270 PrepUs - Week 8

Granulocytopenia

A client begins clozapine therapy after several other antipsychotic agents fail to relieve psychotic symptoms. The nurse instructs the client to return for weekly white blood cell (WBC) counts to assess for which adverse reaction?

Joint manipulation and immobilization

A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would the physician perform?

Vision changes associated with this

A client with advanced breast cancer is ordered tamoxifen. When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately?

"There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive."

A new mother asks her nurse about the safety of taking St. John's wort for postpartum depression. What would be the nurse's best response?

Digoxin 0.125 mg given at 1400 instead of prescribed dose of 0.25 mg.

A nurse administers digoxin 0.125 mg to a client at 1400 instead of the prescribed dose of digoxin 0.25 mg. Which statement should the nurse record in the medical record?

Runs of ventricular tachycardia on a cardiac monitor help treated with this medication. Physicians sometimes use this medication drip, to treat clients whose arrhythmias haven't been controlled with oral medication and whose runs of ventricular tachycardia are visible on the cardiac monitor.

A nurse is caring for a client receiving lidocaine I.V. Which factor is most relevant to administration of this medication?

Use the smallest needle possible for injections

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client?

Depression is common in individuals with this,

A nurse is caring for several hospitalized clients with anorexia nervosa. The nurse would be especially alert for which if noted in the clients' histories?

chemotherapy exposure and risk factors.

A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include

The nurse should record the incident in the client's medical record and fill out a safety event report separately.

A nurse is preparing to file a safety event report after a client experienced a fall. Which statement is correct regarding the filing of a safety event report?

Alleviate the side effects and help client maintain adherence

A nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason?

Clozapine Black box warning

Advantages of this medication, include improvement of negative symptoms without causing the extrapyramidal effects associated with older antipsychotic drugs. However, despite these advantages, it is a second-line drug, recommended only for clients who have not responded to treatment with at least two other antipsychotic drugs or who exhibit recurrent suicidal behavior. The reason for the second-line status of this drug, is its association with agranulocytosis, a life-threatening decrease in white blood cells (WBCs), which usually occurs during the first 3 months of therapy. A BLACK BOX WARNING alerts health practitioners to this dangerous side effect. Weekly WBC counts are required during the first 6 months of therapy; if acceptable WBC counts are maintained, then WBC counts can be monitored every 2 weeks.

Most important to keep a tracheostomy set by the bedside after this

After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep this, at the client's bedside in case of a respiratory emergency.

Age-related adverse drug effects

Age-related physiological changes result in an overall increased risk of this. Drug clearance tends to be slower, so lower doses are normally required

Home safety hazard threats for young children

As babies gain neurologic and musculoskeletal functions, they learn and explore by pulling objects to themselves and placing almost everything in their mouths. Cords, tablecloths, plastic bags, bottles, and cans are tempting, dangerous objects that caregivers must strive to keep out of reach.

Red meat or Dairy products that are high in fat are at increased risk for this

Data suggest that men who consume a diet containing excessive amounts of these things, that are high in fat are at increased risk for prostate cancer.

Suicidal ideation

During an assessment, which would be the most important question topic?

Establishing a support system for the woman and teaching her some coping measures

Following the failure of a woman's recent in vitro fertilization (IVF), the nurse recognizes that she may be at risk of depression. Which intervention is considered a primary suicide prevention measure?

Guidelines for avoiding hip dislocation after replacement surgery

Guidelines after this type of replacement surgery specify: that the hip should not be flexed to put on clothing such as pants, stockings, socks, or shoes. Clients should keep the knees apart at all times, put a pillow between the legs when sleeping, and never cross the legs when seated.

Greater risk for hemorrhage or excessive blood loss from these conditions

Heparin should be administered with extreme caution to patients with peptic ulcer or liver disease or after surgery because those patients would have greater risk for this,

Drug dependency in newborns

Hyperactivity, a persistent shrill cry, frequent yawning and sneezing, and jitteriness are classic symptoms of this, that usually appear within the first 24 hours after birth.

Malpositioned bones intervention

Intervention for this: The physician manipulates the joint or reduces the displaced parts until they return to normal position, then immobilizes the joint with an elastic bandage, cast, or splint for several weeks.

Lithium: medication mgmt and instructions

Management for this medication includes drinking at least six to eight glasses of water per day and avoid caffeine

Permanent pacemaker

PPM

Threats of self-harm

Patients with borderline personality disorder (BPD) are usually admitted to the inpatient setting because of this,

Nephrotoxic agents

Pharmacologic agents that are directly toxic to the renal tubule include aminoglycosides (e.g., gentamicin), chemotherapeutic agents such as cisplatin and ifosfamide, and radiocontrast agents. This type of agents, can cause tubular injury by inducing varying combinations of renal vasoconstriction, direct tubular damage, or intratubular obstruction.

Pin sites are entry points for infection. The nurse should also monitor redness, drainage, and tenderness at the site.

Pin care is a priority for a client with external fixation, because of this,

Reverse Isolation

Precaution used for individuals who are immune-compromised to protect THEM from harmful organisms that may be brought in from outside. Transplant patients are placed on this (along with others). Everyone who enters room wears gown, gloves & mask. All equipment entering room needs to be disinfected.

Risks for breast cancer that increases -twofold

Risk for breast cancer increases twofold if first-degree female relatives (sister, mother, or daughter) have had breast cancer. Increased risk is associated with early menarche (i.e. menses beginning before 12 years of age).

