U-World Questions
seritonin syndrome
sweating, diarrhea, dialated pupils, increased sympathetic effects, drop in blood suger
DVT reinforcement
-Drink plenty of fluids, limit caffeine and alcohol intake to avoid dehydration which predisposes to blood hypercoagulability and venous thromboembolism -elevate legs one sitting, and dorsiflex flex the feet often -walk,swim -stop smoking -avoid restrictive clothing -change positions frequently also: travel doesn't have to be avoided during extended travel periods the person should use preventive measurements such as knee-high compression stockings, exercise captain for the muscles every 30 minutes, take frequent breaks and walk briefly every hour, recline in their seat, remove objects around feet and legs to allow maximum comfort and movement, drink lots of fluids to avoid dehydration
Interventions to treat constipation
-High fiber diet -high fluid intake -regular exercise -bulk forming fiber supplements (dextrin, methycellulose,psyllium)
What teaching can I nurse reinforced to help client mobilize secretions and improve sleep who has chronic bronchitis
1. Increase fluids to at least eight glasses (2-3l) 2. Sleep with a cool mist humidifier 3. take prescribe Robitussin (guaifenesin) before bedtime 4. Use a abdominal breathing and huff cough technique at bedtime also: chest physiotherapy works (postural drainage,percussion, vibration) --pursed lip breathing prolongs exhalation and reduces air trapping in the lungs also decreases dyspnea. It does not turn secretions--
What would be a violation of HIPAA policy
1.sharing results even with spouse 2.disclosing health care info with someone not apart of the patient's health care team 3.
What type of room assignment should a patient with active shingles have
A private room with negative airflow and contact and airborne precautions edu. The client with open lesions from exhausters virus infection such as shingles or chickenpox will require both contact and airborne precautions along with a private room with negative airflow as the shingles virus is a reactivation of the varicella zoster virus
what can be a concern for child safety
A parent giving children responsibilities that are beyond their capacity and placing children in a unsafe situation are indicators of child abuse and neglect as mandated by law healthcare professionals are responsible for identifying suspected child abuse and neglect and reporting them to the appropriate social service and or law enforcement agencies
a nurse is completing drug admin. which would require a incident report 1. Client with chronic stable angina and blood pressure of 84/52 mm Hg, isosorbide mononitrate held 2. Client with depression stopped phenelzine yesterday, escitalopram given today 3. Client with diabetes and morning glucose of 90 mg/dl (5.0 mol/l), the daily NPH insulin 20 units given at 8 AM 4. Client with pulmonary embolism and and International normalized ratio (INR) 2.5, warfarin given
ANSWER: #2 rational: selective serotonin reuptake inhibitors (SSRI'S--ESCITALOPRAM) cannot be combined with monoamine oxidase inhibitors (MAOIS--PHENELZINE) as there is a risk for serotonin syndrome. MAOI Effects persist long after dosing stops. MAOI Should be withdrawn at least 14 days prior to starting SSRIs rational: #1. The isosobride has actions identical to nitroglycerin and can cause hypertension from vasodilation. It should be held Wendy's stock blood pressure is below 90 MM Hg. Perfusion to the kidneys is an adequate if the systolic pressure is below 80 MM Hg. Because the pressure is so low the nurse does not want to lower it by giving the drug #3. Insulin is given to control diabetes. In normal fasting glucose level is between 70 and 99 mg/dl (3.9-5.5 mmol/L). indicates that the dosing is correct and should be given to continue control of blood glucose #4. the effect of warfarin (Coumadin) is monitored by the INR. The therapeutic range of INR is between two and three. This result indicates that the range is normal and that the current dose is achieving the desired effects edu: there must be a minimum of 14 days between administration of Ami allies and SSRIs to avoid serotonin syndrome these medications can I be taken together
A client with chronic heart failure is being discharged home on furosemide & supplementary potassium chloride tablets. Which instructions related to the potassium supplement should the nurse reinforced to the client? 1-" a diet rich in protein and vitamin D will help with absorption" 2-" if the tablet is too large to swallow, crush it and take it in applesauce or pudding" 3-" potassium tablets should not be taken on an empty stomach" 4-" take it with plenty of water and sit upright for a period of time afterward"
Answer #4 Explanation: FUROSEMIDE: is considered a potassium wasting diuretics meaning that a client could experience the loss of potassium. low potassium level a client with HF is dangerious due to dysrhythmias and increase ups ability to toxicity from deduction if taken. Which means that potassium supplementation is needed for this client. POTASSIUM: should not be taken with plenty of water at least 4 ounces of course and the client needs to set up for a period of time after ingestion this prevents the tablet from lodging in the esophagus which can cause erosion and pill-induce esophagitis PILL-INDUCED ESOPHAGITIS: is common with tetracyclines (doxycycline) & bisphosphonates (dronates, alendronate, ibandronate, pamidronate, risedronate) and clients taking these medications should be getting similar instructions #1 rational: a diet rich in protein & Vitamin D will help with calcium supplement absorption #2 rational: some potassium tabs are sustained released and cant be crushed #3 rational: potassium should be taken with a meal or immediately following a meal to prevent gastric upset EDU OBJ: -the nurse should teach the client to take potassium with plenty of water at least 4 ounces and sit up straight after ingestion to prevent pill induced esophagitis. sustained released tabs should not be crushed
