Uworld 13
How many ml is in a gram of weight in a wet diaper
1 ml
A client with acute respiratory distress syndrome is receiving positive pressure mechanical ventilation with 15 cm H2O (11 mm Hg) positive end-expiratory pressure (PEEP). The nurse should assess for which complication associated with PEEP? 1. Barotrauma 2. Decreased oxygen saturation [ 3. Hypertension 4. Oxygen toxicity
Answer: 1 . Barotrauma refers to injuries caused by increased air or water pressure . High levels of PEEP (10-20 cm H2O [7.4-14.8 mm Hg]) can cause overdistension and rupture of the alveoli, resulting in barotrauma to the lung. Air from ruptured alveoli can escape into the pulmonary interstitial space or pleural space, resulting in a pneumothoraxand/or subcutaneous emphysema. . Option 3) Hemodynamic effects of PEEP include increased intrathoracic pressure, which leads to reduced venous return, decreased preload and cardiac output, and hypotension, not hypertension. . (Option 4) Keeping the alveoli open between breaths with PEEP improves gas exchange across the alveolar-capillary membrane, reduces hypoxemia, and allows for the use of a lower FiO2, which can reduce the risk for oxygen toxicity.
A client with diabetes receiving peritoneal dialysis experiences chills and abdominal discomfort. The nurse assesses the client's abdomen by pressing one hand firmly into the abdominal wall. The client experiences pain when the nurse quickly withdraws the hand. The client's most recent blood glucose level is 210 mg/dL (11.65 mmol/L). What is the priority action by the nurse? 1. Collect peritoneal fluid for culture and sensitivity 2. Heat the remaining dialysate fluid and increase the dwell time 3. Place the client in high Fowler's position 4. Prepare to administer regular insulin intravenously
Answer: 1 . Peritonitis is a common but serious complication of peritoneal dialysis. Manifestations include cloudy effluent, fever, abdominal pain, and rebound tenderness. Treatment is based on culture of the peritoneal fluid. Additional Information Reduction of Risk Potential NCSBN Client Need . (Option 3) High Fowler's position can help reduce shortness of breath if the client has volume overload, but it may worsen abdominal pain.
A 65-year-old client with end-stage renal disease comes to the emergency department after missing 5 hemodialysis sessions. Serum potassium level is 7.5 mEq/L (7.5 mmol/L) and ECG shows tall, peaked T waves. Which prescription will immediately protect the client from experiencing dysrhythmias associated with hyperkalemia? 1. Intravenous calcium gluconate 2. Intravenous regular insulin with dextrose 3. Oral sodium polystyrene sulfonate 4. Transport to hemodialysis unit
Answer: 1 Intravenous regular insulin temporarily corrects hyperkalemia by shifting potassium into the cells. Dextrose is administered concurrently to prevent hypoglycemia. Although intravenous regular insulin will effectively decrease serum potassium levels, calcium gluconate will provide immediate protection from dysrhythmias.
A client is receiving lithium carbonate 900 mg/day for a schizoaffective disorder. The laboratory notifies the nurse that the client's lithium level is 1.0 mEq/L (1.0 mmol/L). Based on this result, which prescription does the nurse anticipate receiving from the health care provider? 1. Continue at the current dosage 2. Decrease the dosage 3. Discontinue the medication 4. Increase the dosage
Answer: 1 Lithium levels should be checked frequently given the narrow therapeutic index (0.6-1.2 mEq/L [0.6-1.2 mmol/L]). A level >1.5 mEq/L (1.5 mmol/L) is considered toxic. Chronic toxicity manifests with neurologic symptoms (eg, confusion, tremor, ataxia) and/or diabetes insipidus (eg, polyuria, polydipsia).
The nurse is caring for a client in the acute phase of meningococcal meningitis. Which nursing actions should be included in the client's plan of care? Select all that apply. 1. Assign client to a private room 2. Don mask before entering room 3. Elevate head of bed 10-30 degrees 4. Keep padded tongue blade at bedside 5. Maintain dimmed room lighting
Answer: 1, 2, 3, 5 bacterial meningitis is an inflammation of the membranes that cover the brain and spinal cord and is caused by bacterial infection. Symptoms include headache, neck stiffness, nausea, vomiting, photophobia, fever, and altered mental status. The client with meningitis is at risk for seizure due to increased neuroirritability from fever and alterations in intracranial pressure. Bacterial meningitis is frequently caused by Neisseria meningitidis (meningococcus) in adults. Meningococcal meningitis is highly infectious and requires strict droplet isolation precautions (eg, surgical mask, private room, client masked during transport) (Options 1 and 2). ***droplet precautions
The nurse provides discharge teaching to a client who had a total knee replacement 4 days ago. Which client statement indicates the need for additional teaching? 1. "I have to give myself shots in the belly because my spouse is afraid of needles!" 2. "I have to use a walker because I can't bear any weight on this knee yet." 3. "I will call my health care provider if I get short of breath or sore or swollen below my knee." 4. "The raised toilet seat makes it easier for me to get on and off the toilet by myself."
