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L2 Comprehensive Assessment
L2 Comprehensive Assessment
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1
Slide 140
Feeding glucose water only
Elevating the head for feedings
Avoiding suction unless infant is cyanotic
Elevating the head but give nothing by mouth
2
Slide 9
WBC of 16,300/μL
WBC of 12,700/μL
WBC of 2900/μL
WBC of 8200/μL
3
Slide 5
sulfonamides.
cephalosporins.
erythromycin.
amoxicillin.
4
Slide 77
Accelerates glucose metabolism.
Lowers the renal threshold for glucose.
Mobilizes liver stores of glycogen.
Has a glucose component.
5
Slide 58
Administer acetaminophen every 4 hours for pain relief.
Initiate prophylactic antibiotic therapy prevent infection
Immediately start enteral feeding to prevent malnutrition
Insert an NG and NPO status to allow pancreas to rest
6
Slide 71
Offer the prescribed promethazine (Phenergan).
Instill a mineral oil retention enema.
Administer the prescribed IV morphine sulfate.
Encourage the patient to ambulate.
7
Slide 72
notify the patient’s health care provider.
remove the tube and replace it with a new one.
auscultate for hypotonic bowel sounds.
check for tube placement and reposition it.
8
Slide 142
First term pregnancy for the mother
Maternal history of polyhydramnios
Complicated pregnancy
Maternal age more than 40 years
9
Slide 104
Propranolol (Inderal)
Methimazole
Iodine
Propylthiouracil
10
Slide 46
AV node and depolarizing the atria.
AV node and spreading to the bundle of His
SA node and depolarizing the atria.
SA node and repolarizing the atria.
11
Slide 108
70-yo taking levothyroxine who has irregular pulse of 134
53-yo has Addison’s disease due for dose of hydrocortisone
31-yo with Cushing syndrome and a blood glucose of 244 mg/dL
22-yo admitted with SIADH has serum Na+ level of 130 mEq/L
12
Slide 15
pH, 7.47; PaO2, 82 mm Hg; CO2, 30 mEq/L; HCO3, 31 mEq/L
pH, 7.40; PaO2, 90 mm Hg; CO2, 39 mEq/L; HCO3, 23 mEq/L
pH, 7.32; PaO2, 85 mm Hg; CO2, 57 mEq/L; HCO3, 26 mEq/L
pH, 7.31; PaO2, 95 mm Hg; CO2, 22 mEq/L; HCO3, 19 mEq/L
13
Slide 159
No swim b/c exhaling underwater is dangerous for pt w/asthma
play any type of sport if their asthma is well controlled
limit the child to one athletic activity per school year
usually restricted from physical activities
14
Slide 143
nasogastric tube fails to pass at birth
infant has a low birth weight
radiograph in prenatal period indicates abnormal development
is visually identified at the time of delivery
15
Slide 111
Assess the quality of the left radial pulse.
Irrigate the fistula site with saline every 8 to 12 hours
Compare blood pressures in the left and right arms.
Auscultate for a bruit at the fistula site.
16
Slide 170
Interrupt the client and weigh her immediately
Allow the client to complete her exercise program
Tell the client she is not allowed to exercise rigorously
Interrupt the client and offer to take her for a walk
17
Slide 14
Maintain inflation of the alveoli.
Increase surfactant production.
Dilate the major bronchi.
Enhance ciliary action in the tracheobronchial tree.
18
Slide 101
Low urine specific gravity.
Elevated hematocrit.
Increased serum chloride.
Decreased serum sodium.
19
Slide 152
It can be treated by intramuscular (IM) antibiotics.
The etiology is unknown.
Permanent hearing loss often results.
It is treated with a broad range of antibiotics.
20
Slide 13
Constipation
Insomnia
Tachypnea
Tachycardia
21
Slide 83
10:00 AM
4:00 PM
12:00 AM
2:00 PM
22
Slide 34
Only give the KCl through a central venous line.
Administer the KCl as a rapid IV bolus.
Discontinue cardiac monitoring during the infusion.
Infuse the KCl at a rate of 10 mEq/hour.
23
Slide 27
with a hemoglobin of 8.5 g/dL
who has been on anticoagulants for 10 days
with a blood glucose of 350 mg/dL
with a heart rate of 100 bpm and blood pressure of 100/60
24
Slide 74
50-yo with adenomatous polyposis has occult blood in stool
30-yo has abdominal distention and apical heart rate 136 bpm
40-yo with Crohn’s has had 6 liquid stools in previous 4 hrs
60-yo with new ileostomy drained 800mL over past 8 hrs
25
Slide 103
Observe the dressing for bleeding.