Which client condition is concerning and requires further nursing observation and intervention. Select all that apply. 1-before a liver biopsy, pulse is 80/min and blood pressure is 120/80 mm Hg, one hour after, pulse is 112/min and blood pressure is 90/60 mm Hg 2-but for lumbar puncture, pulse is 100/min and blood pressure is 140/86 mm Hg 3-client with coronary artery disease on metoprolol, pulse is 62/min 4-elderly client with black stool, pulse is 112/min 5-neonate is crying inconsolably at feeding time pulse is 160/min
Answer: 1,4 Explanation: -the liver is very vascular, which places it at risk for internal bleeding after a tissue sample is done for biopsy. Liver dysfunction typically results in coagulopathy coagulation factors are super nice in the liver, either by increasing the risk for bleeding. Early signs of a loss and shocks are taking piña, tachycardia, and agitation. A leader sign is a hypotension -Black stools (melena) indicate slow upper gastrointestinal bleeding, and tachycardia may indicate significant blood loss. Therefore this client needs immediate assessment #1 rationale: the change in battle signs from pre-procedure to post-procedure or cycling flags decreasing Zaidi. This client's vital signs are within normal range. A lumbar puncture does not produce leading serious enough to make a client hypotensive. If the client was bleeding it would compress the spinal cord causing paralysis in the lower extremities. #3 rational: a client has a pulse of 62/min (normal is 60-100) which may indicate a therapeutic effect of Muthappa wrong the nurse should monitor for bradycardia, which is a common and expected finding following administration of a better and your chick blocker, bradycardia with her singing intervention only have the client became symptomatic (hypotension, dizziness, nausea) #5 rational: A neonates resting pulse is 110-160/min. Crying or vigorous kicking can cause a temporary rise. Vital signs are concerning if they arise when a client is at rest EDU OBJ: Vital sign changes that are early signs of concern for hypovolemic shock or tachypnea, tachycardia, and agitation, hypotension is a late finding
the practical nurse is assisting the RN in performing well child examination in a peds unit. which of the following requires further evaluation? 1- bilateral bowlegs (genu varum) in a 15 month old 2-chest rounded with the anteroposterior diameter equal to the lateral diameter in a infant 3-lateral curvature to the spine notes on the examination of a 10 year old girl 4-presence of an s3 heart sound in a 2 year old
Answer:#3 Explanation -indicates scoliosis is commonly diagnosed spinal deformities characterized by lateral curvature of the spine and spinal rotation. -can also be from pathological conditions but mostly idiopathic. -commonly noticed first during the periods of rapid growth, particularly during early adolescence of girls. -screenings are done in schools, well-child visits for girls (ages 10-12), for boys (ages 12-14) #1 rational: bowlegs (genu varum) the lateral bowing of the legs common in toddlers when they learn how to walk it is usually resulting in 18 to 24 months after they develop strength in their legs and lower back. after two years normal alignment will align again progress to valgus deformity until age 4 then will return to normal adult alignment by age 7 #2 rational: a rounded, nearly circular chest shape with the front to back (anteroposterior) that's equal to the side-to-side (lateral) diameter is an expected finding in a healthy infant. the chest is more oval and the lateral diameter is greater than the anteroposterior diameter by age 2 #4 rational: an S3 heart sound reflecting rapid filling of the left ventricle is considered normal when heard in children. S3 is a dull, low-pitched sound heard in diastole immediately after S2 but louder in the material or apical area. which separates it from a split S2 best heard in the pulmonary area EDU OBJ: -An S3 heart sound is a normal finding when heard in children. bowlegs (genu varum) are common until age 18-24 months. Scoliosis is always abnormal. early detection and prompt treatment may reduce the need for surgical procedure
A PN is collaboration g with the RN to form a care plan for a client diagnosed with placenta previa at 33 weeks gestation. what does the nurse anticipate being included in the POC (select all that apply) 1-activity as tolerated 2-non-stress test 1-2 times a week 3-prepare for a c-section at any time 4-type & blood screen 5-vaginal examinations two times weekly
