VATI Pharmacology Remediation|complete latest solution guide.

1. 1. List three (3) teaching points the nurse can provide a client with cholelithi- asis on di- etary choices for symptom man- agement. 2. A nurse re- views an order for ceftriaxone in combination with vancomycin for a client diagnosed with meningitis. Iden- tify three (3) com- ponents of the medication pre- scriptions that, if missing, would require clarifica- tion with the provider 3. An older client asks a nurse what she can do to minimize the risk of de- veloping osteo- porosis. Identify 3 (three) health promotion activ- ities the client should imple- ment. ÏConsume a low-fat diet rich in HDL sources (seafood, nuts, olive oil). Ï Participate in a regular exercise program. Ï Do not smoke. • If missing would required clarification with the provider. • Route, dosage • It has to be administered at least over 60 minutes. ÏConsume adequate amounts of calcium and vitamin D, from food or supplements, especially during young adulthood. ï Foods rich in vitamin D are most fish, egg yolks, fortified milk, and cereal. ï Foods rich in calcium are milk products, green leafy vegetables, fortified orange juice and cereals, red and white beans, and figs. Some soy and rice products are fortified with vitamin D and calcium. Ï Spend time outdoors to increase the body's production of vitamin D. Exposure to the sun for any length of time should include wearing sunscreen to avoid getting a sun- 4. A nurse cares for a client whose family member voices concern that the client may have Alzheimer's. List four (4) mani- festations asso- ciated with mild Alzheimer's Dis- ease. 5. A nurse is car- ing for a client in skeletal traction. What guidelines should the nurse observe regard- ing traction? 6. A nurse is pro- viding discharge burn. Ï Engage in weight-bearing exercises (walking, lifting weights). These activities promote bone rebuilding and maintenance • Memory lapses • Losing or misplacing items • Difficulty concentrating and organizing. • Unable to remember material just read. • Assess neurovascular status of the affected body part every hour for 24 hr and every 4 hr after that. Ï Maintain body alignment and realign if the client seems uncom- fortable or reports pain. Ï Avoid lifting or removing weights. Ï Ensure that weights hang freely and are not resting on the floor. f the weights are accidentally displaced, replace the weights. If the problem is not corrected, notify the provider. Ï Ensure that pulley ropes are free of knots, fraying, loosening, and improper positioning at least every 8 to 12 hr. Ï Notify the provider if the client experiences severe pain from muscle spasms unrelieved with med- ications or repositioning. Routinely monitor skin integrity and document. Ï Use heat/massage as prescribed to treat muscle spasms. Ï Use therapeutic touch and relaxation techniques. Pin care is done frequently throughout immo- bilization (skeletal traction and external fixation methods) to prevent and to monitor for manifestations of infection. ï Drainage and redness (color, amount, odor) ïTake pulse daily at the same time for those with pacemak- ers or combination devices. Notify the provider if heart teaching to a client following a permanent pace- maker insertion. List four (4) im- portant teaching points that need to be included. 7. The nurse is performing a focused gastrointestinal assessment on a client who complains of fever and abdominal pain for 2 days. What additional assessment findings alert the nurse to the possibility of appendici- tis?Suggested Adult Med Surg Learning Activity: Appendicitis 8. Digoxin teaching rate is less than the pacemaker rate. ï Report dizziness, fainting, fatigue, weakness, chest pain, hiccuping, palpitations, difficulty breathing, or weight gain ï Never place items that generate a magnetic field directly over the pacemaker generator. These items can affect function and settings. This includes garage door openers, burglar alarms, strong magnets, generators and other power transmitters, and large stereo speakers. The use of household items is not prohibited. ï Inform airport security personnel about the presence of a pacemaker/ICD, because it will set off airport security detectors. The airport security device should not affect pacemaker functioning. Airport security personnel should not place wand detection devices directly over the pace- maker or ICD. ÏAbdominal pain in the right lower quadrant Ï Rigid ab- domen Ï Decreased or absent bowel sounds Ï Fever Ï Di- arrhea or constipation Ï Lethargy Ï Tachycardia Ï Rapid, shallow breathing Ï Anorexia Ï Possible vomiting Computed tomography scan shows an enlarged diameter of appendix, as well as thickening of the appendiceal wall. 9. A client is refus- ing to take morn- ing medications. How should the nurse respond? 10. A new nurse is orienting to the labor and de- livery unit. List three (3) poten- tial adverse ef- fects this new nurse should know prior to ad- ministering oxy- tocin 11. A nurse is car- ing for a newborn whose mother is an alcoholic. De- scribe withdraw- al symptoms this newborn may ex- hibit. 