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QId: 30030 Adult Health - Gastrointestinal/Nutrition QId: 30031 Adult Health - Gastrointestinal/Nutrition QId: 30035 Adult Health - Gastrointestinal/Nutrition Post-op after laparoscopic cholecystectomy : HIGHEST PRIOR ...

QId: 30030 Adult Health - Gastrointestinal/Nutrition QId: 30031 Adult Health - Gastrointestinal/Nutrition QId: 30035 Adult Health - Gastrointestinal/Nutrition Post-op after laparoscopic cholecystectomy : HIGHEST PRIORTY PLACE IN SIMS POSITION -PREVENT RESPIRATORY COMPLICATIONS (carbon dioxide that was utilized during surgery to fill abdominal cavity GI/ Nutrition Endoscopy Esophagogastroduodenoscopy (EGD) A SUDDEN TEMP SPIKE AFTER AN EGD (101.2), COULD BE A SIGN OF PERFORATION OR A DEVELOPING INFECTION= NOTIFY HCP ABSENT GAG REFLEX AFTER PROLONGED PERIOD (6 HOURS) REPORT TO HCP Peptic Ulcer : AVOID 1. NSAIDS (can cause bleeding) 2. Smoking 3. Alcohol / Caffeine 4. Spicy foods Tx for Peptic Ulcer: triple-drug therapy to avoid relapse (take for 7-14 days) 1. Omeprazole (Prilosec) 2. Amoxicillin 3. Clarithromycin (Biaxin)2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 2/103 QId: 30088 Adult Health - Neurologic QId: 30105 Fundamentals - Safety/Infection Control QId: 30111 Adult Health - Integumentary Cranial nerve IX glossophayngeal is involved in the gag reflex, ability to swallow, phonation and taste Post-op partial laryngectomy- teach them the supraglottic swallow: Instructions: 1. inhale deeply 2. hold breath tightly to close the vocal cords 3. place food in mouth and swallow while continuing to hold breath 4. cough to dispel remaining food from vocal cords 5. swallow a second time before breathing Cranial nerve VIII vestibulocochlear affects hearing and equilibrium C-diff requires contact precautions Required: gown and gloves Private room or cohort with other C-diff infected clients Discard gown and nitrile gloves before leaving room Wash hands with soap and water No alcohol-based hand sanitizers Dedicated equipment remain in room (BP cuffs, stethoscope) Airborne required: N95 Droplet required: surgical mask Review Rule of Nines2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 3/103 QId: 30112 Adult Health - Integumentary QId: 30135 Adult Health - Gastrointestinal/Nutrition QId: 30140 Fundamentals - Skills/Procedures QId: 30143 Leadership & Management - Leadership & Management Concepts Head 9 Anterior Trunk 18 Posterior Trunk 18 Each arm 9 (front and back each 4.5) Perineal 1 Know the parkland formula 4mL * (weight in kg) * (% percentage of body surface area burned) Enteral feedings maintain gut integrity and helps prevent stress ulcers with clients during sepsis and respiratory failure Enteral feedings have lower infection compliations compared to parenteral feedings (TPN) 1 mg = 1000 mcg (small to big) 1000 mcg = 1mg (big to small)2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 4/103 QId: 30200 Critical Care - Critical Care Concepts QId: 30213 Adult Health - Respiratory QId: 30217 Mental Health - Mental Health Concepts Prioritization Hypoglcemia= blood suger <70 is life threatening S/S: tachycardia, shakiness, sweating, hunger, anxiety, pallor, confusion/disorientation, impaired vision and speech, seizures and coma Spinal cord injury (Neurogenic shock) s/s: causes a disruption of the sympathetic nervous system Hypotension Bradycardia Warm/Dry skin Chest tube Suction control chamber = EXPECT GENTLE CONTINUOUS BUBBLING; ALWAYS KEEP 20CM OF STERILE WATER IN THIS CHAMBER AIR LEAK MONITOR= ITS PART OF THE WATER SEAL CHAMBER....CONTINUOUS OR INTERMITTENT BUBBLING INDICATES = AIR LEAK Delirium is a acute onset of disturbed state of mind Risk factors in hospitalized clients: 1. Advanced age >65 2. Neuro-degenerative disease (stroke, dementia) 3. polypharmacy2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 5/103 