nursing of 101 really do file, Lecture notes of Nursing

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Fundamentals: Management of Care Therapeutic Communication: Responding to a Client Who Has Stage IV Metastatic Cancer Ethical Responsibilities: Supporting a Client's Right to Autonomy Legal Responsibilities: Caring for a Client Who Requests the Creation of a Living Will Information Technology: Using Correct Documentation Information Technology: Preparing Change of Shift Report Safe Medication Administration and Error Reduction: Identifying Electronic Databases for Research Information Technology: Access to Medical Records in Mental Health Settings *The essential components of Therapeutic Communication p 178 Time – plan for and allow adequate time to communicate with others Attentive behavior or active listening – Use this to convey interest, trust, and acceptance Caring attitude – show concern and facilitate an emotional connection and support among nurses and clients, families, and significant others Honesty – be open, direct, truthful, and sincere Trust – demonstrate to clients, families, and significant others that they can rely on nurses without doubt, question, or judgment Empathy – convey an objective awareness and understanding of the feeling, emotions, and behavior of clients, families and significant others, including trying to envision what it must be like to be in their position Nonjudgmental attitude – a display of acceptance of clients, families, and significant others encourages open, honest communication *Nurse Christina is caring for a client who decides not to have surgery despite significant blockages of the coronary arteries. Christina understands that this client’s choice is an example of which of the following ethical principles? A. Fidelity – Fulfillment of a promise B. Autonomy – right to own personal decisions C. Justice – fairness in care delivery and use of resources D. Nonmaleficence – commitment to do no harm (question medications) P 13 Beneficence – action that promotes good for others without self-interest, (giving a pain medication before a procedure) ***Nurse Shushan is reviewing the types of Advance Directives with a group of newly licensed nurses. Which of the following is true regarding advance directives? (Select all that apply) P 25 Nurse Christina is receiving a provider’s prescription by telephone for morphine for a client who is reporting moderate to severe pain. Which of the following nursing actions are appropriate? (Select all that apply). A. Repeat the details for the prescription back to the provider. B. Have another nurse listen to the telephone prescription. C. Obtain the providers signature on the prescription within 24hr. D. Decline the verbal prescription because it is not an emergency situation. E. Tell the charge nurse that the provider has prescribed morphine by telephone. P 25– only when absolutely necessary; Must read it back to the provider (pt name, name of med, dosage, time to give it, frequency and route); 17 (one seven), B- boy; Nurse Shushan is teaching newly licensed nurses about safe medication administration. Which of the following statements indicates their understanding? (Select all that apply). A. “I will observe for adverse effects.” B. “I will monitor for therapeutic effects.” C. “I will prescribe the appropriate dose.” D. “I will change the dose if adverse effects occur.” E. “I will refuse to give a medication if I believe it is unsafe.” P 283 – the rights (client, medication, dose, time, route, documentation, client education, right to refuse (explain consequences, inform provider, document), assessment (before, during, after), evaluation, color Fundamentals: Safety and Infection Control Mobility and Immobility: Pressure Injuries Mobility and Immobility: Contraindications for Using Heat Therapy Mobility and Immobility: Evaluating Client Understanding of Crutch Safety Ergonomic Principles: Evaluating Lifting Techniques Home Safety: Teaching About Electrical Fire Prevention Medical and Surgical Asepsis: Preparing a Sterile Field Infection Control: Identifying Need for Sterile Gloves Medical and Surgical Asepsis: Maintaining Aseptic Technique *Nurse Argine is caring for a client who is at risk for developing pressure injury. Which of the following interventions should Argine use to help maintain the integrity of the client’s skin? (Select all that apply). A. Keep the head of the bead elevated 30 degrees. B. Massage the clients’ bony prominences frequently. C. Apply cornstarch liberally to the skin after bathing. D. Have the client sit on a gel cushion when in a chair. E. Reposition the client at least every 3 hr while in bed. P 348 *Nurse Jeff is teaching a group of nursing students about heat therapy. The following response by the student indicates they understand why heat therapy is being used. Three point – requires the client to bear weight on one foot while using both crutches. The affected leg is not to touch the ground Two point – requires the client to have partial weight bearing on both