8 Withhold the heparin infusion 3. client who is postoperative and requests pain medication before ambulation c. A person with atrial fibrillation may have dizziness and syncope ; It does not increase the risk of stroke. A patient is beginning the second round of high dose cisplatin. The nurse is assisting a client on a low-potassium diet to select food items from the menu. Advise the client to splint the surgical incision A nurse is caring for a client receiving moderate (conscious) sedation… Administer reversal agents A nurse has been assigned. Following discharge teaching a male client with duodenal ulcer tells the nurse the he will drink plenty of dairy products such as milk to help coat and protect his ulcer. 4C, pulse 114, resp 22, blood pressure 142/90. The client is experiencing nausea and vomiting following surgery. ) Moist crackles in the lungs D. Assist the client into a position of comfort. B) Always, because nurses who supervise lesstrained individuals are responsible for their mistakes. Prioritize nursing responsibilities in admitting patients to the postanesthesia care unit (PACU). extensive blood loss during the procedure required fluid resuscitation of the client. The nurse suspects the patient is: A) overmedicated. The nurse knows that the purpose of this medication is to In evaluating the effects of lactulose Cephulac which outcome would indicate that the drug is performing as intended? The healthcare provider prescribes digitalis Digoxin for a client diagnosed with congestive heart. Evaluating the client for nausea, vomiting, and anorexia j. Nausea is a queasy sensation that may include or not include an urge to vomit. Introduction Postoperative nausea, retching and vomiting (PONV) remains one of the most common side effects of general anaesthesia, contributing significantly to patient dissatisfaction, cost and complications. An antacid Maalox is prescribed for a client with peptic ulcer disease. Which nursing action would be most appropriate at this time? What is the priority intervention when caring for the client in the immediate postoperative period? Select one: a. A 15-year-old client is being treated at the hospital for severe diarrhea following a bacterial infection. Nausea, vomiting or queasiness; Abnormal movements of the eyes; Headache; Ringing in the ears; Hearing loss; Sweating; Feeling unbalanced and pulled to one direction; If you are assigned to take care of a patient currently experiencing dizziness, here’s how you can write a nursing care plan for vertigo. Correct Maintain a gastric pH of 3. a client who is to receive an antibiotic in 1 hr and has a prescription for a peak and trough level d. A nurse is caring for a client who has been admitted for a small bowel obstruction and has been vomiting for 24 hours. A nurse is reinforcing teaching with an older adult client who has osteoporosis. A clear understanding by the client and family of the purpose, anticipated benefits, and consequences of total laryngec-tomy prior to surgery is vital to promote postoperative recovery. Question: The Nurse Is Caring For A Client Who Has Been Prescribed Intravenous Metoclopramide. ) Full, bounding pulse B. Amoxicillin is a penicillin. Chewing gum has potential as a novel, drug-free alternative treatment. Nursing Times; 109: 22, 24-26. c) The client must be put on immediate life support. ATI COMPREHENSIVE PREDICTOR ALL DOCUMENT QUESTIONS AND ANSWERS1. Pain is whatever the experiencing person says it is. Which of the following is the most likely outcome for this client? a) The client should be transferred to an intensive care area. Postoperative bleeding can become life-threatening. a client with colon cancer is discharged home with morphine for pain management is having episodes of nausea and vomiting which route of morphine administration would be most advantageous to use: rectal: the nurse is caring for four clients which client assessment would be the most indicative for having pain: heart rate of 100 bpm and restless. a client who is schedule for discharge and required wound care teaching b. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. Which of the following best describes the rationale for the; nurse’s position? 1. Which of the following findings indicate that the client is experiencing fluid volume deficit? (Select all that apply. Identify factors that are contributing to nausea or vomiting: copious sputum, aerosol treatments, severe dyspnea, pain. Pulmonary complications are responsible for significant numbers of deaths and morbidity of patients undergoing thoracotomy. The nurse is assigned to care for a female client with complete right-sided hemiparesis. A Penrose drain is in place. The nursing care plan should include activities to meet the patient's needs while helping him cope with these alterations. NR 305 HESI Review Questions with Answers An antacid Maalox is prescribed for a client with peptic ulcer disease. Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam. Which of the following would be subjective information about the client? Select all that apply. The student asks his preceptor what this might indicate. A nurse is caring a client who is taking digoxin (Lanoxin) 0. The nurse is caring for a patient who has postoperative nausea and vomiting. Which of the following interventions should the nurse use that would best prevent this client from developing complications of severe dehydration?. 25mcg tab once a day. The LPN is part of a group of nurses that has an RN team leader as well as another LPN and two nursing assistants who will be providing care to a group of clients. In addition to her chemotherapy regimen, which medication would be best to administer?. I and the patients hearing is amplified. Which of the following would be subjective information about the client? Select all that apply. a nurse is caring for a client following an open thoracotomy for removal of a large tumor. Which intervention by the nurse is most appropriate?. client who is postoperative and requests pain medication before ambulation c. Become a part of our community of millions and ask any question that you do not find in our NCLEX Q&A library. See full list on registerednursing. Cost: free. D- Place in a prone position. An antacid Maalox is prescribed for a client with peptic ulcer disease. And postoperatively, expect about half of your patients to experience nausea and 30% to experience the vomiting with it (Koutoukidis et al. Ferris Bueller Learning Outcomes 1. Clients with a pacemaker, osteoporosis, and peptic ulcer disease need to be monitored closely but are not at risk for major complications, as is the client with alcohol abuse and liver disease. While many pregnant women experience morning sickness, hyperemesis gravidarum develops between the 4th - 6th weeks of pregnancy and may last longer than week 20. 