AH2 final review

A client is instructed to avoid straining on defecation post operatively. The nurse evaluate that the related teaching is understood when the client states, "I must increase my intake of:

Green leafy vegetables. Green leafy vegetables contain fiber which promotes defecation.

The RN who usually works on the pediatric unit is floated to the G.I. medical surgical unit. Which patient is appropriate for the charge nurse to assign to this new float nurse?

The 20-year-old with anorexia nervosa receiving TPN through a central venous line. A pediatric nurse would be familiar with pathophysiology and collaborative treatment for a patient with anorexia nervosa

The nurse on a med unit has received the morning shift report. Which client should the nurse assess first?

The client who is receiving their initial dose of the intravenous antibiotic vancomycin at 0645.

Which patient on a medical surgical unit does the nurse assigned to the LPN/LVN ?

A 39-year-old with a jejunal feeding tube who needs elemental feeding administered

All of these patients are being cared for by intensive care step down unit. Which client should the nurse assigned to an RN who has floated from pediatric unit?

A patient with acute asthma episode who is receiving oxygen of 60% by non-rebreather mask. Because Asthma is a common pediatric diagnosis, the pediatric nurse would be familiar with the assessment and care needed for a patient with this diagnosis.

Which statement describing the administration of an enteral nutrition using the bolus feeding that that is accurate

A specific amount of enteral product is fed intermittently every four hours. There are three methods of tube feeding administration. Always feeding is the intermittent feeding of a specific amount of intro product typically administered every four hours. This is done either manually or by infusion through a mechanical pump or controller device. And continuous feeding, a small amount are infuse continuously over a specific time, similar to intravenous therapy. Cyclic feeding is similar to continuous feeding except that infusion feeding is stopped for about six hours in a 24 hour period. The downtime is allowed for bathing, treatments, and other activities.

Goals for safety in the OR include universal protocol. What is included in this protocol?

A surgical time out is performed just before the procedure is started to verify patient identity, surgical procedure, and surgical site.

A male client who has had reoccurring Renal caliculi has a ureterolithotomy. Before discharge the nurse discusses the need to avoid urinary tract infections or UTIs. The nurse evaluates that the signs and symptoms of infection or understood when the client says he will report:

A: Urgency or frequency of urination. These occur with a urinary track infection because of bladder irritability; burning on urination and fever are additional signs of a UTI.

The nurse working in a hospital emergency department is assigned to care for the following for clients. Which client does the nurse attend to first?

A: a client with an erection for 10 hours is reporting severe pain. The client who has an erection for 10 hours has symptoms of priapism,which is considered a urological emergency because the circulation to the penis may be compromised and the client may not be able to void with an erect penis. The client with a swollen painful scrotum; the client with a hematuria; and the client with a history of benign prostate hyperplasia do not require the nurses immediate attention since these are not medical emergencies.

A 42-year-old patient who has bacterial meningitis is Disoriented and anxious. Which best nursing action will be included in the plan of care?

A: a patient with meningitis and disorientation will be calmed by the presence of someone familiar at the bedside. Restraint should be avoided because they will increase agitation and anxiety. The patient requires frequent assessment for complications. The use of touch and a soothing voice will decrease anxiety for most patients. The patient will have photophobia, so light should be dimmed.

A nurse is caring for a client being treated for fat embolism after multiple fractures. Which data with the nurse evaluate as the most favorable indication of resolution of a fat embolus?

A: an altered mental state is an early indication of fat emboli; therefore, clear mentation is a good indicator that a fat embolus is resolving. Eupnea, not minimal dyspnea is not a normal sign. Arterial oxygen levels should be 80 to 100 MM HG. Oxygen saturation should be higher than 95%.

After a long leg cast is removed, the client should be instructed to:

A: elevate the leg. elevation will help control the Edema that usually occurs after an injury or if the injured part is left in a dependent position

Which action will The public health nurse take to reduce the incidence of epidemic encephalitis in a community?

A: epidemic of encephalitis is usually spread by mosquitoes and ticks. The use of insect repellent is effective in reducing risk. And cephalitis frequently requires that the patient be hospitalized in an ICU during the initial stages. Antibiotic prophylaxis is not used to prevent an cephalitis because the most encephalitis is viral. West Nile virus is most common in adults over age 50 during the summer and early fall.

A parent of a patient suffering from chronic inflammatory bowel disease informs the nurse, "my son has looose stool while he is sleeping. "The nurse teaches the parent the necessary steps to manage the child nocturnal stool leakage. Which statement made by the parent indicates a need for further teaching?

