Unit 4 NUR 1213

A client with the diagnosis of breast cancer is scheduled to receive radiation therapy to the affected area. The nurse teaches the client about how to care for the area that will be irradiated. Which client statement indicates the nurse needs to follow up?

"I will use an oatmeal based lotion" While undergoing radiation therapy, lotions, powders, and ointments should not be applied to the area.

A client with human immunodeficiency virus (HIV) infection is diagnosed with tuberculosis. Before starting antitubercular pharmacotherapy, what essential test results should the nurse review?

Liver function studies. Antitubercular drugs, such as isoniazid (INH) and rifampin (RIF), are hepatotoxic; liver function should be assessed before initiation of pharmacologic therapy.

Lindane

Medication used to treat scabies

Which dermatologic problem is treated by using intralesional corticosteroids?

Psoriasis

RBCs in the urine indicate

Pyelonephritis, kidney trauma, or acute tubular necrosis

Use of alpha-adrenergic blockers for BPH

Relax the muscles around the prostate

A nurse administers carbidopa-levodopa to a client with Parkinson disease. Which therapeutic effect does the nurse expect the medication to produce?

Replacement of a neurotransmitter in the brain

Function of the prostate gland

Secretes fluid that mixes with the sperm to make semen

How to prevent DVT during CBI:

Sequential compression stockings, low dose of heparin, discourage sitting for prolonged periods

Bucks traction

Skin traction used for the hip, knee and femur. Immobilize, position, and align.

Compartment syndrome

Swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissue. Profusion is disrupted and is an emergency.

To get a patients true urinary output during CBI..

Take the output and subtract that from the total amount of fluids given through IV that day

Which drug may cause tooth and bone anomalies as a teratogenic effect?

Tetracycline causes tooth and bone anomalies in fetuses when it is given to the mother during pregnancy.

What does the presence of ketones in the urine of a client with renal dysfunction indicate?

The body of a client with anorexia nervosa produces ketones as an alternate source of fuel for muscles and organs.

Which physiologic characteristics of newborns affect drug dosage considerations?

The body temperature of newborns is less regulated and dehydration occurs easily. Metabolism and excretion are impaired in pediatric clients due to an immature liver and kidneys. The lungs in pediatric clients have weak mucous barriers.

Shear

The force produced when adjacent surfaces slide across one another.

Friction

The force resulting from repeated movement of the skin over surfaces

Vancomycin

A bacterial antibiotic used against resistant strains of streptococcus and staphylococcus

Flushing of the face and sensation of warmth

A client is to have a computed tomography (CT) scan with contrast to assess a potential brain tumor. The nurse should teach the client about which common expected responses to the contrast material? Select all that apply.

Displaced fracture

A fracture in which bone fragments are separated from one another and not in anatomic alignment

Patch testing

A method used to identify a patient's sensitivity to contact materials (e.g., soaps, pollens, dyes).

Parkinson's disease

A neurologic disorder associated with a loss of dopamine production in the brain

Nondisplaced fracture

A simple crack in the bone that has not caused the bone to move from its normal anatomic position; also called a hairline fracture.

Transuretheral resection of the prostate (TURP)

A surgical approach for BPH that uses an instrument inserted through the urethera and is used to remove some of the prostate tissue to relieve pressure so that the patient can void more normally

Mifepristone

A woman in the first trimester of pregnancy wants to terminate her pregnancy due to malformations in her fetus. Which oxytocic drug should be administered to the client?

On the first postoperative day following a thyroidectomy, a client tolerates a full-fluid diet. This is changed to a soft diet on the second postoperative day. The client reports a sore throat when swallowing. What should the nurse do first?

Administer analgesics nefore meals. Soreness is to be expected. A progression to a soft diet will provide nutrients needed for healing and energy and will stimulate the return of bowel activity.

Cefotaxime

Bacterial actibiotic used to treat joint infections, pelvic inflammatory disease, meningitis, pneumonia, urinary tract infections, sepsis, gonorrhea, and cellulitis. It may also be used to prevent infection from certain surgeries.

B&O Suppository

Belladonna & Opium suppository treatment of moderate to severe pain from bladder or rectal spasms as used in response to TURP treatment for BPH

Benign neoplasm

Capable of mytosis but not capable of metastasis

What should the nurse include when teaching a client with severe Parkinson disease about carbidopa-levodopa?

