case study 05/7/2020

A prescription is written for famotidine 20 mg intravenous piggyback (IVPB) every 12 hours. The vial is labeled 10 mg/1 mL. How many milliliters should the nurse administer? Record the answer using a whole number. mL.

-2 ml Have 10 mg 1 mL 10x = 20 x = 20 ÷ 10 x = 2 mL

A client who is to have sclerotherapy asks the nurse, "How did I get varicose veins?" Which etiology should the nurse take into consideration when formulating a response?

-DEFECTIVE VALVES IN THE VEINS Varicose veins are dilated veins that occur as a result of incompetent valves

The nurse is teaching an African-American male patient about the risk for cancer. Which patient statements indicate correct understanding of the information presented? Select all that apply.

-I am at risk for being diagnosed with prostate cancer at a younger age." -I will have an increased risk for mortality if diagnosed with prostate cancer" -"If I am diagnosed with prostate cancer, it may advance at an increased rate."

A client with newly diagnosed hyperthyroidism is treated with propylthiouracil, an antithyroid drug, along with potassium iodide. What should the nurse take into consideration when caring for the client?

-Monitoring for signs of infection or bleeding is necessary. Propylthiouracil can cause depression of leukocytes and platelets

A client had extensive, prolonged surgery. Which electrolyte level should the nurse monitor most closely?

-POTASSIUM Release of adrenocortical steroids (cortisol) by the stress of surgery causes renal retention of sodium and excretion of potassium

A nurse is reviewing a plan of care for a client who was admitted with dehydration as a result of prolonged watery diarrhea. Which prescription should the nurse question?

-Parenteral albumin (Albuminar) Albumin is hypertonic and will draw additional fluid from the tissues into the intravascular space.

The registered nurse teaches the student nurse regarding the priority of care provided to clients with eye injuries due to chemical exposure. Which activity performed by the student nurse indicates effective learning?

-Performing ocular irrigation Ocular irrigation with saline solution should be performed immediately in the client with eye injuries due to chemical exposure.

When interpreting findings from a pain assessment, what does a nurse consider the most significant influence on many clients' perception of pain?

-Previous experience and cultural values

A nurse is assessing the therapeutic action of drugs classified as tumor necrosis factor (TNF) inhibitors. What client response indicates to the nurse that a drug with this classification is effective?

-Reduction of inflammatory joint pain in a client with rheumatoid arthritis TNF is produced mainly by macrophages in synovium; over time, through various mechanisms, the presence of TNF causes inflammation of synovium, destruction of bone and cartilage, joint stiffness, and pain. TNF inhibitors or blockers neutralize TNF, thereby interrupting the inflammatory cascade; this inhibits the inflammatory response and other mechanisms, thereby slowing tissue damage

Which patient population requires increased screening and preventative education related to colorectal cancer?

-african american

Which male patient should the nurse present information related to prostate cancer screening at an earlier age than that recommended for other patients?

-african american African-American men tend to be diagnosed with prostate cancer at an earlier age, have more advanced disease at the time of diagnosis, and have a higher mortality rate than do white men

The nurse assesses an elderly client with a diagnosis of dehydration and recognizes which finding as an early sign of dehydration?

-change in mental status Older adults are sensitive to changes in fluid and electrolyte levels, especially sodium, potassium, and chloride. These changes will manifest as a change in mental status and confusion

What are the clinical indicators that a nurse expects when an intravenous (IV) line has infiltrated? Select all that apply.

-edema -pallor -decreased flow rate The accumulation of fluid in the tissues between the surface of the skin and the blood vessels makes the skin appear pale. The accumulation of fluid in the interstitial compartment causes swelling. As the needle/catheter is dislodged from the vein, the drip rate of the IV slows or cease

After the nurse provides education about hydrochlorothiazide, the client will agree to notify the healthcare provider regarding the development of which symptom?

-generalized weakness Generalized weakness is a symptom of significant hypokalemia, which may be a sequela of diuretic therapy. Insomnia is not known to be related to hypokalemia or hydrochlorothiazide therapy

A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. What should the nurse monitor the client for?

-hyperkalemia Spironolactone is a potassium-sparing diuretic that is used to treat clients with ascites; therefore the nurse should monitor the client for signs and symptoms of hyperkalemia

The nurse is planning care for several pediatric clients. Which client is most likely to experience otitis media?

-native american

A nurse assesses a client's serum electrolyte levels in the laboratory report. What electrolyte in intracellular fluid should the nurse consider most important?

-potassium The concentration of potassium is greater inside the cell and is important in establishing a membrane potential, a critical factor in the cell's ability to function

During which stage of non-rapid eye movement (NREM) sleep does relaxation progress?

-stage 2 Relaxation progresses during stage 2 of non-rapid eye movement (NREM) sleep.

