Nclex Flashcards – Nclex Guide

Mark Klimek Blue Book Flashcards

nclexguide.com — Fri, 07 Nov 2025 18:50:13 +0000

Prepare for the NCLEX-RN exam with the complete Mark Klimek Blue Book Flashcard Collection! This resource features over 2,000 verified NCLEX-style questions and answers drawn from Mark Klimek’s renowned Blue Book lectures — now fully organized by official NCLEX Test Plan categories.

Each section below contains categorized flashcards that cover critical nursing concepts — from Management of Care and Infection Control to Pharmacology and Physiological Adaptation. Use these to reinforce your clinical reasoning, strengthen memory retention, and boost your confidence on test day.

Tip: You can study directly on this page or browse through each flashcard set. The system automatically remembers your progress, allowing you to continue from where you left off when you return using the same browser.

Safe and Effective Care Environment – Management of Care

[{"q":"Is informed consent required before cystoscopy?","a":"Yes."},{"q":"Is hospitalization required for mild preeclampsia?","a":"No, managed at home with rest."},{"q":"Is informed consent required for a spinal tap?","a":"Yes."},{"q":"What is the best way to identify a patient accurately before a procedure?","a":"Check the identification wristband."},{"q":"Is informed consent required for ECT?","a":"Yes."},{"q":"Is informed consent required for an EEG?","a":"No."},{"q":"Can EGD be performed on an uncooperative client?","a":"No, cooperation is required."},{"q":"What pre-test steps must be completed before EGD?","a":"Remove dentures and eyeglasses, sign consent form, and remain NPO after midnight."},{"q":"During which step of the nursing process does the nurse ask the family about their beliefs regarding illness?","a":"The assessment phase."},{"q":"Before evidence can be collected in a rape case, what must be completed?","a":"Signed consent forms."},{"q":"Should a female staff member be present during examination of a rape victim?","a":"Always."},{"q":"The rape victim requires only a pelvic exam. (T\/F)","a":"False — a complete head-to-toe examination is required for evidence collection."},{"q":"Should the vaginal speculum be lubricated during the rape exam?","a":"No, lubrication may alter or destroy evidence."},{"q":"After discharge, how is contact with the rape victim typically maintained?","a":"By telephone follow-up."}]

Safe and Effective Care Environment – Safety and Infection Control

[{"q":"In the emergent phase (field) of burn care, should you cover burns?","a":"Yes, cover with anything clean and dry."},{"q":"Should adhered clothing be removed from a burn?","a":"No."},{"q":"If a child swallows a potentially poisonous substance, what should be done first?","a":"Call for medical help immediately."},{"q":"Should vomiting be induced after ingestion of gasoline or petroleum products?","a":"No, never induce vomiting for petroleum ingestion."},{"q":"When taking a child to the ER after accidental poisoning, what should accompany the child?","a":"The suspected poison container."},{"q":"Which age groups are at high risk for accidental poisoning?","a":"Elderly clients (due to poor eyesight) and school-age children."},{"q":"Through which four routes is AIDS transmitted?","a":"Blood, sexual contact, breastfeeding, and transplacental (in utero)."},{"q":"Is HIV present in all body fluids?","a":"Yes, but it is transmitted only through blood, semen, and breast milk."},{"q":"If the AIDS patient has leukopenia, what type of isolation is used?","a":"Protective (reverse) isolation."},{"q":"Without leukopenia, what precautions should AIDS patients be under?","a":"Standard or blood and body fluid precautions."},{"q":"When the AIDS patient has a low platelet count, what precautions are indicated?","a":"Bleeding precautions—no IM injections, no rectal temperatures, and careful monitoring."},{"q":"Does AIDS require a private room?","a":"Yes, if WBC count is low."},{"q":"When is a gown needed for AIDS patient care?","a":"When contact with secretions is likely."},{"q":"When is a mask needed for AIDS patient care?","a":"Only if the patient has an airborne infection."},{"q":"When are goggles needed for AIDS patient care?","a":"During suctioning, central line starts, or arterial procedures."},{"q":"How should an area contaminated by an AIDS patient’s blood be cleaned?","a":"With a 1:10 bleach-to-water solution."},{"q":"Are all articles used by AIDS patients double-bagged?","a":"No, only items contaminated with secretions."},{"q":"Can AIDS patients leave the floor?","a":"Yes, unless WBC count is extremely low."},{"q":"What is the main danger to staff caring for a client with a cesium implant?","a":"Radiation hazard."},{"q":"What are the three key principles of radiation safety?","a":"Distance, shielding, and time."},{"q":"Does a woman with a cesium implant have a Foley catheter?","a":"Yes."},{"q":"From where should the nurse provide care to a client with a cesium implant?","a":"From the head of the bed."},{"q":"How may a woman with a cesium implant move in bed?","a":"Side to side only."},{"q":"What four symptoms in a client with a cesium implant must be reported immediately?","a":"Profuse vaginal discharge, elevated temperature, nausea, and vomiting (signs of infection or perforation)."},{"q":"Should pregnant staff care for a client with a cesium implant?","a":"No."},{"q":"Can the head of bed be elevated for a woman with a cesium implant?","a":"Yes, but not more than 45 degrees."},{"q":"From where should the nurse communicate with the client with a cesium implant?","a":"From the doorway."},{"q":"Is bed rest necessary while a cesium implant is in place?","a":"Yes, absolute bed rest."},{"q":"How long can a nurse attend a client with a cesium implant each day?","a":"No more than 30 minutes total."},{"q":"What should the nurse do if the cesium implant falls out?","a":"Pick it up with forceps only—never touch it, even with gloves."},{"q":"Should the nurse provide perineal care to a client with a cesium implant?","a":"No, due to radiation hazard."},{"q":"What is a high-priority nursing diagnosis after cataract surgery?","a":"Safety."},{"q":"What is the number one problem associated with central lines?","a":"Infection."},{"q":"How often should central line dressings be changed?","a":"Every other day (QOD)."},{"q":"What type of dressing is used on a central line insertion site?","a":"Sterile occlusive dressing."},{"q":"What should the patient do during central line tubing changes?","a":"Turn head away, hold breath, and perform the Valsalva maneuver."},{"q":"If a central line is found open accidentally, how should the patient be positioned?","a":"On the left side."},{"q":"Should CVA patients have all four side rails up at all times?","a":"Yes, but restraints should not be used unless necessary for safety."},{"q":"Do preschoolers sometimes require physical restraint during painful procedures?","a":"True."},{"q":"Which age group most often uses stalling tactics before painful procedures?","a":"School-age children."},{"q":"Which age groups are most likely to physically resist the nurse during procedures?","a":"School-age children and adolescents."},{"q":"Do toddlers sometimes require restraint for painful procedures?","a":"True."},{"q":"Is the infant restrained before cleft repair surgery?","a":"No, only after surgery."},{"q":"What device is used to restrain the infant after cleft repair?","a":"Elbow restraints."},{"q":"How is the Logan bow cared for?","a":"Remove gauze before feeding, cleanse after feeding with hydrogen peroxide and saline."},{"q":"Should hearing aids be removed before surgery?","a":"Yes, but only immediately before surgery."},{"q":"What solution should be used to clean a hearing aid?","a":"Soap and water."},{"q":"What solution is best when removing a client’s contact lenses?","a":"Sterile saline."},{"q":"Can alcohol be used to clean a hearing aid’s earmold?","a":"No, it dries and cracks the material."},{"q":"What can be used to clean the connecting tube of a hearing aid?","a":"A pipe cleaner."},{"q":"Should PCA drug cartridges be discarded when discontinued?","a":"No, they must be returned to the pharmacy per narcotic laws."},{"q":"Which patients should never be allowed to smoke or smoke alone?","a":"Those using oxygen or who are confused, sedated, or sleepy."},{"q":"When applying restraints, what precautions must be taken?","a":"Avoid bruising, impaired circulation, or accidental entanglement."},{"q":"How can privacy be maintained in shared rooms?","a":"Use drapes or screens during personal care."},{"q":"When restraining clients who object, what legal concern must be avoided?","a":"False imprisonment."},{"q":"When the nurse is not at the bedside, what position should the bed always be in?","a":"Lowest position."},{"q":"Can nurses be held liable if a client is injured after not being told how to use the call light?","a":"Yes."},{"q":"What danger is associated with drafts in hospital rooms?","a":"Spread of microorganisms through air currents."},{"q":"What should the nurse do first if a client objects to side rails?","a":"Explain why they are being used."},{"q":"Is verbal identification by the client adequate for safety purposes?","a":"No, identification bands must always be used."},{"q":"For which clients should bedside rails always be raised?","a":"Elderly, unconscious, infants, children, restless or confused clients."},{"q":"If a family member requests side rails down while visiting, what should the nurse do?","a":"Decline politely; the nurse is responsible for client safety."},{"q":"Are pillows sterilized between uses?","a":"No."},{"q":"What is pediculosis commonly known as?","a":"Lice."},{"q":"What finding is common with pediculosis pubis?","a":"Reddish-brown powder (lice feces) in underwear."},{"q":"What household solution helps remove lice eggs (nits)?","a":"Vinegar."},{"q":"Where are head lice most commonly found?","a":"Back of the head and behind the ears."},{"q":"On what do lice feed?","a":"Human blood."},{"q":"How long should a client be inspected for lice after treatment?","a":"2 weeks."},{"q":"What is the most common symptom of lice infestation?","a":"Itching."},{"q":"What main safety precaution is important during PD?","a":"Prevent falls and dizziness due to fluid shifts."},{"q":"What precautions are essential for severe preeclampsia?","a":"Seizure precautions."},{"q":"Name five seizure precaution measures.","a":"Suction and oxygen at bedside, padded side rails ×4, remain on unit, supervised ambulation, ≤1 pillow."},{"q":"What is the major danger of PROM?","a":"Infection."},{"q":"How can you tell if a woman with PROM has infection?","a":"Maternal fever, fetal tachycardia, foul vaginal discharge."},{"q":"If infection signs appear after PROM, what must be done?","a":"Immediate delivery."},{"q":"Should sexual intercourse be avoided after PROM?","a":"Yes."},{"q":"Should clients on Heparin use an electric or safety razor?","a":"Electric razor."},{"q":"What are Montgomery straps used for?","a":"To change dressings without tape and protect skin."},{"q":"Leaving a wound open to air decreases infection by eliminating what 3 conditions?","a":"Darkness, warmth, and moisture."},{"q":"When removing tape, pull (toward\/away) from the wound.","a":"Toward the wound."},{"q":"What type of dressing prevents microorganisms from entering or leaving the wound?","a":"Occlusive dressing."},{"q":"What solution protects the skin from tape irritation?","a":"Tincture of benzoin."},{"q":"When cleaning an incision, where should you start?","a":"At the incision site and move outward."},{"q":"After removing a soiled dressing, what must be done before applying a sterile one?","a":"Wash hands and don sterile gloves."},{"q":"When a dressing is saturated, can germs enter from outside?","a":"Yes, through capillary action."},{"q":"When is it inappropriate to change a dressing?","a":"During mealtime."},{"q":"What solution should be applied to skin under a brace?","a":"Tincture of benzoin or alcohol (no lotions)."},{"q":"After scoliosis surgery, how is the client turned?","a":"Log-rolled while in a body cast."},{"q":"What is the number one goal in emergency spinal cord injury management?","a":"Immobilize the spine."},{"q":"What maneuver is used to open the airway if spinal injury is suspected?","a":"Modified jaw thrust."},{"q":"In spinal cord injury, the neck should never be ______.","a":"Moved or hyperextended."},{"q":"Define asepsis.","a":"Absence of disease-causing microorganisms."},{"q":"Define antiseptic.","a":"A substance that destroys or inhibits pathogen growth but not spores; safe for use on people."},{"q":"Define disinfectant.","a":"A substance that destroys pathogens but not spores; not intended for human use."},{"q":"Define bactericide.","a":"A substance that kills microorganisms but not necessarily their spores."},{"q":"Define bacteriostatic.","a":"A substance that inhibits the growth of microorganisms."},{"q":"Define anaerobe.","a":"An organism that lives without oxygen."},{"q":"Define aerobe.","a":"An organism that requires oxygen to live."},{"q":"Define pathogen.","a":"A microorganism that causes disease."},{"q":"Define clean technique.","a":"Practices that reduce the number and spread of microorganisms (medical asepsis)."},{"q":"Define sterile.","a":"Free from all microorganisms."},{"q":"Define host.","a":"A living organism that harbors microorganisms."},{"q":"Define portal of entry.","a":"The route through which microorganisms enter the body."},{"q":"Define contaminate.","a":"To make something unclean or unsterile."},{"q":"Define surgical asepsis.","a":"Practices that eliminate all microorganisms (sterile technique)."},{"q":"Define medical asepsis.","a":"Practices that reduce microorganisms (clean technique)."},{"q":"Define spore.","a":"A dormant form of a microorganism that can survive in harsh conditions."},{"q":"Which hand holds the suction catheter and which holds the connecting tube?","a":"Dominant hand holds the catheter; non-dominant holds the connecting tube."},{"q":"What type of asepsis is required during airway suctioning?","a":"Surgical asepsis (sterile technique)."},{"q":"What type of lubricant is used for suctioning?","a":"Sterile water-soluble lubricant."},{"q":"Should suction be continuous or intermittent?","a":"Intermittent, to prevent mucosal damage."},{"q":"For how long should suction be applied per entry?","a":"No longer than 10 seconds."},{"q":"How often should the tubing be cleared during suctioning?","a":"After each pass or removal."},{"q":"To suction the right mainstem bronchus, which way should the head be turned? The left mainstem bronchus?","a":"Turn head to the left for right bronchus, to the right for left bronchus."},{"q":"When should suction be applied—during insertion or removal?","a":"During removal of the catheter."},{"q":"What solution is used to clear the suction tubing?","a":"Sterile saline."},{"q":"What safety measures are included in standard suicide precautions?","a":"Remove sharp objects, drugs, or hanging devices and maintain constant one-to-one observation."},{"q":"Should the nurse change the initial post-mastoidectomy dressing?","a":"No, only reinforce it; the physician performs the first change."},{"q":"In the chain of infection, handwashing breaks which link?","a":"The mode of transmission."},{"q":"What is the most effective way to reduce hospital-acquired (nosocomial) infections?","a":"Proper hand hygiene."},{"q":"Should sterile gloved hands be kept above the waist?","a":"Yes, always."},{"q":"When putting on the second sterile glove, should you grasp the cuff?","a":"No, insert fingers under the cuff to avoid contamination."},{"q":"When putting on the first sterile glove, should you grasp the cuff?","a":"Yes."},{"q":"Should the thumb of the gloved hand be used while donning the second glove?","a":"No, this could contaminate the glove."},{"q":"Airborne microorganisms travel on what particles?","a":"Dust or water droplets."},{"q":"What is another term for medical asepsis?","a":"Clean technique."},{"q":"When opening a sterile pack, how should you unfold the top flap?","a":"Away from your body."},{"q":"What is another name for surgical asepsis?","a":"Sterile technique."},{"q":"Where should a sterile field be set up in a client’s room?","a":"On the overbed table."},{"q":"What is the goal of medical aseptic technique?","a":"To reduce the number of microorganisms, not eliminate all of them."},{"q":"What does “nosocomial infection” mean?","a":"An infection acquired in a healthcare facility."},{"q":"When pouring sterile liquid, from what height should you pour?","a":"6 to 8 inches above the sterile field."},{"q":"Should you wash your hands before putting on gloves?","a":"Yes, always. Handwashing is required even if gloves are used."},{"q":"Do surgical aseptic techniques eliminate all microorganisms?","a":"Yes, they maintain a sterile environment."},{"q":"Should you ever turn your back to a sterile field?","a":"No, it may contaminate the field."},{"q":"What should you do if you accidentally reach across a sterile field?","a":"Consider the field contaminated and replace the sterile setup."},{"q":"In what type of environment do microorganisms grow best?","a":"Warm, dark, and moist conditions."},{"q":"Are the edges of a sterile field considered sterile?","a":"No, the outer one-inch border is considered contaminated."},{"q":"Can you pour sterile water directly into a sterile basin after opening the bottle?","a":"No, pour a small amount into a waste container first to cleanse the bottle lip (“lipping”)."},{"q":"Should nurses wear gloves when applying topical skin preparations?","a":"Yes."},{"q":"Is strict sterile technique required for vaginal medication administration?","a":"No, medical asepsis (clean technique) is sufficient."},{"q":"Is sterile technique required for rectal drug administration?","a":"No, clean technique is adequate."},{"q":"Is it safe to administer medications prepared by another nurse?","a":"No, each nurse must administer only drugs they prepare."},{"q":"Can medications be left at the bedside without an order?","a":"No, a physician’s order is required."},{"q":"Should needles ever be recapped after use?","a":"No, never recap used needles."},{"q":"What should you do if blood appears in the syringe upon aspiration?","a":"Remove the syringe immediately, apply pressure, discard it, and prepare a new syringe with fresh medication."},{"q":"What safety precautions are important for clients with Meniere’s disease?","a":"Keep side rails up and assist with ambulation."},{"q":"What isolation precautions are required for meningitis?","a":"Contact and respiratory precautions."},{"q":"How long should isolation be maintained in meningitis?","a":"Until the patient has been on antibiotic therapy for at least 48 hours."},{"q":"What emergency equipment should be kept at the bedside for MG patients?","a":"Suction apparatus and a tracheostomy or endotracheal setup for airway support."},{"q":"Which clients should have toenails trimmed only by a physician?","a":"Diabetics, clients with peripheral vascular disease, or those with very thick nails."},{"q":"Can nurses provide perineal care to clients of the opposite sex?","a":"Yes, it is permitted professional care."},{"q":"Clients on which therapy must use a safety blade (non-electric) razor?","a":"Oxygen therapy (to prevent sparks)."},{"q":"How should a nurse carry soiled linen?","a":"In a neat bundle held away from the body."},{"q":"What pre-procedure orders are common before ECT?","a":"NPO after midnight, remove dentures, have the client void, raise side rails."},{"q":"When are activity restrictions necessary after an EEG?","a":"Only if sedatives were used; side rails should remain up."},{"q":"Should the client wash their hair before an EEG?","a":"Yes, to remove oils that interfere with electrode contact."},{"q":"What should the client do after an EEG?","a":"Wash their hair to remove electrode paste."},{"q":"What should parents do if epiglottitis is suspected?","a":"Take the child to the emergency department immediately."},{"q":"Should side rails be up after EGD?","a":"Yes, until sedative effects have worn off."},{"q":"Should side rails be raised after stapedectomy?","a":"Yes, the client may experience dizziness."},{"q":"What activities should be avoided post-stapedectomy?","a":"Coughing, sneezing, nose blowing, swimming, showers, and flying."},{"q":"Should a woman douche after surgery to remove an ovarian cyst?","a":"No, douching is not recommended as it destroys the natural protective vaginal flora."},{"q":"When using nasal cannulae, besides the nares, where should the nurse check for skin irritation?","a":"Behind and on top of the ears."},{"q":"Can a client smoke in a room if the oxygen is turned off?","a":"No, the oxygen source must be completely removed from the room before smoking."},{"q":"What are the three safety principles for nurses caring for clients with sealed radioactive implants?","a":"Time, distance, and shielding."},{"q":"Which radiation treatment is most dangerous to nurses: sealed internal, unsealed internal, or external?","a":"Sealed internal radiation, followed by unsealed internal; external therapy poses no danger unless the nurse is in the treatment room during exposure."},{"q":"Should pregnant nurses care for clients receiving sealed internal radiotherapy?","a":"No, absolutely not."},{"q":"Should pregnant nurses care for clients receiving unsealed internal radiotherapy?","a":"Only if they avoid contact with the client’s body secretions."},{"q":"When a patient is receiving radioactive iodine, what precautions are essential?","a":"Wear gloves when in contact with urine and follow strict urine disposal procedures."}]

Health Promotion and Maintenance

[{"q":"Name the six essential nutrients.","a":"Carbohydrates, fats, proteins, vitamins, minerals, and water."},{"q":"What is the major source of energy for the body?","a":"Carbohydrates."},{"q":"How many kilocalories per gram do carbohydrates provide?","a":"4 kcal per gram."},{"q":"Sucrose is a sugar found in what foods?","a":"Fruits and vegetables."},{"q":"Where is lactose found?","a":"Milk."},{"q":"What is glycogen?","a":"A stored form of glucose manufactured by the liver."},{"q":"Is glycogen consumed in food?","a":"No, it is stored and produced by the liver."},{"q":"When the body does not get enough carbohydrates, it burns what for energy?","a":"Protein and fat."},{"q":"What is the most concentrated source of energy for the body?","a":"Fats."},{"q":"How many kilocalories per gram do fats provide?","a":"9 kcal per gram."},{"q":"Fats help carry which vitamins?","a":"Vitamins A, D, E, and K (remember “FADE K”)."},{"q":"Which nutrient is most needed for growth and tissue repair?","a":"Protein (Vitamin C is second best)."},{"q":"How many kilocalories per gram do proteins provide?","a":"4 kcal per gram."},{"q":"Do vitamins and minerals provide energy for the body?","a":"No, they are necessary for metabolic reactions."},{"q":"Is water present in all body tissues?","a":"Yes, even in bone."},{"q":"What percentage of an adult’s total body weight is water?","a":"50% to 60%."},{"q":"Name the four basic food groups.","a":"Milk & Cheese; Meat & Legumes; Fruits & Vegetables; Bread & Cereal."},{"q":"What percentage of an infant’s total body weight is water?","a":"70% to 75%."},{"q":"An individual is overweight if they weigh what percent above their ideal weight?","a":"10%."},{"q":"An individual is considered obese if they weigh what percent above their ideal weight?","a":"20%."},{"q":"With what solution and when should a breastfeeding mother cleanse the areola?","a":"With plain water before and after each feeding."},{"q":"For mothers without retracted nipples, which is better—towel drying or air drying?","a":"Air drying is best."},{"q":"How long should the infant breastfeed on each side?","a":"Approximately 20 minutes per side."},{"q":"How should the mother break the suction of a breastfeeding infant?","a":"By inserting her little finger into the side of the infant’s mouth."},{"q":"When should the breastfeeding infant be burped?","a":"After feeding from each breast."},{"q":"On which side should breastfeeding begin if there is no mastitis?","a":"Begin on the side the baby finished on during the previous feeding."},{"q":"How long can breast milk be safely refrigerated?","a":"Up to 24 hours."},{"q":"How long can breast milk be safely frozen?","a":"Up to 6 months."},{"q":"In what type of container should breast milk be stored?","a":"Sealed plastic bags or containers."},{"q":"Can you microwave frozen breast milk to warm or thaw it?","a":"Never."},{"q":"Which two nutrients are lower in breast milk?","a":"Fluoride and iron."},{"q":"What should you tell a breastfeeding mother about her milk supply when discharged from the hospital?","a":"Milk should come in around postpartum day 3; breastfeed every 2–3 hours to establish good milk supply."},{"q":"Can a woman on oral contraceptives breastfeed?","a":"Oral contraceptives should not be used during the first 6 weeks after birth; estrogen decreases milk supply. Use non-hormonal methods. Breastfeeding alone is not a reliable contraceptive."},{"q":"At what age are accidental poisonings most common?","a":"Around 2 years old."},{"q":"Are poor hygiene and diet the causes of acne?","a":"No, that is false."},{"q":"How often should a client with acne wash their face each day?","a":"Twice a day."},{"q":"Name the five high-risk groups for AIDS.","a":"Homosexual\/bisexual men, IV drug users, hemophiliacs, heterosexual partners of infected people, and infants born to infected mothers."},{"q":"How can AGN be prevented?","a":"By culturing all sore throats for strep and treating strep infections promptly."},{"q":"What are the three adult developmental stages?","a":"Early adulthood, middle adulthood, and later adulthood."},{"q":"What is the age range for early adulthood?","a":"19 to 35 years."},{"q":"What is the age range for middle adulthood?","a":"35 to 64 years."},{"q":"What is the age range for late adulthood?","a":"64 years to death."},{"q":"What is the developmental task for early adulthood according to Erikson?","a":"Intimacy vs. Isolation."},{"q":"What is the developmental task for middle adulthood according to Erikson?","a":"Generativity vs. Stagnation."},{"q":"What does “Intimacy vs. Isolation” mean in Erikson’s theory?","a":"The stage in which individuals form close relationships, marry, and begin families."},{"q":"What does “Generativity vs. Stagnation” mean in Erikson’s theory?","a":"Middle-aged adults focus on contributing to society, helping others, and fulfilling life potential."},{"q":"What is the developmental task for late adulthood according to Erikson?","a":"Ego Integrity vs. Despair."},{"q":"What does “Ego Integrity vs. Despair” mean in Erikson’s theory?","a":"Older adults reflect on their lives with a sense of fulfillment or regret."},{"q":"People over what age should have a yearly cancer screening exam?","a":"Over age 40."},{"q":"Cardiovascular disease (CD) ranks what among the leading causes of maternal death?","a":"Fourth."},{"q":"What is the number one cause of CD in pregnancy?","a":"Rheumatic heart disease."},{"q":"Pregnancy increases cardiac output by what percentage?","a":"30–50%."},{"q":"What is the number one cause of maternal death in CD of pregnancy?","a":"Cardiac decompensation."},{"q":"Is cesarean section mandatory for women with CD of pregnancy?","a":"No."},{"q":"Besides rest, what other treatment is important for CD in pregnancy?","a":"Weight control."},{"q":"Do women have a higher or lower incidence of stroke than men?","a":"Lower."},{"q":"Does use of oral contraceptives increase the risk of CVA?","a":"True."},{"q":"Does chronic alcohol abuse increase the risk of CVA?","a":"False."},{"q":"Does obesity increase the risk of CVA?","a":"True."},{"q":"Does smoking increase the risk of CVA?","a":"True."},{"q":"Does atrial fibrillation increase the risk of CVA?","a":"True, particularly due to emboli."},{"q":"Which meats are highest in cholesterol?","a":"Organ meats such as liver, heart, brain, and kidneys."},{"q":"Which foods are second highest in cholesterol?","a":"Shellfish such as shrimp, crab, and lobster."},{"q":"Is egg white high or low in cholesterol?","a":"Low."},{"q":"Is egg yolk high or low in cholesterol?","a":"High."},{"q":"Which three meats are lowest in cholesterol?","a":"Chicken, pork, and mutton."},{"q":"Is milk high or low in cholesterol?","a":"Low."},{"q":"Is cheese high in cholesterol?","a":"Moderately high."},{"q":"Which oils are high in cholesterol?","a":"Animal fats and oils."},{"q":"Is cholesterol a triglyceride?","a":"No."},{"q":"Do plant foods contain cholesterol?","a":"No."},{"q":"By which post-op day should the client begin stoma self-care?","a":"By day 3 or 4; they should start observing by day 2."},{"q":"Is cystic fibrosis (CF) hereditary?","a":"Yes."},{"q":"Increasing dietary fiber lowers the risk of what disease?","a":"Cancer of the colon."},{"q":"Foods lose fiber when they are __________, __________, __________, or __________.","a":"Processed, cooked, peeled, or refined."},{"q":"Whole grains and grain products are (high\/low) in fiber.","a":"High."},{"q":"Fruits are (high\/low) in fiber.","a":"High."},{"q":"Vegetables are (high\/low) in fiber.","a":"High."},{"q":"Milk and milk products are (high\/low) in fiber.","a":"Low."},{"q":"Meats are (high\/low) in fiber.","a":"Low."},{"q":"Nuts, seeds, and legumes are (high\/low) in fiber.","a":"Low."},{"q":"Which foods have the highest fiber content?","a":"Grains, especially bran."},{"q":"When increasing fiber intake, how should it be done?","a":"Gradually, to prevent discomfort."},{"q":"What are the side effects of a high-fiber diet?","a":"Gas (flatus) and mineral malabsorption."},{"q":"Which type of bread has the highest fiber: milled, enriched, fortified, or whole grain?","a":"Whole grain bread."},{"q":"What is “conservation” in child development, and when does it appear?","a":"Understanding that quantity remains constant despite appearance; develops in the concrete operational stage."},{"q":"What is the age range for formal operational thinking?","a":"12–15 years."},{"q":"What is the sensorimotor stage of intellectual development?","a":"Birth to 2 years; learning through senses and movement."},{"q":"What is the age range for concrete operational thinking?","a":"7–11 years."},{"q":"What is the age range for preoperational thinking?","a":"3–6 years."},{"q":"What is the hallmark of formal operational thinking?","a":"Abstract reasoning."},{"q":"What is egocentricity, and in which stage is it found?","a":"Viewing everything from one’s own perspective; preoperational stage."},{"q":"Prefix “ante-” means what?","a":"Before in time or place."},{"q":"Prefix “im-” or “in-” means what?","a":"Not or into."},{"q":"Prefix “intra-” means what?","a":"Within."},{"q":"Prefix “inter-” means what?","a":"Between."},{"q":"Prefix “per-” means what?","a":"Throughout or completely."},{"q":"Prefix “ec-” means what?","a":"Out of."},{"q":"Prefix “e-” or “ex-” means what?","a":"Out from or away from."},{"q":"Prefix “iso-” means what?","a":"Equal."},{"q":"Prefix “para-” means what?","a":"Beside or similar."},{"q":"How can pyelonephritis be prevented?","a":"By preventing or promptly treating cystitis (UTIs)."},{"q":"Which age group should be routinely screened for scoliosis?","a":"Young adolescents."},{"q":"Scoliosis most commonly affects which group?","a":"Teenage females."},{"q":"What is the average duration of menstrual flow, and what is the normal range?","a":"Average 5 days; normal range is 3–6 days."},{"q":"What is the average blood loss during menstruation?","a":"50–60 mL."},{"q":"What are the two phases of the ovarian cycle?","a":"Follicular phase (first 14 days) and luteal phase (last 14 days)."},{"q":"In the menstrual cycle, what marks day 1?","a":"The onset of menstrual bleeding."},{"q":"How long does the ovarian cycle last on average?","a":"About 28 days."},{"q":"How many days after ovulation does menstruation begin?","a":"Approximately 14 days."},{"q":"Which hormones are active during the follicular phase?","a":"FSH and estrogen."},{"q":"During the luteal phase, which hormones increase?","a":"Progesterone and LH."},{"q":"What is the main function of the luteal phase?","a":"To maintain the corpus luteum, which secretes progesterone to support early pregnancy."},{"q":"If fertilization occurs during the luteal phase, which hormone is secreted?","a":"Human chorionic gonadotropin (hCG)."},{"q":"What is the average daily iron loss during menstruation?","a":"0.5–1.0 mg."},{"q":"What occurs during the follicular phase?","a":"Maturation of the Graafian follicle, leading to ovulation."},{"q":"In what climate is MS most common?","a":"Cool climates."},{"q":"When can sexual activity be resumed after an MI?","a":"Approximately 6 weeks after hospital discharge."},{"q":"What does measurement of skin-fold thickness determine?","a":"The amount of body fat."},{"q":"Do males generally have a higher risk of heart disease than females?","a":"Yes."},{"q":"Do post-menopausal women have a lower risk of heart disease than men aged 25–40?","a":"No, they have a higher risk."},{"q":"Does a family history of diabetes increase the risk of heart disease?","a":"Yes."},{"q":"Does a family history of liver disease increase the risk of heart disease?","a":"No."},{"q":"Does cigarette smoking increase the risk of heart disease?","a":"Yes, significantly."},{"q":"Do oral contraceptives reduce the risk of heart disease?","a":"No, their use increases the risk."},{"q":"Does regular exercise reduce the risk of heart disease?","a":"Yes."},{"q":"What is the inheritance pattern of hemophilia?","a":"Sex-linked recessive."},{"q":"Hypertension is more common among which group: Blacks or Whites?","a":"Blacks."},{"q":"Does aging increase or decrease the risk of hypertension?","a":"It increases the risk."},{"q":"Does obesity increase the risk of hypertension?","a":"Yes, it significantly increases risk."},{"q":"Do oral contraceptives affect blood pressure?","a":"Yes, they increase blood pressure."},{"q":"Name two common dietary changes for hypertension management.","a":"Calorie reduction for weight loss and sodium restriction."},{"q":"Name two common lifestyle changes used to manage hypertension.","a":"Reducing stress and increasing physical activity."},{"q":"After a hysterectomy, how long should a woman wait before resuming sexual activity?","a":"4 to 6 weeks."},{"q":"The development of emphysema is most strongly associated with what history?","a":"Cigarette smoking."},{"q":"What advice should be given to women with endometriosis who wish to have children?","a":"Do not delay pregnancy, as fertility may decrease."},{"q":"Epiglottitis most commonly occurs in children aged ______ to ______.","a":"1 to 8 years."},{"q":"How can epiglottitis be prevented?","a":"Vaccination with H. influenzae type B (Hib) starting at 2 months of age."},{"q":"Autonomy vs. Shame and Doubt corresponds to which developmental stage?","a":"Toddler."},{"q":"Industry vs. Inferiority corresponds to which stage?","a":"School-age child."},{"q":"Ages 18 to 25 years correspond to which developmental stage?","a":"Young adult."},{"q":"The child who frequently says “no” is in which stage?","a":"Toddler stage."},{"q":"Encouraging creativity and collecting things is characteristic of which stage?","a":"School-age stage."},{"q":"Offering limited choices is appropriate for which developmental stage?","a":"Toddler."},{"q":"Centering on basic needs being met characterizes which stage?","a":"Infancy."},{"q":"Ages 18 months to 3 years correspond to which stage?","a":"Toddler."},{"q":"Ages 3 to 6 years correspond to which stage?","a":"Preschooler."},{"q":"Ages 12 to 20 years correspond to which stage?","a":"Adolescent."},{"q":"Initiative vs. Guilt corresponds to which developmental stage?","a":"Preschooler."},{"q":"Ages 6 to 12 years correspond to which developmental stage?","a":"School-age."},{"q":"Trust vs. Mistrust corresponds to which developmental stage?","a":"Infancy."},{"q":"In which stage is the peer group most important?","a":"Adolescent."},{"q":"Encouraging imagination and role play is best for which stage?","a":"Preschooler."},{"q":"Identity vs. Role Confusion corresponds to which stage?","a":"Adolescent."},{"q":"Intimacy vs. Isolation corresponds to which stage?","a":"Young adult."},{"q":"Birth to 18 months corresponds to which developmental stage?","a":"Infancy."},{"q":"Define a nuclear family.","a":"A family consisting of parents and their children."},{"q":"When does a nuclear family become an extended family?","a":"When grandparents, aunts, or uncles live with the family."},{"q":"In the U.S., what is the basic unit of society?","a":"The family."},{"q":"What are the two major roles of the family in society?","a":"Protection and socialization."},{"q":"What percentage of North American families are single-parent families?","a":"Approximately 50%."},{"q":"Who heads 90% of single-parent families?","a":"A female."},{"q":"What does “lightening” mean in pregnancy?","a":"The descent of the fetal head into the pelvis."},{"q":"When does lightening usually occur?","a":"About 2–3 weeks before birth in a primigravida."},{"q":"What is the most common positive effect of lightening?","a":"The woman can breathe more easily after the fetus drops."},{"q":"What are the two earliest signs that a woman is likely in labor?","a":"Low back pain and the appearance of “show” (a blood-tinged mucus plug)."},{"q":"What is the most reliable indication that a woman is in true labor?","a":"Regular contractions that cause progressive cervical dilation and effacement."},{"q":"What is cervical effacement?","a":"The thinning of the cervix."},{"q":"Into how many stages is labor divided?","a":"Four stages."},{"q":"What is accomplished during the first stage of labor?","a":"Full cervical effacement and dilation."},{"q":"How long does the first stage of labor usually last for a primigravida and a multigravida?","a":"About 12 hours for a primigravida, 6 hours for a multigravida."},{"q":"The cervix is fully dilated when it measures how many centimeters?","a":"10 cm."},{"q":"What is accomplished during the second stage of labor?","a":"Delivery of the infant."},{"q":"The second stage of labor begins with ______ and ends with ______ of the ______.","a":"Full dilation; delivery; infant."},{"q":"How long does the second stage of labor last?","a":"Approximately 1½ hours for a primigravida and ½ hour for a multigravida."},{"q":"What is accomplished during the third stage of labor?","a":"Expulsion of the placenta."},{"q":"How long does the third stage of labor usually last?","a":"Less than one hour."},{"q":"What occurs during the fourth stage of labor?","a":"Recovery and stabilization after delivery."},{"q":"When does the fourth stage of labor end?","a":"About 2 hours after placental expulsion."},{"q":"What is the average blood loss during labor?","a":"Approximately 500 mL."},{"q":"When referring to “the three phases of labor,” what does this mean?","a":"It refers to the latent, active, and transitional phases within the first stage of labor."},{"q":"What is the normal length of pregnancy?","a":"240 to 300 days."},{"q":"How many trimesters is pregnancy divided into?","a":"Three trimesters."},{"q":"During the first trimester, are vaginal secretions increased or decreased?","a":"Increased."},{"q":"When do urine pregnancy tests become positive?","a":"Around the time of the first missed menstrual period."},{"q":"Pregnancy tests detect the presence of what hormone?","a":"Human chorionic gonadotropin (hCG)."},{"q":"Are urine and blood pregnancy tests conclusive proof of pregnancy?","a":"No, they only suggest pregnancy."},{"q":"What is Hegar’s sign?","a":"Softening of the uterus."},{"q":"What is Chadwick’s sign?","a":"Bluish discoloration of the cervix."},{"q":"The first trimester covers which weeks of pregnancy?","a":"Weeks 1 to 13."},{"q":"The second trimester covers which weeks of pregnancy?","a":"Weeks 14 to 27."},{"q":"During which weeks can the mother first feel fetal movement?","a":"Between the 16th and 20th weeks."},{"q":"What is the term for the first sensation of fetal movement?","a":"Quickening."},{"q":"The third trimester covers which weeks of pregnancy?","a":"Weeks 28 to 40."},{"q":"In which trimester does backache most commonly occur?","a":"The third trimester."},{"q":"During which trimester is the fetus most vulnerable to external teratogens?","a":"The first trimester."},{"q":"What is the term for the process in which external agents cause birth defects?","a":"Teratogenesis."},{"q":"During which trimester are nausea and vomiting most common?","a":"The first trimester."},{"q":"During which trimester do Braxton-Hicks contractions typically begin?","a":"The third trimester."}]

Psychosocial Integrity

[{"q":"Does stress worsen acne?","a":"Yes."},{"q":"The statement “Time is too short to start another life, though I wish I could,” is an example of what?","a":"Despair."},{"q":"The statement “If I had to do it over again, I’d live my life just about the same,” is an example of what?","a":"Ego integrity."},{"q":"Anorexia nervosa is most common in which group?","a":"Females under 25 years old."},{"q":"What is the primary psychological nursing diagnosis in anorexia nervosa?","a":"Altered body image."},{"q":"What does an infant fear most when hospitalized?","a":"Separation from their primary caregiver."},{"q":"What does a toddler fear most when hospitalized?","a":"Separation from family."},{"q":"What does a preschooler fear most in addition to separation?","a":"Mutilation due to vivid imagination."},{"q":"The toddler and preschooler often believe illness is caused by what?","a":"Something they did wrong."},{"q":"The school-aged child fears separation from whom when hospitalized?","a":"Their peer group."},{"q":"Does the school-aged child see illness as external or internal in cause?","a":"External; they understand illness is not caused by bad behavior."},{"q":"The hospitalized adolescent fears separation from whom and loss of what?","a":"Peers and independence."},{"q":"What should you tell a client embarrassed by colostomy noises post-op?","a":"The noises will subside within a few days to a week."},{"q":"What client behavior best indicates acceptance of the stoma?","a":"Performing their own stoma care."},{"q":"What are symptoms of sensory overload or sensory deprivation?","a":"Fear, panic, depression, poor concentration, restlessness, agitation."},{"q":"What does self-disclosure mean in nursing?","a":"When the nurse shares personal information with the patient."},{"q":"Is nurse self-disclosure always inappropriate?","a":"No, if brief and clearly therapeutic."},{"q":"If the nurse self-discloses, how should it be done?","a":"Keep it short and quickly refocus on the patient."},{"q":"What does insight mean in mental health nursing?","a":"The patient’s ability to understand their problem."},{"q":"During which phase should the nurse examine personal feelings?","a":"Pre-interaction phase."},{"q":"What is “flight of ideas”?","a":"Rapid shifting from one topic to another."},{"q":"The foundation of a therapeutic relationship begins with the nurse’s ______ and ______.","a":"Self-awareness and self-understanding."},{"q":"What are the four phases of the nurse–patient relationship?","a":"Pre-interaction, Orientation, Working, Termination."},{"q":"Should the nurse self-disclose just because the patient asks?","a":"No, only if it serves a therapeutic purpose."},{"q":"The nurse should discuss termination of the relationship during which phase?","a":"Orientation phase."},{"q":"The termination phase actually begins during which phase?","a":"Orientation phase."},{"q":"When a patient expresses thoughts of dying or self-harm, what is the first nursing action?","a":"Immediately assess for suicide potential before anything else."},{"q":"Are children at high or low risk for suicide?","a":"Low risk."},{"q":"Are adolescents at high or low risk for suicide?","a":"High risk."},{"q":"Are young adults at high or low risk for suicide?","a":"Moderate to high risk."},{"q":"Which age group between 25 and 50 years has the risk level for suicide?","a":"Low to moderate risk."},{"q":"In adults over age 50, how does the suicide risk change?","a":"It becomes high."},{"q":"How does having a specific, detailed suicide plan affect risk level?","a":"It increases risk to moderate or high, depending on the plan’s feasibility."},{"q":"What is the suicide risk level for someone planning to use pills?","a":"Moderate risk."},{"q":"What is the suicide risk level for someone with no specific plan?","a":"Low risk."},{"q":"The use of which three methods indicates high suicide risk?","a":"Guns, ropes, and knives."},{"q":"Between men and women, who is generally at higher risk for suicide?","a":"Men."},{"q":"How does marital status affect suicide risk?","a":"Highest risk: separated or divorced; lowest risk: married."},{"q":"What is the nurse’s goal when a suicidal person is on the phone?","a":"To get another person physically present with them, since being alone increases risk."},{"q":"Should a nurse discuss the details of a patient’s suicide attempt after admission?","a":"No, focus on the present condition and future coping, not the attempt itself."},{"q":"Is hyperemesis gravidarum associated with emotional factors?","a":"Yes, it occurs more often in women ambivalent about pregnancy."},{"q":"What are two common psychological reactions after a hysterectomy?","a":"Grief and depression."},{"q":"What is ECT (electroconvulsive therapy)?","a":"A treatment using electrical current to induce a controlled seizure for depression."},{"q":"What condition is primarily treated with ECT?","a":"Major depression."},{"q":"What cognitive function is temporarily impaired after ECT?","a":"Memory."},{"q":"How long does memory impairment last after ECT?","a":"2 to 3 weeks."},{"q":"How will the client appear immediately after ECT?","a":"Drowsy, dull, and apathetic."},{"q":"What should you tell a client worried about being shocked during EEG?","a":"They won’t be shocked; the test only records electrical activity from the brain."},{"q":"What is the first thing a nurse must do to help a family in crisis?","a":"Examine their own personal values."},{"q":"Anxiety-producing thoughts are called _______.","a":"Obsessions."},{"q":"Repetitive actions performed to reduce anxiety are called _______.","a":"Compulsions (e.g., excessive handwashing, repeated cleaning, or checking behaviors)."},{"q":"Which defense mechanism is most closely associated with obsessive-compulsive disorder (OCD)?","a":"Displacement."},{"q":"Should clients with OCD be allowed to perform their compulsive behaviors?","a":"Yes, but limits should be set, and they should be gently redirected."},{"q":"Should you force a client with OCD to stop their compulsive rituals?","a":"No, this increases anxiety."},{"q":"Is obsessive-compulsive disorder classified as neurosis or psychosis?","a":"Neurosis—the client is aware of reality."},{"q":"Should the nurse confront the absurdity of an OCD client’s behavior?","a":"No, instead acknowledge their anxiety (e.g., “You must have been very anxious to wash your hands that long.”)."},{"q":"What can you do if a client with OCD is consistently late due to rituals?","a":"Start preparations earlier to accommodate their routine while maintaining structure."},{"q":"Rape is a crime of passion. (T\/F)","a":"False — it is a violent act, not an act of passion."},{"q":"Most rapes involve people of different races. (T\/F)","a":"False — they usually occur between people of the same race."},{"q":"When should psychological care for a rape victim begin?","a":"Immediately in the emergency room."},{"q":"What are the two phases of Rape Trauma Syndrome?","a":"Disorganization phase and reorganization phase."},{"q":"A rape victim who appears calm and composed is adjusting well. (T\/F)","a":"False — calmness often indicates emotional shock and is a symptom of Rape Trauma Syndrome."},{"q":"What are three common physical symptoms of Rape Trauma Syndrome?","a":"Gastrointestinal irritation, painful urination with itching or burning, and muscle tension with pain."},{"q":"Rape victims often blame whom?","a":"Themselves."},{"q":"In the reorganization phase of Rape Trauma Syndrome, what change is common?","a":"The victim may change residence or telephone number."},{"q":"During the reorganization phase, what sleep disturbance is common?","a":"Nightmares."},{"q":"What four fears are common during the reorganization phase of Rape Trauma Syndrome?","a":"Fear of being indoors or outdoors (depending on the scene), fear of being alone or in crowds, fear of people behind them, and fear of sexual activity."},{"q":"How should rape victims be treated?","a":"With dignity and respect."}]

Physiological Integrity – Basic Care and Comfort

[{"q":"When cleansing an infant's eye, should you cleanse from outer to inner canthus?","a":"No, cleanse from inner to outer canthus."},{"q":"Should you retract the foreskin of a 5-week-old uncircumcised infant to cleanse the area?","a":"No, not until the foreskin retracts naturally and without resistance; then it should be retracted, cleansed, and replaced."},{"q":"What is the correct temperature for tepid sponge bathing water?","a":"98.6°F."},{"q":"How long does it take for the umbilical stump to fall off?","a":"7 to 14 days."},{"q":"What is the main purpose of draping an infant during a bath?","a":"To prevent chilling."},{"q":"Should friction be used to remove vernix caseosa from an infant’s skin?","a":"No, it can cause damage or bruising."},{"q":"What solution is commonly used for umbilical cord care?","a":"70% alcohol to promote drying (though the current trend is toward soap and water)."},{"q":"What are three eye care interventions for a client with Bell’s Palsy?","a":"Use dark glasses, apply artificial tears, and cover the eye at night."},{"q":"What is enuresis?","a":"Involuntary urination or inability to control urine flow."},{"q":"Should fluids be forced or restricted in BPH?","a":"Forced."},{"q":"What solution and material are used to cleanse an infant’s eyes?","a":"Plain water with cotton balls or a soft washcloth."},{"q":"Can cotton swabs be used to clean the eyes, nares, or ears of an infant?","a":"No, it is dangerous."},{"q":"Can the same cotton ball or cloth edge be used for both eyes?","a":"No, it would cause cross-contamination."},{"q":"Should an unhealed umbilical site be covered with the diaper?","a":"No, fold the diaper down."},{"q":"What temperature is appropriate for the water used to bathe an infant?","a":"100°F to 105°F."},{"q":"What is the main purpose of a tepid sponge bath?","a":"To lower body temperature during fever."},{"q":"How should water temperature be tested if a thermometer is not available?","a":"Drop water on the inside surface of your forearm."},{"q":"With which body part do you begin when bathing an infant?","a":"The eyes."},{"q":"What exercises should a post-prostatectomy patient perform after discharge, and why?","a":"Perineal exercises (start and stop urine stream) to reduce temporary dribbling."},{"q":"How often should the urinary drainage bag be emptied?","a":"Every 8 hours."},{"q":"Is dietary protein limited in acute glomerulonephritis (AGN)?","a":"Not usually; restricted only in severe azotemia."},{"q":"What is the most important nursing intervention in treating AGN?","a":"Bed rest until hematuria, edema, and hypertension resolve."},{"q":"What is the most common dietary restriction for AGN?","a":"Moderate sodium restriction; fluid restriction if severe edema."},{"q":"After an above-knee amputation (AKA), the patient should lie in what position several times per day?","a":"Prone position to prevent flexion contracture."},{"q":"What position prevents hip flexion contracture after AKA?","a":"Lying prone several times per day."},{"q":"How can flexion contracture of the knee be prevented after a BKA?","a":"Remind the patient to keep the knee straight when standing."},{"q":"To prevent post-operative swelling, how should the stump be positioned?","a":"Elevated."},{"q":"For how long should the stump be elevated post-operatively?","a":"12 to 24 hours."},{"q":"How often should a stump be washed?","a":"Daily."},{"q":"When wrapping a stump, the bandage should be tightest where and loosest where?","a":"Tightest distally (far from the body) and loosest proximally (near the body)."},{"q":"What is the top priority in caring for a client with anorexia nervosa?","a":"Ensuring adequate food intake and weight gain to sustain life."},{"q":"What is the best goal to evaluate progress in a client with anorexia nervosa?","a":"Achieving adequate weight gain."},{"q":"To lessen pain in appendicitis, what position should the client assume?","a":"Fowler’s position (sitting position)."},{"q":"What is the primary dietary prescription for calcium nephrolithiasis?","a":"Low-calcium diet."},{"q":"The diet for calcium nephrolithiasis should be what type of ash?","a":"Acid ash."},{"q":"If the kidney stone is calcium phosphate, what nutrient must also be restricted?","a":"Phosphorus."},{"q":"What is the primary diet treatment for uric acid nephrolithiasis?","a":"Low-purine diet."},{"q":"The diet for uric acid nephrolithiasis should be low in what?","a":"Methionine."},{"q":"What is methionine?","a":"An amino acid precursor to cystine."},{"q":"Name two foods high in methionine.","a":"Milk and eggs."},{"q":"Clients with cystine nephrolithiasis should have what type of ash diet?","a":"Alkaline ash diet."},{"q":"Increasing fluid intake above 3000 mL per day is more effective in treating kidney stones than any dietary modification. (True\/False)","a":"True."},{"q":"Must clients receiving chemotherapy be kept NPO?","a":"False."},{"q":"With what solution should clients with chemotherapy-induced stomatitis rinse after meals?","a":"Hydrogen peroxide (H₂O₂) solution."},{"q":"What lubricant can safely be applied to cracked lips in chemotherapy-induced stomatitis?","a":"K-Y Jelly."},{"q":"Can women with CD of pregnancy receive analgesics during labor?","a":"Yes; analgesics reduce anxiety and cardiac stress."},{"q":"What is the most common dietary modification for a woman with CD showing decompensation?","a":"Sodium and fluid restriction."},{"q":"How long should a woman with CD of pregnancy remain on bed rest after delivery?","a":"At least one week."},{"q":"What nutrients should be included in the diet of a pregnant woman with CD?","a":"Iron and folic acid to prevent anemia."},{"q":"What is the best position for a woman with cardiac disease during labor?","a":"Semi-recumbent with the head of bed elevated."},{"q":"The nurse should limit the client’s efforts to do what during labor with cardiac disease?","a":"Bearing down."},{"q":"What type of diet is prescribed for a client with a cesium implant?","a":"Low-residue diet to decrease bowel motility."},{"q":"What part of the hand is used to handle a wet cast?","a":"The palm."},{"q":"On what should a wet cast be supported while drying?","a":"Pillows (no plastic covers)."},{"q":"How long does it take for a cast to dry completely?","a":"About 24 hours."},{"q":"Should a wet cast be covered while drying?","a":"No."},{"q":"Can a heat lamp or hair dryer be used to speed cast drying?","a":"No heat lamps or hair dryers; only a fan may be used."},{"q":"To prevent skin irritation near cast edges, the edges should be what?","a":"Petaled (covered with soft tape)."},{"q":"What color is a dry cast?","a":"White."},{"q":"Is a dry cast dull or shiny?","a":"Shiny."},{"q":"When tapped, is a dry cast dull or resonant?","a":"Resonant."},{"q":"Traction is used to do what?","a":"Reduce and immobilize a fracture, relieve muscle spasms, and prevent deformities."},{"q":"Can skin traction be removed for skin care?","a":"Yes."},{"q":"Can skeletal traction be removed for care?","a":"No."},{"q":"Name three types of skin traction.","a":"Buck’s, Bryant’s, and pelvic traction."},{"q":"Name three types of skeletal traction.","a":"Cranial tongs, Thomas splint with Pearson attachment, and 90°–90° traction."},{"q":"What traction is most commonly used for adult hip fractures?","a":"Buck’s traction."},{"q":"What traction is most commonly used for hip fractures in children?","a":"Bryant’s traction."},{"q":"What bed position should be maintained for a client in pelvic traction?","a":"Semi-Fowler’s with knees slightly flexed (knee gatch)."},{"q":"What is the main advantage of balanced countertraction?","a":"Allows easier movement and repositioning in bed."},{"q":"When in Buck’s traction, a patient may turn toward which side?","a":"Toward the unaffected side."},{"q":"What is the prescribed activity level in early management of CVA?","a":"Absolute bed rest."},{"q":"Should fluids be restricted or forced in early CVA care?","a":"Restricted."},{"q":"How high should the head of the bed be after a stroke?","a":"30 degrees."},{"q":"Can a stroke victim be turned side-to-side?","a":"Yes."},{"q":"How often should the CVA patient be turned or repositioned?","a":"Every 2 hours."},{"q":"Should the CVA patient remain on the paralyzed side longer than 20 minutes?","a":"No."},{"q":"How often should range of motion (ROM) exercises be done in CVA patients?","a":"Every 4 hours or three times daily."},{"q":"Should urinary incontinence in CVA be treated with catheterization?","a":"No, incontinence is not a valid reason for catheterization."},{"q":"After meals, what must the nurse check in a CVA patient?","a":"Inside the mouth and cheeks for retained food."},{"q":"Describe bottle nipples used for feeding infants with cleft lip.","a":"Large-holed, soft nipples."},{"q":"Infants with cleft lip\/palate require more frequent what?","a":"Burping."},{"q":"In what position should children with cleft lip\/palate be fed?","a":"In an almost upright position."},{"q":"Before surgery, can an infant with cleft lip cry or breastfeed?","a":"Yes, crying is allowed; breastfeeding is possible with a simple cleft lip but not with a cleft palate."},{"q":"After cleft lip repair, can the infant cry or breastfeed?","a":"No; crying and sucking increase stress on the incision."},{"q":"What device is applied after cleft lip repair?","a":"Logan bow."},{"q":"What is the purpose of a Logan bow?","a":"To reduce tension on the suture line."},{"q":"Can infants with cleft lip\/palate sleep on their backs?","a":"Yes."},{"q":"Which position is contraindicated after cleft lip repair?","a":"Prone (on the abdomen)."},{"q":"What is used to feed an infant after cleft lip repair?","a":"A dropper or syringe with a rubber tip to avoid suction."},{"q":"After feeding, what should the caregiver do for a baby with cleft lip\/palate repair?","a":"Rinse the mouth with water."},{"q":"What is the technique used to remove feces and gas from a colostomy?","a":"Colostomy irrigation."},{"q":"How many times per day is colostomy irrigation performed?","a":"Once daily."},{"q":"Which solution is used to irrigate a colostomy?","a":"Tap water."},{"q":"How warm should colostomy irrigation fluid be?","a":"Slightly warmer than body temperature (99–100°F)."},{"q":"In what position should the client be during colostomy irrigation?","a":"Sitting position."},{"q":"What activity order is prescribed for CHF clients?","a":"Bed rest."},{"q":"Should a client sleep with a hearing aid in place?","a":"No, hearing aids should be removed before sleep."},{"q":"What is the recommended diet for cystic fibrosis?","a":"High-calorie, high-protein, moderate-fat diet."},{"q":"What is the most common intervention for airway clearance in CF?","a":"Postural drainage."},{"q":"Do Parkinson’s patients experience constipation or diarrhea?","a":"Constipation."},{"q":"What type of chair is best for a Parkinson’s patient?","a":"Firm, straight-backed chair."},{"q":"Clients on PCA pumps are less likely to develop postoperative complications. (T\/F)","a":"True, because adequate pain control promotes mobility and prevents complications."},{"q":"Name three common indications for PCA therapy.","a":"Postoperative pain, cancer pain, sickle-cell crisis pain."},{"q":"Do PCA pumps delay ambulation?","a":"False, patients usually ambulate earlier."},{"q":"What is the comfort range for room humidity?","a":"30–60%."},{"q":"What are the disadvantages of plastic pillowcases?","a":"They are hot and slippery."},{"q":"Individuals who are ill are ______ sensitive to noise than healthy individuals.","a":"More sensitive."},{"q":"What is the comfort range for room temperature?","a":"68–74°F (20–23°C)."},{"q":"What skin care is typical in pemphigus?","a":"Cool, wet dressings."},{"q":"What are the top three nursing interventions in pemphigus?","a":"Oral care, infection prevention, high fluid intake."},{"q":"What type of fluids are best tolerated by pemphigus clients?","a":"Cold fluids."},{"q":"Should the head of bed be raised to enhance drainage?","a":"Yes."},{"q":"Can clients on PD sit, eat, urinate, or defecate during dialysis?","a":"Yes, all are allowed."},{"q":"If the client reports abdominal pain during PD, what should the nurse do first?","a":"Encourage movement to improve dialysate distribution."},{"q":"What type of diet is prescribed for polycythemia vera?","a":"Low-iron diet."},{"q":"How often should a post-operative client cough and deep breathe?","a":"Every 2 hours."},{"q":"How often should the post-operative patient turn?","a":"Every 2 hours."},{"q":"How often should the incentive spirometer be used post-op?","a":"Every 1–2 hours."},{"q":"How often should a bedridden post-op patient perform leg exercises?","a":"Every 2 hours."},{"q":"Unless contraindicated, when should a post-op client be out of bed?","a":"Within 24 hours."},{"q":"If a post-op patient reports gas and cramping, what should the nurse do first?","a":"Assess, then ambulate the client."},{"q":"What diet is recommended for mild preeclampsia?","a":"High protein, normal salt intake."},{"q":"What position should a woman with severe preeclampsia rest in?","a":"Left side-lying position."},{"q":"What diet is ordered for severe preeclampsia?","a":"Low salt, high protein."},{"q":"In what position should a child with pyloric stenosis be fed?","a":"High Fowler’s position."},{"q":"Should feedings for an infant with pyloric stenosis be thick or thin?","a":"Thickened feedings."},{"q":"After feeding, in what position should a child with pyloric stenosis be placed?","a":"Right side with head elevated."},{"q":"How does an infant with pyloric stenosis behave after vomiting?","a":"Remains hungry."},{"q":"What does “advance the drain 1 inch” mean?","a":"Gently pull the drain out by 1 inch."},{"q":"After advancing a Penrose drain, should excess tubing be cut off?","a":"Yes."},{"q":"Name four exercises for mild scoliosis.","a":"Heel lifts, sit-ups, hyperextension, breathing exercises."},{"q":"What cast is used after scoliosis surgery?","a":"Risser cast."},{"q":"How many hours per day should a Milwaukee brace be worn?","a":"23 hours."},{"q":"Should clients with Milwaukee brace avoid vigorous exercise?","a":"True."},{"q":"What activity order is prescribed for a client in sickle cell crisis?","a":"Bed rest."},{"q":"When halo traction is used, may the client ambulate?","a":"Yes."},{"q":"When the client is in tongs, on a Stryker frame, or on a circoelectric bed, what is the activity order?","a":"Absolute bed rest."},{"q":"For a neurogenic bladder, how often should straight catheterization be done?","a":"Every 6 hours."},{"q":"Should the client drink fluids after a spinal tap?","a":"Yes, encourage fluids to replace CSF."},{"q":"Can the client turn side to side after a spinal tap?","a":"Yes."},{"q":"What position is used during a spinal tap?","a":"Lateral decubitus (side-lying) position with knees to chest."},{"q":"How long should the client lie flat after a lumbar puncture?","a":"6 to 12 hours."},{"q":"Does the client require sedation before a spinal tap?","a":"No."},{"q":"What is the best position for airway suctioning?","a":"Semi-Fowler’s position."},{"q":"What position should the unconscious client be in during suctioning?","a":"Side-lying, facing the nurse."},{"q":"What is the preferred treatment for breast engorgement?","a":"Application of ice packs to reduce swelling."},{"q":"Should a mother with mastitis stop breastfeeding?","a":"No, she should continue breastfeeding, starting with the unaffected breast."},{"q":"If a mother has an open abscess on her breast, should she continue breastfeeding?","a":"No, breastfeeding must be stopped on that side until healed."},{"q":"Should a non-breastfeeding mother with engorgement express milk to relieve discomfort?","a":"No, expressing milk increases production; use ice or gentle warmth to relieve pressure."},{"q":"What is the best natural treatment for breast engorgement?","a":"Frequent breastfeeding to balance milk supply and demand."},{"q":"When irrigating the eye, in which direction should the solution flow?","a":"From the inner canthus to the outer canthus (I → O)."},{"q":"How should the nurse straighten the ear canal for an adult?","a":"Pull the pinna up and back."},{"q":"How should the nurse straighten the ear canal for a child under 3 years old?","a":"Pull the pinna down and back."},{"q":"After ear drops are given, how long should the client remain on their side?","a":"5 minutes."},{"q":"How far above the ear canal should the dropper be held?","a":"About ½ inch."},{"q":"What should the client do during a Meniere’s attack?","a":"Rest in bed and avoid sudden movements."},{"q":"What activity order is prescribed after labyrinthectomy?","a":"Strict bed rest."},{"q":"What environment is best for a patient with meningitis?","a":"A dark and quiet room."},{"q":"In what position should a patient with opisthotonos be placed?","a":"Side-lying position."},{"q":"What environment helps relieve a migraine headache?","a":"A dark, quiet environment."},{"q":"How should patients with MS walk?","a":"With a wide-based gait for balance."},{"q":"Should MS patients increase or restrict fluid intake?","a":"Increase fluids to prevent urinary tract infections."},{"q":"What type of diet is recommended for MS?","a":"Acid-ash diet."},{"q":"What type of diet is recommended for a patient with MG?","a":"Soft diet to reduce fatigue while chewing and swallowing."},{"q":"What is the activity order for a post-MI patient?","a":"Strict bed rest with bedside commode use only."},{"q":"What is the #1 nursing diagnosis for shingles?","a":"Acute pain; #2 is impaired skin integrity."},{"q":"What are two main purposes of a bed bath?","a":"To cleanse the skin and promote comfort."},{"q":"Should hospitalized clients wear their dentures?","a":"Yes, unless contraindicated."},{"q":"What motion should be used when cleansing the eyes?","a":"From the inner canthus to the outer canthus."},{"q":"If a client cannot hold dentures in place, what should the nurse do?","a":"Leave them out."},{"q":"How often should mouth care be performed for clients on oxygen therapy?","a":"Every 2 hours."},{"q":"Should lemon and glycerin swabs be used for oral cleansing?","a":"No, they are moisturizers used after cleaning, not cleansing agents."},{"q":"How should toenails be trimmed?","a":"Straight across."},{"q":"When giving a bed bath, which body part should the nurse begin with?","a":"The eyes."},{"q":"What are three reasons for giving a back rub?","a":"Comfort, relaxation, and stimulation of circulation."},{"q":"When shaving a client, should the water be hotter or cooler than bath water?","a":"Hotter."},{"q":"What does evening (HS) care include?","a":"Oral hygiene, washing the face and hands, back rub, and straightening linens."},{"q":"What is dentifrice?","a":"A denture adhesive (e.g., Polygrip) that helps dentures adhere to gums."},{"q":"What is sordes?","a":"Crusts on the teeth and gums due to poor oral hygiene."},{"q":"What facilitates trimming brittle toenails?","a":"Soaking them in warm water."},{"q":"What is the initial diet order for clients with hyperemesis gravidarum?","a":"NPO (nothing by mouth)."},{"q":"What instruction is given to clients recovering from hyperemesis gravidarum after meals?","a":"Remain seated upright for at least 45 minutes after eating."},{"q":"What is the biggest challenge in nursing care for clients with hyperemesis gravidarum?","a":"Encouraging and maintaining adequate nutrition."},{"q":"What is the best intervention for abdominal gas after a hysterectomy?","a":"Ambulation to promote peristalsis and relieve discomfort."},{"q":"What position is best for clients with emphysema under normal conditions?","a":"Semi-Fowler’s or high-Fowler’s position."},{"q":"If a client with emphysema experiences severe dyspnea, what position is best?","a":"Sitting upright with arms resting and head forward on an overbed table."},{"q":"What dietary recommendation is most appropriate for clients with emphysema?","a":"Frequent small meals to avoid fatigue."},{"q":"What daily fluid intake is recommended for clients with emphysema?","a":"Approximately 3 liters per day, unless contraindicated."},{"q":"What two discomforts are common during an EGD?","a":"Gagging and nausea\/vomiting."},{"q":"What is the most common complaint after an EGD?","a":"Sore throat."},{"q":"How should eye ointments be applied?","a":"Place a thin strip on the lower inner eyelid, then ask the client to close the eyes gently."},{"q":"How should eye drops be administered?","a":"Instill into the lower conjunctival sac."},{"q":"How should eye irrigation fluid flow be directed?","a":"From the inner canthus to the outer canthus."},{"q":"To control the pain of osteoarthritis, should heat or cold be applied?","a":"Heat."},{"q":"Are rest periods and range-of-motion exercises appropriate in osteoarthritis care?","a":"Yes; rest helps relieve pain, and gentle ROM prevents stiffness."}]

