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4 steps of Critical Thinking - ans1. identify and analyze the problem; 2. recall info you need to resolve the problem; 3. evaluate each option; 4. select the correct or priority option 5-HT3 receptor antagonists (serotonin antagonists) - ansDolasetron (Anzemet) Granisetron (Kytril, Sancuso) Ondansetron (Zofran) Tropisetron (Navoban) It's 'Tron' to the rescue! a 45-year-old client is taking methylprednisolone. What pharmacological action should the nurse expect with this therapy? - anscorticosteroids, such as methylprednisolone, will suppress airway mucus production; therapy should promote responsiveness of beta2 receptors. Adverse effects of this medication include bone loss and formation of candidiasis a 52-year-old client with a Hx of angina has been prescribed transdermal nitroglycerin. Which of the following adverse effects is not seen with this therapy? - ansproductive cough; nitroglycerin therapy does not directly have an effect lung function. Physiologically, vasodilation should effect capillary perfusion and decrease lung secretions. a client has been prescribed lisinopril. What medication interaction should the nurse instruct this client about? - ansPotassium supplements and potassium-sparing diuretics increase the risk of hyperkalemia in clients taking ACE inhibitors such as lisinopril. Clients should only take potassium supplements if prescribed by the provider. Clients should also avoid salt substitutes that contain potassium. a client is prescribed propranolol. What client history findings would require the nurse to clarify this prescription? - ansasthma; clients with asthma should avoid Beta2 Blockade agents such as propranolol. Bronchoconstriction can occur. Clients with asthma should be administered a beta1selective agent. A client is taking disulfiram daily for abstinence maintenance. What is an adverse effect of disulfiram? - anshepatotoxicity a nurse is caring for a client with prescribed digoxin. What should alert the nurse to possible digitalis toxicity? - ansAnorexia, fatigue and weakness are signs of potential digitalis toxicity. GI effects of digitalis toxicity include anorexia, nausea, vomiting and abdominal pain. CNS effects include fatigue, weakness, vision changes (diplopia, blurred vision, yellow-green or white halos around objects). Bradycardia is also commonly noted in digitalis toxicity. a nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client. What is the correct order the nurse should follow? - ansinspect the vials for
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contaminants, roll NPH vial between palms of hands, inject air into NPH insulin vial, inject air onto regular Insulin vial, withdraw short-acting insulin into syringe add intermediate insulin to syringe; when the prescription requires the administration of two types of insulin, it is preferable to mix the solutions into one syringe if they are compatible to prevent the client from receiving two injections. The mixture is stable for 28 days. a nurse is preparing to administer bisacodyl suppository to a client. What actions should the nurse take? - ansDon clean gloves, lubricate index finger with sterile water-soluble lubricating jelly, position the client on the left lateral side, gently retract the buttocks with the nondominant hand, insert the suppository gently through the anus, past the internal sphincter, and against the rectal wall. Following the administration of the medication, the nurse should apply gentle pressure to hold the buttocks together momentarily if needed to keep medication in place. activated partial thromboplastin time (aPTT) - ans20-36; to maintain a therapeutic level of anticoagulation while on heparin, the aPTT should be 1.5 to 2 times the normal value (60 to 80 seconds). adolescents's risks for injury can stem from - ansincreased desire to make independent decisions and relying on peers for guidance rather than family AFTER THE CLOT HAS LEFT THE BUILDING (Thrombolytics) - ansAdminister beta blockers to decrease myocardial oxygen consumption and reduce the incidence and severity of reperfusion arrhythmias. Analysis/data collection requires nurses to look at the data and: - ansrecognize patterns or trends; compare the data with expected standards or reference ranges, and arrive to conclusions to guide nursing care Antianemics - ansInstruct clients to take iron on an empty stomach such as 1 hr before meals to maximize absorption. Stomach acid increases absorption. Instruct clients to space doses at approximately equal intervals throughout day to most efficiently increase red blood cell production. Instruct clients to increase water and fiber intake (unless contraindicated), and to maintain an exercise program to counter the constipation effects. Encourage concurrent intake of appropriate quantities of foods high in iron (liver, egg yolks, muscle meats, yeast). Anticoagulant common meds - ansheparin, coumadin Anticoagulants - ansAnticoagulants prevent the formation of blood clots by interfering with the clotting cascade, thereby preventing coagulation. The use of this class of medications is contraindicated with active bleeding, such as with bleeding disorders, ulcers, or hemorrhagic brain injuries.
