uWorld August 11 #3, August 6 #2
A float nurse from labor and delivery is assigned to the cardiac care unit. Which client is most appropriate for the charge nurse to assign to the float nurse?
Client admitted for hypertensive crisis with blood pressure of 154/92 on almodipine PO Client with unstable angina and history of MI should not
A home health nurse is preparing to start a milrinone infusion via a peripherally inserted central catheter for a client with end-stage heart failure. What equipment is most important to be present in the home? Select all that apply.
-Bathroom scale for daily weights -Blood pressure cuff -CENTRAL LINE DRESSING CHANGE KITS (even peripherally, there is must be kits -infusion pump Milrinone (Primacor) is given to clients with chronic heart failure
When assessing newborns, the nursery nurse should report which findings to the health care provider? Select all that apply.
-Chest wall retractions -Jaundiced appearance -not voiding in 24 hours *Desaquamation (peeling skin) is a normal finding in newborn head circumference 12.5-14.5 Nasal flaring, chest wall retractions and grunting must be reported
interventions to reduce intracranial pressure
-DO NOT CLUSTER CARE -hyperventilate before suctioning -maintain the head in a neutral midline position and elevated head to 30 degrees to reduce venous congestion
What NOT TO DO during informed consent?
-Do not educate the client is there is a misunderstanding about the procedure -Do not explain to the client the right to refuse surgery
Normal uterine contractions during the first stage of labor
-Duration: 45-80 secs. Should not be >90 secs -Frequency: 2-5 contractions every 10 mins. should not occur <2 mins -intensity: strength of contraction at its peak, 25-50 mm, should not exceed 80 mm -Resting tone: tension in the uterine muscle between contractions. Allow fetal oxygenation between contractions. Average 10 mg Hg. Should not exceed 20 mm Hg
contraindications for MRI or MRCP
-I got a rash the last time I had IV contrast -I had my last period 6 weeks ago -I have a hearing aid implanted in my ear *SO pacemaker, cochlear implant and aneurysm clip, pregnancy are contraindications
Right sided heart failure vs Left sided heart failure
-Jugular venous distension -hepatomegaly -splenomegaly -ascites -edema cardiomegaly (S3 sound), pulmonary edema (dyspnea, orthopnea, PND, crackles
Myopia diagnosis
-My child gets headaches frequently -My child is doing poorly in math -My child's eyes blink often
Signs of hyperemesis gravidarum
-Positive urine ketones (moderate) is a severe, persistent nausea and vomiting during pregnancy. Excessive loss of gastric contents leads to fluid and electrolyte imbalances (hypokalemia, hyponatremia), metabolic alkalosis, nutritional deficiencies, ketonuria, and weight loss *ketones is lost NOT PROTEINS
Full liquid diet
-Stained or blended cream soups -custards, pudding -refined cooked cereals -all fruit juices -ice cream, frozen yogurt, sherbet, milkshakes
Signs of cancer
-a sore that does not heal -unusual bleeding or discharge -thickening or lump in the breast -indigestion or difficulty swallowing -obvious change in a wart or mole -nagging cough or hoarsness CAUTION is the acronym for it
Which medications are okay
-allopurinol for tumor lysis syndrome -morphine for percutaneous nephrolithotripsy although last bowel movement was 2 days ago. Bowel movements can be fixed with ducosate -Levofloxacin is okay for UTI and has no cross-sensitivity to penicillin
Clear liquid diet
-clear fat-free broth, bouillon -Gelatin -popsicles -clear fruit juices -carbonated beverages -coffee, tea
risk factors of elder abuse
-female -shared living space
IM injection powder
-perform hand hygiene and don clean gloves -withdraw air from the vial -inject diluent into the vial -roll vial between the palms of the hands to mix -withdraw reconstituted medication from the vial -label syringe with medication name and dosage
6 rights of medication
-right client using 2 identifiers -right medication -right dose -right route -right time -right documentation
When inserting a needle to draw a blood
-withdraw if pulsating happens (you hit an artery) -do not apply it on the ventral side of the wrist since you would most likely hit an artery -Do not shake the specimen vigorously. Just gentle shake 5-10 times
Which pediatric respiratory presentation in the emergency department is a priority for nursing care?
