day 1 nclex bible

Congestive heart failure manifestations

- impaired myocardial function: tachycardia, fatigue, weak pulses, hypotension, cardiomegaly -abnormal heart sounds: s3/s4 gallop -exercise intolerance - pulmonary congestion: dyspnea, orthopnea, cyanosis, wheezing, nasal flaring, adventitious lung sounds - systemic venous congestion: weight gain, hepatomegaly, peripheral edema, ascites and neck vein distention

dexamethasone

-Decadron Corticosteroid

how is delerium different from dementia

-delerium is acute and reversible, it is characterized by changes in memory, judgment, language, mathematical calculation, abstract reasoning, and problem-solving ability. The most common causes of delirium are infection, medications, and dehydration. -dementia develops over time, with a slow progression of cognitive decline. Dementia is not a specific disease but is rather a general term for the impaired ability to remember, think, or make decisions that interferes with doing everyday activities. Main causes of dementia is alzheimer's, lewy bodys & huntingtons

what are common causes of afib

-heart disease -pulmonary disease -stress -alcohol -caffeine

how would you describe how afib looks on an ekg

-irregularly irregular -no p wave, but there is a qrs

what does partially compensated mean

-pH is abnormal -both CO2 & HCO3 are abnormal. One is causing the problem, the other is actively fixing it. you know it is trying to fix it because both are abnormal, but it is only partially compensated & not fully compensated because the pH is still abnormal

what does fully compensated mean

-pH is normal -both CO2 & HCO3 are abnormal. One is causing the problem, the other is actively fixing it. you know it is compensating well because the pH is normal.

what is normal dig level

0.5-2

normal Cr

0.6-1.2

a child should learn to walk by what age

1 10-18 months

what are the steps for using a metered dose inhaler without a spacer?

1) Tilt the client's head back slightly. 2) Have the client open his or her mouth; position the inhaler 1 to 2 inches away from the client's mouth. Some clients may measure this distance as 1 to 2 finger widths for self-administration. This is considered the best way to use the MDI without a spacer. 3) Alternatively, the client may place the inhaler mouthpiece in the mouth with the opening toward the back of the throat. 4) Have the client exhale completely 5) Press down once on the inhaler to release the medication 6) Have the client breathe in slowly and deeply for 5 seconds. 7) Have the client hold his or her breath for approximately 10 seconds 8) Exhale slowly through the nose or pursed lips.

how does cushing's disease affect sodium, potassium, blood glucose and blood pressure?

1) hypernatremia 2) hypokalemia 3) hypertension 4) hyperglycemia

for clients with hf, they should report a weight gain of _____ lbs overnight or _________ in a week

1-2 lbs in a night, 3-5 lbs in a week

what are the 6 Ps of compartment syndrome

1.) Pain (present on passive movement and out of proportion to injury) 2.) Paresthesias (numbness, tingling, decreased sensation) 3.) Pallor (or cyanosis) 4.) Pressure (firm feeling muscle compartment, elevated pressure reading) 5.) Paralysis (late, ominous sign) 6.) Pulselessness (very late, ominous sign)

Platelet transfusions are traditionally used when a client's platelet counts are less than

10,000 or the patient has an acute life threatening bleeding episode

people that are obese should gain how many lbs during pregnancy

11-20 lbs

A suction setting of _____ mmHg is the upper limit for children aged 24 months and older.

120

a fasting blood glucose level greater than ______ mg/dL requires further testing for diabetes mellitus

126

normal sodium

135-145

If GFR is below _____, we need to know that it is an indication of kidney failure

15

people that are overweight should gain how many lbs during pregnancy

15-25 lbs

normal platelet count

150,000-400,000

what is considered dig toxicity

2.5

people that are of normal weight should gain how many lbs during pregnancy

25-35 lbs

people that are underweight should gain how many lbs during pregnancy

28-40 lbs

normal potassium

3.5-5

how should fluids be taken before/during/after meals if you have dumping syndrome?

30 mins-1 hr after

normal hematocrit for females and males

37%-47% for females 42-52% for males

normal wbcs

5,000-10,000

what is considered an a1c of pre diabetes

5.7-6.4%

a child should be sitting up by what age

6 months

normal BUN

6-20

for newborns and neonates, tracheostomies should be suctioned using _______ mmhg

60-80

Threshold to transfuse pt with RBCS is when hemoglobin drops below

7

normal blood pH

7.35-7.45

normal fasting glucose

70-110

For infants and children up to 24 months, tracheostomies should be suctioned using _______ mmhg

80-100

a child should be crawling by what age

9 months

When assessing self-perception, the nurse should ask the client which of the following? A. "How would you describe yourself?" B. "What gives you hope when times are troubled?" C. "Is your normal way of dealing with stress helpful to you?" D. "Are you having difficulty handling any family problems?" Subject Fundamentals Lesson Basic Care & Comfort Client Need Area Psychosocial Integrity 4844

A. "How would you describe yourself?" Choice A is correct. Assessment of self-perception focuses on how the patient thinks of himself/herself. Choices B, C, and D are incorrect. Role addresses the daily duties or tasks. Values address important big concepts of life and death. Coping is in response to a stressor. 82% correct

The nurse is educating a diabetic client regarding foot care. Which of the following statements by the client indicates that he understood the nurse's instructions? Select all that apply. A. "I need to check my feet daily for sores, blisters, dry skin, and cuts." B. "I need to wash my feet daily and keep them dry." C. "If I get sores or blisters on my feet, I should not pop them." D. "I need to apply cream to my heels and between my toes daily." Subject Adult Health Lesson Endocrine Client Need Area Basic Care and Comfort 5118

A. "I need to check my feet daily for sores, blisters, dry skin, and cuts." B. "I need to wash my feet daily and keep them dry." C. "If I get sores or blisters on my feet, I should not pop them." Choices A, B, and C are correct. These statements indicate that the client correctly understood the instructions. Due to the deficit in nerve sensation, some diabetic patients may not feel the ache of a blister or the sting of a cut on their feet. Vascular changes in diabetic patients may cause decreased perfusion of the tissues in the feet. If a wound of any type occurs, it may be slower to heal. Therefore, prevention is the best tool to protect a diabetic patient. It is important that the nurse teach diabetic foot care and ensure that the client has a clear understanding of the risks associated with poor foot care. The patient should be taught to check his feet daily for any signs of blisters, sores, or dryness, which can cause cracking (Choice A). The patient should keep the feet dry and this will prevent chafing from moisture (Choice B). A blister or sore should never be opened. If opened it may create a non-healing open wound because the healing time for a diabetic patient is often delayed (Choice C). Choice D is incorrect. Thin creams or lotions can be applied on the tops and bottoms of feet to keep the feet soft and prevent cracking. However, creams should not be applied between the toes because it promotes moisture, which can lead to chafing, blisters, and open wounds. Moisture between toes may also predispose to fungal infections. Instead, the skin between the toes should be kept dry by sprinkling talcum powder or cornstarch between the toes. 65% correct

A 13-year-old girl diagnosed with acute lymphoblastic leukemia (ALL) is worried about the side effects of her new steroid medications. Which of the patient's following statements indicates to the nurse that the adolescent understands the steroids' side effects? Select all that apply. A. "I will have more water in my body, so I might look puffier." B. "It might hurt to go to the bathroom." C. "I might soon get bruises more easily than before." D. "This medicine might make me moody." Subject Pharmacology Lesson Hematological/Oncological Client Need Area Pharmacological and Parenteral Therapies 5812

A. "I will have more water in my body, so I might look puffier." D. "This medicine might make me moody." Choices A and D are correct. Steroids can cause fluid retention (Choice A) and often result in "puffiness" from the excess fluid. This is often seen in the face and sometimes described as a moon face. The nurse should validate this concern of her adolescent patient and explain why she might experience this. It is essential, to be honest with teenage patients to help them cope with the side effects. Mood swings (Choice D) are a known side effect of corticosteroids. They can cause irritability, anxiety, and depression. It is essential to educate the adolescent client about this side effect and reinforce that she should ask for help if she feels overwhelmed. The parents should also be educated about this side effect to know to expect mood swings and are ready to help their adolescent. Choice B is incorrect. Steroids do not cause constipation, dysuria, or any other pain related to going to the bathroom. The nurse should reinforce education with this adolescent and assure her that she should not experience this. Choice C is incorrect. Steroids do not directly cause bruising. Long-term steroids may thin the skin and predispose to easy bruising. However, newly started steroid therapy should not thin the skin immediately. More immediate side effects include fluid retention, steroid acne, hyperglycemia, and mood swings. Steroids do not cause a decrease in platelets or clotting factors that would cause more frequent bruising immediately. However, due to her acute lymphoblastic leukemia (ALL) diagnosis, she may have decreased platelets because of her cancer. This could cause her to bruise more often, so she may misunderstand the cause of this. The nurse should educate this adolescent about her disease process and what could occur and ensure that the steroid medication does not immediately increase bruising. 35% correct

Which of the following statements by a patient who was recently placed in a cast on the right lower extremity should be the most alarming to the nurse? A. "I've been having pain in my right calf." B. "My right leg feels really itchy." C. "I didn't keep my leg elevated as the doctor asked me to." D. "When I put weight on my crutches, it makes the arthritis in my wrists ache." Subject Adult Health Lesson Musculoskeletal Client Need Area Reduction of Risk Potential 4640

A. "I've been having pain in my right calf." 6 ps of compartment syndrome: pain, paresthesias, pallor, pressure, paralysis, pulselessness Choice A is correct. Pain in the casted extremity could indicate neurovascular compromise. Patients who have been cast should be educated on safety measures and signs of complications before discharge from care. It is not uncommon for the skin inside a cast to itch. However, any signs of neurovascular compromise should be immediately reported. Any time a patient reports pain in a casted extremity, this is an alarming sign that requires immediate assessment/intervention. Patients should be instructed to report pain, tingling, and edema in the extremity that is greater than before the cast was applied, or if the cast feels too loose. Choice B is incorrect. Itching is not an immediate reason for alarm. Heat and sweat will cause the skin under the cast to itch. Patients should be instructed to keep the cast and surrounding skin fresh, clean, and dry. Choice C is incorrect. This answer does indicate a need for further education but is not a sign of immediate distress. Patients should be encouraged to keep the injured limb elevated, especially during the first 48 hours following injury and casting. Elevation helps to decrease swelling and pain at the site of injury. Choice D is incorrect. Although the patient is experiencing pain, this answer option is no reason for alarm. Instead, the patient may need to be educated on how to use crutches properly. Some discomfort is reasonable because the hands and arms were not meant to hold the weight of the entire body. However, with proper instruction on how to use crutches, the patient's discomfort may be reduced. 83% correct

You are attending to a male client who is postoperative day one following mitral valve replacement. He is getting ready to ambulate for the first time. His heart rate is 102 beats/minute and the stroke volume based on the echocardiogram is 72 mL. Which of the following represents his cardiac output (CO)? A. 7.344 L/min B. 30 L/min C. 55% D. 73.444 mL/min Subject Adult Health Lesson Cardiovascular Client Need Area Physiological Adaptation 4897

A. 7.344 L/min CO = HR x SV HR= 102 BPM SV=72 ML, but we need the answer in L/min so it is 72/1000 or 0.072 L CO=102x0.072=7.344 l/min 50% correct

The nurse is triaging phone calls for the primary healthcare provider (PHCP). Which client situation requires immediate notification to the PHCP? A. A client with heart failure that reports an overnight weight gain of three pounds. B. A client with peritoneal dialysis who has not had a bowel movement in two days. C. A client with irritable bowel syndrome (IBS) that reports frequent diarrhea. D. A client with nephrolithiasis that reports bloody urine and flank pain. Subject Leadership & Management Lesson Prioritization Client Need Area Management of Care 6977

A. A client with heart failure that reports an overnight weight gain of three pounds. Choice A is correct. The PHCP should be immediately notified about the client who gained three pounds overnight. Two pounds convert to one kilogram, and that converts to one liter of fluid. Thus, this client is retaining a significant amount of fluid and requires immediate follow-up to ensure they do not develop complications such as pulmonary edema. Choices B, C, and D are incorrect. A client with peritoneal dialysis should be evaluated for their complaints of constipation because it is a major cause of poor outflow. A client with IBS reporting frequent diarrhea is an expected finding, as this condition is manifested by constipation, diarrhea, and abdominal spasms. Nephrolithiasis characteristically presents with hematuria and flank pain. Each client calls about symptoms expected with the corresponding disease process; thus, they do not need to be reported immediately to the PHCP. 79% correct

This nurse is caring for a client who is receiving prescribed cilostazol. Which of the following findings would indicate a therapeutic response? A. Absence of pain while ambulating B. Decreased total cholesterol C. Increased visual acuity D. Improved focus and attention Subject Fundamentals Lesson Medication Administration Client Need Area Pharmacological and Parenteral Therapies 7483

A. Absence of pain while ambulating Choice A is correct. Cilostazol is a phosphodiesterase inhibitor approved to treat peripheral arterial disease. Its action mechanism decreases platelet aggregation and promotes vasodilation, allowing a client to ambulate distances without pain. Choices B, C, and D are incorrect. Cilostazol is not utilized to mitigate total cholesterol levels. Further, this medication does not improve visual acuity or attention. 31% correct

The nurse is witnessing a client provide informed consent. The client is demonstrating which ethical principle? A. Autonomy B. Justice C. Paternalism D. Veracity Subject Leadership & Management Lesson Ethical/Legal Client Need Area Management of Care 6461

A. Autonomy Choice A is correct. By a client providing their consent, this is respecting their decision and, thus, their autonomy. This ethical principle exemplifies the patient's self-determination and ability to make their own choices without interference or coercion. Choices B, C, and D are incorrect. Justice refers to the equality and the nurse to provide care to individuals regardless of cost or other factors. Paternalism refers to taking a course of action (or treatment) guided by someone else in the client's best interest. Veracity refers to telling the truth and not being deceptive.