Answer: 2 A client with total knee arthroplasty needs assistive devices (eg, walker, crutches) and a knee immobilizer to help ambulation; the client should be fully weight bearing by discharge. Prophylactic anticoagulation and recognition of postoperative complications (eg, DVT, PE) are also important. *The client should be fully weight bearing by discharge. Clients use an assistive device (eg, walker, crutches, cane, grab bar, hand rails) to help them sit, rise safely from a sitting to a standing position, and to negotiate steps (Option 2). A knee immobilizer is used to maintain extension during ambulation and at rest for about 4 weeks.
The emergency department nurse cares for a client whose college roommate reports recent changes in the client's behavior. Which behaviors and clinical data meet the criteria for involuntary admission to the mental health unit? Select all that apply. 1. Client has been sleeping on the floor in the den rather than the bed 2. Client has refused food and water for 4 days and has poor skin turgor 3. Client repeatedly mumbles, "I must kill them before they get me" 4. Marijuana was found in the client's personal belongings 5. The health care provider makes a diagnosis of schizophrenia
Answer: 2, 3 . Clients have the right to refuse hospital admission and treatment. However, all states and provinces have laws and procedures for involuntary admission that require clients to receive inpatient treatment for a psychiatric disorder against their will. The legal criteria for involuntary admission include: - The individual appears to be an imminent danger to self or others (Option 3). - The individual has a grave disability (ie, is unable to adequately care for basic needs [food, clothing, shelter, medical care, personal safety]) as a result of a mental illness (Option 2). . Clients also have the right to the least restrictive environment in which treatment can be provided in a safe manner. Involuntary commitment is generally used as a last resort in dealing with a client whose illness is so severe that judgment and insight in deciding to refuse treatment are markedly impaired.
Which actions should the labor and delivery nurse perform when caring for a client who has decided to relinquish her newborn to an adoptive parent? Select all that apply. 1. Avoid discussing the adoption details until after the birth 2. Encourage the birth mother to hold the newborn 3. Notify other staff who may interact with the client of the adoption plan 4. Offer the birth mother a chance to say goodbye to the newborn 5. Use phrases that illustrate adoption as a decision of love, not abandonment
Answer: 2, 3, 4, 5 Caring for a client who plans to relinquish a newborn to an adoptive family involves giving the client an opportunity to express emotions, be involved in decision-making, interact with the newborn, make memories, and feel reassured that the decision is one of love and not abandonment.
The nurse is caring for a client who will have a copper intrauterine device (IUD) inserted. When reinforcing teaching related to the copper IUD, which of the following nurse statements are appropriate? Select all that apply. 1. "Backup contraception is needed for 2 days until the IUD is effective." 2. "Heavier menses and more menstrual cramping are common in clients using a copper IUD." 3. "Missing a period while using a copper IUD is normal and no reason for concern." 4. "You may have cramping and vaginal spotting for a short time after IUD insertion." 5. "You should check for the IUD strings at least once a month after menses."
Answer: 2, 4, 5 . A copper intrauterine device (IUD) is a form of long-acting, reversible contraception that causes an intrauterine inflammatory effect that impairs sperm mobility and prevents implantation of a fertilized egg. It is a highly effective contraceptive and is also used for emergency contraception. IUD insertion commonly causes mild discomfort, cramping, and/or light vaginal bleeding (Option 4). Ibuprofen is recommended before and after insertion for relief of cramping/pain. Menstrual changes are also common among IUD users. For clients with copper IUDs, heavier bleeding and increased cramping during menses are the most common and expected side effects (Option 2). The client should check for the strings at least monthly to ensure that the IUD has not been expelled (Option 5). * levonorgestal takes a few days to work
The nurse is reinforcing education to a client with a venous thromboembolism who is prescribed rivaroxaban. Which statement by the client indicates the medication teaching has been effective? 1. "I need to continue to avoid eating spinach and kale." 2. "I probably will have some weakness in my legs when I take this medicine." 3. "I should avoid taking aspirin while receiving this medication." 4. "I will have to get blood drawn routinely to check my clotting levels."
