PREPARE WITH PURPOSE:

ARCHER REVIEW’S
WEEK OF EXAM
STUDY GUIDE
 Table of Contents

Building Blocks Specialties

& Testing Toolkit 13 Mental Health
1 Arterial blood gases 14 Maternity, Labor
and Delivery
1 Prioritization
1 Delegation 15 Pediatrics

Adult Health Pharmacology

2 Neurological 19 Neurological
3 Respiratory 19 Respiratory
4 Cardiovascular 20 Cardiovascular
7 Gastrointestinal 21 Gastrointestinal
8 Renal 22 Renal
10 Endocrine 22 Mental Health
23 Immune
23 Analgesics

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 Week of Exam
STUDY GUIDE
Building Blocks & Testing Toolkit

Arterial blood gases (ABGs)

CO2 is an ACID HCO3 is a BASE

Too much CO2 = acidosis Too much HCO3 = alkalosis

Too m
Decrease in respiratory drive Excess bicarbonate administration
Not enough HCO3= acidosis
Not enough CO2 = alkalosis Not enough HCO3= acidosis
Kidney injury
Panic attack Kidney injury

Fully compensated ABG Partially compensated ABG Uncompensated ABG

pH is normal
All three values (pH, CO2, pH abnormal
Either CO2 and/or HCO3 is
HCO3) abnormal Either CO2 or HCO3 abnormal
abnormal

Prioritization

Prioritizing clients Prioritizing interventions

Your priority will be whichever client will Ask yourself: Which intervention will do
have the most harm come to them if you the most good for your client?
don’t get to them right away Ensure the intervention falls within your
Life over limb scope of practice
Prioritize acute needs over chronic needs Stay with the client in an emergency

Delegation
Right supervision

5 Rights to
Delegation
Right task
Right person
Right direction/communication
Right circumstance

Notes

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WEEK OF EXAM STUDY GUIDE
Delegation

Unlicensed Assistive Personnel LPN RN

Normal activities of daily living Stable, predictable routine tasks Unstable, new tasks

Adult Health
Neurological
Assessment
Central Peripheral Cranial Nerves
Nervous Nervous Spinal Nerves Pupils
System System Motor Neurons PERRLA
Peripheral Nerves pupils are equal, round and reactive
Brain Sensory Neurons to light and accommodation
Spinal cord Glasgow coma scale
Less than 8, intubate!
Head Injury Skull Fracture Cerebrospinal fluid
Open = Torn dura Should be clear
Closed = Dura is intact Cloudy = infection

Hematoma Epidural Subdural

Dura peeled off skull Dura attached to skull
Arterial blood Venous blood
Quick onset of symptoms Slow onset of symptoms

Meningitis Viral Assessment

Standard precautions Nuchal rigidity, photophobia,
Bacterial Kernig’s sign, Brudzinski’s sign
Droplet precautions
More dangerous

Intracranial Pressure (ICP) Assessment

Altered mental status, vision changes,
headache, vomiting, altered speech
Normal ICP 12-15 Posturing
Decerebrate: arms extend
Causes of increased ICP Decorticate: arms flex to core
Tumor, bleeding, Cushing’s triad
hydrocephalus, edema Increased systolic BP, decreased
heart rate, altered respirations

Notes

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WEEK OF EXAM STUDY GUIDE
Neurological

Spinal Cord Injury Autonomic dysreflexia

Assessment
Sudden severe HTN, bradycardia, headache,
Injured at or above T6: nasal stuffiness, flushing, sweating, blurred
Monitor for autonomic vision, anxiety
dysreflexia! Treatment
Sit the client up, antihypertensives, identify the
cause and treat

Cerebrovascular Accident (Stroke) Hemorrhagic

“Worst headache of my life”
Treatment
BEFAST Reduce intracranial pressure,
Balance, Eyes, Face, Arms, Speech Time craniotomy, EVD
Ischemic
Alteplase (tPA) Embolic: sudden onset
Must be administered within 3-4.5 hours Thrombotic: onset in a stepwise fashion
of onset, door to tPA time 45 minutes Treatment
Contraindications Permissive HTN, thrombolytic
Recent surgery or trauma, brain mass, (alteplase), percutaneous
anticoagulants, active bleeding thrombectomy

Respiratory

Assessment Positioning
ARDS
Signs Prone
Too m of airway compromise Air embolism
Stridor, drooling, wheezing that
Not enough
suddenlyHCO3=
stopsacidosis Left lateral trendelenburg
Absent
Kidneybreath
injurysounds Pulmonary embolism
Complete obstruction High fowlers