A: lactose containing foods such as milk and milk products maybe poorly tolerated and should be avoided because they can change the consistency of the stool and potential he cause leakage. Carbonated beverages should not be given to a patient with bowel disease because they are gastrointestinal irritants and stimulants that can cause discomfort. Food items such as cabbage and broccoli should be avoided because they cause a water and gas.

You are monitoring a student nurse in the ICU while caring for a client with meningococcal meningitis. Which action by the student requires that you intervene most rapidly?

A: meningococcal meningitis is spread through contact with respiratory secretions so the use of a mask and gown is required to prevent transmission of the infection to staff members or other clients. The other actions may not be appropriate but do not require interventions as rapidly the presence of family at the bedside may decrease the clients confusion and agitation. The client with hypothermia frequently report feeling chilled, but warming the client is not an appropriate intervention. Checking the pupils to light is an appropriate Intervention. And should be done every 30 minutes and is uncomfortable for a client with photophobia.

A nurse assesses a client with peritonitis. Which client manifestation should the nurse expect to find?

ABE: distended abdomen, inability to pass gas. A client with peritonitis may present with a distended abdomen diminish bowel sounds and an inability to pass gas or feces, tachycardia and decreased urine output secondary to dehydration. Bradycardia and hyperactive bowel sounds are not associate with peritonitis

Which factors should the nurse inquire about when taking the medical history of the client with suspected appendicitis?

Abdominal pain before nausea and vomiting. Abdominal pain followed by nausea and vomiting indicates appendicitis. Abdominal pain that increases with cough occurs in patients with peritonitis anorexia, not polyphagia, followed by nausea and vomiting indicate appendicitis. Abdominal pain before nausea and vomiting indicates gastroenteritis.

Hey patient has undergone an EGD procedure. which is priority nursing post procedure assessment for this patient?

Ability to swallow secretions. Patient should be monitored closely after EGD to determine whether the gag reflex is intact. This may be determined by their ability to swallow saliva without aspirating. Assessing the level of sedation, pain, and ability to tolerate clear fluids is not a priority.

A nurse cares for a client who is prescribed vancomycin 500 mg intravenous every six hours for MRSA. Which action should the nurse take?

Administer it over 60 minutes using an IV pump. Vancomycin is very irritating to the vans and can easily cause thrombophlebitis. This drug is given over 60 minutes; although it can Cause histamine release leading to red man syndrome, it is not customary to advise Benadryl before starting the infusion. Increasing oral intake is not specific to Vancomycin therapy.

When working with older adults to promote good nutrition, what actions by the nursery most appropriate?

Allow uninterrupted time for eating. Assess dentures for appropriate fit. Ensure the client has glasses on when eating. Serve high calorie, high-protein snacks. Older adults need unhurried an on interrupted time for eating. Dentures should fit properly and glasses, if used, should be on. High calorie, high-protein snacks are a good choice. Salty snacks are not recommended because all adults should limit sodium in their diets.

The home care nurse observes white patches on the oral mucosa other client with severe, chronic airflow limitation. What is the nurses best action?

Asked the client whether he or she uses a steroid in Hailer. Excessive use of steroid inhalers reduce his local immune function and increases the clients risk for oral pharyngeal infections, including candidiasis, Which manifests as white patches on the oral mucosa. The client should not brush the lesions, and salt water does not help the source. Recent illnesses would have no effect on these lesions.

A nurse is this is a client with a mechanical bowel obstruction who reports intermittent abdominal pain. And hour later the client reports constant abdominal pain. Which action should the nurse take next?

Assess the clients bowel sounds. A change in the nature and the timing of abdominal pain and a client with a bowel obstruction can signal peritonitis or perforation. The nurse should immediately check for rebound tenderness and the absence of bowel sounds. The nurse should not medicate the client until the provider has been notified of the change in his or her condition. The nurse may help the client to the knee just position for comfort, but this is not a priority action. The nurse does not need to insert an NG tube for decompression

A client with Asthma reports, "not being able to take deep breath's." The nurse auscultates decreased breath sounds in the bases, and no wheezes. What is the nurses best action?

Assess the clients oxygen saturation. Decreased rate wheezing accompanied by decreased breath sounds Accompanied by decreased breath sounds can mean airway occlusion from you guess and from inflammation. The nurse should assess the clients oxygenation and determine whether additional interventions are needed. Coughing forcefully make a smaller airways to collapse and may not help the client. Encouraging the client to remain calm and to try to take deep breath's is not helpful. Although providing documentation is important, the nurse needs to do more than that.

