Herbal Meds Guide for Nurses

HERBAL MEDS

St. John's wort - antidepressant, photosensitive (C/I
in SULFA drugs)

Garlic - antihypertensive (avoid aspirin)

Ginseng - Anti stress (C/I in coumadin)

Green tea - antioxidant (check if risk for
calculi-oxalates)

Echinacea - immune stimulant (6-8 weeks only)(C/I in
SANDIMMUNE-Immunosuppressant)

Licorice - cough and cold

Ginger root - antinausea (C/I in Coumadin)

Ginkgo - improves circulation (C/I in anticoagulant,
headache side effect - check PT)

Ma huang - bronchodilator, stimulant (Ephedra)

Parent teaching: Use of Infant and Car Seats

Weight below 9 kg (20 lb):
Use infant or convertible seat in back seat of car in backward-facing position.
Keep infant reclined at a 45 degrees.
Never place the infant in the front passenger seat.
Fasten seat securely to car using car seat belt and following manufacturere instructions.
Adjust harness to fit snugly at shoulders and legs.
When using an infant seat, move to larger seat before the infant's head reaches the top of shell.
When using a convertable seat from birth, use one with a 5-point restraint.

Birth-18 kg (40 lb)(Some seats are designed for infants from birht to 40 lbs, others are only designed for
infants up to 20 lb, therefore there are separate instructions for each type)
When using a convertableseat, use reclined for rear-facing and upright for forward facing. (Infant remains
rear facing until they reach 20 lb as in the prior instructions)
Follow manufacturer instructions for proper positions at specfied child weights for that product (Typcially
this is the "child must face rear until they reach 20 lb)
When using a convertible seat, move to a high-backed child seat or booster seat when child's ears are above
the seat.
Always place the seat in the rear of the vehicle. (This is especially true with airbags as when they deploy in an
accident they will seriously injure or kill the child)

Above 13.6 or 18 kg-27 or 36.3 kg (30 or 40 lb-60 or 80 lb) (Most instructions agree on the 40 lb & 40 inch-
height minimum)
Use booster seat fro children who have outgrown convertible/toddler seats
Follow manufacturere instructions for use and specfied child weights for the product (NCLEX questions will
be based on the standards published in nursing textbooks which are those included in this post)
Use booster seat until the vehicle lap and shoulder belt fit correctly
Have all children 12 years and under ride in the rear seat, whether or not in a car seat.

Air bags can seriously injure a child or cause death, when a child is in a car seat in the front passenger seat.
Even when not in a car seat, and when the vehicle is not equipped with a passenger side air bag, the back seat
is the safest for all children.

From the textbook often used to write the NCLEX pediatric questions: (Ball & Bindler)

Preschool child's need for autonomy and control can be met by allowing the child to choose which snacks to
pick or which finger to stick for glucose testing, or help the parent/caregiver gather necessary supplies.

School-age children can learn to test blood glucose, administer insulin, and keep records. They should be
taught how to select foods appropriate for dietary management and how to plan an exercise program. They
need to learn to recognize the signs and symptoms of hypoglycemia and hyperglycemia, and understand the

importance of carrying a rapidly absorbed sugar product.

Adolescents should take on total responsibility for self-care. Although they understand explanations about the
potential complications of diabetes, they are present-time oreinted and may rebel against the daily
regimentation of insulin injections, blood glucose monitoring, and dietary management. Successful self-care
depends in part on the adolescent's adjustment to the chronic nature of the disease and feelings of being
different from peers.

This same textbook defines:

Preschool child, 3-6 years of age
School age child, 6-12 years of age
Adolescent, 12-18 years of age

Primary atypical pneumonia (Mycoplasma pneumonia) is characterized as:

Select all that apply:
O 1 Most common cause of pneumonia in children
O 2 incidence in children between the ages of 5 and 12
O 3 Occurs primarily in summer
O 4 more prevalent in crowded living conditions
O 5 caused by Borelia burdorferi

The correct answers are:
1, 2 & 4
It occurs primarily in the fall and winter months
The causative organism is M. pneumoniae
M. pneumoniae is a common cause of mild pneumonia . Various studies suggest that it causes a higher
percentage of pneumonia in school-aged children.

People at highest risk for mycoplasma pneumonia include those living or working in crowded areas such as
schools and homeless shelters, although many people who contract mycoplasma pneumonia have no
identifiable risk factor.

Symptoms
The symptoms are generally mild and appear over a period of one to three weeks. They may progress to more
severe symptoms in some people.

Common symptoms include the following:
Headache
Fever (may be high)
Chills
Excessive sweating
Cough
Usually dry
Usually without phlegm or blood
Chest pain
Sore throat
Less frequently seen symptoms include the following:
Skin lesions or rash
Eye pain or soreness
Muscle aches and joint stiffness
Neck lump
Rapid respiratory rate
Ear pain

Signs and tests
A physical examination may reveal enlarged lymph nodes and inflammation of the eardrum. An examination
of the chest with a stethoscope (auscultation) reveals crackles.

These tests help confirm the diagnosis:
Blood tests for antibodies to mycoplasma
Sputum culture
Chest x-ray

Treatment
Antibiotics may be prescribed for more serious symptoms related to mycoplasma pneumonia. Home care
includes rest and a high-protein diet with adequate fluids.

Expectations (prognosis)
Most people recover completely even without antibiotics, although antibiotics may speed recovery. In
untreated adults, cough and weakness can persist for up to a month.

EPOGEN - EPOETIN ALFA RECOMBINANT
Possible Test Item:
A client with chronic renal failure on dialysis is to receive EPOGEN. Which of the following
symptoms would warrant the nurse to hold the administration of this human recombinant?
O 1 the client has fever
O 2 the client has hypertension
O 3 heart rate 72/minute
O 4 respiratory rate is 19
O 5 the client is pale
O 6 client has body malaise
The correct answers: 1 & 2
CNS side effect: Pyrexia, withhold the drug
CVS side effect: Hypertension, withhold the drug.
EPOGEN - recent question in the NCLEX-RN
EPOGEN - epoetin alfa recombinant
Classification
Erytrhopoietin, human recombinant
1. normally synthesized in the kidney and stimulates RBC production
2. will elevate and maintain RBC level, decreasing the need for BT
Uses:
Treatment of anemia associated with Chronic Renal Failure in adults
C/I: uncontrolled hypertension
Side effects:
CV - hypertension
CNS - pyrexia
Complication: Polycythemia
What to monitor before and after:
BP. TEMP & HEMATOCRITwater.

1)a young patient most likely to get lead poisining if?
a. he is drinking from a ceramic pitcher.
b. father referinshes old furniture at their home

> ANSWER is B. probably if he refurbishes an old furniture at home.. that is, if the furniture has old
paint on it and during 60's paints have lead content on it (heavy metals) and if you need to remove
that, chips from the old paint may be taken by a kid that leads to Pb poisoning
2) a TB pt understands that he can reduce the risk of spreading his disease if he states?
a. i wont sleep in same room w/ my wife for 1-2 months
b. i will stay away from pregnant women and children
c. i will use plastic utensil when i eat
****>> if the patient is already taking anti-TB drugs, it will only be 2 weeks of chemotherapy and
that (+) PTB will no longer be communicable.. and 1-2 months is long!
CHildren are more susceptible to acquire Primary complex and pregnant women are susceptible and
almost vulnerable to all type of illnesses.. There is no need for the patient to separate their utensils
since PTB is airborne and not by contact in terms of transmission.. so i go for B answer.
3) 4 years old with salmonella what u should do?
a. private room
b. isolation
c. place in a room with 4 year old with cellulitis
d. keep door closed at all times.

*** the (+) salmonella kid may be placed in a private room. Salmonella is transmitted by Enteric..
therefore Enteric precaution is needed and handwashing is very important and gown and gloves,
diaper or bedpan in necessary. Option B, and D are all for pulmonary tuberculosis precautions. I
suppose, the answer is A. place in a private room.

4) wot herb would help with vomiting?
a. ginko
b. ginsing.
c. ginger root
d. echinacea
****> ginger root is good for nausea.. most especially in morning sickness but in moderation for
pregnant women... Option C is the answer
5) allergic to sulfa wot not to take?
a. ma huang
b. echunacea.

...I think the answer is... geez, i forgot..i think its Echinacea..let me check again ok..
6) mother called a nurse from home stating that her child having chicken pox..which of the following
statements by the mother needs immidiate follow up?
a. father of the child with liver failure
b. sibling with anemia
c. child just had tonsillectomy
d. child has intermittent low grade fever
I think the answer is C. the child that just had tonsillectomy. i think the child is
immunocompromised. and varicella (Chicken pox) is a viral one.. we all know that tonsils are one of
the lymph defenses we have against any infection.. Im not really sure with this answer.
7) clientwith allergy to sudafed ..which of the statments is correct?
a. i will take valerian
b. i will take ma huang
c. i will take echinacea for acute viral inf.
d. i will take black cohosh
**valerian root is for cystitis and fungal infections; ma huang is for (I forgot!!),echinacea is for
immune booster but not to be taken with patients with progressive systemic disorders such as AIDS,
PTB, HIV, etc. black cohosh is for menopause.
*** don't you think that Echinacea is the correct option??
8)food processing
a. frozen food can be defrost for up to six hours
b. frozen food which has been defrost can be return back to fridge.
c. cook perishible food should cover and cool
d. frozen food should be defrost by hot water
usually, frozen food must be thawed at cool tap water for freshness. not in the microwave because it
can be cooked outside and raw inside, not in the hotwater with same principle. so i believe, thawing
it FOR UP TO 6 HOURS would be ok. returning thawed food back at fridge is ok but it is unsafe
since salmonella can start thriving in.. Answer is OPTION A.
9) child in a mist tent and the parents brought him a car toy...the child was clutching the toy and the
nurse refused to let him play for wot reason?
a. it will get contaminated with bacteria
b. it will accumalate moisture
c. it could cause a fire
** The answer is OPTION C. Usually car toy have friction on it for the wheels to run.. Oxygen
supports combustion.. and if friction is present together with oxygen (in a mist tent) then, fire could
commence.
11) a mother reported tht her son is throwing up each time she feeds him wot would be the best
question u ask?
a. did u warm up the formula
b. wot kind of formula did u give him
c. does ur son feel hungry each time he throws up
d. does r son have a jelly like stool
***>>> CORRECT OPTION is D.. Does your son have jelly like stool.. jelly like or currant like
stool is a cardinal sign of Intussusception/ Telescoping or invagination of the large intestines in the
Ileoceccal area..

