Saunders NCLEX-RN, 7th Questions And Answers 2023

Saunders NCLEX-RN, 7th Questions And Answers 2023 atelectasis - ANS-excessive mucus collection, with the collapse of alveolar sacs caused by mucous plugs, infectious drainage, or anesthetic medications, results in ineffective gas exchange in general, should medications be taken with an antactid? - ANS-no, because the antacid will affect the aborption of the medication dietary preferences: Buddhism - ANS-*alcohol is usually prohibited *many are lacto-ovo vegetarians *some eat only fish *some avoid only beef dietary preferences: Church of Jesus Christ of Latter-day Saints (Mormon) - ANS- *alcohol, coffee, and tea are usually prohibited *consumption of meat is limited *the first Sunday of every month is optional for fasting dietary preferences: Eastern Orthodox - ANS-*during lent, all animal products, including dairy, are forbidden *fasting occurs during Advent *exceptions from fasting: -illness -pregnancy -children may be exempt dietary preferences: hinduism - ANS-*many are vegetarians *those who eat meat avoid beef and pork *fasting rituals vary *children are not allowed to fast dietary preferences: Islam - ANS-*pork is forbidden *birds of prey are forbidden *meat must be ritually slaughtered *during month of Ramadan, fasting occurs during the day (pregnant women are excluded) dietary preferences: Jehovah's Witnesses - ANS-Any foods to which blood has been added are prohibited. They can eat animal flesh that has been drained. dietary preferences: Judaism - ANS-*must adhere to dietary kosher laws *24 hour fasting observed during Yom Kippur *pregnant women, children and ill people are exempt from fasting. *during passover, only unleavened bread is eaten Dietary Kosher laws - ANS-*meats allowed include animals that vegetable eaters, cloven-hoofed animals (deer, cattle, goats, sheep), and animals that are ritually slaughtered. *fish that have scales and fins are allowed *meat (including fish) cannot be eaten with dairy Pentecostal (Assembly of God) dietary preferences - ANS-*alcohol is usually prohibited *no food to which blood has been added *some avoid pork Roman Catholic dietary preferences - ANS-*avoid meat on ash Wednesday and Fridays on lent *optional fasting during lent season *children, pregnant women, and ill individuals are exempt from fasting Seventh-Day Adventist (Church of God) - ANS-*alcohol and caffeinated beverages are usually prohibited *many are lacto-ovo vegetarians *those who eat meat avoid pork *overeating is prohibited; 5 to 6 hours between meal without snacking is practiced African Americans: description - ANS-citizens or residents of the united states who may have origins in any of the black populations in Africa. African Americans: communication - ANS-*standard english *head nodding doesn't always mean agreement *prolonged eye contact may be viewed negatively *non-verbal communication may be important *personal questions on initial contact viewed as intrusive African Americans: time orientation and personal space preferences - ANS-*time orientation varies and may include past, present, or future orientation *relationships and events may be considered more important than timeliness *comfortable with close personal space when interacting with family and friends African Americans: social roles - ANS-*large extended family networks are important; older adults are respected *many households are headed by a single female parent *religion and church are sources of strength African Americans: food preferences - ANS-*fried foods *chicken *pork *greens such as collard greens *rice *some pregnant women suffer from pica African Americans: health risks - ANS-*sickle cell anemia *hypertension *heart disease *cancer *lactose intolerance *diabetes mellitus *obesity African Americans: cultural interventions - ANS-*assess the meaning of verbal and nonverbal behavior *be flexible and avoid rigidity in scheduling care *encourage family involvement *alternative modes of healing include herbs, prayer, and laying on of hands practices Amish: Description - ANS-*known for simple living, plain dress, and reluctance to adopt modern convenience *Christian religious denominations (Mennonite churches) *cultural beliefs and preferences vary depending on specific amish community Amish: Communication - ANS-*usually speak a German dialect (Pennsylvania Dutch) *German used during worship *English learned in school Amish: social roles - ANS-*women are not allowed to hold positions of power in the congregation *roles for women are considered equally important to those of men, but are very unequal in terms of authority *family life has a patriarchal structure *marriage outside of the faith is not usually allowed; unmarried women remain under the authority of their fathers Amish: health and illness - ANS-*most will need church (bishop and community) permission to be hospitalized as the community will come together to pay the costs *most likely will not have health insurance *barriers to modern health care include distance, lack of transportation, cost, and language (scientific jargon is not often understood) Amish: health risks - ANS-*in general, they