Chest Tubes
Assessment
Suction control chamber Chest Tube Emergencies
Gentle bubbling If the chest tube comes out
Water seal chamber Place sterile, dry dressing and
Intermittent bubbling (tidaling) tape on three sides
If no tidaling: obstruction or the If the tube comes out of the
lung has re-expanded drainage system
Vigorous bubbling: air leak Place the end in sterile saline
Drainage collection chamber If drainage stops in the first 24
Serosanguinous (pink) drainage hours
>70 mL/hour report to the provider

Notes

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WEEK OF EXAM STUDY GUIDE
Respiratory

Chronic Obstructive Pulmonary Disease (COPD)

Nursing considerations Assessment
Keep oxygen saturation between 89-92% Barrel chest
Encourage pursed lip breathing Accessory muscle use
Eat small frequent meals

High Pressure Alarm Low Pressure Alarm

Ventilator
Alarms
Think obstruction or air trapping! Think air leak!

Cardiovascular

Blood flow Right Left

Body Vein Artery Lungs Vein Artery Body
through heart heart
the heart Veins bring blood towards the heart, arteries bring blood away from the heart

Semilunar valves Atrioventricular valves

Heart
“Exit door” to ventricles Between atria and ventricles
Valves Pulmonary valve (right heart) Tricuspid valve (right heart)
Aortic valve (left heart) Mitral/bicuspid valve (left heart)

ECGs
Sinus rhythms Atrial Arrhythmias
Normal, bradycardia, tachycardia Atrial fibrillation, atrial flutter, SVT
Sinus bradycardia only treated if Treated electrically with synchronized
symptomatic cardioversion
Abnormal P waves, narrow QRS

Ventricular arrhythmias Asystole

Ventricular tachycardia, ventricular Cannot be defibrillated Do CPR
fibrillation
Both have absent P waves, wide and Pacing
bizarre QRS complexes For symptomatic, unstable bradycardia
Pulseless = defibrillation Transcutaneous, transvenous, permanent

Notes

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WEEK OF EXAM STUDY GUIDE
Cardiovascular

Hypertension
Risk factors
Complications Modifiable
Causes vessel damage Stress, caffeine, diet, smoking
Stroke, coronary artery disease, Nonmodifiable
renal disease, vision problems Race, age, family history

Coronary Artery Disease

Priority to do ECG within 10 minutes for anyone having chest pain

Stable Angina NSTEMI STEMI

Chest pain does not go

Predictable chest pain, Chest pain does not go
away with rest
usually caused by away with rest
Troponin positive due to
exertion Troponin positive due to
cell necrosis
Myocardial cell ischemia cell necrosis
ECG: ST elevation
Normal ECG ECG: ST depression, T
Treatment: PCI, CABG
Negative troponin wave inversion, can be
ON-TIME
Pain goes away with rest normal
Atypical signs of MI can
Treated with nitroglycerin ON-TIME
occur in elderly, females

Heart Failure (HF)

Causes of heart failure
Heart too weak to move blood forward Hypertension
Decreased tissue perfusion Cardiac damage
Can result in cardiogenic shock
Left HF usually occurs before right HF Treatment
Left: LUNGS - respiratory symptoms Antihypertensives, diuretics, inotropes
Right: REST of the body - symptoms Daily weights
appear in body Low sodium diet

Aortic Aneurysm
Weakening of aortic artery wall
Rupture hypovolemic shock
Do not palpate pulsating mass

Notes

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WEEK OF EXAM STUDY GUIDE
Cardiovascular

Cardiac Tamponade
Beck’s Triad
Blood fills in the pericardial space Hypotension
Compresses and obstructs the heart Jugular vein distension
Heart unable to fill or move blood forward Muffled heart sounds
Cardiogenic shock

Air Embolism

Causes If client experiences respiratory distress during

Central line insertion central line insertion suspect air embolism
Central line gets pulled out Durant’s maneuver!
Air injected into vein Trendelenburg and turn to left side

Central Lines Peripheral IV

Risk for infection, air embolism Need at least 20G for blood
Too m procedure
Sterile transfusion
Not enough
Longer termHCO3= acidosis Clean technique
Can infuse vesicants
Kidney injury Short term
Cannot infuse vesicants

Shock
Common denominator: Hypotension
Cells experience Results in multi organ failure
decreased blood flow
Cardiogenic shock
Pump problem: heart cannot move blood forward
Cellular ischemia MI, cardiac tamponade, PE, heart failure
Symptoms of decreased perfusion

