NCLEX DRUGS

raising all side rails is considered a restraint

..

Sodium for clients with cardiac disease is limited to two grams per day.

2

A nurse in the labor and delivery unit is caring for several clients. For which of these mother-baby pairs should the nurse review the results of the Coombs test in preparation for the administration of Rho (D) immune globulin within 72 hours of birth?

A Rh negative mother who delivers a Rh+ baby may develop antibodies to the fetal red cells to which the mother may have been exposed during pregnancy or at placental separation. If the Coombs test is negative, no sensitization has occurred.

The nurse is auscultating the heart of a client who is diagnosed with dilated cardiomyopathy. What finding would the nurse expect to hear?

A ventricular gallop, S3 is caused by blood flowing rapidly into a distended noncompliant ventricle. This is the most common sound with left-sided heart failure. It sounds like "Kentucky." Increased left heart pressures may cause dilation of the mitral valve in the client with heart failure resulting in a systolic murmur.

risperidone

Antipsychotics work by blocking a specific subtype of the dopamine receptor

hyperglycemic hyperosmolar nonketotic state (HHNS).

BG over 600 and dehydration

A client diagnosed with peptic ulcer disease (PUD) who reports feeling dizzy

Dizziness with PUD may indicate hemorrhaging.

The nurse is caring for a child diagnosed with seizures. While teaching the family and the child about the medication phenytoin, what information should the nurse emphasize?

Maintain good oral hygiene and dental care

phenelzine

Monoamine oxidase inhibitors (MAOIs) prevent the enzyme monamine oxidase from breaking down the neurotransmitters norepinephrine and serotonin (also known as monoamines) in the brain. They are typically used to treat depression.

mannitol

Osmotic Diuretics are low-molecular-weight substances that produce a rapid loss of sodium and water by inhibiting their reabsorption in the kidney tubules and the loop of Henle. They also increase the osmolality of plasma, which increases diffusion of water from the intraocular and cerebrospinal fluids. They are mainly used in the management of cerebral edema to decrease intracranial pressure.

A 71 year-old client is admitted for mitral valve replacement surgery. The client has a history of mitral valve regurgitation and mitral stenosis since he was a teenager. During the admission assessment, the nurse should ask if the client experienced which health issue as a child?

Rheumatic Fever. Clients that present with mitral stenosis often have a history of rheumatic fever or bacterial endocarditis, with valvular damage due to the infection.

school age wt and ht

School-age children gain about 5 1/2 pounds each year and increase about 2 inches in height.

DKA: high hematocrit confirms severe dehydration.

The single most important therapy for DKA is IV fluid administration, usually with added potassium, to lower blood glucose levels and normalize the pH.

IV nitro. what do you watch for

The vasodilatation that occurs as a result of this medication can cause profound hypotension.

adriamycin

cardiotoxicity

DTIC-dome

flu like symptoms

Puerperal infections

post partum infection

The nurse is caring for a 17 month-old child diagnosed with acetaminophen poisoning. Which of these lab reports should the nurse review first?

cetaminophen is toxic to the liver and causes hepatic cellular necrosis. This causes the liver enzymes AST and ALT to be released into the blood stream, which elevates serum levels. The next lab values to review are those associated with coagulation, then the blood counts and lastly the renal-associated labs, including BUN and creatinine.

The client with cancer is being treated with a biological response modifier. Which of the following side effects does the nurse anticipate with biologic therapy?

chills and fever. Biological response modifier cancer therapy agents (for example, interferons and interleukins) are drugs that stimulate the body's own defense mechanisms to fight cancer cells. Flu-like findings such as chills, fever and nausea, are common side effects of this type of therapy. The other assessment findings are not what you would expect when the body is fighting pathogens.

The nurse reviews an order to administer Rh (D) immune globulin to an Rh negative woman after the birth of her Rh positive newborn. Which assessment is a priority before the nurse gives the injection?

coombs test results. Rh (D) immune globulin (RhoGAM) is given only if antibody formation has not occurred; a negative indirect Coombs test confirms that antibodies have not been formed in the new mother. An Rh negative woman should receive RhoGAM within 72 hours after birth. Rh negative women should also receive RhoGAM at about 28 weeks of pregnancy, after a miscarriage, abortion, ectopic pregnancy or an amniocentesis. RhoGAM prevents sensitization and Rh incompatibility. The effects of Rh immune globulin last about 12 weeks, which is why repeat administration is needed in future pregnancies.

A client has been taking furosemide for the past week. The nurse recognizes that which finding may indicate the client is having a negative side effect from the medication?

decreased appetite. Furosemide (Lasix) causes a loss of potassium if a supplement is not taken. Findings of hypokalemia include anorexia, fatigue, nausea, decreased gastrointestinal motility, muscle weakness and dysrhythmias.

A client taking isoniazid for tuberculosis (TB) asks the nurse about the side effects of this medication. The client should be instructed to report which of these findings?

Extremity tingling and numbness. Peripheral neuropathy is a common side effect of isoniazid and other antitubercular medications and should be reported to the health care provider. Daily doses of pyridoxine (vitamin B6) may lessen or even reverse peripheral neuropathy due to isoniazid use.

bisacodyl

Laxatives are typically classified as either bulk-forming agents, osmotics, salines, stimulants (such as bisacodyl) or stool softeners.

A nurse is providing a parenting class to individuals living in a community of older homes that were built prior to 1978. During a discussion about formula preparation, which statement is the most important by the nurse to tell the parents how to prevent lead poisoning?

Let tap water run for two minutes before adding to formula concentrate

atorvastatin

Lipid-lowering Agents reduce LDL ("bad") cholestero

furosemide

Loop Diuretics work in the ascending limb of the loop of Henle

The nurse is caring for a client with acute pancreatitis. After pain management, which intervention should be included in the plan of care?

Encourage the client to cough and deep breathe every two hours. Respiratory infections are a common complication of pancreatitis because fluid in the retro-peritoneum can push up against the diaphragm, causing shallow respirations. Coughing and deep breathing every two hours will diminish the occurrence of this complication. The other interventions are not appropriate, and the client will be NPO during the initial period of treatment for pancreatitis.

The nurse is providing instructions for a client with asthma. Which of these factors is a priority for the client to monitor daily?

The peak airflow volume decreases about 24 hours before clinical manifestations of exacerbation of asthma. Note that the question asks for a priority so all of the options would be monitored. However, the peak air flow is the priority.

Beta thalassemia

blood disorder that reduces the production of hemoglobin. Hemoglobin is the iron-containing protein in red blood cells that carries oxygen to cells throughout the body

A client is receiving nitroglycerin intravenously for unstable angina. What assessment would be a priority for the nurse to monitor for the effects of this medication?

blood pressure. Because an effect of this drug is vasodilation, the client must be monitored for hypotension.

4 month-old infant is being given digoxin. The client's blood pressure is 92/78 mm Hg; resting pulse is 78 BPM; respirations are 28 BPM; and the serum potassium level is 4.8 mEq/L (4.8 mmol/L). The client is irritable and has vomited twice since the morning dose of digoxin. Which finding is most indicative of digoxin toxicity?

brady

The nurse suspects that the client is in cardiogenic shock. Which of the following findings supports this information?

decreased muffled heart sounds. Cardiogenic shock involves decreased cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume; it is the leading cause of death in acute MI. Findings of cardiogenic shock include hypotension, rapid and faint peripheral pulses, distant-sounding heart sounds, cool and mottled skin, oliguria and altered mental status.

A 15 month-old child comes to the clinic for a follow-up visit after hospitalization for treatment of Kawasaki disease and treatment involving immunoglobulins. The nurse should recognize which scheduled immunizations will be delayed?

mmr. Medical management of Kawasaki involves administration of immunoglobulins. Measles, mumps, rubella (MMR) is a live virus vaccine. Following administration of immunoglobulins, live vaccines should be held due to possible interference with the body's ability to form antibodies.

terazosin (alpha-adrenergic blocker) for BPH

move position slowly (orthostatic hypertension)

The nurse is assessing a child with suspected lead poisoning. Which assessment should a nurse expect to find?

numbness and tingling in the feet. A child who has unusual neurologic complaints, such as neuropathy or footdrop that cannot be attributed to other causes, may be affected by lead poisoning. This may occur when a child ingests or inhales paint chips from lead-based paint or dust during remodeling in older buildings. Other findings of lead poisoning are appearance of bluish gum line, hyperactivity and developmental delays.

What would a nurse expect to see in a client who reports symptoms associated with tardive dyskinesia?

rapid tongue movements. Tardive dyskinesia is a syndrome of involuntary movements of the face, mouth, tongue, trunk, and limbs that may occur after years of treatment with neuroleptic agents. Predisposing factors include older age, many years of cigarette smoking, long-term phenothiazine treatment and a diagnosis of diabetes mellitus.

potassium iodine

reduces vascularity of the thyroid gland

A client is diagnosed with iron-deficiency anemia. What is the cause of the symptoms associated with this condition?

tissue hypoxia

methotexate

toxic to about every organ except to heart, toxicity made worse with asprin

beta blockers can be used for what else

tremors

SE for erythromycin

Nausea is a common side effect of erythromycin, for both oral and intravenous forms.

A client with possible hepatitis C discusses his health history with an admission nurse. The nurse should recognize which statement by the client as the most important in supporting this diagnosis?

"I had a blood transfusion in 1990. The client who received a blood transfusion prior to screening for hepatitis C (prior to July 1992) may show findings many years later, as often Hepatitis C is asymptomatic in its early stages. People who may be at risk for hepatitis C include those who have been on long-term kidney dialysis and have regular contact with blood at work. Having unprotected sexual contact with a person who has hepatitis C is less common, although the risk increases with multiple partners. Eating raw oysters would increase the risk of hepatitis A. Travel to Africa would increase the risk of exposure to malaria from mosquitoes carrying this disease, as well as HIV if the person were exposed to blood or had unprotected sex with someone who was HIV positive.

Dont shake NPH bottles roll them

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Postoperative orders for a client who had a mitral valve replacement include monitoring pulmonary artery pressure together with pulmonary capillary wedge pressure with a pulmonary artery catheter. What is the purpose of these actions by a nurse?

Assess the left ventricular end-diastolic pressure. The pulmonary capillary wedge pressure is reflective of left ventricular end-diastolic pressure. Pulmonary artery pressures are an assessment tool used to determine the ability of the heart to receive and pump blood effectively.

Respiratory rates in a newborn, which is the initial four weeks of life, is 30 to 60 breaths/minute. Periods of apnea often occur, lasting up to 15 seconds. The nurse should reassure the parents that this is an expected finding and is known as "periodic breathing" and occurs as the newborn lungs and brain become more coordinated.

kids

magnesium level

1.5-2.5

magnesium level

1.7-2.2

finding of a bulimia patient...

