For IIIC and IIIE. Your homework for the Holiday

Click Homework for the Holiday to get a copy of your assignment. Your assignment is a test on Upper Respiratory Tract Disorders. This test has been copied from Brunner and Suddarth Medical-Surgical Nursing Study Guide.

Read and understand Chapter 22. Management of Patients with Conditions of the Upper Respiratory Tract of your textbook. Print the test and then answer the questions. Write your answers on a 1/4 yellow pad. Use Capital Letters. Deadline: Nov. 30, 2010. Till we meet again!

High Risk Pregnancy Multiple Choice Test

Read and understand Pre-gestational and Gestational Conditions. Answer the Multiple Choice Test on High Risk Pregnancy. Print the test and write your answers before the number. Use Capital letters. Deadline: 27 Sep 2010.

ANSWER KEY:
1. A
2. D
3. C
4. C
5. B
6. B
7. A
8. A
9. A
10. B
11. D
12. A
13. C
14. A
15. A
16. B
17. C
18. A
19. C
20. D

Homework No. 3 Remedial 202

Read Chapter 42 Assessment and Management of Patients with Endocrine Disorders of the same textbook. You can also look into the videos in this blog.

*You can use other textbooks or resources to answer the exercises.

Homework No. 3. Use 1/4 sheet of yellow paper for your answers, also to be submitted on May 12, 2010.

Homework No. 2 for Remedial Class 202

Answer Key

Read Chapter 33 Assessment and Management of Patients with Hematologic Disorders of Brunner & Suddarth's Textbook of Medical-Surgical Nursing 11th edition by Mary Jo Boyer.

Print and complete the Crossword Puzzle below, which will serve as your Homework No. 2.

Crossword Anemia

Homework No. 1 for Remedial Class 202

Read the discussion on fluids and shock and Chapter 15 of Brunner and Suddarth's Textbook of Medical and Surgical Nursing, 11th Edition, by Mary Jo Boyer.

Then, answer Homework No. 1.

Write your answers in a 1/4 yellow sheet. As soon as you are done, do Homework No. 2 (posted in another thread).

Answer Key.
1. A
2. C
3. B
4. A
5. A
6. D
7. C
8. D
9. A
10. C
11. D
12. B
13. increasing, decreasing
14. E. Coli, pseudomonas, salmonella, shigella, helicobacter, spirochetes
15. 90mmHg
16. C
17. fluids/blood transfusion
18. O2 therapy/mechanical ventilation
19. vasoactive meds
20. shock position (other nursing goals & interventions include monitoring hemodynamic status, enhancing safety and comfort, reducing anxiety.

Remedial 202. Activity for Apr 27, 2010 (Tue)

No lecture today..

> use the time to complete your activities for Cardio
*Chapter 26
*Chapter 28
*Chapter 29
*Chapter 30
> put your output in a WHITE SHORT PLASTIC folder
> deadline: Apr 30 (Fri) together with the CD Project
> get your copies of the activities on my table
> Midterm Exams: Apr 29 (Thu)
For the midterm test:
*Coverage: Pain, Respiratory disorders, Cardio disorders
*no receipt, no test (if you can't pay yet, bring a letter of explanation with the signatures of your parents)

Remedial 202 QUIZ1

Remedial 202 Quiz 1

NEW: Answer Key
1. A 6. D 11. A 16. D
2. C 7. B 12. D 17. A
3. B 8. D 13. C 18. D
4. D 9. D 14. A 19. B
5. B 10. A 15. D 20. D

INSTRUCTIONS: DO NOT PRINT THIS TEST ANYMORE. Write your answers on a ¼ yellow pad. Use CAPITAL letters. DEADLINE 4/19/10. Submit on my table.

MULTIPLE CHOICE. Read each question carefully. Choose one best/correct answer from the choices given.

Case: Gina is a runner who joined the marathon. She accidentally stepped on a stone and sprained her ankle. Her ankle immediately became swollen and a hematoma is seen near the ankle.