Masks covering the nose and mouth

Surgical asepsis is a requirement in the restricted zone of the operating suite. What personal protective equipment should the nurse wear at all times in the restricted zone of the operating room?

Wilms' tumor

The abdomen of a child with this, should never be palpated because it may increase the risk of metastasis.

Most common causes for death in children with leukemia

The child with leukemia is susceptible to infection, especially during chemotherapy. Infections such as meningitis, septicemia, and pneumonia are the most common causes for this,

Logrolled

The client who has had spinal surgery, such as laminectomy, must have this done, to keep the spinal column straight when turning.

Nephrotoxic acute tubular necrosis

The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for:

Neonates in this situation, may be slightly hyperglycemic and frequent early feedings with formula can help

The neonate of a mother with gestational diabetes may be this, immediately after birth because of the high glucose levels that cross the placenta from mother to fetus. During pregnancy, the fetal pancreas secretes increased levels of insulin in response to this increased glucose amount that crosses the placenta from the mother. However, during the first 24 hours of life, this combination of high insulin production in the neonate coupled with the loss of maternal glucose can cause severe hypoglycemia. Doing this, can help prevent that.

Internal rotation of the affected leg

The nurse and other caregivers should prevent this, with a new hip joint. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint.

An unintentional injury

The nurse completes the safety event report immediately after this, and is responsible for recording the incident and its effect on the client in the medical record

following guidelines for reverse isolation

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child?

"I will not work tomorrow because I would be a danger to my clients." (Cannot care for client without first ensuring self-care. The nurse is tired and most appropriately is declining to work because the nurse will not be able to function at full capacity.)

The nurse is currently completing the last of three consecutive night shifts. The unit will be short-staffed on day shift and the charge nurse wants the nurse to work this as an overtime shift. What is the nurse's most appropriate response?

82-year-old female with macular degeneration who uses a walker to go to the bathroom.

The nurse knows that which client listed below is at high risk for developing a hip fracture?

Instructions for this type of surgery: Do not bend at the waist, strain, or lift heavy objects for the next 24 hours. contact the primary provider if swelling, new bruising or pain from the procedure puncture site, or a temperature of 101°F or more occur. If bleeding occurs, lie down (groin approach) and apply firm pressure to the puncture site for 10 minutes. Notify the primary provider as soon as possible and follow instructions. If there is a large amount of bleeding, call 911. The client should not drive to the hospital.

The nurse reviews discharge instructions with a client who underwent a left groin cardiac catheterization 8 hours ago. Which instructions should the nurse include?

Alcohol or other central nervous system depressants

The nurse should advise a client taking antihistamines not to take it with these contraindicators, because additive sedative effects can occur.

"Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes."

The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response?

Nasogastric, orogastric, and endotracheal tubes- risks

These tubes, increase the risk of pneumonia because of the risk of aspiration from improperly placed tubes. Frequent oral hygiene and checking tube placement help prevent aspiration and pneumonia.

Permanent pacemaker generators

These, have filters that protect them from electrical interference from most household devices, motors, and appliances, so the client can keep the microwave oven.

Nephrotoxic acute tubular necrosis definition

This condition is described as, the tubular portion of the nephron is injured after the ingestion of toxic drugs

Antihistamine Contraindications

This drug class, are contraindicated during the third trimester of pregnancy, in nursing mothers and newborns, in children and elderly people, and in patients whose conditions may be aggravated by muscarinic blockade (e.g., asthma, urinary retention, open-angle glaucoma, hypertension, prostatic hyperplasia). The major side effect is sedation, although H1 antagonists are less sedating than earlier antihistamines. Additional side effects include nervousness, tremors, dizziness, dry mouth, palpitations, anorexia, nausea, and vomiting.

Thrombocytopenia

This is a condition in which there is an abnormally small number of platelets circulating in the blood and poses a high risk for bleeding

isoniazid (INH)

This is an anti-bacterial drug that has been used to prevent and to treat tuberculosis since 1952 -inhibits mycolic acid synthesis

A three-prong grounded plug adapter

This is needed to carry any stray electricity back to the ground when a patient is receiving an intravenous therapy through an IV pump

The Safety Event Report

This report, is not a part of the medical record and should not be mentioned in the documentation.

Maintaining pin care

This would be the management action of a patient who received an external fixation

The raised toilet lid risk factor

This, exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. The nurse should modify the teaching plan to include content related to chemotherapy exposure and its associated risk factors.

Beneficence

This, is described as the duty to do good for the clients assigned to the nurse's care.

Veracity

This, is described as the nurse's duty to tell the truth in all professional situations.

Laminectomy

This, is the surgical removal of a lamina, or posterior portion, of a vertebra

Doing this can avoid Lymphedema complications caused by the extensive disruption of lymphatic circulation

Validating the lack of lymph node metastasis allows the surgeon to preserve more breast and axillary tissue and chest muscle. Leaving more normal lymph nodes intact reduces the potential for complications like this,

The priority for this, is to determine if the client's physical condition is life-threatening. If so, the priority is to treat the medical condition. Any compromise to the client's airway, breathing, or circulation must be addressed immediately. It's also imperative to determine the time of ingestion because this may determine treatment.

Which action is the priority when assessing a suicidal client who has ingested a handful of unknown pills?

Vitamin B6

Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy?

Palpating both arteries at one time may cause severe bradycardia.

Why should the nurse avoid palpating both carotid arteries at one time?

Gentamicin

aminoglycoside antibiotic