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common Erectile Dysfunction meds - ansSildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis) Notice these end in 'fil'. 'Fil' helps the nitric oxide to 'fil' the penis. Common herbal supplements - ansechinacea, ginger root, ginkgo biloba, valerian, black cohosh Common PPIs - ansOmeprazole (brand names: Prilosec, Zegerid, Omepral, Omez) Lansoprazole (brand names: Prevacid, Zoton, Inhibitol) Dexlansoprazole (brand name: Kapidex, Dexilant) Esomeprazole (brand names: Nexium, Esotrex) Pantoprazole (brand names: Protonix, Somac, Pantozol, Zentro) COUMADIN - ansC-oumadin (generic name Warfarin sodium) interferes with coagulation factors by antagonizing vitamin K. O-ral administration is typically used. Clients may need continued heparin infusion via IV until therapeutic effect of Coumadin is experienced (may take 3-5 days). U-se is contraindicated in clients with low platelet counts or uncontrolled bleeding. M-ephyton (trade name vitamin K) is the antidote for Coumadin. A-dvise clients to avoid foods that are high in vitamin K, and avoid the use of acetaminophen, glucocorticoids, and aspirin. Clients should wear a medical alert bracelet indicating warfarin use. D-oses are typically taken once daily. I-NR and PT are monitored for clients who are taking Coumadin. Depending on intent of therapy, PT should be 1.5 to 2 times control and INR should be 2-3. Target INR is 3 to 4.5 for clients with a mechanical heart valve. N-o Coumadin for pregnant women! Oral anticoagulants fall into Pregnancy Risk Category X. Heparin may be safely used in pregnancy. Discharge planning - ansa process of anticipating and planning for client's needs after discharge. To be effective, discharge planning must begin during admission Dopamine antagonists - ansPromethazine (Phenergan) Prochlorperazine (Compazine) Metoclopramide (Reglan): different in generic name because it can have extra- pyramidal side effects drug administration interactions with iron - ansantacids or tetracycline's reduces absorption of iron. Separate use by at least 2 hr. Echinacea - ansUsed to treat the common cold; with chronic use, echinacea can decrease positive effects of medications for TB, HIV, or cancer.
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Erectile Dysfunction Agents - ansact by increasing nitric oxide which opens and relaxes the blood vessels of the penis causing increased blood flow (helping lead to getting and keeping an erection); side effects: flushing, back pain and muscle aches (with Levitra), temporary vision changes, (blue vision with Viagra); men who have heart problems, uncontrolled blood pressure problems, history of stroke, or a health problem that can cause priapism can't hang out with 'Fil.' Evaluate: Questions to Consider - ans"Did the client meet the planned outcomes?", "were the nursing interventions appropriate and effective?", "should I modify the outcomes or interventions?" Evaluation - ansnurses evaluate clients' responses to nursing interventions and form a clinical judgment about the extent to which clients have met the goals and outcomes; nurses determine the effectiveness of the nursing care plan. They collect data based on the outcome criteria then compare what actually happened with the planned outcomes; clients' outcomes in specific, measurable terms are easier to evaluate Factors that can lead to lack of goal achievement during evaluation - ansan incomplete database, unrealistic client outcomes, nonspecific nursing interventions, and inadequate time for the client to achieve the outcomes FAST: Short acting insulins: Regular (Humulin R). - ansONSET: 30 minutes to 1 hour. PEAK: 2 to 3 hours. DURATION: 5 to 7 hours. FASTEST: Rapid acting insulins:Lispro (Humalog). - ansONSET: Less than 15 minutes. PEAK: 30 minutes to 1 hour. DURATION: 3 to 4 hours. Ginger root - ansUsed to decrease nausea of morning sickness, motion sickness, and nausea induced by surgery; may also decrease the pain and stiffness of rheumatoid arthritis; these medications suppress platelet aggregation; should be used cautiously in pregnancy. Ginkgo biloba - ansPromotes vasodilation and may be used to increase recall ability and mental processes. Used commonly with dementia and Alzheimer's Disease. May also be used for erectile dysfunction in clients who take SSRIs and experience impotence as a side effect. May interact with medications that lower the seizure threshold, such as antihistamines, antidepressants, and antipsychotics. May interfere with coagulation.
