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Friday, August 1, 2008

Free Nclex Review Questions 3 (Nclex Practice Questions)

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The client is at risk of deep vein thrombosis or thrombophlebitis after this surgery, as for any other major surgery. For this reason, the nurse implements measures that will prevent this complication. Range-of-motion exercises, antiembolism stockings, and pneumatic compression boots are all helpful. The nurse should avoid using the knee latch on the bed or elevating the knees with the use of pillows, which inhibits venous return, thus placing the client more at risk for deep vein thrombosis or thrombophlebitis.

Orchidectomy = Surgery to remove one or both testicles

Signs of prostatism that may be reported to the nurse are reduced force and size of urinary stream, intermittent stream, hesitancy in beginning the flow of urine, inability to stop urinating quickly, a sensation of incomplete bladder emptying after voiding, and an increase in episodes of nocturia. These symptoms are the result of pressure of the enlarging prostate on the client’s urethra.

The characteristic lesion of syphilis is painless and indurated. The lesion is referred to as a chancre. Genital herpes is accompanied by the presence of one or more vesicles that then rupture and heal. Scabies is characterized by erythematous, papular eruptions. Genital warts are characterized by cauliflower-like growths or growths that are soft and fleshy.

The client in the case situation is expected to be dehydrated. The nurse assesses this client for weight loss, lethargy or headache, sunken eyes, poor skin turgor (such as tenting), flat neck and peripheral veins, tachycardia, or low blood pressure.

When calculating how to distribute a fluid restriction, the nurse usually allows half of the daily allotment during the day shift, when the client eats two meals and takes most medications. Another two fifths is allotted to the evening shift, with the balance allowed during the nighttime.

The potassium content of vegetables can be reduced by boiling vegetables and discarding the cooking water.

The client taking epoetin alfa is at risk of hypertension and seizure activity as the most serious adverse effects of therapy. This medication is used to treat anemia.

After (TURP), The client should expect that the urine will be pink-tinged for several days after this procedure. Dark red urine may be present initially, especially with inadequate bladder irrigation, and must be corrected if it occurs.

Early treatment of cervical infection can help prevent chronic cervicitis, which can lead to dysplasia of the cervix. Cervical dysplasia is an early cell change that is considered to be premalignant. Oral contraceptives and douches do not decrease the risk for this type of cancer.

A client had a postive papanicolaou smear and underwent cryosurgery with laser therapy. Vaginal discharge should be clear and watery after the procedure. The client will then begin to slough off dead cell debris, which may be odorous. This resolves within approximately 8 weeks. Tub and sitz baths are avoided while the area is healing, which takes about 10 weeks. Mild pain occurs after the procedure, and narcotic analgesics would not be required.

Infiltrating ductal carcinoma of the breast usually presents as a fixed, irregular-shaped mass. The mass is usually single and unilateral and is painless, nontender, and hard to the touch.

postanesthesia care of a client who has just had a mastectomy include during the first 24 hours after surgery, the client is assisted to move the fingers and hands and to flex and extend the elbow. The client also may use the arm for self-care, provided that the client does not raise the arm above shoulder level or abduct the shoulder.

After mastectomy and axillary lymph node dissection, the client is at risk for edema and infection. The client should avoid activities that increase edema such as carrying heavy objects (handbag or grocery bags) or having blood pressures taken on the affected arm. The client should also use a variety of techniques to avoid trauma to the affected arm because trauma can result in infection. Examples include using an electric razor to shave under the arm, wearing rubber gloves when washing dishes, using gloves when working in the garden, using a thimble when sewing, and using potholders when cooking.

The discomfort of reflux is aggravated by positions that compress the abdomen and the stomach. These include lying flat either on the back or stomach (prone) after a meal. Resting with the head elevated is most likely to give relief to the client.

The client has to lie still for endoscopic retrograde cholangiopancreatography (ERCP), which takes about an hour to perform. The client also has to sign an informed consent form. Intravenous (not oral) sedation is given to relax the client, and an anesthetic spray is used to help keep the client from gagging as the endoscope is passed.

The client is placed in the left Sims' position for the procedure. This position takes the best advantage of the client’s anatomy for ease in introducing the colonoscope.

The client with cholecystitis should decrease overall intake of dietary fat. Foods that should be generally avoided to achieve this end include sauces and gravies, fatty meats, cheese, fried foods, high-fat snacks, products made with cream, and heavy desserts.

During an acute episode of cholecystitis, the client experiences severe right upper quadrant pain that radiates to the right scapula and shoulder. This is governed by the pattern of dermatomes in the body. The nurse who has administered pain medication determines whether this type of pain has been relieved.

Ammonia is yielded as a product of protein metabolism. Clients with hepatic encephalopathy have high serum ammonia levels, which are responsible for the encephalopathy symptoms. Limiting protein intake will curb the elevation in serum ammonia and prevent further deterioration of the client’s mental status.

