You are the nurse preparing discharge instructions for a 9 y.o. ♀ newly prescribed methylphenidate (Daytrana) for the treatment of ADHD. The pt's mother appears a bit overwhelmed but reluctant to express any concerns, you take note of this and make sure to emphasize which of the following in her discharge:
methylphenidate (Daytrana) is a transdermal patch, placed on the hip each morning. This eliminates the need for swallowing pills and re-medicating at school.
If the patch is still on at 4:45 then you might as well keep it on throughout the night.
Most patients I've seen have had great success with methylphenidate (Daytrana). The pitfall is the plummet in appetite but she looks nutritionally sound to me.
methylphenidate (Daytrana) is a highly addictive CNS stimulant that may cause hypersensitvity reactions at patch site & severe cardiovascular side effects. Most patients on this therapy end up with long-term polysubstance issues.
A 17 y.o. ♂ patient was admitted yesterday evening for a Crohn's exacerbation. An NG-tube was placed to enforce bowel-rest. She made several comments to the nurse during the 9 AM med pass, one of which potentiated the need for some education. Which of the following statements made by the patient perpetuates the need for further teaching?
"Nobody has been in to check my suction canister since 6 AM, does it look okay to you?"
"I don't understand why I didn't get my Adderall-XR this morning? The hospitalist didn't tell me he was discontinuing any of my meds"
"Could you please disconnect my suction so that I can get up and go to the bathroom?"
"I know this thing in my nose is helping but goodness I'll be happy when it comes out"
A nurse is caring for a febrile 11 y.o. ♂ who is awaiting transport to the OR for an emergency appendectomy—as she disconnects the monitor from the wall unit the patient vomits and begins to cry. He proceeds to tell her that he actually feels a little bit better and that the “pain isn’t as bad”. She immediately suspects rupture, and anticipates which of the following:
Severe internal bleeding evidenced by bradycardia + pallor
Hypovolemic shock d/t aneurysm caused by rupture
Resolution of fever
Rebound pain that is diffuse accompanied by tachycardia + irritability
You are the charge RN on WMCH, a unit inundated with 3 sick babies all of whom need transport to higher-acuity facilities. You receive word that DHART is now available for heli-transport. Prior to consulting with the physicians, your nursing judgment clues you into advocate for which of the following patients:
Infant W—6 hrs. old with severe cleft lip/palate, undetermined chromosomal abnormalities with difficulty breathing
Infant X—9 hrs. old who is irritable and has yet to eliminate with suspected meconium plug obstruction
Infant Y—2 hrs. old with cephalohematoma after traumatic exit
Infant Z—3 hrs. old who has needed constant bulb suction of frothy saliva since delivery
Which of the following diagnostic studies confirms the diagnosis of Hirschsprung’s Disease?
Full thickness rectal biopsy
Blood tests to revealing absence of ganglion cells
Abdominal x-ray indicative of bound-up stool
A nurse is caring for a newborn with Omphalocele, a defect of the umbilical ring into which varying amounts of abdominal organs may herniate. She recognizes the priority nursing intervention is:
Keep umbilical herniation from drying out with sterile H2O
Assess for other serious GI syndromes + defects
Keep moist with NS and cover with bag to prevent rupture
Administer STAT IV antibiotics to prevent infection caused by exposure of viscera
Correct placement of Fat emulsion (lipid infusion) is:
Below the TPN filter
Level with TPN filter
Above the TPN filter
Behind the TPN filter
Which of the following sets of symptoms are consistent with re-feeding syndrome?
fluid retention, hypoglycemia + hypernatremia
N/V, hypokalemia, hypomagnesmia + hypophostphatemia
N/V, hypoglycemia +hypernatremia
fluid retention, hypokalemia, hypomagnesmia + hypophostphatemia
A nurse is assuming the care of a 56 y.o. ♂ who has throat CA with severe esophageal metastasis. He underwent esophageal re-section last evening. The patient is unable to communicate with the nurse but has obvious chills + dyspnea. The nurse obtains a full-set of VS, notes a 101.4 temperature and suspects which of the following:
The nurse knows that all of the following may confirm correct placement of the nasogastric tube but is the golden standard:
Radiographic confirmation (eg. KUB)
Aspiration of gastric fluid + testing of pH
Auscultation of over stomach as air irrigates the NG
Lack of respiratory distress + resistance
Dumping Syndrome & Postprandial Hypoglycemia are both complications of?