The nurse is caring for a 3-year-old newly diagnosed with acute lymphoblastic leukemia (ALL). While talking to the family, which of the following educational points does the nurse know to reinforce based on the child's diagnosis? Select all that apply. A. Bleeding precautions B. Contact precautions C. Neutropenic precautions D. Sternal precautions Subject Child Health Lesson Hematological/Oncological Client Need Area Physiological Adaptation 5811

A. Bleeding precautions C. Neutropenic precautions Choices A and C are correct. Bleeding precautions are an essential educational point for a patient with ALL. Due to the excess of blast cells, their platelet count will drop. With decreased platelets, it will take the patient longer than usual to clot, leading to an increased bleeding risk (Choice A). Neutropenic precautions are essential to discuss with the family of a child with ALL. Since the child has a low absolute neutrophil count and a high blast percentage, their ability to fight infections will be severely impaired. This means that special precautions need to be in place to protect the child from disease. These neutropenic precautions include no fresh flowers or plants in the room; all visitors should wash their hands before entering the room and wear a mask, no sick visitors, and keep the door closed (Choice C) Choice B is incorrect. Contact precautions are not necessary for a patient with ALL. Contact precautions would be used for a disease that is spread from person to person via contact with the infectious agent, such as MRSA. ALL is not a contagious disease that can be transmitted from person to person, so contact precautions are unnecessary. Choice D is incorrect. Sternal precautions are unnecessary for the patient with ALL. Sternal precautions are put in place after an incision is made on the sternum during cardiothoracic surgery. It is to prevent excessive pulling and tension on these sutures while the sternum heals. The patient with ALL does not need sternal precautions. 61% correct

The nurse is caring for a client receiving a continuous infusion of norepinephrine. The nurse should plan to monitor which of the following for the client? Select all that apply. A. Blood pressure B. Intracranial pressure C. Intravenous site D. Urine output E. Blood glucose Subject Pharmacology Lesson Cardiovascular Client Need Area Pharmacological and Parenteral Therapies 6557

A. Blood pressure C. Intravenous site D. Urine output E. Blood glucose Choices A, C, D, and E are correct. An infusion of norepinephrine is indicated if the client is in shock. This medication helps restore vascular tone and is useful in treating life-threatening hypotension. This medication is a vesicant, and the preferred delivery is through a central line. If this is not possible, a large-bore intravenous catheter should be utilized. The patency of this catheter should be assessed frequently to prevent damaging extravasation. Blood pressure needs to be monitored continuously while this medication is administered to assess the desired response of increased vascular tone. This medication causes vasoconstriction, which decreases renal blood flow, thereby decreasing urine output. Norepinephrine causes an increase in blood glucose. Choice B is incorrect. Norepinephrine is a medication used in the management of shock. The nurse must monitor the client's blood pressure, intravenous site, urine output, and blood glucose. One of the monitoring parameters not indicated is intracranial pressure (ICP) - this would be more applicable if the medication was mannitol. 10% correct

The nurse is assessing a client who has Raynaud's phenomenon. Which of the following would be an expected finding? A. Digit color changes B. Flapping hand tremor C. Painless skin ulcers D. Janeway lesions Subject Adult Health Lesson Immune Client Need Area Physiological Adaptation 6924

A. Digit color changes Choice A is correct. Raynaud's phenomenon (RP) results from vascular spasms in the fingers that are triggered by cold temperatures and emotional stress. Choices B, C, and D are incorrect. Flapping hand tremor is referred to as asterixis and is a manifestation associated with hepatic encephalopathy. Painless skin ulcers are a common feature associated with venous insufficiency, not RP. Janeway lesions are findings consistent with infective endocarditis. 73% correct

When an elderly home health client suddenly develops delirium, what is the first thing the home health nurse should assess for? A. Drug intoxication B. Increased hearing loss C. Cancer metastases D. Congestive heart failure Subject Adult Health Lesson Neurologic Client Need Area Reduction of Risk Potential 4607

A. Drug intoxication Choice A is correct. Drug intoxication, from prescription or OTC medications, is more common in the elderly, due to slower metabolism and absorption. Combinations of digoxin, diuretics, analgesics, and anticholinergics should be examined. Delirium is an acute and reversible syndrome. It is characterized by changes in memory, judgment, language, mathematical calculation, abstract reasoning, and problem-solving ability. The most common causes of delirium are infection, medications, and dehydration. Some symptoms of delirium include: Hallucinations Restlessness, agitation, or combative behavior Calling out, moaning, or making other sounds Being quiet and withdrawn — especially in older adults Slowed movement or lethargy Disturbed sleep habits Reversal of night-day sleep-wake cycle Choices B, C, and D are incorrect. Although the other options can lead to delirium, the onset is gradual, not sudden. 84% correct

The nurse performs a physical assessment on a client. Which of the following would the nurse recognize as a technique of inspection? Select all that apply. A. Ecchymosis to sacral area. B. Foul odor noted to urine. C. Jugular veins distended. D. Abdomen is tympanic. E. Bowel sounds hyperactive. Subject Fundamentals Lesson Basic Care & Comfort Client Need Area Health Promotion and Maintenance 5112

A. Ecchymosis to sacral area. B. Foul odor noted to urine. C. Jugular veins distended. Choices A, B, and C are correct. Assessing that the client has bruising over the sacral area is achieved by visually inspecting the skin. Noting the presence of a foul odor is an example of inspection that uses the sense of smell. The nurse would inspect the client's neck to note visible jugular vein distension. Choices D and E are incorrect. Assessment of tympany in the abdomen is obtained through percussion and is typically observed over areas of air-filled organs such as the intestines. Assessment of the bowel sounds is obtained through auscultation with a stethoscope. Inspection is the first step in a physical assessment and describes the process of obtaining purposeful observations about a client using the senses of vision, hearing, and smell. 48% correct

A nurse is assigned to care for a 2-year-old who is newly diagnosed with acute lymphocytic leukemia. Which action should be included in the client's plan of care that is directed to facilitate growth and development in the acutely ill toddler? A. Focus on educating parents to minimize anxiety over the parenting of the child. B. Make sure that the toddler is informed in advance of what is to take place in a procedure. C. Isolate child from parents, especially if there are temper tantrums. D. Encourage regression to a previous developmental level for familiarity and comfort. Subject Child Health Lesson Hematological/Oncological Client Need Area Health Promotion and Maintenance 2741

A. Focus on educating parents to minimize anxiety over the parenting of the child. Choice A is correct. When a toddler is acutely ill, it is best to have parents who are not overly anxious and can work well with hospital personnel. It is, therefore, best to exert effort in educating the parents in this case. Choices B, C, and D are incorrect. Choice B is not an appropriate action because a toddler's thinking is concrete and tangible, and the toddler cannot think beyond the observable. Preparation should be done immediately before the procedure. Temper tantrums are a standard developmental characteristic of a 2-year-old, and the parents must hold her to alleviate fear. Isolating the toddler from her parents is not a therapeutic approach. Choice C is, therefore, incorrect. A toddler may regress during hospitalization but will not facilitate comfort. Choice D is an inappropriate action. 52% correct

Your client has a stat order for a cooling or hypothermia blanket. After you call the appropriate department, the cooling blanket is delivered to your nursing care unit. What is the first thing you should do concerning this stat order? A. Inspect and run the equipment prior to use. B. Immediately use the cooling blanket for the client because it is a stat order. C. Ask the engineering department to perform preventive maintenance on it. D. Inspect the blanket for any frayed cords before to protect against fire. Subject Fundamentals Lesson Safety/Infection Control Client Need Area Safety & Infection Control 2390

A. Inspect and run the equipment prior to use. Choice A is correct. You must thoroughly inspect and run the equipment before use to ensure that it is appropriately functioning BEFORE it is used. This inspection should include an overall assessment for frayed electrical cords and documented evidence that the piece of equipment has had the mandated preventive maintenance and safety inspections according to the facility's policies and procedure. Choice B is incorrect. You would not immediately use the cooling blanket for the client just because it is a stat order because other preventive measures must be taken first before using it. Choice C is incorrect. You would not ask the engineering department to perform preventive maintenance because you should be able to see documented evidence that the preventive maintenance was done on the sticker that is affixed to the piece of equipment. Choice D is incorrect. You would not merely inspect the blanket for any frayed cords before use to protect against fire. 54% correct

The nurse is taking care of a client that is scheduled to undergo a gastric analysis at 8:00 AM tomorrow. Which should be included in the client's plan of care? A. Instruct the client that she should not eat or drink anything after midnight. B. Teach the client that in case she feels hungry, she can chew some gum. C. Instruct the client that she needs to be on bed rest for 2 hours after the procedure. D. Tell the client that she is allowed to smoke 1 hour prior to surgery. Subject Adult Health Lesson Gastrointestinal/Nutrition Client Need Area Reduction of Risk Potential 3469

A. Instruct the client that she should not eat or drink anything after midnight. Choice A is correct. The gastric analysis involves the insertion of a nasogastric tube (NGT) and aspiration of gastric contents for analysis of pH, appearance, and volume. The patient needs to be on NPO (nothing by mouth) for 8 - 12 hours before the test. Choice B is incorrect. The use of tobacco and chewing gum is avoided for 6 hours before the test. Choice C is incorrect. The client can resume her normal activities right after the test and does not need to be on bed rest. Choice D is incorrect. The use of tobacco and chewing gum is avoided for 6 hours before the test. 86% correct

A gastrointestinal disease of childhood where a piece of bowel goes backward inside itself forming an obstruction is called what? A. Intussusception B. Pyloric stenosis C. Hirschsprung's disease D. Omphalocele Subject Child Health Lesson Gastrointestinal/Nutrition Client Need Area Physiological Adaptation 5326

A. Intussusception Choice A is correct. A gastrointestinal disease of childhood where a piece of bowel goes backward inside itself, forming an obstruction, is called intussusception. Choice B is incorrect. Pyloric stenosis is the enlargement and stiffening of the pylorus, the opening from the stomach into the duodenum. This prevents the passage of food into the duodenum and results in projectile vomiting. Choice C is incorrect. Hirschsprung's disease is a congenital anomaly that results in mechanical obstruction. Choice D is incorrect. Omphalocele is a congenital disability in which an infant's intestine or other abdominal organs are outside of the body, protruding through a hole in the umbilical region. 75% correct

The nurse is caring for a client who has just been diagnosed with severe acne vulgaris. Which of the following medications should the nurse anticipate the primary health care provider (PHCP) will prescribe? A. Isotretinoin B. Acyclovir C. Ketoconazole D. Ethambutol Subject Pharmacology Lesson Integumentary Client Need Area Pharmacological and Parenteral Therapies

A. Isotretinoin Choice A is correct. Isotretinoin is approved for the treatment of moderate to severe acne vulgaris. Choices B, C, and D are incorrect. Acyclovir is an antiviral indicated for the treatment of herpes infections. Ketoconazole is an antifungal medication that may be used for fungal infections and is available in various preparations. Ethambutol is a medication indicated in the treatment of pulmonary tuberculosis. None of these medications are indicated in the treatment of acne vulgaris. 74% correct

While reviewing the client's medication list, the nurse understands which of the following prescribed medication (s) is/are classified as calcium channel blocker (s)? Select all that apply. A. Nifedipine B. Propranolol C. Verapamil D. Hydralazine Subject Pharmacology Lesson Cardiovascular Client Need Area Pharmacological and Parenteral Therapies 4879

A. Nifedipine C. Verapamil Choices A and C are correct. Nifedipine and verapamil are calcium channel blockers ( CCBs). Other CCBs include amlodipine, nicardipine, felodipine, and diltiazem. CCBs are broadly classified into dihydropyridine and non-dihydropyridine classes. The dihydropyridine calcium channel blockers ending with the suffix "-dipine" are more selective to the vascular system. They cause systemic vasodilation and are, therefore, used to decrease blood pressure ( treat hypertension). These agents also cause coronary vasodilation and consequently increase the blood flow to the myocardium. Increasing blood flow to the myocardium decreases anginal symptoms, another common reason nifedipine is prescribed (Choice A). However, due to systemic vasodilation, one of the most common side effects of these CCBs with the suffix "-dipine" is "reflex tachycardia." Because of this reflex increase in the heart rate and increased myocardial oxygen demand, the "-dipine" class has limited effectiveness in angina. Using a concomitant β-blocker can overcome this side effect. Verapamil ( Choice C) is a non-dihydropyridine calcium channel blocker that is relatively selective to the myocardium. Verapamil acts by reducing myocardial contractility ( negative inotropy) and is often used to treat angina. Tachycardia is detrimental in angina because increased heart rate increases myocardial oxygen demand. Verapamil is a preferred CCB in treating angina because it does not cause much vasodilation and hence, very minimal reflex tachycardia. Choice B is incorrect. β-blockers can be identified by their suffix ending with "-lol." Propranolol is a non-selective β-blocker. β-blockers block β- adrenergic receptors ( β1 and β2) in various body sites. β-1 receptors are present in the myocardium and kidneys whereas, β-2 are present in bronchial, uterine, vascular, and gastrointestinal smooth muscles. The catecholamines (epinephrine and norepinephrine) function via. β-receptors. Typically, catecholamines ( fight or flight hormones) increase blood pressure, increase pulse, increase contractility, and cause vasoconstriction ( remember - catecholamines increase everything). Therefore, blocking β-receptors decreases them all - reduces blood pressure, heart rate, myocardial contractility, and causes systemic vasodilation. β-blockers are classified into - selective ( atenolol, metoprolol) and non-selective ( propranolol, sotalol, nadolol, labetalol, carvedilol). The selective β-blockers selectively block β-1 receptors while sparing β-2. Therefore, selective β-1 blockers are preferred in treating hypertension, cardiac arrhythmias, angina, and congestive heart failure. The use of β-blockers in congestive heart failure (CHF) warrants further discussion because they have negative inotropic action ( reduces myocardial contractility and thereby reduces ejection fraction). β-blockers should not be used in acute CHF ( decompensated CHF/ CHF exacerbation) because they may worsen the symptoms by acutely reducing the ejection fraction. However, β-blockers are used as adjunctive therapy to ACE inhibitors ( ACEI)/ angiotensin receptor blockers (ARBs) and diuretics ( furosemide) in stable, compensated CHF. Numerous studies have shown β-blockers reduce morbidity and mortality in compensated, stable CHF. In clients with concomitant asthma and chronic obstructive pulmonary disease (COPD), non-selective β-blockers may worsen the respiratory symptoms by blocking β-2 receptors in the airChoices A and C are correct. Nifedipine and verapamil are calcium channel blockers ( CCBs). Other CCBs include amlodipine, nicardipine, felodipine, and diltiazem. CCBs are broadly classified into dihydropyridine and non-dihydropyridine classes. The dihydropyridine calcium channel blockers ending with the suffix "-dipine" are more selective to the vascular system. They cause systemic vasodilation and are, therefore, used to decrease blood pressure ( treat hypertension). These agents also cause coronary vasodilation and consequently increase the blood flow to the myocardium. Increasing blood flow to the myocardium decreases anginal symptoms, another common reason nifedipine is prescribed (Choice A). However, due to systemic vasodilation, one of the most common side effects of these CCBs with the suffix "-dipine" is "reflex tachycardia." Because of this reflex increase in the heart rate and increased myocardial oxygen demand, the "-dipine" class has limited effectiveness in angina. Using a concomitant β-blocker can overcome this side effect. Verapamil ( Choice C) is a non-dihydropyridine calcium channel blocker that is relatively selective to the myocardium. Verapamil acts by reducing myocardial contractility ( negative inotropy) and is often used to treat angina. Tachycardia is detrimental in angina because increased heart rate increases myocardial oxygen demand. Verapamil is a preferred CCB in treating angina because it does not cause much vasodilation and hence, very minimal reflex tachycardia. Choice B is incorrect. β-blockers can be identified by their suffix ending with "-lol." Propranolol is a non-selective β-blocker. β-blockers block β- adrenergic receptors ( β1 and β2) in various body sites. β-1 receptors are present in the myocardium and kidneys whereas, β-2 are present in bronchial, uterine, vascular, and gastrointestinal smooth muscles. The catecholamines (epinephrine and norepinephrine) function via. β-receptors. Typically, catecholamines ( fight or flight hormones) increase blood pressure, increase pulse, increase contractility, and cause vasoconstriction ( remember - catecholamines increase everything). Therefore, blocking β-receptors decreases them all - reduces blood pressure, heart rate, myocardial contractility, and causes systemic vasodilation. β-blockers are classified into - selective ( atenolol, metoprolol) and non-selective ( propranolol, sotalol, nadolol, labetalol, carvedilol). The selective β-blockers selectively block β-1 receptors while sparing β-2. Therefore, selective β-1 blockers are preferred in treating hypertension, cardiac arrhythmias, angina, and congestive heart failure. The use of β-blockers in congestive heart failure (CHF) warrants further discussion because they have negative inotropic action ( reduces myocardial contractility and thereby reduces ejection fraction). β-blockers should not be used in acute CHF ( decompensated CHF/ CHF exacerbation) because they may worsen the symptoms by acutely reducing the ejection fraction. However, β-blockers are used as adjunctive therapy to ACE inhibitors ( ACEI)/ angiotensin receptor blockers (ARBs) and diuretics ( furosemide) in stable, compensated CHF. Numerous studies have shown β-blockers reduce morbidity and mortality in compensated, stable CHF. In clients with concomitant asthma and chronic obstructive pulmonary disease (COPD), non-selective β-blockers may worsen the respiratory symptoms by blocking β-2 receptors in the airway. Cardio-selective β-blockers like metoprolol and bisoprolol are preferred agents in CHF. However, despite being a non-selective β-blocker, carvedilol is one of the most preferred agents in stable CHF. Carvedilol is thought to help CHF patients by causing remodeling of the heart. Choice D is incorrect. Hydralazine is a direct vasodilator. The "-dipine" calcium channel blockers also cause vasodilation, but they work differently. Calcium channel blockers block the calcium channels in the vascular smooth muscle whereas, vasodilators like hydralazine act directly on the peripheral arterial vessels to cause vasodilation. Both CCBs and direct vasodilators lower blood pressure, but by different mechanisms.way. Cardio-selective β-blockers like metoprolol and bisoprolol are preferred agents in CHF. However, despite being a non-selective β-blocker, carvedilol is one of the most preferred agents in stable CHF. Carvedilol is thought to help CHF patients by causing remodeling of the heart. Choice D is incorrect. Hydralazine is a direct vasodilator. The "-dipine" calcium channel blockers also cause vasodilation, but they work differently. Calcium channel blockers block the calcium channels in the vascular smooth muscle whereas, vasodilators like hydralazine act directly on the peripheral arterial vessels to cause vasodilation. Both CCBs and direct vasodilators lower blood pressure, but by different mechanisms. 58% correct