The client with weight gain and edema who also has cirrhosis complicated by ascites is retaining fluid. This is especially true when the client has not demonstrated an appreciable increase in food intake, or when the weight gain is massive in relation to the time frame given. This makes Excess Fluid Volume the highest priority nursing diagnosis. Furthermore, Excess Fluid Volume can place the client at risk for both respiratory and circulatory symptoms

Pain associated with Crohn’s disease is alleviated by the use of analgesics and antispasmodics. It also is reduced by having the client practice relaxation techniques, applying local heat to the abdomen, and lying with the legs flexed. Lying supine with the legs straight does not help because it increases muscle tension in the abdomen and stretches abdominal muscles, which can aggravate inflamed intestinal tissues.

Dicyclomine is an anticholinergic, antispasmodic agent often used to treat irritable bowel syndrome unresponsive to diet therapy. To be effective in decreasing bowel motility, antispasmodic medications should be administered 30 minutes before mealtimes.

The client with a mild to moderate case of ulcerative colitis is often prescribed a diet that is low residue and with limited milk products. This will help to reduce the frequency of diarrhea for this client. Foods commonly avoided include foods with seeds or nuts and raw or dried fruits and vegetables.

The pain associated with acute pancreatitis is often severe and unrelenting, is located in the epigastric region, and radiates to the back.

The client with chronic alcoholism who is experiencing acute pancreatitis is expected to show elevations in serum blood glucose, lipase, and amylase. The client with alcoholism typically has low magnesium levels

The client with chronic pancreatitis should limit fat in the diet. The client should also take in small meals at each sitting. This also will coincidentally reduce the amount of carbohydrate and protein that the client must digest at any one time. The client does not need to limit water-soluble vitamins in the diet.

Quinapril hydrochloride is an angiotensin converting enzyme (ACE) inhibitor that is used in the treatment of hypertension. The client should be instructed to rise slowly from a lying to a sitting position and to permit the legs to dangle from the bed momentarily before standing to reduce the hypotensive effect. The medication does not need to be taken with meals. It may be given without regard to food. If nausea occurs, the client should be instructed to take a noncola carbonated beverage and salted crackers or dry toast. A full therapeutic effect may take place in 1 to 2 weeks.

Quinupristin-dalfopristin is an antimicrobial medication used in the treatment of skin, urinary tract, central catheter, bone and joint, and respiratory infections, and for endocarditis or bacteremia. For intermittent IV infusion (piggyback), the medication should be infused over a 1-hour period.

Diarrhea, nausea, vomiting, loss of appetite, and dizziness are all common side effects of quinidine gluconate. If these occur, the physician or nurse should be notified; however, the medication should never be stopped abruptly because a rapid decrease in medication levels of antidysrhythmics could precipitate dysrhythmia.

Diltiazem hydrochloride is a calcium channel blocker that is used in the treatment of atrial flutter and fibrillation. It acts to decrease myocardial contractility and the workload on the heart, thus decreasing the need for oxygen. A diltiazem hydrochloride bolus of 0.25 mg/kg is administered slowly over a 2 minute period. A continuous drip of 5 to 10 mg/hr may be continued for up to 24 hours.

Vasopressin is a vasopressor and an antidiuretic. It directly stimulates contraction of smooth muscle, causes vasoconstriction, stimulates peristalsis, and increases reabsorption of water by the renal tubules, resulting in decreased urinary output.

The client taking benztropine mesylate should be instructed to avoid driving or operating hazardous equipment if drowsy or dizzy. Tolerance to heat may be reduced owing to a diminished ability to sweat, and the client should be instructed to plan rest periods in cool places during the day. The client should be instructed to contact the physician if difficulty swallowing or speaking, or vomiting occurs. The client should also inform the physician if central nervous system effects occur. The client should be instructed to monitor urinary output and to watch for signs of constipation.

Drowsiness, dizziness, nausea, and vomiting are frequent side effects associated with the medication. Adverse effects include blood dyscrasias. If the client has a fever, sore throat, mouth ulcerations, unusual bleeding or bruising, or joint pain, this may be indicative of a blood dyscrasia, and the physician should be notified.

Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be assessed before initiating treatment and should be monitored closely during the use of this medication. The client also should be monitored for signs indicating agranulocytosis, which may include sore throat, malaise, and fever.

Disulfiram is used as an adjunct treatment for selective clients with chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important assessment is to determine when the last alcoholic drink was consumed. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is also contraindicated in severe heart disease, psychosis, or hypersensitivity related to the medication.

Donepezil hydrochloride is a cholinergic agent that is used in the treatment of mild to moderate dementia of the Alzheimer’s type. It enhances cholinergic functions by increasing the concentration of acetylcholine. It slows the progression of Alzheimer’s disease.

As peristalsis returns after creation of a colostomy, the client begins to pass malodorous flatus. This indicates returning bowel function and is an expected event. Within 72 hours of surgery, the client should begin passing stool via the colostomy.

The client should be taught to include deodorizing foods in the diet on clients with a colostomy, such as beet greens, parsley, buttermilk, and yogurt. Spinach also reduces odor, but is a gas-forming food as well. Cucumbers, eggs, and broccoli are gas-forming foods, and should be avoided or limited.

