Uworld NCLEX P2

A nurse is administering a rituximab infusion to a client with lymphoma in an oncology clinic. Which client symptom would be a priority to report to the health care provider? 1. Dizziness and sudden diarrhea [1%] 2. Nausea and onset of vomiting [0%] 3. New-onset tachypnea and dyspnea [81%] 4. Temperature of 101 F (38.3 C) [17%] Correct Answered correctly 81% Time: 12 seconds Updated: 10/14/2017 Explanation: Rituximab (Rituxan) is a monoclonal antibody (end in -mab) that affects the lymphocytes. It is commonly prescribed to treat certain forms of cancer (eg, lymphoma) and autoimmune diseases (eg, lupus). Like many monoclonal antibodies, rituximab can produce a powerful immune response (eg, bronchospasm, dyspnea, tachypnea, hypotension, angioedema) (Option 3). The nurse should closely monitor the client during and after the infusion. If life-threatening symptoms develop, the nurse should stop the infusion and immediately notify the health care provider. The symptoms will be treated (eg, corticosteroids) and, when resolved, the infusion is usually restarted at a slower rate. (Options 1, 2, and 4) In many clients, monoclonal antibody therapies, like many oncology pharmaceuticals, invoke flu-like responses (eg, fever, chills, diarrhea, nausea, vomiting). Clients are often pretreated with acetaminophen and diphenhydramine in anticipation of these reactions. Clients' symptoms are treated as needed (eg, antiemetics, antidiarrheals). Educational objective: Rituximab can produce a powerful immune response (eg, bronchospasm, dyspnea, tachypnea, hypotension, angioedema). Clients should be closely monitored during and after the infusion. Copyright © UWorld. All rights reserved. Basic Care & Comfort/Pain Management Culture / Spirituality Test Id: QId: 34722 () 2 of 75 A A A 0 The student nurse plans postmortem care for an Orthodox Jewish client hospitalized for the last week with heart failure who did not sign consents for any postmortem actions. Which statement by the student would require further education by the supervising nurse? 1. "I will allow the family to remain with the client at all times." [3%] 2. "I will call the next of kin before providing any postmortem care." [7%] 3. "I will prepare the client for transfer to the morgue for autopsy." [81%] 4. "I will provide a sheet to be placed over the client's face." [7%] Incorrect Correct answer 3 Answered correctly 81% Time: 24 seconds Updated: 11/01/2017 Explanation: Traditional Orthodox Jews believe that the body of the deceased should not be desecrated and is to be treated with respect. Therefore, autopsies are generally not permitted (Option 3). An autopsy is performed only when required by law, if the client provided consent before death, or if the client had a hereditary disease and an autopsy would help save others. Orthodox Jews believe that the body belongs to God and that a complete burial is required to enter heaven. In the event that an autopsy is required, all fluids and body parts are to be returned to the body before burial. (Option 1) It is customary for a member of the client's family to remain with the body until burial to ensure that it is not dishonored. (Option 2) Many cultures and religions prefer to take part in postmortem care (eg, cleansing of the body, dressing). Family beliefs should be clarified before postmortem care is performed. (Option 4) Orthodox Jews believe the dead are disrespected if the effects of death present on the face are seen by others. Therefore, a sheet is placed over the face after death. Educational objective: Orthodox Jews do not permit autopsies unless certain conditions are met (eg, required by law, consent signed by client, investigating hereditary disease to benefit others). Often, the client's family performs postmortem care, covers the face with a sheet, and remains with the body until burial. Families should always be consulted for specific beliefs prior to providing postmortem care. Copyright © UWorld. All rights reserved. Basic Care & Comfort/Pain Management Pancreatitis Test Id: QId: 34358 () 3 of 75 A A A 0 The nurse is caring for a client with chronic pancreatitis. Which meal should the nurse recommend when assisting the client in selecting food items from a menu? 1. Baked tilapia with lemon wedge, sweet potatoes, and green peas [80%] 2. Cream of potato soup and roast beef sandwich on a croissant [11%] 3. Sautéed salmon, macaroni and cheese, string beans, and a biscuit [4%] 4. Shrimp enchiladas with tomato salsa, rice, cornbread, and refried beans [3%] Incorrect Correct answer 1 Answered correctly 80% Time: 40 seconds Updated: 08/02/2017 Explanation: Chronic pancreatitis is an inflammatory disease that causes the tissue of the pancreas to become fibrotic, impairing pancreatic endocrine and exocrine functions. Chronic pancreatitis is most commonly caused by alcohol abuse, but may also result from biliary tract disease (eg, cholelithiasis), autoimmune processes, or cystic fibrosis. Lifestyle modification is a key component of treatment and includes cessation of alcohol and smoking as well as dietary modifications. Clients with pancreatitis often cannot secrete lipase in sufficient quantities to digest consumed fats. Therefore, clients should follow a low-fat diet, with the degree of fat restriction based on the severity of disease. Due to lack of endogenous lipase, oral supplementation of pancreatic enzymes is often required before meals. To avoid exacerbating gastric discomfort, the client should avoid spicy and gas-forming foods. Low-fat food choices include lean meats (eg, fish, chicken), nonfat dairy products, vegetables/fruits prepared without added fat, and low-fat carbohydrates (eg, green peas) (Option 1). (Options 2, 3, and 4) Dairy-containing foods (eg, macaroni and cheese, creamed soup), baked goods (eg, biscuits, cornbread, croissants), and some meats (eg, roast beef) are high in fat. Refried beans also contribute to gas formation and promote bloating. Salsas and spicy foods should be avoided. Educational objective: Clients with pancreatitis often cannot secrete lipase in sufficient quantities to digest consumed fats, requiring the client to follow a low-fat diet. Low-fat food choices include lean meats, non-fat dairy products, vegetables/fruits prepared without added fat, and low-fat carbohydrates. Copyright © UWorld. All rights reserved. Skills/Procedures Central venous access Test Id: QId: 34909 () 4 of 75 A A A 0 The nurse is preparing to change the dressing of a client's subclavian central venous catheter using a chlorhexidine gluconate (CHG)-impregnated patch and transparent adhesive dressing. Place the procedural steps in the correct order. All options must be used. Your Response/ Incorrect Response • Perform hand hygiene, don face mask, place a mask on the client, and apply clean gloves • Remove old dressing and CHG-impregnated patch; assess insertion site • Cleanse the site with CHG for at least 30 seconds using friction; allow to air dry completely • Apply CHG patch over catheter insertion site and cover with a sterile transparent dressing • Discard the clean gloves, perform hand hygiene, and apply sterile gloves Correct Response • Perform hand hygiene, don face mask, place a mask on the client, and apply clean gloves • Remove old dressing and CHG-impregnated patch; assess insertion site • Discard the clean gloves, perform hand hygiene, and apply sterile gloves • Cleanse the site with CHG for at least 30 seconds using friction; allow to air dry completely • Apply CHG patch over catheter insertion site and cover with a sterile transparent dressing Incorrect Correct answer 4,5,3,2,1 Answered correctly 78% Time: 71 seconds