Client with an acute asthma but no wheezing *client without wheezing or breath sounds is an emergency since the airways are blocked (constricted) #silent chest
For which client is it most important for the nurse to provide teaching on ways to prevent the spread of the condition?
Client with tinea corporis transmit from one person to another or from infected animal to a human
When assessing the client's pain level, what will the nurse determine is the most reliable indicator of the pain?
Client's report of symptoms
Which infant is most likely to require oral iron supplementation at this time?
2 month old born at 34 weeks gestation who is bottle fed with breast feed premature infants require iron by 2-3 months
The clinic nurse is assessing the client's understanding of tiotropium, which has been prescribed for chronic obstructive pulmonary disease (COPD). Which statement indicates that the client has a correct understanding of this medication?
A capsule holds the powdered medication that I have to put in a special inhaler
Remember
ALWAYS SUCTION THE OROPHARYNGEAL BEFORE APPLYING 100% OXYGEN
Who is on negative air pressure?
Airborne precaution
The nurse cares for a confused client who continues to pull at the intravenous (IV) catheter on the left forearm despite frequent instructions not to do so. What is the nurse's next action?
Apply a gauze wrap and elastic stockinette around the IV line
The nurse is reviewing new prescriptions for assigned clients. Which prescription would require further clarification from the health care provider?
Ateplase for ischemic stroke in a client with a blood pressure of 192/112 *thrombolytic gents (alteplase, tenecteplase, reteplase) are used for ischemic stroke but CONTRAINDICATED FOR uncontrolled hypertension, bleeding and what not *penicillin and cephalosporins (cephalexin, ceftriaxone) are generally safe during pregnancy
The emergency department nurse cares for a client admitted with a diagnosis of hyperosmolar hyperglycemic state. The nurse understands which characteristics are commonly associated with this complication? Select all that apply.
Blood glucose level >600 *kussmual respirations is not part of it
unlicensed assistive personnel
CAN REAPPLY OXYGEN VIA NASAL CANNULA IF IT ACCIDDENTALLY COMES OFF
Jaundice
Cause itching that can exacerbated by the use of hot water and strong soaps. *Always use cool water and minimum amount of mild soap
Soft diet
Clear and full liquid plus -soups -grounded or finely diced meats, flaked fish -pancakes, biscuits, muffins -pasta, rice, mashed potatoes -cooked or canned fruits & veggies -peanut butter -scrambled eggs
The client with suspected active pulmonary tuberculosis (TB) has a positive tuberculin skin test (TST). Which prescription from the health care provider does the nurse anticipate will confirm the diagnosis in this client?
Collect an early morning sterile sputum specimen on 3 consecutive days
A client with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia has been receiving IV vancomycin for the last 3 days. Which blood test trend is most important for the nurse to review when preparing to administer this medication?
Creatinine levels *vancomycin causes nephrotoxicity
What to do after bariatric sugery
DO NOT CONSUME JUST CARBS as this increases the risk of dumping syndrome
lactase deficiency diet management
DO NOT CONSUME MILK AND ICE CREAM may consume cheese or yogurt in moderations
which medication to question?
Dicyclomine is an antispasmodic drug that decreases intestinal motility and is contraindicated in clients with paralytic ileus
A nurse is changing a sterile dressing for a client with an infected wound. While doing so, the unlicensed assistive personnel (UAP) reports that another client is requesting medication for postoperative pain. What is the nurse's most appropriate action?
Direct the unlicensed assistive personnel to tell the client that you will be there shortly, and complete the sterile dressing *vital signs are unreliable source of pain indicator
The charge nurse is assisting with a nonemergent cardioversion for a client with supraventricular tachycardia. Which action by the primary nurse would cause the charge nurse to intervene?