A patient who has undergone total knee Arthroplasty is under post operative care. The primary healthcare provider advise the patient to use continual passive motion or CPM machine. Which nursing action is most important during the use of a CPM machine?

Assessing the patient's response to the machine. This helps to know the effectiveness of the machine on the patients joint mobility after surgery. The machine is stored on the chair or table when not in use because storing the machine on the floor may damage it. The machine is turned off during meals because the patient cannot use the machine while eating. The controls of the machine should be kept out of reach of the patient if the patient is confused.

A 79-year-old client is admitted to the hospital with painful of abdominal spasms and severe diarrhea of today duration. The order for physical skills the nurse should follow when performing in admitting examination of this client should be inspection followed by

Auscultation, palpitations, percussion. Auscultation must be performed before palpitation and percussion because they may influence intestinal paralysis resulting in accurate results. Palpitation is perform before precaution because percussion will have a greater impact on peristalsis.

What is most important for the nurse to teach the client with allergic rhinitis and glaucoma?

Avoid allergy drugs containing pseudoephedrine or phenylephrine.

You are preparing to admit a client with a seizure disorder. Which priority action can you delegate to an LPN/LVN.

B. The LPN/LVN can set up the equipment for oxygen and suctioning. The RN should perform the complete initial assessment. Controversy exists as to whether padded side rails actually provide safety, and or use me in Barris the client and family. Tongue blades should not be used at the bedside and should never be inserted into the clients mouth after a seizure begins.

A 50-year-old patient is being discharged after a week of antibiotic therapy for acute osteomyelitis in the right leg. Which information will be included in discharge teaching?

B: The patient will be on IV antibiotics for several months and the patient will need to recognize signs of infection at the site and how to care for the catheter during daily activities such as bathing. IV any biotics rather than oral antibiotics are used for acute osteomyelitis. Patients are instructed to avoid exercise and heat application because these will increase swelling and the risk of spreading infection.

A client being measured for crutches asked the nurse why the crutches cannot rest up underneath an arm for extra support. The nurse response knowing that which would most likely result from this improper crutch measurement?

B: crutches are measured so that the tops are 2 to 3 finger with from the axilla. This ensures the clients actually are not resting on the crotch or bearing weight of the crutch, which could result in injury to the nerves of the brachial plexus.

A client enters the emergency department. The paramedic reports that the client has been having a seizure that has lasted for 45 minutes. In addition to securing and maintaining an airway, what is the priority intervention on the part of the nurse?

B: diazepam IV is the drug of choice for status epilepticus.

After surgery for creation of an ileostomy, a client is to be discharged. Before discharge, the primary nursing intervention is to:

B: evaluate the clients ability to care for the ileostomy. The clients feelings, knowledge, and skills concerning the ileostomy must to be assessed before discharge

A client has an above the knee amputation because of a gangrenous leg ulcer. To prevent hip flexion contractures after the second post operative day the nurse should:

B: lying in the prone position stretches the flexor muscle and prevents a flexion contracture of the hip.

The nurse instructs a patient who has osteosarcoma of the tibia about a schedule above the knee amputation. Which statement by the patient indicates that additional teaching is needed?

B: osteogenic sarcoma may be diagnosed following a fracture but is not caused by the injury. The other patient statements indicate that the patient teaching has been effective

The nurse is creating a plan of care for a patient in skin traction. On external traction The nurse should monitor for which priority finding in this client?

B: skin traction is achieved by ace wraps, boots, or slings that apply a direct force on the clients skin. Traction is maintained with 5 to 8 pounds of weight, and this type of traction can cause skin breakdown. Urinary incontinence is not related to the use of skin traction. Although constipation can occur as a result of your mobility and monitoring bowel sounds may be a component of the assessment, this intervention is not the priority assessment. There is no Pin sites with traction of the skin

A nurse cares for a client with an ileostomy. The client states, "I don't think my friends will except me with this ostomy." How should the nurse respond?

B: tell me more about your concerns. Social anxiety and apprehension are coming to clients with the new ostomy. The nurse should encourage the client to discuss concerns. The nurse should not minimize the clients concerns or provide false reassurance.

While a woman with a fractured femur is being prepared for surgery, she exhibits cyanosis, tachycardia, dyspnea, and restlessness. What intervention should the nurse do first?

B: the client probably has a fat embolism; oxygen reduction and surface tension of the fat lobules and reduces hypoxia.

A client with a new fracture reports pain in the side of the fracture. And opioid pain medication was administered 20 minutes ago. Which is the nurses best intervention?

