options were.a.)wear sterile gloves. NO, because this is a clean procedure.b.)clean the urethra with betadine. BEST answer of the two choices, because homecatheter care is a clean procedure, so A would not be the choice. Betadine is agood anti-infective agent but it can be irritating to tissues. Generallycleaning with soap and water is all that is recommended for home care.4.)A woman is coming in for a pap smear what is most import to follow up onbefore the pap smear is performed.a) I just started menstruating and it is very heavy. BEST ANSWER, the best timeto obtain a pap smear is two weeks after the first day of the last menstrualperiod and DEFINITELY NOT when the patient is menstruating, as this will affectthe results.b) my last pap smear was abnormal. No, this is important to know, but not assignificant as A. This is not a contraindication to performing the test.C) I never had sex before. No, this is important to know, but A is moresignificantd)I forgot this choice.Question:1. Alzheimers patient incontinent of urine during the night times. The nursing care includesa) Offers bed pan every 2 hoursb) Limit fluids during evening timesc) Foleys catheter2. After immediate post operative hysterectomy patient to observe (or) Nursing care includesa) Observe vaginal bleedingb) Urine outputc) Vital signs3. Dilantin prescribed to the patient, instructions to patient include
  15. 15. a) Reticulocyte countsb) Platelet counts4. On the ECG found a straight line, first Nursea) Assess the patientb) Cardiopulmonary resuscitationc) IV fluids5. 15% superficial burns, 20% partial thickness burns. If the fluids adequatea) Urine output 30-40ml/hrb) BPc) Vital signsd) Skin turgor6. 20 week pregnant most concerneda) Butterfly rash on both cheeks and noseb) Uterus palpate at the level of symphysis pubisc) Sereous fluid drain in the breastsd) Breast enlargement7. The sterile technique is broken when:a) The sterile field and supplies are wetb) Clean the area peripheral to center8. The metal piece is embedded on the left eyea) Pressure dressing is applied on the left eyeb) Dressing is applied on both eyesc) Irrigate the eye with saline9. After cerebral angiogram, patient isa) Encourage fluidsb) obseve contrast medium in the urinec) walking10. Using clean, non sterile gloves, care is appropriatea) wash the genitelia........YES/NOAnswers:-The following possible best answers are based on the information found in nursing textbooks, andthe underlying principle for safe and effective care that NCLEX is testing for.1. Alzheimers patient incontinent of urine during the night times. The nursing care includesa) Offers bed pan every 2 hours-NO, would be appropriate to bring the client to the toilet orcommode every 2 hours during the day, but this action means you disturb the clients sleep.b) Limit fluids during evening times, BEST ANSWER-(Source: Black & Hawks, Medical-SurgicalNursing 7th edition) Specific interventions for the Alzheirmers client with urinary incontinence:"Sometimes the client forgets where the bathroom is located. Having bright lights and frequently
  16. 16. taking the client there may help control incontinence. Fluid intake after the dinner meal can berestricted to maintain continence during the night."c) Foleys catheter-NO, would increase risk of lower urinary tract infection, inappropriate and notnecessary.2. After immediate post operative hysterctomy patient to observe (or) Nursing care includesa) Observe vaginal bleedingb) Urine outputc) Vital signs-BEST ANSWER, as this provides the best/most information about the clientsresponse to surgery and anesthesia.3. Dilantin prescribed to the patient, to instruct the patient that includesa) Reticulocyte counts-Yes, this will test for decreased reticulocyte count a sign that the patient isdeveloping aplastic anemia, a potentially life threatening side effect of Dilantin therapy.b) Platelet counts-No, however Dilantin can decrease the platelet count and result inthrombocytopenia. Aplastic anemia is considered to be more serious (Davis Drug Guide)4. On the ECG found a straight line, first Nursea) Assess the patient-BEST ANSWER, always assess the patient to be sure there is no equipmentmalfunction, and/or to confirm the information on the monitor.b) Cardiopulmonary resuscitationc) IV fluids5. 15% superficial burns, 20% partial thickness burns. If the fluids adequatea) Urine output 30-40ml/hr BEST ANSWER, the patients fluid balance/hydration status is bestevaluated by assessing urine output. Urine output should be between 0.5 and 1.0 mL/kg/hr, whichfor a 130 lb adult would be between 29.5 -59 mL/hr. Most nursing textbooks consider 30 mL/hr ofurine output to indicate appropriate fluid balance/hydration.b) BPc) Vital signsd) Skin turgorFor b, c, and d many other factors can affect these findings. Urine output directly correlates with thepatients hydration status/fluid balance.6. 20 week pregnant most concernedA) Butterfly rash on both cheeks and nose-NO this is Cholasma the "mask of pregancy", result ofhormonal changes in pregnancy.b) Uterus palpate at the level of symphysis pubis-BEST ANSWER this correlates with 12 weeksgestation and the patient in the question is 20 weeks. This is a significant difference.c) Sereous fluid drain in the breasts-NO, leaking of clear fluid from the breasts during pregnancy isnot unusual.d) Breast enlargement-NO, the breast enlarge during pregnancy.7. The sterile technique is broke whena) The sterile field and supplies are wet-BEST ANSWER, this would allow microorganisms to enterthe sterile field through the wet surface.
  17. 17. b) Clean the area peripheral to center-NO, this is inappropriate technique but response a, specificallydescribes how a sterile field can be contaminated and is an important principle in maintaining sterilefields.8. The metal piece is embedded on the left eyea) Pressure dressing is applied on the left eye-NO, this would "push" the object further into the eye.b) Dressing is applied on both eyes-BEST ANSWER, you want to keep the left eye still, and becauseboth eyes move together the uninjured eye must be covered to prevent movement in the injured eye.c) Irrigate the eye with saline-NO, the object is embedded, meaning deep within the eye. Irrigationwill not remove the object but theoretically it could cause it to move resulting in further damage.9. After cerebral angiogram, patient isa) Encourage fluids-BEST ANSWER, when ever contrast medium/X-ray dyes are administer theclient is hydrated to facilitate excretion of the dye.b) obseve contrast medium in the urine-NO, should not be observable to patient or nurse.c) walking-NO, bedrest would be maintained for a prescribed period of time.10. Using clean, non sterile gloves care is appropriatea) wash the genitelia........YES/NO- YES, this is not a sterile procedure.Question:A patient is receiving 1,000 ml of 5% glucose and 0.45% normal saline with 40 mEq of potassiumchloride. most important for nurse to monitor the patient :A. pulse rateB. daily weightC. skin turgorAnswer1:I would say, always check for urine output before commencing anything with Potassium because itcan only be excreted in the urine. Hence if you are dehydrated & have decrease urine output &commenced on K+ hyperkalemia will arise leading to cardiac arrythmia.Answer2:The answer is pulse rateQuestion:1)a young patient most likely to get lead poisining if?
