Learning Activities I choose are:

1. Safety precautions
Q1. Gloves than googles, gown and mask
Q2. Bacterial Menangitis – droplet precautions
TB- airborn precautions
Varicella-airborn precautions
MRSA – contact precautions
WBC 2100- neutropenic precautions

2. Arterial Blood Gasses

Q1 respiratory alkalosis kidney excrete excess circulating bicarbonate into urine and treat fever
Q2 metabolic acidosis fully compensated and administer insulin to this patient

A nurse is preparing to call a provider to report a change in a client's status. The nurse plans to use I-
SBAR to organize and provide this information. What does I-SBAR stand for?

I – Introduction – Identify yourself and give a reason of calling. “I am calling because … “

S – Situation – Give the patient’s age and gender. What id the patient’s status now? Stable , not stable...
B – background – Give the revelant details such as presenting problems and clinical history
A – Assessment – Pull it all together ( current condition, risks and needs). What is your assessment.
R – Recommendation - Be clear about what you are requesting. When should it happen?

A nurse has received a telephone prescription order from a provider. What steps should the nurse take
to ensure the order is correct and transcribed correctly?
Suggested Fundamentals Learning Activity: Error Prevention

Procedure
1. The authorized prescriber identifies self, specifies the patient’s name, and communicates the
order.
2. The receiver:
a. Documents the order immediately on the prescriber order form including the date, time,
authorized prescriber’s name and pager number/service, receiver’s name, status, and
signature.
b. Repeats the order back to the authorized prescriber including the patient’s name, drug name
and spelling of the drug to avoid an error due to sound alike drugs, dosage, pronouncing it
in single digits ( e.g. 15 mg should be read as one five), route, frequency ( three times a
day, not TID)
c. Requests the indication for the medication to assist in avoiding errors
d. Questions the authorized prescriber if there is any uncertainty regarding the order.
3. The authorized prescriber must countersign the order within 24 hours (or as soon as possible)
after communicating the order.
Regards Policy – LPNs may accept orders for medications for assigned stable patients in designated
patient care units for medications administered by enteral, percutaneous, intramuscular and
subcutaneous routes. Verbal and telephone orders for chemotherapy drugs are not acceptable.
Generic drugs names should be used when drug orders are given. Abbreviations should be avoided
when an order is given or received. Medication Reconciliation Order forms can not be completed as a
telephone order.

Nurses face ethical dilemmas regularly in the health care setting. Provide two (2) examples of ethical
dilemmas in nursing and what steps should the nurse take when solving these dilemmas?

1. Reproductive Rights – the pro choice vs pro life argument is an intensely personal one based on
an individual ‘s core set of values and beliefs. As a nurse even if I am pro choice, I should still
respect patient choice to continue a pregnancy even if it threatens her own life.
2. Honesty vs Information – families will often choose to withhold truthful information to
“protect” a patient from emotional distress. For nurses, this poses another common ethical
dilemma: does a patient have the right to know everything about their condition, even if
sharing the information will cause harm or maybe good. As a nurse I would say the truth, but I
would choose best way and time of when to share it .
3. Patient freedom vs Nurse Control – Since nurses are highly educated and aware of best clinical
course of action when one exists. Sometimes happens that patient rejects medical advice and
makes a decision that may result in less optimal outcomes.

A nurse is caring for a client who is experiencing neutropenia secondary to chemotherapy. What client
education should the nurse provide to this client regarding prevention of infection?
Suggested Fundamentals Learning Activity: Standard Precautions

VRE is ofen dpead person to person by the contaminated hands of caregivers. VRE can get onto a
caregivers hands after they have contact with a person with VRE or after contact with contaminated
surfaces. VRE can spread directly to people after they touch surfaces that are contaminated with VRE.
VRE is not spread through air by coughing or sneezing. So clean your hands often and if in contact
with another person, tell them to use gloves and wash their hands as well. Dishes and utensils can be
washed in a dishwasher or with warm water with soap and rinse. Bed linen and clothing can be washed
in a washing machine using standard detergents for clothing.

A nurse is assigned to care for a client with Vancomycin-Resistant Enterococci (VRE). What
precautions should be used when caring for this client?

Standard precautions including hand washing and glowing should be fallowed. Private room preferred,
semi private acceptable with physician approval, if the other pt is free of transmittable disease.

A nurse is caring for several clients receiving intravenous therapy. What are actions the nurse should
use to prevent IV infections?
Perform proper hand hygiene. Use maximal barriers during catheter insertion. Provide antisepsis with
chlorhexidine gluconate. Choose an appropriate insertion site. to administer medication, flush the line,
and change tubing or caps introduces microorganisms into the lumen. Hub manipulation is the most
common source of infection in long-term catheters

A nurse is caring for a client with a new diagnosis of chronic obstructive pulmonary disease. What
measures can the nurse take to ensure encouragement to the client in a stressful situation?