The client with a new fracture likely has edema; elevating the extremity and applying ice probably will help in decreasing pain. Heat will increase Edema and may increase pain. Dependent position and will also increase Edema. Administration of an additional opioid within the dosage rain guidelines maybe ordered.

A patient has a long arm plaster cast applied for immobilization of a fractured left radius. Until the plaster cast has completely dried, the nurse should

B: until the plaster cast has dried, using the palms rather than the fingertips to handle the cast helps prevent creating protrusions inside the cast that could place the skin under pressure. Left arm should be elevated to prevent swelling. The edges of the cast maybe peddled once the cast is dry, but putting the edges before the cast is dry may cause the cast to be misshapen. The car should not be covered until it is dry because heat builds up during drying

What to assessment findings are changes secondary to chronic pulmonary obstruction disease?

Barrel chest and finger clubbing. With a barrel chest, the ratio between the anterior posterior diaphragm of the chest and it's Lateral diameter is 2:2, rather than the normal one: 1.5. This shape change Results from Long over inflation and diaphragm flattening. Finger clubbing is an indication of decreased arterial oxygen level seen and COPD. W

The client is waiting bariatric surgery in the morning. What action by the nurses most important?

Beginning Venus thromboembolism prophylaxis. Morbidly obese's clients are at high risk for Venus thromboembolism and should Be started on a regimen to prevent this from occurring as a priority.

A client has a fractured tibia and is asking the nurse about External fixation. What are some advantages for the X ternal fixation use for the immobilization of fractures?

Blood loss is less. The device allows early ambulation and exercise, maintains alignment, stabilizes the fracture site, and promotes healing. The device does place the client at risk for infection and does not increase the blood supply to tissues, nor does it visualize the ends of the bones.

The client was gastritis asked the nurse at a screening clinic about analgesics that will not cause epigastric distress. The nurse tells the client to take which of the following medications?

C: Tylenol. Aspirin is irritating to the Gastro intestinal track of the client with a history of gastritis. The client should be advised to take analgesics that do not contain aspirin, such as acetaminophen.

The earliest sign of Icp?

C: a decreased level of consciousness is the earliest signs of increased intracranial pressure.

The nurse is caring for a patient who has had abdominal distention and loose stools for three days due to gastroenteritis. The serum potassium is 3.0 MEq/L and blood pressure is 94/60 which treatment may be best for this client in the situation?

C: abdominal distention loose stool, and low serum potassium level of 3.0 Meq/L and blood pressure of 94/60 indicate that the patient has gastroenteritis. Oral rehydration or ORT, in the patient helps replenish fluid and electrolyte levels..sulfasalazine Is effective in the treatment of ulcerative colitis. Diphenoxylate hydrochloride reduce his Gastro intestinal motility, but it is used sparingly do too it's habit-forming ability.

A client has an open reduction and internal fixation for a fractured hip. Post operatively the nurse should position the clients affected extremity in:

C: abduction reduces stress on anatomical structures and maintains the head of the femur in the acetabulum

You are caring for a client with Carpal tunnel syndrome who has been admitted for surgery. Which intervention should you delegate to the UAP?

C: helping the client with ADLs is within the scope of practice for a UAP. Placing a splint for the first time is appropriate for the scope of practice for PT's. Assessing and testing for paresthesia are not within the scope of practice for you APs.

A nurse assesses a client who is hospitalized with an exacerbation of Crohn's disease. Which clinical manifestations should the nurse expect to find?

C: high-pitched, rushing bowel sounds in the right lower quadrant.

Which drug treatment helps to decrease ICP by expanding plasma and the osmotic affect to move fluid?

C: mannitol is an osmotic diuretic that expands plasma and causes fluid to move from tissues into the blood vessels. Hypertonic saline reduce his brain swelling by moving water out of brain tissue. Oxygen administration is done to maintain brain function. Pentobarbital and other barbiturates are used to reduce cerebral metabolism. Corticosteroid dexamethasone is used to treat basil genetic Edema to stabilize cell membranes and improve Nuro function by improving CBS and restoring auto regulation.

After a client has a seizure, which action can you delegate to a UAP?

C: measurement of vital signs is within the education and scope of practice of UAP's, the nurse should perform neurological checks and document the seizure. Clients was Seizures should not be restrained; however, the nurse may guide the clients movements if necessary.

A client has sustained a closed fracture and has just had a cast applied to the affected arm the client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers an analgesic, with a little relief. Which problem may be causing the pain?

