Comprehensive Exam #1
A client with obsessive compulsive personality disorder (OCD) annoys his coworkers with his rigid-perfectionistic attitude and his preoccupation with trivial details. An important consideration when planning care for this client would be: Helping the client determine how to change his behavior Instructing the client to ignore triggers for obsessive actions Avoiding a discussion of his annoying behavior because it will make him worse Assisting the client identify how to reduce time spent on ritualistic behaviors
Answer 4 is correct. It's important to help the client initially identify what triggers precipitate ritualistic behaviors for patients with obsessive compulsive disorder (OCD) and help them identify ways to reduce time spent on ritualistic behaviors. Obsessive-compulsive disorder is an anxiety disorder that is characterized by obsessions (ideas, emotions, or impulses that repetitively and insistently force themselves into consciousness) or compulsions (recurrent irresistible impulses to perform some act) that interfere with the individual's normal routine. Answer 1 is incorrect because the client with a personality disorder will see no reason to change. The nurse should discuss his behavior and its effects on others with him, so answer 3 is incorrect.
A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which actions should the nurse take first? Place the patient on NPO status. Administer sedative medications. Ensure the consent form is signed. Teach the patient about the procedure.
Answer: 1 is correct. See page 1071 in IGGY. This exam requires the patient to be NPO for 6-8 hrs before the test and is the first action the nurse should take. Post procedure monitor VS every 15 minutes until stable and institute aspiration precautions. The patient will receive sedation drugs during the procedure so be sure to check that the gag reflex has returned before the patient is offered fluids.
During an interview at a crisis center, a newly widowed client reveals the wish "to join my husband in Heaven." After the nurse asks the client to sign a no-harm contract, which question is appropriate to use next as a therapeutic response? "What feelings have you been experiencing?" "Have you considered taking antidepressants?" "What was the cause of your husband's death? "Do you have children who are willing to help you?"
Answer: 1 is the most therapeutic response. The nurse needs to focus on the client and address her feelings. Talking about her feelings helps to decrease the risk of self-harm. Doing so takes precedence over questions about the cause of death and her children's level of support. Antidepressant medications may be indicated but more information is needed about the client's emotional state.
The nurse is assigned four patients. After receiving shift report, in which order from first to last should the nurse assess these clients? 85-year-old client with bacterial pneumonia, temp 102, and complaining of dizziness and shortness of breath when the UAP assisted the patient up to a chair. 60-year-old client with chest tubes 2 days post op following thoracotomy for lung cancer is complaining of pain and BP changed from last reading 120/80 to 134/90 35-year-old client receiving brachytherapy for cancer treatment and the 12-year-old son has been visiting for 90 minutes and is sitting next to the bed holding the clients hand. 29-year-old client post abdominal surgery yesterday has an abdominal dressing over the wound and drainage has changed from sanguineous to serosanguinous since previous shift change.
Answer: 1, 3, 2, and 4. The elderly client with pneumonia and elevated temp with dizziness and SOB is the most acutely ill and should be the highest priority. Dizziness and SOB are always a concern. An elevated temp and shortness of breath can lead to a decrease in the clients oxygen levels. The client receiving brachytherapy is the next priority. If not for patient #1 with respiratory problems/dizzy this patient would be the top priority. Visitors for these patients should be at least 16 years old, limited to 30 minutes at a time, and remain at least 6 feet from the source of radiation, which is inside the patient. It's important you know proper precautions for patients receiving radiation treatments including those with sealed implants. The client with chest tubes needing pain medication is the third priority. The BP has changed, but not enough to be the priority. A change of 20 points would be significant. The client with abdominal wound is not a priority. This is normal drainage.
A nurse is planning care for a client who has a new prescription for total parenteral nutrition (TPN). Which of the following interventions should be included in the plan of care? (Select all that apply.) Obtain a capillary blood glucose four times daily. Administer prescribed medications through a secondary port on the TPN IV tubing. Monitor vital signs three times during the 12‑hr shift. Change the TPN IV tubing every 24 hr. Ensure a daily aPTT is obtained.