12. A 36-year-old client is pre- scribed digoxin for heart failure. What are two (2) contraindica- Many remember to hold digoxin for HR < 60 in adults, but don't know for children and infants. Hold for HR < 70 in children and HR < 90 in infants. Did you know there are herbals that interact with warfarin? Remember the 4 G's: ginseng, garlic, ginkgo biloba, and ginger Respect the client's right to refuse any medication. Ex- plain the consequences, inform the provider, and docu- ment the refusal. uterine rupture, uterine tachysystole, placental abruption Jitteriness, irritability, increased tone and reflex respons- es, seizures -Contraindicated in clients who have disturbances in ven- tricular rhythm, including ventricular fibrillation, ventricular tachycardia, and second-and third-degree heart block. -Use cautiously in clients who have hypokalemia, partial av block, advanced heart failure, and impaired kidney function. tions for the use of digoxin?Sug- gested Pharma- cology Learning Activity: Heart Failure 13. A nurse is car- ing for a surgical client who is pre- scribed neostig- mine for treat- ment of -myas- thenia gravis. List two (2) po- tential adverse effect the nurse should be aware of while provid- ing this treat- ment 14. A client has been taking epo- etin alfa to stimu- late RBC growth for 5 days. Iden- tify two (2) lab values the nurse will monitor to assess therapeu- tic effect.Sug- gested Pharma- cology Learn- ing Activities: Growth Factors 15. A nurse is car- ing for a client Excessive muscarinic stimulation. Cholinergic crisis Iron levels, Hgb and Hct. potassium levels taking captopril. List a lab re- sult that shows evidence of an adverse reac- tion secondary to administration of captopril that needs to be reported imme- diately to the provider 16. A nurse is preparing for a procedure with a client who has a latex al- lergy. What ac- tion should the nurse take re- garding this al- lergy? 17. List three (3) best practices to pre- vent injury when moving a client up in bed. 18. Identify and de- scribe the types of complicated grief If the patient has latex allergy, then the team must use latex-free gloves, equipment, and supplies. Most facilities use non latex gloves. -Have 1 or more staff members assist with positioning clients. -Prepare the environment by removing obstacles prior to the procedure. -Be aware that the safest way to lift a client is with assistive equipment. Types of complicated grief include chronic, exaggerated, masked, and delayed grief. Ï Complicated grief involves difficult progression through the expected stages of grief. Ï Usually, the work of grief is prolonged. The manifestations of grief are more severe, and they can result in depression or exacerbate a preexisting disorder. Ï The client can devel- op suicidal ideation, intense feelings of guilt, and lowered 19. What should the nurse observe when evaluating a client's use of a cane? 20. List the steps for mixing a short acting and long acting insulin in the same sy- ringe. 21. Explain the steps involved in pro- viding an in- self-esteem. Ï Somatic complaints persist for an extended period of time. The client holds the cane on the stronger side of the body Proceeding with Ambulation: 1. the patient stands with weight evenly distributed be- tween the feet and the cane 2. The cane is held on the patient's stronger side and is advanced 4-12in (10-30cm) 3. Supporting weight on the stronger leg, advance the weaker leg forward, parallel with the cane 4. Supporting weight on the weaker leg, advance the stronger leg forward, ahead of the cane 5. The weaker leg is moved forward until even with the stronger leg along with advancement of the cane List the steps for mixing a short acting and long acting insulin in the same syringe. 1. Draw air (equal to the prescribed number of units. 2. inject are into long acting Insulin-being careful not to be making contact with the insulin. 3. Draw air (equal to the prescrived number of units) again with the same needle. 4. Inject air into short acting insulin. 5. Turn the short acting insulin bottle upside down to draw the prescribed number of units. 6. Insert needle (with short-acting insulin) into long acting insulin and draw prescribed number of long acting insulin units. 7. Drawing the insulin in this order prevents the possibility of accidently injecting the long acting insulin into the short acting insulin vial. Prepare the formula and a 60-mL syringe. Remove the plunger from the syringe. Hold the tubing above the instillation site. Open the stopcock on the tubing, and termittent enteral insert the barrel of the syringe with the end up. Fill the feeding. syringe with 40 to 50 mL formula. If using a feeding bag, fill the bag with the total amount of formula for one feeding, 22. A nurse is teach- ing a client about the procedure for ostomy care. What should be included? and hang it to drain via gravity until empty (about 30 to 45 min). If using a syringe, hold it high enough for the formula to empty gradually via gravity. Continue to refill the syringe until the amount for the feeding is instilled. Follow with at least 30 mL water to flush the tube and prevent clogging. EQUIPMENT Ï Pouch system (skin barrier and pouch) Ï Pouch closure clamp Ï Barrier pastes (optional) Ï Gloves Ï Washcloths Ï Towel Ï Warm water Ï Scissors Ï Pen PRO- CEDURE Ï If a wound ostomy continence nurse is not available, educate the client about stoma care. Ï Perform hand hygiene. Ï Put on gloves. Ï Remove the pouch from the stoma. Ï Inspect the stoma. It should appear moist, shiny, and pink. The peristomal area should be intact, and the skin should appear healthy. Ï Use mild soap and water to cleanse the skin, then dry it gently and completely. Moisturizing