Physiological Integrity

1960 soru

Soru 1061Soru →

A 54-year-old client with a history of chronic hepatitis C and cirrhosis has just arrived at the medical-surgical unit following an ultrasound-guided percutaneous liver biopsy. The client is currently drowsy but arousable, with a baseline blood pressure of 118/76 mmHg and a heart rate of 74 bpm. Which of the following nursing actions are appropriate to reduce the risk of potential complications? Select all that apply.

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Cevap: Position the client in a right lateral decubitus position with a rolled towel under the puncture site.; Instruct the client to maintain strict bed rest for the duration prescribed by the healthcare provider.; Evaluate the client for new-onset right shoulder pain to detect potential diaphragmatic irritation from internal bleeding.

Cevap

The correct actions are positioning the client in a right lateral decubitus position, instructing them to maintain strict bed rest, and evaluating for new-onset right shoulder pain.
After a percutaneous liver biopsy, the highest risk to the client is hemorrhage because the liver is highly vascular. Proper risk reduction includes positioning the client on the right side to apply direct pressure to the liver capsule, enforcing strict bed rest to prevent clot dislodgement, and actively assessing for referred right shoulder pain, which is an early indicator of internal bleeding and diaphragmatic irritation.

Adım Adım Çözüm

1
Analyze the clinical scenario and the specific risks associated with the procedure.
The client is post-percutaneous liver biopsy, a procedure involving a highly vascular organ that carries a significant risk of severe internal hemorrhage.
Identifying the primary physiological risk directs the priority nursing interventions for safety.
2
Evaluate appropriate positioning and activity requirements for risk reduction.
The client must be placed on the right side to compress the liver against the chest wall, and strict bed rest must be enforced.
Direct pressure and limited movement facilitate clot formation and maintain its integrity at the puncture site.
3
Identify safe and effective assessment techniques for early complication detection.
The nurse must monitor for early signs of shock and referred pain to the right shoulder, while strictly avoiding interventions that could provoke bleeding, such as deep abdominal palpation.
Early detection of subtle signs of decompensation prevents life-threatening hemorrhagic shock without causing iatrogenic injury.

Anahtar Kavram

Post-Procedure Complication Prevention (Liver Biopsy)
Soru 1062Soru →

A nurse is evaluating an adult client admitted with acute pancreatitis who is receiving aggressive intravenous fluid resuscitation. Which of the following clinical findings indicate a developing complication that requires immediate intervention? (Select all that apply)

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Cevap: Carpal spasm occurring when the blood pressure cuff is inflated; New-onset fine crackles auscultated in the bilateral lung bases; Increasing abdominal rigidity and a board-like feel upon palpation

Cevap

The findings requiring immediate intervention are carpal spasm during blood pressure measurement, new-onset fine crackles in the lung bases, and increasing abdominal rigidity.
The correct answers identify life-threatening complications associated with acute pancreatitis and its treatment. Carpal spasm (Trousseau's sign) indicates severe hypocalcemia caused by retroperitoneal fat necrosis. New-onset crackles suggest fluid volume overload from aggressive fluid resuscitation or the development of Acute Respiratory Distress Syndrome (ARDS). A rigid, board-like abdomen is a classic sign of peritonitis, which can result from pancreatic rupture or severe internal hemorrhage.

Adım Adım Çözüm

1
Analyze the client's current diagnosis and treatment plan.
The client has acute pancreatitis and is receiving large volumes of intravenous fluids for resuscitation.
Understanding the pathophysiology and treatments helps identify potential systemic complications.
2
Evaluate each assessment finding to differentiate between expected disease manifestations and unstable complications.
Epigastric pain radiating to the back and assuming a fetal position are expected findings. The ABG values are normal.
Risk reduction requires prioritizing unexpected, life-threatening physiological changes over expected symptoms.
3
Identify the critical indicators of physiological deterioration.
Trousseau's sign (carpal spasm) indicates severe hypocalcemia. Crackles indicate fluid overload or ARDS. A board-like abdomen indicates peritonitis.
These three findings represent acute, potentially fatal complications that demand immediate medical intervention.

Anahtar Kavram

Reduction of Risk Potential in Acute Pancreatitis
Soru 1063Soru →

The healthcare team is reviewing the mobility and comfort orders for a client who underwent a right above-knee amputation two days ago. Which intervention should the nurse implement to prevent long-term musculoskeletal complications?

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Cevap: Place the client in a prone position for 30 minutes three times a day.

Cevap

Place the client in a prone position for 30 minutes three times a day.
Placing a client with an above-knee amputation in a prone position for 20 to 30 minutes several times a day stretches the hip flexor muscles. This directly prevents the development of hip flexion contractures, which are severe complications that can prevent the future use of a prosthesis.

