Mark Klimek

NCLEX Review

YELLOW BOOK

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[ NOTICE ]
Yellow notes are synchronized with each lecture.
I recommend hiding the answer section with another piece of paper as you go through
each question as you listen to the lectures :)

Lecture 1: Acid and Base Imbalances

1. Rule of the B's: If the ____ and the _____ are ______ in the same direction then it is
meta_____

🗒️pH, Bicarb, Both, Bolic

2. pH 7.30_______ HCO3 20_______

🗒️↓= acidosis; ↓= metabolic

3. pH 7.58_______ HCO3 32_______

🗒️↑= alkalosis; ↑= metabolic

4. pH 7.22_______ HCO3 30_______

🗒️↓= acidosis; ↑= respiratory

5. You are providing care to a client with the following blood gas results: pH 7.32, CO2 49,
HCO3 29, PO2 80, and SaO2 90%. Based on these results, the client is experiencing:
______________________

🗒️↓= acidosis; ↑= respiratory

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6. MACKussmaul?

🗒️The only acid base to cause Kussmaul respirations is Metabolic ACidosis.

7. As the _______ goes, so goes _______ except for _______

🗒️pH, my patient, Potassium

8. Up

🗒️hypokalemia, alkalosis, HTN, Tachycardia, Tachypnea, Seizures, Irritability, Spastic, Diarrhea,

Borborygme, hyperreflexia, etc

9. Down

🗒️hyperkalemia, acidosis, htn, bradycardia, constipation, absent bowel sounds, flaccid, bradypnea

10. Causes of acid-base imbalances: First ask yourself, "Is it _______?" If yes, then it's
_______. Then ask yourself: "Are they _______ or _______. If _______, pick
_______. If _______, pick _______

🗒️lung, respiratory, overventilating, underventilating, overventilating, alkalosis, underventilating,

acidosis

11. Causes of acid-base imbalances: If it's not lung, then it's _______. If the patient has
_______ _______ vomiting or suction, pick _______. For everything else that isn't lung,
pick _______ _______. When you don't know what to pick, choose _______

🗒️metabolic, prolonged gastric, alkalosis, metabolic acidosis, metabolic acidosis

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12. High pressure alarms are triggered by _______ resistance to air flow.

🗒️Increased

13. High pressure alarms are triggered by increased resistance to airflow and can be caused
by obstructions of three types:
1) _______
2) _______
3) _______

🗒️(kinked tube) unkink, (water in tube) empty, (mucus in airway) cough and deep breathe

14. Low pressure alarms are triggered by _______ resistance to airflow.

🗒️Decreased
15. Low pressure alarms are triggered by decreased resistance to airflow and can be caused
by disconnections of the _______ or _______

🗒️tubing (reconnect it), oxygen sensor tube (reconnect it UNLESS tube is on the floor- bag them and
call RT if this happens)

16. Respiratory alkalosis means ventilator settings may be too _______

🗒️High

17. Respiratory acidosis means ventilator settings may be too _______

🗒️Low

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18. What does "wean" mean?

🗒️gradually decrease with the goal of getting off altogether

Lecture 2: Alcoholism & Aminoglycosides

19. What is Maslow's highest priority to lowest priority?

🗒️
1. Physiological
2. Safety
3. Comfort
4. Psychological (problems within the person)
5. Social (problems with other people)
6. Spiritual

20. Arrange from highest to lowest priority using Maslow's:

Spiritual Distress
Pain in Elbow
Denial
Fall Risk
Pathological Family Dynamics
Electrolyte Imbalance

🗒️
Electrolyte Imbalance (Physiological)
Fall Risk (Safety)
Pain in Elbow (Comfort)
Denial (Psychological)
Pathological Family Dynamics (Social)
Spiritual Distress (Spiritual)

21. What are the 5 stages of grief?

🗒️
Denial

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Anger
Bargain
Depression
Acceptance

22. The #1 problem in abuse is _______

🗒️
Denial

23. Denial is the _______ to accept the _______ of their problem

🗒️
refusal, reality

24. Treating denial: _______ it by pointing out to the person the difference between what
they _______ and what they _______. In contrast, _______ the denial of loss and grief

🗒️
confront, say, do, support

25. Dependency: When the _______ gets the Significant Other to do things for them or make
decisions for them

🗒️
Abuser

26. Codependency: When the _______ _______ derives positive _______ from doing
things for or making decisions for the _______

🗒️
Significant Other, self-esteem, abuser

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27. When treating dependency/codependency: Set _______ and _______ them. Agree in
advance on what requests are allowed, then enforce the agreement

🗒️
limits, enforce

28. When treating dependency/codependency: Work on the _______ of the codependent

person

🗒️
self-esteem

29. Manipulation: when the _______ gets the _______ _______ to do things for him/her
that are not in the ______________ of the _______ _______. The nature of the act is
_______ or _______ to the _______ _______

🗒️
abuser, significant other, interest, significant other, harmful, dangerous, significant other

30. Treating manipulation: set _______ and _______

🗒️
limits, enforce

31. Wernicke's (Korsakoff's) Syndrome: _______ induced by Vitamin _______(thiamine)

deficiency

🗒️
Psychosis, B1

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32. Primary symptoms of Wernicke's (Korsakoff's) Syndrome: _______ with _______

🗒️
amnesia (memory loss), confabulation (makeup stuff)

33. 3 Characteristics of Wernicke's (Korsakoff's) Syndrome

🗒️
preventable (take vitamin)
arrestable (take vitamin)
irreversible (kills brain cells)

34. Antabuse/Revia is aka _______ Therapy

🗒️
Aversion

35. Onset and duration of effectiveness of Antabuse/Revia: _______

🗒️
2 weeks

36. Patient teaching with Antabuse/Revia: Avoid _______ forms of _______ to avoid
_______, _______, _______

🗒️
all, alcohol, nausea, vomiting, death

37. What are examples of products that contain alcohol?

🗒️
mouth wash, cologne, perfume, aftershave, elixir, most OTC liquid medicines, insect repellant, vanilla
extract, vinagerettes, hand sanitizer

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38. First thing you ask in overdose question:

🗒️
Is it an UPPER or a DOWNER?

39. What about laxative abuse in the elderly?

🗒️
It is neither an upper or a downer

40. What are upper drugs?

🗒️
Caffeine
Cocaine
PCP/LSD (psychedelics/ hallucinogens)
Methamphetamines
Adderall

41. What are signs and symptoms of upper drugs?

🗒️
Euphoria, seizures, restlessness, irritability, hyperreflexia (3+,4+), tachycardia, increased bowels
(borborygmi), diarrhea

42. What are signs and symptoms of downer drugs?

🗒️
Lethargic, respiratory depression/arrest, constipated, etc

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43. What are downer drugs?

🗒️
Drugs that are not listed on the upper drugs are all downers

44. What is the highest nursing priority that you can anticipate in an upper?

🗒️
suctioning (due to seizures)

45. What is the highest nursing priority that you can anticipate in a downer?

🗒️
intubation/ventilation (due to respiratory arrest)

46. What is the trend of the signs and symptoms of overdose of uppers?

🗒️
Too much (+)

47. What is the trend of the signs and symptoms of withdrawal of downers?

🗒️
Too little (-)

48. Always assume _______ at birth, in a newborn less than 24 hrs after birth.

🗒️
Intoxication (+)

49. 24 hrs or more after birth, you should assume the newborn is in _______

🗒️
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withdrawal (-)

50. Every alcoholic goes through _______. Only a minority get _______

🗒️
Alcohol Withdrawal Syndrome, Delirium Tremens

51. _______ is not life-threatening. _______ can kill you

🗒️
Alcohol Withdrawal Syndrome, Delirium Tremens

52. Patients with _______ are not a danger to themselves or others. Patients with
________ are dangerous to self and others

🗒️
Alcohol Withdrawal Syndrome, Delirium Tremens

53. AWS or DT: semi private room, any location

🗒️
AWS

54. AWS or DT: private room near the nurse's station

🗒️
DT

55. AWS or DT: Regular diet

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🗒️
AWS

56. AWS or DT: Clear liquid or NPO diet (risk for aspiration)

🗒️
DT

57. AWS or DT: Up at liberty

🗒️
AWS

58. AWS or DT: Restricted to bedrest with no bathroom privileges

🗒️
DT

59. AWS or DT: No restraints

🗒️
AWS

60. AWS or DT: Usually restrained with either vest or 2 point (1 arm and 1 leg)

🗒️
DT

61. AWS or DT: Give anti-HTN medication

🗒️
Both

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62. AWS or DT: Give tranquilizer

🗒️
Both

63. AWS or DT: Give multivitamin to prevent Wernicke's

🗒️
Both

64. For Aminoglycosides, think " __ ____ ___ _____"

🗒️
a mean old mycin

65. When are antibiotics/aminoglycosides used?

🗒️
to treat serious, life-threatening, resistant infections

66. All aminoglycosides end in _______, but not all drugs that end in _______ are
aminoglycosides .

🗒️
mycin, mycin

67. What are some examples of wannabe mycins?

🗒️
Azithromycin, Clarithromycin, Erythromycin

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68. What are some examples of aminoglycosides?

