Exam (elaborations)
NUR 283 Transition To Registered Nursing Practice Comprehensive 1 WEEKLY DISCUSSIONS 1 To 4.
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- Galen College Of Nursing
NUR 283 Transition To Registered Nursing Practice
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Comp 1- weekly discussionClient with cancer receiving IV chemotherapy infusions via a central venous catheter
Thanks for your response. Immunosuppression/neutropenia due to bone marrow suppression by cytotoxic
medications is the most significant adverse effect of chemotherapy. Clients who have neutropenia might not develop
a high fever or have purulent drainage, even when an infection is present. We need to monitor the WBC count.
Teaching for these clients at risk of neutropenia should include:
Avoid crowds while undergoing chemotherapy.
Take temperature daily. Report elevated temperature to the provider.
Avoid food sources that could contain bacteria (fresh fruits and vegetables; undercooked meat, fish, and
eggs; pepper and paprika).
Avoid yard work, gardening, or changing a pet’s litter box.
Discard liquid beverages sitting at room temperature for longer than 1 hr.
Wash dishes in hot, soapy water or a dishwasher. Wash glasses/cups after each use.
Wash toothbrush daily in the dishwasher or rinse in a bleach solution.
Do not share toiletry or personal hygiene items with others.
Report manifestations of bacterial or viral infections immediately to the provider (e.g., fever,
mucositis/stomatitis, etc.).
A nurse is demonstrating how to insert an IV catheter. Which of the following statements by a nurse viewing the
demonstration indicates understanding of the procedure?
1. “I will thread the needle all the way into the vein until the hub rests against the insertion site after I see a
flashback of blood.”
2. “I will insert the needle into the client’s skin at an angle of 10 to 30 degrees with the bevel up.”
3. “I will apply pressure approximately 1.2 inches below the insertion site prior to removing the needle.”
4. “I will choose a vein in the antecubital fossa for IV insertion due to its size and easily accessible location.”
Rationale- For older adults remember they have fragile skin. Use a soft cloth between the tourniquet and skin or a
blood pressure cuff inflated 10 to 15 cm (4 to 6 in) above the insertion site to compress only venous blow flow.
Thanks for your response. Administration of chemotherapy falls under the Pharmacological and Parenteral
Therapies section of the test plan. One of the activity statements is to review pertinent data prior to medication
administration (e.g., contraindications, lab results, allergies, potential interactions). Chemotherapy is used to cure
some cancers, augment the treatment of other cancers, and attempt to increase a client’s survival rate and time.
Depending on the agent, it can be given orally, parentally, intravenous, intracavitary, or intrathecal. Specific
training/certification is necessary for administration of some agents.
Try this practice question:
The nurse is admitting a 72-year-old female client and notes multiple bruises on the face, arms, and legs along with
possible cigarette burns on her upper arms. The nurse understands the priority is to first determine how the injuries
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occurred. Upon questioning the client about the injuries during the assessment, the client states she fell on an ashtray
and doesn’t want to talk about it. After the assessment is complete, which nursing intervention is the priority?
- Document the objective findings in the client’s EHR.
- Tell the client she must talk about the situation with the nurse.
- Report the situation to the Adult Protective Services.
- Take photographs of the bruises and cigarette burns.
Rationale- Once the assessment is completed, if abuse is suspected the nurse has a duty to report. Mandatory
reporting is required of all health care providers, including suspected cases of child abuse. There are civil and
criminal penalties for not reporting.
Client post-op TURP with CBI.
Thanks for your response. You learned about BPH and TURP in med/surg. As adult males age, the prostate gland
enlarges. When the enlargement of the gland begins to cause urinary dysfunction, it is called benign prostatic
hyperplasia (BPH).
BPH is a very common condition of the older adult male and can significantly impair the outflow of urine from the
bladder, making a client susceptible to infection and retention. Excessive amounts of urine retained can cause reflux
of urine into the kidney, dilating the ureter and causing kidney infections. Health Promotion and Maintenance covers
care of patients for all ages, which includes stages of development as noted on page 18 of the NCLEX-RN Test Plan.
Try this Health Promotion and Maintenance practice question.