Common findings of bulimia include electrolyte imbalances, such as hypokalemia, hypocalcemia, hypochloremia, and hyponatremia; BUN is increased. Metabolic acidosis is expected with laxative abuse; metabolic alkalosis is due to vomiting.

isometric

A nurse should instruct the client on isometric exercises for the muscles of the casted extremity. This means the client should be instructed to alternately contract and relax muscles without moving the affected part.

A nurse is caring for a trauma victim who has experienced a significant blood loss. Immediately following multiple transfusions, what is the most accurate indicator of oxygenation?

ABG's

benazepril

ACE Inhibitors slow the activity of the enzyme angiotensin converting enzyme (ACE), which decreases the production of angiotensin II. As a result, blood vessels relax and dilate, blood pressure is lowered, and more oxygen-rich blood can reach the heart.

A client is being maintained on heparin therapy for deep vein thrombosis (DVT). A nurse must closely monitor which of these following laboratory values?

APPT. Heparin is used to prevent further clots from being formed and to prevent the present clot from enlarging. The activated partial thromboplastin time (APTT) test measures the time it takes blood to clot and is used to monitor the effectiveness of heparin therapy. The therapeutic range is about 1 1/2 to 2 or 2 1/2 times the normal values. D-dimer is used to evaluate blood clot formation. Platelet counts are used to evaluate abnormal bleeding times. Bleeding time refers to the time it takes for a pinprick to stop bleeding (normally, about 2 1/2 minutes.)

A nurse discovers that the parents of a 2 year-old child continue to use an apnea monitor each night. The parents state: "We are concerned about the possible occurrence of sudden infant death syndrome (SIDS)." In order to take appropriate action, the nurse must understand which point?

About 95% of SIDS cases occur before 6 months of age

acyclovir

Antivirals are designed to work in one of two ways - they either inhibit the ability to multiply or they mimic the virus attachment protein, disrupting the replication process.

SLE

An inflammatory disease caused when the immune system attacks its own tissues. SE: neuropathy (watch for a increase in BUN levels)

lorsantan

Angiotensin Receptor Blockers block the action of angiotensin II by preventing angiotensin II from binding to angiotensin II receptors on blood vessels. As a result, blood vessels enlarge (dilate) and blood pressure is reduced.

nitroglycerin

Antianginals are vasodilators - they dilate the blood vessels, improving blood flow and allowing more oxygen-rich blood to reach the heart muscle and they also relax the veins.

lorazepam

Antianxiety Agents

montelukast

Antiasthmatics either relax the smooth muscles that line the airway (bronchodilators), block the inflammation that narrows the airways (corticosteroids), counteract substances that cause the air passages to constrict and secrete mucus (leukotriene modifiers), or prevent allergic reactions or asthma symptoms.

enoxaparin

Anticoagulants work by inhibiting clotting factor synthesis, inhibiting thrombin, or by interfering with blood platelet formation. Enoxaparin is classified as a low-molecular-weight heparin (LMWH).

loperamide

Antidiarrheals work in a variety of ways. Some slow the passage of stools through the intestines (like loperamide). Others decrease the secretion of fluid into the intestine and inhibit the activity of bacteria (bismuth subsalicylate).

clotrimazole

Antifungal agents are also called antimycotic agents; they kill or inactivate fungi.

A nurse notes sudden onset confusion in an 83 year-old client. Which recently ordered medication would have most likely contributed to this change?

Antihistamine.Older adults are more susceptible to the side effect of anticholinergic drugs, such as antihistamines. Antihistamines often cause confusion in the older adult, especially at higher doses.

mother wants to switch her 9 month-old infant from an iron-fortified formula to whole milk. Upon further assessment, a nurse finds that the baby eats table foods well, but drinks less milk than before. What information is the priority for the nurse discuss with the mother? offer fruit juice continue introducing new food continue with present infant formula change the baby to whole milk

Continue with the present infant formula. Even though the baby is eating table food and may be drinking less formula that she was before, she still needs to get most of her nutrition from formula (or breast milk.) The recommended age for switching from formula to whole milk is 12 months. That's because babies can't digest cow's milk as completely or easily until they are 12 months and cow's milk doesn't have the right amounts of nutrients (drinking cow's milk may even cause iron-deficiency anemia.)

what foods can a patient with celiac disease have?

Corn, rice, soybeans and potatoes are digestible by persons diagnosed with celiac disease.

corticosteroids

Corticosteroids can lower the amount of potassium in the body so the client should eat more potassium-rich foods.

fluticasone

Corticosteroids mimic the effect of hormones produced naturally by the adrenal glands. When the dose exceeds the body's usual hormone levels, they will suppress inflammation, as well as the immune system; they are also used for their antineoplastic activity.

A postpartum client admits to frequent alcohol use throughout the pregnancy. Which newborn assessment finding does the nurse associate with fetal alcohol syndrome (FAS)?

Craniofacial abnormalities. Characteristic facial abnormalities are seen in the newborn with FAS, including small head circumference, smaller eye openings, flattened cheekbones and indistinct philtrum. Newborns often have a low birth weight (not high birth weight). Other irreversible effects of alcohol exposure during pregnancy include mental retardation and delayed development; heart defects and vision difficulties or hearing problems; learning disorders; and behavior problems.

The mother of a 2 month-old baby calls a pediatrician's nurse two days after the first DTaP, inactivated polio vaccine (IPV), Hepatitis B and Haemophilus influenzae type B (HIB) immunizations. She reports that the baby feels very warm, cries inconsolably for as long as three hours, and has had several shaking spells. Which immunization would the nurse expect to be primarily responsible with these findings?

DTAP. DTaP immunization is a vaccine that protects against diptheria, tetanus and pertussis (whooping cough). The majority of reactions described in this question occur with the administration of the DTaP vaccination. Contraindications to giving repeat DTaP immunizations include the occurrence of severe side effects after a previous dose, as well as signs of encephalopathy within seven days of the immunization.

The nurse is caring for a 10 year-old child who is diagnosed with diabetes insipidus (DI) and is receiving vasopressin. What is the priority for the nurse to teach the child and the family members about this prescribed medication?

Diabetes insipidus is characterized by a decreased secretion of antidiuretic hormone (ADH). Decreased ADH results in polyuria and polydipsia; the person is unable to concentrate urine. Vasopressin is the drug of choice to treat central DI. At home, it can be administered 2-3 times a day, either IM, subQ or intranasally. Not drinking enough fluids can cause arrhythmias, fatigue and muscle pain. Other serious side effects include chest pain, skin discoloration and paresthesia.

The nurse is caring for a client who is experiencing urinary incontinence. Which of the following teaching points should the nurse reinforce when discussing this health issue with the client?

Due to their anticholinergic action on the urinary sphincter and bladder, antihistamines can cause urinary retention, followed by sudden overflow incontinence. Still other antihistamines relax the bladder, which also contributes to incontinence. Avoiding sodium has not been shown to reduce or minimize urinary incontinence. Clients with incontinence should control fluid intake and not drink large amounts of fluids at one time, but they should not restrict fluids. If the bladder becomes over-stretched, the muscle may be permanently damaged and lose its ability to contract.

A nurse administers cimetidine to a 79 year-old male with a gastric ulcer. Which parameter may be affected by this drug and should be closely monitored by the nurse?

mental status. Clients who are over the age of 50 or are severely ill may become temporarily confused while taking H2-receptor blockers, especially cimetidine (Tagamet).

A client is admitted with the diagnosis of meningitis. Which finding should the nurse expect when assessing this client?

Flexion of the hips and knees with passive flexion of the neck. Severe neck stiffness in meningitis causes flexion of hips and knees with passive flexion of the neck, known as Brudzinski's sign. The inability to straighten the legs when the hip is flexed to 90 degrees due to hamstring stiffness, is Kernig's sign another physical finding in meningitis.

fluoxetine side effects

Fluoxetine (Prozac) is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Commonly reported side effects include diarrhea, dry mouth, weight gain (sometimes 4.5 kg or more) and sexual dysfunction; other reported side effects are headache, nausea, and insomnia.

Today's prothrombin time for a client receiving warfarin 20 seconds. The normal range listed by the lab is 10 to 14 seconds. What is an appropriate nursing action?

For the client on warfarin therapy, this prothrombin level is within the therapeutic range. Therapeutic levels for warfarin are usually 1 1/2 to 2 times the normal levels.

Several hours after a gastrectomy, the nasogastric tube (NGT) stops draining. After referring to the standing gastrectomy postoperative orders, what order will the nurse implement first?

Gently irrigate the tube with sterile normal saline. The nurse will assess the position and patency of the NGT, as well as the color and amount of gastric drainage. The nurse can gently irrigate the NG tube with sterile normal saline if it becomes clogged. But if that does not resolve the issue or repositioning the tube is needed, the nurse must call the surgeon. The NGT inserted in surgery should not be repositioned by the nurse because of the risk of disrupting any internal sutures. The NGT should be connected to low suction; it would be contraindicated to increase the suction.

The nurse is preparing a client and her healthy newborn for discharge. The nurse provides information about hormonal effects in newborns and tells the client to expect which of the following conditions in her baby?

Gynecomastia. Exposure to maternal hormones in utero may cause temporary conditions in the newborn. About three days after birth, both newborn boys and girls may experience swelling of the breasts as a result of the withdrawal of maternal estrogen. This should go away by the second week after birth.

The nurse is providing information to a client about a prescribed medication. Which one of these statements, if made by a client, indicates that teaching about propranolol (Inderal) has been effective?

I can have a heart attack if I stop this medication suddenly

A nurse is caring for a client who has developed cardiac tamponade. Which finding would the nurse anticipate?

In cardiac tamponade, intrapericardial pressures prevent adequate filling of the heart from the vena cava, and reduce cardiac output. As a result, venous pressures rise and the neck veins become distended

why do you use a blood warner for infusion

Increases peripheral dilatation and comfort

The nurse is performing pulmonary assessment on a client. Indicate the correct sequence of pulmonary assessment by dragging and dropping the steps below into the correct order.

Inspect, palpate, percussion, auscultation.

injection for children

Intramuscular injections should not exceed a volume of 1 mL for infants and toddlers. Medication doses exceeding this volume should be split into two separate injections of 1 mL each. The nurse would insert the needle at a 90 degree angle into the anterolateral thigh muscle.

The nurse provides regular mouth care to the hospice client who is actively dying at home. The family wants to know why the doctor doesn't order an IV since the client's mouth seems so dry. What information can the nurse provide to the family that best answers their question.

Intravenous hydration can delay death.

The nurse is assessing a client who sustained multiple fractures, contusions, and lacerations in a motor vehicle accident three days ago. The client suddenly becomes confused. Which of the following findings would support the nurse's suspicion that the client has developed a fat embolism? (Select all that apply.)