  18. 18. a. he is drinking from a ceramic pitcher.b. father refurnishes old furniture at their home2) a TB pt understands that he can reduce the risk of spreading his disease if he states?a. i wont sleep in same room w/ my wife for 1-2 monthsb. i will stay away from pregnant women and childrenc. i will use plastic utensil when i eat3) 4 years old with salmonella what u should do?a. private roomb. isolationc. place in a room with 4 year old with cellulitisd. keep door closed at all times.4) wat herb would help with vomiting?a. ginkgob. ginseng.c. ginger rootd. echinacea5) allergic to sulfa wat not to take?a. ma huangb. echinacea.6) mother called a nurse from home stating that her child having chicken pox, which of the followingstatements by the mother needs immediate follow up?a. father of the child with liver failureb. sibling with anemiac. child just had tonsillectomyd. child has intermittent low grade fever7) client with allergy to sudafed ..which of the statments is correct?a. i will take valerianb. i will take ma huangc. i will take echinacea for acute viral inf.d. i will take black cohosh8) food processinga. frozen food can be defrost for up to six hoursb. frozen food which has been defrost can be return back to fridge.c. cook perishable food should cover and coold. frozen food should be defrost by hot water9) child in a mist tent and the parents brought him a car toy...the child was clutching the toy and thenurse refused to let him play for wat reason?a. it will get contaminated with bacteriab. it will accumalate moisturec. it could cause a fire11) a mother reported that her son is throwing up each time she feeds him wat would be the bestquestion u ask?a. did u warm up the formulab. wot kind of formula did u give him
  19. 19. c. does ur son feel hungry each time he throws upd. does ur son have a jelly like stool12) a patient had aids the nurse should advise?a. cook ur meat very wellb. not to eat in the same table with familyc. avoid crowdsAnswer:1)a young patient most likely to get lead poisining if?a. he is drinking from a ceramic pitcher.b. father refurbishes old furniture at their home> ANSWER is B. probably if he refurbishes an old furniture at home.. that is, if the furniture has oldpaint on it and during 60s paints have lead content on it (heavy metals) and if you need to removethat, chips from the old paint may be taken by a kid that leads to Pb poisoning2) a TB pt understands that he can reduce the risk of spreading his disease if he states?a. i wont sleep in same room w/ my wife for 1-2 monthsb. i will stay away from pregnant women and childrenc. i will use plastic utensil when i eat****>> if the patient is already taking anti-TB drugs, it will only be 2 weeks of chemotherapy andthat (+) PTB will no longer be communicable.. and 1-2 months is long!CHildren are more susceptible to acquire Primary complex and pregnant women are susceptible andalmost vulnerable to all type of illnesses.. There is no need for the patient to separate their utensilssince PTB is airborne and not by contact in terms of transmission.. so i go for B answer.3) 4 years old with salmonella what u should do?a. private roomb. isolationc. place in a room with 4 year old with cellulitisd. keep door closed at all times.*** the (+) salmonella kid may be placed in a private room. Salmonella is transmitted by Enteric..therefore Enteric precaution is needed and handwashing is very important and gown and gloves,diaper or bedpan in necessary. Option B, and D are all for pulmonary tuberculosis precautions. Isuppose, the answer is A. place in a private room.4) wat herb would help with vomiting?a. ginkob. ginsing.c. ginger rootd. echinacea****> ginger root is good for nausea.. most especially in morning sickness but in moderation forpregnant women... Option C is the answer5) allergic to sulfa wat not to take?a. ma huangb. echinacea.
  20. 20. ...I think the answer is... geez, i forgot..i think its Echinacea..let me check again ok..6) mother called a nurse from home stating that her child having chicken pox..which of the followingstatements by the mother needs immediate follow up?a. father of the child with liver failureb. sibling with anemiac. child just had tonsillectomyd. child has intermittent low grade feverI think the answer is C. the child that just had tonsillectomy. i think the child isimmunocompromised. and varicella (Chicken pox) is a viral one.. we all know that tonsils are one ofthe lymph defenses we have against any infection.. Im not really sure with this answer.7) client with allergy to sudafed ..which of the statments is correct?a. i will take valerianb. i will take ma huangc. i will take echinacea for acute viral inf.d. i will take black cohosh**valerian root is for cystitis and fungal infections; ma huang is for (I forgot!!),echinacea is forimmune booster but not to be taken with patients with progressive systemic disorders such as AIDS,PTB, HIV, etc. black cohosh is for menopause.*** dont you think that Echinacea is the correct option??8)food processinga. frozen food can be defrost for up to six hoursb. frozen food which has been defrost can be return back to fridge.c. cook perishible food should cover and coold. frozen food should be defrost by hot waterusually, frozen food must be thawed at cool tap water for freshness. not in the microwave because itcan be cooked outside and raw inside, not in the hotwater with same principle. so i believe, thawingit FOR UP TO 6 HOURS would be ok. returning thawed food back at fridge is ok but it is unsafesince salmonella can start thriving in.. Answer is OPTION A.9) child in a mist tent and the parents brought him a car toy...the child was clutching the toy and thenurse refused to let him play for wot reason?a. it will get contaminated with bacteriab. it will accumalate moisturec. it could cause a fire** The answer is OPTION C. Usually car toy have friction on it for the wheels to run.. Oxygensupports combustion.. and if friction is present together with oxygen (in a mist tent) then, fire couldcommence.11) a mother reported that her son is throwing up each time she feeds him wat would be the bestquestion u ask?a. did u warm up the formulab. wot kind of formula did u give himc. does ur son feel hungry each time he throws upd. does r son have a jelly like stool