Disengages the "sync" function on the defib *DO NOT DISABLE THE "SYNC" FEATURE, ACCIDENTAL SHOCK COULD BE LETHAL ARRHYTHMIAS DURING CARDIOVERSION *Cardioversion (synchronized) is a defibrillator. Must do: -administer a one time dose of IV midazolam -place the defibrillator pads on upper right and left chest -TURN OFF OXYGEN AND MOVE IT AWAY ASS THIS IS INFLAMMABLE
Chronic heart failure
Do not consume frozen meals because it is high in sodium discharge instruction: weight daily and avoid NSAIDS as this causes sodium retention (fluid retention)
Iron deficiency anemia
During pregnancy, the vagina is more acidic and normal to increase WBC clients are diagnosed with anemia (<iron) when hemoglobin is <11 in the 1st trimesters or <10.5 in the 2nd trimesters
A hospitalized client develops acute hemorrhagic stroke and is transferred to the intensive care unit. Which nursing interventions should be included in the plan of care? Select all that apply.
EVERYTHING IS GOOD BUT DO NOT ADMINISTER ENOXAPARIN INJECTIONS SINCE IT CAUSES HEMORRHAGIC STROKE
ulcerative colitis
Eat a low-residue, high-protein, high calorie diet *the low residue limits trauma to the inflamed colon and may lessen symptoms
A pregnant client provides the following obstetric history to the nurse at the first prenatal visit: Elective abortion at age 17; a 5-year-old daughter born at 40 weeks gestation; and 3-year-old twin boys born at 34 weeks gestation. Using the GTPAL system, which option is correct?
G4, T1, P1, L3 COUNT CURRENT PREGNANCY AS ONE
Febrile seizure for an 8 month old
Give acetaminophen or ibuprofen every 6 hours to control the fever
Which clients can receive opioid agonist-antagonist IV
Gravida 2, 5 cm dilated, 100%, contractions 3-4 minutes apart, moaning and shaking A client with a history of heroin abuse should not be given because it can cause withdrawal symptoms to the mom and fetus. This client should be given epidural anesthetics early phase of stage 1 just needs nonpharm supportd
Left sided heart failure
HAS TO DO WITH LUNGS
A highly intoxicated client was brought to the emergency department after found lying on the sidewalk. On admission, the client is awake with a pulse of 70/min and blood pressure of 160/80 mm Hg. An hour later, the client is lethargic, pulse is 48/min, and blood pressure is 200/80 mm Hg. Which action does the nurse anticipate taking next?
Have CT scan performed to rule out an intracranial bleed *Cushing's triad is related to increased ICP. Early signs: change in LOC. Later sign: bradycardia, increased SYSTOLIC PRESSURE with a WIDENING PULSE PRESSURE(difference between systolic and diastolic), and slowed irregular (Cheyne-stokes) respirations Cheyne-stokes typically present in dying
An elderly client is admitted with chronic obstructive pulmonary disease (COPD) exacerbation. Pulse oximetry is 84% on room air. The client is restless, has expiratory wheezing and a productive cough, and is using his accessory muscles to breathe. Which prescription should the nurse question?
IV morphine 2 mg now and may repeat every 2 hours *can depress the respiratory center and should not be given for COPD patients
The nurse is teaching the parents of a toddler about health promotion. Which statement by one parent requires clarification?
If my child refuses a meal, I will wait a few minutes and try again
The nurse is caring for a client on the organ donation waiting list for cardiac transplantation. Which teaching topic is most important for the nurse to emphasize at this time?
Immunosuppressive therapy as a lifelong commitment
The nurse assesses these symptoms in a client with bacterial pneumonia: chills, elevated temperature, tachypnea, productive cough of yellow sputum, shortness of breath, and fatigue. Based on the assessment data, what is the most appropriate nursing diagnosis (ND) for this client?
Impaired gas exchange which is related to SOB and tachypena
A client had a percutaneous nephrolithotripsy 3 hours ago to remove left renal calculi. Since then, the indwelling urethral catheter has drained 125 mL of urine and the nephrostomy tube has drained 0 mL. The client now reports left flank pain radiating to the left groin along with severe nausea. What is the appropriate nursing intervention?