Assess the patient’s respiratory effort.
Check the blood pressure and pulse.
Support the patient’s head with pillows.
26
Slide 8
Compress ankle using an elastic bandage.
Apply ice directly to the skin.
Apply heat to the ankle every 2 hours.
Ambulate to keep the joint loose.
27
Slide 17
Weak, nonproductive cough effort
Large amounts of greenish sputum
Resting pulse oximetry (SpO2) of 85%
Respiratory rate of 28 breaths/minute
28
Slide 147
Ask the woman about drug use, including over the counter.
Ask the woman if this pregnancy was planned or is wanted.
Encourage the woman to be more forthright with answers.
Call social services to come evaluate the situation.
29
Slide 43
Provide a diet of ground beef, eggs, and chicken breast.
Teach the client to avoid foods high in magnesium.
Encourage the intake of antacids with phosphate.
Monitor the client for irregular heart rhythms.
30
Slide 32
Reported weight gain of 2.2 lb (1 kg)
Serum sodium level of 120 mg/dL
Urinary output of 280 mL during past 8 hours
Serum hematocrit of 42%
31
Slide 137
“The baby will need immunizations earlier now.”
“Be sure to monitor how many diapers the baby wets.”
“Be sure to use an iron-fortified formula instead.”
“That’s OK. formula is just as good for a 5-month-old.”
32
Slide 11
HOB elevated 45 to 60 degrees, with client supine for 15 min
Head of bed flat, with client supine for at least 60 minutes
HOB at 10 degrees w/client in left lateral position 60 min
HOB 30-45 degree w/client in right lateral position 60 min
33
Slide 81
“I will eat to prevent hypoglycemia, even if not hungry.”
“I will eat bedtime snacks because of evening NPH insulin”
“I can have occasional alcohol if included in my meal plan”
"I can eat any food, as long as I use insulin to cover”
34
Slide 161
Notify provider for signs of increasing respiratory distress
Assess IV maintenance fluids and site every hour
Administer oxygen by NC to keep oxygen saturation at 100%
Organize care to allow for uninterrupted rest periods
35
Slide 82
Avoid injecting the insulin into the upper abdominal area
Push plunger down while removing syringe from injection site
Cleans skin with soap & water before insulin administration
Store insulin in freezer after administering prescribed dose
36
Slide 30
Hold breath for 5 sec after using the bronchodilator inhaler
Use inhaled corticosteroid when shortness of breath occurs.
Tremors are expected with rapid acting bronchodilators
Inhale slowly and deeply when using the dry powder inhaler
37
Slide 45
Aortic
Mitral
Tricuspid
Pulmonic
38
Slide 40
Potassium
Phosphorus
Sodium
Magnesium
39
Slide 158
It measures the amount of air the child breathes in.
It will help the medication reach the child’s airways.
It measures the child’s lung volume.
It is used to monitor the child’s breathing capacity.
40
Slide 112
The patient’s peritoneal effluent appears cloudy
The patient’s abdomen appears bloated after the inflow
The patient has an outflow volume of 1800 mL
The patient has abdominal pain during the inflow phase
41
Slide 117
Call the laboratory and repeat the test.
Obtain an ECG strip and have lidocaine available.
Call the cardiac arrest team to alert them.
Take the client’s vital signs and notify the physician.
42
Slide 16
A shortened expiratory phase of the respiratory cycle
Increased oxygen saturation with ambulation
A widened diaphragm documented by chest x-ray
Hyperinflation of lungs documented by chest x-ray
43
Slide 7
“He can’t remember to take his pills or whether he’s bathed”
"She’s convinced that snakes come into her room at night.”
“She was fine last night but this morning she was confused.”
“Dad doesn’t seem to recognize us anymore.”
44
Slide 75
Insert a urinary catheter to drainage.
Infuse metronidazole (Flagyl) 500 mg IV.
Send the patient for a computerized tomography scan.
Place a nasogastric (NG) tube to intermittent low suction.
45
Slide 146
Roseola
Rubella
Herpes simplex virus (HSV)
Measles
46
Slide 26
RSV can survive on nonporous surfaces for about 60 minutes
Frequent handwashing can decrease the spread of the virus.