🗒️
Streptomycin, Cleomycin, Tobramycin, Gentamycin, Vancomycin, Clindamycin

69. When remembering toxic effects of mycin's think _______

🗒️
mice= ears

70. What is the toxic effect of aminoglycosides and what must you monitor?

🗒️
ototoxicity; monitor hearing, balance, and tinnitus

71. The human ear is shaped like a _______ so another toxic effect of aminoglycosides is
_______ so monitor _______

🗒️
kidney, nephrotoxicity, creatinine

72. The number "___" drawn inside the ear reminds you of cranial nerve ___ and frequency
of administration ___

🗒️
8, 8, Q8H

73. Do not give aminoglycosides PO expect in these 2 cases:

1) _______ _______ (due to high _______ level)
2) Pre-op _______ surgery

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🗒️
hepatic encephalopathy (liver coma, ammonia-induces encephalopathy), ammonia, bowel

74. Who can sterilize my bowel?

🗒️
Neo- Kan

75. What is the reason for drawing Trough and Peak levels?

🗒️
Narrow therapeutic level

76. When do you ALWAYS draw the Trough?

🗒️
30 minutes before next dose

77. When do you draw the Peak level of Sublingual medications?

🗒️
5-10 minutes after drug dissolves

78. When do you draw the Peak level of IV medications?

🗒️
15-30 minutes after medication is finished

79. When do you draw the Peak level of IM medications?

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🗒️
30-60 minutes after injecting it

80. When do you draw the Peak level of SQ medications?

🗒️
Depends on type of insulin

81. When do you draw the Peak level of PO medications?

🗒️
Not necessary; not tested

Lecture 3. Calcium Channel Blocker (CCB) / Chest Tube/ CHD/ Infections and
Precautions

82. Calcium Channel Blockers: they are like ________ for your heart. What does that mean?

🗒️
Valium. It relaxes the heart

83. Calcium Channel Blockers: _______ inotropic, chronotropic, dromotropic

🗒️
Negative

84. Inotropic means

🗒️
strength of heart

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85. Positive Inotropic means

🗒️
strong heartbeat

86. Negative Inotropic means

🗒️
weak heartbeat

87. Chronotropic means

🗒️
rate of heartbeat

88. Positive Chronotropic means

🗒️
fast heartbeat

89. Negative Chronotropic means

🗒️
slow heartbeat

90. Dromotropic means

🗒️
conductivity of heart

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91. Positive Dromotropic means

🗒️
excitable heart

92. Negative Dromotropic means

🗒️
blocks/slows conduction

93. Positive Inotropic, Chronotropic, and Dromotropic is seen with which medications?

🗒️
atropine, epinephrine, and norepinephrine

94. Negative Inotropic, Chronotropic, and Dromotropic is seen with which medications?

🗒️
Calcium Channel Blockers and Beta Blockers

95. What do Calcium Channel Blockers treat? (3 indications)

🗒️
Antihypertensives (decrease BP)
Anti Angina (imbalance between O2 supply and demand)
Anti Atrial Arrhythmic (Atrial flutter and Atrial fibrillation)

96. What are some of the side effects of Calcium Channel Blockers (2) ?

🗒️
Headache, hypotension

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97. Names of Calcium Channel Blockers can be remembered by saying....

🗒️
I sop zem dipine in the Calcium Channel ("zem", "dipine", "verapamil/isoptin")

98. "QRS depolarization" always refers to __________

🗒️
Ventricular (not atrial, junctional or nodal).

99. "P wave" refers to _________

🗒️
Atrial

100. What is Asystole?

🗒️
a lack of QRS depolarizations (flat line)

101. Atrial Flutter?

🗒️
rapid P-wave depolarizations in a saw-tooth pattern (flutter)

102. Atrial Fibrillation?

🗒️
chaotic P-wave depolarizations

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103. Ventricular Tachycardia?

🗒️
wide bizarre QRS's

104. Premature Ventricular Contractions (PVC)?

🗒️
Periodic wide, bizarre QRS's

105. Be concerned about PVC's if:

🗒️
● More than 6 per minute
● 6 in a row
● PVC falls on T-wave of previous beat

106. What are the lethal arrhythmias?

🗒️
asystole and ventricular fibrillation

107. What are the potentially life-threatening arrhythmias?

🗒️
1. v-tach, 2. a-fib, 3. a-flutter

108. When dealing with an IV push drug if you don't know go ____ except ________!

🗒️
slow, adenocard

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109. What is the treatment for PVC's?

🗒️
lidocaine and amiodarone

110. What is the treatment for V Tach?

🗒️
lidocaine and amiodarone

111. What are the treatments for supraventricular arrhythmias?

🗒️
ABCD
Adenocard/adenosine
Betablocker (end in lol)
Calcium Channel Blocker
Digitalis/Digoxin (lanoxin)

112.What is the treatment for V-fib?

🗒️
you defib

113.What is the treatment for AsystolE?

🗒️
Give Epi first then Atropine

114.
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🗒️
Asystole

115.

🗒️
atrial fibrillation

116.

🗒️
atrial flutter

117.

🗒️
Normal Sinus Rhythm

118.

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🗒️
Supraventricular tachycardia

119.

🗒️
ventricular fibrillation

120.

🗒️
ventricular tachycardia

121.The purpose for chest tubes is to re-establish _______ pressure in the pleural space.

🗒️
negative

122. In the pneumothorax, the chest tube removes _____

🗒️
Air

123. In the hemothorax, the chest tube removes _____

🗒️
Blood

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124. In the pneumohemothorax, the chest tube removes ___ and _____.

🗒️
air and blood

125. When the chest tube is ______ (____) for ___. aka ____

🗒️
Apical (high), air, apex

126. When the chest tube is ______ (___) for _____ aka ____

🗒️
Basilar (low), blood, base (bottom of lung)

127. How many chest tubes and where for unilateral pneumohemothorax?

🗒️
2; apical and basilar on side of pneumo

128. How many chest tubes and where for bilateral pneumothorax?

🗒️
2; apical for both

129. How many chest tubes and where for post-op chest surgery/chest trauma?

🗒️
assume unilateral pneumohemothorax- 2; apical and basilar on side of pneumo

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130. In routine _____ clamp chest tube. In emergency _____ the chest tube

🗒️
NEVER; CLAMP

131. What do you do if you kick over the collection bottle?

🗒️
Set it back up (not an emergency)

132. What do you do if the water seal breaks? (First thing to do vs. Best thing to do)

🗒️
First - clamp it, cut tube away from device
Best - submerge the tube under water, then unclamp

133. What do you do if the chest tube comes out?

🗒️
First- cover with a gloved hand
Best- cover the hole with Vaseline gauze, put a dry sterile dressing on top, tape on 3 sides

134. If there's bubbling in the water seal intermittently it is...

🗒️
Good

135. If there's bubbling in the water seal and it's continuous it is...

🗒️
Bad

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136. If there's bubbling in the suction control chamber intermittently it is...

🗒️
Bad

137. If there's bubbling in the suction control chamber continuously it is...

🗒️
Good

138. Rules for clamping the tube: never clamp longer than __________ without Dr's order
use ________________

🗒️
15 seconds, rubber tipped double clamps

139. Every congenital heart defect is either ___________ or ____________

🗒️
TRouBLe, No TRouBLe

140. R-L

🗒️
Right to Left shunt

141. “B”

🗒️
Blue

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142. “T”

🗒️
Diseases that starts with the letter "T"

143. What are some examples of "TRouBLe" congenital heart defects?

🗒️
Trunkus arteriosis, Trans. position of great vessels, Tetrology of Fallot, Tricuspid stenosis, TAPZ, Left
ventricular
hyperplasmic syndrome

144. What are some examples of "No TRouBLe" congenital heart defects?

🗒️
Patent fore. ov., ventricular septal defect, pulmonary stenosis

145. A CHD kids will have 2 things in common, whether TRouBLe or No TRouBLe...

🗒️
1. Murmurs
2. Echocardiogram

146. Four defects present in Tetralogy of Fallot are…

🗒️
VarieD
PictureS
Of A
RancH
Ventricular Defect
Pulmonary Stenosis

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Overriding Aorta
Right Hypertrophy

147. What are 4 transmission-based precautions?

🗒️
Standard / universal, Contact, Droplet, Airborne

148. What are infectious disease examples of contact precaution?

🗒️Anything enteric (GI/ fecal/ oral) – c.diff, hepatitis A, E. coli, cholera, dysentery
● Staph
● RSV (droplets fall onto object then pt touches object or put it in mouth; do not cohort 2 RSV pts
unless culture and symptoms say that have the same disease)
● Herpes

149. PPE for contact precaution?

🗒️
● Private room
● Can be in the same room if cohort based on culture and NOT symptoms
● Hand wash → gown → gloves
● Disposable supply (gloves, paper plates, plastic utensils)
● Dedicated equipment (stetho, BP cuff) and toys stay in the room

150. What are infectious disease examples of droplet precaution?

🗒️
For bugs traveling on large particles through coughing, sneezing to less than 3 feet
● Meningitis
● H. influenza b (e.g., epiglottitis – nothing in the throat)

151. PPE for droplet precaution?

🗒️
● Private room
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● Can be in the same room if cohort based on culture AND symptoms
● Hand wash → mask → goggle or face shield → gloves
● Disposable supply
● Dedicated equipment

152. What are infectious disease examples of airborne precaution?

🗒️
“MTV”
● MMR
● TB
● Varicella (chickenpox)

153. PPE for airborne precaution?

🗒️
● Private room
● Can be in the same room if cohort based on culture AND symptoms
● Hand wash → goggle or face shield → gloves
● Wear mask when leaving the room
● Keep door closed
● Disposable supply (not essential)
● Dedicated equipment (not essential)
● Negative pressure airflow

154. What is the donning order?

🗒️
● Gown
● Mask
● Goggle
● Gloves

155. What is the doffing order?

🗒️
● Gloves
● Goggle

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● Gown
● Mask

156. The proper place for donning PPE is ________ the room and doffing PPE is
_________ the room

🗒️
outside, inside

157. Know these math problems for the NCLEX!

🗒️
● Dosage calculation
● IV drip rates = volume x drop factor / time
○ Micro/mini = 60 drops/ml
○ Macro = 10 drops/ml
● Pediatric dose (2.2lbs = 1kg)

Lecture 4: Crutches, Canes, Walkers & psychiatry

158. How do you measure crutches for a person?

🗒️ 2-3 finger widths below anterior axillary fold to a point lateral and slightly in front of foot

159. When the handgrip is properly placed, the angle of elbow flexion will be ____ degrees

🗒️
30

160. 2 point gait steps and indication?

