Physiological Integrity

1960 soru

Soru 981Soru →

A client has just returned to the medical-surgical unit after undergoing a percutaneous liver biopsy. To minimize the risk of post-procedure hemorrhage, which of the following positions should the nurse assist the client into?

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Cevap: Right side-lying position

Cevap

Right side-lying position
The correct answer involves placing the client on their right side. Because the liver is a highly vascular organ situated in the right upper quadrant, a percutaneous biopsy carries a significant risk of hemorrhage. The right side-lying position uses the client's body weight against the mattress to apply direct, continuous pressure to the biopsy site, which promotes hemostasis and minimizes the risk of bleeding.

Adım Adım Çözüm

1
Identify the procedure performed and its primary complication.
The client had a percutaneous liver biopsy. The liver is a highly vascular organ, making hemorrhage the primary post-procedure risk.
Recognizing the major risk associated with an invasive procedure dictates the immediate nursing interventions required for client safety.
2
Determine the anatomical location of the liver.
The liver is located in the right upper quadrant of the abdomen.
Understanding anatomy is necessary to apply targeted interventions, such as localized pressure.
3
Select the position that best mitigates the identified risk based on anatomy.
Positioning the client on their right side utilizes the bed and the client's own body weight to compress the liver against the abdominal wall.
Direct pressure promotes hemostasis and reduces the potential for bleeding.

Anahtar Kavram

Applying physiological principles and anatomical knowledge to reduce post-procedural risks, specifically hemorrhage after a liver biopsy.
Soru 982Soru →

A nurse is developing a post-procedure plan of care for a 54-year-old client who has just returned to the medical-surgical unit following a flexible bronchoscopy with a transbronchial biopsy under conscious sedation. Which of the following nursing actions should be included to reduce the risk of potential complications? Select all that apply.

Geçerli olan tümünü seçin

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Cevap: Assess for the return of the gag and swallow reflexes prior to offering any oral fluids or ice chips.; Auscultate bilateral lung fields to monitor for diminished or asymmetrical breath sounds.; Notify the healthcare provider immediately if the client begins expectorating frank, bright red blood.

Cevap

The correct actions are assessing for the return of the gag reflex before allowing oral intake, auscultating bilateral lung fields for breath sounds, and notifying the provider immediately if frank, bright red blood is expectorated.
Following a transbronchial biopsy under conscious sedation, the client is highly vulnerable to airway compromise and physiological decompensation. Assessing the gag reflex directly prevents aspiration of fluids into the lungs. Auscultating breath sounds is a critical assessment for detecting a pneumothorax, a known complication of lung biopsy. While blood-streaked sputum is a normal finding after tissue removal, expectorating frank, bright red blood indicates an active hemorrhage and requires immediate provider notification.

Adım Adım Çözüm

1
Identify the procedure and its specific physiological risks.
The client had a bronchoscopy with a transbronchial biopsy under conscious sedation. Primary risks include aspiration (due to topical airway anesthesia), pneumothorax (due to lung tissue biopsy), hemorrhage (from the biopsy site), and respiratory depression (from sedation).
Understanding the exact mechanism of the procedure dictates the prioritized nursing assessments.
2
Evaluate the interventions aimed at airway and breathing protection.
Checking the gag reflex before giving fluids directly prevents aspiration. Auscultating lung sounds allows the nurse to detect a pneumothorax early (indicated by diminished or absent sounds on the affected side).
Airway and breathing are always the highest priority in post-sedation and airway-invasive procedures.
3
Differentiate between expected post-procedure findings and dangerous complications regarding bleeding.
Blood-streaked or pink-tinged sputum is normal as the biopsy site heals. However, frank, bright red blood indicates an uncontrolled hemorrhage and requires immediate intervention.
Nurses must be able to recognize when a symptom crosses the line from an expected side effect to an adverse event.
4
Identify the contraindicated actions in the distractors.
Supine positioning increases aspiration risk. Initial assessments on unstable/post-op clients cannot be delegated to UAPs. Mild respiratory acidosis from sedation is treated with respiratory stimulation (deep breathing), not chemical buffering like sodium bicarbonate.
Applying safe delegation, proper positioning, and accurate lab interpretation are core risk reduction strategies.

Anahtar Kavram

Post-bronchoscopy complication management focuses on preventing aspiration (checking gag reflex, proper positioning), detecting pneumothorax (auscultating lungs), monitoring for hemorrhage (differentiating frank blood from expected blood-tinged sputum), and managing expected transient sedation effects safely.
Soru 983Soru →

A client with an established gastrostomy tube is scheduled to receive an intermittent bolus feeding. Arrange the following nursing actions in the correct sequential order from first to last.

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Cevap

The correct sequence begins with elevating the head of the bed, followed by checking placement and residual, flushing the tube, administering the formula, and finally flushing the tube again before clamping.
Safe enteral feeding requires a logical progression that prioritizes airway protection (elevating the head of the bed), followed by clinical assessment (verifying placement and residuals), preparation (initial flush), execution (administering formula), and maintenance (final flush).