Irrigate the nephrostomy tube with sterile normal saline as prescribed
Meningococcal meningitis
Keep the client NPO
The nurse in an outpatient clinic cares for a client with primary adrenal insufficiency (Addison's disease) who has been taking hydrocortisone 20 mg/day for the last 8 years. Which client data is most important to report to the primary healthcare provider (PHCP)?
Low grade fever of 100 because it can mask infection *development of moon face is okay
delegation to LPN
Most medication include bolus feeding is okay but advanced medication (IV) must be performed by the RN
severe state of hypothyroidism
Myxedema coma
A parent calls the clinic nurse concerned about a 5-year-old with a nosebleed. The parent says the child had a similar incident one week ago while at school. Which instructions should the nurse provide? Select all that apply.
NO NEED TO TAKE THE CHILD IN THE HOSPITAL AND IT IS NOT EMERGENCY
What 2 drugs can cause problems for asthma
NSAIDS (ibuprofen, aspririn) and BETA BLOCKERS loratadine (antihistamine) is okay to give since it does not cause asthma attack Guifenesin (Micnex) is an expoectorant used to facilitate mobilization of mucus
Insulin subcu vs IV
Normal can be administered IV or subcu NPH can only be administered subcu
A client in active labor who received an epidural 20 minutes ago reports feeling nauseated and lightheaded. Which action should the nurse perform first?
Obtain blood pressure epidural can cause vasodilation leading to hypotension
The nurse is caring for a client in the first trimester during an initial prenatal clinic visit. Based on the information provided by the client, which factor places the client at an increased risk for preterm labor?
Periodontal disease other reasons for preterm is UTI
The nurse cares for a group of clients on a medical surgical floor. The client with which condition is at highest risk for developing syndrome of inappropriate antidiuretic hormone (SIADH)?
Small cell lung cancer
The nurse is caring for a 72-year-old client with hypothyroidism admitted to the emergency department for altered mental status. The client lives alone but has not taken medications or seen a health care provider for several months. Which action is the priority?
Prepare for intubation
Romberg test
Provide assistance with ambulation has loss of sense of self in space and needs assistance
The nurse is admitting a client who had mastectomy 6 months ago and is scheduled for elective surgery. During the physical assessment, the nurse notices a 0.5 cm mobile, firm, nontender lymph node in the upper arm. What action should the nurse take?
Reassure the client that it is an expected finding
inspecting the Abdomen
Stand on the right side
Laparoscopic cholecystectomy
Surgical wounds can be removed the next day but DO NOT TAKE A BATH SINCE THIS CAN CAUSE INFECTION. SHOWER IS OKAY *resume normal activity and resume work within a few weeks
A client has received a new prescription for nystatin to treat oral candidiasis. Which instructions should the nurse give this client?
Swish liquid in mouth for several minutes, then swallow it
Balloon tamponade tube (Sengstaken-Blakemore, Minnesota)
Temporarily control of bleeding from esophageal varices. It contains 2 balloons and 3 lumen drains inserted through the mouth. If airway obstruction occurs, quickly cut the cord and scissors are placed at the bedside for rapid deflation of balloon and tube removal
Torsades de pointed
Twisting of the points -is a polymorphic ventricular tachycardia characterized by QRS complexes that change size and shape in characteristics TWISTING PATTERN major cause: low magnesium
Clozapine
Watch for neuroleptic malignant syndrome (fever, diaphoresis, change in mental status). Very common with antipsychotic meds. Treatment (cooling body temp and rehydration)
The nurse is performing discharge teaching for the parents of a 4-year-old with heart failure. Which statement by the parents indicates the need for further teaching related to the administration of digoxin?
We will hold the dose if our child's heart rate is above 90. This is a problem because you can give to them. Do not give below 90 for infants and below 70 for older children
The parent of a 3-year-old calls and tells the nurse of finding the child in the bathroom with an empty bottle of mouthwash. The parent thinks that the bottle was about one quarter full. What is the nurse's priority response?
What is the child doing right now?