1. The nurse assessing for pain should
a. believe a patient when he or she states that pain is present
b. doubt that pain exists when no physical origin can be identified
c. realize that patients frequently imagine and state that they have pain without actually feeling painful sensations
d. all of the above

2. Gina did not verbalize that she was in pain. As the nurse of Gina, you are aware that a behavioral response to pain includes
a. an expressionless face
b. clear verbalization of the pain felt
c. immobility of affected part
d. increase in blood pressure and heart rate

3. To reduce the swelling of the sprained ankle and eventually relieve the pain, the nurse should
a. Apply warm compress over the site of injury
b. Apply cold compress over the injured site
c. Apply liniment ointment
d. Play music or use a videotape

4. Cutaneous stimulation is helpful in reducing painful sensations because it
a. Provides distraction from the pain source and decreases awareness
b. Releases endorphins
c. Stimulates large diameter nerve fibers and reduces the intensity of pain
d. All of the above

5. The nurse’s major area of assessment for a patient receiving Morphine Sulfate is assessing which system?
a. Cardiovascular
b. Respiratory
c. Neurologic
d. Integumentary

Case: Isa, who has been having runny nose that goes on and off for a month now sought consult in the school clinic.

6. Nursing measures for viral rhinitis include all of the following except
a. Administering prescribed antibiotics to decrease the severity of the viral infection
b. Informing the patient about the symptoms of secondary infection as a complication of common colds
c. Instructing adequate fluid intake and rest
d. Teaching that the virus is contagious for 3 days before symptoms appear

7. Isa points to the area on the inside of the eye as a point of pain as she mentioned that she feels that her sinuses are congested. The nurse knows that the patient is referring to which sinus?
a. Frontal
b. Ethmoidal
c. Sphenoidal
d. Maxillary

8. Nursing measures for a patient with acute or chronic sinusitis include
a. Adequate fluid intake
b. Increased humidity
c. Local heat applications to promote drainage
d. All of the above

9. Health teachings for viral rhinitis include instructing the patient to
a. blow her nose gently to prevent spread of infection
b. blow through both nostrils to equalize the pressure
c. rest, to promote overall comfort
d. do all of the above

10. Isa has been taking an over-the-counter (OTC) decongestant from the start of her runny nose. Which of the following statements made by Isa needs further instructions?
a. “Decongestants can be used as long as I have this runny nose.”
b. “Rebound congestion is an effect if decongestants are used longer than 3 days.”
c. “Some decongestants need to be taken only twice a day while others may need to be used 3 to 4 times a day.”
d. “The oral form of decongestants is the preferred choice for most cases of nasal congestion.”

Case: Judy, a 36-year-old salegirl, has just undergone tonsillectomy and adenoidectomy. You are assisting her with transport from the recovery room to her room.

11. Based on the knowledge about tonsillitis, you known that Judy may have experienced symptoms that required surgical interventions. Clinical manifestations may have included:
a. Hypertrophy of the tonsils
b. Repeated attacks of otitis media
c. Suspected hearing loss secondary to otitis media
d. All of the above

12. Which diet is appropriate for Judy as soon as she has fully recovered from general anesthesia?
a. Full diet to build up resistance from infection
b. Vit C-rich foods to heal tissues
c. Only clear liquids for 3 days, to prevent pharyngeal irritation
d. Ice chips or ice cream to minimize edema

13. In the recovery room, as Judy starts to regain consciousness, you noticed that she keeps on swallowing. The most significant postoperative complication following tonsillectomy is
a. Epiglotitis
b. Eustachian tube perforation
c. Hemorrhage
d. Oropharyngeal edema

14. Tonsillectomy is recommended for those with recurrent tonsillitis to prevent what complication?
a. Acute rheumatic fever
b. Brain infection
c. Otitis media
d. Hypertension

15. Which of the following measures can prevent atelectasis in a postoperative client like Judy?
a. Chest physiotherapy
b. Mechanical ventilation
c. Suctioning prn
d. Use of incentive spirometer

Case: An elderly client in a home for the aged has been diagnosed with pneumonia.

