PrepU (EXAM 3)

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching?

"I'll make sure to keep my ankle elevated as much as possible."

A young adult with cystic fibrosis is admitted to the hospital for aggressive treatment. The nurse first:

Collects sputum for culture and sensitivity Explanation: Aggressive therapy for cystic fibrosis involves airway clearance and antibiotics, such as vancomycin and tobramycin, which will be prescribed based on sputum cultures. Sputum must be obtained prior to antibiotic therapy so results will not be skewed. Administering oral pancreatic enzymes with meals will be a lesser priority.

Asthma is cause by which type of response?

IgE-mediated

A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments? Vancomycin 1 gram intravenously over 1 hour Ipratropium bromide (Alupent) by metered-dose inhaler Oxygen through nasal cannula at 2 L/minute Intravenous methylprednisolone (Solu-Medrol) 120 mg

Oxygen through nasal cannula at 2 L/minuteExplanation: All options listed are treatments that may be used for a client with an exacerbation of COPD. The first line of treatment is oxygen therapy.All options listed are treatments that may be used for a client with an exacerbation of COPD. The first line of treatment is oxygen therapy.

COPD stages

Stage I: Mild COPD. Lung function is starting to decline but you may not notice it. Stage II: Moderate COPD. Symptoms progress, with shortness of breath developing upon exertion. Stage III: Severe COPD. Shortness of breath becomes worse and COPD exacerbations are common. Stage IV: Very severe COPD.

A client is diagnosed with a first-degree strain of the left ankle related to running 5 miles daily. How would the nurse differentiate the first-degree strain from other strains and sprains?

The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices.

The nurse is instructing the patient with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in the education?

The patient should take the medication an hour before meals or 2 hours after a meal.

Which of the following may occur if a client experiences compartment syndrome in an upper extremity?

Volkmann's contracture

Which factor may contribute to compartment syndrome?

a) Hemorrhage Explanation:The normal pressure of a compartment can be altered in cases of fracture by the force of the injury itself or by development of edema or hemorrhage at the site of the injury. Venous thromboemboli are some of the other early complications of fracture, but they are not related to compartment syndrome. Macular lesion is caused by the accumulation of blood under the skin, as occurs with trauma such as bone fracture. Disuse syndrome mostly occurs in hip fracture.

When is it advisable for the nurse to apply heat to a sprain or a contusion?

b) After 2 days Explanation:It is advisable to apply heat on a sprain or a contusion 2 days after a sprain or a contusion has occurred. This is because after 2 days, swelling is not likely to increase and as a result heat application reduces pain and relieves local edema by improving circulation. Delaying the application of heat prolongs the pain and increases the risk of local edema.

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for:

capillary refill (not swelling / discoloration)

The nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable in a patient with a dislocation to assess for compartment syndrome. It is a complication associated with dislocation.

compartment syndrome

The Nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.)

• Compromised gas exchange • Wheezes • Decreased airflow

Which of the following is a clinical manifestation of a pneumothorax? Select all that apply.

• Sudden chest pain • Asymmetry of chest movement • Unilateral retractions • Oxygen desaturation

A physician orders triamcinolone (Azmacort) and salmeterol (Serevent) for a client with a history of asthma. What action should the nurse take when administering these drugs?

Administer the salmeterol and then administer the triamcinolone. A nurse is

Which nursing intervention is essential in caring for a client with compartment syndrome?

Removing all external sources of pressure, such as clothing and jewelry (not Keeping the affected extremity below the level of the heart)

Apatient is being admitted to the medical-surgical unit for the treatment of an exacerbation of acute asthma. Which of the following medications is contraindicated in the treatment of asthma exacerbations? a) Atrovent (Ipratropium) b) Intal (Cromolyn Sodium) c) Xopenex (Levalbuterol HFA) d) Proventil (Albuterol)

b) Intal (Cromolyn Sodium) Explanation:Intal is contraindicated in patients with acute asthma exacerbation. Indications for Intal are long-term prevention of symptoms in mild, persistent asthma; it may modify inflammation. Intal is also a preventive treatment prior to exposure to exercise or known allergen. Proventil (albuterol), Xopenex (levalbuterol HFA), and Atrovent (ipratropium) can be used to relieve acute symptoms

Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)?

exposure to tobacco smoke

Fractured pelvis: complications

fat embolism!!!

The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the:

femur neck

fat embolism syndrome presents with

high HR High RR resp alkalosis (at first) later resp acidosis

What is the primary treatment for musculoskeletal trauma?

immobilization

A client with chronic obstructive pulmonary disease (COPD) is admitted to an acute care facility because of an acute respiratory infection. When assessing the client's respiratory status, which finding should the nurse anticipate?

An inspiratory-expiratory (I:E) ratio of 2:1

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

Apply ice packs for the first 24 to 48 hours, then apply heat packs. "Explanation: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time

Volkmann's contracture

Condition in which the muscles in the palm side of the forearm shorten, causing the fingers to form a fist and the wrist to bend