Nclex notes 1

1. Co2 causes vasoconstriction. 2.Multiple sclerosis= myelin sheat destruction, disruption in nerve impulse conduction. 3.TIA (transient ischemic attack) mini stroke with no dead brain tissue 4.Hodgkins disease= cancer of lymph is very curable in early stage 5.if HR is <100 do not give dig to children 6.heart defects. Remember for cyanotic -3Ts( Tof, Truncysarteriosus,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. 7.with R side cardiac cath=look for valve problems;with L side in adults look for coronary complications 8.Wilms tumor is usually encapsulated above the kidneys causing flank pain 9.when phenylalanine increases, brain problems occur 10.placenta should be in upper part of uterus 11.eclampsia is seizure 12. caput succedaneum= diffuse edema of the fetal scalp that crossesthesuture lines. Swelling reabsorbswithin 1 to 3 days 13.placenta previa = there is no pain, there is bleeding. Placenta abruption = pain, but no bleeding 14.bethamethasone (celestone)=surfactant. Med for lung expansion 15. milieu therapy= taking care of patient/environment; cognitive therapy= counseling; crisis intervention=short term 16.if patients have hallucinations redirect them. In delusions distract them 17.Teres Minor, Infraspinatus, Supraspinatus, and Subscapularis make up the Rotator Cuff 18.Prazosin (Minipress) -alpha-adrenergic blocking agent; antihypertensive agent.-watch our for First-dose hypotensive reaction 19.Pregnancy-induced hypertension is the most common hypertensive disorder in pregnancy. It is characterized by the development of hypertension, proteinuria, and edema. Glycosuria and ketonuria occur in diabetes mellitus. 20.Primary atypical pneumonia (Mycoplasma pneumonia) is characterized as: occurs primarily in the fall and winter months.The causative organism is M. pneumoniae.People at highest risk for mycoplasma pneumonia include those living or working in crowded areas such as schools and homeless shelters 21.EPOGEN - epoetin alfa recombinant, Erytrhopoietin, human recombinant Classification 1). normally synthesized in the kidney and stimulates RBC production 2). will elevate and maintain RBC level, decreasing the need for BT Uses:Treatment of anemia associated with Chronic Renal Failure in adults C/I: uncontrolled hypertension Side effects: CV - hypertension, CNS - pyrexia(fever) Complication: Polycythemia What to monitor before and after: BP. TEMP & HEMATOCRIT water. 22.An intussusception is a medical condition in which a part of the intestine has invaginated into another section of intestine. s/s:jelly like or currant like stool. 23.Bucks extension traction is used for decreasing painful muscle spasms that accompany fractures 24.Cascara sagrada:laxative. Common s/e: nausea and abdominal cramps 25. Skin graft:Heterograft is skin from another species. Homograft is skin from another human.Autograft is skin from the client

Nclex notes 2
1. Dehydration, sign of improvement: decreased urine specific gravity and decreased hematocrit a. Diabetes: increased urine volume, increased SG (High amount of glucose in urine) b. Hypertension: normal volume, decreased SG c. Early chronic renal disease: increased volume, decreased SG 2.Esophageal atresia: esophagus does not develop properly. s/s: infant drools continuously, lack of stools results.

3. Digoxin toxicity s/s: N/V, diarrhea, abd pain, vision change 4.Urine discoloration: Adriamycyn------ Reddish Rifabutin--------- Red orange Rifampicin------- Red orange Bactrim---------- Red orange Robaxin--------- Brown, Black or Greenish Azulfidine------ Orange yellow Flagyl------------ Brownish Dilantin---------- Pink tinged Anti Psychotic-- Pinkish to Red brown [Trifluoperazine] (Stelazine) 5.S/S of hypoxia in infant: feeding difficulty, inspiratory stridor, nares flare, expiratory grunting, sternal retractions 6.Cushing's dyndrome: tx- lifelong adm. of glucocorticoid synthesis inhibitor( Mitotane, or o,p'-DDD, is a medication used in the treatment of the rare disease adrencortical carcinoma)Inform that there will be poor wound healing 7. Anaphylactic reaction caused by infusion of IgA proteins to IgA-deficient recipient who has developed anti-IgA-antibodies. S/S:Anxiety, urticaria, wheezing progressing to cyanosis, shock, and possible cardiac arrest 8. Acute hemolytic caused by infusion of ABO-incompatible red blood cells. S/S: Chills, fever, low back pain, flushing, tachycardia, hemoglobinuria, hypotension, vascular collapse, bleeding, acute renal failure, shock, cardiac arrest, death. 9.Hirschsprung's disease, or congenital aganglionic megacolon, involves an enlargement of the colon, caused by bowel obstruction resulting from an aganglionic section of bowel (the normal enteric nerves are absent) that starts at the anus and progresses upwards. DX: Rectal biopsy looking for absence of ganglioniccells . Cardinal sign in infants is failure to pass meconium, and later the classic ribbon-like and foul smelling stools 10. Anastrozole (Arimidex) is prescribed for a postmenopausal client with breastcancer. a/e: thromboembolism 11.Cytarabine (Cytosar-U):for nonlymphocytic anemia patient. Toxic effect: bone marrow depression(s/s: fever, sore throat, signs of local infection, easy bruising, or unusual bleeding from any site). Inform the MD!! 12.Docetaxel (Taxotere): antineoplastic agent.S/E:alopecia, hypersensitivity reaction, fluid retention; Pt is prescribed an oral corticosteroid (dexamethasone (Decadron) 16 mg per day for 5 days, beginning day 1 before docetaxel therapy) to reduce the severity of fluid retention or prevent a hypersensitivity reaction. 13.Stavudine (Zerit): for HIV.S/E: Peripheral neuropathy, 14.Ritonavir (Norvir): for HIV; Adm with food. 15.Propofol (Diprivan) is an anesthetic agent for mechanical ventilation. A/E: HoTN 16.NPH insulin peak time: 6-12 hours 17.Chest tube: keep the water seal and suction control chamber at the appropriate water levels by adding sterile water as needed because water loss by evaporation may occur. 18.PCOS- polycystic ovarian syndrome: is treated with oral contraceptives(treat menstrual irregularities and acne), glucophage(Metformin)(is used to improve insulin uptake by fat and muscle cells and treats hyperinsulinemia) and Clomid(Clomiphene) is to treat infertility. 19.A decreased urinary output for the first 24 hours after surgery is a normal response from an increased secretion of Aldosterone and ADH. 20.Paralytic ileus: is treated by insertion of a NG tube. 21.Hematocrit:40%,Venous blood is used, reflects the ratio of blood cells to plasma. 22.SLE s/s:photosensitivity, neuropathies, thrombocytopenia, pleural effusion 23.Localized allergic reation: urticaria at the injection site 24.Autonomic dysreflexia prevention: Check the urinary drainage system for obstructions, monitor bowel movement regularity. 25.LDL/HDL ratio: <4 is acceptable