Physiological Integrity – Pharmacological and Parenteral Therapies

[{"q":"What drug is used to treat bladder spasms?","a":"Belladonna and opiate (B&O) suppositories."},{"q":"With what solution should blood be transfused?","a":"0.9% normal saline."},{"q":"If blood is infused through a central line, what must be done?","a":"The blood must be warmed."},{"q":"How long should it take for one unit of blood to infuse?","a":"Between 1 and 3 hours."},{"q":"What IV solution is hung with a blood transfusion?","a":"0.9% normal saline (never glucose)."},{"q":"What gauge needle is used for a blood transfusion?","a":"A large-bore needle, typically 18 gauge."},{"q":"Can blood be given immediately after removal from refrigeration?","a":"No, it must be warmed for about 20 to 30 minutes first."},{"q":"What is the only intramuscular injection given to a burn patient?","a":"Tetanus toxoid (if previously immunized) or tetanus antitoxin\/immune globulin (if not immunized)."},{"q":"What does Sulfamylon cream cause when applied?","a":"A burning sensation."},{"q":"What does silver nitrate cream do to the skin?","a":"Stains the skin."},{"q":"When should pain medication be administered to burn patients?","a":"30 minutes before wound care."},{"q":"When using silver nitrate, how should dressings be kept?","a":"Wet."},{"q":"What drugs prevent Curling’s ulcers?","a":"H2 receptor antagonists such as Tagamet, Zantac, Pepcid, or proton pump inhibitors like Protonix and Prilosec."},{"q":"What gauge needle should be used to start an IV for a client with abruptio placenta?","a":"18 gauge (in case blood transfusion is needed)."},{"q":"Name three drugs used to treat acne.","a":"Vitamin A, antibiotics, and retinoids."},{"q":"What is the most common retinoid prescribed for acne?","a":"Isotretinoin (Accutane)."},{"q":"Accutane is an analog of which vitamin?","a":"Vitamin A."},{"q":"What is the most common side effect of Accutane, and what is the most important teaching point?","a":"Inflammation of the lips (cheilitis); causes birth defects—strict pregnancy prevention is required."},{"q":"What antibiotic is most commonly prescribed for acne?","a":"Tetracycline."},{"q":"How long does it take for acne treatment to show results?","a":"4 to 6 weeks."},{"q":"What instructions should be given to a client taking tetracycline?","a":"Take on an empty stomach and avoid sunlight (photosensitivity)."},{"q":"Which two classes of drugs are given in combination for HIV-positive patients?","a":"NRTIs (nucleoside reverse transcriptase inhibitors) and PIs (protease inhibitors)."},{"q":"What do NRTIs and PIs do?","a":"They prevent viral replication."},{"q":"What is the mechanism of action of NRTIs?","a":"They integrate into viral DNA, causing incomplete replication and preventing new virus formation."},{"q":"What is the mechanism of action of protease inhibitors (PIs)?","a":"They inhibit protein synthesis needed for viral replication, reducing viral load and delaying disease progression."},{"q":"What is the physician’s goal in prescribing NRTIs and PIs for HIV?","a":"To delay the onset of AIDS as long as possible, often 10–15 years."},{"q":"What is the most common NRTI used for HIV?","a":"AZT (zidovudine)."},{"q":"What is the most challenging aspect of combination drug therapy for HIV?","a":"The large number and frequency of pills required; patients may need reminders such as alarm watches."},{"q":"What class of medication is commonly prescribed for aneurysm patients?","a":"Antihypertensives."},{"q":"What drug treats angina pectoris?","a":"Nitroglycerin."},{"q":"How many nitroglycerin tablets can be taken before calling the doctor?","a":"Up to three."},{"q":"How much time should pass between each nitroglycerin tablet?","a":"Five minutes."},{"q":"By what route is nitroglycerin taken?","a":"Sublingual."},{"q":"What is the action of nitroglycerin?","a":"Dilates coronary arteries to increase oxygen supply and reduces preload."},{"q":"What are the two most common side effects of nitroglycerin?","a":"Headache and hypotension."},{"q":"What precaution must the nurse take when applying topical nitroglycerin paste?","a":"Wear gloves to avoid absorbing the medication."},{"q":"Cancer drugs most commonly cause side effects in which three body systems?","a":"Gastrointestinal, hematologic, and integumentary systems."},{"q":"What are the three most common gastrointestinal side effects of chemotherapy?","a":"Nausea and vomiting, diarrhea, and stomatitis (oral sores)."},{"q":"Is it permissible to give viscous lidocaine before meals for chemotherapy-induced stomatitis?","a":"True."},{"q":"What are the three hematologic side effects of chemotherapy?","a":"Thrombocytopenia, leukopenia, and anemia."},{"q":"Which blood cells are decreased in thrombocytopenia?","a":"Platelets."},{"q":"What drug should not be given to a client with chemotherapy-induced thrombocytopenia?","a":"Aspirin (ASA)."},{"q":"When should intramuscular injections be withheld from a chemotherapy client?","a":"When platelet count is low."},{"q":"What is the number one integumentary side effect of chemotherapy?","a":"Alopecia."},{"q":"What is alopecia?","a":"Hair loss."},{"q":"Is chemotherapy-related hair loss usually temporary?","a":"True."},{"q":"Can scalp tourniquets prevent chemotherapy-induced alopecia?","a":"In some cases, yes."},{"q":"Can ice packs to the scalp prevent chemotherapy-induced alopecia?","a":"In some cases, yes."},{"q":"What are the three most common drugs given to women with CD in pregnancy?","a":"Diuretics, heparin, and digitalis."},{"q":"Why are diuretics given to women with CD of pregnancy?","a":"To promote diuresis, reduce blood volume and preload, and decrease cardiac workload."},{"q":"Why is heparin given to women with CD of pregnancy?","a":"To prevent thrombophlebitis caused by venous congestion."},{"q":"Why is digitalis prescribed for CD of pregnancy?","a":"To increase myocardial contractility and decrease heart rate, improving efficiency."},{"q":"Can morphine be given to a woman with CD during labor?","a":"Yes, because it decreases preload and pain, resting the heart."},{"q":"What are the two primary treatments for cataracts?","a":"Laser treatment or surgical removal (intraocular or extraocular lens extraction)."},{"q":"What drugs are given preoperatively for cataract extraction?","a":"Mydriatics, dilating drops, and antibiotic eye drops."},{"q":"What drugs are given postoperatively after cataract removal?","a":"Stool softeners, antiemetics, and mild analgesics."},{"q":"Can medications be piggybacked into the TPN lumen of a central line?","a":"No, use a separate lumen."},{"q":"Which chemotherapy drug causes hemorrhagic cystitis?","a":"Cytoxan (cyclophosphamide)."},{"q":"Which chemotherapy drug causes peripheral neuropathy, constipation, and ototoxicity?","a":"Cisplatin."},{"q":"Which drug causes pulmonary fibrosis?","a":"Bleomycin."},{"q":"Which chemotherapeutic agent is cardiotoxic?","a":"Adriamycin (doxorubicin)."},{"q":"Which drug causes peripheral neuropathy and adynamic ileus?","a":"Vincristine."},{"q":"Which chemotherapeutic drug causes flu-like symptoms?","a":"DTIC (dacarbazine)."},{"q":"Which drug is toxic to most organs except the heart, worsened by aspirin use?","a":"Methotrexate."},{"q":"What are two common medical treatments for otitis media?","a":"Systemic antibiotics and antibiotic ear drops."},{"q":"Name three drug groups used to treat CHF.","a":"Diuretics, vasodilators, and digitalis."},{"q":"What must you do before administering digitalis?","a":"Measure the apical pulse for one full minute."},{"q":"If an adult’s apical pulse is below 60 bpm, what should you do?","a":"Hold the dose and notify the provider. (Below 70 for children, 90 for infants.)"},{"q":"Which mineral is most often lost due to diuretic therapy in CHF?","a":"Potassium (K⁺)."},{"q":"Name four common toxic effects of digitalis.","a":"Anorexia, nausea\/vomiting, yellow vision, and arrhythmia."},{"q":"Chronic use of what medication can mimic Cushing’s syndrome?","a":"Steroid therapy."},{"q":"Which vitamins must be replaced in cystic fibrosis?","a":"Fat-soluble vitamins A, D, E, and K (in water-soluble form)."},{"q":"What supplement should CF clients take in hot weather?","a":"Sodium chloride (NaCl) tablets."},{"q":"Why is the child with cystic fibrosis given pancreatin, viokase, or pancreas enzymes?","a":"These are pancreatic enzymes that help digest and absorb nutrients."},{"q":"When should pancreatic enzyme replacements be taken in cystic fibrosis?","a":"With meals, so the enzymes mix with food to enhance nutrient absorption."},{"q":"Which pre-procedure medications are commonly given before cystoscopy?","a":"Valium or Demerol for relaxation."},{"q":"Which drugs can induce Parkinson-like symptoms?","a":"Haldol and other antipsychotics ending in -azine."},{"q":"Name four drugs used to treat Parkinson’s disease.","a":"Levodopa, Sinemet, Symmetrel, Cogentin (also Artane, Parlodel)."},{"q":"Which vitamin should be avoided with Levodopa therapy?","a":"Vitamin B6 (pyridoxine)."},{"q":"Should Levodopa be taken with or without food?","a":"With food, to prevent GI upset."},{"q":"What effect can Levodopa have on urine color?","a":"It can darken the urine."},{"q":"PCA pumps maintain a more constant serum drug level than IM analgesia. (T\/F)","a":"True."},{"q":"Do PCA pump clients use more or less medication than those receiving IM injections?","a":"Less."},{"q":"What medicated shampoo treats lice infestations?","a":"Kwell (lindane)."},{"q":"What is the most dangerous toxicity of Kwell?","a":"Central nervous system toxicity."},{"q":"What chemical may be added to bath water in pemphigus care?","a":"Potassium permanganate."},{"q":"What precaution must be taken when using potassium permanganate?","a":"Ensure all crystals are fully dissolved; undissolved ones burn the skin."},{"q":"What drugs are most commonly used for pemphigus?","a":"Steroids."},{"q":"Should steroids be taken with meals?","a":"Yes, always take steroids with meals."},{"q":"Does PD require heparinization?","a":"No, unlike hemodialysis."},{"q":"What is the PD solution called?","a":"Dialysate."},{"q":"To what temperature should dialysate be warmed before use?","a":"Body temperature."},{"q":"How high should the dialysate bag be hung during infusion?","a":"At shoulder height."},{"q":"What is the treatment for pernicious anemia?","a":"IM Vitamin B12 injections."},{"q":"How long must clients with pernicious anemia receive treatment?","a":"For life."},{"q":"Should B12 be given orally in pernicious anemia?","a":"No, it will not be absorbed."},{"q":"Should systemic pain relief be given in active placenta previa labor?","a":"No, it may depress the fetus."},{"q":"What size IV needle should be used for placenta previa with bleeding?","a":"18-gauge or larger."},{"q":"Define phlebotomy.","a":"Withdrawal of 200–500 mL of blood, opposite of transfusion."},{"q":"What drug is commonly used to treat polycythemia vera?","a":"Myleran."},{"q":"Does insulin dosage remain constant throughout pregnancy?","a":"No, it varies by trimester."},{"q":"Are oral hypoglycemics safe during pregnancy?","a":"No, they are teratogenic."},{"q":"What IV solution is used during labor for diabetic clients?","a":"D5W (5% dextrose in water)."},{"q":"Are diuretics used in preeclampsia?","a":"Yes."},{"q":"What medication reduces pulmonary congestion in pulmonary edema?","a":"Diuretics (e.g., Lasix)."},{"q":"What medication improves ventilation in pulmonary edema?","a":"Aminophylline (bronchodilator)."},{"q":"Since pulmonary edema is caused by left ventricular failure, which drug is used?","a":"Digitalis."},{"q":"Why is morphine given in pulmonary edema?","a":"To reduce anxiety and preload, easing the heart’s workload."},{"q":"What anticoagulant is given immediately (IV\/SQ)?","a":"Heparin."},{"q":"What drug is used for long-term anticoagulation?","a":"Coumadin (warfarin)."},{"q":"What is Lovenox?","a":"Low-molecular-weight heparin used post-op to prevent thrombophlebitis (not for PE)."},{"q":"After the acute phase of pulmonary embolus, what drug is given for 6 months?","a":"Coumadin."},{"q":"What medical treatment is required for pyelonephritis?","a":"IV antibiotics for 1–2 weeks, plus follow-up urine culture."},{"q":"Which pain medication should never be given in sickle cell crisis?","a":"Aspirin, because it causes acidosis and worsens sickling."},{"q":"Name three drugs used to treat muscle spasms in spinal cord injury.","a":"Valium, Baclofen, Dantrium."},{"q":"Define antibiotic.","a":"A drug that destroys or inhibits the growth of microorganisms."},{"q":"What is the treatment of choice for syphilis?","a":"Penicillin."},{"q":"Why is penicillin often given with procaine and probenecid?","a":"Procaine reduces injection pain; probenecid prolongs penicillin action."},{"q":"What is the drug class used to treat mastitis?","a":"Antibiotics."},{"q":"What is the medical treatment for mastoiditis?","a":"Systemic antibiotic therapy."},{"q":"What is an emulsion?","a":"A mixture of oil and water."},{"q":"Why are syrups and elixirs a concern for diabetic clients?","a":"They contain sugar."},{"q":"Oral medications have a faster or slower onset than intramuscular (IM) drugs?","a":"Slower onset."},{"q":"Oral medications have a shorter or longer duration than IM medications?","a":"Longer duration."},{"q":"How should medications that can stain teeth be given?","a":"Through a straw."},{"q":"Do parenteral drugs act outside the gastrointestinal (GI) tract?","a":"Yes."},{"q":"What are the four most common parenteral routes?","a":"Subcutaneous (SQ), Intramuscular (IM), Intravenous (IV), and Intradermal (ID)."},{"q":"What size needle should be used for IV blood administration?","a":"18-gauge needle or catheter."},{"q":"How many milliliters (mL) can be injected into one IM site in adults?","a":"Up to 3 mL per site."},{"q":"What is the maximum volume per IM site for children?","a":"2 mL."},{"q":"What is the preferred IM injection site for children under 3 years old?","a":"Vastus lateralis muscle."},{"q":"Why should the dorsogluteal site be avoided for children under 3 years old?","a":"The muscle is not well developed."},{"q":"Can 3 mL be injected into the deltoid muscle of an adult?","a":"No, only 1 mL maximum."},{"q":"What is the main danger when using the dorsogluteal site?","a":"Risk of damaging the sciatic nerve."},{"q":"At what angle should IM injections be administered?","a":"90 degrees."},{"q":"What needle length is preferred for IM injections?","a":"1 to 2 inches."},{"q":"What needle gauge is typically used for IM injections?","a":"21 to 22 gauge."},{"q":"What type of medications are given by the Z-track method?","a":"Medications that are irritating or can stain tissue."},{"q":"How long should the needle remain in place after Z-track injection?","a":"10 seconds."},{"q":"What should be done before giving a Z-track injection?","a":"Change the needle before injecting."},{"q":"When giving a Z-track injection, how should the skin be pulled?","a":"Laterally to one side."},{"q":"At what angle are subcutaneous (SQ) injections typically given?","a":"45 degrees (or as needed to reach SQ tissue)."},{"q":"What needle gauge is preferred for SQ injections?","a":"25 gauge."},{"q":"What needle length is preferred for SQ injections?","a":"5\/8 inch."},{"q":"What is the intradermal route primarily used for?","a":"Skin testing."},{"q":"What are common sites for intradermal injections?","a":"Inner forearm and upper back."},{"q":"After using nasal drops, how long should the client remain supine?","a":"About 5 minutes."},{"q":"What should a client do before receiving vaginal medication?","a":"Void to increase comfort."},{"q":"After vaginal medication is given, how long should the client remain supine?","a":"10 minutes."},{"q":"Should rectal suppositories with an oil base be refrigerated?","a":"Yes."},{"q":"How can the effectiveness of a rectal suppository be ensured?","a":"Place the suppository against the rectal wall."},{"q":"How deep should a rectal suppository be inserted?","a":"4 inches for adults and 2 inches for children."},{"q":"Should the client remain supine after rectal suppository insertion?","a":"No, the client should lie on their side for 5 minutes."},{"q":"What type of lubricant should be used for rectal suppositories?","a":"Water-soluble lubricant."},{"q":"Should eye drops be applied directly onto the cornea?","a":"No, apply into the conjunctival sac, never on the cornea."},{"q":"Eye drops should be placed into which area of the eye?","a":"The conjunctival sac."},{"q":"To prevent systemic absorption of eye drops, where should pressure be applied?","a":"To the nasolacrimal duct for about 10 seconds."},{"q":"Liquid medications should be measured at what level?","a":"Eye level."},{"q":"From which side of the bottle should liquid medications be poured?","a":"The side opposite the label."},{"q":"How should medication be administered to young infants?","a":"Using a dropper."},{"q":"When should Tagamet (cimetidine) be given?","a":"With meals. (Note: Zantac does not need to be given with meals.)"},{"q":"When should Capoten (captopril) be administered?","a":"On an empty stomach, one hour before meals."},{"q":"When should Apresoline (hydralazine) be given?","a":"With meals."},{"q":"How should iron be given if it causes nausea?","a":"With meals."},{"q":"What is important when giving sulfonamides such as Bactrim or Septra?","a":"Take with plenty of water, regardless of meals, to prevent crystalluria."},{"q":"How should codeine be taken?","a":"With plenty of water, regardless of meals, to prevent constipation."},{"q":"When should antacids be given?","a":"On an empty stomach, one hour before meals and at bedtime."},{"q":"How is Ipecac syrup administered?","a":"With 200–300 mL of water; do not give if poison is caustic or petroleum-based."},{"q":"When should Rifampin be taken?","a":"On an empty stomach; note that it may cause red or orange urine."},{"q":"How should NSAIDs be taken?","a":"With food to reduce gastric irritation."},{"q":"When should Aldactone (spironolactone) be given?","a":"With meals."},{"q":"When iron does not cause nausea, how should it be given?","a":"On an empty stomach with orange juice to enhance absorption."},{"q":"When should penicillin be administered?","a":"On an empty stomach."},{"q":"When should erythromycin be administered?","a":"On an empty stomach."},{"q":"How should stool softeners be taken?","a":"With plenty of water, regardless of meals."},{"q":"When should griseofulvin be taken?","a":"With meals—preferably with high-fat foods—to improve absorption."},{"q":"What are tetracycline precautions?","a":"Do not give with milk or dairy; avoid in pregnancy or in children under 8 to prevent tooth enamel damage."},{"q":"When should theophylline derivatives such as aminophylline or Theodur be given?","a":"With meals to decrease gastric irritation."},{"q":"When should corticosteroids be taken?","a":"With meals; taper off slowly, never stop abruptly."},{"q":"When should pancreatic enzyme supplements (pancreatin) be given?","a":"With meals to aid digestion, especially in cystic fibrosis."},{"q":"When should para-aminosalicylic acid (PAS) be given?","a":"With food or meals; used for tuberculosis treatment."},{"q":"When should colchicine be given?","a":"With meals; discontinue if diarrhea develops."},{"q":"How should Thorazine (chlorpromazine) be taken?","a":"With plenty of water, regardless of meals, to prevent constipation."},{"q":"What is the general rule for drugs ending in “-zine”?","a":"They are major tranquilizers that can cause extrapyramidal or pseudo-Parkinsonian effects."},{"q":"When should Carafate (sucralfate) be taken?","a":"On an empty stomach, one hour before meals and at bedtime; give separately from other medications."},{"q":"When should Allopurinol be taken?","a":"With meals and plenty of water; it reduces uric acid buildup in gout and chemotherapy."},{"q":"What electrolyte is sometimes prescribed for Meniere’s disease?","a":"Ammonium chloride."},{"q":"Which two classes of drugs are commonly used to treat Meniere’s disease?","a":"Antihistamines and diuretics (e.g., Diamox)."},{"q":"Name drugs used to treat or prevent migraines.","a":"Sansert (methysergide), Cafergot; for prevention, Imipramine."},{"q":"Is Inderal (propranolol) used to treat or prevent migraines?","a":"It is used to prevent migraines, not to treat acute attacks."},{"q":"Why are ACTH and prednisone given in acute MS?","a":"To reduce inflammation and edema during demyelination."},{"q":"What IV drug is often used for acute MS exacerbations?","a":"ACTH (Corticotropin)."},{"q":"What drug is used to treat urinary retention in MS?","a":"Urecholine (bethanechol)."},{"q":"Name three drugs used to treat muscle spasms in MS.","a":"Valium, Baclofen (Lioresal), and Dantrium."},{"q":"Does Baclofen cause constipation or diarrhea?","a":"Constipation."},{"q":"Does Dantrium cause constipation or diarrhea?","a":"Diarrhea."},{"q":"What class of drugs is used to treat MG?","a":"Anticholinesterase medications."},{"q":"What is the common drug suffix for anticholinesterases?","a":"“-stigmine.”"},{"q":"Are anticholinesterases sympathetic or parasympathetic in action?","a":"Parasympathetic."},{"q":"What type of side effects do anticholinesterases produce?","a":"Cholinergic effects (they mimic the parasympathetic system)."},{"q":"What is the most important nursing point when giving Mestinon or other anticholinesterases?","a":"They must be administered exactly on time; patients may need to set an alarm."},{"q":"Should anticholinesterases be given with or without food?","a":"With food, about 30 minutes before meals to strengthen swallowing muscles."},{"q":"What medications are given to relieve pain during an MI?","a":"Morphine, Demerol, and Nitroglycerin."},{"q":"Why is aspirin (ASA) given after an MI?","a":"To prevent platelet aggregation and further clot formation."},{"q":"Name a newer anti-platelet drug used after MI.","a":"Plavix (clopidogrel)."},{"q":"What drug is used to treat PVCs following an MI?","a":"Lidocaine."},{"q":"What is the name of frozen Factor VIII given to hemophiliacs?","a":"Cryoprecipitate."},{"q":"What topical medications can be used to stop bleeding?","a":"Epinephrine or topical fibrin foam."},{"q":"Name three drugs commonly used to treat shingles.","a":"Acyclovir (antiviral), Tegretol (carbamazepine for nerve pain), and corticosteroids."},{"q":"Why are antiemetics used cautiously in hyperemesis gravidarum?","a":"To avoid potential harm to the fetus."},{"q":"What class of drugs is typically used first to treat hypertension?","a":"Diuretics."},{"q":"What is the most common side effect of antihypertensive drugs?","a":"Orthostatic hypotension (feeling weak or dizzy upon standing)."},{"q":"Would vasodilators or vasoconstrictors treat hypertension?","a":"Vasodilators (they reduce vascular resistance)."},{"q":"Would sympathetic stimulators or sympathetic blockers treat hypertension?","a":"Sympathetic blockers (they reduce cardiac output and resistance)."},{"q":"What gauge IV catheter should be used for a client in hypovolemic shock?","a":"16 gauge or larger."},{"q":"During ECT, is the client awake or under anesthesia?","a":"Under general anesthesia with assisted ventilation."},{"q":"What drug class is given with ECT?","a":"Muscle relaxants, such as succinylcholine."},{"q":"Should sedatives be given before an EEG?","a":"Only if specifically ordered."},{"q":"What class of drugs is used to conservatively treat endometriosis?","a":"Androgens."},{"q":"Which androgen is most commonly used to treat endometriosis?","a":"Danazol."},{"q":"What antibiotics are used to treat epiglottitis?","a":"Penicillin or ampicillin."},{"q":"Is the client sedated before EGD?","a":"Yes, commonly with diazepam (Valium) or another sedative."},{"q":"What drug is used to anesthetize the pharynx during an EGD?","a":"Xylocaine, a local anesthetic."},{"q":"What is the purpose of carbonic anhydrase inhibitors?","a":"To treat glaucoma by decreasing aqueous humor production and lowering intraocular pressure; they also have diuretic effects."},{"q":"Give an example of a carbonic anhydrase inhibitor.","a":"Diamox (acetazolamide)."},{"q":"What are the effects of anticholinergics on the eyes?","a":"They dilate the pupils (mydriasis), cause photophobia, and are used preoperatively for cataract surgery."},{"q":"Give an example of an anticholinergic.","a":"Atropine."},{"q":"What do miotic eye medications do?","a":"Constrict the pupils (e.g., Timoptic, Pilocarpine)."},{"q":"What do mydriatic eye medications do?","a":"Dilate the pupils, cause tachycardia and photophobia; contraindicated in glaucoma."},{"q":"Give an example of a mydriatic.","a":"Neo-Synephrine."},{"q":"What is the most common side effect of carbonic anhydrase inhibitors?","a":"Diuresis."},{"q":"Which two drug classes commonly cause photophobia?","a":"Mydriatics and anticholinergics."},{"q":"Which class of eye medications may cause contact dermatitis?","a":"Miotics."},{"q":"What effect do anticholinergics have on the eye?","a":"Pupil dilation (mydriasis) and paralysis of accommodation (cycloplegia)."},{"q":"Define cycloplegia.","a":"Paralysis of the ciliary muscle, causing loss of lens accommodation."},{"q":"Which two eye drug classes may cause tachycardia due to sympathetic stimulation?","a":"Mydriatics and anticholinergics."},{"q":"What is the main purpose of anticholinergics in ophthalmology?","a":"To dilate the pupil and induce cycloplegia for eye examinations."},{"q":"Name two miotic drugs.","a":"Pilocarpine and Timoptic (or any drug ending in -lol)."},{"q":"Name two anticholinergics used in ophthalmology.","a":"Cyclogel and Atropine."},{"q":"What are the two types of oral contraceptive pills?","a":"Progestin-only and combination estrogen-progestin."},{"q":"For how many days each month is the progestin-only pill taken?","a":"All 28 days of the menstrual cycle."},{"q":"For how many days each month is the combination oral contraceptive taken?","a":"From day 5 through 24, with no pills taken on days 25–4 (8 pill-free days)."},{"q":"How long before surgery should oral contraceptives be discontinued?","a":"One week before surgery."},{"q":"If a woman forgets to take her oral contraceptive for one day, what should she do?","a":"Take the missed pill as soon as she remembers, then take the next pill at the regularly scheduled time."},{"q":"What should a woman do if she forgets to take the oral contraceptive pill for two days in a row?","a":"Take two pills a day for two consecutive days, then resume the normal schedule."},{"q":"What should a woman do if she forgets to take her oral contraceptive pill for three or more days?","a":"Discard the pack, start a new one immediately, and use a backup contraceptive method for 7 days."},{"q":"If a woman on oral contraceptives misses a period, should she continue taking the pills?","a":"Yes, but if two consecutive periods are missed, stop and take a pregnancy test."},{"q":"Will breakthrough bleeding, nausea, and breast tenderness disappear after some time on oral contraceptives?","a":"Yes, usually after 3–6 months of consistent use."},{"q":"What three medications are commonly used for osteoarthritis?","a":"Aspirin, NSAIDs (e.g., Indocin, Ibuprofen), and corticosteroids."},{"q":"What two drugs are commonly prescribed post-stapedectomy?","a":"Codeine or Demerol for pain, and Dramamine for dizziness."},{"q":"How do oral contraceptives affect ovarian cysts?","a":"They stop cyst growth and help reduce cyst size."},{"q":"What is the main difference between sealed and unsealed internal radiation therapy?","a":"In sealed therapy, a solid radioactive implant is placed in a body cavity; in unsealed therapy, a liquid radioactive substance is injected intravenously."},{"q":"What is another term for external radiation therapy?","a":"Beam therapy or external X-ray therapy."},{"q":"How does external radiation differ from internal radiation?","a":"External therapy directs radiation at the tumor from outside the body; internal therapy involves placing or injecting radioactive material inside the body."},{"q":"What skin products should patients receiving external radiotherapy avoid?","a":"Avoid ointments containing metals such as zinc oxide, and do not use talcum powder."},{"q":"What hygiene measures should be taught to patients receiving external radiotherapy?","a":"Use plain water only, avoid soap, pat the skin dry gently, and use cornstarch to relieve itching."},{"q":"What are the major side effects of radiotherapy?","a":"Pruritus, erythema, burning, skin sloughing, anorexia, nausea, vomiting, diarrhea, and bone marrow suppression."},{"q":"What drugs are used to prevent pregnancy after rape?","a":"FDA-approved kits such as Preven (levonorgestrel and ethinyl estradiol) or Plan B (levonorgestrel)."},{"q":"What medication is given to treat RDS and how is it administered?","a":"Survanta (surfactant) given via endotracheal tube; multiple doses may be required."},{"q":"What IV additive may be given to correct acidosis in RDS?","a":"Sodium bicarbonate."}]

Physiological Integrity – Reduction of Risk Potential

[{"q":"What is the best screening method for BPH?","a":"Digital rectal examination."},{"q":"What is the primary purpose of a three-way continuous bladder irrigation (CBI) after TURP?","a":"To keep the catheter clear of clots and to drain urine."},{"q":"What solution is used for continuous bladder irrigation (CBI)?","a":"Normal saline (0.9% NaCl)."},{"q":"How fast should the CBI run?","a":"At whatever rate keeps the urine flowing and free of clots."},{"q":"After prostatectomy, should you take rectal temperatures or give stool softeners?","a":"No rectal temperatures, but give stool softeners."},{"q":"When should the nurse call the physician after TURP?","a":"When there is bright thick bleeding, persistent clots, or continued urine drainage on the dressing."},{"q":"If blood content of urine increases after TURP, what should you do first?","a":"Pull gently on the catheter to apply local pressure on the prostate with the Foley balloon."},{"q":"If clots appear in the catheter tubing, what should you do first?","a":"Increase the flow rate of the irrigation."},{"q":"What is the most common problem related to catheterization?","a":"Urinary tract infection (UTI)."},{"q":"What is the most common organism causing UTI with catheterization?","a":"Escherichia coli (E. coli)."},{"q":"What is the most common route for organisms to enter the bladder when a catheter is used?","a":"Through the inside of the catheter after insertion."},{"q":"Name foods that make the urine acidic.","a":"Cranberry juice and apple juice (avoid citrus juices—they make urine alkaline)."},{"q":"Why must the urinary drainage bag be kept below bladder level?","a":"To prevent backflow of urine, which can cause infection."},{"q":"How should the catheter be taped in a male client?","a":"To the lateral thigh or abdomen."},{"q":"How should the catheter be taped in a female client?","a":"To the upper thigh."},{"q":"What urinary pH helps prevent urinary tract infection?","a":"Acidic (low pH)."},{"q":"Should the drainage bag ever touch the floor?","a":"No."},{"q":"Is it okay to routinely irrigate indwelling catheters?","a":"No."},{"q":"What agents are best for catheter care?","a":"Soap and water."},{"q":"What is the most effective way to reduce UTI risk with catheters?","a":"Keep the drainage system closed; do not disconnect tubing junctions."},{"q":"What are signs of infection in a client with a Foley catheter?","a":"Cloudy urine, foul-smelling urine, and hematuria."},{"q":"Is urinary incontinence an indication for catheterization?","a":"No."},{"q":"What are three appropriate indications for bladder catheterization?","a":"Urinary retention, checking for residual urine, and monitoring hourly urine output."},{"q":"What are the top two nursing diagnoses for a client with a catheter?","a":"#1—Potential for infection; #2—Potential impairment of urethral tissue integrity."},{"q":"What is systole?","a":"The maximum force of blood on the artery walls."},{"q":"What is diastole?","a":"The lowest force of blood on the artery walls."},{"q":"How wide should the blood pressure cuff be relative to the arm?","a":"About two-thirds of the arm’s width."},{"q":"Which artery is most commonly used to measure blood pressure?","a":"The brachial artery."},{"q":"Can the thigh ever be used to obtain a blood pressure?","a":"Yes, but it is rarely done."},{"q":"When auscultating blood pressure, the first sound heard corresponds to which measurement?","a":"The systolic pressure."},{"q":"The change in the character of Korotkoff sounds is known as what?","a":"The first diastolic sound."},{"q":"The cessation of sounds is known as what?","a":"The second diastolic sound."},{"q":"When two values are given in a blood pressure reading, what does the top number represent?","a":"The systolic pressure."},{"q":"In a blood pressure reading, what does the bottom number represent?","a":"The diastolic pressure (cessation of sounds)."},{"q":"What is the normal adult blood pressure?","a":"120\/80 mmHg."},{"q":"What is abnormally high blood pressure called?","a":"Hypertension."},{"q":"What is pulse pressure?","a":"The difference between the systolic and diastolic pressures."},{"q":"If the blood pressure cuff is deflated too slowly, will the reading be high or low, and why?","a":"High—venous congestion raises arterial pressure."},{"q":"If the cuff is too narrow, will the reading be high or low?","a":"High."},{"q":"Vasoconstriction will __________ blood pressure.","a":"Increase."},{"q":"What blood test must be done before a transfusion?","a":"Type and crossmatch."},{"q":"What does a type and crossmatch determine?","a":"Whether the client’s blood and donor blood are compatible."},{"q":"What should the nurse measure before starting a blood transfusion?","a":"Vital signs."},{"q":"How many nurses are required to verify the blood before transfusion?","a":"Two nurses."},{"q":"What happens if blood is administered with dextrose IV solutions?","a":"The blood cells clump together and do not flow properly."},{"q":"If a transfusion reaction occurs, what should the nurse do first?","a":"Stop the blood flow and start running normal saline."},{"q":"How long can a unit of blood remain on the nursing unit before transfusion must begin?","a":"Less than 30 minutes."},{"q":"What should the nurse do with the IV line if a transfusion reaction is suspected?","a":"Keep the line open with normal saline."},{"q":"If a transfusion reaction is suspected, what two samples are collected and sent to the lab?","a":"Urine and blood samples."},{"q":"Which of the following are signs of a transfusion reaction: bradycardia, fever, hives, wheezing, increased blood pressure, or low back pain?","a":"Low back pain, wheezing, fever, and hives."},{"q":"What are the three main types of transfusion reactions?","a":"Hemolytic, febrile, and allergic."},{"q":"What is the first nursing action when a transfusion reaction is suspected?","a":"Stop the blood and start the saline."},{"q":"What are the signs and symptoms of a hemolytic transfusion reaction?","a":"Shivering, headache, low back pain, increased pulse and respirations, decreased blood pressure, oliguria, and hematuria."},{"q":"What are the signs and symptoms of a febrile transfusion reaction?","a":"Low back pain, headache, increasing temperature, confusion, and hemoptysis."},{"q":"What are the signs and symptoms of an allergic transfusion reaction?","a":"Hives (urticaria), wheezing, pruritus, and joint pain (arthralgia)."},{"q":"What does blood typing determine?","a":"The presence of surface antigens on red blood cells."},{"q":"When must typing and crossmatching be performed?","a":"Whenever a client is to receive blood; results are valid for 24 hours."},{"q":"What does blood crossmatching involve?","a":"Mixing a small amount of the client’s blood with donor blood to check for agglutination."},{"q":"When are hemolytic transfusion reactions most likely to occur?","a":"Within the first 10 to 15 minutes of the transfusion."},{"q":"When is a febrile transfusion reaction most likely to occur?","a":"Within 30 minutes of beginning the transfusion."},{"q":"What test identifies Rh factor?","a":"The Coombs test, which detects antibodies to Rh."},{"q":"What is the difference between whole blood and packed red cells?","a":"Packed cells contain less plasma and volume than whole blood."},{"q":"What should the nurse do if the client’s temperature increases before receiving blood?","a":"Notify the physician; blood may be withheld if the temperature is elevated."},{"q":"How long should the nurse remain with the client after starting a transfusion?","a":"At least 15 to 30 minutes."},{"q":"Which blood type is the universal recipient?","a":"Type AB."},{"q":"Which blood type is the universal donor?","a":"Type O."},{"q":"What is the routine schedule for taking vital signs during a transfusion?","a":"Once before transfusion, every 15 minutes ×2 after starting, and once after completion."},{"q":"What nursing actions are appropriate after a transfusion reaction?","a":"Notify the physician, obtain blood and urine samples, monitor vital signs, and send the blood bag to the lab."},{"q":"What blood value dictates IV flow rate in burn patients?","a":"Hematocrit."},{"q":"If IV fluids are run at shock-phase rates during the diuretic phase, what complication may occur?","a":"Pulmonary edema."},{"q":"Burn patients must be monitored for _______ urine output and daily _______.","a":"Hourly urine output and daily weight."},{"q":"How often should vital signs, vaginal bleeding, and fetal heart rate be measured during abruptio placenta?","a":"Every 5–15 minutes for bleeding and maternal vital signs; continuous fetal monitoring; deliver at the earliest sign of fetal distress."},{"q":"What chemicals cause oral mucosa burns when ingested?","a":"Lye and caustic household cleaners."},{"q":"Children who ingest which substances are at high risk for seizures?","a":"Drugs and insecticides."},{"q":"Can impaired skin integrity be a nursing diagnosis after poisoning?","a":"Yes, especially when lye or caustic agents are ingested."},{"q":"What is the initial test used to detect HIV antibodies?","a":"ELISA test."},{"q":"What test confirms a positive ELISA result?","a":"Western Blot test."},{"q":"Which test best indicates the progression of HIV disease?","a":"CD4 count."},{"q":"A CD4 count below what level is associated with the onset of AIDS-related symptoms?","a":"Below 500 cells\/mm³."},{"q":"A CD4 count below what level is associated with opportunistic infections?","a":"Below 200 cells\/mm³."},{"q":"What lab findings are typical in AIDS?","a":"Decreased RBCs, WBCs, and platelets."},{"q":"Define leukopenia.","a":"A decrease in white blood cells, often indicating viral infection."},{"q":"Define azotemia.","a":"Accumulation of nitrogenous wastes in the blood (elevated BUN and creatinine)."},{"q":"What is the best indicator of renal function?","a":"Serum creatinine."},{"q":"What urinalysis findings are seen in AGN?","a":"Hematuria, proteinuria (+3 to +4), and elevated specific gravity."},{"q":"How is fluid excess assessed in a child with AGN?","a":"By daily weight monitoring."},{"q":"How often should vital signs be measured in AGN?","a":"Every 4 hours, with blood pressure monitoring."},{"q":"How can a stump be toughened to prevent skin breakdown from a prosthesis?","a":"Push the stump against a wall or hit it with a pillow to desensitize the area."},{"q":"Which vital signs are most important to monitor with aneurysms?","a":"Pulse and blood pressure."},{"q":"Which vital sign is affected first if an aneurysm ruptures?","a":"The pulse (tachycardia before blood pressure drops)."},{"q":"What type of tube is expected after thoracic aneurysm repair?","a":"Chest tube (due to chest incision)."},{"q":"What type of tube is expected after abdominal aneurysm repair?","a":"NG tube for bowel decompression."},{"q":"After femoral-popliteal resection surgery, what should be checked hourly for the first 24 hours?","a":"The distal extremity for color, temperature, pain, and pulse, and document findings."},{"q":"How can you distinguish angina from myocardial infarction (MI)?","a":"Angina pain is relieved by nitroglycerin and rest; MI pain is not."},{"q":"Is the pulse rate of anorexic clients tachycardic or bradycardic?","a":"Bradycardic."},{"q":"What is the most common gynecologic symptom of anorexia nervosa?","a":"Amenorrhea."},{"q":"What physical finding appears on the body of a client with anorexia nervosa?","a":"Lanugo (soft downy hair)."},{"q":"What is the Apgar scale?","a":"A quick, objective method to evaluate the vital functions of a newborn."},{"q":"When is the Apgar score assessed?","a":"At 1 minute and again at 5 minutes after birth."},{"q":"Name the five criteria measured in the Apgar scale.","a":"Heart rate, respiratory effort, muscle tone, reflex irritability, and color."},{"q":"What is the total scoring range of the Apgar scale?","a":"0 to 10."},{"q":"What is the maximum score an infant can receive on any single Apgar criterion?","a":"2."},{"q":"What does a total Apgar score of 10 indicate?","a":"The baby is in excellent health."},{"q":"What does an Apgar score of 0 indicate?","a":"The baby is stillborn."},{"q":"On the heart rate criterion, a score of 2 means the heart rate is above what?","a":"Above 100 beats per minute."},{"q":"On the heart rate criterion, a score of 1 means what?","a":"Heart rate greater than 0 but less than 100."},{"q":"What heart rate gives a score of 0 on the Apgar scale?","a":"Zero (no heartbeat)."},{"q":"A score of 2 for respiratory effort is given when the newborn does what?","a":"Cries vigorously."},{"q":"A score of 1 for respiratory effort is given when respirations are what?","a":"Slow or irregular."},{"q":"A score of 0 for respiratory effort is given when the infant does what?","a":"Does not breathe."},{"q":"To score 2 on muscle tone, the infant must do what?","a":"Move spontaneously and actively."},{"q":"A score of 1 for muscle tone is given when the newborn does what?","a":"Holds extremities in flexion."},{"q":"A score of 0 for muscle tone is given when there is what?","a":"No movement (limp)."},{"q":"To score 2 on neuromuscular reflex irritability, the infant must do what?","a":"Cry."},{"q":"A score of 1 on reflex irritability is given when the infant does what?","a":"Grimaces."},{"q":"A score of 0 on reflex irritability is given when the infant does what?","a":"Shows no response."},{"q":"To score 2 on color, the infant must be what?","a":"Completely pink."},{"q":"A score of 1 on color is given when what is observed?","a":"The extremities are blue but the trunk and face are pink."},{"q":"A score of 0 on color means the infant is what?","a":"Completely blue or pale."},{"q":"What is acrocyanosis?","a":"Temporary bluish discoloration of the lips, hands, or feet in newborns that disappears with warming."},{"q":"What does rebound tenderness indicate?","a":"Peritoneal inflammation."},{"q":"What is the highest temperature usually seen in appendicitis?","a":"102°F."},{"q":"What blood count is elevated in appendicitis?","a":"White blood cell (WBC) count."},{"q":"What is the term for elevated WBC count?","a":"Leukocytosis."},{"q":"What should be avoided before the physician evaluates a client with suspected appendicitis?","a":"Pain medications, enemas, laxatives, and food (NPO)."},{"q":"What should never be applied to the appendix area?","a":"Heat, because it may cause rupture."},{"q":"After appendectomy, what should be documented in the nurse’s notes?","a":"The return of bowel sounds (peristalsis)."},{"q":"What are the three objective signs of thrombocytopenia (P.E.E.)?","a":"Petechiae, epistaxis, and ecchymosis."},{"q":"What is epistaxis?","a":"Nosebleed."},{"q":"What is ecchymosis?","a":"Bruising."},{"q":"What is petechiae?","a":"Small pinpoint hemorrhages on the skin."},{"q":"Which blood cells are decreased in leukopenia?","a":"White blood cells."},{"q":"When the absolute neutrophil count (ANC) is below what value should reverse isolation be initiated?","a":"Below 500."},{"q":"What are the two most common subjective complaints of a woman decompensating during labor?","a":"Shortness of breath and palpitations."},{"q":"In addition to usual labor assessments, what special assessment is needed for a woman with cardiac disease?","a":"Frequent lung sound assessment."},{"q":"How often should lung sounds be assessed during the first, active, and transition stages of labor?","a":"Every 30 to 10 minutes."},{"q":"What signs and symptoms should be reported after cast application?","a":"Numbness, tingling, burning, pallor, unequal or absent pulses, or coolness."},{"q":"If inflammation occurs under a cast, how will it appear externally?","a":"As a hot spot on the cast surface."},{"q":"What type of cast can cause cast syndrome?","a":"A body cast."},{"q":"What causes cast syndrome?","a":"Anxiety and stress leading to sympathetic shutdown of bowel motility."},{"q":"What is the number one symptom of cast syndrome?","a":"Nausea and vomiting due to bowel obstruction."},{"q":"What is the primary treatment for cast syndrome?","a":"NPO status and nasogastric tube for decompression."},{"q":"How can you tell if Bryant’s traction is working correctly?","a":"The child’s hips\/sacrum should be just off the bed (a hand can slide underneath)."},{"q":"Patients in Russell’s traction are especially prone to what?","a":"Thrombophlebitis."},{"q":"What is a cataract?","a":"Opacity of the crystalline lens."},{"q":"Is cataract surgery performed immediately after diagnosis?","a":"No, surgery is delayed until vision interferes with activities of daily living (ADLs)."},{"q":"What are the three most common visual defects seen in cataracts?","a":"Cloudy vision, diplopia (double vision), and photophobia (light sensitivity)."},{"q":"What does the eye look like when cataracts are present?","a":"The pupil appears cloudy or milky white."},{"q":"What protective device is used after cataract surgery?","a":"A patch or shield for 24 hours, then a metal eye shield at night for three weeks."},{"q":"What should you tell a client about glasses or contacts after cataract surgery?","a":"If an intraocular lens is implanted, glasses may not be needed; if not, temporary glasses are used until permanent ones are prescribed in 2–3 months."},{"q":"Should the client ambulate independently after cataract surgery?","a":"No, depth perception is altered and increases the risk of falls."},{"q":"What positions must be avoided after cataract surgery?","a":"Lying face down or on the operative side for one month."},{"q":"What are signs of postoperative hemorrhage into the eye?","a":"Severe pain and restlessness."},{"q":"What movements must be avoided after cataract surgery?","a":"Coughing, sneezing, bending, straining at stool, rubbing eyes, or sudden head movements."},{"q":"What positions are acceptable after cataract surgery?","a":"Avoid lying on the operative side and lying flat on the back."},{"q":"Should talcum powder or pepper be used near a post-cataract client?","a":"No, they can trigger sneezing and increase eye pressure."},{"q":"What are three signs of increased intraocular pressure?","a":"Moderate to severe pain, restlessness, and increased pulse rate."},{"q":"What is the main nursing goal after cataract removal surgery?","a":"Prevent pressure in or on the eyes."},{"q":"What are five possible causes of cataracts?","a":"Injury, congenital defects, excessive heat exposure, heredity, and aging."},{"q":"What activity restrictions apply when ear tubes are in place?","a":"No swimming, showering, or diving."},{"q":"What is the number one complication of cleft lip\/palate?","a":"Aspiration."},{"q":"A fresh new stoma should appear ________, ________, and ________.","a":"Red, large, and moist."},{"q":"What device helps prevent venous stasis in CHF patients?","a":"Anti-embolism (TED) hose."},{"q":"How often should TED hose be removed?","a":"Daily."},{"q":"When should TED hose be applied?","a":"Before the patient gets out of bed."},{"q":"Can powder be used with TED hose?","a":"Yes."},{"q":"Should the nurse massage the legs of a CHF patient?","a":"Never."},{"q":"What daily measurement best reflects fluid retention in CHF?","a":"Daily weight."},{"q":"Should CHF clients have Foley catheters?","a":"Yes, to monitor urine output accurately when on diuretics."},{"q":"What serious complication is common in CHF?","a":"Pulmonary edema."},{"q":"How much weekly weight gain should a CHF client report immediately?","a":"Three pounds or more in one week."},{"q":"Hearing aids are more useful in which type of hearing loss: sensory or conductive?","a":"Conductive hearing loss."},{"q":"What are the two most common causes of whistling or squealing in a hearing aid?","a":"Loose earmold and low battery."},{"q":"Do hearing aids make sound clearer and more distinct?","a":"False, they only amplify sound but do not clarify it."},{"q":"What is the most common complication of malpositioned contact lenses in confused or comatose patients?","a":"Corneal ulceration."},{"q":"1 kilogram equals how many cubic centimeters (cc)?","a":"1000 cc."},{"q":"1 inch equals how many centimeters?","a":"2.5 cm."},{"q":"1 milliliter equals how many cubic centimeters?","a":"1 cc."},{"q":"1 teaspoon equals how many cubic centimeters?","a":"4–5 cc."},{"q":"1 gram equals how many milligrams?","a":"1000 mg."},{"q":"1 liter equals how many cubic centimeters?","a":"1000 cc."},{"q":"1 ounce equals how many cubic centimeters?","a":"30 cc."},{"q":"1 kilogram equals how many pounds?","a":"2.2 lbs."},{"q":"1 tablespoon equals how many cubic centimeters?","a":"15 cc."},{"q":"1 tablespoon equals how many teaspoons?","a":"3 tsp."},{"q":"1 gram equals how many grains?","a":"15 gr."},{"q":"1 grain equals how many milligrams?","a":"60 mg."},{"q":"Do Cushing’s clients have increased or decreased resistance to infection?","a":"Decreased."},{"q":"What is the classic diagnostic test for cystic fibrosis?","a":"Iontophoresis (sweat chloride test)."},{"q":"How can clients evaluate pancreatic function at home?","a":"By observing stools for steatorrhea."},{"q":"Define cystoscopy.","a":"Direct visualization of the urethra and bladder using a cystoscope."},{"q":"What should the nurse do if the client experiences bladder spasm, burning, or frequency after cystoscopy?","a":"Record the symptoms; no need to notify the provider unless they worsen."},{"q":"What should the nurse do if urine is pink-tinged after cystoscopy?","a":"Document it in the chart; this is expected."},{"q":"Is the client NPO before cystoscopy?","a":"No, unless a child is under general anesthesia; adults are encouraged to drink fluids."},{"q":"Are enemas required before cystoscopy?","a":"No, but they may be ordered."},{"q":"Should fluids be encouraged after cystoscopy?","a":"Yes, to flush the bladder."},{"q":"What vital sign changes are most concerning after cystoscopy?","a":"Decreased blood pressure and increased pulse — signs of hemorrhage."},{"q":"What type of anesthesia is used for cystoscopy?","a":"Local anesthesia; general anesthesia may be used for children."},{"q":"What time of day is most dangerous for Parkinson’s patients?","a":"Mealtime, due to choking risk."},{"q":"Why should patients on Levodopa get assistance when rising from bed?","a":"Risk of orthostatic hypotension."},{"q":"Are clients with COPD good candidates for PCA pumps?","a":"False, narcotics can depress their respiratory drive."},{"q":"Can clients overdose on PCA pumps?","a":"No, due to the lock-out feature."},{"q":"What is the leading cause of death in pemphigus?","a":"Overwhelming infection."},{"q":"Is there a high or low risk of peritonitis with PD?","a":"High risk."},{"q":"Can clients with recent bowel surgery undergo PD?","a":"No."},{"q":"Should clients with respiratory compromise receive PD?","a":"No."},{"q":"What should be done before starting PD?","a":"Weigh the client to monitor fluid balance."},{"q":"If drainage is sluggish, what should the nurse do first?","a":"Reposition the client side-to-side."},{"q":"What color should the dialysate be when drained?","a":"Clear, straw-colored."},{"q":"How often should vital signs be measured during PD?","a":"Every 15 minutes for the first cycle, then hourly."},{"q":"If too much fluid is removed during peritoneal dialysis, what occurs?","a":"Hypotension (low blood pressure)."},{"q":"If the client absorbs too much dialysate during PD, what happens?","a":"Hypertension or circulatory overload."},{"q":"If the client reports dyspnea during PD, what should the nurse do first?","a":"Slow the flow rate and elevate the head of bed."},{"q":"What does cloudy dialysate drainage indicate?","a":"Peritonitis — notify the provider immediately."},{"q":"What should you do if a small amount of blood appears in the first few bottles of PD fluid?","a":"Nothing; it is normal due to initial needle puncture."},{"q":"Is accurate intake and output recording necessary during PD?","a":"Yes, essential for fluid balance monitoring."},{"q":"What condition can mimic pernicious anemia?","a":"Angina pectoris."},{"q":"What test diagnoses pernicious anemia?","a":"Schilling test."},{"q":"What neurologic test is used for this anemia?","a":"Romberg test (positive result indicates imbalance)."},{"q":"What is the hallmark symptom of placenta previa?","a":"Painless third-trimester bleeding."},{"q":"Is placenta previa more common in primigravidas or multigravidas?","a":"Multigravidas."},{"q":"What are three major complications of placenta previa?","a":"Shock, maternal death, fetal death."},{"q":"What is the safest diagnostic method for placenta previa?","a":"Ultrasound."},{"q":"Should all women with placenta previa be hospitalized?","a":"Yes, especially if bleeding."},{"q":"Why might a C-section for placenta previa be delayed?","a":"To allow fetal maturity."},{"q":"Once diagnosed, is C-section usually required if fetus is mature?","a":"Yes, almost always."},{"q":"How should fetal heart tones be monitored in placenta previa with bleeding?","a":"Continuously by electronic fetal monitor."},{"q":"Which acid-base disorder is most common in pneumonia?","a":"Respiratory alkalosis due to hyperventilation."},{"q":"What procedure relieves symptoms in polycythemia vera?","a":"Phlebotomy (removal of blood)."},{"q":"What oral problem occurs in polycythemia vera?","a":"Bleeding mucous membranes."},{"q":"What blood level rises in polycythemia vera due to increased RBC destruction?","a":"Uric acid."},{"q":"How often should lung sounds be auscultated after surgery?","a":"Every 4 hours."},{"q":"The post-op patient should void by how many hours after surgery?","a":"6–8 hours."},{"q":"What post-op findings are typical for lungs, bowels, and temperature?","a":"Lungs: present; Bowels: absent; Temp: mild elevation normal."},{"q":"DVT is most common after which type of surgery?","a":"Lower abdominal or pelvic."},{"q":"What is the major complication of deep vein thrombosis?","a":"Pulmonary embolism."},{"q":"What is the best prevention for thrombophlebitis?","a":"Early ambulation and leg exercises."},{"q":"What is the typical mild post-op inflammatory temperature range?","a":"99.8–101°F."},{"q":"Infection after surgery usually appears on which day?","a":"2nd or 3rd post-op day."},{"q":"Define dehiscence.","a":"Separation of surgical incision edges."},{"q":"Define evisceration.","a":"Protrusion of abdominal organs through a dehiscence."},{"q":"What should be done for dehiscence?","a":"Lower the head of bed slightly, cover with moist sterile gauze, and call the physician."},{"q":"What should be done for evisceration?","a":"Same as dehiscence: lower the head of bed, cover with moist sterile gauze, and call the physician immediately."},{"q":"What is the #1 infant complication from maternal diabetes?","a":"Neonatal hypoglycemia."},{"q":"When does neonatal hypoglycemia most often occur?","a":"Within hours after delivery."},{"q":"Gestational diabetics are prone to which infection?","a":"Yeast (monilial) infections."},{"q":"What test confirms gestational diabetes?","a":"3-hour glucose tolerance test."},{"q":"If ketosis is a big problem before birth, what is the main neonatal risk after delivery?","a":"Hypoglycemia."},{"q":"Why is hypoglycemia so dangerous in infants?","a":"Brain cells die without glucose, leading to brain damage."},{"q":"What daily measurement should women with preeclampsia perform?","a":"Daily weight."},{"q":"When hospitalized for severe preeclampsia, what should the nurse assess most closely?","a":"Deep tendon reflexes and urine protein."},{"q":"When preeclampsia worsens, reflexes become (hyper\/hypo)active.","a":"Hyperreflexic."},{"q":"Preeclampsia makes the neuromuscular system more or less irritable?","a":"More irritable."},{"q":"What visual disturbance is common in preeclampsia?","a":"Blurred vision."},{"q":"When does preeclampsia become eclampsia?","a":"When convulsions occur."},{"q":"What ominous sign usually precedes seizures in eclampsia?","a":"Severe epigastric pain."},{"q":"In eclampsia, urine output usually (increases\/decreases).","a":"Decreases."},{"q":"How can uterine contractions be palpated in an eclamptic woman?","a":"Place flat hand on the fundus and press lightly."},{"q":"Define premature rupture of membranes (PROM).","a":"Spontaneous rupture of amniotic sac before onset of contractions."},{"q":"Labor usually begins within how many hours after PROM?","a":"24 hours."},{"q":"What should be checked in amniotic fluid to confirm rupture?","a":"pH level."},{"q":"Amniotic fluid is (acidic\/alkaline).","a":"Alkaline."},{"q":"Alkaline fluid has a (high\/low) pH.","a":"High pH."},{"q":"What color does nitrazine paper turn in amniotic fluid?","a":"Deep blue."},{"q":"The best test for fetal lung maturity after PROM is the ______ ratio.","a":"L\/S (lecithin\/sphingomyelin)."},{"q":"An L\/S ratio greater than ____ indicates lung maturity.","a":"2.0."},{"q":"If labor doesn’t begin within how many hours after PROM, induction is likely?","a":"24 hours."},{"q":"PROM always causes a large gush of fluid. (T\/F)","a":"False."},{"q":"Can IVs running too fast cause pulmonary edema?","a":"Yes, in clients with poor cardiovascular function."},{"q":"What will the nurse hear when auscultating lungs in pulmonary edema?","a":"Crackles (rales)."},{"q":"What does sputum look like in severe pulmonary edema?","a":"Frothy and blood-tinged."},{"q":"What condition increases pulmonary embolus risk due to inactivity?","a":"Bed rest."},{"q":"What class of medications can lead to pulmonary embolus?","a":"Oral contraceptives."},{"q":"What lab tests monitor Coumadin therapy?","a":"Prothrombin Time (PT) and INR."},{"q":"What is the target INR range for Coumadin therapy?","a":"2.0–3.0."},{"q":"What lab test monitors Heparin therapy?","a":"PTT (partial thromboplastin time)."},{"q":"Effective Heparin therapy raises PTT to about how many times normal?","a":"2.5 times."},{"q":"What is the best prevention of pulmonary embolus postoperatively?","a":"Early ambulation."},{"q":"Should legs be massaged to prevent pulmonary embolus?","a":"No, it may dislodge a clot."},{"q":"What test monitors daily Coumadin therapy?","a":"Prothrombin Time (PT)."},{"q":"Should daily weights be recorded for clients with pyelonephritis?","a":"Yes, to monitor fluid balance."},{"q":"What test confirms pyloric stenosis?","a":"Upper GI series (barium swallow)."},{"q":"Sutures are generally removed on which post-op day?","a":"7th day."},{"q":"What test confirms scoliosis?","a":"X-ray of the spine."},{"q":"What type of brace is commonly used for scoliosis?","a":"Milwaukee brace."},{"q":"How often should neurovascular status be checked post-op in a Risser cast?","a":"Every 2 hours initially."},{"q":"What is a common complication of clients in a body cast (Risser)?","a":"Cast syndrome."},{"q":"Who is at risk for cast syndrome?","a":"Anyone in a body cast."},{"q":"What is the treatment for cast syndrome?","a":"Remove the cast, insert an NG tube for decompression, and keep the patient NPO."},{"q":"How can the nurse assess for developing cast syndrome?","a":"Ask about abdominal symptoms and monitor bowel movements and passage of flatus."},{"q":"What specifically causes cast syndrome in a Risser cast?","a":"Hyperextension of the spine interrupts blood and nerve supply to the bowel."},{"q":"Should a child in sickle cell crisis wear tight clothing?","a":"No, it may further restrict circulation."},{"q":"How should the position of a spinal cord injury patient be changed once mobility is allowed?","a":"Slowly, to prevent severe orthostatic hypotension (use a tilt table)."},{"q":"What is autonomic dysreflexia (hyperreflexia)?","a":"A sudden, severe hypertensive response in quadriplegics triggered by a full bladder or bowel."},{"q":"What vital sign changes occur in autonomic dysreflexia?","a":"Sweating, severe hypertension, headache, nausea, vomiting, and gooseflesh."},{"q":"What is the first nursing action during autonomic dysreflexia?","a":"Raise the head of the bed (HOB)."},{"q":"What is the second nursing action during autonomic dysreflexia?","a":"Check the bladder and bowel for distention or impaction."},{"q":"Should the doctor be called immediately for autonomic dysreflexia?","a":"Only if draining the bladder and relieving impaction do not resolve symptoms."},{"q":"What is the number one treatment for autonomic dysreflexia?","a":"Drain the bladder and empty the bowel."},{"q":"Why is activity restricted after a spinal tap?","a":"To prevent headache due to cerebrospinal fluid (CSF) loss."},{"q":"Should cerebrospinal fluid contain blood?","a":"No, it should be clear and colorless."},{"q":"Must the client be NPO before a spinal tap?","a":"No."},{"q":"What is the normal color of cerebrospinal fluid (CSF)?","a":"Clear and colorless."},{"q":"Into what space is the needle inserted during a spinal tap?","a":"The subarachnoid space."},{"q":"What are the two main purposes of a spinal tap?","a":"To measure or relieve pressure and obtain a CSF sample."},{"q":"Define coagulate.","a":"The process of thickening or clotting."},{"q":"What indicates that suctioning was effective?","a":"Clear lung sounds and stable vital signs."},{"q":"How often should the airway be suctioned?","a":"As needed, based on moist lung sounds, restlessness, or ineffective coughing."},{"q":"What action before suctioning helps prevent hypoxia?","a":"Pre-oxygenate the client with 100% oxygen."},{"q":"What catheter size is used for adult suctioning?","a":"12 to 16 French."},{"q":"What suction pressure is used for an infant?","a":"Less than 80 mm Hg."},{"q":"What suction pressure is used for a child?","a":"80 to 100 mm Hg."},{"q":"What suction pressure is used for an adult?","a":"120 to 150 mm Hg."},{"q":"What postoperative complication can occur after mastoidectomy?","a":"Facial nerve paralysis due to accidental surgical damage."},{"q":"How can a nurse assess facial nerve function after mastoidectomy?","a":"Ask the patient to smile and wrinkle their forehead."},{"q":"Does a simple mastoidectomy cause hearing loss?","a":"No, but a radical mastoidectomy may."},{"q":"What common side effect may occur after mastoidectomy?","a":"Dizziness or vertigo."},{"q":"What is a key nursing diagnosis after mastoidectomy?","a":"Risk for injury related to vertigo—safety is the top priority."},{"q":"What does “sensitivity” (susceptibility) mean in microbiology?","a":"The organism’s response or vulnerability to a particular antimicrobial agent."},{"q":"What does “virulence” mean?","a":"The ability of a microorganism to cause disease."},{"q":"What does “bacteriostatic” mean?","a":"Capable of inhibiting bacterial growth."},{"q":"What does “bactericidal” mean?","a":"Capable of killing bacteria."},{"q":"What does “culture” mean in microbiology?","a":"Growing colonies of organisms for identification and study."},{"q":"What may happen if ear medications are not at room temperature?","a":"The client may experience dizziness or nausea."},{"q":"How can Meniere’s attacks be prevented?","a":"Avoid sudden movements or position changes."},{"q":"What should clients avoid after labyrinthectomy?","a":"Sudden movements and high-sodium foods."},{"q":"What type of diet is prescribed for Meniere’s disease?","a":"Low-sodium diet."},{"q":"What is the definitive diagnostic test for meningitis?","a":"Lumbar puncture with cerebrospinal fluid (CSF) culture."},{"q":"What changes are seen in CSF with bacterial meningitis?","a":"Increased pressure, WBCs, and protein; decreased glucose."},{"q":"What complication can develop in meningitis?","a":"Seizures."},{"q":"What does long-term migraine management focus on?","a":"Identifying and avoiding triggers such as stress."},{"q":"Besides vision, what major sense is commonly affected in MS?","a":"Tactile sense (touch), increasing risk of burns."},{"q":"What temperature conditions can trigger an MS exacerbation?","a":"Both overheating and chilling; symptoms worsen in hot weather."},{"q":"What result indicates a positive Tensilon test in MG?","a":"A sudden, temporary improvement in muscle strength."},{"q":"Besides the Tensilon Test, what other diagnostic test confirms myasthenia gravis (MG)?","a":"Electromyography (EMG)."},{"q":"Name the two types of crises that may occur in MG.","a":"Myasthenic crisis (underdose of Mestinon) and cholinergic crisis (overdose of Mestinon)."},{"q":"What is the primary danger in both myasthenic and cholinergic crisis?","a":"Respiratory arrest."},{"q":"What are the three most common complications following an MI?","a":"Cardiogenic shock, arrhythmias, and congestive heart failure (CHF)."},{"q":"What is the most common arrhythmia after an MI?","a":"Premature ventricular contractions (PVCs)."},{"q":"Which cardiac enzymes indicate an MI?","a":"Elevated CPK, LDH, and SGOT (AST)."},{"q":"Which serum protein rises earliest after myocardial injury?","a":"Troponin."},{"q":"Is troponin normally present in healthy individuals?","a":"No, it is detectable only after myocardial cell injury."},{"q":"How soon after injury does troponin increase?","a":"Within 3 hours, remaining elevated for up to 7 days."},{"q":"What permanent ECG change is seen after an MI?","a":"ST-segment changes."},{"q":"Between CPK and LDH, which rises first?","a":"CPK."},{"q":"What is done in a graft for hemodialysis access?","a":"A synthetic blood vessel is sutured between an artery and a vein."},{"q":"What is an AV fistula?","a":"A surgically created direct connection (anastomosis) between an artery and a vein."},{"q":"Does an AV fistula have anything exiting the skin?","a":"No, it is completely internal."},{"q":"How long can an AV fistula be used?","a":"Indefinitely, if it remains patent."},{"q":"Who is most likely to require a graft for dialysis access?","a":"Patients with diabetes mellitus."},{"q":"How often do clients with renal failure typically undergo dialysis?","a":"Three times per week."},{"q":"Is hemodialysis a short-term or long-term treatment?","a":"It can be both, though short-term dialysis is most often hemodialysis."},{"q":"How long does a typical dialysis session last?","a":"4 to 6 hours."},{"q":"What are the three methods of vascular access for hemodialysis?","a":"AV shunt, AV fistula, and AV graft."},{"q":"What is the most common site for an AV shunt?","a":"Radial artery to radial vein."},{"q":"What must be avoided in the arm with a shunt, graft, or fistula?","a":"No venipunctures or blood pressure measurements."},{"q":"What syndrome occurs when fluid is removed too rapidly during hemodialysis?","a":"Disequilibrium syndrome."},{"q":"What are the symptoms of disequilibrium syndrome?","a":"Altered level of consciousness, nausea, vomiting, headache, and muscle twitching."},{"q":"Does an AV shunt have an external component?","a":"Yes, the plastic tube connecting the artery and vein exits the skin."},{"q":"How long can an AV shunt be used?","a":"Only for a few weeks."},{"q":"During an acute bleeding episode in hemophilia, what should you do?","a":"Apply firm pressure and ice to the area for 15 minutes."},{"q":"In hemophilia, how are the PTT, clotting time, and platelet count affected?","a":"PTT and clotting time are increased (prolonged); platelet count is normal."},{"q":"During bleeding into a joint, should the extremity be immobilized or mobilized?","a":"Immobilized, to prevent dislodging clots that form."},{"q":"To treat hemarthrosis, what should be done with the affected limb?","a":"Elevate the extremity above heart level."},{"q":"After joint bleeding stops, how long should the patient wait before bearing weight or performing range of motion?","a":"48 hours."},{"q":"Before applying elastic stockings, what should the nurse do?","a":"Elevate the legs for 3–5 minutes to reduce venous stasis."},{"q":"Clients on what medications should use an electric razor?","a":"Anticoagulants (e.g., heparin, warfarin, enoxaparin)."},{"q":"What is the greatest danger of placing water in the mouth of an unconscious patient?","a":"Aspiration."},{"q":"Should clients roll elastic stockings down to wash their legs?","a":"No, it can create a constrictive band and impair circulation."},{"q":"Should elastic stockings be removed for bathing?","a":"Yes."},{"q":"When should a patient put on TED hose?","a":"Before getting out of bed, before swelling develops."},{"q":"What are the two major complications of hyperemesis gravidarum?","a":"Electrolyte imbalance (dehydration) and starvation."},{"q":"How many separate measurements are needed to confirm hypertension?","a":"At least three readings."},{"q":"What blood pressure value is considered hypertensive?","a":"Greater than 140\/90 mmHg."},{"q":"Which is more damaging—an elevated systolic or diastolic pressure?","a":"An elevated diastolic pressure."},{"q":"When taking multiple BP readings, how far apart should they be?","a":"At least one week apart."},{"q":"Can hypertension be cured?","a":"No, it can only be managed, not cured."},{"q":"When assessing BP in a hypertensive client, you should measure ________ while the client is ________, ________, and ________.","a":"Both arms; lying, sitting, and standing."},{"q":"What effect do caffeine and smoking have on blood pressure?","a":"They increase it."},{"q":"How is pulse pressure calculated?","a":"Subtract diastolic pressure from systolic pressure."},{"q":"If the BP is 100\/60, what is the pulse pressure?","a":"40 mmHg."},{"q":"What is the normal pulse pressure range?","a":"Approximately 40 mmHg (±10)."},{"q":"Should a Foley catheter be inserted in clients with hypovolemic shock?","a":"Yes, to monitor urine output (shock is resolving when >30 mL\/hour)."},{"q":"How often should vital signs be measured in hypovolemic shock?","a":"Every 15 minutes."},{"q":"Is a Foley catheter typically used after a hysterectomy?","a":"Yes."},{"q":"Are enemas commonly ordered before a hysterectomy?","a":"Yes."},{"q":"What should you do if a post-hysterectomy client reports flank or back pain?","a":"Notify the physician immediately—it may indicate ureteral injury."},{"q":"What causes thrombophlebitis after a hysterectomy?","a":"Venous stasis in the abdomen due to prolonged lithotomy positioning during surgery."},{"q":"What sign indicates the presence of thrombophlebitis?","a":"A hard, red, swollen area in the posterior calf."},{"q":"Should you assess for Homan’s sign in suspected thrombophlebitis?","a":"No, it is no longer recommended as it may dislodge a clot."},{"q":"How long before a hysterectomy should oral contraceptives be discontinued?","a":"3 to 4 weeks prior to surgery."},{"q":"How long should a woman wait before lifting heavy objects after a hysterectomy?","a":"2 months."},{"q":"When can a woman safely resume driving after a hysterectomy?","a":"After 3 to 4 weeks."},{"q":"What are two major complications of a hysterectomy besides hemorrhage?","a":"Thrombosis or pulmonary embolism, and urinary retention."},{"q":"What position should be avoided after a hysterectomy, and why?","a":"Avoid knee flexion—it promotes venous stasis and thrombophlebitis."},{"q":"When do bowel sounds typically return after a hysterectomy?","a":"Within 24 to 72 hours."},{"q":"What are three common complications of ECT?","a":"Aspiration of vomitus, joint dislocation, and rare bone fractures."},{"q":"What position should the client be placed in immediately after ECT?","a":"Side-lying to prevent aspiration."},{"q":"Is the seizure from ECT violent?","a":"No, modern ECT uses muscle relaxants to minimize movement."},{"q":"What does an EEG measure?","a":"Electrical activity of the brain."},{"q":"Should the client be NPO before an EEG?","a":"No, fasting can cause hypoglycemia and alter results."},{"q":"What is the most important instruction during an EEG?","a":"Remain still and avoid movement."},{"q":"How much sleep should the client get before an EEG?","a":"At least 4–5 hours unless it’s a sleep-deprivation EEG."},{"q":"Should caffeine be restricted before an EEG?","a":"Yes, avoid caffeine for 24 hours before the test."},{"q":"What do fatty stools look like?","a":"Large, pale, greasy, and foul-smelling."},{"q":"What is the medical term for fatty stools?","a":"Steatorrhea."},{"q":"Name three types of intestinal parasites found in stool.","a":"Roundworms, tapeworms, and pinworms."},{"q":"What does occult blood in stool indicate?","a":"Hidden bleeding somewhere in the gastrointestinal tract."},{"q":"Are fats a normal component of stool?","a":"Yes, but only in small, normal amounts."},{"q":"A decrease in urobilin causes stool to appear _______.","a":"Clay-colored."},{"q":"Name two common stool tests.","a":"Occult blood and ova\/parasite testing."},{"q":"Is blood normally present in stool?","a":"No."},{"q":"What is melena?","a":"A black, tarry stool indicating gastrointestinal bleeding."},{"q":"What oxygen flow rate is appropriate for clients with emphysema (COPD)?","a":"Low flow—less than 2.5 L\/min; never exceed 2.5 L."},{"q":"What physical sign may be observed on the hands of clients with emphysema?","a":"Clubbing of the fingernail beds."},{"q":"What diagnostic test confirms endometriosis?","a":"Laparoscopy."},{"q":"Women with endometriosis should use (pads\/tampons) during menstruation.","a":"Pads only."},{"q":"What is the greatest danger in epiglottitis?","a":"Airway obstruction."},{"q":"Should you ever use a tongue depressor to examine a child suspected of epiglottitis?","a":"No, never—this may trigger complete airway obstruction."},{"q":"Should a throat culture be done on a child with suspected epiglottitis?","a":"No, inserting anything in the mouth is dangerous."},{"q":"Which behaviors indicate the need for a tracheotomy in epiglottitis?","a":"Restlessness, tachycardia, and retractions."},{"q":"What is an EGD (esophagogastroduodenoscopy)?","a":"Insertion of a fiber-optic scope to visualize the esophagus, stomach, and duodenum."},{"q":"What procedures can be done during an EGD besides visualization?","a":"Removal of polyps, tissue biopsies, and coagulation of bleeding vessels."},{"q":"Can EGD be used for clients with GI bleeding?","a":"Yes."},{"q":"When can a client begin to eat after an EGD?","a":"When the gag reflex returns (it is temporarily suppressed with xylocaine)."},{"q":"Is an EGD a fasting procedure?","a":"Yes, the client must be NPO after midnight."},{"q":"What are potential complications of an EGD?","a":"Perforation of the gastrointestinal tract, aspiration due to vomiting, and respiratory arrest from sedatives like Valium."},{"q":"What is the most dangerous complication of EGD?","a":"Respiratory arrest secondary to Valium administration."},{"q":"Why should anticholinergics not be used in glaucoma?","a":"They increase intraocular pressure."},{"q":"If a woman does not stop taking oral contraceptives one week before surgery, she is at risk for developing what condition?","a":"Thrombophlebitis."},{"q":"People who smoke more than how many cigarettes per day should avoid oral contraceptives?","a":"More than 15 cigarettes, due to increased risk of vessel constriction and thrombophlebitis."},{"q":"What device may be prescribed for cervical osteoarthritis?","a":"A cervical collar."},{"q":"What precaution should clients take when getting up after stapedectomy?","a":"Get up slowly to prevent dizziness."},{"q":"What should clients expect regarding hearing after stapedectomy?","a":"Temporary decrease initially; improvement occurs in about 6 weeks."},{"q":"What should a client do if they must sneeze after a stapedectomy?","a":"Open the mouth to reduce middle ear pressure."},{"q":"Do hearing aids help with otosclerosis?","a":"Yes."},{"q":"What will the Rinne test show in otosclerosis?","a":"Bone conduction is better than air conduction."},{"q":"Is stapedectomy performed under general or local anesthesia?","a":"Local anesthesia."},{"q":"If a client reports decreased hearing after stapedectomy, what should the nurse say?","a":"It’s normal due to postoperative edema; hearing will improve within six weeks."},{"q":"Which side should the client lie on after a stapedectomy?","a":"Depends on physician preference: operative side promotes drainage, unoperative side prevents graft displacement."},{"q":"What is the main reason doctors remove ovarian cysts?","a":"To prevent malignant transformation."},{"q":"What is the major danger of ovarian cyst torsion?","a":"Necrosis and rupture of the ovary."},{"q":"What other disorders may mimic a ruptured ovarian cyst?","a":"Appendicitis or ruptured ectopic pregnancy."},{"q":"What are three signs of a ruptured ovarian cyst?","a":"Pain, abdominal distention, and abdominal rigidity."},{"q":"Compare the symptoms of non-ruptured and ruptured ovarian cysts.","a":"Non-ruptured: dull pelvic pain, low back pain, abnormal bleeding. Ruptured: acute pain, distention, and rigidity."},{"q":"After ovarian cyst removal surgery, when can a woman return to normal activities?","a":"After 4–6 weeks."},{"q":"How soon after removal of an ovarian cyst can a woman resume sexual intercourse?","a":"After 4–6 weeks."},{"q":"What are two early signs of hypoxia?","a":"Restlessness and tachycardia."},{"q":"What is the maximum oxygen flow rate for a nasal cannula?","a":"6 L\/min."},{"q":"How often should the nares be assessed for skin breakdown when using a nasal cannula?","a":"Every 6–8 hours."},{"q":"What is the maximum oxygen flow rate for a client with COPD?","a":"2 L\/min."},{"q":"What are common signs of oxygen toxicity?","a":"Confusion and headache."},{"q":"What can happen if a client with COPD receives high-flow oxygen?","a":"The client may stop breathing due to loss of hypoxic drive."},{"q":"What is a common problem associated with high-flow oxygen via nasal cannula?","a":"Drying of the mucous membranes."},{"q":"When oxygen is administered, what must be added?","a":"Humidification."},{"q":"Do masks deliver higher or lower concentrations of oxygen than nasal cannulae?","a":"Higher concentrations."},{"q":"How often should the nurse check the oxygen flow rate?","a":"At least once per shift."},{"q":"Is oxygen itself explosive?","a":"False — oxygen supports combustion but does not explode."},{"q":"After rape, what follow-up testing is required?","a":"Screening for sexually transmitted diseases (STDs) such as HIV, gonorrhea, and syphilis."},{"q":"In the recovery room (PACU), what position should the patient be placed in?","a":"On either side."},{"q":"What reflex is commonly tested in the recovery room?","a":"The gag reflex."},{"q":"When is the artificial airway removed postoperatively?","a":"When the gag reflex returns."},{"q":"How often are vital signs measured in the recovery room?","a":"Every 15 minutes."},{"q":"In the recovery room, how should the head and neck be positioned?","a":"Head turned to the side with the neck slightly extended downward."},{"q":"Can postoperative pain medications be given in the recovery room?","a":"Yes."},{"q":"What lab test assesses the risk of RDS?","a":"L\/S ratio (lecithin\/sphingomyelin ratio)."},{"q":"What L\/S ratio indicates fetal lung maturity?","a":"A ratio of 2:1."},{"q":"What other test confirms fetal lung maturity?","a":"Presence of phosphatidylglycerol (PG) in amniotic fluid."},{"q":"Severe RDS may require what type of ventilation?","a":"PEEP (positive end-expiratory pressure) or CPAP (continuous positive airway pressure); high-frequency jet ventilation may also be used."},{"q":"High oxygen flow rates in RDS can cause what eye complication?","a":"Retrolental fibroplasia."},{"q":"Retrolental fibroplasia can lead to what condition?","a":"Blindness due to retinal damage."},{"q":"High ventilatory pressures can lead to what chronic lung condition?","a":"Bronchopulmonary dysplasia."}]

