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HESI Milestone Exam 1 Study Guide
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Histamine1 blockers action(mine, zine, dine) - ✔️ bind selectively to H1-histaminic receptors, blocking the actions of histamine at these sites
H1 antagonists are useful in treating - ✔️ - mild allergies(seasonal rhinitis)
- severe allergies(anaphylaxis)
- motion sickness
- insomnia
- common cold
Histamine (H2)-Receptor Antagonists action(tidine) - ✔️ block the H2 receptors responsible for stimulating the secretion of gastric acid
Exenatide (Byetta) hypoglycemia - ✔️ - can occur right after meals
- for severe hypoglycemia give IV dextrose
Exenatide (Byetta) hypoglycemia teaching - ✔️ - teach about s/s of hypoglycemia(cold and clammy give them candy)
- have glucagon emergency kit available
- regular monitoring of A1c levels are required
Exenatide (Byetta) hypoglycemia causes - ✔️ - insulin overdose
- reduced food intake
- vomiting and diarrhea
- excessive alcohol intake
- unaccustomed exercise
- termination of pregnancy
signs and symptoms of hypoglycemia - ✔️ - tachycardia
- palpitations
- sweating
- nervousness
- headache
- confusion
- drowsiness
- fatigue
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antitussives therapeutic action is to - ✔️ Act on the cough control center in the medulla to suppress the cough reflex; used for a cough that is nonproductive and irritating
Anaphylaxis‐PCN - ✔️ - laryngeal edema, bronchoconstriction, severe hypotension= immediate hypersensitivity reaction
Anaphylaxis treatment - ✔️ epinephrine (subQ, IM, or IV) plus respiratory support
What drugs are effective and safe alternatives for patients with penicillin allergies? - ✔️ vancomycin, erythromycin, and clindamycin
To ensure prompt treatment if anaphylaxis should develop patients should be? - ✔️ observed for at least 30 minutes after drug injection (i.e., until the risk of an anaphylactic reaction has passed).
To minimize the chances of an anaphylactic reaction, penicillin should be administered - ✔️ an initial small dose is followed at 60-minute intervals by progressively larger doses until the full therapeutic dose has been achieved
Morphine overdose treatment - ✔️ - Naloxone (narcan)
- Intravenous, IM, and subQ. For initial treatment, administer IV
CT‐diarrhea‐action - ✔️ - decrease intestinal motility and thereby slow intestinal transit, which allows more time for absorption of fluid and electrolytes
- activation of opioid receptors decreases secretion of fluid into the small intestine and increases absorption of fluid and salt.
ACE inhibitor‐hyperkalemia - ✔️ - Inhibition of aldosterone release (secondary to inhibition of angiotensin II production) can cause potassium retention by the kidney.
- significant potassium accumulation is limited to patients taking potassium supplements, salt substitutes (which contain potassium), or a potassium-sparing diuretic.
Leukotrienes‐teaching - ✔️ 1. To take medication 1 hour before or 2 hours after meals
- To increase fluid intake
- Not to discontinue the medication and to take it as prescribed, even during symptom-free period
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- Give IV calcium to help counteract excessive vasodilation and reduced myocardial contractility
- To raise blood pressure, give IV norepinephrine
- Iv Fluids and Trendelenburg's position
- atropine and glucagon to reverse bradycardia and AV block
Calcium Channel Blockers medications - ✔️ - nifedipine (Adalat, Procardia)
- amlodipine (Norvasc)
- verapamil (Calan)
- diltiazem (Cardizem)
NSAIDS medications - ✔️ - Ibuprofen (Advil, Motrin)
- Indomethacin (Indocin) - usually used for GOUT
- Naproxen (Aleve, Naproxyn)
- COX- 2 - Inhibitors: Celecoxib (Celebrex)
Avoid taking calcium channel blockers with - ✔️ - digoxin(increases risk of partial or complete AV block)
- beta blockers(bradicardia,av block, heart failure)
- grapefruit juice
NSAIDs should be used with extreme caution by - ✔️ - pregnant women
- peptic ulcer disease
- bleeding disorders
- anticoagulants
- glucocorticoids
- ACE inhibitors
- ARBS
NSAID administration teaching - ✔️ - take with food, milk or a glass of water
- do not crush or chew enteric-coated or sustained release formulations
- discard aspirin preparations that smell like vinegar
NSAIDs should be avoided in _________ - ✔️ Children with chickenpox or influenza to prevent Reye's syndrome
NSAIDs with caution in patients with - ✔️ - advanced age