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of insulin action, as this is when hypoglycemia is most likely to occur. Signs and symptoms of abrupt-onset hypoglycemia include tachycardia, palpations, diaphoresis, and shakiness. Gradual onset hypoglycemia may manifest with headache, tremors, or weakness. We'll CLIMB TO THE PEAK...starting FAST and ending SLOW. Iron side effects - ansGI distress (nausea, constipation, heartburn). If intolerable, iron can be administered with food to increase compliance with therapy but this does reduce absorption; inform clients to anticipate a harmless dark green or black color of stool; Iron can cause teeth staining (liquid form), teach clients to dilute liquid iron with water or juice, drink with a straw, and rinse mouth after swallowing; iron can cause staining of skin and other tissues with IM injections. If IM route must be used, give IM doses deep IM using Z track technique. nurse-initiated/independent interventions - ansnurses use evidence and scientific rationale to take autonomous actions to benefit clients; based on identified problems and health care needs, and make sure they are within their scope of practice. An example is repositioning a client at least every 2 hours to prevent skin breakdown Objective sources of data - ansData the nurse obtains through observation and examination Planning - ansnurses must establish priorities and optimal outcomes of acre they can readily measure and evaluate, which include interventions to promote, maintain, or restore health preschool and school-aged children often face injury from - anslimited or underdeveloped motor coordination preventing aspiration in infants and toddlers - anskeep all small objects out of reach; check toys and objects for loose or small parts and sharp edges; do not feed the infant hard candy, peanuts, popcorn, or whole or sliced pieces of hot dog; do not place the infant in the supine position while feeding or prop the infant's bottle; a pacifier (if used) should be constructed of one piece and never placed on a string or ribbon around the neck Prioritization Tip - ansTo avoid some common pitfalls when answering priority questions, be aware of the following: Never perform ABC checks blindly without considering whether airway, breathing or circulation issues are acute versus chronic or stable versus unstable. For example, a client who is quadriplegic and on a ventilator has chronic airway/breathing problems. However, if there is not an acute consideration such as pneumonia, the client should be considered chronic and stable. This client would not be the nurse's first priority.
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Proton Pump Inhibitors (PPIs) - ansdecrease stomach acid by inhibiting those gastric proton pumps that make the acid - they stop the acid at the pump!; 'Zole' is very friendly (well-tolerated by most clients), but can cause vitamin B12 deficiency if he stays around too long (with long-term use). Provider-initiated/dependent interventions - ansinterventions nurses initiate as a result of a provider's prescription (written, standing, or verbal) or the facility's protocol (blood administration procedures) Salicylate acid therapy is used in what type of clients? - ansSalicylate acid inhibits platelet aggregation and is often used in the treatment and prevention of thrombosis. Salicylate acid is commonly prescribed to clients with coronary artery disease to prevent thrombus formation. secondary objective sources of data - ansData the nurse collects from other sources; family, friends, caregivers, health care professionals, literature review, medical records, etc. secondary subjective data - answhat others tell the nurse; what the client had told them SLOW: Intermediate-acting insulins: NPH insulin (Humulin N) - ansONSET: 1 to 2 hours. PEAK: 4 to 12 hours. DURATION: 18 to 24 hours. SLOWEST: Long-acting insulins: Insulin glargine (Lantus) - ansONSET: 1 hour PEAK: None DURATION: 10 to 24 hours Statins (HMG-CoA Reductase Inhibitors) - anstreat primary hypercholesterolemia, for prevention of coronary events (primary and secondary), for protection against MI and stroke for clients with diabetes, and to help increase HDL levels in clients with primary hypercholesterolemia; You want your LOW (LDL) LOW and your HIGH (HDL) HIGH. Statins (HMG-CoA Reductase Inhibitors) common meds - ansAtorvastatin (Lipitor) Simvastatin (Zocor) Lovastatin (Mevacor) Pravastatin (Pravachol) Rosuvastatin (Crestor) Fluvastatin (Lescol) Statins (HMG-CoA Reductase Inhibitors) side effects - ansWhen you think 'statins' think that we need to protect the liver and muscles stat: there is a risk of hepatotoxicity. It is important to obtain a baseline liver function and to monitor liver function tests after 12 weeks and then every 6 months and to avoid alcohol. There is also a risk of myopathy