feet; The client moves the crutch which moving the opposite leg at the dame time. This is to mirror the movements of normal arm and leg motion during walking. Support body weight at the hand grips with elbows flexed at 20 – 30 degrees Hold crutches in one hand and grasp the arm of the chair with the other hand for balance while sitting and rising from a chair. The tripod position is the basic crutch stance. The client should place the crutches 15 cm (6 in) n front of and 15 cm (66in) to the sid of each foot to provide a wide base of support. Crutch gait: Client alternates weight from one leg to the other as well as on the crutches. The client should stand with a straight back, hips, head and neck and should not place any weith on the axillae *Nurse Christina is reviewing proper body mechanics during employee orientation. Which of the following statements should Christina identify as an indication that an attendee understands the teaching? (Select all that apply). A. “My line of gravity should fall outside my base of support.” B. “The lower my center of gravity, the more stability I have.” C. “To broaden my base of support, I should spread my feet apart.” D. “When I lift an object, I should hold it as close to my body as possible.” E. “When pulling an object, I should move my front foot forward.” P 76 *Nurse Shushan is caring for a client who is sitting in a chair and asks to return to bed. Which of the following actions is Shushan’s priority at this time? A. Obtain a walker for the client to use to transfer back to bed. B. Call for additional staff to assist with the transfer. C. Use a transfer belt and assist the client back into bed. D. Determine the client’s ability to help with the transfer. P 76 *Nurse Argine is providing discharge instructions to a client who has a prescription for oxygen use at home. Which of the following information should Argine include? (Select all that apply).  A. Family members who smoke must be at least 10 ft from the client when oxygen is in use. B. Nail polish should not be used near a client who is receiving oxygen. C. A “No Smoking” sign should be placed on the front door. D. An irrigation syringe on the sterile field. E. One gloved hand with the other gloved hand. P 52 *Nurse Shushan has prepared a sterile field for assisting a provider with a chest tube insertion. Which of the following events should Shushan recognize as contaminating the sterile field? (Select all that apply). A. The provider drops a sterile instrument onto the near side of the sterile field. B. The nurse moistens a cotton ball with sterile normal saline and places it on the sterile field. C. The procedure is delayed 1 hr. because the provider receives an emergency call. D. The nurse turns to speak to someone who enters through the door behind the nurse. E. The clients hand brushes against the outer edge of the sterile field. P 52 The need for sterile gloves: When coming into touch with a sterile spot, tissue, or bodily cavity, sterile medical gloves must be used. They are required for just about any surgical intervention and invasive contact with the human body. Because skin cannot be sanitized, surgical staff must wear disposable sterile gloves. 1. Choose tight-fitting gloves. Picking up objects, such as surgical instruments, should be easy. These gloves come in multiple sizes. Make sure you choose the size that is right for your hand fit. 2. Always wash hands before putting on sterile gloves and immediately after their removal. Wearing sterile gloves does not replace protective handwashing. Gloves are not a substitute for good hand hygiene. 3. Make sure all tools and supplies are ready before donning gloves Fundamentals Health Promotion and Maintenance Priority Intervention When Assisting a Client with Smoking Cessation Successful intervention begins with identifying users and appropriate interventions based upon the patient's willingness to quit. The five major steps to intervention are the "5 A's": Ask, Advise, Assess, Assist, and Arrange. 1. Ask - Identify and document tobacco use status for every patient at every visit. 2. Advise - In a clear, strong, and personalized manner, urge every tobacco user to quit. Help clients recognize benefits of not smoking (reduce risk for lung cancer and saves money) 3. Assess - Is the tobacco user willing to make a quit attempt at this time? 4. Assist - For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him or her quit. 5. Arrange - Schedule followup contact, in person or by telephone, preferably within the first week after the quit date. Fundamentals – Basic Care and Comfort Fluid Imbalances: Findings to Report Nasogastric Intubation and Enteral Feedings: Nursing Actions for Continuous Enteral Feeding Home Safety: Providing Home Safety Teaching Grief, Loss, and Palliative Care: Performing Postmortem Care Prior to a Family Visit Rest and Sleep: Priority Findings to Report to the Provider Sensory Perception: Caring for a Client Who Has Hearing Loss Sensory Perception: Caring for a Client Who Wears Eye Glasses Sensory