The client expresses relief to the nurse after being prescribed a new medication Quizlet

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Explanation 2
Acute gastroenteritis is associated with nausea, vomiting, diarrhea, and dehydration. An isotonic crystalloid intravenous (IV) solution (eg, 0.9% normal saline, lactated Ringer's) has the same tonicity as plasma and when infused remains in the vascular compartment, quickly increasing circulating volume. It is appropriate to correct the extracellular fluid volume deficit (dehydration) in this client.

(Option 1) A hypertonic, rather than isotonic, solution would be infused in clients with ICP. Increasing circulating volume would only further increase ICP.

(Option 3) Isotonic solutions can exacerbate fluid overload in chronic renal failure and increase blood pressure.

(Option 4) Clients with severe hyponatremia and neurologic manifestations need rapid correction of hyponatremia with hypertonic saline (3% saline).

Educational objective:
Depending on the type/tonicity of intravenous (IV) solution infused, fluids can remain in the vascular compartment or can shift from the extracellular to intracellular compartments, and vice versa. The nurse must be able to assess which type of IV fluid is appropriate in relation to a client's diagnosis and condition.

Explanation 3
When providing care for a client prescribed IV PCA, the nurse assesses pain on a regular and as-needed basis. The client's self-report is considered to be the most reliable indicator of pain, so the priority nursing action is to perform a thorough pain assessment to determine the cause of worsening/continuous pain despite the medication. This includes location, quality, radiation, severity, and associated factors (eg, nausea, diaphoresis) for the severe pain. The assessment data will guide the nurse's subsequent interventions (Option 3).

(Option 1) An IV PCA bolus is an extra, as-needed dose of analgesia (eg, 1-2 mg) for increased pain (eg, before a painful procedure) that is prescribed by the HCP when the PCA is initiated. If needed, the nurse programs the pump to deliver the bolus dose because no one but the client is permitted to push the button. However, this is not the priority action.

(Option 2) If the client's attempts are twice the number of doses actually delivered and adequate pain relief is not achieved, the nurse would notify the HCP to request a dose increase or shorter dose interval. However, this is done after the pain assessment.

(Option 4) The client learns how to use the IV PCA pump when it is initiated. The nurse should reassess the client's knowledge level regarding proper use and reinforce previous teaching. However, it is not the priority intervention.

Educational objective:
When providing care for a client prescribed IV PCA, the nurse assesses pain on a regular and as-needed basis, assesses the client's knowledge level regarding its use, and reinforces previous teaching.

Explanation 3
Clients who have undergone surgery (eg, coronary artery bypass graft) may experience some postoperative cognitive dysfunction (POCD). This may include memory impairment and problems with concentration, language comprehension, and social integration. Some clients may cry easily or become teary. The risk for POCD increases with advanced age and in clients with preexisting cognitive deficits, longer operative times, intraoperative complications, and postsurgical infections. POCD can occur days to weeks following surgery. Most symptoms typically resolve after complete healing has occurred. In some cases, this condition can become a permanent disorder (Option 3).

(Option 1) The client will most likely feel better in a few weeks, but this statement is not therapeutic and does not really provide any useful information.

(Option 2) This is good information for the nurse to have, but it does not directly relate to the client's issues of forgetfulness and becoming teary often.

(Option 4) Two weeks postoperative is most likely too early for a diagnosis of depression. Depression can occur after a major illness or surgery, but antidepressants would be considered only for persistent symptoms.

Educational objective:
The nurse should teach the client that possible memory impairment and problems with concentration, language comprehension, social integration, and emotional lability are common following major surgery. Symptoms typically resolve after 4-6 weeks or when healing is complete. Persistent problems should be reported to the health care provider.