🗒️
1) Move one crutch and opposite foot together
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2) Move other crutch and other foot together (remember 2 points together for a 2 point gait)
> Used for minor weakness on both legs

161.3 point gait - steps?

🗒️
1) Move two crutches and bad leg together
2) Move good foot
> (Remember 3 point is called 3 point because 3 points touch down at once)

162. 4 point gait - steps?

🗒️
1) one crutch
2) opposite foot
3) other crutch
4) other foot
> nothing moves together and everything is really weak

163. Swing through indication:

🗒️
for two braced extremities (Amputees)

164. Use the _____ numbered gaits when weakness is _______ distributed. ___ point for
mild problems and ___ point for severe

🗒️
even, evenly, 2, 4

165. Use the ___ numbered gait when one leg is ______

🗒️
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odd, effected

166. Stairs: which foot leads when going up and down stairs on crutches? ______ with the
_______ and _______ with the _____. The crutches always move with the ____ leg

🗒️
up, good, down, bad, bad

167. Cane: Hold cane on the ___________ side. Advance cane with the _________ side
for a wide base of support

🗒️
unaffected side, opposite

168. What is the correct way to use a walker?

🗒️
pick it up, set it down, and walk to it

169. What is a big NO when it comes to walkers?

🗒️
Do not tie belongings to the front of the walker

170. What is the correct way to get up from a chair using a walker?

🗒️
Hold on to chair, stand up, then grab walker

171.What is the difference between a non-psychotic person and a psychotic person?

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🗒️
a non-psychotic person has insight (know they're sick and that it's messing them up) and is reality
based (they see reality the same way as you) and a psychotic person has no insight and is not
reality-based.

172. Delusion

🗒️
a false, fixed belief or idea or thought. There is no sensory component

173. What are the 3 types of delusions?

🗒️
Paranoid/Persecutory, Grandiose, & Somatic

174. Paranoid or Persecutory Delusion

🗒️
false, fixed belief that people are out to harm you

175. Grandiose delusion

🗒️
False, fixed belief that you are superior

176. Somatic delusion

🗒️
False, fixed belief about a body part

177. Hallucination

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🗒️
a false, fixed sensory experience

178. What are the 5 types of hallucinations?

🗒️
auditory (hearing), tactile (feeling), visual (seeing), gustatory (tasting), and olfactory (smelling)

179. Illusion

🗒️
a misinterpretation of reality. It is a sensory experience

180. What is the difference between illusions and hallucinations?

🗒️
With illusions there is a referent in reality (something to which they can refer to)

181. When dealing with a patient experiencing delusions, hallucinations or illusions, first ask
yourself, "What is their problem?" (what are the different problems that could be going
on?)

🗒️
functional psychosis, psychosis of dementia, and psychotic delirium

182. What are the different types of functional psychosis?

🗒️
schizophrenia, schizoaffective (mood disorder thought process), major depression, and mania

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183. With a functional psychosis the patient has the potential to learn reality. How can you
teach reality to a functional psychotic?

🗒️
1. acknowledge feelings
2. present reality
a. positive- what is reality
b. negative- what is not reality
3. set a limit
4. enforce the limit

184. Psychosis of dementia

🗒️
People with Alzheimer's, Wernicke's, Organic Brain Syndrome, and dementia. This patient has a brain
destruction
problem and cannot learn reality

185. How do you deal with a person with Psychosis of Dementia?

🗒️
1. Acknowledge feeling
2. Redirect- get them to express the fixation that they are expressing inappropriately to appropriately

186. Psychotic Delirium

🗒️
Temporary episodic secondary dramatic sudden onset of loss of reality due to chemical imbalance
(UTI, thyroid
imbalance, electrolyte imbalance)

187. How do you deal with a patient with Psychotic Delirium?

🗒️
1. Acknowledge feeling

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2. Reassure them of safety and temporariness

188. What are the different types of loosening of association?

🗒️
Flight of ideas, word salad, neologisms

189. Flight of ideas

🗒️
Stringing phrases together (loosely associated phrases; tangentiality)

190. Word salad

🗒️
Throw words together

191.Neologisms

🗒️
Making up new words

192. Narrowed self-concept

🗒️
When a PSYCHOTIC refuses to change their clothes or leave the room. *don't make a psychotic do
something they don't want to do

193. Ideas of reference

🗒️
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You think everyone is talking about you

194. Dementia hallmarks

🗒️
Memory loss, inability to learn.
*Functional scan teach, dementias cannot

195. Always acknowledge ______________

🗒️
Feeling

196. What are the 3 "Re's"?

🗒️
Reassure
Redirect
Reality

Lecture 5: diabetes

197. Diabetes mellitus

🗒️
An error of glucose metabolism

198. Diabetes insipidus

🗒️
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Dehydration, polyuria, polydipsia

199. Type I Diabetes Mellitus

🗒️
Insulin dependent (not producing insulin) Juvenile onset
Ketosis prone

200. Type II Diabetes Mellitus

🗒️
Non insulin dependent (body resisting insulin)
Adult onset
Non ketosis prone

201. Signs and symptoms of diabetes mellitus

🗒️
Polyuria (pee a lot)
Polydipsia (drink a lot)
Polyphagia (eat/swallow a lot)

202. Treatment for Type I Diabetes Mellitus

🗒️
3. Diet (calories from carbs)
1. Insulin
2. Exercise

203. Treatment for Type II Diabetes Mellitus

🗒️
1. Diet

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3. Oral hypoglycemics
2. Activity

204. Diet of Diabetics

🗒️
Calorie (carbs) restriction
Need to eat 6x per day--> smaller more frequent meals

205. Insulin acts to _____________ blood sugar

🗒️
Lower

206. Insulin Type: R

🗒️
R= Regular, Rapid, Run (IV)
Onset: 1hr
Peak: 2hr
Duration: 4hr

207. Insulin Type: N

🗒️
N= NPH, Not in the bag, Not so fast, Not clear (cloudy)
Onset: 6hr
Peak: 8-10hr
Duration: 12 hr

208. Insulin Type: Humalog

🗒️
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Insulin Lispro
Fastest
Onset: 15min
Peak: 30min
Duration: 3hrs

209. Insulin Type: Lantus

🗒️
Long acting
Slow absorption
No peak
Duration: 12-24hr

210. With insulin, remember:

🗒️
Check expiration date
Refrigerate but once open no refrigeration

211.Exercise ________ insulin: if more exercise, need _________ insulin. If less exercise,
need __________ insulin

🗒️
Potentiates, less, more

212. Sick day rules for insulin

🗒️
Take insulin
Take sips of water
Stay active as possible

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213. Low blood sugar in Type I Diabetes Mellitus (insulin shock) is caused by:

🗒️
Not enough food
Too much insulin
Too much exercise

214. Why is low blood sugar in Type I Diabetes Mellitus (insulin shock) dangerous?

🗒️
Permanent brain damage

215. Signs and symptoms of low blood sugar in Type I Diabetes Mellitus (insulin shock):

🗒️
Cerebral impairment, vasomotor collapse, cold, clammy, slow reaction time, "drink shock"

216. Treatment for low blood sugar in Type I Diabetes Mellitus (insulin shock):

🗒️
Administer rapidly metabolizable carbohydrate (candy, honey)
Ideal combination: sugar and protein
If unconscious IV D50 IM glucagon

217. High Blood Sugar in Type I Diabetes Mellitus/ DKA/ Diabetic Coma is caused by:

🗒️
Too much food
Not enough insulin
Not enough exercise
#1 cause is acute viral upper respiratory infection within the last 10 days

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218. Signs and symptoms of High Blood Sugar in Type I Diabetes Mellitus/ DKA/Diabetic
Coma

🗒️
Dehydration
Ketones, Kussmaul Breathing, high K+
Acidosis, Acetone breath, Anorexia

219. Treatment for High Blood Sugar in Type I Diabetes Mellitus/ DKA/ Diabetic Coma

🗒️
Insulin IV (R)
IV rate flow 200mg/hr

220. Treatment for low blood sugar in Type II Diabetes Mellitus:

🗒️
Administer rapidly metabolizable carbohydrate (candy, honey)
Ideal combination: sugar and protein
If unconscious IV D50 IM glucagon

221. High Blood Sugar in Type II Diabetes Mellitus

🗒️
Called HHNK or HHNC- Hyperosmolar, Hyperglycemic, Non-Ketotic Coma
This is severe dehydration

222. Signs and symptoms of High Blood Sugar in Type II Diabetes Mellitus

🗒️
Hot, dry, increased HR, decreased skin turgor

223. Treatment for High Blood Sugar in Type II Diabetes Mellitus

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🗒️
Rehydration

224. Long term complications of HHNC are related to

🗒️
Poor tissue perfusion
Peripheral neuropathy

Lecture 6: drug toxicity, hiatal hernia, dumping syndrome,

electrolyte

225. Which lab test is the best indicator of long-term blood glucose control
(compliance/effectiveness/adherence)?

🗒️
Ha1c (average blood sugar over last 90 days)

226.
Cold and clammy - ________________.
Hot and dry - ____________________

🗒️
Get some candy
Sugar's high

227. What are the therapeutic and toxic levels for Lithium?

🗒️
therapeutic level: 0.6-1.2
toxic level: ≥ 2

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228. What are the therapeutic and toxic levels for Lanoxin (Digoxin)?

