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Thursday, August 28, 2008

Nclex Tips 13 (Nclex Test Bank)

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Abdominal pain is the most prominent symptom of acute pancreatitis. The main focus of nursing care is aimed at reducing discomfort and pain by the use of measures that decrease gastrointestinal tract activity, thereby decreasing pancreatic stimulation.

A diagnosis of gout is made on the basis of clinical manifestations, hyperuricemia, and the presence of uric acid crystals in the synovial fluid of the inflamed joint. Blood studies show an increased serum uric acid level of more than 7 mg/100 mL. The erythrocyte sedimentation rate and the white blood cell count may be elevated during an acute episode. T

Probenecid is a uricosuric medication. The client should be instructed to avoid alcohol, because it increases the urate levels and to avoid medications that contain aspirin. Increased fluid intake is encouraged to maintain an adequate urine output and prevent hematuria, renal colic, and stone development. The client is instructed to administer the medication with milk or meals to prevent gastric distress and is also told to limit high-purine foods.

Calcium supplements should not be taken with whole grain cereals, rhubarb, spinach, or bran, because these foods decrease the absorption of the calcium. Most supplements should be taken on an empty stomach (1 hour before meals or at bedtime) to promote absorption, but food might be necessary if gastric irritation develops. The client should be instructed to drink water while taking the supplements to prevent renal stones. Side effects include constipation, gastric irritation, a chalky taste, nausea, and gastric bleeding.

Blood glucose levels for an adult normally range between 60 and 120 mg/dL. A level of 33 mg/dL indicates hypoglycemia. Metabolic disorders can be an etiological factor of delirium.

The Romberg test is an assessment for cerebellar functioning related to balance. The client stands with feet together and arms at the side and then closes the eyes. Slight swaying is normal, but loss of balance indicates a problem and a positive Romberg test.

For the first 12 hours following a laparotomy, the NG tube drainage may be dark brown to dark red. The drainage should then change to a light yellowish brown color. The presence of bile may cause a greenish tinge. The physician should be notified at once of the possibility of hemorrhage if the dark red color continues or if bright red blood is observed. Due to the presence of small amounts of blood and the action of gastric secretions, coffee ground granules might be seen in the NG tube drainage.

The diagnosis of HIV is difficult to accept. Clients can exhibit a variety of reactions that are not necessarily a direct result of ineffective coping skills. The nurse must also know that persons with HIV are living well beyond 1 year. Ignoring the problem will not eliminate the client’s difficulty in understanding the disease process. The nurse must focus on the knowledge deficit of a disease process and other psychosocial interventions.

Sheet grafts are often used to graft burns in visible areas. Sheet grafts are done on cosmetically important areas, such as the face and hands, to avoid the meshed pattern that occurs with meshed grafts.

The incidence of invasive cervical cancer in situ peaks around age 45 and occurs twice as often in African American women than in other races. A classic symptom is painless vaginal bleeding; it can be accompanied by watery, blood-tinged vaginal discharge that can become dark and foul smelling as the disease progresses. A Papanicolaou smear is the initial diagnostic test performed.

Organisms present in the synovial fluid are characteristic of a septic joint condition. Urate crystals are found in gout. Bloody synovial fluid is seen with trauma. Cloudy synovial fluid is diagnostic of rheumatoid arthritis.

Trigeminal neuralgia affects cranial nerve V, causing sudden bursts of electric current–like pain in the face.

In atrial fibrillation with rapid ventricular response, the atrial chambers quiver, do not contract normally, and fill the ventricles with blood during the last part of diastole. This results in the loss of an important atrial contribution to cardiac output, called the “atrial kick.” Loss of the atrial kick and the rapid ventricular rate causes a reduction of cardiac output by as much as 25%.

Physical changes in the client's appearance can occur with Cushing's syndrome. Such changes include hirsutism, moon face, buffalo hump, acne, and striae. These changes cause a body image disturbance.

A fasciotomy is a treatment for compartment syndrome.