Hypovolemic shock
Anaerobic metabolism
Low volume problem
Burns, dehydration, bleeding
Symptoms of decreased perfusion
Lactic acid build up
Distributive shock
Massive vasodilation: the only warm shock
Shock Anaphylaxis, spinal cord injury, septic
Symptoms related to cause

Notes

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WEEK OF EXAM STUDY GUIDE
Gastrointestinal

Digestive Tract
Mouth
Stomach
Temporary storage of food
Esophagus
Pyloric sphincter keeps food in the stomach
Acidic pH 1.5-3.5
Mechanical and chemical digestion occurs here
Liver
Stomach
Small Intestine
Gallbladder Receives digestive enzymes from the pancreas and
Pancreas
bile from the gallbladder
Small Absorbs nutrients
Intestine
Large Intestine
Large
Intestine Absorbs water and electrolytes
Rectum
Forms stool and propels towards the rectum
Anus

Liver
Produces bile, albumin, cholesterol and clotting factors
Accessory Metabolizes: Glucose to glycogen, drugs and toxins, ammonia to urea,
unconjugated bilirubin
Organs: Gallbladder
Stores bile
Liver Sends bile to the small intestine to break down fats
Gallbladder Pancreas
Pancreas Endocrine: Regulates blood sugar (produces Insulin and Glucagon)
Exocrine: Produces digestive enzymes that release into the duodenum
Trypsin breaks down proteins, amylase breaks down
carbohydrates, lipase breaks down fats

Peptic Ulcers Irritable Bowel Syndrome

Gastric Ulcers Duodenal Ulcers Ulcerative Colitis Crohn's Disease
Pain is 1-2 Pain is 2-4 Inflammation Inflammation
hours after hours after of the large and erosion
eating eating intestine only throughout
Pain worse Pain the entire GI
with eating temporarily tract
relieved by Recommend
eating low-fiber diet

Nasogastric Tube
X-ray visualization is the gold standard for placement verification
Hold tube feeding for residuals of 500 ml or greater

Notes

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WEEK OF EXAM STUDY GUIDE
Gastrointestinal

TPN Complications
If TPN runs out, initiate D10W at
Infection risk the same rate that the TPN was
Fluid overload running at to prevent hypoglycemia
Hyper/Hypoglycemia
Air Embolism

Appendicitis Pancreatitis
Too m
Inflammation of the appendix Inflammation of the pancreas
Not enough
Sudden HCO3=
relief acidosis
of pain may indicate Leading cause is alcoholism
Kidney injury
rupture

Hepatic Disorders
Hepatitis Cirrhosis
Can be caused by one of 5 viral infections: Liver cells are replaced by scar tissue
A, B, C, D and E Key treatments:
Also caused by alcohol abuse and poor diet Paracentesis
Strict Is and Os
Hepatic Encephalopathy Daily weights
Increased ammonia levels cause hepatic coma Be careful with drug doses
Lactulose helps to bring ammonia levels down

Renal

Functions of the Renal System

Nephron: Filtration: blood filtering in the glomerulus
the functional Reabsorption: movement of substances from
Kidney unit of the renal tubules back into the blood
kidney Secretion: movement of substances from
Ureter blood into renal tubules
(includes glomerulus,
Bowman’s capsule, Excretion: removal of waste products in urine
proximal tubule, loop of Regulation: electrolytes, acid-base balance,
Bladder Henle, distal tubule, blood pressure, erythropoiesis
and collecting duct) Activates vitamin D
Urethra

Urinary Tract Infection (UTI) Causes

Bacterial infection (commonly E. coli)
Symptoms
Dysuria, frequency, urgency, Treatment
suprapubic pain Antibiotics, increased fluid intake

Notes

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WEEK OF EXAM STUDY GUIDE
Renal

Acute Kidney Injury Chronic Kidney Disease

Rapid loss of kidney function Progressive nephron damage resulting

Pathophysiology Accumulation of waste products in the in gradual loss of kidney function
blood stream Irreversible kidney damage

Acute conditions Chronic conditions

Prerenal: hypovolemia, hypotension, Diabetes mellitus
heart failure Hypertension
Causes Intrarental: Acute tubular necrosis, Glomerulonephritis
glomerulonephritis, toxins Polycystic kidney disease
Postrenal: Obstruction (stones, tumors,
BPH)

Timing Hours to days Months to years

Address underlying condition

Address underlying cause
Medications: antihypertensives,
Medications: diuretics, electrolyte
Treatment erythopoiesis-stimulating agents
management
Lifestyle modifications
Dialysis: if severe
Dialysis or kidney transplant

