Physiological Integrity

1960 soru

Soru 1021Soru →

A nurse is evaluating a client with severe hepatic cirrhosis who recently underwent a therapeutic bedside paracentesis with the removal of 5 liters of ascitic fluid. Twenty minutes after the procedure, the client reports feeling dizzy and nauseous. The nurse observes that the client's heart rate has increased from 78 to 118 beats per minute, and the blood pressure has decreased from 132/82 mm Hg to 94/56 mm Hg. Which of the following actions should the nurse perform first to mitigate the risk of severe hemodynamic collapse?

Cevabı ve açıklamayı göster

Cevap: Initiate the prescribed intravenous infusion of albumin.

Cevap

The most critical action is to initiate the prescribed intravenous infusion of albumin.
The removal of large volumes of ascitic fluid decreases abdominal pressure, leading to splanchnic vasodilation and a massive shift of intravascular fluid back into the peritoneal cavity. The client's symptoms of dizziness, accompanied by tachycardia and hypotension, are classic indicators of impending hypovolemic shock. Administering a colloid volume expander, such as intravenous albumin, increases intravascular oncotic pressure. This pulls fluid back into the bloodstream, restoring cardiac output and mitigating the risk of cardiovascular collapse.

Adım Adım Çözüm

1
Analyze the client's vital sign trends and reported symptoms following the invasive procedure.
The acute onset of dizziness, marked tachycardia, and significant hypotension indicate a severe decrease in intravascular volume.
Large-volume paracentesis decreases intra-abdominal pressure, causing rapid vasodilation and a massive shift of fluid from the intravascular space into the peritoneal cavity.
2
Identify the immediate priority to prevent profound hypovolemic shock.
The primary goal is to restore intravascular volume and maintain organ perfusion.
Without intervention, the fluid shift will lead to progressive hemodynamic collapse and potential organ failure.
3
Select the specific intervention that addresses the underlying pathophysiological mechanism.
Administering intravenous albumin is the correct choice.
Albumin acts as a colloid, increasing plasma oncotic pressure to pull fluid back into the vascular space, effectively reversing the procedure-induced hypovolemia.

Anahtar Kavram

Post-paracentesis hypovolemic shock recognition and volume replacement
Tahmini Süre:1m 15s
Soru 1022Soru →

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

Cevabı ve açıklamayı göster

Cevap: Right side-lying position with a small towel or pillow under the puncture site

Cevap

The correct action is to assist the client into a right side-lying position with a small towel or pillow under the puncture site.
The correct position applies the client's own body weight against the bed to create direct pressure on the liver, which is located in the right upper quadrant. This localized pressure is crucial for achieving hemostasis and preventing post-procedure hemorrhage.

Adım Adım Çözüm

1
Identify the anatomical location of the procedure.
The liver is located in the right upper quadrant of the abdomen.
Knowing the organ's location is essential for determining how to apply pressure to the procedural site.
2
Determine the primary post-procedure risk.
Bleeding or hemorrhage is the most significant risk following a highly vascular procedure like a liver biopsy.
Risk reduction relies on anticipating and preventing specific procedural complications.
3
Select the position that mitigates this risk.
The right side-lying position applies the client's body weight over the site.
Direct pressure promotes hemostasis at the puncture site.

Anahtar Kavram

Post-procedure positioning to prevent hemorrhage
Tahmini Süre:1m 0s
Soru 1023Soru →

A nurse in an orthopedic rehabilitation clinic is providing discharge teaching to a client with a fractured left tibia. The client is prescribed strict non-weight-bearing status for the left leg and is learning to use axillary crutches. When evaluating the client's understanding of how to safely descend a flight of stairs, which statement by the client indicates correct technique?

Cevabı ve açıklamayı göster

Cevap: I will move my crutches down to the lower step first, keep my left foot off the ground, and then step down with my right leg.

Cevap

The statement describing moving the crutches down first, keeping the left foot off the ground, and then stepping down with the right leg demonstrates correct understanding.
When descending stairs with axillary crutches, the correct sequence is to lead with the crutches and the affected extremity ('down with the bad'). The client should first advance the crutches to the lower step while keeping the injured (left) leg lowered but completely off the ground to maintain non-weight-bearing status. The client supports their body weight using their hands on the crutch grips and then steps down with the strong, unaffected (right) leg. This technique ensures a stable base of support is established before the body moves downward.

Adım Adım Çözüm

1
Identify the client's prescribed mobility status and affected extremity.
The client is strictly non-weight-bearing on the left tibia and must use axillary crutches.
Determining the affected side and weight-bearing status dictates the correct crutch-walking technique and precautions.
2
Determine the correct biomechanical sequence for descending stairs with crutches.
The correct sequence is to lead with the crutches and the affected leg ('down with the bad').
Moving the crutches down first establishes a wide base of support on the lower step before the body's center of gravity shifts downward.
3
Evaluate the safety principles of axillary crutch use.
Body weight must always be supported by the handgrips, never by resting the axillae (armpits) on the crutch pads.
Bearing weight on the axillae compresses the brachial plexus, leading to severe nerve damage.
4
Analyze each statement to identify the correct descending sequence and safe technique.
Only the statement describing lowering the crutches first, maintaining non-weight-bearing status on the left leg, and avoiding axillary pressure is correct.
This option strictly adheres to both the correct sequential technique and the safe biomechanical principles of crutch ambulation.