12) a patient had AIDS the nurse should advise?
a. cook ur meat very well
b. not to eat in the same table with family
c. avoid crowds
***>> if you have AIDS, u are immunocompromised.. therefore you are prone to infection..
neutropenic precaution is advised and one that is a must is Avoiding Crowds.. Correct option is C.

Seasonal Affective Disorder (SAD) may affect over 10 million Americans.
The typical symptoms of SAD include depression, lack of energy, increased need for sleep, a craving
for sweets and weight gain. Symptoms begin in the fall, peak in the winter and usually resolve in the
spring. Some individuals experience great bursts of energy and creativity in the spring or early
summer.
Susceptible individuals who work in buildings without windows may experience SAD-type
symptoms at any time of year. Some people with SAD have mild or occasionally severe periods of
mania during the spring or summer. If the symptoms are mild, no treatment may be necessary. If
they are problematic, then a mood stabilizer such as Lithium might be considered. There is a smaller
group of individuals who suffer from summer depression.
SAD is recognized in the DSM-IV (The American Psychiatric Association's diagnostic manual) as a
subtype of major depressive episode.
Some individuals who work long hours inside office buildings with few windows may experience
symptoms all year round. Some very sensitive individuals may note changes in mood during long
stretches of cloudy weather.

A sign of improvement from dehydration would be a decreased urine specific gravity and a
decreased/decreasing hematocrit. So the SG of 1.015 and a Hct of 46% would be the answer. It is the
best answer of the two you had in you question.
The normal urine SG is 1.003-1.035 (Usually between 1.010-1.025 with normal hydration and
volume) (different texts give a slightly different range).
SG 1.025-1.030+ (concentrated urine)
SG 1.001-1.010 (dilute urine)
SG 1.001-1.018 in infants under 2 years of age
Specific gravity is a measurement of the kidney's ability to concentrate urine. The range of urine's
SG depends on the state of hydration and varies with urine volume and the load of solids to be
excreted under standardized conditions; when fluid intake is restricted or increased, SG measures the
concentrating and diluting functions of the kidney. Loss of these functions is an indication of renal
dysfunction.
SG values usually vary inversely with amounts of urine excreated (decrease in urine volume =
increase in specific gravity). However in some conditions this is not the case. For example:
a. Diabetes: increased urine volume, increased SG (High amount of glucose in urine)
b. Hypertension: normal volume, decreased SG
c. Early chronic renal disease: increased volume, decreased SG

Hematocrit: Percentage of packed red cells in a volume of whole blood. The hematocrit will be
increased in dehydration.

Source: A Manual of Laboratory & Diagnostic Tests (Frances Fischbach)

digitalis toxicity includes..
N - nausea
A - anorexia
V - vomiting
D - diarrhea
A - abdominal pain
kasma na changes sa vision..
Digitalis toxicity is the result of the body accumulating more digitalis than it can tolerate at that time.
Patient will complain visual change in color, and loss of appetite.

From RAG book and memory notebook
Drugs which can cause URINE DISCOLORATION
Adriamycyn------ Reddish
Rifabutin--------- Red orange

Rifampicin------- Red orange
Bactrim---------- Red orange
Robaxin--------- Brown, Black or Greenish
Azulfidine------ Orange yellow
Flagyl------------ Brownish
Dilantin---------- Pink tinged
Anti Psychotic-- Pinkish to Red brown
Early signs of hypoxia:
R-restlessness
A-anxiety
T-Tachycardia
Late signs of hypoxia:
B-bradycardia
E-extreme restlessness
D-dyspnea
In pedia-
F-feeding difficulty
I-inspiratory stridor
N-nares flare
E-expiratory grunting
S-sternal retractions
Respiratory Patterns
Kussmaul- fruity acetone breath odor
Cheyne-stokes- near death breathing pattern
CRUTCH WALKING UP STAIRS
Good goes to heaven, Bad goes to hell

CYSTITIS-Inflamation of the urinary bladder
Manifestations:
Urgency and frequency
Lab data:
Culture and sensitivity tests reveal the presence of bacteremia
Usually E.Coli
PREVENTING CYSTITIS
>Drink 8-10 glasses of fluid per day
>Women should wipe from front to back
>Urinate after intercourse
>Avoid vaginal deodorants and bubble baths
>Avoid silk underwear, cotton underwear is preferred
>Maintain acid ash diet (cheese,cranberry,prunes and plums
1.Which of the following statements made by a patient reflects a need for further teaching?
a. I drink a lot of fluids
b. I usually go nonstop driving for 8 hours on weekends--- answer
c. I should avoid bubble baths
d. I love drinking citrus juices
2. Which of goal of nursing care takes priority for a female client with cystitis?
a. increasing urine alkalinity
b. maintaining a balanced fluid I & O
c. Providing instructions on perineal hygiene--- answer
d. screening urine for sedimentation
Muskuloskeletal Anatomical tips
TENDONS- connect muscle to bone
LIGAMENTS- connect bone to bone
CUSHING SYNDROME
Hypersecretion of Glucocorticoids by the adrenal glands
Manifestations:
central type or truncal obesity with thin extremeties
moonface
buffalo hump
hirsutism
Lab data:
Elevated serum cortisol levels

Hypernatremia,hyperglycemia,hypertension
Hypokalemia
Intervention:
High potassium, Low sodium diet
Lifelong administration of glucocorticoid synthesis inhibitors
Eg. Mitotane
Inform that there will be poor wound healing
Sample question:
When assessing a 40-year old patient with cushing’s syndrome, the nurse should expect the person to
demonstrate:
A lability of mood---- answer
B ectomorphism with a moon face
C a decrease in the growth of facial hair
D an increase resistance to bruising and bleeding

EYE ABBREVIATIONS
OU- both eyes
OR- right eye
OS- left eye
LEVELS OF CONSCIOUSNESS
A------ ALERT
V------ VERBAL STIMULI
P------ PAINFUL STIMULI
U----- UNRESPONSIVE
REASONS FOR UNCONSCIOUSNESS(SKIN COLOR)
RED----- Stroke or increase BP
WHITE---- Shock or Hemorrhage
BLUE--- Respiratory or Cardiac Arrest

CIRCULATION ASSESSMENT- 5Ps
Pain
Pallor
Pulse
Paresthesia
Paralysis

CHOLINERGIC CRISIS

S- Salivation
L-Lacrimation
U-Urination
D-Defecation
G
E

ADLs

B-Bathing
A-Ambulation
T-Toileting
T-Transfers
E-Eating
D-Dressing

Instrumental ADLs
S-shopping
C-cooking, cleaning
U-using telephone /transportation
M-managing money and medications

C cane
O opposite

A affected
L leg

IN CASE OF ABDOMINAL TENDERNESS
Inspect, auscultate, percuss, palpate

CUSHINGS (Hypersecretion of Adrenal Cortex Hormones)

C = Check VS, particularly BP
U = Urinary output & weight monitoring
S = Stress Management
H = High CHON diet
I = Infection precaution
N = Na+ restriction
G = Glucose & Electrolytes Monitoring
S = Spousal support

ADDISON'S (Hyposecretion of Adrenal Cortex Hormones)
Always Remember the 6 A's of Addison's disease

1.) Avoid Stress
2.) Avoid Strenuous
3.) Avoid Individuals with Infection
4.) Avoid OTC meds
5.) A lifelong Glucocorticoids Therapy
6.) Always wear medic alert bracelet

IF RESPIRATORY DEPRESSION OR OVERSEDATION IS SUSPECTED:
1. CEASE the PCA
2. CEASE all other infusions that could be contributing to sedation
3. Attempt to rouse the patient
4. Call 777 [MET team] if appropriate
5. If apnoeic: administer bag & mask ventilation with 100% oxygen
6. If breathing: maintain airway, monitor oxygen saturations and administer oxygen via face mask at
8L/min
7. Check circulation. If pulseless: commence chest compressions
8. Prepare naloxone for possible administration
9. Call CPMS for urgent review

Allergic: caused by sensitivity to foreign proteins.
Clinical Manifestations: Urticaria, flushing, itching, no fever.
Treatment: Administer antihistamines as directed.
If manifestations mild and transient, transfusion may resume.
Prevention: Treat prophylactically with antihistamines.

Acute hemolytic: caused by infusion of ABO-incompatible red blood cells.
Clinical manifestations: Chills, fever, low back pain, flushing, tachycardia, hemoglobinuria,
hypotension, vascular collapse, bleeding, acute renal failure, shock, cardiac arrest, death.
Management: Discontinue transfusion, removing/changing IV tubing down to IV catheter.
Send blood samples for serologic testing, and send urine samples to lab. Send blood tubing to
lab/blood bank.
Maintain blood pressure.
Give diuretics as prescribed to maintain urine flow.
Insert indwelling catheter or measure hourly output.
Dialysis may be needed.
Prevention: Meticulously verify recipent from sample collection to transfusion.

Anaphylactic reaction: caused by infusion of IgA proteins to IgA-deficient recipient who has
developed anti-IgA-antibodies.
Clinical Manifestations: Anxiety, urticaria, wheezing progressing to cyanosis, shock, and possible

cardiac arrest.
Treatment: Do not transfuse additional RBC.
Initiate CPR if indicated.
Have epinephrine ready for injection (0.4 ml of a 1:1000 solution SC
Prevention: Give blood composnents from IgA-deficient donors or remove all plasma by washing.