have fewer risks for disease because of their lifestyle (manual labor, diet, rare use of tobacco/alcohol) *genetic disorders are a risk because of intermarriage *nonimmunization *sexual abuse of women Amish: cultural interventions - ANS-*include husband or father in health care decisions for female members *health care instructions must be given in simple, clear language *teaching should be focused on health implications associated with nonimmunization, intermarriage, and sexual abuse issues Asian Americans: communication - ANS-*languages include Chinese, Japanese, Korean, Filipino, Vietnamese, and English *silence is valued *eye contact may be considered inappropriate or disrespectful (some cultures see it as a sexual invite) *criticism or disagreement is not expressed verbally *head nodding doesn't always mean agreement *the word "no" may be interpreted as disrespect for others Asian Americans: personal space preferences - ANS-*formal personal space is preferred, except with family and close friends *usually do not touch each other during conversation *for some cultures, touch is unacceptable between members of the opposite sex *the head is considered sacred in some cultures, so it may be disrespectful to touch the head Asian Americans: social roles - ANS-*devoted to tradition *large extended families are common *loyalty to family and honor are valued *the family unit is structured an hierarchical *men have the power and authority and men are expected to be obedient *education is viewed as important *religions include Taoism, Buddhism, Confucianism, Shintoism, Hinduism, islam, and Christianity *social organizations are strong within the community Asian Americans: health and illness - ANS-*health/illness is due to balance/imbalance between yin and yang (positive and neg energy forces) *healthy body viewed as gift from god *illness may also be attributed to prolonged sitting or lying or to overexertion *food preferences include raw fish, rice, and vegetables Asian Americans: health risks - ANS-*hypertension *heart disease *cancer *lactose intolerance *thalassemia Asian Americans: cultural interventions - ANS-*be aware of and respect personal boundaries, and request permission to touch *limit eye contact *avoid gesturing with hands *female clients usually prefer female health care providers (HCP) *clarify responses to questions and expectations of the HCP *be flexible and avoid rigidity in scheduling care *encourage family involvement Asian Americans: alternative modes of healing - ANS-*herbs *acupuncture *restoration of balance with food *massage *prayers and incense How does yin and yang guide food choices during illness? - ANS-*Yin foods are cold *yang foods are hot *eat cold foods with a hot illness and vice versa Hispanic and Latino Americans: communication - ANS-*languages are primarily English and Spanish *members ted to be verbally expressive, yet confidentiality is important *avoiding eye contact with a person in authority may indicate respect and attentiveness *direct confrontation is usually disrespectful and the expression of negative feelings may be impolite *dramatic body language, such as gestures or facial expressions may be used to express emotion or pain Hispanic and Latino Americans: personal space preferences - ANS-*comfortable in close proximity with family, friends, and acquaintances *very tactile, use embraces and handshakes *value the physical presence of others *politeness and modesty are important Hispanic and Latino Americans: social roles 1 - ANS-*nuclear family is basic unit; and large extended families are common *extended family is highly regarded *needs of the family take precedence over the needs of the individual Hispanic and Latino Americans: social roles 2 - ANS-*depending on acculturation factors, men are usually wage earners and decision makers, and women are homemakers and caretakers *religion is usually catholicism, but may vary *usually have strong church affiliations *social organizations are strong within the community Hispanic and Latino Americans: health and illness - ANS-*health may be viewed as a reward from God or a result of good luck *some believe that health results from a state of physical and emotional balance *illness may be viewed as a punishment from God *some may adhere to nontraditional health measures such as folk medicine Hispanic and Latino Americans: food preferences - ANS-beans, fried foods, spicy foods Hispanic and Latino Americans: health risks - ANS-*hypertension *heart disease *diabetes mellitus *obesity *lactose intolerance *parasites Hispanic and Latino Americans: cultural interventions - ANS-*allow time for client to discuss treatment options with family members *protect privacy *offer to call clergy *ask permission before touching a child when planning to examine or care for him or her *be flexible regarding time of arrival for appointments and avoid rigidity in scheduling care Hispanic and Latino Americans: alternative modes of healing - ANS-*consultation with lay healers *restoration of balance with hot or cold foods *prayer *religious medals Native American: communication - ANS-*silence indicates respect for the