Adım Adım Çözüm

1
Identify the primary long-term complication risk for a client with an above-knee amputation (AKA).
The major risk is a hip flexion contracture, which can permanently impair the client's ability to use a prosthetic device.
Understanding the pathophysiology of post-amputation recovery directs appropriate nursing interventions.
2
Evaluate the timeline post-surgery (two days ago).
After the first 24 hours, interventions must shift from edema management (elevation) to contracture prevention.
Elevation after 24 hours actively promotes hip flexion contractures.
3
Analyze the given options against evidence-based positioning protocols.
Prone positioning stretches the hip flexor muscles, countering the tendency for them to shorten and contract.
Selecting the option that directly mitigates the identified risk.

Anahtar Kavram

Post-amputation contracture prevention
Soru 1064Soru →

A client returns to the surgical unit following a right total hip arthroplasty using a posterior approach. When assisting this client in bed, which nursing action promotes safe positioning?

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Cevap: Place an abduction wedge between the client's legs when turning.

Cevap

Place an abduction wedge between the client's legs when turning.
Following a posterior approach total hip arthroplasty, the client's hip is at a high risk for dislocation. Using an abduction wedge or pillow between the client's legs prevents adduction (crossing the legs) and helps maintain proper joint alignment, especially when turning the client in bed. This is a fundamental comfort and safety measure.

Adım Adım Çözüm

1
Identify the surgical procedure and its primary risks.
The client had a posterior total hip arthroplasty, making them highly susceptible to hip dislocation.
Understanding the specific surgical approach dictates which movements are contraindicated.
2
Recall the positioning restrictions for a posterior hip arthroplasty.
The client must avoid hip adduction (crossing legs) and hip flexion greater than 90 degrees.
These specific movements place stress on the posterior surgical capsule.
3
Select the nursing intervention that enforces these restrictions.
Placing an abduction wedge prevents adduction and keeps the joint safely aligned.
This is a direct application of basic care and comfort principles to prevent injury.

Anahtar Kavram

Safe Positioning Post-Total Hip Arthroplasty
Soru 1065Soru →

An older adult client with advanced Parkinson's disease and documented oropharyngeal dysphagia requires assistance with feeding to mitigate aspiration risk. In what chronological order should the nurse execute the following mealtime interventions?

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Cevap

The sequence must begin with baseline assessment, followed by upright positioning, then pre-meal oral hygiene, executing the safe feeding technique, and concluding with post-meal inspection and sustained positioning.
This sequence strictly adheres to the nursing process and advanced evidence-based dysphagia care. Assessment determines readiness for the procedure. Upright positioning ensures anatomical safety for any subsequent oral intervention. Pre-meal oral hygiene drastically reduces the bacterial load, minimizing pneumonia risk in the event of micro-aspiration. Feeding is then executed using airway-protective maneuvers, followed immediately by post-meal assessment to prevent delayed aspiration events.

Adım Adım Çözüm

1
Evaluate the client's cognitive alertness and ability to manage spontaneous saliva.
Establishes the client's baseline neurological readiness for oral intake.
Feeding a lethargic client guarantees aspiration; assessment must precede any physical intervention.
2
Elevate the head of the bed to a 90-degree angle to establish a safe physical alignment.
Utilizes gravity to protect the trachea from aspiration.
The client must be fully upright before fluids, oral care tools, or food are introduced to the oral cavity.
3
Perform pre-meal oral hygiene to reduce the intraoral bacterial load and stimulate sensory awareness.
Clears preexisting bacteria and stimulates oral mucosa.
Reduces the incidence of aspiration pneumonia if micro-aspiration occurs, but requires the client to be upright first.
4
Guide the client into a chin-tuck posture and introduce half-teaspoon bites of the prescribed diet.
Narrows the airway entrance and safely delivers nutrition.
The chin-tuck mechanically protects the airway while small volumes prevent overwhelming the impaired swallowing mechanism.
5
Examine the buccal cavities for pocketed residue and maintain the upright posture for 45 minutes.
Identifies hidden aspiration risks and promotes safe digestion.
Pocketed food can be aspirated later if the client lies down too soon; sustained elevation prevents gastroesophageal reflux.

Anahtar Kavram

Aspiration Precautions and Dysphagia Management
Soru 1066Soru →

A client requires a combined dose of regular and NPH insulin for morning glycemic control. What is the correct sequence of actions for drawing up these medications into a single syringe? Arrange the steps in chronological order.

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Cevap

The correct sequence is: inject air into NPH, inject air into regular, draw up regular, and finally draw up NPH insulin.
When mixing NPH (cloudy) and regular (clear) insulin, the 'clear before cloudy' rule is strictly followed to prevent contamination of the short-acting regular insulin with the longer-acting NPH insulin. The sequence ensures air is placed in both vials to equalize pressure before drawing up the clear medication first, followed by the cloudy medication.

Adım Adım Çözüm

1
Inject air into the NPH insulin vial.
Pressure is equalized in the NPH vial.
Prevents vacuum formation when withdrawing medication later without contaminating the needle.
2
Inject air into the regular insulin vial.
Pressure is equalized in the regular insulin vial.
Prepares the vial for immediate withdrawal of the medication.
3
Withdraw the regular insulin.
The short-acting, clear insulin enters the syringe first.
Prevents contamination of the short-acting insulin vial with intermediate-acting insulin.
4
Withdraw the NPH insulin.
The intermediate-acting, cloudy insulin is added to the syringe to reach the total combined dose.
Completes the combined dose safely.

