HESI Live Review Workbook for the NCLEX

Name: HESI Live Review Workbook for the NCLEX
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Author: Alice Edwards

A comprehensive NCLEX-RN prep tool featuring practice questions, detailed rationales, and proven test-taking strategies to build clinical judgment and boost exam confidence. Designed to enhance understanding and readiness in a structured format.

Alice Edwards

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Live Review Workbook for the
NCLEX-RN®
Examination
Q t h EDITION
Jtjjk V

HE SI Live Review Workbook for the
NCLEX-RN® Examination
M N I H EDI H U N
EDITED BV
Amanda ( hiirchman, MSN, RN
Progrjff! Director, Prcicuca/ Aursjnc/ Program, Ked Prver chnoJogy Center, Duncan. OkJcth fia

Abase
ftmnilnth (Fig 23)
l egal Aspects of Menial Hcallh
Confidential Health Care
inloriiied< onsem
Good Samaritan l aws
CDimuiinicalitm Skills] 'type* rd I railrr-liip
Delegation and Supervision Skills
f Her rive ream < omimmhatimi ( F ig 2J)
S-BAR
C uElLirails Seiisilhr Care {Fig 2A)
lest- Taking Strategy
Nett Griieralmn NCI F X ' Fxainiihitimi (NGN) Mvtr Q m - i i m i
X C link al Concepts and Mechanisms of Disease
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reproduced or transmitted without publishers prior permission. Violators will be prosecuted.
Operative Care: Preoperadie Care
Postoperative Carr (Tig. J.l)
Nursing .mil ColLiliorjlivr Care
Pain
Fluids and Fleclroh res
L k t l i o l y i e Imbalances
Acid Fkivr
Arteiial Blood Gas Interpretation Practice

Srrjis (nr I ntr rpr*l iLiR Arlrrial Hlucd Gas ( ARG) R r u l l s
Arterial Blood Gas I nteipr elation Practice
Safely: SrufiiiH F.setil'i
Safety; I alri (I ig. J.7)
H»nh Alen Medications
Death and Grief
JnlKliufl
flume n JmmunodriKiriH \ Virus I1I1V)
Cancer
lest-lakmg stiategs
Neu Generation M I I X* Fx.miiiiation ( N t . S ) Style QurMtan
4, Athanced I link al < oncrpuand Disaster Martjflenienl
Anile Ctnnlitioiis: Shoe k
Continuum of Sepsis
Sepsis
Disseminated I mra vascular Coaguiadon (DIC )
Acute Rr pirdlDn IHscrrs* Syndrome (ARRS)
Dciirium
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Rjxn l ife Support
Cardiopuimonan Kesuscitation >md Choking Basks
Disaster Mdnd crncnl
Bitferramm
lr*l Idkilig Ml alrftS

Ventricular Dvsi'hwhmiA*
An tillrrln iInnit Medicalion-
tniljEiiiujion 11ran Disease
Vaivilla t Hr»irl Disr.isi1
Vascular Disorders
Abdominal Aortic Aneurysm
Ve Imo s I hru LilIHMrnihul is IH { V I T i
Test-liking Strategy
Neu Griirratidti N C l . F X " Fhatililidlioh ( N G \ ) Slslr Qm-xtimi
(i. IngrstMn. Digestion, Absorption, and Etimination
GaMroesophdgral Rrlhis DiM-,rr (GF RD)
Peptic Ulcer Disease
Lhimpini' Syndrome
(.elide Di- dsr
( rohn't Drrdsr dml I It rraliv? Colitis
□isertkular Diseases
intestin.il ■ ’bsLi uctiuii
Esophageal Varices
Hepatitis
Pauirtduu
Chdt-f >Mil is olid C taldithidsis
Urinary Tract Infections (Cystitis)
Urinary iracl Obstruclin
BrniQii Prostdtic HvnemLisia (BPII]

Head I n j u n
CSF I I'.ikrfge
Stivke/Lerrbrt»vaM.uhir Atudriii (CVAJ
Parkinson Disease ( w Appendix Cj
GiriHa in-Rarrp Svnrtrnmr . . .
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uuitUln -tMrrr SvnOnilnr
Multiple Sclerosis
Ms asthenia Gravis
Spinal ("ord Injun
Fractuirs (Fig< U.7J
lain) Replacement
.Amputation
( K<n>|U>niM"
Rheumatoid Arthritis
Lupus t n ihriiMlosus
Degen rralHr Join! JTiscow (Oueoartliritis) (Fig. S.12J
GkUCOKM
Cataracts
Lse li.nutki Injun
Hrariiig l a *
lest- Taking Strategy
N e u Grner.itioli NCI. EX • Fxatnuialiuli ( N G N j - S n l r QttmlioO
9. pediatric Nursing
Gr<m I II and Det rlopillcllt

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Nuiui.il (kowtli .Hkl Devrlopikicnl
Pain Aiw«ment and Management
Pvtanfoigs
IflununiutMDS
Coniniuikk able Disuses
Respirator) Disorders
("drillin anular D r u r i l r r v Cun rikitdl R i a r l Disordm
Rheumatic lever
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KdULiukt nhiMM-
Down Syndrome
Cerebral Palsy (CP)
Congenital AbnorauliLiei! of ihe spine
Ityriroc ppKiJiks
Seirures'Epikpsy
Bacterial MMkiltgpfc
(Cry e Syndrukike
Muscular DyMruptay
Renal Disorders
Oiarrhrd
Gasti oiiimtiikdl DHorden
Heni.itolojik al Disorders
Metabolic and Endocrine Dtsordets

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Next Generation NCI FX • Ftaniitutimi f N G N i - S l y t r QueMimi
11. Mental Health Nursing
Important Definition*
therapeutic Communication
Coping ami Deien* ■ Mechanism*
[trerapeuuc Ireatmeut Modalities
Group Therapy
Anxiety
Somatic Symptom Disorder
Crisis Lmenentum
Trauma simsor ft elated Disorder*
Continuation ol Streisand Anxiety
Dissociative Disorders
Prr*mt,tlits Disorders
Caring Disorder*
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Deprrs*hr Disorder*
Suicide
bipolar Disorder
Anitdepresurui Medirallon*
H1GH-.-M FH'I Antidepressant Use
MocKHinune Oxidase Inhibitors (MAOIs)
Schuophienia Spectrum and (J diet Psychotic Uisuidets
AntcpvycboHc Medication*

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\ p p e i H l i t A. M i n i i r i F 1 a t H i r a n m values
Appendix B, comparison of 1 hree types of Hepatitis
Appendix C. ( oni|kirr anil Coiilr.M; P.irkinsniiX Disrasr, Mv.i'-tliPiiLi Gravis, . I Multiple- Sclerosis
Appendix L). Practice Questions loi the M l . L X-HN " Examination
3 Managrtwnt/Leadership
4 Advanced CHiuul Concepts
5 M.ih>i n.iJ X r u b o m Nursing
b Medical-Sargical
7 Psychiatric Nursing
H Leadership and Delegation
3 Management.! eadenhip
4 Advanced Clinic al C o n c e p t s
5 Maternal-Newborn Nursing
h Medical "ni>>iuil
7 Psychiatric Nursing
H leadership and Rrlr dliofl
Appendix E. Next Generalion XL LEA • KN Examination -iiyle I nfolding Case brudies
(inhddiug C ase Muth 'H
Unfolding Case Studv *]
Unfolding C asc Sutdv if 2
Unfolding Case Studv *2
Unfolding Case Snid

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Copyright
Elsevier
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REST LIVE REMEW W ORKBOOK FOR THE NCLF.X -RNK EXAMINATION, NINTH ED1TTON ISBN' 978-0.323-
93439-0
( npyrighl '£ 2025 IlV EKrvir r Inc . All righfs arr rrscrvrd. iiu lurl tnjr llios* far lest rind tlala mining. Al training, and
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Practitioners and researchers must always rely on their experience and knmv i -vjluating and using any
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Previous fclirinus copyrighted 2 W , 2020 2010. 2016, 2014. 2012. 20 it).
Corifem Strategist Heather Bays-Petrovic
/Jfniri r f o/?r» - /k'l-. -'- 'rrirni; F.lli’U Win i-C.iiH- ■
Reviewers
Cantya S. M rrrinwiu MSN, RN. Anockttr Profeam, College of Hurting, East Trnnrsxee Siatc University. Johnson
City. Tennessee
M a r t Judith Yota, PhD. tt.N, CNF, Nurse Consultant, Grants Pass. Oregon

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1
Test-Taking Strategies and Study Guide
Goals of the Live Revieu Course
* Strengthen test’ taking skills.
' Provide practice answering NCLEX-style quest ton*.
■ Iniurp ■ mi'iuk .1 urauws nmi.m.im lest anrit'U
* Formulate a study plan using tools such as die WES1 Eiw Review Vw Kbocrt ’ v the .VCLEX-ffX Exom
■ Review basic curriculum content
NCLEX-RN Examination
* The test covers essential nursing knowledge (based on enm -level nursing that reflects current nursing practice).
*Htt* li'-i plan I', reused rM’ry 1 M jmalHf ■ ike iiu with entry-level nurses Is codjuAfl, (New lest plan
was implemented April 2023.)
■ Infoamjuan about the dew led test plen. including d-rscnpli-ns ol cr rr.ent categories and related content lor each
category, can be found al www,Robii.or I hr X . nHi.il < mid s i ate tkurd y lSursIng (NCSBhl) website
also presents ini umaii’in 1< r simF ms. F\Q'-, and - tmpk- 4 alternate format tfst questif in-.

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About Knowledge lest Questions
• Multiple Choice
— One question with four answer options
— Select one option /
’ M u l t i p l e Response
— Select one or mure options
Select -ill ilui appfj SATA) J)
• Fill In tlx- Blank
— Type in one or more nsmbers
It rounding is necessary, it is performed at tlir m l ot the calculation
• Hot Spot
-- Identify cute urea In 4 graphic
Measures skills related to safetv. physical assessment, and other p txedores and techniques
• f h.iriT thihl i
— Read informsnon in the chariexhibn to arrive at the correct option
Pltnufev Client fusion, l.ibtiraitn' data, .ind clinical <J«i1a on tali'.
• Ordered Rcs|>uiwe or Dreg-«u>d Prop
— Rank order or move options to provide the correct option
instructs the individual to cutlet the steps in the tuned sequence
• A u d i o Item
— Presents the candidate with on audio clip
— Individual uses headpliones to listen to the quesuon and options
F.v.ili i.iicv ,i intHrliiii'V i ompriern v in certain vkdls m ,r .w'.sn'H tn .mvis
■ Graphic Options
— May be used as ail or part of an individual item, either in the question itself or as pari of the response
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Npxi-Gpneration NCI TX Examination (NGN)-Style Question Types
Question types were developed using the NCSBN Clinical ludgmeni MwtMKwneiii Muriel t \ i IM Mt, w h t t l i is a valid
measurement o1 a graduate nurse's level at clinical judgment and decision-mining abilities using the context of a client
SCKUKlO,
The inflowing ttifcinn*km w ts derived from ! mda Silvestri and Donna Igrwtavichrs's "Nen-Genemfon M J . EX v
( N G N ) Item Types and Ortcripffom" (Examples of these N G N Item types will be provided thmugluHii M l N C L £ X
review.)
■ Bttwlie (lur stand alone item imh)
— Item-, ulilres- more than am1 ’tbeci>g< t i v e s k i l h il the N C J M M ui one item. Visually, liu item l a k e
like a bowtie There are five notions for selectinn on the left tide nod five twrinns on the rtoht tide nf the

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* iirag.uio limp ■ lore
— Items will base a minimum ol a and a maximum of 10 selections (known as tokens) There tan be one
ir tniire response targets tn which to ding a token I here is a minimum of one sentence with one target per
sentence and a maximum of five sentences with one taigri per sentence.
■ Drag and Drop Rationale
ilcrrei include one M’otrrH.i' with one cause and one v l i i c i or une ■ metier with on< -ause (•’ 1 wo
viii'iis. This con be a single dyad (one smetHe with iw i , n J , i jmiroie wlih three
targets).
• Highlight in I»*l
— hems will Include! paragraph nt infoim.nmn .uni tin- 1 a r u M u r will need seli-rt parts of tin- u'xi
based on What th. qticsiiofl is asking for the ciiiiitlcl.ni* to wfret, For rumple, the candidate Could hr asked
to lughlight significant infonnation or what > critical tut an action. There can be a inaxinitiui of 10 opuuns
in tltrse question types.
■ Highlight in Table
- Items include a table from which the candidate w ill need to select parts of ihe text based on what the
quebfo-ii is aski> g iliei ■■ h Lur H. sdecijTliere can In a iii.C'iiiiuiii of 10 options. I he table w II mt hid,
two columns (one bclnga header) and up to five rows.
General lesi-Lakiug Str.ilegies .
• Every question must be answered io move on to the next question. Make yout best decision if unsure uf ihe nnswct
• Qnickh ellrninaii' thi' flfUitiiiti Ihat ikt not answer ihe qui’Mi m
• Ren.Mil the question
• Decide what makes
• I bi1 ufiii K b tn
■ Only use hr li
information, you cannot assume that possible circumstance exists,
(piLllifirixorolln-r WtMtfct Ih.i: Spl'C liy whilt tlx qllcfliun asks
responses different from each othei.
yiulit.illi ■ uritM iiifolllU'i .m hit r lyflW m H the qrJi'Stioris.
■irtL.itj.j;i dun the question pinyIde* Ncvn say, “But. wh.it it . 11 tlw question does nrrt sure ihc
Test- Taking Srracegie.s for Your Toolbox
• Use ABCs
— Cliencs with airway problems or Interventions are priorite
- Actual CPR ■ Ciriulamin. Airway, UrejdUngfo-AB)
Acute before chronic
• Maslow X I B e r a n h v til Needs
— Address phi srological needs hist, follow ed by safety ano security needs. 1ive and belonging needs, self-
I ' s i n t n needs, and, Finally. sell-# mall zatmn needs
— When a physiological need is not uddirswd in the question, fotik lor the option that addresses safety.
■ Carefully determine the steps of the nursing process, (Tig. 1.1)

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Awwnitnl rn i p i i i v ftdihei leu ,inrl ; r r i l i d l i n ' m t i h t . i
— A i i a h i h :<■ jim -.iir r i w i i i n u n i l J l m g l l u . .giur-i ■ irl ili i n i i l u i i t p 1ir.il h ii-.mi ■
ability to meet needs.
PI.inning i i- punt's ki> f priuti'.jjaLiun idiid Ol' di : i.itHi.
i i n p k i n r i U d i i o i i di 1
:' L itian.MHl unrni of i
— Evaluation rnmpiirrs actual ouicomrE with c\ [* ■. i■■■L i tuu <mi<■
■ I hink Safety, Safety, SAFETY ::
Perl • Tm lhe ist invasive Ini enml iun - 1r M.
AsHh-v, hrli.'ii jklliUf.- dim. Ui;; s llw |kiiiiiu h l i - w n - disHv .s
— Treat ihe client, not (he machine’
— Gather lttfuii!]j(i<jn and peilurm J I lelrvanl a d i t t i i lun . . . J D . ■ l u J t h care piovulei UlCP).
Deiemtine l . h 1 I ■ ■ ui.isst*- fir-i |r ,is[ d( n k. uiti-l ntcuih unsiablty
Frillt ■,» g u h l r l l w s fra ii .isslg imeith slm.a pulilk
files NC SBM_Deiegaii<Jn_GuideJtnts.pdi
Kcrnembef the ditferewcK between the scope ol p: .icliie Mt (he Ckensecl Registered Nurse 1RN).
L k c i r PliltiH ■ l'N|. Hid Unllcefi’.l'tJ A ■ ■,a1 l > ■ Jiim- ■ 1 \ l ' | .
Assess
Gather information
about the patient’s
condilion
Evaluate
Determine ri
goals met and
outcomes
achieved
Diagnose
Identify the
patient's problemsNursing
process /
Plan and identify

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implement / outcomes (goals)
Perform the Set goals of
nursing actions care and desired
identified In outcomes and
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F I G . 1.) Ihe luirung pint Ri p nli'il wll n-rmiv Uli IrtKli ('0O|H’t K., & l Ill'll. K. LJOI'i I
T" ■■ fetfont o n d o d u h hrrdt1, nurring ifkh cd ] Elsevh r
Mare Test-Taking strategies
• Read the question first ■ usually ihe last sentence). Make sure to understand w hat the question is asking before
reading ihe scenario, ?
Ulis helps a tandldaie pick out lite pertinent Information i the Scenario and eliminate disfr<mnrs.
• The i.'iii 'itkni may Hint mi red flag wind', like (di, notMrti), in nf, and nhrtj."-
• Notifying the HCP is a red flag item Think about the appropriate nursing actions to lake prior tn notifying the
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■ Common nursing Inirrvvntions Im hide;
— Assess client status, vital slgyis, or lab values
Review medication admimsttauon
Provide small, fn-qut'tn feeding1
)
— Recommend fluid Imake: 3 1.'day t 2
— Alternate rest with activity *
Conserve rnrrqy wilh .my aciivilfc
Teaching Points • a
• Risk Iji'tiHS; t i x d i l l . r b l r versus ftmimtldlI iablf
• Prcvenuon and wellness promonon
• New medicaiima and sefl-cure instructions
• Client t mpnwfflnoni \ '
• Antldpaiory gqtdanir
• Incoiporatijg client education information into lifestyle, culture, and spiritual beliefs
Clarification al Frequently Used Terms
* Hralth t in- Prnviilri I H t i l ’ l

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— Dei-.ne looting at inecnuices, leprti ase me question in your own fruji, inen aiiswr. uit
■oetfafe
4. Rule run options.
— Bav'dort Vrm: k n o w H -.■ idt nlify .my itpCi-ins ih.n ifr i ii srtv In car r d , and mrcitalh l i l r l i -
therii.
R.il ■ il i?|lllr!. - 'll il ih-Liv lli .r ■ ■■ I. C h xr,h‘ fijnintcs lh,n < an in- [-I until ■ i r i l l i m ■ y.
— DiftcjcruLau? aiming ilic remaining options using prior knowledge of the subject and tehted
nursing principles,
5. Rr-i rad lhe question wtrli two opiions Lfit,
— Repair ;he quoi on in .■ mine weighing the tun options aval I at
u. Answer ihr question and tnove on.
— Do not second-guess yuwself!
Appropriate Knowledge
■l . I ' l l J Kip? :■■ I..HIT-’ h'llgr !■ .Ill'iWI-t IfclH S4ln
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— Do not respond based on:
* iixif [MM ■ l i f t U t J i r experiences in ligrm.s
’ A nil J.ir ?iir,isi- rar h'liii
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* Vb hat you dunk is renhsric
* YrMir i.lnklien, pii'grfctnck'v, |wn?iUs, riijrrx, pri sondl rvspunM- io a drug, and .51.1ran
— Do r.fHiiid Lt I'd i>n
* ABCs
* S<.irlllllli . L'h.iYiM-.tl. MK ii.?ign,il | . i i r u i p h " .
* Princlplts || [1'<U hiiiidrarTiHig
* Mutaw'i Hierarchy nf Needs
* Nursing process
Alishi'i |i,i‘.rjcnjlv I-■■ '.‘li.ll |L’ qiu’Miull d'.k'. oomuiv. 1 k'.'-
» NCLEX-RN Ideal hospital
’ Bask anatomy and physiology
* 1 -tiiL.d thinking, ( uh ,il m. - J |n !■ 1 wiKuig
Studs Break
B u i 1 4 ______________________________ __________________
1. A ilirnf has not had d bowrl muvrinrlil 111 2 days dJ«l rqtnrl'* ihi*. iidramidtiiHi hi I hr RM. Which iiilrrvriiliini
wnuld tht* R \ implemmt fl nt?

