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Quote for the month

Constant attention by a good nurse may be just as important as a major operation by a surgeon.-Dag Hammarskjold

Friday, October 1, 2010


Trauma Care
    1. Airway with simultaneous cervical spine immobilization
      1. Must use jaw thrust
      2. Do not use head-tilt chin-lift: it could injure neck
    2. Breathing
      1. Look, listen and feel for respirations
      2. Follow CPR procedure
    3. Circulation
      1. Assess pulses
        1. carotid pulse: BP at least 60
        2. femoral pulse: BP at least 70
        3. radial pulse: BP at least 80
      2. Stop any active, visible bleeding
      3. After initial assessment, start large-bore IVs
    4. Disability: brief neurological exam
      1. Level of consciousness
      2. Pupil response to light
      3. Ability to move extremities
      4. Ability to move against resistance
    5. Expose
      1. Undress client
      2. Inspect for injuries or deformities
    6. Fahrenheit
      1. Take temperature
      2. Maintain warmth
        1. warm blankets
        2. warming lights
    7. Get vitals
      1. Pulse
      2. Respiratory rate
      3. Blood pressure
    8. History and head-to-toe full assessment
      1. How did injury occur - mechanism of injury
      2. Client's medical history
      3. Full body system assessment
    9. Inspect the back
      1. Roll the client over - log roll with help
      2. Inspect for injuries or deformities

Cardiac Arrest

Cardiopulmonary resuscitation also known as (CPR) is executed to preserve intact brain function until extra measures are done to reestablish circulation of blood and breathing in a person who is in cardiac and respiratory arrest
1.      Determine unresponsiveness
a.      shake and shout "are you okay?"
b.      call for help
2.      Position the client, if no evidence of trauma (if trauma, see section III of this lesson)
3.      Open the airway
a.      head-tilt, chin lift
b.      jaw thrust (if spinal injury suspected)
4.      Assess for breathing: look, listen and feel
5.      Give rescue breaths
a.      assess if breaths go into lungs by chest movement
b.      if air does not go in, reposition airway (see #3 above)
c.       if air still does not go in, check for foreign body
                                                                                   i.      abdominal thrust (Heimlich manueuver)
                                                                                ii.      do not proceed until airway and rescue breathing established
d.      when airway is clear, check for abscence of pulse
e.      begin chest compressions
                                                                                   i.      be sure client is on a firm surface
                                                                                ii.      hand position is critical
                                                                              iii.      two finger-widths above xiphoid
                                                                               iv.      lower one-half of sternum
1.       for adult, 1.5 to 2 inch compression depth
2.      two rescuers, 80 to 100 compressions per minute
3.      one rescuer, 80 compressions per minute
f.        alternate compressions and breaths
                                                                                   i.      one and two rescuers, 15 compressions to two breaths
                                                                                ii.      reassess cardiopulmonary status after one minute and every few minutes thereafter
6.      Early defibrillation
a.      In adults, the arrhythmia most correctable is ventricular fibrillation if treated promptly
b.      Before starting CPR for ventricular fibrillation, call for help

CPR - Early defibrillation is the key to successful resuscitation for many adults. Continually reassess during CPR to see if the client regains a pulse or begins breathing. Reassess to see that the chest moves and pulses are palpable during CPR.

NCLEX practice questions 10

1.      The nurse is working with parents to plan home care for a 2 year-old with a heart problem. A priority nursing intervention would be to
A)Encourage the parents to enroll in cardiopulmonary resuscitation class
B)Assist the parents to plan quiet play activities at home
C)Stress to the parents that they will need relief care givers
D)Instruct the parents to avoid contact with persons with infection 

The correct answer is A: Encourage the parents to enroll in cardiopulmonary resuscitation class
While all suggestions are appropriate, the education of the parents/caregivers should include techniques of cardiopulmonary resuscitation in order to provide for emergency care of their child.

2.      The nurse notes an abrupt onset of confusion in an elderly patient. Which of the following recently-ordered medications would most likely contribute to this change?
A)               Anticoagulant
B)                 Liquid antacid
C)               Antihistamine
D)               Cardiac glycoside
The correct answer is C: Antihistamine
Elderly people are susceptible to the side effect of anticholinergic drugs, such as antihistamines. Especially at high doses, antihistamines often cause confusion in the elderly.