C: most pain associated with fractures can be minimized with rest, elevation, application of cold, and administration of energy six. Pain that is not it relieved by these measures should be reported to a healthcare provider because pain and relieved by medications and other measures may indicate neurovascular compromise. Because this is a new closed fracture and cast, infection would not have had time to sit in. Intense pain after casting is normally not associated with anxiety or the recent occurrence of the injury. Treatment following the fracture should assist in relieving the pain associated With the injury.

A client is admitted for total hip replacement. Past medical history indicates diabetes type two, a heart attack five years ago, and allergies to sulfa drugs. The client currently takes insulin on a sliding scale and Celebrex. Before administering the clients medication, which action by the nurse is most appropriate?

Call the physician to clarify orders. Celebrex is a COX -2 two inhibitor. These drugs are thought to cause serious adverse reactions such as myocardial in fraction's and renal problems. This client already has coronary artery disease and a past myocardial in fraction, so the nurse should discuss the order with the patient and physician before giving the medication.

The patient is admitted to the hospital with possible bacterial meningitis. During the initial assessment, the nurse questions the patient about a recent history of what?

D,: meningitis is most often the result of an upper respiratory infection or a penetrating wound of the skull, where organisms gain entry to the CNS.

An intensive care unit RN is floated in a MedSurg unit. Which patient does the charge nurse assigned to a float nurse?

D: 36-year-old with peritonitis who just returned from surgery with multiple drains in place. The ICU nurse is familiar with the care of a patient with peritonitis, including monitoring for complications such as sepsis and kidney failure.

The nurse is caring for a client with a radius radius fraction across the shaft and bone splintered into fragments. Information about this type of fracture should be included by the nurse in the clients education?

D: a comminuted fracture Is a complete fracture across the shaft of a bone, with splintering of the bone into fragments. A simple fracture is a fracture of the bone across the entire shaft with some possible displacement but without breaking the skin. A greenstick fracture is an incomplete fracture, which occurs through part of the cross-section of a bone: one side of the bone is fractured, and the other side is bent. A compound fracture, also called an open or complex fracture, is one in which the skin or mucous membranes have been broken and the resulting wound extends to the depth of the fractured bone.

After prostate surgery a clients indwelling catheter and continuous bladder irrigation or CBI are To be removed. The nurse discusses the procedure with the client. The nurse evaluates that the teaching is understood when the client states, "after the catheter is removed I will probably:

D: experience some burning on urination". Because the trauma of the mucous membranes of the urinary tract, burning on urination is expected and will subside gradually.

A client with an above the knee amputation asks why the Residual limb needs to be wrapped with an elastic bandage. The nurse explains that it:

D: pressure supports the tissue, promotes venous return, and limits edema, that's promoting shrinkage of the distal part of the residual limb.

Building confidence in one's worth is important for a client who is scheduled for a below the knee amputation because an amputation:

D: the loss of a limb affects the Idealized self image because it is difficult to deny the body has not been altered

A client with emphysema is short of breath and using pursed lip breathing and accessory muscles of respiration. What does the nurse identify as the clients cause of dyspnea?

Difficulty and expelling the air trapped in the alveoli.

A client with new onset status epilepticus is prescribed phenytoin. After teaching a client about this treatment regimen , the nurse assesses the clients understanding. Which statement indicates that the client understands the teaching?

Discontinuing antiepileptic drugs can lead to the reoccurrence of seizures or status epilepticus. The client does not need to drink more water and can continue to work while taking this medication. The medications will not stop an aura before a seizure

A female client who is being treated for rheumatoid arthritis arrives in the outpatient clinic stating that she has no medical insurance and has not been taking the prescribed drug because it is too expensive. The client reports that the family has arranged to obtain the drug for Mexico. The nurse should;

Discuss the client alternative funding solutions for the medication

A client has received Diphenhydramine And is currently oriented but drowsy. What is the best action for the nurse to take?

Document the response and continue to monitor. The client is experiencing normal side effects of the medication. The nurse will continue to monitor for additive affects. Performing neurological assessment is not necessary, nor is administering epinephrine. There is no reason for the client to be stimulated hourly.

The client with long cancer is lying flat in bed and reports shortness of breath. What action does the nurse take first?

Elevate the head of the bed. The nurses first action should be to elevate the head of the bed. The next, assessing oxygen saturation will help the nurse determine if the clients status. If the oxygen is low, the nurse would increase oxygen flow and have the client to take deep breath's. The provider should be notified after the nearest performs the interventions.

What interventions does the nurse recommend for an older client who is to be discharged home following total hip replacement surgery?