Manifestations of acute confusion, hypoxia, fever and hypotension may indicate fat embolism in a client who has sustained multiple fractures, particularly fractures of the long bones. The occlusion of dermal capillaries by fat with increased friability of the capillaries can result in skin petechiae. This is most common on the chest, neck, upper arm, axilla, shoulder, oral mucous membranes and conjunctiva.

The nurse is providing care for a client diagnosed with sickle cell crisis. Which medication ordered for pain control should be questioned by the nurse?

Meperidine (Demerol) is not recommended in clients with sickle cell disease. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Clients with sickle cell disease are particularly at risk for normeperidine-induced seizures.

celecoxib

Non-steroidal Anti-inflammatory Drugs (NSAIDs) block the cyclooxygenase (COX-1 & COX-2) enzymes and reduce prostaglandins throughout the body, thereby reducing inflammation, pain, and fever.

ketorolac

Non-steroidal Anti-inflammatory Drugs (NSAIDs) block the cyclooxygenase (COX-1 & COX-2) enzymes and reduce prostaglandins throughout the body, thereby reducing inflammation, pain, and fever. They are used to control mild-to-moderate pain, reduce fever, and to treat various inflammatory conditions, such as osteoarthritis.

meloxicam

Nonopioid Analgesics target and block the chemical substances released by the brain in response to injury (particularly prostaglandin) that facilitate the transmission of the pain stimuli to the brain.

A nurse is performing physical assessments on adolescents. What finding should the nurse anticipate concerning female growth spurts?

Normally, females in their teenage years experience a growth spurt about two years earlier than their male peers

A couple attempting to conceive asks the nurse when ovulation occurs. The woman reports a regular 32-day cycle. Which response by the nurse is correct?

Ovulation occurs 14 days prior to menses. .Considering that the woman's cycle is 32 days, subtracting 14 from 32 suggests ovulation is at about the 18th day.

The nurse is caring for a newly admitted 6 month-old infant diagnosed with nonorganic failure-to-thrive (NOFTT). What findings would the nurse expect to observe during the initial assessment?

Pale skin, thin arms and legs, and uninterested in surroundings

ampicillin

Penicillins belong to a group of antibiotics called beta-lactams, which exert bactericidal action by inhibiting bacterial cell wall production. Currently the group includes more than 20 antibiotics.

spironolactone

Potassium-sparing Diuretics are used to conserve potassium in clients receiving thiazide or loop diuretics; they decrease sodium reabsorption in the collecting tubules of the kidneys.

The nurse is caring for a client with a new prescription for a selective serotonin reuptake inhibitor (SSRI) antidepressant. In reviewing the admission history and physical, which item should prompt questions about the safety of this medication?

Prescribed monoamine oxidase (MAO) inhibitor. SSRIs, including fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro) and others, should not be taken concurrently with monoamine oxidase inhibitors (MAOIs) because serious, life-threatening reactions may occur with this combination of drugs. Common MAOIs include: isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and selegiline (Eldepryl, Zelapar).

lispro

Rapid-acting insulin, such as insulin lispro, covers insulin needs for meals eaten at the same time as the injection. Short-acting insulin covers insulin needs for meals eaten within 30 to 60 minutes. Intermediate-acting insulin covers insulin needs for about half of the day or overnight (and is often combined with rapid- or short-acting insulin). Long-acting insulin covers insulin needs for about one full day.

Raynaud's phenomenon

Raynaud's phenomenon is a condition where cold temperatures or strong emotions cause blood vessel spasms, preventing blood flow to the fingers, toes, ears, and nose. Besides not smoking, the most important teaching would be to avoid cold temperatures. Both cold and nicotine cause arterial vasoconstriction and will aggrevate this phenomenon. The question is asking what is the most important teaching. The other approaches tend to be needed less frequently and so are a lower priority.

The nurse is monitoring a client who is receiving the thrombolytic agent alteplase for treatment of an acute myocardial infarction (AMI). What outcome indicates the client is receiving adequate therapy within the first few hours of treatment?

Reduction of ST-segment elevation on a 12-lead ECG. Alteplase (a t-PA) is used in the management of AMI with ST-segment elevation (STEMI). If thrombolytic therapy was successful, a follow-up ECG will show a reduction of 50% or more in the ST segment. This indicates a return in blood flow to the injured myocardium; however, the ST segment may not return to baseline due to myocardial damage. The other responses are incorrect: successful thrombolysis can cause a variety of cardiac arrhythmias; cardiac enzymes peak 8 hours or more after an AMI; and blood pressure may be unstable.

prominent U wave

potassium

A client with a panic disorder has a new prescription for alprazaolam. In teaching the client about the drug's actions and side effects, which point should the nurse emphasize?

Short-term relief can be expected

bleomycin

pulmonary fibrosis

A child is treated with succimer for lead poisoning. Which of these assessments should the nurse perform first?

Succimer (Chemet) is used in the management of lead or other heavy metal poisoning. Although it has generally well tolerated and has a relatively low toxicity, it may cause neutropenia. Therapy should be withheld or discontinued if the absolute neutrophil count (ANC) is below 1200/µ.

trimethoprim-sulfamethoxazole

Sulfonamides are bacteriostatic and have a broad spectrum of activity against both gram-positive and gram-negative bacteria. They are typically used in the treatment of urinary tract infections and also some types of bacterial pneumonia (Pneumocystis Carinii), shigellosis, as well as some protozoal infections.

plastic thoracolumbosacral orthotic

The TLSO is a custom molded brace prescribed to give support to the spinal column from the sixth thoracic vertebra to the sacrum. Clients are advised to wear only a tight fitting t-shirt under the brace to protect the skin and absorb sweat. Although the brace will not be damaged by water, it is typically removed when showering; the client will need to lie down to remove or put on the brace. The health care provider will instruct the client about how often and how long to wear the brace each day. The client is instructed not to attempt to bend or to lift objects weighing more than 10 pounds.

A community health nurse has been caring for a 16 year-old who is 22-weeks pregnant with a history of morbid obesity, asthma and hypertension. Which of these lab reports need to be communicated to the health care provider as soon as possible? Magnesium 0.8 mEq/L (0.33 mmol/L) and creatinine 3 mg/dL (265.2 μmol/L)

The magnesium is low and the creatinine is high, indicating acute renal failure - this is the highest priority. With the history of hypertension, the findings may indicate preeclampsia. The rest of client's lab values are all abnormal except for the platelets. The client needs to be referred for immediate follow-up with a health care provider.

A 16 year-old adolescent is admitted for Ewing's sarcoma of the tibia. In discussing the care with the parents, the nurse should understand that the initial treatment for this diagnosis usually includes which approach?

The initial approach for the treatment of Ewing's sarcoma is usually a combination of radiation and chemotherapy to reduce the size of the tumor.

A newborn weighed 7 pounds 2 ounces at birth. The nurse assesses the newborn at home two days later and finds the weight to be 6 pounds 7 ounces. What should the nurse tell the parents about this weight loss?

The loss is within normal limits for this time period. A newborn is expected to lose 5 to 10% of the birth weight in the first few days postpartum because of changes in elimination and feeding. Within one week the newborn should regain the weight or exceed the birth weight.

Milwakee brace

it is used to correct scoliosis, the lateral curvature of the spine.

clarithromycin

They are used in the treatment of various systemic and local bacterial infections of the respiratory tract, gastrointestinal tract, and soft tissues; they are also effective in treating severe acne and sexually transmitted infections. They are used prophylactically in the prevention of whopping cough and the prevention of endocarditis in dentistry.

chlorothiazide

Thiazide Diuretics are derived from a chemical called benzothiadi(A)zene. They work in the distal convoluted tubule by decreasing the kidney's reabsorption of sodium and chloride (which results in increased urine production) and they also help dilate blood vessels.

streptokinase

Thrombolytics convert plasminogen to plasmin, which then degrades fibrin in clots. They are used for the acute management of coronary thrombosis (MI), massive pulmonary emboli, deep vein thrombosis, and arterial thromboembolism.

The nurse is assessing a client with portal hypertension. Which findings should the nurse expect during the assessment?

acities. Portal hypertension can occur in a client with right-sided heart failure or cirrhosis of the liver. Portal hypertension can lead to ascites from the increased portal pressure as well as a lowered colloid osmotic pressure because of low albumin. When liver functioning deteriorates, protein metabolism is decreased with the result of a low serum albumin

rheumatoid arthritis drugs (tumor necrosis factor)

adalimumab, etanercept, infliximab (major adverse effects include immunosuppression and infection)

constipation

adynamic ileus due to neurotoxicity

latex allergies

allergy to bananas, avocados, and papayas

polycthemia

an abnormally increased concentration of hemoglobin in the blood, through either reduction of plasma volume or increase in red cell numbers.

Russell Sign

anorexia nervosa

side effects of digitalis

anorexia, N/V, yellow vision, arrhythmia

The beta-agonist drugs

are bronchodilators that relieve bronchospasm by relaxing the smooth muscle of the airway. These drugs should be taken first so that other medications can more deeply and effectively penetrate the lungs.

A client who is diagnosed with multiple sclerosis plans to begin an exercise program. What should the nurse be sure to emphasize when discussing this topic with the client?

avoid dehydration. Clients with MS who participate in regular aerobic exercise have better cardiovascular fitness, greater strength, better bowel and bladder function, less fatigue and less depression. But the client must take in adequate fluids before and during exercise periods to prevent dehydration. It is recommended that clients with MS exercise when it is cooler and perform exercise earlier in the day to avoid fatigue.

Indwelling urinary catheter

empty the bladder quickly and completely

A nurse is preparing a 5 year-old for a scheduled tonsillectomy and adenoidectomy when the parents express anxiety and concern about the child's reaction to impending surgery. Which nursing intervention should best prepare the child?

explain the surgery one week prior to the procedure.

The nurse works in an assisted living facility and cares for older adults. The nurse understands that older adults are at a greater risk for drug toxicity than younger adults due to which physiological change associated with aging?

older adults have less water and more fat.

The nurse is assessing a client who has paraplegia. What finding would indicate the probable presence of a fecal impaction?

oozing loquid stool. When the bowel is impacted with hardened feces, there is often a seepage of liquid feces around the obstruction. This is often mistaken for uncontrolled diarrhea. This is a classic finding associated with fecal impaction.

vincristine

peripheral neuropathy, consitpation

cisplatin

peripheral neuropathy, constipation, ototoxicity

The father of an 8 month-old asks the nurse if the child's vocalizations are normal for his this age. Which sound should the nurse expect from a child at this age?

Imitation of sounds

fetal alcohol syndrome

low-set ears, short palpebral fissures, flat nasal bridge and indistinct philtrum

A nurse is assessing a healthy child at the two-year check up. Which finding should the nurse report immediately to the health care provider?