Anahtar Kavram

Mixing clear and cloudy insulin
Soru 1067Soru →

A client with a deep vein thrombosis has a prescription for a continuous heparin infusion at 1,200 units/hr1,200\text{ units/hr}. The pharmacy dispenses an intravenous bag containing 25,000 units25,000\text{ units} of heparin mixed in 250 mL250\text{ mL} of 5%5\% dextrose in water (D5W). At what rate should the nurse set the infusion pump? Record your answer as a whole number.

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Cevap: 12

Cevap

12
To determine the correct pump setting in mL/hr\text{mL/hr}, the nurse must first find the concentration of the solution (25,000 units÷250 mL=100 units/mL25,000\text{ units} \div 250\text{ mL} = 100\text{ units/mL}). Then, divide the prescribed dose by the concentration (1,200 units/hr÷100 units/mL=12 mL/hr1,200\text{ units/hr} \div 100\text{ units/mL} = 12\text{ mL/hr}). Alternatively, the formula DesiredHave×Volume\frac{\text{Desired}}{\text{Have}} \times \text{Volume} can be used: 1,200 units25,000 units×250 mL=12 mL/hr\frac{1,200\text{ units}}{25,000\text{ units}} \times 250\text{ mL} = 12\text{ mL/hr}.

Adım Adım Çözüm

1
Calculate the concentration of the available heparin solution.
25,000 units250 mL=100 units/mL\frac{25,000\text{ units}}{250\text{ mL}} = 100\text{ units/mL}
Finding the concentration identifies how many units of the medication are present in a single milliliter of the fluid.
2
Calculate the required volume to deliver the prescribed hourly dose.
1,200 units/hr100 units/mL=12 mL/hr\frac{1,200\text{ units/hr}}{100\text{ units/mL}} = 12\text{ mL/hr}
Dividing the desired dose by the concentration yields the required infusion rate on the pump.

Anahtar Kavram

Intravenous medication dosage calculation based on concentration
Tahmini Süre:1m 0s
Soru 1068Soru →

While caring for a hospitalized client, the nurse prepares to hang a scheduled intravenous (IV) antibiotic. The client already has a continuous IV drip of a different medication infusing through a single-lumen peripheral venous catheter. What is the most critical action the nurse must take before connecting the antibiotic to the Y-site?

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Cevap: Check a pharmacological reference to confirm the two medications are compatible.

Cevap

Check a pharmacological reference to confirm the two medications are compatible.
Before administering multiple intravenous medications concurrently through the same access point, it is a fundamental safety standard to consult a reliable drug reference to verify physical and chemical compatibility. Administering incompatible medications can result in precipitation, which can occlude the catheter or cause a life-threatening embolus in the client.

Adım Adım Çözüm

1
Identify that two distinct medications are planned to infuse through the same single-lumen intravenous line.
Recognize the potential for the medications to mix at the Y-site and within the client's vein.
Mixing unknown medications poses a significant safety risk.
2
Prioritize client safety by determining the chemical and physical properties of the drug combination.
Consult an approved facility drug reference guide or pharmacist.
Compatibility must be established prior to administration to prevent precipitation, crystallization, or drug inactivation.

Anahtar Kavram

Intravenous Medication Y-Site Compatibility
Soru 1069Soru →

A night-shift nurse is caring for an older adult client with chronic obstructive pulmonary disease (COPD) who reports worsening shortness of breath and an inability to fall asleep. Which independent nursing interventions should be implemented to promote physical comfort and rest? (Select all that apply.)

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Cevap: Assist the client into an orthopneic position by resting their arms on pillows placed on an overbed table.; Adjust the room environment by lowering the ambient temperature and turning on a bedside circulating fan.; Guide the client through relaxation strategies, including guided imagery and pursed-lip breathing exercises.

Cevap

The correct interventions are assisting the client into an orthopneic position, adjusting the room environment to be cool with circulating air, and guiding the client through relaxation and pursed-lip breathing exercises.
Clients with chronic respiratory conditions like COPD experience significant discomfort and anxiety when dyspneic. Independent nursing interventions focus on maximizing lung expansion, reducing the metabolic demand for oxygen, and decreasing the subjective feeling of air hunger. Assisting the client into the orthopneic position, promoting a cool environment with circulating air, and teaching pursed-lip breathing directly target these goals safely and effectively without the need for new pharmacological orders.

