UWorld NCLEX Prep WITH ALL CORRECT ANSWERS
when making room assignments, it is important to remember that a client with an active or suspected
... [Show More] infection should not be paired with who Correct Answer: a client who has a fresh surgical wound or is immunocompromised
clients at risk for suicide are least likely to commit the act if: Correct Answer: they articulate long-term personal goals and family milestones
which co-morbidity is the most likely to hinder healing of a fracture Correct Answer: peripheral arterial disease. bone healing depends on multiple factors, including nutrition, adequate circulation and age. without adequate circulation, the bone is not supplied with oxygen
if dislodgement of a chest tube occurs, what do you do? Correct Answer: a sterile occlusive dressing must immediately be placed over the insertion site until the health care provider can assess the client. if a dressing isn't available, the nurse should cover the insertion site with a gloved hand
a client who undergoes percutaneous coronary intervention using femoral approach is at risk for retroperitoneal hemorrhage. What are s/s of bleeding Correct Answer: -hypotension
-back pain
-flank bruising
-diminished distal pulses
what are the two interventions that can reverse an acute sickling response Correct Answer: -adequate hydration (first)
-adequate oxygenation
clients receiving TPN are at risk for what Correct Answer: hyperglycemia
in clients receiving TPN, because they are at risk for hyperglycemia, what s/s should be monitored for Correct Answer: polydipsia, polyuria, headaches, blurred vision
NPH insulin and regular insulin can be safely mixed and administered as a single injection. Which do you draw up first Correct Answer: (RN) regular before NPH. (clear over cloudy) to avoid contaminating the regular insulin with NPH
blood products should not be left at room temperature for how long Correct Answer: greater than 30 minutes before transfusion is started
ACE inhibitors (pril) and angiotensin II receptor blockers (sartan) can be used to manager hypertension; however what can these drugs worsen Correct Answer: Hyperkalemia!
Clients with chronic kidney disease are unable to excrete what Correct Answer: contrast administered for CT scans
how often should an ostomy appliance be changed Correct Answer: every 5-10 days
what proteins would you give a client who has high potassium in end stage renal disease Correct Answer: chicken, turkey, shrimp, tuna, eggs
what gains would you give a client who has high potassium in end stage renal disease Correct Answer: white bread, white pasta, white rice, etc.
tPA must be administered within how much time of onset of symptoms Correct Answer: must be administered within a 3-4.5 hour window from onset of symptoms for full effectiveness
what platelet count determines thrombocytopenia Correct Answer: less than 100,000
what medication has demonstrated the greatest potential to increase lithium concentrations Correct Answer: thiazide diuretics. (also NSAIDS)
what are the first signs of lithium toxicity Correct Answer: nausea, vomiting, diarrhea
what are the later/chronic signs of ltihium toxicity Correct Answer: ataxia, sluggishness, confusion, agitation, tremor
headache is an expected side effect from nitro. what can be used to treat the headache Correct Answer: aspirin or acetaminophen
what might these symptoms indicate: frequent contractions, abdominal pain*, dark red vaginal bleeding+ Correct Answer: placental abruption
in infants and children a heart rate less than or = to 60 with signs of poor perfusion is treated as Correct Answer: pulseless
what manifestations are characteristic of emphysema Correct Answer: -activity intolerance
-barrel chest
-hyperresonance on percussion
what nursing diagnosis is priority for a bipolar client with an episode of acute mania Correct Answer: imbalanced nutrition
dumping syndrome is a complication of the surgically reduced gastric capacity. what do these symptoms include Correct Answer: abdominal pain, sweating, tachy, dizziness, diarrhea
what can the nurse recommend to assist client suffering from dumping syndrome Correct Answer: -small, frequent meals
-foods high in protein and fat
-avoid meals high in carbs
-eat slowly
a risk of a colonoscopy is perforation. what are the s/s of perforation Correct Answer: -rebound tenderness*
-guarding
-rigid abdomen
what types of foods adhere to the diabetic diet Correct Answer: -low-fat
-high fiber
-restricted saturated fats and sodium
refeeding syndrome is a potentially lethal complication of nutritional replenishment. they signs are what Correct Answer: (PPM)
rapid declines in:
-phosphorous
-potassium
-and/or magnesium
what is the normal phosphorus Correct Answer: 2.4-4.4
what is the normal magnesium level Correct Answer: 1.5-2.5
what symptoms are concerning after hiking through tall grass and wooded areas Correct Answer: -flu like symptoms
-bull's eye rash
(indicators of lyme disease)
s/s SIADH Correct Answer: -decrease urine output
-high urine specific gravity
-low serum sodium
-low serum osmolality
graves disease is hypERthyroidism. what is a complication of graves disease Correct Answer: thyroid storm. large amounts of thyroid hormone are released in response to stress
what are indicators of thyroid storm Correct Answer: -altered mentation
-fever
-anxiety
what serum triglyceride level puts a client at risk for metabolic syndrome Correct Answer: >150
when a client has diverticulitis, what complication are we monitoring for Correct Answer: perforation --> peritonitis
what s/s should we be watching for that may indicate peritonitis Correct Answer: progressive pain in other quadrants of the abdomen, rigidity, guarding, rebound tenderness
what is the normal calcium level Correct Answer: 8.6-10.2
what is more reliable of an acute change in nutritional status, pre-albumin or albumin? Correct Answer: pre albumin [Show Less]