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I In -in Hl Ibe < trrgher to utt ■? .1 gLbA r»f warm prune ]uk t1 al m<' ilrlmi
2. Notify the IICP and request ■ prescripuon fot a stool sotieneu
3, Assess ihe client's medic aJ n'c thrd to determine his niMr1.1l Inwri pattern
-1 11: Ilin I lb- < in t.';' IT Co III. !■ rj' ihr I h i ' i | | \ lliilds 1. 1 Ils . li-tmri, < gl. ■■,'■IS put 1!.■;
2. A diem who has chronic obstructive pulmonarv disease ( C OPD) is resting in a semi-Fowter's position with
oxygen it 2 I min per navd l a n n u l d . 'Hie t h r i l l develops dyspnea Which action would the RN lake first?
L t ill the HER
2. oh.un 0 bedside pulse oxirncrer.
J. Raise the head ul the bed higher.
4 Assess the diem's vital signs
Specific Areas ol ( onu-iit: Lab Values
■ For commonly used laboratory iesG; know what sanations “lean, ar J the bes:. nursinc actions tn uku
* tl.'lllii ,. ' II .Hi. I !■ Hl.Um ■ |H .Si H|
* White blood cells 1WBCs}. red blood cells 1RBCs). platelets
* I . ir<i|'. i.-. I'... . m i l l tK ). S n r . in- 1 N.i ' I a l l Ini' it .1 ' 1 L l u i i i > (I I 1, I' ■■ i - i i i i . . P t ) 4 ’ 1.
Mdgrii’siiiFii (Mg 2 *)
* Ui.iod urta nitrogen i U L S j and m.-uniite
* R. lationshlp of r / * and PO.t 3 -
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’ Arterial blood gases (ABt. sl
* Prurhrinii‘>in flmi PT|. In nation.■! urniii ■I r .ni* ■ t IPs R >, p 1Lil 1: • mihi ■ -mi t lnu 4 PTT? n 1 ncjr
contuse diem.
’ Glycosylated Hgb I A 1c)
Stitch Break
Box 1.2
1. hi LDiiipteliiig 4 client's pci Evprialive luUUnr, die R.N linds that die culisrnt lut lli has Hut b m i signed. Ibe
c l i r i i t lirgins to ask ninft [piestion abtml thr surgkal p r o t p d u r r . Whii i tmn would (he RN lake?
1. Wltnc «hi- client's hlgn.iluir on thr rnnsr-nl Inrm.
2. Answer the client s questions about the surgery.
3. In mini 1he HC Pibal the cln-nt Iws questions about tltesu riv.
4r Reassure tlw client that tbesurxeun will answer any qm -siinns hrt.nr ilw .inu-.iIn-in is .uh..... ..

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C nmplrmrnf'it y .tnd Alternative Therapy
* CiMiqrl>-nH-lil. ■ ■. rid .ill* : illv« l i . - d | i V l'C A M | i i - ' h l l l ri I I . i i l f i l i i ll lm;|m! •• UL- • - i li.il iivdlc .Ur ; ,
JUKI iltlt'r tlrjlHU-ni*. -.ijch .IS .W H|lJc .ULH- .h jpiCbl 112!'. i H g - U j . R i -J. and .11i ‘.lalhci J|1V
— Know the risks and benefits.
Knob ihe iin-. Ii.inl.s n 'lam P'.i<L. ■ tin i- , ilrug tri.itiliu-'-.
— Kniiu. iheconitaindit nn>ns wfth ciadfiional and <nhri- herbal mtdbcalons.
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MU. 1.2 Acupuncture, ibLGukphoto.cciiL-'YdnC.
Nutrition
■ know the values and food sources of vkununs, minerals, pi utefns. caibohydi ues, dietary hbeiP and lais.
* Be able in Icfcntifv funds relative* io Iheir sudiuin content, potassiun level, and levels of phosphate. Iron, or vitamin
K
* Identi'v pregnancy and fetal growth needs
* l i i t m i l i H V rjllc ||' "I .kt .I tlni*‘ I n iFi' inls tip dn i f i t r i m - i l l r i . ■ •>.

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• Fr<ijf!r- -ii'n m dti t nv u i r.ui'ii
* Note client food allergies.
Medication Administration and Pliar iiidiolof’y T h r i k : Safety, Sci/ery, SAFETY
"'die rr-> - ,ii|i>.n d m i n - ' iircm is more ih in |iN knowing ihc action i rlienwdkaii ■ -
■
— Reflect on the holistic picture of the diem
MedK alien Rights.” plu tvi In iji.H? or -kill ev i. utitin
— Doi# interactions y, . *
— Vulnerable argans; labs; what iu assess
Allergies and presence of superittfections
G j m r p t i>| p . i k iimhi'iirnli
— I low you would ev ihtawgf:
• Die drug i* effective.'
■ 11 I'' ■ >i ■ mhh'iii .Hi ihe drug?
— Special conskterations
* tach safety emp.im?ifr:tnt, compliance!
Best Practices lor h a m Success
- Man 't-1 b'sl anxiety I'Fig- 1-3)
• t ,<• :■■ ivr i I.ilk ( “ ! < .m du ihj.Ml*' “ I k i l l be -.tit t t'v>hil!")
* Set up a study schedule and stick to i t
* Avoid negative people.
* Resjieci \uur Ixxlv and viin ni.iiiil..
* EsUblidl a balanced lifestyle (l.e.. a regular schedule for sleeping, earing, exercising, wv i ii ■ .• ind working).
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1 Pl.m ymir M bedulc lor tin' 4 hi H i -i k’. Ii : u r i l h > M r I X i t....... I •:•
2 Organize resources.
J. tdefllify -.iieliglhv ind c Jul k-l
-t r .si ■ : ii i- ■<- ■ ■■ ir- ■ i E x 11.jt o u t s i . Hiu.ii -.
r> Establish jnci stick to n stu- . . ■.< heduli1
,
(j. Pass lhe.NCLLV
V
Exam Success; Tike ( are of Yourself
A WrrJ. B i l i i r i rhe Elam
— Mak* a test drive in the sue.
Be fnmdf uI of traffic patterns
F.imllkirlze ■. ■ irsell * t|» ihtj i*
— Confirm that you have all ot yew documents and that ail informawm is correct.
* 1 he Day Brio re (he L u m
— Allow only 30 minuittjc review test-hiking strategies.
— Assemble all necessary materials;
• Admission ticket
* Diiui dims m icsihiir LiTiii'i
♦ hlriitilkation
— Do something you enjoy.
Do n |H‘i i v‘ui biMly jnd your mind.
* The Day ol the Exam
— Do eat a heahhy med.
— Do di ess curilofldbh

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D u . : hW pler.u Hi-. : i get iJir’jf
— Do lake cuily i our identiflcauon farms into the examination room.
— Du iivuid diMr.n htiri1
-
Du tne p t i u t A r srjj UJiL
■ D u r i n g the Exam
■ Bit j<he deeply arnl le&ular ly
■ Continue [he ;iiislrive':i'lf-r>:;k.
• — Be in the m-jmcni —i » mgrrtv1
* — Do nor allow the number oi questions to influence you level of self-confidence.
Icil- idking Slrdlt y
\ u t i r t l o f i i i h k r : dt.i nih' t i | i i \ l in ,n hli-vr ihr in ivriiiliri N'nrlH?. ill rhlh irvi w o il In “i nr uiflig" ,i few tin !ndmi "■
examination, h dot's not n w i / Instead, organize planned study sessions in an env nonmeni ilui you find relaxing free ut
stress, and supportive of the learning process well in advance of taking you NCLEX
Next Gene rd tinit NCLLX*' Examination (NGN) -Side Question
(Refer to rhe pmiorix ni icmmfaii rnpirdrn the di/frrrnl h,■■e o/ Sr. V cpr'titmx. iti ent h < /nrptrr i>f rluX rrm-w. we vdW
gfve on cxampte of each npe of question so you eon become /onuliur with this new NCLEJC formnL)
D r a g a n d D r o p B a t i o n a f e
Scenario; The R!N is caring for a diem admitted widt heart failure I he home medication list is obtained
H i iH'iliiunm _____( I ) ■ i iiiidlinte >drd 1>. i Hein-, w uh d 1 -iuiy i ii ln' irt Idllurv .iml nin wnixni
symptoms such as (2) L
Home Mcdk alioil I JU ( Option .11) St Hi|kloiirt (Option ff2}
Finn-. mkie40 mu PCI n.dh Exertional Idllftlle
Potassium chloride 2C mEq PO Daily Hypaiension
FiLfglmi/.cirw -!... mg K) i i-iUy Hyperglycemia
Enalapril 5 mg PO BID Unusual bleeding
Answer - Pioglhazone, 2 - e.xertii'nal fatigue.
R.jriffui/r Ph Wfc/AW h n metf/carN>n ir J ;u tn'or tv/*’ 2 dtahnes «rni bus ta'rn Iziown u ■ < ausc or wor f'n heart
rurJiur t- I his mcdicortori is CDnfrdwidlc uti d rn chcna who ? jve hejrr /di/ure a.1
!J ran kud ro j' sciiuiy sympcoms such as
ecetrnwol futii svi I. ' ny u f t " ' fnrnds Vys, «>' f ,frrt; h i p - r t r n v n; nrtd irtness .' brralh

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2
Legal Aspects and Leadership Role of the
Registered Nurse
Legal Systems
* Civil law is rancertied with Lite protection ot the client’s private righis
‘ C r i m i n a l law deals wlih the rights of indivichials ami society a*. definedby h m-.l.iiis r lawv
• Nursing Negligence
— Failure tn exercise the proper degree ot care required by the circumstances that a ri.ivon.iblc. prurient
person would exercise under the same tn similar rfrcumsLar.ces to avoid banning others (conefess uetj.
• Nursing Malpractice °
Nursing Negligence and Malpractice
F.nliiic 1. 1 11 ■ ih|. I.r. •. .1 . : ■ lb. Il I ir.. liii ■ i Ilin:. I I-,' « ',1.1 1 . mil. i lb.- vcinu < i iiiiil.n
circumstance {professions' rteglipencL').
Malpractice is found wtwu
— 1lie nurse owed a duly to tlrP them .
— The nurse dkl m >t carry not ilut duty or breached that dutv
— Hie client was injured
- Hie nurse‘s failure to carry out that dutv caused the cliern ~s injury
Standards of Care
• Nurses are iciumvd t O b ' l l o w siandards of care, why.lwrigin.iie in nurse prat nee acts; Mate and federal liaw(GS)
and provincial. tcrritorul, and federal laws (Canada); accreditation recommendations; rhe guidelines of
nrsnf—< i - n n a l ir>b .i.-.is. iR*. wrl<rwk Mrvbr ' ntwwvrhtri-. tVwi !>♦«*. wMMrrie

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• Nuises art- rrs|v,ns|hlc for performing ptnu-dllBc correctly and e m i d n g pttilt s-Jnn.il Judgment when
implementing health care providers' fliCP) orders.
• \ i i r a - .-i.m u I <■ act limitability anil IMpOOBlbi111> l--i i leii -gali t h are tasks
Studs Break
Box 2.1
1 Tlir iililiiriisrd assistive personnel ( L A P ) repurrs to tile stall registered nurse (RS) dial a client wbu liad
surgery 4 hours ago has had a decrease in blood pressure i UP) front ISO BO to 110 70 in the past hour. The
KN rtthbes the L A P to check the client's dressing for excess drainage and repot t the I indings to the KN.
Which factor is most i m p o r t a n t to consider when assessing the legal rami I k a t forts of this sint.it ion?
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1. The parameters of the state's or province’s nurse practice act
2. I he need to complete the hj >-spl tai S adverse occurrence repon
3. HcBplia) protocol rtgirdtag the lirqurmy ol vital slgr- i > i . hour posinperatlvdy
4. The 1ICPs order for changing the postoperative dressing
2 lire tin* lv III rnwrd KN overhears twu nurses talking in the elevator about a client who will lose her leg
t»ri.iuM-of negligent e of the staff. Which action liy ihr newly licensed RN would be Implemented first?
I Monitor the nurses closely (or further ncnirretwes.
2. Advise tlrem to cease theu comnimucation
3. Inform the nurse manage of the lunvtnmkm.
4. Submit Mloctilnrnct’ or varum c trptm.
Practice Issues
• Nurses must follow rhe HCP's utters unless the nurse believes that it fa IX . , violates huspiui policy, <>t is
harmful to ilw diem.
• If rhe l i r p ermfinnc the prrccrtpntm-ntdn and the nunc st: . belles e the order IS Inappropriate, the m shcnilo
contact rhe charge nurse, nurse manager, or nurse supervisor io intervene.
• The nurw must make i formal trpon tuptelnlng dw refituf.
• The' nurse should tile an inc Idem (occurrence: vat iance) report Ln any situation that will potentially c ause harm to a
diem V *
. -vt
Advance Directives (ADs) (Fig. 2.1)
• Assess die client's knowledge of AD,
• Provide the client with information about AD.
• The rboni'x Jtt w i « l v reviewed nn flifomwirvn T>wn li ch™dd he tllnrl nr In rvuteniv rhnrr

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* Intt'xr.: -.' A|J ! llu- tlirt t pl.jn of CJtf
- AOs < an Im ■' I v-iwlufigjnn measures when iheivJs Uulr nu< Luu ent h t u v r i y .
* 1 ivinp HiH (I W)
— LM/Ji i wntlen document that direct utdtmersi in accordance w ith a ctiem's wishes tn the event ot J
■vnnlii:i illni"--. . ‘■niilir- .|| ilhkf B ikyjfid wiiE'lidtlit il is n<] kmger Lilili ;>n . iriinih-m. ,ir.- h;- «i In i
w Islit's indrpcndrtiily
* Durable Power of Attorney for Health Care
lirnt uppLuiits .1 ri'[KrwnLUiYv (heahh cdiv|MO*y) tu rruike health tdiv det Isujiw based ua dte L'litnC
wishes.
reproduced or transmitted without publisher's prior peimision. Violators will be prosecuted.
FIG, 2J Legal document: Living v ill and advance directive i . medica! decisions,
iStw. kphoitJ.ronVftd ibid i bov
Sluds Hreitk
DOX 2 2

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\n awake, alert clinti with iinprr ting |»»lmrHt*rv eclrtiw i% hnmglir lo tbr emergi in y clqhirtinrut. rhe
diem provides the RN with a copy of a living will dial slates that Mno invasive" medical procedures should
be used io ‘'keep Iwr dlhe. h I he health tare team fo qurMjoning whether ihr dirnt should be intubated.
Which inhirrnalfort would guide the leanfs decision?
I T-- living will removes ike obligarkm to the client In any nt ikaf drcHmn-m.iking,
2. 1he diem is aw . k t and alert, which makes the living, w di irrelevant and nonbinding.
T I i(esdviiiu rrwdMjrts tin inn have m N ' rx|il<iirH*d m lb.-i lli-ni Iwt .mseof the Signed living will.
4. Th 1.1 .illy -Iniulrf I * 00tit*i led 10 d i l n n i l l i r wlm has ditr.ililt- power 0! attorney mt health i are lot the tlJrftt
Abuse
* Vm ■ iimr l i i n m i l nutldvi indiviihul', All viiln, .ililep“: I iliorv eat tr-k
* The National Center on Cider Abuse Identifies rhe two mrsi importer Indicators of ibose as:
Frequent unexplained crying by the alder Indhiduwil
— An older person 's unexplained tear or suspicion of a particular person or persons In the home
* rthvi. i*. . phvsiGil ln|ut \ or neglect (■ g esiden. i • ' main. ■ irtem or prrtener of bruising on rne extremities »r
ttunk i are signs ui possible abuse, d ig. 2.2 1
’ Rrcl Flag: The injury dwsnut n .ifi.li the ■: nv,
* The nunr has legal respcKulbllilies m report Incidents of abuse, neglect, or violence.
* Mandated reporting on vulnerable populations t'e.g.. elder!) . pediacnc vulnerable aduki
* Hrdltll care proteulonah who do not tr]x>tl suspetted .ibuw <ir ru-glv
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FIG, 2,2 Physical signs of elder abase, ISto«|rfKMo.uini RcipjdLve.
Restraints i Fig 23)
* Used on/y to ensure the physical safely ul the client or cd uthei clients When less restrictive lolerventions fail,
* Must -.ivc a wnrri n ord ■ from <t HCP mu-- reaswss ordei ft u , at fl or 24 hours)
■ .Nunsr must li ! ju agency policy and puxedurr lotrsirain any client
' Documentation of restM: tuse and of follow-up assessments must detail thearrempis to use less restrictive
interventions. > V
* Liability toe improper or unlawful resnamr lies w uh the nurse and health care facility.
* The nurse m s l ensure that the UAP or Ikensed faclx al nurse (PN) working under the nurse's supervision uses
TH Irakis properly and according to health cure fact lily polity and priKredum,
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F 1 G . Z 3 Wrist restraint Reprinted with pcnnh'rion I: ■ ■ Cooper. K.. & Gosnell. K_ |2D1 ri .
FnbTiJdtjons one/ fiduit heo/f.'- narsjny "'Uh cd ]. L l v . H T
Studv Hrrrik
Box 2.3 b*"
P " ■>
. A famih member of a cbent wbo is in a restraint asks why it was applied. Which response would the R.X
make?
1. The restraint was ordered by the HCP.
2 There Is not enough staff in keep the client Mie dll the time.
3, I he ■.fiber chews are upset when tine client zanders di night.
4. The clii-r s actions place the client .w high risk for self 'harm.
l e dl Aspect* tif Mental Health
- Adnii'-sinns
— Voluntary
— Involuntary'
Emergency
■ Client rishis
• CompetefKV
S(u<h Rrr.ik
Box 2.4
1. Which nursing action has the highest priority when admitting a client to a psychiatric unit on an
involuntary basis?
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L Reassure the diem that this admission ts only tor a limned amount of ume.
2. Offci lhe client and family die oppjinunih to share then feelinp about iht'tKhnivdoTi.

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Driifininr thu iM'luvIoi?. rlMt resulted In ihr nrrd lor admission.
4. Advise lhe client abcml Ihe k-gul light* ul dll hovpllallicd dk-M*
Confidential Health Care
■ ■ unfidcntjdliiy n the nght of dll du-nn I:?.- Amnkcan Nuisc* ts- r.Littoni exleot Lifoc* feu Nuist-s indthc
Canadian Nurses Associalion Code of Lihics for Registered Nurses assert the duty of die nurse to protect the
i orit kleiilI.Uiiv of r 11vnr-.
* All clients are protected tinder rhe Health Insuiancc Portability and Accotinubibty .Act at 1996 1! UPAA).
* The H1PAA established standards for the verbal. written. and electronic exchange dr:private health Information
* H I PAA esidbIrshes the client h
s rights;
— Tn ■ i-cni ui us.' and li-a lu-i.v of hi'.dih Inli-mi.- ion; . y
— To inspect and copy ihvir medical ret ord*; .and
— To amend mistaken or incom p ; ere information.
■ Thu Pfttoii.il ii'' 'iin.ii : Pimt-i non .mil 1234 Ivi inn. I for A< i (PIPF.DA) (QMdtJ It Mnmjghditlan that
protects personal Information, Including health intonnsifua. PIPED A delineates how private rerun1 otjianiaatk
may 'Inct, us? or di '-rinse p-: -m.il in ■ ■' atrm
InforniPd Consent
■ Competent and of legal age
* Vbluin.ii v
* Risk, benefits, alternatives are explained
* OppominIty for questions
* I h t HEP who is perfurnung tin- ;.;rxudutt «i; tt raiment obtain- krfixmed cc ■ -<riL
- The RN w i i n t v . f . rhe signaturr. This r.isk cannot t ■■ del roa I AP.
* Anste-I : - to uny [jurdfam the client has a>ml JI phKVdmi- .ire ihr II pon-.ihihiy tjf rhe Hep
* Patients have the right to change iheu cmnds iibdrew feonsenL
Studs Break ▼
Box 2.5
I he RN enters the room ef a preoperalivr dieni io witness ihr cbent’s signature <m the surgical < onsenl
form, V* hu h question n niusi impirlaiit for dir RN to ask the clirnl?
I "AsTicn did thu surgeon explain die procedure ra you?"
2. “ h any member of yout family going to be liere during your Mirgeiy.1"
3. "Have you been instructed in postoperative activities and restrictions?”
4. . ...... I'Kt-dan; pnupcrarnt palnmeclkuthin?"

