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Monday, January 26, 2009

NCLEX-RN 101: How to Pass! Few Points Discussed

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Zollinger-Ellison syndrome is a hypersecretory condition of the stomach. The client should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal antiinflammatory medications (Naprosyn and ibuprofen). The client should take acetaminophen for pain relief.

A TURP is done through the urethra. An instrument called a resectoscope is used to cut the tissue using high-frequency current. An incision between the scrotum and anus is made when a perineal prostatectomy is performed. A lower abdominal incision is used for suprapubic or retropubic prostatectomy.

The most common sites for bone marrow aspiration in the adult are the iliac crest and the sternum. These areas are rich in bone marrow and are easily accessible for testing. The femur, scapula, and ribs are not sites for bone marrow aspiration.

Amiloride (Midamor) 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, and it may be an indication for its use.

Early treatment of cervical infection can help prevent chronic cervicitis, which can lead to dysplasia of the cervix. Cervical dysplasia is an early cell change that is considered to be premalignant. Oral contraceptives and douches do not decrease the risk for this type of cancer.

An urticaria reaction is characterized by a rash accompanied by pruritus. This type of transfusion reaction can be prevented by pretreating the client with an antihistamine, such as diphenhydramine.

Infiltrating ductal carcinoma of the breast usually presents as a fixed, irregularly shaped mass. The mass is usually single and unilateral, and is painless, nontender, and hard to the touch.

Common risk factors for colorectal cancer that cannot be changed include age over 40, first-degree relative with colorectal cancer, and history of bowel problems such as ulcerative colitis or familial polyposis. Clients should be aware of modifiable risk factors as part of general health maintenance and primary disease prevention. Modifiable risk factors are those that can be reduced, and include a high-fat and low-fiber diet.

The discomfort of reflux is aggravated by positions that allow the reflux of gastrointestinal contents. The client is instructed to remain upright for 1 to 2 hours after a meal and to sleep with the head of the bed elevated 6 to 8 inches. Lying flat will increase the episodes of reflux, resulting in chest discomfort.

Methylphenidate (Ritalin) is a central nervous stimulant and should be taken before breakfast and before the noontime meal. It should not be taken in the afternoon or evening because the stimulating effect causes insomnia.

A barium swallow, or esophagography, is an x-ray that uses a substance called barium for contrast to highlight abnormalities in the gastrointestinal (GI) tract. The client is told to remove metal objects such as medals and jewelry before the test, so they won’t interfere with x-ray visualization of the field. The client should fast for 8 to 12 hours before the test, depending on physician instructions. Some oral medications are withheld before the test, and the client should follow the physician’s instructions regarding medication administration. It is important after the procedure to monitor for constipation, which can occur as a result of the presence of barium in the GI tract.

Sucralfate (Carafate) is an antiulcer medication. The medication should be scheduled for administration 1 hour before meals and at bedtime. This timing will allow the medication to form a protective coating over the ulcer before it becomes irritated by food intake, gastric acid production, and mechanical movement.

For abdominal paracentesis, the nurse should position the client in an upright position on the edge of the bed with the feet resting on a stool and the back well supported. This position allows the intestine to float posteriorly and helps prevent laceration during catheter insertion.

The most accurate means of assessing pulse rhythm is by auscultation of the apical pulse. When a client has PVCs, the rate is irregular and if the radial pulse is taken, a true picture of what is occurring is not obtained. A very fast regular apical pulse indicates tachycardia. A very slow regular apical pulse indicates bradycardia.

Calcium carbonate is used as an antacid for the relief of heartburn and indigestion. It can also be used as a calcium supplement or to bind phosphorus in the gastrointestinal (GI) tract in clients with renal failure.

Clients with Bell’s palsy should be reassured that they have not experienced a stroke and that symptoms often disappear spontaneously in 3 to 5 weeks. The client is given supportive treatment for symptoms. It is not usually caused by a tumor, and the treatment does not involve administering vasodilators.

Propantheline is an antimuscarinic anticholinergic medication that decreases gastrointestinal secretions. It should be administered 30 minutes before meals. It is usually prescribed to treat peptic ulcer disease.

A patient taking carbamazepine (Tegretol) is given instructions that includes Drowsiness, dizziness, nausea, and vomiting are frequent side effects associated with the medication. Adverse reactions include blood dyscrasias. If the client develops a fever, sore throat, mouth ulcerations, unusual bleeding or bruising, or joint pain, this may be indicative of a blood dyscrasia, and the physician should be notified.

A common treatment for women with estrogen-receptor positive breast tumors is follow-up treatment with tamoxifen (Nolvadex). This medication is classified as an antineoplastic agent and competes with estrogen for binding sites in the breast and other tissues. The medication may be administered for years following surgery.

