RNComprehensiveOnlinePractice2023B

RNComprehensiveOnlinePractice2023B Anurseisprovidingdischargeinstructionstoaclientwhohasanewprescription foramitriptylinetotreatdepression.Thenurseshouldidentifythatwhichofthe followingclientstatementsindicatesanunderstandingoftheteaching?"Ishouldwatchforcommonreactionslikedrymouthandconstipation." Thenurseshouldreinforcethatincreasingdietaryfiber,fluidintake,andchewing sugar-freegumcanalleviatetheanticholinergiceffectsofdrymouthand constipation.Anurseiscaringforanadolescentintheemergencydepartment(ED).LaboratoryResults Sodium140mEq/L(136to145mEq/L)Potassium3.6mEq/L(3.5to5mEq/L) Chloride103mEq/L(98to106mEq/L)BUN15mg/dL(10to20mg/dL) Magnesium1.5mEq/L(1.3to2.1mEq/L)Totalcalcium9.5mg/dL(9to10.5 mg/dL)Phosphate3.7mg/dL(3to4.5mg/dL)Glucose80mg/dL(74to106 mg/dL)Totalprotein7g/dL(6.4to8.3g/dL)Albumin4.5g/dL(3.5to5g/dL) WBCcount19,500/mm3(5,000to10,000/mm​3)Aspartateaminotransferase (AST)30units/L(10to40units/L)Alaninetransaminase(ALT)20units/L(4to36 units/L) DiagnosticResults

CerebrospinalfluidexaminationPressure:35cmH2​O(lessthan20cmH2O)

Color:Cloudy(clearandcolorless)Blood:NoneRBC:0(0cells)WBCtotal:120 cells/µL(0to10cells/µL)Protein:90mg/dL(15to45mg/dL)Glucose:20mg/dL (50to75mg/dL) MedicationAdministrationRecord Whenrecognizingcues,thenurseshouldrecognizethatmanifestationsof bacterialmeningitiscanincludefever,photophobia,nuchalrigidity,petechial rash,andimpairedconsciousness.Theadolescentisexperiencingthese symptoms.Encephalitisischaracterizedbyfever,nuchalrigidity,andaltered 1 / 4

mentalstatus.Reyesyndromeischaracterizedprimarilybyalteredmentalstatus andimpairedhepaticfunction.HistoryandPhysical

2monthsago:

Clientpresentedtoclinicforroutinevisit.Clientreportedfeelingtiredattimesbut gettingthroughtheworkdayandwalkingafterwork.Reportedchronic nonproductivecough.Smokes1.5packsofcigarettesperday.

Today,1030:

Clientreportsfatigueoverthepastseveraldays,spendingmoretimeinbed.Reportschronicproductivecoughwithblood-tingedsputumthismorning.Smokes1packofcigarettesperday.Clienttakeslisinopril20mgPOdaily, atorvastatin20mgPOdaily.Assessment

2monthsago:

Clientstates,"Isleepinmyreclinerandthatworksgreat."Skiniswarm,dry.Lungscleartoauscultation.Chronicnonproductivecough.Abdomensoft, nondistended.Bowelsoundspresent.Slightedemainfeetbilaterally.

Today,1030:

Clientstates,"Ican'tcatchmybreath."Skinpale.Respirationslabored.Crackles presentinleft-lowerlobe.Coughingduringassessment.Blood Foreachassessmentfindingnotedabove,clicktospecifyifthefindingis expectedofpneumonia,COPD,orheartfailure.Pneumonia=tobaccouse,elevatedWBC,productivecoughw/sputum,inc temp,decO2,respacidosis COPD=tobaccouse,decO2sat HF=tobaccouse,BNPlevel,decO2sat Anurseiscaringforaclientwhois1daypostoperativefollowingatotal thyroidectomy. 2 / 4

LaboratoryResults

0700:

Sodium143mEq/L(136to145mEq/L) Potassium3.5mEq/L(3.5to5mEq/L) Chloride104mEq/L(98to106mEq/L) BUN15mg/dl(10to20mg/dl) Magnesium1.5mEq/L(1.3to2.1mEq/L) Totalcalcium8mg/dL(9to10.5mg/dL) Phosphate4.6mg/dL(3to4.5mg/dL) Glucose95mg/dL(74to106mg/dL) WBC9,500/mm3(5,000to10,000/mm3) Nurses'Notes

0700:

Clientalertandorientedtoperson,place,andtime.Respirationsevenand unlaboredwithnoadventitioussounds.Bowelsoundsactiveinall4quadrants.Surgicaldressingdry,slightedemaatincisionsitenoted.Clientratesdullpainin neckof2ona0to10scale.Declinespainmedication.

1100:

Clientalertandorientedtoperson,place,andtime.Respirationsevenand unlaboredwithnoadventitioussounds.Bowelsoundsactiveinall4quadrant theclientisathighestriskfordevelopinghypocalcemiaasevidencedbyclient's reportofmusclespasms,numbnessaroundlips,anddeccalciumlevel.Hypocalcemiaismorelikelytooccurinclientswhohaveexperienceda thyroidectomy,duetoaccidentaldamagetotheparathyroid.Numbnessaround thelipsisaclinicalmanifestationspecifictohypocalcemia.Hypocalcemia presentsasmusclespasmsandcanleadtocardiacdysrhythmias.Hypocalcemia isthehighestpriority,asitrequiresimmediatetreatmentwithcalciumgluconate toavoiddysrhythmiasandothercomplications.Anurseiscaringforaclientwhohasabdominalpain.Nurses'Notes

0900:

Clientreportslossofappetite,weightloss,andfatiguefor1week.Reports abdominalpain,6onascalefrom0to10,for2days.Clientisaperioperative 3 / 4

nurse,returned1weekagofroma2-weekmissiontriptoanunderdeveloped country.

1200:

Resultsofantibodystudiesobtained.Providerprescriptionforantiviral medicationpending.PhysicalExamination

0930:

Lungsoundsclearbilaterally.Skinwarmtotouchandjaundiced.Dryskinnoted onextremities.Sclerayellowbilaterally.Bowelsoundsnormoactiveinfour quadrants.Clientreportsrightupperquadrantpainuponpalpation.Urine specimenobtainedforurinalysis,darkyellowincolor.VitalSigns

0900:

Temperature36.9°C(98.5°F)Heartrate84/minRespiratoryrate18/minBlood pressure118/78mmHgOxygensaturation98%onroomair DiagnosticResults

1100:

Aspartateaminot Foreachcondition,clicktospecifyifthecharacteristicisconsistentwithanacute infectionofhepatitisA,hepatitisB,orhepatitisC.Eachcharacteristicmay supportmorethanonediseaseprocess.ManifestationsofHepA,HepB,&HepC=jaundice,yellowsclera,RUQpainon palpation,darkyellowurine,incAST&ALTlevels HepA=riskfromfecal-oraltransmission(recenttraveltounderdeveloped country&occupationalrisk) HepB&HepC=bloodbornetransmission HepB,&C=antiviralmedication Anurseiscaringforaclientonamedical-surgicalunit.

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