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• Hip fracture . Answer: The left leg is shorter than the right leg and is externally
rotated
• Lyme's disease . Answer: Furth education when patient states there is a RAISED
rash on the palms of the hands
• Bell's Palsy . Answer: Therapeutic communication, Nurse states "You seem
upset."
• Sickle Cell Anemia . Answer: Further education if patient states they will restrict
their fluid intake
• Pressure ulcers . Answer: Concerned if there is blanching of the coccyx
• Head injury . Answer: Most concerned if there is clear, watery fluid draining
from ears
• Thrombophlebitis . Answer: Heparin evaluated with PTT
• Thrombophlebitis2 . Answer: Patient should flex/extend the leg Q2H
• Abdominal pain . Answer: Ask the patient to show the nurse where it hurts
• TEE . Answer: Patient correct when stating, "I will not be able to eat for several
hours after the procedure"
• Bone marrow biopsy . Answer: Patient in the prone position
• Buck's traction . Answer: Used to reduce muscle spasms
• Acute kidney injury . Answer: Potassium is 6.2, monitor heart rate and rhythm
• Cast care . Answer: Intervene if patient states their toes are tingling
, • Ulcerative colitis . Answer: Mild, lower abdominal pain with diarrhea
• BPH . Answer: Difficulty starting urine stream
• Thyroidectomy . Answer: Priority to ask the patient to speak-assessing for
hoarseness
• Hemodialysis . Answer: SATA- No BP taken in arm with AV fistula, No carrying
heavy objects with affected arm
• Pain management . Answer: Best indicator of pain is to ask the patient their pain
level
• Chest tube . Answer: Intervene if there is continuous bubbling in chamber;
bubbling corresponding with patient's respirations is normal
• Wound healing diet . Answer: Patient with gun shot wound should pick Turkey,
potatoes, oranges, ice cream
• Migraine headache . Answer: Unilateral eye pain
• GERD . Answer: Elevate the head when eating at night using pillows
• Brachytherapy . Answer: Intervene if the LPN exits the room and leaves the door
open
• Colonoscopy . Answer: Ask the patient the location of pain-assessing for
perforation
• Cardiac catheterization . Answer: Procedure via left femoral artery, priority to
intervene if the left leg is cooler
• ABG puncture . Answer: Apply pressure to the puncture site for 3-5 minutes
• Glomerulonephritis . Answer: Protein in the urine
• Meningitis . Answer: Patient's temperature is 101.2 F
• Cardiac dysrhythmias . Answer: Patient in A. Fib, need to assess LOC