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Good Samaritan Laws
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reproduced or transmitted without publisher prior permission. Violators will be prosecuted.
* Limits liability if a nurse offers assistance al the scene of an emergency,
* Provide only C f t di.il curtsIsirnl w lib the nurse’s It vel of expcithe.
■ VuiS4? is requiieil to deli; er caie ma ''reas mable and prudt T manner "
ConuHUiiKdrioii Skills: lypcs of Leadership
■ Ata .ireneu of Speech and Uodv Language J ig. 2.4 1
— Reciprocal
— EmpaihetLc
' Authorial iflir Aggressive
* 1 di scz f-.iiie: Pdisive
* Democratic: Assertive
* Consider the type cd leadership indicated by these \ rrbal cramp les:
"Do rt my way."
■ Aggressive communkiitlorVauihuriiarian leader
— " Whatever, as long as you like me/'
* Pass ve t ■ ainn.niH .n .■ -n - e r - f j i i e
- - " L i ’ l X umsiiler ll|i.Mi|ir.ijii>i ,iv .iiLililv.*"
■ Assertive communkation democraiic leader

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_ 1~ T tf~ “1 4 ■ - - - > M J k - _ _ I _ I *-L _ J f j a. J fl ________, __ -L TV - _ . . L
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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
r i G . 2 . 4 A nurse sitting at the same level rh< client m fniirr communication Reprinted with
permission hom Cooper, K.. & Gosnell. EG [2U19] Foundations and uded: heui'th nursing :0th ed.].
Fl'j'vtrl.
Studs Break
R o t 2-fe
]. I he charge nurse (oiiirnnts a staff nurse w hnse behavior has Iwen rpsenihil and negative since a change in
u n h p u U c y \*as .iiiiuMim n l The nurse vUtrv, " D o n ' i h L i m e i u r ; imlwh likt this iilc.i U'hn li is ihr
charge nurse's p r i o r i n action?
1„ C.ortfriHii the other stall members involved m the change of unit ■,
2. (’.ill a linn miTtlngni rrvln* die re.r tns tin i Lunge was made1
.
3. Develop a written unit policy for the expression of comphiin; -
4 Encourage the nurse tu be uvujuntablr for then own bt i v i m .
Delegation and Supervision Skills
• Thu pncHV by which rvsponslhilliy and mtodty —but not arrounmbU/n an- nanviciird id jniHhrr individual.
■ The nuisttig process or any activity requiring nursing judgment may not be delegated to the CAP.
■ l ive Rights o( Drlrgation
1. Rigiu task
2. Right drcurnttance
3. Right person
4. Riglil dir
5u Rtghi supervision 5
* Supervision
DlirvlkWflOidtiiiir wt
— Evahiau&n.'nMniwring
— Folk .w -up

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■ Delegation SkiIk
RN Kespunsibdfoes
• Dfteimlnr ■. Jlcm needs .iqrf when tn delegate
• Ensure proficiency and avaiLi bl Illy of drlcgilte.
• Evaluate ■ uicomes uf and maintain accrjimtability for delegated responsibility■
Drh X',[,, <' Responsibility
• Accept act.; itles based on own competence level.
■ Maintain competence fen delegated R -ponsil ihty
■ M < rn , i io at lunt.ibilii y h >i h-gj1r. t . i: i Ivii t
Sluds Break
Box 2,7
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reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
I Which assignment should the RX delegate to a UAP In an acule-care seitmg?
1. Checking blood glucose huurh foi a diem with a continuous insulin dnp.
2. Giving PO Inetlif al nls left at llir bixhide b ■■ lhe lib to lake alter paling.
l r Taking viluI signs lor .in nlik i i Ill-Ill with Irl numrm! mil It'll ■ u.il fr i. in -.
4 Replacing a client's pressure ulcer dressing that has been soiled by inconunence
_ I hr charge nurse is ui.ikmg .t i griment1
' for r « h of four siaff iiirmbri s. including dil RN. d PN, and Iwu
U AT'< Whir h bt'k Is ltrs! lu assign la the PN?
I Maintain a 24- hi'mr urine coiler11nn
2. Wean a client from a mechanical ventilator.
< Perform sterile wuuml iiriiwtkni.
4, i rtxain si fmluhtl Midi signs
1 Which situation warrants a variance (incident) report tn lhe RN’
1. A client irluses to lake pitM-tibcd ntnlicdtion.
2. A clients slatus mpruves before tornplet ion ol the «jm r te ol twdic<|i
1 A - llnnt fw- an .illcrgji rraction IO a prescribed medka in.
4. A client received medication presenbed for another client.
Effective Team f ommnnicarinn (Fig 2.5)
* ComnMiticalKn locust on:
— Team building
~ FacilHating collaburwMi r ‘
— Consulting
— Flrlrvjllno - »»

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- Supervising X
— Lea ;mg and managing
■ I.ahToJ nnJcni c refers in acts chat occur iimcmg Colleagues fiidlyrn is described as acts perpetrated bv one in a
higbe Jevel ui authority dial utcur uvei ume.
* Tib r -iiits miv affect i lleru M : -ry.
* Fkampta of ibr impart an clieni safety lould hwhidc:
* Delayed medication administration caused tv failure to notify the nurse responsible for administering the
lin'd lt.itlon ot a i fungi-
* Delayed noriikaiwn at a change In prescriptions by the HCP
’ Nurse nmits pcrrirwnl information regarding client "s care or prescriptions
* Best practices lor caannwntcalKn include:
— Communh ate dear k
— Treat others with inspect
— Avoid gossip
ReI; on funs
— Collaborate
— Offer assistance when needl'd
Speak dirccih to the ir ■ ndual wiili w -mi one has an is>iiv
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reproduced or transmitted without publisher prior permission. Violators will be prosecuted.
• Handoff ccmiuumcaiion
A tn nr, tri 111 L i miinn i ni. iintfi dlciiv. i* if 11 juiliorlty and i i ' s p its lb 11ity during ir ■iisitiim ■ m l a i r
— Impiaiiaru i hi-ni InfurmaiLun k 'Jun d at pirtim-nt rnii.s ut rail
— Ensures continuin' of care and client safety’
[mprcrtrt LunutiuoKdni‘ii and afipiupi hue dek'gatr.'n

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FIG. 2.5 T> am iuHnlwrs roltatorailng. Coupe*. lv,4kG«ndL K . [20 1*)J. Foi inJu pir«r.% ormf utto fi
fifu/rh rnndjty [Bib cd |. Elsevier,
Stud* Break
R o t 2.A j y 7
The RN is preparing (nr change of shift, Which action hv the RN k chiiracte ri*tk of ineffective handoff
communication.*
1. '■■ R*J Mali’s Hi ihi RN <<nii -iii, im rlnu, 4,T : i-' ( lit'nl i ' l i n i t i ' ■’ ubiiiil i ■ -iiilii .■ n Tis ,il : i 7 -mpjTi Ri'vn-w
the into mutton provided uGun hnw iu use m uwentm ip to innii-i.”
2. rhe RN refers to the electronic medical record to review the diene's medication administration record.
I. Dm Itiq, n ■■ ■>{■-, ill' Ft'S Lilk' .ilnim Ihr problem lhe I \P iiv.r- . by nm : ■ rtofmlnn a lin -.liik I hud
glucose test on the cllcni.
4, Before giving a report, lhe RM performs rounds on asugned clients so that there is less likelihood of
i nrmiplJori dm lug h.iiHloil
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i BAR
■ S-B AR is an Iruerdlsclplirury commumcarion strategy that promotes idteciiw cnnummicadDn about clients
between care given:.
5 - Situation: biale the issue or problem
R " Background! Pnivhlc ihi ■ lii’tuX lnMury.
— A Auessroenti i .he the nv*M recent •.iial sig:r .md cum-ni lindittgk
— R = Recommendations: State what should be done.
Zulturally Sensitive Care (Fig 2.6}
■ I I ' M I I - . . ............. ................. I .................. <11 . I . .1 . . , | | | « | . ■ ■ , H I H ■ r, r, ,( L. , - , l l ' l . ,, . I , , I . I

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• ■■to » » » 4 * - “ • - * - - — I - - J — W>> ■Mt.ir.'. VtotolMfto
* The I uktiral .-]■■ fmenc . n-.wrrs qu- hih: i:x such d-
— Primary language spoken
Pain HMnagpnkitt expectation1
*
— Support systems
— Feelings toward self<are (for example, c l i e n t s feelings regarding the gender of the caregiver. does the
client !■ I i i w i i r .irits nl giving Id Iv men: ■•■is ■i:| ul dk‘< iMuii- iking.’)
— Diet preferences
— Beliefs regarding death and dying
* Explain to the client and interpreter thai confidentiality will be maintained.
* V.ilm < tl u n i i U i ' M i ' i munbi H ■■■ I by i Indus. I in-’ ■' HT I’
* Employ culturally relet .■ md language appropi lair teadiir j materials andrechnlqu'. i.
FIG 2.6 A nuise oommunkaung and providing .are lur a client ol a diitrfent etluiK background.
|S|| -.|ihuti i t run Rr alPeopli Giotlp,

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R t n J ,<F
lire diargr utirre i* |i|.uiimig < l i n n M nnreiit* fur I hr -hid. T h r u m ream i m l m l an R V a PN, arid a
UAP. Which client is appropriate to be assigned to the P \ ? (SHeci all ihat apply.)
I ■ A them being transp- 'reed for a 5'1AT vray atter a i nil Ironi a * lieekhair
2. A . Iiuiit it- eivin IV plRKV i.ic k v.mu mycin (himigha iwripherally insert vd line
3. A client with sickle cell crisis who is receiving hvdromriphom' via a i-TicmrerHirrollcd analgesia pump
4. A client withd pirssurr ulcer who was piesciibed negater pleasure (wound \ dLuLiii - m i s l e d duvurei care
5. A pa*iiit|wrativecli--Fir who has been prescribed ? unn - ■ padted red b!u id cells
? V charge niitM’ is making assignmen is lor five diems. The nursing learn has an RN. a PN> aiwl two C \Ps,
Which client is appropriate to assign to the ItN? | Select all that apply,|
I A chum I- 1-11Ihf P vlmfr - - i l l Wilh . '.I.ibk- inglna
2. A client wiih a siapf 3 jm -M.itr ulii-i who n.-ciL a In d bath
3. A client with an enreral feeding infusing at sb mL ‘h
4. A postoperative client who h>.l iwticfytsl tribes Inspired
5. A : 11ent with quadriplcgla - u win ini urinary c atheierination is wdi red
Test-Taking Strategy
Du ma secund-guess yuuiselI anddn m>l t k i i i j y ■.■ .m - .% ■ ■- Amu tint answer i-. usually the unint one if you have taken
rhe lime in break down and imd Mand the question Rend each an er option rarefulh and fh-.sr rhe best npnoo based on
youi gut instinct
Nexi Generation NC I TX Examination (NGN)-Style Question
Dr up f l o w n < h i r
Scenario: A hospice nuise is admitting j new client io the company’s Minim. I he client is j bd-y ear-old divorcee with
ihriT grown daughtcrv who was diagnosed wiih small cell lung carcinoma over 1 year ago. The cllem underwent
chentDthfjLipy 2nd radial mn, bui treatment was Ltnsuccwsfiil I hr hospice nurse h disttmlng end-nf hie piani with the
client and the family. 1be client wishes t ;■ make decisions lur care so that the fatnsiY will not have to when the time
romes
Question: Cmnpleie the follosring sentence by choosing from the options.
the nurse w-HjId advise the client complete a(n> 11) . t o officially document ,ill wishes fw end-nf-
IHe ton* to In- implr i n m d oim 1 ihu i. In-in i-. m ■■ . 'r ahlr to make det I shirts. The client will also be advised lo appoint
□fn1 (2) to carrv oin rhe diem’s medical wishes.
I Drop-Down Option 1 Drop- Down Option 2
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LA'dUl Wltll LUgllH) CmiM-m rtHOTDty’ilFlMl
Intormed consent Power nf attorney
|..r4 will and inLanirui Health care fumy
Advance directive Estate planner
Ans w rt : i \ dv j nt r tlit i*Li h r , 2 Healih cat r proxy
FcJornire I An atfrtnce r/rnxtjvv is a fego/ document that dctaiJs a diem s wishes for hcnlrh care to tv instated
ffavtan mid t taut bi-i i t m ituupai ttutedor urwWe ro inuta det mans fotapendcnHy. DgilA w M dignity totiseni is used
for ptasfctan-flBfeted WH rdrS tn Wdk-s wtatr this j■»u/iritaed. InftVnH-tf tYirtScnt R rr LrJred tafare off JWtfSbr
pfwnftirrs hut docs nor pertain n r/irs wr j niton I fust wtiJ and rrstamcnr d/WuvSrs how a cJjcni \ posu-ss/onr wtfj hr
dispersed but does ricu addr ess medico f issues.
hi. rru/r . 1 futlftfr . m r / u Jfy h lb. j.'pp/i r " ' . " H (rim j'or jfk ififivldua.1 wllri ■. ;..'|UHrili n by a i ,' -'I lt> ffwikr hr'tl/ji
rare decisions far the ctant if. * tart the client tvYomes i/mitta tu m.. .■ dri , ,:.-m far itamsefws. The prei.yy should have a
detar'ed undrrstondrng of the dientS wishes for cnd-of-Jrfe can? and shotdd be wi/fing to see that those plans are carried
out m Lurd/m/ly. This person is onfy entitled to nuke heu/fhearr decistorMroid is nut tiivti/wd in /ilium rai divisions or
estate planning. An nnorneydn ari is a person who assures nspansihilliy for making /Honcktl, faguJ, and business
■ O M r decisions far rhe client and is another term far someone with general power of artOriXy. An es»(/ planner helps
in designating ho witf handle a client i assets ar J responsibilities after death.
3
Clinical Concepts and Mechanisms of Disease
Operative Care: Preoperalive Care
* Prtpdidtian
— Ubuun a complete history, including the following;
* Physic al a-AiH, i ,'in
■ 1 ist ■■: i inrent medicanons (presenptions. uver the counter .OTC], complementary, and supplements!
' List of allergies and reactions
* Ph vluu> siii'gH ■ . xpt'ih nti's ih ■[XHi’ie iu anesiiivt h I
* Signer ■ 'insrni mi- ■ infnrrr. i cnnsi’ra before ip ii issrdaicdi '
• Canhrm lahtt and diagnostics
• Skin preparation
• Preop t hcckliM anil pirptriiediiiT verincaiton
- Pmiperative Teaching
— Diet restricti''- ’ (typically M*( >[ nmhjr.rg by mmithl after midntghl before wqjery)
D:t i uv. mediemfons dm. shuuldfai should nui ta taken list day or mrgdry
— Tr.j hcirtigl n,: and ili'rpbrvuiii'iig, im >niK-r -pin»mrii\
— Review meth d . il fsnn onuol
— Use of diromboembokc deterrent stockirgs. sequential cocnpression devices I SCDsjL and ejqaected
unit times
Postnper adve Car p (Fig. 3.1)
- ARt Sand hemotlynamir vtabi Ills (mnnii- r tarsl i- -ifld -■.mptuttv. ■»! shoikji
* Pcifi.Mli n i hew ipine <w law f (■'.■. ■ 7 r s, it -nr f «„ei, ■ndleat ■ :
• Manage pain
• M m t i M i n c w l H . d y u-iupvidtLiiv

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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
h l<>. J.l Nur.e assessing a diem In the recovery room dhei surgery. iStm kphflp.com/Tentpma.
Nursing and Collaborative Care
* Uriiwrv retention
— Check for bladder distention
* Urinary tract infection ( t i l ) Prevention
Remes e uiinars ca(he:tr Bostuperdtive Day (POD) tfl ur "2. unless contraindicataLi
* Pulmonary problems
— Check Breath rounds
— (.heck Q j saturation
* Bowel sounds
— Decreased Peristalsis
— Paulvlk Ileus „ r
* Wound management
— Inn ■-sons. Drains. Skm Intcgnty
Wound dehificence or evsscerauon
* Vrnttu Ehronil»enil»lkin (VTE i pruphvktxh

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R G . 3.2 Teaching postoperative care with a dUw Rqwintcd wllh permission from Potter, P. A..
Pern'. A. t,.. Sleeken. P. A., & Hall, A [2021 Tunckmentals of .Yirrsmp lOih ed.|. Elsevier
Studs Break
Box 3.1
A 72- x car- old i lietit returned (ram vttrgrn <> Ixturr ago. The t 1lent received hvdrwuioi phone 2 tux IV
30 minutes ago for pain rating El 10. The famih member requests her father be checked immediately. On
arrival Io the nwitt. the KM finds the thetil d i f f h u h Io arouse, with a respiration rati1 ill b. W i d t h h lite
priurity nursing action?
1. Elevate the head of the bed
2. Administer naloxone 0.4 mg IV.
3. Assess breath sounds
4 Check vital signs and pulse ottmciry
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Pain
• Pain irutfiiigpmeni h tUt-m centered
• Pain is whatever the client says it is. existing whenever he or she reports p.tln
• Pain occurs in all clinical settings.
- Nurses have both a legal anti eihk el responstbllliv for managing clients' pain and wiB< ring (be aware tif onv
peri.i.i.i.:l blir ■ nilsi uiiL rptlii. .'. .iholil p.ilO mali.igertit'iit'i
• Pain Assessment and Management
Assessment includes;
• P Pret ipluiing or palllaiivc
• Q- Quality
• R. Relief measures region (location}
•S: Severity (rising a cede ifpropriatr tor age arid i Hem timdlri" luitTHwai, descriptive, a u-i o!
faces with explosions)
• T: Timing (onset dnratian)
• L E l l e t i o l pain utiilit-nr

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— Assess for nonverbal behavicrs. which may Instate pain (moaning grimacing, clenched teeth, pacing,
or inactivity) •
— Wonu Bake FACES Pi nR ing r.ile jr.'imnwndcd t ■ per stir - 1 vwnv nt jje and dd< ■ Fig. 3.1 Bi
— Assrti personal culiujZ. spiritual. _ind -ducal beliefs tlui may inilurriLL the perception cd pain
Consider spec i.tl populations: ptH thrive cate, cnd-i'i-lite
Urn iiJiirnt.Hitm Ini Inck pfrtffqvn'isnv-ni i l . i t H p H n t r r v m t i o n anti pnsilnirrviTiilon rating),
interventions iboth nonpharmacdcgical and pharmacoingicij |, and diem teaching
( i ml ml I til MilmldnC ilisfMJSdl nnLM be dert i l l i H n l nI pi'i icgiil.ih n f 11nh’l irtt-s fask Anther tKirw ht
w lines- me Waste <4 J U k d | raiment, ditrfutded In ■...i|i>Ht-..ft trills, of dlsi. urdril litpj.d ciinn-USs)
0 1 2 3 4 5 6 7 8 9 10
U Z l ___1 _ _ _ £ _ _I ___I ___1 ___1 ___I
No Mild Moderate Severe Very severe Worst pain
A pain pain pain pain pain possible
No Hurts Hurts Hurts Hurts Hurts
hurt little bit little more even more whole lot worst
B © Elsevier
FIG J.3 Sample pain scales. A. Visual analog B. Verba] descriptive. Reprinted <ih penn.ssion
lr nil ( ■ u)|M i . K. r A ( :h >ii* i I- [Jril 1 r'liJiif.'i Hik H' ; 'i.j'jjli ; ■ . ' h /,i. - Ti<j i I J. Ib- ln.
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reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
iiLNii ' U H | " i ri,., n i n n t t r i i , n . r u i m u u u n 'n u t i u u m MNy i 1’ " 1 ■ 11 1
* 5inn|)li.irnhic nhgkal NoninvasBr P.iin Hrlii-I Tn litdipjr\
— Repositioning
■ ■ Cutonrullh sliiiHilatimn. Uv.il and cold applli_.it Jun. massagi1 Ilu-iaps, tidli-AuLuiciiii-. < h. Hi ■ ■ i
MjmulMkm (TENS)
— Rrl.in.Hion lechniques
— Gunied inugeiv
CumplemeriUQ and d eniatne medicine (CAM Ue.g.. Kupn surt or vofc.O
R l U i - i i i m iri.ib ■ n i i l h i l h ' g . i|n;«-1 .U! . Ii- H « H i l l e l . ........... i
* Pharmacological Types of Pain Medications
iVcif:. ■?.■..'Jeb tot ritlld p-.ri oj u w i n culrihtrUUOn 1'Ji modeMr; iidUi

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— Opw/d's (or moderate io severe pain
CoondgeML or adjuvant drugs (i.e., anliconvulMnls. aniicirprehsarits) loi iwun>|wihii pain
• Types al Fain Medications.: Nonapioid Analgesics
— Acetaminophen
’ M jslmirrn recommended dosage is 4000 mg 24 haler
• Monitor Uvec and renal (unctmn
' Antidote: Acetylcysteine
Xonsiemidd .Antt-lcrilsmtiMt »ry Drugs {NNAlDv)
• Nonselecttw
■ Salicylates
■ Ibuprofen
> Kttnrnltt
• Indrimeihartn
• Selective IcyclMaregsias l [COX-2] inhibitors) v.i
> CelecoKib
* Types of Pain Medications: Opioid Analgesics and Adjtn ant Drugs
Mu AgunriU
• Morphine
• fhdromatpiiorw?
■ Meperidine y.*
• Methadone
> I < vi.iiphar*i>l
• Fentanyl
• Ovftrjduhe
■ Hydtiicndunr
• Codeine
Pallia! Agonists
• R>..|-r«-nsit".-iilrie hydnic hlutr Je
• Butorphanol
’ Nalbuphine hydrochloride
• Pmta/iKinr hyrlrocidorldi'
— A d j u v a n t Drugs (Used for Neuropathic Pain)
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reproduced or transmitted without publisher prior permission. Violators will be prosecuted.
* Ainu mivulsanis. aHkkprvssaais, am v i l w l u
* Prescribed alone or tn comtdnallon with opioids
■ Cwticosterolds
• Pain Medication Deli\ ery Systems
■ Epidtird an.ilgcsin
« p i«lnnr ....... . ilLwi sliv- « rfhr S *

