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UWORLD 11

Terms in this set (51)

What herbal supplements can cause a risk for bleeding?
Ginko Biloba
Ginger
Garlic
Ginseng
Feverfew
After maintaining NPO for a client with acute cholecystitis who vomits 250 mL of greenish-yellow stomach contents with severe pain in the right upper quadrant with radiation to the shoulder, the next appropriate pharmacologic action is what?
Administer promethazine 25 mg suppository to relieve nausea and vomiting and minimize further fluid loss.
What is the order of priority of interventions for a client with acute cholecystitis who vomits 250 mL of greenish-yellow stomach contents with severe pain in the right upper quadrant with radiation to the shoulder?
1. NPO
2. administer promethazine 25 mg
3. 100 mL NS for fluid & electrolyte replacement.
4. Insert an NG and set to low suction.
What is the most important initial assessment for a client with ventricular tachycardia?
Check for a pulse.
V-tach can be pulseless or with a pulse.
Next, the client should be assessed for stability or instability
The long-term care nurse is caring for a client newly diagnosed with macular degeneration. Which client statement would support this diagnosis?

1. "I have been seeing small flashes of light."

2. "I have trouble threading my sewing needle; I have to hold it at arm's length."

3. "I notice that my peripheral vision is becoming worse."

4. "I see a blurry spot in the middle of the page when I read."
4. "I see a blurry spot in the middle of the page when I read."

Macular degeneration occurs when the central portion of the retina deteriorates secondary to age, giving rise to distortion (blurred or wavy visual disturbance) or loss in the center of the visual field.
The nurse is planning care for a client diagnosed with influenza who has had fever, muscle aches, headache, and sore throat for 36 hours. The health care provider prescribes ibuprofen and oseltamivir. Which of the following should the nurse include in the plan of care? Select all that apply.

1. Instruct client to be 3 ft (0.91 m) away from others when coughing or sneezing

2. Place client on contact precautions

3. Place mask on client when transporting

4. Question the oseltamivir prescription

5. Teach client about the importance of annual vaccination
1,3,5
The nurse administers lactulose to a client diagnosed with cirrhosis and hepatic encephalopathy. Which nursing action is inappropriate when administering this medication?

1. Assess mental status and orientation

2. Give on an empty stomach for rapid effect

3. Hold if 3 soft stools occur in a day

4. Mix with fruit juice to improve flavor
3
The health care provider (HCP) suspects a fat embolism syndrome (FES) in a client who has had multiple long bone fractures. Which findings does the nurse expect to assess to support this diagnosis? Select all that apply.

1. Confusion and restlessness

2. Increasing pain despite the opioid analgesia

3. Paresthesia of the affected extremity

4. Petechiae over neck and chest

5. Pulse oximeter showing hypoxia
1,4,5
Paresthesia of an extremity and increasing pain despite opioid analgesia occur with what disorder?
Compartment syndrome.
The nurse is caring for a client with cirrhosis of the liver. Which blood test values would the nurse typically anticipate to be elevated when reviewing the client's morning laboratory results? Select all that apply.

1. Albumin

2. Ammonia

3. Bilirubin

4. Prothrombin time

5. Sodium
2,3,4
Metabolic syndrome is characterized by which risk factors?
Risk factors:
• Increased waist circumference: ≥40 inches (102 cm) in men, ≥35 inches (89 cm) in women
• Blood pressure: ≥130 mm Hg systolic BP or ≥85 mm Hg diastolic BP or drug treatment for hypertension
• Triglyceride level: >150 mg/dL (1.7 mmol/L) or drug treatment for elevated triglycerides
• HDL levels: <40 mg/dL in men and <50 mg/dL in women or drug treatment for low HDL-C
• Glucose levels: ≥100 mg/dL (5.6 mmol/L) or drug treatment for elevated blood glucose

Pneumonic: We Better Think High Glucose
When a client on fall precautions is found on the floor what is the order of action required?
1. Assess for prescence of adequate pulse
2. Inspect the client for injuries
3. Get help and move the client to bed.
4. Notify the client's HCP
5. Complete an incident report.
A client is being discharged home after an open radical prostatectomy. Which statement indicates aneed for further teaching?

1. "I will try to drink lots of water."

2. "I will try to walk in my driveway twice a day."

3. "I will wash around my catheter twice a day."