Answer: 1, 3, 4 CORRECT: The client is at risk for hyperglycemia during the administration of TPN and can require supplemental insulin. No other medications or fluids should be administered through the IV tubing being used to administer TPN due to the increased risk of infection and disruption of the rate of TPN infusion. CORRECT: Vital signs are recommended every 4 to 8 hr to assess for fluid volume excess and infection. Report any abnormalities. CORRECT: It is recommended to change the IV tubing that is used to administer TPN every 24 hr. aPTT measures the coagulability of the blood, which is unnecessary during the administration of TPN.
The charge nurse is assigning patients for care. There are two registered nurses (RNs), an LPN, and a certified nursing assistant (CNA). The charge nurse would assign which of the following patients to the LPN? An older adult who is receiving IV chemotherapy through a central line and will need a central line dressing change An adult patient diagnosed with insulin-dependent diabetes who will need dressing changes on several stasis ulcers on the lower extremities An adult patient with a right fractured femur and right arm in a cast who needs to urinate An older patient with terminal cancer who will be transferred to hospice
Answer: 2 The patient with diabetes will need stasis ulcer care, which is within the scope of practice of the LPN. The patient receiving chemotherapy through a central line would be assigned to the registered nurse. The nursing assistant would help the female patient with the fractures with the bedpan. The RN should facilitate the transfer of the hospice patient
A nurse is caring for a client who is speaking in a loud voice with clenched fists. Which of the following actions should the nurse take? Insist that the client stop yelling. Remove other patients from the area. Move as close to the client as possible. Walk away from the client.
Answer: 2 is correct. Incorrect. The nurse should not make demands of the client by insisting that he stop yelling. CORRECT: The nurse should remove other patients from the area. Keep in mind additional help may be needed but angry clients may perceive additional staff called to help as a threat. Incorrect. Clients who are angry need a large personal space. Don't get too close. Incorrect. The nurse should never walk away from a client who is angry.
A nurse is providing teaching to a female client with a sealed radium implant. The nurse knows the client correctly understands the teaching when she states: "Visitors can sit at my bedside for 2 hours at a time" "Visitors must stay at least 6 feet from me while in the room" "Visitors must wear a lead apron while in the room" "Visitors may include my 12-year-old niece"
Answer: 2. Each visitor is limited to one-half hour per day and should state at least 6 feet from the source of radiation. See page 389 in IGGY care of the patient with a sealed implant. Children under 16 and pregnant women are not allowed to visit. Nurses must wear a lead apron while providing care. Visitors are not required to wear a lead apron.
The nurse is preparing to administer a preoperative medication that includes a sedative for a client who is having knee replacement surgery. The nurse should do which of the following? Have the family present Shave the operative area with a razor Have the client empty the bladder Inform the client about risks associated with the surgical procedure
Answer: 3 is correct. For safety the client should empty the bladder before receiving a sedative. 1 is not correct. The family does not have to be present, but it is usually desired. 2 is not correct. The Joint Commission SCIP measure for appropriate hair removal with surgery patients notes no hair removal or the use of clippers or depilatory if hair must be removed. Razors are not used as small nicks harbor bacteria. 4 is not correct. It is the surgeon's responsibility to inform the patient of risks associated with the surgical procedure.
The nurse is teaching circumcision care to the mother of a newborn. Which statement indicates the need for further teaching? "The cord will fall off in approximately 10-14 days" "I will clean the area carefully with warm water during each diaper change" "I can place a heat lamp to the area to speed up the healing process" "I should carefully observe the area for signs of infection"
Answer: 3 would need follow-up. The mother should not place an external heat source near the newborn due to risk of burn. The goal for cord care is to prevent or decrease risk for infection and hemorrhage. Teach the mother to assess stump and base of cord for erythema, edema, and drainage with each diaper change. The cord should be cleaned with water.