26.Nonverbal cue: physical appreance 27.SERM(hormone therapy): to block or counter the effect estrogen 28.Cushing's syndrome S/S: Thinning and bruising of the skin, muscle weakness and wasting, fat deposits in the abd region, buffalo hump 29.Absolute contraindications to estrogen therapy: a prior or current history of CAD, a history of known or suspected cancer of the breast. 30.Bisphosphonates meds teaching: take the meds on an empty stomach and wait at least 30 mins before eating,recognize signs of hypocalcemia. 31.ECT therapy priority care: potential for apnea. 32. Child with positive throat cultures for streptococcal infection should discard their toothbrush and replace it witha new one after they have been taking antibiotic for 24 hours. 33.Lasix s/e: photosensitivity 34.Levodopa s/s: orthostatic hypotension 35. Excessive urinary stomal edema: urinary output below 30ml/hour 36. Chronic tinnitus associated with Meniere disease pt education: mask tinnitus with music is recommended. 37.Amitriptyline: tricyclic antidepressant 38.The enema fluid should be administered slowly. If the client complains of pain or cramping, the flow is stopped for 30 seconds and restarted at a slower rate 39.Oxygen may be removed safely from the client with carbon monoxide poisoning once carboxyhemoglobin levelsare less than 5% 40.The use of TCAs in individuals with second-degree and third-degree heart block can be fatal. Therefore, the nurse is responsible to ensure that the psychiatrist orders a baseline ECG before treating the client with TCAs

Nclex notes 3
1.Intussusception common in kids with CF. Obstruction may cause fecal emesis, currant jelly-like stools (blood and mucus). A barium enema may be used to hydrostatically reduce the telescoping. Resolution is obvious, with onset of bowel movements. 2.With omphalocele(abd wall defect, the intestine, liver and other organ remain outside of the abd in a sac due to defect in abd wall) and gastroschisis (herniation of abdominal contents) dress with loose saline dressing covered with plastic wrap, and keep eye on temp. Kid can lose heat quickly. 3. PKU (no meat, no dairy, no aspartame). 4.Basal cell carcinoma TX: surgical excision, electrosurgery, cryosurgery 5. Material safety data shhets provide detailed info about chemicals found in the workplace. 6. TPN-total nutrient admixture: 1.2 micron air-eliminating final filter set is required for nutrient admixtures that contain lipids for removal of inadvertent debris and fungi. 7.Suspected cervical cord injury intervention: assess for visceral damage, adequacy of respiration, evidence of an associated head injury, vital signs. 8.Viginal meds applicator: after the adm of meds, wash, rinse, and dry the applicator, then wrap it in paper towel and place it in the client's top drawer of the bedside cabinet. 9.Male infertility factor: anatomical and structural problems, abnormalities in sperm production, genetic conditions and unknown causes. 10.Rectal suppository adm position: Sim's position 11.A positive Western blot in a child <18 months (presence of HIV antibodies) indicatesonly that the mother is infected. Two or more positive p24 antigen tests will confirmHIV in kids <18 months. The p24 can be used at any age. 12. For HIV kids avoid OPV and Varicella vaccinations (live), but give Pneumococcal and influenza. MMR is avoided only if the kid is severely immunocompromised. 13. Anantacid should be given to a mechanically ventilated patient w/ an ng tube if the ph of the aspirate is <5.0. Aspirate should be checked at least every 12 hrs. 14.Ambient air (room air) contains21% oxygen. 15.Normal PCWP is 8-13. Readings of 18-20 are considered high.

16.High potassium is expected with carbon dioxide narcosis (hydrogen floods the cell forcing potassium out). Carbon dioxide narcosis causes increased intracranial pressure. 17. Pulmonarysarcoid is leads to right sided heart failure. 18. Should not be given to the pt. with digoxin toxicity:[bretylium] and [verapamil] 19.abruptio placentae: premature separation of the placenta, -hidden blood between uterine wall and the placenta. 20.Implied consent means that the patient most likely has been found in distress and it is assumed that person wants to live. 21.tracheainnominate artery fistula:The tracheostomy tube is immediately removed. 22.Suction catheter size: should not exceed half the size of the tracheal lumen. In adults, the standard catheter size is 12 to 14 French. 23. Discharge instructions to a client after a keratoplasty includes telling the client that sutures are usually left in place for as long as 6 months. 24.Enucleation is removal of the eye, leaving the eye muscles and remaining orbital contents intact 25.Isotretinoin (Accutane) is prescribed for a clietn to treat severe cystic acne. 26.Saquinavir (Invirase) is an antiviral medication. It is administeredwithin 2 hours after a full meal. If the medication is taken withoutfood in the stomach, it may result in no antiviral activity

Nclex notes 4
1.Good Samaritan Laws-if a nurse stops at an accident scene and provides care, the nurse will not be held liable for their actions, if the care was provided in good faith according to practice standards 2.Alzheirmer's client with urinary incontinence:Limit fluids during evening times 3.Dilantin a/e: aplastic anemia -decreased reticulocyte count 4.12 weeks gestation: Uterus palpate at the level of symphysis pubis 5.During pregnancy normal s/s: Butterfly rash on both cheeks and nose( hormone change),Sereous fluid drain in the breasts 6.The sterile technique is broke when: The sterile field and supplies are wet 7.One eye injury:Dressing is applied on both eyes 8.Post op cerebral angiogram: encourage fluid, to flush the dye out 9.IV potassium adm: always check pulse rate 10.Toddlers: parallel play 11.Toxoplasmosis risk fators:raw meat,handling cat litter of infected cats, gardening and cultivating soil exposed to cat feces. 12. Flow of blood through the heart:Inferior vena cava and superior vena cava right atrium tricuspid valve rightventricle pulmonic valve pulmonary artery lungs pulmonary veins left atrium bicuspid valve (mitral) left ventricle aortic valve aorta systemic circulation 13. Venereal Warts:cauliflower cluster on perineum, vagina, penis; Complication: Genital Dysplasia Cancer 14.some opportunistic infections of AIDS: -P. Carinii Pneumonia: sob/dry-nonproductive cough -C. Albicans stomatitis: will have difficulty swalling and white exudates in back of throat -C. Neoformans: debilitating form of meningitis that may suffer seizures. -Cytomegalovirus (CMV): will experience lymphadenopathy and may have visual impairment and can affect any organ. -Kaposis Sarcoma: most common malignancy experience with AIDS, small purplish brown, nonpainful, nonpuriitc palpable lesions on the body. 15.Neonate with myelomeningocele: overflow incontinenece with constant dribbling is common,intermittent catheterization is an appropriate technique for management of urinary retention or when a urine specimen is urgently needed. 16.Management of DVT Bed rest, limb elevation , relief of discomfort with warm, moist, heat and analgesics (Tylenol, not narcotics) prn. Ambulation is contraindicated. 17.Myringotomy A surgical procedure that allows fluid to drain from the middle ear,client should lie on unaffected side.

18. After ear surgery clients should be instructed to avoid drinking with a straw for 2-3 weeks; avoid straining and takes stool softeners as prescribed, avoid getting head wet, or washing hair for at least a week and avoid moving the head rapidly, bouncing and bending fro at least 3 weeks. Also avoid air travel.