Psychosocial concerns for COPD patients include increasing dependence on others, lack of control over
symptoms, and decreased energy. Also, they’re at high risk for depression and anxiety because of
symptom burden and functional limitations. These problems can affect their social interactions, role
perception, and physical abilities.

Help them verbalize their feelings and develop healthy coping behaviors. However, know that as
increasing dyspnea makes talking more difficult, conversation may grow burdensome.

Include family caregivers in your discussions when appropriate. If the patient has significant
psycho-social issues, consider a referral to a social worker, psychologist, or psychiatrist.

Sexual intimacy is an area commonly overlooked by healthcare providers. COPD can decrease certain
aspects of sexual functioning. Males may develop erectile dysfunction as lung function declines.
What’s more, the physical exertion of sexual activity leads to dyspnea in most COPD patients. The
effort required for intercourse resembles that needed to climb one flight of stairs at a normal pace.
However, point out that sex doesn’t increase blood pressure, heart rate, or respiratory rate to dangerous
levels. (For patient teaching related to sexual activity, see Teaching patients about sexual intimacy by
clicking on the PDF icon above).

Explain how the nurse would instruct a client on performance of progressive relaxation.

In this relaxation technique, you focus on slowly tensing and then relaxing each muscle group.

This helps you focus on the difference between muscle tension and relaxation. You become more
aware of physical sensations.

One method of progressive muscle relaxation is to start by tensing and relaxing the muscles in your
toes and progressively working your way up to your neck and head. You can also start with your head
and neck and work down to your toes. Tense your muscles for at least five seconds and then relax for
30 seconds, and repeat.

A client asks a nurse to explain different nonpharmacological interventions for pain. What should the
nurse discuss?

Massage - A lot of people find relief from gentle massage, and some hospice agencies have volunteers
who are trained in massage therapy. Several studies have found that massage is effective in relieving
pain and other symptoms for people with serious illness.
Relaxation techniques like Guided imagery, hypnosis, biofeedback, breathing techniques, and gentle
movement such as tai chi. Relaxation techniques are often very effective, particularly when a patient --
or a caregiver -- is feeling anxious.
Acupuncture - Several studies have found that acupuncture can be helpful in relieving pain for people
with serious illnesses such as cancer.
Physical therapy - If a person has been active before and is now confined to bed, even just moving the
hands and feet a little bit can help.
Pet therapy - If you have bouts of pain that last 5, 10, or 15 minutes, trying to find something pleasant -
- like petting an animal's soft fur -- to distract and relax yourself can be helpful.
Gel packs. These are simple packs that can be warmed or chilled and used to ease localized pain.

A nurse is caring for a client who is vomiting. What are signs and symptoms of dehydration?

Mild to moderate dehydration is likely to cause:

Dry, sticky mouth

Sleepiness or tiredness — children are likely to be less active than usual
Thirst
Decreased urine output
No wet diapers for three hours for infants
Few or no tears when crying
Dry skin
Headache
Constipation
Dizziness or lightheadedness

Severe dehydration, a medical emergency, can cause:

Extreme thirst
Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults
Very dry mouth, skin and mucous membranes
Little or no urination — any urine that is produced will be darker than normal
Sunken eyes
Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold
In infants, sunken fontanels — the soft spots on the top of a baby's head
Low blood pressure
Rapid heartbeat
Rapid breathing
No tears when crying
Fever
In the most serious cases, delirium or unconsciousness

Order 200 mg

Available 125 mg per 5ml

How many ml will be given?

125 mg : 5 ml

200 mg : x

X= 8 ml

A nurse is caring for a client prescribed a nicotine patch. What should the nurse instruct a client
regarding transdermal medication patches? (Review the Pharmacology Review Module)

cleanse the area first by gently washing it with soap and water to remove previously applied medication
and any debris. Because dead tissue and encrustations can harbor microorganisms and keep the
medication from absorbing, simply applying new medication over previously applied medication can
increase the risk of infection and reduce the therapeutic effect of the drug. Assess the sites where
topical medications prescribed for systemic effects have previously been applied; check for irritation and
skin breakdown. Rotate the application site on a regular basis to prevent skin irritation. Because the
patches are absorbed by the skin, wear gloves when applying them to protect yourself against
accidental exposure. If the patient’s skin is intact, clean technique (medical asepsis) is acceptable.
However, if the patient’s skin is not intact, you must use sterile technique (surgical asepsis). It is also
important to follow the manufacturer’s instructions to ensure proper absorption of the medication.
When using transdermal patches or nitroglycerin strips, remove the previous dose before applying the
new one to prevent an inadvertent overdose. When removing a patch, do so slowly and carefully to
avoid tearing or removing skin. Also, because skin becomes thinner with age, older patients tend to
absorb topical medication more rapidly than younger patients do. Therefore, it is important when
teaching older patients about their medications to make sure they are aware of the signs of toxicity. For
those who use transdermal patches, emphasize the importance of removing the used patch before
applying a new one.