RSV is transmitted through particles in the air.
RSV can live on skin/paper for a few seconds after contact
47
Slide 138
“She may need to begin taking them at age 6 months.”
“Yes, the baby needs to begin taking them now.”
“Use infant cereal mixed with fluoridated water instead.”
“Is your water fluoridated?”
48
Slide 87
Bedtime glucose of 140 mg/dL
2-hr postprandial glucose of 220 mg/dL
Fasting blood glucose of 130 mg/dL
Noon blood glucose of 52 mg/dL
49
Slide 131
PCP
Alcohol
Cocaine
Heroin
50
Slide 105
Quadriceps-setting exercises
Assisted weight-bearing ambulation
Positioning the left leg in flexion
Immobilization of the left leg
51
Slide 135
“Limit cow’s milk to one bedtime bottle.”
“Children should not get cow’s milk until 1 year of age.”
“Milk is a nutritious choice at this time.”
“Mix cereal with cow’s milk and feed it in a bottle.”
52
Slide 10
Support family to prepare for progression of dementia
Reorient with the day and date each time you interact
Avoid touch and proximity; as this may provoke aggression
Arrange therapist to eval and treat suspected depression
53
Slide 120
Blood glucose.
Blood urea nitrogen (BUN).
Level of consciousness (LOC).
Bowel sounds.
54
Slide 89
Complete blood count (CBC)
Chest x-ray
Echocardiogram
Serum creatinine
55
Slide 166
Place in the Trendelenburg position after eating.
Thicken formula with rice cereal.
Give continuous nasogastric tube feedings.
Give larger, less frequent feedings.
56
Slide 94
Administer the PRN glucagon (Glucagon) 1 mg IM
Give the patient 4 to 6 oz more orange juice
Notify the health care provider about the hypoglycemia
Have the patient eat some peanut butter with crackers
57
Slide 76
Catheterize patient every 3 to 4 hours.
Stabilize the neck when repositioning the patient
Assist patient to ambulate 4 times daily
c.Administer medications to reduce bladder spasm
58
Slide 3
Early onset dementia.
A urinary tract infection.
Skipping breakfast.
A mild cognitive disorder.
59
Slide 86
Teach increased risk for fetal problems with gestational DM
Teach the patient about administering regular insulin
Schedule oral glucose tolerance test at 24th week pregnancy
Schedule the patient for a fasting blood glucose level
60
Slide 100
Obese
Underweight.
Healthy.
Overweight.
61
Slide 49
Meperidine hydrochloride
Supplemental oxygen
Bed rest
Intravenous fluids
62
Slide 35
Lung sounds.
Urinary output.
Peripheral edema.
Peripheral pulses.
63
Slide 153
Avoid children with OM.
Avoid tobacco smoke.
Use nasal decongestant.
Bottle feed or breastfeed in supine position.
64
Slide 53
Remind most of physical changes will resolve after surgery
Discuss diet/exercise with Cushing syndrome wt gain
Teach metabolic impact of Cushing syndrome
Reassure the physical changes common with Cushing syndrome
65
Slide 114
Creatinine 1.6 mg/dL
Blood pressure 98/56 mm Hg
Oxygen saturation 89%
Hemoglobin level 13 g/dL
66
Slide 155
Administer antibiotics as ordered.
Give cool, humidified oxygen.
Position on the side with neck slightly flexed.
Restrict oral and parenteral fluids if tachypneic.
67
Slide 19
The patient reports a recent 15-pound weight gain.
The patient complains about coughing up green mucus.
The patient denies any shortness of breath at present.
The patient takes cimetidine (Tagamet) 150 mg daily.
68
Slide 126
Oatmeal with cream, half a banana, and herbal tea
Cheese sandwich, tomato soup, and cranberry juice
Poached eggs, whole-wheat toast, and apple juice
Split-pea soup, English muffin, and nonfat milk
69
Slide 90
decrease intake of carbs until hemoglobin A1C is < 7%
limit calories until the glucose is < 120 mg/dL
use only the lispro insulin until the symptoms are resolved
check blood glucose q4hrs & call clinic if continues to rise
70
Slide 1
“The local police know that he has wandered off before.”
“We’ve installed locks on all the outside doors.”
“I keep the noise level low in the house.”
“phone number is always on his shirt pocket.”
71
Slide 69
Discontinue the patient’s oral food intake.