3.      An infant has just returned from surgery for placement of a gastrostomy tube as an initial treatment for tracheoesophageal fistula. The mother asks:”When can the tube can be used for feeding?” The nurse's best response would be which of these comments?
A)               Feedings can begin in 5 to 7 days.
B)                 The use of the feeding tube can begin immediately.
C)               The stomach contents and air must be drained first.
D)               The incision healing must be complete before feeding.

The correct answer is C: Stomach contents and air must be drained first
After surgery for gastrostomy tube placement, the catheter is left open and attached to gravity drainage for 24 hours or more

4.      The nurse is teaching a 27 year-old client with asthma about management of their therapeutic regime. Which statement would indicate the need for additional instruction?
A)               "I should monitor my peak flow every day."
B)                 "I should contact the clinic if I am using my medication more often."
C)               "I need to limit my exercise, especially activities such as walking and running."
D)               "I should learn stress reduction and relaxation techniques."

The correct answer is C: "I need to limit my exercise, especially activities such as walking and running."
Limiting physical activity in an otherwise healthy, young client should not be necessary. If exercise intolerance exists, the asthma management plan should include specific medications to treat the problem such as using an inhaled beta-agonist 5 minutes before exercise. The goal is always to return to a normal lifestyle.

5.      A nurse caring for premature newborns in an intensive care setting carefully monitors oxygen concentration. What is the most common complication of this therapy?
A)               Intraventricular hemorrhage
B)                 Retinopathy of prematurity
C)               Bronchial pulmonary dysplasia
D)               Necrotizing enterocolitis

The correct answer is B: Retinopathy of prematurity
While there are other causes for retinal damage in the premature infant, maintaining the oxygen concentration below 40% reduces one risk factor

6.      The nurse is caring for a child with cystic fibrosis. The nurse would anticipate that the child would be deficient in which vitamins?
A)               B, D, and K
B)                 A, D, and K
C)               A, C, and D
D)               A, B, and C

The correct answer is B: A, D, and K
The uptake of fat soluble vitamins is decreased in children with Cystic Fibrosis. Vitamins A, D, and K are fat soluble and are likely to be deficient in clients with Cystic Fibrosis.

7.      The nurse is caring for a client with Rheumatoid Arthritis. Which nursing diagnosis should receive priority in the plan of care?
A)               Risk for injury
B)                 Self care deficit
C)               Alteration in comfort
D)               Alteration in mobility

The correct answer is C: Alteration in comfort
Relieving pain is the number one objective of this client''s plan of care

8.      The nurse is teaching a client with atrial fibrillation about the use of Coumadin (warfarin) at home. Which of these should be emphasized to the client to avoid?

A)               Large indoor gatherings
B)                 Exposure to sunlight
C)               Active physical exercise
D)               Foods rich in vitamin K
The correct answer is D: Foods rich in vitamin K
Vitamin K acts as an antidote to the pharmacologic action of Coumadin therapy, decreasing Coumadin''s effectiveness. Foods high in vitamin K include dark greens, tomatoes, bananas, cheese, and fish

9.      To prevent keratitis in an unconscious client, the nurse should apply moisturizing ointment to the:
A)               Finger and toenail quicks
B)                 Eyes
C)               Perianal area
D)               External ear canals

The correct answer is B: Eyes
Keratitis is a corneal ulcer or abrasion. Keratitis is caused by exposure and requires application of moisturizing ointment to the exposed cornea and a plastic bubble shield or eye patch.

10. The nurse is caring for a 75 year old client in congestive heart failure. Which finding suggests that digitalis levels should be reviewed?
A)               Extreme fatigue
B)                 Increased appetite
C)               Intense itching
D)               Constipation
The correct answer is A: Extreme fatigue
Extreme fatigue and weakness are common, early signs of digitalis toxicity, which would be evident in lab data

11. The nurse is providing foot care instructions to a client with arterial insufficiency. The nurse would identify the need for additional teaching if the client stated
A)               "I can only wear cotton socks."
B)                 "I cannot go barefoot around my house."
C)               "I will trim corns and calluses regularly."
D)               "I should ask a family member to inspect my feet daily."

The correct answer is C: "I will trim corns and calluses regularly."
Clients who are elderly, have diabetes, and/or have vascular disease often have decreased circulation and sensation in one or both feet. Their vision may also be impaired. Therefore, they need to be taught to examine their feet daily or have someone else do so. They should wear cotton socks which have not been mended, and always wear shoes when out of bed. They should not cut their nails, corns, and calluses, but should have them trimmed by their health care provider, nurse, or other provider who specializes in foot care.