🗒️
therapeutic level: 1-2
toxic level: >2

229. What are the therapeutic and toxic levels for Aminophylline?

🗒️
therapeutic level: 10-20
toxic level: ≥ 20

230. What are the therapeutic and toxic levels for Bilirubin?

🗒️
therapeutic level (elevated level): 10-20
toxic level: >20

231. Kernicterus =

🗒️
bilirubin in the CSF

232. Opisthotonos =

🗒️
position of slight extension in neck seen in patients with Kernicterus. (Bad sign)

233. Dumping Syndrome =

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🗒️
Post-Op gastric surgery complication in which gastric contents dump too quickly into the duodenum

234. Hiatal Hernia =

🗒️
Regurgitation of acid into esophagus, because upper stomach herniates upward through the
diaphragm

235. Hiatal Hernia or Dumping Syndrome:

Gastric contents move in the right direction at the wrong rate

🗒️
Dumping Syndrome

236. Hiatal Hernia or Dumping Syndrome:

Gastric contents move in the wrong direction at the right rate

🗒️
Hiatal Hernia

237. Hiatal Hernia or Dumping Syndrome:

GERD like symptoms when supine and after eating

🗒️
Hiatal Hernia

238. ADS (Acute Dumping Syndrome) S&S

🗒️
Abdominal distress (cramping, N/V, hyperactive BS(borborygmi))
Drunk- cerebral impairment
Shock (vasomotor collapse, rapid thready HR)

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239. Treatment for Hiatal Hernia

🗒️
HOB during & 1hr after meals- high
Amount of fluids with meals- high
Carbohydrate content of meals- high
goal: get an empty stomach

240. Treatment for Dumping Syndrome

🗒️
HOB during & 1hr after meals- low
Amount of fluids with meals- low
Carbohydrate content of meals- low
goal: get a full stomach

241. Kalemias do the ______ as the prefix except for ___________ and __________
Hyperkalemia =
Hypokalemia =

🗒️
same; heart rate; urine output
Hyperkalemia= ↑; HR ↓, Urine Output ↓
Hypokalemia= ↓; HR ↑, Urine Output ↑

242. Calcemias do the _______ of the prefix. No exceptions.

Hypercalcemia =
Hypocalcemia =

🗒️
opposite
Hyper=↓
Hypo= ↑

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243. Two signs of neuromuscular irritability associated with _____________:

1. ________
2. ________

🗒️
Hypocalcemia
1. Chvostek's Sign= cheek tap→ facial spasm
2. Trousseau's Sign= BP cuff→ carpal spasm

244. Magnesemias do the ____________ of the prefix.

Hypermagnesemia =
Hypomagnesemia =

🗒️
opposite
Hyper= ↓
Hypo= ↑

245. If symptoms involve nerve or skeletal muscle, pick ________. For any other symptom,
pick __________ ( generally anything effecting ____________)

🗒️
Calcium, Potassium, blood pressure

246. HypErnatermia =

🗒️
dEhydration (dry skin, thready pulse, rapid HR)

247. hypOnatremia =
🗒️
Overload (crackles, distended neck veins)

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248. The earliest sign of any electrolyte disorder is _________ & __________

🗒️
numbness, tingling (paresthesias)

249. The universal sign-symptom of electrolyte imbalance is ________________

🗒️
muscle weakness (paresis)

250. Never push ____________ IV

🗒️
Potassium

251. Not more than ______ of K+ per liter of IV fluid

🗒️
40mEq

252. Give ______ & ______ to decrease K+

🗒️
D5W, insulin (not permanent)

253. Kayexalate

🗒️
K+- exists- late (not as quick, more of a permanent solution)

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254. In a patient with hypercalcemia, which monitor pattern would be the most likely threat?

🗒️
A. Paroxysmal atrial tachycardia with decreased ST segments
B. Bradycardia with 2nd degree Mobitz Type II Block & elevated ST segment
C. Frequent PAC's with multifocal coupling of PVC's and tall T-waves
D. First degree heart block with decreased ST segment and inverted T-waves
D. First degree heart block with decreased ST segment and inverted T-waves

Lecture 7: endocrine system

255. Hyperthyroidism =

🗒️
Hyper- metabolism (high metabolic rate)

256. Signs and Symptoms of Hyperthyroidism

🗒️
weight loss, diarrhea, ↑HR, hot, heat intolerance, HTN, exophthalmos (bulging eyes- Don Knopps)

257. Hyperthyroidism is also known as ____________________. So remember _____

yourself into the ______

🗒️
Grave's Disease; Run; Grave

258. The problem is hyperthyroidism. Treatment options:

🗒️
Radioactive iodine, propylthiouracil, surgical removal

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259. What is the big risk with radioactive iodine?

🗒️
radiation risk in urine- double flush, need private bathroom

260. What does PTU do?

🗒️
propylthiouracil knocks out WBC

261. What is the most common treatment for hyperthyroidism?

🗒️
surgical removal

262. Total thyroidectomy: need lifelong ________ replacement. At risk for ___________

🗒️
hormone; hypocalcemia (difficult to spare parathyroid)

263. What are you at risk for with a subtotal thyroidectomy?

🗒️
thyroid storm

264. What are signs and symptoms of thyroid storm?

🗒️
extremely high vital signs, extremely high fever, psychotically delirious. This is a medical emergency

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265. What is the treatment for thyroid storm?

🗒️
oxygen and lower body temperature

266. Total= T_____

Subtotal= S______

🗒️
Tetany; Storm

267. Post operation risks for total and subtotal thyroidectomy in first 12 hrs

🗒️
airway/breathing, bleeding

268. Post operation risks for total thyroidectomy in 12-48 hrs

🗒️
tetany (r/t ↓Ca)

269. Post operation risks for sub-total thyroidectomy in 12-48 hrs

🗒️
thyroid storm

270. Hypothyroidism = hypo-_________

🗒️
Metabolism

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271. Signs and Symptoms of hypothyroidism

🗒️
weight gain, htn, constipation, lethargy, cold-intolerance, "slow"

272. Hypothyroidism is also known as _______________

🗒️
Myxedema

273. What are the 3 reasons for accu-checks (blood sugar check)?

🗒️
diabetes, TPN, steroids

274. Treatment for hypothyroidism

🗒️
thyroid replacement (s/e: hyperthyroidism)

275. Caution: with hypothyroidism treatment DO NOT ________

🗒️
sedate (they are already sedated)

276. Surgical implications for the hypothyroid patient

🗒️
Anesthesia is very high risk and do not hold thyroid pills when NPO

277. Adrenal Cortex Diseases start with letters ___ or ____

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🗒️
A, C

278. Addison's Disease is _______________ of the adrenal cortex

🗒️
Under-secretion

279. Signs and Symptoms of Addison's Disease

🗒️
hyperpigmented (darker), doesn't respond to stress well (JFK)

280. Treatment for Addison's Disease

🗒️
steroids (need to wear a med alert bracelet)

281. Addison's =

🗒️
Add-a-sone (add a sone drug for treatment)

282. Cushing's Syndrome is ___________ of the adrenal cortex

🗒️
Over-secretion (cushy= more)

283. Signs and Symptoms of Cushing's Syndrome (same as steroids)

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🗒️
moon face, hirsutism (↑ body hair), water retention, gynecomastia (man boobs),
buffalo hump, central obesity (small skinny limbs),↓ bone density, easy bruising,
irritability, immunosuppression

284. Treatment for Cushing's Syndrome

🗒️
adrenalectomy→ replacement therapy→ steroids)

285. What are the 3 principles to consider when choosing appropriate toys for kids?

🗒️
1. is it safe
2. is it age-appropriate
3. is it feasible (can you actually do it? - specific to child's situation)

286. What are some safety considerations when it comes to kids toys?

🗒️
1. size of toy (no small toys for children under 4)
2. no metal toys if oxygen is in use (spark things)
3. beware of fomites (non living object that harbors microorganisms) -worst: plush toys/ stuffed
animals; least- plastic toys that can be disinfected

287. What is the BEST toy for 0-6 months old (sensorimotor)?

🗒️
musical mobile

288. What is the 2nd BEST toy for 0-6 months old (sensorimotor)?

🗒️
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large and soft

289. What is the BEST toy for 6-9 months old (object permanence)?

🗒️
cover/uncover toy (jack in the box)

290. What is the 2nd BEST toy for 6-9 months old (object permanence)?

🗒️
firm but large (wood/ hard plastic allowed)

291. What is the BEST toy for 9-12 months old?

🗒️
verbal toy (tickle me Elmo)

292. Remember with 9-12 months old ___________ activity with _________

🗒️
purposeful, objects

293. Avoid answers with the following words in them for children 9 months and younger:

🗒️
build, sort, stack, make, & construct

294. What is the best toy for toddlers (1-3 years)?

🗒️
push/pull toy (wagon)

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295. What skill is being worked on when toddlers play?