Perception: Caring for a Client Who Has Vision Loss **Nurse Argine is reviewing the laboratory tests results for a client who has an elevated temperature. Argine should identify which of the following findings as a manifestation of dehydration? (Select all that apply). A. Hct 55% B. Blood Osmolarity 260 mOsm/kg >295 dehydration C. Blood sodium 150 mEq/L **Shushan is a home health nurse discussing the dangers of carbon monoxide poisoning with a client. Which of the following information should Shushan include? A. Carbon monoxide has a distinct odor. B. Water heaters should be inspected every 5 years. C. The lungs are damaged from carbon monoxide inhalation. D. Carbon monoxide binds with hemoglobin in the body. P 71 **Nurse Argine is teaching about electrical fire prevention to a family who will be administering oxygen in the home. What is important for Argine to include in her teaching? (Select all that apply) A. Ensure that electrical equipment is in good repair and well grounded. B. Replace bedding that can generate static electricity (wool, nylon, synthetics) with items made from cotton. C. Have a fire extinguisher available and an established exit route if a fire occurs. D. Secure extra oxygen tanks in the garage on their side so they do not fall over. E. Check outlets to ensure they are not loose or discolored. P 67 *Jeff is about to perform postmortem care of a client. The family wishes to view the body. Which of the following actions should Jeff take? (Select all that apply) A. Remove the dentures from the body. Keep in so face looks natural B. Make sure the body is lying completely flat. Elevate head and shoulders on a pillow to prevent discoloration of face C. Apply fresh linens and place a clean gown on the body. D. Remove all equipment from the bedside. E. Dim the lights in the room. P 208, 206 *Nurse Christina is in a provider’s office caring for a client who states that, for the past week, “I have felt tired during the day and cannot sleep at night.” Which of the following responses should Christina ask when collecting data about the client’s difficulty sleeping? (Select all that apply) D. Simvastatin E. Amiodarone P 266 *Nurse Argine is caring for a client who has vision loss and wears glasses. What should be included in caring for this client? A. When the client is out of bed moving around the room keep paths clear and lights on. B. Using toilet paper or a paper towel is ok when cleaning eyeglasses. C. Have glasses readily available on the bedside table outside of the case. D. Encourage families to talk loudly so the client knows they are in the room. P. 262 Fundamentals – Pharmacological and Parenteral Therapies Pharmacokinetics and Routes of Administration: Intradermal Injection *Nurse Jeff is about to administer an intradermal injection to a client. What does Jeff need to know about this method of administration? A. The solution amount should not exceed 0.2mL. (0.01 to 0.1mL) B. Insert the needle with the bevel down. (bevel up with small bleb) C. Massage the site after injection. (no) D. The best site is the inner surface of the mid forearm. P 272: use a fine gauge needed 26-27 in lightly pigmented, thin-skinned, hairless sites (inner surface of mid forearm or scapular area of the back); 10-15 degree angle Fundamentals – Reduction of Risk Potential Vital Signs: Measuring Pulse Deficit Pressure Ulcers, Wounds, and Wound Management: Identifying a Stage III Pressure Injury *Nurse Christina is performing an admission assessment on a client. Christina determines the client’s radial pulse rate is 68/min and the simultaneous apical pulse is 84/min. What is the clients pulse deficit? 16/min: difference between the apical and radial pulse rates and reflects the number of ineffective or nonperfusing heartbeats that do not transmit pulsations to peripheral pulse points. Once the pulse rates have been obtained, the peripheral pulse rate is subtracted from the apical pulse rate. The apical pulse rate will never be lower than the peripheral pulse rate. The resulting number is the pulse deficit. Normally, the Stage 4 – full-thickness skin and tissue loss – with cartilage, bone, fascia, muscle, ligaments or tendon exposed Unstageable due to eschar or slough obscuring the wound Eschar – dead tissue, dry, black and hard Slough – cream or yellow color Nurse Argine is instructing a client, who has an injury of the left lower extremity, about the use of a cane. Which of the following instructions should Argine include? (Select all that apply). A. Hold the cane on the right side. B. Keep two points of support on the floor. C. Place the cane 38 cm (15 in) in front of the feet before advancing. D. After advancing the cane, move the weaker leg forward. E. Advance the stronger leg so that it aligns evenly with the cane. P234 (Cane – Weak Leg – Strong Leg) Pharmacology: Safety and Infection Control *Adverse Effects, Interactions, and Contraindications: Identifying Treatment for Urticaria **Medications Affecting Coagulation: Monitoring Following Heparin Administration Nurse Christina