16. This client may appear with which of the following symptoms except
a. Fever and chills
b. Hemoptysis and dyspnea
c. Pleuritic chest pain and cough
d. Edema and altered mental status

17. When auscultating the chest, the nurse would expect to hear which of the following sounds over areas of consolidation?
a. Bronchial
b. Bronchovesicular
c. Tubular
d. Vesicular

18. He has been treated with antibiotic therapy for 14 days. Which of the following physical symptoms would you expect to find if the therapy was effective?
a. Continued dyspnea
b. Temp of 38.9C
c. Respiratory rate of 32 breaths/min
d. Vesicular breath sounds in right lung base

19. He is also diabetic and hypertensive at the same time. Clients with chronic illnesses are more likely to get pneumonia when which of the following situations is present?
a. Dehydration
b. Group living
c. Malnutrition
d. Severe periodontal disease

20. Nursing management includes assessment for complications such as
a. Atelectasis
b. Hypotension and shock
c. Pleural effusion
d. All of the above

Case Study (Cynthia)

Read the case, Case Study (Cynthia), then answer the questions below (short bond paper, Font Arial 12, single space). Deadline 9/22/09 (Tues)..

Questions:

Q1: What is the condition of Cynthia

Q2: What time frame would be considered prolonged for second stage? Do you think that Cynthia is having a dysfunctional labor? Justify your answer.

Q3: What is McRobert’s maneuver?

Q4. Give the rationale behind the performance of a suprapubic pressure instead of a fundal push/pressure.

Q5. Do you think this case is an example of a precipitous labor? Justify your answer.

Q6. Is Cynthia considered to have a preterm labor? Support your answer.

Surgical conscience

Surgical conscience is the professional behavior that demonstrates understanding and application of principles of surgical technology and legal, ethical, and moral responsibilities to patients and team members for which each practitioner is accountable. Source: AORN Standards and Recommended Practices for Perioperative Nursing. Denver, CO, Association of Operating Room Nurses, 1988.

Test Yourself: NCLEX practice questions 4

Worried about passing the NCLEX? The more practice questions you do, the more confident you'll feel. Try these, then review the answers and rationales that follow. Experts recommend taking many practice questions before the NCLEX, so take advantage of review courses, books, and other products to help you succeed and pass the NCLEX. ANSWERS BELOW. 1. Which characteristic is expected for a client with paranoid personality disorder who receives bad news? a. The client is overly dramatic after hearing the facts. b. The client focuses on self to not become overanxious. c. The client responds from a rational, objective point of view. d. The client doesn’t spend time thinking about the information. 2. Which term describes an effect of isolation? a. Delusions b. Hallucinations c. Lack of volition d. Waxy flexibility 3. Which health finding is expected in a client who chronically abuses alcohol? a. Enlarged liver b. Nasal irritation c. Muscle wasting d. Limb paresthesia 4. A nurse notes a change in voice and mannerisms of a client with dissociative identity disorder (DID) after he learns that his wife has filed for a divorce. Which nursing intervention is most appropriate? a. Avoid discussing the client’s feelings. b. Force the client to discuss his feelings. c. Offer encouragement to the client that he’ll be able to cope with the divorce. d. Encourage the client to verbalize his feelings about the divorce. 5. A client with an ileostomy tells the nurse he can’t have an erection. Which pertinent information should the nurse know? a. The client will never regain functioning. b. The client needs an abdominal X-ray. c. The client has no problem with self-control. d. Impotence is uncommon following an ileostomy. Answers to NCLEX practice questions 1. c. Clients with paranoid personality disorder are affectively restricted, appear unemotional, and appear rational and objective. Clients with histrionic personality disorder are overly dramatic in response to stress. Clients with narcissistic personality disorder focus on themselves and don’t spend time thinking about bad news. Clients with an obsessive-compulsive personality disorder are preoccupied with the fear of becoming very anxious and losing control. 2. b. Prolonged isolation can produce sensory deprivation, manifested by hallucinations. A delusion is a false, fixed belief that has no basis in reality. Lack of volition is a symptom associated with type I negative symptoms of schizophrenia. Waxy flexibility is a motor disturbance that’s a predominant feature of catatonic schizophrenia. 3. a. A major effect of alcohol on the body is liver impairment, and an enlarged liver is a common physical finding. Nasal irritation is commonly seen in clients who snort cocaine. Muscle wasting and limb paresthesia don’t tend to occur with clients who abuse alcohol. 4. d. Encouraging a client with DID to verbalize his feelings will help him cope with his anxieties. Forcing the client to discuss his feelings can increase his level of anxiety. Avoiding discussion of feelings doesn’t reduce anxiety and avoids the issue. Offering encouragement that the client will be able to cope with the divorce gives false reassurance and can erode the client’s trust in the nurse. 5. d. Sexual dysfunction is uncommon after an ileostomy. Psychological causes of impotence should be explored. An abdominal X-ray isn’t indicated for sexual dysfunction. An ileostomy can change a person’s self-control, making sexual functioning difficult. Source: NCLEX-RN Questions & Answers Made Incredibly Easy!, 4th edition, Lippincott Williams & Wilkins, 2008.