Nclex notes 5
1.First tooth: 6 month 2.Anuresis (encourage before bed time)-unable to control urine ;Encopresis- unable to control stool 3.fetal alcohol syndrome Thin upper lip, vertical ridge in upper lip, short up turned nose, mental retardation, motor retardation, hearing disorders, microcephaly. Avoid alcohol 3 months before conception and throughout pregnancy. 4.amniocentesis:16th week detects genetic abnormality 30th week detects L/S ratio: lung maturity. Void before procedure. Ultrasound given to determine position of placenta and fetus. Complications: premature labor, infection, Rh isommunization (if client Rh negative, will be given Rhogam) 5.ultrasound 5th week confirms pregnancy. Determines position of fetus, placenta, and # of fetuses. Client must drink a lot of fluid before procedure for full bladder to have a clear image 6.non- stress test: At 28th week records FHR and fetal movement. Favorable result: 2+ FHR accelerates by 15bpm and last 15seconds in 20 minutes. 7.contraction stress test: Determines placentas response to labor. Done after 28th week. Fowler/Semi-Fowler. Given Oxytocin or Pitocin. Results: Positive: Late decelerations indicates potential risk to fetus Negative: No late decelerations 8.signs of labor: Softening of cervix Expulsion of mucus plug (bloody show) pink tinged mucus secretion Lightening: Primipara: occurs 2 weeks before delivery; multipara: occurs during labor Uterine contractions: regular/progressive not Braxton-Hicks type. 9. Prolapsed cord tx: Place in trendenlenberg position or knee chest position 10.Signs of fetal hypoxia:Early sign: fetal tachycardia >160 in >10minutes Late sign: fetal bradycardia <110 in > 10 minutes 11.variable decelerations indicate:Cord compression. 12.signs of True Labor:Regular contractions increasing in frequency, duration, intensity; Discomfort radiates from back; Contractions do not decrease with rest;Cervix progressively effaced and dilated 13.Prior to Lumbar Epidural block, ask the pt to void 14.Lochia types:Rubra-bloody, day 1-3,Serosa-pink-brown, day 4-9, Alba-yellow-white, 10+ days 15.client soaks pad in 15 minutes or pooling of blood: check for hemorrhage. 16.Ectopic Pregnancy:Unilateral lower quadrant pain. Rigid, tender abdomen; Low Hct and hCG levels; Bleeding; Monitor for shock; Administer RhoGAM;Provide support 17.Placenta Previa:painless, profuse bleeding; 18. Gestational Diabetes Mellitus (GDM):Hyperglycemia after 20 weeks; Usually controlled by diet;Oral hypoglycemic medications contraindicated;Test for diabetes at 24-28 weeks on all women with average risk 20. Frequent monitoring of mother/fetus during pregnancy.Teach to eat prescribed amount of food daily at same times; Home glucose monitoring; Teach about change in insulin requirements 19.Hydatidiform Mole: Elevated hCG; Uterine size larger than expected for dates;No FHT; Minimal dark red/brown vaginal bleeding with grape like clusters; N/V; Associated with PIH; Curettage to remove tissue; Pregnancy discouraged for 1 year; Do not use IUD; hCG levels monitored for 1 year 20.Narcotic- Addicted infant: high pitched cry 21.Toxic Shock Syndrome:Sudden-onset fever; Vomiting, diarrhea; Hypotension;Erythematous rash on palms and soles; Administer antibiotics; Educate about use of tampons (change tampon Q3-Q6 hours) 22. repair of tracheoesolphageal fistula (TEF): high risk for developing esophageal stricture. 23.The use of placebos violates the client's right to ethical care.

24.A fractured femur may require up to 20 weeks for healing in an adult. 25.Psychoanalytic model: hypnosis,dream interpretation, and free association as a means of releasing repressed feelings 26.coffee ground appearance: PUD, esophageal varicies 27.Lipoma is a growth of fat cells in a thin, fibrous capsule usually found just below the skin.---benign tumor 28.High pitched bruits = stenosis, low pitched bruits = aneurysms 29.Abdominal exam:prior to the exam, ask the pt to empty the bladder. Spleen is not palpable.

Nclex notes 6
1.Mononucleosis: complication enlarged spleen; concerned for trauma if child plays dangerous sport 2.Pottery that is unglazed can lead to Lead Toxicity 3.Ampicillin decreases oral contraceptives efficiency. 4.Jackson-prat: Notify physician if drainage increases or becomes bright red 5.Tracheostomy Tube Cuff Inflated during: continuous mechanical ventilation; during and after eating;when patient cannot handle oral secretions 6.Ecchymosis (faint discoloration) around the umbilicus or in either flank indicates retroperitoneal bleeding 7.McBURNEYS POINT: is midway between the right anterior superior iliac crest and theumb ilicus.This is usually the location of greatest pain in the child with appendicitis 8.Grapefruit juice can raise cyclosporine (Sandimmune)[immunosuppresant) levels by 50% to 100%, risk for toxicity 9.Fomepizole(Antizol): an antidote given IV to a client with Ethylene Glycol (Antifreeze) intoxication 10.Phenotolamine(Regitine): antidote for hypertensive crisis 11.Bromocriptine(Parlodel): an antiparkinsonian prolactin inhibitor, is used to treat NMS 12. Hegars sign (Softening and thinningof the lower uterine segment that occurs about week 6 13.Chadwicks sign (bluish coloration of the mucous membranes of the cervix,vagina, and vulva that occurs about week 6 14.Ballottement (rebounding of the fetus against the examiners fingers on palpation) 15.Before NG removal: bowel sounds have to be present 16.Hyperkalemia on EKG:Tall, peaked T waves; prolonged PR interval; widening QRS complex 17.Hypokalemia on EKG:ST segment depression; Flat T wave 18. First-Degree Heart Block: Prolonged P-R interval 19.Bundle Branch Block: Widened QRS complex 20.Myocardial Necrosis in Area: Q waves present 21.HypoCalcemia: Prolonged Q-T interval 22.Myocardial Ischemia:ST segment elevation or depression 23.Variant angina:Triggered by coronary artery spasm; the attacks tend to occur early in the day and at rest. 24.A1-adrenergic receptors: found in the peripheral arteries and veins and cause a powerful vasoconstriction when stimulated A2-adrenergic receptors: several tissues and contract smooth muscle, inhibit lipolysis, and promote platelet aggregation. B1: Found in the heart and cause an increase in heart rate, atrioventricular nodeconduction, and contractility. B2: Arterial and bronchial walls and cause vasodilation and bronchodilation 25. Ma huang - bronchodilator, stimulant 26. Echinacea - immune stimulant (6-8 weeks only) 27. Licorice - cough and cold 28.Ginkgo - improves circulation 29. Elizabeth Kubler-Ross: Five Stages of Grief Denial-anger-bargaining-depression and withdrawl-acceptance 30.mucomyst: acetaminophen toxicity antidote 31. Addisons disease: TX: Fludrocortisone acetate (Florinef)-Mineralocorticoids: cause renal resorption of sodium and chloride ions, and the excretion of potassium and hydrogen ions 32.Wound dehiscence:immediately places the client in low-Fowlers position and instructs the client to lie quietly. These actions will minimize protrusion of the underlying body tissues. The nurse then covers the abdominal wound with a sterile dressing moistened with sterile saline.