Adım Adım Çözüm

1
Elevate the head of the bed
Client is positioned safely at 30 to 45 degrees.
This utilizes gravity to keep formula in the stomach and significantly reduces the risk of pulmonary aspiration.
2
Check placement and residual volume
Tube location is confirmed and digestion is assessed.
Ensures the feeding will go into the gastrointestinal tract and that the client is absorbing previous intake appropriately.
3
Administer the initial water flush
Tube patency is verified.
Clears the tube and confirms that fluids flow easily without resistance.
4
Instill the feeding formula
Client receives prescribed nutrition.
Provides the required enteral nutrition safely by gravity.
5
Administer the final water flush and clamp
The tube is cleared and secured.
Prevents formula from congealing and occluding the tube, maintaining long-term patency.

Anahtar Kavram

Safe administration sequence for enteral tube feedings
Soru 984Soru →

A 70-year-old client with a history of severe chronic obstructive pulmonary disease (COPD) is hospitalized for treatment of a left lower extremity deep vein thrombosis. The client suddenly develops sharp, pleuritic chest pain, severe dyspnea, and profound apprehension.

Current Assessment and Laboratory Data:
- Vital Signs: BP 94/60 mmHg (baseline 135/82), HR 122 bpm, RR 32/min, Temperature 98.9°F (37.2°C).
- SpO2: 84% on 2 L/min oxygen via nasal cannula.
- Skin: Pale, diaphoretic, with circumoral cyanosis.
- Arterial Blood Gas (ABG):
- pH: 7.54
- PaCO2: 28 mmHg (baseline 55 mmHg)
- HCO3-: 26 mEq/L
- PaO2: 52 mmHg

The nurse suspects an acute pulmonary embolism. To reduce the client's risk for immediate cardiopulmonary collapse, which of the following is the most critical initial action?

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Cevap: Increase oxygen delivery to 15 L/min via a non-rebreather mask and immediately activate the rapid response team.

Cevap

Increase oxygen delivery to 15 L/min via a non-rebreather mask and immediately activate the rapid response team.
The client is exhibiting classic signs of an acute pulmonary embolism leading to early obstructive shock and severe hypoxemia. Despite the client's history of COPD, where high-flow oxygen is typically used with caution, acute life-threatening hypoxemia (PaO2 52 mmHg, SpO2 84%) mandates immediate administration of 100% oxygen via a non-rebreather mask. The risk of cardiac arrest from profound hypoxemia far outweighs the theoretical risk of suppressing the hypoxic drive. The rapid response team must be activated immediately to manage the impending cardiopulmonary collapse.

Adım Adım Çözüm

1
Analyze the client's clinical presentation and vital signs.
The client exhibits sudden severe dyspnea, pleuritic chest pain, hypoxia, tachycardia, and hypotension following a DVT, which strongly indicates a pulmonary embolism.
Identifying the underlying medical emergency is essential to determine the priority intervention.
2
Interpret the Arterial Blood Gas (ABG) results.
The ABG shows uncompensated respiratory alkalosis (high pH, low PaCO2) and severe hypoxemia (PaO2 52 mmHg).
This confirms that the client is hyperventilating to compensate for the profound lack of oxygen, ruling out a standard COPD exacerbation (which would present with respiratory acidosis).
3
Determine the highest priority intervention to reduce physiological risk.
Administering high-flow oxygen and calling for emergency assistance is the absolute priority.
Airway and Breathing take precedence. Severe hypoxemia will quickly lead to cardiopulmonary arrest. The theoretical risk of suppressing the hypoxic drive in COPD is superseded by the immediate need to treat lethal hypoxemia.

Anahtar Kavram

Prioritization in Pulmonary Embolism and Acute Hypoxemia
Soru 985Soru →

A nurse is caring for a critically ill client who has a double-lumen peripherally inserted central catheter (PICC). Lumen 1 is infusing continuous norepinephrine, and Lumen 2 is infusing 0.9% sodium chloride at a keep-vein-open rate. The healthcare provider prescribes a continuous infusion of pantoprazole, an intermittent IV piggyback of vancomycin, and a STAT dose of IV push furosemide 40 mg40\text{ mg}. The client's total urine output over the past 2 hours is 25 mL25\text{ mL}. Which of the following nursing actions are appropriate? Select all that apply.

Geçerli olan tümünü seçin

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Cevap: Withhold the vancomycin dose and notify the healthcare provider of the recent urine output.; Flush the designated IV line with 0.9% sodium chloride before and after the furosemide administration.; Administer the 40 mg40\text{ mg} dose of IV push furosemide over a period of at least 2 minutes.

Cevap

The appropriate actions are withholding the vancomycin due to oliguria, flushing the IV line before and after furosemide administration, and pushing the furosemide over at least 2 minutes.
Safe administration of high-risk parenteral therapies requires analyzing multiple client factors simultaneously. Vancomycin is highly nephrotoxic; the client's severe oliguria (12.5 mL/hr12.5\text{ mL/hr}) strongly indicates acute kidney injury, necessitating holding the drug and notifying the provider to prevent irreversible renal failure. Flushing the line before and after furosemide prevents precipitation, as furosemide is chemically incompatible with many medications. Furosemide must be administered no faster than 20 mg/min20\text{ mg/min} to prevent permanent ototoxicity; therefore, a 40 mg40\text{ mg} dose requires at least 2 minutes.