  21. 21. ***>>> CORRECT OPTION is D.. Does your son have jelly like stool.. jelly like or currant likestool is a cardinal sign of Intussusception/ Telescoping or invagination of the large intestines in theIleoceccal area..12) a patient had AIDS the nurse should advise?a. cook ur meat very wellb. not to eat in the same table with familyc. avoid crowds***>> if you have AIDS, u are immunocompromised.. therefore you are prone to infection..neutropenic precaution is advised and one that is a must is Avoiding Crowds.. Correct option is C.Posted by anaski from IP 203.131.185.106 on September 08, 2005 at 03:45:59:Thank you so much English RN2BFuture USRNs, this for you:PRIORITY QUESTIONS (WHO TO SEE FIRST)Sample Test Item:1. Which of the following clients should the nurse deal with FIRST?o 1 A client who needs his daily vitamino 2 A client who needs to be suctionedo 3 A client who needs diaper to be changedo 4 A client who is being prepared for dischargeCorrect Answer: 2. A client who needs to be suctionedPRIORITY (Use ABC)Obstruction in the airway – secretionsNeed to be suctioned2. Delegation, RN, LVN, UAP, CNAWhich of the following clients should the LPN be assigned to?o 1 A newly diagnosed patient with MYASTHENIC CRISISo 2 An immediate post-op client in PACUo 3 A client awaiting medication for vitaminso 4 A new admission for KIDNEY Transplant PatientCorrect Answer: 3-stable, A client awaiting medication for vitaminsMyasthenic Crisis – Unstable, Acute Respiratory FailureImmediate Post – op – Unstable, Risk for Complications,Kidney Transplant – Unstable, needs assessment for rejectionDELEGATION: Remember the 5Rs, Right Task, Right Person, Right Circumstance, RightCommunication & Right Feedback)RN Least stable, unstable, central catheters (hickman, broviac), admission, discharge, healthteachings, patient for transfer, blood transfusion (2RNs)LPN Technical Doer, Stable, medications, wound dressingCNA Routine Care, Urine Dip Stix, Reporting to RN, Routine VSUAP turning q2H, conducting group activities, ambulationFor future USRNsThis is for you... from the purkinje fibers of my heart....Room Assignment(Who to Share Room with)Check:A geB eside the nurses station? At the end of the hallway? Single Room/Private Room?C hain of infection/circumstanceD iagnosisE nviroment (dim light, darkened, red nightlapm)
  22. 22. Sample Test Item:The best roommate for patient with LEUKEMIA isO 1 A 9-year-old with ruptured appendixO 2 A 12-year-old with chicken poxO 3 A 2-year-old with fever of unknown originO 4 A 5-year-old with nephrotic syndromeCorrect Answer: 4. A 5-year-old with nephrotic syndrome.1,2 & 3, manifest symptoms of infection. A client with leukemia is immunosuppressed and Patientswith infection shouldnt be placed in this room. Since patient with nephrotic syndrome receivesdiuretics and steroids, this child will also need immunocompromised host precaution.INFECTION CONTROL:Sample Test Item:3. Which of the following methods should the RN utilize in patient with SALMONELLA?O 1 Airborne PrecautionsO 2 Droplet PrecautionsO 3 Neutropenic PrecautionsO 4 Enteric PrecautionsThe correct answer: 4.Salmonella mode of transmission is fecal oral (enteric)HandwashingGloves must be used in handling bedpan and diapersGown - if soiling is likely to happen.Source of infection:Contaminated food and water.Remember - Transmission Based precautions:A irB orne, small particles are dispersed in the air like MTB, varicellaC ontact, drug-resistant microorganismsD roplet, large particles are dispersed into air, resp.infections except resp syncytialE nteric, fecal-oral like hepaA & salmonellaAGE APPROPRIATE GROWTH AND DEVELOPMENT(HOPPING WITH ONE LEG)Sample test Item:4. Which of the following is NOT a characteristic of a preschooler?O 1 predominantly "parallel play" periodO 2 balances on 1 foot with eyes closedO 3 skips on alternate feetO 4 jumps ropeThe correct answer is: 1. Parallel play is more common in TODDLERS.Preschooler (3-6 years)Gross motor developmentHOPS ON ONE (1) FOOT BY 4 YEARSSKIPS & HOPS ON ALTERNATE FEET BY 5 YEARSPLAY : ASSOCIATIVE, IMAGINATIVE, MAGICAL THINKING, SUPERHEROES (Rememberthe movie: Jingle All The way!)FEAR: Intrusive procedures, venipunctures, IM injections, body mutilation
  23. 23. Toxoplasmosis, where else you can contract this (thinking of cat litter but it aint there)Sample test Item:5. To which of the following pregnant clients will be risk for TOXOPLASMOSIS?Select all that apply:O 1 A pregnant client who eat raw meat.O 2 A pregnant client handling cat litter of infected cats.O 3 A pregnant client gardening and cultivating soil exposed to cat feces.O 4 A pregnant client with low rubella titerO 5 A pregnant client who have undergone external radiation.O 6 A pregnant client with draining, painful vesicles in the external genitalia.The correct answers: 1, 2 & 3.TOXOPLASMOSISHow do people get toxoplasmosis?A Toxoplasma infection occurs by:Accidentally swallowing cat feces from a Toxoplasma-infected cat that is shedding the organism inits feces.This might happen if you were to accidentally touch your hands to your mouth after gardening,cleaning a cats litter box, ortouching anything that has come into contact with cat feces.Eating contaminated raw or partly cooked meat, especially pork, lamb, or venison;by touching your hands to your mouth after handling undercooked meat.Contaminating food with knives, utensils, cutting boards and other foods that have had contact withraw meat.Drinking water contaminated with Toxoplasma.Receiving an infected organ transplant or blood transfusion, though this is rare.(From the internet-Division of Parasitic Disease)Which of these statements by the nurse is incorrect if the nurse has the goal to reinforce informationabout cancers to a group of young adults?1. “You can reduce your risk of this serious type of stomach cancer by eating lots of fruits andvegetables, limiting all meat, and avoiding nitrate-containing foods.”2. “Prostate cancer is the most common cancer in American men with results to threaten sexualityand life.”3. “Colorectal cancer is the second-leading cause of cancer-related deaths in the United States.”4. “Lung cancer is the leading cause of cancer deaths in the United States. Yet its the mostpreventable of all cancers.