Administer cobalamin (vitamin B12) injections.
Teach the patient about total colectomy surgery.
Administer IV metoclopramide (Reglan).
72
Slide 110
The patient plans 30 to 60 minutes for a dialysate exchange
The patient slows the inflow rate with abdominal pain
The patient cleans the catheter while taking a bath each day
The patient leaves the catheter exit site without a dressing
73
Slide 127
Ingest 50G oral glucose solution then blood taken 2,4,5 hrs
The client should follow pretest dietary instructions.
Ingest 100G oral glucose solution then blood taken 1, 2, 3hr
The client will not need to fast for this type of test.
74
Slide 63
“The medication will be tapered if I need surgery.”
“I will need to avoid contact with people who are sick.”
"I will need to use a sunscreen when I am outdoors.”
“The medication prevents the infections that cause diarrhea”
75
Slide 133
A popping sound occurs when breast removed from the mouth
Remove breast from mouth when infant asleep and jaw relaxed
Break suction, inserting finger into corner of infant mouth
Elicit Moro reflex, wake baby, remove breast when baby cries
76
Slide 20
Absence of wheezes, rhonchi, or crackles
Pulse oximetry reading of 92%
Respiratory rate of 18 breaths/minute
Even, unlabored respirations
77
Slide 2
Place identification bracelet on client.
Monitor neurological status on an ongoing basis.
Give one simple direction at a time in a respectful tone.
Assist with needs and personal hygiene.
78
Slide 145
The child should begin a course of oral antibiotics.
The child should be prescribed acyclovir.
No intervention is needed unless varicella develops.
Administer the varicella vaccine as soon as possible.
79
Slide 68
Order a diet high in fiber and fluids.
Give stool softeners and enemas.
Administer IV fluids.
Prepare for colonoscopy.
80
Slide 6
Localized decreased breath sounds
Hyperresonance on percussion
Paradoxical respiration
Barrel shaped chest
81
Slide 67
Metabolic alkalosis.
Projectile vomiting.
Referred back pain.
Abdominal distention.
82
Slide 70
Navy bean soup and vegetable salad.
Roast beef sandwich on whole wheat bread.
Whole grain pasta with tomato sauce.
Baked potato with low-fat sour cream.
83
Slide 25
Abdominal breathing
Nasal flaring
Respiratory rate of 55 breaths/min
Irregular respiratory pattern
84
Slide 168
Assess the family’s beliefs and values about vaccinations
Obtain written informed consent before giving the vaccine
Wipe the dorsal gluteal area with alcohol prior to injection
Give the vaccine info prior to administering the vaccine
85
Slide 12
Medication therapy has changed the normal flora of the mouth
Infection blocks sensation from the taste buds of the tongue
Blocked nasal passages impair the senses of smell and taste.
Anorexia is triggered by the infectious organism.
86
Slide 128
Access to protective resources through social services
Demonstrate effective use of relaxation techniques
Demonstrate understanding of response to traumatic event
Identify feelings through the use of play therapy
87
Slide 132
Continue breastfeeding without any supplements
Start giving the infant a vitamin D supplement
Start feed infant rice cereal with a spoon at evening time
Start an infant feeder and add rice cereal to the formula
88
Slide 59
Inhibit gastric acid secretion
Increase gastric motility.
Increase histamine release.
Neutralize gastric acidity.
89
Slide 85
The patient is scheduled for a chest x-ray in an hour
The patient has gained 2 lbs in the past 24 hours
The patient’s blood glucose level is 174 mg/dL
The patient’s blood urea nitrogen (BUN) level is 52 mg/dL
90
Slide 165
Child will not have constipation & malabsorption syndrome
Child will not experience diarrhea w/malabsorption syndrome
Child will have adequate nutrition AEB weight gain 1 kg/week
The child will experience no abdominal spasms.
91
Slide 125
Birthweight of 10 pounds.
Strong suck response.
Jitteriness or tremors.
Slight jaundice.
92
Slide 122
Pulmonary edema.
Pulmonary emboli.
Pericardial effusion of fluid.
Myocardial ischemia.