A client with Addison's disease is receiving cortisone therapy. The nurse expects what clinical indicators if the client abruptly stops the medication? Select all that apply.

-tachypnea -hypotension Tachypnea occurs with Addisonian crisis because of inadequate circulating glucocorticoids and mineralocorticoids. Inadequate circulating glucocorticoids and mineralocorticoids cause hypotension, pallor, weakness, tachycardia, and tachypnea

An intravenous (IV) solution of 1000 mL 5% dextrose in water is to be infused at 125 mL/hr to correct a client's fluid imbalance. The infusion set delivers 15 drops/mL. To ensure that the solution will infuse over an eight-hour period, at how many drops per minute should the nurse set the rate of flow? Record the answer using a whole number. gtts/min

31 1000 mL x 15/8 x 60 = 15,000/480 = 31.25 = 31 gtts/min

stage 1 of NREM

characterized by decreased physiologic activity

Crohn's disease

chronic inflammation of the intestinal tract (can cause Clients with Crohn disease have diarrhea, resulting in potassium los)

pancytopenia

deficiency of all types of blood cells

myocardial infarction

heart attack

paresthesias

numbness or tingling

A nurse assesses for hypocalcemia in a postoperative client. What is one of the initial signs that might be present?

paresthesias

lipid deposition

what does a decrease in protein synthesis cause Lipid deposits may lead to the formation of a grey ring in the cornea

MRSA (methicillin-resistant Staphylococcus aureus)

A wound infected with MRSA can be transmitted to others via contact, not airborne.

STAGE 3 NREM

Stage 3 of NREM sleep is characterized by completely relaxed muscles

MRSA (methicillin-resistant Staphylococcus aureus)

an infection caused by specific bacteria that has become resistant to many antibiotics

hyperglycemia

high blood sugar

What is the priority nursing care for a client who is prescribed hydroxychloroquine?

- blurred vision Hydroxychloroquine is used to treat rheumatoid arthritis. The adverse effect of hydroxychloroquine is retinal damage; therefore, a client on this medication is taught to report blurred visio

Prednisone

Deltasone Anti-inflammatory

Cushing's disease

Elevated cortisol lients with Cushing disease will retain sodium and excrete potassium

hypertonic

when comparing two solutions, the solution with the greater concentration of solutes Hypertonic solutions contain more than 0.85 g of solute in each 100 mL.

isotonic

when the concentration of two solutions is the same Isotonic solutions are those that cause no change in the cellular volume or pressure, because their concentration is equivalent to that of body fluid.

Enteric tablet coating

Used to prevent core or granules from disintegration in an acidic environment.

vitamin k assists with

Vitamin K assists in synthesizing blood clotting factors

While caring for a client with a burn injury and in the resuscitation phase, the nurse notices that the client is hoarse and produces audible breath sound on exhalation. Which immediate action would be appropriate for the safe care of the client? Select all that apply.

-Providing oxygen immediately -notifying the rapid response team Hoarseness of voice, difficulty in swallowing, or an audible breath sound on exhalation after a burn injury indicates an impaired airway. Therefore the client should be given oxygen immediately. The rapid response team should also be notified for further management.

A client with an abdominal wound infected with methicillin-resistant Staphylococcus aureus (MRSA) is scheduled for a computed tomography (CT) scan of the abdomen. To ensure client and visitor safety during transport, the nurse should implement which precaution?

- covered the infected site with a dressing By covering the infected site with a dressing, this will contain secretions and serve as a barrier, thus decreasing the risk for transmission to others.

When performing a postoperative assessment, which parameter would alert the nurse to a common side effect of epidural anesthesia?

- decrease in BP The most important side effect to monitor in a client who has received epidural anesthesia is hypotension due to autonomic nervous system blockade. Therefore, in the immediate postoperative recovery period, the blood pressure should be assessed frequently

The nurse reviews a medical record and is concerned that the client may develop hyperkalemia. Which disease increases the risk of hyperkalemia?

- end stage renal failure One of the kidneys' functions is to eliminate potassium from the body; diseases of the kidneys often interfere with this function, and hyperkalemia may develop, necessitating dialysi

A client with human immunodeficiency virus (HIV) associated Pneumocystis jirovecipneumonia is to receive pentamidine isethionate intravenously (IV) once daily. The nurse should monitor the client for what adverse effect?

- hyperglycemia Pentamidine isethionate can cause either hypoglycemia or hyperglycemia even after therapy is discontinued, and therefore blood glucose levels should be monitored

A healthcare provider prescribes morphine for a client who had a myocardial infarction. What clinical response will be reduced if the client experiences the intended therapeutic effect of morphine?

- workload of the heart Morphine reduces pain and anxiety that limits the response of the sympathetic nervous system, ultimately decreasing cardiac preload and the workload of the heart.