  24. 24. MEMORIZE MEMORIZE MEMORIZETonometry: normal (10-21 mm Hg)PR Interval: normal (0.12-0.20 seconds)Serum Amylase: normal (25-151 units/dL)Serum Ammonia: normal (35 to 65 mcg/dL)Calcium: adult (8.6-10 mg/dL) child (8 to 10.5 mg/dL) term<1week (7 to 12 mg/dL)Partial Thromboplastin Time (aPTT): normal (20-36 seconds) therapeutic 1.5-2.5Prothrombin Time: normal (Male: 9.6-11.8 seconds) and (Female: 9.5-11.3 seconds)Platelet Count: normal (150,000-400,000 cells/uL)Albumin level: normal (3.4 to 5 g/dL)Serum Osmolality: normal (285 to 295 mOsm/kg) high value indicates dehydrationSafe Suction Range: normal [Infant] 50-95 mm Hg [Child] 95-115 mm Hg [Adult]100-120 mm Hg)Serum Lithium: normal (1 to 1.5 mEq/L) acute mania (0.6 to 1.4 mEq/L) maintenance treatmentPhenytoin (Dilantin): normal serum (10 to 20 mcg/mL)Digoxin: therapeutic blood level (0.8 to 2.0 ng/ml)Magnesium Sulfate: Therapeutic Range (4 to 8 mg/dl)Pregnancy Temperature: normal (36.2-37.6 celcius or 98-99.6 Farenheit)WBC’s In Pregnancy: normal (11,000 to 15,000 cells/mm3, up to 18,000 cells/mm3). Immediatepostpartum period, (maybe as high as 25,000 to 30,000 cells/mm3)Stomach Capacity:  Newborn infant (10 to 20 mL)  1-week-old (30 to 60 mL)  2-3-week-old infant (75 to 100 mL)  1-month-old infant (90 to 150 mL)
  25. 25. Left Atrial Pressure: normal (1 to 10 mm Hg) Fibrinogen Levels: normal (male: 180 to 340 mg/dL) and (female: 190 to 420 mg/dL) with Disseminated Intravascular Coagulation the fibrinogen level drops because fibrinogen is used up in the clotting process.Insulin Insulin Insulin Insulin(Regular, Humulin R) (NPH, Humulin N) (Ultralente, Humulin U) (Humulin 70/30)Type: Fast acting Type: Intermediate Type: Slow acting Type: CombinationOnset: ½ -1 hr acting Onset: 4hr Onset: ½ hrPeak: 2-4 hr Onset: 2hr Peak: 8-20hr Peak: 2-12hrDuration: 6-8 hr Peak: 6-12hr Duration: 24-36hr Duration: 24hr Duration 18-26hr Central Venous Pressure: < 3 mm Hg = inadequate fluid and >11 mm Hg = too much fluid Potassium: 3.5-5.0 mEq/L Sodium: 135-145 mEq/L Calcium: 4.5-5.2 mEq/L or 8.6-10 mg/dL Magnesium: 1.5-2.5 mEq/L Chloride: 96-107 mEq/L Phosphorus: 2.7 to 4.5 mg/dL PR measurements: normal (0.12 to 0.20 second) QRS measurements: normal (0.04 to 0.10 second) Ammonia: 35 to 65 ug/dL Amylase:25 to 151 IV/L Lipase: 10 to 140 U/L Cholesterol: 140 to 199 mg/dL LDL: <130 mg/dL HDL: 30 to 70 mg/dL Triglycerides: <200 mg/dL Bilriubin • Direct: 0 to 0.3 mg/dL • Indirect: 0.1 to 1.0 mg/dL • Total: <1.5 mg/dL Protein: 6.0 to 8.0 g/dL Uric acid: Male 4.5 to 8 mg/dL Female 2.5 to 6.3 mg/dL Glycosylated Hemoglobin HbA1c: good control 7.5% or less Serum creatinine: 0.6 to 1.3 mg/dL
  26. 26. BUN: 9-25 mg/dLNormal CK is 26-174 U/LTroponin I value: normal (<0.6 ng/mL)Troponin T >0.1 to 0.2 ng/mL = MIErythrocyte studies: 0-30 mm/hourSerum iron: Male 65-175 ug/dL Female 50-170 ug/dLRBC: Male 4.5 to 6.2 M/uL Female 4.0 to 5.5 M/uLTheophylline levels normal (10 to 20 mcg/dl) MOTOR DEVELOPMENT Chin up 1 month Chest up 2 month Knee push and “swim” 6 month Sits alone/stands with help 7 month Crawls on stomach 8 month Stands holding on furniture 10 month Walks when led 11 month Stands alone 14 month Walks alone 15 month AT THE PLAY GROUND * Stranger anxiety: 0 -1 year * Separation anxiety: 1 - 3 years * Solitary play: 0 – 1 year * Parallel play: 2 – 3 years * Group play: 3 – 4 years PSYCHOLOGICAL DEVELOPMENT AGE ERIKSON FREUD PIAGET
  27. 27. Infant Oral (trust & 0 – 1.5 Trust vs. mistrust dependence sensorimotor Toddler Anal (holding vs. 1.5 -3 Autonomy vs. shame letting out) preoperationalPre-school Phallic (Oedipus 3-6 Initiative vs. guilt complex) preoperationalSchool age Industry vs. 6 - 11 inferiority latency Concrete operational Identity vs. role 11 - 20 confusion genital Formal operational 20 – 25 Intimacy vs. isolation Generativity vs. 25 – 50 stagnation 50 - ? Integrity vs.despair LABORATORY VALUES ELECTROLYTES Sodium (Na+): 135 – 145 meq/L (increase-dehydration; decrease overhydration) Potassium (K+): 3.5 - 5.0 meq/L Magnesium (Mg++): 1.5 – 2.5 meq/L Calcium (Ca++): 4.5 – 5.8 meq/L Neonate : 7.0 to 12 mg/dL Child: 8.0 to 10.5 mg/dL Phosphorus (PO4): 1.7 – 2.6 meq/L Chloride (Cl-): 96 – 106 meq/L COAGULATION STUDIES Activated partial thromboplastin time(APTT): 20 – 36 seconds depending on the type of activator used Prothrombin time(PT): male: 9.6 – 11.8 seconds Female: 9.5 – 11.3 seconds International Normalized Ratio(INR): 2.0 - 3.0 for standard Coumadin therapy 3.0 – 4.5 for high-dose Coumadin therapy Clotting time: 8 – 15 minutes Platelet count: 150,000 to 400,000 cells/Ul Bleeding time: 2.5 to 8 minutes SERUM GASTROINTESTINAL STUDIES Albumin: 3.4 to 5 g/dL Alkaline phosphatase: 4.5 to 13 King-Armstrong units/dL Ammonia: 15 to 45 ug/dL Amylase: 50 – 180 Somogyi U/dL in adult 20 – 160 Somogyi U/dL in the older adult Bilirubin: direct: 0 - 0.3 mg/dL Indirect: 0.1 – 1.0 mg/dL Total: less than 1.5 mg/dL Cholesterol: 120 – 200mg/dL Lipase: 31 -186 U/L Lipids: 400 – 800 mg/dL Triclycerides: Normal range: 10 – 190 mg/dL Borderline high: 200 – 400 mg/dL High: 400 – 1000mg/dL Very high: greater than 1000mg.dL