Carbidopa-levodopa should be taken with meals to reduce the nausea and vomiting that commonly are caused by this drug.

A client with a high cholesterol level says to the nurse, "Why can't the doctor just give me a medication to eliminate all the cholesterol in my body so it isn't a problem?" Which factor related to why cholesterol is important in the human body should the nurse include in a response to the client's question?

Cellular membranes.

Redness, pain and minimal edema

Clinical manifestations of a first degree burn

Dry, leathery eschar and absence of pain

Clinical manifestations of a fourth degree burn

Severe pain, moist blebs and blisters

Clinical manifestations of a second degree burn

Waxy white, dark brown in appearrance

Clinical manifestations of a third degree brun

Joint pain with deformaties

Clinical manifestations of acromegaly

Slough

Collection of dead cells that have some moisture that doesn't go away with irrigation

Use of 5 alpha-reductase inhibitors for BPH

Decrease prostate size and allows for shrinkage by interfering with a hormone

A client is receiving whole-body radiation for Hodgkin disease. Which side effect should the nurse expect as a result of this therapy?

Decreased number of erythrocytes. Depression of the bone marrow interferes with hemopoiesis, resulting in anemia.

What is the etiology for the development of pressure ulcers in an 80-year-old client?

Decreased subcutaneous fat. In older adults, a decrease in subcutaneous fat leads to skin shearing, which may lead to pressure ulcers.

Venous thromboembolism

Deep vein thrombosis and pulmonary embolism

Tertiary wound healing

Delayed suturing of a wound in which two layers of granulation issue are sutured together. Done when a contaminated wound is left open and sutured closed after the infection is under control

The nurse is caring for a client who is prescribed desmopressin acetate. What is the expected outcome in the client?

Desmopressin acetate is used for the treatment of diabetes insipidus, a disease associated with urine output of more than 4 L/day. The amount of urine output should decrease when the client is treated with desmopressin acetate

Which drug taken by a pregnant woman shows a delayed teratogenic effect in the offspring, making the effect difficult to identify?

Diethylstilbestrol may cause vaginal cancer in a female child 18 or more years after birth.

Eschar

Dry, necrotic tissue

Undermining

Edges of wound that are unattached to wound bed around circumference of open area

Remodeling

Excess bone tissue is reabsorbed in the final stage of bone healing

Tunneling

Extension of wound below skin surface, in one or more areas

mixed pain syndromes

Fibromyalgia and some low back and myofascial pain

Wood's lamp

Filtered black light that is used to illuminate skin disorders, fungi, bacterial disorders, and pigmentation.

Most common drug given for BPH

Finasteride (Proscar)

A client was admitted with a burn injury caused by a quick heat flash. The nurse examined the skin and noticed erythema and mild swelling. What type of burn does the nurse suspect?

First-degree burn.

Continuous Bladder Irrigation (CBI)

For patients following a TURP to keep area patent

Which hormone synthesis does the nurse state is inhibited by hypokalemia?

Aldosterone

Streptomycin

Anti-biotic used for bacterial infections like tubuercolisis, mycobacterium avium complex, endocarditis, brucellosis, Burkholderia infection, plague, tularemia, and rat bite fever.

Meropenem

Anti-biotic used to treat bacterial infections like meningitis, intra-abdominal infection, pneumonia, sepsis, and anthrax

Which points should be included when counseling a woman who is on hormonal therapy?

Appropriate sun protection should be used because hormones make people sensitive to sunlight. The client's body weight should be monitored during hormonal therapy because abnormal bleeding can lead to weight loss and serious complications. Oral drugs should be administered at the same time every day to maintain the appropriate concentration of serum drug levels.

Timed Get Up and Go Test

Assesses mobility, balance, walking ability, and fall risk in adults. Start in chair, stand up, walk ten feet/3 meters, turn around, walk back, sit down. Must complete in 10 seconds or less. Over 20 seconds to complete may be at increased risk for falling. 30 seconds to complete are at high risk. (assistive devices allowed)

When helping a client with Parkinson disease to ambulate, what instructions should the nurse give the client?