You are caring for a 12-year-old patient with a history of seizures. During her stay, you notice that she begins staring blankly. During this period, you are unable to get her attention, and she does not speak. You suspect that this is a: A. Petit mal seizure B. Simple partial seizure C. Grand mal seizure D. Myoclonic seizure Subject Child Health Lesson Neurologic Client Need Area Physiological Adaptation 4409

A. Petit mal seizure Choice A is correct. The petit mal (or absence) seizure is characterized by blank staring and an impaired level of consciousness. This type of seizure usually begins between the ages of 3 and 15 years. Choice B is incorrect. In the simple partial (or Jacksonian) seizure, the patient will be in an awake state but will exhibit abnormal motor or autonomic behaviors that can affect any part of the body. Choice C is incorrect. The grand mal (or tonic-clonic) seizure is the type of seizure in which there is a rapid extension of the arms and legs with sudden jerking and eventual loss of consciousness of the patient. It is often accompanied by incontinence and post-ictal confusion. Choice D is incorrect. During the myoclonic seizure, the patient may be awake or with short periods of loss of consciousness. During this seizure, the patient will have abnormal motor behavior in one or more muscle groups that lasts a few seconds to a few minutes. 52% correct

A patient is being intubated in the trauma bay after falling from a 20-ft deer stand. The doctor instructs the nurse to prepare intubation drugs. Which drug should the nurse administer first? A. Propofol B. Vecuronium C. Succinylcholine D. Rocuronium Subject Critical Care Lesson Critical Care Concepts Client Need Area Pharmacological and Parenteral Therapies 4469

A. Propofol Choice A is correct. Propofol is a sedative agent, which needs to be administered first before a paralytic agent. Choices B, C, and D are incorrect. These are all paralytic agents. Whatever paralytic agent the doctor orders will need to be given after the sedative. 55% correct

Which of the following are components of the definition of critical thinking? Select all that apply. A. Reasoned thinking B. Openness to alternatives C. Adherence to established guidelines D. Ability to reflect E. Loyalty to traditional approaches F. Desire to seek the truth Subject Leadership & Management Lesson Management Concepts Client Need Area Management of Care 4252

A. Reasoned thinking B. Openness to alternatives D. Ability to reflect F. Desire to seek the truth Choices A, B, D, and F are correct. Critical thinking is a combination of reasoned thought, openness to alternatives, the ability to reflect, and a desire to seek the truth. There are many definitions of critical thinking. It is a complex concept and people think about it in different ways. Any situation that requires critical thinking is likely to have more than one "right" answer. You do not need critical thinking to add 2 + 2 and come up with the solution. However, you do need critical thinking to problem-solve essential decisions. A crucial aspect of critical thinking is the process of identifying and checking your assumption. This is also a necessary part of the research process. Critical thinking is a combination of reasoned thought, openness to alternatives, the ability to reflect, and a desire to seek the truth. Choices C and E are incorrect. Adhering to established guidelines does not require critical thinking (Choice C). Loyalty to traditional approaches does not demonstrate critical thinking and could actually hinder it (Choice E). 24% correct

The nurse is caring for a client with congestive heart failure exhibiting signs of ineffective coping. The nurse should take which action based on the findings? A. Recommend a support group B. Review dietary items low in sodium C. Review the client's vaccination status D. Recommend the client take St. John's Wort Subject Adult Health Lesson Cardiovascular Client Need Area Psychosocial Integrity 7517

A. Recommend a support group Choice A is correct. Congestive heart failure is a chronic illness that can be debilitating if not appropriately managed. Approximately 50% of individuals diagnosed with heart failure die within five years of the diagnosis. A local support group would be an appropriate recommendation for this client as the support group is a tertiary level of prevention. Support groups are effective because they enable an individual to be expressive and potentially develop social ties with others. All factors that may mitigate depression. Choices B, C, and D are incorrect. Foods low in sodium would not address ineffective coping. While a client needs to adhere to a low sodium diet, this intervention is incongruent with the client's problem of ineffective coping. Adherence to vaccinations such as the annual influenza vaccine is an appropriate health promotion and maintenance strategy, but this would not mitigate the client's ineffective coping. St. John's Wort has been proven effective for mild depression, but recommending an over-the-counter supplement should come from the primary healthcare provider, not the nurse. Additionally, a support group is a more appealing intervention versus an additional medication. 79% correct

Which of the following are potential complications of dexamethasone administration? Select all that apply. A. Risk of infection B. Hypotension C. Hyperlipidemia D. Hypoglycemia Subject Pharmacology Lesson Endocrine Client Need Area Pharmacological and Parenteral Therapies

A. Risk of infection C. Hyperlipidemia Choices A and C are correct. Like with any corticosteroid, when a patient is receiving dexamethasone, they are at higher risk for infection. They should be monitored closely to evaluate for WBCs trending upwards, increased CRP, becoming febrile, and other indicators of disease (Choice A). Hyperlipidemia is a side effect of dexamethasone. Dexamethasone causes the development of cholesterol and can increase triglycerides as well as low-density lipoproteins (LDLs) (Choice C). Choice B is incorrect. Hypertension, not hypotension, is a side effect of dexamethasone. Choice D is incorrect. Hyperglycemia, not hypoglycemia, is a side effect of dexamethasone. NCSBN Client Need: Topic: Physiological Integrity Subtopic: Pharmacological and Parenteral Therapies 38% correct

Which of the following rhythm changes will have an impact on cardiac output? Select all that apply. A. Supraventricular tachycardia B. Sinus bradycardia C. Ventricular tachycardia D. Mobitz type II heart block Subject Adult Health Lesson Cardiovascular Client Need Area Physiological Adaptation

A. Supraventricular tachycardia B. Sinus bradycardia C. Ventricular tachycardia D. Mobitz type II heart block Choices A, B, C, and D are all correct. All rhythm changes will affect cardiac output. This is especially important to remember when you are administering antiarrhythmics to your patient, as these medications and their effect will also change the cardiac output. There are two reasons that rhythm changes affect cardiac output. 1 - they break your heart rate. 2 - they change your stroke volume. Remember, CO = HR x SV, so any change to either heart rate or stroke volume subsequently affects your cardiac output. 22% correct

The nurse is planning a staff development conference about diabetic ketoacidosis (DKA). Which of the following information should the nurse include? A. The goal is to lower blood glucose by 50 to 75 mg/dL/hr. B. Dextrose 5% should be available for hypoglycemia symptoms. C. Hypovolemia caused by DKA may be treated with 3% saline. D. The urine output would increase once regular insulin is initiated. Subject Critical Care Lesson Critical Care Concepts Client Need Area Physiological Adaptation 7411

A. The goal is to lower blood glucose by 50 to 75 mg/dL/hr. Choice A is correct. DKA treatment aims to lower the blood glucose by 50 to 75 mg/dL/hr. This is accomplished by the prescribed regular insulin, which is given intravenously. Choices B, C, and D are incorrect. Dextrose 50% should be available in the event of severe hypoglycemia. Dextrose 5% is not sufficient to treat hypoglycemia. The treatment goal for the hypovolemia caused by DKA is isotonic saline, not hypertonic saline. Urine output would decrease with the infusion of regular insulin as correcting the hyperglycemia would treat the polyuria, which is a symptom of hyperglycemia. 34% correct

Which statements about therapeutic communication are accurate? Select all that apply. A. Therapeutic communication is goal-oriented, purposeful, caring, and compassionate. B. Therapeutic communication occurs after trust is established in the nurse-client relationship. C. Therapeutic communication occurs between the nurse and other members of the nursing team. D. Therapeutic communication consists of only oral communication that is understandable. E. Therapeutic communication must be modified and altered according to the client's culture. F. Therapeutic communication is fully mindful of any nonverbal messages that are sent by the nurse. 2824

A. Therapeutic communication is goal-oriented, purposeful, caring, and compassionate. B. Therapeutic communication occurs after trust is established in the nurse-client relationship. E. Therapeutic communication must be modified and altered according to the client's culture. F. Therapeutic communication is fully mindful of any nonverbal messages that are sent by the nurse. Choice A is correct. Therapeutic communication is goal-oriented, purposeful, caring, and compassionate. The purpose of therapeutic communication is to facilitate the achievement of optimal client outcomes. Therefore, they must be caring and kind to achieve this goal. Choice B is correct. Therapeutic communication occurs after trust is established in the nurse-client relationship. The therapeutic nurse-client relationship begins with the establishment of trust with the client, after which the working phase of the therapeutic nurse-client relationship can continue with ongoing, open, and honest communication. Choice E is correct. Therapeutic communication must be modified and altered according to the client's culture. Many factors, including culture, impact the therapeutic communication process. Additional factors that impact the therapeutic communication process include age, level of development, perspectives, and values. Choice F is correct. Therapeutic communication is fully mindful of any nonverbal messages that are sent by the nurse. Therapeutic communication consists of both oral communication that is understandable to the client as well as nonverbal communication techniques that are consistent with the received message as well as the client's needs. Choices C and D are incorrect: Choice C is incorrect. Therapeutic communication occurs between the nurse and the client or groups of clients. Although nurses communicate with other members of the nursing team in a respectful, open, and honest manner, this communication is considered professional communication and not therapeutic communication. Choice D is incorrect. Therapeutic communication consists of both oral communication that is understandable to the client as well as nonverbal communication techniques that are consistent with the received message as well as the client's needs. 22% correct

The nurse is teaching a group of students about using reminiscence therapy. Which statements should the nurse include in the teaching? Select all that apply. Incorrect A. This approach helps support self-esteem B. This is an effective intervention in a group setting C. This intervention focuses on looking forward D. Establishing future goals is important part of this intervention E. Reminiscing is a way to express personal identity Subject Mental Health Lesson Mental Health Concepts Client Need Area Psychosocial Integrity 4206

A. This approach helps support self-esteem B. This is an effective intervention in a group setting E. Reminiscing is a way to express personal identity Choices A, B, and E are correct. Reminiscence helps support self-esteem by having an individual look back on past accomplishments and positive life experiences. This strategy may be used one-on-one or in a group setting, facilitating rapport building with other individuals. Finally, reminiscence is a way for an individual to express their personal identity by reflecting on past accomplishments (college work, occupations, marriage, etc.). Choices C and D are incorrect. Reminiscence is about looking at the client's past to support their self-esteem by expressing previous experiences. This therapeutic approach does not involve goal setting or forward-looking approach. 14% correct

Which of the following falls under the right dose of the 8 rights of medication administration? Select all that apply. A. Using a drug reference to verify that the dose ordered is appropriate. B. Identify the patient using 2 separate identifiers. C. Have a second nurse independently calculate the medication dosage. D. Double-check the last time that the medication was administered. Subject Fundamentals Lesson Medication Administration Client Need Area Pharmacological and Parenteral Therapies 5355

A. Using a drug reference to verify that the dose ordered is appropriate. C. Have a second nurse independently calculate the medication dosage. Choices A and C are correct. A is correct. Using a drug reference to verify the dose ordered is appropriate is a part of the right dose check in the 8 rights of medication administration. The nurse should always verify that the dose is appropriate by checking a current drug reference for the medication and verifying that what is ordered is in the safe range. C is correct. Having a second nurse independently calculate the medication dosage is an important part of verifying the right dose. This check ensures that two nurses both calculate the dosages and come up with the same answer, decreasing the chance of an error in calculation. Choice B is incorrect. Identifying the patient using 2 separate identifiers falls under the right patient in the 8 rights of medication administration, not the right dose. The nurse should always verify the correct patient by using 2 separate identifiers, such as name and medical record number, but this is a part of verifying the right patient, not the right dose. Choice D is incorrect. Double-checking the last time that the medication was administered is a part of the right time step in the 8 rights of medication administration. This is important because the nurse needs to verify that she is giving the dose at the correct time and that it is not being administered too frequently based upon the previous administration. This is not a part of the right dose step, however. 24% correct

Hospitalization may affect or delay the progression of which physical development of a 1-yr-old patient? A. Walking B. Running C. Sitting D. Crawling Subject Child Health Lesson Growth & Development Client Need Area Health Promotion and Maintenance 4105

A. Walking Choice A is correct. At 1-year-old, children should be beginning to walk. Hospitalization during this age could delay this stage of development. Choice B is incorrect. The patient should just be learning to walk at this age, not running. Choice C is incorrect. The child should be sitting up by six months of age. Choice D is incorrect. The child should already be crawling before age 1. 82% correct

A nurse is caring for a client receiving digoxin. The client's most recent digitalis level was 2.5 ng/mL. The nurse should take which action? Select all that apply. A. Withhold the client's scheduled dose B. Administer the dose, as prescribed C. Assess the client's 24-hour urinary output D. Assess the client's most recent sodium level E. Assess the client's heart rate and rhythm F. Obtain a prescription for an echocardiogram Subject Pharmacology Lesson Cardiovascular Client Need Area Pharmacological and Parenteral Therapies 5216

A. Withhold the client's scheduled dose E. Assess the client's heart rate and rhythm Choices A and E are correct. The client's digitalis level of 2.5 ng/mL indicates toxicity. Digoxin has a narrow therapeutic index, which can cause significant side effects, such as cardiac arrhythmias (e.g., bradycardia, heart block, ventricular arrhythmias), even at plasma concentrations only twice the therapeutic plasma concentration range. Normal corrective serum digoxin levels range from 0.5-2 ng/mL. A level higher than 2 ng/mL is considered toxic. The nurse is correct in withholding the scheduled dose and assessing the client's heart rate and rhythm, as the client is likely to be experiencing bradycardia. Choices B, C, D, and F are incorrect. It would be incorrect to administer the next dose, as this would exacerbate the toxicity. Assessing the urinary output and sodium is not relative to digitalis toxicity and is not the priority here. A significant trigger in digitalis toxicity is hypokalemia, not hyponatremia. Notifying the physician regarding the toxic level is appropriate, but there is no reason to obtain an echocardiogram. An echocardiogram will not add any additional information at this point. Instead, an electrocardiogram must be obtained to look for any rhythm disturbances due to digoxin toxicity. 15% correct

form of arthritis that primarily affects the spine

Ankylosing spondylosis

-azole

Antifungal

Cilostazol

Antiplatelet that is also used to treat peripheral artery disease. Its action mechanism decreases platelet aggregation and promotes vasodilation, allowing a client to ambulate distances without pain.

A nurse is instructing a patient about a newly prescribed medication, phenytoin. Which statements, if made by the patient, indicate effective teaching? A. "If my gums get irritated and large, I can stop this medication." B. "I will need laboratory work to monitor the medication level." C. "It is okay for me to increase this medication if I have a seizure." D. "I should take this medication with low protein foods." Subject Fundamentals Lesson Medication Administration Client Need Area Pharmacological and Parenteral Therapies 6477

B. "I will need laboratory work to monitor the medication level." Choice B is correct. Phenytoin is an anticonvulsant and is indicated for epilepsy. Therapeutic levels must be maintained to ensure the effectiveness of the drug. The therapeutic drug levels of phenytoin are 10-20 mcg/mL. Choices A, C, and D are incorrect. Phenytoin is an anticonvulsant medication that requires adherence to prevent seizure activity. The client should not stop the drug because of the side-effect of gingival hyperplasia; instead, the client should report this effect. The client's self-discontinuing the medication increases the risk of a seizure. The client should not increase the drug if they have a seizure. Phenytoin can be taken with or without food. This medication does not have any dietary restrictions. 79% CORRECT

You are caring for an 8-month-old infant with a tracheostomy. Upon assessment, you visualize secretions within the tracheostomy that require suctioning. In preparation to suction the infant's tracheostomy, which of the following settings would be the most appropriate suction setting? A. 120 mmHg B. 90 mmHg C. 60 mmHg D. 40 mmHg Subject Child Health Lesson Respiratory Client Need Area Reduction of Risk Potential 2554

B. 90 mmHg Choice B is correct. 90 mmHg would be the most appropriate suction setting for an 8-month-old infant based on the choices provided. For infants and children up to 24 months, tracheostomies should be suctioned using 80-100 mmHg. Choice A is incorrect. A suction setting of 120 mmHg is the upper limit for children aged 24 months and older. Therefore, this suction setting would be too powerful to utilize on an 8-month-old infant. Choice C is incorrect. 60-80 mmHg is the recommendation for suctioning newborns and neonates (i.e., up to 28 days). Therefore, 60 mmHg will likely not provide adequate suctioning power for this client. Choice D is incorrect. Attempting to suction a tracheostomy using 40 mmHg would not produce enough suctioning power to render a viable result. This pressure is not indicated for any age range.

