NCLEX UWorld Exam Latest Updated Graded A+

When do *advanced directives* go into effect? - ANSWER when person is *unable to speak for him/herself* due to either: 1. *Mental Incapacity* - *coma *(GCS score ≤ 7) 2. *Aphasia* (≠as soon as signed; directives ca ...

When do *advanced directives* go into effect? - ANSWER when person is *unable to speak for him/herself* due to either: 1. *Mental Incapacity* - *coma *(GCS score ≤ 7) 2. *Aphasia* (≠as soon as signed; directives can always be changed later by person) SBAR Communication Framekwork Components - ANSWER 1. *S* = Situation - what *prompted* the communication (eg *what* changes occurred) 2. *B* = Background - *pertinent information, relevant history, vital signs* 3. *A* = Assessment - nurse's assessment of the situation (*when* & *what changes* occurred) 4. *R* = Recommendation - *request* for *prescription* or *action* from HCP Appropriate order of actions when client found on floor - ANSWER 1. *Assessment* of *physiological stability* (ABCs) 2. *Assessment* of *injuries* 3. *Moving client* 4. *Notifications* 5. *Documentation* Conditions of being *ineligible to leave AMA* - ANSWER 1 *danger to self or others* 2. *lack of consciousness* 3. *Altered consciousness* 4. *Mental illness* 5. Being under *chemical influence* 6. *Court decision* Effective handoff communication components - ANSWER Nurse should: 1. Provide *identifying information* (eg client's name and room number) 2. Note *care priorities* and upcoming or outstanding tasks (eg time to replace medication infusion bag, need to perform delayed wound care and cause of delay) 3. Provide *exact, pertinent information* (eg medication dose, time, measurable outcomes) 4. Include *multidisciplinary plans* (eg radiology examinations, family meetings, physical therapy) 5. Relay significant client changes in a clear manner *Risk factors* for *cervical cancer* - ANSWER 1. Infection with high-risk HPV strains 2. History of sexually transmitted diseases 3. Early onset of sexual activity 4. Multiple or high-risk sexual partners 5. Immunosuppression 6. Oral contraceptive use 7. Low SES 8. Tobacco use what medications interact with grapefruit? - ANSWER 1. *calcium channel blockers* (diltiazem, nifedipine, verapamil, etc) 2. *statins* 3. *SSRIs* Risk associated with *stent placement* using the *femoral approach* - ANSWER *retroperitoneal hemorrhage* what are early signs of bleeding into the retroperitoneal space? - ANSWER hypotension, back pain, flank ecchymosis (grey turner sign), hematoma formation, diminshed distal pulses what is the grey-turner sign and what is it a sign of? - ANSWER bruising of the flanks and retroperitoneal hemorrhage and is a bluish color what are some physical signs of peripheral arterial disease? - ANSWER intermittent calf muscle pain?, rest pain, hair loss, decreased peripheral pulses, cool, dry, shiny skin, thick brittle nails, gangrene, ulcers (all of these are in the extremities) transplanted hearts are expected to be - ANSWER tachycardic like 90-110 what is the priority intervention for pain with sickle cell crisis and why? - ANSWER administer IV fluids to reduce blood viscosity and restore perfusion to areas affected by vasoocclusion what is the purpose of continuous bladder irrigation? - ANSWER it is perscribed after TURP to prevent obstruction of urine outflow by removing clotted blood from the bladder what is the nurses care of monitoring CBI? - ANSWER monitor quality of drainage, titrate the inflow rate, and manurally irrigating as needed characteristics of a basilar skull fracture - ANSWER periorbital hematomas (raccoon eyes), csf fluid rhinorrhea, and battle sign (behind the ear bruising) immediate client care for basilar skull fracture - ANSWER cervical spime immobilization, close neurologic monitoring, and support of ABCs vomiting with intake may mean - ANSWER viral or bacterial infection tympanosomty tubes are placed for - ANSWER recurrent otis medias nurse actions during a seizure - ANSWER assist them to lie down is standing/sitting, put them on side for patent airway, loosen tight clothing, give oxygen as needed, remove objects from immediate area, document time and duration of seizure (for tests are done later to see which type of seizure and maybe what exacerates it) never put anything in mouth or restrain them since musclec ontractions can occur during a seizure what are some early symptoms of ICP? - ANSWER altered LOC, headache, abnormal reathing, rise in bp, slow pulse, vomiting client who has a TIA is often placed on - ANSWER prophylactic antithrombotic treatment like aspirin or clopidogrel glascow coma scale ranges from - ANSWER 3-15; 3 being worst 15 being best condition (8 or below in a coma) what are the 3 components? - ANSWER eye opening motor response verbal response what is a primary component in TPN? - ANSWER *glucose,* so the nurse should be monitoring blood glucose and be assessing for signs of hyperglycemia when a client is on TPN, the nurse must assess for hyperglycemia why? - ANSWER bc a primary component is glucose. therefore the nurse must be assessing to see if the client is getting too much glucose (hoerglycemia). and with a large urinary output like 4800, this could indicate symptoms of hyperglycemia signs of hyperglycemia - ANSWER - polydipsia, - polyuria, - restless, - confused, - bg over 200, - fatigue, - headache - blurred vision - kussmaul resp Interventions to resolve TPN-associated hyperglycemia - ANSWER - reduce amount of carbohydrate in TPN solution - slow down infusion rate - administer subcutaneous insulin what is the goal for mass casualty events? - ANSWER do the greatest good for the greatest number of people keep in mind that disaster triage ranks the likelihood of survival with treatment, not necessarily the severity of the injury - ANSWER what are the 4 categories for triaging? - ANSWER immediate (red tag)- life threatening injuries with good prognosis once treated delayed (yellow)- injuries requiring treatment within hours minimal (green tag)- injuries requiring treatment within a few days expectant (black tag)- extensive injuries, poor prognosis regardless of treatment rule of nines - ANSWER head: 4.5 front 4.5 back torso: 18 front 18 back each arm: 4.5 front 4.5 back (each arm is 9 total) each leg: 9 front 8 back (each is 18 total) genitals: 1 extrapyramidal side effects - ANSWER ACUTE DYSTONIC REACTION: sudden onset sustained muscle contractions AKATHISIA: restlessness with inability to sit still drug induce PARKINSONISM: tremor, rigidity, bradykinies, masked like faces AKINISIA: loss of involuntary movement TARDIVE DYSKININIA NEUROLEPTIC MALIGNANT SYNDROME dont give morphine if RR under 12 bc it can cause - ANSWER respiratory depression airborne precautions - ANSWER tuberculosis, varicella, and rubeola (measles) wear N95 respirator (and other as needed like for splashes) ALSO (neg pressure room and HEPA) clients