soaps can interfere with adherence of the pouch. Ï Apply paste if necessary. Ï Measure and mark the desired size for the skin barrier. Ï Cut the opening 0.15 to 0.3 cm (1 D18 to 1 D8 in) larger, allowing only the stoma to appear through the opening. Ï If necessary, apply barrier pastes to creases. Ï Apply the skin barrier and pouch. Ï Fold the bottom of the pouch and place the closure clamp on the pouch. Ï Dispose of the used pouch. Remove the gloves and perform hand hygiene 23. What interven- tions should a nurse take when caring for a client with a wound evisceration? Evisceration and dehiscence require emergency treat- ment. Ï Call for help. Notify the provider immediately due to the need for surgical intervention. Ï Stay with the client. Ï Cover the wound and any protruding organs with sterile towels or dressings soaked with sterile normal saline solution to decrease the chance of bacteria invasion and drying of the tissues. Do not attempt to reinsert the or- gans. Ï Position the client supine with the hips and knees bent. Ï Observe for indications of shock. Ï Maintain a calm environment. Ï Keep the client NPO in preparation for returning to surgery 24. A nurse is ed- ucating a client on how to per- form Kegel ex- ercise therapy for urinary incon- tinence. Which of the following points should be included in teaching? Select all that apply. 25. A nurse is ed- ucating a client who is sched- uled for a non- stress test (NST). Which of the following state- ments are cor- rect? Select all that apply 26. A nurse is car- ing for a client di- agnosed with hy- peremesis gravi- darum. Which of the following are expected find- ings for this client? Select all that apply 27. A nurse is car- ing for a newborn client who is experiencing se- -During exercises, tighten pelvic muscles for a count of 10 and then relax for a count of 10 -Improvement in incontinence may be seen after 6 weeks of exercise therapy. The NST can easily be performed in an outpatient setting -Weight loss -Dehydration -Hypotonic -lethargy vere hyperbiliru- binemia. Which of the following are symptoms of kernicterus? Se- lect all that apply. 28. What are charac- teristics of the fe- tus that are re- viewed to de- termine the bio- physical profile (BPP) during an ultrasound? Se- lect all that apply. -fetal tone -qualitative amniotic fluid volume 29. APGAR scoring A= appearance (color all pink, pink and blue, blue [pale]) P= pulse (>100, < 100, absent) G= grimace (cough, grimace, no response) A= activity (flexed, flaccid, limp) R= respirations (strong cry, weak cry, absent) 30. postpartum de- pression 31. postpartum blues occurs within 12 months of delivery and is character- ized by persistent feelings of sadness and intense mood swings Ï Feelings of guilt and inadequacies Ï Irritability Ï Anxiety Ï Fatigue persisting beyond a reasonable amount of time Ï Feeling of loss Ï Lack of appetite Ï Persistent feelings of sadness Ï Intense mood swings Ï Sleep pattern distur- bances PHYSICAL ASSESSMENT FINDINGS Ï Crying Ï Weight loss Ï Flat affect Ï Irritability Ï Rejection of the infant Ï Severe anxiety and panic attac can occur in up to 85% of clients during the first few days after birth and generally continues for up to 10 days. It is characterized by mood swings, tearfulness, insomnia, lack of appetite, and a feeling of letdown. A parent can experience an intense fear, anxiety, anger, and 32. ongoing care for therapeutic pro- inability to cope with the slightest problems and become despondent. Postpartum blues typically resolves in 10 days without intervention. Feelings of sadness Ï Lack of appetite Ï Sleep pattern disturbances Ï Feeling of inadequacies Ï Crying easily for no apparent reason Ï Restlessness, insomnia, fatigue Ï Headache Ï Anxiety, anger, sadness PHYSICAL ASSESS- MENT FINDINGS: Crying Continuously monitor FHR patterns to assess for brady- cardia and variable decelerations during the version and cedures to assist for 1 hr following the procedure with labor and delivery 33. A charge nurse is planning to utilize a nurse from the hospi- tal's float pool. Which of the fol- lowing are disad- vantages to float pools? Select all that apply. 34. A nurse is caring for an infant pre- scribed digoxin. The client's api- cal heart rate is 88 beats per minute. Which of the follow- ing interventions should the nurse take? Select all that apply. -Float pools result in a lack of continuity of client care -Float pools are not a solution to the long-term staffing shortages. Obtain a rhythm strip to assess for heart block., Withhold the medication., Notify the physician. 35. A nurse is car- ing for a neonate diagnosed with a congenital heart defect. Which of the following signs and symp- toms would the nurse note if the client was experi- encing heart fail- ure? Select all that apply. 36. A nurse is car- ing for a client di- agnosed with os- teomyelitis. The nurse would ex- pect which of the following find- ings during the assessment? Se- lect all that apply. 37. An 8-year-old child was ad- mitted to the hospital for possible shunt malfunction. The child has been diagnosed with hydro- cephalus since birth. The nurse under- stands which of the following are Feeding difficulties, Mottling, Tachypnea Leukocytosis, Positive wound cultures, Elevated erythro- cyte sedimentation rate Headache, Increased cluminess, Vomiting symptoms of in- creased intracra- nial pressure? Select all that ap- ply. 38. A nurse is pro- viding instruc- tions for car seat safety to par- ents of an in- fant. The nurse should include which of the fol- lowing? Select all that apply. 