The nurse is caring for a client with bipolar disorder and has been prescribed carbamazepine. Which laboratory tests would need to be monitored for adverse effects? A. Urine analysis B. Complete Blood Count (CBC) C. Cardiac enzymes D. Lipid Panel Subject Pharmacology Lesson Psychiatric Medications Client Need Area Pharmacological and Parenteral Therapies 2636

B. Complete Blood Count (CBC) Choice B is correct. Carbamazepine has been implicated in causing blood dyscrasias. These blood dyscrasias include pancytopenia (low red blood cells, white blood cells, and platelets). Therefore, the nurse should contact the health care provider (HCP) to obtain an order to draw a baseline complete blood count (CBC) with differential before administering carbamazepine to this client. This lab result will serve as the baseline result for this client, as this lab result includes the client's baseline leukocytes, neutrophils, and thrombocytes (among other CBC results). Choices A, C, and D are incorrect. Carbamazepine is not known to affect urine chemistry, cardiac enzymes, or lipid panel. These labs are not pertinent to carbamazepine. 55% correct

The nurse is caring for a child admitted with congestive heart failure. Which of the following assessment findings would be expected? A. S1, S2 heart sounds B. Exercise intolerance C. Bradypnea D. Flattened neck veins Subject Child Health Lesson Cardiovascular Client Need Area Physiological Adaptation 9681

B. Exercise intolerance Choice B is correct. Exercise intolerance is common for a child with heart failure because the cardiac output cannot keep up with the demands of exercise. Fatigue may develop as well as irritability from the child's inability to participate in exercise-related activities. Choices A, C, and D are incorrect. Heart failure produces abnormal heart tones such as S3 and S4, referred to as gallop rhythm. An S3 heart tone is heard in systolic heart failure, whereas an S4 heart tone is expected in diastolic heart failure. S1 and S2 heart tones are normal and would be accompanied by S3 or an S4 heart sound if the client has either systolic or diastolic heart failure. Tachypnea is a common feature of heart failure because of decreasing lung compliance; this is often seen with tachycardia. Flattened neck veins are unexpected in heart failure, whereas distended neck veins are common especially in right sided heart failure because of increased venous pressure. 55% correct

A nurse is caring for a client in the first trimester of pregnancy and notes that the client's serum potassium level is currently 2.9 mEq/L. Which of the following assessment findings is likely related to this lab finding? A. Alcohol consumption during pregnancy B. Hyperemesis gravidarum C. Lack of weight gain since the onset of pregnancy D. Food aversions Subject Maternal & Newborn Health Lesson Antepartum Client Need Area Health Promotion and Maintenance 2577

B. Hyperemesis gravidarum Choice B is correct. A serum potassium level of 2.9 mEq/L indicates hypokalemia. During pregnancy, hyperemesis gravidarum is strongly associated with hypokalemia. Choice A is incorrect. Alcohol exposure in utero increases the risk of spontaneous abortion, decreases birth weight, and can cause fetal alcohol syndrome, a constellation of variable physical and cognitive abnormalities. Choice C is incorrect. Various factors may lead to a woman's lack of weight gain during the first trimester, but this lack of weight gain is unlikely to lead to such significant hypokalemia. Choice D is incorrect. Food aversions may cause the client to feel weak and/or nauseous during the first trimester but is unlikely to lead to hypokalemia. 89% correct

A pregnancy-related spinal change that can alter mobility is known as: A. Ankylosing spondylosis B. Lordosis C. Scoliosis D. Kyphosis 4163 Health promotion & maintenance, maternal & newborn

B. Lordosis Choice B is correct. The spinal change that is common in pregnancy is lordosis. This is the result of the increasing weight of the enlarging uterus and the effect of gravity. As a fetus grows, a variety of changes appear in a pregnant woman's body. The thoracic and lumbar spine curvature change, pain in the low back, and pelvic region can increase, and the balance and gait pattern also changes. Some studies report that the center of gravity of pregnant women moves towards the abdomen, resulting in an increase in lumbar lordosis, posterior tilt of the sacrum, and movement of the head to the back to compensate for the increased weight as the fetus grows. Choice A is incorrect. Ankylosing spondylosis is a form of arthritis that primarily affects the spine, although other joints can become involved. It causes inflammation of the spinal bones (vertebrae) that can lead to severe, chronic pain, and discomfort. Choice C is incorrect. Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. Choice D is incorrect. Kyphosis is an exaggerated, forward rounding of the back. It can occur at any age but is most common in older women. Age-related kyphosis is often due to weakness in the spinal bones that causes them to compress or crack. Other types of kyphosis can appear in infants or teens due to malformation of the spine or wedging of the spinal bones over time. 62% correct

You are taking care of a client who is taking warfarin and lovastatin. Which statement about the interaction warfarin and lovastatin should you incorporate into your plan of care? A. Lovastatin decreases the effects of the warfarin. B. Lovastatin increases the effects of the warfarin. C. Lovastatin has no known effects on the warfarin. D. Combining lovastatin and warfarin causes respiratory depression. Subject Fundamentals Lesson Medication Administration Client Need Area Pharmacological and Parenteral Therapies 3396

B. Lovastatin increases the effects of the warfarin. Choice B is correct. Lovastatin increases the effects of warfarin, so the nurse should incorporate this knowledge related to an increased influence of the anticoagulant, warfarin, into the plan of care. Choice A is incorrect. Lovastatin increases the effects of warfarin. Choice C is incorrect. Lovastatin has known effects on warfarin, an anticoagulant medication, so the nurse should consider this when planning care. Choice D is incorrect. Combining lovastatin and warfarin does not cause respiratory depression. 40% correct

The nurse is caring for a client with an ectopic pregnancy. The primary healthcare provider (PHCP) recommends medical treatment over surgical treatment. The nurse anticipates a prescription for which medication? A. Terbutaline B. Methotrexate C. Methylergonovine D. Nifedipine Subject Pharmacology Lesson Reproductive/Maternity/Newborn Client Need Area Pharmacological and Parenteral Therapies 7877

B. Methotrexate Choice B is correct. Methotrexate (MTX) may be used to medically treat an ectopic pregnancy that has not ruptured, and the woman is hemodynamically stable. Methotrexate is a folic acid antagonist and may be given a variety of routes. Choices A, C, and D are incorrect. Terbutaline and nifedipine are tocolytics employed in the prevention of preterm labor. Methylergonovine is an ergot alkaloid indicated in the treatment of postpartum hemorrhage. None of these medications are indicated for an ectopic pregnancy. 50% correct

The nurse is preparing to sign a patient's surgical consent form after the physician has explained the procedure to the patient and family. As the patient signs the form, she comments "I really didn't understand most of what the doctor said, but I have to have this procedure, so I want to sign." Which is the appropriate nursing action? A. Witness the document, as the patient states she wants to sign it. B. Notify the physician or nursing supervisor. C. Call the OR to cancel the procedure and reschedule at a later date. D. Explain the information she did not understand. Subject Leadership & Management Lesson Ethical/Legal Client Need Area Management of Care 3775

B. Notify the physician or nursing supervisor. Choice B is correct. The person (in this case, the doctor) responsible for performing the procedure has the responsibility to obtain the patient's consent, providing a clear explanation about the procedure and all associated risks. When witnessing the patient's signature, the nurse should confirm that the patient understands the information about the procedure. If the patient denies understanding, the nurse must then contact the physician or the nursing supervisor. Choice A is incorrect. The nurse has to witness the patient's signature but even prior to that, she must confirm that the patient understood the information about the procedure. Choice C is incorrect. The nurse must call the physician or nursing supervisor and inform them that the patient did not understand the procedure information. Canceling the procedure is not necessary as something else needs to be done first. Choice D is incorrect. It is the responsibility of the person performing the procedure (in this case, the doctor) to obtain the patient's consent, providing a clear explanation about the procedure and all associated risks. The nurse only needs to confirm if the patient understood it. 83% correct

Which statement about palliative care at the end of life is most accurate? A. Palliative care at the end of life is conducted in hospice centers. B. Palliative care at the end of life can occur in all care settings. C. Narcotic pain medications can be used in palliative care, but not in curative care. D. Narcotic pain medications can be used in curative care, but not in palliative care. Subject Fundamentals Lesson Basic Care & Comfort Client Need Area Psychosocial Integrity 3543

B. Palliative care at the end of life can occur in all care settings. Choice B is correct. Palliative care at the end of life can occur in all care settings. Palliative care is also referred to as hospice care. It is a philosophy of care that can, and is, carried out in all healthcare settings, including in the client's home. Narcotic pain medications can be used at the end of life using the palliative/hospice care philosophy as well as with curative care. Choice A is incorrect. Palliative care at the end of life can be conducted in hospice centers as well as in other settings and environments. Choice C is incorrect. Narcotic pain medications are not restricted, and they can be used in curative care. Choice D is incorrect. Narcotic pain medications are not restricted, and they can be used in palliative care. 70% correct

The nurse is reviewing the labs of a child who has recently had oral surgery. Which of the following lab results should the nurse pay the closest attention to? A. BUN level B. Prothrombin time C. Creatinine level D. Viral load Subject Fundamentals Lesson Basic Care & Comfort Client Need Area Reduction of Risk Potential

B. Prothrombin time Choice B is correct. After oral surgery or a tonsillectomy, the physician will order a series of labs, including hematocrit, hemoglobin, and prothrombin time. The results of these labs are evaluated to determine whether or not the patient is experiencing bleeding as a result of the surgery and if they can adequately bleed. Choice A is incorrect. BUN levels, or blood urea nitrogen levels, help health care providers evaluate kidney function by calculating how nitrogen is in the blood. Nitrogen is a byproduct of urea, which is made by the kidneys when proteins are broken down. This test is not ordered routinely after oral surgery. Choice C is incorrect. Creatinine laboratory values evaluate kidney function. Creatinine is produced when muscles metabolize. This test is not ordered routinely after oral surgery. Choice D is incorrect. A test to evaluate viral load is used in cases of HIV and Hepatitis. This test is generally run when a viral disease is suspected or being managed. A patient's viral load is not ordered routinely after oral surgery. 76% correct

A pregnant woman is admitted to the ER with an initial diagnosis of placenta previa. The nurse carries out orders to start an IV infusion, administer oxygen, and extract blood for laboratory tests. The client is getting anxious and asks the nurse what is happening. The nurse tells her not to worry and that everything is under control. What is the best description of the nurse's statement? A. Incorrect, the doctor should be the one to offer information and assurances. B. Questionable, because the patient has the right to understand the type of treatment and the reason for the treatment. C. Effective, because the response lowers the client's anxiety. D. Adequate, because the preparations are routine and need no explanation. Subject Maternal & Newborn Health Lesson Antepartum Client Need Area Psychosocial Integrity 3219

B. Questionable, because the patient has the right to understand the type of treatment and the reason for the treatment. Choice B is correct. This is a violation of the client's rights. The client has the right to accurate and complete explanations about any procedures to be performed. Choice A is incorrect. In the Patients' Bill of Rights, the patient has the right to be informed by healthcare staff about any procedure that will be done to her. Choice C is incorrect. The nurse has the responsibility to inform the client regarding the procedure that is going to be performed on her. Choice D is incorrect. The procedure may be routine work for the nurse, but it is not routine for the client and should be explained to her. 85% correct

Your client has been diagnosed with acute renal failure. Which one of the following lab results should be reported immediately? A. Blood urea nitrogen 50 mg/dL B. Serum potassium 6 mEq/L C. Venous blood pH 7.30 D. Hemoglobin of 10.3 mg/dL Subject Adult Health Lesson Urinary/Renal/Fluid and Electrolytes Client Need Area Reduction of Risk Potential 4212

B. Serum potassium 6 mEq/L Choice B is correct. Although all of these findings are abnormal, elevated potassium is a life-threatening finding and must be reported immediately. Acute renal failure can cause a significant imbalance in lab values. Although all of the lab results listed are abnormal, the elevated potassium level is a life-threatening finding. With ARF, a high BUN would be expected, acidic blood pH would be expected, and normal hemoglobin levels differ based on age, sex and general health. Choice A is incorrect. The average BUN level should be 7 to 20 mg/dL. Choice C is incorrect. Venous blood pH should be 7.31 to 7.41. Choice D is incorrect. Normal hemoglobin levels differ based on age, sex, and general health. The normal range for hemoglobin is: For men, 13.5 to 17.5 grams per deciliter. For women, 12.0 to 15.5 grams per deciliter. 79% correct

The nurse is evaluating a patient three days post-operative for signs and symptoms of infection. Which of the following is not a sign of infection from a surgical wound? A. Pus and clear drainage from the site B. Some redness along the edges of the site C. Increasing warmth from the wound D. Red streaks from the site Subject Adult Health Lesson Infectious Disease Client Need Area Reduction of Risk Potential 4019

B. Some redness along the edges of the site Choice B is correct. Some redness at the surgical site is a normal finding three days after surgery. Signs of infection include pus, excess wound drainage, increasing warmth from the wound, and red streaks from the site. Choice A is incorrect. While light, clear drainage is an expected finding three days post-operatively, pus drainage is not. Pus indicates a developing infection. Choice C is incorrect. While some heat is normal, an increase in temperature produced by the wound indicates infection at the site. Choice D is incorrect. Red streaks indicate a potentially dangerous infection at the wound and could mean the development of a disease and even sepsis. 48% correct

Which of the following would not be a normal change during late pregnancy? Select All That Apply. A. Waddling gait B. Sudden edema C. Vaginal bleeding D. Dark cloudy urine Subject Maternal & Newborn Health Lesson Antepartum Client Need Area Health Promotion and Maintenance 4827

B. Sudden edema C. Vaginal bleeding D. Dark cloudy urine Choices B, C, and D are correct. Sudden edema is abnormal and may indicate preeclampsia (Choice B). Vaginal bleeding (more than scant spotting) is never healthy in pregnancy before the start of labor (Choice C). Dark cloudy urine is abnormal and suggests infection or renal impairment (Choice D). Choice A is incorrect. Increased levels of relaxin loosen the cartilage between the pelvic bones, which results in the characteristic "waddling" walk of the third trimester. This is a healthy change during pregnancy. 37% correct

A client with intermittent insomnia asks the nurse about herbal supplements to improve sleep. Which product should the nurse recommend the patient ask her care provider about? A. Raspberry leaf tea B. Valerian root C. Glucosamine D. Black Cohosh Subject Fundamentals Lesson Safety/Infection Control Client Need Area Basic Care and Comfort 3916

B. Valerian root Choice B is correct. Valerian root is a common herbal remedy used to treat occasional insomnia but may interact with some medications. Patients should be encouraged to discuss herbal remedies with their doctors. Choice A is incorrect. Raspberry tea leaf is a popular herbal tea used to induce labor and expedite the shrinking of the uterus post-partum. It is not used to treat insomnia. Choice C is incorrect. Glucosamine is a commonly recommended amino sugar used to promote joint health. It does not correct insomnia. Choice D is incorrect. Black cohosh is an herbal supplement sometimes used to induce abortion in the early first trimester or to induce labor after a woman is forty weeks pregnant. It does not help with insomnia. 55% correct

The nurse is counseling a client who has prediabetes. The nurse understands that the client is meeting the treatment goal as evidenced by A. total cholesterol of 215 mg/dL. B. hemoglobin A1C of 5.4%. C. fasting blood glucose 128 mg/dL. D. random blood glucose of 210 mg/dL. Subject Adult Health Lesson Endocrine Client Need Area Health Promotion and Maintenance 7629