Hirschsprung’s diagnosed with rectal biopsy looking for absence of ganglionic cells. Cardinal sign
in infants is failure to pass meconium, and later the classic ribbon-like and foul smelling stools.

Intussusception common in kids with CF. Obstruction may cause fecal emesis, currant jelly-like
stools (blood and mucus). A barium enema may be used to hydrostatically reduce the telescoping.
Resolution is obvious, with onset of bowel movements.

With omphalocele and gastroschisis (herniation of abdominal contents) dress with loose saline
dressing covered with plastic wrap, and keep eye on temp. Kid can lose heat quickly.

After a hydrocele repair provide ice bags and scrotal support.

No phenylalanine with a kid positive for PKU (no meat, no dairy, no aspartame).

Second voided urine most accurate when testing for ketones and glucose.

Never give potassium if the patient is oliguric or anuric.

Nephrotic syndrome is characterized by massive proteinuria (looks dark and frothy) caused by
glomerular damage. Corticosteroids are the mainstay. Generalized edema common.

A positive Western blot in a child <18 months (presence of HIV antibodies) indicates only that the
mother is infected. Two or more positive p24 antigen tests will confirm HIV in kids <18 months.
The p24 can be used at any age.

For HIV kids avoid OPV and Varicella vaccinations (live), but give Pneumococcal and influenza.
MMR is avoided only if the kid is severely immunocompromised. Parents should wear gloves for
care, not kiss kids on the mouth, and not share eating utensils.

Hypotension and vasoconstricting meds may alter the accuracy of o2 sats.

An antacid should be given to a mechanically ventilated patient w/ an ng tube if the ph of the
aspirate is <5.0. Aspirate should be checked at least every 12 hrs.

Ambient air (room air) contains 21% oxygen.

The first sign of ARDS is increased respirations. Later comes dyspnea, retractions, air hunger,
cyanosis.

Normal PCWP is 8-13. Readings of 18-20 are considered high.

First sign of PE (pulmonary embolism) is sudden chest pain, followed by dyspnea and tachypnea.

High potassium is expected with carbon dioxide narcosis (hydrogen floods the cell forcing
potassium out). Carbon dioxide narcosis causes increased intracranial pressure.

Pulmonary sarcoidosis leads to right sided heart failure.

An NG tube can be irrigated with cola, and should be taught to family when a client is going home
with an NG tube.

Q&As found in the NCLEX FORUM

Question # 1 (Multiple Choice) History and exam indicates your 77 year old

female patient has digitalis toxicity. Which drugs are contraindicated in this

case? Plz provide your rationale.

A) lidocaine and atropine
B) adenosine and amiodarone
C) magnesium sulfate and sodium bicarbonate
D) bretylium and verapamil

Answer::

A) lidocaine and atropine-Don't affect dig level/dig toxicity.

B) adenosine and amiodarone-Amiodarone, increases serum dig levels, possibly

causing dig toxicity. Adenosine doesn't affect dig toxicity. Only one of these

meds is contraindicated in dig levels/toxitiy.

C) magnesium sulfate and sodium bicarbonate. Neither drug affects dig levels

D) bretylium and verapamil-BEST ANSWER: Verapamil, increases serum dig levels,

possibly causing dig toxicity. Bretylium aggravates dig toxicity and digoxin

toxic arrhytmias are exacerbated by bretylium. This answer has two meds that are

should not be given to dig toxic patients.

Question # 2(Multiple Choice) Regarding abruptio placentae

A) Blood loss is confined within the amniotic sac
B) Internal bleeding is generally minimal.
C) Blood loss may be concealed between the uterine wall and the placenta
D) There is always excessive external vagina bleeding

what's the correct one? I just don't agree with c.

Answer::

C. is the best answer because it does describe placenta previa, most correctly.

Placenta previa is premature separation of the placenta, and the blood loss can

be either apparent or concealed. If the edges of the placenta remain attached to

the uterus then there will be no apparent loss of blood. However the woman is

still have significant internal bleeding.

A. is incorect because it does not describe A.P.

B. is incorrect because blood loss is usually significant, not minimal.

D. is incorrect because blood loss can be hidden.

Question # 3 (Multiple Choice) The geriatric patient suffering from organic

brain syndrome or dementia may not be able to make a rational decisions

regarding emergency care. In these situations, you may use ____to permit you to

legally render care

A) Good Samaritan Laws
B) Standards of Care
C) Implied Consent
D) Informed Consent

c is given as correct. why?

Answer:: Implied consent means that the patient most likely has been found in

distress and it is assumed that person wants to live. Therefore, you are within

the law to treat a person who is unable to make a decision about his/her care

who is in an emergency situation.

Above answer to your question explains why C is the best answer. Let me point

out a test taking tip to further support how you would choose this answer on an

exam, like NCLEX. First look at your question and identify, the key words, i.e.

what the question is asking. This question is asking which law will permit you

to deliver care in an emergency situation, when the patient is unable to give

consent. Now define each of the possible reponses.

A) Good Samaritan Laws-This law is to protect the individual that intervene to

provide care in an emergency from litigation. In other words, if a nurse stops

at an accident scene and provides care, the nurse will not be held liable for

their actions, if the care was provided in good faith according to practice

standards. Therefore this is not the answer.

B) Standards of Care-These are established guidelines for the nurse/health care

provider that outline safe and effective nursing care/interventions for given

diagnoses, etc. So, again this is not the answer to the question.

C) Implied Consent-Best answer, the patient can't verbalize consent, due to

their OBS/dementia, but they need emergency care. Because care is required then

consent to provide life saving care is implied. The same principle applies when

giving emergency care to unconscious patients. You can't wait for them to tell

you it is OK, to save their life, the law allows you to intervene. This is

implied consent.

D) Informed Consent-This is when the physician describes the procedure that is

to be preformed. Included in this explanation is the benefits and risks

associated with the procedure. The patient is INFORMED about the procedure and

then they give their consent. Again, this is not the best answer.

Try this technique when answering NCLEX-like questions, and you will find that

you will get more correct.

Question:

1.)a person is holding their neck what do you do?

a.)ask them can they cough.
b.)immediately perform the heimlich maneuver. I got confused because I

know are suppose to ask the person can they talk.

2.) an elderly client has alzheimers and wanders through out the day. To protect
his safety what is the best thing to do?

a.) put alarms on all the doors.
b.) inform all the staff to reorient the client.
c.) have the security guards to check on him.
d.) family to sit with him.

3.)When teaching a pt.about urinary catheter. What is most important?

a.)wear sterile gloves.
b.)clean the urethra with betadine.

4.)A woman is coming in for a pap smear what is most import to follow up on
before the pap smear is performed.

a)I just started menstruating and it is very heavy.
b) my last pap smear was abnormal.
C)I never had sex before.
d)I forgot this choice.

Answer:

These are some thoughts and rationales for the possible best answers to your

questions.

1.)a person is holding their neck what do you do?

a.) ask them can they cough. BEST ANSWER, because you need to confirm/rule out an

obstructed airway. If the patient can cough, then they are encouraged to do so.

If they can't speak or cough (no airway movement/obstructed airway) then you

begin the sequence for removing an airway obstruction, in this case it would be

for a conscious patient.

b.)immediately perform the heimlich maneuver. NOT THE BEST CHOICE, because you

need to confirm whether or not the patient is able to move air effectively

before performing this maneuver. Therefore to rule out an obstructe airway you

need to select an answer that will establish if the patient can speak, cough or

some other indicator of air movement.

I got confused because I know are suppose to ask the person can they talk. This

correct, but as you know from taking the NCLEX, the answer you want is never

there. What you have to do is select the answer that best matches/fits the

principles for the answer you would expect to find. You ask if the patient can

speak to confirm/rule out airway movement. Asking if they can cough will

accomplish the same thing.

2.) an elderly client has alzheimers and wanders through out the day. to protect

his safety what is the best thing to do? Key words in this question are WANDERS,

Alzheimer's patient, and to protect HIS SAFETY.

a.) put alarms on all the doors. BEST ANSWER, this is for the patient's SAFETY,

because Alzhiemer's patients wander and if they were to leave the healthcare

facility their safety would be compromised significantly. The alarms will

immediately alert all staff and the patient can be returned to the unit

immediately.

b.) inform all the staff to reorient the client. NO, remember the question is

asking about safety. Reoriented an Alzheimer’s patient is appropriate nursing

care, but they have no short term memory, so this will not ensure that they will

remain on the unit. They can (and will ) still wander.

c.) have the security guards to check on him. NO, this is both extreme and it is

"passing the buck". On the NCLEX it is up to nursing to solve nursing

problems. The patient could be injured or leave the unit between checks by the

security guards.

d.) family to sit with him. NO, this is "passing the buck" and putting another

burden on a family that is already in crisis due to the fact they have a family

member with Alzheimer's disease.

3.)When teaching a pt.about urinary catheter. What is most important? Both

answer don't match the principles of home care for a client with a catheter, so

it would be interesting to know what the other options were.

a.)wear sterile gloves. NO, because this is a clean procedure.

b.)clean the urethra with betadine. BEST answer of the two choices, because home

catheter care is a clean procedure, so A would not be the choice. Betadine is a

good anti-infective agent but it can be irritating to tissues. Generally

cleaning with soap and water is all that is recommended for home care.

4.)A woman is coming in for a pap smear what is most import to follow up on

before the pap smear is performed.

a) I just started menstruating and it is very heavy. BEST ANSWER, the best time

to obtain a pap smear is two weeks after the first day of the last menstrual

period and DEFINITELY NOT when the patient is menstruating, as this will affect

the results.

b) my last pap smear was abnormal. No, this is important to know, but not as

significant as A. This is not a contraindication to performing the test.

C) I never had sex before. No, this is important to know, but A is more

significant

d)I forgot this choice.