For the first 4 to 6 weeks after colostomy formation, the client should eat a low-residue diet. After this period, the client should eat a high-carbohydrate, high-protein diet. The client also is instructed to add new foods one at a time to determine tolerance to that food.

Ileostomy output is liquid by nature. Shredded wheat is high in dietary fiber, and thus will increase output of watery stool by increasing propulsion through the bowel. Foods that help to thicken the stool of the client with an ileostomy include pasta, boiled rice, and low-fat cheese. Addition or elimination of various foods can help to thicken or loosen this normally liquid drainage.

A complication that occurs frequently after ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of intake and output to detect this complication. Losses require replacement by intravenous fluid until the client can tolerate a diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are complications that could occur later in the postoperative period.

A Kock pouch is a continent ileostomy. As the ileostomy begins to function, the client drains it every 3 to 4 hours, then decreasing to about 3 times a day or as needed when full. The client does not need to wear a drainage bag but should wear an absorbent dressing to absorb mucous drainage from the stoma. Ileostomy drainage is liquid. The client would be able to pass stool from the rectum only if an ileal-anal pouch or anastomosis were created. This type of operation would be a two-stage procedure.

To maintain catheter patency and drainage, the catheter is irrigated with 10 to 20 mL normal saline. This prevents the pouch from overfilling, causing tension on the new suture lines. Water is not used because it is hypotonic. Small amounts are used to prevent rupture of suture lines in the newly created pouch.

The peristomal skin must receive meticulous cleansing because the ileostomy drainage has more enzymes and is therefore more irritating to the skin than colostomy drainage. The area below the ileostomy may be massaged as needed if the ileostomy becomes blocked by foods. It is unnecessary to massage around the stoma each day. Fluid intake should be maintained to at least 6 to 8 glasses of water per day to prevent dehydration. Food items such as nuts and seeds will pass through the ileostomy. The client should be taught that these foods will remain undigested.

Expected outcomes for the client with peptic ulcer disease experiencing pain include elimination of irritating foods from the diet, ability to take prescribed medications that will reduce pain, reporting that pain is relieved or prevented with medication, and an ability to sleep through the night without pain.

The most frequent symptom of duodenal ulcer is pain that is relieved by food intake. These clients generally describe the pain as a burning, heavy, sharp, or hunger pain that often localizes in the midepigastric area. It does not radiate down either arm. The client with duodenal ulcer does not usually experience weight loss or nausea and vomiting. These two symptoms are more typical in the client with a gastric ulcer.

Psychological or emotional stressors that exacerbate peptic ulcer disease may be found either at home or in the workplace. An inability to take breaks or days off is potentially the most stressful of all the options listed. This causes excess fatigue and psychological stress and also is the condition over which the client has least control.

Dietary modifications for the client with peptic ulcer disease include eliminating foods that are irritating to the client. Items that are generally eliminated or avoided include highly spiced foods, alcohol, caffeine, chocolate, and fresh fruits. Other foods may be taken according to the client’s level of tolerance for that specific food.

Naprosyn is a nonsteroidal antiinflammatory drug (NSAID), which is typically irritating to the lining of the gastrointestinal (GI) tract and should be avoided by clients with a history of peptic ulcer disease. Sucralfate coats the surface of an ulcer to promote healing. Famotidine is a histamine-receptor antagonist that reduces the secretion of gastric acid. Omeprazole is a proton-pump inhibitor, which blocks the transport of hydrogen ions into the lumen of the GI tract.

Dumping syndrome occurs after gastric surgery because food is not held as long in the stomach and is “dumped” into the small intestine as a hypertonic mass. This causes fluid to shift into the intestines, causing cardiovascular as well as gastrointestinal symptoms. Symptoms typically include weakness, dizziness, diaphoresis, flushing, hypotension, abdominal pain and distention, hyperactive bowel sounds, and diarrhea.

Hiatal hernia is due to protrusion of a portion of the stomach above the diaphragm, where the esophagus usually is positioned. The client usually experiences pain due to reflux with ingestion of irritating foods, with lying flat after meals or at night, and with ingesting large or fatty meals. Relief is obtained with intake of small, frequent, and bland meals; with use of histamine antagonists and antacids; and with elevation of the thorax after meals and during sleep.

Factors to minimize dumping syndrome after gastric surgery include having the client lie down for at least 30 minutes after eating; giving small frequent meals; having the client maintain low-Fowler’s position while eating; avoiding liquids with meals; and avoiding high-carbohydrate food sources. Antispasmodic medications may also be prescribed as needed to delay gastric emptying.

Dicyclomine is an anticholinergic, antispasmodic agent often used to treat irritable bowel syndrome unresponsive to diet therapy. The most frequent side effects of this medication are heartburn and constipation, due to the action of the medication. Other side effects include decreased sweating and salivation, drowsiness, and confusion.

Blood pressure should be taken with the client seated with the arm bared, positioned with support, and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or ingested caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured.

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