- previous intolerance to NSAIDs
- heavy cigarette smoking
- history of alcoholism
Aspirin toxicity treatment -
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✔️ - sponging with tepid water for external cooling
- infusion of fluids
- bicarbonate as reversal
- mechanical ventilation
A high risk of toxicity exists if the client is taking ibuprofen concurrently with - ✔️ Calcium channel blocker
Eyedrops Administration teaching - ✔️ - Semi prone position
- wash hands before and after administration
- pull down and place in conjunctival fornix
- do not allow the tip of bottle to touch eye
Enema Prep - ✔️ - reinforce misconceptions and concerns
- explain procedure and what to expect
- provide privacy
- position in left side knee chest position
- give at room temperature
- solution must be retain to be effective
- hang 12-18 inch above rectum
resiudal volume - ✔️ - bladder not completely emptied
- assessment of the bladder, urethral meatus , skin integrity, hydration and urine consistency
anuria - ✔️ 24 - hour urine output is less than 50 mL
dysuria - ✔️ painful or difficult urination
frequency of urine - ✔️ increased incidence of voiding
glycosouria - ✔️ glucose in the urine
nocturia - ✔️ excessive urination at night
oliguria - ✔️ 24 - hour urine output is less than 400 mL
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Wheelchair transfer post CVA (stroke) - ✔️ - transfer using gait belt from bed to wheelchair
- place patient stronger leg forward with weaker leg towards the bad to allow stronger leg to support most of patient body
Physical restraints - ✔️ - Side rails, geriatric chairs w/ attached trays, appliances ties at wrist, ankle, or waist
Restraints - ✔️ - used as last resort
- can be applied without an order but must be obtained immediately after
- order must state intended duration(no more than 24 hours)
- pt must be assessed every hour
restraints must be - ✔️ - half bow
- safety knot/quick release
- attached to non-moveable part of bed
Saline flush - ✔️ - if used for intermittent infusion should be flushed with NS prior to each infusion to assess port
- Flushing after to clear infused medication from catheter lumen
- must be locked after completion of flush
- periodic flushing required to keep the catheter patent
Braden interpretation - ✔️ - evaluates for pressure sore
- assess mental status, continence, mobility, activity, and nutrition
Braden Scale for Predicting Pressure Sore Risk - ✔️ 19 - 23 not at risk 15 - 18 mild risk 13 - 14 moderate risk 10 - 12 high risk Less than or equal to 9 very high risk
Normal Hemoglobin - ✔️ 12 - 18 g/dL
Decreased hemoglobin mean - ✔️ low iron=anemia
Hematocrit - ✔️ 40 - 50%
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Decreased hematocrit - ✔️ Anemia
Increased hematocrit - ✔️ dehydration
serum albumin level - ✔️ 3.5-5.5 g/dL
decreased serum albumin - ✔️ - malnutrition (prolonged protein depletion)
Prealbumin - ✔️ 23 - 43 mg/dL
decreased prealbumin - ✔️ - protein depletion
BUN - ✔️ 10 - 20 mg/dL
Increased BUN - ✔️ - Starvation
Decreased BUN - ✔️ malnutrition, overhydration
Creatinine - ✔️ 0.6-1.2 mg/dL
Increased Creatinine - ✔️ dehydration
decreased creatinine - ✔️ - severe malnutrition
- reduction in total muscle mass
Catheter check for kink - ✔️ - prevent tubing from becoming kinked and urine backing up in tubing
- urine can lead to excoriation of the glans
- position below the bladder
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Sleep Assessment - ✔️ assess pt usual times of sleeping and waking, bedtime rituals, preferences for sleep environment
Placebo admin - ✔️ - used in drug trails to determine effects of actual medication
- can be used to determine psychological effects of a patient
Power and Authority - ✔️ gives one or more person the power to act on your behalf as agent of health
Nursing process-outcome statment - ✔️ - reflect result of what to achieve /interventions to go about achieving
- must be patient centered, specific, and measurable
- carrying out planned nursing interventions
- assist client to meet desired outcomes/goals
- promote wellness and disease
- facilitate coping with altered functioning
Benzodiazepines in pregnancy - ✔️ - potential developmental defects on embryo or fetus(facial clefts, cardiac malformations)
- crossing from the breast milk putting breastfed infants at risk for adverse effects
End of life-DNR - ✔️ - DO NOT RESUSCITATE/No code, Allow natural death
