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Wednesday, April 29, 2009

Frye's Nclex Bullets - Nursing for Nurses

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Phenelzine sulfate is in the monoamine oxidase inhibitor (MAOI) class of antidepressant medications. An individual on an MAOI must avoid aged cheeses, alcoholic beverages, avocados, bananas, and caffeine drinks. There are also other food items to avoid, including chocolate, meat tenderizers, pickled herring, raisins, sour cream, yogurt, and soy sauce. Medications that should be avoided include amphetamines, antiasthmatics, and certain antidepressants. The client should also avoid antihistamines, antihypertensive medications, levodopa (L-Dopa), and meperidine (Demerol).

Incentive spirometry is not effective if the client breathes through the nose. The client should exhale, form a tight seal around the mouthpiece, inhale slowly, hold to the count of three, and remove the mouthpiece to exhale. The client should repeat the exercise approximately 10 times every hour for best results.

Proper positioning can decrease episodes of dyspnea in a client. These include sitting upright while leaning on an overbed table, sitting upright in a chair with the arms resting on the knees, and leaning against a wall while standing.

Pleurisy, also known as pleuritis, is an inflammation of the pleura, the lining of the pleural cavity surrounding the lungs, which can cause painful respiration (also called pleuritic chest pain) and other symptoms. Pleurisy can be generated by a variety of infectious and non-infectious causes.

The client with pleurisy should splint the chest wall during coughing and deep breathing. The client may also lie on the affected side to minimize movement of the affected chest wall. Taking small, shallow breaths promotes atelectasis. The client should take medication cautiously so that adequate coughing and deep breathing is performed and an adequate level of comfort is maintained.

Agranulocytosis is an adverse effect of carbamazepine (Tegretol) and places the client at risk for infection. If the client develops a fever or a sore throat, the physician should be notified. Unusual bruising or bleeding are also adverse effects of the medication and need to be reported to the physician if they occur.

Carbamazepine ("CBZ") is an anticonvulsant and mood stabilizing drug used primarily in the treatment of epilepsy and bipolar disorder. It is also used to treat ADD, ADHD, schizophrenia, Phantom limb syndrome, Paroxysmal extreme pain disorder, and trigeminal neuralgia.

NG tubes are discontinued when normal function returns to the GI tract. The tube will be removed before GI healing. Food would not be administered unless bowel function returns.

Fat emulsion therapy can cause overloading syndrome (focal seizures, fever, shock) and adverse effects, including chest pain, chills, and shock. The priority action is to stop the infusion and limit the adverse response before obtaining additional assistance.

Caregiver strain can occur when a client is significantly dependent on someone for personal and health care needs

Warfarin sodium (Coumadin) is an oral anticoagulant that is used mainly to prevent thromboembolitic events, such as thrombophlebitis, pulmonary embolism, and embolism formation caused by atrial fibrillation or other disorders. Oral anticoagulants prolong the clotting time and are monitored by the prothrombin time (PT) and the International Normalized Ratio (INR). Client education should include signs and symptoms of adverse effects and dietary restrictions such as limiting foods high in vitamin K (leafy green vegetables, liver, cheese, and egg yolk) because these increase clotting times.

In treating STDs, all sexual contacts must be contacted and treated with medication. Clients should always use a condom with any sexual contact. Treatment of a teenager at a GYN clinic is confidential and parents will not be contacted, even if the client is under 18 years of age. Any client should always finish the course of antibiotics prescribed by the health care provider.

The client should be taught to report blood glucose levels that exceed 250 mg/dL, unless otherwise instructed by the physician.

Aspirin is irritating to the gastrointestinal (GI) tract of the client with a history of gastritis. The client should be advised to take analgesics that do not contain aspirin, such as acetaminophen (Tylenol). The other medications listed have aspirin in them. Another category of medications that is irritating to the GI tract is the nonsteroidal antiinflammatory drugs (NSAIDs).

Buerger’s disease occurs predominantly in men between 25 to 40 years of age who smoke cigarettes. A familial tendency is noted, but cigarette smoking is consistently a risk factor.

Common client teaching points about beta-adrenergic blocking agents include to take the pulse daily and hold for a rate under 60 beats per minute (and notify physician) and to report shortness of breath. The client should not discontinue or change the medication dose. The client is also instructed to keep enough medication on hand so as not to run out, to change positions slowly, not to take over-the-counter medications (especially decongestants, cough, and cold preparations) without consulting the physician, and to carry medical identification stating a beta-blocker is being taken.

