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Monday, August 18, 2008

Nclex Tips 4 (Pearson Nclex)

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Large quantities of alcohol have been associated with an increased risk of liver cancer. However, according to the client’s statement, the client understood that no alcohol may be consumed. Thus the client requires reinforcement that alcohol is the substance associated with liver cancer; however, clarification is needed that it is an excessive intake that is associated with liver cancer.

Decreased aldosterone secretion results in a fluid volume deficit. Clients are encouraged to maintain an oral intake of 3000 mL/day to avoid dehydration. Clients require a high sodium diet to replace losses. Snacks between meals are encouraged, to prevent hypoglycemia. Clients with Addison’s disease require hormone-replacement therapy with corticosteroids.

Addisonian crisis is a serious, life-threatening response to acute adrenal insufficiency that is most commonly precipitated by a major stressor. The client with addisonian crisis may have any of the signs or symptoms of Addison’s disease, but the primary problems are sudden profound weakness; severe abdominal, back, and leg pain; hyperpyrexia followed by hypothermia; peripheral vascular collapse; coma; and renal failure.

Typical discharge instructions after AICD implantation include reporting to the physician symptoms indicating dysrhythmias, such as fainting, blackouts, rapid pulse, weakness, or nausea. The physician may want to be called each time the device discharges. At a minimum, the client should keep a log recording the date, time, symptoms, and activity before the shock, the number of shocks delivered, and how the client felt afterward. The physician will use this information in managing the ongoing medication regimen. The community emergency medical system should be notified about the device, so they are prepared if they are called to the home. Contingency plans for health care should be made before travel. The family also should become trained in cardiopulmonary resuscitation (CPR).

No special restrictions are imposed after a bone scan. The client is encouraged to drink large amounts of water for 24 to 48 hours to flush the radioisotope from the system. No hazards to the client or staff exist from the minimal amount of radioactivity of the isotope.

A hepatitis A vaccine is available for administration to protect against the infection. In addition, a standard immunoglobulin for passive immunization can be given prophylactically or after exposure. The immunoglobulin for passive immunization provides protection from infection for approximately 2 months. Hepatitis A is transmitted via the fecal-oral route

Outcomes indicating that peritonitis has resolved include an afebrile condition, absence of rebound tenderness, clear appearance of dialysate, absence of bacteria in dialysate, normal WBC count, and no redness or swelling at the catheter site.

Medical management of hyperparathyroidism includes increasing urinary calcium excretion with diuretics.

Clients with hypoparathyroidism experience symptoms related to hypocalcemia ranging from mild paresthesias due to the tetany and possible seizures. Treatment for the disorder involves correction of the hypocalcemia and vitamin D deficiency with pharmacological intervention such as calcium chloride, vitamin D, and calcitriol (Rocaltrol). Nurses should encourage compliance with the prescription regimen as well as teach the client that treatment for this disorder is lifelong. In addition to pharmacological compliance, the client should maintain certain dietary guidelines (high calcium, low phosphorus) if the disease is to be controlled.

PTU is administered to clients in thyroid storm to block thyroid hormone synthesis of T3 and T4. Thyroid antibodies indicate whether an autoimmune disease is causing the client's symptoms. A thyroid scan provides information about whether excessive or diminished activity is present in the gland but provides no information about the degree of hormone synthesis. The TSH stimulation test differentiates primary from secondary hypothyroidism.

The client learns to void after creation of a neobladder by relaxing the external sphincter while increasing the intra-abdominal pressure (Valsalva maneuver). If the client cannot perform this procedure, then the client must learn to do intermittent catheterization of the neobladder.

In the absence of documented heart disease, the desired goal is to have a total cholesterol less than 200 mg/dL, low LDL levels of less than 130 mg/dL, and high HDL levels greater than 50 mg/dL. In the absence of documented heart disease or significant risk factors, the values identified in the question place the client at a low risk for heart disease.

The oropharynx (mouth) should be suctioned last to prevent introducing oral bacteria into the lung field. Allowing at least 30-second intervals between suctioning times will allow the client to equilibrate. Pressure beyond 120 mm Hg will damage the mucous membranes. The suction catheter should not be left in the trachea for more than 15 seconds, or the client will experience hypoxia.

MRI is a test that involves an external magnetic field to visualize soft tissues. Because of the magnetic field, this test is contraindicated in clients with pacemakers because it can reprogram the pacemaker.

Although esophageal varices are caused by portal pressure, rupture of the varices may be caused by increased intrathoracic pressure such as coughing and straining. This pressure may occur during heavy weight-lifting.

The term nephrotic syndrome refers to a kidney disorder characterized by proteinuria, hypoalbuminemia, and edema. The child experiences fatigue, anorexia, increased weight, abdominal pain, and a normal blood pressure.

Nicardipine hydrochloride (Cardene) is a calcium channel blocker that is used to treat chronic stable angina or primary hypertension. Before administering the medication, the nurse would check the client’s blood pressure and pulse rate.

Epstein-Barr virus is transmitted by contact with infectious saliva, close intimate contact with an infectious individual, or contact with infected blood. The infectious period is unknown. Commonly, the virus is shed before clinical onset of the disease until 6 months or longer after recovery.

