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MEDICAL-SURGICAL NURSING NOTE
What is the nursing priority for a patient with epiglottitis?

A. administer steroids
B. assist in endotracheal intubation
C. assist in tracheostomy
D. apply warm moist pack
The correct answer is C. Epiglottitis is an emergency situation requiring immediate

intervention: the inflamed epiglottis is blocking the entrance to the trachea, therefore
clearing the patient’s AIRWAY is the priority nursing action (eliminate options A and D).
Option C is better than Option B; endotracheal intubation will be difficult because the
inflamed epiglottis will not permit the insertion of a laryngoscope.
The following are clinical manifestations of nontoxic goiter (hypothyroidism), EXCEPT:

A. dry skin
B. lethargy
C. insomnia
D. sensitivity to cold
The correct answer is C. Hypothyroidism causes a decrease in thyroid hormones, which in

turn causes decreased metabolism. Options A, B and D are all consistent with decreased
metabolism. Option C is a symptom of increased metabolism found in hyperthyroidism.
ƒ Thyroid gland secretions (T3 and T4) are metabolic hormones

 Thyroid hormones cause increased metabolism: CNS stimulation, increased vital signs,
and increased GI motility (diarrhea)
HYPOTHYROIDISM HYPERTHYROIDISM
All b od y sy stems are DECREASED All b od y sy stems are INC REA S ED
e x c e p t W E I G H T a nd M E N ST R U A T I O N ! e x c e p t W E I GHT a nd M E NST R UAT I ON!
 decreased CNS: drowsiness, memory  increased CNS: tremors, insomnia
problems (forgetfulness)
 decreased v/s: hypotension, bradycardia,  increased v/s: hypertension, tachycardia,
bradypnea, low body temp tachypnea, fever

 decreased GI motility: constipation  increased GI motility: diarrhea
 decreased appetite (anorexia) but with  increased appetite (hyperphagia) but with
WEIGHT GAIN WEIGHT LOSS [high metabolism causes
[low metabolism causes decreased burning of increased burning of fats and carbs]
fats and carbs]
 This leads to increased serum cholesterol 
atherosclerosis (hardening of arteries due to
cholesterol deposits)
 Because of increased cholesterol, hypothyroid
patients are prone to hypertension, myocardial
infarction, CHF and stroke
 decreased metabolism causes decreased  increased metabolism causes increased
perspiration  perspiration 
DRY SKIN and COLD INTOLERANCE MOIST SKIN and HEAT INTOLERANCE
 Menorrhagia (excessive bleeding during  Amenorrhea (absence of menstruation)
menstruation)
Pathognomic sign: EXOPHTHALMOS (bulging
eyeballs)
ƒ NursingManagement for hypothyroidism: ƒ Nursing Management for hyperthyroidism:
 Low calorie diet  High calorie diet
 Warm environment  Cool environment
What is the best way to prevent the spread of STDs?

A. Use condoms
B. Monogamous relationship
C. Abstinence
D. Practice Safe Sex
The correct answer is B. TEST-TAKING TIP: Pick the conservative answer. Remember
the Board of Nursing is composed of older women with traditional values who do not
approve of promiscuity (implied in options A and D). Telling the patient to abstain from
sex (Option C) is not an acceptable response from the nurse.

What is the nursing priority if the client is suffering from 1st, 2nd, 3rd or 4th degree
burns?
A. fluid and electrolyte balance
B. infection
C. pain
D. airway
The correct answer is B. Infection is a priority for all types of burns. Airway is a priority
only for burns to the face and neck. Pain is a second priority for 1st and 2nd degree
burns. Fluid and electrolyte balance is a second priority for 3rd and 4th degree burns
[no pain because nerve endings are damaged].
What is a normal physical finding of the thyroid gland?

A. nodular consistency
B. asymmetry
C. tenderness
D. palpable upon swallowing
The correct answer is A. The thyroid gland is symmetrical, non-tender, and palpable
only if the patient has goiter. The palpable mass on the neck is the thyroid cartilage. It
is present in both males and females but is larger in males; it develops during puberty
What food is most appropriate for a toddler?

A. hotdog
B. grapes
C. milk
D. spaghetti
The correct answer is D. Toddlers need a high-carb diet to sustain their active play
lifestyle. Toddlers are also at risk for aspiration, therefore eliminate foods that are
choking hazards (options A and B). Milk is not the best food for toddlers because of its
low IRON content; Milk is the primary cause of Iron-deficiency Anemia in children.
TEST-TAKING TIP: `Di ba may hotdog ang spaghetti? No, no, no… DO NOT ADD
DETAILS TO THE QUESTION. Do not justify a wrong answer.

What would the nurse include in the teaching plan for a paraplegic client?
A. self-catheterization
B. assisted coughing
C. adapted feeding techniques
D. compensatory swallowing
The correct answer is A. A paraplegic patient has lower extremity paralysis (paralyzed
bladder and bowel). Therefore the nursing priority is ELIMINATION.
Review:
Monoplegia -- 1 limb paralysis
Hemiplegia -- Right or Left side paralysis
Paraplegia – Lower extremity paralysis (note: there is no such thing as upper extremity
paralysis)
Quadriplegia/Tetraplegia – Paralysis from the neck down. The priority for a
quadriplegic patient is AIRWAY.
NERVOUS SYSTEM
ƒ CNS: brain and spinal cord
ƒ PNS: 12 cranial nerves + 31 spinal nerves
 8 cervical nerves (C1 to C8)
 12 thoracic nerves (T1 to T12)
 5 lumbar nerves (L1 to L5)
 5 sacral nerves (S1 to S5)
 1 coccygeal nerve (Co)
ƒ The spinal cord terminates at L1 to L2, therefore a LUMBAR TAP is performed at L3 ,L4 or L5
(no risk of paralysis from spinal cord damage)
AUTONOMIC NERVOUS SYSTEM

S y mpa t he t i c Ne rv ous S y s t e m (S NS ) P a ra s y mpa t he t i c Ne rv ous S y s t e m
(P NS )
ƒ “Fight” or aggression response ƒ “Flight” or withdrawal response
ƒ Also termed adrenergic or parasympatholytic ƒ Also termed cholinergic or sympatholytic

response response
ƒ The neurotransmitter for the SNS is ƒ The neurotransmitter for the PNS is
norepinephrine acetylcholine (Ach)
A l l body ac t i v i t i es are INC REA S ED A l l body ac t i v i t i es are DEC REA S ED
except GIT! except GIT!
 increased blood flow to brain, heart and  normalized blood flow to vital organs
skeletal muscles: These are the most important organs
during times of stress
 increased BP, increased heart rate:  decreased BP, decreased heart rate
To maintain perfusion to vital organs
 bronchodilation and increased RR:  bronchoconstriction, decreased RR
To increase oxygen intake
 urinary retention  FLUID VOLUME EXCESS  urinary frequency  FLUID VOLUME
Fluids are withheld by the body to maintain circulating DEFICIT
volume

 pupillary dilation: MYDRIASIS:  pupillary constriction: MIOSIS
To increase environmental awareness during aggression [this is the correct spelling, not meiosis ]
 decreased GIT activity: CONSTIPATION and  Increased GIT: DIARRHEA and INCREASED
DRY MOUTH: SALIVATION
Blood flow is decreased in the GIT because it is the least
important area in times of stress •
DRUGS WITH SNS effects: DRUGS WITH PNS effects:
ƒ Adrenergic/Parasympatholytic agents: ƒ Anti-hypertensives:
 Epinephrine [Adrenalin]  Methyldopa – for pregnancy induced hpn
ƒ Antipsychotics: (PIH)
 Haloperidol [Haldol], Chlorpromazine  β-blockers (-olol):
[Thorazine], etc.  Propranolol [Inderal], atenolol,
 Side effect of Thorazine: Atopic Dermatitis metoprolol
(eczema) and foul-smelling odor [recall:  ACE inhibitors (-pril):
patients in NCMH are smelly]  Enalapril, Ramipril, Lisinopril,
 Side effect of all antipsychotics: Sx of
Benazepril, Captopril
PARKINSON’S DISEASE, therefore
 Side effect of ACE inhibitors:
antipsychotics are given together with
antiparkinson drugs AGRANULOCYTOSIS and
ƒ Anti-parkinsonians: NEUTROPENIA (blood dyscracias… always
asked in board!)
 Cogentin, Artane, etc.
ƒ Pre-operative drug:
 Calcium channel blockers (Calcium
antagonists)
 Atropine Sulfate (AtSO4) – given before
 Nifedipine [Procardia], Verapamil
surgery to decrease salivary and mucus
[Isoptim],
secretions
• Dialtiazem [Cardizem]
 NURSING ALERT: Anti-hypertensives are not
given to patients with CHF or cardiogenic
shock (Drug will cause a further decrease in
heart rate  Death)
ƒ Rx for Myasthenia Gravis:
 Pyridostigmine [Mestinon]
 Neostigmine [Prostigmin]
The nurse admits a patient with COPD. For the management of hypertension, the
doctor prescribes Inderal 40 mg P.O. What is the appropriate nursing action?
A. administer Inderal 1 hour before or 2 hours after meals
B. withhold Inderal if the pulse is less than 60 bpm
C. question the physician regarding the order
D. monitor BP prior to administration
The correct answer is C. A patient with COPD has decreased respiration. Propranolol [Inderal] is
contraindicated for patients with COPD because of its PNS effects (it will aggravate the patient’s
respiratory depression).
NEURONS
3 characteristics of neurons:
1. Excitability – Neurons are affected by changes in the environment
2. Conductivity – Neurons transmit wave of excitations

3. Permanent cells – Once neurons are destroyed, they are not capable of regeneration.
 3 types of cells according to regenerative capacity:
Labile epidermis (skin), gastrointestinal tract (GIT), genito-urinary
capable of regeneration tract (GUT), respiratory tract (stab wounds to the lungs are
survivable)
Stable kidneys, liver, pancreas, salivary glands
once destroyed, capable of
regeneration but with limited
survival time period
Permanent heart, neurons, osteocytes, retinal cells
once destroyed, not capable of
regeneration
NEUROGLIA
ƒ Function: support and protection of neurons
ƒ Clinical significance: Majority of brain tumors arise from neuroglia
ƒ Types:
 Astrocytes
 Microglia
 Oligodendrocytes
 Ependymal cells
ƒ Note: Astrocytoma is the #1 type of brain tumor
ASTROCYTES – maintain the integrity of the BLOOD-BRAIN BARRIER
 Toxic substances that can cross the BLOOD-BRAIN

BARRIER:
1. Ammonia
2. Bilirubin
3. Carbon monoxide and Lead
4. Ketones
AMMONIA

ƒ Ammonia is a by-product of protein metabolism
ƒ Ammonia is a toxic substance metabolized by the liver into a non-toxic substance (urea), which is
then excreted by the kidneys
ƒ Increase in serum ammonia can cause HEPATIC ENCEPHALOPATHY (Liver cirrhosis)
ƒ Normal liver is scarlet brown; liver with cirrhosis is covered by fat deposits (“fatty liver”)
ƒ The primary cause of hepatic encephalopathy is MALNUTRITION
ƒ The major cause of hepatic encephalopathy is ALCOHOLISM
 Alcoholism causes Thiamine (B1) deficiency (Alcoholic beriberi)
ƒ Ammonia is a cerebral toxin.
ƒ Earlysign of Hepatic Encephalopathy:

 ASTERIXIS – flapping hand tremors. This is the EARLIEST SIGN OF HEPATIC
ENCEPHALOPATHY.
ƒ Late Signs of Hepatic Encephalopathy:

 Headache
 Restlessness
 Fetor hepaticus (ammonia-like breath)
 Decreased level of consciousness  HEPATIC COMA
 Note: The primary Nursing Intervention in hepatic coma is AIRWAY [Assist in
mechanical ventilation]
BILIRUBIN
ƒ Review:
 Bilirubin – yellow pigment
 Biliverdin – green pigment
 Hemosiderin – golden brown pigment
 Hemoglobin – red pigment
 Melanin – black pigment
ƒ Icteric skin and sclerae is termed Jaundice = a sign of HEPATITIS
 Note: Icteric skin with normal sclerae is termed Carotinemia = a sign of PITUITARY
GLAND TUMOR, not hepatitis
ƒ Kernicterus (Hyperbilirubinemia) can lead to irreversible brain damage
CARBON MONOXIDE (CO) AND LEAD (Pb)

ƒ CO and Pb can cause PARKINSON’S DISEASE and SEIZURE
 Note: The initial sign of Parkinson’s disease: PILL-ROLLING TREMORS
ƒ The antidote for Pb poisoning is Calcium EDTA
ƒ The antidote for CO poisoning is Hyperbaric oxygenation (100% oxygen)
KETONES

ƒ Ketones are by-products of fat metabolism
ƒ Ketones are CNS depressants
ƒ Increased ketones can lead to diabetic ketoacidosis (DKA) seen in Type I diabetes mellitus
(DM).
ƒ DKA is due to increased fat metabolism:
DIABETES MELLITUS
Type I DM Type II DM
ƒ Insulin-dependent ƒ Non Insulin-dependent
ƒ Juvenile onset type (common among children) ƒ Adult/Maturity onset type (common among 40 y.o.
& above)
ƒ Non-obese ƒ Obese
ƒ “Brittle disease” ƒ “Non-brittle disease”
ƒ Etiology: Hereditary ƒ Etiology: Obesity
ƒ Symptomatic ƒ Asymptomatic
ƒ Characterized by Weight Loss ƒ Characterized by Weight Gain
ƒ Treatment: Insulin ƒ Treatment: Oral Hypoglycemic Agents (OHA)
ƒ Complications: Diabetic Ketoacidosis (DKA) ƒ Complications: Hyper-Osmolar Non-Ketotic Coma
 Sodium Bicarbonate (NaHCO3) administered to treat (HONCK)
acidosis  Non-ketotic, so no lipolysis
 Can lead to coma  Can also lead to coma
 Can lead to seizure
MICROGLIA
ƒ Microglia are stationary cells that carry on phagocytosis
ƒ Review:
 Brain macrophage = Microglia
 Blood macrophage = Monocyte
 Kidney/Liver macrophage = Kupffer cell
 Lung macrophage = Alveolar macrophage
 Epithelial macrophage = Histiocytes

EPENDYMAL CELLS
ƒ Ependymal cells secrete chemoattractants (glue) that concentrate bacteria
OLIGODENDROCYTES
ƒ Produce myelin sheath
ƒ Function: For insulation and to facilitate nerve impulse transmission
ƒ The demyelinating disorders are MULTIPLE SCLEROSIS and ALZHEIMER’S DISEASE
ALZHEIMER’S DISEASE
ƒ A type of dementia (degenerative disorder characterized by atrophy of the brain tissue)
ƒ Caused by Acetylcholine (Ach) deficiency
ƒ Irreversible
ƒ Predisposing factors:
 Aging
 Aluminum toxicity
 Hereditary
ƒ SSx of Alzheimer’s (5 A’s):
 Amnesia – partial or total loss of memory
 The type of amnesia in Alzheimer’s is ANTEROGRADE AMNESIA.
 2 types of Amnesia:
 Anterograde amnesia – loss of short-term memory
 Retrograde amnesia – loss of long-term memory
 Agnosia – inability to recognize familiar objects
 Apraxia – inability to perform learned purposeful movements (using objects [toothbrush]
for the wrong purpose)
 Anomia – inability to name objects
 Aphasia – inability to produce or comprehend language
 The type of aphasia in Alzheimer’s is RECEPTIVE APHASIA.
 2 types of Aphasia:
 Expressive aphasia (Broca’s aphasia)
 inability to speak
 positive nodding
 nursing management is the use of a PICTURE BOARD
 damage to Broca’s area (in frontal lobe), which is the motor speech center
 Receptive aphasia (Wernicke’s aphasia)
 inability to understand spoken words
 positive illogical/irrational thoughts
 can hear words but cannot put them into logical though
 damage to Wernicke’s area (in temporal lobe), which is the language
comprehension center
ƒ The drugs of choice for Alzheimer’s are Donepezil [Aricept] or Tacrine [Cognex]
 The drugs work by inhibiting cholinesterase (an enzyme that breaks down acetylcholine),
thereby increasing the levels of acetylcholine in the brain
 Best given at bedtime

Which is the characteristic of Alzheimer’s disease?
A. transient ischemic attacks
B. remissions and exacerbations
C. rapid deterioration of mental functioning because of arteriosclerosis
D. slowly progressive deficits in the intellect, which may not be noted for a long time.
The correct answer is D. Option A is a characteristic of stroke. Option B is a characteristic

of Myasthenia Gravis or Multiple Sclerosis. Option C is a characteristic of Dementia (?)
What type of environment is appropriate for a client with Alzheimer’s?

A. familiar
B. variable
C. challenging
D. non-stimulating
The correct answer is A. To promote the patient’s safety and security, the patient needs to
be in a familiar environment.
What is the best nursing action if a client with Alzheimer’s begins to speak about the 1930’s?
A. orient the client to time and place
B. distract the client by inviting him to watch TV
C. encourage the client to talk about recent events
D. listen to the client’s anecdotes
The correct answer is D. A client with Alzheimer’s disease has short-term memory loss, but
has intact long-term memories. Therefore allowing the client to reminisce about the past
reinforces the client’s self-esteem. Options A is incorrect because the client is not
disoriented. Option B is incorrect because it dismisses the client’s concerns. Option C is
incorrect because with short-term memory loss, the client cannot talk about recent events.
MULTIPLE SCLEROSIS (MS)

ƒ Chronic intermittent disorder of the CNS characterized by white patches of demyelination in
the brain and spinal cord
ƒ Characterized by remission and exacerbation
ƒ Common among women 15 to 35 y.o.
 Idiopathic (unknown)
 Slow-growing viruses
 Autoimmune
 Note: other autoimmune diseases: Systemic Lupus Erythematosus (SLE), hypo & hyperthyroidism,
pernicious anemia, myasthenia gravis
ƒ There is no treatment for autoimmune diseases, only palliative or supportive care (just treat S
& Sx)

 Review: A NT IB O D IES
IgG – can cross placenta; provides passive immunity
IgA – found in body secretions (sweat, tears, saliva and
colostrum)
IgM – acute inflammations; the largest antibody
IgE – allergic reactions
IgD – chronic inflammations
S & Sx of Multiple Sclerosis

ƒ Visual disturbances
 BLURRED VISION is the INITIAL SIGN of MULTIPLE SCLEROSIS
 Diplopia (double vision)
 Scotoma (blind spot in the visual field)
ƒ Impaired sensation to touch, pain, pressure, heat and cold
 Tingling sensations
 Paresthesia (numbness)
 Do not give hot packs to patients with MS. Because of decreased heat sensitivity, heat
application can cause burns.
ƒ Mood Swings
 Patients with MS are in a state of euphoria
S & Sx of Multiple Sclerosis (continued)
ƒ Impaired motor activity
 Weakness  spasticity  paralysis
ƒ Impaired cerebellar function
 ATAXIA (unsteady gait)
ƒ Scanning speech
ƒ Urinary retention and incontinence
ƒ Constipation
ƒ Decrease in sexual capacity
 CHARCOT’S TRIAD Sx of MULTIPLE

SCLEROSIS
ƒ Ataxia
ƒ Nystagmus
ƒ Intentional Tremors
Diagnostic Procedures for Multiple Sclerosis

ƒ Cerebral analysis through lumbar puncture reveals increased IgG and protein
ƒ MRI reveals site and extent of demyelination
ƒ LHERMITTE’s SIGN
 continuous contraction and pain in spinal cord following laminotomy
 confirms diagnosis of MS
Nursing Management for Multiple Sclerosis

ƒ Rx:
 ACTH (steroids) – to reduce swelling and edema  prevents paralysis resulting from spinal
cord compression
 Steroids are best administered AM to mimic the normal diurnal rhythm of the body
 Give 2/3 of dose in AM, 1/3 of dose in PM
 ACTH is also administered in Motor Vehicular Accidents leading to spinal injury  prevents
inflammation that can lead to paralysis
 Muscle relaxants: Baclofen [Liorisal] and Dantrolene Sodium [Dantrium]

 Can be used to treat hiccups, which is caused by irritation of the phrenic nerve.
 Interferons – to alter immune response
 Immunosuppresants
 Diuretics – to treat urinary retention
 Bethanecol Chloride [Urecholine] – cholinergic drug used to treat urinary retention; given
subQ
 Side effects of Bethanecol: Bronchospasm and Wheezing, so always check breath sounds 1
hour after administration.
 Normal breath sounds are bronchovesicular.
 Propantheline Bromide [Pro-Banthine] – antispasmodic drug to treat urinary
incontinence
ƒ Provide relaxation techniques
 Deep breathing, yoga, biofeedback
ƒ Maintain siderails – to prevent injury secondary to falls
ƒ Prevent complications of immobility
 Turn to side q 2 h, q 1 h for elderly patients, q 30 minutes on the affected extremity
ƒ Provide catheterization
ƒ Avoid heat application
ƒ To treat constipation: Provide high fiber diet
ƒ To treat UTI: Provide ACID-ASH DIET (acidifies urine to prevent bacterial infection)
 Acid-ash diet consists of Grape, Cranberry, Plums, Prune Juice, Pineapple
 Women are more prone to UTI
 Females have shorter urethra (3 to 5 cm or 1 to 1½ inches) than males (20 cm or 6 to
8 inches)
 Poor perineal hygiene (wiping from front to back)
 Vaginal environment is moist (more conducive to bacteria)
 Nursing Intervention: Avoid scented tissue paper, bubble baths, and using perfume or
talcum powder in the perineum, as these can irritate the vagina
 Male UTI is often related to post-coitus
 Male must urinate after coitus to prevent urine stagnation
What is the action of Baclofen [Liorisal]?
A. induces sleep
B. stimulates appetite
C. muscle relaxant
D. reduce bacterial urine count
The correct answer is C. Baclofen is a muscle relaxant used to treat spastic movement in
multiple sclerosis, spinal cord injury, amyotrophic lateral sclerosis (Lou Gehrig's Disease) and
trigeminal neuralgia.
BRAIN
Composition:
ƒ 80% Brain mass
ƒ 10% Blood
ƒ 10% Cerebrospinal Fluid (CSF)
Cerebrum
ƒ Largest part of the brain
ƒ Composed of 2 hemispheres (Left and Right) joined by the copus callosum
ƒ Functions: sensory, motor and integrative
ƒ Cerebral Lobes

 Frontal
 controls higher cortical thinking
 Personality development
 Motor functions
 Inhibits primitive reflexes
 Broca’s area, the motor speech center, is located in the frontal lobe
 Temporal
 controls hearing
 Short-term memory
 Wernicke’s area, the general interpretative area, is located in the temporal lobe
 Parietal
 Appreciation and discrimination of sensory impulses (touch, pain, pressure, heat, cold)
 Occipital
 Controls vision
 Central (Insula or “Island of Reil”)
 Controls visceral functions
 Limbic system (rhinencephalon)
 Controls smell
 Anosmia is the absence of the sense of smell
 Controls libido
 Long-Term memory
 Basal Ganglia
 areas of gray matter located deep within each cerebral hemisphere
 produce DOPAMINE, which controls gross voluntary movement
Remember:
 Dopamine deficit = PARKINSON’S DISEASE (Rx antiparkinsonian drugs to
increase dopamine)
 Dopamine excess = SCHIZOPHRENIA (Rx antipsychotic drugs to decrease
dopamine)
 Acetylcholine deficit = MYASTHENIA GRAVIS (Rx Mestinon to increase Ach)
 Acetylcholine excess = BIPOLAR DISORDER (Rx Lithium to decrease Ach)
Notice that…
 Neurotransmitter deficit = MedSurg illnesses
 Neurotransmitter excess = Psych illnesses
Diencephalon – interbrain or “between brain”

ƒ Hypothalamus
 Temperature regulation
 Controls BP
 Reticular activating system: controls sleep and wakefulness
 Controls thirst
 Satiety center: controls appetite
 Emotional responses: fear (from known cause) , anxiety (from unknown cause) and
excitement
 Controls pituitary functions
 Pituitary gland relies on stimulation from hypothalamus
ƒ Thalamus
 Relay station for sensation
Mesencephalon (midbrain)

ƒ Relaystation for sight and hearing:
 Controls size and response of pupil
 Normal pupil size is 2 to 3 mm
 Isocoria is equal pupil size
 Anisocoria is unequal pupil size
 Normal pupil response if PERRLA [Pupils equal, round, reactive to light and
accomodation]
 Accomodation is pupillary constriction for near vision, and pupillary dilation for far
vision.
 Controls hearing acuity
Brainstem
ƒ Pons – pneumotaxic center ( controls depth and rhythm of respiration)
ƒ Medulla Oblongata – lowest part of the brain
 Damage to medulla is the most life-threatening
 Controls respiration, heart rate, vomiting, swallowing, hiccups
 Vasomotor center (controls vessel constriction and dilation)
 The medulla oblongata is the termination point of spinal decussation
Cerebellum
ƒ Smallest part of the brain; cerebellum is also known as the “lesser brain”
ƒ For balance, posture, equilibrium and gait
ƒ Cerebellar tests:
 Romberg’s test
 two nurses positioned to the left and right of the patient
 patient assumes normal position, with both eyes closed
 tests for ATAXIA (unsteady gait)
 Finger-to-nose test
 Tests for DYMETRIA (inability of the body to stop a movement at a desired point)
 Alternate pronation and supination
 Also tests for dymetria
MONRO-KELLIE HYPOTHESIS
ƒ The Monro-Kellie hypothesis states the relationship between ICP and cranial components (blood, CSF and
brain tissue):
 The skull is a closed container, therefore any alteration in one of the intrathecal components can
lead to increased intracranial pressure
 The normal ICP is 0 to 15 mmHg.
Cerebrospinal Fluid (CSF)

ƒ 125 to 150 mL produced per day by the choroid plexus
ƒ CSF is clear, colorless, odorless
ƒ contains glucose, protein and WBCs
ƒ does not contain RBCs
ƒ Function: cushions the brain (shock absorption)
ƒ Hydrocephalus – obstruction of the flow of CSF leading to enlargement of the skull posteriorly
 Enlargement due to early closure of posterior fontanel

Blood
CEREBROVASCULAR ACCIDENT (STROKE)
ƒ Partial orcomplete obstruction in the brain’s blood supply.
ƒ Common sites of thrombotic stroke:
 Middle cerebral artery
 Internal carotid artery
ƒ The leading cause of CVA is THROMBUS formation (attached clot)
 A dislodged thrombus becomes an EMBOLUS (free-floating clot)  very dangerous if it
goes to the BRAIN, HEART or LUNGS
ƒ CVA causes increased ICP.
INCREASED INTRACRANIAL PRESSURE (ICP)

ƒ Increased intracranial bulk brought about by an increase in one of the intracranial components
 Head injury
 Tumor
 Localized abscess (pus)
 Hydrocephalus
 Meningitis
 Cerebral edema
 Hemorrhage (stroke)
ƒ Note: For all causes of increased ICP, the patient should be positioned 30º to 45º (Semi-
Fowler’s)
What is the EARLIEST SIGN of increased ICP?

A. headache
B. widening pulse pressure
C. tachycardia
D. agitation
The correct answer is D. A change in the level of consciousness is the earliest sign of
increased ICP. Options A and B are both LATE SIGNS. Option C is incorrect; increased ICP
causes bradycardia, not tachycardia.
Describe a conscious client:

A. Aware
B. Coherent
C. Awake
D. Alert
The correct answer is C. Consciousness describes a patient’s level of wakefulness. The

terms aware, coherent and alert (Options A, B and D) are used when describing a patient’s
orientation to person, place and time.
ƒ EarlySigns of Increased ICP

 Change or decreased level of consciousness (restlessness to confusion)

 Irritability and agitation
 Disorientation to lethargy to stupor to coma
 Remember: The 4 levels of consciousness: Conscious  Lethargy  Stupor  Coma
ƒ LateSigns of Increased ICP

 Changes in v/s
  Increased BP:
 WIDENING PULSE PRESSURE – increased systolic pressure while diastolic pressure
remains the same
 Note: narrowing pulse pressure is seen in SHOCK (inadequate tissue perfusion).
  Decreased Heart rate (bradycardia)
  Decreased Respiratory rate (bradypnea)
 Cheyne-Stokes respiration – hyperpnea followed by periods of apnea
 Increased Temp
 Note: Temp as a vital sign usually parallels BP
Vital signs Increased ICP Shock
BP  increased  decreased
Heart Rate  decreased  increased
Resp Rate  decreased  increased
Temp  high  low
Pulse Pressure  widening  narrowing
 Notes:
 Increased heart rate in shock compensates for blood loss
 Decreased temp in shock is due to decreased blood causing a decrease in warmth.
 Hypertension, Bradycardia and irregular RR = CUSHING’S TRIAD of increased ICP
 Increased BP as a response to increased ICP is termed as CUSHING REFLEX
 Increased BP is an attempt by the body to maintain cerebral perfusion during
increased ICP
 Headache, papilledema, PROJECTILE VOMITTING
 Papilledema is edema of the optic disc in the retina, leading to irreversible blindness
 Projectile vomiting due to compression of the medulla, which is the center for
vomiting.
 Abnormal Posturing:
 Decorticate posture – abnormal flexion, due to damage to the corticospinal tract
(spinal cord & cerebral cortex)
 Decerebrate posture– abnormal extension, due to damage to upper brain
 Note: Flaccid posture is lost muscle tone, not found in increased ICP (found in
poliomyelitis).
 Unilateral dilation of pupils
 Uncal herniation – herniation of uncus (in temporal lobe) puts pressure on Cranial
Nerve III which controls parasympathetic input to the eye, causing unequal pupillary
dilation (ANISOCORIA)
 Possible seizure
ƒ NursingManagement for increased ICP

 Maintain patent airway and adequate ventilation
 To prevent hypoxia (inadequate O2 in tissues) and hypercarbia (increased CO2 in
blood)
 Note: Hypoxemia is inadequate O2 in the blood

Which of the following is a LATE SIGN of hypoxia?
A. Restlessness
B. Agitation
C. Tachycardia
D. Bradycardia
The correct answer is D. Options A, B and C are early signs. The brain is the most
sensitive organ to hypoxia, causing restlessness and agitation. Tachycardia is a
compensatory mechanism to increase O2 in the brain.
TEST-TAKING TIP: When there are two opposite options (Options C and D), one of them
is definitely correct, so eliminate the other options (Options A and B).
Early Signs of Late Signs of

Hypoxia Hypoxia
ƒ Restlessness ƒ Bradycardia
ƒ Agitation ƒ Cyanosis
ƒ Tachycardia ƒ Dyspnea
ƒ Extreme
Restlessness
Hypercarbia – CO2 retention

Remember: increased CO2 is the most potent respiratory stimulant
High CO2  stimulates medulla  increase RR (hyperventilation)  normalized O2 and CO2
(negative feedback mechanism to maintain homeostasis)
ƒ Nursing Management for increased ICP (continued)

 Assist in mechanical ventilation: Ambubag or Mechanical Ventilator
 Note: Ambubag should only be pressed during inspiration
 Hyperventilate or hyper-oxygenate client to 100% before and after suctioning
 Note: Suctioning performed for only 10 to 15 seconds; apply suction only while
removing the suction catheter
 When suctioning an endotracheal tube, insert the suction cath all the way until
resistance is felt, to ensure complete removal of secretions
 Position Semi-Fowler’s
 Elevate head of bed 30 to 45º with neck in neutral position unless contraindicated to
promote venous drainage.
 Limit fluid intake to 1.2 to 1.5 L per day
 Note: Forced fluids is 2 to 3 L per day
 Monitor v/s, I&O and neurocheck (neurovital signs)
 Prevent complications of immobility (turn to side)
 Prevent further increased ICP:
 Provide comfortable, quiet environment
 Stress increases ICP
 Avoid use of restraints [Jacket, wrist or elbow restraints]
 Anxiousness increases ICP
 Maintain siderails
 Avoid clustering of nursing activities together
 Instruct client to avoid activities leading to Valsalva maneuver (bearing down)
 Avoid straining of stool: administer laxatives/stool softeners: Bisacodyl [Dulcolax]

 Avoid excessive coughing: administer antitussives (cough suppresant):
Dextromethorphan [Robitussin]
 Note: common side effect of antitussives is drowsiness, so avoid driving or
operating heavy machinery
 Avoid vomiting: administer anti-emetic: Phenergan [Plasil]
 Avoid bending, stooping, lifting heavy objects
 Administer meds:
 Osmotic diuretics – Mannitol [Osmitrol]
 Check BP before administering; mannitol can lead to low fluid volume 
hypotension
 Monitor strictly I & O and inform physician if output is less than 30 cc per hour
 Mannitol is given as side-drip (piggy-back)
 Regulate at FAST-DRIP to prevent crystallization [formation of precipitates in
tubing]  clogged IV line
 Note: KVO rate is 10 to 15 gtts per minute
 Inform client that he will feel a flushing sensation as the drug is introduced.
 Loop Diuretics – Furosemide [Lasix]
 Nursing management for loop diuretics is the same as for Osmotic diuretics
 Lasix is given IV Push (from ampule)
 Best given AM to prevent sleep disturbances. Lasix given PM will prevent restful
sleep due to frequent urination.
 Corticosteroids: Dexamethasone [Decadron] to decrease cerebral edema
 Side-effect of steroids: respiratory depression
 Mild analgesics: Codein Sulfate
 Anticonvulsants: Dilantin [Phenytoin]
Lasix is given at 7 AM. What is the earliest time that the nurse would expect the client
to urinate?
A. 7:10 AM
B. 7:30 AM
C. 12 noon
D. 1 pm
The correct answer is A. Lasix takes effect in 10 to 15 minutes. Option D (6 hours) is

the maximum therapeutic effect of Lasix.

 SIDE EFFECTS OF LASIX Normal
Values
  K: HYPOKALEMIA 3.5 to 5.5
mEq/L
  Ca HYPOCALCEMIA 8.5 to 11 mg/
dL
  Na: HYPONATREMIA 135 to 145
mEq/L
  Glucose:
HYPERGLYCEMIA 80 to 100 mg/
dL
  Uric Acid:
HYPERURICEMIA 3 to 7 mg/dL
HYPOKALEMIA
H YP O K A LEMIA H YP ER K A LEMIA
ƒ Potassium less than 3.5 mEq/L
ƒ SSx of hypokalemia:
 Weakness, fatigue
 Decreased GI motility: constipation
 Positive U Wave on ECG  can lead to arrhythmias
 Metabolic alkalosis
 Bradycardia (HR 60 to 100 bpm)
ƒ Rx for hypokalemia
 K supplements: Oral KCl, Kalium durule
ƒ Foods rich in K:
 Fruits: Apple, Banana, Cantaloupe
 Note: Green bananas have more K
 Vegetables: Asparagus, Broccoli, Carrots
ƒ Also rich in K: orange, spinach, apricot Potassium greater than 5.5 mEq/L
ƒ SSx of hyperkalemia:
 Irritability, excitement
 Increased GI motility: diarrhea, abdominal cramps
 Peaked T wave  can also lead to arrhythmia
 Metabolic acidosis
HYPOCALCEMIA

ƒ Tetany – involuntary muscle contraction
ƒ SSx of hypocalcemia:
 Trousseau sign – carpal spasm when BP cuff is inflated 150 to 160 mmHg
 Chvostek sign – facial twitch when facial nerve is tapped at the angle of the jaw
ƒ Complications of hypocalcemia: Arrhythmia and Seizure (Calcium deficiency is life-
threatening!)
ƒ Nursing management for hypocalcemia:
 Administer Ca Gluconate IV
 Must be administered slowly to prevent cardiac arrest
 Excess Ca Gluconate  Ca Gluconate toxicity  seizure
 Antidote for Ca excess: Magnesium Sulfate
 Monitor for signs of MgSO4 toxicity (BURP):
 BP low
 Urine output low
 RR low
 PATELLAR REFLEX ABSENT – important! earliest sign of MgSO4 toxicity
HYPONATREMIA
ƒ Low sodium  Fluid Volume Deficit Hypotension
ƒ The initial sign of dehydration is THIRST (adults) or TACHYCARDIA (infants)
ƒ Nursing Management: Force fluids (2 to 3 L/day), administer isotonic IV
HYPERGLYCEMIA
ƒ SSx: 3P’s (Polyuria, Polydipsia, Polyphagia)
ƒ Nursing Management: Monitor Fasting Blood Sugar (Normal FBS is 80 to 100 mg/dL)
HYPERURICEMIA
ƒ Uric acid isa by-product of purine metabolism
ƒ Foods high in uric acid:
 Organ meats, sardines, anchovies, legumes, nuts
ƒ Tophi – uric acid crystals
ƒ Gout – uric acid deposit in joints leading to joint pain & swelling, particularly affecting the
great toes.
ƒ Nursing Management for Gout:
 Force fluids (2 to 3 L/day)
 Rx: Allopurinol [Zyloprim] – drug of choice for gout
 Most common side effect: allergic reaction (maculopapular rash)
 Rx: Colchicine – drug of choice for acute gout
ƒ KIDNEY STONES – tophi accumulation in kidneys
 The pain associated with kidney stones is termed RENAL COLIC
 Nursing Management for Kidney Stones:
 Force fluids
 Rx: Morphine Sulfate – narcotic analgesics are the drug of choice to relieve renal
colic
 Side-effect of narcotic analgesics: Respiratory depression, so always check RR
before administering
 Antidote for Morphine overdose: Naloxone [Narcan]
 SSx of Naloxone toxicity: tremors
 Strain the urine using gauze
ƒA pathognomonic sign is a definitive diagnostic sign of a disease.
PATHOGNOMONIC SIGNS
D i s e a s e Sign

PATHOGNOMONIC SIGNS
Tetany Trousseau and Chvostek signs
Tetanus Risus sardonicus (abnormal sustained spasm of the facial muscles)
Liver cirrhosis Spider angioma, due to esophageal varices
SLE Butterfly rash
Bulimia Nervosa Chipmunk facies (parotid gland swelling)
Leprosy Leonine facies (thickened lion-like facial skin)
Cushing syndrome Moon face
Measles Koplik spots
Diphtheria Pseudomembrane on tonsils, pharynx and nasal cavity
Down Syndrome Protrusion of tongue, Simian crease on palm
Kawasaki’s Disease Strawberry tongue
Pernicious anemia Red beefy tongue
Hyperthyroidism Exophthalmos
Asthma Wheezing on expiration
Emphysema Barrel chest
Pneumonia Rusty sputum
Addison’s disease Bronze-like skin
Appendicitis Rebound tenderness
Pancreatitis Cullen’s sign (bluish discoloration of umbilicus)
Chronic hemorrhagic Gray-turner’s spot (ecchymosis in flank area)
pancreatitis
Cholera Rice-watery stool
Malaria Chills
Typhoid fever Rose spots in abdomen
Thrombophlebitis Homan’s sign
Meningitis Kernig’s and Brudzinski’s sign
Pyloric stenosis Olive-shaped mass
Hyperpituitarianism Carotinemia
Hepatitis Jaundice
Dengue Petechiae
Tetralogy of Fallot Clubbing of fingers
Cataract Hazy vision (loss of central vision)
Glaucoma Tunnel vision (loss of peripheral vision)
Retinal Detachment Curtain veil-like vision (right or left side of vision is blocked)
PTB Low-grade afternoon fever
Cholecystitis Murphy’s sign (pain on deep inspiration when inflamed gallbladder is
palpated)
Angina Pectoris Levine’s sign (hand clutching of chest)
Patent Ductus Arteriosus Machine-like murmur
Myasthenia Gravis Ptosis (drooping of eyelids)
Parkinson’s Disease Pill-Rolling Tremors
 Questions about increased ICP 

A patient has increased ICP due to stroke. What is the immediate nursing action?
A. Administer Mannitol as ordered
B. Elevate the head of the bed 30º - 45º
C. Restrict fluids
D. Avoid the use of restraints
The correct answer is A. Mannitol will produce the fastest response in decreasing the
patient’s intracranial pressure. Option B, while correct, will not produce a fast
response. Option C is incorrect; a patient with increased ICP should have fluids limited,
A patient is at risk for increased ICP. What would be the priority for the nurse to
monitor?
A. Unequal pupil size
B. Decreased systolic BP
C. Tachycardia
D. Decreased body temp
Which nursing intervention is appropriate for a client with intracranial pressure of 20

mmHg?
A. Give the client a warming blanket
B. Administer low-dose barbiturates
C. Encourage client to hyperventilate
D. Restrict the patient’s fluids
The correct answer is C. Increased ICP produces bradypnea, so hyperventilating will

help maintain the client’s oxygenation. Option A is incorrect; increased ICP produces
hyperthermia, so a warming blanket will aggravate the client’s temperature. Option B is
incorrect; barbiturates are CNS depressants that will further decrease the client’s
respiratory rate. Option D is incorrect; a patient with increased ICP should have fluids
limited, not restricted (Semantics? Really?! Note: This can be a valid answer if there are no better
options).

A client who is regaining consciousness after a craniotomy attempts to pull out his IV
line. Which action protects the client without increasing ICP?
A. Jacket restraints
B. Wrap hands in a soft mitten restraint
C. Tuck arms and hands under the draw sheet
D. Apply wrist restraints to each arm.
The correct answer is B. Mittens will protect the client while still allowing freedom of
movement. Options A, C and D will limit the patient’s movement, which will increase
the patient’s anxiety and consequently increase the patient’s ICP.
A patient with a left frontal lobe tumor has a craniotomy. Four hours post surgery,
which data indicates increased ICP?
A. BP 160/90
B. Patient is difficult to arouse
C. Patient has a positive Babinski response
D. Patient has urinary incontinence
The correct answer is B. The earliest and most sensitive sign of increased ICP is a
change in the level of consciousness. Options A and C are both late signs (elevated BP
+ positive Babinski reflex due to damage to the corticospinal tract). Option D is not
diagnostic of increased ICP.
A client with intracranial pressure of 20 mmHg due to multiple stroke is to be

discharged while receiving oxygen at 2 L/min via cannula. What information should the
nurse impart to the client regarding the use of oxygen at home?
A. The client should limit activity at home
B. The use of oxygen will eliminate the shortness of breath
C. Oxygen spontaneously ignites and explodes
D. The use of oxygen during activity will relieve the strain on the client’s heart.
The correct answer is D. Option A is incorrect; it does not convey any information
about the use of oxygen. Option B is incorrect; oxygen can relieve but not eliminate
shortness of breath. Option C is incorrect; oxygen can spontaneously ignite but not
explode.
Drug Monitoring
ƒ The 5 most common drugs given in the board exam: D-L-A-D-A

Drug Toxicity Therapeutic Indication
Range
Digoxin [Lanoxin] Congestive Heart
2 ng/mL 0.5 – 1.5 ng/mL
Cardiac Glycoside Failure
Lithium [Lithane, Eskalith] 2 mEq/L 0.6 – 1.2 mEq/L Bipolar Disorder
Anti-manic agent
Aminophylline
[Theophylline] 20 mg/dL 10 – 19 mg/dL COPD
Bronchodilator
Dilantin [Phenytoin] 20 mg/dL 10 – 19 mg/dL Seizure disorders
Anti-convulsant
Acetaminophen [Tylenol] 200 mg/
10 – 30 mg/dL Osteoarthritis
Non-narcotic analgesic dL
Digoxin
ƒ Indicated for Congestive Heart Failure
ƒ Mechanism of digoxin: increases force of myocardial contractions, thereby increasing cardiac
output
 The normal cardiac output is 3 to 6 L/min.
ƒ Nursing Management when administering Digoxin:
 Check apical pulse rate: if below 60, withhold drug and notify the physician.
ƒ SSx of Dig toxicity:
 GI DISTURBANCES (Early Sign): Anorexia (loss of appetite is the most evident sign),
nausea and vomiting, diarrhea
 Visual disturbances: photophobia, XANTOPSIA (seeing yellow spots), diplopia
 Confusion
ƒ The antidote for dig toxicity is DIGIBIND
Congestive Heart Failure (CHF)

ƒ CHF can be Left-sided or Right-sided
ƒ Left-sided CHF can lead to Right-sided CHF, but Right cannot lead to Left
ƒ Lasix is given to both types of CHF
ƒ CHF is the inability of the heart to pump blood towards systemic circulation
ƒ RIGHT-SIDED CHF – the #1 cause is TRICUSPID VALVE STENOSIS
ƒ LEFT-SIDED CHF – the #1 cause is MITRAL VALVE STENOSIS
Left-Sided Heart Failure (LSHF)

ƒ Can be caused by Rheumatic Heart Disease:
 Tonsillitis  strep bacteria migrate to mitral valve  RHEUMATIC HEART DISEASE 
mitral stenosis  LSHF
ƒ SSx of LSHF:
 Most of the symptoms of LSHF are RESPIRATORY:
 Pulmonary edema and congestion
 Dyspnea:
 Paroxysmal nocturnal dyspnea – difficulty of breathing at nighttime
 Nursing intervention: give patient 2 to 3 pillows
 Orthopnea – difficulty of breathing while lying down
 Nursing intervention: Position patient High-Fowlers or Orthopneic position
 Productive cough, blood-tinged sputum
 Frothy salivation – alveolar fluid in the mouth
 Abnormal breath sounds: Rales (crackles) and bronchial wheezing
 Cardiovascular symptoms:
 Pulsus alternans – weak pulse followed by strong bounding pulse
 Can lead to arrhythmia
 Point of Maximal Impulse (PMI) is displaced laterally
 Fluid in the lungs pushes heart to one side
 Check apical pulse to determine the location of PMI
 Normal PMI is at the left midclavicular line between the 4th and 5th intercostals
space (below the nipple).
 Note: if the PMI is displaced vertically (lower than normal) then the patient
has cardiomegaly.
 S3 extra heart sound (Ventricular gallop)
 Note: S4 sound occurs in myocardial infarction
 Anorexia and body malaise
 Cyanosis
Right-Sided Heart Failure (RSHF)
ƒ SSx of RSHF:
 Venous congestion – blood goes back to superior & inferior vena cava
 Jugular vein distention
 Pitting edema
 Ascites – fluid in the peritoneal cavity
 Weight gain
 Hepatosplenomegaly
 Jaundice
 Pruritus and urticaria
 Esophageal varices
 Generalized body malaise and anorexia
Lithium
ƒ Antimanic agent – indicated for Bipolar Disorder
ƒ Mechanism: decreases acetylcholine (Ach), norepinephrine and serotonin
ƒ SSx of Lithium toxicity:
 Anorexia
 Diarrhea and Dehydration, therefore force fluids
 Hypothyroidism
 Fine tremors
ƒ Nursing management for lithium:
 Force fluids
 Increase Sodium intake to 4 to 10 g daily

Aminophylline
ƒ Indicated for Chronic Obstructive Pulmonary Disease (COPD)
ƒ Bronchodilators dilate the bronchial tree, thereby allowing more air to enter the lungs
ƒ SSx of aminophylline toxicity:
 Tachycardia
 Palpitations
 CNS excitability: irritability, agitation, restlessness and tremors
ƒ Nursing management for aminophylline:
 AVOID COFFEE – will aggravate CNS excitability
4 Types of COPD
Bronchitis Asthma Bronchiectasis Emphysema
“blue-bloater” – “pink-puffer” –
cyanosis with edema acyanotic with
compensatory purse-lip
breathing
Pathognomonic Sign: Hemoptysis – blood in Pathognomonic Sign:
Wheezing on expiration cough Barrel-chest
Reversible Irreversible
Terminal stage
Can lead to
pneumothorax (air in
pleural space),
CO2 narcosis
Caused by allergic Caused by allergic
reaction reaction
Hereditary Hereditary
Surgery:
Pneumonectomy
(removal of 1 lung)
Diagnosis:
Bronchoscopy
Can lead to Cor Can lead to Cor
Pulmonale (enlarged Pulmonale
right ventricle)
ƒ For all types of COPD:

 #1 cause is smoking
 Expect doctor to prescribe bronchodilators
 LOW-FLOW OXYGEN only so as not so suppress the respiratory drive
Phenytoin
ƒ Dilantin is an anticonvulsant – indicated for seizure disorders
ƒ Seizure is the term for the first convulsive attack that an individual experiences
ƒ Epilepsy is the term for the second or succeeding attacks
ƒ Febrile seizures are normal for children below 5 y.o. (febrile seizures are outgrown)
ƒ Nursing management when giving Dilantin:

 Only mixed with plain NSS to prevent formation of crystals/precipitates
 Given via “sandwich method” (give NSS  give dilantin  give NSS)
 Instruct client to avoid taking alcohol (Dilantin + alcohol can lead to severe CNS
depression)
ƒ SSx of Dilantin toxicity:
 GINGIVAL HYPERPLASIA (important!)
 Remember to provide oral care to patient receiving Dilantin:
 use soft bristle toothbrush
 instruct client to massage gums
 Hairy tongue
 Ataxia – positive Romberg’s test
 Nystagmus (abnormal movement of the eyes)
Acetaminophen
ƒ Acetaminophen is the treatment of choice for osteoarthritis
 Pathognomonic sign of osteoarthritis: HEBERDEN’S NODES (knobs on finger joints)
 Note: osteoarthritis is localized while rheumatoid arthritis is systemic.
ƒ Sx of acetaminophen toxicity:
 Hepatotoxicity – therefore monitor LIVER ENZYMES:
 SGPT (serum glutamic pyruvate transaminase), also called ALT (alanine transaminase)
 SGOT (serum glutamic oxaloacetic transaminase), also called AST (aspartate
transaminase)
 Nephrotoxicity – therefore monitor Blood Urea Nitrogen (BUN) and Creatinine
 Normal BUN is 10 to 20 mg/dL
 Normal Creatinine is 0.8 to 1.0 mg/dL
 Creatinine is the most sensitive indicator of kidney function
 Hypoglycemia
 SSx of Hypoglycemia (Remember T-I-R-E-D):
 Tremors, Tachycardia
 Irritability
 Restlessness
 Extreme Fatigue
 Diaphoresis, Depression
ƒ The antidote for acetaminophen overdose is ACETYLCYSTEINE [Mucomyst]
 Note: Acetylcysteine is a mucolytic used for respiratory conditions with excess and thick
mucus production (emphysema, bronchitis, bronchiectasis)
 Oral acetylcysteine comes in granule form and is orange-flavored (like powdered juice)
 Acetylcysteine causes outpouring secretions.
 N.Mgt. for administering acetylcysteine: prepare suction apparatus

The following are symptoms of hypoglycemia EXCEPT:
A. extreme thirst
B. nightmares
C. weakness
D. diaphoresis
The correct answer is A. Options B, C and D are all symptoms of hypoglycemia: nightmares
due to depression, weakness (extreme fatigue) and diaphoresis. Option A is one of the 3
P’s of hyperglycemia: Polydipsia [excessive thirst], Polyphagia [excessive hunger], and
Polyuria [excess urine output].
Parkinson’s Disease
ƒA chronic progressive disorder of the CNS characterized by degeneration of DOPAMINE-
producing cells in the substancia nigra of the midbrain and basal ganglia.
ƒ Parkinson’s disease is irreversible
 Lead and carbon monoxide poisoning
 Arteriosclerosis – hardening of an artery
 Hypoxia
 Encephalitis
 High doses of drugs:
 Antihypertensives: Reserpine [Serpasil] and Methyldopa [Aldomet]
 Anti-psychotic agents: Haloperidol [Haldol] and Phenothiazines
 Recall: Anti-hypertensives have PNS effects, Anti-psychotics have SNS effects
 Side effects of Reserpine: DEPRESSION and BREAST CANCER
 Note: Reserpine is the only antihypertensive with a major side effect of depression 
patient becomes SUICIDAL
 Nursing management for suicidal patients: PROMOTE SAFETY (remove equipment that patient
can use to harm himself)
 Triad causes of suicide:
1. Loss of spouse
2. Loss of job
3. Aloneness
 Nursing management for suicidal patients: DIRECT APPROACH

 Maintain patient on close supervision

In the healthcare setting, suicide attempts most commonly occur:
A. Monday 1 –3 am
B. Sunday 6 – 9 am
C. Saturday 1 – 3 am
D. Friday 6 – 9 am
The correct answer is C. Suicide attempts most commonly occur on weekends and early
mornings when the nursing staff is not around.
 Reserpine is also linked to the development of BREAST CANCER.

ONCOLOGIC NURSING
ƒ The most frequent types of cancer in women (in
order):
1. Breast
2. Cervical
3. Ovarian
4. Uterine
ƒ The most frequent types of cancer in men (in
order):
1. Bronchogenic (lung)
2. Hepatic (liver)
3. Prostate – for men 40 y.o. and above
4. Testicular – for men 30 y.o. and above
 3 L’s of testicular cancer:
 Large
 Lumped
 Loaded (heavy)
The most common preferred treatment for cancer is

A. chemotherapy
B. radiation therapy
C. surgery
D. bone marrow transplant
The correct answer is C. If the cancer is treatable by surgery, it is preferred over other
treatments that have multiple side effects (Options A and B). Option D is a specific
treatment for leukemia that is not applicable to other types of cancer.
Anyway, back to Parkinson’s…

ƒ SSx of Parkinson’s disease:
 Early sign: PILL-ROLLING TREMORS – pathognomonic sign of Parkinson’s
 Second sign: BRADYKINESIA (slowness of movement)
 “cogwheel” rigidity – intermittent jerking movement
 Stooped posture
 Shuffling Gait, Propulsive Gait
ƒ SSx of Parkinson’s disease (continued):

 Overfatigue
 Mask-like facial expression
 Decreased blinking of the eyes
 Difficulty in arising from sitting position
 Monotone speech
 Mood: Lability (depressed)  prone to suicide, therefore PROMOTE SAFETY
 Increased salivation (drooling)
 Prepare suction app at bedside
 Autonomic changes:
 Increased sweating and lacrimation
 Seborrhea (oversecretion of sebaceous gland)
 Decreased sexual capacity
ƒ Stages of Parkinson’s Disease
I. Unilateral flexion of upper extremities
II. Shuffling gait
III. Progressive difficulty in ambulating
IV. Progressive weakness
V. Disability = last stage
ƒ Nursing management for Parkinson’s

 Rx Anti-Parkinson agents:
 Levodopa (L-dopa) [Larodopa] – short-acting anti-parkinson
 Mechanism: increases levels of dopamine
 Side effects:
 GIT irritation (nausea and vomiting)
 ORTHOSTATIC HYPOTENSION – always asked in the board exam!
 Arrhythmia
 Hallucination
 Confusion
 Contraindications of L-dopa
 Not given to clients with glaucoma
 Not given to patients taking MAO inhibitors (tricyclic antidepressants)
 The MAO inhibitors are Marplan, Nardil and Parnate
 Patients taking MAO inhibitors should be instructed to avoid foods rich in
Tyramine (cheese, beer, wine, avocado) because MAOIs + Tyramine =
Hypertensive crisis (severe hpn causing organ damage)
 Nursing management for L-dopa
 Best given with meals to avoid GIT irritation
 Inform client that his urine and stool may be darkened
 Instruct client to avoid foods rich in Vit B6 (Pyridoxine): cereals, green leafy
vegetables and organ meats
 Pyridoxine reverses the therapeutic effect of levodopa
• Note: Vit B6 intake should be increased for patients taking Isoniazid
(INH) to counter INH side-effect of peripheral neuritis
 Carbidopa [Sinemet] – long-acting anti-parkinson
 Mechanism: same as levodopa
 Side effects:
 Hypokinesia
 Hyperkinesias
 Psychiatric symptoms: EXTRA-PYRAMIDAL SYMPTOMS
 Amantadine HCl [Symmetrel]
 Mechanism: same as levodopa
 Side effects:

 Tremors
 Rigidity
 Bradykinesia
 Rx for Parkinson’s (continued):

 Anticholinergics: [Artane] and [Cogentin]
 Anticholinergics are given to relieve tremors
 Mechanism of action: inhibits acetylcholine
 Side-effects: SNS effects
 Antihistamines: Diphenhydramine [Benadryl]
 Antihistamines also relieve tremors
 Side effect for adults: drowsiness
 Patient should avoid driving and operating machinery
 Side effect for children: CNS excitability – hyperactivity (paradoxical effect for
young children < 2 y.o.)
 Dopamine agonists: Bromocriptine [Parlodel]
 Relieves tremors, rigidity and bradykinesia
 Side-effect: Respiratory depression, therefore CHECK RR
 Maintain siderails, to prevent injury related to falls
 Prevent complications of immobility: Turn to side q 2, q 1 if elderly
 Diet should be low-protein in AM, high-protein in PM (give milk before bedtime)
 High-protein diet induces sleep (Tryptophan is a precursor to melatonin, the sleep
hormone)
 Increase oral fluid intake and high-fiber diet to prevent constipation
 Increase intake of bran and psyllium; use bulk-forming laxatives [Metamucil]
 Assist in ambulation
 Safety precautions: Patient should wear flat rubber shoes, and use grab bars
 Assist in surgical procedure: STEREOTAXIC THALAMOTOMY
 A portion of the thalamus is destroyed to reduce tremors
 Complications of the procedure:
 Subarachnoid hemorrhage
 Encephalitis
 Aneurysm
What is the goal collaboratively made by the nurse, physician, physical therapist and
nutritionist for a patient with Parkinson’s disease?
A. Maintain joint flexibility
B. Build muscle strength
C. Improve muscle endurance
D. Reduce ataxia
The correct answer is A. Because of the degenerative nature of Parkinson’s, it is not

possible for the patient to perform exercises that build muscles or increase endurance
(eliminate Options B and C). Option D is irrelevant; ataxia is a symptom of Multiple
Sclerosis, not Parkinson’s.

The client with Parkinson’s disease is being switched from levodopa to carbidopa. What
complication would arise from the prescription change and dosage adjustment?
A. euphoria
B. jaundice
C. v/s fluctuation
D. symptoms of diabetes
The correct answer is C. Recall that a side-effect of levodopa is orthostatic hypotension,

which is a sudden decrease in blood pressure that occurs when changing from lying
position to standing.
A nursing aid is assisting a Parkinson’s patient during meal time. Which of the following
actions by the nursing aid is inappropriate?
A. Allowing the patient to cut his own food
B. Placing the patient upright
C. Filling the coffee cup half-full
D. Setting limits on the length of mealtime
The correct answer is D. A patient with Parkinson’s has bradykinesia (slowness of

movement), thus it is inappropriate to rush the patient with meals.
Note: Allowing the patient to cut his own food (Option A) does not necessarily require the
use of a metal knife (remember: do not add details to the question). The patient should be
allowed to perform activities that he can do independently to maintain his self-esteem.
Meningitis
ƒ Inflammation of the meninges
ƒ The meninges is a three-fold membrane that covers the brain and spinal cord.
 Function of the meninges: support and protection, nourishment and blood supply
 3 layers of the meninges:
 Dura matter – outermost
 Subdural space – between dura and arachnoid matter
 Arachnoid matter – middle
 Subarachnoid space – between arachnoid and pia matter
 The subarachnoid space is where CSF circulates
 The subarachnoid space between L3 and L4 is the site for lumbar puncture.
 Pia matter – innermost
ƒ Etiologic agents for meningitis:
 Meningococcus – most dangerous cause of meningitis
 Pneumococcus
 Streptococcus – causes adult meningitis
 Haemophilus influenzae – causes pediatric meningitis
ƒ The mode of transmission of meningitis is AIRBORNE via droplet nuclei.
 Transmitted through coughing, talking, sneezing, kissing
 Not transmitted through sexual contact
Diagnostic Tests for Meningitis:
ƒ LUMBAR PUNCTURE (spinal tap) – diagnostic procedure for meningitis
 A hollow needle is inserted into the subarachnoid space to obtain a sample of
cerebrospinal fluid
 Nursing management before LP:

 Secure informed consent and explain the procedure to the patient:
 Note: All surgeries should be explained by the doctor, but all diagnostic procedures should
be explained by the nurse!!!
 Empty bladder and bowel to promote comfort.
 Encourage client to arch his back to enable the physician to clearly visualize L3 and L4.
 Nursing management after LP:
 Place client flat on bed for 12 to 24 hours after the procedure to prevent spinal
headache and leakage of CSF.
 Spinal headache is due to decreased CSF pressure (similar to orthostatic
hypotension).
 Force fluids to replace lost CSF
 Check the puncture site for discomfort, discoloration and leakage to tissues
 Assess for movement and sensation of extremities to determine if the procedure
caused any nerve damage.
 If the patient has meningitis:
 CSF analysis would reveal elevated protein and WBC, decreased glucose, increased CSF
opening pressure (normal CSF pressure is 50 – 160 mmHg), and (+) bacterial culture
ƒ Complete blood count (CBC) reveals Leukocytosis (increased WBC)
Notes on Hematology:
Increased Decreased
RBC Polycythemia Anemia
WBC Leukocytosis Leukopenia
Platelets Thrombocytosi Thrombocytopeni
s a
ƒ NDx for patient with Anemia: Activity Intolerance; NMgt is to place the patient on complete
bed rest and administer O2.
ƒ Polycythemia  agglutination  thrombosis  HYPERTENSIVE STROKE
 Initial sign of hpn stroke is headache.
 Late sign is pruritus/itchiness due to abnormal histamine metabolism
ƒ Thrombocytopenia: decreased platelets  bleeding  hemorrhage
 Side-effects of platelet dysfunction:
 Eccymosis
 Petechiae/purpura
 Oozing of blood from puncture site.
 NMgt for thrombocytopenia: Avoid parenteral injections
 Note: Platelets depletion happens in Disseminated Intravascular Coagulation  treated by
heparin
ƒ Leukocytosis leads to increased susceptibility to infections, so place the patient on REVERSE
ISOLATION (to protect the patient).
ƒ Patients with infectious diseases are places on STRICT ISOLATION (to protect other patients).

Identify the type of isolation for clients with the following conditions:
A. Cushing’s Syndrome
B. Aplastic anemia
C. Cancer (any type)
D. Prolonged use of steroids
E. AIDS
F. Post liver transplant
G. Typhoid fever
H. Hepatitis A
I. Measles
J. Mumps
K. Pneumonia
L. PTB
M. Diphtheria
N. Meningitis
O. Asthma
A to F: REVERSE ISOLATION, because the patient has an illness that depresses the immune
system, or is receiving immunosuppressive drugs.
G to H: ENTERIC ISOLATION, because these illnesses are transmitted via a feco-oral route.
I to M: STRICT ISOLATION, because these illnesses are transmitted airborne or droplet
O: none, a patient with asthma does not need to be isolated.
Nursing Management for Meningitis:

ƒ Administer Rx:
 Broad spectrum antibiotics (Penicillin)
 Analgesics
 Antipyretics
ƒ Institute strict respiratory isolation 24 hours after initiation of antibiotic therapy.
ƒ Comfortable and dark environment
ƒ Monitor v/s, I&O and neurocheck
ƒ Maintain fluid and electrolyte balance
ƒ Prevent complications of immobility
ƒ Institute measures to prevent inc ICP
Review: Adrenal Gland
Hormones of the Adrenal Cortex:
ƒ Sugar: Glucocorticoids (e.g. cortisol) control glucose metabolism
ƒ Salt: Mineralocorticoids (e.g. aldosterone) promote sodium and water reabsorption and
potassium excretion
ƒ Sex: Androgenic hormones (testosterone, estrogen, progesterone) promote development of
secondary sexual char
Diseases of the Adrenal Gland:

Addison’s disease Cushing’s syndrome
Hyposecretion of adrenal hormones Hypersecretion of adrenal hormones
ƒ Sugar : hypoglycemia ƒ Sugar : hyperglycemia
ƒ Salt : hyponatremia, with hyperkalemia ƒ Salt : hypernatremia, with hypokalemia
ƒ Sex : decreased libido ƒ Sex : hirsutism, acne, striae

Hypoglycemia (T-I-R-E-D) Hyperglycemia (P-P-P)
ƒ Tremors/Tachycardia ƒ Polyuria
ƒ Irritability ƒ Polydypsia
ƒ Restlessness ƒ Polyphagia
ƒ Extreme fatigue Note: DM is a complication of Cushing’s
ƒ Diaphoresis/Depression
ƒ Decreased tolerance to stress due to ƒ Increased
steroids cause decreased WBC
decreased steroids (Leukopenia)
 can lead to ADDISIONIAN CRISIS  IMMUNODEFICIENCY
Note: Steroids takers (athletes,body builders) experience
ssx of Cushing’s
Hyponatremia Hypernatremia with Fluid Volume Excess
ƒ Hypotension ƒ Hypertension
ƒ Dehydration ƒ Edema
ƒ Weight Loss ƒ Weight Gain
ƒ Pathognomonic Sx of Cushings:
 Moon-face
 Buffalo hump
 Obese trunks
 Pendulous Abdomen
 Thin extremeties
Hyperkalemia Hypokalemia
ƒ Irritability, agitation ƒ Weakness, fatigue
ƒ Diarrhea, abdominal cramps ƒ Constipation
ƒ Peak T waves  arrhythmia ƒ Prominent U wave  can also lead to
arrhythmia
ƒ Decreased sexual urge and loss of pubic and ƒ Hirsutism, acne and striae due to increased sex
axillary hair hormones
ƒ Pathognomonic sx: Bronze-like skin ƒ Other signs:
 Decreased cortisol causes pituitary gland to secrete ƒ Depression
Melanocyte-stimulating hormone ƒ Easy bruising
ƒ Increased masculinity in women
Management: Management:
ƒ Steroids (2/3 dose in AM and 1/3 dose in PM) ƒ Potassium-sparing diuretics: Aldactone
[Spironolactone] – promotes excretion of
sodium while retaining potassium
ƒ DO NOT GIVE LASIX
ƒ Limit fluids
ƒ Increase potassium in the diet
Nursing Management for Meningitis (continued):

ƒ Provide client Health teaching and discharge planning
ƒ Diet: High carb, high protein, high cal with small freq feedings
ƒ Prevent complications: HYDROCEPHALUS and NERVE DEAFNESS
 Patient with meningitis should be referred to an audiologist for testing.
ƒ Rehabilitation for residual deficits: mental retardation or delay in psychomotor development

During the acute stage of meningitis, a 3-year old patient is restless and irritable. Which
nursing intervention is most appropriate?
A. Limit conversations with the child
B. Keep extraneous noise to a minimum
C. Allow child to play in the bathtub
D. Perform treatments quickly
The correct answer is Option B, which will minimize the danger of increased ICP.
Myasthenia Gravis
ƒA neurovascular disorder characterized by a disturbance in the transmission of impulse fro
nerve to muscle cells at the neuromuscular junction leading to DESCENDING MUSCLE
PARALYSIS.
ƒ More common in women aged 20 to 40.
ƒ Etiology: idiopathic, related to autoimmune
 For unknown reasons, the body is producing cholinesterase which destroys acetylcholine,
the neurotransmitter for muscle movement, leading to muscle weakness.
ƒ SSx:
 Initial Sign: PTOSIS (drooping of upper eyelid)
 Diplopia
 Masklike facial expression
 Dysphagia
 Hoarseness
 Respiratory muscle weakness  respiratory arrest (Prepare tracheostomy set at bedside)
 Extreme muscle weakness especially during activity or exertion
ƒ Dx test:
 TENSILON TEST
 Tensilon (Edrophonium HCl) is a short acting anti-cholinesterase
 Tensilon is administered via IV push
 If patient has MG, symptoms will be temporarily relieved (for 5 to 10 minutes)
 CSF analysis reveals elevated cholinesterase levels
LIVING SPRING INSTITUTE 2011
NCLEX PHARM MADE EASY

1. phenytoin(Dilantin): anti-seizure, neuropathic pain, mood-stabilizer (bipolar). Start small and titrate
like a cook. Folate deficiency(eat fresh leafy veggies; watch out for spina bifida), gingival hyperplasia
(gum massage; see a dentist often),blood dyscrasias(anemia,agranulocytosis,thrombocytopenia), sedation
(no machines for 24hrs, avoid sedatives like alcohol, sleeping meds).hypotension = change slowly. Aim
is to get seizure free yrs. Remember quiet environ, dimmed lighting, helmet, avoid alcohol, ketogenic
diet(low carb, high fat in intractable seizures)Others are:carbamazepine, valproate, ethosuximide,
lamotrigine
2. furosemide(Lasix) and hydrochlorothiazide--eat food high in potassium(fruits/foods like

watermelon, cantaloupe, banana, tomatoes, potatoes). Watch out when mixed with digoxin/digitalis
because hypoK+

will cause digoxin toxicity,alkalosis, muscle weakness, muscle cramps, u-wave on ECG, dysrhythmia,
constipation. Thiazides are sulfa meds, so photophobia, Steven Johnson syndrome, kidney damage,gout,
interference with some oral hypoglycemic, are our concern. NSAIDS make loop ineffective. Avoid these
meds at bed time, Weigh same time, I&O, BP, reduce sodium in diet. Others are ethacrynic acid,
bumetanide, chlorothiazide
3. ampicillin, amoxycillin, cloxacillin, dicloxacillin = photosensitivity, makes OCP ineffective, finish

the entire course, may cause pseudomembraneous colitis(C.diff, contact isolation, vancomycin /
metronidazole,fluid), may cause oral thrush(give yogurt to replenish lactobacillus acidophilus). Treatment
for impetigo. Others are, gentamicin-aminoglycoside(ototoxicity, nephrotoxicity, neuromuscular
paralysis), tetracycline-tetracyclines(photosensitivity, avoid from conception to age 12yr because of
teeth/bone effect, avoid antacids/calcium-containing food), ciprofloxacin-fluoroquinolones
4. Clozapine, fluphenazine, haloperidol, chlorpromazine, olanzepine, riseperidone - Treatment of

psychosis. Neuroleptics, antipsychotics, major tranquilizers. Agranulocytosis (check WBC, sore throat,
fever, c-reactive protein, EPS); hyperglycemia; sedation; EPS (akathisia= restlessness, dystonia/ acute
dystonia= oculogyrus, stiff neck/ back, tongue protusion; pardinsonism/ pseudoparkinsonism= masked
face, tremor, pill-rolling, stooped posture, bradykinesia, shuffling gait, drooling, constipation,
micrografia; tardive dysdinesia, slow abnormal rhythmic movement.
5. Allopurinol: for chronic gout (colchicine for acute = “A” for “C”, while “C” for “A”). Take with full
glass of water after meals; at the same time each day. Several weeks. Stomach upset, diarrhea,
agranulocytosis (fever, sore throat).
6. Levadopa/ Carbidopa: hypotension, arrhythmias nausea. Avoid food high in protein and vitamin B6
(pyridoxine). Hair loss, hallucination, excessive libido, dyskinesia
7. Vasotec(enalapril)-ACE inhibitors (end in –pril). Dry cough, hypotension (especially at the beginning)
and hyper K+ so check renal function before starting; avoid potassium-rich food. Monitor blood pressure,
change position gradually.
8. Lovenox (enoxaparin), fondaparinux(Arixtra) Ends in –parin. Low molecular weight heparin. Be

on bleeding precautions (stool softener, avoid aspirin; avoid flossing, use soft tooth-brush, avoid I.M
injections, avoid contact sports, avoid barefoot, report petechiae, ecchymosis hematuria/ pink urine,
black / tarry stool, nose bleed /epistaxis). Use 25G -29G, subcutaneously on anterior thigh, lower
abdomen. Don’t aspirate. Leave air in the injection.
9. Ketaconazole, tiaconazole – Antifungal. Others tiaconazole, fluconazole, must avoid antacids for
absorption. Oligospermia, dizziness, gynecomastia, signs of increased ICP.
10. spironolactone, amiloride, triamterene – K+ sparing. Avoid food rich in potassium. Check renal
function before use (BUN/ Cr and urinary output). Don’t mix with ACE Inhibitors.
11. donepezil(Aricept) ---side effects- acetylcholinesterase inhibitor, nausea/vomiting, anorexia, diarrhea,

Bradycardia (fainting). Effects subside after a while. Start with low dose.
12. omeprazole(Prilosec), lansiprazole, esmoprazole(Nexium) – proton pump inhibitors, decreasing the

amount of acid made; major side effect include leukopenia (monitor WBC, sore throat, fever), nausea,
vomiting and diarrhea. proton-pump inhibitors used for peptic ulcer disease to decrease acid production.
13. Methargine – a potent vasoconstrictor used to stop bleeding in obstetrics (child birth and miscarriage)

14. tadalafil (Cialis) and sildenafil (viagra) – nitrates just like sublingual nitrates (nitroglycerin, brown
bottle- Check for stinging sensation with the tip of tongue test; discard any unused after 3-6 months);
avoid repeating within 24 hours; may cause headache, flushing and hypotension, never to be used with
other nitrates.
15. alendronate(Fosamax), risedronate, etindronate – this is bisphosponate; works by freezing the

bone to stop osteoporosis; should be taken first thing in the morning on empty stomach with a full glass of
water; sit upright for 30 minutes to 2 hours; avoid taking the medication with all foods especially milk
products; (nursing management of osteoporosis include: weight bearing exercise, calcium intake of
1200mg per day).
16. Synthroid – (L-thyroxine, Levo-thyroxine) used to treat hypothyroidism (myxedema, cretinism, and
post-thyroidectomy); should increase thyroid function; side effects include nervousness, weight loss,
tachycardia, hypertension, diarrhea, sweating, hyperthermia); has to be taken for life. You must be
familiar with DDAVP(vasopressin,
17. Sumatriptan--side effects – used to treat migranes; causes vasoconstriction; should be avoided with
coronary artery disease-angina, MI, also in hypertensives and people with peripheral arterial disease; can
make someone’s blood turn green; sulfohemoglobinemia because it contains sulfur;
18. Lithium – treatment of mania and bipolar; has to be taken for life; increase sodium (salt) and fluid;
avoid dehydration; therefore no caffeine and alcohol; side effect and toxicity include nausea and vomiting
(must report to MD), tremors, ataxia, weight gain, thyroid dysfunction (hypo or hyper).
19. bisacodyl(Ducolax) and docusate(Colace) – bisacodyl works by stimulating the bowel and can
rupture appendicitis and diverticulitis and should only be used for a day or two. ducosate works as
mineral osmotic agent pulling water into the bowel so it can be used for very long period.
20. simvastatin(Zocor)- this are -statins. They work by inhibiting the enzyme (HMG CoA reductase)
which manufactures cholesterol at nights so this medication should be taken at night. Side effects include
muscle damage (rhabdomyolysis) and liver toxicity; stop when patient complain of muscle weakness and
pain, jaundice and dark urine; Expected to increase HDL and decrease LDL triglyceride and total
cholesterol. You should be familiar with these too: cholestyramine, ezetimibe, niacin, and gemfibrozil
21. phenelzine(Nardil), isocarboxazide, tranylcypromine – MAO inhibitors therefore food that

contains tyramine should be avoided. Htn, headache, nervousness, tachycardia, such food include cheese,
sour cream, wine, beer, apricot, and banana; Takes 1-4 weeks before it takes effect like all other anti-
depressants.
22. Prednisone and fluticasone – these are corticosteroids/glucocorticosteroids, they are

immunosuppressants and are used in so many conditions where the immune system needs to be reduced.
Example, in inflammatory bowel disease (Crohn’s/UC), Rheumatoid arthritis, asthma prevention, MS;
long term use will lead to cushings (moon face, buffalo hump, poor wound healing, truncal obesity); Do
not discontinue abruptly after two weeks of usage. Take tablet with meal (may cause peptic ulcer disease).
Rinse mouth if used as inhaler (remember to use bronchodilators first).
24. montelukast(Singulair) & zirfurlukast – used for asthma prevention and should be taken on a fixed
interval even without the symptoms; they work by blocking leukotrienes; side effect causes immunity
suppression so monitor for fever and sore throat.
25. Estradiol (Estrace) – are estrogens used to prevent pregnancy, irregular bleeding or hormone
replacement therapy; the highest priority is to monitor for thromboembolic episodes, ex PE (tachypnea,
chest pain and diaphoresis), DVT (swollen calf). Other side effects include cancers of the endometrium,

ovary and breast; hypertension, weght gain; headache, nausea and vomiting (most common side effect).
Effects as a contraceptive can be diminished by antibiotics such as ampicillin.
26. promethazine (Phenergan) / meclizine (Antivert) / diphenhydramine (Benadryl)– these are

antihistamine that decrease pruritus (itching); antiemetic, (vertigo, motion sickness, hyperemesis
gravidarum). These can induce sleep and drowsiness.
27. glipizide (Glucotrol), glyburide(glabenclamide) – oral hypoglycemic for DM II; side effects include
GI symptoms such as diarrhea. Because they are sulfur containing drugs, they also cause Steven-Johnson
Syndrome, photopobia, and nephrotoxicity. Must not be given to DM I and contra indicated in pregnancy.
28. pioglitazone(Actos) - oral hypoglycemic for DM type 2; side effects include GI symptoms such as
diarrhea. Side effects include leucopenia (monitor WBC, sore throat, fever); Must not be given to DM I
and contra indicated in pregnancy.
29. etenercept(Enbrel)/adalimumab(Humira)/abatacept(Orencia) – is a immunosuppressant ( monitor

WBC sore throat and fever); used to treat RA;
30.Vitamin B12(cobalamin, cyanocobalamin)-- requires Intrinsic factor for absorption, so deficiency is

seen in pernicious anemia, vegetarian, gastrectomy, ileostomy. Injection for life in pernicious anemia/
gastrectomy.
31. Vitamin B1(thiamin) – required for alcohol and carbohydrate metabolism. Deficient amount in
carbohydrate eaters and homeless alcoholics. Deficiency may lead to Beri-beri which is Thai language for
“I can’t, I can’t” which is congestive heart failure.
32. Vitamin B2 (riboflavin) – deficiency will cause cheilitis (cracked lips), stomatitis(mouth) and
glossitis (tongue).
33.Vitamin B3(niacin)--toxicity include, diaphoresis, nausea and vomiting, diarrhea, abdominal cramp
(like eating very hot peppery food). Deficiency include pellagra, dermatitis, dementia, diarrhea, death.
34. benazepril, quinapril, lisinopril, enalopril – ACE inhibitors ---side effect is Hyperkalemia
(therefore assess for urinary output/BUN and creatinine before giving; do not combine with other
potassium increasing medications such as angiotensin II receptor blockers- losartan and potassium sparing
diuretics-spironolactone), postural/orthostatic hypotension (worse at the beginning of the treatment so
change position gradually, monitor BP before giving) and dry cough.
35. buspirone (Buspar)/ bupriopion (Welbutrin), aripiprazole (Abilify), – atypical antidepressants

and antianxiety drugs. They take 1-4 weeks to be effective, they have little to no side effect; bupriopion is
used in clients that want to quit cigarette smoking. Decrease in symptoms and not cure is the goal of
therapy.
36. Digoxin, digitalis – works by blocking sodium-potassium pump thereby trapping intercellular
calcium; this would decrease the heart rate (negative cronotropy) and increase the force of heart
contraction (positive inotropy). The apical pulse (fourth and fifth left intercoastal space midclavicular
line, count for 60 sec.) has to be counted before digoxin is administered. To administer digoxin, a
minimum of 60 bpm in adult, 70 bpm in school-age, 90 bpm in toddlers and 110 bpm for newborns
should be assessed for. Antidote for digoxin is digoxin antibodies. Hypokalemia may cause digoxin
toxicity so monitor for potassium level before giving digoxin especially when given with furosemide.
Digoxin toxicity may lead to anorexia, nausea, vomiting and vision disturbance.

37. amiodarone – potassium channel blocker, Verapamil is a calcium channel blocker. Quinidine is a
sodium channel blocker. Propranolol is a beta blocker. All these drugs are used to reduce a
tachydysrhythmias (fast irregular heart rate like Atria tachycardia, ventricular fibrillation) to normal
rhythm and rate.
38. phenazopyridine (Pyridium) – is an agent used to irrigate the bladder to relieve bladder spasm. It
changes urine color to orange just like Rifampin.
39. nifedipine, diltiazem, verapamil, amlodipine - --calcium channel blockers that can reduce blood
pressure, irregular heart rate and angina and Beurger’s disease (Thromboangitis obliterans). Monitor BP,
pulse, headache, dizziness and heart failure.
40. morphine, hydromorphen, meperidine– used to treat severe pain, reduce anxiety and decrease
myocardial oxygen demand, overuse can lead to tolerance which leads to dependence. This should be
treated by giving drug holidays using PCA and treating with methadone. Antidote, naloxone (Narcan),
should be available when administering morphine. Avoid in gallbladder and pancreatic disorders (use
meperidine instead). Monitor for bradypnea, hypotension, constipation, dry mouth, urinary retention,
cough suppression, drowsiness.
41. fluoxetine (Prozac)/ paroxetine (Paxil)/ sertraline(Zoloft) – these are SSRI’s which takes 1-4 weeks
to be effective like other antidepressants, two major side effects include sexual dysfunction (delayed
ejaculation) and hyperserotonin syndrome (nausea, vomiting, abdominal cramp, diarrhea, diaphoresis,
hypertension, tachycardia, headache). Do not combine with other antidepressants.
42. aripiprazole (Abilify) / duloxetine (Cymbalta)- these are new atypical antidepressants; require 1-4
weeks to be effective.
43. ezetimibe(Zetia)--stops absorption of cholesterol into the body in the digestive tract
INFECTION CONTROL, INFECTION

CONTROL, INFECTION CONTROL
Standard Precautions
Standard precautions are a set of guidelines for the nurse to take when caring for the client. These
precautions protect the nurse from transmitting the disease to another client or to herself:
➤Gloves should be worn when there is a chance of contact with blood and body fluids, when handling
other potentially infected material, and when performing vascular access procedures.
➤Gloves should be changed after each client contact and between contact procedures with the same
client.
➤Masks and protective eye-wear should be worn when there is a likelihood of splashes or when body
fluids might become airborne.
➤Gloves and aprons should be worn during procedures in which there is the likelihood of splashes of
blood or body fluids.
➤Hand washing should be done immediately after contact with body fluids or other potentially infected
material and as soon as gloves are removed.

➤Needles and sharps should be disposed of in sharps containers. No recapping, bending, or breaking of
needles should occur.
➤Mouth-to-mouth resuscitation should be performed using a mouthpiece or other ventilation device.
Body fluids likely to transmit blood-borne disease include blood, semen, vaginal/cervical secretions,
tissues, cerebral spinal fluid, amniotic fluid, synovial fluid, pleural fluid, peritoneal fluid, and breast milk.
Body fluids not likely to transmit blood-borne disease unless blood is visible include feces, nasal
secretions, sputum, vomitus, sweat, tears, urine, and saliva (the exception is during oral surgery or
dentistry).
CONTACT PRECAUTION: private room. door does not have to be closed, wash hands before &
after leaving room. last patient to be seen. leave stethoscope in the room. LPN puts on glove, which
must be removed before leaving room. LPN puts on gown when doing perineal care/diarrhea. LPN
puts on glove, gown and mask when irrigating wound).
· DIARRHEAL DISEASES, GASTROENTERITIS,
(SHIGELLA, ROTAVIRUS, CLOSTRIDIUM DIFFICILE,
PSEUDOMEMBRANEOUS
· COLITIS, E.COLI, SALMONELLA)
· RSV, (CROUP, BARKING COUGH, LTB).
· MRSA PATIENT ON VANCOMYCIN
· STAPH AUREUS, TSS(HISTORY OF TAMPON USE), CELLULITIS
(SWOLLEN PART OF THE SKIN), IMPETIGO CAN BE DESCRIBED AS
GOLDEN, HONEY OR YELLOW CRUST.
· EPSTEIN BARR VIRUS, INFECTIOUS MONONUCLEOSIS (19 YEARS
OLD, COLLEGE FRESHMAN).
· VRE, HISTORY OF VANCOMYCIN
· VISA, HISTORY OF VANCOMYCIN
· VRSA, HISTORY OF VANCOMYCIN
· PEDICULOSIS, CAPITIS(HEAD LICE, BEHIND THE EARS), PUBIS
· SCABIES, SARCOPTES SCABIEI, ITCHING LINEAR/CURVED TRACKS
· CUTANEOUS DIPHTHERIA
· TB OF THE SKIN(CUTANEOUS TB)
· ANTHRAX, BACILLUS ANTHRACIS
· HERPES ZOSTER, SHINGLES, (WELL DEMARCATED PAINFUL RASH--
FOLLOWS DERMATOME)
· HSV 1 & 2. HERPES LABIALIS, COLD SORE, FEVER BLISTER,
GENITAL HERPES
· HAV/ HEV WITH DIARRHEA CAUSING N/V AND HEADACHE
· VIRAL CONJUNCTIVITIS
· VIRAL MENINGITIS
· HPV(wart)
· CUTANEOUS DIPTHERIA
DROPLET: Infections caused by organisms suspended in droplets that can travel 3 feet, but are not
suspended in the air for long periods of time. Place the client in a private room if
available or in a room with a client who has the same illness. The clients should be no
closer than 3 feet away from one another. Caregivers should wear a mask, door may
be closed some times. LPN puts on mask, gown & gloves. LPN stays at least 3-5feet.
Patient puts on mask when outside room. Dispose tissues into biohazard container.
• ADENOVIRUS, =COMMON COLD, ACUTE BRONCHITIS

• MUMPS, MUMPS INFECTION,= (SWOLLEN SALIVARY GLANDS, PANCREATITIS,
PAINFUL BREAST AND DISTENDED TESTES).
• RUBELLA CALLED GERMAN MEASLES, SMALL RUNNING NOSE, LOW GRADE
FEVER, RED TEARING EYE WITH SMALL RASH

• STREPTOCOCCAL, PHARYNGITIS, GROUP A STREPTOCOCCUS, (SORE THROAT).
• PNEUMONIA ACQUIRED IN THE COMMUNITY CAUSED BY STREPTOCOCCUS
PNEUMONIAE, a.k.a PNEUMOCOCCUS, =HIGH FEVER WITH COUGH AND CHEST
PAIN.
• MENINGITIS ACQUIRED IN THE COMMUNITY, NEISSERIA MENINGITIDES,
(MENINGOCOCCUS)=NECK STIFFNESS, PHOTOPHOBIA, POSITIVE BRUNDZINSKI
SIGN, SHARP HEADACHES, NUCHAL RIGIDITY, FEVER, POSITIVE
KERNIG'S, LUMBAR PUNCTURE WAS DONE AND IT IS CLOUDY, PETECHIAE
• DIPHTHERIA, CHEST INFECTION IN KIDS, SMELLING SPUTUM
• PERTUSSIS WILL CAUSE WHOOPING COUGH, BORDETELLA PERTUSSIS.(STACCATO
OF COUGH WITH A LONG WHOOP)
• PARVOVIRUS B, CAUSES BY APLASTIC ANEMIA MEANS BONE MARROW IS DEAD,
ESPECIALLY IN SICKLE CELL DISEASE.
• FLU, INFLUENZA
• HAEMOPHILUS INFLUENZA type b, IS A BACTERIA THAT CAUSE EPIGLOTTITIS IN 2-
6 YEARS OLD, DROOLING, SNIFFING DOG, LEANING FORWARD
• SCARLET FEVER, CAUSE BY GROUP A STREP , BODY IS RED, SEEN IN YOUNG
CHILD WITH LOW IMUMITY(SAND-PAPER RASH)
AIRBONE: Place these clients in a private room. Healthcare

workers should wear a HEPA mask or N-95 mask when dealing with
such clients. These mask contain fine fibers and filter out particles,
preventing them from passing through to the healthcare worker;
negative airflow room, air recycles every 6-12/hr; put patient on
regular mask when outside room. must close door at all times.
dispose tissues into biohazard container.
• MEASLES(rubeola), KOPLIK SPOT, RUNNING NOSE (RHINORRHEA)

• PULMONARY T.B, (ALCOHOLIC, HOMELESS, HIV AND IS COUGHING, KNOWN
INTRAVENOUS DRUG USER, NIGHT SWEAT, HEMOPTYSIS, WEIGHT LOSS, COUGH
FOR MORE THAN A MONTH)
• VARICELLA, CHICKEN POX.

BASIC NURSING SKILLS (ARRANGE IN
ORDER=DRAG & DROP)
Tracheostomy suctioning:
1. Wash hands, don clean gloves, etc.

2. Place patient in semi fowlerʼs position
3. Check wall suction (follow facility protocol)
4. Hyperoxygenate patient
5. Open sterile field, don sterile gloves
6. Pour normal saline into the container
7. Dip the tip of the catheter into the normal saline to check for
patency
8. Insert catheter into treach slowly until you meet a resistance
9. Come out in a circular manner, sucking simultaneously as you
come out
10. Dip into normal saline to clean the catheter and go back if you
need to
11. Check you patientʼs oxygen level.
Female Urinary Catheterization:
1. Wash hand
2. Place patient in lithotomy or dorsal recumbent position
3. Open sterile field, don sterile gloves
4. Place specimen collection vessel between patientʼs leg
5. Clean urinary meatus wit iodine, betadine, povidone
6. Lubricant the tip of the catheter
7. Insert the catheter until you see the flow of urine
8. Insert 1 more inch
9. Inflate balloon
10. Gently pull on the catheter until light resistance is felt (to
ensure placement)
11. Secure catheter around the thigh of the patient
12. Secure placement bag on moveable part of the bed
Therapeutic Communication Techniques
Silence
Sitting quietly (or walking with the client) and waiting attentively until the client is able to put thoughts
and feelings into words)
General Leads
“Perhaps you would like to talk about…”
“Would it help to discuss your feelings?”
“Where would you like to begin?”
“And then...what?”
“I follow what you are saying.”
Broad Openings
“I’d like to hear more about that.”
“Tell me about...”
“How have you been feeling lately?”
“What brought you to the hospital?”
“What is your opinion?”
“You said you were frightened yesterday. How do you feel now?”
Restating or Paraphrasing
Client: “I couldn’t manage to eat any dinner last night- not even the dessert.”
Nurse: ‘You had difficulty eating yesterday.”
Client: “Yes, I was very upset after my family left.”
Seeking Clarification
“I’m not sure that I understand what you mean.”
“Would you please say that again?”
“Tell me more about that.”
• Nurses can also clarify their own message with statements.

“I meant this rather than that.”
“I guess I didn’t make that clear- I’ll go over it again.”
Consensual Validation
Client: “My husband never gives me any presents.”
Nurse: “You mean he has never given you a present for your birthday or Christmas?”
Client: “Well-not never. He does get me something for my birthday and Christmas, but he never thinks of
giving me anything any other time.”
Suggesting Collaboration
“Do you want us to help…together we’ll look for a solution”
Offering Self
“I’ll stay with you until your daughter arrives.”
“We can sit here quietly for a while; we don’t need to talk unless you would like to.”
“I’ll help you dress to go home.”
Emphaty
“Its no easy being a father of nine children”

Voicing Doubt
“I find it difficult to see that there is a person under your bed.”
Giving Information
“Your therapy is scheduled for 11 AM tomorrow.”
“You may experience nausea after taking this medication.”
“I do not know the answer to that, but I will find out from Mrs. King, the nurse in charge.”
Giving Recognition
“You trimmed your beard and mustache and washed your hair.”
“I notice you keep squinting your eyes. Are you having difficulty seeing?”
“You walked twice as far today with your walker.”
Placing Event in Time or Sequence

Client: “I vomited this morning.”
Nurse: “Was that after breakfast?”
Client: “I feel that I have been here for weeks.”
Nurse: “You were admitted to the unit on Monday, and today is Tuesday.”
Presenting Reality
“That telephone ring came from the program on television.”
“That’s not a dead mouse in the corner; it is a discarded washcloth.”
“Your magazine is here in the drawer. It has not been stolen.”
Focusing
Client: “My wife says she will look after me, but I don’t think she can, with the children to take care off,
and they’re always after her about something- clothes, homework, what’s for dinner that night.”
Nurse: “You are worried about how well she can manage.”
Reflecting
Client: “What can I do?”
Nurse: What do think would be helpful?”
Client: Do you think I should tell my husband?
Nurse: You seem unsure about telling your husband.”
Summarizing
“During the past half hour we have talked about...”
Planning
“Tomorrow afternoon we may explore this further.”
“In a few days, I’ll review the actions and effects of lithium.”
Role Playing
Nurse: “I’ll be your father, show me how would you confront me the next time I scold you”
Rehearsing
“Supposing you were left at home alone again, what would you do?
Identifying Themes
“When do you feel that there are other people in the room aside from me?”
Exploring
“Tell me more about your friends.”

Encouraging Goal Setting
“Tell me you’re the things that you want to change such as your weaknesses”
Encouraging Decisions
“Which do you prefer, listening to a song or singing?
Encouraging Evaluation
“How did you feel after expressing what you have on your mind?”
“How did you feel after confronting him?”
“What is the reason you don’t want to meet your parents?”
Encouraging Description of Perception

“What are your thoughts about the accident?”
Questioning
“How would you feel if she comes back?”
Non-therapeutic Responses(That means u r on ur own here, if u go this route)
Stereotyping
“Two-year old brats.”
“Women are complainers.”
“Men don’t cry.”
“Most people don’t have pain after this type of surgery.”
Overloading
Nurse: ”I am your nurse today, hello, how are you, how do you feel……(in a fast pace)
Underloading
The patient is finished talking and the nurse doesn’t give feedbacks
Value Judgement
“It’s not right to use those words in here”
Invalidation
Client: Is it ok if I….
Nurse: (chats down notes as if she heard nothing)
Disagreeing
Client: “I don’t think Dr Broad is a very good doctor. He doesn’t seem interested in his patients.”
Nurse: “Dr. Broad is head of the Department of Psychiatry and is an excellent therapist.”
Defending
Client: “Those night nurses must just sit around and talk all night. They didn’t answer my light for over
an hour.”
Nurse: “I’ll have you know we literally run around on nights. You’re not the only client, you know.”
Challenging
Client: “I felt nauseated after that red pill.”
Nurse: Surely you don’t think I gave you the wrong pill?”
Client: “I feel as if I am dying.
Nurse: “How can you feel that way when your pulse is 60?”

Incongruence
Nurse: “I’m really concerned with you”(while gazing at other people or objects)
Probing
Client: “I was speeding and didn’t see the stop sign.”
Nurse: “Why were you speeding?”
Client: “I didn’t see the doctor when he was here.”
Nurse: “Why not?”
Testing
“Who do you think you are?” (enforces people to admit their status is only that of client)
“Do you think I’m not busy?” (forces the client to admit that the nurse really is busy)
Changing Topics and Subjects

Client: “I’m separated from my wife. Do you think I should have sexual relations with another woman?”
Nurse: “I see that you are 36 and that you like gardening. This sunshine is good for my roses. I have a
beautiful rose garden.”
Reassuring
“You’ll feel better soon.”
“I’m sure everything will turn out all right.
“Don’t worry.”
Giving Approval
“That’s good ”
“You should do that.”
“What you did was Right ”
Giving Advice
Client: “Should I move from my home to a nursing home?”
Nurse: “If I were you, I’d go to a nursing home, where you’ll get your meals cooked for you.”
Focusing on Self
Nurse: “Do you have a pet? I have a pet once and his name was……..
Internal Validation
Nurse: “our patient is now feeling well, we can release his restrain ” (a previously manic patient is now
calm because he only wants to be released from the restrain and would resume his activity after restrain is
gone)
SUMMARY OF ASSIGNMENTS & DELEGATION

UAP / CNA TASK
1. Calculating a client’s intake and output
2. Providing oral and bathing hygiene to an immobilized client
3. Collecting vital signs every 30 min for a client who is 1 hr post cardiac catheterization
4. Assisting a client with toileting.
5. Assisting a client with ambulation
6. Turning a client every 2 hr
7. Capillary glucose check / fecal occult blood test.

LPN TASK
1. Monitoring a client’s condition during blood transfusions and intravenous administrations
2. Dressing change of an uncomplicated wound
3. Routine naso-tracheal suctioning
4. Administering an oral medication
5. Administering subcutaneous insulin
6. Administering an IM pain medication
7. Providing written information regarding advance directives
8. Checking a client’s feeding tube placement and patency
RN TASK
1. Developing a teaching plan for a client newly diagnosed with diabetes mellitus
2. Assessing a client admitted for surgery
3. Administering blood to a client
4. Initiating client referrals
5. Receiving report from surgery nurse regarding a client to be admitted to a unit from the PACU
6. Initiating a continuous IV infusion of dopamine with dosage titration based on hemodynamic
measurements
7. Assessing and documenting a client’s decubitus ulcer
8. Evaluating a client’s advance directive status
9. Initial feeding of a client who had a stroke and is at risk for aspiration
10. Developing a plan of care for a client
11. Calculating and monitoring TPN flow rate
Rationale for RN-only tasks:

RNs retain accountability for the nursing process – assessment, diagnosis, planning, and evaluation. All
tasks that involve the steps of the nursing process can only be performed by an RN. In general, some
input measures can be delegated (e.g., I&O, vital signs, reporting client observations), but not
responsibility for the process.
Not all state practice acts allow for LPN performance of parenteral medication
administration (e.g., blood administration, TPN).
Actions like titration of dopamine and feeding clients at risk for aspiration require nursing
judgment.
Practice Questions on Delegation

1. A home care nurse has been managing a client for six weeks. What should be the initial action by
the nurse to determine the quality of care provided by a home health care aide assigned to assist
with the care of this client?
A. Ask the client and family if they are satisfied with the care given by the home health aide
B. Determine if the home health aide's care is consistent with the plan of care
C. Investigate if the home health aide is prompt and stays an appropriate length of time to provide care
D. Check the documentation of the home health aide for appropriateness and comprehensiveness
RATIONALE: Although the nurse must investigate all of the above items, an evaluation of the adherence
to the plan of care is a first priority. The plan of care is based on the reason for referral, the provider's
orders, the initial nursing assessment, the client’s responses to the planned interventions, and the client's
and family's feedback or inquiries.
2. Which client data should a nurse act upon when a home health aide calls the nurse from the
older adult client's home to report these items?
A. "The client has complaints of not sleeping well for the past week."

B. "The family wants to discontinue the home meal service called Meals on Wheels."
C. "The urine in the urinary catheter bag is of a deeper amber, almost brown color."
D. "The partner says the client has slower days for doing things every other day."
RATIONALE: Home health aides often report diverse information to nurses through phone calls and
documentation. The nurse who develops the plan of care for a specific client, and supervises the aide,
must identify potential danger signs which require immediate action and follow-up. The color of the urine
requires first an evaluation for follow-up. The other options may need further assessment after the change
in urine color is dealt with first.
3.A staff nurse complains to a nurse manager that an unlicensed assistive personnel (UAP)
consistently leaves the work area untidy and does not restock supplies. The initial response by the
nurse manager should be which of these statements?
A. "I will arrange for a conference with you and the UAP within the next week"
B. "I can assure you that I will look into the matter in due time"
C. "I would like for you to approach the UAP about the problem the next time it occurs"
D. "I will add this concern to the agenda for the next unit meeting so we can discuss it"
Part of the manager's role is to help the staff manage conflict among themselves. It is appropriate to
urge the nurse to confront the other staff member to work out problems without a manager's
intervention when possible. This is an approach at the first level of management. If the two staff
members cannot resolve the issue then the manager would have a conference with the two staff to
facilitate a negotiation for a win-win result.
4. When caring for a client with an intravenous (IV) infusion for pain control, a nurse should ask an
unlicensed assistive personnel (UAP) to do which action?
A. Monitor the client for the degree of pain relief
B. Readjust the set rate on the pump by two mL/minute
C. Check the IV site for drainage and loose tape when in the room
D. Assist the client with ambulation after supervising a gown change
RATIONALE: When giving assignments to a UAP, the nurse should communicate clearly and
specifically what the task is, what should be reported to the nurse, and when it should be reported.
Implementation of routine tasks with expected outcomes should be delegated to UAPs. The other
options are actions that PNs or RNs could do.
5. During an interview of a prospective employee who just completed the agency application, which
approach should a nurse manager use to assess skills' competence of this potential employee?
A. "What degree of supervision for basic care do you think you need?"
B. "Let's review your skills check-list for type and level of skill for tasks."
C. "Let's talk about your comfort zones for working independently."
D. "What types of complex client care tasks or assignments do you prefer?"
The nurse needs to know that the potential employee has competence in certain tasks that are
common on the unit. One way to do this is to do mutual review of the agency list of skills. The other
questions might be asked during the skills checklist review.
6. Which of these tasks can be safely delegated to a practical nurse (PN) by the charge nurse?
A. Assess the function of a newly created ileostomy
B. Care for a recent complicated double barrel colostomy
C. Provide stoma care for a client with a well-functioning ostomy
D. Teach the initial ostomy care to a client and their family members
The care of a mature stoma and the application of an ostomy appliance may be delegated to a PN. This
client has minimal risk of instability of the situation. The clues in the other options that make them
incorrect for delegation to a PN are in option a – newly created, in option b – recent complicated and in

option d – teach initial …care. Since these three options suggest "initial" care the RN should be the one to
perform the stated actions.
7. Which statement should a nurse use to give an assignment to an unlicensed assistive personnel
(UAP) to help a client ambulate for the first time after a colon resection?
a) "Have the client sit on the side of the bed for 3 to 5 minutes before standing."
b) "If the client is dizzy upon standing, ask the client to look up and hold onto you."
c) "Help the client to sit in a chair in the room as often as desired."
d) "When you help the client to walk, ask if the pain increases or decreases."
Correct answer: A
Rationale: This statement gives clear directions to the UAP about the task and is most closely associated
with the information in the stem. This is the client’s first time out of bed after surgery. The other actions
are either incorrect or too general for delegation.
8. A nurse assigns an unlicensed assistive personnel (UAP) to care for a client with a
musculoskeletal disorder. The client ambulates with a leg splint. Which activity should the UAP be
involved with?
a) Screen for findings of redness overlying joints
b) Assist the client to transfer from a bed to a chair
c) Encourage independence in self-care
d) Monitor the client's response to activity
Correct answer: B
Rationale: UAPs are usually involved in routine activity needs of clients. These routine tasks typically
have predictable outcomes. Option 1 requires a higher level of thinking to screen for abnormal findings.
Option 3 to encourage independence would not necessarily have a predictable outcome.
9. The practical nurse (PN) is caring for a client in isolation. Which task should the PN assign to an
unlicensed assistive personnel (UAP)?
a) Reinforce isolation precautions to any visitors
b) Monitor the client's thoughts about being in isolation
c) Evaluate the visitors' compliance with isolation measures
d) Observe of the client's reaction to the isolation environment
Correct answer: A
Rationale: The UAP may reinforce to any visitors the basic principles of isolation required for clients. The
key word is ‘reinforce’ and not teach. Note the other verbs are not associated with actions of a UAP.
10. An unlicensed assistive personnel (UAP) who usually works in an assisted care agency on
pediatrics is assigned to work on an adult medical-surgical unit. Which of these questions should
the UAP be asked by the charge PN nurse prior to making assignment decisions?
a) "How long have you been a UAP?"
b) "What type of care did you give in pediatrics?"
c) "Do you have your competency checklist for review?"
d) "Are you comfortable caring for adult clients?"
Correct answer: C
Rationale: The UAP must be competent to accept the delegated task. The right task must be delegated to
the UAP. Review of a standardized skills checklist is the most thorough and efficient manner to identify
competencies of any staff member. Option 1 the focus on time in a role does not guarantee skills and

knowledge. Option 2 is too general of a question. Option 4 deals with feelings and not skill level of the
UAP.
11. While caring for a client with the diagnoses of confusion and anemia, which task should a nurse
assign to an unlicensed assistive personnel (UAP)?
a) Check for skin color changes
b) Test stool for occult blood
c) Select foods high in iron off the menu
d) Notice any mental status changes
Correct answer: B
Rationale: The UAP can do standard, unchanging procedures with predictable outcomes. Options 1, 3 and
4 require higher levels of thinking and processing.
12. To whom should the measurement and documentation of vital signs in a long-term care facility
be assigned?
a) Practical nurse (PN)
b) Registered nurse (RN)
c) Unlicensed assistive personnel (UAP)
d) Volunteer
Correct answer: C
Rationale: The measurement and documentation of vital signs which are routine tasks may be delegated
to a UAP. Considerations for assigning care to UAPs would be: who is capable and is the least expensive
worker to do tasks that are routine and have predictable outcomes?
13. Which of these clients should a nurse assign to an unlicensed assistive personnel (UAP)?
a) A client diagnosed with peripheral vascular disease and an ulceration of the lower leg
b) A preoperative client with a history of asthma awaiting surgery for an adrenalectomy
c) An older adult client with hypertension and a self-report of non-compliance
d) A new admission with a history of diagnoses of transient ischemic attacks and dizziness
Correct answer: A
Rationale: This client is the most stable with no risk of instability as compared to the other clients. This
client has a chronic condition and needs supportive care.
Test-taking Tips: Compare the options with the labels of acute and chronic. The chronic diagnoses are
more likely to be assigned to the UAP.
14. An unlicensed assistive personnel (UAP) has completed an agency orientation in the prior week.
During the first day on the unit, which question should a nurse ask to best assess competence?
a) "Do you need supervision for basic care?"
b) "Can I review your skills checklist?"
c) "Are you comfortable working independently?"
d) "What client care tasks do you prefer?"
Correct answer: B
Rationale: The nurse needs to know that new UAPs have competence in certain tasks. One way to do this
is to review documented skills as listed by the agency. The other options are more specific and are
subjective as they refer to feelings or preferences.
15. A practical nurse (PN) from the pediatric unit is assigned to work in a critical care unit. Which
of these clients might the PN offer to be assigned to provide care?

a) A client diagnosed with multitrauma and with a history of a newly implanted pacemaker
b) A middle-aged client diagnosed with a possible myocardial infarction
c) A new admission of a young adult who reports left sided weakness from a probable stroke
d) A young adult client who is in skeletal traction after a motor vehicle accident
Correct answer: D
Rationale: This client is the most stable with a predictable outcome and minimal risk of instability. Use
this guideline when delegating to reassigned personnel.
16. When caring for a client receiving an intravenous (IV) infusion via an electronic pump, which of
these actions should a nurse safely ask an unlicensed assistive personnel (UAP) to perform?
a) Adjust the flow rate as directed by the nurse
b) Monitor the pump's overall operation
c) Check the IV dressing for drainage or nonadhesion
d) Report the reading on the pump for milliliters remaining
Correct answer: D
Rationale: When directing the UAP, communicate clearly and specifically what the task is. When and
what should be reported to the nurse is critical. Only actions or routine tasks should be assigned to UAPs.
This task does not require independent judgment.
17. When walking past a client's room, a nurse hears an unlicensed assistive personnel (UAP)
talking to another UAP. Which one of these statements requires further intervention by the nurse?
a) "If we work together we can get all of the client care completed."
b) "Since I am late for lunch, would you do my client's accucheck glucose test?"
c) "This client seems confused, we need to watch the client closely."
d) "I'll come back and make the bed after I go to the lab."
Correct answer: B
Rationale: Only registered nurses (RNs) and practical nurses (PNs) can delegate to each other or the UAP.
UAPs cannot delegate to other UAPs.
18. Which client statement should the home health PN consider to be a priority and report
immediately to the case manager?
a) "I just didn't sleep well the last few nights. I have thoughts running through my mind."
b) "I really don't want the service of Meals on Wheels. I am just not hungry."
c) "When I emptied my urine catheter bag it looked like rusty colored water."
d) "My neighbors just don't get along with me since I refuse to let them walk across my lawn."
Correct answer: C
Rationale: Although nurses need to report diverse information to case managers through phone calls and
documentation, they need to immediately report findings that suggest serious changes in a clients'
condition. The change in the color of urine to “rusty” suggests blood, a potential danger sign. This
requires immediate reporting, documentation and further assessment.
19. As the RN responsible for a client in isolation, which task can be delegated to a practical nurse
(PN)?
A. Reinforcement of isolation precautions with visitors
B. Assessment of the client's attitude about infection control
C. Evaluation of staff compliance with infection control measures
D. Observation of the client's total environment for risks of harm
PNs and UAPs can reinforce information that was originally given by the RN. The other options are
responsibilities of the RN and cannot be delegated.