Question:

1. Alzheimer's patient incontinent of urine during the night times. The nursing care includes

a) Offers bed pan every 2 hours
b) Limit fluids during evening times
c) Foley's catheter

2. After immediate post operative hysterectomy patient to observe (or) Nursing care includes

a) Observe vaginal bleeding
b) Urine output
c) Vital signs

3. Dilantin prescribed to the patient, instructions to patient include

a) Reticulocyte counts
b) Platelet counts

4. On the ECG found a straight line, first Nurse

a) Assess the patient
b) Cardiopulmonary resuscitation
c) IV fluids

5. 15% superficial burns, 20% partial thickness burns. If the fluids adequate

a) Urine output 30-40ml/hr
b) BP
c) Vital signs
d) Skin turgor

6. 20 week pregnant most concerned

a) Butterfly rash on both cheeks and nose
b) Uterus palpate at the level of symphysis pubis
c) Sereous fluid drain in the breasts
d) Breast enlargement

7. The sterile technique is broken when:

a) The sterile field and supplies are wet
b) Clean the area peripheral to center

8. The metal piece is embedded on the left eye

a) Pressure dressing is applied on the left eye
b) Dressing is applied on both eyes
c) Irrigate the eye with saline

9. After cerebral angiogram, patient is

a) Encourage fluids
b) obseve contrast medium in the urine
c) walking

10. Using clean, non sterile gloves, care is appropriate

a) wash the genitelia........YES/NO

Answers:-
The following possible best answers are based on the information found in nursing textbooks, and
the underlying principle for safe and effective care that NCLEX is testing for.

1. Alzheimer's patient incontinent of urine during the night times. The nursing care includes

a) Offers bed pan every 2 hours-NO, would be appropriate to bring the client to the toilet or
commode every 2 hours during the day, but this action means you disturb the client's sleep.

b) Limit fluids during evening times, BEST ANSWER-(Source: Black & Hawks, Medical-Surgical
Nursing 7th edition) Specific interventions for the Alzheirmer's client with urinary incontinence:
"Sometimes the client forgets where the bathroom is located. Having bright lights and frequently

taking the client there may help control incontinence. Fluid intake after the dinner meal can be
restricted to maintain continence during the night."

c) Foley's catheter-NO, would increase risk of lower urinary tract infection, inappropriate and not
necessary.

2. After immediate post operative hysterctomy patient to observe (or) Nursing care includes

a) Observe vaginal bleeding
b) Urine output
c) Vital signs-BEST ANSWER, as this provides the best/most information about the client's
response to surgery and anesthesia.

3. Dilantin prescribed to the patient, to instruct the patient that includes

a) Reticulocyte counts-Yes, this will test for decreased reticulocyte count a sign that the patient is
developing aplastic anemia, a potentially life threatening side effect of Dilantin therapy.

b) Platelet counts-No, however Dilantin can decrease the platelet count and result in
thrombocytopenia. Aplastic anemia is considered to be more serious (Davis Drug Guide)

4. On the ECG found a straight line, first Nurse

a) Assess the patient-BEST ANSWER, always assess the patient to be sure there is no equipment
malfunction, and/or to confirm the information on the monitor.

b) Cardiopulmonary resuscitation

c) IV fluids

5. 15% superficial burns, 20% partial thickness burns. If the fluids adequate

a) Urine output 30-40ml/hr BEST ANSWER, the patient's fluid balance/hydration status is best
evaluated by assessing urine output. Urine output should be between 0.5 and 1.0 mL/kg/hr, which
for a 130 lb adult would be between 29.5 -59 mL/hr. Most nursing textbooks consider 30 mL/hr of
urine output to indicate appropriate fluid balance/hydration.

b) BP
c) Vital signs
d) Skin turgor
For b, c, and d many other factors can affect these findings. Urine output directly correlates with the
patient's hydration status/fluid balance.

6. 20 week pregnant most concerned
A
) Butterfly rash on both cheeks and nose-NO this is Cholasma the "mask of pregancy", result of
hormonal changes in pregnancy.

b) Uterus palpate at the level of symphysis pubis-BEST ANSWER this correlates with 12 weeks
gestation and the patient in the question is 20 weeks. This is a significant difference.

c) Sereous fluid drain in the breasts-NO, leaking of clear fluid from the breasts during pregnancy is
not unusual.

d) Breast enlargement-NO, the breast enlarge during pregnancy.

7. The sterile technique is broke when

a) The sterile field and supplies are wet-BEST ANSWER, this would allow microorganisms to enter
the sterile field through the wet surface.

b) Clean the area peripheral to center-NO, this is inappropriate technique but response a, specifically
describes how a sterile field can be contaminated and is an important principle in maintaining sterile
fields.

8. The metal piece is embedded on the left eye

a) Pressure dressing is applied on the left eye-NO, this would "push" the object further into the eye.
b) Dressing is applied on both eyes-BEST ANSWER, you want to keep the left eye still, and because
both eyes move together the uninjured eye must be covered to prevent movement in the injured eye.

c) Irrigate the eye with saline-NO, the object is embedded, meaning deep within the eye. Irrigation
will not remove the object but theoretically it could cause it to move resulting in further damage.

9. After cerebral angiogram, patient is

a) Encourage fluids-BEST ANSWER, when ever contrast medium/X-ray dyes are administer the
client is hydrated to facilitate excretion of the dye.

b) obseve contrast medium in the urine-NO, should not be observable to patient or nurse.

c) walking-NO, bedrest would be maintained for a prescribed period of time.

10. Using clean, non sterile gloves care is appropriate

a) wash the genitelia........YES/NO- YES, this is not a sterile procedure.

Question:

A patient is receiving 1,000 ml of 5% glucose and 0.45% normal saline with 40 mEq of potassium
chloride. most important for nurse to monitor the patient :

A. pulse rate
B. daily weight
C. skin turgor

Answer1:

I would say, always check for urine output before commencing anything with Potassium because it
can only be excreted in the urine. Hence if you are dehydrated & have decrease urine output &
commenced on K+ hyperkalemia will arise leading to cardiac arrythmia.

Answer2:
The answer is pulse rate

Question:


b. father refurnishes old furniture at their home




a. private room
b. isolation

4) wat herb would help with vomiting?

a. ginkgo
b. ginseng.
c. ginger root
d. echinacea

5) allergic to sulfa wat not to take?

a. ma huang
b. echinacea.

6) mother called a nurse from home stating that her child having chicken pox, which of the following
statements by the mother needs immediate follow up?


7) client with allergy to sudafed ..which of the statments is correct?


8) food processing

c. cook perishable food should cover and cool

nurse refused to let him play for wat reason?


11) a mother reported that her son is throwing up each time she feeds him wat would be the best
question u ask?


d. does ur son have a jelly like stool

12) a patient had aids the nurse should advise?

c. avoid crowds

Answer:


b. father refurbishes old furniture at their home

> ANSWER is B. probably if he refurbishes an old furniture at home.. that is, if the furniture has old
paint on it and during 60's paints have lead content on it (heavy metals) and if you need to remove
that, chips from the old paint may be taken by a kid that leads to Pb poisoning



****>> if the patient is already taking anti-TB drugs, it will only be 2 weeks of chemotherapy and
that (+) PTB will no longer be communicable.. and 1-2 months is long!
CHildren are more susceptible to acquire Primary complex and pregnant women are susceptible and
almost vulnerable to all type of illnesses.. There is no need for the patient to separate their utensils
since PTB is airborne and not by contact in terms of transmission.. so i go for B answer.


a. private room
b. isolation

*** the (+) salmonella kid may be placed in a private room. Salmonella is transmitted by Enteric..
therefore Enteric precaution is needed and handwashing is very important and gown and gloves,
diaper or bedpan in necessary. Option B, and D are all for pulmonary tuberculosis precautions. I
suppose, the answer is A. place in a private room.

4) wat herb would help with vomiting?

a. ginko
b. ginsing.
c. ginger root
d. echinacea

****> ginger root is good for nausea.. most especially in morning sickness but in moderation for
pregnant women... Option C is the answer

5) allergic to sulfa wat not to take?

a. ma huang
b. echinacea.

...I think the answer is... geez, i forgot..i think its Echinacea..let me check again ok..

6) mother called a nurse from home stating that her child having chicken pox..which of the following
statements by the mother needs immediate follow up?


I think the answer is C. the child that just had tonsillectomy. i think the child is
immunocompromised. and varicella (Chicken pox) is a viral one.. we all know that tonsils are one of
the lymph defenses we have against any infection.. Im not really sure with this answer.

7) client with allergy to sudafed ..which of the statments is correct?


**valerian root is for cystitis and fungal infections; ma huang is for (I forgot!!),echinacea is for
immune booster but not to be taken with patients with progressive systemic disorders such as AIDS,
PTB, HIV, etc. black cohosh is for menopause.

*** don't you think that Echinacea is the correct option??

8)food processing

c. cook perishible food should cover and cool

usually, frozen food must be thawed at cool tap water for freshness. not in the microwave because it
can be cooked outside and raw inside, not in the hotwater with same principle. so i believe, thawing
it FOR UP TO 6 HOURS would be ok. returning thawed food back at fridge is ok but it is unsafe
since salmonella can start thriving in.. Answer is OPTION A.

nurse refused to let him play for wot reason?


** The answer is OPTION C. Usually car toy have friction on it for the wheels to run.. Oxygen
supports combustion.. and if friction is present together with oxygen (in a mist tent) then, fire could
commence.

11) a mother reported that her son is throwing up each time she feeds him wat would be the best
question u ask?

d. does r son have a jelly like stool

***>>> CORRECT OPTION is D.. Does your son have jelly like stool.. jelly like or currant like
stool is a cardinal sign of Intussusception/ Telescoping or invagination of the large intestines in the
Ileoceccal area..

12) a patient had AIDS the nurse should advise?

c. avoid crowds

***>> if you have AIDS, u are immunocompromised.. therefore you are prone to infection..
neutropenic precaution is advised and one that is a must is Avoiding Crowds.. Correct option is C.