2017; Gan et al. Which of the following medications is an appropriate medication to treat this client’s UTI? Cimetidine ; Clopidogrel. III and the patient has depressed reflexes. A patient is beginning the second round of high dose cisplatin. Other times it is the ability to improve the body’s ability to achieve or maintain health. Nursing Care of Children Review of Concepts proctored A nurse is educating the parent of a 9-month-old infant who has recently been diagnosed with cerebral palsy. •Provide routine preoperative care and teaching as explained in Chapter 7. Calories r. What is the best nursing intervention to minimize the adverse effects of this drug therapy? A patient is in the clinic after 6 weeks of taking riluzole Rilutek for a. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? (Select all that apply) A. Which is a priority nursing intervention? 1. A charge nurse is discussing mental status exams with a newly licensed nurse. The nurse has entered the room of a client who is postoperative day 1 and finds the client grimacing and guarding her incision. A nurse is reviewing. which of the following clients should he nurse attend to first? a. ) Orthostatic hypotension E. Topal, Kubra; Aktan, Bulent; Sakat, Muhammed Sedat; Kilic, Korhan; Gozeler, Mustafa. Lab values are aPTT 98 seconds and INR 1. Assess the clients pain on a -to-10 scale. A care plan can be done for a healthy person as well as for someone who is ill. A person with atrial fibrillation may have dizziness and syncope ; It does not increase the risk of stroke. Postoperative Management If the patient is restless, something is wrong. What action should the nurse take? ANS: Escort the client to a quiet area on the nursing unit. Which of the following best describes the rationale for the; nurse’s position? 1. A client with acquired immunodeficiency syndrome experiences nausea, vomiting, and abdominal pain radiating to the back after taking didanosine (Videx). Identify precipitating event, if any; identify frequency, duration, intensity, and location of pain. Aggressive management before, during, and after his chemotherapy can prevent nausea. - Assess the gastro intestinal function by auscultation of bowel sounds. "To assess language. If you don't stop and look around once in a while, you could miss it. The nurse answers the door. by nausea and vomiting. To administer an antacid hourly or to wait one hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a. B- Encourage oral intake of at least 3,000 ml per day. )Decreased skin turgor C. KEY: Postoperative nursing| nausea and vomiting| respiratory assessment| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential. I and the patients hearing is amplified. "To assess affect, I should observe the client's facial expression. C) Provide a clean and comfortable bed. At 0800, 30 minutes after pain medication was administered, the nurse evaluated the client and found that his pain was a 4 on a scale of 0 to 10. The nurse is assessing a client in the urgent care clinic who is complaining of burning with urination. The disease is usually autoimmune and adrenal autoantibodies in plasma was found in 75-80% of patients. As appropriate, refer the family to a community health nurse for follow up care after discharge. Help the client to engage in activities that hard to do. The client is experiencing nausea and vomiting following surgery. Wear a clean nylon stump sock daily b. A nurse is caring for a postoperative client who reports discomfort, but denies serious pain and does not want medication. If you don't stop and look around once in a while, you could miss it. Diabetic Gastroparesis 3. A nurse is caring for a patient who has the following arterial blood gas results : HCO3 18mEq, PaCO2 28mm Hg, and pH 7. Nurse Juvy is caring for a client with cirrhosis of the liver. Which of the following nursing interventions should the nurse implement to modify the client's environment to relieve nausea and vomiting? A) Avoid strong odors in the client's room. Encourage the client perform normal daily activities, according to ability. Learning Outcome: 3 Discuss the medical therapy and nursing care of a woman with hyperemesis gravidarum. It is a classic symptom of infantile hypertrophic pyloric stenosis, in which it typically follows feeding and can be so forceful that some material exits through the nose. The LPN is part of a group of nurses that has an RN team leader as well as another LPN and two nursing assistants who will be providing care to a group of clients. Nursing Care of Patients in Pain Multiple Choice Identify the choice that best completes the statement or answers the question. Client perceived that the present disease condition is much more severe than the previous condition. Nausea and vomiting commonly occur together, but are also distinct symptoms. Correct Maintain a gastric pH of 3. b Supplement your diet with vitamin E. This enables the client to read the nurse’s lips; 2. ATI COMPREHENSIVE PREDICTOR ALL DOCUMENT QUESTIONS AND ANSWERS1. which of the following clients should he nurse attend to first? a. Risk for deficient fluid volume r/t hemorrhage D. Pain is an unpleasant sensation caused by physical injury. The nurse is assigned to care for a client with urinary calculi. Rationale: Choice of interventions depends on the underlying cause of the problem. Identify factors that are contributing to nausea or vomiting: copious sputum, aerosol treatments, severe dyspnea, pain. Glaucoma ANS: D Promethazine is contraindicated in patients with glaucoma since it is an anticholinergic. Based on this assessment the nurse administers pain medication to the client. by nausea and vomiting. Prevent cracking of the skin of the stump by applying lotion daily d. Pharmacology Proctored Assesment A patient newly diagnosed with hypothyroidism is prescribed Levothyroxine Synthroid 0. D) developing shock. To compare effects and. Postoperative bleeding can become life-threatening. A nurse is caring for a client who is 1-day postoperative following a left lower lobectomy and has a chest tube in place. Put in an NG tube A nurse is caring for a client who is postoperative following abdominal surgery. o Potassium level is 3. Paralytic Ileus 2. Although postoperative care is a daily occurrence within many areas of practice, it is evident that the theory underpinning nursing actions is often forgotten in daily practice and hence actions may not be prioritised as they should be. Primary nursing is when the RN assumes 24-hour accountability for the client’s care and has total responsibility for the nursing care of assigned clients during his or her shift. "Take crackers and milk with each dose of the medication. Which is a priority nursing intervention? 