adult I practice B

normal hdl

>60 mg/dL

A nurse is caring for a client who is 9 days postoperative following a total laryngectomy. The nurse removes the client's NG tube and initiates oral feedings. Which of the following statements would the nurse be correct is saying?

"It is no longer possible for you to choke on or aspirate food."

5 things that require immediate follow-up

- No dialysis for 24 hrs - Potassium 7.0 - WBC count 17,000 - Abdomen rigid with decreased bowel sounds (peritonitis) - Crackles through the lungs

pt has COPD, arthritis, cataracts, and BMI 18.5. which are potential barriers for pts nutritional goal?

- Pt relies on public transit system for transportation - Pts mobility impairment bc of arthritis

emphysema fikndings

- dyspnea - barrel chest - clubbing of fingers

A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize that which of the following are manifestations of Cushing's syndrome?

- hypertension - moon face - purple striations - buffalo hump

A nurse is caring for a client who has a pneumothorax.

Anticipated: - obtain ABGs - Prepare for chest tube insertion - obtain IV access Nonessential: - CT of chest - Pulmonary function tests PFTs Contraindicated: - Thoracentesis

A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client?

Chvostek's sign to check for hypocalcemia

pt had a lower lobectomy and chest tube in place. pt has 3 chamber drainage system. no bubbling in the suction control chamber. which action?

verify that the suction regulator is on and check for tubing for leaks (gentle bubbling is good)

Medical History Day 1: Client has a history of emphysema and reports smoking 21 packs of cigarettes per year. Vital Signs Day 1: Temperature 37.6° C (99.7° F) Blood pressure 114/56 mm Hg Heart rate 78/min Respiratory rate 20/min Pulse oximetry 93% on room air Day 2: 1000 Temperature 36.9° C (98.4° F) Blood pressure 88/56 mm Hg Heart rate 118/min Respiratory rate 32/min Pulse oximetry 85% on room air Diagnostic Results Day 1: Chest x-ray shows lung hyperinflation. Day 2 1000: Chest x-ray shows right upper lobe pneumothorax. Nurses' Notes Day 2: 0800: Voided 350 mL of clear yellow urine in a bedpan. 1000: Client reports sudden, sharp, right upper chest pain. Client appears anxious and states pain increases with deep breathing. Respirations labored with use of accessory muscles noted. Crepitus palpated on right upper chest. Trachea midline, breath sounds decreased in right upper lobe. list actions as essential, nonessential, or contraindicated

Essential: - Initiate supplemental oxygen - Prepare client for a chest tube insertion - Administer an analgesic Nonessential: - Insert an indwelling urinary catheter Contraindicated: - Initiate a weight-based continuous heparin infusion

hyperthyroidism s/s

Frequent mood changes also weight loss, weakness, heat intolerance, diarrhea

The nurse is caring for the client immediately following the insertion of the permanent pacemaker. The nurse should monitor the client for _______ and __________ following permanent pacemaker placement.

Incisional site bleeding and Bradycardia

fluid overload

Increased heart rate Increased blood pressure Increased respiratory rate

A nurse is assessing a client who has a pneumothorax with a chest tube in place. For which of the following findings should the nurse notify the provider?

Movement of the trachea toward the unaffected side.

addison's disease at risk for addisonian crisis. what action

weigh the client daily

A client who has chronic lymphocytic leukemia is starting chemotherapy treatments and asks if she needs to make any dietary changes. Which of the following statements should the nurse make?

You should avoid drinking liquids an hour before the treatments

pt has pulmonary TB and uses antitubercular meds. what teaching?

a typical course of treatment involves 6 to 9 months of consistent med use

Manifestations of metabolic acidosis include

diarrhea, circulatory shock, decreased level of consciousness, abdominal pain, cardiac dysrhythmia, and increased depth and rate of respirations.

VTE risk

don't massage legs

pt has cellulitis. what to do

elevate legs on pillows

pt has prolonged vomiting and gets an EKG. which is a sign of hypokalemia?

Abnormally prominent U wave

client had a thoracotomy and lobectomy. which is priority

arterial blood gases

order: 1 g over 6 hr available: 1 g in 250 mL how many mL/hr?