suspected are to wear a surgical mask after triage UAP soft wrist restraints can: - ANSWER do ROM exercises reapply wrist restraints report changes in skin to nurse turn/reposition client in bed a client with major depression and severe weight loss needs what type of diet? - ANSWER high in calories and protein, also foods that are easy to chew and dont require a lot of energy bc they may have a low energy level examples: while milk/dairy, granola muffins, pottoes, meat fish eggs, pasta also small frequent meals memorize MAOIs and remember - ANSWER they cant eat foods high in tyramine like aged cheese, yogurt, fermented foods, beer, red wine, cocolate, avocados do not give lasix to a pneumonia patient with fine crackles bc they dont result from heart failure or edema - ANSWER you can give pneumonia patient exportants, antibiotics, mucolytics, antipyretics, analgesics, and antinflammatories examples are - ANSWER Mucinex, Ibuprofin, decerebrate posturing (toes point down and amrs/legs straight out) is a sign of - ANSWER severe brain damage near drowning hypothermia - ANSWER warm iv fluids, blankets, and air also will find weak and thready pulse a client is not dead until warm and dead!!! - ANSWER nc sometimes a pt is so cold that a pulse cannot be felt intussusception causes intestinal obstruction - ANSWER ileum telescopes into cecum, pain obstruction, edema, compression of BVs, bowel ischemia, rectal bleeing (CURRANT JELLY stools) signs of intussusceotion - ANSWER inital periodic pain with legs drawn up to abdomen, pain is severe and progressive though, inconsolable crying, blood/mucousy stools "current jelly" how is it treated? - ANSWER an air enema guaifenesin (Mucinex) - ANSWER expecorant med that inc resp fluids and thins secretions to facilitate expectoration erythropoeitin Epogen - ANSWER stimulates bone marrow to make RBCs and combats the effects of chemo and used for kidney disease when is hemoccult done? - ANSWER when hidden (occult) blood is suspected due to dark and tarry stool treat intussusception with - ANSWER AIR ENEMA tetraology of fallot - ANSWER exacerbation can happen when infant or child cries, becomes upset, or is feeding you immediately place them in KNEE CHEST position hemolytic uremic syndrome - ANSWER life threatening complication of e. coli diarhea what are the signs? - ANSWER anemia (pallor), low platelets (petechiae and purpura, and acute kidney injury (low UO) cognitive behavioral therapy (CBT) 5 basic components - ANSWER education about pts disorder self observing and monitoring relaxation techniques cognitive restructuring behavioral strategies speicen collection from a foley is considered sterile and should not be delegated to uap - ANSWER a clients first and last name is not PHI privileged health info - ANSWER it is not a violation to cal them by their first and last names or have info heard inadvertently Written consents - Nurse's Role - ANSWER 1. *Witness* that consent was signed *voluntarily* 2. That patient was *competent* at time of signing 3. *Documenting in medical records* after signature obtained with *date/time* of signature what happens if a client does not full undersnad infromed consent?q - ANSWER the nurse must contact the doctor. the nurse is not responsible for verifiying that the client understands how to stop epistaxis - ANSWER tilt the head forward and apply direct continuous pressure on the alaes (sides) for about 5-20 mins can also hold a cold washcloth to the bridge of nose for vasoconstriction keep child calm and quiet IV iodinated contrast used for ct scan can cause - ANSWER kidney injury metformin is discontinued on the day of IV iodine contrast exposure - ANSWER Amlodipine - ANSWER calcium channel blocker used to treat hypertension Gabapentin (Neurontin) - ANSWER used for neuropathic pain Phenytoin (Dilantin) - ANSWER antiseizure Glipizide - ANSWER oral sulfonylurea controls blood sugar Levofloxacin (Levaquin) - ANSWER antibiotic testicular self examination - ANSWER perform monthly and on same day perform while taking hot shower bc temps will relax scrotal tissue and make testis hang lower in scrotum use both hands to feel each testis separately palpate gently using thumb and first 2 fingers normal calcium level - ANSWER 8.6-10.2 review heart rhythms - ANSWER lactated ringers is often used for burns - ANSWER addisons disease= hyperpigmentation of the skin - ANSWER what is one of the earliest signs of ICP? - ANSWER change in respsonsiveness what are some expected symptoms in a TBI? - ANSWER low grade constant HA, slowness in thinking, memory problems, loss of balance, poor coordination, constant exhaustion, inc sensitivity to light, and heightened irritability all symtpoms that can last up to 6 weeks bacterial meningitis - ANSWER high fever change in loc nuchal rigidity meningeal signs (positive kernig and brudzinski signs)-- treat with antibiotics what is the kernig sign? - ANSWER patient lies supine, thigh is flexed at right angle, and it hurts to extend leg what is the brudzinski sign? - ANSWER bending of neck causes flexion of knee and hip what are these 3 signs indicative of? - ANSWER meningitis client identifiers - ANSWER first and last name medical record number DOB expected term newborn findings - ANSWER plantar creases up entire sole presence of babinski Epstein's pearls is the babinski sign present at birth? - ANSWER yes but it disappears at 1 year what does an absent babinski or weak reflex indicate? - ANSWER a neurological deficit babinski sign for a child less than 1 year - ANSWER great toe bends upward and smaller toes fan out. this is NORMAL babinski sign for child more than 1 year and an adult - ANSWER plantar flexion normal toe flexion (no babinski) what are epsteins pearls? - ANSWER white pearl like cysts on gum an palate that are benign and usually go away within a few weeks when does the umbilical cord detach from body? - ANSWER within 2 weeks jaundice in a newborn - ANSWER during first 24 hours: jaundice is pathological (r/t liver problems) after 24 hours: physiological jaundice r/t inc amount of unconjugated bilirubin in system infant formula key points - ANSWER never dilute or concentrate formula wash tops of forumla cans before opening unused prepare formula can be used for up tp 48 hours and then discarded after to warm prepared bottle, place in pan of hot water never microwave formula any forumula left over should be thrown out immediately when done long term management of hyptertension - ANSWER important to take bp meds as perscribed what do statin drugs like atorvastatin, rosuvastatin do? - ANSWER cut LDL drastically and reduce total cholesterol and triglycerides, and inc HDL good cholesterol - ANSWER HDL bad cholesterol - ANSWER LDL what is a serious complication of statin meds? - ANSWER rhabdomyolysis what is rhabdomyolysis? - ANSWER the breakdown of muscle tissue releases muscle fiber contents into