1. Nursing Interventions. A diagnosis is based on the assessment data you have collected on the patient. - Assess the gastro intestinal function by auscultation of bowel sounds. Nurse Juvy is caring for a client with cirrhosis of the liver. Hyperemesis gravidarum is extreme morning sickness that causes long-lasting intense nausea, vomiting, and weight loss. The client rates his or her pain at a 6 on a 0-10 scale ; The client's temperature is 100. b) The client can be discharged from the PACU. Cost: free. a client who is schedule for discharge and required wound care teaching b. 2°F, pulse oximetry 90%, shivering, and client complains of chilling. Episodes of nausea and vomiting. The nurse suspects the patient is: A) overmedicated. A nurse is caring for a client who has been admitted for a small bowel obstruction and has been vomiting for 24 hours. III and the patient has depressed reflexes. by nausea and vomiting. A nurse in a LTC facility notices a client who has Alzheimer’s disease standing at the exit door at the end of the hallway. Symptoms can include abdominal cramps, diarrhoea and vomiting. c) The client must be put on immediate life support. The nurse is preparing to assess a patients pain level. The nursing care plan should include activities to meet the patient's needs while helping him cope with these alterations. The client does not have to turn her head to see the nurse; 3. C) allergic to the anesthesia. Which of the following best describes the rationale for the; nurse’s position? 1. The patients blood pressure is dropping and their heart rate is increasing. A clear understanding by the client and family of the purpose, anticipated benefits, and consequences of total laryngec-tomy prior to surgery is vital to promote postoperative recovery. The nurse recognizes that increased production of aldosterone and antidiuretic hormone (ADH) caused by FVD results in a decrease in which parameter?. The nurse answers the door. •Provide routine preoperative care and teaching as explained in Chapter 7. "To assess cognitive ability, I should ask the client to count backward by sevens. "Take crackers and milk with each dose of the medication. Question 4 5. The nurse is assessing a client in the urgent care clinic who is complaining of burning with urination. Rationale: Choice of interventions depends on the underlying cause of the problem. Pain is an unpleasant sensation caused by physical injury. The urinalysis shows that the client has a urinary tract infection (UTI). Multidisciplinary approach to patient care. 2017; Gan et al. · Monitor Intake and Output · Note color and character at the initial assessment and during your shift · Special attention to nasal and oral care. Postoperative Management If the patient is restless, something is wrong. A nurse is caring for a client with dementia who has. The nurse is caring for a client who is in the chronic phase of stroke (brain attack) and has a right-sided hemiparesis. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse recommends to the primary care provider for the client to receive:. watery diarrhea. B) Have the air-conditioning on in the client's room. Which of the following nursing interventions should the nurse implement to modify the client's environment to relieve nausea and vomiting? A) Avoid strong odors in the client's room. Episodes of nausea and vomiting. The vital signs are: blood pressure 95/48, pulse 114. NR 305 HESI Review Questions with Answers An antacid Maalox is prescribed for a client with peptic ulcer disease. 2010-01-01. Assess and document client response and effects of medication. A nurse is caring for a client who has been admitted for a small bowel obstruction and has been vomiting for 24 hours. Deficient knowledge r/t postop care C. The nurse notes abdominal distentionand revises the client's care plan based on the knowledge that postoperative gas pains develop as a result of impaired peristalsis of the intestines. acid-base management in the nursing interventions classification, a nursing intervention. Unfortunately, pharmaceutical management of PONV is not always successful, leaving patients distressed and health-care staff struggling to manage this event. A nurse is caring for a patient who has the following arterial blood gas results : HCO3 18mEq, PaCO2 28mm Hg, and pH 7. The nurse is caring for a client with Meniere’s syndrome. Which of the following actions should the nurse take? Ask another nurse to witness the disposal of the new patch. Glaucoma ANS: D Promethazine is contraindicated in patients with glaucoma since it is an anticholinergic. Which of the following statements made by the nurse are correct? Select all that apply. The nurse is caring for a client who is in the chronic phase of stroke (brain attack) and has a right-sided hemiparesis. Nursing Times; 106; 46, early online publication. A home care nurse is making a visit with a client who had a double-barrel colostomy created after bowel surgery. Based on this assessment the nurse administers pain medication to the client. Lab values are aPTT 98 seconds and INR 1. Clients with a pacemaker, osteoporosis, and peptic ulcer disease need to be monitored closely but are not at risk for major complications, as is the client with alcohol abuse and liver disease. When to Contact Your Doctor or Health Care Provider: Nausea and vomiting can also be caused by medical conditions unrelated to chemotherapy. 