Adım Adım Çözüm

1
Analyze the client's clinical data against the prescribed medications.
The client has a urine output of 12.5 mL/hr12.5\text{ mL/hr}, indicating oliguria.
Recognizing oliguria is critical because vancomycin is nephrotoxic and requires dosage adjustment or holding in the presence of acute kidney injury.
2
Evaluate the safety parameters for administering IV push furosemide.
Furosemide must be pushed slowly (20 mg/min20\text{ mg/min}) and requires a cleared IV line.
Rapid administration causes ototoxicity. Furosemide is notoriously incompatible with other drugs, requiring thorough saline flushes before and after.
3
Determine the safety of using the norepinephrine line for other medications.
The norepinephrine line cannot be used for IV pushes, and pantoprazole cannot be empirically Y-sited with it.
Pushing meds through a pressor line delivers a lethal bolus of the pressor. Pantoprazole is incompatible with norepinephrine.
4
Evaluate the standard administration rate for vancomycin.
Vancomycin cannot be administered in 30 minutes.
Rapid infusion of vancomycin causes profound histamine release (vancomycin infusion reaction), requiring a minimum 60-minute infusion time.

Anahtar Kavram

Complex multi-medication parenteral therapy requires synthesis of pharmacokinetics (nephrotoxicity, ototoxicity), safe administration rates (preventing infusion reactions), and physical IV line dynamics (preventing pressor bolusing and chemical precipitation).
Soru 986Soru →

A client recovering from a cluster of generalized tonic-clonic seizures has a single 20-gauge peripheral intravenous (IV) catheter in the right forearm. A continuous maintenance infusion of 5% dextrose in 0.45% sodium chloride is currently infusing at 100 mL/hr. The healthcare provider prescribes a loading dose of IV phenytoin to be administered immediately to prevent further seizure activity. Which action is the most appropriate for the nurse to implement?

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Cevap: Stop the primary infusion, flush the catheter with 0.9% sodium chloride, administer the medication slowly, and flush again with 0.9% sodium chloride.

Cevap

The nurse must stop the primary dextrose infusion, flush the IV line with 0.9% sodium chloride (normal saline), administer the phenytoin slowly, and flush again with normal saline before restarting the maintenance fluids.
Phenytoin is highly incompatible with any solution containing dextrose. When mixed, it forms a solid precipitate that can occlude the IV catheter or cause a fatal embolism if it enters the bloodstream. Because the client only has one IV line and the medication is urgently needed, the safest approach is to temporarily stop the dextrose infusion, flush the line thoroughly with 0.9% sodium chloride (normal saline), administer the phenytoin safely (not exceeding 50 mg/min), and flush the line again with normal saline before restarting the primary maintenance fluid.

Adım Adım Çözüm

1
Analyze the prescribed medication and the current IV fluids.
The prescribed medication is phenytoin. The current infusing fluid contains 5% dextrose.
Identifying the components of parenteral therapies is the first step in determining IV compatibility.
2
Recall the pharmacological properties and safety parameters of intravenous phenytoin.
Phenytoin is highly alkaline and precipitates instantly when mixed with dextrose solutions. Furthermore, it carries a strict cardiovascular safety limit (maximum administration rate of 50 mg/min).
Understanding drug-specific risks prevents life-threatening complications such as medication embolism or cardiac arrest.
3
Determine the safest method to administer the medication through the existing single peripheral line.
The nurse must pause the incompatible fluid, clear the line with a compatible flush (0.9% sodium chloride), administer the drug at a safe rate, and clear the line again before resuming the primary fluid.
This sequence ensures the phenytoin reaches the systemic circulation without crystallizing in the tubing and without requiring a delay to place a second IV line.

Anahtar Kavram

Intravenous Phenytoin Administration Safety and Compatibility
Soru 987Soru →

A client is being monitored on the medical-surgical unit for severe bilateral pneumonia. The most recent arterial blood gas (ABG) results show a pH of 7.31, PaCO2 of 56 mm Hg, and HCO3- of 24 mEq/L. Which of the following assessment findings correlate with this acid-base imbalance? Select all that apply.

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Cevap: Lethargy; Headache; Restlessness

Cevap

The correct findings associated with uncompensated respiratory acidosis include lethargy, headache, and restlessness.
The arterial blood gas results demonstrate uncompensated respiratory acidosis. Elevated PaCO2 levels cause cerebral vasodilation and central nervous system depression. This physiological adaptation directly leads to clinical findings such as headache, lethargy, and restlessness.

Adım Adım Çözüm

1
Analyze the arterial blood gas (ABG) results.
The pH is 7.31 (acidosis), PaCO2 is 56 mm Hg (elevated, indicating a respiratory cause), and HCO3- is 24 mEq/L (normal, indicating lack of metabolic compensation).
Correctly identifying the acid-base imbalance is necessary to determine the expected physiological manifestations.
2
Identify the primary acid-base disorder.
The client has uncompensated respiratory acidosis.
The low pH combined with a high PaCO2 confirms a respiratory origin for the acidosis.
3
Correlate the acid-base disorder with clinical manifestations.
Respiratory acidosis is characterized by neurological depression, cerebral vasodilation (headache), and signs of hypoxia (restlessness, lethargy).
Elevated carbon dioxide levels directly affect the central nervous system and cerebral blood flow.