Height and weight percentiles vary widely

A nurse is completing the initial assessment for a child immediately after a surgical correction of a ventricular septal defect. Which nursing assessment should be a priority during the process?

Observe for postoperative arrhythmias.

epinehrine

Vasopressors are potent vasoconstrictors, producing a rise in blood pressure (increase in mean arterial pressure).

cyanocobalamin

vit b12 deficiency

A 6 year-old child diagnosed with acute glomerulonephritis (AGN) presents with anorexia, moderate edema and elevated blood urea nitrogen (BUN) levels. The child requests a peanut butter sandwich for lunch. How should the nurse respond to this request?

"I know that is your favorite, but let me help you pick another lunch." Children with AGN who have edema, hypertension, oliguria and azotemia may have dietary restrictions limiting sodium, fluids, protein and potassium. Because peanuts are made of protein, fats, and carbohydrates, and the sodium content of a tablespoon of peanut butter can be as high a 80 mg, a different choice for lunch might be best. Giving the child a short explanation and offering to talk about an alternative food is appropriate for this age.

A staff nurse complains to the nurse manager that an unlicensed assistive personnel (UAP) consistently leaves the work area untidy and does not restock supplies. The initial response by the nurse manager should be which of these statements?

"I would like for you to approach the UAP about the problem the next time it occurs."

A nurse administered intravenous immune globulin to an 18 month-old child with immune deficiency disorder. The parents asks why this medication is being given. How should the nurse respond?

"This medication is used to prevent bacterial infections." intravenous immune globulin is given to help prevent, as well as to fight, bacterial infections in young children with immune deficiency disorders. Immune globulin is made of antibodies from at least 1,000 donors to provide protection against a wide variety of infections.

A nursing assistant is taking care of a 2 year-old child with Wilm's tumor. The assistant asks the nurse why there is a sign above the bed that says DO NOT PALPATE THE ABDOMEN. Which statement by the nurse would be the best response?

"Touching the abdomen could cause cancer cells to spread."

The nurse is assessing an 8 month-old infant diagnosed with atonic cerebral palsy. Which statement from the parent supports this diagnosis?

"When I put her on her back to sleep, she's still in the same position a few hours later." Cerebral palsy is known as a condition whereby motor dysfunction occurs secondary to damage in the motor centers of the brain. Inability to roll over by eight months of age would illustrate one delay in the infant's attainment of developmental milestones. Cerebral palsy is most commonly associated with cerebral hypoxia during the birth process.

A client has had a positive reaction to purified protein derivative (PPD). When the client asks, "What does this mean?" the nurse should respond with which statement?

"You have been exposed to the organism Mycobacterium tuberculosis

The nurse is caring for a client in the late stages of amyotrophic lateral sclerosis (ALS). Which finding would the nurse expect?

. shallow respirations. ALS is a chronic progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord. In ALS, upper and lower motor neurons degenerate (die) and stop sending messages to muscles; all muscles under voluntary control eventually weaken and atrophy. People eventually lose their ability to speak, eat, move and breathe. However, ALS does not impair a person's mind or intelligence. ALS does not affect a person's ability to see, smell, taste, hear or recognize touch.

azathioprine

Immunosuppressants inhibit cell-mediated immune responses. Azathioprine can also be categorized as an Antirheumatic. Most of these drugs are used in the prevention of transplantation rejection reactions; others are used in the management of selected autoimmune diseases (for example, nephritic syndrome of childhood and severe rheumatoid arthritis).

The client, diagnosed with an acute anterior MI, has a triple lumen infusing with nitroglycerin, alteplase and heparin. The client reports experiencing angina. Which intervention is the priority?

Administer intravenous morphine sulfate as ordered. Nitrates are useful for pain control due to their coronary vasodilating effects. The nurse will titrate the intravenous nitroglycerin infusion for chest pain according to standing orders but if chest pain is unrelieved by the nitroglycerin infusion, the nurse can administer morphine intravenously (IM injections are avoided because they can alter the CPK.) Morphine not only relieves pain and reduces anxiety, but also dilates blood vessels.

A client has been given a prescription for alendronate. Which of the following statements indicate the client understands how to safely take this medication? (Select all that apply.)

Alendronate (Fosamax) can cause esophagitis or esophageal ulcers unless precautions are followed. The client must be able to sit upright or stand for at least 30 minutes after taking the tablet. The client should take the tablet first thing in the morning, with a full glass of water, at least 30 minutes before eating or drinking anything or taking any other medication.

A client on warfarin therapy after coronary artery stent placement calls the clinic to ask: "Can I take Alka-Seltzer for an upset stomach?" What is the best response by the nurse?

Alka-Seltzer is an over-the-counter aspirin-antacid combination. Aspirin is an antiplatelet drug and taking this with warfarin will potentiate the anticoagulant effects of warfarin (Coumadin), which may increase the risk of bleeding.

gentamicin

Aminoglycosides are bactericidal; they primarily act by inhibiting protein synthesis in bacteria and compromising the structure of the bacterial cell wall.

Aminophylline side effects

Aminophylline is a bronchodilator often used to treat symptoms of asthma, bronchitis, and emphysema. Side effects include restlessness and palpitations (it is related chemically to caffeine).

fexofenadine

Antihistamines compete with histamine for histamine receptor sites and when they occupy the histamine receptor sites, they prevent histamine from causing allergic symptoms.

methotrexate

Antineoplastics inhibit or prevent the development, maturation or spread of neoplastic cells by various different mechanisms of action

clopidogrel

Antiplatelet Agents block the formation of blood clots by preventing the clumping of platelets. They are used to treat and prevent thromboembolic events, e.g., stroke, myocardial infarction, peripheral vascular disease. They are used after stent, artificial heart values, and other devices that are placed inside the heart or blood vessels.

isoniazid (INH)

Antituberculars have various actions that affect mycobacteria, with most having bactericidal (for example, rifampin) and/or bacteriostatic (for example, isoniazid) actions. They used in the treatment and prevention of tuberculosis (TB).

The nurse is caring for a client who has a wound on the leg from a motorcycle accident. During a home visit, the nurse should use which assessment parameter as an indication that this client is experiencing normal wound healing?

As the wound granulates, pebbled red tissue in the wound base indicates healing. Any of the other findings would indicate that the wound was not healing properly.

clonazepam

Some Anticonvulsants are thought to generally depress central nervous system function. Others (such as GABA inhibitors) are thought to target specific neurochemical processes, suppress excess neuron function, and regulate electrochemical signals in the brain. Clonazepam is also categorized as a Benzodiazepine.

While caring for a client, the nurse notes a pulsating mass in the client's periumbilical area. Which of these assessments is appropriate for the nurse to perform on the mass?

Auscultation of the abdomen and the finding of a bruit would confirm the presence of an abdominal aneurysm. This would form the basis of information to be given to the health care provider. The mass should not be palpated or percussed because of the risk of rupture.

The client is diagnosed with gastroesophageal reflux disease (GERD). Which recommendation made by the nurse would be most helpful?

Avoid eating two hours before going to sleep

A nurse is caring for a 4 year-old child admitted after being burned over more than 50% of the body. Which laboratory data should be reviewed by the nurse as a priority in the initial 24 hours?

BUN

A client who is newly diagnosed with hypertension is prescribed benazepril. What is the most important point to make when teaching the client about this medication?

Benazepril (Lotensin) is an angiotensin converting enzyme (ACE) inhibitor. Even if you don't know this drug, remember that the spelling of ACE inhibitors usually end with "pril." One of the side effects of ACE inhibitors is a dry cough; sometimes the cough is severe enough to require discontinuation of the drug. But the most important point to make is that if the client's voice changes or "sounds funny" or there is any swelling of the lips, tongue or throat, the client should contact the health care provider because this could indicate angioedema, a potentially fatal condition.

midazolam

Benzodiazepinesde press the CNS, probably by potentiating GABA, which is an inhibitory neurotransmitter. Midazolamcan also be categorized as a Sedative/Hypnotic. These are all Schedule IV drugs.

The pregnant woman asks how a health care provider (HCP) can tell she is pregnant "just by looking inside." What is the best explanation for this?

Bluish coloration of the cervix and vaginal walls. Chadwick's sign is a bluish-purple coloration of the cervix and vaginal walls. It develops after the 6 to 8 weeks and is caused by increased blood supply to the area. Other early signs of pregnancy include Hegar's sign (a softening of the cervical isthmus) and Goodwell's sign (a softening of the cervix), but the HCP would need to compress the tissue to assess these findings. The HCP would not see the mucus plug; the mucus plug dislodges, breaks up and passes out of the body just prior to labor.

risedronate

Bone Resorption Inhibitors bind to hydroxyapatite in bone and inhibit bone resorption by decreasing the number and activity of osteoclasts. They are primarily used in the prevention and treatment osteoporosis in postmenopausal women; they are also used to treat osteoporosis due to other causes, e.g., Paget's disease of the bone and corticosteroid therapy.

The nurse is caring for a 4 year-old child with a greenstick fracture. In explaining this type of fracture to the parents, the best comment by the nurse should include which point?

Bones of children are more porous than adults' and often have incomplete breaks. This allows the pliable bones of growing children to bend, buckle, and break in a "greenstick" manner. A greenstick fracture occurs when a bone is angulated beyond the limits of bending. The compressed side bends and the tension side develops an incomplete fracture.

Intravenous pyelogram (IVP)

Bowel prep is important prior to this procedure because a cleaned out GI tract allows greater visualization of the bladder and ureters.

A nurse is performing an assessment on a client with pneumococcal pneumonia. Which finding should the nurse anticipate?

Bronchial breath sounds in the outer lung fields

The client is seen in the emergency one day after falling in his bathroom at home. The client reports having "a few drinks" prior to the fall. Which finding requires the nurse's immediate attention?

Bruise behind one ear. Bruising behind one ear (over the mastoid process) requires the nurse's immediate attention. Known as "Battle's sign", this injury is seen a day or so following a basilar skull fracture. A CT scan of the brain will confirm a skull fracture. The client may report loss of hearing, smell or vision and he may have blood leaking from the ear. The vomiting and headache could be due to his alcohol intake, as well as the skull fracture.

promethazine

Some Antiemetics may inhibit the chemoreceptor trigger zone in the medulla by blocking dopamine receptors; others act by decreasing the sensitivity of the vestibular apparatus. Phenergan has different effects on the brain - both antihistamine and anticholinergic activity.

The nurse is teaching diet restrictions to a client diagnosed with Addison's disease. The client indicates an understanding of the dietary restrictions when making which of these statements?