Lovastatin (Mevacor) is a reductase inhibitor. It results in an increase in the high-density lipoprotein (HDL) cholesterol and a decrease in the triglycerides and low-density lipoprotein (LDL) cholesterol. This medication is converted by the liver to active metabolites, and therefore is not used in clients with active hepatic disease or elevated transaminase levels. For this reason, clients are recommended to have periodic liver function studies. Periodic cholesterol levels are also needed to monitor the effectiveness of therapy.

Client taking Clonazepam (Klonopin) experiencing signs and symptoms of toxicity with the administration of clonazepam exhibit slurred speech, sedation, confusion, respiratory depression, hypotension, and eventually coma. Some drowsiness may occur but will decrease with continued use. The medication may be taken with food to decrease gastrointestinal irritation.

Persantine (Dipyridamole) combined with warfarin sodium is prescribed to protect the client’s artificial heart valves. Persantine does not prevent heart attacks or strokes. It is an antiplatelet medication, not an antihypertensive.

Discharge planning begins upon admission. Determination of the services, needs, supplies, and equipment requirements should not be made on the day of discharge.

After an acute MI, many clients are instructed to take one aspirin daily. Adverse effects include tinnitus, hearing loss, epigastric distress, gastrointestinal bleeding, and nausea. Following an acute MI, sexual intercourse usually can be resumed in 4 to 8 weeks if the physician agrees. Clients should be advised to purchase a new supply of nitroglycerin tablets every 6 to 9 months. Expiration dates on the medication bottle should also be checked. Activities that include lifting and reaching over the head should be avoided because they reduce cardiac output.

Infection and stopping insulin are precipitating factors for DKA. Nausea and abdominal pain that lasts more than one or two days need to be reported, because these signs may be indicative of DKA.

Clients with chronic venous insufficiency are advised to avoid crossing the legs, sitting in chairs where the feet don’t touch the floor, and wearing garters or sources of pressure above the legs (such as girdles). The client should wear elastic hose for 6 to 8 weeks, and in some situations for life. The client should sleep with the foot of the bed elevated to promote venous return during sleep. Venous problems are characterized by insufficient drainage of blood from the legs returning to the heart. Thus, interventions need to be aimed at promoting flow of blood out of the legs and back to the heart.

Standard postoperative care following vein ligation and stripping consists of bed rest for 24 hours, with ambulation for 5 to 10 minutes every 2 hours thereafter. Continuous elastic compression of the leg is maintained usually for one week following the procedure, followed by long-term use of elastic hose. The foot of the bed should be elevated to promote venous drainage.

Use of measures to prevent vasoconstriction are helpful in managing Raynaud’s disease. The hands and feet should be kept dry. Gloves and warm fabrics should be worn in cold weather, and the client should avoid exposure to nicotine and caffeine. Avoidance of situations that trigger stress is also helpful.

Long-term management of peripheral arterial disease consists of measures that increase peripheral circulation (exercise), promote vasodilation (warmth), relieve pain, and maintain tissue integrity (foot care and nutrition). Application of heat directly to the extremity is contraindicated. The limb may have decreased sensitivity and be more at risk for burns. Additionally, direct application of heat raises oxygen and nutritional requirements of the tissue even further.

Sodium intake can be increased by use of several types of products, including toothpaste and mouthwashes; over-the-counter (OTC) medications such as analgesics, antacids, cough remedies, laxatives, and sedatives; softened water, as well as some mineral waters. Water that is bottled, distilled, deionized, or demineralized may be used for drinking and cooking. Clients are advised to read labels for sodium content.

The uterus is theoretically sterile during pregnancy until the membranes rupture. It is capable of being invaded by pathogens after membrane rupture.

Appropriate hand washing by staff and parents has been effective in the prevention of nosocomial infections in nursery units. This action also promotes parents taking an active part in the care of their infant.

To assess the ulnar nerve status, the client is asked to spread all of the fingers wide and resist pressure. Weakness against pressure may indicate compromise of the ulnar nerve.

