ATI PN Guides d'étude, Notes de cours & Résumés

A nurse is caring for an 82-year-old client in the emergency department who has an oral body temperature of 38.3° C (101° F), a pulse rate of 114/min, and a respiratory rate of 22/min. He is restless and his skin is warm. Which of the following are appropriate nursing interventions for this client? (Select all that apply.) A. Obtain culture specimens before initiating antimicrobials. B. Restrict the client's oral fluid intake. C. Encourage the client to limit activity and rest. D. Allow ...

A nurse is counseling an older adult who describes having difficulty dealing with several issues. Which of the following problems verbalized by the client should the nurse identify as the priority for further assessment and intervention? A. "I spent my whole life dreaming about retirement, and now I wish I had my job back." B. "It's been so stressful for me to have to depend on my son to help around the house." C. "I just heard my friend Al died. That's the third one in 3 months." D....

A nurse is caring for an older adult client who has pneumonia. The client's daughter, who cares for her father at home, says to the nurse, "I'm so glad he is here. You can take much better care of him than I can." Which of the following responses should the nurse make? - ANSWER-It is not easy to care for an older parent A nurse is caring for a client who has a reputation for being demanding of the nursing staff. The nurse says to the charge nurse, "I can't believe I have to care for thi...

Better peripheral perfusion? - ANSWER-Elevate veins, D-Angle Arteries Airborne precautions protective equip - ANSWER-private room, neg pressure with 6-12 air exchanges/hr mask & respirator N95 for TB;measles, chickenpox (varicella) Herpes zoster/shingles TB Droplet precautions - ANSWER-spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia, pertussis, influenza, diptheria, epiglottitis, rubella, mumps, meningitis, mycoplasma or meningeal pneumonia, ade...

A nurse is collecting data for a client who has brittle hair. Which of the following should the nurse determine about the client's nutritional intake? - ANSWER-The client has insufficient protein in their diet (Protein helps promote healthy hair and prevents brittle hair and hair loss) A nurse is caring for client who reports having daily constipatiin. Which of the following information should the nurse provide to the client regarding fiber intake ? (Select all that apply) - ANSWER-Incre...

A nurse is caring for a client who has multiple sclerosis and has a new prescription for baclofen. Which of the following findings indicated to the nurse that the medication is having a therapeutic effect? -decreased muscle spasticity -increased urinary output -increased mental alertness -decreased heart rate - ANSWER--decreased muscle spasticity A nurse is collecting data from a client who is taking ferrous sulfate orally. Which of the following findings reported by the client should ind...

Patient identifiers - ANSWER--Medical record number -home telephone number What lab values should a nurse monitor for a patient with chronic renal failure? - ANSWER-■ Urinalysis Hematuria, proteinuria, and alterations in specific gravity Serum creatinine - Gradual increase of 1 to 2 mg/dL per every 24 to 48 hr for acute renal failure (ARF) - Gradual increase over months to years for chronic renal failure (CRF) exceeding 4 mg/dL ■ Blood urea nitrogen (BUN) - 80 to 100 mg/dL wi...

A nurse is instilling timilol eyedrops for a client who has glaucoma. What action should the nurse take? - ANSWER-The nurse should press the client nasolacrimal after instilling eyedrops Ratiionale: To prevent the medicine from absorbing into systemic circulation Why should the nurse avoid applying pressure to the upper eyelid after instilling eyedrops? - ANSWER-Rationale: It may force the medicine out of the conjunctival sac. Why should the patient avoid blinking their eyes after insti...

Adverse effect of furosemide - ANSWER-Tinnitus, muscle weakness At what age should people start getting occult testing - ANSWER-50, done once yearly Went to receive pneumococcal vaccine? - ANSWER-Around 65 Ear drop administration - ANSWER-lay in a lateral position for at least five minutes after administration Warm the bottle by holding it in the palm for five minutes before administration Manifestations of hypokalemia - ANSWER-Cardiac dysrhythmia, abdominal pain, distention Romb...

Hold medications for tubes if residual is more than - ANSWER-100ml Isotonic IV fluids - ANSWER-*fluid overload *during a surgical procedure *0.9% NS *D5W *lactated ringers Hypotonic IV fluids - ANSWER-*used for cellular dehydration *moves fluid into the cell *0.45% NS Hypertonic IV fluids - ANSWER-*moves fluid into intravascular space *D5W in 0.9% NS *D10W Signs of fluid overload - ANSWER-distended neck veins, edema, sob, crackles, increased BP & Pulse Manifestations ...