RN101
Home of the Registered Nurses (RN) and
Licensed Practical Nurses (LPN)

SITUATION I

 

Question 1:

1. Do not take blood pressure at the fistula arm

2. Nurse to assess fistula every 4 hours

3. Do not administer ACE inhibitor before dialysis 

 

Question 2:

1. Weight

2. Intake and output

      

Question 3:

After dialysis, to prevent hypotension

 

Question 4:

Air embolism

 

Question 5:

1. Stop the dialysis

2. Notify the physician immediately

 

SITUATION II

 

Question 1:

1. Headache

2. Nausea & vomiting

3. Restlessness

4. Decreased level of consciousness and seizures

5. Hypertension

6. Dizziness

 

SITUATION III

 

Question 1:

Decreased ability to detect thirst

 

Question 2:

1. Emptying the bladder regularly and completely.

2. Evacuating the bowel regularly (avoid constipation).

3. Wiping the perineal area from front to back after urination and defecation.

4. Drinking adequate amount of liquid each day. (33ml/kg) anyway, at least 3000 mL.

5. Drink pure cranberry juice or take cranberry essence tablet. 

6. Seek immediate treatment once symptoms are identified.

7. Explain not to use harsh soaps, bubble baths, powders, and sprays in the perineal area.

8. Avoid irritants (caffeine, alcohol, chocolate, and highly spiced).

 

SITUATION IV

 

Question 1:

Patient has asthma,  the nurse wants to be certain that the patient takes medications for asthma because beta-adrenergic blockers are used topically to treat glaucoma. In asthmatic patients, beta-adrenergic blockers can cause bronchospasm, and are contraindicated.

 

SITUATION V

 

Question 1:

1. No bending                                                                        4. Coughing, vomiting

2. No heavy lifting                                                                 5. No intense activity (house works, sports)

3. Valsalva maneuver – straining at stool

 

Question 2:

Unaffected side or right side

 

SITUATION VI

 

Question 1:

Assess gag reflex

 

SITUATION VII

 

Question 1:

Serum creatinine levels

 

SITUATION VIII

 

Question 1:

Check for allergy to iodine

 

Question 2:

Relief of pain

 

Question 3:

1. Nurse to teach patient to strain the urine

2. Nurse to encourage patient to increase fluid intake

3. Nurse to encourage to increase mobilization as tolerated

4. Nurse to teach patient to take antibiotics as prescribed

 

SITUATION IX

 

Question 1:

Septicemia

 

SITUATION X

 

Question 1:

Serum uric acid

 

SITUATION XI

 

Question 1:

Spend time with the client addressing her concerns and then stay with her while she talks with her husband.

 

SITUATION XII

 

Question 1:

The client keeps the drainage bag below the bladder at all times

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SITUATION XIII

Question 2:

 

 

 

 

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