20. The nurse assigns an unlicensed assistive personnel (UAP) to care for a client diagnosed with a
musculoskeletal disorder. The client ambulates with a leg splint. Which task requires supervision of
the UAP during the care of this client?
A. Report signs of redness overlying a joint
B. Monitor the client's response to ambulatory activity
C. Encourage for the client's independence in self-care
D. Assist the client to transfer from a bed to a chair
Monitoring the client’s response to interventions requires evaluation, a task to be performed by an RN.
The other options can be done by UAPs without supervision by the PN or the RN.
21. A client has had a tracheostomy for two weeks. Which task could the RN safely delegate to an
A. Teach the client how to cough up secretions
B. Change the tracheostomy ties when soiled
C. Monitor for shortness of breath and wheezes
D. Perform routine tracheostomy dressing care
UAPs should be able to perform routine tracheostomy care.
22. The measurement and documentation of vital signs is expected for clients in a long term facility.
Which staff type would it be proper to delegate these tasks to?
A. Practical nurse (PN)
B. Registered Nurse (RN)
C. Unlicensed assistive personnel (UAP)
D. Volunteer
The measurement and recording of vital signs may be delegated to UAP. This falls under the umbrella of
routine tasks with expected outcomes for stable clients. Other considerations for delegation of care would
be: Who is capable and is the least expensive worker to do each task?
23. The care of which of these clients should the nurse delegate to an unlicensed assistive personnel
(UAP)?
A. A client with a diagnosis of peripheral vascular disease with an ulceration of the lower leg.
B. A pre-operative client awaiting an adrenalectomy with a history of asthma
C. An older adult client with a diagnosis of hypertension and self-reported non-compliance
D. A new admission with a history of diagnosis of transient ischemic attacks and syncope
This client is stable with no risk of instability as compared to the other clients. This client also has a
chronic condition which needs supportive care. The clues in the other options for a risk of instability are:
option b – awaiting surgery, option c – hypertension…non-compliance, and option d – new admission.
24. Which of these clients should a charge nurse assign to a practical nurse (PN)?
A. An adolescent trauma victim newly admitted with a diagnosis of quadriplegia and a client one day
post-op radical neck dissection
B. An older client with newly diagnosed type 2 diabetes mellitus and a client with a history of AIDS
admitted with a diagnosis of pneumonia
C. A middle-aged client diagnosed with hemiplegia is fed by a nasogastric tube and a client with a left leg
below the knee amputation in rehabilitation
D. A young adult client client with a diagnostic history of schizophrenia with current alcohol withdrawal
syndrome and a client diagnosed with chronic renal failure and anemia
This client requires supportive care and interventions within the scope of practice of a PN. This client is
the most stable with a minimal risk of complications or instability. In the other options some of the clients

would require the RN care. The clues are: in option 1 newly admitted, in option 2 – newly diagnosed and
in option 4 – current alcohol withdrawal. All of these clients would have a high risk of instability.
25. An unlicensed assistive personnel (UAP), who usually works in pediatrics is reassigned to work
on an adult medical-surgical unit. Which of these questions should the charge nurse ask prior to
making delegation decisions?
A. "How long have you been a UAP?"
B. "What type of client care did you give in pediatrics?"
C. "Do you have your competency checklist that we can review?"
D. "How comfortable are you to care for adult clients?"
The UAP must be competent to accept the delegated task. The use of a check list is the most
comprehensive approach to evaluation of the UAPs skill set. Further assessment of the qualifications of
the UAP is important in order to assign the correct types of tasks. In option 1 the length of time in a
position does not ensure competency. In option 2 the client care in pediatrics is irrelevent on an adult unit.
In option 4 the UAPs feelings are not a priority for delegation of assignments. Feelings are important for
the charge nurse to be aware of for approaches of moral support to the UAP.
26. An RN from the women’s wellness health clinic is temporarily reassigned to an adult medical-
surgical unit. Which of these client assignments would be appropriate for this nurse?
A. A newly diagnosed client with type 2 diabetes mellitus who is learning foot care
B. A client from a motor vehicle accident with an external fixation device on the leg
C. A client admitted for a barium swallow after a transient ischemic attack (TIA)
D. A newly admitted client with a diagnosis of pancreatic cancer and severe dehydration
This client is the most stable, requires basic safety measures and has a predictable outcome. The clues in
the other options that indicate not to delegate to a reassigned nurse are: option 1 – newly diagnosed,
option 3 – after a TIA, and option 4 – newly admitted and severe dehydration. All of these client have an
illness as compared to the client in option b who is healthy except for the fracture.
27. A practical nurse (PN) from the pediatric unit is reassigned to work in an adult critical care
unit. Which client assignment would be appropriate for this staff member?
A. A client admitted with multiple trauma with a history of a newly implanted pacemaker
B. A new admission diagnosed with left-sided weakness from a stroke and mild confusion
C. A 53 year-old who had a cardiac arrest and was diagnosed with suspected myocardial infarction (MI)
D. A 35 year-old client in balanced traction admitted six days ago after a motor vehicle accident
This client is the most stable with a predictable outcome. The other options contain key words that
suggest a risk of instability – multiple trauma…newly implanted, new admission..stroke, and cardiac
arrest…MI.
28. Which task for a client diagnosed with anemia and confusion could the nurse delegate to the
A. Assess with documentation of skin turgor and skin color changes
B. Test stool for occult blood and urine for glucose with a report of the results
C. Suggest foods that are high in iron and those easily consumed
D. Report mental status changes and the degree of mental clarity
The UAP can do routine, standard, and unchanging procedures which have known expected outcomes.
These tasks do not require judgments or decision making.
29. A charge nurse of a long term care (LTC) facility is making out assignments. Which assignment
made to an unlicensed assistive personnel (UAP) requires intervention by the nursing director of
the LTC facility?
A. Provide decubitus ulcer care and apply a dry dressing to the site

B. Bathe and feed a client who is on bed and chair rest
C. Oral suctioning as needed of an unresponsive older adult client
D. Review with family members the procedure of intermittent (bolus) feedings via G-tube
Neither initial teaching nor a review of teaching can be delegated to a UAP. PNs can reinforce teaching
and RNs do the initial teaching. The other tasks can be performed by UAPs in LTC facilities.
30. Which statement by the nurse is appropriate when giving an assignment to an unlicensed
assistive personnel (UAP) for the task to help a client ambulate for the first time after a colon
resection?
A. "Have the client stand for at least two minutes before starting to walk"
B. "If the client is dizzy have the client lie back down on the bed."
C. "Help the client to walk in the room as often as the client wishes."
D. "When you help the client to walk, ask if the pain is lessoned in the belly."
This statement gives clear directions to the UAP about the task and is most closely associated with the
information provided in the stem that this is the client's first time out of bed after surgery.
31. When walking past a client’s room, the nurse hears one unlicensed assistive personnel (UAP)
talking to another UAP. Which statement requires follow-up intervention?
A. "If we work together we can get all of the client care completed."
B. "Since I am late for lunch, would you do this one client's glucose test?"
C. "This client seems confused, we need to watch the client more closely."
D. "I'll come back and make the bed after I go to the lab to pick up some blood for the nurse."
Only the RN and PN can delegate to UAPs. One UAP can not delegate a task to another UAP or to any
other team member. The RN or PN is legally accountable for the nursing care. If UAPs cannot complete
assignments, they should notify the PN or the RN on the team.
32. Which of these clients should a charge nurse assign to a practical nurse (PN)?
A. A trauma victim with multiple lacerations and which require complex dressings
B. An older adult client diagnosed with cystitis and an indwelling urethral catheter
C. A confused client whose family complains about the nursing care two days after the client's surgery
D. A client admitted with the diagnosis of possible transient ischemic attack with unstable neurological
signs
This is the most stable client who has more chance of predictable outcomes and a minimal risk for
complications. The other client would need the attention of the RN.
33. A charge nurse delegates the task of taking vital signs of all the clients on the medical-surgical
unit to an unlicensed assistive personnel (UAP). Specific written and verbal instructions are given
to not take the blood pressure on the left arm of a client who is 48 hours post-mastectomy. Later as
the charge nurse is making rounds, the blood pressure cuff is found on that client’s left arm. Which
of these statements is accurate about this situation?
A. The charge nurse has no accountability for this situation
B. The charge nurse did not delegate appropriately
C. The UAP is covered by the charge nurse's license
D. The UAP is responsible for following instructions given by the charge nurse
The UAP is responsible for carrying out the activity correctly once directions have been clearly
communicated and in this case they have been given verbally and in writing.

34.The charge nurse on a cardiac step-down unit makes assignments for the team which consists of
a registered nurse (RN), a practical nurse (PN), and an unlicensed assistive personnel (UAP). Which
client should be assigned to the PN?
A. A 49 year-old diagnosed with a new onset atrial fibrillation with a rapid ventricular response
B. A 58 year-old hypertensive diagnosed with suspected angina
C. A 35 year-old post cardiac catheterization of 14 hours
D. A 65 year-old scheduled for discharge after angioplasty and a stent placement
This is a stable client with minimal risk of instability as compared to the client in other options. The client
in option d requires initial teaching and the client in option a should be considered unstable since the
dysrhythmia is a new onset; the RN should take over the care for both of these. The client in option c
could be assigned to the UAP since this is the most stable client with no risk of instability. Use caution
when answering delegation questions and avoid assignment of PN to the easiest task or the client with no
risk of instability.
35. A 25 year-old client, who is unresponsive after diagnosis of traumatic brain injury, is to be
transferred from the hospital to a long term care facility today. To which staff member should the
charge nurse assign this client?
A. Unlicensed assistive personnel (UAP)
B. Senior nursing student
C. PN
D. RN
The RN is responsible for coordination of discharge to home or other agencies. The transfer to a LTC
facility often requires referrals.
36. The nurse in a same-day surgery unit assigns the unlicensed assistive personnel (UAP) to
provide a client who had an abdominal hernia repair with a soft diet lunch tray. Which statement
by the nurse is most appropriate to minimize distress of the client?
A. "Tell the family they can bring in extra drinks such as gatorade if the client wishes."
B. "Make sure the client gets at least two cartons of milk."
C. "Let me know right away if the client is able to eat any of the food on the tray."
D. "Encourage the client to eat slowly to prevent gas formation in the intestine."
RATIONALE: The professional nurse can delegate tasks with an expected predictable outcomes. The
UAP is given adequate information about the task of what to tell the client and how to promote the best
outcome with less distress for the client. Milk is to be avoided since it often results in gas production in
some people. To have extra fluids available is not a bad action. However, it does not answer the question
of how to minimize distress of the client. It is unlikely that clients in an ambulatory surgical center will be
have difficulty eating after surgery.
37. Which of these clients should a charge nurse assign to a registered nurse (RN)?
A. A 56 year-old with atrial fibrillation and receives daily digoxin
B. A 60 year-old client with a history of asthma and complaints of shortness of air on oxygen at 2 L/min
C. A 24 year-old post-op client newly diagnosed with type 1 diabetes mellitus in the process of discharge
D. An 80 year-old client recovering 24 hours post right hip replacement
Discharge teaching must be done by an RN. Practical nurses (PNs) or unlicensed assistive personnel
(UAPs) can reinforce education after the RN does the initial teaching.
38. Which of these client’s needs should a nurse assign to an unlicensed assistive personnel (UAP)?
A. assist with activities of daily living
B. evaluate the client for safety issues
C. identify basic comfort needs during the shift
D. monitor circulation to hands and feet

RATIONALE: The person to whom the activity is delegated must be capable of performing it. The UAP
is capable of assisting clients with basic or routine needs and tasks with predictable outcomes. However,
the UAP may not be capable of identifying comfort needs, especially those associated with pain
management for a restrained client.
Test Taking Tip: compare the verbs to select "assist" which is most often the action of a UAP.
39. Which of these tasks can be safely assigned to an unlicensed assistive personnel (UAP)?
A. assess the function of a newly created ileostomy
B. provide care for a client who recently received a double barrel colostomy
C. assist with stoma care for a client who has a well-functioning colostomy
D. observe a client for the self-care of an ileostomy
RATIONALE: The care of a mature stoma and the application of an ostomy appliance may be assigned to
the UAP. This implementation of a routine task with an expected outcome does not require independent
judgment as do the other options.
40. A staff nurse complains to a practical nurse (PN) charge nurse that an unlicensed assistive
personnel (UAP) consistently leaves the work area untidy and does not restock supplies. The initial
response by the PN charge nurse should be to
A. write down potential solutions to the problems today by shift's end
B. assure the staff nurse that the complaint will be investigated
C. explore for further identification about the nature of the problem
D. add this concern to the agenda of the next unit meeting
RATIONALE: Helping staff manage conflict is part of the PN charge nurse's role. It is appropriate to
work with the nurse in order to work out problems with minimal intervention from administration when
possible. Further definition of the problem and associated issues would be a first step. The nursing
process can be used to collect more data before plans or interventions are made.
41. Which of these clients would be most appropriate for a practical nurse (PN) who has been
reassigned to a different acute care unit to accept?
A. a trauma victim with multiple lacerations requiring and complex dressings
B. an older adult client diagnosed with cystitis has an indwelling urethral catheter
C. a confused client whose family complains about the nursing care given after the client's surgery
D. a client, admitted for a possible stroke, has unstable neurological findings
RATIONALE: This is a stable client with predictable outcomes and minimal risk of instability. PNs who
are reassigned should be assigned to clients with minimal risk of instability. The other clients have more
complex problems as well as higher risks for instability.
42. The practical nurse (PN) is in charge of the evening shift of a 16-bed unit in a nursing home.
Two unlicensed assistive personnel (UAP) are assigned to the unit. Which factor is most important
for the PN to consider when making assignments.
Who cared for which client the evening before.
The UAP’s preference for assignments.
Which UAP has had a day off most recently.
The UAP that the client compliments often.
43. On a short-staffed unit of a long-term care facility, it is most important that the practical nurse
(PN) assign the unlicensed assistive personnel (UAP) to complete morning care for the resident with
which problem first?
Dyspnea, who uses oxygen continuously.
Straight catheterization to be performed q6h.
Frequent episodes of fecal incontinence.
Bolus feedings via PEG tube to be performed q4h.

44. The practical nurse (PN) is working the day shift in a long-term facility and is preparing for
shift change. Which task should the PN delegate to the unlicensed assistive personnel (UAP) to
perform during the change of shift?
Assess the pain level of each client and provide comfort measures as indicated.
Total the client’s PO intake, fill the water pitchers, empty urinals and catheter bags.
Mark nasogastric tube suction canisters and empty wound drainage collection units.
Assist two postoperative clients on the unit to ambulate in the hallway.
45. The practical nurse (PN) assigns an unlicensed assistive personnel (UAP) to feed a client who is
at risk for aspiration. To ensure that the task is safely delegated, what action should the PN
implement?
Instruct the UAP to notify the PN if the client begins to choke.
Inform the UAP that suction is available at the bedside.
Observe the UAP’s ability to implement precautions during feeding.
Ask the UAP about previous experience performing this skill.
46. The practical nurse (PN) finds a client who is assigned to another PN bleeding from an
intravenous (IV) site and the IV tubing and fluid are on the floor. The PN immediately applies a
dressing to stop the bleeding. What action should the PN take next?
Inform the charge nurse that the findings indicate that the client pulled out the IV.
Record the findings and the application of a dressing in the client’s record.
Complete the shift documentation for this client and include the findings about the IV.
Tell the nurse assigned to the client about the event so the findings can be recorded.
47. In providing care to a client immediately following a tonic-clonic seizure, which activity is best
for the practical nurse (PN)to assign to the unlicensed assistive personnel(UAP) working with the
PN?
Take the client’s vital signs.
Perform neurological tests.
Help the client to a side-lying position.
Document how long the seizure lasted.
Vitamins
Vitamin B1 (Thiamin)
Used to metabolize carbohydrate (CHO) and alcohol (ETOH)
Risk Factors
· Homeless (alcoholics)
· Asians (rice eaters)
Lead to
Ø Congestive Heart Failure

o Beri Beri (Thailand language for “I cannot, I cannot)

o Beri Beri is a nickname for Heart Failure (CHF)
Ø Wermicke’s encephalopathy
o Degenerative brain disorder
o Ataxia, confusion, ophthalmoplegia
Ø Dementia
o Confabulation (making up stories)
o Korsakoff Syndrome
o Amnesia (forgetting things)
Note: Wermicke’s encephalopathy and Dementia
Vitamin B2 (Riboflavin)
Ø Required for functioning of mucosa (mucus membranes).
Deficiency:
Ø Mouth: inflammation of the mouth = stomatitis

Ø Lips : cracked lips = cheilosis (cheilitis)
Ø Tongue: strawberry colored, beefy tongue (glossitis)
Note: Vitamin B2 (Riboflavin) is spoilt/ damaged by light.
Vitamin B3 (Niacin)
Ø Pellagra
o Four (4) Ds
§ Dermatitis (dry rough, scaly skin)
§ Dementia (forgetting things)
§ Diarrhea (passing frequent watery stools)
§ Death
o Large amount of B3 used to reduce cholesterol (all cholesterol medications
damage the muscles and the liver)
Ø Niacin toxicity

o Pepperish
§ Diarrhea
§ Sweating profusely
§ Flushing
§ Abdominal cramp
Vitamin B6 (Pyridoxine)
Ø Used in TB (INH)
Ø Avoided in Parkinson’s (Levadopa)
Vitamin B9 (Folic acid/ Folate)
Ø Deficiency in pregnant woman

o Neural tube defect
§ Spinal bifida (divided spine)
· Meningocele
· Myelomeningocele
o Megaloblastic anemia
Note: Anti-seizure medications will lead to folic acid deficiency
Vitamin B12 (Cobalamin / Cyanocobalamin)
Ø Deficiency
o Chronic gastritis
o Pernicious anemia (antibodies against intrinsic factor)
o Gastrectomy
o Ileostomy
o Vegan
Signs and symptoms:
Ø Red beefy tongue

Ø Numbness

Ø Paresthesia
Ø Anemia
Ø Dementia (pseudo-dementia)
Vitamin C (Ascorbic Acid)
Ø Especially from citrus fruits

Ø Deficiency
o Scurvy
§ Bleeding
Ø Helps in absorption of calcium
Ø Wound healing
Fat Soluble Vitamins
Vitamin A (Retinol)
Ø Helps you see in the dim light
Deficiency
Ø Nyctalopia
o Night blindness (not seeing well in dim light)
Ø Rough skin
Excess
Ø Raised intracranial pressure
Vitamin D (Cholecalciferol)
Ø Absorbs calcium
Deficiency
Ø Low calcium/ high phosphorus

Ø Rickets (wobbly) in children
o Soft bones
Treatment

Ø Calcium and Vitamin D
Note: encourage activities – outdoors (5-6 minutes of sun exposure), to enable the sun to activate vitamin
D.
Vitamin E (Tocoferol)
Ø Fertility drug, especially in lower animals

Ø Anti- oxidant
Ø Helps to nourish mucous membrane
o Skin
Vitamin K (Aquamephyton)
Ø Produced by the intestine in the body

Ø Vitamin for clotting
Deficiency
Ø Bleeding
Sources
Ø Pork
ØVegetables
Ø In the body
Note: give vitamin K to newborns at birth, via vastus lateralis (side of their thighs: midway btw
trochanter and knee)
Random Notes
A kid with Hepatitis A can return to school 1 week within the onset of jaundice.
2. After a patient has dialysis they may have a slight fever...this is normal due to the fact that the dialysis
solution is warmed by the machine.
3. Hyperkalemia presents on an EKG as tall or peaked T-waves
4. The antidote for Mag Sulfate toxicity is ---Calcium Gluconate

5. Impetigo is a CONTAGIOUS skin disorder and the person needs to wash ALL linens and dishes
separate from the family. They also need to wash their hands frequently and avoid contact.
positive sweat test. indicative of cystic fibrosis

1. Herbs: Black Cohosh is used to treat menopausal symptoms. When taken with an
antihypertensive, it may cause hypotension. Licorice can increase potassium loss and may cause
dig toxicity.
2. With acute appendicitis, expect to see pain first then nausea and vomiting. With gastroenteritis,
you will see nausea and vomiting first then pain.
3. If a patient is allergic to latex, they should avoid apricots, cherries, grapes, kiwi, passion fruit,
bananas, avocados, chestnuts, tomatoes and peaches.
4. Do not elevate the stump after an AKA after the first 24 hours, as this may cause flexion
contracture.
5. Beta Blockers and ACEI are less effective in African Americans than Caucasians.
1. for the myelogram postop positions. water based dye (lighter) bed elevated. oil based dye heavier
bed flat.
2.autonomic dysreflexia- elevated bed first....then check foley or for impaction
3. any of the mycin's..check for tinnitus or hearing loss
4. cloudy dialysate...always further assess and call doctor
5.osteoporosis prevention and mgt. choose weight bearing (walking) instead of calcium if both
are choices
1. Dilantin can cause gingival hypoplasia, advise good oral hygiene and freq. dental visits, IVP
25-50 mg/min
2. Placentia Previa is painless, bright red bleed
3. Abruption is painful, board-like abdomen
4. Need MAP of 70-90 to perfuse organs
5. Vitamin C can cause false + occult blood
1. celiac disease cant have BROW! BARLEY RYE OAT WHEAT
2. any eye surgery place on pt on unaffected side
3. if pt has lung cancer, craniotomy, or some kinda pituitary surgery watch for diabetes insipidus
4. sickle cell- hydration hydration important and treat pain if in crisis
5.dont palpate a wilm's tumor on the peds pt. can cause cancer cells to be released!
oh one more:
6. terbutaline (Brethine) and mag sulfate- tx for preterm labor

Librium-antianxiety used to tx symptoms of acute alcohol withdrawal.
Cogentin-used to tx parkinsonian side effects of Thorazine (antipsychotic med)
Methadone hydrochloride-opiod analgesic; tx for narcotic withdrawal
Procardia-antianginal med (CCB) decreases myocardial O2 demand.
Digoxin-strengthens myocardial contractio0n & slows conduction thru AV node
Coumadin-inhiits prothrombin synthesis
Amicar-antifibrinolytic; prevents recurrence of subarachnoid hemorhage.
Lithium-tx manic phase of bipolar
Nimodipine-CCB; decreases spasm in cerebral blood vessels
diltiazem-CCB; inhibits Ca+ influx in vascular smooth muscle; reduces myocardial O2 demand &
decreases force of ventricular contraction
clotrimazole-antifungal; treats rashes.
NEVER NEVER NEVER administer KCl via IV push.
The level in the water seal chamber (chest tubes) fluctuates with respiration- no fluctuation indicates an
obstruction and excessive bubbling indicates an air leak.
Stay with the client for 15 minutes at the start of a blood transfusion.
Nephrotic Syndrome leads to proteinuria while Glomerulonephritis leads to hematuria.
Goodell's Sign is the softening of the cervix at the start of the 2nd month of pregnancy
Nagele's Rule is First date of last menstrual period + 7 days - 3 months + 1year.
Vinca Alkaloids (Vincristine) lead to neurotoxicity and can present with numbness and tingling in the legs
or paralytic ileus.
Avoid herbal supps like ginsing, ginger, ginko, garlic (all the G's) if on any clotting drugs/products
(coumadin, platelets, ASA, Plavix)
High triglycerides may cause a false HIGH Hemoglobin A1C (normal is 2.6-6)
Deer ticks transmit Lyme Disease and it is most common in the NE Atlantic states. (Go figure I thought it
was down here in the South)
Think of pain last or as a psychosocial UNLESS: Burns, sickle cell crisis, or kidney stones.
Anemia of pregnancy is common in the 2nd trimester due to rapid expanding blood volume and is not a
cause for concern. It can get as low as 10.5 and still be OK. 1st and 3rd trimesters can go as low as 11 and
still be ok
Preterm labor--after 20 weeks and before 37
True labor pain INCREASES with activity and usually moves from the back to the front.IT HURT ALL
OVER THE DANG PLACE AND INCREASED WITH EVERYTHING ).
Recommended weight gain for pregnancy 12.5-16 kg or 25-35 lbs .
Normal newborn jaundice-- AFTER 24 hours of life

Pathologic jaundice-- BEFORE 24 hours of life and after 4 days

Diarrhea....metabolic acidosis.
Vomiting...metabolic alkalosis.
1. priority unstable pt- words to look for: cyanotic, sudden, increasing pain, hypoxic,
restlessness
2. when left with two choices pick the one thing you can do to make pt. comfortable,
safe, and more stable
3. no narcotics to any head injury..wont be able to accurately assess LOC. so pick

the narcotic if you have an order to question.
4. fluid resuscitation: burn formula: kg X 4ml/kg X %(burn area)= total

give half of total in first 8 hours, the other half in 16hrs
5. after thyroid surgery-maintain airway-keep emergency trach set nearby, check

for blood at sides and back of dressing, teach pt to support neck
6. bucks traction-no pins tongs. skin traction
7. should not hear a bruit over anything except dialysis shunts. if so this is the
unstable pt
8. DVT- elevate extremity , bed rest, warm (not hot) compresses
Rubella- rash on face goes down to neck and arms then trunk and legs
pregnant women should avoid contact with any child who has Rubella or just received the vaccine. if she
does she has to get vaccine after she has delivered
MMR #1 @ 12- 15 months MMR #2 4-6 years old
Before checking or measuring fundal height have the patient empty her bladder! A full bladder can throw
off the measurement by 3cm.
Meniere disease= ringing in the ears and hearing damage cause from HIGH sodium levels. Need
diuretics. Avoid caffeine, nicotine, and alcohol
Meningitis= look for nuchal rigidity, Kernig’s sign(can't extend knee when hip is flexed) and Brudzinski’s
sign (flex neck and knee flexes too) petechial rash. People who have been in close contact may need
Rifampin as a prevention. Vaccine for meningitis after 65 years of age and every 5 years
MI=#1 pain relief, helps decrease 02 demand
Acute Asthma = diffuse expiratory wheezes
Cessation of wheeze omnimous
Infective endocarditis = murmur

Fluid overload = auscultate lungs 1st
24 hours after thyroidectomy, watch for s/s of thyroid storm not for decreased levels of thyroid hormones
1.hypoglycemia= T.I.R.E.D
T-tachycardia
I- irritability
R- restless
E- excessive hunger
D- diaphoresis
2.posturing- deceberate(brainstem problem)- hands like an "e", decorticate (cord

problem)- hands pulled in toward the cord
3.tetralogy of fallot- have child squat to increase return to heart. just remember
fallot=squat
4. cant sign consent after preop meds are given...call doctor if not signed
5. rubella (german measles)-airbone contact precautions, 3 day rash
6. rubeola (red measles)- droplet contact precautions, koplik spots in mouth
Amphetamine= Depression , disturbed sleep, restlessness , disorientation
Barbituates= nausea & vomiting, seizures, course tremors,

tachy
Cocaine= Sever cravings, depression , hypersomnia, fatigue
Heroin= Runny nose, Yawning , fever, muscle & joint pain, diarrhea (Remember Flu
like symptoms)
1. When using a cane to aid ambulation: Step up on the good extremity then place the can and
affected extremity on the step. Reverse when coming down. (Up with the good, down with the
bad)
2. In infants, pyloric stenosis = projectile vomiting
3. Croup: seal-bark cough, dyspnea, inspiratory stridor, irritable. In children considered a medical
emergency due to narrowed airway
4. Skull fracture: Battle's sign (bruising over mastoid bone) and raccoon eyes
5. Pheochromocytoma: catecholamine secreting tumor. Look for persistent hypertension,

pounding headache

1. peritoneal dialysis- if outflow slow check tube for patency, turn pt side to side
2. pts with the same infection can room together or two clean non contagious
disorders can room together.
3. pulse parodoxus- pulse is weak on inspiration and strong on expiration...could be a

sign of CARDIAC TAMPONADE
4. fat embolism- high risk pt...fracture of long bone..greatest risk in first 48 hrs.
5. pancreatitis-elevated amylase (cardinal lab value)
6. JP DRAIN- SQUEEZE=SUCK... squeeze the bottle to let air out then replace cap.
7.lymphocytic leukemia causes a decrease in all blood cells. It causes rbcs to be low
also!
8. mannitol for ICP
Oxytocin is always given via an infusion pump and and can never be administered through the primary
IV.
One of the first signs of ICP (increased intracranial pressure) in infants is a high pitched cry.
Regarding blood transfusions, a hemolytic reaction is the most dangerous kind of reaction...S & S include
NAUSEA
VOMITING
PAIN IN LOWER BSCK
HEMATURIA Treatment is to STOP blood, get a urine specimen and maintain perfusion and blood
volume.
Febrile reaction S&S

FEVER
CHILLS
NAUSEA
HEADACHE
Narcan is given for to reverse respiratory depression...a rate of 8 or less is too low and requires nursing
action.
Miller abbott tube is used for decompressing intestine, which relieves the small intestine by removing
fluid and gas from small intestine.
If a client takes lithium the nurse should instruct the client to take in a good amount of sodium, without it
causes retention of lithium and in turn leads to toxicity.
Rinne test- a vibrating tuning fork is held against the mastoid bone till pt can't hear sound...then moved to
ear.

1) A subarachnoid (spinal block) for labor may cause a headache, a lumbar epidrual will not
since the dura mater is not penetrated
2) Tracheoesophageal fistula: 3 C's: coughing, choking, & cyanosis
3) Hypothyroidism: Decreased T3 +T4, but increased TSH

Hypertyroidism: Increased T3 + T4, but decreased TSH
4) NO tyramine containing foods if taking and MAO inhibitor ( smoked meat, brewer's
yeast, aged cheese, red wine, banana, sour cream)
5)Regular insulin is the only type that can be given IV
1. Dilantin can cause gingival hyperplasia, advise good oral hygiene and freq. dental visits, IVP
25-50 mg/min
ESSR method of feeding cleft palate/ cleft lip
ENLARGE nipple
STIMULATE sucking
SWALLOW
REST
1)Immunizations
Before 1 years old:
Hep B 3x):Only one that is given at birth and one month (3rd dose at 6 months)
IPV(4x), DTaP(5x), Hib(4x), PCV(4x): all given at 2, 4, & 6 months
Hib, PCV: again at 12-15month

DTaP: again at 12-18months
DTaP, IPV: last doses are given 4-6yrs
1yrs old and older:

MMR: (2x) 12-15months, then at 4-6 years* *if dose not given from 4-6 give from 11-12yrs old
Varicella Zoster: (1x) 12-18months
Td: (1x): 11-12yrs old
2)Fundal height: pt supine, measure from symphysis pubis to top of fundus, if patients is 18+ wks
pregnant the height in cm will be same as weeks pregnant give or take 2 cm
3)Isolation**:
STRICT Contact: use universal precautions, gown when contact with pt., single pt. room in most
situations
Used with: Any colonizing infections, MSRV, Fifths disease, RSV, infected wounds, skin, or eyes
STRICTER Droplet: include all universal precautions, gown, goggles, masks on you, on pt. if leaving
room, single pt. rooms

Used with: Majority of infectious diseases
STRICTEST Airborne: include all universal precautions and negative pressure single patient rooms,
gown, goggles, mask on you, mask on pt. if leaving room which should only be done if absolutely
necessary
Used with:
Measles
Varicella
Disseminated Varicella Zoster
Tuberculosis
**Always check facilities policies when following isolation precautions/procedures
4) Self breast exams: do monthly, 7-10 days after menses
5) Pt's taking Monoamine Oxidase inhibitors (for depression usually) should avoid foods containing
tyramine which include
• Avocados, bananas
• Beef/chicken liver
• Caffeine
• Red wine, Beer
• Cheese (except cottage cheese)
• Raisins
• Sausages, pepperoni
• Yogurt, sour cream
1. dumping syndrome-tx no fluids with meals /no high carbs /lie down after eating.
they need a high fat high protien diet
2. multiple sclerosis- avoid hot showers and baths
3. parial thickness burns=blisters...... full thickness-charred, waxy
4 PKU- no nuts, meats, dry beans, eggs, dairy (basically no protein stuff) give
specially prepared formula to baby because they can digest this protein well
5. introduce rice cereal to infant at 6 mos and strained veggies one at a time
6. pt must keep taking prescribed insulin on sick days, drink plenty of fluids and
notify doctor. also insulin is also given when pt comes from surgery on NPO status
because trauma and infection makes sugar go up!
In an infant of a diabetic mom, hypoglycemia 30-90 min after birth...then look for them to also have
hypocalcemia after 24 hours

Non Stress Test on a preggo....should be REACTIVE (rise of 15 bpm above baseline for 15 sec) if it's
NOT reactive they need a contraction stress test and the result that you want from it is NEGATIVE
With Diabetic Ketoacidosis don't give K+ until the patient has been hydrated and urine output is adequate.
Post-op Total Hip replacement-- abduction (toes pointing in) or patient laying on non-operative hip. Avoid
adduction (letting the foot turn out)
mother/baby stuff
1. Rh negative mom gets Rhogam if baby Rh positive. Mom also gets Rhogam after
aminocentesis, ectopic preganancy, or miscarriages.
2. fetus L/S Ratio less than 2= immature lungs......2-3=borderline....greater than 3=good

lung maturity dude!! may give dexamethasone to speed up maturity if baby needs to be
delivered soon.
3. prolasped cord position knee chest or trend..call for help!! GET THAT BOTTOM OFF
THE CORD! SUPPORT CORD WITH YA HAND
4. decelerations early vs late----always good to be early but dont ever show up late. early
mirrors the contraction, late comes after the contraction
5. LOCHIA SEQUENCE...lochia rubra- red, clotty....lochia serosa...pink, brown....lochia

alba..white.........SHOULD NEVER HAVE A FOUL ODOR!
1. In prioritizing cardiac patients, check the pt with INDIGESTION first because that could be a
sign of MI.
2. ABG's need to be placed on ice and sent to the lab ASAP.
3. If active TB is suspected, a sputum culture for acid-fast bacillus is the only metod to actually
confirm active TB (NOT a mantoux skin test!)
4. Celebrex is contraindicted in pts with a history of cirrhosis.
5. In psych pts, the client most at risk for self-harm is always the pt that has stopped taking their
meds.
One more!
6. Change in resp rate in a pt receiving mag sulfate could indicate toxicity.
1. dont give atropine for glaucoma. it increases intraocular pressure!
2. drug abusers at risk for heart valve disease.
3. after a liver biopsy place pt. on right side to put pressure on site.
4. end stage cirrhosis the ammonia level is elevated. doctor may order lactoluse to

decrease levels.
5. dont do a vaginal exam on a pregnant cliet thats bleeding
Ulcerative colitis...3-30 stools per day WITH blood and mucus.
Pain in LLQ: relieved by defecation.
Crohns disease-NO obvious blood or mucus in stool.
Pain: Right lower quadrant pain that is steady or cramping...or pain could be in periumbilical area,
tenderness and mass in the RLQ.
Rheumatoid arthritis: Pain and stiffness is on arising, lasting less than an hour...can also occur after long
periods of inactivity. Joints red, hot swollen, boggy, and decreased ROM.
Osteoarthritis: Pain and stiffness occurs during activity. Joints may appear swollen, cool, and bony hard.
Hemodialysis: disequilibrium syndrome- N&V, headache, decreased LOC, rapid changes in PH, bun...
Transfusion reaction: Chills, dyspnea, itching, uticaria, back or arm pain, fever.
Peritoneal dialysis: When more dialysate drains than has been given, more fluid has been lost(output). If
less is returned than given, a fluid gain has occured.
Slow dialysate instillation- increase height of container, reposition client.
Poor dialysate drainage-Lower the drainage, reposition.
If you give terbutaline and a corticosteroid together, a possible drug interaction is pulmonary edema
(Smeltzer)
Rapid: (Lispro) Onset: <15min Peak: 1hr Duration : 3hr
Short: (Regular) Onset: 1/2hr-1hr Peak: 2-3 hr Duration: 4-6 hr
Intermediate: (NPH or Lente) Onset: 2hr Peak: 6-12 Duration: 16-24
Long Acting: (Ultralente) Onse:t 4-6 hr Peak: 12-16hr Duration: >24 hrs
Very Long: (Lantus) Onset: 1 hr Peak: NONE Duration: 24 hr continuous
Mydriatic: with a D= Dilate pupils

Miotic:with an O= cOnstrict pupils
Anticholinergic SE:(atropine, benztropine, tricyclic antidepressants)

can't see
can't pee
can't spit
can't sh*t

Hyperkalemia "MACHINE"- causes of increase plasma K+
M-medications (ACE inhibitors, potassium-spairing diuretics, ARBs)
A-acidosis (Metabolic and respiratory)
C-cellular destruction (burns, crush injury, tumor lysis crisis, hemolysis)
H-hypoaldosteronism, hemolysis
N-nephrons, renal failure
E- eating(dried apricot, baked potato, banana, watermelon, cantaloupe)
Signs and symptoms of increase serum K+= MURDER

M-muscle weakness
U-urine, oliguria, anuria
R-respiratory distress
D-decr cardiac contractility
E-ECG changes
R- reflexes, hyper-reflexia, or flaccid
HYPERNATREMIA-you are fried

F-fever (low grade), flushed skin
R-restless (irritable)
I-incr fluid retention and incr BP
E-edema ( peripheral and pitting)
D-decr urinary output, dry mouth
Hypocalcemia-"CATS"
C-convulsions
A-arrythmias
T-tetany
S-spasms and stridor
For those of you who have trouble with mcg/kg/min problems.

try this solution.
Exp: 7mg of dopamine in 500ml in NS ; pt is 110lbs
first convert 110lbsto kg =110lbs/2.2 kg=50kg

then change 7 mg to mcg =7000 mcg
Now plug in the numbers. 7000* 50kg*60mins

------------------
500ml
answer is 16.8 mcg/kg/min
A way we were taught to remember which Beta Blockers are contra-indicated in patients with Resp
problems are easy....
Contra-Indicated- so think.... Coreg, Corgard, Inderal
Administering ear medication... pull the ear UP and back for OLD, and down for young (<3 yo)
Fill for a thrill, listen for a bruit.

Assess your patient. not the monitor.... So, If a question asks what you do FIRST.... always, always go
with assess the patient.
Carbamazepine therapeutic serum level is 4 - 12 mcg/dL
Cycloserine is an antituburculan and needs weekly drug levels
foscarnet (Foscavir) can be toxic to kidneys so creatinine is monitored.
Android Pelvis is wedge shaped, narrow and unfavorable for birth
Therapeutic serum digoxin is 0.5 - 2 mg/dL
No meperidine (Demerol)to pancreatitis pt. b/c is causes spasms in the Sphincter of Oddi
Hyperkalemia = narrow, peaked T waves on cardiac monitor
Hypokalemia = Peaked P, Flat T, Depressed ST and Prominent U
p24 Antigen Assay confirms HIV in an infant
MORPHINE IS CONTRAINDICATED IN ACUTE PANCREATITIS BECAUSE IS CAUSES

THE SPASMS BUT THE DEMEROL IS THE DRUG OF CHOICE. AT LEAST THATS HOW I
LEARNED IT.
if you see Mg/Ca, think MUSCLE first. Mg and Ca act like SEDATIVES.
HYPOCALCEMIA (not enough sedatives)

+ trouseau and + chovstek's sign
incr DTR
stridor, laryngospasm
swallowing problem=aspiration
BURN pt.
Carbon monoxide poisoning is the MOST COMMON airway injury.
Carboxyhemoglobin : blood test to determine carbon monoxide poisoning.
Treat burn pt with fluid replacement therapy;Check hourly to make sure you are not overloading them
with CVP= measures the right atrial pressure.
Rubella is spread by droplets....
The benefit of a venturi mask- oxygen can be regulated to deliver between 24 and 50%.
Shilling test is done to detect pernicious anemia.
Shift to the left in WBC differential – reflects bacterial infection
Pneumocystis carinii pneumonia is caused by – Protozoal infection.

Open-angle glaucoma is characterized by Halo and blurred vision
Detached retina- floater or sensation of a curtain or veil over the visual field
Good lung down- position a patient with right side pneumonia , with the left side dependent
Atrial fibrillation might require synchronized cardioversion
Ventricular tachycardia require defribillation
Second degree heart block- needs a pace maker
Respiratory syncytial virus- contact precautions
systemic lupus erythematosus- butterfly rash on nose and cheek. avoid sunlight
with DIC...get worried if you see blood oooze from the IV line. notify doctor
Tegratol- tx for seizures..watch for drowsiness, n/v, blurred vision, h/a.
kayexalate- may be ordered for a high potassium level
THERAPEUTIC LEVEL
10-20 mcg/ml
Theophylline
Acetaminophen
Phenytoin
Chloramphenicol
10-21 mmHg - normal intraocular pressure
1. nebulizers used by HIV patients are cleansed with warm water after each treatment and allow it to
air dry. soaked in wht vinegar and water for 30f min at the end of the day
2.SHARE support group for parents who have experienced misscarriage
3. RESOLVE support grp for infertile clients
4. CANDLELIGHTERS families who have lost child to cancer
5 FETAL ALCOHOL SYNDROME child small head circumferance, low birth wt,
underdeveloped cheeks.
DO not radiate children under 8 y.o.

Insulin can be kept on room temp 1 month.
PARATHYROID PROBLEMS
hyperparathyroidism= hypercalcemia=hypophosphatemia
hypoparathyroidism=hypocalcemia=hyperphosphatemia
**calcium and phosphorus are inversely related**

THYROID PROBLEMS
hypothyroid (myxedema):no energy, depress pt. everything is slow
hyperthyroid (grave's): very ENERGETIC, manic pt., everything is high
**watch out for heart problems, rhythm changes**
Dantrium (dantroline) common drug kept in the OR for us with Malignant Hyperthermia.
some oncology
dont give methotrexate in the first trimester of pregnancy.
radioactive iodine- excreted in urine
sealed source implant- body fluids not radioactive- nursing care-limit total time care
provider with pt. limit distance around pt. no pregnant women in room or children. keep
forceps and lead container in room.
chemo drugs: in case of extravasation...stop infusion...remove any remaining drug from

tubing and aspirate the infiltrated area...do not remove needle...notify doctor.
Prenatal Visits
q 4 weeks -28-32 weeks
q1 week -36-40 weeks
care of the NEWBORN
term infant -38-42 weeks

L-45-55 cm =18-22inches
W-2500-4300 kg=5.5-9.5lb
in males prepuce retractable on about 3 y.o. don’t do that before->Adhesions

Normal Hyper- Bilirubinemia after 24 hr, if before pathological. (in premature it appears after 48 hr, if
before Report)
Hyper-bilirubinemia- DO normal Breast feeding,q2-4hr.
RDS-basically because infant cant expand lungs->cant breath normally, because of luck of surfactant in
lungs.
s/s:cyanosis,increased RR, nasal flaring, grunting.
treatment-intratracheal surfactant, and supportive -O2-if on O2 worry about retinal damage.
if Mother-DRUGS: NEWBORN -Irritable->Swaddle&reduce stimulation aside from abcd.
FAS(fetal alcohol syndrome)-craniofacial abnormalities, growth retarded,, palmar creases.

IRRITABILITY.RNs goal-nutritional balance.
When BATHIN Newborn go from CLEAN to DIRTY -eyes, face...diaper area the last.

in Diabetic mother the newborn at risk for hypoglycemia, RDS, hypocalcemia, congenital anomaly.
Diabetic mother during pregnancy-1st trimester insulin DECREASE. 2 and 3rd Trimester INCREASE
INSULIN (placental hormones produce insulin resistance)
BUT after PLACENTAL DELIVERY INSULIN REQUIREMENTS DECREASE.m
about Scoring
Apgar measures HR,RR,Muscle tone, Reflexes,Skin color

each 0-2 point. 8-10 OK. 0-3 RESUSCITATE.
GLASGOW COMA SCALE. EYES, VERBAL,MOTOR!

It is similar to measuring dating skills...max 15 points -one can do it
if below 8 you are in Coma.
So, to start dating you gotta open your EYES first, if you are able to do
that spontaneously and use them correctly to SEE whom you are dating you earn 4. But if she has to
scream on you to make you open them it is only 3....and 1 you don’t care to open even if she tries to hurt
you, if you get good EYE contact (4 points) then move to VERBAL.
Talk to her/ him! if you can do that You are really ORIENTED in
situation she/he uncontiously gives you 4 points! if you like her try not to be CONFUSED (3), and of
cause do not use
INAPPROPRIATE WORDS (3), she will not like it)), try not to RESPOND WITH
INCOMPREHENSIBLE SOUNDS (2), if you do not like her-just show no VERBAL RESPONSE(1)
Since you've got EYE and VERBAL contact you can MOVE now using your Motor Response Points.
THis is VERY important since Good moves give you 6!
filgrastim (Neupogen) - increase NEUtrophil count
epoietin alfa (Epogen) - increase RBC/erythrocytes--may cause HTN(check BP)
Cholecystectomy due to cholelithiasis and cholecystitis, WATCH for BLEEDING problems, because vit
K FAT soluble, is poorly absorbed in the absence of bile. by the way T-tube used for drainage-Reason for
T tube to maintain patency of common bile duct.
Chronic RF the best way to asses fluid status-WEIGHT the PATIENT daily
When NGT present mouth care ICE CHIPS but be aware not give that too much-> it becomes water-
>stomach->NGT suck it with K and other electrolytes present in stomach. LOST K
Heat cramps in hot weather-Sodium (Na) loses
Following Gastrectomy NGT drainage should NOT be BLOODY after 12 hr
Thyroid storm's main sign is FEVER
ALDOSTERONE insufficiency -Hyponatremia, Hyperkalemia, hypovolemia. WHEN Na decrease, K

increases
An easy way to remember addisons and cushings

addisons= down, down down up down
cushings= up up up down up
addisons= hyponatremia, hypotension, decreased blood vol, hyperkalemia, hypoglycemia

cushings= hypernatremia, hypertension, incrased blood vol, hypokalemia, hyperglycemia
everything else wouldnt be hard to remmenber> moon face, hirsutism, buffalo hump, obesity
1. prozac, zoloft, paxil- tx of depression.
2. sodium nitroprusside- sheild from light. wrap in foil
3. cephalosporins- CHECK FOR ALLERGIES TO PENICILLINS. pt could be

hypersensitive.
4. pts recieving Lasix should be assessed for tinnitus and hearing loss
5. anticoagulants cant dissolve a formed thrombus but tPAs can.
1. Shock: BP <90/60 Pulse > 100
2. Fluid of choice in pt in shock are isotonic: NS, LR
3. PVCs: Always treat: >6 UNIFOCAL and/or >3 MULTIFOCAL with LIDOCDAINE 75mg 4:1
drip
4. SIADH
Na <120
Hx of lung cancer
Specific gravity > 1.035
Diabetes Insipidus
Na> 160
head injury
Specific gravity <1.005
5. Pt with radium implants you can only stand at the head of their bed. When performing bath
remember: 'pits and crotch' ONLY
1. Verapamil (calan) - treatment of supraventricular tachycardias, check heart rate

2. clomid - inducesovulation by changing hormonal effect on the ovary
3. phobias include projection and displacement
4. blood glucose monitoring of glucose preferred over urine because the level of glucose starts to
appear in the urine increases, leading to false negative readings
5. corneal abrasion - unable to close the eye voluntarily, cranial nerve VII affected, secretions
unable to protect the eye, complication of CVA, prevented with RN care
other randoms
- when the lungs re-expanded, the fluid in the water seal does not fluctuate with respirations

- pacemaker- increases cardiac output, acts to regulate cardiac rhythm
NEVER examine a bleeding gravida vaginally
contractions > 90 seconds, FHR < after contraction peak. . .turn off the pitocin [oxytocin] (if running)
give O2 by tight face mask, reposition on left side, increase IV fluid rate, notify caregiver, document
use reliable form of birth control for at least 4 weeks (8 is better) after rubella immunization [of course
this applies to women only]
abdominal pain, tender uterus, dark red or no bleeding = abruption
painless, bright red bleeding usually first episode in 2nd trimester = placenta previa
DO NOT give a pregnant laboring patient on methadone STADOL (precipitates withdrawal)
KVO rate is 20ml/hr
MAOIs: Nardil, Marplan, Parnate

Of course, no tyramine because of hypertensive crisis, which is treated with Procardia.
Aminoglycosides (gentamycin, etc.) affect 8th cranial nerve function (hearing) and are nephrotoxic.
Hyperparathyroid states can cause renal stones which can present with hematuria.
Bell's Palsy- facial paralysis, prevent corneal abrasions.
I teach APGARs this way
A= appearance (color all pink, pink and blue, blue [pale])

P= pulse (>100, < 100, absent)
G= grimace (cough, grimace, no response)
A= activity (flexed, flaccid, limp)
R= respirations (strong cry, weak cry, absent)
OH SWEET DELEGATION
DO NOT delegate what you can EAT!
E - evaluate
A - assess
T - teach
only the RN should do this...hope that helps
Macular degeneration: mac is in the middle (central vision loss)
digoxin toxicity: halos, nausea, vomiting

Fractured hip: shorter extremity and external rotation
hip replacement: teach pt not to cross legs; keep leg abducted to avoid dislocation of hip
Schillings test: measures % of B12 excreted in 24hr used to diagnose pernicious anemia
1. cardiac meds: -pine=calcium channel blockers

-olol=beta blockers
-pril=ACE inhibitors
-artan=angiotensin II receptor blockers
2. No pee, no K+
3. Before treating BPH, must restore urinary flow
4. Sign of toxic ammonia level is asterixis (hands flapping)
5. Diuretics: Lasix and Bumex are K+ wasting Aldacton is K+ sparing
1 - Dopamine and Lasix are incompatible
2 - Hypoglycemic jitters can be stopped by holding the limb, seizure clonus can't
3 - Normal urine output in an infant is at least 1cc/kg/hr
4 - Septic babies will often DROP their temp
5 - SE of PGE1, used to keep the ductus arteriosus open, are hypotension, fever, and apnea. The
therapeutic effect is not necessarily dose-dependent, but the severity of SE is.
The adverse effects of Anti psychotics can be remembered using this: SHANCE
S-SUNLIGHT SENSITIVITY( Use hats and sunscreen)
H-HEPATOTOXICITY( Monitor LFT)
A-AGRANULOCYTOSIS( Characterized by fever and sore throat)
N-NEUROLEPTIC MALIGNANT SYNDROME( Characterized by fever and muscular rigidity)
C-CIRCULATORY PROBLEMS( Leukopenia and orthostatic hypotension)
E-EXTRA PYRAMIDAL SYMPTOMS( Administer anticholinergics and anti-parkinsonian agents)
Now for some skin assessment!
ABCDEs of malignant melanoma:
A = Asymmetry;
B = Border;
C = Color;
D = Diameter;
E = Elevation
Antidote for Coumadin- Aquamephyton

Side effect of Aminophylline-head and irregular pulse
Treatment for Angina-sublingual nitro (given q5min X3)and rest
Anterior fontanel closes at-12-18mon

Posterior fontanel closes at-birth to 3mon
Classic sign of Diabetes-3 "p"s (polyuria, polydysia, polyphasia)
CVA pt with hemianopsia-approach from unaffected side
Discharge teaching after cataract surgery-avoid sneezing, coughing,
straining or bending
Lyme disease-wear long sleeves clothing
Post laminectomy -flat position
Diet for cirrhosis-low protein, high calorie
Fundus displaced to right side-ask pt to void
fundus is boggy-message fundus
Self breast exam-done 5-7 days after menses
SandS of Pyloric Stenosis-projectile vomit, metabolic alkalosis,olive size bulge unger the ribcage
Position for Meneries-affected side
Raynards disease-wear gloves, keep hands warm
Trigeminal neuralgia (tic douloureax) - eat warm, soft foods
Preparing to breast feed - wash braest with water and rub with a towel everyday
Ventricular gallop is the earliest sign of heart failure
Levin tube - feedings at room temperature, do not clamp between feedings
position for liver biopsy - supine with arms raised above head
rheumatoid arthritis - heat, ROM, weight reduction
Bells Palsy: avoid cold temperatures: make sure pt. closes windows when they are sleeping. Some even
take eyes shut.
Nurses' priority intervention after a patient receives a skin graft is to prevent movement of the graft.
Greatest risk for postpartum hemorrhage is from distended bladder.
Herpes zoster (shingles) is from reactivation of the varicella virus.
1 grain = 60mg (I always forget this one)
Risk factors for legionnaires disease: advanced age, immunosuppression, end stage renal disease, and
diabetes
Hepatitis
5 types
A,B, C, D, and E
Hep A-spread by drinking unsanitary water and uncooked foods

Hep B-spread by contact with blood or bodily fluids and is an STD
Hep C-spread by contact the same way as Hep B, can lead to cirrhosis (mostly seen with alcoholism)
Hep D-only contracted if you already have Hep B
Hep E-usually spread by contact with contaminated water

In nursing school, my instructor taught us to remember the different types like this:
VOWEL = BOWEL
Hep A and E---if your infected you will have problems with bowels...
Some Therapeutic Drug Levels
Digoxin 05-2.0 ng/ml

Lithium 0.6-1.5 mEq/L
Dilantin 10-20 mcg/dl
Theophylline 10-20 mcg/dl
Coumadin PT: 12-20 sec....therapeutic range 1.5-2 times the control

INR: 2-3
Heparin PTT: 30-60 sec...therapeutic range 1.5-2 times the control
CREATININE AND CREATININE CLEARANCE
With renal impairment, serum creatinine goes up,urinary clearance goes down.
Serum Creatinine-men 0.8-1.8mg/dl

women-0.5-1.5mg/dl
Urinary creatinine clearance-85-135ml/min--requires a 24 hour urine specimine. Decreases with renal

malfunction.
With a unilateral kidney disease, if one of the kidneys is healthy, a decrease in the creatinine clearance is
not to be expected.
ATROPINE OVERDOSE
Hot as a Hare(temperature)
Mad as a hatter(confusion, delirium)
Red as a Beet(flushed face)
Dry as a bone(decreased secretions, thirsty)
CYSTIC FIBROSIS
Diet: Low in fat and high in sodium
Meds: Antibiotics, liposoluable vitamins(A D E K) Aerosol Bronchodialators, mucolytics, pancreatic
enzymes.
5 A's to alzheimers
Anomia-unable to remember things
Apraxia-failure to identify objects
Agonsia-can't recognize sounds, tastes and other sensations, familiar objects.
Amnesia-memory loss
Aphasia-can't express SELF through speech.

GLOMEULONEPHRITIS-it's an antigen antibody complex from a recent strep infection which causes
inflammation/ decreased glomerular filtration rate.
BETA BLOCKERS
B1-affects the heart
B2-affects lungs
EMERGENCY DRUGS TO LEAN ON

Lidocain
Epinephrine
Atropine
Narcan
AUTONOMIC DYSREFLEXIA-triggered by sustained stimuli at T6 or below. Vasodialation above

injury,(flushed face, increased bp etc) vasoconstriction below injury(pale, cool, no sweating.)
AIRBORNE
My - Measles
Chicken - Chicken Pox
Hez - Herpez Zoster
TB
Private Room - negative pressure with 6-12 air exchanges/hr

Mask, N95 for TB
DROPLET
think of SPIDERMAN!
S - sepsis
S - scarlet fever
S - streptococcal pharyngitis
P - parvovirus B19
P - pneumonia
P - pertussis
I - influenza
D - diptheria (pharyngeal)
E - epiglottitis
R - rubella
M - mumps
M - meningitis
M - mycoplasma or meningeal pneumonia
An - Adenovirus
Private Room or cohort

Mask
CONTACT PRECAUTION
MRS.WEE
M - multidrug resistant organism
R - respiratory infection
S - skin infections *
W - wound infxn
E - enteric infxn - clostridium difficile
E - eye infxn - conjunctivitis

SKIN INFECTIONS
VCHIPS
V - varicella zoster
C - cutaneous diphtheria
H - herpez simplex
I - impetigo
P - pediculosis
S - scabies
Private room or cohort

Gloves
Gown
Airborne
*keep door closed*
In addition to DROPLET PRECAUTION:

*Maintain spatial separation of 3 feet between infected patient and visitors. Door may remain open.
1. Widening pulse pressure is a sign of increased ICP

2.Pt taking Digoxin should eat a diet high in potassium (hypokalemia-> dig toxicity)
3.Key sign of PUD... hematemesis which can be bright red or dark red with the consistency of coffee
grounds
4.Common symptom of Aluminium hydroxyde: constipation
5.In a child anemia is a the first sign of lead poisoning
6.Diuretic used for intracranial bleeding, hydrocephalus (Increased ICP,...) MANNITOL (osmotic
diuretic)
7.Treatment of celiac disease: gluten free diet
8.cystis fibrosis==> excessive mucus production, respiratory infection complications,...
9.Cholelithiasis causes enlarged edematous gallbladder with multiple stones and an elevated bilirubin
level.
10.Fat embolism is mostly seen in LONG BONES (femur,...)
1. Abruptio placentae may be a complication of severe preeclampsia

2. Syrup if ipecac is not administered when the ingested substance is corrosive in nature
3. Pt before liver biopsy is NPO 4-6 hours
4. Assess renal fct before giving an osmotic diuretic (mannitol)
5. Patient in addisonian crisis ecreased BP, Na, Blood glucose, Increased K
6. Amniocentesis is done as early as 14 weeks of gestation
7. Chorionic villi sampling is done as early as 10 weeks of gestation
8. Increased level of alpha fetoprotein in pregnant woman => neural tube defects
9. Insulin is safely given throughout pregnancy; oral hypoglycemic agents are contraindicated
10. Phenobarbital (Luminal) is commonly used to treat and prevent recurrent seizures in infants and
young children
11. Aspirin is associated with Reye's syndrome in children with fever or viral infection
12. Glycerin suppositories are preferred agents to treat constipation in children

13. Corticosteroids may produce an altered effect of a vaccine
14. Thiazide diuretics (HCTZ,...) may induce hyperglycemia
15. Anticonvulsants INCREASE the seizures THRESHOLD!!!!
16. Hyperbilirubinemia in newborn: bilirubin levels are greater than 13-15 mg/dl
1. Postpartum period: circulating hcG disappears within 8-24 hours

2. S/S opioid withdrawl: rhinorrhea, dilated pupils, abdominal cramps
3. S/S sedative withdrawl: Increased motor activity, tachycardia
4. S/S alcohol withdrawl: tremors, N/V, diaphoresis
5. S/S stimulant withdrawl: CNS depression, fatigue, depression, confusion,...
6. Hb values: neonates have Hb higher than those of older children to sustain them until active
erythropoiesis begins
7. Toclytic therapy: to arrest preterm labor
8. Child with chickenpox can be treated with oatmeal preparation baths and calamine lotion at home
to relieve the itching...
9. child with rheumatoid arthritis should sleep in bag to keep joints warm and promote flexibility!!!!
Wow...
10. When an eye patch is used to correct strabismus, the normal eye is patched. That forces the child
to use the "lazy" eye, thereby increasing that eye's muscle strengths
11. If a chest tube accidently get disconnected, clamp it or place the open end of the tube in a
container of sterile water or saline solution
12. Women should avoid pregnancy for at least 3 months after a rubella vaccine
13. Most accurate method to detect TB: sputum culture!!!
A child with KAWASAKI disease might be given a high dose of aspirin to reduce the risk of heart
problems.
some respiratory
1. RSV- child in private room...CONTACT PRECAUTIONS..not droplet or airbone.

(sometimes i get this mixed up because its called respiratory synctical virus..i used to
pick droplet precautions but i have down now lol!
2. Elderly adults generally present with confusion rather than S/S of an illness.
3. pneumonia- droplet precautions
4. COPD pts should get low flow Oxygen b/c of the hypoxic drive. (1-3L/min) teach
pursed lip breathing.
5. ARDS- this pt doesnt respond to even 100% FiO2
6. TB- hemotysis (advanced stage) v/s pulmonary edema- frothy blood tinged sputum
7. Allen's test- done b/f an ABG by applying pressure to the radial artery to determine

if adequate blood flow is present.
8. INH (Isoniazid)- tx of TB. give vit B6 to prevent peripheral neuritis
9. SIMV mode on vents commonly used for weaning pt off ventilator.
10. vent alarms: high alarm (increased secretions then suction......, biting tube-need
an oral airway,...... or coughing and anxiety- need a sedative)
low alarm- there is a leak or break in system...check all connectors and cuff.
11. if a trach becomes accidently dislodged try to replace it with an obturator..if no

luck keep the hole open with hemostats until physician arrives.
No Pee, no K (do not give potassium without adequate urine output)
Most common cause of SIADH is cancer, esp. lung cancer
IV KCL should infuse no faster than 20 mEq/hr
Valsalva maneuver is used for symptoms of SVT
Ototoxic drugs: loop diuretics (Lasix), NSAIDs, and cisplatin (Platinol-AQ)
And thank you whomever posted about Demerol being the DOC for pancreatitis! That has already come
in handy on my practice tests!
1. Profile of gallbladder disease: 5Fs: fair, fat, forty, five pregnancies, flatulent(disease can occur in
all ages and both sexes)
2. Hip fractures commonly hemorrhage, whereas femur fractures are at risk for fat emboli
3. Religious beliefs: Hindu- No beef or items containing gelatin
4. Renal diet- High calorie, high carbohydrate, low protein, low K, low Na, and fluid restricted to
intake = output +500 ml
5. Treatment for sickle cell crises- HHOP: Heat, hydration, oxygen, pain meds
6. RN and MD institute seclusion protection
7. MD or hospice RN can pronounce the client dead
8. For hospital triage, care for the client with a life-threatening illness or injury first
9. For disaster triage, choose to triage first those clients who can be saved with the least use of
resources!
10. It is contraindicated to induce vomiting if the patient has ingested gasoline, acid and alkaline!!!
MAOIs
Non-Popular Meds
Nardil
Parnate

Marplan
1. teach a pt with GERD after meals to remain upright for at least 20 min.
2.levodopa toxicity- notify physician if twitching develops.
3. Curling's ulcers or stress ulcers can cause sudden massive hemmorage.
4. 5 mm induration positive reaction (mantoux test) for HIV or immunosuppressd pts
5. Schilling test done to see how well a pt can absorb vit b12. checking to see if they have
pernicious anemia.
6. Prednisone, Prograf, and Cellcept helps to prevent kidney rejection.
1. Air/Pulmonary Embolism (S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic,

sense of impending doom) --> turn pt to left side and lower the head of the bed.
2. Woman in Labor w/ Un-reassuring FHR (late decels, decreased variability, fetal

bradycardia, etc) --> turn on left side (and give O2, stop Pitocin, increase IV fluids)
3. Tube Feeding w/ Decreased LOC --> position pt on right side (promotes emptying of the
stomach) with the HOB elevated (to prevent aspiration)
4. During Epidural Puncture --> side-lying
5. After Lumbar Puncture (and also oil-based Myelogram)--> pt lies in flat supine (to prevent
headache and leaking of CSF)
6. Pt w/ Heat Stroke --> lie flat w/ legs elevated
7. During Continuous Bladder Irrigation (CBI) --> catheter is taped to thigh so leg should be
kept straight. No other positioning restrictions.
8. After Myringotomy --> position on side of affected ear after surgery (allows drainage of
secretions)
9. After Cataract Surgery --> pt will sleep on unaffected side with a night shield for 1-4 weeks.
10. After Thyroidectomy --> low or semi-Fowler's, support head, neck and shoulders.
11. Infant w/ Spina Bifida --> position prone (on abdomen) so that sac does not rupture
12. Buck's Traction (skin traction) --> elevate foot of bed for counter-traction
13. After Total Hip Replacement --> don't sleep on operated side, don't flex hip more than
45-60 degrees, don't elevate HOB more than 45 degrees. Maintain hip abduction by separating
thighs with pillows.
14. Prolapsed Cord --> knee-chest position or Trendelenburg
15. Infant w/ Cleft Lip --> position on back or in infant seat to prevent trauma to suture line.

While feeding, hold in upright position.
16. To Prevent Dumping Syndrome (post-operative ulcer/stomach surgeries) --> eat in reclining
position, lie down after meals for 20-30 minutes (also restrict fluids during meals, low CHO and
fiber diet, small frequent meals)
17. Above Knee Amputation --> elevate for first 24 hours on pillow, position prone daily to
provide for hip extension.
18. Below Knee Amputation --> foot of bed elevated for first 24 hours, position prone daily to
provide for hip extension.
19. Detached Retina --> area of detachment should be in the dependent position
20. Administration of Enema --> position pt in left side-lying (Sim's) with knee flexed
21. After Supratentorial Surgery (incision behind hairline) --> elevate HOB 30-45 degrees
22. After Infratentorial Surgery (incision at nape of neck)--> position pt flat and lateral on
either side.
23. During Internal Radiation --> on bedrest while implant in place
24. Autonomic Dysreflexia/Hyperreflexia (S&S: pounding headache, profuse sweating, nasal

congestion, goose flesh, bradycardia, hypertension) --> place client in sitting position (elevate
HOB) first before any other implementation.
25. Shock --> bedrest with extremities elevated 20 degrees, knees straight, head slightly elevated
(modified Trendelenburg)
26. Head Injury --> elevate HOB 30 degrees to decrease intracranial pressure
some GI/hepatic
hepatitis--all forms standard precautions
s/s of bowel perforation--sudden diffuse abdominal pain, no bowel sounds, resp. rapid and shallow, rigid
abdomen.
nursing care for undiagnosed abdominal pain--npo, no heat on stomach, no enemas, no narcotics, no
laxatives.
crohns-small intestine vs ulcerative colitis-large intestine..sulfasalzine used to treat both.
pyloric stenosis- olive shaped mass felt in R. epigastric area, projectile vomiting
if a pt requires TPN and it is temp. unavailable then give D10W OR 20% DW until available.
before a Dx test of after 3 enemas, returns are not clear, notify physician
if diarrhea occurs with a colostomy. check meds (some cause diarrhea)..dont irrigate

as a general rule antacids should be taken 1-2 hours after other oral meds.
Symptothermal method of birth control - combines cervical mucus evaluation and basal body temperature
evaluation, non-prescription/drug
percipitus/rapid labor - risk factor for early postpartum hemmorhage and amniotic fluid embolism
In elderly, change in mental status and confusion are often the presenting symptoms of infection
antiseizure meds - notify anesthesia prior to surgery, may need to decrease the amount of anesthetic given
neuroleptic malignant syndrome - increased temp, severe rigidity, oculogyric crises, HTN, complication
of antipsychotic meds, notify MD
Dilantin - pregnancy risk category D, should investigate possibility of pregnancy (LMP) prior to
administering
Transcutaneous electrical nerve stimulation (TENS) - used for localized pain (back pain, sciatica) - use
gel, place electrodes over, above or below painful area, adjust voltage until pain relief/prickly "pins and
needles"
1. S/S delusional thought patterns => suspiciousness and resistance to therapy

2. Use of neologism (new word self invented by a person and not readily understood by another)
=>associated with thought disorders
3. Age and weight are VERY important to know after a child has ingested a toxic substance
4. Child with celiac disease can eat corn, rice, soybeans and patatoes (gluten free)
5. Anaphylactic rx => administer epinephrine first, then maintain an open airway. (Not the other
way around )
6. Client with asthma => monitor peak of airflow volumes daily. Pulse ox after!!!!
7. DKA pt => a HCT of 60 (way high...) (extreme dehydration) would be more critical than a pH
less than 3! (Fluids first...)
8. Assess for abdominal distention after placement of a VP shunt! (You know why right? )
9. GFR is decreased in the initial response to severe burns, with fluid shift occuring. Kidney fct
must be monitored closely or renal failure may follow in a few days
10. Vomiting => metabolic alkalosis (loss of stomach acid content)
11. Diarrhea => metabolic acidosis (loss of bicarbonate)
12. COPD => respiratory acidosis (CO2 retention)
13. Anxious client => hyperventilation can cause respiratory alkalosis. A paper bag will help.
(Increase CO2) Right?
14. Client with low H&H after splenectomy => the initial priority is REST due to the inability of
RBCs to carry O2
15. Mild to moderate diarrhea in a child => maintain a NORMAL diet with fluids to rehydrate the
poor child

Don't forget Vancomycin can cause "Red man Syndrome" = decreased BP and flushing of face and neck
--> give antihistamine. Also watch for liver damage with this one.
Peripheral vascular disease - patient should sit with feet flat on floor to prevent hyper-flexion of the knee
Myelominigocele - baby should like on abdomen with head to the side
Tegretol - interferes with action of hormonal contraceptives, should use alternate type of birth control
Clozapine (Clozaril) - antipsychotic, treats schizophrenia, potential to suppress bone marrow and cause
agranulocytosis (look for sore throat and fever)
Bucks traction - remove foam boots 3x/day to inspect skin, turn client to unaffected side, dorsiflex foot on
affected side, elevate foot of bed
phlebitis - tenderness and redness at IV insertion site and redness proximally along the vein. Remove the
IV and apply warm soaks
Crede maneuver - apply manual pressure to bladder, aids in emptying the bladder completely, results in
reduced risk for infection; if performed every day can result in bladder control for some SCI
Frequent use of nasal sprays to relieve allergic symptoms can result in vasoconstriction that causes
atrophy of nasal membranes (frequent nosebleeds)
Lung cancer is a common cause of SIADH (abnormal secretion of ADH, increase water absorption and
dilutional hyponatremia)
ginko - antiplatelet, CNS stimulant, given for dementia, increase risk of bleeding with NSAIDS
Native Americans are present oriented and do not live by the clock (will be late for appointments)
Pulmonic area - 2ICS, left of sternum
Chronic alcohol use is the most common cause of hypoMg, which ma result in cardiac arrest (increase
neuromuscular irritability, tremors, tetant, seizures)
SCD - two fingers between sleeve and leg, opening at the knee and popliteal pulse point, antiembolism
stockings can be applied under sleeve to decrease itching, sweating and heat buildup
Peritoneal Dialysis when Outflow is Inadequate --> turn pt from side to side BEFORE checking for
kinks in tubing (according to Kaplan)
Timeouts for children - 1minute for each year of age
Temporal lobe - hearing

Frontal - personality changes
Occipital - visual
brain stem - bladder/bowel
Bulimia - susceptible to tracheosophageal fistula from esophageal tear, laryngitis is a danger sign (hoarse

voice that is barely audible)
mycins - if fever, notify MD
screening for HTN - two readings, 5minutes apart
encourage geriatric patients to talk about life and important things in his/her past, especially with recent
memory loss
NO morphine for pancreatitis and cholecystitis.... google for the reason
1 unit of packed RBCs = 220mL
if allergic to sulfonamides don’t take acetazolamide (Diamox)
VENTRICULAR FIBRILLATION: TREATMENT
"Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa Shock":
Shock= Defibrillate
Everybody= Epinephine
Little= Lidocaine
Big= Bretylium
Momma= MgSO4
Poppa= Pocainamide
methotrexate- dont take supplemental folic acid and please dont take while pregnant..can
cause premature labor and bleeding.
oh dont take cytoxan while pregnant or dont handle the drug while pregnant.
infections that occur with AIDS clients are called opportunistic infections.
Pneumocystis carinii pneumonia is not contagious unless you are immunocomprimised. this
infections occurs mostly with AIDS pts.
infant with HIV should NOT recieve chickenpox or oral polio vaccine. can give inactivated
polio vaccine though.
Priority...
if patient having allergic reaction or going into anaphilactic BUT still consious... what you do 1st action:
1. call immideately MD
2. Ensure Airway
3. Give O2 by mask

4. Epinephrine as prescribed
****
by the way who took NCSBN questions online. What score may say that you likely to pass NCLEXRN
______
answer 4
After Lumbar Puncture (and also oil-based Myelogram)--> pt lies in flat supine (to prevent headache
and leaking of CSF)
not very correct. The head is usually ELEVATED if an OIL-based or water -soluble contrast agent is used.
lumbar puncture - flat
OIL based - flat
WATER soluble contrast - elevate 15-30 degrees
palpating the carotid pulses together can cause a vagal response and slow the clients heart rate
adrenal insufficiency - steroids increased prior to surgery
thyroidectomy - acess for numbness from decreased Ca
Bactrim - mild to moderate rash the most common SE
If when removing a PICC a portion of the catheter breaks - apply tournaquet to the upper arm, feel radial
pulse
emptying a drainage evacuator - wash hands, don gloves, elevate bed, pour drainage itno measuring cup,
compress the evacuator and replace the plug
Percodan - oxycodone and aspirin

Percocet - oxycodone and acetaminophen
low back pain, h/a and restless...cardinal of hemolytic transfusion reaction..stop

transfusion..change tubing...infuse NS.
initate a blood transfusion w/i 30 min of recieving blood.
fresh frozen plasma administerd to DIC because of the clotting factors in it
cryoprecipitate given in hemophilia...also with hemophilia they tend to bleed into the joints
so they may have joint problems.
Myasthenia Gravis: worsens with exercise and improves with rest.

Myasthenia Crisis: a positive reaction to Tensilon--will improve symptoms

Cholinergic Crisis: caused by excessive medication-stop med-giving Tensilon will make it worse
Head injury medication: Mannitol (osmotic diuretic)-crystallizes at room temp so ALWAYS use filter
needle
Prior to a liver biospy its important to be aware of the lab result for prothrombin time (PT)
Pregnancy Induced Hypertension: The nurse would be MOST concerned if the patient complained of
epigastric pain and a HA.
COPD: Administer low flow Oxygen! We never administer: 5L NC
1. Watery vaginal discharge and painless bleeding => endometrial cancer

2. Frothy vaginal discharge => trichomonas infection
3. Thick, white vaginal discharge => candida albicans
4. purulent vaginal discharge => PID
5. Approximately 99% of males with cystic fibrosis are sterile due to obstruction of the vas deferens
6. Lyme's disease is transmitted by ticks found on deer and mice in wooded areas
7. Children 18-24 months normally have sufficient sphincter control necessary for toilet training
8. Complications of TPN therapy are osmotic diuresis and hypovolemia!!!
9. L/S ratio => fetal lung maturity
10. Kava-kava can increase the effects of anesthesia and post-op analgesia
11. NEVER give chloride potassium by IV push
12. GINKGO interacts with many meds to increase the risk of bleeding; therefore, bruising or
bleeding should be reported to MD
13. Vanco therapeutic range 10-20 mcg/mL
14. Client with disseminated herpes zoster (shingles) => AIRBORNE precautions
15. The client taking methotrexate should avoid multivitamins b/c multivitamins contain folic acid.
Methotrexate is a folic acid antagonist!!!
1. Pt with increased ICP => Lumbar puncture is contraindicated b/c risk of brain herniation
2. If pt states "I have a constant throbbing headache! This is the worst headache I ever had" => may
be having ICB (Intracranial bleeding); assess pt for increased ICP, and of course notify MD
3. Cardinal sign of increased ICP => change in LOC (level of consciousness)
4. Diabetes insipidous => dilute urine, concentrated plasma
5. SIADH => concentrated urine , dilute plasma
Hypovolemia and osmotic diuresis that are complications of TPN result from hyperglycmia!
Let's recapitulate TPN => Hyperglycemia => osmotic diuresis & hypovolemia...

Drooling - 4 months
Responds to own name 6-8months
deliberate steps when standing 9-10months
picks up bite size peices of cereal 11months
24months: kick ball w/o falling, build tower of 6blocks, 2-3 word phrases, 300 word vocab
30months: jump with both feet, run, say first and last name
36months: tricycle
Left CVA - speech, math skills, analytical thinking

Right CVA - behavior, disorientation to person, place and time
Ectopic pregnancy - LLQ pain, vaginal spotting
tricuspid valve: 5ICS left sternal border
Here are some that help me and hope they help you guys too.
1. Always identify the topic and assess before anything else!!!
2. Dont ask open ended questions and never ask a patient why!
3. With removal of the thyroid, elevated vital signs signify thyroid storm, give Inderal, PTU, and oxygen!
4. With renal calculi, sickle cell, and pancreatitis: Pain is priority...or IV hydration in sickle cell laboring
patients.
5. With otitis media, a complication can be meningitis.
6. To determine HR, count the small boxes between R waves and divide by 1500.
7. For dumping syndrome: lay patient flat for an hour after meals and don’t give fluids after meals.
8. Never remove traction weights!
9. For hypothermia, monitor for VFIB
10. PICC LINE complications: air embolism s/s: pale, SOB, tachy. Place pt. in trendelenberg and to their
Left!
compartment syndrome...significant increase in pain not responsive to pain meds.
Plaquenil-tx of Rhem Arthritis...recommend eye exam every 3 mo.
Statins- tx of high cholesterol...ASSESS FOR MUSCLE PAIN...moniter liver enzymes.
Nicotinic Acid (Niacin)-tx of high cholesterol- flushing occurs in most pt. will diminish over several
weeks.
stages of shock (its more but i made it simple "KISS" keep it simple stupid lol!)

early- increase in pulse...normal urine output
intermediate-RAS (renin-angioten system), low urine output, cool skin, pallor
late-no urine output, low BP irreversible stage!
Myxedema/hypothyroidism: slowed physical and mental function, sensitivity to cold, dry skin
and hair
Graves’ disease/hyperthyroidism: accelerated physical and mental function; sensitivity to
heat, fine/soft hair
Thyroid storm: increased temp, pulse and HTN
Post-thyroidectomy: semi-Fowler’s, prevent ncek flexion/hyperextension, trach at bedside
Hypo-parathyroid: CATS – convulsions, arrhythmias, tetany, spasms, stridor (decreased

calcium), high Ca, low phosphorus diet
Hyper-parathyroid: fatigue, muscle weakness, renal calculi, back and joint pain (increased
calcium), low Ca, high phosphorus diet
Hypovolemia – incrased temp, rapid/weak pulse, increase respiration, hypotension, anxiety,

urine specific gravity >1.030
Hypervolemia – bounding pulse, SOB, dyspnea, rares/crackles, peripheral edema, HTN, urine
specific gravity <1.010; Semi-Fowler’s
Diabetes Insipidus (decreased ADH): excessive urine output and thirst, dehydration,
weakness, administer Pitressin
SIADH (increased ADH): change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a,
HA; administer Declomycin, diuretics
Hypokalemia: muscle ewakness, dysrhythmias, increase K (raisins, bananas, apricots,

oranges, beans, potatoes, carrots, celery)
Hyperkalemia: MURDER – muscle weakness, urine (oliguria/anuria), respiratory depression,
decreased cardiac contractility, ECG changes, reflexes
Hyponatremia: nausea, muscle cramps, increased ICP, muscular twitching, convulsion;

osmotic diuretics, fluids
Hypernatremia: increased temp, weakness, disorientation/delusions, hypotension, tachycardia;
hypotonic solution
Hypocalcemia: CATS – convulsions, arrhythmias, tetany, spasms and stridor
Hypercalcemia: muscle weakness, lack of coordination, abdominal pain, confusion, absent
tendon reflexes, sedative effect on CNS
HypoMg: tremors, tetany, seizures, dyrshythmias, depression, confusion, dysphagia; dig toxicity
HyperMg: depresses the CNS, hypotension, facial flushing, muscle ewakness, absent deep
tendon reflexes, shallow respirations, emergency
Addison’s: hypoNa, hyperK, hypoglycemia, dark pigmentation, decreased resistance to stress,

fractures, alopecia, weight loss, GI distress
Cushings: hyperNa, hypoK, hyperglycemia, prone to infection, muscle wasting, weakness,
edema, HTN, hirsutism, moonface/buffalo hump
Addisonian crisis: n/v, confusion, abdominal pain, extreme weakness, hypoglycemia,
dehydration, decreased BP
Pheochromocytoma: hypersecretion of epi/norepi, persistent HTN, increased HR,

hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bating and rest breaks,
avoid cold and stimulating foods, surgery to remove tumor
--In complete heart block, the AV node blocks all impulses from the SA node, so the
atria and ventricles beat independently, b/c Lidocaine suppresses ventricular
irritability, it may diminish the existing ventricular response, cardiac depressant are
contraindicated in the presence of complete heart block.
--administrate Glucagon when pt is hypoglycemia and unresponsive
--Bromocriptine (Parlodel) or Dantrolene (Dantrium) is used for CNS toxicity
--Ibuprofen (Motrin) S/E includes epigastric distress, nausea, occult blood loss, peptic
ulceration, use cautiously with history of previous gastrointestinal disorders.
--Aminophylline (Truphylline) use with Propranolol (Inderal) may decrease metabolism
and lead to toxicity
--Antianxiety medication is pharmacologically similar to alcohol, is used effectively as
a substitute for alcohol in decreasing doses to comfortably and safely withdraw a client
from alcohol dependence
-- Tagamet decrease gastric secretion by inhibiting the actions of histamine at the H2-
receptor site, constipation is a common side effect of this med, should increase fiber in
diet. Take with meals and at bedtime.
--elderly clients and clients with renal problems are most susceptible to CNS side
effects (confusion, dizziness) of the medication
Ultrasound screening -can be vaginal or Abdominal (in latter make Her drink water to fill
bladder)
-Confirms viability
-Indicates fetal presentation
-Confirms multiple gestation
-Identifies placental location
-Measurements can be taken to confirm/estimate gestational age
-Identify morphologic anomalies
Chorionic villus sampling

8-12 weeks
for early diagnosis of genetic, metabolic problems
Amniocentesis -13-14 weeks

Is done under US scan to obtain a sample of amniotic fluid for direct analysis of fetal
chromosomes, development, viability and lung maturity
AFP (alpha feto-protein)

15-18 weeks-Maternal Blood Drawn
AFP also called =Quad marker screening:
-maternal serum alpha fetoprotein (MSAFP),
-human chorionic gonadotropin (HcG),
-unconjugated estriol (UE),
-and inhibin A
low AFP-Down syndrome
high-Spina bifida
it is not an absolute test if it is abnormal -further investigation is recommended

Kick counts (tests Uretro placental capability)
Same time every day mother records how often she feels the fetus move
if minimum 3 movements are not noted within an hour's time, the mother is encouraged to call
her physician immediately!
Nonstress Test
checks FHR and mother detects Fetal movements.
Contraction Stress Test -tests perfusion between Placenta and Uterus (basically O2 and CO2
exchange)
-IV accessed and performed in a labor and deliver unit under electronic fetal monitoring
contractions initiated by Pitocin or nipple stimulation
the desired result is a "negative" test which consists of three contractions of moderate intensity
in a 10 minute period without evidence of late decelerations
the test is done to detect problems so if it is Positive (persistent late decelerations
) then-CS
how is done:
The electronic fetal monitor is placed on the maternal abdomen for 20-30 minutes
Each time the fetus moves, FHR should accelerate 15 beats/min above the baseline for 15
seconds
A reactive (good) test =>2 accelerations in FHR occur with associated fetal movement
Biophysical Profile (BPP)
identification of a compromised fetus and consists of 5 components:
-fetal breathing movement
-fetal movement of the body or limbs
-fetal tone (extension or flexion of the limbs)
-amniotic fluid volume index (AFI) visualized as of fluid around the fetus
-reactive non-stress test
each component 0-2, 8-10-desirable.
Percutaneous Umbilical Blood sampling -like amniocentesis but cord punctured

-chromosomal anomalies, feta karyotyping, and blood disorders
Evrywhere where woman's abdomen is punctured informed consent is needed, and risks like
amnionitis spontaneous abortion, preterm labor/delivery, and premature rupture of membranes
must be explained. If she Rh--she may be RHoGAM given.
Determination of lung maturity through amniocentesis is done at the last trimester of pregnancy
"Amniocentesis may be done after 13-14 week of pregnancy. Performed to determine genetic disorders,
metabolic defects, and FETAL LUNG MATURITY"
echocardiogram-used to assess heart valves.
valve disorders require prophylactic antibiotics before invasive procedures.
avoid IM injections when suspecting MI can affect CK levels
hemodynamic measurements-transducer placed @ the midaxillary line at the fourth or

fifth intercostal space phlebostatic axis.
calcium channel blockers-assess for constipation
1. Neuroleptic malignant syndrome (NMS):

-NMS is like S&M;
-you get hot (hyperpyrexia)
-stiff (increased muscle tone)
-sweaty (diaphoresis)
-BP, pulse, and respirations go up &
-you start to drool
2. I kept forgetting which was dangerous when you're pregnant; regular measles (rubeola), or
German measles (rubella), so remember:
-never get pregnant with a German (rubella)
3. When drawing up regular insulin & NPH together, remember:

-RN (regular comes before NPH)
4. Tetralogy of fallot; remember HOPS

H- hypertrophy of right ventricle
O- over-riding aorta
P- pulmonary stenosis
S- septal defect
5. MAOI's that are used as antidepressants:

weird way to remember, I know. pirates say arrrr, so think; pirates take MAOI's when they're
depressed.
- explanation; MAOI's used for depression all have an arrr sound in the middle (Parnate, Marplan,
Nardil)
Autonomic dysreflexia: potentially life threatening emergency

- elevate head of bed to 90 degree
- loosen constrictive clothing
- assess for bladder distention and bowel impaction (trigger)
- Administer antihypertensive meds (may cause stroke, MI, seizure )
Normal ICP : 0 - 15mmHg
Pulmonary embolus: S/S

- pleuritic chest pain, dyspnea, low-grade fever, tachycardia, blood-tinged sputum.
COPD : S/S
- dyspnea on exertion, barrel chest, clubbed fingers and toes, tachypneic with prolonged expiratory phase.
Tension pneumothorax - tracheal shift to opposite side, decreased venous return, neck vein bulge,
tachycardia and tachypnea.
allopurinol - for chronic gout

colchicine - for acute gout attack

easy way to remember MAOI'S!
think of PANAMA!
PA - parnate
NA - nardil
MA – marplan
the laxative step-ladder....to manage constipation

1. bulk-forming laxatives are first
2. stool softners
3. osmotics
4. stimulants
5. suppositories
6. enemas are last
atropine is contraindicated in paralytic ileus, ulcerative colitits, obstructive GI disorders, benign prostatic
hypertrophy, myasthenia gravis and narrow angle glaucoma
withdrawal s/s of benzos: agitation, nervousness, insominia, anorexia, sweating, muscle

cramps.....basically about the same as alcohol withdrawal s/s.
thrombophlebitis s/s: redness, warmth, and induration along the vein, tenderness on palpation of the vein.
hypokalemia-prominent U WAVE (u is down hypo), hyperkalemia-tall T wave (T is tall hyper)
superior vena cava syndrome s/s: nosebleeds, edema in the eyes, edema of hands, dyspnea, mental status
changes.
s/s of rheumatic fever: painful swollen joints, jerky movements, enlarged heart, heart murmur, nontender
lumps on bony areas, white painful lesions on the trunk
s/s of vit B12 deficiency: pallor, slight jaundice, smooth beefy red tongue, tingling hands and feet, and
difficulty with gait
good pasture syndrome affects the lungs and kidneys so expect pulmonary symptoms and kidney
symptoms (failure symptoms)
Metronidazole (Flagyl)- antiprotozoan: Disulfiram-like action, so no alcohol. vinegar, alcohol mouth

wash or wine (unless you are planning on vomiting for awhile)...this drug has a metallic bitter taste.
Digoxin-check pulse, less than 60 hold, check dig levels and potassium levels.
Amphojel: tx of GERD and kidney stones....watch out for contipation.
Vistaril: tx of anxiety and also itching...watch for dry mouth. given preop commonly
Versed: given for conscious sedation...watch for resp depression and hypotension
PTU and Tapazole- prevention of thyroid storm

Sinemet: tx of parkinson...sweat, saliva, urine may turn reddish brown occassionally...causes drowsiness
Artane: tx of parkinson..sedative effect also
Cogentin: tx of parkinson and extrapyramidal effects of other drugs
Tigan: tx of postop n/v and for nausea associated with gastroenteritis
Timolol (Timoptic)-tx of gluacoma
Bactrim: antibiotic..dont take if allergic to sulfa drugs...diarrhea common side effect...drink plenty of
fluids
Gout Meds: Probenecid (Benemid), Colchicine, Allopurinol (Zyloprim)
Apresoline(hydralazine)-tx of HTN or CHF, Report flu-like symptoms, rise slowly from sitting/lying
position; take with meals.
Bentyl: tx of irritable bowel....assess for anticholinergic side effects.
Calan (verapamil): calcium channel blocker: tx of HTN, angina...assess for constipation
Carafate: tx of duodenal ulcers..coats the ulcer...so take before meals.
Theophylline: tx of asthma or COPD..therap drug level: 10-20
Mucomyst is the antedote to tylenol and is administered orally
Diamox: tx of glaucoma, high altitude sickness...dont take if allergic to sulfa drugs
Indocin: (nsaid) tx of arthritis (osteo, rhematoid, gouty), bursitis, and tendonitis.
Synthroid: tx of hypothyroidism..may take several weeks to take effect...notify doctor of chest pain..take
in the AM on empty stomach..could cause hyperthyroidism.
Librium: tx of alcohol w/d...don't take alcohol with this...very bad nausea and vomiting can occur.
Oncovin (vincristine): tx of leukemia..given IV ONLY
kwell: tx of scabies and lice...(scabies)apply lotion once and leave on for 8-12 hours...(lice) use the
shampoo and leave on for 4 minutes with hair uncovered then rinse with warm water and comb with a
fine tooth comb
Premarin:tx after menopause estrogen replacement
Dilantin: tx of seizures. therapeutic drug level: 10-20
Navane: tx of schizophrenia..assess for EPS
Ritalin: tx of ADHD..assess for heart related side effects report immediately...child may need a drug
holiday b/c it stunts growth.

dopamine (Intropine): tx of hypotension, shock, low cardiac output, poor perfusion to vital
organs...monitor EKG for arrhythmias, monitor BP
1. Terbutaline a beta-2 agonist is given for preterm delivery to relax smooth muscle
and halt contractions
2. High circulating levels of progesterone released by the "corpus luteum" are thought
to be responsible for the immediate post-ovulation rise in body temperature
3. Geriatrics pts may increase consumption of salt and sweets b/c change in test
perception... Watch for health problems that may result from that!
4. 8 month infant => Recognizes but is fearful of strangers
5. 10-12 months infant => 3-words vocabulary1!!!
6. 12 months infant => stands alone
7. 8-12 weeks infant => can hold head up
8. Pregnant woman with "Charley horse" pain (pain in the "gastrocnemius muscle" =>the
muscle in the back part of the leg that forms the greater part of the calf; responsible for the
plantar flexion of the foot) is relieved by dorsiflexing the foot, which reduces the
muscle spasm
9. The criteria used to distinguish TRUE from FALSE labor is "evidence of cervical
change"... Wow!
10. Pediatrics... Lead poisoning primarily affects the CNS, causing increased ICP. This
results in irritability and change of LOC, as well as seizure disorders, hyperactivity
and learning disabilities
11. 4 months infant => palmar grasp
12. 7-9 months infant => can bang 2 cubes together
13. 9-12 months infant => can put a block in a cup
14. 10-12 months infant => can demonstrate pincer grasp
15. Hydatidiform mole => increased HCG levels, marked nausea and vomiting
A possible complication of impetigo is posstreptococcal glomerulonephritis and periorbital edema is

indicative of postreptocccal glomerulonephritis.
client should weight themselves daily when taking lithium-- and after the first dose, client should have
his/her levels checked within 8-12 hours and two times a week for the first month. Lithium also causes
polyuria and dehydration. S&S of toxicity are, ataxia, vomiting, diarrhea, muscular weakness and
drowsiness.
Guthrie blood test helps determine PKU for neonate.
child can return to school with Hep A, a week after onset of jaundice

bulge test is a test for confirming fluid in the knee
it's important not to touch the bed when using defibrillator in order to prevent accidental counter-shock!!
Extrusion reflex means is the same meaning as tongue thrust which disappears between 3- 4mos of age.
Administer oral steroids in the morning with food to prevent ulcerogenic effects!
Increased abdominal distention, nausea and vomiting are signs of paralytic ileus that should be reported to
the physician!
It's important for a client with an internal radium implant to be on a low residue diet in order to prevent
many bowel movements because stool can dislodge it.
Heparin is not transmitted to infant from breastfeeding.
Haldol is effective for reducing assaultive behavior, for example, a pt threatening to hurt another.
Narcotic analgesics are contraindicated for pt's with ICP because it can mask symptoms.
Pt's with SLE(lupus) should be in remission for 5 months before becoming pregnant.
Fixed and DIALATED pupil are signs of ICP and should be reported, it is an emergency.
For stabismus, the brain receives two images.
Vomiting is contraindicated for a pt/child who swallows lighter fluid(hydrocarbons) because there's a risk
of aspiration.
Change IV tubing every 48-72 hours (every time I want to choose every 24 hours!)
Extreme tearing and redness are signs of viral conjunctivitis and if there is a worker with these signs,
make sure they are sent home because it is contagious!
For amputations after wound has healed..., assess for skin breakdown, wash, rinse and dry stump daily,
alcohol dries so don't apply DARN IT! , no lotion. Elevate stump 24-48 hours after surgery, discourage
semi fowler's position to prevent contractures of the hip.
Flush NG tube with 30ml of air before aspirating fluid.
Turp(transurethral resection of the prostate)--hemorrhage is a complication, bleeding should gradually

decrease to light pink in 24 hrs.
DVT: tx with compression stockings, low dose heparin, discourage sitting for prolonged periods.
Hot and dry=sugar high(symp of hyperglycemia)

cold and clammy=need some candy(hypoglycemia)
Type one diabetes is diagnosed usually before age 15. NO insulin produced
Type 2 diabetes--INSUFFICIENT insulin production. Keto acidosis not common. Affects adults over 40

mostly.
Diabetes insipidus--history of head injury or pituitary tumor or craniotomy...HYPOsecretion of ADH.

Polyruria,
decreased specific gravity, decreased osmolarity, HYPOvolemia, increased thirst, tachycardia, decreased
bp.
SIADH--excess ADH is released. HYPERvolemia, weightgain, administer diuretics...Declomycin could

be prescribed.
Adrenal crisis: Profound fatigue, dehydration, vascular collapse, renal shut down, decreased NA,
increased K.
Good ol' Maslow:

1st Physiologic needs
2 Security and safety
3 Love and belonging
4 Self actualization
Sterile field and procedure facts...

For sterile field--never turn your back, avoid talking , moisture barriers carries bacteria, open pack
away from field, do not reach over sterile field.
Sterile procedures--Surgical procedures, biopsies, caths, injections, infusions, dressing changes.
In regards to surgery, aspirin, antidepressants, steroids, nsaids are drugs that put clients at risk!
The consent for surgery--Dr. gives client explanation, consent signed by Dr., client and witness. Signed
prior to pre op meds, remains a permanent part of client chart.
For pain: PQRST

Provoking
Quality
Region
Severity
Timing
Ask if pain is stabbing, burning crushing.
Narcotics---MORPHINE, MEPERIDINE(DEMEROL), HYDROMORPHONE(DILAUDID),

OXYCODONE(OXYCOTIN).
Non-narcotics--ACETOMINOPHEN(TYLENOL), SALICYLATES.
Non steroidal(NSAIDS) TYLENOL, IBPROFEN, NAPROSYN, INDOCIN.
Clozapine(Clozaril) is used for schizophrenic patient's who don't respond to other antipsychotic drugs.
(Benztropin)Congentin is used for the extrapyramidal effects associated with antipsychotic agents.
Chlorpromazine (Thorazine) is used to treat hallucinations, agitation, and thought disorders.
Adenosine(Adenocard) is an antiarrhythmic drug, this drug is good for paroxysmal atrial tachycardia...it
slows conduction from av node.

Atropine for symptomatic bradycardia.
Digoxin for atrial fibrillation.
Lidocaine for ventricular ectopy.
For assessing the abdomen, correct order is INSPECTION, AUSCULTATION, PERCUSSION,

PALPATION "I Am Peed PAAAAA!" )
Cheyne strokes respirations are periods of apnea for 10-60 seconds then slowly increasing rate and
depth... occur typically with heart failure and cerebral depression.
Bulls eye rash is classic in lyme disease.
To relieve breast engorgement, pt should pump each breast for 10 minutes every 3-4 hours and during the
night if she's awake.
Anticholinergic effects(drugs that block acetylcholine) cause dry mouth, constipation, urine retention.
5 rights of delegation
Right task
Right circumstance
Right communication
Right person
Right feed back
Cystic fibrosis is a recessive trait, there is a one in four chance that each offspring will have the trait or
disorder.
Cushings triad is something to look out for in patient's with increased ICP which is decreased heart rate,
decreased respiratory rate BUT increased blood pressure.
Withdrawal from stimulants results in depression, fatigue and confusion.
Withdrawal from alcohol results in vomiting, nausea, tremors and diaphoresis.
Withdrawal from sedatives results in increased motor activity and tachycardia.
Withdrawal from opioids results in rhinorrhea, abdominal cramps and DILATED pupils.
Inflammation: HIPER
Heat
Induration
Pain
Edema
Redness
Hallucinations--sensory perceptions without external stimuli.
Illusions--real stimuli is misinterpreted.
Delusions--falsed fixed belief('I am the queen of England!" for example)

Ok here is for TB drugs
Think SPRITE
S- Streptomycin (Monitor for ototoxic, nephrotoxic and neurotoxic rxn)
P-Pyrazinamide ( Photosensitivity-- so avoid sunlight or UV rays)
R- Rifampin ( Red orange urine is normal.. think about R for rifampin and R for red urine)
I- INH ( SE is Vit B6 deficiency so pt needs inj. and avoid tyramine containing foods)
T- Tubasal aka Aminosalicylate sodium ( avoid aspirin with this med)
E- Ethambutol ( E for eye problems- assess visual acuity and color discrimination esp to green)
Also for ventilator alarms

HOLD
High alarm- Obstruction due to incr. secretions, kink, pt. coughs, gag or bites
Low press alarm- Disconnection or leak in ventilatior or in pt. airway cuff, pt. stops spontaneous
breathing
to remember blood sugar:

hot and dry-sugar high (hyperglycemia)
cold and clammy-need some candy (hypoglycemia)
2. ICP AND SHOCK HAVE OPPOSITE V/S

ICP-increased BP, decreased pulse, decreased resp.
shock- decreased BP, increased pulse, increased resp.
3. cor pulmonae: right sided heart failure caused by left ventricular failure (so pick edema,
jvd, if it is a choice.)
4. herion withdrawal neonate: irratable poor sucking
5. Jews: no meat and milk together
6. Brachial pulse: pulse area cpr on an infant.
7. Test child for lead poisioning around 12 months of age
8. bananas, potatoes, citrus fruits source of potassium
11. Cultures are obtained before starting IV antibiotics
12. a pt with leukemia may have epitaxis b/c of low platelets
13. best way to warm a newborn: skin to skin contact covered with a blanket on mom.
14. when a pt comes in and she is in active labor...nurse first action is to listen to fetal
heart tone/rate
15. phobic disorders...use systematic desensitiztion.

1. Clients of the islam religious group might want to avoid jello, pork and alcohol
2. Most common side effect of daunorucibin (cerubidine) for a client with leukemia is cardiotoxicity
3. Patient having a surgery on the lower abdomen should be placed in the trendelenburg position
4. Flumazenil (Romazicon) is the antidote for versed (Needless to remind you that versed is used for
conscious sedation... Say thank you Jean LOL)
5. Patients taking isoniazid (INH) should avoid tuna, red wine, soy sauce, and yeast extracts b/c of
the side effects that can occur such as headaches and hypotension
6. A Patient with gout who is placed on a low-purine diet should avoid spinach, poultry, liver,
lobster, oysters, peas, fish and oatmeal
7. A patient who needs a high-iron diet should eat: sliced veal, spinach salad, and whole-wheat roll
8. Pegfilgastrin (Neulasta) is a chemotherapeutic drug given to patients to increase the white blood
cells count
9. Amphoteracin B (Fungizone) should be mixed with D5W ONLY!!!
10. Pt with leukemia taking doxorubicin (Adriamycin) should be monitored for toxic effects such as
rales and distended neck veins (carditoxicity manifested by change in ECG and CHF)
11. Cardidopa/levodopa (Sinemet) is given to clients with Parkinson's disease. Watch for toxic effects
such as spasmodic eye winking
12. Nimotop (Nimodipine) is calcium channel blocker that is given to patients with ruptured cerebral
aneurysm. Do you know why? Look it up! Vasospasm...
hope this discussion is moved to Sticky Threads soon, it is so awesome.

1. A conductive hearing loss involves interference in the transmission of sound waves to the inner ear.
2. A sensorineural hearing loss is the result of nerve impairment.
3. An acoustic neuroma is a benign Schwann cell that adversely impacts the 8th cranial nerve.
4. DKA is an acute insulin deficiency followed by a decrease in glucose in body cells and an increase
production of glucose by the liver.
5. Lymphedema results from an obstruction of lymph circulation and can be acquired or can be secondary
to other disorders.
6. The Reed-Sternberg cell is the malignant cell type associated with Hodgkin's Disease.
7. The incidence if Hodgkins and non - Hodgkins lymphomas are increased in those taking drugs such as
phenytoin ( Dilantin ).
Necrosis is "tissue death " whereas gangrene is necrosis on a larger scale. Gangrene usually
results from interruption of blood flow/supply to large areas of tissue or bone. Commonly
affected areas are the extremities ( fingers, toes, lower legs, etc ) or the bowel.
Dry Gangrene= occurs when the necrotic tissue has little blood supply and is relatively
aseptic.
Wet Gangrene= is potentially life threatening due to release of toxins into the
bloodstream.
Gas Gangrene= is gangrene infected with a gas bacillus, most commonly, Colstridium
Perfringens.
Treatment is usually debridement of the wound, cleansing the area with an antibacterial or
antiseptic, removal of the affected tissue, and possibly a course of antibiotics.

1. S/S croup (child) => hoarse voice, inspiratory stridor, barking cough
2. Client with hepatic encephalopathy => Neomycin decreases serum ammonia concentration by
decreasing the number of ammonia producing bacteria in the GI tract
3. A 2 year old can remove one garment
4. A 2 and half year old can build a tower of eight cubes and point out a picture
5. A 3 year old can wash and dry his/her hands
6. S/S perforated colon => severe abdominal pain, fever, decreasing LOC
7. Hyperglycemia => b/c polyuria assess for signs of deficit fluid volume such as rapid, thready
pulse, decreased BP, and rapid respirations
8. A child with nephrotic syndrome is at risk of skin breakdown from generalized edema
9. Tetracycline should be taken on an empty stomach. Avoid dairy products, Ca, Mg, Al and Fe
(Iron)
10. Upper GI series => NPO 6-8 hrs b/f procedure
11. Mumps is the childhood infectious disease that most significantly affects male fertility
12. Client allergic to penicillin may be also allergic to cephalosporins
13. Infants and children up to age 7 are abdominal breathers
14. Placental transport of substances to/from the fetus begins in the 5th week
15. Duration of contractions => period from the onset of uterine tightening to uterine relaxation
16. Frequency of contractions => period b/t one contraction and the beginning of the next contraction
17. Erbs point => 3rd L ICS; pulmonic and aortic murmurs are best heard there
1. One of the CHF symptoms is S3 ventricular gallop

2. Hypertensive crisis => Priority in the first hour is brain damage due to rupture of the cerebral
blood vessels. Neurologic status must be closely monitored
3. Client with A-fib => a cold, pale lower leg suggests the presence of an embolus. Peripheral pulses
should be checked immediately
4. S/S anemia in a 10 months old infant => pale mucosa of eyelids and lips
5. S/S dehydration in 2 years old => sunken eyes, dry tongue, lethargy, irritability, dry skin,
decreased play activity, and increased pulse
6. Pt with anaphylaxis => The entire body may turn bright red b/c massive vasodilation
7. Teaching pt with Zollinger-Ellison syndrome => Report promptly to his/her healthcare provider
any finding of peptic ulcer (night time awakening with burning, cramp-like abdominal pain,
vomiting and even hematemesis, and change in appetite)
8. Infant with epiglottitis : 4 D's => Drooling, Dysphagia, Dysphonia and Distress inspiratory efforts
9. Niacin (Vit B) is a lipid lowering agent. Foods high in Niacin are meats, eggs, milk, dairy
products
10. Child with 3 C's (Cough-Choke-Cyanosis) should be assessed for tracheoesophagial fistula
11. Gastric lavage is a priority for an infant who has been identified as suffering from botulism
12. Viral meningitis usually does not require protective measures

Myasthenia gravis--muscle weakness that occurs mostly in the throat and face as results from the deficits
of the nerve impulses conducting at the myoneural junction. Pancuronium and succinylcholine are
neromuscular agents that should be used with caution because of the chance of prolonging recovery.
Clients with CRF are to be on a high carbohydrate diet to prevent protein metabolism. Pt's must limit
protein, sodium and potassium and fluids because the kidneys cannot excrete an adequate amount of
urine.
ABG's is the best way to monitor pulmonary status by analyzing the level of hypoxia caused by
pulmonary edema and for monitoring effects of treatment.
Cardiogenic shock--there is low cardiac output from heart pump failure such as in heart failure, sever
cardiomyopathy, acute MI.
Pancreatitis-high carb, low fat diet.
IV cimetidine(Tagamant) given as treatment for a bleeding peptic ulcer may experience hyptotention if
given too rapidly
Watch for cardiac arrythmias when suctioning pt from an ET because of the loss of oxygen.
Chest pain and dypnea are classic signs of pulmonary embolism, typically they may have a cough with
blood tinged sputum.
1. Larngotracheobronchitis: inspiratory stridor and restlessness

2. Thorazine: antidote cogentine SE: akathisia(motor restlessness) dystonia(tongue protrusion,
abnormal posture) and dyskinesia(stiff neck, difficulty swallowing)
3. Toddlers- parallel play; infants enjoy company but self play.
4. IV infiltration D/C IV and apply warm compress.
5. Urticaria= hives.
6. Graves disease: enlarged thyroid, increased metabolism and of course weight loss.
7. The goal for COPD is to improve ventilation.
8. From birth to 18 months Trust vs Mistrust
9 HbA1C- indicates BS for past 6-8 weeks(time varies with source) 2.5-6% normal.
10. myasthemia gravis: autoimmune disease of neuro jnx. destroys Acetylecholine receptors.
11. Meniere's: Inner ear disease: vertigo, tinnitus, sensorineuro hearing loss, N/V
12. Use play therapy for children d/t inability to verbalize emotions.
13. Promethazine: Check vein patency (very important)
14. Visine: contraindicated in glaucoma d/t vasocontriction
1. Autonomic Dysreflexia--asses Bladder, Bowel, Skin

2. GIVE Dantrolene to treat pt. in MH crisis
3. JOMACS (mini mental status exam)= Judgement, Orientation, Memory, Affect,
Consciousness, Speech
4. -ostomy- make opening
5. -oscopy- look into or at
6. -otomy- cutting into
7. -ectomy- removal of
9. Colporrhaphy- surgical repair of the vagina (Very random )
10. Do not Palpate WILM's tumor
11. Albumin is the best indicator of nutritional status

12. In V-fib always look at pt first anything can mimic the pattern on EKG
13. V-tach is usually caused by an underlying cause treat cause
14. Precipitous delivery may cause amniotic emboli
15. Hct: Hgb approx 3% : 1g/dl
16. WBC= 5000-10000
17. Platelets= 150,000-400,000
18. PPI's (-prazole: esomeprazole, omeprazole, lansoprazole) stop gastric acid secretion
19. Vasoconstriction stops itching and inflammation (give cool bath)
20. Anticholinergic effects- Cant SEE, Cant PEE, Cant POOP, and dry mouth
21. Trauma to frontal may casuse Frontal Lobe disinhibition
22. Creatinine is the best indicator of renal function
23. Every drop of urine counts during 24hr creatinine clearance (if one sample is thrown out must
start over) First void of the morning is not included but the first pee of the next morning is
(because it is considered Last nights urine)
24. Best position to improve respiratory effort = Left Lateral, Fowler & modifications of it
1. When getting down to two answers, choose the assessment answer (assess,
collect, auscultate, monitor, palpate) over the intervention except in an
emergency or distress situation. If one answer has an absolute, discard it.
Give priority to answers that deal directly to the patient’s body, not the
machines/equipments.
2. Key words are very important. Avoid answers with absolutes for example:
always, never, must, etc.
3. with lower amputations patient is placed in prone position.
4. small frequent feedings are better than larger ones.
5. Assessment, teaching, meds, evaluation, unstable patient cannot be
delegated to an Unlicensed Assistive Personnel.
6. LVN/LPN cannot handle blood.
7. Amino-glycosides (like vancomycin) cause ototoxicity and nephrotoxicity.
8. IV push should go over at least 2 minutes.
9. If the patient is not a child an answer with family option can be ruled
out easily.
10. In an emergency, patients with greater chance to live are treated first
11. ARDS (fluids in alveoli), DIC (disseminated intravascular coagulation)
are always secondary to something else (another disease process).
12. Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues).
13. in pH regulation the 2 organs of concern are lungs/kidneys.
14. edema is in the interstitial space not in the cardiovascular space.
15. weight is the best indicator of dehydration
16. wherever there is sugar (glucose) water follows.
17. aspirin can cause Reye’s syndrome (encephalopathy) when given to
children
18. when aspirin is given once a day it acts as an antiplatelet.
19. use Cold for acute pain (eg. Sprain ankle) and Heat for chronic (
rheumatoid arthritis)
20. guided imagery is great for chronic pain.
21. when patient is in distress, medication administration is rarely a good
choice.
22. with pneumonia, fever and chills are usually present. For the elderly
confusion is often present.
23. Always check for allergies before administering antibiotics (especially
PCN). Make sure culture and sensitivity has been done before adm. First dose
of antibiotic.

24. Cor pulmonale (s/s fluid overload) is Right sided heart failure caused
by pulmonary disease, occurs with bronchitis or emphysema.
25. COPD is chronic, pneumonia is acute. Emphysema and bronchitis are
both COPD.
26. in COPD patients the baroreceptors that detect the CO2 level are
destroyed. Therefore, O2 level must be low because high O2 concentration
blows the patient’s stimulus for breathing.
27. exacerbation: acute, distress.
28. epi always given in TB syringe.
29. prednisone toxicity: cushing’s syndrome= buffalo hump, moon face, high
glucose, hypertension.
30. 4 options for cancer management: chemo, radiation, surgery, allow to
die with dignity.
31. no live vaccines, no fresh fruits, no flowers should be used for
neutropenic patients.
32. chest tubes are placed in the pleural space.
33. angina (low oxygen to heart tissues) = no dead heart tissues. MI=
dead heart tissue present.
34. mevacor (anticholesterol med) must be given with evening meal if it is
QD (per day).
35. Nitroglycerine is administered up to 3 times (every 5 minutes). If
chest pain does not stop go to hospital. Do not give when BP is < 90/60.
36. Preload affects amount of blood that goes to the R ventricle.
Afterload is the resistance the blood has to overcome when leaving the heart.
37. Calcium channel blocker affects the afterload.