Elevated toilet seat, walker. This client will be using a walker, because crutches are used only for younger clients. Ted hose should be worn until the patient regains for mobility and Coumadin is discontinued. Our Walker will be needed until the client regaines strength and is able to walk with full weight-bearing on the operative side. Crutches or not use because they do not provide enough support for the client during ambulation and pose a risk of falls. Heating pad to increase blood flow to the area and may increase pain. Ice pack should be used instead, as needed. Continuous passive motion machines are not used for hip therapy

The nurse is caring for a patient who has granular dark vomitus that resembles coffee grounds. Which type of ulcer does the nurse suspect this patient has?

Gastric. The vomitus of a patient with a gastric ulcer is more likely to resemble coffee grounds.

A client who has undergone preadmission testing has had blood drawn a series of laboratory studies, including a CBC, coagulation studies, and electrolytes as well as creatinine levels. Which laboratory results should be reported to the surgeons office by the nurse, knowing that it could cause surgery to be postponed?

Hemoglobin, 8.0. Routine screening test include CBC, serum electrolytes analysis, coagulation studies, and see him creatinine test. The complete blood count includes hemoglobin analysis. All these values are within normal range except the hemoglobin. If the client has low hemoglobin, the surgery is likely to be postponed by the surgeon.

A patient in the PACU has emergent Delirium manifested by agitation and thrashing. What should the nurse assess for first in this patient?

Hypoxemia

In teaching to patient about asthma medication the nurse reinforces the need to use long acting beta agonist or labor as directed. Which statement by the patient indicates a need for the teaching?

I may use my long acting beta agonist as needed for wheezing and coughing. Long-acting bronchodilator's take time to build up a therapeutic fact. They are used as a controller medication and should not be used as needed. They are given twice daily every day and are not used for treating acute asthma.

The client states that he is allergic to poison ivy. Which statement by the client indicates good understanding of this type of hypersensitivity?

I need to try to avoid coming into contact with poison ivy. Reactions to poison ivy are a type four hypersensitivity reaction. They are T cell mediated in the skin. Avoidance of the offending allergen is the most appropriate intervention.

The nurse is caring for a client who will be having surgery with spinal anesthesia. The client says to the nurse, "I change my mind I don't want to be awake during surgery!" What does the nurse do?

I will call the anesthesiologist to come and talk with you. The nurse should recognize the clients concern and pass them onto the anesthesiologist. The nurse should not try to convince the client or teach him or her at this time.

A client is going home after Endo scopic transnasal hypophysectomy. Which statement by the client indicates an adequate understanding of discharge instructions?

I will keep food on upper shelves so I do not have to bend over. After this surgery, the client must take care of to avoid activities that can increase intracranial pressure. The client should avoid bending from the waist and not bear down, or lie flat. With this approach, there is no incision to clean and dressed.

Which statement indicates that the client understands teaching about the use of long acting beta two agonist medications?

I will take this medication daily to prevent an acute attack. This medication will help prevent an acute asthma attack because it is long-lasting. The client will take this medication every day for best effect. This is not medication for the client to be used during an acute asthma attack because it does not have an immediate onset of action. The client will not be weaned off this medication because this is likely to be one for daily use.

A nurse cares for a client with a 40 year smoking history who is experiencing distended neck veins and dependent Edema. Which physiological process should the nurse correlate with This clients history and clinical manifestations?

Increased pulmonary pressure creating a higher workload on the right side of the heart. Smoking increases pulmonary hypertension, resulting in cor pulmonale, or right side heart failure. Increased pressures in the Longs make it more difficult for low blood flow through the lungs. Blood backs up into the right side of the heart and then into the peripheral venous system, creating distended neck pain and dependent Edema. Inflammation in the bronchial and bronchiolus create an airway obstruction which manifests as wheezing. Thick mucus in the lungs has no impact on distended neck fans and Edema. Left ventricular hypertrophy he is associated with left heart failure and is not Caused by a 40 year smoking history.

The nurse is caring for a client with gastrointestinal disorders should understand that which category best describes the mechanism of action of sucralfate (Carafate)?

It is a mucosal barrier fortifier.

A female client with scleroderma tells the nurse that she often has numbness and tingling in her hands followed by the blanching of her fingers. The nurse concludes the client has Raynaud's phenomenon, I condition commonly associated with scleroderma. The nurse plans to advise the patient to;

Keep her hands warm by wearing gloves. Raynaud's phenomenon is caused by vasospasm, precipitated by exposure to cold or emotional stress. Keeping hands warm helps to limit episodes of Raynaud's phenomenon. Raynaud's phenomenon is commonly associated with scleroderma, a connective tissue disorder.