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. -X.X ... Z.X . , . xz. . ,
• XoEiphjrnhic.ologkdi tmasive Pain Relief Trthrnqury
— Nerve blocks
Inh'impdor ’ neural ■ uh .iy ■
— Sptnai cord sumulauon
— Acupuncture
Studv Break
Box 3.2 .j
A tbriii has <m order lor hvdrwnorphonr intravenous (IV J push 1 mg every J h u u i i . I hr drug is available a>
J mg ml per vial The RN admlnislcrs nd ■( hydromorphone for one dose. (Fill in rhe blank.)
Fluids and Electrolytes
’ Fluid Balance
< li.r s III ■ ur.i . ......... ... I1
. Ill I . . H i t i . t i f ll« <1 H I’ll. ‘ II i i i l l H [■' in
entirely due to sodium
1h r osmolar nv of intracellular fluid I'U H is related tu many panicles, with pottos mm being the primary
eleciralvte r
— Tilt pn ssuirs in lhe I T T .ind ih? IFF are .ilmnc? hk-rrtlr, ’ I H i h ECT • IFF changes in
ccncentrauorL fluid shtin num the area or leaser concentiauon iu the m a ot reuiEi concentnuon
• Fluid Xnhinie Excess
' Congestive bean failure (CHF) i must commoni renal failure, cirrhosis, overhydration
— SyrnpWms
► I'ti-plii’i id i i h i i n Ihig. 5.4i ■t'FJuil. -J edi' H w i l - i l hlui.ti: , t’sfluri i HP), di, i m-.i, .3 ■ I'tllcM- id
consciousness (LO )
— Lab findings
» . Hlcxxl im-.i nii>. ■ i Bl \ . l Hf’ glirbin Hhg), . Henidi'Xrr I Hr I) . M'nim minul.- fy 1 n r - -
gravity
— Treatment
* Dniii'hi ■. -iuid rr i ti thins, weigh rl.i v mtHin'.i K‘r
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FIG. 3.4 Pitting ectnu. Kepnnted wiih pemt. ton "uni 1 .•.lupei. K.. & Gosnell. K .[201 'J.
F u i . n M m (Wk/diMt hi'ifhh nfirsln ■Bill rd J. F l a ' v h i
• Fluid Volume Drlirif
— Causes
■ Inadequate fluid intake, hetnorrliage,' vomiting. diarrhea, bums, massive edema
— Symptoms 'A
* Weight loss, oligu: pasm f hyporcrtsion. dr. mucous membranes
— Lab findings \ Z
■ B L N and ■ or normal creatinine. f Hgb, ' Het. i urineipeolic gravity
TivJlincm
* Sirtct Intake and Output i, replace with m turtle holds, monimr BP, weigh dalh
* types of IV Fluids
fsnaonJc fluids expund tin* Ft F volume betwwn 250 and «X) m t h n i ' L f ; 0.9% normal saline
NS), lactated Ringer (I R| solution
— jpporotdr fluids move wain m , the r d l by osmosis, causing them to swell (osmolarity less ihan
2aU mOsm.L}; 0.45% Nb
fl | i r fu/lJf Ihliii'. pull iliim i i i'll . ■ ■■Im.' ■ i m - riilk I.mis Kill mO-iii'l ) D i l l ; 1'
saline, D5 Ln 0,45% NS
ElctlrolvU’ hnbdldtK.es
Sodium i Skeletal muscle contraction, cardiac contraction . nerve impu >e trarijmissicm normal osmolarity; and vcitime of
ECF

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— LQUstJ uiureucs. gasuoimesunai o_u . tjuia toss. nypotomc n uuius, mapnuresi*
— n>i/«yrjosr/r : N.r | t t > m F a | l ■ t 'lifi iniuol. t |
— Signs & syndroms: Muscle cramps, confusion, weakness. seizures
* Niihin* #nrl ( qll.ilmi-4iitr M.iiutneiwm
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■ Nursing arid LoiJdLioranve Management
* Chrt k BP fivqilfflll)
* Kf’.inct fluids
- D u i (lixxL high 11 V a * i c HE-ni)
* Cheese
’ [able salt
■ Seafood
* Processed meat
* Cawed Iwxh
* Kcu hup
■ Salt- snark foods
* Hypernatremia
Cunwv Water dept s iinFir ili.H:‘'ics insipidus, r- nal fail' Cush ng syndrome
— Signs A svmprmfls,1 Dry mucous tru'mbroheN. thick irmrus. low uj u-i-v ituipur, diTreascd skin lurgor.
restlessness, agitation, contusion, flushed skin, pulmonary edema, seizures, thirst, fever
Diorjncuricr Na* -|4 niF<|.l 1 145 mmol/l 1
— Nursing and Collaborative Management
* No I Vs lhal contain sodium
■ Re trlt 1 dietary MHI .m
* Weigh dally
Potassium: Depolarizes and generates action potential1
' :.ju I,.i 1: . inotein synthesis and glucose use and storage
* Hypokalemia
— Gauses: DiD:e:ics. ■■ wnjtrng. diarrhea. Cushing syndrome, gastric suction
- - K * '-1* (rtEq/|. ( m m o l l j
— Signs A Syrnpcoms: Rapid, thready pulse, flat I waves, anorexia, muscle cramps, weakness, fatigue.
i n g l l n . iiiliillifltn r-. ii.iU'-i ii. ViilniUriu, Cor.hllpaUnm 1 .1 b k i . i U n g . [wl[ J i i l l m i ' .
Niir-.kiJg.tiHl C ull.tbor.ilive M.iJuigrinriH
» IV potassium
» ilii-t: luixp, high n K+
* Oranges ►
* Bananas
* Apriccus
* f lOFfll/Minr

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• Legumes
■ Leafy vegetables
■ Potatoes
* Meat
• Salt substitute
■ Hyperk.ilrinU
— Causes? Oliguria.. acidosis, renal failure. Addison disease
K* "i tn] | I (mn 11 i
— Signs & Symptoms: Tc.i tented T waves, bradyc ardia, muscle wea.<ness, tiredness, numbness, tingling.
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------ U l i j | « U « - 1 F I 1 I j T V I I I J i !<*■■ VL.IJ1L.M h FT U 1 4. 3 . U t U U V . U ■ ’JJUi LU U - M A . L M I U F . J J , U l L KkJ rv -1 H U L H O I I t J . 1 i LI I I Ifc,-
nausea. -urniiiiig. respirators disuess, .mpii. i, palpitations, ineguLir iratibeai
Nursing >md C oll.ilxjraiivr Manageruriii
' 111I nf regular In in a nd -J mt ra! Icxtn 50% In wdlri | t>Ai iW,i
* Sodium polystyrene sulfonate is used to treat hyperkalemia
* IV kiop diuretics
* Renal dluiysis
CtikhMU Milnuiins bom strength and density. activate# enzymes. allows skeletal and cardiac muscle cumractiun,
contir |> nerve impulse transmission. and allows fur blood driftina
Because this is a premium document. Subscribe to unlock this documentand more.
* Hypocalcemia
— Causes, Rena! failure, hvpoparathyroidism malabsorption. pancreatitis, alkalosis
— OL’ijwd/r: C . i ” - 9 m g d L { 2 25 mtnd'L)
— Signs & Symptoms: Positive Trousseau sign (Fig. 3.51 (carp ipedal spasm which occurs when a BP cuff
is inlljird abuse sysiulJc BP [ SHP] lot 3 minutes]; dtaiihrd, nuniwis. convulsions; uumbriesv and
tingling of f l i i g n v and diuimural (aiDuiii1 -? ChvouekS ugn I Fig. Xfi|
■ i mir.Kiion of tacidl muscles when facial nerve is lopprajFnypcriitiivr reflexes; muwlr twiu I -u m l
cramping, carpal and peda] spasms, m y : seizures Uryngiispasm; cysrhydimids
\ n m n g and I oll.iboraiivr Management
■ Admin MiT i ah Iurn supplcnicnb
• Administer IV calcium slowly d
• Lntuuiagr cakjum-:tch I iuxls, vitamin D, piuttin
• Fi r dcute hypocalcemia keepa tracheratcffnv tray and resusc natkai bac, ■' bedside in caseol
Luvngeal spasms
* Hypercalcemia
t U..W- Hvppfparalhvr 'idism. nwligr ■ ■ Ikine drsedse. e.u.essivp supplem- - MluHi
— Dithrtosrlr- Ca r + >10.5 nig. ul ( >2.62 mmol'l.)
.Supn \ Spr runra: Minde weakness, rrmMlpatfoft. nausea ami vomiting, dysriiyihmi.is, iwliavloral

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cnanRESji anottvid. taligi •. 'iiniiTiisneU tenetes, lemngy, w reared level nr (onsciuuwiesi, cunlusion.
.U-I-- < l l . H i i l . I | | f l ! i H i l l - iF ' V l ’ f r
— Nursing and Collaborative Management
• Limit vnamm 1) imake
■ Avoid Cdk;um-bd3ed uiijkiod*-
■ Adminisl rr ik Itrmln rn r i duce catnum
• Renal dialysis may be required
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Flt.r. L5 Innissi ,n. Mgri. RcpnrHecI i"Hii f i r m , . ..un l i m n ( > r. K., \ (Fijsiifll. K. | J n M
Fo . '.lyfJon ufnj yJJr iwtjf 1 nurslfly Ifllh ■ <1 j l: l'.P\icr

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FIG, J.6 Chvostcksruii. Repnnted *ilh prrmi iDn fr .rr» Cooper k . . K Gnsndl, K, [21)1 r
Fi-unJurions und uduh health nursiny Itllh ed j Efeevit i
Magnesium: Ccrntluk skeletal muscle cotiddi in !i. t arbolivtll ale meldl>olbin, adtnusme triphosphate (AJ Pl lommUon.
vlraniln KilVdiiin, .mih ell ritwih
* Hypomagnesemia
£ <?.. -.i".: Alcohol 5brr ™lab‘'i'rpti(mJ diabetic ketoji ukiMS. diurri -

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Mg* - t . t m t q L i unnioUL;
— Signs & Sympfturb; Skdrlal muscle wvakMM* byfferaiJitL’ deep icridciii n fk-xrs; uumbnrv n >'
angling: painful muscle contractions: decreased GI motilirv: nausea
— Ntining and l.Qllaboralivr ? fanagemeut
■ y Iminislet iral s ipplemer i-
* Im rfdsr ritet.irv Intake nl matteslum
* IS magnesium via mfusniD pump
’ Monitors Hal signs
* Hv|n riii.kgiu riiiia
— Causes Renal failure. adrenal insufficiency, excess rep;acement
Mg 2 * J l m l q l . i I ,D> imnnl'i
— Silins & jgwpfoms; Bradycardia: peripheral vasvlilatior hypotension: prolonged PR Interval with a
■■Mili’ii L-d QRS complex. (Jr-.tiM-iiivi abscm tkep tendon ivflrxtt
- >i turnin' and i olLiboralive Managi'ment
1 'v ■ nidgm -niin ilrum- lor ■i-n ki : n'v rii < .■ ■<■( C K D i ■ iieur
* IS adnunisuatJon of calcium chloride or calcium gluconate
PhutplwnMH: At livjics v II amiir. ,mil enzyltfS. lornis ATP Im energy supplies, assists in cell growth and nwUhoUlOk
maintains acid- base balance and calcium tapeastasis
* Hypuphusphaitmia
— Cdusi’V Alcohol w hlKir.iw.il. lii.iherlt keirKtcidtiMS, respiratory alkalosis
. - p . , h ;pi.iirir; P ■ .-.phm. LU njiq -It. i 05-" mmol [.)
— Signs & Symptoms; i Cardiac output, v*eak penpheial pubes, skeletal muscle weakness
Muring .md <: oll.ibor.ilIvr M.iu.igrmrnt
* Oral supptementanon
* Diet high in phosphorus
* Hyperphosphatemia
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- - Cauu>s ■ Ren. i. f a i l i i r cess intake
—D jnostir: Phosphate 4.3 mg dL ( l 43 mmol L i
Sign’, Symptoms: in. imfes ol hypocalcemia
S u r i n g and Ctillaljor.uivr Ma......
■ Phosphate binders
» Dirt low in phosphorus
Studs Break
Box L J

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1. A i l t r n t h t h r i v i n g all in In %itin of ihihuidnlitlr In ilnn l i l o n i k . I hr nrdei rr.nh Inhisr dnliLil.illlifir IV at 5
tin kgm i n dVdil.iliJi in StHJ nig in 2SO ml D5W. T h r t l i m l writ ■ 65 kg. Cdh Lil.ilr I hr Bou tali- in nil hr
mL/hr
2. Which Liloidton result for d piroprtdinr d i m uuuld prompt the RW locontaii the health cate ptovidrt?
t Pldtek-t t oiinr 151JNWmni3{ 1 51 ■ 1 W I )
2. While hh Hide ell (WBCJ count: 8:501 mm l (8 < 1091)
3. berum potassium level; 2. ? mmol L (2.fl mEq'L.l
4. Ur in i’ spreUk gJJVfty LOU
Acid Base
' Acid- Bose Baltftce
— PH (
* Normal " 7215 in 7.45
* <7.33 ’ Mtdosis
’ >7.43 = alkalosis
- p C O i
* Normal = 35 to 43 mm Hg
■ -45 ■ addoMs
J*<35 ~ alkalosis
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* N tHinal 21 -28 mE ■■;-1 ( ?1-28 mmu 1 1. )
* <21 - acidosis
■ 28 - alkalosis
- P a O ;
■ hionndJ - HO to 100 mm Hg
— Anion gap
* ](] tu I h mt I i n - id nun -i Li
Arterial Blood Gas Interpretation Practice
t . Determine whether the pl I value is normal, acidic, or alkalodc.
11
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1. 731
2. 7.47
3. 7J6

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1. 7.31 Acidic
2, 7.4" Alk.ilotk
4 7.3b Nurm.kl
2 Determine whcrh< r rhe clicm H tapoventilating, hypervent ilining or has normal ventilation
l . p C O 2 ' 4 2
2 pCO 2 = 33
1 pCO 2 - 55
Rd Lio rid k
1 [if X )2 - 42* Nurmi I ventilation
2. pCO 2 = 33, Hyjwrenulatiliig: blowing off L O j
3 p c o 2 - ss, HvjKiventiladng,: retaining c o
V y
1 neirrmint' whirr ■ i rhe value Ind ■ ■ s a ■■.tie of arldosls, alkalosis, or nnmul
J. JlcU - JiJ
2. HCO3 - 3 3 : "
. I V F i
1 H U J 3 - 21
X
Rationale
l . H C O 3 = 2DAa<Ma
_ I ICO3 = 33 Alkalosis
3. H( O3 21 Normal
Steps for Interpreting Arterial Blood Gas ( ABG) Results
1 Is there alkalosis or acidosis presag? First look at pH results
pH ■ 7 IS ” 4H Rk>sK
pH >7 43 = a i k a l M l s
2 Whai 15 the respitalon (p< 1 Jjl componeni ’
* The nunibvr js the amoira : COa in ihc L.uid
■ CO 2 Is the ri piniiory compcHicnl In ihr blood measured by milllrneicrs. of Mercury (mm Hg)
• Normal (.O 2 level is between 35 4 j mm Hg
• Respiratory alkalosis Is pCO 2 below 35 mm Hg; symptom is hyperventilation
• Ri pkaicirY acidosis h pCQ? above 45 mm Hg; related 10 hyirovviidlaiJun. synqicnm Is confusion w

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rrvtlesMirv.
V C het k your blood gas report for ihe bn arhonan.- i H(”O 3 ) level [i is rhe irn.il < • nupi .nenr In the acid-base balance.
Un 11 ■mial I- 1- hit iln- i-iji ii. 21 .in.' ."i mF I.
4 Determine wherht r then is compensation tor the pl J imbdnce. Generally, the pulmonary and renal systems
compensate feu each Hirer to nL:urn the pH to normal. The lungs will crimpen ate tar metabolic instability by
changing COj excretion and tbe kidneys will compensate for the respiratory instability by altering bicarbonate
retention and 11 - excretion,
Arterial Blood Gas Interpretation Practice
* pH = 7.32
* pCO2 - 50
* HOQa : 25
This diem Iws
H a l i u i u l r ; pH - add(36& pOOj - ockbr. HCO 3 ■ hi' '■ ' li.ih Lilinmi|reflx.aec| neural Oi \ ,n nl.:i-.;-
2.
- pH ’ 7.2a
* pCO 2 = 35
■ HCOg - ia
This diem Iwn ____________
Rationale: pH = acidosis. pCCK = normal. I [CO3 = acidic This diem has uncompensated mrabolic acidosis
■ pH = 7.43
* pCo 2 - 40 4
* HC.O3
This client lias ,
RatioFHk: pH - normal pCQj - noim u 1ICO 3 - normal This client has noHnal ABG resding
4.
• p H = 7.56
* pCO2 = 44
HC0 3 -3ft

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This diem has
Rationale: pH = alkal'.~t5, ptJ V = norma HCCb = alk.ilcrtic. Ihis . hent ha- uncompensated metabolic alkalosis,
5.
■ pH = 7.33
■ pCOj - 50
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• HCO3 “ 29
This client has
Rationale: pH ■ acicknis. pCO • addle. H C U j - dlkJoric. This client lw» partial!} cotnpeTisatcd rrspiraioiy Ailduh
Safety: Senlind Events
• An unexpected otHcomc involving a death or serious Injury.
• signals ihe need for immediate investigation and response
• Accredited hospitals are expected to identity and respond lo all sentinel events.
• Fx.implrs o| Sentinel Rents
— Client suicide
— Operatrve.poslciperativT complication
— Wiung-sile suigeiy
— Medication error
— Client fall /
— Client death or ttij ury in restraints
— Tiamtudoo error
• Respcnhr In Srillini'I F vents
-— Analyzing tool cause
• Designing aL nun plan tu implement improvements 10 . tisk
— Irttplinw ni inn Imprcrvtairnu
— Mentoring dhTilvenrss of ih Improvements
Safety: Falls (Fig. 3.7)
• Risk Factors
— Adults
• neptesston ,>Xs
• j Mobility
• History of seizures, falls

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’ L se ot assistive G-evices
* Puhplunnanv
* F.nvLionmcnral issues
* | ct ettlng or ignoring nil ib!!itx I'.sut-
— Infants and Children
* I <'ngth til si.iv
* IV or saline Lock
* Lse of antiselzure medications
* \i,.iL (ji i tn nlc ui; inpnljf iljagnij‘.r
* Receiving physical or occupational therapy
* IllStlH y oi kills
— Nursing and CoEl.iboralive Mami cniriiL
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* I all prevention
* Safety surveillance
* .!■ s iii-L-i bn p,un H-lb'l. S' "Jnp nil |' 'mug
* Frequent jeonentanon
* ( bent and family education
■ \d Lrefe i w iunmt r ul iotn ■ =ns
* Client sitter

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FIG. 3.7 A m i i v a d i m nuh- flout dining.i fait. Reprinted with pt-rmlv. m from Cooper,
K ., & Gosnell K I JO 10}]. Fawidorioni anti aduit health nurslny (fiih ed.]. Elsevier
High-Alert Medications
• Most likely lo cause signlllc am harm 10 a client Ctrl* when used as Inlendrd-
— Types of Drags
• Anticoagulants, narcotics iindupiaii*- insulin, cbettwtherapmic drugs. and sedatives
— Types tit Harm
• Hypotension. bleeding, hypoglycemia, delirium, lethargy, brndscardi.i. respimuwy depression or
distress
— P t w m k m Strategies
• HuiU- 1it redundancies
■ Doubles becking
• Smart pumps
• Standardized or prorocnl-dnven order sets
• Two-person verification process

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Death anti Grief '
■ Stages of Grid /
— Demal
— Anftw
— FWgaming
— Depression
Ait quant r
* Facilitate grieving process by using ihaapeutk touch, displaying warm and caring behavioiy and
ini ng '■['• "-ended statement . tn liner, to and assist ihr se who are grieving t> ■ understand their own
IeelIngs dfid behav nus.
• entourage ■ lienl io cxpre- , jngor
» Do nor mke away the dr term mechanisms tot coping that the dicni uses in cnsu.
• Customs Mirroundmg death and dving vary among cultures,
* Make every attempt ViJiidctMand and ucconmodiite tlw familC’. < iiliur .d mtfdotH when caring fol
die dying diem,
Inlet lion
’ Infection is the Invasion ot' the body by a pathogen
• Response to 1he invasion can be:
— Localized
— Sysremlc
’ Xiisui nmiat, iir hospiiaI-acquired, infections
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— Acquired as a n-suli crt exposure m a rnkTOdi aiMsm Ina hospital <-nlng
Hutihin immunodeficiency Virus {XIV )
■ Rnulrs of Transmission
— Unpi elected sexual contecl
• Musi trimmon motte n| inui'-mhslon
— F.Hjjosurt' tn blood through iinii|-uUng rqulptneni
— Perinatal transmission
• During pit-gnajuv
» Ai die time ut delivery
• BreaMfeedlna h
* Laboratory Iftung for HIV
— Annbudy test'-