Posted by anaski from IP 203.131.185.106 on September 08, 2005 at 03:45:59:

Thank you so much English RN2B
Future USRNs, this for you:

PRIORITY QUESTIONS (WHO TO SEE FIRST)
Sample Test Item:
1. Which of the following clients should the nurse deal with FIRST?
o 1 A client who needs his daily vitamin
o 2 A client who needs to be suctioned
o 3 A client who needs diaper to be changed
o 4 A client who is being prepared for discharge

Correct Answer: 2. A client who needs to be suctioned
PRIORITY (Use ABC)
Obstruction in the airway – secretions
Need to be suctioned

2. Delegation, RN, LVN, UAP, CNA
Which of the following clients should the LPN be assigned to?
o 1 A newly diagnosed patient with MYASTHENIC CRISIS
o 2 An immediate post-op client in PACU
o 3 A client awaiting medication for vitamins
o 4 A new admission for KIDNEY Transplant Patient

Correct Answer: 3-stable, A client awaiting medication for vitamins
Myasthenic Crisis – Unstable, Acute Respiratory Failure
Immediate Post – op – Unstable, Risk for Complications,
Kidney Transplant – Unstable, needs assessment for rejection

DELEGATION: Remember the 5R's, Right Task, Right Person, Right Circumstance, Right
Communication & Right Feedback)
RN Least stable, unstable, central catheters (hickman, broviac), admission, discharge, health
teachings, patient for transfer, blood transfusion (2RNs)
LPN Technical Doer, Stable, medications, wound dressing
CNA Routine Care, Urine Dip Stix, Reporting to RN, Routine VS
UAP turning q2H, conducting group activities, ambulation

For future USRNs
This is for you... from the purkinje fibers of my heart....

Room Assignment(Who to Share Room with)
Check:
A ge
B eside the nurse's station? At the end of the hallway? Single Room/Private Room?
C hain of infection/circumstance
D iagnosis
E nviroment (dim light, darkened, red nightlapm)

Sample Test Item:
The best roommate for patient with LEUKEMIA is
O 1 A 9-year-old with ruptured appendix
O 2 A 12-year-old with chicken pox
O 3 A 2-year-old with fever of unknown origin
O 4 A 5-year-old with nephrotic syndrome

Correct Answer: 4. A 5-year-old with nephrotic syndrome.
1,2 & 3, manifest symptoms of infection. A client with leukemia is immunosuppressed and Patients
with infection shouldn't be placed in this room. Since patient with nephrotic syndrome receives
diuretics and steroids, this child will also need immunocompromised host precaution.

INFECTION CONTROL:
Sample Test Item:

3. Which of the following methods should the RN utilize in patient with SALMONELLA?

O 1 Airborne Precautions
O 2 Droplet Precautions
O 3 Neutropenic Precautions
O 4 Enteric Precautions

The correct answer: 4.
Salmonella mode of transmission is fecal oral (enteric)
Handwashing
Gloves must be used in handling bedpan and diapers
Gown - if soiling is likely to happen.

Source of infection:
Contaminated food and water.

Remember - Transmission Based precautions:
A ir
B orne, small particles are dispersed in the air like MTB, varicella
C ontact, drug-resistant microorganisms
D roplet, large particles are dispersed into air, resp.infections except resp syncytial
E nteric, fecal-oral like hepaA & salmonella

AGE APPROPRIATE GROWTH AND DEVELOPMENT
(HOPPING WITH ONE LEG)
Sample test Item:

4. Which of the following is NOT a characteristic of a preschooler?

O 1 predominantly "parallel play" period
O 2 balances on 1 foot with eyes closed
O 3 skips on alternate feet
O 4 jumps rope

The correct answer is: 1. Parallel play is more common in TODDLERS.

Preschooler (3-6 years)
Gross motor development

HOPS ON ONE (1) FOOT BY 4 YEARS
SKIPS & HOPS ON ALTERNATE FEET BY 5 YEARS
PLAY : ASSOCIATIVE, IMAGINATIVE, MAGICAL THINKING, SUPERHEROES (Remember
the movie: Jingle All The way!)
FEAR: Intrusive procedures, venipunctures, IM injections, body mutilation

Toxoplasmosis, where else you can contract this (thinking of cat litter but it aint there)
Sample test Item:
5. To which of the following pregnant clients will be risk for TOXOPLASMOSIS?


O 1 A pregnant client who eat raw meat.
O 2 A pregnant client handling cat litter of infected cats.
O 3 A pregnant client gardening and cultivating soil exposed to cat feces.
O 4 A pregnant client with low rubella titer
O 5 A pregnant client who have undergone external radiation.
O 6 A pregnant client with draining, painful vesicles in the external genitalia.

The correct answers: 1, 2 & 3.
TOXOPLASMOSIS
How do people get toxoplasmosis?
A Toxoplasma infection occurs by:

Accidentally swallowing cat feces from a Toxoplasma-infected cat that is shedding the organism in
its feces.
This might happen if you were to accidentally touch your hands to your mouth after gardening,
cleaning a cat's litter box, or
touching anything that has come into contact with cat feces.
Eating contaminated raw or partly cooked meat, especially pork, lamb, or venison;
by touching your hands to your mouth after handling undercooked meat.
Contaminating food with knives, utensils, cutting boards and other foods that have had contact with
raw meat.
Drinking water contaminated with Toxoplasma.
Receiving an infected organ transplant or blood transfusion, though this is rare.
(From the internet-Division of Parasitic Disease)

Which of these statements by the nurse is incorrect if the nurse has the goal to reinforce information
about cancers to a group of young adults?
1. “You can reduce your risk of this serious type of stomach cancer by eating lots of fruits and
vegetables, limiting all meat, and avoiding nitrate-containing foods.”
2. “Prostate cancer is the most common cancer in American men with results to threaten sexuality
and life.”
3. “Colorectal cancer is the second-leading cause of cancer-related deaths in the United States.”
4. “Lung cancer is the leading cause of cancer deaths in the United States. Yet it's the most
preventable of all cancers.

MEMORIZE MEMORIZE MEMORIZE

Tonometry: normal (10-21 mm Hg)

PR Interval: normal (0.12-0.20 seconds)

Serum Amylase: normal (25-151 units/dL)

Serum Ammonia: normal (35 to 65 mcg/dL)

Calcium: adult (8.6-10 mg/dL)
child (8 to 10.5 mg/dL)
term<1week (7 to 12 mg/dL)

Partial Thromboplastin Time (aPTT): normal (20-36 seconds) therapeutic 1.5-2.5

Prothrombin Time: normal (Male: 9.6-11.8 seconds) and
(Female: 9.5-11.3 seconds)

Platelet Count: normal (150,000-400,000 cells/uL)

Albumin level: normal (3.4 to 5 g/dL)

Serum Osmolality: normal (285 to 295 mOsm/kg)
high value indicates dehydration

Safe Suction Range: normal [Infant] 50-95 mm Hg

[Child] 95-115 mm Hg

[Adult]100-120 mm Hg)

Serum Lithium: normal (1 to 1.5 mEq/L)

acute mania (0.6 to 1.4 mEq/L) maintenance treatment

Phenytoin (Dilantin): normal serum (10 to 20 mcg/mL)

Digoxin: therapeutic blood level (0.8 to 2.0 ng/ml)

Magnesium Sulfate: Therapeutic Range (4 to 8 mg/dl)

Pregnancy Temperature: normal (36.2-37.6 celcius or 98-99.6 Farenheit)

WBC’s In Pregnancy: normal (11,000 to 15,000 cells/mm3, up to 18,000 cells/mm3). Immediate
postpartum period, (maybe as high as 25,000 to 30,000 cells/mm3)

Stomach Capacity:
 Newborn infant (10 to 20 mL)
 1-week-old (30 to 60 mL)
 2-3-week-old infant (75 to 100 mL)
 1-month-old infant (90 to 150 mL)

Left Atrial Pressure: normal (1 to 10 mm Hg)

Fibrinogen Levels: normal (male: 180 to 340 mg/dL) and

(female: 190 to 420 mg/dL)

with Disseminated Intravascular Coagulation the fibrinogen level drops because fibrinogen is
used up in the clotting process.

Insulin Insulin Insulin Insulin
(Regular, Humulin R) (NPH, Humulin N) (Ultralente, Humulin U) (Humulin 70/30)
Type: Fast acting Type: Intermediate Type: Slow acting Type: Combination
Onset: ½ -1 hr acting Onset: 4hr Onset: ½ hr
Peak: 2-4 hr Onset: 2hr Peak: 8-20hr Peak: 2-12hr
Duration: 6-8 hr Peak: 6-12hr Duration: 24-36hr Duration: 24hr
Duration 18-26hr

Central Venous Pressure: < 3 mm
Hg = inadequate fluid and >11 mm Hg = too much fluid

Potassium: 3.5-5.0 mEq/L
Sodium: 135-145 mEq/L
Calcium: 4.5-5.2 mEq/L or 8.6-10 mg/dL
Magnesium: 1.5-2.5 mEq/L
Chloride: 96-107 mEq/L
Phosphorus: 2.7 to 4.5 mg/dL

PR measurements: normal (0.12 to 0.20 second)

QRS measurements: normal (0.04 to 0.10 second)

Ammonia: 35 to 65 ug/dL
Amylase:25 to 151 IV/L

Lipase: 10 to 140 U/L

Cholesterol: 140 to 199 mg/dL
LDL: <130 mg/dL
HDL: 30 to 70 mg/dL
Triglycerides: <200 mg/dL

Bilriubin
• Direct: 0 to 0.3 mg/dL
• Indirect: 0.1 to 1.0 mg/dL
• Total: <1.5 mg/dL