39. A nurse is car- ing for a client who has MRSA in a wound. Which of the fol- lowing infection control precau- tions should be initiated? Select all that apply 40. A nurse is caring for a client who is being treat- ed with internal radiation. Which nursing interven- tions are appro- priate for this client? Select all that apply. Infants should be rear facing until they weigh 9.1kg (20 lbs)., A five point restraint system is recommended for car seats. Wear a protective gown when entering the client's room., Don clean gloves when delivering the client's meal tray., Use a face shield when irrigating the client's wound. Always face the radiation source., Assign the client to a private room with a private bath., Encourage visitors to stay at least 6 feet from the client. 41. actively involve the participants in practice of techniques A nurse is plan- ning community education focus- ing on the prin- ciples of first aid. Which of the following strate- gies is likely to be most effective with adolescent learners? 42. a nurse is col- lecting data on a 5-month-old in- fant. Which of the following is an expected find- ing? 43. A nurse is help- ing parent's se- lect appropriate independent ac- tivities for their 8-year-old child. Which of the following would be an appropri- ate activity? 44. A nurse is caring for a client being discharge home who has he- mophilia. Which of the following points would be taught to the par- Babinski reflex present Providing frequent trips to the library Dress toddlers in extra layers of clothing. ents prior to dis- charge? 45. A nurse is car- ing for a client with respiratory syncytial virus (RSV). The nurse is aware that which of the fol- lowing strategies would not pre- vent the spread of infection? 46. A client is diagnosed with rheumatic fever. Which clini- cal manifestation would the nurse recognize asso- ciated with the presentation of rheumatic fever? 47. The nurse is con- ducting a phys- ical examination of a 2-month-old with suspected pyloric stenosis. Which finding in- dicates pyloric stenosis? 48. There are dif- ferent parenting styles that are exhibited with- Encouraging children to participate in school activities. polyarthritis Hard, moveable "olive-like mass" in the upper right quad- rant democratic in a family. Which of the fol- lowing parenting styles is exhibit- ed when a parent states, "My child can play video games for one hour a day after his homework is completed"? 49. A nurse has pro- vided discharge education to a school age client and his par- ents following a radius fracture with cast ap- plication. Which of the follow- ing statements by the client's parent indicates a need for addi- tional teaching? 50. A nurse con- cludes that ad- ditional teaching about the Dia- betic Sick Rule is needed when the mother of the child states which of the fol- lowing? When we get home we will use a hair dryer to finish drying the cast. "I will take my child blood sugar every 6 hours." 51. A nurse is teach- ing a com- munity health class on commu- nicable diseases to adolescents. During the dis- cussion on infec- tious mononu- cleosis, which statement would lead the nurse to conclude that further teaching is needed? 52. A nurse is admit- ting a client diag- nosed with post- traumatic stress disorder (PTD) to the mental health unit. The client is con- fused and disori- ented. When de- veloping a plan of care, which of the following would be the pri- ority intervention for this client? 53. The nurse is assessing the family dynam- ics of a widow with end stage terminal cancer. Mononucleosis is a bacterial infection." Accept and make the client feel safe "It does not matter what we think, the living will says 'do not resuscitate'." Which statement made between the adult chil- dren would best indicate the need for further teach- ing 54. A nurse is car- ing for a client of the Buddhist faith who has just given birth to a stillborn in- fant. Which of the following inter- ventions is most appropriate? 55. A nurse is preparing to dis- charge an old- er adult client to the home of a family member while recovering from hip surgery. Which of the fol- lowing may neg- atively affect the client's adjust- ment to living with family mem- bers? 56. A client who is suffering from delusions states, "I can't stay Inquire about any rituals the parents would like to perform at this time The family is insisting on maintaining financial control for the client. It articulates what is expected without reinforcing the delu- sion in group today. I am expect- ing the gover- nor to be here any minute!" The nurse leading the group responds, "I understand, but right now it is time for group and we expect everyone to attend." Which of the follow- ing explains why the nurse's state- ment would be considered ther- apeutic? 