Uworld Leadership & Management Concepts

Leadership & Management Concepts Priority, Projectile Vomit Test Id: Question Id: 32076 () 4 of 20 A A A The nurse is managing assigned clients on the evening shift. Which client presentation is a priority? Unordered Options Ordered Response 1. Blunt head trauma with projectile vomiting 2. History of Alzheimer disease with agitation 3. History of carpal tunnel syndrome with hand numbness 4. History of third cranial nerve pathology with double vision You answered this question correctly. Time Spent: 66 Seconds 95% of people answered this question correctly. Last Updated: 12/30/2015 Explanation A client with a traumatic head injury from blunt force can have delayed symptoms if there is bruising in the brain and subdural hematoma/cerebral edema develops. A subdural hematoma is typically a slower venous bleed, and symptoms appear 24-48 hours later. Signs and symptoms are similar to those of increased intracranial pressure and include change in level of consciousness, projectile vomiting, ataxia, ipsilateral (unilateral) pupil dilation, and seizures. Brain herniation can occur if the condition is not recognized and treated. (Option 2) Neuropsychiatric symptoms such as agitation, aggression, delusions, hallucinations, wandering, and depression are very common in clients with dementia. Some may have an underlying etiology (eg, pain, infection) that requires identification and treatment. This client is the second priority as the condition is not immediately lifethreatening. (Option 3) Carpal tunnel syndrome is a compression of the median nerve within the carpal tunnel at the wrist. Clinical manifestations are weakness, pain, numbness, and impaired sensation in the median nerve distribution. Numbness is an expected symptom; a splint is worn to relieve the pressure. (Option 4) The third cranial nerve controls the majority (4/6) of the extraocular muscles. As a result, the lesion can cause weakness in eye movements with resultant diplopia, which is an expected finding. Educational objective: A client with a head injury and signs of increased intracranial pressure (eg, change in level of consciousness, projectile vomiting, pupil dilation, ataxia) is a priority. Leadership & Management Concepts DIC Priority Test Id: Question Id: 34070 () 6 of 20 A A A The nurse is caring for clients on a busy medical-surgical unit. Which client would be priority to assess first? Unordered Options Ordered Response 1. A client with an ileostomy bag that has leaked stool all over 2. A client with chronic obstructive pulmonary disease, diminished breath sounds, and SpO2 of 91% 3. A client with deep venous thrombosis who missed the last warfarin dose 4. A client with sepsis who is developing petechiae You answered this question correctly. Time Spent: 189 Seconds 69% of people answered this question correctly. Last Updated: 2/25/2016 Explanation Clients with sepsis are at risk for developing disseminated intravascular coagulation (DIC), a condition that initially causes clotting within the microvessels. Platelets and clotting factors are consumed in clotting and become unavailable for body use, leading to bleeding complications. The initial clotting also disrupts blood flow to extremities and organs. Signs of DIC include frank external bleeding (eg, venipuncture site bleeding), signs of internal bleeding (petechiae, ecchymosis, hematuria, hematemesis, and bloody stools), and respiratory distress (eg, bleeding/clotting into lungs). Signs of DIC need immediate assessment and emergency intervention. Rapid replacement of clotting factors (fresh frozen plasma), platelets, and blood is needed to save the client from death. (Option 1) Stool leaking from an ileostomy bag is not a priority. (Option 2) It is common for clients with chronic obstructive pulmonary disease to have diminished breath sounds; the goal SpO2 level in this population is generally ≥90%. (Option 3) Although missing warfarin can increase the risk of clotting, most clients will usually have a therapeutic INR for 1-2 days. This is not a priority over the DIC client. Educational objective: Disseminated intravascular coagulation (DIC) results from abnormal activation of clotting cascade followed by consumption of clotting factors and platelets; this quickly leads to life-threatening external and internal bleeding. Any signs of DIC should be assessed immediately as emergent replacement of clotting factors, blood, and platelets is needed to save the client. Postoperative Assessment - Prioritization Test Id: Question Id: 31099 () 8 of 20 A A A A nurse receives the following change-of-shift morning report for the assigned clients. Which client should the nurse assess first? Unordered Options Ordered Response 1. Client 1 day postoperative with fine inspiratory crackles in the lung bases on auscultation who is to ambulate for the first time this morning 2. Client 1 day postoperative with serosanguineous drainage on the abdominal surgical dressing and temperature of 100.4 F (38 C) 3. Client 2 days postoperative receiving intermittent epidural bolus analgesia who now reports incisional pain as a 4 on a 0-10 scale 4. Client 2 days postoperative receiving fluids infusing at 125 mL/hr, with a Foley catheter and urine output of 100 mL during the last 8 hours You answered this question correctly. Time Spent: 408 Seconds 76% of people answered this question correctly. Last Updated: 12/13/2015 Leadership & Management Concepts Postoperative DVT Priority Assessment Test Id: Question Id: 33974 () 12 of 20 A A A The nurse receives report on 4 assigned clients. Which client should the nurse assess first? Unordered Options Ordered Response 1. Client 1 hour post laparoscopic cholecystectomy for gallstones who reports right shoulder pain 2. Client 4 hours post tracheostomy who has a small amount of pink drainage on the tracheotomy dressing 3. Client 48 hours post abdominal hysterectomy who is ambulatory and reports aching in the right leg 4. Client 3 days post open gastric bypass who reports fever and foulsmelling discharge at the surgical site You answered this question correctly. Time Spent: 387 Seconds 37% of people answered this question correctly. Last Updated: 3/8/2016 Explanation The nurse should first assess the client showing symptoms of a deep venous thrombosis (DVT) (eg, unilateral edema, warmth, redness, tenderness on palpation). DVT is a postoperative complication related to venous stasis and subsequent thrombosis. If a DVT is suspected, early diagnostic testing (eg, venous ultrasound) and treatment with anticoagulant therapy (eg, heparin, enoxaparin) are critical to prevent clots from traveling to the pulmonary circulation and causing pulmonary embolism. (Option 1) The client is experiencing a common post laparoscopic cholecystectomy problem of referred pain to the right shoulder. Carbon dioxide, used to inflate the abdominal cavity during surgery, causes irritation to the phrenic nerve and diaphragm, which may cause difficulty breathing. Interventions for alleviation include the Sims position, deep breathing, ambulation, and analgesics. (Option 2) A small amount of pink serosanguineous drainage at the new tracheostomy site is expected postoperatively. The nurse should notify the health care provider if bleeding becomes excessive. (Option 4) Conditions that increase the likelihood of surgical site infection include obesity, immunosuppression, malnutrition, diabetes, and advanced age. The nurse should notify the health care provider of signs and symptoms of infection (eg, fever, purulent drainage), but the client with a DVT is priority due to the risk of pulmonary embolism. Educational objective: Assessing the client with a possible deep venous thrombosis is the priority due to lifethreatening risk of pulmonary embolism. Characteristic manifestations of deep venous thrombosis include calf pain, unilateral edema, warmth, redness, and tenderness on palpation. Leadership & Management Concepts Disasters Test Id: Question Id: 30694 () 15 of 20 A A