Protein: 6.0 to 8.0 g/dL

Uric acid: Male 4.5 to 8 mg/dL
Female 2.5 to 6.3 mg/dL

Glycosylated Hemoglobin HbA1c: good control 7.5% or less

Serum creatinine: 0.6 to 1.3 mg/dL

BUN: 9-25 mg/dL

Normal CK is 26-174 U/L

Troponin I value: normal (<0.6 ng/mL)
Troponin T >0.1 to 0.2 ng/mL = MI

Erythrocyte studies: 0-30 mm/hour

Serum iron: Male 65-175 ug/dL
Female 50-170 ug/dL

RBC: Male 4.5 to 6.2 M/uL
Female 4.0 to 5.5 M/uL

Theophylline levels normal (10 to 20 mcg/dl)

MOTOR DEVELOPMENT

Chin up 1 month

Chest up 2 month

Knee push and “swim” 6 month

Sits alone/stands with help 7 month

Crawls on stomach 8 month

Stands holding on furniture 10 month

Walks when led 11 month

Stands alone 14 month

Walks alone 15 month

AT THE PLAY GROUND

* Stranger anxiety: 0 -1 year
* Separation anxiety: 1 - 3 years
* Solitary play: 0 – 1 year
* Parallel play: 2 – 3 years
* Group play: 3 – 4 years

PSYCHOLOGICAL DEVELOPMENT

AGE ERIKSON FREUD PIAGET

Infant Oral (trust &
0 – 1.5 Trust vs. mistrust dependence sensorimotor
Toddler Anal (holding vs.
1.5 -3 Autonomy vs. shame letting out) preoperational
Pre-school Phallic (Oedipus
3-6 Initiative vs. guilt complex) preoperational
School age Industry vs.
6 - 11 inferiority latency Concrete operational
Identity vs. role
11 - 20 confusion genital Formal operational

20 – 25 Intimacy vs. isolation
Generativity vs.
25 – 50 stagnation

50 - ? Integrity vs.despair

LABORATORY VALUES

ELECTROLYTES

Sodium (Na+): 135 – 145 meq/L
(increase-dehydration; decrease overhydration)
Potassium (K+): 3.5 - 5.0 meq/L
Magnesium (Mg++): 1.5 – 2.5 meq/L
Calcium (Ca++): 4.5 – 5.8 meq/L
Neonate : 7.0 to 12 mg/dL
Child: 8.0 to 10.5 mg/dL
Phosphorus (PO4): 1.7 – 2.6 meq/L
Chloride (Cl-): 96 – 106 meq/L

COAGULATION STUDIES

Activated partial thromboplastin time(APTT): 20 – 36 seconds depending on the
type of activator used
Prothrombin time(PT): male: 9.6 – 11.8 seconds
Female: 9.5 – 11.3 seconds
International Normalized Ratio(INR): 2.0 - 3.0 for standard Coumadin therapy
3.0 – 4.5 for high-dose Coumadin therapy
Clotting time: 8 – 15 minutes
Platelet count: 150,000 to 400,000 cells/Ul
Bleeding time: 2.5 to 8 minutes

SERUM GASTROINTESTINAL STUDIES

Albumin: 3.4 to 5 g/dL
Alkaline phosphatase: 4.5 to 13 King-Armstrong units/dL
Ammonia: 15 to 45 ug/dL
Amylase: 50 – 180 Somogyi U/dL in adult
20 – 160 Somogyi U/dL in the older adult
Bilirubin: direct: 0 - 0.3 mg/dL
Indirect: 0.1 – 1.0 mg/dL
Total: less than 1.5 mg/dL
Cholesterol: 120 – 200mg/dL
Lipase: 31 -186 U/L
Lipids: 400 – 800 mg/dL
Triclycerides: Normal range: 10 – 190 mg/dL
Borderline high: 200 – 400 mg/dL
High: 400 – 1000mg/dL
Very high: greater than 1000mg.dL

Protien: 6.0 – 8.0 g/L
Uric acid: male: 4.5 – 8 ng/dL
Female: 2.5 – 6.2 ng/dL

GLUCOSE STUDIES

Fasting blood sugar: 70 – 105 mg/dL
Glucose monitoring (capillary Blood): 60 – 110 mg/dL

RENAL FUNCTION TEST

Creatinine: 0.6 – 1.3 mg/dL
Blood urea nitrogen (BUN): 5 – 20 mg/dL

ERYTROCYTES STUDIES

Erytrocyte sedimentation rate(ESR): 0 – 30 mm/hr depending on age
Hemoglobin: male: 14 – 16.5 g/dL
Female: 12 – 15 g/dL
Hematocrit: male: 42% - 52% (increased in hemoconcentration, fluid loss and dehydration)
Female: 35% - 47% ( decreased in fluid retention)
Red blood cell (RBC): male: 4.5 to 6.2 million/uL
Female: 4 to 5.5 million/uL

White blood cell (WBC): 4500 to 11,000/uL
Erytrocyte Protoporthyrin (EP) : <9ug/dL
Phenylalanine Level: <2 mg/dL
PKU: >25 mg/dL

CRANIAL NERVES

MAJOR FUNCTIONS

I. Olfactory (S) smell

II. Optic (S) vision

III. Oculomotor (M) Eye movement
IV. Trochlear (M)
Facial sensation
V. Trigeminal (S-M) Jaw movement

VI. Abducent (M) Eye movement
Taste
VII. Facial (S-M) Facial expression

VIII. Acoustic (S) Hearing and balance
Taste
IX. Glossopharyngeal (S-M) Throat sensation
Gag and swallow
Gag and swallow
X. Vagus (S-M) Parasympathetic activity
Neck and back muscles
XI. Spinal Accessory (M)

XII. Hypoglossal (M) Tongue movement

On Old Olympus’ Towering Tops, A Finn And German Viewed Some Hops
Some Says Marry Money, But My Brother Says Bad Business Marry Money

ARTERIAL BLOOD GAS (ABG)

pH: 7.35 – 7.45
PCO2: 35 - 45 mmHg
PO2: 80 - 100 mmHg
HCO3: 22 - 27 mEq/L
O2 saturation: 96% - 100%
Acid-base “RAMS”(Respiratory Alternate, Metabolic Same)

GLASGOW COMA SCALE

Eye opening response
Motor response
Verbal response

AUTONOMIC NERVOUS SYSTEM

SYMPATHETIC/ PARASYMPATHETIC/
ADRENERGIC CHOLINERGIC
Increased heart rate
Heart Increased conduction Decreased heart rate
Increased force

Bronchi dilation constriction

GI tract Reduced motility Increased motility
Empties rectum
Rectum Allows filling Relaxes internal sphincter
Empties bladder
Bladder Allows filling Relaxes internal sphincter

Erection Maintains erection

Ejaculation Triggers ejaculation

Pupils of eye Big (mydriasis) Small (miosis)

Salivary glands Secretion
Depends on receptors
Blood vessels -a contrict
-b dilates

FLOW OF BLOOD THROUGH THE HEART

Inferior vena cava and superior vena cava – right atrium – tricuspid valve – right ventricle –
pulmonic valve – pulmonary artery – lungs – pulmonary veins – left atrium – bicuspid valve (mitral)
– left ventricle – aortic valve aorta – systemic circulation

CARDIAC IMPULSES

Sinoatrial (SA) node – right and left atria (atria contract) – atrioventricular (AV) node – bundle his –
bundle brabches – purjinje’s fibers – ventricles contract.

Blood volume: 5000mL
Central venous pressure: 4 to 10 cmH2O (increased in cardiac overload; decreased in dehydration)
Pressure within the right atrium: 2 to 7 mmHg
Capillary refill time: <3 seconds
Normal sweat chloride: <40 mEq/L
Normal pupil diameter: 3 to 5mm
Normal ocular pressure: 10 to 21 mmHg
Normal Pulmonary capillary wedge pressure (PCWP): 8 to 13 mmhg
Normal cardiac output : 4 to 8 L/min.

THERAPEUTIC SERUM MEDICATION LEVELS

Acetaminopen (Tylenol) 10 – 20 ug/mL
Amikacin (Amikin) 25 – 30 ug/mL
Amitryptyline (Elavil) 120 -150 ng/mL
Carbamazepine (Tegretol) 5 -12 ug/mL
Chloramphenicol (Chloromycetin) 10 – 20 ug/mL
Desipramine (Norpramin) 150 -300 ng/mL
Digotoxin ( Crystodigin) 15- 25 ng/mL
Digoxin ( Lanoxin) 0.5 – 2.0 ng/mL
Disopyramide (Norpase) 2 -5 ug/mL
Ethosuximide ( Zarontin) 40 – 100 ug/mL
Gentamycin (Garamycin) 5 – 10 ug/mL
Imipramide (Tofranil) 150 – 300 ug/mL
Lidocaine (Xylocaine) 1.5 – 5.0 ug/mL
Lithium (Lithobid) 0.5 -1.5 ug/mL
Magnesium sulphate 4 -7 mg/dL
Nortriptyline (Aventyl) 50 – 150 ng/mL
Phenobarbital (Luminal) 10 – 30 ug/mL
Phenytoin (Dilantin) 10 -20 ug/mL
Primidone (Myoline) 5 – 20 ug/mL
Procainamide (Pronestryl) 4 – 10 ug/mL
Propranolol (Inderal) 50 – 100 ng/mL
Quinidine (Quinalaglute, Cardioquin) 2 – 5ug/mL
Salisylate 100 -250 ug/mL
Theophylline (Aminiphylline, Theo-Dur) 10 -20 ug/mL
Tobramycin (Nebcin ) 5 -10 ug/mL
Valproic acid (depakene) 50 -100 ug/mL

Pulmonary capillary wedge pressure: 5 to 13 mmHg
Pulmonary artery pressure: systolic: 16 to 30 mmHg
Diastolic: 0 to 7 mmHg
Spinal pressure: 70 to 200mmH2O
Morphine sulphate pediatric dose: 0.1mg/kg every 3 – 4 hour

SULFONYLUREAS
For treatment of NIDDM
 Sulfonylureas should not be given to patients with liver or kidney failure.