38. for a CABG operation when the great saphenous vein is taken it is
turned inside out due to the valves that are inside.
39. unstable angina is not relieved by nitro.
40. dead tissues cannot have PVC’s(premature ventricular contraction. If
left untreated pvc’s can lead to VF (ventricular fibrillation).
41. 1 t (teaspoon)= 5 ml
1 T(tablespoon)= 3 t = 15 ml
1 oz= 30 ml
1 cup= 8 oz
1 quart= 2 pints
1 pint= 2 cups
1 gr (grain)= 60 mg
1 g (gram)= 1000 mg
1 kg= 2.2 lbs
1 lb= 16 oz
* To convert Centigrade to F. F= C+40, multiply 9/5 and substract 40
* To convert Fahrenheit to C. C= F+40, multiply 5/9 and substract 40.
42. angiotensin II in the lungs= potent vasodialator. Aldosterone attracts
sodium.
43. REVERSE AGENTS FOR TOXICITY
heparin= protamine sulfate
coumadin= vitamin k
ammonia= lactulose
acetaminophen= n-Acetylcysteine.
Iron= deferoxamine
Digitoxin, digoxin= digibind.
Alcohol withdraw= Librium.

- methadone is an opioid analgesic used to detoxify/treat pain in
narcotic addicts.
- Potassium potentiates dig toxicity.
44. heparin prevents platelet aggregation.
45. PT/PTT are elevated when patient is on coumadin
46. cardiac output decreases with dysrythmias. Dopamine increases BP.
47. Med of choice for Vtach is lidocaine
48. Med of choice for SVT is adenosine or adenocard
49. Med of choice for Asystole (no heart beat) is atropine
50. Med of choice for CHF is Ace inhibitor.
51. Med of choice for anaphylactic shock is Epinephrine
52. Med of choice for Status Epilepticus is Valium.
53. Med of choice for bipolar is lithium.
54. Amiodorone is effective in both ventricular and atrial complications.
55. S3 sound is normal in CHF, not normal in MI.
56. give carafate (GI med) before meals to coat stomach
57. Protonix is given prophylactically to prevent stress ulcers.
58. after endoscopy check gag reflex.
59. TPN(total parenteral nutrition) given in subclavian line.
60. low residue diet means low fiver
61. diverticulitis (inflammation of the diverticulum in the colon) pain is
around LL quadrant.
62. Appendicitis (inflammation of the appendix) pain is in RL quadrant with
rebound tenderness.
63. portal hypotension + albuminemia= Ascites.
64. beta cells of pancreas produce insulin
65. Morphine is contraindicated in Pancreatitis. It causes spasm of the
Sphincter of Oddi. Therefore Demerol should be given.
66. Trousseau and Tchovoski signs observed in hypocalcemia
67. with chronic pancreatitis, pancreatic enzymes are given with meals.
68. Never give K+ in IV push.
69. mineral corticoids are give in Addison’s disease.
70. Diabetic ketoacidosis (DKA)= when body is breaking down fat instead of
sugar for energy. Fats leave ketones (acids) that cause pH to decrease.
71. DKA is rare in diabetes mellitus type II because there is enough
insulin to prevent breakdown of fats.
72. Sign of fat embolism is petechiae. Treated with heparin.
73. for knee replacement use continuous passive motion machine.
74. give prophylactic antibiotic therapy before any invasive procedure.
75. glaucoma patients lose peripheral vision. Treated with meds
76. cataract= cloudy, blurry vision. Treated by lens removal-surgery
77. Co2 causes vasoconstriction.
78. most spinal cord injuries are at the cervical or lumbar regions
79. autonomic dysreflexia ( life threatening inhibited sympathetic response
of nervous system to a noxious stimulus- patients with spinal cord injuries
at T-7 or above) is usually caused by a full bladder.
80. spinal shock occurs immediately after spinal injury
81. Multiple sclerosis= myelin sheat destruction, disruption in nerve
impulse conduction.
82. myasthenia gravis= decrease in receptor sites for acetylcholine. Since
smallest concentration of ACTH receptors are in cranial nerves, expect fatigue
and weakness in eye, mastication, pharyngeal muscles.
83. Tensilon test given if muscle is tense in myasthenia gravis.

84. Guillain-Barre syndrome= ascending paralysis. Keep eye on respiratory
system.
85. parkinson’s = RAT: rigidity, akinesia (loss of muscle mvt), tremors.
Treat with levodopa.
86. TIA (transient ischemic attack) mini stroke with no dead brain tissue
87. CVA (cerebrovascular accident) is with dead brain tissue.
88. Hodgkin’s disease= cancer of lymph is very curable in early stage.
89. Rule of NINES for burns
Head and Neck= 9%
Each upper ext= 9%
Each lower ext= 18%
Front trunk= 18%
Back trunk= 18%
Genitalia= 1% ?
90. Birth weight doubles by 6 month and triple by 1 year of age.

91. if HR is <100 do not give dig to children.
92. first sign of cystic fibrosis may be meconium ileus at birth. Baby is
inconsolable, do not eat, not passing meconium.
93. heart defects. Remember for cyanotic -3T’s( Tof, Truncys arteriosus,
Transposition of the great vessels). Prevent blood from going to heart. If
problem does not fix or cannot be corrected surgically, CHF will occur
following by death.
94. with R side cardiac cath=look for valve problems
95. with L side in adults look for coronary complications.
96. rheumatic fever can lead to cardiac valves malfunctions.
97. cerebral palsy = poor muscle control due to birth injuries and/or
decrease oxygen to brain tissues.
98. ICP (intracranial pressure) should be <2. measure head circumference.
99. dilantin level (10-20). Can cause gingival hyperplasia
100. for Meningitis check for Kernig’s/ Brudzinski’s signs.
101. Wilm’s tumor is usually encapsulated above the kidneys causing flank
pain.
102. hemophilia is x-linked. Mother passes disease to son.
103. when phenylalanine increases, brain problems occur.
104. Buck’s traction= knee immobility
105. Russell traction= femur or lower leg
106. Dunlap traction= skeletal or skin
107. Bryant’s traction= children <3y, <35 lbs with femur fx.
108. place apparatus first then place the weight when putting traction
109. placenta should be in upper part of uterus
110. eclampsia is seizure.
111. a patient with a vertical c-section surgery will more likely have
another c-section.
112. perform amniocentesis before 20 weeks gestation to check for cardiac
and pulmonary abnormalities.
113. Rh- mothers receive rhogam to protect next baby.
114. anterior fontanelle closes by 18 months. Posterior 6 to 8 weeks.
115. caput succedaneum= diffuse edema of the fetal scalp that crosses the
suture lines. Swelling reabsorbs within 1 to 3 days.
116. pathological jaundice= occurs before 24hrs and last7 days.
Physiological jaundice occurs after 24 hours.
117. placenta previa = there is no pain, there is bleeding. Placenta

abruption = pain, but no bleeding.
118. bethamethasone (celestone)=surfactant. Med for lung expansion.
119. dystocia= baby cannot make it down to canal
120. pitocin med used for uterine stimulation
121. Magnesium sulfate(used to halt preterm labor) is contraindicated if
deep tendon reflexes are ineffective. If patient experiences seizure during
magnesium adm. Get the baby out stat (emergency).
122. Do not use why or I understand statement when dealing with patients
123. milieu therapy= taking care of patient/environment
124. cognitive therapy= counseling
125. crisis intervention=short term.
126. FIVE INTERVENTIONS FOR PSYCH PATIENTS
-safety
-setting limits
-establish trusting relationship
-meds
-leas restrictive methods/environment.
126. SSRI’s (antidepressants) take about 3 weeks to work.
127. Obsession is to thought. Compulsion is to action
128. if patients have hallucinations redirect them. In delusions distract
them.
129. Thorazine, haldol (antipsychotic) can lead to EPS (extrapyramidal side
effects)
130. Alzheimer’s disease is a chronic, progressive, degenerative cognitive
disorder that accounts for more than 60% of all dementias
For a nurse to treat chest pain with standing orders for the nurse to implement before notifying the
physican, heres how the order goes....
Give O2 2L/min(nasal canula)

Check vital signs(particularly blood pressure)
Administer sublingual nitro
Evaluate the client's response
Codeine's onset of action is 30 minutes.
Couple quick laboratory values:

Potassium--normal 3.5-5.5mEq/L( side note: hypokalemia depresses the release of insulin and also
results in glucose intolorance)
Chloride--normal--100-110mEq/L
Bun--normal--8-26 mg/dl
Creatinine--normal--0.8-1.4mg/dl
The client with a laryngectomy should keep his house humidified to prevent irritation of the stoma that
can occur during low humidity---of course avoid swimming.
Lymphedema is the result of removing or irradiating the axillary lymph nodes.
The primary signs of breast cancer are a painless mass in the breast, usually in the upper

outer quadrant.
Tamoxifen may help to prevent breast cancer.
After a mastectomy, patients should be advised to sleep on the unaffected side.
Simmond's disease is a rare disorder that results from destruction of the pituitary gland.
Diabetes insipidus results from a lack of antidiuretic hormone.
Aldactone is used to treat ascites, as it specifically antagonizes aldosterone.
Delirium is a sudden transient state of confusion that may be brought on by high fever, head trauma or
other disorders.
In dementia, there is a gradual and irreversible loss of intellectual abilities.
Arterial disorders
Buerger's disease- males
Raynaud's disease - females
S/S- cold, numbness, decrease peripheral pulses, skin/nail changes classic sign-Intermittent
claudication (pain while walking because O2 demand incr)
Causes of Buerger and Raynaud's disease

-smoking, cold, emotions--causes VASOCONSTRICTION!!
-affects lower extremities and fingers
Treatment- Avoid smoking, avoid cold- Wear gloves and shoes that fit well and avoid trauma to foot
Never elevate legs because aterial blood (oxygenated blood) is having difficulty getting to tissue.
Instead we dangle leg at side of bed to promote circulation!!!
Radioactive iodine precautions- stay distance of 1 arm length from babies/ preggo within 24 hour period,
avoid sharing foods and utensils.
Hemophilia A is caused by a deficiency in clotting factor VIII.
No conduction between the atria and ventricles would be a third degree block.
A patient who gets an organ transplant is a t risk for graft-vs-host disease.
Eczema, recurrent bloody diarrhea, and thrombocytopenia are characteristic of Wiscott-

Aldrich syndrome.
ACE-I exert their effect by reducing preload.

Digitalis and related cardiac glycosides act by directly inhibiting the Na/K pump in the cell
membranes.
In the unconscious patient, a doll's eye reflex indicates intact brain stem function.
Just a couple I just thought of, not sure if anyone posted it already
1. To remember how to draw up INSULIN think:

Nicole Richie RN (a teacher taught us this is school, thought it was
funny and never forgot it!!!)
Air into NPH, then air into regular, draw up regular then draw up NPH
2. HYPERthyroidism think of MICHAEL JACKSON in THRILLER!

SKINNY, NERVOUS, BULDGING EYES, Up all night, heart beating fast
There is just a couple I thought of...i'll try to think of some more!
Atropine used to decrease secretions

Phenergan an antiemetic used to reduce nausea
Diazepam is a commonly used tranquilizer given to reduce anxiety before OR
Demerol is for pain control
Do not give demerol to pts. with sickle cell crisis.
Iron injections should be given Z-track so they don't leak into SQ tissues.
tay sach's disease - cherry-red spots in the macula
down's syndrome - white flecks in the iris
osteogenesis imperfecta - blue tinged sclera
Types of partial seizures

• Simple partial: symptoms confined to one hemisphere
• Complex partial: begins in one focal area; spreads to both hemispheres.
Types of generalized seizures
• Abscense (petit mal): loss of responsiveness, but continued ability to maintain posture control and
not fall.
• Myoclonic: movement disorder (not a seizure)
• Clonic: opposing muscles contract and relax alternately in rhythmic pattern.
• Tonic: muscles are maintained in continuous contracted state (rigid posture)
• Tonic-clonic: (grand mal, major motor); violent total body seizure
• Atonic: drop and fall attack
• Akinetic: suddenr brief loss of muscle tone or posture.

• Terbutaline: Medication given to stop pre-term labor
• Methergine: Given for postpartum hemorrhage.
• Cervidil: Cervical ripening agent
• Mag Sulfate: Pregnancy Induced Hypertension - prevents seizure. Absence of deep tendon reflex
is sign of toxicity
• Pitocin: Used for induction of labor and postpartum to help the uterus contract.
• Early Decelerations are okay, follow the contraction.
• Late Decelerations are a sign of fetal distress and continue after contraction. Reposition client
(left side)
• 3- 5 beat Variability in FHR is good sign, you want to see that.
• Stop pitocin if contractions longer than 90 seconds and closer than 2 minutes.
• Once the membranes rupture, important to monitor temperature hourly as risk for infection
increases.
• First thing to do after rupture is to auscultate fetal heart tones! Assessing for cord prolapse if
decels occur.
• Analgesics are typically not given during the transitional phase of labor as delivery is imminent
and could lead to decreased respiratory rate in neonate.
• If patient has boggy uterus - place the infant to nipple, it causes release of natural pitocin
• If uterus deviated to one side - encourage client to void.
• Rhogam given to Rh negative mothers with Rh positive babies.
1. S/s of a perforated peptic ulcer include: sudden, severe upper abd pain, vomiting, and a very
tender rigid abdomen.
2. After a cardiac cath--the site is monitored for bleeding and hematoma formation, the pulses
palpated distal to the site q 15 min for at least an hour, patient is on bedrest with lower extremities
extended for 8 hrs.
3. Cullen's sign (the bluish discoloration around the umbilicus) is often seen with with a
perforated pancreas.
4. The 6 F's are causes of abd distention: flatus, feces, fetus, fluid, fat, and fatal neoplasm.
5. An elevated serum amylase level is a cardinal sign of pancreatitis.
6. S/s of digitalis toxicity: blurred vision, nausea, vomiting, light flashes, and yellowish-green
halos around dark objects.
Tidal volume is the volume of air inhaled and exhaled with a normal breath.
Insiratory reserve volume is the maximum volume of air inspired at the end of normal

inspiration.
Expiratory reserve volume is the maximum volume of air exhaled after a normal
respiration.
Vital capacity is the maximum amount of air expired after maximal inspiration.
Pleurisy is an inflammation of the visceral and parietal pleura.
A collection of fluid between the visceral and parietal pleura is a pleural effusion.
1.Versed—given before cardioversion/ hypnotic/sedative – hold digitalis 48 before cardioversion to

prevent ventricular fibrillation.
2. Plasmapheresis – similar to hymodialysis/ done to remove antibodies that may be causing symptoms
- warm blankets to prevent chills and hypothermia that may occur during plasmapheresis
3. Cholsetyramine (Questran)-- for hypercholesterolemia -- comes in gritty powder that must be mixed
thoroughly in juice or water before administration
Monitor for s/sx of peptic ulcer
Taken with sufficient liquids.
4. Lovastin (Mevaco) shld not be administered with anti coagulant
Caution – immunosuppressive medications
Monitor liver enzymes
Instruct pt to have eye exam bec the med causes cataract formation
5. Gemfibrozil (Lopid should not be taken with anticoagulants, and if client is taking anticoagulant, the
anticoagulant shld be reduced and the INR shld be monitor closely
Do not administer Lopid with lovastin
1. Levophed – infuse with dextrose solution

Client should be attended at all times
2. Dopamine - headache is an early symptom of drug excess/ use infusion pump
3. Isuprel – do not t give at hs – interrupts sleep patterns
4. Sudafed – S/E dry mouth, palpitations, difficulty urinating. Do not take at hs/ don’t combine
with MAOI
5. Dobutrex – incompatible with alkaline sol (Sodium Bicarb) / administer thru Central Venous
Cath or large peripheral vein using an infusion pump
Monitor EKG, BP, I and O, K+
1. Before administering lidocaine, always check the vial label to prevent administering a form that
contains epi or preservatives because these solutions are used for local anesthesia only
1:100 only for inhalation
1:1000 for parenteral admin (SC or IM)
2. Do not administer antidysrthmics with food or antacids to reduce gastro stress

Always administer IV antidysrthymics via an infusion pump
3. Amiodarone hydrochloride may cause pulmonary fibrosis, photosensitivity, bluish skin

discoloration, corneal deposits, peripheral neuropathy, tremor, poor coordination, abnormal gait,
and hypothyroidism.
Instruct client taking amiodarone to use sunscreen and protective clothing to prevent

photosensitivity rxn
4. Bretylium tosylate – may cause vertigo, syncope, and dizziness

After administering bretylium, keep the client supine and monitor for hypotension.
.
5. Sodium Nitroprusside (Nitropress) Direct Acting Vasodilator
Monitor cyanide and thiocyanate levels
Protect from light because the medication decomposes
When administering, solution must be wrapped in aluminum foil and is stable for 24 hrs. Discard
medication when it turns red or blue.
Myocardial Infarction: Think MONA: Morphine, O2, Nitro, ASA
When palpating a fundus on a postpartum patient, always have them void first
When Brethine is given for preterm labor, tachycardia is always the problem
Epiglottiditis: priority is having a trach set at the bedside and NEVER inspect the throat! It causes spasms
and can occlude the airway
Veinous occlusion (DVT) think warm and red...increase venous RETURN by RAISING the leg
Arterial occlusion think cold and pale..increase arterial outflow by keeping the leg in a flat or slightly
dependent position
Newborn infant with tuft of hair: spina bifida occulta
White spots on a babys gums are normal..called Epsteins pearls
Fundal height > # of weeks pregnant = always suspect hydatidform mole
1 oz= 30 mL 1 tsp= 5mL 1 tbsp= 15 mLs
Patients taking antipsychotics are at risk for Neuroleptic Malignant Syndrome which is a medical
emergency characterized by hyperthermia
uncuffed endotracheal tubes are used in children up to age 8

1.epidural anesthesia is placed outside the dura
2.give 1 cc of epi of it enters the vessels to combat vascular collaspe
3.spinal anesthesia is placed in the subaracnoid space
4.children 1yr and older are NPO 8-hours prior to surgery
5.children under 1yr are given formula 6-hours prior to surgery and clear liquids 4-hours before
1. S/S lithium toxicity: lethargy, vomiting, diarrhea

2. When giving rectal suppository, advance approximatively 3 inches into the rectum
3. Diphenhydramine (Benadryl) inhibits methotrexate excretion, which increase the risk of
methotrexate toxicity
4. Glucagon interacts adversely with oral anticoagulants, increasing the anticoagulant effects
5. Amitriptyline (Elavil) is an antidepressant that can have an additive effect when used with other
CNS depressants (antihistamines, antpsychotics,...)

6. Concomitant use of corticosteroids and terbutaline (Bricanyl) may cause pulmonary edema
7. Tetracycline should be taken on an empty stomach
8. Tricyclic antidepressants can have anticholinergic adverse effects whith dry mouth being the most
common
9. Metronidazole (Flagyl) commonly causes a metallic taste
10. Meteprolol masks the common signs of hypoglycemia; therefore glucose level should be
monitored closely in diabetics
11. A cholinergic blocking agent may delay the sublingual absorption of nitroglycerin because of dry
mouth
spantaneous abortion most commonly present Pain followed by bleeding
Medications that are contrindicated in breast-feeding mothers

• Tetracyline inhibition of bone growth
• Warfin * safe to use? Hand out
• Chloramphenicol bone marrow suppression
Magnesium Sulfate becomes toxic at:
• Loss of reflexes
Levels > 8 meq/L
• Respiratory arrest
Level > 12 meq/L
Two drugs are used to treat Eclampsia

• Magnesium Sulfate 4-6q IV bolus
Followed by a: 2 g/h infusion:

• Hydralazine 10-20 mg IV
Staphylococcus aureus common cause mastitis
• 1st week of postpartum not present (mastitis)
Seen:
3-4 weeks post partum
SX:
• Fever
• Chills
• swollen red breast
normal fetal heart rates
120-160 Bpm

Abnormal
If bradycardia is detected, position the mother on her left side
• give O2
• IV fluid Bolus.
when giving Bronchodilator & Glucocorticoids at the same time, give the bronchodilator first.
remember B before G!
Acute blood loss ( hemorrhage ) is likely to cause sinus tachycardia.
When the heart rate increases with inspiration and decreases with expiration it is called
sinus arrythmia.
When someones heart "skips a beat" this is most times called premature atrial
complex.
The person who hyperventilates is most likely to experience respiratory alkalosis.
When a pleural effusion recurs within days or weeks following a thoracentesis, this
usually indicates the underlying cause is a malignancy.
Estrogen influences fibrocystic breast changes.
In the TNM classification system, the "N" stands for node.
Edema, ascites, and hepatomegaly are characteristic of right-sided cardiac failure.
When assessing for heart failure the echocardiogram is the most important test.
Lower extremity rubor indicates arterial damage.
The patient who is neutropenic from chemotherapy should not eat fresh produce or
have fresh flowers in their room. Visitors should be cautioned to wash their hands
extra well before entering the room.
The most frequent cause of increased platelet destruction is DIC ( disseminated intravascular
coagulation ).
With Hirschprung's disease the infant presents with failure to thrive, abdominal distention, and ribbon like
stools.
Dopamine is used to treat hypotension.
Nitroprusside is used for hypertensive emergencies.
Tumor lysis syndrome is a potential complication of leukemia.
A deficiency of vitamin A is linked to lung cancer.

Following an angiogram, the nurse should watch for bleeding at the femoral insertion site.
• Greatest threat to a pedi pt recovering from a bone marrow transplant is infection b/c of non-
functioning WBCs.
* Clinical manifestations of intracranial tumor: Ha, vomit, papilladema, sz activity.
* Toxic effects of vincristine are: N/V/A, urinary retention, neurotox, alopecia
* A chemo agent that crosses the blood-brain barrier is cytarabine (Cytosar)
* Kids w/ Cerebal Palsy are at risk for nutritional deficits b/c they have difficulty chewing and
swallowing.
* Prednisone suppresses immunity!
* Pts with nephrotic syndrome require good skin care and frequent position changes d/t edema.
* Myelomeningocele or meningomyelocele(occulta & cystica--cover with wet sterile gauze)

involves a protruding, sac-like structure that contains: meninges, spinal fluid and neural tissue.
Meningocele--only the meninges.
* When a 2 year old has 3 dolls and won't share w/ another child, the best way to deal w/ situation
is to go find another doll for the other kid -- once the kid is 3 y.o., they can begin to share toys
(interesting factoid for me -- a single girl w/out kids).
* Therapeutic management for a kid with ringworm is oral griseofulvin.
* Increased physical exercise will increase the use of glucose and decrease the body's need for
insulin.
* After leukemia, brain tumors cause the most deaths in peds.
Ready for cardio?... Note: deceleration = decrease; incr = increase
*CVP will be increased in CHF; decr CVP is shock (vasodilation) or hemorrhage.
* Decr Na+ levels could be a development of dig toxicity.
* Newborn w/ sickle cell anemia will not have s/s b/c of incr Hgb in fetal blood (could go back up
to peds, I know).
* S/S of pulmonary embolism: sharp, stabbing chest pain that worsens on inspiration; incr pulse,
dyspnea; productive cough;tachycardia; hemoptysis
* Diltiazin (Cardizem) a calcium-channel blocker, inhibits Ca++ transport in heart and vasculary
muscle cells therefore inhibiting excitation and subsequent contraction.
* 1st sign of digoxcin tox is decreased pulse.
* An AE for hyperstat which is given for hypertensive crisis is incr blood glucose.

* PVCs could lead to v. fib.
* DOC (drug of choice) for controlling vedntricular arrhythmias is lidocaine.
* Early sign of lidocaine OD is: bradycardia, decr BP, confusion, severe dizziness or faint.
* In aortic stenosis, CO will decrease
* S/S of angina: pain; tachy/bradyarrhythmia
* Contractility of myocardium decr in late stage of MI due to acidosis.
* In ventricular tachycardia, atria and ventricles usually beat independently.
* A mitral murmur can best be heard at the apex (bottom) of the heart -- I'd always gone by the
mneumonic tri-right; mitral -left, but it didn't get me very far on this question...
Epiglottitis often = kiddo in tripod position
Acid-Base
Check first for pH: If increase =alkalosis

If decrease =acidosis
If: Resp acidosis- ph= below 7.35 / PaC02 =above 100 (resp. depression)
Resp alkalosis-ph= above 7.45 / PaC02 =below 80mmHG(hypervent)
If: Metab acidosis- ph=below 7.35 / HC03 = below 21mEqL

Metab alkalosis-ph=above 7.45/HC03 = above 27mEqL
Niacin can produce negative effects ( when taken to excess as vitamin supp ). Reactions include a
reddened flush on the skin of the face,arms,and chest, accompanied by burning, tingling and itching.
Vitamin A is for vision, tissue growth ( skin and mucous membranes ),reproduction, and immune
function.
Meconium ileus is a sign of cystic fibrosis.
" Blue spells " or "tet spells" is characteristic of tetrology of fallot.
An important pharmacologic regimine for cystic fibrosis is pancreatic enzymes.
Naturally aquired active immunity: results from having the disease and recovering
successfully.
Naturally aquired passive immunity: antibodies received from placenta or breast milk.
Artificially aquired active immunity: from immunizations.

Artificially aquired passive immunity: antibodies transfered from sensitized person as in immune serum
globulin ( gamma globulin ).
Altered direction of the urinary stream is indicative of hypospadias.
A gluten-free diet is needed in celiac disease.
The development of the fetus is directly related to the diet of the mother.
Egg protein has a higher biological value than meat protein.
1. Ace Inhibitors can cause hyperkalemia and chronic cough- pt's should
not use salt substitutes because they are mostly made from K+ which
will further increase the K+
2. Valium- suppresses non-rem sleep. Overdose Antidote is flumazenil.
3. There is no antidote for barbiturates which suppress REM sleep. S/S of

allergy to barbiturates is Barbs=prickly sensation ,edema of
membranes in mouth.
4. Tylenol = Liver toxic (no more than 4 g/day) Give Mucomyst for
overdose. Whereas, Ibuprofen = kidney toxic
5. Vancomycin- treats MRSA; Adverse Effects- Red man syndrome-

flushing from quick admin of this Rx can be prevented with benadryl before admin of RX.
Ileostomy is an opening of the ileum onto the abdominal surface; most frequently done
for treatment of ulcerative colitis, but may also be done for Crohn's disease.
Continent ileostomy ( Kock's Pouch ) is an intra-abdominal reservoir with a nipple valve formed from the
distal ileum. The pouch acts as a reservoir for feces and is cleaned at regular intervals by insertion of a
catheter.
Morphine causes spasms of the Sphincter of Oddi, which will result in worsening an episode of acute
pancreatitis.
Oliguria is a primary sign of hypovolemic shock related to hemorrhage.
When teaching pt. with UTI priority teaching for home care is to take all prescribed antibiotics
because sign and symptoms of UTI usually disappear within several days of antibiotic therapy so pt
has tendency to stop meds. Also, sexual intercourse is permitted during treatment for UTI.
Four point gait is best for stability for pt. with arthritis since the client can bear weight on both legs.
Pt with rheumatoid arthritis who take prednisone( corticosteroids) for long period of time has

complication of brittle bones and breaking their bones with even a minor injury.
Carbidopa/Levodopa ( Sinemet )- tx for Parkinson's, carbidopa prevents metabolism of levodopa and

allows more levodopa for transport to brain. Levodopa ( Larodopa ) should be d/c'd 8 hours before
statring Sinemet.
Bromocriptine ( Parlodel ) - tx of Parkinson's, amenorrhea, galactorrhea, female infertility, suppression of

postpartum lactation, acromegaly.
Ropinirole ( Requip ) - tx of idiopathic Parkinson's disease.
Quinidine - give with food, monitor electrolytes, monitor liver and kidney function, encourage patient to
report dizziness or faintness immediately.
Used in a-fib and a-flutter.
Practice universal precautions when caring for all clients regardless of their diagnosis in order to
minimize contact with blood and body fluids and to prevent the transmission of specific infections such as
HIV and Hep.B:
1.Hands MUST always be washed before and after client contact.
2.Hands must be washed before and after gloves have been worn.
3.If hands come in contact with blood or body fluids or human tissue they should be immediately washed
with soap and water. ( 20-30 seconds )
4.Gloves should be worn before touching mucous membranes or non-intact skin.
5.Gloves should be changed between each client contact and if torn.
6.Wear masks and protective eyewear during procedures that are likely to get splashed with body fluids.
7.Wear gowns during procedures that are likely to generate splashes of blood or other body fluids and
when cleaning spills from incontinent clients or changing soiled linen.
8.Disposible masks should be worn when performing CPR.
9.Dispose of used needles properly in designated sharps containers. They should not be recapped, bent,
broken,or removed from syringes.
Hypovolemic shock- decreased circulating blood volume-caused by blood loss, plasma

loss as in burns, or fluid loss as in from excess vomiting or diarrhea.
The concentration of dextrose in TPN solutions is usually at least 30%.
The patient receiving regional anesthesia has nerve impulses blocked but does not lose
consciousness.
Calcium functions in development of bones and teeth, transmission of nerve impulses, muscle
contraction,permeability of cell membranes, catalyze thrombin formation, and maintenance of normal
heart rhythm.
Trental is used for intermittent claudication.
Atropine sulfate would be given to a client with a dangerously slow heart rate.
Digitalis is used to slow and strengthen the heart in clients with heart failure.

Lidocaine is given to clients who have episodes of premature ventricular contractions.
Seven Warning Signs of Cancer! Caution!

C=change in bowel habits
A=a sore that does not heal
U=unusual bleeding or discharge
T=thickening or lump in breast ( or elsewhere )
I=indigestion or dysphagia
O=obvious change in wart or mole
N=nagging cough or hoarseness
TNM classification:
T=primary growth.1-4 with increasing size; T1s indicates carcinoma in situ
N=lymph node involvment.0-4 indicates progressively advancing nodal disease
M=metastasis.1 indicates presence of metastasis
Stages 0-IV: all cancers divided into 5 stages incorporating size, nodal involvement, and spread
Low Sodium diet for pt. with menieres disease

--HYPOkalemia= TPN, Steroid tx, Diarrhea
--HYPERkalemia= DKA, ACE inhibitors
--Finger foods for preschoolers, NO cooked veggie (raw instead)
--Dont encourage (force) to eat all food on plate
--Lyme disease test not reliable for 4-6wk post exposer
DO NOT BURN TICK why you ask? because it will spread the disease (who knew )
instead flush down the potty
--avoid salt substitutes when taken dig and k-supplements because many are
potassium based
--use portable X-RAY for pt with MRSA
--Bacillus Calmette-Guerin (BCG) Vaccine used to promote active immunity to TB (may
give false positive on PPD)
--Pt. taking Dig and Lasix shoould increase Potassium intake (bc of Lasix)
--Airborne= Mask, gloves
--Contact= Gown, glove
--Flail Chest= FX of 2 or more adjacent ribs with paradoxical movement of chest
during respiration
Autonomic dysreflexia - caused by bladder and bowel distention, patients often complain of a pounding
headache and profuse sweating.
Addison's disease (need to "add" hormone)

Cushing's syndrome (have extra "cushion" of hormones)
The cuff of an ED tube is for preventing aspiration and sealing the airway to prevent leaks. When the cuff
deflates, aspiration is the greatest risk (due to secretions)

Dumping syndrome: increase fat and protein, small frequent meals, lie down after meal to decrease
peristalsis, wait 1 hr after meals to drink.
Use DISTRACTION methods with toddlers and manic patients only.
For radiologic procedures: if dye will be used, always check for shellfish allergy.
For blood types: "O" is the universal donor (remember "o" in donor)
"AB" is the universal receipient
Disseminated Herpes Zoster is AIRBORNE PRECAUTIONS, as to Localized Herpes Zoster is

CONTACT PRECAUTIONS. A nurse with a localized herpes zoster CAN care for patients as long as the
patients are NOT immunosuppressed and the lesions must be covered!
ADHD, antipsychotics, and corticosteroids can stunt growth in children.
Give NSAIDS, Corticosteroids, drugs for Bipolar, Cephalosporins, and Sulfanomides WITH food.
Fat soluble vitamins are Vitamins A, D, E, K
IPV is given PO
Most live vaccines (rebulla, MMR) are given SQ
Non-live vaccines (Hep B, DTaP) are given IM
Coartication of the aorta is characterized by upper extremity hypertension and diminished pulses in the
extremities.
Do not mix dilantin with dextrose as crystallization can occur. ( IV ) Flush IV line with normal saline
before & after giving. Do not give with other drugs.
Verapamil reduces afterload and with concurrent use of nitroglycerine can cause ( increase ) hypotension.
Menieres disease: vertigo, tinnitus, impaired hearing (menieres...in the ear)
Tuberculosis- assessment findings: cough ( yellow mucoid sputum ) , dyspnea, hemoptysis, rales or
crackles, anorexia, malaise, wt.loss, afternoon low grade temp., pallor, fatigue, pain, night sweats.
Diagnostic Tests used in TB - Chest x-ray indicates presence and extent od disease but cannot show if
active or inactive. Skin test (PPD) positive;area of induration 10mm or more in diameter after 48 hrs.
Sputum positive for bacillus ( 3 samples is diagnostic for TB ). Culture will be positive. WBC & ESR will
be elevated.
Trach care should be prvided once every 8 hours and prn.
A major goal for the pt with COPD is that the pt. will use a breathing pattern that does not lead to tiring

and to plan activities so that he/she does not become overtired. Care should be spaced, allowing frequent
rest periods, and preventing fatigue.
Ethambutol, isonazid, streptomycin, and rifampin are first-line drugs in the treatment of TB.
With antibiotics:
Peak and Trough levels--each drug has their own peak/trough therapeutic index to tell us whether
the drugs are working therapeutically.
Peak: draw 45min to 1 hr after drug is administered -- highest peak

Trough: draw before administering next dose -- lowest level
Lidocaine is the drug of choice for reducing pvc's.
Colchicine relieves inflammation and is used to treat gout.
IV Valium and Dilantin are used to treat status epilepticus.
Solu-medrol is a 1st line drug used to control edema after spinal cord trauma.
Alprazolam ( Xanax )- antianxiety agent, usual dose is 0.25-0.5 mg two

to three times daily. Side effects: drowsiness, dizziness, lethargy,
confusion.
Amlodipine ( Norvasc )- CCB used for systemic vasodilation and

decreased blood pressure. Coronary vasodilation and decreased
frequency and severity of angina. CONTRAINDICATION BP <90mmHg.
Fosinopril ( Monopril )- tx of hypertension and CHF; dosage is 5-40 mg

once daily max dose in a day is 80mg
Rosiglitazone ( Avandia )-tx type 2 diabetes; dosage is 4-8 mg as a

single daily dose or in 2 divided doses ( use cautiously if edema or
CHF )
Drugs with these endings........ usually are in this class

-caine ;local anesthetics
-cillin; antibiotic
-dine ;anti-ulcer ( H2 blocker )
-done; opioid analgesic
-ide; oral hypoglycemics
-lam; antianxiety
-mide ;diuretic
-mycin ;antibiotic
-nium; neuromuscular blocking
-olol; beta blocker

-oxacin ;antibiotic
-pam ;antianxiety
-pril ;ACE inhibitor
-sone ;steroids
-statin ;cholesterol
-vir; antiviral
-zide; diuretic
Ativan is the treatment of choice for status epilepticus
When using a bronchodilator inhaler inconjuction with a glucocorticoid inhaler, administer the
bronchodilator first
Theophylline increases the risk of digoxin toxicity and decreases the effects of lithium and Dilantin
Intal, an inhaler used to treat allergy induced asthma may cause bronchospasm
Isoniazid causes peripheral neuritis
Axid, Zantac, Pepcid, are H2 receptor antagonist used to treat active ulcer disease.
Tagamet, Nexium, Prevacid, are proton pump inhibitors
Peptic ulcers caused by H. pylori are treated with Flagyl, Prilosec and Biaxin. This treatment kills bacteria
and stops production of stomach acid, but does not heal ulcer.
Patients in the acute care setting are often given protonx to prevent stress ulcers.
For delegating : LVN / Float RN = with stable pt with predictable outcome

enteral feeding= check ph
never leave the pt.
review compartment syndrome
choice betwee mother and fetus... focus on fetus first unless mom is dying
observing not usually the answer
hydrocephalus child-- do not elevate head, do provide frequent feedings
to prevent subdural hematoma-- lie flat
pku- no meat,fish,vegis and whole grains
cystic fibrosis= no fats, increase protein
renal failure look at creat clearance.. ability to clear meds
psychosocial.. "I" and "why" question not usually the answer
dead pt... remain with the family
"restlessly" a key word=hypoxia
"sometimes" not usually the answer
Head injury--look for DI
Burns =if to the fron of the body.. think AIRWAY
IV lasix.. think check the BP
wbc<500= reverse isolation

Rhinoplasty--place on side
Glycopyrrolate ( Robinul )-tx preanethestic agent, adjunct in peptic ulcer disease therapy,
reverse neuromuscular blockade. * has less CNS effects than atropine. Do not mix with
barbituates or alkaline drugs.
Atropine sulfate causes dry mouth & decreases secretions, which is why it is given as a
preanethestic.
Atropine can cause constipation; high fiber foods and fluids should be encouraged.
Cancers that origionate from blood forming organs are leukemias.
A characteristic of a malignant tumor is that it will have a greater than normal blood supply.
One expected side effect of radiation therapy is stomatitis which is an inflammatory reaction in the
mouth.
Interferons are used to treat hairy cell leukemis, chronic myelogenous leukemia, melanoma, and Kaposi's
sarcoma.
You have to know these common disease in NCLEX:
hypertension
provide for physical and emotional rest
provide for special safety needs
health teaching (client and family)
dysrhythmias
provide for emotional and safety needs
prevent thromboemboli
prepare for cardioversion with atrial fibrillation if indiated
provide for physical and emotional needs with pacemaker insertion
cardiac arrest
prevent irreversible cerebral anoxic damage
establish effective circulation, respiration
angina pectoris
provide relief from pain
provide emotional support
health teaching
myocardial infarction
reduce pain, discomfort
maintain adequate circulation, stabilize heart rhythm
decrease oxygen demand/promote oxygenation, reduce cardiac workload
maintain fluid electrolyte, nutritional status

facilitate fecal elimination
promote sexual functioning
health teaching
cardiac valvular defects

reduce cardiac workload
promote physical comfort and psychological support
prevent complications
prepare for surgery
cardiac catheterization & percutaneous transluminal coronary angioplasty

precatheterization:
provide for safety, comfort
health teaching
postcatheterization:
health teaching
cardiac surgery
cardiopulmonary bypass
preoperative:
provide emotional and spiritual support
health teaching
postoperative:
provide constant monitoring to prevent complications
promote comfort, pain relief
maintain fluid, electrolyte, nutritional balance
promote emotional adjustment
promote early mobilization
health teaching
heart failure (HF)

provide physical rest / reduce emotional stimuli
provide for relief of respiratory distress; reduce cardiac workload
maintain fluid and electrolyte balance, nutritional status
health teaching
pulmonary edema
promote physical, psychological relaxation measures to relieve anxiety
improve cardiac function, reduce venous return, relieve hypoxia
health teaching (include family or significant other)
shock
promote venous return, circulatory perfusion
disseminated intravascular coagulation (DIC)

prevent and detect further bleeding
pericarditis
promote physical and emotionl comfort
maintain fluid, electrolyte balance

chronic arterial occlusive disease
promote circulation; decrease discomfort
prevent infection, injury
aneurysms
provide emergency care before surgery for dissection or rupture
prevent complications postoperatively
promote comfort
health teaching
Raynaud’s phenomenon
Maintain warmth in extremities
Increase hydrostatic pressure, and therefore circulation
Health teaching
Varicose veins
Promote venous return from lower extremities
Provide for safety
Health teaching
Vein ligation and stripping

Prevent complications after discharge
Health teaching to prevent recurrence
Deep vein thrombosis (thrombophlebitis)

Provide rest, comfort, and relief from pain
Prevent complications
Health teaching
Iron deficiency anemia & Hemolytic anemia

Promote physical and mental equilibrium
Health teaching
Pernicious anemia
Promote physical and emotional comfort
Health teaching
Polycythemia vera
promote comfort and prevent complications
health teaching
leukemia (acute and chronic)

prevent, control, and treat infection
assess and control bleeding, anemia
provide rest, comfort, nutrition
reduce side effects from therapeutic regimen
provide emotional/spiritual support
health teaching
idiopathic thrombocytopenic purpura (ITP)

prevent complications from bleeding tendencies
health teaching
splenectomy

prepare for surgery
prevent postoperative complications
health teaching
fluid volume deficit

restore fluid and electrolyte balance-increase fluid intake to hydrate client
promote comfort
prevent physical injury
fluid volume excess

maintain oxygen to all cells
promote excretion of excess fluid
obtain/ maintain fluid balance
prevent tissue injury
health teaching
common electrolyte imbalances

hyponatremia
obtain normal sodium level
prevent further sodium loss
prevent injury
hypernatremia
obtain normal sodium level
hypokalemia
replace lost potassium: increase potassium in diet
prevent injury to tissues
prevent potassium loss
hyperkalemia
decrease amount of potassium in body
hypocalcemia
prevent tetany
prevent tissue injury
prevent injury related to mediction administration
in less acute condition
hypercalcemia
reduce calcium intake: decrease foods high in calcium
prevent injury
hypomagnesemia
provide safety
health teaching
hypermagnesemia
obtain normal magnesium level
respiratory adidosis
assist with normal breathing
protect from injury

health teaching
metabolic acidosis
restore normal metabolism
health teaching
respiratory alkalosis
increase carbon dioxide level
prevent injury
health teaching
metabolic alkalosis
obtain, maintin acid-base blance
prevent physical injury
health teaching
pneumonia
promote adequate ventilation
control infection
provide rest and comfort
prevent potential complications
health teaching
severe acute respiratory syndrome (SARS)

infection control
supportive care
atelectasis
relieve hypoxia
health teaching
pulmonary embolism
monitor for signs of respiratory distress
health teaching
histoplasmosis
relieve symptoms of the disease
health teaching
tuberculosis
reduce spread of disease
promote nutrition
promote increased self-esteem
health teaching
emphysema
promote optimal ventilation
employ comfort measures and support other body systems
improve nutritional intake
provide emotional support for client and fmily

health teaching
asthma
promote pulmonary ventilation
facilite expectoration
health teaching to prevent further attacks
bronchitis
assist in optimal respirations
minimize bronchial irritation
improve nutritional status
acute adult respiratory distress syndrome (ARDS)

assist in respirations
health teaching
pneumothorax & hemothorax

prevent damage until medical intervention available
protect against injury during thoracentesis
promote respirations
prepare client for closed chest drainage, physically and psychologically
prevent complications with chest tubes
health teaching
chest trauma
Flail chest
restore adequate ventilation and prevent further air from entering pleural cavity
thoracic surgery
preoperative care:
minimize pulmonary secretions
preoperative teaching
postoperative care:
maintain patent airway
promote gas exchange
reduce incisional stress and discomfort
prevent complications related to respiratory function
maintain fluid and electrolyte balance
postoperative teaching
tracheostomy
preoperative care
relieve anxitety and fear
postoperative care
alleviate apprehension
improve nutritional status
health teaching
burns
alleviate pain, relieve shock, and maintain fluid and electrolyte balance
prevent physicl complications

promote emotional adjustment and provide supportive therapy
promote wound healing – wound care
health teaching
rheumatoid arthritis
prevent or correct deformities
health teaching
lupus erythematosus
minimize or limit immune response and complications
health teaching
infectious diseases
Lyme disease
minimize irreversible tissue damage and complications
alleviate pin, promote comfort
maintain physical and psychological well-being
health teaching
acquired immunodeficiency syndrome (AIDS)

reduce risk of infection; slow disease progression
prevent the spread of disease
provide physical and psychological support
health teaching
The perioperative experience

Preoperative preparation
reduce preoperative and intraoperative anxiety and prevent postoperative complications
instruct in exercises to reduce complications
reduce the number of bacteria on the skin to eliminate incision contamination
reduce the risk of vomiting and aspiration during anesthesia; prevent contamination of
abdominal operative sites by fecal material
promote rest and facilitate reduction of apprehension
protect from injury;ensure final preparation for surgery
intraoperative preparation
promote comfort
observe for indications of malignant hyperthermia
postoperative experience
promote a safe, quiet, nonstressful environment
promote lung expansion and gss exchange
prevent aspiration and atelectasis
promote and maintain cardiovascular function
promote psychological equilibrium
maintain proper function of tubes and appatatus
general postoperative nursing care

promote lung expansion
provide relief of pain
promote adequate nutrition and fluid and electrolyte balance
assist client with elimination
facilitate wound and prevent infection
promote comfort and rest

encourage early movement and ambulation to prevent complications of immobilization
general nutritional deficiencies

prevent complications of specific deficiency
health teaching
celiac disease
altered nutrition, less than body requirements
diarrhea
fluid volume deficit related to loss through excessive diarrhea
knowledge deficit
hepatitis
prevent spread of infection to others
promote comfort
pancreatitis
control pain
rest injured pancreas
prevent fluid and electrolyte imbalance
prevent respirtory and metabolic complications
provide adequate nutrition
health teaching
cirrhosis
relieve discomfort caused by complications
improve fluid and electrolyte balance
promote optimum nutrition within dietary restrictions
health teaching
esophageal varices: life-threatening hemorrhage

provide safety measures related to hemorrhage
promote fluid balance
prevent complications of hepatic coma
health teaching
diaphragmatic (hiatal) hernia

presurgical: promote relief of symptoms
postsurgical:
provide for postoperative safety needs
promote comfort and maintain nutrition
health teaching
gastroesophgel reflux disease(GERD)
promote comfort and reduce reflux episodes
health teaching
peptic ulcer disease

promote comfort
prevent/ recognize signs of complications

health teaching
gastric surgery
promote comfort in the postoperative period
promote wound healing
promote adequate nutrition and hydration
dumping syndrome
health teaching
total parenteral nutrition

prevent infection
preent fluid and eclectrolyte imbalance
diabetes
obtain and maintain normal sugar balance
health teaching
nonketotic hyperglycemic hyperosolar coma (NKHHC)

promote fluid and electrolyte balance
cholecystits/ cholelithiasis
nonsurgical interventions romote comfort
preoperative: prevent injury
postoperative romote comfort
health teaching
obesity
decrease weight, initially 10% from baseline
appendicitis
promote comfort
hernia
health teaching
diverticulosis
bowel rest during acute episodes
promote normal bowel elimination
health teaching
ulcerative colitis & Crohn’s disease

prevent disease progression and complications
reduce psychological stress
health teaching
intestinal obstruction
obtain and maintain fluid balance

relieve pain and nausea
prevent respiratory complications
postoperative nursing care
fecal diversion-stomas
preoperative period:
prepare bowel for surgery
relieve anxiety and assist in adjustment to surgery
postoperative period:
maintain fluid balance
prevent other postoperative complications
initiate ostomy care
promote psychological comfort
hemorrhoids
reduce anal discomfort
prevent complications related to surgery
health teaching-avoid constipation
pyelonephritis (PN)
combat infection, prevent recurrence, alleviate symptoms
promote physical and emotional rest
acute glomerulonephritis
monitor fluid balance, observing carefully for complications
provide adequate nutrition
provide reasonable measure of comfort
prevent further infection & health teaching
acute renal failure (ARF)
maintain fluid and electrolyte balance and nutrition
use assessment and comfort measures to reduce occurrence of complications
maintain continual emotional support
health teaching
chronic renal failure

maintain fluid/ electrolyte balance and nutrition
employ comfort measures that reduce distress and support physical function
health teaching
dialysis
reduce level of nitrogenous waste
correct acidosis, reverse electrolyte imbalances, remove excess fluid
kidney transplantation
preoperative:
promoe physical and emotional adjustment
encourage expression of feelings
health teching
postoperative:
promote uncomplicated recovery of recipient
observe for signs of rejection-most dangerous complication
maintain immunosuppressive therapy

nephrectomy
preoperative ptimize physical and psychological functioning
postoperative
promote comfort and prevent complications
renal calculi (urolithiasis)

reduce pain and prevent complications
health teaching
lithotripsy
enourage ambulation and promote diuresis through forcing fluids
benign prostatic hyperplasia

relieve urinary retention
health teaching
prostatectomy
promote optimal bladder function and comfort
assist in rehabilitation
urinary diversion
prevent complications and promote comfort
health teaching
laryngectomy
preoperative care: provide emotional support and optimal physical preparation
health teaching
postoperative care
maintain patent airway and prevent aspiration
promote optimal physical and psychological function
health teaching
aphasia
assist with communication
Meniere’s disease
provide safety and comfort during attacks
minimize occurrence of attacks
health teaching
otosclerosis & stapedectomy

preoperative health teaching
postoperative
promote physical and psychological equilibrium
health teaching
deafnessmaximize hearing ability and provide emotional support.health teaching

glaucoma
reduce intraocular pressure
health teaching

cataract & cataract removal
preoperative
prepare for surgery
postoperative
reduce stress on the sutures and prevent hemorrhage
promote psychological well-being
health teaching
retinal detachment
preoperative:
reduce anxiety and prevent further detachment
health teaching
postoperative
reduce intraocular stress and prevent hemorrhage
support coping mechanisms
health teaching
blindness
promote independence and provide emotional support
health teaching
traumatic injuries to the brain

sustain vital functions and minimize or prevent complications
provide emotional support and use comfort measures
increased intracranial pressure

promote adequate oxygenation and limit further impairment
craniotomy
preoperative obtain baseline measures
provide psychological support
prepare for surgery
postoperative
prevent complications and limit further impairment
epilepsy
prevent injury during seizure
postseizure care
prevent or reduce recurrences of seizure activity
health teaching
transient ischemic attacks

reduce cerebral anoxia
promote cerebrovascular function and maintain cerebral perfusion
provide for emotional relaxation
client safety
health teaching
pain
immobility

complications of fractures
types of traction
teaching crutch walking
compartment syndrome
recognizes early indications of ischemia
osteoarthritis
promote comfort: reduce pain, spasms, inflammation, swelling
health teaching to promote independence
total hip replacement

preoperative:
prevent deep vein thrombosis or pulmonary emboli
prevent infection: antibiotics
health teaching
postoperative
prevent respiratory complications
prevent complications of shock or infection
prevent contractures, muscle atrophy
promote early ambulation and movement
prevent constipation
prevent dislocation of prosthesis
promote comfort
health teaching
total knee replacement

achieve active flexion beyond 70 degrees
amputation
prepare for surgery,physically and emotionlly
promote healing postoperatively
gout
decrease discomfort
prevent kidney damage
health teaching
primary hip arthroplasty
herniated/ reptured disk

relieve pain and promote comfort
health teaching
laminectomy
relieve anxiety
prevent injury postoperatively
promote comfort

prepare for early discharge
health teaching
spinal cord injuries

prevent further damage
relieve edema:anti-inflammatory medications,corticosteroids
relieve discomfort,analgesics,sedatives,muscle relaxants
promote comfort
health teaching
posterior spinal fusion (PSF)
spinal shock
prevent injury related to shock
autonomic dysreflexia
decrease symptoms to prevent serious side effects
maintain patency of catheter
promote regular bowel elimination
prevent decubitus ulcers
hyperthyroidism
protect from stress
promote physical and emotional equilibrium
health teaching
thyroid storm
thyroidectomy
promote physical and emotional equilibrium
prevent complications of hypocalcemia and tetany
promote comfort measures
hypothyroidism
provide for comfort and safety
health teaching
cushing’s disease
promote comfort
health teaching
pheochromocytoma
prevent paroxysmal hypertension
prepare for surgical removal of tumor
adrenalectomy
preoperative:reduce risk of postoperative complications
postoperative promoe hormonal balance

health teaching
Addison’s disease
decrease stress
promote adequate nutrition
Health teaching
Multiple sclerosis
maintain normal routine as long as possible
decrease symptoms-medications as ordered
Myasthenia gravis
promote comfort
decrease symptoms
promote increased self-concept
health teaching
Parkinson’s disease
promote maintenance of daily activities
protect from injury
Amyotrophic lateral sclerosis (ALS)

maintain independence as long as possible
health teaching
Guillain-Barre syndrome
prevent complications during recovery from paralysis
monitor for signs of autoimmune dysfunction
prevent tachycardia
assess cranial nerve function
maintain adequate ventilation
in acute phase:check for progression of muscular weakness
maintain nutrition
prevent injury and complications
support communication
Chemotherapy
assist with treatment of specific side effect
health teaching
Radiationtherapy
External radiation:
prevent tissue breakdown
decrease side effects of therapy
health teaching
internal radiation : sealed
assist with cervical radium implantation
health teaching
internal radiation: unsealed
reduce radiation exposure of others

Immunotherapy
decrease discomfort associated with side effects of therapy
health teaching
Palliative care
make client as comfortable as possible
assist client to maintain self-esteem and identity
assist client with psychological adjustment
Types of cancer:
Lung cancer
Make client aware of diagnosis and treatment options
Prevent complications related to surgery
Assist client to cope with alternative therapies
colon and rectal cancer
assist through treatment protocol
surgery reoperative
preparefor surgery
promote comfort
postoperative :
facilitate healing
facilitate rehabilitation
health teaching
breast cancer
assist client through treatment protocol
prepare client for surgery
reduce anxiety and depression
support coping mechanisms
health teaching
uterine cancer
prostate cancer
assist client through treatment protocol
prepare client for surgery
assist with acceptance diagnosis and treatment
prevent complication during postoperative period
bladder cancer
laryngeal cancer
additional typers of cancer,etc.
when taking cyclosporine (Sandimmune) to prevent graft rejection, remember that these GEAK,
increase cyclosporine level...
G - grapefruit
E - erythromycin
A - amphotericin B
K – ketokonazole

Atopic dermatitis is an inflammatory condition involving a skin reaction to irritants or allergens.
*Clinical features of SLE involve multiple body systems.When the musculoskeletal system is involved,
the client has joint tenderness, edema, and morning stiffness.
*Eyes that are red,burning,or tearing are commonly associated with allergic rhinitis ( hay fever ).
*Psoriasis is marked by profuse,erythmatous scales or plaques, often covering large areas of the body.
The client may complain of itching, pain and possibly of arthritic symptoms such as joint stiffness.
*Restasis is for dry eyes. ( as seen on tv )
*Boniva is for osteoporosis ( taken once a month )
Does anyone remember the side effects of Boniva? If you do could you please list them? I have not seen
the commercial in a while. Thanks!
1. UAP (Unlincensed Assisitive Personnel) should be able to perform "routine" trach care
2. Only RN & PN can delegate to UAPs. One UAP can not delegate task to another UAP
3. Antihistamines can aggravate urinary incontinence. Teach pt accordingly
4. Atropine is contraindicated for a client with angle-closure glaucoma b/c it can cause pupillary
dilation with an increase in acqueous humor, leading to a resultant increase in optic pressure
5. Warn asthma pt about using aspirin. It can induce an asthma attack
6. Assess mood change in pt taking Aldomet for HTN
7. It is critical to assess weight of a 10 years old starting heparin therapy
8. Demerol is contraindicated in clients with sickle cell disease. It may cause seizures
9. Silvadene (used for severe burns) may cause a transient neutropenia as well as renal fct changes
with sulfa crystals production & kernicterus
10. A pt with C4 spinal cord injury may still have an erection (reflex rx)
11. Normal serum albumin in elderey (3.0-5.0 g.dl)
12. Pt taking ACE inhibitors (Lisinopril, Captopril,...) may avoid foods high in K and salt substitutes
(risk of hyperkalemia)
13. Malignant hypertheremia is a rare potentially fatal adverse rx to inhalated anesthetics. There is a
great genetic predisposition to this disorder
14. Anticholinergics may exacerbate symptoms of GERD
15. The eldery are at risk for developing confusion when taking Cimetidine (Tagamet)
Thiazide diuretics increase blood sugar.

*Diabetics need food high in potassium like oranges, bananas, and broccoli.
*Vitamin K is a natural coagulant, so should be avoided if using blood thinners.
*ACE-Inhibitors are the primary drug of choice for vasodilation in heart failure.
*Vitamin B12 is essential for nervous system function. Neurological manifestations of B12 deficiency can
include paresthesias.
*Immobility can cause stores of calcium in the bone to enter the bloodstream which can result in
hypercalcemia.
*Aldosterone conserves sodium and promotes potassium excretion which helps to control sodium and
water balance.
*Low blood volumes stimulates the pituitary to secrete antidiuretic hormone.

1. Normal total serum protein level is 6.0-8.0 g/dL
2. Xanax is a short term benzo useful in controlling panic symptoms quickly
3. Prozac (a SSRI) side effects are diarrhea, dry mouth, weight loss, reduced libido
4. Succinylcholine (Anectine) is given before ECT (Electroconvulsive therapy)
5. Cardioversion is contraindicated if the pt received digoxin during the preceding 24 hours
6. The most common problem associated with enteral feedings is atelectasis
7. Infant with intussusception => "Currant jelly" stools (blood and mucus stools)
8. Infant with pyloric stenosis => projectile vomiting
9. Child with Hirschsprungs disease => Ribbonlike stools
10. Child with Wilms tumor => Palpable mass over the flank .NEVER PALPATE THE ABDOMEN
IF YOU SUSPECT WILMS TUMOR...
11. Infant with biliary atresia => abdominal distention, poor weight gain , clay-colored stools
12. A severe complication of Kawasaki disease is the creation of a giant aneurysm
13. Desferal (desferoxamine) is used to treat iron toxicity
Immunization schedule
Hep B - birth,2, 4, 6 months

Hep A- after 1st bday and 6 months later
Rotavirus- 3 doses total at 2, 4, 6 months ( must be given before 32 weeks of age)
Dtap 2, 4, 6, 12, months, age 4 or before school
Pneumococcal - 2,4, 6, 12 months
Inactivated poliovirsu - 2, 4, 6, 12, months and 4th dose at age 4
Infleunza after 6 months and yearly thereafter
Haemophilus influenza- 2, 4, 6 months & another dose after 1st birthday
MMR- after age 1, age 4
varicella 12 months, age 4
HPV- 9-25 years, 3 doses total give first dose, 2 months later give second dose, 6 months later give
3rd dose
When giving Kayexalate we need to worry about dehydration ( K ha ineverse relationship with Na)
Impetigo- ok to care by pregnant nurse, need to wear gloves and gowns
Yogurt has live cultures- dont give to immunosuppressed pt
Pneumonectomy- no chest tube reqd
Itching under cast area- cool air via blow dryer, ice pack for 10- 15 minutes. NEVER use qtip or
anything to scratch area

PS: What is the antidote for digoxin and opioid analgesics? I am sure you know...
Antidote for digoxin is digibind
antidote for opiod analgesic is narcan
antidote for lovenox is protamin sulfate and NO labs reqd for lovenox
My way of understanding the ABGs:

pH=7.35-7.45 (below 7.35 is acidosis)
PCO2= 35-45 (above 45 is acidosis)
O2= 80-100%
HCO3= 22-26 (Below 22 is acidosis)
The value parameters are the opposite for alkalosis
If the pH is increased (>7.40) and the pCO2 is decreased (<35)...Resp alkalosis
If the pH is decreased (<7.40) and the pCO2 is increased (>45)...Resp acidosis
If the pH is increased (>7.40) and the HCO3 is increased (>26)...Met Alkalosis
If the pH is decreased (<7.40) and the HCO3 is decreased (<22)...Met Acidosis
- Suction for an NG shouldn't exceed 25 mm Hg

- Serum Protein 6 - 8
- Ammonia 35 - 65 (increases hepatic disease, encephalopathy, NO PROTEIN if elevated
- Amylase - 25 - 151 (increases with pancreatitis, levels are higher in acute pancreatitis than with chronic
pancreatitis. ETOH most common reason for chronic Panc.)
- Lipase 10 - 140
- Kosher meals : NO dairy and meat in same meal. No shrimp/shellfish b/c fish must have scales.
- Low residue diet for ileostomy. NO stool softners or laxatives (no docusate or Milk of Mag, cuz might
lead to fluid / electrolyte imbalances)
- Pork is good source of thiamine
- If pt coughs/resp distress while putting in NG, pull back and wait until coughing/resp. distress is
resolved then attempt again. Remember pt should be in High Fowlers, when tube reaches orophar., neck
must be flexed to cover airway and swallow sips of h20 to facilitate tube).
- Pancreatitis pain: epigastric pain radiate to back (remember that pancreas is retroperitoneal (behind).
After all, Turner's sign, seen with pancreatitis. is grayish/bluish around the flanks; Cullen’s sign is seen
periumbilical)
- Prolapsed stoma - protrusion of stoma
- Retracted stoma - sunken, hidden
- Ischemic stoma - dusky
- Normal stoma - beefy red, may bleed a lil when washed/irrigated, normal
- Red Meat / Turnips / Hoarseradish may give false + for guaiac.
- When given an adult dose and asked about the kids dose you take the ADULT DOSE X Kids weight in
POUNDS / 150 = childs dose.
- No sunscreen for infants < 6 mo old.
- Normal responses to dye : feeling warm, face flushin, salty taste . URTICARIA IS NOT NORMAL -
indicative of serious rxn
- ASA often is a trigger for an asthma attack

- Koch/Kock Pouch- is continent, doesn't nec need a drainage bag, use absorbent dressing on it. Drain
with catheter Q 3-4.
• PE prevention= Turn pt. Left side for 20-30 min allows air enter R atrium and
Pulmonary artery
• Ethambutol ADR =Optic Neuritis color blind for green is initially.
• Pyrazinamide (PZA) = DC if big toe pain; means Hyperuricemia ;Gout.
• Rifampin  body fluids orange;contact lenses permanently stained.
• Immediately after a pt is put on mech ventilator check BP (Hypotension)
• Most important after ileostomy surgerycheck ileostomy output
• Epiglottisinflamation of epiglotis, life threatning, NO tongue blade. Determine
need for O2 by Pulse OX and start IV. Tx : Moist O2 & antibiotics
• Humira (adalimumab)tx Rheumatoid arthritis, Chrohn’s if other meds no help,
psoriasis  prevent further damage to bones/joints. get a TB test done
before starting humera.
• Adriamycin(doxorubicin)= bone marrow suppression =notify doctor if s/s
infection (fever,sore throat)hematuria ok for 1-2 days of start stomatitis
(ulceration of mouth) ok after 10-15 days start =rinse mouth with water,
sponge brush for teeth.
• Dislocation of prosthesis for hip surgery  leg outwardly rotated, shortening,
pain, inability to move.
• NO tongue blade for tonic –clonic seizures ,can chip teeth.
• Paracentisis  provide a BP cuff. Check BP s/s of shock.
• NO Tetrahydrolazine (Visine ) for Open Angle Glaucoma Ophtalmic
vasoconstrictor used as gtt in the eye. Caution with HTN.
1. Fifth disease (erythema infectiosum) is caused by human parvovirus B19 (droplet precautions
right?...). It is found in respiratory secretions. It is NOT CONTAGIOUS after the rash
develops
2. Morphine toxicity => Patient's pupils are pinpoint
3. Neostigmine (Prostgmin) is a cholinergic and can cause bronchoconstriction in asthmatic
patients
4. Native Americans have the highest incidence of cleft lip and palate
5. Prolapsed cord => Put pt in trendelenburg position
6. Latex allergies => Assess for allergies to bananas, apricots, cherries, grapes, kiwis, passion fruit,
avocados, chestnuts, tomatoes, peaches
7. Pt with glaucoma => The priority is to prevent deterioration of the vision; vision can not be
improved
8. Myelogram => Meds that lower the seizure threshold (phenothiazines, thorazine), MAO
inhibitors (Marplan, Nardil, Parnate), tricyclic antidepressants (Tofranil, Elavil), CNS
stimulants, psychoacive drugs (Ritalin) should be held for 48 hrs before and 24 hrs after test

9. In panic level anxiety, the pt is unable to see, hear or function
10. Double-bind communication => emotions communicated verbally are opposite of emotions
communicated physically
11. Depressed client => help client to identify unrealistic behaviors
12. Benztropine (Cogentin) => treat parkinsonian side-effects of anitpsychotics meds
13. Imipramine (Tofranil) => tricyclic antidepressant used to treat panic attacks
14. CPR adults => depress sternum 1.5 to 2 inches; rescue breaths 12 times per minute
15. Pt with a dislodged trach => Priority is to hyperextend the pt neck (patent airway...) Not 100%
sure about that one but you can look it up or give additional inputs...
16. Pt allergic to sulfa drugs should take Cipro
17. Vecuronium (Norcuron) (neuromuscular blocking agent) is given to a pt who is fighting the
ventilator... => Pt is unable to blink! Administer complete eye care
18. Pt on dilantin => Urine may turn pink, red or brown...
Here's my share:
• BRAT (Banana, rice, apple, toast/tea) - NOT recommended for a child with acute diarrhea (has
low nutritional value, low protein/energy, high carbs)
• SHOCK - elevate lower extremities to improve circulation to the brain and vital organs
• Ct with dementia - reinforce ROUTINE, talk to ct face-to-face
• Barium enema - take slow deep breaths, tell ct stool will be light-colored for 2-3 days after test
• DIC - oozing blood; sepsis is most frequent cause
• hospitalized school-age child = greatest fears are perceived loss of control and separation to
friends/peers
• Licorice - increases K+ loss, DONT take to prevent Digoxin toxicity
• epiglottitis - NEVER insert a tongue blade - gag reflex can obstruct airway
• Dilantin comes in a suspension, SHAKE it!!
So Many Wonderful Tips! Thanks to all who have contributed to this thread!!!!!
* Active aquired immunity consists of immunologic responses that develop as the body is
being defended.
* Rheumatic endocarditis results from rheumatic fever caused by group A streptococcal
infection.
* People with type O blood are more susecptible to peptic ulcers.
* Tagamet is used in tx of peptic ulcers because it inhibits acid secretion.
* Diverticulitis is most often tx with diet and meds.
*The ideal tx for UTI is an antibacterial agent such as trimethoprim-sulfamethoxazole.
* A positive antibody test for HIV means you have been infected with the HIV virus &
your body has produced antibodies.
* AZT ( Zidovudine ) works to fight against AIDS by inhibiting new virus production.

* Herpes Simplex Type I is the virus that causes cold sores on the lips.
* Signs of meningitis include a positive Kernig's sign, a positive Brudzinski's sign ,
headache , fever and nuchal rigidity.
* Varicella Zoster is transmitted by airborne contact.
* Ceftriaxone and doxycycline are used to tx gonorrhea.
* Wear gloves when in contact with excretions, secretions, blood, or any other body fluids.
* Complications of chlamydial infections significantly contributes to the incidence of
ectopic pregnancy.
The secondary stage of syphilis is when the rash appears.
The medication of choice for syphilis is penicillin G benzathine.
Staphylococcous is the organism responsible for most skin infections.
The drug of choice for MRSA is vancomycin.
When assessing a pt. with diarrhea, the nurse should first determine hydration status.
Legionaire's disease is treated most often with ethromycin.
Signs & symptoms of wound sepsis include elevated pulse and temperature, elevated WBCs , swelling,
warmth, and tenderness.
Lesions at the midbrain result in decerebrate posturing.
The motor cortex governs voluntary motion.
Upper motor neurons refer to motor pathways from the brain to the spinal cord.
Destruction or dysfunction of the basal ganglia leads to muscle rigidity.
Most important indicator of increased ICP is a change in LOC.
In adults, most brain tumors origionate from glial cells.
* Tensilon is used in myesthenia gravis to confirm the diagnosis.

* Myesthenia gravis is caused by a disorder in the transmission of impulses from nerve to muscle cell.
* Amyotrophic lateral sclerosis ( ALS ) is a condition in which there is a degeneration of motor neurons in
both the upper & lower motor neuron systems.
* The trend in tx of rheumatoid arthritis is with COX-2 that acts as an anti-inflammatory.
* Paget's disease is characterized by excessive bone destruction, skeletal deformities, and cortical
thickening.
Chicken Pox-tx with Acylovir

Diptheria-tx with diptheria antitoxin, penicillin; erythromycin
Lyme Disease-tx with tetracycline;penicillin
Typhoid Fever-tx with chloramphenicol; ampicillin; sulphatrimethoprim
Expected patient outcomes for a patient with osteoporosis include: has positive self-esteem, experiences

no new fractures, understands factors that contribute to potential injury.
Nursing management of pt.with cerebral aneurysm or intracranial hemorrhage:

use gentleness in moving pt.
keep room darkened
keep pt. on bedrest, HOB at 30 degrees
give no ice water
initiate bowel program to prevent straining at stool
only a few visitors at a time
decrease stimuli, no tv no radio in severe cases
no rectal temperatures, no enemas, no suppositories
Tips on answering nclex-rn questions
Decide What the Question is Dealing With:
Which part of the Nursing Process: Assessment; Analysis; Planning; Implementation or Evaluation?
Next, Decide the Order of Priority First you must decide what part of the nursing process the question is
connected with:
ANALYSIS--is the process of identifying potential and actual health problems. Most identify pertinent
assessment information and assimilate it into the nursing diagnosis. Prioritize the needs that have been
identified during analysis. Some common words that are associated with ANALYSIS questions: diagnose;
contrast; compare; analyze; order; prioritize; define; classify; catagorize; synthesize; sort; arrange;
ASSESSMENT--consists of a collection of data. Baseline information for pre and post procedures is
included. Also included the recognition of pertinent signs and symptoms of health problems both present
and potential. Verification of data and confirmation of findings are also included. Assess a situation before
doing an intervention. Some common words that are associated with ASSESSMENT questions: observe;
gather; collect; differentiate; assess; recognize; detect; distinguish; identify; display; indicate; describe;
PLANNING--Involves formulating goals and outcomes. It also involves various members of the health
care team and the patient's family. All outcome criteria must be able to be evaluated with a specific time
frame. Be sure to establish priorities and modify according to question. Some common words that are
associated with.
PLANNING questions: rearrange; reconstruct; determine; outcomes; formulate; include; expected;

designate; plan; generate; short/long term goal; develop;
IMPLEMENTATION--Addresses the actual/direct care of a patient. Direct care entails pre, intra and
postoperative management, preforming procedures, treatments, activities of daily living. Also includes the
coordination of care and referral on discharge. It involves documentation and therapeutic response to
intervention and patient teaching for health promotion and helping the patient maintain proper health.
Some common words that are associated with IMPLEMENTATION questions: document; explain; give;
inform; administer; implement; encourage; advise; provide; perform;
EVALUATION--Determines if the interventions were effective. Were goals met? Was the care delivered
properly? Are modification plans needed. Addresses the effectiveness of patient teaching and understands
and determines in proper care was offered. Evaluation can involve documentation, reporting issues,
evaluates care given and determine the appropriateness of delegating to others. Most significantly, it finds
out the response of the patient to care and the extent to which the goals we met. Some common words that
are associated with EVALUATION questions: monitor; expand; evaluate; synthesize; determine; consider;

question; repeat; outcomes; demonstrate; reestablish; After determining what part of the nursing process
the question is concerned with, next focus your attention on determining the category of priority: Safe and
effective care environment is always first. Patient safety is related to the proper preparation and delivery
of nursing techniques and procedures as part of the nursing practice. It relates to every aspect of the
delivery of care. Physiologic integrity is the ability to provide competent care Information that may be
described as traditionally medical- surgical and pediatric nursing falls into this category. Specific
questions in this area can be related to many direct-care aspects of nursing practice. The importance of
this area is highlighted because it is one in which planning, implementation and evaluation of care needs
can easily be identified and tested. Physiologic integrity is always a slight lower priority than safety
unless it involves airway, breathing and circulation. "ABC's" always comes first! Psychosocial integrity
tests the knowledge about a patients response to a disease or disorder. An understanding of stress, anxiety
and ways to cope are essential. This is a lower priority the physiological integrity. Health maintenance
deals with health promotion, health teaching, disease prevention and assessment of risk factors for health
problems. Normal growth and development is a major theme in this category. This however, is a low
priority.
In Summary, when choosing the right answer for you NCLEX exam question: 1) ask yourself, "what part
of the nursing process is this question dealing with: analysis, assessment, planning, implantation or
evaluation? and 2) Remember to prioritize your choices: safety always being first, second physiological
integrity, third,psychosocial integrity and health maintenance always has the lowest priority when
choosing an answer.
Other tidbits: avoid choices with the answers "all" "always" "never" or "none". Nothing is ever a definite
in Science. look for answers that are different. If three answers say the same thing but in different words,
choose the answer that is different. when given choices that are pharmacologically based or non
pharmacologically based, choose the non pharmacological intervention. It is more often then not, the
correct answer.
the decelerations during pregnancy get confused in my head. this is what I use to keep them straight. note
the bold text.
early deceleration - fetal head compression (the ear is a part of the head)
late deceleration - uteroplacental insuffiency
variable deceleration - umbilical cord compression
• with urolithiasis avoid wearing synthetic underwear and pantyhoses.

• salt substitutes shouldnt be used by clients with chronic renal failure due to risk of hyperkalemia.
• s/s of epididymitis- scrotal pain and edema, n/v, and chills
SPINAL NERVES cross tracts as opposed to CRANIAL NERVES… if you are paralyzed on the left, your
right brain is screwed up. HOWEVER, if your left eye doesn’t constrict it’s your LEFT BRAIN that’s
screwed up (Get it? Cuz the cranial nerves don’t cross tracts but the spinal nerves that innervate your
skeletal muscles do..)
Most likely for things to go down the Right Bronchus cuz it’s shorter, fatter and more vertical. If after
intubation, there are decreased breath sounds/ decreased lung expansion on the left, it’s probably b/c the
person who intubated put the ETTube down too far, past the carina (where it’s supposed to be) and it’s in

the right bronchus.
Kids with spina bifida are more prone to latex allergies
Pregnant women can not administer Ribavarin (for RSV)
Mumps can lead to male infertility
BNP (B type natriuretic peptide) should be <100, used to diagnose CHF
RAST radioallergosorbent test measures Ig E for latex allergy
6L Nasal Cannula is the most you can give, anything above that really doesn’t improve oxygenation. 1L
NC = 24% Fi02, 2 L = 28%, 3 L = 32% …get it? Keep adding four until you get to 6L = 44% Fi02
Nonrebreather give you the most Fi02, Venturi allows you to give the most precise amount, Face tent is
use with facial trauma/burns
Incentive spirometer – tell patient to inspire, hold, get floater-thing to about 600-900 then exhale.. 10X
per hour awake. Pt must be able to breathe spontaneously and make a tight seal around the mouthpiece.
Yearly Occult blood tests are good to catch colon cancer (I would be hesitant to pick colonoscopy over
occult blood tests).
With Hepatitis, early signs include bone pain (arthalgia) and flu like symptoms
T tube to drain bile. Normal output/day = 500 – 1000cc. Clamp before meals so pt can use bile to digest
food.
With pneumonia, you will hear BRONCHIAL sounds in areas of consolidation.
BiPAP = CPAP and PEEP
ARDS is often unresponsive to increased 02 – intubate. Placing prone may help.
Pancreatitis is a painful inflammatory condition where it's enzymes are prematurely activated and results
in autodigestion. Some of the most common causes are: gallstones, alcoholism, trauma, viral infection,
genetics, etc.
Nursing Priorities:
1. control pain and promote comfort
2. treat/prevent fluid & electrolyte imbalance
3. reduce pancreatic stimulation while maintaining adequate nutrition
4. prevent complications
5. provide client teaching re: disease process, prognosis, treatment needs
Give meds as ordered which usually include: narcotic analgesics, sedatives ( valium, antispasmodics like
atropine ), antacids ( maalox ), may also give Prevacid or Tagamet, etc.
Here are some more:
Levothyroxine (Synthroid)—thyroid preparation. Give at breakfast to prevent insomnia.
Carbamazepine (Tegretol)—interferes with contraceptives. SE: photosensitivity.

Isoniazid (INH)—SE: peripheral neuropathy (administer pyridoxine Vit. B6), rash,
urticaria, and swelling of the face, lips, and eyelids.
Carbamazepine (Tegretol)—prevention of seizures and relief of pain in trigeminal

neuralgia. Trigeminal neuralgia (Tic douloureux) is an agonizing pain that may result in
severe depression and suicide.
Clonidine (Catapres-TTS)—a centrally acting alpha-adrenergic for HTN; SE: drowsiness,

sedation, orthostatic hypotension, heart failure. If patch used be cautious around
microwaves results in burns, dispose of carefully, and heat will increase medication
absorption leading to toxicity.
Autologous blood—may give blood 5 weeks before surgery; can give 2 to 4 units of
blood; may have to take iron pills
Carbidopa/Levodopa (Sinemet)—used to treat symptoms of Parkinson’s disease. Take

immediately before meals and high-protein meals may impair effectiveness of
medication. Reduces rigidity and bradykinesis and facilitates client’s mobility.
Doxycycline (Vibramycin)—a tetracycline taken at regular intervals but not within 1

hour of bedtime because it may cause esophageal irritation. Use another method of
birth control, do not take antacids within 1-3 hours of taking medication, and may
cause photosensitivity.
Albuterol (Proventil)—a bronchodilator. SE: tremors, headache, hyperactivity,

tachycardia. Use first before steroid medication so opens up bronchioles for steroid to
get in. Wait one minute between puffs of the inhalers for best effect.
Beclomethasone (Vanceril)—a steroid . SE: fungal infections, dry mouth, throat

infections.
Topiramate (Topamax)— an anticonvulsant. Should drink 2000-3000ml of fluid daily

to prevent kidney stones. Side effects: orthostatic hypotension, ocular symptoms,
blindness, and decrease effects of hormonal contraceptives.
Propranolol (Inderal)—a beta-blocker may mask symptoms of hypoglycemia
Phenazopyridine (Pyridium)—acts on urinary tract mucosa to produce analgesic or local

anesthetic effects. SE: bright orange urine, yellowish discoloration of skin or sclera
indicates drug accumulation due to renal impairment.
Trimethoprim-sulfamethoxazole (Bactrim)—most common SE : mild to moderate rash

(urticaria)
Aminoglycosides are ototoxic.
Butorphanol Tartrate (Stadol)—analgesic for moderate/ severe pain; SE: change in BP,
bradycardia, respiratory depression.
• Onchyomycosis is a fungal infection of the nail plate.

* Hirsutism is a male pattern of hair growth in women that may be normal or the result of

excessive secretion of androgenic hormones.
* Psoriasis is a chronic skin disease with thickening of both the epidermis and dermis, with scaly,
pruritic, erythmatous plaques.
* A furnucle is an infection of the hair follicle that extends to the surrounding tissue.
* A carbuncle is a collection of infected hair follicles that forms a draining abcess.
* Cellulitis is a diffuse infection of the dermis and subcutaneous tissue.
Some more nuggets:

1) Oligomenorrhia/Amenorrhia - Thyroid Storm/Thyrotoxicosis
2) Menorrhagia - Hypothyroidism
3) PTU, used to tx hyperthy causes leukopenia, agranulocytosis - watch out for sore throat and other signs
of dec. immune sys
4) Addison's pts may need more glucocorticoids (sugar) in times of stress: ie before dental surgery/oral
procedure / surgery
5) Excessive Prolactin causes galactorrhea (excessive milk flow), decreased libido in men, impotence.
Hypophysectomy can help.
6) Incision in a transphenoidal hypophysectomy is made between the gingival mucosa of the upper teeth
and upper lip area. (So btw upper gum and upper lip)
7) S/S Disulfram rxn - flushing, angina, palpitations, vertigo,
8) It is the OCULOMOTOR (CN III) not OPTIC that causes the pupillary changes in increased ICP.
9) Loss of central vision is a sign of macular degeneration
• Macrocytic/megaloblastic anemias are most commonly caused by vitamin B12 deficiency.

Pernicious anemia can be fatal unless vitamin B12 replacement is given.
* Microcytic-hypochromic anemias are characterized by small red cells with insufficient

hemoglobin content. The most common cause is iron-deficiency.
Always taper steroids if taking chronically --> never stop abruptly!
Earliest sign of larynx cancer is hoarseness or change in vocal quality.
If in doubt whether a patient is hyper or hypoglycemic, treat pt for hypoglycemia.
CSF leakage through the nose (rhinorrhea) or through the ear (otorrhea) = increased ICP --> DO NOT
SUCTION!
Positioning for Cleft lip and Cleft palate

Cleft lip - on side or upright in infant seat (not prone)
Cleft palate - on side or abdomen
Transesophageal Fistula (TEF) - esophagus doesn't fully develop (this is a surgical emergency)
The 3 C's of TEF in the newborn:
1) Choking
2) Coughing
3) Cyanosis
Pyloric stenosis - projectile vomiting
Intussusception - "currant jelly" stools (blood and mucus mixed)

Here's One....
A person with eczema is at greatest risk for latex allergy!
Two...
Always see difficulty breathing, swallowing, or person with pain after giving pain med an hour ago
FIRST
Three...
When getting pt out of bed have open end of chair facing the foot of the bed.
Four...
Ausculate S3 and S4 extra heart sounds by turning pt on the left side and using the bell of stethoscope to
listen at apex.
Five...
The more babies out.. its get loose... more prone to hemorrhage
Some pharm stuff I typed from before using the ATI review:
(hope it helps)....
• Hallmark signs of digoxin toxicity  blurred and double vision

• Guaifenesin  can cause drowsiness, so ct should avoid driving…that requires
alertness
• Anticholinergic effect  urinary retention
• Safe to take with albuterol (Proventil) for a ct with cardio disease  spironolactone
(aldactone) =>K+ sparing diuretic that decreases risk of hypokalemia & ECG changes)
• Supplemental thyroid hormone (Levothyroxine) for hypothyroidism will be required
throughout the child’s LIFETIME.
• Severe allergic rxn to Cephalosporins  ct have high incidence of allergic rxns to
PENICILLINS (avoid penicillins)
• Ct receiving Phenobarbital IV for anticonvulsant therapy, interventions include:
 Observing the ct for RR depression
 Monitoring the ct for excessive sedation
 Avoiding extravasation of the parental solt’n
• Sumatriptan (Imitrex) SQ therapy  take medication AS SOON AS MIGRAINE SXS
APPEAR/ATTACK
• Intravenous  fastest, most effective route; deliver the medication directly into the
bloodstream, allowing rapid distribution throughout the body
• Opioid antagonist (Naloxone, narcan)  increase RR, improvement of RR
• Baclofen  improved ability to perform ADLs in spinal cord injury pts (decreases
frequency & severity of MUSCLE SPASMS)
• Erythromycin (Erythrocin)  contraindicated with chronic alcoholism & cirrhosis who
has resp infection (liver toxicity)
• Review insulin drawing in syrine (units)
• Cts taking K+-sparing diuretics should avoid consuming foods that contain high

levels of K+. Salt substitutes are high in K+ chloride content.
• A ct dx with acute MI is tx in an emergency dep’t with alteplase (Activase) which has a
short half-life  must administer drug concurrently with alteplase => heparin (short
half-life opens an occluded artery quicky, reduce risk of reocclusion with heparin)
• 17 yr old ct receiving testosterone (Depo-Testosterone) injections monthly to correct
delayed puberty, monitor use  x-rays of the hand & wrist q 6 mos. (determine rate
of bone maturation, drug can help bone mature w/o producing a compensating gain in
liner growth)
• With renal impairment, there is decreased elimination of atropine => [FONT='Times
New Roman','serif']↑[/font] anticholinergic effects of atropine = confusion
• A diuretic Acetazolamide (Diamox)  contraindicated with SULFONAMIDES
• Hold Metoprolol (Lopressor) dose if client develops DYSPNEA (sign of exacerbation of
congestive heart failure, might precipitate it)
• Progestins (oral contraceptive)  can cause WT GAIN  can increase appetite
• How to use a metered-dose inhaler to administer albuterol (Proventil)
 Hold the inhaler so that drug’s metal canister is inverted
 Release 1 or more test sprays into the air if it’s a new inhaler
 Shake the inhaler before administering a dose
 Rinse mouth with water p the last inhalation
• A pplying a cool, damp cloth to person’s forehead, neck, wrists  helps promote
comfort for pts who are N & V
• Ct taking Allopurinal (Zyloprim) to reduce uric acid level for secretion, must avoid
CORN  tends to acidify urine and might increase the risk of URIC ACID STONE
formation.
• Dry persistent cough  common during 1st wk of ACE inhibitor therapy d/t
accumulation of bradykinin from inhibition of angiotension-converting enzymes
• Giving 2 antiHTNs together  interact synergistically (potentiation) => the effect of
giving both drugs should be greater than that of either administered alone
• Lasix/furosemide  check BP (can cause a substantial drop in BP by decreasing
circulatory volume and by relaxing venous smooth muscle => reduce venous bld
return to the heart)
• Collagenase (Santyl) to tx leg ulcers  within about a week, this ointment will remove
dead tissue so that ulcers can heal
• Immunizations with live vaccines  long-lasting active immunity
• Ct receiving Epoetin (Procrit) to tx anemia, rxn r/t this drug  HA (if hct rises too
quickly, HTN & seizure can result  HA is early sign)
• 2nd cycle of Fertinex for fertility txment  verifies that today’s dose is based on the
ct’s response in the preceding cycle
• Bronchospasm  SOB and hypoxia
• Interaction between Reglan & Morphine  increased SEDATION
• MANNITOL  MUST BE USED WITH EXTREME CAUTION IN CTS WHO HAVE HEART
DISEASE => CHF AND PULMONARY EDEMA
• Benadryl  DON’T USE SLEEPING PILL (avoid CNS depressants to could increase
sedation)
• Life-threatening rxn to GAMMA GLOBULIN = chest tightness,
bronchoconstriction, angioedema, hypoTN  anaphylaxis
• Nurse to apply sulfamylon to burn injury:

o Administer the PRN analgesic 30mins before applying (for pain, b/c it is painful)
o Apply p daily tubbing (to remove old previously applied cream)
o Monitor f&e & acid base balance
o Sched wound care at least 1hr before meals (time to recover)
• Thrombocytopenia = platelet count <150,000/microleter
• Cyclosporine (Neoral)  mix the drug with milk/juice to increase taste/palatability
• Hexachlorophene (phisohex)  harmful for breastfeeding
• Review PEDS calculations (with kg)
• Gold salt therapy on rheumatoid arthritis  slows progression of disease
• Uric acid  should be monitored prior to and periodically throughout therapy with
thiazides and related diuretics (hyperuricemia is one or more common SE of thiazides)
• Simvastatin (Zocor) required lab test during therapy  Creatine kinase
Ct who has most risk factors for depression  35 yr old single FEMALE (living alone,
ages: 25-44)
• The public health nurse provides health care to a single population of ppl. The
primary difference between PHN & Occupational & School health nsg is that O&S are
limited to one geographic setting and one subpopulation (type) of ct
• Adult day care centers  provide temporary care for elders who live at home with
family/friends, but need supervision & help during workday
• LBW Baby consumed cow’s milk before 6 months of age  iron deficiency anemia =>
get hgb level
• To achieve complete eradication of Hepatitis B  required immunization of all infants
& children
• Family  1 or more individuals possess some common emotional bond
• Ethnicity  group of ppl who share common, distinctive characteristics such as race,
ancestry, nationality, language, religion, food preferences, hx
• Medicaid  administration falls to STATE govt’s
• Healthy ppl 2010  set of health goals for aggregates; rationale is that our society
can little afford the cost of tx preventable diseases and injuries
• Early crisis  w/c can last from moments to days, rxn is primarily emotional;cts
express shock, disbelief, numb, panicky, cant cope
• Public Health Dep’t  PHN focus is the health of the community. During a home visit,
will provide education & referrals for specified problems that impact the health of the
community
• Occupational health nurse  work for businesses & industries to support employee
health (eg; job related injury)
• Breast self-exam  14-19yrs (must begin in high school)
• The most basic and important action for nurses in providing culturally competent
care  confront own racism & ethnocentrism (if the nurse isn’t aware of his/her own
culture, biases and prejudices, it’s not possible to competently assess and
communicate with indiv of other cultures)
• When designing maternal-infant programs and services in a community, most
important consideration  developmental level of the groups being served (to identify
needs of specific aggregates for whom services are intended (adolescents, career
women, migrants).

• Understanding of the developmental tasks & psychosocial issues of each
population should be the cornerstone of a well-developed program.
• Compared to younger ppl, it is even more important for interventions targeted to the
elderly to promote physical exercise (People aged 65yrs and older are less likely than
younger ppl to exercise)
• A female student comes to the school nurse’s office to express concern about a
“friend” who induces vomiting in the BR p lunch q day.  nurse must continue to
assess for other signs that might indicate a mental disorder.
• The best way to evaluate the success of a campaign to increase the # of
immunizations in a school district is to  compare the # of children in the district who
were immunized during the past year to the # immunized in the preceding year.
• Common aspect of both elder abuse & child abuse  victims are usually dependent
on the abuser
• Rural American group  have an uninsured or underinsured status
• Single most prevalent health problem among the homeless  ALCOHOLISM
• Denver II test  overall dev’t status can be appropriately screened during bith to 6
yrs (revision of the classic Denver Devt’al Screening Test)
• Highest risk of dying from severe burn injury  toddlers (1-9yrs)
• An intervention to address alcohol/drug abuse at the level of subgroups within a
community would be to  provide a support group for employees who are recovering
from alcohol or drug abuse (the support group constitutes a sub-group within the
community; the intervention is targeted for just those ppl)
• EMPOWERMENT  CITIZEN PARTICIPATION
• Women expected to live 6yrs longer than men b/c  Men are less likely than women
to obtain preventive physical exam (women more likely to engage in health
maintenance)
• OSHA  regulation of potential hazards in the workplace
• Salmonella  properly store & thoroughly cook eggs and poultry
• E coli  raw beef; wash hands
C.jejuni  drink only chlorinated drinking water
ere's some more Community Facts: (sorry if they're too long.....)
• Erikson’s Generativity vs. Stagnation  middle adults (>40y) guide and care for the
younger generation and assist the older one
• Neonate should gain 0.5-1 oz (15-30g/day)
• Serum lead [c] = 16mg/dL and been above 10mg/dL for several months 
investigate the child’s environment
• (+) reaction to tuberculin skin test  induration (hardening) larger or equal to 15mm
in a person >4yrs who has not risk factors for TB
• Pertussis  vaccine composed of INACTIVATED bacteria
• Disaster  cannot be relieved without assistance (that’s why disaster preparedness is
important)
o OUTSIDE AREA  area not directly affected by the disaster but can offer assistance
• Community competence  parts of community (org, groups, aggregates) collaborate
effectively in identifying the problems & needs of a community, achieving similar goals
and priorities

• Behavior or lifestyle  greatest effect on the health of a community as a whole. This
underscores the importance of primary prevention.
• Nursing strategy for HOMELESS:
o Using reflective statements that convey an understanding of situation
o Accepting the political commitments essential for advocacy for homeless cts
o Focus on primary prevention (identify other educational, placement, and legal
services that they can’t access)
• Hospice  focus of care is COMFORT for individual facing death
• Evaluation in community assessment barrier  setting goals that are unrealistic or
inappropriate tend to break down progress rapidly
• Morbidity stats  reflect the extent and distribution of illness and disability in the
community
• Prevalence rate  # of old & new cases of specified disease
• Incidence rate  # of NEW cases of a specified disease within a pop
• Older smokers who try to quit smoking are MORE LIKELY to stay off cigarettes.
• Older adults might be at risk for POOR NUTRITION  loss of dentition (or poor fitting
dentures interfere with biting/chewing)
• Nurse refers client to inappropriate health care provider  making negligent referral
• Secondary prevention  working with person in affected pop (ppl experiencing
effects of violence and ensuring safety)
• Providing doc of physical evidence in a case of suspected physical/sexual abuse 
use body mapping & photographs in addition to written doc
• Boy fell forward in the ground  Fracture of the forearm
• Physical exercise  greater energy reserve
o Does NOT change person’s perception of stress
• Immunization in order:
o Hepatitis B
o DTaP, Hib, IPV, PCV
o Influenza
o MMR and varicella
• HIPAA  to protect workers from losing health care coverage with a job change or
loss
• Nicotine  GATEWAY for substance abuse
• SIDS  "back to sleep"
• Tertiary prevention  helping a ct with asthma use an inhaler (long-term & chronic)
• Secondary prevention  giving first aid for injuries sustained during activities
• Enviro-mechanical hazards in the workplace:
o Inadequate lifting device (risk for injury)
o Excessively cluttered work areas
o Slippery floors
o Poor workstation-worker fit
• Ethnocentrism  belief that one’s own ways are the best, most superior
Ok for those of you who did not take Kaplan, this is their infamous Decision Tree
(Can't say I use it a lot, but some swear by it)

1. Can you identify the Topic?
Yes= proceed to step 2
No= read answers for clues, read stem, re word question
identify and proceed to step 2
2. Are all answers Assessments or Implementations?

Yes= proceed to step 3
No= determine from stem if assessment needed, validation needed; if so assess
*if no assess in stem then you need to assess
*if assess in stem, do you need validation?
*if assess or validation required and there are no right assess answers, then implement
3. Does Maslows fit?

Yes= Do they make sense? Apply ABC's.
*eliminate psychosocial/pain (consider pain psychosocial for nclex)
*don't always pick airway
No= are all physical? yes..then proceed to step 4
are all psychosocial? yes..then proceed to step 5
4. Are all answers physical?

Yes= apply ABC's
No= proceed to step 5
5. What is outcome of each?

do they make sense?
why?
and yes folks then you should have your answer!!!!
INFECTION CONTROL
Airborne Precautions:
Varicella
TB
Rubeola
pt must wear mask when transporting
Droplet Precautions:
Mennigittis
Pneumonia
Pertussis
Rubella
Mumps

private room unless other pt has same organism
maintain 3 feet distance unless giving care
Contact Precautions:
RSV
Synctial virus
C Diff
MRSA
Ecoli
Scabies
Impetigo
Room needs to be private unless same organism
gloves/gown when in contact with secretions
Standard Precautions:
CF
Bronchitis
Hantavirus
Tonsillitis
Cutaneous Anthrax
For airborne, make sure the patient is in a room that has negative air pressure with at least
6-12 exchanges an hour, and N95 mask for TB.
Also remember MTV Cd for airborne: Measles (Rubeola), TB, Varicella (Shingles), Chickenpox,
Disseminated varicella zoster.
Piaget is known for cognitive development.
Freud veiws anxiety as a warning to the person of impending danger.
Vitamin B1 deficiency is linked to Korsakoff's syndrome.
Korsakoff's syndrome is associated with ataxia, confabulation, and myopathy.
A liver that is tender on palpation is suggestive of viral hepatitis.
The inability of diseased liver cells to clear normal amounts of bilirubin from the blood is found in
hepatocellular jaundice.
Hepatitis B has an incubation period of 2-5 months.
Patients with renal disease need to be monitored for potassium imbalances especially hyperkalemia. The
primary method of treating hyperkalemia is with hemodialysis.
Here are some I've found while studying:
Approximately 2 weeks after starting pt on antidepressants, assess for increased energy, could be sign of
suicidal ideation
If you believe pt to be in respiratory detress, assess lung sounds first, LOC, retractions, skin color, etc
would all be late signs

if dealing with a pt that is hallucinating, ask pt what voices in head are saying to assess for presence of
command hallucinations
Bi-polar pt in mania phase will be full of energy, difficulty sitting still, provide finger foods as well as
private room
Chest tube water seal chamber should fluctuate with breaths, this is normal
Chest tube should not bubble, this could be sign of air leak
Trach balloon should be inflated any time there is any risk of pt aspirating (ie eating, increased
secreations, when getting tube feeds, on vent, and 30 min after eating)
When changing trach ties, remove old ties with non-sterile gloves, then put on sterile gloves to apply
clean ties
With a pt receiving tube feeds, only fill bag with enough feeds for 4 hrs, and assess for residuals every 4
hours
Cystic Fybrosis pt---Contact and Droplet precautions, pt must wear mask if leaving room
Avoid asking "why"
After administering Fosamax, instruct pt to remain sitting up for 30 min
Never palpate a Wihlm's Tumor, could cause cancer cells to break off
When doing adominal assessment, auscultate, then palpate, Palpating first will alter bowel sounds
When instilling eye drops into the lower conjunctival sac hold the dropper 1 to 2 cm ( 0.4 to 0.8 inches )
above the sac.
Discolored amniotic fluid such as green is a sign of fetal distress.
Placenta previa = painless bleeding. No vaginal exams.
After the rupture of membranes, the babies heart is checked then rechecked a few minutes later or after
next contraction.
In the Apgar score, the first time done reflects the transitional score, the second Apgar score reflects the
planning of care for the newborn.
Score over 7, baby is ok but score under 5 needs resuscitation or intensive care.
Hep.B vaccine given within 12 hours of birth.
Anterior fontanelle closes at 12 to 15 months.
At 7-12 months they are aware of themselves and can imitate. Be sure toys have no small pieces. Should
be weaning from bottle to sippy cup by 12 months ( 1 year ).
At 10 to 13 months walks while holding on to furniture and can stand ok.

At 2-3 months they should be able to smile and follow objects.
Anaphylactic reaction to baker's yeast is contraindication for Hep B vaccine.
** Ask for allergy to eggs before Flu shot

** Ask for anaphylactic rxn to eggs or neomycin before MMR
** When on nitroprusside, monitor thiocynate (cyanide). Normal value should be 1, >1 is heading toward
toxicity
**If kid has cold, can still give immunizations
**SARS (severe acute resp syndrome) airborne + contact (just like varicella)
** Hepatitis A is contact precautions
** Tetanus, Hepatitis B, HIV are STANDARD precautions
** William's position - Semi Fowlers with knees flexed (inc. knee gatch) to relieve lower back pain.
** SIGNS of a Fractured hip: EXTERNAL ROTATION, SHORTENING, ADDUCTION
** Fat Embolism: Blood tinged sputum (r/t inflammation), inc ESR, respiratory alkalosis (not acidosis r/t
tachypnea), hypocalcemia,increased serum lipids, "snow storm" effect on CXR.
**Complications of Mechanical Ventilation: Pneumothorax, Ulcers
** Paget's Disease - tinnitus, bone pain, enlargement of bone, thick bones.
** NO VITAMIN C with Allopurinol
** IVP requires bowel prep so they can visualize the bladder better
**Acid Ash diet - cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread
** Alk Ash diet- milk, veggies, rhubarb, salmon
** Orange tag in triage is non emergent Psych
** Greenstick fractures, usually seen in kids bone breaks on one side and bends on the other
Gout- a build up of crystals of uric acid (Kidney stones) depositing in tissues of the body. Tx: adequate
fluid intake, reduce alcohol, medications that reduce hyperuricemia, and diet changes like decrease in
foods that contain purines( organ meats, seafood etc.)
Moxifloxacin, can cause inflamed and ruptured tendons, so assess for tendon swelling and pain
Steroids can increase gastric secretions, increasing your risk of gastric ulcers and GI bleeds, so try to
avoid asprin
Letrozole is used to treat advanced breast cancer, skeletal and bone pain is a common side effect
Lopressor and other Beta adrenergic blockers can commonly cause impotence
When administering chemotherapy, remember to wear gloves, eye protection, and a mask that covers both
your mouth and nose
Mg toxicity, assess for loss of deep tendon reflexes, respiratory depression, drop in heart rate and blood
pressure, and a sudden drop in fetal heart rate
Klonopin, pt will experience clumsiness and unsteadiness early in therapy, should disappear with long
term use
Rifampin and INH, take together on empty stomach for maximum absorption

Administer Haldol and anti-Parkinson medications at same time to decrease risk of extrapyramidal effects
of the Haldol
When instructing a pt on how to hold a cane, it should be at the level of the greater trochanter and femur,
on the good side
When administering an enema, position the pt in a left Sims position. Do not elevate the head of bed
Tinnitus, most common symptom pts experience with inner ear disorders
Administering ear drops in a child, pull down and back on ear lobe
In adult, pull up and back on auricle. Instruct pt to keep head up for 10-15 min after administering drops
An isolated warmer area in the middle of a cast could be indicative of infection
PVC's are concerning of there are greater than 6 per min, if they occur in pairs, are multifocal, or if the
fall on the T wave
Niacin, used to treat hyperlipidemia
Antiparkinson drugs, monitor for urinary retention, hypotension
Synthroid (for hypothyroidism), should only be given in the morning because of it's risk of causing
insomnia if given at bedtime
Hyperthyroidism (Grave's Disease)---things speed up, monitor for tachycardia, nervousness, insomnia,
weight loss, bulging eyes, diarrea, sensitive to heat
Hypothyroidism (Myexedma)--things slow down, weight gain, constipation, decreased activity level,
bradycardia
Incontinence is normal with aging--not a prob
Lymes is found mostly in Conneticut
Cervical cancer--hx of many sexual partners--risk factor
Breast cancer--hx of young menstural age and oral contraceptives for 8yrs
Asthma and Arthritis--swimming best
Asthma has intercostal retractions--be concerned
Braxton hick contractions in pregnancy are normal--it's when the stomach is tensed and relaxes
Post pituitary hormones--oxytocin, vasopressin, and ADH

Ant pituitary hormones--growth, TSH, ACTH, LH, and FSH
Water heater temp should be set no higher then--120 degrees--children precautions
DKA--300-600

HHNKS--600-1200 Blood sugars
CVP normal range 3-12
Transition phase of labor--shallow resperation (pant)
PCA--patient controlled analgesics--itching is common side effect
S3 vetricular gallop is early sign of HF
Inflow and Intake recorded seperately
Cystic fibrosis--both parents carry recessive trait, an autosomal recessive trait
Nephrotic syndrome--complication--venous thrombosis
placenta previa--c-section
FVO-fluid vol overload--rales and inc Pulse
Cystic fibrosis--pos sweat test=replace enzymes and inc salt intake

a resp and GI disease
Hartavirus Pulm syndrome--assess for s/s of thrombocytopenia

--caused by rodents
IOP--intra ocul pressure--10-21mm/hg
Vitamin
B-12 ==anemia
B-1 ==alcohol
B-9 == folic acid
B-6 ==TB
Synthroid in morning to prevent insomnia
Tardive Dyskinesia - irreversible - involuntary movements of the tongue, face and extremities,
may happen after prolonged use of antipsychotics
Akathisia - motor restlessness, need to keep going, tx with antiparkinsons meds, can be
mistaken for agitation.
Schizophrenia - disturbances in affect, mood, behavior, & thought processes. " do not go along
with the delusions or hallucinations", set limits on the persons behavior when it interferes with
others & becomes disruptive.
Protein and vitamin C are necessary for wound healing.
Poultry and milk are good sources of protein. ( to name a few )

Broccoli and strawberries are good sources of vitamin C. ( to name a few )
Normal serum creatinine level is 0.6 to 1.3 mg/dl. The person with mild renal
insufficiency would have a slightly increased level. Levels of 3.5mg/dl means possible
acute or chronic renal failure.
Theophylline increases risk of digoxin toxicity and it decreases effects of both lithium and
dilantin. Barbituates decrease the effects of theophylline.
If the question asks for an immediate action/response, all options might be correct so select
the answer based on priorities.
Capsules & sustained release meds are not to be crushed.
After cataract surgery the person should not sleep on the operative side.
After liver biopsy the person is instructed to lay on their right side.
When giving an enema place the patient in left laying Sim's position so the enema can flow by
gravity in the natural direction of the colon.
After a craniotomy keep head of bed ( HOB ) elevated 30 degrees to 45 degrees.
When drawing an ABG, you need to put the blood in a heparinized tube, make sure there are no bubbles,
put on ice immediately after drawing, with a lable indicating if the pt was on room air or how many liters
of O2.
Remember to preform the Allen's Test prior to doing an ABG to check for sufficient blood flow
Before going for Pulmonary Function Tests (PFT's), a pt's bronchodilators will be with-held and they are
not allowed to smoke for 4 hrs prior
For a lung biopsy, position pt lying on side of bed or with arms raised up on pillows over bedside table,
have pt hold breath in midexpiration, chest x-ray done immediately afterwards to check for complication
of pneumothorax, sterile dressing applied
For a lumbar puncture, pt is positioned in lateral recumbent fetal position, keep pt flat for 2-3 hrs
afterwards, sterile dressing, frequent neuro assessments
EEG, hold meds for 24-48 hrs prior, no caffeine or cigarettes for 24 hrs prior, pt can eat, pt must stay
awake night before exam, pt may be asked to hyperventilate and watch a bright flashing light, after EEG,
assess pt for seizures, pt's will be at increased risk
Diamox, used for glaucoma, can cause hypokalemia
Dexedrine, used for ADHD, may alter insulin needs, avoid taking with MAOI's, take in morning
(insomnia possible side effect)
Cytovene, used for retinitis caused by cytomegalovirus, pt will need regular eye exams, report dizziness,
confusion, or seizures immediately
INH, used to treat and prevent TB, do not give with dilantin, can cause phenytonin toxicity, monitor

LFT's, give B6 along with, hypotension will occur initially, then resolve
Rifampin, for TB, dyes bodily fluids orange
If mixing antipsychotics (ie Haldol, Throazine, Prolixin) with fluids, med is incompatible with caffine and
apple juice
Haldol preferred anti-psychotic in elderly, but high risk extrapyramidal side effects (dystonia, tarditive
dyskinesia, tightening of jaw, stiff neck, swollen tongue, later on swollen airway), monitor for early signs
of reaction and give IM Benadryl
Risperdal, antipsychotic, doses over 6mg can cause tarditive dyskinesia, first line antipsychotic in
children
Levodopa, for parkinsons, contraindicated in pts with glaucoma, avoid B6
Sinemet, for parkinsons, contraindicated with MAOI's
Hydroxyurea, for sickle cell, report GI symptoms immediately, could be sign of toxicity
Zocor, for hyperlipidemia, take on empty stomach to enhance absorption, report any unexplained musle
pain, especially if fever
Cushing Syndrome:
salt, sugar, stress is UP
Addison's:
salt, sugar, stress is down
Hypocalemia, Hypomagnesia, and Hypokaleia, all increase risk of digoxin toxicity
Ulcerative colitis, frequent liquid stools, contain blood, affects rectum and left colon
Chrohn's---diarrhea, contains fat, affects ileum and right colon
Remember McBurney's Point (pain between umbilicus and right iliac crest) when assessing pts with
appendicitis
Appendicitis, no hot packs, may have ice to alleviate pain, no pain meds (may mask rupture)
Hirschsprung's disease, infant fails to pass meconium, abd distention, caused by obstruction in intestine,
will get colostomy, that is usually reversed when child is 17-22 lbs.
Aside from monitoring the vital signs of a pt. post-tonsillectomy check for frequent
swallowing which could be a sign of post-op bleeding.
Trach cuffs should be deflated & reinflated periodically to prevent necrosis of trachial tissues.
Post tonsillectomy/adenoidectomy no straws!
Monitor the daily weight if pt. taking Lasix.

Post-thyroidectomy, monitor for s/s of airway obstruction; hemmorhage (be sure to check behind client's
neck, as bandage may appear clean when severe bleeding may be draining underneath); thyroid storm;
tetany; and recurrent laryngeal nerve damage
Chvostek's Sign - Test which reveals spasm of the facial muscle when the face is tapped over the facial
nerve, in the area of the parotid gland - positive results may indicate hypocalcemia, acid-base imbalance,
or reaction to a blood transfusion
Trousseau's Sign - A carpopedal spasm that occurs when a blood pressure cuff is inflated above the
client's SBP and left in place 2-3 minutes - an indication of latent tetany, which may indicate
hypocalcemia (although it is a less sensitive test than Chvostek's)
Mannitol (Osmitrol): A hyperosmotic agent that increases intravascular pressure by drawing fluid frin
the interstitial spaces and from the brain cells (monitor renal function)
Corticosteroids: Stabilize the cell membrane, reduce the leakiness in the blood-brain barrier, and
decrease cerebral edema (clients must be withdrawn slowly from corticosteroids to prevent adrenal crisis)
Antihypertensives: May be required to maintain cerebral perfusion at a normal level (notify physician if
BP range below 100 or above 150)
Antipyretics and Muscle Relaxants: Temperature reduction decreases metabolism, cerebral blood flow,
thus ICP; muscle relaxants prevent shivering
Anticonvulsants: May be given prophylactically to prevent seizures, which increase metabolic

requirements, thus increasing ICP
IV Fluids: Administered via IV infusion pump to control the amount of fluid administered (NO
HYPERTONIC SOLUTIONS are given, due to the risk of promoting additional cerebral edema)
Erikson's Stages
birth to 18 months = trust vs. mistrust
18 months to 3 yrs = autonomy vs. shame & doubt
3 yrs to 6 yrs = initiative vs. guilt
6yrs to 12 yrs = industry vs. inferiority
12 yrs to 20 yrs = identity vs. role confusion
20 yrs to 35 yrs = intimacy vs. isolation
35 yrs to 65 yrs = generativity vs. stagnation
65 yrs to death = integritiy vs. despair
Dumping syndrome happens most often after gastric resection. s/s occur approx. 30 minutes
after eating, nausea & cramping, feeling of fullness, diarrhea, palpitations, tachycardic,
sweaty, weak & dizzy, gas!
Diet 4 this is: high protein, high fat, & low carbs, tell pt to eat small frequent meals and lay
down after eating & avoid sugar and salt.

