Free SNLE Exam Flashcards

Sublingual nitroglycerin dilates coronary arteries and reduces preload, lowering myocardial oxygen demand. Given after airway and oxygen if systolic blood pressure is adequate. Aspirin and anticoagulants follow per ACS protocol but do not primarily relieve pain.

Crackles at lung bases from pulmonary congestion as blood backs up into pulmonary circulation. Also expect dyspnea, orthopnea, and frothy sputum. JVD, peripheral edema, and hepatomegaly suggest right-sided failure instead.

Protamine sulfate binds heparin and neutralizes anticoagulation rapidly. Vitamin K reverses warfarin over hours to days, not heparin. Monitor aPTT and bleeding sites; stop infusion and notify provider per protocol.

Low-flow nasal cannula (often 1-2 L/min) targeting saturations around 88-92% preserves hypoxic respiratory drive in chronic retainers. High-flow masks risk suppressing drive and worsening hypercapnia.

Peaked (tall, tented) T waves signal hyperkalemia before QRS widening and sine-wave patterns. Treat with cardiac membrane stabilization (calcium), insulin and glucose, beta-agonists, and removal therapy per severity.

Hyperglycemia, metabolic acidosis, ketonuria, and dehydration. Priority is IV fluids then insulin after potassium is verified adequate (insulin drives K intracellularly). Monitor glucose, electrolytes, and mental status hourly early in treatment.

Prepare for emergent needle decompression: tracheal deviation, absent breath sounds on affected side, hypotension, and distended neck veins. Do not delay for chest X-ray if clinical picture is classic. High-flow oxygen while awaiting intervention.

Face drooping, Arm weakness, Speech difficulty, Time to call emergency services. Time last known well guides thrombolytic eligibility. Maintain airway, check glucose, and avoid unnecessary BP lowering unless extreme.

Obtain blood cultures before antibiotics when possible, administer broad-spectrum antibiotics, measure lactate, and begin 30 mL/kg crystalloid for hypotension or lactate 4 mmol/L or higher. Frequent reassessment of perfusion and urine output.

Negative-pressure airborne infection isolation room, N95 respirator for staff, patient wears surgical mask during transport. Continue until three consecutive negative sputum smears or physician de-isolation order per local policy.

Ensure immediate safety: constant observation per protocol, remove harmful objects, and do not leave patient alone. Complete suicide risk assessment and notify provider. Therapeutic communication follows once environment is secure.

Hypokalemia increases digoxin binding and toxicity risk. Early symptoms include nausea, vision changes (yellow halos), and bradycardia with arrhythmias. Hold digoxin, check potassium and digoxin level, and treat per protocol.

Two large-bore IV lines, type and crossmatch, monitor hemoglobin and vital signs, keep NPO, and assess for orthostatic changes. Avoid unnecessary sedatives that mask neurologic decline. Prepare for possible transfusion.

Noxious stimulus below injury level (often blocked bladder or bowel) causes severe hypertension, headache, and bradycardia. Sit patient upright, loosen clothing, check catheter and rectum, and treat hypertension per protocol. Common in T6 and above injuries.

Estimates first 24-hour crystalloid needs from burn size and weight to replace capillary leak losses. Half given in first 8 hours from burn time. Monitor urine output (typically 0.5 mL/kg/h adult) to titrate fluids.

Muscle pump activity reduces venous stasis. Combine with mechanical prophylaxis and pharmacologic anticoagulation when ordered. Leg pain, unilateral swelling, or warmth warrants further evaluation.

Limit high-phosphorus foods (dairy, nuts, colas) and take phosphate binders with meals when prescribed. Rising phosphorus contributes to bone disease and cardiovascular calcification. Patient education includes reading food labels.

Give 15 g fast-acting carbohydrate (glucose tablets, juice), recheck in 15 minutes, repeat if still under 70 mg/dL. Follow with snack if next meal is delayed. Unconscious patients need IV dextrose or glucagon, not oral sugar.

Sudden dyspnea, pleuritic chest pain, and tachycardia. May have hypoxia, hemoptysis, or leg swelling. High clinical suspicion warrants immediate evaluation; anticoagulation after stability confirmed.

Target typically 20-30 cm H2O to prevent aspiration leak while avoiding tracheal mucosal ischemia and stenosis. Overinflation impairs perfusion; underinflation increases aspiration risk. Check per unit policy with manometer.

Stage 1 is latent then active labor; active phase traditionally begins at 6 cm cervical dilation with regular contractions. Full dilation (10 cm) ends Stage 1. Stage 2 is pushing until birth; Stage 3 is placenta delivery; Stage 4 is immediate recovery.

Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), Respiration. Each 0-2 points; 7-10 is reassuring, 4-6 moderate assistance, 0-3 requires immediate resuscitation. Score at 1 and 5 minutes routinely.

Massage fundus to stimulate contraction, ensure bladder empty, count pads, and establish large-bore IV access while calling for help. Oxytocin and other uterotonics per order. Early recognition prevents shock.

Systolic 160 mmHg or higher or diastolic 110 mmHg or higher on two occasions, plus symptoms such as headache, visual changes, epigastric pain, or thrombocytopenia. Requires urgent evaluation and often magnesium sulfate for seizure prophylaxis.