Avoid leaning forward. The client with Parkinson disease often has a stooped posture because of the tendency of the head and neck to be drawn down; this shift away from the center of gravity causes instability.

While reviewing the urinalysis reports of an elderly client, the nurse finds white blood cells (WBCs) in the urine. Which condition might the client have?

Kidney or urinary tract infection

Proper diet for wound healing

High in protein, carbohydrates, and vitamins with moderate fat intake

A primary healthcare provider is treating the red-color wound of a client caused by pressure ulcers. Which dressings are beneficial for wound recovery?

Hydrocolloid dressings, transparent film dressings, and telfa dressings with antibiotic ointment are beneficial for the healing of a red wound caused by pressure ulcers

A client with diabetes who is receiving long-term corticosteroid therapy is admitted to the hospital with leg ulcers. What increased risk does the nurse consider when assessing this client?

Inadequate wound healing. Because the antiinflammatory response is depressed as a result of increased cortisol levels, the wounds of clients receiving long-term corticosteroid therapy tend to heal slowly

A nurse is caring for a client with a diagnosis of benign prostatic hyperplasia (BPH). Which information about this condition is important for the nurse to consider when caring for this client?

It predisposes to hydronephrosis. Inability to empty the bladder as a result of pressure exerted by the enlarging prostate on the urethra causes a backup of urine into the ureters and finally the kidneys (hydronephrosis).

The laboratory report of a pregnant client shows increased adrenocorticotropic hormone, salivary cortisol, and blood glucose levels. What should the primary healthcare provider instruct the nurse to include in the plan of care for the client to help to reduce the risk of death in the client?

Monitoring weight. The increased adrenocorticotropic hormone, salivary cortisol, and blood glucose levels indicate pituitary Cushing's syndrome. In pituitary Cushing's syndrome, prevention of fluid overload is very important as it can cause pulmonary edema, which may result in death. The easiest way to monitor fluid overload is monitoring the weight of the client. Each 1 lb (about 500 g) of weight gained is equal to 500 mL of retained water. The weight should be taken at the same time daily before breakfast using the same scale.

Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse assesses for which adverse responses that are associated with this medication?

Nausea and emotional changes

Callus formation

New bone is formed

Benign Prostatic Hyperplasia (BPH)

Non-cancerous enlargement of the prostate gland

Residual urine test

Obtaining a catheterized specimen after the patient has emptied the bladder by voiding, to determine the amount of urine remaining in the bladder; also known as a residual specimen. Residual urine may also be determined by ultrasound and bladder scan.

6 P's of compartment syndrome

Pain, pulselessness, paresthesia, pallor, paralysis, pressure

Colase and laxative purpose during CBI

To prevent patient from straining during bowel movements

What does the presence of casts in the urine of a client with renal dysfunction indicate?

Urinary calculi

Clinical manifestations of BPH

Urinary frequency, urinary urgency, hesitancy, incomplete bladder emptying, straining, decreased force of stream, dribbling

Virchow's triad

Venous stasis, blood hypercoagulability, endothelial damage

A client is admitted with severe burns, is obese, and has pre-existing respiratory problems. Which complication should the nurse anticipate?

Venous thromboembolism

A client with Hodgkin disease is to receive the cyclic antineoplastic vincristine as part of a therapy protocol. The client asks how this medication works. What mechanism of action does the nurse consider when responding to the client's question?

Vincristine is a plant alkaloid that is cell-cycle specific. It affects cell division during metaphase by interfering with spindle formation and causing cell death.

peripheral neurologic assessment

sensation, motor function, pain

Drug absorption, renal drug excretion, protein binding of drugs, and hepatic drug metabolism

What are the pharmacokinetic reasons for drug sensitivity in infants? Select all that apply.

secondary intention wound healing

Wounds that occur from trauma, injury, and infection have large amounts of exudate, and wide irregular wound margins with extensive tissue loss. May have edges that cannot be apporximated

Methemoglobinemia

a blood disorder in which an abnormal amount of methemoglobin, a form of hemoglobin, is produced

Thrombocytopenia

a condition in which there is an abnormally small number of platelets circulating in the blood

parasthesia

abnormal sensation such as numbness and tingling

Performance-Oriented Mobility Assessment

aids in the identification of gait and balance impairments

Things to avoid that would make BPH worse

alcohol, caffeine and antihistamines

arthroscopy

allows direct visualization of the interior of a joint through an endoscope

A nurse is reviewing the clinical record of a client with a diagnosis of benign prostatic hyperplasia (BPH). Which test result will the nurse check to confirm the diagnosis?