33.Phenelzine sulfate-MAO-I 34. best indicator of effectiveness of Albuterol: increase in peak expiratory flow rate. 35. Prevent infection in pt with an internal fixation and hip ;pinning: changing the surgical dressings using sterile technique. 36. Acute toxicity of MAO inhibitors is manifested by restlessness, anxiety, and insomnia. Dizziness and hypertension may also occur 37.ADHD meds: Methylphenidate hydrochloride (Ritalin) is a central nervous system (CNS) stimulant.Taking the medication at breakfast and lunch and avoiding taking the medication in the evening can prevent insomnia. 38.Abdominal Aortic Aneurysm (AAA)-Abdominal pain (unchanged by position),Cold Lower Extremities, peripheral pulse loss.3.5-5 cm careful observation; 5-7 cm elective surgery;>7 cm non-elective surgery 39.septic shock is a major risk with appendicitis. 40.Ligament of Treitz: differentiates the upper and lower GI tract 41. Melena (black tarry stools) is usually a lower GI sign of an upper GI bleed. 42.Occasionally occult fecal blood:must have 3 separate positives on 3 separate occasions for true Dx 43.Hemoccult Testing (GUIAC)-occult stool 44. High-pitched tinkling sounds are indicative of an intestinalobstruction; 45. Absent or diminished sounds may be indicative of a paralytic ileus. 46. Elder pt. :Due to their lower than normal body temperature, an early sign of fever would be a temperature of 99 F degrees rectally.Blood-tinged sputum is usually a sign of congestive heart failure. 47.Arteriosclerosis is described as a thickening and loss of elasticity of the arteries 48.Atherosclerosis is a deposit of fatty plaques linking the arteries 49.Somnambulism (sleepwalking), apraxia (inability to perform purposeful movements) 50.COPD:Destruction of alveolar walls 51. An infant who suddenly becomes pale, cries out, and draws the legs up to the chest is demonstrating physical signs of intussusception.

Nclex notes 7
1. Ethacrynic Acid (Edecrin)are considered loop diuretics and are potassium wasting 2.Glipizide (Glucotrol):s/e aplastic anemia and photosensitivity 3.Bethanechol (Urecholine)a cholinergic or parasympathomimetic used to treat functional urinary retention; mimics action of acetylcholine 4.Carbamazepine (Tegretol)interferes with action of hormonal contraceptives. Side effects: photosensitivity 5.Doxycycline (Vibramycin):tetracycline; may cause esophageal irritation, photosensitivity, better use anothermethod of birth control 6.Albuterol (Proventil)-Wait one minute between puffs of the inhalers for best effect 7.Beclomethasone (Vanceril)a steroid medication.Side effect: fungal infections, dry mouth, throat infections 8.Topiramate (Topamax)is 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 9.Propranolol (Inderal):may mask symptoms of hypoglycemia 10.Butorphanol Tartrate (Stadol)analgesics. 11.Verapamil, Bretylium, and Amiodarone increases serum dig levels, possibly causing Digitalis Toxicity 12.Dexamethasone (Decadron): to take it with food or milk because Decadron increases the production of hydrochloric acid, which maycause gastrointestinal ulcers. 13.A Neologism is a new word self invented by a person and not readily understood by another that is often associated with a thought disorder. 14. Bone marrow Aspiration---done at iliac crest; painful 15.T-Tube: 500-1000 cc/day, bloody first 2 hours 16. (INR) of 2.0 to 3.0 is appropriate for most clients. An INR of 3.0 to 4.5 is recommended for clients with mechanical heart valves. 17.Battery is the actual contact with ones body.

18. Food high in high phosphates:fish, eggs, milk products, vegetables, whole grains, and carbonated beverages. Coffee, tea, and cocoa are not high in phosphates. 19.Hypoglycemia is immediately treated with 10 to 15 grams of carbohydrate 20.For minor burns,exposure to cool running water is the best treatment. This stops the burning process and helps to alleviate pain. Ice is contraindicated, because it mayadd more damage to already injured skin. 21.Bee sting Pain can be alleviated by applying an ice pack and elevating the site. 22.If a nonreassuring fetal heart pattern occurs (tachycardia, bradycardia, decreased variability, and late decelerations), the nurse would intervene to increase fetal oxygenation. The oxytocin infusion is stopped immediately. 23.Sickle cell anemia: pain med should be around the clock; hydration is very important. 24. Passive aggressive disorder: improving sign- the verbal and nonverbal message is congruent. 25.SLE nursing diagnosis: ineffective protection; intervention: pcarefully wash hand 26.Pancreatic cancer has poor prognosis. Family management: the grieving process 27. Serious systemic complication of IV push: speed shock 28.Normal tidal volume in pt on ventilator: 7ml/kg 29.Ketalar (Ketamin)is a phenylcyclidine derivative and can cause hallucinations and nightmares.Pt needs to be put in a low verbal, tactile, and visual stimulation environment. 30.Signs of preceding labor: a surge of energy,increased vaginal discharge, bloody show, a return of urinary frequency ans the fetus engages in the pelvis, and weight loss of 0.5kg to 1.5kg, lightening, backache, stronger Braxton-hicks contractions, cervical ripening, and rupture of membranes. 31. Taking-in phase: 1-2 days postpartum; Taking -hold phase: 4-5 weeks 32.Tetralogy of Fallot: stenosis of the pulmonary artery, interventricular septal defect, deviation of the aorta. 33.Delusion of grandeur: satisfy the pt's implied need to feel important. 34.Hepatitis B pt education: prevention the spread of infection to others. 35.Early decelerations: mirror the contraction pattern. Due to head compression 36. Scleral buckling for a detached retina: avoid abrupt movement of the head. 37.Infant with congenital heart defect need high energy when feeding.Thus increase oxygen for feedings. 38.Triamcinolone acetonide[Azmacort]- corticosteroid inhalant, s/e: oral candidiasis; tx: rinse the mouth after adm. 39.Meditation is not helpful in OCD 40.propylthiouracil (PTU) for hyperthyroidism-s/e:bone marrow depression( report any unusual bleeding or bruising)

Nclex notes 8
1. Flail chest: painful, rapid, shallow respirations,severe dyspnea.--intubation tray is necessary 2. Epidural catheter: Aspiration of clear fluid of less than 1 mL is indicative of epidural catheter placement. More than 1 mL of clear fluid or bloody return means that the catheter may be in the subarachnoid space or in a vessel.Therefore, the nurse would not inject the medication and would notify the anesthesiologist 3. Air embolus: the nurse should clamp the catheter immediately and notify the physician.The client is placed in the lateral Trendelenburg position on the left side to trap the air in the right atrium. 4. Indirect laryngoscopy is done to assess the function of the vocal cords or to obtain tissue for biopsy; Upright position. 5. Radioactive iodine therapy-expect to see pt's thyroid level is decreased. Won't happen until 6-8 weeks. 6.CAD:Reducing the demands on the heart by encouraging rest andrelaxation is important for the hospitalized client with CAD. 7. Nitroglycerin- monitor BP is very important. 8. Angioplasty: involves using a balloon-tipped catheter to displaceor flatten the plaque built up along the arterial walls, therebyenlarging the diameter of the vessel. 9. Ischemia represents a decreased amountof oxygen to the myocardium.EKG: T wave inversion 10.Most clients experiencing chest discomfort use rationalization and deny that they are experiencing pain. 11. A troponin I level greater than 1.5 ng/mL is consistent with a myocardial infarction. A troponin T level greaterthan 0.1 to 0.2 ng/mL is consistent with a myocardial infarction. 12. An infant who suddenly becomes pale, cries out, and draws the legs up to the chest is demonstrating physical signs of intussusception.