  28. 28. Protien: 6.0 – 8.0 g/LUric acid: male: 4.5 – 8 ng/dL Female: 2.5 – 6.2 ng/dL GLUCOSE STUDIESFasting blood sugar: 70 – 105 mg/dLGlucose monitoring (capillary Blood): 60 – 110 mg/dL RENAL FUNCTION TESTCreatinine: 0.6 – 1.3 mg/dLBlood urea nitrogen (BUN): 5 – 20 mg/dL ERYTROCYTES STUDIESErytrocyte sedimentation rate(ESR): 0 – 30 mm/hr depending on ageHemoglobin: male: 14 – 16.5 g/dL Female: 12 – 15 g/dLHematocrit: male: 42% - 52% (increased in hemoconcentration, fluid loss and dehydration) Female: 35% - 47% ( decreased in fluid retention)Red blood cell (RBC): male: 4.5 to 6.2 million/uL Female: 4 to 5.5 million/uLWhite blood cell (WBC): 4500 to 11,000/uLErytrocyte Protoporthyrin (EP) : <9ug/dLPhenylalanine Level: <2 mg/dLPKU: >25 mg/dL CRANIAL NERVES MAJOR FUNCTIONS I. Olfactory (S) smell II. Optic (S) vision III. Oculomotor (M) Eye movement IV. Trochlear (M) Facial sensation V. Trigeminal (S-M) Jaw movement VI. Abducent (M) Eye movement Taste VII. Facial (S-M) Facial expression VIII. Acoustic (S) Hearing and balance Taste IX. Glossopharyngeal (S-M) Throat sensation Gag and swallow Gag and swallow X. Vagus (S-M) Parasympathetic activity Neck and back muscles XI. Spinal Accessory (M)
  29. 29. XII. Hypoglossal (M) Tongue movementOn Old Olympus’ Towering Tops, A Finn And German Viewed Some HopsSome Says Marry Money, But My Brother Says Bad Business Marry Money ARTERIAL BLOOD GAS (ABG) pH: 7.35 – 7.45 PCO2: 35 - 45 mmHg PO2: 80 - 100 mmHg HCO3: 22 - 27 mEq/L O2 saturation: 96% - 100% Acid-base “RAMS”(Respiratory Alternate, Metabolic Same) GLASGOW COMA SCALE Eye opening response Motor response Verbal response AUTONOMIC NERVOUS SYSTEM SYMPATHETIC/ PARASYMPATHETIC/ ADRENERGIC CHOLINERGIC Increased heart rateHeart Increased conduction Decreased heart rate Increased forceBronchi dilation constrictionGI tract Reduced motility Increased motility Empties rectumRectum Allows filling Relaxes internal sphincter Empties bladderBladder Allows filling Relaxes internal sphincterErection Maintains erectionEjaculation Triggers ejaculationPupils of eye Big (mydriasis) Small (miosis)Salivary glands Secretion Depends on receptorsBlood vessels -a contrict -b dilates FLOW OF BLOOD THROUGH THE HEART
  30. 30. Inferior vena cava and superior vena cava – right atrium – tricuspid valve – right ventricle –pulmonic valve – pulmonary artery – lungs – pulmonary veins – left atrium – bicuspid valve (mitral)– left ventricle – aortic valve aorta – systemic circulation CARDIAC IMPULSESSinoatrial (SA) node – right and left atria (atria contract) – atrioventricular (AV) node – bundle his –bundle brabches – purjinje’s fibers – ventricles contract.Blood volume: 5000mLCentral venous pressure: 4 to 10 cmH2O (increased in cardiac overload; decreased in dehydration)Pressure within the right atrium: 2 to 7 mmHgCapillary refill time: <3 secondsNormal sweat chloride: <40 mEq/LNormal pupil diameter: 3 to 5mmNormal ocular pressure: 10 to 21 mmHgNormal Pulmonary capillary wedge pressure (PCWP): 8 to 13 mmhgNormal cardiac output : 4 to 8 L/min. THERAPEUTIC SERUM MEDICATION LEVELSAcetaminopen (Tylenol) 10 – 20 ug/mLAmikacin (Amikin) 25 – 30 ug/mLAmitryptyline (Elavil) 120 -150 ng/mLCarbamazepine (Tegretol) 5 -12 ug/mLChloramphenicol (Chloromycetin) 10 – 20 ug/mLDesipramine (Norpramin) 150 -300 ng/mLDigotoxin ( Crystodigin) 15- 25 ng/mLDigoxin ( Lanoxin) 0.5 – 2.0 ng/mLDisopyramide (Norpase) 2 -5 ug/mLEthosuximide ( Zarontin) 40 – 100 ug/mLGentamycin (Garamycin) 5 – 10 ug/mLImipramide (Tofranil) 150 – 300 ug/mLLidocaine (Xylocaine) 1.5 – 5.0 ug/mLLithium (Lithobid) 0.5 -1.5 ug/mLMagnesium sulphate 4 -7 mg/dLNortriptyline (Aventyl) 50 – 150 ng/mLPhenobarbital (Luminal) 10 – 30 ug/mLPhenytoin (Dilantin) 10 -20 ug/mLPrimidone (Myoline) 5 – 20 ug/mLProcainamide (Pronestryl) 4 – 10 ug/mLPropranolol (Inderal) 50 – 100 ng/mLQuinidine (Quinalaglute, Cardioquin) 2 – 5ug/mLSalisylate 100 -250 ug/mLTheophylline (Aminiphylline, Theo-Dur) 10 -20 ug/mLTobramycin (Nebcin ) 5 -10 ug/mLValproic acid (depakene) 50 -100 ug/mLPulmonary capillary wedge pressure: 5 to 13 mmHgPulmonary artery pressure: systolic: 16 to 30 mmHg Diastolic: 0 to 7 mmHgSpinal pressure: 70 to 200mmH2OMorphine sulphate pediatric dose: 0.1mg/kg every 3 – 4 hour SULFONYLUREAS For treatment of NIDDM  Sulfonylureas should not be given to patients with liver or kidney failure.