Anahtar Kavram

Assistive Device Ambulation: Stair Descent with Axillary Crutches
Soru 1024Soru →

A client, age 82, with advanced emphysema and cor pulmonale is receiving treatment for hospital-acquired pneumonia. The client is currently prescribed continuous supplemental oxygen at 4 L/min via nasal cannula. During an assessment, the nurse finds the client somnolent, difficult to arouse, and taking 9 shallow breaths per minute. The most recent arterial blood gas analysis reveals a pH of 7.24, PaCO2 of 74 mm Hg, PaO2 of 56 mm Hg, and HCO3 of 32 mEq/L. Based on these clinical findings, which immediate intervention should the nurse implement?

Cevabı ve açıklamayı göster

Cevap: Activate the rapid response team and prepare to initiate manual positive-pressure ventilation.

Cevap

The most appropriate action is to activate the rapid response team and prepare to initiate manual positive-pressure ventilation.
The client is exhibiting classic signs of CO2 narcosis (somnolence, bradypnea) and acute respiratory failure, as evidenced by the severe respiratory acidosis on the ABG analysis. In clients with advanced COPD, excessive supplemental oxygen (such as 4 L/min) can eliminate their hypoxic drive to breathe. The immediate priority is to secure the airway, assist ventilation to eliminate excess carbon dioxide, and summon emergency assistance.

Adım Adım Çözüm

1
Analyze the client's clinical presentation.
The client is somnolent with bradypnea (9 breaths/min) and shallow breathing.
Identifying these signs is crucial as they indicate a life-threatening airway and breathing compromise.
2
Interpret the arterial blood gas (ABG) values.
pH 7.24, PaCO2 74 mm Hg, and HCO3 32 mEq/L indicates acute-on-chronic uncompensated respiratory acidosis.
This confirms severe hypercapnia, which is causing the decreased level of consciousness known as CO2 narcosis.
3
Evaluate the current interventions in the context of the client's disease process.
The client is receiving 4 L/min of oxygen.
In advanced emphysema, excessive supplemental oxygen can blunt the hypoxic drive to breathe, directly causing or worsening CO2 retention.
4
Determine the priority risk reduction action.
The client requires immediate manual ventilation and emergency assistance.
Positive-pressure ventilation is necessary immediately to blow off excess carbon dioxide and restore adequate oxygenation while the rapid response team arrives.

Anahtar Kavram

Hypercapnic Respiratory Failure and CO2 Narcosis in COPD
Soru 1025Soru →

A 55-year-old client is 3 days postoperative following an exploratory laparotomy. During a forceful coughing episode, the client reports a sudden "popping" sensation in the abdomen. The nurse inspects the surgical site and observes an abdominal evisceration. Place the following nursing interventions in the correct priority order to minimize the risk of severe physiological complications. (Arrange the steps from first to last.)

Öğeleri doğru sıraya koymak için sürükleyin

Cevabı ve açıklamayı göster

Cevap

The correct priority sequence is: 1) Call for immediate assistance, 2) Position the client in a low Fowler's position with flexed knees, 3) Cover the viscera with sterile moist dressings, 4) Assess vital signs, and 5) Prepare the client for emergency surgery.
In the event of an abdominal evisceration, the overarching goal is to reduce the risk of bowel ischemia, infection, and shock. The nurse must first call for immediate assistance to obtain sterile supplies and alert the surgeon, ensuring they do not leave the unstable client. Before supplies arrive, placing the client in a low Fowler's position with flexed knees immediately relaxes the abdominal musculature, minimizing further organ protrusion. Once the sterile saline and dressings arrive, the nurse covers the exposed viscera to maintain moisture and viability. After securing the physical defect, the nurse evaluates the client's hemodynamic status by checking vital signs to detect early hypovolemic shock. Finally, the nurse verifies intravenous access and prepares the client for the definitive treatment, which is emergency surgical closure.

Adım Adım Çözüm

1
Call for immediate assistance and instruct a colleague to bring sterile supplies and notify the surgeon.
The nurse secures additional help and necessary supplies without leaving the client's bedside.
An evisceration is a surgical emergency. The nurse cannot leave the client alone to gather supplies, so mobilizing the team is the first necessary action.
2
Position the client in a low Fowler's position with the hips and knees flexed.
Intra-abdominal pressure is rapidly reduced.
Flexing the knees and raising the head of the bed slightly relaxes the abdominal muscles, reducing tension on the wound and preventing further organ protrusion while waiting for supplies to be brought to the room.
3
Cover the protruding viscera with sterile dressings moistened with sterile normal saline.
The exposed internal organs are protected from the external environment.
Moist, sterile dressings prevent the viscera from drying out, which could lead to severe ischemia and necrosis, while also reducing the risk of bacterial contamination.
4
Assess the client's vital signs and monitor for clinical indicators of shock.
The client's hemodynamic status is systematically evaluated.
Evisceration can lead to rapid fluid shifts and hypovolemic shock. Once the physical wound is stabilized, assessing vital signs is the next critical priority.
5
Verify peripheral intravenous access and prepare the client for emergency surgery.
The client is readied for definitive surgical management.
The only resolution for an evisceration is surgical repair. Ensuring patent IV access allows for fluid resuscitation and administration of preoperative medications.