Poisoning
Prevention is the key! Treat the patient, then the posion!
Contraindications to vomiting: danger of aspiration or aspiration pneumonia (diminished gag

reflex), decreased LOC, ingested lighter fluid or kerosene, ingested drain cleaner
Aspirin poisoning: symptoms include tinnitus, change in mental status, increased temp,
hyperventilation (resp. alkalosis), bleeding issues (decreased platelet aggregation)
Tylenol poisoning: symptoms include n/v, hypothermia (if NO treatment --> major danger-liver
damage). Mucomyst is the antidote for tylenol poisoning.
Lead toxicity (AKA plumbism): symptoms include lethargy, decreased activity, increased ICP
(seizures), diagnostic tests include blood lead level (>9 mcg = toxic), xray of long bones (will
show lead deposits)
Lead can be ingested --> pica-eating of non-food items such as chalk, dirt, lead, paint
Hazardous wastes: if chemical poses a threat to the patient, decontaminate first! If chemical
poses no threat or patient is contaminated, then begin care. If immediate threat to life, put on
PPE and stabalize patient!
Disaster Planning: do greatest good for greatest number of people

Resources used for patients w/ greatest probability of survival
Triage-order treated:
Red-unstable (SOB, bleeding)
Yellow-stable, can wait (brooken bone, burn)
Green-stable can wait longer ("walking wounded"-sore back, hang nail)
Black-unstable, probably fatal (fatal injury, less likely to survive)
DOA -dead on arrival
External radiation:
Leave markings on skin, avoid use of creams, lotions, check skin for redness, cracking
Internal radiation:
Sealed source --> lead container and long-handled forceps in room, save all dressings, bed linen
until radiation removed; urine and feces not radioactive, don't stand close or in line with source,
patient is on bedrest while implant is in place
Unsealed source of radiation --> all bodily fluids are contaminated --> greatest danger 1st 24-96
hours. Time and distance is important, private room, sign on door, nurse wears dosimeter film
badge at all times, limit visitors and time spent in patient's room, rotate staff
For an ear exam:

adult --> pull up and back
child --> pull back and down
(remember it like the alphabet --> b, child, d)
Cranial Nerve Disorders

Trigeminal Neuralgia--stabbing, burning facial pain, facial muscle twitching

Bell's Palsy--(7th cranial nerve)-inability to close eye, increased lacrimation, distorted side of
face
Acoustic Neuroma--deafness, dizziness
Tetrology of Fallot
Tetra means four so it consists of four defects:
pulmonary artery stenosis
hypertrophy of right ventricle
venticular septal defect
overriding of aorta
Dx of Tetrology of Fallot is done by chest x-ray that shows a typical boot shaped heart.
An echocardiogram, 3 dimentional echocardiography, & cardiac cath help to confirm
diagnosis.
s/s of TOF include: " blue spells or tet spells " relieved by having child squat. Murmur may
be present. Poor growth, clubbing of fingers.
1) Detached Regina - curtain being drawn over field, floaters, must patch BOTH EYES !
2) Cataracts - decreased Color vision, Cloudy, better vision with dim light (pupil
dilation)
3) Glaucoma - halo around lights, decrease peripheral vision, intraocular pressure >
22mmHg. They see better with light. COAG (chronic open angle glaucoma has little to
no symptoms, pressure in the eye gradually increases 30-50mmHg), while acute closed
angle glaucoma has sudden pain and the pressure in the eye is usually higher ( 50 - 70).
4) Ishihara chart - to assess color vision (specifically red -green blindness)
5) Post op stapedectomy - vertigo, nausea, vomitting is expected
Contraindications to immunizations:
Flu-= allergy to eggs
MMR=allergy to neomycin, pregnancy
HepB= allergy to yeast
IPV= allergy to strptomycin,polymycin,neomycin
Varicella=allergy to gelatin, untreated TB, HIV, pregnancy
Hep A= allergy to alum
SOme more.......
PT to be put on streptokinase ask if they had a recent strep infections, med won't be as effective
Caution with the "Mycins" for pt with Multiple Sclerosis, Myasthenia Gravis, THESE EXACERBATE
MUSCLE WEAKNESS

Management for sprain:
R- Rest
I - Ice
C -Compression
E - Elevate
Management for Sickle Cell Crisis: (In order of PRIORITY)
H - Hydration
H - Heat
O - Oxygen (why? coz if you give oxygen before hydration it doesn't make sense at all since hydrating
the client would prevent further clumping of RBC's thus increasing oxygenation)
P – Pain
Renal Function:Norms
BUN = 8 to 25 mg/dl
Serum Creatinine = 0.6 to 1.3 mg/dl
Creatinine Clearance = 100 to 120 mL per minute
Serum Uric Acid = 2.5 to 8.0 mg/dl
Urine Uric Acid = 250 to 750 mg/ 24 hours
Normal activated partial thromboplastin time ( APTT ) is 20-36 seconds

At theraputic levels, heparin will increase this by 1.5 to 2.5 times the normal
If the APTT is over 80, dosage needs to be reduced
Heparin is for prevention of DVT/thromboembolism
Coumadin monitored with PT & INR

Average PT is 9.6 to 11.8 seconds coumadin makes these numbers longer
The higher the number the greater the chances of bleeding
Normal INR is 1.3 to 2.0 a theraputic INR for most patients will be 2 to 3. Some pts. it
may be ok to go higher
When performing a heel stick, put thumb over walking surface of the heal, strike later aspect of heal, wipe
of 1st drop, don't smear, streak or sqeeze area (due to high ECF in infants)
~ Before infant feeds, insert gloved hand into mouth to assess palate.
~ Head circumference should be 2cm > than chest when born, but equal by 1 year.
~ Skin tags and low set ears in infants - suspect chromosomal abnormalities
~ Circumoral cyanosis in infants - see if it improves with crying. If it doesn't , report it cuz it might
indicate cardiac pathology.
~ Toilet Training - when kid can communicate need to go (non verbal or verbal), holds on to please mom
and doesn't let go to please self, sphincter control 18 months - 24 months (myelination of the cord is
complete now), motor skill. Ability to stay dry for 2hours, can sit still on toilet for 5 - 10 mins without
fussing, curiousity about older people's habits. No right or wrong time !

~ 1 TABLESPOON per year of age = a serving (so 2 year old's serving is 2 tablespoons or an ounce)
~ Toddlers should be drinking 3-4 cups of milk max, need to make sure they get nutrients from other
foods.
~ Infants need 110kcal/kg/day
~ Breast milk has 20 kcals per ounce (so 20 kcal per 30 cc)
~ Breast milk has everything BUT slightly deficient in Vitamin D
Pleural Drainage System:

Bottle 1 = Drainage= No bubbles
Bottle 2 = Water Seal = Intermittent bubbles
Bottle 3 = Suction= Continuous bubbles
Mental Health:
Language & Communication
NEOLOGISM = a new word made up that has meaning only to the patient
ECHOLALIA = repeating of words or phrases they heard someone else say
WORD SALAD = form of speech in which words & phrases are connected without any meaning
MUTISM = absense of verbal speech
CLANG ASSOCIATION = repeating of words & phrases that are similar in sound but not in any
other way ( Dr. Seuss type of speech )
Defense Mechanisms:
Compensation = putting extra effort to achive in areas of real or not-real weaknesses
Sublimation = replacing of an unacceptable need, attitude or emotion with one that is more
accepted
1. Widening pulse pressure is a sign of increased ICP

2.Pt taking Digoxin should eat a diet high in potassium (hypokalemia-> dig
toxicity)
3.Key sign of PUD... hematemesis which can be bright red or dark red with the
consistency of coffee grounds
4.Common symptom of Aluminium hydroxyde: constipation
6.Diuretic used for intracranial bleeding, hydrocephalus (Increased ICP,...)
MANNITOL (osmotic diuretic)
8.cystis fibrosis==> excessive mucus production, respiratory infection
complications,...
9.Cholelithiasis causes enlarged edematous gallbladder with multiple stones
and an elevated bilirubin level.
10.Fat embolism is mostly seen in LONG BONES (femur,...) HIV QUICK NOTES:
Transmission thru contact with body and oral fluids
Primary symptoms: Flu like, progressive weight loss, decreased CD4 count
High risk: IV drug users,multiple sexual partners,contaminated blood prdcts, perinatal
transmission

Diagnostics:
1. ELISA detects dvpt of antibodies. test is positive or negative
2. Western blot detects HIV infection and viral load. It confirms positive or negative
CD4 and viral load levels indicate response to treatment.
Management:
Antiretroviral- taken daily and on time to avoid replication and mutation
megace for apetite stimulation
immunization against disease is encouraged
small frequent high calori meals. PLASTIC UTENSILS USED instaed of metal ones to avoid
altered food perception not to prevent spread of disease.
Confidentiality a must, periodic evaluations, lab works always
Paracentisis is most commonly used to drain peritoneal fluid caused by ascites, they check the
fluid for microorganisms, cell count, specific gravity, and protein. Ascites can cause abdominal
discomfort/pain and may also cause some respiratory distress so the paracentisis can help
alleviate that as well.
Care of T-tubes:
make sure it is closed to gravity drainage system. avoid any kinks, clamping, or pulling of tube.
expect 300-500 ml of bile during first 24 hours. monitor color of urine & stools which will be
light colored changing gradually to normal coloring ). assess for s/s of peritonitis, assess skin
around t-tube; clean often & keep dry.
Nursing mgt/teaching for home care;

1. wash hands before and after
2.use humidifier/nebulizer for extra moisture.Drink lotsa fluid
3. Avoid OTC cough meds as they dry out airway
4.For suctioning: 4-5 deep breaths before inserting sucionng catheter. do not suction more than 10 sec. Do
not suction more than 3 times per session. Wait 5-10 minutes between sessions
5. CAtheter care: clean catheter in hot soapy water,rinse with tap water. soak in 50:50 water and vinegar
for 1 hr and rinse with saline solution. Dry in clean covered container. Wash suction tube daily with
hot,soapy water.
6. May use thin vaseline coat outside stoma t prevent crusting.
7. Stoma can be covered with ccarf, gauze when bathin, no swimming.
8. pt loses sense of smell and taste, so dental care and smoke detector are a must.
And....
Esophageal speech 101: Pt swallows air into her esophagus and she burps up the air at the moment of
articulation.
Cast Care:
Nursing Assessment:
Neuro check to areas below/distal to cast and above, compare
report absent or diminished pulses, cyanosis, blanching, coldness, lack of sensation, unable to
move toes or fingers, any swelling
check for odor that may indicate infection
report all complaints of numbness/tingling or burning sensations
check for bleeding and " hot spots " that can signal inflammation under the cast
teach pt. to wriggle fingers/toes
elevate affected extremity to reduce swelling and for pain control
apply ice if ordered

The first step in decontamination is the removal of the pts clothing &
jewelry & rinsing the pt with water very well.
Those with symptoms of anthrax who have been in a hot zone should be
given 60 days of prophylactic antibiotic therapy.
The pt who is returning to the unit post-lumbar spinal fusion should

be kept flat in bed.
Pituitary Gland = Master Gland ; the anterior lobe secretes, TSH,

ACTH, FSH, LH, GH or somatotropin and LTH or prolactin.
Amputation Care:
* provide routine post op care
* prevent contractures,i.e in above the knee amps, do not keep leg up
after 24 hrs
* avoid letting pt sit too long with hips flexed
* have pt lay prone several time a day & position hip in extension,
unless otherwise ordered
* do not elevate stump longer than 24 hrs unless otherwise ordered
* give pain meds
* stump bandages should be tight to promote prothesis fitting
* initiate active ROM when ordered
* provide stump care: look daily for signs of skin irritation, wash
daily with warm water and bacteriocide soap then rinse and dry well,
do not use irritating stuff like lotions, powders or alcohol.
PACEMAKER TEACHING:
*fundamental cardiac physiology
*daily pulse check for 1 full minute
*report any sudden slowing/speeding up of the heart rate
*importance of following up with weekly monitoring during first 1-2 months after
placement & at anticipated battery depletion time
*wear loose fitting clothing around area with pacemaker
*call doctor if develop pain/redness over site
*no heavy contact sports
*carry ID card/medic alert braclette with info on model of pacemaker, rate set at, and
manufacturer
*remind of need for periodic hospitalization for battery changes or possible unit
replacement
Blood Transfusion Reactions:

* chills * sweating * thready, rapid pulse * pallor * cyanosis *
muscle aches, back pain * chest pain * headache * rash/hives *
aprehension * n/v and diarrhea
Reactions that are not immediate include:
* fever, jaundice, low Hct level
If a reaction happens the pt. should be closely monitored for life-

threatening symptoms. The infusion is stopped immediately & the doctor
is called!!!! The blood bag and the tubing must be returned to blood
bank with an explaination of the reaction. Nurse must stay with pt.
during first 15 minutes of transfusion. Also, if the temperature goes
up by 2 degrees from the baseline during an infusion this could be a
reaction.
1) Gout : low purine diet, avoid organ meat e.g. liver.

2) Hypertension : low sodium diet.
3) Renal calculi, calcium kidney stones : follow alkaline ash diet e.g. spinach, milk, banana. Aim
is to increase pH.
Before start INH for TB, usually a baseline live function test is recommended.
TB skin positive, normal 10mm, if HIV, 5mm is positive
Corticosteroids can cause stomach ulcers.

Isoniazid can cause drug induced hepatitis-look for yellow color of the skin,nausea,vomitting.
Re: Anyoone up for random FACT THROWING??

14. 1. for the myelogram postop positions. water based dye (lighter) bed elevated. oil based dye
heavier bed flat.
2. autonomic dysreflexia- elevated bed first....then check foley or for impaction
3. any of the mycin's..check for tinnitus or hearing loss
4. cloudy dialysate...always further assess and call doctor
5. osteoporosis prevention and mgt. choose weight bearing (walking) instead of calcium if both
are choices.
1. Dilantin can cause gingival hyperplasia, advise good oral hygiene and freq. dental visits, IVP
25-50 mg/min
2. Placentia Previa is painless, bright red bleed
3. Abruption is painful, board-like abdomen
4. Need MAP of 70-90 to perfuse organs
5. Vitamin C can cause false + occult blood
MAP= diastolic x 2 + systolic

___________________
divided by 3
1. celiac disease can’t have BROW! BARLEY RYE OAT WHEAT
2. any eye surgery place on pt on unaffected side
3. if pt has lung cancer, craniotomy, or some kinda pituitary surgery watch for diabetes insipidus

4. sickle cell- hydration hydration important and treat pain if in crisis
5.dont palpate a wilm's tumor on the peds pt. can cause cancer cells to be released!
oh one more:
6. terbutaline (Brethine) and mag sulfate- tx for preterm labor
Librium-antianxiety used to tx symptoms of acute alcohol withdrawal.

Cogentin-used to tx parkinsonian side effects of Thorazine (antipsychotic med)
Methadone hydrochloride-opiod analgesic; tx for narcotic withdrawal
Procardia-antianginal med (CCB) decreases myocardial O2 demand.
Digoxin-strengthens myocardial contractio0n & slows conduction thru AV node
Coumadin-inhibits prothrombin synthesis
Amicar-antifibrinolytic; prevents recurrence of subarachnoid hemorrhage.
Lithium-tx manic phase of bipolar
Nimodipine-CCB; decreases spasm in cerebral blood vessels
diltiazem-CCB; inhibits Ca+ influx in vascular smooth muscle; reduces myocardial O2 demand
& decreases force of ventricular contraction
clotrimazole-antifungal; treats rashes.
The level in the water seal chamber (chest tubes) fluctuates with respiration- no fluctuation
indicates an obstruction and excessive bubbling indicates an air leak.
Stay with the client for 15 minutes at the start of a blood transfusion.
Nephrotic Syndrome leads to proteinuria while Glomerulonephritis leads to hematuria.
Goodell's Sign is the softening of the cervix at the start of the 2nd month of pregnancy
Nagele's Rule is First date of last menstrual period + 7 days - 3 months + 1year.
Vinca Alkaloids (Vincristine) lead to neurotoxicity and can present with numbness and tingling in
the legs or paralytic ileus.
A few more.... and forgive the spelling it is way late and my brain is turning to MUSH.
Avoid herbal supps like ginseng, ginger, ginkgo, garlic (all the G's) if on any clotting drugs/
products (coumadin, platelets, ASA, Plavix)
High triglycerides may cause a false HIGH Hemoglobin A1C (normal is 2.6-6)
Deer ticks transmit Lyme Disease and it is most common in the NE Atlantic states. (Go figure I
thought it was down here in the South)
Think of pain last or as a psychosocial UNLESS: Burns, sickle cell crisis, or kidney stones.
Anemia of pregnancy is common in the 2nd trimester due to rapid expanding blood volume and is
not a cause for concern. It can get as low as 10.5 and still be OK. 1st and 3rd trimesters can go as
low as 11 and still be ok
Preterm labor--after 20 weeks and before 37

true labor INCREASES with activity and usually moves from the back to the front (according to
our instructors but from personal experience IT HURT ALL OVER THE DANG PLACE AND
INCREASED WITH EVERYTHING ).
Recommended weight gain for pregnancy 1.5-16 kg or 25-35 lbs

normal newborn jaundice-- AFTER 24 hours of life
pathologic jaundice-- BEFORE 24 hours of life
*feed orally ASAP because if it gets too high Kernicterus
5. after thyroid surgery-maintain airway-keep emergency trach set nearby, check for blood at
sides and back of dressing, teach pt to support neck
6. bucks traction-no pins tongs. skin traction
7. should not hear a bruit over anything except dialysis shunts. if so this is the unstable pt
8. DVT- elevate extremity , bed rest, warm (not hot) compresses

Menieres disease= ringing in the ears and hearing damage cause from HIGH sodium levels. Need
diuretics. Avoid caffeine, nicotine, and ETOH
Meningitis= look for nuchal rigidity, Kerning’s sign(can't extend knee when hip is flexed) and
Brudinskis sign (flex neck and knee flexes too) petichial rash. People who have been in close
contact may need Rifampin as prevention. Vaccine for meningitis after 65 years of age and every
5 years
MI=#1 pain relief, helps decrease 02 demand
Acute Asthma = diffuse expiratory wheezes
Cessation of wheeze ominous
Infective endocarditis = murmur
Fluid overload = auscultate lungs 1st

1.hypoglycemia= T.I.R.E.D
T-tachycardia
I- irritability
R- restless
E- excessive hunger
D- diaphoresis
2.posturing- deceberate(brainstem problem)- hands like an "e", decorticate (cord problem)- hands
pulled in toward the cord
3.tetralogy of fallot- have child squat to increase return to heart. just remember fallot=squat
4. cant sign consent after preop meds are given...call doctor if not signed
5. rubella (German measles)-airborne contact precautions, 3 day rash
6. rubeola (red measles)- droplet contact precautions, koplik spots in mouth
Withdrawl Symptoms:

Amphetamine= Depression , disturbed sleep, restlessness , disorientation
Barbiturates= nausea & vomiting, seizures, course tremors,

tachy
Cocaine= Sever cravings, depression , hypersomnia, fatigue
Heroin= Runny nose, Yawning , fever, muscle & joint pain, diarrhea (Remember Flu like
symptoms)
1. When using a cane to aid ambulation: Step up on the good extremity then place the can and
affected extremity on the step. Reverse when coming down. (Up with the good, down with the
bad)
2. In infants, pyloric stenosis = projectile vomiting
3. Croup: seal-bark cough, dyspnea, inspiratory stridor, irritable. In children considered a medical
emergency due to narrowed airway
4. Skull fracture: Battle's sign (bruising over mastoid bone) and raccoon eyes
5. Pheochromocytoma: catecholamine secreting tumor. Look for persistent hypertension,

pounding headache
Oxytocin is always given via an infusion pump and can never be administered through the
primary IV.
One of the first signs of ICP (increased intracranial pressure) in infants is a high pitched cry.
Regarding blood transfusions, a hemolytic reaction is the most dangerous kind of reaction...S & S
include
NAUSEA
VOMITING
PAIN IN LOWER BSCK
HEMATURIA Treatment is to STOP blood, get a urine specimen and maintain perfusion and
blood volume.
Febrile reaction S&S

FEVER
CHILLS
NAUSEA
HEADACHE
Narcan is given for to reverse respiratory depression...a rate of 8 or less is too low and requires
nursing action.
Miller abbott tube is used for decompressing intestine, which relieves the small intestine by
removing fluid and gas from small intestine.
If a client takes lithium the nurse should instruct the client to take in a good amount of sodium,
without it causes retention of lithium and in turn leads to toxicity.
Rinne test- a vibrating tuning fork is held against the mastoid bone till pt can't hear sound...then
moved to ear.

1) A subarachnoid (spinal block) for labor may cause a headache, a lumbar epidural will not since
the dura mater is not penetrated
2) Tracheoesophageal fistula: 3 C's: coughing, choking, & cyanosis
3) Hypothyroidism: Decreased T3 +T4, but increased TSH

Hyperthyroidism: Increased T3 + T4, but decreased TSH
4) NO tyramine containing foods if taking and MAO inhibitor ( smoked meat, brewer's yeast,
aged cheese, red wine)
5)Regular insulin is the only type that can be given IV
1)Immunizations
Before 1 years old:
Hep B 3x):Only one that is given at birth and one month (3rd dose at 6 months)
IPV(4x), DTaP(5x), Hib(4x), PCV(4x): all given at 2, 4, & 6 months
Hib, PCV: again at 12-15month

DTaP: again at 12-18months
DTaP, IPV: last doses are given 4-6yrs
1yrs old and older:

MMR: (2x) 12-15months, then at 4-6 years* *if dose not given from 4-6 give from 11-12yrs old
Varicella Zoster: (1x) 12-18months
Td: (1x): 11-12yrs old
2)Fundal height: pt supine, measure from symphysis pubis to top of fundus, if patients is 18+ wks
pregnant the height in cm will be same as weeks pregnant give or take 2 cm
3)Isolation**:
STRICT Contact: use universal precautions, gown when contact with pt., single pt. room in most
situations
Used with: Any colonizing infections, MSRV, Fifths disease, RSV, infected wounds, skin, or eyes
STRICTER Droplet: include all universal precautions, gown, goggles, masks on you, on pt. if
leaving room, single pt. rooms
Used with: Majority of infectious diseases
STRICTEST Airborne: include all universal precautions and negative pressure single patient
rooms, gown, goggles, mask on you, mask on pt. if leaving room which should only be done if
absolutely necessary
Used with:
Measles
Varicella
Disseminated Varicella Zoster

Tuberculosis
**Always check facilities policies when following isolation precautions/procedures
4) Self breast exams: do monthly, 7-10 days after menses
5) Pt's taking Monoamine Oxidase inhibitors (for depression usually) should avoid foods
containing tyramine which include
· Avocados, bananas
· Beef/chicken liver
· Caffeine
· Red wine, Beer
· Cheese (except cottage cheese)
· Raisins
· Sausages, pepperoni
· Yogurt, sour cream
1. dumping syndrome-tx no fluids with meals /no high carbs /lie down after eating. they need a
high fat high protein diet
2. multiple sclerosis- avoid hot showers and baths
3. partial thickness burns=blisters...... full thickness-charred, waxy
4 PKU- no nuts, meats, dry beans, eggs, dairy (basically no protein stuff) give specially prepared
formula to baby because they can digest this protein well
5. introduce rice cereal to infant at 6 mos and strained veggies one at a time
6. pt must keep taking prescribed insulin on sick days, drink plenty of fluids and notify doctor.
also insulin is also given when pt comes from surgery on NPO status because trauma and
infection makes sugar go up!
1. In prioritizing cardiac patients, check the pt with INDIGESTION first because that could be a
sign of MI.
2. ABG's need to be placed on ice and sent to the lab ASAP.
3. If active TB is suspected, a sputum culture for acid-fast bacillus is the only method to actually
confirm active TB (NOT a mantoux skin test!)
4. Celebrex is contraindicated in pts with a history of cirrhosis.
5. In psych pts, the client most at risk for self-harm is always the pt that has stopped taking their
meds.
One more!
6. Change in resp rate in a pt receiving mag sulfate could indicate toxicity.
1. Cushing's Triad = HTN (widening pulse pressure, systolic rises), Bradycardia, irregular resp.
2. Tx of DIC = Heparin
3. Assessment for Cancer =

C: Change in bowel or bladder habits
A: A sore that doesn’t heal
U: Unusual bleeding or discharge

T: Thickening or lump
I: Indigestion or difficulty swallowing
O: Obvious changes in a wart or mole
N: Nagging cough or hoarseness.
4. Acid Base =
Respiratory
Opposite
Metabolic
Equal
5. For Injuries such as twisted ankles use RICE acronym

Rest
Ice
Compress
Elevate
Ulcerative colitis...3-30 stools per day WITH blood and mucus.
Pain in LLQ: relieved by defecation.
Crohns disease-NO obvious blood or mucus in stool.
Pain: Right lower quadrant pain that is steady or cramping...or pain could be in periumbilical area,
tenderness and mass in the RLQ.
Rheumatoid arthritis: Pain and stiffness is on arising, lasting less than an hour...can also occur after long
periods of inactivity. Joints red, hot swollen, boggy, and decreased ROM.
Osteoarthritis: Pain and stiffness occurs during activity. Joints may appear swollen, cool, and bony hard.
Hemodialysis: disequilibrium syndrome- N&V, headache, decreased LOC, rapid changes in PH, bun...
Transfusion reaction: Chills, dyspnea, itching, uticaria, back or arm pain, fever.
Peritoneal dialysis: When more dialysate drains than has been given, more fluid has been lost(output). If
less is returned than given, a fluid gain has occurred.
Slow dialysate instillation- increase height of container, reposition client.
Poor dialysate drainage-Lower the drainage, reposition.

INSULIN:
Rapid: (Lispro) Onset: <15min Peak: 1hr Duration : 3hr
Short: (Regular) Onset: 1/2hr-1hr Peak: 2-3 hr Duration: 4-6 hr

Intermediate: (NPH or Lente) Onset: 2hr Peak: 6-12hr Duration: 16-24
Long Acting: (Ultralente) Onset: 4-6 hr Peak: 12-16hr Duration: >24 hrs
Very Long: (Lantus) Onset: 1 hr Peak: NONE Duration: 24 hr continuous

Mydriatic: with a D= Dilate pupils
Miotic:with an O= cOnstrict pupils
aniticholinergic SE:
can't see
can't pee
can't spit
can't sh*t
Hyperkalemia "MACHINE"- causes of incr serum K+

M-medications (ace inhibitors, Nsaids)
A-acidosis (Metabolic and respiratory)
C-cellular destrx-burns, traumatic injury
H-hypoaldosteronism, hemolysis
N-nephrons, renal failure
E- excretion-impaired
Signs and symptoms of incr serum K+= MURDER

M-muscle weakness
U-urine, oliguria, anuria
R-respiratory distress
D-decr cardiac contractility
E-ECG changes
R- reflexes, hyperreflexia, or flaccid
HYPERNATREMIA-you are fried

F-fever (low grade), flushed skin
R-restless (irritable)
I-incr fluid retention and incr BP
E-edema ( peripheral and pitting)
D-decr urinary output, dry mouth
Hypocalcemia-"CATS"
C-convulsions
A-arrhythmias
T-tetany
S-spasms and stridor
V-FIB=DEFIB
DONT SHOCK ASYSTOLE!
EEG- MUST BE SLEEP DEPRIVED FOR THE PROCEDURE
Albumin best indicator of nutrition normal range 3.5 - 5.5
altered LOC- earliest sign of ICP

to check dehydration in an infant (inner thigh)...elderly (on top of forehead or sternum)
shift to the left when number of immature cells are increasing in the bloodstream to fight an infection
Respiratory syncytial virus- contact precautions
systemic lupus erythematosus- butterfly rash on nose and cheek. avoid sunlight
with DIC...get worried if you see blood oooze from the IV line. notify doctor
Tegratol- tx for seizures..watch for drowsiness, n/v, blurred vision, h/a.
kayexalate- may be ordered for a high potassium level
THERAPEUTIC LEVEL
10-20 mcg/ml
Theophylline
Acetaminophen
Phenytoin
Chloramphenicol
10-21 mmHg - normal intraocular pressure
1. nebulizers used by HIV patients are cleansed with warm water after each treatment and allow it to air
dry. soaked in white vinegar and water for 30f min at the end of the day
2. SHARE support group for parents who have experienced miscarriage
3. RESOLVE support group for infertile clients
4. CANDLELIGHTERS families who have lost child to cancer
5 FETAL ALCOHOL SYNDROME child small head circumference, low birth wt, underdeveloped
cheeks.
here is a quick one.... Dantrium (dantroline) common drug kept in the OR for us with Malignant
Hyperthermia.
No birth control pills with antiseizure meds....lowers the BCP's effects

filgrastim (Neupogen) - increase NEUtrophil count
epoietin alfa (Epogen) - increase RBC/erythrocytes
Apgar measures HR, RR, Muscle tone, Reflexes, Skin color

each 0-2 point. 8-10 OK. 0-3 RESUSCITATE.
GLASGOW COMA SCALE. EYES, VERBAL,MOTOR!

It is similar to measuring dating skills...max 15 points -one can do it
if below 8 you are in Coma.
Cholecystectomy due to cholelithiasis and cholesysthitis, WATCH for BLEEDING problems, because vit
K FAT soluble, is poorly absorbed in the absence of bile. by the way T-tube used for drainage-Reason for

T tube to maintain patency of common bile duct.
Chronic RF the best way to asses fluid status-WEIGHT the PATIENT daily
When NGT present mouth care ICE CHIPS but be aware not give that too much-> it becomes water-
>stomach->NGT suck it with K and other electrolytes present in stomach. LOST K
Heat cramps in hot weather-Sodium (Na) loses
Following Gastrectomy NGT drainage should NOT be BLOODY after 12 hr
Thyroid storm's main sign is FEVER
ALDOSTERONE insufficiency -Hypo-Na-emia, Hyper-K-emia, hypo-Volemia. WHEN Na decrease, K

increase
Addison’s= hyponatremia, hypotension, decreased blood vol, hyperkalemia, hypoglycemia

Cushing’s= hypernatremia, hypertension, increased blood vol, hypokalemia, hyperglycemia
1. Prozac, Zoloft, Paxil- tx of depression.
2. sodium nitroprusside- shield from light. wrap in foil
3. cephalosporins- CHECK FOR ALLERGIES TO PENICILLINS. pt could be hypersensitive.
4. pts receiving Lasix should be assessed for tinnitus and hearing loss
5. anticoagulants cant dissolve a formed thrombus but tPAs can.

1. cardiac meds: -pine=calcium channel blockers

-olol=beta blockers
-pril=ACE inhibitors
-artan=angiotensin II receptor blockers
2. No pee no K+
3. Before treating BPH, must restore urinary flow
4. Sign of toxic ammonia level’s is asterixis (hands flapping)
5. Diuretics: Lasix and Bumex are K+ wasting Aldacton is K+ sparing
The adverse effects of Anti psychotics can be remembered using this: SHANCE
N-NEUROLEPTIC MALIGNANT SYNDROME( Characterized by fever and muscular rigidity)
E-EXTRA PYRAMIDAL SYMPTOMS( Administer anticholinergics and anti parkinsonian agents)

acute renal failure-abrupt loss of kidney function, usually reversible, with minor functioning loss
prerenal (renal ischemia)

intrarenal (any kidney tissue disease)
postrenal (obstruction...i.e calculi, prostatic hypertrophy)
chronic renal failure- progressive, irreversible loss of renal function.
-statin = lipid lowering agents

-mycin= antibiotics; watch for oto and nephrotoxicity
-vir=antivirals
-zine=can be antipsychotics or antiemtics; watch for agranulocytosis and eps effects
-tidine=H2 blockers
-prazole=proton pump inhibitors
Bells Palsy: avoid cold temperatures: make sure pt. closes windows when they are sleeping. Some even
take eyes shut.
Nurses' priority intervention after a patient receives a skin graft is to prevent movement of the graft.
Greatest risk for postpartum hemorrhage is from distended bladder.
Herpes zoster (shingles) is from reactivation of the varicella virus.
1 grain = 60mg (I always forget this one)
Risk factors for legionnaires disease: advanced age, immunosuppression, end stage renal disease, and
diabetes
Heart Arrhythmias:
SVT - Adenosine
Atrial Flutter - Anticoagulants
Atrial Fibrillation - Beta Blockers, Digoxin
PVC - Amiodarone
Ventricular Tachycardia - Amiodarone
Ventricular Fibrillation - Defibrillation
Torsades de Pointes - Magnesium Sulfate
1st Degree AV Block - No treatment usually
2nd Degree AV Block Type I - Atropine
2nd Degree AV Block Type II - Pacemaker
3rd Degree AV Block Complete - Emergent Pacemaker, Atropine, Epinephrine, Dopamine
Sinus Bradycardia - Atropine or Epinephrine
Sinus Tachycardia - Beta Adrenergic or Calcium Channel Blocker
Hepatitis
5 types
A,B, C, D, and E
Hep A-spread by drinking unsanitary water and uncooked foods

Hep B-spread by contact with blood or bodily fluids and is an STD
Hep C-spread by contact the same way as Hep B, can lead to cirrhosis (mostly seen with alcoholism)

Hep D-only contracted if you already have Hep B
Hep E-usually spread by contact with contaminated water
In nursing school, my instructor taught us to remember the different types like this:
VOWEL = BOWEL
Hep A and E---if your infected you will have problems with bowels...
Some Therapeutic Drug Levels
Digoxin 0.5-2.0 ng/ml

Dilantin 10-20 mcg/dl
Theophylline 10-20 mcg/dl
Coumadin PT: 12-20 sec....therapeutic range 1.5-2 times the control

INR: 2-3
Heparin PTT: 30-60 sec...therapeutic range 1.5-2 times the control
CYSTIC FIBROSIS
Diet: Low in fat and high in sodium
Meds: Antibiotics, liposoluble vitamins(A D E K) Aerosol Bronchodilators, mucolytics, pancreatic
enzymes.
5 A's to Alzheimer’s
Anomia-unable to remember things
Apraxia-failure to identify objects
Agonsia-can't recognize sounds, tastes and other sensations, familiar objects.
Amnesia-memory loss
Aphasia-can't express SELF through speech.
GLOMEULONEPHRITIS-it's an antigen antibody complex from a recent strep infection which causes
inflammation/ decreased glomerular filtration rate.
BETA BLOCKERS
B1-affects the heart
B2-affects lungs
EMERGENCY DRUGS TO LEAN ON

Lidocaine
Epinephrine
Atropine
Narcan
AUTONOMIC DYSREFLEXIA-triggered by sustained stimuli at T6 or below. Vasodilation above injury,

(flushed face, increased bp etc) vasoconstriction below injury(pale, cool, no sweating.)
4.Common symptom of Aluminum hydroxide: constipation

6.Diuretic used for intracranial bleeding, hydrocephalus (Increased ICP,...) MANNITOL (osmotic
diuretic)
8.cystis fibrosis==> excessive mucus production, respiratory infection complications,...

9.Cholelithiasis causes enlarged edematous gallbladder with multiple stones and an elevated bilirubin
level.
10.Fat embolism is mostly seen in LONG BONES (femur,...)
TRANSMISSION-BASED PRECAUTIONS:
Remember ADC - airborne, droplet, contact
AIRBORNE
My - Measles
Chicken - Chicken Pox
Hez - Herpes Zoster
TB
Private Room - negative pressure with 6-12 air exchanges/hr

Mask, N95 for TB
DROPLET
think of SPIDERMAN!
S - sepsis
S - scarlet fever
S - streptococcal pharyngitis
P - parvovirus B19
P - pneumonia
P - pertussis
I - influenza
D - diphtheria (pharyngeal)
E - epiglottis
R - rubella
M - mumps
M - meningitis
M - mycoplasma or meningeal pneumonia
An - Adenovirus
Private Room or cohort

Mask
CONTACT PRECAUTION
MRS.WEE
M - multidrug resistant organism
R - respiratory infection
S - skin infections *
W - wound infxn
E - enteric infxn - clostridium difficile
E - eye infxn - conjunctivitis
SKIN INFECTIONS
VCHIPS
V - varicella zoster
C - cutaneous diphtheria
H - herpes simplex
I - impetigo
P - pediculosis
S - scabies

Private room or cohort
Gloves
Gown
1. Abruptio placentae may be a complication of severe preeclampsia

2. Syrup if ipecac is not administered when the ingested substance is corrosive in nature
3. Pt before liver biopsy is NPO 4-6 hours
4. Assess renal fct before giving an osmotic diuretic (mannitol)
5. Patient in addisonian crisis decreased BP, Na, Blood glucose, Increased K
6. Amniocentesis is done as early as 14 weeks of gestation
7. Chorionic villi sampling is done as early as 10 weeks of gestation
8. Increased level of alpha fetoprotein in pregnant woman => neural tube defects
9. Insulin is safely given throughout pregnancy; oral hypoglycemic agents are contraindicated
10. Phenobarbital (Luminal) is commonly used to treat and prevent recurrent seizures in infants and
young children
11. Aspirin is associated with Reye's syndrome in children with fever or viral infection
12. Glycerin suppositories are preferred agents to treat constipation in children
13. Corticosteroids may produce an altered effect of a vaccine
14. Thiazide diuretics (HCTZ,...) may induce hyperglycemia
15. Anticonvulsants INCREASE the seizures THRESHOLD!!!!
16. Hyperbilirubinemia in newborn: bilirubin levels are greater than 13-15 mg/dl
PVD if it's arterial they are hairless dry scaly and dependent ruber; venous is edematous, weepy, and
dependent cyanosis
1. Postpartum period: circulating hcG disappears within 8-24 hours

2. S/S opioid withdrawl: rhinorrhea, dilated pupils, abdominal cramps
3. S/S sedative withdrawl: Increased motor activity, tachycardia
4. S/S alcohol withdrawl: tremors, N/V, diaphoresis
5. S/S stimulant withdrawl: CNS depression, fatigue, depression, confusion,...
6. Hb values: neonates have Hb higher than those of older children to sustain them until active
erythropoiesis begins
7. Toclytic therapy: to arrest preterm labor
8. Child with chickenpox can be treated with oatmeal preparation baths and calamine lotion at home to
relieve the itching...
9. child with rheumatoid arthritis should sleep in bag to keep joints warm and promote flexibility!!!!
Wow...
10. When an eye patch is used to correct strabismus, the normal eye is patched. That forces the child to
use the "lazy" eye, thereby increasing that eye's muscle strengths
11. If a chest tube accidently get disconnected, clamp it or place the open end of the tube in a container of
sterile water or saline solution
12. Women should avoid pregnancy for at least 3 months after a rubella vaccine
13. Most accurate method to detect TB: sputum culture!!!
1. RSV- child in private room...CONTACT PRECAUTIONS..not droplet or airborne. (sometimes i get

this mixed up because its called respiratory synctical virus..i used to pick droplet precautions but i have
down now lol!

3. pneumonia- droplet precautions
4. COPD pts should get low flow Oxygen b/c of the hypoxic drive. (1-3L/min) teach pursed lip breathing.
5. ARDS- this pt doesn’t respond to even 100% FiO2
6. TB- hemolysis (advanced stage) v/s pulmonary edema- frothy blood tinged sputum
7. Allen's test- done b/f an ABG by applying pressure to the radial artery to determine if adequate blood
flow is present.
8. INH (Isoniazid)- tx of TB. give vit B6 to prevent peripheral neuritis
10. vent alarms: high alarm (increased secretions then suction......, biting tube-need an oral airway,...... or
coughing and anxiety- need a sedative)
low alarm- there is a leak or break in system...check all connectors and cuff.
11. if a trach becomes accidently dislodged try to replace it with an obturator..if no luck keep the hole
open with hemostats until physician arrives.
Dupuyten contracture - slow, progressive contracture of the palmar fascia causing flexion on the 4th and
5th fingers. Risk factors include men over 50, diabetes, gout, arthritis, alcoholism
Condom cath- remove hair on penis, apply tape in a spiral manner, 1-2in space between end of the
condom and tip of the glans penis
Bulge test - confirms presence of fluid in the knee, legs should be extended and supported on the bed
Lofenalac formula - for PKU

1. Profile of gallbladder disease: 5Fs: fair, fat, forty, five pregnancies, flatulent(disease can occur in all
ages and both sexes)
2. Hip fractures commonly hemorrhage, whereas femur fractures are at risk for fat emboli
3. Religious beliefs: Hindu- No beef or items containing gelatin
4. Renal diet- High calorie, high carbohydrate, low protein, low K, low Na, and fluid restricted to intake =
output +500 ml
5. Treatment for sickle cell crises- HHOP: Heat, hydration, oxygen, pain meds
6. RN and MD institute seclusion protection
7. MD or hospice RN can pronounce the client dead
8. For hospital triage, care for the client with a life-threatening illness or injury first
9. For disaster triage, choose to triage first those clients who can be saved with the least use of resources!
10. It is contraindicated to induce vomiting if the patient has ingested gasoline, acid and alkaline!!!
MAOIs
Non-Popular Meds
Nardil
Parnate
Marplan
avoid Tyramine

teach a pt with GERD after meals to remain upright for at least 20 min.
2.levodopa toxicity- notify physician if twitching develops.
3. Curling's ulcers or stress ulcers can cause sudden massive hemorrhage.
4. 5 mm induration positive reaction (mantoux test) for HIV or immunosuppressd pts
5. Schilling test done to see how well a pt can absorb vit b12. checking to see if they have pernicious
anemia.
6. Prednisone, Prograf, and Cellcept helps to prevent kidney rejection.
Positioning Facts:
1. Air/Pulmonary Embolism (S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of
impending doom) --> turn pt to left side and lower the head of the bed.
2. Woman in Labor w/ Un-reassuring FHR (late decels, decreased variability, fetal bradycardia, etc) -->
turn on left side (and give O2, stop Pitocin, increase IV fluids)
3. Tube Feeding w/ Decreased LOC --> position pt on right side (promotes emptying of the stomach) with
the HOB elevated (to prevent aspiration)
4. During Epidural Puncture --> side-lying
5. After Lumbar Puncture (and also oil-based Myelogram)--> pt lies in flat supine (to prevent headache
and leaking of CSF)
6. Pt w/ Heat Stroke --> lie flat w/ legs elevated
7. During Continuous Bladder Irrigation (CBI) --> catheter is taped to thigh so leg should be kept straight.
No other positioning restrictions.
8. After Myringotomy --> position on side of affected ear after surgery (allows drainage of secretions)
9. After Cataract Surgery --> pt will sleep on unaffected side with a night shield for 1-4 weeks.
10. After Thyroidectomy --> low or semi-Fowler's, support head, neck and shoulders.
11. Infant w/ Spina Bifida --> position prone (on abdomen) so that sac does not rupture
12. Buck's Traction (skin traction) --> elevate foot of bed for counter-traction
13. After Total Hip Replacement --> don't sleep on operated side, don't flex hip more than 45-60 degrees,
don't elevate HOB more than 45 degrees. Maintain hip abduction by separating thighs with pillows.
14. Prolapsed Cord --> knee-chest position or Trendelenburg
15. Infant w/ Cleft Lip --> position on back or in infant seat to prevent trauma to suture line. While
feeding, hold in upright position.

16. To Prevent Dumping Syndrome (post-operative ulcer/stomach surgeries) --> eat in reclining position,
lie down after meals for 20-30 minutes (also restrict fluids during meals, low CHO and fiber diet, small
frequent meals)
17. Above Knee Amputation --> elevate for first 24 hours on pillow, position prone daily to provide for
hip extension.
18. Below Knee Amputation --> foot of bed elevated for first 24 hours, position prone daily to provide for
hip extension.
19. Detached Retina --> area of detachment should be in the dependent position
20. Administration of Enema --> position pt in left side-lying (Sim's) with knee flexed
21. After Supratentorial Surgery (incision behind hairline) --> elevate HOB 30-45 degrees
22. After Infratentorial Surgery (incision at nape of neck)--> position pt flat and lateral on either side.
23. During Internal Radiation --> on bedrest while implant in place
24. Autonomic Dysreflexia/Hyperreflexia (S&S: pounding headache, profuse sweating, nasal congestion,
goose flesh, bradycardia, hypertension) --> place client in sitting position (elevate HOB) first before any
other implementation.
25. Shock --> bedrest with extremities elevated 20 degrees, knees straight, head slightly elevated
(modified Trendelenburg)
26. Head Injury --> elevate HOB 30 degrees to decrease intracranial pressure some GI/hepatic
hepatitis--all forms standard precautions
s/s of bowel perforation--sudden diffuse abdominal pain, no bowel sounds, resp. rapid and shallow, rigid
abdomen.
nursing care for undiagnosed abdominal pain--npo, no heat on stomach, no enemas, no narcotics, no
laxatives.
crohns-small intestine vs ulcerative colitis-large intestine..sulfasalzine used to treat both.
pyloric stenosis- olive shaped mass felt in R. epigastric area, projectile vomiting
if a pt requires TPN and it is temp. unavailable then give D10W OR 20% DW until available.
before a Dx test of after 3 enemas, returns are not clear, notify physician
if diarrhea occurs with a colostomy. check meds (some cause diarrhea)..dont irrigate
as a general rule antacids should be taken 1-2 hours after other oral meds.
Symptothermal method of birth control - combines cervical mucus evaluation and basal body temperature
evaluation, non-prescription/drug
percipitus/rapid labor - risk factor for early postpartum hemmorhage and amniotic fluid embolism

In elderly, change in mental status and confusion are often the presenting symptoms of infection
antiseizure meds - notify anesthesia prior to surgery, may need to decrease the amount of anesthetic given
neuroleptic malignant syndrome - increased temp, severe rigidity, oculogyric crises, HTN, complication
of antipsychotic meds, notify MD
Dilantin - pregnancy risk category D, should investigate possibility of pregnancy (LMP) prior to
administering
Transcutaneous electrical nerve stimulation (TENS) - used for localized pain (back pain, sciatica) - use
gel, place electrodes over, above or below painful area, adjust voltage until pain relief/prickly "pins and
needles"
1. S/S delusional thought patterns => suspiciousness and resistance to therapy

2. Use of neologism (new word self invented by a person and not readily understood by another)
=>associated with thought disorders
3. Age and weight are VERY important to know after a child has ingested a toxic substance
4. Child with celiac disease can eat corn, rice, soybeans and potatoes (gluten free)
5. Anaphylactic rx => administer epinephrine first, then maintain an open airway. (Not the other way
around )
6. Client with asthma => monitor peak of airflow volumes daily. Pulse ox after!!!!
7. DKA pt => a HCT of 60 (way high...) (extreme dehydration) would be more critical than a pH less than
3! (Fluids first...)
8. Assess for abdominal distention after placement of a VP shunt! (You know why right?)
9. GFR is decreased in the initial response to severe burns, with fluid shift occurring. Kidney fct must be
monitored closely or renal failure may follow in a few days
10. Vomiting => metabolic alkalosis (loss of stomach acid content)
11. Diarrhea => metabolic acidosis (loss of bicarbonate)
12. COPD => respiratory acidosis (CO2 retention)
13. Anxious client => hyperventilation can cause respiratory alkalosis. A paper bag will help. (Increase
CO2) Right?
14. Client with low H&H after splenectomy => the initial priority is REST due to the inability of RBCs to
carry O2
15. Mild to moderate diarrhea in a child => maintain a NORMAL diet with fluids to rehydrate the poor
child
Clozapine (Clozaril) - antipsychotic, treats schizophrenia, potential to suppress bone marrow and cause
agranulocytosis (look for sore throat and fever)
Bucks traction - remove foam boots 3x/day to inspect skin, turn client to unaffected side, dorsiflex foot on
affected side, elevate foot of bed
phlebitis - tenderness and redness at IV insertion site and redness proximally along the vein. Remove the
IV adn apply warm soaks
Cred e maneuver - apply manual pressure to bladder, aids in emptying the bladder completely, results in
reduced risk for infection; if performed every day can result in bladder control for some SCI
Frequent use of nasal sprays to relieve allergic symptoms can result in vasoconstriction that causes
atrophy of nasal membranes (frequent nosebleeds)

Lung cancer is a common cause of SIADH (abnormal secretion of ADH, increase water absorption and
dilutional hyponatremia)
ginkgo - antiplatelet, CNS stimulant, given for dementia, increase risk of bleeding with NSAIDS
Native Americans are present oriented and do not live by the clock (will be late for appointments)
Pulmonic area - 2ICS, left of sternum
Chronic alcohol use is the most common cause of hypoMg, which may result in cardiac arrest (increase
neuromuscular irritability, tremors, tetany, seizures)
SCD - two fingers between sleeve and leg, opening at the knee and popliteal pulse point, antiembolism
stockings can be applied under sleeve to decrease itching, sweating and heat buildup
if allergic to sulfonamides dont take acetazolamide (Diamox)

methotrexate- dont take supplemental folic acid and please dont take while pregnant..can cause premature
labor and bleeding.
oh dont take cytoxan while pregnant or dont handle the drug while pregnant.
infections that occur with AIDS clients are called opportunistic infections.
Pneumocystis carinii pneumonia is not contagious unless you are immunocompromised. this infection
occurs mostly with AIDS pts.
infant with HIV should NOT receive chickenpox or oral polio vaccine. can give inactivated polio vaccine
though.
Erb's point - 3ICS left of the sternum
Ambulatory electrocardiography - continuously records cardiac activity during a 24hour period, should
not use electric devices, bathe or shower, no diet changes, record everything in daily log
Demerol -crosses the placenta which decreases FHR variability
Ascites management - albumin given to pull fluid back into blood vessels then diuretic given to excrete
excess fluid
TB - need vitamin B6
bloody dyalasate (spelling?) - assess if patient is menstruating
placing an abductor pillow between patients legs after hip replacement prevents dislocation of the hip
while turning, important especially when the client is confused
palpating the carotid pulses together can cause a vagal response and slow the clients heart rate
adrenal insufficiency - steroids increased prior to surgery
thyroidectomy - access for numbness from decreased Ca
Bactrim - mild to moderate rash the most common SE

If when removing a PICC a portion of the catheter breaks - apply tourniquet to the upper arm, feel radial
pulse
emptying a drainage evacuator - wash hands, don gloves, elevate bed, pour drainage into measuring cup,
compress the evacuator and replace the plug
Percodan - oxycodone and aspirin

Percocet - oxycodone and acetaminophen
Myasthenia Gravis: worsens with exercise and improves with rest.
Myasthenia Crisis: a positive reaction to Tensilon--will improve symptoms
Cholinergic Crisis: caused by excessive medication-stop med-giving Tensilon will make it worse
Head injury medication: Mannitol (osmotic diuretic)-crystallizes at room temp so ALWAYS use filter
needle
Prior to a liver biopsy its important to be aware of the lab result for prothrombin time (PT)
1. Watery vaginal discharge and painless bleeding => endometrial cancer

2. Frothy vaginal discharge => trichomonas infection
3. Thick, white vaginal discharge => candida albicans
4. purulent vaginal discharge => PID
5. Approximately 99% of males with cystic fibrosis are sterile due to obstruction of the vas deferens
6. Lyme's disease is transmitted by ticks found on deer and mice in wooded areas
7. Children 18-24 months normally have sufficient sphincter control necessary for toilet training
8. Complications of TPN therapy are osmotic diuresis and hypovolemia!!!
9. L/S ratio => fetal lung maturity
10. Kava-kava can increase the effects of anesthesia and post-op analgesia
11. NEVER give chloride potassium by IV push
12. GINKGO interacts with many meds to increase the risk of bleeding; therefore, bruising or bleeding
should be reported to MD
13. Vanco therapeutic range 10-20 mcg/mL
14. Client with disseminated herpes zoster (shingles) => AIRBORNE precautions
15. The client taking methotrexate should avoid multivitamins b/c multivitamins contain folic acid.
Methotrexate is a folic acid antagonist!!!
Hypovolemia and osmotic diuresis that are complications of TPN result from hyperglycemia!
Let's recapitulate TPN => Hyperglycemia => osmotic diuresis & hypovolemia...
Drooling - 4 months
Responds to own name 6-8months
deliberate steps when standing 9-10months
picks up bite size pieces of cereal 11months
24months: kick ball w/o falling, build tower of 6blocks, 2-3 word phrases, 300 word vocab
30months: jump with both feet, run, say first and last name
36months: tricycle
Left CVA - speech, math skills, analytical thinking

Right CVA - behavior, disorientation to person, place and time
Ectopic pregnancy - LLQ pain, vaginal spotting

tricuspid valve: 5ICS left sternal border
Meconium should be passed within 12-24 hrs
transitional stools - 3rd day - thin greenish brown
breastfed baby - golden yellow stools with sour milk odor
compartment syndrome...significant increase in pain not responsive to pain meds.
Plaquenil-tx of Rhem Arthritis...recommend eye exam every 3 mo.
Statins- tx of high cholesterol...ASSESS FOR MUSCLE PAIN...monitor liver enzymes.
Nicotinic Acid (Niacin)-tx of high cholesterol- flushing occurs in most pt. will diminish over several
weeks.
stages of shock (its more but i made it simple "KISS" keep it simple stupid lol!)
early- increase in pulse...normal urine output
intermediate-RAS (renin-angioten system), low urine output, cool skin, pallor
late-no urine output, low BP irreversible stage!
Myxedema/hypothyroidism: slowed physical and mental function, sensitivity to cold, dry skin and hair
Graves’ disease/hyperthyroidism: accelerated physical and mental function; sensitivity to heat, fine/soft
hair
Thyroid storm: increased temp, pulse and HTN
Post-thyroidectomy: semi-Fowler’s, prevent neck flexion/hyperextension, trach at bedside
Hypo-parathyroid: CATS – convulsions, arrhythmias, tetany, spasms, stridor (decreased calcium), high
Ca, low phosphorus diet
Hyper-parathyroid: fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium), low
Ca, high phosphorus diet
Hypovolemia – increased temp, rapid/weak pulse, increase respiration, hypotension, anxiety, urine
specific gravity >1.030
Hypervolemia – bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, urine specific
gravity <1.010; Semi-Fowler’s
Diabetes Insipidus (decreased ADH): excessive urine output and thirst, dehydration, weakness, administer
Pitressin
SIADH (increased ADH): change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a, HA;
administer Declomycin, diuretics
Hypokalemia: muscle weakness, dysrhythmias, increase K (raisins, bananas, apricots, oranges, beans,
potatoes, carrots, celery)
Hyperkalemia: MURDER – muscle weakness, urine (oliguria/anuria), respiratory depression, decreased
cardiac contractility, ECG changes, reflexes
Hyponatremia: nausea, muscle cramps, increased ICP, muscular twitching, convulsion; osmotic diuretics,
fluids
Hypernatremia: increased temp, weakness, disorientation/delusions, hypotension, tachycardia; hypotonic
solution
Hypocalcemia: CATS – convulsions, arrhythmias, tetany, spasms and stridor
Hypercalcemia: muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon
reflexes, sedative effect on CNS
HypoMg: tremors, tetany, seizures, dyrshythmias, depression, confusion, dysphagia; dig toxicity
HyperMg: depresses the CNS, hypotension, facial flushing, muscle weakness, absent deep tendon

reflexes, shallow respirations, emergency
Addison’s: hypoNa, hyperK, hypoglycemia, dark pigmentation, decreased resistance to stress, fractures,
alopecia, weight loss, GI distress
Cushing’s: hyperNa, hypoK, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN,
hirsutism, moonface/buffalo hump
Addisonian crisis: n/v, confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration,
decreased BP
Pheochromocytoma: hypersecretion of epi/norepi, persistent HTN, increased HR, hyperglycemia,

diaphoresis, tremor, pounding HA; avoid stress, frequent bating and rest breaks, avoid cold and
stimulating foods, surgery to remove tumor
Screenings for Fetal Problems
1st TRIMESTER (Chorionic villis sampling, US scan)
2nd TRIMESTER (AFP screening or Quad Screening,Amniocentesis)
3rd TRIMESTER (kick counts,Nonstress Test, Biophysical Profile, Percutaneous Umbilical Blood
sampling, Contraction Stress Test )
Ultrasound screening -can be vaginal or Abdominal (in latter make Her drink water to fill bladder)
-Confirms viability
Chorionic villis sampling

8-12 weeks
for early diagnosis of genetic, metabolic problems
Amniocentesis -13-14 weeks

Is done under US scan to obtain a sample of amniotic fluid for direct analysis of fetal chromosomes,
development, viability and lung maturity
AFP
AFP also called =Quad marker screening:
-human chorionic gonadotropin (HcG),
-and inhibin A
high-Spina bifida
it is not an absolute test if it is abnormal -further investigation is recommended
Kick counts (tests Uretro placental capability)

Same time every day mother records how often she feels the fetus move
if minimum 3 movements are not noted within an hour's time, the mother is encouraged to call her
physician immediately!
Nonstress Test
checks FHR and mother detects Fetal movements.
Contraction Stress Test -tests perfusion between Placenta and Uterus (basically O2 and CO2 exchange)

contractions initiated by Pitocin or nipple stimulation
the desired result is a "negative" test which consists of three contractions of moderate intensity in a 10
minute period without evidence of late decelerations
the test is done to detect problems so if it is Positive (persistent late decelerations
) then-CS
how is done:
Each time the fetus moves, FHR should accelerate 15 beats/min above the baseline for 15 seconds
A reactive (good) test =>2 accelerations in FHR occur with associated fetal movement
Biophysical Profile (BPP)

Percutaneous Umbilical Blood sampling -like amniocentesis but cord punctured

Everywhere where woman's abdomen is punctured informed consent is needed, and risks like amnionitis
spontaneous abortion, preterm labor/delivery, and premature rupture of membranes must be explained. If
she Rh--she may be RHoGAM given.
--In complete heart block, the AV node blocks all impulses from the SA node, so the atria and ventricles
beat independently, b/c Lidocaine suppresses ventricular irritability, it may diminish the existing
ventricular response, cardiac depressant are contraindicated in the presence of complete heart block.
--administrate Glucagon when pt is hypoglycemia and unresponsive
Bromocriptine (Parlodel) or Dantrolene (Dantrium) is used for CNS toxicity
Ibuprofen (Motrin) S/E includes epigastric distress, nausea, occult blood loss, peptic ulceration, use
cautiously with history of previous gastrointestinal disorders.
Aminophylline (Truphylline) use with Propranolol (Inderal) may decrease metabolism and lead to toxicity
Antianxiety medication is pharmacologically similar to alcohol, is used effectively as a substitute for
alcohol in decreasing doses to comfortably and safely withdraw a client from alcohol dependence
Tagamet decrease gastric secretion by inhibiting the actions of histamine at the H2-receptor site,
constipation is a common side effect of this med, should increase fiber in diet. Take with meals and at
bedtime.
elderly clients and clients with renal problems are most susceptible to CNS side effects (confusion,
dizziness) of the medication
atropine is contraindicated in paralytic ileus, ulcerative colitis, obstructive GI disorders, benign prostatic
hypertrophy, myasthenia gravis and narrow angle glaucoma
withdrawal s/s of benzos: agitation, nervousness, insomnia, anorexia, sweating, muscle

cramps.....basically about the same as alcohol withdrawal s/s.
thrombophlebitis s/s: redness, warmth, and induration along the vein, tenderness on palpation of the vein.
hypokalemia-prominent U WAVE (u is down hypo), hyperkalemia-tall T wave (T is tall hyper)
superior vena cava syndrome s/s: nosebleeds, edema in the eyes, edema of hands, dyspnea, mental status

changes.
s/s of rheumatic fever: painful swollen joints, jerky movements, enlarged heart, heart murmur, nontender
lumps on bony areas, white painful lesions on the trunk
s/s of vit B12 deficiency: pallor, slight jaundice, smooth beefy red tongue, tingling hands and feet, and
difficulty with gait
good pasture syndrome affects the lungs and kidneys so expect pulmonary symptoms and kidney
symptoms (failure symptoms)
For donning: Got my free gold: gown, mask, face shield (goggles), gloves
For removing: Google for glad Molly: gloves, face shield (goggles), gown, mask
Also gloves are the last thing you put on and the first thing that you take off.
Metronidazole (Flagyl)- antiviral: no alcohol (unless you planning on vomiting for awhile)...this drug has
a metallic bitter taste.
Digoxin-check pulse, less than 60 hold, check dig levels and potassium levels.
Amphojel: tx of GERD and kidney stones....watch out for constipation.
Vistaril: tx of anxiety and also itching...watch for dry mouth. given preop commonly
Versed: given for conscious sedation...watch for resp depression and hypotension
PTU and Tapazole- prevention of thyroid storm
Sinemet: tx of Parkinson...sweat, saliva, urine may turn reddish brown occasionally...causes drowsiness
Artane: tx of Parkinson..sedative effect also
Cogentin: tx of Parkinson and extrapyramidal effects of other drugs
Tigan: tx of postop n/v and for nausea associated with gastroenteritis
Timolol (Timoptic)-tx of glaucoma
Bactrim: antibiotic..dont take if allergic to sulfa drugs...diarrhea common side effect...drink plenty of
fluids
Gout Meds: Probenecid (Benemid), Colchicine, Allopurinol (Zyloprim)
Apresoline(hydralazine)-tx of HTN or CHF, Report flu-like symptoms, rise slowly from sitting/lying
position; take with meals.
Bentyl: tx of irritable bowel....assess for anticholinergic side effects.
Calan (verapamil): calcium channel blocker: tx of HTN, angina...assess for constipation
Carafate: tx of duodenal ulcers..coats the ulcer...so take before meals.
Theophylline: tx of asthma or COPD..therap drug level: 10-20

Mucomyst is the antidote to Tylenol and is administered orally
Diamox: tx of glaucoma, high altitude sickness...dont take if allergic to sulfa drugs
Indocin: (nsaid) tx of arthritis (osteo, rheumatoid, gouty), bursitis, and tendonitis. Synthroid: tx of
hypothyroidism..may take several weeks to take effect...notify doctor of chest pain..take in the AM on
empty stomach..could cause hyperthyroidism.
Librium: tx of alcohol w/d...dont take alcohol with this...very bad nausea and vomiting can occur.
Oncovin (vincristine): tx of leukemia..given IV ONLY
kwell: tx of scabies and lice...(scabies)apply lotion once and leave on for 8-12 hours...(lice) use the
shampoo and leave on for 4 minutes with hair uncovered then rinse with warm water and comb with a
fine tooth comb
Premarin:tx after menopause estrogen replacement
Dilantin: tx of seizures. thera drug level: 10-20
Navane: tx of schizophrenia..assess for EPS
Ritalin: tx of ADHD..assess for heart related side effects report immediately...child may need a drug
holiday b/c it stunts growth.
dopamine (Intropine): tx of hypotension, shock, low cardiac output, poor perfusion to vital
organs...monitor EKG for arrhythmias, monitor BP
IF it is a depression med,
AND it look likes it's been in a commercial / you know someone on it (e.g. Prozac, Paxil, Celexa, zoloft)
then it is an SSRI.
IF not,
then it is either a tricylic OR a MAOI...
... common tricylics USUALLY have 3 syllables (pamelor, elavil). (remember: tri = 3)
... common MAOI's USUALLY have two (nardil marplan)
If ya can't remember, go with the syllables.
Serotonin syndrome is a risk for all depression meds, it is marked by vasoconstrictive crisis
(hypertension, temp increase, mentation).
Remember: serum toner (serotonin)... the first discovered role of serotonin was in vasoconstriction!
This is a medical emergency, similar to NMS.
MAOI drugs have a specific risk for tyramine ingestion. Aged cheeses and wine are high in it, fermented /
moldy foods. M for munchies, A for aged
Respiratory Rate:
Newborn35-40
Infant 30-50
Toddler 25-35
School Age 20-30
Adolescent/Adult 14020
Adult 12 -20

Heart Rate
Infant 120-160 (110 at rest)
Toddlers 90-140
Preschool/School Age 75-110
Adolescent/Adult 60-100 (max 120 before concern)
Pulse
Bounding 4+
Normal 3+
Difficult to palpate 2+
Weak 1+
None 0
Have trouble remembering fhr patterns in OB? Think VEAL CHOP
VC
EH
AO
LP
V = variable decels; C = cord compression caused

E = early decels; H = head compression caused
A = accels; O = okay, not a problem!
L = late decels P = placental insufficiency, can't fill
For cord compression, place the mother in the TRENDELENBERG position because this removes
pressure of the presenting part off the cord. (If her head is down, the baby is no longer being pulled out of
the body by gravity)
If the cord is prolapsed, cover it with sterile saline gauze to prevent drying of the cord and to minimize
infection.
For late decels, turn the mother to her left side, to allow more blood flow to the placenta.
For any kind of bad fetal heart rate pattern, you give O2, often by mask...
When doing an epidural anesthesia hydration before hand is a priority.
Hypotension and bradypnea / bradycardia are major risks and emergencies.
NEVER check the monitor or a machine as a first action. Always assess the patient first; for example
listen to the fetal heart tones with a stethoscope in NCLEX land. Sometimes it's hard to tell who to check
on first, the mother or the baby; it's usually easy to tell the right answer if the mother or baby involves a
machine. If you're not sure who to check first, and one of the choices involves the machine, that's the
wrong answer.
If the baby is a posterior presentation, the sounds are heard at the sides.
If the baby is anterior, the sounds are heard closer to midline, between the umbilicus and where you
would listen to a posterior presentation.
If the baby is breech, the sounds are high up in the fundus near the umbilicus. If the baby is vertex, they
are a little bit above the symphysis pubis

A possible complication of impetigo is poststreptococcal glomerulonephritis and periorbital edema is
indicative of postreptocccal glomerulonephritis.
client should weight themselves daily when taking lithium-- and after the first dose, client should have
his/her levels checked within 8-12 hours and two times a week for the first month. Lithium also causes
polyuria and dehydration. S&S of toxicity are, ataxia, vomiting, diarrhea, muscular weakness and
drowsiness.
Gurie blood test helps determine PKU for neonate.
child can return to school with Hep A, a week after onset of jaundice
bulge test is a test for confirming fluid in the knee
it's important not to touch the bed when using defibrillator in order to prevent accidental countershock!!
Extrusion reflex means is the same meaning as tongue thrust which disappears between 3- 4mos of age.
Administer oral steroids in the morning with food to prevent ulcerogenic effects!
Increased abdominal distention, nausea and vomiting are signs of paralytic ileus that should be reported to
the physician!
It's important for a client with an internal radium implant to be on a low residue diet in order to prevent
many bowel movements because stool can dislodge it.
Heparin is not transmitted to infant from breastfeeding.
Haldol is effective for reducing assaultive behavior, for example, a pt threatening to hurt another.
Narcotic analgesics are contraindicated for pt's with ICP because it can mask symptoms.
Pt's with SLE(lupus) should be in remission for 5 months before becoming pregnant.
Fixed and DIALATED pupil are signs of ICP and should be reported, it is an emergency.
For strabismus, the brain receives two images.
Vomiting is contraindicated for a pt/child who swallows lighter fluid(hydrocarbons) because there's a risk
of aspiration.
Change IV tubing every 48-72hourse(every time I want to choose every 24 hours!)
Extreme tearing and redness are signs of viral conjunctivitis and if there is a worker with these signs,
make sure they are sent home because it is contagious!
For amputations after wound has healed..., assess for skin breakdown, wash, rinse and dry stump daily,
alcohol dries so don't apply DARN IT! , no lotion. Elevate stump 24-48 hours after surgery, discourage
semi fowler's position to prevent contractures of the hip.
Flush NG tube with 30ml of air before aspirating fluid.

Turp(transurethral resection of the prostate)--hemorrhage is a complication, bleeding should gradually
decrease to light pink in 24 hrs.
DVT: tx with compression stockings, low dose heparin, discourage sitting for prolonged periods.
Hot and dry=sugar high(symp of hyperglycemia)

cold and clammy=need some candy(hypoglycemia)
Type 1 diabetes is diagnosed usually before age 15. NO insulin produced
Type 2 diabetes--INSUFFICIENT insulin production. Keto acidosis not common. Affects adults over 40
mostly.
Diabetes insipidus--history of head injury or pituitary tumor or craniotomy...HYPOsecretion of ADH.

Polyruria,
decreased specific gravity, decreased osmolarity, HYPOvolemia, increased thirst, tachycardia, decreased
bp.
SIADH--excess ADH is released. HYPERvolemia, weight gain, administer diuretics...Declomycin could

be prescribed.
Adrenal crisis: Profound fatigue, dehydration, vascular collapse, renal shut down, decreased NA,
increased K.
Good ol' Maslow:

1st Physiologic needs
2 Security and safety
3 Love and belonging
4 Self actualization
Sterile field and procedure facts...

For sterile field--never turn your back, avoid talking , moisture barriers carries bacteria, open pack away
from field, do not reach over sterile field.
Sterile procedures--Surgical procedures, biopsies, caths, injections, infusions, dressing changes.
In regards to surgery, aspirin, antidepressants, steroids, nsaids are drugs that put clients at risk!
The consent for surgery--Dr. gives client explanation, consent signed by Dr., client and witness. Signed
prior to pre op meds, remains a permanent part of client chart.
For pain: PQRST

Provoking
Quality
Region
Severity
Timing
Ask if pain is stabbing, burning crushing.
Narcotics---MORPHINE, MEPERIDINE(DEMEROL), HYDROMORPHONE(DILAUDID),

OXYCODONE(OXYCOTIN).

Non-narcotics--ACETOMINOPHEN(TYLENOL), SALICYLATES.
Non steroidal (NSAIDS) TYLENOL, IBPROFEN, NAPROSYN, INDOCIN.
Clozapine (Clozaril) is used for schizophrenic patient's who don't respond to other antipsychotic drugs.
Cogentin (Benztropin) is used for the extrapyramidal effects associated with antipsychotic agents.
Chlorpromazine (Thorazine) is used to treat hallucinations, agitation, and thought disorders.
Adenosine(Adenocard) is an antiarrhythmic drug, this drug is good for paroxysmal atrial tachycardia...it
slows conduction from av node.
Atropine for symptomatic bradycardia.
Digoxin for atrial fibrillation.
Lidocaine for ventricular ectopy.
For assessing the abdomen, correct order is INSPECTION, AUSCUTATION, PERCUSSION,

PALPATION "I Am Peed PAAAAA!" )
Cheyne strokes respirations are periods of apnea for 10-60 seconds then slowly increasing rate and
depth... occur typically with heart failure and cerebral depression.
Bulls eye rash is classic in lymes disease.
To relieve breast engorgement, pt should pump each breast for 10 minutes every 3-4 hours and during the
night if she's awake.
Anticholinergic effects(drugs that block acetylcholine) cause dry mouth, constipation, urine retention.
5 rights of delegation
Right task
Right circumstance
Right communication
Right person
Right feedback
Cystic fibrosis is a recessive trait, there is a one in four chance that each offspring will have the trait or
disorder.
Cushing’s triad is something to look out for in patient's with increased ICP which is decreased heart rate,
decreased respiratory rate BUT increased blood pressure.
Withdrawal from stimulants results in depression, fatigue and confusion.
Withdrawal from alcohol results in vomiting, nausea, tremors and diaphoresis.
Withdrawal from sedatives results in increased motor activity and tachycardia.
Withdrawal from opioids results in rhinorrhea, abdominal cramps and DIALATED pupils.
to remember blood sugar:

hot and dry-sugar high (hyperglycemia)

cold and clammy-need some candy (hypoglycemia)
2. ICP AND SHOCK HAVE OPPOSITE V/S

ICP-increased BP, decreased pulse, decreased resp.
shock- decreased BP, increased pulse, increased resp.
3. cor pulmonae: right sided heart failure caused by left ventricular failure (so pick edema, jvd, if it is a
choice.)
4. heroin withdrawal neonate: irritable poor sucking
5. Jews: no meat and milk together
6. Brachial pulse: pulse area cpr on an infant.
7. Test child for lead poisoning around 12 months of age
8. bananas, potatoes, citrus fruits source of potassium
11. Cultures are obtained before starting IV antibiotics
12. a pt with leukemia may have epitaxis b/c of low platelets
13. best way to warm a newborn: skin to skin contact covered with a blanket on mom.
14. when a pt comes in and she is in active labor...nurse first action is to listen to fetal heart tone/rate
15. phobic disorders...use systematic desensitization.
1. Clients of the Islam religious group might want to avoid jello, pork and alcohol
2. Most common side effect of daunorucibin (cerubidine) for a client with leukemia is cardiotoxicity
3. Patient having a surgery on the lower abdomen should be placed in the trendelenburg position
4. Flumazenil (Romazicon) is the antidote for versed (Needless to remind you that versed is used for
conscious sedation... Say thank you Jean LOL)
5. Patients taking isoniazid (INH) should avoid tuna, red wine, soy sauce, and yeast extracts b/c of the
side effects that can occur such as headaches and hypotension
6. A Patient with gout who is placed on a low-purine diet should avoid spinach, poultry, liver, lobster,
oysters, peas, fish and oatmeal
7. A patient who needs a high-iron diet should eat: sliced veal, spinach salad, and whole-wheat roll
8. Pegfilgastrin (Neulasta) is a chemotherapeutic drug given to patients to increase the white blood cells
count
9. Amphoteracin B (Fungizone) should be mixed with D5W ONLY!!!
10. Pt with leukemia taking doxorubicin (Adriamycin) should be monitored for toxic effects such as rales
and distended neck veins (carditoxicity manifested by change in ECG and CHF)
11. Cardidopa/levodopa (Sinemet) is given to clients with Parkinson's disease. Watch for toxic effects
such as spasmodic eye winking
12. Nimotop (Nimodipine) is calcium channel blocker that is given to patients with ruptured cerebral
aneurysm.
A conductive hearing loss involves interference in the transmission of sound waves to the inner ear.
2. A sensorineural hearing loss is the result of nerve impairment.
3. An acoustic neuroma is a benign Schwann cell that adversely impacts the 8th cranial nerve.
4. DKA is an acute insulin deficiency followed by a decrease in glucose in body cells and an increase

production of glucose by the liver.
5. Lymphedema results from an obstruction of lymph circulation and can be acquired or can be secondary
to other disorders.
6. The Reed-Sternberg cell is the malignant cell type associated with Hodgkin's Disease.
7. The incidence if Hodgkin’s and non - Hodgkin’s lymphomas are increased in those taking drugs such as
phenytoin ( Dilantin ).
On the ECG or EKG:
P wave = atrial depolarization
P-R interval = represents atrial,AV node, & Purkinje depolarization
Q wave = septal depolarization
R wave = apical depolarization
S wave = depolarization of lateral walls
QRS complex = spread of excitation through the muscle of the ventricles
T wave = ventricular repolarization
Starling's Law = the greater the strength of the myocardium as the ventricles fill with blood, the stronger
the contraction.
Cardiac output = the amount of blood that is pumped out of the LV each minute.
The mitral valve is the most common site for vegetations.
1. S/S croup (child) => hoarse voice, inspiratory stridor, barking cough
2. Client with hepatic encephalopathy => Neomycin decreases serum ammonia concentration by
decreasing the number of ammonia producing bacteria in the GI tract
3. A 2 year old can remove one garment
4. A 2 and half year old can build a tower of eight cubes and point out a picture
5. A 3 year old can wash and dry his/her hands
6. S/S perforated colon => severe abdominal pain, fever, decreasing LOC
7. Hyperglycemia => b/c polyuria assess for signs of deficit fluid volume such as rapid, thready pulse,
decreased BP, and rapid respirations
8. A child with nephrotic syndrome is at risk of skin breakdown from generalized edema
9. Tetracycline should be taken on an empty stomach. Avoid dairy products, Ca, Mg, Al and Fe (Iron)
10. Upper GI series => NPO 6-8 hrs b/f procedure
11. Mumps is the childhood infectious disease that most significantly affects male fertility
12. Client allergic to penicillin may be also allergic to cephalosporins
13. Infants and children up to age 7 are abdominal breathers
14. Placental transport of substances to/from the fetus begins in the 5th week
15. Duration of contractions => period from the onset of uterine tightening to uterine relaxation
16. Frequency of contractions => period b/t one contraction and the beginning of the next contraction
17. Erbs point => 3rd L ICS; pulmonic and aortic murmurs are best
PE ( Pulmonary Embolism )
Risk factors:
* venous thrombosis * immobility * post-op pts. * trauma * pregnancy * CHF * obesity * oral
contraceptives
Signs/Symptoms:
* pleuritic chest pain
* severe dyspnea
* feeling of doom
* tachypnea & tachycardic
* hemoptysis

* shock ( if huge )
* low pCO2, increased pH ( from hyperventilating )
* fever
* rales/crackles
RISK for DIABETES:

* genetics/family hx
* obesity
* race ( African-American, Native American, Hispanic, Asian, Pacific Islanders )
* over 40 yrs
* had an impaired fasting glucose or impaired glucose tolerance before
* HTN
* High cholesterol and triglycerides
* hx of gestational diabetes
Lithium
therapeutic range is small watch closely, 0.6 to 1.2 mEq/L.
Check Lithium level every 1-2 months or with behavior change.
Some side effects:
* polyuria
* polydipsia
* mild thirst
* hand tremors
* bloating of abdomen
* weight gain
* lethargy
* headache
Watch salt intake & ensure pt getting enough.

monitor renal function
don't give diuretics with lithium
no alcohol
maintain good oral fluid intake
CRUTCHES:
The three point gait is the most commonly used. It is used when the pt can only have weight on 1
extremity.
* advance the crutches together first along with the affected leg all at same time.
* bring the unaffected leg up to the crutches, supporting the weight of the body on the hands.
* ensure proper length of the crutches, when pt is standing as upright as possible position the top of crutch
2 inches below armpit, and tip of each crutch is 6 in. to the front and side of the feet. Pts. elbows should
be slightly flexed when the hand is on the grip.
EGD is an invasive diagnostic test to see into the esophagus & stomach to accurately diagnose an ulcer &
evaluate the effectiveness of the patient's tx.
An occult blood test shows the presence of blood but does not show where it is coming from.
Gastric ulcer pain usually happens 30-60 minutes after a meal & not at night. A duodenal ulcer has pain
during the night that is often relieved by eating food. So, gastric ulcer food=pain. Duodenal ulcer food
eases pain.

Sharp pain in the upper stomach ( abdomen ) after eating a heavy meal is a symptom of gallbladder
disease.
Hirschsprung's disease, infant fails to pass meconium, abd distention, caused by obstruction in intestine,
will get colostomy, that is usually reversed when child is 17-22 lbs.
Naturally acquired active immunity: results from having the disease and recovering successfully.
Naturally acquired passive immunity: antibodies received from placenta or breast milk.
Artificially acquired active immunity: from immunizations.
Artificially acquired passive immunity: antibodies transferred from sensitized person as in immune serum
globulin ( gamma globulin ).
1. Ace Inhibitors can cause hyperkalemia and chronic cough- pt's should
not use salt substitutes because they are mostly made from K+ which
will further increase the K+
2. Valium- suppresses non-rem sleep. Overdose Antidote is flumazenil.
3. There is no antidote for barbiturates which suppress REM sleep. S/S of

allergy to barbiturates is Barbs=prickly sensation ,edema of
membranes in mouth.
4. Tylenol = Liver toxic (no more than 4 g/day) Give Mucomyst for
overdose. Whereas, Ibuprofen = kidney toxic
5. Vancomycin- treats MRSA; Adverse Effects- Red man syndrome-

flushing from quick admin of this Rx can be prevented with Benadryl before admin of RX.
· Terbutaline: Medication given to stop pre-term labor

· Methergine: Given for postpartum hemorrhage.
· Cervidil: Cervical ripening agent
· Mag Sulfate: Pregnancy Induced Hypertension - prevents seizure. Absence of deep tendon reflex is sign
of toxicity
· Pitocin: Used for induction of labor and postpartum to help the uterus contract.
· Early Decelerations are okay, follow the contraction.
· Late Decelerations are a sign of fetal distress and continue after contraction. Reposition client (left side)
· 3- 5 beat Variability in FHR is good sign, you want to see that.
· Stop pitocin if contractions longer than 90 seconds and closer than 2 minutes.
· Once the membranes rupture, important to monitor temperature hourly as risk for infection increases.
· First thing to do after rupture is to auscultate fetal heart tones! Assessing for cord prolapsed if decels
occur.
· Analgesics are typically not given during the transitional phase of labor as delivery is imminent and
could lead to decreased respiratory rate in neonate.
· If patient has boggy uterus - place the infant to nipple, it causes release of natural pitocin
· If uterus deviated to one side - encourage client to void.
· Rhogam given to Rh negative mothers with Rh positive babies.
Therapeutic Ranges
PACT of 10-20

-Phenytoin
-Acetaminophen
-Chloramphenicol
-Theophylline
...amine=150-300 ng/ml
-Imipramine
-Desipramine
...LOL Valproic 50-100!

-propranoLOL ng/ml
-Valproic Acid mcg/ml
MgSO4 = 4-7
**************
Phenobarbital =10-30
Therapeutic range of these drugs are CODED in their names; Di=2(means two) Amide-5 letters,
the rest in CAPITAL Letters (lower range) and total number of letters (higher range).
DIsopyrAMIDE 2-5
GENTAmicin 5-10
TOBRAmycin 5-10
CARBAmazepin (e) 5-12
*************
EthoSUXemide 40-100, it is just suxs))
I dont gave LITHIUM, Digoxin, lidocain since we already must know them!
Li =0.5-1.3 mEq/L
Di=0.5-2 ng/ml
Lido 1.5-5 mcg/ml
1. Autonomic Dysreflexia--asses Bladder, Bowel, Skin

2. GIVE Dantrolene to treat pt. in MH crisis
3. JOMACS (mini mental status exam)= Judgement, Orientation, Memory, Affect, Consciousness, Speech
4. -ostomy- make opening
5. -oscopy- look into or at
6. -otomy- cutting into
7. -ectomy- removal of
9. Colporrhaphy- surgical repair of the vagina (Very random )
10. Do not Palpate WILM's tumor
11. Albumin is the best indicator of nutritional status
12. In V-fib always look at pt first anything can mimic the pattern on EKG
13. V-tach is usually caused by an underlying cause treat cause
14. Precipitous delivery may cause amniotic emboli
15. Hct: Hgb approx 3:1
16. WBC= 5-10 (thousand)
17. Platelets= 150-400 (thousand)

18. PPI's stop gastric acid secretion (permanently)
19. Vasoconstriction stops itching and inflammation (give cool bath)
20. Anticholinergic effects- Cant SEE, Cant PEE, Cant POOP, and dry mouth
21. Trauma to frontal may cause Frontal Lobe disinhibition
22. Creatinine is the best indicator of renal function
23. Every drop of urine counts during 24hr creatinine clearance (if one sample is thrown out must start
over) First void of the morning is not included but the first pee of the next morning is (because it is
considered Last nights urine)
24. Best position to improve resp. effort = Left Lateral, Folwer & modifications of it
1. When getting down to two answers, choose the assessment answer (assess,
collect, auscultate, monitor, palpate) over the intervention except in an
emergency or distress situation. If one answer has an absolute, discard it.
Give priority to answers that deal directly to the patient’s body, not the
machines/equipments.
2. Key words are very important. Avoid answers with absolutes for example:
always, never, must, etc.
3. with lower amputations patient is placed in prone position.
4. small frequent feedings are better than larger ones.
5. Assessment, teaching, meds, evaluation, unstable patient cannot be
delegated to an Unlicensed Assistive Personnel.
6. LVN/LPN cannot handle blood.
7. Amynoglycosides (like vancomycin) cause nephrotoxicity and ototoxicity.
8. IV push should go over at least 2 minutes.
9. If the patient is not a child an answer with family option can be ruled
out easily.
10. In an emergency, patients with greater chance to live are treated first
.
11. ARDS (fluids in alveoli), DIC (disseminated intravascular coagulation)
12. Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues).
13. in pH regulation the 2 organs of concern are lungs/kidneys.
14. edema is in the interstitial space not in the cardiovascular space.
15. weight is the best indicator of dehydration
16. wherever there is sugar (glucose) water follows.
17. aspirin can cause Reye’s syndrome (encephalopathy) when given to
children
18. when aspirin is given once a day it acts as an antiplatelet.
19. use Cold for acute pain (eg. Sprain ankle) and Heat for chronic (
rheumatoid arthritis)
20. guided imagery is great for chronic pain.
21. when patient is in distress, medication administration is rarely a good
choice.
22. with pneumonia, fever and chills are usually present. For the elderly
23. Always check for allergies before administering antibiotics (especially
PCN). Make sure culture and sensitivity has been done before adm. First dose
of antibiotic.
24. Cor pulmonale (s/s fluid overload) is Right sided heart failure caused
by pulmonary disease, occurs with bronchitis or emphysema.
25. COPD is chronic, pneumonia is acute. Emphysema and bronchitis are
both COPD.
26. in COPD patients the baroreceptors that detect the CO2 level are

27. exacerbation: acute, distress.
28. epi always given in TB syringe.
29. prednisone toxicity: Cushing’s syndrome= buffalo hump, moon face, high
glucose, hypertension.
30. 4 options for cancer management: chemo, radiation, surgery, allow to
die with dignity.
31. no live vaccines, no fresh fruits, no flowers should be used for
neutropenic patients.
32. chest tubes are placed in the pleural space.
33. angina (low oxygen to heart tissues) = no dead heart tissues. MI=
dead heart tissue present.
34. mevacor (anticholesterol med) must be given with evening meal if it is
QD (per day).
35. Nitroglycerine is administered up to 3 times (every 5 minutes). If
chest pain does not stop go to hospital. Do not give when BP is < 90/60.
36. Preload affects amount of blood that goes to the R ventricle.
Afterload is the resistance the blood has to overcome when leaving the heart.
37. Calcium channel blocker affects the afterload.

38. for a CABG operation when the great saphenous vein is taken it is
turned inside out due to the valves that are inside.
39. unstable angina is not relieved by nitro.
40. dead tissues cannot have PVC’s(premature ventricular contraction. If
left untreated pvc’s can lead to VF (ventricular fibrillation).
41. 1 t (teaspoon)= 5 ml
1 T(tablespoon)= 3 t = 15 ml
1 oz= 30 ml
1 cup= 8 oz
1 quart= 2 pints
1 pint= 2 cups
1 gr (grain)= 60 mg
1 g (gram)= 1000 mg
1 kg= 2.2 lbs
1 lb= 16 oz
* To convert Centigrade to F. F= C+40, multiply 9/5 and substract 40
* To convert Fahrenheit to C. C= F+40, multiply 5/9 and substract 40.
42. angiotensin II in the lungs= potent vasodilator. Aldosterone attracts
sodium.
43. REVERSE AGENTS FOR TOXICITY
heparin= protamine sulfate
coumadin= vitamin k
ammonia= lactulose
acetaminophen= n-Acetylcysteine.
Iron= deferoxamine
Digitoxin, digoxin= digibind.
Alcohol withdraw= Librium.
- methadone is an opioid analgesic used to detoxify/treat pain in
narcotic addicts.
- Potassium potentiates dig toxicity.
44. heparin prevents platelet aggregation.
45. PT/PTT are elevated when patient is on coumadin

46. cardiac output decreases with dysrythmias. Dopamine increases BP.
47. Med of choice for Vtach is lidocaine
48. Med of choice for SVT is adenosine or adenocard
49. Med of choice for Asystole (no heart beat) is atropine
50. Med of choice for CHF is Ace inhibitor.
51. Med of choice for anaphylactic shock is Epinephrine
52. Med of choice for Status Epilepticus is Valium.
53. Med of choice for bipolar is lithium.
54. Amiodorone is effective in both ventricular and atrial complications.
55. S3 sound is normal in CHF, not normal in MI.
56. give carafate (GI med) before meals to coat stomach
57. Protonix is given prophylactically to prevent stress ulcers.
58. after endoscopy check gag reflex.
59. TPN(total parenteral nutrition) given in subclavian line.
60. low residue diet means low fiver
61. diverticulitis (inflammation of the diverticulum in the colon) pain is
around LL quadrant.
62. Appendicitis (inflammation of the appendix) pain is in RL quadrant with
rebound tenderness.
63. portal hypotension + albuminemia= Ascites.
64. beta cells of pancreas produce insulin
65. Morphine is contraindicated in Pancreatitis. It causes spasm of the
Sphincter of Oddi. Therefore Demerol should be given.
66. Trousseau and Tchovoski signs observed in hypocalcemia
67. with chronic pancreatitis, pancreatic enzymes are given with meals.
68. Never give K+ in IV push.
69. mineral corticoids are give in Addison’s disease.
70. Diabetic ketoacidosis (DKA)= when body is breaking down fat instead of
sugar for energy. Fats leave ketones (acids) that cause pH to decrease.
71. DKA is rare in diabetes mellitus type II because there is enough
insulin to prevent breakdown of fats.
72. Sign of fat embolism is petechiae. Treated with heparin.
73. for knee replacement use continuous passive motion machine.
74. give prophylactic antibiotic therapy before any invasive procedure.
75. glaucoma patients lose peripheral vision. Treated with meds
76. cataract= cloudy, blurry vision. Treated by lens removal-surgery
77. Co2 causes vasoconstriction.
78. most spinal cord injuries are at the cervical or lumbar regions
79. autonomic dysreflexia ( life threatening inhibited sympathetic response
of nervous system to a noxious stimulus- patients with spinal cord injuries
at T-7 or above) is usually caused by a full bladder.
80. spinal shock occurs immediately after spinal injury
81. Multiple sclerosis= myelin sheat destruction, disruption in nerve
impulse conduction.
82. myasthenia gravis= decrease in receptor sites for acetylcholine. Since
smallest concentration of ACTH receptors are in cranial nerves, expect fatigue
and weakness in eye, mastication, pharyngeal muscles.
83. Tensilon test given if muscle is tense in myasthenia gravis.
84. Guillain-Barre syndrome= ascending paralysis. Keep eye on respiratory
system.
85. parkinson’s = RAT: rigidity, akinesia (loss of muscle mvt), tremors.
Treat with levodopa.
86. TIA (transient ischemic attack) mini stroke with no dead brain tissue

87. CVA (cerebrovascular accident) is with dead brain tissue.
88. Hodgkin’s disease= cancer of lymph is very curable in early stage.
89. Rule of NINES for burns
Head and Neck= 9%
Each upper ext= 9%
Each lower ext= 18%
Front trunk= 18%
Back trunk= 18%
Genitalia= 1% ?
90. Birth weight doubles by 6 month and triple by 1 year of age.

91. if HR is <100 do not give dig to children.
92. first sign of cystic fibrosis may be meconium ileus at birth. Baby is
inconsolable, do not eat, not passing meconium.
93. heart defects. Remember for cyanotic -3T’s( Tof, Truncys arteriosus,
Transposition of the great vessels). Prevent blood from going to heart. If
problem does not fix or cannot be corrected surgically, CHF will occur
following by death.
94. with R side cardiac cath=look for valve problems
95. with L side in adults look for coronary complications.
96. rheumatic fever can lead to cardiac valves malfunctions.
97. cerebral palsy = poor muscle control due to birth injuries and/or
decrease oxygen to brain tissues.
98. ICP (intracranial pressure) should be <2. measure head circumference.
99. dilantin level (10-20). Can cause gingival hyperplasia
100. for Meningitis check for Kerning’s/ Brudzinski’s signs.
101. Wilm’s tumor is usually encapsulated above the kidneys causing flank
pain.
102. hemophilia is x-linked. Mother passes disease to son.
103. when phenylalanine increases, brain problems occur.
104. Buck’s traction= knee immobility
105. Russell traction= femur or lower leg
106. Dunlap traction= skeletal or skin
107. Bryant’s traction= children <3y, <35 lbs with femur fx.
108. place apparatus first then place the weight when putting traction
109. placenta should be in upper part of uterus
110. eclampsia is seizure.
111. a patient with a vertical c-section surgery will more likely have
another c-section.
112. perform amniocentesis before 20 weeks gestation to check for cardiac
and pulmonary abnormalities.
113. Rh- mothers receive rhogam to protect next baby.
114. anterior fontanelle closes by 18 months. Posterior 6 to 8 weeks.
115. caput succedaneum= diffuse edema of the fetal scalp that crosses the
suture lines. Swelling reabsorbs within 1 to 3 days.
116. pathological jaundice= occurs before 24hrs and last7 days.
Physiological jaundice occurs after 24 hours.
117. placenta previa = there is no pain, there is bleeding. Placenta
abruption = pain, but no bleeding.
118. bethamethasone (celestone)=surfactant. Med for lung expansion.
119. dystocia= baby cannot make it down to canal
120. pitocin med used for uterine stimulation
121. Magnesium sulfate(used to halt preterm labor) is contraindicated if

deep tendon reflexes are ineffective. If patient experiences seizure during
magnesium adm. Get the baby out stat (emergency).
122. Do not use why or I understand statement when dealing with patients
123. milieu therapy= taking care of patient/environment
124. cognitive therapy= counseling
125. crisis intervention=short term.
-safety
-setting limits
-meds
-leas restrictive methods/environment.
126. SSRI’s (antidepressants) take about 3 weeks to work.
127. Obsession is to thought. Compulsion is to action
128. if patients have hallucinations redirect them. In delusions distract
them.
129. Thorazine, haldol (antipsychotic) can lead to EPS (extrapyramidal side
effects)
130. Alzheimer’s disease is a chronic, progressive, degenerative cognitive
disorder that accounts for more than 60% of all dementias
Fluids:
· 0.45% NaCl - best for dehydration - hypotonic
· D5NS - contraindicated in dehydratoin - hypertonic
· Lactated ringers - isotonic, used to replace electrolytes
· 0.9% NaCl - Isotonic
Pregnancy r/t:
· Add 300 Calories to diet when pregnant, 500 when breastfeeding.
· Calcium Gluconate can cause severe chemical burns - most important to check patency of veins when
giving (given to a patient experience magnesium sulfate toxicity)
· Take prenatal vitamins in the morning with orange juice - acid aids in absorption.
Misc:
· If a tracheostomy tube falls out, replace it immediately (maintain airway) then check for breath sounds.
· If patient in Buck's traction is sliding down in bed, elevate the foot of bed with blocks. Keeps leg
straight, doesn't alter pull of traction.
· When Charting Chief Complaint it should be written in pt's own words.
Pharmacology:
· Artane and Cogentin - Tx for acute extrapyramidal symptoms from antipsychotics
· INH - Tx for TB may cause peripheral neuropathy - tingling
· Flagyl and Alcohol causes an Antabuse like reaction - n/v, flushed skin
Larngotracheobronchitis: inspiratory stridor and restlessness

2. Thorazine: antidote cogentine SE: akathisia(motor restlessness) dystonia(tongue protrusion, abnormal
posture) and diskinesia(stiff neck, difficulty swallowing)
3. Toddlers- parallel play; infants enjoy company but self play.
4. IV infiltration D/C IV and apply warm compress.
5. Urticaria= hives.
6. Graves disease: enlarged thyroid, increased metabolism and of course weight loss.
7. The goal for COPD is to improve ventilation.
8. From birth to 18 months Trust vs Mistrust
9 HbA1C- indicates BS for past 6-8 weeks(time varies with source) 2.5-6% normal.

10. myasthenia gravis: autoimmune disease of neuro jnx. destroys Acetylcholine receptors.
11. Meniere’s: Inner ear disease: vertigo, tinnitus, sensorineuro hearing loss, N/V
12. Use play therapy for children d/t inability to verbalize emotions.
13. Phenergan: Check vein patency (very important)
14. Visine: contraindicated in glaucoma d/t vasoconstriction
1. One of the CHF symptoms is S3 ventricular gallop

2. Hypertensive crisis => Priority in the first hour is brain damage due to rupture of the cerebral blood
vessels. Neurologic status must be closely monitored
3. Client with A-fib => a cold, pale lower leg suggests the presence of an embolus. Peripheral pulses
should be checked immediately
4. S/S anemia in a 10 months old infant => pale mucosa of eyelids and lips
5. S/S dehydration in 2 years old => sunken eyes, dry tongue, lethargy, irritability, dry skin, decreased
play activity, and increased pulse
6. Pt with anaphylaxis => The entire body may turn bright red b/c massive vasodilation
7. Teaching pt with Zollinger-Ellison syndrome => Report promptly to his/her healthcare provider any
finding of peptic ulcer (night time awakening with burning, cramp-like abdominal pain, vomiting and
even hematemesis, and change in appetite)
8. Infant with epiglottitis : 4 D's => Drooling, Dysphagia, Dysphonia and Distress inspiratory efforts
9. Niacin (Vit B) is a lipid lowering agent. Foods high in Niacin are meats, eggs, milk, dairy products
10. Child with 3 C's (Cough-Choke-Cyanosis) should be assessed for tracheoesophagial fistula
11. Gastric lavage is a priority for an infant who has been identified as suffering from botulism
12. Viral meningitis usually does not require protective measures
When using an inhaler, instruct the patient to exhale forcefully, use lips to form a tight seal around the
inhaler, press top of inhaler and inhale deeply, hold breath as long as possible, wait 3-5 mins before taking
another inhalation of the drug.
-Munchausen Syndrome is a psychiatric disorder that causes an individual to self-inflict injury or illness
or to fabricate symptoms of physical or mental illness, in order to receive medical care or hospitalization.
In a variation of the disorder, Munchausen by proxy (MSBP), an individual, typically a mother,
intentionally causes or fabricates illness in a child or other person under her care.
-Multiple Sclerosis is a chronic, progressive disease with demyelinating lesions in the CNS which affect
the white matter of the brain and spinal cord.
Motor S/S: limb weakness, paralysis, slow speech
Sensory S/S: numbness, tingling, tinnitus
Cerebral S/S: nystagmus, ataxia, dysphagia, dysarthria
Huntington's Chorea: 50% genetic, autosomal dominant disorder

S/S: chorea --> writhing, twisting, movements of face, limbs and body
-gait deteriorates to no ambulation
-no cure, just palliative care
-WBC shift to the left in a patient with pyelonephritis (neutrophils kick in to fight infection)
-Definitive diagnosis for abd. aortic aneurysm (AAA) --> CT scan
-Don't use Kayexalate if patient has hypoactive bowel sounds.
-Uremic fetor --> smell urine on the breath
-Hirschsprung’s --> bile is lower obstruction, no bile is upper obstruction; ribbon like stools.

-Pancreatic enzymes are taken with each meal! Not before, not after, but WITH each meal.
Leukemia - the main affected are: Blood, Bone mArrow, Spleen, & Lymph. The biggest problem of
leukemia is the big "ANT" Anemia, Neutrepenia, and Thrombocytopenia.
ALL- problem of B & T-lymphocyte (more in children)

AML- problem of macrophage, granulocytes, RBC, & platelets (more in children)
CML & CLL - more in elderly
Note: there's 2 types- Acute and Chronic

and 2 category- myeloid (myelocitic) & lymphoid (lymphocytic)
Bioterrorism
Level I- local emergency
Level II- regional aid from surrounding counties
Level III- local and regional assets are overwhelmed state or federal assistance is needed
Disaster tagging – tags are numbered and identify the triage priority; includes the name, address, age,
location and description of injuries and treatment and meds given
Ethical conflicts- they arise because of the perspective of disaster nursing.
There are 4 levels of protective equipment
Level A – highest priority covered from head to toe
Level B – RESP covered but less skin and eye precautions
Level C- requires air purified respirator chemical- resistant coverall with splash hood, gloves and boots
Level D – work uniform
Decontamination – is a 2 step process

1.removal of clothing and jewelry and rinsing with water
2.thorough soap and water wash and rinse
ALL OF THESE BIOLOGICAL WARFARE AGENTS CAN BE MADE!
Anthrax – can be topical, inhaled or ingested

·topical – contact precautions
·inhaled – standard precautions
· ingested standard precautions
Smallpox – on contact precautions
Botulism - standard precautions

Tularemia- standard precautions
Types of radiation
·Alpha particles - cannot penetrate the skin but can enter through inhalation, ingestion. Localized damage
·Beta particles- can moderately penetrate the skin and cause cell damage or internal injury if penetrates
the skin * exposure time is a key factor
·Gamma radiation - is penetrating and is difficult to shield against
Exposure to radiation “time, distance and shielding”
Three types of radiation induced injury can occur

1.external -pt is not radioactive does not require isolation
2.contamination – from gases, liquids or solids *requires immediate intervention to prevent incorporation
3.incorporation - uptake of radioactive material into every cell, tissue, organ
Acute radiation syndrome-

·N/V
·Bloody diarrhea
·Fever
·Cerebral edema
·Increased ICP- poor outcome and imminent death
·HA
·Skin may be red and become necrotic within day to months
LIVING SPRING WILL keep repeating infection control, since it is the crux of the matter.
Airborne Precautions
Patients who have or may have an infectious disease that is spread by the airborne route must be placed
on Airborne Precautions in addition to Standard Precautions. Airborne Precautions (formerly respiratory
isolation) applies to most infections which were previously classified as requiring "Strict," "AFB," and
"Respiratory" isolation under the old category-specific system of isolation precautions.
Diseases Requiring Airborne Precautions
Tuberculosis, Pulmonary (or laryngeal) -suspected or confirmed
Varicella (chickenpox) [requires use of Contact Precautions as well]
Herpes Zoster (shingles) - in an immunocompromised patient [requires use of Contact Precautions as

well]
Herpes Zoster (shingles) - disseminated [requires the use of Contact Precautions as well]
Rubeola (Measles)
SARS
Note: Airborne Precautions require a negative pressure room in addition to a private room. Negative
pressure rooms are specially designed to prevent the flow of air from the room into the corridors and
common areas where susceptible persons may be exposed. This is accomplished through fans and vents
that direct the airflow outside of the building and/or through HEPA filters.
Droplet Precautions

Droplet Precautions are designed to reduce the risk of droplet transmission of infectious agents. Droplet
transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a
susceptible person with large particle droplets containing microorganisms generated from a person who
exhibits a clinical disease or who is a carrier of the microorganism. The patient can generate these
droplets from coughing, sneezing, and talking, as well as during certain procedures such as suctioning and
bronchoscopy. Transmission via large droplets requires close contact (within 3 feet or less) between the
source patient and the susceptible individual. Droplets (due to their large size) do not remain suspended in
air and travel short distances - three feet or less. Thus, Droplet Precautions require the use of a standard
surgical mask within three feet of the patient. However, it is prudent to wear a mask upon entering the
room of a patient on Droplet Precautions to avoid any inadvertent exposure.
Bacterial:
Invasive Hemophilus influenzae disease: (meningitis, pneumonia (in infants and small children),
epiglottitis).
Invasive Neisseria meningitidis disease:(meningitis, pneumonia, and bacteremia).
Mycoplasma pneumonia
Group A Streptococcal pharyngitis, pneumonia, or scarlet fever in infants and young children
Viral
Influenza
Adenovirus (requires Contact Precautions in addition)
Mumps
Parvovirus B19
Rubella
Contact Precautions
Contact Precautions are designed to reduce the risk of transmission of organisms and specific diseases by
direct or indirect contact.
Direct contact transmission involves skin to skin contact and physical transfer of microorganisms to a
susceptible host from an infected or colonized person, such as occurs when personnel turn patients, bathe
patients or perform other patient care activities that require physical contact. Direct contact can also occur
between patients that may have physical contact with each other.
Indirect contact transmission involves a susceptible host with a contaminated intermediate object, usually
inanimate, in the patient's environment.
Contact Precautions are to added to Standard Precautions for patients known or suspected to have
organisms and/or diseases easily transmitted via direct or indirect contact.
Contact Precautions are required if:

A patient is colonized and/or infected with multidrug-resistant organism. A multidrug-resistant organism
is an organism that is resistant to treatment with standard first-line antibiotics.
A particular organism is identified as being potentially hazardous to others and/or to the ecology of the
hospital environment because of its antibiogram, pathogenicity, virulence, or epidemiologic
characteristics (i.e., VRE, MRSA).

Contact Precautions Disease List
In addition to Standard Precautions, Contact Precautions must be used for patients known or suspected to
have specific diseases/multidrug- resistant organisms easily transmitted by direct patient contact or
contact with items in the patient's environment. Examples of such illnesses/organisms include:
Vancomycin Resistant Enterococcus (VRE)
Methicillin Resistant Staphylococcus aureus (MRSA)
Clostridium difficile colitis
Respiratory Syncytial Virus (RSV)
Parainfluenza virus
Enteroviral infections in infants and young children
Pediculosis
Scabies
Escherichia coli 0157:H7, Salmonella, Shigella, Hepatitis A, Rotavirus-in diapered or incontinent patients
Diptheria (cutaneous)
Herpes Simplex virus

(neonatal, disseminated, or severe mucocutaneous)
Impetigo
Major (uncontained) abcesses or decubiti
Varicella (chickenpox), Herpes, Zoster (disseminated or in the immunocompromised host) also requires
Airborne Precautions
Viral/ Hemorrhagic Conjunctivitis
Viral Hemmorrhagic Fevers

(e.g., Ebola, Lassa, or Marburg)
Nclex tips
Assess first( check the question to see if the assessment has been done)
Take care of the patient first, the machines and documentation later
Always choose the most complete answer with the least opportunity for error
In Priority question, look for acute and unstable pt to see first
Always remember your ABCs

Maslow's will usually work and pain is seen as a psychosocial need---Not a physical need
Incident or Occurrence reports--Never refer to them in the pt's chart

should complete for any time there is a variance from what should have happened with Pt care
should not include blame or anything but just the facts
when charting, do not use the words, " Error, mistake, accident or incorrect."
Errors in charting are corrected by making one simple line through the words
If a RN comes from another unit, give that RN a pt who does not need to have a RN from specific unite
care for him/her. EX. --Post op mastectomy needs an ONco nurse to take with.
Delegation--If you are assigning pt care to LPN/NA, rank order the pt as to the ones who have the least
acute problems/changes to the most
Anytime a question comes up about a procedure or diagnostic test, consider the possible complications
Vital signs are a LATE signa of pt status change
Rales=CHF
Rhonchi=pneumonia
Wheezes=asthma
Hemoptysis=Lung cancer or TB
Pleural Pain=Pssible PE
Intercostal retractions=respiratory distress
Role play the situation
Read the question and answers out loud
Safety for the pt is always first, then the family, then the nurse
Never isolate a pt with Alzheimer's disease
Any time a pt has traction applied or a broken bone, consider:

circulation
Movement
Sensation
skin integrity
restlessness is often the first sign of hypoxia
if you chose an answer with the word, why or check in it, make sure it is truly the best answer.

Rarely is the right answer to call the physician--Don't pass the responsibility
Psychiatric pt:
--For someone with psychosis--acknoledge the hallucination or delusion and then realityorientation
--for someone with dementia--change the subject, divert the attention
Medications to know: antipsychotics--Haldol, Thorazine, Zyprexa, Geodon\
antidepressants--Tricyclics--typically sedating so take at bedtime, cause otthostasis, dry mouth, very

dangerous with OD. NEED to wean off.
MAO-I---low tyramine diet, if they eat something high tyramine--hypertensive crisis
Interact with a lot of other meds, can have hypertensive crisis with other meds
Need to be off other antidepressants for at least 2 wks before starting.
SSRI--can treat anxiety to. Typically take in the morning because they are more likely to be stimulating.
Can cause diarrhea. Need to wean off.Serotonin serge.
Anti-mania--lithium--need to have levels drawn, Tend to get increased level if sweating, vomiting. Know
the S/S of toxicity. Know normal Li levels( 0.6-1.2)
Anti-seizure family( Depakote, Tegretol, Lamictal, Trileptal, etc) most can lead to liver failure. Should
have levels of Depakote/Tegretol done at intervals.
Anti-anxiety-Benzodiazepines----addictive and lead to seizures during withdrawl. Very dangerous if

combined with alcohol. Sedating except may have paradoxical
Reaction in the elderly
Safety is always first priority if someone is losing control of her/his behavior.
--must try all other interventions before using restraints/seclusion

someone must stay within arms's reach of the pt if they are restraints
Need to release one restraint or do Prom every 15 min.
Restraint to orders need to be specific and cannot be PRN and only good for 24hrs.
Chemical restraints count as restraints
The pt with Depression needs to increase interaction.
the pt with psychosis typically is very concrete in thinkgs and it not going to be able to process groups,
etc
Well pt with addictive disorders use the denail as their primary coping mechanism
Manic phase pts need finger foods or calories as they burn a lot being busy
Suicidal pts --look for any phrase that implies helplessness, hopelessness, worthlessness
Post op eye surgery--don't bend at the waist, avoid straining

If someone has an object that has penetrated his/her body, leave it there until it is assessed as safe to
remove.
INTERVENTIONS FOR COPD (using ABCDEF)
A-Aminophylline
B-Brochodilators
C- Chest Physiotherapy
CORTICOSTEROIDS
D- Deliver oxygen at 2 liters
E- Expectorants
F- Force Fluids
Tuberculosis ( Meds) Use RISE
R-Rifampin
I-Isoniazid (INH)
S-Streptomycin
E-Ethambutol
Care of Client After Masectomy

(BREAST)
B-Bp not on affected side
R- Reach recovery
E-Elevate affected side

Exension and flexion exercise- initialy (Squeeze a ball)
A-Abduction and external rotation should not be initial exercise
S-SBE- Once a month- about one week after period
T-To promote a positive self image
TURPS
T-Tubes
U-Urinary output

R- Red drainage
P-Pieces of clots
S-Spasms
Meniere's Disease
Administer diuretics to decrease endolymph in the cochlea, restrict sodium, lay on affected ear when in
bed.
TRIAD
-vertigo
-Tinnitus
-Nausea and vomiting.
Use FIRST to help you remember
F- find hypoxia
I- Immunocompromised
R- Real bleeding ( Trauma, hemorrhage)
S-Safety
T- Try infection
Breast Cancer Risk Factors:
• >50 years of age

• FIRST child born after 30 years of age
• Grandmother, Mother, Sister has it
• Personal history of breast cancer
Garlic has a hypoglycemic effect do not give with insulin
Eye problems do not want head in dependent position. Lie on good side and have bad eye up or elevate
the head of the bed to 35 degrees.
Lay on right side after liver biopsy.
Clear fluid from head CSF medical emergency call the doctor
1 yr old with nausea, vomiting, and diarrhea is emergency because young children become dehydrated
very easily
Assess pt for claustrophobia with CAT scans and MRIs, also, NO METAL.