Adım Adım Çözüm

1
Analyze the client's primary problem and needs.
The client has COPD and is experiencing dyspnea that is preventing them from resting.
Understanding the pathophysiology of COPD helps identify which interventions will safely relieve symptoms.
2
Evaluate the proposed positioning interventions.
The orthopneic position is selected because it facilitates lung expansion, while the supine position is rejected because it worsens breathing effort.
Positioning directly affects diaphragmatic excursion and the work of breathing.
3
Evaluate environmental and supportive measures.
Cool circulating air and relaxation techniques are selected.
These independent actions directly reduce the subjective sensation of dyspnea and decrease metabolic oxygen demand.
4
Apply safety and delegation principles to the remaining options.
UAP delegation for assessment and the use of restraints for oxygen tubing are rejected.
UAPs cannot perform clinical assessments, and physical restraints are contraindicated for simply maintaining a nasal cannula without prior indication of severe risk.

Anahtar Kavram

Non-pharmacological comfort and positioning for respiratory compromise
Soru 1070Soru →

An older adult client is receiving a continuous intravenous heparin infusion for a newly diagnosed left lower extremity deep vein thrombosis (DVT). The nurse is developing a plan of care focusing on the client's basic comfort, mobility, and safety. Which intervention is the most appropriate to include in the plan of care?

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Cevap: Assist the client with supervised ambulation once therapeutic anticoagulation levels have been confirmed

Cevap

The correct answer is to assist the client with supervised ambulation once therapeutic anticoagulation levels have been confirmed.
Current evidence-based practice guidelines recommend early ambulation for clients with an acute deep vein thrombosis (DVT) once therapeutic anticoagulation levels have been achieved. Ambulation promotes venous return, decreases edema, and alleviates pain without increasing the incidence of pulmonary embolism. Strict bedrest is no longer routinely recommended as it can contribute to further venous stasis and functional decline.

Adım Adım Çözüm

1
Analyze the client's diagnosis and current phase of treatment.
The client has an active deep vein thrombosis (DVT) and is actively receiving therapeutic anticoagulation (heparin).
Understanding the phase of treatment dictates the safe limits of client mobility and comfort interventions.
2
Evaluate the physiological impact of ambulation on an active, anticoagulated DVT.
Evidence demonstrates that early ambulation does not increase the risk of pulmonary embolism and effectively reduces leg swelling and pain compared to strict bedrest.
Nursing practice must align with current evidence-based guidelines regarding safe mobility.
3
Assess the alternative interventions for potential safety hazards or contraindications.
Popliteal pressure restricts venous return; SCDs on an active DVT can dislodge the clot; and sudden confusion suggests hypoxia from a pulmonary embolism, not normal aging.
Identifying contraindicated actions eliminates incorrect options and ensures client safety.

Anahtar Kavram

Evidence-based mobility and comfort interventions for acute deep vein thrombosis
Soru 1071Soru →

A client with terminal esophageal cancer and severe ascites is receiving continuous enteral nutrition via a newly placed percutaneous endoscopic jejunostomy (PEJ) tube. The client experiences severe orthopnea requiring upper body elevation, but reports that elevating the head of the bed by bending the mattress at the hips causes agonizing abdominal pressure and intractable nausea. Which action by the nurse best manages the enteral feeding safely while simultaneously addressing the client's competing comfort and respiratory needs?

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Cevap: Place the entire bed frame in a reverse Trendelenburg position at a 30-degree angle while maintaining the mattress in a flat, unbent alignment.

Cevap

Placing the entire bed frame in a reverse Trendelenburg position at a 30-degree angle while maintaining the mattress in a flat, unbent alignment.
The correct action utilizes the reverse Trendelenburg position to tilt the entire bed frame upward at the head. This harnesses gravity to pull the abdominal organs away from the diaphragm, effectively relieving the client's orthopnea. It also maintains the required head elevation to prevent aspiration during continuous enteral feeding. Crucially, because the mattress remains completely flat, it prevents flexion at the hips, entirely avoiding the severe abdominal compression and agonizing pain caused by standard semi-Fowler's positioning in clients with massive ascites.

Adım Adım Çözüm

1
Analyze the client's conflicting physiological needs and constraints.
The client requires head elevation for orthopnea and tube feeding safety, but cannot tolerate hip flexion due to severe ascites compressing the abdomen.
Standard bed elevation (Fowler's positions) bends at the hips, which forces fluid upward, worsening abdominal pain, nausea, and diaphragmatic pressure in clients with massive ascites.
2
Evaluate positioning alternatives that elevate the head without bending the torso.
The reverse Trendelenburg position tilts the entire bed frame, elevating the head and thorax above the stomach without bending the client's body.
This position utilizes gravity to pull the abdominal organs and diaphragm downward, relieving orthopnea, while keeping the abdomen uncompressed.
3
Select the safest, most comprehensive intervention.
Implementing the reverse Trendelenburg position addresses all competing needs simultaneously.
It promotes respiratory function, allows for the safe continuation of enteral feeding, and prevents exacerbation of abdominal pain.