Anahtar Kavram

Abdominal Evisceration Emergency Management Sequence
Soru 1026Soru →

A nurse is preparing to administer an intravenous (IV) infusion of amphotericin B deoxycholate to a client diagnosed with a severe systemic fungal infection. Which of the following nursing actions are appropriate when managing this parenteral therapy? Select all that apply.

Geçerli olan tümünü seçin

Cevabı ve açıklamayı göster

Cevap: Administer prescribed prophylactic acetaminophen and diphenhydramine 30 minutes prior to the infusion.; Monitor the client's serum creatinine and blood urea nitrogen (BUN) levels closely throughout therapy.; Evaluate the intravenous insertion site frequently for signs of phlebitis and extravasation.

Cevap

The correct actions are to administer prescribed prophylactic medications prior to the infusion, monitor renal function (BUN and creatinine) closely, and evaluate the IV site frequently for complications.
Amphotericin B is associated with severe infusion reactions (fever, chills, rigors), making pre-medication with acetaminophen and diphenhydramine a standard safety practice. Because it is highly nephrotoxic, meticulous monitoring of BUN and creatinine levels is required to prevent acute kidney injury. Furthermore, it is a known vesicant and chemical irritant, requiring frequent assessment of the IV site to prevent severe tissue necrosis from extravasation.

Adım Adım Çözüm

1
Analyze the medication profile of amphotericin B deoxycholate.
Identified high potential for severe adverse effects including 'shake and bake' infusion reactions, nephrotoxicity, and phlebitis.
Understanding the drug's toxicity profile is required to determine the necessary nursing interventions.
2
Evaluate the options related to preparation and infusion mechanics.
Determined that the medication must be diluted in D5W (not normal saline) and infused slowly over 2 to 4 hours (not rapidly).
Saline causes precipitation, and rapid infusion can lead to fatal cardiovascular collapse.
3
Evaluate the options related to physiological monitoring and safety.
Confirmed the need for pre-medication, renal lab monitoring, and IV site assessment, while identifying that the drug causes hypokalemia, not hyperkalemia.
Proactive monitoring and symptom management prevent irreversible organ damage and severe discomfort.

Anahtar Kavram

Amphotericin B is a highly toxic antifungal medication requiring strict administration protocols: dilution in D5W only, slow infusion over 2-4 hours, pre-medication to prevent infusion reactions, and vigilant monitoring for nephrotoxicity, hypokalemia, and phlebitis.
Soru 1027Soru →

A nurse is preparing to discontinue a client's peripheral intravenous (IV) catheter. Place the following steps in the correct chronological order from first to last.

Öğeleri doğru sıraya koymak için sürükleyin

Cevabı ve açıklamayı göster

Cevap

The correct sequence is: perform hand hygiene and don gloves, clamp tubing and remove dressing, withdraw the catheter, apply firm pressure, and finally inspect the catheter tip.
The correct sequence ensures patient safety, infection control, and proper hemostasis during the discontinuation of a peripheral IV line. Standard precautions must be taken first. Then, the site is freed from securement devices so the catheter can be withdrawn smoothly without causing trauma. Once removed, immediate direct pressure prevents bleeding and hematoma formation. Finally, inspecting the catheter ensures that no fragments have broken off into the patient's circulatory system.

Adım Adım Çözüm

1
Initiate standard precautions by performing hand hygiene and applying gloves.
The nurse is protected, and the patient is safe from contamination.
Infection control is the foundational first step for any procedure involving potential blood exposure.
2
Stop the flow of fluids by clamping the tubing and remove the adhesive dressing.
The IV catheter is no longer secured to the patient's skin.
The dressing must be removed before the catheter can be physically withdrawn.
3
Pull the catheter out of the vein in a smooth, straight motion.
The catheter is completely removed from the patient's arm.
Removing it parallel to the skin prevents injury to the vein wall.
4
Immediately place a sterile gauze pad over the site and hold firm pressure.
Bleeding stops and a clot begins to form.
Direct pressure is required to achieve hemostasis and prevent a hematoma.
5
Look closely at the tip of the removed IV catheter.
The nurse confirms the entire catheter was removed.
A missing tip indicates a catheter embolus, which is a medical emergency requiring immediate intervention.

Anahtar Kavram

Discontinuation of a Peripheral Intravenous (IV) Catheter
Soru 1028Soru →

A 68-year-old client is admitted to the medical unit with a history of recurrent syncope, dehydration, and the recent initiation of a new antihypertensive medication. The healthcare provider prescribes orthostatic vital sign measurements. To ensure accurate assessment and reduce the risk of a potential fall, arrange the following procedural steps in the correct chronological order.