Donepezil hydrochloride (Aricept) is a cholinergic agent that is used in the treatment of mild to moderate dementia of the Alzheimer’s type. It enhances cholinergic functions by increasing the concentration of acetylcholine. It slows the progression of Alzheimer’s disease.

Ondansetron hydrochloride (Zofran) is a selective receptor antagonist used as an antinausea and antiemetic. Frequent side effects include anxiety, drowsiness, dizziness, headache, fatigue, constipation, diarrhea, urinary retention, and hypoxia. Occasional side effects include abdominal pain, diminished saliva secretion, fever, feeling of cold, paresthesia, and weakness. Rare side effects include hypersensitivity reaction and blurred vision.

With intrinsic renal failure, there is a fixed specific gravity and the urine tests positive for proteinuria. In postrenal failure, there is a fixed specific gravity and little or no proteinuria. In prerenal failure, the specific gravity is high, and there is very little or no proteinuria.

Sertraline (Zoloft) is a serotonin reuptake inhibitor. Serious potentially fatal reactions may occur if sertraline is administered concurrently with a monoamine oxidase inhibitor (MAOI). Phenelzine sulfate is an MAOI. MAOIs should be stopped at least 14 days before sertraline therapy. Sertraline should also be stopped at least 14 days before MAOI therapy.

Betamethasone (Celestone), a corticosteroid, is administered to increase the surfactant level and increase fetal lung maturity, reducing the incidence of respiratory distress syndrome in the newborn infant. Surfactant production does not become stable until after 32 weeks’ gestation. If adequate amounts of surfactant are not present in the lungs, respiratory distress and death are possible consequences. Delivery needs to be delayed for at least 48 hours after the administration of betamethasone in order to allow time for the lungs to mature.

Influenza (commonly know as the flu) refers to an acute viral infection of the respiratory tract. It is a communicable disease spread by droplet infection, and measures are instituted to prevent its spread. The client is instructed to remain at home, practice frequent hand washing, and cover the nose and mouth when sneezing and coughing. Supportive measures to relieve fever and myalgia such as the use of acetaminophen are also encouraged. It is unrealistic to completely isolate oneself in a room from other family members, and there is no useful reason to use a separate bathroom because the infection is spread through droplets. Influenza immunization is administered before the start of the “flu” season, not after developing the infection.

BUN and creatinine are measured during therapy with streptomycin because the medication is nephrotoxic. The client taking isoniazid (INH) for tuberculosis is at risk for hepatotoxicity. Vision testing is done during treatment with ethambutol (Myambutol).

To avoid causing tension pneumothorax, the nurse avoids clamping the chest tube for any reason unless specifically ordered. In most instances, clamping of the chest tube is contraindicated by agency policy. The nurse keeps the drainage collection system below the level of the client’s waist to prevent fluid or air from reentering the pleural space. Water is added to the suction control chamber as needed to maintain the full suction level ordered. Connections between the chest tube and system are taped to prevent accidental disconnection.

For acute or chronic rheumatoid arthritis or osteoarthritis, the normal oral adult dose for an older client is 200 to 800 mg three to four times a day.

Baclofen (Lioresal) is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases, or multiple sclerosis.

Lorazepam (Ativan) is contraindicated if hypersensitivity or cross-sensitivity with other benzodiazepines exist. It is also contraindicated in clients who are comatose, with preexisting central nervous system (CNS) depression, with uncontrolled severe pain, and those with narrow-angle glaucoma. It is also not prescribed for clients who are pregnant or breastfeeding.

The client’s symptoms indicate mild hypoglycemia. If the hospitalized client complains of symptoms of hypoglycemia, a blood glucose test with a blood glucose meter should be performed. (In the nonhospitalized client, it is safer to assume and treat hypoglycemia if a blood glucose meter is unavailable.) The nurse then treats the reaction by administering a carbohydrate such as 4 ounces orange juice, 6 ounces regular soda, 6 to 8 ounces 2% milk, or a similar item containing 10 to 15 g of carbohydrate if the reaction is mild. Once the condition is corrected, the nurse would assess the client to determine the cause. The nurse should then document the client’s complaints, the blood glucose level, treatment and response, the potential cause of the reaction, and other significant information related to the reaction.

The client who suddenly becomes disoriented and confused following TURP could be experiencing early signs of hyponatremia. This may occur because the flushing solution used during the operative procedure is hypotonic. If enough solution is absorbed through the prostate veins during surgery, the client experiences increased circulating volume and dilutional hyponatremia. The nurse needs to report these symptoms.

Equipment needed to perform tracheostomy care includes a tracheostomy care kit, sterile water and saline solutions for cleansing and rinsing, and a suction kit for client suctioning. As part of tracheostomy care, the client’s airway should be suctioned before cleansing the tracheostomy. New sterile solutions are obtained once per 24 hours, which is often done at the beginning of the work day. A tracheostomy care kit contains the needed supplies for cleaning the tracheostomy and for changing the dressing and tapes.

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