Answer:2,3,4 Explanation: -in placenta previa, the placenta is palpated over or very near the cervix. from that placental blood vessels may be disrupted during dilation & effacement -because of the increased risk of hemorrhage the pt should have a type and screen for blood -a nonstress test or biophysical profile should be done once or twice a week to ensure fetal well-being -with asymptomatic clients, a c-section is planned after 36 weeks gestation & before the onset of labor to prevent blood loss to the mother and fetus. If bleeding is becoming profusely or consistently or goals into activity for a cesarean birth is typically performed immediately #1 rationale: the recommended activity for clients less than 36 weeks station with diagnosed placenta previa is bedrooms and bathroom coverages a stable client may be released to continue bedrest at home, but the client must be closely monitored and returned to the hospital immediately if bleeding occurs #5 rational: clients with Center PBR are placed on pelvic rest. Vaginal examinations, douching, and vaginal intercourse are contraindicated due to the risk of hemorrhage EDU OBJ: -clients with placenta previa artist for him merging. Bedrest and back and beverages are recommended for a client at least less than 36 weeks of gestation. A non-stressed test or biophysical profile should be formed once or twice a week to assess fetal well-being. Pelvic rest is instituted to prevent the destruction of the civics. A cesarean births plan before onset of labor
A home health nurse is supervising a home health aide who is changing the dressing for a client with chronic kill wound. Which actions by the aid indicate adherence to appropriate infection control procedures select all that apply 1-Open sterile container of 4 x 4's using the outermost corner to peel back the cover 2-call glove off over the soil dressing up to encase add before disposal 3-save and you sterile four by fours by keeping the original package set for the next dressing change 4-wash hands prior to pulling on the gloves and after removing them 5-wraps oil dressings and paper towels before disposing or in the trashcan
Answers: 1,2,5 Explanation: What is this possible for absorbing of the home health aide periodically during delegated tasks. The aid should wash the hands prior to gloving and after removal (#4) sterile dressing supplies should be open prior to the dressing change, this should be done by carefully peeling from the outermost corner of the package to expose the contents without contaminating the sterile product (#1). A contaminated used dressing should be placed in Emporia plastic or paper bag before disposal in the household trash (#2). #3 rational: I need to steal supplies should not be safe as it is not possible to ensure they're sterile #5 rational: paper towels aren't impervious and impervious waste from the dressing can seep through and into other items in the trash can EDU OBJ: in the home care setting, infection control procedures for changing the dressing include washing of the hands before and after loving, opening still supplies carefully to avoid contamination, placing all dressing inside the glove or plastic bag before disposal in the household trashcan
teaching of bed bugs
Bedbugs can spread quickly and travel in bedding, clothing and furniture it's important to recognize bedbugs bite and eliminate this pest from the home. Client treatment aims to minimize itching until rash is gone
A woman had a C-section delivery five hours ago and appears inches and a port shortness of breath. The practical nurse should assess for which priority problem before notifying the registered nurse
Calf warmness and tenderness can be a indication of a deep vein temples is formation if untreated it could be dislodge and travel to the lungs resulting in a pulmonary embolus
What to do if a client has a abdominal incision that has separated and has a protruding part
Dehiscence also known as surgical incision separation with evisceration also known as internal organ protruding through incision. Is a medical emergency. The nurse should stay with a patient and monitor the client, and the client should be put in low Fowlers position, and instructed not to strain. The wound should be covered with sterile, moist dressings, healthcare provider must be notified immediately in preparation for emergency surgery. Vital signs should be collected and interventions documented 1.stay with patient 2. have someone alert medical professional 3.place in low fowlers with knees fixed to relate abd pressure 4.apply sterile dressing 4.monitor vitals to monitor for shock (ex.tachycardia,tachypnea,hypotension) --DON'T GIVE ORAL MEDS CLIENT NEEDS TO BE NPO FOR emergency SURGERY. ONLY IV analgesics SHOULD BE GIVEN--
isotretinoin (Absorica, Amnesteem)
Is a acne medication that can cause harm to pregnant women if taken within someone pregnant it can cause harm to the fetus since it is a teratogenic medication. -females need to have at least two negative pregnancy test and participate in a risk management program before taking also have two forms of contraception (this is done one month before and after taking) -blood donation is discouraged for both male and females while taking side effects: -dry eyes -photosensitivity
The nurse prepares for a master at Oso radioactive iodine to a 39-year-old female client with Graves' disease. Which is the most important action for the nurse to take 1. Ask the client when her last menstrual cycle occurred 2. Confirm pregnancy test results is negative 3. Obtain a baseline assessment of the mouth and throat 4. Teach the client about signs and symptoms of hypo thyroidism