  31. 31.  Accummulation of drug will increase risk of hypoglycaemia. DURATIONtolbutamide 8hGlycburide, glipizide 20 h, most potentchlorpropamide 48 h Apothecary and Household SystemGrain –gr 1 gr = 60 mgDram – dr 5 gr = 300 mgOunce –oz 15 gr = 1000mg or 1gMinim – min, M, m 1/150 gr =0.4 mgQuart – qt 1 oz = 30 mLPint – pt 1 dr = 4 mLDrop – gtt 1 T = 15 mL or 3 tspTablespoon – T or tbs 1 min = 1 gttTeaspoon – t or tsp 15 min = 1mLPound – lb 60 min = 1 dr 8 dr = 1 oz 1 qt = 1000mL or 1L 1 qt = 2 pt or 32 oz 1 pt = 16 oz 16 oz = 1 lb 2.2lb = 1 kgFahrenheit to Celcius (F – 32) divide 1.8 = CCelcius to Fahrenheit 1.8 C + 32 = F Formula for Calculating a Medication DosageD (desired ) = the dosage that the physician orderedA (available) =the dosage strength as stated on the medication labelQ (quantity ) = the volume that the dosage strength is available in, such as tablet, capsules, or mLD X Q = XA Formulas for Intravenous CalculationsFlow Rates: Total volume x gtt factor = gtt per min Time in minutesInfusion Time: Total volume to infuse = Infusion time mL per hour being infused IMMUNIZATIONBirth Hepatitis B
  32. 32. 1 months Hepatitis B2 months OPV, DPT, HIB4 months DPT, HIB, OPV6 months DPT, HIB, hepatitis B12 months HIB, OPV15 months MMR18 months DPT12 – 18 months Varicella vaccine4 -6 years DPT, OPV, MMR11 – 12 years MMR ( if not administered at 4 -6 years)11 – 16 TD booster SPINAL CORD INJURYCervical Injury:  C2 to C3 injury usually fatal  C4 is the major innervation to the diaphragm by th phrenic nerve  Involvement above th C4 causes respiratory difficulty and paralysis of all the four extremities  C5 or below client may have movement in the shoulderThoracic Level Injury:  loss of movement of the chest, trunk, bowel, bladder, and legs, depending on the level of injury  Leg paralysis (paraplegia)  Autonomic dysreflexia with lesions above T6 and in cervical lesions  Visceral distention from a distended bladder or impacted rectum may cause reactions such as sweating, bradycardia, hypertension, nasal stuffiness, and goosefleshLumbar and Sacral Level Injuries:  loss of movement and sensation of the lower extremities.  S2 and S3 center on micturation; therefore below this level, the bladder will contract but not empty (neurogenic bladder)  Injury above S2 in males allows them to have an erection, but they are unable to ejaculate because of sympathetic nerve damage.  Injury between S2 and S4 damages the sympathetic and parasympathetic response, preventing erection and ejaculation. RULE OF NINE Head and neck 9% Anterior trunk 18% Posterior trunk 18% Arms (9%) 18% Legs (18%) 36% Perineum 1% NORMAL ADULT WHITE BLOOD CELL DIFFERENTIAL Neutrophils 56% or 18000 – 7800/uL Bands 3% or 0 – 700/uL Eosinophils 2.7% or 0 – 450/uL Basophils 0.3% or 0 – 200/uL Lymphocytes 34% or 1000 – 4800/uL
  33. 33. Monocytes 4% or 0 – 800/uL THYROID STUDIES Thyroid –stimulating hormone (thyrotropin; THS): 0.2 to 5.4 ug/dL Thyroxine (T4): 5.0 to 12.0 ug/dL Thyroxine free (FT3) : 0.8 to 2.4 ng/dL Triiodothyronine (T3): 80 to 230 ng/dLNormal Fribrinogen level: for men: 180 to 340mg/dL Women: 190 to 420mg/dLFribrinogen is used up in the clotting process.Erythrocyte Protoporhyrin (EP): < 9ug/dLPhenylalanine level: < 2mg/dLPKU: >25 mg/dLUrine specific gravity: 1.016 - 1.022 increase in SIADH; decrease in diabetes insipidusNormal CSF protein: 15 – 45 mg/dL increase in Guillain-Barre syndromeNormal CSF pressure: 5 – 15 mmHgNormal serum osmolality: 285 – 295 mOsmlkgH2O increase in dehydration; Decrease in over hydrationNormal scalp pH: 7.26 and above Borderline acidosis: 7.20 to 7.25 Acidosis: < 7.15 HERBAL MEDICINEAloe vera Gel – abrasionsand dermatologic conditionsAmerican Ginseng (Panax quinquefolius) – boost energy, relieve stress, improve concentration and enhance physical or cognitive performance.Ashwagandha (Withania somnifera) – stress arthritisAsian gingseng (Panax ginseng) – enhance health and combat stress and diseaseBilberry (Vaccinium myrtillus) – vision and peripheral vascular disorders and as antioxidantBlack Cohosh (Cimicifuga racemosa) – menopausalBlack Currant and Borage oil (Ribes nigrum and Borago offinalis) – anti-inflammatory, rheumatoid arthritisCapsicum Peppers (Capsicum spp.) – arthritis, neuralgia and other painful treatmentChamomile (Matricaria recutita) “manzanilla”- skin inflammation, colic, or dyspepsia and anxietyChaste tree (Vitex agnus-castus) – menstrual related disorders, PMS, cyclical mastalgiaChodroitin – osteoarthritisCoenzyme Q10 – antioxidantColtsfoot ( Tussilago farfara ) – cough and other respiratory disodersCranberry (Vaccinium macrocarpon) – UTIDevil’s Claw ( Harpagophytum procumbers) – anti inflammatory and analgesicEchinacea (Echinacea spp.) – acute viral URI symptomsEderberry (Sanbacus nigra) – respiratory tract infectionEphedra or Ma Huang (Ephedra sinica) Source of ephedrine and pseudoephedrineEvening Primrose Oil (Oenothera biennis) – eczema, breast pain associated with PMS and inflammatory conditionFenugreek (Trigonella foenum-graecum) – lowering blood glucoseFeverfew ( Tanacetum parthenium) – migraine headache prophylaxisGarlic (Allium sativaum)- help prevent cardiovascular disease and cancerGinger (Zingiber officinale) –nausea and motion sickness, anti-inflammatoryGinkgo (Ginkgo biloba) – dementia and intermittent claudication, memory enhancement and treatment of vertigo nad tinnitusGlucosamine – osteoarthritisGoldenseal ( Hydrastis Canadensis) – tonic and antibioticGotu Kola (Centella asiatica) – mental support, wound healing and venous disorders