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' LJu-Jn t v i u j j . j i A J U . - c > l u Lit v m d | j c i > u i i > dK-.-u Ji Ui j. n u m CLL4.V u ic~ 1111h n i u u i i i u i r . w i t i t i i i
— Anir n/andbody rests
• I ‘ k fnr Vtlh IHV .itttlbodJCi mil .mn 'ns
— NA I s (nucleic acid lesuj
» I lot the .Kill 11 vlnr 111 the b l i n d
— [ji’Home HIV Tesu Positive ttsuh preliminary; ii must lx- confirmed by an HCP
— Diagnosis of AIDS (HJV-III) ' ■ /
• I I I V p i H i l B i ' dll'' . i : e l l i i . i if 2IW1 ■ I linn- n .111. >p(x utliiir:.-. Ini ■ , 1 11
’ HIV Symptoms
Prim, iv Hl\ mhi linn
• Earliest surge: begins with i. dike symptoms and ann.todies may develop in weeks J to 12
— Earlt I symptomatic I HIV disease signs and symptoms may not be present until to to 14 years ahcr
■ 1KidI - V ' l M i r O i l l i u u i 'remni’ui
• Reilgt#. m ight lov molten , mil-, i;naif plained li'Vri ilgjhl sweats. dr, ■ ough
- Patas.ies, lungi. bacwna, and viruses: L-uise of opportunistic diseases
» (" r-ndididsh lungs, bronchi. ewjpha 'js
■ |in.<s|vco-r’.H dl 1 -im I'I
• Cytomegalovirus tCMV )
» HlV-rrlaled vlict p i.dopalhv
■ \ t i r x i n g d f i i H ullialwralive M a i M g e n u n t
Man ■ if disr.-. - propr v.ion .md Immune turn 1 -n
— Prevent development of oppotnaiBuc diseases
Detect and Ural opportunistic diseases
— Manage symptoms
— Prevent or decrease complications of treatment
Proven, trati"-mivsiun HIV
— En< nMirage 11mper n1uni itm
— Refer to mental health counseling
— Encourage sate sex practices
F.iituMiragr
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* HIV Drug Therapy
— tniu aie and monitor omblnarmn antiretroviral therapy (cART). formerly retened to as highly active
antiviral therapy (HAART)
1Im .• ( ioalv o| Liiug nit'Hip
* Decrease the viral load
* Maintain ot raise CD4 1 !*cell counts
* De'ay the development ol HIV-related svnipm ns and pportunistic diseases
— The clk'iil should have regular hloml counts It) track CD4 IpvrK .md 1hr viral load

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Side vttr< is ap.' i,omm n. and t l - n art -i.mv dr.- diuc internet i' ■ -
H A Medications
• Nucleoside reverw u inscriptase Inh rntors iNRTIs)
• N on- nucleuside rev erse transcriptase inhibitors | NNRI !
• Protease inhibitors i Pls)
• liuegraw inhibitor*
• fusion inhibitors
• fnirv inhibitor S
• PiAi.iitikhiiH-nt InfiitHtDis
* Pediatric HIV: Clinical Manifestations
Recurrent infections such as ifu -h (unrl candidiasis)
— L'rwMipIdlnwi fever
— LvmphidtfHip.ilhy
— Hef-atosplencniegaly
— Fjllurr to thrive x
— Developmental delay
• Nursing and Collaboralivc Management
Tr.nh ' m th dii i> I Limin - i l i i i h ' r mis dl'--
— Sai, is issues include npropriate storage of special mer ■• aliens and equipment
Pre’. r*ri1iLHi is J key Lt :::pulit-ni ul HIV edutaLiun
Aggressive pain niarw cement Is essential
Cl nmi. In P1-'' n w j c i j : lilt-, in. Ill* liH- ■■ .'i-i)n',.irr<if lhe .iy?= ■ .
— Do nor administer live viruses
Address psy i In ism Lil i uni rrts
— [t dll H I V ' i n l i . I. tei| nil libel |s nrjtL'd u Lth J.ldiA udlinr duiin ptvgnaiH y and ihr neunaie Is treatedl alter
birth, the probability of HIV infection of die child decreases
Studs Break
Box 3.4
A client, wliu HIV positive, usks uliv it is uetesury tu have a Mi j| load sludv pr if united every Hu l
months. Which infornuiion umild the RN provide?
1. To determine the progression o| the disease.
2. Io evaluate the enzyme-linked immunosorbent assay (ELISA).
T<> monitor 'lie ell- 1 tKrib ■ d rhr i-r.uiiH'iu.
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4. To track die effectiveness of die vaccine.

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C i i l i t e r
• I he leading sites of primary cancer In men are lire prustale. lungs. colon, and rectum; the leading she* of primary
l.llll i- WillIH‘|I d l r t l tul'd-.K, Itg- ■■ Ill, dJSlI III II. I
4 Lung im ir i- ihr loading cut-- fcann ri i.m :- jrh'- n mih r-. - and v ‘men
■ I he incidence • : canitt is highest among African Ameiic ana.
' Priman Prevention
F j h k . i r | l : l l l l I l l i ■ IV ■ 11,11 k ■ . m i l IL k I. II ■ ■■
* Suu iking -in ikc-li-v . wb.n, ■
♦ Dietary habits
• I lirdviolet radiation
4 F. " rsslvc ih ohol use
4 EnvlDOTunenial/chanical carcinogens
- Cancel iitk assi-umeni
♦ -- Gent'rh <mime Im#
• ■ Health Pronin lion
— H e National Carreer hHii >.mmended im hiding ai basi (it i ■ r vA fruits <irrf vegetables in Ite
tkllL lu’l; ill .-ililJlli.nl .I>.■ [III- Inlh A Ilk n<iHim :.lij||inf
■ Eat foods from protein sources such as lean meat. fish, and < iless poultry
» Choosr luw-lai ddity pruducis, nu iudilig white c I? i I :han yrlhiM.
* Eat wlmlr grains
* Include beans in ihr did
•Avoid sah’diurcL smoked, rutritc-.ared loc-ls
■l.lrnn inl.iketil ■>itm.iU'il I it .inti added sup i r
■ Warning Signs
( J i mgt- m Nnwi4 tn bladder h.d.H
— A w onnd that does nor heat
— U nusual bleeding « dlsdui ge
— Thickening yr lump bitasi o elsewhere, etc.
Indigestion nr illHUnliv su-d lowing
— Obvious change in warts dr'moles
— Nagging t ough at boarsermv
• Screrninc Rec i jiimendaiions
Breast: Brtjsi seli-e.xdnunauon (BSE) every niunih irdrfy 2Qs: educate about the benefits and hmiiationsj; lor
ptvmmopftiojl women, several days rtgj l u n w : fur postmenopausal wewnen, die u m r dav each (nntiih.
Emphasis is on reporting any new b n M w npuinK to the HCp; dinkrai breast cxamlnatian (CBE) everjr 3 yrus
and annually after age 4C mammography bianmiaUy at age 40 ur,-
.. age 74
Cervix.
Wuinm ages 21 29: Pdp usi .limit- evert .3 vran
I IPV testing alone can hr considered for women ages 25-29, but Pap tests iire preferred

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Wniwn age* JO-65: have three nptinns fur te'ting
Opiinn | : pup test and an Hfri n*M (i a-iesiing) every > years
Oprinn 2: Pap test alone even 3 yean
Option 3; 11P\ testing alone every 5 years
Calamtal: Feral occult blood test IFOBTT stool DMA; flexible sigmoidoscopy every 5 yean, or barium enema
e v m 5 yr ii . , < >l< ■n ip\ , r y 10] i-.HS, orcompuird tomography (CT) coIonography every 5 yean
Endometrial. Report any unexpected bleeding or spotting to the I1CP
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I ung. !.»>«, dose ''i Hui CT
— Prostate: Digital ttoal examination (DRE) and prostate -specific antigen test (PSA)
■ Testicular: Testicular self-examination IT5E ) monthly
• ■ Diagnosis of Carn er
• Considerations for use m tile diagnosis ol cancer
• Bhifnsy
• Endoscope (brondtoscopv. colonoscopy)
• Diagnostic imaging (Chest X-tay ILXR1, Intravenous pyel»gram If API I J i g . 3.8 1
• Ratilol sot' >|H? studies (base scannlng)
• Cnmpun rizfd tomography (CT) rrMunitlr revCinarKc imng ng i MR!) posltton emission tomography (PET)
• Laboratory tests
• Alkaline phosphatase blood levels
• Call iiiintn
■ Carcinoembrvonic antigen (CEA)
• Tumor markets
• Stool for wadi Mood
• ■ Cancer Iberapies
Surgery: M i\ I f ■.<■vctii.ii dlagcoyili , I'n .itivr, nr pulllai <■
• ■ Ntffsing considerations: Teaching specific tu jurgety
— Chemdlheiapy
— Bone marrow transplant

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FIG. 3.8 Vinous radiographic images confimunc diagnosis of Jung cancer
iStc?ck p1io«oxonVradin|<• gist
External Kiiiihiiion
• Keep ihe sidn dry
Di ■ i ,1pp. ’. ImiriH- ilium i rrr.nr. .. .iml ; .s I. i ■ n.nk- ■< ams. y ■.irhm. >1 m . ; i - pi. i l l . i i l
the physician
* Protect the radiated area from dirtc! Mtnhglu

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■ — Instruct the chcnt not to rctnuve the mark in gs
• Ai old apph- Jlions ut heal oi colld
* — FmnuLige 1 iu 3 L df t'lnId-- per day
■ — Ln. ji.ifjc .idhri hljh in pt. -tnand < jJartes
Internal H diatfan /
*
V
■<!■ I'. .1 h- i | . Im- ■■ ■- |l\ i in
— Unsealed: Radioactive i qmne
Plate d i i ' t i l iti [inVdU- morn
— Ni ■ t'gltiihl i .m l i i k r : i < H vlhJlnrs ul|tiu> tl Lri fr. m
— Keep lead-lined container in ro un
Wear iddidtluo badge w hen piuviding cafe
Mon nor vital s every J hours
— Aswvt for lash
— Monitor l&U (oral. catheter i
Studs Break
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B o i J.5
I hr KN u s i g n i n g twins loi four new cliriiiv. Only one private ro-orn is availablr iti I hr oncology unil.
Whk h i lienr would br placed in the private r&oin?
I The client with uv.irl.in C n r r w h n is roc thing c hcrnolhernp)
2. Fhe client with breast cancer who is receiving external beam radiation.
3. The client with p i m w cancer whu Ins |usi twid a uamunihral n-smlon.
4. The client wiih cervical cancer who is receiving inuacavity radiation.
■ Clirniu therapy
— Stria guidelines must be followed
- lhew dings iHtmally ate adnii/iisieied by clienxjthtraLH ■■.'it tilled nut se*
Piqtnani nursrv shtwld nr;i administer nwtt of ihrve agents
— Weai personal protective rquipnieiii t; ■ iLtr.iiniMr. drug handling
■ Gowns: Disposable made ol fabric that has low permeability to the agents in use. with closed from
and cults
* Claves: Pczdcr fiw. labelii: tor use ■■■, h rhemijtherapv drugs, latex, mi rile, or m ipimc
• Face and rye protection when splj- hmg i$ pmsible

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■ An approved rvsplratnr when rtwrc Ha risk ol inhaling ctmg aerosols (riurlns qHII or cleanup}
— {-hemoLhcrdpetiik .Agents
' Monitor for extravawi m i : . ! ng ini' dnd notify the H< l ’ i r ledlatelv iMhi- ixcurs
• I x pl- H I \ ..I • r.- .■ X L[ c II n l Im dmlnKn Him:
■ indwelling catheter
* imptailicit |mrf
• Side ctk’L is iu rnuAltur idn-t chemotherapy
•Leu kopenia [ WRi ' 400(1 mm ]
* NeulJ'jpeiiid
’Anemia
* Thitunbocyuipenia
* Stomatitis
* Alopecia
* Anorexia. nausea, vontdng
' Inlenility. sexual Jttrattans
' Diarrhea
■Tumor lysis svudrome
Study Break
B o x 3.6
1 I hr t o n i p i r l r blood count ( C l l L l m u l u lot a dicni receiving chemotherapy are lieniuglobtn a.5 mg dL (5.2B
mmol T ); hematocrit 32%; WBC count 6500 rrIK mm3 [&,.i X 10*T.). Whi< h meal choice is best lor this
d i ent?
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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
I. Grilled chicken, rn fn-sh Iniii salad, milk
2 Rimkd Mrjk, whi-.i wile. ' rolls, spiii.u li s. lad, ,i|ld * H<T
3. Smoked ham. mashed potatoes, applesauce, and iced tea
■I. lurid nuo .111- ids si-i1.:Ir, gar iku sal. nd lemorkide
i . T I i r RS is Caring l o r d i l i e n l who is 24 hours post proc pillin' lor d hr mil ulrt tnnii wilh d Ifniporarv
colnsinniv placement. Thr R \ ai.*rtfr« ih? client'* Mom-i. which fe drv and dark red. Which action should
die RN take based on this finding?
1. Notify the HCP of the finding,
2. Ikw ...... -in :h< Hnti ig Inihv i llimi rn uni
3. Replace the pouch system over the stoma.
4. place pctr.jldium uju/i; dfesung ufl the -2uma
J. After the d i d n g e o f shift report, the H 5* reviews a*wgnnieois. V* hkh < lient would the RH assess lirsi?
I The elderly cllcnl receiving palliative rare lor hear! failure who c Dm|)tiiins rif cnnxtipiition arul nrrvousnew.

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2. The aduli dletii who is 4B hours postoperative I w a nilrcfunr qi.i I i is rvponed tn be having nausea and
vomiting
3. The middle-aged client with chronic renal failure w b o w i rinan cniheter has been draining 95 ml. for B
hours.
4. The client who Is 2 days postoperative lor a thocacotnmy and who has chest tubes, is on uxygeh at 3 L/mhy
and li. is a r. spl i .ini n rale <4 12 biralfo mln
4. A practical nurse (PN) is assigned io care lot an 02-yeai-old client who had a total r i g h t hip replacement
with irmelit 2 days ,ign. Which alian would Ihr P \ iiiimetlidirlv report lo the RN/ (Si'letl all thal
a p p l y )
1 The client complaiins of inc s ''rial pair rating, it a 6 an a scale of 0 to JC
2. I h t d i e m has had a change morieniauuii to person but not to time cn place.
3. Swelling and rviirnv. have ch vetoped in ihr cii<niX lower Jcri leg,
4. The practical nm emptied 1“ ml. ol blmids dr.iln.ipc t i r m lhe Jackson- Frail drain.
5. 1he client s last set of vital signs was temperature 10U 2 F (J" 9 C), pulse S7„ respirations 12, blood
pre. Mm i ift'74. .onI O z sMurffllon 13%
Test- Taking Strategy
V,||<|| ■■ ■■'./III.- ■ ipp ■ ■ I ? i|:r--:-.n.- Iis i 11 J -r-.-. ■ .:i ; . ' i - i ,r I ■. f a t m It . , xn n1 if yin +.n->
nnl j t n l i l \ : i M i n l l l l r : i n r i v r on -I't’iulicinalJy ,md . ' i c i i .i K Will ■ .>■ V : T X. . ...... H gi i hut k • any p u t ions
questions and change your answer, so forget about the question once you mcve past it If you feel spin between two options,
pick the option ilhil yuui gul I r i s u n a is tcIHiyg you 11ust \ out gut instinct, You may nut know exactly why, but sumt-thing
I- ep Inside y inji ■ 11nsr i< ■usness is idling you thi ■ answer. A l a , 11 s feci i 1■ h.■ ■ . ■ gi i iny. i h rcxigi thee sjin th.in tu Mi ant l
wni n, ri a single question Worrying and obsessing over a question you didn't know will only distract your torus from the
rest al the exam.
Next Generation NCLI X Bi Examination (NGN)-Style Question
Drftp D o w n In T a b l e
Drop- Down in lab lei Scenario A 3 1 - y e j f - a l d lenuled ent presc t* to the c l i n k lor a preuperative af . o i n t m e n t lor
ripen h din. ill m d Inn lurrtl rigt 1 tibia ...... tllmLi
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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
History and Physical:
Client is seen today fora pi I'cnirive inpidrur in in ih* uitliopedic clinic for a history c f a foil while bitytling. She
was seen In the F.metgency Department (FD) yrMetday lor a ctimpuund h a r i u r r cd rlghi iibi.t and minsviiw’ ii.n l u i r
of the right fibula. A soft casi was applied in Ihe ED and surgery consult ordered.
Fur each body system, i l t w e for appropriate inter entfon(s) iu perform lot this client. U n e u r m o i e
inters unions may lie approprialr for each binfv system | In this t w m d quesiltifk ihf optforft Would appear as a <ln ifr-
dnwn menu and vmi would select the options within that area Since we are unable to perform ihdi In ihlv formal, the

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Inlormaiion r presented as a lafale. Please makeyour ielrtiicins by placing a < hrt.k in ihv middle column nexi lo ihr
dt jn-tl IrMi'nendon.)
Rudi Syslrnt Jnirrveiitiuir. hi Prrlorm
CaidHiVLisinl.w Obtain a CBC
Assess distal pulses in all ejcu entitles.
Elevate aiiccti-d exit emny.
bleui'-logical Assess sensation in left lower extremity
Imuart? seizure pieGntuons.
Ask r bent to move toes on both feet
Genilourinar) Stud ItQU rnfasunetTwrus-
AilimiiMrr iSiLirrriiv fur swelling.
Obtain g pregnant y n-si
\ l l s u c r
Body System Inten entions to Perform
Cantovascuiar X Obtain a CBC i%
X Asses* distai pulses in all extremities.
X Elei iae affected extremity,
Ncuh logical As'-L--- sensjk m in k li l-:iwri > u i f i n i i .
- u
|iulii:r sel/UTr pi rt d.Hinns,
X Ask dienl lo move toes on b uh feet.
Genii....... Strii ■ T\O mr « mriiri :r .
AilniirtisItTdiiirriicS f •’ swelling.
X Obtain a prrg tancy n-ii
Rationale;
Thecllcni K rielugjinpatt-il !cr surgery. It is impdrtjni loubtoin preupTaiive laljoraltiry data stub a-. a (fit itir.i
severe iracluri' like IhiMo assm pulses, skin temperature, ninvi'ijirril, anil srns.ilH.fli in thr rMrrrtnty. A loss til pulses in
the extremity could indkare eonrpartmrni syndrome which b a medical emergency. Elevating (he extremity can reduce
swelling and decrease pain. Ask “g rhe jMiient tn move her toes in h-ch feel will help to assess neurological function in
the extremities. A pivyrkmty test should be obtained iui ali telltales _d dnld’bearlng age brlore suigen to avoid any
oini|Hkdtiuns in the fetus. Assessing the sensation should be focused in tlw ritfii extremity (the sido ol injury), not the
|p|l IliiTt' Is no mthcdUcin in til ■iriiJiiiUh.il -I .’ ■r pi i i .Hiltons .sr. w.r; .irih-il rn< tin-, < lirnt Sum I At K .n- >U
needed at this time. [ he swelling this pauent is experiencing in the extremity is related to inflamtnatjon due to injury;
.idmlnisining . i d l i i i r i i t will mu rrwlw ihls issiw .»rnl. ....... 1 1t-.ite uthri umn-irssdiv tinm-n:<

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4
Advanced Clinical Concepts and Disaster
Management
Acute Conditions: Shoe k
■ Htdgrs at Slunk iFift JJ
Initial Siagc
• Decrease in mean arterial pre 5nre (MAP) of 5 to 10 - im I fg from bawl me value
• Increased sy nip thdiu stimuLinuii
' M i l d vasw onstrictkwi
' Im reused taswi rate (HR)
— Compensatory Stage
’ Decrease in MAP of 10 ta J 3 mm Hg hum baseline value
'< ontlnued sytnp<uhHic stimulation
» C onrinufd svmpath ■’Tic si muiation utts In systemic vascular ronsirirticin
• Utcxeased HR
' Decreased pulse pressure
• ( hrmlt ,il " ■ n p, ir,.i i tun
■ Renin, aldostercme. and antidiureiic hormone wcretion produces an increased vasoconstriction
(cumpeBMies fix shock)
■ I breast'd ferine otiip Jl
' St :r,ildiiirT . 1 the thirst reflex
■ Same anaerobic metabolism m nonx sul organs
• Mild acidosis
• Mild hyperkalemia
— Progressive Stage
' DrcrtMsr m MAP of Ju mm I ig ii i?m bawlme value
• Anoxia o! nonvita) on Mls
' HvpoxU of vital cjqpns

