1.

Signs and symptoms of Digitalis Toxicity: 0-8-2ng/ml

-fatigue
-nausea/vomiting,
-changes in heart rate and rhythm
-loss of appetite (anorexia)
-diarrhea
-visual disturbances (yellow or green halos around objects)
-confusion
-dizziness
-nightmares
-agitation and/or depression, as well as a higher acute sense of
sensual activities.
-Hypersalivation
2. Signs and symptoms of Magnesium Sulfate Toxicity:
-Excess magnesium sulfate results in magnesium sulfate toxicity,
which results in both
respiratory depression and a loss of deep
tendon reflexes (hyporeflexia).
-visual disturbances and facial flushing.
-nasal stuffiness and chest pain.
-gastrointestinal upset.
3. Side effects of Nitroglycerine (Toxic Effect):
-tingling sensation
-dizziness, headache, light-headedness, worsened angina pain and
flushing.
-Rare Nitroglycerin side effects may include dry mouth, diarrhea,
fainting, heart pounding, low blood pressure, nausea, vomiting, pallor,
restlessness, severe allergic reactions, rash, sweating, vertigo, fatigue,
and numbness.
4. Signs and symptoms of Thyrotoxic Crisis:
-uncontrolled fever, increased BP, Increased PR/HR
5. Signs and symptoms of Angina Pectoris:
-chest pain/discomfort characterized by pressure, heaviness, tightness,
squeezing,
burning, or choking sensation.
-Apart from chest discomfort, anginal pains may also be experienced in
the epigastrium (upper central abdomen), back, neck area, jaw, or
shoulders.
-Pain may be accompanied by breathlessness, sweating and nausea
6. Signs and Symptoms of Hypokalemia: 3.4-5.1
-muscle weakness, muscle aches, and muscle cramps.

-palpitations (irregular heartbeats) may be experienced by the patient.

In severe cases,
hypokalemia can lead to dangerous disturbances in
heart rhythm (arrhythmias).

7. Signs and symptoms Hyperkalemia:

Extreme hyperkalemia is a medical emergency due to the risk of
potentially fatal
abnormal heart rhythms (arrhythmia).
- Symptoms are fairly nonspecific and generally include malaise,
palpitations and muscle weakness; mild hyperventilation may
indicate a compensatory response to
metabolic acidosis, which
is one of the possible causes of hyperkalemia. Often, however,
the
problem is detected during screening blood tests for a medical
disorder, or it only comes to medical attention after complications have
developed, such as cardiac
arrhythmia or sudden death.
8. Position of Patient after Liver Biopsy:
-Place the patient on right lateral position and place folded towel on the
punctured site for at least 3 hours to provide pressure on the site and
prevent bleeding.
9. How to reduce odor from Colonoscopy?
- diet modification
10. Complication Post Thyroidectomy:
-Monitor for respiratory distress
-Have a tracheostomy set, oxygen, and suction at the bedside.
-Monitor surgical site for edema and for signs of bleeding; check
dressing anteriorly and the back of the neck.
-Limit client talking, and asess level of hoarseness.
-Monitor for laryngeal nerve damage, as evidenced by respiratory
obstruction, dysphonia, high-pitched voice, stridor, dysphagia, and
restlessness.
-Monitor for signs of hypocalcemia and tetany, which can be due to
trauma to the parathyroid gland
-Prepare to administer calcium gluconate as prescribed for tetany.
-Monitor for thyroid storm
-Elevated temperature
-Tachycardia
-Systolic hypertension
-Nausea, vomiting, and diarrhea
-Agitation, tremors, anxiety
-Irritability, agitation, restlessness, confusion, and seizures as the
condition progresses

