MED-SURG RN Form B Questions and Answers Full Semester 2024

MED-SURG RN Form B Questions and Answers Full Semester 2024 Cancer treatment options: Safety precautions for a sealed radiation implant ◯ Nursing Actions ■ Place the client in a private room away from other clients when possible. ■ Place appropriate sign on the door warning of the radiation source. ■ Wear a dosimeter film badge that records personal amount of radiation exposure. ■ Limit visitors to 30-min visits, and have visitors maintain a distance of 6 ft from the source. ■ Visitors and health care personnel who are pregnant or under the age of 16 should not come into contact with the client or radiation source. ■ Keep a lead container in the client's room if the delivery method could allow spontaneous loss of radioactive material. Tongs are available for placing radioactive material into this container. ■ Precautions listed above should be carried out at home if the client is discharged during therapy. ◯ Client Education ■ Inform client of the need to remain in an indicated position to prevent dislodgement of the radiation implant. ■ Instruct the client to call the nurse for assistance with elimination. ■ Instruct client and family about radiation precautions needed in the health care and home environments. Fractures and immobilization: Assessment of a new cast Neurovascular assessment is essential throughout immobilization. Assessments are performed every hour for the first 24 hr and every 1 to 4 hr thereafter following initial trauma to monitor neurovascular compromise related to edema and/or the immobilization device. Nursing Actions Monitor neurovascular status and assess pain. Apply ice for 24 to 48 hr. Handle a plaster cast with the palms, not fingertips, until the cast is dry to prevent denting the cast. Avoid setting the cast on hard surfaces or sharp edges. Prior to casting, the area is cleaned and dried. Tubular cotton web roll is placed over the affected area to maintain skin integrity. The casting material is then applied. After cast application, position the client so that warm, dry air circulates around and under the cast (support the casted area without pressure under or directly on the cast) for faster drying and to prevent pressure from changing the shape of the cast. Use gloves to touch the cast until it is completely dry. Elevate the cast above the level of the heart during the first 24 to 48 hr to prevent edema of the affected extremity. If any drainage is seen on the cast, it should be outlined, dated, and timed, so it can be monitored for any additional drainage. Older adult clients have an increased risk for impaired skin integrity due to the loss of elasticity of the skin and decreased sensation (comorbidities). Acute Kidney Injury and Chronic Kidney Disease: Over the counter medications Administer calcium channel blocker to prevent the movement of calcium into the kidney cells, maintain cell integrity, and increase glomerular filtration rate (GFR).Avoid administering antimicrobial medications (e.g., aminoglycosides and amphotericin B), NSAIDs, angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, and IV contrast dye, which are nephrotoxic. ◯ Digoxin (Lanoxin), a cardiac glycoside, increases contractility of the myocardium and promotes cardiac output. ■ Monitor digoxin laboratory levels due to slow excretion of the medication with CKD. ■ Administer digoxin (Lanoxin) after receiving dialysis. ◯ Sodium polystyrene (Kayexalate) to increase elimination of life-threatening serum potassium, which may cause dangerous cardiac dysrhythmias and peaked T waves. ■ Restrict sodium intake. Sodium polystyrene contains sodium and can cause fluid retention and hypertension, a complication of CKD. ◯ Erythropoietin alfa (Epogen, Procrit) to stimulate production of red blood cells, given for anemia ◯ Ferrous sulfate (Feosol), an iron supplement to prevent severe iron deficiency. ◯ Aluminum hydroxide gel (Amphojel) ■ Taken with meals to bind phosphate in food and stop phosphate absorption. ■ Take 2 hr before or after digoxin. ◯ Furosemide (Lasix), a loop-diuretic administered to excrete excess fluids. ■ Avoid administering to a client who has end-stage kidney disease. ■ Clients may also receive thiazide diuretics, potassium-sparing diuretics, and osmotic diuretics. Heart failure and pulmonary edema: monitoring the effects of beta blockers Beta-adrenergic blockers (beta-blockers) ■ Medications such as carvedilol (Coreg) and metoprolol (Lopressor) may be used to improve the condition of the client who has sustained increased levels of sympathetic stimulation and catecholamines. This would include clients who have chronic heart failure. ■ Nursing considerations Monitor BP, pulse, activity tolerance and orthopnea. Check orthostatic