ALPHABET NURSING FACT:
Activated charcoal - To absorb poison
AAA- Complication is hemorrhage and shock
A positive mantoux test indicate the pt has produced an immune response
Complication of warfarin- (3H) hemorrhage, hematuria and hepatitis
Colchine for treatment of gout attack
Codeine- onset- 30mins, peak- 1hr, duration 4-6hrs
COPD -use of acessory muscle for respiration indicate the pt is having difficulty breathing
Chlamydia, Genital herpes and HPV - Do not report
Crackles are heard on inspiration and dont clear with cough
Diaphramatic and purse lip breathing are the best for pt with COPD
DMD- X-linked recessive and female are carrier and male are affected.
DI- Treatment is DDAVP
Gastric lavage - To remove poison
Indomethacin - helps in closing PDA
Left sided HF- pulmonary
Myelomingocele complication - clubbfoot and hydrocephalus
Meningitis- Droplet
Osteoarthritis- Joint pain, crepitus, heberden's node, bouchard's node and enlarge joints
Pentoxifyline- hemorheologic Agent that improve blood flow and is used to treat intermittent claudication
Prostaglandin E is administerd to provide blood ming and also help to keep open the ductus arteriosus
Right side HF- systemic
Rhonchi are heard on expiration and clear with cough
Rabies- contact precaution
tPA- used to treat Acute MI
Thrombolytic- dissolve clots
To avoid falsely elevated serum digoxin, the nurse should wait @ least 8hrs after administering oral

digoxin and @ least 6hrs after administering I.V digoxin to draw a blood sample.
TB- airborne
Disaster planning
A disaster plan needs to be activated when there is a life threatening situation with a large number of
patients involve. A way to remember who to remove first is by using ABC
A- Ambulatory
B- Bed Ridden
C- Critical Care
You may ask why but the goal is to move the greatest number of clients.
Appendicitis- position of comfort is on the side with the legs flexed agains the abdomen. HOB should
remain slightly elevated to decrease the upward spread of infection in case the rupturing of appendix
occurs.
Here are a few facts I came across while doing questions.
Brown pigmentation around the ankles of patient indicates venous insufficeny
Cloudy outflow during peritoneal dialysis indication of infection and needs to be reporeted to MD
Afte colonoscopy a patient should report rebound tenderness. Abdominal cramping, fatigue and passage
of liquid stool are all normal findings after colonoscopy.
A patient with pertussis should be in a private room, mask and under droplet precautions.
Hydromorhone ( Dilaudin) can Cause urinary retention.
Respite care important for caretaker of Alzheimer's patient to allow for physical and emotional rest.
Antihistamines can cause urinary retention and exacerbate symptoms of BPH.
Applying pressure to the inner cantus of the eye prevents overflow of medication into the nasolacrimal
duct and possibly systemic absorption.
Ethical dilema- Determination of facts. identify possible solutions, consider patients wishes.
An Increase in peak expiratory flow rate indicates that airway restriction is resolving ( asthma patient)
Salem sum tube- turn patient every 2 hours to promote emptying of stomach contents.
Fatigue, abdominal bloating and persistent dyspnea of patient with COPD contributes to patients inability
to maintain adequate nutrition.

Serosanguienous drainage beyond post-op day 5 may indicate dehiscence; therefore surgeon should be
notified.
There is no need for a parent of a child who is HIV positive to notify the childs daycare provider.
INDERAL- serious side effect decrease heartrate due to blockade of betta1 receptors in the heart.
Bulima patient with bloody emesis due to esophageal tears due to purging.
Pacemaker spikes on T wave indicate that the pacemaker is not capturing appropriately and should be
adjusted for this patient.
A patient who is having muscle spasm while in traction should be repositioned to see if the spasms
decrease.
REASONS FOR UNCONSCIOUSNESS ( skin Color)
RED- Stroke or increase in blood pressure
BLUE- Respiratory or cardiac arrest
WHITE- Shock or Hemorrhage.
BETA BLOCKERS
B-bronchospasm( do not give to asthma, bronchial constriction patients)
E- elicits a decrease in cardiac out put and contractility.
T- treats hypertension
A- Av conduction decreases
T- tenormin ( atenolol) hypertension & angina
L- Lopressor ( metopolol) hypertension & angina
C- Corgard ( naldolol) hypertension & angina ( renally excreted)
Glomerulonephritis- fever, periorbital edema, weakness, and chills caused by grop B strep.
It is normal for a patient that has had dialysis to have a slight fever afterwards due to the dialysis solution
being warmed by the machine.
Positive sweat test indicative of cystic fibrosis.
After thyroid surgery- maintain airway keep a trach kit at patients bedside, check for bleeding, be sure to
check at sides and back of neck due to gravity and teach patient to support their neck.

A bit about B-Vitamins
B-1 (thiamine) and all B vitamins – Alcoholic (to prevent Wernicke’s encephalopathy and
Korsakoff’s syndrome.
B-6 (pyridoxide hydrochloride) –TB patient (Pt is likely on INH which can cause peripheral
neuropathy, dizziness, and ataxias, B-6 can prevent these unwanted affects).
B-9 (folic acid) – Pregnant pt to prevent neural tube defects in fetus
B-12 (cobalamine) – Pernicious anemia (autoimmune disease that attacks the parietal cells
preventing intrinsic factor from being released, which is needed to absorb B-12.
1. Hep B immune globulin and Hep B vaccine are given to infants with perinatal exposure to
prevent hepatitis and achieve lifelong prophylaxis; administered within 12 hours of birth.
2. Immune globulin is given to prevent Hep A.
3. Cyanocobalamin (Vit B12) is used to treat states of vit B12 deficiency; the most common
manifestation of untreated cyanocobalamin deficiency is pernicious anemia.
4. Pernicious anemia is one of the risk factor for gastric cancer.
5. child with Celiac disease: dietary management is the mainstay; eliminate all wheat, rye, barley,
and oats; replaced with corn and rice; vitamins supplements, especially fat-soluble vit and folate,
may be needed in the early period of treatment to correct deficiencies.
1. Acid is lost from the stomach (emesis) leading to metabolic alkalosis
2. Bicarbonate is lost from diarrhea leading to metabolic acidosis
3. Irritability (rather than lethargy) is an initial finding for cerebral hypoxia which would occur
from the retained fluid in the brain that results in increased ICP
4. Signs of increased ICP in infants include: bulging fontanel, irritability, high pitched cry, and
continually cries when held; R more often slow, deep and irregular
5. The peak airflow volume decreases about 24 hours before clinical manifestations of
exacerbation of asthma; it is the most important to monitor for asthma pts
6. the peak flow meter is used to measure peak expiratory flow volumes; provides useful info
about the presence and/or severity of airway obstruction: green (good); yellow/red (caution and
get help)
7. When a pregnant women is admitted with C/O painless vaginal bleeding: do abdominal
ultrasound because it's the least invasive diagnostic test
8. dexamethasone (Decadron) increases the production of HCl, which often leads to GI ulcers;
take it with food or milk
9. Pancreatic enzymes are to be given to pt with cyctic fibrosis; with each meal and every snack
to allow for digestion of all foods that are eated
10. If the peak flow reading is 50% less of the pt's baseline reading, give a short-acting beta-
agonist immediately (rather than giving oxygen because the pt's airways need to be opened up
first)
NCLEX TRAPS

When you read the question ask yourself can I IDENTIFY the TOPIC of this question?
Note: NCLEX HIDES the TOPIC of a question
Example:
A nurse is evaluating the effects of medical therapy for a client with pulmonary edema. The nurse
determines that the interventions that were most effective if the client exhibited which of the following?
U=urine output RR= respiratory rate BP=blood pressure P=pulse
a) BP= 96/56 mmHg; P=110 beats/min; RR=28 breaths/min; U=20 ml/hr
b) BP=88/50 mmHg; P= 116 beats/min; RR=26 breaths/min; U=25 ml/hr
c) BP=108/62 mmHg; P=98 beats/min; RR=24 breaths/min; U= 40 ml/hr
d) BP= 116/70 mmHg; P= 88 beats/min; RR= 20 breaths/min; U= 50 ml/hr
This question has been copied from another thread in which the person was inquiring why the answer she
chose was not correct, and from eight responses no one could tell the person who posted this example the
rationale for the correct answer. First thing: identify the topic which is client's needs- physiological
integrity. The NCLEX makers want to know if you know how to apply the fifth nursing process which is
evaluation within the context of physiological integrity. You need to evaluate if the set of vitals you took
after giving medication therapy are withing normal limits. Eliminate first the wrong answers. Answers
#a and # b are wrong (below normal limits)...just by looking at the blood pressures, you know those
answers are wrong. You are just left with two choices which is better than having to choose between fours
answers. Do you see the advantages of elliminating wrong answers, first?
The next step is to eliminate the last wrong answer, let's look at answer # c...everything is within normal
limits except the respiratory rate (normal for an adult RR=12-20 bpm). Since you have to eliminate # c,
then the right answer must be # d, which is indeed, all those numbers are within normal limits, by the
way, normal urinary output is at least 30 ml/hr. That is a good example of how cleverly the NCLEX
makers could hide the topic. They wanted to know if the test taker knows how to apply the nursing
process of evaluation by throwing a question about evaluating a set of vitals.
IDENTIFY THE TOPIC OF THE QUESTION:
• if you have no idea what is the question asking: read the answer choices for clues to identify the
topic
In some questions validation is required in order to answer the question corectly...meaning the question
may ask you to assess or evaluate as opposed to implement (do some action, for example, call the
doctor, start CPR, reposition the patient or give oxygen to the patient, etc.) Remember the intent of the
question will be hidden to you.
• read the stem question for determining whether you should assess or implement and within that
context eliminate the answers which do not fit to with what you must do, that will lead you to the
right response.
If all the anwers fit in to implementation, then move on to use Maslow Hierarchy of Human Needs
--Physical needs take priority over other needs--
Pain is not a physical need--it is considered psychosocial, so it goes higher up on Maslow scheme

If all answers fit in to the physical needs apply ABC (air/blood/circulation) scheme
• do not automatically select respiratory answers--remember to thow out wrong answers first
If all answers are psychosocial do not choose the answer that "sounds right": determine the outcome of
each answer, throw out first the answers with negative outcome. Ask yourself "is this answer choice has
a desired outcome?"
Examples of Undesirable Answers you are Looking for to Throw Out First:
a) pass the buck

b) judgmental
c) bad nursing
d) off topic
e) take the buck
f) encourage dependency
g) asking why
h) do not persuade
i) leave patient alone
J) non therapeutic
k) gives false reasurance
l) blame
m) do nothing answers
n) answers which by pass the nursing process such as implementing a particular tx before assessing the
situation
o) by pass proper delegation qualifications
p) by pass priority of care
q) do not involve the patient in their own healing process
r) do not listen to the patient in a respectful manner
s) violate patient's rights
t) do not show cooperation with the health team
u) answers that contain absolute worlds such as only, always--watch for those
If Manslow and ABC does not apply: Evaluate ask yourself why, as I did in the example above, the
answers presented are wrong by comparing them against the normal values, throw out first wrong ones
for that will lead you to the one you are looking for: the right answer. Best wishes to all of you who are
taking the NCLEX in February. feliz3
Fosamax (alendronate sodium)

-treatment for OSTEOPOROSIS
Teach the patient --FOSAMAX causesESOPHAGITIS.
1)Remain upright for 30 minutes and do not eat or drink anything else for 30 minutes.
2)Take these drugs on an empty stomach, first thing in the morning, with water. Must be taken with a
sufficient amount of water so it does not pass through the esophagus completely...
What I've learned today in my review

1.Tagamet- to be taken at bed time
2.Dilatin- Aside from the regular visit to the dentist, when given IV can only be given w/ normal saline,to
be kept in room temperature, AE agranulocytocis and aplastic anemia, client will need freq. CBC
3.Side effect of ZYPREXA development of parkinson
4. Client taking Methotrexate should avoid multi Vitamins because they contain Folic Acid( antidote of
Methotrexate)

5.Client taking Isoniazid should have negative sputum within 3 months.
3.
Nurses must assume what the physician will order first:
DKA-----Initiate fluid replacement first ( IV .9% normal saline)
Hemophilia A-------- transfuse Factor VII
Ventricular Fibrillation (UNRESPONSIVE)-----Defibrillate 200j (300j:360j)

if unsuccessful ------CPR
Sickle cell anemia---------- 0xygen 100% Fi02 (HHOP)
ARDS (acute respiratory distress syndrome)-----(O2 nonrebreathing mask)

if no improvement w/ nonrebreather mask----intubate /mechanical ventilator
Pulmonary edema (sx. asses breath sound--crackles)----------tx: Furosemide
MI (chest pain)----------tx.morphine
Skin test reaction(SOB,anxious,reddened blotches,dizzy)-administer epinephrine
tension pneumothorax-----------------chest tube
Fractures:
Immobilize joint above andü below fracture
Cover open fracture with cleanest material availableüü Check temperature, color, sensation, capillary
refill distal to fracture
ü Close reduction—manually manipulate bone or use traction
Buck’s Traction
Use to relieve muscle spasm of leg and back
If used for muscles spasms only, they can turn to either side.
If used for fracture treatment, only can turn to unaffected side.
Use 8-20 lbs of weight, if used for scoliosis will use 40 lbs of weight.
Elevate head of bed for countertraction or foot bed
Place pillow below leg not under heel or behind knee.
Russell’s Traction
Sling is used
Check for popliteal pulse
Place pillow below lower leg and heel off the bed
Don’t turn from waist down
Lift patient, not the leg
Cervical Tongs
Never lift the weights
No pillow under head during feedings
Balanced Suspension Traction

For femur realignment
Maintain weights hanging free and not on floor

Maintain continuous pull
Halo Jacket
ü Maintain pin cleansing
Casts
Don’t rest on hard surface
Don’t cover until dry 48+ hours
Handle with palms of hands not with fingers Keep above level of heart
Check for CSMü
Fractured Hip
• Assessments
Leg shortened§
Adducted§
Externally rotated§
• Implementation
Care after a total hip replacement§
• Abduction pillows
• Crutch walking with 3-point gait
• Don’t sleep on operated side
• Don’t flex hip more than 45-60 degrees
• Don’t elevate head of the bed more than 45 degrees
Amputations
• Guillotine (open)
• Flap (closed)
• Delayed prosthesis fitting
Residual limb covered with§ dressing and elastic bandage (figure eight)
• Figure-8 doesn’t restrict blood flow, shaped to reduce edema
Check for bleeding§
Elevated 24 hours§ (AKA-pillow, BKA-foot of bed elevated)
Position prone daily§
Exercises,§ crutch walking
Phantom Pain: acknowledge feelings, that pain is real for§ them
Isoniazid (INH)-Anti-tuberculosis
s.e.: peripheral neuropathy-watch out for signs:numbness, tingling or weakness
liver damage-watch out for signs of hepatitis:yellow eyes or skin, NV, anorexia, dark urine, unusual
tiredness, or weakness
Aminoglycosides: Anti-infective
Amikacin(Amikin) Gentamicin,(Garamycin) Tobramycin (Tobrax)
s.e.Ototoxicity(CN VIII)-immediately report hearing or balance problems
Nephrotoxicity -Teaching:encourage fluids 8-10 glasses daily
Antihistamine
Loratadine (Claritin),Fexofenadine (Allegra),Cetirizine HCI (Zyrtec)
s.e. Drowsiness/Dizziness -teach pt:caution in potentially hazardous activities..
-avoid use of alchohol,& other CNS depressants

Dry mouth
-*generic name ends with "zine"*
cyclizine, trimeprazine, methdilazine, meclizine, and promethazine
an antihistamine preventing or countering motion sickness as well as
nasea and vomiting.
Heparin /-anticoagulant
s.e.: hemorrhage- watch out for:bleeding gums, nose, unusual, black tarry stools, hematuria, fall in
hemacrit or bl. pressure, guaiac-positive stools
teach pt:avoid ASA & NSAIDs
-antidote: protamine sulfate w/in 30 min
-injec.=deep SQ-onset 2-6- min, dur. 8-12 hrs
-IV: pk 5 min, dur. 2-6 hrs/NEVER GIVE IM
-check -therapeutic PPT (20-36) @1.5-2.5 X the control
Warfarin (Coumadin)/anticoagulant
s.e.:hemorrhage-
Caution:if pt said "I LOVE TO EAT VEGETABLE IN THE GARDEN)
teach:-avoid foods high in Vit K, green leafy vegs
-antidote: vit. K
-therapeutic PT (9.6-11.8)@1.5-2.5 X control, INR @ 2.0=3.0
-onset: 12-24 hrs, pk 1-1/2 to 3 days, dur: 3-5 days
Anti-malarials
Hydrozychloroquine (Plaquenil),Quinine Sulfate
s.e.: eye disturbances, NV, Anorexia
Teach:take at same time each day to maintain blood levels
Anti-protozoals:
Metronidazole (Flagyl, Flagyl ER)
s.e.-CNS symptoms, abd cramps, metallic taste,
teach pt o not drink alcohol in any form, during and 48 hrs after use,
disulfiram-like reaction can occur.
-avoid hazardous activities
-dark-reddish brown urine
Opioid Analgesic-
Methadone, Hydromorphone (Dilaudid) , Propoxyphene (Darvon, Darvocet-N (propoxyphene with
acetominophen),
Oxycodone (Oxy Contin; with aspirin Percodan, with acetaminophen Percoset)
Codeine,Meperidine(Demerol),Hydrocodone Bitartrate & Acetaminophen
(Lortabs)
s.e.-Drowsiness, sedation,nausea, vomiting, anorexia,Respiratory depression
constipation, cramps,orthostatic hypotension,confusion, headache,rash
-do not give if RR less than 12 per min
Cephalosporins(generic name begins with "cef/cep")

Cefadroxil (Duricef) ,Cephalexin (Keflex, Keflet) ,Cephapirin (Cefadyl)
Cephradine (Velosef) ,Cefaclor (Ceclor, Ceclor CD) ,Cefamandole (Mandol)
Cefonicid (monocid) ,Cefotetan (Cefotan)
s.e. Diarrhea
*generic name ends with "phylline"*

Xanthine bronchodilator -
aminophylline, dyphylline, oxtriphylline, theophylline
s.e.- nausea,vomiting,anorexia,gasstrointestinal reflux,TACHYCARDIA
indication:acute asthma, chronic bronchitis, emphysema, COPD
contraindicated:peptic ulcer,hyperthyroidism,cardiac dysrhythmias
Child undergoing cardiac catheterization - priority nursing Dg. is - Deficit knowledge ( parental ) related
to cardiac. cath., not decreased cardiac output related to structural defect !
Planning care for child before corrective surg. for Tetralogy of Fallot - priority nursing Dg. - Deficit
knowledge related to upcoming surg. and postoperative events, not impaired gas exchange related to
structural cardiac def.
Kawasaki Disease - aspirin + IV gamma globulin - to reduce immune response

- steroids contraindicated - increase aneurysm formation
- dipiridamole to increase coronary vasodilatation and decrease platelet accumulation
A positive Kernig's Sign is a manifestation of meningeal irritation

2. A serum creatinine above1.4 mg/dl indicates renal failure
3. Epioglottis develops acutely and emergently
4. Bells Palsy is Cranial Nerve VII
5. Bridiging Technique ,which I had never heard of is a type os positioning of pillows used to relieve
pressure on bony prominences
CARE OF A PATIENT IN TRACTION

T = Temperature
R = Ropes hang freely
A = Alignment
C = Circulation - the 5 P's - Pain, pulse, pallor, paresthesia, paralysis
T = Type and location of fracture
I = Increase fluid intake
O = Overhead trapeze
N = No weights on bed or floor
Here are my five: Knowledge Based

I am back to the drawing board with Fluids & Electrolytes
Hypovolemia: decreased urinary o/p; increased urine specific gravity
Hypervolemia: increased urinary o/p; decreased urine specific gravity
Hyponatremia: increased urinary o/p; decreased urine specific gravity (just think of dehydration-losing
fluids).
Hypernatremia: decreased urinary o/p; increased specific gravity(just think of the body holding the Na+
in, and output will be decreased).
Hyponatremia: Monitor for lithium toxicity if pt is on this med. It can decrease lithium excretion, causing
lithium toxicity.
Hypokalemia: Increased urinary o/p; decreased specific gravity (just think of the body losing fluids, just
like with hyponatremia).
This condition is life-threatening, b/c it affects every body system.

TX: give K+ Chloride- Never give K+ IV push, IM, or SQ.
Never exceed 20 mEq/hr
If pt receives >10 mEq/hr place on cardiac monitor.
Assess renal function before administering med and monitor I/O's during tx.
Hyperkalemia:
Early sx muscle twitches, cramps, parasthesias.
Place on cardiac monitor.
Hypocalcemia: Positive Trousseau's & Chvostek's sign

Monitor cardiovascular, respiratory, neuromuscular, GI; place on cardiac monitor.
Give Ca+ supplements PO or Ca+ IV.
Ca+ IV-Warm solution to body temp. before admin. & give slowly; monitor for ECG changes.
Hypercalcemia:
early sx is increased HR.
late sx: Bradycardia that can turn into cardiac arrest.
Increased urinary o/p that can lead to dehydration.
Check for urinary stones, by straining the urine. Place on cardiac monitor.
Hypoactive bowel sounds.
Don't combine aspirin with glipizide (Glucotrol) therapy or

alcohol with insulin; both can cause hypoglycemia.
1. Barium swallow for 3 month old infant - NPO for three hours
2. Temporary pacemaker for MI client - increase cardiac output is the primary purpose
3. Plasma cholesterol screening - only sips of water for 12 hours
4. Reminiscing group - primary goal is to review and share their life experience with the
group member
5. Miller-abbott tube - removes fluid and gas in the small intestine; provides intestinal
decompression
6. Levin or salem stump - decompresses the stomach; prevent fluid and gas accumulation in
the stomach
7. Promethazine Hcl (Phenergan) - check patency of the patient's vein before admin of drug,
extravasation will cause necrosis
8. Insulin dependent diabetic, unable to urinate -- autonomic neuropathy
9. Overdose of aspirin will produce parkinsons dse type sx
10. Do not admin erythromycin to Multiple Sclerosis pt
Here are my five for today: NCLEX answers -

1) If you have never heard of it, nobody else probably had, so don't choose that answer.
2) If your pt. is unstable don't choose reassess in 15 min. He might be dead in 15 min - don't delay
treatment. find first question that will kill or harm pt., secondly that will delay treatment and eliminate
those. if there is something you can do before calling doctor, do it ( pick that question ). sometimes to call
the doctor may be the only right option.
3)Maslow's hierarchy : Physiologic needs -
A) Maintaining airways and respiration
B) Maintaining circulation
C) Nutrition and elimination
D) Sleep
Safety needs - when no physiological needs exist, safety takes priority - mainatining safe and secure
enviroment for pt. and nurse
4) Communication - focus on pt. feelings first

5) Teaching and learning - motivation and readiness - assess if pt. had previous experiences or any
information first
How to Determine Whether to Delegate or Not
UAP= unlicensed assistive personnel
Ask yourself:
1) Are the and rules in place which support the delegation?
a) yes---go to step 2
b) no--- do not delegate
2) Is the task to be delegated within the scope of practice of the RN/LPN?
a) yes---got to step 3
b) no---do not delegate
3) Is the RN/LPN has the knowledge and experience to make delegation decisions?
b) no---do not delegate. Action to take: provide education and document education provided
4) Has there been assessment of the client's needs?
a) yes---move to step 5
b) no---assess client's needs first, then proceed with considerations to delegations
5) Is the UAP competent, has the experience to accept the delegation?
b) no---do not delegate. Action to take: Provide education and document the education given to the
UAP
6) Does the ability of the care giver match the care needs of the client?
7) Can the task to be delegated be performed without requiring nursing judgment?
8) Are the results of the task reasonably predictable?
9) Can the task be safely performed according to exact, unchanging directions?

10) Can the task be safely performed without complex observations or decisions based on critical
thinking?
11) Can the task be performed without repeated nursing assessments?
12) Is appropriate supervision available?
a) yes--- all other steps met, it is safe to delegate

Delegation= Transferring a selected nursing task in a situation to an individual who posses the
knowledge, experience that makes the person competent to perform that specific task.
The Nurse Practice Act and any practice limitation, such as been unfamiliar with the particular task which
needs to be delegated, define which aspects of care can be delegated and which must be performed by the
registered nurse.
Only the task not the ultimate accountability may be delegated to another. The nurse who delegates
maintains accountability for the overall nursing care of the client. The nurse must know what are her
clients preferred outcomes in terms of health care delivery goals, so that the process of delegation is
geared toward achieving desirable outcomes.
The RN must match the task to be delegated based on the Nurse Practice Act and appropriate position
descriptions.
Task that which are the responsibility of the RN only:
a) unstable patients with the least predictable medical outcomes

b) central line care
c) any tasks involving teaching, observation, discharge of a patient, assessment and critical thinking based
decisions
d) blood transfusions
e) parenteral nutrition
f) patient controlled analgesia
g) development of a plan of care
h) taking a medical history
i) taking phone doctor's orders for prescription and treatment
j) doing an admission assessment
K) initiate a Care Plan
Task that can be delegated to LPN/LVN only
a) patients who are stable and with predictable outcomes and common, well-defined health problems
b) give meds, oral, topical and inhalants, can administer treatments such as sterile wound care, blood
sugar testing, nasogastric tube insertion, tube feedings and charting
c) LPN/LVN can start an IV of saline and superimpose IV fluids with vitamins, nutrients and electrolytes

by primary or secondary infusion lines, infuse blood and blood products with IV Certification
d) give injections
e) monitor running IV
f) give enemas
g) monitor a urinary catheter
h) do simple wound dressing change
i) any task which does not require nursing judgment or complex observation, nurse can delegate to the
LPN. RN must inform the parameters of what to report as abnormal
j) use sterile technique procedures such as putting a urinary catheter
K) can give intra muscular injections, subcutaneous, intradermal
l) cannot give IV Push, infuse antibiotics or other medications via secondary IV line
m) can initiate teaching and a care plan
n) cannot infuse IV fluids such as TPN or other fluids via a central line and cannot do blood withdrawal
via central line
o) can do blood withdrawal via venipuncture or peripheral line with blood withdrawal certification
UAP
a) bathing patient
b) ambulation
c) making beds
d) routine vital signs feeding patients
e) transferring patients
SLAP---Quick Suicide Assessment
S---assess how specific is the plan: goes beyond thinking about it = suicide ideation
L---assess how lethal is the method of doing it
A---assess the availability of whatever object the person chooses to commit suicide with
P---proximity how far or close this person is from getting help or from someone to notice his/her
intentions and try to stop him/her
If at least one these four items is affirmative on a patient, the patient is at risk and rising if there is no
intervention in place such as placing the patient on suicide precautions.
AIRBORNE PRECAUTIONS:
a) private room with monitored negative air pressure flow with 6-12 air changes per hour
b) keep the door closed and patient in the room
c) can cohort or place the patient with another patient with the same organism but no other organism
d) care giver ware mask N-95 and respirator around mouth and nose
e) place a mask on the client if being transported
DROPLET PRECAUTIONS:
a) involves contact of conjuntive or mucous membranes of nose, mouth that happens during coughing,
sneezing, talking or during procedure such as suctioning or bronchoscopy
b) private room or with patient with same infection but no other infection
c) maintain a spacial separation of three feet between infected patient and visitors or other patients
d) door may remain open
e) place mask on patient if being transported

CONTACT PRECAUTIONS:
a) needed for patient care activities that require skin-to-skin contact such as turning a patient, bathe a
patient or hand contact between two patients or contact with a contaminated objects in the patient's
environment
b) private room or with another patient with the same infection but no other infection
c) clean nonsterile gloves when entering the room
d) change globes after patient contact with fecal material or wound drainage
e) remove globes before leaving patient's environment and wash hands with antimicrobial agent
f) wear a gown before entering the room if clothing will have contact with patient, environment surfaces,
or if patient is incontinent, has diarrhea, an ileostomy, colostomy or wound drainage
g) remove the gown before leaving the room
h) use dedicated equipment or clean and disinfect between patients
Entrance into the Isolation Room:
a) put the surgical mask or respirator around mouth and nose (type of mask depend on the type of
isolation)
b) apply eyeware or goggles snugly around the face and eyes (when needed)
c) apply gown and make sure it covers all outer garments, pull sleeves down to wrist and tie the gown
securely on the neck and waist
d) apply disposable globes to cover over the edge of the gown sleeves
e) enter the patient's room
f) equipment such as stethoscope, pressure cuff, thermometer--disposable--.
g) nondisposable equipment remains in the room... clean nondisposable equipment with alcohol before
and after using it, place dedicated equipment on a clean surface
Leaving Isolation Room:
a) remove gloves, discard

b) untie top mask string and then bottom string pull mask away from face and do not touch the outer
surface of the mask
c) untie waist and neck string of the the gown, allow the gown to fall from the shoulders
d) remove hands from sleeves without touching the outside of the gown
e) hold the gown inside at the shoulders seams and fold inside out and discard
f) remove eyeware or goggles
g) wash hands
h) leave the room and close the door if the patient is on airborne precautions
. The 3 classic signs of pre-eclampsia are: Hypertension, generalized edema and

proteinuria.
2. REFLEXES
• Moro reflex- Elicited by striking a flat surface the infant is lying on. The reflex of
abducting extremities and fanning fingers when a sound is heard should be gone by 3-4
months. Strongest at 2 months.
• Rooting - When the cheek of the newborn is stroked, the newborn will turn his head in
the direction of the stroke.
• Tonic neck - While the n/b lies supine, his head is turned causing the extremities on the
same side to straighten and those on the opposite side to flex.
• Babinski - When the sole of the foot on the side of the n/b small toe is stroked upward,

the toes will fan upward and out.
• Plantar grasp - Infant’s toes will curl downward when sole of foot is touched.
• Startle - A loud noise such as a hand clap will elicit the n/b to abduct his arms and flex
his elbows.
3. Terbutaline (Brethine) and Mag sulfate - treatment for preterm labor.
4. Nagele’s Rule: First day of last menstrual period + 1 year & seven days minus 3 months.
5. True labor INCREASESwith activity.
6. Normal newborn jaundice - AFTER 24 hours of life.

Pathologic jaundice - BEFORE 24 hours of life.
7. Fetal Fibronectin (FFN) test helps determine if there is pre-term labor.
8. A subarachnoid (spinal block) for labor may cause a headache, a lumbar epidural will not
since the dura mater is not penetrated.
9. Tracheoesophageal fistula: 3 C's: coughing, choking, & cyanosis.
10. Pregnancy r/t: Add 300 Calories to diet when pregnant, 500 when breastfeeding.
11. Non Stress Test on a pregnant female....should be REACTIVE (rise of 15 bpm above
baseline for 15 sec) if it's NOT reactive they need a contraction stress test and the
result that you want from it is NEGATIVE.
12. Pregnancy Induced Hypertension: The nurse would be MOST concerned if the patient
complained of epigastric pain and a headache.
13. LOCHIA SEQUENCE.: lochia rubra- red, clotty....lochia serosa...pink, brown....lochia

alba..white.........SHOULD NEVER HAVE A FOUL ODOR!
14. When a pregnant women is admitted with C/O painless vaginal bleeding: do abdominal
ultrasound because it's the least invasive diagnostic test
15. Calcium Gluconate can cause severe chemical burns - most important to check patency
of veins when giving (given to a patient experience magnesium sulfate toxicity)
16. Take prenatal vitamins in the morning with orange juice - acid aids in absorption.
17. Fetal heart rate: 120-160 BPM

Variability: 6-10 BPM
Contractions:
Frequency - every 2-5 minutes
Duration - less than 90 secs.

Intensity - less than 100 mmHg
Amniotic fluid - 500 to 1200 ml - Nitrozene paper (litmus paper) - if urine it turns green.
If amniotic fluid litmus paper turns blue.
18.FAB 9 - Folic Acid (AKA B9) B = Brain. Decreases the incidence of neural tube defects.
The client should begin taking B9 three months prior to becoming pregnant.
19. AVA - The umbilical artery has 2 arteries (carries deoxygenated blood) and 1 vein
(carries oxygenated blood).
20. TORCH syndrome in the neonate - A combination of diseases: Toxoplasmosis, Rubella

(German measles), cytomegalovirus, herpes, and syphilis. Pregnant nurses should not be
assigned to care for a client with toxoplasmosis or cytomegalovirus.
21. Android Pelvis is wedge shaped, narrow and unfavorable for birth.
22. Prenatal Visits

q 1 week -36-40 weeks
23. Posterior fontanel close - 2-3months

Anterior close After - 12-18 months
24. Most dangerous when you're pregnant; regular measles (rubeola), or German measles
(rubella), so remember: Never get pregnant with a German (rubella).
25. Apgar measures heart rate, respiratory rate, muscle tone, reflexes, and skin color.
Measured by 0 for absent, 1 for decreased, 2 for strong positive. 8-10 OK. 0-3
RESUSCITATE. Performed at 1 and 5 minutes.
26. In the Apgar score, the first time done reflects the transitional score, the second
Apgar score reflects the planning of care for the newborn. Score over 7, baby is ok but
score under 5 needs resuscitation or intensive care.
27. NEVER examine a bleeding gravida vaginally.
28. Maternal hypotension = STOP

Stop Pitocin (oxytocin) infusion
Turn patient on left side

Oxygen
Push IV fluids.
29. The criteria used to distinguish TRUE from FALSE labor is “EVIDENCE OF CERVICAL
CHANGE“.
30. Fetal heart patterns in OB? Think VEAL CHOP
V C V = variable decels; C = cord compression caused

E H E = early decels; H = head compression caused
A O A = accels; O = okay, not a problem!
L P L = late decels P = placental insufficiency, can't fill
For any kind of bad fetal heart rate pattern, you give O2, often by mask...
Woman in Labor w/ Un-reassuring FHR (late decels, decreased variability, fetal
bradycardia, etc) --> turn on left side (and give O2, stop Pitocin, increase IV fluids)
31. For cord compression, place the mother in the TRENDELENBERG position because this
removes pressure of the presenting part off the cord. (If her head is down, the baby is no
longer being pulled out of the body by gravity). If the cord is prolapsed, cover it with
sterile saline gauze to prevent drying of the cord and to minimize infection. Place client in
knee-chest position or Trendenlenberg
32. Once the membranes rupture, important to monitor temperature hourly as risk for
infection increases. First thing to do after rupture is to auscultate fetal heart tones!
Assessing for cord prolapse if decels occur.
33. For late decels, turn the mother to her left side, to allow more blood flow to the
placenta.
34. Greatest risk for postpartum hemorrhage is from distended bladder.
35. Hypotension and bradypnea/bradycardia are major risks and emergencies.
36. NEVER check the monitor or a machine as a first action. Always assess the patient
first; for example listen to the fetal heart tones with a stethoscope in NCLEX land.
Sometimes it's hard to tell who to check on first, the mother or the baby; it's usually easy
to tell the right answer if the mother or baby involves a machine. If you're not sure who
to check first and one of the choices involves the machine, that's the wrong answer.
37. If the baby is a posterior presentation, the sounds are heard at the sides.
the baby is anterior, the sounds are heard closer to midline, between the umbilicus and
where you would listen to a posterior presentation.

If the baby is breech, the sounds are high up in the fundus near the umbilicus. If the baby
is vertex, they are a little bit above the symphysis pubis.
38. Use reliable form of birth control for at least 4 weeks (8 is better) after rubella
immunization [of course this applies to women only].
39. Increase calorie intake by 300 for pregnancy; 200-500 for lactation.
40. Fluid intake for pregnancy minimum 2000 mL; minimum 3000 mL for lactation.
41. Interventions for late decels: Stop Pitocin if on, turn mom to left side, increase IV
fluids, O2 8-10 L/min.
42. Ways to speed delivery: Prostaglandins (Prepidil or Cervidil), Misoprostol, (Cytotec),

artificial rupture of membranes, oxytocin (Pitocin).
43. Spontaneous abortion: Most commonly present Painfollowed by bleeding
44. RHoGAM : given at 28 weeks, 72 hours post partum, IM. Only given to Rh NEGATIVE
mother. Also if indirect Coomb’s test is positive, don’t need to give RHoGAM cause she has
antibody only give if negative Coombs
45. Discolored amniotic fluid such as green is a sign of fetal distress.
46. Placenta previa = painless bleeding. No vaginal exams.
47. After the rupture of membranes, the babies heart is checked then rechecked a few
minutes later or after next contraction.
48. Hep. B vaccine given within 12 hours of birth.
49. GP-TPAL: G=#pregnancies, P=#births, T=#term pregnancies (38+ weeks), P=#preterm

pregnancies (20 weeks-37 6/7 weeks), A=#abortions (spontaneous and therapeutic <20
weeks), L=#living children.
50. Fetal Development in utero:

Week 1 : free floating blastocyst
Week 2-3 : 2mm long
Week 8 : 3 cm long and may weigh in at 2 grams
Week 12 : 8 cm long
Week 20 : approx. 19 cm long & weighing in at 465 grams
Week 32 : 30 cm long

51. Estrogen stimulates uterine development to provide a environment for the fetus, and
stimulates the breasts to prepare for lactation.
52. Measure fundal Height: Start measuring at 18 weeks. Should equal the week of
gestation. Have client empty bladder.
Step 1 - place client in supine position
2 - place end of tape measure at level of symphysis pubis
3 - stretch tape to top of uterine fundus
4 - note and record the measurement
53. Staphylococcus aureus common cause mastitis

1st week of postpartum not present (mastitis)
Seen: 3-4 weeks post partum
SYMPTOMS: Fever, Chills, swollen red breast. Normal fetal heart rates,
54. Normal heart rate: 120-160 Bpm

Abnormal: If bradycardia is detected, position the mother on her left side
55. Abdominal pain, tender uterus, dark red or no bleeding = abruption

Painless, bright red bleeding usually first episode in 2nd trimester = placenta previa
56. DO NOT give a pregnant laboring patient on methadone STADOL (precipitates

withdrawal)
57. Analgesics are typically not given during the transitional phase of labor as delivery is
imminent and could lead to decreased respiratory rate in neonate.
58. If patient has boggy uterus - place the infant to nipple, it causes release of natural
Pitocin If uterus deviated to one side - encourage client to void.
59. RHoGAM given to Rh negative mothers with Rh positive babies within 72 following
birth. RHoGAM : given at 28 weeks, 72 hours post partum, IM. Only given to Rh
NEGATIVE mother. Also if indirect Coomb’s test is positive, don’t need to give RHoGAM
because she has antibody, only give if negative Coombs. Rh- mothers receive RHoGAM to
protect next baby.
60. SIGNS OF PREGNANCY

Presumptive Probable Positive
Amenorrhea Hegar’s sign Fetal heart sounds
Nausea/vomiting Chadwick sign Fetal movement
Quickening Goodell’s sign visualization of fetus
Striae gravidarum Braxton Hicks
Linea nigra + pregnancy test

Breast changes Abdominal enlargement
Presumptive - Changes experienced by the woman that make her think she is pregnant.
Probable - Changes observed by the examiner that make the examiner believe she is
pregnant
Positive - Signs that can be only be explained by pregnancy.
Goodell’s sign: Softening of the cervical tip.

Chadwick’s sign: Bluish discoloration of the vaqinal mucosa
Hegar’s sign: Softening of the lower uterus.
61. The postpartum check should include: status of fundus, lochia, breasts, perineum,
Homan's sign, pain, evidence of parent-baby bonding.
62. The woman with hydatidiform mole ( gestational trophoblastic disease ) should get
follow up medical care for at least a year for possibility of choriocarcinoma. Advise pt. not
to get pregnant during this time.
63. At 0 station, the presenting part is at the level of the ischial spines. Above zero is -
and below is +(+ is closer to delivery).
64. IgA breAst milk
65.Contraindications to Breast feeding include

1.) Baby has galactosemia
2) Mom HIV and on antiretrovirals
3) Mom on Chemo or Radiation
66. The greatest period of danger to the developing fetus for structural anomalies is day
15 to 18 weeks from conception.
67. Begin assessing fetal movement between 16 and 20 weeks.
68. Estrogen stimulates uterine development to provide a environment for the fetus, and
stimulates the breasts to prepare for lactation.
69. Physiologic jaundice of the new born is due to mild hyperbilirubinemia that subsides in
a week or two. Pathologic jaundice is due to severe hyperbilirubinemia and can cause brain
damage. pathological jaundice= occurs before 24hrs and last7 days. Physiological jaundice
occurs after 24 hours.
70. Pregnant women cannot administer Ribavarin (for RSV).

80. Abruptio placentae may be a complication of severe preeclampsia.
90. Fundus displaced to right side-ask pt to void. Fundus is boggy-message fundus.

91. Postpartum period: circulating HcG disappears within 8-24 hours.
92. Symptothermal method of birth control - combines cervical mucus evaluation and basal
body temperature evaluation, non-prescription/drug
93. Precipitous/rapid labor - risk factor for early postpartum hemorrhage and amniotic
fluid embolism.
94. A patient with a vertical c-section surgery will more likely have another c-section.
95. Caput succedaneum= diffuse edema of the fetal scalp that crosses the suture lines.
Swelling reabsorbs within 1 to 3 days.
96. Dystocia= baby cannot make it down to canal.
97. Meconium ileus is a sign of cystic fibrosis.
98. “Blue spells " or "TET spells" is characteristic of tetrology of fallot.
99. Transesophageal Fistula (TEF) - esophagus doesn't fully develop (this is a surgical
emergency)
The 3 C's of TEF in the newborn:
1) Choking
2) Coughing
3) Cyanosis
100. CARDIOVASCULAR DISORDERS OF THE NEWBORN

• Tetrology of Fallot - Tetra means four so it consists of four defects:
pulmonary artery stenosis
hypertrophy of right ventricle
venticular septal defect
overriding of aorta
Dx of Tetrology of Fallot is done by chest x-ray that shows a typical boot shaped heart.
An echocardiogram, 3 dimensional echocardiography, & cardiac cath help to confirm
diagnosis. S/S of TOF include: " blue spells or tet spells " relieved by having child squat.
Murmur may be present. Poor growth, clubbing of fingers.

• Atrial Septal Defect : abnormal opening between atria which causes increased flow of
oxygenated blood to go into right side of heart. Right atrial & right ventricle enlarge. May
be closed using cardiac catheterization or surgically with cardiopulmonary bypass which is
done before school age.
• Ventricular Septal Defect: characteristic murmur, CHF is common, many times will close
by itself if small-moderate defect.
• Patent Ductus Arteriosus ( PDA ): characteristic machine like murmur , can be

asymptomatic or s/s of CHF, wide pulse pressure & bounding pulses.
• Coarctation of the aorta: narrowing near insertion of ductus arteriosus. S/S of CHF in
infants, HTN & bounding pulses in arms but weak or absent femoral pulses, low extremities
may be cool.
101. Omphalitis - infection of umbilical stump. Don't rely on smell to detect infection b/c
umbilical stump heals thru gangrene.
102. Make sure to assess vernix and heel creases soon after baby is born because vernix
will be wiped off and heel creases develop as soon as foot dries.
103. SQUARE WINDOW - term infants can flex wrist onto arm, preterms can only do a
90degree flexion which creates a "square window"
104. SCARF SIGN - term infants can't extend elbow past midline but preemies can, they
extend hand across created a "scarf" effect since they have no resistance
105. On the Ballard Scale, score of 35 is 38 weeks, 40 is 40 weeks and 45 is 42 weeks.
106. Post-term babies are at risk for..

- Polycythemia r/t hypoxia, less 02 from placental (placental insufficiency)
- Meconium Aspiration - hypoxia relaxes anal sphincter and they poop
- Hypoglycemia - Interference with nutrient supply as placenta deteriorate
107. When performing a heel stick, put thumb over walking surface of the heal, strike
latter aspect of heal, wipe of 1st drop, don't smear, streak or squeeze area (due to high
ECF in infants)

108. Before infant feeds, insert gloved hand into mouth to assess palate.
109. Head circumference should be 2cm > than chest when born, but equal by 1 year.
110. Skin tags and low set ears in infants - suspect chromosomal abnormalities
111. Circumoral cyanosis in infants - see if it improves with crying. If it doesn't , report it
because it might indicate cardiac pathology.
112. Infants need 110kcal/kg/day

Breast milk has 20 kcals per ounce (so 20 kcal per 30 cc)
Breast milk has everything BUT slightly deficient in Vitamin D
113. Shoulder and Upper back lanugo is normal for term baby and vernix in deep creases
and skin folds is also ok for term babies.
114. Fetal Alcohol Syndrome babies will appear with a small head circumference, low birth
weight, and underdeveloped chin & cheekbones, smooth philthrum. They may need vitamins
(especially B's).
115. Pregnancy diabetes, during the first trimester, maternal insulin need decrease.
During second and third trimesters, requiring an increase in the client’s insulin dose.
After placental delivery, insulin requirements decrease.
116. Autosomal DOMINANT disorders :

**Marfans (prone to aneursyms, long long long people "Abe Lincoln" type folks ).
**Polydactly (too many digits)
**Achondroplastic dwarfism
** PKD polycystic kidney disease
**Huntington (doesn't show up until 40s 50s, which is why the gene is perpetuated in the
gene pool because when the symptoms show up in the 40s/50s, you've probably already had
kids and passed the gene along)
Autosomal Recessive
** Sickle Cell
** Cystic Fibrosis
** PKU
** Galactosemia (can't digest galactose in breast milk)
117. Spinnbarkheit: Describes the elasticity of the cervical mucus that is present at
ovulation.

118. Ferning: Formation of a palm-leaf pattern by crystallization of cervical mucus as it
dries at mid-cycle. Helpful in determining time of ovulation.
119. Aerocyanosis: is a bluish discoloration of the hands and feet and may be present
in te first few hours after birth, but resolves as circulation improves.
120. Erythema appears: as a rash on newborns usually after 24-48 hrs of live.
121. Harlequin color results as: a vasomotor disturbance, lasting 1-20 seconds, which
is transient in nature and not of clinical consequence.
122. Vernix caseosa: is a cheese like substance that protected the newborn skin
while in utero.
123. Ovulation typically occurs 1to2 years after menarche.
124. To prevent anemia, females ages 10 to 55 should consume 18mg of iron daily.
125. Climacteric is the cessation of the reproductive functioning in women (menopause)

and decreasing testicular action in men.
126. In Diabetic mother the newborn at risk for hypoglycemia, RDS, hypocalcemia
congenital anomalies. Diabetic mother during pregnancy-1st trimester insulin DECREASE. 2
and 3rd Trimester INCREASE INSULIN (placental hormones produce insulin resistance).
BUT after PLACENTAL DELIVERY INSULIN REQUIREMENTS DECREASE. Insulin is
safely given throughout pregnancy; oral hypoglycemic agents are contraindicated.
MATERNITY MEDS
• Bethamethasone (celestone)=surfactant. Med for lung expansion.
• Metylergonovine- To contract uterus. before giving check BP. don’t give if vascular
diseases are present.
• Terbutaline: Medication given to stop pre-term labor Methergine: Given for postpartum
hemorrhage.
• Cervidil(dinoprostone, a.k.a. Pg E2) & cytotec(misoprostol) Cervical ripening agent.
• Magnesium Sulfate: CNS depressant and Anticonvulsant = normal range 4-7.5, effective
if no seizures. 4-6q IV bolus, Followed by a: 2 g/h infusion:
Magnesium Sulfate becomes toxic at levels > 8 meq/L. Respiratory arrest occurs at
levels > 12 meq/L. Magnesium sulfate(used to halt preterm labor) is contraindicated if
deep tendon reflexes are ineffective. If patient experiences seizure during magnesium
administration. Get the baby out stat (emergency).
Adverse reactions: Inform client of these: Flushing, decrease in respiratory rate, muscle

weakness. TOXICITY S/S: Absence of deep tendon reflex, Urine output < 30 ml/hour,
↓’ed LOC, respirations <12/minute.
Pregnancy Induced Hypertension - prevents seizure.
ANTIDOTE: Calcium Gluconate
• Pitocin: Used for induction of labor and postpartum to help the uterus contract. Causes
uterine stimulation.
Medications that are contraindicated in breast-feeding mothers

Tetracycline - inhibition of bone growth
Warfin * safe to use? Hand out
Chloramphenicol bone marrow suppression
Two drugs are used to treat Eclampsia

• Magnesium Sulfate 4-6q IV bolus
Followed by a: 2 g/h infusion:
• Hydrolazine 10-20 mg IV
MATERNAL TESTING
• 1st TRIMESTER (Chorionic villas sampling, US scan)
• 2nd TRIMESTER (AFP screening or Quad Screening, Amniocentesis)
• 3rd TRIMESTER (kick counts, Nonstress Test, Biophysical Profile, Percutaneous
Umbilical Blood sampling, Contraction Stress Test )
• Ultrasound screening -can be vaginal or Abdominal (in latter make Her drink water to fill
bladder)
-Confirms viability
• Chorionic villus sampling
8-12 weeks - for early diagnosis of genetic, metabolic problems
• Amniocentesis -13-14 weeks
Is done under US scan to obtain a sample of amniotic fluid for direct analysis of fetal
chromosomes, neural tube defects, sex of the baby, development, viability and lung
maturity. Can be used to measure fetal lung maturity ONLY in the 3rd trimester.
• AFP - also called =Quad marker screening:
-human Chorionic gonadotropin (HcG),

-and inhibin A
high-Spina bifida - Increased level of alpha fetoprotein in pregnant woman => neural tube
defects. It is not an absolute test if it is abnormal -further investigation is recommended.
• Kick counts (tests Ureteroplacental capability)
Same time every day mother records how often she feels the fetus move if minimum 3
movements are not noted within an hour's time, the mother is encouraged to call her
physician immediately!
• Nonstress Test
Checks FHR and mother detects Fetal movements.
Contraction Stress Test -tests perfusion between Placenta and Uterus (basically O2 and
CO2 exchange)
contractions initiated by Pitocin or nipple stimulation. The desired result is a "negative"
test which consists of three contractions of moderate intensity in a 10 minute period
without evidence of late decelerations. The test is done to detect problems so if it is
Positive (persistent late decelerations) then-CS
how is done:
Each time the fetus moves, FHR should accelerate 15 beats/min above the baseline for 15
seconds. A reactive (good) test =>2 accelerations in FHR occur with associated fetal
movement
• Biophysical Profile (BPP)
• Percutaneous Umbilical Blood sampling -like amniocentesis but cord punctured
Everywhere a woman's abdomen is punctured, informed consent is needed, and risks like
amnionitis, spontaneous abortion, preterm labor/delivery, and premature rupture of
membranes must be explained. If she Rh--she may be given RHoGAM.
Here is a little bit on Psych for NCLEX. Hope you all like. Remember to keep those of us who havent
taken it yet in your prayers.
PSYCHIATRIC NURSING
1. In psych patients, the client most at risk for self-harm is always the patient that has

stopped taking their meds.
2. Hallucinations: Sensory impressions without external stimuli - Redirect patient.

Illusions: Real stimuli misinterpreted.
Delusions: False fixed beliefs. Distract the patient.
3. Bipolar Disorder
Manic Depressive
Mood elevated Anxious, hopeless
Speech loud, fast, vulgar ↓’ed interest in pleasure
Grandiose delusions negative views
Distracted Fatigue
Hyperactive ↓’ed appetite
Flight of ideas Insomnia
Inappropriate dress Suicidal

-safety
-setting limits
-meds
-least restrictive methods/environment.
5. If patients have hallucinations redirect them. In delusions distract them.
6. Language & Communication

NEOLOGISM = a new word made up that has meaning only to the patient
ECHOLALIA = repeating of words or phrases they heard someone else say
WORD SALAD = form of speech in which words & phrases are connected without any
meaning
MUTISM = absence of verbal speech
CLANG ASSOCIATION = repeating of words & phrases that are similar in sound but not in
any other way ( Dr. Seuss type of speech )
7. Defense Mechanisms:
Compensation = putting extra effort to achieve in areas of real or not-real weaknesses
Sublimation = replacing of an unacceptable need, attitude or emotion with one that is more
accepted.
8. The adverse effects of Anti psychotics can be remembered using this: SHANCE
N-NEUROLEPTIC MALIGNANT SYNDROME( Characterized by fever and muscular
rigidity)

E-EXTRA PYRAMIDAL SYMPTOMS( Administer anticholinergics and anti-parkinsonian
agents)
Psychiatric emergencies
Acute alcohol intoxication
Assessment:
• Drowsiness, slurred speech, tremor, impaired thinking ,nystagmus, nausea, vomiting,
hypoglycemia, increased respiration, grandiosity, loss of inhibitions, depression
Nursing diagnosis:
• Injury , risk for
Nursing :
• Quiet environment ,allow to “sleep it off”
• Monitor vital signs
• Protect airway from aspiration
• Assess for injuries
Hallucinogenic drug intoxication
Assessment :
• Eye:
• red-marijuana;
• dilated-LSD, mescaline, belladonna;
• constricted-heroin and derivatives
Care plan:
1, talk down :
* keep talking ,keep eyes open
* focus on here and now, inanimate objects
* use simple, concrete , repetitive statement,
* repetitively orient to time, place
* confidentiality; don’t moralize, challenge beliefs
2. medication
* valium
* lithium
3. hospitalization: (if more than 12-18hrs)
Homicidal or assaultive reaction

Cause:
* antisocial behavior, paranoid psychosis, previous violence, substance abuse, depression.
Intervention:
* physically restrain if client has a weapon
* separate from intended victims
* approach: calm and unhurried
* prevent suicidal behavior
Suicidal
• suicidal ideation
• concepts and principles related to suicide
• assessment of suicide
• composite picture: male, older than 45 yrs, unemployed, divorced, living alone, depressed,
history of substance abuse and suicide within family
Psychiatric emergencies----suicidal
• 10 factors to predict potential suicide and assess risk:
*age, sex and race: teenage, older age, more women make attempts, more men complete ;
occurs in all races and socioeconomic groups.
*recent stress related to loss.
• clues to suicide:
* verbal clues: direct “I am going to shoot myself ”; indirect: “this is the last time you’ll
ever see me”
* behavior clues: direct: pills, razor; indirect: sudden lifting of depression, buying a casket,
giving away cherished belonging, writing a will.
• suicide plan: the more details, the higher risk
• previous suicidal behavior
• medical and psychiatric status
• communication: the risk reduced if the patient has talked about
• style of life: such as substance abuse
• alcohol: alcohol reinforce helpless and hopeless feeling
• resources: the fewer resources, the higher risk
nursing care plan

• short-term goals
* medical : gastric lavage, respiratory and vascular support, wound care
• suicide precautions
*one on one supervision at all times
*check whereabout every 15 min
*explain to client what you will be doing, and why accompany the client for tests,
procedures
*look through client’s belongs, remove any potentially harmful objects : pills, matches,
belts, razors, glass, tweezers
*allow visit, but maintain one-on-one supervision
*check that visitors don’t leave potentially harmful objects
*Meal tray : contains no glass or metal silverware
don’t discontinue without order
• General approaches
• Observe closely at all times
• Be available ; empathy
• Avoid : extremes in your own mood
• Focus : directly on client’s self-destructive idea
• Make a contract: no suicide within 24 hrs; or call someone
• Point out client’s self-responsibility for suicidal act
• Support the part of the client that wants to live
• Remove sources of stress : make all decision when client is severe depression
• Prove hope: problem can be solved with help

• Provide with opportunity to be useful
Pseudo suicide attempts:
• Cry for help
• Desire to manipulate others
• Need attention
• Self-punishment
• Wish to punish others
• What will you do when you facing ~ ?
Crisis intervention
• definition of crisis
• Sudden event in one’s life disturbs homeostasis, during which usual coping mechanisms
cannot resolve the problem
a. maturational (internal, relate to developmental

stages and associated role changes)
b. situational (external, associate with a life event )
c. adventitious (relate to a disaster)
Crisis intervention
• characteristic of crisis intervention:
a. acute, sudden onset
b. responsive to brief therapy with focus on immediate problem
c. focus shifted from the psyche in the individual to the individual in the environment;
deemphasis on intrapsychic aspects
d. crisis is time limited (usually up to 6wk)
Crisis intervention
nursing care plan:
• Goal:
• return to pre-crisis level
• Focus here and how
Care plan:
• Encourage expressing
• Explore past coping skill and reinforce adaptive ones
• Set limit
• Use all resource
Domestic violence
Characteristics
• 1.victims: feel helpless, powerless; blame themselves, ambivalent about leaving the
relationship
• 2. abusers: often blame the victims, use power to threaten and subject victims to their
assault
• 3.cycle of stages
a. buildup of tension
b. battering
c. calm
risk factors
• Learned responses
• Pregnant women and whose with one or more preschool children
• Women who Fear punishments form abuser
care plan
a. provide safe environment; refer to community resources for shelter.

b. treat physical injuries
c. document injuries
d. supportive, nonjudgmental approach
e. encourage individual and family therapy for victim and abuser.
Rape-trauma syndrome
Assessment :
• Physical trauma
• Emotional trauma: tears, hyperventilation, anxiety, self-blame, anger, fears, phobia,
sleeping and eating problem.
Nursing care:
• Acknowledge feeling,
• Handle legal matters and police contact
• Medical attention
• Notify family and friends
• Remain available and supportive
• Contraception discussing
• Explore guilt and shame feeling
• Maintain confidentiality and neutrality
• Health teaching :
*avoid isolated areas and being helpful to strangers
*how to resist attack : scream , run
*Teach what to do if pregnancy or STD is outcome
Battered child
Clues in history:
• Delay in seeking medical care
• Discrepancies
• Multiple ER visits
• Vague and contradictory story
Clue in physical examination:

• Child : withdrawn, apathetic, does not cry
• Child : doesn’t turn to parents for comfort; unusual desire to please parent; fear parents
• Child: poorly nourished
• Multiple bruises, old bruises in addition to fresh one
• Burns: cigarette burs, rope marks
• Clues in parent : exaggerate care and concern
Nursing :
• Report suspected child abuse

• Conduct assessment interview in private with child and parent separated
• Be supportive and nonjudgmental
Evaluation:
• Parents have agreed to seek help
Sexual abuse children

Assessment: (characteristic)
• Relationship: filling paternal role (uncle, grandfather, cousin) with unquestioned access to
the child
• Methods of pressuring victim into sexual activity: offering material good,
misrepresenting moral standards (“it is ok”)
• Methods of pressuring victim to secrecy : fearing of punishment ,no being believed,
rejection, being blamed for the activity, abandonment
Disclosure:
• Direct visual or verbal confrontation and observation by others
• Verbalization of act by victim
• Visible clues : excess money and candy,, new clothes, pictures
• Sings and symptoms: bed-wetting; excessive bathing ,tears, avoiding school, somatic
distress
• Overly solicitous parental attitude toward child
Sexual abuse children• Child feeling:

• guilty.
• responsible for being a victim.
• powerlessness
Nursing :
• Safe environment
• Encourage child to verbalize feeling
• Observe for symptoms: phobic reaction when hearing or seeing offender; sleep pattern
changes, nightmares
• Look for silent reaction
Health teaching :
* teach child that his (her) body is private
* teach family
Elder abuse
Concepts:
• Elders who are currently being abused often abused their abusers

• Victim: diminished self-esteem, feeling responsibility for the abuse, isolated
• Abuser: physical or psychosocial stressors
• Legal : most states have mandatory laws to report elder abuse
Nursing :
• Early case finding , early treatment
• Report case to law enforcement agencies
• Provide elder with phone number
• Shelter
• Self help group
Sleep disturbance
Types of sleep :
• Rapid eye movement sleep
• Non-REM sleep
• Sleep cycle (90 min)
• Adolescents spend 30% REM of total sleep time; adults : 15% ;
Nursing care:
• Obtain sleep history
• Duplicate normal bedtime rituals
• Environment : quiet , dim lights,
• Encourage daytime exercise
• Allow uninterrupted sleep cycle: 90 min
• Back rub, warm milk, relaxation
• Taper off hypnotics
• Avoid caffeine and hyperstimulation at bedtime
• What about taking a nap during daytime?
Eating Disorders
Anorexia nervosa
• Anorexia nervosa is an illness of starvation related to a severe disturbance of body image
and a morbid fear of obesity; it is an eating disorder, usually seen in adolescences.
Assessment:
• Body-image disturbance
• Ambivalence: hoards food; avoids food
• Low sex drive
• Pregnancy fears
• Self-punitive behavior leading to starvation
• Physical signs:

*Weight loss
*Amenorrhea and secondary sex organ atrophy
*Hyperactivity: compulsiveness, excessive gum chewing
*Constipation
*Hypotension, bradycardia, hypothermia
*Skin: dry, poor turgor
Bulimia
• Bulimia nervosa is another type of eating disorder (binge-purge syndrome) also

encountered primarily in late adolescence or early adulthood. It is characterized by at
least two binge-eating episodes of large quantities of high calories food over a couple of
hours followed by disparaging self-criticism and depression, self-induced vomiting, abuse
of laxatives, and abuse of diuretics are commonly associated．
Eating Disorders
Analysis
• a. altered nutrition, less than body requirements, and fluid volume deficit
• b. risk for actual fluid deficit
• c. risk for self-inflicted injury
• d. altered eating
• e. body –image disturbance/chronic low self esteem
• f. compulsive behavior
Nursing care plan

• help reestablish connections between body sensations (hunger) and responses (eating).
*weigh regularly , at same time, with same amount of clothing , with back to scale
*Water drinking is avoided before weighing
*One-to-one supervision during and after mealtime to prevent attempts to vomit food
*Monitor exercise program, set limits in physical activity
• monitor physiological signs and symptoms
• health teaching
• Explain normal sexual growth and development to improve knowledge and confront sexual
fear
• Behavior modification to reestablish awareness of hunger
• Teach parents skills in communication
Evaluation:
• Attains and maintains minimal normal weight for age and height
• Regular meal
• Awareness hunger, talking about being hungry
• Increase self-esteem

Most drugs especially psychotropic medications acts as CNS STIMULANTS OR CNS
DEPRESSANTS. THIS strategy involves in determining which are the CNS excitations and
CNS INHIBITIORS. if 3 of the options are all CNS up and 1 CNS DOWN- pick the CNS
DOWN. if 3 of the options are all CNS down and 1 is CNS UP - PICK THE CNS UP.
FOR EXAMPLE.
The nurse administer WYAMINE to a client. The nurse should monitor which of the
following adverse effect associated with WYAMINE.
HYPOTENSION
BRADYCARDIA
SHOCK
HYPERTENSION
THE ANSWER IS (d) HYPERTENSION BECAUSE IT IS THE ONLY ONE WITH HIGN
CNS.
HERE'S A LITTLE RESPIRATORY NURSING FOR NCLEX - GOOD LUCK ALL
RESPIRATORY
1.RSV- child in private room...CONTACT PRECAUTIONS. Not droplet or airborne.
3. Pneumonia- droplet precautions.
4. COPD pts should get low flow Oxygen because of the hypoxic drive. (1-3L/min) teach
pursed lip breathing.
5. ARDS- this pt doesn’t respond to even 100% FiO2.
6. TB - hemoptysis (advanced stage) vital signs pulmonary edema- frothy blood tinged
sputum.
7. Allen's test- done before an ABG by applying pressure to the radial artery to determine
if adequate blood flow is present.
.

8. INH (Isoniazid)- treatment of TB. Give vitamin B6 to prevent peripheral neuritis.
10. Vent alarms:

A. High alarm (increased secretions then suction......, biting tube-need an oral airway,...... or
coughing and anxiety- need a sedative)
B. Low alarm- there is a leak or break in system...check all connectors and cuff.
11. If a tracheostomy becomes accidentally dislodged try to replace it with an obturator..if

no luck keep the hole open with hemostats until physician arrives.
12. When giving Bronchodilator & Glucocorticoids at the same time, give the bronchodilator
first. Remember B before G!
13. A collection of fluid between the visceral and parietal pleura is a pleural effusion.
14. RESPIRATORS
Tidal volume is the volume of air inhaled and exhaled with a normal breath.
Inspiratory reserve volume is the maximum volume of air inspired at the end of normal
inspiration.
Expiratory reserve volume is the maximum volume of air exhaled after a normal
respiration.
Vital capacity is the maximum amount of air expired after maximal inspiration.
Pleurisy is an inflammation of the visceral and parietal pleura.
Mechanical Ventilators:
Can be short term, long term or in between!!! As the nurse:
1) Assess pt. first then the vent 2) assess vitals, respiratory. rate and breathing pattern
3) monitor color of lips & nail beds 4) monitor chest for symmetry 5) Assess need for
suctioning & observe type, color, and amount of secretions 6) check pulse ox 7) check
alarms on vent 8) empty vent tubing’s when moisture collects 9) turn pt. every 2 hours and
PRN 10) have resuscitation equipment by bedside.
Causes of Alarms:
High Pressure Alarm
a) increased secretions in the airway
b) wheezing or bronchospasm
c) displaced ET tube
d) obstructed ET tube( check 4 kinks )
e) pt coughing, gagging, bites tube
f) pt. fighting vent (bucking)
Low Pressure Alarm
a) Disconnection or leak

b) Patient stops spontaneous breathing
15. TYPES OF RESPIRATIONS

Cheyne-stokes respirations: (rhythmic, with periods of apnea). May indicate a metabolic
dysfunction or dysfunction in the cerebral hemisphere or basal ganglia.
Neurogenic hyperventilation(regular, rapid and deep sustained respirations). Indicates a

dysfunction in the low midbrain and middle pons.
Apneustic respirations:(irregular, with pauses at the end of inspiration and expiration)

---Indicates a dysfunction in the middle or caudal pons
Ataxic Respirations: (totally irregular in rhythm and depth). Indicates a dysfunction in

the medulla
Cluster respirations: (clusters of breaths with irregularly spaced pauses).. Indicates a

dysfunction in the medulla and pons
16. Signs of hypoxia: restless, anxious, cyanotic tachycardia, increased respirations. (also
monitor ABG's).
17. The cuff of an ET tube is for preventing aspiration and sealing the airway to prevent
leaks. When the cuff deflates, aspiration is the greatest risk (due to secretions)
18. Weighted NI (Naso intestinal tubes) must float from stomach to intestine. Don't tape
the tube right away after placement, may leave coiled next to patient on HOB. Position
patient on RIGHT to facilitate movement through pylorus.
19. If you suspect an air embolus you must put patient in Trendenlenberg and position
patient on the LEFT side because you want the air embolus to trap/dissolve/disintegrate/
burst/cease to exist in the RIGHT ATRIUM.
20. Pneumonectomy- no chest tube required.
21. OXYGENATION
A. 6L Nasal Cannula is the most you can give, anything above that really doesn’t improve
oxygenation. 1L NC = 24% Fi02, 2 L = 28%, 3 L = 32% …get it? Keep adding four until you
get to 6L = 44% Fi02.
B. Non-rebreather give you the most Fi02, Venturi allows you to give the most precise
amount, Face tent is use with facial trauma/burns
C. Incentive spirometer – tell patient to inspire, hold, get floater-thing to about 600-900
then exhale.. 10X per hour awake. Pt must be able to breathe spontaneously and make a

tight seal around the mouthpiece.
22. BiPAP = CPAP and PEEP
23. ABG's is the best way to monitor pulmonary status by analyzing the level of hypoxia
caused by pulmonary edema and for monitoring effects of treatment.
24. The person who hyperventilates is most likely to experience respiratory alkalosis.
25. When a pleural effusion recurs within days or weeks following a thoracentesis, this
usually indicates the underlying cause is a malignancy.
26. Three lobes on the right. Two lobes on the left.
27. If you believe pt to be in respiratory distress, assess lung sounds first, LOC,
retractions, skin color, etc would all be late signs.
28. KEY SIGNS/SYMPTOMS OF RESPIRATORY DISORDER
• Dyspnea
• Fatigue
• Cough
• Accessory muscle use
• Retractions
• Adventitious breath sounds: Crackles, rhonchi, wheezing, & pleural friction rub.
• Changes in mentation
• Cyanosis
29. To remember which Beta Blockers are contra-indicated in patients with Respiratory
problems are easy.. Contra-Indicated- think.... Coreg, Corgard, Inderal.
30. SUCTIONING
• Encourage client to cough prior to suctioning.
• Use surgical aseptic technique when opening suction catheter kits.
• Medical aseptic technique is used for oral suctioning only. Surgical aseptic technique is
used for all other types of suctioning.
• Set suction pressure to 80 to 120 mm Hg.
• Limit each suction attempt to NO LONGER THAN 10-15 SECONDS. Limit suction
attempts to 2-3 times.
• Once suctioning is complete, clean tubing with water/normal saline solution.
• NASOPHARYNGEAL/NASOTRACHEAL SUCTIONING
A. Suction is performed with flexible catheter.
B. Hyperoxygenate client during equipment preparation with 100% FiO2.
C. DO NOT APPLY SUCTION WHILE INSERTING THE CATHETER.
D. Intermittent suction is only applied during catheter withdrawal, lasting no longer than
10-15 seconds.
E. Allow client time to recover between sessions, 20-30 seconds. Hyperoxygenate the
client before each suctioning pass.
F. DO NOT reuse tubing.

• ENDOTRACHEAL SUCTIONING (ETS)
A. ETS performed through tracheostomy or endotracheal tube.
B. Sterility must be maintained.
C. Advance the approximate distance from nose to base of earlobe.
D. Intermittent suction is applied during catheter withdrawal lasting no longer 10-15
seconds.
E. Allow client time to recover between sessions 20-30 seconds. Hyperoxygenate client
before each suctioning pass.
F. Hyperoxygenate client with 100% FiO2.
31. MECHANICAL VENTILATION
A. Assist mode: The patient initiates inspiration and receives a preset tidal volume from
the machine which augments patient’s ventilator effort & lets him determine his own rate.
B. Control mode: Ventilator delivers a set tidal volume at a prescribed rate using
predetermined inspiratory and expiratory times. This mode can fully regulate ventilation in
a patient with paralysis or respiratory arrest.
C. Assist control mode: The patient initiates breathing and a backup control delivers a
preset number of breaths at a set volume.
D. Negative pressure systems provide ventilation for patients who can’t generate adequate
inspiratory pressures.
E. High-frequency ventilation (HFV) systems provide high ventilation rates with low peak
airway pressures synchronized to the patient’s own inspiratory efforts.
F. NURSING INTERVENTIONS
1. Check all connections between ventilator and patient q1-2 hours. Make sure all alarms
are turned on. Make sure patient can reach call bell.
2. Verify ventilator settings are correct and that ventilator is operating at those settings.
3. Check humidifier and refill as necessary.
4. Monitor fluid I&O and electrolyte balance. Monitor for stress ulcers.
5. Using sterile technique, change the humidifier, nebulizer, and ventilator tubing
according to protocol.
6. Reposition patient frequently.
7. Provide emotional support to reduce stress and give antacids & medications as ordered
to reduce gastric acid production and to help GI complications.
8. Check stools and NG aspirates for blood.
32. Drugs that can be given via Endotracheal tube. LANE
Lidocane
Atropine
Narcan
Epinephrine
33. When drawing an ABG, you need to put the blood in a heparinized tube, make sure
there are no bubbles, put on ice immediately after drawing, with a lable indicating if the pt
was on room air or how many liters of O2.
34. Remember to perform the Allen's Test prior to doing an ABG to check for sufficient
blood flow

35. Before going for Pulmonary Function Tests (PFT's), a pt's bronchodilators will be with-
held and they are not allowed to smoke for 4 hrs prior
36. For a lung biopsy, position pt lying on side of bed or with arms raised up on pillows over
bedside table, have pt hold breath in mid-expiration, chest x-ray done immediately
afterwards to check for complication of pneumothorax, sterile dressing applied
DIAGNOSTIC TEST AND PROCEDURES

BRONCHOSCOPY
• Direct visualization of the trachea and bronchial tree
• Used to obtain biopsies and deep tracheal suctioning
• Explain procedure to patient, obtain informed consent & place on chart. Without fluid
and liquids.
• Check for return of gag reflex before giving anything by mouth after procedure.
• Monitor pulse oximetry.
PULMONARY ANGIOGRAPHY
• Procedure using an injection of radiopaque dye through a catheter.
• Radiographic examination of the pulmonary circulation.
• Assess patient’s allergies to iodine, seafood and radiopaque dye.
• Place written informed consent on patients chart
• Assess neurovascular status.
• Check insertion site for bleeding.
• Monitor for delayed allergic response
SPUTUM STUDIES
• Microscopic evaluation that includes culture & sensitivity, gram stain, and acid-fast
bacillus
• Obtain early morning sterile specimen from suctioning or expectoration.
• Send to laboratory immediately after obtaining.
THORACENTESIS
• Surgical perforation of the chest wall and pleural space to obtain specimens, instill
medication into the pleural space, remove fluid or air.
• The amount of fluid removed is limited to 1 L at a time to prevent cardiovascular collapse
• Ensure that informed consent is obtained and placed on chart.
• Apply dressing over puncture site and position client on the unaffected side for one hour.
• Encourage deep breathing to help in lung expansion.
• Obtain post procedure chest x-ray to rule out pneumothorax.
• Monitor V/S for hypotension, diaphoresis, faintness, reflex bradycardia
TUBERCULOSIS - TB
A. Lung infection caused by Mycobacterium tuberculosis
B. Any tissue can be infected.
C. Is an airborne disease caused by droplet nuclei.
D. CLINICAL MANIFESTATION:
• Night sweats

• Weight loss
• Low-grade fever, chills, flu-like symptoms
• Indigestion
• Frequent cough with copious frothy pink sputum, mucoid or mucopurulent sputum - lasts
longer than 3 weeks.
E. LABORATORY
1. Positive tuberculin skin test (indicates exposure) Mantoux skin test
• Read test 48 - 72 hours after giving
• Induration of 5 mm or less, negative
• Induration of 10 mm or more indicates exposure only. Test further
2. Sputum culture
• Obtain first morning sputum for 3 consecutive days.
3. Chest X-ray
• A. Appearance of characteristic Ghon tubercle on x-ray.
• B. Shows nodular lesions and patchy infiltrates.
F. TREATMENT /NURSING INTERVENTIONS
• Antituberculotics
• IV therapy - Saline lock
• Precautions - Standard and airborne
• Activity: Bed rest.
• Place patient in a negative air pressure that has 6-12 full air exchanges per hour
and is vented to the outside or has its own filtration system.
• Post precaution sign on patient’s door.
• Staff fitted for N-95 respirator masks
• Provide small frequent meals.
• Provide emotional support
• Instruct patient to cover nose and mouth when sneezing or coughing.
• Reinforce need to finish entire course of medication – 6 to 12 months.
• G. NURSING INTERVENTIONS
• Diet: High in calorie, protein, carbohydrates, vitamins
• Vitamin B6 - Potatoes, bananas, beans, seeds, nuts, red meat, poultry, fish, eggs, spinach,
& fortified cereal.
• B. Vitamin C - Red berries, tomatoes, broccoli, spinach, orange and grapefruit juice, Kiwi,
red & green bell pepper.
• Provide negative pressure room
• Monitor liver function test, urinary function test.
• Instruct patient to cover nose & mouth with 2-ply tissue when coughing and sneezing. Do
not use bare hands.
• If patient leaves room, they must wear HEPA mask.
• Monitor I & O
• 7. After 2-4 weeks patient is usually no longer infectious.
• Tuberculosis- assessment findings: cough ( yellow mucoid sputum ) , dyspnea, hemoptysis,

rales or crackles, anorexia, malaise, weight loss, afternoon low grade temperature, pallor,
fatigue, pain, night sweats.
Diagnostic Tests used in TB - Chest x-ray indicates presence and extent of disease but
cannot show if active or inactive. Skin test (PPD) positive; area of induration 10mm or more
in diameter after 48 hrs. Sputum positive for bacillus ( 3 samples is diagnostic for TB ).
Culture will be positive. WBC & ESR will be elevated. Ethambutol, Isoniazid, streptomycin,
and Rifampin are first-line drugs in the treatment of TB.
• for treatment of TB and major side effects:
Rifampicin(Red-urine, tears, sweat)
INH (the N is for Neurological, H is for Hepatic)
Pyrazinamide (hyperurecimia)
Ethambutol(optic neuritis)
• The use of a multiple medication regimen destroys organisms as quickly as is possible and
minimizes the emergence of medication resistant organisms.
First-line medications: Isonazid, Rifampin, Ethambutol, Streptomycin, Pyrazinamide

These provide the most effective therapy for TB.
Second-Line medications: Capreomycin, Ethionamide, Aminosalicylate sodium, Cycloserine,

Kanamycin
These are used in combination with first line medications but are more toxic.
Multi-drug therapy is used because of resistant strains.

With first-line meds for TB - watch for liver function, peripheral neuritis, hepatitis, dry
mouth, dizziness, hepatotoxicity, monitor CBC and blood glucose levels. Some side effect
with 2nd line TB meds - nephrotoxicity, ototoxicity, neuromuscular blockade.
ANTITUBERCULOTICS
1. CYCLOSERINE
• Maximum dose is 1 gm daily.
ADVERSE REACTIONS
• Suicidal behavior, psychosis, loss of memory
• Coma, seizures.
• Hyperirritability, paresthesia.
• If taken with Isoniazid may increase risk of CNS toxicity causing dizziness or
drowsiness.
D. NURSING CONSIDERATIONS
• Advise patient to avoid alcohol - increases risk for CNS toxicity.
• Give with other antituberculine drugs to prevent the development of resistant organisms.
• Monitor levels periodically for symptoms of CNS toxicity.
• Observe for psychotic symptoms.
• Monitor CBC levels and liver function tests.

2. ETHAMBUTOL - (Etibi, Myambutol)
• 0.5 to 1 gm daily
• Not given in children under the age of 13.
ADVERSE REACTIONS
• Headache, dizziness, confusion
• Optic neuritis - Causes red/green color discrimination. If this develops discontinue
drug
• Joint pain.
D. NURSING CONSIDERATIONS
• Perform baseline visual acuity test and color discrimination test during therapy
• Monitor uric acid levels and for symptoms of gout.
• Give one hour before or two hours after antacids containing aluminum because they
reduce absorption.
• Obtain AST and ALT levels before therapy and monitor every 3-4 weeks.
• Give drug with other antitubuculotics.
• Monitor uric acid levels; observe patient for signs and symptoms of gout.
3. ISONIAZID -( Isotamine, Nydrazid)

• Up to 300 mg daily.
• Drug of choice.
• Continued for 6 months to 18 months.
• Not for use with children under age of 15.
• Continued for 6 months up to 18 months.
F.. ADVERSE REACTIONS
• Toxic encephalopathy. Seizures.
• Optic neuritis
• Nausea, vomiting, epigastric distress.
• Hepatitis. Jaundice.
• Rheumatic and lupus-like symptoms
G. NURSING CONSIDERATIONS
• 1. Advise patient that antacids and laxatives containing aluminum may decrease
absorption. Give at least one hour before antacids or laxatives.
• Demerol may increase CNS adverse reactions and hypotension. Monitor for toxicity
• If given with Rifampin monitor liver function tests. May increase risks for
hepatotoxicity.
• Advise that foods containing tyramine - Beer, aged cheese, chocolate, sauerkraut, soy
sauce, tofu, teriyaki sauce, avocados, eggplant, fruit - figs, oranges, raisins, plums,
pineapple, prunes may cause hypertensive crisis. Advise patient to avoid such foods. Clients
who are taking INH should avoid tuna, red wine, soy sauce, and yeast extracts because of
the side effects that can occur, such as headaches and hypotension
• Monitor for hepatitis and liver function tests. Severe hepatitis may develop. S/S:
fever, jaundice, right upper quadrant abdominal pain.

• Advise to take drug one hour before or 2 hours after meal.
• Give pyridoxine to prevent peripheral neuropathy.
• Increase intake of vitamin B-6 - potatoes, bananas, beans, seeds, nuts, red meat, poultry,
eggs, spinach and fortified cereals.
• Always give with another antituberculotic.
• Patients receiving Isoniazid should be questioned about numbness, tingling,
paraesthesias, and feeling of heaviness in the arms and legs as this may indicate the
development of peripheral neuropathy.
• Should be taken on an empty stomach.
• Vitamin B6 (pyridoxine) is used to prevent toxicity from isonizid.
• Monitor for neurotoxicity.
4. RIFAMPIN- (Rifadin, Rimactane,Rimycin, Rofac)

• Up to 600 mg daily.
• Give one hour before or 2 hours after meal with full glass of water
• Give with at least one other antituberculotic.
• Liver abnormalities are most common side effect. Symptoms that may indicate liver
dysfunction are: anorexia, malaise, jaundice, change in stools.
• If given with Isoniazid, may increase risks for hepatotoxicity.
• If patient drinks alcohol this increases risks for hepatotoxicity.
NURSING CONSIDERATIONS
• Monitor liver function tests and CBC
• Alert patient that body fluids (sweat, tears, urine, feces) may turn orange-Red
• Advise patients taking oral contraceptives, anticoagulants, oral hypoglycemic agents, or
steroids that absorption is decreased. Advise with patient taking oral contraceptives the
need for alternative methods for birth control.
• Give one hour before or 2 hours after a meal.
• Advise against use of alcohol.
5. STREPTOMYCIN
• Maximum dose 3 g/daily.
• Streptomycin is also an aminoglycoside.
• Second line of treatment for tuberculosis.
• Causes ototoxicity and nephrotoxicity. Monitor hearing ability and renal function.
• Monitor patient’s hearing and kidney function before starting therapy.
• Causes 8th cranial nerve damage (acoustic nerve - hearing)
• Use gloves when preparing drug to prevent skin irritation.
• Do not use a heparinized tube; heparin is incompatible with streptomycin and other
aminoglycosides.
• NURSING CONSIDERATIONS
• Monitor fluid intake. Fluids should be increased 2.5 to 3 liters/day.
• Monitor for tinnitus, vertigo, deafness, renal function test - BUN, creatinine
• If patient on Lasix or other antidiuretics monitor for ototoxicity - increases risks for

ototoxicity.
• Protect hands when preparing drug.
• Alternate injection sites.
• Monitor for signs of super-infection: Continued fever, chills, increased pulse rate.
• 7. Offer small frequent meals and maintain bed rest.
• 6. To decrease the development of drug resistance, newer drugs contain a
combination of Rifampin and Isoniazid (rifamate) or Rifampin, Isoniazid and
pyrazinamid (rifater). Drug non-compliance is a major contributing factor in the
development of resistant strains of TB.
PNEUMONIA
A. Inflammatory process that produces excess fluid .
B. With pneumonia, you will hear BRONCHIAL sounds in areas of consolidation.
C. Two types of pneumonia.
• Community acquired pneumonia - Often a complication of influenza.
• Hospital acquired pneumonia - AKA nonsocomial pneumonia. High mortality rate, more
likely to be resistant to antibiotics.
D. SIGNS AND SYMPTOMS
Viral
• Low grade fever
• Nonproductive cough
• WBC normal to slightly high
• Less severe than bacterial pneumonia.
Bacterial
• High fever
• Productive cough
• WBC high
• More severe than viral pneumonia.
• Crackles/wheezes
E. NURSING INTERVENTIONS
• Administer medications as ordered: Penicillin’s and cephalosporin’s, bronchodilators,
steroids. Prednisone suppresses immunity!
• Obtain sputum culture before starting antibiotics
• 1. Rusty, green or bloody - Pneumococcal pneumonia.
• 2. Yellow-Green - Bronchopneumonia.
• For steroids monitor for side effects of immunosuppression, fluid retention,
hyperglycemia, poor wound healing. Steroids increase blood sugar and weaken immune
system. Always taper steroids if taking chronically --> never stop abruptly!
• Administer heated and humidified oxygen.
• Position high fowler’s
• Encourage coughing and deep breathing and suction
• Teach importance of flu vaccinations
• Monitor for complications

o ATELECTASIS: Collapse of lung. Diminished or absent breath sounds over affected
area.
o ACUTE RESPIRATORY FAILURE (ARDS): Persistent hypoxemia. Monitor O2 levels and
acid/base balance. Prepare for intubation and mechanical ventilation (PEEP). Cardinal sign
of ARDS is hypoxemia (low oxygen level in tissues).
o SEPSIS (Bacteremia)
o ARDS (fluids in alveoli), DIC (disseminated intravascular coagulaton)
• Provide rest periods.
• Increase fluids, 3-4 L/day.
• Diet: High calorie, high protein.
• With pneumonia, fever and chills are usually present. For the elderly
COPD
COPD is a group of diseases that results in persistent obstruction of the bronchial airflow.
Disease include:
Emphysema
• Stimulus to breathe is low partial pressure of arterial oxygen (PaO2). PaO2 measures
oxygen in the blood.
• Characterized by loss of lung elasticity and hyperinflation of lung tissue.
Asthma
• A chronic inflammatory disorder of the airways.
• Characterized by airflow obstruction and airway hyper-responsiveness to various stimuli.
Bronchiectasis
• Chronic dilation of the bronchi and bronchioles.
• Infection destroys the bronchial mucosa which is replaced by fibrous scar tissue.
Chronic bronchitis
• Chronic inflammation of the lower respiratory tract characterized by excessive mucous
section, cough, and dyspnea associated with recurrent infections of the lower respiratory
tract.
• Excessive bronchial mucous production causes chronic or recurrent productive cough.
SIGNS AND SYMPTOMS
• Productive cough and sputum production lasting at least 3 months a year for 2 successive
years.
• Barrel chest - due to air trapping with diaphragmatic flattening.
• Exertional dyspnea.
• D. Wheezes, crackles
• E. Use of accessory muscles.
• COPD is chronic, pneumonia is acute. Emphysema and bronchitis are
both COPD.
• In COPD patients, the baroreceptors that detect the CO2 level are

NURSING INTERVENTIONS
• Position client for maximum ventilation - high fowler’s.
• Administer medications:
• Short acting Beta2 agonists: Albuterol (proventil, ventolin) provide rapid relief.
• If patient is also using a corticosteroid inhaler, instruct them to use the
• Bronchodilator first and then wait 5 minutes before using the corticosteroid. This
lets the bronchodilator open the air passages for maximum effectiveness.
• Anti-inflammatories: Decreases airway inflammation (Corticosteroids - Fluticasone
(flovent) and prednisone). Monitor for serious side effects - immunosuppression, fluid
retention, hyperglycemia, poor wound healing.
• Administer heated and humidified oxygen. Monitor for skin breakdown.
• Instruct patient on pursed lip breathing and diaphragmatic breathing.
• Diet: High in protein, carbohydrates, vitamin C, calories - small frequent meals.
• Encourage/Force fluids - 3000 ml/day.
• Oxygen therapy - 2-3 liters/minute.
o DO NOT GIVE OXYGEN AT 100% TO PATIENTS WITH COPD because you can
depress the respiratory center drive. In COPD patient’s the drive to breathe is
hypoxemia.
• Nebulizer treatments should be given before meals to improve lung ventilation and
reduce fatigue that accompanies eating.
• Reinforce pursed lip breathing to prolong expiration and to increase airway pressure.
PNEUMOTHORAX
A. Collapse of the lung due to loss of negative intrapleural pressure.
B. Air accumulation in the pleural space.
C. SIGNS AND SYMPTOMS
• Dyspnea. Tachycardia, tachypnea
• Subcutaneous emphysema
• Tracheal deviation to the unaffected side.
• Diminished breath sounds on the affected side and tension pneumothorax.
• Unequal chest expansion (is reduced on the affected side).
• Crepitus over the chest.
• Restlessness, anxiety
• Unequal chest expansion
• Signs of mediastinal shift.
D. MANAGEMENT
• O2 Therapy
• Needle decompression (tension pneumothorax).
• Insertion of chest tube to water seal drainage.
• Laboratory ABG values

• Position high Fowler’s
• Analgesic: Tylox
• Insertion of large bore needle into the 2nd intercostal space may be done to alleviate
pressure before chest tube insertion with a tension pneumothorax.
• Assess respiratory status
• Administer oxygen
• Keep patient in high Fowler’s
• Monitor and record chest tube drainage, air leak, or subcutaneous emphysema, and labs.
• Document ventilator settings every hour.
• Monitor ABG’s, V/S, SaO2
F. MEDICATIONS
1. Lorazepam (Ativan) & Midazolam (Versed)
• Keep emergency oxygen & resuscitation equipment available.
• Monitor respirations every 5 to 15 minutes and before each IV dose.
• Refrigerate intact vials and keep from sunlight.
• Monitor for hypoventilation and hypotension
LARYNGECTOMY
A. Temporary or permanent artificial airway.
B. Partial laryngectomy: Surgical excision of a lesion on one vocal cord.
C. Total laryngectomy: Surgical removal of the larynx, hyoid bone, and tracheal rings with
closure of the pharynx and formation of a permanent tracheostomy.
D. NURSING INTERVENTIONS
• Establish methods of communication: Writing, call bell, “magic slate”, and picture board.
• Maintain aseptic conditions when suctioning or cleaning tracheostomy.
• Advise clients with total laryngectomies they will lose their natural voice.
• Keep tracheostomy tube obturator at head of bed for reinsertion in case of accidental
dislodgement.
• Encourage the patient to express their feelings about changes in their body and loss of
their voice.
• Assess pain level, administer medications.
• Observe for hemorrhage.
• Keep a spare unused tracheostomy tube at bedside for emergency use.
• Encourage turning, coughing, deep breathing and use of incentive spirometer.
• Keep patient in semi-Fowler’s
• Assess color, amount, and consistency of sputum.
• Demonstrate ways to prevent debris from entering the stoma.
• Use thickened liquids, cut food into small pieces, and provide food that can be formed
into a bolus.
• Trach balloon should be inflated any time there is any risk of pt aspirating (ie eating,
increased secretions, when getting tube feeds, on vent, and 30 min after eating).
• When changing trach ties, remove old ties with non-sterile gloves, then put on sterile

gloves to apply clean ties.
• If pt coughs/respiratory distress while putting in NG, pull back and wait until coughing/
respiratory. Distress is resolved then attempt again. Remember pt should be in High
Fowlers, when tube reaches oropharynx., neck must be flexed to cover airway and swallow
sips of h20 to facilitate tube).
• If a tracheostomy tube falls out, replace it immediately (maintain airway) then check for
breath sounds.
RADICAL NECK DISSECTION

1. Removal of all tissue under the skin from the ramus of the jaw down to the clavicle,
from midline back to the angle of the jaw.
2. Surgical excision of the sternocleidomastoid and omohyoid muscles, muscles of the floor
of the mouth, submaxillary gland, internal jugular vein, external carotid artery, and
cervical chain of lymph nodes, in addition to laryngectomy.
NURSING INTERVENTIONS
• Assess for respiratory compromise – dyspnea, cyanosis, edema, dysphagia, hoarseness.
• Auscultate for decreased breath sounds, crackles, and wheezes.
• In the immediate post-op state, Auscultate over the trachea to assess for stridor
indicative of edema.
• Assess vital signs, s/s of infection. Observe patient for hemorrhage.
• Keep emergency suctioning and airway equipment at bedside during meals.
• Ask if patient would prefer privacy during meals.
• Place call bell and other articles that patient may need within easy access.
• Observe for lower facial paralysis which may indicate facial nerve injury.
• Watch for shoulder dysfunction which may occur after surgery.
• Keep patient high Fowlers.
• Advise patient against swimming, showers and using aerosol sprays.
LUNG RESECTION
A. Lobectomy – Surgical removal of one lobe of the lung
B. Wedge resection – surgical removal of a wedge-shaped section of a lobe.
C. Pneumonectomy – Surgical removal of a lung.
• Maintain patient’s positioning.
1. Pneumonectomy: On back or side of surgery until stabilized.
2. Lobectomy or wedge resection: On back or side opposite surgery.
• Assess chest tube insertion for subcutaneous air & drainage.
• Reinforce turn, cough, and deep breathing, use of incentive spirometer.
• Provide suction, chest physiotherapy and postural drainage.
• Pneumonectomy usually does have a chest tube in order to let fluid collect in the lung
space.
• Assess pain level, administer medication, and check effectiveness.
• Administer O2 and maintain ET tube to ventilator.
• Monitor V/S, I & O, labs, ECG.

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS, shock lung)
A. Respiratory failure that occurs in critically ill patients.
B. Persistent hypoxemia. Monitor O2 levels and acid/base balance. Prepare for intubation
and mechanical ventilation (PEEP). Cardinal sign of ARDS is hypoxemia (low oxygen level in
tissues).
C. Lung injury causes platelets to aggregate. Alveoli collapse impairing gas exchange.
D. Oxygen and carbon dioxide levels in the blood decrease
E. Metabolic acidosis results.
F. SIGNS AND SYMPTOMS
• Dyspnea, tachypnea, tachycardia, cyanosis, and hypotension.
• Intercostal and substernal retractions
• Cough
• Crackles/rhonchi
• Anxiety
• Restlessness, altered LOC
• Decreased breath sounds
G. NURSING INTERVENTIONS
• Oxygen therapy. Intubation and mechanical ventilation using PEEP (positive end
expiratory pressure). Monitor mechanical ventilation.
• Monitor V/S, I&O, CVP, ECG, etc.
• DIET: RESTRICT FLUID INTAKE
• Position: High Fowler’s
• Activity: Bed rest
• DVT prophylaxis
• Administer TPN
• Weigh patient daily
• Allow patient to express feelings.
H. MEDICATIONS
• Antibiotics: Amoxicillin (Amoxil), ampicillin (Omnipen)
• Analgesics: Morphine
• Diuretics: Lasix (furosemide), Edecrin (Ethacrynic acid)
• Anticoagulant: Heparin
• Steroids: Hydrocortisone (Solu-Cortef), solu-medrol
• Antacid: Aluminum hydroxide gel (AmternaGel)
• Sedative: Lorazepam (Ativan)
• Neuromuscular blocking agents: Pancuronium (Pavulon) Vecuronium (Norcuron)
• Mucosal barrier fortifier: Sucralfate (Carafate).
BRONCHIECTASIS
A. Chronic cough that produces copious, foul-smelling, mucopurulent sections, possibly
totaling several cupfuls a day.
B. Is marked by chronic abnormal dilation of bronchi (large air passages of the lungs) and
destruction of the bronchial walls.

C. It is an irreversible condition.
D. SIGNS/SYMPTOMS
• Chronic persistent cough that produces copious amounts of purulent foul smelling sputum.
• Course crackles during inspiration.
• Dyspnea, wheezes.
• Weight loss.
• Recurrent fever and bouts of pulmonary infection.
• Intermittent hemoptysis and breathlessness.
• Finger clubbing.
• Perform chest physiotherapy including postural drainage and chest percussion several
times a day. BEST TO PERFORM IN EARLY AM or just before bedtime.
• Encourage increased fluids.
• Instruct patient to avoid noxious fumes, dust, smoke and other pulmonary irritants
• Teach patient to monitor sputum. Report if change in quantity or character occurs.
• Encourage regular dental care because copious sputum may affect dentition.
• Administer medications: Antibiotics and bronchodilators.
ASTHMA
A. A chronic reactive airway disorder that causes episodic, reversible airway obstruction
with bronchospasm, increased mucous secretion and mucosal edema.
B. An airway disorder characterized by airflow obstruction and airway
hyperresponsiveness to various stimuli.
C. Two forms of asthma
1. Extrinsic (atopic): caused by sensitivity to a specific external allergen (pollen, dust,
dander, food additives).
2. Intrinsic (nonatopic): Caused by reaction to internal non-allergic factors. (Endocrine
changes, noxious fumes, respiratory infections, stress, humidity/temp)
D. SIGNS AND SYMPTOMS
• Absent or diminished breath sounds during severe obstruction.
• Chest tightness
• Dyspnea, tachypnea, tachycardia, prolonged expiration.
• Productive cough with thick mucus.
• Lack of symptoms between attacks.
• Wheezes primarily on expiration but also sometimes on inspiration.
• Take appropriate measures to maintain airway, relieve bronchoconstriction.
• Administer low flow humidified O2 to reduce inflammation, ease breathing and increase
SaO2.
• Administer medications
1. Bronchodilators: Terbutaline (Brethine), Aminophylline, Theophylline (Theo-Dur)
Theophylline: therapeutic drug level: 10-20. via a metered dose inhaler
2. Steroids: hydrocortisone (Solu-Cortef), methylprednisolone (Solu-Medrol)
3. Beta-adrenergic drugs: Epinephrine (Adrenalin), salmeterol (Serevent)

4. Antacids
5. Antibiotics
• Auscultate lungs for improved breath sounds and effectiveness of therapy.
• Activity as tolerated.
• Keep patient in high Fowlers.
• Encourage fluids.
• Monitor and record color, amount, and consistency of sputum.
• Monitor V/S. Tachycardia may indicate worsening asthma or drug toxicity.
• Teach proper use of inhaler and taking medications correctly.
• Teach pursed lip & diaphragmatic breathing.
• Increase fluid intake to 3 qts (3L) a day.
FLAIL CHEST
A. Flail Chest= Fracture of 2 or more adjacent ribs with paradoxical movement of chest
during respiration.
B. Loss of stability of the chest wall as a result of multiple rib fractures, or combined rib
and sternum fractures.
C. During respiration, the detached part of the chest will be pulled in on respiration and
blown out on expiration (paradoxical movement).
D. It is accompanied by severe respiratory distress.
E. Associated with lung contusion, lung laceration, and diffuse alveolar damage.
F. SIGNS AND SYMPTOMS
• Paradoxical movement of the chest
• Increased respiratory effort, pain on inspiration
• Cyanosis
• Dyspnea
G. NURSING INTERVENTIONS
• Stabilize the flail portion of the chest with hands, apply pressure dressing and turn on
injured side or place a 10 lb sandbag on flail portion.
• Prepare for ET insertion and mechanical ventilation.
• Position semi-Fowler’s unless patient requires shock position.
• Analgesic: Morphine.
• Mechanical ventilation using positive pressure.
TENSION PNEUMOTHORAX
A. Occurs when air enters the pleural space during inspiration and is trapped there.
B. The increase in pressure compresses the blood vessels and limits venous return, leading
to a decrease in cardiac output.
C. Relief of tension pneumothorax is considered as a medical emergency.
D. Can be converted to a simple pneumothorax by insertion of a large bore needle into the
pleural space which relieves the pressure and vents the air trapped to the outside.
E. SIGNS AND SYMPTOMS
• Air hunger
• Agitation, hypotension, and cyanosis
• Asymmetrical lung expansion and tracheal deviation to the affected side.

• Cyanosis.
• Subcutaneous emphysema.
• Jugular vein distention.
F. Immediate thoracentesis is done to relieve positive pressure or tension in the lung.
CARDIAC TAMPONADE
A. Compression of the heart as a result of fluid within the pericardial sac that is usually
caused by blunt or penetrating trauma to the chest.
B. SIGNS AND SYMPTOMS
• Falling blood pressure
• Distended jugular veins elevated CVP.
• Muffled heart sounds from impaired diastolic filling of the heart.
• Pulsus paradoxus (audible blood pressure fluctuation with respiration). Systolic blood
pressure drops and fluctuates with respiration.
• Dyspnea, cyanosis, and shock.
• Patient may be anxious, confused and restless.
• Dyspnea, tachypnea, and precordial pain.
C. BECK’S TRIAD - 3 D’s of cardiac tamponade
• D = DISTANT HEART SOUND
• D = DECREASED BLOOD PRESSURE
• D = DISTENDED JUGULAR VEIN
D. TREATMENT
• Thoracotomy
• Pericardiocentesis – needle aspiration of fluid from the pericardium.
COR PULMONALE
A. Is the enlargement of the right ventricle that results from diseases affecting the
function or the structure of the lungs. It is heart disease caused by lung disease.
B. A condition that deprives the lungs of oxygen.
• Increasing dyspnea and fatigue, orthopnea, paroxysmal nocturnal dyspnea.
• Distended jugular veins, peripheral edema, hepatomegaly.
• Bibasilar crackles, split second heart sound on auscultation.
• Edema of the feet and legs.
• Ascites.
• Chronic productive cough.
• Diet: Low salt with restricted fluid intake to prevent fluid retention. Provide small,
frequent feedings rather than three heavy meals.
• Limit patient’s fluid intake to 1-2 qt (1-2 l/day).
• Monitor serum potassium levels. Low levels can increase risk of toxicity.
• Teach the patient to take radial pulse before taking a cardiac glycoside & to report any
changes.
• Monitor Digoxin levels to prevent symptoms of cardiac glycoside toxicity (anorexia,

nausea, vomiting, and yellow halos around visual images).
• Provide meticulous respiratory care, and teach pursed lip breathing.
• Monitor ABG levels.
• Avoid CNS depressants (opiods, hypnotics).
E. MEDICATIONS
• Diuretics to lower PAP by reducing total blood volume and excess fluid in lungs. Lasix
(furosemide)
• Angiotension converting enzyme inhibitor – captopril (Capoten)
• Calcium channel blockers: diltiazem (Cardizem)
• Vasodilators: Diazoxide (Hyperstat), hydralazine (Apresoline), Nitroprusside
(Nitropress),
PLEURAL EFFUSION & EMPYEMA
A. Pleural effusion is an excess of fluid in the pleural space.
B. Empyema is the accumulation of pus and necrotic tissue in the pleural space.
C. Pleural effusion is almost always secondary to other diseases.
D. Empyema is usually associated with infection in the pleural space.
E. SIGNS AND SYMPTOMS
• Dyspnea, pleuritic chest pain, dry cough.
• Dullness or flatness to percussion (over areas of fluid) with decreased or absent breath
sounds. Decreased chest motion.
• Pleural friction rub.
• Tachycardia and tachypnea.
F. NURSING INTERVENTIONS
• Administer oxygen as ordered.
• Provide meticulous chest tube care using sterile technique for empyema. Record amount,
color, and consistency of tube drainage.
• Observe patient’s breathing pattern, O2 sats, and other vital signs.
• Ensure chest tube patency by watching for bubbles in the underwater seal chamber to
prevent respiratory distress resulting from chest tube obstruction.
PNEUMOCYSTIS CARINII PNEUMONIA
A. Part of the normal flora in most healthy people.
B. Pneumocystis carinii pneumonia (PCP) is an opportunistic infection strongly associated
with HIV infection. Also seen in other immunocompromised patient’s – leukemic patients,
cancer, organ transplants, and lymphoma.
• Generalized fatigue
• Low-grade, intermittent fever
• Nonproductive cough
• Shortness of breath, tachypnea. Progresses to intercostal retractions, nasal flaring and
cyanosis
• Weight loss
• Insidious onset

• Assess respiratory status frequently and monitor ABG levels q4h.
• O2 therapy prn and ambulate. Deep breathing and incentive spirometry to facilitate
effective gas exchange.
• Administer medications
A. Antipyretics as required.
B. Antibiotics: Co-trimoxamole (Bactrim), Clindomycin (Cleocin) with primoquine.
Pentamidine.
1. If patient is receiving Bactrim watch for nausea, vomiting, rash, bone marrow
suppression, thrush, fever, hepatotoxicity and anaphylaxis.
2. Never give pentamidine IM because it can cause pain and sterile abscesses. Administer
the IV drug form slowly over 60 minutes to reduce the risk of hypotension.
3. If patient is receiving pentamidine monitor for hypotension, cardiac arrhythmias,
dizziness, azotemia (abnormal increase in urea in blood), hypocalcemia and hepatic
disturbances. These measures detect problems early to avoid crisis.
• Diet: High calorie, protein rich diet. Offer small frequent meals. Allow ample time for
meals to reduce anxiety.
• Provide a relaxing environment, eliminate excessive environmental stimuli.
NEUROSENSORY SYSTEM
PARKINSON’S DISEASE
1. A progressive degenerative disease of the CNS system associated with Dopamine
deficiency.
2. The lack of Dopamine impairs the area of the brain responsible for control of
voluntary movement.
3. SIGNS AND SYMPTOMS
· Pill rolling tremors at rest
· Mask-like facial expression.
· Shuffling gait, dyskinesia, cogwheel rigidity, stopped posture.
• Small handwriting.
• Bradykinesia (slowness of movement)
· Nonexistent arm swing.
4.MANAGEMENT
A. Anticholinergics: To reduce transmission of cholinergic pathways. Effective in controlling
tremor but causes confusion and hallucinations.
• Are more likely to cause mental problems in older patients.
• Are contraindicated in patients with glaucoma.
B.DRUGS: Artane,
A. Congentin (benztropine) – Toxic psychosis. Advise patient to avoid hot weather
because of drug induced lack of sweating may cause overheating.
• Never stop drug abruptly. Reduce dosage gradually.
B. Amantadine (symmetrel)
• Increases the release of dopamine in the brain.

• Monitor for mental status changes and suicidal tendencies. Drug can worsen mental
problems in patients with mental disorders.
C. Levodopa (larodopa)
• Used when other drugs cannot adequately relieve symptoms.
• Use cautiously in patients with heart disease, asthma, emphysema, glaucoma.
· Monitor for psychiatric disturbances: Dementia, hallucinations, suicide ideation, mood changes,
delirium, depression.
• May cause blepharospasm – eye twitching. Early sign of toxicity.
• Antacids may decrease absorption. Give antacids 1 hour before or 2 hours after
levodopa.
D. Pyridoxine (vitamin B6) may decrease the effectiveness of levodopa. Teach patient to avoid
vitamins and foods high in B6.
• Advise patient to take with food to lessen GI symptoms. Avoid high protein foods.
· Advise patient and caregivers that multivitamins, fortified cereals and certain over the counter
drugs may contain vitamin B6.
· Levodopa-carbidopa (sinemet) (Parcopa)
• Drug combination
• May cause suicidal tendencies.
· Do not give with iron salts. Give iron one hour before or 2 hours after sinemet.
· Do not give with MAO inhibitors – may cause severe hypertension.
• Teach patient to avoid foods high in protein. Don’t give levodopa with high protein
foods.
• If patient takes levodopa, stop drug at least 8 hours before starting levodopa-
carbidopa.
• Encourage patient to participate in daily exercise, stretching exercises.
• Instruct patient to use a broad-based gait. Reinforce gait training to improve
mobility.
• Have patient make a conscious effort to swing arms while walking.
• Instruct patient to chew slowly.
• Monitor V/S, monitor for hypotension.
• Instruct patient to rise slowly out of bed and chair.
· TEACH PATIENT TO AVOID VITAMIN B6 PREPARATIONS AND FOODS HIGH IN B6. Eat
high fiber foods.
· Teach patient to adhere to medication regimen and to not stop taking medications abruptly.
• Teach client and family for malnutrition, fall precautions and environmental hazards.
MULTIPLE SCLEROSIS
1. A progressive disease that destroys myelin in the neurons of the brain and spinal
cord.
2. Degeneration of the myelin sheath results in patches of sclerotic tissue and
impairs the ability of the nervous system to conduct motor nerve impulses.
3. There is no known cure for the disease.
4. Is characterized by exacerbations and remissions

• Fatigue and weakness.
• Abnormal reflexes – absent or exaggerated.
• Vision disturbances: Double vision, blurred, optic neuritis and nystagmus.
• Scanning speech
• Urinary and bowel disturbances. Frequency, urgency, incontinence. Frequent urinary
infections.
• Intolerance to heat.
• Mood swings, irritability.
• Intention tremor
• Inability to sense of gauge body position.
6. MANAGEMENT
• Overall goal of care is to maintain as much independent function as possible.
• Include rest periods to prevent fatigue which exacerbates the symptoms.
• Maintain a fluid intake of 2,000 ml/day to maintain bladder and bowel function and
to prevent impaction and urinary tract infection.
• Avoid sources of infection: Illness can act as a stressor and trigger an
exacerbation.
• Advise patient on avoiding extreme temperatures which exacerbates acteric.
7. MEDICATIONS:
• Corticosteroids are used to decrease inflammation, shorten duration of relapse or
exacerbation
· Prednisone (Deltasone)
A. Cause the kidney to retain sodium and water while promoting potassium loss.
B. Can cause edema and hypokalemia.
C. Monitor for hyperglycemia, hypokalemia, carbohydrate intolerance, growth
suppression in children, delayed wound healing, acute adrenal insufficiency.
D. Advise against abrupt withdrawal of drug – may cause rebound inflammation,
fatigue, weakness, dizziness, lethargy, depression. After prolonged use, abrupt
stoppage can be fatal.
E. If taking with anticoagulants monitor PT and INR.
F. Use cautiously in patient with GI ulcer, renal disease, diabetes, hypertension,
ulcerative colitis, recent MI, myasthenia gravis.
G. Give with food.
H. Diabetic may need insulin dose increased.
I. Monitor for infections. Decreases immunity.
· Interferon – Beta-1a (Avonex, Rebif) & Beta-1b (betaseron)

A. Beta interferons are derived from fibroblasts (connective tissue cells)
B. Monitor for blood toxicity- WBC, platelet count, liver function test,
C. Monitor patient closely for depression and suicidal ideation.
D. Use drug as soon as possible but must be used within 6 hours of reconstituting.
Store at 36-46 degrees. Do not freeze.
E. Rotate sites of injection.

