Spinal Cord Injury

Common to highly educated person

Common in July

Cause: vehicular accident, violence, sports related injuries  eg diving

Areflexia- absence of reflexes after injury

stroke

-sudden neuro deficit

Diagnosis: Right CVA – left hemapheresis

                   Left CVA – Right hemapheresis

40% - thrombotic

30% -embolic

          Lacunar

           Hemorrhagic – devastating

*prone to depression

*prevent depression – family support

2 common cause in depression

1.       Acquired

2.       Side effects of drugs

Stages of Recovery:

1.       Flaccidity

2.       Spasticity begin

3.       Spasticity continues

4.       Peak spasticity 

5.       Spasticity declines

6.       Spasticity disappear – normal recovery

Risk Factors:

Lifestyle, obesity, diabetes mellitus, increase serum cholesterol, age, black people

Management:

1.       Drug – anti – coagulant (heparin)

2.       Carotid endarterectomy – surgical removal of plaques ; side effects – alzheimer’s disease

Bacillar artery affected = death

Pontine artery affected = doll’s eye phenomenon (oculo cephalic reflex)

Complication: immobility, contractures, sexual dysfunction

**prevent footdrop contractures – wear high tennis shoes

Rx: Meridia

(ANTIOBESITY)
SIBUTRAMINE HCL
(ANTISIBU- ANTI SEBO :)
10 mg OD with or without food
Sideeffects:
...M igraine
E ar pain
R ash
I ncrease appetite
D yspepsia
I increase thirst
A norexia

Adverse effects: (Report to the doctor)
Seizure, ecchymosis and liver damage
Monitor LFT: ALT or SGPT (Hepatotoxic)

California Hospital bans hiring of Filipino Nurse

CALIFORNIA, United States—I love Filipino nurses.

Next to cheap garments at Wal-Mart and female impersonators, I’d have to put them on the top of the list as the Philippines’ leading export.

If the country had a team mascot, it would have to be the “Fighting Nurses.” (Notre Dame has the “Fighting Irish,” why not?)

So, of course, I’m alarmed by the news that a de facto ban against hiring Filipino nurses at the St. Luke’s Campus of Sutter Health’s California Pacific Medical Center (CPMC) appears to be policy in San Francisco.

No Filipinos, as blatant as that. Just like the old sign that the Filipino National Historical Society displays, the one from the 1920s that reads, “Positively No Filipinos Allowed.”

You can take that sign and stick it on the door at St. Luke’s, right now, says the California Nurses Association, the nurses union.

And now it wants to do something about it.

The union wants the San Francisco Human Rights Commission to investigate the hospital. But that’s just the opening shot. The union intends to file a class action grievance against Sutter and CPMC.

The union provided compelling evidence which included signed statements by former managers and current job stats to back up the claim that Filipinos are being unfairly discriminated at St. Luke’s.

From numbers provided by CPMC, the numbers don’t lie.

Before the take-over of the hospital in 2007 the Filipino RNs at St. Luke’s were 66 percent of the nursing population.

Between 2007 and 2008, just 48 percent of new hires were Filipino.

From February 2008, when the nurses union and the community organized to stop the closure of St. Luke’s, to the present, the percentage of new RN hires who were Filipino dropped dramatically to just 10 percent.

They didn’t all just give up their RN credentials and take jobs as Wal-Mart greeters.

Nato Green, the labor representative who works at St. Luke’s said it’s no coincidence. “I believe this reflects Sutter’s decision to use race to divide workers and stop collective bargaining activity,” Green told me. “Going from 66 percent to 10 percent (of new hires) is a fairly remarkable coincidence.”

It all comes after the union forced Sutter to keep St. Luke’s open. The nurses union expected some push back, but not this.

“CPMC and Sutter have chosen to retaliate by carrying out a punitive, illegal, and immoral campaign of discrimination,” said Zenei Cortz, the California Nurses Association president. “There is no excuse for racial or ethnic discrimination. A hospital should be a center of therapeutic healing for patients, not a model for bigotry.”

The union also produced affidavits signed under penalty of perjury. Ronald Rivera, a former nurse manager, who worked there from April 2006 to April 2010 when he resigned on good terms, provided his testimony.

“One day I spoke with Diana Karner (VP of nursing) on the phone about hiring new RNs,” he attested. “Diana said to me that we probably should not hire any more foreign graduate nurses. She explained that patients complain because ‘it is hard to understand them and be understood by them.’”

Another signed affidavit came from Ronald Villanueva, who actually was sitting in and overheard the conversation between Karner and Rivera. “I was shocked and I wondered if she knew I was a foreign graduate nurse,” he wrote.

A third declaration came from Chris Hanks, who was the Director of Critical Care from 2008 to 2009 and reported directly to Karner. Hanks was alarmed when told point blank “you are not to hire any Filipino nurses.” Hanks challenged Karner at their weekly meetings, until Karner told him, “The Filipinos are always related, or know each other, and that’s not good. You’re not to hire them.”

Karner the VP of nursing didn’t return my telephone call.

Kevin McCormack, of CPMC’s media relations said she was out of the office and unavailable. What did he think of a ban on hiring Filipino nurses? “That would be illegal,” he said. “You can’t ban hiring specific groups.”

He called it “ridiculous” and implied it was a stunt by CNA to fan the ongoing dispute with CPMC.

But the numbers don’t lie.

The Filipino nursing staff at St. Luke’s is shrinking and it isn’t by accident.

If you’re a Filipino nurse wanting to get to San Francisco, the climate is getting ugly.


http://globalnation.inquirer.net/viewpoints/viewpoints/view/20100822-288174/California-hospital-bans-hiring-of-Filipino-nurses

Highly Active Antiretroviral Therapy

HAART is the name given to aggressive treatment regimens used to suppress HIV viral replication and the progression of HIV disease. The regimen combines t 3 or more different drugs ...such as 2 nucleoside reverse transcriptase inhibitors (NRTIs) & a protease inhibitor (PI), two NRTIs and a non-nucleoside reverse transcriptase inhibitor (NNRTI)

HERBAL MEDS

Chamomile

Uses: Chamomile is often used in the form of a tea as a sedative.

