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Questions I got wrong from your best grade. 1. For steroids that have Crohn’s disease, Yearly colonoscopy for colorectal cancer screening, bone density assessment, routine liver function tests, routine kidney function tests. Remember crohn’s ulcerative colitis is at a high risk for developing colorectal cancer. 2. NG tube (NGT) who has dysphagia DO NOT ask client to take a sip of water when advancing the tube can cause nasopharynx, if unable to advance the NG tube using a non-swallowing technique, the client should be referred to radiology for placement. 3. Systemic infection of foot wound Increased HR, palpable lymph nodes in the groin area, white clammy skin 4. IF A CHEST X-RAY SHOWS NO ABNORMALITIES MAY INDICATE PULMONARY CONTUSION affects one or both lungs. ARDS typically develops 24hrs or longer after chest injury & it affects BOTH lungs (common complication of pulmonary contusions). Pneumothoraxes have a thin sharp line that separates normal lung tissue from the peripheral space on chest x-ray. Hemothorax will show as a pleural effusion. 5. People with type 2 diabetes who has steep rise serum glucose >600 & serum osmolality is at risk for developing HHS non-kenotic syndrome. Which can CAUSE PROFOUND DEHYDRATION (FVD can reach up 10 liters). HHS can be provoked by underlying INFECTION, STRESS OR SURGERY. 6. To prevent cross contamination by implementing isolation, washing hands before entering the room. 7. Cushing’s syndromeDisturbed thought processes 8. Which medication should the nurse assess for signs of constipation  codeine cough syrup, codeine slows down peristalsis in the GI & frequently causes CONSTIPATION (antacids & PPIs also cause constipation). Cimetidine (histamine-2 receptor blocker) Diarrhea, gynecomastia & HA’s. PrednisoneHTN, blood glucose abnormalities, wt gain, peptic ulcer formation. Ganciclovir(antiviral) should be monitored for abnormal blood values(anemia, thrombocytopenia, neutropenia) & elevated liver function tests. 9. To dx TIA all neurological symptoms must have resolved within 24 hrs 10. When starting DMARDS ALL CLIENTS MUST GET A CHEST X-RAY TO RULE OUT TB to prevent reactivation of hep B& C. DMARDS are immunosuppressive medications. 11. Most common cause of left hypertrophy & LHR is HTNprovide salt-free meals. 12. Infant with cleft lip Feed the baby in upright position, hold upright for 30 minutes after feeding, burp after every 15 to 30 ml of fluid. Feed using a syringe placed on the inside of the mouth is used after cleft lip is repaired. 13. When a controlled substance are missing  complete an occurrence report, recount the controlled substance to confirm 14. Prolonged PR intervalINDICATES CARDIA DEPRESSION, notify HCP for changes (giving lidocaine could further cardiac depression) 15. Total hip replacement 30 minutes after administering pain medication and still reporting pain  remove blankets to inspect the feet and legs (could be a sign of prosthesis dislocation) 16. PREPARING IV SOLUTION  Removes the protective cap from fluid bag and the spiked ending of tubing, while keeping the spike sterile, fills drip chamber half way by pinching & releasing it, primes the line prior to connecting to the client, closes roller clamp. Before spiking the bag the nurse should close the tubing clamp and keep the IV bag inverted. It will prevent fluid from

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spilling all over the floor and air entering the tubing system. Once the bag is spiked & the drip chamber is filled the bag can be hung on the IV pole. Verbalizing feelings the nurse voices something that the pt seems to have implied feelings. Exploring ”tell me more” without making assumptions. General leads  “I see”, “go on” & “um hum” In EMERGENT PAHSE OF HYPOVOLEMIC SHOCK GIVE LACTATED RINGER’S for INTIAL TX. Freud stages of psychosexual developmentoral stage (birth-18months) weaning or thumb sucking, Anal stage (18months-3-4yrs) toilet training or constantly adjusting underclothing around the buttock region, Phallic stage (3-4yrs-5-7yrs) sexual identity or self-fondling genitals, latency stage (5-7yrs-puberty) learning or looking at