A client with end-stage kidney disease is receiving continuous ambulatory peritoneal dialysis. The nurse is monitoring the client for manifestations of complications associated with peritoneal dialysis. Select all that apply. Pruritus Oliguria Tachycardia Cloudy outflow Abdominal pain Nausea/Vomiting
Answer: 3, 4, 5, 6 1 is not correct. Severe itching (pruritus) is caused by metabolic waste products that are deposited in the skin; dialysis removes metabolic waste products, preventing this adaptation associated with kidney failure. 2 is not correct. The production of abnormally small amounts of urine (oliguria) is a sign of kidney failure, not a complication of peritoneal dialysis. 3 is correct. Tachycardia can be caused by peritonitis, a complication of peritoneal dialysis; the heart rate increases to meet the metabolic demands associated with infection. 4 is correct. Cloudy or opaque dialysate outflow (effluent) is the earliest sign of peritonitis; it is caused by the constituents associated with an infectious process. 5 is correct. Abdominal pain is associated with peritonitis, a complication of peritoneal dialysis; pain results from peritoneal inflammation, abdominal distention, and involuntary muscle spasms. 6 is correct. Nausea and vomiting are manifestations of peritonitis
A nurse is assessing a 12-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider? Closed anterior fontanel Eruption of six teeth Birth weight doubled Birth length increased by 50%
Answer: 3. By the age of 12 months, the infant's birth weight should have tripled. Therefore, the nurse should report this finding to the provider. 1 does not need reported. By the age of 12 to 18 months, the infant's anterior fontanel should close. 2 does not need reported. By the age of 12 months, the infant should have six to eight teeth erupted. 4 does not need reported. By the age of 12 months, the infant's birth length should increase by 50%.
The nurse on an orthopedic unit has become aware of the following client situations. It would be a priority for the nurse to follow-up for a client who 1. had a total hip replacement 8 hours ago has had 100 ml of bloody drainage in the closed would suction device2. has an external fixation device after a repair of a fractured femur is requesting pain medication3. had an ORIF of a fractured femur 12 hours ago and has developed a rash on the chest and neck4. had a total hip replacement three hours ago and has a temperature of 100.2° F
Answer: 3. Fat embolism, a serious complication of fractures of long bones is manifested by petechiae (a fine rash) over the chest, neck, upper arms or abdomen, restlessness, tachycardia, tachypnea, fever and respiratory distress. This client should be evaluated first.
In discussing home care with a client after transurethral resection of the prostate (TURP), the nurse should teach the male client that dribbling of urine: a. Can be a chronic problem b. Can persist for several months c. Is an abnormal sign that requires intervention d. Is a sign of healing within the prostate
Answer: B. Dribbling of urine can occur for several months after TURP. The client should be informed that this is expected and is not an abnormal sign. The nurse should teach the client perineal exercises (Kegels) to strengthen sphincter tone. The client may need to use pads for temporary incontinence. Reassure the client that continence will return in a few months and will not be a chronic problem. Dribbling is not a sign of healing but is related to the trauma of surgery.
A nurse assesses five newly hospitalized patients. Which patients have the highest suicide risk? Select all that apply. a) 82-year-old white male b) 35-year-old Hispanic female c) 28-year-old Hispanic male d) 19-year-old Native American male e) 22-year-old Alaskan Native male
Answer: a, d, and e. Whites have the highest suicide rates. The rate is particularly high for older adults and teens. Other high-risk groups include adolescent and young adult Alaskan Native and Native American males. Rates are not high for Hispanics or African Americans. Having access to a gun also increases the risk of suicide. The team must apply restraints to a combative patient to preven
A patient diagnosed with HTN has received the first dose of lisinopril. Which interventions will the RN delegate to the UAP? Select all that apply. a. restrict the patient to bed rest for at least 12 hours. b. recheck the patient's vital signs every 4-8 hrs c. ensure the call light is within the patients reach d. keep the patient's bed in a supine position with all side rails up e. remind the patient to rise slowly from the bed and sit before standing f. assist the patient to get out of bed and use the bathroom g. assess the patient for signs of dizziness.