Anahtar Kavram

Complex Client Positioning and Comfort Synthesis
Tahmini Süre:1m 30s
Soru 1072Soru →

A 62-year-old62\text{-year-old} client is admitted to the telemetry unit with an exacerbation of heart failure. The client has +3 pitting edema in the bilateral lower extremities. The client's vital signs are blood pressure 148/92 mmHg148/92\text{ mmHg}, heart rate 88 bpm88\text{ bpm}, and respiratory rate 22 breaths/min22\text{ breaths/min}. The most recent basic metabolic panel reveals a serum potassium level of 4.2 mEq/L4.2\text{ mEq/L}. The healthcare provider prescribes 40 mg40\text{ mg} of intravenous (IV) furosemide. Which of the following is the most important nursing action when administering this medication?

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Cevap: Administer the medication slowly over at least 2 minutes to prevent the risk of ototoxicity.

Cevap

The correct action is to administer the intravenous furosemide slowly over at least 2 minutes to minimize the risk of ototoxicity.
The correct answer emphasizes administering IV furosemide slowly. Furosemide is a potent loop diuretic, and rapid intravenous push administration is a classic cause of ototoxicity (tinnitus and permanent hearing loss). To ensure safety, the standard administration rate is typically 20 mg20\text{ mg} per minute, meaning a 40 mg40\text{ mg} dose must be pushed slowly over at least 2 minutes.

Adım Adım Çözüm

1
Analyze the clinical scenario and the prescribed medication.
The provider ordered an IV push dose of furosemide for a client with heart failure and a normal serum potassium level.
To identify specific safety parameters and contraindications for this drug before administration.
2
Recall the pharmacological safety principles for IV furosemide administration.
Furosemide must be administered slowly (typically 20 mg20\text{ mg} per minute) to prevent adverse effects.
Rapid administration is associated with speed shock, severe hypotension, and ototoxicity.
3
Select the option that aligns with safe administration guidelines.
Administering the medication over at least 2 minutes is the correct action.
This directly ensures patient safety and aligns with standard parenteral therapy protocols.

Anahtar Kavram

Safe administration of intravenous furosemide requires a slow push rate to prevent ototoxicity.
Soru 1073Soru →

A nurse is developing a care plan focusing on basic care and comfort for a client admitted with acute decompensated heart failure. The client is experiencing severe orthopnea, fatigue, and marked dependent pitting edema in the lower extremities. Which nursing interventions should be included in the plan of care? Select all that apply.

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Cevap: Position the client in a high Fowler's alignment while allowing the arms to rest on a padded overbed table.; Supply frequent oral hygiene along with sugar-free hard candies to alleviate dry mouth associated with prescribed fluid restrictions.; Establish a strict repositioning schedule every two hours that includes thorough inspection of dependent skin surfaces.

Cevap

The correct interventions are positioning the client upright while leaning over a bedside table, providing oral care with hard candies, and ensuring strict repositioning every two hours.
Clients with acute decompensated heart failure and orthopnea benefit from an orthopneic position (upright, leaning forward on an overbed table) to maximize chest expansion and decrease venous return. Frequent oral hygiene and hard candies promote comfort for dry mouth, a common issue due to fluid restrictions and mouth breathing. Edematous skin is highly susceptible to breakdown due to poor tissue perfusion, making a strict turning and inspection schedule essential.

Adım Adım Çözüm

1
Analyze the client's clinical presentation.
The client has acute decompensated heart failure with severe orthopnea (difficulty breathing when lying flat) and marked dependent edema.
Identifying the physiological deficits determines which basic care and comfort measures are safe and effective.
2
Evaluate the positioning interventions for safety and efficacy.
High Fowler's with arms on an overbed table (orthopneic position) maximizes lung expansion. Elevating the legs significantly is contraindicated as it increases venous return (preload) and worsens pulmonary congestion.
Positioning must balance comfort with respiratory safety in heart failure.
3
Assess the hydration, hygiene, and skin integrity interventions.
Providing oral care and hard candies relieves dry mouth from fluid restrictions. Frequent repositioning protects edematous skin, which is highly prone to breakdown.
Edematous tissue has reduced blood supply and is fragile; fluid restrictions necessitate alternative mouth comfort measures.
4
Review the delegation intervention.
Evaluating the severity of edema requires clinical judgment and cannot be delegated to a nursing assistant.
Nursing assistants can perform hygiene tasks, but the registered nurse must evaluate clinical status.

Anahtar Kavram

Basic care interventions in acute decompensated heart failure focus on maximizing respiratory function through positioning, preventing skin breakdown in edematous areas, and providing comfort measures while adhering to fluid restrictions.
Soru 1074Soru →

A nurse is formulating a plan of care focusing on basic care and comfort for an older adult client who sustained deep partial-thickness burns to the anterior neck, chest, and bilateral axillae 48 hours ago. Which of the following interventions should the nurse include? Select all that apply.

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Cevap: Position the client's head without pillows and place a small rolled towel under the shoulders.; Maintain the ambient room temperature between 85°F and 90°F (29.4°C to 32.2°C) to prevent hypothermia.; Provide a high-protein, high-calorie diet with oral nutritional supplements to support wound healing.

