med surge vati practice assessments with Complete Solution

med surge vati practice assessments with Complete Solution Acute Hemarthrosis (hemephilia patient) - The nurse should reinforce with the parent to keep the child's affected joints elevated and immobilized to minimize bleeding. After the acute episode, the child should begin active range-of-motion exercises. dig toxicity - vomiting constipation can lead to UTI - celiac disease - The nurse should reinforce to the guardian that celiac disease is a genetic autoimmune disorder in which eating gluten, even in very small amounts, can damage the child's small intestine. Currently, the only treatment for the disease is a lifelong, strict adherence to a gluten-free diet. The nurse should stress the importance of avoiding foods containing wheat, rye, barley, and oats. The child should consume foods that are gluten-free, such as milk, cheese, rice, corn, eggs, potatoes, fruits, vegetables, fresh poultry, meats, fish, and dried beans. Whole wheat bread Lead screening - -Blood lead level (BLL) should be checked 9-12 mo & 24 mo - 10 micrograms/dl ~ok - 10-14; repeat BLL in 12 wekks -15 --lead poisoning -45 begin chelation therapy risk factor for adolecent amenorrhea - hypothyroidism canibas use oral contracepetives emotional stress administering oph drops - The nurse should apply pressure to the lacrimal punctum to prevent the medication from entering the nasopharynx. The nurse should hold the dropper 1 to 2 cm (0.4 to 0.8 in) above the eye to administer the medication. the nurse should have the child extend his head while administering the ophthalmic drops. determine the effectiveness of pancrelipase, - Recording the amount and consistency of the child's stools will help determine the effectiveness of pancrelipase, which is taken to decrease the bulk of feces. infant birth wt by 12 months - triples - The nurse should identify that a high-pitched cry is an indication of increased intracranial pressure. Juvenile Idiopathic Arthritis (JIA) - splint joints at night to decrease pain allergic reaction to contrast dye - Manifestations of the allergic reaction include urticaria, itching, flushing of the skin, and possible anaphylaxis. Enterobiasis - pinworm keep fingernails trimmed Treatment of strabismus - eye patch- includes covering the strong eye to strengthen the muscles in the weak eye. early manifestation of an anaphylactic reaction. - hives - The nurse should check the location over the kidney in an infant who is experiencing a sickle cell crisis for manifestations of a kidney infarction. Other manifestations of sickle cell anemia include dilute urine, hematuria, and enuresis. finding in child with GERD - chronic cough A client who has been experiencing prolonged vomiting has the following ABG results: pH 7.48; pCO2 40 mm Hg; HCO3 34 mEq/L; pO2 85 mm Hg. The nurse determines that the client is experiencing which of the following imbalance - Metabolic Alkalosis Metabolic Alkalosis - Metabolic alkalosis results from: • Base excess Oral ingestion of bases (antacids) Venous administration of bases (blood transfusions, TPN, or sodium bicarbonate) Acid deficit Loss of gastric secretions (through prolonged vomiting, NG suction) Potassium depletion (due to thiazide diuretics, laxative abuse, Cushing's syndrome) Metabolic alkalosis results in: Increased HCO3 priority lab value for patient with chest pain - Cardiac troponin troponin normal range - .10ug/L indicates cardiac damage Myoglobin normal range - less than 90 A client is having an exercise electrocardiography (stress test) performed. The nurse recognizes the need to stop the test if which of the following occurs? - An ST segment depression or T wave inversion on the EKG. -Significant ST segment depression or T wave inversion are indications of myocardial ischemia and the stress test should be stopped