I will increase sodium and fluids and restrict potassium. The manifestations of Addison's disease (also called adrenal insufficiency or hypocortisolism) are due to mineralocorticoid deficiency that results in renal sodium wasting and potassium retention. Other findings are dehydration, hypotension, hyponatremia, hyperkalemia and metabolic acidosis.

verapamil

Calcium Channel Blockers slow the rate at which calcium passes into the heart muscle and into the vessel walls; this relaxes the vessels and allows blood to flow more easily through them, thereby lowering blood pressure.

The nurse is teaching a group of women in a community clinic about prevention of osteoporosis. Which over-the-counter medication should the nurse recognize as having the most elemental calcium per tablet?

Calcium carbonate contains 400 mg of elemental calcium in 1 gram of calcium carbonate.

Captopril SE

Captopril is an ACE inhibitor used to control blood pressure. Some common side effects include rash, itching and blurred vision. Like many antihypertensives, ACE inhibitors can cause impotence. But a chronic cough is one of the most common and disturbing problems for clients using ACE inhibitors, prompting a change in blood pressure medication.

The nurse must remove a fecal impaction in a 75 year-old client. During the procedure, the nurse should remember what critical information?

Cardiac dysrhythmias such as severe bradycardia can occur from vagal nerve stimulation during fecal impaction removal. The other actions are appropriate though they are not the priority consideration.

cephalexin

Cephalosporins belong to a group of broad spectrum, semi-synthetic beta-lactam antibiotics derived from the mold Cephalosporium. The mechanism of action is the same as penicillins (they interfere with bacterial cell wall synthesis). An example of a 1st generation Cephalosporin is cephalexin.

changes in speech and altered LOC

Changes in speech patterns and level of conscious are indicators of potential continued intracranial bleeding or extensions of a stroke. Further diagnostic testing may be indicated. Recall the word "FAST" with stroke findings: "F" is for changes in the face such as drooping of corner of the eye or mouth, "A" is for a drifting down of one arm when the arms are raised to shoulder height, "S" is for slurred speech and "T" is to telephone 911.

A nurse is teaching adolescents about sexually transmitted diseases. What should the nurse emphasize is the most common infection?

Chlamydia is the most frequently reported bacterial sexually transmitted disease in the United States. Prevention is similar to safe sex practices taught to prevent any sexually transmitted disease, such as abstinence, and the use of a condom and spermicide for protection during intercourse. This infection has subtle findings so the infected persons are less likely to pursue medical attention.

The nurse is caring for a client with total parenteral nutrition (TPN). What is the most important action on the part of a nurse?

Clients receiving TPN are very susceptible to infection. The concentrated glucose solutions are a good medium for bacterial growth. Strict sterile technique is crucial in preventing infection at IV infusion site.

The client is being treated for tuberculosis (TB). Which assessment would indicate that the client is having a possible adverse response to isoniazid?

Clients who are being treated with isoniazid are at risk for developing drug-induced hepatitis. The appearance of jaundice may indicate an elevation of the client's serum bilirubin levels; liver enzymes (AST and ALT) will also be elevated. A small number of adults taking isoniazid develop severe hepatitis that may progress to liver failure and even death unless the drug is stopped immediately.

A client is admitted with the diagnosis of pulmonary embolism (PE). While taking a history, the client says: "I was admitted for the same thing twice in the past six months. In fact, the last time was just three months ago." The nurse should anticipate a need for education may be centered around which approach to treatment?

Clients with recurrent PE or those with excessive clotting complications related to medical therapy may require vena cava interruption. This is the placement of a filter device in the inferior vena cava. A filter can be placed transvenously to trap clots before they travel into the pulmonary circulation.

Due to a recent outbreak in the community, the nurse is speaking to a group of parents and elementary school teachers about rheumatic fever. Which information is most important for the nurse to emphasize?

Clumsiness and behavior changes should be reported. Sydenham chorea is a major sign of acute rheumatic fever; it may be the only sign of rheumatic fever in some clients. Symptoms include jerky, uncontrollable, and purposeless movements that look like twitches (these disappear during sleep); loss of fine motor control (causing changes in handwriting); and loss of emotional control (as evidenced by inappropriate crying or laughing). Sydenham chorea usually clears up in a few months and no complications are expected.

The nurse is caring for a child who is diagnosed with coarctation of the aorta. Which finding would the nurse expect when assessing the child?

Coarctation of the aorta, which is a narrowing or constriction of the descending aorta, causes increased blood flow to the upper extremities, resulting in a bounding pulse in the arms. Cardinal signs include resting systolic hypertension, absent or diminished femoral and pedal pulses, and a widened pulse pressure.

propranolol side effects

Common side effects of this drug include nausea, diarrhea, constipation, stomach cramps, rash, tiredness, dizziness, sleep problems, and vision changes. Additionally, propranolol may cause decreased sex drive, impotence or difficulty having an orgasm in men.

Which of these client's behaviors would indicate that the nurse-client relationship has passed from the orientation phase to the working phase?

Identifies feelings about situations and expresses them appropriately. The working phase of the nurse-client relationship is also called exploration or the identification stage. That's because the client identifies his/her problems and works with the nurse to solve problems and develop coping skills, a positive self concept and, eventually, independence. These skills will help the client to adapt and behave more appropriately.

A man diagnosed with epididymitis two days ago calls the nurse at a public health clinic to discuss his diagnosis. Which information is most important for the nurse to ask about at this time?

Epididymitis can result from Chlamydia, a sexually transmitted infection. The client may need to be tested, and if positive his sexual partners should be tested as well. All of the questions should be asked, however, the determination of the reason for the client's referral is the most important to start with.

A client initially experiences a large local reaction with swelling of the entire leg after being stung by a bee. A concerned family member drives the client to the emergency department. The client is now having difficulty breathing and has swelling of the tongue. Which of the following medications should be administered first?

Epinephrine (Adrenaline) IV. Difficulty breathing and swelling of the face, eyes or tongue are severe and life-threatening allergic reactions to the allergen. Epinephrine, 0.3-0.5 mL of a 1:1000 solution may be administered IM but airway obstruction due to angioedema, respiratory compromise due to bronchospasm, or circulatory collapse (or combination of these 3 conditions) requires IV administration. The other medications are more appropriate for mild-to-moderate distress: antihistamines, such as diphenhydramine or hydroxyzine, or oral steroids can help reduce the severity of the itching and albuterol may be used for treatment of bronchospasm without obstruction.

A 35 year-old female client talks to the nurse in her health care provider's office about her new diagnosis of uterine fibroids. What statement by the woman is incorrect and indicates that more teaching is needed?

Even if the fibroids cause no problems, they will still need to be taken out."

Parents of a 7 year-old child call a community clinic nurse because their daughter was sent home from school because of a rash. The child had been seen the day before by the health care provider and was diagnosed with fifth disease (erythema infectiosum). What is the most appropriate action by the nurse?

Explain that this rash is not contagious and does not require isolation. Fifth disease is a viral illness with an uncertain period of communicability (perhaps one week prior to and one week after onset). Isolation of the child with fifth disease is not necessary except in cases of hospitalized children who are immunosuppressed or have aplastic crises. The parents may need written confirmation of this from the health care provider to give to the teacher.

The nurse is teaching a 10 year-old child prior to heart surgery. Which form of explanation meets the developmental needs of this age child?

Explain the surgery using a model of the heart. According to Piaget, the school-age child is in the concrete operations stage of cognitive development. The use of something concrete, like a model will help the child understand the explanation of the heart surgery.

A client is being discharged home today and will be taking potassium (K-Dur) 20 mEq per day by mouth. What should the nurse advise the client to avoid due to its effects of lowering serum potassium levels?

Frequent daily snacks of black licorice. Excessive intake of black licorice can lead to decreased serum potassium due to the effect of glyceric acid (aldosterone effect). The excessive use of salt substitutes (which usually contain potassium chloride), potassium-sparing diuretics and NSAIDs have the potential for raising potassium levels.

post op draining. when should you call the doctor?

If the drainage exceeds 100 mL/hr, the nurse should call the surgeon.

An 8 year-old child is hospitalized with minimal-change disease (MCD). The nurse assists the child to select a lunch menu. Which menu selection is the best choice?

Grilled chicken strips, corn on the cob with 1 pat of butter, skim milk. MCD is a kidney disease in which large amounts of protein are lost in the urine. Corticosteroids are used to treat the disease; ACE inhibitors and diuretics are used to treat the edema. Treatment also includes eating a healthy, low-sodium diet with high-quality protein. Of the given choices, grilled chicken strips, corn on the cob and a glass of skim milk has the smallest total sodium content (less than 500 mg) and is the healthiest diet. Since nearly every layer of a sandwich is loaded with salt, the bologna and cheese sandwich (with around 1260 mg sodium) and the frankfurter on the bun (717) are not the best choices. However, the peanut butter and sliced banana sandwich, apple and milk option is a close second (about 650 mg sodium.)

The nurse is caring for a 4 year-old who will have surgery for tetralogy of Fallot tomorrow. Which laboratory report must receive priority attention by the nurse?

H & H. Tetralogy of Fallot is a cyanotic heart defect, which can manifest in polycythemia due to release of erythropoietin. Hemoglobin values of up to 20 and hematocrit's of 60 or higher may be seen. These must be noted and reported to the health care provider.

The nurse is caring for a client who received tenecteplase to open an occluded coronary artery following an acute myocardial infarction. Which finding should cause the greatest concern for the nurse?

Hematemesis. Hemorrhage, or bleeding, is the most common risk associated with any thrombolytic. Tenecteplase (TNKase) is currently indicated for the management of acute myocardial infarction (AMI). Minor bleeding from the gums or nose can occur in about 25% of people who receive these drugs. Remember that the spelling of many of the generic thrombolytic agents end with "ase."

A client with heart failure has digoxin ordered. What would the nurse expect to find when evaluating for the therapeutic effectiveness of this drug?

Improved respiratory status with increased urinary output. Digoxin, a cardiac glycoside, is used in clients with heart failure to slow and strengthen the heartbeat. As cardiac output is improved, renal perfusion is improved and urinary output increases. Clients can become toxic on this drug, indicated by findings of bradycardia or tachycardias above 120, arrhythmia, visual or gastrointestinal disturbances. Clients being treated with digoxin should have the apical pulse evaluated for one full minute prior to the administration of the drug.

The nurse is teaching the client with chronic renal failure (CRF) about medications. The client questions the purpose of taking aluminum hydroxide. What is the best explanation for the nurse to give the client about the therapeutic effects of this medication?

It decreases serum phosphate. Aluminum binds phosphates that tend to accumulate in the client with chronic renal failure due to decreased filtration capacity of the kidney

The nurse is caring for a child diagnosed with Kawasaki disease (mucocutaneous lymph node syndrome or infantile polyarteritis). The nursing care plan should be based on the knowledge that this child is at risk for developing what complication?