The nurses working with a patient who has severe rheumatoid arthritis in both hands. The client states that she is frustrated at meal time because it is difficult for her to manage cups and silverware. What is the nurses best response?

Let's see if the occupational therapist can provide you with some utensils that are easier for you to use. The client wishes to be more independent at meal times; adaptive eating utensils from the occupational therapist will help her meet these goals.

A client has been diagnosed with carpal tunnel syndrome. Which intervention does the nurse question in the treatment of this injury?

The client with carpal tunnel syndrome can be treated nonsurgically by administration of oral NSAIDs and corticosteroid injections. Most clients find relief with taking these medications and the use of hand brace or splint to immobilize the rest. Use of opioids such as morphine should not be necessary. NSAID's and corticosteroids decrease inflammation and pain.

Which cast care instructions should the nurse provide to a client who has just had a plaster cast applied to the right forearm?

Letters a BC: a plaster cast takes 24 to 72 hours to dry synthetic cast dry in 20 minutes. The cast and extremities should be elevated to reduce it if prescribed. A wet cast is handled with the palm of the hand until it is dry, the extremities turned unless otherwise indicated so that all the sides of the wet cast will dry. A cool setting on a hairdryer can be used to drive a plaster cast, he cannot be used on the plaster cast because it the cast heats up and it will burn the skin of the patient. The cast needs to be kept clean and dry, and the client has instructed not to stick anything under the cast because of the risk of breaking the skin integrity. The client is instructed to monitor the extremity for circulatory impairment, such as pain, swelling, discoloration, tingling, numbness, coolness, or diminished pulses. The healthcare provider is notified immediately if circulatory impairment occurs.

The nurse manager in a long-term care facility plans nutritional assessment of all residents. Which nutritional assessment activity does the nurse delegate to the unlicensed assistive personnel at the facility?

Measuring the daily food and fluid intake of all residents. This girl does not include clinical judgment to be completed accurately. Assessing residence abilities to swallow, determining residence functional status, and screening with the mini nutritional assessment require broad knowledge of normal physiology, nutrition, and factors that affect nutrition and should be done only by licensed nursing staff.

What is included in a nursing care that applies to the management of all urinary catheters in hospitalized patients?

Measuring urine output every one to two hours to ensure patency. Routine irrigation are not performed. Turning the patient to promote drainage is recommended only for supra pubic catheter. Cleaning the insertion site with soap and water should be performed for urethra and super pubic catheter's but not lotion or powered are applied to the site.

The nurse is planning care for a client diagnosed with meningococcal meningitis. In addition to gloves, what personal protective equipment does the nurse use?

Meningeal meningitis is spread via saliva and droplets. Caregivers should wear surgical masks when within 6 feet of the client and should continue to use standard precautions. A particle respirator and isolation gowns, and shoe covers are not necessary for droplet precautions.

The nurse assesses which clinical manifestations in the client with suspected encephalitis?

Nuchal rigidity is associated with meningeal irritation and is frequently present in clients with encephalitis.

During a preoperative physical examination, the nurses alluded to the possibility of compromise respiratory function during or after surgery in a patient with which problem?

Obesity. Obesity, as well as final, chest, and airway deformities, may compromise respiratory function during and after surgery. Dehydration may require pre-operative fluid therapy and in large liver may indicate hepatic dysfunction that increases perioperative risk related to glucose control, coagulation, and drug interactions. With peripheral pulses may reflect the circulatory problems that could affect healing.

The nurse instructed client on the steps needed to obtain a peak expiratory flow rate. In which order should the steps occur?

One make the device read zero. To stand up. Three take a deep breath as possible. For meter in your mouth and close your lips around the mouthpiece. Five blowout as hard and as fast as possible for 1 to 2 seconds. Six repeat the process to additional times and record the highest number in your chart. Seven write down the obtained value

A client has decided to become a strict vegetarian and wishes to plan a diet to ensure adequate protein quality. To provide guidance, the nurse instruct the client to;

Plan a careful mixture of plant proteins to provide a balance of amino acids. Complementary mixtures of amino acid's in plant proteins provide complete dietary protein equivalence

A patient is brought to the emergency department with labored breathing, wheezing, and Marked use of accessory muscles. The patient has low oxygen and low CO2 and is receiving oxygen by nasal cannula at a rate of 2 L/ minute. After the patient has Received an aerosolized bronchodilator medication, the nurse assesses no wheezes and an oxygen saturation of 82%. What is the next action by the nurse?