-Delirium and coma

11. Nursing management for Venous Leg Ulcer:
-Compression and elevation of affected leg
12. Deep Vein Thrombosis - is the formation of a blood clot ("thrombus") in
a deep vein. It is a form of thrombophlebitis (inflammation of a vein with clot
formation).
- Anticoagulation is the usual treatment for DVT. In general, patients
are initiated on a brief course (i.e., less than a week) of heparin
treatment while they start on a 3- to 6month course of warfarin (or
related vitamin K inhibitors).
13. Approach to patient on Manic State:
-give finger foods
14. What is the by-product of Protein digestion?
-Urea and Uric Acid
15. Why you should not administer oxygen on high concentration for patients
with COPD?
-so as not to reverse the Hypoxic drive for breathing
16. Management of patient after ESWL (Extracorporeal shock wave
lithotripsy):
- Extracorporeal shock wave lithotripsy (ESWL) uses shock waves to
break a kidney
stone into small pieces that can more easily travel
through the urinary tract and pass from the body.
- It may take a few days or weeks for all the stone fragments to pass
from your body.
You may have mild pain as the small fragments pass
through the urinary tract.
- Complications of ESWL include:

Pain caused by the passage of stone fragments.

Blocked urine flow as a result of stone fragments becoming stuck in the
urinary tract. The fragments may then need to be removed with a
ureteroscope.

Urinary tract infection.

Bleeding around the outside of the kidney.

17. Priority Nursing Management for Sickle Cell Crisis:

- sickle cell disease results from mutation, or change, of certain types

of hemoglobin chains in red blood cells (the beta hemoglobin chains). The
changes in the building of normal hemoglobin result in the abnormal
hemoglobin of sickle cell disease. These mutated molecules do not have the
smooth motion needed for oxygenation and deoxygenation. When the
oxygen concentration in the blood is reduced, the red blood cell assumes the
characteristic sickle shape. This causes the red blood cell to be stiff and rigid,
and stops the smooth passage of the red blood cells through the narrow
blood vessels.
-People with sickle cell disease often suffer from vaso-occlusive crisis.
It is caused when the abnormal red blood cells begin to restrict blood flow to
the organs and obstruct capillaries. A person suffering from vaso-occlusive
crisis experiences intense pain, ischemia, and most of the time, organ
damage. Sometimes the condition is called painful crisis, with the
frequency and severity of the crisis periods varying from time to time.
- Painful crises are treated symptomatically with analgesics; pain
management requires opioid administration at regular intervals until the
crisis has settled. For milder crises, a subgroup of patients manage on
NSAIDs (such as diclofenac or naproxen). For more severe crises, most
patients require inpatient management for intravenous opioids; patientcontrolled analgesia (PCA) devices are commonly used in this setting.
Diphenhydramine is also an effective agent that is frequently prescribed by
doctors in order to help control any itching associated with the use of
opioids.

18. How to approach patient with Alzheimers Disease?

-establish routine activities, reorient the patient, reinforce/identify
retained skills.
19. Signs and symptoms of Congestive Heart Failure (CHF):
- Congestive heart failure (CHF) is a condition in which the heart's
function as a pump
is inadequate to deliver oxygen rich blood to the
body. Congestive heart failure can be
caused by:
1. diseases that weaken the heart muscle,
2. diseases that cause stiffening of the heart muscles, or
3. diseases that increase oxygen demand by the body tissue beyond the
capability of the heart to deliver adequate oxygen-rich blood.
-Signs and Symptoms:

- An early symptom of congestive heart failure is fatigue.

- As the body becomes overloaded with fluid from congestive
heart failure,
swelling (edema) of the ankles and legs or
abdomen may be noticed. This can
be referred to as "right sided
heart failure" as failure of the right sided heart
chambers to
pump venous blood to the lungs to acquire oxygen results in
buildup of this fluid in gravity-dependent areas such as in the legs.
-in addition, fluid may accumulate in the lungs, thereby causing
shortness of
breath, particularly during exercise and when
lying flat. In some instances,
patients are awakened at night,
gasping for air.
- The extra fluid in the body may cause increased urination,
particularly at
night.
- Accumulation of fluid in the liver and intestines may cause
nausea, abdominal
pain, and decreased appetite.
20. Nursing Management after Cardiac Catheterization:
-prevent bleeding on the open wound (catheter port), apply pressure.
-monitor cardiac rate
-bed restfor upper extremity until V/S are stable, for lower extremity
for 24 hours.
21. Nursing Responsibility in Delegation:
-the delegator delegates the task, not the responsibility
22. Immediate action when you hear two employees talking about patients
condition:
-call their attention, remember patients confidentiality
23. Immediate action when you saw an employee taking patients meds from
medication cabinet:
-call the employees attention