the blood. these substances can cause kidney damage what are some early signs of rhabdomyolysis? - ANSWER muscle aches or weakness- immediately report to hcp! behaviors of bulimic person - ANSWER episodes of bing eating followed by self induced vomiting using enemas/laxatives intense frequent exercise signs of bulemia someone may notice - ANSWER going to bathroom after meals large amonts of food disappearing hidden wrappers/empty food containers like sweets intense physical exercise parotid gland enlargement calluses on hands preoccupation with weight food and dieting weight loss/gain in anorxic.bulemic pt - ANSWER anorexic: lose weight bulemic: maintain weight children born before 38 weeks are - ANSWER preterm and must "catch up" their developmental milestones onset of type 1 diabetes - ANSWER childhood onset of tpe 2 diabetes - ANSWER after age 40 medicine healers are important part of native american culture - ANSWER be mindul of a patients spirtual needs. allow them to do rituals first thing to do if a pt is in ventricular tachycardia? - ANSWER assess them for a pulse (bc they can either have a pulse or not) how to treat unstable client in vtach with a pulse? - ANSWER synchronized cardioversion how to treat stable client in vtach with a pulse? - ANSWER antiarrythmic meds like amidorone when to initiate cpr and defibrillation with a client in VT? - ANSWER only if there is no pulse what is in the lpn scope of practice? - ANSWER monitor RN findings reinforce education routine procedures like catheterization most medication administrations ostomy care tube patency and enteral feeding specific assessments notify hcp if child temp is over 100.4 after immunizations - ANSWER what are common SE of immunizations? - ANSWER mild fever and soreness and redness at injection site anorexia/fussiness in the first 24 hours GP llb/llla receptor inhibitors (abciximab, etc) can cause serious BLEEDING - ANSWER careful monitoring of puncture site after percutaneous coronary intervention signs of internal bleeding and to watch carefully when GP llb/llla receptor inhibitors are given - ANSWER hypotension, tachycardia, changes in heart rhythm, blood in urine, abom/back pain, mental status changes, black tarry stools thrombocytopenia - ANSWER low platelet count; so this increases risk for bleeding what is SIADH? - ANSWER high antidiuretic hormone production leads to water retention increased total body water DILUTIONAL HYPONATREMIA -will see signs of fluid volume overload, changes in loc, weight gain w/o edema, hypertension, tachycardia -seizure precautions what can hyponatremia cause? - ANSWER SEIZURES, confusion, neurologic complications institute seizure precautions treatment of SIADH - ANSWER fluid restriction less than 1000 ml per day oral salt tablets to inc serum sodium hypertonic saline (3%) or NS IV and/or vasopresson receptor antagonists to decrease renal response to ADH so a pt with SIADH - ANSWER does not need extra fluid needs salt seizure precautions strict I/Os RACE for FIRES in a hospital - ANSWER R: rescue any pts in immediate danger and move them to safety A: alarm- sound alarm C: confine fire by closing all doors to all rooms E: extinguish fire with extinguisher what is asystole? - ANSWER complete absence of ventricular electrical activity in the heart. no ventricular contraction occurs client is pulseless, apneic, and unresponsive how to treat asystole? - ANSWER CPR initiate advanced cardiac life support give epinephrine and/or vasopressin place an airway hepatic encephalopathy - ANSWER sleep disturbances (early), lethargy, coma, mental status altered, not oriented to person place or time, asterixis- flapping tremor of hands, fetor hepaticus, elevated ammonia asterixis - ANSWER flapping tremors of the hands how is asterixis assessed? - ANSWER have pt extend the arms and dorsiflex the wrist what is the drug of choice for SVT? - ANSWER *adenosine*- administer it *rapidly over 1-2 secs* and *flush after w/ NS* administer *as close to heart as possible* (NOT distally) before the med, how is SVT usually treated? - ANSWER *vagal maneuvers* (eg bearing down) what is adenosine? - ANSWER an arrhythmic it treats irregular heartbeats what is the purpose of having a pt do a vagal maneuver? - ANSWER full weight bearing - ANSWER independent; no assistance needed unless they are uncooperative or they are a fall risk, which is 1 person standby partial weight bearing - ANSWER 1 person assist stand & pivot transfer with gait belt or motorized assist device if cooperative 2 person assist with full body sling if uncooperative no weight bearing - ANSWER motorized assist device if cooperative and they have upper body strength 2 person assist with full body sling if uncooperative and/or has no upper body strength clients should use as much of their own weight as possible - ANSWER how to measure how to safely transfer a pt the first time - ANSWER assess if they can bear weight assess whether they are cooperative 1 gram of weight is equal to how many ml of fluid? - ANSWER 1 what is adeaute UO for an infant? - ANSWER 2 ml/kg/hr how to measure UO in diapers? - ANSWER subtract the weight of the diaper when dry from its weight when wet how often and where is growth hormone replacement given to a child? - ANSWER daily sub q injections tretment is most successful when it begins early in a child's life, as soon as growth delays are noted when is replacement therapy usually stopped? - ANSWER when bone growth stops or when paretns determine what is the classic sign of a tenson pneumothorax? - ANSWER mediastinal shift and tracheal deviation why does tension pneumothorax cause hypotension? - ANSWER bc the heart and great vessels are compressed/shifted anc cardiac output is reduced it is LIFE THREATENING what is the treatment for tension pneumothorax? - ANSWER emergency large bore needle decompression chest tube if injury to the spinal cord, what important precaution to take? - ANSWER hard cervical collar and backboard major depressive disorder demonstrates - ANSWER loss of appetite, weight loss, and insomnia or hypersomnia sleep disturbances how to help improve sleep - ANSWER dont nap during day physical activity at least 5 hours before bed 20 mins of natural sunlight avoid caffeine after noon avoid alcohol or smoking at bedtime relaxing activity before bed decrease environmental stimuli avoid heavy meals or large amounts of fluid at bedtime warm milk or small carbs before bed what can a baby born to an opioid dependent mom have? - ANSWER neonatal abstinence syndrome. the baby experiences opiod withdrawal 24-48 hrs after birth wht are symptoms of withdrawal from opioid in infants? - ANSWER the baby is HYPERSENSITIVE irritability high pitched cry jitteriness sneezing diarrhea vomiting poor feeding tx: opiod therapy like methadone or morphine what is the nursing care focus opioid dependent newborns? - ANSWER reduce stimulation