Answer: b, c, e, and f Rationale: After the first dose of HTN medication dizziness is a common side effect. Remember dizziness is always a priority to follow up on with any patient. The patient should call for help when getting out of bed and the call light should be within easy reach. The patient should rise slowly, sitting on the side of the bed before standing, and then can be assisted to the bathroom. The UAPs scope of practice includes these actions. Patients are not restricted to bed rest or kept in a supine (flat) position, and side rails are not all kept up for the safety of the patient. Assessment is not within the scope of practice for a UAP. However, the RN can instruct the UAP to ask the patient about dizziness before and during ambulation and then report any dizziness immediately to the RN. It is important to monitor BP sitting and standing. The UAP should also be instructed to report the VS as the RN needs to be aware if there is orthostatic hypotension. Remember the definition of postural hypotension is a decrease in SPB of 20 mm or more and a decrease in DBP of 10 mm or more. If this is noted in any patient it is the RNs responsibility to follow-up.
We learn more about prioritization and delegation next week. Try this practice question about Stan and provide a rationale for options selected. Which of these activities can be safely delegated to the UAP? Select all that apply. Applying a pulse oximetry monitor Measuring his VS every 15 minutes Assessing peripheral circulation Monitoring hemoglobin and hematocrit levels Emptying the Foley catheter collection bag each hour Obtaining consent from K.L. for the blood transfusions
Answers: 1, 2, and 5. Activities that can be safely delegated to a UAP in this situation include noninvasive and nonsterile treatments such as emptying Foley catheters, collecting and reporting data such as VS, and initiating pulse oximetry monitoring. The nurse cannot delegate to the UAP any aspect of patient assessment, evaluation of the effectiveness of care, or any health counseling unless it is reinforcement of previously taught material.
What are nursing best practices for administering and reading a Mantoux test?
Mantoux tuberculin skin test (TST) is the standard method of determining whether a person is infected with Mycobacterium tuberculosis. Reliable administration and reading of the TST requires standardization of procedures, training, supervision, and practice. The TST is performed by injecting 0.1 ml of tuberculin purified protein derivative (PPD) into the inner surface of the forearm. The injection should be made with a tuberculin syringe, with the needle bevel facing upward. The TST is an intradermal injection. Use a single-dose tuberculin syringe with a ¼- to ½-inch, 27-gauge needle with a short bevel. Insert slowly, bevel up, at a 5- to 15-degree angle. When placed correctly, the injection should produce a pale elevation of the skin (a wheal) 6 to 10 mm in diameter. An induration of more than 5 mm is considered positive for individuals with decreased immunity. This includes HIV positive individuals, clients with organ transplants, recent contact with someone positive for TB, or other immunosuppressed clients. Less than 5mm diameter induration is considered negative. 10mm or > is considered positive in IV drug users, children less than 4 years of age, recent immigrants from high-prevalence countries, and residents/employees in high-risk congregate settings. More than 15mm diameter induration is considered positive in individuals with normal immunity. The PPD test should be read 2-3 days after administration. A positive response indicates the client may have been exposed to the TB bacteria or dormant disease.
What are the recommendations for patients with CRE regarding infection control/precautions?
Patients in ICUs, nursing homes, and those that are immunosuppressed are at high risk for CRE. The CDC recommends patients at high-risk for CRE be placed on contact precautions. Be sure you know what is required for contact precautions. Also, bathing in chlorhexidine is recommended to prevent CRE or decrease colonization and other infections from MDROs.
Students often score low on cancer questions with ATI. You should be familiar with radiation therapy for cancer patients including patient teaching, which is the responsibility of the RN. For patients receiving teletherapy (external) radiation for treatment of cancer, skin protection is very important. What does IGGY note as key education points to teach patients about protecting their skin during radiation therapy?