  34. 34. Hawtorn ( Crategus species) – CHF and related cardiovascular conditionsHorebound (Marribium vulgare) – primary cough suppression and expectorationHorse Chestnut Seed (Aesculus hippocastanum) chronic venous insufficiencyIvy (Hedera helix) – coughs, rheumatic disordes and skin diseaseKava ( piper methysticum) – mild psychoactive and antianxiety propertyLemon Balm (Melissa officinalis) – sedative and for dyspepsiaLicorice (Glycyrrhiza glabra) – respiratory disorders, hepatitis, inflammatory diseases, and infectionsMelatonin – insomia, jet lagMilk Thistle – hepatitis, liver deseaseMints (Mentha species) – minor calcium channel antagonists, used for upper respiratory problems, irritable bowel syndrome, dyspepsia, and colonic spasm and as a topical counterirritantNettle (Urtica dioica) – arthritis pains, allergies, BPH, or as diureticPapaya (Carica papaya) – digestive aid, dyspepsia, and for inflammatory, topically applied to woundsPassion flower (Passiflora incarnata)- sedative-hypnotic or anxiolytic herbPokeroot (Phytolacca Americana) – inflammatory conditions also as an emetic/catharticPygeum (Pygeum africanum) – mild symptoms of BPHRed Clover (Trifolium pratense) – used as a natural estrogen substitute for women’s healthSt. John’s Wort (Hypericum perforatum) – antidepressant effectTea Tree Oil (Melaleuca alternifolia) – antifungal and antibacterialTurmeric (Curuma longa ) – anti-inflammatory, anti-arthritis, anti cancer, and antioxidantUva Ursi (Arctostaphylos uva ursi) – urinary antiseptic and diureticYohimbe – erectile dysfunctionFOUR STRATEGIES: 1. If the question asks what you should do in the situation. Use the nursing process to determine which step in the nursing process would be next? 2. If the question asks what the client needs. Use maslow’s hierarchy to determine which need to address. 3. If the question indicates that the client doesn’t have urgent physiologic need, focus on the patient safety. 4. If the question involves communicating with a patient. Use principles of therapeutic communication.REMEMBER:AIRWAY, BREATHING,CIRCULATION AND SAFETY (ABCS)The nurse in primary care clinic is caring for a 50-year-old woman. History reveals that she hadexperienced on and off chest pain. After series of cardiac tests (EKG & Blood Chem), the doctororders for THALLIUM STRESS TEST. Which of the following medications should the RN prepareif the patient needs an alternative exercise in thallium test?1.Nitroglycerin2.Morphine3.Aminophylline4.PersantinThe correct answer is #4. Persantin (dipyridamole)Persantin is use as an alternative to exercise in thallium myocardial perfusion imaging for theevaluation of CAD in those who cannot exercise adequately.Purpose: to determine myocardial wall viabilityOther names:1. Cardiac pooling2. MUGA-multigated radionuclide angiographic scanning3. nurclear scan4. sestamibi test5. thallium scan6. dipyridamole or persantin stress test7. In short, heart scan :)Loving NCLEX-RNURC09178364589
  35. 35. Posted by Anaski from IP 203.131.183.186 on August 23, 2005 at 21:44:00: For Future USRNs: Cervical Cancer Etiology: * Early age of sexual intercourse * Multiple sexual partners * Sexually Transmitted Disease (Venereal Wart) * Virus - HPV Cancer Carcinoma in SITU - only in epithelial linings Situ sounds like Ziru - Stage 0 Tumor marker - CEA Signs and Symptoms (3 Ps) POST COITAL BLEEDING PAINFUL INTERCOURSE PROFUSE (PERIOD IRREGULARITIEs - menorrhagia and metrorrhagia) Management: U - pera (Surgery HYSTERECTOMY) R - radiation (intracavitary cessium - remember STD - shielding, timing and distance)) C - chemotherapy to destroy the DNA,RNA & CHON synthesis. MIKE’S NOTES (60 pp.) O universal donor/AB universal recipient. ABO BLOOD TYPE COMPATIBILITY Blood Type Can Receive from: Can donate to: O O O,A,B,AB A A,O A,AB B B,O B,AB AB O,A,B,AB AB Autologous Transfusion: •Collected 4-6 weeks before surgery •Contraindicated—infection, chronic disease, cerebrovascular or cardiovascular disease Hypotonic Solution Isotonic Solution Hypertonic Solution• ½ NS (0.45% • 0.9% NaCl (Normal Saline) • 10% D/W (10% Dextrose in water) Saline) • 5% D/W (Dextrose in Water) • D15W • Lactated Ringer’s • 5% D/NS (5% Dextrose in 0.9% Saline) • 5% D/ ¼ NS (5% Dextrose in 0.225% • 5% D/ ½ NS (5% Dextrose in 0.45% Saline ) Saline) • 3% NaCl • 5% Sodium Bicarbonate Change tubing Q72 hours Change bottle Q24 hours Infiltration •Assessment: cool skin, swelling, pain, decrease in flow rate •Implementation: discontinue IV, warm compresses, elevate arm, start new site proximal to infiltrated site IV Phlebitis, Thrmobophlebitis •Assessment—redness, warm, tender, swelling, leukocytosis •Implementation—discontinue IV, warm moist compresses, start IV in opposite extremity Hematoma
  36. 36. •Assessment—ecchymosis, swelling, leakage of blood •Implementation—discontinue IV, apply pressure, ice bag 24 hours, restart IV in opposite extremityIV Clotting •Assessment—decreased flow rate, back flow of blood into tubing •Implementation—discontinue, do not irrigate, do not milk, do not increase rate of flow or hang solution higher, do not aspirate cannula, inject Urokinase, D/C and start on other site.Insertion of Percutaneous Central Catheters: •Placed supine in head-low position •Turn head away from procedure •Perform Valsalva maneuver •Antibiotic ointment and transparent sterile dressing •Verify position with x-ray •Change tubing Q24 hours •Nurse/patient both wear mask when dressing change 2-3x/week Adrenergics Adrenergic Medications Adrenergics Side effects: Actions: •Levophed •Dysrhythmias •Stimulate the sympathetic •Dopamine •Tremors nervous system: increase in •Adrenalin •Anticholinergic effects peripheral resistance, increase •Dobutrex Adrenergics Nursing blood flow to