13.Hirschsprung's Disease:lack nerve cells in a part or all of the large intestine. Ribbon-like stool, bilestained emesis, abdominal distension, and the absence of peristalsis are symptoms of congenital megacolon 14.crush injury: increase fluid intake to flush the kidney 15.ALL:Bleeding into joints; cold applications will decrease joint discomfort. 16. phenothiazine antipsychotics. A/E: EPS 17. Osteomyelitis: occurs mostly in open fracture. 18. Epiphysis:Growth takes place at the epiphysis of the long bone. A fracture at this level can destroy the layer of germinal cells of theepiphysis, resulting in growth disturbance. 19.A drop in expiratory flow is the most reliable early sign of an asthma episode. 20.Chest percussion and postural drainage are normally used to clear air passages forchildren with cystic fibrosis 21.Numerous, frequent episodes of a child staring off into space and then quickly returning to conversation or activities are a classic sign of absence seizures that can be confirmed by an EEG. 22.Gestational hypertension:Edema should be investigated further. Other S/S: proteinuria, hypertension 23.Tetracyclines are deposited in the teeth and bones of the fetus.These medications can cause permanent tooth enamel discoloration and can depress bone growth. 24.A Hickman catheter is a vascular access device that is surgically inserted, tunneled through the subcutaneous tissue,and is used to manage long-term intravenous therapy. 25.Burn with resp.injury /S/: facial burns, the presence of soot around the mouth or nose, and singed nasal hairs. 26.:Gallium scan is similar to a bone scan, but an injection of gallium isotope instead of technetium Tc 99m isadministered 2 to 3 hours before the procedure. Theprocedure takes 30 to 60 minutes to perform. The clientmust lie still during the procedure. There is no special aftercare. 27.The nurse can best assist the client in skeletal traction with repositioning by providing a trapeze on the bed for the client's use. 28. Vasopressin is a synthetic antidiuretic hormone. Administration of this hormone into the bloodstream reduces bleeding. It acts directly on gastrointestinal smooth muscle as a vasoconstrictor.Because it is a vasoconstrictor, it should be infused intravenously via a central line 29.A hallmark sign of pancreatitis: is severe abdominal pain that is not relieved by vomiting. 30.The T-piece or Briggs device requires that the client is removed from the mechanical ventilation for a short period of time, usually beginning with a 5-minute period. The ventilator is disconnected and the T-piece is connected to the client's artificial airway. 31. Sutures are usually removed 7 to 10 days after a skin biopsy. 32.A Wood's light examination is a painless procedure. Examination of the skin under a Wood's light is always carried out in a darkened room. This is a noninvasive examination; therefore an informed consent is not required. A hand-held long wave length ultraviolet light or Wood's light is used. The skin does not need tobe shaved, and a local anesthetic is unnecessary. 33. Lyme disease cannot betransmitted from one person to another 34. Reye's Syndrome: is caused by use of aspirin and other salicylate containing medications. Cause damage to the brain, liver, s/s: hypoglycemia,fatty liver, encephalopathy. 35.Sickle cell anemia-vaso-occlusive crisis:Tx- hydration, oxygenation, and measures to decrease metabolism. 36.The earliest finding associated with increased ICP would be irritability. 37.Tourette's disorder involves motor and verbal tics that cause marked distress and significant impairment in socialand occupational functioning. 38.Glaucoma eyedrop meds: pt need to take it for the rest of their life. 39.Case management represents an interdisciplinary health care delivery system that promotes appropriate use of hospitalpersonnel and material resources to maximize hospital revenueswhile providing for optimal outcome of care. Case managementmanages client care by managing the client care environment. 40.Miller-Abbott tube: Initial insertion of the tube is a physician's responsibility. 41.Pertussis, also known as whooping cough. Oxygen adm 42. Autonomic dysreflexia: s/s:severe headache. The client may sweat profusely above the level of the cord lesion and complain of a stuffy nose.

43.Spinal shock:loss of all neurological function below the level of injury. Flaccid paralysis, bradycardia, and hypotension occur. The body is unable to use either shivering orperspiring as a means of controlling body temperature. 44.Cardiac tamponade: hypotension, tachycardia, jugular vein distention,cyanosis of the lips and nails, dyspnea, muffled heartsounds, diaphoresis, and paradoxical pulse. A paradoxical pulse is a decrease in systolic arterial pulsation exceeding10 mm Hg during inspiration.

Nclex notes 9
1.The client with myocardial infarction should avoid activities that tense the muscles, such as isometric exercises. These increase intraabdominal and intrathoracic pressures and can decrease the cardiac output. They canalso trigger vagal stimulation, causing bradycardia. 2.Venous insufficiency is characterized by an achy type of leg pain that intensifies as the day progresses 3. peripheral arterial insufficiency:Intermittent claudication,sudden onset of leg pain that occurs with exercise and is relieved by rest 4.Skin problem: Melanoma: is an irregularly shaped pigmented papule orplaque with a red, white, or blue-toned color. Basal cellcarcinoma appears as a pearly papule with a central craterand rolled [waxy border]. Squamous cell carcinoma is a firmnodular lesion topped with a crust or a central area of [ulceration]. Actinic keratosis, a premalignant lesion,appears as a small macule or papule with dry, roughadherent yellow or brown scale. 5.Haloperidol (Haldol) is an antipsychotic agent used tocontrol tics and vocal utterances of Tourette's syndrome. 6.Sodium nitroprusside decreases blood pressure by vasodilation, thus reducing pressure in the aneurysm 7.Ruscus aculeatus (Butche's Broom) is an evergreen foundin the Mediterranean and the southern region of the United States. It has been used to treat varicose veins, peripheralvascular disease, arthritis, hemorrhoids, and leg edema. It has also been used as a laxative, as a diuretic, and to treat diabetic retinopathy. 8.Sulfonylurea drugs, Orinase for example, lowers the blood sugar by stimulating the beta cells of the pancreas to synthesize and release insulin 9.Quinidine to pt with kidney disease: may cause cardiac arrest. (kidney can not excrete the quinidine, result excessive level in the body 10.Dicumarol is an anticoagulant drug: shave with an electric razor. 11.colchicine(for gout) toxicity:diarrhea is the most common early sign 12.Atopic dermatitis is chronic, pruritic and allergic in nature. Typically it has a longer course 13. dialysis treatment: will improve the high creatinine level. decrease it to normal. 14. determining the presence of cerebrospinal fluid from a head injury pt:Allow the drainage to drip on a sterile gauze and observe for a halo or ring around the blood 15.Hypoxic states may cause cerebral edema. Hypoxia also causes cerebral vasodilatation particularly in response to a decrease in the PaO2 below 60 mmHg 16.Complication after contusion: Laceration of the brain 17.pyrazinamide (Pyrazinamide) for TB:check liver function.l 18.Hypothermia or fever may lead to an inaccurate reading of pulse oximetry. 19.Snake bite:A restrictive band 2 to 4 inches above the snake bite is most effective in containing the venom and minimizing lymphatic and superficial venous return. 20.Bladder irrigation:Irrigate with 20mL's of normal saline to establish patency 21.oral cholecystogram.:Explain that diarrhea may result from the dye tablets.Each dye tablet is given at 5 minute intervals, usually with 1 glass of water following each tablet. 22.peptic ulcer disease: Inserting a nasogastric tube to determine the presence of blood. 23.arterial insufficiency and Raynaud's disease pt education: keeping the environment warm to prevent vasoconstriction. 24.TB: A positive sputum culture takes at least 3 weeks, due to the slow reproduction of the bacillus 25.Crutchfield tongs:used in head injury to hyperextend the vertebral column 26.finger probe pulse oximeter:Identify if the client has had a recent diagnostic test using intravenous dye; in that case, the reading will be inaccurate.