promote nutrition and comfort after feeding an infant, what does placing it in the side lying position do - ANSWER promotes gastric emptying and reduces the risk of vomiting Acceptable *methods of blood collection* in *neonate* - ANSWER - *heel stick* - *venipuncture* (drawing blood from vein) - considered *less painful* and often requires *fewer punctures* to obtain sample, especially if *larger volume* is needed Neonatal heel stick - ANSWER - used to collect a blood sampke to *assess capillary glucose* and perform *newborn screening for inherited disorders* (eg *congenital hypothyroidism, phenylketonuria*) *Neonatal heel stick* proper *technique* - ANSWER 1. Select location on the *medial or lateral side* of the *outer aspect of the heel* 2. *Warm the heel* for several minutes with warm towel compress or approved single-use instant heat pack 3. *cleanse* intended puncture site with *alcohol* 4. *Sucrose and nonnutritive sucking* on a pacifier may reduce pain 5. Use an *automatic lancet*, what is the blood loss amount to be considered postpartum hemorrhage (PPH)? - ANSWER >500 ml after vaginal birth >1000 ml after c-section what is uterine atony? - ANSWER a soft boggy poorly contracted uterus and most commonly causes early PPH what usually causes delayed postpartum hemorrhage? - ANSWER retained placental fragments what are some risk factors for postpartum hemorrhage? - ANSWER a hx of PPH uterine distension uterine fatigue high parity certain meds what do chvosteks/trousseaus signs indicate? - ANSWER hypocalcemia what to do first with an unrestrained pt invovled in a sudden deceleration accident during emergency trauma care? - ANSWER spinal precaustions are first!! before checking pulse AND opening their airway place cervical collar dementia characteristic - ANSWER slow onset family members usually notice first gradual progressive inability to remember recent events delerium signs - ANSWER fluctuating acute mental status changes inattention with disorganized thinking like hallucinations altered level of consciousness and the presence of infection can cause delerium what is a barium enema aka lower GI series? - ANSWER uses fluroscopy to visualize the colon outlined by contrast to detect abnormalities like polyps, ulcers, tumors, and diverticula preprocedure instructions for barium enema - ANSWER -take a cathartic (magnesium citrate, polythylene glycol) to empty stool from the colon -CLD day before procedure for bowel prep and to avoid dehydration. avoid red/purple liquids -NPO 8 hours before test -abdominal cramping may be felt during procedure postproceudre instructions for barium enema - ANSWER chalky white stool until barium passes take a laxative like milk of magnesia to help expel barium drink plenty of fluids to promote hydration and eat a high fiber diet make sure directions given from nurse to uap are specific and explicit - ANSWER GCS score of 8 or below is classified as what? - ANSWER a coma when you are 8, intubate - ANSWER Amyotrophic lateral sclerosis (ALS) typical symptoms - ANSWER limb weakness, dysarthria (difficulty speaking), and dysphagia what is trismus? - ANSWER LOCKJAW inablity to open the mouth due to a tonic contraction of the chewing muscles scarlett fever - ANSWER sandpaper skin rash and fever peritonsillar abcess? a collection of pus - ANSWER a serious complication that can reuslt from tonsilities symptoms include fever, sore throat, dysphagia, trismus, muffled voice, uvula deviation, pooling of saliva normal pH - ANSWER 7.35-7.45 paÓ - ANSWER 80-100 PaCÓ - ANSWER 35-45 HCǑ - ANSWER 22-26 Ó sat - ANSWER 95-99 ABG values that mean ARF are what? - ANSWER PaÓ less than or equal to 60 and PaCÓ greater than or equal to 50 what type of med is clopidogrel? - ANSWER antiplatelet and should be stopped 5-7 days before surgery NSAIDS should also be stopped 7 days before surgery to prevent excess bleeding - ANSWER ginko= bleeding - ANSWER what does foul smelling lochia suggest? - ANSWER endometrial infection what are other signs of endometrial infection? - ANSWER maternal fever, tachycardia, and uterine pain/tenderness WBC is usually elevated up to what during the first 24 hours postpartum? - ANSWER up to 30,000. temperature is also elevated pinworm infection - ANSWER anal itching thats worse at night how much folic acid do pregnant women need daily? - ANSWER min of 400 mcg what foods have folic acid? - ANSWER green leafy vegetables are an excellent source others are beans, rice, peanut butter, and fortified cereals what is topical capsaicin cream (Zostrix)? - ANSWER OTC analgesic that relived minor pain like osteoarthritis special instrution: wait 30 mins after massaging cream into hands before washing orthodox jews cant take capsules why? - ANSWER the gelatin is not kosher (fit to be consumed) what is the most accurate indicator of fluid loss or gain? - ANSWER daily weight what are some risk factors for respiratory depression? - ANSWER elderly underlying pul disease post surgery obesity smoking opiate naaive nursing care for pts in acute mania - ANSWER quiet structured non stimulating envrionment one on one activities instead of group limiting contact with other people high protein high cal finger foods easy to eat what type of drug is theophylline - ANSWER bronchodilator symptoms of theophylline toxicity - ANSWER cns stimulation like HA, insomnia, and seizures, n/v, cardiac toxicity digoxin toxicity - ANSWER 1st GI disturbances and visual changes what type of drainage is expected after a surgical procedure? - ANSWER serosanguinous (pink) Normal amount of *drainage* in *first 24 hours following surgery* - ANSWER depends on type of procedure performed, but about *80-120 mL/hour* of *serosanguineous or sanguineous drainge* can be expected what does a cpap machine do - ANSWER positive pressure opens the airway that was previously cut off narcotics like morphine can do what with obstructive sleep apnea symptoms - ANSWER exacerbate them opioid agonist-atagonist meds can be used when during labor? - ANSWER in the active phase of stage 1 labor when labor contractions are well established and the cervix is dilated to atleast 4 cm if pt is in resp distress what do you assess first - ANSWER AIRWAY what are the mejor side effects of opioid analgesics - ANSWER sedation, respiratory depression, hypotension, constipation how should hydromorphine be administered? - ANSWER slowly over 2-3 minutes intramuscular injetions can cause bleeding - ANSWER how should IV potassium be administered? - ANSWER must be given in an infusion pump so the rate can be regulated. not by gravity infusion. it should also always be diluted symptoms of cold stress in a newborn - ANSWER irritability, lethargy, decreased temp, hypoxia, bradycardia, weak suck and cry, emesis, hypoglycemia whos at a high risk fr cold stress and why? - ANSWER premature babies due to decreased brown adipose tissue do babies shiver to