heart, Considerations: bronchodilation, increase blood •Monitor BP flow to skeletal muscle, •Monitor peripheral pulses increase blood flow to uterus •Check output •Stimulate beta-2 receptors in lungs •Use for cardiac arrest and COPD Anti-Anxiety Anti-Anxiety Anti-Anxiety Action: Medications: Side effects: •Affect neurotransmitters •Librium, Xanax, •Sedation Used for: Ativan, Vistaril, •Confusion •Anxiety disorders, manic Equanil •Hepatic dysfunction episodes, panic attacks Anti-Anxiety Nursing Considerations: •Potention for addiction/overdose •Avoid alcohol •Monitor Liver Function AST/ALT •Don’t discontinue abruptly, wean off •Smoking/caffeine decreases effectivenessAntacids Antacids Medications AntacidsActions: •Amphojel Side effects: •Neutralize gastric acids •Milk of Magnesia •ConstipationUsed for: •Maalox •Diarrhea •Peptic ulcer •Acid rebound •Indigestion, reflex Antacids esophagitis Nursing Considerations: •Interferes with absorption of antibiotics, iron preps, INH, Oral contraceptives •Monitor bowel function •Give 1-2 hours after other medications •1-3 hours after meals and at HS •Take with fluidsAntiarrhythmics Antiarrhythmics AntiarrhythmicsAction: Medications: Side effects: •Interfere with electrical •Atropine sulfate •Lightheadedness excitability of heart •Lidocaine •HypotensionUsed for: •Pronestyl •Urinary retention •Atrial fibrillation and •Quinidine Antiarrhythmics flutter •Isuprel Nursing Considerations: •Tachycardia •Monitor vital signs •PVCs •Monitor cardiac rhythmAminoglycosides Aminoglycosides Aminoglycosides (Antibiotics)
  37. 37. (Antibiotics) (Antibiotics) Side effects: Action: Medications: •Ototoxicity and Nephrotoxicity •Inhibits protein •Gentamycin •Anorexia synthesis in gram- •Neomycin •Nausea negative bacteria •Streptomycin •Vomiting Used for: •Tobramycin •Diarrhea •Pseudomonas, Aminoglycosides (Antibiotics) E.Coli Nursing Considerations: •Harmful to liver and kidneys •Check 8th cranial nerve (hearing) •Check renal function •Take for 7-10 days •Encourage fluids •Check peak/trough levelCephalosporins Cephalosporins Cephalosporins (Antibiotics)(Antibiotics) (Antibiotics) Side effects:Action: Medications: •Bone marrow depression: caution with anemic, and low PLT •Inhibits synthesis of •Ceclor px bacterial cell wall •Ancef •SuperinfectionsUsed for: •Keflex •Rash •Tonsillitis, otitis •Rocephin Nursing Considerations: media, peri-operative •Cefoxitin •Take with food prophylaxis •Cross allergy with PCN •Meningitis •Avoid alcohol •Obtain C&S before first dose: to make sure medication is effective against disease/bacteria •Can cause false-positive for proteinuria/glycosuriaFluoroquinolones Fluoroquinolones Fluroquinolones(Antibiotics) (Antibiotics) (Antibiotics)Action: Medications: Side effects: •Interferes with DNA •Cipro •Diarrhea replication in gram- •Decreased WBC and Hematocrit negative bacteria •Elevated liver enzymes (AST, ALT)Used for: •Elevated alkaline phosphatase •E.Coli, Pseudomonas, S. Nursing Considerations: Aureus •C&S before starting therapy •Encourage fluids •Take 1 hour ac or 2 hour pc (food slows absorption) •Don’t give with antacids or iron preparation •Maybe given with other medications (Probenicid: for gout)Macrolide (Antibiotics) Macrolide (Antibiotics) Macrolide (Antibiotics)Action: Medications: Side effects: •Binds to cell membrane •Erythromycin •Diarrhea and changes protein •Clindamycin •Confusion function •HepatotoxicityUsed for: •Superinfections •Acute infections Nursing Considerations: •Acne •Take 1hr ac or 2-3 hr pc •URI •Monitor liver function •Prophylaxis before dental •Take with water (no fruit juice) procedures if allergic to •May increase effectiveness of: Coumadin PCN and Theophylline (bronchodilator) Penicillin Penicillin Penicillin Action: Medications: Side effects: •Inhibits synthesis of cell •Amoxicillin •Stomatitis wall •Ampicillin •Diarrhea Used for: •Augmentin •Allergic reactions •Moderate to severe •Renal and Hepatic changes
  38. 38. infections Nursing Considerations: •Syphilis •Check for hypersensitivity •Gonococcal infections •Give 1-2 hr ac or 2-3 hr pc •Lyme disease •Cross allergy with cephalosporins Sulfonamides (Antibiotics) Sulfonamides (Antibiotics) Sulfonamides (Antibiotics) Action: Medications: Side effects: •Antagonize essential component •Gantrisin •Peripheral Neuropathy of folic acid synthesis •Bactrim •Crystalluria Used for: •Septra •Photosensitivity •Ulcerative colitis •Azulfidine •GI upset •Crohn’s disease •Stomatitis •Otitis media Nursing Considerations: •UTIs •Take with meals or foods •Encourage fluids •Good mouth care •Antacids will interfere with absorptionTetracyclines TEtracyclines Tetracyclines (Antibiotics)(Antibiotics) (Antibiotics) Side effects:Action: Medications: •Discoloration of primary teeth if taken during pregnancy or if •Inhibits protein •Vibramycin child takes at young age sythesis •Panmycin •GlossitisUsed for: •Rash •Infections •Phototoxic reactions •Acne Nursing considerations: •Prophylaxis for •Take 1 hr ac or 2-3 hr pc opthalmia •Do not take with antacids, milk, iron neonatorum •Note expiration date •Monitor renal function •Avoid sunlight UTIs •Medication: o Furadantin •Action: o Anti-infective •Side effects: o Asthma attacks o Diarrhea •Nursing Considerations: o Give with food or milk o Monitor pulmonary status UTIs •Medication o Mandelamine •Action: o Anti-infective •Side effects: o Elevated liver enzymes •Nursing Considerations: o Give with cranberry juice to acidify urine o Limit alkaline foods: vegetables, milk, almonds, coconut UTIs •Medication o Pyridium •Side effects: o Headache o Vertigo •Action

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