2021 UWORLD* Review Study Guide 63 + Pages Comprehensive Material for NCLEX

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UWORLD REVIEW TB and all airborne transmission based precautions (chickenpox, measles) ­ Use a surgical mask not an N95 for clients. ­ This helps protect Health care workers and other clients ... from respiratory secretions, and contain respiratory secretions ­ The HCWs who transport the clients from a negative pressure room to another location need to wear an N95 mask to protect themselves from infection.  Cirrhosis of the liver. These blood tests would be elevated in the lab results: ­ Ammonia, bilirubin, prothrombin time ­ Elevated bilirubin (jaundice) exists due to the decreased inability of the liver to conjugate and excrete bilirubin ­ Most coagulation factors are produced in the liver. A cirrhotic liver cannot produce the factors essential for blood clotting. As a result, the PT, aPTT, and INR levels are elevated.  Total knee replacement ­ A recent/current infection is a contraindication to total replacement surgery as a wound infection is more likely to occur in a client with a pre­existing infection. ­ Burning on urination should be investigated as it could indicate a UTI ­ Severe knee pain is expected. ­ Stop taking NSAIDS including selective COX­2 inhibitors (celecoxib) 7 days prior to surgery to decrease the risk of intra and post op bleeding.  Transfusion reaction ­ Chills, fever, low back pain, flushing, itching) ­ Stop transfusion immediately, maintain IV line with NS, monitor VS, notify HCP and blood bank, recheck tags numbers and client’s blood type, and return bag to blood bank for further testing. Collect blood and urine sample to evaluate hemolysis, and complete necessary facility paperwork to document the reaction.  Chronic kidney disease with a large plural effusion. Findings : ­ Decreased fremitus ­ Diminished lung sounds ­ A pleural effusion is an abnormal collection of fluid (>15­20ml) in the pleural space between the parietal and visceral pleurae that prevents the lung from expanding fully. This results in decreased lung volume, Atelectasis, and ineffective gas exchange. ­ Other s/s: dyspnea on exertion, non­productive cough, diminished breath sounds, dullness to percussion, and decreased tactile fremitus. If the effusion is large, the trachea is deviated to the opposite side. ­ Sounds travel faster in solids (consolidation) than in an aerated lung, resulting in increased fremitus in pneumonia. fluid or air outside the lung interrupts the transmission of sound, resulting in decreased fremitus in pleural effusion and Pneumothorax. Cancer ­ Unintentional weight loss of greater than 10 percent of usual weight (in nonobese) clients require evaluation and could indicate underlying cancer. N, anorexia, and dysgeusia (altered taste sensation) are also clinical features of cancer and contribute to weight loss. ­ CAUTION acronym of cancer Change in bowel or bladder habits A sore throat that does not heal Unusual bleeding or discharge from body orifice Thickening or lump in the breast or elsewhere Indigestion or difficulty in swallowing Obvious change in wart or mole Nagging cough or hoarseness ­ Orange peel appearance of breast tissue, or retracted nipple  Restrained client ­ Position sideways or semi fowlers, because supine position can cause risk of aspiration ­ Don’t tie the knot a square knot. Do a quick release knot. ­ Tie to bed frame not bed rail ­ Provide care to meet basic needs every 2 hours  Gout ­ To prevent future exacerbations 1) Achieve and maintain a healthy weight 2) Drink plenty of fluids 3) Limit alcohol consumption and carbonated beverages containing high fructose corn syrup. ­ You don’t need to eliminate all foods with protein. Just red meats and seafood intake  Hip fractures ­external rotation, abduction, muscle spasm, and shortening of the affected extremity.  