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• Overall ■ ■■ iboiji-ni i- iin.ir i.hk
• Moderate acidosis
■ Moderate hyperkalemia
"Tlssur iM hrmla
— Refractory Stage
• Severe tn-bue livp.,.i.._- wnh !■• hi-mw and liein »r
• K easedI lyaca dial dtp ■ '-..ml I ■ Irotn the pam -. ■-.
- Buildup of toxic mrt.ibohli’s
_ . _ , . ■ V j - h . r . 1 . . . . .1., , ■.,<-„ !• I I rl r - . _ .
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■ Multiple oryan dysfunction syndrome •:MODS)
• Drath
■ Tvpes uf Shark
— Hypovolemic
• . Lirculdiing volume t elalrd io linenul ui e urinal blood loss or dehydratioji
• Older adults at risk adaicd t- diuiem :liera|iv . ihiru udley, .inricaiguhricin riietapv
Vasogenic I fMMpliylKlk, Neurogenic. beplic)
■ Excessive vasodilation and impaired distribution ol blood flow
. ....... I r i s k r i ■' 11 h I . Htiiiiiiin.- I. ■,]iutl>
.- ■ u‘s, l i . r l i l i i l l il I
— Cardiogenic
• Pump failure
■ Results In J ididiac out pm and MAP
• Older ai/i ’ l i s k n ■ -i io ■: then-s nirl liras, udtomvi ..nhlt- ■ ■ grill ■ impa imc-ni
» MyocardtaJ infairiion js rhe rnosr common came
- Obstructive
• Ph-, ,ic«ll i ' l i ' . u u c l u t . i rh,il In - - | i ' . ' i l l . - p, ainl . . . . i i i n i i n i>l ill I .in
• Pericardiils. cardiac tamponade
■ i Hder adult risk rt to .j-.r- intmimo . hsoi ■■. malignancies pulrm n-'v livpe - ' nslou
* \i urging and < idl.ihnr«»liir M.iiugnuent
— Ccurcci decreased tissue pertu- <in and restore cardiac output
• optimize oxygeiuuuti and ventilation
• Fluid resuscitation
• ( I I I t j ■ I : i | | | l . H . m l l i . l lip,
— In cardiogenic shock. . olunu? expanders may precipitate pulmonary edema
- Assessment ilaM ls_
■ Vital Signs
• Mental status
» I nne output
' i r e d l m e n l ul Shm k
- □nJgihi't ,ipy 2n

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• p -ri?|!- I . i n l l . i c l l l l u l n i l l !|.> .<1 .Jli r ’ t n l ot li - k (HI p f r | i -Atl, - < | | i . . n i illd ■ i ! l | U . | i l | | j B
■ Replace blood volume or lluid loss
* \ Iminisipr medic.<icjn? dependink ■■ ~ urns? i- hick
• — Vdwxh!dhn\
* — Vasoconstriaors
Increased Size el capillary
DOd H m o biOOd v o l u m e
Tno tovuft i i a
decreased mean
artenai pressure
( M A P i ar*d a
doewisud
b*ood flow
(perfusion)
Decri-.ised s-zetff c a p i a f y
bou samfl t - c o d volwno
The «MJ|1 it an
jrwi ased mean
arterial pressure
(MAP] and an
incmuaed laic
ct Wood flow
uaion*.
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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
5 T,>
- . ',; :■;.’ ■ y.v .-.v .•?.%'.••■■►’.>
IHiCKl vrihimti
normal capillary bed sue
The re&Ut is a
decreased moan
d>ioi<tU piBKSMte
I <MA P and a
decreased rate
i jf Uoodlkrw
(pptluswi}.
Decreased t crxl vOMnW.
■ncru.iMid capdiiuy bed B«zn
The rvsufi is a
targe i m p m mean
oritMidt pn - ...'i?
r (MAP) and a
-/.■ •* ■
nr. 4.| i H’larih J I r. ■ ui|i i- . nJ Hi u r o J :h- . .iplll.wi, lu’d .itlih tinn m in in
pressure (MAP) Repnnted Vi th permission from l nataMcius, D. D., Workman, M L.. Rebar. C.
R.. .‘s Heimgartner. N, M. [2021 [. McdicaZ-suryica/ Concept fur infcrprn/wsiofflilO
cn/fuburulivr < on? [ 10th rd, J, J- Isevler
Study Break

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1. A client in shock develops a MAP of 60 nun Tig and a UR oi llu brahmin. Which ordered intervention
would th? r?pi tei ed ruurw (KN) implement first?
1. Incredse ilte rote o| Oz ilm*
2. < obtain arterial blood gas results.
3. Inu i L an indwell i ng uiliidis idlheler
4. Incrr.' i’ the rote ol Inrrflvmous (TV) fluids.
2 A dlr nt wjlh a known cjrdi.it history k a du i il led In the ucule fare unit U1 ih Stable angina At 7:00 i.m., I be
dient had stable vital signs and was on 2 L of oxygen via nasal cannula. At 10:00 am,. the client reports
<hrM pain ol 6 on .t Male ol (r to 10. k dighily diaphnretii and pale, ha> .i bltHxl pressure (BP) id 100 12 mm
Hg, and has a respiratory rate uf 24 brraihs.'min. Which action should the RN implement first?
1. Apply 4 L of oxygen as ordered.
2. Administer a Him > this >.)l 0.9 noimd saline.
1 \dmlnister rhe prescribed opioid Im pain conrrol
4 i >bcain a lull set ni vital signs, including temperattirr
C o n t i n u u m of Sepsis
• Svslriim liilbmiiiijliiiv |r%|H)i?.< vidii.i- 1? |SJRS>
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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
• Sepsis
• Severe sepsis
•SepOl sinxk
• MODS
Sepsis
• SIRS is an assortment of insults, including sepsis, ischemia, infarction, and injury.
4 i .i’ll. i ili/i'i.l ...... K 1 1 ii <ng,!- ■ i . rm'll' h m i du 'i. i h uh.
* SIRS u-zudlly sians wlih an Iniecucm.
4 Syndrome starts with an infection ih.tr pro presses io bacteremia, then sepsis, then severe sepsis, then sepne shock,
and tinally MODS.
•Thr pr ,gnosis Inr M O D S K porn.
♦ Nursing andt dl a boraiive Ma&igemrnt
Ihe most important al is to prevent ihe progression oi MftS tn M U D S
1 Ir -miiMrig I-, . r i i ' i i d v i :! ■■., cilh-. ni .mil ■ ulrig mpiilliir . m il<i, ■ i i'.iil-. i g n s U igmi
dysfunction
— Collaborative care tiKUses on: v

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■ Pnexenrion strategies
■ Lariy recognition of subtle c . i ces in HR, systolic BP. respnuijiy ran-, j .ygen saiurauon, urinary
■ p i l l , .q ■. I I ' l V i . i ! rivi VI, I. - '.V'.u in i tungc 1
-
* Smim lat m e and glm L»«iif levels
■ Blood culture before in ubieties (Fig, 4.21
* RlihKl-S|n1rurtl within 1 in < hirtir , ul iidrlir, null
* Mainmnanc tri tissue uxygeruidon
* Nutritional and metabolic support
* Support ui individual failing organs
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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
I IG. 4.2 Bb.od culmre wnh positive bacterial grawit (lStockphcro.com Abdun . tnant .ulmez j
Dtsseminated Intravascular Coagulation (D1C)
• I l l i I-. ■ -.L'lid' . ...... i| hl?|l ' ■,l.l!.|'- ' ' l l l i t i y ' Wl I *4illH .Il I r i l ) | . -ig ! , i r , |<il f l'tl In UllC li -ilL1
processes in response to diseases or injury .
• Asiule ongoing evjluation and assessment are needed.

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' Faster dotting ■ in dotting fanws and platelets ■ h morrh.igc - P ■
■ DIC nui lead ti unconuoltable banonhagr.
* Friih (lfietiliin> ■ iilrrtlinx. bi>il' ». cull anti tivrn, K the pr n u t m il
* I) dime: assay mcjsuics the degree ot lit-nnolysis i n b i i n pmducn in rtu* bhxxli
■ Assess the client for signs of external and internal bleeding.
* Hr alt :■ Im III..ml. -.I.H.- . n| tlm tyndmm ■
* Heparin infusion i early in DIC, when dots are terming}.
’ Blood, fresh frojm plu'rna ( H P ) tr.msfu1
-.- and cryoprecipi tale.
* \ ppi up i ate trc,un ici 11 11MMMires i an be > 1>.■I ic1ifting .111.1 - r .mT i111t>4 [iur .uh >v
Acute Respiratory Distress Syndrome (ARDS)
* A Severe Form of Respit atury Failure
Considered to be present it dw client hji hypoxemia that doesn't improve ■- nh oxy gen
A|NvC |I r ■ nnil'tion kil ARDS Wilfnn -IS fi ■ irs id <»■ ut'al nianlffstjlu
\ i .ntcr.nildil <>r alvroLir Ini i.::.ik's on A eh<V x 1,1V 4 whilnHII < whih lung)
* Progression
I ■ ■;: ■. ki*cl I dii'ld.i I|llll.in iiH'llll)! ifai Willi- i'-ri|u k'.ik.n; if IlllItK illlu I ■ llllrr.111
spaces itnd alveoli
— A’. ARDS progresses. profound respiratory distress develops, requiring end :rachv:' intubation, and
positive-pressure v unIHalion
* Nursing Assessment
— hypoxemia
— Dyspnea A
Senn u-d 1 1 H kh‘-(
— Increased u ark of breathing
Inli-ruALiil ini act Inns
— Ri'splralLH'V dlkdloiii ( r a l l y ) IcatS H> 1— ;il ralLn \ at Idosls 1later)
— Pleural effusions
Dtii eased cm diac otnpui
— Cywnls
* Surging and < dl a borainc Management
- ( JvF dl onais
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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
<.Jverall goals
• P.iC 'i .. Ill 11 .. ■.■ ! Iv I .Hill H g
• Adequate lung ventilation tt maintain normal pH
Cii,. hj| i i i * u ' l i i i g c l u ' i u
• PaOj wiihin normal limits tor age or baseline \ alues on room air
■ S i O i , -Oil

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* Paieiu airway
- C k\ir lungs im iiusculiuilon
Delirium
■ Aft iicule stale 111 Ldnhi -n, ;ind iti EI Ku 11\ concentrating I Fig. 4.3 1
— Common among elderly, hospitalized clients
Mas mdk Nttt impending change1 In u>rklllion(l.r.t M w N f e u y tract Infection J l i T l I )
* Risk Factors
— Sleep deprivation, advarxed age, or vision and hearing impairmer'
U sr t>i 111111■itls ,t i id ' i *i . 'ilit ■ ■■ i. k ' i d '
— Drug nr alcohol abuse * *
— LTI. fluid and electrolyte imbalance
Posioperative (unscheduled su.'gei vl. I d . or emergent delirium
* ’Surging a n d ( allaboraihc Maiwgrnient
— Prevention and early re ugniriui i moriitot ncuiological sums)
■ Protect the client fr-m harm
l’n ide .1 Inu ■ tlnuil ■ Hi Pnvk'Hinn'nl (cdlm)
— Pros ide ihe apf ropriart1 level of supervkkMV'suveillance
— ftcohEnt the diem u d . . nimuni-.dtf wuh simple statement
— Consider mamgemerrt with neuroleptic drugs ( e,g,, haloperidol I Haldol| ) as prescribed
Fmi uragr ■ tfullv vr-iu liv .uid vtippi’ii
reproduced or uansmiTted without publisher's prior permission. Violators will be prosecuted.

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Reprinted with permission from Ennper. K „ Hi CnsnelL, K, 120I 9|. FtN porloru and aduft hculih
nursrng ]Bth ed.]. Elsevier.
A client recovering from \ R D s is awake and alert but li*s residual fatigue and generalized weakness. Tlie
client's current vital signs are HR U3 beats/min, BP L04 V I nim Hg. respirators rate 27 breaths min. and
SpOj 92% on 2 L/mhi oxygen *ia nasal cannula. VV hit h vital sign requires the k v lu lake action?
1. HR of 83 beats- min
2. BP of K 4 W tnm J«K
3. Respiratory raleot 27 breads mln
4 S[H Jj n?' .. nt 2 |. mtn 0 2 x :a nasal cannula
2 A client is admitted with a 2-dav histon nf cuugh. fever, and fatigue, I he medical history is positive lor tvpe
I diabetes and recent upper respiratory inlecthm. Vital signs are HR 109 beat s,min. RP 102/5# mm llg.

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rrsjnratori, rale 24 breaths/mm. lemptralurr 104 T (40 C J, and SpD ? 92% on 2 L orygeo via nasal
cannula, Which order hai the highcM priority in this ikiilS care?
I I nidate la igt■-bone TV access.
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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
2. Draw two sets oi blood culuires.
3. AdtniniMi r ihe oidt«i-i| IV anilbiiMk'-
4. Dr jw serum lactact and glucose |e\ cl ,
3 A dient with a history of uterine fibroid* had a cesarean delivery 12 hour* earlier and delivered healthy
twins, M d i i l i change, lhe R \ avscvw* ihr client and notes dicnlrw'is ol breath, cool r n l i r m i l i t * . and ooring
of btaod from the incision site. Rased on (he dient’s presentation, which nursing action has the- highest
priority?
1. Assess the client's temperature.
2. Notily Hu ' e.illh i ah pun lU i
3. Clean die blood from the incision she.
4. Draw labs for pruhrombin lime, partial thromboplastin time, temple1’ blood count, and fibrinogen
B.isit Life Supj ji) i t
• Cardiac arrest Is the most common event requiring candiopulmonan ftnschaiion (CPR)
- CAB: Chest compression -Airway Breathing
— High-quality chest compressions
Pi ■ ii nd .uni push l '
— Adult: 11X1io- 120 compressions :iin
• ln-Hospilal C ardiac A n r M
Determine uncesporhiveness
— Activate rmerqency response m' cardiac arrest team
- Call lor an automated ettei rui detibnlhior ( A L D i o r emagency uasTi van (do inx leave diem)
Initiate (.PR ■■ i basic rjn.ii(.ipiilmrjnaD life support (B( LSI guidelines
[nil . ' . - i i i m p r r lin i Fig. 4.4
■ After 2.U compressions, open airway with head rik-diin lift i Fig. 4.5 j and venal ate with bag-valve
• ■.i*k(prtnide two breuthv.r.K hover I secondl
* M - i t U l l l j r rnpi r iis-|t»4ii. .itlis r.< >il .i ?
— Once the defibrillator or AED arrives, apply'♦quick-look” paddles or A ED io determine whether
Jfauon is necessan ; def ibullate as indicated atLuib . i> hospital policies and ptuceduits
— Resume CPR

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H G . 4,5 Htdil-Clll'. -ill' IIL-.III'UM I Rq II II' i l l wilt inks i l i m i i i.ipi'i, k . -Si C.1I- .'ll, k .
[2OI9|. Foundorions and trdiifr health nursing |fith ed I Elsevier
Cardiopulmonary Resuscitation and t Jinking Basics
M e o n a t e s and C h i l d r e n Ages 1 tc 8
* Indiuij ms Im < PR In i hildit'n un illlh ..■ n tli.m i i M1 Jin adiihs.
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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
* i uu K di J - ii.it iwi * rr. in mumni a»v iiiiitntfci njun m-jw ivi duunar
— Kronain and infant*: Ilypmi i. hypr ; v rm..-, hypothermia, acidosis hspercoapi ihility
— Cliddrcn: Respiratory attest, ptolunged hypoxemia secondary io respiratory insult ot shock, including
septic slnxli
* ( iilldfl.ru 'i V,«\ '■ Ki'il nr. thr iigi- nt I he ihild 11 ill ■ ■ ■ ill.iii .s wnn. cd
— It the tniant or child is unresponsive, call a “code, ' or cardiac arresi. to inmate response ot cardiac arrest
ream
- Obiatn \ED or emdgcncy trashcan with iielJ-:itl.iidr
— Begir. CPR per guidelines Irsicd below
* Guidelines van uased ui the age ut die JulJ II the collapse .?■ nin witnessed
— Cher k for pnlM‘
* Infant age I yt'ar Bradil.il ptilsr
* Children aged I year to puberty: Carond or remora!
( iini|Me'isli>m(hvglii within 10 seconds)
* jfn/tznrs: C u.npi'i's- >ns cover unr thud rd the anruriejr Ji>ti'rinr in mum ■ nt die . hest: di-[ :h Is 112
inches f Fig. 4.6}
* t h-Jdren; t orupressicins tme-ihi J ut the dnlenijrfpusleri « diameter ol the .liesi, depth is J
Inches \
* CDfflpressiofl-ro-ltasOTh ftnr/o Fm infanta ndtfiddirn the rauo is 20:2 when onl wio itscuer is
available. When two or mor-, rescuers are available co assist with resusc nation, then the ratio changes
io 15:2
— Del u er each breath o\ c I secand and observe lor ftasuk abdominal distension
— If the infant or child does not respond after 2 minutes of high-quality CPR. then call a “code." or cardiac

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H G. J.7 \ t m ira ■i ini p<ai i ■ ;idles in a rt’liilb'.i i u.iiihia resir-u.nt..>r 11■11 inlath ■ Reprinted w 1111
pern -sion Inr.rn IgMtavIcius. P. D., Workman. XT.-I.., Rebar, C R.. ft Hi ■’iiganm ■ V M 120311.
AfeJi'Lij/’Su' k rd nirfsjjy t oncrpts for rote/'pnj sslonuf roUdbordtiyr corp I luth ed.]. Llseviet'.
Studv Break
Li ox 4.4
T our cHeots arrrre in the eniergetKy department ( F P ) alter an explosion In wlitdi order should tfoev be
assessed. All options must be used,
I “n-Vi’.ir- ill | wild ■ < (Iin;i: - n i l l f l I.' i |Mili h-vpl rd H i 0 1mm ■ h.iri; '■ rTi
2. \ S3-year -..id ii'ii! partial and Util thkkneh burns in ihr ante nor and pirsit iio! chest
3. A23-year-old with a superficial bum to the right anterior arm and lateral chest
4. A 42-ypjr-uld with a partlal-diickiwss bum lo ihe anceriur luwti extremity and confusion
2. The RN is assessing diems at ihe site of a community disaster. Lsing the color code system tor triage, which
d i e n i would the RIX I w with a red code?
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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
turn i vioutu (nt Ki> idg wiin a red cnocr
L A client with a large head injury dial is bleeding, an open chest wound, cvdomic skin, no capillary refill, and
.|',!<H1.|| I t ' . I I I . n i l 'I
2. A client with bruising and swelling cu the right forearm, issoned lacerations to die face and neck, dry skin,
nunndl Clip i Haiy refill, and a respiratory rate of Ilf

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3. A hunt wiih M j.ii- '.i"- .in i - rape ■ hf In i.i and L i e who is I nplnp, and helping olhi i : ii?ni ■ ..n riic K,i i f ,
4. A client v j th an open wound to the abdomen, and a dekrmed nghi femut, pulse I25 h delayed capillary refill,
resptrattuii rate 32, who is noaninR.
Bintrrrnt ism
*Relrtew ■■stpriiure infi' rmaiion, assessment, dndln. ■ and Erramnein r i '-.n iixis agents
* Qursuonj nu> deal with disasters and bl I !-.npllMT. J 4. dll'-, □tfcc.nhc ndlYidual Victim*. lam 1ltrs, and the
community.
Study Break
Box 4,5 J
The RN is asiintml lu receive ,i ■ lienl in i L FD with supper led .uithrax exposure pre lift rniF.iiiiiii.nion.
Which transmission precautions would be most appropriate for the client? (Select all that apply.)
L Airborne
2. Conner
3. Vector
■L Dioplet
5. Standard
2 The CD RN is a -esxing a ctirnl with a vesicular rash ns a result of susprr (rd smallpox exposure. W h k h
transmission precautions would be most appropriate lot this client? (select all that apply,)
1. Airborne
2. 1 ntaci
3. Vector
4. HruplOI
5. Standard
J. I hr RN h caring (ora client in shock of u n k n o w n riiologs and observes a rhylhm chat isvrn i r i r g u l a r with
no discvniahlr QRS complexe'- m> Hie niontlon Whit h is the R V s p r i o r i t y i n l e n e n l i o n ?
1. Check for a carotid pulse.
2. Defibilllaic the client with JbO Joules of energy
3P Administer an IV wtine bokrs,
4 r.lve iwo ‘ H-.uhs via h.<H maxlulevhe
4 The KN admits a client with suspected early D1C, Which symptom! s) of D1C is evidence of early organ
iMlwiina trilled to (hr client's diaRiiiris? (Sr let I all that apply.)
I. Slight Rinpiv.tl bhx-.ling
2. Alteration in mental status
i. Priec hial heniuiihdkic to che t

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4. SI.;,hl decrease In urine nuiput
5. Bluish discoloration of fingertips
Tesl-Taking Strategy
Et<AH’,4 .ng ftrfxl htmi'irx liM s.|XHtlii rtiiliirnl-. i .m . nip in \rry h.iiuh w hiIr preparing for the NCLEX. Having & tMSlC
knowledge of foods that are rich in potassium, sodium calcium, iron, and v.smins C □. and K is recommended for
.■UJVjd nii i l h ' i i l -:u:ill ■■ r d m . i l i <
Next Generation NCI .EX $ Examination (NGN) Sn ip Question
M u l t i p l e R e s p o n s e - S e l r t I A l l T h a i \ p p l v
Si rtMfia: The RN Is taring Im at lirin who lids anew I'rtrv.rlpliun lor wait.itlri ZttgPOtuilv 1 Ir H \ j m w u l L i i g
medication education for the client and ts discussing dietary insiruciions Including foods to avoid while taking this
medication.
Question; Which vecrtable v. juld the RN Insirun this client to at . I w i n - take g warfarin * (Select all that apply.}
1. Collard greens
2. Iceberg lettuce
3. B r u i t nl
4. Rrusst k sprouts
j. Green beans
G. Spinach
7. Zucchini squash
fl Kale
Amwer; 1. X 4. 6> <•
fiuri<wilc Coifaft/ tfww, hflfcrccjff, sprouts, spintn h, unj kale afv Itmd’i thm urc drnmM K-rJt fi und should
bcoxToided while taking warfarin and other aiwirwgti/aFJti iceberg lerratY green beans, andzucchrnt squash are lower
irl Crfaruirt K ,.r J do ■ nJ -uh ■ru'.ufes /or these H riKlcrb/r-. /or J iTi 'J-bu/un c J diet.