Cevap

The correct interventions are positioning the head without pillows to promote neck extension, maintaining a warm ambient room temperature, and providing a high-protein, high-calorie diet.
The appropriate plan of care for a client with extensive burns must prioritize interventions that prevent joint contractures, maintain core body temperature, and meet hypermetabolic nutritional needs. Removing pillows promotes neck extension to prevent anterior neck contractures. Maintaining a warm room temperature (85°F to 90°F) is essential because clients with significant burns lose their ability to regulate body temperature and are at high risk for hypothermia. Providing a high-protein, high-calorie diet supports the intense metabolic demands of tissue repair and prevents severe weight loss.

Adım Adım Çözüm

1
Analyze the client's specific burn locations (anterior neck, axillae) to determine appropriate contracture-prevention positioning.
The neck requires extension (no pillows, towel under shoulders), and the axillae require abduction (arms positioned away from the body).
Burn scars contract as they heal, pulling skin into flexion or adduction if not properly positioned during the acute and rehabilitative phases.
2
Evaluate the systemic physiological impact of large surface area burns on basic care needs.
The loss of the skin barrier leads to impaired thermoregulation, and massive tissue damage causes hypermetabolism.
Nursing interventions must compensate for these losses by keeping the room warm and providing high-protein, high-calorie nutrition.
3
Assess the distractors regarding delegation boundaries and geriatric clinical presentations.
Skin evaluation cannot be delegated to a UAP, and sudden confusion indicates a pathological change (such as hypoxia or sepsis).
Registered nurses must retain assessment responsibilities. Furthermore, abnormal neurological changes in older adults warrant immediate medical investigation, not dismissal as a normal part of aging.

Anahtar Kavram

Basic care for major burns requires anti-contracture positioning, thermoregulation support, hypermetabolic nutrition, and vigilant assessment for complications like hypoxia.
Soru 1075Soru →

An individual who recently experienced a cerebrovascular accident has residual hemiparesis on the right side of their body. The nurse is preparing to assist the client in transferring from the edge of the bed to a wheelchair. Which placement of the wheelchair is most appropriate for a safe transfer?

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Cevap: On the client's left side, placed at a slight angle to the bed

Cevap

The wheelchair should be placed on the client's left side, positioned at a slight angle to the bed.
The safest transfer technique for a client with hemiparesis requires placing the wheelchair on the client's unaffected (strong) side. Since this client has right-sided weakness, the chair should be positioned on their left side at a slight angle. This allows the client to bear weight and pivot on their strong left leg while reaching for the far wheelchair armrest with their strong left arm, ensuring a stable and controlled movement from the bed to the chair.

Adım Adım Çözüm

1
Identify the client's strong and weak sides based on the clinical presentation.
The client has right-sided hemiparesis (weakness), meaning the left side is the unaffected, strong side.
Transfers must always lead with the strong side to ensure the client can support their own weight safely.
2
Determine the optimal placement for the wheelchair.
The wheelchair must be placed on the left side of the bed at a 30 to 45-degree angle.
Placing the chair on the unaffected side allows the client to pivot on their strong leg and use their strong arm to reach the armrest.

Anahtar Kavram

Safe Client Transfer Techniques
Soru 1076Soru →

A critically ill pediatric client weighing 15 kg15 \text{ kg} is prescribed an epinephrine infusion at 0.1 mcg/kg/min0.1 \text{ mcg/kg/min} to manage severe hypotension. The available medication concentration is 1 mg1 \text{ mg} of epinephrine mixed in 50 mL50 \text{ mL} of 5%5\% dextrose in water. A newly licensed nurse programs the infusion pump to deliver 4.5 mL/hr4.5 \text{ mL/hr} and prepares to connect the primary tubing to the client's 22-gauge22\text{-gauge} peripheral forearm catheter. Which evaluation by the supervising nurse is most accurate regarding this intended action?

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Cevap: The pump rate is correctly calculated, but the medication must be rerouted to a central venous access device.

Cevap

The calculation of 4.5 mL/hr4.5 \text{ mL/hr} is correct, but epinephrine is a potent vesicant that must be administered through a central venous catheter to prevent severe tissue necrosis.
The supervising nurse must recognize two critical factors: the mathematical calculation is accurate, but the intended route is dangerous. The calculation (15 kg×0.1 mcg/kg/min×60 min/hr÷20 mcg/mL15 \text{ kg} \times 0.1 \text{ mcg/kg/min} \times 60 \text{ min/hr} \div 20 \text{ mcg/mL}) equals exactly 4.5 mL/hr4.5 \text{ mL/hr}. However, epinephrine is a potent vasoconstrictor and vesicant. Administering a continuous infusion through a peripheral vein places the client at an unacceptably high risk for extravasation, which can rapidly lead to severe ischemic tissue necrosis. A central venous catheter is required.