Öğeleri doğru sıraya koymak için sürükleyin

Cevabı ve açıklamayı göster

Cevap

The correct sequence requires obtaining a resting supine baseline, then measuring vital signs in the supine position, followed by standing the client, waiting for a brief period, and taking the final standing measurements.
Measuring orthostatic vital signs is a key diagnostic procedure to reduce the risk of syncope and falls in vulnerable clients. The correct sequence ensures standard baseline measurements are obtained while supine, followed by a controlled position change, an appropriate delay for the body's physiological response, and a final measurement to identify significant hemodynamic changes.

Adım Adım Çözüm

1
Establish a resting baseline state.
The client is placed in a supine position for 5 to 10 minutes.
This allows hemodynamics to stabilize before any initial measurements are taken.
2
Obtain baseline vital signs.
Blood pressure and heart rate are measured and recorded.
This provides the critical comparison values for subsequent position changes.
3
Change the client's position to induce an orthostatic challenge.
The client is assisted to a standing position.
Gravity causes blood to pool in the lower extremities, challenging the cardiovascular system's compensatory mechanisms.
4
Allow time for physiological compensation.
The nurse waits 1 to 3 minutes.
This provides time for baroreceptors to detect the drop in blood pressure and attempt to increase heart rate and vascular resistance.
5
Reassess vital signs.
Blood pressure and heart rate are measured again.
This allows identification of a drop in systolic blood pressure of 20 mm Hg or more, or a diastolic drop of 10 mm Hg or more.

Anahtar Kavram

Orthostatic Vital Sign Assessment Sequence
Soru 1029Soru →

A nurse is preparing to draw a blood specimen from a client's central venous catheter (CVC). To maintain catheter patency, prevent infection, and ensure accurate laboratory results, arrange the following steps in the correct chronological sequence.

Öğeleri doğru sıraya koymak için sürükleyin

Cevabı ve açıklamayı göster

Cevap

The correct sequence is to disinfect the hub, flush to confirm patency, draw and discard the waste blood, obtain the required diagnostic specimen, and finally perform a thorough flush to prevent line occlusion.
Following this exact sequence ensures three critical risk reduction goals: preventing infection by scrubbing first, ensuring accurate diagnostics by clearing the line of fluids before sampling, and maintaining the integrity of the device by flushing away residual blood to prevent thrombosis.

Adım Adım Çözüm

1
Disinfect the access hub.
Microorganisms are removed from the connector surface.
Prevents the direct introduction of pathogens into the central circulation.
2
Flush the catheter with normal saline.
Line patency is verified.
Ensures the line is functioning properly and clears residual medications.
3
Aspirate and discard the initial volume of blood.
Mixed blood and saline is removed from the catheter.
Prevents laboratory results from being falsely altered by fluid dilution.
4
Withdraw the required blood specimen.
A pure, undiluted blood sample is collected.
Provides an accurate sample for necessary diagnostic laboratory analysis.
5
Perform a final flush of the catheter.
Residual blood is completely cleared from the line.
Prevents blood from clotting inside the catheter, maintaining patency for future use.

Anahtar Kavram

Reduction of risk potential during central venous catheter blood sampling involves strict aseptic technique, proper clearing of line fluids to ensure accurate diagnostics, and thorough flushing to prevent catheter occlusion.
Soru 1030Soru →

A nurse on a medical-surgical unit is evaluating the status of four assigned clients. Based on the provided clinical data, which client requires the nurse's immediate intervention?

Cevabı ve açıklamayı göster

Cevap: A client with a fractured pelvis whose blood pressure changed from 134/80 mm Hg to 110/88 mm Hg and heart rate increased from 78 to 108 beats/min.

Cevap

The client with a fractured pelvis whose blood pressure is narrowing and heart rate is increasing requires immediate intervention.
The client with the fractured pelvis is exhibiting early signs of hypovolemic (hemorrhagic) shock. The sympathetic nervous system attempts to compensate for blood loss by increasing the heart rate (tachycardia) and causing peripheral vasoconstriction, which raises the diastolic blood pressure and results in a narrowing pulse pressure. Because pelvic fractures can cause massive internal bleeding, this client is the most unstable and requires immediate life-saving assessment and intervention.

Adım Adım Çözüm

1
Evaluate the clinical data for the client with the fractured pelvis.
The pulse pressure has narrowed from 54 mm Hg (134-80) to 22 mm Hg (110-88), and the heart rate has increased from 78 to 108 beats/min.
Pelvic fractures carry a high risk of concealed hemorrhage; these vital sign changes are the earliest indicators of compensatory shock.
2
Analyze the arterial blood gas values for the client with COPD.
The pH is normal (7.36), PaCO2 is elevated (56 mm Hg), and HCO3 is elevated (31 mEq/L).
This confirms fully compensated respiratory acidosis, a stable and expected baseline for chronic COPD, rather than an acute emergency.
3
Assess the post-procedure status of the client who had a lumbar puncture.
The client is experiencing a mild headache while lying supine.
This is an expected side effect, and the supine position is the appropriate prophylactic and therapeutic measure.
4
Review the behavioral changes in the client with dementia.
Increased confusion and agitation in the evening is identified as sundowning.
This is a chronic, expected manifestation of dementia rather than an acute, life-threatening physiological change.