The client with unilateral neglect must learn to scan the environment and gradually come to a realization of the affected side

Alcohol can precipitate an attack of pancreatitis. Coffee and cola products, which contain caffeine, stimulate the pancreas. Carbohydrates actually should be encouraged, since they are less stimulating to the pancreas. Since smoking can overstimulate the pancreas, teaching is effective when the client will try to stop smoking.

Hypercalcemia is a phenomenon associated with multiple myeloma. Due to the hypercalcemia, pathological fractures are possible. Ambulation is important, because immobility increases the likelihood of hypercalcemia. Most clients with multiple myeloma will not tolerate aerobic exercise because of their anemia.

Even if testicular cancer is detected in an early stage, the client newly diagnosed with testicular cancer might be afraid he will be sexually handicapped, and feelings of sexual inadequacy may occur. An appropriate nursing diagnosis would be Ineffective Role Performance.

Ventilators need to be assessed routinely by the respiratory therapist. Ventilators are machines, and machines can fail.

The normal white blood cell count is 5,000 to 10,000/mm3. Chemotherapy agents cause medication-induced leukopenia, and treatment focuses on this side effect.

A fractured femur may require up to 20 weeks for healing in an adult. Full weight-bearing is permitted as soon as bony union is present. Ambulation with a cane requires at least partial to full weight-bearing status. Full weight-bearing is usually restricted until there is radiographic evidence of bony union of the fracture fragments. Callus formation is too weak, and the fracture site may refracture with full weight-bearing. The stage of fracture healing dictates the amount of weight-bearing, not range of motion, muscle strength, or pain.

Perforation of the gastrointestinal wall is a potential complication of any endoscopic procedure. Signs of perforation include abdominal pain, bleeding, and fever. Temperature elevation does not usually accompany internal hemorrhage. The temperature may be elevated in both severe dehydration and with a nosocomial infection, but the potential complication that can occur with this procedure is perforation of the intestine.

Clients who test positive for HIV antibody are at risk for opportunistic infection. The normal CD4+ T cell count is between 500 mcg/L and 1600 mcg/L. As the CD4+ T cell count falls, the client’s risk for infection increases. Clients with HIV infection or acquired immunodeficiency syndrome are commonly afflicted with diarrhea, not constipation.

Clients with chronic illness often experience feelings of anger and depression. Manifestations of chronic hepatitis include profound fatigue, resulting in an inability to pursue normal daily activities. Ineffective coping involves inappropriate use of defense mechanisms (alcohol consumption). It can also include the inability to meet role expectations (working). The destructive use of alcohol will contribute to the client’s illness and rehabilitation time, and further prolong fatigue and the inability to work.

Nocturnal attacks of reflux from hiatal hernias are common, especially if the person has eaten near bedtime. Large meals, alcohol, and smoking can also precipitate attacks. Therefore, if the client did more entertaining earlier in the day, attacks might be decreased or eliminated.

The client with Addison’s disease is experiencing deficits of mineralocorticoids, glucocorticoids, and androgens. Aldosterone deficiency affects the ability of the nephrons to conserve sodium, so the client experiences sodium and fluid volume deficit. The client needs to manage this problem with daily hormone replacement and increased fluid and sodium intake. Clients are instructed to weigh themselves daily as a means of monitoring fluid volume balance. Glucocorticoids and mineralocorticoids are essential components of the stress response. Additional doses of hormone replacement therapy are needed with any type of physical or psychological stressor. This information needs to be conveyed to the client and also requires that the client wear a Medic-Alert bracelet, so that health care professionals are aware of this problem if the client were to experience a medical emergency.

The client with ulcerative colitis is most likely anemic due to chronic blood loss in small amounts that occur with exacerbations of the disease. These clients often have bloody stools and are therefore at increased risk for anemia

If a transfusion reaction is suspected, the transfusion is stopped and then normal saline is infused, pending further physician orders. This maintains a patent IV access line and aids in maintaining the client’s intravascular volume. The IV line would not be removed, because then there would be no IV access route. Normal saline is the solution of choice over solutions containing dextrose, because saline does not allow red blood cells to clump.