Anahtar Kavram

Respiratory Acidosis Clinical Manifestations
Soru 988Soru →

The nursing team is providing morning hygiene care for a client who recently sustained a right-sided cerebrovascular accident (CVA). The client presents with left-sided hemiplegia and left homonymous hemianopsia, and is receiving continuous enteral nutrition via a nasogastric (NG) tube. The registered nurse (RN) is providing specific parameters to the unlicensed assistive personnel (UAP) regarding the care routine. Which directive from the RN represents the safest and most comprehensive approach to this client's basic care and comfort?

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Cevap: Maintain the head of the bed at a 30- to 45-degree angle during oral hygiene, and approach the client from their right side to explain the procedure before touching them.

Cevap

Maintain the head of the bed at a 30- to 45-degree angle during oral hygiene, and approach the client from their right side to explain the procedure before touching them.
The correct answer properly addresses both the risk of aspiration and the client's sensory deficit. Continuous enteral nutrition requires keeping the head of the bed elevated at 30 to 45 degrees to prevent aspiration, even during oral hygiene. Additionally, because a right-sided CVA causes left homonymous hemianopsia (blindness in the left half of both visual fields), approaching the client from their intact right side prevents startling them and promotes psychological comfort.

Adım Adım Çözüm

1
Analyze the client's clinical presentation and care requirements.
The client has a right-sided CVA (causing left hemiplegia and left visual field deficit) and is on continuous enteral feeds.
Identifying all deficits and treatments is required to plan safe, individualized basic care.
2
Determine the necessary safety precautions for continuous enteral nutrition.
The head of the bed must remain elevated at 30 to 45 degrees at all times, including during hygiene care, unless the feeding is explicitly paused.
Keeping the head of the bed elevated utilizes gravity to prevent gastric reflux and fatal pulmonary aspiration.
3
Determine the appropriate comfort and communication approach for homonymous hemianopsia.
Caregivers must approach and interact with the client from the unaffected side (the right side, in this case).
Approaching from the blind visual field causes startling and anxiety, decreasing the client's sense of comfort and safety.

Anahtar Kavram

Basic care modifications for neurological deficits and continuous enteral nutrition
Soru 989Soru →

An adult client requires a morning dose of both short-acting (regular) and intermediate-acting (NPH) insulin. The nurse is drawing up both medications into a single syringe. Place the steps of this preparation process in the correct chronological sequence.

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Cevap

The correct chronological sequence is to roll the NPH insulin vial, inject air into the NPH vial, inject air into the regular insulin vial, withdraw the regular insulin, and finally withdraw the NPH insulin.
The standard sequence for mixing insulins ensures the safety and purity of the short-acting medication. By injecting air into the NPH first, then air into the regular, the nurse can draw up the regular insulin ('clear') before the NPH insulin ('cloudy'). This universally accepted 'clear before cloudy' principle prevents the NPH insulin from inadvertently altering the rapid-acting profile of the regular insulin vial.

Adım Adım Çözüm

1
Roll the NPH insulin vial between the palms.
The cloudy suspension is mixed evenly.
Rolling prevents the formation of air bubbles that can occur if the vial is shaken, ensuring an accurate dose.
2
Inject air into the NPH insulin vial and withdraw the needle.
The vial is pressurized without withdrawing any medication.
Injecting air first equalizes pressure and prevents regular insulin from being pushed into the NPH vial later.
3
Inject air into the regular insulin vial and leave the needle inserted.
The clear insulin vial is pressurized and ready for withdrawal.
This sets up the syringe to immediately draw the regular insulin.
4
Withdraw the exact dose of regular insulin.
The clear insulin is safely inside the syringe.
Drawing the clear (regular) insulin first guarantees that it will not be contaminated by the cloudy (NPH) insulin.
5
Insert the needle back into the NPH vial and withdraw the exact dose.
The combined insulin dose is ready for administration.
This completes the mixture. Care must be taken not to push any regular insulin into the NPH vial during this step.

Anahtar Kavram

Insulin Mixing Procedure (Clear before Cloudy)
Tahmini Süre:45s
Soru 990Soru →

A nurse is caring for an adult client who is post-operative day one following a right total hip arthroplasty. The client is receiving a continuous intravenous (IV) infusion of 0.9%0.9\% sodium chloride. The provider has prescribed several new oral and intravenous medications. Which of the following nursing actions demonstrate safe pharmacological and parenteral therapy practices? Select all that apply.

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Cevap: Stopping the primary continuous infusion and flushing the line with normal saline before and after administering an incompatible secondary antibiotic.; Scrubbing the needleless connector hub with an approved antiseptic swab with friction prior to attaching a medication syringe.; Verifying the client's identity using two acceptable identifiers and scanning the medication barcode prior to administration.

Cevap

The correct actions are stopping the primary infusion and flushing before and after incompatible antibiotics, scrubbing the needleless hub prior to access, and verifying client identity with two identifiers alongside barcode scanning.
Safe pharmacological administration requires strict adherence to infection control (scrubbing the hub), the rights of medication administration (using two patient identifiers and scanning barcodes), and proper intravenous line management (flushing lines before and after incompatible medications to prevent precipitation).