27.A client being treated for esophageal varices has a Sengstaken-Blakemore tube: Regularly assess respiratory status 28.acute pancreatitis position:Bedrest in Fowler's position 29.acute renal failure :acute metabolic acidosis 30.suprapubic cystostomy:Clamping the tube and allowing the client to void through the urinary meatus before removing the tube 31. Check the ability to ambulate: Romberg's test: is the ability to maintain an upright position without swaying when standing with feet close together and eyes closed. 32.Pneumonia is a major complication of unresolved atelectasis 33.The purpose of the footplate is to prevent footdrop while the client is immobilized in traction 34.promoting the environmental safety of a client with a cognitive disorder Applying an identification bracelet on the client 35.Any disposable equipment and supplies used for chemotherapy must be disposed of in "bio-health hazard 36.During an acute episode of diverticulitis, measures focus on resting the colon, such as keeping the client on nothing-by-mouth status, administering I.V. fluids, and maintaining nasogastric suctioning and bedrest. 37.intervertebral disc herniation: Positioning the client with the head of the bed elevated and his knees slightly flexed increases the disc space and may help to decrease the clients pain. Bedrest is important. 38.The exact cause of acne is not really known 39.rectovaginal fistula is at high risk for infection: performing perineal hygiene, including irrigations 40.TX for increased ICP:Osmotic diuretics 41.A tension pneumothorax occurs when the pressure increases in the pleural space. Thus,removing an occlusive dressing will release the increased pressure in the pleural space and helpresolve the tension. 42. Women breast health program teaching:Optional monthly BSE, yearly clinical examination, and yearly mammograms after age 40 43. Following mechanical valve replacement surgery, clients need to be educated about the need for lifelong oral anticoagulant therapy. 44.Povine or bovine valve replacements do not require anticoagulants. 45.An Unna boot is medicated gauze applied to the affected limb from the toes to the knees after the ulcer is cleaned. The boot is then wrapped in plastic wrap and hardens like a cast promoting venous return and preventing stasis 46. PEEP helps keep the alveoli expanded, increasing the area available for gas exchange,thus improving the clients oxygenation. 47.bigeminy :every other heartbeat is a premature ventricular contraction.Checking the rhythm strip and assessing blood pressure 48.Lasix therapy:For the elderly client, a systolic blood pressure of 150 mm Hg would be considered normal and thus indicative that the drug therapy is effective. 49.The client with arterial occlusive disease needs to enhance the blood supply to the body parts affected; keeping legs in a dependent position in relationship to the heart to improve peripheral blood flow enhances the blood flow to the extremities. 50.new amputation, the dressing inadvertently comes off the stump: nurse should Immediate application of an elastic compression bandage wrapped around the limb 51.emphysema: distant breath sounds.(little sputum) 52.Uncontrolled coughing in the client following a thoracentesis may indicate the development of pulmonary edema that requires immediate attention. 53.Nasogastric tube feedings may result in aspiration leading to pneumonia, suggested by the hacking cough, low-grade fever, and moderate dyspnea.

Nclex notes 10
1.acute arterial occlusion S/S: sudden onset of let pain, pale, cold, numb,pulselessness; Intervention: Using warm water when bathing 2.Radiation therapy marks: These marks must remain in place and should not be washed off

3. COPD, pneumonia: increase fluid intake 4. MI pt. family education:Encouraging the clients family to take a cardiopulmonary resuscitation (CPR) course 5.Arterial insufficiency: Complaints of pain in the legs with activity 6.Pneumonia, (eg right chest pain) intervention:Splinting the affected side, such as by having the client lie on the right side, restricts expansion and reduces friction between pleurae, which helps decrease the pain. 7.Ischemia EKG:Inverted T waves 8. Right-sided heart failure S/S: N/V 9.Demand type pacemaker: senses the hearts intrinsic rhythm; it will only function if the clients own heart rate falls below the predetermined set rate(eg, set for 60, but the pt's HR is 80, this is ok, keep monitoring the pt's HR) 10. IBS education: eat a high-fiber, low gas-producing diet and increase fluid intake 11. Frostbite: Elevation of the body part helps to reduce the edema 12.A dissecting aneurysm usually occurs in the chest, not the legs; a tearing or ripping sensation of pain in the anterior chest,back, epigastric region, or abdomen is common. 13.Postphlebitic syndrome is characterized by a brownish discoloration of the skin, the hallmark sign 14.Dental surgery is one of the predisposing factors for the development of endocarditis 15.AAA abdominal aortic aneurysm S/S:Pulsatile mass and systolic bruit 16. Bacterial pneumonia breath sound:Bronchial breath sounds over consolidated lung fields 17.Adventitious breath sounds, including crackles and wheezes, would be indicative of acute respiratory failure. 18.Exposure to certain chemicals such as tar, soot, asphalt, oils, and sunlight put this occupation at the highest risk. 19.A major complication associated with pericarditis is pericardial effusion or cardiac tamponade manifested by hypotension and muffled heart sounds. 20. Ankle arm index: is an objective indicator of arterial disease. Normal value is 1.0.Values less than 0.5 indicate ischemic rest pain. 21.Pulses graded as +4 are considered normal. 22.Mitral stenosis is an obstruction of blood flowing from the left atrium into the left ventricle, commonly manifested by progressive fatigue due to low cardiac output, hemoptysis, and dyspnea on exertion secondary to pulmonary venous hypertension. 23.Aortic insufficiency refers to the backflow of blood from the aorta into the left ventricle during diastole; most clients are asymptomatic,except for a complaint of a forceful heartbeat. 24. Aortic stenosis refers to a narrowing of the orifice between the left ventricle and the aorta; many clients experience no symptoms early on, but eventually develop exertional dyspnea, dizziness, and fainting. 25.Mitral insufficiency refers to the backflow of blood from the left ventricle and aorta; many clients experience no symptoms early on,but eventually develop exertional dyspnea, dizziness, and fainting 26.COPD prevention of acute exacerbations:Elimination of exposure to pulmonary irritants 27.Depending on the degree of exposure to pathogens, hand washing may last from 10 seconds to 4 minutes. After routine patient contact, hand washing for 30 seconds effectively minimizes the risk of pathogen transmission 28.Sterile technique is used whenever Invasive procedures are performed 29.A natural body defense that plays an active role in preventing infection is: body hair 30.removing a contaminated gown, the first thing to touch is: Waist tie and neck tie at the back of the gown 31.most effective form or universal precautions:Discard all used uncapped needles and syringes in an impenetrable protective container 32.Leukocytosis is any transient increase in the number of white blood cells (leukocytes) in the blood. 33.Correct method for determining the vastus lateralis site for I.M. injectionDivide the area between the greater femoral trochanter and the lateral femoral condyle into thirds, and select the middle third on the anterior of the thigh 34.The mid-deltoid injection site is seldom used for I.M. injections because it can accommodate only 1 ml or less of medication 35. intradermal injection: 26 G 36. Parenteral penicillin can be administered as IM or IV