24. CererboVascular Accident: interruption of blood supply to any part of

the brain, causing the brain cells to die. Also called Brain Stroke.
- The blockage of an artery in the brain by a clot (thrombosis) is the
most common
cause of a stroke. The part of the brain that is supplied by
the clotted blood vessel is
then deprived of blood and oxygen. As a result
of the deprived blood and oxygen, the
cells of that part of the brain die
and the part of the body that it controls stops working.
-Symptoms of Stroke:
- Sudden numbness or weakness of the face, arm or leg,
especially on one side
of the body. The loss of voluntary

movement and/or sensation may be complete

or partial. There may
be an associated tingling sensation in the affected area.
- Sudden confusion or trouble speaking or understanding.
Sometimes weakness
in the muscles of the face can cause
drooling.
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or
coordination
- Sudden, severe headache with no known cause.
25. Menieres Disease- affects the inner ear.
-is a disorder of the inner ear that can affect hearing and balance
to a
varying degree. It is characterized by episodes of
vertigo and tinnitus and
progressive hearing loss, usually in
one ear
-due to imbalance of endolymphatic fluids
-Risk factors : increased altitudes, pilots, deep sea diving
26. Parkinsons Disease:
- A generative disease caused by the depletion of dopamine, which
interferes with the
inhibition of excitatory impulses.
-Results in a dysfunction of the extrapyramidal system.
-Slow progressive disease that results in a crippling disability.
-The debilitation can result in falls, self-care deficits, failure of body
systems, and
depression.
-Mental deterioration occurs late in the disease.
Assessment:
-Bradykinesia - abnormal slowness of movement, and
sluggishness of physical
and mental responses.
-Akinesia inability to initiate movements
-Monotonous speech
-Handwriting that becomes progressively smaller
-Tremors in hands and finger at rest (pill rolling)
-Tremors increasing when fatigued and decreasing with
purposeful activity or
sleep
-Rigidity with jerky interrupted movements
-Restlessness and pacing
-Blank facial expression-mask like face
-Drooling
-Difficulty in swallowing and speaking
-Loss of coordination and balance.
-Shuffling steps, stooped position, and propulsive gait
Intervention:
-Assess neurological status
-Assess ability to swallow and chew

-Provide high calorie, high protein, high fiber, soft diet with small
frequent
feedings.
-Increase fluid intake to 2L/day
-Monitor constipation
-Promote independence along with safety measures
-Avoid rushing the client with activities
-Assist in ambulation and provide assistive devices
-Administer anticholinergic medication to treat tremors and
rigidity and to
inhibit
action of acetylcholine
-Administer antiparkinsonian meds to increase the dopamine in
the CNS
-Avoid vitamin B6 and monoamine oxidase inhibitors.
27. Common complication of using Laryngoscope:
-Broken tooth
28. Early Signs and symptoms of Increased Intracranial Pressure (ICP):
-may be due to brain tissue swelling, blood or other fluid accumulating
in the skull or
the combination of these situations.
-Increased systolic BP, decreased pulse, increased temp, widening
pulse pressure
-Headache, Nausea and vomiting (projectile)
-Loss of Consciousness
- Dilated pupils that do not constrict when exposed to bright light
(an early
sign of serious head injury) or changes in pupil symmetry.
- Lateral loss of motor nerve function in which one side of the
body becomes
paralyzed (may not occur immediately)
- Slow respiratory rate or change in respiratory pattern
- A steady rise in the systolic blood pressure (may not be present
if there is
significant bleeding elsewhere).
- A rise/widening in the pulse pressure (systolic pressure minus
diastolic pressure)
-elevated body temperature, restlessness (indicates insufficient
brain
oxygenation)
-slurred speech
-convulsion/twitching
-abnormal posture
29. Advantage/Disadvantage of using Cast and Skin traction:
30. Signs and symptoms of Hyperglycemia:
Polyphagia - frequent hunger, especially pronounced hunger
Polydipsia - frequent thirst, especially excessive thirst

Polyuria - frequent urination

Blurred vision

Fatigue (sleepiness)

Weight loss

Poor wound healing (cuts, scrapes, etc.)