Physiological Integrity – Physiological Adaptation

[{"q":"Which cranial nerve is affected in Bell’s Palsy?","a":"The facial nerve (cranial nerve VII)."},{"q":"What is the number one symptom of Bell’s Palsy?","a":"Unilateral (one-sided) facial paralysis."},{"q":"Complete recovery from Bell’s Palsy usually occurs in how many months?","a":"4 to 6 months."},{"q":"In Bell’s Palsy, which sense is also affected besides facial movement?","a":"Taste."},{"q":"Will the patient with Bell’s Palsy be able to close the eye on the affected side?","a":"No."},{"q":"As the prostate enlarges in BPH, what structure does it compress, and what does this cause?","a":"It compresses the urethra and causes urinary retention."},{"q":"At what age does benign prostatic hypertrophy (BPH) commonly occur?","a":"In men over 50 years of age."},{"q":"What does the abbreviation BPH stand for?","a":"Benign Prostatic Hypertrophy."},{"q":"In BPH, does the frequency of urination increase or decrease?","a":"It increases."},{"q":"In BPH, what happens to the force of the urinary stream?","a":"It decreases."},{"q":"How is the urinary stream described in a man with BPH?","a":"Forked stream."},{"q":"What does “hesitancy” mean in a man with BPH?","a":"Difficulty starting urination."},{"q":"Will a man with BPH have enuresis, nocturia, or hematuria?","a":"Enuresis – No; Nocturia – Yes; Hematuria – Maybe."},{"q":"What does TURP stand for?","a":"Transurethral resection of the prostate."},{"q":"What is the most radical prostate surgery for BPH?","a":"Perineal prostatectomy."},{"q":"What type of diet is used for clients with BPH?","a":"Acid-ash diet."},{"q":"What is the purpose of an acid-ash diet?","a":"To decrease urine pH and make it more acidic."},{"q":"Which foods are included in the acid-ash diet?","a":"Cheese, eggs, meat, fish, oysters, poultry, bread, cereal, whole grains, pastries, cranberries, prunes, plums, tomatoes, peas, corn, and legumes."},{"q":"Will a post-prostatectomy patient be impotent?","a":"After TURP—No; after perineal prostatectomy—Yes."},{"q":"Vasodilation will __________ blood pressure.","a":"Decrease."},{"q":"Shock will __________ blood pressure.","a":"Decrease."},{"q":"Increased intracranial pressure will have what effect on pulse pressure?","a":"It increases (widens) the pulse pressure."},{"q":"If a person’s blood pressure is 190\/110 mmHg, what is the pulse pressure?","a":"80 mmHg."},{"q":"Give three reasons for a blood transfusion.","a":"To restore blood volume after hemorrhage, maintain hemoglobin in anemia, and replace specific blood components."},{"q":"What is another name for Buerger’s disease?","a":"Thromboangiitis obliterans."},{"q":"Which extremities are affected by Buerger’s disease?","a":"The lower extremities."},{"q":"Which sex is most commonly affected by Buerger’s disease?","a":"Males."},{"q":"Which group has the highest incidence of Buerger’s disease?","a":"Smokers."},{"q":"What symptom does a patient with Buerger’s disease experience when walking?","a":"Intermittent claudication."},{"q":"What is intermittent claudication?","a":"Pain in the calf during walking due to poor circulation."},{"q":"What color is a first-degree burn?","a":"Red."},{"q":"Do first-degree burns have vesicles?","a":"No."},{"q":"What color is a second-degree burn?","a":"Red."},{"q":"Are second-degree burns dull or shiny?","a":"Shiny."},{"q":"Do second-degree burns have vesicles?","a":"Yes."},{"q":"Are second-degree burns wet or dry?","a":"Wet."},{"q":"What color is a third-degree burn?","a":"White."},{"q":"Are third-degree burns wet or dry?","a":"Dry."},{"q":"Are third-degree burns hard or soft?","a":"Hard."},{"q":"Which burn degree causes the least pain and why?","a":"Third-degree burns, because nerve endings are destroyed."},{"q":"What is the purpose of using the Rule of Nines?","a":"To estimate the percentage of body surface burned (not used for children)."},{"q":"In the Rule of Nines, what percentage is assigned to the head and neck, and to each arm?","a":"Head and neck: 9%; each arm: 9%."},{"q":"In the Rule of Nines, how much is assigned to the front trunk, back trunk, each leg, and genitalia?","a":"Front trunk: 18%; back trunk: 18%; each leg: 18%; genitalia: 1%."},{"q":"What are the three phases of burn care?","a":"Shock, diuretic, and recovery phases."},{"q":"During the shock phase, fluid moves from the _________ to the _________.","a":"Bloodstream to interstitial space."},{"q":"The shock phase of a burn lasts how long?","a":"24 to 48 hours."},{"q":"During the shock phase of a burn, are potassium levels increased or decreased? Why?","a":"Increased, due to potassium release from damaged cells."},{"q":"What acid-base imbalance occurs in the shock phase of a burn?","a":"Metabolic acidosis."},{"q":"What is the number one therapy in the shock phase of a burn?","a":"Fluid replacement\/resuscitation."},{"q":"What is the simple formula for calculating fluid replacement needs in the first 24 hours after a burn?","a":"3 cc × body weight (kg) × % body surface burned per day."},{"q":"If 2,800 cc of fluid is ordered for the first 24 hours after a burn, how much should be infused in the first 8 hours?","a":"Half, or 1,400 cc."},{"q":"How can you tell that the burn patient has entered the fluid mobilization or diuretic phase?","a":"Urine output increases."},{"q":"How long does the diuretic phase of a burn last?","a":"2 to 5 days."},{"q":"During the diuretic phase, do potassium levels rise or fall?","a":"Fall (diuresis causes hypokalemia)."},{"q":"What is Curling’s ulcer, and why is it a problem in burn patients?","a":"A stress-related gastrointestinal ulcer that occurs after severe physical stress."},{"q":"In abruptio placenta, the placenta __________ from the uterine wall __________.","a":"Separates prematurely."},{"q":"Abruptio placenta typically occurs in __________ women over the age of ________.","a":"Multigravida women over 35 (often with hypertension, trauma, or cocaine use)."},{"q":"How does bleeding in abruptio placenta differ from that in placenta previa?","a":"Bleeding in abruptio placenta is painful; in previa it is painless but more voluminous."},{"q":"How is an infant usually delivered when abruptio placenta is present?","a":"By cesarean section."},{"q":"Is fetal death more common in abruptio placenta or placenta previa?","a":"Higher incidence in abruptio placenta."},{"q":"In which trimester does abruptio placenta most commonly occur?","a":"The third trimester."},{"q":"What is the causative organism of acne?","a":"Propionibacterium acnes (P. acnes)."},{"q":"What structures are primarily involved in acne vulgaris?","a":"The sebaceous glands."},{"q":"What are the three major causative factors in acne vulgaris?","a":"Heredity, bacterial infection, and hormonal influences."},{"q":"What are comedones?","a":"Blackheads and whiteheads."},{"q":"What virus causes AIDS?","a":"Human immunodeficiency virus (HIV)."},{"q":"The AIDS virus invades which immune cells?","a":"Helper T-lymphocytes (CD4 cells)."},{"q":"List six common symptoms of HIV disease.","a":"Anorexia, fatigue, weakness, night sweats, fever, and diarrhea."},{"q":"Do clients with AIDS tend to gain or lose weight?","a":"Lose weight."},{"q":"What microorganism causes the typical pneumonia in AIDS patients?","a":"Pneumocystis carinii."},{"q":"What type of oral or esophageal infections are common in AIDS patients?","a":"Candida infections (thrush)."},{"q":"What is the most common cancer in AIDS patients?","a":"Kaposi’s sarcoma."},{"q":"Kaposi’s sarcoma is a cancer of what tissue?","a":"The skin."},{"q":"Do AIDS patients commonly develop lymphomas?","a":"Yes."},{"q":"Do most clients recover from acute glomerulonephritis (AGN)?","a":"Yes, the majority recover completely."},{"q":"How long after a strep infection does AGN develop?","a":"About 2 to 3 weeks."},{"q":"What organism causes acute glomerulonephritis?","a":"Group A beta-hemolytic streptococcus."},{"q":"What happens to the kidneys in AGN?","a":"They become inflamed and clogged with antigen-antibody complexes, reducing function."},{"q":"Will clients with AGN have hypo- or hypertension, and why?","a":"Hypertension due to fluid retention."},{"q":"What are the first signs of AGN?","a":"Puffiness of the face and dark-colored urine."},{"q":"What does AKA stand for?","a":"Above-the-knee amputation."},{"q":"What does BKA stand for?","a":"Below-the-knee amputation."},{"q":"What is the number one contracture problem in AKA?","a":"Flexion of the hip."},{"q":"What is the number one contracture problem after a BKA?","a":"Flexion of the knee."},{"q":"Pain felt in a missing limb after amputation is known as what?","a":"Phantom limb sensation."},{"q":"How long does phantom limb sensation usually last?","a":"A few months."},{"q":"What is an aneurysm?","a":"An abnormal widening and weakening of an arterial wall."},{"q":"Which artery is affected in a thoracic aneurysm?","a":"The aorta."},{"q":"What are two causes of aneurysms?","a":"Infection and syphilis."},{"q":"What is the most common symptom of an abdominal aneurysm?","a":"A pulsating mass above the umbilicus."},{"q":"Which aneurysm is often asymptomatic?","a":"The abdominal aneurysm (“silent”)."},{"q":"What is the prescribed activity level for a client with an aneurysm?","a":"Strict bed rest."},{"q":"Should unstable aneurysm patients be encouraged to cough, turn, and deep breathe?","a":"No, keep on bed rest until stable."},{"q":"What is the greatest danger of an aneurysm?","a":"Rupture leading to shock and death."},{"q":"What are the signs of a ruptured aneurysm?","a":"Restlessness or decreased level of consciousness, tachycardia, and hypotension (signs of shock)."},{"q":"What is the number one priority if an aneurysm ruptures?","a":"Transport the patient to the operating room immediately."},{"q":"What can be done before surgery for a ruptured aneurysm?","a":"Apply antishock trousers if available, but only if it doesn’t delay surgery."},{"q":"What causes angina pectoris?","a":"Decreased blood supply to the myocardium, leading to ischemia and pain."},{"q":"Describe the pain of angina pectoris.","a":"Crushing substernal chest pain that may radiate."},{"q":"Does every patient with angina require bypass surgery?","a":"False; many are treated medically."},{"q":"The diagnosis of anorexia nervosa is made when weight loss exceeds what percent of body weight?","a":"15% or more (hospitalize if 30% weight loss)."},{"q":"What is appendicitis?","a":"Inflammation of the appendix due to obstruction."},{"q":"Appendicitis occurs most commonly in what age group?","a":"Between 15 and 35 years old."},{"q":"What is the most common complication of appendicitis?","a":"Peritonitis."},{"q":"What is peritonitis?","a":"Inflammation of the peritoneum."},{"q":"What is the first sign of appendicitis?","a":"Right upper quadrant abdominal pain."},{"q":"What symptom follows the initial abdominal pain of appendicitis?","a":"Nausea and vomiting."},{"q":"Where does the pain of appendicitis eventually localize?","a":"Right lower quadrant (McBurney’s point)."},{"q":"What is the only treatment for appendicitis?","a":"Surgical removal (appendectomy)."},{"q":"Does the term “neoplasm” refer to benign or malignant tumors?","a":"Both; it refers to all new tissue growths."},{"q":"Which type of tumor is more malignant: differentiated or undifferentiated?","a":"Undifferentiated."},{"q":"When cancer spreads to a distant site, what is it called?","a":"Metastasis."},{"q":"Is the exact cause of cancer known?","a":"False."},{"q":"What does “decompensation” mean?","a":"Failure of the heart to maintain adequate circulation."},{"q":"What physical finding is seen in the neck of a client with CD of pregnancy?","a":"Jugular venous distension (JVD)."},{"q":"What heart sound is heard in clients with CD of pregnancy?","a":"Murmurs."},{"q":"What lung sounds are heard in CD of pregnancy?","a":"Crackles or rales."},{"q":"If a client with CD of pregnancy develops sudden heart failure, what is the most common symptom?","a":"Sudden shortness of breath (dyspnea)."},{"q":"What is the number one treatment for CD during pregnancy?","a":"Rest."},{"q":"What type of disease is celiac disease?","a":"Malabsorption disorder."},{"q":"What substance can clients with celiac disease not tolerate?","a":"Gluten."},{"q":"What is gluten?","a":"A protein."},{"q":"What does gluten do to the intestines of clients with celiac disease?","a":"It damages and destroys the intestinal lining."},{"q":"How are the stools of clients with celiac disease described?","a":"Large, greasy, and foul-smelling."},{"q":"Which mineral is poorly absorbed in celiac disease?","a":"Iron."},{"q":"Clients with celiac disease do not absorb fats; therefore, they lack which nutrients?","a":"Fat-soluble vitamins (A, D, E, and K)."},{"q":"Malabsorption of which vitamin causes bleeding disorders?","a":"Vitamin K."},{"q":"How does the abdomen of a client with celiac disease typically appear?","a":"Distended with gas and bloating."},{"q":"What is the number one treatment for celiac disease?","a":"Gluten-free diet."},{"q":"Are vegetables allowed in a gluten-free diet?","a":"Yes."},{"q":"Are fruits allowed in a gluten-free diet?","a":"Yes."},{"q":"Are all grains prohibited in celiac disease?","a":"False."},{"q":"Which grains are allowed in a gluten-free diet?","a":"Rice and corn."},{"q":"Which grains are not allowed in a gluten-free diet?","a":"Wheat, oats, rye, alfalfa, and barley."},{"q":"Are foods made with wheat, oat, or rye flour allowed on a gluten-free diet?","a":"No."},{"q":"Is milk allowed on a gluten-free diet?","a":"Yes."},{"q":"Are meats allowed on a gluten-free diet?","a":"Yes, but avoid breaded meats and processed items like hot dogs that may contain grains."},{"q":"Are eggs allowed on a gluten-free diet?","a":"Yes."},{"q":"Is commercial ice cream allowed on a gluten-free diet?","a":"No, it often contains grain-based additives."},{"q":"Are puddings allowed on a gluten-free diet?","a":"No, they often contain flour."},{"q":"Which soups are not allowed on a gluten-free diet?","a":"Creamed soups, as they commonly contain flour."},{"q":"A CVA is the __________ of brain cells due to decreased ________ and ________.","a":"Destruction; blood flow and oxygen."},{"q":"Name the three types of cerebrovascular accidents (CVA).","a":"Embolic, thrombotic, and hemorrhagic."},{"q":"What is a transient ischemic attack (TIA)?","a":"A temporary neurologic deficit lasting 30 seconds to 24 hours, a warning sign of CVA."},{"q":"Do CVA patients experience headaches?","a":"Yes."},{"q":"What is usually the first sign of CVA?","a":"Change in level of consciousness (LOC)."},{"q":"What type of paralysis is typical in CVA?","a":"Hemiplegia."},{"q":"Why does the right brain control the left body side and vice versa?","a":"Motor tracts cross over (decussate) in the medulla."},{"q":"If the patient has right hemiplegia, which side of the brain was affected?","a":"The left side."},{"q":"What is hemianopsia?","a":"Loss of half of the visual field."},{"q":"How should a patient with hemianopsia be taught to compensate?","a":"By scanning—moving the head side to side."},{"q":"If a client has right homonymous hemianopsia, which side of the tray may be ignored?","a":"The right side."},{"q":"When a patient cannot understand incoming language, what type of aphasia is it?","a":"Receptive aphasia."},{"q":"When a patient understands but cannot express language, what type of aphasia is it?","a":"Expressive aphasia."},{"q":"What is global aphasia?","a":"Both receptive and expressive language impairment."},{"q":"Aphasia is most common with a stroke in which hemisphere?","a":"The dominant hemisphere."},{"q":"How do you determine the dominant hemisphere?","a":"It controls the dominant hand (e.g., right-handed → left-brain dominant)."},{"q":"What communication strategy is best for receptive aphasia?","a":"Use short, simple, slow instructions."},{"q":"What strategy is best for expressive aphasia?","a":"Anticipate needs and listen carefully."},{"q":"What is apraxia?","a":"Loss of ability to perform purposeful, skilled movements (e.g., brushing teeth)."},{"q":"What is otitis media?","a":"Chronic infection or inflammation of the middle ear."},{"q":"Is otitis media more common in adults or children?","a":"Children."},{"q":"Which part of the ear is affected in otitis media?","a":"The middle ear."},{"q":"What are two common subjective symptoms of otitis media?","a":"Hearing loss and a feeling of fullness in the ear."},{"q":"What are two objective signs of otitis media?","a":"Fever (hyperpyrexia) and ear drainage."},{"q":"What complication commonly occurs secondary to otitis media?","a":"Perforation of the tympanic membrane (eardrum)."},{"q":"Do all children with otitis media need ear tubes?","a":"No."},{"q":"What is the most severe complication of otitis media?","a":"Meningitis or mastoiditis."},{"q":"What is a cholesteatoma?","a":"An epidermal cyst in the ear often associated with otitis media."},{"q":"What is a cleft lip?","a":"An opening in the upper lip extending to the nostrils."},{"q":"What is a cleft palate?","a":"An opening in the roof of the mouth into the nasopharynx."},{"q":"Can cleft lip or palate occur independently?","a":"Yes, one or both may occur."},{"q":"When is cleft lip usually repaired?","a":"Between 10 weeks and 6 months of age."},{"q":"When is cleft palate usually repaired?","a":"Between 1 and 5 years of age."},{"q":"Why is cleft lip repaired early?","a":"It improves feeding and appearance, helping parental bonding."},{"q":"Children with cleft lip\/palate often have long-term problems with what?","a":"Hearing, speech, and teeth."},{"q":"How many surgeries are usually required to repair a cleft palate?","a":"Two — the first at 12–18 months, the final at 4–5 years."},{"q":"Why is final cleft palate repair delayed until 4–5 years?","a":"To prevent interference with tooth development."},{"q":"What is the primary treatment for cleft lip and cleft palate?","a":"Surgical repair."},{"q":"What is a colostomy?","a":"A surgically created opening of the colon through the abdominal wall."},{"q":"Name three common reasons for performing a colostomy.","a":"Cancer, diverticulitis, and ulcerative colitis."},{"q":"What does “temporary colostomy” mean?","a":"It’s not permanent; the bowel will later be reconnected for normal defecation."},{"q":"What is a “double-barrel” colostomy?","a":"A procedure in which the colon is cut and both ends are brought out through the abdominal wall."},{"q":"Colostomies performed for cancer are usually (temporary\/permanent).","a":"Permanent."},{"q":"Colostomies performed for a gunshot wound are usually (temporary\/permanent).","a":"Temporary."},{"q":"In a double-barrel colostomy, from which stoma will stool be expelled?","a":"From the proximal stoma."},{"q":"The more colon removed, the more _______ the stool.","a":"Liquid."},{"q":"Describe stool characteristics for an ileostomy.","a":"Liquid stool, mild odor, highly irritating to skin, continuous drainage, risk for electrolyte imbalance, incontinent, never irrigate."},{"q":"Describe stool characteristics for a transverse colostomy.","a":"Soft stool, typical odor, may irritate skin, empties several times daily, may irrigate, moderate fluid imbalance risk."},{"q":"Describe stool characteristics for a descending colostomy.","a":"Formed stool, typical odor, predictable emptying (2–3 times\/day), lowest fluid imbalance risk, continent, can irrigate."},{"q":"Can congestive heart failure (CHF) affect one or both sides of the heart?","a":"True; it can be right-sided, left-sided, or both."},{"q":"What does right-sided CHF mean?","a":"Right ventricle failure causing dependent edema, JVD, abdominal distention, hepatosplenomegaly, anorexia, weight gain, nocturnal diuresis, and hand swelling."},{"q":"What does left-sided CHF mean?","a":"Left ventricular failure leading to pulmonary congestion and shortness of breath."},{"q":"Can CHF result from myocardial infarction?","a":"True."},{"q":"Name three compensatory mechanisms of the failing heart.","a":"Ventricular hypertrophy, dilation, and increased heart rate."},{"q":"What does “cardiac decompensation” mean?","a":"Failure of compensatory mechanisms—heart can no longer maintain adequate output."},{"q":"Some women experience discomfort when wearing contact lenses during pregnancy or menstruation. (T\/F)","a":"True."},{"q":"Cushing’s syndrome is caused by what?","a":"Oversecretion of glucocorticoids, mineralocorticoids, and androgens by the adrenal gland."},{"q":"In Cushing’s syndrome, blood sugar levels are (increased\/decreased).","a":"Increased."},{"q":"In Cushing’s syndrome, sodium levels are (increased\/decreased).","a":"Increased."},{"q":"What is the characteristic facial appearance of Cushing’s syndrome?","a":"Moon face."},{"q":"In Cushing’s, the trunk is _______ and the extremities are _______.","a":"Obese; thin."},{"q":"What is seen on the abdomen of a Cushing’s patient?","a":"Purple striae (stretch marks)."},{"q":"Men with Cushing’s often develop what condition?","a":"Gynecomastia (female-type breast enlargement)."},{"q":"What is gynecomastia?","a":"Development of female-type breasts in men."},{"q":"What changes occur in women with Cushing’s?","a":"Hirsutism and amenorrhea."},{"q":"What is hirsutism?","a":"Excess hair growth in abnormal locations (e.g., face)."},{"q":"The Cushing’s patient may develop what on their upper back?","a":"A “buffalo hump.”"},{"q":"In Cushing’s syndrome, blood pressure is (increased\/decreased).","a":"Increased due to sodium and water retention."},{"q":"In Cushing’s syndrome, patients experience _______natremia, _______kalemia, and _______glycemia.","a":"Hypernatremia, hypokalemia, and hyperglycemia."},{"q":"Summarize “Cushing’s Man.”","a":"Moon face, infection, buffalo hump, central obesity, thin limbs, striae, high glucose and salt, low potassium."},{"q":"Which glands are affected in cystic fibrosis?","a":"Exocrine glands."},{"q":"What is the appearance of stool in cystic fibrosis?","a":"Fatty, frothy, foul-smelling, floating stools (steatorrhea)."},{"q":"What are the two primary nursing diagnoses for cystic fibrosis?","a":"Ineffective airway clearance and altered nutrition\/absorption."},{"q":"Which two organ systems are most affected in cystic fibrosis?","a":"Lungs and pancreas."},{"q":"What is the major pathophysiologic problem in cystic fibrosis?","a":"Thickened secretions causing obstruction of exocrine ducts."},{"q":"What neonatal history is often seen in CF patients?","a":"Meconium ileus due to thick, sticky stool causing obstruction."},{"q":"What brain structure is most affected in Parkinson’s disease?","a":"Basal ganglia."},{"q":"The neurotransmitter imbalance in Parkinson’s disease involves a decrease in ______ activity.","a":"Dopamine activity."},{"q":"What is the classic motor symptom of Parkinson’s disease?","a":"Pill-rolling tremor."},{"q":"What type of rigidity is seen in Parkinson’s disease?","a":"Cogwheel rigidity."},{"q":"Parkinson’s patients move (fast\/slow).","a":"Slow."},{"q":"What type of gait is typical of Parkinson’s disease?","a":"Shuffling gait."},{"q":"Parkinson’s patients typically have what type of speech?","a":"Monotone speech."},{"q":"Do Parkinson’s tremors improve or worsen with purposeful movement?","a":"Improve; tremors lessen during voluntary activity."},{"q":"What are typical lesions seen in pemphigus?","a":"Foul-smelling blisters that rupture easily; common in the elderly."},{"q":"What is the characteristic lesion of pemphigus?","a":"Large vesicular bullae (fluid-filled blisters)."},{"q":"What are bullae?","a":"Large fluid-filled blisters."},{"q":"What unusual high-priority nursing diagnosis is associated with pemphigus?","a":"Fluid and electrolyte imbalance."},{"q":"Define pemphigus briefly.","a":"Autoimmune blistering skin disorder causing painful bullae, often fatal if untreated."},{"q":"What is peritoneal dialysis (PD)?","a":"Removal of wastes and fluids using the peritoneum as a semipermeable membrane."},{"q":"How long does one PD session usually last?","a":"About 10 hours."},{"q":"When fluid accumulates during PD, what problem occurs first?","a":"Dyspnea (shortness of breath) from pressure on the diaphragm."},{"q":"What nutrient is most lost during PD?","a":"Protein."},{"q":"What area is punctured to perform PD?","a":"Abdominal wall."},{"q":"What force allows dialysate to flow into the peritoneal cavity?","a":"Gravity."},{"q":"How long does the inflow of dialysate take?","a":"About 10 minutes."},{"q":"How long is dialysate left in the abdomen before draining?","a":"15–30 minutes."},{"q":"How long does the drainage phase take?","a":"About 10 minutes."},{"q":"What factor is missing in pernicious anemia?","a":"Intrinsic factor."},{"q":"Which vitamin is not absorbed in pernicious anemia?","a":"Vitamin B12."},{"q":"What is another name for Vitamin B12?","a":"Extrinsic factor."},{"q":"Why isn’t Vitamin B12 absorbed in pernicious anemia?","a":"Because intrinsic factor is absent."},{"q":"What happens to RBCs in pernicious anemia?","a":"They fail to mature properly, leading to anemia."},{"q":"What are classic signs of pernicious anemia?","a":"Beefy red tongue, mouth sores, paresthesia, chest pain."},{"q":"Can pernicious anemia be cured?","a":"No, only managed."},{"q":"In placenta previa, the placenta is implanted _______ and covers the _______.","a":"Lower in the uterus; cervical os."},{"q":"What do “total” and “partial” placenta previa mean?","a":"Total: placenta covers entire cervical opening; Partial: covers part of it."},{"q":"Pneumonia is an ______ of the ______ in the ______.","a":"Infection of the alveoli in the lungs."},{"q":"Pneumonia is only caused by bacteria. (T\/F)","a":"False — it can also be viral or due to aspiration."},{"q":"What is polycythemia vera?","a":"Blood disorder with excessive RBCs, WBCs, and platelets."},{"q":"What is the typical appearance of a client with polycythemia vera?","a":"Ruddy or purplish skin tone."},{"q":"What are three signs of polycythemia vera?","a":"Headache, weakness, itching."},{"q":"Is hemoglobin increased or decreased in polycythemia vera?","a":"Increased."},{"q":"Which organ enlarges in polycythemia vera?","a":"Spleen (due to excessive RBC destruction)."},{"q":"Define paralytic ileus.","a":"Temporary bowel paralysis after surgery, especially abdominal."},{"q":"Does pregnancy increase or decrease insulin requirements?","a":"Increases."},{"q":"Can pregnancy induce diabetes in non-diabetic women?","a":"Yes."},{"q":"What is diabetes that begins during pregnancy called?","a":"Gestational diabetes."},{"q":"Is gestational diabetes more common with age?","a":"Yes, incidence increases with age."},{"q":"Do pregnancy hormones oppose insulin?","a":"Yes."},{"q":"What is a common sign of gestational diabetes?","a":"Excessive weight gain."},{"q":"Which women are at highest risk for gestational diabetes?","a":"Obese women."},{"q":"Does thirst increase or decrease in gestational diabetes?","a":"Increases (polydipsia)."},{"q":"Does urine output increase or decrease in gestational diabetes?","a":"Increases (polyuria)."},{"q":"What obstetric history is associated with gestational diabetes?","a":"Large baby (>9 lb), stillbirth, miscarriage, congenital defects."},{"q":"Babies of gestational diabetics are usually (small\/large)?","a":"Large for gestational age."},{"q":"What are the two main treatments for gestational diabetes?","a":"Diet and insulin."},{"q":"How often should diabetic pregnant women visit their doctor?","a":"Twice monthly, then weekly in the third trimester."},{"q":"How much weight should be gained per week in 2nd–3rd trimesters for diabetics?","a":"About 1 lb per week."},{"q":"Should carbohydrates be severely restricted in gestational diabetes?","a":"No, risk of ketosis."},{"q":"Which macronutrients are increased in the diet of gestational diabetics?","a":"Protein and fat."},{"q":"When is insulin indicated in gestational diabetes?","a":"When diet alone doesn’t control glucose."},{"q":"When should diabetic pregnant women be delivered?","a":"Between 37–39 weeks."},{"q":"After delivery, the mother's insulin requirements will (rise\/fall).","a":"Fall."},{"q":"During pregnancy, what fetal complication is most dangerous for diabetic mothers?","a":"Ketosis."},{"q":"Which gravidas are most likely to develop pregnancy-induced hypertension (PIH)?","a":"Primigravidas."},{"q":"Which age groups are at highest risk for PIH?","a":"Under 18 and over 35 years."},{"q":"After which week of gestation does preeclampsia typically develop?","a":"After 20 weeks."},{"q":"What are the three main signs of preeclampsia?","a":"Hypertension, edema (weight gain), and proteinuria."},{"q":"What are the three primary treatment goals in eclampsia?","a":"Lower BP, control seizures, promote diuresis."},{"q":"What is typical management if PROM occurs before fetal viability?","a":"Termination of pregnancy."},{"q":"What is typical management for PROM after viability but before 36 weeks?","a":"Hospitalization, monitor for infection, allow fetal maturation."},{"q":"Pulmonary edema is accumulation of ______ in the lungs.","a":"Fluid."},{"q":"Pulmonary edema is a common complication of what disorders?","a":"Cardiovascular disorders."},{"q":"Pulmonary edema usually results from failure of which heart chamber?","a":"Left ventricle."},{"q":"What pressure causes pulmonary edema in left ventricular failure?","a":"Increased hydrostatic pressure in pulmonary capillaries."},{"q":"What are the four classic signs of pulmonary edema?","a":"Dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, and coughing."},{"q":"What does “dyspnea on exertion” mean?","a":"Shortness of breath during activity."},{"q":"What does “paroxysmal nocturnal dyspnea” mean?","a":"Sudden nighttime episodes of difficulty breathing."},{"q":"What does “orthopnea” mean?","a":"Difficulty breathing when lying flat."},{"q":"Is the heart rate fast or slow in pulmonary edema?","a":"Fast (tachycardia)."},{"q":"Is oxygen therapy indicated in pulmonary edema?","a":"Yes."},{"q":"What is the first nursing action when a client suddenly develops pulmonary edema?","a":"Elevate head of bed, give oxygen, then call the physician."},{"q":"Define pulmonary embolus.","a":"Obstruction of the pulmonary capillary bed by a dislodged thrombus or foreign material."},{"q":"Where do most pulmonary emboli originate?","a":"In the legs (deep veins)."},{"q":"What besides a thrombus can cause a pulmonary embolus?","a":"Air, fat, or tumor cells."},{"q":"What cardiac arrhythmia can cause a pulmonary embolus?","a":"Right atrial fibrillation."},{"q":"Which genetic disease predisposes to pulmonary embolus?","a":"Sickle cell anemia."},{"q":"What is the first symptom of pulmonary embolus?","a":"Sudden dyspnea."},{"q":"Dyspnea in pulmonary embolus is accompanied by what?","a":"Pleuritic chest pain."},{"q":"Does heart rate increase or decrease in pulmonary embolus?","a":"Increase (tachycardia)."},{"q":"How will a client with severe pulmonary embolus appear?","a":"In shock."},{"q":"What are two main treatments for pulmonary embolus?","a":"Oxygen and anticoagulants."},{"q":"What is pyelonephritis?","a":"Bacterial infection of the kidneys."},{"q":"What is the most common organism causing pyelonephritis?","a":"E. coli."},{"q":"What symptoms are common to both pyelonephritis and cystitis?","a":"Frequency, urgency, burning, cloudy and foul-smelling urine."},{"q":"How does pyelonephritis differ from cystitis?","a":"Cystitis = bladder infection; Pyelonephritis = kidney infection."},{"q":"What usually precedes pyelonephritis?","a":"Cystitis (lower UTI)."},{"q":"Name five signs of pyelonephritis not seen in cystitis.","a":"Fever, flank pain, chills, elevated WBC, malaise."},{"q":"What is the major danger of pyelonephritis?","a":"Permanent renal scarring and damage."},{"q":"Is hematuria common in pyelonephritis?","a":"Yes, but not always present."},{"q":"Does pyelonephritis cause hypertension or hypotension?","a":"Hypertension."},{"q":"Where is the pyloric sphincter located?","a":"At the distal end of the stomach, leading to the duodenum."},{"q":"What does “stenosis” mean?","a":"Narrowing or constriction."},{"q":"How is pyloric stenosis treated?","a":"Surgical correction (pyloromyotomy)."},{"q":"Infants with pyloric stenosis are prone to what complications?","a":"Dehydration and failure to thrive."},{"q":"Why does the pyloric valve become stenosed?","a":"It hypertrophies."},{"q":"What visible sign is seen during and after feeding?","a":"Peristaltic waves moving left to right."},{"q":"Is vomiting projectile or non-projectile in pyloric stenosis?","a":"Projectile and not bile-stained."},{"q":"What finding is palpated under the right rib cage in pyloric stenosis?","a":"An olive-sized mass (hypertrophied pylorus)."},{"q":"At what age do symptoms of pyloric stenosis appear?","a":"Between 4 and 6 weeks."},{"q":"Describe the typical child with pyloric stenosis.","a":"Firstborn, full-term, white male."},{"q":"Define contusion.","a":"Internal bruise."},{"q":"Define debridement.","a":"Removal of necrotic tissue from a wound."},{"q":"What is the purpose of a wound drain?","a":"To remove secretions and promote healing."},{"q":"A round wound closed by sutures, staples, or steri-strips heals by which intention?","a":"First intention."},{"q":"What is another term for second intention healing?","a":"Granulation."},{"q":"Define laceration.","a":"A cut or tear in the tissue."},{"q":"Scoliosis is a ______ curvature of the ______.","a":"Lateral curvature of the spine."},{"q":"Which spinal regions are most affected by scoliosis?","a":"Thoracic and lumbar."},{"q":"Thoracic scoliosis is usually convex to which side?","a":"Right side."},{"q":"Lumbar scoliosis is usually convex to which side?","a":"Left side (think “Lumbar = Left”)."},{"q":"With which other spinal deformities is scoliosis associated?","a":"Kyphosis (humpback) and Lordosis (swayback)."},{"q":"Define Kyphosis.","a":"Humpback in the thoracic region."},{"q":"Define Lordosis.","a":"Swayback in the lumbar region."},{"q":"Difference between structural and functional scoliosis?","a":"Structural = congenital; Functional = due to poor posture."},{"q":"What are three common complaints in scoliosis?","a":"Back pain, dyspnea, fatigue."},{"q":"What treatment is used for severe scoliosis?","a":"Surgical spinal fusion with rod insertion."},{"q":"What rod is commonly used to correct spinal curvature?","a":"Harrington rod."},{"q":"What is cast syndrome?","a":"Nausea, vomiting, and abdominal distention resulting in intestinal obstruction."},{"q":"What is the inheritance pattern of sickle cell anemia?","a":"Autosomal recessive."},{"q":"What does heterozygous mean?","a":"Having one defective gene from one parent."},{"q":"People who are heterozygous for the sickle gene have what condition?","a":"Sickle cell trait."},{"q":"What does homozygous mean?","a":"Having defective genes from both parents."},{"q":"People who are homozygous for the sickle gene have what condition?","a":"Sickle cell disease."},{"q":"Do individuals with sickle cell trait have symptoms?","a":"Usually no, but severe stress may cause mild symptoms."},{"q":"What are the top two causes of sickle cell crisis?","a":"Hypoxia and dehydration."},{"q":"What type of crisis is most common in sickle cell disease?","a":"Vaso-occlusive crisis."},{"q":"In vaso-occlusive crisis, what occludes the vessels?","a":"Abnormally shaped red blood cells."},{"q":"What is the abnormal hemoglobin in sickle cell anemia called?","a":"Hemoglobin S (Hgb S)."},{"q":"What shape do sickled RBCs take?","a":"Crescent-shaped."},{"q":"Why do sickled RBCs cause vessel occlusion?","a":"They clump together, forming sludge and blocking blood flow."},{"q":"What are the top three nursing priorities during a sickle cell crisis?","a":"Oxygenation, hydration, and pain control."},{"q":"At what age is death most likely in sickle cell anemia?","a":"Young adulthood."},{"q":"Symptoms of sickle cell anemia usually appear after what age?","a":"Six months, when fetal hemoglobin decreases."},{"q":"Sickle cell anemia is most common among which population?","a":"African Americans."},{"q":"Are spinal cord injuries more common in males or females?","a":"Males."},{"q":"What age range has the highest incidence of spinal cord injury?","a":"Ages 15 to 25."},{"q":"What two surgeries are commonly used to treat spinal cord injury?","a":"Laminectomy and spinal fusion."},{"q":"What is spinal shock?","a":"Temporary loss of all reflex activity below the level of injury due to cord swelling."},{"q":"When does spinal shock occur?","a":"Immediately or within 2 hours after injury."},{"q":"How long does spinal shock last?","a":"From 5 days to 3 months."},{"q":"Injury at what level results in quadriplegia?","a":"C1 to C8."},{"q":"Injury at what level causes permanent respiratory paralysis?","a":"C1 to C4."},{"q":"Can a patient with a C7 spinal injury experience respiratory arrest?","a":"Yes, during spinal shock, but it is temporary."},{"q":"Injury in the thoracic or lumbar regions results in what type of paralysis?","a":"Paraplegia."},{"q":"Do spinal cord injury patients have flaccid or spastic muscles?","a":"Spastic."},{"q":"What does the suffix “-pathy” mean in medical terms?","a":"Disease or suffering."},{"q":"What does the suffix “-penia” indicate?","a":"A deficiency or lack of something."},{"q":"What does the root “-sect” mean?","a":"To cut."},{"q":"What does the suffix “-plast” refer to?","a":"Surgical repair or plastic surgery of a specific part."},{"q":"What is meant by the term “-sclerosis”?","a":"Hardening of tissue due to inflammation or mineral deposits."},{"q":"What does the suffix “-centesis” mean?","a":"Surgical puncture or perforation."},{"q":"What does the suffix “-genic” mean?","a":"To produce, originate, or cause."},{"q":"What does the suffix “-emia” indicate?","a":"A condition of the blood."},{"q":"What does “-otomy” mean in medical terminology?","a":"To cut or make an incision."},{"q":"What does “-pexy” mean?","a":"Surgical fixation of an organ or structure."},{"q":"What does the suffix “-atresia” describe?","a":"A condition involving closure or absence of a normal opening."},{"q":"What does “-desis” mean?","a":"Surgical binding or fusion."},{"q":"What does “-cele” refer to?","a":"A tumor, swelling, or cavity."},{"q":"What does “-cis” mean in medical context?","a":"To cut or destroy."},{"q":"What does “-rhaphy” mean?","a":"Suturing or surgical joining of tissues."},{"q":"What does “-scope” or “-scopy” refer to?","a":"An instrument or procedure for visual examination."},{"q":"What does “-osis” indicate?","a":"A process, condition, or disease state."},{"q":"What does “-oma” mean?","a":"Tumor or neoplasm."},{"q":"What does “-ostomy” mean?","a":"Creation of a surgical opening."},{"q":"What does “-stasis” mean?","a":"Stoppage or control of flow."},{"q":"What does “-itis” signify?","a":"Inflammation."},{"q":"What does “-ology” refer to?","a":"The study or science of something."},{"q":"What does “-lysis” mean?","a":"Breaking down or destruction."},{"q":"What does “-ectomy” mean?","a":"Surgical removal."},{"q":"What does “-tripsy” mean?","a":"Crushing with a surgical instrument."},{"q":"What does “-ase” mean in a biological term?","a":"Denotes an enzyme."},{"q":"What does “-gram” or “-graphy” mean?","a":"To write or record."},{"q":"How is syphilis transmitted?","a":"Sexually transmitted."},{"q":"Which tissues are first infected in syphilis?","a":"Mucous membranes."},{"q":"What are the stages of syphilis infection?","a":"Primary, secondary, latent, and late."},{"q":"Is untreated syphilis fatal?","a":"Yes, it can be fatal if not treated."},{"q":"What organism causes syphilis?","a":"Treponema pallidum."},{"q":"What lesion appears during primary syphilis?","a":"A chancre (painless ulcer)."},{"q":"Are chancres of syphilis painful?","a":"No, they are painless."},{"q":"Do chancres disappear without treatment?","a":"Yes, but the disease progresses internally."},{"q":"Which organs are affected in late-stage syphilis?","a":"Liver, heart, and brain."},{"q":"What test confirms the presence of syphilis?","a":"Dark-field microscopic examination for Treponema pallidum."},{"q":"What is the most common sign of neurosyphilis?","a":"Ataxia or unsteady gait."},{"q":"Mastitis and breast engorgement are more common in which mothers?","a":"Primiparas (first-time mothers)."},{"q":"Where does the organism that causes mastitis usually come from?","a":"The infant’s mouth or nose."},{"q":"Which microorganism most commonly causes mastitis?","a":"Staphylococcus."},{"q":"How do long intervals between breastfeeding affect mastitis risk?","a":"They increase the risk."},{"q":"Can tight bras contribute to mastitis?","a":"Yes, they can obstruct milk ducts."},{"q":"Mastitis typically occurs how many days after delivery?","a":"About 10 days postpartum."},{"q":"How do the breasts appear in mastitis?","a":"Hard, swollen, and warm."},{"q":"What temperature indicates mastitis?","a":"Fever above 102°F (38.9°C)."},{"q":"What causes breast engorgement (not infection)?","a":"Temporary increase in blood and lymph supply for milk production."},{"q":"When does breast engorgement occur compared with mastitis?","a":"Usually 2–5 days after delivery, earlier than mastitis."},{"q":"Does breast engorgement interfere with breastfeeding?","a":"Yes, it makes latching difficult."},{"q":"Are antibiotics indicated for breast engorgement?","a":"No, because it is not an infection."},{"q":"What is mastoiditis?","a":"Inflammation or infection of the mastoid bone."},{"q":"What is the most common cause of mastoiditis?","a":"Chronic otitis media (middle ear infection)."},{"q":"What are common symptoms of mastoiditis?","a":"Ear drainage, high fever, headache, ear pain, and tenderness over the mastoid process."},{"q":"What surgical procedure is performed for mastoiditis?","a":"Simple or radical mastoidectomy."},{"q":"What is Meniere’s disease?","a":"A disorder caused by excess endolymph in the inner ear, leading to severe vertigo."},{"q":"What is the classic triad of Meniere’s disease?","a":"Vertigo, sensorineural hearing loss, and tinnitus (ringing in the ears)."},{"q":"Does Meniere’s disease occur more often in men or women?","a":"Women."},{"q":"What is the most common age range for Meniere’s disease?","a":"Between 40 and 60 years old."},{"q":"What surgery is performed for severe Meniere’s disease?","a":"Labyrinthectomy."},{"q":"What condition may occur after a labyrinthectomy?","a":"Bell’s palsy (temporary facial paralysis)."},{"q":"What is a permanent effect of labyrinthectomy?","a":"Total hearing loss in the operated ear."},{"q":"Meningitis is an inflammation of which structures?","a":"The meninges, the protective linings of the brain and spinal cord."},{"q":"What are common causes of meningitis?","a":"Viruses, bacteria, or chemical irritants."},{"q":"Name four organisms that commonly cause meningitis.","a":"Pneumococcus, Meningococcus, Streptococcus, and Haemophilus influenzae."},{"q":"Is the child with meningitis initially lethargic or irritable?","a":"Irritable."},{"q":"What visual symptom is common in meningitis?","a":"Photophobia (sensitivity to light)."},{"q":"What is the most common musculoskeletal sign of meningitis?","a":"Nuchal rigidity (stiff neck)."},{"q":"Does the patient with meningitis typically have a headache?","a":"Yes, severe headache is common."},{"q":"What is a positive Kernig’s sign?","a":"Pain in the knee when the leg is straightened with the hip flexed."},{"q":"What type of vomiting occurs in meningitis?","a":"Projectile vomiting."},{"q":"What is opisthotonos?","a":"Severe hyperextension causing arching of the back, neck, and ankles due to meningeal irritation."},{"q":"What type of pain characterizes a migraine?","a":"Throbbing pain."},{"q":"Are migraines more common in men or women?","a":"Women."},{"q":"What other symptoms commonly accompany migraines?","a":"Nausea, vomiting, and visual disturbances."},{"q":"What physiological process occurs during migraines?","a":"Reflex constriction followed by dilation of cerebral arteries."},{"q":"Where is migraine pain usually located?","a":"Temporal or supraorbital region."},{"q":"Are migraines typically unilateral or bilateral?","a":"Unilateral."},{"q":"Multiple sclerosis (MS) is a progressive ______ disease of the CNS.","a":"Demyelinating."},{"q":"What is the function of myelin?","a":"It allows fast, smooth conduction of nerve impulses."},{"q":"Does MS affect men or women more?","a":"Women."},{"q":"What is the typical age range for MS onset?","a":"20–40 years old."},{"q":"What is usually the first sign of MS?","a":"Blurred or double vision (diplopia)."},{"q":"Can MS lead to urinary incontinence?","a":"Yes."},{"q":"Can MS cause impotence in men?","a":"Yes."},{"q":"Are the muscles in MS spastic or flaccid?","a":"Spastic."},{"q":"In myasthenia gravis (MG), where is the transmission defect located?","a":"At the neuromuscular junction."},{"q":"What is the primary sign of MG?","a":"Severe muscle weakness."},{"q":"What are the early symptoms of MG called?","a":"Bulbar signs — difficulty swallowing and visual disturbances."},{"q":"Who is more commonly affected by MG, men or women?","a":"Women."},{"q":"At what age does MG usually occur in women?","a":"Younger adults."},{"q":"At what age does MG usually occur in men?","a":"Older adults."},{"q":"Which neurotransmitter is affected in MG?","a":"Acetylcholine."},{"q":"What surgical treatment may be performed for MG?","a":"Thymectomy (removal of the thymus gland)."},{"q":"Does muscle weakness in MG improve with exercise?","a":"No, it worsens with activity."},{"q":"What facial appearance is typical in MG?","a":"Mask-like face with a “myasthenic smile.”"},{"q":"How do patients typically describe the pain of a myocardial infarction (MI)?","a":"Crushing, heavy, squeezing pain radiating to the left arm, neck, jaw, or shoulder."},{"q":"What is a myocardial infarction (MI)?","a":"An obstruction of coronary blood flow due to a clot, spasm, or plaque, resulting in myocardial cell death."},{"q":"What is the #1 symptom of an MI?","a":"Severe chest pain unrelieved by rest or nitroglycerin."},{"q":"Are men or women more likely to experience an MI?","a":"Men."},{"q":"Death due to MI occurs within what time frame in 50% of cases?","a":"Within one hour of symptom onset."},{"q":"What is another name for an MI?","a":"Heart attack."},{"q":"Does fluid resuscitation correct cardiogenic shock?","a":"No, it requires cardiac medications; fluids may worsen the condition."},{"q":"Will a client with an MI experience nausea and diaphoresis?","a":"Yes, both are common symptoms."},{"q":"How will the extremities feel in a patient with an MI?","a":"Cold and clammy."},{"q":"Does the MI patient require 100% oxygen for the entire hospital stay?","a":"No, moderate flow (3–6 L\/min) is sufficient for the first 48 hours."},{"q":"Hemophilia is what type of disorder?","a":"A bleeding disorder."},{"q":"Hemophilia A is caused by a deficiency of which clotting factor?","a":"Factor VIII."},{"q":"What does hemarthrosis mean?","a":"Bleeding into the joints."},{"q":"Which symptom is NOT seen in hemophilia: prolonged bleeding, petechiae, ecchymosis, or hematoma?","a":"Petechiae."},{"q":"Hepatitis is an _____, ______ disease of the _______.","a":"Acute, inflammatory disease of the liver."},{"q":"Hepatitis A, B, C, and D are caused by what type of organism?","a":"Viruses."},{"q":"What is an early sign of hepatitis A?","a":"Anorexia or fatigue."},{"q":"Early-stage hepatitis often resembles which common illness?","a":"Influenza (the flu)."},{"q":"In later stages of hepatitis, what happens to the urine?","a":"It becomes dark due to bilirubin accumulation."},{"q":"What does “pre-icteric” mean?","a":"The stage before jaundice appears."},{"q":"What is the “icteric stage” of hepatitis?","a":"The phase when jaundice is present."},{"q":"What two skin symptoms are common in hepatitis?","a":"Pruritus (itching) and jaundice, caused by elevated bilirubin levels."},{"q":"Which type of hepatitis has more severe symptoms—A or B?","a":"Hepatitis B."},{"q":"Patients with hepatitis often have an aversion to what?","a":"Cigarettes."},{"q":"In hepatitis, what color are the stools?","a":"Light-colored; bilirubin is excreted in urine instead of stool."},{"q":"What is the common name for herpes zoster?","a":"Shingles."},{"q":"What type of rash occurs with shingles?","a":"A vesicular rash following the path of a sensory nerve."},{"q":"How long does it usually take for shingles to heal?","a":"About 30 days."},{"q":"What is the most common symptom reported by patients with shingles?","a":"Severe pain."},{"q":"What other disease is related to shingles?","a":"Chickenpox (varicella)."},{"q":"What organism causes shingles?","a":"Varicella-zoster virus."},{"q":"Describe key facts about Hepatitis A.","a":"Fecal–oral transmission; incubation 3–5 weeks; vaccine and immune globulin available; enteric precautions."},{"q":"Describe key facts about Hepatitis B.","a":"Transmitted via blood and body fluids; incubation 5–35 weeks; vaccine and immune globulin (HBIG) available; HBsAg positive in blood."},{"q":"Describe key facts about Hepatitis C.","a":"Transmitted via blood only; incubation 2–23 weeks; no vaccine and immune globulin is ineffective."},{"q":"Hyperemesis gravidarum is ______ and ______ vomiting that persists into the ______ trimester.","a":"Severe and prolonged vomiting that continues into the second trimester."},{"q":"Give three possible causes of hyperemesis gravidarum.","a":"Pancreatitis, multiple pregnancies, and hydatidiform mole."},{"q":"Hypertension is an ________ or sustained elevation in the ________ blood pressure.","a":"Intermittent or sustained elevation in diastolic blood pressure."},{"q":"If untreated, hypertension can be fatal. (T\/F)","a":"True."},{"q":"Which four organs are most affected by hypertension?","a":"Brain (stroke), eyes (blindness), heart (MI), and kidneys (renal failure)."},{"q":"In hypovolemic shock, there is a ________ in circulating ________, resulting in ________ tissue perfusion with ________.","a":"Decrease; blood volume; decreased perfusion; reduced oxygen delivery."},{"q":"What is the most common cause of hypovolemic shock?","a":"Acute blood loss."},{"q":"What happens to blood pressure in hypovolemic shock?","a":"It decreases."},{"q":"What happens to pulse pressure in hypovolemic shock?","a":"It narrows (the difference between systolic and diastolic becomes smaller)."},{"q":"In hypovolemic shock, the level of consciousness (LOC) is (increased\/decreased).","a":"Decreased."},{"q":"What type of heart rate occurs in hypovolemic shock: bradycardia or tachycardia?","a":"Tachycardia."},{"q":"In hypovolemic shock, urine output falls below how many cc per hour?","a":"Less than 25–30 mL\/hour."},{"q":"Describe the skin appearance in hypovolemic shock.","a":"Cool, pale, and clammy due to vasoconstriction."},{"q":"What acid-base imbalance is most common in hypovolemic shock?","a":"Metabolic acidosis (from lactic acid buildup due to poor oxygenation)."},{"q":"Which two vital signs increase during hypovolemic shock?","a":"Heart rate and respiratory rate."},{"q":"What are the first two signs of hypovolemic shock?","a":"Change in level of consciousness and tachycardia."},{"q":"What is the #1 medical treatment for hypovolemic shock?","a":"Replace blood and fluids."},{"q":"What are MAST trousers?","a":"Pneumatic garments inflated around the legs to push blood toward vital organs."},{"q":"In what position should you place a client with suspected hypovolemic shock?","a":"Supine with legs and arms elevated."},{"q":"If systolic BP drops below 80 mmHg during hypovolemic shock, what should be done first?","a":"Increase the oxygen flow rate."},{"q":"What is a hysterectomy?","a":"Surgical removal of the uterus."},{"q":"What is an ectopic pregnancy?","a":"Implantation of a fertilized ovum outside the uterus."},{"q":"What is the most common site for ectopic pregnancy?","a":"The fallopian tube (≈90% of cases)."},{"q":"Have IUDs or pelvic infections been linked to ectopic pregnancies?","a":"Yes, both increase the risk."},{"q":"What is the most common symptom of fallopian tube ectopic pregnancy?","a":"Unilateral pelvic pain."},{"q":"What is the most dangerous complication of ectopic pregnancy?","a":"Rupture of the fallopian tube."},{"q":"If a fallopian tube ruptures in an ectopic pregnancy, care resembles that for _________.","a":"Shock and peritonitis."},{"q":"How does the uterus feel after rupture of a fallopian ectopic pregnancy?","a":"Boggy and tender."},{"q":"What is usually the first sign of a ruptured ectopic pregnancy?","a":"Sudden, sharp abdominal pain."},{"q":"Are ectopic pregnancies usually carried to term?","a":"Almost never."},{"q":"What is the usual medical-surgical treatment for ectopic pregnancy?","a":"Surgical removal of the embryo and damaged tissue."},{"q":"What surgery is performed for ectopic pregnancy?","a":"Exploratory laparotomy."},{"q":"In emphysema, the alveoli are over-_____ and under-_____.","a":"Over-enlarged and under-ventilated, causing air trapping."},{"q":"In emphysema, appetite ______, body weight ______, and the anterior-posterior chest diameter ______.","a":"Decreases, decreases, increases."},{"q":"What is the term for the increased anterior-posterior chest diameter in emphysema?","a":"Barrel chest."},{"q":"Clients with emphysema often have ______, ______ lips and (slow\/rapid) breathing.","a":"Pursed, grunting lips and rapid breathing."},{"q":"The client with emphysema is typically (ruddy\/pale\/cyanotic).","a":"Cyanotic."},{"q":"Overproduction of thyroid hormone is known as what disorder?","a":"Graves’ disease (hyperthyroidism)."},{"q":"Excess growth hormone in childhood causes what disorder?","a":"Gigantism."},{"q":"Oversecretion of mineralocorticoids only results in what disease?","a":"Conn’s disease."},{"q":"Deficiency of growth hormone results in what condition?","a":"Pituitary dwarfism."},{"q":"Excess growth hormone in adulthood causes what disorder?","a":"Acromegaly."},{"q":"Undersecretion of adrenal cortex hormones causes what disorder?","a":"Addison’s disease."},{"q":"Hypothyroidism in an adult is known as what?","a":"Myxedema."},{"q":"Oversecretion of adrenal cortex hormones results in what syndrome?","a":"Cushing’s syndrome."},{"q":"Oversecretion of adrenal medulla hormones causes what condition?","a":"Pheochromocytoma."},{"q":"Hypothyroidism in a child is known as what?","a":"Cretinism."},{"q":"Oversecretion of ACTH leads to what disease?","a":"Cushing’s disease."},{"q":"What is endometriosis?","a":"Growth of endometrial tissue outside the uterus."},{"q":"Endometriosis most commonly occurs in women aged ______ to ______.","a":"25 to 40 years."},{"q":"After menopause, endometriosis (increases\/decreases).","a":"Decreases."},{"q":"What is the most common symptom of endometriosis?","a":"Dysmenorrhea (painful menstruation)."},{"q":"What is the major complication of endometriosis?","a":"Infertility."},{"q":"Is endometriosis life-threatening?","a":"No, it is not life-threatening."},{"q":"What organism most commonly causes epiglottitis?","a":"Haemophilus influenzae type B."},{"q":"What level of fever is typical in epiglottitis?","a":"Above 102°F (39°C)."},{"q":"What are the classic symptoms of epiglottitis?","a":"Muffled voice, drooling, and inspiratory stridor."},{"q":"Does a child with epiglottitis usually cough?","a":"No, there is typically no spontaneous cough."},{"q":"How does a child with epiglottitis position themselves to breathe?","a":"Leaning forward with flared nostrils (“tripod position”)."},{"q":"Osteoarthritis is a ______ disease of the ______.","a":"Degenerative disease of the joints."},{"q":"Osteoarthritis is most commonly caused by wear and tear over time. (T\/F)","a":"True."},{"q":"What is the most common symptom of osteoarthritis?","a":"Joint pain."},{"q":"Which joints are most commonly affected by osteoarthritis?","a":"The knees and hips."},{"q":"What physical finding may appear on the fingers of clients with osteoarthritis?","a":"Heberden’s nodes."},{"q":"Are Heberden’s nodes painful?","a":"Not initially, but they can become painful with swelling."},{"q":"Is the pain of osteoarthritis better or worse with rest? With activity?","a":"Better with rest, worse with activity."},{"q":"What age group is most affected by osteoarthritis?","a":"Adults aged 60–80 years."},{"q":"Osteoarthritis occurs more often in women than in men. (T\/F)","a":"False; incidence is about equal."},{"q":"What is arthroplasty?","a":"Surgical joint replacement."},{"q":"What is arthrodesis?","a":"Surgical joint fusion."},{"q":"What is otosclerosis?","a":"Overgrowth of spongy bone in the middle ear that prevents ossicle vibration and impairs hearing."},{"q":"What additional symptom occurs with otosclerosis besides hearing loss?","a":"Tinnitus (ringing in the ears)."},{"q":"What type of hearing loss occurs in otosclerosis?","a":"Conductive hearing loss."},{"q":"What surgery is used to correct otosclerosis?","a":"Stapedectomy."},{"q":"Which gender has a higher incidence of otosclerosis?","a":"Women."},{"q":"Are ovarian cysts usually malignant?","a":"False; most are benign."},{"q":"Do small ovarian cysts cause symptoms?","a":"No, only large cysts cause noticeable symptoms."},{"q":"What are common symptoms of large ovarian cysts?","a":"Low back pain, pelvic pain, and abnormal uterine bleeding."},{"q":"What does torsion of an ovarian cyst mean?","a":"Twisting of the cyst, cutting off its blood supply."},{"q":"Raynaud’s disease is an arterial or venous disorder?","a":"It is an arterial disorder characterized by vasospasms."},{"q":"What part of the body is most affected by Raynaud’s disease?","a":"The fingers."},{"q":"Raynaud’s disease affects men or women more commonly?","a":"Women, particularly young women."},{"q":"What three factors can trigger a Raynaud’s attack?","a":"Exposure to cold, emotional stress, and tobacco use."},{"q":"Are the digits hot or cold during a Raynaud’s attack?","a":"Cold."},{"q":"What do the fingers look like during a Raynaud’s episode?","a":"Pale or bluish in color."},{"q":"What will you find when assessing the legs of patients with arterial insufficiency?","a":"Weak or absent pulses, cool pale skin, loss of hair, and shiny thin skin."},{"q":"What three sensations does the client with Raynaud’s experience?","a":"Pain, numbness, and tingling."},{"q":"What should clients with Raynaud’s avoid?","a":"Exposure to cold and smoking; they should wear warm gloves."},{"q":"What are the three stages of acute renal failure?","a":"Oliguric, diuretic, and recovery stages."},{"q":"Define renal failure.","a":"Inability of the kidneys to excrete waste and maintain fluid and electrolyte balance."},{"q":"What is the greatest danger in renal failure?","a":"Hyperkalemia and its effect on the heart."},{"q":"What is anuria?","a":"Urine output less than 50 mL in 24 hours."},{"q":"What is oliguria?","a":"Urine output less than 500 mL in 24 hours."},{"q":"What dietary changes are needed during the recovery phase of acute renal failure?","a":"Increased carbohydrates and protein intake."},{"q":"What are the dietary needs during the diuretic phase of acute renal failure?","a":"Increased carbohydrates and protein; moderate potassium and sodium; possible fluid increase to prevent dehydration."},{"q":"What dietary modifications are required during the oliguric phase of acute renal failure?","a":"Increased carbohydrates; decreased protein, sodium, potassium, and water."},{"q":"What causes the itching seen in end-stage renal failure?","a":"Accumulation of waste products in the blood."},{"q":"What is the first phase of acute renal failure?","a":"The oliguric phase."},{"q":"During the oliguric phase, what happens to blood volume, sodium, and potassium levels?","a":"All increase."},{"q":"How long does the oliguric phase last?","a":"7–10 days."},{"q":"During the diuretic phase, what happens to blood volume, sodium, and potassium levels?","a":"All decrease."},{"q":"How long does the diuretic phase last?","a":"3–4 days, up to 2–3 weeks in some cases."},{"q":"During the diuretic phase, urine output can reach how many liters per day?","a":"4–5 liters per 24 hours."},{"q":"Which is more dangerous: oliguria or anuria? Why?","a":"Oliguria, because concentrated potassium increases the risk of severe hyperkalemia."},{"q":"Respiratory Distress Syndrome (RDS) occurs in full-term infants. (T\/F)","a":"False — it primarily affects premature infants."},{"q":"RDS rarely occurs after which week of gestation?","a":"After the 37th week."},{"q":"Another name for Respiratory Distress Syndrome is _______.","a":"Hyaline Membrane Disease (HMD)."},{"q":"What causes RDS in premature infants?","a":"A lack of surfactant in the lungs."},{"q":"What does surfactant do?","a":"Decreases surface tension inside the alveoli to keep them open."},{"q":"Surfactant prevents what in the alveoli?","a":"Collapse of the alveoli."},{"q":"Lack of surfactant causes the neonate to lose lung capacity with each what?","a":"Breath."},{"q":"Death from Respiratory Distress Syndrome most often occurs within how many hours of birth?","a":"Within 96 hours."},{"q":"Within minutes of birth, what three respiratory signs occur in RDS?","a":"Retractions, nasal flaring, and grunting."},{"q":"What acid–base imbalance occurs in RDS?","a":"Respiratory acidosis due to CO₂ retention."},{"q":"What lung sounds are heard in a neonate with RDS?","a":"Diminished breath sounds with crackles."},{"q":"In what season do rheumatoid arthritis flare-ups commonly occur?","a":"Spring."},{"q":"Clients with rheumatoid arthritis often have a low-_____ fever.","a":"Low-grade fever."},{"q":"What factor is found in the blood of clients with rheumatoid arthritis?","a":"Rheumatoid factor."}]