A nurse is preparing a bolus feeding for a patient. She aspirates for gastric residual with a return of 520 mL’s. Which of the following are appropriate interventions going forward?
Hold the feeding
Reassess in 4 hrs.
Administer 5 mg of metoclopramide (Reglan)
Proceed with the feeding as the patient is significantly malnourished
A nurse is documenting her assessment findings on a 2 wk. old infant with pyloric stenosis. Which of the following statements made by the nurse might you expect to find in the chart: (Hint=3)
Hyperactive bowel sounds noted in all 4 quadrants
Pyloric spasms noted superficially
Labs consistent with metabolic alkalosis
XX is a clinical nurse specialist formulating the care-plan for a 6-day-old baby girl who has a cleft lip + palate she recognizes the 2 most important nursing diagnoses are:
Failure to cope—as parents were not prepared for this type of impairment
Increased risk for infection—as void lip exposes oral cavity to all kinds of bacteria
Failure to thrive—as nutritional needs are impaired by ability feed
Increased risk for aspiration—as palate deformity make swallowing difficult
A long-time L&D nurse who conducts home-visits for parents + babies with extra needs. She reviews the chart of a 22 y.o. first-time mom who is 37 wks. pregnant with a baby boy who has an ultrasound-establish cleft-lip & palate. She knows which of the following will be needs of mom + baby within the first several weeks:
You are doing a medication teaching with a patient newly prescribed cholestyramine (Questran) which of the following might you include in the teaching:
You may take up to 9 grams of Questran daily
Administer other medications 1 hour before or 4 hrs. after Questran
Questran may cause constipation + bloating
Questran may increase LDL cholesterol
Questran may eliminate the need for cholesysectomy
XX is the CRNA scrubbing in on 1-day old meconium-ileus obstruction with a student nurse. After sedating and intubating the neonate she begins to describe the disorder to the SN, including which of the following:
Meconium ileus is caused by inhalation of meconium into the GI tract
Meconium ileus is the precursor to Cystic Fibrosis
Meconium ileus typically manifests 48 hrs. after delivery
The tube coming from the infants nose was placed to decompress the stomach
A mother frantically carries her 4 yr. old ♂ in the ED yelling “it all started with a sore throat!” You note the boy’s color is good but he’s clammy, his tongue is out and he’s drooling. Your next step:
Have the patient lay down, administer 2L of oxygen and call the charge RN
Reassure her in saying “he isn’t blue so he is moving oxygen around just fine”
Encourage the mother to sit down and take a few deep breaths while you assess her son’s airway
Recognize this is likely epiglottitis—bypass triage and find him a blue room with a available intubation supplies
Which of the following assessment finding(s) are consistent with Acute Epiglottitis?
You are the nurse caring for a 6 yr. old ♀ with Acute Laryngotracheobronchitis (LTB). She is stridorous, with an occasional bark, has a temp of 99.6° F and is saturating at 93% on RA. Using your nursing judgment you plan to implement which of the following intervention(s):
Administer 2L of oxygen
Stop IV fluids
Administer IV corticosteroids
Offer a cool pop to dilate the blood vessels in the back of the patient's throat
The nurse recognizes ___________________ is the most specific marker of myocardial infarction (MI)
B-type Natriuretic Peptide (BNP)
A nurse is preparing to administer Nitro-BID (paste) to a patient with CP. Which of the following are important action(s) preformed by the nurse prior to medicating:
Confirm Name & D.O.B.
Place patient on 2L of oxygen prophylactically
Ensure skin is clean, dry and free of rash
Which of the following sets of EKG findings are consistent with Chronic Stable Angina?
Q-waves + tall T-wave
ST-segment depression + T-wave inversion
Which of the following patient(s) are NOT candidates for Fibrinolytic Therapy?