Reactions: Allergic reactions can occur, particularly in persons allergic to ragweed. Reported reactions include abdominal cramps, tongue thickness, tightness in the throat, swelling of the lips, throat and eyes, itching all over the body, hives, and blockage of the breathing passages. Close monitoring is recommended for patients who are taking medications to prevent blood clotting (anticoagulants) such as warfarin.

Echinacea

Uses: Largely because white blood cells in the laboratory can be stimulated to eat particles, Echinacea has been touted to be able to boost the body's ability to fight off infection.
Reactions: The most common side effect is an unpleasant taste. Echinacea can cause liver toxicity. It should be avoided in combination with other medications that can affect the liver (such as ketaconazole, leflunomide (Arava), methotrexate (Rheumatrex), isoniazide (Nizoral).

St. John's Wort

Uses: St. John's Wort is popularly used as an herbal treatment for depression, anxiety, and sleep disorders. It is technically known as Hypericum perforatum. C

Nclex-RN notes

NCLEX-RN NOTES

California's new memo on NCLEX expiration

As of April 26, 2010, the California Board of Registered Nursing (BRN) no longer accepts applications that do not contain a valid U.S. Social Security Number (SSN). The California Nursing Practice Act provides for a unified examination and licensing application. Once an applicant passes the examination, a license is automatically issued. Under these circumstances, the BRN cannot accept applications for the examination and licensure, without a valid U.S. Social Security Number.

Prior to April 26, 2010, once an applicant passed the NCLEX-RN examination, the applicant was allowed a three-year time period to submit a valid SSN. After that time period had elapsed, the file was considered abandoned and the file was destroyed. Additionally, an applicant was also allowed to request an extension on the file Abandonment Date. This was done as a courtesy to the applicant. As of April 26, 2010, the BRN will no longer grant an extension on the file abandonment date.

An applicant, who has passed the NCLEX-RN exam and is affected by file abandonment and file destruction, still has the following options:

· Once the valid U.S. Social Security Number is obtained, the applicant may re-apply to the BRN. The applicant will not have to retest, because even though the file is abandoned and destroyed, the NCLEX-RN test result is still valid. Applicants do need to submit a new Application Fee Schedule for Examination; a transcript and the fingerprint card. When the Board receives all the requirements (a new application; transcript from school; the fingerprint clearance and a valid U.S. SSN) we needed; the CA RN license will be issued.

· An applicant may request that the California NCLEX-RN test result (NCLEX-RN CANDIDATE REPORT with your picture) be provided to any U.S. jurisdiction; if the applicant wishes to apply to a jurisdiction that does not require the SSN for licensure (There is a $10 fee that must be included with a test result (NCLEX-RN CANDIDATE REPORT with your picture) request). The applicant must contact other U.S. jurisdictions to inquire as to each jurisdiction’s licensure requirements. For a list of U.S. jurisdictions, please visit the National Council of State Boards of Nursing (NCSBN) official Web site.

· To assist an applicant who is requesting a VisaScreen® certificate from the International Commission on Healthcare Professions (ICHP), the BRN will certify the applicant’s California NCLEX-RN test results (there is a $60 fee that must be included with the certification request). Information related to the VisaScreen® certificate requirements may be found on the International Commission on Healthcare Professions official Web site

ZETIA

ZETIA (EZETIMIBE)
♥ ♥ ♥

Z...etia is an anticholesterol drug
E...zetimibe is the generic name
T...ime of effectiveness (2 weeks)
I... nstruct to report muscle pain
....Zetia increases skeletal muscle break down
A...void during pregnancy, kidney failure and allergy to Zetia

report myalgia since zetia increases skeletal muscle breakdown

MECHABICAL VENTILATOR

MECHANICAL VENTILATOR
Mechanical ventilation is a method to mechanically assist or replace spontaneous breathing.

This may involve a machine called a ventilator or the breathing may be assisted by a physician or other suitable person compressing an ambu bag. Traditionally divided into negative-pressure ventilation, where air is essentially sucked into the lungs, or positive pressure ventilation, where air (or another gas mix) is pushed into the trachea.

HFQ: Low pressure alarm-leak-check connections

HFQ: High pressure alarm-obstruction or client is biting the tube - suction prn or insert oral airway

Laryngitis

L aryngeal inflammation which causes hoarseness of voice
A lcohol, viruses, bacteria (SY) are the causes
R esults from overuse of the vocal cords
Y in (cold) drinks must be avoided
N o alcohol and smoking
G ive warm, soothing liquids
I hale steam from a bowl of hot water
T hroat lozenges and nonprescription pain reliever
I instruct to complete ANTIBIOTIC therapy
S peaking in public must be avoided during recovery ♥

DRUG THERAPEUTIC LEVELS

Digoxin = 0.5-2.0 ng/ml
Lidocaine = 1.5-6.0 mcg/ml
Carbamazepine = 4-12 mcg/ml
Phenytoin = 10-20 mcg/ml
Theophyline = 10-20 mcg/ml
Valproic Acid = 50-100 mcg/ml
Vancomycin = 30-40 mg/ml (peak); 5-10 mg/ml (through)

Toxin and Antidote

acetaminophen - mucomyst
benzodiazepine - flumazenil
digoxin - digibind
heparin - protamine so4
opiods - nalaxone
warfarin - vit. k
insulin - glucagon

NCLEX sample q's 103

1. A nurse is reviewing a patient’s medication during shift change. Which of the following medication would be contraindicated if the patient were pregnant? Note: More than one answer may be correct.

