1210 Exam 1: Nutrition, Obesity, Elimination

The nurse recognizes that which surgical procedure is most effective in enhancing facial appearance after weight loss? 1 Lipectomy 2 Liposuction 3 Restrictive surgery 4 Malabsorptive surgery

2 Liposuction is a cosmetic surgery that helps improve facial appearance around the chin, jaw, and nasal folds after weight loss. Lipectomy is a cosmetic surgery that improves body image. It is effective for the breasts, abdomen, and lumbar and femoral areas but not for the facial areas. Restrictive and malabsorptive surgeries are bariatric surgeries, which reduce the size of the stomach but do not affect the facial appearance.

A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins? 1. "Blood in my urine has become less noticeable, so maybe I don't need this procedure." 2. "I have been taking cephalexin (Keflex) for an infection." 3. "I previously had several ESWL procedures performed." 4. "I take over-the-counter naproxen (Aleve) twice a day for joint pain."

4

An older adult woman confides to the nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond? 1. "Don't worry about it. You need them." 2. "Shop at night, when stores are less crowded." 3. "Tell everyone that they are for your husband." 4. "That is tough. What do you think might help?"

4

The nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? 1. "For the best effect, perform all of your exercises while you are seated on the toilet." 2. "Limit your exercises to 5 minutes twice a day, or you will injure yourself." 3. "Results should be visible to you within 72 hours." 4. "You know that you are exercising correct muscles if you can stop urine flow in midstream."

4

The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which statement by the client indicates that teaching was effective? A. "I am so relieved that I can continue eating my fried fish meals every week." B. "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." C. "My wife will be happy to know that I can keep enjoying her liver and onions recipe." D. "I will no longer be able to have red wine with my dinner."

4

What clinical finding in a postmenopausal client with urethritis does the nurse attribute to low estrogen levels? 1. The urinalysis indicates pyuria. 2 The urethral culture is positive for bacteria. 3. The urinalysis indicates presence of bacteria. 4. A pelvic examination shows tissue changes.

4

Which client does the nurse manager on the medical unit assign to an experienced LPN/LVN? 1. 42-year-old with painless hematuria who needs an admission assessment 2. 46-year-old scheduled for cystectomy who needs help in selecting a stoma site 3. 48-year-old receiving intravesical chemotherapy for bladder cancer 4. 55-year-old with incontinence who has intermittent catheterization prescribed

4

client reports experiencing involuntary loss and constant dribbling of urine due to an enlarged prostate. How does the nurse document this incontinence? 1. Stress incontinence 2. Urge incontinence 3. Reflex incontinence 4. Overflow incontinence

4

hat does the nurse teach a client to do to decrease the risk for urinary tract infection (UTI)? 1. Limit fluid intake. 2. Increase caffeine consumption. 3. Limit sugar intake. 4. Drink about 3 liters of fluid daily.

4

A man who weighs 90 kg has a total body water content of approximately ________ L

54 90 x 0.6 = 54

BMI that is considered underweight?

<18.5

BMI range that is considered obese?

>30

For which patients is it most important for the nurse to refer to a dietitian for a complete nutritional assessment? A - A 55-year-old with a history of alcoholism who is hospitalized with a fractured femur resulting from a fall B - A 45-year-old hospitalized with nausea and abdominal pain who has had no oral intake and has received only C - A 38-year-old diabetic who is undergoing laser eye surgery D - A 24-year-old who has been taking a burst of corticosteroid therapy for 1 week for treatment of an asthma exacerbation

A - A 55-year-old with a history of alcoholism who is hospitalized with a fractured femur resulting from a fall

After major surgery, a patient receives parenteral nutrition. If the patient develops refeeding syndrome, the nurse would expect which of the following findings? A - Serum phosphate level of 1.9 mg/dL B - Serum potassium level of 5.7 mEq/L C - Blood glucose level of 148 mg/dL D - White blood cell count of 15.6 x 103/μL

A - Serum phosphate level of 1.9 mg/dL Refeeding syndrome is characterized by fluid retention and electrolyte imbalances (hypophosphatemia, hypokalemia, hypomagnesemia). Hypophosphatemia is the hallmark of refeeding syndrome and is associated with serious outcomes, including cardiac dysrhythmias, respiratory arrest, and neurologic disturbances (e.g., paresthesia).

What is Refeeding Syndrome

A metabolic complication that occurs when nutritional support is given to a severely malnourished patient. Electrolyte imbalance can occur especially with a DECREASE of Phosphate (normal is 2.4 to 4.1)

After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates that the teaching has been effective? a. "I can have a glass of low-fat milk at bedtime." b. "I will have to eliminate all spicy foods from my diet." c. "I will have to use herbal teas instead of caffeinated drinks." d. "I should keep something in my stomach all the time to neutralize the excess acids."

C Patients with gastroesophageal reflux disease should avoid foods (such as tea and coffee) that decrease lower esophageal pressure. Patients should also avoid milk, especially at bedtime, as it increases gastric acid secretion. Patients may eat spicy foods, unless these foods cause reflux. Small, frequent meals help prevent overdistention of the stomach, but patients should avoid late evening meals and nocturnal snacking.

The health care provider orders a 10% fat emulsion solution to be administered to a critically ill patient who is currently receiving peripheral parenteral nutrition. Which assessment finding would alert the nurse to a systemic problem related to lipid administration? A - A random capillary blood glucose level of 148 mg/dL B - Erythema, tenderness, and exudate at the catheter insertion site C - The onset of vomiting and fever D - Retention of fluid with peripheral edema

C - The onset of vomiting and fever Rationale: The key here is "systemic"

Lacto-Ovo Vegetarians

Eat plant foods and sometimes dairy products and eggs Watch for vitamin and mineral deficiencies -Iron Deficiency Anemia! (fatigue, tired, No energy)

Tube Feeding administration...

Patient should be sitting or lying with HOB at 30-45 degrees (BOLUS) HOB should remain elevated for 30-60 minutes for intermittent delivery Irrigate with water before/after each feeding, drug administration and residual checks Continuos feedings administered on feeding pump with occlusion alarm

Enteral tube feedings are inserted into the...

stomach duodenum OR jejunum

During the starvation process...