F. Inform patient that drug causes flu-like symptoms – fever, fatigue, muscle fatigue, aches,
headaches, chills and joint pain occur as a side effect.
G. Advise patient to use sunscreen and avoid sun exposure.
H. Beta-1b can cause serious liver damage including liver failure requiring transplant.
Monitor liver function test.
I. Inject immediately after preparing.
J. Advise patient to report signs of tissue death.
· CYCLOPHOSPHAMIDE – (Cycloblastin, Cytoxan, Endoxan, Neosar, Procytox) – SEE

ONCOLOGY FOR DRUG
MYASTHENIA GRAVIS
1. Myasthenia gravis means “grave muscle weakness”.
2. A chronic progressive disorder of the peripheral nervous system affecting
transmission of nerve impulses to voluntary muscles. Causes muscle weakness and
fatigue that increases with exertion and improves with rest. Eventually leads to
fatigue without relief from rest.
3. Onset is usually slow but can be precipitated by emotional stress, hormonal
disturbances, infection, vaccinations, trauma, surgery, temperature extremes,
excessive exercise, etc.
4. Myasthenia Gravis: worsens with exercise and improves with rest.
5. Myesthenia gravis is caused by a disorder in the transmission of impulses from
nerve to muscle cell.
• Extreme muscular weakness and fatigue that decreases with rest.
• Vision disturbances: Diplopia and ptosis from ocular weakness.
• Facial muscle weakness that causes a masklike appearance.
• Dysarthria and dysphagia.
• Hanging jaw.
• Bobbing motion of the head.
• Respiratory failure.
7.DIAGNOSIS: Tensilon test. IV administration of Tensilon which allows acetylcholine to bind with
its receptors which improves the symptoms of myasthenia gravis.
· Tensilon (edrophonium) also differentiates myasthenic gravis crisis from cholinergic crisis.
• In cholinergic crisis, symptoms worsen with tensilon.
• Tensilon (edrophonium) is used only for diagnostic purposes to determine whether
muscular weakness is due to worsening of the disease (myasthenic crisis) or to
overmedication (cholinergic crisis)
• When edrophonium is used, keep suction equipment, oxygen, mechanical ventilation
and emergency drugs – atropine at bedside
8. TREATMENT:
A. ANTI-CHOLINESTERASES:
• Neostigmin (prostigmin), Pyridostigmin (Mestinon): Counteracts fatigue and muscle
weakness. Promotes muscular contractions

• Anticholinesterase drugs are not effective during a myasthenic crisis so they are
discontinued until respiratory function improves.
• Take with food to decrease GI symptoms.
• Advise patient to eat within 30 minutes of taking drug to strengthen chewing and
reduce aspiration risk.
• Advise patient to take drug at same time every day, not to miss a dose.
· Schedule patient’s diagnostic studies around medication schedule. If patient must be off unit when
drugs are to be administered, take the medication to the patient
• Observe for nausea, vomiting, cramps, facial muscle twitching and dyspnea – may
indicate toxicity.
· Avoid morphine and its derivatives, curare, quinine, mycin antibiotics and drugs containing
magnesium. These reduce cholinergic effects.
· Corticosteroids reduce the effects of drug, monitor patient closely.
1. IMMUNOSUPPRESSANTS (Corticosteroids)
A. Azathioprine (Imuran)
• Decrease dosage of Imuran if patient is also taking Allopurinol because it inactivates
Imuran.
• Watch for clay-colored stools, dark urine, jaundice – HEPATOTOXICITY
• Monitor liver function test, WBC and CBC.
• Give after meals to minimize GI effects.
• Avoid giving IM injections if platelet count below 100,000.
• Warn patients to report even mild infections – cold, fever, sore throat, malaise
because drug is a potent immunosuppressant.
• Warn patient hair may lose hair and thin.
• Cyclosphoshamide (Cytoxan) – SEE ONCOLOGY FOR MORE
• Don’t give drug at bedtime; infrequent urination during the night may increase
possibility of cystitis. Test urine for blood.. Hydrate patient’s before and after
dose. May cause hemorrhagic cystitis.
· Encourage patient to urinate every 1-2 hours while awake and drink at least 3 liters of fluid/daily
• Advise patient not to take tablet form before bedtime
2. NURSING MANAGEMENT
• Maintain patient’s diet: High calorie, soft foods. Encourage small frequent meals.
Assess clients gag and swallow reflexes before each meal.
• Administer medications before meals to maximize muscles for swallowing.
• Determines patient’s activity tolerance.
• Teach patient to avoid exposure to infections, especially respiratory.
• Provide eye care: Instill artificial tears, use patch over eye for double vision.
Sunglasses to protect eyes from too much sun.
• Instruct patient to avoid extremes of hot or cold, exposure to infections, emotional
stress and OTC drugs which exacerbate symptoms. Instruct patient to avoid taking
medication with fruit, coffee, tomato juice or other medications.
• Teach patient to recognize symptoms of crisis
•

MYASTHENIA CRISIS – Under-medication
A. Symptoms of myasthenia gravis are worsened.
B. Extreme fatigue.
C. Respiratory distress.
D. Symptoms improve with tensilon
CHOLINERGIC CRISIS – Overmedication
A. Respiratory distress, needs mechanical ventilation
B. Symptoms worsen with tensilon.
C. Symptoms improve with administration of anticholinergic medication – Atropine.
D. NEVER LEAVE PATIENT ALONE DURING A CRISIS
Anyone up for some pediatric info for NCLEX?
PEDIATRICS
Growth and development
1. Motor skills progress in a proximal to distal manner.
2. NEONATE (Birth to 28 days):
A. Vital signs:
1. Pulse: 110 - 160 BPM count apical for one minute
2. Respiratory rate: 32 - 60 BPM. Neonate is an obligate nose breather.
3. Blood pressure: 82/46.
4. Temperature regulation is altered because of poorly developed sweating and shivering mechanisms.
A. Limit exposure time during baths.
B. When the neonate is wet or cold cover his head.
5. Mortality rate is higher in the neonatal period than in any other growth stage.
B. Head and chest circumference are relatively equal. Head circumference may be up to ¾ greater than
the chest circumference.
C. Head length is one-fourth total body length.
D. Brain growth depends on myelinization.
E. All behavior is under reflex control. Extremities are flexed.
1. Moro reflex- Elicited by striking a flat surface the infant is lying on. The reflex of abducting
extremities and fanning fingers when a sound is heard should be gone by 3-4 months. Strongest at 2
months
2. Rooting - When the cheek of the newborn is stroked, the newborn will turn his head in the direction of
the stroke.
3. Tonic neck - While the newborn lies supine, his head is turned causing the extremities on the same side
to straighten and those on the opposite side to flex.
4. Babinski - When the sole of the foot on the side of the newborn small toe is stroked upward, the toes
will fan upward and out
5. Plantar grasp - Infant’s toes will curl downward when sole of foot is touched.
6. Startle - A loud noise such as a hand clap will elicit the newborn to abduct his arms and flex his elbows.
F. Hearing and touch are well developed; a hearing screening is recommended.
G. The neonate is stimulated by being held or rocked; listening to music and watching a black-white
mobile.
H. While laying prone, the neonate can lift his head.
3. INFANCY: Age 1 month to 1 year.
A. Period of rapid growth in which the head, especially the brain, grows faster than other tissues.
B. According to Erickson, the infant is in the critical stage of Trust vs. mistrust. It is important for the
child to develop a trusting relationship with a consistent primary caregiver. Interference may cause failure
the thrive.

C. Birth weight doubles in 6 months.
D. Birth weight triples in one year.
E. Posterior fontanel closes by 2-3 months.
F. Anterior fontanel remains open until 18 months.
G. Height increases by 50% in 1 year.
H. Head circumference > than chest circumference until 1 year.
I. Tooth eruption starts at 4 months -> 1 tooth per month.
J. AGES 1 TO 4 MONTHS
1. Instinctual smile appears at age 3 months. The social smile is the infants first social response. The
social smile initiates social relationships, indicates memory traces, and signals the beginning of thought
processes.
2. The infant develops binocular vision; the eyes can follow an object 180 degrees and any intermittent
strabismus should be resolved by age 4 months.
3. The infant reaches out voluntarily but uncoordinatedly.
4. At age 4 months the infant laughs in response to environment.
5. Recognizes parents voices.
6. Explores his feet.
7. Appropriate toys: Music box, mobile, mirror.
K. AGES 5-6 MONTHS
1. Birth weight doubles.
2. Can sleep through the night with 1-2 naps a day.
3. Lower central incisors appear first. Results in ’ed drooling and irritability.
4. Rolls over from stomach to back.
5. Infant cries when parents leave - a normal sign of attachment. Exhibits stranger anxiety.
6. Can transfer toys from one hand to another
7. Exhibits comforting habits - sucks thumb, rubs his ears, holds a blanket or stuffed toy.
A. All these symbolize parents and security.
B. Thumb sucking in infancy doesn’t result in malocclusion of permanent teeth.
8. Appropriate toys: Bright toys, soft toys, rattle - THINK SAFETY.
L. AGES 7 - 9 MONTHS
1. Sits alone without assistance
2. Creeps on his hands and knees with his belly off of the floor.
3. Infant stands and stays up by grasping for support.
4. Develops a pincer grasp; places everything in his mouth - ‘ed risk of aspiration.
5. Self-feeds crackers; the infant who’s physically and emotionally ready can begin to be weaned to a cup.
6. Likes to look at self in mirror.
7. Develops object permanence and searches for objects outside his perceptual field.
8. Understands the word “NO”; discipline can begin. Cries when reprimanded.
9. Can verbalize consonants but speaks no intelligible words. 10. Appropriate toys: Peek-a-boo, cloth
toys.
M. AGES 10 - 12 MONTHS
1. Birth weight triples and birth length increases about 50%.
2. Imitative behaviors.
3. Infant cruises (takes steps while holding on) at age 10 months, walks with support at 11 months, and
stands alone and takes his first steps at 12 months.
4. Infant claps his hands, waves bye-bye and enjoys rhythm games.
5. Enjoys books and toys to build with and knock over.
6. Cooperates when dressed.
7. Can say Mama/dada and two syllable words.
8. Shows jealousy.
9. Infant explores everything by feeling, pushing, turning, pulling, biting, smelling, and testing for sound.
10. Appropriate toys: Push toys, large ball, large blocks.
N. NUTRITION

1. Introduce foods in this sequence
A. Breast milk or iron-fortified formula: According to AAP (American Academy of Pediatrics) they
recommend breast feeding exclusively for the first 4-6 months of life and then in combination with infant
foods until age 1.
1. Give breast fed infants iron supplements after age 4 months because iron received before birth is
depleted.
2. Breast milk is a rich source of linoleum acid (essential fatty acid) and cholesterol which are needed for
brain development.
3. Contains immune factors that protect infants from infection.
B. Don’t give solid foods for the first 6 months
1. Before age 6 months, the GI tract tolerates solid food poorly.
2. Because of strong extrusion reflex, the infant pushes food out of his mouth.
3. The risk of food allergy development may increase.
C. Provide rice cereal as the first solid food followed by any other cereal except wheat.
D. Give yellow or green vegetables next.
E. Provide no citrus fruits followed by citrus fruits after age 6 months.
F. Give infants teething biscuits during teething period.
G. Provide food with sufficient protein such as meat, after age 6 months.
H. After 12 months, switch from formula to regular WHOLE milk.
1. Don’t give skim milk because fatty acids are needed for myelinization.
2. Whole milk should be continued until age 2 as recommended by the AAP.
I. RULES FOR FEEDING
1. Don’t prop up baby bottle - ’s risk of aspiration & ear infections.
2. Don’t put food or cereal in a baby bottle.
3. Introduce one new food at a time; wait 4-7 days before introducing new food to determine infant’s
tolerance to it and the potential for allergy.
O. SAFETY GUIDELINES
1. Place infants supine for sleep to decrease the risk of sudden infant death syndrome.
2. Keep crib rails up at all times, keep away from windows and curtain cords. Crib slats should not be
more than 2” apart with mattress firmly against its rails to prevent infant falling in-between mattress and
slats.
3. Use car seats properly - keep infant placed facing back of back seat.
4. Never leave infant unattended on dressing table or any other high place.
5. Don’t warm formula or breast milk in microwave. Defrosting in microwave may destroy its immune
factors. Formula/food should be lukewarm.
6. Insert safety plugs in wall outlets
7. Use gates along stairways.
8. Keep soft objects and loose bedding out of the crib. Pillows, quilts, sheepskins and comforters should
be kept out of infant’s sleeping environment.
9. Avoid overheating; infant should be lightly clothed for sleep.
10. ALWAYS support infants head.
11. Check temperature of bath water - should be 90-100 degrees.
P. TODDLER (Ages 1 to 3)
1. Vital signs: Pulse 100 BPM
Respiratory rate: 26 BPM
Blood pressure: 99/64
2. Period of slow growth with a weight gain of 4-6 lbs per year. Normally weighs four times birth weight.
3. Anterior fontanel closes between ages 12 and 18 months.
4. The toddler is egocentric.
5. Follows parents wherever they go.
A. Start playing peek-a-boo to develop trust.
B. Progress to playing hide and seek to reinforce the idea that his parents will return.
6. Separation anxiety arises.

A. The toddler sees bedtime as desertion.
B. Develops a fear of the dark. Nightmares begin around 2-3.
C. Separation anxiety demonstrates closeness between the toddler & his parents.
D. The parent who is leaving should say so and should promise to return.
1. Parent should leave a personal item with the toddler.
2. Prepare the parents for the toddlers reaction, and explain that this process promotes trust.
E. According to Erickson, this is the critical stage of AUTONOMY (self control & will power) VS
SHAME. The child develops a sense of independence and should be allowed to explore the environment
with the encouragement of the primary caregiver. Temper tantrums, negativism, and disciplinary problems
are the hallmarks of this age group as the child learns to control his environment and express his will. The
child should be taught to tolerate frustration through socialization and proper toilet training.
1. According to Freud, toddlers are egocentric and possessive and struggle with holding on and letting go
behaviors (ANAL STAGE).
2. Toddlers usually begin to imitate sex role behavior.
3. Piaget: Sensorimotor stage the child enters the pre-operational stage in which he begins using a trial
and error method of thinking and reasoning.
F. The toddler may engage in solitary play and have little interaction with others, this progresses to
parallel play (toddler plays along-side but not with other children.
G. To promote development of autonomy, allow the toddler to perform tasks independently.

H. Toddler understands object permanence.
I. Discipline during this stage should be a demonstration of love, not anger. The toddler needs limits set
on unacceptable demands, such limits offer security. He should be praised liberally, but only when
deserved.
J. Things to expect:
1. Sphincter control begins at age 2.
2. All deciduous teeth erupt by 21 months - 2 years.
3. Pot-bellied appearance.
K. 18 months
1. Is in the “MY” stage. 2. Vocabulary of 25 words.
3. Walks independently 4. Can use a spoon.
5. Climbs.
Appropriate toys: Push/pull toys, blocks.
L. 24 months
1. Negativistic 2. Temper tantrums
3. Transitional object 4. 2-4 word sentences, 400 words
5. Walks up/down stairs 6. Turns door knobs
7. Builds tower of 6 blocks 8. Removes clothes
9. Appropriate play: Parallel play, sand, riding toys, water play, finger paints.
10. Manage temper tantrums: Ignore behavior, monitor for safety.
11. Toddler uses “NO” excessively and shows assertiveness. Is curious how parents will react to use of
“NO”.
12. Overcriticizing and restricting the toddler may dampen his enthusiasm and increase shame and doubt.
13. Total sleep required is 12-14 hours. Sleep problems are common.
14. Toilet training
A. Consider emotional readiness
B. The toddler acts to please others, trusts enough to give up his body products, and begins autonomous
behavior
C. Parents must be committed to establishing a toileting pattern and must communicate well with the
toddler.
D. Offer PRAISE for success - NEVER punishment for any failure.
E. Don’t refer to bowel movements as being “dirty” or “yucky”. Excrement is the toddler’s first creation.
F. Introduce underpants as a badge of success and maturity.

G. Most toddlers achieve day dryness by age 18 months to 3 years and night dryness by ages 2-5. NEVER
punish for “ACCIDENTS”. If toddler is not trained by age 5, seek further evaluation.
H. Toddler may fear being “sucked” into the toilet.
I. Teach proper wiping technique (front to back) and hand washing.
15. When the toddler starts climbing over the crib rails, switch to a bed.
16. Use locks on cabinets, keep handles away from edges of tables or stoves.
17. AVOID bean bag toys.
18. Appropriate toys: Nested toys, toys with parts that open and close. Toys designed for pounding such
as play hammers and drums. Toy telephones, dolls. Provide the child with opportunities for positive
imitative play. They enjoy simple songs with repetitive rhymes as well as moving in time to music. A
musical activity should be scheduled into each day.
19. NUTRITION:
A. Toddler feeds himself, provide finger foods in small portions
B. Because of increased risk of aspiration avoid foods such as hot dogs, grapes, nuts and candy (or cut
into small pieces).
C. Nutritional needs decrease because of slow growth period.
D. Child may become a picky eater. Nutritional content of food is important.
E. The toddler shouldn’t drink more than 24 ounces of milk a day in order to have room for
BURNS
1. Smoke and inhalation injuries result from inhalation of hot air or noxious chemicals.
2. The resulting effect of burns is influenced by the temperature of the burning agent, the duration of
contact time, ad the tissue type burned.
3. Burn treatment is related to injury severity determined by depth. The extent is calculated by the percent
of the total body surface area (TBSA), location, and patient risk factors.
4. Causes
A. Radiation: X-ray, sun, nuclear reactors
B. Mechanical: Friction
C. Chemical: Acids, alkalies, vesicants. Chemical burns alter tissue perfusion and lead to necrosis.
D. Electrical: Lightening, electrical wires. Severity depends on type and duration of current and amount
of voltage - they follow the path of least resistance (muscles, bone, blood vessels and nerves)
E. Thermal: Flame, steam, frostbite, scald. These cause cellular destruction that results in vascular, bony,
muscle, or nerve complications; thermal burns can also lead to inhalation injury if the head, neck or chest
area is affected.
5. Burns are defined by degrees: First degree (superficial partial thickness burn), second degree (deep
dermal partial thickness burn), and third degree (full-thickness burn)
A. Superficial partial-thickness burn (first degree): Sunburn type. Involves only the dermal layer. S/S:
Erythema, edema, pain, blanching.
B. Deep dermal partial-thickness (2nd degree): Involves the epidermal and dermal layers. S/S; Pain,
oozing, fluid filled vesicles, Erythema, Shiny wet subcutaneous layer after vesicles rupture.
C. Full-thickness burn (3rd & 4th degree): Involves epidermal, dermal, and subcutaneous layers, and
nerve endings, muscle, tendons and bone. S/S: Eschar, edema, little or no pain.
6. Second and third degree burn extent can be determined using a total body surface area based on two
guides: Lund-Browder chart and Rule of Nines. Burn extent is often revised after edema subsides and
demarcation of injury zones occurs.
A. RULE OF NINES
Head= 9% Arms = 18%( 9% each) -
Back= 18% Legs= 36%( 18% each)
Genitalia= 1%
B. LUND-BROWDER CHART: This method accounts for changes in body proportion that occur with
age. Its greater accuracy can be used to help determine a patient’s exact fluid replacement requirements
after a burn injury.

7. Hands, feet, and eye burns may make jeopardize future function. Buttocks or genitalia burns are more
susceptible to infection. Circumferential burns to the extremities can cause circulatory compromise distal
to the burn.
8. Patient usually tetanus and immune globulin.
9. Burn management is organized chronologically into 3 phases: Emergent (resuscitative), Acute (wound
healing), and rehabilitation (restorative)
A. EMERGENT: Period of time required to resolve immediate, life-threatening problems. Phase may last
from time of burn to 3 or more days, but usually lasts 24- 48 hours.
1. Priority care is on ABC’s. Assess for smoke inhalation (singed nares, eyebrows, or lashes; burns on the
face or neck: stridor, increasing dyspnea) and give oxygen at 100% as prescribed. Be prepared for
emergency intubation and mechanical ventilation if severe inhalation injury or carbon monoxide
inhalation has occurred.
2. Assess for signs of shock caused by fluid shifts (increased pulse, falling B/P and urine output, pallor,
cool clammy skin, deteriorating level of consciousness.
3. Initial fluid shift/Fluid resuscitation: Occurs in first 24 hours after burn.
A. Fluid seeps out of the tissue because of increased capillary permeability. The majority of this leaking
occurs within the first 24 hours. Fluid deficit = shock.
B. H & H is elevated due to loss of fluid volume and fluid shift into interstitial space (third spacing)
C. Sodium is decreased due to third spacing.
D. Potassium is increased due to cell destruction.
E. Common rule: Calculate what is needed for the first 24 hours and give ½ of the volume calculated
during the first 8 hours (Parkland formula)
1. BROOKE FORMULA: Uses 2 mL/kg/% TBSA burned (¾ crystalloid plus ¼ colloid) plus
maintenance fluid of 2,000 mL D5W per 24 hours.
2. PARKLAND FORMULA: Uses 4 mL formula uses 4 mL/kg/TBSA burned per 24 hours = total fluid
requirements for the first 24 hours.
A. 1st 8 hours = ½ of total volume
B. 2nd 8 hours = ¼ of total volume
C. 3rd 8 hours = ¼ of total volume
3. No matter what formula the doctor uses, the formula will tell the amount of fluid the patient will get per
hour.
4. Medication therapy: Pain therapy, tetanus prophylaxis, topical antimicrobial as well as systemic
antibiotics.
5. Primary concern is the onset of hypovolemic shock and edema formation. Toward the end of the phase,
if fluid replacement is adequate, the capillary membrane permeability is restored.
6. Fluid loss and edema formation cease. The interstitial fluid gradually returns to the vascular space.
7. Diuresis occurs with low urine specific gravities.
8. Manifestations include shock from the pain and hypovolemic. Areas of full thickness and deep partial-
thickness burns are initially anesthetic because the nerve endings are destroyed. Superficial to moderate
partial-thickness burns are painful.
9. Shivering occurs as a result of chilling and most patients are alert.
10. COMPLICATIONS
A. Cardiovascular system: Dysrhythmias and hypovolemic shock.
B. Respiratory system: Vulnerable to upper airway injury causing edema formation and/or obstruction of
airway and inhalation injury.
C. Renal system: If patient is hypovolemic, kidney blood flow may decrease, causing renal ischemia. If it
continues, acute renal failure may develop.
D. With full-thickness burns, myoglobin and hemoglobin are released into the bloodstream and occlude
the renal tubules.
11. DIET: High protein, high calorie with increased fluids, high calorie high protein drinks.
12. If fingers/toes are burned, wrap each finger/toe separately.
13. Monitor urine output - if less than 30 mL/hour, assess for renal failure.

B. ACUTE PHASE
1. Begins with the start of diuresis (usually 48 to 72 hours post-burn) and ends with closure of the burn
wound. Phase concludes with burned area is completely covered with skin grafts or when wounds are
healed.
2. Margins of full-thickness Eschar take longer to separate. As a result, they require surgical debridement
and skin grafting for healing.
3. Because the body is trying to reestablish fluid and electrolyte homeostasis, it is important for the nurse
to follow the patient’s serum electrolyte levels closely (hypo - or hypernatremia, or hypo- or
hyperkalemia).
4. Complications include wound infection progressing to transient bacteremia as a result of manipulation
(after hydrotherapy and debridement). Same cardiovascular and respiratory system complications as in
emergent phase may continue.
5. Patient can become extremely disoriented, withdraw, or be combative. This is a transient state lasting
from a day to several weeks. ROM may be limited and contractures can occur. Paralytic ileus results from
sepsis.
6. Management involves wound care with daily observation, assessment, cleansing, debridement, and
dressing reapplication.
1. Use sterile technique when handling burn.
2. Give pain killer before dressing changes and hydrotherapy. Pain control is usually opioid analgesics
required.
C. REHABILITATIVE PHASE
1. Begins with wound closure and ends when the client returns to the highest level of health restoration.
2. Goals are to assist the patient in resuming a functional role in society and accomplish functional and
cosmetic reconstructive surgery.
3. Provide support and management. Use preventive measures to prevent contractures
10. NURSING INTERVENTIONS
A. Ensure airway patency and provide oxygen
B. Monitor V/S, laboratory findings, capillary refill, adequate tissue perfusion.
C. Keep patient NPO and administer H2 antagonist to prevent Curling (stress) ulcer.
D. Elevate clients extremities (increase venous return).
E. Use pressure dressings to prevent scarring and edema.
F. Give pain medication prior to any treatment and especially before dressing changes.
G. Nutritional requirements are increased with burns.
H. Encourage ROM. Neutral positions are best to prevent contractures, unless neck is burned, then
hyperextend.
I. Maintain warm environment during acute phase.
J. Monitor for shock symptoms. Maintain protective precautions. Reverse isolation.
K. If client underwent grafting, keep pressure off donor side to maintain blo
Re: Anyoone up for random FACT THROWING??

Here is a little info on the thyroid gland - hope this helps
DISORDERS OF THE THYROID GLAND
1. GRAVES DISEASE - Hyperthyroidism - TOO MUCH ENERGY

A. Increased synthesis of thyroid hormone from overactivity.
B. Excessive secretion of thyroid hormone
1. Leads to increased basal metabolic rate (BMR).
2. Increased cardiovascular function, ^’ed GI function, ^’ed neuromuscular function, weight loss, and heat
intolerance.
3. Thyroid hormone affects metabolism of fats, carbohydrates, and proteins.
4. Calcitonin inhibits mobilization of calcium from bone and ¯’s blood calcium levels

C. An autoimmune disorder.
D. Etiology: Excess secretion of TSH from pituitary gland. Thyroiditis, tumor, goiter. Physiological or
psychological stress, infections,
F. S/S: Nervousness, weight loss despite increased appetite, sweaty/hot (heat intolerance), exophthalmus
(no cure for this), hyperactivity (cant sit still), ^’ed appetite, B/P ’ed, flushed smooth skin,
oliogomenorrhea or amenorrhea, palpitations, insomnia. ALL V/S ARE ^’ed - think of patient as being
hyperactive.
G. DIAGNOSIS: Serum T3 and T4 are increased. Radio-iodine uptake is increased. Thyroid scan shows
enlarged thyroid gland or nodules.
H. TREATMENT/NURSING INTERVENTIONS
1. Monitor V/S & I & O - determine presence of thyroid storm.
2. Lifelong antithyroid medication.
3. Surgical removal of thyroid.
A. Radioactive iodine 131
1. The thyroid gland absorbs the I-131 which destroys some of the thyroid cells over a period of 6 to 8
weeks. RULE OUT PREGNANCY FIRST.
2. Advise patient against close contact with other people, avoid kissing for 24-hours.
3. Test females for pregnancy. Pregnancy should be delayed 12 months.
4. Advise patient to drink with straw
B. Thyroidectomy or partial thyroidectomy
1. Instruct patient to hold hands behind neck when coughing, sitting, turning, or getting up/back into bed
to reduce post-op pain and decrease tension on suture line.
2. Position semi-fowlers with head and neck supported. Ice collar to wound to prevent edema.
3. Monitor for hemorrhage, edema, exudates over upper chest, upper back, shoulders, back of neck.
4. Promote patent airway - keep HOB elevated 30 degrees. Keep sterile oral suction and emergency
tracheotomy tray within reach. Avoid hyperextension of the neck
5. Keep phone, personal items, call bell, remote control within reach.
6. Diet: Increase calories
7. Assess for laryngeal nerve damage: assess for hoarseness. Could lead to vocal cord paralysis. If there is
paralysis of both cords, airway obstruction will occur requiring immediate trach. Bilateral nerve damage
= breathing difficulties and aphonia (inability to speak)
8. Instruct patient to report any signs of pressure on neck.
9. Give eye care for exophthalmus: Moisten eyes frequently with artificial tears to prevent irritation
corneal infection. Protect eyes from photophobia with glasses. Sleep with HOB elevated to minimize
pressure on optic nerve and eye patches to protect eyes during sleep if lids do not close. Soothe eyes with
cool compresses.
10. Prevent tetany by identifying hypocalcemia - numbness or tingling of toes, extremities, and lips,
muscle twitches, positive Chvostek’s & Trousseau.
I. THYROID STORM/THYROID CRISIS

1. Life threatening emergency that occurs in EXTREME hyperthyroidism.
A. Thyrotoxicosis, and thyrotoxic crisis and thyroid storm are the same.
B. It is hyperthyroidism multiplied by 100.
C. Results from a sudden surge of large amounts of thyroid hormones into the bloodstream causing a
greater in body metabolism
2. S/S: Temperature > 102 up to 106 (hyperthermia). Tachycardia, systolic hypertension, abdominal pain,
N/V, diarrhea, agitation, tremors, confusion, seizures, delirium to psychosis. Triad S/S of thyroid storm:
Tachycardia, hyperthermia, agitation. ALL HYPERTHYROID MANIFESTATIONS ARE ^'ed.
3. May be precipitated by stress - surgery or infection, etc.
4. TREATMENT
A. Focuses on reducing circulating thyroid hormone levels by drug therapy.
B. Inhibition of thyroid hormones with propranolol (Inderal), corticosteroids, and thioamides (PTU)
C. Treat hyperthermia with cooling blankets, Tylenol (acetaminophen). Aspirin is contraindicated -it

releases thyroxin, provide cool sponge baths or ice packs to axilla and groin to decrease fever.
D. Treat dehydration with IV fluids and electrolytes.
E. Treatment of precipitating event.
F. Administer insulin for hyperglycemia. B-blockers (-LOL) for tachycardia
2. MYXEDEMA - Hypothyroidism - NOT ENOUGH ENERGY/ CRETINISM

A. Occurs when there is an insufficient amount of thyroid hormone (TH) being secreted by the thyroid
gland causing a ¯’ed metabolic rate, decreased heat production. CRETINISM: Hypothyroidism present at
birth
B. Hyposecretion of thyroid hormone results in overall decrease in metabolism.
C. ETIOLOGY: An autoimmune disorder (Hashimoto’s thyroidism)causing destruction of the thyroid
gland. External irradiation of the thyroid gland, infections, iodine deficiency. Lithium therapy.
1. Hashimoto’s thyroidism: The immune system attacks the thyroid gland.
D. S/S: Fatigue, weight gain, dry flaky skin, cold intolerance, course brittle hair, hypothermia, lethargy,
diminished reflexes, periorbital edema, bradycardia, dysrhythmias, infertility, C/O cold hands and feet,
hair loss, prolonged DTR-¯’ed, enlarged heart, muscle aches or weakness, constipation & ¯’ed libido.
E. CRETINISM: Hypothyroidism that is present at birth. Is very dangerous and can lead to slowed mental
and physical development if undetected.
1. State of severe hypothyroidism in infants. Infants do not produce normal amounts of thyroid hormone.
2. Their skeletal maturation and CNS development are altered resulting in retardation of physical growth,
mental growth, or both.
F. TREATMENT/NURSING INTERVENTIONS
1. Diet: High fiber, high protein, low calorie, ^’ed fluid intake (2000 mL/day)
2. Because of altered metabolism, patients do not tolerate barbiturates or sedatives. Therefore CNS
depressants are contraindicated.
3. Give medication in the AM one hour before food or 2 hours after.
4. Do not give beta blockers to asthmatics or diabetics - hides symptoms of hypoglycemia.
5. Start thyroid medications at lowest dose and graduate to larger doses.
A. Dosage is increased every 2-3 weeks until the desired response is achieved. Advise patient that
treatment is lifelong requiring constant monitoring by MD. If thyroid drug is discontinued, it must be
tapered.
B. Teach patient S/S of hyperthyroidism which can occur with overmedication.
6. Caution patient against electric blankets, extra clothing because of vasodilation.
G. MYXEDEMA COMA: Life threatening crisis state of hypothyroidism.

1. Myxedema coma/crisis occurs as a result of long-standing or untreated hypothyroidism who experience
significant stress as infection, medication, exposure to a cold environment or systemic disease.
A. Can be precipitated by infection, drugs - especially opioids, tranquilizers, and barbiturates.
2. Myxedema is an accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues.
This causes characteristic signs of hypothyroidism: puffiness, periorbital edema, and mask-like affect.
Thinning eyebrows.
3. Virtually every organ system is affected.
4. S/S: Lethargy, stupor, ¯’ed oxygen & blood flow to the brain occurs. Bradycardia & ¯’ed contractility =
low cardiac output. ¯’ed renal function. Unresponsiveness, edema, hypoventilation, hyponatremia,
hypotension, hypothermia, Progressive stupor. Periorbital edema, non-pitting edema, puffy face and
tongue. Significantly depressed respirations.
5. TREATMENT
A. The overall treatment is restoration of euthyroid state (having a normal thyroid gland as rapidly and
safely as possible with hormone replacement. Levothyroxine (Synthroid) is the drug of choice - give
slowly
B. Maintain airway patency.
C. Maintain circulation with IV therapy and ECG monitoring.
D. Monitor V/S, ABG, I & O, patient temperature.

E. Keep patient warm
F. Administer corticosteroids as ordered. Assess for infections.
G. Patient at risk for CAD - monitor
H. Assess for skin alterations - apply lotion, etc.
I. With rapid administration of thyroid hormone, plasma T4 levels may initiate adrenal insufficiency,
hence steroid therapy may be ordered.
6. MEDICATIONS
A. SYNTHROID (thyroxin- T4) - Contraindicated in patients with MI, use cautiously in elderly and
patients with diabetes, diabetes insipidus.
1. When starting thyroid replacement therapy, care must be taken with older patients and those with CAD
to avoid coronary ischemia because of increased O2 demands of the heart. Start with lower doses first
then .
2. Teach to take at same time each day 1 hour before meals/2 hours after. 3. Advise to take with plenty
water or milk. Optimal time is before breakfast.
4. Withhold medication if heart rate above 100 or notify MD.
5. Report weight gain of 5 pounds.
B. CYTOMEL (liothyronine sodium {T3}) - Use cautiously in elderly patients and those with angina,
renal insufficiency or ischemia.
1. Long term use causes bone loss.
2. Monitor B/P and pulse.
3. Do not give IM or subcutaneously.
C. PTU - Propylthiouracil (Propyl-Thyracil)

1. Inhibits oxidation of iodine in thyroid gland, blocking ability of iodine to combine with tyrosine to
form T3. May prevent formation of T4
2. S/E: Headache, N/V, vertigo, paresthesia, CNS stimulation, fever, hepatotoxicity, visual disturbances,
diarrhea, leukopenia, myalgia.
3. INTERVENTIONS.
1. Advise patient that iodized salt and shellfish should not be eaten because they alter drugs effectiveness.
2. Instruct patient to take with meals to reduce GI reaction.
3. Monitor lab values, especially CBC and hepatic function.
D. RADIOACTIVE IODINE (sodium iodide 131)

1. Limits thyroid hormone secretion by destroying thyroid tissue
2. S/E: N/V, skin rash, urticaria, pruritus, pain on swallowing.
3. INTERVENTIONS
A. ALL antithyroid drugs must be stopped 1 week before 1st dose.
B. Not used on patients younger than 30.
C. Institute full radiation precautions. Isolate patient, advise to avoid close contact with other people for at
least 24 -48 hours
D. Advise patient to fast overnight before therapy and to force fluids
E. Monitor thyroid hormone levels
E. POTASSIUM IODIDE (SSKI, Lugol solution, ThyroSafe, Thyroshield)

1. Inhibits thyroid hormone formation, limits iodide transport into the thyroid gland and blocks thyroid
hormone release.
2. Used to prepare patient for thyroidectomy: given TID after meals for ten days before surgery.
3. S/E: periorbital edema, N/V, diarrhea, inflammation of salivary glands, burning mouth and throat, sore
teeth and gums, potassium toxicity, acne- type rash. DO NOT GIVE ace inhibitors or potassium sparing
diuretics with drug; may cause hyperkalemia.

F. PROPRANOLOL (Inderal) "OLOL"- A adrenergic blocker. Relieves the adrenergic effects of excess
thyroid hormone (sweating, palpitations, tremors)
G. INTERVENTIONS
1. Dilute oral solution in water, milk, or juice and give AFTER meals.
2. Give through straw to avoid teeth discoloration.
3. Earliest signs of delayed hypersensitivity reactions caused by iodides are irritation and swollen eyelids.
4. Signs of iodide hypersensitivity are: Angioedema, cutaneous and mucosal hemorrhage, fever,
arthralgia, lymph node enlargement, and eosinophilia.
5. Monitor patient for iodism which can cause a metallic taste, burning in mouth and throat, sore teeth and
gums, increased salivation, sneezing, eye irritation with swelling of eyelids, severe headache, rash or
soreness of the pharynx, larynx, and tonsils, GI irritation.
6. Advise patient that sudden withdrawal may cause thyroid crisis.
7. Teach patient S/S of K+ toxicity: confusion, irregular heartbeat, numbness, tingling, pain or weakness
of hands and feet & tiredness.
8. Advise patient NOT to increase potassium in diet.
9. Advise patient not to eat iodized salt or shellfish.
I. THYROIDECTOMY CARE
1. O2 therapy, suction secretions.
2. Monitor for signs of bleeding and excessive edema
3. Elevate HOB 30º. Support head and neck to avoid tension on sutures
4. Check dressing frequently, check behind the neck, shoulders for bleeding.
5. Assess for signs of respiratory distress, hoarseness (laryngeal edema or damage.
6. Keep tracheostomy set in patient’s room for emergency use.
7. Administer food and fluid with care (dysphagia is common).
8. Encourage client to gradually ROM of neck.
9. Teach about medications, frequent follow-up. If thyroidectomy - life long replacement of medication
(T5, T4). Subtotal thyroidectomy - careful monitoring of return of thyroid function.
10. THINK BOW TIE:
B = Bleeding
O = open airway
W = whisper
T = trach set
I = incision
E = emergency
11. Be alert for post op complications
A. Tetany: Due to hypocalcemia caused by accidental removal of parathyroid gland. Assess for numbness,
tingling, or muscle twitching. Monitor for Chvostek’s sign and Trousseau’s sign. Give calcium gluconate
IV slowly.
B. Hemorrhage: Monitor for hypotension, tachycardia, other signs of hypovolemia. Irregular breathing,
swelling, choking - possible hemorrhage and tracheal compression. Early signs of hemorrhage: Repeated
clearing of throat, difficulty swallowing.
C. Thyroid storm: Life threatening. Sudden increased release of thyroid hormone. Assess for fever,
tachycardia, ’ing restlessness, agitation, and delirium.
GROWTH AND DEVELOPMENT FOR PEDIATRICS
PEDIATRICS
1. Motor skills progress in a proximal to distal manner.

2. NEONATE (Birth to 28 days):
A. Vital signs:

1. Pulse: 110 - 160 BPM count apical for one minute
2. Respiratory rate: 32 - 60 BPM. Neonate is an obligate nose breather.
3. Blood pressure: 82/46.
4. Temperature regulation is altered because of poorly developed sweating and shivering
mechanisms.
A. Limit exposure time during baths.
B. When the neonate is wet or cold cover his head.
5. Mortality rate is higher in the neonatal period than in any other growth stage.
B. Head and chest circumference are relatively equal. Head circumference may be up to ¾
greater than the chest circumference.
C. Head length is one-fourth total body length.
D. Brain growth depends on myelinization.
E. All behavior is under reflex control. Extremities are flexed.
1. Moro reflex- Elicited by striking a flat surface the infant is lying on. The reflex of
abducting extremities and fanning fingers when a sound is heard should be gone by 3-4
months. Strongest at 2 months
2. Rooting - When the cheek of the newborn is stroked, the newborn will turn his head in
the direction of the stroke. Usually disappears 3-4 months
3. Tonic neck - While the newborn lies supine, his head is turned causing the extremities
on the same side to straighten and those on the opposite side to flex (fencing posture).
Disappears at 3-4 months.
4. Babinski - When the sole of the foot on the side of the newborn small toe is stroked
upward, the toes will fan upward and out
5. Plantar grasp - Infant’s toes will curl downward when sole of foot is touched.
6. Startle - A loud noise such as a hand clap will elicit the newborn to abduct his arms and
flex his elbows. Best elicited after infant is at least 24 hours old and disappears within 4
months.
7. Palmar/plantar grasp - Place a finger in the palm of the newborn’s hand and then place a
finger at the base of the toes, the newborn’s fingers and toes curl downward.
F. Hearing and touch are well developed; a hearing screening is recommended.
G. The neonate is stimulated by being held or rocked; listening to music and watching a
black-white mobile.
H. While laying prone, the neonate can lift his head.
3. INFANCY: Age 1 month to 1 year.
A. Period of rapid growth in which the head, especially the brain, grows faster than other
tissues.
B. According to Erickson, the infant is in the critical stage of Trust vs. mistrust. It is
important for the child to develop a trusting relationship with a consistent primary
caregiver. Interference may cause failure the thrive.
C. Birth weight doubles in 6 months.
D. Birth weight triples in one year.
E. Posterior fontanel closes by 2-3 months.
F. Anterior fontanel remains open until 18 months.

G. Height increases by 50% in 1 year.
H. Head circumference > than chest circumference until 1 year.
I. Tooth eruption starts at 4 months -> 1 tooth per month.
J. AGES 1 TO 4 MONTHS
1. Instinctual smile appears at age 3 months. The social smile is the infants first social
response. The social smile initiates social relationships, indicates memory traces, and
signals the beginning of thought processes.
2. The infant develops binocular vision; the eyes can follow an object 180 degrees and any
intermittent strabismus should be resolved by age 4 months.
3. The infant reaches out voluntarily but uncoordinatedly.
4. At age 4 months the infant laughs in response to environment.
5. Recognizes parents voices.
6. Explores his feet.
7. Appropriate toys: Music box, mobile, mirror.
K. AGES 5-6 MONTHS
1. Birth weight doubles.
2. Can sleep through the night with 1-2 naps a day.
3. Lower central incisors appear first. Results in ’ed drooling and irritability.
4. Rolls over from stomach to back.
5. Infant cries when parents leave - a normal sign of attachment. Exhibits stranger
anxiety.
6. Can transfer toys from one hand to another
7. Exhibits comforting habits - sucks thumb, rubs his ears, holds a blanket or stuffed toy.
A. All these symbolize parents and security.
B. Thumb sucking in infancy doesn’t result in malocclusion of permanent teeth.
8. Appropriate toys: Bright toys, soft toys, rattle - THINK SAFETY.
L. AGES 7 - 9 MONTHS
1. Sits alone without assistance
2. Creeps on his hands and knees with his belly off of the floor.
3. Infant stands and stays up by grasping for support.
4. Develops a pincer grasp; places everything in his mouth - ‘ed risk of aspiration.
5. Self-feeds crackers; the infant who’s physically and emotionally ready can begin to be
weaned to a cup.
6. Likes to look at self in mirror.
7. Develops object permanence and searches for objects outside his perceptual field.
8. Understands the word “NO”; discipline can begin. Cries when reprimanded.
9. Can verbalize consonants but speaks no intelligible words. 10. Appropriate toys: Peek-a-
boo, cloth toys.
M. AGES 10 - 12 MONTHS
1. Birth weight triples and birth length increases about 50%.
2. Imitative behaviors.
3. Infant cruises (takes steps while holding on) at age 10 months, walks with support at 11
months, and stands alone and takes his first steps at 12 months.

4. Infant claps his hands, waves bye-bye and enjoys rhythm games.
5. Enjoys books and toys to build with and knock over.
6. Cooperates when dressed.
7. Can say Mama/dada and two syllable words.
8. Shows jealousy.
9. Infant explores everything by feeling, pushing, turning, pulling, biting, smelling, and
testing for sound.
10. Appropriate toys: Push toys, large ball, large blocks.
N. NUTRITION
1. Introduce foods in this sequence
A. Breast milk or iron-fortified formula: According to AAP (American Academy of
Pediatrics) they recommend breast feeding exclusively for the first 4-6 months of life
and then in combination with infant foods until age 1.
1. Give breast fed infants iron supplements after age 4 months because iron received
before birth is depleted.
2. Breast milk is a rich source of linoleum acid (essential fatty acid) and cholesterol which
are needed for brain development.
3. Contains immune factors that protect infants from infection.
B. Don’t give solid foods for the first 6 months
1. Before age 6 months, the GI tract tolerates solid food poorly.
2. Because of strong extrusion reflex, the infant pushes food out of his mouth.
3. The risk of food allergy development may increase.
C. Provide rice cereal as the first solid food followed by any other cereal except wheat.
D. Give yellow or green vegetables next.
E. Provide no citrus fruits followed by citrus fruits after age 6 months.
F. Give infants teething biscuits during teething period.
G. Provide food with sufficient protein such as meat, after age 6 months.
H. After 12 months, switch from formula to regular WHOLE milk.
1. Don’t give skim milk because fatty acids are needed for myelinization.
2. Whole milk should be continued until age 2 as recommended by the AAP.
I. RULES FOR FEEDING
1. Don’t prop up baby bottle - ’s risk of aspiration & ear infections.
2. Don’t put food or cereal in a baby bottle.
3. Introduce one new food at a time; wait 4-7 days before introducing new food to
determine infant’s tolerance to it and the potential for allergy.
O. SAFETY GUIDELINES
1. Place infants supine for sleep to decrease the risk of sudden infant death syndrome.
2. Keep crib rails up at all times, keep away from windows and curtain cords. Crib slats
should not be more than 2” apart with mattress firmly against its rails to prevent infant
falling in-between mattress and slats.
3. Use car seats properly - keep infant placed facing back of back seat.
4. Never leave infant unattended on dressing table or any other high place.
5. Don’t warm formula or breast milk in microwave. Defrosting in microwave may destroy

its immune factors. Formula/food should be lukewarm.
6. Insert safety plugs in wall outlets
7. Use gates along stairways.
8. Keep soft objects and loose bedding out of the crib. Pillows, quilts, sheepskins and
comforters should be kept out of infant’s sleeping environment.
9. Avoid overheating; infant should be lightly clothed for sleep.
10. ALWAYS support infants head.
11. Check temperature of bath water - should be 90-100 degrees.
P. TODDLER (Ages 1 to 3)
1. Vital signs: Pulse 100 BPM
Respiratory rate: 26 BPM
Blood pressure: 99/64
2. Period of slow growth with a weight gain of 4-6 lbs per year. Normally weighs four times
birth weight.
3. Anterior fontanel closes between ages 12 and 18 months.
4. The toddler is egocentric.
5. Follows parents wherever they go.
A. Start playing peek-a-boo to develop trust.
B. Progress to playing hide and seek to reinforce the idea that his parents will return.
6. Separation anxiety arises.
A. The toddler sees bedtime as desertion.
B. Develops a fear of the dark. Nightmares begin around 2-3.
C. Separation anxiety demonstrates closeness between the toddler & his parents.
D. The parent who is leaving should say so and should promise to return.
1. Parent should leave a personal item with the toddler.
2. Prepare the parents for the toddlers reaction, and explain that this process promotes
trust.
E. According to Erickson, this is the critical stage of AUTONOMY (self control & will
power) VS SHAME. The child develops a sense of independence and should be allowed to
explore the environment with the encouragement of the primary caregiver. Temper
tantrums, negativism, and disciplinary problems are the hallmarks of this age group as the
child learns to control his environment and express his will. The child should be taught to
tolerate frustration through socialization and proper toilet training.
1. According to Freud, toddlers are egocentric and possessive and struggle with holding on
and letting go behaviors (ANAL STAGE).
2. Toddlers usually begin to imitate sex role behavior.
3. Piaget: Sensorimotor stage the child enters the pre-operational stage in which he begins
using a trial and error method of thinking and reasoning.
F. The toddler may engage in solitary play and have little interaction with others, this
progresses to parallel play (toddler plays along-side but not with other children.
G. To promote development of autonomy, allow the toddler to perform tasks independently
and provide choices.
H. Toddler understands object permanence.

I. Discipline during this stage should be a demonstration of love, not anger. The toddler
needs limits set on unacceptable demands, such limits offer security. He should be praised
liberally, but only when deserved.
J. Things to expect:
1. Sphincter control begins at age 2.
2. All deciduous teeth erupt by 21 months - 2 years.
3. Pot-bellied appearance.
K. 18 months
1. Is in the “MY” stage. 2. Vocabulary of 25 words.
3. Walks independently 4. Can use a spoon.
5. Climbs.
Appropriate toys: Push/pull toys, blocks.
L. 24 months
1. Negativistic 2. Temper tantrums
3. Transitional object 4. 2-4 word sentences, 400 words
5. Walks up/down stairs 6. Turns door knobs
7. Builds tower of 6 blocks 8. Removes clothes
9. Appropriate play: Parallel play, sand, riding toys, water play, finger paints.
10. Manage temper tantrums: Ignore behavior, monitor for safety.
11. Toddler uses “NO” excessively and shows assertiveness. Is curious how parents will
react to use of “NO”.
12. Overcriticizing and restricting the toddler may dampen his enthusiasm and increase
shame and doubt.
13. Total sleep required is 12-14 hours. Sleep problems are common.
14. Toilet training
A. Consider emotional readiness
B. The toddler acts to please others, trusts enough to give up his body products, and
begins autonomous behavior
C. Parents must be committed to establishing a toileting pattern and must communicate
well with the toddler.
D. Offer PRAISE for success - NEVER punishment for any failure.
E. Don’t refer to bowel movements as being “dirty” or “yucky”. Excrement is the toddler’s
first creation.
F. Introduce underpants as a badge of success and maturity.
G. Most toddlers achieve day dryness by age 18 months to 3 years and night dryness by
ages 2-5. NEVER punish for “ACCIDENTS”. If toddler is not trained by age 5, seek
further evaluation.
H. Toddler may fear being “sucked” into the toilet.
I. Teach proper wiping technique (front to back) and hand washing.
J. Toilet Training - when kid can communicate need to go (non verbal or verbal), holds on to
please mom and doesn't let go to please self, sphincter control 18 months - 24 months
(myelination of the cord is complete now), motor skill. Ability to stay dry for 2 hours, can
sit still on toilet for 5 - 10 minutes without fussing, curiosity about older people's habits.

No right or wrong time !
15. When the toddler starts climbing over the crib rails, switch to a bed.
16. Use locks on cabinets, keep handles away from edges of tables or stoves.
17. AVOID bean bag toys.
18. Appropriate toys: Nested toys, toys with parts that open and close. Toys designed for
pounding such as play hammers and drums. Toy telephones, dolls. Provide the child with
opportunities for positive imitative play. They enjoy simple songs with repetitive rhymes as
well as moving in time to music. A musical activity should be scheduled into each day.
19. NUTRITION:
A. Toddler feeds himself, provide finger foods in small portions
B. Because of increased risk of aspiration avoid foods such as hot dogs, grapes, nuts and
candy (or cut into small pieces).
C. Nutritional needs decrease because of slow growth period.
D. Child may become a picky eater. Nutritional content of food is important.
E. The toddler shouldn’t drink more than 24 ounces of milk a day in order to have room for
other nutritious food.
MILESTONES
By Age 3:
Able to jump in place Able to kick a ball
Able to ride a tricycle Able to state name, age, and gender
Able to copy a cross and circle Most speech is understandable by others
By Age 4:
Able to sing simple songs Able to draw a person with 3 or more body parts
Able to distinguish between reality and fantasy
Able to state first and last name
Able to build tower with at least 10 blocks
Able to hop on one foot at least 3 times
Able to throw ball over handed All speech is understandable
By Age 5: (Enters Kindergarten)
Able to dress self without assistance
Able to state entire name (first, middle, and last)
Able to state home address and home phone number
Able to follow 2-3 step directions
Able to count to 10 on fingers
Able to copy a triangle or square
Able to draw a person with head, body, and all extremities
Able to recognize most letters of the ABC’s and able to print a few
Plays “make believe”
By Age 6:
Able to walk heel/tow forward and backwards

Able to hop on either foot
Able to catch baseball size ball with 2 hands
Able to feed self correctly using knife, fork, and spoon
Able to cut out simple shapes with scissors
Able to distinguish between right and left hand
Able to play games involving matching skills
Able to repeat simples nursery rhymes
Able to choose peers for play
Is protective of younger siblings
NCLEX QUESTIONS
1. When does birth length double - By 4 years
2. When does child sit unsupported - By 8 months
3. When does a child achieve 50% of adult height - 2 years
4. When does a child throw a ball overhand - 2 years
5. When does a child speak 2-3 word sentences - 2 years
6. When does a child use scissors - 4 years
7. When can a child tie his/her shoes - 5 years
8. Girl’s growth spurt during adolescence begins earlier than boys. May begin as early as 10
years old.
9. Temper tantrums are common in the toddler; they are considered normal or average
behavior.
10. Adolescence is a time when the child forms his/her identity and that rebellion against
family values is common for this age group.
Dont foget to d/c aspirin 48 hours before the pt's scheduled OR.
Page 299 on the forum
The only insulin that can be given IV is Regular which happens to be the only one
of the insulins which is clear.
- bethanechol chloride (Urecholine) is used in neurogenic bladder & urinary

retention, s/sx of overdose include increased salivation, sweating and flushing,
when administering keep atrophine sulfate nearby as an antidote
-don't forget to give bedpan since Urecholine promotes diuresis
- avoid grapefruit juice with cyclosporine (Neoral), it raises blood levels and
increases risk of toxicity
• Always administer Morphine IV push slowly,over 5 minutes to avoid cardiac

arrest,cirulatory arrest.
Administer diuretics in the morning
Always administer Lipitor at 17:00 since the enzymes works best during the
evening time.

• Admisiter ACE inhibitors (prils) with food to avoid gastric upset.
Give aspirin with food to avoid gastric irritation.
• Aspirin causes ear toxicity,teach patient to report the tinnitus to their HCP.
• Dont even admister calcium channel blockers to a patient who just drank a
grapefruit juice,doing so can cause the calcium channels blockers to rise to
dangerous levels.
• Calcium channels blockers are contraindicated for patients with Congestive
heart failure,the only calcium channel blocker that can be safely administered
to a pt with CHF is Norvasc.
• Do not administer NSAIDS to a pt with CHF since NSAIDS promote sodium
retention and peripheral vasoconstriction-actions that can make CHF
worse.Additionally they reduce the efficiency and intensify the toxicity of
diuretics and ACE inhibotors.
• Gingo Biloba helps to delay the progression of Alzheimer's Disease.
• Dimenhydrinate (dramamine) is the most common OTC drug for motion
sickeness.
• Sumatriptan (Imitrex) an serotonin receptor agonist is given for migraine
headache.
• Antihistamines are prescribed for a variety of reasons like
nausea,vomitting,dyskinesia,cough,allergy,itching, sedation.
• Atropine is an antidote for wild mushroom toxicity,s/s of mushroom toxicity
include increased salivation,excessive tearing,diarrhea.
• Give iron preparation with orange juice,since citrus juice enhance the
absorption of iron.
• For cardiac meds, remember if it ends in -ine, such as Atropine...think "it
can't be seen"...vasoconstrictor...if it ends in -ide, such as Nipride..think
"makes them wide"..as in vasodilator..
• With insulins, remember when mixing, Regular (clear) always comes before
NPH (cloudy)...R before N = RN!
• Morphine is contraindicated for patients with pancreatitis and gallbladder
disease because it cost spasm of the Sphincter of Odi
• Sx of right sided heart failure:
Shortness of breath
Swelling of feet and ankles
Urinating more frequently at night
Pronounced neck veins
Palpitations
Irregular fast heartbeat
Fatigue
Weakness
Fainting
• Sx of left sided heart failure:

(I think Left with Lung-they both start with L)
Cough (produces frothy or blood-tinged mucus)
Decreased urine production
Difficulty lying down; need to sleep with the head elevated to avoid shortness
of breath
Fatigue, weakness, faintness

Irregular or rapid pulse
Palpitations
Shortness of breath
Waking up due to shortness of breath (paroxysmal nocturnal dyspnea)
Weight gain from fluid retention
• 1) Gout : low purine diet, avoid organ meat e.g. liver.
2) Hypertension : low sodium diet.
3) Renal calculi, calcium kidney stones : follow alkaline ash diet e.g. spinach,
milk, banana. Aim is to increase pH.
4) Post MI : incr troponin T, n/r : 0.1 to 0.2 ng/ml.
5) Post MI: incr isoenzyme for lactic dehydrogenase LDH1.
• Always associate FRACTURES with fat embolism Always associate MAJOR
SURGERIES with pulmonary embolism.
• Mumps: i remember (mumps- enlarged humps on neck & enlarged testicles
(orchitis)
Rubella: bad for pregnant women
• As far as immunization schedule for the infants and children it goes like that
the newborns get their first Hepatitis B shot at birth followed by 2 more
doses.
• Then the babies at 2 months recieve a couple of vaccinations which include
(keep in mind that they have to be at least 6 week old) Rotavirus dose
(followed by two other doses at different time),DTaP
(Diphteria,Tetanus,Pertussis,followed by 4 more doses at different time
period),Haemophilus Influenza type b (followed by 3 other
doses),Pneumoccocal vaccine (followed by 3 other doses) and finally
Inactivated (dont confuse with ACTIVATED,the word can be used as great
mislead in one of the NCLEX question,activated polio is no longer given to
babies).
• Next it is recommended for the babies to get influenza shot,however the
baby must be at least 6 month of age to get this vaccine.When the baby turn
one year old it is time for MMR (Measles mumps,Rubella all- in -one,remeber
that the baby must be at least ONE year old or older),also at the same time
the infant can get its first varicella shot and Hepatitis A shot (for both the
baby must be at least one year old)
• Clozaril - the "Z" in Clozaril - med for SchiZophrenia. Most worrisome
complication is agranulocytosis, therefore weekly blood tests must be done
• Corticosteroids can cause stomach ulcers.
Isoniazid can cause drug induced hepatitis-look for yellow color of the
skin,nausea,vomitting.
• Before start INH for TB, usually a baseline live function test is recommended.
TB skin positive, normal 10mm, if HIV, 5mm is positive
• Nclex tips
Assess first( check the question to see if the assessment has been done)
Take care of the patient first, the machines and documentation later
Always choose the most complete answer with the least opportunity for error
In Priority question, look for acute and unstable pt to see first

Always remember your ABCs
Maslow's will usually work and pain is seen as a psychosocial need---Not a

physical need
Incident or Occurrence reports--Never refer to them in the pt's chart

should complete for any time there is a variance from what should have
happened with Pt care
should not include blame or anything but just the facts
when charting, do not use the words, " Error, mistake, accident or incorrect."
Errors in charting are corrected by making one simple line through the words
If a RN comes from another unit, give that RN a pt who does not need to
have a RN from specific unite care for him/her. EX. --Post op mastectomy
needs an ONco nurse to take with.
Delegation--If you are assigning pt care to LPN/NA, rank order the pt as to

the ones who have the least acute problems/changes to the most
Anytime a question comes up about a procedure or diagnostic test, consider

the possible complications
Vital signs are a LATE signa of pt status change
Rales=CHF
Rhonchi=pneumonia
Wheezes=asthma
Hemoptysis=Lung cancer or TB
Pleural Pain=Pssible PE
Intercostal retractions=respiratory distress
Role play the situation
Read the question and answers out loud
Safety for the pt is always first, then the family, then the nurse
Never isolate a pt with Alzheimer's disease
Any time a pt has traction applied or a broken bone, consider:

Circulation

Movement
Sensation
skin integrity
restlessness is often the first sign of hypoxia
if you chose an answer withthe word, why or check in it, make sure it is truly
the best answer.
Rarely is the right answer to call the physician--Don't pass the responsibility
Psychiatric pt:
--For someone with psychosis--acknoledge the hallucination or delusion and

then realityorientation
--for someone with dementia--change the subject, divert the attention
Medications to know: antipsychotics--Haldol, Thorazine, Zyprexa, Geodon\
antidepressants--Tricyclics--typically sedating so take at bedtime, cause

otthostasis, dry mouth, very dangerous with OD. NEED to wean off.
MAO-I---low tyramine diet, if they eat something high tyramine--

hypertensive crisis
Interact with a lot of other meds, can have hypertensive crisis with other
meds
Need to be off other antidepressants for at least 2 wks before starting.
SSRI--can treat anxiety to. Typically take in the morning because they are
more likely to be stimulating. Can cause diarrhea. Need to wean off.Serotonin
serge.
Anti-mania--lithium--need to have levels drawn, Tend to get increased level if

sweating, vomiting. Know the S/S of toxicity. Know normal Li levels( 0.6-1.2)
Anti-seizure family( Depakote, Tegretol, Lamictal, Trileptal, etc) most can

lead to liver failure. Should have levels of Depakote/Tegretol done at
intervals.
Anti-anxiety-Benzodiazepines----addictive and lead to seizures during

withdrawl. Very dangerous if combined with alcohol. Sedating except may
have paradoxical

Reaction in the elderly
Safety is always first priority if someone is losing control of her/his behavior.
--must try all other interventions before using restraints/seclusion

someone must stay within arms's reach of the pt if they are restraints
Need to release one restraint or do Prom every 15 min.
Restraint to orders need to be specific and cannot be PRN and only good for
24hrs.
Chemical restraints count as restraints
The pt with Depression needs to increase interaction.
the pt with psychosis typically is very concrete in thinkgs and it not going to
be able to process groups, etc
Well pt with addictive disorders use the denail as their primary coping
mechanism
Manic phase pts need finger foods or calories as they burn a lot being busy
Suicidal pts --look for any phrase that implies helplessness, hopelessness,
worthlessness
Post op eye surgery--don't bend at the waist, avoid straining
If someone has an object that has penetrated his/her body, leave it there
until it is assessed as safe to remove.
• Drugs which are incompatible with INTRAVENOUS Potassium
Chloride ( IV KCL)
adrenaline HCL ( this drug also interacts/incompatible with diazepam)

amphotericin B ( " " " " " diazepam )
cholesteryl (interacts with ergotamine tartrate)
sulfate complex (intereacts with methicillin sodium)
atropine sulfate ( interacts with phenytoin sodium)
cephalophin sodium ( " " phenytoin )
choramphenicol ( interacts with sulphadiazine sodium )
sodium succinate ( interacts with suxamethoniun chloride )
chlorpromazine HCL ( interacts with thiopentone sodium )
diazepam
ergatamine tartarate
methicilline sodium
phenytoin sodium
phenytoin
sulphadiazine sodium
suxamethonium chloride
thiopentone sodium

Drugs which CANNOT be given by IVPush Route
Potassium Chloride (KCL)---never to IVPush

Heparin SQ---can be given as a Drip, but no to IVP Route
Ibuprofen - PO
Insulin---only Regular (clear) can be given intravenous but never IVPush
Keppra--PO
Lovenox SQ
Mestinon PO, IV
Florinef PO
Dobutamine IV and drip ---NO to IVPush Route
Docusate PO
Coumadine PO
Cefazolin PO/IV/IM -------" " " "
Calcium Gluconate PO/IV/IM---never to IVPush Route
Atropine IV/PO/IM/SC
aspirin PO/PR
Albumin IV
acetaminophen PO/PR
• Differentiating types of Crises for NCLEX mental health related questions
Types of Crises:
Situational Crisis= from an external source
Examples:
a) divorce
b) death of a love one
c) mental illness
d) abortion
e) loss of a job
f) a change in financial status
g) severe physical illness
Advantageous Crisis= from an external source
Examples:
a) earthquake
b) flood
c) any natural disaster
Maturational Crisis= related to rites of passage
Examples:
a) retirement

b) birth of a child
c) kids going to college, moving out---empty nest
d) marriage
Infection Control
The three bloodborne patogens of most concern to healthcare workers are:
• HIV
• Hepatitis B Virus
• Hepatitis C Virus
Difference between Universal Precautions and Standard Precautions:
• In 1980's the CDC created specific recommendations known as Universal

Precautionsto prevent the spread of bloodborne patogens such as HIV, HBV
HCV and other bloodborne diseases in the healthcare environment.
• Later Universal Precautions changed from being a CDC recommendation to
a workplace regulation enforced by OSHA as a Prevention of Bloodborne
Patogens Standard.
• Standard Precautions = A set of procedures designated by the CDC to
prevent the spread of known and unknown sources of infection via body
fluids, excretions and secretions of the skin and oral mucosa. Please note,
that the difference for Standard Precautions include all body fluids while
Universal Precautions is about bloodborne patogens only.
• Memory aid for signs of potential problems for Oral
Contraceptives = ACHES
A - Abdominal pain (possible liver/ gallbladder issue)

C- Chest pain or SOB (possibility of pulmonary embolus)
H - Headache (possibility of hypertension / brain attack)
E - Eye problem (possibile hypertension / vascular attack)
S - Severe leg pain (possible thromboembolic process)
Cleft Lip: nursing care plan (post OP) = CLEFT2 LIP
Crying = minimize
Logan bow
Elbow restraints
Feed w/ Brecht feeder
Teach feeding techniques; average age for repair is TWO months.
Liquid (sterile water)/ rinse after feeding
Impaired feeding (no sucking)
Position - never on abdomen
KAWASAKI DISEASE:
Unknown cause
Early tx with Gamma globulin to reduce cardio damage.
Abrupt onset of fever (102-106 F) lasting more than 5 days that get no
better with antibiotics/antipyretics.

Conjunctivitis, bilateral and nonpurulent.
Peeling of the palms of the hands and feet.
Generalized rash on trunk and extremeties, w/o crusts or vesicles.
Lab tests results for KAWASAKI DISEASE = elevated ESR, WBC & Platelet
count.
• Screening tests.
-women should pay attention to their breast at the age of 20,this is the time when females should
start perform self breast examination,once a month 7 days after their menstrual period
beggins,they dont have to have a mammograph yet however it is recommended that women
between ages 20-29 should have a professional physical examination of breast every three years.
-women who are 40 and over should have a mammograph plus physical breast examination done
every year.
-the first pap smear should be performed at the onset of sexual relations and done annually after a
woman reaches the age of 18.
-men who turn 50 (or man who are 40 with a risk factors) should have a prostate specific antigen
test done annually for prostate cancer.
-men who turn 40 should have a rectal digital exam done yearly to screen for colon cancer.
-men who turn 50 should have a a guiac test for occult blood done annually (to screen for colon
cancer)
-men who turn 50 should have a proctoscopy done every 3 to 5 years to screen for a colon cancer.
-people especially men when they turn 45 and have a normal cholesterol level should have this
test done every five years.
-men (especially adolescent men) should perform self-testicular exam every month after a warm
shower.
-all the people above the age of 21 should have their blood pressure checked.
• When drawing two different insulins Cloudy CLEAR CLEAR Cloudy
Air in cloudy air in clear, draw clear draw cloudy
GI assessment Inspect Auscultate Percuss Palpate
Antidote for Coumadin- Vitamin K

Antidote for Heparin- Protamine Sulfate
• Some antipsychotic drugs end in -done (like risperdone) and -zine (thorazine)
Common side effect of the antipsychotic drugs
-insomia
-weight gain
-agitation
-extrapyramidal movements
-orthostatic hypotension
-sedation
-diziness
-headache
-dry mouth
-trouble urinating
-constipation
-decrease in WBC
Some popular antipsychotic meds; zyprexa,seroquel,haldol,molindone.geodon,risperido

ne,thorazine,clozaril

• Spina Bifida- allergy likely to Latex
Streptoccocal glomeruler nephritis----ask if sore throats, pr impetigo (skin condition)- normal BP
nephrotic syndrome- BP high
After pregnancy BP should b normal
What does it matter if a patient has supplement O2 if they are hemmorhaging, okay she they will
be hemmorhaging oxygenated blood--ex circulation before airway
spironolactone- is a potassium sparing diuretic--not exact spelling
Lithium--need to maintain normal sodium intake to not predispose to toxicity
Judaism- really care about pain relief at end of life care, once dead some will stay with body
Celiac Disease-- can have corn substitutes--includes popcorn as a snack
infant with Hep A----is put on contact precautions becuase incontinent of feces
remember words::: Nance Reagan RN--for insulin adm-----put air into regular, put air into NPH,
withdrawal NPH then withdrawal Regular
• Blood Transfusion Reactions
Allergic- You will see rash, fever, anaphalyxis reaction as well. Treatment: Oxygen, benadryl,
monitor patent airway (ABCs)
Hemolytic- It means blood incompatibility. You will see pain in lower back, hypotension,
decrease urinary output. Treatment: O2, benadryl, vasopressors, maintain patent airway
Febrile- Most common type of reaction, especially for patients who receive a lot of blood. The
blood given has antibodies that reacts with the patient's own. You will see fever, chill, nausea ,
tachy. Treatment: antibiotics
Bacteria- gave contaminated blood. You will see hypotension, shock, fever. Treatment: IV fluids,
vasopressors, steroids, antibodies.
Some meds..
Adrenergics ( Levophed, Dopamine, Adrenalin, Dobutrex) for CARDIAC ARREST, COPD
Anti- Anxiety ( Librium, Xanax, Ativan, Vistaril, Equanil) for MANIC, ANXIETY, PANIC
ATTACKS
Antacids ( Amphojel, milk of mangnesia, maalox ) for PEPTIC ULCER, INDIGESTION,
REFLEX ESOPHAGITIS. CAUTION DONT GIVE ANTACIDS WITH FOOD BECAUSE IT
DELAYS GASTRIC EMPTYING. ANTIACIDS INTERFERE WITH ANTIBODIES, INH (TB
MED), ORAL CONTRACEPTIVES, IRON PREPARATIONS.
Glucocorticoids ( Solu-Cortex, decadron, deltasone) for ADDISON DISEASE, CROHN'S
DISEASE, COPD, LEUKEMIAS
Mineralcorticoids ( Florinex) for ADRENAL INSUFFICIENCY
Cholinergics ( Tensilon, Prostigmin) for MYASTHENIA GRAVIS, POSTPARTUM URINARY
RETENTION.
Anticonvulsants ( Dilantion, Luminal, Depakote, Tegretol, Klonopin) for SEIZURES
iNFECTION CONTROL
airborne- Rubeolla, Herpes zoster, Tb, chicken pox
droplet- pneumonia, meningitis

contact- MRSA, scabies, RSV
during seizures position patient on his or her side in a lateral position. Jaundice is best observe
in sclera, nail beds and mucous membranes. If patient is getting enema and has pain= clamp
tubing for 30 seconds and restart the flow at slower rate. After completing a tube feeding- patient
is placed on right sie to promote emptying of stomach while preventing aspiration. First step in
problem solution is to indentify the problem and generate possible solutions ( MANAGEMENT
OF CARE). IOP tends to be higher in the morining, early assessment of glaucoma is good AM for
that reason. Bulge test- confirms presence of fluid in the knee. TPN has a higher glucose content,
monitor glucose level. Oral anticougulant therapy (coumadin) should be instituted 4 to 5 days
before discontinuing heparin therapy.......
• 1. Causes of Cor Pulmonale
Cor Pulmonale doesn’t need to be a jolt to think of Colt: use COLT to remember the causes of
Cor pulmonale.
C- COPD / and Cystic Fibrosis
O- Obesity
L- Living at high altitude
T- Tuberculosis
These all increase the heart’s workload and lead to right side hypertrophy.
---------------------------------------------------------------------------------------------------------------------
--------
2. Treatment of Cor pulmonale
Treatment of Cor pulmonale (right-sided heart failure) can be remembered by using the acronym
SODA:
S- Sputum Culture
O- O2 administration
D- Digoxin
A- Antibiotics: to treat any underlying respiratory infection.
• Signs and Symptoms of Conjunctivitis
Conjunctivitis is redness and swelling of the conjunctiva leading to redness and edema. Since the
main cause for the spread of conjunctivitis is poor hand washing use the word SOAP to remember
the signs and symptoms of conjunctivitis.
S- Swollen, red eyelids

O- Occasional drainage from eye
A- An itching or burning
P- Photophobia
==================================================
================================================== ===================
Rheumatic Fever Signs and Symptoms
Rheumatic fever is a complication of untreated strep throat, caused by bacteria called Group A
Streptococcus. It is potentially life threatening. Since one of the main symptoms of rheumatic
fever is pain in the joints, use the word, JOINTS to remember the signs and symptoms.
J- Joints are painful
O- Over a long period it can damage the heart
I- Infection may be too mild to be recognized
N- Nervous system can be affected leading to chorea
T- Throat that is sore
S- Swollen joints

• POINTS TO REMEMBER (PHYSIOLOGY)
CARDIOVASCULAR SYSTEM
• Cardiovascular disease is the leading cause of death among Americans.
• Take blood pressures correctly
1. Give client 5 minutes rest.
2. Take blood pressure while client is lying, sitting, and standing.
3. Ask client if he/she has recently smoked, drank a beverage containing caffeine or was
emotionally upset. If so, repeat blood pressure in 30 minutes.
• Rarely, the heart may lie on the right side instead of the left, this is called Dextrocardia.
• Valves control the direction of the blood flow through the heart. Flow is unidirectional.
• When the atria contract, the atrioventricular valves swing open, allowing the blood to flow down
into the ventricles.
• When the ventricles contract the valves snap shut preventing blood from flowing back up into the
atria. Semilunar valves open allowing blood to eject during ventricular contraction.
• If the SA node fails to generate an impulse, the AV node takes over, generating a slower rate. If
the AV node fails to generate an impulse, the Bundle of His takes over, generating an even slower
rate. If the Bundle of His fails to generate an impulse, the Purkinje fibers take over and generate
an even slower rate.
• Damaged areas of the heart may also stimulate contractions and produce arrhythmias.
• Rapid, short-term control of blood pressure is achieved by cardiac and vascular reflexes that are
initiated by stretch receptors (baroreceptors) in the walls of the carotid sinus and the aortic arch.
• Many clients with angina or MIs benefit from involvement in a structured cardiac rehabilitation
program to assist clients to increase their activity level in a monitored environment.
• Current research suggests that life style and personal habits are closely related to cardiac changes
once attributed to aging.
• The elderly are less able to physically adapt to stressful physical and emotional conditions,
because their hearts do three things less quickly: the myocardium contracts less easily, the left
ventricle ejects blood less quickly, and the heart is slower to conduct the impulse for a heartbeat.
• Because different enzymes are released into the blood at varying periods after a myocardial
infarction, it is important to evaluate enzyme levels in relation to the onset of the physical
symptoms such as chest pain.
• Clients who are in postoperative recovery, on bed rest, obese, taking oral contraceptives or had
knee or hip surgery should be monitored closely for thrombophlebitis.
RESPIRATORY
• Oxygen is essential for life. So, before all else, keep airways open and ease breathing.
• Clients with chronic lung disease use more oxygen and energy to breathe; this can create a
vicious cycle in which the client works harder, and continually requires more oxygen and more
energy.
• Nursing interventions for clients with lung disease should include pacing of activities, because
clients have little reserve for exertion.
• Quality of life for clients can be significantly improved if you teach clientsdiaphragmatic
breathing and pursed-lip breathing.

• Clients with asthma must understand the different types of inhalers and when to use each type.
Some are rescue inhalers for acute dyspnea; others are maintenance drugs.
• A finger oximeter reading is simply one element of an assessment; it's not the whole picture.
• Cyanosis is determined by oxygenation and hemoglobin content; anemic clients may be severely
hypoxemic and never turn blue; polycythemic clients may be cyanotic with adequate tissue
oxygenation.
• Control of pulmonary TB is a serious public health issue.
• If a client is in respiratory distress, start out by administering oxygen by non-rebreather mask at
10-15 LPM until the client's condition is clarified or stabilizes.
• When caring for a client with a chest tube, you must know whether the client has a leak from the
lung. Only when you know there is no leak, should you apply an occlusive dressing.
• When caring for a client on a ventilator, if an alarm sounds, first, assess the client. See if the
alarm resets or if the cause is obvious. If the alarm continues to sound and the client develops
distress, disconnect the client from the ventilator, use a manual resuscitation bag and page or call
the respiratory therapist immediately.
• To maximize therapeutic effect of inhalers, the key is technique. It is critical to teach clients the
right technique and test how well they use the inhaler.
• Smoking cessation is critical to reduce the risk and severity of lung disease. Second-hand smoke
hurts children most.
• Best treatment of pulmonary embolus is prevention by using intermittent compression
stockings (with anticoagulants in extra-high risk clients) to prevent clots in deep veins.
• TB clients need intensive community follow up to ensure that they continue with
pharmacological treatment once discharged from the hospital. Clients who stop therapy
too soon are the source for the more deadly multi-drug resistant forms of TB.
NEUROLOGICAL SYSTEM
• In Multiple Sclerosis, early changes tend to be in vision and motor sensation; late
changes tend to be in cognition and bowel control.
• Peripheral nerves can regenerate, but nerves in the spinal cord cannot regenerate.
• During a seizure, do not force anything into the client's mouth.
• A major problem often associated with a left CVA is an alteration in communication.
• Clients with CVAs are at high risk for aspiration. These clients must be evaluated to
determine if dysphagia is present.
• The rate, rhythm and depth of a client's respirations are more sensitive indicators of
intracranial pressure than blood pressure and pulse.
• When caring for a comatose client, remember that the hearing is the last sense to be
lost.
• A CVA can result in a loss of memory, emotional lability and a decreased attention span.
• Communication difficulties in a CVA client usually indicate involvement of the dominant
hemisphere, usually left, and is associated with right sided hemiplegia or hemiparesis.
• The client with myasthenia gravis will have more severe muscle weakness in the
morning due to the fact that muscles weaken with activity and regain strength with rest.
EYE
• Anything that dilates the pupil obstructs the canal of Schlemm, increases intraocular
pressure.

• Color blindness is caused by a deficiency in one or more types of cones and is caused
by a sex-linked recessive gene.
• Destruction of either the right or left optic nerve tract results in blindness in the
respective side of both eyes
• When mydriatics are instilled, caution clients that vision will be blurred for up to two
hours
• Following eye surgery teach client to avoid, for six weeks, activities that can increase
IOP
o Stooping
o Bending from the waist
o Heavy lifting
o Excessive fluid intake
o Emotional upsets
o Constrictive clothing around neck
o Straining with bowel movement (or straining at stool)
• Teach client proper administration of eyedrops
• Provide sunglasses for photophobia
• Assist with activities of daily living as required
• When clients wear eye patches, they lose depth perception. Remember that this loss
presents a safety risk.
• Systemic disorders that can change ocular status include diabetes mellitus,atherosclerosis,
Graves' disease (hyperthyroidism), AIDS, leukemia, lupus erythematosus, rheumatoid
arthritis sickle cell disease.
Ear
• Changes in barometric pressure will affect persons with ear disorders
• Hearing loss
o can be partial or total
o can affect one or both ears
o can occur in low, medium or high frequencies
• AMA formula for hearing loss: hearing is impaired 1.5% for every decibel that the pure
tone average exceeds 25 decibels (dB)
• A hearing loss of 22.5% usually affects social functionality and requires a hearing aid
• Noise exposure is the major cause of hearing loss in the United States
• Ask client how he/she communicates: lip-reading, sign language, body gestures, or
writing
• To gain the client's attention, raise your hand or touch the client's arm
• When talking with client, speak slowly and face him/her
• Speak toward the client's good ear
• If the client wears a hearing aid, allow him/her to show you how it's inserted
• Speaking louder to a hearing impaired client does not increase his/her chances of
hearing

• Communicate the client's hearing loss to other staff members
• Ototoxic drugs include:
o Aminoglycosides
o Antimyobacterials
o Thiazides
o Loop diuretics
o Antineoplastics
• Tell clients taking ototoxic drugs to report any signs of dizziness, loss of balance,
tinnitus, or hearing loss
GASTRO-INTESTINAL
• Most obstructions occur in the small bowel.
• Most large bowel obstructions are caused by cancer.
• Onset of cirrhosis is insidious with symptoms such as anorexia, weight loss, malaise,
altered bowel habits, nausea and vomiting.
• Management of cirrhosis is directed towards avoiding complications. This is achieved by
maintaining fluid, electrolyte and nutritional balance.
• A client with esophageal varices must be monitored for bleeding (e.g., melena stools,
hematemesis, and tachycardia.
• The rupture of esophageal varices is life threatening and associated with a high mortality
rate.
• Pancreatitis is often associated with excessive alcohol ingestion.
• Pancreatic cancer is an insidious disease that often goes undetected until its later
stages.
• Diverticula are most common in the sigmoid colon.
• Clients with diverticulosis are often asymptomatic.
• A deficiency in dietary fiber is associated with diverticulitis.
• Colostomies: an ascending colostomy drains liquid feces, is difficult to train and requires
daily irrigation; a descending colostomy drains solid feces and can be controlled.
• Frequent liquid stools can be indicative of a fecal impaction or intestinal obstruction.
• Bowel sounds tend to be hyperactive in the early phases of an intestinal obstruction.
GENITO-URINARY
• After a urinary catheter is removed, the client may have some burning on urination,
frequency and dribbling. These symptoms should subside.
• After a TUR (transurethral resection), tell the client that, because the three-way foley
catheter has a large diameter, he will continuously feel the urge to void.
• After prostatic surgery, it is normal for the client's urine to be blood tinged and for him to
pass blood clots and tissue debris.
• Because the prostate gland receives a rich blood supply, it is important to observe the
client undergoing a prostatectomy for bleeding and shock.
• Breast cancer starts with the alteration of a single cell and takes a minimum of two years
to become palpable.

• At the time of diagnosis, about 1/2 of clients with breast cancer have regional or distant
metastasis.
• antidisrtythmic drugs:
sodium channel blockers: Lidocaine,quinidine,procainamide-have many

adverse reactions given only after other therapies have failed;
Adverse affects;prolonged Qtc or QRS,nausea,vomitting,heart

block,confusion,seizures (especially with a
lidocaine),rash,sedation,respiratory depression,torsades de pointes,can cause
increased bleeding when combine with anticoagulants,should never be taken
with potassium channel blockers,increased risk of digoxin toxicity
Potassium channel blockers: Amiodarone,sotalol,can cause hear

failure,pulmonary fibrosis,heart block,sinus arrest,liver damage,use suncreen
and protect your eyes
anticholinergics : Atropine-for bradycardia associated with increased vagal

tone,high-alert drug,can cause flushing of the skin for 20-30 minutes when
given by injection,produces anticholigergic effect such as
sedation,constipation,dry mouth,urinary retention.
aceytlcholine-sensitive K-current activator:adenosine
uses:chemical conversion of supraventricular tachycardia after failure of

vagal maneuver
Adverse affects;transient asystole,dysrythmias,dyspnea,chest

tightness,hypotension,flushing,nausea
• take tetracycline on emty stomach,do not take it with MILK products-delays
absorption.
Take statins with at night with meals.
Do not administer calcium channel blockers with Grapefruit juice.
Do not administer aspirin to people with asthma.
Antilipids can cause bleeding and breakdown of skeletal muscles.
Niacin is an antilipid and can cause intense flushing,increased serum uric acid
(stones),abdominal pain,joint pain.
Do not administer beta blockers to pt with COPD or diabetes mellitus.
Beta blocker can cause depression in people.
Give ampicillin on empt stomach (penicillin can be given without regards to
meals)
Give captopril one hour before meals.
• Some more drug endings
-zosins-alpha1 blockers,they are used for hypertension and benign prostatic

hyperthrophy.
-none-phosphodiesterase inhibitors for heart failure when other drugs fail or
a pt is awaiting heart transplants,side effects;letal dysrtythmias dangerous

drug!
-kinase-thrombolytics-for MI,PE,deep vein thrombosis,for the MI must be
given within 4 to 6 hr,contraindicated in brain neoplasm,cerebral
hemmorage,recent major trauma or spinal surgery,high potential for
bleeding.
One more facts always check K+ when administering digoxin (contraindicated

in hypokalemia) and -prils (contraindicated in hyperkalemia)
• Calcium Channel Blockers are

Very- Verapamil
Nice- Nifedipine
Drugs- Ditalizem aka Cardizem
• 1st degree heart block looks like NSR but the PR interval is 0.20 or greater
2nd Degree Heart block aka Mobitz 1 alsp aka Wenkeback the PR interval
keeps getting longer and longer
then suddenly drops a PR interval- remember Wenkebach=Warning (the
warning, the PR interval is getting longer and longer)
2nd degree Heart block Type 2- no PR interval getting longer and longer it
just suddenly drops (suddenly=serious)
• For Acute MI's remember MONA, not administered in that order : MONA
Morphine, O2, Nitroglycerine, Aspirin
administration is least invasive to most so that would be : O2, Aspirin, Nitro
x3 q5 min, Morphine
• Meds:
---mab for Cancer:

bevacizumab (Avastin) blocks the growth of blood vessels to the tumor and
cetuximab (Erbitux) and panitumumab (Vectibix) both block the effects of
hormone-like factors that promote cancer cell growth.
Lung---No.1 Killer among cancer
small cell or non-small cell and stage of cancer
; surgery, radiation therapy, chemotherapy,
and targeted biological therapies such as bevacizumab
(Avastin) and erlotinib (Tarceva).
--mab again: for lymphoma; monoclonal antibodies, such as rituximab (Rituxan) and
alemtuzumab(Campath),
directed at lymphoma cells are used for initial treatment
and recurrence of some types of non-Hodgkin lymphoma,
as are antibodies linked to a radioactive atom,
such as ibritumomab tiuxetan (Zevalin) and iodine I 131
tositumomab (Bexxar).
----"have baby" and "use oral contraceptives " both decrease risk for ovarian
cancer. ( I do not know that before, then I should try first). Age is the big risk for
ovarian cancer. Then I want to be young forever!!!!!!!!
-----Prostate cancer
most frequently diagnosed cancer in men. reasons unclear

second-leading cause of cancer death in men.
chemoprevention: finasteride and dutasteride
• Substance Poisoning and Antidotes

Methanol =>ethanol
carbon monooxide=>Oxygen
Dopamine=>Phentolamine
Benzo=>flumazenil
Lead=>Succimer
Iron=>Deferoxamine
• INTERVENTIONS FOR COPD (using ABCDEF)
A-Aminophylline
B-Brochodilators
C- Chest Physiotherapy
CORTICOSTEROIDS
D- Deliver oxygen at 2 liters
E- Expectorants
F- Force Fluids
Tuberculosis ( Meds) Use RISE
R-Rifampin
I-Isoniazid (INH)
S-Streptomycin
E-Ethambutol
Care of Client After Masectomy

(BREAST)
B-Bp not on affected side

R- Reach recovery
E-Elevate affected side
Exension and flexion exercise- initialy (Squeeze a ball)
A-Abduction and external rotation should not be initial exercise
S-SBE- Once a month- about one week after period
T-To promote a positive self image
TURPS
T-Tubes
U-Urinary output
R- Red drainage
P-Pieces of clots
S-Spasms
Meniere's Disease

Administer diuretics to decrease endolymph in the cochlea, restrict sodium,
lay on affected ear when in bed.
TRIAD
-vertigo
-Tinnitus
-Nausea and vomiting.
• pheochromocytoma: neuroendocrine tumor of the medulla of the adrenal

glands. This causes and increased secretion
of catecholamines (epinephrine, and norepinephrine) Signs and Symptoms
same as body's Sympathetic Nervous System Response:
>Elevated HR
>Elevated BP
>Palpitations
>Anxiety
>Diaphoresis
>Headaches
>Pallor
>Wt. Loss
>Elevated Blood Glucose Level (due to catecholamine stimulation of lipolysis)
• Tetany tests:
Chovstek's sign- Tap facial nerve 2 cm anterior to earlobe just below zygomatic arch. Twitching
of facial muscles indicates tetany.
Trousseau's sign- Inflate BP cuff to 20mmHg above Systolic. Carpal spasms w/in 2-5 mins
indicates tetany.
Abnormal Breathing Patterns:
Cheyenne stokes- "Dead man breathing" Tachypnea with periods of apnea.
Kussmauls breathing- Deep and Fast, seen in pts experiencing Hyperglycemia also look for
Fruity Breath.
The diabetes that isn't really a diabetes:
Diabetes Insipidus- Named diabetes b/c of the diuresis it causes similar to that which a person
with diabetes would experience. The polyuria is caused by a deficiency of the ADH(Anti-diuretic
hormone) causing the patient to excrete alot of urine. Check for Low Specific gravity,
hypernatremia, Serum Osmolality may be low for . Pt will have to urinate frequency, have
extreme thirst and may easily become dehydrated. Unlike SIADH (syndrome of inappropriate
ADH) you want to increase fluid intake to hydrate the patient.
SIADH- Syndrome of Inappropriate ADH or as I like to think of it "Syndrome

of IncreasedADH". Common in patients with a damaged CNS (Central Nervous System).
Excessive ADH is released from the Pituitary gland resulting in hyponatremia, concentrated urine
and fluid overload.
• NSAIDS like Ibuprophen (Motrin) can cause GI bleeds, never take on an Empty stomach.
Think"NSAIDS take with BREAD"

No milk served with meat- Jews
Clients with physical disabilities frequently respond good to support groups
Do’s and Don’ts
Don’t pass buck

Don’t provide false Reassurance
Don’t ask why
Don’t treat psychosocial first
Do ask patient to express themselves, their concerns
INH can cause liver problems so stay away from alcohol
Risk Factors for Pneumonia Old age, bed ridden, post op, pre existing lung problems
Cane walking- Hold the cane in hand opposite of weak leg and move with weak leg. I.E. with
weak right leg, advance left hand (cane) followed by right leg then left leg.
Lying prone prevents flexion contracture of hip
Poor Potassium values Call Physician. Cardiac Emergency!

• Pavlik harness- is a harness applied to young children with hip dysplasia. it goes around their
mid section and over their shoulders in the front looking like a pair of suspenders. It then makes
and x in the back and connects to the child's feet and ankles in the front and back. The child
should wear knee high socks and a under shirt to prevent skin break down. Massage the skin
under the straps daily (w/out lotions, ointments)
JVD (jugular vein distention) is a symptom of a cardiac tamponade, a complication of CABGs

caused by blood accumulating around the heart in the pericardial sac and compressing the
myocardium, atrium, and ventricles.
• IF you have a female patient undergoing Peritoneal Dialysis and the output is bloody you need to
determine if she is menstruating. The reason being, the dialysate is so concentrated to pull fluid
from the abdominal cavity that the hypertonicity may cause blood to be pulled from the uterus
through the fallopian tubes and into the effluent.
• Here are a few facts:
Use FIRST to help you remember
F- find hypoxia
I- Immunocompromised
R- Real bleeding ( Trauma, hemorrhage)
S-Safety
T- Try infection
For Cardiac

It use to be MOAN but the American heart Association has changed it
Now it is ONAM
O- Oxygen
N-Nitoglycerine
A- Asprin
M- Morphine
• Breast Cancer Risk Factors:
• >50 years of age
• FIRST child born after 30 years of age
• Grandmother, Mother, Sister has it
• Personal history of breast cancer
• Garlic has a hypoglycemic effect do not give with insulin
Eye problems do not want head in dependent position. Lie on good side and have bad eye
upor elevate the head of the bed to 35 degrees.
Lay on right side after liver biopsy.
Clear fluid from head CSF medical emergency call the doctor
1 yr old with nausea, vomiting, and diarrhea is emergency because young children become
dehydrated very easily
Assess pt for claustrophobia with CAT scans and MRIs, also, NO METAL.
• ALPHABET NURSING FACT:
Activated charcoal - To absorb poison
AAA- Complication is hemorrhage and shock
A positive mantoux test indicate the pt has produced an immune response
Complication of warfarin- (3H) hemorrhage, hematuria and hepatitis
Colchine for treatment of gout attack
Codeine- onset- 30mins, peak- 1hr, duration 4-6hrs
COPD -use of acessory muscle for respiration indicate the pt is having difficulty breathing
Chlamydia, Genital herpes and HPV - Do not report
Crackles are heard on inspiration and dont clear with cough
Diaphramatic and purse lip breathing are the best for pt with COPD
DMD- X-linked recessive and female are carrier and male are affected.

DI- Treatment is DDAVP
Gastric lavage - To remove poison
Indomethacin - helps in closing PDA
Left sided HF- pulmonary
Myelomingocele complication - clubbfoot and hydrocephalus
Meningitis- Droplet
Osteoarthritis- Joint pain, crepitus, heberden's node, bouchard's node and enlarge joints
Pentoxifyline- hemorheologic Agent that improve blood flow and is used to treat intermittent
claudication
Prostaglandin E is administerd to provide blood ming and also help to keep open the ductus
arteriosus
Right side HF- systemic
Rhonchi are heard on expiration and clear with cough
Rabies- contact precaution
tPA- used to treat Acute MI
Thrombolytic- dissolve clots
To avoid falsely elevated serum digoxin, the nurse should wait @ least 8hrs after administering
oral digoxin and @ least 6hrs after administering I.V digoxin to draw a blood sample.
TB- airborne
• Disaster planning
A disaster plan needs to be activated when there is a life threatening situation with a large number
of patients involve. A way to remember who to remove first is by using ABC
A- Ambulatory
B- Bed Ridden
C- Critical Care
You may ask why but the goal is to move the greatest number of clients.
Appendicitis- position of comfort is on the side with the legs flexed agains the abdomen. HOB
should remain slightly elevated to decrease the upward spread of infection in case the rupturing of
appendix occurs.

MEDS that can cause ototoxicity
Aminoglycosides
bumetanide, parenteral (Bumex)
cisplatin
erythromycin ( renal impairment and high doses)
ethacrynic acid ( Edecrin)
furosemide ( Lasix)
hydroxychloroquine ( Plaquenil)
nonsteroidal anti-inflammatory drugs (NSAIDs)
salicylates ( chronic high doses, overdose)
Vancomycin, parenteral ( high doses and renal impairment)
Drugs that can cause Nephrotoxicity
Acetaminophen ( high doses, acute)

Acyclovir, parenteral ( Zovirax)
aminoglycocides
amphotericin B, parenteral ( Fungizone)
analgesic combinations containing acetaminophen, asprin, or other salicylates in high doses,
chronically
ciprofloxacin
cisplatin ( Platinol)
methotrexate ( high doses)
nonsteriodal anti-inflammatory drugs ( NSAIDs)
rifampin
sulfonamides
tetracyclines ( exceptions are doxycline and minocycline)
vancomycin, parenteral (Vancocin)
Drugs that can cause Hepatotoxicity
ACE inhibitors
acetaminophen
alcohol
iron overdose
erythromycins
estrogens
fluconazole ( Diflucan)
isoniazid ( INH)
itraconazole ( Sporanox)
Ketoconazole ( Nizoral)
nonsterodial anti-inflammatory drugs ( NSAIDs)
phenothiazines
Phenytoin ( Dilantin)
rifampin ( Rifadin)
sulfamethooxazole and trimethoprin ( Bactrin, Septra)
Sulfonamides
• Differentiating Parathyroid Hormone and Calcitonin's effect on calcium placement.
Calci-Tonin increases Calcium in the BONE

PTH-
Puts
The calcium in the
Heme (blood)
• Protease Inhibitors
indinavir ( Crixivan)
nelfinavir ( Viracept)
ritonavir ( Norvir)
saquinvir ( Invirase)
If you notice all end in vir
Nucleoside or Reverse transcriptase inhibitors
didanosine ( Videx)
lamivudine ( Epivir))
stavudine ( Zerit)
zalcitabine (HIVID)
zidovudine ( Retrovir)
Notice all of these end in (ine)

• What helps me most with math problems is to break everything down into its lowest components.
For example, if you have 3gr or 180mg in 500ml, how many ml per single mg? Divide 500 by
180. Once you know how many ml are in a single mg, you can multiply to get your answer
• Pericarditis
*chest pain, dry cough, fever, fatigue, anxiety.
Tx w/ steriods, pericardiocentesis, antibiotics, colchicine.
Myocarditis
*Chest pain, CHF sx, palpitations.
BPH
*weak urine stream, heard to start urination, dysuria, nocturia, frequency.
Labs to look for w/ dehydration

*increased specific gravity, increased urine and serum osmolarity, HYPERnatremia (think less
water...so the sodium becomes very concentrated) increased HCT, BUN....Anyone think of any I
have forgotten??
ACE inhib(-pril)
*dizziness(hypotension), angioedema, dry cough & hyperkalemia.
• Pulm embolism
*low grade fever, tachypnea, diaphoresis, tachycardia, blood tinged sputum.
• COPD
prolonged expiratory phase.
Tension Pneumothorax
*trachea deviate to opposite side (opposite=pneumothorax, same=atelectasis.) hypotension and
bradycardia.

• Albuterol
*tachycardia, nervousness, insomnia, anxiety.
• Hip fracture
*Fractured leg shorter, externally rotated, adducted.
• Radiation
*Stomatsis(irriation of mucous membrane), Xerostomia(dry mouth) and dysgeuia(decreased
taste)
*protrusion of ileal conduit=stoma prolapse.

*Take nystatin after meals.
*lower lung sounds-vesicular close to trachea(but not directly over)=bronchial
*Multiple mylomas=increased immunloglobins expected.
• COMMON DRUGS THAT SHOULD NOT BE CRUSHED
Trade name Generic Name
Cardizem.......................................... diltiazem hydrochlride

Depakote.........................................valproic acid
EES............................................... .erythromycin ethylsuccinate
E-mycin...........................................er ythromycin base
Erythromycin ...................................erythromycin estolate
Feosol............................................ .ferrous sulfate
Glucotrol XL......................................glipzide
Klor-con...........................................pota ssium chloride
K-tab............................................... potassium chloride
MS Contin.........................................mor phine sulfate
Phazyme........................................... simethicone
Prilosec.......................................... ...omeprazole
Prozac............................................ ..fluoxetine hydrochloride
Slow-K..............................................potassium chloride
Theobid........................................... ..theophylline
Theo-Dur...........................................theophylline
• to enhance ingestion and prevent aspiration have your patient sit up. If sitting up position is
not possible, a side-lying position will also work.
• when obtaining a bottle of medication you must watch for: expiration date, patient name,
dose and route.
• the usual gauge (size of the needle) for an IM injection is 19-23.
• The greater the viscosity (thickness) of the medication the larger the gauge (circumference
of the needle) needs to be.
• for administering blood the usual gauge is 19
• larger gauge = smaller gauge number
• for IM injections given to adults the usual needle length is 1, 1 and a half (1/2) or 2 inches
• the dorsogluteal (upper, outer quadrant of the buttock) is the traditional site for IM
injections
• for infants under 7 months, the vastus lateralis site if preferred because that muscle is more
developed than other sites.
• Brown pigmentation around the ankles of patient indicates venous insufficeny

Cloudy outflow during peritoneal dialysis indication of infection and needs to be reporeted to MD
Afte colonoscopy a patient should report rebound tenderness. Abdominal cramping, fatigue and
passage of liquid stool are all normal findings after colonoscopy.
A patient with pertussis should be in a private room, mask and under droplet precautions.
Hydromorhone ( Dilaudin) can Cause urinary retention.
Respite care important for caretaker of Alzheimer's patient to allow for physical and emotional
rest.
Antihistamines can cause urinary retention and exacerbate symptoms of BPH.
Applying pressure to the inner cantus of the eye prevents overflow of medication into the
nasolacrimal duct and possibly systemic absorption.
Ethical dilema- Determination of facts. identify possible solutions, consider patients wishes.
An Increase in peak expiratory flow rate indicates that airway restriction is resolving ( asthma
patient)
Salem sum tube- turn patient every 2 hours to promote emptying of stomach contents.
Fatigue, abdominal bloating and persistent dyspnea of patient with COPD contributes to patients
inability to maintain adequate nutrition.
Serosanguienous drainage beyond post-op day 5 may indicate dehiscence; therefore surgeon
should be notified.
There is no need for a parent of a child who is HIV positive to notify the childs daycare provider.
INDERAL- serious side effect decrease heartrate due to blockade of betta1 receptors in the heart.
Bulima patient with bloody emesis due to esophageal tears due to purging.
Pacemaker spikes on T wave indicate that the pacemaker is not capturing appropriately and
should be adjusted for this patient.
A patient who is having muscle spasm while in traction should be repositioned to see if the
spasms decrease.
REASONS FOR UNCONSCIOUSNESS (skin Color)
RED- Stroke or increase in blood pressure
BLUE- Respiratory or cardiac arrest
WHITE- Shock or Hemorrhage.
BETA BLOCKERS

B-bronchospasm(do not give to asthma, bronchial constriction patients)
E- elicits a decrease in cardiac out put and contractility.
T- treats hypertension
A- Av conduction decreases
T- tenormin ( atenolol) hypertension & angina
L- Lopressor ( metopolol) hypertension & angina
C- Corgard ( naldolol) hypertension & angina ( renally excreted)
Glomerulonephritis- fever, periorbital edema, weakness, and chills caused by grop B strep.
It is normal for a patient that has had dialysis to have a slight fever afterwards due to the dialysis
solution being warmed by the machine.
Positive sweat test indicative of cystic fibrosis.
After thyroid surgery- maintain airway keep a trach kit at patients bedside, check for bleeding, be
sure to check at sides and back of neck due to gravity and teach patient to support their neck.
• B-1 (thiamine) and all B vitamins – Alcoholic (to prevent Wernicke’s encephalopathy and
Korsakoff’s syndrome.
B-6 (pyridoxide hydrochloride) –TB patient (Pt is likely on INH which can cause peripheral
neuropathy, dizziness, and ataxias, B-6 can prevent these unwanted affects).
B-9 (folic acid) – Pregnant pt to prevent neural tube defects in fetus
B-12 (cobalamine) – Pernicious anemia (autoimmune disease that attacks the parietal cells
preventing intrinsic factor from being released, which is needed to absorb B-12.
• clozapine (Clozaril) can cause agranulocytosis so teach pt to watch for sore throat and fever!
phentoin (Dilantin) is EXTREMELY hepatotoxic; if liver is impaired, may cause toxicity of

Dilantin b/c it can't be metabolized & builds up
• Cardiovascular toxicity is an issue that arises with the use of tricyclic

antidepressants, so question such an order if the client has cardiac disease.
• Knowing Potentials Creates Meaning
K ↑ Po4↑=============
Ca↓ Mg ↓============ ↑ Action Potentials seen in S/S
K ↓ Po4↓ =============
Ca↑ Mg↑ ============= ↓ Action Potentials seen in S/S

• Lung CA is a common cause of SIADH which results in an increased water
absorption and dilutional hyponatremia...
• Droplet Precautions
• Nurses and guests Use regular mask; clients wear surgical mask on transport
• Droplets larger than 5 microns
• Use standard prec within 3 feet
• Private room
• May be cohorted with clients with same infection without any additional infection
• Diphtheria, Mycoplasma pneumonia, rubella, Pertussis, mumps, strep pharyngitis,
pneumonia, scarlet fever
• Door to room may remain open
• Airborne
• Negative air pressure room

• N-95 respirator mask
• Avoid coughing and sneezing into another
person; use napkins/wipes
• Tuberculosis
• Contact Isolation
• Private room
• Use gown, gloves and mask
• Example:
• Clostridium difficile B infection
• Putting Gown, Mask, Gloves

• 1. Wash hands
• 2. Place mask on face
• 3. Put on gown
• 4. Put on clean or sterile gloves
• Removing Gown, Glove, Mask

1. Remove gloves
2. Remove mask

3. Untie gown
4. Wash hands
5. Remove gown
6. Fold it inside out and discard
7. Wash hands again
• CHVOSTEK’S SIGN
• Sign of hypocalcemia
• Characterized by twitching when tapped on the facial muscle
• hypoparathyroidism
• TB Test
• Positive skin test (Mantoux test)- 10 mm
induration; not redness/erythema
• Indicates exposure to bacilli
• Confirmatory:
• Chest X-ray, 3 (+) sputum AFB
• Universal Precautions
• “Everybody is infected”
• Body, body fluids, secretions, excretions,
• Mask, eye shields, gloves, gown
• Hand hygiene
• Myocardial Infarction (MI)
• Immediate treatment: MONA

Morphine,
Oxygen,
Nitroglycerine,
ASA

• Hypoxia
• Early signs: REMEMBER (RAT)
• Restlessness, Anxiety,Tachycardia / Tachypnea
• • Late signs: REMEMBER (BED)

• Bradycardia, Extreme restlessness, Dyspnea (severe)
• Iron Administration
• REMEMBER:
• Iron supplements IM or IV----iron dextran (IV route is preferred)
• IM causes pain, skin staining, higher incidence of anaphylaxis
• Take oral supplements with meals if experience GI upset
• Then resume between meals for max absorption
• Use straw if liquids are used
Depression & Suicidal
• Depression and signs and symptoms

of suicide: watch for suicidal ideation.
• Suicide alert: when depressed mood
begins to lift and/or energy level increase.
• INH
• Prevent and treat TB
• Remember when taking INH
• Do not drink alcohol
• Take vitamin B6 to prevent peripheral
neuropathy
• Take with food if not tolerated on an empty
stomach
• Do not get pregnant

• Growth & Development
• Birth weight doubles in 6 months
• Pre-schooler - has imaginary friends
• Infant gains head control by 4 months
• Posterior fontanel closes at 2-3 months
• Anterior fontanel closes by 12-18 months
• Patient on MAOI
• Monoamine Oxidase Inhibitors
• No tyramine containing foods.
• No aged cheese, wine or pickles
• Insulin
• Clear first before cloudy
• Regular first before NPH
• Pneumonia
• Productive cough, yellow blood streaked
• Rusty sputum - infection
• Contact Precautions
• While giving bath and changing linens for a client with MRSA infection the nurse
should:
–Wear gown and gloves when giving direct care or touching contaminated surfaces
–Wear gloves before entering room and remove before leaving room
–Wash hands after removing gloves
• Are you planning to kill yourself?

A client who is terminally ill says to the nurse, “This is too much for me. You have
been very good to me so I will give you my watch.” The nurse’s response should
be:
a. “Give it to your family.”

b. “Keep it.”
c. “Are you planning to kill yourself?”
d. “Don’t worry.”
• Closed Liver Biopsy

• PRE:
– NPO 4-6 hours
– Consent
– Reinforce teaching about procedure
– Baseline VS, bleeding parameter
– Empty bladder
– Supine position on far right side
• Liver Biopsy
• DURING:
– Hold breath after exhalation to keep diaphragm and liver high in abdominal cavity
during insertion
– Needle insertion between the 6th-7th ICS
– 10 -15 seconds to obtain tissue
• Liver Biopsy
• AFTER:
– Apply direct pressure right after needle removal
– Right side lying position
– Vitals to check for bleeding
– NPO for 2 more hours
– No coughing, lifting, or straining for 1-2 weeks
• Myxedema
• Adult form of hypothyroid crisis
• Characterized by mental sluggishness, drowsiness, lethargy progressing to coma;
• Hypotension
• Which among these patients

need a private room?

• HIV patient
• Client awaiting renal transplant
• Hepatitis
• Scabies
• Answer: Scabies is caused by sarcoptes scabei leading to skin infestation.
Female mite burrows in areas between fingers and toes and warm folds of the
body such as axilla, groin, to lay eggs.
• Scabies
• S/S:
• Burrows - visible dark lines
• Mite - seen as black dot at end of burrow
• Severe itching
• Scratching with resulting secondary infection
• Scabies Treatment
• Permethrin Cream (Elimite)
• Lindane lotion(kwell shampoo)
• Scrub body with soap and water then apply lotion on all areas except the face
• Leave permethrin on the skin for 8-12 hours and then wash off completely with
warm water
• All who had close contact with person within 30-60 day period should be treated
• Hearing Impaired
• DO not touch patient until they are aware you’re in the room
• Speak to the face
• Articulate clearly but not too slowly
• Move close to patient; do not cover mouth with hands
• Provide alternate methods of communicating: Magic Slate, Sign
• A mother is concerned of a breastfed baby about gaining too much weight!

• With adequate output (DIAPER COUNT) in infants this ensures adequacy of
nutritional intake
• Which should a nurse see first among these clients in active labor?