A: Coumadin

B: Finasteride

C: Celebrex

D: Catapress

E: Habitrol

F: Clofazimine

2. A nurse is reviewing a patient’s PMH. The history indicates photosensitive reactions to medications. Which of the following drugs has not been associated with photosensitive reactions? Note: More than one answer may be correct.

A: Cipro

B: Sulfonamide

C: Noroxin

D: Bactrim

E: Accutane

F: Nitrodur

3. A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following patient’s medication does not cause urine discoloration?

A: Sulfasalazine

B: Levodopa

C: Phenolphthalein

D: Aspirin

4. You are responsible for reviewing the nursing unit’s refrigerator. If you found the following drug in the refrigerator it should be removed from the refrigerator’s contents?

A: Corgard

B: Humulin (injection)

C: Urokinase

D: Epogen (injection)

5. A 34 year old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb?

A: IgA

B: IgD

C: IgE

D: IgG

6. A second year nursing student has just suffered a needlestick while working with a patient that is positive for AIDS. Which of the following is the most important action that nursing student should take?

A: Immediately see a social worker

B: Start prophylactic AZT treatment

C: Start prophylactic Pentamide treatment

D: Seek counseling

7. A thirty five year old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect?

A: Atherosclerosis

B: Diabetic nephropathy

C: Autonomic neuropathy

D: Somatic neuropathy

8. You are taking the history of a 14 year old girl who has a (BMI) of 18. The girl reports inability to eat, induced vomiting and severe constipation. Which of the following would you most likely suspect?

A: Multiple sclerosis

B: Anorexia nervosa

C: Bulimia

D: Systemic sclerosis

9. A 24 year old female is admitted to the ER for confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Which of the following would you most likely suspect?

A: Diverticulosis

B: Hypercalcaemia

C: Hypocalcaemia

D: Irritable bowel syndrome

10. Rho gam is most often used to treat____ mothers that have a ____ infant.

A: RH positive, RH positive

B: RH positive, RH negative

C: RH negative, RH positive

D: RH negative, RH negative

Answer Key

1. (A) and (B) are both contraindicated with pregnancy.

2. (F) All of the others have can cause photosensitivity reactions.

3. (D) All of the others can cause urine discoloration.

4. (A) Corgard could be removed from the refigerator.

5. (D) IgG is the only immunoglobulin that can cross the placental barrier.

6. (B) AZT treatment is the most critical innervention.

7. (C) Autonomic neuropathy can cause inability to urinate.

8. (B) All of the clinical signs and systems point to a condition of anorexia nervosa.

9. (B) Hypercalcaemia can cause polyuria, severe abdominal pain, and confusion.

10. (C) Rho gam prevents the production of anti-RH antibodies in the mother that has a Rh positive fetus.

NCLEX Pharma

1. Muscarinic Agonists

A. Bethanecol (URECHOLINE) – increase GI motility

B. Carbachol (ISOPTO, MIOSTAT, CARBACHOL) – various types of glaucoma

C. Methacholine (PROVOCHOLINE) – test hyperactivity of airways

D. Pilocarpine – used for glaucoma

2. Anticholinesterases

A. Pysostigmine (ANTILIRIUM) – treat glaucoma, crosses BBB, reverse anticholinergic toxicity.

B. Neostigmine (PROSTIGMIN) – synthetic form of Pysostigmine

(Anticholinesterases) – used for Myasthenia gravis, glaucoma, and to increase tone in bladder

Symptoms of Anticholinesterase toxicity:

1. Miosis
2. Rhinitis
3. Bradycardia
4. GI spasms
5. brochoconstriction
6. involuntary voiding of urine

NCLEX Practice Test 101

1. A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to assess circulation in the lower extremities every 2 hours. Which of the following outcome criteria would the nurse use?

1. Body temperature of 99°F or less

2. Toes moved in active range of motion

3. Sensation reported when soles of feet are touched

4. Capillary refill of <>

2. A 30-year-old male from Haiti is brought to the emergency department in sickle cell crisis. What is the best position for this client?

1. Side-lying with knees flexed

2. Knee-chest

3. High Fowler's with knees flexed

4. Semi-Fowler's with legs extended on the bed

3. A 25-year-old male is admitted in sickle cell crisis. Which of the following interventions would be of highest priority for this client?

1. Taking hourly blood pressures with mechanical cuff

2. Encouraging fluid intake of at least 200mL per hour

3. Position in high Fowler's with knee gatch raised

4. Administering Tylenol as ordered

4. Which of the following foods would the nurse encourage the client in sickle cell crisis to eat?

1. Peaches

2. Cottage cheese

3. Popsicle

4. Lima beans

5. A newly admitted client has sickle cell crisis. The nurse is planning care based on assessment of the client. The client is complaining of severe pain in his feet and hands. The pulse oximetry is 92. Which of the following interventions would be implemented first? Assume that there are orders for each intervention.

1. Adjust the room temperature

2. Give a bolus of IV fluids

3. Start O₂

4. Administer meperidine (Demerol) 75mg IV push

6. The nurse is instructing a client with iron-deficiency anemia. Which of the following meal plans would the nurse expect the client to select?

1. Roast beef, gelatin salad, green beans, and peach pie

2. Chicken salad sandwich, coleslaw, French fries, ice cream

3. Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie

4. Pork chop, creamed potatoes, corn, and coconut cake

7. Clients with sickle cell anemia are taught to avoid activities that cause hypoxia and hypoxemia. Which of the following activities would the nurse recommend?

1. A family vacation in the Rocky Mountains

2. Chaperoning the local boys club on a snow-skiing trip

3. Traveling by airplane for business trips

4. A bus trip to the Museum of Natural History

8. The nurse is conducting an admission assessment of a client with vitamin B12 deficiency. Which of the following would the nurse include in the physical assessment?