Adım Adım Çözüm

1
Calculate the total required dose per minute.
0.1 mcg/kg/min×15 kg=1.5 mcg/min0.1 \text{ mcg/kg/min} \times 15 \text{ kg} = 1.5 \text{ mcg/min}
Weight-based dosing requires multiplying the prescribed rate by the client's total body weight.
2
Convert the per-minute dose to an hourly dose.
1.5 mcg/min×60 minutes/hr=90 mcg/hr1.5 \text{ mcg/min} \times 60 \text{ minutes/hr} = 90 \text{ mcg/hr}
Infusion pumps are programmed in milliliters per hour, so the dose must reflect an hourly rate.
3
Determine the concentration of the available medication.
1 mg=1000 mcg1 \text{ mg} = 1000 \text{ mcg}. Therefore, 1000 mcg÷50 mL=20 mcg/mL1000 \text{ mcg} \div 50 \text{ mL} = 20 \text{ mcg/mL}
The dose is in micrograms, so the medication supply must be converted from milligrams to micrograms to match the units.
4
Calculate the final infusion rate in mL/hr\text{mL/hr}.
90 mcg/hr÷20 mcg/mL=4.5 mL/hr90 \text{ mcg/hr} \div 20 \text{ mcg/mL} = 4.5 \text{ mL/hr}
Dividing the hourly dose by the concentration yields the required pump rate. This confirms the new nurse's math is entirely accurate.
5
Evaluate the route of administration for safety.
Identify that continuous epinephrine via a 22-gauge22\text{-gauge} peripheral IV is unsafe.
Epinephrine is a high-alert vesicant and a potent vasoconstrictor. Continuous infusions require central venous access to prevent severe localized ischemia and tissue necrosis from potential extravasation.

Anahtar Kavram

Continuous infusions of potent vasopressors and vesicants (such as epinephrine) require precise weight-based calculation and administration via a central venous access device to prevent ischemic tissue necrosis.
Soru 1077Soru →

A registered nurse is preparing to administer a prescribed dose of intravenous (IV) push furosemide to a client. The client is currently receiving a continuous IV infusion of milrinone. A drug reference guide indicates that furosemide and milrinone are incompatible, and the client has only one peripheral IV access site. What is the correct sequence of actions for the nurse to safely administer the furosemide?

Öğeleri doğru sıraya koymak için sürükleyin

Cevabı ve açıklamayı göster

Cevap

The correct sequence is to first stop the milrinone infusion, flush the line with normal saline to clear the incompatible drug, administer the furosemide over the recommended time, flush again with normal saline at the same slow rate, and finally restart the continuous milrinone infusion.
When administering an IV push medication through a line running an incompatible continuous infusion, the nurse must prevent the two medications from mixing to avoid precipitation. The correct sequence is to first stop the continuous infusion. Next, flush the line with a compatible solution (such as 0.9% sodium chloride) using the port closest to the patient to clear out the primary drug. Then, administer the IV push medication. After administration, flush the line again with the compatible solution at the same slow rate as the medication to safely clear the tubing without causing a bolus effect. Finally, the continuous infusion is restarted.

Adım Adım Çözüm

1
Stop the milrinone infusion.
The flow of the incompatible primary medication is halted.
Prevents the mixing of incompatible medications in the IV tubing.
2
Clean the injection port and flush with 10 mL of normal saline.
The IV line is cleared of any residual milrinone.
Creates a physical barrier between the incompatible drugs and verifies the patency of the IV site.
3
Administer the IV push furosemide.
The medication is delivered safely into the vein.
Provides the prescribed therapeutic intervention.
4
Flush with 10 mL of normal saline at the administration rate.
The remaining furosemide in the dead space of the tubing is cleared.
Ensures the entire dose reaches the client while preventing a dangerous rapid bolus effect.
5
Restart the milrinone infusion.
The continuous medication therapy is resumed.
Maintains the prescribed baseline pharmacologic support.

Anahtar Kavram

Safe administration of an IV push medication through an incompatible continuous IV line requires stopping the primary infusion and flushing the line with a compatible solution both before and after the medication is given.
Soru 1078Soru →

The registered nurse is preparing to administer medications to an older adult client who has a continuous intravenous (IV) fluid infusion. The client has new prescriptions for an IV piggyback antibiotic and an IV push opioid analgesic. To ensure safe parenteral therapy, which of the following actions are appropriate for the nurse to perform? Select all that apply.

Geçerli olan tümünü seçin

Cevabı ve açıklamayı göster

Cevap: Flush the IV line with normal saline immediately before and after administering the IV push opioid.; Assess the client's baseline respiratory rate and sedation level prior to administering the opioid analgesic.; Verify the compatibility of the IV piggyback antibiotic with the primary continuous IV fluid prior to administration.

Cevap

The correct actions include flushing the IV line before and after the opioid push, assessing respiratory rate and sedation prior to the opioid, and verifying the compatibility of the antibiotic with the primary IV fluid.
The correct actions represent foundational safety standards for parenteral therapies. Flushing the IV line ensures patency and prevents accidental mixing of incompatible drugs. Assessing respiratory status is critical prior to administering CNS depressants like opioids. Checking IV compatibility prevents life-threatening line precipitation.

