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nclex.KAPLAN test

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can a pt give consent if he has been drinking or is pre-medicated?
no
When, if at all, is 5th disease contagious?
Yes, but only before a rash develops when pt usually has cold-like symptoms.
what signs can indicate morphine toxicity?
pin-point pupils and/or resp < 13
what's the primary physiological effect of Narcan?
reverses resp depression
who is responsible for communicating medical diagnosis to a pt?
physician
why is it better to lock up medications rather than place child-proof caps?
children can still open "child-proof" caps;
most common cause of poisoning is improper storage
infants should sit in rear-facing car seats until ____
1 yo and 20 lbs
the function of a booster seat is to ___ and they are indicated when a child is ____
allow the seat belt to be properly positioned over the child's chest and pelvis;
shorter than 4' 9" and weight >40 lbs
children can sit in a regular adult seat in a car once they are ____
> 4' 9" in height
neostigmine (Prostigmin) is used to tx ____ and causes ____
myasthenia gravis;
bronchoconstriction
why might you place a patch over an eye injury?
to minimize eye movt until a surgeon is available
what special steps are needed when administering iron dextran IM?
dorso-gluteal
Z-track method
aspirate 0.2ml of air after drawing up, then change needle
do NOT massage site after
what might RQ pain in pregnant woman indicate?
impaired liver function from pre-eclampsia
pre-eclampsia Sx
hypertension, 4+ proteinuria and edema; severe: BP > 150/100, headache, epigastric pain
who has the highest incidence of cleft lip & palate?
Native Americans, then Asians.
Boys > girls
what is the purpose of an amniocentesis? is a prior miscarriage a CI (contra-indication)?
to determine possible birth defects; no
meconium-stained amniotic fluid indicates ____
infant has likely experienced a recent episode of hypoxia
RN priority upon assessing meconium-stained amniotic fluid?
assess fetal heart rate
furosemide (Lasix) can cause ____ (esp. in elderly)
postural (orthostatic) hypotension
prolapse of the umbilical cord indicates what pt positioning?
Trendelenburg
what is the diff between a spinal anaesthetic and an epidural?
spinal anaesthetic injects into the intravertebral space BEYOND the dura mater (into the subarachnoid space) and blocks PAIN AND MOVT; whereas an epidural injects into the intravertebral space ABOVE the dura mater and blocks PAIN ONLY
if hypoTN occurs as a result of an epidural, what position is best?
side-lying, NOT supine as will compress maternal vena cava
if pt has internal radiation tx, what is nursing priority?
RN should wear individual dosimeter badge to measure radiation exposure
myelogram
insertion of contrast dye into the sub-arachnoid space (via lumbar puncture) to visualize the vertebral column
RN priority pre-myelogram?
encourage fluids, withhold phenothiazines and CNS depressants for 48 hrs (which lower seizure threshold) and check allergies
certain food allergies (i.e. bananas) may indicate an allergy to ___. The list includes ...
latex (commonly used in surgery); grapes, cherries, apricots, passion fruits, avocados, chestnuts, peaches and tomatoes
Bryant's traction
aortic & pulmonic areas are found at the ____ intercostal space
2nd
Erb's point is found at the ____ intercostal space
3rd
tri-cuspid soudns are best heard at the ____ intercostal space
4th
the mitral valve is best heard at the ____ intercostal space
5th
PMI is best found at the ____ intercostal space
5th
the most critical factor post-amputation in any extremity is ____
resulting circulation. Most LE amputations are the result of poor peripheral circulation (i.e. PVD) from diabetes or cardiac disease.
a figure-8 bandage on a residual limb (post-amputation) helps to ____
reduce post-op swelling
in prep for toilet training, the toddler needs to ____
be able to control anal and urethral sphincter, recognize urge to void/defecate and communicate this to parent(s)
during an anxiety attack, is the pt's sensory input incr or decr?
decr (since pt is unable to see hear, or function)
benztropine (Cogentin): class & use
anti-Parkinsonian that manages extra-pyramidal Sx
when might benztropine (Cogentin) be used other than to tx Parkinson's disease?
to counter Parkinsonian-like SE of antipsychotics/anti-depressants (recall antipsychotics/anti-depressants (i.e. Thorazine) can cause extra-pyramidal Sx, and benztropine (Cogentin) can help to reverse these)
Imipramime (Tofranil): class & indication
TCA used to tx panic attack
are phobias symbolic of unresolved conflicts from the past?
yes
how does nifedipine (Procardia) work?
decr myocardial O2 demand
is coughing post liver biopsy a concern?