Teaching points for skin protection during radiation therapy: Wash the irradiated area gently each day with either water or a mild soap and water as prescribed by your radiation therapy team. Use your hand rather than a washcloth when cleansing the therapy site to be gentler. Rinse soap thoroughly from your skin. If ink or dye markings are present to identify exactly where the beam of radiation is to be focused, take care not to remove them. Dry the irradiated area with patting motions rather than rubbing motions; use a clean, soft towel or cloth. Use only powders, ointments, lotions, or creams on your skin at the radiation site that are prescribed by the radiation oncology department. Wear soft clothing over the skin at the radiation site. Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site. Avoid exposure of the irradiated area to the sun: ▪ Protect this area by wearing clothing over it. ▪ Try to go outdoors in the early morning or evening to avoid the more intense sun rays. ▪ When outdoors, stay under awnings, umbrellas, and other forms of shade during the times when the sun's rays are most intense (10 AM to 7 PM). Avoid heat exposure.
A nurse is preparing discharge teaching for a client with a diagnosis of gastroesophageal reflux disease (GERD). What would be important for the nurse to include in this teaching plan to help the client neutralize acid in the stomach and decrease reflux?
Teaching should focus on actions that will help either neutralize the acid in the stomach or decrease the physiologic reflux, which include: Avoid wearing constrictive clothing Remain upright for 1-2 hours after eating Sleep with the HOB elevated 6-12 inches Teach these patients to avoid eating for 3 hours before bedtime. Eating before going to bed will exacerbate GERD Avoid caffeine and spicy foods, which can exacerbate GERD
The nurse is planning care for a client scheduled for esophagogastroduodenoscopy (EGD) and a barium swallow in the am. What will the nursing care plan include?
The patient will be NPO before a barium swallow and an esophagogastroduodenoscopy (EGD). A clear liquid diet is appropriate the evening before the procedures. The client can consume liquids and solid meals as tolerated after procedure once the gag reflex returns.
The nurse is caring for a client who goes into ventricular tachycardia. Which intervention should the nurse implement first? a. Call a code immediately b. Assess the client for a pulse c. Begin chest compressions d. Continue to monitor the client
Yes, answer: b. The nurse must first determine if the client has a pulse. Remember if the patient is in VFib or VTach without a pulse, this IS a shockable rhythm and the priority is to defibrillate. Always locate the AED or crash cart before starting CPR. The nurse should call a code if the client does not have vital signs. Defibrillation is used when a client has ventricular fibrillation or pulseless ventricular tachycardia. Be sure you can recognize these shockable rhythms. Chest compressions (100 per minute with a ratio of 30:2 for compressions/breaths) are not the priority and are only done if the client is not breathing and has no pulse. vTach is a life-threatening dysrhythmia so continuing to monitor is not the priority. Pulseless ventricular tachycardia is treated as ventricular fibrillation - always defib the v-fib!
The nurse is working in a clinic. Four children with respiratory problems have arrived at the clinic and need to be assessed. Which child will the nurse assess first? 6-year-old with intermittent asthma who awoke with a cough for the last 8 nights. 7-year-old with exercise-induced asthma who has been short of breath while playing soccer. 12-year-old with mild persistent asthma who has used all of the prescribed rescue inhaler in the last 5 days. 14-year-old with moderate persistent asthma whose peak flows have dropped from 96% to 87% of the personal best.
Yes. Answer: 3 National guidelines state that the goal for asthma control is that patients will need to use the short-acting beta-agonist (SABA) medication two or less times per week; since this child has clearly used SABA very frequently, the asthma is not well controlled and the nurse should quickly assess parameters such as lung sounds, respiratory rate, respiratory effort, and oxygen saturation. The 6-year-old may have increasing airway inflammation, but the data do not indicate acute shortness of breath or possible hypoxemia. The 7-year-old is not at risk for dyspnea except when exercising. Although the peak flow for the 14-year-old is decreasing, it is still in the green zone of 80% to 100% of the personal best.