Explanation 2,4,5
Incisions may take 4-6 weeks to heal. The nurse should instruct clients on how to care for their incisions; these instructions are as follows:

Wash incisions daily with soap and water in the shower. Gently pat dry (Option 4).
Itching, tingling, and numbness around the incisions may be present for several weeks due to damage to the local nerves (Option 1).
Tub baths should be avoided due to risk of introducing infection (Option 3).
Do not apply powders or lotions on incisions as these trap the bacteria at the incision (Option 3).
Report any redness, swelling, and increase in drainage or if the incision has opened (Option 2).
Wear a supportive elastic hose on the legs. Elevate legs when sitting to decrease swelling (Option 5).
Educational objective:
The nurse should instruct the client with chest and leg incisions from CABG to wash them daily with soap and water in the shower. In addition, the client must be instructed not to apply any powders or lotions to the incisions, to report any redness, swelling or increase in drainage, and to wear an elastic compression hose on the legs.

Explanation 3
Clients facing surgery often have concerns and anxiety over the procedure, postoperative course, outcome, and issues related to altered body image. The best response by the nurse uses 2 therapeutic approaches aimed at reducing the client's concerns and anxiety:

The client is provided with factual information about facial surgery and the healing process.

The client is given assurance and support that something can be done to minimize the complications of wound healing. This will provide the client with a plan of action and a sense of control over the condition and post-surgical course. It is impossible to predict the lasting effect of the surgery on the client's facial appearance; however, teaching on managing wound care will help lessen the client's anxiety.

(Option 1) This is not the best or priority response. Although the HCP will be able to give the client more information and details about the surgery and potential outcomes, the response suggests that the nurse has little or no role in providing information or teaching the client about the upcoming procedure. The response is also a "yes" or "no" question; closed-ended questions tend to minimize nurse-client interactions.

(Option 2) This is a non-therapeutic response; it gives advice to the client, suggests that the nurse "knows better," and minimizes the client's concerns. It also introduces a more serious issue about the diagnosis.

(Option 4) This is a non-therapeutic response. Although it is true that there are methods to conceal scars and other skin discolorations, the response is dismissive and does not address the client's concerns.

Educational objective:
Clients facing surgery often have concerns and anxiety over the procedure, postoperative course, outcome, and altered body image. Providing information about the surgical procedure, healing process, and self-care activities, and giving support will lessen anxiety and give the client a sense of control.

Which client is at greatest risk for the development of hospital-acquired pressure ulcers (HAPUs)?

1. 25-year-old quadriplegic client with urosepsis, temperature of 101 F (38.3 C), and white blood cell (WBC) count of 18,000 µL
2. 50-year-old client with AIDS, weight loss of 20 lb (9 kg) in a month, prealbumin level <10 mg/dL, mean arterial blood pressure of 50 mm Hg, and receiving Levophed infusion
3. 80-year-old client 2 days postoperative from hip replacement, with dementia, two Jackson-Pratt drains, and hemoglobin level of 14 g/dL
4. 85-year-old client 2 days postoperative from open cholecystectomy

Explanation:2
Pressure ulcers are areas of localized injury of skin and underlying tissue caused by external pressure with or without friction and/or shearing. They result from ischemia and hypoxia of tissue following periods of prolonged pressure. Clients at greatest risk include older adults with limited movement and fractured hips, those with quadriplegia, and the critically ill. Clients with deficits in mobility and activity, incontinence, inadequate nutrition, chronic illness, renal failure, anemia, problems with oxygenation, edema, and infection are also at increased risk.

Client 2 has 5 risk factors: chronic illness and immune deficiency disease; significant weight loss; prealbumin <16 g/dL indicating inadequate nutrition and protein deficiency; hypotension (decreases perfusion pressure); and receiving Levophed (norepinephrine), a vasoconstrictor. These risks affect circulation, capillary perfusion pressure, and ability to provide adequate nutrition to the cells.

(Option 1) This client has 4 risk factors: a deficit in independent mobility and activity, spinal cord injury with quadriplegia, decreased sensation, and fever and infection.

(Option 3) This client has 3 risk factors: advanced age, surgery, and dementia. Hemoglobin is within the normal range.

(Option 4) This client has 2 risk factors: advanced age and surgery. Surgery can be associated with deep-tissue injury (DTI) ulcers. Positioning and immobility during the surgical procedures (>2½ hours) and receiving anesthetic and vasoactive drugs (to treat hypotension) present a special risk for the development of DTI in postoperative clients.