Anahtar Kavram

Early recognition of shock through subtle vital sign trends (such as a narrowing pulse pressure and mild tachycardia) is a critical nursing priority over expected chronic or post-procedural findings.
Soru 1031Soru →

A nurse is planning care for an 82-year-old client admitted with an acute exacerbation of heart failure. The client has marked lower extremity edema, requires continuous supplemental oxygen, and is on strict bed rest. During the night shift, the client becomes increasingly restless and makes repeated attempts to climb out of bed. Which of the following basic care and safety interventions should the nurse include in the client's plan of care? Select all that apply.

Geçerli olan tümünü seçin

Cevabı ve açıklamayı göster

Cevap: Apply a bed alarm system and ensure the bed is locked in the lowest position; Elevate the head of the bed to at least 45 degrees to optimize respiratory effort and promote physical comfort

Cevap

The correct interventions are to apply a bed alarm system while keeping the bed in the lowest position, and to elevate the head of the bed to at least 45 degrees.
Applying a bed alarm and keeping the bed in the lowest position are the safest, least restrictive measures to prevent falls in a restless client. Elevating the head of the bed to at least 45 degrees (Fowler's position) uses gravity to reduce venous return to the heart and lowers the diaphragm, which optimizes lung expansion, improves oxygenation, and promotes physical comfort for a client with heart failure.

Adım Adım Çözüm

1
Analyze the client's clinical presentation.
The client is an older adult with heart failure, edema, and oxygen requirements who is exhibiting acute restlessness and fall risk behaviors.
Identifying the client's underlying pathology and current symptoms is essential for prioritizing safe care.
2
Evaluate the need for physiological support.
Elevating the head of the bed addresses the client's respiratory needs and promotes comfort without causing harm.
Clients with heart failure and hypoxia require positioning that maximizes lung expansion and decreases cardiac workload.
3
Assess the safety interventions against the principle of least restrictive care.
Using a bed alarm is a non-invasive, low-restriction safety measure, whereas immediate restraint application violates safety protocols.
Nurses must implement the least restrictive alternatives first to protect client autonomy and prevent restraint-related injuries.
4
Review the scope of practice for delegation.
Evaluating skin integrity is identified as an RN-level assessment that cannot be delegated to a UAP.
Delegating assessments jeopardizes client safety and violates nursing practice acts.

Anahtar Kavram

Basic Care, Comfort, and Safety Interventions in the Older Adult
Soru 1032Soru →

A nurse is caring for a client with dysphagia who is preparing to eat breakfast. Which positioning action is most appropriate to prevent aspiration?

Cevabı ve açıklamayı göster

Cevap: Position the client in an upright, seated position at a 90-degree angle.

Cevap

Position the client in an upright, seated position at a 90-degree angle.
Sitting completely upright at a 90-degree angle (High-Fowler's position) uses gravity to help move food down the esophagus and provides the best anatomical alignment to protect the airway from aspiration during a meal. This is the standard baseline intervention for any client at risk for aspiration.

Adım Adım Çözüm

1
Identify the primary risk factor for the client.
The client has dysphagia (difficulty swallowing), which inherently increases the risk of choking and pulmonary aspiration.
Swallowing difficulties impair the normal physiological mechanisms that protect the airway during oral intake.
2
Determine the safest physical alignment for oral intake.
A 90-degree upright position (High-Fowler's) is required during meals.
This specific position utilizes gravity to facilitate the movement of food into the esophagus while keeping the trachea structurally protected.

Anahtar Kavram

Aspiration Precautions and Positioning
Tahmini Süre:45s
Soru 1033Soru →

A client is receiving low continuous nasogastric suction for a small bowel obstruction. The nurse should monitor the client for which primary acid-base imbalance resulting from this therapy?

Cevabı ve açıklamayı göster

Cevap: Metabolic alkalosis

Cevap

Metabolic alkalosis
The correct answer identifies that gastric secretions are highly acidic due to the presence of hydrochloric acid. When these secretions are continuously extracted from the body via nasogastric suction, there is a significant depletion of hydrogen ions. This net loss of acid causes an increase in the blood pH and a relative excess of bicarbonate, directly resulting in metabolic alkalosis.

Adım Adım Çözüm

1
Identify the physiological effect of the prescribed therapy.
Nasogastric suction continuously removes gastric contents from the client's stomach.
Understanding what is physically being removed from the body is required to identify the resulting imbalance.
2
Determine the composition of the fluid being lost.
Gastric secretions contain a high concentration of hydrochloric acid.
Knowing that acid is being depleted explains the subsequent shift in blood pH.
3
Correlate the specific fluid loss with the corresponding acid-base imbalance.
The continuous loss of acid leaves a relative excess of bicarbonate in the bloodstream, raising the pH.
A primary loss of acid from the upper gastrointestinal tract directly leads to a metabolic alkalotic state.

Anahtar Kavram

Acid-Base Imbalances related to Gastrointestinal Fluid Loss
Soru 1034Soru →

A nurse is directing the basic care and comfort measures for an 82-year-old client admitted to the medical-surgical unit with severe bilateral pneumonia. The client has a history of mild dementia and is currently experiencing significant dyspnea, generalized fatigue, and an oxygen saturation of 88% on room air. Which of the following nursing actions should the nurse include in the client's plan of care? (Select all that apply)

Geçerli olan tümünü seçin

Cevabı ve açıklamayı göster

Cevap: Assist the client into an orthopneic position, leaning forward over a padded overbed table, to maximize lung expansion and ease respiratory effort.; Provide meticulous oral care every two to four hours to clear dried secretions, moisten mucous membranes, and enhance overall physical comfort.