57. Gross motor skills by age 3 58. Gross motor skills by age 4 59. gross motor skills by age 5 60. Measles, mumps and rubella vac- cine (MMR) 61. Client education for celiac dis- ease -Rides a tricycle -jumps off bottom step -stands on one foot for a few seconds -skips and hops on one foot -throws ball overhead. -catches ball reliably. -jumps rope -walks backward with heel to toe -throws and catches a ball with ease. Administer doses at 12 to 15 months and 4 to 6 years - administer one dose at 12 to 15 months and 4-6 years or two doses administered a minimum of 4 weeks apart if administered after age 13 years. -eat foods that are gluten-free (milk, cheese, rice, corn, eggs, potatoes, fruits, vegetables, fresh meats and fish, dried beans) 62. Treatment for celiac disease 63. Electrolyte im- balances can de- pend on -Read labels on processed products have gluten as an ingredient. -Read labels and research nonfood products (lipstick, communion wafers, vitamin supplements), which can also have gluten as an ingredient. limited to avoiding gluten. However, eliminating gluten, which is found in wheat, rye and barley, is difficult because it is found in many prepared foods. Clients must read food labels carefully in order to adhere to a gluten-free diet. Some gluten-free products are unappealing to clients, and many are more expensive than other products. Prog- nosis is good for clients who adhere to a gluten-free die the client's method of purging (laxatives, diuretics, vom- iting). Ï Hypokalemia Ï Hyponatremia Ï Hypochloremia Ï Hy- pomagnesemia (occurs due to malnutrition) Ï Hypophos- phatemia (occurs due to malnutrition) Ï Decreased es- trogen (females who have anorexia) Ï Decreased testos- terone (males who have anorexia) 64. Iron teeth staining (liquid form) client education: Dilute liquid iron with water or juice, drink with a straw, and rinse mouth after swallowing. 65. client teaching on montelukast 66. lab tests for acute glomeru- lonephritis Take montelukast once daily at bedtime. For exercise-in- duced bronchospasm, take 2 hr before exercise. If taking daily montelukast, do not take an additional dose for exercise induced bronchospasm ÏThroat culture: to identify possible streptococcus infection (usually negative by the time of diagnosis) Ï Urinalysis: proteinuria, smoky or tea-colored urine, hematuria, increased speci c gravity Ï Renal function: elevated BUN and creatinine ÏAntistrep- tolysin O (ASO) titer: positive indicator for the presence of streptococcal antibodies Ï Antihyaluronidase (AHase) ÏAntideoxyribonuclease B (ADNase-B) Ï Antistreptokinase (ASKase) Ï Antideoxyribonuclease B (ADNase-B) Ï Serum complement (C3): decreased initially; increases as recovery takes place; returns to normal at 8 to 10 weeks post glomerulonephritis 67. lab tests for Urinalysis/24-hr urine collection Ï Proteinuria: present; up nephrotic syn- to 15 grams of protein in a 24-hr specimen Ï Hyaline casts drome Ï Few RBCs Ï Oval fat bodies Ï Increased specific gravity Blood chemistry Hypoalbuminemia: reduced blood pro- tein and albumin Hyperlipidemia: elevated blood lipid lev- els Hemoconcentration: elevated Hgb, Hct, and platelets Possible hyponatremia: reduced sodium level Glomerular filtration rate: normal or high Total calcium: decreased Erythrocyte sedimentation rate (ESR): increased 68. Findings for -Mild to severe hypertension acute glomeru- -low grade fever lonephritis -vomiting -encephalopathy 69. manifestations -headache and blurred vision for -seizures leading to coma hypoglycemia -shakiness, pallor, cool skin, -irritability 70. therapeutic pro- Castings Ï Series of castings starting shortly after birth cedure for club- and continuing until maximum correction is accomplished. foot Ï Weekly manipulation of the foot to stretch the muscles with subsequent placement of a new cast. Ï Following casting, a heel cord tenotomy is usually performed fol- lowed by a long leg cast for 3 weeks. Ï After 6 weeks, a Denis Browne bar that connects specialized shoes can be applied to maintain the correction and prevent recurrence. NURSING CARE Ï Assess neurovascular status. Ï Perform cast care. CLIENT EDUCATION Ï Proper cast care. Ï Fol- low-up care for cast changes. Ï Change diapers frequently Ï Check for decrease circulation (pallor and coldness) and notify the provider 71. nursing care for nephrotic syn- drome ÏProvide rest. Ï Maintain strict I&O. Weigh infant diapers for recording output. Ï Monitor urine for protein. Ï Monitor vital signs. Ï Monitor daily weights; weigh the child on the same scale with the same amount of clothing. Ï Monitor edema and measure abdominal girth daily. Measure at the widest area, usually at or above the umbilicus. Assess degree of pitting, color, and texture of skin. Ï Elevate legs and feet to relieve edema. Ï Monitor and prevent infection (increased Risk for upper respiratory infection). Ï Encour- age nutritional intake within restriction guidelines. Salt can be restricted during the edematous phase. Ï Cluster care to provide for rest periods. Ï Assess skin for breakdown areas. Ï Provide support to families and make appropriate referrals as needed. Relapses can cause physical, emo- tional, and financial stress for the client and family 72. expected find- ings for hyper- calcemia **NEUROMUSCULAR Ï Decreased reflexes Ï Bone pain Ï Flank pain if renal calculi develop **CARDIOVASCULAR Ï Dysrhythmias Ï Increased risk for blood clot **GI: Anorexia, nausea, vomiting, constipation **CENTRAL NERVOUS SYSTEM Ï Weakness, lethargy Ï Confusion, decreased level of consciousness 73. aortic stenosis A narrowing of the aortic valve Ï INFANTS: Faint pulses, hypotension, tachycardia, poor feeding tolerance Ï CHIL- DREN: Intolerance to exercise, dizziness, chest pain, pos- sible ejection murmur 74. findings of hypocalcemia alteration in bowel movement -diarrhea is a result of radiation to the abdominal area. Some chemotherapeutic agents can cause constipation. If mobility and nutrition decrease, the child is more likely to develop constipation. 