• Gravida 1 para 0 with bulging of membranes
• Gravida 2 1 cm dilated
• Para 4, 1 cm dilated with history of C-section
• Para 5, 2cm dilated
• Answer
• Para 4 with hx of CS takes priority in order monitor and prevent the occurrence of
uterine rupture.
• Which one of these patient assignment for a travel nurse should be

reassigned?
• HIV client
• Client with contagious disease
• Client who just developed a rash
• Patient with green purulent sputum
Answer: Client with RASH
• Verbal Orders
• Which of these medications need a specific written order from aprescribing
physician?
• Insulin
• Digoxin
• Coumadin
• Chemotherapeutic agents
• Answer: Chemotherapeutic agents as this requires also double checking with a
chemo certified RN. A chemo certification is required for administration of chemo
agents
• Conversion Guide
• • 1tsp=5ml
• 3tsp= 1 Tbsp
• 0.06ml= 1 minim= 1 drop
• 10z= 30ml

• 1 kg=1000mg
• 1mg=1000mcg
• • 1kg= 2.2 pounds
• Safest site for Intramuscular

injections???
• • Vastus lateralis
• Deltoid
• Gluteus maximus
• Rectus abdominis
• Answer: VASTUS LATERALIS is the safest spot
because it doesn’t contain important nervous
tissues that may be damaged and it is less
• vascular than the other areas mentioned
• Medication Administration
• • 7 Rs:
• Right Drug
• Right Amount
• Right Route
• Right time
• Right patient
• Right approach
• • Right documentation
• Medication Administration
• 2 ml= maximum volume of injection per
site
• Ear drops:
– 1-3 years: pull pinna down and back
– Above 3 years: pull pinna up and back
– Rationale: shorter ear canal in children
Microdrop factor for IV fluids- 60
Macrodrop factor for IV fluids- 15

Blood transfusions run for 4-6 hours
• INSULINS
• Draw clear followed by cloudy insulins to avoid contamination of clear insulins by
the cloudy
insulins
• Roll vials in between palms
• Rotate injection sites to prevent lipodystrophy
• Be reminded of the peak hours of insulin administered- this is the best time to
provide snacks as this time hypoglycemic effect of insulin is peaks
• Facilitate difusion of glucose from plasma to cells
• Uses: treatment of diabetes mellitus and its acute complications
• Given as subcutaneous shots or IV drip
• S/E- HYPOGLYCEMIA
• Lipodystrophy
• DIGOXIN
• LANOXIN
• Given for mild to severe heart failure
• (+) inotropic effect- increases force of ventricular contraction
• (-) chronotropic effect- decreases heart rate
• Check pulse rate prior- do not give if below 60/min
• Side effects: Halo vision, yellow vision, bradycardia
• Earliest s/e: anorexia, nausea, vomiting
• Digoxin and Dudes and Babies

• DO NOT GIVE IF HEART RATE
• Newborn- below 100/min
• 1-3 years old- below 90/min
• 3-8 years old- below 70/min
• 8 years old and above- below 60/min
• Bronchodilators

• Review relevant history , VS, character of secretions, other conditions
• Monitor VS and breath sounds
• Increase fluid intake 2 to 3 Liters/day
• Therapeutic levels of theophylline should be maintained
• Evaluate responses to medication
• S/E: CNS stimulation,Tachycradia, tremors, headache, nausea, epigastric pain,
bronchospasm
• Diapers weight for volume

approximation
• 1 liter of fluid= I kilogram of weight
assuming dry weight of the source (diaper)
has been subtracted
• Head lice
• S/S: severe itching in affected areas; appearance of lice on hair or clothing
• Tx: Kwell/lindane shampoo
Extra-fine-tooth comb
• Wash all linens and clothing in hot water to destroy nits and eggs
• Potassium Rich Diet

• Fruits and fruit juices
• Dried fruits/plums
• Apricots
• Bananas
• Cantaloupe
• Water melon
• Sickle cell Anemia

• Mgt:
• Oxygenation
• Hydration
• Rest
• Diet: High calorie High protein, increased fluids

• Folic acid supplementation for anemia
• Open-angle VS Close-angle
Glaucoma
Open-angle- loss of peripheral vision, tunnel vison, difficulty adapting to the dark,
halos around
lights, difficulty focusing on near objects
Vague symptoms with client unaware of them for a time; visual acuity deteriorates
over time with increasing IOP
Close-angle glaucoma- triggered by pupil dilationhigh emotions and darkness;
S/s: severe eye and face pain, N&V, cplored halos around lights
• Crutches
Use palms of the hands when crutch walking
Going upstairs: “Good boys go to heaven”
good leg goes first bad leg goes last
• Suppository Administration
• 2 inches vaginally or rectally
• Lube it!!!!
• Nothing more nothing less
• Cardiac diet
• Low sodium
• Low cholesterol
• For heart failure: low sodium
• For hypertension: low na, low fat
• For MI: low Na, low fat
• Opening a Sterile Package

• Check label for contents, expiry date, instructions
• Break seal, touching only edge of package. Open one flap away from you. Do not

bend over package
• Open side flap, let fall on flat surface. Repeat same with other flap.
• Lift flap nearest you
• Inhalers
• Hold inhaler 2 inches away from mouth
• Shake canister before each puff
• Exhalethrough pursed lips
• Depress inhalation device slowly and
deeply through the mouth
• Hold breath for 10 sec and exhale slowly
with pursed lips
• Wait 2-5 min between puffs
• Spacers
• Place lips tightly around mouthpiece so no
medication will escape
• Same process as any inhalers
• Good care of spacer: warm water rinses
• MEDS for Hyperthyroidism

• Antithyroids:Methimazole (Tapazole)
• Beta-blockers: Propranolol (Inderal)
• Iodine: Lugol’s solution
• Radiation: Radioactive Iodine 131
• Iron Rich Foods

• Red meats
• Egg yolks
• Leafy vegetables
• Whole wheat breads
• Legumes

• Dried fruits
• Potassium Rich Foods

• Apricots
• Avocado
• Banana
• Cantaloupe
• Raw carrots
• Dried peas, beans, fruits
• Melon, orange, orange juice
• Peanuts, white/sweet potatoes
• Prune juice, spinach
• Tomatoes and tomato products, winter squash
• Insulins
Peak hours:
• Regular insulin- 2-4 hours
• Insulin Aspart (Novolog)- 1-3 hours
• Inslulin lispro (Humalog)- 1 hour
• NPH/Humulin N- 6-12 hours
• Insulin Zinc (Lente)- 8-12 hours
• Ultralente- 18-24 hours
• Insulin glargine- 5 hours
• Humulin 70/30 4-8 hours
• Appendicitis
• Pain: located at McBurney’s angle; right lower quadrant pain with rebound
tenderness
• Elevated WBCs
• Surgery stat
• Preop: NPO, no enemas, no pain medications,no heat applications just cold
packs, IVFs, check lytes; Semi Fowler’s right side-lying to localize infection

• Postop: immediate ambulation in 6-8 hours
• Hypoglycemia
• • Always a priority!!!!
• Can cause brain damage
• Manage according to facility protocol
• Glucose tabs, Orange/apple juice if awake
• Dextrose 50% 1/2 amp to 1 ampule IV
• Glucagon shot
• Dextrose 10% IV infusion
• SLE
Systemic Lupus Erythematosus
• Nursing Interventions:
– Emotional support in coping with prognosis
– Alternative activity and planned rest periods
– Avoid persons with infections, undue exposure to sunlight, and emotional stress
to prevent exacerbations
– Diet: high in Iron : liver, shellfish, leafy vegies, enriched bread and cereals
• Restraints
• Release every 2 hours for med-surg restraints
and check every 1 hour for color movement and
sensation in the extremity involved
• Requires order renewal every 24 hours
• Siderails, medications are considered restraints
• Bone Scan
• Isotope imaging of skeleton
• Prep: IV injection of radioactive tracer
• Empty bladder prior; hold fluids 4-6 hours prior
to scan

• Takes about an hour
• May be asked for various positions during test
• C/I: pregnancy; barium enema
• Crohn’s Disease
• Inflammatory disease affecting small bowels and
possibly large bowels characterized by
ulcerations in intestinal linings, scar tissue
formation causing narrowing and thickness in
bowels
• Unknown cause
• May lead to perforation, stricture and obstruction
S/S:
– Abdominal pain and cramping
– Diarrhea
–Weight loss
– Fever
– Anemia
–Weakness and fatigue
– Anorexia
– Abdominal tenderness
• Meds: Sedatives, antidiarrheals, antibiotics, steroids, antispasmodics and analgesics
• Hydration with IVF
• High calorie, high-protein, low-residue diet
• Occult Blood Testing

• Avoid red meats 3 days prior to test
• May use stool specimen

• anytime your pt is taking Antabuse , you should instruct them on AVOIDING any meds that
contain alcohol, such as OTC drugs
• 1.Conjuctivitis-until discharge ceases.

2.Diarrhea (with other acute symptoms)-until symptoms resolve and Salmonella infection is ruled
out.
3.Hepatis A-until 7 days after the onset of jaundice.
4.Hepatits B (acute)-partial client restriction with gloves worn for procedures involving tissue
trauma and mucous membrane or non-intact skin.
5.Hepatitis B (chronic) -unit antigenemia resolves.
6.Group A streptoccocal Infection-until 24 hours after the start of the treatment.
7.Herpes simplex (hands)-until lesion resolve.
8.Herpes Zoster (acute)-Exclusion from care of clients at high risk for infection with use of
appropiate barriers.
9.Herpes Zoster (postexposure)-From days 10 to 21 after exposure or until all lesion dry and
crust.
10.measles (active)-until 7 days after rash appear.
11.Measles (post-exposure)-from day 5 to 21 after exposure
12.Mumps(active)-Until 9 day after after onset of parotitis
13.Mumps(post exposure)-from days 12 to 26 after exposure.
14.Scabies-until treated
15.S.Aureus skin lesions-until lesion resolve.
16.Upper respiratory infections-Until acute symptoms resolve with exclusion from care of clients
at high risk for infection.
17.Varicella (acute)-until all lesions dry and crust.
18.Varicella (post-exposure)-from day 10 to 21 after exposure.
Transmision based precautions
Precautions-Indications.
Airborne-private,negative airflow room with adequate filtration;mask;mask required by client

during transport out of the room,transmission via airborne route;measles,TB,varicella.
Droplet-private room or cohabitation with client infected with the same organism;mask required
when working within 3 feet of of client;mask worn by client during transport,transmission of
large droplets through sneezing,coughing,talking,haemophilus influenza,multidrug resistant
strains,neisseria meningitidis,diphtheria,rubella,mycoplasma pneumonia,mumps,scarlet
fever,strep throat,epiglottis
Steps of the procedure of preparing and maintaining sterile field
Equipment:
*Flat work surface
*sterile drape.
*sterile supplies as needed (sterile gauze,sterile
basin,solutions,scissors,foreceps),packed sterile gloves.
1.Wash your hands

2.Check for the integrity of the sterile package,expiration date etc.

3.During the entire procedure,NEVER turn your back on the sterile field or
lower your hands below the level of the field.
4.Open the sterile drape
*start from the outer wrapper and place the inner drape in the center of the
of the work surface with the outer flap facing away from you
*touching the outside of the flap only,reach around rather than over the
sterile field to open the flap away from you first
*open the side flaps,in the same manner,using the right hand for the right
flap and the left hand for the left flap.
5.Lastly ,open the inner most flap that faces you,being careful that it does
not touch your clothing or any object.
Adding sterile supplies to the the field.
general rule
*generally before opening the sterile package you want to assess the order
in which supplies will be used during the procedure so that supplies
used first can be added to the field last
1.Prepackaged sterile supplies are open by peeling back the partially sealed
edges with both hands or lifting up the unsealed edge,taking care not to
touch the supplies with your hands.
2.Hold supplies 10 to 12 inches above the field and allow them to fall to the
middle of the sterile field.Wrapped sterile supplies are added by grasping the
sterile object with one hand and unwrapping the flaps with the other hand.
3.Grasp the corners of the wrapper with the free hand and hold them against
the wrists of the other hand while you carefully drop the subject onto the
sterile field.
Adding sterile solutions to a sterile field

1.Read the solution label and expiration date
2.Remove cap and place it within facing up on the flat surface.Do not touch
the inside of the cap or rim of the bottle.
3.Hold bottle 6 inches above the container on the sterile field and pour slowly
to avoid spills.
4.Recap the solution bottle and label it with date and time of opening if the
solution is to be reused.
5.Add any additonal supplies and don sterile gloves before starting the
procedure.
• 7. Diltiazem ( Cardizem ) adverse reaction is Heart Failure, hypotention Calcium channel

blocking agents, such as diltiazem, are used cautiously in clients with conditions that
could be worsened by the medication, such as aortic stenosis, bradycardia, heart failure,
acute myocardial infarction, and hypotension.
8. Furosemide adverse effect Nocturia and sleep disturbances.
9. Anticholinergic agents cause Dry mouth and urine retention.
10. Atenolol ( Tenormin ) Decrease cardiac output and systolic and diastolic blood
pressure. Atenolol may cause bradycardia.
11. Dexamethasone used to decrease cerebral edema and pressure.
12. Methyldopa to reduce blood pressure.

13. Phenytoin to prevent seizure.
14. propranolol adverse effects nausea vomiting depression fatigue impotence.
15. Morphine adverse effects Sedation nausea vomiting constipation and respiratory
depression.
16. Nifedipine adverse effects flushing dizziness headache and pedal edema. The client
receiving a calcium channel blocking agent such as nifedipine may develop weakness
and lethargy as expected effects of the medication.
17. Atrophine used to treat bradycardia.
18. Dobutamine used ti treat heart failure and low cardiac output.cardia.
19. Amiodarone used to treat ventricular fibrillation and unstable ventricular tachycardia.
20. Lidocaine used to treat ventricular ectopy ventricular tachycardia and ventricular
fibrillation.
21 PTSA give antocoagulant aspirin
22. Hydrochlorothiazide is a potassium-losing diuretic, and clients are at risk for
hypokalemia. Potassium is found in many foods, especially unprocessed foods, many
vegetables, fruits, and fresh meats. Because potassium is very water-soluble, foods that
are prepared in water are often lower in potassium than the same foods cooked another
way (e.g., boiled versus baked potato). Clients who need potassium added to the diet
are encouraged to take in these foods. Many salt substitutes are also high in potassium.
23. Phenazopyridine ( Pyridium)--Urine will appear orange.
24.Co trimoxazole ( trimethoprim-sulfamethoxazole) given for uti tell pt to drink at least
eight 8 oz glasses of fluid daily.
25.Sulfamethoxazole (Gentanlol) adverse effect diarrhea.
26. Co trimoxazole ( Septra) Used to treat UTI and therefore absence of bacteria on
urine culture indicates drug effective.
27. phenazopyridine ( pyridium) Used to treat UTI
28. Aldosterone is responsible for sodium reabsorption and potassium excreation by the
kidney.
29. During oliguria phase fluids should be limit.
30. Dipyridamole ( Persantine ) to reverse effect if Dipyridamole nurse should have
available Aminophyllin ( Theophylline )
• Grave disease-hyperthyroidism
• Anxiety
• Irritability
• Difficulty sleeping
• Fatigue
• A rapid or irregular heartbeat
• A fine tremor of your hands or fingers
• An increase in perspiration
• Sensitivity to heat
• Weight loss, despite normal food intake
• Brittle hair
• Enlargement of your thyroid gland (goiter)
• Change in menstrual cycles

• Frequent bowel movements
• Pharm Prefix/Suffix:
-ase = thrombolytic
-azepam = benzodiazepine
-azine = antiemetic; phenothiazide
-azole = proton pump inhibitor, antifungal
-barbital = barbiturate
-coxib (cox 2 enzyme blockers
-cep/-cef = anti-infectives
-caine = anesthetics
-cillin = penicillin
-cycline = antibiotic
-dipine = calcium channel blocker
-floxacin = antibiotic
-ipramine = Tricyclic antidepressant
-ine = reverse transcriptase inhibitors, antihistamines
-kinase = thrombolytics
-lone, pred- = corticosteroid
-mab = monoclonal antibiotics
-micin = antibiotic, aminoglycoside
-navir = protease inhibitor
nitr-, -nitr- = nitrate/vasodilator
-olol = beta antagonist
-oxin = cardiac glycoside
-parin = anticoagulant
-prazole = PPI’s
-phylline = bronchodilator
-pril = ACE inhibitor
-statin = cholesterol lowering agent
-sartan = angiotensin receptor blocker
-sone = glucocorticoid
-stigmine = cholinergics
-terol = Beta 2 Agonist
-thiazide = diuretic
-tidine = antiulcer
-trophin = Pituitary Hormone
-vir = anti-viral, protease inhibitors
-zosin = Alpha 1 Antagonist
-zolam = benzo/sedative
-zine = antihistamine
• Alpha vs. Beta: ABCDE
Alpha = Constricts
Beta = Dilates
Beta 1 = Enhances

Rennin stops the runnin' (HOH retention)
Agonist vs. Antagonist

AGOnst - "A GO' - stimulates action
ANTAGOnist - "ANTI "NO GO" - blocks action
Drug Overdoses - ABCD
Anti Depressants (Tricyclics)

Beta Blockers
Calcium Channel Blockers
Digoxin
Diuretics:
Lasix = Loop
Mannitol = osmotic
LASIX = LAsts SIX hours
Aluminum vs. Magnesium Antacid SE's
Think aluminum can - b/c it can constipate

Mag - may move bowels (diarrhea)
Give Narcan for Narcotic OD
Opioid Examples: Her Cousin Meets More Deviates

- Heroin
- Codeine
- Methadone
- Morphine
- Demerol
• Pepper has bacteria in it and clients who have aids have to avoid pepper d/t
being immunocompromised. Never would have though of that till it came up
as a review question.
• ANTICOAGULANTS - ends in parin, rin

THROMBOLYTICS - ends in ase, kinase
ACE INHIBITORS - ends in pril
ANGIOTENSIN II RECEPTOR BLOCKER- ends in sartan
ALPHA ADRENERGIC - ends in zocin
BETA-BLOCKERS - ends in olol
CALCIUM CHANNEL BLOCKER - ends in dipine
DIRECT ACTING VASODILATORS - starts with nitro
CARDIAC GLYCOSIDES - starts with dig
BRONCHODILATORS - ends in terol, terenol, phrine, phylline

ANTIHISTAMINES - ends in tadine, amine, ramine
H2 BLOCKER - ends in tidine
ANTI-EMETICS - ends in setron
PANCREATIC ENZYME REPLACEMENT - starts with pancrea
ADH MEDS - ends in pressin
THYROID MEDS - starts with thyro, thy, thro
CALCIUM REGULATORS - ends in dronate (hypocalcemia), tonin
(hypercalcemia)
SULFONYLUREAS - ends in ide, amide, zide, ride
NON-SULFONYLUREAS - ends in glinide, glitazone
ANTIBIOTICS - ends in cillin
CEPHALOSPORINS - starts with ceph, cef
AMINOGLYCOSIDE - ends with mycin, micin
QUINOLONES - ends in floxacin, oxacin
• *An antiacid shouldn't be taken w/ medication bcs antacid will affect the
absorption of the medication.
*Lopressor---lowers blood pressure
Lo---Low
pressor---pressure
*Angiotensin-converting enzyme meds (ACE)---they end with "pril" such as

Ecopril which are for treating hypertension.
• Colloidal Silver is usually excreted from the body when administered in low
amounts (under 50 mg per day), but when it accumulates, it can cause
"argyria" which turns the skin grey or BLUE!
• lol's -betablockers
prils- ace inhibitors
PTT- Heparin (because the two "tt's" make an H)
INR- Warfarin
• BIOLOGICAL WARFARE: BP-AS-TOLERATED-FEVER
B - botulism > (AFW) - Air,Food,Wound contaminated

P - Plague > (FleaR) - Fleas, Rodents
A - anthrax > (GIS) - Gastrointestinal,Inhalation,skin
S - Smallpox > Air Droplet, Materials contaminated
Tolerated - tularemia > (Till death Apart) Tick,Deer flies, Animal
infected
Fever - hemorrhagic Fever > (MR) Mosquitoes, Roddents
• sources of potassium
P - potatoes,pork,beef,veel
O-oranges

T-tomatoes
A-avacado,banana,carrots,cantaloupe
S- spinach
S-strawberries,raisins
I- fIsh
U
M-mushrooms
• Five quick facts for today.

Maternity: 1) Mother's temp > 100.4 F @ 2 consecutive readings, despite increased
hydration is considered febrile, report to physician.
2) Boggy uterine fungus, massage gently until firm, observe for increased bleeding
or clots.
3) Normal FHR : 110-160 bpm.
Pharmacology: 4) Glycerine emmolient used for dry, cracked and irritated skin.
Cardiovascular: 5) Triametrene, a potassium sparing diuretic, avoid foods high in
potassium, e.g. bananas, avocados, oranges, mangoes, nectarines, papayas and dried
pprunes
• Maternity: clinical manifestations of cord compression is variable deceleration

with brief accelaration after a gush of amniotic fluid. Perform manual sterile
vaginal exam to detect the prolapsed cord.
Pharmacology: Client with tachydysrythmias, dont give bronchodilators
containing catacholamines, e.g. Epinephrine(Primatene Mist) and
Isoproterenol HCL(Isuprel)
Child Health: After pyloromyotomy, surgical treatment for hypertrophic
pyloric stenosis, head of bed is elevated and the infant is placed prone to
prevent aspiration.
• Infant with laryngomalacia(congenital laryngeal stridor), place in prone

position with neck hyperextended to decrease stridor.
• Decorticate posturing: flexion of the upper extremities and the
extension of the lower extremities. Also plantar flexion of the feet.
Decerebrate posturing: extension of the upper extremities with internal
rotation of upper arms and wrists. The lower extremities extend with
some internal rotation noted at knees and feet. Progression from
decorticate to decrebrate posturing indicates deteriorating neurological
function.
• Hep B related jaundice: may get worse before resolving.
• Client teaching: discard unused nitroglycerine tablets 3-6 months after
bottle opened & obtain new prescription.
• Oral intake after laryngectomy starts with semi-solid diet.
• In a neonate, hypoglycemia causes central nervous system symptoms
e.g. high pitched cry, also exhibited by lack of strength during feeding.

• Misoprostol(cytotec) is administered to prevent gastric mucosal injury
caused by regular use of NSAID's
•
• MAOI diet ( Tyramine restrictions)
• FOODS: MUST AVOID COMPLETELY
• Aged red wines (cabernet sauvignon/merlot/Chianti)
• Aged (smoked, aged, pickled, fermented, marinated, and

processed) meats (pepperoni/bologna/salami, pickled
herring, liver, frankfurters, bacon, ham)
• Aged/mature cheeses (blue/cheddar/provolone/Brie/

Romano/Parmesan/Swiss)
• Overripe fruits and vegetables (overripe bananas/

sauerkraut/all overripe fruit)
• Beans (fava/Italian/Chinese pea pod/fermented bean curd/

soya sauce/tofu/miso soup)
• Condiments (bouillon cubes/meat tenderizers/canned

soups/gravy/sauces/soy sauce)
• Soups (prepared/canned/ frozen)
• Beverages (beer/ales/vermouth/whiskey/liqueurs/nonalcoholic
wines and beers)
• FOODS: USE WITH CAUTION (MODERATION)
• Avocados (not overripe)
• Raspberries (small amounts)
• Chocolate (small amount)
• Caffeine (2– 8 oz. servings per day or less)
• Dairy products (limit to buttermilk, yogurt, and sour cream

[small amounts]; cream cheese, cottage cheese, milk OK if
fresh)
• MEDICATIONS: MUST AVOID
• Stimulants and decongestants
• OTC medications (check with PCP/pharmacist)
Opioids (e.g., meperidine
• 1. Insertion of CVC, pt. should NOT deep breath. instead pt SHOULD do

Valsalva Maneuver.

2. Sulfonamides are to treat inflammatory bowel disease, increase fluids
3. Multiple Myeloma is unique as a neoplastic condition that is better dected

with a plain radiograph than with a nuclear scan. If bone scan is done then
false negative result will occur. Therefore avoid bone imaginig for pt with
multiple myeloma.
4.mumps s/s= HA,malaise, anorexia, earache
• A nurse is preparing to administer digoxin (Lanoxin) to an infant with
congestive heart failure (CHF). Before administering the medication, the nurse
double-checks the dose, counts the apical heart rate for 1 full min. and
obtains a heart rate of 88beats/min. Based on this finding, what is the
appropirate nursing action?
• Digoxin is effective within a narrow therapeutic range (1.0 to 2.0 ng/mL).
Safety in dosing is achieved by double-checking the dose and counting the
apical heart rate for 1 full minute. If the heart rate is less than 100 beats/min
in an infant, the nurse would withhold the dose and contact the physician.
• Differentiating Gastric ulcer pain & duedonal ulcer pain:
Gastric ulcer pain often occurs in the upper epigastrium, with localization to
the left of the midline, and may be exacerbated by food. The pain occurs a
half-hour to an hour after a meal and rarely occurs at night. Duodenal ulcer
pain is usually located to the right of the epigastrium. The pain associated
with a duodenal ulcer occurs 90 minutes to 3 hours after eating and often
awakens the client at night.
• After amputations the nurse should ensure that a surgical tourniquet is in the
client's room as one of the priority items. The wound and any drains are
monitored closely for excessive bleeding because hemorrhage is the primary
immediate complication of amputation. Therefore, a surgical tourniquet is kept
at the bedside in case of acute bleeding.
• Educating of a patient who has arteriovenous (AV) fistula should include
following info:
An AV fistula provides access to the client's bloodstream for the dialysis
procedure. The client is instructed to monitor fistula patency daily by palpating
for a thrill. The client is instructed to avoid compressing the fistula with tight
clothing or when sleeping and that blood pressure measurements and blood
draws should not be performed on the arm with the fistula. The client also is
instructed to assess the fistula for signs and symptoms of infection, including
pain, redness, swelling, and excessive warmth.
• I like this Trend ,it has helped me alot in preparation for my test,Guys keep
the ball rolling. Let me chip in this fact hopefully it will help.
FLUROQUINOLONES:
EXAMPLES,CIPROFLOXACIN,NORFLOXACIN,OFLOXACIN.
They may increase the serum level of methylxanthines eg theophyllines
causing methylxanthines toxicity.
For CIPROFLOXACIN,use with caution on patients with renal
disease,CNS,and seizure disoders,even those taking theophylline.It can cause
nausea, vomiting, diarrhrea, constipation, dizziness, flatulence, headache and
confusion.Watch out for toxic effect which can cause superinfecton

• Cardio
VT
Ventricular tachycardia is characterized by the absence of P waves on ECG
and there are wide QRS complexes (longer than 0.12 second), and typically a
rate between 140 and 180 impulses/min. The rhythm is regular.
• Cardio
Pericardiocentesis (a procedure which can be performed to fix cardiac tamponade

problem)
-- Following pericardiocentesis, a rise in blood pressure and a fall in central venous

pressure are expected.
--The client usually expresses immediate relief.
-- Heart sounds are no longer muffled or distant.

• What to do when a patient comes to an ER with an insect in the ear?
-- Insects are killed before removal unless they can be coaxed out by a
flashlight or by a humming noise.
-- Mineral oil or diluted alcohol may be instilled into the ear to suffocate the
insect, which is then removed by using ear forceps.
-- When the foreign object is vegetable matter, irrigation is not used because
such material may expand with hydration, thereby worsening the impaction.
• How to communicate with a patient who has a hearing impairment?
-- speaking in a normal tone; avoiding shouting
-- talking directly to the client while facing the client; and speaking clearly.
-- If the client does not seem to understand what is said, the statement should be expressed
differently. Moving closer to the client and toward the better ear may facilitate communication, but
talking directly into the impaired ear should be avoided.
• Weber's hearing test
-- In the Weber tuning fork test, the nurse places the vibrating tuning fork in the middle of the
client's head, at the midline of the forehead, or above the upper lip over the teeth. Normally, the
sound is heard equally in both ears by bone conduction.
-- If the client has a sensorineural hearing loss in one ear, the sound is heard in the other ear.
-- If the client has a conductive hearing loss in one ear, the sound is heard in that ear.
• How to conduct an otoscopic examination on an adult patient?
In the otoscopic examination;
--the nurse tilts the client's head slightly away and holds the otoscope upside down as if it were a
large pen.
--The pinna is pulled up and back and the nurse visualizes the external canal while slowly inserting

the speculum.
--A small speculum is used in pediatric clients. The nurse may not be able to adequately visualize
the ear canal if a small speculum is used in the adult client.
• Mastoidectomy:
What is the mastoid bone?

The mastoid bone is a bone located behind the ear (felt as a hard bump
behind the ear). Inside it looks like a honeycomb, with the spaces filled with
air. These air cells are connected to the middle ear through an air filled cavity
called the mastoid antrum. Although the mastoid bone serves as a reserve air
supply to allow normal movement of the eardrum, its connection to the
middle ear may also result in the spread of middle ear infections to the
mastoid bone (mastoiditis).
What is a mastoidectomy?
A mastoidectomy is a surgical procedure designed to remove infection or
growths in the bone behind the ear (mastoid bone). Its purpose is to create a
"safe" ear and prevent further damage to the hearing apparatus.
After mastoidectomy,
-- the nurse should monitor vital signs and inspect the dressing for drainage or bleeding.
-- The nurse also should assess for signs of facial nerve injury (cranial nerve VII).
-- The nurse also should monitor for signs of pain, dizziness, or nausea.
-- The head of the bed should be elevated at least 30 degrees, and the client should be instructed
to lie on the unaffected side.
-- The client probably will have sutures, an outer ear packing, and a bulky dressing, which is
removed on approximately the sixth day postoperatively.
• Presbycusis
Presbycusis is a type of hearing loss that occurs with aging. It is a gradual sensorineural loss
caused by nerve degeneration in the inner ear or auditory nerve.
• Motion sickness medications
-- To be maximally effective, medications to prevent motion sickness should be taken at least 1

hour before the triggering event.
-- Medications that are commonly used for this purpose include
** imenhydrinate (Dramamine)
**scopolamine (Transderm-Scop)
**promethazine (Phenergan)

**prochlorperazine (Compazine).
• Labs
Creatine Kinase MB and Troponin - indicative of a MI if elevated

Troponin is more popular... its more specific and will remain elevated for a longer period of time
after pt has a MI.
C-Reactive Protein - if elevated, pt has inflammation in body... it is not specific to where the
inflammation is
INR - Warfarin
aPTT - Heprin
MEDS
Digoxin - works by strengthening heart contraction, give to pt who has CHF
ACE Inhibitors - be cautious of a persistent cough (contact MD if present)
COPD pts
- teach pursed liped breathing
- never give more than 2L of O2
• - Rubella immunization is contraindicated during pregnancy because the vaccine contains live
virus which ca have teratogenic effects on the fetus.
- (+) Homan's sign indicates thrombosis which is abnormal for a postpartum client
- Metropolol masks the signs of hypoglycemia
- Ambivalence is the most common characteristic among suicidal clients
- Salicylates may interact with insulin causing hypoglycemia.
- Kaposi's sarcoma is the most common cancer associated with AIDS
• Valproic Acid (Depakene)- antiepileptic
Lithium- dose should be adjusted when sweating, adding meds, illness with high fever
Thyroid replacement- lifelong therapy
Gentamycin- do not apply to large areas may cause toxicity
tPa- lab values that should be examined, Hemoglobin, hematocrit, and platelet
Interferon- tx of hepa B
Ulna- heals in about 12 weeks

Femur- heals in 24 weeks
Epstein Pearls- tiny hard white nodules found in the mouth of the neonate, normal and usually
disappears without tx
Stationary bike- best for non-wt bearing exercise

• Endocrine tips
In the test result for glycosylated hemoglobin A1c,
----7% or less indicates good control,
---- 7% to 8% indicates fair control,

----8% or higher indicates poor control.
**This test measures the amount of glucose that has become permanently bound to the red blood
cells from circulating glucose. Elevations in the blood glucose level will cause elevations in the
amount of glycosylation.
**Thus, the test is useful in identifying clients who have periods of hyperglycemia that are
undetected in other ways. Elevations indicate continued need for teaching related to the prevention
of hyperglycemic episodes.
• Endocrine
The primary goal of treatment in hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is
---to rehydrate the client to restore fluid volume and to correct electrolyte deficiency.
---Intravenous fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and
begins with IV infusion of normal saline.
---Regular insulin, not NPH insulin, would be administered.

• ---An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout
the day and night
--- the client can self-administer a bolus with an additional dose from the pump before each meal
as needed.
---Regular insulin is used in an insulin pump.

• ---Insulin doses should not be adjusted nor increased before unusual exercise.
---If ketones are found in the urine, it possibly may indicate the need for additional insulin.
---To minimize the discomfort associated with insulin injections, insulin should be administered at
room temperature.
---Injection sites should be rotated systematically within one anatomic site.

• In DKA (Diabetic Ketoacidosis),
---the arterial pH is lower than 7.35,
---plasma bicarbonate is lower than 15 mEq/L,
--- the blood glucose level is higher than 250 mg/dL,
---ketones (Acids created by the process of burning body fat; if the body produces too many
ketones, they are excreted in the urine) are present in the blood and urine.
---The client would be experiencing polyuria, and Kussmaul's respirations would be present.
---A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis.
• ---Shakiness is a sign of hypoglycemia and would indicate the need for food or glucose.
---A fruity breath odor, blurred vision, and polyuria are signs of hyperglycemia.
• During illness,

---the client should monitor blood glucose levels and should notify the physician if the level is
higher than 250 mg/dL.
--- Insulin should never be stopped. In fact, insulin may need to be increased during times of
illness.
---Doses should not be adjusted without the physician's advice and are usually adjusted based on
blood glucose levels.
• Potassium chloride
--administered intravenously must always be diluted in IV fluid and infused via a pump or
controller.
--The usual concentration of IV potassium chloride is 20 to 40 mEq/L.
--Potassium chloride is never given by bolus (IV push). Giving potassium chloride by IV push can
result in cardiac arrest.
--Dilution in normal saline is recommended, but dextrose solution is avoided because this type of
solution increases intracellular potassium shifting.
--The IV bag containing the potassium chloride is always gently agitated before hanging.
--The IV site is monitored closely because potassium chloride is irritating to the veins and the risk
of phlebitis exists.
--The nurse monitors urinary output during administration and contacts the physician if the urinary
output is less than 30 mL/hr.
• After adding a medication to a bag of intravenous (IV) solution,
--the nurse should agitate or rotate the bag gently to mix the medication evenly in the solution.
--The nurse should then attach a completed medication label.
--The nurse can then prime the tubing.

• --Prednisone is a corticosteroid. With prolonged use, corticosteroids cause adrenal atrophy, which
reduces the ability of the body to withstand stress. When stress is severe, corticosteroids are
essential to life. Before and during surgery, dosages may be increased temporarily.
--Ferrous sulfate is an oral iron preparation used to treat iron deficiency anemia.
--Cyclobenzaprine (Flexeril) is a skeletal muscle relaxant.
--Conjugated estrogen (Premarin) is an estrogen used for hormone replacement therapy in

postmenopausal women.
***These other three medications may be withheld before surgery without undue effects on the
client.
• Anticoagulants alter normal clotting factors and increase the risk of bleeding after surgery.
--Aspirin has properties that can alter the clotting mechanism and should be discontinued at least
48 hours before surgery.

• Lisinopril
-- is an antihypertensive angiotensin-converting enzyme inhibitor.
--The usual dosage range is 20 to 40 mg daily.
--Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, tachycardia, and
angioedema.
--Specific client teaching points include taking one pill a day, not stopping the medication without
consulting the physician, and monitoring for side effects and adverse reactions.
--The client should notify the physician if side effects occur.

• --Polypharmacy is a concern in the geriatric population.
--Duplication of medications needs to be identified before drug-drug interactions or adverse side

effects can be determined.
--The phone call to the health care provider is the intervention after all other information has been
collected.
• Asthma is a chronic inflammatory disease of the airways.
--Inhaled aerosolized short-acting β2 agonists are quick relief medications and recommended for
clients with status asthmaticus after epinephrine has been administered.
--Leukotriene modifiers, antiallergic medications, and nonsteroidal anti-inflammatory

medications are long-term control medications.
• Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific
coagulation proteins.
--The primary treatment is replacement of the missing clotting factor; additional medications, such
as those to relieve pain, may be prescribed depending on the source of bleeding from the disorder.
--A child with hemophilia A will be at risk for joint bleeding after a fall. Factor VIII will be
prescribed intravenously (IV) to replace the missing clotting factor and minimize the bleeding.
• In severe cystic acne, isotretinoin (Accutane) is used to inhibit inflammation.
--Adverse effects include elevated triglyceride levels, skin dryness, eye discomfort such as dryness
and burning, and cheilitis (lip inflammation).
--Close medical follow-up is required, and dry skin and cheilitis can be decreased by the use of
emollients and lip balms.
--Vitamin A supplements are stopped during this treatment.

• Propylthiouracil is used to treat hyperthyroidism
---propylthiouracil (PTU) may convert the client from a hyperthyroid state to a hypothyroid state.
If this occurs, the dosage should be reduced.
--Temporary administration of thyroid hormone may be required.

• --Levothyroxine (Synthroid) is a synthetic thyroid hormone that increases cellular metabolism.

--Levothyroxine should be given in the morning in a single dose to prevent insomnia and should
be given at the same time each day to maintain an adequate drug level.
• Desmopressin acetate (DDAVP)
--is a synthetic form of antidiuretic hormone that causes increased reabsorption of water, with a
resultant decrease in urine output.
--The therapeutic response to DDAVP would be a decrease in serum osmolality, because more
fluid is retained, and an increase in urine osmolality, because less fluid is excreted.
--Hypotension may be apparent with diabetes insipidus and blood pressure may increase as
extracellular fluid volume is restored.
• Classic symptoms of hyperglycemia include
--polydipsia (Excessive thirst or drinking),
--polyuria
-- polyphagia (excessive appetite for food)

• Polydipsia and polyuria are classic symptoms of diabetes insipidus. The urine is pale, and the
specific gravity is low. Anorexia and weight loss occur.
• Because of the hypermetabolic state, the client with hyperthyroidism needs to be provided with
--an environment that is restful physically and mentally.
--Six full meals a day that are well balanced and high in calories are required because of the
accelerated metabolic rate.
--Foods that increase peristalsis, such as high-fiber foods, need to be avoided.
--These clients suffer from heat intolerance and require a cool environment.
• Following thyroidectomy,
--weakness and hoarseness of the voice can occur as a result of trauma from the surgery.
--If this develops, the client should be reassured that the problem will subside in a few days.
--Unnecessary talking should be discouraged.

• DKA (Diabetic ketoacidosis) tretment
--Lack (absolute or relative) of insulin is the primary cause of DKA.
--Treatment consists of insulin administration (regular insulin), IV fluid administration (normal

saline initially), and potassium replacement, followed by correcting acidosis.
• Hyperglycemic hyperosmolar nonketotic syndrome
-- occurs in clients with type 2 diabetes mellitus.
--The onset of symptoms may be gradual.
--The symptoms may include polyuria, polydipsia, dehydration, mental status alterations, weight
loss, and weakness

•
To know the normal systolic for a child 1-7 years old
Age +90. Example 3yo child = 93 systolic.
Here is another. Do not mix zosyn and gentamycin IV wait at least an hour to decrease the risk of
gentamycin inactivation.
• Coal tar
--is used to treat psoriasis and other chronic disorders of the skin.
--Coal tar suppresses DNA synthesis, mitotic activity, and cell proliferation.
--Coal tar has an unpleasant odor, frequently stains the skin and hair, and can cause phototoxicity.
--Systemic toxicity does not occur.

• Mafenide acetate
--is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to
reduce bacteria present in avascular tissues.
--The client should be informed that the medication will cause local discomfort and burning.
-- is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing
acidosis.
-- Clients receiving this treatment should be monitored for signs of an acid-base imbalance
(hyperventilation).
--If this occurs, the medication should be discontinued for 1 to 2 days.

• Sodium hypochlorite
--is a solution used for irrigating and cleaning necrotic or purulent wounds.
--It cannot be used to pack purulent wounds because the solution is inactivated by copious pus.
--The solution should not come into contact with healing or normal tissue and should be rinsed off
immediately following irrigation.
--The solution loses its potency during storage, so fresh solution should be prepared frequently.
• Isotretinoin (Accutane)
-- can elevate triglyceride levels.
--Blood triglyceride levels should be measured before treatment and periodically thereafter until
the effect on the triglycerides has been evaluated.
• Lindane (treatment for scabies)
--is applied in a thin layer to the body below the head. No more than 30 g (1 oz) should be used.
--The medication is removed by washing 8 to 12 hours later.
--In most cases, only one application is required.
• Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from
regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum,
genitalia), and lower from regions where permeability is poor (back, palms, soles).
• The normal platelet count is 150,000 to 450,000/mm3. When the platelets are lower than 50,000 /
mm3, any small trauma can lead to episodes of prolonged bleeding. The normal white blood cell
count is 5,000 to 10,000/mm3. When the white blood cell count drops, neutropenic precautions
need to be implemented. The normal clotting time is 8 to 15 minutes. The normal ammonia value
is 15 to 45 mcg/dL.

• Crestor=Rhabdomyolysis (muscle Weakness)
PH of stomach acid lessthan 4 is good
Drug catagory X=risk for fetus
Colchicine=antigoout medication
Lasix=K wasting=increasebananas and oranges
heart failure infant=increased resp rate
PIH=periorbital and facial edema
Thallium stress test=allergic to Iodine should be asked
Warm insulin bottle is good for 1 month only
Causes of abdominal distention
The 6 F's
Flatus----Feces----fetus----Fluid---Fat----Fatal(Malignant) neoplasm
• 1. If mishap occured like patient fell, write up an incident report and NEVER chart in the medical
records that an incident report was filed.
2. If px died and was found on drivers license to be an organ donor, still have to get permission
from next of kin before taking organs. order of priority is
1st ask the spouse, if none...2nd ask son or daughter, 3rd mother, 4th adult brother or sister, 5th
Legal Guardian.
3. For airborne diseases measles, varicella, TB....use a particulate filter mask not a surgical mask
4. For droplet isolation patients, everyone must wear a mask if they are going wtihin 3 feet of the
patient.
• 5. PKU, baby born without ability to utilize essential amino acid called phenylalanine so don't give
diet soda bec it contains nutrisweet, nutrisweet contains phenylalanine.
• The rules of Management:
Do not delegate assessment teaching or evaluation
Delegate care for stable pt's with expected outcomes
Delegate tasks that involve standard unchanging proceedures
Treatment for Monnucleosis= Bedrest
Amphojel=S/E Constipation
Diagnostic test for cirrhosis=Liver biopsy
Contaminated shellfish=Hep A
Murphy's sign=On deep inspiration pain is elicited and breathing stops
Abd Ultrasound=Dx for cholecystitis
Pancreatitis=avoid Caffine and alcohol
Pancreatitis= increased Amylase and lipase and glucose and decreased serum CA levels
After liver biopsy=place client on the right side laying position with the bed flat
Tensilon test=Mysthesia gravis
Xerostomia=dry mouth
dysgeusia=siminish sense of taste
Dilantin can cause decreased HR hypotension
Pyridium=Causes the urine to be red or orange
Club soda=sodium chloride
Gallbladder is on the right
Guthrie blood test is a test for PKU
Tetracycline can cause staining of the teeth
Test for seizures=EEG
Vit C may decrease warfarin effects
Vit E may increase warfarin effects
Dumping syndrome=moderate fat low carbs diet
Colostomy begins to function 3-6 days after surgery

Viagra=NO Nitroglycerin
250ml=I unit of PRBC (packed red blood cells)
• Calcium and aluminum based antacids cause constipation
Magnesium based cause diarrhea
Mydriatics (big word big pupil) treats cataracts...I always picture a cat acting ( CAT ar ACTS) in a
big whole ...it sound stupid I know!
Miotics (small word small pupil) treats glaucoma
Maternal hypotension after an epidural anethesia: STOP

S= stop pitocin if infusing
T= Turn on left side
O=Oxygen
P= Push fluids (if hypovolemia)
• HELLP= hemolysis, elevated liver enzymes, and low platelet count=elevated hepatic enzymes
Chronic renal failure patients should avoid astringent cleansing pads
Clients with a central venous catheter receiving TPN has an air embolus the nurse should clamp
the catheter immediately and notify the physician.
Crackles in the lung fileds of the peritoneal dialysis client result from overhydration or from
insufficient fluid removal during dialysis. Intake grater than the output of the peritoneal dialysis
fluid would overhydrate the client, resulting in lung crackles.
Colonoscopy=Left sims position
Normal platelets=150-400 cells mcg/l
No morphine=pancreatitis it causes spasms of oddis spincter.
Antineoplastic drugs=leukopenia=private room
Terminal patient=Palliative care
Tamoxifen increases the effects of Warfarin sodium
Tachycardia commonly occurs after giving Atropine
MMR Vaccine=Ask if Allergic to Gelatin, Eggs, or neomycin
Pneumocystis Carinii=Fungal
Vasopressin is a synthetic ADH Its used for treatment for Diabetes Insipidus which results from
deficient ADH
Glyburide=30 mins before breakfast
Pt with Thrombus in the leg on heparin=Strict bed rest
Ticlopidine (Ticlid) is used as a antiplatelet drug for Salicylate (Aspirin) sensitivity.
Protamine sulfate=comes from the sperm of salmon and other fish so don't use if allergic to fish
Blood drawn for APTT on heparin is in 4 hours. Early would show high
Potassium is the most abundant cation in the ICP followed by Magnesium.Because Potassium isn't
stored it must be replaced every day.
• Rh immunization for pregnant is:
Rh immunization of Rhogam is given when an Rh incompatibility occurs, which only oocurs if

the mother is Rh negative and the baby being born is Rh positive. It does NOT occur when an Rh
positive mom gives birth to an RH negative baby.
If some of the baby's red blood cells leak into RH-mom's system, then her body may produce
antibodies to the Rh D factor (a condition called sensitization). These antibodies can cross the
placenta and destroy the red blood cells in your unborn baby or in the next Rh-positive baby you
have.
***In most cases, the mom will not be exposed to the baby's blood until she gives birth.......
This usually means that first baby will NOT be affected.

****HOWEVER, large amounts of the baby's blood can leak into the mother during delivery. If
the mom is Rh negative, the next Rh-positive baby that she could have may have problems if the
Rh-negative mom has developed antibodies
***** Occasionally, in the following situations, some of the baby's blood may leak into the mom's
blood system during pregnancy:
1. After amniocentesis or other invasive procedure

2. During a miscarriage or abortion
3. During an ectopic pregnancy
4. If the mom bleeds heavily during pregnancy.
Disseminated intravascular coagulation (DIC) and s/s
Disseminated intravascular coagulation (DIC) occurs when the body's clotting mechanisms are
activated throughout the body in response to an injury or a disorder, instead of being isolated to the
area of initial onset. Platelets circulating throughout the body form small blood clots (thrombi)
primarily in the area of the capillaries. This eventually causes the clotting factors to be used up,
and none are left to form clots at the site of the injury. The presence of numerous small clots
precipitates the release of clot-dissolving mechanisms, and the end result is generalized bleeding
throughout the body.
This disorder can result in clots or, more often, in bleeding. The bleeding can be severe.
Risk factors for DIC include:
Blood transfusion reaction

Cancer, including leukemia
Infection in the blood by bacteria or fungus
Pregnancy complications (such as retained placenta after delivery)
Recent surgery or anesthesia
Sepsis (an overwhelming infection)
Severe liver disease
Severe tissue injury (as in burns and head injury)
Signs & Symptoms Include:
Bleeding (possibly from multiple sites in the body),

Blood clots,
Drop in blood pressure, AND
Sudden bruising
• therapeutic level of Lithium..
I have answers from 2 different resources;
0.8 to 1.2 mEq/L ................AND ...................
0.6 to 1.2 mEq/L with therapeutic dose = 300-2700 mg/d

• Risk factors for specific cancers:
Bladder = Smoking, exposure to industrial, chemicals, radiation.

Prostate= African American and age 55 and older
Laryngeal = Smoking, uses of tobacco and alcohol, exposure to environmental pollutants,

exposure to radiation and carcinogens, nutritional deficiency (riboflavin)
Lung = Smoking, exposure to environmental pollutant, vitamin A deficiency, heredity.
Pancreatic= High fiber and high carb, smoking, exposure to industrial chemicals, diabetes, chronic
pancreatitis.
Breast = family history, early menarche and late menopause, previous cancer of the breast, uterus,
or ovaries, nulliparity, obesity, high-dose radiation exposure to chest, diet high in fat, alcohol
intake, the use of birth control pills and hormonal replacement.
Endometrial= history of uterine polyps, nulliparity, polycystic ovary disease, estrogen stimulation,
late menopause, family history.
Ovarian= diet high in fat, family history of ovarian or breast cancer, alcohol use, history of breast
cancer, endometrium cancer, colon cancer, nulliparity, infertility,
Cervical= low socioeconomic, early first marriage, early and frequent intercourse, multiple sex
partners, poor hygiene, Human papillomavirus, HIV infection, smoking during pregnancy and
cervical infection.
Testes= over the age of 15 and 40, infection, genetic and endocrine factors, cryptorchidism
• PIH=Periorbital and facial edema
Pt. intubeted and a high alarm will sound when the patient is bitting the tube.
Halo traction=Sterile pin site care
T-12 spinal injury=No message to the bladder.
Thallium stress test=Allergic to Iodine should be asked
5 Post ops causes of fever
Wind-check lungs
Wound-Cl sirgoca; sote
Water-I V site
Walk-DVT check
Whiz-Catheter
Wonder drungs-drug fever
Measles warrents=resp isolation
Bacterial meningitis=Resp isolation
Methotrexate therapy=in 2 weeks expect to see signs of bone marrow depression
When pregnant increase your calories by 500 Kcals
Dystonia occurs after a few days of treatment of haldol
Heart failure infant=Increased resp rate
Trough level=lowest level of the drug should be done immediately before administering the next
dose
Glycosylated hemoglobin values less than or equal to 7.5% indicates good diabetic control
Preterm infant before 37 weeks
Term infant older than 37 weeks
post erm 42 weeks
38-41 weeks is term
you should not insert a NG tube if there is a suspected skull fracture.
Deferoxamine is the antidote for iron poisoning
Cipro treats anthrax
Cretinism=Hypothyroidism found in the neonate
Nrdil (Pnenelazine) is a MAOI avoid figs, chocolate, and eggplant. It cause hypertensive crisis.
Multiple sclerosis=test EEG/LP
A pregnant nurse should not be assigned to any client with radioactivity present.
OK for a Preg nurse to care for a client receiving liner ascelerator radiation therapy for lung
cancer.
Client with Cushing syndrome, with incresed level of cortisone cause the client to be immune
suppressed, Pt should be put in a private room.
complications of bucks traction=Weak peda pulses

• 1. To check for petechiae in a dark-skinned client, assess the oral mucosa
2. Seventh-Day Adventists are usually vegetarians
3. The three types of embolism are air, fat, and thrombus
4. Before discharge, a client who has had a total laryngectomy must be able to perform
tracheostomy care and suctioning and use alternative means of communication.
5. The universal blood donor is o negative
6. The universal blood donor is ab positive
7. Mucus in a colostomy bag indicates that the colon is beginning to function
8. Fatique is an adverse effect of radiation therapy.
9. celiac disease may eat rice
10. Dumping syndrome-limit liquids and high carbohydrate foods.
• Addisons Disease: Hypo NA+, Hyoglycemia, Hypercalcemia and Hyperkalemia.... and the exact
oppisite for Cushings syndrome!
• Diabetes Insip... can concentrat urine!
Addisoinan Crisis is treated with High dose steriods and Fluid replacment
• for treatment of hypertension try 4,3,2,1
• ANGIOTENSIVE CONVERTING ENZYME INHIBITOR .
• BETA ENVAS.
• CALCIUM CANNEL BLOCKER.
• DIURATICS
• A 44-lb preschooler is being treated for inflammation. The physician orders 0.2 mg/kg/day of
dexamethasone (Decadron) by mouth to be administered every 6 hours. The elixir comes in a
strength of 0.5 mg/5 ml. How many teaspoons of dexamethasone should the nurse give this client
per dose?
Answer:
• Correct Answer: 2
Your Answer: 2
RATIONALES: To perform this dosage calculation, the nurse should first convert
the child's weight from pounds to kilograms:
44 lb ÷ 2.2 lb/kg = 20 kg
Then she should calculate the total daily dose for the child:
20 kg × 0.2 mg/kg/day = 4 mg
Next, the nurse should calculate the amount to be given at each dose:
4 mg ÷ 4 doses = 1 mg/dose
The available elixir contains 0.5 mg of drug per 5 ml (which is equal to 1 teaspoon).
Therefore, to give 1 mg of the drug, the nurse should administer 2 teaspoons (10 ml)
to the child for each dose.
CLASS DISCUSSIONS--------PRACTICE QUESTIONS
1-The infant who had cleft palate surgery at risk of what ?

a) Otitis media (possible answer)
b) Vomiting
c) Aspiration
2-A client with portal hypertension what to expect?

Ans: ascites
3-An older adult found on the floor and is losing consciousness and have
seizures. What should the nurse do next?
Ans: stay with patient and observe airway obstruction.
4-A baby born preterm is have bradypnea, cyanosis, the md diagnose

pneumothorax. What should the nurse prepare first?
5-Foods that may trigger cholecystitis (sata)
6-Sputum collection (put in order)
7-Administering Meter dose inhaler (put in order)
8-Which is an elder abuse when And elderly states

a) My son don•t cook and feed me hot meals
b) My son don•t let me pay my bills and see my mails (ans)
9-Foods that should me limited when patient on warfarin(sata)
10-A patient with latex allergy which foods to can he have croos allergy to
(sata)
11-A patient with ranaud•s disease . which should he avoid

a) Running
b) Drinking
c) Smoking (ans)
d) Swimming
12-A mother of two just had a c-section for her 3rd son. When breastfeeding
she has abdominal cramping. what explanation can the nurse give.
Ans: breastfeeding stimulate oxytocin production which triggers uterine
contraction.
13-A pt with bells palsy what cranial nerve is involve.
Ans: CN VII
14-16 hours postpartum, a mother•s fundus is still at the level of umbilicus.
How should she report this finding?
Ans : normal at this time
15-A question on delirium tremens

16-A pt has elevated PSA and ask the mining to the nurse,Ans can indicate
prostatic hypertrophy or cancer
I had these meds: glipizide, actos, embrel, psych meds (clozaril, prolixin wellbutrin,
buspar),
1 What question will you ask a patient who is taking Tricyclic?
a. What is your birthday?

b. When did you last take your ECT
c. Do you have any history of Depression in your family?
2.
What is the effect of antipsychotic on ----·
Alters the effect of Dopamine in the brain
3. A Patient who is on Cialis, what advice should a nurse, give him in
respect of the use of Nitrate patches?
· Patient on Cialis should not take any form of Nitrate
4. Had a question of Glasgow Coma scale

5. A patient with hip biopsy was crying pain after taken pain medication,
what is the initial action by the nurse?
· Chick when the last pain med, was taken
· Elevate the legs to hip level
· Notify the Doctor
6.
COPD patient assessed on therapeutic response
· Feel better and breathing better when sitting on a chair and leaningforward
· Feel less anxious today than yesterday
7.
Appropriate toy for an 18 months old child
· Pulling toy
9.
A question about Bipola Maniac level patient
· Avoiding to look at the nurse but talking in a monotone voice
10 A patient put on Low molecular heparin, which medication would you question?
· A pt on wafarin for DVT
· Apt on Wafarine for Arterial fibrillation
· A pt on Lovenox from Laparoscopy
· A Pt on Lovanox for clotting problem
11 A question on Hypothyroidism
14 A question on Documentation of correct statement
15 Question on Roman Catholic Christian

· Baby should be Baptized by any body
16 (Therapeutic Communication) A Clint on long term dialysis states I do

not want this any more, stating that I spent time here than I do with my family.
What will the nurse say?
17 (Delegation) A nurse working CAN

· Ask the CAN to collect urine spacemen
18 Caring for a Semiconscious patient

· Do not use tooth brush for during mouth care for fear of aspiration
19 A nurse attending a conference meeting, present a problem on a
surgery informed concern, what statement would reflect this

· Client who is a minor, the parent or guidance should sign for him
· (All the other options were correct too b/c they all answered thequestion)
20 Many questions conference attendance
21 A patient with a skin wound (picture of wound shown) but area not
identify, Question ask

· Put a dough lope cushion around the wound
· Put a pillow, in between the knee of a patient when lying on a
side lying position
22 SATA on Alzheimer
23 SATA on TB
24 SATA on impetigo
25 SATA on Advance Directive (I had 22 select all that apply)
26 Exhibit question on:

(Dx is asthma, Has Allegy, V/S normal except temperature, Treated with
Tylenol and Benadryl)
· Possible answer, remove fresh plants and raw fruits in the room
27 Question on Down Syndrome What is the cause

Different word use, I am sure the word represented Chromosome
· i.e Ch 8, Ch18, Ch21
28 Question on fracture pt on how to ambulate
29 A question on fracture right leg on how to clime the steps
30 SATA with list of diseases to select what to consider under contact precaution
31 Client to be consider for further referrer additional dx

· Pt who had irregular menstruation
· Pt who has had unprotected sex for one year but was not pregnant
· Pt with a noodle in the breast who feels tender at times

32 Priority question on who to see first
· Pt who complain seeing clot of ••• the size of a quarter
33 A pt on Propranalol (Beta Blocker) what to chick

· Frequent urination
· Pulse rate of 60
34 What of follow up on new born baby

· Red line on the baby skin and under the eye
· Body Temperature of 36
1. Question on pellagra
2. Question on impetigo
3. Select all that apply on succor medication
4. Therapeutic effect of medication for cholesterol
5. How to go up the stairs with crutches
6. What type of toys for a 3yr old
7. What a 9 month old can do
8. What type of play does an 18 month old participate in
9. Lab values- all in range except temperature
10. 2 questions on lung sound
11. 2 ECG strips...one was v-fib
12. question on pulmonary embolism
13. question on diabetes
14. Risk factors for cervical cancer
15. question on osteoarthritis

16. what shows the therapeutic effect of iron-black stool
17. where to start abdominal auscultation
18. question on G Tube
19. 5 exhibits.
12 select all that apply
Topics for NCLEX 12/7/10
• Checking NG tube – measure acidity

• Thrombophlebitis – remove the IV
• Wet cast – palm while drying
• Cystic Fibrosis – Dx, nursing intervention, Rx – I had like 8 questions, mostly repititive.
• Hypoglycemia – give juice
• Thyroidectomy – priority is airway
• Diverticulosis – diet: no fruit that have seeds
• Fat emoblism compilcations
• Surgery intervention – encourage to cough
• Traction – never release weights
• any scope from upper part of body- (nose/mouth) – no food until gag reflex return
• Infection Control – know the different type of precautions (airborne, droplet, contact)
• If you see handwashing as am option, usually is the answer
• Know impetigo
• Kernigs sign – knee flex with pain
• Budzinski sign – knee raised neck rise
• Babinski sign – touching infant•s sole of feet
• Battles sign – something bulging behind ear

• Lithium – toxicity symptoms
• Know ALL EPS
• Opioid overdose - nursing intervention
• Someone is dying – companion is vital
• Depo-provera – 3 months
• Listen to sounds of ronchi – listen to wheezing and stridor to compare the difference
• Immunization first given
• Know Erickson!!!
• Meniere•s disease – why you have to stand up in front of them – answer: so they won•t
have to turn their head
• Toxic Shock – first sign – low BP
• Know –sartan meds – side effects
• Practice Delegations, priority questions and infection control. I have plenty questionson these.
Remember ABCD and Maslow.
• Practice Select all that apply. DO NOT CLICK ON ANSWERS THAT YOU NEVER
SEEN BEFORE EVEN WHEN YOU THINK IT IS RIGHT!!!
• Elimination helps so don•t be discouraged if you do not know what the question isasking. If you know
the other options, then you can easily distinguish the answer fromthe rest of the options. Ex. The question
asked me about battles sign. I knew kernigs,
budinski and babinski so I knew the answer was the remaining which was somethingbehind the ear.
12/20/101 Cialis ----------------- avoid nitrate
2 some one that has beriberi what vitamin is he lacking -------------- vit B1
3 G tube - place in a correct order
4 how will a nurse reposition a patient that has right hip replacement ------- log roll
5 A patient on coumadin, which food selection required a need for further teaching
---------- green leafy veg
6 Cushing's syndrome select all that apply
7 Addison's disease select all that apply
8 Question on lung sound
Broch asthma
pleurisy
pneumothorax
9 macular degeneration
10 paracentesis
11 Which of the following patient should be place on airborne precaution
12 Glasgow coma scale
13 Enalapril ---------------------------- angiotensin 1 to angiotensin 11 receptor blockers
14 Babinski's reflex
15 homo hemianopia
16 Shingles ( picture)
17 Catheter -------arrange in order18 Enbrel (etanercept)

These are some of the questions and some options that I could recall
1. A toddler with meningitis will show which of the symptoms ( select all that apply)
a.) A barking coughb.) Dysphagia
c.) nuchal rigidity
2. A patient has just had cerebral angiography. What statement made by the patient will
alert the nurse to take further action
a.) '' my wife brought me lunch an hour ago"
b.) '' my legs and toes are feeling numb and tinglingc.) ''It wasn't fun lying on that hard , cold table''
3. A nurse knows that which religion believes in anointing of the sick just before deatha.) catholics
b.) islam
4. (Dr. Ejike,this question # 4 was about how atrial flutter will be manifested, and they
had options about (i) Absent P waves, (ii) sawtooth pattern
5. Electroconvulsive therapy will be done in
a.) Physician's office
b.) Recovery room
6. A trained assistive personnel was asked to take a finger-stick on a patient. At lunch

the patient told the nurse he could not eat since as he has not had his finger-stick taken.
What action should the nurse take?
a.) Go and look for the assistive personnel and ask if the blood sugar reading was
taken
b.) Take the blood sugar reading
7. A nurse has just received an end of shift report about the following, who will the nurse
see first ?
a.) A patient with COPD who has been coughing an is dyspneic
b.) A patient with pneumonia who was admitted 48 hours ago
c.) A patient who had just stepped on a nail and was bleeding
12/20/10
1 _ a pt with leukemia what will the nurse do?
Ans; risk for infection .
2_2nurses want to reposition a pt with right hip replacement?

Ans:logroll the pt with leg abducted.
3_a pt is taking beta blocker.

Ans:tell the pt to get up slowly.
4_ apt is taking alendronate.

Ans:tell the pt to take it before breakfast and sit up for 1hr after.
5_ a pt who is going for cardiac catherisation understand the teaching when he said?

Ans: l will lie flat for 6hr after the procedure.
6_a pt with COPD :t=102 resp=28 BP=96/65 plse=90

Ans:give o2
7_ a child is having seizure when you enter the room

Ans:turn him to his side
8_the picture of a child with shingle

*put the pt on droplet precaution
*apply heat compress
*give the pt a private room
*wear a surgical mask when entering the room
9_which pt will the nurse see firstAns:a pt with asthma with respiratory wheezing
!)what will the nurse delegate to the CNAAns: take the vitals s
10 pt with k+ level of 4.6, calcium 6.5 mEq/lAns:avoid calcium supplement
11 a pt on lithiumAns:avoid competitive sport
i had 20 select all that applyand 9 on nursing care conference.
Event Reports: after preparing an event report, where do you place the report?
Are names of employees as well as clients included in the report?
Are event reports only done by RNs?
Who is responsible for the preparation of the event report?
Event reports to be used as quality assurance tools and added to the Agenda for
inservice for employees?
Weight of Child at 12 months?

Linear nigra- where is it located?
Cleft lip when do you feed the child post surgery?
Room assignment –ISOLATION: a. pt with TB and Measles b. Pt with UTI and
other patient with Varicella and the other with Pneumonia.

Patient with a Serum Potassium of 6, the patient is at risk for?
Patient with Gout, what medication and diet does this patient receive?
Patient vomited 8 times in one hour, what electrolyte is imbalance?
Many questions on what to include on the on the agenda to in-service staff.. A

scenario is given and you are required to suggest what will be essential to be
used for training?
Many Care Plan questions.
A lot of questions on maternity and child care.

Malpractice law; Assault; Battery; Scandal. Situations are given and you are to
identify which law suit will be filed?
Three questions on HIPPA- Patient confidentiality.
Woman has c-section complains of pain and the fundus is above the umbilical
what is the nursing intervention?
Assignments to be given to CAN- delegation.
Exhibit: VS; BS normal, patient is restless, what to expect?
Aplastic Anemia
Pernicious Anemia
Placenta Previa
Patient with Bulimia, what are the signs and symptoms?
Anorexia patient.
Baby at 8 months of age what should be expected?
Accurate charting. UAP calls finds the patient on the floor, checks patient and
the patient says she slipped and fell while going to the restroom. Patient says
she is not in pain. (answer selected: pt found lying on floor no apparent injury; Pt

put back to bed and stated she is not in pain).
Calculating delivery date.

Patient returns from surgery, thyroidectomy and writes a note to the nurses
thanking them for the wonderful care and states that he would not be there the
next morning. Ans: suspect suicide.
Medications used for schizophrenia-fluphenazine
Lithium used for Bi-polar and the therapeutic range.
Which patient to see first: Patient with respiratory issues.
UAP assignment made based on qualification and acquity.
When to wear mask and gown – isolation
Diabetes insipidus --si/sx
Regular insulin-what time to give and what is peak time.
Anterior fontanelle when does it close?
Rubella Vaccine.
Macular degeneration/Glaucoma
Atypical antipsychotic.
Shock- what is priority?
Shock SATA?
8 month old baby that cannot say DADA.
Simvastatin – lab value to monitor.
Right sided heart failure.
Procardia
Cardizem
Patient diagnosed with Alcoholism when is treatment effective?
What to include in patient care plan for a patient with Alcoholism?
What to include on the Agenda for in service?(alcoholism patient)
Alzheimer SATA: 1. Remove rug 2. Keep night light on
SIDS (SATA).
Labyrinthitis s/s: avoid turning head suddenly.
Baby diagnosed with cystic fibrosis= Croup.

Gastrostomy care after, what diet?
Laminectomy: wear back brace
Ditropan- bladder spasm
Patient arrive at ER with a diagnosis of ruptured appendix- what position to place
patient in to avoid the spread of the ruptured substance prior to surgery?
DO NOT PANIC IF YOU GET MORE THAN 85 QUESTIONS. I GOT ALMOST
130 QUESTIONS AND STILL PASSED. SO MAINTAIN YOUR COMPOSURE
DO NOT KILL THE PATIENT AND COMMUNICATE WITH YOUR STAFF.

REVIEW NURSING CARE PLAN AND EDUCATED THE STAFF.
3 Questions on neutropenia
1. Client teaching
2. What client should avoid
3. Correct statement the client made that show understanding about thedisease
2. how a client should use a walker
How to position self when standing with crutch
Q. 3. side effect of lipitol
Q4. The peak time for normal insulin
Q5. Drag and drop= how to do wound culture
Q5. How to transfer a client from the bed to the stretcher. Drag and drop
Q6. A mother complains that his son always scratch the anus. Answer: pinworm
---teaching to the parent of a child with pinworm
Q7. How will a nurse communicate with a client who just had tracheostomy 4 hours ago
Q8. Listen to audio sound which was stridor
Listen to audio sound which was wheezing
Q9. A picture of a skin disease which was shingles
Q10. Sign of dumping syndrome
Answer: Diaphoresis
Q11. Sign of Addison disease select all that apply
Q12. How to feed a baby with cleft palate
--- the kind of toy that will be good for a 5 month old
Q13. What kind of food should a client with crohn•s disease?
Q. 14. A nurse had a conference with a group of psychotic client all of a sudden, one of
them stood up and started shouting and screaming. What will the nurse do?
Q15. Which medication is contraindicated with MAOI?
Q16. How to do breast self examination (how to position self)
Q. 17. At what age is cancer of the testes done

Q&A
Q. After receiving a change of shift report, which client would the nurse assess first?
A. a client who has pulmonary pneumonia and is expectorating blood stinged sputum.
Q. a client is suffering from Meniere disease, what teaching will the nurse reinforce?
A. reduce sodium intake
Q. a client on crutches, what statement made by the client require further teaching?
A. client states”I will use my crutches to pull myself up”.
Q. a client with right sided HF. What classic manifestations will the nurse observe
(select all that apply).
A. edema, weight gain, distended jugular neck vein.
Q. a client on lithium, what will be the nursing teaching? (SATA)

A. increase fluid intake, avoid dehydration.
Q. what statement by the parents of a newborn requires further teaching?
A. we will sleep with our child in our room.
Q. the parents of a student came to the school nurse, which statement made by theparents require a follow
up?
A. the helm of my child•s pants are unequal.
Q. a female client who came to the clinic four hours ago said to the nurse, “if I had fouthharder, I couldn•t
have been raped” . what is the best response by the nurse?
A. would you like to meet with a counselor?
Q. a nurse coming out of a client room on contact isolation, what action by the nurserequires further
teaching?
A. the nurse came out of the room before removing the gown.
Q. the following patient came to ER. If there is only one room available, who should beallocated this
room?
A. a client with a white blood cell count of 2500.
Q. client suffering from mild Alzheimer•s disease. What shows the client•s condition is
getting worse?
A. the client loses the keys and watch.
Q. a client on isolation. Which statement if made by the client shows an understanding
of the teaching?
A. the client asked that, the fresh flowers and fruits should be left outside the room.
Q. which room allocation is appropriation for measles•s client?
A. a negative pressure.
Q. a nurse said to a student that, he has narcissistic behavior. Which statement by the
student confirm•s these behavior?
A. I have the best voice in the class.
Q. a client on crutches. Which statement by the client shows an understanding of theteaching?
A. I will bear my weight on my arms.
Q. as a nurse, what action will you take on a client for thoracenthsis?
A. a client will be placed in the sitting position, with the hands on the bedside table andleaning forward.
Q. a client at risk for fall is to be discharged, what statement by the spouse require aneed for follow up?
A. spouse said, “I have staged the rug on the floor.”
Q. which reflex can still be elicited in a one year old?
A. Babinski reflex.
Q. how will a nurse reposition a client with right hip replacement?
A. by log roll.
Q. a nurse tells a client that he has positive brudzinski sign?
A. when you lift your shoulders, your legs will flex inward.
Q. a client with diverticulitis, which food choices if selected, show an understanding of the teaching?
A. baked chicken, rice and banana.
Q. which of the following clients should be placed on airborne precaution?
A chicken pox client
Q. place the following wound care procedure in the correct order. All options should be
used. (drag and drop)
A.1- put on clean gloves2- remove old dressing and observe3- put on sterile gloves4- clean wound from
top to bottom5- put a dry gauze.
Q. a client on Coumadin (warfarin), which food selection require a need for further teaching?
A. client selects green leafy vegetables.
Q. a client with diverticulitis, what food selection shows and understanding of the teaching ?

A. roasted chicken, mash potatoes and orange juice.
Q. as a nurse, what would you do to a hepatitis client to help in the prevention of the
disease?
A. by giving the client hepatitis A immunoglobulin
Q. a client is on contact isolation. How can the nurse prevent the spread of the infection?
A. by wearing a gown when taking the client to the bathroom.
Q. a client who underwent an operation for coronary artery bypass graft(CABG). What complication
should the nurse report immediately to the physician?
A urine output of 20ml/hr
Q. a client who sustained a head injury in a motor vehicle accident is brought to the ER with a blood
pressure of 136/76 mmHg. What manifestation will show that he situation is getting sores.
A. the pulse pressure is increasing.
Q. the nurse is caring for a dark-skinned client hospitalized with hepatitis. The nurse can best observe the
presence of jaundice in the by assessing the client•s:
A. soft and hard palate.
Q. a client having transient ischemic attack (TIA). As a nurse, what will you be
observing for?
A. myocardial infarction (MI)
Q. a client receiving eye ointment what shows an understanding of the teaching?
A. the client keeps the eye motionless for proper absorption.
Q. a new born with an Apgar score of 9 and 10 at 1 and 5 minutes. Which statement by the parents need
further teaching?
Q. to prevent infectionRemove gown before leaving the room, wash hands after leaving room.
1-aneurism: what does it cause in the brain.
Give HTN meds to decrease renal output.
2-Select all that apply on cast care: elevate the leg on pillow – palm cast rather than lift for skin
breakdown – dry on RM temp – apply prescribed anti-itching as ordered.
3-Contraindication in patient with thrombophlebitis.
Oral contraceptive should not be taken.
4-Patient on allopurinol
Encourage fluid intake.

5-What shows the patient develops pancreatitis.
Presence of lipase and amylase.
6-Meds for patients with pancreatitis Morphine and mepiridine
7-A patient on zidovudine what lab test should be monitor
CBC
8-BSE. 5-7 days after menstruation, stand in front of mirror.
9-ezetimibe(Zetia) will lower cholesterol absorption10-Patient most at risk for ovarian cancer
Patient has herpes zosterUse tampon
Early menarche.
11-Peritoneal dialysis considerations:
Infection, take daily weight, intake and output.
12-Treatment of xerostomia
Give mucomyst and hard candy13-Food high in potassium for patient on digoxin/furosemideStrawberry,
apple slice.
14-Plastic ring circumcisions:

The ring fall in 7 days15-Charge nurse assign PN area not trained and the assignment must not be
changed.
PN will say/ask charge nurse so they plan how to work together.

16-Tetralogy of fallot defeats in children.
Stenosis of pulmonary artery _ over riding of the aorta
17-Teaching fo COPDPursed lip breathingBlowing through the strawInspire 1 second through the nose
and expire 2 seconds through the mouth
18-Calories for pregnant breastfeeding woman300 t0 500

19-What to discuss in conference for pt undergoing ECT.
Patient will be confused and disoriented.

20-PPD needle gauge is 2721-Behavior of a 1 year old child : identify 2 or 3 body parts.
01/15/2011
1. Occult blood testing

What do you do during the test:-Check what the client ate for the past three days
2. Anorexia {what will you observe:3.

Chickenpox {Infection control as a picture
4. Many infection Control questions {Airborne, droplet and contact
MRSA, TB, Pneumonia, Chickenpox, Rubella,
Identification and what the nurse and client will wear and rooming
5. Many priority questions {Airway,

6. Some delegation questions {the CNA can weigh, take intake and output
7. Anti-lipidemics question in an exhibit form{
All labs were normal; all medications matched diagnosis, except elevate liver enzymes
8. What will a PKU client avoid{ diet coke

9. One calculation to be rounded up to one decimal place{
10. Priority question to arrange in order {first airway,
11. Some Conference education{
12. AAA what will be the sign
13. 2 questions about laparoscopy and complications that can arise{
14. Many select all that apply questions{ Infection control,
01/14/2011
DRUGS
1) What medication not to take with Levodopa2) Pioglitazone3) side effects of ARB(-Sartans). I got
Candersatan (Atacand)
MATERNITY AND PEDS
4) Birth Process

Engagement,Descent,Flexion,Internal rotation,Extension,External Rotation,Expulsion5) 2 questions on
Mastitis. one was sign is crack and reddened nipple6) How to feed cleft lip7) 2YR old nutrition pattern-
decreased appetite.
MED SURG
8) Mastectomy care/teaching1.drug calculation
THE NEED TO KNOW INFECTION CONTROL CANNOT BE OVEREMPHASIZED. I

probably would not pass, if I didn't know it. TONS AND TONS OF QUESTION
HERE..
I remember
Psoriasis ( who can pt room with)
What type of infection control, for Pneumonia, meningitis, MRSA,TB
Who would you wear mask and what type of mask to take vital signs,
who would you room together
who would you closed their door or gloves.
A lot of therapeutic communication as well as staff conference educations. lots of this...
Sorry! I was to nervous to remember how questions and options were framed.
Major RESPECT to all those that were able to remember everything.
GOOD LUCK!!!
Jan 22nd 2011
1. Procedure or steps for removing urinary catherization (it was drag and drop).
2. An Islamic pt who was about to die and the family members were there present what would you
anticipate as a nurse? (The only option that made sense was pt would be facing east of mecca)
3. What type of food would an Islamic 1st eat. (options on ham & bacon was eliminated)
choose cabbage,fish,fruits.
4. On complimentary therapy of a pt post-op for RA and says he would use aloe vera
what would you respond (Therapeutic com)
5. A nurse was about to administer antibiotic med's to a resident but when she got there
client's door was locked and she sensed client was making out with his wife what would you do?.
a. Bang hard on the door and enter in for mins.
b. Tell the room mate to come visit the room.
c. Go and come in 30 min.
d. Tell them to stop.
6. If a client/pt request for his medical records what would you do?
a. Tell pt he would get it after his treatment/discharge.
b. show it to pt.
c. Tell him he has no right.
7. Who is responsible if a nurse administer a wrong prescription by a doctor.(Actually it
was an allergy reaction I shell fish) I choose the nurse/Dr.
8. A pt who after extra-corporeal shock therapy what statement would he make that would

required further teaching.
a. I would drink 3 liter of water.
b. I would stay on bedrest for 1 to 2 weeks.
c. I would see blood in my urine. ( i choose (b) cause ambulation is necessary afterECST
9. Question on TURP 8 hrs after surgery.
a. Client passing small amount of light color.
10. What are signs of hyponatremia.
a. Dry mucus membrane and thirst.
b. Muscle weakness and abdominal cramp. ( I choose a cause dry mucus is associated with low sodium
while thirst is next)
11. What shows a pt has low calcium ? I choose the option of face spasm.
12. A pt on alcohol withdrawal stared trembling and shaking and the family member told
you that he just abused alcohol what would you as a nurse?
a. Refer him immediately to AAA.
b. Massage and rub his back . (don't remember my answer.
13. A picture of a one day old baby with spots on his fontanel(forehead) what kind of
precaution would you take.
a. Airborne.
b. use gloves and mask.
c. Keep him with other babies.
d. Were gown when changing the diapers. ( I felt a day old can have rubella cause she is immunodeficient
for the first 6. months).
14. A pt with hepatitis"A" what or where would you think she contracted it from ?.
a. Day care.
b. Through sex. (I can't remember the others)
15. A person takes phenelzine sulfate (Nardil). What would you anticipated to educate
(an answer option on cheese cake0.
16. Priority questions :
An Anemic of Hb 8g/dlHypertensive but with intermittent dyspnea. ( wasn't sure about the rest)
17. How do you transport some with MRSA would you put on a gown ?
a. Would you put on a mask or would you cover pt with gown
18. A question on the side effect of Nifedipine(calcium channel blocker)
20. Therapeutic level of lithium is needed to answer this one(0.6 -1.5 mg/dl)
21. Conference questions on slander/libel/assault/negligence.
I was tired of conference questions.
22. SATA
On diabetic foot care (I could recognise all except the issue of using hot/cold
compress.
23. What is your immediate concern about a pt whom you are about to administerfusamax.
a. An 1/2 empty bottle of orange juice on her table.
b. She is lying on the bed.
c. She is reacting for her pill.
I assumed it would be the 1/2 bottle of orange juice cause you take fasamax onempty stomach.
24. Diffrentiate between RA & Osteoarthritis. (I choose option on herbeeden Nodes)

25. A woman in active labor complains that for the past 2 hrs she being see tiny drips of
amniotic fluid coming out from her cervix . What would you anticipate ?.
a. Check in the labor if its amniotic fluid.

b. She is going into second stage of labor.
There was'nt check of FHR
26. A baby born with a tiny red like mole on the tip of her nose . what would you say to
the mother?
27. To care for a 4yr old, what would you include in his plan of care.
a. Squaller (honestly, don't know what this is)
b. Painting
27. Question on neutropenic precaution.
30. What food would you ot give to one with celiac disease.
a. Oat meal
c. Rice cake
d. Bread
e. Rye
31. What would a pt who is doing self breast examination say is right concerning BSE
32. What would you teach a family member concerning multiple sclerosis
33. A nurse came to visit a client who was told she had terminal cancer when she came
the amily members said "she has being sitting in the dark all day and refused to talkto anyone' what stage
of griefing is this.
a. Daniel
b. Anger
c. Bargaining
d. Acceptance and Anger
34. A question on Female condom . (I could'nt remember all the option.
a. Put on six hrs before sex then wash and reused after sex etc,
37. Second degree (partial thickness burn) what do you expect to see?.
a. Painful and blanching
b. painless and blanching
c. Lethary.
38. Medication for cholesterol.

I think its cholestyramine
39. Someone that has psoriasis and complains of dryskin what would you encourage?
a. Corn starch bath
b. Glycerine cream
c. Wash with cold water and mild soap
d. Emollient creams (this is what i choose)
40. So many question on client rights. Some questions on infection control (you have toknow what to do
at any level of infection control example after cleaning perinal whatwould you do with cloves ect, how to
transport them.
41. Calculation on BMI/ medication adminstration to a child(nearest whole number).
42. Low serum albumin what does it mean?
43. Mental status evaluation (you have to know what to evaluate)
44. How do you approach a pt with 'bitemporal hemianopsia" (I just guessed)
45. I got (Arixtra=fondaparinux) honestly it was from the option i knew it was ananticoagulant cause i
saw "use electric razor".
46. How to collect stool samples to dectect parasitic problems.
47. A therapeutic question on an anorexic pt who was having a conversation with the
nurse and said "you have to hurry up cause i've started jogging every evening and itsalmost time for my
judging ' what would you say?.
48. Risk factor for cervical cancer
49. A question on bucks traction (position)
50. A question on total knee replacement.

51. What is barbinski sign
52. Who would you give a private room
a. A one day old baby with spots on her buttocks.
b. A 7 months old baby with swollen (mold) under the tongue (this could be mumps---
droplet precaution)
53. A question on Webb's test. The options was on the meaning.
1—What would need the nurse•s immediate attention
Answer: A pt with potassium of 3.22—A pt was treated for allergy, what would you see as an
anaphylactic reaction?
Answer: Nasal congestion
3. SATA question: What would you do for an Alzheimer patient?

4. A diabetic client reports she has white cottage cheese discharge?
Possible answer: Ask what sort of detergent you use for bath and laundary.
5. A boy with sickle cell anemia: what would let you know that the patient teaching is
successful to avoid sickle cell crisis?
Answer: We planned a trip to the mountains for hiking but we had to cancel it.
6. Patient just received Dilaudid prescribed PRN. Pt states pain is now a 5 on pain scale
of 10 after 2 hours. What should the nurse do next?
Choices: (a) Dim the light in the patient•s room(correct!)
(b) Tell the patient he can have pain medication in 2 hours.
7. What would the nurse tell the patient taking Rifampin?
Answer: It would stain your soft contact lenses
8. A patient is taking INH for TB, what should the nurse tell the patient?
Answer: You need regular blood test for liver function
9. A nurse is transporting a TB patient, what should the nurse do?
Answer: Put a special respiratory mask on the patient
10. SATA question on Enalapril
11. SATA question on Metropolol
12. An adolescent tells the nurse that she wants to give the baby up for adoption. What
is the best response by the nurse?
Choices (a) Ask the client if she spoke to her parents about her decision
(b) Inform the patient that you would speak to the social worker about her decision
13. SATA Vasotec
14. SATA Viagra
15. What reaction do you expect from flexiril
16. What medication should you NOT take if you are taking Keflex
Answer: Ampicilin
17. A nurse is taking care of a patient who has Vancomycin Resistance Enterococus
(VRE) in the wound. What protective gear should you wear?
Answer: Gown and gloves
18. A nurse leaves a patient room diagnosed with TB; what should the nurse do prior to
leaving the room?
Answer: Wash her hands
19. The nurse is trying to prevent the spread of influenza on her unit, what should she
do?
Possible answer: Tell the CNA to wear a surgical mask when bathing the patient
20. A patient•s WBC is 2000, what does the nurse ask the patient?
Answer: Ask the patient if they have plants in the house
21. A person on an appointment gets an infection; how do you know that the patient
teaching has been effective?

Answer: Pt states “I will purchase a thermometer to make sure my meat is fully cooked.
22. SATA question on Addison disease
One of the answers was hyperpigmentation
23. What does the nurse expect to see when client takes a three (3) month-old to the
clinic?
Answer: The posterior fontanelle is closed.
24. Four children are admitted to the hospital, what toy would you give them to play
with?
Answer: Coloring book and crayons to an 18 month old.
25. Which illness would the nurse consult a dietician for?
Answer: Glucosenate test 10%
26. Which patient would you place in a private room?
Answer: A pt that had a heart transplant in the last month.
27. Which patient would the nurse see first?
Answer: A pt that had a femur fracture and is coughing (a sign of fat embolism)
28. SATA question on Rheumatoid arthritis
29. A child weighed 10 Lbs at birth, how much kg did the child weigh?
30. A pt had for lunch 20ml juice, 2 oz of carrot, 1 oz of pear, and 16 oz. of milk.
Calculate how many ml the patient had.
31. A patient had at 12 noon had 240 cc of urine, 50cc in JP, 2 large BM in diaper. How
much output did the patient have?
32. What should the nurse tell the CNA about a patient with TB?
Answer: Make sure the patient gets disposable utensils.
33. A patient is treated with Isoniazid (INH) 300mg PO, and on Rifampin. His urine is
orange, pink colored. Which of the following vitamins would the nurse expect the patient
to receive?
(a) Pyrodixine (vitamin B6) (probable answer)
(b) Vitamin B12
34. A nurse is taking care of a client with C. difficile, what would the nurse do?
(a) Remove glove, wash hands before leaving the patient•s room
35. A pt. on Magnesium sulfate, what would the nurse do
(a) Check respiration (and deep tendon reflex ) ----I added this portion
36. Pt is on Zestril, what do you monitor?
(a) Blood pressure (answer)---Zestril is a BP medicine
(b) Cholesterol
37. How do you give an oral Tylenol to a 3 year-old?
(a) Medicine cup (possible answer)
(b) With a straw
(c) With a spoon
38. The patient•s lab from CBC read thus: (Sodium (130), potassium (3.9), WBC (5000),
and platelets (160000). Which of these lab values would you report immediately?
(a) Sodium (possible answer)
(b) Potassium
(c) Calcium
(d) Platelets
39. A pt with Huntington disease could not eat because his hands were shaking badly.
Who would you report pt•s condition to for follow-up
(a) An occupational therapist ------( the possible answer)
(b) A neurologist
(c) A physical therapist
(d) A nutritionist

40. A patient with Hypothyroidism, what symptom would the patient have?
(a) Cold intolerance
41. A patient with diabetic Mellitus---What diet would the patient have?
(a) A low sodium, low fat, low protein diet----(most probable answer)
42. Which food would the nurse give to a patient with WBC count of 2000?
(a) Skim milk
(b) A milk shake
(c) Sliced apple
(d) Tossed salad
43. A woman who delivered by C-Section was receiving epidural IV infusion. When is it
appropriate to time to discontinue the epidural?
(a) When fully recovered from anesthesia
(b) One hour after delivery
(c) When she says she has abdominal cramps
(d) When she complains of no more pains ---- (plausible answer)
44. A patient with PNEUMONIA. What should the nurse avoid? (SATA question)
*This may be an infection control question
45. A depressed patient states “I do not want to live anymore”. What would be the
appropriate statement for the nurse to ask?
(a) “Do you have a plan to kill yourself?”
46. A patient lost his mom, what grieving process would the patient go through? ( a
SATA question)
Answer -----D.A.B.D.A
47. A manic patient—What behavior would you expect the manic patient to exhibit?
(a) Speaking a lot to the staff nurse-----(plausible answer)
48. A lot of psychiatry questions!!!!!!!!!!!!!
49. A lot of therapeutic communication questions. Even some of the med-surgical
questions were in therapeutic communication format!!!!!!!!
50. How do we care for the pin traction site for a client with skeletal traction?
(a) Apply betadine at the site to prevent infection
••
51. Patient is taking Prozac (Flouxentine) what will the patient say to show its
effectiveness?
(a) Pt is happy
52. What is the therapeutic outcome for Hydrochlorothiazide?
Answer- decreased BP, decreased edema.
53. What would need the nurse•s attention?
A patient with potassium of 3.2
54. A patient was treated for allergy, what would you see as anaphylactic reaction?
---- Nasal congestion
55. What would you do for an Alzheimer•s patient?
---- This is a SATA question.
56. A diabetic patient reports that she has white cottage cheese discharge.
---- Ask her what sort of soap you use for bath and laundry
57. A boy with sickle cell anemia, what statement would let you know that patient /parent
teaching was successful?
----- We planned a trip to the mountains for hiking but we had to cancel it.
58. Pt just received Dilaudid prescribed prn, patient said pain is now a 5 on pain scale of
10 after 2 hours. What should the nurse do next?
---- (a) Dim the light in pt•s room

---- (b) Tell the pt he can have pain medication in 2 hours
59. What should you tell a patient taking Rifampin?
----- It would stain your soft lenses.
60. The nurse is transporting a TB patient, what should the nurse do?
----- Put a special respiratory mask on patient.
61. A patient taking INH for TB, what should the nurse tell the patient?
----- You need a regular blood test for liver function.
62. SATA question on Enalapril
63. SATA question on Metoprolol
64. SATA Vasotec
65. SATA Viagra
66. An adolescent tells the nurse she wants to give up her baby for adoption, what is the
best response by the nurse?
----- (a) Ask the adolescent whether she spoke with her parents about her decision
----- (b) Inform the patient that you will speak to the social worker about her decision.
67. What reaction do you expect from Flexiril?
68. What medication you should not take if you are taking Keflex
----- Ampicilin
68. The nurse is taking care of a patient who has VRE (Vancomycin Resisitant
Enterecoccus) in the wound. What sort of protective gear should she wear?
----- Gown and gloves
69. A nurse leaves the room of a patient diagnosed with TB. What should she do prior to
leaving the room?
----- Wash her hands
70. The nurse is teaching staff how to prevent the spread of influenza on her unit. What
are some of the appropriate things to teach?
----- The CNA should wear a surgical mask when bathing the patient.
71. A pt•s WBC count is 2000, what relevant question should the nurse ask the patient?
----- Ask the patient if they have plants in their house.
72. SATA question on Addison disease.
----- Hyperpigmentation etc.
73. What does the nurse expect to see when a parent takes a 3 month old to the clinic?
-----Posterior fontanelle closed.
73. Four children are admitted to the hospital, what toy would you give them to play
with?
----- Coloring book and crayons to a 18 month old.
74. Which sickness would the nurse consult a dietician for?
----- Glucosenate test 10%
75. Which patient would you put into a private room?
----- A patient who had a heart transplant in the last month.

----- A pt with mumps (possible answer)
76. Which pt would the nurse see first?

----- A patient with a femur fracture and is coughing (a sign of fat embolism)
77. A SATA question on rheumatoid arthritis
78. A child weighs 10Ibs at birth how much kg did the child weigh?
79. A pt had for lunch 20ml juice, 2 oz of carrot, 1 oz. of pear, and 16 oz. of milk.
Calculate how many ml the patient had.
80. A pt at 12 noon had 240 cc of urine, 50cc in JP, 2 large BM. How much output did
the patient have?
81. What should the nurse tell the CNA about a patient with TB?

----- Make sure the patient gets disposable utensils.
82. Sclerotherapy--- what is it used for
-----Removal of hemorrhoids by laser
83. What should the nurse do when transporting a TB patient?
___ Put a mask on the client
84. SATA question again on Viagra
85. Before administering Olanzipine, when would there be the need to hold the
medication?
_____When the client has temperature (Fever)
85. A client with Multiple Sclerosis---what would trigger the occurrence of the disease?
Answer: The husband got fired from the job. (Emotional stress tend to occur before the
onset of MS)
86. What to monitor when a pt is on Keflex (an antibiotic)
____ Dizziness, drowsiness, Lower BP (possible answer)
87. When would there be a need for pt teaching for a client with Meniere•s disease?
Answer: When the patient states I will eat no restricted diet.
88. A pt diagnosed with ALS and the spouse is in a state of denial. What would be an
appropriate statement from the nurse?
___ Are you shocked about your husband•s disease?
89. What would be the most important teaching to a client with hiatal hernia?
Answer: Sleeping with the head of the bed elevated.
90. What precautions would be placed on a client with impetigo?
Answer: Contact precaution --- wash clothes separately in hot water and hot dryer.
91. SATA on HIV patient
92. A client has black tarry stools----which medication would the nurse follow up?
Answer: Heparin
92. How do you elicit the dancing reflex on a 7 day-old infant?
Answer: Touching under the feet with your finger and the infant pulls towards the
abdomen.
93. What would be an abnormal finding on a 5 month-old infant during a wellness clinic
check-up?
Answer: Child has a head lag when pulled to a sitting position from lying on the back.
94. Pt teaching on epidural
95. Pt teaching on sclerotheraphy
96. A question on the posterior fontanel which closes at 2 months.
97. What patient would be relevant to give to a client receiving epidural?

Answer: We would monitor you for bladder distension.
98. A pt is experiencing Alcohol withdrawal, what would show spouse understanding of
treatment regimen?
Answer= We would decline parties where alcohol is served.
99. Pt with cancer is upset her spouse doesn•t know about it, what should be the
nurse•s response?
Answer – Tell me what concerns you about it.
100. A dying Muslim has asked about what will be done when he dies?
Answer---Tell family and same sex member to help wash the body.
101. What will confirm a positive outcome for a pt taking BUMEX
Answer--- Decreased edema
102. Question on Diabetes insipidus
103. How to administer IM injections (SATA)
---- Answer may include washing hands, applying pressure to site etc
103. How to apply urinary catheter?

___Hold penis at 90 degree angle
104. A patient was to be catheterized, what will be the concern to the nurse?
----Possible answer: “I just urinated before coming to the hospital”
105. A pt has a urinary catheter in place, what will be the priority for the nurse?
___ Answer = Urine leaked out of the catheter when the patient sneezed.
106. Which of the following will the nurse see first?
Possible answer = Pt who says pain medication is not effective and complains of pain.
107. How will you resolve conflict amongst CNAs in the job environment?
Answer = Allow staff to verbalize concerns and perform further investigation.
108. Which would you delegate to CNA?
____ Tell CNA to check patients vital signs and report the findings.
109. Signs of left-sided heart failure
____Dyspnea
110. A nurse mistakenly gave morphine CR instead of morphine IR. What will the nurse
document in the patient•s chart?
____ Answer = Administered 25 mg morphine CR instead of morphine IR, charge nurse
notified, physician notified, patient stable. *** Do not write that incident report was
written in the chart.
111. What will a patient with mild Alzheimer say that will reflect abuse?
Possible answer: Pt states, “My son doesn•t let me pay my bills and look at my
statement.”
112. A woman unable to have children says she is going back to teach nursery school
kids. What type of defense mechanism is she exhibiting?
Answer: Compensation
113. A patient is brought into the emergency unit with a depressed sunken skull, what
the nurse will check for initially?
Possible answer: Check corneal reflex and neurological status.
114. What is the therapeutic effect of anzemet?
Answer: It is used to prevent nausea and vomiting (from cancer chemotherapy).
115. A patient had undergone cardiac catheterization, what advise would you give to the
patient?
Answer: Maintain bed rest for 12 hours
116. Which of the laboratory values will be of concern to a patient with sickle cell
Answer: Hematocrit of 30
117. What will be of concern when the husband says the wife is almost his height now?
Answer: Signs of osteoporosis
118. What statement made by a 10 year old with type 1 diabetes shows an
understanding of his disease condition?
Boy states, “I will eat my favorite food of peanut butter sandwich before going to bed,”
119. Which of the these patients need to be seen as a matter of priority and concern to
the nurse
Possible answer: A patient with a brownish red lesion on the hand. (Possible sign of skin
cancer)
120. Which of the following will be of concern to a nurse?
(a) A pregnant woman at 34 weeks gestation who complains of headache and a +1
proteinuria.
121. A pt is treated with Isoniazid (INH) 300 mg p.o. and Rifampin. His urine is orange-
pink color. Which of the following vitamin would the nurse expect the patient to receive?
(a) Pyredixine (vitamin B6)---- answer
(b) Vitamin B 12
122. A nurse taking care of a client with C. difficile; what would the nurse do?
(a) Remove gloves, wash hands before living the patient room ---answer

123. Pt on magnesium sulfate, what is essential for the nurse to do?
Check the respiratory rate---- answer
124. Pt on Zestril, what would the nurse monitor?
(a) Blood pressure
(b) Cholesterol
125. How do you give oral Tylenol to a 3-year-old?
(a) medicine cup----- probable answer
(b) with straw
(c) with spoon ---126.
The pt•s lab values from CBC read thus: sodium= 130, potassium = 3.47, WBC =
5000 and platelets =160000. Which of these lab values would you report to the
physician immediately?
(a) Sodium
(b) The potassium
(c) Calcium
(d) Platelets
127. What will show understanding of type 1 diabetes to a 10-year-old patient?
Probable answer: The boy says, “I will eat my favorite food of peanut butter sandwich
before going to bed.”
128. Which of the following would be a concern to the nurse?
Probable answer: Pregnant woman at 34 weeks gestation who complains of headache
and a +1 proteinuria
129. What would you observe in a child with hypothyroidism?

Probable answer--- nervousness
130. If a client presents black tarry stools, what medication should the nurse follow-up
as the cause of this condition
Answer--- Heparin
131. How do you elicit the dancing reflex in a 7-day-old infant?
Probable answer: By placing the sole of the child•s feet on a flat surface and the child
moves the legs as if trying to walk. Or stroke the feet and the child will pull leg towards
the abdomen.
132. Which pt teaching will be relevant to a client with epidural analgesia?
Probable answer: Expect bladder distension.
133. Which client would you refer to the speech therapist for a follow-up?
(a) Pt with Bell•s palsy with mouth drooping
(b) Pt with myasthenia gravis who cannot swallow. ( possible answer)
134. Which of these foods are low in Potassium?
(a) Orange juice
(b) Apple juice--- (probable answer)
(c) Canteloupe
(d) Watermelon
135. SATA teaching on Prolixin (Fluphenazine), an anti-psychotic drug.
--- Pt should report tardive dyskenesia
--- Pt should avoid sun (photophobia)
----Given IM especially to clients known for non-compliance with medications.
----Take about a week or more to attain therapeutic effect.
136. Which food is high in protein?
--- (a) peas, milk and meatloaf--- (probable answer)
--- (b) Milk, bread and orange juice
--- (c) Scrambled eggs, baked peas and milk
137. Which of these clients should be seen by the occupational therapist?
(a) A 6-month-old infant who cannot sit without support.

(b) A 4-year-old infant with positive Babinski sign.
(c) A 3 month-old infant with anterior fontanel palpable
(d) A 3-year-old infant who cannot drink from a cup ---- (probable answer)
138. How do you assess the understanding of a pt. teaching of a client being prescribed
Sildenafil (Viagra)? Pt will state:
(a) The medication should be taken one time every 24 hours.
(b) The medication should not be taken with Nitroglycerin. ( The answer)
(c) Report flushing of the face.
(d) Take it on an empty stomach.
139. Pt underwent hysterectomy should refrain from?
Answer: Not to lift 2 year-old daughter
140. Pt with VRE, which action noticed by the nurse warrants an intervention
Answer: A nursing assistance removing the gloves after leaving the room.
141. Question on NG tube insertion procedure ----a drag and drop question
141. A six-month old infant in a well-child clinic, which vaccination would be needed.
Answer: Hepatitis B
142. A pt is prescribed Spirolactone, what condition will indicate that the medication is
working?
(a) Pt has sodium level of 139
(b) Pt has a pulse of 98
(c) Pt•s BP is 129/78
(d) Calcium level of 6
143. A child weighing 30 Ibs is to be given medication 25gm/kg. The drug comes in
500gm/ml, how much of the drug would be given
144. A pt underwent tubal ligation, which statement would an understanding of her
condition?
Answer: “I will continue to have my menses until I get to menopause”
145. SATA question on the side effects of Aricept
146. Pt taking antipsychotic drug asked why he is taking Cogentin too.
Answer: For extrapyramidial symptoms (Parkinson-like symptoms). SATA question
147. Pt with pneumonia, which precautions to take.
148. Pt with migraine, what is the pt teaching?
149. Pt with above the knee amputation (AKA) wants to go somewhere he can get help
after discharge.
Answer: select the answer the nurse is reassuring him
150. A pt is concerned about sexual dysfunction (erectile dysfunction)
Answer: Ask patient whether he is taking any medication (bearing in mind some BP
meds can cause sexual dysfunction)
151. SATA question on a pt with Meniere•s disease
152. SATA question on Addison disease
153. A pt is depressed and has suicidal thoughts. What would pt say that would demand
the attention of the nurse?
Answer: Pt states he is feeling better.
154. A SATA question for a pt with Eczema
Answers: Use cotton clothes, use tepid water, keep nails short.
155. What essential question would you ask a client with Parkinson•s disease who is
being discharged to go home?
Answer: What kind of flooring do you have in your house?
156. Pt with history of alcohol withdrawal, what statement by spouse will indicate
understanding of treatment regimen?
Answer: “We will decline invitation to parties where alcohol will be served.”

157. A dying Muslim asked about what would be done to the body after his death.
Answer: Family member of the same sex (like the dead) would help wash the corpse.
158. What would confirm a positive outcome for a client on BUMEX.
Answer: Pt would report decreased edema.
159. A nurse administered regular insulin at 7:30 am. When does the nurse return to the
room to check on the patient?
The answer is when the insulin is at its peak---between 2 to 3 hours ( at about mid
morning)
160. A Muslim patient is dying with only the family members in the room. What action
would the nurse anticipate the family members would request from the nurse?
Answer: To assist to turn the bed and body towards the east (Mecca).
161. The pt is taught by the nurse on the proper way to do a Crede•s maneuver. What
return demonstration would indicate a proper understanding of Crede•s maneuver?
Answer: The client massages the pubis downwards.
162. A nurse assessing a depressed client would consider putting the client on suicide
precaution for which reason?
Answer: Pt claims he feels better and has sudden burst of energy
163. Where would the nurse document data on pt•s daily input and output?
Answer: The flow sheet./graphic sheet.
164. Pt has right sided CVA; why would the nurse anticipate that the pt would need
assistance in ambulation?
Answer: Because of left-sided hemianopsia
165. What medication should a pt taking Levonox avoid?
Answer is Motrin…..also choose any NSAID if you find any.
166. A pt with a left-sided CVA, in what areas of functioning would be affected?
Answer: Communication problems.
167. How should the CNA measure output and input of an infant?
Answer: Weigh wet diaper and subtract the difference from dry diapers
168. How do you weigh an uncooperative infant?
Answer: The mother can hold the baby and you subtract the mother•s weight from the
total weight.
169. A pt is taking Spironalactone (Aldactone), which action by the patient would the
nurse follow up.
Answer: The patient is eating a lot of bananas (Rationale: Aldactone is a potassium
sparing diuretic so eating a lot of Bananas can lead to hyperkalemia)
170. When taking care of a pt with Hepatitis B and AIDS, what precautions would you
take?
Answer: Universal precaution.
171. A drag and drop question on wound irrigation
172. An SATA question on Schizophrenia pt. (Remember the Bleurer•s 4 “A” s)
173. Which of these clients would you place on contact precaution (SATA)
(a) Rubella
(b) Varicella
(c) Mumps
(d) Impetigo
174. How would you know that a client is in an advanced stage of Alzheimer disease?
175. What would be the best diet for a client with nephrotic syndrome?
Answer: High protein and low sodium diet.
175. What is the recommended diet for a client wit Crohn•s disease?
Answer--High calorie, high protein, low residue diet.
176. Priority post procedure nursing intervention for client who underwent

Extracorporeal Shockwave Therapy for renal calculi.
Answer—Instruct client to push fluids to flush out stones (and strain the urine)
177. Allopurinol for gout, essential nursing teaching?
Answer—Increase fluid intake
178. Manifestation of hypokalemia is
Answer---Positive Chovstek and Trousseau signs. Look up for indication of the following medications
179. Prilosec---suppresses gastric secretions

180. Fosamax---Decreases symptoms of Osteoporosis and Paget•s disease
181. Methergine---treatment for postpartum hemorrhage
182. What position should the patient be placed in before an amniotomy is performed.
Answer—Supine
183. When a pt is taking Spironalactone (Aldactone), which situation would make the
nurse intervene?
Answer—The pt is observed eating a lot banana (rationale: Aldactone is a potassium
sparing diuretic---therefore eating a lot of banana will cause a hyperkalemia condition
for the client.
184. What would indicate that a pt on Synthroid is deriving therapeutic benefits from the
drug?
Answer—Pt reports increase in energy
185. At a community health teaching seminar, which statement made by a participant
indicates that teaching has been effective.
Answer--- A 15 year-old stating he would do monthly TSE (Testicular Self-Examination).
186. A client with black tarry stool what medication would the nurse follow-up with?
Answer—Heparin
187. A patient is going to have a test of myelogram. What should the nurse assess for?
Answer—Allergy to shell fish
188. Who should be in a private room?
(a) A cardiac pt complaining of chest pain
(b) An Alzheimer patient with diarrhea ---preferred answer
189. A 13-year-old girl goes to the clinic, what condition would strike the nurse most?
Answer—The hem of the pants are uneven (a sign of Scoliosis)
190. What position should the nurse place the client post left knee amputation?
Answer--The first 24 hours the amputated leg can be elevated on a pillow to reduce the
swelling. Thereafter the leg should lie flat on the bed or the pt should be placed prone
for some hours a day
191. A client who is in reverse isolation related to low white cell count. What is the
appropriate nursing action?
Answer -- Place a mask on the client when going out for a procedure
192. Before feeding a client you checked for residual and the residual was 100 cc. What
would the nurse do next?
Answer – Hold feeding, recheck within 1 hour if residual continues to be 100 ml and
more, call the physician
193. How would you position a client with a prolapsed cord?
Answer—Knee chest position or Tredelenburg position.
194. The pt who is to undergo surgery (eye) and you were supposed to administer preop
meds. Which order would you question?
Answer – Atropine
195. A six-month-old infant is seen at the well infant clinic. Which vaccination would the
child receive today?
Answer – Hepatitis B

196. Pt is taking an antipsychotic drug and asks why he is taking Cogentin too? (SATA
question)
Answer – To treat extrapyramidal effects (EPS)
197. A client diagnosed with anorexia nervosa; which manifestation would confirm the
diagnosis?
Answers (a) Pt wants to eat at night only
(b)Pt purge after eating
(c) Pt states I have not seen my menstruation for the past 4 months ( plausible answer)
198, A SATA question on Levonox drug
--- pt should use soft tooth brush and avoid flossing teeth
--- Pt should trash safety razor and use electric razor
n Pt should get blood drawn every month for PTT level
n Pt should eat a lot of green leafy vegetables
n Pt should take Aspirin OCD
199. What should alert the nurse before administering Lithium to a client?
Answer -- Pt states he feels thirsty
200. A client states that her dad who has Alzheimer disease is behaving abnormally
than usual. What behavior would alert the nurse that the Alzheimer pt•s condition is
deteriorating?
(a) Pt cannot talk anymore
(b) Patient wanders
(c) Pt puts on different colors of socks on each leg
(d) Pt puts on his army uniform and states he is going to fight in world war II
201. What activity would you advice the client with sickle cell to avoid?
Answer--Mountain climbing
202. Cialis—what important pt teaching should be given?
Answer: Take meds 1 hour before intercourse
203. A woman who passes urine while laughing; what sort of incontinence is she
experiencing?
Answer: Stress incontinence
204. What is Babinski reflex used for?
Answer: Check for neurological function.
205. If you are taking Viagra and have an erection for more than 4 hours report it to your
Doctor.
206. When administering eye medication, position the client on the affected side.
207. A client with Bipolar Disorder is hyperverbal and taken over peer group.
Answer: Tell him others need to talk
208. A woman with colostomy who states she loves to swim.
Answer: Tell me about other activities that interest you.
209. A pt teaching for a client who is scheduled for EEG
Answer: Shampoo hair the night before; do not apply any grease after washing hair.
210. Electroconvulsive therapy: procedure involves inducing a seizure for 30-60
seconds.
211. Allen Test—what would you explain to the client what it is about?
Answer: To test for radial and ulnar artery circulation.
212. The client with neutropenic precaution: do not bring gifts of fresh flowers, raw fruits and stuffed
animals.
213. Which client would you give private room if there is only one available?
A. Client with Impetigo
B. Client with conjunctivitis

214. What cultural consideration would be important to the Hispanic mother who has just delivered a
baby?
Answer: Protect from the evil eye
215. Be familiar with the meaning of these psychiatric terms related to side effects of
psychotropic meds (EPS). This questions were in SATA format
(a) Tardive dyskinesia
(b) Dystonia
(c) Akathisia
216. Which lab values would the nurse monitor for if a client has Liver cirrhosis and
esophageal varicesAnswer: Most probably is hematocrit
217. Lithium question: The answer is to maintain consistent amount of sodium (Salt)
218. A question on hypothyroidism
219. Lots of question on infection control----VRE, MRSA, C.diff, VISA, shingles(herpes
Zozter), scabies, pin worm, impetigo, , TB, Pneumonia
220. What should the nurse do before transporting a TB patient outside his room.
Answer: Provide mask for the pt to put on.
221. What nursing intervention would be appropriate for a client who has Bell•s palsyAnswer: Administer
eye drops (artificial tears) into the affected eye to prevent dryness.
222. RSV (Respiratory Synctivial Virus)---safety precautions to avoid transmission. The
answer would most probably related to hand washing.
223. What would be the cause of stomach cancer?
Answer: Smoked foods especially meats
224. Infection control question on pediculosis
225. A SATA question on client who is undergoing cystoscopy?
226. How does Ducolax work?
227. What you assess in a patient with diabetic neuropathy?
228. What are the signs of Toxic Shock Syndrome?
· Sudden spiking fever
· Flulike symptoms
· Hypotension
· Generalized rash resembling a heartburn
· Peeling skin on the palms or solesTSS is associated with the trapping of bacteria in the reproductive
tract for a long periodof time. Risk factors include the prolonged use of high absorbency tampons,
cervicalcaps, or diaphragms.
229. How do you prepare a client for cholangiopancreatography?
230. How do you describe the presence of scabies on the skin?
Answer: Scabies causes curved or linear white erythematosus ridges in the skin that areeasily
visible.rugrats
231. What is expected in a 6-month-old child?
(a) Crawling all over the house

(b) Sitting with support (most probable answer)
232. A significant finding with client with Anorexia nervosa is Amenorrhea.
233. What food would be recommended for clients with cystic fibrosis?
234. A question on Somatization Disorder
235. Bell palsy: Give artificial eye drops in the affected eye
236. Which of these statements is correct?
a. Women of child bearing age should eat foods containing folic acid
b. Women should take folic acid 30 days after they become pregnant..
237. SATA question on Intravenous Pyelogram (IVP)
238. Which of the statements on documentation is correct?
(a) Every proper care taken and all occurrences would be documented in order to avoidlaw suits.

