and Explanations | Latest For Nightingale
Contact Lenses Removal - ANSWER -Contact lenses should be removed to
prevent damage or loss during surgery.
Partial Dentures Removal - ANSWER -Partial dentures should be removed to
prevent damage or loss during surgery.
Tachycardia - ANSWER -A pulse change resulting in tachycardia for a
prolonged time in a post-operative client is a critical observation.
Postoperative Client Monitoring - ANSWER -Monitoring for significant changes
in vital signs is crucial for postoperative care.
Client Education on HIV - ANSWER -Informing the client how to protect sexual
and needle-sharing partners is essential during post-test counseling.
Self-catheterization technique - ANSWER -Catheterize every 3 to 4 hours.
Sterile technique - ANSWER -Although sterile technique is indicated in
healthcare facilities, clean technique is often followed by the client when
performing self-catheterization at home.
Fungal infection (candidiasis) - ANSWER -Good handwashing is all that is
needed to prevent nosocomial spread.
Wheezing in asthma - ANSWER -If the client is successfully responding to
bronchodilators and respiratory treatments, wheezing should become louder as the
air flow increases in the airways.
, PEG tube feeding protocols - ANSWER -Keeping the head of the bed elevated
30 degrees, changing the enteral-feeding bag every 24 hours, checking the
placement of the tube by means of gastric aspiration, and flushing the tube with 50
ml of normal saline solution after each feeding are interventions used to provide
care of the client with a PEG tube.
Assessment of residual amounts - ANSWER -Residual amounts should be
assessed each time, prior to each feeding.
Residual amounts - ANSWER -Should be assessed each time, prior to each
feeding.
Hospice care - ANSWER -Provides symptom management and pain control
during the dying process and enhances the quality of life for a client who is
terminally ill.
Hospice practical nurse (PN) - ANSWER -Administers medications for pain
relief, shortness of breath, and nausea.
Sperm count and smoking - ANSWER -Smoking can decrease the quantity and
quality of sperm.
Cessation of smoking - ANSWER -Improves general health and fertility.
Sperm specimen collection - ANSWER -Sperm specimens should be collected in
2 subsequent days.
Radiation therapy side effects - ANSWER -Dry, itchy skin changes may occur,
along with the possibility of long bone pain and permanent pigment changes to the
breast.
Low-residue diet - ANSWER -May be ordered to reduce the likelihood of
diarrhea.
, Mycobacterium avium complex (MAC) - ANSWER -An opportunistic infection
that presents as a tuberculosis-like pulmonary process.
Desired outcome for MAC client - ANSWER -Return to pre-illness weight using
oral, enteral, or parenteral supplementation as needed.
Secondary syphilis precautions - ANSWER -Gloves should be worn during direct
contact with the client's skin.
Infection control - ANSWER -Handwashing is required before and after contact
with the client.
Client education on breast cancer treatment - ANSWER -Important to include
information on potential dry, itchy skin changes.
Pain management in hospice - ANSWER -Administering medication and
monitoring for therapeutic and adverse effects is within the scope of practice for
the PN.
Client behaviors and symptoms - ANSWER -Clarifying family members' feelings
about the meaning of client behaviors and symptoms is a nursing activity.
Plan of care development - ANSWER -Developing a plan of care after assessing
the needs of the client and family is a nursing responsibility.
Signs of client discomfort - ANSWER -Teach the family to recognize
restlessness and grimacing as signs of client discomfort.
Semen analysis - ANSWER -The first semen analysis should be repeated to
confirm sperm counts.
Therapeutic effects monitoring - ANSWER -Monitoring for therapeutic and
adverse effects is essential in hospice care.
, Quality of life in terminal illness - ANSWER -Hospice care enhances the quality
of life for a client who is terminally ill.
Skin changes from radiation - ANSWER -Side effects from radiation to the
breast most often include temporary skin changes such as dryness, tenderness,
redness, swelling, and pruritis.
Opportunistic infections - ANSWER -MAC is a major contributing factor to the
development of wasting syndrome.
Secondary stage of syphilis - ANSWER -A systemic blood-borne disease that
presents with skin lesions and rashes that may drain the highly contagious
spirochete.
Contact precautions - ANSWER -Precautions that should be taken to prevent the
spread of infections through direct contact with the client's skin.
Glaucoma - ANSWER -A condition that increases intraocular pressure, which
can be exacerbated by certain over-the-counter medications.
OTC medications - ANSWER -Over-the-counter medications that may contain
ephedrine, phenylephrine, or pseudoephedrine, which can cause adrenergic side
effects.
Transcutaneous electrical nerve stimulation (TENS) unit - ANSWER -A device
used for chronic pain relief that requires evaluation of the client's ability to control
pain by adjusting the voltage.
Cerebral spinal fluid - ANSWER -Fluid that should be evaluated in nasal
discharge following a head injury to determine if there is a tear in the dura.
Premenstrual syndrome - ANSWER -A condition characterized by symptoms
such as heart palpitations, sleeplessness, increased appetite, and food cravings.