1. Palpate the spleen

2. Take the blood pressure

3. Examine the feet for petechiae

4. Examine the tongue

9. An African American female comes to the outpatient clinic. The physician suspects vitamin B12 deficiency anemia. Because jaundice is often a clinical manifestation of this type of anemia, what body part would be the best indicator?

1. Conjunctiva of the eye

2. Soles of the feet

3. Roof of the mouth

4. Shins

10. The nurse is conducting a physical assessment on a client with anemia. Which of the following clinical manifestations would be most indicative of the anemia?

1. BP 146/88

2. Respirations 28 shallow

3. Weight gain of 10 pounds in 6 months

4. Pink complexion

11. The nurse is teaching the client with polycythemia vera about prevention of complications of the disease. Which of the following statements by the client indicates a need for further teaching?

1. "I will drink 500mL of fluid or less each day."

2. "I will wear support hose when I am up."

3. "I will use an electric razor for shaving."

4. "I will eat foods low in iron."

12. A 33-year-old male is being evaluated for possible acute leukemia. Which of the following would the nurse inquire about as a part of the assessment?

1. The client collects stamps as a hobby.

2. The client recently lost his job as a postal worker.

3. The client had radiation for treatment of Hodgkin's disease as a teenager.

4. The client's brother had leukemia as a child.

13. An African American client is admitted with acute leukemia. The nurse is assessing for signs and symptoms of bleeding. Where is the best site for examining for the presence of petechiae?

1. The abdomen

2. The thorax

3. The earlobes

4. The soles of the feet

14. A client with acute leukemia is admitted to the oncology unit. Which of the following would be most important for the nurse to inquire?

1. "Have you noticed a change in sleeping habits recently?"

2. "Have you had a respiratory infection in the last 6 months?"

3. "Have you lost weight recently?"

4. "Have you noticed changes in your alertness?"

15. Which of the following would be the priority nursing diagnosis for the adult client with acute leukemia?

1. Oral mucous membrane, altered related to chemotherapy

2. Risk for injury related to thrombocytopenia

3. Fatigue related to the disease process

4. Interrupted family processes related to life-threatening illness of a family member

16. A 21-year-old male with Hodgkin's lymphoma is a senior at the local university. He is engaged to be married and is to begin a new job upon graduation. Which of the following diagnoses would be a priority for this client?

1. Sexual dysfunction related to radiation therapy

2. Anticipatory grieving related to terminal illness

3. Tissue integrity related to prolonged bed rest

4. Fatigue related to chemotherapy

17. A client has autoimmune thrombocytopenic purpura. To determine the client's response to treatment, the nurse would monitor:

1. Platelet count

2. White blood cell count

3. Potassium levels

4. Partial prothrombin time (PTT)

18. The home health nurse is visiting a client with autoimmune thrombocytopenic purpura (ATP). The client's platelet count currently is 80, It will be most important to teach the client and family about:

1. Bleeding precautions

2. Prevention of falls

3. Oxygen therapy

4. Conservation of energy

19. A client with a pituitary tumor has had a transphenoidal hyposphectomy. Which of the following interventions would be appropriate for this client?

1. Place the client in Trendelenburg position for postural drainage

2. Encourage coughing and deep breathing every 2 hours

3. Elevate the head of the bed 30°

4. Encourage the Valsalva maneuver for bowel movements

20. The client with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is:

1. Measure the urinary output

2. Check the vital signs

3. Encourage increased fluid intake

4. Weigh the client

21. A client with hemophilia has a nosebleed. Which nursing action is most appropriate to control the bleeding?

1. Place the client in a sitting position with the head hyperextended

2. Pack the nares tightly with gauze to apply pressure to the source of bleeding

3. Pinch the soft lower part of the nose for a minimum of 5 minutes

4. Apply ice packs to the forehead and back of the neck

22. A client has had a unilateral adrenalectomy to remove a tumor. To prevent complications, the most important measurement in the immediate post-operative period for the nurse to take is:

1. Blood pressure

2. Temperature

3. Output

4. Specific gravity

23. A client with Addison's disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids (Solu-Medrol). Which of the following interventions would the nurse implement?

1. Glucometer readings as ordered

2. Intake/output measurements

3. Sodium and potassium levels monitored

4. Daily weights

24. A client had a total thyroidectomy yesterday. The client is complaining of tingling around the mouth and in the fingers and toes. What would the nurses' next action be?

1. Obtain a crash cart

2. Check the calcium level

3. Assess the dressing for drainage

4. Assess the blood pressure for hypertension

25. A 32-year-old mother of three is brought to the clinic. Her pulse is 52, there is a weight gain of 30 pounds in 4 months, and the client is wearing two sweaters. The client is diagnosed with hypothyroidism. Which of the following nursing diagnoses is of highest priority?

1. Impaired physical mobility related to decreased endurance

2. Hypothermia r/t decreased metabolic rate

3. Disturbed thought processes r/t interstitial edema

4. Decreased cardiac output r/t bradycardia

Mnemonics 01

MI management: MONA
Morphine
O2
Nitroglycerine
Aspirin

HYPOGLYCEMIA: TIRED
T Tired
I Irritability
R Restless
E Excessive hunger
D Diaphoresis-Depression

HEART MURMURS: SPASM
S Stenosis
P Partial obstruction
A Aneurysms
S Septal defect
M Mitral regurgitation

Hyperthyroidism (s/s)
THYROIDISM
Tremor
Heart rate up
Yawning (fatigueability)
Restlessness
Oligomenorrhea & amenorrhea
Intolerance to heat
Diarrhea
Irritability
Sweating
Muscle wasting & weight loss

Miotic: Little word=Little pupil
Mydriatic: Big word=Big pupil

Anticholingergics Side Effects:
Can't see
Can't pee
Can't spit
Can't sh*t

5W's of common causes of post-op fever

Wind (think pneumonia, splinting, incentive spirometer exercises not done, DB+ coughing not done)
Water (dehydration...)
Wound (infection, dehiscence...)
Walking (PE...)
Wonder drug (approriate antibiotic...)