93
Slide 118
Increased calories needed b/c glucose lost d/t hemodialysis
Dietary K+ not restricted b/c level normalized by dialysis
More protein OK b/c urea & creatinine removed by dialysis
Unlimited fluids allowed b/c fluid removed during dialysis
94
Slide 79
The pt drank several glasses of water an hour previously
The patient has had a 10-lb weight gain in the last month
The patient reports having occasional orthostatic dizziness
The pt takes oral corticosteroids for rheumatoid arthritis
95
Slide 150
“See the doctor when the baby gets a respiratory infection.”
“Have your pediatrician prescribe erythromycin.”
baby will have maternal immunity that will last 18 month”
“Make sure your child gets the pertussis vaccine.”
96
Slide 24
Place a paper bag over the patient’s face to re-breathe CO2
Use oxygen cautiously in this patient.
Administer CO2 via mask.
Administer high levels of oxygen.
97
Slide 55
Coughs and deep breathes
Blood pressure within normal
Shallow breathing
Hypoglycemia
98
Slide 66
Nausea
Headache
Joint pain
Fever
99
Slide 130
A daily consumption of ETOH indicates a risk for alcoholism.
She will be at risk for abusing other substances as well.
The fetus is at risk for multiple organ anomalies.
The fetus is placed at risk for altered brain growth.
100
Slide 115
Prevent hematemesis
Prevent reflux
Increase gastric acid production
Reduce gastric acid production
101
Slide 42
Magnesium
Calcium
Potassium
Sodium
102
Slide 62
Administer the prescribed PRN IV morphine sulfate.
Teach the effects of ketorolac typically last about 6-8 hrs
Reassure that postoperative pain is expected after surgery
Notify the health care provider about the ongoing pain.
103
Slide 91
Peripheral edema is increased.
Urine specific gravity is increased.
Urinary output is increased.
Weight has increased.
104
Slide 162
Pancreatic enzymes
Cool humidified oxygen
Intermittent positive pressure ventilation
Erythromycin intravenously
105
Slide 92
“I will weigh self daily & report sudden weight loss/gain”
“I need to limit fluid intake to < 1 qt of liquids a day”
“I should eat food high in K+ as diuretics cause K+ loss”
“I need foods low in Na+ & avoid adding salt to food”
106
Slide 119
Reduce caffeine and alcohol intake.
The DASH diet is effective in lowering blood pressure.
Encourage routine sitting sessions to reduce stress.
Limit Salt intake if one is salt sensitive.
107
Slide 124
"I should not stop taking the carvedilol suddenly“
"I can expect feel short of breath when taking carvedilol“
"Carvedilol will help my heart muscle work harder"
"Carvedilol will increase the blood flow to my heart muscle"
108
Slide 116
Blood urea nitrogen (BUN) level
Creatinine level
Glomerular filtration rate (GFR)
Urine volume
109
Slide 60
Reduce hydrochloric acid secretion.
Augment the immune system.
Treat helicobacter pylori infection.
Potentiate the effects of antacids.
110
Slide 96
“Have you had a recent unplanned weight gain or loss?”
“What methods do you use to help cope with stress?”
“Do you have to get up at night to empty your bladder?”
“Have you experienced any blurring or double vision?”
111
Slide 21
Rest in bed high-Fowler’s position with the knees flexed
Have PT sit up at bedside in a chair & lean slightly forward
Have PT rest in bed with head elevated to 15- 20 degrees
Place PT in Trendelenburg position with pillows behind head
112
Slide 84
Instruct the patient how to self-catheterize.
Catheterize for residual urine after voiding.
Assist the patient to the toilet every 2 hours.
Teach the patient the Credé method.
113
Slide 99
RN checks the blood pressure in both arms
RN lowers thermostat to decrease temperature in the room
RN orders saline eye drops for pt’s bulging eyes
RN palpates the neck to assess thyroid size
114
Slide 158
Give ordered antibiotics on time.
Provide oxygen via face tent.
Prepare to administer a bronchodilator.
Assess the airway for a foreign body.
115
Slide 28
Immune system
Hepatic System
Endocrine system
Neurologic system
116
Slide 97
Surgery will be required to remove the thyroid gland
Restriction of iodine is needed to reduce thyroid activity
Exercise is contraindicated to avoid increase metabolic rate
Antithyroid meds may take several months for full effect
117
Slide 22
Increases the risk of pneumonia and atelectasis
Decreases diaphragmatic excursion and depth
Is drying to nasal mucosal passages
Decreases the client’s oxygen-based respiratory drive
118
Slide 39
Potassium
Phosphorus
Magnesium
Sodium
119
Slide 144
“It is far riskier to not immunize your baby.”