There is a decreased BMR, sparing of skeletal muscle and decreased protein breakdown

An older adult patient in the hospital complains of sleep deprivation. Which intervention may improve sleep patterns for this patient? a. Decrease noise and dim the lights at bedtime. b. Administer an opioid pain medication to induce sleep. c. Set the room temperature at 78 degrees F to induce drowsiness. d. Offer to give the patient a back massage until he falls asleep.

a. Decrease noise and dim the lights at bedtime. Hospital noise and bright lights can cause sleep difficulties. Although adequate pain management improves the duration and quality of sleep, opioid medications alter sleep and place the patient at risk for sleep-disordered breathing. Although backrubs are a good method to promote relaxation, the nurse cannot really afford the time to spend extended periods of time giving this patient a backrub.

The nurse reviews the arterial blood gases of a patient. Which result would indicate the patient has later stage COPD? a. pH 7.32, PaCO2 58 mm Hg, PaO2 60 mm Hg, HCO3 30 mEq/L b. pH 7.30, PaCO2 45 mm Hg, PaO2 55 mm Hg, HCO3 18 mEq/L c. pH 7.40, PaCO2 40 mm Hg, PaO2 70 mm Hg, HCO3 25 mEq/L d. pH 7.52, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 35 mEq/L

a. pH 7.32, PaCO2 58 mm Hg, PaO2 60 mm Hg, HCO3 30 mEq/L In later stage COPD, the patient will have a low or low normal pH, a high normal or above normal PaCO2, and a high normal or above normal HCO3-. This indicates compensated respiratory acidosis, as the patient has chronically retained CO2 and the kidneys have conserved HCO3- to increase the pH to near or within the normal range.

Android obesity resembles a/an

apple

The nurse explains to a patient with an episode of acute pancreatitis that the most effective means of relieving pain by suppressing pancreatic secretions is the use of: a. antibiotics. b. NPO status. c. antispasmodics. d. proton pump inhibitors.

b Pain from acute pancreatitis is aggravated by eating; NPO status will help to alleviate the pain by decreasing pancreatic secretions.

As a fluid circulates through the capillaries, there is movement of fluid between the capillaries and the interstitum. What describes the fluid movement that would cause edema? (Select all that apply) a. Plasma hydrostatic pressure is < plasma oncotic pressure b. Plasma oncotic pressure is > interstitial oncotic pressure c. Plasma hydrostatic pressure is > plasma oncotic pressure d. Plasma hydrostatic pressure is < interstitial hydrostatic pressure e. Interstitial hydrostatic pressure is < plasma hydrostatic pressure

c, e At the arterial end of the capillary, capillary hydrostatic pressure exceeds plasma oncotic pressure and fluids moves into the interstitial space

What is an example of an IV solution that would be appropriate to treat an extracellular fluid volume deficit? a. D5W b. 3% saline c. Lactated Ringer's d. D5W in 1/2 normal saline

c. An isotonic solution does not change the osmolality of the blood and does not cause fluid shifts between the ECF and ICF. In the case of ECF loss, an isotonic solution is ideal because it stays in the ECF compartment. A hypertonic solution would pull fluid from the cells into the ECG compartment, resulting in cellular fluid loss and possible vascular overload.

A patient with chronic kidney disease has hyperphosphatemia. What is a commonly associated electrolyte imbalance? a. Hypokalemia b. Hyponatremia c. Hypocalcemia d. Hypomagnesmia

c. Kidneys are hte major route of phosphate excretion, a function that is impaired in renal failure. a reciprocal relationship exists between phosphorous and calcium and high serum phosphate levels of kidney failure cause low calcium concentration in the serum.

A common collaborative problem related to both hyperkalemia and hypokalemia is which potential complication? a. Seizures b. Paralysis c. Dysrhythmias d. Acute kidney injury

c. Potassium maintains normal cardiac rhythm, transmission and conduction of nerve impulses, and contraction of muscles. Cardiac cells demonstrate the most clinically significant changes with potassium imbalance because of changes in cardiac conduction. Although paralysis may occur with severe potassium imbalances, cardiac changes are seen earlier and much more common

A nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? a. "I must avoid drinking carbonated beverages." b. "I need to douche vaginally once a week." c. "I should drink 2½ liters of fluid every day." d. "I will not drink fluids after 8 PM each evening."

c. "I should drink 2½ liters of fluid every day." Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis.

An older patient is admitted to the hospital with a urinary infection and possible bacterial sepsis. The family is concerned because the patient is confused and not able to carry on a conversation. Which statement by the nurse is most appropriate? a. "Depression is a common cause of confusion in older adults in the hospital." b. "It is normal for an older person to have cognitive problems while in the hospital." c. "The mental changes are most likely caused by the infection and most often reversible." d. "Drug therapy with antipsychotic agents is indicated to slow the progression of dementia."

c. "The mental changes are most likely caused by the infection and most often reversible." Delirium, a state of temporary but acute mental confusion, is a common, life-threatening, and possibly preventable syndrome in older adults. Clinically, delirium is rarely caused by a single factor. It is often the result of the interaction of the patient's underlying condition with a precipitating event.

In a patient with positive Chvostek's sign, the nurse would anticpiate the IV administration of which medication? a. Calcitonin b. Vitamin D c. Loop diuretics d. Calcium gluconate

d. Chvostek's sign is a contraction of facial muscles in response to a tap over the facial nerve. This indicates the neuromuscular irritability of low calcium levels and IV calcium is the treatment used to prevent laryngeal spasms and respiratory arrest.

What stimulates aldosterone secretion from the adrenal cortex? a. excessive water intake b. Increased serum osmolality c. Decreased serum potassium d. Decreased sodium and water

d. Aldosterone is secreted by the adrenal cortex in response to decreased plasma volume (loss of water), serum sodium, or renal perfusion. It is also secreted in response to an increase in serum potassium

A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins? a. "Blood in my urine has become less noticeable; maybe I don't need this procedure." b. "I have been taking cephalexin (Keflex) for an infection." c. "I previously had several ESWL procedures performed." d. "I take over-the-counter naproxen (Aleve) twice a day for joint pain."

d. "I take over-the-counter naproxen (Aleve) twice a day for joint pain." Because a high risk for bleeding during ESWL has been noted, clients should not take NSAIDs before this procedure. The ESWL will have to be rescheduled for this client.

An older adult woman confides to a nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond? a. "Don't worry about it. You need them." b. "Shop at night-when stores are less crowded." c. "Tell everyone that they are for your husband." d. "That is tough. What do you think might help?"

d. "That is tough. What do you think might help?" This response acknowledges the client's concerns and attempts to help the client think of methods to solve her problem.

A nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? a. "For the best effect, perform all your exercises while you are seated on the toilet." b. "Limit your exercises to 5 minutes twice a day, or you will injure yourself." c. "Results should be visible to you within 72 hours." d. "You know that you are exercising correct muscles if you can stop urine flow in midstream."

d. "You know that you are exercising correct muscles if you can stop urine flow in midstream." When the client can start and stop the urine stream, the pelvic muscles are being used.

Malabsorptive Surgery (Bariatric)

"Biolipancreatic Diversion (BPD)" -REMOVES 3/4 of the stomach and the the remainder is connected to the lower portion of the small intestine.

The nurse is educating a patient about preparing for bariatric surgery. Which adherence goal is important for the patient to meet prior to surgical intervention? 1 Walking 1 mile daily 2 Weight reduction of 20% 3 Consistent intake of carbohydrates 4 Eating according to prescribed reducing diet

The patient preparing to undergo bariatric surgery must demonstrate adherence to the prescribed reducing diet. After surgery, the patient's adherence to reduced intake is necessary because of the concern for abdominal distension, cramping abdominal pain, and possible diarrhea. Walking 1 mile a day is a good exercise regimen, but it is not mandatory prior to bariatric surgery. The percent of body weight reduction depends on the patient's baseline weight and physical condition. Consistent intake of carbohydrates will not help the patient to reduce food intake as a preparation for surgery.

The nurse is admitting a patient to the clinical unit from surgery. Being alert to potential fluid volume alterations, what assessment data will be important for the nurse to monitor to identify early changes in the patient's postoperative fluid volume (Select all that apply) a. Intake and output b. Lung sounds c. Respiratory rate d. Change in level of consciousness e. Skin turgor

a, b, c, d, e

Direction of fluid shift; pick one: a. From blood vessels into interstium b. From ECF to cell c. From ICF to ECF d. From Interstitium to vessels In: 1. Burns 2. Dehydration 3. Fluid overload 4. Hyponatremia 5. Low serum albumin 6. Administration of 10% glucose 7. Application of elastic bandages

1. a 2. b 3. c, d 4. d 5. a 6. a 7. d

The nurse develops a weight-reduction plan with a patient. The nurse should encourage the patient to set a weight-loss goal of how many pounds in a 4-week time period? 1 A goal of 1 to 2 pounds 2 A goal of 3 to 5 pounds 3 A goal of 4 to 8 pounds 4 A goal of 5 to 10 pounds

3 A realistic weight loss goal for patients is 1 to 2 lb/wk, which prevents the patient from becoming frustrated at not meeting weight loss goals. If a patient loses 1 to 2 pounds per week, the weight loss in a 4-week time period would be 4 to 8 pounds.

The nurse determines that an obese patient has varicose veins and cellulite. Which body condition creates a high risk for this condition? 1 Gynoid body shape 2 Android body shape 3 Primary obesity 4 Secondary obesity

1 A patient with gynoid obesity is at risk for osteoporosis, varicose veins, and cellulite due to fat being mainly located in the upper legs. A patient with android obesity has excess fat depositions primarily in the abdominal area. A person with either primary obesity or secondary obesity may develop varicose veins or cellulite; however, the conditions are associated with where fat accumulates on the body rather than the specific cause (primary or secondary) of the patient's obesity.

What is the optimal Waist-to-hip Ratio (WHR) for women?

0.8

What is the optimal Waist-to-hip Ratio (WHR) for men?

0.9

What does the nurse teach a client with cystitis about preventing further flare-ups of the disease? 1. Consume at least 2-3 L of fluids daily. 2. Take tub baths often. 3. Wash the perineal area with antiseptic solution. 4. Empty the bladder at least every 6 hours.

1

the nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows a correct understanding of what the nurse has taught? 1. "I should be drinking at least 1.5-2.5 liters of fluids every day." 2. "It is a good idea for me to reduce germs by taking a tub bath daily." 3. "Trying to get to the bathroom to urinate every 6 hours is important for me." 4. "Urinating 1000 mL on a daily basis is a good amount for me."

1

During an assessment, a patient reports to the nurse that he or she has a habit of overeating and lives a mostly sedentary lifestyle. Which primary factor that leads to obesity does this example illustrate? 1 Caloric intake exceeding energy expended 2 Energy expended exceeding caloric intake 3 Metabolic problems that relate to insulin resistance 4 Corticosteroids causing increased blood sugar levels

1 Caloric intake in excess of energy expended is an example of primary obesity that would occur if a patient overeats without getting physical activity. Energy expended in excess of caloric intake would lead to weight loss, not gain and obesity. Metabolic problems relating to insulin resistance and corticosteroids causing increased blood sugar are causes of secondary obesity.

The nurse assists the patient who has undergone bariatric surgery in making dietary selections. Which types of food items should be recommended? 1 High-protein 2 High-carbohydrate 3 High-fat 4 High-roughage

1 Following bariatric surgery, a patient is usually prescribed a diet high in protein and low in carbohydrates, fats, and roughage. Fluids and foods high in carbohydrates tend to promote diarrhea and symptoms of dumping syndrome.

The nurse provides weight-loss education to a patient with a body mass index (BMI) of 30 kg/m2. Which statement made by the patient indicates the need for further teaching? 1 "I will limit intake to 500 calories a day." 2 "Engaging in weekend exercise only is not recommended." 3 "Two thirds or more of my diet should be plant-source foods." 4 "I should track my activity with a goal of 10,000 steps a day."

1 Limiting intake to 500 calories per day is not indicated for this patient, and the severe calorie energy restriction would place this patient at risk for multiple nutrient deficiencies. A diet plan that limits calories to a total of 800 or less per day is not sustainable on a long-term basis. The nurse should stress to patients that engaging in weekend exercise only is not advantageous and can actually be dangerous. Two thirds or more of an individual's diet should be plant-source foods. Patients should track activity with a goal of 10,000 steps a day.

The nurse teaches an elderly patient that aging problems can be exacerbated by obesity and includes what example? 1 Arthritis 2 Sinusitis 3 Vision problems 4 Chewing difficulty

1 Obesity can place more demands on arthritic joints, and the mechanical strain on weight-bearing joints can lead to premature immobility, thereby exacerbating arthritis. Sinusitis, vision problems, and chewing difficulty are not related to obesity.

Why does the nurse, who is preparing a diet regimen for an obese patient, advise the patient to lose approximately 1 to 2 pounds each week? 1 To ensure better cosmetic results 2 To reduce number of plateau periods 3 To reduce risk of venous complications 4 To provide a motivation for weight loss

1. Steady, reasonable weight loss ensures that the patient does not have loss of skin elasticity and skin tone, providing better cosmetic results. Slow weight loss will not reduce plateau periods. The nurse instructs the patient to ambulate frequently to reduce the risk of venous complications. To provide motivation, the nurse teaches about advantages of weight loss and weight control but does not set a goal for weight loss.

