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Wednesday, January 7, 2009

Springhouse NCLEX- RN Review Cards

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Exposure to silica dust occurs with activities such as pottery making and doing stone masonry. Exposure to the finely ground silica, such as is used with soaps, polishes, and filters, is also dangerous. Silica is not a pesticide and is not found in the average soil. Silica is not inhaled in fumes, such as with woodworking or painting.

Food items and liquids that are naturally high in phosphates should be avoided by the client with hyperphosphatemia. These include fish, eggs, milk products, vegetables, whole grains, and carbonated beverages.

Aggressive pulmonary measures are used to prevent respiratory complications in the client who has Impaired Gas Exchange as a result of a burn injury. These include turning and repositioning, positioning for comfort, using humidified oxygen, providing incentive spirometry, and suctioning the client on an as-needed basis. The least helpful measure is to keep the client in one single position. This will ultimately lead to atelectasis and possible pneumonia.

Risk factors for cervical cancer include African and Native American individuals, having multiple sexual partners or a partner who had multiple sexual partners, early age of first intercourse, smoking tobacco, low socioeconomic status, untreated chronic cervicitis, sexually transmitted diseases, and having a partner with a history of penile or prostate cancer.

Primary prevention for pelvic inflammatory disease includes avoiding unprotected intercourse, multiple sexual partners, the use of an IUD, and douching.

Following vasectomy, the client must continue to practice a method of birth control until the follow-up semen analysis shows azoospermia. Live sperm may be present in the ampulla of vas following this procedure.

Interventions for prostatitis include antiinflammatory agents or short-term antimicrobial medication. Warm sitz baths and normal sexual activity are recommended. Dietary restrictions are not necessary unless the person finds that certain foods are associated with manifestations.

A high intake of dietary fat is a risk factor for prostate cancer.

Keeping the testes cool by avoiding hot baths and tight clothing appears to improve the sperm count. Avoiding factors that depress spermatogenesis, such as the use of drugs, alcohol, marijuana, and exposure to occupational or environmental hazards, and maintaining good nutrition are key components to prevent infertility.

Discharge instructions to a client with total hip replacement includes not to sit continuously for longer than 1 hour. The client should be instructed to stand, stretch, and take a few steps periodically. The client cannot drive a car for 6 weeks after surgery unless allowed to do so by a physician. A support stocking should be worn on the unaffected leg and an Ace bandage usually is prescribed to be placed on the affected leg until there is no swelling in the legs and feet, and until full activities are resumed. The legs are abducted by placing a pillow between them when the client lies down.

The client needs to be instructed to take insulin even if he or she is vomiting and unable to eat. It is important to self-monitor blood glucose more frequently during illness (every 2 to 4 hours). If the premeal blood glucose is greater than 250 mg/dL, the client should test for urine ketones and contact the physician.

If a hypoglycemic reaction occurs, the client will need to consume 10 to 15 g of carbohydrate. Six to eight ounces of milk contains this amount of carbohydrate. Tremors and diaphoresis are signs of mild hypoglycemia. Insulin is not taken as a treatment for hypoglycemia because the insulin will lower the blood glucose. Hypoglycemic reactions can occur at any time of the day or night.

Many kidney stones are composed of calcium oxalate. Foods that raise urinary oxalate excretion include spinach, rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.

The mother is instructed to avoid tilting up the nipple or squeezing the areola and pushing it into the newborn’s mouth. This action does not facilitate the breastfeeding process or flow of milk.

The mother needs to be instructed that cough syrup and cold medicines are not to be administered because they may dry and thicken secretions in a client with croup. Sips of warm fluid will relax the vocal cords and thin mucus. A cool mist humidifier rather than a steam vaporizer is recommended because of the danger of the child pulling the machine over and causing a burn. Acetaminophen (Tylenol) will reduce the fever.

Buspirone (BuSpar) is prescribed to a client with anxiety disorder. The medicine may be administered without regard to meals, and the tablets may be crushed. This medication is not available in liquid form.

Discharge instructions to a client hospitalized for pancreatitis includes the need to avoid alcohol, coffee and tea, spicy foods, and heavy meals, which stimulate pancreatic secretions and produce attacks of pancreatitis. The client is instructed in the benefit of eating small frequent meals that are high in protein, low in fat, and moderate to high in carbohydrates.

Foods containing high amounts of purines should be avoided in the client with uric acid stones. This includes limiting or avoiding organ meats, such as liver, brain, heart, and kidney. Other foods to avoid include sweetbreads, herring, sardines, anchovies, meat extracts, consomm├ęs, and gravies. Foods that are low in purines include all fruits, many vegetables, milk, cheese, eggs, refined cereals, coffee, tea, chocolate, and carbonated beverages.