It should not be used as treatment for pregnant clients so a negative pregnancy test will be needed prior to treatment. -radioactive iodine is the primary treatment for non-pregnant adults with hyperthyroid disorders such as Graves' disease which is a auto immune hyper thyroid disease. The use of radioactive iodine is contraindicated in pregnancy and can cause harm to the fetus. Pregnancy results we need to be confirmed using a valid pregnancy test in our clients who still have menstrual cycles rather than using subjective form of assessment such as asking when last menstrual period occurred rational: #3. Radiation thyroiditis and parotitis which causes dryness and irritation to the mouth make her after radioactive iodine treatment. Based on this assignment is helpful but is that most important action listed the nurse can teach the client to take sips of water frequently or to use a salt and soda the gargle solution 3 to 4 times daily to relieve symptoms #4. Radioactive iodine damages or destroys the thyroid tissue thereby limiting thyroid secretion, and can result in hypothyroidism. Clients need to take thyroid supplementation levothyroxine for life. Because the symptoms are delayed this teaching can occur before or after the procedure it's not as important as assessing pregnancy status edu. Radioactive iodine - what is the thyroid gland, making clients permanently hypothyroid and requiring lifelong thyroid supplements, and female clients a non-pregnant status should be confirmed with a valid pregnancy test prior to administering radioactive iodine and radioactive iodine is contraindicated in pregnancy and may cause harm to the fetus
what to do when taking sucralfate
It's a oral medication that forms a protective layer in the gastrointestinal mucosa which provides a barrier against acid and enzymes 1. Take one hour before meals and at bedtime and for effective results take on it in the stomach with a glass of water 2. Don't take with other medication's as it binds to many and can decrease the effectiveness instead other medications should be taken one to two hours before 3. As reducing agents (anti-acids, proton pump inhibitors, H2 blockers) should be avoided within 30 minutes of taking sucralfate. All other medication's should be taken 1-2 hours before or after taking sucralfate
can MAOIS and SSRIS be taken together?
NOOOOOO
What would be alarming about a seven month old child during a well child visit
Not being able to put their pacifier back into the mouth without any help rational: infants develop a certain fine motor skill such as using their hands to bring Alex to the mouth by ages 4 to 5 months and purposely grasping objects by the age of five months if by age 7 months the infant is not able to do this then for the assessment is required
What should you expect with shaken baby syndrome (SBS)
You should expect irritability and vomiting. BUT ALSO: lethargic, inability to suck or eat, seizures, inconsolable crying. Usually there are no external signs of trauma except for occasional small be using on the chest or upper arms where the child was held during the episode CAN CAUSE: bleeding in the brain, or eyes
a primigravida client and labor is admitted and reports intensive back pain with contractions. The fetal position is determined to be right occupied post you. Which action by the nurse for best help for leaving the clients back pain during early labor? 1. Apply counter pressure to the client sacrum to rain contractions 2. Encourage the client to remain in bed during early labor 3. Position in the client on the left side with pillows for support 4. Requesting that the nurse anesthesiologist administer epidural anesthesia
answer is #1 rational: fetal occiput posterior position is a common fetal malposition which occurs when the fetal occiput rotates and faces the mothers posterior. It can cause lower back pain the nurse Kampai counterpressure to the clients sick room during contractions to help relieve the back pain due to the fetal positioning. Firm continuous pressure is applied at the sacrum to relieve pain with a closed fist and the CEO of the hand or other firm objects such as a tennis ball or back massager (#1) #2. Client should be encouraged to change positions frequently every 30 to 60 minutes during labor to remote fetal rotation and increase maternal comfort remaining in bed doing early labor increases the risk for persistent Vito malposition and slows labor progression #3. Left lateral positioning is better for uteroplacental blood flow and fetal oxygenation then supine position when the client is resting in bed however it may not alleviate the clients back pain 4. Although epidural anesthesia can promote effective back pain it can limit client mobility and contribute to persistent fetal malposition this client is also an early labor and has not requested an epidural at this time edu. Fetal posterior position can cause intense back pain during labor client comfort can be increased by applying counter pressure to the sacrum during contractions
The the nurse is preparing to administer a sodium polystyrene retention sulfonate retention enema. Which explanation by the nurse best describes the purpose of this type of enema a. A contrast medium is administered rectally to visualize the colon via x-ray b. Bedridden clients receive this enema to stimulate defecation and relieve constipation c. This enema assist the large intestines in removing excess potassium from the body d. This enema is administered before bowel surgery to decrease bacteria in the colon