Kawasaki disease affects the mucus membranes, lymph nodes, walls of the blood vessels and the heart. It can cause inflammation of the arteries, especially the coronary arteries of the heart, which can lead to aneurysms and possible heart attack in the child.

The nurse is caring for an unconscious client. To prevent keratitis, the nurse should apply moisturizing ointment to which area of the body?

Keratitis is eye inflammation from a corneal ulcer or abrasion. Keratitis is caused by exposure to the air without the normal blink. It requires regular applications of moisturizing ointment to the exposed cornea and a plastic bubble shield or eye patch.

The home health nurse is visiting a client recently discharged after an episode of acute pyelonephritis. Which nursing action should take the highest priority?

Observe client findings for the effectiveness of antibiotic therapy. The priority nursing action is to determine whether the antibiotic therapy has been effective in treating this serious kidney infection. Fever, flank pain, nausea and vomiting would be indicators that the antibiotic therapy has not been effective, requiring contact with the provider for further treatment orders.

A nurse is caring for a client who is receiving methyldopa. Which assessment finding would indicate to the nurse that the client may be having an adverse reaction to the medication?

Methyldopa (Aldomet) is used to treat hypertension. The nurse should assess the client for alterations in mental status, such as sedation. Other common side effects are dizziness, dry mouth, headache and weakness. These changes should be reported to the health care provider.

potassium bicarbonate & potassium citrate

Minerals/electrolytes/pH modifiers are taken to correct imbalances of substances in the blood (minerals and electrolytes) or to make the urine more alkaline (pH modifiers). They are used in the prevention and treatment of any deficiencies or excesses of electrolytes. Acidifiers and alkalinizers are also used to prevent crystals from forming in the urine and inhibit the formation of kidney stones. Magnesium sulfate is used for pre-eclampsia and eclampsia. Some of these meds are used to neutralize gastric acid.

A practical nurse (PN) is assigned to care for a newborn with a neural tube defect. Which dressing, if applied by the PN, would be correct and need no further intervention by the charge nurse?

Moist, sterile nonadherent dressing

A nurse is caring for a client with renal calculi. Which focus of the health care provider's orders would be a priority?

Morphine sulfate using patient-controlled analgesia. The priority action is to administer narcotic analgesics, which will provide prompt relief of the severe pain caused by kidney stones. Intravenous fluids will help with hydration and if the client isn't vomiting, oral fluids (two to three quarts a day) will help move the stone through the urinary system.

The nurse is caring for a client who is in the advanced stage of multiple myeloma. Which action should be included in the plan of care?

Multiple myeloma occurs when abnormal plasma cells (myeloma cells) collect in several bones. This disease may also harm other tissues and organs, especially the kidneys. This type of cancer causes hypercalcemia, renal failure, anemia,and bone damage. Because multiple myeloma can cause erosion of bone mass and fractures, extra care should be taken when moving or positioning a client due to the risk of pathological fractures.

An infant has just had a pyloromyotomy. Initial postoperative nursing care would include which of these approaches?

NPO then glucose and electrolyte solutions. Pyloric stenosis is caused when a muscle between the stomach and duodenum grows too large and thick, blocking food from being pushed from the stomach into the duodenum. During a pyloromyotomy, the surgeon cuts through the thickened muscle. Postoperatively, the initial feedings for infants are small quantities of clear liquids, such as glucose water or water with electrolytes in it. If the infant tolerates clear liquids, caregivers will give watered-down breast milk or formula; feedings are then advanced to regular breast milk or formula.

infliximab

Some Antirheumatics relieve pain (analgesics), some reduce inflammation (NSAIDs & steroids), while others control the underlying disease (disease modifying rheumatoid arthritis drugs or DMARDs & biologic drugs, like infliximab).

A nurse is teaching a school-age child and family members about the use of inhalers prescribed for asthma. What is the best way to evaluate the effectiveness of the treatments?

Observe us of peak flow meter. The peak flow meter can help determine if the symptoms of asthma are in control or are worsening. It works by measuring how fast air comes out of the lungs when the client forcefully exhales (the peak expiratory flow or PEF) after inhaling fully. The client should record the highest of three readings in an asthma diary. Children ages 4 and up should be able to use a peak flow meter.

The nurse observes 4 year-old children playing in the hospital playroom. What activity does the nurse expect to see?

Older preschoolers (4 years) will develop the necessary social, problem-solving and creative skills by playing with friends and engaging in simple games and activities. This is cooperative play. Younger preschoolers (3 years) and older toddlers engage in parallel play (playing with their own toys next to other children) or associative play (playing separately, but talking to each other.) School-age children follow rules designed by others, as in board games.

A nurse is caring for a 14 month-old just diagnosed with cystic fibrosis. The parents state this is the first child in either family diagnosed with this disease, and ask about the risk to future children. What is the best response by the nurse?

One in four risk for each child to have the disease. Cystic fibrosis has an autosomal recessive transmission pattern. In this situation, both parents must be carriers of the trait for the disease because neither one of them has the disease. Therefore, for each pregnancy, there is a 25% chance of the child having the disease, 50% chance of carrying the trait and a 25% chance of having neither the trait nor the disease.

fentanyl

Opioid Analgesics interact with opioid receptors in the central nervous system, acting as agonists of endogenously occurring opioid peptides (eukephalins and endorphins); this action alters perception and response to pain. They can be categorized as long-acting, short-acting, or rapid-onset agents. Fentanyl is a rapid-acting and long-acting Opioid Analgesic approved for cancer breakthrough pain. They are all Schedule II drugs.

Orchiectomy

Orchiectomy is the removal of the testicles

A nurse is talking by telephone with a parent of a 4 year-old child who has chickenpox. Which approach demonstrates appropriate teaching by the nurse?

Papules, vesicles and crusts will be present at one time. All three stages of the chickenpox lesions will be present on the child's body at the same time. Children should not be medicated with aspirin due the possibility of developing Reye's syndrome. A person with chickenpox is contagious one to two days before their blisters appear and remain contagious until all the blisters have crusted over. Antiviral medications are not usually prescribed to otherwise healthy children. Over-the-counter hydrocortisone creams can help relieve itchy skin.

The nurse is making rounds with the pediatrician on the postpartum unit. Which of the following newborns should the pediatrician see first?

Part of the examination of a newborn is to palpate suture lines; they should be palpable and separated. In cases where there is molding present, they may overlap. If suture lines are widely spaced it may be an indication of hydrocephaly or growth restriction. All the other findings are within normal limits for newborns at term: they usually pass their first meconium stool within 12 to 24 hours after birth; normal blood glucose is 40-60 mg/dL (hypoglycemia is anything < 40 mg) and umbilical cords have two arteries and one vein (only one artery can be indicative of a renal anomaly in the newborn.)

what do monitor when giving phenytoin?

Phenytoin causes thickening or enlargement of gingiva (gingival hyperplasia). Although this may be dose-related, it can be minimized by good dental care, such as frequent brushing and daily flossing. Any liquid medication must be measured using a measuring spoon or medicine cup, not a tablespoon. Phenytoin is an anticonvulsant drug that is used to treat seizures.

A client is admitted to the psychiatric unit with a diagnosis of bipolar disorder. This client constantly "bothers" other clients, tries to help the housekeeping staff, demonstrates pressured speech and demands constant attention from the staff. Which activity should the nurse attempt to get the client to do? ping pong, cards, checkers, read a book

Ping-pong provides an outlet for physical energy and requires limited attention. The other options would over-tax the client's level of self-control because the client has a need to be active

The nurse is teaching a client about an oral hypoglycemic medication. The nurse should place primary emphasis on which of the following points?

Taking the medication at specified times

The nurse explains dietary restrictions to a client who is taking tranylcypromine. Which food selection would be contraindicated for this client?

Red wine and cheese contain tyramine, as do chicken livers and ripe bananas. Foods containing tyramine are contraindicated when taking an MAOI like tranylcypromine (Parnate). Fava beans contain other vasopressors that can interact with MAOIs, causing malignant hypertension.

A newborn who is delivered at home and without a birth attendant is admitted to the hospital for observation. The initial temperature is 95 F (35 C) axillary. The nurse should recognize that cold stress may lead to what complication?

Reduced partial pressure of oxygen in arterial blood (PaO2). Hypothermia and cold stress cause a variety of physiologic stresses including increased oxygen consumption, metabolic acidosis, hypoglycemia, tachypnea and decreased cardiac output. The baby delivered in such circumstances needs careful monitoring. In this situation, the newborn must be warmed immediately to increase its temperature to at least 97 F (36 C). Normal core body temperature for newborns is 97.7 F to 99.3 F (36.5 C to 37.3 C).

The nurse is consulting with a nutritionist regarding an appropriate diet for a client recently diagnosed with renal disease. Select the most appropriate diet for the client with renal disease.

Restricted protein, low sodium, low phosphorus

rheumatic fever

Rheumatic fever, also known as acute rheumatic fever (ARF), is an inflammatory disease that can involve the heart, joints, skin, and brain.[1] The disease typically develops two to four weeks after a throat infection.[2] Signs and symptoms include fever, multiple painful joints, involuntary muscle movements, and a characteristic but uncommon non itchy rash known as erythema marginatum

A client is diagnosed with rheumatoid arthritis (RA). Which types of drugs might the nurse expect to be ordered as a combination drug therapy regimen? (Select all that apply.) Biological-response modifers anti imflammatory glucocorticoids

Rheumatoid arthritis is a chronic, systemic autoimmune disorder that results in symmetric joint destruction. Research shows that multiple drug therapy is most effective in protecting against further destruction and promoting function. Analgesics and anti-inflammatory drugs are used. Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate help slow or stop progression of RA. Biological response modifiers are used to help stop inflammation. Glucocorticoids can also be used for severe RA or when RA symptoms flare to ease the pain and stiffness of affected joints. Because RA is not an infectious disease, antimicrobials are ineffective. Although there is swelling in the joints, it is not fluid, so diuretics are not part of the treatment plan.

flecainide

Some Antiarrhythmics slow down the heart (the calcium channel blockers, digoxin, and beta-blockers); other slow the heart's electrical impulses by blocking the heart's potassium channels (amiodarone, sotalol, dofetilide). They are generally classified by their effects on cardiac conduction tissue (Class IA, IB, IC, II, III, IV). Flecainide is in Class IC.

6 year-old child with moderate edema and severe hypertension associated with acute glomerulonephritis (AGN) is admitted to the hospital. Which intervention would be the priority for the nurse?

SZ precautions. The severity of the acute phase of AGN is variable and unpredictable. A child with edema, severe hypertension and gross hematuria may be subject to complications such as the development of hypertensive encephalopathy. Assessment for findings such as headache, confusion and vomiting is indicated as well as institution of seizure precautions. The child would typically be on bed rest during the acute phase. Dietary restrictions should include fluids, protein, sodium and potassium. Although antibiotics may be indicated if a bacterial infection is still present, this is not the priority action.