Yes... coughing or straining may cause hemorrhage
during CPR, depress the sternum ____
1.5" - 2"
post bleeding into joint for a hemophiliac pt, the RN should recommend ____
active ROM exercises (to prevent crippling effects of bleeding; note that passive ROM contraindicated as pt's pain level should dictate level of activity/stretching)
what is the opposite of Diabetes Insipidus?
SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone), an EXCESS of ADH (from pituitary) causes water intoxication
Lasix is a ____ diuretic that inhibits ____ reabsorption
loop; Na & Cl
ecchymosis
bruise
petechiae
pin-point hemorrhages
melena
black, tarry stool
neomycin sulfate (Neo-fradin): class & use
Abx to suppress intestinal bacteria (E. coli & Psuedomonas) pre-operatively
CPR rescue breathing rate
12 bpm
voncristine sulfate (Oncovin): class & Tx
antineoplastic to treat cancer
pt w/ a sensitivity to penicillins should take caution when using ____ due to a cross-allergy
cephalosporins (i.e. Cephalexine (Keflex))
when using crutches, allow ___ inches clearance from the side of the feet
8-10"
when using crutches, follow the crutches w/ the weak|strong leg
strong (so that if you falter, the strong leg is already in motion to help regain balance)
vecuronium bromide (Norcuron): class and use
neuromuscular blocking agent used to promote skeletal relaxation while pt under mechanical ventilation
vecuronium bromide (Norcuron): common SE and RN priority
inability to blink, requiring eye care to avoid corneal abrasion
stapedectomy
removal of the stapes bone of the middle ear to improve hearing (i.e. for pt w/ osteoclerosis, an abnormal mineralization of the temporal bone)
Warfarin sodium (Coumadin) thins the blood by ____
inhibits vit K clotting factors (i.e. inhibits the synthesis of prothrombin)
why might hypovolemic shock occur w/ bone fracture? what solution should be used to replace fluids?
since bone is highly vascularized; LR or 0.9% NS
what's the difference between rheumatoid arthritis and osteoarthritis?
RA is a chronic systemic inflammatory disease of the joints, whereas O is non-systemic and a degenerative disease of the synovial joint
presbycusis
age related changes to hearing that causes loss in higher frequencies
appropriate intervention for pt w/ presbycusis
face pt and speak slowly w/ a slightly lower voice
name a harmless SE of phenytoin (Dilantin)
pink, red or brown urine
for the following eye exam procedures, briefly explain the procedure and its purpose:
doll's eye oculocephalic reflex
turn pt's head side-to-side quickly and eyes should move in opposite direction; establishes intact reflex
direct light response
in darkened room w/ other eye covered, move bright light towards the midline of the face and into the open eye: pupil should shrink immediately; establishes intact reflex
conjugate gaze
move two fingers in "cross-figure" in front of pt's face, asking to follow fingertips; establishes conjugate gaze intact
corneal reflex
touch cotton ball to cornea, pt should blink immediately; establishes normal reflex
when might doll's eye oculocephalic reflex be contra-indicated?
spinal injury
levodopa (Levopa) treats ____ by ____
Parkinson's Disease; restoring dopamine levels in extrapyramidal centers
milk, celery and fish are naturally high in sodium
T
CRF diet
avoid excessive protein and use HBV (high biological value) proteins, low sodium & potassium and incr carbs
uretolithotomy
removal of calculi (stone) from ureter
uretolithotomy: should the RN irrigate post-op?
NO! urine should drain clear (after initially a small amount of blood-tinged urine)
during pain, what VS changes occur?
incr HR, BP, respirations
decr skin temp
other: pupils dilate
Crohn's disease is a form of regional ____ causing ____ and is characterized by ____
IBS;
restriction in absorption of nutrients (esp. proximal colon);
weightloss, diarrhea and RLQ abdominal pain
Crohn's disease diet
hi calorie, hi protein, low fat, low residue
for an Abx to remain effective, what must be maintained?
consistent blood level, therefore dosages should be equally spaced
verapamil (Calan): class, important SE and instructions
CCB (Ca Channel Blocker);
transient hypotension, incr liver enzymes;
take with meals
propantheline (Pro-Banthine): class, effect
anticholinergic that inhibits gastric secretions and decr GI motility
thrombocytopenia
low platelet levels (i.e. below 100)
thrombocytopenia: major causes
vit B12 or folic acid deficiency, leukemia, sepsis, liver failure (deficiency in thrombopoeitin)
thrombocytopenia: sx
petechiae or ecchymoses, large blood filled bullae in mouth
which is more important in determining premature labor: REGULAR contractions or cervical effacement and dilation?
REGULAR contractions
enuresis
bed-wetting
early sx of glomerulonephritis
oliguria