How did swine flu originate? (Just for fun:-)

This picture was emailed to me by anonymous, nevertheless I still want to share it with you guys, just for fun..

H1N1 Flu Alert! From CDC

Test Yourself: NCLEX practice questions

Worried about passing the NCLEX? The more practice questions you do, the more confident you'll feel. Try these, then review the answers and rationales that follow. Experts recommend taking many practice questions before the NCLEX, so take advantage of review courses, books, and other products to help you succeed and pass the NCLEX. ANSWERS BELOW. 1. A woman is worried she might have lice. Which assessment finding is associated with this infestation? a. Diffuse pruritic wheals b. Oval, white dots stuck to the hair shafts c. Pain, redness, and edema with an embedded stinger d. Pruritic papules, pustules, and linear burrows of the finger and toe webs 2. During group therapy, a client listening to another client's description of an abusive incident that occurred during childhood says, “I didn't think anyone else felt like I did as a child.” The nurse recognizes this statement as a reflection of which curative factor of group therapy, as identified by Yalom? a. Altruism b. Universality c. Catharsis d. Existential factors 3. An 86-year-old client in an extended care facility is anxious most of the time and frequently complains of a number of vague symptoms that interfere with his ability to eat. These symptoms indicate which disorder? a. Conversion disorder b. Hypochondriasis c. Severe anxiety d. Sublimation 4. Which nursing intervention is given priority in a care plan for a client having an acute panic attack? a. Tell the client to take deep breaths b. Have the client talk about the anxiety c. Encourage the client to verbalize feelings d. Ask the client about the cause of the attack 5. A nurse is caring for a client with delirium. Which nursing intervention has the highest priority? a. Providing a safe environment b. Offering recreational activities c. Providing a structured environment d. Instituting measures to promote sleep

ANSWERS:

1. b. Nits, the eggs of lice, are seen as white oval dots. Diffuse pruritic wheals are associated with an allergic reaction. Bites from honeybees are associated with a stinger, pain, and redness. Pruritic papules, vesicles, and linear burrows are diagnostic for scabies. 2. b. One of the 11 curative factors of group therapy identified by Yalom is universality, which assists group participants in recognizing common experiences and responses. This action helps reduce anxiety and allows other group members to provide support and understanding. Altruism, catharsis, and existential factors are other curative factors Yalom described, but they don't describe this particular incident. Altruism refers to finding meaning through helping others; catharsis is an open expression of previously suppressed feelings; and existential factors describe the recognition that one has control over the quality of one's life. 3. b. Complaints of vague physical symptoms that have no apparent medical causes are characteristic of clients with hypochondriasis. In many cases, the GI system is affected. Conversion disorders are characterized by one or more neurologic symptoms. The client's symptoms don't suggest severe anxiety. A client experiencing sublimation channels maladaptive feelings or impulses into socially acceptable behavior. 4. a. During a panic attack, the nurse should remain with the client and direct what's said toward changing the physiologic response, such as taking deep breaths. During an attack, the client is unable to talk about anxious situations and isn't able to address feelings, especially uncomfortable feelings and frustrations. While having a panic attack, the client is also unable to focus on anything other than the symptoms, so the client won't be able to discuss the cause of the attack. 5. a. The nurse's highest priority when caring for a client with dementia is to ensure client safety. Offering recreational activities, providing a structured environment, and promoting sleep are all appropriate interventions after safety measures are in place.

Source: NCLEX-RN Questions & Answers Made Incredibly Easy!, 4th edition, Lippincott Williams & Wilkins, 2008.