QId: 30253 Adult Health - Respiratory QId: 30254 Adult Health - Respiratory QId: 30260 Pharmacology - Cardiovascular QId: 30267 Adult Health - Respiratory 4. coexisting medical conditions (infection) 5. acid-base/arterial blood gas imbalance (acidosis, hypercarbia, hypoxemia) 6. Metabolic/electrolyte imbalances 7. impaired mobility- EARLY AMBULATION PREVENTS DELIRIUM 8. surgery (post-op setting) 9. untreated pain/ inadequate analgesia Atelectasis = for post op clients that have respiratory problems such as pneumonia, its best to use an incentive spirometer Flid overload= best to give diuretics for fluid volume overload Airway Clearance diagnosis - IMPAIRED WITH INADEQUATE HYDRATION (this will help thin secretions and facilitate expectorate of mucus) =CLIENT WITH COMMUNITY-ACQUIRED PNEUMONIA SVT - DOC is ADENOSINE Give Adenosine 6mg IV rapidly over 1-2 seconds followed by a 20 mL saline flush Repeat boluses of 12 mg may be given twice if rhythm persists Injection site should be close to the heart (ANTECUBITAL AREA) Brief period of asystole is ok bc adenosine is slowing condution in AV node Monitor client for flushing dizziness, chest pain, palpitations during and after administration of ADENOSINE2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 6/103 QId: 30277 Pharmacology - Respiratory QId: 30284 Adult Health - Gastrointestinal/Nutrition QId: 30299 Mental Health - Mental Health Concepts COPD clients with exacerbation Morphine and other medications such as Benzodiazepines can depress the respiratory center and SHOULD NOT be used in clients with COPD exacerbations, can worsen CO2 (carbon dioxide) retention Can use during acute COPD exacerbations: Albuterol - beta agonist; rapid and short-acting Methylprednisolone (Solu-Medrol)- corticosteroid, can decrease inflammation Initiation of low flow oxygen 2 L/min by nasal cannula Albuterol - nebulizer treatment for asthma exacerbation client Therapeutic effects are: RESPIRATORY RATE decreases and PEAK FLOW increases Short Acting Beta Agonists SE: tachycardia, tremors, palpitations restlessness and HYPOKALEMIA MUST KNOW! Take notes in the morning about Valsalva maneuver Diagnosed with chronic anxiety. Client possesses resilience when: Practices stress reduction techniques daily Resilience centers on the adaptive techniques an individual uses to address the resulting symptoms2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 7/103 QId: 30301 Adult Health - Respiratory QId: 30302 Pharmacology - Respiratory QId: 30316 Adult Health - Gastrointestinal/Nutrition CODP patient use pursed lip breathing = prevent airway collapse and promote carbon dioxide elimination Regular practice (5-10 minutes 4 times daily) Pursed-Lip Breathing Steps: 1. Relax the neck and shoulders 2. Inhale for 2 secs through the nose with mouth closed 3. Exhale for 4 secs through pursed lips. If unable to exhale for this long, exhale twice as long as inhaling Albuterol short-acting beta agonist (SABA) for quick relief; (wheezing, breathlessness, chest tightness) = RESCUE DRUG; AS-NEEDED BASIS ONLY Beclomethasone is an inhaled corticosteroid (ICS) for long-term; USED TO PREVENT EXACERBATIONS; first-line drug for inflammation; DO NOT OMIT EVEN IF SABA WAS EFFECTIVE SABA FIRST.......ICS SECOND; SABA IS NOT ALWAYS TAKEN WITH THE ICS SABA = take it apart, wash mouthpiece only not the canister under warm water and let air dry 1-2 times a week ICS= take it apart and wash it daily Partial Gastrectomy- removal part of the stomach; these clients experience DUMPING SYNDROME (gastric contents are emptied to rapidly into duodenum)2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 8/103 QId: 30321 Pharmacology - Respiratory QId: 30331 Adult Health - Neurologic Dumping Syndrome s/s: HYPOTENSION, ABDOMINAL PAIN, DIARRHEA, N/V, DIZZINESS, GENERALIZED SWEATING, TACHYCARDIA Dietary teachings to delay