Which foods should the client with urinary calcium oxalate stones avoid to prevent future stone formation? Select all that apply. 1. Spinach 2. Organ meats 3. Black tea 4. Sardines 5. Rhubarb

1, 3 5

When developing a weight-reduction plan for an overweight patient, it is important for the nurse to first assess the presence of which factor? 1 The patient's readiness to make lifestyle changes 2 The patient's current body mass index (BMI) 3 The patient's waist-to-hip circumference ratio 4 The patient's current employment status

1. Eating patterns are established early in life, and eating has many meanings for people. To establish a weight-reduction plan that will be successful for the patient, the nurse should first explore the social, emotional, and behavioral influences on the patient's eating patterns. Current BMI, waist-to-hip circumference, and employment status are not correlated with success of weight loss or the development of a weight-loss plan.

Which bariatric surgical technique does not usually result in patients experiencing problems with dumping syndrome and malabsorption? 1. ajustable gastric banding 2. vertical banded gastroplasty 3. biliopancreatic diversion 4. Roux-en-Y gastric bypass

1. The adjustable gastric banding type of bariatric surgery does not cause dumping syndrome and malabsorption. Image 1 indicates the adjustable gastric banding type of bariatric surgery. Patients undergoing surgical techniques illustrated in images 2 (vertical banded gastroplasty), 3 (biliopancreatic diversion), and 4 (Roux-en-Y gastric bypass) are at higher risk for developing dumping syndrome and malabsorption problems.

When providing teaching to an obese patient, the nurse should emphasize that a healthy weight loss average is how many pounds per week? 1. 2 pounds 2. 3 pounds 3. 6 pounds 4. 8 pounds

1. A realistic weight loss goal is 1 to 2 pounds per week, which prevents the patient from becoming frustrated at not meeting weight-loss goals. Also, it is not so rapid that the patient's skin and underlying tissue lose elasticity and become flabby.

The nurse provides dietary recommendations to an obese patient who is planning to lose weight. What should the nurse include? 1 "Bake, broil, or steam your foods." 2 "Eliminate carbohydrates from your diet." 3 "Two thirds of your diet should be animal-source foods." 4 "Eating small pieces of candy between meals is recommended to suppress your appetite."

1. Broiling, baking, or steaming foods reduces fat intake. Low-carbohydrate diets reduce the opportunity to get adequate amounts of fiber, vitamins, and minerals. Two thirds of the diet should be plant-source foods. Candy contains excess sugar, which increases the risk of weight gain.

While providing postoperative care for a patient who underwent bariatric surgery, the nurse finds that the patient is unconscious and has not fully recovered from anesthesia. What action should the nurse take? 1 Perform a jaw-thrust maneuver. 2 Assist the patient with compression stockings. 3 Administer intravenous fluids and electrolytes. 4 Open nasal airways by closing the patient's mouth.

1. The adipose tissue in the body stores anesthetics that are administered to induce sedation. Obese patients have excessive adipose tissue that releases the anesthetics into the bloodstream; therefore, these patients are at an increased risk for resedation after the surgery. This resedation can cause respiratory depression and subsequent fatal effects in the patient. Therefore, to prevent this risk, the nurse performs a jaw-thrust maneuver or head-tilt to ensure respiration. Compression stockings reduce only the signs of deep vein thrombosis, not the signs of resedation; therefore, they should not be used in this situation. Intravenous fluids and electrolytes do not reverse the signs of resedation in the patient; therefore, they are not administered to the patient. Closing the patient's mouth and opening only the nasal airways may not provide adequate respiration; therefore, the nurse should open the patient's oral and nasal airways to ensure safety.

A patient that is participating in a weight-loss program tells the nurse, "When I lose 5 pounds, I plan to have a spa treatment." Which behavioral technique is the patient using? 1. Reward 2. Motivation 3. Self-monitoring 4. Stimulus control

1. The patient is setting a target and establishing a reward if the target is achieved. This indicates that the patient is setting a benchmark to earn rewards. While providing motivation to a patient, the nurse teaches the patient about advantages of weight loss and weight control. A patient who performs self-monitoring will keep a record of the time and type of food that he or she is consuming. A patient who separates him- or herself from activities that stimulate hunger is exhibiting stimulus control.

The nurse is caring for an obese patient and anticipates that what diagnostic studies will be performed? Select all that apply. 1 Serum glucose 2 Liver function tests 3 Chest x-ray 4 Magnetic resonance imaging (MRI) 5 Electrocardiogram (ECG)

1. 2. 3. 5 Patients with obesity may experience elevated serum glucose and abnormal liver function tests. A chest x-ray may demonstrate an enlarged heart. An ECG may show dysrhythmia. An MRI is not necessary as part of an initial assessment.

Which nursing intervention would be beneficial for an obese patient who is at risk for deep venous thrombosis after surgery? Select all that apply. 1 Providing compression stockings 2 Administering low-dose heparin 3 Administering aspirin medication 4 Encouraging range-of-motion exercises 5 Instructing in cough and deep-breathing techniques

1. 2. 4. Compression stockings help to prevent the formation of blood clots. Heparin is an anticoagulant, which helps reduce the risk of blood clots. Range-of-motion exercise will help reduce the risk of blood clots. Aspirin increases the risk of bleeding, so the nurse should not administer aspirin. Cough and deep-breathing techniques help reduce pulmonary complications associated with bariatric surgery.

When assessing a patient with obesity, what questions are appropriate for the nurse to ask the patient? Select all that apply. 1 What kind of food do you prefer? 2 Where do you go for a vacation? 3 Are other family members obese? 4 What is your motivation to lose weight? 5What is your educational background?

1. 3. 4 Asking about food preferences helps to evaluate the patient's food habits, inquiring about the weight of family members will reveal any family history of weight issues, and asking about motivation to lose weight will clarify the patient's reasons for trying to lose weight. These all help in detailing the history and planning the required lifestyle modifications. Information about where the patient goes for vacation and about educational background is not relevant.