- no attempts to restore life to patient
- must be signed by provider
Grief mastectomy - ✔️ - anticipatory grief
Wound irrigation - ✔️ - debridement to promote wound healing
- irrigation fluid= 0.9% NS
autolytic debridement - ✔️ - occlusive dressing: hydrocolloids or transparent films
- used own body enzymes and defense mechanisms to loosen and liquify necrotic tissue
Enzymatic debridement - ✔️ uses commercially prepared enzymes to speed up body autolytic process
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mechanical debridement - ✔️ - used external physical force to dislodge and remove debris and necrotic tissue
- done by wound irrigation with pulsed pressure lavage, whirlpool therapy, laser treatment, ultrasound, or surgical debridement
primary prevention - ✔️ preventing development of disease or injury ex:vaccines, family planning, poison control information, accident prevention, seatbelts and helmets
secondary prevention - ✔️ early detection of illness ex: vision, medical, and dental appointments;screenings
Tertitary prevention - ✔️ reducing disability and helping to live with disease with maximum functioning ex:teaching diabetic patient s/s of hyper/hypoglycemia
Stage 1 pressure ulcer - ✔️ nonblanchable erythema of intact skin
stage 2 pressure ulcer - ✔️ partial thickness skin loss with exposed dermis (viable, pink, red moist)
stage 3 pressure ulcer - ✔️ Full thickness loss of skin extending into subcutaneous tissue
Stage IV pressure ulcer - ✔️ full thickness skin and tissue loss exposure of muscle, tendon, ligaments, cartilage, and bone
unstageable pressure ulcer - ✔️ obscured full-thickness skin and tissue loss (eschar and slough)
Cranial nerve 1 - ✔️ Olfactory (smell)
Cranial nerve 2 - ✔️ Optic - vision(snellen chart)
Cranial Nerve 3 - ✔️ Oculomotor (pupil size shape,size, and equality)
Cranial nerve 4(IV) -
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Assess pulse-GERI - ✔️ - peripheral pulse weaker in older adults
- decreased resting HR due to meds
Pedal Pulse - ✔️ - dorsal pedis(top of foot)
- posterior tibial (inner ankle)
- palpate bilateral note differences
- if unable to find use doppler ultrasound stethoscope
assess carotid artery - ✔️ - Inspect boule stoke seen with S1 and S
- palpate strength of pulse and grate bilaterally
- palate one side at a time
- auscultate for bruit and murmurs(use bell and ask pt to hold breath)
- listen in three locations: jawline, mid neck, above clavicle line
Male perianal assessment - ✔️ - position on side, spread buttocks, and inspect perineal area
- note loose sphincter, lesions, hemorrhoids
Female perianal assessment - ✔️ - make sure no menses or intercourse before pap test
- place in semi-lithotomy position
- inspect, palpate, collect specimens inner and outter
isometric exercise - ✔️ contractions of a particular muscle or group of muscles ex:yoga, holding position
isotonic exercise - ✔️ Muscle shortening and active movement ex: ADLS,independent ROM, swimming, walking, jogging, and bicylcing
isokinetic exercise - ✔️ muscle contractions with resistance ex: rehabilitative exercises for knee and elbow injuries and lifting weights
Health history menopause - ✔️ - 12 months consecutively without menses
- estrogen decreases ,uretine becomes smaller, ovaries shrink
- increase risk of vaginal infections, UTIs, dyspareunia, and diminished libido
- bone loss accelerates
menorrhagia - ✔️ - menstrual bleeding lasts longer than 7 days
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- treated with NSAIDs, birth control and iron tablets
Allergic reaction interview - ✔️ - verify allergies and compare to MAR
broncial breath sounds - ✔️ - loud high pitched and found over trachea and larynx
- course or tubular
- inspiration less than expiration
- abnormal if heard outside or normal location
Barrel chest - ✔️ - COPD
- anterior to posterior depth of chest widens, causing thorax to become barrel shaped
- harder to inhale deeply causes diminished respiratory volume
Assess leg - ✔️ - symmetry
- ROM
- color, hair, and nails
- edema
- palate pulses for circulation
Abdominal inspection - ✔️ - Inspect, Auscultate, Percuss, Palpate
Chest precussion - ✔️ - performed to outline pt heart boarders and to check for cardiac enlargement with suspected heart failure
- dull is cardiac tissue
- dullness noted in 4th and 5th left ICS at mid clavicular line
Carpal Tunnel - ✔️ A numbness and tingling in the hand and arm caused by a pinched nerve in the wrist.