4. "If I get constipated, I will use a suppository."
4.
The primary health care provider prescribes a 24-hour urine collection for a client with suspected Cushing syndrome. Which instructions should the nurse give the client regarding this test? Select all that apply.

1. "A continuous urinary catheter must be inserted for this test and the urine will collect in an attached bag."

2. "Keep the urine collection container in the refrigerator or a cooled ice chest when it is not in use."

3. "Only daytime urine should be collected in the container as cortisol levels are higher in the morning."

4. "Record the time the urine collection is started and then empty the bladder into the toilet so that the start time coincides with an empty bladder."

5. "You will be given a dark plastic jug containing a powder that absorbs into the urine that you will collect in the jug."
2,4,5
The registered nurse (RN) is caring for a postoperative client who becomes short of breath on the night of surgery and initiates the prn prescription for oxygen at 3 L/min by nasal cannula. The client makes frequent requests to use the bathroom during the night. Which tasks can be delegated to the unlicensed assistive personnel (UAP)? Select all that apply.

1. Assisting the client to the bathroom

2. Deciding if supplemental oxygen is necessary when the client is ambulating

3. Documenting vital signs in the electronic medical record

4. Notifying the nurse immediately if the client's respirations exceed 20/min

5. Reapplying the nasal cannula if it accidentally comes off
1,3,4,5
The nurse is performing an assessment of a neonate 1 hour after spontaneous vaginal delivery. Which of the following are the expected normal findings in the client? Select all that apply.

1. Capillary glucose of 60 mg/dL

2. Holosystolic murmur auscultated at 4th intercostal space

3. Respirations of 56 breaths per minute

4. Single transverse crease across the palm of the hand

5. White papules on the bridge of the nose
1,3,5
A single transverse crease across the palm of the hand could signal what for a neonate?
Down Syndrome
A client is admitted to the medical surgical floor with a hemoglobin level of 5.0 g/dL (50 g/L). The nurse should anticipate which findings? Select all that apply.

1. Coarse crackles

2. Dyspnea

3. Pallor

4. Respiratory depression

5. Tachycardia
2,3,5
The nurse will implement which nursing actions when caring for a client recently diagnosed with a hiatal hernia? Select all that apply.

1. Elevate the head of the hospital bed

2. Instruct the client to avoid tobacco and caffeine

3. Offer small, frequent, low-fat meals

4. Provide a girdle to reduce the hernia

5. Teach the client to avoid lifting or straining
1,2,3,5
Do you need an order for elbow restraints?
No!!!!!!!
When should a child's first dental visit be?
At one year old
Dietary management of the client with PKU includes what?
1. Monitoring serum levels of phenylalanine
2. Including synthetic proteins and special formulas (eg, Lofenalac, Phenyl-Free) in the diet
3. Eliminating high-protein/phenylalanine foods (eg, meats, eggs, milk) from the diet
4. Encouraging consumption of natural foods low in phenylalanine (most fruits and vegetables)
How long will someone with PKU have to follow the PKU diet?
Lifetime
What are indications for inserting an indwelling urinary catheter?
1. Clients with urinary obstruction or retention, or a need for strict intake and output in critically ill clients
2. Perioperative use for surgical procedures such as urologic surgery or prolonged surgeries, or when large doses of fluid or diuretics are given during surgery
3. During prolonged immobilization when bedrest is essential
4. To improve end-of-life comfort
5. To facilitate healing of an open perineal or sacral wound in incontinent clients.
What are Inappropriate uses of an indwelling urinary catheter?
• Convenience or replacement for nursing care when the client is elderly, confused, incontinent, or voids frequently (Options 2, 3, and 4)
• For obtaining a urine culture when the client can follow instructions and void voluntarily
• Postoperatively for prolonged periods when other appropriate indications are not present
1. The parent of a newborn is concerned about the possibility of the child developing hip dysplasia. Which intervention should the nurse encourage to help reduce the risk in this newborn?