The primary diagnostic tool for pulmonary tuberculosis is a sputum culture. A negative culture indicates effectiveness of treatment. Nausea and vomiting and clay-colored stools are side effects of the medication used to treat tuberculosis. Their presence or absence does not measure the therapeutic effectiveness of the medication. The Mantoux test is a screening tool, not a diagnostic test for tuberculosis. Because the Mantoux test indicates exposure to the organism but not active disease, the test results will remain positive.

Hypoglycemia is a problem during pregnancy and needs to be assessed. A diabetic pregnant client has a higher incidence of developing pregnancy-induced hypertension than the nondiabetic pregnant client. Insulin needs will increase during the last trimester because of increased placenta degradation. Ultrasounds are done frequently during a diabetic pregnancy to check for congenital anomalies and determine appropriate growth patterns.

Aspirin can interact with the anticoagulant medication and increase clotting time beyond therapeutic ranges. Avoiding aspirin is a priority. Not all activities need to be avoided. Walking and climbing stairs are acceptable activities. The client does not need to avoid brushing the teeth; however, the client should be instructed to use a soft toothbrush.

The client has been unable to refuse requests in the past. Saying “no” now indicates that the client is trying to meet her own needs. “No” is being said now without guilt and apology. During the treatment process, the client has learned how to meet her own needs, and this can help to maintain health upon discharge.

Depression may be a recurring illness for some people. The client needs to understand the symptoms of depression and recognize when or if treatment needs to begin again. The other statements indicate that the client has learned some coping skills, such as setting limits, taking medications, and reframing an a potentially unpleasant experience into a more positive one.

Taking an axillary temperature for at least 5 minutes is most accurate.

Salt tablets should not be taken because they can contribute to dehydration. Frequent fluid breaks should be taken to prevent dehydration. Early detection of decreased body weight alerts an individual to drink fluids before becoming dehydrated. Sixteen ounces of fluid should be consumed for every pound lost to prevent dehydration.

The client taking sublingual nitroglycerin should lie down upon taking the medication because lightheadedness and dizziness may occur as a result of postural hypotension. The client should use up to three tablets at 5-minute intervals before seeking medical attention.

With a uric acid stone, the client should limit intake of foods high in purines. Organ meats, sardines, herring, and other high-purine foods are eliminated from the diet. Foods with moderate levels of purines, such as red and white meats and some seafood, are also limited.

LGA infants tend to be more difficult to arouse and therefore will need to be aroused to facilitate nutritional intake and attachment opportunities. These infants also have problems maintaining a quiet alert state. It is beneficial for the mother to interact with the infant during this time to enhance and lengthen the quiet alert state. Even though the infant is large, motor function is not usually as mature as in the term infant. LGA infants need to be aroused for feedings, usually every 2 1/2 to 3 hours for breast feeding.

In polymyositis, necrosis and inflammation are seen in muscle fibers and myocardial fibers.

The client who has chest tubes following thoracic surgery should be encouraged to cough and deep breathe every 1 to 2 hours after surgery. This helps facilitate drainage of fluid from the pleural space, as well as facilitate the clearance of secretions from the respiratory tract. Milking and stripping of the chest tube may be done when there is an occlusion, such as with a small clot. Even then, it is done only with a physician’s order or when allowed by agency policy. The client is maintained in semi-Fowler’s position and may lie on the back or on the nonoperative side. The client may be allowed to lie on the operative side according to surgeon preference, but care must be taken not to compress the chest tube or attached drainage tubing. Ambulation is generally allowed and also facilitates optimal respiratory function.

The Mantoux skin test for tuberculosis is read in 48 to 72 hours

The client with Ineffective Airway Clearance has ineffective coughing and excess sputum in the airways. The nurse assesses for knowledge of contributing factors, such as dehydration and lack of knowledge of proper coughing techniques. Reduction of these factors helps limit exacerbations of the disease.

When a client is in a state of immunosuppression or has decreased levels of some normal oral flora, an overgrowth of the normal flora Candida can occur. Careful routine mouth care is helpful in preventing recurrence of Candida infections. The client should use a mouthwash consisting of warm saline (or water). Red meat will not prevent thrush.

The client should be taught that ketoconazole (Nizoral) is an antifungal medication. It should be taken with food or milk. Antacids should be avoided for 2 hours after it is taken because gastric acid is needed to activate the medication. The client should avoid concurrent use of alcohol, because the medication is hepatotoxic. The client should also avoid exposure to sunlight, because the medication increases photosensitivity.

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