is preparing to administer an IM dose of penicillin to a client who has a new prescription. The client states when they took penicillin 3 years ago, they developed a rash. Which of the following actions should Christina take? A. Administer the prescribed dose. (cause a severe reaction) B. Withhold the medication. (and notify the provider) C. Ask the provider to change the prescription to an oral form. D. Administer an oral antihistamine at the same time. P 44 mild hives and rash treated with diphenhydramine; Antihistamines – available either over the counter or by prescription – are a frequently recommended treatment for hives. They work by blocking the effect of histamine, a chemical in the skin that can cause allergy symptoms, including welts. Antihistamines that don’t make you drowsy are preferred. They are effective and long-lasting (may be taken once a day) and have few side effects. Your allergist may recommend a combination of two or three antihistamines to treat your hives, along with cold compresses or anti-itch balms to ease the symptoms. Nurse Argine is explaining the mechanism of action of combination oral contraceptives to a group of clients. Argine should tell the clients that which of the following actions occur with the use of combination oral contraceptives? (Select all that apply) A. Thickening the cervical mucus (slows sperm passage) B. Inducing maturation of ovarian follicle C. Increasing development of the corpus luteum D. Altering the endometrial lining (inhibits implantation) E. Inhibiting ovulation P. 253 monophasic (dosage of estrogen to progesterone remines the same), biphasic, triphasic, or quadriphasic (estrogen/progesterone changes like a normal menstrual cycle) – used to prevent pregnancy; reduce menstrual blood loss esp. with iron deficiency anemia; reduce cramping and protect against endometrial and ovarian cancers; Complications – MI, PE, thrombophlebitis, stroke; avoid smoking, report warmth, edema, tenderness, or pain in lower legs; monitor for HTN, break through bleeding, breast cancer, hyperglycemia; and hyperkalemia (renal or adrenal insufficiency) Contraindications – smokers and over the age of 35; history of thrombophlebitis and cardiovascular events; family history or risk for breast cancer; abnormal vaginal bleeding; HTN, diabetes, gallbladder dz, seizures, and migraines Pharmacology: Pharmacological and Parenteral Therapies *Adverse Effects, Interactions, and Contraindications: Priority Intervention for an Allergic Reaction *Eye and Ear Disorders: Teaching About Adverse Effects of Timolol **Medications Affecting Urinary Output: Adverse Effects of Chlorthalidone ** Cardiac Glycosides and Heart Failure: Findings to Report to the Provider in a Client Who Is Taking Digoxin ** Medications Affecting Coagulation: Medication Interactions with Warfarin * Medications Affecting Coagulation: Identifying an Allergic Reaction to Aspirin * Dosage Calculation: Calculating a Dose of Phenytoin * Diabetes Mellitus: Reviewing Formulary About NPH Insulin * Non-Opioid Analgesics: Administering Headache Medications to a Client Who Has a History of a Peptic Ulcer ** Medications Affecting Urinary Output: Client Teaching About Spironolactone *** Nonopioid Analgesics: Pain Medication for a Client Who Has Cholelithiasis * Connective Tissue Disorders: Pain Medication for Fibromyalgia Priority Intervention for an Allergic Reaction:  Anaphylaxis is a life-threatening, immediate systemic reaction caused from an allergic response to a medication, dye, food, or insect bite/sting  Start with anxiety, weakness, generalized itching and hives that progress to erythema and angioedema of the head and neck  Crackles, wheezing, decreased breath sounds, a feeling of a lump in the throat, hoarseness, and stridor can develop into a life-threatening condition that results in resp failure, hypoxemia, hypotension, tachycardia, and death.  Prevention and rapid intervention are vital to avoid a fatal outcome  Injectable epinephrine should be available at all times if the pt has a known allergy  Stop the medication immediately and notify the RRT, establish an airway and administer bronchodilators  Treat with epinephrine IM or IV to constrict blood vessels and improve cardiac contraction and promote bronchodilation of the pulmonary system – give every 5 to 15minutes  Administer diphenhydramine, an antihistamine, to decrease manifestation of the angioedema and urticaria  Administer oxygen, obtain ABGs and plan for client to receive inhaled beta-adrenergic agonist or bronchodilator (Albuterol, metaproterenol) every 2 to 4 hrs  Administer corticosteroids for late recurrence of manifestations  Monitor hemodynamics – watch for fluid overload from too rapid IV infusion and pulmonary status Nurse Christina is providing teaching to a client who has a new prescription for digoxin. Christina should instruct the client to monitor and report which of the following adverse effects that is a manifestation of digoxin toxicity? (Select all that apply) A. Fatigue (and weakness are early CNS