1. Choose an infant carrier with a narrow seat

2. Place 2 diapers on the infant at all times

3. Swaddle the infant with hips flexed and abducted

4. Use an infant swing that keeps both legs straight
3
What is proper post-procedure care for an above-the-knee amputation?
Care of the client with above-the-knee amputation includes placement in prone position for 30 minutes 3 or 4 times a day and using a figure eight compression bandage to decrease edema. The client's residual limb should not be elevated as this will promote flexion contractures.
Why should carotid arteries be palpated separately and not at the same time?
It can cause vagal stimulation, causing dysrhythmia's such as bradycardia a syncopal episode.
What is the proper ordered protocol for dealing with fires?
Acronym Race
Rescue clients
Alarm - pull it. Activate code red
Confine the fire. Close the doors & windows
Extinguish the fire vertically then horizontally and evacuate clients.
When calculating input for a dialysis client what is important?
Subtract the output during dialysis.
What are manifestations of Osteoarthritis?
• Pain, often described as aching, exacerbated by weight-bearing activities—results from synovial inflammation, muscle spasm, and nerve irritation (Option 4)
• Crepitus, a grating noise or sensation with movement that can be heard or palpated—results from the presence of bone and cartilage fragments that float in the joint space (Option 1)
• Morning stiffness that subsides within about 30 minutes of arising
• Decreased joint mobility and range of motion
• Atrophy of the muscles that support the joint (eg, quadriceps, hamstring)—due to disuse
What is the patho of OA?
Explanation:
OA, also known as degenerative joint disease, is a disorder of the synovial joints (eg, knee, hip, fingers). OA causes progressive erosion of the articular (joint) cartilage and bone beneath the cartilage. As the degenerative process continues, bone spurs (osteocytes), calcifications, and ulcerations develop within the joint space, and the cushioning between the ends of the bones breaks down
A nurse is making a home visit to a client with chronic venous insufficiency (CVI). The home health (HH) aide is there with the client. Which action by the HH aide would require intervention by the nurse?

1. Applying lotion to the client's dry, cracked skin on lower extremities

2. Assisting the client with placing medications in a daily pill reminder box

3. Cutting the client's fingernails and toenails

4. Putting compression stockings on the client
3

The client with CVI has leg veins and incompetent valves that allow retrograde blood flow. This client commonly has leg edema, chronic inflammatory changes, and is at risk for the development of venous leg ulcers.

The client is taught to avoid any trauma to the limbs. The nurse should intervene when the HH aide is cutting the client's toenails as the toenails should be cut by a trained professional or podiatrist.
The charge nurse must assign rooms to 4 clients who are scheduled for admission. Which client has the highest priority for a private room assignment?

1. Client who is a known IV drug abuser who has osteomyelitis of the arm and chronic hepatitis C
2. Client with chronic obstructive pulmonary disease who has a latent tuberculosis infection
3. Client with diabetes mellitus and HIV infection who is in diabetic ketoacidosis
4. Client with pneumonia who has a positive methicillin-resistant Staphylococcus aureus nose culture
4.

A client with a positive nose swab for methicillin-resistant Staphylococcus aureus (MRSA) is colonized and can transmit the bacteria to others. If signs of infection are absent, treatment is not required. Colonized clients are at increased risk for infection with MRSA; if signs (eg, fever, wound drainage, purulent mucus) are present, treatment is required.

The Centers for Disease Control and Prevention (CDC) recommends placing a colonized client on contact precautions and in a private room. The CDC also recommends that the highest priority be given to placing a colonized client who may transmit the bacteria through body secretions or excretions (eg, sputum, wound drainage) in a private room. Therefore, the client with pneumonia should be placed in the private room.
A hospitalized client with acute pancreatitis has nausea, vomiting, epigastric pain, and tachycardia. Laboratory results show elevated serum lipase levels. Which interventions would the nurse anticipate being prescribed for the client? Select all that apply.

1. Administer hydromorphone IV PRN for pain

2. Administer intravenous fluids

3. Insert a nasogastric tube for nasogastric suction

4. Maintain client in a supine position, with head of bed flat

5. Provide small, frequent, high-carbohydrate, high-calorie meals
1,2,3
A client with mitral valve prolapse (MVP) has been experiencing occasional palpitations, lightheadedness, and dizziness. The health care provider prescribes a beta blocker. What additional teaching should the nurse include for this client?

