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UWORLD TABLE OF CONTENTS
FUNDAMAMENTALS
ADULT CARE
MATERNAL & NEWBORN CARE
CHILD CARE
CRITICAL CARE
PSYCHIATRIC NURSING
PHARMACOLOGY
LEADERSHIP
ASSESSMENT
,FUNDAMENTALS
,1. An 8-year-old hospitalized due to a bowel obstruction is to be discharged
home with a temporary colostomy. The parents' primary language is
Vietnamese and their English proficiency is very limited. What is the best
approach for the nurse to use when instructing the parents on how to care for
the child at home?
1. Demonstrate the procedure using simple English phrases
2. Give the parents written instructions with picture illustrations
3. Tell the parents to have a friend or relative come in to translate
4. Use an interpreter via the telephone interpretation service
Ans: 4
Explanation:
Effective teaching can be accomplished only with effective communication,
which can be compromised by language barriers, cultural differences, and
low health literacy. When an interpreter is necessary, using a translator who
is skilled in medical terminology is the best approach to provide accurate
information (Option 4). Hearing instructions and information in one's primary
language decreases the risk of adverse clinical consequences.
When a professional medical translator is unavailable, language lines,
telephone systems, and remote video interpreting services can be
used. Translation by family members and friends should only be used as a
last resort and only with the permission of the client, especially in situations
where sensitive information needs to be communicated (Option 3). Children
should not be used as translators except in an emergency situation when there
are no other options.
(Option 1) This client's parents have very limited English language
proficiency; this approach will not be effective in providing instructions about
the child's care at home.
(Option 2) Providing written materials without verbal teaching does not give
the client (or the client's legal guardian) the chance to ask questions, nor does
it give the nurse the opportunity to assess the client's understanding of the
given information.
Educational objective:
When language is a barrier to effective communication and teaching, the nurse
should use a trained medical interpreter for translation purposes.
2. A postoperative client with obesity and diabetes mellitus has an abdominal
wound and is at risk for poor wound healing. Which interventions would the
nurse include in the plan of care to prevent wound dehiscence? Select all
that apply.
1. Administer docusate orally, daily
2. Administer ondansetron IV PRN for nausea
3. Apply an abdominal binder
, 4. Implement caloric restriction to promote weight loss
5. Monitor blood sugar to maintain tight glucose control
Ans: 1,2,3,5
The edges of a surgical wound may
fail to approximate or they may
separate due to a partial or total
separation of the skin and tissue
layers. This condition is known
as dehiscence and is a complication of
wound healing. Factors associated
with dehiscence include conditions that
impair circulation, tissue oxygenation,
and wound healing (eg, diabetes,
smoking, obesity, advanced age, malnutrition, infection, steroid use) and
cause mechanical stress on the wound (eg, straining to cough, vomit,
defecate). Interventions to prevent surgical wound dehiscence include:
Administering stool softeners such as docusate (Colace) to prevent
straining during defecation and alleviate constipation caused by
postoperative immobility and opioid pain medications (Option 1)
Administering antiemetics such as ondansetron (Zofran) as needed to
prevent straining that can occur with vomiting (Option 2)
Applying an abdominal binder to provide hemostasis, support the
incision, and reduce mechanical stress on the wound when coughing
and moving (Option 3)
Monitoring blood sugar to maintain tight glycemic control (<140
mg/dL [7.8 mmol/L] fasting glucose, <180 mg/dL [10 mmol/L] random
glucose) to help prevent infection and promote wound healing (Option
5)
Splinting the abdomen by holding a pillow or folded blanket against
the abdomen to support the wound when coughing and moving
(Option 4) Nutritional therapy is critical to support normal wound
healing. The wound healing process depends on adequate intake of calories
and protein. Although this client is obese and should be educated on
measures to promote weight loss, this is not the priority in the immediate
postoperative period and would delay wound healing.
Educational objective:
Interventions to prevent wound dehiscence include use of stool softeners and
antiemetics, application of an abdominal binder, and tight blood glucose
control.
3. It is 0700 and the nurse is caring for an 84-year-old client with dementia and
a fractured hip. The client has been disoriented to time, place, and person
since admission. The client moans frequently and grimaces when moving.
He is prescribed morphine IV every 2 hours as needed for pain and was last
medicated at 0530. He is scheduled for surgery at 1000 to repair the hip
fracture, but the consent has not yet been signed. The client's spouse and
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