75. adverse effects of chemotherapy 76. complications of organ neo- plasms anorexia, nausea, vomiting. . mucositis and dry mouth NURSING ACTIONS Ï Provide a soft toothbrush and/or swabs. Ï Lubricate the child's lips. Ï Give soft, nonacidic foods. A pureed or liquid diet can be required. Ï Provide analgesics. Ï Avoid hydrogen peroxide and lemon glycerin swabs due to mucosal drying and irritation on eroded tissue. CLIENT EDUCATION Ï Visit a dentist before therapy. Ï Use chlorhexidine mouth wash or salt rinses using ½ tsp table salt mixed with 1 tsp baking soda and 1 quart wate 77. asthma Monitor for shortness of breath, dyspnea, and audible wheezing. An absence of wheezing can indicate severe constriction of the alveoli 78. complications of status asthmati- cus 79. nursing interven- tion for diabetes mellitus 80. skin care for communica- ble diseases 81. 81. Respiratory failure Persistent hypoxemia related to asth- ma can lead to respiratory failure. NURSING ACTIONS Ï Monitor oxygenation levels and acid-base balance. Ï Pre- pare for intubation and mechanical ventilation as indicat- ed Assist with an exercise plan. ï Children active with team sports will require a snack 30 min prior to activity. ï Pro- longed activities will require food intake every 45 to 60 min ï Encourage sugar free, noncaffeinated liquids to prevent dehydration SKIN CARE Ï Provide calamine lotion for topical relief. Ï Keep the skin clean and dry to prevent secondary infec- tion. Ï Keep the child cool, but prevent chilling. Ï Dress the child in lightweight, loose clothing. Ï Give baths in tepid water. Ï Keep the child's fingernails clean and short. Ï Apply mittens if the child scratches. Ï Teach good oral hygiene. A sore throat can be managed with analgesics, lozenges, and saline rinses. Ï Change linens daily. risk factors for nutrition during pregnancy 82. physical findings for gestational hypertension .Adolescents might have poor nutritional habits (a diet low in vitamins and protein, not taking prescribed iron supplements) ÏHypertension Ï Proteinuria Ï Periorbital, facial, hand, and abdominal edema Ï Pitting edema of lower extremities Ï Vomiting Ï Oliguria Ï Hyperreflexia Ï Scotoma Ï Epigastric pain Ï Right upper quadrant pain Ï Dyspnea Ï Diminished breath sounds Ï Seizures Ï Jaundice Ï Manifestations of progression of hypertensive disease with indications of worsening liver involvement, kidney failure, worsening hy- pertension, cerebral involvement, and developing coagu- lopathies 83. preeclampsia is GH with the addition of proteinuria of greater than or equal to 1+. Report of transient headaches might occur along with episodes of irritability. Edema can be present. 84. HELLP syn- drome 85. assessment re- lated to possible rupture of mem- branes 86. prophylactic cer- vical cerclage is a variant of GH in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction. HELLP syndrome is diagnosed by laboratory tests, not clinically. Ï H: Hemolysis resulting in anemia and jaundice Ï EL: Elevated liver enzymes resulting in elevated ala- nine aminotransferase (ALT) or aspartate transaminase (AST), epigastric pain, and nausea and vomiting Ï LP: Low platelets (less than 100,000/mm3 ), resulting in thrombo- cytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possibly disseminated intravascu- lar coagulopathy ïA sample of the fluid can be obtained and viewed on a slide under a microscope. Amniotic fluid will exhibit a frond-like ferning pattern. Assess the amniotic fluid for color and odor. Expected findings are clear, the color of water, and free of odor. Abnormal findings include the presence of meconium, abnormal color (yellow, green), and a foul odor is the surgical reinforcement of the cervix with a heavy ligature that is placed submucosally around the cervix to 87. intraprocedure for amniocentesis 88. gastrointestinal system and bowel function post partum 89. nursing interven- tion for placenta previa 90. hyperemesis gravidarum expected findings strengthen it and prevent premature cervical dilation. Best results occur if this is done at 12 to 14 weeks of gestation. The cerclage is removed at 36 weeks of gestation or when spontaneous labor occurs. Assist client into a supine position, and place a wedge under their right hip to displace the uterus off the vena cava, and place a drape over the client exposing only the abdomen Flatus is common after a cesarean birth. Encourage the client to ambulate or rock in a chair to promote passage of flatus, and to avoid gas-forming foods. Antiflatulence medications can be required. ÏAssess for bleeding, leakage, or contractions. Ï As- sess fundal height. Ï Refrain from performing vaginal ex- ams (can exacerbate bleeding). Ï Administer IV fluids, blood products, and medications as prescribed. Corti- costeroids, such as betamethasone, promote fetal lung maturation if early delivery is anticipated (cesarean birth). Ï Have oxygen equipment available in case of fetal distress. ÏExcessive vomiting for prolonged periods Ï Dehydration with possible electrolyte imbalance Ï Weight loss Ï In- creased pulse rate Ï Decreased blood pressure Ï Poor skin turgor and dry mucous membranes 91. evaporation Loss of heat as surface liquid is converted to vapor. Gently rub the newborn dry with a warm sterile blanket (adher- ing to standard precautions) immediately after delivery. If thermoregulation is unstable, postpone the initial bath until the newborn's skin temperature is 36.5° C (97.7° F). When bathing, expose only one body part at a time, washing and drying thoroughly 92. therapeutic pro- cedure for pho- totherapy The newborn's bilirubin should start to decrease within 4 to 6 hr after starting treatment. 