blood pressure readings. ■ Client Education Instruct the client to weigh daily. Advise the client to regularly check BP. Tell the client to follow the provider's instructions on increasing medication dosage. Chronic Obstructive Pulmonary Disease: Nebulizer Treatment ◯ Bronchodilators (inhalers) ■ Short-acting beta2 agonists, such as albuterol (Proventil, Ventolin) provide rapid relief. ■ Cholinergic antagonists (anticholinergic medications), such as ipratropium (Atrovent), block the parasympathetic nervous system. This allows for the sympathetic nervous system effects of increased bronchodilation and decreased pulmonary secretions. These medications are long acting and are used to prevent bronchospasms. ■ Methylxanthines, such as theophylline (Theo-24), relax smooth muscles of the bronchi. These medications require close monitoring of serum medication levels due to narrow therapeutic ranges. Use only when other treatments are ineffective. ■ Nursing Considerations Monitor the client's serum levels for toxicity when taking theophylline. Side effects will include tachycardia, nausea, and diarrhea. Watch the client for tremors and tachycardia when taking albuterol. Observe the client for dry mouth when taking ipratropium. ■ Client Education Encourage the client to suck on hard candies to help moisten dry mouth while taking ipratropium. Encourage client to increase fluid intake, report headaches, or blurred vision. Monitor heart rate. Palpitations can occur, which may indicate toxicity of ipratropium. Urinary Tract Infections: Client Teaching About Antibiotics Instruct clients to take SMZ-TMP on an empty stomach with a full glass of water. ● Instruct clients to complete the prescribed course of antimicrobial therapy, even though symptoms may resolve before the full course is completed Antiseptics: Inform clients that urine will have a brownish discoloration. ● Encourage clients to administer with food if GI symptoms occur. ● Instruct clients to complete the prescribed course of antimicrobial therapy, even though symptoms may resolve before the full course is completed. ● Recommend that clients avoid crushing tablets because of the possibility of tooth staining. ● Instruct clients to avoid nitrofurantoin while pregnant (can cause infant birth defects). Fluoroquinolones: Ciprofloxacin is available in oral and intravenous forms. ◯ Discontinue other IV infusions or use another IV site when administering IV ciprofloxacin. ● Decrease doses of ciprofloxacin in clients who have renal dysfunction. ● Intravenous ciprofloxacin should be administered in a dilute solution slowly over 60 min in a large vein. ● For inhalation anthrax infection, ciprofloxacin is administered every 12 hr for 60 days. ● Instruct clients to complete the prescribed course of antimicrobial therapy, even though symptoms may resolve before the full course is completed. Gastrointestinal Therapeutic Procedures: Calculating Infusion Volume of TPN TPN contains complete nutrition, including calories (in a high concentration [20% to 50%] of dextrose), lipids/essential fatty acids, protein, electrolytes, vitamins, and trace elements. Standard IV bolus therapy is typically less than or equal to 700 calories/day. Basic guidelines regarding when to initiate TPN A weight loss of 7% body weight and NPO for 5 days or more A hypermetabolic state The flow rate is gradually increased and gradually decreased to allow body adjustment (usually no more than a 10% hourly increase in rate). Pressure Ulcers, Wounds, and Wound Management: Signs of Wound Healing Stages of Wound Healing ◯ The inflammatory stage begins with the injury and lasts 3 to 6 days. Initial care involves the following. ■ Controlling bleeding with vasoconstriction and retraction of blood vessels, and with clot formation. ■ Delivering oxygen, white blood cells, and nutrients to the area via the blood supply. ◯ The proliferative stage lasts the next 3 to 24 days. Effects to the wound include: ■ Replacing lost tissue with connective or granulated tissue. ■ Contracting the wound's edges. ■ Resurfacing of new epithelial cells. ◯ The maturation or remodeling stage involves the strengthening of the collagen scar and the restoration of a more normal appear TYPE OF HEALING CHARACTERISTICS WOUND TYPE Primary intention › Little or no tissue loss › Edges approximated, as with a surgical incision › Heals rapidly › Low risk of infection › No or minimal scarring Secondary intention › Loss of tissue › Wound edges widely separated (pressure ulcers, open burn areas) › Longer healing time › Increase for risk of infection › Scarring Tertiary intention › Widely separated › Deep › Spontaneous opening of a previously closed wound › Risk of infection › Extensive drainage and tissue debris › Closed later › Long healing time