B. hemoglobin A1C of 5.4%. Choice B is correct. This is an optimal hemoglobin A1C as it is less than 5.7%. A hemoglobin A1C of 5.7% to 6.4% is prediabetes. This is a concerning finding as the client is on a negative trajectory toward diabetes mellitus. A hemoglobin A1C of 6.5% is the diagnosis of diabetes mellitus. Choices A, C, and D are incorrect. Total cholesterol of 215 mg/dL is a concerning finding. The goal is to have total cholesterol of less than 200 mg/dL. Elevated total cholesterol contributes to metabolic syndrome, which is the driver of diabetes mellitus. Fasting blood glucose of 128 mg/dL is elevated (this is impaired fasting glucose), and a level greater than 126 mg/dL requires further testing for diabetes mellitus. Random blood glucose of 210 mg/dL is concerning as this is a provisional diagnosis for diabetes mellitus. 84% correct

The nurse is assessing clients for the risk of developing Cushing's syndrome. The nurse should identify which client is at greatest risk for this syndrome? A client: A. recently diagnosed with hyperpituitarism and high blood pressure. B. who has been taking prednisone for 2 years to treat rheumatoid arthritis (RA). C. who has a goiter, and is receiving propranolol and propylthiouracil (PTU). D. experiencing eczema and is prescribed a seven-day course of topical hydrocortisone. Subject Adult Health Lesson Endocrine Client Need Area Physiological Adaptation 7370

B. who has been taking prednisone for 2 years to treat rheumatoid arthritis (RA). Choice B is correct. Cushing's syndrome is characterized by chronic exposure to a glucocorticoid. This is oftentimes referred to as secondary Cushing's syndrome. This client has been on a steroid for two years, and considering the long duration, this client is at the highest risk of developing this syndrome. Choices A, C, and D are incorrect. A client diagnosed with hyperpituitarism may risk Cushing's disease because of the increase in circulating cortisol and aldosterone. However, this client does not have the greatest risk because this client was recently diagnosed compared to the client with RA, and has been exposed to prednisone for two years. A goiter is a manifestation associated with hyperthyroidism and treating hyperthyroidism with propranolol and PTU would be appropriate. This would not have a relationship to increasing the risk for Cushing's syndrome. Topical steroids do not pose a significant risk for Cushing's syndrome, especially if they are used in short bursts. 63% correct

peptides released when there is fluid retention & the heart senses the need to pump harder to move fluid forward, especially in hf

BNP

test done for CHF

BNP

The nurse is counseling a client about a metered-dose inhaler. Which of the following statements by the client indicates effective teaching? Select all that apply. A. "I will be careful not to shake the canister before using it." B. "I will inhale the medication through my nose." C. "After I deliver a dose, I will hold my breath for 10 seconds." D. "I will only inhale one spray with one breath." E. "I will exhale completely and then press down on the inhaler to release the medication." Subject Pharmacology Lesson Respiratory Client Need Area Pharmacological and Parenteral Therapies 4832

C. "After I deliver a dose, I will hold my breath for 10 seconds." D. "I will only inhale one spray with one breath." E. "I will exhale completely and then press down on the inhaler to release the medication." Choices C, D, and E are correct. For clients with a metered dose inhaler (MDI), after a dose is administered, they should hold their breath for ten seconds to allow for the medication to be dispersed in their lungs. The client should only administer one dose (or press the button once) per breath. Before the client presses the button to administer the dose, the client is instructed to exhale completely and then administer the dose during the next inhalation. Choices A and B are incorrect. Common mistakes clients make when using metered-dose inhalers include failing to shake the canister and inhaling through the nose rather than the mouth. 28% correct

A client who is pregnant and is attending a prenatal class. Which statement, if made by the client, requires further teaching? A. "Since my body mass index is normal, I should be gaining 25-35 pounds." B. "It will be okay for me to continue using sugar substitutes, such as sucralose." C. "Since I am pregnant, I will have to abandon my vegan diet." D. "I will need to keep my caffeine intake less than 200 mg/day."

C. "Since I am pregnant, I will have to abandon my vegan diet." Choice C is correct. This statement is false and requires follow-up. A vegan diet may be continued during pregnancy if the woman is methodical in her food choices. The concern with vegan diets is the consumption of complete proteins. However, evidence has indicated that plant proteins can meet pregnancy needs. Choices A, B, and D are incorrect. These statements are true and do not require follow-up. For a woman with a normal BMI, the average weight during pregnancy should be 25-35 pounds. Sugar substitutes are permitted in moderation. The current recommendation for daily caffeine intake is not to exceed 200 mg/day.

The nurse supervises a student nurse auscultating lung sounds on a group of clients. Which statement by the student nurse would require follow-up? A. "Wheezes arise from the small airways and usually do not clear with coughing." B. "A pleural friction rub causes loud, rough, scratching sounds usually during inspiration." C. "Thick, tenacious secretions that clear with coughing cause crackles." D. "Fluid or secretions in large airways typically cause coarse crackles." Subject Fundamentals Lesson Basic Care & Comfort Client Need Area Psychosocial Integrity 8060

C. "Thick, tenacious secretions that clear with coughing cause crackles." Choice B is correct. Palliative care at the end of life can occur in all care settings. Palliative care is also referred to as hospice care. It is a philosophy of care that can, and is, carried out in all healthcare settings, including in the client's home. Narcotic pain medications can be used at the end of life using the palliative/hospice care philosophy as well as with curative care. Choice A is incorrect. Palliative care at the end of life can be conducted in hospice centers as well as in other settings and environments. Choice C is incorrect. Narcotic pain medications are not restricted, and they can be used in curative care. Choice D is incorrect. Narcotic pain medications are not restricted, and they can be used in palliative care. 48% correct

What is the priority nursing intervention for a newly admitted client with the possible nursing diagnosis of self-care deficit: bathing and hygiene? A. Helping the client with their self-care needs in terms of bathing and hygiene. B. Asking a family member to assist the client with their bathing and hygiene self-care needs. C. A thorough assessment of the client in terms of their self-care strengths and weaknesses. D. A thorough assessment of the client in terms of their bathing and hygiene preferences. Subject Fundamentals Lesson Basic Care & Comfort Client Need Area Basic Care and Comfort 3046

C. A thorough assessment of the client in terms of their self-care strengths and weaknesses. Choice C is correct. The priority nursing intervention for a newly admitted client with the possible nursing diagnosis of "self-care deficit: bathing and hygiene" is to perform the priority first phase of the nursing process. Your priority nursing intervention is to perform a thorough assessment of the client in terms of their bathing and hygiene self-care strengths and weaknesses so that you can determine if the client has or does not have a possible self-care deficit in terms of bathing and hygiene. Choice A is incorrect. Helping the client with their self-care needs in terms of bathing and hygiene may be an appropriate nursing intervention for this client. However, there is something else that you would do first. Choice B is incorrect. Asking a family member to assist the client with their bathing and hygiene self-care needs may be an appropriate nursing intervention for this client. However, there is something else that you would do first. Choice D is incorrect. Although you would perform a thorough assessment of the client in terms of their bathing and hygiene preferences, this is not the priority. There is something else that you would do first. 54% correct

Which of the following special considerations should the nurse make when caring for a Hindu patient based on her religion? Select all that apply. A. Provide all vegetarian meals. B. Handle the client's temple garments with care. C. Be sure the bathroom is equipped with a shower and not just a tub. D. Be aware that the patient will likely refuse blood transfusions. E. Arrange for female nursing staff to provide care for the client as much as possible. F. Be aware that the patient will likely refuse pain medication. Subject Fundamentals Lesson Cultural, Spiritual, and Religion Concepts Client Need Area Psychosocial Integrity 4249

C. Be sure the bathroom is equipped with a shower and not just a tub. E. Arrange for female nursing staff to provide care for the client as much as possible. Choices C and E are correct. Hindus prefer to wash in free-flowing water (e.g. a shower instead of a bathtub). If a shower is not available, provide a jug of water for the person to use in the tub. Hindus practice ayurvedic medicine, which encompasses all aspects of life, including diet, sleep, elimination, and hygiene. Most Hindus are lactovegetarians. Most will not eat beef and avoid bovine-derived medications because they believe in the reincarnation of certain gods. Fasting usually means eating only "pure" foods, such as fruit or yogurt, but it is not expected of the sick. Hindu women are modest and usually prefer to be treated by female medical staff (Choice E). Choice A is incorrect. Although some Hindus will eat eggs and even chicken, most are lactovegetarians, consuming milk but no eggs. Choice B is incorrect. Hindus may wear a "sacred thread" or religious jewelry around their body or wrist. Mormons, not Hindus, wear "temple garments". Choice D is incorrect. Jehovah's Witnesses—not Hindus—refuse to accept blood transfusions or blood products, which they view as morally wrong. Choice F is incorrect. Christian Scientists—not Hindus—would be likely to refuse pain medication. 9% correct

A community health nurse is evaluating different populations for risks of developing a latex allergy. Which of the following groups is at the highest risk of developing a latex allergy? A. Kindergarteners B. The homeless C. Hospital housekeepers D. Individuals with a lowered immune system Subject Adult Health Lesson Immune Client Need Area Health Promotion and Maintenance 3991

C. Hospital housekeepers Choice C is correct. Professionals who routinely wear latex gloves, such as housekeepers, nurses, or hairdressers, are at a higher risk of developing a latex allergy than other populations. Reoccurring exposure to latex is responsible for this increased risk. Choices A, B, and D are incorrect. These populations are not at an increased risk of developing a latex allergy. 65% correct

The nurse is caring for a patient who is 1-day postoperative following a left total knee replacement. Which assessment data would indicate to the nurse that the patient is progressing as expected? A. T 99.2 degrees F, HR 102, RR 18, BP 89/40 mm Hg B. Urine output of 200 mL in the past 8 hours C. Lung bases are clear upon auscultation D. The patient consistently rates left knee pain as 9/10 Subject Adult Health Lesson Musculoskeletal Client Need Area Reduction of Risk Potential 4304

C. Lung bases are clear upon auscultation Choice C is correct. Clear lung bases indicate adequate gas perfusion and suggest normal progression of postoperative recovery. Inadequate gas perfusion would increase the risk of complications and slows healing. Choice A is incorrect. The patient's temperature and heart rate are slightly elevated, whereas the blood pressure is low. This abnormal data should be investigated. Etiology includes infection; dehydration, or sepsis with shock. Choice B is incorrect. Urine output should be at least 30 mL/hour, or 240 mL/8 hours. A urine output of 200 mL for 8 hours would be too low, which indicates that intervention is needed. Provider should be notified so that the potential causes of decreased urinary output ( eg; dehydration, acute renal failure) can be explored. Choice D is incorrect. Localized pain is expected following total knee replacement surgery, but should not be consistently at the 9/10 level. Such assessment data would indicate ineffective pain management. Pain control should be optimized. 64% correct

The nurse is caring for a 13-year-old male child in the pediatric unit with a left-side below the knee cast. The boy reports pain and numbness of the foot. The nurse notes that the toes of the left foot are cold. Which of the following actions should the nurse take first? A. Remove the cast. B. Have the child ambulate. C. Notify the physician. D. Elevate the leg on two pillows. Subject Leadership & Management Lesson Prioritization Client Need Area Reduction of Risk Potential

C. Notify the physician. Choice C is correct. The client is already showing the signs of compartment syndrome. The client has pain, numbness, and cold feet (low perfusion). Pain, pulselessness, pallor, paresthesias, and paralysis are the "5 Ps" associated with compartment syndrome. Compartment syndrome is an emergency. The nurse should be able to recognize signs and symptoms of compartment syndrome and notify the physician STAT. Compartment syndrome often results after trauma and is more common in the anterior compartment of the leg. Following a trauma, there may be decreased intra-compartmental space or increased intra-compartmental fluid volume (due to fracture, hematoma, etc). Because the surrounding fascia is noncompliant, the compartment pressure increases. In normal circumstances, there is a balance between venous outflow and arterial inflow. But increasing compartmental pressure results in a reduction of venous outflow. Consequently, venous pressure increases, further fueling an increase in compartmental pressure. Once compartmental pressure increases more than arterial pressure, arterial blood flow gets affected, and ischemia ensues. If ischemia lasts longer, irreversible necrosis/death of the tissue occurs. Choice A is incorrect. The child is displaying signs of neurovascular compromise due to compartment syndrome. The cast should be removed to relieve pressure; however, it is not the first action to be taken by the nurse. Cast removal should be arranged after informing the physician. Fasciotomy may be needed, and the physician needs to know immediately. Choice B is incorrect. The child should not ambulate as this will increase the child's risk of further injury. Choice D is incorrect. After notifying the physician, the affected limb should be placed at the level of the heart, not above the heart level. While elevation above the heart level may help venous drainage, it also reduces arterial inflow further and worsens the ischemia. Please note that elevating the limb above the heart level is indicated to reduce edema and prevent compartment syndrome soon after the cast is applied. Once compartment syndrome has already happened, the limb must not be elevated. 75% correct

The nurse is helping a client with a chest tube ambulate to the bathroom. The client turns suddenly and the chest tube becomes dislodged. What is the priority action for the nurse to take? A. Immediately re-insert the tube and call for help. B. Place your hand over the chest tube site and yell for help. C. Place a sterile dressing taped on three sides over the chest tube site and call for help. D. Monitor the patient's vital signs while he finishes ambulating to the bathroom and then call for help. Subject Adult Health Lesson Respiratory Client Need Area Reduction of Risk Potential 6057

C. Place a sterile dressing taped on three sides over the chest tube site and call for help. Choice C is correct. Placing a sterile dressing that is taped on three sides over the chest tube site and calling for help would be the appropriate actions. By placing a sterile dressing over the site the nurse follows infection prevention. By taping the dressing on three sides the dressing will cover the site; this will prevent a tension pneumothorax by allowing exhaled air to escape the dressing. The nurse should then immediately call for help. Choice A is incorrect. Under no condition should the nurse ever reinsert the chest tube. This is not in the scope of practice of the nurse and it is not safe to insert a dirty item into the chest cavity of the client. Choice B is incorrect. It is not appropriate for the nurse to place their hand over the chest tube site. The chest tube site leads directly into the thoracic cavity of the client, so placing a hand over it is an infection risk. Choice D is incorrect. It is not appropriate to allow the client to finish ambulating to the bathroom and simply monitor the vital signs. Chest tube dislodgement is an emergency that requires immediate action. 84% correct

The nurse is caring for a group of assigned clients. Which of the following actions by the nurse is an example of a nurse-initiated intervention? Select all that apply. A. The nurse administers 1000 mg of ciprofloxacin to a client with pneumonia. B. The nurse consults with a psychiatrist for a client suspected of pain medication abuse. C. The nurse checks the skin of bedridden clients for signs of breakdown. D. A nurse assists an orthodox Jewish client with ordering a kosher meal. E. The nurse records the intake & output of a client as prescribed by her physician. F. The nurse provides teaching to a client on how to care for a newly placed ostomy. Subject Fundamentals Lesson Basic Care & Comfort Client Need Area Management of Care 5129

C. The nurse checks the skin of bedridden clients for signs of breakdown. D. A nurse assists an orthodox Jewish client with ordering a kosher meal. F. The nurse provides teaching to a client on how to care for a newly placed ostomy. Choices C, D, and F are correct. Nurse-initiated interventions, also known as independent nursing actions, involve carrying out nurse-prescribed interventions resulting from their assessment of client needs that are written on the nursing care plan, as well as other activities that nurses can initiate without the direction or supervision of another healthcare personnel. The nurse can take initiative independently by monitoring clients' skin for breakdown, assisting a client to order an appropriate meal, and providing education to clients and family members. Choices A, B, and E are incorrect. Administration of medications and initiation of intake-output monitoring are dependent interventions because these actions require a physician's order or physician supervision. Consulting with a psychiatrist is a collaborative intervention, not an independent nursing action. 17% correct