Early signs of lithium toxicity include vomiting, diarrhea, lethargy, and muscle twitching. Moderate toxicity results in ataxia, giddiness, tinnitus, blurred vision, clonic movements, and severe hypotension. Acute toxicity is characterized by seizures, oliguria, circulatory failure, and death.

Poor nutrition during pregnancy can negatively influence fetal growth and development. Although pregnancy poses some nutritional risk for the mother, not all clients are at high risk. Calcium is critical during the third trimester, but must be increased from the onset of pregnancy. Intake of dietary iron is usually insufficient for the majority of pregnant women, and iron supplements are routinely encouraged.

One of the earliest indicators of successful adaptation of the newborn infant is the Apgar score. Scoring ranges from 0 to 10. A score of 8 to 10 indicates that the infant is adjusting well to extrauterine life. A score of 5 to 7 often indicates an infant who requires some resuscitative intervention. Scores of less than 5 indicate infants who are having difficulty adjusting to extrauterine life and require vigorous resuscitation.

Kegel exercises strengthen the pelvic floor (pubococcygeal muscle). The increased tone of this muscle is beneficial during pregnancy and afterward.

Hemorrhoids are varicosities and are likely to be precipitated during pregnancy by the pressure of the growing fetus inside the abdominal cavity. Standing aggravates the problem. Dietary factors, such as fluids and bulk, and manual reduction are measures that should be included in the plan of care. Hormonal changes are not a factor in the development of hemorrhoids during pregnancy.

Oxygen is administered continuously during labor to the client with sickle cell anemia to provide adequate oxygenation and prevent sickling.

HELLP is a laboratory diagnosis for a variant of severe preeclampsia and is characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). One of the signs of HELLP syndrome is a decrease in the platelet count.

When performing fundal massage, one hand is placed just above the symphysis pubis to support the lower uterine segment, while the fundus is gently but firmly massaged in a circular motion. Pushing on an uncontracted uterus could invert the uterus and cause massive hemorrhage.

Symptoms of infection are moistness, oozing, discharge, and a reddened base around the cord. If symptoms of infection occur, the mother should be instructed to notify a health care provider because antibiotics may be needed. If these symptoms occur, antibiotics are necessary.

In term infants, jaundice first appears after 24 hours and disappears by the end of day 7. Jaundice is first noticed in the head, especially the sclera and mucous membranes. The newborn infant has a high rate of bilirubin production. The reabsorption of bilirubin from the neonatal small intestine is considerable.

Criteria for early discharge in the newborn infant include no evidence of significant jaundice within the first 24 hours after birth. The infant should have urinated and passed at least one stool, completed at least two successful feedings, and have normal vital signs for at least 12 hours. These criteria may vary depending on agency policy.

If the newborn infant is apneic or has gasping respirations after stimulation, or if the heart rate is below 90 beats/minute, positive-pressure ventilation by bag and mask can be given. The ventilation bag used for neonatal resuscitation should have a pressure gauge. Ventilations should be given at a rate of 40 to 60 breaths/minute at pressures of 15 to 20 cm H2O. An initial pressure of 30 to 40 cm H2O may be necessary to inflate collapsed alveoli.

After the placenta separates, it can usually be delivered if the mother bears down. The cord may be gently pulled to assist in the delivery of the placenta. Excess traction on the cord may cause it to break, making the placenta harder to deliver.

Complete uterine rupture results in massive blood loss; however, external bleeding may not be noted because most of the blood is lost into the peritoneal cavity. Signs of shock, as evidenced by a decrease in blood pressure, tachycardia, tachypnea, pallor, cool and clammy skin, anxiety, and pain, develop quickly. Cessation of uterine contractions occurs.

The nurse should report the time of the last food intake to the physician. General anesthesia may be used for an emergency cesarean delivery. Gastric contents are very acidic and can produce chemical pneumonitis if aspirated.

Situational Low Self-Esteem represents temporary negative feelings about self in response to an event.

Ineffective Coping implies that the person is unable to manage stressors adequately.

Dysfunctional Grieving implies prolonged unresolved grief leading to detrimental activities.

Deficient Knowledge indicates a lack of information or psychomotor skill concerning a condition or treatment.

Dystocia (antonym eutocia) is an abnormal or difficult childbirth or labour.

Abnormal labor patterns are assessed according to the nature of the cervical dilation and fetal descent. Progressive changes in the cervix are a reassuring pattern in labor

After a precipitate delivery, the mother may need help to process what has happened and time to assimilate it all. The mother may be exhausted, in pain, stunned by the rapid nature of the delivery, or simply following cultural norms. Providing support to the mother is the most appropriate and therapeutic action by the nurse.

As the placenta separates, the uterus changes from a discoid to a globular shape. Other signs of placental separation include lengthening of the umbilical cord, a sudden gush of dark blood from the introitus, and a firmly contracted uterus. The client may experience vaginal fullness, but not sudden abdominal pain.

The lower uterine segment does not contain the same intertwining musculature as the fundus of the uterus, making this site more prone to postpartum bleeding.

The client most at risk for abruptio placenta is the woman who smokes or uses alcohol, illegal drugs such as cocaine, or caffeine during pregnancy.

The normal fetal heart rate is 120 to 160 beats/minute. Signs of potential complications of labor include contractions consistently lasting 90 seconds or longer, contractions consistently occurring 2 minutes or less apart, fetal bradycardia, tachycardia, persistently decreased variability, or an irregular FHR.

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