Hurst Review Book (NCLEX RN)

hypervolemia is defined as?
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Terms in this set (64)
what are s&s of hypovolemia?weak and thready pulse weight decrease decreased Urinary output tachycardiawhat are some examples of isotonic solutions and what are they used for?NS, LR, D5W replacement of lost fluids from n&v, burns, sweating, and traumawhat type of patient does not need to receive an isotonic solution?pts w/ hypertension, cardiac disease, or renal failurewhat are the causes of hypermagnesemia?renal failure antacid usewhat is the antidote to magnesiumcalcium gluconatewhat are the causes of hypercalcemia?hyperparathyroidism thiazides immobilizationwhat are signs and symptoms of hypermagnesemia and hypercalcemia?decrease DTRs weak/flaccid muscle tone decreased LOC decreased HR and RRwhat are s&s of hypomagnesemia and hypocalcemia?rigid muscle tone increased DTR positive Chvostek's sign (tap cheek) positive Trousseau's (pump up BP cuff)what are causes and s&s of hypernatremia?dehydration heat stroke diabetes insipidus s&s dry mouth swollen tongue neuro changeswhat are causes and s&s of hyperkalemia?kidney trouble spironalactone s&s twitching muscle weakness flaccid paralysiswhat is a short term fix for hyperkalemia?glucose and insulin kayexalatewhat is the long term treatment for hyperkalemia and kidney failure?dialysisnever give ______________via IVP and always remind the patients that it will burn during administrationpotassiumwhere do most burns occur?at homewhat is the rule of nines?quick way to determine how much of the skin's surface has been burnedanytime a burn occurs on the face, neck, or chest, the priority is........?airway maintenancein burn patients, how is the burning process stopped?cool water (NOT COLD) for no more than 10 minutes blankets to hold in body heat and keep out germs removal of any jewelry and clothingburn patients need how many IVs and what type of IV fluids?at least 2 large bore IVs crystalloids (LR) and colloids (albumin)how is fluid resuscitation in burns determined?total body surface area burned x weight in kilograms divide in half first half in the first 8hrs remaining amount over the next 16hrsin burn patients, what is the nurse's priority?hypoxiawhat is the most accurate determination of fluid volume status in burn patients?urine outputwhy is albumin given to burn patients?it increases vascular volume, kidney perfusion, BP, and COwhat electrolyte imbalance is the main concern in burn patients?hyperkalemiato prevent contractures in burn patients, what should the nurse do?if burned on the hand, the nurse should wrap each finger separately and use splints for burns on the neck/face, do not place pillows under the head. extend the neck (head is back) to prevent chin-chest contractureswhat is the number one intervention in chemical burns?flushing for 15-30 min with cool water or sterile salinewhat is the number one concern with electrical burned patients?internal wounds and cardiac dysrhythmiaswhat is the number one preventable cause of cancer?tobaccowhat is primary prevention?Health promotion and illness preventionwhat is secondary prevention?This is using screenings to pick up on diseases early, when there is a greater chance for cure or controlhow often should women over 40 receive a breast exam?yearlyhow often should women 18-39 receive breast exams?every 3 yearshow often should women receive mammograms after age 40?annuallywhat teaching to the nurse provide to patients before a mammogram?absolutely NO powders, lotions, deodorants can be applied before the testwhat is tertiary prevention?rehab after injury has occurredwhat are things to keep in mind with a patient receiving internal radiation therapy?rotate nurses daily limit visitors to 30 min/day (must stay 6ft away) bed rest w/ low fiber dietwhat is the goal of chemotherapy?eliminate or reduce the number of cancer cells by destroying the cells as they are developingwhat are full precautions when handling and administering chemo drugs?gown 2 pairs of chemo gloves (one under and one over the gown) googleshow are chemotherapy wastes disposed of?rigid chemo waste containers w/ yellow chemo waste bagswhat is the first thing a nurse should if a chemo spill occurs?obtain a spill kit for that specific drughow are chemo drugs most often given?through a central line (decreases risk of extravasation)how are stem cells given?into a vein, much like a blood transfusion, and over time they settle in the bone marrow and produce healthy blood cellswhat are the most common side effects of chemotherapy?GI System nausea and vomiting, stomatitis, diarrhea, Integumentary alopecia Hematopoietic system bone marrow suppression (increases risk of infection) Fatigue PainA client has returned to the room post stem cell transplant. What early signs of rejection should the nurse monitor for in the client? Select All That Apply 1. Abdominal pain 2. Straw colored urine 3. Jaundice 4. Pruritus 5. Diarrhea1., 3., 4., & 5. These are early signs of rejection that the nurse must monitor for: abdominal pain, jaundice, pruritus or itching, and diarrhea.what should the nurse do with a patient who has neutropenic precautions in place?abx as prescribed vital signs at least q4h private room w/ door closed and sign posted antimicrobial soap for handwashing no invasive procedures (IM inj, rectal exams/meds) avoid indwelling catheters or NG tubes Limit use of Tylenolwhat is important to remember about patients w/ cancer and opioids?pain is what the patient says it is there is no ceiling on the dose of an opioid nor a risk for dependency w/ a cancer patientwhat is thrombocytopenia caused by?decrease in number of platelets in the bloodwhat are examples of thrombocytopenic precautions/treatments?monitor for bleeding soft toothbrush electric razor only platelet and RBC infusionswhat hormones does the thyroid gland produce?T3, T4, and Calcitoninwhat dietary item is needed to make hormones?iodinewhat is the treatment of hyperthyroidism (AKA Grave's Disease)PTU and Methimazole (stops the thyroid from making hormones) Radioactive Iodine therapy Beta-Blockers (decrease CO, HR, BP) thyroidectomy: subtotal or completeThe nurse receives a new prescription for tamoxifen for a client with breast cancer. Which information found in the client's medical record would require follow-up with the health care provider? A: documentation of an allergy to shellfish and Peanuts B: history of smoking cessation 5 years ago C: hospitalization w/ DVT one year ago D: previous treatment for depression following the death of a parentC Tamoxifen is a selective estrogen receptor modulator that is prescribed to treat certain types of breast cancer and to prevent breast cancer recurrence. Tamoxifen works by blocking estrogen receptors in certain estrogen-sensitive tissues (eg, breast, vagina), but it also increases affinity for estrogen in some tissues, such as the uterus. In the treatment of breast cancer, tamoxifen inhibits growth of estrogen receptor-positive tumorout of subtotal or a total thyroidectomy procedure, who is at risk for developing thyroid storm/crisis?subtotal (partial)temp greater than 105, extremely high BP (ie 210/180), severe tachycardia (ie 180-200), and psychotic delirium are all symptoms of......?thyroid stormwhat interventions does the nurse need to implement for a patient in thyroid stormGET THE TEMPERATURE DOWN AND OXYGEN UP FIRST 1st way to get the temp down: ice packs best way to get the temp down: oxygen per mask @ 10L DO NOT USE TYLENOL