The RN is training a new nurse on a medical-surgical floor. Which action would warrant intervention by the experienced RN? A. The nurse administers ceftriaxone via IV 30 minutes early for a pneumonia client. B. The nurse places a surgical mask on a patient with influenza before transport. C. The nurse obtains green drainage from a nasogastric tube for culture. D. The nurse secures a Jackson-Pratt drain to the patient's gown with a safety pin. Subject Leadership & Management Lesson Prioritization Client Need Area Management of Care 6420

C. The nurse obtains green drainage from a nasogastric tube for culture. Choice C is correct. Nasogastric tubes drain gastric contents, which are typically yellow/green in color due to the presence of bile. Sending these contents for culture may cause unnecessary worry for the patient and would not be appropriate since this is an expected assessment. All other actions listed are appropriate. Choice A is incorrect. Non-time-critical scheduled medications are those where early or delayed administration within 1-hour window would not result in harm or substantial sub-optimal therapeutic response. Scheduled IV antibiotics may be given within a 1-hour window unless they are precisely timed. The nurse may administer the IV ceftriaxone up to 30 minutes before the scheduled time. Choice B is incorrect. A diagnosis of influenza requires droplet precautions, which include the patient wearing a surgical mask when transported outside of the room. Choice D is incorrect. Jackson-Pratt drainage systems can be pinned to a patient's gown and should be secured below the exit site to prevent tension on the tubing. 33% correct

Select the disorder which is accurately paired with its preferred corrective action. A. Pediculus capitis: The application of a depilatory B. Scabies: The application of lindane C. Tick: Removing it with a tweezer D. Hirsutism: The application of permethrin Subject Adult Health Lesson Integumentary Client Need Area Physiological Adaptation 3060

C. Tick: Removing it with a tweezer Choice C is correct. A tick must be removed with a tweezer by pulling it out gently using a straight horizontal movement rather than twisting or turning it so that the tick's entire body is pulled out intact. Twisting or turning is contraindicated since the tick's mouthparts may break off and remain in the skin. Tick paralysis can occur due to neurotoxins present in the tick's saliva that enter the bloodstream while the tick is feeding. Symptoms can occur within 2-7 days, present with lower extremity weakness, and if the tick is not removed, it progresses to respiratory muscle weakness and death. Tick paralysis progresses only in the presence of the tick. Once the tick is removed, symptoms resolve rapidly. Because the toxin is present within the tick's salivary glands, utmost care must be taken to remove the entire tick intact. Otherwise, the tick paralysis symptoms may persist. Pathogenic ticks can transmit parasites responsible for causing Lyme disease; Rocky Mountain Spotted fever, Tularemia, Babesiosis, and Ehrlichiosis. Unlike tick paralysis, these diseases are caused by the continued proliferation of parasites in the hosts even long after the tick is removed. Choice A is incorrect. A depilatory is a chemical used to remove hair from the skin and is used for cosmetic purposes. The application of a depilatory is not used to treat pediculus capitis or head lice; instead, permethrin is used to treat unwanted hair Choice B is incorrect. The application of lindane is not preferred for the treatment of scabies. Lindane (Kwell) was widely used to treat scabies in the past. However, the U.S. Food and Drug Administration (FDA) has cautioned against lindane's use because of neurotoxicity concerns. Lindane is now only used as a second-line agent only if other agents have failed. Scabies, an infestation of mites, is treated with the thorough washing of the client's skin, clothing, and bed linens, followed by applying a scabicide lotion such as topical permethrin. Choice D is incorrect. The application of permethrin is indicated for treating pediculus capitis or head lice and not for hirsutism. Hirsutism, which is unwanted hair in unusual places, such as facial hair on females, is removed with a tweezer or a depilatory to remove the unwanted hair. 69% correct

Your client is on complete bed rest for 7 days. Which of the following is the highest priority nursing diagnosis for this client? A. At risk for severe sensory deprivation related to complete bed rest. B. At risk for venous stasis related to complete bed rest. C. At risk for decreased muscular strength related to complete bed rest. D. At risk for urinary stasis related to complete bed rest. Subject Leadership & Management Lesson Prioritization Client Need Area Management of Care 2869

Choice B is correct. "At risk for venous stasis related to complete bed rest" is the highest priority nursing diagnosis for a client who is on complete bed rest for seven days. Venous stasis adversely affects the circulatory system, and this venous stasis can lead to life-threatening complications such as venous stasis and pulmonary emboli. According to the "ABCs" of the airway, breathing, and cardiovascular status, Maslow's Hierarchy of Needs, and the MAA-U-AR method of priority setting method, all establish the highest priorities as A: Airway, B: Breathing, and C: Circulation in that decreasing order of preference. Choice A is incorrect. "At risk for severe sensory deprivation related to complete bed rest" is not the highest priority nursing diagnosis for a client who is on complete bed rest for seven days. Choice C is incorrect. "At risk for decreased muscular strength related to complete bed rest" is not the highest priority nursing diagnosis for a client who is on complete bed rest for seven days. Choice D is incorrect. "At risk for urinary stasis related to complete bed rest" is not the highest priority nursing diagnosis for a client who is on complete bed rest for seven days. 75% correct

A client with a history of smoking has an increased risk in the development of which of the following? A. Raynaud disease B. Peripheral arterial disease (PAD) C. DVT D. Venous insufficiency Subject Adult Health Lesson Respiratory Client Need Area Health Promotion and Maintenance 4785

Choice B is correct. Smoking is one of the most devastating risk factors associated with peripheral arterial disease. (PAD). Choice A is incorrect. Raynaud disease is characterized by spasms of the arteries in the extremities, especially the fingers (Raynaud's phenomenon). It is typically brought on by constant cold or vibration and leads to pallor, pain, numbness, and in severe cases, gangrene. Choice C is incorrect. Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. Factors that increase the risk of developing DVT include: injury to a vein that is often caused by fractures, severe muscle injury, or major surgery (mainly involving the abdomen, pelvis, hip, or legs). Choice D is incorrect. In healthy veins, there is a continuous flow of blood from the limbs back toward the heart. Valves within the veins of the legs help prevent the backflow of blood. Either blood clots or varicose veins most often cause venous insufficiency. 52% correct

The patient has been diagnosed with scleroderma. Which of the following will the nurse expect to be the management? A. Maintain a warm atmosphere during the day and a cool room during the night. B. Keep the client supine for 1 hour after meals. C. Initiate strict bed rest. D. Administer prescribed corticosteroids.

Choice D is correct. Scleroderma is a medical condition in which connective tissue and skin harden. The surest way to manage this disease is to administer prescribed corticosteroids. Choice A is incorrect. Changes and temperature can be harmful to a patient suffering from scleroderma. Rather, the room should be kept at a constant temperature all day and night. Choice B is incorrect. Patients with scleroderma should be kept supine after meals. Clients should sit upright for 1-2 hours after meals if the esophagus has been affected. Choice C is incorrect. Strict bed rest is not necessary for patients with scleroderma. The nurse should encourage activity when the patient can manage it.

While orienting a new graduate nurse in the ICU, you take care of a patient scheduled for peritoneal dialysis. Which of the following principles do you explain to the new graduate about peritoneal dialysis functions? Select all that apply. Incorrect Correct Answer(s): A,B A. Osmosis B. Diffusion C. Oncotic pressure D. Osmotic pressure Subject Adult Health Lesson Gastrointestinal/Nutrition Client Need Area Physiological Adaptation 4515

Choices A and B are correct. Osmosis is an essential principle upon which peritoneal dialysis functions. Osmosis is the passive movement of solvents, such as water, across a permeable membrane. The peritoneum is a permeable membrane. (Choice A). Diffusion is an essential principle upon which peritoneal dialysis functions. Distribution is the passive movement of solutes across a membrane. Solutes diffuse from an area of higher concentration to an area of lower concentration, across the peritoneum, until there is an equal amount of each on both sides of the membrane (Choice B). Choice C is incorrect. The oncotic pressure is a form of osmotic stress induced by proteins in a blood vessel's plasma that displaces water molecules. This is not an essential principle upon which peritoneal dialysis is based. Choice D is incorrect. Osmotic pressure is the pressure that would have to be applied to a pure solvent to prevent it from passing into a given solution by osmosis. This is not an essential principle upon which peritoneal dialysis is based. 22% correct

The nurse caring for a client with cardiac arrhythmias is alerted to a new order from the health care provider (HCP) to administer an additional digoxin dose to the client. The nurse reassesses the client and the client's most recent lab values from that morning before relaying to the HCP that the client's heart rate is 40 BPM and serum potassium was 2.8 mmol/L. The HCP, however, insists and threatens, "Give the digoxin now, or I will have you fired!". The most appropriate response by the nurse would be: A. "Fine. I'll give the digoxin now, but this client will die." B. "I don't have to listen to you." C. "Don't you raise your voice at me again, or we'll see who gets fired." D. "I think we should discuss this with the pharmacist or the unit manager first." Subject Leadership & Management Lesson Ethical/Legal Client Need Area Management of Care 2621

D. "I think we should discuss this with the pharmacist or the unit manager first." Choice D is correct. This is an appropriate and assertive response that not only that accomplishes the primary goal of keeping the client safe, but does so while avoiding infringing upon the HCP's rights. Additionally, by bringing in a third party (such as a pharmacist or unit manager), not only will the issue be clarified, but the situation will likely be diffused. Choice A is incorrect. In addition to being an aggressive and unprofessional form of communication, as a nurse, you would never intentionally administer a medication knowing it would harm the client. Here, the client's current bradycardia would be further reduced by administering the additional digoxin dose. Additionally, the client's hypokalemia increases the risk of digoxin toxicity. Therefore, a nurse would be correct in declining to administer this medication regardless of what the HCP has threatened. Choice B is incorrect. In addition to this being an unprofessional comment, nurses typically should listen to the health care provider (HCP). Choice C is incorrect. This comment is an aggressive and unprofessional form of communication. Although the health care provider (HCP) acted unprofessionally does not necessitate the nurse to do so as well. 98% correct

A nurse is taking care of a client undergoing cerebral angiography. Which statement by the client would most warrant additional attention from the nurse? A. "I feel like I'm going to vomit." B. "I hope my results are okay." C. "It's getting a bit hot in here." D. "My throat is getting a bit itchy, and my eyes are getting watery." Subject Fundamentals Lesson Skills/Procedures Client Need Area Reduction of Risk Potential

D. "My throat is getting a bit itchy, and my eyes are getting watery." Choice D is correct. Iodinated contrast materials are used during cerebral angiography, potentially causing severe allergic reactions. Here, the client's itchy throat and watery eyes are classic indications of an allergic reaction that may progress to an anaphylactic reaction. Symptoms of a severe anaphylactic reaction include airway compromise due to laryngeal edema or angioedema (stridor), bronchoconstriction (wheezing, cough, and dyspnea), and/or circulatory collapse (shock). This is an extreme emergency, as the client's airway is at risk of compromise. The nurse should promptly assess the client for additional signs of anaphylaxis, notify the health care provider (HCP), and initiate interventions to stop further symptom progression while alleviating the current manifestations. Choice A is incorrect. Nausea is likely a reaction to the administration of contrast material, presumably capable of being alleviated by the administration of a PRN (as needed) intravenous antiemetic medication. While this statement should be of concern to the nurse, this is not the priority concern. The nurse should prioritize airway-related symptoms in this client. Choice B is incorrect. This statement by the client may indicate anxiety or a flushing sensation being experienced by the client. The nurse should address the client's concern; however, it is not prioritized over an airway-related complaint. Choice C is incorrect. A warm, flushed feeling is a benign and anticipated reaction following the intravenous administration of contrast media. The sensation may be felt throughout the body but is often pronounced in certain regions - most clients experience this as a warm sensation around the throat, which gradually moves down to the pelvic area. 65% correct

The patient has been diagnosed with scleroderma. Which of the following will the nurse expect to be the management? A. Maintain a warm atmosphere during the day and a cool room during the night. B. Keep the client supine for 1 hour after meals. C. Initiate strict bed rest. D. Administer prescribed corticosteroids. Subject Pharmacology Lesson Integumentary Client Need Area Physiological Adaptation 3980

D. Administer prescribed corticosteroids. Choice D is correct. Scleroderma is a medical condition in which connective tissue and skin harden. The surest way to manage this disease is to administer prescribed corticosteroids. Choice A is incorrect. Changes and temperature can be harmful to a patient suffering from scleroderma. Rather, the room should be kept at a constant temperature all day and night. Choice B is incorrect. Patients with scleroderma should be kept supine after meals. Clients should sit upright for 1-2 hours after meals if the esophagus has been affected. Choice C is incorrect. Strict bed rest is not necessary for patients with scleroderma. The nurse should encourage activity when the patient can manage it. 73% correct

The nurse is planning a staff educational conference about indwelling urinary catheters. Which of the following information should the nurse include? A. Sterile gloves should be used to perform urinary catheter care. B. Urinary specimens may be collected from a catheter bag. C. You may irrigate a catheter with warm water for poor outflow. D. Daily use of soap and water should be used around the urinary meatus. Subject Fundamentals Lesson Skills/Procedures Client Need Area Basic Care and Comfort 6914

D. Daily use of soap and water should be used around the urinary meatus. Choice D is correct. Daily cleaning of the urinary meatus with soap and water is recommended for catheter care. Sterile gloves do not need to be used for this process as it is a clean procedure. Soap and water is an acceptable practice for daily catheter care as alcohol, CHG, and other antiseptics may be highly irritating to the urinary meatus. Choices A, B, and C are incorrect. It is not necessary to utilize sterile gloves for catheter care as this is a waste of resources. Urinary specimens should not be collected from the catheter bag as this sample will be contaminated. If irrigating a urinary catheter is required, normal saline should be used as it is sterile. Water should not be used as it is not sterile and will cause cystitis.

A client just received a transfusion of one unit of platelets. In order for the nurse to determine that the intervention has been therapeutic, which of the following would the nurse anticipate the client to exhibit? A. An increased hemoglobin level B. An increased hematocrit level C. The client's temperature returns to normal compared to the pre-transfusion febrile state D. Decreased oozing of sanguineous drainage from surgical puncture sites Subject Adult Health Lesson Hematological/Oncological Client Need Area Pharmacological and Parenteral Therapies 2599

D. Decreased oozing of sanguineous drainage from surgical puncture sites Choice D is correct. Platelets are essential for proper blood coagulation. A decreased platelet count increases the client's risk for poor clotting and excessive bleeding. Following the transfusion of platelets, the nurse would anticipate a decrease or discontinuation in the amount of oozing of sanguineous drainage from the client's puncture sites compared to pre-transfusion. Choice A is incorrect. A platelet infusion would not increase the client's hemoglobin level, as a transfusion of red blood cells (also referred to as packed red blood cells (PRBCs)) would be needed to increase the client's hemoglobin level. Choice B is incorrect. A platelet infusion would not affect the client's hematocrit level. To increase this client's hematocrit level, the client would require a transfusion of red blood cells (also referred to as packed red blood cells (PRBCs)). Choice C is incorrect. Platelets do not affect the pathophysiology of a fever.