Nephrotic Syndrome Causes

Infections, lupus flare, toxins
Symptoms
Proteinuria, hypoalbuminemia, Treatment
anasarca, hyperlipidemia, Medication: steroids, diuretics, ACE
hyponatremia inhibitors
Diet: high protein diet

Glomerulonephritis Causes
Autoimmune disease, infections
Inflammation of the glomeruli in (commonly streptococcus)
the nephron
Treatment
Symptoms
Medications: antibiotics, steroids,
Hematuria, proteinuria, oliguria, immunosuppressants, diuretics,
edema, hypertension antihypertensives
Sore throat and malaise Diet: low protein, low sodium
Elevated BUN and creatinine

Notes

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WEEK OF EXAM STUDY GUIDE
Renal

Peritoneal Dialysis Hemodialysis

Uses the peritoneum as a filter to Uses a machine and dialyzer to filter

remove waste and excess fluid from waste and excess fluid from the blood
blood AV fistula or central venous catheter
Peritoneal catheter Performed at dialysis center 3 times
Daily treatments, usually done per week, 3-5 hours each session
overnight Causes rapid fluid shifts
Dialysate dwells for approx. 6 hours Risks:
More gentle form of dialysis Hypotension
Risks: Disequilibrium syndrome
Peritonitis Air embolism

Endocrine

Major glands and hormones Thyroid

Pituitary gland T3, T4
Calcitonin
Anterior pituitary
Growth hormone (GH) Adrenal gland
Adrenocorticotropic hormone (ACTH)
Thyroid stimulating hormone (TSH) Cortex
Follicle-stimulating hormone (FSH) Cortisol
Posterior pituitary Aldosterone
Antidiuretic hormone (ADH) Medulla
Oxytocin Epinephrine
Norepinephrine
Pancreas Gonads
Insulin
Ovaries
Glucagon
Estrogen
Pineal gland Progesterone
Testes
Melatonin Testosterone

Parathyroid disorders
Hyperparathyroidism
Hypoparathyroidism Symptoms
Symptoms Hypercalcemia, bone pain, kidney stones
Hypocalcemia, tetany, muscle cramps
Treatment
Treatment Parathyroidectomy, hydration,
Calcium supplements, vitamin D biphosphonates

Notes

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WEEK OF EXAM STUDY GUIDE
Endocrine
Thyroid disorders
Hyperthyroidism
Hypothyroidism Symptoms
Symptoms Weight loss, heat intolerance,
Fatigue, weight gain, cold intolerance, tachycardia, exophthalmos
bradycardia
Causes
Causes Graves’ disease
Hashimoto’s thyroiditis Toxic nodular goiter
Iodine deficiency
Treatment
Treatment Antithyroid medications
Thyroid replacement medication: (methimazole, propylthiouracil)
levothyroxine Radioactive iodine
Thyroidectomy

Pancreatic disorders
Diabetes type 1 Diabetes type 2
Symptoms
Symptoms Polyuria, polydipsia, polyphagia,
Polyuria, polydipsia, polyphagia, obesity
weight loss
Causes
Causes Insulin resistance
Autoimmune destruction of beta cells Beta cell dysfunction
Treatment Treatment
Insulin Lifestyle and diet modification
Oral antihyperglycemics (metformin)
Insulin

Diabetic Ketoacidosis (DKA) Hyperosmolar hyperglycemic

state (HHNS)
Symptoms
Signs of hyperglycemia + ketonuria, Symptoms
metabolic acidosis, signs of Signs of hyperglycemia + signs of
dehydration, Kussmaul respirations dehydration

Causes Causes
Infection Infection
Poor medication compliance Poor medication compliance

Treatment Treatment
IV fluids, insulin, electrolyte IV fluids, insulin, electrolyte
replacement replacement

Notes

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WEEK OF EXAM STUDY GUIDE
Endocrine
Adrenal gland disorders

Addison’s disease Cushing’s Syndrome

Steroid hormone (aldosterone, cortisol) deficiency Steroid hormone (aldosterone, cortisol) excess
Symptoms Symptoms
Weight loss, hypotension, Weight gain, moon face, buffalo
hyperpigmentation, hypoglycemia hump, hypertension, hyperglycemia
Electrolyte imbalances: Electrolyte imbalances:
Hyperkalemia, hyponatremia Hyperkalemia, hyponatremia

Causes Causes
Autoimmune destruction of adrenal Prolonged corticosteroid use
cortex Adrenal tumors
Infections
Treatment
Treatment Gradual cessation of steroid use
Glucocorticoid and mineralocorticoid Tumor removal
replacement (hydrocortisone,
fludrocortisone)