🗒️
gross motor skill

296. What type of play do toddlers do?

🗒️
parallel play (play alongside but not with)

297. What types of toys should be avoided with toddlers?

🗒️
toys that require good finger control/dexterity

298. Preschoolers need toys that work on:

🗒️
fine motor skills (fingers) and balance (dance, ice skating and tumbling)

299. Preschoolers play is characterized by

🗒️
cooperative play (play with each other)

300. Preschoolers like to play ________.

🗒️
Pretend

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301. School age (7-11 years) aka _________ are characterized by the 3 C's:
1: ____
2: ____
3: ____

🗒️
Concrete
1. created/creative (give blank paper; get them involved)
2. competitive (winners and losers)
3. collective (baseball cards and barbies)

302. Adolescents (12-18 years)- their "play" is _______ _______ _____________. Allow
adolescents to be in each others' rooms unless one of them is :
1: ____
2: ____
3: ____

🗒️
peer group association (hang out in groups)
1. fresh post-op (less than 12 hours)
2. immunosuppressed
3. contagious

303. When given a variety of ages to choose from always go __________ because children
________ when sick and you want to give them
__________________________________

🗒️
younger, regress, as much time to grow

304. Laminectomy =

🗒️
"Ectomy"= removal of
"lamina"= vertebral spinus processes

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305. What is the reason for a laminectomy?

🗒️
to treat nerve root compression

306. What are the 3 signs and symptoms of nerve root compression?

🗒️
Pain
Paresthesia (numbness & tingling)
Paresis (muscle weakness)

307. What are the different locations for a laminectomy?

🗒️
cervical (neck)
thoracic (upper back)
lumbar (lower back)

308. What is the most important assessment in a pre-op cervical laminectomy?

🗒️
function of Upper extremities and breathing

309. What is the most important assessment in a pre-op thoracic laminectomy?

🗒️
cough (tests abdominal muscles) and bowel sounds

310. What is the most important assessment in a pre-op lumbar laminectomy?

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🗒️
urine output and legs

311. What is the #1 post-op answer on NCLEX?

🗒️
always log roll your patient

312. What is the specific "activity"/mobilization strategy post-op?

🗒️
1. do not dangle/sit on side of bed
2. allowed to walk, sit, stand and lie down
3. limit sitting 20-30 min at a time

313. Post-op complication for cervical laminectomy

🗒️
watch for pneumonia

314. Post-op complication for thoracic laminectomy

🗒️
watch for pneumonia and paralytic ileus

315. Post-op complication for lumbar laminectomy

🗒️
watch for urinary retention

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316. Laminectomy with fusion involves taking a _____ ______ from the ______
______. Of the two incisions, which site has the most:
● Pain?
● Bleeding/Drainage?
● Risk for infection?
● Risk for rejection?

🗒️
bone graft, illiac crest (hip)
hip
hip
hip/spine
spine

317. Surgeons are using cadaver bone from bone banks. Why?

🗒️
Because it gets rid of 2nd incision and cuts recovery time in half

318. What are some temporary restrictions (6 wks) with discharge teaching?

🗒️
1. Don't sit for longer than 30 min
2. Lie flat and log roll for 6 wks
3. Lifting restrictions: do not lift more than 5lbs

319. What are some permanent restrictions for laminectomy patients?

🗒️
1. Laminectomy patients will never be allowed to lift by bending at the waist (use their needs)
2. Cervical laminectomy patients will never be allowed to lift objects above their heads
3. No horseback riding, off-trail biking, jerky amusement park rides, etc.

Lecture 8: lab values

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320. Creatinine?

🗒️
Best indicator of kidney function

321. Creatinine lab values

🗒️
0.6-1.2 → If elevated it's abnormal but not too worrisome (just means kidneys are failing)

322. INR (International Normalized ratio)?

🗒️
Monitors Coumadin (Warfarin) therapy (Coumadin and War Fare make you bleed)

323. What is the therapeutic range for INR?

🗒️
2-3
↑INR= bleed risk
≥4 is critical

324. What do you do when INR is ≥ 4?

🗒️
Hold all Coumadin
Assess bleeding
Prepare to give Vitamin K
Call the Dr

325. What is the therapeutic range for Potassium (K+)?

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🗒️
3.5-5.0

326. What do you do if Potassium is low?

🗒️
Critical
Assess heart
Prepare to give Potassium
Call the Dr

327. What do you do if Potassium is 5.4-5.9?

🗒️
Critical (high but still in the 5's)
Hold all Potassium
Assess heart
Prepare Kayexalate/D5W
Call the Dr

328. What do you do if Potassium is ≥6?

🗒️
Deadly Dangerous
Do all of the following at once: Hold Potassium, assess heart, prepare Kayexalate/D5W, Call Dr (will
need a team to address this)

329. What is the therapeutic range of pH?

🗒️
7.35-7.45

330. What do you do if pH is in the 6's?

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🗒️
Deadly Dangerous. Get vitals and call Dr
(most important when asked in question)

331. What is the therapeutic range for BUN (blood urea nitrogen)?

🗒️
8-30 (8 buns in a pack)

332. What do you do when a patient has an elevated BUN?

🗒️
Be concerned
Check for dehydration

333. What is the therapeutic range for Hgb (hemoglobin)?

🗒️
12-18 (teenage years)

334. What do you do when a patient has a 8-11 hgb?

🗒️
Be concerned. Monitor the patient

335. What do you do if a patient has a hgb of <8?

🗒️
Critical. Assess bleeding, prepare for transfusion, call Dr

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336. What is the therapeutic range for HCO3?

🗒️
22-26.
If out of range it is abnormal but not worrisome

337. What is the therapeutic range for CO2?

🗒️
35-45

338. What do you do if CO2 is in the 50's?

🗒️
Critical (sign of respiratory insufficiency)
Assess respirations
Do pursed lip breathing (blow out candle and exhale for longer periods)
Don't give O2 (it will increase CO2)
This does not apply to COPD (this is their "normal")

339. What do you do if CO2 is in the 60's?

🗒️
Deadly Dangerous
Sign of respiratory failure
Assess respirations
Do pursed lip breathing (to ↓ anxiety)
Prepare to intubate and ventilate
Call respiratory therapy
Call Dr

340. What is the therapeutic range for Hct?

🗒️
36-54.

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(If abnormal be concerned)

341. What is the therapeutic range for PO2?

🗒️
80-100

342. What do you do if PO2 is 70-77?

🗒️
Critical
Sign of respiratory insufficiency
Assess respirations
Give Oxygen

343. What do you do when PO2 is ≤60's?

🗒️
Deadly Dangerous
Sign of respiratory failure
Assess Respirations
Give Oxygen
Prepare intubate and ventilate
Call respiratory therapy.
Call Dr

344. What is the therapeutic range for O2 saturation?

🗒️
93-100

345. What do you do if O2 saturation is less than 95?

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🗒️
Assess respirations and give oxygen

346. BNP?

🗒️
Good indicator of CHF

347. What is the therapeutic range for BNP?

🗒️
<100

348. What do you do if BNP is elevated?

🗒️
Be concerned and continue to monitor patient

349. What is the therapeutic range for Sodium?

🗒️
135-145

350. What do you do if Sodium is abnormal in a patient?

🗒️
Be concerned until there's a change in the LOC (then it becomes critical)

351. What is the therapeutic range for WBC's?

🗒️
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5,000-11,000

352. What is the therapeutic range for ANC?

🗒️
500 (want above 200)

353. What is the therapeutic range for CD4 count?

🗒️
<200= AIDS

354. What is another name for high WBC count?

🗒️
Leukocytosis

355. What are some other names for low WBC count?

🗒️
Leukopenia
Neutropenia
Agranulocytosis
Immunosuppression
Bone Marrow Suppression

356. What do you do when WBC is <5,000

🗒️
Critical- immunosuppressed
Neutropenic precautions

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357. What do you do if ANC is < 500?

