Which point should the nurse include when instructing a client in the use of a budesonide (Rhinocort) nasal preparation?
1. "Use this preparation before your nasal decongestant."
2. "Avoid the use of ultrasonic humidifiers with this preparation."
3. "You should see improvement in your symptoms in about a week."
4. "You could experience nosebleeds."
Correct Answer: 4
Rationale 1: The nasal decongestant should be used first, then the steroid.
Rationale 2: Moisture in the air can help prevent excess drying; a humidifier is a good idea.
Rationale 3: Improvement is not apparent for several weeks in most clients.
Rationale 4: Intranasal corticosteroids can cause excessive drying of the nasal mucosa, resulting in nosebleeds.
Global Rationale: In order to achieve maximum effect, decongestant nasal sprays should be used first, before a nasal steroid. Transient nasal irritation, burning, sneezing, dryness are common adverse effects of nasal steroids. Nasal ulceration leading to nosebleeds may occur. Moisture in the air can help prevent excess drying; a humidifier is a good idea. Improvement is not apparent for several weeks in most clients.
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A man was crying and said, "I didn't mean to do it. She just got me so angry I lost control. It will never happen again." The woman said, "It was my fault. I shouldn't have upset him." Then, looking at the nurse, the woman added,
"Please don't report this. It will never happen again." Which of the following is the most appropriate response by the nurse? a. "Abusers don't stop unless intervention occurs. I have to report it." b. "If you're sure it won't happen again, I'll let it go this time." c. "Legally, I'm required to put this in the medical record." d. "The decision is up to the physician, not me."
The nurse is attempting to control bleeding in a patient with a profusely bleeding scalp wound. The most effective initial treatment of bleeding is to:
a. elevate the head. b. apply direct pressure. c. apply an ice pack. d. apply indirect pressure.
The following questions refer to your patient who is on IV heparin therapy according to the "Standard Weight-Based Heparin Protocol" noted below. The patient weighs 144 pounds. On admission, the patient's APTT is 30 seconds. You initiate IV heparin therapy at 1130 on 06/06/XX. Record your answers in the spaces below unless provided with the "Standard Weight Based Heparin Protocol Worksheet" by
your instructor. Standard Weight-Based Heparin Protocol For all patients on heparin drips: 1. Weight in KILOGRAMS required for order to be processed: ______ kg. 2. Heparin 25,000 units in 250 mL of 1/2 NS. Boluses to be given as 1,000 units/mL. 3. APTT q.6h or 6 hours after rate change; daily after two consecutive therapeutic APTTs. 4. CBC initially and repeat every ____ day(s). 5. Obtain APTT and PT/INR on day one prior to initiation of therapy. 6. Guaiac stool initially, then every __ day(s) until heparin discontinued. Notify if positive. 7. Neuro checks every ____ hours while on heparin. Notify physician of any changes. 8. D/C APTT and CBC once heparin drip is discontinued unless otherwise ordered. 9. Notify physician of any bleeding problems. 10. Bolus with 80 units/kg. Start drip at 18 units/kg/h. 11. If APTT is < 35 secs: Rebolus with 80 units/kg and increase rate by 4 units/kg/h. 12. If APTT is 36-44 secs: Rebolus with 40 units/kg and increase rate by 2 units/kg/h. 13. If APTT is 45-75 secs: Continue current rate. 14. If APTT is 76-90 secs: Decrease rate by 2 units/kg/h. 15. If APTT is > 90 secs: Hold heparin for 1 hour and decrease rate by 3 units/kg/h. Calculate the dosage of heparin that should be administered for the bolus for this patient. ? __________ units ? What does the protocol indicate as the required solution concentration (supply dosage) of heparin to use for the bolus? ? __________ units/mL ? Calculate the dose volume of heparin that should be administered for the bolus for this patient. ? __________ mL Fill in the blank(s) with correct word
Which of the following best describes what insurance companies did to decrease their constantly increasing costs? (Select all that apply.)
a. Did not cover any illnesses that were diagnosed before the person (or his or her employer) purchased insurance b. Limited coverage to only certain services, eliminating any that were experimental, nontraditional, or too costly c. Reimbursed only the care that was requested by the patient's primary physician d. Limited providing insurance to companies who hired mainly young, healthy persons e. Required preapproval before expensive services were used f. Ceased coverage on any person who used an exorbitant number of services, whenever possible