A client who had a stroke needs to be fed. What instruction should the nurse give to the unlicensed assistive personnel (UAP) who will feed the client? Provide a rationale for your response. Position the client sitting up in bed before feeding. Check the client's gag and swallowing reflexes. Feed the client quickly because there are three more clients to feed. Suction the client's secretions between bites of food.
correct. Answer: 1. Positioning the client in a sitting position decreases the risk of aspiration. Instructing the patient to also tilt their head forward will help decrease the risk of aspiration. 2 is not correct. The UAP is not trained to assess gag or swallowing reflexes. 3 is not correct. The client should not be rushed during feeding. 4 is not correct. A client who needs suctioning performed between bits of food is not handling secretions and is at risk for aspiration. This type of client would need to be assessed further by the RN or SLP before feeding. Tip: I recommend you are familiar with proper suctioning technique.
A patient tells the nurse, "My husband lost his job. He's abusive only when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me." What risk factor was most predictive for the husband to become abusive? Provide a rationale for your answer. History of family violence Loss of employment Abuse of alcohol Poverty
Yes. Answer: 1. An abuse-prone individual is an individual who has experienced family violence and was often abused as a child. This phenomenon is part of the cycle of violence. The other options may be present but are not as predictive. However, the consumption of alcohol or drugs has been frequently found within abusive relationships. Abuse victims often report that the abuser is very controlling of the victim or family activities, even to the point of paranoia. Abusers also tend to be very jealous or possessive. They gain power by using intimidation. Abusers isolate the victim from others. The abuser usually has low self-esteem and poor social skills. There is a real danger an abuser may kill the victim. Women often stay with their abusers due to economic reasons.
What is the difference in manifestations of Diabetes Insipidus (DI) and Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) and what are the treatments for these disorders?
DI is a water metabolism problem caused by ADH deficiency (either decrease in ADH synthesis or inability of kidneys to respond to ADH). Manifestations include polyuria, dehydration, fluid/electrolyte imbalances (elevated Na). These patients also have increased thirst. Keep in mind if the patients thirst mechanism is poor or absent, or if the patient cannot obtain water, dehydration becomes more severe and can lead to death. Ensure DI patients do not go over 4 hours without fluids d/t severe dehydration risk. Treatment is DDAVP as the preferred drug - Desmopressin acetate, which is a synthetic form of vasopressin and will decrease urine output. Teach patients with DI to weigh themselves daily to identify weight gain, watch for fluid overload/water retention. If more than 1kg gain or other signs of water toxicity (persistent headache, acute confusion) seek emergency help if they experience a persistent headache, acute confusion, nausea, vomiting. For SIADH, Vasopressin is secreted even when plasma osmolarity is low or normal. Water is retained, results in dilutional hyponatremia (decreased serum sodium level) and fluid overload. Manifestations of SIADH include decreased urine output, a decrease in plasma osmolarity, and low serum sodium levels. Interventions include fluid restriction (500-1000mL/24 hrs for some patients) and Vasopressin antagonists in patients with low Na levels. Hypertonic saline 3% may also be prescribed. Monitor for fluid overload in these patients, there is an increased risk of pulmonary edema & HF with older adults or those with cardiac, kidney, pulmonary, or liver problems. Watch for bounding pulse, increasing neck vein distention, crackles in lungs, increasing peripheral edema, and reduced urine output.
The nurse is caring for a client with a head injury and has developed increased intracranial pressure. What complications do we monitor for in patients with increasing ICP and what interventions are appropriate?