educational materials in the client lounge LATE SIGNS OF ICP IN PEDS WIDENING PULSE PRESSURE, BRADYCARDIA, INCREASED SYSTOLIC PRESSURE (CUSHINGS TRIAD) & FIXED & DILATED PUPILS EARLY SIGNS OF ICP IN PEDS N/V, Dizziness, HA, pupils unequal Head lice prescribed with pediculicide shampoo a nit comb should be used every 2-3 days to remove dead eggs. Nits (eggs), nymphs (hatch from the egg & mature into adults), adult lice (tan colored & moved through the hair across the scalp). If shampoo is used while lice are in the nits stage then they will not hatch (no need to repeat tx shampoo in 7-10 days if nits are still present) ONLY REPEATED IF LIVE LICE ARE FOUND 7-10 DAYS AFTER TX EXPECTED DEVELOPMENTAL MILESTONES FOR A 9 MONTH OLD pulling up to stand, drinking from a cup, saying mama/dada & using a pincr grasp (thumb & index finger) GROSS MOTOR SKILLS sitting without support, crawling or scooting. USING A RAKING MOTION TO PICK UP OBJECTS IS A 6 MONTH MILESTONE & NOT ADVANCING TO A PINCER GRASP AT 9 MONTHS COULD BE AN EARLY SIGN OF FINE MOTOR DELAY. 12 MONTHS MILESTONE  using utensils, true words not expected till 12 months. Scalp rash (cradle cap) yellow greasy scales & slight erythema. CAN USE SELENIUM SULFIDE. Can occur on the face, trunk (folds), neck & diaper area. Rub scalp with baby oil before washing & washing daily PEDS with CF don’t need to be in a negative pressure room, high calorie & high fat diet Injection in deltoid no more than 1ml should be administered at the site, ventrogluteal sitepreferred site for IM injections b/c it contains no large nerves or blood vessels, vastus lateralis site choice for IM injections for infants 1 yr & younger, rectus femoris site  site for pt’s to administer their own injections b/c it can be easily reached S/S OF HEAT STROKE TEMP >103, RED, HOT, DRY SKIN, & FAST BOUNDING PULSE,  MONITOR THROBBING HA, DIZZINESS, NAUSEA, CONFUSION, SEVERE LOC. INTERVENTIONS BODY TEMP EVERY 10 MIN, PREPARE FOR TRANSPORT TO LOCAL ED, MOVE INDOORS, SPRAY CHILD WITH COOL WATER FROM HOSE. DO NOT GIVE JUICE OR POPSCILE. PICC LINE DOES NOT NEED TO BE CHANGED OFTEN CAN BE LEFT IN PLACE FOR WEEKS-MONTHS. Utilize a home infusion therapy company. NSAIDS FOR PAIN MEDICATIONS FOR TOF  beta blockers & morphine BENIGN FOCAL EPILEPSIY PROVIDE REASSURANCE, PROVIDE VERBAL INSTRUCTIONS TO THE CLIENT DURING THE SEIZURE Crohn’s disease bowel movementloose watery stools Acetaminophen is unlikely to cause epigastric distress WBC>26,000 may indicate a perforated appendix

34. In a young child, ages 3 to 6 years, the maximum volume of medication that can be safely injected into the ventral gluteal muscle is 1.5 mL. 35. Yin foods are considered to be COLD, yang foods are considered to be HOT 36. Assessment findings associated with fluid volume excess include cough, dyspnea, crackles, tachypnea, tachycardia, elevated blood pressure, bounding pulse, elevated CVP, weight gain, edema, neck and hand vein distention, altered level of consciousness, and decreased hematocrit. 37. HYPERNAcushing’s, client taking corticosteroids and the client with hyperaldosteronism, Increased specific gravity of the urine, decreased UO, muscle twitches 38. HYPONAmuscle weakness, increased urinary output, and decreased specific gravity 39. Asses for tachypnea & crackles in pulmonary venous congestion, green sputum implies pulmonary infection 40. Hypoglycemiasweating & HA, fatigue. WEIGHT LOSS & POOR APPETITE TYPICALLY SEEN IN CHILDREN WITH TYPE 1 DIABTES EXPERIENCING HYPERGLYCEMIA. 41. Educate that inhaled steroids (fluticasone) may DECREASE growth velocity which is most pronounced in the 1st year of tx. 42. COUGH MEDICINE IS NOT RECOMENED FOR CHILDREN UNDER 4 43. 5yr old should be able to draw a square or a person, copying a circle is appropriate for age 3. 