The nurse is teaching a patient about developing strategies for a weight-loss program. What should the nurse include in the education? Select all that apply. 1 Providing information about stimulus control and self-monitoring 2 Stating that diet therapy alone is often effective 3 Advising to stay focused on reasons to lose weight. 4 Recommending that weight loss medication is part of the initial plan 5 Including a reduced-calorie diet, exercise, and behavior modification in the plan

1. 3. 5. Various behavioral techniques for patients engaged in a weight-loss program include self-monitoring and stimulus control. It is important to focus on reasons to lose weight. A multifaceted approach needs to be used and will include nutritional therapy, exercise, and behavior modification. Drugs are reserved for patients that meet specific criteria. Advising diet therapy or medication and surgical intervention for all patients is not recommended.

Match the following descriptions with mechanisms of fluid and electrolyte movement 1. ATP 2. Uses a carrier molecule 3. Force exerted by a fluid 4. Pressure exerted by proteins 5. Force determined by osmolality of a fluid 6. Flow of water from low-solute concentration to high-solute concentration 7. Passive movement of molecules from an area of high concentration to low concentration a. Osmosis b. Diffusion c. Active transport d. Oncotic pressure e. Osmotic pressure f. Faciliated diffusion g. Hydrostatic pressure

1. c; ATP--active transport 2. f; uses a carrier molecule--facilitated diffusion 3. g; force exerted by a fluid--hydrostatic pressure 4. d; pressure exerted by proteins--oncotic pressure 5. e; Force determined by osmolality of a fluid--osmotic pressure 6. a; Flow of water from low-solute concentration to high-solute concentration--osmosis 7. b; Passive movement of molecules from an area of high concentration to low concentration--diffusion

A patient with consistent dietary intake who lost 1 kg of weight in 1 days has lost _________ mL of fluid?

1000 mL or 1 L

BMI range that is considered normal weight?

18-25

A client in the hospital has an indwelling catheter. What intervention does the nurse perform to prevent catheter-related infection? 1. Apply clean technique when inserting the catheter. 2. Ensure the urine collection bag is below bladder level. 3. Clean the perineum with antibiotic ointment. 4. Avoid the use of coated catheters.

2

A client is prescribed the extended-release form of the anticholinergic drug oxybutynin (Ditropan XL) for urge incontinence. How should the client take the drug? 1. Chew the tablet. 2. Swallow the tablet whole. 3. Crush and dissolve the tablet in water. 4. Perform an allergy test before taking the tablet.

2

A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instruction does the nurse provide for postprocedure home care? 1. "After 12 hours, your toilet should be cleaned with a 10% solution of bleach." 2. "Do not share your toilet with family members for the next 24 hours." 3. "Please be sure to stand when you are urinating." 4. "Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded."

2

The nurse is caring for a client who has pyuria. What does the urinalysis reveal in this client? 1. Kidney stones. 2. White blood cells in the urine. 3. Red blood cells in the urine. 4. Heavy bacteria in the urine.

2

The nurse is caring for a client with calcium oxalate kidney stones. What dietary changes does the nurse recommend? 1. Reduce intake of milk and other dairy products. 2. Avoid spinach, black tea, and rhubarb. 3. Limit intake of animal proteins. 4. Limit organ meats and red wine.

2

The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? 1. 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C) 2. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours 3. 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy 4. 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed

2

What complication may the nurse expect in an older client with an indwelling catheter for urinary continence? 1. Skin breakdown 2. Risk for infection 3. Damage to tissues 4. Urine retention

2

the nurse is assessing a female client who has a history of recurrent urinary tract infection (UTI) after sexual intercourse. What does the nurse teach this client to prevent future infections? 1. Wash the perineal area vigorously with antiseptic soap. 2. Empty the bladder before and after intercourse. 3. Practice vaginal douching. 4. Use scented or flavored vaginal lubricants.

2

The nurse reviews the medical record of a patient and notes documentation of class I obesity. This determination was made because the patient has which body mass index (BMI)? 1 26 kg/m2 2 32 kg/m2 3 37 kg/m2 4 42 kg/m2

2 A patient who has a BMI between 30 and 35 kg/m2 is class I obese. A patient who has a BMI between 25 and 29.9 kg/m2 is overweight but not obese. A patient with a BMI between 35 and 40 kg/m2 is class II obese. A patient who has a BMI that is more than 40 kg/m2 is a severely obese or class III obese patient.

A patient who is scheduled for gastric bypass surgery asks for information about dumping syndrome. How should the nurse explain dumping syndrome? 1 The inability to digest high-fat foods 2 When the passage of food into the small intestine occurs too rapidly 3 A decrease in the secretion of insulin caused by carbohydrates 4 An increase in the secretion of both bile and pancreatic enzymes

2 It is believed that the cause of dumping syndrome is the passage of undiluted food into the jejunum. This causes a surge of insulin to be released, resulting in the symptoms of profuse sweating, nausea, dizziness, and weakness. Dumping syndrome is frequently seen in patients who have undergone subtotal gastrectomy or gastric bypass surgery. Dumping syndrome is not caused by an inability to digest high-fat foods, a decrease in the secretion of insulin, or an increase in the secretion of bile and pancreatic enzymes.

An obese patient is scheduled for cosmetic surgery for body image enhancement. The nurse provides education about reducing the risk of obesity recurrence. Which statement made by the patient indicates the need for further teaching? 1 "I can include baked food in my diet." 2 "I can eat candy and honey any time." 3 "I need to exercise every day." 4 "I need to drink low-fat milk and eat salads."

2. The patient is undergoing a lipectomy, which is a cosmetic surgery to reduce body fat. However, there is still a risk of recurrence of obesity unless the patient maintains a proper diet. Candies and honey contain excess sugar, which increases the risk of obesity. Therefore, the patient should prefer fresh fruits to candies. Baked foods are lower in fat, so they can be included in the diet. Exercise is necessary to maintain proper body structure and reduce the risk of obesity. Low-fat milk and salads provide adequate nutrition and reduce the risk of obesity.

The nurse is caring for a patient with a herniated lumbar disc whose body mass index (BMI) is 28 kg/m2. The nurse identifies that the BMI places the patient in which weight category? 1 Normal weight 2 Overweight 3 Obese 4 Severely obese

2. A normal BMI is 18.5 to 24.9 kg/m2, whereas a BMI of 25 to 29.9 kg/m2 is considered overweight. A BMI of 30.0 to 39.9 kg/m2 is considered obese, and a BMI of 40 kg/m2 or greater is severely obese.

The nurse provides education to a patient about reducing the risk of obesity. Which statement made by the patient indicates the need for further teaching? 1 "I should eat two ounces of baked chicken for dinner." 2 "I should incorporate canned fruits into my everyday diet." 3 "I should eat vegetables and salad at lunch and dinner." 4 "I should include a cup of low-fat milk at breakfast."