About the Mark Klimek Blue Book

The Mark Klimek Blue Book has become a cornerstone resource for NCLEX-RN students worldwide. It simplifies complex nursing concepts into clear, memorable ideas — making it one of the most effective NCLEX prep tools ever created. This digital flashcard version transforms that wisdom into an interactive, category-based learning experience.

Every flashcard is aligned with the official NCLEX Test Plan and helps you understand the “why” behind every answer. Study one topic at a time, track your progress, and return as often as you need — all completely free on NCLEXGuide.com.

Disclaimer: This collection is for educational use only and is not affiliated with or endorsed by Mark Klimek, NCSBN, or any official NCLEX program.

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Mark Klimek Q&A Flashcards

nclexguide.com — Thu, 02 Oct 2025 08:35:25 +0000

If you want to save study time and revisit the most-tested NCLEX topics with focus, Mark Klimek Q&A Flashcards are for you. These are authentic Mark Klimek Q&A flashcards that mirror the exam format—concise questions, memorable rationales, and high-yield cues that flag common pitfalls.

Built for active recall and spaced repetition, they make short daily sessions easy—whether it’s your first attempt or a retake. Answers and rationales are on the back: just flip or tap to reveal (click-to-learn) and check your reasoning instantly.

Management Of Care Flashcards

[{"q":"If the pH and the BiCarb are both in the same direction then it is?","a":"Metabolic"},{"q":"If the pH is up it is?","a":"Alkalosis"},{"q":"If the pH is down it is?","a":"Acidosis"},{"q":"If disconnected tube on floor?","a":"Bag patient → call for help → new tube → reconnect."},{"q":"If disconnected tube on chest?","a":"Reconnect (above waist is ok)."},{"q":"“Bizarre” means?","a":"Tachycardia."},{"q":"If kernicterus & opisthotonos → ?","a":"Call MD, draw bili, increase IV, start phototherapy."},{"q":"Thyroidectomy post-op 0–12h risks?","a":"Hemorrhage, airway."},{"q":"Post-op 12–48h Subtotal risk?","a":"Thyroid storm."},{"q":"Adolescents (12–18 yrs) \"play\" is?","a":"Peer association."},{"q":"How often monitor in labor?","a":"q15min until 2h PP, then q1h."},{"q":"1st stage of labor has how many phases?","a":"3."},{"q":"3 phases of labor?","a":"Latent \/ Active \/ Transition."},{"q":"Side effects of Terbutaline?","a":"Maternal tachycardia (not safe if cardiac disease is present)."},{"q":"Side effects of Nifedipine?","a":"Headache and hypotension."},{"q":"Prioritization questions give what 4 details?","a":"Age \/ Gender \/ Diagnosis \/ Modifying phrase."},{"q":"Most important info in prioritization?","a":"Modifying phrase."},{"q":"What 2 details do NOT matter in prioritization?","a":"Age and gender."},{"q":"Four rules of prioritization?","a":"Acute > Chronic \/ others \/ Unstable > Stable \/ More vital organ > less vital (tie-breaker)."},{"q":"Best prioritization rule?","a":"Rule #4 (organ vitality)."},{"q":"What makes a patient stable?","a":"Chronic illness \/ >12h postop \/ Local\/regional anesthesia \/ Unchanged assessment \/ \"To be discharged\" \/ Lab values A or B \/ Expected signs and symptoms."},{"q":"What makes a patient unstable?","a":"Acute illness \/ <12h postop \/ General anesthesia \/ Changed assessment \/ "Newly admitted\/diagnosed" \/ Lab values C or D \/ Unexpected signs and symptoms."},{"q":"Main 6 organs in order?","a":"Brain > Lung > Heart > Liver > Kidney > Pancreas."},{"q":"What do you NOT delegate to family?","a":"Safety responsibilities."},{"q":"Family can only do what you ____ them?","a":"Teach."},{"q":"If staff does something illegal you?","a":"Report to supervisor."},{"q":"If staff behavior is legal, not harmful but inappropriate you?","a":"Counsel them later."}]

Safety And Infection Control Flashcards

[{"q":"High pressure alarms trigger when?","a":"Ventilator cannot push air in."},{"q":"High pressure alarms are caused by?","a":"Kinking \/ Water in dependent loops \/ Mucus in airway."},{"q":"If tube kinking present?","a":"Unkink."},{"q":"If water in dependent loops?","a":"Open system and empty."},{"q":"If mucus present?","a":"Turn, cough, deep breathe. If ineffective → suction."},{"q":"Low pressure alarms trigger when?","a":"Too easy to push air in."},{"q":"Low pressure alarms are caused by?","a":"Disconnection."},{"q":"If tubing disconnected?","a":"Reconnect."},{"q":"If O2 sensor line disconnected?","a":"Reconnect."},{"q":"Overdose of an upper?","a":"Everything ↑"},{"q":"Withdrawal of an upper?","a":"Everything ↓"},{"q":"Withdrawal of a downer?","a":"Everything ↑"},{"q":"Contact precautions for?","a":"RSV, herpes, staph, enteric infections."},{"q":"Contact precautions include?","a":"Private room, gloves, gown (direct care), handwashing, disposable supplies."},{"q":"Droplet precautions for?","a":"All meningitis, all influenza."},{"q":"Droplet precautions include?","a":"Private room, gloves, mask (#1), handwashing, patient mask when leaving, disposable supplies."},{"q":"Airborne precautions are for what 4 diseases?","a":"SARS, TB, measles, varicella."},{"q":"Airborne precautions have what 9 things?","a":"Private room (door closed), mask, gloves, gown, handwashing, special respirator mask, patient wears mask when leaving room, disposable-dedicated supplies, negative airflow room."},{"q":"PPE contains?","a":"Gloves, gown, goggles, mask (unless told otherwise)."},{"q":"Proper order for donning PPE?","a":"1. Gown, 2. Mask, 3. Goggles, 4. Gloves."},{"q":"Where do you remove PPE?","a":"Inside the room."},{"q":"Where do you put on PPE?","a":"Outside the room."},{"q":"In airborne precautions it is ok to remove what PPE outside the room?","a":"Mask."},{"q":"What position are your hands for handwashing?","a":"Hands below elbows."},{"q":"How long do you wash hands?","a":"15 seconds."},{"q":"Can the faucet have handles for handwashing?","a":"Yes."},{"q":"What do you use in handwashing?","a":"Soap and water."},{"q":"When do you wash your hands?","a":"Before\/after gloves, entering\/exiting room, after soiling hands."},{"q":"Hand position for scrubbing?","a":"Elbows below hands."},{"q":"Length of hand scrubbing?","a":"3–7 minutes."},{"q":"What agent is used for hand scrubbing?","a":"Cleaning agent with prefix \"chlor\"."},{"q":"Can the sink have handles for scrubbing?","a":"No."},{"q":"When do you use scrubbing?","a":"Immunosuppression, surgery, transplant, chemo, HIV."},{"q":"Dry your hands from...?","a":"Cleanest to least clean."},{"q":"When can you use alcohol-based solution?","a":"Before\/after gloves, entering\/leaving room."},{"q":"Allow adolescents in each other’s rooms unless?","a":"Contagious, immunosuppressed, or fresh post-op."},{"q":"If WBC low, precautions?","a":"Strict handwashing, BID antimicrobial showers, avoid crowds, private room, no fresh flowers\/plants, low-bacteria diet (no raw fruits\/veggies, no undercooked meat), no sitting water, vitals q4h, daily WBC, and no reusable utensils."},{"q":"What 4 conditions are always unstable?","a":"Hemorrhage \/ Hypoglycemia \/ Fever >104°F \/ Pulselessness & breathlessness."},{"q":"If staff endangers patient physically\/psychologically you?","a":"Intervene and take over."}]

[{"q":"Teach Antabuse patients to avoid?","a":"Alcohol."},{"q":"Other things to avoid with Antabuse?","a":"Elixirs \/ Vanilla extract \/ Aftershave & perfumes \/ Alcohol hand sanitizer \/ Insect repellent \/ Mouthwash \/ Vinaigrette"},{"q":"“Supra” means?","a":"Above."},{"q":"Sick diabetic teaching?","a":"Take insulin \/ Sip fluids \/ Stay active."},{"q":"Children under 4 should not have?","a":"Small toys."},{"q":"If a child has O2, what toys are contraindicated?","a":"Metal toys."},{"q":"Best toy for a 0–6 month old?","a":"Musical mobile (remove at 6 months or if the child can sit)."},{"q":"2nd best toy for a 0–6 month old?","a":"Anything soft and large."},{"q":"Best toy for a 6–9 month old?","a":"Cover\/uncover toys (peek-a-boo)."},{"q":"2nd best toy for a 6–9 month old?","a":"Anything large they can't swallow."},{"q":"Best toy for a 9–12 month old?","a":"Talking toys."},{"q":"2nd best toy for a 9–12 month old?","a":"Purposeful activities (rolling ball back and forth)."},{"q":"5 words to avoid in toy questions under 9 months?","a":"Build, make, construct, sort, stack."},{"q":"Best toy for a toddler (1–3 yrs)?","a":"Push\/pull toys."},{"q":"What should you work on with a toddler?","a":"Gross motor skills."},{"q":"Toddler play is characterized by?","a":"Parallel play."},{"q":"What 2 things to work on with preschooler (3–6 yrs)?","a":"Fine motor (fingers), balance (dance, gymnastics)."},{"q":"What sort of play do preschoolers prefer?","a":"Pretend play."},{"q":"Preschooler play is characterized by?","a":"Cooperative play."},{"q":"School age (7–11 yrs) play is characterized by 3 C's?","a":"Creative (blank paper, no coloring book), collecting, competitive."},{"q":"Naegele’s rule for due date?","a":"LMP + 7 days – 3 months."},{"q":"Normal pregnancy weight gain?","a":"28 ± 3 lb."},{"q":"1st trimester weight gain?","a":"1 lb\/month."},{"q":"2nd\/3rd trimester weight gain?","a":"1 lb\/week."},{"q":"Fundus palpable at week?","a":"12."},{"q":"Fundus at umbilicus at week?","a":"20–22."},{"q":"If fundus not above umbilicus, baby not?","a":"Viable."},{"q":"Positive signs of pregnancy?","a":"Fetal skeleton (X-ray) \/ Fetal presence (US) \/ FHR auscultation \/ Examiner palpates fetal movement."},{"q":"Probable\/presumptive pregnancy signs?","a":"Urine & blood tests."},{"q":"Chadwick’s sign?","a":"Cervical cyanosis."},{"q":"Goodell’s sign?","a":"Cervical softening."},{"q":"Hegar’s sign?","a":"Uterine softening."},{"q":"Prenatal visit frequency (monthly)?","a":"Until 28 weeks."},{"q":"Visit frequency every 2 weeks?","a":"28–36 weeks."},{"q":"Visit frequency weekly?","a":"36–42 weeks."},{"q":"Is mild anemia in pregnancy normal?","a":"Yes."},{"q":"Pregnant women should void how often (pregnancy–6 weeks PP)?","a":"q2h."},{"q":"Teaching for Baclofen\/Flexeril?","a":"No driving or operating machinery \/ No alcohol \/ Do not care for children under 12 years."},{"q":"Mnemonic for Baclofen?","a":"\"On Baclofen you're back loafin’.\""},{"q":"Nursing teaching in sensorimotor stage?","a":"Teach while doing it \/ What you are doing \/ Use verbal teaching."},{"q":"Nursing teaching in pre-operational stage?","a":"Teach day-of \/ What you will do \/ Use play."},{"q":"Nursing teaching in concrete operational stage?","a":"Teach ahead of time \/ What you will do \/ Use visuals, audio, age-appropriate reading."}]

[{"q":"Biggest problem in abuse?","a":"Denial (applies to all abuse)."},{"q":"Treat denial by?","a":"Confrontation."},{"q":"How to confront?","a":"Point out the difference between words and actions."},{"q":"Only time to support denial?","a":"Loss & Grief."},{"q":"Dependency is?","a":"Abuser gets significant other to make decisions\/do things."},{"q":"Codependency is?","a":"Significant other gains self-esteem from helping the abuser."},{"q":"Treat dependency\/codependency?","a":"Set limits, enforce, and build the significant other’s self-esteem."},{"q":"Manipulation is?","a":"Abuser gets significant other to do harmful things for them."},{"q":"Treat manipulation?","a":"Set limits, enforce."},{"q":"Why is manipulation easier to treat?","a":"People hate being manipulated."},{"q":"Are AWS patients dangerous?","a":"No."},{"q":"Are DT patients dangerous?","a":"Yes."},{"q":"Delusion is?","a":"False fixed belief (no sensory)."},{"q":"Types of delusions?","a":"Paranoid \/ Grandiose \/ Somatic."},{"q":"Paranoid delusion?","a":"Others are out to harm you."},{"q":"Grandiose delusion?","a":"Superior identity (God, Pope)."},{"q":"Somatic delusion?","a":"False belief about the body (e.g. X-ray vision)."},{"q":"Types of hallucinations?","a":"Auditory \/ Visual \/ Tactile \/ Olfactory \/ Gustatory."},{"q":"Illusion is?","a":"Misinterpretation of reality (sensory)."},{"q":"Difference hallucination vs illusion?","a":"Illusion has a referent from reality."},{"q":"Functional psychosis types?","a":"Schizophrenia \/ Schizoaffective \/ Major depression \/ Mania."},{"q":"Manage functional psychosis delusion\/illusion?","a":"Acknowledge feelings → Present reality → Set limits → Enforce."},{"q":"Psychosis of dementia examples?","a":"Alzheimer’s \/ Dementia \/ Organic brain syndrome \/ Wernicke’s \/ Senility."},{"q":"Manage dementia psychosis?","a":"Acknowledge & redirect."},{"q":"Flight of ideas?","a":"Rapid topic change (word association)."},{"q":"Word salad?","a":"Random unrelated words."},{"q":"Neologism?","a":"New made-up words."},{"q":"Narrowed self-concept?","a":"Refusal to leave\/dress (don’t force)."},{"q":"Ideas of reference?","a":"Think everything is about them."},{"q":"Nevus\/Nevi is?","a":"Birthmark."},{"q":"Piaget stage 0–2 years?","a":"Sensorimotor."},{"q":"Piaget stage 3–6 years?","a":"Pre-operational."},{"q":"Piaget stage 7–11 years?","a":"Concrete operational."},{"q":"Piaget stage 12–15 years?","a":"Formal operational."},{"q":"Sensorimotor stage is characterized by?","a":"Present-oriented, focused on what they sense\/do now."},{"q":"Pre-operational stage is characterized by?","a":"Fantasy-oriented, illogical, no rules."},{"q":"Concrete operational stage is characterized by?","a":"Rule-oriented, cannot abstract."},{"q":"At what Piaget stage can you teach skills (e.g., insulin draw-up)?","a":"Concrete operational."},{"q":"Formal operational stage can be taught like?","a":"An adult."},{"q":"For Peds, when in doubt call it?","a":"Normal."},{"q":"For Peds, when in doubt pick?","a":"The older child."},{"q":"For Peds, when in doubt pick the?","a":"Easier task."},{"q":"Empathy questions have what?","a":"Quote in question + quote in answer."},{"q":"In Psych empathy questions, choose what?","a":"Feelings (not words)."}]

Basic Care And Comfort Flashcards

[{"q":"N\/I for DT?","a":"Private room near nurses \/ NPO → clear liquids \/ Strict bed rest \/ Restraints \/ Tranquilizer \/ Multivitamin (B1) \/ Antihypertensive"},{"q":"N\/I for AWS?","a":"Semi-private \/ Regular diet \/ Ad-lib activity \/ No restraints \/ Tranquilizer \/ Multivitamin (B1) \/ Antihypertensive"},{"q":"2-point restraint is?","a":"One arm + opposite leg."},{"q":"N\/I for restraints?","a":"Check every 15 minutes, rotate every 2 hours."},{"q":"Apical chest tube placed?","a":"High (air)."},{"q":"Basilar chest tube placed?","a":"Low (blood)."},{"q":"Post-surgery chest tube assumption?","a":"Unilateral pneumohemothorax."},{"q":"Pneumonectomy chest tube?","a":"No."},{"q":"Water seal breaks steps?","a":"Clamp → Cut → Submerge in NS → Unclamp."},{"q":"Best thing (not first) if seal breaks?","a":"Submerge in NS."},{"q":"Chest tube comes out steps?","a":"Hand cover → Vaseline gauze → Sterile dressing → Tape 3 sides."},{"q":"Clamp chest tube max time?","a":"15 seconds (no order)."},{"q":"Use what to clamp chest tube?","a":"Rubber-tipped double clamps."},{"q":"1 fingerwidth = ?","a":"1 cm."},{"q":"Proper crutch elbow flexion?","a":"30°."},{"q":"Crutches below armpit?","a":"2–3 fingerwidths."},{"q":"2-point gait?","a":"One crutch + opposite foot → other crutch + other foot."},{"q":"3-point gait?","a":"Both crutches + bad leg → good leg."},{"q":"4-point gait?","a":"One crutch → opposite foot → other crutch → other foot."},{"q":"Swing-through gait?","a":"For 2 braced legs: move crutches, then hop."},{"q":"Even-numbered gaits used when?","a":"Bilateral weakness."},{"q":"2-pt gait is for?","a":"Mild bilateral problem."},{"q":"4-pt gait is for?","a":"Severe bilateral problem."},{"q":"Odd-numbered gait used when?","a":"Unilateral problem."},{"q":"Stairs with crutches rule?","a":"UP with GOOD, DOWN with BAD."},{"q":"Crutches move with?","a":"Bad leg."},{"q":"Cane held on?","a":"Strong side."},{"q":"Cane advances with?","a":"Weak side (for wide base)."},{"q":"Walker use?","a":"Pick up → set down → walk to it."},{"q":"Calories\/day Type II?","a":"1200–1800."},{"q":"Feedings\/day Type II?","a":"6."},{"q":"Tx hypoglycemia conscious?","a":"Rapid carb or carb + protein\/starch."},{"q":"Tx hypoglycemia unconscious?","a":"Glucagon IM or Dextrose IV."},{"q":"Rapid carb examples?","a":"Juice, candy, icing, honey, syrup."},{"q":"HHNK Tx?","a":"Rehydrate (no insulin)."},{"q":"Hiatal hernia Tx?","a":"High Fowler’s \/ increase fluids \/ increase carbs."},{"q":"Dumping syndrome Tx?","a":"Side-lying \/ decrease fluids with meals \/ decrease carbs (increase protein)."},{"q":"Pre-op thoracic laminectomy assessment?","a":"1. Cough \/ 2. Bowel sounds."},{"q":"Pre-op lumbar laminectomy assessment?","a":"1. Voiding \/ 2. Leg motor-sensory."},{"q":"#1 post-op answer on NCLEX?","a":"Log roll patient."},{"q":"Post-op laminectomy activity restrictions?","a":"No dangling \/ May stand, walk, lie \/ Don’t sit >30 min."},{"q":"Which laminectomy incision site is more painful?","a":"Hip site."},{"q":"Default restriction timeframe if not given?","a":"6 weeks."},{"q":"Laminectomy discharge teaching (temporary)?","a":"No sitting >30 min \/ Lie flat & log roll \/ No driving \/ No lifting >5 lb (for 6 weeks)."},{"q":"Permanent restrictions after laminectomy?","a":"No lifting by bending at the waist \/ No jerky activities (rides, horses) \/ Cervical: no lifting above head."},{"q":"Treat morning sickness (1st trimester)?","a":"Dry carbohydrates."},{"q":"Treat urinary incontinence (1st & 3rd)?","a":"Void q2h."},{"q":"Treat dyspnea (2nd & 3rd)?","a":"Tripod position."},{"q":"Treat back pain (2nd & 3rd)?","a":"Pelvic tilt exercises."},{"q":"Most valid sign of labor?","a":"Regular contractions."},{"q":"Dilation is?","a":"Cervical opening (0–10 cm)."},{"q":"Effacement is?","a":"Cervical thinning (0–100%)."},{"q":"Station is?","a":"Fetal part relation to ischial spines (+ = below, good; – = above, bad)."},{"q":"Engagement is?","a":"Station 0."},{"q":"Lie is?","a":"Relation of baby’s spine to mother’s spine (parallel = good, transverse = bad)."},{"q":"Presentation is?","a":"Part of fetus entering birth canal first."},{"q":"1st stage of labor is?","a":"Labor."},{"q":"2nd stage of labor is?","a":"Delivery of baby."},{"q":"3rd stage of labor is?","a":"Delivery of placenta."},{"q":"4th stage of labor is?","a":"Recovery (first 2 hours after placenta)."},{"q":"How do you treat painful back labor?","a":"Knee to chest position \/ Use your fist and press on the patient's sacrum."},{"q":"How do you treat prolapsed cord?","a":"Push head back in \/ Position in knee-chest position or Trendelenburg."},{"q":"The second stage of labor and delivery is all about?","a":"Order."},{"q":"What do you do in order for the second stage?","a":"Deliver the head \/ Suction mouth then nose \/ Check for nuchal cord \/ Deliver shoulders and body \/ Apply ID band."},{"q":"During the third stage of labor and delivery you do what two things?","a":"Ensure the placenta is intact (if not → hemorrhage first, infection second) \/ Check for three vessels (2 arteries, 1 vein = AVA)."},{"q":"What are the 4 things you do 4 times an hour during the 4th stage?","a":"VS – check for shock \/ Fundus – if boggy, massage; if displaced, void\/cath \/ Perineal pad – excessive lochia = saturated pad in 15 min (911) \/ Roll patient to check for bleeding."},{"q":"The uterus should be like what after delivery?","a":"Firm (not boggy) \/ Fundal height = days postpartum \/ Midline (if not, catheterize)."},{"q":"Lochia color rubra?","a":"Red (rub it red)."},{"q":"Lochia color serosa?","a":"Pink (rose pink)."},{"q":"Lochia color alba?","a":"White (albino white)."},{"q":"Moderate lochia is?","a":"4–6 inches on pad in 1 hour."},{"q":"Excessive lochia is?","a":"Saturated pad in 15 minutes."},{"q":"Extremity assessment postpartum should include?","a":"Pulses \/ Edema \/ Signs of thrombophlebitis (bilateral calf circumference – unequal calves suggest DVT)."},{"q":"Postpartum assessment should include what?","a":"Uterus \/ Lochia \/ Extremities."},{"q":"Milia is?","a":"Distended sebaceous glands appearing as tiny white spots on the baby's face."},{"q":"Epstein's pearls are?","a":"Small white epithelial cysts on the baby's gums."},{"q":"Mongolian spots are?","a":"Bluish-black macules on the buttocks\/thighs of darker-skinned neonates."},{"q":"Erythema toxicum neonatorum is?","a":"Benign red papular rash on the torso, disappears after a few days."},{"q":"Hemangioma is?","a":"Benign tumor of capillaries."},{"q":"Vernix caseosa is?","a":"Whitish, cheese-like substance covering the unborn baby's skin."},{"q":"Acrocyanosis is?","a":"Normal cyanosis of the baby's hands\/feet in the first 7–10 days."},{"q":"For IM injection, needle must be?","a":"Gauge 21 (ends with 1), length 1 inch."},{"q":"For SubQ injection, needle must be?","a":"Gauge 25 (ends with 5), length 5\/8 inch."},{"q":"ACE of spades answer for Nutrition?","a":"Choose chicken or fish."},{"q":"Never choose what for children’s food?","a":"Casserole."},{"q":"For a toddler, pick what kind of food?","a":"Finger food."},{"q":"For a preschooler, ____ meals\/day is OK?","a":"1 meal\/day."},{"q":"First thing you do in Med-Surg?","a":"Airway."},{"q":"In Peds always give?","a":"More time."}]

Pharmacological And Parenteral Therapies Flashcards

[{"q":"If my pH is up my potassium (K+) is?","a":"Down"},{"q":"If my pH is down my potassium (K+) is?","a":"Up"},{"q":"Vitamin B1 helps breakdown?","a":"Alcohol."},{"q":"Antabuse onset & duration?","a":"2 weeks."},{"q":"5 uppers?","a":"Caffeine \/ Cocaine \/ Methamphetamines \/ PCP-LSD \/ ADHD meds"},{"q":"Downers are?","a":"Everything else."},{"q":"Aminoglycosides end in?","a":"“-mycin” (e.g. vancomycin)."},{"q":"If it has \"thro\" in it?","a":"Throw it out (not aminoglycoside)."},{"q":"Toxic effects of aminoglycosides?","a":"Ototoxicity \/ Nephrotoxicity \/ CN VIII damage (hearing, balance)."},{"q":"Monitor with aminoglycosides?","a":"Hearing, balance, tinnitus, creatinine."},{"q":"Frequency aminoglycosides?","a":"every 8 hours."},{"q":"Route aminoglycosides?","a":"IM or IV."},{"q":"Aminoglycosides PO for?","a":"Hepatic encephalopathy \/ Pre-op bowel surgery."},{"q":"Who can sterilize bowel?","a":"“Neo”, “Kan”."},{"q":"Trough level drawn?","a":"30 minutes before the next dose."},{"q":"Peak SL?","a":"5–10 minutes after dissolved."},{"q":"Peak IV?","a":"15–30 minutes after infusion."},{"q":"Peak IM?","a":"30–60 minutes after injection."},{"q":"Peak\/trough depend on?","a":"Route (not drug)."},{"q":"CCBs are like?","a":"Valium for the heart."},{"q":"CCB treat (6 A’s)?","a":"Antihypertensive \/ Anti-anginal \/ Anti-atrial arrhythmia \/ SVT"},{"q":"CCB side effects (2 H’s)?","a":"Headache, hypotension."},{"q":"90% of CCB end in?","a":"“-dipine” or “-zem”."},{"q":"Hold CCB if?","a":"SBP ≤100."},{"q":"Treat PVC?","a":"Lidocaine \/ Amiodarone."},{"q":"Treat V-Tach?","a":"Lidocaine \/ Amiodarone."},{"q":"Treat SV arrhythmias?","a":"Adenosine \/ Beta-blockers \/ CCB \/ Digoxin."},{"q":"Treat V-Fib?","a":"Defibrillate."},{"q":"Treat Asystole?","a":"Epinephrine + Atropine (reverse order)."},{"q":"Treat A-Fib first?","a":"Heparin (then ABCD medications)."},{"q":"Type I diabetes?","a":"Insulin dependent \/ Juvenile \/ Ketosis prone."},{"q":"Type II diabetes?","a":"Non-insulin \/ Adult \/ Non-ketosis prone."},{"q":"Treat Type I (DIE)?","a":"Diet (3rd) \/ Insulin (1st) \/ Exercise (2nd)."},{"q":"Treat Type II (DOA)?","a":"Diet (1st) \/ Oral meds (3rd) \/ Activity (2nd)."},{"q":"2 drugs ↑ blood sugar?","a":"Glucagon, Epinephrine."},{"q":"More exercise → need?","a":"Less insulin."},{"q":"Less exercise → need?","a":"More insulin."},{"q":"4 insulin types?","a":"Regular \/ NPH \/ Humalog \/ Lantus."},{"q":"Regular insulin onset?","a":"1 hour."},{"q":"Regular insulin peak?","a":"2 hours."},{"q":"Regular insulin duration?","a":"4 hours."},{"q":"NPH insulin onset?","a":"6 hours."},{"q":"NPH insulin peak?","a":"8–10 hours."},{"q":"NPH insulin duration?","a":"12 hours."},{"q":"Humalog onset?","a":"15 minutes."},{"q":"Humalog peak?","a":"30 minutes."},{"q":"Humalog duration?","a":"3 hours."},{"q":"Only safe insulin at bedtime?","a":"Lantus (Glargine)."},{"q":"Fastest insulin?","a":"Humalog."},{"q":"DKA Tx?","a":"IV fluids (fast) + Regular insulin."},{"q":"Lithium therapeutic?","a":"0.6–1.2."},{"q":"Lithium toxic?","a":">2.0."},{"q":"Digoxin therapeutic?","a":"1–2."},{"q":"Digoxin toxic?","a":">2.0."},{"q":"Aminophylline therapeutic?","a":"10–20."},{"q":"Aminophylline toxic?","a":">20."},{"q":"Dilantin therapeutic?","a":"10–20."},{"q":"Dilantin toxic?","a":">20."},{"q":"Dilantin is?","a":"Anticonvulsant."},{"q":"Aminophylline is?","a":"Airway antispasmodic."},{"q":"Digoxin is?","a":"CHF, atrial arrhythmia."},{"q":"Lithium is?","a":"Anti-mania."},{"q":"Never push what electrolyte?","a":"K+."},{"q":"To decrease K+ quickly?","a":"D5W + R insulin (buys time)."},{"q":"To remove K+?","a":"Kayexalate (slow)."},{"q":"Max K+ per IV liter?","a":"40 mEq."},{"q":"Graves Tx options?","a":"Radioiodine \/ PTU \/ surgery."},{"q":"Thyroidectomy types?","a":"Total \/ subtotal."},{"q":"Total Thyroidectomy needs?","a":"Lifelong hormone replacement."},{"q":"Thyroid storm Tx?","a":"O2, cooling (ice packs)."},{"q":"Tx hypothyroidism?","a":"Hormone replacement."},{"q":"Hypothyroid NPO pre-op → still give?","a":"Thyroid meds."},{"q":"Addison’s Tx?","a":"Steroids (“-sone”)."},{"q":"Cushing’s Tx?","a":"Adrenalectomy."},{"q":"INR monitors what?","a":"Coumadin\/Warfarin therapy."},{"q":"INR therapeutic level?","a":"2–3."},{"q":"If INR >4 you?","a":"Hold Warfarin, assess for bleeding, prepare Vitamin K, and call the doctor."},{"q":"If potassium <3.5 you?","a":"Assess heart, prepare potassium, and call the doctor."},{"q":"If potassium 5.4–5.9 you?","a":"Hold potassium (IV), assess heart, prepare D5W with insulin, and call the doctor."},{"q":"If potassium >6 you?","a":"Assess; if symptomatic, call Rapid Response; if not, follow the same protocol as for 5.4–5.9."},{"q":"If pH <6 you?","a":"Assess vitals and call the doctor ASAP."},{"q":"If Hgb <8 you?","a":"Assess bleeding, prepare blood, and call the doctor."},{"q":"If CO2 in 50’s?","a":"Assess respirations, encourage pursed-lip breathing, prolong exhalation; if not working, call the doctor."},{"q":"If CO2 in 60’s (respiratory failure)?","a":"Assess, encourage pursed-lip breathing, prepare for intubation, and call RT and the doctor."},{"q":"If PO2 70–77?","a":"Assess and give O2."},{"q":"If PO2 <60?","a":"Assess, give O2, prepare for intubation, and call RT and the doctor."},{"q":"If O2 sat <93?","a":"Assess and give O2."},{"q":"If platelets <90,000?","a":"Check for bleeding and implement bleeding precautions."},{"q":"If platelets <40,000?","a":"Prepare for transfusion and call the doctor."},{"q":"Do not give what type of pain medication to a woman in labor if the medication is likely to peak when the baby is born?","a":"Systemic medications (IM, IV, Oral)."},{"q":"Tocolytics do what to labor?","a":"Stop contractions."},{"q":"What are the two tocolytics?","a":"Terbutaline (Brethine) \/ Nifedipine (Procardia)."},{"q":"What are the two oxytocics?","a":"Pitocin (Oxytocin) \/ Cervidil (Prostaglandin)."},{"q":"Side effects of Pitocin?","a":"Hyperstimulation (>90s, <2min apart). If FHR <110, stop it. If FHR is normal, slow it. Also used for postpartum hemorrhage."},{"q":"Side effects of Cervidil?","a":"Effacement leading to contractions."},{"q":"What are the two neonatal lung medications?","a":"Betamethasone \/ Survanta."},{"q":"How do you give Betamethasone?","a":"To the mother \/ Before delivery \/ IM."},{"q":"Side effect of Betamethasone?","a":"Increases maternal glucose (monitor blood sugar)."},{"q":"How do you give Survanta?","a":"To the baby \/ After delivery \/ Inhalation."},{"q":"Humulin 70\/30 is what?","a":"70% N insulin + 30% R insulin."},{"q":"When drawing up insulins it's?","a":"RN → Regular first, then N."},{"q":"If pressurizing vials for insulin draw-up you?","a":"Insert air in NR order, but draw up in RN order."},{"q":"What routes can you give Heparin?","a":"IV or SubQ."},{"q":"How quickly does Heparin work?","a":"Immediately."},{"q":"What do you monitor with Heparin?","a":"PTT."},{"q":"Antidote for Heparin?","a":"Protamine sulfate."},{"q":"Heparin is what pregnancy class?","a":"Class C."},{"q":"How is Coumadin given?","a":"Oral only."},{"q":"How long for Coumadin to work?","a":"3–5 days."},{"q":"What do you monitor with Coumadin?","a":"PT-INR."},{"q":"Antidote for Coumadin?","a":"Vitamin K."},{"q":"Coumadin is what pregnancy class?","a":"Class X."},{"q":"All K+ wasting diuretics end in?","a":"\"-x\" (if it ends in X, it wastes K+; others are K+ sparing)."},{"q":"What is Baclofen (Lioresal, Flexeril)?","a":"Muscle relaxant."},{"q":"Side effects of Baclofen\/Flexeril?","a":"Drowsiness and muscle weakness."},{"q":"If you know what a drug does, choose side effect in the ____ system?","a":"Same body system."},{"q":"If you don’t know the drug, and it’s PO, choose what side effect?","a":"GI side effect."}]