37.1gr=60mg 38.hemolytic reaction to blood transfusion S/S: Hemoglobinuria 39. S/S phlebitis: pain or discomfort, edema and heat at the I.V. insertion site, and a red streak going up the arm or leg from the I.V. insertion site 40.Most tablets designed for oral use, except for extended-duration compounds can be administered via gastrostomy tube 41. Cough Is a protective response to clear the respiratory tract of irritants 42. A clinical nurse specialist is a nurse who has Completed a masters degree in the prescribed clinical area and is a registered professional nurse 43. Reduce the risk for falls includes use of sturdy and secure railings on all staircases and ample lighting. 44.Nursing care after bone biopsy includes monitoring the site for swelling,bleeding, and hematoma formation.The biopsy site is elevated for 24 hours to reduce edema. 45.No activity or dietary restrictions must be followed after a bone scan. The client is encouraged to drink large amounts of water for 24 to 48 hours to flush the radioisotope from the system 46.Signs and symptoms of infection under a casted area include odor or purulent drainage from the cast or the presence of hot spots, 47. A casted extremity is elevated continuously for the first 24 to 48 hours to minimize swelling and to promote venous drainage 48. DVT management: bed rest for a period as prescribed; limb elevation; relief of discomfort with warm moist heat and analgesics as needed; anticoagulant therapy; and monitoring for signs of pulmonary embolism. Ambulation is contraindicated, because the tail of the thrombus could dislodge and travel to the lungs as a pulmonary embolus. 49. Chronic venous insufficiency: avoid crossing the legs, sitting in chairs where the feet do not touch the floor, wearing garters or sources of pressure above the legs (such as girdles), and to avoid prolonged standing or sitting. The client should wear elastic hose for 6 to 8 weeks, and perhaps for life. The client should sleep with the foot of the bed elevated to promote venous return during sleep. 50. Legal blindness implies that the person cannot perform work that requires visual ability. The person who is legally blind usually retains some perception of light and movement. Total blindness means the absence of all light perception.

Nclex notes 11
1.paracentesis position:Fowlers position or sitting on side of the bed with feet on stool 2.Transurethral resection of the prostate (TURP)for benign prostatic hypertrophy (BPH) 3.It is not advisable to bathe a newborn or infant after a feeding because handling may cause regurgitation. Because bathing is thought to be relaxing to the newborn, before feeding may be the best time 4.Lasix: take it in the morning 5.The code of ethics for nurses: guide for carrying out nursing responsibilities that provide quality care and for the ethical obligation of the profession 6. emaciated- very skinny from starvation, risk for pressure ulcers. 7.dorsal recumbent position: nurse should help to prevent Hyperextension of the knees 8.Long time high fowlers position- nurse should prevent Posterior flexion of the lumbar curvature 9.Pt is experiencing pain related to incisional swelling following laminectom: Encourage the client to log roll when turning 10.[Doxycycline]-Tetracyclilne- S/E: n/v, photosensitivity, discoloration and softening of the teeth INTERVENTION: avoid calcium rich foods or dairy production. 11.[ Epoitetin]-Antianemics-elevate RBCs.renal failure pt -S/E: HTN, thrombotic events for hemodialysis pt; A/E:seizures INTERVENTION: seizure precaution; may require increased the anticoagulant agents dosage. 12.[Estradiol]-estrogen hormones; S/E: HA, intolerance to contact lenses, N/V(eat solid food will relieve), weight changes, amenorrhea, dysmenorrhea; male: impotence, testicular atrophy; oily skin, gynecomastia(men), breast tenderness A/E: MI, thromboembolism, edema, HTN; INTERVENTION: assess BP before and after adm the meds. monitor weight. Caution pt smoking will increase the a/e 13.Fentany-opioid analgesics.A/E: Apnea, laryngospasm. Avoid use in patients who have received MAO inhibitors withinthe previous 14 days (may produce unpredictable, potentially fatalreactions) 14. [Fludrocortisone]-corticosteroids.

15. [Fluphenazine]-antipsychotics. S/E: EPS, photosensitivity, HoTN, tachycardia, urinary retention, Agranulocytosis INTERVENTION: may cause Q wave, T wave changes in EKG. 16. [Haldol]: S/E:EPS, blurred vision, dry eye, dry mouth, consitpation, urinary retention, photosensitivity, A/E: seizures, neuroleptic malignant syndrome. 17.Isotretinoin[ Accutane] is used to treat severe recalcitrant nodular acne (a certain type of severe acne) that has not been helped by other treatments, such as antibiotics. Isotretinoinis in a class of medications called retinoids. S/E: conjunctivitis, dry lips,skin, nosebleeding.A/E: psychosis, hepatotoxicity, birth defects, depression. DRUG INTERATION: Tetracycline taken with Accutane can increase ICP; Corticosteroid take with Accutane may weaken the bones. Vitamin A in high doses has many the same S/E as Accutane. 18.[Lactulose]-laxatives-Decrease serum ammonia level for liver disease.INTERVENTION: check effectiveness by pt. pass a soft, formed bowel movement, usually within 24-48 hrs.; clearing of confusion, apathy, and improved mental status in PSI. 19.Ankylosing spondylitis: is a type of arthritis that affects parts of the spine S/S: Pain and stiffness in the lower back."Poker back". 20.Osteoblast: new bone forming cells, reabsorbs, and removes old damaged bone cells 21.Glycogenosis: the synthesis of glycogen from glucose 22. uric acid leve- 2-6 mg/dl 23.Blilrubin: direct-0.3; indirect- 0.1-1.0 24. AST: 8-20 MALE, 8-40 FEMALE 25. ALT: 98-251 MALE, 81-312 FEMALE 26.GuillainBarr syndrome :CSF protein level will be increased 27.Serum osmolality: 285-295 , increase in dehydration 28. Urine specific gravity, decrease in dehydration 29.[chlorpromazine ](Thorazine): liquid form of phenothiazine has a more predictable onset of action 30.Hypothalamus regulates the unconscious responses- fight-or-flight 31. Limbic system: emotional expressing, learning and memory 32.Reticular activating system: sleeping and wakefulness 33.Somatic nervous system: voluntary control over skeletal muscles 34.Bipolar disorder, manic phase, promote nutrition: offer finger foods and sandwiches 35.Antipsychotic S/E: amenorrhea; Instruct pt to continue contraceptive use even when experiencing amenorrhea. 36.[Digoxin] therapeutic effects: increase BP, decrease HR, decrease RR 37.[Valium], benzodiazepine:S/E: motor incoordination and ataxia 38.[Nateglinide] (Starlix) is an antidiabetic medication used to treat type 2 DM 39.[tamoxifen citrate](Nolvadex) for breast CA, s/e: vaginal bleeding A/E: visual damage 40. [tolterodine tartrate] (Detrol LA)antispasmodic,TX for overactive bladder; Avoid in pt with urinary retention and uncontrolled narrow-angle glaucoma 41.[Metamucil] is a bulk-forming laxative. It should be taken with a full glass of water or juice, and followed by another glass of liquid. 42.Fluid oscillation in the tubing of a chest drainage system indicates that the system is working properly 43.Sengstaken-Blakemore tube: in semi-Fowler position. 44.Blood transfusion needle size: 16 to 20G 45.Residual urine is urine that remains in the bladder after voiding. The amount of residual urine is normally 50 to 100 46.Nitroglycerin patch should be moved before an MRI 47.Ectopic pregnancy: Unilateral, dull abd pain; Need to seek the doctor immediately!!!! 48. Hydralazine (Apresoline) -calcium channel blocker, decrease BP 49.During pregnancy, breast sensitive and sore:apply cold compress and wear a well-fitting, supportive bra. 50.Hyperparathyroidism- excessive calcium- renal caculi- hematuria