Calcium gluconate is the antidote for respiratory depression or cardiac effects. Loss of deep tendon reflexes is an early clinical sign. Monitor respiratory rate, urine output, and magnesium level per protocol.

Large surface-area-to-weight ratio, thin skin, and limited subcutaneous fat cause rapid heat loss by conduction, convection, radiation, and evaporation. Dry immediately, skin-to-skin or radiant warmer, and monitor axillary temperature.

Feed on demand, ensure asymmetric latch with wide mouth and chin touching breast, and hand-express briefly before latch if areola is too firm. Avoid scheduled long gaps early postpartum. Report cracked nipples with signs of mastitis.

Delayed skin tenting and sunken anterior fontanel (infants) indicate moderate dehydration. Dry mucous membranes, decreased tears, and oliguria support diagnosis. Shock signs (weak pulses, lethargy) need urgent fluid resuscitation.

Barking seal-like cough and inspiratory stridor, often worse at night. Mild cases: cool mist and comfort. Severe distress, drooling, or fatigue suggests epiglottitis or severe obstruction — keep child calm and prepare for advanced airway support.

Turn child on side, protect from injury, do not put objects in mouth, and time the event. Most are brief and benign. Seek emergency care if seizure lasts over 5 minutes, child is under 6 months, or neurologic deficit persists after.

Avoid in smokers over 35, history of thromboembolism, migraine with aura, uncontrolled hypertension, and certain liver disease. Estrogen increases thrombotic risk. Progestin-only methods may be alternatives when estrogen is contraindicated.

Maximize skin exposure per device instructions, protect eyes, monitor bilirubin trends, and maintain hydration and feeding frequency. Phototherapy converts bilirubin to water-soluble isomers for excretion. Watch for bronze baby syndrome with certain conditions.

Objective factual description of injuries (size, shape, location, color), child statements in quotes, and behaviors. Do not confront alleged perpetrator in front of child. Follow mandatory reporting laws and facility policy immediately.

Live attenuated vaccines (MMR, varicella, nasal flu in some formulations) are contraindicated in severe immunocompromise and pregnancy. Separate live vaccines by at least 28 days if not given same day. Document lot number and site.

Amenorrhea, unilateral pelvic pain, and vaginal bleeding; positive pregnancy test. Rupture causes shoulder pain (referred), hypotension, and shock. Do not delay surgical or medical management once diagnosed.

Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Breaking any link prevents spread. Standard precautions apply to all patients regardless of known diagnosis.

Surgical (sterile) technique eliminates all microorganisms and spores from objects and fields — required for invasive procedures. Medical asepsis (clean technique) reduces number and spread of pathogens — used for routine care and clean dressing changes.

Right patient, drug, dose, route, time, documentation, reason, response, and form (plus facility-specific rights). Two identifiers before every dose. Independent double-check for high-alert medications per policy.

Infiltration: non-vesicant fluid leaks into tissue causing swelling and coolness — stop infusion, elevate, warm compress per policy. Extravasation: vesicant causes tissue necrosis — stop immediately, aspirate if protocol allows, and apply antidote per drug.

Multiply patient weight in kg by ordered mg/kg/day for 24-hour total, then divide by number of doses per day. Verify concentration when converting to mL. Always have second nurse check high-risk calculations when policy requires.

Assessment, diagnosis, planning, implementation, and evaluation (ADPIE). Assessment must precede interventions; evaluation determines whether plan continues or changes. Documentation reflects each step.

Airway, breathing, circulation, and homeostasis come before safety, belonging, esteem, and self-actualization in acute care prioritization. A patient with airway compromise is addressed before psychosocial concerns.

Witness signature and confirm patient received information in understandable language; nurse does not explain surgical risks (provider duty). Ensure voluntary decision without coercion. Consent must be obtained before sedation when possible.

Full-thickness skin loss with visible subcutaneous fat; bone, tendon, or muscle not exposed. Slough or eschar may be present. Requires pressure redistribution, moisture management, and wound care per interprofessional plan.

Hold feeding and reassess abdomen if gastric residual exceeds facility threshold (often 200-500 mL depending on policy). High residuals risk aspiration. Verify tube placement and consider prokinetics or post-pyloric feeding per provider.

Right task, circumstance, person, direction/communication, and supervision/evaluation. RN retains accountability for outcome. Tasks requiring nursing judgment are not delegated to unlicensed assistive personnel.

Initial assessment, care planning, teaching that requires RN judgment, and triage decisions remain RN responsibilities. LPNs administer medications and perform assigned procedures under RN supervision per licensure law and facility policy.

Situation (concise problem), Background (relevant history), Assessment (your findings), Recommendation (requested action). Standardizes handoffs and provider calls to reduce errors during transitions of care.

Incident report documents event for risk management without admitting fault; it is not part of the medical record. Root cause analysis is a systems-focused review after serious events to identify process failures and prevent recurrence.

Competent patients may refuse treatment even if refusal leads to harm or death. Ensure informed decision, assess decision-making capacity, and document discussion. Beneficence does not override valid autonomous refusal.