2. Canned fruits contain excess sugars, so the patient will have a higher risk of obesity. Therefore, the patient should avoid canned fruits. Two ounces of baked chicken should be included with dinner because baked foods have a lower fat content. Vegetables and salads should be included in the diet because vegetables contain protein and vitamins for effective growth. Low-fat milk does not contain excess fat and provides adequate calcium for development, so it should be included in the diet.

After completing an assessment, the nurse classifies a patient as overweight based on which body mass index (BMI) range? 1 18.5 to 24.9 kg/m2 2 25 to 29.9 kg/m2 3 30 to 40 kg/m2 4 Greater than 40 kg/m2

2. A BMI between 18.5 to 24.9 kg/m2 reflects a normal body weight, and a BMI of 25 to 29.9 kg/m2 is considered overweight. A BMI at 30 kg/m2 or above indicates obesity, and more than 40 kg/m2 indicates extreme obesity.

The nurse recalls that which anatomical change is observed after biliopancreatic diversion surgery? 1 The stomach is sleeve shaped with a 60- to 150-mL capacity. 2 There is an anastomosis between the stomach and the intestine. 3 A band encircles the stomach, creating a stoma and a gastric pouch. 4 A gastric pouch is connected to the jejunum, and the remaining stomach is bypassed.

2. Biliopancreatic diversion surgery is a malabsorptive surgery in which the patient will undergo a 70 percent stomach removal with a duodenal switch. The stomach appears like a tube. The surgery creates an anastomosis between the stomach and the intestine. A vertical sleeve gastrectomy is a surgical procedure where 85 percent of the stomach is removed, leaving a sleeve-shaped stomach with a 60- to 150-mL capacity. A vertical banded gastroplasty is a restrictive surgery in which the patient will have a band encircling the stomach, creating a stoma and a gastric pouch. A Roux-en-Y gastric bypass is a combined malabsorptive and restrictive surgery in which the patient will have a gastric pouch connected to the jejunum and the remaining stomach will be bypassed.

A patient underwent an irreversible bariatric surgical procedure that involved creating a small gastric pouch and attaching it directly to the small intestine using a piece of the small bowel. The nurse recognizes that the patient had what surgical procedure? 1 Biliopancreatic diversion 2 Roux-en-Y gastric bypass (RYGB) 3 Adjustable gastric banding 4 Sleeve gastrectomy

2. The RYGB procedure is a combination of restrictive and malabsorptive surgery. This surgical procedure is the most common bariatric procedure performed in the United States. This procedure, which is irreversible, involves creating a small gastric pouch and attaching it directly to the small intestine using a Y-shaped limb of the small bowel. After the procedure, food bypasses 90% of the stomach, the duodenum, and a small segment of jejunum. A biliopancreatic diversion removes 70% of the stomach horizontally and creates an anastomosis between the stomach and the intestine. Adjustable gastric banding is reversible (the band can be adjusted to be tighter or looser). Sleeve gastrectomy removes 85% of the stomach, leaving a sleeve-shaped stomach with 60 to 150 mL capacity.

The nurse has completed initial instruction with a patient regarding a weight-loss program. The nurse determines that the teaching has been effective when the patient makes which statement? 1 "I plan to lose 4 pounds a week until I have met my 60-pound weight loss goal." Correct2 "I will keep a diary of weekly weights to track my weight loss." 3 "I will restrict my carbohydrate intake to less than 30 g/day to maximize weight loss." 4 "I should not exercise more than my program requires because increased activity increases the appetite."

2. The patient should monitor and record weight once per week. This prevents frustration at the normal variations in daily weights and may help the patient to maintain motivation to stay on the prescribed diet. Weight loss should occur at a rate of 1 to 2 lb/week. The diet should be well balanced rather than lacking in specific components that may cause an initial weight loss; this weight loss is not usually sustainable. Exercise is a necessary component of any successful weight loss program.

What should the nurse include in a postoperative plan of care for a patient who has undergone bariatric surgery? 1 Avoid ambulating the patient. 2 Give 30 mL of water every 2 hours. 3 Give solid foods along with liquids. 4 Avoid sugar-free liquids in the patient's diet.

2. While performing postoperative care for a patient who has undergone bariatric surgery, the nurse should give 30 mL of water every 2 hours to maintain the patient's fluid and electrolyte balance. Limiting ambulation can result in deep vein thrombosis (DVT). Therefore, the nurse should encourage the patient to perform early ambulation. The combination of solids and liquids in the patient's diet should be avoided because it puts stress on the gastrointestinal system, causing the patient discomfort. Sugar-rich liquids can result in dumping syndrome, so the nurse should give sugar-free liquids to the patient.

When teaching a patient about reducing weight by using a calorie-restricted diet, what instructions should the nurse include? Select all that apply. 1 Skip meals if not hungry. 2 Exercise regularly. 3 Avoid concentrated sweets. 4 Select fried foods. 5 Select steamed and baked foods.

2. 3. 5. To follow a calorie-restricted diet to reduce weight, the patient should exercise regularly; avoid concentrated sweets such as sugar, candy, honey, pies, cakes, cookies, and regular sodas; and eat steamed and baked foods. It is not advisable to skip meals or to consume fried and greasy foods.

BMI range that is considered overweight?

25-30

A client is prescribed estrogen therapy for urinary incontinence. What does the nurse teach the client about this therapy? 1. Change positions slowly, especially in the mornings. 2. Report urine output that is significantly lower than fluid intake. 3. A thin application of cream is adequate. 4. Use hard candy to moisten the mouth.

3

Which factor does the nurse attribute to stress urinary incontinence in a client? 1. Impaired cognition 2. Spasmodic bladder 3. Weak pelvic muscles 4. Decreased bladder capacity

3

Which nursing activity illustrates proper aseptic technique during catheter care? 1. Applying Betadine ointment to the perineal area after catheterization. 2. Irrigating the catheter daily. 3. Positioning the collection bag below the height of the bladder. 4. Sending a urine specimen to the laboratory for testing.

3

cognitively impaired client has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan? 1. Bladder training 2. Credé method 3. Habit training 4. Kegel exercises

3

The nurse recognizes that a patient with a pear-shaped body is at high risk for which health problem? 1 Heart disease 2 Breast cancer 3 Varicose veins 4 Diabetes mellitus

3 A patient with a pear-shaped body will have fat deposition in the upper legs. Therefore, the patient will have an increased risk of varicose veins. A patient with an apple-shaped body will have fat deposition in the abdomen and the upper body and will have a higher risk of heart disease, breast cancer, and diabetes mellitus.

