Oct 3

A nurse is preparing for the discharge of a client with heart failure. Upon review, the nurse notes that the client has been prescribed digoxin and furosemide. Which of the following laboratory tests must the client have monitored due to this combination of prescribed medications? Correct A. Fecal occult blood [1%] B. Serum electrolytes [93%] C. Urinalysis [4%] D. Glycosylated hemoglobin

Explanation Choice B is correct. Digoxin and furosemide increase renal perfusion when taken together, leading to potassium loss. The client should be educated and instructed to monitor serum electrolyte levels (most notably the serum potassium) at designated intervals. Heart Failure Treatment "UNLOAD FAST" Upright position Nitrates Lasix Oxygen ACE inhibitors Digoxin Fluids (decrease) Afterload - decrease Sodium - decrease Tests: dig level, ABG, K+

24 hour urine collection

A 24-hour urine collection may be ordered to evaluate the type and severity of certain renal disorders. The nurse is responsible for providing the collection container and educating the patient on the correct process of collecting the specimen. At the beginning of the 24-hour urine procedure, the patient should not collect or save the first urine specimen. This first void is considered "old urine" or urine in the bladder before the test began. This specimen should be flushed and the time at which its discarded is noted. After the first discarded specimen, urine is collected for the next 24 hours.

Cataracts vs Glaucoma

:Cataracts: -Vision impairment worse at nighttime - Opacity in the eye - Blurred vision - vision impairment worse at nighttime is a classic manifestation of cataracts. - Blurred vision that feels 'smudged.' Glaucoma: - Increase in intraocular pressure (IOP) - Blurred vision Glaucoma may cause a loss in peripheral vision -Glaucoma is caused by increased intraocular pressure (greater than 21 mm Hg). -Vision may be blurred, and may have peripheral vision loss. -Open angle: mild pain & gradual loss of peripheral vision (tunnel vision) -Closed angle: sudden EXTREME pain (NCLEX TIPS) Key words: EXTREME, "severe", "sudden" eye pain Education: after surgery (AVOID) NCLEX TIPS because it Adds pressure AFTER surgery NO Coughing, sneezing NO Bending at the waist NO Lifting heavy objects NO Nausea & vomiting NO Valsalva maneuver (bearing down) Constipation Priority NO Anticholinergics (Atropine, Ipratropium) NO Diphenhydramine (brand: Benadryl)

The charge nurse is planning patient care assignments for a licensed practical/vocational nurse (LPN/VN). Which of the following would be an appropriate patient assignment for the LPN? Select all that apply. -A 67-year-old one-hour post-procedure from a cardiac catheterization. -An 88-year-old client who was just admitted for intractable pain secondary to metastatic cancer. -A 42-year-old being discharged following a diagnosis of type 2 diabetes mellitus. -A 75-year-old inpatient client with colon cancer needing colostomy care. -A 50-year-old client being treated for herpes zoster with prescribed oral antivirals.

A 75-year-old inpatient client with colon cancer needing colostomy care. A 50-year-old client being treated for herpes zoster with prescribed oral antivirals

A client in diabetic ketoacidosis (DKA) will be at risk for hyperkalemia, not hypokalemia. When a client is in diabetic ketoacidosis, glucose cannot be transported into cells due to the lack of insulin. The body resorts to breaking down fat cells for energy, producing ketones, and driving blood pH down. Due to the blood's acidity and high glucose content, fluid and potassium are forced out of the cells and into the blood, causing hyperkalemia.

A client in diabetic ketoacidosis (DKA) will be at risk for hyperkalemia, not hypokalemia. When a client is in diabetic ketoacidosis, glucose cannot be transported into cells due to the lack of insulin. The body resorts to breaking down fat cells for energy, producing ketones, and driving blood pH down. Due to the blood's acidity and high glucose content, fluid and potassium are forced out of the cells and into the blood, causing hyperkalemia.

A client with renal failure will be at risk for hyperkalemia, not hypokalemia. The kidneys will be unable to excrete potassium as they usually do, and there will be a build-up of potassium in the blood leading to hyperkalemia.

A client with renal failure will be at risk for hyperkalemia, not hypokalemia. The kidneys will be unable to excrete potassium as they usually do, and there will be a build-up of potassium in the blood leading to hyperkalemia.

The nurse reviews assigned clients' arterial blood gas (ABG) results. Which ABG result requires immediate follow-up? A. pH = 7.46; PaO2 = 90 mm Hg; PaCO2 = 33 mm Hg; HCO3- = 22 mEq/L; SaO2 = 94% B. pH = 7.27; PaO2 = 73 mm Hg; PaCO2 = 50 mm Hg; HCO3- = 25 mEq/L; SaO2 = 85% C. pH = 7.45; PaO2 = 95 mm Hg; PaCO2 = 38 mm Hg; HCO3- = 26 mEq/L; SaO2 = 96% D. pH = 7.32; PaO2 = 93 mm Hg; PaCO2 = 42 mm Hg; HCO3- = 20 mEq/L; SaO2 = 94%

B. pH = 7.27; PaO2 = 73 mm Hg; PaCO2 = 50 mm Hg; HCO3- = 25 mEq/L; SaO2 = 85%

Burns destroy tissue and lyse cells, causing large amounts of intracellular potassium to be released into the vascular space, causing hyperkalemia. A client with third-degree burns will be at risk for hyperkalemia, not hypokalemia.

Burns destroy tissue and lyse cells, causing large amounts of intracellular potassium to be released into the vascular space, causing hyperkalemia. A client with third-degree burns will be at risk for hyperkalemia, not hypokalemia.

Which of the following vaccines contains a live virus? Correct A. IPV [9%] B. DTaP [10%] C. Varicella [77%] D. Hepatitis B [4%]

C. Varicella

The nurse is teaching a client who is scheduled for a percutaneous kidney biopsy. Which of the following information should the nurse include? A. "You will need to lay flat immediately after this procedure." [41%] B. "A heating pad will be applied to the affected area for pain relief." [4%] C. "Before you eat, your gag reflex will need to return." [15%] D. "You can resume your regular activities and diet right after the procedure."

Choice A is correct. A percutaneous kidney biopsy will be required to lay supine immediately following the procedure to achieve and maintain hemostasis. A back roll may be used to provide additional support. Choice D is incorrect. After a percutaneous kidney biopsy, clients are typically advised to rest and avoid certain activities for a specified period to reduce the risk of complications. ✓ The client will be positioned prone for the procedure, and immediately following the procedure, the client should be supine for four to six hours to ensure hemostasis. ✓ Urine output will be monitored closely post-procedure. ✓ The nurse should immediately report any bruising to the area and hematuria.

A patient is being evaluated in the clinic for pancreatitis. Besides an elevated white blood cell count and serum lipase levels, which assessment finding indicates a positive finding for pancreatitis?

Choice A is correct. The discoloration of the abdomen and periumbilical area is known as Cullen's sign and indicates pancreatitis when it occurs in conjunction with other symptoms. Other findings include elevated white blood cell count, bilirubin, and urinary amylase levels. "pain: Severe pain in the mid-epigastric area radiating to the back."

The nurse is teaching a group of unlicensed assistive personnel (UAPs) concepts of client identification. Which situation would require two client identifiers? Select all that apply. -Providing a meal tray -Changing bed linens -Replacing a suction cannister -Obtaining vital signs -Providing range of motion exercises

Choices A, D, and E are correct. Anytime the nurse or unlicensed assistive personnel (UAP) engages directly with the client, two identifiers (name and date of birth) should be asked. This prevents misidentification and mitigates errors related to care delivery. 1-Providing a meal tray will require the identifiers because diets vary by client and are prescribed by the primary healthcare provider (PHCP). 2-Obtaining vital signs requires the two identifiers so the nurse (or UAP) may accurately record these vital signs. 3-Finally, providing range of motion requires two identifiers as it is a task directly involving the client. Choices B and C are incorrect. These tasks do not involve the client, nor is there a risk for client harm when these tasks are executed. They do not require two client identifiers.

TPN (total parenteral nutrition) هاااااااااااااااااااام

Complications ● Big infection risk..... Scrub that hub! Wash your hands!! Gloves!!! Dressing changes or inserting that line --> sterile technique. if only administering medicine then just clean tech. ○ Bag and tubing is changed every 24 hours ○ Refrigerated until ready to hang. ● Fluid overload ○ Daily weight ○ Check electrolytes. ● Hyper OR hypoglycemia ○ Do not turn on or off suddenly ■ If you run out of TPN give Dextrose 10% at the SAME rate the TPN was running ○ Titrate up when turning on and down when turning off ○ Check blood glucose levels every 4-6 hours ● Embolism

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. [35%] B. Urinary specimens may be collected from a catheter bag. [12%] C. You may irrigate a catheter with warm water for poor outflow. [7%] D. Daily use of soap and water should be used around the urinary meatus.

Daily cleaning of the urinary meatus with soap and water is recommended for catheter care. Soap and water is an acceptable practice for daily catheter care. alcohol, CHG, and other antiseptics may be highly irritating to the urinary meatus. 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. Urinary specimens should not be collected from the catheter bag as this sample will be contaminated.

The nurse is caring for a child with nephroblastoma. The nurse plans to take which action? A. Post a sign that states, "Do not palpate abdomen" B. Recommend foods low in protein C. Insert an indwelling urinary catheter D. Initiate fluid restrictions

Explanation Choice A is correct. Nephroblastoma (Wilms tumor) is the most common childhood cancer. Common treatments include surgical removal followed by chemotherapy. Nursing care involves minimal manipulation of the abdomen (no palpation) and a posted sign. It is essential to keep the encapsulated tumor intact. Choices B, C, and D are incorrect. These are not interventions relevant to a client with nephroblastoma; instead, these may be used for acute or chronic renal disease. While nephroblastoma may impair renal function, this is not commonly seen. Additional Info ✓ Nephroblastoma is a tumor affecting the kidney(s). ✓ The average age at diagnosis is three years in children with single kidney disease. ✓ It is slightly younger for those with bilateral involvement. Nephroblastoma nursing care involves ✓ Frequent blood pressure monitoring because this tumor may induce renin-related hypertension ✓ Avoid any activities that may cause palpation of the abdomen ✓ Gastrointestinal assessment as obstruction may consequently occur (absent bowel sounds, abdominal distention should be reported) ✓ Assessment of hemorrhage (tachycardia and hypotension)

Stage 4. Industry Vs. Inferiority 7-11

Industry: If children are encouraged by parents and teachers to develop skills, they gain a sense of industry—a feeling of competence and belief in their skills. They start learning to work and cooperate with others and begin to understand that they can use their skills to complete tasks. This leads to a sense of confidence in their ability to achieve goals. Inferiority: الدونية عقدة النقص On the other hand, if children receive negative feedback or are not allowed to demonstrate their skills, they may develop a sense of inferiority. They may start to feel that they aren't as good as their peers or that their efforts aren't valued, leading to a lack of self-confidence and a feeling of inadequacy.

