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The scope of this Nursing Test III is parallel to the NP3 NLE Coverage: Medical Surgical Nursing
Decreased pain in the fetal position
Urine output of 35mL/hr
CVP of 12 mmHg
Cardiac output of 5L/min
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Sleep with a hot pad
Take to aspirins before arising, and wait 15 minutes before attempting locomotion
Take a hot tub bath or shower in the morning
Put joints through passive ROM before trying to move them actively
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Eating mainly bland food and milk or dairy products
Reducing intake of high-fiber foods
Eating small, frequent meals and a bedtime snack
Eliminating intake of alcohol and coffee
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Tripod gait
Two-point gait
Four-point gait
Three-point gait
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Advising the client not to urinate around catheter
Intermittent catheter irrigation with saline
Giving prescribed narcotics every 4 hour
Repositioning catheter to relieve pressure
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NPO
Small feedings of bland food
A regular diet given frequently in small amounts
Frequent feedings of clear liquids
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Positioning the client in Semi-Fowler’s position
Administering a sedative to reduce anxiety
Chilling the tube before insertion
Warming the tube before insertion
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Orange juice.
Whole milk.
Ginger ale.
Black coffee.
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Giving backrubs with alcohol
Use of a bed cradle
Frequent assessment of the skin
Encouraging a high-protein diet
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Potentiates the action of digoxin
Promotes calcium retention
Promotes sodium excretion
Puts the client at risk for digitalis toxicity
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Supine on the unaffected side
Low-Fowler’s on the back
Semi-Fowler’s on the affected side
Semi-Fowler’s on the unaffected side
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Whole grain cereal, orange juice, and apricots
Turkey, green bean, and Italian bread
Cottage cheese, cooked broccoli, and roast beef
Fish, green beans and cherry pie
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Assess extremities for weakness and flaccidity
Support the head and neck during position changes
Position the client in high Fowler’s
Medicate for restlessness and anxiety
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Serve a high-protein, high-carbohydrate diet
Encourage full liquid diet
Serve a high-fat diet, high-fiber diet
Monitor intake to prevent weight gain
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Administer an enema
Perform range-of-motion exercise to all extremities
Ensure maximum fluid intake (3000ml/day)
Put the client on the bedpan every 2 hours
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Reducing physical and emotional stress
Providing a low-sodium diet
Restricting fluids to 1500ml/day
Administering insulin-replacement therapy
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Side-lying, alternating left and right sides
Sitting in a reclining chair twice a day
Lying on abdomen several times daily
Supine with stump elevated at least 30 degrees
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“I should call the physician if I have a cough or cold before surgery”
“I will be able to drive soon after surgery”
“I will not be able to do any heavy lifting for 3-6 weeks after surgery”
“I should support my incision if I have to cough or turn”
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Avoid extremes in temperature
Install safety devices in the home
Attend support group meetings
Avoid physical exercise
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Using standard precautions and medical asepsis
Enforcing a “no visitors” rule
Using moist heat on painful joints
Monitoring a vital signs every 2 hour
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Sleep Pattern disturbance
Impaired physical mobility
Noncompliance
Fluid volume excess
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Slow, irregular pulse
Dull, abdominal discomfort
Urinary frequency
Throbbing headache
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Place the client in a lateral position every 2 hour
Splint the patient’s chest with pillows when coughing
Use humified oxygen
Offer fluids at regular intervals
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5 minutes
60 seconds
30 seconds
2 minutes
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Compression stockings promote venous return
Compression stockings divert blood to major vessels
Compression stockings decreases workload on the heart
Compression stockings improve arterial circulation
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Placing food in the unaffected side of the mouth
Increasing fiber in the diet
Asking the patient to speak slowly
Increasing fluid intake
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Periorbital edema
Increased specific gravity of urine
A urinary output of 50mL/hr
Daily weight gain of 2 lb or more
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Expanding ecchymosis
Ascites and serum albumin of 3.2 g/dl
Slurred speech
Hematocrit of 37% and hemoglobin of 12g/dl
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Allow plenty of time after the insulin injection and before beginning the match
Eat a carbohydrate snack before and during the badminton match
Drink plenty of fluids before, during, and after bed time
Take insulin just before starting the badminton match
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CVP of 5mmHg
Glasgow Coma Scale score of 13
Polyuria and dilute urinary output
Insomnia
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Nephropathy
Macroangiopathy
Carpal tunnel syndrome
Peripheral neuropathy
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Elevate the stump on a pillow for the first 24 hours
Encourage use of trapeze
Position the client prone periodically
Apply a cone-shaped dressing
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Monitor the client’s vital signs
Keep the client on bed rest
Keep the patient on bed rest
Give a stat dose of Sucralfate (Carafate)
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Notify the family to report the client’s condition
Immediately administer the narcotic as ordered
Keep client on right side supported by pillows
Encourage coughing and deep breathing every 2 hours
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Drink 3-4 quarts of fluid every day
Empty the bladder every 2-4 hours while awake
Encourage the use of coffee, tea, and colas for their diuretic effect
Teach Kegel exercises to control bladder flow
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Sex partner of 3 months ago must be treated
Women with gonorrhea are symptomatic
Use a condom for sexual activity
Sex partner needs to be evaluated
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Promptly clean with a 1:10 solution of household bleach and water
Promptly clean up the blood spill with full-strength antimicrobial cleaning solution
Immediately mop the floor with boiling water
Allow the blood to dry before cleaning to decrease the possibility of cross-contamination
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Rub the client’s back until relaxed
Prepare a glass of warm milk
Give the second dose of pentobarbital sodium
Explore the client’s feelings about surgery
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Assess the lung sounds
Suction the client right away
Look at the client
Turn and position the client
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Use gloves and handwashing before and after client contact
Do nasal cultures on healthcare providers
Place the client on total isolation
Use mask and gown during care of the MRSA client
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“You will probably have to eat six meals a day for the rest of your life.”
“Eating six meals a day can be a bother, can’t it?”
“Some clients can tolerate three meals a day by the time they leave the hospital. Maybe it will be a little longer for you.”
“ It varies from client to client, but generally in 6-12 months most clients can return to their previous meal patterns”
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“How much of a difference have you noticed”
“It’s part of the swelling your body is experiencing”
“It’s probably because you have been less physically active”
“Your liver is not destroying estrogen hormones that all men produce”
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No eye pain is expected postoperatively
Semi-fowler’s position will be used to reduce pressure in the eye.
Eye patches may be used postoperatively
Return of normal vision is expected following surgery
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Talk to the client about the caregiver and support system
Complete a gastrointestinal and neurological assessment
Check the lab data for serum albumin, hematocrit and hemoglobin
Complete a police report on elder abuse
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Wash the catheter with soap and water after each use
Lubricate the catheter with Vaseline
Perform the Valsalva maneuver to promote insertion
Replace the catheter with a new one every 24 hour
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Call the physician
Give a prn pain medication
Clarify if the client is on a new medication
Use gown and gloves while assessing the lesions
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Speech pattern may be altered
Respiratory isolation is necessary for 24 hours after antibiotics are started
Perform skin culture on the macular popular rash
Expect abnormal general muscle contractions
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Nutrition, less than body requirements
Injury, potential for sensory-perceptual alterations
Impaired mobility, related to muscle weakness
Anticipatory grieving, due to the loss of independence
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