findings) B. Constipation (N/V/D) C. Anorexia D. Rash E. Blurred Vision (yellow-tinged vision) P 172 Nurse Shushan is teaching a client who has a new prescription for digoxin to treat heart failure. Which of the following instructions should Shushan include in the teaching? A. Contact the provider if heart rate is less than 60/min. B. Check pulse rate for 30 seconds and multiply result by 2. (1 full minute before each dose) C. Increase intake of sodium. (decrease sodium and avoid excess fluid) D. Take with food if nausea occurs. (nausea is a reportable finding for possible toxicity) P 172 Warfarin – Vitamin K Inhibitor p 196 Prevent venous thrombosis and PE in clients with A Fib or prosthetic heart valves Interactions: Use of heparin, aspirin, Tylenol, glucocorticoids, sulfonamides parenteral cephalosporins increase effect of warfarin, which increase the risk of bleeding – read labels for OTC meds with aspirin in them; monitor PT, INR, and PTT Use of phenobarbital, carbamazepine, phenytoin, oral contraceptives, and vitamin K decrease the anticoagulant effects – monitor for reduced PT and INR Foods high in Vit K (dark green leafy vegies, lettuce, cooked spinach, cabbage, broccoli, brussels sprouts, mayonnaise, and canola and soybean oil and decrease anticoagulant effects Resveratrol and saw palmetto increase the risk of bleeding through antiplatelet effects Coenzyme Q-10 (CoQ-10) can decrease effectiveness due to a similar structure to vitamin K Feverfew, garlic, ginger, glucosamine, or ginkgo biloba can increase risk of bleeding Nurse Jeff is teaching clients about the use of insulin to treat type 1 diabetes mellitus. For which of the following types of insulin should Jeff tell the clients to expect a peak effect 1 to 5 hrs after administration? A. Insulin glargine (long acting no peak effect B. NPH insulin (peaks 6-14 hrs) C. Regular insulin (peaks 1-5 hrs) D. Insulin lispro (peaks 30min to 2.5hrs) P 317, 309-310 NPH and premixed insulins should appear cloudy. NPH by SQ route. Instruct clients to inject in one general area to have a consistent rate of absorption Nurse Christina is caring for a client who has peptic ulcer disease and reports a headache. Which of the following medications should Christina plan to administer? A.Ibuprofen B.Naproxen C.Acetaminophen D.Ketorolac P 283 d/t GI discomfort and increase ulcer formation Nurse Shushan is monitoring a client who is receiving spironolactone. Which of the following findings should Shushan report to the provider? A. Blood sodium 144 mEq/L B. Urine output 120 mL in 4 hr (30ml/hr or 120 ml in 4hrs) C. Blood potassium 5.2 mEq/L D. Blood pressure 140/90 mm Hg P 153 potassium sparing Diuretic; potassium retention and excretion of water and sodium, treat HTN and edema; for heart failure; take up to 12 to 48 hrs for a therapeutic effect; Given orally; Complications – Hyperkalemia, Drowsiness, and metabolic acidosis; Client Education: avoid salt substitutes that contain potassium and reduce potassium rich foods like oranges, bananas, potatoes, and dates; self-monitor BP; keep a log of BP and weight; report cramps, diarrheas, thirst, altered menstruation or deepened voice, avoid activities that require alertness Nurse Jeff provides teaching to a client who is prescribed spironolactone. Jeff should limit the intake of which of the following foods? (Select all that apply) A. Bananas B. White Rice C. Tomatoes D. Avocados E. Sweet Potatoes Pink Book p 296 due to being high in potassium A client who has a deep vein thrombosis is receiving a heparin infusion. Current lab values include an aPTT of 40seconds. Which of the following actions should Christina implement? A. Stop the infusions B. Increase the infusion C. Decrease the infusion D. No change in the infusion Pink Book p 297 normal range for aPTT is 30 to 40 seconds. Therapeutic levels of aPTT are usually 1.5 to 2 times normal control levels. The above is subtherapeutic. Nurse Shushan is preparing to administer heparin 8,000 units subcutaneously every 12 hr. Available is heparin injection 10,000 units/mL. How many mL should Shushan administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero). Step 1: what is the unit of measurement the nurse should calculate? mL Step 2: What is the dose the nurse should administer? Desired = 8,000units Step 3: What is the dose available? Have = 10,000units Step 4: Should the nurse convert the units of measuremet? No Step 5: What is the quantity of the dose available? Quantity = 1mL Step 6: Set up the equation and solve for X 10,000units/1mL = 8,000units/ XmL X = 0.8mL Nurse Argine is preparing to administer vancomycin 1g by intermittent IV bolus. Available is vancomycin 1g in 100mL of dextrose 5% in water (D5W) to infuse over 45 minutes. The drop factor of the manual IV tubing is 10 gtt/mL. Argine should adjust the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Do not use a trailing zero). Step 1: what is the unit of measurement the nurse should calculate? gtt/min  Should the nurse convert the units of measurement? No  What is the quantity