Educational objective:
Although pressure ulcers can develop in any client with limited mobility and activity, those at most risk include older adults; those with quadriplegia; the critically ill; and those with fracture of a long bone (hip, femur), anemia, nutritional deficits, incontinence, chronic illness, renal failure, problems with oxygenation and circulation, infection, or fever.

1,3,4 Explanation
The nurse needs to consider several factors when selecting teaching strategies; these include client characteristics (eg, age, educational background, language skills, culture), subject matter, and available resources. Learning can be improved as follows:

Using pictures and simplified text is beneficial to the older adult with low literacy.
Including a family member in the teaching process will assist the client in reinforcement of the material at a later date.
Professionally produced programs are beneficial as they contain high quality visual content as well a delivery of auditory content in lay person's language.
(Option 2) Older adults are using the internet in increasing numbers as are clients with low literacy. Several organizations are developing and promoting user-friendly websites. Society in general relies heavily on web-based health information. It is important for the nurse to teach the client and possibly supply a list of reputable sites for the client to view.

(Option 5) Unless the client is hard of hearing, speaking slowly and loudly is unnecessary and demeaning.

Educational objective:
For a client with low literacy, the nurse should use multiple teaching strategies including professionally produced educational programs, pictures with simplified text, and inclusion of a family member during teaching sessions.

Explanation 4
Individuals who practice Orthodox Judaism follow Kosher laws. These regulations are strict regarding the use of certain animal products (eg, no pork, shellfish, fish without scales) and the separation of meat/poultry from dairy. When meat or poultry is consumed, at least 3-6 hours must pass before a dairy product can be consumed. Certain foods, including fresh fruits and vegetables, grains, tea, and coffee, are considered neutral and can be consumed at any time. Pita chips and hummus are non-dairy foods and would be an appropriate snack. This choice also provides a combination of carbohydrates and protein, which will help in regulating blood glucose.

(Option 1) This choice would be allowable under Kosher rules; however, it is not the best choice for a client with diabetes due to the high carbohydrate content.

(Option 2) Low-fat cheese is a dairy product and cannot be consumed within 3-6 hours of a meat/poultry meal.

(Option 3) Yogurt is a dairy food and would not be an appropriate choice for a 2:00 PM snack.

Educational objective:
Clients of the Orthodox Jewish faith follow Kosher rules. These include no pork, shellfish, or fish without scales. When meat or poultry is consumed, at least 3-6 hours must pass before a dairy product can be consumed.

Explanation 3
It is not unusual for parents to feel devastated after learning that their child has a chronic illness, such as diabetes. Reactions include shock, denial, helplessness, anger, fear, and anxiety. They may question, "Why did this happen to my child?" or have feelings of guilt that they somehow contributed to or failed to prevent the development of the disease. The parents' emotional response, adaptation, and coping strategies will greatly impact the child's perception of self and the ability to self-manage the disease.

In providing diabetes education to the family and the child, the RN needs to emphasize and reinforce that with planning and preparation, diabetes can be managed and controlled, regular day-to-day activities can be resumed, and the child can have a normal life.

When the parents perceive themselves and their child as being in control rather than victimized and dependent, it increases the likelihood that they will be actively engaged in diabetes self-management activities.

(Option 1) This is not a true statement. Clients with diabetes can participate in a wide variety of sports.

(Option 2) The diagnosis and management of diabetes in a child will affect the whole family. However, parents and siblings should be able to lead a normal life. The use of the word "sacrifice" suggests that the parent is feeling victimized by the disease.

(Option 4) Nutritional management of diabetes does not require special foods. Clients need to learn to balance food choices with medications and exercise for blood sugar control. Nutrition education should emphasize healthy food choices for the client and the family.

Educational objective:
The diagnosis of a chronic illness, such as diabetes, in a child will have an impact on the entire family. When the parents see themselves and their child as capable of being independent and in control of the condition, there is an increased likelihood that the disease will be better managed and controlled.

Explanation 3
The electronic record is a legal document and should contain factual, descriptive, objective information that the nurse sees, feels, hears, and smells. It should be the result of direct observation and measurement. "Inspiratory wheezes heard in bilateral lung fields" best fits these criteria. The nurse should avoid vague terms such as "appears," "seems," and "normal." These words suggest that the nurse is stating an opinion and do not accurately communicate facts or provide information on behaviors exhibited by the client. The nurse should provide exact measurements, establish accuracy, and not provide opinions or assumptions.