2°F, pulse oximetry 90%, shivering, and client complains of chilling. Nursing Times; 109: 22, 24-26. What is the best nursing intervention to minimize the adverse effects of this drug therapy? A patient is in the clinic after 6 weeks of taking riluzole Rilutek for a. A client with acquired immunodeficiency syndrome experiences nausea, vomiting, and abdominal pain radiating to the back after taking didanosine (Videx). Chapter 37: Care of the Surgical Patient Test Bank MULTIPLE CHOICE 1. Which of the following statements made by the nurse are correct? Select all that apply. put the client in high fowler's position. a nurse is receiving change-of-shift report for a group of clients. Chapter 34: Drugs Used to Treat Nausea and Vomiting Test Bank MULTIPLE CHOICE 1. So patient is psychologically depressed. Correct response p 448: Ineffective thermoregulation 6. link full download: https://bit. B) Have the air-conditioning on in the client's room. NURS 6521N Midterm Exam – Advanced Pharmacology A nurse is caring for a postsurgical patient who has small tortuous veins and had a difficult IV insertion. Nausea is a queasy sensation that may include or not include an urge to vomit. C) Provide a clean and comfortable bed. A diagnosis is based on the assessment data you have collected on the patient. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. A nurse’s challenge is to be aware of feelings and to always act in the best interest of the client, avoiding inappropriate involvement. The patients blood pressure is dropping and their heart rate is increasing. ) Flat neck veins. Post-operative nausea and vomiting (PONV) is one of surgery’s most distressing outcomes and can incur major physical and psychological suffering. I and the patients hearing is amplified. D) developing shock. Chapter 37: Care of the Surgical Patient Test Bank MULTIPLE CHOICE 1. They may also provide guidance for creating long-term goals for the client to work on after discharge. What is the best nursing intervention to minimize the adverse effects of this drug therapy? A patient is in the clinic after 6 weeks of taking riluzole Rilutek for a. In connection with ambulatory surgery, postoperative nausea can lead to prolonged stays in the department, hospitalisation (6) and a delay in the return to normal activity and work (7), which results in. b) Explain to the client what is happening and provide support. The nurse is caring for a patient who has postoperative nausea and vomiting. 2017; Gan et al. The nurse is examining a client who presents with the following symptoms: muscle pains, productive cough, stuffy nose, nausea, vomiting, fever of 38. The nurse has taught the client with a below the knee amputation about prosthesis and stump care. Comfort is often the priority for the patient following surgery. See full list on nursing. A nurse is caring for a client who is experiencing nausea and vomiting. Prevent cracking of the skin of the stump by applying lotion daily d. Which of the following neurologic deficits should the nurse expect to find when assessing the client? ( select all that apply) 2. Chapter 34: Drugs Used to Treat Nausea and Vomiting Test Bank MULTIPLE CHOICE 1. RN Adult Medical Surgical Online Practice 2019 A 1. The nurse is caring for a client with Meniere’s syndrome. management [man´ij-ment] the process of controlling how something is done or used. from the acute care facility after experiencing acute pancreatitis. 25 mg PO daily. Aggressive management before, during, and after his chemotherapy can prevent nausea. Lab values are aPTT 98 seconds and INR 1. Use of volatile anesthetics within 0-2 hours, Nitrous oxide and or intraoperative and postoperative. Although thirsty, she is unable to tolerate fluids because of nausea and vomiting, and she has liquid stools 2–4 times per day. 2017; Gan et al. Gastroenteritis is an illness triggered by the infection and inflammation of the digestive system. Calories r. Decrease production of gastric secretions. hypertension b. Symptoms can include abdominal cramps, diarrhoea and vomiting. The nurse is preparing to assess a patients pain level. Clients with a pacemaker, osteoporosis, and peptic ulcer disease need to be monitored closely but are not at risk for major complications, as is the client with alcohol abuse and liver disease. Nausea is a queasy sensation that may include or not include an urge to vomit. The nurse is caring for a client nwith a peptic ulcer who has just had an EGD. Deficient knowledge r/t postop care C. Prioritize nursing responsibilities in admitting patients to the postanesthesia care unit (PACU). Have the client sit up in a recliner. 11) The prenatal clinic nurse is caring for a client with hyperemesis gravidarum at 14 weeks gestation. Which of the following statements made by the nurse are correct? Select all that apply. which of the following clients should he nurse attend to first? a. In connection with ambulatory surgery, postoperative nausea can lead to prolonged stays in the department, hospitalisation (6) and a delay in the return to normal activity and work (7), which results in. · Monitor Intake and Output · Note color and character at the initial assessment and during your shift · Special attention to nasal and oral care. The nurse will explain that, when given as antiemetics, these drugs are given 7. Question 10 A nurse is caring for a client who has congestive heart failure (CHF) and was started on digoxin (Lanoxin). The Nurse Determines That The Client Likely Is Being Treated For Which Condition? 1. A patient who is receiving chemotherapy will be given dronabinol (Marinol) to prevent nausea and vomiting. Post-operative outcomes in older patients: a single-centre observational study. )Decreased skin turgor C. The ambulatory care nurse should provide which response as telephone advice to this client? 1. The nurse plans care knowing that this condition: a. The nurse plan to refer the client to a day treatment program in order to help him with:. b Supplement your diet with vitamin E. link full download: https://bit. And postoperatively, expect about half of your patients to experience nausea and 30% to experience the vomiting with it (Koutoukidis et al. What causes postoperative bleeding? Surgical problems can cause postoperative bleeding. The nurse is teaching a group of nursing students about the use of antipsychotic drugs for antiemetic purposes. ) Orthostatic hypotension E. Nausea, vomiting or queasiness; Abnormal movements of the eyes; Headache; Ringing in the ears; Hearing loss; Sweating; Feeling unbalanced and pulled to one direction; If you are assigned to take care of a patient currently experiencing dizziness, here’s how you can write a nursing care plan for vertigo. Future anticipations. Text Mode – Text version of the exam. The parents of the child ask