A 48 y.o. ♂ with controlled HTN & DM who lives 2 hrs. away from a tertiary facility with PCI
A 60 y.o. ♀ on warfarin therapy for A-FIB
A 32 y.o. ♀ with congenital heart history, who is 22 wks. pregnant
A 56 y.o. ♂ MV vs. tree, after arresting behind the wheel. Actively bleeding.
The first line of treatment for patient's with confirmed STEMI:
Percutaneous Cardiac Intervention (PCI)
Morphine Sulfate is utilized in the collaborative treatment of ACS by working in which of the following way(s):
Relaxing bronchioles to improve oxygenation
Revascularizing ischemic myocardial tissue
Reducing preload thus, reducing pain
Increasing respiratory rate to facilitate oxygen support to area of ischemia
Baby X was rushed to the ED following her mother's complaint that the infant has been irritable, difficult to breastfeed and has had diarrhea for the past 3 days. The infant's respiratory rate is elevated and the fontanels are sunken. The ED physician orders ABGs after assessing ABCs, with results as follows: pH 7.39, PaCO2 27 mmHg and HCO3 19 mEq/L. What does this mean?
Respiratory Alkalosis, Fully Compensated
Metabolic Acidosis, Uncompensated
Metabolic Acidosis, Fully Compensated
Respiratory Acidosis, Uncompensated
A 3 y.o. ♂ is admitted to the hospital with a diagnosis of asthma and respiratory distress syndrome. The mother of the child tells you that she has witnessed slight tremors and behavioral changes in her child over the past 4 days. The attending physician orders routine ABGs following an assessment of the ABCs. The ABG results are pH 7.35, PaCO2 72 mmHg and HCO3 38 mEq/L. What acid-base disorder is shown?
Metabolic Alkalosis, Partially Compensated
Respiratory Acidosis, Fully Compensated
X, was drinking a glass of wine when she syncopized and hit her head. Her friend dials "911" because AP is unconscious, with depressed ventilation (shallow and slow respirations), rapid heart rate, and is profusely bleeding from both ears. Which primary acid-base imbalance is AP at risk for if medical attention is not provided?
X is admitted to the hospital and is to undergo brain surgery. You note the patient is reluctant to ask any questions or express concerns but has become increasingly anxious. He begins to hyperventilate, hands contract tries to articulate that he "feels dizzy" before he loses consciousness. STAT ABGs reveal pH 7.61, PaCO2 22 mmHg and HCO3 25 mEq/L. What is the ABG interpretation based on the findings?
Respiratory Alkalosis, Partially Compensated
Respiratory Alkalosis, Uncompensated
Why is it important to encourage oral rinse mouth after using inhaled corticosteroids?
Corticosteroids are corrosive and may cause ulcerations in the oral mucosa
Corticosteroids may break down tooth enamel
Corticosteroids may cause thrush, a candidal infection
Corticosteroids will be reabsorbed by the oral mucosa and exert it's action twice
___________________ = the most important indicator of Asthma in an asymptomatic patient
Detailed history of symptoms + episodes
A nurse on a pulmonary-rehab floor is reconciling med's with a patient and his wife. The nurse notes the patient, despite being on safer and equally effective therapies, is still prescribed theophylline (Theo-Dur). She stars the medication so that she can SBAR with the pulmonologist. Fondly recalling nursing school the nurse knows the following are true of Methylxanthines:
Have a narrow margin of safety
Cause CNS stimulation + dysrhythmias at high doses
Are the primary treatment option for persistent asthma
Require strict monitoring of drug levels
Are the mainstay for acute asthma attacks
A nurse is evaluating suitable treatment options for a 61 yr. old ♀ who has a history of Asthma & Parkinson's Disease. Which of the following would be most-appropriate for this patient and increase her compliance?
DPI (dry powder inhaler)
MDI with Spacer
Earl is a 56 y.o. ♂ cruising the tropics with his wife. On the 2nd day of his trip, he develops a a gnarley sinus infection and present's to the ship infirmary. The practitioner asks Earl about PMH, but after a couple of morning libations he forgets to disclose the fact he takes daily carvediolol (Coreg) + rosuvastatin (Crestor). He is prescribed pseudoephedrine (Sudafed) and sent back up to the deck for a limbo contest. Where in lays the problem?