H1N1 Flu (Swine Flu): Face mask and Respirator Use

April 27, 2009 011:00AM ET copied from the CDC Website

This document provides interim guidance and will be updated as needed.

Detailed background information and recommendations regarding the use of masks and respirators in non-occupational community settings can be found on PandemicFlu.gov in the document Interim Public Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic.

Information on the effectiveness of facemasks¹ and respirators² for the control of influenza in community settings is extremely limited. Thus, it is difficult to assess their potential effectiveness in controlling swine influenza A (H1N1) virus transmission in these settings. In the absence of clear scientific data, the interim recommendations below have been developed on the basis of public health judgment and the historical use of facemasks and respirators in other settings.

In areas with confirmed human cases of swine influenza A (H1N1) virus infection, the risk for infection can be reduced through a combination of actions. No single action will provide complete protection, but an approach combining the following steps can help decrease the likelihood of transmission. These actions include frequent handwashing, covering coughs, and having ill persons stay home, except to seek medical care, and minimize contact with others in the household.Additional measures that can limit transmission of a new influenza strain include voluntary home quarantine of members of households with confirmed or probable swine influenza cases, reduction of unnecessary social contacts, and avoidance whenever possible of crowded settings.

When it is absolutely necessary to enter a crowded setting or to have close contact³ with persons who might be ill, the time spent in that setting should be as short as possible. If used correctly, facemasks and respirators may help reduce the risk of getting influenza, but they should be used along with other preventive measures, such as avoiding close contact and maintaining good hand hygiene. A respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through a respirator for long periods of time. For more information on facemasks and respirators, visit the CDC H1N1 Flu website..

When crowded settings or close contact with others cannot be avoided, the use of facemasks¹ or respirators² in areas where transmission of swine influenza A (H1N1) virus has been confirmed should be considered as follows:

1. Whenever possible, rather than relying on the use of facemasks or respirators, close contact with people who might be ill and being in crowded settings should be avoided.
2. Facemasks¹ should be considered for use by individuals who enter crowded settings, both to protect their nose and mouth from other people's coughs and to reduce the wearers' likelihood of coughing on others; the time spent in crowded settings should be as short as possible.
3. Respirators² should be considered for use by individuals for whom close contact with an infectious person is unavoidable. This can include selected individuals who must care for a sick person (e.g., family member with a respiratory infection) at home.

These interim recommendations will be revised as new information about the use of facemasks and respirators in the current setting becomes available. For more information about human infection with swine influenza virus, visit the CDC H1N1 Flu website.

1 Unless otherwise specified, the term "facemasks" refers to disposable masks cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices. This includes facemasks labeled as surgical, dental, medical procedure, isolation, or laser masks. Such facemasks have several designs. One type is affixed to the head with two ties, conforms to the face with the aid of a flexible adjustment for the nose bridge, and may be flat/pleated or duck-billed in shape. Another type of facemask is pre-molded, adheres to the head with a single elastic band, and has a flexible adjustment for the nose bridge. A third type is flat/pleated and affixes to the head with ear loops. Facemasks cleared by the FDA for use as medical devices have been determined to have specific levels of protection from penetration of blood and body fluids.

2 Unless otherwise specified, "respirator" refers to an N95 or higher filtering facepiece respirator certified by the U.S. National Institute for Occupational Safety and Health (NIOSH).

3 Three feet has often been used by infection control professionals to define close contact and is based on studies of respiratory infections; however, for practical purposes, this distance may range up to 6 feet. The World Health Organization uses "approximately 1 meter"; the U.S. Occupational Safety and Health Administration uses "within 6 feet." For consistency with these estimates, this document defines close contact as a distance of up to 6 feet.

"Energy Drinks" Potentially Harmful to Patients With Cardiovascular Disease

NEW YORK (Reuters Health) Apr 03 - Consumption of energy drinks increases blood pressure and heart rate, and should therefore be avoided by people with hypertension or heart disease, according to results of a small prospective study.

The beverages, marketed to enhance cognitive function and stamina, usually contain caffeine, taurine, sugars, vitamins, and other nutritional supplements, Dr. James S. Kalus, at Henry Ford Hospital in Detroit, and co-authors note in The Annals of Pharmacotherapy for April. The potential hemodynamic or electrocardiographic effects of energy drinks have not been studied.