speaker *may speak in low tone of voice and expect others to be attentive *eye contact may be viewed as a sign of disrespect *body language is important Native American: personal space preference - ANS-*personal space is important *members may lightly touch another person's hand during greeting *massage may be used for the newborn to promote bonding between the infant and mother *some groups may prohibit touching of a dead body Native American: social roles - ANS-*members are family orientated *basic family unit is the extended family, which often includes persons from several households *grandparents may be viewed as family leaders *elders are honored *children are taught to respect traditions *father usually works outside of home, mother assumes domestic duties Native Americans: religion/spirituality - ANS-*sacred myths and legends provide spiritual guidance for some *most adhere to some form of christianity with healing practices integrated *community and social organizations are important Native Americans: health and illness - ANS-*health is usually considered a state of harmony between the individual, family, and environment *some believe that illness is caused by supernatural forces and disequilibrium between the person and environment *traditional health and illness beliefs may continue to be observed, including natural and religious folk medicine traditions Native Americans: food preferences - ANS-*cornmeal *fish *game *fruits *berries Native Americans: health risks 1 - ANS-*alcohol abuse *obesity *heart disease *diabetes mellitus Native Americans: health risks 2 - ANS-*tuberculosis *arthritis *lactose intolerance *gallbladder disease Native Americans: cultural interventions 1 - ANS-*clarify communication *understand that a lack of eye contact doesn't mean client isn't listening *be attentive to your own use of body language Native Americans: cultural interventions 2 - ANS-*obtain input from extended family *encourage client to personalize space *in the home, assess for the availability of running water, and modify infection control and hygiene practices as necessary Native Americans: alternative modes of healing - ANS-*herbs *restoration of balance between the person and the universe *consultation with traditional healers White Americans: health risks - ANS-*cancer *heart disease *diabetes *obesity *hypertension *thalassemia End of Life Care: Amish - ANS-*permit organ donation with the exception of heart transplants (heart is soul of body) *funerals conducted in home: no eulogy, plain casket with no flowers or other displays *women are usually buried in wedding dress *soul moves on to heaven or hell End of Life Care: catholic and orthodox - ANS-*a priest anoints the sick *sacraments are given before death *some eastern orthodox oppose autopsy and/or cremation End of Life Care: church of jesus christ of latter day saints (mormons) - ANS-*a sacrament may be administered at client's request *may prohibit cremation End of Life Care: protestant - ANS-*no last rites are provided *prayers are given to offer comfort and support End of Life Care: Jehovah's Witnesses - ANS-*not allowed to receive blood transfusions *believe the soul cannot live after the body has died End of Life Care: Islam 1 - ANS-*second degree male relatives (cousins or uncles) should be contact people and they will determine if client/family should be informed *may choose to face mecca (west or southwest) *head should be elevated above body End of Life Care: Islam 2 - ANS-*discussions about death are not usually welcome *stopping medical treatment is against the will of Allah *grief may be expressed by slapping or hitting the body End of Life Care: Islam 3 - ANS-*after death, only a same-sex muslim should touch the body, if not possible, non-muslims should wear gloves *some oppose autopsy and/or cremation *organ transplant is permitted for the purpose of saving human life End of Life Care: Judaism - ANS-*a client placed on life support should remain so until death *a dying person should not be left alone (a rabbi's presence is desired) *autopsy and cremation are usually not allowed *people in the Jewish faith generally oppose prolonging life after irreversible brain damage End of Life Care: Hinduism - ANS-*pre-death rituals include -tying a thread around the neck or wrist of dying person -sprinkling person with special water -placing a basil leaf on person's tongue *after death, the sacred threads are not removed and the body is not washed *cremations is usually preferred; ashes are cast into a holy river End of Life Care: Buddhism - ANS-*a Buddha shrine may be placed in room *time for meditation at the shrine is important *may refuse medications that alter their awareness (e.g., opioids) *after death, a monk may recite prayers for 1 hour (need not be done in presence of the body) *organ donation is encouraged as an act of mercy End of Life Care: African Americans - ANS-*members discuss issues with spouse or older family members *family is highly valued and is central to care of terminally ill members *open displays of affection are common and expected *prefer to die at home End of Life Care: Asian Americans - ANS-*family