of the dose available? Quantity = 5mL  Set up the equation and solve for X  250/5 = 200/X  XmL = 4mL P 31 Med Surg – Management of Care Cardiovascular Diagnostic and Therapeutic Procedures: Evaluating Understanding of PICC Therapy *Nurse Christina is planning care for a client who has a PICC line in the right arm. Which of the following interventions should Christina include? (Select all that apply) A. Use a 10mL syringe to flush the PICC line. (The smaller size the more pressure that could cause the catheter to fracture/rupture) B. Apply gentle force if resistance is met during injection. (Avoid force) C. Cleanse ports with alcohol for 15 seconds prior to use (allow to air dry prior to use to help decrease risk for bacterial contamination) D. Maintain a transparent dressing over the insertion site. (Decrease risk of infection and allow for visualization. Change every 7 days and when wet, loose, or soiled). E. Flush with 10mL heparin before and after medication administration. (flush with 0.9% NaCl, a flush with 5mL of heparin (10U/mL) is recommended when the PICC is not actively in use). P. 177 Use a PICC for up to 12 months, for blood, long-term administration of chemo, ABX, and TPN Med Surg – Health Promotion and Maintenance Heart Failure and Pulmonary Edema: Risk Factors for Heart Failure Gastrointestinal Therapeutic Procedures: Evaluating Teaching About Bariatric Surgery Osteoporosis: Dietary Recommendations for Health Promotion ***Nurse Shushan is discharging a patient after having bariatric surgery. What should be included in the patient education? (Select all that apply) A. Must adhere to a limited diet of liquids or pureed foods for the first 6 months (6 weeks). B. The volume of liquid that can be consumed at one time should not exceed 1 cup. C. Walk daily for at least 30 min. D. Take vitamin and mineral supplements. E. Encourage the client to consume meals in a low-fowler’s position (15- 30 degrees – remain for 30 min after eating to delay stomach emptying and minimize dumping syndrome p336) P 313 *Nurse Argine is caring for a client who has heart failure and reports increased shortness of breath. Which of the following actions should Argine take first? A. Obtain the client’s weight. A. Avoid sexual intercourse for 3 months after the surgery. B. If urine appears bloody, stop activity and rest. C. Avoid drinking caffeinated beverages. D. Take a stool softener once a day. E. Treat pain with ibuprofen. P 444 Comes from a tree that grows to 10feet and the fruit is the medicine. Could slow blood clotting so do not use when on blood thinners and could decrease the effect of birth control pills d/t decreasing estrogen levels. Saw palmetto is most commonly used for decreasing symptoms of an enlarged prostate called benign prostatic hypertrophy (BPH). But it doesn't seem to improve this condition. Saw palmetto is also used to prevent complications from prostate surgery and for treating other prostate conditions, male-pattern baldness (androgenic alopecia), sexual dysfunction, and other conditions, but there is no good scientific evidence to support most of these uses. How does it work ? Saw palmetto doesn't shrink the overall size of the prostate, but it seems to shrink the inner lining that puts pressure on the tubes that carry urine. Saw palmetto also might prevent testosterone from being converted to a more potent form called dihydrotestosterone (DHT). It is thought that some types of hair loss are caused by increased sensitivity of hair follicles to DHT. Reduced levels of DHT may help prevent these types of hair loss. *Nurse Shushan is providing information about capsaicin cream to a client who reports continuous knee pain from osteoarthritis. Which of the following information should Shushan include in the discussion? A. Continuous pain relief is provided (temporary) B. Put on gloves before applying the cream to other parts of the body (cause burning) C. Leave cream on the hands for 10min following application (leave on for 30min then wash hands) D. Apply the medication every 2hrs during the day (apply up to 4 times a day) P485 Glucosamine and chondroitin supplements – aid in repair and maintenance of cartiledge; Glucosamine reduces inflammation and chondroitin helps strengthen cartiledge; Glocosamine – GI upset, rash, HA, drowsiness; Chondroitin – risk for bleeding if taken with anticoagulants; for low back pain – massage, spinal manipulation, mindfulness, yoga, acupuncture, TENS unit Med Surg – Pharmacological and Parenteral Therapies Anemias: Expected Laboratory Findings Following a Blood Transfusion Blood and Blood Product Transfusions: Client Identification for Autologous Blood Transfusion Blood and Blood Product Transfusions: Intervention for Adverse Transfusion Reaction Blood and Blood Product Transfusions: Recognizing Fluid Overload Multiple Sclerosis: Anticipated Prescription for the Provider to Prescribe *Expected lab values following a blood transfusion: Hemoglobin 12-16g/dl in females and 14-18g/dl in males Hematocrit 37-47% in females and 42-52% in males