Answer: 3 . Factor Xa inhibitors (eg, rivaroxaban [Xarelto], edoxaban, apixaban) are anticoagulants used to prevent and treat venous thromboembolism. Factor Xa inhibitors are being prescribed more frequently than other oral anticoagulants (eg, warfarin), as they have a lower risk of bleeding and require less ongoing monitoring (eg, PT/INR). . The combined anticoagulant effects increase the risk for uncontrolled bleeding and hemorrhage.
The parent of a 1-year-old says to the nurse, "I would like to start toilet training my child as soon as possible." What information does the nurse provide to the parent that correctly describes a child's readiness for toilet training? 1. A good time to start toilet training is when your child can dress and undress autonomously." 2. "When your child can sit on the toilet until urination occurs, you can start toilet training." 3. "Your child may be ready to start toilet training when able to communicate and follow directions." 4. "Your child will be ready to start toilet training at about age 15 months."
Answer: 3 Readiness for toilet training is dependent on the child's ability to voluntarily control the anal and urethral sphincters, which usually occurs at age 18-24 months. Other developmental and behavioral indicators of toilet training readiness include the child's ability to express the urge to defecate or urinate, understand simple commands, pull clothing up and down, and walk to and sit on the toilet. Additional Information Health Promotion and Maintenance NCSBN Client Need
The nurse is caring for a client who, 30 minutes ago, underwent an ablation procedure for supraventricular tachycardia in the cardiac catheterization laboratory. The client has a dressing over the femoral insertion site with a small amount of oozing blood. Which action by the nurse causes the charge nurse to intervene? 1. Applies pressure above the femoral insertion site 2. Assesses bilateral pedal pulses frequently 3. Assists client to sit on the side of the bed to use the urinal 4. Reports client chest pain of 2 on a scale of 0-10 to health care provider
Answer: 3 radio-frequency catheter ablation is a cardiac catheterization procedure indicated for a client with recurrent episodes of supra-ventricular tachycardia. After cardiac catheterization, the client must remain supine with the head of the bed at ≤30 degrees and the affected extremity straight to prevent bleeding from the catheter insertion site.
The nurse is making assignments for the next shift. Which client should the nurse assign to the new nurse coming out of orientation? 1. Client diagnosed with chronic anemia receiving iron via IV route 2. Client newly admitted for uncontrolled diabetes mellitus type 2 with blood glucose >600 mg/dL (33.3 mmol/L) 3. Client undergoing ultrafiltration for congestive heart failure [3%] 4. Client with a prescription for routine hemodialysis who has chronic renal failure
Answer: 4 There is a high incidence of IV iron causing hypersensitivity reactions, including anaphylaxis. Therefore, a test dose needs to be given first. This client should be assigned to a more experienced nurse. . The nurse is looking for the most stable client to assign to the new nurse. The client who is scheduled for hemodialysis has a chronic disorder and receives this therapy on a regular basis. There is no indication that this client might be unstable.
An elderly client with depression, diabetes mellitus, and heart failure has received a new digoxin prescription for daily use. Which client assessment indicates that the nurse should follow up on serum digoxin levels frequently? 1. Apical heart rate is 62/min 2. Blood sugar level is 240 mg/dL (13.3 mmol/L) 3. Client is taking 20 mg fluoxetine daily 4. Serum creatinine is 2.3 mg/dL (203 µmol/L)
Answer: 4 . Digoxin (Lanoxin) is a cardiac glycoside that increases cardiac contractility but slows the heart rate and conduction. It is used in heart failure (to increase cardiac output) and atrial fibrillation (to reduce the heart rate). The drug is excreted almost exclusively by the kidney. BUN and creatinine levels are measurements of kidney function. ***hypokalemia can increase the risk of toxicity * need an apical HR of 60 to administer the drug
The charge nurse on a medical-surgical step-down unit is responsible for making assignments. Which client is most appropriate to assign to a new graduate nurse who is still in orientation? 1. 65-year-old client 1 day postoperative left femoral-popliteal bypass graft surgery with a diminished pedal pulse 2. 66-year-old client admitted for hypertensive crisis 2 days ago; blood pressure currently 180/102 mm Hg; reports headache and blurred vision 3. 75-year-old client with an ischemic stroke transferred from the intensive care unit 1 hour ago; unresponsive with right-sided paralysis 4. 78-year-old client with diabetes and cellulitis of the left foot; requires frequent dressing changes due to excessive drainage
Answer: 4 The less experienced graduate nurse is assigned to more stable clients who require basic nursing care.