Cranial Nerves

Oh Olfactory Some
Oh Optic Say
Oh Oculomotor Marry
To Trochlear Money
Touch Trigeminal But
And Abducens My
Feel Facial Brother
Virgin Vestibulocochlear Says
Girl's Glossopharangeal Big
Violins Vagus Breasts
Ah Accessory Mean
Heaven Hypoglossal More

For the third column, S stands for sensory, M for motor, and B is both. Also, you have one nose, so Olfactory is CNI, two eyes, so optic is CNII. To remember which order the As come in, ABducens comes before ACcessory alphabetically.

Acute Pancreatitis: I GET SMASHED

I - idiopathic
G - gallstone
E - EtOH
T - trauma
S - steroids
M - mumps (paramyxovirus) and other viruses (EBV, CMV)
A - autoimmune
S - scorpion sting / snake bite
H - hypercalcemia, hyperlipidemia and hypothermia
E - ERCP
D - drugs, duodenal ulcers

To apply a telemetry monitor:
White over right (top right shoulder)
Black beside the white (Over lt shoulder)
Checkers (red below the black)
Christmas (Green beside the red)
Then ofcourse, the brown will be in the middle!

The HYPERKALEMIA "Machine" - Causes of Increased Serum K+
M - Medications - ACE inhibitors, NSAIDS
A - Acidosis - Metabolic and respiratory
C - Cellular destruction - Burns, traumatic injury
H - Hypoaldosteronism, hemolysis
I - Intake - Excesssive
N - Nephrons, renal failure
E - Excretion - Impaired


Signs and Symptoms of Increased Serum K+: MURDER
M - Muscle weakness
U - Urine, oliguria, anuria
R- Respiratory distress
D - Decreased cardiac contractility
E - ECG changes
R - Reflexes, hyperreflexia, or areflexia (flaccid)

HYPERNATREMIA
"You Are Fried"

F - Fever (low grade), flushed skin
R - Restless (irritable)
I - Increased fluid retention and increased BP
E - Edema (peripheral and pitting)
D - Decreased urinary output, dry mouth


"CATS" of "HYPOCALCEMIA"

C - Convulsions
A- Arrhythmias
T - Tetany
S - Spasms and stridor

NCLEX sample q's 102

. After the lungs, the kidneys work to maintain body pH. The best

explanation of how the kidneys accomplish regulation of pH is that they

a. Secrete hydrogen ions and sodium.

b. Secrete ammonia.

c. Exchange hydrogen and sodium in the

kidney tubules.

d. Decrease sodium ions, hold on to

hydrogen ions, and then secrete

sodium bicarbonate.

Answer: d

Rationale: By decreasing NA+ ions, holding onto hydrogen ions, and secreting sodium

bicarbonate, the kidneys can regulate pH. Therefore, this is the most complete answer,

and while this buffer system is the slowest, it can completely compensate for acid-base

imbalance.

2. (skip)

3. The nurse explains to a client who has just received the diagnosis

of Noninsulin-Dependent Diabetes Mellitus (NIDDM) that

sulfonylureas, one group of oral hypoglycemic agents, act by

a. Stimulating the pancreas to produce or release insulin

b. Making the insulin that is produced more available for use

c. Lowering the blood sugar by facilitating the uptake and

utilization of glucose

d. Altering both fat and protein metabolism

Answer: a

Rationale: Sulfonylurea drugs, Orinase for example, lowers the blood sugar by stimulating

the beta cells of the pancreas to synthesize and release insulin.

4. Myasthenic crisis and cholinergic crisis are the major complications

of myasthenia gravis. Which of the following is essential nursing

knowledge when caring for a client in crisis?

a. Weakness and paralysis of the muscles for swallowing

and breathing occur in either crisis

b. Cholinergic drugs should be administered to prevent further

complications associated with the crisis

c. The clinical condition of the client usually improves after

several days of treatment

d. Loss of body function creates high levels of anxiety and fear

Answer: a

Rationale: The client cannot handle his own secretions, and respiratory arrest may be

imminent. Atropine may be administered to prevent crisis. Anticholinergic drugs are

administered to increase the levels of acetylcholine at the myoneural junction. Cholinergic

drugs mimic the actions of the parasympathetic nervous system and would not be used.

5. A 54-year-old client was put in Quinidine (a drug that decreases

myocardial excitability) to prevent atrial fibrillation. He also has

kidney disease. The nurse is aware that this drug, when given to a

client with kidney disease, may

a. Cause cardiac arrest

b. Cause hypotension

c. Produce mild bradycardia

d. Be very toxic even in small doses

Answer: a

Rationale: Kidney disease interferes with metabolism and excretion of Quinidine, resulting

in higher drug concentrations in the body. Quinidine can depress myocardial excitability

enough to cause cardiac arrest.

6. A client is about to be discharged on the drug bishydroxycoumarin

(Dicumarol). Of the principles below, which one is the most important

to teach the client before discharge?

a. He should be sure to take the medication before meals

b. He should shave with an electric razor

c. If he misses a dose, he should double the dose at the

next scheduled time

d. It is the responsibility of the physician to do the teaching

for this medication

Answer: b

Rationale: Dicumarol is an anticoagulant drug and one of the dangers involved is bleeding.

Using a safety razor can lead to bleeding through cuts. The drug should be given at the same

time daily but not related to meals. Due to danger of bleeding, missed doses should not be

made up.