Physiological Adaptation Flashcards

[{"q":"Why does the MI patient’s white count go up?","a":"Inflammatory response."},{"q":"Why does their temperature go up?","a":"Inflammatory response."},{"q":"If a MI patient performs the Valsalva, which nerve can be stimulated?","a":"Vagus"},{"q":"If you stimulate the vagus nerve long enough, what is going to happen to the heart rate?","a":"Decrease"},{"q":"What happens to the size of the complex when the vagus nerve is stimulated?","a":"Widens; could lead to asystole."},{"q":"What is your natural pacemaker?","a":"SA Node"},{"q":"Can the electrical part of your heart be working and the mechanical not?","a":"Yes, but not for long."},{"q":"What are the major symptoms of left-sided failure and explain why?","a":"Dyspnea, cough, pulmonary congestion, blood-tinged sputum; restlessness, tachycardia; blood backs up into the lungs."},{"q":"Why does a patient in left-sided failure have restlessness and tachycardia?","a":"Because they are hypoxic."},{"q":"Why does a patient with left-sided failure have nocturnal dyspnea?","a":"When they lie down, more blood can go back up to the heart and lungs."},{"q":"Why does the patient with left-sided failure basically have pulmonary symptoms?","a":"Blood is backing up in the lungs."},{"q":"What are the major symptoms of right-sided failure?","a":"Enlarged organs, edema, weight gain, distended neck veins, ascites; blood backs up into the venous system, engorging everything."},{"q":"When a patient is in right-sided failure, is the blood backing up into the arterial system or the venous system?","a":"Venous"},{"q":"What does a Swan Ganz catheter measure inside the heart?","a":"Pressures"},{"q":"If volume is building up in the right side of the heart, what measurements (in regard to the Swan Ganz catheter) are going to be affected and why?","a":"Any pressure reading on the right side of the heart. More volume = more pressure."},{"q":"What is the wedge pressure?","a":"Indirect reading of left side of heart (left-sided pressures)."},{"q":"Why does the patient in heart failure develop cardiomegaly?","a":"Because the heart muscle is pumping so hard, it hypertrophies."},{"q":"When you slow down someone’s heart rate, you give the ventricles more time to do what?","a":"Fill with blood."},{"q":"When your heart squeezes down with more force and strength and on more blood, what is going to happen to cardiac output? What is going to happen to kidney perfusion?","a":"Cardiac output increases. Kidney perfusion is going to also increase."},{"q":"Anytime you increase kidney perfusion, what is probably going to happen to urine output?","a":"Urine output will increase."},{"q":"When you increase a patient’s cardiac output, what is actually happening inside the heart?","a":"More blood is being ejected from the left ventricle to the systemic circulation."},{"q":"When you increase a patient’s cardiac output, should they appear better oxygenated or less oxygenated?","a":"Better oxygenated"},{"q":"When you start giving somebody Dig, we expect their cardiac output to increase; therefore, what should happen to their: a. level of consciousness? b. lung sounds? c. urine output? d. skin? e. peripheral pulses? f. blood pressure?","a":"A. increase B. lungs should be dry C. urine output will increase D. skin should feel warmer E. should improve F. should go up"},{"q":"What is pulmonary edema?","a":"The sudden onset of fluid accumulation in the lungs leading to severe hypoxia."},{"q":"How does a patient develop pulmonary edema?","a":"The left ventricle is failing, so the blood is not being pumped forward into the systemic circulation; therefore, the blood backs up into the lungs."},{"q":"What are the major S\/S of pulmonary edema?","a":"Sudden onset, breathlessness, hypoxia, pink frothy sputum, tachycardia."},{"q":"When does pulmonary edema usually occur and why?","a":"At night – because when lying down preload increases, so we are dumping more blood into the right side of the heart and into the lungs."},{"q":"What is intermittent claudication?","a":"The pain that develops as a result of inadequate oxygenation in an extremity associated with arterial problems."},{"q":"Explain how intermittent claudication develops.","a":"When oxygenated blood cannot get to an area, the patient is going to switch in that extremity from aerobic metabolism to anaerobic metabolism. The product of anaerobic metabolism is a buildup of lactic acid. The lactic acid is what promotes the pain."},{"q":"When a patient has an arterial problem, that means the oxygen\/blood are having a hard time getting to the tissue, so therefore different S\/S develop. Explain the S\/S.","a":"Coldness, numbness, decreased pulses, atrophy of the extremity occur because oxygenated blood is not getting to the extremity. You may even see ischemia and gangrene."},{"q":"Could a patient with an arterial problem develop ischemia and necrosis in the affected extremity? Explain.","a":"Yes - Because oxygenated blood is not getting there."},{"q":"Whether you are studying Buerger’s disease or Raynaud’s disease, what is the key word that I told you to remember?","a":"Vasoconstriction"},{"q":"In Buerger’s disease and Raynaud’s disease, there is significant vasoconstriction. What types of things bring on the vasoconstriction in Buerger’s and Raynaud’s disease?","a":"Emotional upset, smoking, coldness"},{"q":"When a patient has a venous disorder, are they having trouble with oxygenation of the affected extremity?","a":"No"},{"q":"Explain or list some different venous problems a patient can have.","a":"Phlebitis, thrombophlebitis, deep vein thrombosis"},{"q":"Explain the pathophysiology behind a venous disorder.","a":"The blood can get to the area. The problem is once it gets there, it cannot get away. So you get stagnation of blood flow in one area."},{"q":"What is the pleural space?","a":"It is the potential space between the visceral and parietal pleura."},{"q":"When the pleural space fills with fluid, what happens to the lung?","a":"Collapse."},{"q":"When a patient has a pulmonary embolus, why does their pulse go up?","a":"Hypoxia."},{"q":"When a patient has a pulmonary embolus, describe their chest pain.","a":"Sharp, stabbing."},{"q":"When a patient has a pulmonary embolus, the blood pressure is going to go up in their lungs. What effect will that have on the right side of the heart?","a":"It will increase the workload on the right side of the heart."},{"q":"With a pulmonary embolus, the patient will have fever and their WBC count will go up. Why?","a":"Inflammation."},{"q":"Why does the PO2 go down with a pulmonary embolus?","a":"Hypoxia."},{"q":"With a mediastinal shift, what will happen to the trachea?","a":"Tracheal deviation."},{"q":"Why does the patient with flail chest develop paradoxical chest wall movement?","a":"Because of the broken ribs."},{"q":"What is the definition of cardiac tamponade?","a":"When fluid is accumulating in the pericardial sac."},{"q":"With cardiac tamponade, the blood pressure goes down and the CVP goes up. Explain why.","a":"Blood pressure goes down because you are hemorrhaging. CVP goes up because as the sac fills around the heart, this puts pressure on the heart, squeezing the heart. Therefore, the pressure inside the heart goes up, making the CVP go up."},{"q":"Why do the heart sounds sound muffled with cardiac tamponade?","a":"Because of all the blood around the heart."},{"q":"With cardiac tamponade, why does a patient go into shock?","a":"Because they are hemorrhaging."},{"q":"What are the major side effects of Rifampin?","a":"Fever; body fluids turn red or orange."},{"q":"When a patient is on streptomycin, what are two possible side effects?","a":"Ototoxicity and nephrotoxicity."},{"q":"What is the major cause of glomerulonephritis?","a":"Streptococcus."},{"q":"When a patient has glomerulonephritis, why do they develop malaise and headache?","a":"Build-up of toxins."},{"q":"When a patient has glomerulonephritis, why does their urine output go down?","a":"Because the kidneys are failing."},{"q":"When a patient has glomerulonephritis, why does their BUN and creatinine go up?","a":"They are unable to excrete the urea and creatinine through the kidneys."},{"q":"When a patient has glomerulonephritis, why do they get protein in the urine?","a":"Because the glomerulus has holes in it, so protein can leak out."},{"q":"In glomerulonephritis, why does the blood pressure go up?","a":"Retaining fluid."},{"q":"And what will happen to the urine specific gravity?","a":"Increases."},{"q":"In glomerulonephritis, why are the patient’s red blood cells affected?","a":"Erythropoietin can be altered."},{"q":"With any type of kidney disease, it is not uncommon for the BUN to be elevated; therefore, why do we limit the protein in the diet?","a":"Because protein increases your urea level in your blood."},{"q":"If you gave a patient with any type of renal disease protein in their diet, what will happen to the BUN?","a":"Increase."},{"q":"When a patient is in the acute stages of glomerulonephritis, do you think their serum potassium level will be increased or decreased? What about the magnesium? What about the phosphorus level?","a":"Potassium and magnesium will be increased in the blood, as will the phosphorus because the patient is unable to excrete the electrolytes as they should."},{"q":"When a patient has nephrotic syndrome, what is the major element that is leaking out into their urine?","a":"Protein."},{"q":"If a patient does not have protein or albumin in their vascular space (blood), what is going to happen to all the fluid that is supposed to stay in their vascular system?","a":"It goes out into the interstitial space tissue."},{"q":"How does this affect the vascular space?","a":"Decreases the volume in the vascular space."},{"q":"When a patient has nephrotic syndrome, they develop total body edema. What is the proper term for total body edema?","a":"Anasarca."},{"q":"How can bradycardia cause renal failure?","a":"Decreased perfusion."},{"q":"How can hypovolemia cause renal failure?","a":"Decreased perfusion."},{"q":"How can shock cause renal failure?","a":"Decreased perfusion."},{"q":"How can decreased cardiac output cause renal failure?","a":"Decreased perfusion."},{"q":"How can glomerulonephritis, nephrotic syndrome, or diabetes cause renal failure?","a":"Vascular damage."},{"q":"How can a kidney stone cause renal failure?","a":"Urine can be trapped in the kidney."},{"q":"How can ureteral swelling cause renal failure?","a":"Urine can be trapped in the kidney."},{"q":"How can a tumor or an enlarged prostate cause renal failure?","a":"Urine can be trapped in the kidney."},{"q":"When a patient is in renal failure, why does their BUN and creatinine go up?","a":"Because the patient is unable to excrete urea and creatinine."},{"q":"What happens to the specific gravity in renal failure?","a":"It usually goes up, but it can also become fixed. When it becomes fixed, this means that the patient’s urine specific gravity does not respond to high volumes of fluids or restriction of fluids; it stays the same."},{"q":"Why can a renal failure patient become anemic?","a":"Because erythropoietin can be altered."},{"q":"Why does the renal failure patient’s blood pressure go up?","a":"Because they are retaining fluid."},{"q":"Why is the renal failure patient at risk for congestive heart failure?","a":"Because they are retaining fluid."},{"q":"Why does the renal failure patient develop anorexia, nausea, and vomiting?","a":"Because of the build-up of toxins."},{"q":"Why does the renal failure patient develop an itching frost?","a":"Urea builds up in the blood and eventually accumulates on the skin."},{"q":"Why does a renal failure patient have to worry about osteoporosis?","a":"Because the renal failure patient retains phosphorus; therefore, that makes them excrete their calcium, which lowers the serum calcium, and then the patient starts pulling calcium from the bone."},{"q":"There are two phases of renal failure. The first phase is an oliguric phase. If a patient is oliguric, what has happened to the urine output?","a":"Urine output has decreased."},{"q":"Why does the oliguric patient develop hyperkalemia?","a":"Unable to excrete potassium"},{"q":"The second phase of renal failure is called the diuretic phase. When a patient is diuresing, what has happened to their urine output?","a":"Increasing"},{"q":"If a patient goes into a fluid volume deficit, what will happen to their blood pressure?","a":"Decrease"},{"q":"What will happen to their heart rate? Explain why.","a":"Increase – trying to compensate for the decrease in volume."},{"q":"When a patient is diuresing, their serum potassium level goes down (hypokalemia). Explain why.","a":"Because potassium is being excreted through the kidneys."},{"q":"When a patient has CAPD, why do they have a constant sweet taste and why do they have anorexia?","a":"The dialysate that is used is of high glucose content."},{"q":"What are the major signs of kidney stones?","a":"Hematuria and pain"},{"q":"Why is the serum creatinine not affected by what we eat?","a":"Because creatinine is constantly produced in our bodies due to skeletal muscle breakdown."},{"q":"Is the BUN affected by what we eat?","a":"Yes"},{"q":"In sickle cell, what is happening to the red blood cells and why?","a":"The shape of the red blood cell is changing due to hypoxia."},{"q":"Are patients who have sickle cell hypoxic?","a":"Yes"},{"q":"Why do sickled cells become tangled so easily?","a":"Due to the shape, they start hanging together."},{"q":"Why is a sickle cell patient always anemic?","a":"Because their red blood cells sickle. So their red blood count decreases."},{"q":"Why does a sickle cell patient develop jaundice?","a":"Jaundice develops when the overabundance of sickle cells are fragile and rapidly destroyed in circulation, releasing the bilirubin."},{"q":"Why does a sickle cell patient develop heart problems?","a":"Since the patient is hypoxic, they stay tachycardic most of the time; therefore, this stresses the heart."},{"q":"Why does the sickle cell patient have to be on folic acid?","a":"To help them make red blood cells."},{"q":"What is anemia?","a":"A decrease in red blood cells."},{"q":"When you do not have enough red blood cells, the patient will be hypoxic. Why?","a":"There aren’t enough RBCs to carry the oxygen."},{"q":"How can hemorrhage cause anemia?","a":"Losing red blood cells."},{"q":"How can poor nutrition cause anemia?","a":"Not forming red blood cells."},{"q":"How can decreased erythropoietin cause anemia?","a":"Without erythropoietin, immature red blood cells cannot mature."},{"q":"When a patient is anemic, why does their heart beat fast (tachycardia)?","a":"Because they are hypoxic."},{"q":"When a patient has anemia, why do they have shortness of breath?","a":"Because they are hypoxic."},{"q":"When a patient is anemic, why do they have a pale conjunctiva?","a":"They do not have enough red blood cells."},{"q":"Why do anemic patients develop heart problems?","a":"The heart is always stressed due to chronic hypoxia."},{"q":"Why do anemic patients feel weak and tired?","a":"Hypoxia."},{"q":"Patients with iron-deficient anemia develop poor red blood cells (anemia) due to the fact that they do not have enough iron in their diet. What are some foods that are high in iron?","a":"Organ meat, egg yolk, seafood, enriched bread, whole wheat cereals, legumes, green leafy vegetables, dried fruit, sunflower seeds, molasses, almonds, pecans, cashews, apricots, broccoli, prunes, brussels sprouts, raisins, brewer’s yeast, wild rice, Swiss cheese, yogurt, wheat germ, and bananas."},{"q":"When a patient has had pernicious anemia, what vitamin are they deficit in?","a":"Vitamin B-12."},{"q":"After what surgery can a patient develop pernicious anemia? Explain why.","a":"Gastrectomy - Because they have lost their intrinsic factor. Without intrinsic factor, you cannot absorb oral B-12; therefore, you would not develop normal red blood cells."},{"q":"What are the two odd signs you get with pernicious anemia?","a":"Red swollen tongue and neurological changes."},{"q":"What is the major diagnostic test for pernicious anemia?","a":"Schilling's Test."},{"q":"Will the Schilling’s test tell you about any other type of anemia besides pernicious anemia?","a":"No."},{"q":"What is the first thing you need to think of when you think of leukemia?","a":"Large amounts of immature white blood cells."},{"q":"Why does the leukemic patient develop anemia?","a":"Because there are so many immature white cells, there’s no room for red blood cells."},{"q":"Why does the leukemic patient develop thrombocytopenia?","a":"There is no room for platelets."},{"q":"Why does the leukemia patient develop weakness and fatigue?","a":"Hypoxia."},{"q":"Why does the leukemia patient have S\/S such as bleeding, bruises, or petechiae?","a":"Decreased platelets."},{"q":"Hemophilia is an inherited disease. Does it affect males or females?","a":"Males."},{"q":"Hemophiliacs are sometimes called “free bleeders.” Explain the major symptoms a hemophiliac will have.","a":"Large spreading bruises. They may bleed into the joints or into the muscles of the GI tract."},{"q":"When a patient is having bleeding into the joints, what is the proper term for this?","a":"Hemarthrosis."},{"q":"What are some of the purposes of traction?","a":"To realign bones; to decrease muscle spasms and to immobilize."},{"q":"What is phantom pain?","a":"Pain that is experienced in the amputated extremity. The pain is real to the patient."},{"q":"Rheumatoid arthritis is an altered immune response. What are some S\/S of rheumatoid arthritis?","a":"Swollen joints, fatigued patients, increased white count, reddened fingers due to inflammation, morning stiffness (stiffness lasting longer than 30 minutes), and a low-grade temperature."},{"q":"With rheumatoid arthritis, what happens to the pain with stress?","a":"Increases"},{"q":"Is rheumatoid arthritis seen more in males or females?","a":"Females"},{"q":"List the S\/S separately and explain why the patient develops each symptom.","a":"All signs and symptoms are due to inflammation. Morning stiffness, motion pain, tenderness in at least one joint, swelling of at least one joint, symmetrical joint swelling"},{"q":"Why is it so important that the rheumatoid arthritis patient’s joints stay in proper position?","a":"Because the joints tend to contract with inflammation."},{"q":"What is the difference in rheumatoid arthritis and osteoarthritis?","a":"Rheumatoid arthritis is an immune response whereas osteoarthritis is a degenerative disorder."},{"q":"What is gout?","a":"When uric acid crystals accumulate in an area of little blood flow"},{"q":"What are the S\/S of gout?","a":"Pain, redness, inflammation"},{"q":"When a patient is having a cerebral angiography, it is not uncommon for them to complain of warmth in the face. Explain why.","a":"The dye causes a flushed feeling."},{"q":"What are some general symptoms of meningitis?","a":"Fever, chills, headache, vomiting, stiff neck (nuchal rigidity), photophobia, Kernig’s sign, Brudzinski’s sign because the meninges have been punctured into, so an infection could have been introduced."},{"q":"Explain S\/S of a basal skull fracture.","a":"Bleeding in the eyes, ears, nose, and throat."},{"q":"What is Battle’s sign?","a":"Bruising on the mastoid; indicates a basal skull fracture."},{"q":"What are raccoon eyes?","a":"Bruises around the eyes."},{"q":"Explain the S\/S of a concussion.","a":"May become unconscious for a couple of seconds or may just get dizzy for a couple of seconds or see spots."},{"q":"What happens to intracranial pressure (ICP) when the patient sits up and lies down?","a":"When the patient sits up, ICP goes down; when they lie down, ICP goes up."},{"q":"What is posturing?","a":"A sign of severe neurological damage. Be sure to look at a picture in your med-surg book."},{"q":"Explain the two different types of posturing.","a":"A. Decerebrate – when the spine is arched and you have plantar flexion (worst type). B. Decorticate – when arms are flexed inwardly to the core of the body. The legs are extended with plantar flexion."},{"q":"Why are osmotic diuretics used in the treatment of intracranial pressure? Explain exactly how they work.","a":"To pull fluid off the brain. Osmotic diuretics pull fluid off of the brain into the vascular system and the excess fluid is excreted through the kidneys."},{"q":"Why are patients with increased intracranial pressure given steroids?","a":"To decrease cerebral edema"},{"q":"How can hyperventilation decrease intracranial pressure?","a":"Hyperventilation causes cerebral vasoconstriction and decreases cerebral blood flow to decrease ICP."},{"q":"What would happen to the intracranial pressure if the temperature were to exceed?","a":"ICP would go up"},{"q":"What is the purpose of a barbiturate induced coma?","a":"To decrease cerebral metabolism, therefore decreasing ICP."},{"q":"Why is it so important to restrict the fluids in a head injured patient?","a":"Too many fluids will increase ICP."},{"q":"If a patient were to become bradycardic, what would happen to the cerebral perfusion? Explain why.","a":"Decrease because not as much blood would be pumped out by the left ventricle; therefore, not as much blood would make it to the brain."},{"q":"If a patient were to develop an increased blood pressure, what will happen to cardiac output? Explain how this would affect cerebral perfusion?","a":"The higher the blood pressure is, cardiac output goes down; therefore, cerebral perfusion would decrease."},{"q":"What is myasthenia gravis?","a":"Defect in impulse transmission."},{"q":"When a patient has impulse problems, what is going to happen to their muscle tone?","a":"Muscle tone decreases."},{"q":"Explain the S\/S of myasthenia and explain why the patient develops these symptoms.","a":"Extreme muscle weakness that increases with effort and eases with rest; there is symmetrical involvement, diplopia, ptosis, sleepy mask-like expression, dysphonia, chewing, and swallowing problems, and the diaphragm and respiratory muscles can be affected. All of these symptoms are due to a decrease in muscle tone."},{"q":"Why do we have to worry about the airway with myasthenia gravis?","a":"Because the respiratory muscles could become affected."},{"q":"Why do we have to worry about aspiration with the myasthenia gravis patient?","a":"Because the patient may not be able to swallow as well as they did before."},{"q":"If a patient with myasthenia gets too tired or takes an over-the-counter medicine, what could happen?","a":"These things could promote a crisis."},{"q":"What is the difference in the myasthenic crisis and a cholinergic crisis? How do you differentiate them?","a":"In the myasthenic crisis, the patient has not had enough medicine. In a cholinergic crisis, the patient has had too much medicine. To differentiate, you inject with Tensilon again. If the patient improves after the Tensilon injection, it is a myasthenic crisis. If the patient gets worse, it is a cholinergic crisis."},{"q":"When a patient is in a crisis with myasthenia, why would you prepare them for the ventilator?","a":"Because of the progressive decreased tone in the respiratory muscles."},{"q":"What would be a major sign of perforation post-gastroscopy?","a":"Pain"},{"q":"What are the two major functions of the pancreas?","a":"Endocrine - insulin; Exocrine – digestive enzymes"},{"q":"What is the major cause of pancreatitis?","a":"Gallbladder disease and alcoholism."},{"q":"How can gallbladder disease cause pancreatitis?","a":"A gallstone can block the pancreatic duct, trapping the enzymes inside the pancreas."},{"q":"List all of the symptoms of pancreatitis. (explain WHY these occur) a. Abdominal distention and ascites b. Abdominal mass c. Rigid board-like abdomen d. Bruising e. Fever f. Nausea\/vomiting g. Jaundice h. Hypotension i. Serum lipase and amylase (up or down?) j. WBC’s (up or down?) k. Blood sugar (up or down?) l. SGOT, SGPT (up or down?) m. PT, PTT (shorter or prolonged?) n. Serum bilirubin (up or down?) o. H\/H (up or down?)","a":"A. Losing fluid into the abdomen. B. A large pancreas. C. Possible hemorrhage D. Possible hemorrhage E. Inflammation F. Inflammation G. Liver involvement H. Bleeding or ascites I. Increases J. Increases K. Increases L. Increases M. Prolonged N. Increases O. Increases if dehydrated; decreases if bleeding"},{"q":"Is it possible that a pancreatitis patient might have to have insulin? Explain why.","a":"Yes – because the pancreas is altered."},{"q":"What is cirrhosis?","a":"Liver cells are destroyed and are replaced with connective and scar tissue; therefore the blood pressure in the liver goes up and the patient has portal hypertension."},{"q":"When a patient has cirrhosis, what happens to the blood pressure in their liver and what is the proper term for this?","a":"Increased – portal hypertension"},{"q":"Explain the S\/S of cirrhosis and also explain why the patient develops each symptom.","a":"Firm, nodular liver – due to connective and scar tissue. Abdominal pain – liver capsule has been stretched. Chronic dyspepsia – GI tract is altered. Change in bowel habits – GI tract is altered. Ascites – liver is not producing albumin as it should; therefore we lose fluid out of the vascular space into the abdomen. Increased SGOT & SGPT – liver enzymes are increased because the liver is altered."},{"q":"Why does the cirrhosis patient sometimes develop hepatic encephalopathy and coma?","a":"A build-up of ammonia"},{"q":"Where is the first place a cirrhosis patient might develop jaundice?","a":"Sclera"},{"q":"What chemical builds up in the blood that makes a patient go into a hepatic coma?","a":"Ammonia"},{"q":"How did that chemical develop?","a":"Because the liver is unable to convert ammonia to urea."},{"q":"What are symptoms of a hepatic coma? Explain why the patient develops these symptoms?","a":"Minor mental changes; decreasing LOC, asterixis, decreased reflexes; slowing EEG and fetor. All of these symptoms are due to a build-up of ammonia in the blood."},{"q":"If a patient is in hepatic failure and eats protein, what is going to happen to the ammonia level in their blood? Explain why.","a":"Increase because the liver cannot convert ammonia to urea."},{"q":"What are bleeding esophageal varices?","a":"Protruding vessels in the esophagus waiting to rupture."},{"q":"Why does a patient develop bleeding esophageal varices?","a":"The back pressure in the liver forces the vessels in the esophagus to protrude."},{"q":"What is the difference in ulcerative colitis and Crohn’s disease?","a":"Ulcerative colitis is a large intestine disease. Crohn’s disease is a small intestine disease."},{"q":"What are the symptoms of ulcerative colitis and Crohn’s disease?","a":"Diarrhea, rectal bleeding, weight loss, vomiting, cramping, dehydration, blood in stool, anemia, rebound tenderness, and fever."},{"q":"What is another name for Crohn’s disease?","a":"Regional Enteritis"},{"q":"What is the surgical treatment for ulcerative colitis?","a":"They may do a total colectomy or a Koch’s pouch, or they could just remove the part that is damaged and re-hookup everything normally."},{"q":"What is the surgical treatment for Crohn’s disease?","a":"May remove the entire small intestine or only the affected area."},{"q":"Why does a patient develop appendicitis?","a":"Because the appendix fills with bowel contents and becomes inflamed and can rupture."},{"q":"Explain symptoms of peptic ulcers.","a":"Burning pain in the mid-epigastric area. The pain may radiate to the back."},{"q":"What is the difference in a peptic ulcer and a duodenal ulcer?","a":"The location."},{"q":"What is dumping syndrome?","a":"When the stomach empties too rapidly after a gastrectomy or gastric bypass."}]

Reduction Of Risk Potential Flashcards

[{"q":"Why is it so important that the angina patient avoid isometric exercise, overeating, caffeine, or any drugs that increase the heart rate and avoid cold weather?","a":"Because these increase the workload of the heart."},{"q":"What is the major complication of a thrombolytic?","a":"Hemorrhage"},{"q":"Before you give a thrombolytic, you are supposed to get a good history. What did I tell you to focus on (what type of diseases or illnesses)?","a":"Any past bleeding problems, stroke, pregnancy, surgery, bleeding ulcer."},{"q":"After someone has received a thrombolytic, why is it so important that we decrease puncture sites?","a":"To prevent hemorrhage. They will bleed at any puncture site."},{"q":"Why is it so important that you ask the patient if they are allergic to iodine before they go for a heart catheterization?","a":"Because contrast dye is used and it contains iodine."},{"q":"If a CHF patient notices their weight increasing, what could that put them at risk for?","a":"Pulmonary edema"},{"q":"Why is it so important that we hurry up and decrease the circulating volume in the pulmonary edema patient?","a":"Because they cannot handle the volume of blood in their lungs."},{"q":"Why are the elderly, the very young, MI patients, or kidney patients at risk for going into fluid volume overload or pulmonary edema?","a":"Because these patients may not have the ability to pump extra fluid or to excrete extra fluid."},{"q":"Any time you are pulling fluid from a patient’s body (thoracentesis, paracentesis, Foley catheter), you are putting the patient at risk for going into a fluid volume deficit or fluid volume excess. Why?","a":"Fluid volume deficit anytime you pull fluid from the body, the vascular space could deplete."},{"q":"There is a possibility with a thoracentesis that a pneumothorax could occur. Why?","a":"Because the doctor could puncture all the way into the lung."},{"q":"If a break in the chest system occurs, air from the outside can rush into the pleural space and cause what life-threatening complication?","a":"Pneumothorax."},{"q":"How can dehydration promote an embolus?","a":"Blood becomes thick and could form a clot."},{"q":"How can venous stasis promote a pulmonary embolus?","a":"Because a thrombus can form, dislodge, and go to the lungs."},{"q":"How can birth control pills promote a pulmonary embolus?","a":"Birth control pills make your blood thick."},{"q":"What is the name of the bacteria that causes TB?","a":"Mycobacterium tuberculosis."},{"q":"What type of light will kill TB?","a":"Ultraviolet light."},{"q":"When a patient is on INH, what lab work has to be monitored?","a":"Liver enzymes"},{"q":"When a patient is on INH, what should be eliminated from their diet?","a":"Alcohol"},{"q":"What lab work should be monitored with Rifampin?","a":"Liver enzymes"},{"q":"How would you monitor for these side effects?","a":"Nephrotoxicity – BUN and creatinine; Ototoxicity – hearing (ringing and pain in the ears)."},{"q":"What would be S\/S of infection with peritoneal dialysis?","a":"Cloudy or dark fluid return."},{"q":"What types of things will bring on a crisis in a sickle cell patient? Explain why.","a":"Any type of stress which increases oxygen demand; decreased O2 concentration causes the sickling process."},{"q":"What is the common cause of death for the sickle cell patient?","a":"Infection"},{"q":"When a patient has leukemia, they are at high risk for infection. Why?","a":"Because you cannot fight infection with immature white cells."},{"q":"What type of emboli do you worry about with a fracture?","a":"Fat."},{"q":"Give S\/S of a fat embolus?","a":"Petechiae over the chest; conjunctival hemorrhages, patchy infiltrates on chest x-ray, usually occurs within the first 36 hours of an injury."},{"q":"What is compartment syndrome?","a":"When circulation is being cut off to an extremity"},{"q":"If you suspect a compartment syndrome, what should you do first?","a":"Loosen the cast"},{"q":"When a patient with an orthopedic injury complains of pain, what is the first thing you should do?","a":"Neurovascular check"},{"q":"Weight on traction should hang freely. Explain why.","a":"If the weights are not hanging freely, then the amount of traction being applied is not what the doctor has ordered."},{"q":"Why is it so important that the total hip replacement patient avoid flexion?","a":"The hip could be dislocated."},{"q":"Give examples of things a total hip replacement patient should avoid specifically related to flexion.","a":"Bending over, sitting in a low chair, climbing stairs."},{"q":"Why is it important that we keep a tourniquet at the bedside with amputation?","a":"In case of hemorrhage"},{"q":"What happens to the pulse pressure with increased intracranial pressure?","a":"It widens."},{"q":"If a neuro patient complains of a headache, what would this mean?","a":"Increased intracranial pressure"},{"q":"Explain the doll’s eye reflex.","a":"When the eyes move the opposite way that the head is turned. Assesses brain stem function"},{"q":"Explain the ice water calorics test.","a":"When ice water is instilled into the ear canal by the physician to assess brain stem function. Normal response would be to look towards the painful stimuli."},{"q":"Explain the Babinski and what is the difference for a child less than one year of age and anyone greater than one year of age.","a":"When the bottom of the foot is stroked, you watch to see what the toes are going to do. In a child less than 1 year, a positive Babinski is okay --- + Babinski means toes fan out. Anyone greater than 1 year of age, we want the toes to curl up. This would be a negative Babinski."},{"q":"Why is it so important that a patient who is about to have cerebral angiography be well hydrated?","a":"To help the patient excrete the dye through the kidneys."},{"q":"Why is it so important that we assess the peripheral pulses before cerebral angiography?","a":"Post-procedure, we will need to check the circulation in the extremity to make sure a clot did not form distal to the puncture site, so baseline data should be collected pre-procedure."},{"q":"Why is it important that we watch for an embolus after cerebral angiography? Explain what you would watch for specifically in your patient.","a":"Because a clot could form and go to the brain. We’re looking for a change in LOC or any motor or sensory deficits, and one-sided weakness or paralysis."},{"q":"Why is the patient who has had a myelogram or any procedure where you have gotten into cerebrospinal fluid at risk for meningitis?","a":"Because the meninges have been punctured, so an infection could have been introduced."},{"q":"What are some reasons for doing a lumbar puncture?","a":"To check for blood, to measure pressures, and to obtain a specimen."},{"q":"What is the most common complication of a lumbar puncture?","a":"Headache"},{"q":"What is a fatal complication of a lumbar puncture?","a":"Herniation."},{"q":"If a patient has an epidural hematoma, explain the sequence of events that will occur and why the patient has these changes.","a":"The patient loses consciousness, then wakes up after going through a recovery period; but then as the bleeding in the head increases, the patient starts having neuro changes and they possibly will pass out again."},{"q":"What is the treatment for an epidural hematoma?","a":"Stop the bleeding; control the ICP."},{"q":"When a patient has a subdural hematoma, explain the sequence of events that can occur (S\/S).","a":"With a subdural hematoma, it can be acute or chronic. If it is an acute bleed, the ICP is going to go up rapidly due to the rapid bleeding; therefore, we must control the bleeding and control the ICP. If it is a chronic bleed, this one can present itself as other things (stroke) as they are bleeding slowly."},{"q":"With which fracture is the patient most at risk for infection?","a":"Open"},{"q":"With a neuro patient, why do we want to avoid narcotics?","a":"Because we do not want to mask the neuro checks."},{"q":"What would be a potential nursing diagnosis for a patient receiving an osmotic diuretic?","a":"Potential for fluid volume deficit"},{"q":"Why do we avoid restraints, bowel and bladder distension, hip flexion, valsalva, isometrics, suctioning, and coughing in the head injured patient?","a":"All of these things increase ICP."},{"q":"Your patient is going to have a liver biopsy. What clotting studies should be checked? Please explain why.","a":"PT; PTT – One of the main functions of the liver is to help our blood to clot. After puncturing into the liver, there is a chance our blood may not clot as quickly as it should."},{"q":"Why is it so important to monitor the vital signs pre- and post-paracentesis?","a":"Because you are worried about throwing the patient into a fluid volume deficit."},{"q":"During a paracentesis, the patient could be thrown into a fluid volume deficit or fluid volume excess?","a":"Deficit"},{"q":"Why does the respiratory status have to be monitored specifically for the pancreatitis patient?","a":"Because the ascites could be pressing up on the diaphragm."},{"q":"What is the major electrolyte imbalance a pancreatitis patient can get into? Explain why.","a":"Hypocalcemia – The pancreas is filled with calcium, but when it starts digesting itself we lose our calcium; therefore the serum calcium goes down."},{"q":"Why are we worried about I & O and daily weights with the cirrhosis patient?","a":"Because we have a patient with a fluid volume problem due to the ascites"},{"q":"Why are we worried about prevention of bleeding in the cirrhosis patient?","a":"Because the liver is altered; therefore the patient is at high risk for hemorrhage."},{"q":"Why is the ileostomy patient at risk for kidney stones?","a":"Because they are always a little dehydrated."},{"q":"Why is it important that the peptic ulcer patient decrease stress?","a":"Because stress increases stomach acid."},{"q":"Why is it important that the peptic ulcer patient stop smoking?","a":"Smoking increases stomach acid."}]

nclexguide.com — Wed, 01 Oct 2025 20:02:11 +0000

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NCLEX Flashcards: Study Smarter for the Next Gen NCLEX®

The NCLEX-RN® and NCLEX-PN® are the national licensure exams required to practice as a nurse in the United States. Effective prep blends concise content review with active recall using flashcards and realistic NCLEX practice questions—especially the newer case-style and SATA formats.

NCLEX Practice Questions by Core Categories

Our NCLEX flashcards are organized around the four official exam categories: Safe & Effective Care Environment, Psychosocial Integrity, Health Promotion & Maintenance, and Physiological Integrity. Click a card to reveal the answer, strengthen clinical judgment, and track progress with quick, focused sessions.

Next Gen NCLEX (NGN): Build Clinical Judgment

Practice case-style items aligned with Next Gen NCLEX (NGN) to develop decision-making and clinical judgment. Mix NGN cases with traditional multiple-choice to mirror real testing conditions.

High-Yield Topics: NCLEX Pharmacology & NCLEX Lab Values

Zero in on the heavy hitters: NCLEX Pharmacology (mechanisms, adverse effects, priority teaching) and NCLEX Lab Values (must-know normals and critical thresholds). Use spaced repetition to keep meds and labs fresh.

Prioritization and Delegation NCLEX

Sharpen your ability to prioritize care and delegate safely. These questions train you to identify the most urgent interventions and assign tasks appropriately across the care team.

Infection Control NCLEX

Master isolation precautions, PPE sequencing, and prevention strategies. Quick refresher cards help you answer infection control items with confidence.

Start Practicing Now

Pair these flashcards with your Q-bank for short daily sessions. Bookmark this page and return often—consistent practice builds confidence for test day.

Physiological Integrity Flashcards

nclexguide.com — Wed, 01 Oct 2025 19:37:55 +0000

Master the largest NCLEX category with high-yield flashcards covering basic care and comfort, pharmacological therapies, reduction of risk potential, and physiological adaptation. Review fluid & electrolyte balance, oxygenation, burns, oncology, renal, cardiac, respiratory, and neuro nursing care. These cards sharpen your clinical judgment for the most content-heavy portion of the NCLEX RN®/PN® and help you practice high-priority scenarios with confidence.

Basic Care And Comfort Flashcards

Part 1

[{"q":"Where is ADH stored?","a":"Pituitary gland."},{"q":"What is ascites?","a":"Fluid in the abdomen (peritoneum), third spacing."},{"q":"When you have a patient who is developing ascites, you know you are supposed to measure the abdominal girth every day. If the abdominal girth increases every day, what does that tell you about the vascular space?","a":"There is still too much fluid in the vascular space, and the excess is pouring over into the abdomen."},{"q":"Define CVP. Where is CVP measured?","a":"Central Venous Pressure. It is measured in the right atrium of the heart."},{"q":"What is normal CVP?","a":"2-6 mmHg (if measured by a monitor); 3-8 cm H2O is measured with a manometer."},{"q":"What happens to the weight in hypervolemia? Why?","a":"It increases; excess fluid causes weight to increase rapidly."},{"q":"What kind of diet are you going to place a hypervolemic patient on? Explain why.","a":"Sodium-restricted to decrease fluid retention."},{"q":"If you put a hypervolemic patient on a high-sodium diet, what would happen?","a":"The patient will retain more fluid, and the condition would worsen."},{"q":"Why do we want a hypervolemic patient to be on bed rest?","a":"Bed rest induces diuresis by increasing kidney perfusion; when you are supine, you perfuse the kidneys more effectively."},{"q":"Define fluid volume deficit.","a":"Loss of water and sodium from the vascular space equally."},{"q":"What is the treatment for mild fluid volume deficit?","a":"Increase oral fluids."},{"q":"What is the treatment for severe FVD?","a":"Administer IV fluids."},{"q":"How do we get rid of excess magnesium from our body?","a":"Through our kidneys."},{"q":"Why is it so important to get the patient walking or weight-bearing with hypercalcemia?","a":"To stress the bones; this encourages calcium to return to the bones. When calcium moves back into the bones, serum calcium levels decrease."},{"q":"Why is it so important to increase fluids in hypercalcemia?","a":"To prevent kidney stones."},{"q":"Why is it so important to ensure proper water replacement with tube feedings?","a":"If you don’t give proper amounts of water, the patient can dehydrate."},{"q":"Why is it so important to assess urine output before starting IV potassium?","a":"When you are giving IV potassium, the patient must have a way to excrete the excess. The only way to excrete K is through the kidneys. If the kidneys are not working well, then K will be retained."},{"q":"What is the normal treatment for hypoxia?","a":"Give O2"},{"q":"What is the immediate treatment for respiratory alkalosis?","a":"Have the patient breathe into a bag. Re-breathe CO2. (Take it back in.)"},{"q":"Explain the Rule of Nines.","a":"Estimate of total Body Surface Area that has been burned: Head = 9; each Arm = 9; each Leg = 18; Anterior trunk = 18; Posterior trunk = 18; Genitalia = 1."},{"q":"Explain the common rule for fluid replacement after a major burn.","a":"Calculate what is needed the first 24 hours and give ½ during the first 8 hours; during the 2nd 8 hours give ¼ of total volume; during the 3rd 8 hours give ¼ of total volume."},{"q":"What is the purpose of measuring a gastric residual?","a":"To ensure that the supplement is moving through the GI tract."},{"q":"When a patient has a radiation implant, why do we put them on a low fiber diet?","a":"To help prevent dislodgment that could occur if the intestines distend."},{"q":"Why does this patient have a Foley catheter?","a":"To help keep the bladder non-distended (could promote dislodgment). If the bladder becomes distended, the implant could be pushed out."},{"q":"If you have to turn a patient with a radiation implant, how do you turn them?","a":"Log roll."},{"q":"Why do we want to keep the patient with a radiation implant on bed rest?","a":"To help prevent dislodgment."},{"q":"When a patient has a radiation implant, do you force fluids or do you restrict fluids?","a":"Increase."},{"q":"Explain the nursing care for the markings that a patient will have when they are receiving external radiation therapy.","a":"Do not wash them off or put lotion on them."},{"q":"When a patient has had an abdominal hysterectomy, what is the position of choice? And explain why.","a":"Supine would be the best position, but we have to worry about aspiration too. If the head is up too much, more blood could pool in the pelvis."},{"q":"Explain the postop care for a patient who has had a mastectomy.","a":"Elevate the arm on the affected side; protect the extremity, brush hair, squeeze a tennis ball, wall climbing – promote circulation and mobility; check for bleeding."},{"q":"Why is it so important that the mastectomy patient elevate her arm on the affected side?","a":"To prevent swelling."},{"q":"Why is it important that the patient exercise the affected side after a mastectomy?","a":"It promotes circulation and mobility."},{"q":"What is the nursing care for a patient who has lymphedema?","a":"No constriction, no blood pressure or injections, wear gloves when gardening, watch for cuts, protect the extremity."},{"q":"When a patient has a bronchoscopy, they are NPO until what returns?","a":"Gag reflex."},{"q":"Explain sputum specimen.","a":"The best time to obtain it is in the morning – it should be sterile – the patient should rinse their mouth with water first. Do not let lips touch the cup."},{"q":"When a patient has had a pneumonectomy, what is the nursing care as far as positioning and why?","a":"Position on the affected side – the affected side will fill with fluids; the good side (non-surgical side) should be up to promote lung expansion; we want the affected side to fill; avoid severe lateral positioning, as it could promote a mediastinal shift."},{"q":"Why does the patient who has had a total laryngectomy need to have a tracheostomy?","a":"Because the epiglottis has been removed (no airway protection left)."},{"q":"Why does the patient who has had a total laryngectomy have to be positioned in the Fowler’s position?","a":"To decrease edema around the airway."},{"q":"Why does the laryngectomy patient need to have NG feedings?","a":"To protect the suture line."},{"q":"Why is it important that the laryngectomy patient have frequent mouth care?","a":"To prevent mouth bacteria from moving down to the surgical site or to the lungs."},{"q":"Explain suctioning.","a":"It is a sterile procedure; hyperoxygenate before and after; stop advancement of the catheter when you meet resistance; suction on the way out and for no more than 10 seconds; watch for vagus nerve stimulation (pulse drops)."},{"q":"Explain, in your own words, an ileal conduit.","a":"When a piece of the ileum is used to make a bladder. One end of the ileum has the ureters plugged into it; the other end is brought to the abdominal surface as a stoma."},{"q":"What is the major symptom of bladder cancer?","a":"Painless hematuria."},{"q":"Why is it important that hourly outputs be monitored after a patient has had an ileal conduit?","a":"If urine output is dropping, then the surgical area could be becoming edematous, thereby causing urine backup into the kidneys and increasing the chance for renal failure."},{"q":"Is mucous in this urine normal?","a":"Yes."},{"q":"Explain how a three-way catheter works and why the prostatectomy patient has to have it.","a":"It maintains patency and flushes out clots. We do not want any clots because this could occlude the urinary tract and promote renal failure. The fluid is instilled into the bladder, flushes out blood, and then the irrigant (fluid) drains down into the Foley catheter drainage bag."},{"q":"How do Kegel exercises help prostatectomy patients?","a":"They strengthen pelvic floor muscles and help prevent incontinence."},{"q":"Why does the prostatectomy patient have to take Colace?","a":"To prevent straining – straining promotes bleeding."},{"q":"When a patient has had a fresh GI surgery, such as gastrectomy, is it okay for the nurse to manipulate the NG tube?","a":"No – this could disrupt the suture line."},{"q":"When a patient has had a thyroidectomy, why is it so important for them to support their neck?","a":"We do not want to stress the suture line."},{"q":"How do you want a thyroidectomy patient to be positioned? Explain why.","a":"In Fowler's position – to decrease edema."},{"q":"Why is it important that the hypoparathyroid patient have a diet that is limited in phosphorus?","a":"Serum phosphorus is already high."},{"q":"Why does the Addison’s disease patient need more sodium in their diet?","a":"To retain volume in the vascular space. (They’re losing their Na.)"},{"q":"Why is I & O such an important nursing intervention with the Addison’s disease patient?","a":"Because this patient has a severe fluid volume problem."},{"q":"Is the Addison’s disease patient in a fluid volume deficit or a fluid volume excess?","a":"Deficit"},{"q":"Is the Cushing’s syndrome patient in a fluid volume deficit or excess?","a":"Excess"},{"q":"When a patient has Cushing’s syndrome, their serum potassium level goes down. Why?","a":"Because they have too much aldosterone (so they retain Na and H2O and lose K+)."},{"q":"Why does the Cushing’s syndrome patient need more calcium in their diet?","a":"Because steroids decrease serum calcium levels by making you excrete it through the GI tract."},{"q":"Does the Cushing’s syndrome patient need to be on a low-sodium diet or a high-sodium diet? Explain.","a":"Low. Na makes you retain H2O. This patient doesn’t need more fluid retention because they are already in an excess."},{"q":"What is the common treatment for Type II diabetics?","a":"Diet and exercise, oral agents and\/or insulin."},{"q":"In the treatment of a diabetic, why do we have to limit the protein in their diet?","a":"Because of possible kidney damage. Diabetics tend to have kidney damage and excess glucose destroys vascularity in the kidneys. We always limit protein with kidney problems."},{"q":"When the diabetic patient exercises, why do they have to worry about hypoglycemia and how can they prevent it?","a":"Exercise lowers blood sugar; eat fruit, low-fat milk."},{"q":"Why is it important that a diabetic patient exercise when their blood sugar is at its highest?","a":"To prevent hypoglycemia."},{"q":"Why is it so important that the injection sites the diabetic patient uses be rotated?","a":"To prevent tissue damage; lipodystrophy decreases absorption."},{"q":"What are some general S\/S of hypoglycemia and what is the immediate nursing action?","a":"Shaky, weak, decreased LOC, cool clammy skin, nervousness, increased pulse, nausea, sweating, headache; Simple Sugar (PO)."},{"q":"You give an unconscious patient an amp of D50W because you think they are hypoglycemic. The patient should start to wake up. When they are awake, what should you get them to do?","a":"Eat"},{"q":"When you get the diabetic ketoacidosis patient into the emergency room, why do we start normal saline?","a":"Patient is in a fluid volume deficit."},{"q":"Explain foot care thoroughly.","a":"Clip nails straight across; be careful with lotions; inspect feet each day; dry in between toes very well; wear leather shoes all the time."},{"q":"What is going to happen to urine output when you have a patient who has decreased cardiac output?","a":"Decrease; no perfusion."},{"q":"Why is it so important that the angina patient rest frequently?","a":"To decrease the workload of the heart."},{"q":"Is it okay for a patient with angina to take their nitroglycerin prophylactically?","a":"Yes"},{"q":"Before they take their nitroglycerin, should the patient sit down or stand up? Explain.","a":"Sit down, nitroglycerin makes them dizzy; they may faint."},{"q":"Will rest or nitroglycerin relieve MI pain?","a":"No"},{"q":"When a patient goes into V-fib, what is the priority nursing action?","a":"D-fib"},{"q":"Any time you have a patient who is injected with iodine-based dye, what is the common complaint the patient will have?","a":"Warm\/flushing\/sweating"},{"q":"When a patient has a heart cath, they will have a puncture site. Where might that puncture site be? Give two locations.","a":"Femoral\/brachial"},{"q":"In post-cardiac catheterization, you have to watch the puncture site closely. What are we watching it for?","a":"Bleeding\/hematoma formation"},{"q":"When a patient has had a heart cath, you have a pertinent nursing assessment you need to do distal to the insertion site. Explain.","a":"Assess circulation. Pulses, skin temperatures; capillary refill; skin color."},{"q":"Why is it so important that we immobilize the arm on the affected side after pacemaker insertion?","a":"The wires need time to embed in the heart; if the arm is moving too much, the wires (leads) could pull out."},{"q":"Why does the pacemaker patient need to check their pulse every day?","a":"To ensure the pacemaker stays within the range it’s set on."},{"q":"What is an A-line?","a":"Arterial line – in artery – measures continuous BP on a monitor."},{"q":"What is an Allen’s test?","a":"Checks for alternate circulation prior to inserting A-line."},{"q":"Why is it so important that the distal circulation be checked when a patient has an A-line? Explain your checks that you are going to do (nursing assessment).","a":"Skin temperature, color, pulse, capillary refill – These need to be checked because the A-line could decrease heart perfusion, so the line is normally placed in the radial artery."},{"q":"If an A-line is accidentally pulled out, what is the first thing that needs to be done?","a":"Apply pressure"},{"q":"When a patient has an A-line, pressure has to be kept on the infusion bag. Why? What would happen if you didn’t keep the pressure on the infusion bag?","a":"To prevent backflow of arterial blood – If you did not place pressure on the flush bag, the high pressure of the artery would force blood back up through the tubing and fill the flush bag with blood."},{"q":"When a patient goes on a low-sodium diet and bed rest, what might happen to them?","a":"Diuresis may occur"},{"q":"Why do we give diuretics in the morning?","a":"So the patient will not be up all night using the bathroom"},{"q":"Why is it so important that a CHF patient weigh themselves every day?","a":"To monitor themselves for fluid retention."},{"q":"When a patient is in pulmonary edema, why is it important that you sit them up with their legs down?","a":"To decrease venous return."},{"q":"What is one quick check you can do on patients to see if they are going into pulmonary edema?","a":"Lung sounds."},{"q":"When you are taking care of a patient who is at risk for pulmonary edema, why do we use 10-inch blocks? Explain.","a":"To enhance pooling of blood in lower extremities; decrease venous return."},{"q":"Explain the nursing care for someone with Buerger’s disease and Raynaud’s disease.","a":"Buerger’s disease – excellent foot care and avoid the cause. Raynaud’s – avoid the cause."},{"q":"Why do Buerger’s disease patients have to do such excellent foot care?","a":"Foot care is appropriate with any peripheral vascular condition."},{"q":"Do you elevate venous disorders or lower venous disorders (such as an affected extremity)?","a":"Elevate"},{"q":"When taking care of a patient with a venous disorder, do you use warm moist heat or cold wet packs?","a":"Warm moist heat to decrease inflammation."},{"q":"What is a thoracentesis?","a":"Removal of fluid from the pleural space."},{"q":"When a patient is having a thoracentesis, where is the fluid being removed from?","a":"Pleural space."},{"q":"What has happened when a patient needs a chest tube?","a":"The lung is collapsed."},{"q":"a. Chest tubes have a water seal. First of all, what is the purpose of the water seal and what would happen if there was no water seal? b. Also in chest tubes, the chest bottle will have an air vent at the top of the bottle. What is the purpose of the air vent?","a":"a. To promote one-way flow of air out of the pleural space. If there was no water seal or if the water seal was broken, air from the outside environment could go backwards into the pleural space and re-collapse the lung. b. To let air that comes out of the pleural space escape from the bottle."},{"q":"When a patient has a chest tube, you should see fluctuation of the fluid in the water seal tubing. What does this fluctuation mean?","a":"A good connection."},{"q":"When a patient has chest tubes, hopefully the lung should do what?","a":"Re-expand."},{"q":"What would you do if the tubing became disconnected?","a":"Hook it back up unless you happen to have a sterile connector in the room. Then you would use a brand new sterile connector."},{"q":"What would happen if the water seal in the chest system is broken?","a":"Air from the outside environment would rush into the pleural space and re-collapse the lung."},{"q":"What is the first thing the nurse should do if the chest tube is accidentally dislodged from the patient?","a":"Place your hand over the insertion site."},{"q":"What is a hemothorax?","a":"Blood in the pleural space."},{"q":"What is a pneumothorax?","a":"Air in the pleural space."},{"q":"When blood or air or fluid accumulates in the pleural space, what is going to happen to the lung?","a":"Collapse."},{"q":"What should you do if a patient presents with a penetrating object to the chest?","a":"Leave it in place."},{"q":"What is a tension pneumothorax?","a":"The pressure has accumulated in the pleural space and has collapsed the lung and pushed everything to the opposite side."},{"q":"When a patient has an open pneumothorax, you are supposed to put a piece of petroleum gauze over the area. How many sides are taped down? Why do we leave one side open?","a":"Three – the fourth side acts as an air vent. There is a chance there is some air that will need to come out, so you will have to leave a way for it to come out."},{"q":"When a patient has a fractured sternum or ribs, why are the respirations so shallow? What acid-base imbalance will this put them at risk for?","a":"Because it hurts; respiratory acidosis."},{"q":"With a fractured sternum or ribs, why is the patient put on a ventilator with PEEP?","a":"To expand the chest to realign ribs."},{"q":"What is PEEP?","a":"Positive end-expiratory pressure."},{"q":"What is CPAP?","a":"Continuous positive airway pressure."},{"q":"What is the major difference between the two (PEEP and CPAP)?","a":"PEEP exerts pressure at the end of exhalation and CPAP is pressure throughout the breathing cycle."},{"q":"What is flail chest?","a":"Multiple rib fractures."},{"q":"What is paradoxical chest wall movement?","a":"When your chest does not rise and fall symmetrically; you are said to have a seesaw chest."},{"q":"When a patient has glomerulonephritis, are they in a fluid volume deficit or a fluid volume excess?","a":"Fluid volume excess."},{"q":"Explain CVA tenderness.","a":"This is costovertebral angle tenderness. It is when you tap over the kidneys and tenderness occurs."},{"q":"Why does the glomerulonephritis patient need bed rest?","a":"For diuresis."},{"q":"When determining fluid replacement for a renal disease patient (glomerulonephritis), you always give them what they lost in a 24-hour period plus 500cc. What is the purpose of adding 500 cc’s?","a":"To account for the insensible fluid loss."},{"q":"Once diuresis begins in glomerulonephritis, will the patient be at risk for a fluid volume deficit or fluid volume excess?","a":"Fluid volume deficit."},{"q":"What will protein or albumin hold onto in the vascular space?","a":"Fluid."},{"q":"Therefore, will the nephrotic syndrome patient (in the acute stages) be in a fluid volume deficit or fluid volume excess?","a":"Fluid volume deficit."},{"q":"Why will a patient who is diuresing go into a fluid volume deficit?","a":"Losing volume"},{"q":"Is hemodialysis done every day?","a":"No"},{"q":"Explain the basic nursing care for a circulatory access (A-V shunt, fistula, or graft).","a":"No blood pressures, no punctures in that extremity, do not wear a watch on that extremity, check it for adequate circulation."},{"q":"When a patient is having peritoneal dialysis, where is the fluid going into?","a":"Abdomen - Peritoneal cavity"},{"q":"What would you do if you instilled 1,000 cc’s of fluid into the peritoneal dialysis patient and only 700 cc’s came back?","a":"Turn the patient from side to side or reposition the patient."},{"q":"What should the drainage of peritoneal dialysis look like?","a":"Clear and straw colored."},{"q":"Explain in your own words a 24-hour urine.","a":"Discard the first voiding, keep all urine for the next 24 hours in a special container, and save the last voiding."},{"q":"A Creatinine Clearance test requires what type of urine specimen?","a":"24-hour urine"},{"q":"When a patient has an IVP (intravenous pyelogram), exactly what is this x-ray looking at?","a":"Kidneys, ureters, and bladder"},{"q":"What does a cystoscopy look at specifically?","a":"Urethra and bladder"},{"q":"What is the normal pre-procedure activities for a cystoscopy?","a":"Sedative and topical anesthetic"},{"q":"Explain the major S\/S post-cystoscopy?","a":"Watch for urine retention, burning is common for a couple of days due to urethra irritation, and blood-tinged urine is okay for a day or so."},{"q":"What type of specimen do you have to have to test a creatinine level on a patient?","a":"Blood"},{"q":"Any time a patient is having a transfusion reaction, what type of specimen should be obtained promptly?","a":"Urine"},{"q":"What should be done during a crisis?","a":"Hydration is No. 1; oxygen will be needed, blood transfusions will be needed, bed rest, and pain management."},{"q":"Why does the leukemia patient need bed rest?","a":"Bed rest is needed due to decreased red blood cells (hypoxia) and also to prevent trauma."},{"q":"Explain a neurovascular check.","a":"Checking pulses, color, movement, sensation, capillary refill, and skin temperature."},{"q":"In your Board Review book I explained several different things under “Cast Care,” such as ice packs should go on the sides. Go through those components under “Cast Care” and explain why we do all of those things. a. Ice packs on sides b. No indentations c. Use palms for the first 24 hours. d. Keep uncovered and dry. e. Do not rest cast on hard surface or sharp edge. f. Cover cast close to the groin with plastic. g. Elevate.","a":"A. We don’t want to indent the cast B. Could cause pressure sores under the cast C. To prevent indentations D. To allow heat to escape E. To decrease indentations or damage to the cast F. Keep it clean G. Elevate to decrease edema"},{"q":"What is skin traction? Give examples.","a":"The skin has not been penetrated. Buck’s traction and Russell’s traction are examples."},{"q":"What type of assessment is very important when a patient has skin traction? Explain why.","a":"Skin, because the skin is being pulled on."},{"q":"What is skeletal traction? Explain. Give examples.","a":"Prolonged traction using pins and wires. Steinmann pins or a Halo Vest."},{"q":"Explain how to do pin care.","a":"Use sterile technique; remove the crust."},{"q":"When a patient has a total hip replacement, there are some important things to remember about positioning. a. Explain why you want neutral rotation. b. Limit flexion. c. Want extension. d. Abduction","a":"A. Internal rotation or external rotation could dislocate the new hip B. Could dislocate the hip C. Extension minimizes hip dislocation D. Keeps the balls of the hip in the socket"},{"q":"Discuss the general nursing care for someone with the continuous passive motion machine.","a":"Assess the degree of flexion the machine is exerting; assess the patient’s pain level and tolerance of the machine."},{"q":"What are some good exercises for the total hip replacement patient?","a":"Isometrics such as gluteal and quadriceps squeezing; rocking in a rocking chair; walking and swimming."},{"q":"Why is elevation so important with an amputation (for the first 24 hours)?","a":"To decrease edema and bleeding"},{"q":"What can we do in the amputation patient to prevent hip and knee contractures?","a":"Extend the joint – prone position is a good position to extend the hip and knee."},{"q":"Describe the nursing care with someone with phantom pain?","a":"Diversional activity and pain medications are given."},{"q":"Why is weight loss so important with the osteoarthritis patient?","a":"To decrease stress on the weight-bearing joints, particularly the knees."},{"q":"When performing an assessment on the neuro patient, what is most important?","a":"LOC"},{"q":"What is the pulse pressure?","a":"Difference in systolic and diastolic blood pressure."},{"q":"Explain the post-procedure care for the cerebral angiography patient and explain why.","a":"Same care as for a heart catheterization patient – check peripheral circulation and keep the extremity still. We’re checking to see if a clot is forming, and we want to decrease movement of the extremity to reduce the chance of hemorrhage."},{"q":"What is a myelogram?","a":"An x-ray of the subarachnoid space."},{"q":"When a patient has a myelogram, are we getting into the cerebrospinal fluid?","a":"Yes"},{"q":"What is the pre-procedure care for a patient who is about to have a myelogram?","a":"The patient will be NPO and have a light sedative."},{"q":"What is an EEG?","a":"Electroencephalogram"},{"q":"What is the pre-procedure care for a patient who is going to have an EEG?","a":"Hold sedatives, no caffeine, do not make the patient NPO."},{"q":"If a patient were about to have an EEG, what would you tell them about the procedure?","a":"They will be asked to lie quietly first; then they may be asked to do such things as hyperventilate during the procedure."},{"q":"When a patient is having a lumbar puncture, do we get into cerebrospinal fluid?","a":"Yes"},{"q":"How do you position a patient for a lumbar puncture?","a":"Left side in the fetal position or propped up over the bedside table."},{"q":"Why do you put them in this position?","a":"We want to arch the back to increase the space between the discs and to thin out the meninges."},{"q":"What should cerebrospinal fluid look like?","a":"Clear and colorless"},{"q":"What is the post-procedure care of a lumbar puncture? Explain why.","a":"We want the patient to be on bed rest, lying flat so a seal can form at the puncture site. Patients should drink plenty of fluids. We should check the dressing to make sure it is not wet."},{"q":"What is an open head injury?","a":"That’s when the meninges have been broken and there is direct entry into the brain."},{"q":"What is a closed head injury?","a":"Meninges have not been broken."},{"q":"When a patient has a basal skull fracture, where is the fracture?","a":"Base of the skull"},{"q":"What is cerebrospinal rhinorrhea?","a":"Leakage of CSF from the nose."},{"q":"How do you tell CSF from other drainage?","a":"It will test positive for glucose and form a halo on a sheet or pillowcase."},{"q":"When a patient is on an osmotic diuretic, they better have two organs that are working perfectly. What are they?","a":"Heart and kidneys."},{"q":"When taking care of a head injured patient with increased intracranial pressure, why is it so important that you space your nursing interventions?","a":"Every time you do something to a head injured patient, ICP goes up."},{"q":"What should you restrict the fluids to? (How many cc’s per day?)","a":"1200 - 1500 cc per day"},{"q":"What is the pre-procedure care for a patient who is going to have an upper GI?","a":"The patient will be NPO past midnight. No smoking."},{"q":"You are taking care of a patient who is going to have an upper GI. Explain what is going to happen to the patient.","a":"The patient will have to swallow dye and x-rays will be taken."},{"q":"Your patient is going to have a barium enema. What is the pre-procedure care?","a":"Clear liquids, laxatives or enemas until clear; sometimes they have to drink a large volume of fluid to flush out the GI tract."},{"q":"How would you describe a barium enema to a patient?","a":"Just like an enema and x-rays will be taken."},{"q":"Why is it so important that the patient have a bowel movement after a barium enema?","a":"Because we don’t want the barium to stay in the body."},{"q":"What is the pre-procedure care of a gastroscopy? Explain to your patient what to expect if they are going to have a gastroscopy.","a":"NPO – pre, they will be sedated; a tube will be placed in the throat and through the esophagus into the stomach."},{"q":"When a patient has a gastroscopy, they have to be NPO until their gag reflex returns. Why?","a":"Because we do not want them to aspirate."},{"q":"How is a patient positioned during a liver biopsy?","a":"On their back with the right arm behind the head."},{"q":"How is a patient positioned post-liver biopsy? Explain why.","a":"On the right side to hold pressure."},{"q":"Why does the patient have to exhale and hold while the physician is puncturing into the liver?","a":"To get the diaphragm out of the way."},{"q":"What is a paracentesis?","a":"Removal of fluid from the peritoneal cavity."},{"q":"When a patient is having a paracentesis, what position do you put them in?","a":"Sit them up."},{"q":"Why is it important that the paracentesis patient void pre-procedure?","a":"Do not want to puncture the bladder."},{"q":"What is a peritoneal lavage and how does the pancreatitis patient benefit from this?","a":"In lavage, you instill fluid into the abdomen and then drain it back out to see if it comes back pink tinged. It helps identify internal bleeding."},{"q":"Why is rest so important with a cirrhosis patient?","a":"To rest the liver"},{"q":"Why do we measure the abdominal girth in the cirrhosis patient and what will it tell us?","a":"We are measuring the abdominal girth to see how much fluid the patient is accumulating in their abdomen. The more fluid the patient accumulates in the abdomen indicates that the vascular volume is going down."},{"q":"When a patient has liver disease, what should be done with protein in the diet?","a":"Decrease"},{"q":"Why does the liver patient need a low-sodium diet?","a":"To decrease ascites"},{"q":"Why is oxygen important with a patient who has bleeding esophageal varices?","a":"Because the patient is anemic and we want what few red blood cells they have to be hyper-oxygenated."},{"q":"Why does the patient with bleeding esophageal varices need a Sengstaken Blakemore tube?","a":"To hold pressure on the bleeding varices."},{"q":"What is the nursing care associated with a Sengstaken Blakemore tube?","a":"Keep scissors at the head of the bed; make sure the tube is not coming out. Mark the tube at the nares and observe maintenance of tube position. If respiratory distress occurs due to tube dislodgement, have scissors available to cut the tube and deflate the balloon."},{"q":"When a patient has ulcerative colitis or Crohn’s disease, do they need a high-fiber or a low-fiber diet? Why?","a":"Low fiber diet because a high fiber diet would increase motility."},{"q":"Why does the patient with ulcerative colitis or Crohn’s need to avoid cold foods and smoking?","a":"These will increase motility."},{"q":"When a patient has an ileostomy, what will the drainage be like?","a":"Continuous liquid drainage."},{"q":"Why should an ileostomy patient need to avoid rough foods or high-fiber foods?","a":"These will increase motility and therefore make the patient lose even more water."},{"q":"Why does the ileostomy patient need Gatorade?","a":"To replace fluid and electrolytes."},{"q":"When a patient has an ileostomy, what electrolyte are they losing a lot of?","a":"Potassium"},{"q":"Explain the nursing care for a colostomy.","a":"Bowel training and irrigation will be needed."},{"q":"When a patient has had any abdominal surgery, what is the position of choice and why?","a":"Elevate the head of the bed to decrease stress on the suture line."}]