An older adult tells the nurse, "I read about a vitamin that may be related to aging because of its antioxidant effects on the structure of cell walls. I wonder whether it is wise to take it." Which vitamin does the nurse conclude the client is describing?

-Vitamin E has antioxidant properties.

epidural blocks

An epidural block, a type of regional anesthesia, involves the injection of a local anesthetic into the epidural (extradural) space; it works by binding to nerve roots as they enter and exit the spinal cord. Epidural blocks are not used for moderate sedation. The oral route of drug administration is commonly used for pediatric clients, not adults.

A client is admitted to the hospital with pancytopenia as a result of chemotherapy. What should the nurse plan to teach this client in an effort to minimize the risk of complications as a result of pancytopenia?

Avoid traumatic injuries and exposure to infection. Reduced platelets increase the likelihood of uncontrolled bleeding; reduced lymphocytes increase susceptibility to infection

The client is receiving high-flow intravenous (IV) fluid replacement therapy. Which nursing assessment findings are consistent with fluid volume overload? Select all that apply.

Bounding pulse Presence of dependent edema Neck vein distention in the upright position

chloride and sodium loss

Clients with gastroesophageal reflux disease are prone to vomiting that may lead to sodium and chloride loss with minimal loss of potassium.

A 28-year-old male client is undergoing tests to confirm the diagnosis of Hodgkin lymphoma. The client and his wife are worried that he may have cancer. The wife states, "Don't you think it is unlikely for someone like my husband to have cancer?" The nurse's response is based on what information about Hodgkin lymphoma?

Diagnosed during adolescence and young adulthood Hodgkin lymphoma occurs most often between the ages of 15 and 35 years and 50 and 60 years

General Anesthia

General anesthesia usually is administered via inhalation of the vapor of a volatile liquid or an anesthetic gas via a mask or endotracheal tube; as a result, the client is unconscious, unaware, and anesthetized.

hydrochlorothiazide

Hydrochlorothiazide belongs to a class of drugs known as diuretics/"water pills." It works by causing you to make more urine. This helps your body get rid of extra salt and water. This medication also reduces extra fluid in the body (edema) caused by conditions such as heart failure, liver disease, or kidney disease.

Neomycin, 1 gram, is prescribed preoperatively for a client with cancer of the colon. The client asks why this is necessary. How should the nurse respond?

It will kill the bacteria in your bowel and decrease the risk for infection after surgery. Neomycin provides preoperative intestinal antisepsis

Which statement about the findings of the adult eye is correct?

Lipid depositions may lead to the formation of arcus senilis in older adults.

The nurse is caring for a client with an abdominal aortic aneurysm before surgery. Which nursing care is essential preoperatively?

Maintaining a reduced blood pressure Maintaining a low blood pressure reduces the risk of aortic rupture

paresthesias

Normally, calcium ions block the movement of sodium into cells. When calcium is low, this allows sodium to move freely into cells, creating increased excitability of the nervous system. Initial symptoms are paresthesias

Prednisone, an adrenal steroid, is prescribed for a client with an exacerbation of colitis. When administering the first dose of the medication, what information does the nurse provide to the client?

Prednisone is not curative, but does cause a suppression of the inflammatory process. Prednisone inhibits phagocytosis and suppresses other clinical phenomena of inflammation; this is a symptomatic treatment that is not curativ

The health care provider prescribes a low-fat, 2 g sodium diet for a client with hypertension. The nurse should explain that the purpose of restricting sodium is to do what?

Prevent reabsorption of water in the distal tubules Sodium cause reabsorption of water in the kidneys' renal tubules. When dietary intake of sodium is decreased, water is not reabsorbed, and edema is reduced. A decrease in sodium will prevent the reabsorption of water.

Propylthiouracil

Propylthiouracil can cause depression of leukocytes and platelets

STAGE 4 NREM

Stage 4 of NREM sleep is characterized by significant slowing of the vitals.

vitamin b1 is essential for

Vitamin B 1 is necessary for protein and fat metabolism and for functioning of the nervous system

vitamin c is essential for

Vitamin C is used for formation of collagen, which is important for maintaining capillary strength, promoting wound healing, and resisting infection.

Abdominal Aortic Aneurysm

When the large blood vessel (aorta) that supplies blood to the abdomen, pelvis, and legs becomes abnormally large or balloons outward.

When teaching an African American patient about heart failure, which statement should the nurse include in the educational session?

You will have a higher risk of death and disability if you develop heart failure." African American patients have a higher mortality rate when developing heart failure; therefore, the nurse should include this statement in the education session

Propylthiouracil (PTU)

antithyroid is an oral medication that is used to manage hyperthyroidism which is due to an overactive thyroid gland