The pseudoephedrine (Sudafed) is contraindicated in patient's with HTN as it too causes hypertension
The pseudoephedrine (Sudafed) is likely to cause rebound congestion, which will interfere with his aerial lesson he has scheduled for the evening
Earl should know better than to be drinking Bloody Mary's with his high cholesterol
He will be getting cozy in his cabin for the rest of the trip as pseudoephedrine (Sudafed) causes significant photosensitivity
The prescription of pseudoephedrine (Sudafed) was probably not necessary, as the Mai Tai's are likely the culprit of Earl's congestion
Clinical Manifestations of Myocardial Infarction (MI) include which of the following:
S3 + S4 heart sounds
Jugular venous distention (JVD)
Crushing chest pain unrelieved by rest, position change + nitrates
Severe cramping of the lower extremities
Nausea + vomiting
Prinzmetal's Angina can be best described as:
Angina r/t to the lack of collateral circulation
Angina r/t to coronary artery spasm
Angina that produces QT-interval prolongation
Angina that produces symptoms similar to GERD
A child diagnosed with ADHD is reprimanded for taking the nurse's pen without asking first. He reponds by shouting, "You don't like me! You won't let me have anything, even a pen!" The nurse is most therapeutic when responding:
"I do like you, but I don't like it when you grab my pen."
"Liking you has nothing to do with whether I will loan you my pen."
"It sounds as though you are feeling helpless and insecure."
"You need ask for permission before taking someone else's things."
Freddy is a 7 y.o. ♂ who was recently diagnosed with ADHD. He is taking methylphenidate (Ritalin) to help him cope with the symptoms of the disorder. As the school nurse, you are assisting in planning his care. Which of the following statements by Freddy's mother best indicates an accurate understanding of the treatment that has been planned for him?
"Freddy's medication will make him behave appropriately and like other kids his age."
"I am already looking forward to the teenage years, when his bothersome symptoms will disappear."
"If I can keep Kevin on a special restricted diet, he will outgrow his ADHD in 5 to 8 years."
"Freddy's medication, plus decreasing his environmental stimuli, will help him control his behavior."
The priority nursing diagnosis for a child diagnosed with ADHD is:
Risk for anxiety
Risk for injury
Impaired verbal communication
While talking with you (the school nurse), Freddy's mother states "I feel like I caused all of his problems." Which response would be most appropriate?
"You shouldn't feel that way. No one really knows what causes ADHD."
"There's no reason to feel that way. Most experts feel there is no connection between heredity or parenting skills and ADHD."
"Sometimes parents feel that way, when they shouldn't. I can give you information about a support group for parents of children with ADHD."
"It may be true that ADHD is inherited, but there is nothing you can do about that now."
Freddy is a 7 y.o. ♂ who was recently diagnosed with ADHD. He is taking methylphenidate (Ritalin) to help him cope with the symptoms of the disorder. As the school nurse, you are assisting in planning his care. Which of the following best indicates to you that the time of Kevin's methylphenidate administration may need to be adjusted?
Freddy has not eaten his lunch in several days, stating, "I'm just not hungry."
Freddy's math grade has risen from 62% to 82% since the beginning of the school year.
According to Freddy's mother, he has been sleeping well every night.
At noon recess, Freddy has been socializing effectively with his peers
An 8 y.o. ♀ just moved in a couple of houses down. You miss out on much of the neighborhood action because your a night-shift nurse. Your neighbors however have described her as "extremely obstinate" for an 8 yr. old as well "aggressive" and "deceitful." One neighbor witnessed her kicking a dog at the bus stop, and another destroying a garden. You recognize her behaviors are consistent with:
Oppositional Defiant Disorder (ODD)
Inhibited Reactive Attachment Disorder
A nurse is caring for a 27 y.o. ♂ with a Paralytic Ileus. Which of the following medication orders would prompt immediate intervention by the nurse:
bismuth subsalicylate (Kaopectate)
naproxen sodium (Aleve)