Cevap

The correct nursing actions are to assist the client into an orthopneic position to maximize lung expansion, and to provide meticulous oral care every two to four hours to maintain mucosal moisture and clear secretions.
The correct nursing actions prioritize both critical respiratory function and fundamental physical comfort. Assisting the client into an orthopneic position (leaning forward over an overbed table) allows for maximum downward displacement of the diaphragm and recruits accessory muscles, which significantly decreases the work of breathing. Additionally, providing meticulous oral care every two to four hours is essential to clear dried secretions and moisturize mucous membranes that become rapidly dehydrated due to tachypnea and supplemental oxygen therapy.

Adım Adım Çözüm

1
Analyze the client's clinical presentation.
The 82-year-old client has severe pneumonia, significant dyspnea, hypoxia (88% SpO2), and a history of mild dementia.
Understanding the physiological limitations imposed by severe respiratory distress and geriatric factors is required to plan safe basic care and comfort measures.
2
Evaluate the positioning and hygiene interventions.
Orthopneic positioning actively recruits accessory muscles for breathing. Frequent oral care prevents mucosal drying from tachypnea and oxygen therapy. Conversely, lowering the bed to a flat position for perineal care is unsafe and will severely worsen dyspnea.
Basic care interventions must always prioritize airway and breathing (ABCs) while simultaneously addressing hygiene and physical comfort.
3
Evaluate the delegation and safety interventions.
Delegating the evaluation of respiratory tolerance to a UAP is unsafe and outside their scope. Applying restraints without trying alternatives violates safety protocols. Dismissing acute confusion as normal dementia progression ignores a critical sign of worsening hypoxia.
The RN must retain all assessment responsibilities, utilize the least restrictive safety measures, and immediately recognize acute changes from baseline in older adults.

Anahtar Kavram

Providing basic care and hygiene for clients with severe respiratory compromise requires adapting standard procedures (such as avoiding supine positioning) to prioritize the ABCs, while adhering strictly to RN scope of practice and recognizing acute geriatric physiological changes.
Soru 1035Soru →

A nurse is preparing to administer a newly prescribed intravenous (IV) antibiotic as a secondary infusion (piggyback) to a client who is currently receiving a continuous primary IV infusion of 0.9% sodium chloride. Which of the following is the priority nursing action before initiating the secondary infusion?

Cevabı ve açıklamayı göster

Cevap: Verify the chemical and physical compatibility of the antibiotic with the primary 0.9% sodium chloride solution.

Cevap

Verify the chemical and physical compatibility of the antibiotic with the primary 0.9% sodium chloride solution.
Before administering any secondary intravenous medication (piggyback) into an existing continuous IV line, the nurse must always verify that the medication is chemically and physically compatible with the primary infusing solution. Failure to verify compatibility can result in precipitation within the IV tubing. This precipitation can lead to loss of drug efficacy, occlusion of the IV catheter, or the infusion of dangerous microemboli into the client's bloodstream.

Adım Adım Çözüm

1
Identify the primary continuous IV fluid that is currently infusing into the client.
The nurse confirms the client is receiving 0.9% sodium chloride.
Knowing the primary solution is the first step in assessing whether a secondary medication can safely share the same IV line.
2
Consult a drug reference guide, pharmacy resource, or facility database to check the compatibility of the prescribed antibiotic with 0.9% sodium chloride.
The compatibility status is confirmed before attaching the secondary tubing to the primary line's Y-port.
Mixing incompatible intravenous medications and fluids can cause crystal formation (precipitation) in the tubing, leading to catheter occlusion or life-threatening emboli.

Anahtar Kavram

Intravenous Medication Compatibility
Soru 1036Soru →

A 68-year-old client is 2 hours post-percutaneous coronary intervention (PCI) utilizing a right femoral artery approach. The arterial sheath was removed 45 minutes ago, and a mechanical compression device is currently in place. The client reports a new onset of vague right lower back and flank pain, accompanied by mild nausea. Over the past 45 minutes, the client's heart rate has progressively increased from 72 to 110 bpm, and the blood pressure has trended from 134/82 mm Hg down to 112/74 mm Hg. The right femoral insertion site is dry, intact, and free of any superficial bleeding or palpable hematoma. Which of the following actions is the priority for the nurse to perform to reduce the risk of severe physiological deterioration?

Cevabı ve açıklamayı göster

Cevap: Maintain the client in a flat, supine position and immediately activate the rapid response team for suspected retroperitoneal hemorrhage.

Cevap

Maintain the client in a flat, supine position and immediately activate the rapid response team for suspected retroperitoneal hemorrhage.
The correct answer accurately identifies a high-risk, life-threatening complication: retroperitoneal hemorrhage. Flank or back pain, accompanied by compensatory tachycardia, narrowing pulse pressure, and nausea following a femoral artery puncture, are classic early signs of internal bleeding. Because the blood tracks backward into the retroperitoneal space, the external insertion site often remains clean and dry without a palpable hematoma. The immediate priority is to maintain the client in a flat, supine position to prevent further mechanical stress on the arteriotomy and to activate the rapid response team to initiate aggressive volume resuscitation and advanced interventions.

