Exam (elaborations)
NUR 283 Transition To Registered Nursing Practice Comprehensive Exam 3 Week 9 Discussions
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- Galen College Of Nursing
NUR 283 Transition To Registered Nursing Practice
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WEEK 9 DISCUSSIONS-You are the nurse caring for a patient with a seizure disorder.
Seizures are an abrupt, abnormal, excessive, and uncontrolled electrical discharge of neurons
within the brain that can cause alterations in the level of consciousness and changes in motor and
sensory ability and behavior.
Epilepsy is the term used to define chronic recurring abnormal brain electrical activity resulting
in two or more seizures. Seizures resulting from identifiable causes, such as substance
withdrawal or fever, are not considered epilepsy.
A nurse is preparing a teaching plan for a client who has a new prescription for carbamazepine.
Which of the following instructions should the nurse include in the teaching? Select all that
apply.
1. “This medication can safely be taken during pregnancy.”
2. “Eliminate grapefruit juice from your diet.”
3. “You will need to have a complete blood count and carbamazepine levels drawn
periodically.”
4. “Notify your provider if you develop a rash.”
5. “Avoid driving for the first few days after starting this medication.”
ANSWER- 2,3,4,5
1. Carbamazepine is a Pregnancy Category Risk D medication. The client should be
instructed to avoid pregnancy while taking carbamazepine and to use a non-hormonal
form of birth control as they may have a reduction in the efficacy of hormonal
contraception.
2. CORRECT: Grapefruit juice affects carbamazepine metabolism and should be avoided.
3. CORRECT: Carbamazepine blood levels and the CBC should be monitored during
therapy. The client is at risk for bone marrow depression while taking carbamazepine and
should notify the provider for a sore throat or other manifestations of an infection.
4. CORRECT: Carbamazepine can cause Stevens-Johnson syndrome, which can be fatal.
The client should notify the provider promptly if a rash occurs.
5. CORRECT: CNS effects (drowsiness or dizziness) can occur early in treatment with
carbamazepine, and the client should avoid activities requiring alertness until these
effects subside.
Carbamazepine is not only prescribed as an anticonvulsant medication used to treat epilepsy, but
also used to treat neuropathic pain and schizophrenia (as a second-line agent in bipolar disorder).
Diagnostic procedures for patients experiencing seizures include:
Electroencephalogram (EEG) records electrical activity and can identify the origin of
seizure activity.
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, Magnetic resonance imaging (MRI), computed tomography (CT) imaging/computed
axial tomography (CAT) scan, positron emission tomography (PET) scan, cerebrospinal
fluid (CSF) analysis, and skull x-ray can be used to identify or rule out potential causes of
seizures.
You learned about caring for cancer patients previously. I recommend that you are familiar with
nursing care for patients receiving radiation therapy. Patient teaching is the responsibility of the
RN. For patients receiving teletherapy (external) radiation for treatment of cancer, what are
important teaching points?
ANSWER-
With external beam or teletherapy, the radiation source is outside the patient. There is no hazard
to others, the patient is not radioactive.
Teaching points for skin protection during external radiation therapy:
Wash the irradiated area gently each day with either water or a mild soap and water as
prescribed by your radiation therapy team.
Use your hand rather than a washcloth when cleansing the therapy site to be gentler.
Rinse soap thoroughly from your skin.
If ink or dye markings are present to identify exactly where the beam of radiation is to be
focused, take care not to remove them.
Dry the irradiated area with patting motions rather than rubbing motions; use a clean, soft
towel or cloth.
Use only powders, ointments, lotions, or creams on your skin at the radiation site that are
prescribed by the radiation oncology department/provider.
Wear soft clothing over the skin at the radiation site.
Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at
the radiation site.
Avoid exposure of the irradiated area to the sun, ensure the patient knows to avoid direct
skin exposure to the sun during treatment and to avoid the sun for one year after the
treatment.
Avoid heat exposure.
Patients experiencing seizure activity may have triggers such as:
Increased physical activity
Excessive stress
Hyperventilation
Overwhelming fatigue
Acute alcohol ingestion
Excessive caffeine intake
Exposure to flashing lights
Substances such as cocaine, aerosols, and inhaled glue products
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, What are the important teaching points to review with patients that have a permanent pacemaker
implanted?
ANSWER-
Teach the patient to avoid tight clothing on the side of the pacemaker and high-strength magnets.
Follow restrictions on physical activity to allow pacemaker to settle in place. Advise to avoid
lifting the arm over the head or lifting more than 10lb for 4 weeks. No sudden jerky movements
for 8 weeks. Microwaves are safe to operate. Bathing and showering are not a problem for these
patients.
Cell phones should be used on the opposite side of the body from the pacemaker and the patient
should report dizziness or chest pain to the healthcare provider. Keep in mind with many patients
(cardiac, renal, etc.) teaching should always include to report increased fatigue and weakness.
This can be a sign of complications developing.
You are the nurse caring for a patient receiving TPN via a CVC.
Metabolic complications of TPN include hyperglycemia, hypoglycemia, and vitamin
deficiencies.
Try this mental health practice question and include a rationale for your responses:
A nurse assesses five newly hospitalized patients. Which patients have the highest suicide risk?
Select all that apply.
a) 82-year-old white male
b) 35-year-old Hispanic female
c) 28-year-old Hispanic male
d) 19-year-old Native American male
e) 22-year-old Alaskan Native male
ANSWER- A, D, E
Whites have the highest suicide rates. The rate is particularly high for older adults and teens.
Other high-risk groups include adolescent and young adult Alaskan Native and Native American
males. Rates are not high for Hispanics or African Americans.
Having access to a gun also increases the risk of suicide.
TPN contains complete nutrition, including calories in a high concentration (10% to 50%) of
dextrose, lipids/essential fatty acids, protein, electrolytes, vitamins, and trace elements. Standard
IV bolus therapy is typically no more than 700 calories/day. Partial parenteral nutrition or
peripheral parenteral nutrition (PPN) is less hypertonic, intended for short-term use, and
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