Signs of pregnancy

Presumptive signs of pregnancy -Amenorrhea -Nausea and vomiting -Fatigue -Urinary frequency -Quickening (slight fluttering movement, usually between 16-20 weeks gestation) Probable signs of pregnancy -Goodell's sign (softening of the cervix) -Chadwick's sign (bluish appearance of the cervix) -Hegar's sign (softening of the isthmus of the cervix) -Ballottement (sudden tap on the cervix during the vaginal examination may cause the fetus to rise in the amniotic fluid and then rebound to its original position) -Braxton hicks contractions -Positive pregnancy test -Palpation of fetal outline Positive signs of pregnancy -Fetal movements detected by an examiner -Auscultation of fetal heart sounds -Visualization of embryo or fetus

Trust vs. mistrust 0-1 YR

Trust vs. mistrust is the first stage of Erik Erikson's theory of psychosocial development. This stage occurs between birth and 18 months of age. During this stage, infants are completely dependent on their caregivers to meet their needs. The infant's response to the caregiver's response determines whether they develop trust or mistrust.

Lithium

Vomiting, diarrhea, blurred vision, abdominal pain, tremors, and tinnitus are symptoms of lithium toxicity. labs to monitor: lithium thyroid Creatinine, Sodium The client should have daily intake of 1-2 L of water and salty snacks

PEEP

PEEP is a setting that may be added to a mechanical ventilator, CPAP, or BiPAP. PEEP is commonly prescribed for clients with acute respiratory distress syndrome (ARDS) because PEEP prevents alveolar collapse, allowing for better gas exchange, thus, improving oxygenation. The increase in pressure may cause a client to develop a stress ulcer. This puts the client at risk for bleeding. The nurse should obtain a prescription for a proton pump inhibitor (pantoprazole) or histamine antagonist (famotidine) to prevent a stress ulcer. Antiemetics such as ondansetron or promethazine would not prevent a gastric ulcer. The increased intrathoracic pressure can decrease cardiac output because PEEP decreases cardiac preload. The decreased preload decreases the volume discharged by the heart, thus, creating a situation of decreased cardiac output. The client is at risk for hypotension, and the nurse should monitor the client's blood pressure. PEEP would effectively treat respiratory acidosis because it promotes better gas exchange. Fever is not an adverse effect associated with PEEP. Additional Info ✓ PEEP is a setting that may be added to a mechanical ventilator, CPAP, or BiPAP ✓ PEEP is commonly prescribed for clients with acute respiratory distress syndrome (ARDS) because PEEP prevents alveolar collapse, allowing for better gas exchange, thus, improving oxygenation ✓ By improving gas exchange, therapeutically, the client will enjoy increased oxygen and less lactic acid from the stress of breathing (clients with low pulmonary compliance will have an increase in their breathing, thus, creating lactate and sending the client into acidosis ✓ PEEP can cause decreased venous return and lower the mean arterial pressure ✓ The blood pressure should be monitored closely for a client receiving PEEP because of the risk of hypotension ✓ PEEP also raises the client's risk for a stress ulcer ✓ 5-15 cm H2O is the range for PEEP that may be adjusted

Pulse deficit is when the client's peripheral pulse rate differs from the apical one. This occurs in arrhythmias such as atrial flutter and atrial fibrillation

Pulse deficit is when the client's peripheral pulse rate differs from the apical one. This occurs in arrhythmias such as atrial flutter and atrial fibrillation

preeclampsia question. The nurse in a clinic is triaging clients. Which of the following clients should the nurse see first? Correct A. A 17-year-old complaining of abdominal cramping with moderate bloody vaginal discharge [7%] B. A 25-year-old primigravida reporting blurred vision. [73%] C. A 50-year-old menopausal client expelling dark red blood clots. [10%] D. A 70-year-old client who states her uterus is going to "fall out."

Signs and symptoms of preeclampsia include blurred vision, hypertension, generalized edema, and proteinuria. The client is also a primigravida (first-time pregnant), predisposing her to preeclampsia. The nurse should prioritize the client to include further assessment and intervention.

As a nurse working in the emergency department, you are working with a client who was admitted with a magnesium level of 1.4 mEq/L(1.5-2.5 mEq/L), which falls below the normal range of 1.5-2.5 mEq/L(1.5-2.5 mEq/L). You need to create a list of foods that you recommend the client should consume. What foods would you suggest to add to the list? Select all that apply. Spinach Onions Mushrooms Salmon Bananas

Spinach salmon banana

A 22-year-old female was admitted voluntarily to the inpatient unit following a need to 'get help with her eating habits.' Reportedly, the client admits to eating a large amount of food and feeling 'disgusted' afterward, which triggers self-induced vomiting. She has done this multiple times and reports it has 'gotten out of control.' She says she is always worried about her appearance 'not being good enough.' She denies using any laxatives or diuretics; however, her mother reports she found two empty boxes of laxatives in her apartment. On exam, the client is alert and completely oriented. She is cooperative during the exam and has an anxious and worried affect. She has a slender appearance and a current body mass index (BMI) of 20. Scars were observed on both index fingers. She says physically, her only complaint is daily heartburn and occasional dizziness during exercise.

The nurse develops a care plan for this client based on the history and physical For each nursing diagnosis, click to specify the appropriate nursing intervention Explanation This client is demonstrating signs of bulimia nervosa. To address the imbalanced nutrition nursing diagnosis, the nurse should provide small, frequent meals. This decreases the interval between large meals, decreasing the likelihood of purging. The client should not eat meals alone as they risk purging. They should be supervised thirty minutes following meal consumption. Group therapy is recommended for a client with a disturbed body image. This allows the client to engage with others and develop rapport and self-esteem. Conversations should not be focused on the client's weight as this will further condition their altered perception. Visitation with friends and family should not be restricted as they will be essential in the discharge process. Promoting positive reframing is always an effective strategy for anxiety nursing diagnosis. This helps decondition this cognitive and behavioral disconnect. Decision-making should not be made for the client; allowing the client to be alone encourages rumination. This could increase anxiety. Additional Info Bulimia nervosa is an eating disorder characterized by an individual binging and purging. An individual usually consumes a large number of calories and may experience a sense of revulsion, triggering them to purge. An individual may also abuse laxatives and diuretics and engage in excessive exercise. Fluoxetine is the only approved medication indicated in the treatment of this eating disorder.

Calcium مراجعة ضروري

Thiazide diuretics cause calcium retention, making their administration a potential cause of hypercalcemia. Malignancy, especially malignancies with metastasis involving the bones, may induce hypercalcemia from the breakdown of the bone. This causes the calcium to transition into the bloodstream. Hyperparathyroidism can cause hypercalcemia, not hypoparathyroidism End-stage kidney disease commonly causes hypocalcemia because of the body's inability to recycle vitamin D and have it absorb the calcium high phosphorus levels drive down calcium levels (inverse relationship). Crohn's disease may cause malabsorption of vitamins and minerals, and a clinical feature of Crohn's disease is hypocalcemia.

case study: فرق بين البنومونيا و الشوك

This client most likely has pneumonia. His biggest risk factor was recent hospitalization which puts him at risk for health care-associated pneumonia which is more pathogenic. Other symptoms supporting this likely problem include productive cough, fever, adventitious lung sounds, and dyspnea. The client does not have tachycardia which is one of the hallmarks of shock. A pleural effusion is excluded because it generally does not feature a fever

erythroblastosis fetalis

a disorder that results from the incompatibility of a fetus with Rh-positive blood and a mother with Rh-negative blood, causing red blood cell destruction in the fetus; a blood transfusion is necessary to save the fetus

Adrenal Insufficiency (Addison's Disease)

adrenal cortex does not produce enough hormone (cortisol or aldosterone) Low mood or irritability Loss of appetite and unintentional weight loss Frequent urination Increased thirst Craving for salty foods A low sodium, high potassium

Which of the following are appropriate nursing interventions to prevent aspiration after a child has vomited? Select all that apply. -Position the child on their side. -Suction the mouth to remove vomitus. -Offer the child a sip of water to clear the mouth. -Assess the character and amount of vomitus. -Ask primary healthcare provider about antiemetic medication

Choices A and B are correct. Positioning the child on their side will prevent aspiration and maintain a patent airway (Choice A). Suctioning the mouth will remove any further vomitus keeping the mouth clean and preventing aspiration (Choice B). Choice C is incorrect. It is not safe to offer the child a sip of water at this time as they may aspirate on thin liquids. The child first needs to be assessed and the problem identified before it is decided that they are safe for oral intake. Chocie D is incorrect. Although it is an appropriate nursing intervention to assess the character and amount of emesis, this does not do anything to prevent aspiration after the child has vomited. Choice E is incorrect. A child that is vomiting may benefit from an antiemetic, but this does not prevent aspiration in the child who has already vomited.

Initiative vs. Guilt 3-6 YR

Initiative: When caregivers encourage and support children to take the initiative, they can start planning activities, accomplish tasks, and face challenges. The children will learn to take the initiative and assert control over their environment. They can begin to think for themselves, formulate plans, and execute them, which helps foster a sense of purpose. Guilt: If caregivers discourage the pursuit of independent activities or dismiss or criticize their efforts, children may feel guilty about their desires and initiatives. This could potentially lead to feelings of guilt, self-doubt, and lack of initiative.