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Corticosteroids should be avoided as they may increase aspirin effects. Concurrent use of aspirin may reduce hypertensive action of beta blockers. What should the nurse do if the wrong medication was administered to a client? - ansthe nurse should acknowledge the error and report it to the provider for further orders, monitor the client for adverse effects, and complete an incident report per institutional policy after notifying the health care provider What teaching should the nurse provide to a client that is taking montelukast? - ansadvise client to take the medication once daily at bedtime; leukotriene modifiers are used for long-term therapy of asthma in adults and children, and to prevent exercise- induced bronchospasm WHAT'S THE GOAL? (Thrombolytics) - ansRestoration of circulation, as evidenced by relief of chest pain, and reduction of initial ST segment injury pattern as shown on ECG. WHAT'S THE RISK (Thrombolytics) - ansIncreased bleeding. These medications should only be given while the client is closely monitored. Baseline platelet and blood counts (including aPTT, PT, and INR) should be carefully assessed. Venipunctures and SQ and IM injections should be limited. When two insulins are to be mixed, withdraw the ___ insulin first to avoid contaminating the stock vial with ___ insulin. - ansshort-acting; NPH WHO YOU GONNA CALL? (Thrombolytics) - ansStreptokinase (Streptase). Call right away! Must be administered within 4 to 6 hours of onset of symptoms. A charge nurse at a long-term care facility ensures that the workload is distributed equally among staff when making assignments. Wh following ethical principles is the nurse upholding? justice veracity Autonomy Fidelity - ANSjustice A charge nurse is observing a newly licensed nurse administer an enteral feeding to a client who has an established gastrostomy tube. Which of the following actions by the newly licensed nurse indicates that the charge nurse should intervene? The nurse administers 15 mL of water before administering the feeding.
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The nurse adds food coloring to the tube feeding. The nurse checks the volume of the aspirate . The nurse checks the pH of the aspirate. - ANSThe nurse adds food coloring to the tube feeding. A newly-licensed nurse tells another nurse that their password has expired and asks for assistance with inputting data into a client's electronic medical record. Which of the following statements should the nurse make? You won't be able to input any data until you reset your password." You can use my password on another terminal, but just this one time. If you'd like to give me the data, I can enter it for you." The charge nurse can log on for you and watch you input the data. - ANSYou won't be able to input any data until you reset your password." A nurse at a long-term care facility is caring for a client who has AIDS. The client accidentally spills the contents of their urinal on the floor. After cleaning up the spill with soap and water, the nurse should apply a solution of water and which of the following disinfectants to the floor? Chlorhexidine Bleach Hydrogen peroxide Isopropyl alcohol - ANSBleach A nurse at a pediatric clinic is checking the vital signs of a 2-week-old infant. Which of the following findings is outside of the expected reference range? Apical heart rate 124/min Axillary temperature 36.6° C (97.9° F) BP 64/42 mm Hg Respiratory rate 68/min - ANSBP 64/42 mm Hg
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Determine if the client has prepared their advance directives. - ANSConfirm with the client's family that the consent form has been signed A nurse is assisting with the care of a client who is in labor with ruptured membranes and has herpes simplex virus with active lesioi the following actions should the nurse take? Administer ampicillin IV to the client. initiate an oxytocin Infusion for the dient. Begin an amnioinfusion for the client. Prepare the client for a cesarean birth. - ANSPrepare the client for a cesarean birth. A nurse is assisting with the care of a client who is receiving 1 unit of packed RBs. The client is coughing and reports a headache and difficulty breathing. The client's vital signs indicate tachycardia and hypertension. The nurse should identify that the client is experiencing which of the following types of transfusion reactions? Mild allergic Febrile nonnemolytic Sepsis Circulatory overload - ANSSepsis A nurse is caring for a client at a follow-up visit who has been taking lithium therapy for bipolar disorder. Which of the following findings should indicate to the nurse that the client is experiencing lithium toxicity? Dysrhythmia Urinary retention Hypoglycemia Excess salivation - ANSExcess salivation A nurse is caring for a client who has a compound fracture of the femur. Which of the following findings should the nurse report to the provider as a manifestation of a fat embolism?