Part 2

Pharmacological And Parenteral Therapies Flashcards

Part 1

[{"q":"How can IV fluids with sodium induce hypervolemia?","a":"Because sodium makes you retain water."},{"q":"Alka-Seltzer contains a lot of what?","a":"Sodium"},{"q":"How can Alka-Seltzer throw you into hypervolemia?","a":"Alka-Seltzer has a lot of sodium, so if you are taking Alka-Seltzer, the sodium will make you retain fluid in the vascular space."},{"q":"Fleets enemas contain a lot of what?","a":"Sodium"},{"q":"How can a fleets enema throw you into hypervolemia?","a":"Increase in sodium intake, therefore you retain fluid in the vascular space."},{"q":"Diuretics are given to the hypervolemic patient. Explain why.","a":"Because the patient has too much volume and they need to diurese."},{"q":"Lasix is a common diuretic. What is the major electrolyte imbalance you have to watch for?","a":"Hypokalemia."},{"q":"What is the major electrolyte imbalance you have to watch for with thiazide diuretics?","a":"Hypokalemia."},{"q":"Aldactone is a potassium-sparing diuretic. What is the major electrolyte imbalance you have to watch for with this drug?","a":"Hyperkalemia."},{"q":"What class of IV solution would be good for someone who is hypovolemic? Explain why and give examples.","a":"Isotonic solutions are appropriate because they go into the compartment in which they are administered and stay there, thereby increasing the vascular volume. Examples include 0.9% Normal Saline or Lactated Ringer's (LR)."},{"q":"Why would you dialyze someone who has hypermagnesemia?","a":"To help the patient eliminate excess magnesium."},{"q":"Why do you give calcium gluconate to someone who has hypermagnesemia?","a":"Calcium gluconate is the antidote for any magnesium toxicity, regardless of how it occurs; the calcium will antagonize the magnesium, thereby decreasing the chance for arrhythmias."},{"q":"Why is it so important to discontinue the magnesium sulfate infusion if a patient begins to have flushing and sweating?","a":"Flushing and sweating can easily occur when one is receiving magnesium; however, these could be signs that the patient is becoming toxic. Magnesium causes vasodilation, which makes you feel flushed and warm, and also lowers blood pressure."},{"q":"How can D5W make someone’s serum sodium go down?","a":"Water dilutes blood."},{"q":"What are some IV fluids that have sodium?","a":"NS; LR"},{"q":"How can renal failure cause hyperkalemia?","a":"Not excreting K."},{"q":"How can Aldactone cause hyperkalemia?","a":"K-sparing diuretic; therefore, serum K goes up."},{"q":"When you have a hyperkalemic patient, why do we dialyze them?","a":"To remove excess K+."},{"q":"Why do we give the hyperkalemic patient calcium gluconate?","a":"Calcium gluconate protects the heart from life-threatening arrhythmias."},{"q":"Why do we give the hyperkalemic patient glucose and insulin?","a":"Insulin will drive the K out of the vascular space back into the cell, thereby lowering the serum K level. However, the blood sugar will drop too, so we have to give additional glucose to prevent hypoglycemia."},{"q":"What is the action of insulin on the blood sugar and what is the action of insulin on the serum potassium level?","a":"See 127."},{"q":"How does Kaexalate work?","a":"It exchanges Na for K in the GI tract; therefore, it lowers the K+ level. Na increases."},{"q":"Do you give Kaexalate for hyperkalemia or hypokalemia?","a":"Hyperkalemia"},{"q":"When you give Kaexalate, you can expect the serum potassium level to go down; therefore, what will happen to the serum sodium level? Explain.","a":"Goes up. Kaexalate exchanges Na for K; therefore, Na level goes up."},{"q":"How does Aldactone help hypokalemia?","a":"Aldactone makes you retain K."},{"q":"What are some of the major side effects of oral potassium supplements?","a":"GI upset."},{"q":"What is a drug that is given in respiratory acidosis to quickly correct the acidosis?","a":"IV Na Bicarb."},{"q":"What is the problem chemical?","a":"CO2"},{"q":"What is the bicarb level going to do in respiratory alkalosis?","a":"Decrease"},{"q":"How will sedation affect respiratory alkalosis?","a":"Decrease respiratory rate; retain CO2."},{"q":"How can resuscitation induce metabolic alkalosis?","a":"Patient gets a lot of Na+ bicarb in a code."},{"q":"What is the treatment for carbon monoxide poisoning? Explain why.","a":"100% O2. Because the patient is hypoxic. By giving 100% O2, we are increasing the probability that O2 will bind with the hemoglobin before carbon monoxide can."},{"q":"How will an IV with albumin help fight shock?","a":"It helps hold fluid in the vascular space."},{"q":"Explain the difference between the tetanus toxoid and the tetanus immune globulin.","a":"The immune globulin gives immediate protection because it is the injection of antibodies (passive immunity). Toxoid: the body has to make antibodies (active immunity)."},{"q":"Why do patients with burns have to take Mylanta and Tagamet?","a":"For stress ulcers."},{"q":"Why are multiple antibiotics used when treating burns?","a":"To prevent resistance of bacteria. We don’t want bacteria to build tolerance."},{"q":"What is a vesicant?","a":"A chemo drug. If a vesicant infiltrates, it will cause massive tissue necrosis."},{"q":"What do you do if a vesicant infiltrates?","a":"Stop the infusion, apply ice packs to promote vasoconstriction and decrease absorption of the drug."},{"q":"Give examples of the antithyroid drugs:","a":"Propacil, PTU, Tapazole."},{"q":"When someone has been given radioactive iodine, what do you expect to happen to their thyroid hormone levels?","a":"Decrease."},{"q":"When a patient has been placed on an antithyroid, what do you expect to happen to their thyroid hormone levels?","a":"Decrease."},{"q":"Why do we give iodine compounds preoperatively?","a":"They decrease vascularity and decrease the chance of hemorrhage."},{"q":"How do you treat hypothyroidism?","a":"Give thyroid hormones – Synthroid, Proloid, Cytomel."},{"q":"When a patient has started on drug therapy for hypothyroidism, is it temporary or permanent?","a":"Permanent."},{"q":"Explain how Amphojel works for the hypoparathyroid patient.","a":"Amphojel binds with phosphorus, which decreases phosphorus levels and increases calcium levels."},{"q":"What are the four major actions of glucocorticoids?","a":"Change mood, break down protein\/fat, alter defense mechanisms (suppress the immune system), and inhibit insulin."},{"q":"When you hear the word mineralocorticoid, what is the major word you need to think of?","a":"Aldosterone."},{"q":"What is another name for glucocorticoids, mineralocorticoids, or sex hormones?","a":"Steroids – adrenocorticotropic hormones (ACTH), cortisol."},{"q":"Why do steroids drive your blood sugar up?","a":"They inhibit insulin, causing blood sugar to rise."},{"q":"When a patient has Cushing’s syndrome, do they have too many steroids or not enough steroids?","a":"Too many"},{"q":"In the diabetic patient, what is absent that makes their blood sugar go up?","a":"Insulin."},{"q":"What is the normal action of insulin? (How does it work?)","a":"Carries glucose out of the vascular space to the cell. Decreases blood sugar."},{"q":"Explain how oral hypoglycemic agents work and give examples.","a":"They stimulate the pancreas to make insulin. Micronase – Diabeta, Glucotrol."},{"q":"Why will an oral hypoglycemic agent not work in a Type I diabetic?","a":"Because they don’t produce insulin; the pancreas is not working. Type I’s can’t produce insulin even with stimulation."},{"q":"When you start giving a patient insulin, what is going to happen to their blood sugar?","a":"Decrease"},{"q":"When you give somebody insulin, why should they not have ketones and glucose in their urine?","a":"Because insulin should lower blood sugar. Therefore, there shouldn’t be any excess glucose in the urine. Also, insulin should keep the body from breaking down body fat. (The body will be using glucose instead of fat for energy.)"},{"q":"If you are giving somebody insulin and they do have glucose and ketones in their urine, what needs to be done to the dose of the insulin?","a":"Increased"},{"q":"Why do we draw up regular insulin first?","a":"Draw the clear insulin up first to prevent contamination of the regular (clear) insulin with a medication or long-acting insulin (cloudy). Remember clear\/regular insulin is the only insulin that can be given IV."},{"q":"What is the only type of insulin that can be given IV?","a":"Regular"},{"q":"Explain the peaks of the three different classes of insulin.","a":"Rapid – 2-4 hours; Intermediate (NPH) – 7-12 hours; Long-acting (Protamine Zinc) – 18+ hours."},{"q":"When insulin is at its peak, that means the insulin is working really hard; therefore, what is going to happen to the blood sugar at the peak time?","a":"Decrease – risk for hypoglycemia."},{"q":"When patients have given themselves insulin, they need to know when insulin peaks because what is the major complication of the peak time?","a":"Hypoglycemia"},{"q":"When a diabetic patient is sick, their blood sugar is going to go up; therefore, what do they need to do with the dose of their insulin?","a":"Increase"},{"q":"Do we aspirate insulin? Why?","a":"No – tissue damage."},{"q":"Are D50W and injectable glucagon temporary or permanent increases in the blood sugar?","a":"Temporary"},{"q":"Why is it so important that a diabetic patient eat regularly and take their insulin regularly?","a":"To prevent hypoglycemia – keep blood sugar within normal limits."},{"q":"When you give somebody insulin, what do you expect it to do to their blood sugar? Why?","a":"Decreases – insulin drops the blood sugar."},{"q":"When you give somebody insulin, what do you expect it to do to their serum potassium level? Explain why.","a":"Decreases – because insulin makes potassium leave the serum and go into the cell."},{"q":"How does normal saline work?","a":"Since normal saline is isotonic, it will go into the vascular space and stay and build up."},{"q":"When you get the DKA patient into the emergency room, you are going to see the doctor order IV push insulin; therefore, what is going to start happening to the blood sugar rapidly?","a":"Decrease"},{"q":"When the blood sugar drops to about 300 (I know this is still too high), why do we switch the IV fluids to D5W in place of normal saline?","a":"To prevent throwing the patient into a hypoglycemic state."},{"q":"How could you throw a DKA patient into hypoglycemia?","a":"By decreasing blood sugar rapidly with insulin."},{"q":"Why is nitroglycerine given?","a":"To relieve the pain – it vasodilates which increases blood\/oxygen to the heart."},{"q":"When you give somebody nitroglycerine, more ____________ is going to get to the heart?","a":"Blood flow – oxygen"},{"q":"How do you teach a patient to take their nitroglycerine?","a":"1 every 5 minutes for up to 15 minutes (3 doses max)."},{"q":"Why should nitroglycerine burn?","a":"Some preparations of nitroglycerine burn and that is normal."},{"q":"Why do patients with angina need beta blockers? List several examples.","a":"They decrease the workload of the heart and decrease contractility; decrease blood pressure. Inderal – Lopressor"},{"q":"Why do angina patients need calcium channel blockers? List several examples.","a":"Decrease blood pressure; decrease workload of the heart. Verapamil, Calan, Procardia. These drugs also dilate coronary arteries, which enhances blood flow to the heart."},{"q":"Explain cardiac enzymes and include: a. Why do we have to draw the isoenzymes? b. Tell me the time frames for which these peak (CPK and LDH). c. Tell me about Troponin.","a":"a. To determine if heart muscle, skeletal muscle, or brain is affected. b. CPK – immediately increases 4-6 hours; peaks 18-24 hours. LDH – detects further back 48-72 hours; peaks. c. High specificity for myocardial cell injury; always normal in non-cardiac muscle diseases; elevates sooner and stays elevated longer."},{"q":"When a patient has had a MI, what is the drug of choice?","a":"Nitroglycerin"},{"q":"What drug is sometimes started IV on a MI patient to prevent things like PVCs or V-tach or V-fib?","a":"Lidocaine"},{"q":"When a patient is given lidocaine, why can they develop neuro changes?","a":"They develop lidocaine toxicity."},{"q":"When a patient goes into a third-degree block, what are the major drugs that are used?","a":"Atropine\/Epi – pacemaker"},{"q":"How do thrombolytics work? Give me three examples of common thrombolytics.","a":"They dissolve the clot that is blocking blood flow to the heart muscle. They decrease the size of the infarction. Streptokinase, TPA, Eminase"},{"q":"What do artificial pacemakers do?","a":"Depolarize heart muscle – shoot electricity through muscle."},{"q":"Explain the difference between a demand and a fixed-rate pacemaker.","a":"Demand – kicks in only when the patient needs it. Fixed – fires at a fixed rate constantly."},{"q":"You really need to get worried about a pacemaker malfunctioning when the rate of the pacemaker does what?","a":"If the rate decreases at all."},{"q":"Why does the pacemaker patient have to avoid microwaves and MRIs?","a":"They can alter or damage the pacemaker."},{"q":"Explain how digitalis works.","a":"Digitalis slows down the heart rate, which gives the ventricles more time to fill with blood. Then the heart can squeeze down with a stronger contraction on more blood; therefore, it increases cardiac output."},{"q":"When you start giving a patient Digoxin, should their cardiac output go up or down?","a":"Up."},{"q":"Why does a congestive heart failure patient need Lasix?","a":"To decrease the circulating volume"},{"q":"When a patient is in pulmonary edema, why do we give them Digoxin?","a":"Given to strengthen the contraction more and increase cardiac output."},{"q":"When a patient is in pulmonary edema, why do we give them Aminophylline?","a":"Aminophylline is a bronchodilator given to help the patient breathe better."},{"q":"What are some common side effects of Aminophylline?","a":"Nervousness and tachycardia"},{"q":"When a patient is in pulmonary edema, why do we give them morphine?","a":"To vasodilate; therefore decreasing preload and afterload; and to decrease anxiety."},{"q":"How much morphine do we give them?","a":"About 2 milligrams"},{"q":"How will angioplasty help an arterial problem?","a":"Angioplasty will restore oxygenated blood flow to an area. (opens up the artery)"},{"q":"What type of line will be put into the patient to monitor the right side of the heart?","a":"Swan-Ganz Catheter."},{"q":"How will Heparin help the patient who has developed a pulmonary embolus?","a":"It will decrease the formation of new clots and keep the clot that has already developed from getting any larger."},{"q":"With a fractured sternum or ribs, why do we give non-narcotic analgesics?","a":"We do not want to depress the respirations even more."},{"q":"One of the major drugs used for TB is INH (Isoniazid). What is the major side effect? And what vitamin can be given to prevent that major side effect?","a":"Peripheral neuritis – B6"},{"q":"When a patient has nephrotic syndrome, it is not uncommon for them to be placed on prednisone. Why?","a":"To decrease inflammation and reduce the size of the holes in the glomerulus so protein can no longer leak out."},{"q":"If a patient is allergic to Heparin, they cannot be hemodialyzed. Why?","a":"Because heparin is used during the procedure."},{"q":"Why can’t a patient who has an alternate circulatory access device have blood pressures or venipunctures in that extremity?","a":"Because these could cause a clot to occur in the circulatory access device."},{"q":"Explain in your own words what peritoneal dialysis is.","a":"Fluid is instilled into the abdomen. Fluid stays in for a period of time, then it is drained out of the abdomen along with all of the excess electrolytes and toxins that have accumulated in the patient’s body."},{"q":"Why can’t a patient with CHF or poor kidneys have whole blood?","a":"Because they cannot handle the volume of blood. They have to have packed red blood cells."},{"q":"Why do we have to agitate platelets when we are administering them?","a":"Because they will aggregate together."},{"q":"Why do we give Albumin or Dextran in shock? How do these work?","a":"These are forms of protein which will hold fluid in the vascular space."},{"q":"What should you do if your patient begins to have a transfusion reaction?","a":"Stop the blood; start some saline."},{"q":"How long do you have to get it infused?","a":"4 hours"},{"q":"Explain the major symptoms of a febrile or septic blood transfusion reaction (include treatment).","a":"Febrile reaction symptoms: sudden chills and fever, headache, flushing, anxiety, muscle pain. Cause: sensitivity to donor’s blood products. TX: Antipyretics. Septic reaction - contaminated blood has been used. Patient immediately has fever, chills, low blood pressure, and shock. TX: IV antibiotics and symptomatic treatment."},{"q":"Explain the major S\/S of an allergic reaction with a blood transfusion (include treatment).","a":"Allergic reaction: symptoms – flushing, itching, urticaria, hives. TX: Benadryl. Cause: Sensitivity to blood product."},{"q":"What are the major symptoms you need to watch for that would indicate a patient is having a hemolytic reaction during a blood transfusion?","a":"Back pain is number one. Chills, fever, flushing, increased pulse, increased RR, blood pressure decreases."},{"q":"Why do hemolytic reactions occur?","a":"Incompatible blood; stop the blood; start the saline; get a urine specimen; save the blood; call the doctor; call the blood bank; get vital signs and prepare to flush out the kidneys with Mannitol."},{"q":"Why do we give Mannitol when a patient is having a hemolytic reaction?","a":"To flush out the kidneys."},{"q":"What can be given with iron to increase the absorption?","a":"Vitamin C."},{"q":"What are some major side effects of iron (ferrous sulfate)?","a":"GI upset and constipation."},{"q":"What can iron do to the teeth?","a":"Stain."},{"q":"What does iron do to the stools?","a":"Makes stools very dark."},{"q":"Why do we give iron IM Z-track method?","a":"We want to trap the injection fluid deep into the muscle. We do not want it leaking out into the tissue – it can stain the skin."},{"q":"Why are IM injections of B-12 effective with pernicious anemia? Why does oral B-12 not work in this patient?","a":"Because they can absorb IM B-12 without intrinsic factor. Without intrinsic factor, you cannot absorb B-12; therefore, you would not develop normal red blood cells."},{"q":"Why does the leukemia patient need PRBCs?","a":"To replace red blood cells – to fight anemia."},{"q":"Why does the leukemia patient need platelets?","a":"To replace the platelets – help with clotting and control bleeding."},{"q":"Why is the rheumatoid arthritis patient placed on aspirin, prednisone, or NSAIDs?","a":"To decrease inflammation"},{"q":"Why is the rheumatoid arthritis patient placed on chemotherapy?","a":"To decrease the immune system since rheumatoid arthritis is an “immune” response"},{"q":"What is the general treatment for osteoarthritis? Explain why.","a":"Lose weight, non-steroidal medications, steroids, and rest."},{"q":"What are the three major drugs used for gout? Explain how they work.","a":"Colchicine to decrease pain and swelling; Zyloprim to decrease uric acid levels; and Probenecid to decrease uric acid levels."},{"q":"It is important that you ask this patient who is about to have cerebral angiography if they are allergic to something. What is it?","a":"Iodine"},{"q":"Why is it so important in the myelogram patient that we increase the fluids?","a":"To help the patient get rid of the dye (dye is excreted through the kidneys) and also to help replace any cerebrospinal fluid that could have been lost during the procedure."},{"q":"How is this complication treated?","a":"Bed rest, fluids, pain medications, and a blood patch may need to be done."},{"q":"Tensilon is used to help diagnose myasthenia gravis. Explain what will be done.","a":"Tensilon increases nerve impulses. The patient will be injected with Tensilon and if they have myasthenia, they will improve immediately."},{"q":"Why are Prostigmin and Mestinon used to treat myasthenia gravis?","a":"These drugs increase acetylcholine concentration at the myoneural junctions to facilitate transmission of impulses across the nerves, therefore increasing muscle tone."},{"q":"Why do we give steroids to the myasthenia patient?","a":"Myasthenia is thought to be an autoimmune problem; therefore, steroids are given to decrease the immune response."},{"q":"Why do we give the pancreatitis patient steroids?","a":"To decrease inflammation"},{"q":"Why do we give the pancreatitis patient Tagament and antacids?","a":"To decrease acid in the stomach"},{"q":"Why do you have to avoid narcotics in any liver patient?","a":"Because the liver cannot metabolize narcotics."},{"q":"What are the two major drugs used in hepatic coma? Explain why.","a":"Neomycin and Lactulose because they decrease ammonia."},{"q":"Explain how Vasopressin works.","a":"It decreases the blood pressure in the liver and hopefully the bleeding will subside."},{"q":"What is one of the complications of giving Vasopressin?","a":"Causes vasoconstriction in other parts of the body."},{"q":"What is another name for Vasopressin?","a":"Pitressin"},{"q":"What is one of the major antibiotics given for ulcerative colitis and Crohn’s disease? How does this drug help?","a":"Gantrisin, which is a sulfonamide (antibiotic) to decrease infection and inflammation."},{"q":"Why does the patient with ulcerative colitis or Crohn’s disease need steroids?","a":"To decrease inflammation."},{"q":"Why do we give the peptic ulcer patient antacids? What type of antacids would be the best—liquid or tablet?","a":"To decrease acid; liquid to coat the stomach."},{"q":"Why do we give the patient with peptic ulcer disease H-2 receptor antagonist? List some examples.","a":"To decrease acid; Tagamet, Pepcid, Zantac."},{"q":"Why do we give the peptic ulcer patient Carafate?","a":"To form a barrier over the wound so acid cannot get on the wound."}]

Part 2

Physiological Adaptation Flashcards

Part 1

[{"q":"How can congestive heart failure throw you into hypervolemia (or fluid volume excess)?","a":"Decrease in cardiac output, decrease in kidney perfusion, decrease in urine output, too much fluid in the vascular space."},{"q":"How can renal failure throw you into fluid volume excess?","a":"If your kidneys are not working, then the fluid will be retained in the vascular space."},{"q":"What is the normal action of aldosterone?","a":"Aldosterone makes you retain sodium and water in the vascular space."},{"q":"How can aldosterone throw you into hypervolemia?","a":"If you have too much aldosterone, then you are retaining too much sodium and water."},{"q":"What is the name of the disease a patient can have that will induce hypervolemia due to too much aldosterone?","a":"Primary hyperaldosteronism or Cushing's syndrome."},{"q":"What is the normal action of ADH, and what does ADH stand for?","a":"Antidiuretic hormone. Makes you retain water in the vascular space."},{"q":"How can ADH throw you into hypervolemia?","a":"If you have too much ADH, you retain too much water in the vascular space (SIADH)."},{"q":"What will the effects be on the body if a patient is producing too much ADH and what is the name of this disease?","a":"If you have too much ADH, you will retain too much water; this condition is called SIADH."},{"q":"What will the effects be on the body if the patient does not have enough ADH and what is the name of this disease?","a":"Diabetes Insipidus—diuresis—shock (losing water)."},{"q":"What happens to your veins when you are hypervolemic?","a":"They distend (become full)."},{"q":"Why does the hypervolemic patient develop edema?","a":"The vascular space gets full and reaches a point where it can’t hold anymore, causing fluid to leak into the tissues."},{"q":"Why does the hypervolemic patient develop ascites?","a":"The vascular space gets so full it can’t hold any more, so the fluid leaks into the abdomen, resulting in decreased vascular volume."},{"q":"If a patient is hypervolemic, what will happen to the CVP?","a":"It increases (more volume = more pressure)."},{"q":"If a patient is hypovolemic, what will happen to the CVP?","a":"It decreases (less volume = less pressure)."},{"q":"If a patient has a high CVP, what does that tell us is probably going on in the vascular space?","a":"The vascular space is overloaded with fluid."},{"q":"If a patient is hypervolemic, what are the lung sounds like and why?","a":"Wet: Shortness of breath can occur due to fluid in the lungs."},{"q":"Why does the patient who is hypervolemic develop polyuria?","a":"The kidneys are trying to compensate by getting rid of the excess fluid."},{"q":"What happens to the blood pressure and pulse with hypervolemia and explain why?","a":"Blood pressure increases because there is so much volume; the pulse increases as the heart is trying to pump faster and harder to keep the blood moving forward; we would rather the blood go forward instead of backwards into the lungs."},{"q":"Which two organs are affected by FVE\/FVD? Are they weakened by aging?","a":"Heart and kidneys; yes."},{"q":"How can GI losses affect your vascular space?","a":"Excessive GI loss can reduce the volume in the vascular space; anytime you lose fluid from your body, no matter where it comes from, the vascular space can eventually be depleted."},{"q":"What is third spacing?","a":"Fluid leaves the vascular space and goes somewhere where it does you no good (tissue and abdomen)."},{"q":"How can ascites induce hypovolemia?","a":"Fluid leaves the vascular space and goes out into the abdomen; therefore, the vascular volume goes down."},{"q":"How can burns induce hypovolemia?","a":"Fluid leaves the vascular space and goes to the tissue (edema occurs) or out of the body completely."},{"q":"The diabetic patient will develop polyuria. Why?","a":"Because they are trying to get rid of the particles (excess glucose particles) in the vascular space. The glucose has to go out in volume (with fluid). You have never just excreted a sugar particle!"},{"q":"How does this polyuria affect the vascular space?","a":"It decreases volume in the vascular space."},{"q":"The person with polyuria will eventually develop what life-threatening complication?","a":"Shock."},{"q":"What changes will you see in the urine output that will indicate the body is compensating?","a":"After someone has had polyuria for a long time, the vascular volume will eventually deplete, and now the patient is in shock. The kidneys are not being perfused well at this point, so they make less urine. Also, the kidneys could start trying to conserve what little fluid is left in the body, therefore decreasing urine output as well. With either of these conditions, the urine output will switch to oliguria and could possibly go all the way to anuria. If either of these occur, I would have to start worrying about renal failure."},{"q":"If you are hypovolemic, what happens to your blood pressure and pulse? Tell why.","a":"Blood pressure decreases due to less volume, resulting in less pressure. The pulse increases, but it is weak and thready because your heart is trying to pump what little fluid you have around the body to perfuse vital organs."},{"q":"What happens to your CVP? Explain why.","a":"It decreases; less volume equals less pressure."},{"q":"What happens to your veins? Explain why.","a":"They become smaller because there is not much volume to distend them."},{"q":"Why do the extremities of a patient who is hypovolemic become cool?","a":"Peripheral vasoconstriction helps shunt blood to vital organs; when you vasoconstrict peripherally, the skin gets cool."},{"q":"And what is going to happen to the urine specific gravity if a patient is hypovolemic?","a":"It increases; the kidneys will not be producing much urine, so what little urine is excreted will be very concentrated."},{"q":"Renal failure can cause hypermagnesemia. Explain why.","a":"Because magnesium is excreted by the kidneys, and if your kidneys are not functioning, you will retain magnesium in your blood."},{"q":"Magnesium acts like a _____________________.","a":"Sedative."},{"q":"If a patient has hypermagnesemia, what will happen to their DTRs, respirations, and level of consciousness?","a":"They will decrease."},{"q":"Could they have a life-threatening arrhythmia?","a":"Yes, because magnesium affects all muscles in the body (sedative effect)."},{"q":"What is going to happen to their muscle tone?","a":"Muscles will be weak and flaccid."},{"q":"Why does the patient who has hypermagnesemia develop flushing and warmth?","a":"Because vasodilation occurs when you have high magnesium levels."},{"q":"What kind of effect will this have on the blood pressure?","a":"The vasodilation will cause the blood pressure to decrease. Vasodilation always lowers blood pressure."},{"q":"Why would you put somebody (on a ventilator) who has hypermagnesemia?","a":"They could go into respiratory distress because respiratory muscles could become depressed due to the sedative effect."},{"q":"Why do we have to be very careful with renal patients in relation to hypermagnesemia?","a":"Because they cannot excrete excess magnesium."},{"q":"In what part of the GI tract do you have a lot of magnesium?","a":"In the intestines, specifically the lower GI tract."},{"q":"If you have a patient with hypomagnesemia, what will their muscles be like?","a":"Tight, hyper-excitable, and rigid."},{"q":"Could they have a seizure?","a":"Yes."},{"q":"Why does the patient have a positive Chvostek's and Trousseau's sign if they have hypomagnesemia, and what will happen to the DTRs?","a":"Because the muscles are tight and hyperexcitable, the DTRs will increase."},{"q":"How does calcium act?","a":"Like a sedative."},{"q":"Calcium has an inverse relationship with what other electrolyte?","a":"Phosphorus."},{"q":"How does this affect the bloodstream?","a":"Hyperphosphatemia leads to hypocalcemia, while hypophosphatemia leads to hypercalcemia."},{"q":"How does vitamin D help calcium?","a":"It helps utilize calcium."},{"q":"What is the normal action of parathormone?","a":"It increases serum calcium levels by pulling calcium from the bone and putting it into the blood."},{"q":"Hyperparathyroidism can induce hypercalcemia. Explain how.","a":"With hyperparathyroidism, you have too much parathyroid hormone (PTH). PTH causes calcium to be pulled from the bone and released into the blood, resulting in elevated serum calcium levels."},{"q":"If a patient has too much calcium in their blood, what kind of muscle tone will they have?","a":"Weak."},{"q":"What will their DTRs be like?","a":"Decreased."},{"q":"Could they have a kidney stone? Why?","a":"Yes, because excess calcium in the blood promotes stone formation."},{"q":"What do steroids do to your serum calcium level?","a":"Steroids lower the serum calcium level by causing you to excrete calcium through the GI tract."},{"q":"How does hypoparathyroidism affect your serum calcium level?","a":"If you are hypoparathyroid, you do not have enough PTH. Without sufficient PTH, serum calcium cannot increase and may only decrease."},{"q":"How could a radical neck dissection\/thyroidectomy affect the serum calcium level?","a":"With these two surgeries, the doctor could accidentally remove one or more of your parathyroid glands. If so, you would not have as much PTH as you used to, leading to decreased serum calcium levels."},{"q":"List five symptoms of hypocalcemia and explain why the patient has these symptoms. a. b. c. d. e.","a":"A. Muscle tone – rigid and tight due to decreased sedative effect. B. Laryngospasm – airway smooth muscle lacks sedative. C. Positive Chvostek's sign – muscles are tight due to lack of sedative. D. Positive Trousseau's sign – muscles are tight due to lack of sedative. E. Arrhythmias – no sedative leads to tight muscles."},{"q":"Why does the patient who is hypernatremic have dry sticky mucous membranes and why are they thirsty?","a":"They have too much Na; not enough water."},{"q":"There is one organ in the body that really does not like it when sodium is out of balance. What is it?","a":"Brain"},{"q":"What organs must be working properly to help maintain your normal potassium level in your blood?","a":"Kidneys"},{"q":"What are the major symptoms of hyperkalemia?","a":"Muscle weakness, arrhythmias."},{"q":"When a patient with a potassium imbalance has an arrhythmia, they are very dangerous. Why? What types of arrhythmias will the patient have?","a":"Life-threatening; V-tach, V-fib, asystole."},{"q":"What are the S\/S of hypokalemia?","a":"Muscle cramps, muscle weakness, arrhythmias."},{"q":"In respiratory acidosis or alkalosis, what are the problem organs?","a":"Lungs."},{"q":"In respiratory acidosis or alkalosis, who is going to compensate?","a":"Kidneys."},{"q":"In metabolic acidosis or alkalosis, what are the problem organs?","a":"Kidneys."},{"q":"In metabolic acidosis or alkalosis, who is going to compensate?","a":"Lungs."},{"q":"When you think of the lungs, what chemical needs to pop into your mind?","a":"CO2"},{"q":"When you think of the kidneys, what chemicals need to pop into your mind?","a":"Bicarb and hydrogen"},{"q":"Can CO2 be a chemical that makes you sick and be a chemical that makes you compensate?","a":"Yes"},{"q":"Can bicarb and hydrogen be chemicals that make you sick and be chemicals that make you compensate?","a":"Yes"},{"q":"What is the only way you can have a buildup of CO2 in your blood?","a":"Not exhaling properly."},{"q":"What is the only way to lower CO2 in the blood?","a":"Exhale"},{"q":"In respiratory acidosis, which organs are not working right? Who is going to compensate? How does the compensation work?","a":"Lungs. Kidneys. The bicarb level will start to go up in the arterial blood and make the pH less acidic."},{"q":"In respiratory acidosis, what has happened to the CO2 level in your blood? How did it get that way? Give examples.","a":"It has gone up. Slow or shallow breathing makes the CO2 level increase in the blood. Ex: too much narcotic, post-op, pain."},{"q":"In respiratory acidosis, how is the patient breathing? And how does this affect the CO2 level in the blood?","a":"Slowly; makes the CO2 level increase in the blood."},{"q":"In respiratory acidosis, how many days does it take for the bicarb level to change?","a":"Three days"},{"q":"What is going to happen to the bicarb level in respiratory acidosis?","a":"Increases"},{"q":"When someone gets very acidotic, what happens to their level of consciousness?","a":"Decreases: Anytime the pH is out of balance (whether it is too high or too low) the brain is unhappy."},{"q":"When you have a patient in respiratory acidosis, what is the primary thing that has to be fixed? Explain some ways this can be fixed.","a":"The breathing has to be fixed. How we fix it depends on the cause. If they have a pneumothorax...chest tubes. If they have thick pulmonary secretions...push fluids to liquefy secretions. If they have shallow respirations...turn, cough, deep breathe, incentive spirometry. Whatever it takes to fix the problem. Every patient is different."},{"q":"What are the early signs of hypoxia?","a":"Restlessness and tachycardia; not enough O2 to the brain; the heart senses that the body needs more O2, so the pulse increases to pump out more O2 to the body."},{"q":"What are late signs of hypoxia?","a":"Cyanosis (hemoglobin not being saturated); bradycardia; the heart is tired."},{"q":"Explain why the patient gets all of these symptoms.","a":"See 168 and 169."},{"q":"In respiratory alkalosis, what are the problem organs?","a":"Lungs"},{"q":"How does this chemical affect the body in regard to acidosis or alkalosis?","a":"If you have too much CO2 in the body, you will be acidotic. If you do not have enough CO2 in the body, you will be alkalotic."},{"q":"When someone is in respiratory alkalosis, what organs are going to compensate? With what chemicals are they going to compensate? Explain the compensation.","a":"Kidneys – They are going to excrete bicarb and retain hydrogen."},{"q":"When someone is in respiratory alkalosis, how do they have to be breathing?","a":"Hyperventilating. (This is what caused their problem to start with.)"},{"q":"How does their breathing throw them into alkalosis?","a":"They are exhaling out too much CO2."},{"q":"What has happened to the pH in respiratory alkalosis?","a":"Increased"},{"q":"Which organs are responsible for affecting this bicarb level?","a":"Kidneys"},{"q":"How can an overdose of aspirin induce respiratory alkalosis?","a":"Aspirin stimulates the respiratory center; therefore, making you breathe rapidly. (Blow off CO2)"},{"q":"If you have a patient who is on the ventilator and the respiratory rate is set too high, will the patient go into respiratory acidosis or respiratory alkalosis? Explain why.","a":"Respiratory alkalosis, because they are breathing off too much CO2."},{"q":"In metabolic acidosis, which organs have messed up? Therefore, what chemicals are altered?","a":"Kidneys. Bicarb and hydrogen."},{"q":"What has happened to the pH and why?","a":"Decreased. Retaining too much hydrogen and excreting too much base (bicarb)."},{"q":"Which organs are going to try to compensate? With what chemical will they compensate?","a":"Lungs; CO2."},{"q":"If you have a patient who is in acidosis, do you want that patient to retain CO2, to compensate, or do you want this patient to lose more CO2?","a":"Lose."},{"q":"CO2 is a what?","a":"Acid"},{"q":"If you have a patient in metabolic acidosis, what is going to happen to their respiratory rate and why?","a":"Increase – to blow off CO2."},{"q":"Would this be an expected reaction or would this be an adverse reaction?","a":"Expected"},{"q":"How can a DKA patient go into metabolic acidosis?","a":"In DKA, the cells are not getting enough glucose because there is not enough insulin to carry the sugar into the cell. The cells are starving, so they start breaking down fat and protein for energy. When you break down fat, you get ketones. Ketones are acids. So the patient gets acidotic."},{"q":"How can an anorexic or bulimic patient go into metabolic acidosis?","a":"When you are starving, you start breaking down fat. Fat breakdown produces ketones, and ketones are acids."},{"q":"What are ketones and how do they affect the blood?","a":"Acids – make your blood acidic."},{"q":"How can diarrhea induce metabolic acidosis?","a":"Lower GI is base; when you are losing your base in the form of diarrhea, you are left with acid."},{"q":"In any type of acidosis, what is going to happen to the serum potassium level? Therefore, what is the major electrolyte imbalance they will have and what is the major side effect they will have?","a":"Increase – hyperkalemia – muscle weakness and life-threatening arrhythmias."},{"q":"In metabolic alkalosis, which organs are messed up or altered? Therefore, what chemicals are going to be altered?","a":"Kidneys – bicarb and hydrogen."},{"q":"In metabolic alkalosis, which organs are going to compensate? What chemical are they going to compensate with?","a":"Lungs – CO2."},{"q":"In metabolic alkalosis, you know the kidneys are impaired; therefore, the lungs will compensate with CO2. Do you want this patient to retain more CO2 or lose more CO2? How will their breathing be affected by this compensation and why?","a":"Retain – their respiratory rate will decrease to retain CO2."},{"q":"How can vomiting or a NG tube suction induce metabolic alkalosis?","a":"When you lose stomach acid, you are left alkaline inside."},{"q":"Why do we have to worry about hypokalemia in the alkalotic patient?","a":"The potassium level always goes down in alkalosis."},{"q":"If someone has been burned, fluid seeps out into the tissue, why?","a":"Increased capillary permeability. (Vessels are leaking.)"},{"q":"When the fluid seeps out into the tissue, what happened to the blood pressure and the pulse? Explain why.","a":"Pulse increases to compensate for decreased volume. Blood pressure decreased because there is no volume. (Less volume = less pressure)"},{"q":"Why does the cardiac output decrease when the fluid seeps out into the tissue?","a":"Volume is decreased in the vascular space; therefore, there is less volume to pump out."},{"q":"During this phase (when the fluid is seeping out into the tissue), is this patient in a fluid volume deficit or fluid volume excess?","a":"Deficit."},{"q":"When a patient is in a fluid volume deficit, why does their urine output decrease?","a":"Either because of decreased perfusion or the kidneys are trying to hold on to what volume they have left."},{"q":"After a major burn, when fluid is seeping out into the tissue, why is it important that ADH and aldosterone are secreted?","a":"These help retain Na+ and H2O and increase vascular volume."},{"q":"What is a paralytic ileus?","a":"The GI tract shuts down."},{"q":"Why can a patient with an electrical burn have kidney failure?","a":"Toxins build up and damage the kidneys. Electricity destroys any circulation; kidneys are very vascular."},{"q":"What is a major nursing diagnosis for a patient who is receiving external radiation therapy?","a":"Alteration in skin integrity."},{"q":"List basic side effects of chemotherapy.","a":"Alopecia, decrease in appetite; nausea\/vomiting, pancytopenia, impaired taste, decreased WBC."},{"q":"What is the danger of a vesicant infiltrating?","a":"Tissue necrosis."},{"q":"What is one of the major complications post-hysterectomy and why?","a":"Hemorrhage; pelvic congestion of blood."},{"q":"When a patient has had a mastectomy, not only is the breast removed but another system is removed. What is it?","a":"The lymphatic system."},{"q":"Explain the pathophysiology behind an enlarged prostate (benign prostatic hypertrophy).","a":"The enlarged prostate is squeezing the urethra, therefore cutting off urine flow."},{"q":"What are the symptoms? Why do they get these symptoms?","a":"Hesitancy, nocturia, frequency, retention, bladder infection – because the urine pathway is blocked; the prostate restricts the urethra."},{"q":"What is another name for hypothyroidism?","a":"Myxedema."},{"q":"When someone is hypothyroid, what has happened to their thyroid hormone levels?","a":"They are decreased."},{"q":"What are the signs and symptoms of hypothyroidism?","a":"Fatigue, gastrointestinal slowing, increased weight, slow speech, cold intolerance."},{"q":"What is cretinism?","a":"Hypothyroidism present at birth (retardation can occur)."},{"q":"When somebody is hyperparathyroid, what is the major electrolyte imbalance they have?","a":"Hypercalcemia."},{"q":"Why do you have to worry about the bones of a patient with hyperparathyroidism?","a":"Because calcium is being pulled from the bones and put into the blood, leading to osteoporosis."},{"q":"Why does the hyperparathyroid patient have kidney stones?","a":"There is too much calcium in the blood."},{"q":"What is the major electrolyte imbalance a hypoparathyroid patient will have?","a":"Hypocalcemia."},{"q":"When a patient has pheochromocytoma, what is the major problem they have?","a":"There is a problem with the adrenal medulla – benign tumors that secrete norepinephrine, which increases blood pressure and heart rate."},{"q":"How does aldosterone work?","a":"It makes you retain sodium and water."},{"q":"If a patient is making too much aldosterone, what is going to happen to the vascular space? Explain why.","a":"Blood volume increases due to retaining sodium and water."},{"q":"Explain briefly the basic pathophysiology of Addison’s disease.","a":"The body doesn’t have enough steroid (aldosterone) – sodium and water are lost, and potassium is retained (think shock and hyperkalemia)."},{"q":"When you think of Addison’s disease, what is the chemical I told you to focus on?","a":"Aldosterone."},{"q":"What is the major electrolyte imbalance a patient with Addison’s disease will have?","a":"Hyperkalemia."},{"q":"What are the signs and symptoms of hyperkalemia?","a":"Muscle weakness, decreased bowel sounds, anorexia, gastrointestinal upset, and arrhythmias."},{"q":"Why does the Addison’s disease patient have trouble with shock?","a":"Losing volume; not enough aldosterone."},{"q":"What happens to the Addison’s disease patient’s blood pressure?","a":"Decreases"},{"q":"When a patient has Cushing’s syndrome, explain briefly, in your own words, what they will look like?","a":"Moon face, buffalo hump, women with male traits, fluid volume excess, skinny arms\/legs, large abdomen."},{"q":"Why does the Cushing’s syndrome patient experience the following? a. Growth arrest b. Thin extremities and skin c. Increased risk for infection d. Hyperglycemia e. Psychosis to depression (changes in mood)","a":"Too many glucocorticoids will result in all these situations."},{"q":"Why does the Cushing’s syndrome patient develop high blood pressure?","a":"Fluid volume excess."},{"q":"Why does the Cushing’s syndrome patient develop congestive heart failure?","a":"Because they are in a fluid volume excess."},{"q":"Why does the Cushing’s syndrome patient have ketones in their urine and glucose in their urine?","a":"Sugar – because insulin is inhibited and blood sugar increases and excess spills into urine. Fats are being broken down and this produces ketones."},{"q":"Why does the Cushing’s syndrome patient not have protein in their urine? Is it normal to have protein in the urine?","a":"It’s not normal – only have protein if there is glomerular damage. The Cushing’s patient does not have glomerular damage."},{"q":"In the diabetic patient, why does the glucose build up in their blood?","a":"Because there is no insulin."},{"q":"In the diabetic patient, why does their body start breaking down protein and fat?","a":"The cells are starving for energy, so we try to get energy from other sources."},{"q":"Anytime you break down fat, you are going to get production of what?","a":"Ketones"},{"q":"Ketones are what?","a":"Acids"},{"q":"What is the major acid-base imbalance the diabetic patient can develop and explain why.","a":"Metabolic acidosis. Because fat is being broken down for energy and this produces ketones which are acids; therefore, more acids in the blood."},{"q":"Why does the diabetic develop the following symptoms? a. Polyuria b. Weight loss c. Polydipsia d. Polyphagia","a":"a. Kidneys are trying to excrete glucose. b. Losing a lot of fluid. c. They have excessive thirst from losing volume. d. They are hungry because brain cells are starving."},{"q":"Why does a Type II diabetic have problems with wounds that will not heal or repeated vaginal infections?","a":"Blood sugar is high and bacteria can grow rampantly."},{"q":"Why are diabetics prone to coronary artery disease?","a":"There is a lot of glucose in the blood and it deposits just like fat (arteriosclerosis occurs)."},{"q":"What is going to happen to anybody’s blood sugar when they are sick or stressed?","a":"Increase"},{"q":"If a diabetic patient gets sick and they do not increase the dose of their insulin, what are they going to go into (major complication)?","a":"DKA"},{"q":"Why is hypoglycemia considered to be more dangerous than hyperglycemia?","a":"Because brain cells need glucose to survive."},{"q":"If you walk into a diabetic patient’s room and they are unconscious, do you treat the patient like they are hypoglycemic or hyperglycemic?","a":"Hypoglycemic"},{"q":"Why does the diabetic patient sometimes develop Kussmaul’s respirations?","a":"They are trying to blow off CO2 to compensate for the acidosis."},{"q":"Explain the basic pathophysiology behind diabetic ketoacidosis.","a":"Not enough insulin – blood sugar increases – polyuria, polydipsia, polyphagia – fat breakdown (acidosis) – Kussmaul’s respirations."},{"q":"When you get a diabetic ketoacidosis patient into the hospital, they may have polyuria, anuria, or oliguria. Please explain, in the proper sequence, why the patient starts with polyuria, then converts to oliguria and anuria.","a":"Polyuria – trying to get rid of sugar in the body. Polyuria causes vascular volume to decrease. Kidneys aren’t being perfused as well, so oliguria occurs and possibly anuria could occur."},{"q":"What could the patient’s blood sugar be with DKA?","a":"Increased >"},{"q":"Diabetic patients have problems with their vascular system. Why? Give examples.","a":"They have poor circulation everywhere due to increased sugar deposition. Sugar deposits like fat (retinopathy, kidney problems, nerve damage, amputations)."},{"q":"What is cardiac output?","a":"The amount of blood being pumped out of the left ventricle with each beat."},{"q":"If your cardiac output is decreased, do you perfuse as well as you normally do?","a":"No"},{"q":"If you are taking care of a patient with decreased cardiac output, what is going to happen to their level of consciousness?","a":"Decrease"},{"q":"Could they start complaining of chest pain?","a":"Yes"},{"q":"Why does a patient’s (whose cardiac output is low) skin feel cool and clammy?","a":"Because there is no perfusion. (Peripheral vasoconstriction in an effort to shunt blood to vital organs.)"},{"q":"When you are taking care of a patient who has decreased cardiac output, why do they get short of breath and have wet lung sounds?","a":"The heart is not pumping the fluid out to the body, so it backs up to the lungs."},{"q":"When you are taking care of a patient who has decreased cardiac output, why do their peripheral pulses diminish?","a":"Because the heart is not pumping out to the periphery."},{"q":"When you have a patient with decreased cardiac output, why does their blood pressure drop?","a":"Because the heart is not pumping out as much volume. Less volume = less pressure."},{"q":"How will bradycardia affect cardiac output?","a":"Decrease, because the heart is not pumping out much volume; the heart is pumping slowly."},{"q":"How can tachycardia (i.e., heart rate > 150) affect cardiac output?","a":"Decrease – ventricles can’t fill up; don’t have time to fill because the heart is beating so fast."},{"q":"When someone has had an MI, how can this affect cardiac output and why?","a":"Cardiac output decreases – dead muscle doesn’t pump well."},{"q":"If my blood pressure is really high, how will this affect cardiac output and why?","a":"Decrease – heart can’t pump as much blood out against the high pressure."},{"q":"What is preload?","a":"The amount of blood returning to the right side of the heart."},{"q":"If you increase preload, what do you do to the workload of the heart?","a":"Increase"},{"q":"List some ways preload can be increased.","a":"Trendelenburg position; hypervolemia; supine; elevate legs."},{"q":"List some ways preload can be decreased.","a":"Standing upright; hypovolemia; less volume; lower legs, raise head of bed."},{"q":"Explain afterload in your own words.","a":"Amount of pressure in the aorta that the ventricle has to pump against."},{"q":"If you increase afterload, what do you do to cardiac output?","a":"Decrease"},{"q":"If cardiac output is decreasing, that means the blood is not moving forward. If blood is not moving forward, then it has got to go backwards, so therefore where is it going to wind up?","a":"Lungs"},{"q":"What is angina?","a":"Decreased blood flow to the myocardium causing ischemia."},{"q":"Explain the pain a patient has with angina.","a":"Blood flow decreases (decreased oxygen) and causes chest pain (pressure sensation)."},{"q":"With a MI (myocardial infarction), why does the patient have necrosis?","a":"Because of decreased blood flow and oxygen to the myocardium."},{"q":"Explain how MI pain feels.","a":"Severe, non-stop pain; chest pressure; radiation to the left arm and jaw."},{"q":"Why does an MI patient get cold, clammy, and their blood pressure drop?","a":"Decreased CO (dead tissue doesn’t pump well)."}]