Isoniazid (INH)

Liver toxicity is a severe adverse effect of isoniazid. Healthcare providers should monitor for signs of jaundice, fatigue, elevated liver enzymes, and loss of appetite. Liver enzyme tests are usually performed monthly during therapy to identify early hepatotoxicity. Isoniazid is a bacteriocidal for actively growing organisms and a bacteriostatic for dormant mycobacteria. It is selective for M. tuberculosis. Isoniazid is used alone for chemoprophylaxis, or in combination with other antitubercular drugs when treating active disease

CT scan with contrast

NPO 8 hrs before test. question contrast dye if pt has poor renal status, elevated creatinine levels ✓ Before IV contrast administration, prescreening must include questioning the patient regarding prior reactions to contrast dye or allergies to medications/substances. Any allergy may increase the risk of having an IV contrast dye reaction. ✓ If there is a history of severe allergies or prior reaction to contrast dye, such patients may be premedicated with diphenhydramine and steroids. ✓ Shellfish allergy is not a contraindication. Students who would like to learn more about this should refer to these articles at

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. Withhold the client's scheduled dose Administer the dose, as prescribed Assess the client's 24-hour urinary output Assess the client's most recent sodium level Assess the client's heart rate and rhythm Obtain a prescription for an echocardiogram

Withhold the client's scheduled dose 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. ADDITIONAL INFO The normal therapeutic range for digitalis is 0.5-2 ng/dL. Hypokalemia is a significant cause of digitalis toxicity and may be induced by certain diuretics. The earliest manifestation of digoxin toxicity is lack of appetite, nausea, and vomiting.

cushing's syndrome

hypersecretion of cortisol --> hypernatremia and hypokalemia

Vaccines either not recommended or contraindicated during pregnancy include:

✓ MMR ✓ Varicella ✓ Zoster ✓ HPV ✓ Polio ✓ Any live vaccine

Pneumpthorax

✓ Pneumothorax may be caused by chest wall trauma, insertion of a central vascular access device (subclavian or intrajugular), severe pulmonary tuberculosis, and cystic fibrosis ✓ Pneumothorax causes a loss of negative pressure in the pleural space, leading to the collapsing of the lung that causes a reduction in vital capacity ✓ Manifestations of a pneumothorax include reduced/Diminished or absent breath sounds on the affected side, tachypnea, tachycardia, and hyper resonance on chest percussion ✓ Nursing care includes applying supplemental oxygen and the preparation of the physician inserting a chest tube ✓ Pneumothorax is diagnosed by chest radiograph (x-ray)

Isotretinoin

Isotretinoin (Accutane) is a synthetic retinoid that is frequently prescribed for severe acne that does not respond to other topical and oral treatments. This medication is usually given for 4 to 6 months or until significant improvement is noticed. Effects can include dry skin and changes in the appearance of the skin. However, oral isotretinoin can cause severe side effects. The FDA required that the labeling of isotretinoin be changed to add that there is a possible association between isotretinoin and critical mood changes. At every visit, the nurse should review symptoms such as depression, irritability, altered sleep patterns, and suicidal ideation with the client. The nurse should educate the family members to monitor for such mood changes and report them to the primary healthcare provider (PHCP).

Olanzapine

Olanzapine is an atypical antipsychotic drug. Adverse reactions of olanzapine include neuroleptic malignant syndrome, which is manifested by tachycardia, delirium, fever, and muscle rigidity. Thus, muscle rigidity should be reported to the provider immediately. Choices B, C, and D are incorrect. Weight gain, hyperglycemia, and fatigue are all side-effects of this drug class but do not require immediate notification to the provider.

-Amniocentesis: Amniocentesis is a widely used antepartum test that may determine: The gender of a fetus. The presence of neural tube defects. Chromosomal abnormalities. Fetal lung maturity. -Chorionic Villous Sampling (CVS) : determine if the fetus has any chromosomal abnormalities. -Maternal serum alpha-fetal protein: assesses neural tube defects. -A biophysical profile (BPP): assesses five variables : Heart rate, Muscle tone, Movement, Breathing, Amniotic fluid.

-Amniocentesis: Amniocentesis is a widely used antepartum test that may determine: The gender of a fetus. The presence of neural tube defects. Chromosomal abnormalities. Fetal lung maturity. -Chorionic Villous Sampling (CVS) : determine if the fetus has any chromosomal abnormalities. -Maternal serum alpha-fetal protein: assesses neural tube defects. -A biophysical profile (BPP): assesses five variables : Heart rate, Muscle tone, Movement, Breathing, Amniotic fluid.

هااااااااااااااااااااااااااااااااااااااااااااااااااااااااااااام The nurse is caring for an infant whose mother used heroin during pregnancy. Which signs and symptoms would the nurse expect to see in this infant experiencing withdrawal? Temperature 36.5 degrees Celsius. no Respiratory rate 88. yes Diaphoretic. yes Constipation. yes Hyperactive reflexes.

B is correct. A respiratory rate of 88 is tachypneic, which would be expected for an infant experiencing neonatal abstinence syndrome (NAS). Tachypnea is a common sign of NAS, as is respiratory distress. It is not uncommon to appreciate an increased work of breathing, including things such as nasal flaring, head bobbing, and retractions in these infants. C is correct. Diaphoresis or excessive sweating is a common symptom of infants with neonatal abstinence syndrome. Most of these infants are incredibly irritable, hot, and sweaty. It is similar to the withdrawal you would expect in an adult that goes cold turkey on a drug . E is correct. Newborns experiencing Neonatal Abstinence Syndrome (NAS) often display hyperactive reflexes. This heightened neurological excitability is a hallmark of NAS and may manifest as jitteriness, a high-pitched cry, or an exaggerated startle response. The hyperactive reflexes result from the newborn's withdrawal from the substances they were exposed to in utero. an infant withdrawing from heroin would likely present with a fever. For NAS scoring, a fever is higher than 37.8 degrees Celsius. Most of these infants are incredibly irritable, hot, and sweaty. In an infant experiencing neonatal abstinence syndrome, you would expect frequent loose stools, not constipation. These loose stools are so prevalent that many of these infants end up with horrible skin breakdown due to sitting in diapers filled with loose stool. Knowing that diarrhea is a common sign of NAS is essential to ensure to monitor for these complications. An infant born to a mother who used heroin during pregnancy may exhibit signs of neonatal abstinence syndrome (NAS), a group of problems a baby experiences when withdrawing from exposure to narcotics. Symptoms usually appear within 1 to 3 days of birth but may take up to a week. Here are some of the signs and symptoms the nurse might expect: ✓High-pitched crying or excessive crying: This is often the first and most common symptom noticed. A baby with NAS's cry can be shrill and more continuous than others. ✓Irritability: The baby may be unusually fussy and hard to comfort. Poor feeding and sucking reflex: The baby may have difficulty latching on or staying on the bre

You are assigned to take care of a client who just underwent a cholecystectomy. Which of the following would decrease the risk of developing atelectasis in this client?

Choices A, B, C, D and E are correct. Atelectasis is defined as the total or partial collapse of the alveoli. This is a common complication in the immediate postoperative period, especially after abdominal surgeries. If atelectasis is not addressed, it may progress to pneumonia. Since alveoli are responsible for gas exchange, alveolar collapse can lead to impaired gas exchange/impaired oxygenation. Post-operatively, the client may not be able to take deep breaths due to pain from the movement of abdominal muscles. This impaired expansion of the alveoli leads to the accumulation of secretions/mucus plug, decreased surfactant, as well as the obstruction of airway and collapse of alveoli. Additional factors that predispose to this may include hypoventilation, sedation, and reduced mobility. When such factors are identified, the nurse should encourage the client to adopt interventions to mitigate those factors and prevent atelectasis. Such interventions include: Encouraging clients to take deep inspirations (Choice A) and use incentive spirometry (Choice E). An incentive spirometer encourages the client to pursue deep breathing. Deep breathing aids in gas exchange and promotes the full expansion of the alveoli. Keeping the client in the supine position with the head end of the bed elevated (Choice B) or semi-recumbent area (head of the bed raised 30 to 45 degrees). This allows for maximum thoracic expansion by lowering the abdominal pressure on the diaphragm. Encouraging the client to change position at least every 2 hours (Choice C). This increases mobility and allows full chest expansion and increases perfusion to both lungs. Encouraging the client to cough at least ten times per hour (Choice D) when awake. This helps promote alveolar expansion. The above interventions are aimed at preventing atelectasis. However, the nurse should be aware of detecting atelectasis if it did end up happening. Physical exam findings assist in the diagnosis and include fever and decreased breath sounds on the side of atelectasis. In the case of complete atelectasis/collapse, the trachea/mediastinum may be shifted to the same side due to the pull by a collapsed lung. Atelectasis in the postoperative period is referred to as "resorp

autonomy VS shame and doubt 1-3 YR

shame and doubt occur during the second stage of psychosocial development, between the ages of 1½ and 3 years. This stage is when children learn to be independent and make their own decisions

The nurse is caring for a client who has been prescribed a 14-day course of prednisone. Which of the following statements, if made by the nurse, would be correct? Select all that apply. "This medication may make you gain weight." "It is best to take this medication in the morning with food." "If you have further pain, it is okay to take naproxen." "Your blood pressure may decrease while taking this medication." "Do not abruptly stop taking this medication."

*Choices A, B, and E are correct. Prednisone is a corticosteroid and is indicated for various conditions, including exacerbations of rheumatoid arthritis. The medication potentiates aldosterone causing sodium and water retention, thereby allowing the client to gain weight. Steroids are best taken in the morning with food. Taking it with food decreases gastrointestinal upset. If the steroid is taken at nighttime, it may cause insomnia. The cessation of this drug should be tapered to avoid adrenal insufficiency. This medication should not be abruptly discontinued. *Choices C and D are incorrect. Corticosteroids should not be combined with NSAIDs such as naproxen because that would hasten the risk of peptic ulcer disease. Blood pressure would increase because of fluid retention. Additional Info Corticosteroids may cause an array of adverse effects while they mitigate inflammation. This includes peptic ulcer disease, edema, hypokalemia, hyperglycemia, and hypernatremia. The client should be educated to maintain low sodium and high potassium diet while taking prednisone.

↓ Hypokalemia ↓

- Important in muscle contraction, nerve impulses, & acid-base imbalances Causes: "DITCH" - DRUGS: laxatives, diuretics, corticosteroids - INADEQUATE K+ intake: NPO, eating disorders, alcoholism - Too much water: polydipsia, excessive IVF -Cushing's Syndrome: too much cortisol, Na/H2O retention, K+ secretion -Heavy Fluid loss: NGT suction, vomiting, diarrhea, wound drainage, sweating - Alkalosis - Hyperinsulinism Treatment - Place on cardiac telemetry -Hold lasix or other potassium wasting drugs - Hold digoxin - Encourage diet rich in potassium - Oral potassium supplements Give with food to prevent Gl upset -IV potassium supplements • Give slowly!! And always on a pump, never IV push! • Monitor IV site for extravasation, K+ causes tissue damage. slightly peaked p wave Slightly prolonged PR interval ST depression Shallow T wave prominent بارز U wave Signs & Symptoms -Decreased deep tendon reflexes - Weakness, flaccidity - Shallow respirations -Decreased bowel sounds - Constipation, abdominal distention - Orthostatic hypotension - Weak, thready pulse - Cardiac dysrhythmias - EKG CHANGES that can lead to heart blocks, v-fib, & cardiac arrest

The nurse supervises a student nurse giving medications through a nasogastric tube (NGT) to a client receiving continuous enteral feeding. Which actions by the student require follow-up by the nurse? Select all that apply. -Gives each medication separately -Verifies placement of the NGT prior to medication administration -Elevates the head of the bed to 15 degrees -Adds crushed medications directly to a tube feeding -Crushes each tablet into a fine powder

-Elevates the head of the bed to 15 degrees -Adds crushed medications directly to a tube feeding. Choices C and D are correct. These actions by the student are incorrect and require follow-up. To prevent aspiration, the client should be elevated between 30-45 degrees during and after this procedure. Crushed medications should not be added directly to the tube feeding because the tube feeding may alter the efficacy of the medication. The medication should be administered directly to the client after the tubing has been flushed with 20 to 30 mL of tap water. If giving only one dose of medication, flush the tubing with 20 to 30 mL of water after administration. Choices A, B, and E are incorrect. These actions are correct and do not require follow-up. Each medication should be given separately because mixing all the medications together could cause interactions. Verifying placement of the NGT before medication administration is an appropriate action. If the gastric pH is less than 5, the tube tip is in the stomach. It is preferred that liquid medications instead of crushed tablets should be administered. If crushed tablets are given, flush the tubing before and after the medication administration to prevent the medication from adhering to the inside of the tube. Additional Info ✓ After the placement of an NGT, the nurse should verify the placement via an x-ray ✓ Subsequent verification should come through gastric pH analysis. A pH < 5 indicates the tube is likely in the stomach. ✓ When administering medications via NGT, the nurse should never crush extended-release or sustained-release medications. ✓ Once the medications have been administered, the nurse should flush the NGT with 20-30 mL of tepid tap water.