answer: c rational: Sodium polystyrene sulfonate (kayexelate) retention enema is a medicated enema administered to clients with high serum potassium levels. It replaces sodium ions for potassium ions in the large intestine and promotes evacuation potassium rich waste from the body thereby lowering the serum potassium level. It can also be taken orally and is more effective. It's also associated with intestinal necrosis a. A barium enema uses contrast medium (barium) administered rectally to visualize the colon using fluoroscopic x-ray b. A feet number relieves constipation by infusing a hypertonic solution into the bowel, pulling fluid into the colon and causing dissension and then defecation d. A neomycin enema is a medicated enema that reduces the number of bacteria and the intestine in preparation for colon surgery edu. Kayexalate retention enema's are medicated enemas and minister to clients with high serum potassium levels the resin Inca tessellate replaces sodium ions for potassium ions in the large intestine and promotes evacuation of potassium rich waste from the body thereby lowering the serum potassium level
The nurse is John bar from the clients prefer old thing for laboratory specimens. Which of the following are correct nursing actions select all that apply 1. Do not leave a tourniquet on more than one minute while looking for a vein 2. Draw the specimen while the skin is still wet with the alcohol prep 3. Pulsating red blood is noted, withdraw the needle and apply pressure for five minutes 4. Use a highly visible vein on the ventricle side of the clients wrist 5. Vigorously shake the specimen to to mix obtain blood with anticoagulant solution
answers 1,3 rational: A tourniquet should be applied 3 to 5 inches above the desired countryside and no longer than one minute for looking for a vein. I've longer time is needed police and do that for at least three minutes before reapplying. Prolong obstruction of blood flow can change some test results Pulsating bright red blood indicates that an artery was access if this happens the needle should be removed immediately and pressure should be applied for at least five minutes followed by a pressure dressing to prevent a hematoma #2. Skin preparation involves considering using a anti-septic solution and friction and allowing the skin to dry. Remaining solution may hemolyze or dilute the blood sample. Traditionally alcohol is applied in a circular motion, from insertion site outward. Current research suggest that the most effective method is applying a chlorhexidine (2%) and a back-and-forth motion followed by adequate training time #4 the veins on the ventricle aspect of the wrist are located near nerves, resulting in painful venipuncture and a higher risk for nerve injury. There is also an increase risk of arterial access on the ventricle aspect of the wrist and so this site would be avoided #5. The filled tube should be gently and voted 5 to 10 times to mix anticoagulant solution with the blood vigorously shaking can cause hemolysis and false results edu: when performing phlebotomy for a laboratory specimen, allow the cleanse area to air dry, do not use the ventral side of the wrist, position the tourniquet for no more than one minute at a time and invert the tube gently 5-10 times to mix the solution with blood. Insertion in an artery will cause pulsation, if this happens immediately remove the needle and apply pressure for five minutes
A blizzard is predicted to hit a large city within the few hours the home health nurse is prioritizing and revising the schedule and estimates that three home visits can be made before the blizzard hits. Which clients should the nurse include select all that apply 1. A client who fell and hit the head but refuses to go to the emergency department 2. A client who is due for maintenance dose of cyanocobalamin 3. A client who needs prefilled insulin syringes 4. A client who was discharged from the hospital yesterday after heart failure treatment 5. A client with stage two pressure injury in need of a dressing change
answers: 1,3,5 rational: #2. Maintenance doses of cyanocobalamin for vitamin B 12 deficiency are usually administered every four weeks. Although his client should receive the injection as soon as possible, postponing the home care visit for 1 to 2 days will not harm the client #4. This client can be provided with telephone care management, the nurse can perform medication reconciliation over the phone and provide instructions regarding care
A nurse in a clinic is obtaining a developmental history of 818 month your old which theories would be expected to be performed select all that apply a. Goes up the stairs while holding a hand b. No holds approximately 350 words c. Runs without falling d. stacks six blocks in a tower e. Turns two pages in A book at a time
answers: a,,e rational: a toddlers development centers I'm fine motor and gross skills by 18 months the toddler should be able to manage the stairs while holding a hand and turn two or three pages in a book. The direction of development his towards improving loco motion Skills. (a,e) (b,c,d). A 24 month old should be able to build a tower of six or seven blocks, run without falling and have a vocabulary containing over 300 words edu. In 18 month old typically is developing both fine and gross motor skills which include going up stairs while holding her hand and turning two or three pages in a book
What is the best measurement and most accurate indicator of fluid loss or gain
daily weight