12. A client has been taking alprazolam (Xanax) for 3 days. Nursing assessment should reveal which expected effect of the drug?
A)               Tranquilization, numbing of emotions
B)                 Sedation, analgesia
C)               Relief of insomnia and phobias
D)               Diminished tachycardia and tremors associated with anxiety

The correct answer is A: Tranquilization, numbing of emotions
The anti-anxiety drugs produce tranquilizing effects and may numb the emotions.

13. The primary teaching for a client following an extracorporeal shock-wave lithotripsy (ESWL) procedure is
A)               Drink 3000 to 4000 cc of fluid each day for one month
B)                 Limit fluid intake to 1000 cc each day for one month
C)               Increase intake of citrus fruits to three servings per day
D)               Restrict milk and dairy products for one month
The correct answer is A: Drink 3000 to 4000 cc of fluid each day for 1 month
Drinking three to four quarts (3000 to 4000 cc) of fluid each day will aid passage of fragments and help prevent formation of new calculi

14. A pre-term baby develops nasal flaring, cyanosis and diminished breath sounds on one side. The provider's diagnosis is spontaneous pneumothorax. Which procedure should the nurse prepare for first?
A)               Cardiopulmonary resuscitation
B)                 Insertion of a chest tube
C)               Oxygen therapy
D)               Assisted ventilation
Your response was "A". The correct answer is B: Insertion of a chest tube Because a portion of the lung has collapsed, a chest tube will be inserted to restore negative pressure in the chest cavity.

15. The nurse is teaching a group of adults about modifiable cardiac risk factors. Which of the following should the nurse focus on first?
A)               Weight reduction
B)                 Stress management
C)               Physical exercise
D)               Smoking cessation
The correct answer is D: Smoking cessation
Stopping smoking is the priority for clients at risk for cardiac disease, because of the effect to reduce oxygenation and constrict blood vessels
16. The nurse is caring for a 5 year-old child who has the left leg in skeletal traction. Which of the following activities would be an appropriate diversional activity?
A)               Kicking balloons with right leg
B)                 Playing "Simon Says"
C)               Playing hand held games
D)               Throw bean bags
The correct answer is C: Playing hand held games
Immobilization with traction must be maintained until bone ends are in satisfactory alignment. Activities that increase mobility interfere with the goals of treatment.
17. A client is scheduled to have a blood test for cholesterol and triglycerides the next day. The nurse would tell the client
A)               "Be sure and eat a fat-free diet until the test."
B)                 "Do not eat or drink anything but water for 12 hours before the blood test."
C)               "Have the blood drawn within 2 hours of eating breakfast."
D)               "Stay at the laboratory so 2 blood samples can be drawn an hour apart."

The correct answer is B: "Do not eat or drink anything but water for 12 hours before the blood test."
Blood lipid levels should be measured on a fasting sample

18. Which of these clients would the triage nurse request for the health care provider to examine immediately?
A)               A 5 month-old infant who has audible wheezing and grunting
B)                 An adolescent who has soot over the face and shirt
C)               A middle-aged man with second degree burns over the right hand
D)               A toddler with singed ends of long hair that extends to the waist
The correct answer is A: A 5 month-old infant who has audible wheezing and grunting
The age and the findings puts this client at immediate risk for respiratory complications.

19. In assessing a post partum client, the nurse palpates a firm fundus and observes a constant trickle of bright red blood from the vagina. What is the most likely cause of these findings?
A)               Uterine atony
B)                 Genital lacerations
C)               Retained placenta
D)               Clotting disorder

The correct answer is B: Genital lacerations
Continuous bleeding in the absence of a boggy fundus indicates undetected genital tract lacerations.

20. The community health nurse has been following the care for an adolescent with a history of morbid obesity, asthma, hypertension and is 22 weeks in to a pregnancy. Which of these lab reports sent to the clinic need to be called to the teens health care provider within the next hour?
A)               Hemoblobin 11 g/L and calcium 6 mg/dl
B)                 Magnesium 0.8 mEq/L and creatinine 3 mg/dl
C)               Blood urea nitrogen 28 and glucose 225 mg/dl
D)               Hematocrit 33% and platelets 200,000

The correct answer is B: Magnesium 0.8 mEq/L and creatinine 3 mg/dl
The client’s lab values are all abnormal except for the platelets. The magnesium is low and the creatinine is high which indicates renal failure. With the history of hypertension the findings exhibit the risk of preeclampsia. The client needs to be referred for immediate follow up with a health care provider.