“It is your decision to immunize your child or not.”
“This has to be reported to the health department.”
“You should probably think about this decision.”
120
Slide 169
Varicella
HepA
IPV
DTaP
121
Slide 148
“She should be vaccinated between 4 and 6 years of age.”
“This vaccine is administered when the child 11 years old”
“The first dose is given any time after the first birthday.”
“Your baby can get the measles vaccine now.”
122
Slide 18
Impaired gas exchange related to respiratory congestion
Impaired transfer ability related to weakness
Hyperthermia related to infectious illness
Ineffective airway clearance related to thick secretions
123
Slide 109
Send to radiology for CT scan of right leg
Administer dose of gentamicin 60 mg IV
Obtain blood cultures from two sites
Administer acetaminophen now and q4 hrs PRN for fever
124
Slide 136
Constantly chewing on the bottle nipple
Frequently throwing the bottle down
Takes very little formula from bottle
Appears to be sucking consistently when given a bottle
125
Slide 29
Hematocrit level of 45%
Hemoglobin level of 8.0
Pulse oximetry of 90%
Red blood cell count of 5.0 million/mm3
126
Slide 123
Electrolyte balance
Dental decay
Body weight well below ideal range
Moist, oily skin
127
Slide 37
Dietary protein intake.
Daily alcohol intake.
Over-the-counter (OTC) laxative use.
Multivitamin/mineral use.
128
Slide 64
The patient uses incontinence briefs to contain loose stools
The patient asks for antidiarrheal med after each stool
The patient uses witch hazel compresses to soothe irritation
The patient cleans perianal area with soap after each stool
129
Slide 149
“I’ll give her plenty of liquids to keep her hydrated.”
“I can give her acetaminophen for a fever.”
“I should keep her covered lightly when she has a fever.”
“I’ll look for over-the-counter aspirin or ibuprofen.”
130
Slide 88
Glomerular filtration rate is decreased.
Last eye examination was 18 months ago.
Hemoglobin A1C level is 7.9%.
Patient has questions about the prescribed diet.
131
Slide 121
The client states that the pain "wakes me up at night“
Client states pain "goes away" with 1 sublingual NTG tablet
The client rates the pain at a level 3 to 5 (0 - 10 scale)
Client says "pain increased in frequency over the last week"
132
Slide 50
Bradycardia
Peripheral edema
Increased urinary output
Hypertension
133
Slide 80
Changes diet/exercise may control blood glucose in type 2 DM
Complications of type 2 DM are less serious than type 1 DM
Insulin is not used to control blood glucose with type 2 DM
Type 2 DM diagnosed when pt is admitted w/hyperglycemic coma
134
Slide 52
Steak sauce
Sherbet
Leafy green vegetables
Apple juice
135
Slide 4
Helps prevent constipation.
Increase intake through out the day.
The person may be anorexic.
Assists with monitoring food intake.
136
Slide 93
Impaired gas exchange related to fluid retention in lungs
a.Excess fluid volume related to intake greater than output.
Risk for impaired skin integrity r/t generalized edema
Sleep pattern disturbance r/t frequent waking to void
137
Slide 33
Assign the patient to a room near the nurse’s station.
Place the patient in a room nearest to the water fountain.
Assign the patient to a semi-private room.
Place the patient on telemetry to monitor for peaked T waves
138
Slide 167
Doesn't require as much formula in first few days of life
tires easy first few days but will gradual take more formula
infant probably having difficulty adjusting to the formula
Stomach capacity small at birth but will expand in few days
139
Slide 141
embryonal failure foregut to differ to trachea & esophagus
extra connection because of genetic abnormalities.
the defect occurs in the second trimester of pregnancy.
fistula b/t esophagus & stomach result oral intake aspirated
140
Slide 156
Dehydration
Febrile episodes
Seizures
Exercise
141
Slide 106
The reason for oral antibiotic for 7-10 days after discharge
How to monitor and care for a long-term IV catheter
Need for daily exercise to help maintain muscle strength
How to apply warm packs to the leg to reduce pain
142
Slide 98
Administer IV calcium gluconate.
Prepare for endotracheal intubation.
Plan for emergency tracheostomy.
Suction the patient’s airway.