Part 2

Part 3

[{"q":"What is increased intracranial pressure (ICP)?","a":"A rise in pressure within the skull that reduces cerebral perfusion and compresses brain tissue."},{"q":"What are early signs of increased ICP?","a":"Headache, restlessness, confusion, and changes in level of consciousness."},{"q":"What are late signs of increased ICP?","a":"Fixed and dilated pupils, bradycardia, widened pulse pressure, and abnormal posturing."},{"q":"What is Cushing’s triad?","a":"Hypertension with widened pulse pressure, bradycardia, and irregular respirations—indicating increased ICP."},{"q":"Why should a client with increased ICP be placed in semi-Fowler’s position?","a":"To promote venous drainage from the brain without compromising perfusion."},{"q":"Why should neck flexion and tight tracheostomy ties be avoided in ICP?","a":"They impede venous return and further increase intracranial pressure."},{"q":"Why should sneezing, coughing, and the Valsalva maneuver be avoided in ICP?","a":"These actions increase thoracic pressure and raise ICP."},{"q":"Why should the environment be kept quiet for a client with increased ICP?","a":"Stimulation can increase cerebral metabolism and worsen swelling."},{"q":"Why is mannitol used for increased ICP?","a":"It is an osmotic diuretic that draws fluid from brain tissue into the bloodstream."},{"q":"Why are corticosteroids sometimes prescribed for brain tumors?","a":"To reduce cerebral edema and inflammation."},{"q":"Why is hyperventilation sometimes used temporarily in ICP management?","a":"It lowers CO₂ levels, causing cerebral vasoconstriction and decreased ICP."},{"q":"What are common causes of head injury?","a":"Motor vehicle accidents, falls, sports injuries, and assaults."},{"q":"What is the major concern after any head injury?","a":"Increased intracranial pressure and secondary brain injury."},{"q":"Why should cerebrospinal fluid leakage from nose or ears be reported immediately?","a":"It indicates a basilar skull fracture and risk for meningitis."},{"q":"How can cerebrospinal fluid be identified?","a":"It tests positive for glucose or forms a “halo” ring on absorbent material."},{"q":"Why should the head of the bed be elevated after a head injury?","a":"To reduce cerebral edema and promote venous drainage."},{"q":"Why should narcotics be used cautiously after a head injury?","a":"They may mask neurological changes."},{"q":"Why are ICP monitoring devices used?","a":"To measure and guide treatment for elevated intracranial pressure."},{"q":"What are signs of brain herniation?","a":"Dilated, non-reactive pupils, loss of brainstem reflexes, coma, and respiratory arrest."},{"q":"What does a positive Babinski reflex indicate in an adult?","a":"Severe neurological damage or brain injury."},{"q":"What is meningitis?","a":"Inflammation of the meninges surrounding the brain and spinal cord."},{"q":"What are classic signs of meningitis?","a":"Fever, headache, nuchal rigidity, photophobia, and vomiting."},{"q":"What diagnostic test confirms meningitis?","a":"Lumbar puncture showing elevated protein and low glucose in cerebrospinal fluid."},{"q":"Why should a client with suspected increased ICP never undergo lumbar puncture?","a":"It can cause brain herniation."},{"q":"What isolation precautions are used for bacterial meningitis?","a":"Droplet precautions until antibiotics have been given for at least 24 hours."},{"q":"What are signs of meningeal irritation?","a":"Positive Brudzinski’s and Kernig’s signs."},{"q":"Why is broad-spectrum antibiotic therapy started immediately in meningitis?","a":"To reduce morbidity and mortality before culture results return."},{"q":"What is the priority nursing action when a client has a seizure?","a":"Protect the airway, turn the client on the side, and note the time and duration of the seizure."},{"q":"What should never be done during a seizure?","a":"Do not restrain the client or place anything in the mouth."},{"q":"What is status epilepticus?","a":"Continuous or recurrent seizures without recovery between episodes, lasting more than 5 minutes."},{"q":"What is the immediate treatment for status epilepticus?","a":"Administer benzodiazepines such as lorazepam or diazepam."},{"q":"What safety measures should be implemented for clients with seizure disorders?","a":"Padded side rails, bed in lowest position, and suction and oxygen equipment at bedside."},{"q":"What are potential complications of spinal cord injury?","a":"Paralysis, autonomic dysreflexia, infection, and impaired bladder and bowel control."},{"q":"What is autonomic dysreflexia?","a":"A life-threatening sympathetic response to stimuli below a spinal injury, causing hypertension and bradycardia."},{"q":"What are common triggers of autonomic dysreflexia?","a":"Bladder distention, fecal impaction, or tight clothing."},{"q":"What is the immediate nursing action for autonomic dysreflexia?","a":"Sit the client upright, remove the stimulus, and notify the provider."},{"q":"What are signs of autonomic dysreflexia?","a":"Sudden severe headache, flushed face, nasal congestion, sweating above the lesion, and piloerection."},{"q":"What is the goal of rehabilitation after spinal cord injury?","a":"To maximize independence and prevent complications such as contractures and pressure injuries."},{"q":"Why is temperature regulation affected after spinal cord injury?","a":"Loss of sympathetic control prevents normal vasodilation and sweating."},{"q":"What is the Glasgow Coma Scale used for?","a":"To assess the level of consciousness based on eye, verbal, and motor responses."},{"q":"What score on the Glasgow Coma Scale indicates a coma?","a":"A score of 8 or less."},{"q":"What does decorticate posturing indicate?","a":"Damage to the cerebral hemispheres."},{"q":"What does decerebrate posturing indicate?","a":"Damage to the brainstem and a more severe injury."},{"q":"Why is temperature control critical in clients with brain injury?","a":"Fever increases cerebral metabolism and oxygen demand."},{"q":"Why should hypotonic fluids be avoided in clients with increased ICP?","a":"They increase cerebral edema by allowing fluid to shift into brain tissue."},{"q":"Which IV solution is safest for a client with head trauma?","a":"Isotonic saline (0.9% NaCl)."},{"q":"Why is frequent neurological assessment essential after head injury?","a":"To detect early signs of deterioration and prevent secondary brain injury."},{"q":"What is thoracentesis?","a":"A procedure to remove fluid or air from the pleural space using a needle inserted into the chest wall."},{"q":"Why is a thoracentesis performed?","a":"To relieve pressure, improve breathing, and obtain fluid for diagnostic testing."},{"q":"What position should the client be in for a thoracentesis?","a":"Sitting upright, leaning forward over a bedside table to expand the intercostal spaces."},{"q":"What should be done before a thoracentesis?","a":"Obtain informed consent and baseline vital signs."},{"q":"What should be done after a thoracentesis?","a":"Apply a sterile dressing, monitor breath sounds, and assess for pneumothorax."},{"q":"What is a pneumothorax?","a":"Air in the pleural space that collapses the lung."},{"q":"What are signs of pneumothorax?","a":"Shortness of breath, decreased breath sounds on one side, and unequal chest expansion."},{"q":"What is a tension pneumothorax?","a":"Air enters the pleural space and cannot escape, causing pressure on the heart and opposite lung."},{"q":"What are signs of tension pneumothorax?","a":"Severe respiratory distress, tracheal deviation, distended neck veins, and hypotension."},{"q":"What is the immediate treatment for a tension pneumothorax?","a":"Insert a large-bore needle into the second intercostal space to release trapped air."},{"q":"What is a hemothorax?","a":"Accumulation of blood in the pleural space."},{"q":"Why is a chest tube inserted?","a":"To remove air, fluid, or blood from the pleural space and re-expand the lung."},{"q":"What are the three chambers of a chest drainage system?","a":"Collection chamber, water seal chamber, and suction control chamber."},{"q":"What does continuous bubbling in the water seal chamber indicate?","a":"An air leak."},{"q":"What should be done if continuous bubbling is observed in the water seal chamber?","a":"Check for air leaks and secure all connections."},{"q":"What does tidaling in the water seal chamber indicate?","a":"Normal fluctuation of fluid with respiration, showing the system is patent."},{"q":"Why should the chest drainage system be kept below the level of the chest?","a":"To prevent fluid from flowing back into the pleural space."},{"q":"What should be done if the chest tube becomes disconnected?","a":"Place the end in sterile water to restore the water seal temporarily."},{"q":"What should be done if the chest tube is accidentally pulled out?","a":"Cover the site with a gloved hand or occlusive dressing and call the provider."},{"q":"Why is daily chest X-ray important for clients with chest tubes?","a":"To confirm lung re-expansion and tube position."},{"q":"What is the purpose of thoracentesis fluid analysis?","a":"To identify infection, cancer, or cause of effusion."},{"q":"Why is coughing and deep breathing encouraged after thoracic surgery?","a":"To prevent atelectasis and pneumonia."},{"q":"Why should incentive spirometry be used after surgery?","a":"To promote lung expansion and improve oxygenation."},{"q":"What are signs of respiratory distress?","a":"Restlessness, tachypnea, use of accessory muscles, and cyanosis."},{"q":"What is pulmonary embolism (PE)?","a":"A blockage in a pulmonary artery, usually caused by a blood clot."},{"q":"What are classic signs of pulmonary embolism?","a":"Sudden dyspnea, chest pain, tachycardia, anxiety, and low oxygen saturation."},{"q":"Why is the client with PE placed in high Fowler’s position?","a":"To maximize lung expansion and improve oxygen exchange."},{"q":"What is the immediate treatment for pulmonary embolism?","a":"Administer oxygen, anticoagulants, and possibly thrombolytics."},{"q":"What medication prevents pulmonary embolism?","a":"Heparin or enoxaparin."},{"q":"What is a common side effect of heparin therapy?","a":"Bleeding."},{"q":"What is the antidote for heparin overdose?","a":"Protamine sulfate."},{"q":"What is acute respiratory distress syndrome (ARDS)?","a":"A sudden, severe form of respiratory failure due to noncardiac pulmonary edema."},{"q":"What are common causes of ARDS?","a":"Sepsis, trauma, near drowning, and aspiration."},{"q":"What is a key finding on a chest X-ray in ARDS?","a":"Bilateral “white-out” infiltrates."},{"q":"Why is oxygen alone often insufficient in ARDS?","a":"The alveoli are filled with fluid and cannot participate in gas exchange effectively."},{"q":"What is the purpose of mechanical ventilation in ARDS?","a":"To maintain oxygenation and reduce the work of breathing."},{"q":"What is PEEP?","a":"Positive End-Expiratory Pressure—maintains alveolar inflation and improves oxygenation."},{"q":"Why can high levels of PEEP be dangerous?","a":"They can decrease cardiac output and cause barotrauma."},{"q":"What is CPAP?","a":"Continuous Positive Airway Pressure—provides constant airway pressure for spontaneous breathing clients."},{"q":"What is BiPAP?","a":"Bilevel Positive Airway Pressure—provides higher pressure during inspiration and lower pressure during expiration."},{"q":"Why should suctioning be limited in clients on ventilators?","a":"It increases ICP and causes hypoxia if prolonged."},{"q":"Why is mouth care important for ventilated clients?","a":"To prevent ventilator-associated pneumonia (VAP)."},{"q":"What are early signs of hypoxia?","a":"Restlessness, anxiety, and tachycardia."},{"q":"What are late signs of hypoxia?","a":"Cyanosis and bradycardia."},{"q":"Why is the tripod position used in respiratory distress?","a":"It helps expand the chest and ease breathing effort."},{"q":"What is the difference between hypoxemia and hypoxia?","a":"Hypoxemia is low oxygen in the blood; hypoxia is low oxygen in the tissues."},{"q":"Why is oxygen humidified when delivered by nasal cannula?","a":"To prevent drying and irritation of the nasal mucosa."},{"q":"What is the maximum safe oxygen flow rate for a client with COPD?","a":"2 liters per minute, to avoid suppressing the respiratory drive."},{"q":"Why is pursed-lip breathing taught to COPD clients?","a":"It prolongs exhalation and prevents airway collapse."},{"q":"Why is postural drainage used?","a":"To mobilize secretions and improve airway clearance."},{"q":"What is the purpose of chest physiotherapy?","a":"To loosen and move secretions from the lungs."},{"q":"What should be done before chest physiotherapy?","a":"Administer a bronchodilator to open airways."},{"q":"Why are clients with respiratory disease encouraged to stop smoking?","a":"Smoking damages cilia, reduces oxygenation, and increases infection risk."},{"q":"What is the best indicator of respiratory improvement?","a":"Rising oxygen saturation and reduced work of breathing."},{"q":"Why must fractures be immobilized promptly?","a":"To prevent further tissue damage, bleeding, and displacement."},{"q":"What type of embolus is a concern after a long bone fracture?","a":"Fat embolus."},{"q":"What are signs of a fat embolus?","a":"Petechiae on the chest, hypoxia, confusion, and patchy infiltrates on chest x-ray, usually within 24–72 hours."},{"q":"How should an open fracture be managed initially?","a":"Cover it with a sterile dressing to reduce contamination and bleeding."},{"q":"What is a neurovascular check?","a":"Assessment of circulation, movement, sensation, capillary refill, and pulses distal to an injury."},{"q":"What are the 5 Ps of neurovascular assessment?","a":"Pain, pallor, pulselessness, paresthesia, and paralysis."},{"q":"What is compartment syndrome?","a":"Increased pressure within a muscle compartment that compromises circulation and tissue viability."},{"q":"What is the first nursing action if compartment syndrome is suspected?","a":"Loosen the cast or bandage and notify the provider urgently."},{"q":"Why is traction used in orthopedics?","a":"To align fractures, reduce muscle spasms, and maintain immobilization."},{"q":"What must remain free when using traction weights?","a":"The weights must hang freely to provide continuous traction."},{"q":"What is the difference between skin and skeletal traction?","a":"Skin traction uses straps or boots on the skin; skeletal traction uses pins or wires inserted into bone."},{"q":"What is pin care and why is it necessary?","a":"Sterile cleaning around skeletal traction pins to prevent infection."},{"q":"Why is elevation important after amputation (first 24 hours)?","a":"To reduce edema and bleeding."},{"q":"What is phantom limb pain?","a":"Pain perceived in the limb that was amputated; a real and treatable phenomenon."},{"q":"How can phantom limb pain be managed?","a":"Analgesics, mirror therapy, and nonpharmacologic interventions such as distraction."},{"q":"What is the purpose of a continuous passive motion (CPM) machine after joint replacement?","a":"To promote joint mobility and prevent stiffness."},{"q":"Why must hip replacement clients avoid certain positions?","a":"To prevent dislocation—avoid extreme flexion, adduction, and internal rotation as ordered."},{"q":"What are important cast care instructions?","a":"Keep the cast dry, avoid inserting objects, use palms for the first 24 hours, and monitor for increased pain or swelling."},{"q":"What is the priority assessment after applying a cast?","a":"Neurovascular checks distal to the cast including pulses, color, temperature, capillary refill, and sensation."},{"q":"How do you recognize a dislocated prosthetic hip?","a":"Sudden pain, limb shortening, and inability to move the extremity."},{"q":"Why must the residual limb be elevated after amputation?","a":"To reduce edema and promote venous return."},{"q":"When should a tourniquet be available after amputation?","a":"Immediately at bedside in case of hemorrhage."},{"q":"What are expected long-term concerns after orthopedic surgery?","a":"Risk of deep vein thrombosis, infection, impaired mobility, and chronic pain."},{"q":"How is DVT prevented after orthopedic surgery?","a":"Early ambulation, anticoagulation as ordered, and compression devices."},{"q":"What is osteomyelitis and how is it treated?","a":"Bone infection treated with prolonged IV antibiotics and sometimes surgical debridement."},{"q":"Why is pin site redness and drainage significant?","a":"It may indicate infection requiring prompt attention."},{"q":"What should be done if a cast feels tight and circulation is compromised?","a":"Elevate the extremity, open or bivalve the cast per protocol, and notify the provider."},{"q":"What is the major cause of glomerulonephritis?","a":"A streptococcal infection, often following strep throat or skin infection."},{"q":"What happens to urine output in glomerulonephritis?","a":"It decreases due to impaired renal filtration."},{"q":"What are the typical signs of glomerulonephritis?","a":"Hematuria, proteinuria, edema, hypertension, and dark (cola-colored) urine."},{"q":"Why does blood pressure increase in glomerulonephritis?","a":"Fluid retention and sodium accumulation increase vascular volume."},{"q":"Why does BUN and creatinine rise in glomerulonephritis?","a":"The kidneys cannot adequately excrete waste products."},{"q":"Why is rest important in glomerulonephritis?","a":"To promote renal recovery and reduce metabolic demand on the kidneys."},{"q":"What diet is recommended for glomerulonephritis?","a":"Low sodium and low protein to control edema and reduce waste buildup."},{"q":"Why should clients with glomerulonephritis monitor weight daily?","a":"Weight gain may indicate fluid retention."},{"q":"What is the primary nursing concern during the oliguric phase of renal disease?","a":"Fluid volume excess and hyperkalemia."},{"q":"What is nephrotic syndrome?","a":"A condition causing massive protein loss in urine due to glomerular damage."},{"q":"What is the main symptom of nephrotic syndrome?","a":"Generalized edema (anasarca) due to hypoalbuminemia."},{"q":"Why does hypoalbuminemia occur in nephrotic syndrome?","a":"Protein leaks into the urine through damaged glomeruli."},{"q":"Why are corticosteroids prescribed in nephrotic syndrome?","a":"To reduce inflammation and decrease protein loss."},{"q":"What type of diet is recommended for nephrotic syndrome?","a":"High protein (to replace losses) and low sodium (to reduce edema)."},{"q":"Why does nephrotic syndrome cause risk for blood clots?","a":"Loss of proteins alters coagulation, increasing clotting tendency."},{"q":"What happens to urine specific gravity in renal failure?","a":"It may become fixed and unresponsive to fluid changes."},{"q":"Why does renal failure cause anemia?","a":"The kidneys fail to produce enough erythropoietin, reducing red blood cell production."},{"q":"Why does renal failure cause pruritus (itching)?","a":"Urea and waste products accumulate in the blood and excrete through the skin."},{"q":"Why is phosphorus restricted in renal failure?","a":"To prevent hypocalcemia and bone demineralization."},{"q":"Why does renal failure cause osteoporosis?","a":"Phosphorus retention lowers calcium, stimulating bone resorption."},{"q":"What electrolyte imbalance is most dangerous in renal failure?","a":"Hyperkalemia, which can cause life-threatening arrhythmias."},{"q":"Why must potassium levels be monitored closely in renal clients?","a":"Elevated potassium can cause cardiac arrest."},{"q":"What is dialysis?","a":"A treatment that filters waste products and fluid from the blood when kidneys cannot."},{"q":"What is hemodialysis?","a":"Blood is circulated through a machine that removes toxins and excess fluid."},{"q":"How often is hemodialysis performed?","a":"Usually three times per week."},{"q":"Why is heparin used during hemodialysis?","a":"To prevent clotting in the dialysis circuit."},{"q":"What is the antidote for heparin?","a":"Protamine sulfate."},{"q":"Why should blood pressure and weight be measured before and after dialysis?","a":"To assess fluid removal and hemodynamic stability."},{"q":"Why must a bruit and thrill be checked in an AV fistula or graft?","a":"They indicate patency and blood flow through the access."},{"q":"What are safety precautions for an arm with an AV fistula or graft?","a":"No blood draws, IVs, or blood pressure measurements in that arm."},{"q":"What is peritoneal dialysis?","a":"Dialysis using the peritoneal membrane as a filter inside the abdominal cavity."},{"q":"What is the most common complication of peritoneal dialysis?","a":"Peritonitis, indicated by cloudy dialysate, fever, or abdominal pain."},{"q":"What should peritoneal dialysis outflow look like?","a":"Clear and straw-colored; cloudy fluid indicates infection."},{"q":"What should be done if outflow is less than inflow during peritoneal dialysis?","a":"Reposition the client or have them turn side to side."},{"q":"Why should the peritoneal dialysis client increase protein intake?","a":"Protein is lost during each dialysis exchange."},{"q":"Why should the peritoneal dialysis client increase fiber intake?","a":"Constipation can interfere with dialysate flow."},{"q":"What are signs of renal calculi (kidney stones)?","a":"Severe flank pain, hematuria, nausea, and vomiting."},{"q":"Why is fluid intake increased for kidney stones?","a":"To help flush the urinary tract and prevent stone formation."},{"q":"What are common causes of kidney stones?","a":"Dehydration, high calcium or uric acid levels, and infection."},{"q":"What are signs of urinary tract infection (UTI)?","a":"Dysuria, frequency, urgency, suprapubic pain, and cloudy urine."},{"q":"Why are women more prone to UTIs?","a":"The female urethra is shorter and closer to the anus."},{"q":"What are ways to prevent UTIs?","a":"Drink fluids, void frequently, wipe front to back, and avoid tight clothing."},{"q":"Why is phenazopyridine prescribed in UTIs?","a":"It relieves urinary discomfort but causes orange-colored urine."},{"q":"What is the best indicator of kidney function?","a":"Serum creatinine level."},{"q":"Why is creatinine more reliable than BUN?","a":"It is not affected by diet or hydration status."},{"q":"What does an elevated creatinine level indicate?","a":"Impaired kidney function or renal failure."},{"q":"If someone has been burned, fluid seeps out into the tissue. Why?","a":"Because of increased capillary permeability causing vessels to leak."},{"q":"When fluid seeps into the tissue, what happens to the blood pressure and pulse? Explain why.","a":"Pulse increases to compensate for the decreased volume, while blood pressure decreases because of fluid loss."},{"q":"Why does cardiac output decrease when fluid seeps out into the tissue?","a":"There is less volume in the vascular space, so the heart pumps out less blood."},{"q":"During this phase, is the client in a fluid volume deficit or fluid volume excess?","a":"Fluid volume deficit."},{"q":"When a client is in a fluid volume deficit, why does urine output decrease?","a":"Decreased renal perfusion causes the kidneys to conserve fluid."},{"q":"After a major burn, why is it important that ADH and aldosterone are secreted?","a":"They help retain sodium and water, increasing vascular volume."},{"q":"What is the treatment for carbon monoxide poisoning? Explain why.","a":"100% oxygen, because it replaces carbon monoxide on hemoglobin and corrects hypoxia."},{"q":"When a client has upper body burns, why is the airway a concern?","a":"Airway damage and edema can occur, leading to obstruction."},{"q":"What are the signs of airway injury in a burn client?","a":"Singed nasal or facial hair, soot on the face, dark secretions, coughing black mucus, or oral blisters."},{"q":"Explain the Rule of Nines.","a":"It estimates body surface area burned: Head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, genitalia 1%."},{"q":"Using the Consensus formula, what percentage of fluid is given in the first 8, 16, and 24 hours?","a":"Give half of total fluid in first 8 hours, one-fourth in the second 8 hours, and one-fourth in the last 8 hours."},{"q":"What is the best measurement to evaluate fluid volume status in a burn client?","a":"Daily intake and output measurements."},{"q":"How does IV albumin help treat shock?","a":"It increases oncotic pressure and holds fluid in the vascular space."},{"q":"Explain the difference between tetanus toxoid and tetanus immune globulin.","a":"Toxoid provides active immunity by forming antibodies; immune globulin provides immediate passive immunity with injected antibodies."},{"q":"What is the purpose of an escharotomy?","a":"To relieve pressure and restore circulation in burned tissue."},{"q":"Which electrolyte imbalance is common after burns?","a":"Hyperkalemia, because damaged cells release potassium into the blood."},{"q":"Why do burn clients receive GI protectants such as antacids or PPIs?","a":"To prevent stress ulcers."},{"q":"What is the purpose of checking gastric residual in burn clients?","a":"To ensure feeding tolerance and that the GI tract is moving."},{"q":"Why are multiple antibiotics used in burn treatment?","a":"To prevent bacterial resistance."},{"q":"In an electrical burn, what arrhythmia is the client at highest risk for?","a":"Ventricular fibrillation."},{"q":"How long is a client with an electrical burn at risk for life-threatening arrhythmias?","a":"For the first 24 hours."},{"q":"Why can electrical burn clients develop kidney failure?","a":"Muscle breakdown releases toxins that damage the kidneys."},{"q":"What are the two types of cancer?","a":"Solid tumors and hematologic malignancies."},{"q":"What is the number one cause of preventable cancer?","a":"Tobacco use."},{"q":"What is the most important risk factor for cancer?","a":"Aging."},{"q":"Name three examples of primary prevention for cancer.","a":"Avoid smoking, exercise regularly, maintain normal weight, limit alcohol, get vaccinated for Hepatitis B and HPV, and avoid carcinogens."},{"q":"Name three examples of secondary prevention for women.","a":"Monthly breast self-exam starting at 20, yearly clinical exam after 40, Pap smear starting at 21, colonoscopy at 50, and yearly fecal occult blood test at 50."},{"q":"Name three examples of secondary prevention for men.","a":"Testicular self-exam, annual clinical exam, PSA and digital rectal exam starting at 50, colonoscopy every 10 years, fecal occult blood yearly."},{"q":"Give two examples of tertiary prevention for cancer clients.","a":"Support groups and rehabilitation programs."},{"q":"What does the acronym CAUTION stand for in cancer warning signs?","a":"Change in bowel\/bladder habits, A sore that doesn’t heal, Unusual bleeding\/discharge, Thickening\/lump, Indigestion\/difficulty swallowing, Obvious change in mole, Nagging cough\/hoarseness."},{"q":"What is the number one symptom reported by cancer clients?","a":"Fatigue."},{"q":"Why does a total laryngectomy client need a tracheostomy?","a":"Because the epiglottis and airway protection are removed."},{"q":"Why should the laryngectomy client be positioned in Fowler’s position?","a":"To decrease edema around the airway."},{"q":"Why are NG feedings used for the laryngectomy client?","a":"To protect the surgical suture line."},{"q":"Why must the laryngectomy client have frequent mouth care?","a":"To prevent bacterial migration to the lungs or surgical site."},{"q":"Which activities are restricted for a client with a total laryngectomy?","a":"No whistling, no drinking through a straw, no smoking, and no swimming."},{"q":"What are the three primary goals of cancer treatment?","a":"Cure, control, and palliation."},{"q":"List four purposes of surgery in cancer care.","a":"Prevention, diagnosis, treatment, and reconstruction."},{"q":"Describe postoperative care after mastectomy.","a":"Elevate affected arm, protect from injury, encourage exercises like wall climbing or squeezing a ball, and monitor for bleeding."},{"q":"Why elevate the arm on the affected side after mastectomy?","a":"To promote lymphatic drainage and prevent swelling."},{"q":"Why encourage exercise after mastectomy?","a":"To promote circulation and mobility."},{"q":"Give discharge precautions after mastectomy.","a":"No blood pressure or injections in the affected arm, wear gloves for gardening, avoid cuts or injuries."},{"q":"What three factors determine if cancer surgery was successful?","a":"Whether all cancer was removed, if spread was present, and if margins were adequate."},{"q":"What are the three main radiation safety principles?","a":"Time, distance, and shielding."},{"q":"How should nurses be assigned to internal radiation clients?","a":"Rotate daily, and one nurse should care for only one radiation client per shift."},{"q":"Why is a low-fiber diet prescribed for internal radiation clients?","a":"To prevent bowel distention and dislodgment of the implant."},{"q":"Why does the client have an indwelling catheter during internal radiation?","a":"To prevent bladder distention that could dislodge the implant."},{"q":"Why must the client be on bed rest during internal radiation?","a":"To avoid implant displacement."},{"q":"What should be done if a radiation implant becomes dislodged?","a":"Use forceps to place it in a lead container and notify the radiation department."},{"q":"How should the nurse care for markings from external radiation?","a":"Do not wash or apply lotion; protect the area from sunlight and UV exposure for one year."},{"q":"List common side effects of chemotherapy.","a":"Alopecia, nausea, vomiting, anorexia, pancytopenia, and impaired taste."},{"q":"Which body systems are most affected by chemotherapy?","a":"Blood, gastrointestinal, skin, and hair systems."},{"q":"What equipment is needed when handling chemotherapy drugs?","a":"Chemotherapy gown, double gloves, and goggles or mask if splashing risk exists."},{"q":"How is a chemotherapy spill managed?","a":"Use a chemo spill kit with protective equipment and dispose of waste in yellow chemo containers."},{"q":"What is a vesicant?","a":"A chemo drug that causes tissue necrosis if it infiltrates."},{"q":"What should be done if a vesicant infiltrates?","a":"Stop the infusion and apply ice packs to reduce absorption."},{"q":"What are signs of organ transplant rejection?","a":"Abdominal pain, nausea, vomiting, jaundice, dark urine, rash, or itching."},{"q":"List six ways to prevent infection in a chemotherapy client.","a":"Private room, strict hand hygiene, limit visitors, change IV dressings daily, no fresh plants or raw fruits, monitor temperature closely."},{"q":"What is the best way to assess neutropenia?","a":"Calculate the absolute neutrophil count (ANC)."},{"q":"List three risk factors for neutropenia.","a":"Advanced cancer, malnutrition, and certain chemotherapy drugs."},{"q":"Why are cancer clients at risk for deep vein thrombosis?","a":"Prolonged bedrest, tumor compression, or certain chemotherapy agents."},{"q":"What should be assessed for thrombocytopenia?","a":"Bleeding, petechiae, bruising, headache, or changes in level of consciousness."},{"q":"What does leukoreduction do?","a":"Makes blood products CMV-negative and safer for immunocompromised clients."},{"q":"List nonpharmacologic treatments for chemotherapy-induced nausea and vomiting.","a":"Ginger, aromatherapy, acupuncture, relaxation, and distraction."},{"q":"What drug class is the gold standard for cancer pain?","a":"Opioids."},{"q":"List accepted complementary therapies for cancer pain.","a":"Acupuncture, massage, hydrotherapy, distraction, and cannabis."},{"q":"What are the major symptoms of hyperthyroidism?","a":"Nervousness, weight loss, heat intolerance, excessive sweating, exophthalmos, increased appetite, rapid gastrointestinal activity, hypertension, irritability, and decreased attention span."},{"q":"What is the most common cause of hyperthyroidism?","a":"Graves’ disease."},{"q":"Why do clients develop symptoms of hyperthyroidism?","a":"Because of excess production of thyroid hormones (T3 and T4), which accelerate metabolic activity."},{"q":"What happens to the heart’s workload in hyperthyroidism?","a":"It increases due to elevated heart rate and blood pressure."},{"q":"What dietary element is required to make thyroid hormones?","a":"Iodine."},{"q":"How do antithyroid drugs work?","a":"They inhibit the synthesis of thyroid hormones, reducing excessive hormone production."},{"q":"Give two examples of antithyroid drugs.","a":"Methimazole and propylthiouracil (PTU)."},{"q":"Why are iodine compounds given preoperatively for thyroid surgery?","a":"To reduce thyroid vascularity and minimize bleeding risk during surgery."},{"q":"Why should iodine solutions be given with milk or juice and a straw?","a":"To prevent staining of the teeth."},{"q":"Why are beta blockers prescribed for hyperthyroid clients?","a":"To reduce heart rate, blood pressure, and anxiety associated with increased adrenergic activity."},{"q":"How does radioactive iodine therapy work?","a":"It destroys overactive thyroid cells to reduce hormone production."},{"q":"What is a major complication of radioactive iodine therapy?","a":"Thyroid storm due to rebound hyperthyroidism."},{"q":"After a thyroidectomy, why should clients support their neck when moving?","a":"To prevent tension on the surgical suture line."},{"q":"In what position should a thyroidectomy client be placed?","a":"Fowler’s position to reduce neck edema."},{"q":"Why check for bleeding behind the neck after thyroidectomy?","a":"Blood may pool posteriorly and cause airway compression."},{"q":"Why must a tracheostomy set be kept at the bedside after thyroidectomy?","a":"In case of airway obstruction from swelling or laryngospasm."},{"q":"How is recurrent laryngeal nerve damage assessed after thyroid surgery?","a":"By listening for hoarseness or voice changes."},{"q":"Why assess for accidental parathyroid removal during thyroidectomy?","a":"Because parathyroids are near the thyroid and may be removed accidentally, causing hypocalcemia."},{"q":"What are signs of parathyroid removal or hypocalcemia?","a":"Muscle rigidity, tetany, positive Trousseau’s and Chvostek’s signs."},{"q":"Why is a quiet environment important for hypocalcemic clients?","a":"To minimize stimulation and prevent seizures."},{"q":"Why should a tracheostomy tray be available for hypocalcemic clients?","a":"Because laryngospasm can occur from hypocalcemia, leading to airway obstruction."},{"q":"Why should a hypoparathyroid client follow a low-phosphorus diet?","a":"Because serum phosphorus is already elevated."},{"q":"What is the main problem in pheochromocytoma?","a":"Tumors of the adrenal medulla secrete excessive epinephrine and norepinephrine, causing hypertension and tachycardia."},{"q":"What diagnostic test is used for pheochromocytoma?","a":"The 24-hour urine test for vanillylmandelic acid (VMA), which measures catecholamine levels."},{"q":"What are the four main effects of glucocorticoids?","a":"They alter mood, break down proteins and fats, suppress the immune response, and inhibit insulin."},{"q":"What is the key function of mineralocorticoids?","a":"Sodium and water retention through aldosterone."},{"q":"Why do steroids increase blood glucose levels?","a":"They inhibit insulin, leading to higher serum glucose."},{"q":"If a client produces too much aldosterone, what happens to the vascular space?","a":"Blood volume increases due to sodium and water retention."},{"q":"Briefly explain Addison’s disease.","a":"The adrenal glands fail to produce enough corticosteroids, leading to sodium and water loss, potassium retention, and risk of shock."},{"q":"What electrolyte imbalance occurs in Addison’s disease?","a":"Hyperkalemia."},{"q":"What are the signs and symptoms of hyperkalemia?","a":"Muscle weakness, decreased bowel sounds, nausea, arrhythmias, and cardiac irregularities."},{"q":"Why can Addison’s disease cause life-threatening arrhythmias?","a":"Because of dangerously high potassium levels."},{"q":"Why does Addison’s disease cause shock?","a":"Loss of sodium and water leads to hypovolemia and hypotension."},{"q":"Why does the Addison’s client need more sodium in their diet?","a":"To help retain vascular volume and prevent dehydration."},{"q":"Why is strict intake and output monitoring essential in Addison’s disease?","a":"Because of the severe risk of fluid imbalance."},{"q":"What happens to blood pressure in Addison’s disease?","a":"It decreases due to hypovolemia."},{"q":"Describe the appearance of a client with Cushing’s syndrome.","a":"Moon face, buffalo hump, thin arms and legs, central obesity, and fluid retention."},{"q":"Explain why Cushing’s clients experience thin skin and muscle wasting.","a":"Because cortisol causes protein breakdown and muscle catabolism."},{"q":"Why are Cushing’s clients at high risk for infection?","a":"Cortisol suppresses immune and inflammatory responses."},{"q":"Why do Cushing’s clients have high blood sugar levels?","a":"Because cortisol promotes gluconeogenesis and insulin resistance."},{"q":"Why is the Cushing’s client often hypertensive?","a":"Excess aldosterone causes sodium and water retention, increasing blood volume and pressure."},{"q":"Why is serum potassium low in Cushing’s syndrome?","a":"Aldosterone promotes potassium excretion."},{"q":"Why do Cushing’s clients need extra dietary calcium?","a":"Because steroids increase calcium loss through the GI tract, causing bone demineralization."},{"q":"Should Cushing’s clients follow a low-sodium or high-sodium diet?","a":"Low-sodium, to prevent further fluid retention."},{"q":"Why might glucose and ketones appear in the urine of a Cushing’s client?","a":"Because high cortisol levels cause hyperglycemia and fat breakdown, producing ketones."},{"q":"What is the basic problem in diabetes mellitus?","a":"Insufficient insulin leads to glucose buildup in the blood."},{"q":"Why does the body break down protein and fat in diabetes?","a":"Cells lack glucose for energy, so the body uses alternate energy sources."},{"q":"What do fat breakdown products produce in diabetes?","a":"Ketones, which are acidic."},{"q":"What acid–base imbalance occurs in diabetic ketoacidosis (DKA)?","a":"Metabolic acidosis due to ketone accumulation."},{"q":"Explain the classic signs of diabetes: polyuria, polydipsia, polyphagia.","a":"Polyuria—kidneys excrete glucose; polydipsia—thirst from fluid loss; polyphagia—hunger because cells lack glucose."},{"q":"How does metformin work?","a":"It improves insulin sensitivity and decreases hepatic glucose production."},{"q":"Why don’t oral antidiabetic drugs work in Type 1 diabetes?","a":"Because the pancreas produces no insulin."},{"q":"Why do Type 2 diabetics experience slow-healing wounds and recurrent infections?","a":"Hyperglycemia promotes bacterial growth and impairs circulation."},{"q":"What is the typical treatment plan for Type 2 diabetes?","a":"Diet, exercise, oral medications, and sometimes insulin."},{"q":"Why is dietary protein restricted in diabetic clients?","a":"To prevent further kidney damage from protein overload."},{"q":"Why are diabetics at risk for coronary artery disease?","a":"Chronic hyperglycemia leads to atherosclerosis."},{"q":"Why can exercise cause hypoglycemia in diabetics?","a":"Physical activity lowers blood glucose; eating before exercise prevents drops."},{"q":"When is it best for diabetics to exercise?","a":"When blood glucose is at its peak to avoid hypoglycemia."},{"q":"Which type of insulin can be given intravenously?","a":"Regular insulin."},{"q":"How often is long-acting insulin such as glargine administered?","a":"Once daily."},{"q":"What indicates that insulin dosing is properly adjusted?","a":"No glucose or ketones in the urine."},{"q":"What types of insulin are used in basal-bolus therapy?","a":"Long-acting insulin for basal coverage and rapid-acting insulin before meals."},{"q":"What does a hemoglobin A1C of 8% indicate?","a":"Poor blood glucose control over the past three months."},{"q":"What insulin type is used in insulin pumps?","a":"Rapid-acting insulin."},{"q":"How does basal-bolus insulin mimic normal pancreatic function?","a":"Basal insulin provides steady coverage; bolus insulin covers meal-related spikes."},{"q":"What happens to blood sugar during insulin peak time?","a":"It decreases, creating a risk for hypoglycemia."},{"q":"How can hypoglycemia be prevented?","a":"Eat meals and snacks on time, avoid skipping insulin doses."},{"q":"Why should injection sites be rotated in insulin therapy?","a":"To prevent lipodystrophy and ensure consistent absorption."},{"q":"What happens to blood sugar during illness or stress?","a":"It increases."},{"q":"What should a diabetic do if ill or stressed?","a":"Increase insulin as prescribed and monitor glucose frequently."},{"q":"What major complication can occur in Type 1 diabetes if uncontrolled?","a":"Diabetic ketoacidosis (DKA)."},{"q":"What are early signs of hypoglycemia and what is the immediate action?","a":"Shakiness, sweating, confusion—give simple carbohydrates."},{"q":"What should follow simple carbohydrate treatment for hypoglycemia?","a":"Complex carbs and protein to maintain stable glucose."},{"q":"Explain the 15-15-15 rule for hypoglycemia.","a":"Eat 15g of carbs, recheck blood sugar in 15 minutes, repeat if still low."},{"q":"Why is hypoglycemia more dangerous than hyperglycemia?","a":"Because the brain depends on glucose and can be permanently damaged by deprivation."},{"q":"If a diabetic client is unconscious, should they be treated as hypoglycemic or hyperglycemic?","a":"Treat as hypoglycemic—it is safer."},{"q":"Explain the basic pathophysiology of diabetic ketoacidosis.","a":"Insulin deficiency leads to hyperglycemia, dehydration, fat breakdown, acidosis, and Kussmaul respirations."},{"q":"Why monitor blood glucose and potassium in DKA?","a":"Insulin therapy lowers both serum glucose and potassium, risking hypokalemia."},{"q":"What effect does insulin have on serum potassium?","a":"It drives potassium into cells, lowering serum levels."},{"q":"Why monitor the ECG in DKA?","a":"To detect arrhythmias caused by potassium shifts."},{"q":"Why measure hourly urine output in DKA?","a":"To monitor renal perfusion and detect worsening dehydration."},{"q":"What is the concern if urine output falls to oliguria or anuria?","a":"Kidney failure due to poor perfusion."},{"q":"Describe proper diabetic foot care.","a":"Inspect feet daily, cut nails straight, dry between toes, avoid barefoot walking, and wear proper shoes."},{"q":"Define preload and afterload.","a":"Preload is the amount of blood returning to the right side of the heart and the stretch it causes. Afterload is the pressure the left ventricle must pump against to eject blood into the aorta."},{"q":"What is cardiac output?","a":"The amount of blood pumped from the left ventricle each minute."},{"q":"If cardiac output decreases, how is tissue perfusion affected?","a":"It decreases, leading to poor oxygen delivery to tissues."},{"q":"What factors affect cardiac output?","a":"Heart rate, blood volume, and myocardial contractility."},{"q":"How does decreased cardiac output affect level of consciousness?","a":"It decreases cerebral perfusion, causing confusion or restlessness."},{"q":"Can decreased cardiac output cause chest pain?","a":"Yes, because of myocardial ischemia."},{"q":"Why does a client with low cardiac output have cool, clammy skin?","a":"Peripheral vasoconstriction occurs to shunt blood to vital organs."},{"q":"Why do clients with low cardiac output have shortness of breath and crackles?","a":"Blood backs up into the lungs, causing pulmonary congestion."},{"q":"Why do peripheral pulses diminish with low cardiac output?","a":"Reduced stroke volume decreases perfusion to the extremities."},{"q":"How does decreased cardiac output affect urine output?","a":"Renal perfusion drops, leading to oliguria."},{"q":"Why does blood pressure drop with decreased cardiac output?","a":"Less volume is ejected from the heart, reducing arterial pressure."},{"q":"How does bradycardia affect cardiac output?","a":"It decreases cardiac output because fewer contractions occur per minute."},{"q":"How does extreme tachycardia affect cardiac output?","a":"It decreases output because the ventricles don’t have enough time to fill."},{"q":"How does myocardial infarction affect cardiac output?","a":"Dead myocardial tissue cannot contract effectively, decreasing output."},{"q":"How does high blood pressure affect cardiac output?","a":"Increased afterload makes it harder for the heart to pump, lowering output."},{"q":"What is chronic stable angina?","a":"Chest pain caused by decreased blood flow to the myocardium during exertion."},{"q":"Describe the pain of angina.","a":"Pressure or heaviness in the chest that may radiate to the left arm or jaw, relieved by rest or nitroglycerin."},{"q":"Why is nitroglycerin given for angina?","a":"It dilates coronary arteries, improving oxygen delivery and reducing pain."},{"q":"How should nitroglycerin be taken?","a":"One tablet every five minutes, up to three doses; sit down before taking to avoid dizziness."},{"q":"What is a common side effect of nitroglycerin?","a":"Headache due to vasodilation."},{"q":"How does nitroglycerin affect blood pressure?","a":"It lowers blood pressure through vasodilation."},{"q":"Why are beta blockers given for angina?","a":"They reduce heart rate, contractility, and oxygen demand."},{"q":"Why is aspirin used for angina?","a":"It prevents platelet aggregation and reduces the risk of thrombus formation."},{"q":"What should clients with angina avoid?","a":"Overeating, caffeine, cold exposure, and stress, as they increase cardiac workload."},{"q":"What should clients do before taking nitroglycerin?","a":"Sit or lie down to prevent fainting from hypotension."},{"q":"Why must clients be asked about iodine allergies before cardiac catheterization?","a":"Because contrast dye contains iodine."},{"q":"What is a normal sensation during iodine dye injection?","a":"A warm, flushed feeling."},{"q":"What is the priority assessment after cardiac catheterization?","a":"Check the puncture site for bleeding and assess distal circulation."},{"q":"Why does myocardial infarction cause necrosis?","a":"Blocked coronary blood flow deprives the myocardium of oxygen, leading to cell death."},{"q":"Is MI pain relieved by rest or nitroglycerin?","a":"No, MI pain is persistent and severe."},{"q":"Describe MI pain.","a":"Intense, crushing, continuous pain that may radiate to the jaw, arm, or back."},{"q":"Why does a client having an MI become cold and clammy?","a":"Decreased cardiac output activates the sympathetic nervous system."},{"q":"Which cardiac biomarker confirms MI after several hours?","a":"Troponin."},{"q":"Is a negative myoglobin result good or bad?","a":"Good, it indicates no muscle injury."},{"q":"Which arrhythmia poses the greatest risk after MI?","a":"Ventricular fibrillation."},{"q":"What is the priority intervention for ventricular fibrillation?","a":"Immediate defibrillation."},{"q":"What drug is used if VFib persists after defibrillation?","a":"Amiodarone."},{"q":"What medications are typically given to a client with chest pain on arrival to the emergency department?","a":"Oxygen, chewable aspirin, nitroglycerin, and morphine."},{"q":"How do thrombolytic drugs work?","a":"They dissolve clots blocking coronary arteries to restore blood flow."},{"q":"Give examples of thrombolytic agents.","a":"Streptokinase, tissue plasminogen activator (tPA), and reteplase."},{"q":"What is the major risk of thrombolytic therapy?","a":"Hemorrhage."},{"q":"What history must be reviewed before giving thrombolytics?","a":"Any recent surgery, trauma, stroke, or bleeding disorders."},{"q":"What nursing action is important after thrombolytic therapy?","a":"Minimize punctures and invasive procedures to prevent bleeding."},{"q":"What is angioplasty and its main complication?","a":"Balloon dilation of coronary arteries; the main risk is reocclusion or MI."},{"q":"How does increased preload affect cardiac workload?","a":"It increases workload because the heart must pump a larger volume."},{"q":"How can preload be increased?","a":"Supine position, leg elevation, or hypervolemia."},{"q":"How can preload be decreased?","a":"Upright positioning, hypovolemia, or lowering legs."},{"q":"What happens to cardiac output when afterload increases?","a":"It decreases because the heart pumps against higher resistance."},{"q":"If blood does not move forward from the left ventricle, where does it back up?","a":"Into the lungs."},{"q":"What are signs of left-sided heart failure?","a":"Dyspnea, orthopnea, pulmonary congestion, crackles, and cough with pink frothy sputum."},{"q":"Why does left-sided failure cause tachycardia and restlessness?","a":"Hypoxia stimulates the sympathetic nervous system."},{"q":"Why does lying flat worsen dyspnea in left-sided failure?","a":"It increases venous return, worsening pulmonary congestion."},{"q":"What are signs of right-sided heart failure?","a":"Jugular vein distention, edema, ascites, hepatomegaly, and weight gain."},{"q":"Where does blood back up in right-sided heart failure?","a":"Into the venous system."},{"q":"What does a Swan-Ganz catheter measure?","a":"Pressures inside the heart to evaluate preload and afterload."},{"q":"What is the purpose of an arterial line (A-line)?","a":"Continuous blood pressure monitoring and arterial blood sampling."},{"q":"Why must distal circulation be checked when an A-line is in place?","a":"To ensure arterial perfusion is not compromised."},{"q":"What should be done if an A-line is accidentally removed?","a":"Apply firm pressure to the insertion site immediately."},{"q":"Why must pressure be maintained in the A-line flush system?","a":"To prevent arterial backflow and maintain patency."},{"q":"Why does the heart enlarge in chronic heart failure?","a":"The myocardium hypertrophies to compensate for increased workload."},{"q":"Which two medication groups are standard for treating heart failure?","a":"ACE inhibitors and ARBs."},{"q":"How does digoxin work?","a":"It slows heart rate and increases contractility, improving cardiac output."},{"q":"Why is digoxin used cautiously in the elderly?","a":"Decreased renal function increases the risk of toxicity."},{"q":"What clinical improvements indicate effective heart failure therapy?","a":"Increased urine output, warm skin, improved pulses, better mentation, and stable blood pressure."},{"q":"Why is furosemide used in heart failure?","a":"To reduce fluid overload by promoting diuresis."},{"q":"Why are diuretics given in the morning?","a":"To prevent nocturia and sleep disruption."},{"q":"What is the heart’s natural pacemaker?","a":"The sinoatrial (SA) node."},{"q":"What is the function of an artificial pacemaker?","a":"It delivers electrical impulses to stimulate heart contractions."},{"q":"What is the difference between a demand and a fixed-rate pacemaker?","a":"A demand pacemaker fires only when needed; a fixed-rate fires continuously."},{"q":"When should pacemaker malfunction be suspected?","a":"If the heart rate drops below the set rate."},{"q":"Why must the arm on the pacemaker side be immobilized temporarily?","a":"To prevent dislodging the pacing leads."},{"q":"Why should pacemaker clients check their pulse daily?","a":"To ensure the pacemaker is maintaining the prescribed rate."},{"q":"Why must pacemaker clients avoid electromagnetic fields?","a":"They can interfere with pacemaker function (e.g., MRI machines, airport security)."},{"q":"What does sudden weight gain in a heart failure client indicate?","a":"Fluid retention and risk for pulmonary edema."},{"q":"What is pulmonary edema?","a":"Acute fluid accumulation in the lungs causing severe respiratory distress and hypoxia."},{"q":"Why does pulmonary edema occur?","a":"Left ventricular failure causes blood to back up into the lungs."},{"q":"When does pulmonary edema commonly occur?","a":"At night when lying flat increases venous return."},{"q":"What are signs of pulmonary edema?","a":"Sudden breathlessness, restlessness, anxiety, and frothy sputum."},{"q":"Why is oxygen administered in pulmonary edema?","a":"To improve oxygenation impaired by alveolar fluid."},{"q":"What position helps relieve pulmonary edema?","a":"Sitting upright with legs down to reduce venous return."},{"q":"What are hallmark signs of cardiac tamponade?","a":"Increased central venous pressure (CVP) and decreased blood pressure."},{"q":"Why do these signs occur in tamponade?","a":"Fluid compresses the heart, preventing proper filling and lowering output."},{"q":"What events can lead to cardiac tamponade?","a":"Trauma, pericarditis, post-CABG bleeding, or right ventricular biopsy."},{"q":"What is intermittent claudication?","a":"Pain in the extremities caused by inadequate oxygenation from arterial insufficiency."},{"q":"What are signs of arterial insufficiency?","a":"Coldness, pallor, weak pulses, atrophy, and risk of ischemia or gangrene."},{"q":"How does angioplasty help arterial disorders?","a":"It opens blocked arteries, restoring oxygenated blood flow."},{"q":"What is the main problem in venous disorders?","a":"Blood reaches the extremity but cannot return effectively, leading to pooling."},{"q":"How are venous disorders treated?","a":"Elevate the affected limb, use compression, and administer anticoagulants if needed."},{"q":"How do TED hose help venous disorders?","a":"They improve venous return and reduce stasis."},{"q":"What type of heat therapy is recommended for venous disorders?","a":"Warm, moist heat to promote circulation and decrease inflammation."},{"q":"How can DVT be prevented?","a":"Early ambulation and adequate hydration."},{"q":"What are the main functions of the pancreas?","a":"It produces digestive enzymes and regulates blood glucose through insulin and glucagon secretion."},{"q":"What are the two major causes of pancreatitis?","a":"Gallstones and alcohol abuse."},{"q":"Why does autodigestion occur in pancreatitis?","a":"Pancreatic enzymes activate prematurely and begin digesting pancreatic tissue."},{"q":"What are the classic signs of pancreatitis?","a":"Abdominal pain radiating to the back, nausea, vomiting, fever, and elevated amylase and lipase levels."},{"q":"Why does pain in pancreatitis worsen after eating?","a":"Food stimulates enzyme secretion, increasing inflammation and pain."},{"q":"Why are narcotics like morphine used cautiously in pancreatitis?","a":"They may cause spasm of the sphincter of Oddi, worsening pain."},{"q":"Why are anticholinergics prescribed in pancreatitis?","a":"They reduce gastric secretions and decrease pancreatic stimulation."},{"q":"Why is the client kept NPO during acute pancreatitis?","a":"To rest the pancreas and prevent further enzyme release."},{"q":"Why is NG suction used in pancreatitis?","a":"To remove gastric secretions and prevent stimulation of pancreatic enzymes."},{"q":"Why is insulin often required during acute pancreatitis?","a":"Pancreatic damage decreases insulin production."},{"q":"Why are alcohol and greasy foods restricted after pancreatitis?","a":"They can trigger enzyme secretion and cause relapse."},{"q":"Why do liver enzymes rise in liver disease?","a":"Damaged hepatocytes release enzymes like ALT and AST into the bloodstream."},{"q":"What is the primary function of the liver?","a":"Metabolism of drugs, detoxification, production of bile, and synthesis of clotting factors."},{"q":"Why do liver failure clients bleed easily?","a":"The liver cannot produce enough clotting factors."},{"q":"Why does a cirrhosis client develop ascites?","a":"Portal hypertension and low albumin cause fluid to leak into the peritoneal cavity."},{"q":"Why does cirrhosis cause jaundice?","a":"The liver cannot conjugate and excrete bilirubin properly."},{"q":"What is a major complication of cirrhosis?","a":"Esophageal varices due to portal hypertension."},{"q":"Why are esophageal varices dangerous?","a":"They can rupture and cause massive bleeding."},{"q":"Why are beta blockers used in cirrhosis?","a":"To reduce portal hypertension and prevent variceal rupture."},{"q":"Why are laxatives given to cirrhosis clients?","a":"To decrease ammonia absorption by emptying the intestines."},{"q":"Why is lactulose used in hepatic encephalopathy?","a":"It traps ammonia in the gut and promotes excretion, reducing confusion."},{"q":"What are early signs of hepatic encephalopathy?","a":"Mental confusion, hand tremors (asterixis), and slowed speech."},{"q":"Why should a cirrhosis client avoid protein-rich foods?","a":"Protein breakdown increases ammonia levels, worsening encephalopathy."},{"q":"Why is paracentesis performed in ascites?","a":"To remove excess peritoneal fluid and relieve pressure."},{"q":"What should be done before paracentesis?","a":"Have the client void to prevent bladder puncture."},{"q":"Why should vital signs be monitored during paracentesis?","a":"Rapid fluid removal can cause hypotension and shock."},{"q":"Why are patients with cirrhosis advised to avoid acetaminophen?","a":"The drug is hepatotoxic and can worsen liver injury."},{"q":"What is the primary cause of peptic ulcer disease?","a":"Helicobacter pylori infection and NSAID use."},{"q":"What relieves pain in duodenal ulcers?","a":"Eating food or taking antacids."},{"q":"What aggravates pain in gastric ulcers?","a":"Eating food increases gastric acid and worsens pain."},{"q":"What lifestyle factors worsen peptic ulcers?","a":"Smoking, alcohol, caffeine, and stress."},{"q":"What foods should be avoided in ulcer clients?","a":"Spicy, acidic, or irritating foods like citrus, coffee, and pepper."},{"q":"What are signs of GI bleeding?","a":"Hematemesis, melena, low blood pressure, and tachycardia."},{"q":"What does bright red vomit indicate?","a":"Active upper GI bleeding."},{"q":"What is the goal of antacid therapy?","a":"To neutralize gastric acid and reduce irritation of the mucosa."},{"q":"Why are proton pump inhibitors used for ulcers?","a":"They inhibit gastric acid secretion and allow mucosal healing."},{"q":"What is a major complication of a peptic ulcer?","a":"Perforation leading to peritonitis."},{"q":"What are signs of peritonitis?","a":"Abdominal rigidity, severe pain, fever, and rebound tenderness."},{"q":"What is ulcerative colitis?","a":"Chronic inflammation of the colon causing ulceration and bloody diarrhea."},{"q":"What is Crohn’s disease?","a":"Inflammatory bowel disease that can affect any part of the GI tract, leading to thickened intestinal walls."},{"q":"What diet is recommended for ulcerative colitis?","a":"Low-fiber, high-protein diet to rest the bowel."},{"q":"Why are steroids used in ulcerative colitis?","a":"To reduce intestinal inflammation."},{"q":"Why are antidiarrheals avoided in ulcerative colitis?","a":"They can cause toxic megacolon by retaining stool."},{"q":"What is the primary surgical treatment for ulcerative colitis?","a":"Total colectomy with ileostomy."},{"q":"How does stool differ between an ileostomy and a colostomy?","a":"Ileostomy output is liquid and continuous; colostomy output is more formed."},{"q":"What foods should an ileostomy client avoid?","a":"High-fiber foods like nuts, seeds, and corn that may cause obstruction."},{"q":"Why are fluids important for ileostomy clients?","a":"They lose large amounts of fluid and electrolytes."},{"q":"What is appendicitis?","a":"Inflammation of the appendix, usually due to obstruction."},{"q":"What is the classic symptom of appendicitis?","a":"Pain starting around the umbilicus and shifting to the right lower quadrant."},{"q":"Why is appendicitis dangerous if untreated?","a":"It can lead to rupture and peritonitis."},{"q":"What should not be applied to the abdomen in suspected appendicitis?","a":"Heat, because it can increase inflammation and risk of rupture."},{"q":"Why are opioids used cautiously before appendectomy?","a":"They can mask changes in pain that signal rupture."},{"q":"Why is postoperative ambulation important after abdominal surgery?","a":"It promotes peristalsis and prevents gas buildup and pneumonia."},{"q":"What is the primary goal in treating hiatal hernia?","a":"To prevent reflux by elevating the head of the bed and avoiding large meals."},{"q":"Why are antacids and PPIs used in GERD?","a":"They reduce acid reflux and esophageal irritation."},{"q":"What lifestyle changes help control GERD?","a":"Eat small meals, avoid lying down after eating, avoid alcohol, caffeine, and smoking."},{"q":"Why is bariatric surgery used for morbid obesity?","a":"It limits stomach capacity, promoting weight loss and reducing comorbidities."},{"q":"What is dumping syndrome?","a":"Rapid gastric emptying causing weakness, dizziness, and diarrhea after eating."},{"q":"How can dumping syndrome be prevented?","a":"Eat small, frequent meals and avoid fluids with meals."}]

Reduction Of Risk Potential Flashcards

Part 1

[{"q":"What will happen to your weight with hypovolemia and why?","a":"It will decrease because there is less volume."},{"q":"If you are hypovolemic, why will your urine output eventually decrease?","a":"Decreased perfusion due to hypovolemia can cause a decrease in kidney perfusion, or the patient may be trying to conserve fluid."},{"q":"Why do you do hourly outputs on someone who is hypovolemic?","a":"To ensure the kidneys are receiving adequate perfusion."},{"q":"How can diarrhea induce hypomagnesemia?","a":"Because magnesium is present in the intestine."},{"q":"Why are alcoholics prone to hypomagnesemia?","a":"We obtain a lot of our magnesium through our diet, and alcoholics often do not eat. Additionally, alcohol causes diuresis, and magnesium is excreted through the kidneys. The alcoholic is not eating and is diuresing a lot."},{"q":"Why is it so important to check renal function prior to giving IV magnesium?","a":"Because magnesium is excreted by the kidneys; we must ensure our patients can excrete the excess."},{"q":"If you are taking care of a patient with hypomagnesemia, why do you have to take seizure precautions?","a":"Because their muscles are tight and hyperexcitable, the possibility of a seizure is likely."},{"q":"If a patient has hyperphosphatemia, what other electrolyte imbalance will they have?","a":"Hypocalcemia."},{"q":"If a patient has hypophosphatemia, what other electrolyte imbalance will they have?","a":"Hypercalcemia"},{"q":"What will their symptoms look like?","a":"Weak muscle tone, decreased DTRs, slow GI tract, sedation."},{"q":"If you have a patient whose blood is very dilute; in other words, it is filled with water, what will happen to their serum sodium level? And explain why.","a":"Na level decreases because sodium is measured in relation to water (diluted). The more water you have, the lower the Na goes."},{"q":"If you have a patient who is very dehydrated, what will happen to their serum sodium level? Explain why.","a":"Increase because of the concentration. The more concentrated your blood is, the higher the Na goes."},{"q":"If you have a patient who is dehydrated, what will happen to their H&H? Explain why.","a":"If you are dehydrated, then the blood is concentrated (not enough water). Concentration makes most numbers go up, so the Hemoglobin and Hematocrit would go up."},{"q":"Why is it so important when you are trying to lower someone’s serum sodium level that you dilute the patient with IV fluid gradually?","a":"Because the brain cells cannot handle rapid Na shifts."},{"q":"If you have a patient who is becoming dehydrated, what will begin to happen to their sodium level? And what should you do before the patient becomes hypernatremic?","a":"Increase; increase fluids."},{"q":"If a patient is hyponatremic, what is their blood like? Concentrated or dilute? Why?","a":"Dilute – They have too much water and not enough Na."},{"q":"How can drinking too much water make your serum sodium go down?","a":"When you take in an excessive amount of water, the blood becomes diluted, and this would make the serum Na go down."},{"q":"When you have a hyponatremic patient, it is important that you restrict water. Explain why.","a":"Because the body has too much water, and restricting water helps increase Na."},{"q":"How can vomiting induce hypokalemia?","a":"K+ lives in the stomach, so vomiting gets rid of K+."},{"q":"Why is it so important that you monitor the digoxin patient closely for hypokalemia or other electrolyte imbalances?","a":"When any electrolyte gets out of balance, this makes a patient prone to digoxin toxicity. However, the imbalance that will promote toxicity the most is hypokalemia."},{"q":"When a patient has a high CO2 level in their blood, what is going to happen to the oxygen level in their blood?","a":"Decreases"},{"q":"When a patient has an electrical injury, they are at a high risk for what arrhythmia?","a":"V-fib."},{"q":"How long is the patient at risk for life-threatening arrhythmias?","a":"24 hours."},{"q":"Why must a patient’s white blood count be at least 3,000 before they will receive their chemo?","a":"The chemo is going to decrease the white blood count even more."},{"q":"What are some complications of a bronchoscopy that you need to watch for?","a":"Respiratory distress, hoarseness, dysphagia, subcutaneous emphysema."},{"q":"Why are ulcerative colitis and Crohn’s disease considered to be risk factors for colon cancer?","a":"Chronic irritation."},{"q":"What is the major lab work assessed when prostate cancer is suspected?","a":"PSA – prostate-specific antigen and the acid phosphatase."},{"q":"What is the most common complication of a TURP?","a":"Hemorrhage."},{"q":"When a patient has had a TURP, why do they not have to worry about impotency and infertility?","a":"No nerve involvement – no incision."},{"q":"Why is it important that the prostatectomy patient avoid sitting, driving, strenuous exercise, and lifting?","a":"To prevent hemorrhage."},{"q":"What is one of the major signs diagnostically of stomach cancer?","a":"No HCl in the stomach."},{"q":"Why do we check for bleeding behind the neck with a thyroidectomy patient?","a":"This is where pooling could occur."},{"q":"Why do we keep a trach set at the bedside with a thyroidectomy patient?","a":"It is needed for emergency airway; laryngospasm could occur."},{"q":"How do you assess for recurrent laryngeal nerve damage in the thyroidectomy patient?","a":"Listen for hoarseness."},{"q":"Why do we have to assess for parathyroid removal in the thyroidectomy patient?","a":"Because they are close to the thyroid; they could have been accidentally removed."},{"q":"How do you assess for parathyroid removal?","a":"Watch for muscle rigidity – tight muscles; tetany. Look for signs and symptoms of hypocalcemia."},{"q":"What are the signs and symptoms of parathyroid removal?","a":"Any sign of hypocalcemia."},{"q":"What is the major diagnostic test for pheochromocytoma? Explain.","a":"VMA – vanillylmandelic acid test – 24-hour urine specimen; looking for increased levels of epinephrine\/norepinephrine."},{"q":"When a patient has diabetic ketoacidosis, why is it so important that we measure the blood sugar and the potassium hourly?","a":"Because insulin transports the sugar and potassium back into the cell. Now we are worried about hypokalemia and hypoglycemia."},{"q":"Why is it so important that we monitor the diabetic ketoacidotic patient’s EKG so closely?","a":"Risk for hypokalemia; chance of arrhythmias."},{"q":"Why are we measuring hourly output on the diabetic ketoacidosis patient?","a":"Because polyuria could turn to oliguria then anuria (renal failure)."},{"q":"When a patient has oliguria and anuria, what do you really have to start worrying about and why?","a":"Kidney failure – because the kidneys aren’t being perfused properly."},{"q":"What is angioplasty and what is the major complication of angioplasty?","a":"Balloon to open coronary arteries to enhance blood flow – MI."}]