The emergency department (ED) nurse cares for a client with a suspected cerebrovascular accident (CVA). Which actions should the nurse take? Select all that apply. -Perform a Glasgow coma scale (GCS) -Assess the client's capillary blood glucose (CBG) -Prepare the client for an immediate computed tomography (CT) scan of the brain -Insert a nasogastric tube (NGT) -Determine the onset of the symptoms or the last known well (LKW)

-Perform a Glasgow coma scale (GCS) -Assess the client's capillary blood glucose (CBG) -Prepare the client for an immediate computed tomography (CT) scan of the brain -Determine the onset of the symptoms or the last known well (LKW).

The following scenario applies to the next 6 items 27-year-old female presents to the clinic who is presumptively pregnant Item 1 of 6 A 27-year-old nulliparous female presented to the clinic stating that she took an over-the-counter urine pregnancy test, which was positive. She states that she is two weeks late for her menstrual period. Her symptoms include nausea, fatigue, increased urinary frequency, vaginal discharge that is malodorous, burning with urination, and breast tenderness. She is not in a committed relationship and uses no contraceptive methods. She reports having multiple sexual partners. She has a negative gynecological and medical history.

Based on the client's symptoms, she is presumptively pregnant. Expected presumptive pregnancy signs include nausea, vomiting, frequent urination, breast tenderness, and amenorrhea. The client also has one probable sign of pregnancy, which is the positive home pregnancy test. The two symptoms reported by the client of burning with urination and vaginal discharge are not expected signs of a presumptive pregnancy. Thus, the nurse should investigate these reported symptoms further because they are concerning. The symptoms that the client is reporting (nausea, fatigue, increased urinary frequency, vaginal discharge that is malodorous, burning with urination, and breast tenderness) may be categorized as a manifestation belonging to pregnancy, gonorrhea, or cystitis. Malodorous vaginal discharge is a classic manifestation associated with gonorrhea. Increased urinary frequency is commonly seen in the first trimester of pregnancy and is also classically found with gonorrhea and cystitis. The fluctuating hormones cause the woman to experience breast tenderness and would be an expected finding with presumptive pregnancy. Burning with urination is not a manifestation associated with pregnancy (only increased urinary frequency) this manifestation of dysuria is associated with cystitis and gonorrhea. The cessation of menses is a classic presumptive pregnancy sign and not associated with cystitis or gonorrhea. The nurse understands that the client is most likely experiencing which condition? Select all that apply Pyelonephritis Chlamydia yes Cystitis Gonorrhea yes Pre-eclampsia

You are caring for an 80-year-old woman with a long-standing history of asthma. You are preparing to give a dose of theophylline to the patient. You know that the most critical sign to assess before giving this dose is: A. Temperature [2%] B. Blood Pressure [37%] C. Urinary Output [8%] D. Pulse

Choice D is correct. The nurse should evaluate the character of the pulse since one of the toxic effects of theophylline is cardiac arrhythmias. If the pulse rate is significantly increased or erratic, it may alert the nurse regarding a potential arrhythmia from theophylline drug toxicity. Severe adverse events, including arrhythmias, seizures/ status epilepticus, nausea with vomiting, and hypotension, usually occur when the theophylline is at a toxic level in the body (drug toxicity). If such signs are detected, the nurse should hold the next dose of theophylline and immediately notify the healthcare provider. Theophylline should be given with a full glass of water on an empty stomach. must be used regularly to be effective does not work right away and should not be used to relieve sudden shortness of breath and breathing problem

The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which assessment finding requires immediate follow-up? Correct A. Disorientation [83%] B. High urine specific gravity [5%] C. Oliguria [8%] D. Increased thirst [4%]

Choice A is correct. Hyponatremia is a classic clinical feature associated with the syndrome of inappropriate antidiuretic hormone (SIADH). The hyponatremia may become severe and cause the client to have an altered mental status (AMS). This AMS is concerning because this signals that the serum sodium is quite low and warrants immediate intervention. Choices B, C, and D are incorrect. Expected findings associated with SIADH include increased urine-specific gravity (concentrated urine), oliguria (reduced urinary output), and inappropriately increased thirst. These are expected findings, so they would not require immediate follow-up. It is important to note that increased thirst can be seen both in diabetes insipidus as well as SIADH. Plasma osmolality is the primary factor that regulates antidiuretic hormone (ADH) and thirst. Most of the osmolality is determined by the sodium content. If the osmolality increases, it stimulates ADH release and increases thirst. If osmolality decreases, it suppresses ADH and thirst. The normal function of ADH is to retain water. However, there is inappropriate ADH secretion in SIADH, and this general feedback between plasma osmolality, ADH, and thirst regulation is lost. Despite low sodium and low osmolality, there is inappropriately high ADH and inappropriately increased thirst. Inappropriately increased thirst in SIADH is felt to be because of the downward resetting of the osmotic threshold in the thirst center.

The nurse is caring for a newborn of a heroin-addicted mother. Which nursing intervention should the nurse implement in caring for this newborn? A. Decrease the newborn's sensory stimulation. B. Perform activities in one setting. C. Loosely wrap the neonate in a blanket. D. Place the newborn in a stimulating environment

Choice A is correct. The drug-dependent newborn is irritable and very sensitive to environmental stimuli. He/she should have limited sensory input to allow extensive rest periods. Choice B is incorrect. The newborn should have procedures to him/her as tolerated. He/she should always have extended rest periods. Choice C is incorrect. The neonate should be wrapped tightly in a flexed position to promote rest Choice D is incorrect. Increasing environmental stimuli can exacerbate the newborn's irritability and restlessness.

The nurse is caring for a client post-coronary artery bypass graft (CABG) and is implementing measures to promote airway clearance related to retained secretions. Which nursing intervention is inappropriate? Correct A. Administering NSAIDs before deep breathing and coughing exercises. [65%] B. Splinting the incision site with "heart pillows" or pillows before and during coughing. [10%] C. Assisting the client to ambulate as tolerated. [16%] D. Teaching the client the correct use of an incentive spirometer.

Choice A is correct. This action is inappropriate. Deep breathing and coughing must be encouraged. However, client may experience severe pain with coughing following CABG. Analgesics should be administered. However, NSAIDs may be unsafe in post-CABG setting due to risk of cardiovascular events and bleeding. In 2005, the Food and Drug Administration (FDA) issued a boxed warning against NSAID administration after coronary artery bypass graft (CABG) surgery. In accordance with this warning, NSAIDS should be avoided. For pain relief, a post-coronary artery bypass graft (CABG) client should receive opioids, not NSAIDs. The only NSAID that's recommended in post-CABG setting is aspirin. Though aspirin is an NSAID, the American Heart Association guidelines recommend giving aspirin within 6 hours after CABG because aspirin reduces thromboses, improves graft patency, and increases long term survival. Choice B, C, and D are incorrect. These are appropriate nursing interventions and the nurse should promote them. Splinting the incision site before and during coughing promotes more intense coughing efforts by the client. Therefore, this is an appropriate nursing intervention that the nurse should pursue. Respiratory effort increases with ambulation. As a result, deep breathing occurs, allowing the client to clear retained secretions and excess mucus more easily than if they remained bedridden. The correct use of an incentive spirometer encourages sustained inspiration to open alveoli and promotes the clearing of chest secretions. Learning Objective Recognize that the FDA black box warning discourages the use of NSAIDs in the post-CABG setting. The only NSAID that's recommended is aspirin because its benefits outweigh the bleeding risks. Additional Info After coronary artery bypass grafting (CABG) surgery, chest tubes may be inserted to drain excess fluid and air from the pleural cavity and mediastinum. These chest tubes play a vital role in postoperative care and assist in promoting lung expansion, preventing complications such as pneumothorax or hemothorax, and ensuring adequate drainage. Encourage early ambulation and mobilization to prevent complications associated with immobility and improve circulation. Carefull

The nurse observes a client go up the stairs with a cane. It would indicate effective teaching if the client grabs the handrail and هاااااااااااااااااااااااااااااااااااااااااااااام Correct Answer(s): A A. places the stronger leg up a step, then simultaneously moves up the weaker leg and cane. B. holds the cane in one hand and hops up each stair using the stronger leg. C. places the cane up a step, then simultaneously moves up the stronger and weaker legs. D. places the weaker leg up a step, then simultaneously moves up the stronger leg and cane.

Choice A is correct. When a client is ambulating upstairs using a cane, the client will face the stairs and place the cane on the side opposite the handrail. Then, the client will advance the unaffected (stronger) leg up to the next step, then the cane and the affected (weaker) leg simultaneously. This reflects adequate understanding. هام Remember that the weaker side and the cane share the load and should always move together. Walking on a level surface: When walking on a level surface, the client should hold the cane on the same side as the stronger leg. ✓ This helps the client shift the weight to the stronger side as they move. Therefore, the client should move the weaker or injured leg simultaneously while moving the cane. ✓ Always remember that the cane and the injured/ weaker side act as partners - they always move together. By doing this, the cane can share the load with the injured leg. ✓ The client should step with the weak leg as they pick up the cane and press down with the cane again when they step down with their weak leg. B. Using the stairs: " Up with the good, and down with the bad" is a good statement while educating the client regarding cane usage to navigate the stairs. ✓ Up with the good: If the client must ascend stairs, the nurse should instruct the client first to hold the cane on their stronger side. ✓ Then the client should advance the unaffected (good) leg onto the step and, following that, move the affected (weaker) leg and the cane simultaneously onto the step. ✓ The cane and the weaker side should always move together. ✓ Down with the bad: If the client must descend stairs, the nurse should instruct the client to hold the cane on their stronger side. The client should simultaneously place the cane and the affected (weaker) leg down on the next step, followed by the unaffected (stronger) leg.