(b) I will not document in detail
© I will use abbreviations and short cuts
238. Which of these patients would you room alone?
(a) Pt with stage 2 ulcer in the coccyx
(b) Pt with productive cough and the color is green.
239. Pt undergoing Alcohol withdrawal 48 hours later-- will suffer from Delirium Tremens
(DTs)
240. Teaching to a diabetic client==== carry sugar with you always when exercising
241. Which of these clients is at risk for developing Osteoporosis== a pt who hasSalpingooopherectomy
done. (Removal of the ovary would cause lack of estrogen)
242. Teaching for a client with Buergers• disease is=====smoking cessation.
243. Which is normal for a 2 year-old?
a. Running with a wide-stance (most probable answer)
b. Drinks a bottle of juice before taking a nap.
c. Uses 30 words and points to objects.
244. A question of neglect in a facility. The most plausible answer may be====neglect
could be noticed by malnutrition or dehydration in old people.
245. Which statement made by the client would indicate a correct understanding ofcongestive heart
failureProbable answer: I will call my doctor if my ankles and feet are swollen.
246. What would the nurse consider as normal after a prostatectomy?
(a) I will experience urinary dribbling for 2 weeks
(b) Will have blood-tinged urine for 2-3 days
247. What are the signs and symptoms of hypermagnesemia.
· Bradycardia and other dysrhythmias
· Hypotension
· Lethargy or drowsiness
· If not treated, the client would experience coma, respiratory failure, or cardiac failure
248. The client with femur fracture complains of pain of 8/10 after pain meds have beenadministered.
What should the nurse assess further?
a. Capillary refill
b. Pedal pulse
249. Client with nasogastric tube--
a. Check vital signs q 8h

b. Irrigate tube with normal saline ---possible answer.
c. Check for sodium
250. Pt teaching you would provide for a client undergoing ultrasonography
251. ECT> what it is used for; and NPO for 12hrs.
252. Gastrostomy tube> SATA
253. EMG > client will experience slight pain.
254. T.B > SATA
256. Circumcision > apply pressure with sterile gauze if bleeding.
257. Alcoholic . what nutrient the client is lacking=thiamine
258. Guillian Barre --what to monitor= pulse oximetry
259. Shingles > a Picture was shown = contact
260. How would u know that a wound is healing = red and moist
261. Basal-cell carcinoma = rolled-up irregular border
262. P-wave at 250, and saw-toothed = atrial flutter
263. Buspirone: how long it takes to begin working = 1-2 wks
264. food low in potassium and phosphorus
265. BP on newborn= arm and thigh( about 75/48mmHg
266. cardiac stress test.

267. A client on O2 = no smoking in the room
268. food for a client with coronary artery disease = complex carbohydrates
269. What is the effect of Garlic = reduces hyperlipidemia, and reduce BP.
270. Further teaching for alendronate(Fosamax): = taking it with milk.
271. Which case will u report = a newborn with apical pulse of 90 bpm.
272. osteoporosis: = do a 3 day/ week wight-lifting exercise
273. aplastic anemia; further teaching
274. SIADH = wt. gain
275. Judaism: SATA = let family member to see the body
276. Delegation for UAP = range of motion every 4 hours.
277. Agranulocytosis: = put in a private room
278. Acute Glomerular nephritis
279. Opioid: > preoperative teaching.
280. Picture of a hand and inflammation = elevated ESR
281. A pregnant woman at 30-weeks; what else should be in the room = fetal heart
monitor
282. SATA on mild & moderate Alzheimer•s disease
283. Pt. teaching on Alzheimer•s disease
284. pt. teaching on renal failure
285. S/ E of bumex
286. dragging on occult blood test
287. the cause of beriberi disease
288. the cause of rickets disease
289. when r u going to put on thrombolytic stucking
290. diabetic foot care
291. how do prepare ampule
292. TB –pt. teaching on infection control

293. who need a private room
-a pt. with rubella
-a pt .with Impetigo
-a pt. with HIV has NG tube

-a pt. with pneumonia
294. a pt. understanding teaching on neutropenic precaution = the pt. asked the nurseto give him the gift
card &leave the flower in the nursing station
1. Position for hip replacement: abduction2.Guided imagery: reduces the pain I am experiencing.
3.Scabies: wash clothes in hot water
4.Chovostek sign: twitching of face5.know how to mix regular insulin and nph insulin6.hook worm: tell
children to wear shoes when playing outside.
7.CVA patient: give patient a pencil and pad as a means of communication.
8.post bronchoscopy: do not give anthing by mouth until gag reflex returns9.position for incentive
spirometer: sitting upright (90 degrees) then put your lips on themouthpiece.
10.Alzheimers patient: place familiar items on her door if she•s getting lost to her own
room.
11.Schizophrenic pt. “I cannot swallow anymore. I can•t do anything anymore. Life is notworth living”
Nurses response: Are you thinking about killing yourself?
12. Phoslo use: Take it with meals
13:Patient states “I•m tired of living. Nurses response: are you trying to kill yourself?
14.Child has a Right Femur fracture and multiple bruises. Nurse suspects abuse. Nurseshould: confront
the parents directly.

15.Patient with low hematocrit: should rest more
16.MRSA precautions: contact precautions. Meaning the patient uses equipment one
time and discard(single use)
17. how do you dry a wet cast: Allow to dry with ambient(room).
18.Alcohol: may lead to a decrease in life expectancy19.How do patient with Guillian Barre syndrome
eat: it•s better to have mashed potatoesthan milk. (thickened liquids)
20.DiuRil:decreases potassium level21.DiuRil: check blood pressure every day.
22.Newborn complications:blue hands and feet.
23:Ileostomy: does not require irrigation24:Priority patient nurse should take care of first:
C.O.P.D25Pneumonia precautions: mask, gown
26. MAOI: avoid aged cheese27.Patient states: “ the person on the tv is calling me. they want to kill me: it
must be afrightening feeling28.Know how to take Lopressor29 know about prednisone
30False statement about STD: pregnancy reduces STD.

31.Signs of tonsillectomy complications: frequent swallowing
32.Abnormal wbc value: 15,000(normal value:5000-10,000)
33:high glucose level:140 (normal value=70-110 )
34.Treatment for MI(myocardial infarction) : urokinase, streptokinase IV.
35.Know the cause of primary hypertention
(male,age,black,stress,obesity,sedentary,sodium,smoking,family)etc.
36.know eg. of negligence
37.food low serum potassium level:6.1 MEQ( this is different from potassium
leve(3.5-5.0)
38.11 year olds have interest in: playing with the opposite sex(double ck in peds book)
39.wrong with sickle cell disease:(stressful exercise,high-rise,dehydration,iron overload)
40. Things to document on a mental client(select all that applies)
41.Abatacept(Orencia): for rheumatoid arthritis
(low immunity, risk for cancer, avoid immuniztion)Know the side eff and nursing
intervention,
42.Nexium: for heart burn
Nursn int: take 1 hour before meals.

43.Viagara: for Erectile dysfunction. Know the side eff .and nursn. Intervention44.Scarlett fever: skin
condition from strep A group.
Signs and symptoms:
.sandpaper rash . enlarged tonsils . swollen lymph nodes. Red strawberrytongue .pale around
mouth .pastia lines:darkening of the normal skin creases.
45.zocor: decreases cholesterol
Side eff: hepatotoxicity, muscle weakness,

Nursn int: avoid fats
46. Anorexia nervosa(select all): signs and symptoms

.ammenorrhea . electrolyte imbalance . alopecia . weight loss . manipulation47.Milia: pearly white pin
point papules on face and nose of newborn.
48.Arm tunnel syndrome: wear wrist splint on and off every 2 hours49Pregnants mom•s statement to
follow up: she has headache and swollen face.

50.14 year old had an emergency car colition. Signs of ICP:
.decreased LOC . change in pupil dilation(ipsilateral pupil dilation) .criduca:patientcries like a
cat .contralateral loss of motor function .leakage of CSF . increasedtemperature and BP .decreased
respiration and pulse . lethargy . headache51.Fosamax: for osteoporosis.
Nursn int: take it sitting up and also 30 minutes before meals.

52Vaginal fistula: urine and feces passing through the vagina
53.38 weeks pregnant womans• teaching to follow up about exercise: doing exercise flaton her stomach
54.lochia xerosa: (5-10 dayd) color is pint and thick
55. moms• statement about her 2 year old son which requires follow up: my child cannotsleep without
drinking milk.
56.captopril: for hypertention
Side eff: cough
Nursn int: take 1 hour before meals
57bumex: for edema, water retention, CHF, kidney disease(works like laxis)
Know it•s nursn int

58.patient teaching concerning nitroglycerin: stand up slowly, keep in dark bottle,
discard after 6 months,
Side eff: hypotension, facial flushing, headache.
59. lactulose (select all that applies)

Know its use: laxative/ rids ammonia
Know the side eff: diarrhea, etc etc60positive for PPD:
Meaning patient has had an exposure and will be put in a negative pressure room.
61.food with low Na: baked potatoes
62: child with thrombocytopenia: should play video game inside. It will limit outside
activity.
63.prednisone: corticosteroid. Do not stop med abruptly. Know signs and symptoms.
64.Addison•s disease: lacks cortisol. Know the signs and symptoms.
65. cushings syndrome: increase adrenal cortisol. Know sighs and symptoms.
66.statement about diabetes insipidus to follow up: no matter how much I drink I thirst
67.infection control for a TB patient: x-ray, with mask( n-95 respirator)
68.TB preventative measure: isolation precaution( airborne isolation and negative
pressure room)
69. cholestipol: for reducing cholesterol.
Side eff: muscle weakness and spasms.
Causes bronchospasm in asthma patients.
70.Trousseau sign: tremors on the arm when blood pressure cuff is applied.
71. lithium: eat low salt and more water but in moderation.
72narcissist: someone who thinks everything she does is the best.
73. a person states she is chocking, nurses response and action: place a ball of fist
underneath her abdomen(heimleck)

74.signs and symptoms of glomerulonephritis:
.coca-cola urine(dilute ice tea urine)
Foam in the toilet
High bpFatigueDecreased frequent urination:oliguria
1. Infection control: VRE,TB,Pnemonia

asking questions about the isolation for these illness,who would you put in the isolation
2.Scabies question,how would you take care of this person
3. who would you put in isolation impetigo or conjuntivitis

4.Rubella question,what precautions you warn the pt about before you give the shot andafter: pregnancy
5.cardiac cath: pre,post op care

6.code of ethics,know this well. got a couple questions on this
7. math questions: child weighing 40lbs and medication comes 30mgs and is available
250mg/5 how many mls would you give?
8.lots of select all that apply most of my questions were hypothyroidism,hyperthyroidism
9.a medication that I hadnt seen before something called zexa,I think
10.prednisone med side effects
11.review mr.pauls questions,book some of the questions was on the test from the last
set he gave us
12.Contact question on HIV pt.
13. A question describing DI,just know the syptoms of this disorder

14. question on a pt who had a GI procedure and had complications of pain,nauseagave you choice of
what food caused the complication
1.scrambled eggs,2.yogurt,3.tuna fish 4. cant remember the next choice
15.Maternity question describing placent previa
16. how many pernial pads, the question stated pt went thru 5 pad in hr.
17.priority questions who you see first,know the abc's for these questions
18.drag drop question that you put in order for medication
19.blood transfusion question on pt who started cough,dyspnea which problem is this:
hypovolemic shock,febrile,fluid overload,can't remember the 4th question.
20.medication question what should be corrected,i think the answer to this:

documenting on a chart that you gave a medication instead of the mar
21.questions on VRE,TB,Pnemonia please know the isolation for these--can't express it enough
1...someone with impetigo, what kind of rash will u see?

Ans…blister filled with yellow fluid, oozing and crusting
2...infection control for pertussis (what to wear)

3...some1 taking levodopa/carbidopa, what•s the patient teaching?
Options…a. Take sometimes in the morning or before bedtime
B.avoid foods high in pyridoxine (vit b6)…
4. Infection control for RSV (know what to wear)
5...infection control for asthmatic bronchitis patient (this came as an exhibit)

Options
a. Wear mask
B.put on a gown
C.avoid putting flowers in the client room
6...some1 with 1500WBC count, what information will you give to the patient
Options
a. Use electric razor
B.ask client to take frequent rest when he is on vacation.
7...exhibit..low Hb and low HCT,whats patient teaching
Ans…frequent rest period
8...what are the signs and symptoms you see in a patient taking omeprazole that will
make you to hold the medication.
Option
A.3 frequent loose stool in the past 5hrs
B.headach and vomiting
9.side effect of Nixium(I know its for GERD)
10. Foods low in potassium and phosphorus (since you know the food high in
potassium, choose any option that has no potassium in it)
11. Patient teaching on hydrochlorothiazide
Ans...Increase potassium intake
12. What will you see in someone with mild concussion?
Options
a. Fixed dilated pupil
b.apnea
c.bradycardia
d.amnesia
13. what will you see in some1 that had head injury 1hr aga that will make you call the
physician
Options
a. Pupil of 3mmirs ago is now 4mm
B.bp 140/82
C.glasgcow score of 14 is now 12
14.patient teaching on nitrofuratoin
Options
a. Take other forms of oral contraceptive
B.take in an empty stomach to aid in absorption
C.take 1hr after meals
15.what is HMG-COA reductase inhibitors used for?
Options
a.antiplateletB.treat myocardial infarctionC.reduce cholesterol
16. How to collect urine sampleOptionsa.clean the perineum with providine iodine.
b.collect the urine in a container with ice and take to the laboratory within 1hrc.ask client to initiate
voiding,stop and ask client to finish voiding.(I choose this 1 becosit looks more like a mid stream urine
collection)
17.s/s of cushions18.s/s of AddisonAns..patient craving for salt19.infection control for viral
pneumonia20.laboratory result for some1 with hypothyroidismOptionsa.increase thyroid stimulating
hormonesb.increased trioiodothyroxinec.increased thyroxine21.what needs immediate attention after
thyroid surgery isAns..tingling of the mouth22.T10 soinal cord injury after days,what will show patient
understand teachingregarding bowel movement?
23.constipation teachingOptionsa.reduce exercise

b.reduce fluid
c.take OTC laxative dailyd.try initiating bowel movement yourself daily24.PT with myasthenia gravis
and paraplegia,what shows that patient needs moreteachingAns..asking his boss if he can come back to
work25.SATA…patients bill of rite26.depo-provera,correct statement by ptAns..i might gain weight while
taking this medication27.pt with new colostomy,whats statement means pt understand teaching?
Optionsa.
a.i will change my colostomy every day to avoid odor
b.i will gradually increase my fiber intake(I choose this but check)
c.i will clean my colostomy daily with providine iodine28.s/s of pre eclampsiaOptionsa.blurred vision
b.polyuriac.seizure
d.no deep tendon reflex29.what information will you report to the charge nurse?
30 .patient on radiation therapy..what is the correct statement made by the patient?

Options
a.i should mentain no contact for several hrs after the therapy
b.i t can only affect my friend only if they come incontact with my secretions
c.my friend should maintain atleast 3 feet away when talkin to me.(I choose this optionsbecos the B
options said ONLY)
31.what medication will you question(check kelfiprim for seizure becos that was the onlyodd 1 at of the
options)
32.correct definition of denial,compensation,displacement,projection33.s/s of toxic shock
syndrome34.some1 post cataract surgery whats the teaching?
35.pt with incontinence teachingOptionsa.use two padsb.frequent bathroom schedulingc.wait till you have
the urge to void36.s/s associated with Huntington
diseaseOptionsa.bradykinesiab.apneac.bradycardiad.seizure
37.what is contraindicated in a child with epiglotitis38.pt teaching on burspironeAns..effect take upto
2-4weeks39.picture.(skin with chicken pox).what is the correct statementAns..its caused by a
virus40.sata..pictures on different skin disorder,which 1 will you assing to a CAN?
41.remal calculi preventionAns..increase fluid
42.wrong statement with some1 with aplastic aneamiaAns…I will have to do a bone marrow transplant.
43.s/s of ulcerative colitis44.what test is require for a paragravida 8th weeks woman who is in the hospital
for herfirst prenatal check up.
45.what is the nursing priority for a pregnant woman in labor (early latent stage)
Ans…safety46.abnormal finding in a new born47.how to take blood sample from a newborn to check
glucose level48.knw signs of anxiety disorder
49.I had 3 question on suicidal thoughts.
50.many therapeutic communication51.many priority questions too
1. How to use crutch in a CVA patient: 4 gait
2. Where to assist client with left sided hemiplegia
3. Regular insulin: short or long acting

4. What will be your concern(Leucopenia or hemoglobin)
5. What will be your concern: HDL
6. Rheumatoid Arthritis: When to exercise
7. What will be concern post partum SATA (I am full, distended)
8. Which to follow up(platelet 75,000, WBC)
9. Which means he understands teaching( (A) I will drive my car in a month (b) I willride on train and
aero plane only (c) I will avoid microwave use
10. Which of the following will be a newborn (a)? Rounded abdomen?
11. Picture of wound requiring debridement (pack with wet gauze and normal saline)

12. Picture of back with rashes and normal saline
13. Sign /symptom of hypotension
14. What to check when on lisinopril?
15. What will the client teaching be following pacemaker insertion and discharge?
16. Addison patient complaint? I crave for salty food”
17. What to follow up when a diabetic says “ @ my HBA 1C will be checked in a week
or a month
18. What will be your concern in an adolescent with depression (when he starts givinghis belongings to
his roommate)
19. What will be your concern to a patient being discharged who has peripheralneuropathy? (Respiratory
rate)
20. PN concern in a patient with cast being discharged? (check neuro)
21. What precaution will PN take in cough and greenish sputum in the hospital
22. Advise to patient with HAV
23. Alcohol withdrawal
24. S/S RT. Heart failure
25. SE of Digoxin
26. PPD
Metoprolol 2 HCTH, 3 Scarlet fever Amilovide, Digoxin, scabies, pertusin, Cushing,
tomy wet, breast cancer, support group, electromyographyTrocal=Lower FXN
Depression=ECT
Bear in mind that you will have a lot of select all that apply questions. I have up to 18-20select all that
apply at a point I was so tires and lose hope never did I know that Gods isat work.
Please read your infection control, know all the disease that falls in each group ofcontact airborne and
droplet.
Know you hyperthyroidism, signs and symptoms and select all that apply will come outof this group.
Know your electrolytes and labor valuesKnow your priority delegation of LPN, RN,UPAKnow your
medication. I did not have much medication.
Know how to rearrangeRearrange on
1. Catheterization on Female client
2. NG Tube
3. Tracheostostomy
Hypothyroids sign and symptoms, it was select all that apply
Weight loss
Lethargic
Dry skin
Growth delay
Irritability
Patient is having myelogram test- check for allergy
Cystic fibrosis-best choice they do not absorb nutrient
End stage renal disease which electrolyte will be a choice. Potassium of 5.2
09/01/11
1. What can u child of 3 month can do?
- Turn from his stomach on his back
- Tonic head
2. What to feel over the fistula for a ct. on dialysis
- Thrill
- Bruit
- only way know about dialysis
3. Diet of a COPD pt.(SATA)

- low calories
- high carbohydrate
- high protein
- high in calories
4. BKA pt. how to position him the first hour of the procedure
- Elevate
- Flat
- Supine
5. Priority (who to see first)
- pt. with heart catheterization; 3hours ago
- child with Epiglotitis
6. A 16 year old girl is to receive MMR vaccine. What questions to ask?
- When was your last menstruation?
7. By testing gestational Diabetic, pregnant woman is schedule for fasting Blood exam?
- Give the juice then take the blood
- make he walk on b/w the test
8. How to use a cane(but the option really needed you to think a lot; I can't remember them)
9. Which one is contact
- chicken pox
- small pox
- thyroid
- plague(this is the one I chose)
10. Lot of infectious control
11. Lot of questions on what will show that the nurse charge for neglect(20 questions about neglect)
12. Main cause of sterility in women

- chlamydia
13. Elderly abuse

- U need to report
14. A child of a mild pt. with Alzheimer refuse to take him to his appointment
- abuse
15. Alzheimer pt.

- talk to him loving gesture
- dim light for him to rest(answer)
16. A pt. with BKA, What show acceptance

- the pt. is embarrassed in church
- the pt. says "I would have to take consideration of my situation when I shop"
17. SATA on panic attack
18. When to give Fosamax

- take at night
- early in the morning
- with milk
19. A drug ending with "Codone"(that is how I knew , it was a pain med, side effect was constipation)

20. A drug ending with mide( I guess it was -
- give at night
- push fluid
- can,t remember of the option
21. SATA on cushings
22. Question on Erythromycin
23. What to do in case of iron deficiency
24. foods low in Potassium

- chicken sandwich
25. drag and drop on female catheterization
26. A child cry and then play start crying again

- check stool
- prepare of surgery
27. How to ambulate a bling person where u stand
28. SATA on meniere’s dz
29. STD in elderly people; Are they more expose?
30. Allopurinol
- push fluid
31. Difference b/w RA and OA
32. Cocaine , Alcohol, Opioid know their sign of withdrawal
33. Jewish pt. care after death

- family stay with the body
34. SATA on normal aging process
35. How to palpate the abdomen. they were asking where to start
- End with the place where the ct. feel pain
- start where the ct. is not feeling any pain
36. what to do after lumbar puncture

- seat up
- drink water(I don’t remember other option)
37. What will be the concern before given Erythromycin

- Urine with foul smell
- sputum with blood tinge
38. Question about depression; How would the nurse know that the ct. is depress
- the answer was about the way the person talk , showing no will to live

39. Bladder irrigation
40. SATA : sign of hypoxia
40. Lot of question on pre-eclampsia and eclampsia where they asked for sign and what to do
41. Mild Alzheimer's(SATA)

- Talk to the ct. loving gesture
- provide calm and restful environment
42. How to test for gestational diabetic
43. Buck traction ; How to clean each pin site

- use different cotton for each site
44. What will the nurse do to be report to the board of nursing

- I can't remember options
13. The nurse knows that which of the following is an appropriate finging an 18 year old patient
- Rate of growth will decrease
- Rate of growth will be more rapid than ever
- Will ingage in associative play
14. Which of these statements if made by a ct. with Hep B indicates an understanding regard the
transmission of the dz to the child
- My baby can not be infected while in the womb
- It is unfortunate I would not be able to breast feed my baby
15. What do u expect in an 18 month old baby

- can stand and walk up to the stairs while holding someone
- other options were a lot higher than what an 18 month old can do
16. A picture that shows a stage 2 dirty wound. Nurse's appropriate intervention for the would
- Reposition the pt. every 2hours
- I can't remember other options including correct one
17. Appropriate meal for a patient with celiac dz
18. precaution for bacterial pneumonia

- droplet
19. The nurse is caring for a patient with Epiglottitis which of the following is necessary for the nurse to
wear before administering the medication?
- gown
- mask
- google
20. Syncytial virus

- contact precaution
21. VRE
- contact

22. symptoms of TB (SATA)
- weight loss
- Night sweat
23. Which of these pt. should the nurse see first

- a pt. that had bronchoscopy hrs ago and is coughing out clear sputum
- a pt. who had TURP 3 days ago and is passing pinkish urine
24. The nursing is conducting conference teaching on myasthenia gravis should emphasis that this
disorder
- results in extreme muscle weakness and fatigue that improves with rest
25. The nurse ambulating a blind ct. should

- give description to the ct. and monitor client's movement
- walk slightly behind the ct.
- walk ahead of the ct.
26. Which of the following medication prescribed for TB pt. would cause peripheral neuritis
- Ethambutol
- Rifampin
- Isonizide
27. Teaching for a pt. with Cystic Fibrosis

- take moderate protein
- take high calories
- take low sodium
28. The nurse teaches the ct. that the medication(Niacin) prescribed for him will help to control this
- Hypertension
- Hyperlipidemia
- Hyperglycemia
29. Drag and drop on urinary catheter insertion in a female pt.

- wash the vagina with water
- wash hands
- open the sterile field
- etc
30. Electro cardiogram
31. The nurse is teaching a group of new nurses about Autonomic dysreflexia, which of the following
indication understanding of the teaching(SATA)
- It is a potential life threatening condition
- occurs most commonly in indivisuals with spinal dord injuries above T6
- U causes decrease in blood pressure
32. A pt. has undergone coronary artery bypass which of the following statement by the pt. indications
understanding
- I need to increase my LDL
- I need to increase my HDL
- I need to decrease my HDl

33. A question on total hip replacement surgery
- Keep the legs abducted with pillow and give bed pan when needed
34. The doctor prescribed med for four ct. which of these orders should the nurse seek clarification
- Cyclosporine for a pt. that had lives transplant
- Pioglitazone(Actos) for a pt. with DM type I
35. which of the following ct. is at increase fisk of Lung cancer

- A pt. whose mother died of lung cancer
- A elderly pt. who lives in the same house with a son that smokes
36. The nurse should monitor a pt. on Lisinopril

- Hyperkalemia
37. The nurse found a pt. with DM typeI weak, diaphoretic and confused what should the nurse do first?
- give emergency juice
- check the blood sugar
38. About five different questions on what a GNA can do
39. The doctor prescribed Vancomycin hydrochloride for a child to be given 10mg/kg/day every 6hours.
The child weighs 33Lbs and the medication is available in 50mg/5ml. How many ml will the nurse give
for each dose?(Answer should be in one decimal)
40. The doctor prescribed Clozapine for pt. to be given 5mg/kg/day every 8 hours, the pt. weighs 200lbs,
the medication is available in 250mg.
How many mg will the pt. receive for each dose.(Leave answer in one decimal place)
41. SATA on defense mechanisms, Rationalization, denial, Repression, Progection, Restitution---Here

some of the defense mechanisms were defined wrongly, u have to select the ones that has correct
definition
42. A pt. had the extremities casted, a mouth later the legs were amputated. The family members charged
the nurse for negligence. Which of the following documentation supports the charge of negligence
08/31/11
1.Temper tramper a 2 years old
set a time of 5 minute to him
promise him some candy
ignore him
2.who to see first (priority)

pt. with hip fracture and tingling sensation on the sole of feet
pt. with potassium of 3.4
3.pt. had hip replacement 3 days ago, who to follow up

pt. said i put pillow between my leg to sleep
my wife should raise the home toilet up.
i will sit up and rising forward
4.pt. with cerebral palsy; to who would you refer pt.

a.neurologist
b.nutritionist

c.physical therapist
occupational therapist
pt. with huntington to who will you refer him

which of this the nurse delegate to LPN/LVN
pt. who need ambulation
pt. admitted 24 hours with MI
pt. with epiglottitis who just add thickened
7.schizophrenia pt. said to that nurse, i am hearing the voices. the nurse ask pt. what the voices are
saying. how can the nurse describe this
a.depression
b.auditory hallucination
pt. meniere disease how do you approach to him

cover your mouth when talking
raise and lower your voice
stay in the illumines when talking
question on cimetidine, what to follow up

pt. who is drinking milk
10.what to avoid when an vasotec(pril)

question on claspi
meter inhaler drag and drop
question on poison lead
question on mild Alzheimer
question on dialysis
what to follow up on with diabetic foot care
question on DVT
question on cardiac catheterization
question with ECT
question with HbA1C (need to know the range)
pt. have rash and said it is itching
diet of pt. with renal failure
depress pt. is caring oxygen and said if i can just explode this tank
hypothyroidism pt. ask the nurse if synthyroid is for life or for a period
question on pernicious anemia
question on rape
question on domestic abuse
question on lice
question on glaucoma
osteoarthritis
bronchoscopy
question macular disease
what man stress test is use for?
SATA a lot
1. A woman who is 40 weeks gestation is having clonus. What does that mean?
Spasms in the hand with cuff (possible answer)
2.Drag and drop Urinary catheter (The options are different)
3. Which of these medications will the nurse clarify (Exhibit on vital signs and lab values but all of them
are fine).

a) Glipizide
b) Chlorpromazine
c) Oxygen
d) Pulse oximetry
4. Lots of infection control. Eg. Impetigo, Pertussis, Meningitis, Influenza, Diphteria, Epiglottitis,
Mycoplasma, Pneumonia, Parvovirus BIG.
5. Select all that apply-Contact precautions.
a) Scarlet fever
b) Scabies
c) Herpes zoster
d) Impetigo
e)TB
6.What is the cause of peritonitis?
Rupture of the appendicitis (Possible answer)
7. Lots of priority questions. (whom to see first)
8. SATA Neutropenia precautions.
9. After colporrhaphy, what do the patient have?
a) Urinary catheter in place (Possible answer).
b) Clear liquid before surgery.
10. What does amniotic fluid do (SATA)
a) Cushion the baby and prevent from injury)
b) Clear in fluid (Possible answers)
11. Medication megal r. msgee (I can’t remember the spelling).
08/16/11
You are about to administer a MMR vaccine to a 16 year old girl. What question is of the highest priority
to ask her?
The date of her last menstrual period.
Any allergies to eggs.
If there is anyone in her household who is immunocompromised.
For a patient with a new order for Lasix, whish of the following would be of the greatest concern?
The pt has been taking Digoxin for the last 2 weeks.
The pt states the last time the dr gave me sulfamethoxazole/trimethoprim (Bactrim, my tongue swelled up
and I developed a rash.
The pt has been voiding frequently.
The pt is on Warfarin sodium.
For a patient taking Digoxin, what teaching would the nurse give him regarding the medicine?
It is used to treat heart block.
You can take the medicine with meals.
Hold the medication if the pulse is 64.
Which of the following features would be found in a preterm neonate? Select all that apply.
Pink skin with visible blood vessels.
Prominent creases on the soles and palms.
Lanugo covering most of the body.
Narrow labia with a prominent clitoris.
Select all that apply for Chorionic villus sampling.
Done to all women over 35 years of age.
High alpha-fetoprotein (AFP) indicates downs syndrome.
Can be used to detect neural tube defects.
Can be done at 10-12 weeks.
For a patient with mycoplasma pneumonia, select all the precautions needed.

For a pt with varicella, select all the precautions needed.
For a pt with inhalation anthrax, select all the precautions needed.
Precautions for a pt with scabies. Select all that apply.
For an elderly pt with moderate dementia and chronic Hep B which of the following is appropriate?
Private room.
The dietary dept should provide disposable plates and plastic utensils.
The nurse should wear gloves when providing incontinence care.
The nurse should wear gloves when taking vital signs.
For a pt with ulcerative colitis, which of the following teachings is correct?

Avoid milk products.
A bowl of oatmeal with fresh fruit is a good choice for breakfast.
Eat a high fiber diet.
Eat three large meals.
Which of these tasks can be assigned to a CNA?
Assist the pt to apply a condom catheter.
Teach the pt deep breathing and coughing.
Assess the pin sites for redness and edema.
A nurse has been sued after a diabetic client with a cast on the right leg developed an ulcer under the cast
and had the leg amputated. Which of the following documentation supports the pt’s claim of negligence?
Pt is complaining of pain in the right leg.
The patient is complaining of numbness and tingling of the right leg that has not changed since the cast
application 3 days ago.
The right leg is edematous on day 2, elevated on 2 pillows.
Which of the following pts would the nurse attend to first?
A pt on traction for 2 days who needs pain medication.
A pt admitted with pneumonia 3 days ago.
An elderly pt with COPD who is complaining of shortness of breath after using the toilet.
A pt newly diagnosed with diabetes who is due for discharge today and needs teaching prior to discharge,
For a pt with Labyrinthitis, which of the following symptoms are expected?
A feeling of fullness in the ear.
Vertigo and nystagmus.
SOB and palpitations.
Fever and drowsiness.
What teaching would you give to a pt taking Niaspan for elevated cholesterol?
Niaspan can be taken together with cholestyramine.
Take Niaspan in the morning.
Taking aspirin 30 minutes before Niaspan helps minimize flushing.
Niaspan can be taken during pregnancy.
Teaching for pt with Gonorrhea. Select all that apply.
Symptoms for panic disorder. Select all that apply.
When a CNA reports smelling alcohol in a nurse’s breath, what is appropriate thing to do?
Review the institution’s policy regarding alcohol.
Confront the nurse in an empty room regarding the accusation.
Notify the nursing supervisor.
Inform the CAN that you will investigate the matter further.

For a pt undergoing Chorionic villus sampling, which of the following indicates understanding of the
procedure?
I should avoid caffeinated beverages on the day of the test.
I should bring someone to drive me home since I will be sedated for the test.
I will be placed on bed rest for 24 hours after the test.
I should have a full bladder during the test.
Which of the following pts would the nurse see first?
A 9 month infant on Bryant traction.
A 4 year old recovering from meningitis for 2 days.
A 8 year old admitted with a closed head injury who is drowsy and is vomiting.
A 16 month old with otitis media.
For a pt undergoing posterior colporrhaphy, which of the following is accurate?
Pt will be required to douche on the first night postop.
Pt will be sent home with a foley catheter.
Pt will be on a liquid diet for 24 hours before the surgery.
Enema will be administered preop.
For a pt with mechanical intestinal obstruction, which of the following is accurate?
The nurse should not palpate the abdomen.
Enemas will be administered.
Strict intake and output.
The pt is put on a liquid diet.
The cause of Turner syndrome is?
Autoimmune
Chromosomal
Bacterial
Viral
For a pt with hepatic encephalopathy, what might the nurse observe?
Asterixis
Numbness and tingling of the extremeties
Nausea and vomiting
Gait disturbances.
For a pt exhibiting muscle weakness, constipation and dysrhythmia, which of the following might be the
cause?
Hyperaldosterone
Addison’s disease.
Aldactone (spironolactone)
Lisinopril
Which of the following PPEs should the nurse remove first?
Gown
Mask
Gloves
Goggles
Which of the following would require a one on one caregiver?
A 3 month old recovering from cleft palate repair.
A 16 month old recovering from viral meningitis.
A 6 year old with laryngotracheobronchitis.
A 3 year old with pneumonia.
29)What teaching would be appropriate for a pt postop inguinal hernia repair?

No heavy lifting for 1 week.
Elevate the scrotum and apply ice packs to reduce swelling.
Coughing and deep breathing postop.

30)What discharge teaching is accurate for a pt with TB?
Expect yellowing of the skin as a common side effect of the medication.
The pt is no longer contagious after one sputum culture is negative.
The pt will need to wear a mask when out in public places.
The pt might have to report to an outpatient clinic daily for medication administration.
31)Which of the following pts would the nurse see first?
A 6 year old with a cast who is complaining of discomfort.
A 13 year old in a sickle cell crisis with 60ml remaining in the IV bag.
A 16 month old recovering from rheumatic fever.
A 3 year old with chicken pox.
32)Which of the following is true regarding electrophysiologic study(EPS)?
It’s not invasive.
It’s used to test the electrical conduction system of the heart.
It’s used to study the functioning of the brain.
33)Precautions needed for Diphtheria. Select all that apply.
34)When should the female pt do a self breast exam?

35)Patient teaching for bisoprolol(Zebeta).
36) Which of the following is accurate regarding Herpes Zoster?
I’m immune since I had chicken pox as a child.
I will have to deal with the moderate pain caused by the disease.
The prescribed acyclovir(Zovirax) will reduce the severity of the symptoms.
1.A patient diagnosed with (acute respiratory disease). What is the priority care for this pt at the
beginning of the shift.
a. Increase fluid to soften mucus
b. Check lung sound every shift
c. Put in tredenlenburg position
2. How can you identify a child with hip dsyplasia
3. A woman 55yrs old on chemotherapy, what would she not eat
a. Lettuce
b. walnut
c. salad
d. Grill turkey
e. Roasted beef
4. What is the risk factor for breast cancer
a. Excessive alcohol
b. smoking
c. Use of oral contraceptives
d.
5. A female pt newly diagnosed with breast cancer told the nurse not tell the husband because he has a
bad heart . What is the best response
a. I will not tell anybody
b. it is illegal for me to reveal to you medical information without permission
c. Why are you afraid to tell your husband
d. You seem to be concerned about how your husband will feel about your breast cancer
6. A patient taking tetracycline for gastric infection , what will the pt not take?
a. Milk & milk products

b. Cabbage
c. Orange
d. Salt
8. What is respondea superior?
9. A pt with this lab Dx & cardiac + strip (exhibit) showed?

a. Lab: Hb 12
WBC 8000
K+ 3.1
Na 136
b. EKG a fibrillation and CAD
Which of this med will you not give?
A. Vasotec
B. --sartan
C. Another -pril
D. furosemide
10 Your are infusing a packed RBC on a pt she starts having chill pain radiation to the back and urticuria
what will you do?
Stop infusion
Give 0.9 Na chloride
Notify the family
Continue to monitor elevate the legs
11. Pt infusing iron dextran what will be the intervention for this med?
Keep pt at high fowler after infusion
Have emergency resuscitative equipments available in case of server and fatal allergic reaction
Give po orange juice during infusion
Monitor IV site for infection
12. Pt with scabies should be on what isolation?

Contact droplet
Airborne
No isolation
13 Pt with pertussis should be on what isolation?
Droplet
14. Pt taking bumetanide (Bumex) how will you know it is having therapeutic effect?
Ankle edema reduced (measure the ankle size)
Offer a cup of chicken soup
Give fried scallop
Elevate the feet.
15. A Pt with gout which of these food pt will not eat?
Fried scallop
Baked bean
Whole grain
Fried chicken

16. A 54 yrs old lady came to the clinic to complain of lack of sexual drive and vaginal dryness. What will
the nurse suspect to be the underline cause.
A. Elevated Estrogen
B. Yearly Mammogram
C. Lack of interest in sexual life
D. Give prescribed OCP to stimulate her
E. Menopause
17. Huntington chorea what is S/S of this disease
A. Restlessness and dance-like movement
B. Lethargy.
C.
D. Non compliance with medications
18. Know the site for PPD (Exhibit)
19. Exhibit to identify vastus lataralis for IM injection for a child.
1. Question on when to give Humolog(fast action)
2. What to monitor a pt. at hyperthyroidism that is on steroid

- Infection
3. Drag and drop on how to do finger stick

- choose a sight
- Rub or squeeze the sight: clean with alcohol
- Position your needle in a way: can't remember what they call the position to put your needle
- Pinch the sight
- Squeeze off, clean the first blood because it might be a mixture of alcohol and blood
- Then got a sample of the blood
4. Drag, drop on rights of giving medication

- Check the history of the client to be sure the drug is compatible with the history
- Open and put the med in a cup
- Identify the pt. with the wrist band Id
- Administer the med and stay with the pt. to make sure they swallow it
- Document the procedure
5. Exhibit on potassium 3.1
6. Select all that apply on sign of hyperkalemia
7. Select all that apply on sigh of hypocalcimia
8. What will you to after colporrhaphy surgery
9. Question on penicillin : what to teach the mother
10. Question of cranial nerve you are testing when u tell the ct. to say “aaah!”

11. What will pt. with bell's dz tell you that will require further teaching
- I picked that she'll say she can't eat whatever and swallow while testing since the disease has nothing
to do mother throat
12. A lot of calculation questions about converting Lbs to kilo

- eg) A doctor orders 150mg/kg/day of erythromycin to be given every hrs the med is available in 50g
per 100ml and the child weigh 180Lb, how many mls will you give per dose : some ask to round to
whole number, 1 decimal point (nearest tenth), a lot of this
13. Question on a pt. that has C diff, RSV, TB mostly about the infection control leaflets that was given
to us at the tutorial center
14. What mask do you use when treat a pt. that is on droplet precaution
15. Select all that apply to a pt. on airborne

- Do you needle to wear a shoe protective
- How many circle should the air be doing per hr: This come out exactly like 6-12 air exchange every
hour
- Do u need to wear ngs for the pt. when going out of his /her room
16. Question on Aricept : who to give
17. Question of what to increase in a pt. that has just finish dialysis
- They put to increase high biological protein
- I don't know what they mean by biological but that's what I picked since I know they loose protein
with dialysis
18. Select all that apply on what to give to a baby in the first 2hrs of life
- Vitamin K shot
- Erythromycin and I know I shouldn't have chosen Hep b shot but I did
19. Therapeutic communication
20. What will you see in a pt. that is antisocial
21. Question on arterial fibrillation

- That's what they are asking
22. They have just removed a temporary NG tub in a pt. what is the first nursing intervention
- Lubricate the nose
- Raise the head of the bed : 1 choose this
23. This question seems more anatomy about what happen when the diagnose pt. on arteriosclerosis
- they asking what is happening to the vein or artery : honestly I don't know what I choose
24. A question about a PN delegating a clear and accurate task a CNA
25. A ct. that has never worked in a surgery and they are floating her there because of under staff
- the right task to give
26-Life style modification for a patient with hypertension.

27- Exhibit on pt. on chemotherapy what lab result will u see that will require scheduling the next
chemotherapy or radiation to another time– Low WBC

28-A PT with a new stoma says he will expect his stoma or be violet or purple color- teaching is not
effective
29- Signs of EPS(extrapyramidal syndrome) is noted what will u teach your patient.
30-A lot of questions on beta blockers and who not to give
31- A pt on Amiloride and having leg cramps
32- what can a nurse do to increase her chance of negligence
33-Bucks traction – 5- 7 lbs
34- 11 months hold baby will do which of the following
Arranging blocks
Saying some words
Walking with support – ANS
35- What will u see in a pt that will suggest been high Opiate
Pm point pupil
36-What will a pt say that will confirm depression
Not been able to sleep- insomnia
37- how do u treat a child with a lice
38- how do u treat a child with scabies
39- A pt is diagnose with HEB.B and the and the partner say she will have to wash her hand very well
and be extra neat since it is fecal oral – This show she need further teaching.
40- SATA on symptoms of TB
41- Question on Clozapine – Agranulocytosis
42- A lot of question on patient teaching, delegation, therapeutic communication, infections control
mostly on droplet.
NCLEX AUGUST 3,2011
Three questions on ECT

When is ECT used = The patient is severely depression and fails to respond to several anti-depressant
therapy.
What to expect from a client after a ECT= SATA =Confusion, Nausea+vomiting,
Description of ECT= Electricity is used to stimulate the CNS
Borderline Personality
Expected behavior of a 9 years old boy SATA= Riding a bicycle, taking part in sport, and competitive
games
Delirium Tremors= Tremors, Diaphoresis
Korsakoff syndrome= confabulation
Droplet precaution= SATA = pneumonia, pertussis
Lacto-vegetarian =SATA= Milk, Cheese, yogurt, Vegetables…….NO EGGS
Prednisolone= monitor for hyperglycemia
What to expect on a baby the is 42 weeks= dry cracked skin
Use of Cane= place cane on the unaffected side
Used of crutch going down the stairs= affected leg
BPH= what do you expect = frequent urination at night time

What do you expect a two year old to be saying = the only option I see correct was saying NO to
everything you asked him
What to do if there is fire in a patient room=options drag and drop
Bring the patient to safe area

Report
Close the door
Extinguish the fire
The Md order 5/mg/kg of streptomycin the infant weighs 16 pounds . The drug is available in 10 mg.
How much will the infant receive………The was 2 questions like this ( one you have to round off to
nearest tenth and the other nearest whole number)
A question on Projection
A patient opoids overdose= constrict pupils
Care conference for a pt with HIV
Who would you refer to a dietitian = some one on MAOI
Hypocalcemia = tenany
Paroxetine= treat premature ejaculation
SATA= BIPOLAR= elation, flight of ideas, bounding energy, suicidal
Right Hip replacement= Log Roll, keep leg abducted
Precaution – a pt with a wound that has excessive drainage= what to wear, = glove, gown, googles
Postpartum = abnormal= distended abdomin
Meconium 2 questions
GERD what to avoid= caffeine , alcohol, carbonated beverage
A person with a illeostomy = avoid foods that causes flatus
A patient is prescribed =
Epiglottitis
Laryngeal cancer= tobacco, alcohol
HCTZ= monitor potassium
What to delegate to UAP lot of questions = out put, intake, temperature etc..
Fluphenazine= agranulocytosis
A pt is allergic to floroquinolones which meds should not be given= Ciprofloxacin
1. What teaching for a pt. with meniere dz

a) to take diuretic daily
b) to ambulate frequently
2.How to check for a Cullen test
3. Signs of hypernatremia SATA
4. What a nurse will teach a spouse when her partner during seizure
5. What a spouse did to her partner during seizure that shows she need further teaching
- Ans; holding the legs and hands during seizure
6. Pt. taking Norvasc for angina pectoris, what the pt. said for the nurse to know that understanding the
teaching
- I can't take my Nitrate when taking this med
7. Calculation : change Lb to Kg doctors

- keep ans to one decimal point
8. What to do for pt. suffering for hepB SATA
9. Who at high risk for Hep A

- Ans ; A day care worker
10. hypocalcemia SATA
11. A lot of conference meeting like 20 something SATA
12. A medication called Sulindac SATA
13. A pt. with right sided stroke SATA
14. How many word can 5yrs old says?
15. What is abnormal in 4yrs old

- Ans ; when 4yrs says only 500 words
16. Which group like masturbation?
17. What are going to see as a new nurse see another nurse doing to know its negligence?
18. Pt. before taking Allopurinol

- check the liver function test
19. A pt. on sickle cell crisis what a signs

-Ans ; pain, pain,pain......
20 Pt that is on bleeding precaution what needs further teaching?

Ans; I will decrease my green leafy vegetables
21, Pt on niaspan sata
22 how to use cane sata
23 crutches coming down stair further teaching
24 how to walk with Pt visually impaired?
25 How to asses Pt Loc sata
26 First stage of Alzheimer , what you will see to help Pt
27, Pt talking capoten (pril) what teaching is effective
Ans: it will help with my diabetes
28 Sata on acute glomerulo nephrtis sata
29 sata on contact precaution
30 sata on airborne Isolation
31 what to do for Pt with heb
Ans: wash hands in between activities for same client
Further teaching on clear liquid sata
32 Alendronate further teaching
Ans: Pt state in need to take med in the night when about to sleep
33 conflict management sata
34 informed consent sata, what the nurse is doing that is wrong
Ans: 1) helping pt to write her signature 2) advising the pt on what to do
35 Best place to give MMR vaccine
Ans: deltoid

36 Further for CAN
Ans: taking vital signs with pt with Hep B
37difference b/w RIa and OA
Ans osteo have herbedeen nodes
38 what to report to physician
Ans pinkish urine after prostate surgery
39 Pyelography
Ans: increase fluid
40 After lumber puncture sata
41 Lice on children
Ans: reportable signs of sexual abuse
42 what to report to board of nursing sata
43 to put in private room sata
44 hydrocephalus sata
45 celiac disease food to avoid sata
46 A what teaching for a patient with meniere disease
Ans to take diuretic daily
B, to ambulate frequently
47 how to check for a Cullen test
48 signs of hypernatremia sata
49 what a nurse will teach a spouse when her partner during seizure
50 What a spouse did to her partner during seizure that shows she need further teaching
Ans holding the legs and hands during seizure
51 Pt taking narcotic for angina pectoris what the Pt said for the nurse to know that understanding the
teaching.
Ans: I can’t take my nitrate when taking this med
52 Calculation change Lb to Kg doctors order and keep ans to one decimal point the
Ans: 10.0ml or 3.8ml
What to do for Pt suffering for hep B sata
53 Who at high risk for hep A
Ans a day care worker
54 hypocalcemia sata
55 A lot of conference meeting like 20 something sata
56 A medication called sulindac sata
57 A p twith right sided stroke sata
58 How many word can 5yrs old says
59what is abnormal in 4yrs old
Ans when 4yrs says only 500words
60 Which group like masturbation
Ans:
61 What are going to see as a new nurse see another nurse doing to know its negligence
Pt ask for ice-cream 1 hr ago
62 Pt before taking allopurinol
Ans check the liver function test
63 A pt on sickle cell crisis
Sign: pain, pain
04/11/11
What happy in transition stage of labor
Lead poison
36 wks gestation pt complain that her amniotic fluid is leaking, what will you have in the examination
room
A child is admitted with rigid neck and a bulging fontanel ,what precaution will you place the child

A child impetigo what precaution will place the child
How will administer ear-drop to a child -5 mins apart
What statement will make a pt suit –a staff member telling other staff member that the pt was in jail
for arm robber
What will you inspect in pt on buck traction -check the skin at the back of the calf.
What is the reason for incentive Spirometer – to prevent atelectasis
A pt that was admitted this morning, started coughing rusted having dyspnea
I had 6 calculation , adding liquid together
Chess like substance on a new born – full term
What will you report in a new born -acromegaly cyanosis
A pale in new born indicate what-
A pt had BKA , what will be nursing priority in the first 24 hours
A woman in labor is passing meconium mix with blood what will be nursing priority
A child with reye disease what food will he note eat
Convert lbs to kg
Select all that apply in nutrition
What will a pt who have cystic fibrosis do before eating – mix enzymes with his food
Select all that apply diet in ulcerative colitis
I had question on piget disease
exhibit on insulin – 4 questions
exhibit on medical records- care conference
contact isolation and airborne isolation – so many questions
PKU
cleft Pilate
osteoarthritis
osteomy care
polycetemia vera – avoid the sun
nursing delegation- can
Many question on cardiovascular
immediately after the electroencephalogram ? what do you do? Remove the paste from the hair
sign and symptom of left sides heart failure.
sickle cell
H pyloric
pneumonia –select all that apply questions
fat embolism
priority question on who to see first on contact precaution
last result for pulse ox meter
ear lobes
medications like- nitrate, sildenafil citrate, nexium, levonox rout to administer, fosamax sit up 30minutes,
methargine, zirfurlukast, ace –pril, acto
19 years old that look at herself as fat but people tell her that she look slim.-Aneroxia
when is chicken pox highly effected?
what will you see in skin cancer- irregular boarder shape and multiple color
a new born baby that has red rash on his nose.
what to avoid in celiac disease.
04/13/11
1. How is lovenox administered?
Ans: administer with air in the syringe
2. Food to avoid when a child has celiac disease

Ans: avoid food that contain gluten

3. Male patient with hemoglobin of 17. What do you expect?
Ans: normal lab value. Child is actively playing/ normal activity
4. Drag and drop:

Tracheostomy care
How to position patient from supine to lateral position
5. Picture of a patient smiling: what cranial nerve is responsible?
6. Picture of blisters in the finger

Ans: picture of herpes
7. Picture of ulcer on the foot

stage III ulcer (very deep with muscles exposed)
8. what symptoms do you see to administer simvastatin medication?

Ans: onset of migraine
9. What is seen in addison’s disease? Select all that apply
10. Which food not to give someone with lactose intolerance?

Ans: chicken sandwich (nothing that contain milk or cheese)
11. Food with low-residue diet

Ans: food that is low in fiber (answer was baked chicken and potato)
Other option were all fruits and vegetables that are high in fiber
12. Ostomy that is purplish in color, what to do?

Contact physician immediately
13. Cast care: select all that apply

Use palm to handle wet cast
Avoid using sharp objects to scratch skin underneath
Report any numbness or tingling sensation
14. Patient is a vegetarian and pernicious anemia?

Give vitamin B12 for life
15. Patient taking ketoconazole for which reason?

Ans: antifungal
16. Question on slander, nurse overhears CNA saying something to another CNA
Slander is what is said about someone that causes damage, defame someone’s character
17. Malpractice law suit- probable cause for a malpractice law suit
Ans: nurse did not do what a capable nurse can do in the same situation.
18. Patient with c. diff., what precaution?

Ans: contact precaution
19. Question on MRSA, not sure if it was on what causes MRSA or what precaution:
Precaution on patient with Leukemin?
Ans: tell nursing aide not to put fresh fruits on the room tray.

20. What do you document in the third stage of labor?
Ans: I selected “the delivery of the placenta”
21. What can a 3 year old do?

Ans: ride a tricycle
22. TB precaution
Ans: airborne
23. Patient with mononucleosis (two questions on this disease)

Ans: don’t share utensils, pt. to rest until advised otherwise
24. nursing aide comes from a patient’s room who has c. diff, what will the aide do for the nurse to
intervene?
Ans: comes out still wearing gloves used in the room
25. what allergy will the nurse ask when patient is taking varicella vaccine?
Ans: egg
26. Muslim patient, what food not to include?

Gelatin (Jello)
27. Highest priority, patient has stroke (VCA) 3 days earlier, who does she see first
Answers were :
physical therapy,
speech therapist ( this is what I chose she should see first)
social worker
28. lots of priority questions: who should the patient see first
29. lots of infection control (I got at least 20, if not more)
30. Patient’s spouse diagnosed with terminal illness, shouts at the nurse that it’s the wrong diagnosis
Ans: denial
Nurse changing sterile dressing , what to put on?
I chose sterile gloves and gown
04/11/11
1. A Patient taking an iron supplements, how would he/she take it?
Possible answer chosen was :
an orange juice.
Antacids
2. What statement made by a student nurse that require further teaching.
(a) ECT must be administered first before any other medications.
3 The side effects of Olanzipine.
4. A patient that fractured his right tronchanter, how do you document this?
(a) Assist patient with their morning activities.
(b) Independence of the patient, will walk with an assistance of a walker
5. Lots of infection control questions.

6. Patient experiencing a PERTUSSIS.
(a) Leave stethoscope in patient room.
(b) The nurse would wear gloves and mask
7. A vegetarian patient morning diet should consist the following:

(a) egg omelets with cheese and a sliced bread.
(b) hamburger, sausage
8. Possible indicating signs for one who is Anorexia Nervosa.
Answer: A 15 years student that jogs 10 miles daily.
9. A suicidal patient said he is hearing voices?

Answer selected : Was the voice asking him to kill himself?
10 Patient teaching for a client on haloperidol
11. How do you as a nurse assist a breast feeding mother? The available answers that made some sense to
me are:
(a) wear a gloves.
(b) wear a gown
12. what will you recommend to the conference meeting that you are attending, that indicates a patient
is experiencing a Neuroleptics signs: The answer that I chose was:
Patient is taking to the Television.
13. Possible side effect of fluphenazine (Prolixin)

(a) Sudden abnormal tone and eyes contractions, I knew this was (dystonia)
1. A pat. Has Ulcerative Colitis and is incontinent , what precaution will u take
a.. Remove gloves immediately after u live the pat. Room
b Put the pat. In private room
2. A pat diagnosis with Addision’s disease which of the following is persistent to the disease
……………..(A) Hyponatrinia
3.A woman diagnosed with metasized cancer suddenly told the nurse that she has a plan, and that they
should not worry about the treatment….What is the first step the nurse should take
4.Drag and paste… Use all the options to arrange for correct procedural steps on condom catheter for a
male client.
5. Exibit….Which medications order with u question..
Pat. Med. Record…Allergy to cefuroxine
Lab. Values e.g Na, WBC, K …all are normal
Vital signs… all are normal
Answer…. Penicillin
6. A question on Autonomic Dysreflexia…..Ans…Full bladder.
7. A question on Dantrolene …..Ans.. Check Liver function test
8. Pat on Amatandine … what is the therapeutical effect
9.Risk factor for Ulcerative Colitis
10. Parents of a pat. Press law- charges on the nurse that was assigned a night he committed suicide.
Which of the following documentation support the charges
Ans…Client sleeping with Resp. rate of 8-10
11. A question on good Samaritan law
12.Which of the following activities need further teaching when told by a child with Hemophillia ……
Contact sport
13.Click on the Picture ….. What type of posture a child is showing and what part of brain is affected…
Decerebrate posture and Pon at mid brain

14.Questions on Calcium channel blocker and beta adrenergic blocker
15.Two Questions on Hodgkin’s disease
16. Questions on:
Infection control
Adolesence Risk-taking behavior
Pat. Taking isocarboxide
17. which of the follg. Will u check b/4 giving losartan ….hyperlipemia
18 A question on mother feeding a cleft palete baby
19. Effective teaching on 3-pint gait
20. Scenarios….Resp. Acidiosis, Metabolic Alkalosis, Suicidal thought
21… priority question…. Which of the follg pat. Will u attend to first
22. A question on Lyme disease
23. Further teaching on pat taking Cromolyn …..i will only take it when the attack occurs.
1. A Patient taking an iron supplements, how would he/she take it?

Possible answer chosen was :
(a) an orange juice.
(b) Antacids
2. What statement made by a student nurse that require further teaching.
(a) ECT must be administered first before any other medications.
3 The side effects of Olanzipine.
4. A patient that fractured his right tronchanter, how do you document this?
(a) Assist patient with their morning activities.
(b) Independence of the patient, will walk with an assistance of a walker
5. Lots of infection control questions.
6. Patient experiencing a PERTUSSIS.

(a) Leave stethoscope in patient room.
(b) The nurse would wear gloves and mask
7. A vegetarian patient morning diet should consist the following:

(a) egg omelets with cheese and a sliced bread.
(b) hamburger, sausage
8. Possible indicating signs for one who is Anorexia Nervosa.
Answer: A 15 years student that jogs 10 miles daily.
9. A suicidal patient said he is hearing voices?

Answer selected : Was the voice asking him to kill himself?
10 Patient teaching for a client on haloperidol
11. How do you as a nurse assist a breast feeding mother? The available answers that made some
sense to me are:
(a) wear a gloves.
(b) wear a gown
12. what will you recommend to the conference meeting that you are attending, that indicates a
patient is experiencing a Neuroleptics signs: The answer that I chose was:
(a) Patient is taking to the Television.
13. Possible side effect of fluphenazine (Prolixin)

Sudden abnormal tone and eyes contractions, I knew this was (dystonia)
1. Drag and Drop:

- Dry sterile wound
- Indwelling Foley catheter in an elderly female client
- Hand washing
- Order of wearing protective equipments:-gown, mask, eye protector, gloves
2. Just one private room is available. Which client should get this private room?
- Client with meningitis
- Client with pneumonia
- Client with chicken pox(correct answer)
3. What diet is appropriate for a patient with hypoparathyroidism?
4. Diet for vitamin D deficiency
5. s/s for pheochromocytoma
6. nursing intervention for a patient with pediculosis capitus
7. precaution for bacterial meningitis
8. precaution for pneumonia
9. Amiotic fluid ruptures and the pregnant woman suddenly starts passing out fluid mixed with
meconium. What would the nurse do? (ans:prepare the patient for an immediate C-Section)
10. Calculation.how many ML?(you have to convert lbs to kg then multiply by mg)
11. Mumps. What precaution?
12. Fall prevention
13. Conference committee questions (a lot of them)
14. Medications
- Lisinopril (side effect)
- Vemox( who shouldn’t take)
- Nifedipine
- Sumatriptan
- Heparin
15. Pregnancy induced hypertention (PIH)
16. how would you(the nurse) tell if a patient with Alzheimer is improving?
- patient can remember what he ate last night
- patient can remember the name of the president of the united states
-
-
17. chevotek sign.( ans. Twitching of the face)
18. leucopenic precation
19. Several questions on values like:- Hct,Hgb,platelets,WBC, potassium
20. s/s of premenstrual syndrome.(select all that apply)
21. a visually impaired patient.(select all that apply)
22. A bunch of questions on infection control
23. A bunch of questions on prioritization(like who should the nurse see first)
24. A Jewish orthodox patient dies, how would the body be handled?
25. 2 questions on negligence
26. toddler safety
27. 2 questions on domestic violence
28. A picture of a patient with some rash on one side of the back.what precaution would you take for this
patient?
29.Infectious mononucleosis. What would you avoid?
30. Imagery
31. Diabtes Ketoacidosis (DKA)

-S/S Coronary artery disease.
-Everything about tuberculosis. Because it comes like 5 times
-MESA- What precautions.
-Select all:Side effect of Seroquel.
-Piaget Disease.
-Wilheukel? Encephalophaty?-S/S Select all.
-Drag & Drop- Nasogastric tube.
-Congestive heart failure-select all that apply.
-Side effect of Clozapine- Select all that apply.
-Care of feet in diabetic patient- Select all that apply.
-Ferrous Sulfate Magnesium- How to administer?
-Nitroglycerin- What side effect to report.
-Care of colostomy.
-Internal radiation- select all that apply.
-Rubella- What precaution?
-Olazepine-what to report?
-Position for insertion of PICC.
-Meningococal Conjugate What for?.
-S/S to report in Pacemaker. Select all.
RSV-What precautions.
-Use of pulmonary function test?
-conjuctivitis-protection and precaution-select all
-Baby's pain-S/S? Select all.
-Hydralazine(Apresoline) What to do when BP IS 90/60
-Clozarine- What to monitor weekly?
-Drag&Drop Ztrack injection
The rest are very simple and common sense ones like:Therapeutic communication,infection
control,common medicines like Allopurinol,Digoxoin,Halloperdol,Codinephosphate(Paveral), and some
management questions.
1 -diltiazem: avoid grape fruit

2 -Z-track :drag and drop
3 -Wound care :drag and drop
4 - sterile procedure :drag and drop
5 -how to take BP:drag and drop
6 - Relafen SATA:
-avoid alcohol
-wear protective clothing
7 -Pt with skin lesion , variegated color: need to follow up visit
8 –pt with kelloid : at risk for cancer
9 –rubella vaccine : avoid pregnancy for three month
10 –clozaril: monitor wbc
11 –how to perform heel stick to a newborn
12 –which option affect in a schizophrenic patient: I chose the pt was looking like he was listening to a
voice(not very sure)
13 –fosamax: sit up for 30 min after taking med
14 –raise rough area on the back of a newborn : strawberry hemangioma , normal finding that will
disappear
15 –chest breathing during labor : take a cleansing breath before and after contraction
16 –TENS: know the procedure

17 –risk factor for cervical cancer : hpv
18 –how does a 24 month old child respond to pain
-said to mom that he feels pain
- point at the area and cried but refused pain when he is ask if pain is present (I chose this option but
not too sure)
19 –two therapeutic communications
- A mother whose 15 years old daughter just gave birth to a newborn and sign for adoption ask to see
her baby and the mom said no because she can change her mind if she see the baby : which therapeutic
communication is most correct.
- You need to talk to your mom so you all can agree before you see your baby
- We will let you see the baby and we will talk about your feelings later(I chose this option)
20 –what will you question: if the nurse raise side rails of a confuse pt -
21 –seizure precaution: raise side rails
22 –bone infection
23 –which food to give to patient with vit B2 deficiency
24 –olanzapine: SE urinary retention
26 -before doing guide imagery: always da relaxation technique first
27 –pt whith hyperkalemia,whose lab value shows kidney problem: administer kayesalate
28 –incident report if nurse administered wrong medication
29 –scarlet fever : droplet precaution
30 –impetigo: wear gown before taking pt to the bathroom
31 –respiratory alkalosis sata
- Ph 7,51
- Hco2 26
32 –how to perform rombert test
33 –pediculosis: sock cumb and brush in hot water forabout 15min at 130F
34 –jacket restrain
35 –I had 3 question on negligence
-the doctor walk up to the patient room and find that the patient lab result ca 7mg/dl
36 –cva pt with dysphagia ,nursing goal is to feed the patient whithought coughing
1. Two questions on evisceration

2. Questions on pregnancy
3. Question on PPD test: reading above 10: what does patient do: tell other family members to get
tested? It was a SATA
4. Question on student who is on Lacto-ovo-vegetarian diet
5. What statements by parents of a two years old indicate that they understand the age of the child?
(child enjoys playing with children of same age, child does not disturb mother when reading, child turns
page one at a time, etc.
6. Question on infection controls all SATA: mumps, meningitis (2 questions),influenza, scarlet fever,
MRSA, Rubealla, E Coli and Measles. Options were depending on the question: leave stethoscope,
thermometer in the room to be used only by the patient, door closed at all times, patient with surgical
mask when outside (here I got confused because of the word surgical mask instead of regulad?), gloves
when taking BP, gown when taking patient to bathroom, private room…)
7. Question on Toddler and safety SATA
8. Domestic abuse SATA and asked: what would indicate that there is a tension of abuse cycle? I
chose when wife states that “I know that this abuse will never happen again”
9. Physician order of medications to question SATA: there were medications to be administered “once
daily”. But I was not convinced about lantus insulin. My reasoning was that this insulin is given once a
day but at sleep time because is a long lasting. So when said “once daily”, is confusing to me and I should
clarify with MD
10. Question on restraint SATA

11. SATA . As a patient advocate, what should the nurse “clarify” with the administration team “ to do
first” when planning to implement safety measures against client ‘s falls: I selected the option that the
nurse should suggest that the team “review the client’s history/medical record of falls”
12. Vision impairement SATA
13. Low residue diet SATA (whole grain wheat, fruit and vegetable, fried chicken, etc)
14. There were many questions of “initially”, “priority”, client to see first, highest, …
15. Irrigation with temporary fluctuation
16. Malpractice SATA: what will show that there was malpractice
17. Question on negligence SATA
18. 2 to 4 questions on therapeutic communication
19. One question on concerning nonpharmacology techniqueS SATA: which one true about herbal and
other techniques. There was also a statement regarding science and these medication
20. DKA SATA
21. Question on venous return and elastic stockings
22. Question on Hyperparathyroidism SATA
23. Pharmacology: Zantac SATA
24. Hodgkin’s disease SATA
25. Medication to clarify from Physician orders: there were different medications with a table of labs
and dx: one lab has K: 2.7 mEq/L. So I chose Lasix
26. Question on deficiency in vitamins
27. Hypovolemic shock
28. Narcan: overdose for which medication: there was acetaminophen, valium, methadone,…
29. 2 Questions on head lice (Pediculosis capitis ) SATA: related to school mates, sharing brush and
comb, clothes
30. constipation
31. Diabetes Insipidus
32. Diabetes mellitus type 2
33. MOST Proper hand washing technique SATA: wash hands with soap before wetting them, turn
faucet off with clean paper towel, rubbing vigorously both hands for 10 seconds, and rubbing vigorously
hands with paper towel. I chose the one that is related to infection: turn faucet with clean paper
34. Lumber puncture
35. Thoracentesis : position to question. There was supine position
36. 2 questions on quality improvement . One had to do with “client satisfaction”
37. Risk for breast cancer ; husband smoke alcoholic for 10 years, cervical cancer, client history of
smoking for past 5 years
38. Aricept
39. Alzheimer (2 questions)
40. Paranoid schizophrenic: SATA If he refuse medication: what should nurse do: tell patient hat she
will tell MD, mix medication in pudding and give again, go and come back, and one non therapeutic
respond
41. Bipolar disorder and manic: durty cloths,
42. Mastitis and breastfeeding
43. Self Breast Examination. SATA, options included; 7 days before menstruations, palpate breast while
standing in front of mirror , and two other option
44. Prostate cancer risk increases if what increase: ESR, urine specific, patient is 68 years old,
45. Questions on reinforcing teachings
1, s/s of Hodgkin's disease---- ans night sweating

2, how to prevent skin cancer----ans applying suncreams
3, what will the nurse note in a patient with liver cirrhosis-----ans ascites
4, dry wood care, drag and drop
5, what kind of precaution will the nurse use for TB------Air born

7, a nurse is caring for a pt with terminal illness and is not familiar with the pt's culture, what
interventions will the nurse apply------select all that apply
8, which of the following should the nurse follow up? a person who runs 10miles daily or a strict
vegetarian?
9, how should the pt administer self insulin?------pinch on the abdomen and inject at 90 degree
10, what precaution should the nurse wear when caring for a pt with MRSA?-----contact
11, viral conjunctivitis, -------contact or droplet
12, there is only a single room available, which pt should receive a private room------pt with hepatitis B
13, a pt who is using a cane for ambulation understand that he/she should------cane for support when
getting up or hold the cane on the unaffected side, 6inch in front of the leg and 6inch from the side of the
leg
14 a pt who weight is 60 pound is to receive a medication 0.28mg/kg/ml daily divided into two dosage,
meds came as 100mg/ml, how many ml will the nurse administer with each divided dose?
15, allopurinol, how does it work in the GI?
16, mumps------ droplet or contact
17, which of the following should the nurse follow up in a new born?-----full anterior fontanel or a white
exudate on the axillary?
18, consent form select all that apply, under 18yrs should give consent in ER situation for his/her own
treatment? can the spouse of a client give a consent for diagnostic test but not for a surgical procedure?
19, PERTUSSIS, -------contact or droplet?
20, MEASLES(rubeola), what should the nurse wear when caring for the client?--------select all that apply
21 i had about 13 select all that apply mostly infection control
22 i had about 8 prioritization and about 20 questions on infection control
23, which of the following clients should the nurse see first?-----------a pt with DM type 1 who has
vomited 150ml or a with COPD who is ambulating and doing deep breathing exercise?
24,which of the following intervention by the nurse is correct during bladder scan? Place the pt in a high
fallow position or apply the gel in the low left quadrant (LLQ)?
25, a pt was told by the physician that she can never get pregnant, the pt told the nurse that she has apply
for a job as an Aid teacher in a school. What kind of defense mechanism is she using? Regression,
intellectualization, reaction formation, or compensation
26, a pt who is schedule for ambulation, assisted by two nurses decide not to wait for assistant form the
nurses and on trying to get out of the bed, she fell and had multiple fractures. What do u think the nurses
may suede for?----malpractice, assault, Bartle, or libel
27, what is the rational for aspiration of the NG tube b4 feeding the pt?
· Narcan- Which of the following medication is used to reverse opiods toxicity

· Infection- Bacterial meningitis- droplet
· A question on ECT – What the patient will experience after a ECT options include, seizure,
confusion……
· NG tube –A)drag and drop on installation procedure…. B)series of option given, to identify which is
not relevant
· Hypoglycemia –manifestation- select all that apply options include: polyuria, polydipsia, polyphagia
· Crohn’s disease –either dietary or manifestation
· Rickets – lack of vitamin D
· Pernicious anemia – vitamin B12 for life
· Lack of vitamin B1- beriberi
· Metabolic Alkalosis ---select all that apply
· Emphysema–increase in chest diameter
· Diversity- Islam – option include take birth before ------
· A question on negligence by the nurse in relation to delegation- an assignment to a
UAP without supervision---series of option given to choose which one constitute negligence

· A picture of a hand indicating 3 pimples like structure with pus in it. The question was asking if it is
transmitted by which means—answers include virus and others. The question is not focusing on contact
precaution
· A question on HIV series of options to choose which is the best options—transmission to baby
through placenta----transmission of baby through breast feeding
· A question on right side hemiplegia ---left brain damage
· A question on heart failure stating what teaching will the nurse give to patient ----one option was to
lower sodium consumption
· A question on Hogkin’s disease----one option is enlarge nodes
· A question on Brudzinki’s sign----option includes raising of thigh and leg as a result of lifting the
neck toward the chest
· Older adult eat less than young ones due to ---option decrease in taste and soar
· Calculation-----A child prescribed 3ml/kg/day. The child weigh 118 lbs, medication available is
40ml to be given at 3 doses of 8 hrs shift . How many ml will the child receive per dose
· Which of the following requires follow up------vital signs, pain level, neurological status..
· Exhibit NSG notes : The client rate pain 6 out of 10 , was placed on semi-fowler position with leg
elevated------Vital signs within normal ranges------Lab value HCT, HGB are less than normal ranges
· A lot of questions on re-enforcement that has to do with a nurse attending a conference and
contributing plan of care for each overseeing process
· Also questions on priority patent designating from ABC directly
· Questions in which patient do you see first also not including ABC direcctly
6/3/11
1. How would classify clozapine?
A. typical
B. atypical
C. conventional
2. SATA on food to avoid when taking MAOI
3. SATA on catopril
4. Side effect of imperamine
5. Embrel
6. 2 meds calculations without answers
7. A 37 weeks pregnant woman who calls and report that her water is leaking. What will you advise her
A. have a bed rest
B. it is a sign of labor
C. to go to the doctors office immediately
8. Arrange in order how to suction
9. Arrange in order the developmental milestone of a 4 year old
A. turn from back to abdomen
B. sit up with support
C. turn from abdomen to back
D. lift head up when prompt
10. Drag and drop on wound care
11. From the picture of a wound on the leg, identify the stage of the ulcer
12. Which client will you position in a private room if there is only one available.
13. Play for a 3 years child
14. How would you know that a client has understood colostomy care
15. What will client with peripheralneuropathy state to show that teaching is understood
16. Arrange in order how to remove PPE
17. What will the nurse do to a client after electroencephalogram
18. What to ask a client before performing occult blood test? Ans= have you eaten any red meat
19. How to position a client for thoracentisis
20. SATA on caring for a client with Alzheimer

21. SATA on visual impair
22. What to avoid when speaking to a client with hearing
A. speak slowly and loudly
B. avoid chewing gum
C. avoid writing down statements
23. What kind of precaution is viricella
24. What kind of precaution is rubella
25. Where will you place a pt with viricella
26. Question on scabies
27. How to administer pancreatic enzyme to a child with cystic fibrosis
28. A 72 year old woman with Rheumatic arthritis what will she do when in pain?
A. apply hot pack
B. do ROM exercise
29. Pt teaching before ECT
30. Pt teaching after ECT
31. Where to ECT and why
32. Arrange in order how to insert a catheter to a female client
32. Picture of a foot with a red spot and to identify the kind of disease
A. cellulitis
B. pancreatic
C. cirrhosis
I had about 20 SATA and so many questions on infection control in various forms
1. A patient fractured his left tibia in an auto-mobile accident. Which of the followings would be included
in the nursing teaching of how to use a crutch.(Select all that apply)
- Hand is to be flex 30 degree
- Crutch should 2 finger breadth from shoulder
- Move the right crutch wit the left leg first
2. A patient is receiving Humalog, he took his first dose @11:00 a.m. , when do you expect it to start
working?
- 11:15 a.m.
3. The nurse obtains the lab result of a diabetic patient whose HA1c is 11, what would be the appropriate
nursing teaching?
- Teach patient appropriate diet modification
4. The nurse is teaching a patient about his new prescription of Digoxin, which of the following is said by
the nurse is incorrect and requires further teaching?
- GI upset is normal when taking this medication
5. What is the nursing teaching for a patient has Thrombocytopenia.(Select all that apply)
- Patient should avoid using razor
6. A nurse is assigned to an 80 year old patient with the following medical history.
< Exhibit >
Dx : COPD, CHF, Liver Cirrhosis
BP 148/100, Pulse 101, SaO2 68
Allergies : Fluoroquinolones
Which of the followings would be contraindicated? (Select all that apply)
- Cipro
7. What will you teach a patient undergoing ECT?

- Tell patient he will experience temporary memory loss immediately after the test
8. A 30 year old trucker was reprimanded by his boss for delivering his goods 1hr late, he returns home
and smashed the dinner dish on the wall when his wife inquired how his day went, what kind of defense
mechanism did he exhibit?
9. The trucker angrily left home and returned with an expensive jewelry that the wife requested
weeks back. Which defense mechanism is he using?
10. Which of the following is not an appropriate nursing intervention for a patient having Seizure?
- Leave him alone in dimmed room to avoid stimulation
11. A patient is brought to the ER with a stiff neck, complains of severe headache and fever. Upon
examination the nursing noticed that when the leg is bent at the hip and knee, the patient complains of a
painful knee. What does this indicate?
- Meningitis
12. How do you elicit Rovsing's sign?

- Palpate the left iliac fossa to produce pain in the right iliac fossa
13. Locate the Mcburney's point on this diagram?
14. Which of the following should the nurse be concerned about an 8 month baby?
-cannot hold his head still when sitting
15. A patient with hepatic encephalopathy is receiving lactulose, what is the purpose of this medication?
- To eliminate ammonia in the system
16. An 80 year old patient has a UTI and was prescribed Pyridium, he complains to the nurse that his pain
is reduced but that still voids Odoms (Odom's?) urine, what is the appropriate nursing answer?
- Pyridium reduces the pain, but does not cure UTI
17. Arrange the following in the right order 1 being the first and 5 being the last.
- CPR
18. A patient with Alzheimer's is receiving Aricept. What is the purpose of this medication?
-It slows the progression of memory loss
19. A high priced lawyer makes the following statement to a psychologist, " I drink every evening,
because it helps me forget having to split my property with my ex-wife, who did not do contribute
anything to deserve it"
- Rationalization
20. A patient is taking Aceazolamide, what will be the nurse's concern?

- Potassium
21. A patient is using Albuterol for the first time and complains that " he feels like is heart is pounding".
What is the appropriate response?
- It's a normal side effect of this medication
22. Which of the following is an appropriate nursing action for a patient with TB?
- Nurse should wear a HEPA mask

23. Which of the following action is inappropriate for a patient in a maniac phase of depression?
- Compete in a card game
24. Which of the following is true about the use of restrain? (Select all that apply)
- Restrain order should be renewed every day
- Use restrain only as the last resort
- Check patient every 15-30 minutes
- Release restrain every 2 hrs
25. The nurse is removing his PPE. Which order should the nurse remove them?
- glove, goggle, gown, mask
26. A patient ask the nurse why he has to take his Iron pill with a straw, what is the appropriate response
from the nurse?
- To avoid staining teeth
27. An elderly patient became restless, and dyspnic 1 hr after infusion?

- Fluid volume overload
28. A 4 year old develops hives after being stung by a bee while play in the field with his friend. He was
brought to the ER. Which of the following is the priority nursing action?
- Maintain patent airway
29. Which of the following statement will be source of concern for the nurse?
- A patient on INH complains of tingling sensation in the leg
30. A patient is dx with glumerolonephrities. Which of the following is the right question for the nurse to
ask?
- Have you had sore throat in the past month?
31. A patient who is taking Streptomycin complains that he has difficulty hearing?
- Call the M.D.
32. Why is Filgrastim prescribed for a patient with anemia?

- To stimulate neutrophil
33. A patient is undergoing chemotherapy, what is the priority nursing action?

- Monitor for infection
34. A patient complains that his neck size has increased from 16 to 17?
- Venacava syndrome
35. Pt. develops TB

- Test all family members
36. Pt. develops rash on his chest 16 hrs after a fracture of his femur?
- Fat embolism
37. What is the priority teaching for a woman in her first trimester?
- Nutrition
38. Appropriate Immunization for a child at 12 months of age(Select all that apply)
- MMR, DTP, Varicella

39. How to use spirometer?
40. What is the purpose of pursed lip breathing?
41. A Pt. received a burn to his entire face and neck, his groin area and entire left leg. Following the rule
of 9, how many percent should the nurse record?
- 29%
42. What is the nursing teaching for a pt. with GERD?

- Tell pt. to sit up after meal
ALMOST NEW
1 . What question will you ask a patient who is taking Tricyclic?

a. What is your birthday?
b. When did you last take your ECT
c. Do you have any history of Depression in your family?
2. What is the effect of antipsychotic on -----

· Alters the effect of Dopamine in the brain
3. A Patient who is on Cialis, what advice should a nurse, give him in respect of the use of Nitrate
patches?
· Patient on Cialis should not take any form of Nitrate
4. Had a question of Glasgo Comma scale
5. A patient with hip biopsy was crying pain after taken pain medication, what is the initial action by
the nurse?
· Chick when the last pain med, was taken
· Elevate the legs to hip level
· Notify the Doctor
6. COPD patient assessed on therapeutic response

· Feel better and breathing better when sitting on a chair and leaning forward
· Feel less anxious today than yesterday
7. Appropriate toy for an 18 months old child

· Pulling toy
9. A question about Bipola Maniac level patient

· Avoiding to look at the nurse but talking in a mononoto voice
10 A patient put on Low molecular heparin, which medication would you question?
· A pt on wafarin for DVT
· Apt on Wafarine for Arterial fibrillation
· A pt on Lovenox from Laparoscopy
· A Pt on Lovanox for clotting problem
11 A question on Hypothyroidism
14 A question on Documentation of correct statement

15 Question on Roman Catholic Christian
· Baby should be Baptized by any body
16 (Therapeutic Communication) A Clint on long term dialysis states I do not want this any more,
stating that I spent time here than I do with my family. What will the nurse say?
17 (Delegation) A nurse working CAN

· Ask the CAN to collect urine spacemen
18 Caring for a Semiconscious patient

· Do not use tooth brush for during mouth care for fear of aspiration
19 A nurse attending a conference meeting, present a problem on a surgery informed concern, what
statement would reflect this
· Client who is a minor, the parent or guidance should sign for him
· (All the other options were correct too b/c they all answered the question)
20 Many questions conference attendance
21 A patient with a skin wound (picture of wound shown) but area not identify, Question ask
· Put a dough lope chushing around the wound
· Put a pillow, in between the knee of a patient when lying on a side lying position
22SATA on Alzheimer
23
SATA on TB
24 SATA on impetigo
25 SATA on Advance Directive (I had 22 select all that apply)
26 Exhibit question on:

(Dx is asthma, Has Allegy, V/S normal except temperature, Treated with Tylenol and Benadryl)
· Possible answer, remove fresh plants and raw fruits in the room
27 Question on Down Syndrome What is the cause

Different word use, I am sure the word represented Chromosome
· i.e Ch 8, Ch18, Ch21
28 Question on fracture pt on how to ambulate
29 A question on fracture right leg on how to clime the steps
30 SATA with list of diseases to select what to consider under contact precaution
31 Client to be consider for further referrer additional dx

· Pt who had irregular menstruation
· Pt who has had unprotected sex for one year but was not pregnant
· Pt with a noodle in the breast who feels tender at times
32 Priority question on who to see first

· Pt who complain seeing clot of ½ the size of a quarter

33 A pt on Propranalol (Beta Blocker) what to chick
· Frequent urination
· Pulse rate of 60
34 What of follow up on new born baby

· Red line on the baby skin and under the eye
· Body Temperature of 36
Again, a lot of select all that apply
12/07/11
1. Question on pellagra
2. Question on impetigo
3. Select all that apply on succor medication
4. Therapeutic effect of medication for cholesterol
5. How to go up the stairs with crutches
6. What type of toys for a 3yr old
7. What a 9 month old can do
8. What type of play does an 18 month old participate in
9. Lab values- all in range except temperature
10. 2 questions on lung sound
11. 2 ECG strips...one was v-fib
12. question on pulmonary embolism
13. question on diabetes
14. Risk factors for cervical cancer
15. question on osteoarthritis
16. what shows the therapeutic effect of iron-black stool
17. where to start abdominal auscultation
18. question on G Tube
19. 5 exhibits.
20. 12 select all that apply
1. Cialis ----------------- avoid nitrate

2. some one that has beriberi what vitamin is he lacking -------------- vitC
3. G tube - place in a correct order
4. how will a nurse reposition a patient that has right hip replacement ------- log roll
5. A patient on coumadi, which food selection reqired a need for further teaching ---------- greenleafy veg
6. Cushing's syndrome select all that apply
7. Addison's disease select all that apply
8. Question on lung sound

Broch asthma
pluersy
pnumothorax
9. macular degeneration
10. paracentsis
11. Which of the following patient should be place on airborne precaution
12. Glasgow coma scale
13. Enalpril ---------------------------- angiotensin 1 to angiotensin 11 receptor blockers
14. Babinski's reflex
15. homo hemianopia
16. Shingles ( picture)
17. Catheter -------arrange in order
11/22/10
1. A toddler with meningitis will show which ofthe symptoms ( select all that apply)
a.) A barking cough
b.) Dysphagia
c.) nucchard rigidity
2. A patient has just had cerebral angiography. What statement made by the patient will alert the nurse to
take further action
a.) '' my wife brought me lunch an hour ago"
b.) '' my legs and toes are feeling numb and tingling
c.) ''It wasn't fun lying on that hard , cold table''
3. A nurse knows that which religion believes in anointing of the sick just before death
a.) catholics
b.) islam
4. (Dr. Ejike,this question # 4 was about how atrial flutter will be manifested, and they had options about
(i) Absent P waves, (ii) sawtooth pattern

5. Electroconvulsive therapy will be done in
a.) Physician's office
b.) Recovery room
6. A trained assistive personel was asked to take a fingerstick on a patient. At lunch the patient told the
nurse he could not eat since as he has not had his fingerstick taken. What action should the nurse take?
a.) Go and look for the assistive personel and ask if the blood sugar reading was taken
b.) Take the blood sugar reading
7. A nurse has just received an end of shift report about the following, who will the nurse see first ?
a.) A patient with COPD who has been coughing an is dyspnic
b.) A patient with pneumonia who was admitted 48 hours ago
c.) A patient who had just stepped on a nail and was bleeding
1. Deficiency in Vit. D --- Rickets Dx
2. Question on VIP ---push fluid after the procedure.
3. Exhibit on Hypothyroidism
4. A lot of Infection Control
5. Prioritization
6. Interdisciplinary care,
7. Delegation
8. Liver Biopsy, which statement needs further teaching?, lie prone after the procedure.
9. Pagets dx
b. Drag & drop on sterile wound
c. Drag & drop on how to transfer pt from bed to stretcher.
10.Carpal Tunnel--- hairdresser
11. Picture on Pressure Ulcer
12. SATA on Anorexia Nervosa
and SATA on prevention of fall
13. Question on Renal Calculi
14. Questions on Battery
and Assault
15. ^ ^ 5 yrs. old characteristic
16. ^ ^ BKA

17. ^ ^ Scabies
18. ^ ^ Pediculosis
19. 3 Therapeutic Communication
20. C F what kind of food?
21. Food for Goiter SATA
b. 3 meds : Olanzapine, Zofran
22. Bipolar when on Manic phase
23. Question on Peripheral Venous dx
24. ^ ^ Bronchoscopy, what statement will alert the nurse?

b.- pt says he had a heavy breakfast in the morning.
25. Question on Colonoscopy
26. ^ ^ head injury
27. ^ ^ diet for wound healing
28. ^ ^ Parkinson dx,what to avoid
29. ^ ^ Glascomal Scale
30. 3 calculation on oz
31. Pt. on Coumadin, what to avoid
32. When to put on Sted stockings
33. Question on Testicular Self Exam.
34. Pictures
35. Endocrine
36. Medications
1 _ a pt with leukemia what will the nurse do?

Ans; risk for infection .
2_2nurses want to reposition a pt with right hip replacement?

Ans:logroll the pt with leg abducted.
3_a pt is taking beta blocker.

Ans:tell the pt to get up slowly.
4_ apt is taking alendronate.

Ans:tell the pt to take it before breakfast and sit up for 1hr after.
5_ a pt who is going for cardiac catherisation understand the teaching when he said?
Ans:l will lie flat for 6hr after the procedure.
6_a pt with COPD :t=102 resp=28 BP=96/65 plse=90

Ans:give o2
7_ a child is having seizure when you enter the room

Ans:turn him to his side
8_the picture of a child with shingle

*put the pt on droplet precaution
*apply heat compress
*give the pt a private room
*wear a surgical mask when entering the room
9_which pt will the nurse see first

Ans:a pt with asthma with respiratory wheezing
!)what will the nurse delegate to the CNA

Ans:take the vitals s
10 pt with k+ level of 4.6 calcium6.5 smg

Ans:avoid calaium supplement
11 a pt on lithium
Ans:avoid competiti ve sport
i had 20 select all that apply

and 9 on nursing care conference.
Q&A
1. Q. After receiving a change of shift report, which client would the nurse assess first?
A. a client who has pulmonary pneumonia and is expectorating blood tinged sputum.
2. Q. a client is suffering from Meniere disease, what teaching will the nurse reinforce?
A. reduce sodium intake
3. Q. a client on crutches, what statement made by the client require further teaching?
A. client states “I will use my crutches to pull myself up”.
4. Q. a client with right sided HF. What classic manifestations will the nurse observe (select all that
apply).
A. edema, weight gain, distended jugular neck vein.
5. Q. a client on lithium, what will be the nursing teaching? (SATA)

A. increase fluid intake, avoid dehydration.
6. Q. what statement by the parents of a newborn requires further teaching?

A. we will sleep with our child in our room.

7. Q. the parents of a student came to the school nurse, which statement made by the parents require a
follow up?
A. the helm of my child’s pants are unequal.
8. Q. a female client who came to the clinic four hours ago said to the nurse, “if I had fouth harder, I
couldn’t have been raped” . what is the best response by the nurse?
A. would you like to meet with a counselor?
9. Q. a nurse coming out of a client room on contact isolation, what action by the nurse requires further
teaching?
A. the nurse came out of the room before removing the gown.
10. Q. the following patient came to ER. If there is only one room available, who should be allocated this
room?
A. a client with a white blood cell count of 2500.
11. Q. client suffering from mild Alzheimer’s disease. What shows the client’s condition is getting
worse?
A. the client loses the keys and watch.
12. Q. a client on isolation. Which statement if made by the client shows an understanding of the
teaching?
A. the client asked that, the fresh flowers and fruits should be left outside the room.
13. Q. which room allocation is appropriation for measles’s client?

A. a negative pressure.
14. Q. a nurse said to a student that, he has narcissistic behavior. Which statement by the student confirms
these behavior?
A. I have the best voice in the class.
15. Q. a client on crutches. Which statement by the client shows an understanding of the teaching?
A. I will bear my weight on my arms.
16. Q. as a nurse, what action will you take on a client for thoracentesis?
A. a client will be placed in the sitting position, with the hands on the bedside table and leaning forward.
17. Q. a client at risk for fall is to be discharged, what statement by the spouse require a need for follow
up?
A. spouse said, “I have staged the rug on the floor.”
18. Q. which reflex can still be elicited in a one year old?

A. Babinski reflex.
19. Q. how will a nurse reposition a client with right hip replacement?
A. by log roll.
20. Q. a nurse tells a client that he has positive brudzinski sign?

A. when you lift your shoulders, your legs will flex inward.
21. Q. a client with diverticulitis, which food choices if selected, show an understanding of the teaching?
A. baked chicken, rice and banana.

22. Q. which of the following clients should be placed on airborne precaution?
A chicken pox client
23. Q. place the following wound care procedure in the correct order. All options should be used. (drag
and drop)
A.1- put on clean gloves
2- remove old dressing and observe
3- put on sterile gloves
4- clean wound from top to bottom
5- put a dry gauze.
24. Q. a client on Coumadin (warfarin), which food selection require a need for further teaching?
A. client selects green leafy vegetables.
25. Q. a client with diverticulitis, what food selection shows and understanding of the teaching ?
A. roasted chicken, mash potatoes and orange juice.
26. Q. as a nurse, what would you do to a hepatitis client to help in the prevention of the disease?
A. by giving the client hepatitis A immunoglobulin
27. Q. a client is on contact isolation. How can the nurse prevent the spread of the infection?
A. by wearing a gown when taking the client to the bathroom.
28. Q. a client who underwent an operation for coronary artery bypass graft
(CABG). What complication should the nurse report immediately to the physician?
A urine output of 20ml/hr
29. Q. a client who sustained a head injury in a motor vehicle accident is brought to the ER with a blood
pressure of 136/76 mmHg. What manifestation will show that he situation is getting sores.
A. the pulse pressure is increasing.
30. Q. the nurse is caring for a dark-skinned client hospitalized with hepatitis. The nurse can best observe
the presence of jaundice in the by assessing the client’s:
A. soft and har d palate.
31. Q. a client having transient ischemic attack (TIA). As a nurse, what will you be observing for?
A. myocardial infarction (MI)
32. Q. a client receiving eye ointment what shows an understanding of the teaching?
A. the client keeps the eye motionless for proper absorption.
33. Q. a new born with an Apgar score of 9 and 10 at 1 and 5 minutes. Which statement by the parents
need further teaching?
34. Q. to prevent infection

Remove gown before leaving the room, wash hands after leaving room.
aneurism: what does it cause in the brain.
35. Give HTN meds to decrease renal output.
36. Select all that apply on cast care: elevate the leg on pillow – palm cast rather than lift for skin
breakdown – dry on RM temp – apply prescribe anti-itching as ordered.

37. Contraindication in patient with thrombophlebitis.
Oral contraceptive should not be taken.
38. Patient on allopurinol.

Encourage fluid intake.
39. What shows the patient develops pancreatitis.

Presence of lipase and amylase.
40. Meds for patients with pancreatitis

Morphine and mepiridine
41. A patient on zidovudine what lab test should be monitored

CBC
42. BSE. 5-7 days after menstruation, stand in front of mirror.
43. Zetia will lower cholesterol absorption
44. Patient most at risk for ovarian cancer

Patient has herpes zoster
Use tampon
Early menarche.
45. Peritoneal dialysis considerations:

Infection, take daily weight, intake and output.
46. Treatment of xerostonia

Give mucomyst and hard candy
47. Food high in potassium for patient on digoxin/furosemide

Strawberry, apple slice.
48. Plastic ring circumcisions:

The ring fall in 7 days
49. Charge nurse assign PN area not trained and the assignment must not be changed.
PN will say/ask charge nurse so they plan how to work together.
50. Tetralogy of fallot defeats in children.

Stenosis of pulmonary artery _ over riding of the aorta
51. Teaching for COPD

Pursed lip breathing
Blowing through the straw
Inspire 1 second through the nose and expire 2 seconds through the mouth
52. Calories for pregnant breastfeeding woman

300 t0 500
53. What to discuss in conference for pt undergoing ECT.

Patient will be confused and disoriented.

54. PPD needle gauge is 27
55. Behavior of a 1 year old child : identify 2 or 3 body parts.
1. Occult blood testing{

What do you do during the test:-Check what the client ate for the past three days
2. Anorexia {what will you observe:-
3. Chickenpox {Infection control as a picture
4. Many infection Control questions {Airborne, droplet and contact
MRSA, TB, Pneumonia, Chickenpox, Rubella,
Identification and what the nurse and client will wear and rooming
5. Many priority questions {Airway,
6. Some delegation questions {the CNA can weigh, take intake and output
7. Anti-lipidemics question in an exhibit form{
All labs were normal; all medications matched diagnosis, except elevate liver enzymes
8. What will a PKU client avoid{ diet coke
9. One calculation to be rounded up to one decimal place{
10. Priority question to arrange in order {first airway,
11. Some Conference education{
12. AAA what will be the sign {
13. 2 questions about laparoscopy and complications that can arise{
14. Many select all that apply questions{ Infection control,
1. ~Scabies
2. ~MRSA
3. ~Impetigo
4. ~Influenza
5. ~Meningitis
6. ~TB
7. ~Cystic Fibrosis – snack
8. ~Celiac disease- correct statement …

1). which one will you question?
2). Food not to give
9. ~Four year old- able to distinguish right and left hand
10. ~Which one causes Hypokalemia? Spironolactone
11. ~What to question if UAP works with MRSA … remove gloves outside of the room
12. ~When taking TB patient is outside, … wear mask
13. What to do for a TB patient, … select all that apply

-Air pressure room
-mask, gloves, etc
14. ~What to tell visitors for a TB patient … select all that apply

15. ~Pertussis – what will the nurse wear before administering meds
16. ~Sumatriptan- for migraine
17. ~ Alzheimer’s who is aggressive –use distraction
18. ~what show Alzheimer’s is progressing
19. ~what is brudzinski?
20. ~Chvostek – tapping face and twitching
21. ~Diabetes Insipidus medication- desmopressin
22. ~Type 1 DM- not oral meds
23. ~Type 2 DM- no insulin
24. Lots of priority questions
25. ~Colon cancer- report bleeding in stool
26. ~smoking pregnant woman- low birth weight
27. what med? “-pril” meds
28. ~Tibia fracture- positioning
29. ~housekeeper needs further teaching if he closes patient door
30. ~Chemo patient – what food will you question? Fresh fruits and vegetables
03/24/11
1. Bumex // How do you know it is effective? What do you monitor?
2. Intussecption// Characteristics: 1. A lot of diarrheal stool

2. Sausage shaped mass at RUQ (Answer)
3. Ileal Stoma// The correct answer was cut pouch 1/8 larger than stoma
4. Arthrocentesis//
5. West Nile Virus// Transmitted via mosquitoes
6. Scleroderma//
7. Endoscopy//
8. GERD// Select all that apply pertaining to Nexium: What its used for, how its administered, etc.
9. Dumping Syndrome// Select all that apply: Patient Teaching

10. Appendicitis// They asked about isolation precautions
11. Rheumatoid Arthritis// Select all that apply// ~Stiffness in AM ~Joint Pain ~Ulna Deviation???
12. Cast Care// Compartment Syndrome: The answer was check color and temperature of affected vs
unaffected extremity
13. Wheezing// AUDIO & SATA BASED ON AUDO// I chose: Give prescribed bronchodilator, Give
prescribed O2, Put patient in high fowlers (Decrease fluids was there but I didn’t choose it)
14. MMR// What question do you ask female who is about to receive this vaccine? Answer: When was
your last menstrual period?
15. FOBT// Ask patient about dietary intake for the past 3 days
16. CT Scan without Contrast Medium
17. MRI// What should you be concerned about? Answer: Patient states “I had aneurysm clips inserted
one year ago.”
18. Bone Marrow Biopsy// SATA//

-Taken from iliac crest, -Will be on bed rest for 12 hours, -Will be given a local anesthetic prior to the
procedure// I did NOT pick “Tenderness for several days is expected”
19. Cholecystititis
20. Cushings// What could cause it? I chose “Pituitary Adenoma”
21. Alcohol // Patients will frequently relapse
22. Select all that apply// DEFENSE MECHANISMS
23. Slander// Example of
24. SSRI
25. ALL ISOLATION QUESTIONS WERE BASICALLY SATA
26. Hepatitis D// Transmission
27. 3 Physical Therapy Questions// Who would you refer?
28. Myasthenia Gravis// Temporary muscle weakness
29. Cataracts// Change all lighting in house to non glare light bulbs
30. NIDDM
31. Normal Age Related Changes in males// SATA
32. Phototherapy// Mother stating she will give infant liquids q2-3 hours is correct
33. KETOROLAC

34. Patient fell in house. What requires follow up?
Temperature of 99.1
Pulse Rate of 100
Lethargy (answer)
35. Bucks Traction/ Skeletal Traction
36. Bronchoscopy
37. Test to assess newborns gestational age
03/24/211
Cervical cancer risk factors select all apply
Cervical cancer final test
How to collect urine sample from a cathetrized pt drag and drop. Clamp the tube for 30 min,clean the
catheter ,insert the syringe, withdraw the urine, watch u tube video for the correct step
A pt with gout which sentence shows un understanding of the teaching
1,pt says he can take NSAID and allopurinol
5.side effect of allopurinol
6.side effect of ECT, short term memory loss and diarrhea was together in the choice I don’t know
About diarrhea
7 side effect of captopril
8, contact precaution select all that apply MRSA,CDF,VRE were in the choice
9. 28 week pregnant women came to the clinic and says at night she have spasm in her leg what do you
advice her
A,elevate her your leg in a pillow
B,stretch your leg and bebd your toes out ward this is what I choose I am not sure
C, call the dr
10,many questions about osteomyelitis
11,when you go to give allopurinol which one is a concern?
when you see an empty orange bottle in the table b/c the med is given in empty stomach
12, which one shows abuse
When the pt says my daughter will not show me or allow me to see my bank account
13.many delegation questions and priority questions
14.about meningitis how to isolate the pt
03/25/11
1. Nexium – Uses and side effects - Select all that apply
2. Mitral valve prolapse - symptoms – Select all that apply
3. Ostomy care - what to report to the doctor
4. Rheumatoid Arthritis - Select all that apply
Stiffness in AM
Joint tenderness
Ulna Deviation
Pain relief with exercise
Apply heat to joint
5. Mastitis
6. AUDIO – Wheezing – Select all that apply based on Audio
Give prescribed bronchodilator
Give prescribed O2
Put patient in high fowlers
Decrease fluid intake

7. Fecal occult blood test
Correct option = Ask patient about dietary intake for the past 3 days
8. Urolithiasis - Lithotripsy – Side effects – Select all that apply
9. Cholecystitis
10. Cushing’s syndrome
11. Alcohol withdrawal symptoms
12. DEFENSE MECHANISMS
Correct option = Repression
13. Slander
14. Antianxiety and Antidepressant medications
15. Tyramine – Select all that apply – Foods containing tyramine

16. New shift – Which pt to see first
- Which pt to see last
17. Delegation
18. A lot of questions on Infection Control - Isolation Questions/ what to leave behind in pt’s room – A lot
of Select all that apply
19. Prioritization – If there is only one Private Room, which pt to put in it
20. Hepatitis A Infection – Soiled hands from feces – How do you clean hands?
Correct option = Wash hands with water
One other option = Use alcohol hand cleanse
21. Cataracts
Correct option = Change all lighting in house to non glare light bulbs
22. Open angle glaucoma
23. NIDDM
24. IDDM – Select all that apply
25. Testicular cancer – what age group it affects
26. Testicular cancer - Select all that apply
time of the day to test for it
how the lump in one testes feels like
27. Tracheostomy - Suctioning an infant
28. Chest tube
29. Hemodialysis
30. Pneumonia symptoms – Select all that apply
31. Medications, Medications, Medications
32. Meningitis – Brudzinski’s sign
33. Stages of labor – Pt in active stage of labor and 8cm dilation ---------???????
34. Arterial blood gases – Respiratory Alkalosis
35. Parahypothyroidism symptoms – Select all that apply
Hypocalcemia
Osteoporosis
Hypercalcemia
36. Hypocalcemia
Correct option = Chvostek’s sign
37. Methargine
38. Pyridium
Correct option = Discolors bodily fluids and turns lens of the eye orange
39. MDI – How to use – Drag and Drop
40. Placenta previa
Correct option = Painless vaginal bleeding
41. Amniocentesis -----?????
42. Pulmonary embolism
43. 2 yr old - developmental stage

Correct option = Temper tantrums
44. Mormons diet
Correct option = Avoid caffeine
45. Mononucleosis – what to avoid – Select all that apply
03/25/11
Antidepressant Medications for Depression
SSRIs-----ZOLOFT sideeffect
TCA sideffect ...dry mouth
Amitriptyline, sinequan
MOAIs ..What kind of food aviod Tyamine (sour cream)
- Nardil
Paranaton-Mointo blood pressur frequently .
-If Pt.Lithim toxicity ....hold Lihtim and notfy the phyican

-Abilfy side effect
-ADHD medication Amphetamin
-Alzheimers med....Cognex
-What Atiaxiety medication do
-Withdrawal of Barbitrates i Have to symptoms, Q. 1.. delirum
2.Behavioral change
-A lot of priortzing Q.
-Addison disease...select al apply( WT. loss fatigue..)
-Cushing diseae select all that apply ( wt. gain, moonface, fragile skin)
Phechromocytoma ...montor blood pressure
-Hypothyroidism select all apply
-hyperthyroidism
-thyroid storm.....life threatening condition)
-thyroidectomy ...monitor laryngeal nerve damage evidenced by respiratory obstruction
-Hypoparathyrodism ..Troussau's digns
- Diabetes mellitus..sign & symptom of hypoglycemia
-Insulin ... pick timm R.Insulin
-COPD
- ASTHMA
-Low Alarm pressure...disconnection or leak
-Pneumonia (high Temp.)
-Tuberculosis...night sweats
-Hiatal hernia,,,feeling fullness
-B12
- Duodenal ulcers
-Cervical Cancer risk factor
-Dumping syndrome
-ileostomy
- crohn's disease
-Cardiac catheterization....post procedure (monitor vital sign)
-TURP

-peritoneal dialysis ...infectin
-UTI
-Pyelonephrits...flank pain
-renal calculi ...Sharp pain
-epogen
- sulfonamides
-cipro
-cerebral palsy
-cleft palate
-celiac disease what kind food avoid...
-amniotic fluid embolism
-pulmonary embolism: position the client head of the bed elevated
-Thrombophlebitis, tenderness & pain in the affected lower extremity
-Prostaglandin...for postpartum hemorrhage
-Brethine
-6 to 7 month.....sits with support
-Pyloric stenosis
-ESSR method of feeding ....enlarge the nipple, swallow, stimulate the suck reflex, rest to allow the child
to finish....
-Scoliosis....
-wilms' tumor....abdominal pain
-infection control a lot like 10....you have to know all......
-Hepatitis B transmission.....
03/25
Isoniazid = VIT B12
Fosamax =S/E
Procardia= BP, S/E
How to use inhaler= drag and drop
A lot of prioritizing Qs = ABC,ABC,ABC
Infection control = C Diff = 3 QS
Leukemia =Fever
Chemotherapy
TB=airborne
Regular Insulin=IV
WBC = Normal level
Mantoux Test= when to read it
5 SATA QS
5X5 Of Hyperglycemia
Withdraw from Cocain=5X5
TPN= diabetes
Delegation
A lot of therapeutic communication
CPR =Drag and Drop
Impetigo = what type of isolation
Huntington disease
03/28/11
1. A pat. Has Ulcerative Colitis and is incontinent , what precaution will u take
a.. Remove gloves immediately after u live the pat. Room
b Put the pat. In private room

2. A pat diagnosis with Addision’s disease which of the following is pertinent to the disease ……………..
(A) Hyponatremia
3.A woman diagnosed with metastasized cancer suddenly told the nurse that she has a plan, and that they
should not worry about the treatment….What is the first step the nurse should take
4.Drag and paste… Use all the options to arrange for correct procedural steps on condom catheter for a
male client.
5. Exhibit….Which medications order will u question..

Pt. Med. Record…Allergy to cefuroxime
Lab. Values e.g Na, wbc, k …all are normal
Vital signs… all are normal
Answer…. Penicillin
6. A question on Autonomic Dysreflexia…..Ans…Full bladder.
7. A question on Dantrolene …..Ans.. Check Liver function test
8. Pt on Amatandine … what is the therapeutical effect
9. Risk factor for Ulcerative Colitis
10. Parents of a pat. Press law- charges on the nurse that was assigned a night he committed suicide.
Which of the following documentation support the charges
Ans…Client sleeping with Resp. rate of 8-10
11. A question on good Samaritan law
12. Which of the following activities need further teaching when told by a child with Hemophillia ……
Contact sport
13. Click on the Picture ….. What type of posture a child is showing and what part of brain is affected…
Decelebrate posture and Pon at mid brain
14. Questions on Calcium channel blocker and beta adrenergic blocker
15. Two Questions on Hodgkin’s disease
16. Questions on:

Infection control
Adolescence Risk-taking behavior
Pat. Taking isocarboxide
17. which of the follg. Will u check b/4 giving losartan ….Bp, K+
18 A question on mother feeding a cleft palate baby
19. Effective teaching on 3-point gait
20. Scenarios….Resp. Acidosis, Metabolic Alkalosis, Suicidal thought
21… priority question…. Which of the following pat. Will u attend to first

22. A question on Lyme disease
23. Further teaching on pat taking Cromolyn …..i will only take it when the attack occurs.
03/28/11
1-what restraint method is used for a lip cleft baby. Elbow restraint
2-Which nursing intervention is used for a pregnant patient who has leg edema. Elevate the leg with a
pillow
3-Which client will the nurse attend to first (priority)

The client who has given his bracelet to the room-mate
4-Which client will you see first .

The diabetic client who after insulin therapy asks for break-fast.
5-What should the nurse be concerned about after 30 hours of a baby's delivery?
The baby's Voiding of meconium
6-What should be expected of a seven month baby?

-Walk with the furniture
-Try to roll over
-Sit and lean forward
7-The Doctor has ordered 50mg of pain medication for a child whose weight is 32lb. The medication
available is 200/5ml. How many milliliter would be given.
8-A client with Diabetic Insipidus is on medication. What will the nurse expect if the medication is
effective?
The urine specific gravity is normal .
9-A client os diagnosed with Rheumatoid Fever. Three of the four choices were concerned with
Rheumatoid Arthritis Only one one answer was attributed to Rheumatoid Fever.
10-What is normal aging? STAT
11-What protection precaution would a nurse use when attending to a client with impetigo.
12-An Alzheimer patients complaints that he was a good teacher,but now "I am use less."
Where did you teach?
13-I heard the breath sound ,long and deep . The question was what is the nurse do for the client
-Give oxygen
-Give 2 pillows
-Place the client upright
14-What will the nurse teach a client with osteoporosis to do.

- Decrease calcium intake
-Increase Phosphorus intake
-Bed rest all the time
-Walk five times a week.
15-Which client with the nurse attend to first?

-A Chronic COPD client

-The client with anorexia nervosa
-The patient sitting at the edge of the bed with dyspnea.
16-One question was about the heart beat with diagram

-Sines tachycardia
-Atria Fibrillation

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PLEASE MEMORIZE & MASTER

What is the nursing priority for a patient with epiglottitis?

The correct answer is C. Epiglottitis is an emergency situation requiring immediate

The following are clinical manifestations of nontoxic goiter (hypothyroidism), EXCEPT:

The correct answer is C. Hypothyroidism causes a decrease in thyroid hormones, which in

ƒ Thyroid gland secretions (T3 and T4) are metabolic hormones

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What is the best way to prevent the spread of STDs?

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What is a normal physical finding of the thyroid gland?

What food is most appropriate for a toddler?

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AUTONOMIC NERVOUS SYSTEM

ƒ Also termed adrenergic or parasympatholytic ƒ Also termed cholinergic or sympatholytic

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ASTROCYTES – maintain the integrity of the BLOOD-BRAIN BARRIER

 Toxic substances that can cross the BLOOD-BRAIN

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ƒ Earlysign of Hepatic Encephalopathy:

ƒ Late Signs of Hepatic Encephalopathy:

CARBON MONOXIDE (CO) AND LEAD (Pb)

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The correct answer is D. Option A is a characteristic of stroke. Option B is a characteristic

What type of environment is appropriate for a client with Alzheimer’s?

MULTIPLE SCLEROSIS (MS)

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S & Sx of Multiple Sclerosis

 CHARCOT’S TRIAD Sx of MULTIPLE

Diagnostic Procedures for Multiple Sclerosis

Nursing Management for Multiple Sclerosis

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Diencephalon – interbrain or “between brain”

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Cerebrospinal Fluid (CSF)

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INCREASED INTRACRANIAL PRESSURE (ICP)

What is the EARLIEST SIGN of increased ICP?

Describe a conscious client:

The correct answer is C. Consciousness describes a patient’s level of wakefulness. The

ƒ EarlySigns of Increased ICP

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ƒ LateSigns of Increased ICP

ƒ NursingManagement for increased ICP

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Early Signs of Late Signs of

Hypercarbia – CO2 retention

ƒ Nursing Management for increased ICP (continued)

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The correct answer is A. Lasix takes effect in 10 to 15 minutes. Option D (6 hours) is

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ƒA pathognomonic sign is a definitive diagnostic sign of a disease.

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 Questions about increased ICP 

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Which nursing intervention is appropriate for a client with intracranial pressure of 20

The correct answer is C. Increased ICP produces bradypnea, so hyperventilating will

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