A nurse is caring for an unresponsive client with a tracheostomy who is receiving mechanical ventilation.
How often should oral care be provided to this client?

Brush teeth, gums and tongue at least twice a day using a soft pediatric or adult toothbrush. Provide
oral moisturizing to oral mucosa and lips every 2 to 4 hour. Use an oral chlorhexidine gluconate (0.12%)
rinse twice a day during the perioperative period for adult patients who undergo cardiac surgery.
Routine use of oral chlorhexidine gluconate (0.12%) in other populations is not recommended at this
time

A home health nurse has found a client collapsed on the floor. What initial action should the nurse take?

First I should come to the patient and check if he or she is conscious and then check id pt is breathing
and his circulations. (ABC)
CASE STUDY

The HCP ordered 1 Liter of LR to infuse over 6 hours. Calculate the flow rate you will program the
infusion pump. _____________________mL/h (round to the nearest whole number).

1000ml:6=167 ml/hr

The client states she has pain to her left forearm four (4) hours after the start of the infusion. Upon
inspection and palpation of her forearm, the nurse notes redness and swelling at the IV site and the
forearm is warm to touch. What is the initial action the nurse should take?

I would discontinue the IV site first and then apply moist, warm compress over the area.

What are the recommended nursing interventions when an IV becomes infiltrated? What are the
recommended nursing interventions when phlebitis is noted?

Phlebitis - discontinue the IV site first and then apply moist, warm compress over the area.

Infiltration – results when IV catheter is dislodged and fluid infuses into the tissue. It is characterized by
edema, pallor, decreased skin temperature around the site and pain. Usually when site is infiltrated then
discontinue the IV line and elevating the extremity. It is also recommended to apply a warm compress at
the site to help absorb the fluid.

A urine culture C& S is ordered. How would the nurse obtain a urine C& S from a indwelling urinary
catheter?

Use surgical asepsis when inserting a catheter and allow a small amount of urine to pass prior to filling a
sterile cup for sampling.

If we have a pt that has urinary catheter in place then we should use a needleless system that involves
cleansing the port and using a syringe to withdraw a sample from tubing.

To whom can the nurse delegate the task of taking the urine sample to the labatory? How should the
specimen be transported?

store it in a fridge, in a sealed plastic bag, if you can’t hand it in straight away. If it is transported then
keep it in a cooler. We can delegate this task to CNA or lab tech.

After an X-ray has confirmed placement of the NG tube, how would the nurse check for placement prior
to the administration of medication(s) and/or feeding(s) through the NG tube?

Draw some content from the tube and test it for gastric pH

The nurse is checking placement of the NG tube, what would a gastric pH of 4 or lower indicate? What
would a pH of 6 or higher indicate?
gastric placement is indicated by a pH of less than 4, where pH readings are more than 5.5, or in a
patient who is unconscious or on a ventilator, an X-ray must be obtained to confirm the initial position
of the nasogastric tube.

Name two complications that can occur with an NG tube? List nursing actions to prevent these
complications.

The tube may enter the lungs Because of the proximity of the larynx to the esophagus, the nasogastric
tube may enter the larynx and trachea. This may cause a pneumothorax. To prevent it check the tube
placement each time you give a med or any fluids ( by checking gastric ph)

The tube may coil up in the patient’s throat This is particularly likely if if the patient retches.
Refrigerating the tube may help to avoid coiling and keeps it stiff. Alternatively, using a guide wire can
help with both these issues.

The tube can enter the brain There are case reports of NG tubes perforating the base of the skull and
reaching the brain (Geissler, 2007). A well-lubricated tube may help to decrease friction during insertion.
If the nostrils are of unequal size the wider one should be used. If resistance is felt, the tube should not
be forced.

The client asks the nurse if she could have a glass of water because she is extremely thirsty. What is the
best response for the nurse to make?

It depends what doctor ordered but patient might be able to get a little sips of water or just ice chips to
see if she can tolerate

The client’s lab results have returned. What findings (urine and serum) would indicate dehydration?

They will be increased

What would be a priority nursing diagnosis for this client? List one short-term goal.

ND - Fluid Valume Deficit

Short term – Patient will be able to tolerate ice chips within 24- 48 hrs