The nurse is planning care for a client with pneumococcal pneumonia. Which intervention would be most effective in promoting the clearance of respiratory secretions?

Secretion removal is enhanced with adequate hydration, which thins and liquefies secretions

temazepam

Sedatives/Hypnotics are substances that moderate activity and excitement while inducing a calming effect (and may be anxiolytic) or substances that may induce drowsiness and sleep.

sertraline

Selective Serotonin Reuptake Inhibitors (SSRIs) block the reabsorption (reuptake) of serotonin. They are used primarily to treat moderate-to-severe depression and chronic fatigue syndrome; they may also be used to treat premenstrual dysphoric disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, and generalized anxiety disorder.

duloxetine

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) block or delay the reuptake of serotonin and norepinephrine by the presynaptic nerves. The increased levels of these neurotransmitters elevates mood.

The nurse is providing postoperative care for a client who has undergone a laparoscopic cholecystectomy. Which assessment finding should be reported immediately to the health care provider?

Severe right up quadrant pain. Shoulder pain is a common complaint following laparoscopic surgery due to the effects of carbon dioxide gas. Postoperative drowsiness is expected. Although bowel sounds should be assessed after surgery, absence of bowel sounds immediately after surgery is not a cause for alarm. Right upper quadrant pain could be from a retained gallstone or bile duct injury; severe postoperative pain in the right upper quadrant is a medical emergency after a laparoscopic cholecystectomy.

A nurse is working in an OB-GYN clinic. A 40 year-old woman in the first trimester of an unplanned pregnancy provides a health history to the nurse. Which information should receive priority attention?

She has been taking an ACE inhibitor for her blood pressure for the past two years. A report by the client that she has been taking medications in the first trimester of pregnancy should be followed up immediately. ACE inhibitors, commonly used to control high blood pressure, are pregnancy category X, as they can cause teratogenic effects on the developing fetus, increasing the risk of birth defects. Women who are taking medications and who are planning a pregnancy should be switched to medications that are not harmful to the developing fetus before they begin trying to get pregnant.

The nurse is assessing an infant with developmental dysplasia of the hip. Which finding should a nurse anticipate?

Shortening of the affected leg is a sign of developmental dysplasia of the hip. Other signs of hip dysplasia in an older infant include limited hip abduction and asymmetric gluteal skin folds. An ultrasound examination is typically used to confirm developmental dysplasia of the hip in the young infant; x-rays are used when the infant is older than 3 months.

cyclobenzaprine

Skeletal Muscle Relaxants act centrally on the spinal cord or brain stem and inhibit neuronal transmission; dantrolene is the only one that acts directly on skeletal muscle. These medications are typically classified by their pharmacologic properties as either antispasticity (baclofen & tizanidine) or antispasmodic (cyclobenzaprine & carisoprodol) agents.

A nurse is assessing a young child at a clinic visit for a mild respiratory infection. Koplik spots are noted on the oral mucous membranes. What should the nurse assess next?

Skin. A characteristic sign of rubeola is Koplik spots (tiny white spots). These are found on the buccal mucosa in the mouth about a few days before the onset of the measles rash (which appears as small red, irregularly shaped spots with a bluish white center). Although the nurse should assess the child's lungs with any reports of a respiratory infection, these spots would indicate that the skin should be checked for the presence of a rash. Sometimes a complication of measles is pneumonia, but it may be a bit premature to do a sputum culture.

A young child is receiving treatment for lead poisoning. Which of the following is the most serious effect of long-term exposure to lead?

damage to the central nervous system

glimepiride

Some Oral Antidiabetic Agents (sulfonylureas and meglitinides) work by stimulating insulin release from the beta cells of the pancreas - glipizide is a sulfonylurea. Other (biguanides) improve insulin's ability to move glucose into cells, especially muscle cells. Some (thiazolidinediones) enhance insulin effectiveness in both muscle and adipose tissue. Others (alpha-glucosidase inhibitors) block enzymes that help digest starches, slowing the rise in blood sugar.

sumatriptan

Some Vascular Headache Suppressants(ergot derivatives) directly stimulate alpha-adrenergic and serotonergic receptors, producing vascular smooth muscle vasoconstriction.

pantoprazole

Some of the Antiulcer Agents (PPIs) block the secretion of gastric acid by the gastric parietal cellsSome of the Antiulcer Agents (PPIs) block the secretion of gastric acid by the gastric parietal cells.the spelling of PPIs often end with "prazole."

lidocaine side effects

Some of the side effects of lidocaine is bradycardia, heart block, cardiovascular collapse and cardiac arrest. This medication should not be administered without continuous cardiac monitoring.

donepezil

Some of these Anti-Alzheimer's Agents (cholinesterase inhibitors, like donepezil) are thought to prevent the breakdown of acetylcholine by blocking the activity of acetylcholinesterase.

ropinirole

Some of these Antiparkinson Agents replenish dopamine, while others mimic the role of dopamine or block the effects of other chemicals that cause problems in the brain when dopamine levels drop. Ropinirole (Requip) is a dopamine agonist.

rosiglitazone

Some of these Oral Antidiabetics (sulfonylureas and meglitinides) work by stimulating insulin release from the beta cells of the pancreas. Other (biguanides) improve insulin's ability to move glucose into cells, especially muscle cells. Some (thiazolidinediones - like rosiglitazone) enhance insulin effectiveness in both muscle and adipose tissue. Others (alpha-glucosidase inhibitors) block enzymes that help digest starches, slowing the rise in blood sugar.

A nurse is caring for a client suspected to have a diagnosis of active tuberculosis (TB). Which diagnostic tests is essential for the nurse to obtain for the determination of the presence of active TB?

Sputum culture for cytology

A nurse is teaching the parent of a 9 month-old infant about diaper dermatitis. Which of these actions would be appropriate for the nurse to include during the teaching?

Stop any new food that was added to the infant's diet prior to the rash. The addition of new foods to the infant's diet commonly can cause diaper dermatitis. The other actions are incorrect to deal with this problem.

The nurse is reviewing the list of medications for a client who is scheduled for electroconvulsive therapy (ECT). Which medication does the nurse recognize as the one that will promote skeletal muscle relaxation? Succinylcholine (Anectine)

Succinylcholine is the drug of choice for skeletal muscle relaxation in ECT, due to its brief duration of action. Atropine is an anticholinergic drug and may be used for ECT to help reduce the risk of arrhythmias and to minimize oral or other secretions and to prevent bronchial constriction.

autonomic dysreflexia,

T-2 spinal cord injury reports having a "pounding" headache. Further assessment by the nurse reveals excessive sweating, rash, pilomotor erection, facial flushing, congested nasal passages and a heart rate of 50.

The nurse is teaching a client about the difference between tardive dyskinesia (TD) and neuroleptic malignant syndrome (NMS). Which statement is true about tardive dyskinesia?

TD can occur in clients taking antipsychotic drugs longer than two years. Tardive dyskinesia (TD) is an extrapyramidal side effect that appears after prolonged treatment with antipsychotic medication. Early symptoms of TD are fasciculations of the tongue or constant smacking of the lips. Neuroleptic malignant syndrome is a more serious side effect of antipsychotic medications in which the client presents with hyperthermia, rigidity, and autonomic dysregulation (hypertension, tachycardia, tachypnea, agitation, diaphoresis). TD can be treated with the anticholinergic medication benztropine; therapy is started with a low dose and gradually increased to find the smallest amount necessary for relief. Tourette syndrome is a movement disorder, but it is unrelated to TD.

doxycycline

Tetracyclines exert their bacteriostatic effect by inhibiting protein synthesis in bacteria. They are broad spectrum anti-infectives. They are typically used in the treatment of respiratory tract infections, acne and skin infections, genital infections (syphilis, Chlamydia), urinary tract infections, Lyme disease, mycoplasmal infections and rickettsial infections and the infection that causes stomach ulcers (helicobacter pylori).

coombs test

The Coombs test looks for antibodies that may stick to your red blood cells and cause red blood cells to die too early.

A health care provider orders digoxin 0.125 mg by mouth daily and furosemide (Lasix) 40 mg daily by mouth. Which of these foods should the nurse reinforce for the client to eat at least one serving daily?

Tomato juice is highest in potassium per serving of the given foods. The other three foods are in a category of low potassium foods and will do little to replace potassium lost by the diuretic. Tomato juice (½ cup) has about 400 mg potassium; pear nectar (1 cup) has 33 mg; blueberries (½ cup) is 64 mg; and wheat cereal (1 cup) is 62 mg. The low potassium foods would be recommended for clients diagnosed with renal failure.

A client has been taking alprazolam for three days. The nurse should expect to find which intended effect of this drug?

Tranquilization and calming effects. Alprazolam (Xanax) is a benzodiazepine used in the treatment of anxiety, panic disorder, and anxiety associated with depression; it is also beneficial to those suffering from sleep disorders. This medication is a central nervous system depressant, producing a drowsy or calming effect; it may cause a lack of coordination. Alprazolam has a very short half-life and produces immediate symptom relief. It does not cause analgesia nor is it used to treat phobias.

amitriptyline

Tricyclic Antidepressants inhibit the nerve cell's ability to reuptake serotonin and norepinephrine, resulting in increased levels of these neurotransmitters in the brain. They also block the action of acetylcholine and histamine (which causes many of the side effects of these meds). They are used to relieve depression and may also be used to treat obsessive compulsive disorder and bedwetting.

The client is diagnosed with superficial thrombophlebitis of the left leg. Which nursing intervention should be given the highest priority?

Unlike deep vein thrombosis, superficial venous thrombosis involves a sudden inflammatory reaction (redness, pain, swelling), but it rarely involves an embolism. Treatment involves elevating the leg because dangling the extremity will increase the swelling and the pain.

A woman in labor calls a nurse to assist her in the bathroom. The nurse notices a large amount of clear fluid on the bed linens. The nurse should act based on knowledge that fetal monitoring must now assess for what complication?

When the membranes rupture, there is increased risk initially of cord prolapse if the head is at a minus level. Fetal heart rate patterns may show variable decelerations, which require immediate nursing action to reposition the client, apply oxygen and notify the health care provider.

A nurse is caring for a 10 year-old child who will be started on heparin therapy. Which assessment is critical for the nurse to make before initiating this therapy?

weight. Check the client's weight because the dosage for anticoagulants in children is calculated on the basis of weight.