Pituitary gland disorders

Syndrome of Inappropriate
Diabetes Insipidus
Antidiuretic Hormone (SIADH)
Antidiuretic hormone (ADH) deficiency Antidiuretic hormone (ADH) excess
Symptoms Symptoms
Not enough antidiuresis = body Too much antidiuresis = body holds
loses water through the urine! onto water
Polyuria, polydipsia, severe Hyponatremia, seizure risk, weight
dehydration, dilute urine, weight gain, decreased urine output
loss
Causes
Causes CNS disorder
ADH deficiency Lung disease
Kidney resistance to ADH Medications

Treatment Treatment
Vasopressin Sodium replacement
Fluid resuscitation Fluid restriction
Hypertonic saline

Notes

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WEEK OF EXAM STUDY GUIDE

Specialties
Mental Health

Bulimia Nervosa Anorexia Nervosa

Eating disorder characterized by binge Eating disorder marked by an intense

eating followed by purging by self fear of gaining weight, leading to
induced emesis to prevent weight gain extreme food restriction
Average or above normal BMI BMI below normal
Normal BMI 19-24 Distorted body image
Russell’s sign Body dysmorphia
Scars to knuckles from self
induced vomiting Clients with eating disorders are at
No bathroom use for 90 minutes risk for malnutrition and
after eating fluid/electrolyte imbalances!
Prioritize physiological needs first

Schizophrenia Suicide 1:1 observation

Negative symptoms (traits removed from a person) Precautions No sharps in room
Flat affect, anhedonia Important for
Positive symptoms (traits added to a person) clients newly
Hallucinations, delusions started on
Command hallucinations (auditory) antidepressants
Assess what the voices are saying

Bipolar disorder Electroconvulsive Therapy

Provide high-calorie finger food when manic
Mania can affect judgement Must obtain informed consent
Client at risk for harming self Normal to have period of
confusion after the procedure
Hold benzodiazepines and
Anxiety antiepileptic medications
morning of procedure
During a panic attack stay with the client and General anaesthetic
ensure their safety administered

Therapeutic communication
Encourage talking/reflecting upon emotions and triggers
Use open ended communication
Avoid asking “why”
Never dismiss a client’s feelings or give false reassurance

Notes

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WEEK OF EXAM STUDY GUIDE
Maternity, Labor and Delivery

Signs of Pregnancy

Presumptive Probable Positive

Amenorrhea Positive pregnancy test

Ultrasound
Quickening Goodell’s sign
Fetal heart sounds
Nausea and vomiting Chadwick’s sign
Delivery of fetus
Fatigue Hegar’s sign

Naegele’s Rule Rhogam

1st day of last menstrual period Give to Rh- mothers

7 days Give any time maternal/fetal blood mix
3 months Miscarriage, abortion, amniocentesis
1 year Routinely at two times
Estimated due date 28 weeks
Within 72 hours after delivery

Nonstress Test Stress Test Glucose 1hr test (not fasting)

Tolerance 50g glucose PO
Test <140
Reactive Negative Good!
Accelerations! Good! No decels! Good!
3hr test (fasting)
Non-reactive Positive 100g glucose PO
Decelerations! Bad! >140
Decels! Bad! Gestational
diabetes

Prolapsed Cord

Do NOT push back in!

Lift the presenting part off of the cord
Reposition mom to knees to chest or trendelenburg
Keep the cord moist

Fundus
Boggy = BAD! Do fundal massage
Displaced to the side = have the client urinate (fundus misplaced by full bladder)

Notes

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WEEK OF EXAM STUDY GUIDE
Maternity, Labor and Delivery

Placenta Previa Placental Abruption

If mom is bleeding, NO vaginal checks!

Placenta partially or fully covers Placenta tears away from uterine wall
cervix Painful, dark red bleeding
Painless, bright red bleeding Board-like abdomen (internal bleeding)

Pediatrics
APGAR
Appearance Score of 1-10
Pulse Assess at 1 min and 5 min of life
Grimace The higher the number the better
Activity transitioning the baby is doing
Respiration after birth

Meconium Aspiration
Treatment
Meconium passed in utero or Suction immediately: Mouth then nose
at time of delivery Intubation
IV antibiotics and IV fluids

Growth and Development

Cognitive Psychosocial
Piaget development
Erickson development
0-2: Sensorimotor 0-1: Trust vs. Mistrust
2-7: Preoperational 1-3: Autonomy vs. Shame and Doubt
7-11: Concrete operational 3-5: Initiative vs. Guilt
11+: Formal operational 5-11: Industry vs. Inferiority
11-20: Identity vs. Role confusion