Adım Adım Çözüm

1
Evaluate the medication administration steps for adherence to the rights of medication administration and infection control.
Identifying the patient with two identifiers and scrubbing the hub with friction are standard, mandatory safety protocols.
These actions prevent critical medication errors and healthcare-associated infections.
2
Analyze the management of intravenous lines when multiple medications are involved.
Administering incompatible medications requires stopping the primary infusion and flushing the line thoroughly between medications. Compatibility must always be checked.
Mixing incompatible medications can cause crystallization or precipitation in the IV line, leading to catheter occlusion or systemic emboli.
3
Assess the clinical context (total hip arthroplasty) and mathematical principles for safe administration.
Positioning the client with hips flexed past 90 degrees violates post-operative hip precautions. Converting pounds to kilograms requires division, not multiplication.
Flexing the hip past 90 degrees can dislocate the new prosthesis. Multiplying pounds by 2.2 leads to a dangerous medication overdose.

Anahtar Kavram

Safe Pharmacological and Parenteral Therapies
Soru 991Soru →

An oncology registered nurse is preparing to obtain a blood specimen from a client's implanted venous access port. The nurse has gathered all necessary supplies. Arrange the following steps for accessing the port and drawing the blood specimen in the correct chronological sequence.

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Cevap

The correct sequence is: apply sterile PPE, cleanse the port site, access the port with a non-coring needle, discard the initial 5 mL of blood waste, withdraw the required sample, and finally flush the port with saline and heparin.
Accessing an implanted venous access port requires precise chronological execution of parenteral safety standards. The nurse must first ensure strict asepsis by donning a mask and sterile gloves, followed by vigorously cleansing the site with chlorhexidine and allowing it to completely air dry. Next, the port is accessed using a non-coring (Huber) needle to prevent damage to the septum. Before the actual laboratory sample is collected, the nurse must aspirate and discard approximately 5 mL of blood; this clears the catheter of the heparin or saline locking solution that would otherwise contaminate the specimen. After the correct sample volume is obtained in a new syringe, the port must be flushed with a minimum of 10 to 20 mL of 0.9% sodium chloride to clear any remaining blood and prevent catheter occlusion, followed by a heparin flush to maintain patency if the port is being de-accessed or locked.

Adım Adım Çözüm

1
Establish a sterile field and prepare the insertion site.
The nurse dons sterile PPE and cleanses the area with chlorhexidine.
Implanted ports are central venous access devices; accessing them requires strict asepsis to prevent life-threatening infections.
2
Access the implanted port.
A non-coring needle is inserted through the skin into the port's septum.
Using a non-coring needle prevents mechanical damage to the port's silicone seal, ensuring its longevity.
3
Clear the line of previous locking solutions.
The nurse aspirates and discards the first 5 mL of blood.
Failing to discard this initial volume will result in a specimen diluted with saline or contaminated with heparin, causing inaccurate lab values.
4
Collect the specimen and secure the line.
The diagnostic sample is drawn, and the line is flushed with saline and heparin.
Vigorous saline flushing removes residual red blood cells from the catheter, and heparin prevents clot formation within the lumen.

Anahtar Kavram

Implanted Venous Access Port Management and Blood Sampling
Tahmini Süre:1m 30s
Soru 992Soru →

A nurse is developing a plan of care for a 62-year-old client who has just been admitted to the telemetry unit following a left-sided cardiac catheterization via the femoral approach. The client has a documented history of severe chronic obstructive pulmonary disease (COPD). Which of the following nursing actions are appropriate to reduce the risk of potential complications? (Select all that apply)

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Cevap: Compare the quality of the left pedal pulse to the right and monitor the groin insertion site for swelling.; Maintain the client on strict bed rest with the left leg extended and immobilized for the prescribed duration.; Instruct the client to apply firm manual pressure over the left groin insertion site when coughing or sneezing.

Cevap

The correct nursing actions to reduce complications include comparing bilateral pedal pulses while monitoring for swelling, maintaining the affected leg straight and immobilized, and instructing the client to apply pressure to the groin site when coughing.
Following a femoral cardiac catheterization, the highest priority is preventing arterial hemorrhage and maintaining distal tissue perfusion. Comparing pedal pulses and monitoring the site ensures early detection of neurovascular compromise or hematoma. Keeping the leg extended and immobilized prevents mechanical disruption of the arterial clot. Finally, instructing the client to apply manual pressure when coughing provides necessary counter-pressure to prevent bleeding caused by sudden spikes in intra-abdominal pressure.