To look into this, the researchers studied 15 healthy volunteers, 20-39 years of age, who abstained from other dietary sources of caffeine, beginning 48 hours prior to baseline.

The subjects drank 500 mL (2 cans, each containing 100 mg taurine and 100 mg caffeine) of an energy drink over 30 minutes daily for 7 days. On days 1 and 7, blood pressure, heart rate, and electrocardiograms were obtained prior to consuming the drinks and 5 times during the 4 hours afterward.

Mean heart rate increased significantly from baseline by 7.8% on day 1 and by 11.0% on day 7; corresponding increases for systolic blood pressure were 7.9% and 9.6%, and for diastolic blood pressure, 7.0% and 7.8%. EKG parameters did not change significantly.

"Increases in blood pressure and heart rate of the magnitude observed in our study could be significant in persons with known cardiovascular disease," Dr. Kalus and his associates maintain, especially in patients who exhibit impaired baroreflex buffering in response to vasoactive substances. Young individuals with undiagnosed, premature cardiovascular disease could also be at risk.

They advise clinicians that "consumption of these drinks could, theoretically, be a frequently overlooked cause of altered medication effectiveness or even hospital admissions or emergency department visits."

Ann Pharmacother 2009;43.

Copied from http://www.medscape.com/viewarticle/590582?src=mp&spon=24&uac=3980SX

How can you avoid this medication error?

See how your staff or students analyze this error--and how they'd avoid it What happened: Jean Watson, a postoperative patient, has a low serum potassium level on her second postoperative day (2.1 mEq/L), and her health care provider orders an additional 20 mEq of KCl to be added to her I.V. bag. Currently, she has 1,000 ml 5% dextrose in 0.45% NaCl with 20 mEq KCl hanging with 200 ml left in the bag and infusing at 125 ml/hour. The nurse draws up the 20 mEq of KCl and adds it to the current infusion without changing the infusion rate. Situation: This could cause hyperkalemia that might be lethal. Adding KCl to an I.V. bag with 200 ml remaining can create a solution too concentrated to administer I.V. What should have been done: The nurse should have discarded the hanging bag, wasting the 200 ml of I.V. fluid, and hung a new 1,000-ml bag with the additional 20 mEq of KCl added. That I.V. would have 40 mEq of KCl per 1,000 ml, which can be safely given at 125 ml/hour. Administering the I.V. solution through an infusion pump would be safest because it avoids a potential sudden infusion of excess I.V. fluid. Source: Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed., AC Abrams, Lippincott Williams & Wilkins, 2006.

Pistachio Recall Expanded

April 7 (HealthDay News) -- A nationwide recall of pistachio products from a California plant was significantly expanded Monday after federal and state health officials found salmonella bacteria in "critical areas" of the Setton Pistachio facility. Investigators didn't provide any more details. The company announced it's now recalling all lots of roasted in-shell pistachios, roasted shelled pistachios and raw shelled pistachios produced from nuts harvested in 2008, the Washington Post reported. Last week, Setton recalled about 2 million pounds, which represents just a small portion of the 2008 harvest. At the time, it was believed the pistachios may have been contaminated by a sanitation problem that affected only one or two production lines. Setton is the second-largest pistachio processor in the United States and supplies about 35 wholesalers and food manufacturers that repackage the nuts for retail sale or use them as ingredients in other products, the Post reported. The U.S. Food and Drug Administration said it could take weeks before there's a complete list of affected products. To help consumers, the pistachio industry created a Web site that lists products not affected by the recall. The Web site address is www.pistachiorecall.org.