Adım Adım Çözüm

1
Analyze the client's history and current clinical manifestations.
The client had a right femoral artery puncture. They now have new-onset right flank/back pain, increasing tachycardia, decreasing blood pressure, and nausea.
Identifying the constellation of symptoms following an invasive vascular procedure is critical for recognizing early complications.
2
Correlate the symptoms with potential post-procedural complications.
The symptoms strongly indicate internal bleeding into the retroperitoneal space. The external site is clear because the blood is tracking internally into the retroperitoneum.
Retroperitoneal hemorrhage is a life-threatening, hidden complication of femoral access that presents with flank pain and subtle signs of early hypovolemic shock before severe hypotension occurs.
3
Determine the safest, most immediate risk-reduction intervention.
The nurse must keep the client flat to minimize intra-abdominal pressure on the femoral puncture site and immediately activate emergency personnel.
Medical intervention (fluids, potential surgical coiling) is urgently required, and maintaining a flat position prevents exacerbation of the arterial bleed.

Anahtar Kavram

Early recognition and mitigation of retroperitoneal hemorrhage following femoral artery catheterization.
Soru 1037Soru →

Following a percutaneous liver biopsy, a client remains on bed rest for post-procedure monitoring. Which specific clinical findings should immediately alert the nurse that this client is developing early hemorrhagic shock? Select all that apply.

Geçerli olan tümünü seçin

Cevabı ve açıklamayı göster

Cevap: New-onset restlessness and vague anxiety; Apical pulse increase from 78 to 116 beats per minute; Blood pressure shift from 132/74 mmHg to 124/88 mmHg

Cevap

The findings indicating early hemorrhagic shock are new-onset restlessness, an increased apical pulse rate, and a narrowing pulse pressure.
In the early (compensatory) stage of hemorrhagic shock, decreased intravascular volume triggers the sympathetic nervous system. This physiological adaptation attempts to maintain cardiac output and tissue oxygenation, resulting in tachycardia (increased heart rate) and peripheral vasoconstriction. Vasoconstriction raises the diastolic blood pressure, leading to a narrowed pulse pressure. Additionally, subtle changes in cerebral perfusion present as early restlessness, anxiety, or mild confusion.

Adım Adım Çözüm

1
Analyze the clinical scenario.
The client has undergone a liver biopsy, involving a highly vascular organ, placing them at significant risk for internal bleeding (hypovolemic/hemorrhagic shock).
Identifying the primary complication risk sets the context for interpreting vital signs.
2
Recall the physiological adaptation in early (compensatory) hemorrhagic shock.
The sympathetic nervous system activates to preserve perfusion to vital organs by increasing heart rate, increasing respiratory rate, and causing peripheral vasoconstriction.
Understanding the body's compensatory mechanisms explains the specific symptom presentation.
3
Evaluate each option against these compensatory mechanisms.
Restlessness reflects early cerebral hypoxia. Heart rate increases (tachycardia) to boost cardiac output. Blood pressure demonstrates a narrowed pulse pressure due to vasoconstriction raising diastolic pressure.
Matching clinical data to the pathophysiology accurately identifies the correct early indicators.
4
Eliminate normal findings and contradictory symptoms.
A capillary refill of 2 seconds, warm skin, and a normal respiratory rate of 14 are all normal or opposite to the expected signs of shock (prolonged refill, cool/clammy skin, tachypnea).
Differentiating abnormal shock manifestations from baseline normal findings eliminates distractors.

Anahtar Kavram

Early compensatory mechanisms and assessment findings in hemorrhagic shock
Soru 1038Soru →

A critical care nurse is evaluating a client with a history of acute severe asthma who is undergoing a spontaneous breathing trial (SBT) via a T-piece. Thirty minutes into the trial, the client becomes restless and diaphoretic. The nurse draws an arterial blood gas (ABG) sample, which reveals the following results: pH 7.28, PaCO2 56 mm Hg, PaO2 62 mm Hg, and HCO3- 24 mEq/L. To mitigate the risk of physiological decompensation, which action should the nurse take immediately?

Cevabı ve açıklamayı göster

Cevap: Halt the spontaneous breathing trial and prepare to resume full mechanical ventilatory support.

Cevap

The correct action is to halt the spontaneous breathing trial and prepare to resume full mechanical ventilatory support.
The client's ABG results demonstrate acute uncompensated respiratory acidosis (low pH, elevated PaCO2, normal HCO3-) combined with hypoxemia (low PaO2). The clinical signs of restlessness and diaphoresis, alongside these objective lab values, indicate that the client is failing the spontaneous breathing trial and experiencing profound respiratory fatigue. The immediate priority to reduce the risk of respiratory arrest is to halt the trial and reinstitute mechanical ventilation to ensure adequate alveolar ventilation and oxygenation.