Adım Adım Çözüm

1
Identify the primary physiological risks associated with a femoral approach cardiac catheterization.
The client is at high risk for arterial bleeding, hematoma formation, retroperitoneal hemorrhage, and peripheral neurovascular compromise.
The femoral artery is a large, high-pressure vessel; preventing clot disruption is paramount immediately post-procedure.
2
Determine the appropriate physical positioning and client education to mitigate these bleeding risks.
The affected leg must remain extended and immobilized, the head of the bed should be kept at 30 degrees or flatter, and the client must apply manual counter-pressure during Valsalva maneuvers like coughing.
Bending the leg or raising the head of the bed sharply increases mechanical stress on the arterial puncture site.
3
Evaluate the client's comorbidity (COPD) against the post-procedure restrictions.
While clients with severe COPD typically benefit from a high Fowler's position, doing so post-cardiac catheterization is contraindicated. Additionally, a compensated ABG showing elevated PaCO2 and a normal pH is expected, not an acute crisis.
Routine interventions for chronic conditions must be carefully balanced against acute post-operative safety protocols to avoid creating life-threatening complications.
4
Review general assessment standards for detecting internal complications.
Physical assessment of the abdomen for retroperitoneal bleeding must strictly follow the standard sequence of inspection, auscultation, and then palpation.
Altering the assessment sequence can lead to inaccurate clinical findings, such as artificially stimulated bowel sounds.

Anahtar Kavram

Post-procedure care and complication prevention following femoral cardiac catheterization, integrating competing priorities from chronic comorbidities.
Soru 993Soru →

A nurse is caring for a client who has experienced profuse, watery diarrhea for the past 48 hours. The nurse monitors the client closely for early indications of hypovolemic shock. Which of the following vital sign changes represents the earliest physiological compensatory mechanism for fluid volume deficit?

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Cevap: An increase in resting heart rate

Cevap

An increase in resting heart rate
The body's initial compensatory response to fluid volume depletion is activation of the sympathetic nervous system, which causes an increased heart rate (tachycardia) to maintain cardiac output and tissue perfusion. This typically occurs before any significant drop in blood pressure can be observed.

Adım Adım Çözüm

1
Identify the primary clinical risk based on the client's history.
The client's severe diarrhea leads to significant fluid volume deficit, increasing the risk for hypovolemic shock.
Recognizing the underlying fluid loss is the first step in anticipating the body's physiological responses.
2
Recall the body's initial compensatory mechanisms for decreased intravascular volume.
The sympathetic nervous system activates immediately to maintain cardiac output and tissue perfusion, primarily by increasing the heart rate.
Tachycardia occurs as an early warning sign, compensating for the lower stroke volume before the blood pressure drops.
3
Evaluate the other vital sign options against the known progression of shock.
Hypotension is a late sign. Respiratory rate generally increases. Pulse pressure narrows due to vasoconstriction.
Distinguishing between early compensatory signs and late decompensatory signs is critical for prompt nursing intervention.

Anahtar Kavram

Early compensatory mechanisms in hypovolemic shock
Soru 994Soru →

An 82-year-old client with advanced Parkinson's disease is admitted for severe dehydration and profound weight loss. Assessment reveals pronounced bradykinesia, freezing of gait episodes, and prominent dysphagia with coughing during meals. When prioritizing the daily basic care, mobility, and comfort needs for this client, which of the following evidence-based interventions should be incorporated? Select all that apply.

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Cevap: Schedule energy-intensive activities such as bathing and hallway ambulation precisely during the peak action of the client's dopaminergic medications.; Teach the client to consciously lift the toes and visualize stepping over a target on the floor to overcome episodes of gait freezing.

Cevap

The correct interventions are scheduling activities during peak medication times and teaching the client to visualize stepping over a target to overcome freezing of gait.
For clients with Parkinson's disease, coordinating energy-intensive activities like hygiene and ambulation with the peak effect of dopaminergic medications ensures optimal muscle function and reduces injury risk. Furthermore, teaching the client to visualize and step over an imaginary target effectively utilizes intact neural pathways in the frontal cortex to overcome the freezing of gait caused by basal ganglia dysfunction.

Adım Adım Çözüm

1
Analyze the client's clinical presentation.
The client has advanced Parkinson's disease, bradykinesia, freezing of gait, dysphagia, and dehydration.
Understanding the complex physiological deficits dictates the priority safety and comfort interventions.
2
Evaluate each intervention for safety and efficacy regarding mobility and basic care.
Timing care with medication peaks and utilizing conscious motor strategies directly address the complications of Parkinson's disease safely.
These interventions promote independence, reduce fatigue, and decrease fall risk.
3
Identify contraindicated or unsafe actions in the remaining options.
Delegating assessments, hyperextending the neck during meals, using immediate restraints, and dismissing sudden confusion as 'normal' are all significant safety violations.
Standard nursing guidelines require RN-level assessment for dysphagia, a chin-tuck position for feeding, restraint alternatives, and immediate evaluation of acute delirium.

Anahtar Kavram

Basic Care and Comfort: Complex Mobility, Nutrition, and Safety in Neurological Degeneration
Soru 995Soru →

An older adult client with generalized weakness and a history of mild dysphagia is about to receive their lunch tray. Which nursing action is most appropriate to promote safe swallowing and prevent aspiration?

Cevabı ve açıklamayı göster

Cevap: Elevate the head of the bed to a 90-degree angle during the meal and for at least 30 minutes afterward.

Cevap

The correct action is to elevate the head of the bed to a 90-degree angle during the meal and for at least 30 minutes afterward.
Elevating the head of the bed to a 90-degree angle (high-Fowler's position) is the most critical intervention for a client with dysphagia. This upright position utilizes gravity to help food and liquids travel down the esophagus and prevents gastric reflux. Maintaining this position for 30 to 45 minutes after the meal provides ongoing protection against delayed aspiration.