produce heat? - ANSWER no what is red man syndrome and what does it haooen from - ANSWER rapid infusion of vancomycin- flushin, erythema, pruritis on face neck and chest what is wound evisceration? - ANSWER protrusion of internal organs thru the wall of an incision. placing them in low fowlers with the knees bent helps reduce the tension on the wound dont forget to always assess first - ANSWER what should always be at beside for a gastric lavage? - ANSWER intubation and suction supplies why is it done and how soon after overdose? - ANSWER remove toxins and irrgate stomach and within one hour after overdose manisfestions of OA - ANSWER pain exacerbted by weight bearing crepitus morning stiffness dec joint mobility and rom atrophy of the muscles during pregnancy, why are women in a hypercoaguble state? - ANSWER to protect them from hemorrhage but there is a risk for DVT ambulate the pt soon after childbirth who should get the flu vaccine? - ANSWER all pts 6 months old or greater unless pt has life threatening allergy to the vaccine or one of its ingredients symptoms of addisonian crisis - ANSWER sudden drop in bp, tachycardia, hypoglycemia, abdom pain, and weakness how to treat - ANSWER give IV hydrocortisone warfarin - ANSWER blocks the availibility of vitamin k and reduces risk of stroke venous thrombosis or PE what is the fluid of choice for the rapid correction of hypotension? - ANSWER 0.9 sodium chloride what is nitroglycerin used for? - ANSWER its a vasodilator that restores myocardial perfusion s/s of dig toxicity - ANSWER visual changes n/v confusion lethargy weakness cardac arrythmias take pulse and withold which med if less than 60? - ANSWER digoxin antihypertensives are held before dialysis - ANSWER never clamp a chest tube during transport of a pt. what may it cause? - ANSWER tension pneumothorax cuz the air has no way to escape what is parallel play that toddlers do? - ANSWER play alongside rather than with other children how to asisst a blind pt with walking? - ANSWER walk slightly ahead of them and to the side, and let them grab onto your elbow post op instructions for total hip replacement - ANSWER AVOID ADDUCTION and hip flexion client supine with hob elevated less than or equal to 45deg what are the steps to deliver a dose via a metered dose inhaler MDI? - ANSWER shake MDI and attach to spacer exhale completely place lips tightly around mouthpiece deliver one puff of med into spacer take a slow deep breath and hold it for 10 scds rinse mouth with water why is putting an IV in the arm of a mastectomy contraindicated? - ANSWER any trauma to the arm on the operative side can cause lymphedema with painful and lengthy swelling what are some reasons for venipuncture to be contraindicted un upper extremities? - ANSWER weakness paralysis infection av fistula or graft mastectomy what are the 2 clinical features of MDD - ANSWER depressed mood and loss of interest or pleasure why do opioids cause hypotension? - ANSWER they dilate peripheral BVs. if the pt stands it can cause orthostatic hypotension classic heart attack symptoms - ANSWER dizziness, sweating cold clammy skin, sob, n/v, ischemic chest pain, pain radiating to neck, jaw, left shoulder, arms, epigastrum symptoms of a pleural effusion - ANSWER dyspnea on exertion, non-productive cough, diminshed breath sounds, dullness to percussion, dec tactile fremitus how soon after a blood transfusion does an acute hemolytic reaction occur? - ANSWER 15 mins what are normal fetal heart tones? - ANSWER 110-160 what is nifedipine? - ANSWER calcium channel blocker antihypertensive. do not give if bp on the lower end range what side effects do beta adrenergics have? - ANSWER tremor or palpitations normal sodium value - ANSWER 135-145 if sodium is too low what could this lead to? - ANSWER altered mental status and seizures cystic fibrosis - ANSWER bronchodilators before chest physiotherapy diet high in fat calories and proteins pancreatic enzyme supplements with all meals and snacks recurrent respiratory infections what can determine if a person with heart problems can resume sexual activity? - ANSWER walking 1 block or climbing 2 flights of stairs without symptoms what is a major complication of RA? - ANSWER morning stiffness. how to fix? take a warm shower or bath characteristics of neuroleptic malignant syndrome - ANSWER fever, muscle rigidity, altered mental status, sweating, hypertension, and tachycardia what does torsades de pointes look like - ANSWER a strand of dna what is the first line of treatment for torsades de pointes? - ANSWER iv magnesium a porlonged QT interval is usually the result of electrolyte imbalances so what is usually the treatment? - ANSWER look for electrolyte in the answer drug of choice for symptomatic hypotension? - ANSWER dopamine tachyarrythmias? - ANSWER metoprolol can be used what does DOPAMINE do? - ANSWER speeds up the heart rate increases cardiac contractility what type of fluids do pts in hypovolemic shock need? - ANSWER isotonic solutions like NS, LR what is the purpose of norepinephrine? - ANSWER vasoconstriction and improved contractility/output what are some non pharmacologic interventions that help with phantom limb pain? - ANSWER wrapping the extremity or applying ice what are some signs of a bowel obstruction? - ANSWER nausea, vomiting, abdominal distention, dec stool active infection is a contraindication for what? - ANSWER elective surgery what are some classic signs of DVT? - ANSWER unilateral leg edema, local warmth, erythema, low grade fever (PS a negative homan is normal) LITHIUM- bipolar range? - ANSWER 0.6-1.2 wat levels of lithium are considered toxic? - ANSWER over 1.5 while taking lithium clients should: - ANSWER drink 1-2 L of fluid daily maintain normal sodium levels have their blood drawn regularly for therapeutic levels what can cause lithium toxicity in a pt taking lithium? - ANSWER dehydration decreased renal function, diet low in sodium, and drug-drug interactions like nsaids at what age does an infant have equal head and chest circumference? - ANSWER 1 year Normal *weight gain* in *first 6 months* in infants - ANSWER *5-7 oz (140-196 g) a week* Normal *weight gain* from *age 6-12 months* - ANSWER *3-5 oz (84-140 g) a week* at 12 months, an infants weight should be - ANSWER tripled the birth weight at 12 months can in infant go fom standing to siting - ANSWER yes when does teeth eruption happen in infants? - ANSWER 6-10 months how to calculate the # of teeth a child should have in the first 24 months? - ANSWER age of child in months minus 6 what are vegans at rsk for since they dont eat animal products? - ANSWER tingling and numbness from vit B 12 deficiency vit b 12 defieicny affects the entire nervous system from peripheral nerves to spinal cord and brain - ANSWER when do you not give a vaginal exam for a pregnant woman? - ANSWER bleeding with unknown origin what is suspected in a