A frequent side effect of therapy with any of the angiotensin-converting enzyme (ACE) inhibitors, such as ramipril, is the appearance of a persistent, dry cough. The cough generally does not improve while the client is taking the medication. Clients are advised to notify the physician if the cough becomes very troublesome to them.

Nitroglycerin is a coronary vasodilator used in the management of coronary artery disease. The client is generally advised to apply a new patch each morning and leave it in place for 12 to 14 hours as per physician directions. This prevents the client from developing tolerance (as happens with 24-hour use). The client should avoid placing the system in skin folds, hairy areas, or excoriated areas. The client can apply a new patch if it falls off, because the dose is released continuously in small amounts through the skin.

Verapamil is a calcium channel–blocking agent that can be used to treat rapid-rate supraventricular tachydysrhythmias, such as atrial flutter or atrial fibrillation. The client must be attached to a cardiac monitor to evaluate the effectiveness of the medication. A noninvasive blood pressure monitor is also helpful, but is not as essential as the cardiac monitor.

The client should take in increased fluids (2000 to 3000 mL/day) to make secretions less viscous. This can help the client to expectorate secretions. This is standard advice given to clients receiving any of the adrenergic bronchodilators, such as albuterol, unless the client has another health problem that could be worsened by increased fluid intake.

The client taking a potassium-wasting diuretic such as chlorothiazide needs to be monitored for decreased potassium levels.

Amiloride is a potassium-sparing diuretic used to treat edema or hypertension. A daily dose should be taken in the morning to avoid nocturia. The dose should be taken with food to increase bioavailability. Sodium should be restricted if used as an antihypertensive. Increased blood pressure is not a reason to hold the medication, although it may be an indication for its use.

When ranitidine is given as a single daily dose, it should be taken at bedtime. This allows for prolonged effect, and the greatest protection of gastric mucosa around the clock.

Urinary retention is a side effect of benztropine mesylate. The nurse needs to observe for dysuria, distended abdomen, infrequent voiding of small amounts, and overflow incontinence.

Quinapril hydrochloride is an angiotensin-converting enzyme inhibitor used in the treatment of hypertension. The client should be instructed to rise slowly from a lying to 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 regards to food. If nausea occurs, the client should be instructed to consume a non-cola carbonated beverage and salted crackers or dry toast. A full therapeutic effect may take place in 1 to 2 weeks.

Quinidine gluconate is an antidysrhythmic medication used as prophylactic therapy to maintain normal sinus rhythm after conversion of atrial fibrillation and/or atrial flutter. It is contraindicated in complete AV block, intraventricular conduction defects, abnormal impulses and rhythms due to escape mechanisms, and in myasthenia gravis. It is used with caution in clients with preexisting asthma, muscle weakness, infection with fever, and hepatic or renal insufficiency.

Ganciclovir causes neutropenia and thrombocytopenia as the most frequent side effects. For this reason, the nurse monitors the client for signs and symptoms of bleeding, and implements the same precautions that are used for a client receiving anticoagulant therapy. These include providing a soft toothbrush and electric razor to minimize the risk of trauma that could result in bleeding. Venipuncture sites should be held for approximately 10 minutes. The medication does not have to be taken on an empty stomach. The medication may cause hypoglycemia, but not hyperglycemia.

Diarrhea, nausea, vomiting, loss of appetite, and dizziness are all common side effects of quinidine. If these should occur, the physician should be notified; however, the patient should not discontinue the medication. A rapid decrease in medication levels of antidysrhythmics could precipitate dysrhythmia.

Benzonatate (Tessalon) is a locally acting antitussive. Its effectiveness is measured by the degree to which it decreases the intensity and frequency of cough without eliminating the cough reflex.

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

Parlodel is an antiparkinson prolactin inhibitor used in the treatment of neuroleptic malignant syndrome. Vitamin K is the antidote for warfarin (Coumadin) overdose. Protamine sulfate is the antidote for heparin overdose. Vasotec is an angiotensin-converting enzyme (ACE) inhibitor and an antihypertensive that is used in the treatment of hypertension.

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

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