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Monday, January 19, 2009

NCLEX-RN Notes: Core Review and Exam Prep

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Open-ended questions and silence are strategies used to encourage clients to discuss their problem in a descriptive manner.

An infiltrated IV is one that has dislodged from the vein and is lying in subcutaneous tissue. The pallor, coolness, and swelling are the result of IV fluid being deposited in the subcutaneous tissue. When the pressure in the tissues exceeds the pressure in the tubing, the flow of the IV solution will stop. The corrective action will be to remove the catheter and have a new IV line started.

When communicating with a hearing-impaired client, the nurse should speak in a normal tone to the client and should not shout. The nurse should talk directly to the client while facing the client and speak clearly. If the client does not seem to understand what is said, the nurse should express the statement differently. Moving closer to the client and toward the better ear may facilitate communication, but the nurse needs to avoid talking directly into the impaired ear.

When a depressed client is mute or silent, the nurse should use the communication technique of making observations. A statement such as “you are wearing your new shoes” is an appropriate statement to make to the client.

Routine instructions to the client with an AV fistula, graft, or shunt includes reporting signs and symptoms of infection, performing routine range of motion to the affected extremity, avoiding sleeping with the body weight on the extremity with the access site, and avoiding carrying heavy objects or compressing the extremity that has the access site.

Nitroglycerin ointment is used on a scheduled basis and is not prescribed specifically for the occurrence of chest pain. The ointment is not rubbed into the skin. It is reapplied only as directed.

Furosemide is a potassium-losing diuretic, so there is no need to avoid high-potassium products, such as a salt substitute. Orthostatic hypotension is a risk, and the client must use caution with changing positions and with exposure to warm weather. The client needs to discuss the use of alcohol with the physician.

The clonidine patch should be applied to a hairless site on the torso or upper arm. It is changed every 7 days and is left in place when bathing or showering. The patch should not be trimmed because it will alter the medication dose. If it becomes slightly loose, it should be covered with an adhesive overlay from the medication package. If it becomes very loose or falls off, it should be replaced. The patch is discarded by folding it in half with the adhesive sides together.

Colestipol hydrochloride (Colestid), a bile-sequestering agent, is used to lower blood cholesterol levels. However, the bile salts (rich in cholesterol) interfere with the absorption of the fat-soluble vitamins A, D, E, and K, as well as folic acid. With ongoing therapy, the client is at risk of deficiency of these vitamins and is counseled to take supplements of these vitamins.

Because of the resistant strains of tuberculosis, the nurse must emphasize that noncompliance regarding medication could lead to an infection that is difficult to treat and may cause total drug resistance. Clients may prevent nausea related to the medications by taking the daily dose at bedtime. Antinausea medications may also prevent this symptom. Medication doses should not be skipped.

Discharge instruction on a client with jaundice experiencing pruritus includes pruritus is caused by the accumulation of bile salts in the skin and results from obstructed biliary excretion. Antihistamines may relieve the itching, as will tepid water or emollient baths. The client should avoid the use of alkaline soap and wear loose, soft cotton clothing. The client is instructed to keep the house temperature cool.

Early detection of smoke and, subsequently, immediate evacuation from the house have been shown to significantly impact mortality. The installation of a sprinkler system is very expensive and not usually used in residential situations. Fire extinguishers are a good idea to have in the kitchen for small fires, but they are unrealistic and dangerous to use to attempt to extinguish large fires. Although fire-resistant products may help slow down a blaze, even fire-resistant products can eventually catch on fire.

Following insertion of tubes in the tympanic membrane, it is important to avoid getting water in the ears. For this reason, swimming, showering, or washing the hair is avoided after surgery until the time frame designated for each is identified by the surgeon. A shower cap or ear plug may be used when showering, if allowed by the physician. The client should take medication as advised for postoperative discomfort.

Phenytoin causes gum bleeding and hyperplasia and, therefore, a soft toothbrush and gum massage should be instituted to diminish this complication and prevent trauma. Intake and output and blood pressure are not affected by this medication. Directions for administration of this medication include administering it with food to minimize gastrointestinal upset.

Infected house cats transmit toxoplasmosis through the feces. Handling litter boxes can transmit the disease to the pregnant client. Meats that are undercooked can harbor microorganisms that can cause infection. Hands should be washed frequently throughout the day. The use of topical corticosteroids will not prevent exposure to the disease.

Children with CF are managed with a high-calorie, high-protein diet. Pancreatic enzyme replacement therapy and fat-soluble vitamin supplements are administered. Fat restriction is not necessary.

It is best to assess crutch-walking ability and instruct the client in the use of the crutches before surgery, because this task can be difficult to learn when the client is in pain and not used to the imbalance that may occur following surgery.

Clients who are taking Antabuse (Disulfiram) must be taught that substances containing alcohol can trigger an adverse reaction. Sources of hidden alcohol include foods (soups, sauces, vinegars), medicine (cold medicine), mouthwashes, and skin preparations (alcohol rubs, aftershave lotions).

TSE should be performed every month. Small lumps or abnormalities should be reported. The spermatic cord finding is normal. After a warm bath or shower, the scrotum is relaxed, making it easier to perform TSE.

Post-discharge instructions typically include avoiding tight clothing or belts over AICD insertion sites, rough contact with the AICD insertion site, electromagnetic fields such as with electrical transformers, radio/TV/radar transmitters, metal detectors, and running motors of cars or boats. Clients must also alert physicians or dentists of the device, because certain procedures such as diathermy, electrocautery, and magnetic resonance imaging may need to be avoided to prevent device malfunction. Clients should follow the specific advice of a physician regarding activities that are potentially hazardous to self or others, such as swimming, driving, or operating heavy equipment.

Most children nine years old or older can understand the principles of monitoring their own insulin requirements. They are usually responsible enough to determine the appropriate intervention needed to maintain their health.

Clients with thrush cannot tolerate commercial mouthwashes because the high alcohol concentration in these products can cause pain and discomfort to the lesions. A solution of warm water or mouthwash formulas without alcohol are better tolerated and may promote healing. A change in diet to liquid or pureed food often eases the discomfort of eating. The client should avoid spicy foods, citrus juice, and hot liquids.

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