The oncoming nurse learns that her new patient is suffering from Syndrome of Inappropriate Antidiuretic Hormone (SIADH) secretion. Which of the following nursing actions is the most important? Correct A. Assess the patient's mental status [49%] B. Provide oral hygiene [0%] C. Keep accurate intake and output measurements [48%] D. Reduce stress and discomfort [2%]

Choice A is correct. When caring for a patient with SIADH, the nurse should carefully monitor for changes in mental status and level of consciousness. SIADH causes excess free water retention and hyponatremia, which may lead to confusion and behavioral changes. These alterations in the mental state may also lead to seizures. Patients with SIADH may also experience cardiac dysrhythmias. Choice B is incorrect. Nurses should always assist their patients in caring for their oral hygiene, especially when suffering from SIADH. However, providing oral health is not the priority nursing intervention in this situation. Choice C is incorrect. SIADH creates alterations in a patient's fluid and electrolyte balance, and thus nurses must keep accurate accounts of all intakes and outputs. However, monitoring the patient's mental status is more important. Choice D is incorrect. While reducing pain and stress is an essential part of nursing care, monitoring a patient with SIADH for mental status and LOC changes is a higher priority.

A client is receiving allopurinol and asks what they should know about taking this medicine. The nurse would be most correct in stating which of the following? A. "Facial swelling is expected in the first few days of therapy." B. "Drink at least 3000 mL of water per day." C. "Do not eat while taking this medication." D. "This medication begins working immediately."

Choice B is correct. Allopurinol is prescribed to patients with gout or kidney stones and works by reducing the amount of uric acid produced by the body. Patients taking this medication should be encouraged to drink plenty of water, at least 3,000 mL per day. Choice A is incorrect. Facial swelling is not normal and may indicate an emergency reaction. Patients who experience swelling should seek medical attention as soon as possible. Choice C is incorrect. Eating with this medication is appropriate. Choice D is incorrect. This medication does not work immediately and may take a few months to reach full

A nurse in the surgical ICU is taking care of a young man that was involved in a four-wheeling accident 4 hours ago. He was diagnosed with a grade two renal laceration, multiple rib fractures, and a concussion upon arrival. While performing the last head-to-toe assessment before the transfer, the nurse notices a small amount of bruising around the patient's umbilicus. What should the nurse do? A. Administer pain medication for rib fractures B. Notify the trauma surgeon of bruising immediately C. Perform serial abdominal exams and keep monitoring the umbilicus D. Assess pupillary reaction

Choice B is correct. Bruising around the umbilicus is called Cullen's sign. This is important to identify after trauma because it indicates abdominal bleeding. The nurse must notify the surgeon immediately to assess the patient further. The surgeon may monitor the patient medically or take him back into surgery. Choice A is incorrect. The patient may need pain medication, but the most important intervention at this time is to notify the trauma surgeon of Cullen's sign that was noted. Choice C is incorrect. The trauma surgeon may order serial abdominal exams after assessing the patient, but he needs to be called to evaluate the patient first. Choice D is incorrect. This assessment is not warranted at this time.

The nurse has received a prescription for a high-potency topical corticosteroid lotion. The nurse should instruct the client to avoid applying the lotion to the client's A. feet. [2%] B. face. [88%] C. outer thigh. [5%] D. abdomen. [5%]

Choice B is correct. Clients should be discouraged from using over-the-counter topical glucocorticoids on their faces because these creams may cause permanent hypopigmentation and thinning of the skin. If a topical corticosteroid must be applied to the face, it is usually a low-dose formulation for less than two weeks. Choices A, C, and D are incorrect. Most over-the-counter topical glucocorticoids may be safely used short term. The nurse should advise the client not to use topical corticosteroids on the face, between skin folds, and on the axilla. Additional Info ✓ Topical corticosteroids are indicated in the treatment of psoriasis, severe atopic dermatitis, severe contact dermatitis ✓ They come prepared as a lotion, gel, ointment, or foam ✓ If a topical corticosteroid is necessary for the face, it should be low-potency and used for less than two weeks ✓ For optimal absorption, it is advised to apply topical corticosteroids to moist skin either immediately after bathing or after wet soaks

The nurse is caring for a client with narcolepsy. The nurse anticipates which prescription from the primary healthcare? A. Trazodone [16%] B. Modafinil [46%] C. Diazepam [26%] D. Fluoxetine [11%]

Choice B is correct. Narcolepsy is a disorder characterized when a client unexpectedly falls asleep in the middle of normal daily activities. Agents to keep the client awake during the day are the treatment goal. A common medication used is modafinil. Modafinil is a central nervous stimulant dosed during daylight hours to keep the client alert. Choices A, C, and D are incorrect. The treatment goal for narcolepsy is for the client to stay awake during the day. Trazodone and diazepam are central nervous system depressants and would cause sleepiness. Fluoxetine is not indicated in the treatment of narcolepsy as this medication modulates serotonin and is helpful for anxiety and depressive disorders. Narcolepsy is a condition characterized by the client experiencing 'sleep attacks,' which may cause serious injury if one should occur while the client is driving, etc. The client with narcolepsy may also have Cataplexy, a sudden skeletal muscle weakness. The condition is often associated with strong emotions (e.g., joy, anger), and commonly the knees buckle, and the individual falls to the floor while still awake.

The nurse is planning a staff development conference about vaccines. Which of the following information should the nurse include? A. MMR vaccine should be administered in the first trimester of pregnancy. B. Human Papillomavirus vaccine can reduce the risk of cervical cancer. C. Influenza vaccine may be administered to an infant at 3 months D. Herpes zoster vaccine is recommended starting at age 40.

Choice B is correct. The Human Papillomavirus (HPV) vaccine is the only vaccine proven to decrease the risk of cervical cancer. Nearly all cases of cervical cancer are linked to HPV and thus, the vaccine is an effective primary prevention method. Choices A, C, and D are incorrect. MMR vaccine is contraindicated during pregnancy. The client should not receive this vaccine or any other live vaccines during the pregnancy period. The seasonal influenza vaccine is an effective prevention method for children 6 months and older. Herpes zoster immunization is recommended starting at age 50. Additional Info The MMR vaccine should not be administered to clients currently pregnant or four weeks prior to pregnancy. This is a two-series vaccine and is recommended for children starting at 12 to 15 months. The HPV Vaccine is available as a two or three-dose vaccine depending on which age it is started. Initial vaccination is recommended for males and females aged 11 to 12. The vaccine is recommended up to age 26. This vaccine is not recommended during pregnancy. The influenza vaccine comes in a variety of preparations - recombinant influenza vaccine, this vaccine is recommended for those aged 18 or older; inactivated influenza vaccine (IIV), which is recommended for ages six months or greater; live attenuated influenza vaccine (LAIV) that is given intranasally for those aged 2 through 49. The herpes zoster vaccine is recommended for individuals aged 50 or greater. This vaccine protects a client against shingles. This vaccine should be administered regardless of prior infection of varicella or herpes zoster.

The nurse is assessing a 2-year-old client with the following symptoms: excessive drooling, stridor, difficulty swallowing, and difficulty speaking. Based on these assessment findings, which condition does the nurse suspect? A. Croup B. Epiglottitis C. Laryngotracheal bronchitis D. Bronchiolitis

Choice B is correct. The cardinal signs of epiglottitis are the "4 Ds" - drooling, dysphonia, dysphagia, and distress. Difficulty swallowing is dysphagia and difficulty speaking is dysphonia. Stridor is a high-pitched wheezing sound caused by disrupted airflow, hence the distress. This child is presenting with all of those cardinal symptoms and is therefore highly suspicious of epiglottitis. Choice A is incorrect. Croup is a respiratory infection presenting with a loud barking cough. It does not cause airway obstruction. Choice C is incorrect. Laryngotracheal bronchitis is another name for croup. The cardinal sign of this disorder is a loud, barking cough. It is sometimes described as a "seal-like" barking cough. It lasts 3-5 days and the child is typically febrile. Choice D is incorrect. Bronchiolitis is inflammation of the bronchioles or lower airway. It is characterized by a runny nose, fever, and cough. Children with bronchiolitis do not present with the signs of airway obstruction described; those are very specific to epiglottitis.

The nurse is preparing to administer prescribed medications to a client. After reviewing the client's vital signs below, the nurse plans on holding which prescribed medication? p: 54 o2: 95% RR 20 BP 119/70 T: 97 F A. Amlodipine 5 mg PO B. Diltiazem 60 mg PO C. Ibuprofen 500 mg PO D. Ciprofloxacin 500 mg PO

Choice B is correct. The client is experiencing bradycardia. Therefore, it is important to withhold medications that may exacerbate bradycardia. Diltiazem is a calcium channel blocker (CCB). Because of its cardiac depressant (negative chronotropic and negative inotropic) properties, diltiazem reduces the heart rate and contractility. Because of negative chronotropic action, it can cause bradycardia. For this reason, therapeutic uses of diltiazem include atrial arrhythmia and paroxysmal supraventricular tachycardia. When the client has baseline bradycardia, it is important to hold the diltiazem and notify the healthcare provider for further orders or dosage modification. Choices A, C, and D are incorrect. Amlodipine is a dihydropyridine CCB that is more selective to vascular smooth muscle calcium channels. Therefore, it causes vasodilation and can be used to treat hypertension. Amlodipine does not cause bradycardia. The client is experiencing bradycardia but not hypotension. Amlodipine need not be held if there is asymptomatic bradycardia without hypotension. Side effects of dihydropyridine CCBs (amlodipine, felodipine, nifedipine) include hypotension, flushing, peripheral edema/ ankle edema, headache, and reflex tachycardia. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID). NSAIDs do not affect the client's heart rate and can, therefore, be given regardless of their heart rate. Ciprofloxacin is a fluoroquinolone antibacterial and can be given even if the client's heart rate is low. Ciprofloxacin's most reported cardiac side effects include QTc prolongation and torsades de pointes (ventricular arrhythmias). Bradycardia is unusual. Additional Info Calcium channel blockers are classified into two categories: 1. dihydropyridine (amlodipine, felodipine, nimodipine, and nifedipine) 2. non-dihydropyridine (diltiazem, verapamil). ✓ Dihydropyridine CCBs are vaso-selective. Therefore, they cause vasodilation. They do not cause reduced contractility or heart rate because of minimal effects on cardiac muscle calcium channels. Consequently, they are safe in congestive heart failure. CCBs like amlodipine is most commonly used to treat hypertension. Because of their vasodilatory properties, their side effects i