pregnant woman having painless vaginal bleeding after 20 weeks gestation? - ANSWER placenta previa a tuft of hair at base of spine in a newborn indicates what? - ANSWER spina bifida taking folic acid during pregnancy prevents what? - ANSWER neural tube defects and spina bifida UAPs CAN perform oral suction for pts during oral care - ANSWER normal albumin level - ANSWER 3.5-5.0 what is the function of albumin> - ANSWER to keep fluid from leaking out of vessels when serum albumin is low this can cause - ANSWER pitting edema while talking with a delusional pt, focus on the pts feelings and reinforce reality - ANSWER for priority questions, anything with a new onset problem is usually first - ANSWER in therapeutic communication, dont choose "why" questions - ANSWER birth weight should double at 6 mo and triple at 12 mo - ANSWER when does the anterior fontanel close? - ANSWER 18 mon when does the posterior fontanel close? - ANSWER 2 months whatis typically seen in a retinoblastoma? - ANSWER absence of red reflex. the pupil reflects a white color what route is the best way to give burn victim meds? - ANSWER IV 14 gauge catheter - ANSWER fluids and drugs in prehospital or emergency setting or hypovolemic shock 18 gauge - ANSWER infusing blood or large amounts of fluids in adults drug for fibromyalgia - ANSWER duluxetene (cymbalta) it has both antidepressant and pain reliving affects its also perscribed for MDD what is fobromyalgia? - ANSWER abnormal cns pain transmission and processing incentive spirometer use - ANSWER piston rises with each deep inhalation why isit used> - ANSWER tp revent atelectasis in post op clients how many breaths are recommended? - ANSWER 5-10 breaths per session every hour while awake process for breathing from an incentive spiromeyer - ANSWER sit in high folwers or sitting seal lips tightly to prevent air leakage inhale deeply hold breath for 2-3 seconds exhale slowly breathe normal for several breaths before repeating the process cough at the end of the session what is a serious side effect of statin drugs? - ANSWER muscle aches and weakness if mypopaty is present, what will ve very elevated? - ANSWER creatinine kinase side effect of clcium channel blcokers? - ANSWER headaches the use of radioactive iodine is contraindicated in - ANSWER a pregnant client. all females should be tested before Primary use of radioactive iodine? - ANSWER - primary treatment for *nonpregnant adults* with *hyperthyroid disorders* (eg *Graves disease*) - RAI damages or *destroys thyroid tissue* and can result in *hypothyroidism* - clients need to take thyroid *supplementation (levothyroxine) for life* lyme disease - ANSWER initial symptoms: flu like ha, fever, myalgia, fatigue, bulls eye rash. give antibiotics to prevent it from spreading to heart brain or joints any condition that causes a decrease in RR is at risk for reveloping - ANSWER respiratory acidosis respiratory acidosis - ANSWER low ph and high pacó metabolic acidosis - ANSWER low ph and low hcǒ respiratory alkalosis - ANSWER high ph and low pacó metabolic alkalosis - ANSWER high ph and low hcǒ hypoventilating can cause a buildup of carbon dioxide in the blood and can lead to - ANSWER respiratory acidosis delusions of reference - ANSWER cts believe songs nespaper articles the radio and other things are personal and significant to them somatic delusion - ANSWER of having some physical defect or disease persecutory (paranoid) delusion - ANSWER the belief of being treated in a malicious way what is creatinine clearance> - ANSWER a measure of glomerular function and an indicator for renal disease progression it is a 24 HOUR URINE COLLECTION. the test must be started again if all urine in the 24 hours period is not collected when the test begins, the first urine is taken and thrown away what is palliative care? - ANSWER manages symptoms, provide psychosial support, coordinate care to relieve suffering and improve quality of life for cts with serious illnesses classic symptoms of a rotator cuff injury - ANSWER shoulder pain & weakness, sever pain on arm abduction what is a saline lock? - ANSWER the cap that goes onto an iv insertion catheter. it allows you the ability to stop giving iv fluids and then start again at a later time without having to do another venipuncture patient with the flu precautions - ANSWER droplet be in 3 ft when coughing or sneezing place mask on pt when transporting what is the purpose of unfractioned heparin? - ANSWER to slow the time it takes the blood to clot thereby keeping the current clot from getting bigger and preventing new ones from forming mono is caused by the - ANSWER epstein barr VIRUS is aspirin contraindicated in children and why? - ANSWER yes bc they can get reye syndrome symptoms of mono? - ANSWER fatigue, fever, sore throat, splenomegaly, hepatomegaly, swollen lymoh nodes contact sports should be avoided what is normal CVP? - ANSWER 2-8 what is CVP and what does it monitor? - ANSWER central venous pressure measuring right ventriculr preload and reflects fluid volume status connect it to the proximal port to pressure monitoring system how to asisst a falling client? - ANSWER stand behind and let out leg for supporting them to ground parasthesia is an early sign of what? - ANSWER neurovascular impairment REMEMBER NOT TO CHOOSE A YES/NO ANSWER QUESTION - ANSWER what is a major adverse effect of TNF inhibitors like infliximab or adalimumab? - ANSWER infection bc they cause immunsuppression positions - ANSWER for paracentesis - ANSWER high fowlers enema administration - ANSWER sims after a lumbar puncture - ANSWER supine after liver biopsy - ANSWER right side (to put pressure on the liver) after cardiac catherterization - ANSWER lie flat normal newborn RR - ANSWER 30-60 glucose levels are normally decreased 1 hour after birth - ANSWER what will damage to the occipital lobe cause? - ANSWER visual disturbances what do advanced care documents include? - ANSWER healthy care proxy and living will if pt comes into ER and says they have the worst HA of their life what could it be - ANSWER an aneurysm what is the most important med to give for anaphylactic shock? - ANSWER IM epinephrine what are mongolian spots? - ANSWER benign discoloration bluish gray but usually fades after an amputation, should the residual limb be elevated? - ANSWER NO, to prevent hip flexion contractures buck traction - ANSWER immobilizes hip and femur fractures . the weight pulls the limb into traction. the foot of the bed is elevated following total hip replacement, how is hip dislocation prevented? - ANSWER using an abductor pillow to maintain hip in a straight position. dont bend hip more than 90 deg before starting broad spectrum antibiotics, what must be done? - ANSWER blood culture and sensitivity what is HELLP related to pregnancy? - ANSWER Hemolysis Elevated Liver enzymes Low Platelet it is a severe sign of preeclampsia. symptoms