Watch for vision changes with ethambutol.

Do not give potassium supplements or salt substitutes to a client taking an

angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker.
Sucralfate must be given before meals to coat the gastric ulcer mucosa.
Quinolone antibiotics should not be given with antacids or supplements that will
bind with the drug.

emphysema

include
shortness of breath,
exercise intolerance,
tachypnea, diminished breath sounds with a prolonged expiratory phase, use of
tripod position (leaning forward), and presence of barrel chest

Absence seizures are characterized by a brief loss of consciousness and the

appearance of inattention or daydreaming without loss of postural tone. Most
absence seizures occur in children age 4-12, last less than 10 seconds, and may
occur multiple times daily.

When a feeding tube becomes clogged, the nurse should first attempt to unclog
the tube by using a large-barrel syringe to flush and aspirate warm water in a
back-and-forth motion through the tube. A digestive enzyme solution may help if
warm water flushing is not effective

Tube feedings decrease phenytoin (Dilantin) absorption, which reduces serum

drug concentrations (therapeutic index 10-20 mcg/mL [40-79 mcmol/L]) and may
precipitate seizures. The nurse should pause tube feedings for 1-2 hours before
and after phenytoin administration to ensure adequate absorption
A heart rate of 62/min is expected in a client taking digoxin (therapeutic index 0.5-
2.0 ng/m

The Valsalva maneuver is contraindicated in the client diagnosed with increased

intracranial pressure, stroke, head injury, heart disease, glaucoma, eye surgery,
abdominal surgery, and liver cirrhosis.

Lithium is a mood stabilizer most often used to treat bipolar affective disorders.
It has a narrow therapeutic index (0.6-1.2 mEq/L). Risk factors for lithium toxicity
include dehydration, decreased renal function (in the elderly), diet low in sodium,
and drug-drug interactions (eg, nonsteroidal anti-inflammatory drugs [NSAIDS]
and thiazide diuretics).

Chronic toxicity can result in:

1. Neurologic manifestations – ataxia, confusion or agitation, and

neuromuscular excitability (tremor, myoclonic jerks)
2. Nephrogenic diabetes insipidus – polyuria and polydipsia (increased thirst)
(Option 4)

Acute pancreatitis may cause severe midepigastric abdominal pain, elevated

blood glucose levels, and steatorrhea. The nurse should watch closely for high
fever, increasing abdominal pain, and leukocytosis as these findings may
indicate infection of the necrosed pancreas or pancreatic abscess formation.

The nurse can teach a client or caregiver to inject subcutaneous enoxaparin. The
appropriate site of injection is on the right or left side of the abdomen at least 2 in
from the umbilicus.
Red man syndrome (RMS) is a condition that can occur with rapid IV vancomycin
administration.

It is characterized by flushing, erythema, and pruritus, typically on the face,

neck, and chest.
Muscle pain, spasms, dyspnea, and hypotension may also occur. RMS is usually
a rate-related infusion reaction and not an allergic reaction. It can be reduced by
infusing vancomycin over a minimum of 60 minutes. It can be difficult to
differentiate severe RMS from anaphylaxis as flushing and hypotension can
occur in both conditions. However, hives, angioedema (lip swelling), wheezing,
and respiratory distress are more suggestive of anaphylaxis

Edema, shortness of breath, and activity intolerance are chronic, expected

manifestations of congestive heart failure

Clients taking desmopressin for diabetes insipidus are at risk for water
intoxication and hyponatremia. Client reports of headache, mental status
change, and/or muscle weakness may indicate hyponatremia from water
intoxication and should be reported to the health care provider immediately

Supine hypotension occurs commonly in the third trimester when the gravid
uterus compresses the vena cava, resulting in decreased venous return to the
heart and maternal hypotension. If a pregnant client becomes symptomatic (eg,
dizzy, nauseated) while lying supine, the nurse should immediately reposition the
client to the left side

Circumcision care includes:

● Washing hands before providing care.

● Applying petroleum jelly to the glans penis at diaper changes (unless
PlastiBell was used) for 3-7 days to prevent the exposed glans from
adhering to the diaper until the site heals. The circumcision site typically
heals within 7-10 days.
● Expecting yellow exudate on the penis after the first day, a normal part of
the healing process (Option 4). Exudate should not be removed forcefully
 and disappears in 2-3 days. Swelling, increasing redness, odor, or
abnormal discharge may indicate infection.

