Author: Anonymous

A nurse is caring for a client diagnosed with a pneumothorax who had a chest tube inserted 4 hours prior.  There is vigorous bubbling in the water seal chamber of the chest tube drainage system. What is the nurse’s best action?

A client with asthma is receiving albuterol.  When teaching the client about the use of albuterol it is most important that the nurse include which of the following?

A client is receiving her third course of fluorouracil therapy and knows that Stomatitis is a potential adverse effect of antineoplastic therapy.  What will the nurse teach her client about managing stomatitis?

The client just had a thoracentesis for a recurrent left lower lung pleural effusion caused by lung cancer. The thoracentesis removed 1000 mL of fluid.  Based on this information, which post procedure client assessment necessitates a priority intervention by the nurse?

The nurse is performing an assessment on a client who was just brought to the ED complaining of fatigue. Upon assessment, the nurse observes a large amount of bruising on the extremities, fever, and tenderness localized in the left upper quadrant. A health history reveals frequent infections for the past 2 months. Laboratory tests indicate severe anemia, significant neutropenia, and thrombocytopenia. Based on the symptoms, what could be the client’s diagnosis? 

The nurse educator is giving a presentation on prostate cancer at the local adult community. Which of the following should the nurse include in the presentation? Select All That Apply:

You are administering heparin and following the protocol below for a client weighing 189 lbs. The order is to administer an initial heparin bolus IV followed by a titrated IV infusion. Round to the tenths place. HEPARIN PROTOCOL Initial bolus- 50 units/kg Initial rate – 18 units/kg/hr Obtain a PTT every 6 hours, and adjust dosage and rate as follows: If  PTT is less than 35 secs:      Repeat bolus with 80 units/kg and increase the rate by 4 units/kg/hr. If  PTT is 36 to 44 seconds:       Repeat bolus with 40 units/kg and increase the rate by 2 units/kg/hr. If  PTT is 45 to 75 seconds:       Continue current rate. If  PTT is 76 to 90 seconds:       If  PTT is 76 to 90 seconds:          Decrease rate by 2 units/kg/hr. If  PTT is greater than 90 secs: Hold the heparin for 1 hour and decrease rate by 3 units/kg/hr. Available (for bolus)  – heparin 1,000 units/mLAvailable (for infusion) –  heparin 25,000 units in 250 mL D5W    How many mL will the client receive for the repeat heparin IV bolus in response to the PTT of 40 secs?

Following chemotherapy, the client reports tingling, decreased reflexes, muscle weakness, muscle cramping and nausea.  What complication does the nurse suspect?

A client is post-op and has an indwelling urinary catheter.  What interventions should the nurse include in the client centered plan of care to prevent catheter-associated urinary tract infection (CAUTI)?    (SELECT ALL THAT APPLY)     

A client is admitted to the emergency department complaining of intermittent numbness, tingling, and burning pain occurring as the color changes on his hands. What associated underlying disease can cause these symptoms?