A pediatric nurse would be concerned by which of the following?
a.Newborn: HR 165, RR 45
b. 15-month-old: HR 158, RR 50
c. 8-year-old: HR 88, RR 20
d. 13-year-old: HR 70, RR 18
Rationale- normal vitals for toddlers are HR: 80-140, BP: 90-105/55-70, T: 97.6-99.5, RR: 22-37
Thanks for your response. Transurethral resection of the prostate (TURP) is the most common surgical procedure for
BPH. Postoperative treatment for a TURP usually includes placement of an indwelling three-way catheter. The
urinary catheter drains urine and allows for instillation of a continuous bladder irrigation (CBI) of normal saline
(isotonic) or another prescribed irrigating solution to keep the catheter free from obstruction. The rate of the CBI is
adjusted to keep the irrigation return reddish/pink color. For example, if bright-red or ketchup-appearing (arterial)
bleeding with clots is observed, the nurse should increase the CBI rate.
Disease prevention (including cancer) is divided into primary, secondary, and tertiary prevention. What is the
difference in primary and secondary prevention? Provide examples of secondary prevention strategies for cancer and
primary disease prevention strategies.
ANSWER-
Primary prevention includes interventions that keep a cancerous process from ever developing. Primary
prevention addresses the cause of cancer, so disease does not occur. Examples of primary prevention
strategies are avoiding tobacco products and red meat as well as receiving vaccines per recommendations.
Primary prevention is focused on modifying associated factors (avoidance of known or potential carcinogens),
vaccines, stress reduction, and removal of at-risk tissues.
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Secondary prevention is the use of screening strategies to detect cancer early when cure or control is more
likely. Secondary prevention identifies disease before the onset of symptoms and keeps it from becoming more
extensive. Examples of secondary prevention strategies are interventions leading to the discovery and control
of cancerous or precancerous processes while localized, i.e., screening and early detection. Breast self-exams
(BSE) and testicular self-examination are examples of secondary prevention. Be sure you know the teaching
for patients regarding testicular exams and BSE.
Tertiary prevention reduces complications and progression of disease once it has become clinically apparent.
Tertiary measures are focused on clinical stage, recovery, disability, or death stage. An example of tertiary
prevention would be speech, physio- and occupational therapy and associated medical therapy, following a
cerebrovascular accident. Another example, related more to the clinical stage, would be the management of
diabetes. Their purpose is to reduce or eliminate long-term impairments and disabilities, minimize suffering,
optimize function, assist in adjusting to limitations in health and function resulting from the event, and
sometimes extend survival.
Client with encephalopathy who needs a blood transfusion.
Thanks for your response. Fetor hepaticus (a fruity, musty breath odor) is an expected finding of hepatic
encephalopathy in the client who has advanced cirrhosis.
You learned about blood transfusions in med/surg. Entry level nurses need a good understanding of the steps
involved with blood administration.
Try this practice question:
Which statement is the scientific rationale for infusing a unit of blood in less than four hours?
a. The blood will coagulate if left out of the refrigerator for over 4 hours.
b. The blood has the potential for bacterial growth if allowed to infuse longer.
c. The blood components begin to break down after four hours.
d. The blood will not be affected; this is a laboratory procedure
Rationale- blood is a medium for bacterial growth, any bacteria contaminating the unit will begin to grow if left
outside of a controlled refrigerated temperature for longer than 4hrs, placing the client at risk for septicemia.
Also, blood is usually administered over 3 hours via an 18 or 20g needle. Make sure the patient has an appropriately
sized IV catheter before you obtain the blood for infusion then check the blood for discoloration or bubbles.
Contaminated blood may appear unusually dark or contain gas bubbles.
Always check blood with another nurse at the bedside then prime the tubing with 0.9NaCl before priming the tubing
with blood. Remember we only administer blood with 0.9NS solution to prevent hemolysis. Never hang a dextrose
or lactated ringer solution with blood. The nurse should remain with the patient for the first 15 minutes of the
transfusion and monitor VS during this time. Once the first 15 minutes is complete without any s/s of a reaction, an
LPN can monitor patient. If there is any indication of a reaction such as chills or hives the priority action is to stop
the transfusion and change the tubing at the hub to avoid infusing any more of the blood in the IV tubing. Then
notify the provider.
Thanks for your response. Hepatic encephalopathy is a life-threatening complication of liver failure. Toxic
substances, which are normally detoxified by the liver, enter systemic circulation. A change in orientation indicates
hepatic encephalopathy in a client who has advanced cirrhosis.
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