Coping Mechanisms
1.Compensation - extra effort in one area to offset real or imagined lack in another area Short man becomes assertively verbal and excels in business 2. Conversion - A mental conflict is expressed through physical symptoms Woman becomes blind after seeing her husband with another woman 3. Denial - treating obvious reality factors as though they do not exist because they are consciously intolerable Mother refuses to believe her child has been diagnosed with leukemia. "She just has the flu." 4. Displacement - transferring unacceptable feelings aroused by one object to another, more acceptable substitute Adolescent lashes out at parents after not being invited to party 5. Dissociation - walling off specific areas of the personality from consciousness Adolescent talks about failing grades as if they belong to someone else; jokes about them 6. Fantasy - a conscious distortion of unconscious wishes and need to obtain satisfaction A student nurse fails the critical care exam and daydreams about her heroic role in a cardiac arrest 7. Fixation - becoming stagnated in a level of emotional development in which one is comfortable A sixty year old man who dresses and acts as if he were still in the 1960's. 8.Identification - subconsciously attributing to oneself qualities of others Elvis impersonators. 9.Intellectualization - use of thinking, ideas, or intellect to avoid emotions Parent becomes extremely knowledgeable about child's diabetes. 10.Introjection - incorporating the traits of others Husband's symptoms mimic wife's before she died. 11.Projection - unconsciously projecting one's own unacceptable qualities or feelings onto others Woman who is jealous of another woman's wealth accuses her of being a gold-digger. 12.Rationalization - justifying behaviors, emotions, motives, considered intolerable through acceptable excuses. "I didn't get chosen for the team because the coach plays favorites." 13.Reaction Formation - expressing unacceptable wishes or behavior by opposite overt behavior. Recovered smoker preaches about the dangers of second hand smoke. 14.Regression - retreating to an earlier and more comfortable emotional level of developlment. Four year old insists on climbing into crib with younger sibling. 15.Repression - unconscious, deliberate forgetting of unacceptable or painful thoughts, impulses, feelings or acts. Adolescent "forgets" appointment with counselor to discuss final grades. 16.Sublimation - diversion of unacceptable instinctual drives into personally and socially acceptable areas. Young woman who hated school becomes a teacher

Poisoning
1. aspirin poisoning:Tinnitus, change in mental status, Increased temperature, hyperventilation, bleeding, nausea and vomiting. Nursing care: induce vomiting, maintain hydration, reduce temperature (sponge baths), monitor for bleeding. 2. tylenol poisoning:Symptoms: nausea/vomiting, hypothermia, If no treatment, hepatic/liver involvement. If liver gets involved patient may have RUQ pain, jaundice, confusion, and coagulation abnormalities. Nursing care: induce vomiting, maintain hydration, monitor liver and kidney function with labs such as AST/ALT enzymes. Antidote N-acetylcysteine (Mucomyst) 3.lead toxicity:Symptoms: Irritability, decreased activity, abdominal pain, Increased ICP; Diagnostic tests: Blood lead levels (>9micrograms = toxic), Erythrocyte protoporphyrin (EP), X-ray long bones (lead deposits in long bones) Children engage in PICA (ingesting nonfood substances) Lead blocks formation of hemogloblin and toxic to kidneys. Nursing care: identify source, chelating agents, teaching parents 4. When an individual comes in contact with a poison ivy plant, the sap from the plant forms an invisible film on the human skin. The nurse should instruct the parents to immediately shower the child and lather and rinse the skin several times in running water.

Lab

Tonometry: normal (10-21 mm Hg) PR Interval: normal (0.12-0.20 seconds) QRS measurements: normal (0.04 to 0.10 second) Serum Amylase: normal (25-151 units/dL) Serum Ammonia: normal (35 to 65 mcg/dL) aPTT: Partial Thromboplastin Time: normal (20-36 seconds) PT:Prothrombin Time: normal (Male: 9.6-11.8 seconds) and (Female: 9.5-11.3) Platelet Count: normal (150,000-400,000 cells/uL) Albumin level: normal (3.4 to 5 g/dL) Serum Osmolality: normal (285 to 295 mOsm/kg), high value indicates dehydration Safe Suction Range: normal [Infant] 50-95 mm Hg [Child] 95-115 mm Hg [Adult]100-120 mm Hg Magnesium Sulfate: Therapeutic Range (4 to 8 mg/dl) Left Atrial Pressure: normal (1 to 10 mm Hg) Central Venous Pressure: 3-11 <3 mm Hg = inadequate fluidand >11 mm Hg = too much fluid Protein: 6.0 to 8.0 g/dL Uric acid: [Male 4.5 to 8 mg/dL Female 2.5 to 6.3 mg/dL Serum iron: Male65-175 ug/dL Female50-170 ug/dL] Blood volume: 5000mL Central venous pressure:4 to 10 cmH2O (increased in cardiac overload; decreased in dehydration) Pressure within the right atrium:2 to 7 mmHg Capillary refill time:<3 seconds Normal sweat chloride:<40 mEq/L Normal pupil diameter:3 to 5mm Normal ocular pressure:10 to 21 mmHg Normal Pulmonary capillary wedge pressure (PCWP):8 to 13 mmhg Normal cardiac output :4 to 8 L/min. Thyroid stimulating hormone (thyrotropin; THS):0.2 to 5.4 ug/dL Thyroxine (T4):5.0 to 12.0 ug/dL Triiodothyronine (T3):80 to 230 ng/dL The normal CD4+ T cell count is between 500 mcg/L and 1600 mcg/L

IMMUNIZATION
Birth Hepatitis B 1 months Hepatitis B 2 months OPV, DPT, HIB 4 months DPT, HIB, OPV 6 months DPT,HIB, hepatitis B 12 months HIB, OPV 15 months MMR 18 months DPT 12 18 months Varicella vaccine 4 -6 years DPT, OPV, MMR 11 12 years MMR ( if not administered at 4 -6 years) 11 16 TD booster

THERAPEUTIC SERUM MEDICATION LEVELS

Acetaminopen (Tylenol): 10 20 ug/mL

Amikacin (Amikin) Amitryptyline (Elavil) Carbamazepine (Tegretol) Chloramphenicol (Chloromycetin) Desipramine (Norpramin) Digotoxin ( Crystodigin) Digoxin ( Lanoxin) Disopyramide (Norpase) Ethosuximide ( Zarontin) Gentamycin (Garamycin) Imipramide (Tofranil) Lidocaine (Xylocaine) Lithium (Lithobid) Magnesium sulphate Nortriptyline (Aventyl) Phenobarbital (Luminal) Phenytoin (Dilantin) Primidone (Myoline) Procainamide (Pronestryl) Propranolol (Inderal) Quinidine (Quinalaglute, Cardioquin) Salisylate Theophylline (Aminiphylline, Theo-Dur) Tobramycin (Nebcin ) Valproic acid (depakene)

25 30 ug/mL 120 -150 ng/mL 5 -12 ug/mL 10 20 ug/mL 150 -300 ng/mL 15- 25 ng/mL 0.5 2.0 ng/mL 2 -5 ug/mL 40 100 ug/mL 5 10 ug/mL 150 300 ug/mL 1.5 5.0 ug/mL 0.5 -1.5 ug/mL 4 -7 mg/dL 50 150 ng/mL 10 30 ug/mL 10 -20 ug/mL 5 20 ug/mL 4 10 ug/mL 50 100 ng/mL 2 5ug/mL 100 -250 ug/mL 10 -20 ug/mL 5 -10 ug/mL 50 -100 ug/mLr