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Pulses 2+ distal to the client's fracture Petechia over the client's chest Report of pain as 6 on a scale of O to 10 Bruising around the fracture site - ANSPetechia over the client's chest A nurse is caring for a client who has dementia and is at risk for falls. Which of the following preventive measures should the nurse take? Position the client's bedside table at the foot of the bed. Place the client's bed in the low position. Encourage the client to wear socks when ambulating. Raise the four side rails on the client's bed. - ANSPlace the client's bed in the low position. A nurse is caring for a client who has heart failure and is taking furosemide. Which of the following statements by the client indicates a need for the nurse to intervene? I suck on hard candy for my dry mouth." I'm urinating in larger amounts." I've lost 3 pounds in the last week." I have to sleep sitting up." - ANSI have to sleep sitting up." A nurse is caring for a client who has vegetative signs of major depression. Which of the following actions should the nurse take? Encourage the client to rest in bed during the day. Request a prescription for antidiarrheal medication. offer the dient high-protein fluids frequently. Provide low-calorie snacks throughout the day. - ANSProvide low-calorie snacks throughout the day
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jaundice Tachypnea - ANSBleeding A nurse is caring for a client who is pregnant and Rh-negative. The nurse should plan to monitor which of the following maternal laboratory test results to determine maternal- fetal blood incompatibility? Homocysteine aPTT Erythropoietin indirect Coombs - ANSErythropoietin A nurse is caring for a client who is receiving oxygen via nasal cannula at 4 L/min. Which of the following actions should the nurse take? Keep the oxygen tubing off the floor. Position the cannula prongs curving upward in the nose. Clean the cannula prongs dally. Avoid the use of humidifiers. - ANSPosition the cannula prongs curving upward in the nose. A nurse is caring for a preschooler immediately following a tonsillectomy and notices the child swallowing frequently. Which of the following actions should the nurse take? Check the back of the throat with a pen light. Administer analgesla. Offer the child a drink of water. obtain the child's vital signs in 15 min. - ANSobtain the child's vital signs in 15 min. A nurse is caring of a client who has dementia. Which of the following actions should the nurse take to promote communication? offer correction of incorrect client statements.
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Reorient the client to date and time with each encounter. Face the client at eye level when communicating. Avoid using gestures when communicating with the client. - ANSFace the client at eye level when communicating A nurse is checking a newborn's Moro reflex. Which of the following actions should the nurse take to elicit this reflex? Place the newborn on a flat surface and clap hands loudly. Place the newborn on their abdomen and observe the movement of their extremities. Stroke upward on the lateral aspect of the newborn's foot. Stroke the newborn's cheek toward their mouth. - ANSStroke the newborn's cheek toward their mouth. A nurse is collecting data for a client's health history and physical examination. Which of the following information should the nurse identify as: risk factor for type 2 diabetes mellitus? History of mumps HIstory of exercise-induced asthma Age 35 years BMI 32.2 - ANSBMI 32. A nurse is collecting data from a 24-month-old toddler during an annual physical examination. Which of the following findings should the nurse report to the provider? Jumps with both feet Can draw a circle Weighs 12 kg (26.5 Ib) Has a vocabulary of four words - ANSWeighs 12 kg (26.5 Ib)
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Replace lovastatin with cholestyramine. Increase the dosage of levothyroxine. Restrict the client's intake of iodized salt. - ANSIncrease the dosage of levothyroxine. A nurse is collecting data from a client who has osteoarthritis and reports pain and limited mobility in both knees. Which of the following recommendations should the nurse make? Use a recliner when sitting for long periods. Place large pillows under the knees when lying in bed. Sleep on a soft mattress. Apply moist heat to the knees. - ANSApply moist heat to the knees. A nurse is collecting data from a client who has recently stopped smoking. Which of the following findings should the nurse recognize as a manifestation of acute nicotine withdrawal? Vomiting Tachycardia Weight loss Nervousness - ANSNervousness A nurse is collecting data from a client who is at 29 weeks of gestation. Which of the following findings should the nurse identify as a potential indication of a prenatal complication? Melasma Blurred vision Ptyalism Leg cramps - ANSBlurred vision
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A nurse is collecting data from a client who is recovering from a recent stroke. Which of the following findings should indicate to the nurse the need for a referral to a speech- language pathologist? Fine motor tremors Urinary incontinence Coughing while eating Facial flushing - ANSCoughing while eating A nurse is collecting data from an adolescent client who takes digoxin. The nurse should monitor the client for which of the following adverse effects? Bleedins gums Blurred vision Yelow sclera Frequent swallowing - ANSYelow sclera A nurse is collecting data from an adult client. The nurse should identify that which of the following conditions increases the client's risk for falls? GERD Hyperthyroidism crohn's disease Multiple sclerosis - ANSMultiple sclerosis A nurse is collecting data from an infant who has severe dehydration. Which of the following findings should the nurse expect? Slow respirations Sunken fontanels increased blood pressure Capillary refill 3 seconds - ANSSunken fontanels