7. A cyanotic client with an unknown diagnosis is admitted to the emergency

room. In relation to oxygen, the first nursing action would be to

a. Wait until the client's lab work is done

b. Not administer oxygen unless ordered by the physician

c. Administer oxygen at 2 liters flow per minute

d. Administer oxygen at 10 liters flow per minute and check

the client's nail beds

Answer: c

Rationale: Administer oxygen at 2 liters per minute and no more, for if the client is

emphysemic and receives too high a level of oxygen, he will develop CO2 narcosis

and the respiratory system will cease to function

8. A client with a diagnosis of gout will be taking colchicine and

allopurinol bid to prevent recurrence. The most common early

sign of colchicine toxicity that the nurse will assess for is

a. Blurred vision

b. Anorexia

c. Diarrhea

d. Fever

Answer: c

Rationale: Diarrhea is by far the most common early sign of colchicine toxicity. When

given in the acute phase of gout, the dose of colchicine is usually 0.6 mg (PO) q hr

(not to exceed 10 tablets) until pain is relieved or gastrointestinal symptoms ensue.

9. A client has chronic dermatitis involving the neck, face and antecubital

creases. She has a strong family history of varied allergy disorders. This

type of dermatitis is probably best described as

a. Contact dermatitis

b. Atopic dermatitis

c. Eczema

d. Dermatitis medicamentosa

Answer: b

Rationale: Atopic dermatitis is chronic, pruritic and allergic in nature. Typically it has a

longer course than contact dermatitis and is aggravated by commercial face or body lotions,

emotional stress, and, in some instances, particular foods.

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12. The nurse would expect to find an improvement in which of the blood

values as a result of dialysis treatment?

a. High serum creatinine levels

b. Low hemoglobin

c. Hypocalcemia

d. Hypokalemia

Answer: a

Rationale: High creatinine levels will be decreased. Anemia is a result of decreased

production of erythropoietin by the kidney and is not affected by hemodialysis. Hyperkalemia

and high base bicarbonate levels are present in renal failure clients.

13. A 24-year-old client is admitted to the hospital following an automobile

accident. She was brought in unconscious with the following vital signs:

BP 130/76, P 100, R 16, T 98F. The nurse observes bleeding from the

client's nose. Which of the following interventions will assist in determining

the presence of cerebrospinal fluid?

a. Obtain a culture of the specimen using sterile swabs and send

to the laboratory

b. Allow the drainage to drip on a sterile gauze and observe

for a halo or ring around the blood

c. Suction the nose gently with a bulb syringe and send specimen

to the laboratory

d. Insert sterile packing into the nares and remove in 24 hours

Answer: b

Rationale: The halo or "bull's eye" sign seen when drainage from the nose or ear of a

head-injured client is collected on a sterile gauze is indicative of CSF in the drainage. The

collection of a culture specimen using any type of swab or suction would be contraindicated

because brain tissue may be inadvertently removed at the same time or other tissue damage

may result.

14. A 24-year-old male is admitted with a possible head injury. His arterial

blood gases show that his pH is less than 7.3, his PaCO2 is elevated

above 60 mmHg, and his PaO2 is less than 45 mmHg. Evaluating this

ABG panel, the nurse would conclude that

a. Edema has resulted from a low pH state

b. Acidosis has caused vasoconstriction of cerebral arterioles

c. Cerebral edema has resulted from a low oxygen state

d. Cerebral blood flow has decreased

Answer: c

Rationale: Hypoxic states may cause cerebral edema. Hypoxia also causes cerebral

vasodilatation particularly in response to a decrease in the PaO2 below 60 mmHg.

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16. A client is admitted following an automobile accident in which he sustained

a contusion. The nurse knows that the significance of a contusion is

a. That it is reversible

b. Amnesia will occur

c. Loss of consciousness may be transient

d. Laceration of the brain may occur

Answer: d

Rationale: Laceration, a more severe consequence of closed head injury, occurs as the brain

tissue moves across the uneven base of the skull in a contusion. Contusion causes cerebral

dysfunction which results in bruising of the brain. A concussion causes transient loss

of consciousness, retrograde amnesia, and is generally reversible.

17. A client with tuberculosis is given the drug pyrazinamide (Pyrazinamide).

Which one of the following diagnostic tests would be inaccurate if the

client is receiving the drug?

a. Liver function test

b. Gall bladder studies

c. Thyroid function studies

d. Blood glucose

Answer: a

Rationale: Liver function tests can be elevated in clients taking pyrazinamide. This drug

is used when primary and secondary antitubercular drugs are not effective. Urate levels

may be increased and there is a chemical interference with urine ketone levels if these

tests are done while the client is on the drug.

18. Which one of the following conditions could lead to an inaccurate pulse

oximetry reading if the sensor is attached to the client's ear?

a. Artificial nails

b. Vasodilation

c. Hypothermia

d. Movement of the head

Answer: c

Rationale: Hypothermia or fever may lead to an inaccurate reading. Artificial nails may

distort a reading if a finger probe is used. Vasoconstriction can cause an inaccurate reading

of oxygen saturation. Arterial saturations have a close correlation with the reading from the

pulse oximeter as long as the arterial saturation is above 70 percent.

19. While on a camping trip, a friend sustains a snake bite from a poisonous

snake. The most effective initial intervention would be to

a. Place a restrictive band above the snake bite

b. Elevate the bite area above the level of the heart

c. Position the client in a supine position

d. Immobilize the limb

Answer: a

Rationale: A restrictive band 2 to 4 inches above the snake bite is most effective in

containing the venom and minimizing lymphatic and superficial venous return. Elevation

of the limb or immobilization would not be effective interventions.

