A male client has a prostate specific antigen level of 22 nanograms. The nurse realizes that this client will most likely be scheduled for a(n):
1. bone scan
2. CT scan
3. testicular biopsy
4. duplex ultrasonography
1
In clients with PSA levels of 20 nanograms and higher, a radionuclide bone scan is done to rule out metastasis. A CT scan detects enlarged lymph nodes, but it does not provide clear pictures of intraprostatic features. A testicular biopsy is not needed with an elevated prostate-specific antigen level. A duplex ultrasonography is used to diagnose marked arterial insufficiency as a cause of erectile dysfunction.
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A nurse looks up an unfamiliar medication in the drug handbook and recognizes that an incorrect dose can result in patient injury. What component of professional negligence is represented in this scenario?
A) Duty to use due care B) Failure to meet standard of care C) Foreseeability of harm D) A direct relationship between failure to meet the standard of care (breach) and injury can be proved.
The nurse is providing information to a patient who has recently been diagnosed with genital herpes. Which statements indicates the need for further instruction? (Select all that apply.)
a. "I am only contagious when I have open sores." b. "The infection is limited to only my ge-nital region." c. "There is no permanent cure for this con-dition." d. "I will need to contact my physician for antibiotic cream for the open lesions whenever I have an outbreak." e. "Washing my hands is going to be a good method to prevent introduction of bacteria to the area."
When examining the client's external ear, a nurse palpates painless nodules on the pinna. The nurse should inquire about history of which of the following?
A. An old injury to the external ear B. Gout, sun or chemical exposure, arthritis C. Superficial infections of the outer ear D. Considered to be a normal variant of aging
You are in the middle of your shift in the coronary care unit (CCU) of a large urban medical center. Your new admission, C.B., a 47-year-old woman, was just flown to your institution from a small rural community more than 100 miles away
She had a STEMI (ST segment elevation myocardial infarction) last evening. Her current vital signs (VS) are 100/60, 86, 14. After you make C.B. comfortable, you receive this report from the flight nurse: "C.B. is a full-time homemaker with four children. She has had episodes of 'chest tightness' with exertion for the past year, but this is her first known MI. She has a history of hyperlipidemia and has smoked one pack of cigarettes daily for 30 years. Surgical history consists of total abdominal hysterectomy 10 years ago after the birth of her last child. She has no other known medical problems. Yesterday at 8 pm, she began to have severe substernal chest pain that referred into her neck and down both arms. She rated the pain as 9 or 10 on a 0-to-10 scale. She thought it was severe indigestion and began taking Maalox with no relief. Her husband then took her to the local emergency department, where a 12-lead electrocardiogram (ECG) showed hyperacute ST elevation in the inferior leads II, III, aVF and V5 to V6. Before tissue plasminogen activator could be given, she went into ventricular fibrillation (V-fib). CPR was started and when the code team arrived, she was successfully defibrillated after two shocks. She then was started on nitroglycerin (NTG), heparin, and amiodarone drips. She was given IV metoprolol and aspirin 325 mg to chew and swallow. This morning her systolic pressure dropped into the 80s, and she was placed on a low-dose norepinephrine drip and urgently flown to your institution for coronary angiography and possible percutaneous transluminal coronary angioplasty. Currently, she has amiodarone infusing at 1 mg/min, heparin at 1200 units/hr, and norepinephrine at 0.5 mcg/kg/min. The NTG has been stopped because of low blood pressure. Laboratory work that was done yesterday showed Na 145 mEq/L, K 3.6 mEq/L, HCO3 19 mEq/L, BUN 9 mg/dL, creatinine 0.8 mg/dL, WBC 14,500/mm3, Hct 44.3%, and Hgb 14.5 g/dL." Because the 12-lead ECG can tell you the location of the infarction, evaluate the leads that showed ST elevation. What areas of C.B.'s heart have been damaged? Given the diagnosis of acute myocardial infarction (MI), what other laboratory results are you going to look at? Indicate the expected outcome for C.B. associated with each medication she is receiving. For each of the drugs listed, state the purpose. a. Intravenous (IV) nitroglycerin (NTG) b. IV heparin c. IV amiodarone d. IV metoprolol e. Aspirin, chewed and swallowed f. IV norepinephrine Laboratory Test Results Creatine Phosphokinase (CK) Levels On ED admission 95 units/L 4 hours 1931 units/L 8 hours 4175 units/L CK-MB Isoenzymes On ED admission 5% 4 hours 79% 8 hours 216% LDL 160 mg/dL PT 11.9 sec INR 1.02 aPTT (before heparin) 26.9 sec Mg 2.2 mg/dL K 3.3 mEq/L You review the lab work on her chart. For each laboratory value listed previously, interpret the result, and evaluate the meaning for C.B. List at least two complications C.B. is at risk for at this time and the assessments that are needed to identify these risks. You note that C.B.'s Spo2 on oxygen (O2) at 6 L/min by nasal cannula is 92%. How do you interpret this result? What can be done to promote her oxygenation at this time?