Biopsy of prostatic tissue. A definitive diagnosis of the cellular changes associated with benign prostatic hyperplasia [1] [2] (BPH) is made by biopsy, with subsequent microscopic evaluation.

Fracture hematoma

Blood clot that forms at the site of a broken bone

A 4-year-old child is admitted to the pediatric unit with the diagnosis of acute lymphocytic leukemia (ALL). A blood transfusion is ordered, and an intravenous line is started. What will the nurse do in regard to administering the transfusion?

Blood should be administered within 4 hours; the risk for bacterial proliferation increases over time and exposure to room temperature.

What yearly screenings are recommended for early detection of BPH?

Digital rectal exam and blood test for prostate-specific antigen

Malignant neoplasm

Disease of the cell characterized by abnormal function, growth and dissemination of affected cells

Consolidation

Distance between bone fragments diminishes and eventually closes

A client who has been diagnosed with acute lymphocytic leukemia will be receiving doxorubicin infusions as part of a chemotherapy regimen. The nurse monitors the client for signs and symptoms of doxorubicin toxicity. What clinical finding indicates that toxicity has occurred?

Doxorubicin is cardiotoxic, which is manifested by transient ECG abnormalities. Cardiac rhythm abnormalities are to be expected.

Muromonab-CD3

Drug used for lessening transplant rejection. Prolonged administration may lead to aseptic meningitis.

Antithymocyte Globulin (rabbit)

Drug used for reducing transplant rejection. Prolonged administration may cause thrombocytopenia and leukopenia.

Cyclosporine

Drug used to prevent transplant rejction. Prolonged administration may cause nephrotoxicity.

Sirolimus

Drug used to prevent transplant rejection. Prolonged administration may cause thrombocytopenia and hypercholesterolemia.

Which teratogenic effect is seen due to lithium?

Ebstein anomaly (heart defect in which the right atrium doesn't work properly)

Colle's fracture

Fracture of the distal radius at the wrist

Fat embolism

Freely floating fat globule in the blood stream, which can obstruct blood circulation to vital organs (e.g., heart, brain). Usually caused by injury to subcutaneous tissue or a bone fracture that allows fat release.

Crepitus

Frequent, audible crackling sound with palpable grating that accompanies movement

Unstageable ulcer

Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

Sign of tertiary syphilis

Gummas on the skin

A client suspected of having a hyperactive thyroid is scheduled for protein-bound iodine, T 3, and T 4 laboratory tests. What should the nurse ask the client to ensure accuracy of the test?

Had recent x-rays using radiopaque dye. Many radiopaque dyes contain iodine, which will alter the protein-bound iodine test results.

Stridor

Harsh, high-pitched sound usually produced on inspiration because of airway obstruction.

6 P's for fracture assessment

Pain, pulses, pallor, parasthesia, paralysis and pressure

A client with a parotid tumor that involves the lymph glands in the neck is prescribed vincristine, cyclophosphamide, and prednisone. The nurse should monitor the client for what adverse effect?

Peripheral parasthesia. It is an indication of toxicity from a plant alkaloid such as vincristine.

A 90-year-old resident of a nursing home falls and fractures the proximal end of the right femur. The surgeon plans to reduce the fracture with an internal fixation device. What general fact about the older adult should the nurse consider when caring for this client?

Physiologic coping defenses are reduced.

Which condition results in elevated serum adrenocorticotropic hormone (ACTH) and urine cortisol levels?

Pituitary Cushing's syndrome

While reviewing a client's laboratory reports, the nurse finds a neutrophil count of 12,000/mm 3. Which condition may be present in this client?

Pneumonia

A client on immunosuppressive therapy is diagnosed with a peptic ulcer. Which medication might have led to this condition?

Prednisone. Prednisone is a corticosteroid that suppresses inflammatory responses. A side effect of prednisone is the development of peptic ulcers.

Which monoamine oxidase inhibitor is used to treat Parkinson disease?