Adım Adım Çözüm

1
Identify the safety principles associated with administering multiple IV medications.
Recognize the need for proper flushing techniques and strict compatibility checks.
Following these principles prevents drug precipitation in the line and ensures the entire medication dose is safely delivered.
2
Evaluate the specific nursing responsibilities regarding assessment and delegation.
Determine that assessing respiratory status before giving opioids is mandatory, and that initial monitoring for adverse reactions cannot be delegated.
The registered nurse must maintain responsibility for evaluating a client's baseline status and initial physiological response to any new medication.
3
Analyze the physiological considerations for an older adult receiving parenteral therapies.
Identify that sudden mental status changes require immediate clinical investigation.
Acute confusion is an adverse event or sign of toxicity, not a normal physiological change associated with aging.

Anahtar Kavram

Safe Parenteral Medication Administration and Assessment
Soru 1079Soru →

A client with a systemic methicillin-resistant *Staphylococcus aureus* (MRSA) infection and a deep vein thrombosis is receiving a continuous intravenous (IV) infusion of heparin through a single-lumen peripheral IV catheter. The nurse prepares to administer a scheduled dose of IV vancomycin 1 g1\text{ g}, which must infuse over 90 minutes90\text{ minutes}. A drug reference indicates that vancomycin and heparin are incompatible at the Y-site. Which action should the nurse take?

Cevabı ve açıklamayı göster

Cevap: Establish a second peripheral IV access to administer the vancomycin infusion.

Cevap

Establish a second peripheral IV access to administer the vancomycin infusion.
The correct action is to establish a second peripheral IV access. Heparin and vancomycin are chemically incompatible and cannot be administered through the same IV line simultaneously. Because heparin has a very short half-life, pausing the continuous infusion for a 90-minute90\text{-minute} vancomycin administration would cause the client's anticoagulation levels to drop rapidly into a subtherapeutic range, severely increasing the risk of thrombus extension. Therefore, the safest and most effective nursing action is to insert a new, dedicated peripheral IV line for the antibiotic.

Adım Adım Çözüm

1
Identify the incompatibility between intravenous heparin and vancomycin at the Y-site.
Recognize that the two medications cannot physically mix in the same IV line without forming a dangerous precipitate.
Mixing incompatible medications can cause crystallization, leading to severe complications like catheter occlusion or emboli.
2
Evaluate the feasibility of pausing the continuous heparin infusion.
Determine that pausing the heparin for 90 minutes90\text{ minutes} is clinically unsafe for this client.
Heparin has a very short half-life (60 to 90 minutes60\text{ to }90\text{ minutes}). Stopping the infusion for an extended period risks rapid decline in anticoagulation levels and potential thrombus extension.
3
Select the safest alternative intervention based on nursing scope of practice.
Decide to establish a new, dedicated peripheral IV line.
A separate IV access allows both critical medications to infuse simultaneously and safely without physical interaction or therapeutic interruption.

Anahtar Kavram

IV compatibility and pharmacokinetics of continuous high-alert infusions
Tahmini Süre:1m 30s
Soru 1080Soru →

A client is admitted to the neurosurgical unit immediately following a supratentorial craniotomy for tumor resection. The client is lethargic but appropriately responsive to verbal stimuli. To promote comfort and optimize physiological stability, which positioning intervention should the nurse implement?

Cevabı ve açıklamayı göster

Cevap: Elevate the head of the bed 30 degrees and utilize rolled towels to maintain the client's head in a neutral, midline alignment.

Cevap

Elevate the head of the bed 30 degrees and utilize rolled towels to maintain the client's head in a neutral, midline alignment.
Following a supratentorial craniotomy, the priority in basic care and comfort is to position the client to promote optimal cerebral venous drainage, which prevents a dangerous rise in intracranial pressure (ICP). Elevating the head of the bed 30 degrees and keeping the neck in a neutral, midline position (avoiding flexion or rotation) facilitates venous return via the jugular veins while providing comfort and reducing facial and periorbital edema.

Adım Adım Çözüm

1
Analyze the client's surgical procedure.
The client had a supratentorial craniotomy.
Different craniotomy approaches (supratentorial vs. infratentorial) require distinct post-operative positioning to prevent complications.
2
Determine the physiological priority for comfort and safety in this population.
The priority is preventing increased intracranial pressure (ICP) by ensuring adequate cerebral venous drainage while maintaining a comfortable resting posture.
Post-operative swelling and fluid accumulation can compromise brain tissue if venous return is blocked.
3
Evaluate the impact of each positioning option on venous drainage and intracranial pressure.
Head elevation of 30 degrees with a neutral neck alignment uses gravity to assist venous return without kinking the jugular veins. Flat positions, neck flexion, and sharp hip flexion all impede venous return or increase intra-abdominal pressure.
Understanding the anatomical relationship between hip/neck flexion and intracranial pressure is essential for safe basic care.

Anahtar Kavram

Post-operative Positioning for Craniotomy
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Physiological Integrity Alıştırma Soruları — NCLEX-RN — Sayfa 54 | Examkin