Manifestations of increased intracranial pressure include: Severe headache, nausea, vomiting Deteriorating level of consciousness, restlessness, irritability Dilated or pinpoint nonreactive pupils Cranial nerve dysfunction Alteration in breathing pattern (Cheyne‑Stokes respirations, apnea) Deterioration in motor function, abnormal posturing (decerebrate, decorticate, flaccidity) Cushing's triad is a late finding characterized by severe hypertension with a widening pulse pressure and bradycardia. Remember from 265, Cushing's triad indicates imminent death. Brain herniation may occur unless immediate action is taken to lower intracranial pressure. Implement actions that decrease ICP. Monitor for change in LOC or restlessness/agitation and report immediately. Make sure you are not performing any activities that would increase intracranial pressure. Elevate head at least 30°to reduce ICP and to promote venous drainage. Avoid extreme flexion, extension, or rotation of the head, and maintain the body in a midline neutral position. Maintain a patent airway. Provide mechanical ventilation as indicated. Administer oxygen as indicated to maintain PaO2 greater than 60 mm Hg. The client can be hyperventilated on mechanical ventilation to decrease ICP. The client should receive stool softeners and avoid the Valsalva maneuver with increased ICP. Report presence of CSF from nose or ears to the provider. Provide a calm, restful environment. (Limit visitors. Minimize noise.) Implement measures to prevent complications of immobility (turn every 2 hr, footboard, and splints). Monitor fluid and electrolyte values and osmolality to detect changes in sodium regulation, onset of diabetes insipidus, or severe hypovolemia. A high urine output suggests diabetes insipidus, a common complication of intracranial trauma. Provide adequate fluids to maintain cerebral perfusion and to minimize cerebral edema. When a large amount of IV fluids are prescribed, monitor for excess fluid volume which could increase ICP. Maintain safety and seizure precautions (side rails up, padded side rails, call light within the client's reach). Even if the level of consciousness is decreased, explain to the client the actions being taken and why. (Hearing is the last sense affected by a head injury.) Mannitol, furosemide, and opioids are commonly prescribed for TBI patients. Mannitol is an osmotic diuretic used to treat cerebral edema. When used for increased ICP, the medication draws fluid from the brain into the blood.
You learned about teaching for patients with Diabetes in NUR242. Expect questions on ATI, Comps, and NCLEX on care of patients with Diabetes. What are important teaching points for patients with diabetes regarding exercise?
See page 1301 in IGGY, chart 64-4. You should know these teaching points. It's important that patients understand to consume a carb snack before exercising to prevent hypoglycemia if it's been more than 1 hour since they had a meal or if they will be doing high intensity exercise. Also, teach these patients to avoid exercise if their glucose is not between 80-250. Ketones in urine is another contraindication for exercise. It's also important to avoid exercise during times insulin peaks or within 1 hr of insulin injection. They should keep a simple sugar snack available during exercise in case of hypoglycemia.
The nurse is providing teaching on home monitoring for an adult patient prescribed digoxin. What are the most important points the nurse needs to include in patient education?
See pages 535-537 in your Kee Pharmacology book. I recommend you know teaching for patients prescribed digoxin. Checking apical pulse rate for a full minute is important. Withhold dose and notify health care professional if pulse rate is <60 bpm in an adult, <70 bpm in a child, or <90 bpm in an infant. Digoxin has a narrow therapeutic range and side effects are seen in 10-20% of all cases. Teach patient the importance of monitoring for s/s of dig toxicity (anorexia, n/v, visual disturbances, brady) and to report. Children should have levels drawn monthly. Low serum K levels increase the risk of dig toxicity, monitor for hypokalemia. As noted in the nursing process box of the Kee textbook advise patients to eat foods high in potassium. These include fruits (fresh, dried, juices) and vegetables including potatoes.
Which statement indicates that a client with COPD correctly understands home discharge instructions? "I will avoid direct contact with others when I experience increased shortness of breath" "I will implement measures to decrease pain when I experience increased shortness of breath" "I will use oxygen via nasal cannula at 5L/min when I experience increased shortness of breath" "I will call my healthcare provider if I experience increased shortness of breath with exertion"
Yes, answer: 4. Increasing dyspnea on exertion indicates the client may be experiencing complications of COPD and the provider should be notified. 1 is not correct. It is not necessary to avoid being around others. 2 is not correct. Pain is not a common symptom of COPD. 3 is not correct. Clients with COPD use low-flow oxygen supplementation at 1-2L/min to avoid suppressing the respiratory drive, which is stimulated by hypoxia for those with COPD.