Selegiline

6 categories of Braden Scale

Sensory perception, moisture, activity, mobility, nutrition, friction and shear

Venous thrombosis

The formation of blood clots within a vein

Most common pressure ulcer sites

The heel and the sacrum

Os-cal

The medical history of a client with osteoporosis indicates renal calculi. Which medication would be contraindicated?

arthrography

Visualization of a joint by injection of a radiopaque substance intp the joint cavity, alowing for the evaluation of bones, cartilage, and ligaments (knee and shoulder)

A client is being treated for pressure ulcers. The primary healthcare provider advises the client to eat foods with high amounts of vitamin C. What is the role of vitamin C in wound healing?

Vitamin C is required for collagen production by fibroblasts.

bisphosphonates

antiresponsive agents that slow or stop the reabsorption of calcium from the bone, resulting in maintained or increased bone density and strength (osteoporosis)

visceral pain

arises from within the body cavity, most commonly the thorax, abdomen, and pelvis. Respond to stretching, swelling, and oxygen deprovation, and the pain may radiate to other locations in the ack or chest

peripheral vascular assessment

color, temperature, capillary refill, peripheral pulses, edema

bone mineral density

diagnostic test used to determine the core mineral content and the density of bone (osteoporosis and osteopenia)

Signs and symptoms of fat embolism syndrome (FES)

dyspnea, chest pain, temperature elevation

bone scan

evaluates the bone uptake of a radionuclide material; the uptake is related to the metabolism of the bone (metastatic cancer in the bone)

electromyography

evalutation of electrical activity generated within the muscle

Leukocytosis

increase in the number of white blood cells

somatic pain

sharp pain that is well localized to a specific area or injury

Greenville Early Mobility Scale

used in inpatient settings to track the status and progress of a patients mobility

Primary intention wound healing

wounds that heal under conditions of minimal tissue loss

A client with multiple fractures is admitted to the hospital. What is a nurse in the proficient stage expected to do in this situation?

Coordinate with all the appropriate members of the healthcare team when providing client care. A nurse who has reached the proficient stage is able to assess an entire situation and transfer knowledge gained from multiple past experiences

Shearing force

Pressure exerted on the skin when it adheres to the bed and the skin layers slide in the direction of body movement

Ossification

Prevents movement of fracture site when bones are stressed

Octreotide

Primary medication for acromegaly

Granulation tissue

Produces the basis for new bone substance

The healthcare provider prescribes finasteride for a client with benign prostatic hyperplasia. What information does the nurse provide to the client?

Protection should be worn during intercourse with a pregnant female. Contact with the semen of a client taking finasteride can adversely affect a developing male fetus in a pregnant woman.

Signs and symptoms of compartment syndrome

excessive pain, pain with passive stretch of the affected extremity muscles, pallor, paresthesia, with late signs of paralysis and pulselessness

Immunomodulators

function to waeken or modulate the activity of the immune system, therby decreasing the inflammatory response

polycythemia vera

general increase in red blood cells (erythremia)

Symptoms of BPH (benign prostatic hyperplasia)

hesitancy, intermittent voiding, urgency, nocturia, post-void leakage, difficulty voiding

computed tomography (CT) scan

identifies soft tissue and bony abnormalities and evaluated muscuskeletal trauma

Primary nursing concern for patient with fractures

neurovascular assessment distal to the fracture site

Which part of the reproductive system secretes androgens in female clients?

The ovaries and adrenal glands

muscle relaxants

provide relief by eliminating muscle spasms

RICE

rest, ice, compression, elevation

Band Neutrophils

new neutrophils..left shift..signals an immune response to produce more WBCs to fight infection

dual energy x-ray absorptiometry

noninvasive x-ray procedure that measures bone density

Nociceptive pain

normal funcitoning of the somatosensory system in response to noxious stimuli (tissue injury) that is perceived as being painful (sunburn, surgery, trauma). may feel like an ache, throbbing, or cramping.

Myelogram

radiographic study of the spinal cord and nerve root using contrast dye (back pain)

neuropathic pain

results from a pathology or disease of the somatosensory system. Examples are postherpetic neuralgia, diabetic neuropathy, phantom pain, complex regional pain syndrome.