20. There is a physician's order to irrigate a client's bladder. Which one of the

following nursing measures will ensure patency?

a. Use a solution of sterile water for the irrigation

b. Apply a small amount of pressure to push the mucus out of

the catheter tip if the tube is not patent

c. Carefully insert about 100 mL of aqueous Zephiran into the

bladder, allow it to remain for 10 hour, and then siphon it out

d. Irrigate with 20mL's of normal saline to establish patency

Answer: d

Rationale: Normal saline is the fluid of choice for irrigation. It is never advisable to force

fluids into a tubing to check for patency. Sterile water and aqueous Zephiran will affect the

pH of the bladder as well as cause irritation.

21. A female client has orders for an oral cholecystogram. Prior to the test,

the nursing intervention would be to

a. Provide a high fat diet for dinner, then NPO

b. Explain that diarrhea may result from the dye tablets

c. Administer the dye tablets following a regular diet for dinner

d. Administer enemas until clear

Answer: b

Rationale: Diarrhea is a very common response to the dye tablets. A dinner of tea and toast

is usually given to the client. Each dye tablet is given at 5 minute intervals, usually with 1

glass of water following each tablet. The number of tablets prescribed will vary, because it

is based on the weight of the client.

22. The physician has just completed a liver biopsy. Immediately following the

procedure, the nurse will position the client

a. On his right side to promote hemostasis

b. In Fowler's position to facilitate ventilation

c. Supine to maintain blood pressure

d. In Sims' position to prevent aspiration

Answer: a

Rationale: Placing the client on his right side will allow pressure to be placed on the puncture

site, thus promoting hemostasis and preventing hemorrhage. The other positions will not be

effective in achieving these goals.

23. When a client has peptic ulcer disease, the nurse would expect a priority

intervention to be

a. Assisting in inserting a Miller-Abbott tube

b. Assisting in inserting an arterial pressure line

c. Inserting a nasogastric tube

d. Inserting an IV

Answer: c

Rationale: An NG tube insertion is the most appropriate intervention because it will determine

the presence of active gastrointestinal bleeding. A Miller-Abbott tube is a weighted, mercury-

filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or

fluid overload in the client; therefore, an arterial line is not appropriate at this time and an IV

is optional.

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25. In preparation for discharge of a client with arterial insufficiency and

Raynaud's disease, client teaching instructions should include

a. Walking several times each day as a part of an exercise routine

b. Keeping the heat up so that the environment is warm

c. Wearing TED hose during the day

d. Using hydrotherapy for increasing oxygenation

Answer: b

Rationale: The client's instructions should include keeping the environment warm to prevent

vasoconstriction. Wearing gloves, warm clothes, and socks will also be useful in preventing

vasoconstriction, but TED hose would not be therapeutic. Walking will most likely increase pain.

26. When a client asks the nurse why the physician says he "thinks" he has

tuberculosis, the nurse explains to him that diagnosis of tuberculosis can

take several weeks to confirm. Which of the following statements supports

this answer?

a. A positive reaction to a tuberculosis skin test indicates that the client

has active tuberculosis, even if one negative sputum is obtained

b. A positive sputum culture takes at least 3 weeks, due to the slow

reproduction of the bacillus

c. Because small lesions are hard to detect on chest x-rays, x-rays

usually need to be repeated during several consecutive weeks

d. A client with a positive smear will have to have a positive culture

to confirm the diagnosis

Answer: b

Rationale: Answer b is correct because the culture takes 3 weeks to grow. Usually even

very small lesions can be seen on x-rays due to the natural contrast of the air in the lungs;

therefore, chest x-rays do not need to be repeated frequently (c). Clients may have positive

smears but negative cultures if they have been on medication (d). A positive skin test indicates

the person only has been infected with tuberculosis but may not necessarily have active disease (a).

27. The nurse is counseling a client with the diagnosis of glaucoma. She explains

that if left untreated, this condition leads to

a. Blindness

b. Myopia

c. Retrolental fibroplasia

d. Uveitis

Answer: a

Rationale: The increase in intraocular pressure causes atrophy of the retinal ganglion cells

and the optic nerve, and leads eventually to blindness.

28. A nursing assessment for initial signs of hypoglycemia will include

a. Pallor, blurred vision, weakness, behavioral changes

b. Frequent urination, flushed face, pleural friction rub

c. Abdominal pain, diminished deep tendon reflexes, double vision

d. Weakness, lassitude, irregular pulse, dilated pupils

Answer: a

Rationale: Weakness, fainting, blurred vision, pallor and perspiration are all common symptoms

when there is too much insulin or too little food - hypoglycemia. The signs and symptoms in

answers (b) and (c) are indicative of hyperglycemia.

29. The physician has ordered a 24-hour urine specimen. After explaining the

procedure to the client, the nurse collects the first specimen. This specimen

is then

a. Discarded, then the collection begins

b. Saved as part of the 24-hour collection

c. Tested, then discarded

d. Placed in a separate container and later added to the collection

Answer: a

Rationale: The first specimen is discarded because it is considered "old urine" or urine that

was in the bladder before the test began. After the first discarded specimen, urine is collected

for 24 hours.

30. Following an accident, a client is admitted with a head injury and

concurrent cervical spine injury. The physician will use Crutchfield

tongs. The purpose of these tongs is to

a. Hypoextend the vertebral column

b. Hyperextend the vertebral column

c. Decompress the spinal nerves

d. Allow the client to sit up and move without twisting his spine

Answer: b

Rationale: The purpose of the tongs is to decompress the vertebral column through

hyperextending it. Both (a) and (c) are incorrect because they might cause further damage.

(d) is incorrect because the client cannot sit up with the tongs in place; only the head of

the bed can be elevated.

31. The most appropriate nursing intervention for a client requiring a finger

probe pulse oximeter is to

a. Apply the sensor probe over a finger and cover lightly with

gauze to prevent skin breakdown

b. Set alarms on the oximeter to at least 100 percent

c. Identify if the client has had a recent diagnostic test using

intravenous dye

d. Remove the sensor between oxygen saturation readings

Answer: c

Rationale: Clients may experience inaccurate readings if dye has been used for a diagnostic

test. Dyes use colors that tint the blood which leads to inaccurate readings.