The client post cholecystectomy with incisional pain and the client reporting
nausea after open reduction of the right femur are in need of nursing attention.
However, these are not life-threatening problems.

Clients taking metronidazole (Flagyl) should avoid alcohol.

Those with glaucoma or urinary retention should avoid anticholinergic drugs.

Oral iron is better absorbed on an empty stomach and with vitamin C.
Phenazopyridine (Pyridium) will turn urine an orange-red color.

Excessive postpartum bleeding is commonly caused by uterine atony. If the

nurse suspects uterine atony is caused by bladder distension (ie, boggy fundus,
fundus above the umbilicus and deviated to the right) the client should first be
assisted to void; fundal massage and oxytocin should follow as needed to control
the bleeding.) Oxygen delivery at 10 L/min via a nonrebreather facemask may be
initiated if the client becomes symptomatic following excessive blood loss.

A troponin value of 0.7 ng/mL (0.7 mcg/L) indicates cardiac muscle damage and
should be the priority and immediate focus of the nurse. Normal values: troponin
I <0.5 ng/mL (<0.5 mcg/L); troponin T <0.1 ng/mL (<0.1 mcg/L).

During pregnancy, the white blood cell (WBC) level increases to support the
immune system; WBC levels can reach 16,000/mm 3 during pregnancy (non-
pregnancy normal: 4,000-11,000/mm3).
In the immediate postpartum period, lochia should be assessed frequently to monitor for
postpartum hemorrhage. Soaking a perineal pad in ≤1 hour would indicate excessive
bleeding that requires urgent intervention.

classic heart attack symptoms of dull chest pain with radiation down the left arm.
Instead, they can have "atypical" symptoms such as nausea, vomiting, belching,
indigestion, diaphoresis, dizziness, and fatigue.

Shaken baby syndrome is a form of child physical abuse resulting from violent
shaking of an infant by the extremities or shoulder that causes bleeding within
the brain and/or eyes. The clinical findings of shaken baby syndrome are
nonspecific and include lethargy, vomiting, seizures, irritability, inability to eat,
and inconsolable crying. Multiple and severe shaking episodes can result in
breathing difficulty and lifelessness. Caregivers typically do not report a history
of trauma.

blood in the nasogastric tube could be a complication of peptic ulcer disease and
the use of nonsteroidal anti-inflammatory drugs and corticosteroids.

Long-term use of PPIs (eg, omeprazole, pantoprazole, esomeprazole) is

associated with osteoporosis, C difficile infection, and pneumonias. Clients
should be encouraged to increase calcium and vitamin D intake to help prevent
osteoporosis. bone density test

Unless otherwise indicated by the health care provider, antihypertensives and

other blood pressure-lowering medications (eg, furosemide), antibiotics, digoxin,
and water-soluble vitamins (B, C, and folic acid) should be held prior to dialysis.

Massaging a body part that has sustained a cold injury is contraindicated due to
the risk of tissue injury.
self-administer a nasal spray, the nurse teaches the client to:

● Assume a high Fowler's position with head slightly tilted forward (Option 1)
● Insert the nasal spray nozzle into an open nostril, occluding the other
nostril with a finger (Option 3)
● Point the nasal spray tip toward the side and away from the center of the
nose (Option 2)
● Spray the medication into the nose while inhaling deeply (Option 4)
● Remove the nozzle from the nose and breathe through the mouth
● Repeat the above steps for the other nostril
● Blot a runny nose with a facial tissue, but avoid blowing the nose for
several minutes after instillation

The 6 Ps of compartment syndrome include:

1. Pain: Increasing despite elevation, analgesics, and ice. Pain will also
increase with passive stretching/movement. Increasing pain is an early
sign and indicates muscle ischemia (Option 3).
2. Pressure: Affected extremity or digits are firm and tense; skin is tight and
appears shiny.
3. Paresthesia: Tingling, numbness, or burning sensation, which is also an
early sign and indicates nerve ischemia (Option 1).
4. Pallor: Skin appears pale; capillary refill is >3 seconds. These indicate
poor perfusion.
5. Pulselessness: Pulse distal to injury or compartment is impalpable.
Absent pulses are a late sign.
6. Paralysis: Loss of function or inability to move extremity or digits. Muscle
weakness occurs before paralysis which is also a late sign and indicates
dead muscle tissue.