gastric emptying: small frequent meals; eat slow; avoid high simple carbohydrates (sugar, syrup); consume DIET HIGH IN PROTEIN, FAT, FIBER, LOW CARBS (takes longer to digest and remain in stomach longer than carbs); fluid intake after meals or between meals; AVOID sitting up after meals LAYING DOWN AFTER MEALS= CLIENT DO THIS...GOOD ;-) Albuterol is for short-term use for acute asthma exacerbation; RESCUE INHALER SE: insomnia, N/V, palpitations (tachycardia), mild tremor Dosing of albuterol in an acute asthma attack should not exceed 2-4 puffs every 20 minutes x 3 If the albuterol is not effective, an inhaled corticosteroid is used to treat the inflammatory component Thiamine is given to clients with history of chronic alcohol abuse Purpose for Thiamine is to prevent Wernicke encephalopathy Gross tremors with alcoholics treated with benzodiazepines (endings EPAM...OLAM) Seizures with alcoholics are treated with benzodiazepines2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 9/103 QId: 30354 Fundamentals - Safety/Infection Control QId: 30367 Pharmacology - Infectious Disease QId: 30369 Adult Health - Gastrointestinal/Nutrition BLOOD TRANSFUSION HEMOLYTIC REACTION s/s: fever, chills, nausea, vomiting, pruritus, hypotension, decreased urine output, back pain, dyspnea Drag and drop 1. Stop transfusion 2. Using new tubing, give IV normal saline fluids 3. Administer meds to treat reaction (VASOPRESSOR, ANTIHISTAMINES, STERIODS, IV FLUIDS) 4. Collect urine sample 5. Notify HCP 6. Document and send blood and tubing back to blood bank High risk clients on ISONIAZID THERAPY for treatment of tuberculosis may experience neurological side effects due to a decrease in the body's ability to utilize vitamin B6 (PYRIDOXINE) Parenteral Nutrition Interventions to resolve TPN-associated hyperglycemia 1. reduce amount of carbohydrate in the TPN solution 2. slowing down the infusion rate 3. administering SQ insulin The nurse should assess client blood sugar before implementing an intervention2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 10/103 QId: 30372 Adult Health - Gastrointestinal/Nutrition QId: 30377 Pharmacology - Respiratory QId: 30394 Adult Health - Hematological/Oncological Manage S/S for GERD: 1. AVOID caffeine, chocolate, alcohol, peppermint, nicotine, spicy foods 2. low fat foods (no high fat foods) 3. sip water with meals / no carbonated drinks 4. eat 5-6 small meals daily 5. chewing gum / wear loose clothes 6. Elevate HOB / no eating at bedtime / do not lie down after eating Symptom of GERD: heartburn, regurgitation, persistent sore throat, painful swallowing, chronic cough Tx for GERD: 1. Antacids (calcium carbonate, magnesium hydroxide 2. PPIs (omeprazole) 3. H2 receptor antagonists (ranitidine) Theophylline toxicity = CNS stimulation (H/A, insomnia, seizures), GI problems (N/V), cardiac toxicity (arrhythmia) Digoxin toxicity = Alteration of color perception and visual changes Phenytoin (Dilantin) toxicity = gum hypertrophy (gingivitis) Acetylsalicylic acid (Aspirin) toxicity = hyperthermia and tinnitus Heparin -induced thrombocytopenia (HIT) may cause arterial or venous thrombosis Nurse should monitor PLATELET count in clients receving heparin and2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 11/103 QId: 30395 Maternal & Newborn Health - Labor/Delivery QId: 30414 Adult Health - Neurologic QId: 30432 Pharmacology - Mental Health Concepts QId: 30433 Pharmacology - Gastrointestinal/Nutrition QId: 30446 Maternal & Newborn Health - Postpartum REPORT a decrease in platelet count >50% or below 150,000 to the HCP Infants of diabetic mothers at risk for HYPOGLYCEMIA...and HYPOCALEMIA Infant blood sugar <40mg/dL is hypoglycemic (jittery, irritability, hypotonia (low muscle tone), apnea, lethargy, temperature instability Review about increasing ICP SSRI and MAOIs can not be combined together..... RISK