 Accummulation of drug will increase risk of hypoglycaemia.

DURATION

tolbutamide 8h

Glycburide, glipizide 20 h, most potent

chlorpropamide 48 h

Apothecary and Household System

Grain –gr 1 gr = 60 mg
Dram – dr 5 gr = 300 mg
Ounce –oz 15 gr = 1000mg or 1g
Minim – min, M, m 1/150 gr =0.4 mg
Quart – qt 1 oz = 30 mL
Pint – pt 1 dr = 4 mL
Drop – gtt 1 T = 15 mL or 3 tsp
Tablespoon – T or tbs 1 min = 1 gtt
Teaspoon – t or tsp 15 min = 1mL
Pound – lb 60 min = 1 dr
8 dr = 1 oz
1 qt = 1000mL or 1L
1 qt = 2 pt or 32 oz
1 pt = 16 oz
16 oz = 1 lb
2.2lb = 1 kg

Fahrenheit to Celcius (F – 32) divide 1.8 = C

Celcius to Fahrenheit 1.8 C + 32 = F

Formula for Calculating a Medication Dosage

D (desired ) = the dosage that the physician ordered
A (available) =the dosage strength as stated on the medication label
Q (quantity ) = the volume that the dosage strength is available in, such as tablet, capsules, or mL

D X Q = X
A

Formulas for Intravenous Calculations

Flow Rates:
Total volume x gtt factor = gtt per min
Time in minutes

Infusion Time:
Total volume to infuse = Infusion time
mL per hour being infused

IMMUNIZATION

Birth Hepatitis B

1 months Hepatitis B
2 months OPV, DPT, HIB
4 months DPT, HIB, OPV
6 months DPT, HIB, hepatitis B
12 months HIB, OPV
15 months MMR
18 months DPT
12 – 18 months Varicella vaccine
4 -6 years DPT, OPV, MMR
11 – 12 years MMR ( if not administered at 4 -6 years)
11 – 16 TD booster

SPINAL CORD INJURY
Cervical Injury:
 C2 to C3 injury usually fatal
 C4 is the major innervation to the diaphragm by th phrenic nerve
 Involvement above th C4 causes respiratory difficulty and paralysis of all the four
extremities
 C5 or below client may have movement in the shoulder

Thoracic Level Injury:
 loss of movement of the chest, trunk, bowel, bladder, and legs, depending on the level of
injury
 Leg paralysis (paraplegia)
 Autonomic dysreflexia with lesions above T6 and in cervical lesions
 Visceral distention from a distended bladder or impacted rectum may cause reactions such as
sweating, bradycardia, hypertension, nasal stuffiness, and gooseflesh

Lumbar and Sacral Level Injuries:
 loss of movement and sensation of the lower extremities.
 S2 and S3 center on micturation; therefore below this level, the bladder will contract but not
empty (neurogenic bladder)
 Injury above S2 in males allows them to have an erection, but they are unable to ejaculate
because of sympathetic nerve damage.
 Injury between S2 and S4 damages the sympathetic and parasympathetic response,
preventing erection and ejaculation.

RULE OF NINE

Head and neck 9%
Anterior trunk 18%
Posterior trunk 18%
Arms (9%) 18%
Legs (18%) 36%
Perineum 1%

NORMAL ADULT WHITE BLOOD CELL DIFFERENTIAL

Neutrophils 56% or 18000 – 7800/uL
Bands 3% or 0 – 700/uL
Eosinophils 2.7% or 0 – 450/uL
Basophils 0.3% or 0 – 200/uL
Lymphocytes 34% or 1000 – 4800/uL

Monocytes 4% or 0 – 800/uL

THYROID STUDIES
Thyroid –stimulating hormone (thyrotropin; THS): 0.2 to 5.4 ug/dL
Thyroxine (T4): 5.0 to 12.0 ug/dL
Thyroxine free (FT3) : 0.8 to 2.4 ng/dL
Triiodothyronine (T3): 80 to 230 ng/dL

Normal Fribrinogen level: for men: 180 to 340mg/dL
Women: 190 to 420mg/dL
Fribrinogen is used up in the clotting process.

Erythrocyte Protoporhyrin (EP): < 9ug/dL
Phenylalanine level: < 2mg/dL
PKU: >25 mg/dL
Urine specific gravity: 1.016 - 1.022 increase in SIADH; decrease in diabetes insipidus
Normal CSF protein: 15 – 45 mg/dL increase in Guillain-Barre syndrome
Normal CSF pressure: 5 – 15 mmHg
Normal serum osmolality: 285 – 295 mOsmlkgH2O increase in dehydration;
Decrease in over hydration
Normal scalp pH: 7.26 and above
Borderline acidosis: 7.20 to 7.25
Acidosis: < 7.15

HERBAL MEDICINE

Aloe vera Gel – abrasionsand dermatologic conditions
American Ginseng (Panax quinquefolius) – boost energy, relieve stress, improve concentration and
enhance physical or cognitive performance.
Ashwagandha (Withania somnifera) – stress arthritis
Asian gingseng (Panax ginseng) – enhance health and combat stress and disease
Bilberry (Vaccinium myrtillus) – vision and peripheral vascular disorders and as antioxidant
Black Cohosh (Cimicifuga racemosa) – menopausal
Black Currant and Borage oil (Ribes nigrum and Borago offinalis) – anti-inflammatory,
rheumatoid arthritis
Capsicum Peppers (Capsicum spp.) – arthritis, neuralgia and other painful treatment
Chamomile (Matricaria recutita) “manzanilla”- skin inflammation, colic, or dyspepsia and anxiety
Chaste tree (Vitex agnus-castus) – menstrual related disorders, PMS, cyclical mastalgia
Chodroitin – osteoarthritis
Coenzyme Q10 – antioxidant
Coltsfoot ( Tussilago farfara ) – cough and other respiratory disoders
Cranberry (Vaccinium macrocarpon) – UTI
Devil’s Claw ( Harpagophytum procumbers) – anti inflammatory and analgesic
Echinacea (Echinacea spp.) – acute viral URI symptoms
Ederberry (Sanbacus nigra) – respiratory tract infection
Ephedra or Ma Huang (Ephedra sinica) Source of ephedrine and pseudoephedrine
Evening Primrose Oil (Oenothera biennis) – eczema, breast pain associated with PMS and
inflammatory condition
Fenugreek (Trigonella foenum-graecum) – lowering blood glucose
Feverfew ( Tanacetum parthenium) – migraine headache prophylaxis
Garlic (Allium sativaum)- help prevent cardiovascular disease and cancer
Ginger (Zingiber officinale) –nausea and motion sickness, anti-inflammatory
Ginkgo (Ginkgo biloba) – dementia and intermittent claudication, memory enhancement and
treatment of vertigo nad tinnitus
Glucosamine – osteoarthritis
Goldenseal ( Hydrastis Canadensis) – tonic and antibiotic
Gotu Kola (Centella asiatica) – mental support, wound healing and venous disorders

Hawtorn ( Crategus species) – CHF and related cardiovascular conditions
Horebound (Marribium vulgare) – primary cough suppression and expectoration
Horse Chestnut Seed (Aesculus hippocastanum) chronic venous insufficiency
Ivy (Hedera helix) – coughs, rheumatic disordes and skin disease
Kava ( piper methysticum) – mild psychoactive and antianxiety property
Lemon Balm (Melissa officinalis) – sedative and for dyspepsia
Licorice (Glycyrrhiza glabra) – respiratory disorders, hepatitis, inflammatory diseases, and
infections
Melatonin – insomia, jet lag
Milk Thistle – hepatitis, liver desease
Mints (Mentha species) – minor calcium channel antagonists, used for upper respiratory problems,
irritable bowel syndrome, dyspepsia, and colonic spasm and as a topical counterirritant
Nettle (Urtica dioica) – arthritis pains, allergies, BPH, or as diuretic
Papaya (Carica papaya) – digestive aid, dyspepsia, and for inflammatory, topically applied to
wounds
Passion flower (Passiflora incarnata)- sedative-hypnotic or anxiolytic herb
Pokeroot (Phytolacca Americana) – inflammatory conditions also as an emetic/cathartic
Pygeum (Pygeum africanum) – mild symptoms of BPH
Red Clover (Trifolium pratense) – used as a natural estrogen substitute for women’s health
St. John’s Wort (Hypericum perforatum) – antidepressant effect
Tea Tree Oil (Melaleuca alternifolia) – antifungal and antibacterial
Turmeric (Curuma longa ) – anti-inflammatory, anti-arthritis, anti cancer, and antioxidant
Uva Ursi (Arctostaphylos uva ursi) – urinary antiseptic and diuretic
Yohimbe – erectile dysfunction

FOUR STRATEGIES:
1. If the question asks what you should do in the situation. Use the nursing process to determine
which step in the nursing process would be next?
2. If the question asks what the client needs. Use maslow’s hierarchy to determine which need
to address.
3. If the question indicates that the client doesn’t have urgent physiologic need, focus on the
patient safety.
4. If the question involves communicating with a patient. Use principles of therapeutic
communication.