The nurse is reviewing cultural and ethnic factors related to obesity. Which statement does the nurse identify as being true? 1 Among men, Hispanics have the lowest prevalence of being overweight or obese. 2 Native Americans have a lower prevalence of being overweight than the general population. 3 Among women, African Americans have the highest prevalence of being overweight or obese. 4 Asian Americans have the same prevalence of being overweight and obese compared with the general population.

3 African Americans and Hispanics have a higher prevalence of obesity than whites. Among women, African Americans have the highest prevalence of being overweight or obese, and 15% are severely obese. Among men, Mexican Americans have the highest prevalence of being overweight or obese. Native Americans have a higher prevalence of being overweight than the general population. Asian Americans have the lowest prevalence of being overweight and obese compared with the general population.

The nurse measures the waist circumferences of four patients and identifies that which patient has a high risk of obesity? 1 A 20-year-old male with a waist circumference of 32 inches 2 A 40-year-old male with a waist circumference of 40 inches 3 A 30-year-old female with a waist circumference of 38 inches 4 A 22-year-old female with a waist circumference of 30 inches

3 Males who have a waist circumference greater than 40 inches and females who have a waist circumference greater than 35 inches have a high risk of obesity. A waist circumference of 38 inches in a 30-year-old female indicates an increased risk of obesity. A 20-year-old male with a waist circumference of 32 inches has a normal waist circumference. A 22-year-old female with a waist circumference of 30 inches is not at high risk. A 40-year-old male with a waist circumference of 40 inches is at the upper limit of normal risk.

The nurse is creating a plan of care for an obese patient who is at risk for cardiovascular disease. How many minutes of daily exercise should the plan include? 1. 10 2. 20 3. 30 4. 90

3 Most experts recommend 30-60 minutes of daily exercise to reduce the risk of cardiovascular disease. Exercising for 10 or 20 minutes is not long enough, and 90 minutes is more than necessary to prevent heart disease.

A patient presents with a body mass index (BMI) of 20 kg/m2. What should the nurse document about the patient's weight classification? 1 Obese 2 Overweight 3 Underweight 4 Normal weight

3 Patients with a BMI between 18.5 and 24.9 kg/m2 are considered to have a normal body weight. Patients with a BMI less than 18.5 kg/m2 are considered underweight, those with a BMI of 25 to 29.9 kg/m2 are overweight, and those with a BMI of 30 kg/m2 or above are considered obese.

What concern related to bariatric surgery can be addressed through use of cosmetic surgery? 1 Dehiscence 2 Dumping syndrome 3 Altered body image 4 Deep venous thrombosis

3. Massive weight loss often leaves the patient with large quantities of flabby skin, which can result in problems related to altered body image. Cosmetic surgery may alleviate this situation. Wound infection, dehiscence, and delayed healing are potential complications that are addressed by careful skin assessments. The nurse instructs the patient to restrict fluid with meals to prevent dumping syndrome. The patient with deep venous thrombosis will have effective treatment with low-dose heparin.

Which statement made by a patient who underwent a bariatric surgery indicates the need for further teaching about steps to maintain proper weight? 1 "I should reduce carbohydrates in my diet." 2 "I should limit cheese and butter in my diet." 3 "I should drink plenty of fluids with my meals." 4 "I should increase the protein content in my diet."

3. Fluids should be restricted because they may cause dumping syndrome. Excessive carbohydrates increase the risk of diarrhea. Cheese and butter contain excess calories and intake should be limited. Protein is essential to build muscle mass and produce energy.

The nurse is caring for an obese patient who takes orlistat. The nurse should monitor the patient for which adverse effect? 1 Insomnia 2 Dizziness 3 Fecal incontinence 4 Abnormal heart rate

3. Orlistat is a nutrient absorption-blocking drug that blocks fat breakdown and absorption. This action of the drug may result in fecal incontinence. Insomnia and dizziness are the side effects associated with appetite-suppressing drugs like nonamphetamines. Phentermine and topiramate are anticonvulsant drugs that may cause an abnormal heart rate.

Following a Roux-en-Y gastric bypass, the patient experiences vomiting, nausea, sweating, faintness, and occasional episodes of diarrhea. The nurse reviews the patient's oral consumption after the surgery and suspects that what triggered the patient's symptoms? 1 Fish 2 Meat 3 Candy 4 Spinach

3. Signs and symptoms such as vomiting, nausea, sweating, faintness, and occasional diarrhea following a Roux-en-Y Gastric Bypass procedure indicate dumping syndrome in the patient. Sugar-rich foods, such as candies, pass through the stomach quickly and further increase the risk of dumping syndrome in the patient. Protein-rich foods, such as fish and meat, do not pass through the stomach quickly and usually do not result in dumping syndrome. Spinach, which is a high-fiber soluble food, prevents the quick transfer of sugars to the stomach and does not worsen dumping syndrome.

The nurse provides discharge education to a patient who has undergone bariatric surgery. Why does the nurse instruct the patient to restrict foods that are high in carbohydrates? 1 To reduce the risk of hernia 2 To reduce the risk of venous stasis 3 To reduce the risk of dumping syndrome 4 To reduce the risk of small bowel obstruction

3. Fluids and food high in carbohydrate tend to promote diarrhea and the symptoms of dumping syndrome. A hernia is not related to restricting foods high in carbohydrates. Venous stasis is the condition of slow blood flow in the veins that may arise due to bed rest and an increase in body fat. Bowel obstruction may be seen late in the recovery and rehabilitation stage.

A patient has a body mass index (BMI) of 27 kg/m2. The nurse has discussed weight-loss goals with the patient. Which statement made by the patient indicates understanding of the teaching? 1 "I will exercise for 15 minutes every day of the week." 2 "I will limit my intake to 500 calories per day." 3 "I will increase my intake of sugar-free foods and beverages." 4 "I will begin to steam and broil my foods for most meals."

4 Broiling and steaming foods is a healthier way to prepare meals. Limiting intake to 500 calories per day is not indicated for this patient, and the severe calorie-energy restriction would place the patient at risk for multiple nutrient deficiencies. Low-calorie diets are defined as those having 800 to 1200 calories per day. Exercise should be at least 30 minutes per day.