Test Yourself: NCLEX practice questions 3

Worried about passing the National Council Licensure Examination (NCLEX), the test from the National Council of State Boards of Nursing (NCSBN) that your state board of nursing will use to determine whether you’re ready to practice nursing? The more practice questions you do, the more confident you'll feel. Try these, then review the answers and rationales that follow. Experts recommend taking many practice questions before the NCLEX, so take advantage of review courses, books, and other products to help you succeed and pass the NCLEX. A nurse is preparing a teaching plan for a client who was prescribed enalapril maleate (Vasotec) to treat his hypertension. Which of the following instructions should she include in the teaching plan? Select all that apply. Instruct the client to avoid salt substitutes. Tell the client that light-headedness is a common adverse effect that he doesn't need to report. Inform the client that he may have a sore throat for the first few days of therapy. Advise the client to report facial swelling or difficulty breathing immediately. Tell the client that blood tests will be necessary every 3 weeks for 2 months and periodically after that. Advise the client not to change position suddenly to minimize orthostatic hypotension. A physician prescribes I.V. normal saline solution to be infused at a rate of 150 mL/hour for a client admitted with dehydration and pneumonia. How many liters of solution will the client receive during an 8-hour shift? _____________________ A nurse is caring for a terminally ill client. In which order is she likely to observe the following five stages of death and dying, as described by Elisabeth Kubler-Ross? bargaining denial and isolation acceptance anger depression A nurse is caring for a client in the fourth stage of labor. Based on the nurse's note below, which postpartum complication has the client developed? 6/7/06 1745 Pt.'s 24-hour blood loss is 600 mL. Uterus is soft and relaxed on palpation and pt. has a full bladder. Assisted pt. in emptying bladder and notified Dr. G. McMann of findings. Vital signs stable at present. See graphic sheet for ongoing assessments and perineal pad weights.-----S. Jones, RN postpartum hemorrhage puerperal infection deep vein thrombosis mastitis Which nonpharmacologic interventions should a nurse include in the care plan for a client who has moderate rheumatoid arthritis? Select all that apply. massaging inflamed joints avoiding range-of-motion exercises applying splints to inflamed joints using assistive devices at all times selecting clothing that has hook-and-loop (Velcro) fasteners applying moist heat to joints

Answers to NCLEX practice questions

1,4,6 Rationale: When teaching a client about enalapril maleate, the nurse should tell him to avoid salt substitutes because they may contain potassium, which can cause light-headedness and syncope. He should report facial swelling or difficulty breathing immediately because they may be signs of angioedema, which would trigger his prescriber to discontinue the drug. The client should also be advised to change position slowly to minimize orthostatic hypotension. The nurse should tell the client to report light-headedness, especially in the first few days of therapy, so his dosage can be adjusted. The client should also report signs of infection, such as sore throat and fever, because the drug may decrease his white blood cell (WBC) count. Because this effect is generally seen within 3 months, the WBC count and differential should be monitored periodically. 1.2 L Rationale: The ordered infusion rate is 150 mL/hour. The nurse should multiply 150 mL by 8 hours to determine the total volume in milliliters the client will receive during an 8-hour shift (1,200 mL). Then she should convert milliliters to liters by dividing by 1,000. The total volume in liters that the client will receive in 8 hours is 1.2 L. 2,4,1,5,3 Rationale: According to Kubler-Ross, the five stages of death and dying are denial and isolation, anger, bargaining, depression, and acceptance. 1 Rationale: Blood loss from the uterus that exceeds 500 mL in a 24-hour period is considered postpartum hemorrhage. If uterine atony is the cause, the uterus feels soft and relaxed. A full bladder can prevent the uterus from contracting completely, increasing the risk of hemorrhage. Puerperal infection is an infection of the uterus and structures above; its characteristic sign is fever. Two major types of deep vein thrombosis occur in the postpartum period: pelvic and femoral. Each has different signs and symptoms, but both occur later in the postpartum period (femoral, after 10 days postpartum; pelvic, after 14 days). Mastitis is an inflammation of the mammary glands that disrupts normal lactation and usually develops 1 to 4 weeks postpartum. 3,5,6 Rationale: Supportive, nonpharmacologic measures for the client with rheumatoid arthritis include applying splints to treat inflamed joints, using Velcro fasteners on clothes to aid in dressing, and applying moist heat to joints to relax muscles and relieve pain. Never massage inflamed joints because massage can aggravate inflammation. A physical therapy program including range-of-motion exercises and carefully individualized therapeutic exercises prevent loss of joint function. Use assistive devices only when marked loss of range of motion occurs. Source: NCLEX-RN 250 New-Format Questions, 2nd ed., Lippincott Williams & Wilkins, 2007.