The nurse is reviewing labs for a client with a serum potassium level of 3.3 mEq/L(3.5-5 mEq/L). The nurse should take which essential action? A. Educate the client on potassium-rich foods B. Implement continuous telemetry monitoring C. Obtain an order for calcium gluconate D. Assess the client's neurological status

Choice B is correct. The normal range for serum potassium is between 3.5-5 mEq/L, so this client's level is low. Hypokalemia can lead to life-threatening cardiac arrhythmias. Of the options provided, initiating telemetry monitoring would be the highest priority to assess the client's heart function and monitor for any changes. Choice A is incorrect. Educating the client on potassium-rich foods is an important aspect of long-term potassium management. However, in a client with a serum potassium level of 3.3 mEq/L (hypokalemia), the immediate priority is addressing the potential risk of cardiac arrhythmias associated with low potassium levels. Choice C is incorrect. Calcium gluconate is not indicated for the treatment of hypokalemia. It is primarily used to counteract the effects of hyperkalemia and protect the heart from arrhythmias in that context. Choice D is incorrect. While neurological symptoms can occur with severe potassium imbalances, they are not typically immediately life-threatening in the context of hypokalemia. The primary concern with hypokalemia is the risk of cardiac arrhythmias. Neurological assessment should be conducted once cardiac stability has been ensured through telemetry monitoring.

The nurse is precepting a new graduate who will be caring for a client with bacterial cystitis. Which of the following statements by the new graduate requires follow-up? A. "The client should be counseled to increase their fluid intake." B. "A 24-hour urine sample will be needed to confirm the diagnosis." C. "Risk factors include frequent intercourse and douching." D. "Cranberry concentrate may be used to prevent future infections."

Choice B is correct. This statement is false and requires follow-up. Bacterial cystitis may be diagnosed based on urine analysis. A simple, clean-catch midstream urine sample is sufficient for diagnosing bacterial cystitis. A 24-hour urine is utilized for diagnosing conditions such as pheochromocytoma and abnormal protein quantification in multiple myeloma - not bacterial cystitis. Choice A is incorrect. Teaching points for a client diagnosed with bacterial cystitis should include increasing their fluid intake of non-caffeinated and non-alcoholic beverages. Increased hydration promotes increased urination and natural flushing of the bacteria. Choice C is incorrect. The client should be advised of the risk factors of bacterial cystitis, such as douching, frequent intercourse, inappropriate perianal hygiene, and invasive devices such as indwelling catheters. Choice D is incorrect. Cranberry concentrate has shown efficacy in preventing recurrent bacterial cystitis in some clients. While cranberry helps protect against recurrent urinary tract infections (UTI), there is no clear evidence to support its use in treating an active UTI episode. Therefore, educate the clients that cranberry can be used for UTI prevention, not UTI treatment. Additional Info ✓ Cystitis refers to inflammation of the bladder. When bacteria cause inflammation, it is called bacterial cystitis. ✓ Acute bacterial cystitis can easily be recognized by demonstrating pyuria (the presence of pus in the urine, typically from bacterial infection) in the urinalysis. In the absence of pyuria, the presence of bacteria alone does not mean an active infection and could merely represent colonization. Generally, clinically significant pyuria refers to greater than or equal to 10 leucocytes per microliter. ✓ Ideally, a clean-catch, midstream sample of the first urine of the day is the best specimen. However, this is not always feasible, and there is no clear evidence it is more accurate than the specimen collected at the time of clinical evaluation. Therefore, a clean catch and midstream urine sample is sufficient. The nurse should educate the client regarding the specimen collection - the initial portion of the urine stream should be discarded since th

The critical care nurse is caring for a sedated client on a pressure-controlled ventilation. The ventilator alarm is continuously sounding despite the client's stable condition and normal vital signs. What initial action should the nurse to take? A. Suction secretions [6%] B. Check tubing for holes or kinks [90%] C. Call respiratory therapy STAT [2%] D. Continue to monitor

Choice B is the correct answer. If the client's presentation and vitals are stable, the nurse should check for any apparent equipment malfunction. If no air leaks or kinks are immediately identifiable, the nurse should call respiratory therapy. Persistent alarms despite stable vitals may indicate the client is trying to talk, or is developing a pneumothorax from increased intrathoracic pressure, or is biting/gagging on the endotracheal tube, or is experiencing bronchospasms. These alarms should never be ignored or turned off, as they may indicate early signs of a change in the client's condition. Choice A is incorrect. The nurse should assess the client and breath sounds before performing suction. Choice C is incorrect. The nurse should assess the client, suction if needed, check the ventilator and tubing, remove excess water from the pipe, and check the endotracheal cuff pressure. If no clear cause for alarm, the nurse should then remove the client from the ventilator and manually ventilate with an Ambu bag, then call respiratory therapy (STAT). After that, the nurse can continue to assess until mechanical ventilation is resumed. Choice D is incorrect. Alarms should not be ignored or silenced. If unable to determine the cause, the nurse should call for assistance. Additional Info High pressure: causes: client coughing, gagging, bronchospasm, fighting the ventilator, ETT occlusion, kink in the tubing, increased secretions, thick secretion, water in ventilator circuit. Low pressure: causes: tubing is disconnected, loose connections, leak, extubation, cuffed ETT ir trach is deflated, poorly fitting CPAP/BiPAP mask.

The nurse has completed medication administration to assigned clients. The nurse should initially follow up on the client who received prescribed A. mirtazapine and reports sleepiness. B. citalopram and reports nausea. C. fluphenazine and reports fever. D. clonidine and reports dizziness while rolling over in bed.

Choice C is correct. Fluphenazine is a typical antipsychotic used in the management of schizophrenia. Fever associated with an antipsychotic (first or second generation) requires immediate follow-up because this could be a manifestation of life-threatening neuroleptic malignant syndrome (NMS). NMS is idiosyncratic and is manifested by the client having fever, muscle rigidity, delirium, and tachycardia. Choice A is incorrect. Mirtazapine is a serotonergic medication indicated in the management of insomnia. Sleepiness is an expected finding, which is why it is almost always dosed at night time. Choice B is incorrect. Citalopram is a serotonergic medication used to manage anxiety and depressive disorders. Nausea, vomiting, and diarrhea are transient side effects and may improve by the client taking the medication with food or right before bedtime. Choice D is incorrect. Clonidine is an alpha-agonist indicated in treating explosive disorders and attention deficit hyperactivity disorder. In non-psychiatric settings, clonidine is used to treat hypertension. Dizziness, while the client rolls over in bed is expected and typically subsides after a few doses. The nurse should prioritize the client most likely experiencing a life-threatening effect, NMS, over dizziness.

Which assessment data should the nurse recognize as a sign of acute kidney injury (AKI)? Correct A. Hypernatremia [16%] B. Metabolic alkalosis [8%] C. Oliguria [71%] D. Hypokalemia

Choice C is correct. Oliguria (urine output less than 400 mL/24 hours) is the most common initial sign of an AKI. It is usually seen within the first week of the injury. Choice A is incorrect. When the kidneys are damaged, they are unable to retain sodium. Sodium levels would be decreased (hyponatremia), not increased. Choice B is incorrect. Metabolic acidosis, not alkalosis, is typically seen with AKI. The kidneys are unable to excrete acids and unable to synthesize the ammonia needed to excrete hydrogen ions. Serum bicarbonate decreases and reabsorption of bicarbonate is ineffective, resulting in acidosis. Choice D is incorrect. Hyperkalemia, not hypokalemia, is seen with acute kidney injury. In AKI, the kidneys cannot excrete excess potassium normally. Metabolic acidosis can also develop, causing increased hydrogen ions into the cell, which forces additional potassium into the extracellular fluid.

The nurse is assessing a female client with syphilis. Which of the following would be an expected finding? Correct A. Dysuria B. Vaginal discharge C. Chancre lesion D. Dyspareunia

Choice C is correct. Syphilis is a sexually transmitted infection caused by T. pallidum. This insidious infection causes a client to experience a painless chancre in the area where the infection was contracted. That could be the penis, vagina, or rectum. This chancre lesion will eventually disappear and cause constitutional symptoms such as a generalized macular rash and malaise. a generalized macular rash and malaise. Choices A, B, and D are incorrect. Syphilis does not cause penile or vaginal discharge. Discharge that is foul smelling may be associated with other infections such as trichomoniasis, gonorrhea, or chlamydia. Dyspareunia is pain during intercourse commonly associated with pelvic inflammatory disease. Additional Info ✓ Syphilis is a highly contagious sexually transmitted infection. ✓ Different stages are found in this infection and are classically marked by a painless chancre lesion in the primary stage, a diffuse rash in the secondary stage, and systemic cardiovascular abnormalities in the tertiary stage.

A client is scheduled to undergo a 24-hour urinalysis, beginning at 0800 on the first day and ending 24 later at 0800 the following day. In preparation for the test, the nurse should instruct the client to do which of the following? Correct A. Discard the specimen taken at 0800 on the second day B. Discard the first and last samples C. Discard the first sample صح D. Collect all samples

Choice C is correct. When instructing a client on the proper way to perform a 24-hour urinalysis collection, the client should be taught that the specimen collection begins at 0800. At that time, the client should urinate in the toilet. That initial void - officially marking the commencement of the test - is not saved and should be flushed. Following the discarding of this initial first sample, all urine voided by the client during the following 24-hour period must be collected and stored in the designated collection bottles provided by the laboratory (of note, the entire specimen must be refrigerated or kept on ice during the collection period). At 0800 the next morning, the client voids and adds that final specimen to the specimen container, thus marking the end of the 24-hour urinalysis collection.

The nurse is caring for a client diagnosed with Multiple Sclerosis (MS). The nurse should anticipate a prescription for which medication? A. Topiramate B. Risperidone C. Prazosin D. Baclofen

Choice D is correct. Multiple Sclerosis (MS) may produce symptoms such as muscle spasticity, optic neuritis, fatigue, heat intolerance, and symptoms that seem to intensify on occasion (relapses). Muscle spasticity is best controlled with muscle relaxers such as baclofen. Choices A, B, and C are incorrect. Topiramate is an anticonvulsant drug indicated in the treatment of epilepsy as well as psychiatric conditions such as bipolar disorder. Risperidone is indicated for psychotic disorders such as schizophrenia. Prazosin is an antihypertensive that may be used for high blood pressure. This medication also may be indicated for psychiatric illnesses such as PTSD.