Dry mouth

Dry or itchy skin

Tingling in feet or heels

Erectile dysfunction

Recurrent infections external ear infections (swimmer's ear)

Cardiac arrhythmia

Stupor

Coma

31. Signs and symptoms of Hypoglycemia:

Shakiness, anxiety, nervousness
Palpitations, tachycardia

Sweating, feeling of warmth (although sweat glands have muscarinic

receptors, thus "adrenergic manifestations" is not entirely accurate)

Pallor, coldness, clamminess

Dilated pupils (mydriasis)

Feeling of numbness "pins and needles" (paresthesia)

Abnormal mentation, impaired judgment

Nonspecific dysphoria, moodiness, depression, crying, exaggerated

concerns

Negativism, irritability, belligerence, combativeness, rage

Personality change, emotional lability

Fatigue, weakness, apathy, lethargy, daydreaming, sleep

Confusion, amnesia, dizziness, delirium

Staring, "glassy" look, blurred vision, double vision

Flashes of light in the field of vision

Automatic behavior, also known as automatism

Difficulty speaking, slurred speech

Ataxia, incoordination, sometimes mistaken for "drunkenness"

Focal or general motor deficit, paralysis, hemiparesis

Paresthesia, headache

Stupor, coma, abnormal breathing

Generalized or focal seizures

32. Signs and Symptoms of Myocardial Infarction:

- Chest pain is the most common symptom of acute myocardial
infarction and is often described as a sensation of tightness, pressure, or
squeezing. Chest pain due to ischemia (a lack of blood and hence oxygen
supply) of the heart muscle is termed angina pectoris. Pain radiates most
often to the left arm, but may also radiate to the lower jaw, neck, right arm,
back, and epigastrium, where it may mimic heartburn. This type of pain
cannot be relieved by rest or nitroglycerine.
- Shortness of breath (dyspnea) occurs when the damage to the heart
limits the output of the left ventricle, causing left ventricular failure and
consequent pulmonary edema. Other symptoms include diaphoresis (an
excessive form of sweating), weakness, light-headedness, nausea, vomiting,
and palpitations.
33. Complications Post Thyroidectomy:
1. Hypothyroidism/Thyroid insufficiency in up to 50% of patients after ten
years
2. Thyrotoxic crisis/Thyroid storm
3. Laryngeal nerve injury in about 1% of patients, in particular the
recurrent laryngeal nerve: Unilateral damage results in a hoarse voice.
Bilateral damage presents as laryngeal obstruction on removal of the
tracheal tube and is a surgical emergency: an emergency
tracheostomy must be performed. Recurrent Laryngeal nerve injury
may occur during the ligature of the inferior thyroid artery.
4. Hypoparathyroidism temporary (transient) in many patients, but
permanent in about 1-4% of patients

5. Anesthetic complications
6. Infection
7. Stitch granuloma
8. Haemorrhage/Hematoma
o

This may compress the airway, becoming life-threatening. A

suture removal kit should be kept at the bedside throughout the
postoperative hospital stay.