🗒️
Critical-immunosuppressed
Neutropenic precautions

358. What do you do if CD4 <200?

🗒️
Critical- immunosuppressed
Neutropenic precautions

359. What are neutropenic precautions?

🗒️
aka Reverse/Protective Isolation
Strict hand washing
Shower BID with antimicrobial soap
Avoid crowds
Private Room
Limit number of staff entering room
Limit visitors to healthy adults
No fresh flowers or potted plants
Low bacteria diet: no raw fruits, veggies, salads or undercooked meat Do not drink water that has been
standing for longer than 15 minutes
Vital signs (temp) every 4 hours
Check WBC (ANC) daily
Avoid use of indwelling catheter
Do not re-use cups... must wash between uses
Use disposable plates, cups, straws, utensils
Dedicated items in room: stethoscope, BP cuff, Thermometer, gloves

360. What is the therapeutic range for platelets?

🗒️
150,000-400,000

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361. What do you do if platelets are <90,000?

🗒️
Critical
Assess for bleeding
Bleeding Precautions

362. What do you do if platelets are <40,000?

🗒️
Deadly Dangerous (can spontaneously bleed to death)
Assess for bleeding
Bleeding Precautions

363. What are bleeding precautions?

🗒️
No unnecessary venipuncture- injection or IV. Use small gauge Handle patient gently (use drawsheet)
Use electric razor
No toothbrushing or flossing
No hard foods
Well-fitting dentures
Blow nose gently
No rectal temp, enema, or suppository
No aspirin
No contact sports
No walking in bare feet
No tight clothing or shoes
Use stool softener. No straining
Notify MD of blood in urine, stool

364. What is the therapeutic range for RBC's?

🗒️
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4-6 (If abnormal be concerned)

365. What are the 5 D's?

🗒️
(remember the 6's)
1. K+≥6
2. pH in the 6's
3. CO2 in the 60's
4. pO2 ≤60's
5. Platelets < 40,000

366. When should you call a Rapid Response Team?

🗒️
When lab values are Critical or Deadly Dangerous or if bad symptoms during assessment

Lecture 9: psychotropic drugs

367. All psych drugs cause....

🗒️
Hypotension, weight changes, and primary weight gain

368. Phenothiazines

🗒️
All end in "zine"
Ex: Thorazine, Compazine
Actions: large doses- antipsychotic, small doses- antiemetic, major-tranquilizers

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369. Side Effects of Phenothiazines

🗒️
Remember ABCDEFG...
A= anticholinergic (dry mouth)
B= blurred vision and bladder retention
C= constipation
D= drowsiness
E= EPS (tremors, parkinsonian)
F= "f"otosensitivity (skin burns)
G= aGranulocytosis (low WBC count- immunosupressed)
> Teach patient to report sore throat and signs and symptoms of infection to doctor
> Never stop the zine

370. Nursing care for Phenothiazines

🗒️
Treat side effects. Number one diagnosis is safety

371. Decanoate or "D"

🗒️
Long acting IM form of Phenothiazine given to non compliant patients

372. Tricyclic Antidepressants

🗒️
"Mood elevators" to treat depression
Ex) Elavil, Trofranil, Aventyl, Desyrel

373. Side effects of Tricyclic Antidepressants

🗒️
(Elavil starts with "E" so this group goes to "E")

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A= anticholinergic (dry mouth)
B= blurred vision
C= constipation
D= drowsiness
E= euphoria (happy)
> Must take med for 2-4 weeks before beneficial effects

374. Benzodiazepines

🗒️
Antianxiety meds (considered minor tranquilizers)
Always have "Pam"/"lam" in name
Prototype: Valium
Indications: induction of anesthetic, muscle relaxant, alcohol withdrawal, seizures (especially status
epilepticus),
facilitates mechanical ventilation
Tranquilizers work quickly. MUST NOT take for more than 6 weeks- 3 months. Keep on Valium until
Elavil kicks in
Number one nursing diagnosis is safety

375. Side effects of BenzoDiazepines

🗒️
A= anticholinergic
B= blurred vision
C= constipation
D= drowsiness

376. Monoamine Oxidase (MAO) Inhibitors

🗒️
Antidepressants
Depression is thought to be caused by deficiency of norepinephrine, dopamine, and serotonin in the
brain. Monoamine
oxidase is the enzyme responsible for breaking down norepinephrine, dopamine, and serotonin. MAO
Inhibitors prevent

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the breakdown of these neurotransmitter a and thus restore more normal levels and decrease
depression
Drug names: MARplan, NARdil, PARnate

377. Side effects of MAO inhibitors

🗒️
A= anticholinergic
B= blurred vision
C= constipation
D= drowsiness

378. Interactions/ patient teaching for MAO Inhibitors

🗒️
To prevent sever, acute, sometimes fatal hypertensive crisis, the patient MUST avoid all foods
containing tyramine
Foods containing tyramine:
Fruits and veggies- remember salad "BAR"→ avoid Bananas, Avacados, Raisins (any dried fruits);
Grains: ll okay except things made from active yeast
Meats: no organ meats- liver, kidney, tripe, heart, etc. no preserved meats- smoked, dried, cured,
pickled, hot dogs
Dairy: no cheese except mozzarella and cottage cheese (no aged cheese) Other: no alcohol, elixirs,
tinctures
(iodine/betadine), caffeine, chocolate, licorice, soy sauce

379. Lithium

🗒️
An electrolyte (notice "ium" ending as in potassium etc)
Used for treating bipolar disorder (manic-depression)→ it decreases the mania

380. Side effects of Lithium

🗒️
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The three "P's":
Peeing (polyuria)
Pooping (diarrhea)
Paresthesia (tingling/numbness)
Medically inducing a lithium/electrolyte imbalance
Toxic: tremors, metallic taste, severe diarrhea, and any other neuro sign
number one intervention: good fluid hydration. If sweating, give sodium (or other electrolyte) as well as
fluids.
Don't give water. Drink Gatorade or other electrolyte solution. Monitor sodium levels

381. Prozac

🗒️
SSRI (Selective Serotonin Reuptake Inhibitor)
Similar to Elavil
Antidepressant- mood elevator

382. Side effects of Prozac

🗒️
A= anticholinergic
B= blurred vision
C= constipation
D= drowsiness
> Causes insomnia, so give before 12 noon. If BID, give at 6am and 12 noon
> When changing the dose of Prozac for an adolescent or young adult, watch for suicide

383. Haldol (Haloperidol)

🗒️
Tranquilizer
Also has a decanoate form
Long acting IM form given to non compliant patients

384. Side effects of Haldol

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🗒️
A= anticholinergic
B= blurred vision
C= constipation
D= drowsiness
E= EPS
F= fotosensitvity
G= aGranulocytosis
> Elderly patients may develop NMS from overdose. NMS is Neuroleptic Malignant Syndrome- a
potentially fatal
hyperplasia (fever) with temp of 104.0. Dose for elderly patient should be half of usual adult dose.
Safety concerns r/t side effects

385. Clozaril (clozapine)

🗒️
Atypical antipsychotic
Used to treat severe schizophrenia
Advantage: it does not have side effects A-F
Do not confuse with Klonopin (clonazepam)

386. Side effects of Clozaril

🗒️
Agranulocytosis (worse than cancer drugs)
Can only be prescribe for 7 days then get WBC drawn for 4 weeks, then once a month for 6 months
then every 6 months

387. Zoloft (Sertraline)

🗒️
Another SSRI like Prozac
Antidepressant
Also causes insomnia but can be given in evening
Watch for interaction with St John's Worst (serotonin syndrome), and warfarin (watch for bleeding)

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388. Side effects of Zoloft

🗒️
SAD Head
Sweating
Apprehensive
Dizzy
Headache

Lecture 10: maternity and newborn 1

389. Naegele's Rule (Calculating due date)

🗒️
Take the first day of the last menstrual period (LMP) Add 7 days. Subtract 3 months

390. Total weight gain during pregnancy

🗒️
25-31 lbs

391. 1st trimester weight gain

🗒️
1 lb per month (3 lbs total for first trimester)

392. 2nd/3rd trimester weight gain

🗒️
1 lb per week

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393. Fundus (top of uterus) in not palpable until week ____

🗒️
12

394. Fundus typically reaches the umbilical (navel) level at week ______

🗒️
20-22

395. What are 4 positive signs of pregnancy?

🗒️
1. fetal skeleton on an x-ray
2. fetal presence on ultrasound
3. auscultation of the fetal heart (doppler)
4. examiner palpates fetal movement/outline

396. What are some probably/presumptive signs of pregnancy?

🗒️
1. all urine and blood pregnancy tests
2. Chadwick's sign (color change of the cervix to cyanosis)
3. Goodell's sign (cervical softening)
4. Hegar's sign (uterine softening)

397. Morning sickness: Which trimester and what treatment?

🗒️
1st trimester
eat dry carbs, cracker before out of bed, and avoid empty stomach

398. Urinary incontinence: Which trimester and what treatment?

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🗒️
1st/3rd
void Q2H

399. Dyspnea: Which trimester and what treatment?

🗒️
tripod position (lean forward with hands on knees)

400. Back pain: Which trimester and what treatment?

🗒️
2nd/3rd
pelvic tilt exercises
(put foot on stool then back again)

401. What is the truest, most valid sign of labor?

🗒️
onset of regular contractions

402. Dilation

🗒️
opening of cervix (0-10 cm)

403. Effacement

🗒️
thinning of cervix (thick-100%)

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404. Station

🗒️
relationship of fetal presenting part to mom's ischial spine (tightest squeeze for baby head)
negative= above spine
positive= below spine

405. Engagement

🗒️
station "0" at ischial spines

406. Lie

🗒️
Relationship between spine of baby and spine of mom

407. Presentation

🗒️
part of baby that enters birth canal first

408. What is stage 1 of labor and delivery?

🗒️
Onset of labor
3 phase of labor- latent, active, transitional

409. What is stage 2 of labor and delivery?

🗒️
delivery of baby

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410. What is stage 3 of labor and delivery?