WBC 5-10,000/mm3 Platelets 150-400,000 mm3 ***Nurse Christina is caring for a client who is receiving a blood transfusion. Which of the following is an indication the client is in circulatory overload? (Select all that apply) A. Dyspnea B. Cough C. Bradycardia D. Hypotension E. Crackles Some signs and symptoms that may be present in a patient with TACO (transfusion Related Circulatory overload) include: dyspnea, orthopnea, cyanosis, hypoxemia, elevated BNP, tachycardia, hypertension, pulmonary edema, pedal edema, and cardiomegaly. P 261 ***Circulatory overload with blood transfusions: p 261 Oder clients or those who have pre-existing increased circulatory volume are at an increased risk. Findings include crackles, dyspnea, cough, anxiety, jugular vein distension, and tachycardia. Can progress to pulmonary edema. Slow the transfusion or stop it; position the client upright with feet lower than the level of the heart, administer oxygen, diuretics and morphine (decrease cardiac output) as prescribed. ***Nurse Shushan is teaching a client who has multiple sclerosis and a new prescription for baclofen. Which of the following statements should Shushan include in the teaching? A. “This medication will help you with your tremors.” (Propranolol a beta blocker and clonazepam and benzodiazepine to treat tremors) B. “This medication will help you with your bladder function.” (Propantheline is an anticholinergic to treat bladder dysfunction) C. “This medication can cause your skin to bruise easily.” (Prednisone is a corticosteroid to treat inflammation and can cause bruising) D. “This medication can cause you to experience dizziness.” P 62 baclofen is an antispasmodic – drowsiness and dizziness, do not discontinue abruptly B. Apply a dry, sterile dressing. (allow for continuous assessment of color and quantity) C. Apply direct pressure to the site. (cause discomfort and potential harm to pt) D. Place the client in a supine position. (elevate head of bed to promote lung expansion) P 318 *Nurse Christine is caring for a client who has disseminated intravascular coagulation (DIC). Which of the following laboratory values indicates that clients clotting factors are depleted? (Select all that apply) A. Platelets 100,000/mm3 (150-400,000) B. Fibrinogen levels 120 mg/dL (200-400) C. Fibrin degradation products 4.3 mcg/mL (<10) D. D-dimer 0.03 mcg/mL (<0.4) E. Sedimentation rate 38 mm/hr (0-22 in men and 0-29 in women) not indication for DIC P 274 Platelets are decreased causing clotting factors to be depleted and clotting times increased raising the risk for fatal hemorrhage; Fibrinogen is decreased; Fib Deg products are increased; D-dimer increased; sed rate increased **Nurse Shushan is caring for a client who has rheumatoid arthritis. Which of the following laboratory tests are used to diagnose this disease? (Select all that apply) A. Urinalysis (detect kidney failure) B. Erythrocyte sedimentation rate (ESR) - elevated C. BUN (detect kidney failure) D. Antinuclear antibody (ANA) titer (positive) E. WBC Count (decreased) P 589 *Nurse Argine is instructing a client who is scheduled for a transurethral resection of the prostrate (TURP) about postoperative care. Which of the following information should Argine include in the teaching? A. “You might have a continuous sensation of needing to void even though you have a catheter.” (large balloon causing pressure on the internal sphincter of the bladder) *Nurse Christina is caring for a client following a thoracentesis. Which of the following manifestations should Chrsitina recognize as risks for complications? (Select all that apply) A. Dyspnea (indicate a pneumothorax or reaccumulation of fluid) B. Localized bloody drainage on the dressing (expected) C. Fever (indicate infection) D. Hypotension (indicate intrathoracic bleeding) E. Report of pain at the puncture site (expected) p. 110 *Aortofemoral Bypass – p 194 Before Surgery – informed consent, an IV, blood thinners to prevent clots and antibiotics to prevent infection, general anethesia During – incision in the groin near the femoral artery and one in the abdomen near the aorta (use vein from arm or leg to use as the graft) After Surgery – maintain airway, deep breathing and coughing; out of bed when the nurse says ok to prevent DVT usually within 24hrs; exercises in bed; Ambulate 25-100ft 3 times a day; monitor HR and BP; monitor LOC, monitor chest tube and measure drainage hourly; control pain; medicine for heartbeat and blood pressure along with blood thinners *Nurse Shushan is caring for a client who has a closed-head injury with an ICP reading ranging from 16 to 22 mm Hg. Which of the following actions should Shushan take to decrease the potential for raising the clients ICP? (Select all that apply) A. Suction the endotracheal tube frequently. (increases ICP) B. Decrease the noise level in the client’s room. (restrict visitors) A. Encourage dependent positioning of the residual limb (improve circulation to the end of the stump and promotes healing) B. Inspect for presence and amount