Select the age group that is accurately paired with an expected outcome that would indicate effective coping with their age-related stressor. A. Infants: will develop autonomy. B. Toddlers: will compete in the school environment. C. Adolescents: will begin to manage their home. D. Middle-aged adults: will cope with the challenges of the "sandwich generation". Subject Mental Health Lesson Mental Health Concepts Client Need Area Psychosocial Integrity 3421

D. Middle-aged adults: will cope with the challenges of the "sandwich generation". Choice D is correct. During the middle-aged adult years, there is a lot of coping with challenges associated with work, raising adolescent children, and caring for their adult aging parents. Caring for one's children and caring for aging parents places middle-aged adults in the "sandwich generation". Choice A is incorrect. Infants have to cope with and develop trust, but not autonomy. Choice B is incorrect. Toddlers have to cope with and develop autonomy, but not compete in the school environment. Choice C is incorrect. Adolescents have to cope with the changes associated with puberty and the development of interpersonal relationships, but not managing the home. 69% correct

The nurse notes the inflammation of the gums along with recession and bleeding. This observation should be documented using which term? A. Glossitis B. Caries C. Cheilosis D. Periodontitis Subject Adult Health Lesson Hematological/Oncological Client Need Area Physiological Adaptation 4793

D. Periodontitis Choice D is correct. Periodontitis is marked by inflammation of the gums. Choice A is incorrect. Glossitis is inflammation of the tongue. Choice B is incorrect. Caries refer to the presence of tooth decay. Choice C is incorrect. Cheilosis is the ulceration of the lips. 70% of people correct

The nurse is providing health education on a client with dumping syndrome. Which teaching point about drinking fluids is accurate? A. The client should drink fluids immediately before meals B. The client must only drink fluids with meals C. The client must drink fluids before and during meals D. The client should drink fluids at least a half an hour after meals Basic care & comfort, adult health, gi & nutrition 2747

D. The client should drink fluids at least a half an hour after meals Choice D is correct. Fluids should be taken at least 30 minutes to 1 hour after meals to avoid dumping syndrome. Choices A, B, and C are incorrect. Fluids consumed at the same time as food increase the speed of gastric emptying, subsequently increase the likelihood of dumping syndrome. 83% of peers got right

The nurse is giving discharge instructions to a client recently diagnosed with vaginitis. Which of the following instructions should the nurse include? A. Use oral contraceptives during sexual intercourse. B. Practice regular douching. C. Abstain from eating yogurt. D. Wear loose-fitting clothing and cotton underwear. Subject Adult Health Lesson Reproductive Client Need Area Physiological Adaptation 3306

D. Wear loose-fitting clothing and cotton underwear. Choice D is correct. Clients are encouraged to wear loose-fitting clothing and cotton underwear, avoid tight pants and thongs, and avoid using tampons to facilitate ventilation and improve circulation. Choices A, B, and C are incorrect. The client should use a condom during sexual intercourse to prevent her partner from acquiring the infection. Oral contraceptives do not provide a barrier that prevents disease. Clients are advised not to practice regular douching unless prescribed by the healthcare provider. Clients are advised to include yogurt or supplements containing Lactobacillus acidophilus in their diet to maintain vaginal flora. 91% correct

The nurse is caring for a client with afib. The nurse should anticipate which prescription from the primary healthcare provider (PHCP)? See the exhibit. A. captopril B. atropine C. adenosine D. diltiazem Subject Adult Health Lesson Cardiovascular Client Need Area Reduction of Risk Potential 7797

D. diltiazem Choice D is correct. The tracing in the exhibit shows irregularly irregular rhythm with no identifiable p-waves. This rhythm can be clearly identified as "atrial fibrillation. Diltiazem is a calcium channel blocker (CCB) and provides rate control in atrial fibrillation. Atrial fibrillation results in increased ventricular rate and reduced ventricular diastolic filling. If the ventricular rate is not controlled, cardiac output is reduced, resulting in hypotension and congestive heart failure. Initial treatment in atrial fibrillation is aimed at ventricular rate control with calcium channel blockers (diltiazem, verapamil, amiodarone), a beta-blocker ( atenolol, metoprolol), or digoxin. If the atrial fibrillation remains persistent, cardioversion is considered. Choices A, B, and C are incorrect. Captopril (choice A) is an ACE inhibitor used to treat heart failure and hypertension. Atropine (choice B) increases the heart rate and is efficacious for symptomatic sinus bradycardia, not atrial fibrillation. Adenosine (choice C) is approved for supraventricular tachycardia when vagal maneuvers are not efficacious. Note that the term " supraventricular tachycardia ( SVT)" refers to a wide variety of atrial arrhythmias ( atrial flutter, atrial fibrillation, atrial tachycardia) when the rhythm can not be clearly identified. During an SVT, the heart rate is very high at 150 to 220 beats per minute. The rate needs to be slowed so the rhythm can be appropriately identified and treated precisely. Vagal maneuvers ( carotid sinus massage, Valsalva maneuver) are applied first. IV adenosine is used to slow down or terminate if the SVT is refractory to vagal maneuvers. Adenosine's principal purpose in an SVT is to slow the rate to allow for appropriate rhythm identification. Because the rhythm strip in the exhibit can clearly be identified as atrial fibrillation, adenosine is unnecessary and must be treated with more specific rate-controlling medications (CCBs, beta-blockers). 38% correct

what iv fluids should be ready for patients with severe hypoglycemia

Dex 50%

Lab that evaluates kidney function, how fast/the rate the kidney is filtering out the bad stuff. The higher the rate, the more & faster the blood is being filtered & the better the kidney function is.

GFR

what is glucosamine used for

Glucosamine is a commonly recommended amino sugar used to promote joint health and cartillage repair for patients with osteoarthritis

symptoms of delerium

Hallucinations Restlessness, agitation, or combative behavior Calling out, moaning, or making other sounds Being quiet and withdrawn — especially in older adults Slowed movement or lethargy Disturbed sleep habits Reversal of night-day sleep-wake cycle changes in memory, judgment, language, mathematical calculation, abstract reasoning, and problem-solving ability

Protein in our RBCs that pick up oxygen in our lungs & carry/drop it of throughout the rest of our body to carry out our daily functions.

Hemoglobin

what happens if bilirubin is high

High bilirubin will produce jaundice, & is an indicative of liver damage. Unless it is in a newborn where the liver isn't fully developed yet. the liver needs to get rid of it

if albumin is low

If we don't have enough albumin, we think there is a liver problem/damage. The fluid will also start to leak out into our tissues & they will have edema, hypotension (because there's not enough fluid staying in the vessels), third spacing, ascites. Fluid leaking out where it shouldn't be.

what is c reactive protein

Marker of inflammation that can help predict the risk of cardiac disease and cardiac events says there is iinflammation, but doesn't tell us where.

rocuronium

Nondepolarizing neuromuscular blocker used with general anesthesia medicines for rapid sequence intubation and routine tracheal intubation

classic triad of preeclampsia

PRE proteinuria rising bp edema

what is creatinine

Product of muscle breakdown, measurement of kidney function

does having a seafood allergy increase risk if given contrast media

Research shows that clients with seafood allergies are not at any additional risk if given contrast media.

What is succinylcholine used for?

Short-term, rapid onset neuromuscular block/paralytic agent, useful for intubation.

A client presents with the following ABG results. What is the correct interpretation: a. pH: 7.37 b. CO2: 80 c. HCO3-: 42

Step #1: Acidosis or Alkalosis? pH <7.4 → Acidosis Step #2: Respiratory or metabolic? The CO2 is high. CO2 is an acid. High acid causes acidosis. CO2 is causing the problem → Respiratory. Step #3: Compensation. Since CO2 is causing the problem, look to HCO3 and see if it is trying to help. The HCO3 is high. HCO3 is a base. Lots of base raises our pH. This is helping the problem - so the gas is compensated. Partially or fully? Look at the pH! It is within the normal range, so the HCO3 has fully fixed the problem. This is a fully compensated blood gas. Answer: Fully Compensated Respiratory Acidosis

10. A client presents with the following ABG results. What is the correct interpretation: a. pH: 7.20 b. CO2: 70 c. HCO3-: 22

Step #1: Acidosis or Alkalosis? pH <7.4 → Acidosis Step #2: Respiratory or metabolic? The CO2 is high. CO2 is an acid. High acid causes acidosis. CO2 is causing the problem → Respiratory. Step #3: Compensation. Since CO2 is causing the problem, look to HCO3 and see if it is trying to help. The HCO3 is normal...not helping, so this is uncompensated. Answer: Uncompensated Respiratory Acidosis

A client presents with the following ABG results. What is the correct interpretation: a. pH: 7.23 b. CO2: 67 c. HCO3-: 28

Step #1: Acidosis or Alkalosis? pH <7.4 → Acidosis Step #2: Respiratory or metabolic? The CO2 is high. CO2 is an acid. High acid causes acidosis. CO2 is causing the problem → Respiratory. Step #3: Compensation. Since CO2 is causing the problem, look to HCO3 and see if it is trying to help. The HCO3 is normal...not helping, so this is uncompensated. Answer: Uncompensated Respiratory Acidosis

A client presents with the following ABG results. What is the correct interpretation: a. pH: 7.32 b. CO2: 30 c. HCO3-: 20

Step #1: Acidosis or Alkalosis? pH <7.4 → Acidosis Step #2: Respiratory or metabolic? The CO2 is low. CO2 is an acid. Low acid causes alkalosis. The HCO3 is low. HCO3 is a base. A low base causes acidosis. We have an acidosis, so the HCO3 is causing the problem. When HCO3 is the problem, it is metabolic. Step #3: Compensation. Since HCO3 is causing the problem, look to CO2 and see if it is trying to help. The CO2 is low. CO2 is an acid. Low acid raises the pH, and the current pH is too low. This is helping the problem - so the gas is compensated. Partially or fully? Look at the pH. It is NOT within the normal range, so the CO2 has only partially fixed the problem. This is a partially compensated blood gas. Answer: Partially Compensated Metabolic Acidosis

A client presents with the following ABG results. What is the correct interpretation: a. pH: 7.37 b. CO2: 32 c. HCO3-: 12

Step #1: Acidosis or Alkalosis? pH <7.4 → Acidosis Step #2: Respiratory or metabolic? The CO2 is low. CO2 is an acid. Low acid causes alkalosis. The HCO3 is low. HCO3 is a base. A low base causes acidosis. We have an acidosis, so the HCO3 is causing the problem. When HCO3 is the problem, it is metabolic. Step #3: Compensation. Since HCO3 is causing the problem, look to CO2 and see if it is trying to help. The CO2 is low. CO2 is an acid. Low acid raises the pH. The pH is normal now, but it is <7.4 so we know it was an acidosis before compensation occurred. The CO2 is helping the problem - so the gas is compensated. Partially or fully? Look at the pH. It is within the normal range, so the CO2 has fully fixed the problem. This is a fully compensated blood gas. Answer: Fully Compensated Metabolic Acidosis

A client presents with the following ABG results. What is the correct interpretation: a. pH: 7.58 b. CO2: 48 c. HCO3-: 38

Step #1: Acidosis or Alkalosis? pH >7.4 → Alkalosis Step #2: Respiratory or metabolic? The CO2 is high. CO2 is an acid. High acid causes acidosis. The HCO3 is high. HCO3 is a base. A high base causes alkalosis. We have an alkalosis, so the HCO3 is causing the problem. When HCO3 is the problem, it is metabolic. Step #3: Compensation. Since HCO3 is causing the problem, look to CO2 and see if it is trying to help. The CO2 is high. CO2 is an acid. High acid lowers the pH, and the current pH is too high. This is helping the problem - so the gas is compensated. Partially or fully? Look at the pH! It is NOT within the normal range, so the CO2 has only partially fixed the problem. This is a partially compensated blood gas. Answer: Partially compensated Metabolic Alkalosis

A client presents with the following ABG results. What is the correct interpretation: a. pH: 7.43 b. CO2: 51 c. HCO3-: 42

Step #1: Acidosis or Alkalosis? pH >7.4 → Alkalosis Step #2: Respiratory or metabolic? The CO2 is high. CO2 is an acid. High acid causes acidosis. The HCO3 is high. HCO3 is a base. A high base causes alkalosis. We have an alkalosis, so the HCO3 is causing the problem. When HCO3 is the problem, it is metabolic. Step #3: Compensation. Since HCO3 is causing the problem, look to CO2 and see if it is trying to help. The CO2 is high. CO2 is an acid. High acid lowers the pH, and the current pH is too high. This is helping the problem - so the gas is compensated. Partially or fully? Look at the pH. It is within the normal range, so the CO2 has fully fixed the problem. This is a fully compensated blood gas. Answer: Fully Compensated Metabolic Alkalosis

A client presents with the following ABG results. What is the correct interpretation: a. pH: 7.62 b. CO2: 14 c. HCO3- : 18

Step #1: Acidosis or Alkalosis? pH >7.4 → Alkalosis Step #2: Respiratory or metabolic? The CO2 is low. CO2 is an acid. Low acid causes alkalosis. The HCO3 is low. HCO3 is a base. Low base causes acidosis. The CO2 is causing the problem → Respiratory. Step #3: Compensation. Since CO2 is causing the problem, look to HCO3 and see if it is trying to help. The HCO3 is low. Low HCO3 lowers the pH, and the current pH is too high. This is helping the problem - so the gas is compensated. Partially or fully? Look at the pH! It is NOT within the normal range, so the HCO3 has only partially fixed the problem. This is a partially compensated blood gas. Answer: Partially compensated Respiratory Alkalosis

A client presents with the following ABG results. What is the correct interpretation: a. pH: 7.42 b. CO2: 27 c. HCO3- : 18

Step #1: Acidosis or Alkalosis? pH >7.4 → Alkalosis Step #2: Respiratory or metabolic? The CO2 is low. CO2 is an acid. Low acid causes alkalosis. The HCO3 is low. HCO3 is a base. Low base causes acidosis. The CO2 is causing the problem → Respiratory. Step #3: Compensation. Since CO2 is causing the problem, look to HCO3 and see if it is trying to help. The HCO3 is low. Low HCO3 lowers the pH. The pH is normal now, but it is >7.4, so we know it was too high before compensation occurred. The HCO3 is helping the problem - so the gas is compensated. Partially or fully? Look at the pH! It is within the normal range, so the HCO3 has fully fixed the problem. This is a fully compensated blood gas. Answer: Fully Compensated Respiratory Alkalosis

Place the following steps for starting a peripheral intravenous line in the correct sequential order: -Place the tourniquet 1 to 2 inches above the selected vein site. -Allow the area to air dry. -Prep the selected area with an antiseptic wipe. -Pull the skin taut above the selected vein. -Place a sterile dressing over the IV site. -Stabilize the intravenous catheter. -Advance the catheter until a flash of blood is seen. -Inspect and palpate the extremity for a suitable vein. -Insert the intravenous catheter at a 15 to 30 degree angle. Subject Fundamentals Lesson Skills/Procedures Client Need Area Safety & Infection Control 3782

The correct sequence of steps to start a peripheral intravenous line are as follows: Inspect and palpate the extremity for a suitable vein. Place the tourniquet 1 to 2 inches above the selected vein site. Prep the selected area with an antiseptic wipe. Allow the area to air dry. Pull the skin taut above the selected vein. Insert the intravenous catheter at a 15 to 30-degree angle. Advance the catheter until a flash of blood is seen. Stabilize the intravenous catheter. Place a sterile dressing over the IV site. 37% correct

how does sinus bradycardia impact cardiac output

The heart rate is lower, due to bradycardia, so the cardiac output is lowered. Remember, CO = HR x SV. Decreased HR = decreased CO.

how does vtach impact cardiac output

There is an increase in heart rate and a decrease in stroke volume. This is because the heart is beating fast and irregularly. There is not enough time for diastole and therefore not enough time for the atriums to fill with blood. This decreases preload, which decreases contractility due to Starling's law, which reduces stroke volume. Patients in VT have decreased cardiac output. This is a lethal rhythm.

how does mobitz type 2 heart block impact CO

This type of heart block causes a decreased heart rate, which once again decreases cardiac output. CO = HR x SV. Decreased HR = decreased CO. Patients in Mobitz type II heart block have decreased cardiac output.

what is valerian root

a common herbal remedy used to treat occasional insomnia but may interact with some medications

what is raspberry tea leaf used for

a popular herbal tea used to induce labor and expedite the shrinking of the uterus post-partum.