may be RUQ pain n/v and malaise normal sodium - ANSWER 135-145 homonymous hemianopsia - ANSWER loss in half of the visual field on the same side oxytocin - ANSWER induction or augmentation of labor should be given by an electronic infusion pump requires frequent mother/fetal assessment adverse affects: maternal hypotension and water intoxication what are some seizure triggers? - ANSWER excess caffeine, alcohol, sleep deprivation, and stress phenytoin - ANSWER gingival hyperplasia dont give nsaids with nasal polyps - ANSWER dont give beta blockers to asthma patient - ANSWER treat asthma with - ANSWER albuterol. SE: n/v, insomnia, palpitations, tremor proton pump inhibitors can increase the risk of - ANSWER C-diff common proton pump inhibitors PPIs - ANSWER Prazoles: omeprazole, lansoprazole, etc heparin is measured thru what levels? - ANSWER PTT normal wbcs - ANSWER 4,000-11,000 a pt with heparin should have a ptt of 1.5-2 times the normal range which is 25-35 scds - ANSWER what is the causitive agent of fifth disease? - ANSWER human parvovirus fifth disease - ANSWER "slapped face" distinct red rash on cheeks its on communicable before the onset of symptoms spreads via respiratory PKU - ANSWER low phenylalanine diet specal infant formula no meat eggs or dairy warning signs of cancer - ANSWER CAUTION what do rales (crackles) indicate? - ANSWER fluid in the lungs proper nasal spray administration - ANSWER high fowlers and head bowed slightly forward occlude one nostril and put it in open one point tip toward side and away from center spray while inhaling deeply normal platelets - ANSWER 150,000-400,000 how to close a hemovac - ANSWER compress to create negative suction pressure and APPLY PLUG BEFORE RELEASING THE PRESSURE most important to monitor bulemic pts when? - ANSWER cystic fibrosis - ANSWER chest physiotherapy- to remove secretions that cause ineffective airway clearance CF is genetic HIGH fat HIGH calorie diet liberal fluid intake when would you see dry shiny hairless skin? - ANSWER peripheral atherosclerotic arterial disease wilms tumor is on the - ANSWER kidney presents as abnormal bulging on one side of child's abdomen DO NOT PALPATE ABDOMEN process for a burn at home - ANSWER soak in cool water to stop buring process remove clothing around burn cover with a clean dry cloth dont put any meds or anything on the wound post surgical pts are usually perscrbed which prn med to help from the opioid drugs they were on - ANSWER naloxone (Narcan) but it wears off in 1-2 hours so be prepared to give more than once monitor RR and give oxygen cushings triad - ANSWER bradycardia, slowed RR, widened pulse pressure what is the normal pulse rate for a 1 year old - ANSWER 100-160 hypokalemia can cause - ANSWER heart arrythmias and muscle cramps and weakness what do you closely monitor when giving furosemide? - ANSWER blood pressure potassium BUN creatinine what type of medication is clopidogrel? - ANSWER antiplatelet "look, listen, feel" approach - ANSWER ppl with long bone or pelvic fractures are at risk for developing what? - ANSWER fat embolism what patients are considered immunosuppressed? - ANSWER on steroids/chemo, HIV pos, new post op, multiple chronic co morbidities, splenectomy, diabetes, very young/elderly what kind of precautions do you need for open lesions from shingles? - ANSWER both *contact* and *airborne* precautions and a negative airflow room symptom of macular degeneration - ANSWER loss of central field of vision seeing small flashes of light is a sign of - ANSWER retinal detachment what is presbyopia? - ANSWER inability to see things close up some of the "cin" antibiotics can cause what? - ANSWER prolonged QT interval and can also cause hepatotoxicity so make sure to check liver function tests diet for chronic kidney disease - ANSWER restrict fluids, sodium, potassium, and phosphorus what wilyl you hear in lungd during atelactasis? - ANSWER fine crackles (high pitched popping sound) calcium channel blockers end in - ANSWER "pine" what are the most important adverse effects of calcium channel blockers? - ANSWER dizziness, flushing, HA, peripheral edema, and constipation poor thiamine consumption can lead to wernicke encepalopathy - ANSWER tracheostomy allow for 1 finger to fit under the ties - ANSWER main care with someone with a new tracj - ANSWER prevent dislodgement what is Docusate - ANSWER stool softener what are foods high in vitamin k? - ANSWER leafy green veggies, asparagus, brocoli, kale, brussel sprout, spinach some symptoms of tardive dyskinesia - ANSWER unusualy movements of arms, legs, face, body metoclopramide - ANSWER can cause tardive dyskinesia therapeutic trough levels of vancomycin - ANSWER 10-20 normal creatinine level - ANSWER 0.6-1.3 normal BUN level - ANSWER 6-20 elevated bun and creatinine may indicate what? - ANSWER nephrotoxicity first level priority problems - ANSWER airway breathing circulation & cardiac (become first priority in cardiac arrest) vital signs second level priority problems - ANSWER altered mental status acute pain untreated medical problems (like hyperglycemia in client with diabetes) chronic pain acute elimination problems abnormal lab results risk for infection, safety where should the nurse listen for a bruit in abdominal aneyurism - ANSWER epigastric/periumbilical area what are TORCH infections - ANSWER cause *fetal abnormalities in pregnant women* what does TORCH stand for? - ANSWER T: *toxoplasmosis* O: *other parvo- b 19, varicella zoster* R: *rubella* C: *cytomeglovirus* H: *herpes* How is *toxoplasmosis acquired*? - ANSWER exposure to infected *cat feces* or ingestion of *undercooked meat* or *soil contaminated fruits/vegetables* pt with measles precautions - ANSWER airborne and neg pressure room n95 respirators priority intervention for excema - ANSWER prevent scratching when are pancreativ supplements taken? - ANSWER with or judt before every meal what will chronic pancreatitis show in stool - ANSWER greasy, foamy, foul-smelling, fatty how about biliary obstruction - ANSWER light gray clay colored RA causes bilateral symmetrical pain insmall joints of hands wrists and feet - ANSWER displacement - ANSWER angry at boss and comes home yelling at wife warfarin - ANSWER monthly INR spironolactone - ANSWER potassium sparing diuretic liver dysfunction abnormalities - ANSWER low albumin, high ammonia, elevated INR/PT, increased bilirubin, low platelets symptoms of malignant hyperthermia - ANSWER tachycardia, tachypnea, rigid jaw, high fever. it is triggered by drugs used for anesthesia give them IV DANTROLENE PTSD patients tend to - ANSWER blame themselves. make sure to tell them it wasnt their fault how to use the peak flow meter for asthma - ANSWER exhale quickly and forcibly thru the mouthpiece nursing care for acute pancreatitis - ANSWER NPO IV opioids IV fluids NG tube for suction what puts a patient at risk for preterm