Adım Adım Çözüm

1
Analyze the arterial blood gas (ABG) results.
The pH of 7.28 indicates acidosis. The PaCO2 of 56 mm Hg is elevated (primary respiratory cause). The HCO3- of 24 mEq/L is normal (uncompensated). The PaO2 of 62 mm Hg is low (hypoxemia).
To identify the client's primary acid-base disturbance and oxygenation status during the weaning trial.
2
Interpret the client's overall clinical picture.
The objective data (uncompensated respiratory acidosis with hypoxemia) and subjective data (restlessness, diaphoresis) indicate that the client is failing the spontaneous breathing trial due to respiratory muscle fatigue.
To determine whether the client is successfully tolerating the transition off mechanical ventilation.
3
Determine the priority nursing intervention based on the ABCs.
The nurse must prioritize airway and breathing by stopping the trial and immediately restoring mechanical ventilatory support.
To prevent total respiratory arrest and reduce the risk of severe physiological decompensation.

Anahtar Kavram

Interpretation of Arterial Blood Gases (ABGs) and Management of Mechanical Ventilation Weaning Failure
Soru 1039Soru →

A nurse is monitoring a client admitted with blunt abdominal trauma. The nurse suspects the client is actively bleeding internally. Which assessment findings should the nurse recognize as early compensatory signs of hypovolemic shock? (Select all that apply.)

Geçerli olan tümünü seçin

Cevabı ve açıklamayı göster

Cevap: Restlessness and anxiety; Heart rate of 115 beats/minute; Respiratory rate of 24 breaths/minute

Cevap

The early compensatory signs of hypovolemic shock include restlessness and anxiety, a heart rate of 115 beats/minute, and a respiratory rate of 24 breaths/minute.
During the early (compensatory) stage of hypovolemic shock, the body activates the sympathetic nervous system to maintain cardiac output and tissue perfusion. This results in tachycardia (heart rate of 115 beats/minute) and tachypnea (respiratory rate of 24 breaths/minute). Additionally, the brain is highly sensitive to slight drops in oxygenation and perfusion, making restlessness, anxiety, or mild confusion some of the earliest observable indicators of impending shock.

Adım Adım Çözüm

1
Analyze the client's risk factor
The client has blunt abdominal trauma, placing them at high risk for internal bleeding and subsequent hypovolemic shock.
Identifying the primary risk guides the targeted assessment for specific complications.
2
Differentiate between early (compensatory) and late (progressive/irreversible) signs of shock
Early signs reflect the body's attempt to maintain perfusion (tachycardia, tachypnea, restlessness). Late signs occur when compensation fails (hypotension).
The question specifically asks for early compensatory signs, requiring the exclusion of late manifestations.
3
Evaluate each assessment finding against the pathophysiology of early hypovolemic shock
Tachycardia, tachypnea, and restlessness are compensatory. Hypotension is late. Warm/dry skin is atypical for hypovolemia.
This confirms the correct clinical manifestations to select.

Anahtar Kavram

Early recognition of hypovolemic shock relies on identifying compensatory mechanisms such as tachycardia, tachypnea, and altered mental status, rather than waiting for late signs like hypotension.
Soru 1040Soru →

A client is recovering on the medical-surgical unit two hours after a diagnostic lumbar puncture. The nurse enters the room and observes the client sitting upright on the edge of the bed. The client reports a severe, throbbing headache that began shortly after sitting up. Vital signs are within baseline limits. Which of the following is the most appropriate initial nursing action to reduce the client's risk for further physiological decompensation?

Cevabı ve açıklamayı göster

Cevap: Assist the client back into bed and maintain a flat, supine position.

Cevap

Assist the client back into bed and maintain a flat, supine position.
The correct action is to assist the client into a flat, supine position. A post-dural puncture headache is a common complication of a lumbar puncture, resulting from the ongoing leakage of cerebrospinal fluid through the dural hole. The hallmark presentation is a severe headache that acutely worsens when sitting or standing and is significantly relieved by lying flat. Positioning the client flat minimizes further fluid leakage by decreasing hydrostatic pressure at the puncture site and immediately relieves the downward traction on the meninges that causes the pain.

Adım Adım Çözüm

1
Analyze the client's clinical presentation in the context of their recent procedure.
The client underwent a lumbar puncture and is now experiencing a new, severe headache upon assuming an upright position.
Recognizing the hallmark signs of a post-dural puncture headache (spinal headache) is essential for identifying the underlying cause, which is a cerebrospinal fluid (CSF) leak.
2
Determine the physiological impact of the client's current upright positioning.
Sitting upright increases gravity's pull on the remaining CSF, causing a downward shift of the brain and increased traction on pain-sensitive meningeal structures.
Understanding the mechanics of a CSF leak highlights why the upright position actively worsens the client's condition.
3
Select the priority risk-reduction intervention.
The nurse must immediately reposition the client to a flat, supine posture.
Laying the client flat equalizes pressure, relieves meningeal traction, and physically reduces the pressure gradient driving the ongoing CSF leak.

Anahtar Kavram

Post-procedure Positioning and Complication Mitigation
Tahmini Süre:1m 0s
ÖncekiSayfa 52 / 98Sonraki
Physiological Integrity Alıştırma Soruları — NCLEX-RN — Sayfa 52 | Examkin