Clients with the highest risk of contrast agent allergies are those with

a previous history of reactions to contrast media, those taking beta-blockers, and those with heart disease, asthma, and/or renal insufficiency

what is propofol

a sedative/hypnotic agent often given before giving paralytic agents

15. While precepting a new graduate nurse, you are assigned to care for a client in diabetic ketoacidosis (DKA). The new nurse obtains an ABG and the results are as follows: pH: 7.2 CO2: 11 HCO3: 14 Which of the following statements by the new nurse demonstrate a need for further teaching regarding the acid-base status of this client? Select all that apply. a. "Our client is acidotic because they have lost so much CO2" b. "Because the bicarbonate is causing this imbalance, this is a metabolic alkalosis" c. "Since our client has been experiencing kussumal respirations, it makes sense that their bicarbonate is so low" d. "This arterial blood gas is fully compensated" e. "This client is experiencing a metabolic acidosis, which is expected in DKA. Other clients that could have this imbalance are those with vomiting or using diuretics"

a. "Our client is acidotic because they have lost so much CO2" b. "Because the bicarbonate is causing this imbalance, this is a metabolic alkalosis" c. "Since our client has been experiencing kussumal respirations, it makes sense that their bicarbonate is so low" d. "This arterial blood gas is fully compensated" e. "This client is experiencing a metabolic acidosis, which is expected in DKA. Other clients that could have this imbalance are those with vomiting or using diuretics" Answers: A, B, C, D, and E A is correct. A is correct. This client is acidotic, but not because they have lost CO2. The normal range for CO2 is 35-45. CO2 is an acid, and the loss of it therefore results in an alkalosis, or elevated pH; so this statement requires further teaching to the new nurse. B is correct. This client is not experiencing a metabolic alkalosis, rather they are experiencing a metabolic acidosis. The normal range for pH is 7.35-7.45, and this client hasa low, or acidotic pH at 7.2. If the new nurse states that a metabolic alkalosis is occurring, they need further education regarding acid base imalances. C is correct. Kussumal respirations are fast, deep respirations that sometimes occur in Diabetic Ketoacidosis (DKA). They are the body's response to a metabolic acidosis. By breathing fast and deep, the body is exhaling and therefore removing carbon dioxide, an acid, from the body. This should raise the pH and help compensate for the acidosis. While it does make sense that the client is having kussumal respirations with their ABG results, it is not the reason that their HCO3 is low; it is the reason that their CO2 is low. D is correct. This is a partially compensated arterial blood gas, not fully. E is correct. This statement indicates that the new graduate nurse correctly understands DKA causes metabolic acidosis, but they incorrectly state other potential causes. Clients with vomiting or diuretic use are at risk for metabolic alkalosis. Other clients who could experience a metabolic acidosis include clients with diarrhea or renal disease.

14. The nurse is working in a in-client psychiatric facility caring for a client experiencing an acute panic attack. Upon assessing the client, they tell the nurse that they are dizzy, lightheaded, and feel they might pass out. Which of the following lab values does the nurse expect to note? a. CO2- 20 b. pH - 7.8 c. HCO3 - 46 d. pH - 7.44 e. CO2 - 35 f. HCO3 - 28

a. CO2- 20 b. pH - 7.8 f. HCO3 - 28 A is correct. A low CO2 would be expected in the client having an acute panic attack as their body exhales large amounts of CO2. This results in a respiratory alkalosis. Bi s correct. The client having an acute panic attack is expected to have a high pH. This is due to the loss of CO2 due to hyperventilation. F is correct. The client having an acute panic attack would be expected to have a normal HCO3 level. In an acute attack, the kidneys have not yet had time to begin the process of compensating, therefore the HCO3 remains normal. It takes the kidneys hours to days to begin producing more bicarbonate to raise the pH and compensate for the acidosis. This would be expected in more gradual processes that cause aciodisis over days, such as prolonged diarrhea. C is incorrect. A high bicarbonate level would indicate that compensation is occurring as the kidneys produce more base to raise the pH and correct the acidosis. This is not expected during an acute attack, as they kidneys take hours to days to begin the compensation process. D is correct. The client having an acute panic attack would not have a normal pH of 7.44- their pH will be low due to the loss of CO2. E is incorrect. The client having an acute panic attack would not have a normal CO2 of 35- their CO2 will be low as they are hyperventilating and loosing CO2.

13. The nurse is taking the health history of an 87-year-old client and asks what medications he takes. He lists lisinopril, digoxin, Tums, and Alka-Seltzer. Which of the following acid-base imbalances is this client at the highest risk of? a. Metabolic alkalosis b. Metabolic acidosis c. Respiratory acidosis d. Respiratory alkalosis

a. Metabolic alkalosis A is correct. The client using over the counter antacids such as Alka-Setlzer is at risk of developing metabolic alkalosis. This is due to the high amount of sodium bicarbonate present in this medication. If the client takes too much of it, their HCO3 level can increase, causing a metabolic alkalosis. B is incorrect. Clients at risk for metabolic acidosis include those experiencing diarrhea, renal disease, and diabetic ketoacidosis. These clients are loosing HCO3 causing their pH to become acidotic. C is incorrect. Clients at risk for respiratory acidosis include those with chronic obstructive pulmonary disorder, those experieincing respiratory depression after an overdose, or any client otherwise hypoventilating. These clients are retaining CO2 causing their pH to become acidotic. D is incorrect. Clients at risk for respiratory alkalosis include who are hyperventilating, such as when they are experiencing a panic attack. These clients are loosing CO2 causing their pH to become alkalotic.

pH less than 7.35 is

acidosis

protein in the blood that Help keeps fluid inside our blood vessels & helps prevent third spacing & edema

albumin

pH greater than 7.45 is

alkalosis

what arrhythmias affect cardiac output

all of them

Waste product created by the liver from muscle breakdown that is later converted into urea nitrogen

ammonia

what is black cohosh used for

an herbal supplement sometimes used to induce abortion in the early first trimester, to induce labor after a woman is forty weeks pregnant, or relieve symptoms of menopause

if someone's wbcs are low, what should we give them asap

antibiotics because they don't have enough wbcs to fight off infection so we need to give them something to help the fight

if you take this medication, you are of high risk to develop a contrast agent allergy

beta blockers

waste product of rbc breakdown

bilirubin

what lab value indicates hf

bnp bnp are peptides produced in the heart that are released when the heart needs to work harder. bnp monitoring helps detect, diagnose and evaluate the severity of hf

what happens if ammonia is high

can cause hepatic encephalopathy we worry about liver damage

presence of tooth decay

caries

what are the most common agents for treating afib/controlling the ventricular rate

ccb, bb & less commonly digoxin digoxin (not as commonly used), amiodarone, diltiazem, verapamil, or atenolol are the medications used to achieve rate control in atrial fibrillation

what meds can exacerbate hf

ccbs and nsaids

ulceration of the lips

cheilosis

____________ is characterized by chronic exposure to glucocorticoid

cushings syndrome

12. The nurse is caring for a client recovering from a clonazepam overdose. Which of the following ABG results would be expected? a. pH 7.4, CO2 40, HCO3 28 b. pH 7.42, CO2 52, HCO3 42 c. pH 7.56, CO2 22, HCO3 22 d. pH 7.25, CO2 74, HCO3 26

d. pH 7.25, CO2 74, HCO3 26 D is correct. This is an uncompensated respiratory acidosis. Clonazepam is a benzodizepine which depresses the central nervous system. It therefore lowers the respiratory rate and can cause respiratory depression. When the cleint's respiratory rate decreases too much, their body retains CO2 (which as an acid, lowers the pH and causes acidosis). The elevated CO2 level and subsequently low pH is what the nurse would expect after a clonazepam overdose. A is incorrect. This is a normal ABG, which would not be expected in a client who has experienced a clonazepam overdose. B is incorrect. This is a fully compensated metabolic alkalosis. An example of a client that the nurse would expect this ABG is a client who has taken too many over-the-counter antacids, such as Alka-Seltzer. This client has ingested too much sodium bicarbonate (hence their high HCO3 level), which caused their pH to go up. The body compensating by retaining CO2 (hence the high CO2 level), and brought he pH back down into normal range. A metabolic alkalosis is not the ABG the nurse would expect for a client who has experienced a clonazepam overdose. C is incorrect. This ABG shows an uncompensated respiratory alkalosis. The nurse would expect a client experiencing a panic attack to have his ABG result. In a panic attack, the client is hyperventilating and loosing CO2. The loss of CO2 (an acid), causes the pH to increase- hence the alkalosis. This ABG is uncompensated, because the HCO3 remains normal and is not helping to fix the abnormal pH. The nurse would not expect that the client who has experienced a clonazepam overdose would present with respiratory alkalosis.

what is the most common adverse effect in carbamazepine

decrease in baseline leukocytes, neutrophils, and thrombocytes - so get a cbc monitored

ccb ending

dipine

The most significant complication associated with atrial fibrillation is

embolic stroke

normal hemoglobin count for males & females

female: 12-16 male: 14-18

inflammation of the tongue

glossitis

The application of permethrin is indicated for treating

head lice

pediculus capitis

head lice

Ratio of RBCs to total volume of blood, usually tells us how concentrated our blood is with RBCs

hematocrit

intrinsic pathway is affected by what anticoag

heparin ptt: 30-40 seconds not on heparin, 45-90 seconds on heparin

if cr is high, we worry about

impaired kidney function

if BUN is high, we worry about

impaired kidney function or dehydration

how does svt impact cardiac output

increase in heart rate, but a decrease in stroke volume. This is because the heart is beating so fast that there is not enough time for diastole and, therefore, not enough time for the atriums to fill with blood. This decreases preload, which decreases contractility due to starling's law, which reduces stroke volume. Patients in SVT have decreased cardiac output

leukocytosis

increase in the number of white blood cells

calcium channel blockers affects what anticoagulant in what way

increases the effects of the warfarin.

if wbcs are high, it is an indication of

infection somewhere Or can be elevated after an operation because they are trying to heal the surgical wounds.

Calculated from PT to monitor how well warfarin is working

inr

A gastrointestinal disease of childhood where a piece of bowel goes backward inside itself, forming an obstruction

intussusception

jelly like stool

intussusception -

what iv fluids should treat hypovolemia caused by hypoglycemia?

isotonic, like normal saline

an exaggerated, forward rounding of the back that can occur at any age but is most common in older women

kyphosis

what is d dimer

lab value that tells us if there is a possible DVT or PE, some sort of clot somewhere. if negative can rule out dvt/pe

The goal is to have total cholesterol of

less than 200

what are the 6 Ls of hypokalemia

lethargy low respirations limp muscles lethal dysrhythmias leg cramps lots of urine

The spinal change that is common in pregnancy as a result of the increasing weight of the enlarging uterus and the effect of gravity.

lordosis

11. The nurse is caring for a client with the following ABG result. pH: 7.31 CO2: 32 HCO3: 19 Which of the following conditions are possible causes for the client's acid-base imbalance? Select all that apply. a. 5-day history of severe diarrhea b. Hyperemesis gravidarum c. End-stage renal disease d. Diabetic Ketoacidosis e. Chronic Obstructive Pulmonary Disease f. Hyperglycemic Hyperosmolar Non-ketotic Syndrome

metabolic acidosis a. 5-day history of severe diarrhea b. Hyperemesis gravidarum c. End-stage renal disease d. Diabetic Ketoacidosis A is correct. Diarrheal stools are high in bicarbonate. The loss of this bicarbonate, which is a base, from the stools results in metabolic acidosis. C is correct. End-stage renal disease causes metabolic acidosis due to the inability of the kidneys to produce sufficient bicarbonate. Because bicarb is a base, and the kidneys cannot make enough of it, acidosis occurs. D is correct. Diabetic Ketoacidosis can cause metabolic acidosis. This occurs when a client with Type I DM has so little insulin, that the cells have no glucose for energy and resort to breaking down fat for energy. A byproduct of this fat breakdown is ketones, which are acids, and cause acidosis. B is incorrect. Hyperemesis gravidarum is a pregnancy complication resulting in excessive nausea and vomiting. Vomiting causes the client to lose gastric secretions, which contain large amounts of hydrochloric acid. The loss of this acid causes alkalosis. E is incorrect. Chronic Obstructive Pulmonary Disease (COPD) can cause acidosis, but it is due to a respiratory cause, not metabolic. In COPD, clients retain carbon dioxide due to obstructive disease. Because carbon dioxide is an acid, the retention of CO2 causes acidosis. Because the cause of the acidosis is CO2, it is classified as respiratory acidosis. This client has metabolic acidosis, where the low pH is due to low HCO3 levels, not high CO2 levels. F is incorrect. Hyperglycemic Hyperosmolar Non-ketotic Syndrome (HHNS) is a complication of Type II DM. This client is not expected to have an acid-base imbalance. They have very high blood glucose levels, resulting in symptoms such as dry mouth, polydipsia, polyuria, and tachycardia, but their body does not resort to breaking down fat for energy. They, therefore, do not produce ketones and do not become acidotic.

what is vecuronium used for

nicotinic antagonist and nondepolarizing neuromuscular blocker used before surgery to produce prolonged muscle paralysis

A client presents with the following ABG results. What is the correct interpretation a. pH: 7.35 b. CO2: 40 c. HCO3-: 23

normal

if pH is normal, the ABG balance is either __________ or ___________

normal (pH, CO2 & HCO3 are all in normal ranges) or fully compensated (pH is normal, & both CO2 & HCO3 are abnormal (both high or both low) because 1 is trying to correct the other)

If we have low hemoglobin, we worry about

oxygenation status, anemia & if they're bleeding somewhere or if they need a blood transfusion.

If hematocrit is low, we worry about

oxygenation status, anemia, blood loss/bleeding somewhere, if they need a transfusion, micronutrient deficiency

what does uncompensated mean

pH balance is abnormal either CO2 or HCO3 is abnormal, but one of them is normal. the other is not trying to fix it at all.

what are the "5 Ps" associated with compartment syndrome

pain pallor paresthesia paralysis pulselessness

Manifestations of PAD include

pain while walking (claudication) decreased peripheral pulses painful ulcers that don't heal weakness smooth, shiny skin skin cool to touch cold/numb toes

if pH is abnormal, the ABG balance is either __________ or ___________

partially compensated (both CO2 & HCO3 are abnormal because 1 is trying to fix the other) or uncompensated (either CO2 or HCO3 is abnormal but the other value is in normal range, not trying to balance the other out)

inflammation of the gums

peridontitis

If hematocrit is high, it is really viscous & we worry about

polycythemia vera

Ethambutol is a medication indicated in the treatment of

pulmonary tuberculosis

enlargement and stiffening of the pylorus, the opening from the stomach into the duodenum. This prevents the passage of food into the duodenum and results in projectile vomiting.

pyloric stenosis

lump in the abdomen - intussusception or pyloric stenosis

pyloric stenosis firm & movable & feels like an olive

treatment options for afib are aimed at what 2 things

rate control and anticoagulation Digoxin (not as commonly used), amiodarone, diltiazem, verapamil, or atenolol are the medications used to achieve rate control in atrial fibrillation. The client may be prescribed an oral anticoagulant ( apixaban, rivaroxaban, dabigatran, or warfarin) to prevent thrombosis/ stroke. If medication is not effective, synchronized cardioversion may be prescribed.

what do corticosteroids do

reduce inflammation, but also increase risk of infection & can cause hyperlipidemia

systolic heart failure has what type of cardiac abnormality

s3 gallop sys-tol-ic = 3 syllables, s3 gallop di-a-stol-ic = 4 syllables, s4 gallop

diastolic heart failure has what type of cardiac abnormality

s4 gallop sys-tol-ic = 3 syllables, s3 gallop di-a-stol-ic = 4 syllables, s4 gallop

sideways curvature of the spine that occurs most often during the growth spurt just before puberty

scoliosis

what is phenytoin used for

seizures

Drug intoxication, from prescription or OTC medications, is more common in what population and why

the elderly d/t slower metabolism and absorption

if plts are low, we worry about

them bleeding somewhere or not being able to stop bleeding if something happens & they need to be on bleeding precautions

if plts are high, we worry about

them getting clots

what lab work needs to be done for phenytoin

therapeutic phenytoin levels 10-20

if wbcs are low, we worry about

they are immunocompromised or have cancer or are taking immunosuppressants. Don't have enough wbcs to fight off an infection, so we need to get them some antibiotics asap to help with the fight.

group of proteins found in skeletal and cardiac muscle fibers that regulate muscular contraction, test is done to help detect cardiac injury/MI

troponin

depilatory cream is used to treat

unwanted hair A lotion that dissolves hair and removes it from the surface of the skin.

ccbs that dont end in dipine

verapamil, diltiazem

extrinsic pathway is affected by what anticoag

warfarin INR: 0.9-1.2 without warfarin, 2-3 on warfarin PT: 10-12 seconds

what is urea nitrogen

waste product of protein metabolism, it is converted from ammonia that is created by the liver & it is excreted by the kidneys