42 ml/hr (250 ml / 6 hr = 42)

gunshot sucking chest wound: resp 40

administer o2

A nurse is completing discharge planning for a client who has bacterial endocarditis. The client will need to receive 12 weeks of antibiotic therapy. Which of the following venous access devices would be appropriate for the client?

peripherally inserted central catheter (PICC line)

s3 sound

ventricular gallop

A nurse is observing the closed chest drainage system of a client who is 24 hr post thoracotomy. The nurse notes slow, steady bubbling in the suction control chamber. Which of the following actions should the nurse take?

continue to monitor client's resp status

50-year-old client presented to emergency department reporting fever, chills, night sweats, and fatigue for the past several days. Yesterday, client became short of breath and has been unable to complete ADLs. Client has history of hypertension, hyperlipidemia, myocardial infarction at age 48, and osteoarthritis. Treated with penicillin 3 weeks ago for abscessed molar. History of smoking for 10 years, hasn't smoked for past 20 years. Client reports no alcohol or substance abuse.

- obtain blood cultures and request antibiotic prescription - probably endocarditis - monitor temperature and neuro status

hypoglycemia s/s

blurred vision, moist clammy skin, and tachycardia

normal ldl

less than 130 (100 better)

A nurse has received the following report about a client that they will be admitting to the medical-surgical unit. Highlight the findings in the transfer report that require immediate action by the nurse when the client arrive.

- Current vital signs are: blood pressure 86/46 mm Hg, pulse rate 100/min, respiratory rate 28/min. Oxygen saturation 94% on 2 L via nasal cannula. (The respiratory rate indicates tachypnea and the hypotension and tachycardia indicate possible hypovolemia) - There is a new prescription for 0.9% sodium chloride at 125 mL/hr. There is also a prescription for the transfusion of 2 units of packed RBCs; the first unit has been ordered from the blood bank. (should start immediately)

A nurse is caring for a client who has COPD. Home health nurse admission note: Client discharged from healthcare facility yesterday following a 4-day stay for exacerbation of COPD. Lives alone; alert and oriented to person, place, and time. Lung fields with scattered rhonchi throughout, cough productive for thick white sputum, dyspnea with minimal exertion. Clubbing is noted on fingers, chest is barrel-shaped. Supplemental oxygen at 2L/min via nasal cannula. Home Health Nurse Note 3 days following discharge from health care facility: Client sleeping in recliner with nasal canula on their lap; awakens easily and is oriented to person but disoriented to place and time. Lung sounds with scattered rhonchi, cough productive for thick, yellow secretions. 2+ pitting edema bilateral in ankles and feet. Re-oriented client. Client states "I don't remember if I did that breathing machine thing you told me about." Instructed client on oxygen use, safety, and nebulizer treatments. Elevated lower extremities. meds: Indacaterol 75 mcg, one inhalation daily Acetylcysteine 20% solution 3 to 5 mL nebulizer every 6 to 8 hr while awake vs: Home Health Nurse Admission Note: Temperature 36.7° C (98.1° F)

- Disorientation - Yellow sputum - Nebulizer use - Ankle edema - Lives alone not: barrel-shaped chest, sao2 92, clubbing (all expected for copd)

A nurse is caring for a client on a medical-surgical unit. 1515: Oxygen saturation 95%. The client's voice is hoarse. The client reports tingling around the mouth. Moderate serosanguinous drainage noted on neck dressing. The client has a slight tremor noted in both hands. The client's temperature has increased in 1 hr from 37.5° C (99.5° F) to 38.6° C (101.5° F). The client appears restless. A nurse is caring for a client who is postoperative following a subtotal thyroidectomy. Highlight the findings below that the nurse should report to the provider.

- Pt reports tingling around the mouth - Pt has a slight tremor noted in both hands - Pt's temp has increased in 1 hr from 99.5 f to 101.5 f - Pt appears restless

4 findings that put u at risk for pneumonia

- not getting pneumococcal vaccine over age 65 - not getting flu vaccine - low fluid intake - old age

Client presents to the ED with substernal chest pain that comes and goes. The client states that the pain has been occurring for the last 8 hr. The pain, at times, radiates down the left arm. Client also reports intermittent nausea. Client appears pale and slightly diaphoretic. Client rates current pain as 7 on a scale of 0 to 10. Respirations 18/min Pulse 115/min; irregular Blood pressure 185/88 mm Hg Oxygen saturation 91% on room air

anticipated: - apply ECG continuous monitoring - administer o2 to maintain o2 sat > 90% -obtain vascular access nonessential: - obtain family history contraindicated: - administer furosemide - prep client for intubation