Part 2

Physiological Integrity – Labor, Delivery, and Postpartum Complications

[{"q":"What are the characteristics of true labor?","a":"Unlike false labor, true labor produces regular rhythmic contractions, abdominal discomfort, progressive descent of the fetus, bloody show, and progressive effacement and dilation of the cervix."},{"q":"How can a mother safely break a breastfeeding infant’s suction?","a":"To help a mother break the suction of her breast-feeding infant, the nurse should teach her to insert a finger at the corner of the infant’s mouth."},{"q":"What can administering high levels of oxygen to a premature neonate cause?","a":"Administering high levels of oxygen to a premature neonate can cause blindness as a result of retrolental fibroplasia."},{"q":"What is amniotomy?","a":"Amniotomy is artificial rupture of the amniotic membranes."},{"q":"What is the average weight gain during pregnancy?","a":"During pregnancy, weight gain averages 25 to 30 lb (11 to 13.5 kg)."},{"q":"What is the effect of rubella infection during the first trimester?","a":"Rubella has a teratogenic effect on the fetus during the first trimester and can produce abnormalities in up to 40% of cases without interrupting the pregnancy."},{"q":"What test measures immunity to rubella?","a":"Immunity to rubella can be measured by a hemagglutination inhibition test (rubella titer). A titer greater than 1:8 indicates immunity in a woman."},{"q":"What does 'floating' mean when describing fetal descent?","a":"When used to describe the degree of fetal descent during labor, floating means the presenting part isn’t engaged in the pelvic inlet but is freely movable above it."},{"q":"What does 'engagement' mean in labor?","a":"Engagement occurs when the largest diameter of the presenting part has passed through the pelvic inlet."},{"q":"What does fetal station indicate?","a":"Fetal station indicates the location of the presenting part in relation to the ischial spines, measured in centimeters above (-) or below (+) the spines."},{"q":"What position provides comfort during the first stage of labor?","a":"During the first stage of labor, the side-lying position usually provides the greatest degree of comfort, although the patient may assume any comfortable position."},{"q":"What should be done if the umbilical cord is around the neonate’s neck and cannot be loosened?","a":"If the umbilical cord can’t be loosened and slipped from around the neonate’s neck, it should be clamped with two clamps and cut between the clamps."},{"q":"What does the Apgar score indicate?","a":"An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6 indicates moderate distress, and 0 to 3 indicates severe distress."},{"q":"How is Moro’s reflex elicited?","a":"To elicit Moro’s reflex, the nurse holds the neonate and suddenly drops the head backward; normally, the neonate abducts and extends extremities, then adducts and flexes them."},{"q":"What defines pregnancy-induced hypertension (preeclampsia)?","a":"Pregnancy-induced hypertension is an increase in BP of 30\/15 mm Hg over baseline or BP of 140\/95 mm Hg on two occasions at least 6 hours apart with edema and albuminuria after 20 weeks’ gestation."},{"q":"What are positive signs of pregnancy?","a":"Positive signs of pregnancy include ultrasound evidence, fetal heart tones, and fetal movement felt by the examiner (usually after 4 months)."},{"q":"What is Goodell’s sign?","a":"Goodell’s sign is softening of the cervix."},{"q":"When does quickening occur?","a":"Quickening, a presumptive sign of pregnancy, occurs between 16 and 19 weeks’ gestation."},{"q":"What is the proper method to estimate the date of delivery using Nägele’s rule?","a":"Count backward 3 months from the first day of the last menstrual period and add 7 days to estimate the date of delivery."},{"q":"What is the purpose of administering vitamin K to newborns?","a":"Vitamin K is administered to neonates to prevent hemorrhagic disorders because a neonate’s intestine can’t synthesize vitamin K."},{"q":"What causes respiratory distress syndrome in premature infants?","a":"Respiratory distress syndrome develops in premature infants because their pulmonary alveoli lack surfactant."},{"q":"What are the three phases of a uterine contraction?","a":"The three phases of a uterine contraction are increment, acme, and decrement."},{"q":"What is the gynecoid pelvis?","a":"The gynecoid pelvis is the most ideal type for delivery; other types include platypelloid, anthropoid, and android."},{"q":"Why should pregnant women avoid alcohol?","a":"Pregnant women should be advised that there is no safe level of alcohol intake."},{"q":"What is Fetal Alcohol Syndrome (FAS)?","a":"Fetal alcohol syndrome presents in the first 24 hours after birth and produces lethargy, seizures, poor sucking reflex, abdominal distention, and respiratory difficulty."},{"q":"How can respiratory distress be identified in a premature neonate?","a":"In a premature neonate, signs of respiratory distress include nostril flaring, substernal retractions, and inspiratory grunting."},{"q":"What is the male and female chromosome combination?","a":"The male sperm contributes an X or a Y chromosome, while the female ovum contributes an X chromosome; fertilization produces XX (female) or XY (male)."},{"q":"What is organogenesis?","a":"Organogenesis occurs during the first trimester of pregnancy, specifically days 14 to 56 of gestation."},{"q":"What are the four stages of labor?","a":"Stage 1: onset to full dilation; Stage 2: full dilation to birth; Stage 3: birth to placenta expulsion; Stage 4: postpartum stabilization up to 4 hours."},{"q":"When is a neonate considered premature?","a":"A premature neonate is one born before the end of the 37th week of gestation."},{"q":"What is the classic triad of preeclampsia symptoms?","a":"The classic triad of preeclampsia includes hypertension, edema, and proteinuria; severe cases may show hyperreflexia, visual disturbances, and epigastric pain."},{"q":"What is eclampsia?","a":"Eclampsia is the occurrence of seizures in a woman with pregnancy-induced hypertension that are not caused by another cerebral disorder."},{"q":"What differentiates abruptio placentae from placenta previa?","a":"Abruptio placentae causes painful vaginal bleeding, while placenta previa causes painless bleeding."},{"q":"What medication prevents postpartum hemorrhage caused by uterine atony?","a":"Methylergonovine (Methergine) is an oxytocic agent used to prevent and treat postpartum hemorrhage due to uterine atony or subinvolution."},{"q":"What are Braxton Hicks contractions?","a":"Braxton Hicks contractions are irregular, painless abdominal contractions that do not cause cervical change."},{"q":"What does variable deceleration in fetal heart rate indicate?","a":"Variable decelerations indicate umbilical cord compression or prolapse during fetal monitoring."},{"q":"What are the components of a biophysical profile?","a":"The biophysical profile assesses fetal breathing, body movement, tone, reactive heart rate, and amniotic fluid volume by ultrasound."},{"q":"What is HELLP syndrome?","a":"HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome is a severe variation of pregnancy-induced hypertension."},{"q":"What is uterine atony?","a":"Uterine atony is the failure of the uterus to remain firmly contracted after delivery and is the leading cause of postpartum hemorrhage."},{"q":"What is the major cause of uterine atony?","a":"A full bladder is the major cause of uterine atony after delivery."},{"q":"What causes neonatal hypoglycemia?","a":"Neonatal hypoglycemia can result from prematurity, postmaturity, small or large gestational size, and maternal diabetes, causing jitteriness and seizures."},{"q":"What is the normal range for neonatal blood glucose?","a":"The normal blood glucose level for neonates is 45 to 90 mg\/dl."},{"q":"What does meconium in the amniotic fluid indicate?","a":"The presence of meconium in amniotic fluid indicates possible fetal distress and risk of meconium aspiration."},{"q":"What is caput succedaneum?","a":"Caput succedaneum is edema under the fetal scalp from labor pressure that resolves spontaneously and does not cross suture lines."},{"q":"What is the purpose of oxytocin (Pitocin) administration during labor?","a":"Oxytocin stimulates uterine contractions and may be used to induce labor or strengthen contractions during delivery."},{"q":"What should be done if a mother becomes hypotensive during labor?","a":"If a woman suddenly becomes hypotensive during labor, increase IV fluid rate and place her on her left side."},{"q":"What should be done if contractions last longer than 90 seconds during oxytocin infusion?","a":"The oxytocin infusion should be stopped immediately if contractions last 90 seconds or longer."},{"q":"What are the signs of magnesium sulfate toxicity?","a":"Signs include respiratory depression, absent reflexes, and decreased urine output; respiratory rate and reflexes must be monitored."},{"q":"What is the normal heart rate of a neonate?","a":"A neonate’s normal apical pulse rate averages 120 to 160 beats per minute."},{"q":"What is the most common reason for cesarean birth?","a":"The most common reasons are malpresentation, fetal distress, cephalopelvic disproportion, pregnancy-induced hypertension, or failure to progress in labor."},{"q":"When should the mother begin breastfeeding after birth?","a":"If the neonate is stable, breastfeeding should begin within the first hour of life."},{"q":"What causes postpartum hemorrhage in a multiparous woman?","a":"Overstretched uterine muscles in multiparous women may not contract efficiently, increasing bleeding risk."},{"q":"What indicates postmaturity in a neonate?","a":"Long, brittle fingernails and desquamation (skin peeling) indicate postmaturity."},{"q":"How can postpartum gas pain be relieved?","a":"Ambulation helps relieve gas pain and flatulence in postpartum patients."},{"q":"What is the cause of respiratory distress syndrome in neonates born via cesarean?","a":"Cesarean-delivered neonates have higher risk of respiratory distress due to retained lung fluid and lack of thoracic compression."},{"q":"What is the role of prostaglandin gel in labor induction?","a":"Prostaglandin gel is applied to ripen an unfavorable cervix before induction with oxytocin."},{"q":"What are signs of respiratory distress in neonates?","a":"Expiratory grunting, sandpaper breath sounds, and seesaw chest movements are signs of neonatal respiratory distress."},{"q":"What is the priority nursing action after rupture of membranes?","a":"The nurse must immediately assess fetal heart rate to check for cord prolapse."},{"q":"What defines a complete abortion?","a":"A complete abortion occurs when all products of conception are expelled from the uterus."},{"q":"What is hydramnios (polyhydramnios)?","a":"Hydramnios is an excessive amount of amniotic fluid, more than 2,000 ml in the third trimester."},{"q":"What characterizes the transition phase of the first stage of labor?","a":"The cervix is dilated 8 to 10 cm, and contractions occur every 2–3 minutes lasting about 60 seconds."},{"q":"What defines a reactive nonstress test?","a":"A reactive (negative) nonstress test shows two or more fetal heart-rate accelerations of 15 beats per minute above baseline within 20 minutes."},{"q":"What defines a nonreactive nonstress test?","a":"A nonreactive (positive) nonstress test shows fewer than two fetal heart-rate accelerations of 15 beats per minute in 20 minutes."},{"q":"Why is a nonstress test performed?","a":"It is used to assess fetal well-being in pregnancies complicated by diabetes, hypertension, prolonged gestation, or poor outcomes."},{"q":"How much water should a pregnant woman drink daily?","a":"A pregnant woman should drink at least eight 8-oz glasses (about 2,000 ml) of water daily."},{"q":"How can a breastfeeding mother maintain milk supply?","a":"Stress, dehydration, and fatigue may reduce a mother’s milk supply; adequate rest and hydration help maintain production."},{"q":"What is placenta previa?","a":"Placenta previa is abnormal low implantation of the placenta that encroaches on or covers the cervical os."},{"q":"What is abruptio placentae?","a":"Abruptio placentae is premature separation of a normally implanted placenta, causing pain, vaginal bleeding, and a board-like abdomen."},{"q":"What is the classic difference between abruptio placentae and placenta previa?","a":"Abruptio placentae causes painful bleeding; placenta previa causes painless bleeding."},{"q":"What are the normal stages of lochia?","a":"Lochia rubra (first few days, blood), serosa (4–7 days, serous), alba (7–10 days, leukocytes and decreased blood)."},{"q":"What is colostrum?","a":"Colostrum is the first breast secretion after delivery, rich in antibodies and protein."},{"q":"How does the uterus change during pregnancy?","a":"The uterus lengthens from 6.3 cm before pregnancy to 32 cm at term."},{"q":"What is the true conjugate?","a":"The true conjugate equals the diagonal conjugate minus 1.5 cm (≈10.5 cm), allowing the fetal head (≈10 cm) to pass."},{"q":"What should the nurse do in an emergency delivery to protect the fetus’s head?","a":"Apply gentle pressure to control descent and prevent rapid pressure changes in the molded skull."},{"q":"What pelvic measurement represents the smallest outlet diameter?","a":"The intertuberous diameter—the transverse distance between the ischial tuberosities—is the smallest outlet measurement."},{"q":"Why is methylergonovine (Methergine) administered postpartum?","a":"It prevents or treats postpartum hemorrhage by stimulating uterine contractions."},{"q":"How should methylergonovine (Methergine) be administered in emergencies?","a":"Inject 0.2 mg I.V. over 1 minute while monitoring blood pressure and uterine contractions."},{"q":"What is precipitate labor?","a":"Precipitate labor lasts only about 3 hours and ends with rapid delivery of the neonate."},{"q":"What is pica during pregnancy?","a":"Pica is a craving for nonfood items such as dirt, chalk, starch, or hair, which can endanger the fetus."},{"q":"Why should a pregnant woman take folic acid?","a":"Folic acid is needed for rapid cell division and helps prevent neural-tube defects."},{"q":"What is clomiphene (Clomid) used for?","a":"Clomiphene induces ovulation and may lead to multiple births."},{"q":"When is cervical suturing (cerclage) usually performed?","a":"Between 14 and 18 weeks to treat an incompetent cervix, removed by 35 weeks."},{"q":"What are the FDA drug risk categories for pregnancy?","a":"A (no risk), B (no animal risk), C (adverse in animals), D (evidence of risk but possible benefit), X (clear fetal anomalies and unacceptable risk)."},{"q":"What are symptoms of a ruptured ectopic pregnancy?","a":"Sharp lower-abdominal pain, spotting, rigidity, rapid respirations, tachycardia, and signs of shock."},{"q":"What are the mechanics of delivery?","a":"Engagement, descent and flexion, internal rotation, extension, external rotation (restitution), and expulsion."},{"q":"What is McDonald’s sign?","a":"A probable sign of pregnancy: ease in flexing the uterine body against the cervix."},{"q":"What is the risk of introducing air during oral sex in pregnancy?","a":"Air embolism may occur; partners should avoid blowing air into the vagina."},{"q":"What is the effect of cytomegalovirus infection in pregnancy?","a":"It can be transmitted to the fetus and cause congenital infection; pregnant staff should avoid exposure."},{"q":"What is fetal demise?","a":"Fetal demise refers to death of the fetus after viability."},{"q":"What increases insulin needs during pregnancy?","a":"Placental hormones have anti-insulin effects, so insulin requirements rise during the third trimester."},{"q":"What are common congenital defects in infants of diabetic mothers?","a":"Skeletal abnormalities and ventricular septal defects; malformations occur three times more often than in nondiabetic infants."},{"q":"What indicates preeclampsia in a patient?","a":"Puffiness around the eyes or hand edema, such as difficulty wearing rings, may signal preeclampsia."},{"q":"How does postpartum blood pressure change in preeclampsia?","a":"Blood pressure usually returns to normal during the puerperal period."},{"q":"What lab test detects maternal antibodies attached to neonatal RBCs?","a":"The direct antiglobulin (Direct Coombs’) test detects antibodies on neonatal red cells."},{"q":"What causes nausea and vomiting in early pregnancy?","a":"Rising levels of human chorionic gonadotropin (hCG) during the first trimester."},{"q":"What should a patient report after abortion?","a":"Bright-red clots, bleeding >7 days, foul discharge, fever > 100 °F, severe cramping, nausea, or vomiting."},{"q":"How long is normal pregnancy?","a":"About 280 days, 40 weeks, 9 calendar months, or 10 lunar months."},{"q":"What is normal initial neonatal weight loss?","a":"5 % to 10 % of birth weight during the first few days."},{"q":"What are normal neonatal hemoglobin values?","a":"Hemoglobin 17 to 20 g\/dL."},{"q":"What is the Apgar score used for?","a":"To assess neonatal respiratory effort, heart rate, muscle tone, reflex irritability, and color at 1 and 5 minutes after birth."},{"q":"How does maternal hypertension affect fetal blood gases?","a":"It decreases placental blood flow, raising fetal CO₂ and lowering fetal pH."},{"q":"What does lightening refer to?","a":"Settling of the fetal head into the brim of the pelvis near term."},{"q":"What is molding?","a":"The process by which the fetal head changes shape to pass through the birth canal."},{"q":"Why is oxytocin added to IV solution postpartum?","a":"To promote uterine involution and stimulate lactation after the placenta is delivered."},{"q":"What is supine hypotensive syndrome?","a":"Compression of the inferior vena cava by the uterus when lying supine, reducing venous return and causing hypotension."},{"q":"How is supine hypotension treated?","a":"Have the patient lie on her left side to relieve vena-cava pressure."},{"q":"What is the effect of relaxin during pregnancy?","a":"It relaxes pelvic connective tissue and joints to facilitate fetal passage during delivery."},{"q":"What causes dependent edema in pregnancy?","a":"Increased femoral venous pressure from 10 to 18 mm Hg causes dependent edema."},{"q":"What is hemodilution of pregnancy?","a":"Increased plasma volume relative to red-cell mass lowers hematocrit, creating physiologic anemia of pregnancy."},{"q":"What is the normal mean arterial pressure threshold for hypertension in pregnancy?","a":"A mean arterial pressure > 100 mm Hg after 20 weeks is hypertensive."},{"q":"What is the purpose of Kegel exercises postpartum?","a":"To strengthen perineal muscles and improve urinary control."},{"q":"What is subinvolution?","a":"Failure of the uterus to return to its normal size, often due to bladder distention or retained tissue."},{"q":"What are possible causes of fundal height smaller than expected?","a":"Growth retardation, missed abortion, transverse lie, or false pregnancy."},{"q":"What causes fundal height larger than expected?","a":"Multiple gestation, polyhydramnios, uterine myomata, or a large baby."},{"q":"What are the risks of amniocentesis?","a":"Spontaneous abortion, trauma, premature labor, infection, and Rh sensitization."},{"q":"What should be monitored after amniocentesis?","a":"Abdominal cramping or vaginal bleeding may indicate complications."},{"q":"What is the difference between gravida and para?","a":"Gravida = number of pregnancies (total); Para = number reaching viability (≥20 weeks)."},{"q":"What are the stages of uterine contraction?","a":"Increment (rising tension), acme (peak), decrement (relaxation)."},{"q":"What are signs of narcotic withdrawal in a neonate?","a":"Tremors, restlessness, high-pitched cry, irritability, poor sleep, and feeding difficulty."},{"q":"What are neonatal signs of heroin withdrawal?","a":"Begin several hours to 4 days after birth; include tremors, irritability, and poor feeding."},{"q":"When do methadone-withdrawal symptoms appear in neonates?","a":"From 7 days to several weeks after birth."},{"q":"What is the treatment for neonatal narcotic withdrawal?","a":"Drugs such as phenobarbital, paregoric, or diazepam may be prescribed; a dark, quiet environment is provided."},{"q":"What should be done after delivery of the placenta?","a":"Massage the uterus to stimulate contraction and prevent hemorrhage."},{"q":"What is the purpose of neonatal phototherapy?","a":"To reduce bilirubin levels in jaundiced infants; eyes and genitals must be covered during exposure."},{"q":"What is lanugo?","a":"Fine fetal hair covering the body until about 20 weeks, then disappearing from the face, trunk, and limbs."},{"q":"What is the normal specific gravity of neonatal urine?","a":"1.003 to 1.030; lower = overhydration, higher = dehydration."},{"q":"What is the neonatal period?","a":"The first 28 days after birth, also called the first month of life."},{"q":"What is the normal neonatal body temperature range?","a":"98° to 99° F (36.7°–37.2° C)."},{"q":"What are normal neonatal respirations?","a":"40 to 60 breaths per minute; count for a full minute."},{"q":"What is the normal length and weight of a full-term newborn?","a":"A full-term neonate typically weighs 5 to 9 lb (2 to 4 kg), measures 18 to 22 inches (45.5–56 cm) in length, and has a head circumference 1 inch larger than the chest."},{"q":"What is the normal neonatal head circumference compared to chest circumference?","a":"The head circumference is normally 2 to 3 cm greater than the chest circumference."},{"q":"When does the anterior fontanel close?","a":"The diamond-shaped anterior fontanel closes between 12 and 18 months of age."},{"q":"When does the posterior fontanel close?","a":"The triangular posterior fontanel closes by about 2 months of age."},{"q":"What does a tuft of hair over a newborn’s spine indicate?","a":"A tuft of hair over the spine is an abnormal finding and may indicate spina bifida."},{"q":"What is the normal neonatal water content?","a":"The percentage of water in a neonate’s body is about 78% to 80%."},{"q":"How should a neonate be positioned for nasotracheal suctioning?","a":"Position with neck slightly hyperextended in a “sniffing” position, chin up and head tilted back slightly."},{"q":"What are signs of postmature neonates?","a":"Long, brittle fingernails and desquamation (skin peeling) are common in postmature infants."},{"q":"What indicates chromosomal abnormalities in neonates?","a":"Low-set ears may indicate chromosomal abnormalities such as Down syndrome."},{"q":"When is meconium normally passed?","a":"Meconium is usually passed in the first 24 hours after birth, but may take up to 72 hours."},{"q":"Why should boys born with hypospadias not be circumcised?","a":"Because the foreskin may be needed for reconstructive surgery."},{"q":"When are hepatitis B vaccine and immune globulin given to newborns?","a":"Hepatitis B vaccine is usually given within 48 hours of birth, and immune globulin within 12 hours if the mother is HBsAg positive."},{"q":"What is the primary cause of diaphragmatic hernia symptoms in neonates?","a":"The herniated organs compress and displace the lungs and heart, causing respiratory distress shortly after birth."},{"q":"What is neonatal jaundice within 24 hours called?","a":"Pathological jaundice; it may indicate erythroblastosis fetalis."},{"q":"What does neonatal acrocyanosis indicate?","a":"Acrocyanosis (blueness of hands and feet) is normal in neonates due to immature peripheral circulation."},{"q":"What is ophthalmia neonatorum and how is it prevented?","a":"A severe eye infection caused by maternal gonorrhea; prevented with erythromycin, tetracycline, or silver nitrate instilled at birth."},{"q":"How should the neonate be positioned after birth to drain mucus?","a":"Place the neonate in a 30-degree Trendelenburg position to facilitate mucus drainage."},{"q":"How should heat loss be prevented in newborns?","a":"Keep the neonate under a radiant warmer or wrap in a warmed blanket; expose only one body part at a time."},{"q":"How many vessels are in a normal umbilical cord?","a":"The umbilical cord normally has two arteries and one vein."},{"q":"What is the proper way to provide umbilical cord care?","a":"Clean the cord area with alcohol after every diaper change to prevent infection and promote drying."},{"q":"What is the purpose of neonatal phototherapy eye and genital protection?","a":"To protect from light exposure and prevent damage during treatment."},{"q":"What is mongolian spot?","a":"A bluish or brown patch commonly on the sacrum or buttocks in nonwhite infants, disappearing by age 2–3 years."},{"q":"What is vernix caseosa?","a":"A cheeselike substance covering the fetus’s skin in utero, protecting it; may be rubbed in or washed off in 1–2 baths."},{"q":"What is Harlequin sign in neonates?","a":"When lying on one side, the dependent side appears red and the upper side pale; due to immature vasomotor control."},{"q":"What is cutis marmorata?","a":"Mottling or purple discoloration of infant skin caused by a transient vasomotor response to cold."},{"q":"What is Ortolani’s sign?","a":"An audible click or palpable jerk on thigh abduction indicating congenital hip dislocation."},{"q":"What are features of Down syndrome in neonates?","a":"Hypotonia, slanted eyes, excess neck skin, flat facial features, small genitalia, simian crease, and absence of Moro reflex."},{"q":"What are causes of postpartum hemorrhage?","a":"Uterine atony, retained tissue, trauma, or coagulopathies."},{"q":"What is the leading cause of maternal death in the United States?","a":"Pregnancy-induced hypertension is a leading cause of maternal death."},{"q":"What is the Guthrie test used for?","a":"It is a screening test for phenylketonuria, most reliable between the second and sixth days after birth after protein ingestion."},{"q":"What indicates fetal well-being in the biophysical profile?","a":"Normal fetal breathing movements, tone, movements, reactive heart rate, and adequate amniotic fluid."},{"q":"What is the difference between physiological and pathological jaundice?","a":"Physiological appears after 24 hours; pathological within 24 hours and indicates disease."},{"q":"What is the function of the placenta during pregnancy?","a":"Acts as a fetal lung, enabling gas exchange; interruption causes fetal acidosis and hypoxia."},{"q":"When should vaginal exam be avoided in pregnancy?","a":"When vaginal bleeding is undiagnosed until placenta previa is ruled out by ultrasound."},{"q":"What causes a high alpha-fetoprotein (AFP) level?","a":"Neural tube defects; low levels are associated with Down syndrome."},{"q":"What defines macrosomia in infants of diabetic mothers?","a":"Excessive birth weight due to increased insulin and fat deposition in the fetus."},{"q":"What is the purpose of Rho(D) immune globulin administration?","a":"To prevent Rh sensitization in an Rh-negative mother after delivering an Rh-positive infant."},{"q":"What happens if a pregnant woman is rubella nonimmune (titer <1:8)?","a":"She should be immunized after delivery and avoid pregnancy for 3 months."},{"q":"What is HELLP syndrome?","a":"Hemolysis, elevated liver enzymes, and low platelets—a severe variant of preeclampsia requiring immediate medical attention."},{"q":"What is uterine inversion?","a":"A rare but life-threatening condition where the uterus turns inside out, causing hemorrhage and shock."},{"q":"What defines fetal engagement?","a":"The largest diameter of the fetal head has passed through the pelvic inlet."},{"q":"What is the role of prolactin?","a":"Prolactin stimulates and sustains milk production in the postpartum period."},{"q":"What are signs of preterm labor?","a":"Uterine contractions, pelvic pressure, low back pain, and cervical dilation before 37 weeks."},{"q":"What is the purpose of tocolytic therapy?","a":"To suppress premature labor contractions using agents like terbutaline, ritodrine, or magnesium sulfate."},{"q":"What are contraindications to tocolytic therapy?","a":"Fetal death, distress, or severe maternal hemorrhage."},{"q":"What is the most urgent neonatal surgical emergency?","a":"Diaphragmatic hernia due to respiratory compromise."},{"q":"What is meconium aspiration?","a":"Inhalation of meconium-stained amniotic fluid causing respiratory distress after birth."},{"q":"What is the significance of 3-vessel cord anomalies?","a":"A single umbilical artery may indicate congenital anomalies."},{"q":"What are signs of retained placenta?","a":"Continued vaginal bleeding and failure of the uterus to contract firmly after delivery."},{"q":"What is the postpartum stabilization phase?","a":"The 4th stage of labor lasting up to 4 hours after placenta delivery, allowing mother’s recovery and observation."},{"q":"Why is ambulation encouraged postpartum?","a":"Promotes circulation, prevents thrombosis, and relieves gas pain."},{"q":"What are the characteristics of premature infants?","a":"Thin, shiny skin, weak cry, poor muscle tone, and minimal subcutaneous fat."},{"q":"What are the normal fetal heart rate parameters?","a":"120–160 bpm baseline, accelerations indicate well-being, decelerations indicate possible distress."},{"q":"What does late deceleration in fetal heart rate indicate?","a":"Fetal hypoxia from uteroplacental insufficiency."},{"q":"How should the nurse respond to late decelerations?","a":"Turn mother on her left side, administer oxygen 8–10 L\/min, and notify the physician."},{"q":"What defines variability in fetal heart rate?","a":"Fluctuations from the baseline (120–160 bpm) indicating fetal autonomic function and oxygenation."},{"q":"What should be done for a prolapsed umbilical cord?","a":"Relieve pressure by positioning the mother in knee-chest or Trendelenburg, and maintain manually until delivery."},{"q":"What is a probable cause of infertility in men tested for sperm count?","a":"Low sperm motility or insufficient abstinence period before collection (<48 hours)."},{"q":"What defines oligohydramnios?","a":"Amniotic fluid volume less than 500 ml in the third trimester, often due to renal abnormalities."},{"q":"What defines polyhydramnios?","a":"Excess amniotic fluid (>2000 ml), associated with maternal diabetes and fetal anomalies."},{"q":"What are signs of magnesium sulfate toxicity?","a":"Respiratory depression, absence of deep tendon reflexes, decreased urine output (<30 ml\/hr)."},{"q":"What indicates preterm labor risk?","a":"History of previous preterm births, uterine anomalies, or multiple gestation."},{"q":"What is the normal fetal station at the level of ischial spines?","a":"Station 0."},{"q":"How is fetal descent measured?","a":"In centimeters relative to the ischial spines: negative above, positive below."},{"q":"What defines station +5?","a":"The presenting part is at the vaginal opening, ready for delivery."},{"q":"What defines station –5?","a":"The presenting part is still at the pelvic inlet, high in the pelvis."}]

Psychosocial Integrity Flashcards

nclexguide.com — Wed, 01 Oct 2025 19:21:09 +0000

Strengthen your preparation for the NCLEX RN®/PN® with flashcards focused on mental health, coping mechanisms, stress management, and therapeutic communication. Review psychiatric disorders, crisis intervention, substance use, grief, abuse, and end-of-life care. These cards help you recognize patient needs, support safe environments, and apply psychosocial principles to clinical judgment.

Part 1

Part 2

[{"q":"Describe their level of consciousness.","a":"Disoriented."},{"q":"Why did I tell you when you are taking care of a restless patient to think hypoxia first?","a":"Because restlessness is the first sign of hypoxia."},{"q":"When someone is hysterical, why can they go into respiratory alkalosis?","a":"Because they are hyperventilating (blowing off CO2)."},{"q":"Why is the patient in pulmonary edema restless and anxious?","a":"Hypoxia"},{"q":"When jaundice gets to the skin, what is one of the major nursing diagnoses?","a":"Alteration in skin integrity"},{"q":"Why does the patient with ulcerative colitis or Crohn’s disease possibly need psychotherapy?","a":"Many believe that there might be an emotional basis to these diseases."},{"q":"Why is the client with depression irritable?","a":"due to decreased because serotonin is a mood elevator"},{"q":"Why do we want to prevent isolation when a person is depressed?","a":"the depressed person likes to be alone but interacting with others actually makes the client feel better even if they don’t want to do it"},{"q":"Why as depression lifts does the suicide risk go up?","a":"it goes up because they now have the energy to go ahead and complete the task"},{"q":"How do you respond to a client’s delusion of grandeur?","a":"you let them know that you accept they need the belief but you do not believe it"},{"q":"Why does the manic client like to dress seductively?","a":"attention getting mechanism and they have no inhibitions"},{"q":"What is the reason a manic client likes to manipulate?","a":"manipulation makes them feel secure and powerful so you have to set limits and the staff must be consistent"},{"q":"Why do you not want to argue with or try to reason with the manic client?","a":"it will increase their anxiety level"},{"q":"What is an example of inappropriate affect in the schizophrenia client?","a":"laughing and smiling while talking about their mother who died a tragic death"},{"q":"How does the nurse respond to the schizophrenia client’s neologism?","a":"always seek clarification. You say “I don’t understand”"},{"q":"What is the most important thing to remember with a suicidal client?","a":"to provide a safe environment. We need to safe proof the room"},{"q":"If you use restraints for a suicidal client what must you do?","a":"check q15min and don’t forget hydration, nutrition and elimination"},{"q":"What is most important in the treatment of paranoia?","a":"be reliable. If you say you will do something you must do it. The #1 thing you’re trying to build is trust"},{"q":"Why does the highly anxious client need step-by-step instructions?","a":"because they cannot make decisions"},{"q":"Why do we include time in the schedule for rituals with an obsessive compulsive disorder client?","a":"their anxiety levele goes up If they cant perform this ritual"},{"q":"Why does the alcoholic have trouble with losing their magnesium and potassium?","a":"alcohol makes you diurese. And the 2 electrolytes you lose when you diurese are mg and k"},{"q":"Why would you observe the bulimic client for one hour after they have eaten a meal?","a":"to make sure they don’t go and throw up"},{"q":"Explain the reason follow up is the key to successful treatment of a phobia?","a":"it takes a while to desensitize someone. The anxiety presents itself as a phobia"},{"q":"How can the client with panic attacks learn to stop their anxiety?","a":"they must first learn how their anxiety feels when it starts to come on. That’s the first thing they have to do is learn how it feels in the early stages."},{"q":"Why do you warn a hallucinating client before you touch them?","a":"if you touch them without saying something first it could scare them. When they get scared they can get violent"},{"q":"Why do you give atropine pre procedure for electro-convulsive therapy?","a":"so they wont aspirate. To dry up secretions"}]

Psychosocial Integrity – Maternal Emotions, Family Adaptation, and Postpartum Support

[{"q":"What is postpartum blues?","a":"Postpartum blues are mild mood swings, tearfulness, and irritability that appear a few days after delivery and usually resolve within two weeks without medical treatment."},{"q":"What differentiates postpartum depression from postpartum blues?","a":"Postpartum depression lasts longer than two weeks, causes withdrawal, hopelessness, and may interfere with daily functioning or bonding."},{"q":"What are signs of postpartum psychosis?","a":"Extreme agitation, hallucinations, delusions, and disorganized behavior requiring immediate emergency intervention."},{"q":"What nursing intervention supports a mother experiencing postpartum depression?","a":"Encourage verbal expression of feelings, provide reassurance, and connect her with counseling and family support."},{"q":"What is the nurse’s priority when a patient expresses suicidal thoughts postpartum?","a":"Ensure safety by continuous supervision and notifying mental health professionals immediately."},{"q":"What is an appropriate nursing response to a grieving mother after a stillbirth?","a":"Allow the mother to see and hold the baby if desired, provide privacy, and support expression of grief without rushing the process."},{"q":"Why should parents be allowed to hold their stillborn infant?","a":"It helps with emotional closure, acceptance, and facilitates healthy grieving."},{"q":"What is anticipatory grief?","a":"Emotional preparation and mourning before an expected loss, such as terminal illness."},{"q":"What communication approach should be used with a grieving family?","a":"Use active listening, empathy, silence, and avoid clichés like “It was meant to be.”"},{"q":"What is the nurse’s role in end-of-life care?","a":"Provide comfort measures, ensure dignity, and support emotional, spiritual, and physical needs of both patient and family."},{"q":"What are signs of impending death?","a":"Decreased blood pressure, irregular breathing (Cheyne–Stokes), cold extremities, and decreased consciousness."},{"q":"What is the nurse’s role after a patient’s death?","a":"Provide postmortem care, respect cultural or religious practices, and allow family time with the body."},{"q":"What does palliative care focus on?","a":"Relieving symptoms and improving quality of life for patients with life-limiting illnesses."},{"q":"What is the goal of hospice care?","a":"To provide comfort and support to terminally ill patients and their families rather than curative treatment."},{"q":"How can nurses promote therapeutic communication?","a":"Maintain eye contact, listen attentively, use open-ended questions, and avoid giving false reassurance."},{"q":"What is the best response when a patient expresses fear about death?","a":"Encourage the patient to talk openly about their fears and listen without judgment."},{"q":"What is the purpose of a therapeutic relationship?","a":"To establish trust and rapport that facilitates healing and emotional support."},{"q":"What are characteristics of effective therapeutic communication?","a":"Empathy, respect, active listening, and appropriate use of silence."},{"q":"How should a nurse respond when a patient cries during assessment?","a":"Pause the interview, offer tissues, and allow the patient time to express feelings without interruption."},{"q":"What communication technique enhances patient understanding?","a":"Restating and clarifying the patient’s statements to ensure accuracy and show active listening."},{"q":"What is the nurse’s best action when a patient refuses treatment?","a":"Respect the decision, assess understanding of consequences, and document the refusal accurately."},{"q":"What nursing approach supports family coping with chronic illness?","a":"Provide education, identify support systems, and involve family in care planning."},{"q":"What is caregiver role strain?","a":"Physical, emotional, and financial stress experienced by individuals providing long-term care to loved ones."},{"q":"How can nurses assist caregivers under stress?","a":"Encourage respite care, stress management techniques, and use of community resources."},{"q":"What is the nurse’s role when caring for an anxious patient?","a":"Remain calm, speak softly, provide reassurance, and encourage slow breathing."},{"q":"What are common physical signs of anxiety?","a":"Restlessness, rapid heartbeat, sweating, tremors, and shortness of breath."},{"q":"What is the best nursing intervention for a patient in crisis?","a":"Stay with the patient, ensure safety, and help prioritize immediate needs."},{"q":"What is the purpose of stress management in nursing care?","a":"To help patients develop coping mechanisms and reduce physiological tension."},{"q":"What is a defense mechanism in psychology?","a":"An unconscious coping method used to protect oneself from anxiety or emotional pain."},{"q":"What is denial as a defense mechanism?","a":"Refusal to accept reality or facts, acting as if a painful event or situation does not exist."}]

Safe And Effective Care Environment Flashcards

nclexguide.com — Wed, 01 Oct 2025 19:16:54 +0000

Master one of the four core NCLEX categories with focused flashcards on management of care and safety/infection control. Practice high-yield scenarios on prioritization, delegation, legal/ethical issues, radiation safety, isolation precautions, and patient safety standards. These cards help you build clinical judgment, reduce errors, and answer the toughest NCLEX RN®/PN® questions with confidence.

Management Of Care Flashcards

Part 1

[{"q":"What is fluid volume excess?","a":"Retaining too much water and sodium in the vascular space."},{"q":"What is another term for fluid volume excess?","a":"Hypervolemia"},{"q":"What is another name for fluid volume deficit?","a":"Hypovolemia."},{"q":"How can fever and sweating induce hypovolemia?","a":"Fever and sweating can cause fluid loss."},{"q":"What will the patient’s symptoms be?","a":"Tight muscle tone, irritable, increased DTRs, depression; hallucinations + Chvostek’s + Trousseau’s."},{"q":"Why does it do this?","a":"It is compensating (building up in the blood), making the patient less acid."},{"q":"When a patient has any type of upper body burns, why do we have to worry about the airway?","a":"You have to worry about airway edema."},{"q":"Explain the general care for a patient with an internal radiation implant.","a":"Private room; mark room, bed rest – body fluids are active – no pregnant nurses or visitors; supine – log roll to turn; flush commode twice; don’t forget the patient is also immunosuppressed."},{"q":"When a patient has a radiation implant, there is a chance it will become dislodged. What would you do?","a":"Get gloves; using forceps, pick it up and put it in a lead-lined container – call the radiation department."},{"q":"Why is it important that the ileal conduit patient change their appliance in the morning?","a":"Because output is at its lowest in the morning. (Don’t want to let urine get on skin as excoriation will occur.)"},{"q":"Could the Addison’s disease patient also have a life-threatening arrhythmia? If so, why?","a":"Yes – too much K+"},{"q":"Does the Addison’s disease patient have too many steroids in their blood or not enough steroids in their blood?","a":"Not enough."},{"q":"After a patient has experienced hypoglycemia and they have drank a coke or eaten some candy or whatever, what do they need to do next? Explain why.","a":"Eat complex carbohydrates and protein (peanut butter and crackers, cheese and crackers) – so blood sugar won’t drop again; drink milk."},{"q":"Draw a picture of my square heart and include the lungs and the aorta and trace the normal blood flow through the heart.","a":"Check in your Hurst Review Book."},{"q":"What is a common and expected side effect of nitroglycerin?","a":"Headache."},{"q":"When you give somebody nitroglycerin, are they going to vasoconstrict or vasodilate? Therefore, what is going to happen to their blood pressure?","a":"Vasodilate – decrease"},{"q":"What does the wedge pressure tell you about?","a":"Pressures in the left side of the heart."},{"q":"If a patient’s wedge pressure is increasing, that means volume is building up in the left side of the heart. When volume is building up in the left side of the heart, that puts the patient at risk for developing what?","a":"Pulmonary edema"},{"q":"Why does a patient with a venous disorder need Heparin?","a":"To decrease the chance of a new clot forming and to keep the present clot from getting larger."},{"q":"How do TED hose help venous disorders?","a":"They enhance venous return and decrease pooling."},{"q":"When somebody has a positive skin test, what does that mean?","a":"It means the patient has been exposed."},{"q":"Does the nephrotic syndrome patient need a high-sodium diet or a low-sodium diet? Explain why.","a":"A low-sodium diet is needed to decrease further edema."},{"q":"Does the nephrotic syndrome patient need a high-protein diet or a low-protein diet? Explain why.","a":"A high-protein diet is needed to help offset the amount of protein this patient is losing through their glomerulus."},{"q":"Why does the oliguric patient go into a fluid volume excess?","a":"Retaining fluid"},{"q":"Does the patient who is being hemodialyzed have to watch what they eat and drink in between treatment? Why?","a":"Yes, because between treatments the patient is unable to excrete excess electrolytes and fluids."},{"q":"Once you get the blood from the blood bank, how long do you have to get it hanging?","a":"30 minutes"},{"q":"Why does a sickle cell patient develop ischemia or infarction in extremities?","a":"Little clots can form and cut off circulation to an area."},{"q":"Why does the sickle cell patient develop pain or have pain and swelling?","a":"Because the cells can cut off circulation to an area."},{"q":"There are two parts to a neurovascular check. a. What is the neuro component? b. What is the vascular component?","a":"A. Neuro - movement and sensation B. Vascular – capillary refill, skin temperature, skin color, pulse"},{"q":"When a patient is having a CT of the head, is it okay for them to talk?","a":"No"},{"q":"Can a CT scan be done with contrast medium (dye)?","a":"Yes"},{"q":"Can a patient become claustrophobic with a CT scan?","a":"Yes"},{"q":"What type of patient cannot tolerate an MRI scan?","a":"Claustrophobic"},{"q":"Explain everything that you would teach a patient about an MRI.","a":"They will be in a closed space; need to lie still, they will hear a clanging sound, they can talk to others while they are in the tube, and no metal objects are allowed in the tube."},{"q":"What is cerebral angiography?","a":"It is an x-ray of cerebral circulation using dye."},{"q":"When a patient is having cerebral angiography, what artery do they go through?","a":"Usually femoral."},{"q":"What other procedure did we use the femoral artery for?","a":"Heart Catheterization"},{"q":"When a patient is posturing, what happens to their caloric needs?","a":"Increases"},{"q":"Why do we give the pancreatitis patient anti-cholinergic drugs?","a":"To dry secretions"},{"q":"Explain the major symptoms of appendicitis.","a":"Right lower quadrant pain and an elevated white blood count; may have some nausea and vomiting and rebound tenderness."},{"q":"Why do we avoid giving an enema to a patient who has appendicitis?","a":"Because we do not want to rupture the appendix."}]

Part 2

Safety And Infection Control Flashcards

Part 1

[{"q":"Why is it so important to give IV fluids very slowly to the elderly?","a":"Their heart and kidneys are weak. The heart may not be able to pump the excess forward, and the kidneys may have problems excreting the excess."},{"q":"Why is it so important to be careful with drugs, like sedatives, hypnotics, and narcotics?","a":"Because they decrease respiration and retain CO2."},{"q":"Why does the hypoparathyroid patient need a quiet environment?","a":"To reduce stimuli – they are at risk for seizures."},{"q":"Why does the hypoparathyroid patient need a trach tray at the bedside?","a":"To provide emergency airway in case of laryngospasm."},{"q":"Do they use dye with a KUB?","a":"Not usually – it is just an x-ray"},{"q":"Does an IVP use dye? If so, what had you better ask the patient if they are allergic to?","a":"Yes - iodine"},{"q":"Why do we need to avoid IM injections in the leukemia patient?","a":"Because they don’t have enough platelets; therefore, they will bleed into the muscle."},{"q":"Why does the leukemia patient need to avoid aspirin?","a":"You wouldn’t want to give the patient anything that would promote more bleeding (they do not have enough platelets)."},{"q":"Who is the carrier and the transmitter of hemophilia?","a":"Females."},{"q":"Why does the hemophiliac patient need to avoid aspirin and IM injections?","a":"They don’t need anything that is going to increase their bleeding episodes."},{"q":"Why is dental hygiene so important with a hemophiliac?","a":"They don’t need to be having frequent dental work due to the chance of hemorrhage."},{"q":"Why is it so important that fractures be immobilized as soon as possible?","a":"To prevent further trauma."},{"q":"What would you do if a patient came in with an open fracture?","a":"Cover it with something sterile."},{"q":"What is one of the most important things you need to remember with a scalp injury?","a":"Fight infection."},{"q":"When a trauma patient comes into the emergency room, why do we have to assume a C-spine injury is present?","a":"Because with any trauma, we assume the C-spine is injured until proven otherwise."},{"q":"Why is it so important to keep the body in perfect alignment after trauma?","a":"To protect the cervical spine and spinal cord."},{"q":"When you have a head-injured patient, why is it so important that we keep the environment quiet?","a":"To decrease the stimuli which could initiate seizures."},{"q":"When you have a head-injured patient, why do we have to pad the side rails?","a":"Because we are worried about seizures."},{"q":"What is a major risk when a patient has an ICP monitoring device?","a":"Infection"},{"q":"Why is it so important that we keep the connections tight on an ICP monitoring device and also why is it so important to keep the dressings dry?","a":"To decrease the chance for infection."},{"q":"Why is it so important that vital signs be checked pre-liver biopsy?","a":"We are worried about hemorrhage."},{"q":"Why do you need to know med-surg core content first when delegating routine tasks to LPNs and unlicensed assistive personnel (UAPs)?","a":"because you have to look at every client situation and make a judgment call based on med surg knowledge"},{"q":"Why can UAPs only perform routine, simple, repetitive common activities on stable clients in uncomplicated situations?","a":"because these activities do not require nursing judgments"},{"q":"What types of assignment transfers both responsibility and accountability?","a":"RN to RN"},{"q":"Why is the RN responsible for knowing the staff’s strengths and weaknesses in regards to delegation?","a":"to help delegate to the right personnel and improve client care"},{"q":"What should the RN do when a weakness is identified in a staff member?","a":"teach"},{"q":"Why can the LPN not do any form of evaluation?","a":"because evaluation involves assessment, we never delegate assessment"},{"q":"Why should the RN assess the newly admitted client first?","a":"because a new admit is always considered unstable"}]

Part 2

Safe and Effective Care Environment – Maternal Safety, Infection Control, and Delivery Procedures

[{"q":"What should the nurse do first after rupture of membranes?","a":"Assess the fetal heart rate immediately to ensure there is no cord compression or prolapse."},{"q":"What is the priority nursing action when a patient has placenta previa?","a":"Avoid vaginal examinations and prepare for possible cesarean delivery if bleeding occurs."},{"q":"What is the nurse’s legal duty when obtaining informed consent?","a":"Ensure that the patient understands the procedure, risks, and alternatives before signing, but only the provider explains the details."},{"q":"What should the nurse do if a patient does not understand a surgical procedure before signing consent?","a":"Notify the surgeon to return and clarify; the nurse must not interpret or provide detailed explanations."},{"q":"What is the nurse’s role in verifying informed consent?","a":"Witness the patient’s signature and confirm that consent was given voluntarily."},{"q":"What is the nurse’s first priority during a fire emergency in the hospital?","a":"Follow RACE protocol: Rescue patients in danger first, then activate the alarm, contain the fire, and extinguish it if possible."},{"q":"What is the meaning of RACE in fire safety?","a":"Rescue, Alarm, Contain, Extinguish — the correct sequence of actions in a hospital fire emergency."},{"q":"What does PASS stand for when using a fire extinguisher?","a":"Pull the pin, Aim at the base, Squeeze the handle, Sweep side to side."},{"q":"What is the safest position for a pregnant woman experiencing hypotension?","a":"Turn the woman onto her left side to improve venous return and placental perfusion."},{"q":"What should a nurse do during a disaster when triaging patients?","a":"Treat those with the greatest chance of survival first, prioritizing airway and circulation."},{"q":"What is the best infection control measure for all patients?","a":"Consistent hand hygiene before and after every patient contact."},{"q":"What are standard precautions?","a":"Infection control practices applied to all patients, regardless of diagnosis, including handwashing and use of gloves."},{"q":"What are transmission-based precautions?","a":"Additional measures used for patients known or suspected to be infected with pathogens spread by contact, droplet, or airborne routes."},{"q":"What PPE is required for contact precautions?","a":"Gloves and gown must be worn; use dedicated equipment for the patient."},{"q":"What PPE is required for droplet precautions?","a":"Surgical mask, gloves, and gown; used for infections like influenza or pertussis."},{"q":"What PPE is required for airborne precautions?","a":"N95 respirator, negative pressure room, and closed-door policy; used for TB, measles, or varicella."},{"q":"What is the safest action after exposure to blood or body fluids?","a":"Wash the area immediately with soap and water and report the incident to the supervisor."},{"q":"What is the proper method for removing contaminated gloves?","a":"Grasp the outside of one glove, peel it away, holding it in the gloved hand, then slide an ungloved finger under the other glove to remove it without skin contact."},{"q":"What is the correct sequence for removing PPE?","a":"Gloves → Gown → Goggles → Mask — to minimize contamination."},{"q":"What is the correct order for donning PPE?","a":"Gown → Mask → Goggles → Gloves — ensuring clean-to-dirty technique."},{"q":"What is the best way to prevent needlestick injuries?","a":"Avoid recapping used needles and dispose of them immediately in puncture-resistant sharps containers."},{"q":"What should the nurse do after a needlestick injury?","a":"Wash the site, report immediately, and follow protocol for post-exposure prophylaxis."},{"q":"What is the most effective method to prevent hospital-acquired infections?","a":"Proper and consistent hand hygiene before and after any patient contact."},{"q":"How should linens contaminated with blood be handled?","a":"Wear gloves and place the linens in a leak-proof biohazard bag without shaking."},{"q":"What is the proper disposal method for infectious waste?","a":"Place all biohazard materials in red, labeled bags or containers according to facility policy."},{"q":"What is the purpose of patient identification bands?","a":"To ensure correct patient identification before administering medications or procedures."},{"q":"What information must be verified before medication administration?","a":"The “five rights”: right patient, right drug, right dose, right route, and right time."},{"q":"What should the nurse do if a medication error occurs?","a":"Assess the patient, notify the provider, complete an incident report, and do not document the error in the chart."},{"q":"What is the correct procedure for telephone orders?","a":"Repeat the order back to confirm accuracy and document with the provider’s name and time received."},{"q":"What is the nurse’s responsibility regarding patient confidentiality?","a":"Protect patient information and discuss it only with authorized personnel involved in care."},{"q":"What is HIPAA?","a":"The Health Insurance Portability and Accountability Act, which ensures confidentiality and security of patient health information."},{"q":"How should the nurse dispose of documents with patient information?","a":"Shred or place in a designated locked container for confidential disposal."},{"q":"What is the purpose of incident reporting?","a":"To document unusual occurrences for quality improvement and risk management, not for punishment."},{"q":"What should be done when a patient falls?","a":"Assess for injury first, notify the provider, and complete an incident report per facility policy."},{"q":"How should side rails be used safely?","a":"Raise only necessary rails to prevent falls while avoiding entrapment or restraint classification."},{"q":"When are physical restraints appropriate?","a":"Only when all less restrictive measures have failed and the patient poses a danger to self or others."},{"q":"What documentation is required for restraints?","a":"Reason for use, type, alternatives tried, time applied, and frequent reassessments per protocol."},{"q":"What should be done before applying restraints?","a":"Try verbal de-escalation, reorientation, or sitter supervision before restraint use."},{"q":"What are the nursing priorities for a patient in restraints?","a":"Check circulation, skin integrity, and range of motion every two hours."},{"q":"What is the maximum time a restraint order is valid?","a":"Typically 24 hours; it must be renewed daily by the provider."},{"q":"What is an advance directive?","a":"A legal document stating a patient’s wishes for healthcare decisions if they become incapacitated."},{"q":"What is a living will?","a":"A type of advance directive specifying medical treatment preferences at end of life."},{"q":"What is a durable power of attorney for healthcare?","a":"A legal appointment of another person to make healthcare decisions on the patient’s behalf."},{"q":"What is the nurse’s role in end-of-life care documentation?","a":"Respect the patient’s wishes, ensure comfort, and follow the advance directive accurately."},{"q":"What is the best action if a patient refuses a prescribed treatment?","a":"Respect the patient’s right to refuse, document the refusal, and notify the provider."},{"q":"What should the nurse do if a patient wants to leave the hospital against medical advice (AMA)?","a":"Explain risks, obtain the patient’s signature on the AMA form, and document the event thoroughly."},{"q":"What is the nurse’s legal protection when following physician orders?","a":"The nurse must clarify any order that seems unsafe or unclear; following a wrong order is not a defense."},{"q":"What is the correct method for transferring a patient using a wheelchair?","a":"Lock wheels, assist the patient into the chair using a gait belt, and position footrests properly."},{"q":"How should a fall-risk patient be assisted during ambulation?","a":"Walk slightly behind and to the side, holding a gait belt for support."},{"q":"What is the purpose of safety reminder devices like bed alarms?","a":"To alert staff when patients at risk for falls attempt to leave the bed unassisted."},{"q":"What is the priority nursing action after a patient experiences a seizure?","a":"Protect the head, maintain airway, place the patient on their side, and do not insert anything into the mouth."},{"q":"What precautions should be taken with oxygen equipment?","a":"Keep away from flames or sparks, avoid petroleum-based products, and post “No Smoking” signs."},{"q":"What is the first action if a patient’s IV site becomes red and swollen?","a":"Stop the infusion immediately, remove the IV, and restart at another site."},{"q":"What should the nurse do if a medication is spilled on the floor?","a":"Dispose of it safely and obtain a new dose; never administer contaminated medication."},{"q":"What is the correct response to a small electrical fire from equipment?","a":"Unplug the equipment if safe, use a CO₂ or dry chemical extinguisher, and report to maintenance."},{"q":"What is the nurse’s priority during a bomb threat call?","a":"Stay calm, keep the caller talking, gather details, and notify security immediately after the call."},{"q":"What is the protocol during a mass casualty event?","a":"Apply triage principles: treat those who can be saved first; tag and document patients clearly."},{"q":"What is the primary focus of risk management in healthcare?","a":"Identifying and reducing potential causes of harm to patients or staff."},{"q":"What is the nurse’s responsibility when delegating tasks?","a":"Ensure the delegated task matches the staff member’s competence and scope of practice."},{"q":"What should never be delegated by a registered nurse?","a":"Assessment, evaluation, and nursing judgment should not be delegated."},{"q":"What are the key principles of effective delegation?","a":"Right task, right circumstance, right person, right direction, and right supervision."},{"q":"What is the nurse’s responsibility after delegating a task?","a":"The nurse remains accountable for the outcome and must evaluate the results."},{"q":"What should be done if an unlicensed assistant reports abnormal findings?","a":"The nurse must reassess the patient personally to confirm and interpret the findings."},{"q":"What is continuity of care?","a":"Providing consistent, coordinated care as the patient transitions between settings or providers."},{"q":"What should be included in a handoff report?","a":"Current condition, recent changes, vital signs, treatments, and pending tests."},{"q":"What is the purpose of an interdisciplinary team conference?","a":"To collaborate across disciplines for comprehensive patient care planning."}]

Health Promotion And Maintenance Flashcards

nclexguide.com — Tue, 30 Sep 2025 19:40:48 +0000

Focus your NCLEX-RN®/PN® prep on prevention, screening, and patient education with high-yield flashcards for health promotion. Practice growth & development, immunizations, prenatal care, nutrition, and community-level interventions that appear frequently on the exam. Use these cards to master anticipatory guidance and evidence-based screening so you can promote wellness and prevent complications confidently.

Part 1

Part 2

[{"q":"What are some foods high in potassium?","a":"Bananas, dried fruits, melons, baked potatoes, greens, strawberries."},{"q":"On what day of the menstrual cycle should a woman complete a self-breast exam and why?","a":"Days 7-12; least amount of swelling and tenderness."},{"q":"Why do testicular exams need to be done monthly?","a":"Because these tumors grow fast."},{"q":"Why should the testicular exam be done in the shower?","a":"Testicles descend with the warmth of the shower, thereby promoting a better exam."},{"q":"How can a high-fiber diet benefit a diabetic patient?","a":"Helps maintain steady blood sugar levels by slowing the absorption of glucose in the GI tract and preventing glucose spikes."},{"q":"How can this complication be prevented?","a":"Inform the patient to eat; take insulin regularly; eat healthy snacks."},{"q":"What is the most important thing to teach your patient about Buerger’s disease or Raynaud’s disease—to avoid the?","a":"Cause"},{"q":"Explain the skin test for TB?","a":"An intradermal injection is given, and a wheal should form. If a wheal does not form, the test has to be repeated."},{"q":"When a patient has CAPD for their renal failure, why do they have to increase protein and fiber in their diet?","a":"This patient needs protein because protein can leak into the peritoneal cavity during the procedure. The patient needs fiber because of the constipation problems they have due to decreased peristalsis."},{"q":"What is the number one thing you need to remember with kidney stones?","a":"Fluids, fluids, fluids"},{"q":"What are some things you would teach a hemophiliac in regard to day-to-day living?","a":"Avoid trauma; ibuprofen is fine for minor aches and pains; avoid forceful nose blowing, coughing, and straining; use an electric razor and soft toothbrush."},{"q":"What diet changes should the gout patient make?","a":"Decrease proteins and purines. Need to eat alkaline ash foods like milk, potatoes, and citruses."},{"q":"Why is it so important that the gout patient drink lots of fluids, decrease alcohol, and avoid becoming dehydrated?","a":"To flush out the uric acid crystals. Alcohol promotes diuresis and when you become dehydrated, uric acid crystals tend to accumulate and promote an attack."},{"q":"If a patient has been diagnosed with a concussion, what things should you teach before they go home?","a":"Be aware of S\/S such as difficulty awakening or speaking, confusion, severe headaches, vomiting, pulse changes, unequal pupils, or one-sided weakness."},{"q":"Is it okay for a concussion patient to go home alone?","a":"No"},{"q":"What are the dietary changes needed for the pancreatitis patient?","a":"Clear liquids, increase food slowly, no stimulating food, frequent small meals, high carbohydrates for energy."},{"q":"Explain what you would teach a peptic ulcer patient about diet?","a":"Eat what you can tolerate but avoid extra spicy foods."},{"q":"List presumptive, probable, and positive signs of pregnancy.","a":"a. Presumptive signs: amenorrhea, N\/V, frequency, breast tenderness b. Probable signs: positive pregnancy test, Goodell’s sign, Chadwick’s sign. Hegar’s sign, uterine enlargement, Braxton Hick’s contractions, Pigmentation\/changes of the skin: Linea nigra, abdominal striae, facial chloasma, darkening of the areola c. Positive signs: fetal heartbeat, fetal movement felt by experienced examiner, ultrasound"},{"q":"When teaching a pregnant client about exercise what heart rate do you tell her not to get above when exercising? And why?","a":"140 because it decreases cardiac output and uterine perfusion"},{"q":"The client should be taught to be alert for what danger signs during pregnancy?","a":"Sudden gush of vaginal fluid, bleeding, persistent vomiting, severe headache, abdominal pain, increase temps, edema, no fetal movement."},{"q":"What signs of true labor would the nurse teach the client?","a":"Regular contractions, contractions increase in frequency and duration, discomfort in back radiating around the abdomen, pain level increases with a change in activity."},{"q":"When you assess tachycardia in a postpartum client, what should you think?","a":"hemorrhage"},{"q":"What should the nurse do when palpating the postpartum client’s fundus that is boggy? And why?","a":"massage it until firm to control bleeding and check for bladder distention"},{"q":"The nurse teaching a group of pregnant clients about breast feeding would include what important points?","a":"Cleanse with warm water after each feeding; let air dry, support bra, ointment for soreness or express some colostrum and let it dry, breast pads to absorb moisture, initiate breast feeding ASA after birth, if breast feeding interrupted, mom can pump, increase calorie intake by 500 calories, fluid\/milk intake 8-10 eight ounce glasses\/day."},{"q":"What assessments are scored with the Apgar and when is it done?","a":"Heart rate, respiration, muscle tone, reflex irritability, color; 1 and 5 minutes"},{"q":"Hurst Review Services 1","a":"Complications of Maternity"},{"q":"What is the first sign of an ectopic pregnancy?","a":"pain"},{"q":"What are the two priorities in the treatment of Abruptio placenta?","a":"manage fetus status and maternal shock"},{"q":"List treatments for the client with Hyperemesis Gravidarum.","a":"NPO for 48 hours, IVFs about 3000 mL for 1st 24 hours, antiemetic, vitamins, quiet environment\/not close to nurse’s lounge, oral hygiene, don’t talk about food, keep emesis basin out of sight, 6-8 small, dry feedings followed by clear liquids, should be icy cold or steaming hot, well-ventilated room"},{"q":"By definition, preeclampsia involves what assessment data?","a":"increase BP, proteinuria, edema after 20th week"},{"q":"Why do the face and hands of the preeclamptic client swell?","a":"the client is losing protein and albumin is protein, fluid doesn’t stay in vascular space it leaks into the tissues"},{"q":"Why is betamethasone (Celestone) given to the mom in preterm labor?","a":"To stimulate maturation of the baby’s lungs in case preterm birth occurs."},{"q":"Why is it important to check FHT’s when membranes rupture, either artificially or spontaneously?","a":"prolapsed cord can occur when the presenting part is not engaged"},{"q":"When are pregnant clients routinely assessed for GBS risk factors?","a":"cultured around 35-37 weeks and on admission to L&D"},{"q":"Hurst Review Services 1","a":"Pediatrics"},{"q":"What is the order of obtaining vital signs in the pediatric client?","a":"Least invasive first; observe before touching or even talking with them. Resp. rate, heart rate, blood pressure, temp"},{"q":"At what stage do children begin to use language to express thoughts?","a":"toddler"},{"q":"Discuss nursing strategies that could be used to communicate with a child with developmental disabilities.","a":"use of gestures, writing boards, head nods, eye blinks"},{"q":"Why might nebulized epinephrine be used to treat LTB? What should you observe for after its use?","a":"constricts edematous blood vessels"},{"q":"Why is it so important to recognize signs and symptoms of RSV quickly?","a":"It is important to know the onset S\/S because the disease will becomes worse at day 2-3. S\/S can range from mild to severe; can go from cough, runny nose with copious amounts of mucous, to severe respiratory distress."},{"q":"Why is the child with Cystic Fibrosis at risk for hyponatremia?","a":"the child is losing sodium on their skin"},{"q":"Why do we need to feed the pediatric client with heart failure when they are well rested, when they wake up and are showing signs of hunger, and before they start crying?","a":"crying increases the workload on the heart, and eating tires the client with HF"},{"q":"Why should an infant with a cleft lip and palate be burped frequently?","a":"because they swallow a lot of air that puts them at risk for abdominal distention which puts them at risk for vomiting and aspiration"},{"q":"Why is the child, post tonsillectomy, positioned on their side, or head of bed elevated, or prone?","a":"to help prevent aspiration"},{"q":"Why would we want the child with Otitis Media to lie on the affected side?","a":"helps relieve pain"}]

Health Promotion and Maintenance – Pregnancy, Prenatal, and Newborn Development

[{"q":"What does “lightening” mean during pregnancy?","a":"Lightening is the settling of the fetal head into the pelvic brim, usually occurring 2 weeks before delivery in first pregnancies, leading to easier breathing but increased urination."},{"q":"What is quickening?","a":"Quickening refers to the first fetal movements felt by the mother, typically between 16 and 19 weeks of gestation."},{"q":"What is the function of the placenta?","a":"The placenta acts as the fetus’s respiratory and metabolic organ, facilitating oxygen and nutrient exchange between mother and baby."},{"q":"What is the primary purpose of prenatal visits?","a":"Prenatal visits allow assessment of maternal and fetal health, early detection of complications, and reinforcement of healthy lifestyle habits."},{"q":"What does the term “gravida” indicate?","a":"Gravida refers to the total number of times a woman has been pregnant, regardless of outcome."},{"q":"What does “para” mean in obstetrics?","a":"Para represents the number of pregnancies carried beyond 20 weeks, regardless of whether the infant was born alive or stillborn."},{"q":"What is Goodell’s sign?","a":"Goodell’s sign is softening of the cervix, typically noticed around the second month of pregnancy, due to increased vascularity."},{"q":"What is Chadwick’s sign?","a":"Chadwick’s sign is the bluish discoloration of the cervix, vagina, and vulva caused by increased blood flow, visible around week 6 of pregnancy."},{"q":"What is Hegar’s sign?","a":"Hegar’s sign is the softening of the uterine isthmus, the area between the cervix and uterus, indicating early pregnancy."},{"q":"What is the importance of prenatal folic acid supplementation?","a":"Folic acid prevents neural tube defects such as spina bifida and anencephaly by promoting proper closure of the fetal neural tube."},{"q":"How should iron supplements be taken during pregnancy?","a":"Iron should be taken on an empty stomach with vitamin C to enhance absorption, and not with milk, tea, or coffee."},{"q":"How can constipation be reduced during pregnancy?","a":"Encourage a diet high in fiber, adequate fluid intake, and moderate daily exercise such as walking."},{"q":"What causes heartburn in pregnancy?","a":"The relaxation of the cardiac sphincter due to progesterone and pressure from the growing uterus cause gastric reflux."},{"q":"What causes varicose veins in pregnant women?","a":"Increased venous pressure in the lower extremities due to uterine compression on pelvic veins leads to varicosities."},{"q":"How can pregnant women prevent varicose veins?","a":"Avoid standing for long periods, elevate the legs when sitting, and wear support stockings."},{"q":"What are common discomforts in the second trimester?","a":"Heartburn, backache, constipation, and leg cramps are common in the second trimester."},{"q":"What is the purpose of Kegel exercises during pregnancy?","a":"Kegel exercises strengthen pelvic muscles, improve bladder control, and help with postpartum recovery."},{"q":"What is the normal duration of pregnancy?","a":"Normal pregnancy lasts approximately 280 days or 40 weeks from the first day of the last menstrual period."},{"q":"What is the first immunization given to a newborn?","a":"The hepatitis B vaccine is usually given within the first 12 hours of life."},{"q":"Why is vitamin K given to newborns?","a":"Vitamin K prevents hemorrhagic disease of the newborn by promoting blood clotting until intestinal flora develop."},{"q":"What newborn screening is mandatory in most states?","a":"The Guthrie test for phenylketonuria (PKU) is routinely performed between the second and sixth days after birth."},{"q":"What is the normal fetal heart rate during pregnancy?","a":"The normal fetal heart rate ranges between 120 and 160 beats per minute."},{"q":"What is the purpose of a nonstress test?","a":"The nonstress test evaluates fetal well-being by measuring heart rate accelerations associated with fetal movement."},{"q":"What is a normal expected result of a nonstress test?","a":"A reactive result—two or more accelerations of 15 bpm lasting 15 seconds within 20 minutes—indicates fetal health."},{"q":"When should a pregnant woman contact her healthcare provider immediately?","a":"If she experiences vaginal bleeding, leakage of fluid, severe headache, blurred vision, or decreased fetal movement."},{"q":"How can morning sickness be minimized?","a":"Eat small frequent meals, avoid fatty or spicy foods, and drink fluids between rather than with meals."},{"q":"What is ptyalism?","a":"Ptyalism is excessive salivation during pregnancy, a common discomfort caused by hormonal changes."},{"q":"What is line nigra?","a":"Linea nigra is a dark vertical line appearing on the abdomen during pregnancy due to hormonal changes."},{"q":"What is chloasma?","a":"Chloasma, or “mask of pregnancy,” is hyperpigmentation over the cheeks and forehead, caused by increased estrogen and progesterone."},{"q":"What is colostrum?","a":"Colostrum is the thick yellowish pre-milk fluid rich in antibodies and protein, produced before breast milk."},{"q":"When should breastfeeding ideally begin?","a":"Breastfeeding should begin within the first hour after birth if the mother and baby are stable."},{"q":"How long should exclusive breastfeeding continue?","a":"Exclusive breastfeeding is recommended for the first six months of life."},{"q":"What are the benefits of breastfeeding for the baby?","a":"It provides antibodies, optimal nutrition, protection from infection, and promotes bonding."},{"q":"What are the benefits of breastfeeding for the mother?","a":"It promotes uterine involution, delays ovulation, and helps with postpartum weight loss."},{"q":"What causes leg cramps during pregnancy?","a":"Compression of pelvic nerves by the uterus and decreased calcium levels contribute to leg cramps."},{"q":"What can help relieve leg cramps during pregnancy?","a":"Dorsiflex the affected foot and increase calcium intake under healthcare supervision."},{"q":"What is the most reliable indicator of fetal growth?","a":"The fundal height measurement correlates closely with gestational age after 20 weeks."},{"q":"What is the significance of fundal height measurements?","a":"A height that deviates more than 2 cm from expected may indicate growth restriction or multiple gestation."},{"q":"What causes frequent urination during pregnancy?","a":"Increased pressure of the growing uterus on the bladder, especially in the first and last trimesters."},{"q":"How can urinary tract infections be prevented during pregnancy?","a":"Encourage fluid intake, frequent voiding, wiping front to back, and avoiding bubble baths."},{"q":"What is the recommended daily caloric increase during pregnancy?","a":"Approximately 300 additional calories per day are required to support fetal growth."},{"q":"What are the key nutrients needed during pregnancy?","a":"Increased protein, iron, folic acid, and calcium intake are essential for maternal and fetal health."},{"q":"What should be avoided during pregnancy?","a":"Alcohol, smoking, recreational drugs, and unpasteurized foods should be avoided to protect fetal development."},{"q":"What is the average weight gain for a healthy pregnancy?","a":"The recommended total weight gain is 25 to 35 pounds for women with normal pre-pregnancy BMI."},{"q":"What is the safest sleeping position during pregnancy?","a":"The left lateral position improves uteroplacental blood flow and reduces vena cava compression."},{"q":"Why should pregnant women avoid supine position?","a":"Lying flat compresses the vena cava, reducing blood return and causing hypotension."},{"q":"What foods should be avoided due to listeria risk?","a":"Unpasteurized cheese, deli meats, and undercooked hot dogs should be avoided."},{"q":"What causes hemorrhoids in pregnancy?","a":"Increased pressure on rectal veins and constipation contribute to hemorrhoid formation."},{"q":"How can hemorrhoids be relieved during pregnancy?","a":"Use warm sitz baths, avoid prolonged sitting, and increase dietary fiber and fluids."},{"q":"What is the average fetal heart rate at 10 weeks?","a":"Around 170 beats per minute, gradually decreasing to 120–160 bpm near term."},{"q":"What are warning signs of preterm labor?","a":"Regular contractions, backache, pelvic pressure, and watery discharge before 37 weeks."},{"q":"What is the normal fetal presentation at term?","a":"Cephalic (head-first) presentation is the most common and ideal position for delivery."},{"q":"What is the recommended interval between pregnancies?","a":"At least 18 months between deliveries reduces maternal and neonatal complications."},{"q":"What are common prenatal tests?","a":"Urinalysis, CBC, blood type, rubella titer, syphilis screen, hepatitis B, and glucose testing."},{"q":"What is an ultrasound used for in pregnancy?","a":"To determine fetal age, growth, position, and placental location."},{"q":"What is amniocentesis used for?","a":"To analyze amniotic fluid for chromosomal abnormalities and fetal lung maturity."},{"q":"When is amniocentesis safest to perform?","a":"Usually between 14 and 16 weeks of gestation."},{"q":"What is chorionic villus sampling (CVS)?","a":"A procedure performed between 10 and 13 weeks to obtain placental tissue for genetic testing."},{"q":"What is the main risk of chorionic villus sampling?","a":"Increased risk of limb defects if performed before 9 weeks and miscarriage."},{"q":"What is the purpose of an alpha-fetoprotein (AFP) test?","a":"To screen for neural tube defects (high AFP) and Down syndrome (low AFP)."},{"q":"What are common discomforts in the first trimester?","a":"Nausea, fatigue, breast tenderness, and frequent urination are typical."},{"q":"What is the significance of a triple or quad screen?","a":"It evaluates maternal AFP, hCG, estriol, and inhibin A to identify fetal chromosomal abnormalities."},{"q":"What can cause round ligament pain?","a":"Stretching of ligaments supporting the uterus causes sharp groin pain during rapid movements."},{"q":"How can round ligament pain be relieved?","a":"Rest, slow position changes, and gentle stretching can alleviate discomfort."},{"q":"What is the purpose of prenatal education classes?","a":"To prepare expectant parents for childbirth, breastfeeding, and newborn care."},{"q":"What are the stages of fetal development?","a":"Zygote (0–2 weeks), embryo (2–8 weeks), and fetus (9 weeks to birth)."},{"q":"What is the role of estrogen during pregnancy?","a":"Estrogen promotes uterine growth, increases vascularity, and prepares breasts for lactation."},{"q":"What is the role of progesterone during pregnancy?","a":"Progesterone maintains uterine lining and prevents contractions early in pregnancy."},{"q":"What is the role of relaxin?","a":"Relaxin softens connective tissue and the cervix to facilitate delivery."},{"q":"What are Braxton Hicks contractions?","a":"Irregular, painless contractions that prepare the uterus for labor but do not cause cervical change."},{"q":"What is the purpose of the mucus plug?","a":"It seals the cervical canal to prevent bacteria from entering the uterus."},{"q":"What are normal fetal movements per hour in the third trimester?","a":"At least 10 movements in 2 hours are expected; fewer should be reported."},{"q":"What is the recommended daily fluid intake for pregnant women?","a":"About 2 to 3 liters of water daily to maintain hydration and prevent constipation."},{"q":"What is the recommended daily calcium intake during pregnancy?","a":"About 1,000 mg per day to support fetal skeletal development."},{"q":"How can pregnant women prevent urinary leakage during late pregnancy?","a":"Perform Kegel exercises and empty the bladder frequently."},{"q":"Why should hot tubs and saunas be avoided in early pregnancy?","a":"High temperatures increase the risk of neural tube defects."},{"q":"What is the safest form of exercise during pregnancy?","a":"Low-impact activities like walking, swimming, or prenatal yoga are safest."},{"q":"When should sexual activity be avoided during pregnancy?","a":"In cases of vaginal bleeding, placenta previa, or history of preterm labor."},{"q":"What are signs of pregnancy complications?","a":"Vaginal bleeding, swelling of hands or face, visual changes, or severe abdominal pain."},{"q":"Why should caffeine be limited in pregnancy?","a":"Excess caffeine may contribute to low birth weight and miscarriage."}]