93. cost-effective Strategies that achieve optimal results in relation to the money spent to achieve those results. In other words, cost effective means "getting your money's worth." Exam- ple: Spending increased money on staff training for trans- mission based precautions, resulting in the increased and effective use of PPE for client care. These actions have the end result of a decrease in infection transmission and an overall savings in the cost of caring for clients who would have acquired these infections. 94. Nursing role in advanced direc- tives 95. Strategy: Compromis- ing/Negotiating -provide written information regarding advanced direc- tives -document the client's advanced directives status -ensure that the advanced directives reflect the client's current decisions -inform all members of the health care team of the client's advance directives ÏThis approach generally minimizes the losses for all in- volved while making certain each party gains something. For example, the nurse might offer to work on another medical surgical unit if someone from that unit feels com- fortable in the pediatric environment. Ï Although each party is giving up something (the manager gives in to a different solution and the nurse still has to work on another unit), this sort of compromise can result in a win win resolution. 96. negotiation The focus is on a win win solution or a win/lose win/ lose solution in which both parties win and lose a portion of their original objectives. Each party agrees to give up something and the emphasis is on accommodating differences rather than similarities between parties. 97. Durable power of attorney for healthcare is a legal document that designates a health care sur- rogate, who is an individual authorized to make health care decisions for a client who is unable. Ï The person who serves in the role of health care surrogate to make decisions for the client should be very familiar with the client's wishes. Ï Living wills can be difficult to interpret, especially in the face of unexpected circumstances. A durable power of attorney for health care, as an adjunct to a living will, can be a more effective way of ensuring that the client's decisions about health care are honored 98. advocacy ÏThe complex health care system puts clients in a vulner- able position. Nurses are clients' voice when the system is not acting in their best interest. 99. Quality improve- is the process used to identify and resolve performance ment deficiencies. Quality improvement includes measuring performance against a set of predetermined standards. In health care, these standards are set by the facility and consider accrediting and professional standards. Ï Standards of care should reflect optimal goals and be based on evidence. Ï The quality improvement process fo- cuses on assessment of outcomes and determines ways to improve the delivery of quality care. All levels of em- ployees are involved in the quality improvement process. Ï The Joint Commission's accreditation standards require institutions to show evidence of quality improvement in order to attain accreditation status 100. respiratory dis- s can occur from compression of trachea due to hem- tress orrhage, which is most likely to occur in the first 24 hr. Respiratory distress also can occur due to edema. Ensure that tracheostomy supplies are immediately available. Hu- midify air, assist to cough and deep breathe, and provide oral and tracheal suction if needed. 101. PERFORMANCE A formal system for conducting performance appraisals APPRAISAL should be in place and used consistently. Performance AND PEER appraisal tools should reflect the staff member's job de- REVIEW scription and can be based on various types of scales or surveys 102. social media pre- do not take pictures that show clients or their family mem- cautions bers 103. ÏNurses must continuously set and reset priorities in order to meet the needs of multiple clients and to maintain prioritization and time manage- ment 104. Ethical Decision Making 105. steps of the problem-solving process 106. provider's pre- scriptions 107. Use appropri- ate communica- tion to ad- dress hallucina- tions and delu- sions 108. Physical exhaus- tion and possible death client safety. Ï Priority setting requires that decisions be made regarding the order in which: ï Clients are seen. ï Assessments are completed. ï Interventions are provided. ï Steps in a client procedure are completed. ï Components of client care are completed. Ï Establishing priorities in nursing practice requires that the nurse make these de- cisions based on evidence obtained: ï During shift reports and other communications with members of the health care team. ï Through careful review of documents. ï By continuously and accurately collecting client data. Process that requires striking a balance between science and morality identify the problem. State it in objective terms, minimizing emotional overlay ÏUnless a do not resuscitate (DNR) or allow natural death (AND) prescription