143
Slide 57
Ascites and peripheral edema
Temperature over 102o F (38.9o C)
Left upper abdominal pain
Hematochezia
144
Slide 154
22 1/8 lb
29 1/2 lb
14 3/4 lb
Unable to estimate weigh at 1 year
145
Slide 151
symptomatic treatment and observation for 48-72 hrs after dx
oral antibiotic, such as amoxicillin, 5 times/day for 7 days
pneumococcal conjugate vaccine
myringotomy with tympanoplasty tubes
146
Slide 44
Heart sounds.
Capillary refill.
Skin turgor.
Mental status.
147
Slide 23
Not be touched until the entire process is finished.
Be aware of the procedure being done.
Not know that respiration are being assessed.
c.Understand that respirations are estimated to save time.
148
Slide 160
Inhaled corticosteroids
Short-acting beta2-adrenergic agonist
Long-acting bronchodilators
Leukotriene blockers
149
Slide 78
fasting preprandial glucose levels.
glucose control over the past 90 days.
hypoglycemic episodes in the past 3 months.
glucose levels 2 hours after a meal.
150
Slide 36
Respiratory acidosis.
Respiratory alkalosis.
Metabolic alkalosis.
Metabolic acidosis.
151
Slide 134
The woman's stable emotional and psychological status.
Total protein excretion & creatinine clearance WNL
Evaluation of retinopathy by an opthalmologist.
Degree of glycemic control before and during pregnancy.
152
Slide 102
Symptoms of hypothyroidism may occur during RAI therapy
About radioactive precautions with all body secretions.
Symptoms of hyperthyroidism should be relieved about 1 week
to DC antithyroid meds taken before the radioactive therapy
153
Slide 139
IV solutions while the child is NPO.
antidiarrheal medications.
oral rehydration solution (ORS).
clear liquids.
154
Slide 41
Diabetes Mellitus
Fluid volume deficit
SIADH
Fluid volume excess
155
Slide 51
Give 4 oz of fruit juice orally.
Recheck the blood glucose level.
Infuse 5% dextrose and 0.9% saline.
Administer O2 therapy as needed.
156
Slide 61
Ambulate six times daily.
Monitor stools for blood.
Increase dietary fiber intake.
Restrict oral fluid intake.
157
Slide 31
Potassium
Calcium
Sodium
Phosphorus
158
Slide 95
The patient is confused and lethargic
The patient’s urine specific gravity is 1.003
The patient has a urine output of 400 mL/hr
The patient reports a recent head injury
159
Slide 65
Medication use.
Enteral nutrition.
Fluid restriction.
Activity restrictions.
160
Slide 38
There is prolonged skin tenting over the sternum
Oral fluid intake is 100 mL for the past 8 hours
Blood pressure is 90/40 mm Hg
Urine output is 30 mL/hr.
161
Slide 163
Teach the parents how to do infant CPR
Teach parents to position the infant on the left side
Have parents keep an accurate record of intake and output
Reinforce the parent knowledge of infant developmental needs
162
Slide 113
Have several servings of dairy products daily.
Avoid commercial salt substitutes.
Restrict fluid intake to 1000 mL daily.
Take phosphate binders after meals.
163
Slide 56
Request an order for acetaminophen (Tylenol).
Place ice packs in the patient’s axillae.
Ask the provider to prescribe a different antibiotic.
Have the patient use the incentive spirometer.
164
Slide 73
Assessment of the nares for irritation
Applying petroleum jelly to the lips
Auscultation for bowel sounds
Nasogastric (NG) tube irrigation
165
Slide 164
Keep patient NPO.
Obtain CBC on admission to nursing unit.
Start IV of D5/0.45 normal saline at 60 mL/hr.
Apply K-pad to abdomen prn for pain.
166
Slide 48
Preventing bearing down
Administering oxygen
Being reassuring
Maintaining strict asepsis
167
Slide 129
Fetal addiction to the substance inhaled
Genetic changes and anomalies
Intrauterine growth restriction
Extensive central nervous system damage
168
Slide 107
Review the patient’s serum creatinine.
Obtain the patient’s oral temperature.
Change the prescribed wet-to-dry dressing.
Ask the patient about any nausea.
169
Slide 54
Serum hematocrit of 42%
Serum sodium level of 120 mg/dL
Reported weight gain of 2.2 lb (1 kg)
Urinary output of 280 mL during past 8 hours
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Slide 47
Stay on a low protein diet
Consume a diet high in carbohydrates
Avoid alcohol ingestion.
Eat high-fat foods
