UWorld Deck? Flashcards
The nurse is assessing a client with scleroderma. Which of the following findings would be a priority to follow up?
- Abrupt-onset hypertension and headache
- Colour changes on the skin of the fingers
- Dry cough and exertional dyspnea
- Heartburn and difficulty swallowing
- Abrupt-onset hypertension and headache
Scleroderma is an overproduction of collagen that causes tightening and hardening of the skin and connective tissues. The progressive disease has NO CURE, and treatment is aimed at managing complications.
Renal crisis is a life-threatening complication of scleroderma that causes malignant hypertension due to the narrowing of the vessels that provide blood to the kidneys. Early recognition and treatment of renal crisis are needed to prevent acute organ failure and even death.
The nurse is reviewing prescriptions for assigned adult clients. The nurse should question the prescription for:
- 0.45% NaCl for a client with syndrome of inappropriate antidiuretic hormone secretion who has a decreased sodium level
- 0.9% NaCl for a client with GI bleeding who has a decreased Hgb level
- 1000 mL bolus of 0.9% NaCl for a client with septic shock who has an increased WBC count
- LR solution for a client with hypovolemic shock and a thermal burn who has an increased Hct level
Ans: 1
SIADH is a/w increased water reabsorption and excessive intracellular and extracellular fluid (resulting in hypervolemia from fluid retention and dilutional hyponatremia).
In SIADH, the nurse should question a prescription for a hypotonic solution (0.45% NaCl) as it would worsen the fluid and electrolyte imbalance. A prescription for fluid restriction and a HYPERTONIC sol’n (3% NaCl) administered in small quantities would be appropriate to shift fluid back into the vascular compartment and correct hyponatremia
The labour and delivery nurse is receiving report for a pregnant client who is having a scheduled CS birth for placenta accreta. Which information is priority for the nurse to ascertain?
- The client has a history of 3 previous CS births
- The client has a signed consent form for a CS hysterectomy
- The client has removed all metal jewelry and contact lenses
- The client has two 18-g IVs and a blood type and crossmatch
Ans: 4
Placenta accreta - abnormal placental adherence in which the placenta implants directly in the myometrum rather than the endometrium.
- Prenatal US detects prenatal accreta, although detection can rarely occur after birth when the placenta is adherent (ie., retained)
- A CS birth before term gestation at a facility with adequate resources is recommended for clients w/ placenta accreta
- The major complication of this condition is life-threatening hemorrhage, which occurs during attempted placental separation. At least 2 large-bore IVs and a blood type/crossmatch are priority concerns in case blood transfusions are necessary
The nurse is preparing to flush a client’s central venous catheter. Which size syringe is best for the nurse to choose?
- 1 mL
- 3 mL
- 10 mL
- 30 mL
Ans: 3
Flushing the lumen of a CVC w/ NS is recommended to assess patency before medication infusion, prevent medication incompatibilities after infusion, and prevent occlusion after blood sampling.
A 10 mL syringe is generally preferred for flushing the lumen of a CVC. The smaller the syringe, the greater the amount of pressure per square inch exerted during injection, increasing the risk for damage to the CVC
The push-pause method involves slowly injecting NS into the CVC catheter and stopping for any resistance. Injecting against resistance can damage the CVC, which may result in complications including embolism and malfunction.
The nurse is preparing to flush a client’s central venous catheter. Which size syringe is best for the nurse to choose?
- 1 mL
- 3 mL
- 10 mL
- 30 mL
Ans: 3
Flushing the lumen of a CVC w/ NS is recommended to assess patency before medication infusion, prevent medication incompatibilities after infusion, and prevent occlusion after blood sampling.
A 10 mL syringe is generally preferred for flushing the lumen of a CVC. The smaller the syringe, the greater the amount of pressure per square inch exerted during injection, increasing the risk for damage to the CVC
The push-pause method involves slowly injecting NS into the CVC catheter and stopping for any resistance. Injecting against resistance can damage the CVC, which may result in complications including embolism and malfunction.
The nurse is caring for a client who had a gastrojejunostomy and is reporting episodes of nausea, dizziness, and sweating that occur shortly after eating. Which of the following nursing actions should the nurse take?
- Encourage the client to increase consumption of carbohydrates
- Check the client’s BP while lying down and standing
- Recommend that the client consume extra fluids with meals
- Instruct the client to recline for a short time after meals
Ans: 4
Gastrojejunostomy (Billroth II) removes part of the stomach and shortens the upper GI tract. After a partial gastrectomy, many clients experience dumping syndrome which occurs when rapid gastric emptying causes a fluid shift into the small intestine.
Dumping syndrome: dizziness, sweating, nausea, abdominal cramping, tachycardia, and diarrhea shortly after meal consumption
To reduce occurrence of s/s, clients should recline after eating meals to slow the gastric emptying process. An upright/seated position increases the force of gravity, which increases the rate of gastric emptying