(Option 1) The nurse should not use the word "appears" as it is too vague. "Eyes closed" is a factual observation. A more accurate entry would be, "Client lying in bed with eyes closed. Respirations even and unlabored."

(Option 2) It is a good practice to document client quotes. However, in this case, the nurse should have elicited more information from the client, such as a pain scale, and then documented the analgesic the client was given.

(Option 4) This documentation would be more descriptive if it listed how much urine, its color and clarity, and if an odor was present.

Educational objective:
Nursing documentation should be factual, descriptive, and contain objective information that the nurse sees, hears, feels, or smells. It must include direct observation and measurement.

1,2,3 Explanation
The incidence of cervical cancer is higher among Hispanics, American Indians, and African Americans. The mortality rate for cervical cancer among African American women is twice as high as that for white American women (Option 1).

African Americans have the highest incidence of hypertension in the world, and this condition is more prevalent among the women than men in this ethnic group. The mortality rate for hypertension among African American women is higher than that for white American women (Option 2).

African Americans have a higher incidence of ischemic stroke than whites or Hispanics. Risk factors for stroke are related to an increased rate of hypertension, diabetes mellitus, and sickle cell anemia (Option 3).

(Option 4) White and Asian women have a higher incidence of osteoporosis than African Americans, but the disease affects all ethnic groups.

(Option 5) Melanoma of the skin is more common in people who are of white ancestry, light-skinned, and over age 60 with frequent sun exposure. The incidence of melanoma is 10 times higher in white Americans than African Americans.

Educational objective:
African Americans have the highest incidence of hypertension in the world as well as increased incidence of stroke and cervical cancer. Whites have a high incidence of osteoporosis and skin cancer (melanoma).

Explanation 4
Constipation may develop as a side effect of anesthesia, pain medication, physiological stress, and/or immobility. The nurse's first priority is to assess the client. The nurse can administer the as-needed laxative once it has been determined to be safe. The HCP is contacted if the focused abdominal assessment indicates a potential complication, such as postoperative ileus.

(Option 1) The nurse's first priority is assessment. A laxative would not help if this client had intestinal obstruction (from adhesions).

(Option 2) The client is taught to eat a high-fiber diet and increase fluid intake to promote normal bowel function. The nurse would not change the diet until further assessment of the client is accomplished and the HCP has prescribed a new diet.

(Option 3) The nurse should further assess the client before contacting the HCP.

Educational objective:
Constipation may be a side effect of anesthesia, pain medication, physiological stress, and/or immobility. The nurse's first priority is to assess the client and then use measures that promote normal bowel function (eg, as-needed laxatives, stool softeners, bulk agents, high-fiber diet, increased fluids).

Explanation: 4
Therapeutic communication is used to establish trust, encourage communication, and display respect for the client. Empathizing with the client's feelings conveys concern and understanding on the part of the nurse and helps establish a therapeutic dialogue. It can be helpful to offer a "blameless apology," in which the nurse apologizes for the problem (eg, long wait) without taking personal responsibility for causing it. This technique can be helpful for diffusing negative emotions as clients feel acknowledged for the "wrong" they believe they have endured (Option 4).

(Option 1) Security may be called if the client appears to be losing control or is a risk to self or others. However, initially calling security or using an authoritative approach may further escalate the situation and does not address the client's concern. The nurse should initially try to diffuse the situation and the client's anger.

(Option 2) Although sharing an observation is therapeutic, attempting to change the subject will only further infuriate the client. Clients want their feelings to be recognized and validated.

(Option 3) A defensive response may communicate that the client's feelings are wrong or lack importance. In this example, the client knows that the HCPs are qualified; stating this information is defensive and ignores the client's concern.

Educational objective:
When a client is angry and upset, therapeutic communication skills such as acknowledging the feeling, empathy, active listening, and offering a blameless apology may help deescalate the situation. The nurse should not initially ignore the client or use threats, authoritative rules, or aggressive behaviors.