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1
Analyze the client's clinical presentation.
The client is an older adult with generalized weakness and a documented history of mild dysphagia.
Identifying the client's specific deficits highlights that they are at a high risk for aspiration during oral intake.
2
Identify the primary nursing goal for this procedure.
The primary goal during meal assistance is to promote safe swallowing and protect the airway.
Basic care and comfort must prioritize physiological safety, specifically preventing aspiration pneumonia.
3
Evaluate the proposed nursing interventions against safety standards.
Positioning the client upright at 90 degrees utilizes gravity to assist food transit and keeps the airway protected, whereas tilting the head back, ignoring coughing, or delegating to a UAP introduces severe safety risks.
Standard nursing guidelines require the high-Fowler's position during and immediately after meals for any client with swallowing difficulties.

Anahtar Kavram

Aspiration Precautions and Safe Feeding Techniques
Soru 996Soru →

A client with a history of heart failure is receiving a continuous intravenous infusion of 0.9% sodium chloride at 125 mL/hr. During a reassessment, the nurse notes new-onset bibasilar crackles, a respiratory rate of 28 breaths/min, and an oxygen saturation of 88% on room air. The latest arterial blood gas (ABG) results are pH 7.30, PaCO2PaCO_2 52 mm Hg, PaO2PaO_2 55 mm Hg, and HCO3−HCO_3^- 25 mEq/L. Which action should the nurse take first to reduce the risk of further physiological deterioration?

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Cevap: Elevate the head of the bed to a high-Fowler's position and initiate prescribed oxygen therapy.

Cevap

The priority action is to elevate the head of the bed to a high-Fowler's position and initiate prescribed oxygen therapy.
Elevating the head of the bed to a high-Fowler's position uses gravity to pull the diaphragm downward, maximizing lung expansion. Importantly, it also decreases venous return (preload) to the right side of the heart, which is crucial for reducing pulmonary congestion in a client experiencing heart failure exacerbation. Concurrently administering oxygen directly addresses the severe hypoxemia (PaO2PaO_2 55 mm Hg) indicated by the ABG results.

Adım Adım Çözüm

1
Analyze the clinical presentation and laboratory data.
The client shows signs of fluid volume overload (crackles) leading to acute respiratory failure, as indicated by uncompensated respiratory acidosis (pH 7.30, PaCO2PaCO_2 52 mm Hg) and hypoxemia (PaO2PaO_2 55 mm Hg).
Identifying the underlying physiological problem is essential for selecting the correct risk-reduction intervention.
2
Determine the immediate priority to reduce the risk of deterioration.
The primary risk is worsening hypoxia and complete respiratory collapse.
According to the ABCs (Airway, Breathing, Circulation) framework, optimizing oxygenation and ventilation takes absolute precedence.
3
Select the most appropriate nursing intervention.
Placing the client in a high-Fowler's position and providing oxygen directly addresses the immediate physiological threats.
High-Fowler's position uses gravity to promote maximum lung expansion and decrease venous return (preload) to the heart, while supplemental oxygen treats the life-threatening hypoxemia.

Anahtar Kavram

Prioritization of care for acute pulmonary edema involves immediate positioning to optimize lung expansion and reduce cardiac preload, alongside supplemental oxygenation to correct hypoxemia.
Soru 997Soru →

A nurse is providing care for a postoperative client who is prescribed strict bed rest. To reduce the client's risk of developing deep vein thrombosis (DVT), which interventions should the nurse include in the plan of care? Select all that apply.

Geçerli olan tümünü seçin

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Cevap: Apply prescribed sequential compression devices to the legs; Encourage the client to perform active range-of-motion foot exercises; Administer prescribed prophylactic doses of low-molecular-weight heparin

Cevap

The correct interventions are applying sequential compression devices, encouraging active range-of-motion foot exercises, and administering prophylactic low-molecular-weight heparin.
Applying sequential compression devices (SCDs), encouraging active range-of-motion foot exercises, and administering prophylactic low-molecular-weight heparin all actively promote venous return, reduce blood stasis, and prevent clot formation. These are standard, evidence-based risk reduction interventions for postoperative clients on bed rest.

Adım Adım Çözüm

1
Identify the client's primary risk factor from the clinical scenario.
The client is postoperative and on strict bed rest.
Immobility and surgical trauma significantly increase the risk for venous thromboembolism (VTE) due to venous stasis and hypercoagulability.
2
Evaluate each potential intervention for its effect on venous circulation.
Compression devices, foot exercises, and anticoagulants maintain flow or prevent clotting; placing pressure on the popliteal space (via pillows or knee gatch) impedes flow.
Effective risk reduction requires interventions that actively maintain venous circulation and avoid positioning that creates vascular compression.

Anahtar Kavram

Deep Vein Thrombosis (DVT) Prophylaxis and Safe Positioning
Tahmini Süre:45s
Soru 998Soru →

A nurse is evaluating a client who underwent a percutaneous liver biopsy two hours ago. The client is currently resting on their right side with a rolled towel under the puncture site. Which of the following assessment findings requires the most immediate notification to the healthcare provider to reduce the risk of a severe physiological complication?