Raynaud’s phenomenon ­ An episodic vasospastic disorder of the small cutaneous arteries, mainly of the fingers and toes. ­ Occurs most often in young women age 15­40. ­ Vasospasm induced color changes of the fingers, toes, ears, and nose. ­ Decreased perfusion initially causes pallor (white) followed by cyanotic (blue purple) and last color change is red. ­ Coldness numbness, followed by throbbing, aching, tingling, swelling (hyperemic phase). ­ Exposure to cold, emotional stress, and caffeine, and tobacco use may bring on symptoms. ­ Don’t use substances with vasoconstrictive properties­ Perform stress management  Emphysema ­ Barrel chest, decreased activity tolerance, diminished breath sounds, distant heart sounds ­ Wheezing ­ SOB that worsens over time ­ tachypnea, prolonged expiratory phase ­ Hyperresonance on percussion, pursed­lip breathing, use of accessory muscles and use of tripod position  Hyperosmolar hyperglycemic state complications: ­ Blood glucose levels are very high (>600) ­ History of type 2 diabetes. Older age ­ Neurological manifestations (blurry vision, lethargy, obtundation (decreased LOC), progression to coma) ­ Gradual onset of hyperglycemic symptoms (as some insulin is produced) ­ Hyperventilation and abdominal pain less common ­ Bicarb greater than 18 mEq/L ­ Normal anion gap ­ Serum osmolality >320 mOsm/kg ­ Negative or small serum ketones  Diabetes insipidus ­ Insufficient production or suppression of ADH ­ Polydipsia (increased thirst); polyuria (increased urine output) and can lead to dehydration resulting in weight loss, hypernatremia, and high serum osmolality (>295 mmol/kg). ­ Dilute and copious urine (2­20 L/day) with a low specific gravity (<1.005)  Dilantin (Phenytoin) ­ Anticonvulsant used to treat generalized tonic­clonic seizures. ­ Therapeutic range: 10­20 mcg/ml, and it takes 3­12 months for steady state to be reached. ­ Early toxicity signs: horizontal nystagmus and gait unsteadiness. Slurred speech, lethargy, confusion, and even coma. Bradyarrhythmias and hypotension are usually seen with IV Phenytoin ­ Gingival hyperplasia is common expected side effect of Phenytoin and does not indicate drug toxicity. Occurs more in those less than 23 y/o who are prescribed >500 mf/day. Good oral hygiene can limit symptoms. ­ Other s/s: ataxia, decreased alertness  Metronidazole ­ Metallic taste in the mouth is common­ It’s an antibiotic  Trisomy 18 ­ A genetic disorder with a short life expectancy (a few weeks after birth) . It’s a chromosome anomaly characterized by severe cardiac defects and multiple musculoskeletal deformities. ­ End of life issues should be discussed early after the diagnosis is confirmed. Trisomy 13 (patau syndrome) also results in death ­ No treatment at this time available  Warfarin ­ Anticoagulant. Range: 2.3­3.5. ­ Warfarin should only be administered after INR has been checked. Can be given if it is less than 3.5 and should be held and HCP contacted if greater than 3.5. ­ Antidote: Vitamin K  Neutrophils ­ Normal: >1500/mm3 ­ Neutropenic precautions: private room, strict Handwashing, avoid exposure to people who are sick, avoid ALL fresh fruits, veggies, and flowers; ensure all equipment used with the client has been disinfected. ­ Infections in immunosuppressed clients are life threatening ­ Avoid IM injections and minimize venipunctures when platelet count is below 50,000 as these can cause prolonged bleeding  Blood lead levels ­ Common source is lead based paint found in houses built before 1978. ­ Screenings are recommended at ages 1, 2, and up to 6, if not previously tested. ­ Lead poisoning particularly affects the neurological system, due to immature development of the brain and nervous system. This is more concerning than the other effects. ­ Can cause neuro impairment, developmental delays, reading difficulties, visual­motor issues; can lead to permanent cognitive impairment, seizures, blindness, or even death. ­ GI bleeding is for iron toxicity not lead poisoning. ­ Lead poisoning is the most threatening to the kidneys and neuro system (developmental delays, cognitive impairment, seizures). ­ Liver injury typically does not occur. Severe liver damage is closely associated with acetaminophen overdose or Reye syndrome.  Asystole ­ Total absence of ventricular electrical activity (pulseless, apneic, unresponsive) ­ Treatment: CPR, ACLS, epinephrine and/or vasopressin, advanced airway use, and any reversible treatment. ­ Vasopressin is a vasopressor, that increases vasoconstriction and MAP [Show More]

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