labor? - ANSWER infection like periodontal disease symptoms of active tuberculosis - ANSWER cough, ,fever/chills, malaise, weight loss, night sweats, anorexia, fatigue positive T skin test abnormal chest xray can transmit latent TB infection - ANSWER positive TST, neg chest xray, asymptomatic, cant transmit steroids can convert latent to active TB - ANSWER what is an amniotomy? - ANSWER artificial rupture of the membranes what should the nurse do during an amniotomy? - ANSWER assess FHR before and after, note characteristics of amniotic fluid, assist client to an upright position after the procedure symptoms of anaphylaxis - ANSWER oral/airway swelling dizziness tachycardic stridor/hoarseness wheezing rash pruritis flushing n/v abdom pain treatment of anaphylaxis - ANSWER IM epinephrine before starting on statin drugs, what must be checked? - ANSWER liver function tests bc they can cause hepatotoxicity what can statins cause? - ANSWER muscle aches and can lead to rhabdomyolysis aphasia - ANSWER inability to express thoughts and comprehend language what does a pt with Marfan syndrome look like - ANSWER tall and thin. they often have heart abnormalities so contact sports are dicouraged so no contact sports with Marfan syndrome - ANSWER what is the Bishop score? - ANSWER assesses and rates cervical favorability and readiness for induction of labor. a score above 8 is good carbidopa-levodopa - ANSWER treats parkinson's- improves spontaneos activity seen with this disease what does a person see with glaucoma eye - ANSWER tunnel vision what does a sacral dimple on a newborn signify? - ANSWER spina bifida what is a normal newborn HR - ANSWER 110-160 what type of drug is clopidogrel, prasugrel, and ticagrelor - ANSWER antiplatelet prior to an EEG which diagnoses seizures: - ANSWER non caffeine, stimulants or depressants wash hair what is Duchenne muscular dystrophy? - ANSWER childhood form of MD x linked recessive lacks protein called dystrophin for proper muscle stabliizing mucles of proximal lower extremities are affected first they do the gower sign to help them stand remove clutter to prevent falls what is the gower sign? - ANSWER uses ones hands to rise from sqaut to a chair x linked recessive - ANSWER carried by females and affects males what is methotrexate? - ANSWER antineoplastic, immunosuppressant to treat malignancies chemotherapy, rheumatoid arthritis, psoriasis, and for abortions what are the major side effects with methotrexate? - ANSWER bone marrow suppression, hepatotoxicity, fetal death. you dont need monthly eye exams when taking it remember for lung positioning: - ANSWER GOOD LUNG DOWN transport techs need to/dont need to know which info - ANSWER need:pertinent info to transport pt dont need: exact diagnosis you can put last names on boards in nurses station - ANSWER what is the only med approved for ALS? - ANSWER Riluzule (Rilotek) pneumonia vaccine - ANSWER 65 and above need 2 vaccines advere reaction to gentamicin - ANSWER ototoxicity and nephrotoxicty what is an exected side effect symptom of nitroglycerine? - ANSWER headache some calclium channel blockers like nifepidine cause what - ANSWER edema from vasodilation calcium channel blockers end in - ANSWER PINE= vasodilation radioactive iodine (RAI) - ANSWER treats hyperthyroidism destroys thymus gland take precautions to not spread this to others. aka everything private Myasthenia gravis clinical manifestations - ANSWER - ocular (*ptosis*) & facial muscle weakness - *difficulty speaking, swallowing, chewing* - can progress to *respiratory muscles* and affect *breathing* *1st line treatment* for *Myasthenia Gravis* - ANSWER *Pyridostigmine* a chest tube and catheter should both be placed - ANSWER below chest and bladder what kind of environment do autistic kids need? - ANSWER a private calming one with minimal stimulation rifampin - ANSWER turns liquids red signs of developmental dysplasia of the hip? - ANSWER thigh folds laxity of the hip joint hypoglycemia symptoms - ANSWER tremors, palpitations, anxiety, restlessness, sweating, and pallor what type of drug is celecoxib? - ANSWER nsaid if pt has an infection, do not do total anything replacement - ANSWER classic symptoms of neurogenic shock - ANSWER hypotension, bradycardia, and pink an dry skin any kind of shock, what do you do - ANSWER FLUIDS what number is considered sever neutropenia? - ANSWER less than 500 aura comes before what? - ANSWER seizure back pain after catheterization could be what? - ANSWER retroperitoneal bleeding parkland formula... what is the formula and actually how much is given? - ANSWER 4 x weight in kg x % of body burned half of the calculated fluid must be given in the first 8 hours low platelets= ICP bleeding= change in LOC - ANSWER kidney bx - ANSWER BLEEDING Azathioprine - ANSWER immunosuppressant drug causing bone marrow suppression and increases risk for infection when is digoxin held in kids? - ANSWER pulse less than 90 ARBs and ACE inhibitors are contraindicated in - ANSWER pregnancy what does elevated cvp mean - ANSWER right vent failure or fluid overload c diff room needs - ANSWER single rubella titer is contrain in - ANSWER pregnancy mass casualty goal - ANSWER greatest good for greatest # of ppl furosemide can cause what - ANSWER ototoxicity lithium toxicity - ANSWER GI side effects mainly client self determination act - ANSWER clients must be given info about their rights to identify written directions about the care that they wish to get in the enent they become incapacitated and are unabe to make healthcare decisions.asked about advance directive on admission 2 types of advance directives - ANSWER instructional directive - ANSWER lists medical treatment the client wants to omit or refuse if they become unable to make decision durable power of attorney - ANSWER health care proxy chosen by client to make health care decision on clients behalf id client can no longer make decisons informed consent is not needed for an unconscious adult comes into the er why? - ANSWER bc delyaing treatmnt could causes injury or death to the pt intractible diarrhea - ANSWER chronic, diarrhea that is hard to control influenza is transmitted how? - ANSWER droplet what does a dnr exactly mean to withhold? - ANSWER CPR and other lifesaving measures what is Tofranil? - ANSWER trycyclic antidepressant what is osteoporosis - ANSWER low bone density stage 1 ulcer - ANSWER intact skin non-blanchable with localized rednes stage 2 - ANSWER blister, abrasion, shallow open ulcer red pink wound with no sloughing stage 3 - ANSWER full thickness skin loss with visible sub q fat stage 4 - ANSWER full thickness skin loss exposed muscle tendon or bone unstageable - ANSWER full thickness skin loss ulcer base covered by slough and eschar that needs to be removed to stage which long acting insulins can you not mix? - ANSWER glargine and detemir what does lead poisoning cause? - A