A client with chronic kidney disease (CKD) is scheduled for hemodialysis at 9 am. It is now 6:30 am and the client is eating breakfast. How should the nurse help the client to prepare for hemodialysis?

administer vit D assess potency of the access site administer prescriber phosphate binder weigh the client

A client visits a community clinic for the treatment of recurrent pelvic inflammatory disease (PID). The nurse should plan to teach this client with the knowledge that this condition most frequently follows which type of infection?

chlymidia. Chlamydia and gonorrhea infections are the most frequent cause of pelvic inflammatory disease. A complication of recurrent infection is the obstruction and scarring of the fallopian tubes, resulting in infertility. These sexually transmitted infections often have subtle findings; therefore they are often not diagnosed early in their course, before more widespread infection and complications occur. This also prevents appropriate detection and treatment before transmission to others during sexual activity.

Lactulose has been prescribed for a client with advanced liver disease. Which finding should the nurse use to evaluate the effectiveness of this treatment?

decreased lethargy. Lactulose is a synthetic sugar used to treat constipation and reduce the amount of ammonia in the blood of clients with liver disease. It works by drawing ammonia from the blood into the colon, where it is removed by the body. Hepatic encephalopathy (HE) occurs in people with end-stage liver disease. People with HE may experience problems with memory, concentration and may experience drowsiness and lethargy; lactulose is used to help manage these symptoms. Lactulose is not used to treat edema or jaundice.

The health care provider orders potassium iodide (SSKI) drops for a client scheduled to undergo a thyroidectomy. How should the nurse administer the medication?

dilute the drops in 180 ml of water, juice, or milk. Potassium iodide drops should be mixed with water, fruit juice, milk, broth or even formula; the client can use a straw to drink the mixture. To minimize gastrointestinal irritation, it can be given after meals or with food. The medication is used preoperatively, 10 to 14 days before surgery, to reduce the size and vascularity of the thyroid gland.

A nurse consistently ignores the call lights of clients who practice alternative lifestyles. The nurse's behavior is an example of what approach?

discrimination. Discrimination is the differential treatment of individuals because they belong to a minority group. This generally refers to the limiting of opportunities, choices, or life experiences because of prejudices against individuals, cultures or social groups.

The client is prescribed dexamethasone by mouth every other day and asks the nurse for more information about the medication. What information would the nurse want to share with the client?

don't get any immunizations mark you calendars to keep track take the medication with food

A client is prescribed trimethoprim/sulfamethoxazole for recurrent urinary tract infections. Which information would be important to reinforce during client teaching?

drink at least 8 glasses of water a day. Trimethoprim/sulfamethoxazole (Bactrim) is a highly insoluble drug and clients should drink plenty of fluids while taking this medication to lower the risk of developing kidney stones. It is not necessary to take it with food, unless it causes stomach upset. When taking antibiotics, women who normally use oral contraceptives should be counseled to use additional forms of birth control. Clients should take the medication for the prescribed length of time.

fecal occult blood screening that can result in a positive

eating a steak dinner teeth cleaning during regular dental visits recent use of corticosteroids aspirin therapy

A nurse is caring for a client with schizophrenia who has been treated with quetiapine for one month. Today the client is increasingly agitated and reports having muscle stiffness. Which of these additional findings should be reported to the health care provider?

elevated temp and sweating. Neuroleptic malignant syndrome (NMS) is a rare disorder that can occur as a side effect of antipsychotic medications. It is characterized by muscular rigidity, tachycardia, hyperthermia, sweating, altered consciousness, autonomic dysfunction, and increased creatine phosphokinase (CPK). This is a life-threatening complication that can occur anytime during therapy with antipsychotic medications.

A 14 month-old child ingested half a bottle of aspirin tablets. Which finding should the nurse expect to see in this child?

epitaxis. A large dose of aspirin inhibits prothrombin formation and lowers platelet levels. With an overdose, clotting time is prolonged. Spontaneous bleeding often occurs from the nose or mucous membranes in the mouth.

A client, who had his entire stomach surgically removed six months ago, is now readmitted. Which of the following assessment findings would indicate that the client is experiencing complications associated with this surgery?

finding consistent with fatigue. When clients have the stomach surgically removed, they no longer have the stomach's production of intrinsic factor, leading to poor Vitamin B12 absorption. This results in anemia with symptoms of fatigue, due to the decreased number of red blood cells to carry oxygen to the body. The client with gastrectomy or gastric bypass surgery is also at risk of experiencing dumping syndrome with abdominal cramping pain, diarrhea, lightheadedness, tachycardia and hypoglycemia. Dumping syndrome is usually associated with eating too much or too rapidly, and can be avoided by following the proper diet (five to six small meals per day, high protein, low carbohydrate and fat, eaten slowly) and by avoiding fluids with meals that move food rapidly into the small intestine.

peripheral neuropathy

foot drop, paresthesia, hoarseness, jaw pain, constipation

antidiabetic drugs

glyburide, glipizide, glimepiride

A client has end-stage renal disease. Which of these statements made by the client indicates a correct understanding of the issues related to this disease?

have to go for epoetin (Procrit) injections at the health department. Anemia in end-stage renal failure is caused by reduced endogenous erythropoietin production in the kidney. Anemia in primary end-stage renal disease is treated with subcutaneous injections of Procrit or Epogen to stimulate the bone marrow to produce red blood cells. With kidney failure, too much phosphorus can build up in the blood and calcium is pulled from the bones, resulting in weakened bones. The statement about producing variable amounts of urine is incorrect, as the client will produce little to no urine at this stage of the disease.

The nurse is assessing a 72 year-old client with a full-leg cast on his left leg three days after cast application and finds bilateral pedal edema. Based on this finding, what condition should the nurse consider?

heart failure. Swelling after injury or surgery and reduction usually peaks within 24 to 48 hours, with only minimal swelling expected afterwards. If the client had pedal edema only on the casted leg, the nurse should consider extension of the initial injury/trauma, compartment syndrome, or thrombophlebitis. However, with bilateral pedal edema, the nurse should consider right-sided heart failure.

A nurse has administered several blood transfusions over three days to a 12 year-old client with thalassemia. What lab value should the nurse monitor during this therapy?

hemoglobin. Children with beta thalassemia major will usually require blood transfusions about every three to four weeks throughout their life. Transfusions help maintain hemoglobin at a high enough concentration to provide oxygen to the body and prevent growth abnormalities and organ damage; therefore, the nurse should monitor hemoglobin following a transfusion. A reticulocyte count is used as a diagnostic tool (to help rule out iron-deficiency anemia). Monitoring platelets would be indicated following transfusion of platelets.

cytoxan cyclophosphamide

hemorrhagic cystitis

A client has been admitted with a diagnosis of bacterial meningitis. In reviewing the laboratory analysis of cerebrospinal fluid (CSF), the nurse should expect to see which result?

high protein levels. A positive CSF for bacterial meningitis would include the presence of protein, a positive blood culture, decreased glucose, cloudy color with an increased opening pressure, and an elevated white blood cell count. If it was viral meningitis, the difference would be that the CSF glucose would be within normal parameters.

acute spasmodic croup

humidified air and increased oral fluids

moist productive cough is a late sign of CF

in infants

A nurse is taking a health history from parents of a child admitted with possible Reye's syndrome. Which recent illness would the nurse recognize as increasing the risk of developing Reye's syndrome?

influenza. Varicella (chickenpox) and influenza are viral illnesses that have been identified as increasing the risk for Reye's syndrome. Use of aspirin with viral infections is contraindicated in children (from birth to 19 years of age) as it increases the risk of developing Reye's syndrome.

pinworm

intense perianal itching.

what is the classic test for CF

iontophoresis (sweat test)

nitroprusside (nitropress, nipride)

is a vaso dilator given during infusion

methotrexate

is teratogenic

The nurse is reviewing lab values for a client. Which abnormal serum lab value should the nurse anticipate to stay the same during hemodialysis?

low hemoglobin

A pregnant client asks a nurse about the purpose of a blood test for alpha-fetoprotein (AFP). What would be the nurse's best response?

possible, neurologial defects might be identified. A fetus with neural tube defects loses alpha-fetoprotein (AFP) to the amniotic fluid and hence the maternal blood. High levels in the blood indicate the possibility of defects such as spina bifida and meningocele. Further evaluative tests are indicated if a test is positive.

A client with liver failure has just been admitted with portal hypertension. Which nursing diagnosis would be a priority in planning care?

potential complication of hemmorrage

The nurse is caring for a client with orders for complete bed rest. Which action by the nurse is most important in the prevention of the formation of deep vein thrombosis (DVT)?

prevent pressure on the back of the knees

The nurse is performing the initial assessment of a client with asthma at the beginning of the shift. The client has oxygen running at 2 liters per minute per nasal cannula. Which assessment finding would the nurse be most concerned about?

rapid shallow respirations with intermitted wheezing.

rhinorrhoea

rhinorrhoea is a condition where the nasal cavity is filled with a significant amount of mucus fluid

The nurse cares for a newborn with tracheoesophageal fistula (TEF) and esophageal atresia (EA.) Which nursing diagnosis is the highest priority?

risk for aspiration. With TEF, there's an abnormal opening between the trachea and esophagus; fluids are easily aspirated into the trachea and lungs. With EA, the esophagus ends in a blind pouch and doesn't attach to the stomach, so food can't get from the esophagus into the stomach. The 3 C's of TEF are choking, coughing and cyanosis; symptoms of EA include vomiting and drooling. The priority is to prevent aspiration and maintain an open airway. TEA with EA is a clinical and surgical emergency.

A client develops volume overload from an intravenous infusion that has infused too rapidly. What finding should the nurse expect when assessing the client?

s3 heart sound. Auscultation of an S3 heart sound is an early sign of volume overload and heart failure because during the first phase of diastole, when blood enters the ventricles, an extra sound is produced due to the presence of fluid left in the ventricles.

The nurse is caring for a client admitted with a diagnosis of Meniere's disease. When teaching the client about the disease, the nurse should explain that the client should avoid foods high in which substance?

sodium. The client with Meniere's disease has an alteration in the balance of the fluid in the inner ear (endolymph). A low-sodium diet will aid in reduction of the fluid. Sodium restriction is commonly ordered as adjunct to diuretic therapy in the acute and chronic treatment.

A client is being discharged with a prescription for chlorpromazine. Before the client leaves for home, which finding should the nurse teach the client to report right away?

sore throat and fever. A sudden sore throat and fever may be findings of agranulocytosis, a serious side effect of chlorpromazine (Thorazine). If white blood cell and differential counts are low, the treatment should be stopped and antibiotic therapy started. Other common side effects of chlorpromazine include dry mouth and nasal congestion, extrapyramidal reactions, motor restlessness and hypotension

The nurse is caring for a child diagnosed with nephrotic syndrome. What finding should the nurse expect when assessing the child?

swelling around the eyes. Nephrotic syndrome in children causes excess excretion of protein and retention of fluid, causing edema (around the eyes, feet, ankles) and weight gain. In this type of kidney disease, large amounts of protein are lost in the urine (proteinuria). Children may be more tired and irritable than usual.