members may make decisions about care and often do not tell the client the diagnosis or prognosis *dying at home may be considered bad luck *organ donations may not be allowed in some groups End of Life Care: Hispanic and Latino groups 1 - ANS-*the family generally makes decisions and may request to withhold the diagnosis or prognosis from the client *extended family members often are involved in end-of-life care (pregnant women are exempt) *several family members may at the dying person's bedside End of Life Care: Hispanic and Latino groups 2 - ANS-*vocal expressions of grief are expected *may refuse procedures that alter the body (autopsy) *dying at home may be considered bad luck End of Life Care: Native Americans - ANS-*family meetings may be held to make decisions about end-of-life care and the type of treatments that should be pursued *some groups avoid contact with the dying (may prefer to die in the hospital) categories of complementary and alternative medicines (CAM) - ANS-*whole medical systems *mind-body medicine *biologically based practices *manipulative and body-based practices *energy medicine commonly used herbs and health products: aloe - ANS-*anti-inflammatory and antimicrobial effect *accelerates wound healing commonly used herbs and health products: black cohosh - ANS-*produces estrogenlike effects commonly used herbs and health products: chamomile - ANS-*antispasmodic effect *anti-inflammatory effect *mild sedative effect commonly used herbs and health products: dehyroepiandrosterone (DHEA) - ANS- *converts to androgens and estrogen *slows effects of aging *used for erectile dysfunction commonly used herbs and health products: Echinacea - ANS-*stimulates the immune system commonly used herbs and health products: Garlic - ANS-*antioxidant *lowers cholesterol levels commonly used herbs and health products: Ginger - ANS-*antiemetic; used for nausea and vomiting commonly used herbs and health products: Ginkgo biloba - ANS-*antioxidant *used to improve memory commonly used herbs and health products: Ginseng - ANS-*increases physical endurance and stamina *used for stress and fatigue commonly used herbs and health products: Glucosamine - ANS-amino acid that assists in the synthesis of cartilage commonly used herbs and health products: Melatonin - ANS-*a hormone that regulates sleep *used for insomnia commonly used herbs and health products: milk thistle - ANS-*antioxidant *stimulates production of new liver cells *reduces liver inflammation *used for liver and gallbladder disease commonly used herbs and health products: peppermint oil - ANS-*antispasmodic *used for irritable bowel syndrome commonly used herbs and health products: saw palmetto - ANS-*anti-estrogen activity *used for UTIs and benign prostatic hypertrophy commonly used herbs and health products: st. johns wart - ANS-*antibacterial *antiviral *antidepressant commonly used herbs and health products: Valerian - ANS-used to treat nervous disorders such as anxiety, restlessness, and insomnia teaching points for herbs - ANS-*moisture sunlight and heat may alter the components of herbal preparations *if surgery is planned, herbs may need to be discontinued 2-3 weeks before surgery common low risk therapies - ANS-*meditation *relaxation techniques *imagery *music therapy *massage *touch *laughter and humor *spiritual measures, such as prayer general tasks that can be delegated to UAP - ANS-*noninvasive interventions: -skin care -range of motion exercises -ambulation -grooming -hygiene measures general tasks that can be delegated to LPN or LVN - ANS-*all tasks a UAP can perform *dressing changes *suctioning *urinary catheterization *medication administration (oral, subQ, IM, and selected piggyback meds) *review of teaching initially taught by RN a wound that is pulsating bright red blood indicates what type of puncture - ANS-arterial puncture triage: emergent - ANS-*tagged red/priority 1 *assigned to clients with life threatening conditions needing immediate attention *continuous evaluation *high probability for survival once stabilized conditions that are considered emergent - ANS-*trauma victims *chest pain *severe respiratory distress *cardiac arrest *limb amputation *acute neurological deficits *chemical splashes to the eye triage: urgent - ANS-*tagged yellow/ priority 2 *assigned to clients who require treatment and whose injuries have complications that are not life-threatening, provided that they are treated within 30 minutes to 2 hours *continuous evaluation every 30-60 minutes after initial treatment conditions considered urgent - ANS-*open fracture with a distal pulse *large wounds triage: non-urgent - ANS-*tagged green/ priority 3 *assigned to clients with local injuries, no immediate complications, and who can wait at least 2 hours for treatment *evaluate every 1-2 hours after after initial treatment non-urgent conditions - ANS-*closed fracture *minor lacerations *sprains *strains *contusions anasarca - ANS-*(generalized edema) excessive accumulation of fluid in the interstitial space throughout the body *occurs as a result of conditions such as cardiac, renal, or liver failure sources of fluid intake - ANS-*ingested water = mL *ingested food = 800-1100 mL *metabolic oxidation = 300 mL total daily intake = mL sources of fluid output - ANS-kidneys = 1500 mL insensible loss (skin) = 600-800 mL insensible loss (lungs) = 400-600 mL GI tract = 100 mL total daily output = mL function of aldosterone - ANSfunction of antiduretic hormone - ANSisotonic dehydration - ANS-water and dissolved electrolytes are lost in equal proportions causes of isotonic dehydration - ANS-*inadequate intake of fluids and solutes *fluid shifts between compartments *excessive losses of isotonic body fluids hypertonic dehydration - ANS-water loss exceeds electrolyte loss causes of hypertonic dehydration - ANS-*conditions that increase fluid loss -excessive perspiration -hyperventilation -ketoacidosis -prolonged fever -diarrhea -early-stage kidney disease -diabetes insipidus hypotonic dehydration - ANS-electrolyte loss exceeds water loss causes of hypotonic dehydration - ANS-*chronic illness *excessive fluid replacement (hypotonic) *kidney disease *chronic malnutrition Fluid Volume Deficit: Cardiovascular assessment findings - ANS-* thready, increased pulse rate * decreased BP and orthostatic hypotension * flat neck and hand veins in dependent positions * diminished peripheral pulses * decreased central venous pressure * dysrhythmias Fluid Volume Deficit: Respiratory assessment findings - ANS-* increased rate and depth of respirations * dyspnea Fluid Volume Deficit: Neuromuscular assessment findings - ANS-* decreased central nervous system activity, from lethargy to coma * fever, depending on the amount of fluid loss * skeletal muscle weakness Fluid Volume Deficit: Renal assessment findings - ANS-* decreased urine output Fluid Volume Deficit: Integumentary assessment findings - ANS-* Dry skin * poor turgor, tenting * dry mouth Fluid volume deficit: GI assessment findings - ANS-* decreased motility and diminished bowel sounds *constipation * thirst * decreased body weight fluid volume deficit: laboratory findings - ANS-*increased serum osmolality *increased hematocrit *increased blood urea nitrogen(BUN) level * increased serum sodium level *increased urinary specific gravity fluid volume excess: cardiovascular assessment findings - ANS-*bounding, increased pulse rate *elevated BP *distended neck and hand veins *elevated central venous pressure *dysrhythmias fluid volume excess: respiratory assessment findings - ANS-*increased respiratory rate & shallow respirations *dyspnea *moist crackles fluid volume excess: neuromuscular assessment findings - ANS-*altered level of consciousness *headache *visual disturbances *skeletal muscle weakness *parethesias fluid volume excess: renal assessment findings - ANS-*increased urine output if kidneys can compensate; decreased output if kidney damage is the cause fluid volume excess: integumentary assessment findings - ANS-*pitting edema in dependent areas *pale, cool skin fluid volume excess: GI assessment findings - ANS-*increased motility in the GI tract *diarrhea *increased body weight *liver enlargement *ascites fluid volume excess: laboratory findings - ANS-*decreased serum osmolality *decreased hematocrit *decreased BUN level *decreased serum sodium level *decreased urine specific gravity interventions for fluid volume deficits - ANS-* monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and GI status * prevent further fluid losses and increase fluid compartment volumes to normal ranges *provide oral rehydration therapy if possible and IV fluid replacement if the dehydration is severe; monitor intake and output *generally, isotonic dehydration is treated with isotonic fluid, hypertonic dehydration is treated with hypotonic fluid, and hypotonic dehydration is treated with hypertonic fluid *administer meds as prescribed, such as antidiarrheal, antimicrobial, antiemetic, and antipyretic meds, to correct the cause and treat any symptoms *adminster oxygen as prescribed *monitor electrolyte values and prepare to administer medications to treat an imbalance if one is present causes of isotonic overhydration - ANS-*inadequately controlled IV therapy *kidney disease *long term cortosteroid therapy causes of hypertonic overhydration - ANS-*excessive sodium ingestion *rapid infusion of hypertonic saline *excessive sodium bicarbonate therapy causes of hypotonic overhydration - ANS-*early kidney disease *heart failure *syndrome of inappropriate antidiuretic hormone secretion *inadequately controlled IV therapy *replacement of isotonic fluid loss with hypotonic fluids *irrigation of wounds and body cavities with hypotonic fluids interventions for fluid volume excess - ANS-* monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and GI status * prevent further fluid overload and restore normal fluid balance *administer diuretics: osmotic diuretics typically are prescribed first to prevent severe electrolyte imbalances *restrict fluid and sodium intake as prescribed *monitor intake and output; monitor weight *monitor electrolyte values and prepare to administer medications to treat an imbalance if one is present normal sodium value - 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