Psychosexual
Freud development
0-1.5: Oral
1.5-4: Anal
4-6: Phallic
6-11: Latency
11-21: Genital

Notes

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WEEK OF EXAM STUDY GUIDE
Pediatrics

Reflexes Presence or absence can indicate Jaundice

a neurological abnormality
Moro (startle)
Baby extends arms and legs outward, then pulls Physiological
them back toward body Appears at 2-3 days of life
Most prominent in the first few months, diminishes Due to normal transition from the
around 3-6 months placenta removing the bilirubin to
the infant
Rooting Pathological
Touch a baby's cheek or mouth and they turn their Occurs within the first 24 hours
head to that side and make sucking motions Usually caused by a liver disorder
Present at birth and persists until 4-6 months or ABO incompatibility
Babinski Kernicterus
When the sole of the foot is stroked the great toe Brain damage caused by
extends upward and the other toes fan out increased bilirubin levels
Expected finding in infants up to approximately 1 PREVENTABLE!
year of age
Phototherapy
Palmar grasp Breaks down bilirubin to be able
When the palm of an infant’s hand is touched they to be excreted in stool
respond by curling their fingers around the object Eyes and genitals MUST be
Strongest during the first few months of life and covered and protected
diminishes around 4-6 months Hydration is important

Hirschsprung’s Disease Assessment Treatment

Delayed meconium >24hrs Surgery
Neurons responsible for Ribbon-like stool Nutrition education
peristalsis are missing Green, brown emesis is important!

Omphalocele/Gastroschisis Treatment
Keep intestines moist! Thermoregulation is important
Omphalocele: Peritoneal sac intact IV antibiotics
Gastroschisis: Peritoneal sac not intact Surgery
Silo

Pyloric Stenosis Intussusception

Narrowing of pylorus Intestines telescope, usually where

Non-bilious emesis small and large intestines meet
Olive shaped mass Red currant jelly stool
Dehydration and electrolyte Green, bilious emesis
imbalance Infection risk high IV antibiotics
Surgical correction Treated with enema or surgery if
enema ineffective

Notes

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WEEK OF EXAM STUDY GUIDE
Pediatrics
Esophageal atresia/Tracheoesophageal Fistula
3 C’s
Malformation of the esophagus and/or the trachea Choking
Coughing
NPO until surgically corrected Cyanosis

Cystic Fibrosis Respiratory Considerations

Autosomal recessive disorder
Affects respiratory, GI, and reproductive systems Larger occiput, larger tongue
Increased mucous production obstructs pathways Can’t clear own secretions
Bronchioles Do not have the same reserve
Pancreatic ducts that adults do
Small intestine Peds decompensate quicker!
Biliary ducts Trend in vital signs is a key
Diagnosis assessment
Meconium ileus, chloride sweat test Retractions = concern!
Goal is to prevent respiratory infections Subcostal, intracostal, or
Pancreatic enzymes taken 30 min before meals tracheal tug (supracostal)

Bronchiolitis Croup
Inflammation of the Inflammation of the upper
bronchioles airway
Usually caused by viral agent Usually viral cause
Supportive treatment Distinct, hoarse,
“bark-like” cough
Treat with corticosteroids
and racemic epinephrine

Cleft Lip and Cleft Palate

Malformation of the upper lip or hard palate
Positioning is key!
Surgically corrected
Cleft lip: NO prone
Protect the suture line
Cleft palate: Can prone
Use special bottle for feedings

Epiglottitis
4 D’s
Inflammation of the epiglottis Dysphagia
Medical emergency Dysphonia
Drooling
Absolutely no interventions or throat assessment Distress
until emergency airway equipment available

Notes

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WEEK OF EXAM STUDY GUIDE
Pediatrics

Cyanotic Congenital Heart Defects

Tetralogy of Fallot (TOF) Tet spells
4 defects Hypercyanotic episode leading to increased
Large VSD right to left shunt resulting in more
Pulmonary stenosis deoxygenated blood circulating throughout
Right ventricular hypertrophy the body
Overriding aorta Treatment
Requires surgical correction Comfort and calm, knee-to-chest
position, O2, sedation, IV fluids

Acyanotic Congenital Heart Defects Causes left to right shunt

Increased blood backing
Patent Ductus Arteriosus (PDA) into lungs
Machine-like murmur Can close spontaneously or
Treated with indomethacin or ibuprofen require surgical closure
Prostaglandin keeps PDA open
Ventricular Septal Defect
Atrial Septal Defect (ASD) Hole between the ventricles
Hole between the atria Heart failure symptoms
Dyspnea on exertion CHF management
Poor weight gain If surgically corrected
Murmur heard over defect area Give prophylactic antibiotics to
prevent bacterial endocarditis