44. Meningococcal vaccine 11-3 & booster at 16 45. ASSESS FOR HIP DYPLASIA BARLOW MANEUVER, Flex hips to 90 degrees. Gently adduct thighs to midline while applying downward & latera pressure (should hear a clunk sound, palpable clunk indicates that the femoral head dislocates). Other findings for developmental dysplasia is asymmetrical inguinal skin folds, leg length discrepancy & POSITIVE ORTOLANI SIGN  flex hips 90 degrees & gently abduct thighs from neutral position while applying anterior pressure( A clunk is hear when the femoral head is reduced back into the socket) abduction & internal rotation of the extended leg are used to evaluate hip dysfunction in adults 46. Erikson psychosocial Infancy(0-1) trust vs mistrust, toddler(1-3)-Autonomy vs shame(encourage Autonomy by allowing the toodler to climb the stairs wither supervision), preschool(3-6)-initiative vs guilt (sit still & stop touching everything), school age(6-12)-industry vs inferiority, Adolescence(12-18) Identity vs Confusion 47. Orchiopexy  surgical procedure for undescended testicle is moved into the scrotum & secured into place to prevent twisting & retracting NOT DONE BEFORE 6 MONTHS. Avoid straddling the pt across the hip for 2 weeks & apply an antibacterial ointment over the incision, regular bathing can resume the day after surgery, steri-strips should be left on the skin for up to 2 weeks 48. Acromial process can be used after age 3(deltoid muscle) 49. PED EVALUATION OF RIGT INGUINAL CRYPTORCHIDISM(testicle does not descend into the scrotum, premie males are prone & often present with unilateral, COMMON PLACES-abdominal, inguinal, & suprascrotal areas) Place the pt in supine position, abduct the pt’s thighs, remove the pt’s diaper, place gentle upward pressure on the suprapubic area, palpate the inguinal canal with a warm hand. 50. S/s of shunt failure irritablity, malaise, HA, Nausea & low grade fever 51. Bicarb is lost due to diarrhea since it’s considered the body’s base. To compensate for increased acidity of the internal environment, breathing frequency increases, causes more CO2 to be expelled out to restore balance

52. SGA COMPLICATIONS meconium aspiration, hypoglycemia, hypothermia, hypervisocity(increased thickness of the blood) caused by increased fetal RBCs production due to intrauterine stress & fetal hypoxia. Hyperviscosity can result in HF, stroke, & resp distress after birth 53. BP readings obtained in the legs are generally higher than the arm. It can increase by 1040mmHg. 54. PROTIEN,ZINC & VIT C ARE NEEDED TO HELP WITH WOUND HEALING IN STAGE 4 PRESSURE ULCER 55. Humidification of the oxygen source is required at all times to prevent damage to the mucosa & to keep secretions liquified. CUFF PRESSURE SHOULD RANGE 15-30CM H2O 56. Obtain vancomycin trough levels(drawn q 30 mins before next dose, typically drawn after the 3rd dose & before the 4th, trough levels 10-20, if its too low increase the dosage, if its too high hold med or decrease it, OTOTXCITY & NEPHROTOXCITY, administer IV vancomycin infusion(OVER 60 MINS), administer IV ceftriaxone infusion(NOT COMPATIBLE WITH make sure to flush iv line before administering over 30mins), obtain vancomycin peak level(drawn 12 hrs after, peak levels 25-50), collect blood culture specimen 57. Veracity telling the truth, non-maleficencedo no harm describes the duty to no harm or cause harm to the pt, beneficencedo good & relates to the duty to always act in the pt’s best interest. 58. To prevent systemic absorption of the eye, apply pressure on the lacrimal duct after providing the medication 59. RECOMMENDED MACRONUTRIENT DISTRIBUTION45-65% CARBS, 20-35% FATS, 10-35% PROTEINS 60. Post exposure prophylaxis for HIV Zidovidune (very low risk newborns) ART for high risk newborns 61. Reasoning for taping the eye shield from mid forehead to left zygomatic bone the tape stays secure as the placement does not involve facial hair, we want to avoid obstructing the pt’s right eye, this placement ensures the tape does not obstruct the pt’s nares, securing the shield this way may minimize impact on facial movement, it prevents the shield from sliding down on the cheek 62. Prescence of a large U wave my indicate hypokalemia, hypokalemia is a known SE of fursemide 63. Self management means the pt is actively involved in the management of the disorder 64. OCCUPATIONAL THERPIST CAN HELP SELECT TOOLS THAT PROMOTE MOBILITY & ASSIST THE PT WITH ADLS 65. SIGNS OF ACUTE PAIN TACHYCARDIA, DISPHRORESIS & TACHYPNEA 66. Elevated temperatures in burns is COMMON due to inflammatory response & is a poor