OF SEROTONIN SYNDROME!!! Irritable Bowel Syndrome (IBS) Contraindicated: Anticholinergic medication =Dicyclomine hydrochloride (Bentyl) ANTICHOLINERGICS ARE CONTRAINDICATED FOR CLOSEDANGLE GLAUCOMA, BOWEL ILEUS/OBSTRUCTION, URINARY RETENTION (bph) Postpartum uterine infection may occur following vaginal or C-section delivery. A blood culture is obtained prior to starting broad-spectrum2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 12/103 QId: 30451 Fundamentals - Skills/Procedures QId: 30462 Child Health - Gastrointestinal/Nutrition ANTIBIOTICS Postpartum endometritis = fever, chills, tachycardia, uterine tenderness, foul-smelling lochia Calculation problem client weight 8 lb 9 oz.....we need kg weight in lb = 8 + 9 oz / = 8 + 0.5625 = 8.5625 lb 16 oz weight in kg= weight (lb) = 8.5625 lb = 3.8920 kg 2.2 lb 2.2 lb Intussusception -intestines telescoping into itself Initially has intermittent pain with the legs drawn up toward the abdomen RED CURRANT JELLY STOOLS A CONTRAST ENEMA is used to diagnose and reduce intussusceptions An AIR (pneumatic) ENEMA considered safer than a barium enema Human recombinant erythropoietin (EPOETIN ALFA) used to combat effects of chemotherapy and kidney disease2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 13/103 QId: 30474 Maternal & Newborn Health - Labor/Delivery QId: 30485 Maternal & Newborn Health - Antepartum QId: 30490 Child Health - Respiratory QId: 30507 Adult Health - Urinary/Renal Read about Bishop score (maternity) Pregnant women receive MMR vaccination during post-partum period. + immune response = indicates past infection or vaccination - nonimmune response = indicates client susceptible to rubella disease and REQUIRES vaccination MMR is live attenuated vaccine Review Asthma in Hurst notes /Saunders Frequent coughing at night is the warning signal that child airway is sensitive to stimuli may be only sign in "silent" asthma Triggers: tobacco smoke, pet dander, cockroach feces, air pollution, hay fever, food allergies, Chronic Kidney Disease clients must restrict diet in fluids sodium, potassium, and phosphrous Allowable foods for CKD clients include apples, pears, grapes, pineapples, blackberries, blueberries, and plums Dairy products (milk, yogurt)= HIGH K+/ PHOSPHORUS.... Fruits (bananas oranges, coconuts, watermelons, avocados) = HIGH K+2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 14/103 QId: 30514 Maternal & Newborn Health - Antepartum QId: 30518 Adult Health - Respiratory QId: 30525 Pharmacology - Mental Health Concepts Preeclampsia = HTN and proteinuria AFTER 20th week gestation Eclampsia = onset of convulsions and seizures DELIVERY IS ONLY CURE Magnesium sulfate (CNS depressant) used to prevent/control seizures NURSE PRIORITY WITH MAG: assess VS, I&O, monitor for s/s of MAG TOXICITY (decreased reflexes, respiratory depression, urine output) THERAPEUTIC MAG LEVEL 4-7 is good to prevent seizures in a preeclamptic client HTN meds to lower in these clients: HYDRALAZINE, METHYLDOPA, LABETALOL (consider using is BP >160/110 mm Hg) Tocolytic meds: TERBUTALINE, MAG SULFATE, INDOMETHACIN, NIFEDIPINE) = used to suppress uterine contractions in PRETERM labor Corticosteroid: improves fetal lung maturity Peak flow meter is a hand held device used for measure of peak expiratory flow rate (PEFR) and is most helpful for clients with moderate to severe asthma. EXHALE QUICKLY AND FORCIBLY The peak flow meter is used after a short-acting bronchodilator rescue MDI to evaluate response (albuterol) Clozapine (atypical antipsychotic) used to treat schizophrenia HIGH RISK FOR AGRANULOCYTOSIS (it is reversible)2/18/2018 UWorld NCLEX-RN QBank http://www.uworld.com/ClientApp/V1/apps/Qbank/index.html#/test/notes/3656232 15/10 ::::::::::::::::::::::::::::::::::::::::CONTENT CONTINUED IN THE ATTACHMENT:::::::::::::::::::::::::::::::::::::::::::::::::::