Bridging the Gap: Basic Spanish keywords

When you're caring for a Spanish-speaking patient, sometimes it isn't necessary to translate an entire sentence. Instead, you may be able to use one keyword or phrase to convey information to your patient.

- please - thank you - yes - no - maybe - sometimes - never - always - date - signature - good-bye

por favor gracias sí no quizás or tal vez a vecas nunca siempre fecha firma hasta luego or adiós

Source: Medical Spanish Made Incredibly Easy!, 3rd edition, Lippincott Williams & Wilkins, 2008.

Test Yourself: NCLEX practice questions 2

Worried about passing the NCLEX? The more practice questions you do, the more confident you'll feel. Try these, then review the answers and rationales that follow. Experts recommend taking many practice questions before the NCLEX, so take advantage of review courses, books, and other products to help you succeed and pass the NCLEX. ANSWERS BELOW.

1.	To maintain airway patency during a stroke in evolution, which nursing intervention is appropriate?
	1.	Thicken all dietary liquids.
	2.	Restrict dietary and parenteral fluids.
	3.	Place the client in the supine position.
	4.	Have tracheal suction available at all times.
2.	Primary prevention of osteoporosis includes which measure?
	1.	Place items within reach of the client.
	2.	Install bars in the bathroom to prevent falls.
	3.	Maintain the optimal calcium intake.
	4.	Use a professional alert system in the home in case a fall occurs when the client is alone.
3.	A client is admitted with right lower quadrant pain, anorexia, nausea, low-grade fever, and an elevated white blood cell count. Which complication is most likely the cause?
	1.	A fecalith
	2.	Bowel kinking
	3.	Internal bowel occlusion
	4.	Abdominal wall swelling
4.	Which nursing intervention should be taken for a client who complains of nausea and vomitus 1 hour after taking his morning glyburide (DiaBeta)?
	1.	Give glyburide again.
	2.	Give subcutaneous insulin and monitor blood glucose.
	3.	Monitor blood glucose closely and look for signs of hypoglycemia.
	4.	Monitor blood glucose closely and assess for symptoms of hyperglycemia.
5.	Which comfort measure can be recommended to a client with genital herpes?
	1.	Wear loose cotton underwear.
	2.	Apply a water-based lubricant to the lesions.
	3.	Rub rather than scratch in response to an itch.
		4. Pour hydrogen peroxide and water over the lesions. Answers to NCLEX practice questions 1. 4 Because of a potential loss of the gag reflex and potential altered level of consciousness, the client should be kept in Fowler's or a semiprone position with tracheal suction available at all times. Thickening dietary liquids isn't done until the gag reflex returns or the stroke has evolved and the deficit can be assessed. Unless heart failure is present, restricting fluids isn't indicated. 2. 3 Primary prevention of osteoporosis includes maintaining optimal calcium intake. Placing items within reach of the client, using a professional alert system in the home, and installing bars in bathrooms are all secondary and tertiary prevention methods to prevent falls. 3. 1 The client is experiencing appendicitis. A fecalith is a fecal calculus, or stone, that occludes the lumen of the appendix and is the most common cause of appendicitis. Bowel wall swelling, kinking of the appendix, and external occlusion, not internal occlusion, of the bowel by adhesions can also be causes of appendicitis. 4. 3 When a client who has taken an oral antidiabetic agent vomits, the nurse should monitor glucose and assess him frequently for signs of hypoglycemia. Most of the medication has probably been absorbed. Therefore, repeating the dose would further lower glucose levels later in the day. Giving insulin will also lower glucose levels, causing hypoglycemia. The client wouldn't have hyperglycemia if the glybluride was absorbed. 5. 1 Wearing loose cotton underwear promotes drying and helps avoid irritation of the lesions. The use of lubricants is contraindicated because they can prolong healing time and increase the risk of secondary infection. Lesions shouldn't be rubbed or scratched because of the risk of tissue damage and additional infection. Cool, wet compresses can be used to soothe the itch. The use of hydrogen peroxide and water on lesions isn't recommended. Source: NCLEX-RN Questions & Answers Made Incredibly Easy!, 4th edition, Lippincott Williams & Wilkins, 2007.