indicator of infection. LOOK FOR GREEN-YELLOW DRAINGE INDICATES INFECTION. Full thickness burns can lead tomassive fluid loss resulting in hypovolemia, infection, hypokalemia, hypoalbuminemia, hypothermia, tissue ischemia 67. SCI REMEMBER TO NOT BEND OR TWIST TORSO LOGROLL PT WHEN MOVING IN BED 68. Genital herpes infection explain that the infection can be transmitted to others during & between outbreaks, obtain a blood & urinary sample, check the pt’s HPV vaccination status 69. Neutophils50, previous breast cancer diagnosis, exposure to radiation, use of oral contraceptives, & obesity, no kids (or baby after 30), pt reports using combined hormonal replacement therapy since menopause, pt has a sibling with breast cancer at age 55 Windshield assessment is used to collect data about a community’s environment. This method reveals common characteristics about how people live, where they live & type of housing they have Cyclosporine modified (gengraf)immunosuppressant medication used to prevent organ rejection in pt’s with transplants. It can also be used to tx autoimmune conditions such as RA & psoriasis. SE- malignant HTN, electrolyte imbalance(hypomg, hyperk, hyperuricemia), LIVER & KIDNEY TOX, NEUROTOX, clotting abnormalities, hirsutism, gingival hyperplasia & acne Hyperosmotic hyperglycemic nonketotic syndrome(HHNS) glucose >600mg/dl, absence of ketones, serum osmolality>300, dehydration. Expect dry mucous membranes, tachycardia, hypotension, some cases altered mental statis. Septicdue to massive release of immune system mediators secondary to infection. tachycardia, tachypnea, hypotension, flushed (early shock) or pale/cool skin (late shock), hypothermia/hyperthermia, bounding pulse & altered LOC

42. Cardiogenic shockdue to an obstruction of the heart or its great vessels (massive pulmonary embolism, pericarditis) tachypnea, tachycardia, hypotension, pale/cool/clammy skin, NO change in temp, decreased or no UO, chest pain, syncope, JUGULAR VEIN DISTENSION 43. Hypovolemic shockas a response to reduced blood volume(massive hemorrhage, dehydration). Tachypnea, tachycardia, hypotension, pale/cool/clammy skin, weak pulses, confusion, dizziness, little no UO 44. Tx for neurogenic shockimmobilization, airway management, IV fluids, vasopressors(phenylephrine) & meds to help regulate HR & rhythm(atropine), & tx the underlying cause 45. Occlusion of the LAD results in anterior MI small complex tachycardia, ST elevations in V1-V6, pathological Q waves in V1-V4. Inferior MI due to obstruction of the right coronary artery (RCA)broad complex bradycardia, ST elevation in II, III & aVF, ST depression in I, aVl. Wolfparkinson white syndrome (AV re entrant tachycardia) Broad complex tachycardia, delta waves, shortened PR interval. Complete right bundle branch blockQRS prolongation, rSR “rabbit ear” pattern in V1, ST depression in several chest leads 46. START IS FOR MASS CASULTY EVENTS DO NOT CONFUSE WITH EMERGENCY ROOM TRIAGE 1. The walking wounded (green), 2. Immediate (red), 3. Delayed (yellow), 4. Unsalvageable (black) 47. Normal pulmonary artery wedge pressure (8-10mmhg) the pulmonary artery wedge pressure reflects the left atrial left ventricular end- diastolic pressures, which estimate preload of the left ventricle. When the pressure is elevated the client could be experiencing LEFT VENTRICULAR FAILURE 48. Normal range for amylase 30-110 units per liter, lipase level 0-160 (both responsible for the pancreas) 49. Dupuytren contracture is a connective tissue disorder that results in fibrosis of the plamar fascia. Pt’s have difficulty extending the 4th & 5th finger. The nurse should palpate the pt’s palm & assess for nodules & thickening & stiffness of palmar connective tissue. Tinel testgently tap the inside of the wrist & ask if the pt experiences pain & tingling in the 4 th & 5th finger, this test is used to provoke s/s associated with carpal tunnel syndrome. OAinspect the hands for deformity & crepitus of the distal & proximal interphalangeal joints, s/s pain. Neurological examask the pt to make a fist around the nurse’s index fingers & squeeze as hard as he can, used to assess finger strength in pt’s recovering from stroke....