Tinel's sign - ✔️ lightly tapping (percussing) over the nerve to elicit a sensation of tingling
Phalens test - ✔️ pushing the dorsal surface of hands together and holding for 30 to 60 seconds
Reduced LOC-pain - ✔️ - moaning and crying
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What labs to check when taking tylenol? - ✔️ - AST= 10-30 U/L ALT=10 to 40 U/L (used to detect liver damage
Insulin-regular peak time - ✔️ 1 - 5 hours
Foods high in tyramine - ✔️ - yogurt
- aged cheese
- smoked and processed meats
- red wine
- figs
- rasins
- avocados
Isoniazid with foods in tyramine - ✔️ should be avoided because it is an MAOI and can cause redness, itchy skin, flushing, sweating, tachycardia, headache, lightheadedness
Antacid in pt with renal failure - ✔️ - secreted through the kidneys
Furosemide - ✔️ - Loop diuretic
- Given PO,IV,IM
- Monitor for hypokalemia=dysrhythmias
- Teach pt to eat foods high in potassium
Foods high in potassium - ✔️ nuts, dried fruits, spinach, citrus fruits, potatoes, bananas
S/S of hypokalemia - ✔️ - irregular heartbeat
- muscle weakness
- cramping
- flaccid paralysis
- leg discomfort
- extreme thirst
- confusion
When taking lasix avoid? - ✔️ lithium, digoxin and other ototoxic drugs
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Lasix adverse effects - ✔️ hyponatremia, dehydration, hypotension, hypokalemia, ototoxicity, and hyperglycemia
Tetracycline teaching - ✔️ - broad spectrum
- take 1 hour before or 2 hours after meals to prevent GI upset
- allow 2 hrs in between milk products, calcium supplements, iron supplements , magnesium laxatives, most antacids
- notify provider of significant diarrhea
- avoid excess sun exposure, wear protective clothing and use sun screen
Pregnant /lactating women + children under 8 should avoid tetracycline because? - ✔️ it can cause discoloration of developing teeth
Thyroid overdose signs - ✔️ - tachycardia
- angina
- tremors
- nervousness
- insomnia
- hyperthermia
- heat intolerance
Metronidazole teaching - ✔️ - separate drugs and other cation compounds by 6 hours
- may cause deep tendon rupture in pt over 60
- risk for photo-toxicity
Steroids discontinue - ✔️ - risk for infection(monitor fever, and sore throat)
- risk for osteoporosis(take calcium, vitamin d, thiazide diuretics)
- Adrenal insufficiency(wear med alert band)
- Fluid+electrolyteimbalance(monitor weight gain, and swelling to lower extremities)
- Cataracts and glaucoma
- Peptic ulcer disease
Oseltamivir (Tamiflu) - ✔️ - inhibits flu virus neuromidase with possible alteration of virus
- use=prevention+treatment of influenza A+B
- take 2 days pf symptoms of flu and continue for 5 days
- take with food
- take 3 hour prior to bed time