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s
Oxygenation, Ventilation, Transportation, and
Perfusion
Chest 'Oibes and Water or Dry Seal Management
* Lliesl tubes ait inserted into the pleural space to rernove an fluid and restore intratlhracic pressure, whkfi all*
the Isinrg lo rvtXpand.
* A chest collection drainage system has thiee compartments nr chambers.
■ Collection Chamber (Fig. 5.1)
Air arid fluid <re ctilkided liom r’ .■ pl- tral or Hu-iJl.isi iftj |klte
— Fluid remaicK and jlr k vonrrti rhe ovoriri « omrifeMniMit. the waier-seAl chamber

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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
FIG, 5 4 A commonly used disposable chest drainage system. Reprinted with permission Irani
Vincent, J. L., Abraham, b . M< I \ . Kin li.nu k,, I 1 M,, & Kink, M. P. 1301 7], Textbook of
critical care prh cd.' Elsevier.
Water Seal Chamber ( r i g . 5.2)
— I j j n i i ! . . 2 u I WdH.'F - hk h ;■ > M ' l i h .<!■. klln'A lirid Litl- . .i <nii- wav Vai1
. ■
— Fluctuations in the wau-r level are knovm j s i I doling; fluid should m.Mr .in! uh t-.i-.h inspire Inn and
downward with each cKptradon J V

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reproduced or transmitted without nnhlisherk nrior nprmi=sioTi Violators will be prosecuted.
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Suction Water seal Drainage
control collection
FIG, 5,2 Lhdgrani of chambers of water seal chest drainage. Reprinted with permission I n n
IghauviclUK D. D.< Vfcjrkmaft, M, t, . Rebar, C R . Hrlmgiinnif, N, M. [202 1J. MedlcoFwn/fr yl
nursing: Concepts for mtcrpnojessionaf ajJJtrtwrative core f lOdi ed.]. Elsevier
Suction Control Chamber
Wrl '-i: iii?n 1i- J O i m u l Water lodld II Gaining -III I hml Iruill I1 ■ lirM
— Dry suction pru v ides an effective level c ■ vacuum by continuously balan< ing the tor. i-s of suction crane J and
atmosphere
Nursing ,m<| CollabaratKr Manageniont
— Check that water level is act iir.itr al 2 t in r v r r i , shift; arid MrflJe u atft in the chamber if needed
— Keep the unit lower than the client s dies*
Keep ihr unn <-iralghl ■ all lul in., Iinr \ tuiliiJ I plui* level, with ■ I u m ■ turns I < ludiiqkiJ
— Moniiiit the fluid drainage and mark ihe nme uf meastmdlmu and the fluid Level; notify hojlih<air provider
| HCP) it there is 7 0 mL hr drainage

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— Monnor respiratory enon ana pom levels '
— Assess rent lidding; observe Luc Air bubbling tn the wairr-seal chambei 1Excessive bubbling tn the waiet’Stal
chamber mav indicate an air leak.)
Replarr the unh when i ilIuciIon chamber h lull
— If the chest tube is accidentally ±$todged. then:
■ ( i <•■ will: ■ ky Minh rhissi:
It .in mi I, ,tk Is nr i tl, ; i|M- in ihi 1 1 Miks
Notify the I ECP r~m,edtatdv
Stiich Break
B o x 5 . 1 r
). I hr KN is p i n ruling dii KN onentec who h l a i m g l u i a client with a chrJ tube. 1he client is 12 hours
pastoperdtivr ftum a Irfl p n r i i a l pilrumolwt lumv. W h i c h dSM Miircit f i n d i n g will ihu RN advise flic orit iHn
to immrdlnlrly report tn rhe h r a h h rare provider ( l i t P)? [Select all that a p p l y )
1. Pain level of 0 out o! 10 onihe Jett side
2. Tr.iuhisil '■ vlailon low, ml rhe tight Mik’
3. Drainage from the chest rube of 50 mL Ln the last hour
4. Oxygen saturation of 90% on 2 L/mm
i, \ igiiimis I hiding in i he w . i-i-wal ikiinlx4
i
2 Tire RN' pal pares a crackling sensation around rhe insenion site of a chest cube in a client who has had
thoracic lUrgriy Vduth action would the KN lake/
1. Return the client Io surgery
T F'r. . n : n . | n r ini.z. H i , ■■- . .• ■. I >■ r ,■■h. r m h * '
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2. Prepare Icir insertion nl u laiger rheu tn tic
3. Increase the water-seal suction pressure
■l.< itltllllri' i nUJiUI ■■ ihi- ir '.cltKni ■■Hi-
Pneumonia
• Inflammation r»l lung tissue, cutBing conobdailoa if exodair
* Etiology
Bmtrri ltd iii-i.' I’--. . r. il ■ .--I ■. v .■! r). v n il, liF.u- il i -.in . r .tspiiaimn
— Community -acqulud |meumunla (CAP) arhnvpnul -acquired pneumonia (HAP)
— Ventilator-associated event (VAE)
* VentiKular’j icxidiid pneumonia
♦ Sepsis
' Acute expiratory distress syndrome ( ARDS)

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* Puirni >|i.n\ k-nihi>|i<-m J
* Piilmini.iiv E-ik-mu
* Risk Factors
Agr 46 years oi resident* In Juckg-lei m care
— Rftini sui cry (abdominal, tliwaclr)
— Altered cantXiOUSneU: orinbohim, head injury, sfnokmp splenic dysfuticttoa, unrslhMla, drug
overdose. cerebrovascular acodtnr (CVA*
Prolonged immobility
— InimunQsuppressfon
' Prevenlion
< l > l l l . l l i ■:■ N i l - . : ■ ■■ n i J L l M l ■ I Vdl.- l l U H l ! d l l ..;ii:-> |1- m i t ' M r f r.|l ■I'.lx-: l h ch < . 1 ' 1 ? ! 2
— CDT r> i ummends additional | neumtx K i.d x nation t> ■ chllcren and adults who have attain
chronr medierd << ndltlonn or ocher risk t u t o r s , and .ill ad...ts ovts i ’ i years old: see Clx: web str for hv.i
of these conditions
- I urlurrw.d ViKcinr yearly
* V.AE Practice Bundle
- Meticulous hand hygiene
Hi-.uhil licd(H<)B> e ■ vatlon UJ—lpi d. gjres
— Oral care per facility protocuI
— sixtion only u needed with sterile technique
Use routine peptic ulcer prophylaxis
— Conniindtr vpncii.iin i.'. m1 i ■- ib- 1 A >di pimtiinroin hivolhinx trials (SHTs)
— Early mobilization protocols. VTL prophylaxis
■ Xiirsing Ass?*'rueni
Taihyprii'd
— Pioducdve cough
— Pleuritic pjm
Fever of abrupt onset
— Dyspnea
— Increased, tacule fremitus
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reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
— increased ramie rremitus
Menial stains changes
— Crackles, decreased breach sounds
— DuIincss on perrussinai
— Anerial blood leases JABGs) mdicauveol hypoxemia
* \ n r - i n g and C dhibnraiive Management
— Hand uaslilRu. r i ndu.. e 1.10s-. 1 nnumin i!ion
— Blocd and sputum cultures, before antibiotic adnunisnaliori
K i J j F m n It 411 T l l u v l

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Administer and encnur-ice fluids, If not < ontnundicatud
- - Adnunisler iintipv retie. as ordered
Arfmlnhicr empiric anti Info t h m -is prescribed
— Manage pain
Monn-orOgi saturation and ackninister humidified Og asapp opnate
— Teach coughing, luming, and deep breazhing techniques
— Encourage use of incentive spuometiv
I IHlis -hi | | i / i- | •■■ 1. 1 I v l t t i J i l l S IP I I . . - i l h l p l i r . r l l l Un ■ 11' ■111, i 111 I | 1 : r-* 111| i , .1ill I sec 1 1 ' i ■>n
mobilization
* Anti-btfedives
Penkfllitis
* Srmisymhetlr penicillins
Oxacillin
AniipsrailoniardI penu illins
" Pi|H'raiillin sodium
— Aminoglycosides
* lefiacyL'lint'
Dcmct It < ycline
— TetTKydint*
• Bertramvein iiareh used)
Vjncomrln
— t-tphainsportro
• Ceftriaxone sodium
» f . ! r s iUli< I n d i x n l i h i r i i l u
■ — Macrotides
• (.IdTithiuniycm i Bus ml
Fhior»<|ldnoIoni s
* Cipjofloxacin ( Cipro i
Stuck Break
Box 5.2
1 A client who is 1 day postoperauxe alter a left pneuiiiunettonn is king on his tight side with the head ol the
iwd I HOB) olrcatpd 10 decrees. The RX assesses his respiralnn rate al 12 breaths. m in . in wbal order
-M-nul't rim r t K r%*r(nr»> rhf< I n l L i l o n ;*4-|i<»n*i'>
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would the RN perform the following actions?
1. Elevate die HOB

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t X1 IS,III. : .r I Ill'll. t '. ll !.Ilhlll
4. Administer intravenous ( I \ -'R\ mcrphine
2 I lie Rbi is Mi-trni nig a graduate mirsr (GVJ < artng h i r a d i r n i drpro deni mi a ventilator. Whk'h action hv I hr
C N deruonsrrares undertf.Hiding ul ventilator associated event (VAE) care? (Select all that apply)
1. Administers a proion pump inhibitor « prescribed
2. Kinses I he client's 'ial cas its with chloriiexidine even 2 4 hours
3. Elevates ihe HOB 60 degiw
4 Implements spontaneous bicaililnp trial
5. Performs hand hygiene befc-ro and after care
Chronic Airflow 1 imitation (C AL) (Fig. 5.3)
• Chronic Obstructive Puhntinary Disease ( C O P D j
— Chronic progressive disease
— A collection ol lou er airway C::-urdeis that inter irfe with airflow and gas exchange which includes;
* FniphY'-i in.i
* Chronic bronchitis
— Etiology and prescription tact? re
» Cigarette smoking
Environmental expcKiat
occupy iLi. . xpi-.uic
Genetic predisposition y
■ ( hemin Brom hili'.
— Clu HC spilinn With I :nlgh |M ■ lilclltir; -.n a il h fkaxis lur .i minimum 1*1 niinllli vc.li
— Chronic hypoxemia cor pulmonale
— Inciwsed mucus production
t|K l»d%i:il bi DIM hl al Wdll ihh. l.i;«‘>s((ihh;Li.rts<m r luw)
pA.il ifi.nli ;. nsiMlly iliii' ill Inh i (Uni
— Increased CO2 retention, acidemia
Rukx L-d H %|M>ireiVI'/i> || h” , 'll. Hint . I ' l l l r l I hypOXHl -.r||; ..li
• Emphysema
— Ah" i.:maI enlargement di the air spaces distal tothe teirnmai alvei Lu waib
Increased dyspnea.' wink til bteaihing
* Rt luted g.is exchange suit j<e area
— [ l u x ' j ' i d j.- trapping i inc roast d anrenji-posiiiwi diameict i
— Decreased capillary network
hr ir.iMil u ■ L Im. i' r i l l ) i ■.limp .il
• COPD: biursine Assessment
I n s p n i l u n

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- Brum hltlv
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reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
* Right-sided heart failure (HF i
* ( yano«is dbteffihri net k veins
Emphysema
* Pursed-lip breathing
* Nuncvanouc, thin
A i i M i i l cation
* Brom liln ■
* Crackles
* Rhrmrlil
►Inspirator. expiralon wlirw.es
Emphysema
* Disunl bfrdth sounds
* Diminishnl breath nmiK
* Wheezes L z
■ COPD: Nursing and Collaborative Management
Kivp SdO2 rn ■il.i'!i. (hiring irM. >ii‘qi. uld iWImfl, m ! .«■ l*.it l; 6<> Him Hg
Lonst-iem rciunucius O j thetapv (LI V I 1 more than 1> hours per -.iy;
■ Increase* survtvaL exercise tolerant?. and Improved mental sums in chenu wph faypcmcmta
— Maintain injection control tecH.ques
Mon H I........ .Hill v>lll|Hi i ol lln. jovi-ih
— Baseline ABCs for CCV. retainers
I rm I- llh ■ ' i pm i ii ip bin diking
— Orrhopntk posklon *
— Nutrition consult "**-
— Acute exaceibaiLunuMOdigemein
Stuck Break
Box i»3 i| ___________________________ _______________________________________________
1. A client with pneumonia has impending respirator) failure, tv inch set o f A B G values
drliiiiRMr.iir Hinlr rr p i r a l t i n failure?
t. pH - 7.30, PC O2 - 52, P(J2 - jt. IICXJ3 ■ 26
2. pH - 7. PCO Z - 44, PO? -- B6. HC0 3 - 25
3. pit = 7.45. PCOj = 62. PU2 = 6 6 1 , c o 3 = 3 1
4 pH = ’,30. P€O 2 = 39, P0 2 = 88. HCC = 20

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Asthma
— Reactive airway disease
R| ’.II illh I Hull ' .'IV dr.id.fi l»l lll<- HlVf.iV. I fed In m ekdg> i ik'd bm.nhiH ■■ Ilium
response w a wide variety of stimuli
* Allergens
Environmental irritants
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reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
Cdd air
Exercise
Beu-bfoctafs
Respirator> 1111if! ir Hi
Emotional stress
lie t lux nopttagun
Cenirl&cinar jr
centrilobular
emptiyiema atincts
" ro pr njry
ErroUMZhlDi -S moBl
severely, t s usua y
- p srv- •• n1tw
' M l W the tWWiiyj OvWtMKi to
common stimuli with brondXMpawn.
etMtmataus swollnfl of the mucous
and ccpous txoduchofl
O' lhh> lefwucioijt mucuK by
abundant r peftrnrrwl muCoua
antfs A.ftvay obstruction 4 usually
•rtermlTf r
r «mphYK«ni», |«n.; , rulwMua
coflapse itc f. dlls, jf brcnchii -ss, ard
areolar an- sacs As these wa ■s
ncAafwo, pw E)rcinerw*it and ahwnli
tw4tof|p bom n numtwir cd nrnaN
alastic stmchirea with flfflat
rfcir BMChanging surface area mtu
W H ........M l MM 1 •■ MM
h!hu surbeu area An e trapbed m
these disL*i structures, espvaar>
dunoq fcwced wpnat-on such ft ,
c;> 'itung. J i d Iha lunqi hype - - lUilu
The IrappM an siagrakM Junn can
no .nnger E-opiy ne oed oxy tr. m
The nearby captKanes
chrome bronthiUi ink-. ■
txoncbia I ’ i a n t B cause increased
--rcmnc t rdoma Bmncrxispasm,
ind irrt|Hi 1 m,jr-x .i v VA- inon
mitammnMfl ol tfw txoncW waits
causes rivm io th -un This
thrtcnlng together with flatcrauvo
1.04 t*> II > I -waya a i d
r 11tfkrjfi ;ji s exchange

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Pnn»rinqf fit pnnk.itiulai
ompfvaerria nSecte
His entire Bcirar unit It
!■ usuaQV menu wvuru
in t i t mwei lur f
FIG. 5.3 Lauses of narrowed airways. Repjimed with pennjssicn from Ignatavicius, D. D .
Wmkm.ni. M. I.., Rebar, C. R., St Heimg.uliMi, N. M. l.' ; | 2 1 1. UrJti iJ-Yunjti ttl niifsMp; f ont rpJs
for ™ rp/ '< i slone; . ■ i /oboradve core 110th «L | El s-vier.
Drug Therapy for Asthma and COPD IFig, 5.4)
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reproduced or cransmitted without publisher's prior permission. Violators will be prosecuted.
■ Asthma Medication Goals
Q u u . k i t ' l i r l niedlLjln?[L\
i rfMljl-Wtm i nn:nj| in, <!i <rjI j qirts
■ e n p o Medir.tfion Go.d*
— Reduce exacerbations
Long-acting beta-agonists
— hunt usial space Inliakd conktKterokfe Internal t anuld MeruiM
* Bronchodilators
■ Short-ailing inhaled 2-adrenergic agoniM’
• 3 1:114 urlnR Inlulrd pJ’.hi i'ni'ip aguni 1
• — Lon g-acring oral |J2 -adrenergic Agonists
• Anticbohrtergics 1inhaled!
• lj:< airuplum
AcEidinium bromide
* pZadrrnelgU Agonists
Inhaled: Short acting
• MeljpnileitTHil: u d x i l i z r i ■ il i.d ■■■-.■ |i x :iirh'H<i i k n ' mturli-i ( M P 4
Salbutamol sulf arc: nebulizer, MDl. oral tablets
levalbuirrul; nebulizer, M D l
terbutaline; oral tablet nebuhnq; HtbaitWH'oub, MDl
biiciltet' MDT. wbuilzc-i
— Inhaled: 1. ting acting
■ Salmetero] linafoate Dry ponder inhaler (DPI)
Fomioientl I uniatalt; DEI
9

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hnmrdkaiir « fin
* F ;iJflL'phllni hydiiM lilui Idr: 11:10001 -uh-cul.im-iUto
' Corticosteroid'
i
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I IG. 5.4 (. hifd receiving a nebulized brealhing treatmem for H hnu, istock pho? ■ com Nik'da
Sii'i.xliiiovh ,
COPD and Asthma Assessment and Collaborative Management
Milrsinjf AsM Miirnl
* — Dyspnea, ufherzing, chest tightness
* — Assess precipitating iactors
•— Mediation htaory
* — Determine nnii lor vraiUtvy suppcri
Collaborative Management
- M m i l U l t I r ' L ,11 l i M i r u i l I,! I i l l ’ | 1 ■■ininhiHi'.