If the client does not breathe normally between incentive spirometer breaths, hyperventilation and fatigue can result. Hyperventilation is the most common cause of respiratory alkalosis, which is characterized by lightheadedness and dizziness.

Reoccurrence of pulmonary embolism can be minimized by wearing elastic or supportive hose. Elastic or supportive hose enhances venous return. The client also enhances venous return by avoiding crossing the legs at the knees or ankles, interspersing periods of sitting with walking, and doing active foot and ankle exercises. The client should also take in sufficient fluids to prevent hemoconcentration and hypercoagulability.

Oral contraceptive use is a risk factor for heart disease, particularly when it is combined with cigarette smoking. Regular exercise and keeping total cholesterol levels under 200 mg/dL are general measures to decrease cardiovascular risk.

After surgery, measures are taken to prevent venous stasis. They include applying elastic stockings or leg wraps, use of pneumatic compression boots, discouraging leg crossing, avoiding the use of the knee gatch, performing passive and active ROM, and avoiding the use of pillows in the popliteal space. Leg elevation while sitting will promote venous drainage and help prevent postoperative edema.

A severe complication of atrial fibrillation is the development of mural thrombi. The blood stagnates in the “quivering” atria, because of the loss of organized atrial muscle contraction and “atrial kick.” The blood that pools in the atria can then clot, which increases the risk of pulmonary and cerebral emboli.

Measures to provide relief of heartburn include eating small, frequent meals and avoiding fatty fried foods, coffee, and cigarettes. Mild antacids can be used if they do not contain aspirin or sodium. Frequent sips of milk or hot tea is helpful.

Antibiotics are not taken prophylactically to prevent chlamydia. The risk of reinfection can be reduced by limiting the number of sexual partners and by the use of condoms. In some instances, follow-up culture is requested in 4 to 7 days to confirm a cure.

Stool softeners are ordered for the client with prostatitis to prevent constipation, which can be painful. It has no direct effect on decreasing swelling. Constipation does not cause complications of prostatitis. Stool softeners are not a standard prescription for “anyone with an abdominal problem.”

Signs and symptoms of Parkinson’s disease usually begin to resolve within 2 to 3 weeks of starting therapy, although in some clients marked improvement may not be seen for up to 6 months. Clients need to understand this concept to aid in compliance with medication therapy.

The therapeutic range for serum phenytoin levels is 10 to 20 mcg/mL in clients with normal serum albumin levels and renal function. A level below this range indicates that the client is not receiving sufficient medication and is at risk for seizure activity. In this case, the medication dose should be adjusted upward. A level above the therapeutic range indicates that the client is entering the toxic range and is at risk for toxic side effects of the medication. In this case, the dose should be adjusted downward.

Dilantin (phenytoin) is an anti-epileptic drug used to control seizures.

An annual prostate exam and a PSA test should be done beginning at the age of 50 and beginning at the age of 45 if the client is at high risk for this type of cancer. Increased intake of green or yellow vegetables or lycopene contained in tomatoes may be helpful in reducing risk. A low-fat, high-fiber diet diminishes prostate cancer risk.

High-quality proteins come from animal sources and include such foods as eggs, chicken, meat, and fish. Low-quality proteins derive from plant sources and include vegetables and foods made from grains. Because the renal diet is limited in protein, it is important that the proteins ingested are of high quality.

Unilateral neglect is a pattern of lack of awareness of body parts such as paralyzed arms or legs. Initially, the environment is adapted to the deficit by focusing on the client’s unaffected side, and the client’s personal items are placed on the unaffected side. Gradually, the client’s attention is focused to the affected side. The client is assisted from the affected side, and the client grooms the affected side first. The client needs to scan the entire environment.

Home care instructions to a child with (HIV) include immunizations must be kept up to date. Blood spills are wiped up with a paper towel. The area is then washed with soap and water, rinsed with bleach and water, and allowed to air dry. Hands are washed with soap and water if they come in contact with blood. Parents are instructed that toothbrushes are not to be shared.

Acquisition of psychomotor skills is best evaluated by observing how a client can carry out a procedure. The client may be able to verbalize how to do the procedure but may not be able to actually perform the psychomotor function.

An implanted vascular port does not need to be pumped in order to maintain patency. The site will need to be kept clean and dry, and the physician would need to be notified of signs and symptoms of infection. Saline is used to flush the site to maintain patency.

A stump sock must be worn at all times to absorb perspiration and is changed daily. The residual limb (stump) is washed, dried, and inspected for breakdown twice each day. The socket of the prosthesis is cleansed with a mild detergent, and rinsed and dried carefully each day. A strong bactericidal agent would not be used.

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