1. Avoid aerobic exercise

2. Ensure you receive antibiotics prior to dental work

3. Stay well hydrated and avoid caffeine and alcohol.

4. Wear a medical alert bracelet
3. Stay well hydrated and avoid caffeine and alcohol.
What are foods to avoid post-ileostomy surgery?
the following:
• Stringy texture: celery, broccoli, asparagus stalks
• High fiber: bread, brown rice, oatmeal, Multigrain bagels
• Seeds or pits: strawberries, raspberries, olives
• Edible peels: apple slices, raw cucumber, dried fruits
• Nuts: peanuts, almonds, cashews
What are risk factors for DVT formation?
Risk factors associated with DVT formation include the following:
1. Trauma (endothelial injury and venous stasis from immobility)
2. Major surgery (endothelial injury and venous stasis from immobility)
3. Prolonged immobilization (eg, stroke, long travel) causing venous stasis
4. Pregnancy (induced hypercoagulable state and some venous stasis by the pressure on inferior vena cava)
5. Oral contraceptives (estrogen is thrombotic)
6. Underlying malignancy (cancer cells release procoagulants)
7. Smoking (produces endothelial damage by inflammation)
8. Old age
9. Obesity and varicose veins (venous stasis)
10. Myeloproliferative disorders (increase blood viscosity)
A client comes to the emergency department with ischemic stroke symptoms that started 7 hours ago. The client's current blood pressure is 202/108 mm Hg. What priority action related to blood pressure should the nurse implement?

1. Assess the National Institutes of Health stroke scale

2. Document the current findings

3. Request a prescription for IV blood pressure medication

4. Request a prescription for IV antiseizure medication
2

After an acute ischemic stroke, the body senses the need for the increased pressure to perfuse the penumbra (area of swollen and vulnerable but salvageable tissue) to keep the stroke from extending. This is a protective mechanism as this "permissive hypertension" usually autocorrects within 24-48 hours and does not require treatment. The usual goal is to not allow the systolic blood pressure to fall below 170 mm Hg.

The blood-brain barrier is no longer intact if the blood pressure is >220/120 mm Hg; treatment would be initiated if the blood pressure reached this level. If the stroke is hemorrhagic (bleeding) then a lower blood pressure target is also indicated.
What are pre-procedure instructions for a client having a pharmacologic nuclear stress test?
• Do not eat, drink, or smoke on the day of the test (NPO for at least 4 hours). Small sips of water may be taken with medications (Option 3).
• Avoid caffeine products 24 hours before the test (Option 2).
• Avoid decaffeinated products 24 hours before the test as these contain trace amounts of caffeine(Option 1).
• Do not take theophylline 24-48 hours prior to the test (if tolerated).
• If insulin/pills are prescribed for diabetes, consult the HCP about appropriate dosage on the day of the test. Hypoglycemia can result if the medicine is taken without food (Option 5).
• Some medications can interfere with the test results by masking angina. Do not take the following cardiac medications unless the HCP directs otherwise, or unless needed to treat chest discomfort on the day of the test:
o Nitrates (nitroglycerine or isosorbide)
o Dipyridamole
o Beta blockers(Option 4)
A client with a middle cerebral artery stroke exhibits the ability to understand and follow some commands but is unable to respond to questions with appropriate word choices. The nurse documents this type of communication deficit as which of the following?

1. Aphasia

2. Dysarthria

3. Dysphagia

4. Dysphasia
4. Dysphasia

"Aphasia" and "dysphasia" are often used interchangeably in medical literature and documentation. The primary difference between them is the ability to comprehend and use language. Clients able to communicate verbally but with difficulty are described as having dysphasia. Clients unable to respond verbally or comprehend what is communicated to them are described as having aphasia
A nurse is preparing a client for below-the-knee amputation surgery. Which actions should the nurse complete? Select all that apply.

1. Administer a preoperative IV antibiotic

2. Ensure that the correct limb to be amputated is marked appropriately

3. Place a red "no known allergies" bracelet on the client

4. Place operative permits in the client's chart

5. Replace the current 20G IV catheter with an 18G IV catheter
1,2,4

A allergies bracelet is only placed if the client has an allergy.
Torsades de Pointes is caused by what?
Hypomagnesemia (normal: 1.5-2.5 mEq/L [0.75-1.25 mmol/L]) causes a prolonged QT interval that increases the client's susceptibility to ventricular tachycardia. Torsades de pointes is a type of polymorphic ventricular tachycardia coupled with a prolonged QT interval; it is a lethal cardiac arrhythmia that leads to decreased cardiac output and can develop quickly into ventricular fibrillation. The American Heart Association recommends treatment with IV magnesium sulfate.
The nurse is caring for a client with a chest tube that was placed 2 hours ago for a pneumothorax. Where would the nurse expect gentle, continuous bubbling?