CLOPIDOGREL
an antiplatelet agents (clopidogrel, ticagrelor, prasugrel, aspirin) *blood pressure doesn't have to do with antiplatelet problem
The nurse auscultates rhonchi in a client with a tracheostomy tube and performs endotracheal suctioning to clear the secretions. Which nursing interventions are most appropriate to limit the risks associated with suctioning? Select all that apply.
apply suction only while withdrawing catheter *DO NOT INSTRILL NORMAL SALINE
Complication of colonoscopy
are perforation and rectal bleeding. Perforation can lead to peritonitis, with positive rebound tenderness, guarding, abdominal distension, tenesmus, and rigid abdomen. Abdominal cramping, flatus, and watery stool are expected findings
CVA tenderness is
at the 12th rib
metoprolol
beta blockers treat heart rate control in tachyarrhythmias
24-month-old (2 yr olds)
build 6-7 towers, calls self by name, and use a doorknob to open a door
Blood transfusion
cannot be run with another IV unless it is normal saline SO D5 DEXTROSE IS NO GOOD
Ineffective breathing patterh
change in rate, rhythm, timing, depth, or chest and abdominal wall excursion during inspiration and/or expiration that affects a client's ability to maintain adequate ventilation. Breath sounds clear bilaterally, but diminished in the bases on auscultation. SOB at rest, sitting upright, leaning over bedside table hypoxia and hypoxemia are impaired gas exchange crackles, wheezes, rhonchi are related to ineffective airway clearance
7 yr old with nephrotic syndrome
characterized by massive more protein, edema, and less albumin Most common in children age 2-7 *Do not organize a playdate because the child needs to be alone due to infection Treatment: Corticosteriods, loss of appetite management, infection prevention
Cough that lasts for 3 months during winter
chronic bronchitis
neglects in older adults
client breaks eye contract when discussing caregiver *clients who have experienced abuse or neglect may display apprehension, restlessness, withdrawal, poor eye contact, shame, or depair
Polycythemia vera
excessive amounts of RBC, WBC, and platelets This clients are at risk for developing clots due to blood viscosity and risk for stroke can be caused by hypoxemia
glaucoma
eye redness which is associated with intraocular pressure
Pursed-lip breathing
inhale for 2 seconds through the nose, keeping mouth closed and exhale for 4 seconds through pursed lips COPD patients use it
strabismus
misalignment of the eyes. So if a kid closes one eye to read then it is strabismus
delegation to UAP
monitoring daily weight
Hypertensive crisis
organ damage and retinopathy systolic >180 and diastolic >120
A charge nurse is monitoring a newly licensed registered nurse. What action by the new nurse would warrant intervention by the charge nurse?
prepares to administer IVPB potassium chloride via gravity infusion for a client with hypokalemia POTASSIUM CHLORIDE NEEDS AN IV PUMP
children fecal impaction
reward is given for making the effort, NOT for having bowel movements while sitting on the toilet
18-month-old
should have developed fine and gross motor skills, going up and downstairs while holding a hand and turning 2 or 3 pages in a book
unexpected and projectile vomiting without nausea is
sign of increased intracranial pressure
A nurse is preparing to perform postmortem care on a client who recently died from metastatic cancer. No family members were present at the time of death. What interventions can be delegated to experienced unlicensed assistive personnel? Select all that apply.
transporting the client to the morgue
Dopamin
treats hypotension
Adenosin
treats supraventricular tachycardia
Hemolytic reactions during packed red blood cells
urine specimen sent to analyze hemolyzed red blood cells. Signs: Early sign: red urine, fever, hypotension. Late sign: hypovolemic shock and disseminated intravascular coagulation
Bronchiolitis
viral illness in children caused by RSV with symptoms (rhinorrhea, congestion) *use saline drops and bulb syringe to suction nares breastfeeding is okay since it helps with dehyrdation
A sexually active female client has had 3 urinary tract infections (UTIs) in 12 months. Which instructions should the nurse include in teaching the client how to prevent UTI recurrence? Select all that apply.
wear underwear with a cotton crotch DON'T USE FRAGRANCE OR DOUCHE WITH WATER AND VINEGER