The nurse is assessing a client who is newly diagnosed with rheumatoid arthritis (RA). Which of the following findings is consistent with this diagnosis? A. Janeway lesions B. Tophi C. Unilateral joint pain D. Low-grade fever

Choice D is correct. Rheumatoid arthritis (RA) is characterized by symmetrical joint involvement, which means it typically affects joints on both sides of the body. Symptoms of RA include bilateral joint pain, joint swelling, fatigue, low-grade fever, and weight loss. A low-grade fever can occur in RA due to the inflammatory nature of the disease. Choice A is incorrect. Janeway lesions are painless, small, red, or hemorrhagic macules or nodules on the palms or soles. They are typically seen in conditions like infective endocarditis, not in rheumatoid arthritis. Choice B is incorrect. Tophi are deposits of uric acid crystals that can develop in individuals with gout, not in rheumatoid arthritis. Choice C is incorrect. Rheumatoid arthritis is characterized by symmetrical joint involvement, meaning that it typically affects joints on both sides of the body, not just unilaterally. Unilateral joint pain is less likely to be associated with RA.

The nurse is triaging phone calls at a local obstetrics clinic. Which client situation requires immediate follow-up? A client reporting Correct A. ten fetal movements in the past hour. B. irregular, painful contractions that are decreased with repositioning. C. abdominal cramping following her amniocentesis six hours ago. D. epigastric pain and a frontal headache not relieved with acetaminophen.

Choice D is correct. These symptoms are strongly suggestive of severe pre-eclampsia. Severe pre-eclampsia manifests as epigastric to right-upper quadrant pain suggestive of a liver injury. This, combined with a frontal headache, is highly concerning for severe pre-eclampsia. The client needs to be immediately evaluated as these symptoms may worsen to an eclamptic seizure. Choice A, B, and C are incorrect. A decrease in fetal movements is only concerning if the fetal movements are less than ten in two consecutive hours. Irregular, painful contractions that are decreased with repositioning is false labor, also known as Braxton-hick contractions. This does not require follow-up; the client should be instructed to hydrate and rest. Abdominal cramping that occurs less than 24 hours from the amniocentesis is normal and does not require follow-up. ✓ Preeclampsia is hypertension (systolic blood pressure ≥140 mm Hg or diastolic ≥90 mm Hg) occurring after 20 weeks of pregnancy in women with previously normal blood pressure, usually accompanied by proteinuria. ✓ The client with preeclampsia should be instructed to check her blood pressure and report symptoms that suggest worsening preeclampsia, such as visual disturbance, severe headache, or epigastric pain. ✓ Symptoms that suggest a fetal compromise, such as reduced fetal movement, also should be taught. PRE eclampsia : Proteinuria, Rising BP, Edema

The nurse is preparing to transfuse platelets to a client. Which of the following actions would be appropriate for the nurse to take? Select all that apply. Obtain the client's weight Ensure ABO type compatibility Infuse the platelets over 2 to 4 hours Verify completed consent for platelet transfusion Obtain pre-transfusion vital signs

Choices D and E are correct. When administering platelets to a client, the nurse should ensure that a completed blood product consent is obtained before transfusion. Further, the nurse (or UAP) will obtain pre-transfusion vital signs and infuse platelets over 15-30 minutes. The blood product that requires transfusion over 2 to 4 hours is a unit of packed red blood cells - not platelets. Choices A, B, and C are incorrect. Platelets are pooled from as many as ten donors, and ABO compatibility is not required. Very few red blood cells are present in a platelet transfusion, thus, decreasing the risk of a hemolytic reaction. The nurse should obtain pre-transfusion vital signs, but weight is not necessary. Platelets are infused over 15-30 minutes.+ Additional Info Platelets are indicated for severe thrombocytopenia, typically when the platelet count is less than 25,000. ✓ The nurse will need to verify consent before transfusion and verify the blood product with another nurse before initiation. ✓ Platelets are infused over 15-30 minutes. Following the transfusion, the nurse should obtain post-transfusion vital signs. ✓ Platelets are not required to be ABO compatible; while compatibility is preferred, this is not always available. ✓ Clinically significant hemolytic transfusion reactions secondary to transfusion of ABO-incompatible platelet products (e.g., group O platelets given to group A client) are uncommon, but they do occur.

The nurse prepares to suction a tracheostomy tube to help clear a patient's secretions. After opening the package, filling the cup with sterile water, and putting on sterile gloves, the nurse uses one hand to connect the catheter to the suction. What action would be most appropriate for the nurse to take next? Correct Answer(s): A A. Use the contaminated hand to preoxygenate the patient prior to suction. B. Use the sterile hand to slowly insert the catheter while applying intermittent suction. C. Restart the procedure due to contamination after applying sterile gloves. D. Assess the patient's baseline oxygenation status. Explanation

Explanation Choice A is correct. Open suction of a tracheostomy tube requires an aseptic technique. After setting up a sterile field and applying sterile gloves, the nurse would designate one hand as contaminated and ensure the other remains sterile. The contaminated hand should be used to connect/disconnect the catheter tubing, use the resuscitation bag, and operate the suction control. If preoxygenation is indicated, the nurse would use the contaminated hand to administer it. Choice B is incorrect. The sterile hand would be the correct choice for advancing the catheter, but suction should never be applied during insertion. Intermittent suction would only be used while withdrawing the catheter. Choice C is incorrect. The nurse has performed the procedure steps correctly so far and has not taken any action that would compromise the sterile field or require re-starting the procedure. Choice D is incorrect. The nurse should assess the patient's oxygenation status prior to setting up the sterile field and starting the procedure to use as a baseline for monitoring the patient's response to the procedure.

The nurse is teaching a parent of a 7-month-old client about food choices that may be introduced into the diet. The nurse should recommend which dietary item? Correct A. cows milk [22%] B. apple juice [32%] C. soy-based yogurt [45%] D. flavored sports drinks [0%]

Explanation Choice C is correct. Soy-based yogurt is permitted as it does not contain added sugars and will not cause intestinal complications, unlike cow's milk products. Choice A is incorrect. Cow's milk is prohibited until 12 months because it may put the infant at risk for intestinal and renal complications because of the dense amount of protein, sodium, and potassium. It also lacks essential nutrients like iron, vitamin E, and some fats that are crucial for an infant's growth and development. Choice B is incorrect. Fruit juices like apple juice should be limited in the diet of young children due to their high sugar content. Choice D is incorrect. Flavored sports drinks are not appropriate for infants or young children due to their sugar and electrolyte content. Additional Info Infant nutritional considerations include - ✓ No honey until 12 months because of the risk of botulism ✓ No cow's milk until 12 months because of the risk of intestinal and renal impairment ✓ Children younger than 24 months should not consume foods with added sugars which include sports drinks and soda ✓ Juice should be avoided until 12 months

The primary healthcare provider (PHCP) is preparing to intubate a client. The PHCP prescribes succinylcholine. The nurse understands that this medication is intended to Correct A. sedate the client during the procedure. [20%] B. decrease oral and airway secretions. [33%] C. increase heart rate in case of a vagal response. [3%] D. cause skeletal muscle paralysis.

Explanation Choice D is correct. Skeletal muscle paralysis is the intent of this medication. Succinylcholine is a neuromuscular blocking medication typically given immediately prior to intubation to assist with the procedure. Choices A, B, and C are incorrect. Sedation does not occur with succinylcholine as it causes paralysis. This medication may be used adjunctively with sedatives for a client receiving mechanical ventilation. This medication has an anticholinergic effect but is not given to decrease oral and airway secretions or prevent a vagal response. A medication that may be used to accomplish both would be atropine. Additional Info The muscle paralysis induced by depolarizing NMBDs (e.g., succinylcholine) is sometimes preceded by muscle spasms, which may damage muscles. These muscle spasms cause the release of potassium which may lead to hyperkalemia. Prolonged exposure to this medication may lead to hyperkalemia, and this medication should not be used if the client already has hyperkalemia. Finally, this medication may cause malignant hyperthermia. If a client develops a significant fever, muscle rigidity, and tachycardia, immediate treatment must be implemented.

The nurse in the psychiatric unit notes that a client with paranoid schizophrenia is yelling and blocking the television. Other psychiatric clients around the yelling client are now becoming agitated. What is the most appropriate action for the nurse? A. Restrain the client [2%] B. Escort the other clients from the room [29%] C. Administer haloperidol via intramuscular (IM) injection to the client causing a disruption [3%] D. Approach the client causing a disruption calmly while accompanied by two additional staff

Explanation Choice D is correct. The initial intervention is to approach the client calmly, attempt to de-escalate the situation, and remove this client from the room (preferably on the client's own accord). For the safety of staff and all other individuals in the room, staff members should never make face-to-face contact with an agitated psychiatric client without being accompanied by other trained healthcare personnel. Choice A is incorrect. The use of physical restraints for this client (or any client) is typically reserved as a final approach. The first nursing intervention should be an attempt by the nurse to verbally de-escalate the situation with the goal of ultimately removing the client from the room peacefully. Choice B is incorrect. Unless the situation escalates to the point where the other clients are placed in physical danger, the nurse should try to avoid removing the other clients from the room, as these clients are not the individuals causing the issue at hand. The primary goal for the nurse in this situation should be to remove the disruptive client from the room. Choice C is incorrect. Although an intramuscular (IM) injection of haloperidol may be indicated at some point, this is not the most appropriate action for the nurse at this time. First, even if the client has an existing PRN order for this medication, accessing and preparing the medication will take time. Second, the client is currently agitated. Attempting to physically restrain the client to provide the client with an IM haloperidol injection will not only increase the client's agitation, but significantly jeopardize the nurse and other staff members' safety. Third, an IM injection of haloperidol does not work instantaneously, as the medication's onset of action is approximately 15 minutes. Therefore, before resorting to an IM injection of haloperidol, the nurse should exhaust all other less invasive options. Learning Objective When caring for a client with paranoid schizophrenia who is yelling and blocking the television in a room full of other psychiatric clients, identify that the most appropriate nursing action is to approach the disruptive client calmly while accompanied by two additional staff members. Additional Info

13-year-old male arrived from the primary healthcare provider's office and was admitted with right lower lobe pneumonia. The client has a medical history of cystic fibrosis, diabetes mellitus, and failure to thrive. The mother and father are present, helping the client settle into the room. On assessment, the client is alert and oriented to person, place, and time. The client endorses pain 5/10 on the numerical pain scale as he coughs. The client's skin is very dry, and the color is pale with blue-tinged nail beds. Capillary refill is less than 3 seconds. Lung sounds are clear on the left, and audible rhonchi and wheezes on the right—labored respirations. The client appears in moderate distress and underweight. Vital signs T 101.1° F (38.4° C), P 92, RR 26, BP 114/74. Physician notified for admission orders. The nurse notifies the admitting physician for orders and prescriptions Select the anticipated orders and prescriptions from each of the following categories