Prepare for emergency intubation . Sudden absence of wheezing and a patient with severe asthma symptoms can indicate complete airway obstruction and may require a tracheotomy. The nurse should prepare for an emergency intubation . Administering more medication or increasing oxygen will not be effective if the airway is obstructed. Systemic steroid medication does not have a rapid onset.

Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN?

Reinforce the teaching about avoiding alcohol and caffeine for a patient with chronic gastritis.

After reviewing the patient's laboratory reports, the Anastasia team suggest that the surgeon reschedule the cardiac surgery. The nurse recognizes that which laboratory perimeter needs correction before surgery?

Serum potassium level of 6.5. Increased potassium levels but the patient at risk for dysrhythmias when Anastasia is administered.

In addition to ambulation, which nursing intervention could be implemented to prevent or treat post operative complications of syncope?

Slowly progress to ambulation with slow changes in position

After abdominal surgery and a client is to receive a progressive post surgical diet. This diet is characterized by progressive alterations in the

Texture of food. This diet progresses from one that makes the least metabolic demand on the body like clear liquid to a regular diet that requires the capability of unimpaired digestion.

The nurse is teaching a client who is newly diagnosed with epilepsy. Which statement by the client indicates a need for further teaching concerning the drug Regime?

The nurse must emphasize that antiepileptic drugs must be taken even if seizure activity has stopped. Discontinuing the medication can predispose the client to seizure activity and status epilepticus. The client should not drink alcohol while taking seizure medications. The client should wear a medical alert bracelet and should make the doctor aware of all medications to prevent complications of polypharmacy.

The physician has ordered the client to receive an enema before Belle surgery, so the nurse prepares the equipment and solution. The nurse assist the client into which position to administer the enema?

The patient should be assisted into Sims position

Which teaching by the nurse during the pre-operative. Best informs the patient regarding the primary purpose of the device being shown(incentives barometer)?

This device will help you keep your lungs expand it after surgery. Using an incentive spirometer will encourage lung expansion, decreasing atelectasis. Information regarding holding her breath for 3 to 5 seconds at a time, setting daily goals, and sealing the lips tightly around the mouthpiece are all directions on how to use the device but not describing its function.

Which statement indicates that a client understands teaching about the correct use of cortical steroid medication?

This drug is effective in decreasing the frequency of my asthma attacks. Corticosteroids decrease inflammatory and immune responses in many ways, including preventing this synthesis of mediators. Both inhaled corticosteroids and those taken orally or preventative; they are not effective in reversing symptoms during an asthma attack and should not be used as a rescue drugs. Systemic corticosteroids, because of the severe side effects, or avoided for mild to moderate intermittent asthma and are used on a short-term basis for moderate Asthma.

The nurse is preparing a patient with ostium arthritis for hip surgery and instruct the patient to discontinue hormone replacement therapy. What is the rationale behind this intervention?

To prevent Venus thromboembolism's. Venus thromboembolism is a serious post operative complications from hip surgery. Drugs that increase the risk for clotting and bleeding should be avoided to prevent Venus thromboembolism's. Hormone replacement therapy, causes blood clot formation and should be discontinued a week before surgery to prevent embolism's. There is no relationship between hormone therapy and elevated blood glucose levels. The patient is advised to sleep on clean linens and follow hygiene measures to prevent infections and subsequent prosthetic failure.

The nurse is assessing the results of diagnostic test on a client cerebral spinal fluid. Which values and observations does the nurse correlate as most indicative of viral meningitis?

Viral meningitis does not cause cloudiness or increased turbidity of CSF protein levels are slightly increased and glucose levels are normal. And bacterial meningitis, the presence of bacteria and white blood cells causes the fluid to be cloudy.

A patient says, "I hate the stupid COPD." What is the best response by the nurse?

What is bothering you? Encourage the patient and the family to express their feelings about the limitations on their lifestyle and about the disease progression.

Which signs and symptoms is associated in diagnosing asthma in a non-smoker?

Wheezing. Wheezing in a patient who is a non-smoker is an indicator of airway obstruction. Although dyspnea, chest tightness, and increased mucus production can also be seen an asthma, the signs and symptoms are also more present with other respiratory conditions.

A client is complaining of joint stiffness, especially in the morning. Which diagnostic test should the nurse expect a position to order to rule out osteoarthritis?

X-ray of the affected joints. X-rays reveal loss of joint cartilage which appears as a narrowing of the joint space in the clients diagnosed with OA.