9. Surgical scar/keloid
-Mangement:

-Monitor for respiratory distress

Have a tracheostomy set, oxygen, and suction at the bedside.
Monitor surgical site for edema and for signs of bleeding; check
dressing anteriorly and the back of the neck.
Limit client talking, and asess level of hoarseness.
Monitor for laryngeal nerve damage, as evidenced by respiratory
obstruction, dysphonia, high-pitched voice, stridor, dysphagia, and
restlessness.
Monitor for signs of hypocalcemia and tetany, which can be due to
trauma to the parathyroid gland
Prepare to administer calcium gluconate as prescribed for tetany.
Monitor for thyroid storm
Elevated temperature
Tachycardia
Systolic hypertension
Nausea, vomiting, and diarrhea
Agitation, tremors, anxiety
Irritability, agitation, restlessness, confusion, and seizures as the
condition progresses
Delirium and coma

34. Nursing Management for Reddened skin surface:

35. Approach on Depressed Patient:
36. What is the focus of nursing management on an infant on active
seizure?

-Safety
37. What Laboratory test determines the therapeutic level of Coumadin
(Warfarin)?
-PT, INR (Pt=9.6-11.8) (INR=1.3-2)
38. Basic Infection Control:
-handwashing
39. Complication of Miscarriage:
-Incomplete Miscarriage
An incomplete miscarriage means that you still have tissue retained in
your uterus from the pregnancy. Sometimes this condition will resolve on its
own, but other times you
might need a D&C.
-Excessive Bleeding
The general rule is that if you're soaking through a menstrual pad in
under an hour,
you should seek medical attention immediately. A small
percentage of women have hemorrhaging as a complication of miscarriage.
-Infection
A post-miscarriage infection can be dangerous but is easily treated
with antibiotics. Be
sure to contact your doctor if you think you have
symptoms of an infection after
miscarriage.
-Depression
Grief is a normal reaction to miscarriage and pregnancy loss. But if you
start to show
signs of clinical depression, it could be helpful to talk to a
counselor or other mental
health professional.
-Anxiety Disorders
Even more common than clinical depression after miscarriage are
anxiety and stress
disorders. It is even possible to develop symptoms of
post-traumatic stress disorder
(PTSD) after a miscarriage.
-Recurrent Miscarriages
Sadly, some women will have more than one miscarriage. If you have
two or three
consecutive miscarriages, it can be a good idea to talk to a
doctor about testing for
possible causes.
-Asherman's Syndrome
Asherman's syndrome is a rare complication of a D&C. The syndrome
involves scarring and adhesions in the uterus that can cause fertility
problems and further miscarriages.
40. Where is the Apical pulse located?
-heard at the apex of the heart using a sthetoscope.

41. Drug of Choice for Oral Thrush:

-Anti-fungals (Diflucan, Nizoral, Mycostatin, etc.)
42. Nursing intervention for Post Coronary Angiogram:
- An angiogram is an X-ray image of blood vessels after they are filled
with a contrast material. An angiogram of the heart, a coronary angiogram,
is the "gold standard" for the evaluation of coronary artery disease (CAD). A
coronary angiogram can be used to identify the exact location and severity
of CAD.
43. Leukemia:
- is a type of cancer of the blood or bone marrow characterized by an
abnormal increase of white blood cells.
-Check CBC
44. Anemia:
- is a decrease in number of red blood cells (RBCs) or less than the
normal quantity of
hemoglobin in the blood.
-Check CBC
45. Care for patient with Chest Tube:
b.
c.

d.

e.
f.

Assess patient for respiratory distress and chest pain, breath sounds over
affected lung area, and stable vital signs
Observe for increase respiratory distress
Observe the following:
(1)
Chest tube dressing, ensure tubing is patent
(2)
Tubing kinks, dependent loops or clots
(3)
Chest drainage system, which should be upright and below level of
tube insertion
Provide two shodded hemostats for each chest tube, attached to top of
patients bed with adhesive tape. Chest tubes are only clamped under
specific circumstances:
(1)
To assess air leak
(2)
To quickly empty or change collection bottle or chamber; performed
by soldier medic who has received training in procedure
(3)
To change disposable systems; have new system ready to be
connected before clamping tube so that transfer can be rapid and
drainage system reestablished
(4)
To change a broken water-seal bottle in the event that no sterile
solution container is available
(5)
To assess if patient is ready to have chest tube removed (which is
done by physicians order); the solider medic must monitor patient for
recreation of pneumothorax
Position the patient to permit optimal drainage
(1)
Semi-Flowers position to evacuate air (pneumothorax)
(2)
High Flowers position to drain fluid (hemothorax)
Maintain tube connection between chest and drainage tubes intact and
taped

(1)
(2)
g.
h.