Explanation Laboratory: The client should be ordered a sputum sample and blood cultures. These will need to be obtained before initiating the prescribed antibiotic. The client's pneumonia is concerning because it may spread to the bloodstream, giving the client bacteremia. A CBC is recommended to determine if the client has any blood dyscrasias. A serum type and screen are irrelevant to the care of a client with pneumonia. While the client is pale and has dry skin, this is likely due to the current febrile illness, not anemia. Medications: The client is diagnosed with pneumonia, and azithromycin is an effective antibiotic because it has superior lung penetration. This is a highly reasonable order to obtain. Pancrelipase before meals is a common medication for a client with cystic fibrosis because it allows the client to digest their food and lessens the steatorrhea. Considering the client was assessed as underweight and malnourished appearance, a multivitamin is reasonable. This is a common medication individuals with CF take home. Arformoterol via nebulizer is not indicated because this is a long-acting bronchodilator. The client requires a short-acting bronchodilator such as albuterol so they may get the maximum benefit sooner, not later. Other medications expected include prescribed corticosteroids and magnesium sulfate to relax the bronchioles. Diet: The diet for a client with CF is high-calorie, high-fat, high-sodium, and high-protein. Failure to thrive is a common complication associated with CF, and the diet is unrestricted so the client can increase the dietary macro and micronutrients they so desperately need. The client does not require a sodium-restricted diet because, in this condition, the client wastes sodium through their skin. Fluid restrictions would be contraindicated for a client who is febrile. Intravenous therapy: The nurse must start a vascular access device so the client can receive prescribed antibiotics and isotonic saline. The saline is necessary because of the client's dehydrated state. The fluids will also attenuate the client's fever. The client has a medical history of diabetes, likely caused by the CF. D5W would be unhelpful because it would raise serum glucose levels. The sali

serotonin syndrome

Explanation This client is experiencing serotonin syndrome (serotonin toxicity). Evidence supporting this is that the client is hyper-alert, experiencing diarrhea, diaphoretic, tachycardia, and has a significant fever. The cause of the serotonin syndrome is the client self-dosing the paroxetine, as reported by the husband. Additionally, the tramadol the client takes directly contributes to this toxicity. This, combined with the client increasing their paroxetine, is the likely etiology of the toxic serotonin levels. Malignant hyperthermia (MH) is a medical emergency induced by anesthesia. This client has not been exposed to any anesthetic agent. Succinylcholine is often the offending agent triggering MH. This client is not experiencing mania because nothing in their health history indicated a bipolar diagnosis. Individuals with mania are hyper-alert, expansive, and experience psychomotor agitation, but fever is not part of the clinical picture. Neuroleptic malignant syndrome (NMS) is immediately excluded because the trigger for NMS is an antipsychotic. This client is not taking an antipsychotic, as paroxetine is an SSRI. While certain clinical features of NMS and serotonin syndrome overlap (psychomotor agitation, fever, delirium), clients with serotonin syndrome have hyperreflexia and myoclonus. Clients with NMS feel like a lead pipe because of the muscle rigidity they develop, along with hyporeflexia. The nurse must implement seizure precautions because seizures may occur from CNS overstimulation. Setting limits is not necessary because this client is not manic; this is an appropriate intervention for a client with a cluster b personality disorder or acute mania. Dantrolene is ineffective for serotonin syndrome as this skeletal muscle relaxant is an effective treatment for MH. Dantrolene is ineffective in clients with severe temperature elevation not caused by skeletal muscle receptor abnormalities. The client needs aggressive dosing of prescribed parenteral benzodiazepines. The nurse was wise to establish a peripheral vascular access device because frequent dosing of diazepam (or lorazepam) is required. The client's cardiac rhythm and rate are concerning as she is significantly tachycardic. This is a key mo

Stage 5. Identity Vs. Role Confusion 12-18

Identity: If adolescents are supported in their exploration and given the freedom to explore different roles, they are likely to emerge from this stage with a strong sense of self and a feeling of independence and control. This process involves exploring their interests, values, and goals, which helps them form their own unique identity. Role Confusion: If adolescents are restricted and not given the space to explore or find the process too overwhelming or distressing, they may experience role confusion. This could mean being unsure about one's place in the world, values, and future direction. They may struggle to identify their purpose or path, leading to confusion about their personal identity.

1845 - Emergency ultrasound-guided abdominal paracentesis was performed because the client presented with labored respirations, dyspnea, abdominal cramping, and overall discomfort. Informed consent was obtained, and the client agreed to the procedure. Prior to the procedure, the client emptied their bladder. The site was cleaned and numbed with 1% lidocaine, and using an aseptic technique and an ultrasound; a 14-gauge catheter was inserted to remove 10 mL of clear ascitic fluid. Subsequently, the fluid was drained via tubing. 6 liters of fluid were removed. The client tolerated the procedure well and reported immediate relief in the dyspnea and abdominal cramping following the procedure.

Immediately following this procedure, the nurse should monitor the client's (blood pressure) because the client is at risk of (hypotension). If the client should experience this immediate post-procedure complication, the nurse should anticipate a prescription for (albumin) The client had six liters of fluid drained from their peritoneal cavity. This is a significant volume (any volume > 5 liters is considered a large abdominal paracentesis). The rapid fluid removal could cause a fluid shift; therefore, the nurse should be prepared to monitor the client for post-procedure hypotension. This hypotension can be treated by infusing prescribed albumin, a colloid. This colloid will restore intravascular fluid volume, which shifted during the procedure. Infection is a concern associated with the procedure. However, it would not be an immediate post-procedure complication. The client emptied their bladder before this procedure, significantly decreasing the likelihood of bladder trauma. Additional Info Abdominal paracentesis is performed for clients with gross ascitic fluid due to liver cirrhosis. Nursing care for an abdominal paracentesis includes - ➢ Witnessing informed consent that the primary healthcare provider obtains ➢ Assisting the client to void before the procedure ➢ Obtaining baseline vital signs ➢ Measure the abdominal girth ➢ Gather appropriate supplies (suction, tubing, paracentesis kit) ➢ Position the client per the physician's prescription. The positioning is likely upright to allow the fluid to settle in the lower abdominal quadrants. ➢ Monitor the client and the drainage ➢ Send the initial ascitic fluid to the lab for culture and sensitivity, as prescribed ➢ Reposition the client, as needed to facilitate better drainage ➢ Monitor the client's vital signs throughout and after the procedure ➢ Administer an infusion of albumin, as prescribed for large volume (> 5 liters) paracentesis

The nurse cares for a client at 30 weeks gestation at risk of delivering preterm. Which of the following medication would the nurse anticipate the primary healthcare provider (PHCP) to prescribe? A. Penicillin G [] B. Nifedipine [] C. Oxytocin [] D. Misoprostol

Nifedipine is a calcium channel blocker indicated as a tocolytic in preterm labor. This medication relaxes smooth muscle and reduces uterine contractions. ✓ Nifedipine is a tocolytic agent indicated for the prevention of preterm labor. ✓ This medication is given orally and has very few adverse fetal effects. ✓ Maternal blood pressure should be monitored before and after this therapy because of the risk of maternal hypotension. ✓Considering this medication may cause dizziness, the client should be advised to change positions slowly.

Primary prevention: Intervening before health effects occur Secondary prevention: Screening to identify diseases in the earliest Tertiary prevention: Managing disease post diagnosis to slow or stop

Primary prevention: Intervening before health effects occur Secondary prevention: Screening to identify diseases in the earliest Tertiary prevention: Managing disease post diagnosis to slow or stop

Dumping syndrome

The client should be instructed to consume high-fiber foods to prevent late dumping syndrome. Late dumping syndrome occurs one to three hours after eating. This occurs because carbohydrates' rapid movement into the intestine stimulates insulin production to maintain normoglycemia. However, the rapid movement causes the blood glucose to drop, giving the client hunger, fatigue, tremors, and hypoglycemia. Consuming high-fiber foods slows the digestive process, giving the client a feeling of satiety much longer. A staple in the teaching plan for a client experiencing dumping syndrome is for them to eat five to six small meals a day to avoid overloading the stomach. This prevents significant spikes in blood glucose and subsequent hypoglycemia. The client is instructed to lie down for about 15 minutes following eating to slow peristalsis to prevent dumping syndrome. Simple carbohydrates (cookies, candy, juice) contain a large amount of concentrated sugars, aggravating dumping syndrome. These foods should be avoided. Client Education for Dumping Syndrome ✓ Avoid foods high in simple carbohydrates (candy, cookies, cakes, fruit juices, sweetened drinks, ice cream, canned fruits in heavy syrup, sugar alcohol). ✓ Eat protein with each meal and snack (eggs, cheese, meats, fish, poultry, legumes, low-fat milk). ✓ Avoid drinking liquids with meals. Instead, drink 30 to 45 minutes before and 1 hour after the meal. ✓ Limit the use of caffeine, tea, and alcohol. These beverages can stimulate gastric motility. Discuss the appropriate intake of alcohol with your healthcare provider. ✓ Eat five to six small meals daily to avoid overloading the stomach. ✓ Lie down for about 15 minutes after eating to help slow gastric emptying. ✓ Avoid very hot or very cold foods and liquids; they can increase the severity of DS. ✓ Choose high-fiber foods to decrease the risk of late dumping

The nurse is caring for a client with a migraine headache. Which assessment findings should the nurse expect? Select all that apply. -unilateral frontotemporal pain X -drowsiness X -phonophobia X -shuffling gait -dysphagia -Vomiting X

The most common manifestations associated with an acute migraine headache include Unilateral frontotemporal pain that may be described as throbbing or dull Sensitivity to light (photophobia) and sound (phonophobia) Nausea and/or vomiting Altered mentation (drowsiness) Dizziness, numbness, and tingling sensations Choices D and E are incorrect. An acute migraine headache (MH) would not produce symptoms such as a shuffling gait. This clinical feature would be linked to Parkinson's disease. Dysphagia is not a manifestation associated with an MH. Additional Info Migraine headaches have a complex pathophysiology that is not entirely understood. The current thought process regarding this syndrome is that it is caused by a combination of neuronal hyperexcitability and vascular, genetic, hormonal, and environmental factors. During an acute migraine headache, often the client may feel as though they are experiencing a stroke because of transient facial paralysis and/or numbness that may be experienced.