the nurse what illness can cause this rash for 6 days. A nurse in a LTC facility notices a client who has Alzheimer’s disease standing at the exit door at the end of the hallway. Nurse Juvy is caring for a client with cirrhosis of the liver. Pharmacology ATI 1. The home health psychiatric nurse visits a client with chronic schizophrenia who was recently discharged after a prolong stay in a state hospital. He thinks it is a serious form of cancer and the recovery is very poor. The nursing care plan should include activities to meet the patient's needs while helping him cope with these alterations. While the nurse is changing the client's appliance, there is a knock on the door. The LPN is part of a group of nurses that has an RN team leader as well as another LPN and two nursing assistants who will be providing care to a group of clients. Chapter 37: Care of the Surgical Patient Test Bank MULTIPLE CHOICE 1. Unfortunately, pharmaceutical management of PONV is not always successful, leaving patients distressed and health-care staff struggling to manage this event. The client has complete bilateral paralysis of the arms and legs. Nursing Care: Assessment · Abdominal assessment ­ suction must be off to auscultate bowel sounds · Verify placement - at the beginning of every shift and before instilling anything. The physician is ruling a digoxin toxicity. After 6 weeks of treatment the nurse dtermines that the medication was effective if the: 1 Thyroid stimulating hormone TSH level is 2 microunits/mL 2 Total t4 level is 2 mcg/dL A nurse providing teaching to a client who has just been prescribed prazosin. To lower blood pressure, the nurse should instruct the client to choose low fat dairy products. The nurse has entered the room of a client who is postoperative day 1 and finds the client grimacing and guarding her incision. Advise the client to splint the surgical incision A nurse is caring for a client receiving moderate (conscious) sedation… Administer reversal agents A nurse has been assigned. Produce an adherent barrier over the ulcer. The nurse knows that the purpose of this medication is to In evaluating the effects of lactulose Cephulac which outcome would indicate that the drug is performing as intended? The healthcare provider prescribes digitalis Digoxin for a client diagnosed with congestive heart. A nurse in a LTC facility notices a client who has Alzheimer’s disease standing at the exit door at the end of the hallway. Browse from thousands of NCLEX questions and answers (Q&A). a nurse is receiving change-of-shift report for a group of clients. from the acute care facility after experiencing acute pancreatitis. B) Have the air-conditioning on in the client's room. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. The patients blood pressure is dropping and their heart rate is increasing. Severe, chemotherapy induced nausea and vomiting (CINV) occurred following the first treatment, requiring 72 hours of continuous IV hydration. Chapter 37: Care of the Surgical Patient Test Bank MULTIPLE CHOICE 1. A nurse is caring for a child who has a vesicular rash. a client with colon cancer is discharged home with morphine for pain management is having episodes of nausea and vomiting which route of morphine administration would be most advantageous to use: rectal: the nurse is caring for four clients which client assessment would be the most indicative for having pain: heart rate of 100 bpm and restless. So patient is psychologically depressed. A care plan can be done for a healthy person as well as for someone who is ill. Client receiving heparin continuous IV infusion and warfarin 5 mg PO daily. Nausea and Vomiting Most people think of nausea and vomiting as something pretty insignificant, however it is a side effect that can delay someone's discharge home if uncontrolled. Nausea, vomiting or queasiness; Abnormal movements of the eyes; Headache; Ringing in the ears; Hearing loss; Sweating; Feeling unbalanced and pulled to one direction; If you are assigned to take care of a patient currently experiencing dizziness, here’s how you can write a nursing care plan for vertigo. A nurse is caring for a client who is experiencing nausea and vomiting. The client suddenly complaints of anorexia, nausea, vomiting, and diarrhea. This article, the first in a two-part series, identifies the principles of postoperative nursing care. Hyperemesis gravidarum is extreme morning sickness that causes long-lasting intense nausea, vomiting, and weight loss. "To assess affect, I should observe the client's facial expression. •Provide routine preoperative care and teaching as explained in Chapter 7. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intension to increase the intake of: a. - A client c Alzheimer experiences chronic confusion. Aggressive management before, during, and after his chemotherapy can prevent nausea. Postoperative care of thoracic surgical patients is a very important part of patient recovery and can be very challenging. watery diarrhea. The nurse plans care knowing that this condition: a. A nurse is performing an abdominal assessment on a client who complains of abdominal pain. Pain is whatever the experiencing person says it is. A nurse is caring for a client who has been admitted for a small bowel obstruction and has been vomiting for 24 hours. An antacid Maalox is prescribed for a client with peptic ulcer disease. While many pregnant women experience morning sickness, hyperemesis gravidarum develops between the 4th - 6th weeks of pregnancy and may last longer than week 20. Assess the clients pain on a -to-10 scale. A clear understanding by the client and family of the purpose, anticipated benefits, and consequences of total laryngec-tomy prior to surgery is vital to promote postoperative recovery. Documentation Guidelines Physical findings indicative of HF:Mental confusion,pale,cyanotic,clammy skin,presence of jugular vein distension and HJR,ascites,edema,pulmonary crackles or wheezes,adventitious heart sounds. link full download: https://bit. A nurse is caring for a patient who has the following arterial blood gas results : HCO3 18mEq, PaCO2 28mm Hg, and pH 7. Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam. Which definition of pain should the nurse use to guide practice? a. a client who is schedule for discharge and required wound care teaching b. On an ongoing basis, monitor patients for gastric distention, nausea, bloating, and vomiting. A wide variety of factors increase the risk of postoperative complications. The nurse plan to refer the client to a day treatment program in order to help him with:. Abrupt postoperative reversal of opioid depression may result in nausea, vomiting, sweating, tremulousness, tachycardia, increased blood pressure, seizures, ventricular tachycardia and fibrillation, pulmonary edema, and cardiac arrest which may result in death. D- Place in a prone position. The nurse recognizes the client is experiencing which of the following acid base imbalances? metabolic acidosis, respiratory acidosis, metabolic alkalosis, respiratory alkalosis. I and the patients hearing is amplified. As appropriate, refer the family to a community health nurse for follow up care after discharge. Learning Outcome: 3 Discuss the medical therapy and nursing care of a woman with hyperemesis gravidarum. The nurse stands directly in front; of the client when speaking. Episodes of nausea and vomiting. After 6 weeks of treatment the nurse dtermines that the medication was effective if the: 1 Thyroid stimulating hormone TSH level is 2 microunits/mL 2 Total t4 level is 2 mcg/dL A nurse providing teaching to a client who has just been prescribed prazosin. A nurse is caring for a client with dementia who has. The nurse is examining a client who presents with the following symptoms: muscle pains, productive cough, stuffy nose, nausea, vomiting, fever of 38. A nurse in a LTC facility notices a client who has Alzheimer’s disease standing at the exit door at the end of the hallway. Toughen the skin of the stump by rubbing it with alcohol c. A client with this risk factor also would be at risk for experiencing alcohol withdrawal during the postoperative period. link full download: https://bit. Which of the following instructions should the nurse in the teaching? a Place throw rugs on wooden floors at home. The client refuses the nurse's offer of p. d Take calcium supplements with meals. A home care nurse is making a visit with a client who had a double-barrel colostomy created after bowel surgery. A diagnosis is based on the assessment data you have collected on the patient. Gastroenteritis is an illness triggered by the infection and inflammation of the digestive system. A nurse is caring for a client who is experiencing nausea and vomiting. In addition to her chemotherapy regimen, which medication would be best to administer?. Provide covered container for sputum and remove at frequent intervals. Complications also may arise when a patient resumes a general diet too soon, especially if he or she is still experiencing extreme nausea. 4°C for the past 2 days, burning eyes and sensitivity to light. )Decreased skin turgor C. a client who is to receive an antibiotic in 1 hr and has a prescription for a peak and trough level d. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used. NR 305 HESI Review Questions with Answers 1. Irrigating the Penrose drain using sterile procedure 3. C) allergic to the anesthesia. Tang, Benjamin; Green, Cameron; Yeoh, Aun Chian; Husain, Faisal; Subramaniam. Instructing the client to eat foods that are low in potassium h. Pharmacology ATI 1. Impaired comfort r/t passage of endoscope through throat. A nurse is reviewing. Which of the following would be subjective information about the client? Select all that apply. This enables the client to read the nurse’s lips; 2. Nursing Interventions. Symptoms can include abdominal cramps, diarrhoea and vomiting. The client is experiencing nausea and vomiting following surgery. Which intervention by the nurse is most appropriate?. , A nurse is providing discharge teaching about. Nursing Care of Patients in Pain Multiple Choice Identify the choice that best completes the statement or answers the question. Risk for Falls. A nurse is caring for a postoperative client with a new colostomy. The nurse identifies that the client is unable to feed self. The Nurse Determines That The Client Likely Is Being Treated For Which Condition? 1. Extends from the time the client is admitted to the recovery room, to the time he is transported back into the surgical unit, discharged from the hospital, until the follow- up care Begins when the client is admitted to the PACU or a nursing unit and ends with the client’s postoperative evaluation in the physician’s office. KEY: Postoperative nursing| nausea and vomiting| respiratory assessment| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential. Nursing assessment findings reveal a temperature of 96. Primary nursing is when the RN assumes 24-hour accountability for the client’s care and has total responsibility for the nursing care of assigned clients during his or her shift. Based on this finding the nurse anticipates assisting the physician with which treatment? Perform synchronized cardioversion. To administer an antacid hourly or to wait one hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a. The term ‘postoperative nausea and vomiting’ (PONV) is a generic term that includes nausea and/or vomiting following surgery (4, 5). Assess the clients pain on a -to-10 scale. A nurse is caring for a client with a genitourinary tract infection receiving amoxicillin (Augmentin) 500 mg every 8 hours. Assess NG tube for patency. b Supplement your diet with vitamin E. The nurse stands directly in front; of the client when speaking. d Take calcium supplements with meals. The nurse is preparing to assess a patients pain level. Chua a 78 year old. Postoperative Nursing CarePostoperative Nursing Care Nursing DiagnosisNursing Diagnosis Ineffective airway clearance- increased secretions 2 to anesthesia, ineffective cough, pain Ineffective breathing pattern- anesthetic and drug effects, incisional pain Acute pain Urinary retention Risk for infection 52. B) experiencing normal adaptation to the postoperative period. Complications also may arise when a patient resumes a general diet too soon, especially if he or she is still experiencing extreme nausea. Nursing Care of Patients in Pain Multiple Choice Identify the choice that best completes the statement or answers the question. "Take crackers and milk with each dose of the medication. The nurse recognizes that increased production of aldosterone and antidiuretic hormone (ADH) caused by FVD results in a decrease in which parameter?. The disease is usually autoimmune and adrenal autoantibodies in plasma was found in 75-80% of patients. Comfort is often the priority for the patient following surgery. Which of the following best describes the rationale for the; nurse’s position? 