1. Air leak monitor

2. Collection chamber

3. Suction control chamber

4. Water seal chamber
3. Suction Control Chamber
Which type of diabetes has an onset in childhood?
Type I
What information would the nurse consider a priority when conducting a health history on a 2-year-old? Select all that apply.

1. Below 5th percentile on the growth chart

2. Family history of type 2 diabetes

3. History of respiratory problems

4. Mother and father are age 23

5. Vaginal birth at 34 weeks
1,3,5


Type-I diabetes has onset in childhood not type II.
A client with community-acquired pneumonia is receiving 0.9% normal saline (NS) at 50 mL/hr. Pulse oximetry shows 95% on nasal O2 at 3 L/min. The nurse identifies a nursing diagnosis of ineffective airway clearance. Which prescription would the nurse expect to best facilitate secretion removal?

1. Incentive spirometer every 2 hours

2. Increase 0.9% NS to 125 mL/hr

3. Increase nasal oxygen to 4 L/min

4. Place the client in semi-Fowler's position
2
A nurse is caring for a postpartum client who has breast engorgement following the decision to bottle-feed her newborn. What should the nurse teach regarding relief of breast engorgement?

1. Apply heat frequently to both breasts for 15 to 20 minutes

2. Manually express milk several times a day

3. Massage breasts from the base to the nipple 3 to 4 times a day

4. Use chilled, fresh, raw cabbage leaves on breasts throughout the day
4
Expressing milk stimulates more milk production.

Breast engorgement is often painful, and the following treatments are recommended in a client wishing to dry up the milk:
1. Use ice packs for 15 to 20 minutes on for every 3 to 4 hours. Ice packs should cover both breasts. Ice causes vasoconstriction and reduces blood flow and swelling.
2. Apply chilled, fresh, raw cabbage leaves to the breasts. The leaves are placed on the breasts throughout the day. The leaves are replaced with fresh leaves after they wilt. The mechanism of action is unclear but may be related to the effect of the cool temperature or to a substance from the leaves.
3. An anti-inflammatory analgesic, such as ibuprofen, is also recommended for pain associated with breast engorgement.
A client with acute respiratory distress syndrome is receiving positive pressure mechanical ventilation with 15 cm H2O (11 mm Hg) positive end-expiratory pressure (PEEP). The nurse should assess for which complication associated with PEEP?

1. Barotrauma

2. Decreased oxygen saturation

3. Hypertension

4. Oxygen toxicity
1

High levels of PEEP (10-20 cm H2O [7.4-14.8 mm Hg]) can cause overdistension and rupture of the alveoli, resulting in barotrauma to the lung. Air from ruptured alveoli can escape into the pulmonary interstitial space or pleural space, resulting in a pneumothorax and/or subcutaneous emphysema.
Educational objective:
High PEEP is commonly used to prevent small airway/alveolar collapse in clients with ARDS. PEEPhelps to reduce oxygen toxicity. However, high levels of PEEP (10-20 cm H2O [7.4-14.8 mm Hg]) can cause barotrauma to the lung, resulting in a pneumothorax, and decreased venous return causeshypotension.
A client comes to the emergency department with crushing, substernal chest pain. Temperature is 98.6 F (37 C), blood pressure is 173/84 mm Hg, pulse is 92/min, and respirations are 24/min. Oxygen saturation is 95% on room air. What is the nurse's next priority action?

1. Attach defibrillator pads to the client's chest

2. Check the lipid profile laboratory results

3. Obtain a 12-lead electrocardiogram (ECG)

4. Prepare to administer a heparin drip
3
What are the Initial interventions in emergency management of chest pain?
• Assess airway, breathing, and circulation (ABCs)
• Position client upright unless contraindicated
• Apply oxygen, if the client is hypoxic
• Obtain baseline vital signs, including oxygen saturation
• Auscultate heart and lung sounds
• Obtain a 12-lead electrocardiogram (ECG)
• Insert 2-3 large-bore intravenous catheters
• Assess pain using the PQRST method
• Medicate for pain as prescribed (eg, nitroglycerin)
• Initiate continuous electrocardiogram (ECG) monitoring (cardiac monitor)
• Obtain baseline blood work (eg, cardiac markers, serum electrolytes)
• Obtain portable chest x-ray
• Assess for contraindications to antiplatelet and anticoagulant therapy
• Administer aspirin unless contraindicated
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