Obstructive Congenital Heart Defect

Coarctation of the Aorta Assessment
Narrowed aorta Impedes blood flow to the Differing assessment findings in
lower body upper vs lower body
Symptoms appear once PDA closes Upper
Treatment Bounding pulses, hypertension,
Prostaglandins initially to keep PDA open warm and well-perfused skin
Surgical repair Lower
Weak/absent pulses,
hypotension, pale, cool skin

Mixed Congenital Heart Defect

Hypoplastic Left Heart Syndrome Treatment

Left sided structures don’t develop normally Prostaglandins
Small aorta Palliative surgery
Once PDA closes very little blood to
peripheral circulation

Notes

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WEEK OF EXAM STUDY GUIDE

Pharmacology
General Tips

NCLEX Pharmacology questions typically require you to know the intended effect of
medications AND what you should teach patients about side effects, adverse effects,
and toxicity
Populations who are susceptible to problems with medications:
Children, the elderly, liver damage, and kidney failure patients will have altered
medication metabolism, absorption, and excretion
Pregnant clients
Many drugs are not safe to give in pregnancy
When in doubt, err on the side of caution
Grapefruit juice interacts with many drugs
When in doubt, avoid it!
Many herbal supplements interact with anticoagulants and increase bleeding time
(especially the ones that start with a “G”!)
If a drug has a therapeutic range, a level of toxicity, or an antidote, pay attention to it

Pharmacology - Neurological
Antiepileptic
Phenytoin
Therapeutic range: 10-20 mcg/ml
Side effect
Gingival hyperplasia
Regular dental visits
Soft bristled toothbrush
Nursing considerations
Infuse with 0.2 micron in-line filter
Administer antiacids and phenytoin at least two hours apart

Pharmacology - Respiratory
Short-acting beta adrenergics
Albuterol
Results in bronchodilation
Used in COPD/asthma
Side effect
Tachycardia, jitteriness
Flight or flight mechanism activated

Notes

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WEEK OF EXAM STUDY GUIDE
Pharmacology - Cardiovascular
Antihypertensives

ACE-Inhibitors (-pril)
Inhibits the RAAS system to lower blood pressure
Side effects ALL antihypertensives have
Dry cough and angioedema a risk for hypotension and
HOLD the medication if this occurs! dizziness
Hypotension (ie. orthostatic hypotension)
Dizziness
Hyperkalemia aldosterone suppression

Beta blockers (-olol)

Blocks the sympathetic (fight or flight) nervous system in the heart
Results in lower blood pressure and lower heart rate
Nursing considerations
Hold if HR <60 bpm or if blood pressure low
Safe in pregnancy

Positive inotropes
Digoxin
Increases contractility of the heart
Used in heart failure and atrial fibrillation
Therapeutic range: 0.5-2 ng/ml
Toxicity
Yellow/green halos in vision
Severe bradycardia, fatal arrhythmias
Nursing considerations
Check electrolytes levels: hypokalemia can lead to toxicity
Check heart rate before administration: hold if HR<60

Sympathomimetic agents
Epinephrine
Stimulates sympathetic (fight or flight) nervous system
Increases heart rate, blood pressure, and heart contractility; causes bronchodilation
Indications
CPR, shock, anaphylaxis

Anticoagulants
Warfarin
Disrupts liver synthesis of vitamin K clotting factors
Therapeutic range: INR 2-3 seconds
Antidote: Vitamin K

Notes

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WEEK OF EXAM STUDY GUIDE
Pharmacology - Cardiovascular
Anticoagulants
Heparin/low molecular weight heparins (-parin)
Inhibits thrombin activation
Side effects
Bleeding, heparin-inducted thrombocytopenia and thrombosis (HITT)
Nursing considerations
Monitor hemoglobin, APTT, and platelet levels
Antidote: Protamine sulfate

Pharmacology - Gastrointestinal
Antihyperglycemics
Metformin
Helps control blood sugars by increasing the body’s response to insulin
Side effects
GI related: diarrhea, gas
Affects kidney and liver
Nursing considerations
Hold 24 hours before and 48 hours after contrast dye administration

Serotonin 5-HT3 receptor antagonist

Ondansetron
Effective for treating nausea and vomiting
If given IV, administer slowly to avoid ventricular tachycardia
Can prolong QT interval