1. Which of the following nursing interventions should the nurse implement to modify the client's environment to relieve nausea and vomiting? A) Avoid strong odors in the client's room. Comparison of epidural morphine versus intramuscular morphine for postoperative analgesia. The client has weakness on the right side of the body, including the face and tongue. A home care nurse is making a visit with a client who had a double-barrel colostomy created after bowel surgery. At 0730, the nurse notes that the client states that his pain is a 7 on a scale of 1 to 10. Rationale: Choice of interventions depends on the underlying cause of the problem. Help the client to engage in activities that hard to do. A nurse is caring for a client with a postoperative wound evisceration. Carbohydrates t. Place the patient in a comfortable position so that vomit out. To compare effects and. Nausea, vomiting or queasiness; Abnormal movements of the eyes; Headache; Ringing in the ears; Hearing loss; Sweating; Feeling unbalanced and pulled to one direction; If you are assigned to take care of a patient currently experiencing dizziness, here’s how you can write a nursing care plan for vertigo. Toughen the skin of the stump by rubbing it with alcohol c. Nausea is a queasy sensation that may include or not include an urge to vomit. D) developing shock. headache d. Projectile vomiting is vomiting that ejects the gastric contents with great force. The nurse has taught the client with a below the knee amputation about prosthesis and stump care. So patient is psychologically depressed. Which of the following nursing interventions should the nurse implement to modify the client's environment to relieve nausea and vomiting? A) Avoid strong odors in the client's room. The nurse is aware that the patient has reached stage: a. Question 4 5. Using a mirror to inspect. A nurse is caring for a client who has chronic renal disease and is receiving epoetin alfa (Epogen) therapy. In evaluating the effects. See full list on nursing. analgesia and, on discussion, states that this refusal is motivated by his fear of becoming addicted to pain medications. Chapter 34: Drugs Used to Treat Nausea and Vomiting Test Bank MULTIPLE CHOICE 1. Which of the following actions should the nurse take? Ask another nurse to witness the disposal of the new patch. So patient is psychologically depressed. Instructing the client to eat foods that are low in potassium h. The nurse is assessing a client in the urgent care clinic who is complaining of burning with urination. Which of the following interventions should the nurse use that would best prevent this client from developing complications of severe dehydration?. Which of the following interventions should the nurse include in the plan? A- Administer low flow oxygen continuously. The client has complete bilateral paralysis of the arms and legs. The nursing care plan should include activities to meet the patient's needs while helping him cope with these alterations. The urinalysis shows that the client has a urinary tract infection (UTI). Client receiving heparin continuous IV infusion and warfarin 5 mg PO daily. Which aspect of this patient's health history would be of concern? a. A nurse is caring for a male client who reports nausea and vomiting and is receiving IV fluid therapy. by nausea and vomiting. a client who is schedule for discharge and required wound care teaching b. 8 Withhold the heparin infusion 3. To lower blood pressure, the nurse should instruct the client to choose low fat dairy products. Injury to other organs may also have occurred during surgery. Client perceived that the present disease condition is much more severe than the previous condition. Multidisciplinary approach to patient care. A nurse is performing an abdominal assessment on a client who complains of abdominal pain. The nurse identifies that the client is unable to feed self. The client can perform the activity. Although postoperative care is a daily occurrence within many areas of practice, it is evident that the theory underpinning nursing actions is often forgotten in daily practice and hence actions may not be prioritised as they should be. The nurse plans care knowing that this condition: a. See full list on nurseslabs. The nurse has taught the client with a below the knee amputation about prosthesis and stump care. A nurse is caring for a client who is to receive 1500 mL of 0. The vital signs are: blood pressure 95/48, pulse 114. For example, blood vessels may need to be secured, or stitches may have come apart. Term Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. Episodes of nausea and vomiting. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse recommends to the primary care provider for the client to receive:. MED-SURG PART B Questions & Answers Rationale 1. What causes postoperative bleeding? Surgical problems can cause postoperative bleeding. Nurse Juvy is caring for a client with cirrhosis of the liver. Based on this finding the nurse anticipates assisting the physician with which treatment? Perform synchronized cardioversion. Which of the following nursing interventions is appropriate? Collect a urine specimen for culture and sensitivity. The client lives in a boarding home, reports no family involvement, and has little social interaction. The client is complaining of a headache and nausea and is extremely restless. Postoperative care of thoracic surgical patients is a very important part of patient recovery and can be very challenging. A nurse is reinforcing teaching with an older adult client who has osteoporosis. Encourage the client perform normal daily activities, according to ability. Patient refused a newly open fentanyl patch. 9% sodium chloride hung at 3 pm. - Assess the gastro intestinal function by auscultation of bowel sounds. Aggressively prevent nausea and vomiting in those with risk factors in female gender, non-smoker, history of motion sickness/postoperative nausea/vomiting. 