is written, the nurse should initiate CPR when a client has no pulse or respirations. The written prescription for a DNR or AND must be placed in the client's medical record. The provider consults the client and the family prior to administering a DNR or AND. Ï Additional prescriptions by the provider are based on the client's individual needs and decisions and provide for comfort measures. The client's decision is respected in regard to the use of antibiotics, initiation of diagnostic tests, and provision of nutrition by artificial means. Ask the client directly about hallucinations. The nurse should not argue or agree with the client's view of the situation, but can offer a comment, such as, "I don't hear anything, but you seem to be feeling frightened." a client in a true manic state usually will not stop moving and does not eat, drink or sleep. 109. Partial hospital- ization programs this can be a medical emergency These programs provide intense short-term treatment for clients who are well enough to go home every night and who have a responsible person at home to provide support and a safe environment. Ï Certain detoxification programs are a specialized form of partial hospitaliza- tion for clients who require medical supervision, stress management, substance use disorder counseling, and relapse prevention 110. home care Home care provides mental health assessment, inter- ventions, and family support in the client's home. This is implemented most often for children, older adults, and clients who have medical conditions. With psychiatric home care, there are four criteria that must be met. The client must be homebound, have psychiatric diagnosis, need the skills of the mental health nurse and 111. Autism Spec- trum Disorder 112. anger manage- ment nursing care 113. preschool chil- dren (ages 3-6) This type of disorder is present in early childhood and is more common in boys than girls. -Provide a safe environment for the client who is aggres- sive, as well as for the other clients&staff on the unit -Follow policies of the mental health setting when working w/ clients who demonstrate aggression -Assess for triggers or preconditions that escalate client emotions ÏEgocentric thinking. Ï Magical thinking allows for the belief that thoughts can cause an event (death [as a result, child can feel guilt and shame]). Ï Interpret separation from parents as punishment for bad behavior. Ï View dying as temporary because of the lack of a concept of time and because the dead person can still have attributes of the living (sleeping, eating, breathing) 114. Biofeedback A nurse or other health professional trained in this method uses a sensitive mechanical device to assist the client to gain voluntary control of such autonomic functions as heart rate and blood pressure. Exercise gadgets and smart watches provide the ability to track sleep and heart rates. 115. Delirium an acute, temporary, and can have a physiological source (infection, sleep deprivation, or pain) or related to a change in surroundings (being in an unfamiliar or new environment); delirium is often the first manifestation of infection (uti) in older adults. disturbed state of mind that occurs 116. borderline Characterized by instability of affect, identity, and relation- ships, as well as splitting behaviors, manipulation, impul- siveness, and fear of abandonment; often self-injurious and potentially suicidal; ideas of reference are common; often accompanied by impulsivity 117. mild anxiety occurs in the normal experience of everyday living. Ï It increases one's ability to perceive reality. Ï There is an identifiable cause of the anxiety. Ï Other characteristics include a vague feeling of mild discomfort, restlessness, irritability, impatience, and apprehension. Ï The client can exhibit mild tension-relieving behaviors (finger or foot tap ping, fidgeting, lip chewing). 118. suicide precau- tions 119. displacement ÏSearch the client's belongings with the client present. Remove all glass, metal silverware, electrical cords, vas- es, belts, shoelaces, metal nail files, tweezers, matches, razors, perfume, shampoo, plastic bags, and other poten- tially harmful items from the client's room and vicinity. Ï Allow the client to use only plastic eating utensils. Count utensils when brought into and out of the client's room. Ï Check the environment for possible hazards (windows that open, overhead pipes that are easily accessible, non-breakaway shower rods, non-recessed shower noz- zles). Ï Ensure that the client's hands are always visible, even when sleeping Shifting feelings related to an object, person, or situation to another less threatening object, person, or situation ADAPTIVE USE: An adolescent angrily punches a punch- ing bag after losing a game. MALADAPTIVE USE: A person who is angry about losing their job destroys their child's favorite toy. 120. Buprenorphine INTENDED EFFECTS Ï Buprenorphine is an agonist-an- tagonist opioid used for both withdrawal and mainte- nance. Ï This medication decreases feelings of craving and can be effective in maintaining compliance. Ï FDA has approved a variety of schedule III buprenorphine products, some containing naloxone, and are available as sublingual tablets, buccal film, and a surgical skin implant. NURSING ACTIONS Ï Unlike methadone, a primary care provider can prescribe and dispense buprenorphine. Ï Ad- minister the medication sublingually