A 24-year-old female client reports throbbing pain, swelling, discoloration, and warmth in right calf for three days. Also reports shortness of breath for one day. Denies anything that makes it better or worse and denies any other symptoms. Client reports pain as 7 on a scale of 0 to 10. Reports that only medication is a combined hormonal oral contraceptive every day, started four months ago. Labs were drawn and the client is scheduled for venous duplex which 2 conditions?

deep vein thrombosis and pulmonary embolism

diabetes insipidus

dehydration

A nurse is caring for a client who has a new diagnosis of urolithiasis. Which of the following should the nurse identify as an associated risk factor?

family history

Client presents to the ED and reports dyspnea, chest pain, and tachycardia. Client returned home from a vacation out of the country 24 hr ago. 1515: The client has become diaphoretic, increasingly dyspneic, and states that their chest pain is sharp and increasing. The client states, "I feel like I'm going to die." Crackles auscultated in bilateral lower lobes, S3 and S4 heart sounds noted. Petechiae noted on the client's chest. Pulmonary embolism protocol initiated. Vital Signs 1500: Temperature: 38.1° C (100.6° F) Heart rate: 110/min Respiratory rate: 24/min BP: 138/52 mm Hg Oxygen saturation: 92% oxygen at 2 L/min via nasal cannula 1515: Temperature: 38.1° C (100.6° F) Heart rate: 135/min Respiratory rate: 32/min BP: 120/50 mm Hg Oxygen saturation: 90% on 4 L/min via nasal cannula which 2 actions?

first, place pt in high-fowler's position second, obtain iv access

active TB patient. what do

give a room with air exhaust directly to the outdoor environment. airborne infection isolation room

A nurse is assessing a client who has a long history of smoking and is suspected of having laryngeal cancer. The nurse should anticipate that the client will report that her earliest manifestation was

hoarseness

Medical History 78-year-old female admitted with watery diarrhea x 4 days Denies vomiting Reports having an upper respiratory infection 1 week ago and was treated with ampicillin Reports anorexia, unaware of any weight loss Lives alone Past medical history includes hypertension, COPD, and diabetes mellitus Walks for 30 min 5 out of 7 days/week Drinks an occasional glass of wine Smokes one-two cigarettes/day Nurses' Notes 0800: Alert and oriented x 3 Reports weakness and dizziness Skin pale and cool, poor skin turgor Mucous membranes dry with a white coating Denies nausea Lungs clear to auscultation Abdomen soft with hyperactive bowel sounds x 4 Reports diffuse abdominal tenderness on palpation Reports 3 watery bowel movements in the last 8 hr Urine dark yellow in color Output 30 mL/hr 1000: Up to bathroom with assistance of assistive personnel. Has syncopal episode. Assisted back to bed. No injuries noted. Instructed to not get out of bed without assistance. Vital Signs Temperature 37.2° C (99.0° F) oral Apical pulse 102/min regular Radial pulse 102/min regular and weak Respiratory rate 28/min Blood pressure 96/68 mm Hg Diagnostic Results 0800: Basic Metabolic Profile Sodium 149 mEq/

hypernatremia and metabolic acidosis (diarrhea)

pt is receiving liothyronine for hypothyroidism. which is the therapeutic response

increase in energy

A nurse is providing teaching to a client who is postoperative following coronary artery bypass graft (CABG) surgery and is receiving opioid medications to manage discomfort. Aside from managing pain, which of the following desired effects of medications should nurse identify as most important for the client's recovery?

it facilitates the client's deep breathing

chronic kidney disease: which abg?

metabolic acidosis (low ph, low hco3)

a pt is receiving 1 unit of packed RBCs to treat intraoperative blood loss. pt has back pain and chills and bp is 80/64. what action first?

stop the infusion of blood (s/s show acute iv hemolytic reaction)

hyperthyroidism what to do to prevent thyroid crisis

provide a quiet, low-stimulus environment

the client findings of fatigue, headache, bruising, and decreased platelet count are related to

thrombocytopenia. thus at risk for disseminated intravascular coagulation (DIC) due to decreased platelet count

A nurse in a clinic is reviewing the lab values of a patient who has primary hypothyroidism. The nurse should anticipate an elevation of which lab values?

thyroid stimulating hormone TSH