of drainage (check for infection) C. Implement shrinkage intervention of the residual limb (to fit the prosthetic) D. Wrap the residual limb in a circular manner using gauze (use elastic bandage in a figure eight manner to prevent restriction of blood flow0 E. Assess for feeling for body image changes. (depression, anger, withdrawal, and grief) P. 463 **Pre-op teaching for a Modified Radical Mastectomy – p. 635 HOB elevated 30degrees when awake and support their arm on a pillow, lying on the unaffected side can relive pain Wear a sling while ambulating to support the arm Avoid injections, taking blood pressure or obtaining blood from the affected arm Well-fitted breast prosthesis Emotional support Encourage to express feelings related to sexuality and body image Monitor drains Arm and hand exercises to precent lymphedema *Reducing the Risk of Complications Intraoperatively – p663 Prevent respiratory depression Prevent fluid overload Prevent deep vein thrombosis Prevent infection Med Surg – Physiological Adaptation Respiratory Management and Mechanical Ventilation: Nursing Action for a Low-Pressure Alarm Cancer Treatment Options: Adverse Effects of Radiation Therapy Cancer Treatment Options: Caring for a Client Who Is Receiving Brachytherapy *Nurse Jeff is caring for a client who has cervical cancer and is scheduled for brachytherapy. Which of the following actions should Jeff take? (Select all that apply) A. Permit visitors to stay with the client 30min at a time (keep 6 ft away) B. Warn pregnant individuals to visit the room only once daily. (not at all is preferred) C. Wear a dosimeter when in the client’s room D. Place soiled dressings in a biohazard bag before discarding in the regular trash. (not in regular trash must be put in a radioactive container) E. Dispose of soiled linen in the hamper outside the clients room. (no stays in the room in a special hamper) P 610 *Plan of Care Following Acute Myocardial Infarction – p 202 *Nurse Christina is caring for a client immediately post-op from a subtotal thyroidectomy. What does post op care include? (Select all that apply) A. Provide comfort measures and place the client in a semi-fowlers position with the head and neck supported with pillows. (decrease strain on the suture line) B. Assess the dressing for drainage including the area under the neck and shoulders. C. Assess for the ability to speak aloud – loss of vocal volume is expected. (no loss of vocal volume and permanent hoarseness are a danger) Monitor oxygen saturation levels, >95% Assess hand grasps for muscle weakness Assess TRs Implement fall precautions due to muscle weakness *Manifestations of Pulmonary Congestion p 212  Shortness of breath, especially if it comes on suddenly  Trouble breathing or a feeling of suffocating (dyspnea)  A bubbly, wheezing or gasping sound when breathing  Coughing up phlegm that looks pink or has blood in it  Breathing difficulty with a lot of sweating  A blue or gray color to the skin  Confusion  A big drop in blood pressure that causes lightheadedness, dizziness, weakness or sweating  A sudden worsening of any of pulmonary edema symptoms *Interpreting Laboratory Values for a Client Who Has Asthma p 294 Respiratory alkalosis -hypoxemia from asthma Decreased Co2, decreased or normal H+ concentration Tachypnea, inability to concentrate, numbness, tingling, tinnitus, possible Loss of consciousness Tachycardia, ventricular and arterial dysrhythmias Rapid deep respirations PH > 7.45 PaCo2 less than 35 or greater than 45 *Gastric Lavage p 335 Insert NG tube (irrigate with NS or water – obtain x-ray to confirm placement, monitor for absence or presence of blood, adminaiter IV mediations (proton- pump inhibitors, H2-receptor antagonists) C. Increase protein intake. D. Instruct the client to consume 2000 calories/day. (5000 a day) E. Restrict fresh flowers in the room. P 507 *Controlling an External Hemorrhage p 8 Apply direct pressure to visible bleeding, infuse isotonic solution like lactated ringers or 0.9% NaCl or blood products, elevate lower extremities to shunt blood to vital organs *Nurse Christina is assessing a client who has a casted compound fracture of the femur. Which of the following findings is a manifestation of a fat embolus? A. Altered mental status (early sign with dyspnea, chest pain and hypoxemia) B. Reduced bowel sounds (adverse effect of opioids and can result in constipation) C. Swelling of the toes distal to the injury (reduced circulation due to a tight cast, elevate and apply ice) D. Pain with passive movement of the foot distal to the injury (expected, severe pain unrelieved by narcotics is a manifestation of compartment syndrome) p. 478 ***Nurse Shushan is admitting a client who reports nausea, vomiting, and weakness. The client has dry oral mucous membranes and blood pressure 102/64 mm Hg. Which of the following findings should Shushan identify as manifestations of fluid volume deficit? (Select all that apply) A. Decrease skin turgor. B. Concentrated urine. C. Bradycardia. (tachycardia) D. Low-grade fever.