32. A client being treated for esophageal varices has a Sengstaken-

Blakemore tube inserted to control the bleeding. The most important

assessment is for the nurse to

a. Check that a hemostat is at the bedside

b. Monitor IV fluids for the shift

c. Regularly assess respiratory status

d. Check that the balloon is deflated on a regular basis

Answer: c

Rationale: The respiratory system can become occluded if the balloon slips and moves up

the esophagus, putting pressure on the trachea. This would result in respiratory distress

and should be assessed frequently. Scissors should be kept at the bedside to cut the tube

if distress occurs. This is a safety intervention.

33. A 55-year-old client with sever epigastric pain due to acute pancreatitis

has been admitted to the hospital. The client's activity at this time should be

a. Ambulation as desired

b. Bedrest in supine position

c. Up ad lib and right side-lying position in bed

d. Bedrest in Fowler's position

Answer: d

Rationale: The pain of pancreatitis is made worse by walking and supine positioning. The

client is more comfortable sitting up and leaning forward.

34. Of the following blood gas values, the one the nurse would expect to

see in the client with acute renal failure is

a. pH 7.49, HCO3 24, PCO2 46

b. pH 7.49, HCO3 14, PCO2 30

c. pH 7.26, HCO3 24, PCO2 46

d. pH 7.26, HCO3 14, PCO2 30

Answer: d

Rationale: The client with acute renal failure would be expected to have metabolic acidosis

(low HCO3) resulting in acid blood pH (acidemia) and respiratory alkalosis (lowered PCO2)

as a compensating mechanism. Normal values are pH 7.35 to 7.45; HCO3 23 to 27 mEg;

and PCO2 35 to 45 mmHg.

35. A client in acute renal failure receives an IV infusion of 10%

dextrose in water with 20 units of regular insulin. The nurse

understands that the rationale for this therapy is to

a. Correct the hyperglycemia that occurs with acute renal failure

b. Facilitate the intracellular movement of potassium

c. Provide calories to prevent tissue catabolism and azotemia

d. Force potassium into the cells to prevent arrhythmias

Answer: b

Rationale: Dextrose with insulin helps move potassium into cells and is immediate management

therapy for hyperkalemia due to acute renal failure. An exchange resin may also be employed.

This type of infusion is often administered before cardiac surgery to stabilize irritable cells and

prevent arrhythmias; in this case KC1 is also added to the infusion.

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38. A client has had a cystectomy and ureteroileostomy (ileal conduit). The

nurse observes this client for complications in the postoperative period.

Which of the following symptoms indicates an unexpected outcome and

requires priority care?

a. Edema of the stoma

b. Mucus in the drainage appliance

c. Redness of the stoma

d. Feces in the drainage appliance

Answer: d

Rationale: The ileal conduit procedure incorporates implantation of the ureters into a portion

of the ileum which has been resected from its anatomical position and now functions as a

reservoir or conduit for urine. The proximal and distal ileal borders can be resumed. Feces

should not be draining from the conduit. Edema and a red color of the stoma are expected

outcomes in the immediate postoperative period, as is mucus from the stoma.

39. A nursing care plan for a client with a suprapubic cystostomy would

include

a. Placing a urinal bag around the tube insertion to collect

the urine

b. Clamping the tube and allowing the client to void through

the urinary meatus before removing the tube

c. Catheter irrigations every 4 hours to prevent formation of

urinary stones

d. Limiting fluid intake to 1500 mL per day

Answer: b

Rationale: Allowing the client to void naturally will be done prior to removal of the

catheter to ensure adequate emptying of the bladder. Irrigations are not recommended,

as they increase the chances of the client developing a urinary tract infection. Any time

a client has an indwelling catheter in place, fluids should be encouraged (unless

contraindicated) to prevent stone formation.

40. For a client who has ataxia, which of the following tests would

be performed to assess the ability to ambulate?

a. Kernig's

b. Romberg's

c. Riley-Day's

d. Hoffmann's

Answer: b

Rationale: Romberg's test is the ability to maintain an upright position without swaying

when standing with feet close together and eyes closed. Kernig's sign, a reflex contraction,

is pain in the hamstring muscle when attempting to extend the leg after flexing the thigh.

41. A client admitted to a surgical unit for possible bleeding in the cerebrum

has vital signs taken every hour to monitor to neurological status. Which

of the following neurological checks will give the nurse the best information

about the extent of bleeding?

a. Pupillary checks

b. Spinal tap

c. Deep tendon reflexes

d. Evaluation of extrapyramidal motor system

Answer: a

Rationale: Pupillary checks reflect function of the third cranial nerve, which stretches

as it becomes displaced by blood, tumor, etc.

42. Assessing for immediate postoperative complications, the nurse knows that

a complication likely to occur following unresolved atelectasis is

a. Hemorrhage

b. Infection

c. Pneumonia

d. Pulmonary embolism

Answer: c

Rationale: Pneumonia is a major complication of unresolved atelectasis and must be treated

along with vigorous treatment for atelectasis. Hemorrhage and infection are not related to

this condition. Pulmonary embolism could result from deep vein thrombosis.

43. A young client is in the hospital with his left leg in Buck's traction. The

team leader asks the nurse to place a footplate on the affected side at the

bottom of the bed. The purpose of this action is to

a. Anchor the traction

b. Prevent footdrop

c. Keep the client from sliding down in bed

d. Prevent pressure areas on the foot

Answer: b

Rationale: The purpose of the footplate is to prevent footdrop while the client is

immobilized in traction. This will not anchor the traction, keep the client from sliding

down in bed, or prevent pressure areas.