9% sodium chloride IV over 8 hours. Nausea, vomiting, and other effects of anesthesia cause alterations in comfort. Postoperative Nursing CarePostoperative Nursing Care Nursing DiagnosisNursing Diagnosis Ineffective airway clearance- increased secretions 2 to anesthesia, ineffective cough, pain Ineffective breathing pattern- anesthetic and drug effects, incisional pain Acute pain Urinary retention Risk for infection 52. We aim to conduct a large, definitive randomised controlled trial of the efficacy and safety of peppermint. What action should the nurse take? ANS: Escort the client to a quiet area on the nursing unit. · Monitor Intake and Output · Note color and character at the initial assessment and during your shift · Special attention to nasal and oral care. The nurse recognizes the client is experiencing which of the following acid base imbalances? metabolic acidosis, respiratory acidosis, metabolic alkalosis, respiratory alkalosis. Which definition of pain should the nurse use to guide practice? a. Chapter 34: Drugs Used to Treat Nausea and Vomiting Test Bank MULTIPLE CHOICE 1. A nurse is caring for a child diagnosed with fluid volume deficit (FVD). a client who is to receive an antibiotic in 1 hr and has a prescription for a peak and trough level d. The nurse is preparing to assess a patients pain level. The term ‘postoperative nausea and vomiting’ (PONV) is a generic term that includes nausea and/or vomiting following surgery (4, 5). The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U. Nursing care comes in many forms. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse recommends to the primary care provider for the client to receive:. link full download: https://bit. A nurse is caring for a client who has acute renal failure. Nursing assessment findings reveal a temperature of 96. The client has weakness on the right side of the body, including the face and tongue. B- Encourage oral intake of at least 3,000 ml per day. 4C, pulse 114, resp 22, blood pressure 142/90. Pain is an unpleasant sensation caused by physical injury. Which of the following should the nurse recognize as an. the nurse should immediately. The urinalysis shows that the client has a urinary tract infection (UTI). Which aspect of this patient's health history would be of concern? a. This enables the client to read the nurse’s lips; 2. A client with acquired immunodeficiency syndrome experiences nausea, vomiting, and abdominal pain radiating to the back after taking didanosine (Videx). The nurse recognizes the client is experiencing which of the following acid base imbalances? metabolic acidosis, respiratory acidosis, metabolic alkalosis, respiratory alkalosis. What is the best follow-up action by the nurse? 2. "To assess language. Nursing Care Plan for Addison's Disease Addison's Disease was first discovered by Addison in 1885 was caused by a malfunction of the adrenal tissue. Which is a priority nursing intervention? 1. Instructing the client to eat foods that are low in potassium h. 2010-01-01. link full download: https://bit. Which of the following statements by the parent should indicate to the nurse that teaching has been effective? A nurse is caring for a child who is in Bucks traction. Aggressively prevent nausea and vomiting in those with risk factors in female gender, non-smoker, history of motion sickness/postoperative nausea/vomiting. 4°C for the past 2 days, burning eyes and sensitivity to light. Based on this assessment the nurse administers pain medication to the client. 2°F, pulse oximetry 90%, shivering, and client complains of chilling. , A nurse is providing discharge teaching about. Which aspect of this patient's health history would be of concern? a. The nurse has taught the client with a below the knee amputation about prosthesis and stump care. A client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. "Take crackers and milk with each dose of the medication. Help the client to engage in activities that hard to do. The nurse will explain that, when given as antiemetics, these drugs are given 7. This enables the client to read the nurse’s lips; 2. Unfortunately, pharmaceutical management of PONV is not always successful, leaving patients distressed and health-care staff struggling to manage this event. Post-operative nausea and vomiting (PONV) is one of surgery’s most distressing outcomes and can incur major physical and psychological suffering. C) If the nurse failed to determine whether the nursing assistant was competent to take care of the client. The vital signs are: blood pressure 95/48, pulse 114. client who is postoperative and requests pain medication before ambulation c. )Decreased skin turgor C. analgesia and, on discussion, states that this refusal is motivated by his fear of becoming addicted to pain medications. Which of the following statements by the parent should indicate to the nurse that teaching has been effective? A nurse is caring for a child who is in Bucks traction. The nurse is caring for a client nwith a peptic ulcer who has just had an EGD. A wide variety of factors increase the risk of postoperative complications. A nurse is caring for a client with dementia who has. Which nursing action would be most appropriate at this time? What is the priority intervention when caring for the client in the immediate postoperative period? Select one: a. See full list on nurseslabs. Chapter 34: Drugs Used to Treat Nausea and Vomiting Test Bank MULTIPLE CHOICE 1. The findings are indicative of which nursing diagnosis? a. The nurse is aware that the patient has reached stage: a. management [man´ij-ment] the process of controlling how something is done or used. A care plan can be done for a healthy person as well as for someone who is ill. Risk for Falls. So patient is psychologically depressed. Which of the following nursing interventions should the nurse implement to modify the client's environment to relieve nausea and vomiting? A) Avoid strong odors in the client's room. At 0800, 30 minutes after pain medication was administered, the nurse evaluated the client and found that his pain was a 4 on a scale of 0 to 10. The nurse notes abdominal distentionand revises the client's care plan based on the knowledge that postoperative gas pains develop as a result of impaired peristalsis of the intestines. When assessing the client's three-chamber drainage system, the nurse notes that there is no bubbling in the suction control chamber. Patient refused a newly open fentanyl patch. Nursing assessment findings reveal a temperature of 96. A male client with hypertension who received new antihypertensive prescriptions at his last visit returns to the clinic two weeks later to evaluate his blood. Postoperative pain is poorly managed with up to 67% of patients in the UK experiencing unnecessary moderate to severe pain.