🗒️
delivery of placenta

411. What is stage 4 of labor and delivery?

🗒️
recovery- first 2 hours to stop bleeding

412. Transverse lie and station that won't go positive=

🗒️
c-section

413. Latent:
CM dilated?
CXN freq?
Duration?
Intensity?

🗒️
0-4cm
5-30 min
15-30 sec
mild

414. Active:
CM dilated?
CXN freq?
Duration?
Intensity?

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🗒️
5-7 cm
3-5 min
30-60 sec
Moderate

415. Transition:
CM dilated?
CXN freq?
Duration?
Intensity?

🗒️
8-10 cm
2-3 min
60-90 sec
Strong

416. Contractions should not be longer than ____ seconds or closer than every ___
minutes.

🗒️
90; 2

417. Assessment of contractions: Frequency

🗒️
beginning of one contraction to the beginning of the next contraction

418. Assessment of contractions: Duration

🗒️
Beginning to end of one contraction

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419. Assessment of contractions: Intensity

🗒️
strength of contraction. Palpate with fingers of one hand over the fundus

420. What complication of labor is indicated if the mom is having painful back pain?

🗒️
Baby turned around backwards.
Low priority
Position knee-chest then put on her back

421. What should you do with a prolapsed cord?

🗒️
Push head back in off cord and position in knee-chest or Trendelenburg (hips up, shoulders down). Prep
for c-section

422. Interventions for all other complications of labor and birth

🗒️
Left side/ Lateral
IV increase
Oxygen
Notify
stop Pit if in crisis

423. Do not administer a SYSTEMIC pain medication to a woman in labor IF the baby is likely
to be ______ when the _______ is _________

🗒️
born, pain, peaking (respiratory depression)

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Lecture 11: labor and delivery

424. What do you do with a low fetal heart rate?

🗒️
It’s bad
You do - “LION pit“

425. What do you do with FHR Accelerations?

🗒️
Not a crisis

426. What do you do with low baseline variability?

🗒️
bad
LION pit

427. What do you do with high baseline variability?

🗒️
record it

428. What do you do with late decelerations?

🗒️
bad
Do “LION pit”

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429. What do you do with early decelerations?

🗒️
HR ↓

430. What do you do with variable decelerations?

🗒️
can be very bad
Indicative of prolapsed cord

431. Second stage of labor and delivery- what do you do?

🗒️
1. deliver the head (stop pushing)
2. suction mouth and nose
3. check for nuchal cord (cord around neck)
4. deliver shoulders and body
5. make sure baby has ID band

432. What do you check for with the delivery of the placenta?

🗒️
3 vessels (2 arteries and 1 vein) "AVA"

433. During the ___ stage (recovery stage) (first 2 hours after delivery) what __ things do you
do ___ times an hour

🗒️
4th, 4, 4
1. vital signs (assess for signs and symptoms shock
2. check fundus (if boggy, massage. if displaced, void/cath)
3. check pads (excessive lochia= pad sat in 15 min)
4. roll on to side (check for bleeding under patient)

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434. What is the tone, height and location of the uterus postpartum?

🗒️
tone: firm not boggy
height: right after delivery it is by pubis by 24 hours it is at navel. 2 cm for every PP day
location: midline (if displaced from R/L if means catheterize)

435. What is the color of lochia in the first days?

🗒️
Rubra

436. What is the color of lochia after a week or so of postpartum?

🗒️
Serosa

437. What is a moderate amount of lochia?

🗒️
4-6 in on pad in one hour

438. What is an excessive amount of lochia?

🗒️
Saturate pad in 15 min

439. What do you assess for in the postpartum assessment?

🗒️
Uterus, lochia, extremities (pulses, edema, S/S thrombophlebitis)

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440. Distended sebaceous glands which appear as tiny white spots on baby's face

🗒️
Milia

441. Small, white epithelial cysts on baby's gums

🗒️
Epstein’s pearls

442. Bluish-black macules appearing over the buttox and/or thighs of darker-skinned
neonates
🗒️
Mongolian spots

443. Red papular rash on baby's torso which is benign and disappears after a few days

🗒️
erythema toxicum neonatorum

444. benign tumor of capillaries

🗒️
hemangiomas

445. Swelling caused by bleeding between the ostium and periosteum of the skull. This
swelling does not cross suture lines

🗒️
Cephalohematoma

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446. Edematous swelling on the scalp caused by pressure during birth. This swelling may
cross suture lines. It usually disappears in a few days

🗒️
caput succedaneum

447. Normal, physiologic jaundice appears after 24 hours of age and disappears at about
one week of age

🗒️
Hyperbilirubinemia

448. Whitish, cheese-like substance which appears intermittently over the first 7-10 days

🗒️
vernix caseosa (caseus= cheese)

449. Normal cyanosis of baby's hands and feet which appears intermittently over the first
7-10 days

🗒️
acrocyanosis

450. Generic term for birthmark

🗒️
1. nonblanchable port wine stain
2. blanchable pink "stork bites"

451. nevus/nevi

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🗒️
1. nevus flammeus
2. telangiectatic nevi

452. Tocolytics (stop contractions)

🗒️
Terbutaline (Brethine)
S/E- tachycardia (don't give with cardiac disease) Nifedipine
S/E- headache/hypotension (can give with cardiac disease)

453. Oxytocics- stimulate labor

🗒️
Pitocin (Oxytocin)
S/E- uterine hyperstimulation
Cervidil (Prostaglandin)- dilates cervix
S/E- uterine hyperstimulation

454. Fetal/ Neonatal Lung Meds

🗒️
Betamethasone (steroid)- give to mother IM; give before baby after viability. can repeat
S/E- ↑BS
Survanta- give to baby after baby is born (transtracheal)

455. Steps of drawing up insulin

🗒️
1. draw up the total dose in air
2. pressurize the "N" vial (put air in)
3. pressurize the "R" vial
4. draw up "R" dose
5. draw up "N" dose
(Nichole Richie, RN) “NRRN”

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456. IM- length and gauge

🗒️
1 in both the gauge and length (I looks like 1)

457. SQ- length and gauge

🗒️
5 in both parts (S looks like a 5)

458. Heparin

🗒️
-works immediately
-can only take for 21 days
-antidote: -Protamin sulfate (heParin)
-labs: PTT and all clotting and bleeding times -http--> Ptt Heparin
-can use in pregnancy
-pregnancy class C

459. Coumadin

🗒️
-takes days
-can take for
-entire life
-PO only
-antidote: vitamin K -labs: PT, INR
-can't use if pregnant -class x pregnancy

460. Baclofen (Lioresal)

🗒️
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Muscle relaxant
1. cause fatigue
2. cause paresis (muscle weak)
3. do not drink alcohol
4. do not drive a car
5. do not watch kids under age 12
> When you are on Baclofen you are on your back "loafin"

461. Sensorimotor

🗒️
Age: 0-2y/o
Characteristics: totally present-oriented. Only think about what they are sense or are doing right now
Teaching Guidelines:
When: as it happens
What: you are doing now
How: tell them what you're doing as you're doing it

462. Pre-Operational

🗒️
Age: 3-6y/o (preschoolers)
Characteristics: Fantasy oriented. illogical. no rules. (can teach ahead of time but not too far)
Teaching Guidelines:
When: slightly ahead of time (morning of...)
What: you will do
How: play, toys, stories

463. Concrete Operations

🗒️
Age: 7-11y/o
Characteristics: Rule-oriented. Live and die by the rules! Cannot abstract
Teaching Guidelines:
When: days ahead of time
What: you're gonna do and skills
How: age appropriate reading and A/V material, role play is ok

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464. Formal Operations

🗒️
Age: 12-14 y/o
Characteristics: able to think abstractly. Understand cause-effect. Thinking like adults emotionally but
physically not
there but they can think like one
Teaching Guidelines:
When: like an adult
What: like an adult
How: like an adult

Lecture 12: prioritization, management, & delegation

465. _______ beats _______

🗒️
acute, chronic

466. _______ __________ beats _______ or _______ _________

🗒️
fresh post op, medical, other surgical

467. ______ beats _______

🗒️
unstable, stable

468. What makes a patient stable?

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🗒️
1. use of the word stable
2. chronic illness
3. post op> 12 hrs
4. local or regional anesthesia
5. unchanged assessment
6. phrase: "To be discharged"
7. lab values A/B
Stable patients are experiencing the expected typical signs and symptoms of the disease with which
they have been diagnosed and for which they are receiving treatment

469. What makes a patient unstable?

🗒️
1. Use of the word unstable
2. acute illness
3. post op <12 hours
4. general anesthesia
5. changing assessment
6. phrase: "newly admitted" or "newly diagnosed"
7. lab values C/D
> Unstable patients are experiencing unexpected atypical signs and symptoms, complications

470. What 4 patients are always unstable?

🗒️
1. hemorrhage
2. hypoglycemia
3. fever ≥104
4. pulselessness or breathlessness

471. The more _____ the ______, the higher the priority

🗒️
vital, organ
> Most vital→ brain → lungs → heart → liver → kidney → pancreas

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472. What responsibilities would you not delegate to an LPN?