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Cevap: Sudden onset of dyspnea, pleuritic chest pain, and absent breath sounds at the right lung base.

Cevap

The assessment finding of sudden onset of dyspnea, pleuritic chest pain, and absent breath sounds at the right lung base.
The correct answer describes the classic presentation of a right-sided pneumothorax (dyspnea, pleuritic pain, absent breath sounds). Because the biopsy needle is inserted through the lower right intercostal spaces to access the liver, there is a risk of accidentally puncturing the diaphragm and pleural space. This represents an acute respiratory emergency requiring immediate provider notification for potential chest tube placement.

Adım Adım Çözüm

1
Analyze the specific anatomical risks associated with a percutaneous liver biopsy.
Because the liver is highly vascular and located immediately below the diaphragm on the right side, the primary procedural risks are hemorrhage and accidental puncture of the pleural cavity (pneumothorax).
Understanding the anatomy involved dictates which complications to anticipate during post-procedure monitoring.
2
Evaluate each assessment finding to differentiate between expected post-procedure variations and signs of severe decompensation.
Normal ABGs, minor blood pressure fluctuations, and referred right shoulder pain (due to phrenic nerve irritation) are expected or non-emergent. Sudden respiratory distress with absent breath sounds is highly abnormal.
Risk reduction requires the ability to quickly filter out benign data and isolate pathological cues.
3
Apply the ABC (Airway, Breathing, Circulation) framework to prioritize the abnormal findings.
The symptoms of dyspnea and absent right-sided breath sounds indicate a pneumothorax, representing a critical 'Breathing' emergency that takes precedence over other findings.
Airway and breathing compromise lead to rapid physiological deterioration and death if not immediately addressed.

Anahtar Kavram

Post-Procedure Complication Recognition (Liver Biopsy)
Soru 999Soru →

A nurse is caring for a client receiving parenteral nutrition via a subclavian central venous catheter (CVC). Upon entering the room, the nurse discovers the IV tubing has disconnected from the catheter hub. The client is suddenly grasping their chest, gasping for air, and reporting a feeling of impending doom. Arrange the following nursing actions in the correct order of priority to manage this life-threatening complication.

Öğeleri doğru sıraya koymak için sürükleyin

Cevabı ve açıklamayı göster

Cevap

First, clamp the catheter; second, position the client in left lateral Trendelenburg; third, administer oxygen; fourth, notify the healthcare provider; and finally, obtain vital signs.
In the event of a disconnected CVC and suspected air embolism, the nurse must prioritize actions using the ABCs and immediate life-saving physical interventions. The sequence must proceed from stopping the source of the harm (clamping), mitigating the anatomical damage (left lateral Trendelenburg positioning), supporting physiological function (oxygen), escalating care (calling for help), and finally, gathering systemic data (vital signs).

Adım Adım Çözüm

1
Clamp the CVC
Stops further air entry into the vascular system.
Preventing the embolus from enlarging is the most critical first step in risk reduction.
2
Position in left lateral Trendelenburg
Traps the air in the right atrium.
Prevents the air bubble from acting as a complete mechanical obstruction in the right ventricular outflow tract.
3
Administer 100% oxygen
Alleviates tissue hypoxia and reduces bubble size.
Increases the diffusion gradient, helping nitrogen wash out of the air bubble, causing it to shrink.
4
Notify HCP and Rapid Response
Summons advanced medical intervention.
The client may require vasopressors, intubation, or needle aspiration of the air by a physician.
5
Obtain vital signs
Establishes a baseline for ongoing monitoring.
Provides data to the arriving response team about the client's hemodynamic stability following the initial interventions.

Anahtar Kavram

Emergency Management of Central Line Air Embolism
Soru 1000Soru →

Following a right femoral cardiac catheterization, a client is admitted to the progressive care unit. To minimize the risk of a severe physiological complication, which assessment must the nurse prioritize?

Cevabı ve açıklamayı göster

Cevap: Palpating the client's right dorsalis pedis pulse

Cevap

Palpating the client's right dorsalis pedis pulse
Following a femoral artery catheterization, the highest priority is assessing circulation distal to the insertion site to promptly detect arterial occlusion or hemorrhage. Palpating the pedal pulse verifies adequate blood flow to the extremity, thereby reducing the risk of severe ischemic complications.

Adım Adım Çözüm

1
Identify the procedure and its associated primary risks.
A femoral cardiac catheterization involves an arterial puncture, which carries a high immediate risk of hemorrhage or arterial occlusion at the access site.
Understanding the procedure-specific risks dictates the nursing priorities.
2
Determine the priority assessment required to mitigate these risks.
Evaluating the circulation distal to the puncture site is essential to confirm adequate limb perfusion.
Loss of blood flow is a medical emergency that can lead to tissue ischemia and limb loss if not detected early.
3
Evaluate the options to find the action that directly addresses distal circulation.
Palpating the right dorsalis pedis pulse directly assesses arterial blood flow beyond the femoral insertion site.
This action aligns with the priority of preserving physiological integrity.

Anahtar Kavram

Post-Catheterization Vascular Assessment
ÖncekiSayfa 50 / 98Sonraki
Physiological Integrity Alıştırma Soruları — NCLEX-RN — Sayfa 50 | Examkin