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* Momtnriespirirtiipni andiisw brt'.nl wutuh
' M inutor oxygen suturatiun
■ — MrHiirnrrnriH.il status
* — Chew physiotherapy
* Assess peripheral pul 1* ■ md w.unnh and color of extremities
* ■ PttMofl Itir rMxIlnuin VQQtlhdon
* — Entourage slow, pursed-lip breathing
* I’h- ■IhiiK-. of di.!p ..«p,rtLd[Jt biLMllui . H)l5| in roll,ill v i t l ( I )l-'l.l n-nij.i i i l u l r :
* — AdnilniMU iLdfljkln ns! cixygcn thumps
■ — Nutritional therapy
* — Pros ide eduCBiitui on peak flow meitr nrorii tui ini’ frhponaDce of medkauoa compliance, and trigger avoidance
Pulmonary Tlibeix iilosis (TB)
1 TH Is a communicable disease causedtiy the Mycodoc-rrriwn mbcrtuJos/s or iht- tubercle bacillus, an acld-hsl
oi'ganisra, spread by atiborne trans jnissioiL
’ Priman Infection (fig. 5.5)
Bacteria Intuited
■ Latent TB infection (LTBl )r The TB bacteria remain inactive
■ Risk t-actun for I R
— fiiui.LinH iimpi. iiilMTl il.tlcs, ii;.iliiuli H i
— Mnltidnig-resisLint TB
-- Disproportionately tn pool, undeneived. and num. dues
Under age 5 and older dtenis
• — Alcohol abuse, IV drug uwis
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• Living in crowded areas, meh as long-term care ar prisons
■ VtFMiij* AsvesMiient
— Low-grade fever
— pdkif
— Chills
Nigh* sweats
— Easy tatigability
— Anorexia
Weight IcKi
Collaborative M.inageruriit
• — Diagnosis with nucleic .u id .impliii- .ition tiro(NAAr). Q t i l l RON 11!, ct punhed protein
derivative (PPD.i (Mantoux rest)
ftiMih Imai jxiblii InMllh dep.inmenl

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Airframe precautions iwjlation
Siiiglt-i.MiL up.io iixfli with negative pressure
PI <h efficiency parrn . ).ire air (HEPA1 nu k-.
— Spurtrnn specimens
[each ihe client to cover his or her nose and m 'Uthv-tth paper tissues whenever enu ;liinp. sneezing. or
piixlui inn spururn
— Emphasize caretui hand wash ng aliei Handling sputum and soiled tissues
[ft he them nwfv to be out of the ncgajlvp-pre ure luurr, he or she ttllwi wear a standard isolation
mask io prevent exposure to others
* TH Drugs and Side Effects
1 irsiline Drugs
■ hi ret-Im- riuEs .ire bacii :'-". id./ Kunsi rapidly i'ixnluig'6. and ■•- against wmi-d rmanl
bar lerta t J y
■ [soniazid tl.XH): Clinical hepatitis, fj.minam nepstitis peripheral neurotoxicity
* Rd ampin (Rifadin, Rafael}; Cutaneous reaciifliu. gaMjuiniotindl fi>l j diMmbance (nauvea.
acorrxlii. dibtlonuiijl pain), Unlike syndKirne. Iii'iialiuuvit iiy, ininninotogkdl n uw- ■ ■■■.>
di-'cnlnrarkm ot bodily fluids (spuuim. urine, sweat, lears)
■ Ltfiambuial hydrochloride l E t i b i ) . Reuafrui-baj neurttis {decreased rctbgreen color disertminauon),
vkrn rasA
• Ril.iluittn (Myi iilmliii): h.m.iUili . loxltli Cl mm .,',.iirln .i .'Luhi| =i illru,
grange discoloration ot bodily fluids
■ Pi ra/ i [lami dr ( P / Xj: I h ■ ■■ i. ■ i 4 symptoms ( ruusua, n.millmgl, pul Vditltialgld1
-, i k j i ] ush.
hipiuiinu'rnid, du mat 11is
Managing Active TB
• t) reks w ith J\H. rii ampin, ethambutul. and PZA
Folkiwptl b\ iHwet'k IVH .anil lit.- mi
Cavities open into
the txonchi, allowing
spread of M tuberculosis
through coughing
private use only. No part of this book may be
Aerosol transmission
of ths TB organism
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caseation, forms
a scar that shows
on chest x-ray 90%-95%
ot infected
individuals
S%-W%
of infected
■FKiividLi '
-------------------------------------------------------------►
Secondary infection reaction of TB after
immunosuppression, HIV infection or smoking
Progression to
active TB
FIG. 53 P:irihirv' TB llllt’f ■ 11 Will ■:r>pJv.Mi :■ . i Mi r inj|ir\ ml' ■■llmi I .!l llvr ilkt’i,Mb HIV,
human immune deficiency virus; M ruhtjrt.'uL:j-..i, Mycobacterium ruhiwul j.s; mberculusls.
I llusTration from Workman, M L-. & LaCharity. L. [2016] Understanding phannacologv ; 2nd cd.].
St. Ijouls: Saunders: photo from Kuirw, A., A A*M L 12(1} 5J. ftnfifrtm uqri bcrdn
pathologic basis for disease i9th ed ]. Philadelphia: Saunders.
Studs Hrrak
■ I he KN is pre] iring rt> administer a PPD resi to a client who Is entering nursing school. Vs hich action is ihc
RN rs p r i o r i t y ?
I I |MIC I' ' UlL M n t i l H I I t i i I i i l l C H . I l h i i s t l l l l i
2. Assess i he sldn condition on the tore,:rm
d. leach H.r client about positive firutin<
4. Inquire aboil hacllkb Calmette-Guerin (BCG) vauzihe history
Pul monan Embolus
• .Any substance can cause an em’.-jlibm: ty pically . the embolism enters the \ entMis circulation and lodges in the
|inhiHMi.iry c i ciiLiiiin i F'ig. 5.6
— Bln d embedism in.m tkep ; i : n ihj«inibi»sis]DVT)r Litui vein thumihcr .■ til lac nr femota]*. ar atHal
fibnUation
Ah rmbollsm hom Ijir.ivetnn -- Itirraps
— Fat embolism trom long bone fractures
Amni U'. Iluidembol m d u n - , picgn-im v.'chi. i >inh (v-.ir‘. mi'd raie)
■ R c k Iactors fur venous thromboembolism (VTE) leading to pulmonary embolism p t )
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— Central venous ciitheim
Surgery In the ksl J n wnths
— Obesity
— Malignancy
- Cloning disorders
Htvinry id iliiijnilMH'iidwdiMii
— Smoking, birth control pitJ, pregnancy
Heart failure
Si i r «nnJ Symptoms.
— Dyspnea, tachvpnea, Mchycardia
— Sharp, slabbing chest pain
— Cough
— i 1.1. kh'\ |ili tiJdl I Jiii.ii »fi mb
— i D j sacuranwi. respiratory alkalosis, then respiratory7 acidosis
— Pleural I r k l i o n nib S
— S3 or S4 heart sound
Fi l ling rd Impending ilnom
— Low-grade fever
— Hemoptysis y
— Hypoxemia
— Elevated D-dmwr level
D.j-ictsed by finding. Spiral Computed tomography (L 1 i. nunit- opliageil echocudiugiaphy ( I L L :
Vcniil.- ■ibQii.i' ■. 'il 1 1 rfnvlbii |V Q) st - i
kui'Miig and C triIdL o r a i n e Maiiagrmrnt
— Prevention
• FUnRe-ol-jpmtun nitt -tan
\nib-jlare and turn
\vcijd popliteal pressure
Use iiiitienibLkjvni and pneumatic cui
p<dpbi - ■ .rriiLilHin
\dlniiii ■ | i t i i b r i pmphyl.! mth ujilmit ,jr.-! .itilq4 n f i e l d 1.. . ■
Teach the client and family about precautions
I Iti uUl-ifii' ill'. 1 I ■TH III ' ,||» $intikirig and | | 1-XI1I Isr
— Acute man ement
’Oxygen therapy
MuniU' ABG und pulse -\iniet : \
Check vii.if slpnv lung ■- umls, and 1 ardlat status
Lmboleciomy
JntericKT vena cava fiitration with placement of a vena cava filter
Ibnb rhk Ml i l k ' i t i o i i '
V
stockings

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* \ nt ico-i Rul-mts ijrjjM'd tn pmi r t emliflliis I'nlar fmi'nc ami du- h rn.ulnn t n r w r l u K nwvUht.mt n will
acthe bleeding, smoke, md recent trauma
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» .utarin (Coumadin} shnuid be Initiated within the first 3 davs of hepannlzarlon and Is continued tor
1 to tt months port FE
■ Lu ■■■-molecular-weight hepann is usually used unless i -■ PE - massive at uccu ■ ith henKJdyr-.-mic
inytahilliy
• IV hqidJtn tor more seven- cases
— Therapeutic aPTT values usually range from L 5 to 2.5 times
■ niruuUjolyiicsU k ri tilit mlvi drugs)
■ Abcplaw lActivasr 1 .irhtloi. streptokin-TW
Buih anticoagulants and thrunibc lytic drugs ait high’alen drug'.- . . 1 . me adnunistet rd by the K.N
Embolism Mechanism

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Z J * Jtu '' I \ I'uliiKwirj arttry
, Ji ■■ «*bntrufled by the rtnhfllun
m Ji JiPrinted by: yasminegivens81@gmail.com . Printing is for personal, private use only. No part of this book m
reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted.
t fl' V %bhktfl fk»* ihtMnbto funttprkin llifnttibtta
* bPlaces uiiKi likclv of Ihronibu* furinuUon: A - Hip, It - 1 liigli C - Leg (cittn
FIG. 5.6 Mechanism of pulmonary embolism. iiStockphoto.com IFakert! 1
Hematologic Problems: Anemia and Its Many Causes
* ; Lrythrocyte production
■ . Hrniiin.loblli ntlir-.. ■
* Iron defu lent \
* Defective DNA synthesis
* 3 2 jn< l dtiidenty k
* i Number of errihrocyie precursor s
* (_luuni<. disease !r or disuidets
* Chemotherapy
* Rlnod |o«s
■ Biood vessel rupture
* Chiotui guhUis
* Traunui
* Menonnagia

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Blond Transfusions . x V
• Rhioil (.runps ,ind H p o
— AB< ; ■ '. sir Hl hH'ludts B, O, j i i i l AR trkWKl r. , ■ ■.
— F<h i j' nr is an antigenic substance in the erythrvcvtes
Ll bl rxl h miMn.ik bed during ir ansim ■, a ujj.-.luMi.-i rtjciium Eiccurs
■ rr.dristns H’iicikm is rin anrgtm- antibody u’.utkm
It ran range f mm J mliti rrspnnsf .rvi H- naphvl-t. UC shot k
• IVpes of Reactions
Ailllr In tlbiis ln , 11'hr ill', w n rttinlyik (tKKl mild d l k l g i t , dluph yldi tn , Ek'lavd Iieiimhni
■ Nursing and Calldburaiiu- Maiwgrmeiu
— Perform assessment before, during, and after, inc uding the [X' site
Determine identifiers
— Confirm informed consent
— Identify ihr c Mnpatlblhry
■ Initiate a transfusion slowly, then maintain the infusion rale
• TyjH-s af Rlmrtl PrtxliiH h
— RBCs
■ Packed RBCs(PRBCs|
Autologous PRBCs
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reproduced or transmitted without publisher's prior permission. Violators w ill be prosecuted.
• Washi-d RR{
• Frozen RBCi
• Leukocyte-poor RBC*
• ( KlHji Lellulai lunqnnmts
’ Platelets
• Granulocytes
• Phtsmii crwnponi'nts
* Fresh frozen plasma (FFP)
• Ctyuprecipmre
Studs Break
Roa S.fi
X client who r« irceivine a tranrfusion of parked rrd blood celL has an inflamed IV rite, Which irtion would

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1. DcHjble<Jieck dn Mood type at the U j ? r using, unit of blood mih pnother nunc
2. Discontinue the transfusion and send the r-msininc blood and tubing to the lab
1 l l l r i n < l l iHkh S t i l l . K l \ ,111011 i -.III' i l f ' i ! HSUI1H' Ils' 'll H i x l i i HU' ■ ■ iHNl-.ss
4. Continue to monitor the site t u signs of Infection and notify me HCP
Hypertension (HTN)
* PerSlslEill hlt»(» m?sM.re(BP) Hi i.itloii I4IVJM) mm Hg
* Risk Factors
- V modifiable: Family history. gender. age, ethnicity
Mi ' ' i l i l r i. til .i nl o' i ; ii, i jl finer, -i i ■ nliir, Uh'MVh ■''■'ll
■ Mrdkaiiuns
— Diuretics, antihypertensive?. anaiofttisin-converuDg enzsuie (ACE.i inhibitors, calcium channel blockers
* H l b.dmatian I'ig, 5.7.
— The number one cause of umke brain, attack) is nonadherence to HTM medicat cuts
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Partial coronary artery demure with collateral d rail a11on being esiabhshrd. C, Total coronary artery
occlusion with coll cf.tial drailauon bypassing the occlusion to supply blood to the myocareiuni.
Reprinted with perrnMIon front H.uihng. M , Kwong. L. Rubens. D., Hagler. D., A R e l m u h , C,
120201 U'wK s mtiih df .turgtidi1nuxsjnj ?Umunenr tmd mdim menr of triJntenf prob/ertr. ’ L 11h
ed.J. Elsevier.
Reduction of Ririe F a r i o n
Smoking lesulinn
— Weight loss
— Lowering chote-bterol loebr
— GlvcemLc control s
w J
— Stress reduction
— Medication Lompliance /
r A d i i -ityWi live
C hole-stentI-Lowering Drugs
* M.it !v LniiLiirJ Lt dh-i r > !ilh .n-.>.:i Is ■' . ii-sMil
— Atorvastatin (Lipitor)
L.U-..I ■ J l l l H M v v . J l m, A J ■ . r r T
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— PtaVMd tin iPrav.it h... 1 r °
Because this is s premium document. Subscribe to unlock this document and more.
- bum asiatin i £ocor)
— E/rrlmibl1 (Fy.'Clrjl)
— Gumflbrazil (I jjpid i
— frsacin (nicotinic acid)
* Risk i iiln r ”Jii .th ■ ■ Rh.il ■ ■myi'-.' i' m ■ il vim- u.ftn y
Nutritional Management
* Diet modi f teat i< ■ : Dfelarv .ippnw; h to Mop hvpt'ritrnsion (DASH)
* Thp gi .J Is lu ■■ In.. <■ m i n < In;!- .u'ii jJ .i : iTini- ii iglvi i-i : ■■
* Maintain ideal body weight
■ 1 1 'i iv . Ii-.li s-ri iiiil-.v :i H.|]|.1 lr I-- .i- • . l".i . • ' nip, il.ii
Acute Coronary Syndrome (ACS): Angina
* Stable angina Pit-dii wide, sHbsitj-y with i .■■■i
* IJtlst.ihit angina: Unpn dirtahle, nwv not .nhstdr with rr c
.i w nltroglitcrin
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■ Pi i n / m d . i l (variant > angina; Vasospasm etkufogy, wxuis >n r m and may be pmiplnued by smoking or otlwi
SUbbUKt
* Ma v radiate t o r n hot arm shoulder jaw neck, nr epigastric area
* Li diet signs anil symptoms: Dyspnea, tachi cardia, palpi tai. .ms, nausea ind vomiting, ch spepsia. latigue.
diaphoresis, pallor. svTKope
■ ( itirn I' I ' ipibHi’il h1
, rtenlM 1
, i< Id expiK.ii', hr v v iw.iJ. sin SS, liilenou! <
* Drug Classes for Angina Management
Anliplalrlrl Agents;
Ateiv Isalkyln. add (ASA)
— rinp.dngjl-l
— G P l l b l l l a inhibitor ipotent platelet Inhibitors]: epufibatide (IntegriJin)
' Bela-Bl<i<:kei5
H - ■ I I H l Vrlrl k " II' ■!. J UK Hjl'fl l l l ' l l i d ' l l ■ l| . l l l l t t
- Nilrares
■ Cakium Channel lilnckei'i
I Conduction ihmughAV node; slows heart rate; l Oxygen demand by myocardium
* Anfir uagul.uit
* Ihrombolyiic Therapy [ W i t h i n Protocol Guidelines)
- L selui when inlarcuon is diagnc-ed early; streptokinase .nd tPA; administered IX
Mi M I'Hettive II given within '■ hum s pl onsel - 1 > l»e>l p > ii; hqxirin iherapv will usually I low
Ehromb'iivdr thi-rapy
* ACE [ n h i h l l a n
* Analgesics
* Drug Hter.ipv Prolutol
* M O N A
V,
* Morphinr sullate
‘ AnjlgLSsU . .mxlc-iv; j tachypnea; relaxes bnrnfhlal snrnath muscle: Impinves gas exchange
* — Oxygen
* — Nitroglycenn
* I hid H’S r hr ■ -I I ML!n nli'14* *- -
‘ • Rltxxl flow to ihr damaged iiea o! myncatdiuni
* Dose; 0.4 mg. table!
■ 1 lab sublingual evts s rirninute* ■ J doses
‘ — ASA
* T i l H t i M B l h i S J Nrsi aJiernativ r prultMol fur tn.lodgement ol %CSt replacing MONA
* 111Ienapyrlillrn-s. In-par m rncixa palmr rm m -angiuirnvln svstrin blm kefs, oxygrti, itunphlnr, bri.i
blacker, Inirrvetkihin, nitroglycerin, siarlEL halkylaii'
* Medical Intervention*

Loading page 103...

— Percutaneous transluminal coronary angioplasty I PTC A)
Ballotm dngiapkftty
— Tmworonarv srents
— Coroiwv arte :v bvta s arafi «<..AXH il
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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
— LOHMiary artery Bypass at t n_.-wuj
Acute Coronary Syndrome: Acute Myocardial Infarction (Ml)
’ f H’hlnn. :HUI n: I!-.-.I -I ..III I|?A1I< ■ II? In Lt k ill hl > -I ,m [ | i . vgrn : ph
• Rugln * lik (Mt hisn of the cnrcMury anery
* Ischemia, injury, infarction
* S [■■L-lLW iLioti M i l S I L M b I ltd di nui idI M l I ■:Fig, 5.9 I
- Non-STEMI(( <.=":ioi>n In women)
• IwbriUU
— Results from reduced blood flew and oxygen to the coronary arteries
if nor irvetsiii. then injury occurs
— he Lemin lasting 20 m. um?-. or moiv i- -idth ji-in n ■ pnwi. ■ t irti "K-rsIble u : -.ur damage
— T wawe invasion on e'ectrocardingram (ECG )
* I n j u n
— Prolonged inlet njpr km ot oxygen siippk and nmrtents
— C d h are still salvageable
— ST elevation
* I n f . i n n o r i
— Tissue necrosis and death
— Irreversible damage
Si .■ l r - . ........... . Sil ■ I'll c l l i i . l l H i l l ' l l " I I 'I 1.1'1 I ■ ''lllx
— Wiihin 24 hours of IrmiTtfon rhe heal ng process begins
— Pathological Q waves
• CotiiplkalLDtis
V. many . r »"■ il i. l..n: . --.il :■ cumpl .iilmi in linl ....... Inti- Aing:
* Dysrhythmias
Cardiac failure
Cui ilIrkgHut shdfk
ThromiM>ennbohsni
I t a n n w mpturr Y *
• Signs and Svmpionis
— Pain
* Sudden cnsei: seventy increases
M,iv p«M5t for hours or ■ n n relit v« d nv iesl ■ -r nilrm; \ ■■ erin

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Loading page 105...

-THROMBINS2
■ UeU’lduckt!!
HiP I'l'ilvlii 'Ir i.ipv vi.i i i ri/nl' .»
Pi- i tir.arn'riii-' iim.ii \ Irili i v ■ ,::on (Pi I ;■.mil li cil-i wr n TCI inr'.iili-. >I f i ■■ . i IrM
— If PCI unavailable,, risk versus benefit or intravenous thrombolytic therapy rs completed
- CABG V
* Srwn? C.XD lii-tn. nil
■ Cm bn e - ’ Ci'nt < • ■ lectivc
Characteristics
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Ischemia Inverted T wave
ST segment elevation
reversible if
reperfusion occurs.
i

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Infarction
Q wave greater than
one-third the height of the
R wave indicates necrosis
through the entire wall
(transmural).
FIG, 5.9 rhn [neardinfthiphiT ihdnf ■ s with rnvocairln nlarcl m. Rep:inrcd with perm i m
from Liman, A. D., tv. .Matteson. M. A. |2U2U I yuiri nursing I ’th ed. Llseviei
Heart I allure
* L Oology
— CAD, prim XU
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reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
— Chiosuc H TN
— Cardtomvopauiv
Dildh tl, Idhip.nhii
— Hyperthyroidism
— Diabries
VaI Villar and Limgeniidl heart disease
Pulmonary diseases
* Left-dded Heart Failure (LI IF)
-- Causa: Left ventricular (LV|i infarct cardiomwMthv. hypertension
Syinploim: [H'vpnrd. uiugli, tfilnipuea, [Hilnuxury etk-ma, paimysinal notnu iidl dyspnea (PND)
— Signs: S3 gallop, tachyiardla Lnspirai' rv rales
Ldlnir.ilory limJitigv: MiG .-veil liv|nnem»ii 1 XR ■.. ■• . . H i : .11 y >- !■ ni.i > >i -"Jtairl ; uli-
B-iype ndirkUTiu peptide (BNP) HR nil
’ Righl Sided Hurt Faihn* (RUF)
* — Causes: LIU-. right ventricular (RX 1 infarct pulnicu .uy 01 tricuspid valve dj>ease, pulmonary 1I1N,
COPD. PE

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