Antiulcer agents
H2 Receptor Blockers (-tidine)
Inhibits histamine release; histamine causes secretion of gastric acid

Proton pump inhibitors (-prazole)

Inhibits HCl secretion
Give 30-60 minutes before meals

GI protectant
Sucralfate
Creates a barrier over ulcers
Take on an empty stomach 1 hour before meals or 2 hours after meals
Avoid administration with antacids

Notes

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WEEK OF EXAM STUDY GUIDE
Pharmacology - Renal

Loop diuretics
Furosemide
Promotes diuresis: used in clients with congestive heart failure or edema
Nursing considerations
Monitor potassium levels We pee out potassium!
Administer in the morning
When given IV push administer slowly, fast administration can cause ototoxicity
Monitor blood glucose, lithium levels, and digoxin levels closely

Pharmacology - Mental Health

CNS depressants
Benzodiazepines (-zepam, zolam)
Treats anxiety and causes sedation
Nursing considerations
Monitor for respiratory depression
Don’t give with other CNS depressants

Antidepressants For all antidepressants

Monitor for serotonin
Selective Serotonin Reuptake Inhibitors (SSRI) (-ine) (-lopram) syndrome
Tricyclic antidepressants (-triptyline) Increased risk for suicide
Monoamine Oxidase Inhibitors (selegiline, isocarboxazid) in the first 2-3 weeks
Don’t discontinue quickly

Mood stabilizer
Lithium
Used to treat mania in bipolar disorder
Therapeutic range: 0.6-1.2 mEq/L
Toxicity causes thyroid dysfunction and cardiovascular collapse
Nursing considerations
Don’t administer with NSAIDs
Monitor sodium levels

Antipsychotics
Haloperidol, Quetiapine
Side effects
Extrapyramidal symptoms: tremors, slurred speech, shuffled gait
Neuroleptic malignant syndrome: fever, muscle rigidity, confusion
Tardive dyskinesia

Notes

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WEEK OF EXAM STUDY GUIDE
Pharmacology - Immune

Antibiotics
Penicillins and cephalosporins
Commonly used for strep and respiratory infections
Penicillins are the most common drug allergy

Tetracyclines (doxycycline)
Broad spectrum antibiotic Nearly all antibiotics can
Nursing considerations cause diarrhea and
Don’t give with dairy products (decreases absorption) photosensitivity!
Causes teeth/bone staining
Avoid in pregnancy and pediatrics Many are nephrotoxic
Teach clients to finish the
Fluoroquinolones (levofloxacin) whole course of antibiotic
Nursing considerations treatment to reduce risk for
Can prolong the QT interval and cause tendon rupture drug resistant organisms
Increases seizure risk like MRSA and VRSA
Interacts with many medications

Glycopeptide (vancomycin)
Used to treat C. diff and MRSA
Therapeutic range: 20-40 mcg/ml
Nursing considerations
Red Man’s Syndrome if given too fast
Give via central line over at least 60 minutes

Immunosuppressants
Corticosteroids (-sone)
Decreases inflammatory processes, causes immunosuppression
Side effects
Muscle wasting, weight gain, moon face, ostoporosis
Nursing considerations
Causes fluid retention: watch for hypertension
High infection risk
Increases blood glucose level in diabetics

Pharmacology - Analgesics
Opioids
Morphine, fentanyl, oxycodone, hydromorphone
Releases endorphins to block painful stimuli
Antidote: naloxone
Monitor for respiratory depression, sedation, constipation(increase fiber and water intake)
High risk of dependance and addiction

Notes

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WEEK OF EXAM STUDY GUIDE
Pharmacology - Analgesics
Non-opioid analgesia
Acetaminophen
Treats mild/moderate pain, also works as antipyretic
Antidote: N-acetylcysteine
Nursing considerations
Liver toxicity if above 4g/day
Clients should not take more than 3g/day with long term use

NSAIDs (ibuprofen, ketorolac, celecoxib)

Treats mild/moderate pain, also has anti-inflammatory properties
Nursing considerations
Prostaglandin inhibition increases risk for peptic ulcers
Monitor for GI bleed
Increases risk of lithium toxicity
Take care in cardiovascular disease (increases sodium and blood pressure)

Aspirin
Given for mild/moderate pain, stroke and MI prophylaxis
Nursing considerations
Caution with other anticoagulants
Caution with pediatric clients can cause Reye’s syndrome

General
testing tips

Avoid Follow
You got this,
changing test-taking
your strategies
answer!
FUTURE
Trust
your gut!
Breathe!
You are
smart and
NURSE !
capable!

© 2010-2024 USMLE Galaxy LLC