🗒️
-Starting an IV
-Hanging or mixing IV meds
-Evaluating an IV site
-Giving an IV push/PB meds
-Giving a blood transfusion
-Performing assessments that require inferences/judgments (can gather data) - can make
observations about stable people but cannot make assumptions
-Plan of care
-Developing or performing teaching (can reinforce and review)
-Taking verbal orders from MD or transcribing orders

473. What would you not delegate to a UAP?

🗒️
-cannot chart but may document what they did
-assessments- except for VS and accucheck
-meds and IVs- may apply otc topical lotions and creams
-treatments- except for SSE. Not fleets
You may delegate baths, beds, and ADLs

474. Do not delegate to ___________: _______ responsibilities. They can only do what you
_______ them to do.

🗒️
family, safety, teach

475. How do you intervene with inappropriate behavior of staff? (4 options)

🗒️
1. tell the supervisor
2. intervene immediately
3. counsel them later on

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4. ignore it. Just let it go (never the right answer)

476. What questions should you ask when dealing with inappropriate behavior from staff?

🗒️
1. Is what they're doing illegal? (if yes tell the supervisor)
2. Is the patient or staff member in immediate danger of physical or psychological harm? (if yes
intervene immediately)
3. Is this behavior legal, not harmful, but simply inappropriate? (if yes counsel them later on)

477. Pre-interaction phase

🗒️
purpose: for the nurse to explore his/her feelings. to prevent judgmental, intolerant reactions
length: begins when you learn you are going to be caring for someone and ends when you meet them
correct answer: "the nurse will explore his/her feelings about..."

478. Introductory phase (orientation phase)

🗒️
purpose: to establish and explore/assess
length: begins when you first meet the patient and ends when a mutually agree-upon care plan is in
place
correct answer: Should be very tolerant, accepting, explorative, probing, "nosy". Be warm and fuzzy

479. Working phase (therapeutic phase)

🗒️
purpose: to implement the plan of care
length: from the finished care plan until discharge
correct answer: should be focused, directive, "tough". in some ways these answers will seem stern and
slightly
unfriendly. set limits. enforce proper communication

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480. When does the termination phase begin?

🗒️
on admission

481. Psych Treatment Protocol for depression

🗒️
Whenever a patient displays any notion of suicide or harm you MUST inquire about it
Must get a safety contract
*activities with other people that doesn't require interaction

482. Psych Treatment Protocol for schizophrenia

🗒️
If pacing Psych→ reduce stimulation (clear the room), make observation, offer presence
*need reality based activities but not competitive; should be with other people

483. Psych Treatment Protocol for Bipolar

🗒️
Mania's can't go to work or maintain family order whereas a hypo manic can
-finger foods are best; especially ↑ calorie
-8hrs of sleep. Encourage naps
*exercise the gross motor that is non competitive

484. Psych Treatment Protocol for Anxiety Disorder

🗒️
Phobia- irrational fear that limits daily life
tx: desensitization: gradually expose
1. Talk about it
2. Show pics
3. Be around

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4. Interact
> When you move to next step, make sure not anxious

485. Restraint protocol

🗒️
In psych: need to be evaluated within 1 hr. Must be constantly observed Not psych: observe every 15
min. No
evaluation. Need Dr order Q24h

486. Psych Treatment Protocol for Violent Clients

🗒️
It takes 5 people to control a violent client. One for each limb and head. Only one person talks. The
person is given a few seconds to de escalate

EXTRA TOPICS (Not covered in lectures but still important to

know! * )

487. What are Biological Agents in Category A?

🗒️
STAPH B
Small Pox
Tularemia
Anthrax
Plague
Hemorrhagic illness
Botulism

488. What are Biological Agents in Category B?

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🗒️
All others

489. What are Biological Agents in Category C

🗒️
Nipeh Virus; Hanta Virus

490. When it comes to Biological Agents: Category __ is _______, Then Category __, Then
Category __

🗒️
A, the worst, B, C

491. Smallpox

🗒️
Inhaled transmission/ on airborne precautions dies from septicemia- no treatment
rash starts around mouth first
Category A

492. Tularemia

🗒️
chest symptoms
dies from respiratory failure treat with streptomycin Category A

493. Anthrax

🗒️
spread by inhalation
looks like the flu
dies from respiratory failure

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treat with supro, PCN, and streptomycin Category A

494. Plague

🗒️
spread by inhalation
has the 3 H's: Hemoptysis (coughing up blood), Hematemesis (vomiting up blood), Hematochezia
(blood in stool)
dies from respiratory failure and DIC (bleed to death)
treat with Doxycycline and Mycins
no longer communicable after 48 hours of treatment
Category A

495. Hemorrhagic illnesses

🗒️
primary symptoms are petechiae (pinpoint spots) and ecchymoses (bruising)
high % fatal
Category A

496. Botulism

🗒️
it is ingested
has 3 major symptoms: descending paralysis, fever, but is alert dies from respiratory arrest
Category A

497. What are some examples of chemical agents that cause bioterrorism?

🗒️
Mustard gas
Cyanide
Phosgine chlorine
Sarin

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498. What is the primary symptom of Mustard Gas?

🗒️
Blisters (vesicant)

499. What is the primary symptom of Cyanide and how do you treat it?

🗒️
Respiratory arrest. Treat with Sodium Thiosulfate IV

500. What is the primary symptom of Phosgine Chlorine?

🗒️
Choking

501. What are the symptoms of Sarin (hint it's a nerve agent)?

🗒️
BB SLUDGE- just remember every secretion in your body is being excreted excessively
Bronchospasm
Bronchorrhea
Salivating
Lacrimating (tears)
Urination
Diaphoresis/ Diarrhea
G.I upset
Emesis

502. What do you use when cleansing patients exposed to chemical agents?

🗒️
All chemical agents require only soap and water cleansing except Sarin, which requires bleach.

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503. Which agents do you isolate the patient for?

🗒️
Biological Agents

504. Which agents do you decontaminate for?

🗒️
Chemical Agents

505. How does decontamination work?

🗒️
Gather exposed people
Take to decontamination center where people remove clothing, shower, dress in non-contaminated
clothes, then
release to other services
Put contaminated clothing in special bag and throw away (be sure not to touch it)

506. In airborne and droplet precautions only, the mask is removed _______ the room and
the patient removes the mask ________ the room.

🗒️
outside, inside

507. Hand-washing or Scrubbing: position hands below elbows

🗒️
hand-washing

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508. Hand-washing or Scrubbing: position elbows below hands

🗒️
Scrubbing

509. Hand-washing or Scrubbing: length seconds

🗒️
hand-washing

510. Hand-washing or Scrubbing: length minutes

🗒️
Scrubbing

511. Hand-washing or Scrubbing: can touch handles

🗒️
hand-washing

512. Hand-washing or Scrubbing: not allowed to touch handles

🗒️
Scrubbing

513. Hand-washing or Scrubbing: use when entering/leaving room, before/after glove use,
whenever hands get soiled

🗒️
hand-washing

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514. Hand-washing or Scrubbing: use when patient is immunosuppressed (beginning of
stuff)

🗒️
Scrubbing

515. Hand-washing or Scrubbing: soap and water

🗒️
hand-washing

516. Hand-washing or Scrubbing: use "chlor---"

🗒️
Scrubbing

517. When can you use an Alcohol-based solution?

🗒️
Only substitute for handwashing, enter/leave room, before/after gloves, NEVER substitute after soiling
hands

518. Can you use an alcohol-based solution after using the restroom?

🗒️
No! (Soiling hands)

519. Dry hands from ________ to _________. Turn water off with _____ paper towel

🗒️
cleanest, dirtiest, new

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520. Sterile Gloving:

🗒️
glove ________ hand first
grasp ________ of cuff
touch only the _______ of glove surface
do not _______ cuff
fingers _______ second glove cuff
keep thumb _______
only touch _______ surface of glove
dominant
outside
inside
roll
inside
abducted
outside

521. Skin touches _______ of glove

🗒️
Inside

522. OUTside of glove only touches _______ of glove

🗒️
OUTside

523. Remove ______ to _______; _______ to _______

🗒️
glove, glove, skin, skin

524. What patients do NOT need interdisciplinary care?

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🗒️
People who have multiple problems in the same division of care Ex: COPD, arthritis, cancer of bowel (all
medical
problems)

525. What are the major criteria for interdisciplinary care?

🗒️
1. Patients with multidimensional needs (physical, intellectual, emotional, social, spiritual) - Ex COPD,
homelessness, & schizophrenia (need medical, SW, and psychiatrist)
2. Patients who need rehabilitation (PT, SW, OT, Speech will be affected)

526. What is the minor criteria for interdisciplinary care?

🗒️
a patient whose current treatment is ineffective
a patient who is preparing for discharge

527. Skin still intact, non blanching, erythema (redness)

🗒️
Stage 1 Pressure Sore

528. Ulcerated, superficial,pink dermis

🗒️
Stage 2

529. Yellow subcutaneous (fat)

🗒️
Stage 3

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530. Red-white (muscle and bone)

🗒️
Stage 4

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