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Sunday, July 27, 2008

Nclex Exam Questions 6 Saunders

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Following hydrostatic reduction, the nurse observes for the passage of barium or water-soluble contrast material with stools.

The glycosylated hemoglobin measures the glucose molecules that attach to the hemoglobin A molecules and remain there for the life of the red blood cell, approximately 120 days. This is not reversible and can’t be altered by human intervention. Daily glucose logs are useful if they are kept regularly and accurately, but they only reflect the blood glucose at the time the test was done. A fasting blood glucose level is also time-limited in its scope, as is the dietary history.

Surgical intervention breaks some of the body’s primary defenses against infection. Infection can endanger the life of a client. The most important measure in preventing postoperative wound infection is adherence to meticulous aseptic techniques. The temperature in the surgical suite is kept cool to deter bacterial growth. Most pathogenic bacteria metabolize and reproduce at or near normal body temperature. By keeping the room temperature below body temperature, bacterial growth may be inhibited. By keeping air currents and movement to a minimum, airborne contamination can be controlled. Therefore, doors to the surgical suite must remain closed at all times. The skin preparation is performed to free the operative site as much as possible from dirt, skin oils, and transient microbes. This should be accomplished with the least amount of tissue irritation.

Preschoolers are often fearful and likely to move during an injection, making it most important to have assistance to administer the injection. Gluteal muscles may be used for an intramuscular injection in preschoolers in addition to the vastus lateralis. The choice of standing is unacceptable because it is difficult to locate landmarks. Distraction is helpful but not the best action.

Sinus tachycardia is characterized by a rapid, regular rhythm at a rate of 100 to 180 beats per minute. The P waves and the QRS complex are normal. It often occurs in response to an increase in sympathetic stimulation or decreased vagal (parasympathetic) stimulation. Sinus bradycardia occurs when the sinoatrial node fires at a rate of less than 60 times per minute. In normal sinus rhythm, the rhythm is regular, the rate is 60 to 100 beats per minute, and the P-R interval is 0.12 to 0.20 second. In ventricular fibrillation, the electrocardiogram displays bizarre, fibrillatory wave patterns, and it is impossible to identify P waves, QRS complexes, or T waves.

Urinary output will be decreased secondary to decreased renal perfusion. Other signs and symptoms of blood loss (hypovolemic shock) include decreased peripheral pulses due to decreased circulating blood volume, restlessness or agitation due to decreased cerebral perfusion, and increased respiratory rate due to decreased circulating oxygen.

Haloperidol (Haldol) is an antipsychotic agent used to control tics and vocal utterances of Tourette’s syndrome. The medication produces a tranquilizing effect.

A priority intervention for a suicidal individual is to communicate the risk for suicide to all team members. The plan of activities would provide the suicidal client with something to do, but the communication of the risk is the priority.

Sodium nitroprusside decreases blood pressure by vasodilation, thus reducing pressure in the aneurysm.

The nurse would first monitor vital signs and review with the client that the client had just received an ECT treatment.

Atenolol is a beta blocker with antihypertensive effects. Chlorpromazine can also lower blood pressure. The potential for falls related to orthostatic hypotension and sedation is of concern to the nurse administering chlorpromazine. This risk is greatly increased when an antihypertensive agent is added.

Ruscus aculeatus (Butcher’s Broom) is an evergreen found in the Mediterranean and the southern region of the United States. It has been used to treat varicose veins, peripheral vascular disease, arthritis, hemorrhoids, and leg edema. It has also been used as a laxative, as a diuretic, and to treat diabetic retinopathy.

All characteristics of sinus bradycardia are the same as those of normal sinus rhythm, except the rate is slower.

Sambucus nigra (Elderberry) is a shrub found in the United States and Europe. It has been used to treat colds, diaphoresis, toothache, headache, sinusitis, hay fever, wounds, skin disorders, hepatic conditions, and inflammation.

Giving information that explains the situation clearly empowers the couple, fostering a reduction of fear and willingness to cooperate in a positive way. It also enhances the couple’s feeling that the nurse is supportive and in control of the situation. Stressing what they can do to help prevents or decreases any feelings of helplessness.

Lying supine (on the back) applies additional gravity pressure on the abdominal blood vessels (iliac, interior vena cava, ascending aorta) increasing compression and impeding blood flow and cardiac output. This results in hypotension, dizziness, nausea, pallor, clammy (cool, damp) skin, and sweating. Raising one hip higher than the other reduces the pressure on the vena cava, restoring the circulation and relieving the symptoms.

By placing the call button within easy reach of the client, the client has immediate access to the health care team. The client can be reassured that a member of the health care team is available and will come if the client calls. This hopefully will decrease the client’s perception of being alone and give the client some sense of control.

Valeriana officinalis (Valerian) is a perennial that is cultivated throughout the world. It has been used to treat nervous disorders such as anxiety, restlessness, and insomnia.

Safety during defibrillation is essential to prevent injury to the client and the personnel assisting with the procedure. The person performing the defibrillation ensures that all personnel are standing clear of the bed by a verbal and visual check of “all clear.” Charged paddles should never be handed to other personnel. For the shock to be effective, some type of conductive medium (lubricant, gel) must be placed between the paddles and the skin. Firm pressure is needed to reduce the chances of arcing and to reduce impedance to the flow of current.

The goal of pharmacotherapy following an MI is to increase oxygen supply to the myocardium and provide anticoagulation and analgesia. Heparin, morphine sulfate, and nitroglycerin will accomplish this. Digoxin, which is a positive inotropic agent, increases cardiac output by improving the contractile force of the heart. This is used with caution in the acute phase of MI and is contraindicated in ventricular fibrillation and ventricular tachycardia unrelated to congestive heart failure.

Clients taking captopril should be instructed to report sore throat, fever, chest pain, edema or swelling of the face, hands, and feet. Swelling of the face, lips, hands, or feet may be indicative of angioedema (an acute, painless dermal swelling).

Spironolactone (Aldactone) is a potassium-sparing diuretic. The client on a potassium-sparing diuretic is at risk for hyperkalemia. If a potassium supplement were prescribed, the nurse would question the order.

Bearing down while defecating causes a Valsalva effect that decreases cardiac output and venous return and puts the client at risk for syncope and dysrhythmias.

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