Water-seal vent must be without occlusion

Suction-control chamber vent must be without occlusion when suction
is used
Coil excess tubing on mattress next to patient. Secure with rubber band and
safety pin or systems clamp
Adjust tubing to hang in straight line from top of mattress to drainage
chamber. If chest tube is draining fluid, indicate time (e.g., 0900) that
drainage was begun on drainage bottles adhesive tape or on write-on
surface of disposable commercial system
(1)
Strip or milk chest tube only per MD/PA orders only
(2)
Follow local policy for this procedure.

46. How to prevent Dumping Syndrome?

- is a condition where ingested foods bypass the stomach too rapidly
and enter the small intestine largely undigested. It happens when the upper
end of the small intestine, the duodenum, expands too quickly due to the
presence of hyperosmolar (substances with increased osmolarity) food from
the stomach.
- Dumping syndrome is largely avoidable by avoiding certain foods that
are likely to cause it, therefore having a balanced diet is important.
Treatment includes changes in eating habits and medication. People who
have gastric dumping syndrome need to eat several small meals a day that
are low in carbohydrates, avoiding simple sugars, and should drink liquids
between meals, not with them. Fiber delays gastric emptying and reduces
insulin peaks.
47. Breast Mastectomy Medications:
-Pain management
48. Position of Patient after Renal Biopsy:
- After the test, patients lie on their backs in the hospital for a few
hours. Patients who have a transplanted kidney lie on their stomachs. During
this time, the staff will monitor blood pressure and pulse and take blood
samples to assess for blood loss. On rare occasions when bleeding does not
stop on its own, a transfusion may be necessary to replace lost blood. Most
patients leave the hospital the same day. Patients may notice some blood in
their urine for 24 hours after the test.
A rare complication is infection from the biopsy.
Patients should tell their doctors or nurses if they have any of these
problems:

bloody urine more than 24 hours after the test

inability to urinate

fever

worsening pain in the biopsy site

faintness or dizziness

49. Adverse Effect of Risperidal:

- is an atypical antipsychotic drug often prescribed for treatment of
schizophrenia and
the psychotic features of bipolar disorder and other
mental illnesses.
Drowsiness
o Drowsiness and increased need for sleep are common side
effects of Risperdal. If these side effects become bothersome,
discuss what options are available to you with your physician.
Bladder Control
o Incontinence occurs in some individuals that take Risperdal. If
this occurs, contact your physician about alternatives that are
available.
Weight Gain
o Weight gain can occur when taking Risperdal. Increased appetite
is commonly reported among individuals taking Risperdal. Eating
a balanced diet and regular exercise can help lessen the severity
of weight gain.
Diabetes
o Risk of developing diabetes increases when taking Risperdal.
Being overweight and having a family history of diabetes
increase this risk. Close monitoring of diabetes is necessary for
diabetics taking this medication.
Tardive Dyskinesia
o Tardive Dyskinesia (TD) is a side effect that involves involuntary
muscle movement. If you experience this side effect, contact
your physician immediately, since it can become permanent.
Neuroleptic Malignant Syndrome
o Antipsychotic medications, including Risperdal, are associated
with development of Neuroleptic Malignant Syndrome (NMS).
NMS symptoms include fever, muscle rigidity, high blood

pressure, confusion, and tremors. Although rare, NMS can be

fatal.
50. Delirium - (acute confusional state) is a common and severe
neuropsychiatric syndrome with core features of acute onset and fluctuating
course, attentional deficits and generalized severe disorganization of
behavior. It typically involves other cognitive deficits, changes in arousal
(hyperactive, hypoactive, or mixed), perceptual deficits, altered sleep-wake
cycle, and psychotic features such as hallucinations and delusions.
51. Computations:
-3% solution in 600mg drugs, how many ml?
-computation with different units of measurement (ex, mcg, mg)
-Heparin 40,000 units in 1L D5W at 1,000 units per hour, how many ml
will be
consumed per hour