REMEMBER:
AIRWAY, BREATHING,CIRCULATION AND SAFETY (ABCS)

The nurse in primary care clinic is caring for a 50-year-old woman. History reveals that she had
experienced on and off chest pain. After series of cardiac tests (EKG & Blood Chem), the doctor
orders for THALLIUM STRESS TEST. Which of the following medications should the RN prepare
if the patient needs an alternative exercise in thallium test?
1.Nitroglycerin
2.Morphine
3.Aminophylline
4.Persantin
The correct answer is #4. Persantin (dipyridamole)
Persantin is use as an alternative to exercise in thallium myocardial perfusion imaging for the
evaluation of CAD in those who cannot exercise adequately.
Purpose: to determine myocardial wall viability
Other names:
1. Cardiac pooling
2. MUGA-multigated radionuclide angiographic scanning
3. nurclear scan
4. sestamibi test
5. thallium scan
6. dipyridamole or persantin stress test
7. In short, heart scan :)
Loving NCLEX-RN
URC
09178364589

Posted by Anaski from IP 203.131.183.186 on August 23, 2005 at 21:44:00:
For Future USRN's:
Cervical Cancer
Etiology:
* Early age of sexual intercourse
* Multiple sexual partners
* Sexually Transmitted Disease (Venereal Wart)
* Virus - HPV
Cancer Carcinoma in SITU - only in epithelial linings
Situ sounds like Ziru - Stage 0
Tumor marker - CEA
Signs and Symptoms (3 P's)
POST COITAL BLEEDING
PAINFUL INTERCOURSE
PROFUSE (PERIOD IRREGULARITIEs - menorrhagia and metrorrhagia)

Management:

U - pera (Surgery HYSTERECTOMY)
R - radiation (intracavitary cessium - remember STD - shielding, timing and distance))
C - chemotherapy to destroy the DNA,RNA & CHON synthesis.

MIKE’S NOTES (60 pp.)
O universal donor/AB universal recipient.

ABO BLOOD TYPE
COMPATIBILITY
Blood Type Can Receive from: Can donate to:
O O O,A,B,AB
A A,O A,AB
B B,O B,AB
AB O,A,B,AB AB

Autologous Transfusion:
•Collected 4-6 weeks before surgery
•Contraindicated—infection, chronic disease, cerebrovascular or cardiovascular
disease

Hypotonic Solution Isotonic Solution Hypertonic Solution
• ½ NS (0.45% • 0.9% NaCl (Normal Saline) • 10% D/W (10% Dextrose in water)
Saline) • 5% D/W (Dextrose in Water) • D15W
• Lactated Ringer’s • 5% D/NS (5% Dextrose in 0.9% Saline)
• 5% D/ ¼ NS (5% Dextrose in 0.225% • 5% D/ ½ NS (5% Dextrose in 0.45%
Saline ) Saline)
• 3% NaCl
• 5% Sodium Bicarbonate

Change tubing Q72 hours

Change bottle Q24 hours
Infiltration
•Assessment: cool skin, swelling, pain, decrease in flow rate
•Implementation: discontinue IV, warm compresses, elevate arm, start new site proximal to infiltrated
site
IV Phlebitis, Thrmobophlebitis
•Assessment—redness, warm, tender, swelling, leukocytosis
•Implementation—discontinue IV, warm moist compresses, start IV in opposite extremity
Hematoma

•Assessment—ecchymosis, swelling, leakage of blood
•Implementation—discontinue IV, apply pressure, ice bag 24 hours, restart IV in opposite extremity

IV Clotting
•Assessment—decreased flow rate, back flow of blood into tubing
•Implementation—discontinue, do not irrigate, do not milk, do not increase rate of flow or hang solution
higher, do not aspirate cannula, inject Urokinase, D/C and start on other site.

Insertion of Percutaneous Central Catheters:
•Placed supine in head-low position
•Turn head away from procedure
•Perform Valsalva maneuver
•Antibiotic ointment and transparent sterile dressing
•Verify position with x-ray
•Change tubing Q24 hours
•Nurse/patient both wear mask when dressing change 2-3x/week

Adrenergics Adrenergic Medications Adrenergics Side effects:
Actions: •Levophed •Dysrhythmias
•Stimulate the sympathetic •Dopamine •Tremors
nervous system: increase in •Adrenalin •Anticholinergic effects
peripheral resistance, increase •Dobutrex Adrenergics Nursing
blood flow to heart, Considerations:
bronchodilation, increase blood •Monitor BP
flow to skeletal muscle, •Monitor peripheral pulses
increase blood flow to uterus •Check output
•Stimulate beta-2 receptors in
lungs
•Use for cardiac arrest and
COPD

Anti-Anxiety Anti-Anxiety Anti-Anxiety
Action: Medications: Side effects:
•Affect neurotransmitters •Librium, Xanax, •Sedation
Used for: Ativan, Vistaril, •Confusion
•Anxiety disorders, manic Equanil •Hepatic dysfunction
episodes, panic attacks Anti-Anxiety
Nursing Considerations:
•Potention for addiction/overdose
•Avoid alcohol
•Monitor Liver Function AST/ALT
•Don’t discontinue abruptly, wean off
•Smoking/caffeine decreases
effectiveness

Antacids Antacids Medications Antacids
Actions: •Amphojel Side effects:
•Neutralize gastric acids •Milk of Magnesia •Constipation
Used for: •Maalox •Diarrhea
•Peptic ulcer •Acid rebound
•Indigestion, reflex Antacids
esophagitis Nursing Considerations:
•Interferes with absorption of antibiotics,
iron preps, INH, Oral contraceptives
•Monitor bowel function
•Give 1-2 hours after other medications
•1-3 hours after meals and at HS
•Take with fluids

Antiarrhythmics Antiarrhythmics Antiarrhythmics
•Interfere with electrical •Atropine sulfate •Lightheadedness
excitability of heart •Lidocaine •Hypotension
Used for: •Pronestyl •Urinary retention
•Atrial fibrillation and •Quinidine Antiarrhythmics
flutter •Isuprel Nursing Considerations:
•Tachycardia •Monitor vital signs
•PVCs •Monitor cardiac rhythm
Aminoglycosides Aminoglycosides Aminoglycosides (Antibiotics)

(Antibiotics) (Antibiotics) Side effects:
Action: Medications: •Ototoxicity and Nephrotoxicity
•Inhibits protein •Gentamycin •Anorexia
synthesis in gram- •Neomycin •Nausea
negative bacteria •Streptomycin •Vomiting
Used for: •Tobramycin •Diarrhea
•Pseudomonas, Aminoglycosides (Antibiotics)
E.Coli Nursing Considerations:
•Harmful to liver and kidneys
•Check 8th cranial nerve (hearing)
•Check renal function
•Take for 7-10 days
•Encourage fluids
•Check peak/trough level

Cephalosporins Cephalosporins Cephalosporins (Antibiotics)
Action: Medications: •Bone marrow depression: caution with anemic, and low PLT
•Inhibits synthesis of •Ceclor px
bacterial cell wall •Ancef •Superinfections
Used for: •Keflex •Rash
•Tonsillitis, otitis •Rocephin Nursing Considerations:
media, peri-operative •Cefoxitin •Take with food
prophylaxis •Cross allergy with PCN
•Meningitis •Avoid alcohol
•Obtain C&S before first dose: to make sure medication is
effective against disease/bacteria
•Can cause false-positive for proteinuria/glycosuria

Fluoroquinolones Fluoroquinolones Fluroquinolones
(Antibiotics) (Antibiotics) (Antibiotics)
•Interferes with DNA •Cipro •Diarrhea
replication in gram- •Decreased WBC and Hematocrit
negative bacteria •Elevated liver enzymes (AST, ALT)
Used for: •Elevated alkaline phosphatase
•E.Coli, Pseudomonas, S. Nursing Considerations:
Aureus •C&S before starting therapy
•Encourage fluids
•Take 1 hour ac or 2 hour pc (food slows
absorption)
•Don’t give with antacids or iron preparation
•Maybe given with other medications (Probenicid:
for gout)

Macrolide (Antibiotics) Macrolide (Antibiotics) Macrolide (Antibiotics)
•Binds to cell membrane •Erythromycin •Diarrhea
and changes protein •Clindamycin •Confusion
function •Hepatotoxicity
Used for: •Superinfections
•Acute infections Nursing Considerations:
•Acne •Take 1hr ac or 2-3 hr pc
•URI •Monitor liver function
•Prophylaxis before dental •Take with water (no fruit juice)
procedures if allergic to •May increase effectiveness of: Coumadin
PCN and Theophylline (bronchodilator)

Penicillin Penicillin Penicillin
•Inhibits synthesis of cell •Amoxicillin •Stomatitis
wall •Ampicillin •Diarrhea
Used for: •Augmentin •Allergic reactions
•Moderate to severe •Renal and Hepatic changes

infections Nursing Considerations:
•Syphilis •Check for hypersensitivity
•Gonococcal infections •Give 1-2 hr ac or 2-3 hr pc
•Lyme disease •Cross allergy with cephalosporins

Sulfonamides (Antibiotics) Sulfonamides (Antibiotics) Sulfonamides (Antibiotics)
•Antagonize essential component •Gantrisin •Peripheral Neuropathy
of folic acid synthesis •Bactrim •Crystalluria
Used for: •Septra •Photosensitivity
•Ulcerative colitis •Azulfidine •GI upset
•Crohn’s disease •Stomatitis
•Otitis media Nursing Considerations:
•UTIs •Take with meals or foods
•Encourage fluids
•Good mouth care
•Antacids will interfere with
absorption

Tetracyclines TEtracyclines Tetracyclines (Antibiotics)
Action: Medications: •Discoloration of primary teeth if taken during pregnancy or if
•Inhibits protein •Vibramycin child takes at young age
sythesis •Panmycin •Glossitis
Used for: •Rash
•Infections •Phototoxic reactions
•Acne Nursing considerations:
•Prophylaxis for •Take 1 hr ac or 2-3 hr pc
opthalmia •Do not take with antacids, milk, iron
neonatorum •Note expiration date
•Monitor renal function
•Avoid sunlight

UTIs
•Medication:
o Furadantin
•Action:
o Anti-infective
•Side effects:
o Asthma attacks
o Diarrhea
•Nursing Considerations:
o Give with food or milk
o Monitor pulmonary status

UTIs
•Medication
o Mandelamine
•Action:
o Anti-infective
•Side effects:
o Elevated liver enzymes
•Nursing Considerations:
o Give with cranberry juice to acidify urine
o Limit alkaline foods: vegetables, milk, almonds, coconut

UTIs
•Medication
o Pyridium
•Side effects:
o Headache
o Vertigo
•Action

Herbal Meds Guide for Nurses

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