The nurse provides teaching to a severely obese patient who is scheduled for a Roux-en-Y gastric bypass (RYGB) procedure. Which statement made by the patient indicates effective learning? 1 "This surgery will preserve the function of my stomach." 2 "This surgery will remove the fat cells from my abdomen." 3 "This surgery can be modified whenever I need it to be changed." 4 "This surgery decreases how much I can eat and how many calories I can absorb."

4 The RYGB decreases the size of the stomach to a gastric pouch and attaches it directly to the small intestine so food bypasses 90% of the stomach, the duodenum, and a small segment of the jejunum. The vertical sleeve gastrectomy removes 85% of the stomach but preserves the function of the stomach. Lipectomy and liposuction remove fat tissue from the abdomen or other areas. Adjustable gastric banding can be modified or reversed at a later date.

The nurse assesses a patient with Alzheimer's disease and determines that the patient's body mass index (BMI) is 28.8 kg/m2. The nurse concludes that the patient most likely has what type of obesity? 1 The patient has gynoid obesity. 2 The patient has primary obesity. 3 The patient has android obesity. 4 The patient has secondary obesity.

4. A BMI of 28.8 kg/m2 indicates that the patient is overweight. Alzheimer's disease is one of the types of central nervous system lesions. Patients with this disease may become obese due to cognitive loss and functional inabilities. Secondary obesity may result from central nervous system lesions or congenital anomalies. Therefore, the nurse infers that the patient has secondary obesity. If an obese patient has a greater amount of fat in the upper body, it indicates that the patient has gynoid obesity. If the calorie intake is more than the calorie expenditure for the body's metabolic demands, it is called primary obesity. If an obese patient has a greater proportion of fat deposited in the abdominal area, it indicates that the patient has android obesity.

A patient tells the nurse, "I often feel fatigued. I think it's related to my obesity." What action should the nurse take? 1 Identify a medical professional who specializes in treating fatigue. 2 Help the patient obtain reimbursement for a weight management program. 3 Explain that a loss of 3-5% of weight will produce multiple health benefits. 4 Use motivational interviewing principles to explore the patient's desires.

4. Motivational interviewing will help the patient explore desires for improved health and gain confidence in achieving weight loss. For the goal of reducing weight, seeing a medical professional who specializes in treating fatigue will not be helpful to this patient. Reimbursement for weight loss programs is not always easy to obtain and does not directly help the patient understand his or her motivation for better health. A loss of 3-5% of body weight will produce multiple health benefits, but this may is not be enough of a motivating factor for weight loss.

The nurse is providing postoperative care for a bariatric surgery patient who experiences difficulty breathing and abdominal pressure. What action should the nurse take? 1 Perform the jaw-thrust maneuver 2 Assist the patient to walk a short distance 3 Administer a low dose of heparin to the patient 4 Place the patient's head at a 35- to 40-degree angle

4. Placing the patient's head at a 35- to 40-degree angle will reduce pressure on the abdomen and help in lung expansion, improving breathing. The jaw-thrust maneuver is performed to reduce the risk of pulmonary aspiration and to promote airway opening in a sedated patient. After a bariatric surgery, the patient is encouraged to walk for short distances 3 to 4 times a day to prevent complications such as deep venous thrombosis. A low dose of an anticoagulant, such as heparin, will help prevent deep venous thrombosis.

The nurse recognizes that which finding indicates that a patient has gynoid obesity? 1 Apple-shaped body 2 Waist-to-hip ratio of 0.7 3 Waist circumference of 32 inches 4 Deposition of fat in the upper legs

4. The presence of a pear-shaped body with distribution of fat in the upper legs indicates that the patient has gynoid obesity. An apple-shaped body occurs when fat is deposited in the abdominal area, which indicates android obesity. A normal waist-to-hip ratio should be less than 0.8; a waist-to-hip ratio of 0.7 indicates that the patient has a normal waist. The normal waist circumference for females is less than 35 inches and less than 40 inches for males; the patient has a waist circumference of 32 inches, which indicates that the patient has a normal waist circumference.

An overweight patient tells the nurse, "I had a friend who lost a lot of weight on a low-carbohydrate diet. I would like to try that." The nurse should respond to the patient with what factor in mind? 1. Low-carbohydrate diets are safe and easy to follow. 2. Low-carbohydrate diets produce long-lasting weight loss. 3. Low-fat diets provide more chance of success than low-carbohydrate diets. 4. Low-carbohydrate diets reduce the opportunity to get adequate amounts of fiber, vitamins, and minerals.

4. Low-carbohydrate diets do produce a rapid weight loss but reduce the opportunity to get adequate amounts of fiber, vitamins, and minerals. These restrictive diets are difficult to maintain for long-term weight loss. It is best to recommend a dietary approach in which calorie restriction includes all food groups. Low-carbohydrate diets are generally not safe nor are they easy to follow. They produce short-term, not long-term, weight loss. Low-fat diets are not necessarily more successful than low-carbohydrate diets.

Stress-Related Mucosal Disease

AKA - Physiological stress ulcers! Occur after a major physiologic insult (basically everyone in the ICU) -Severe burns -Trauma -Major Surgery -Mechanical Ventilation See note care for Peptic Ulcer Disease for treatment info

28. A nurse is caring for an 8-year-old patient who is embarrassed about urinating in his bed at night. Which intervention should the nurse suggest to reduce the frequency of this occurrence? a. "Drink your nightly glass of milk earlier in the evening." b. "Set your alarm clock to wake you every 2 hours, so you can get up to void." c. "Line your bedding with plastic sheets to protect your mattress." d. "Empty your bladder completely before going to bed."

ANS: A ANS: A Nightly incontinence and nocturia are often resolved by limiting fluid intake 2 hours before bedtime. Setting the alarm clock to wake does not correct the physiological problem, nor does lining the bedding with plastic sheets. Emptying the bladder may help with early nighttime urination, but will not affect urine produced throughout the night from late-night fluid intake.

4. A patient requests the nurse's assistance to the bedside commode and becomes frustrated when unable to void in front of the nurse. The nurse understands the patient's inability to void because a. Anxiety can make it difficult for abdominal and perineal muscles to relax enough to void. b. The patient does not recognize the physiological signals that indicate a need to void. c. The patient is lonely, and calling the nurse in under false pretenses is a way to get attention. d. The patient is not drinking enough fluids to produce adequate urine output.

ANS: A Attempting to void in the presence of another can cause anxiety and tension in the muscles that make voiding difficult. The nurse should give the patient privacy and adequate time if appropriate. No evidence suggests that an underlying physiological or psychological condition exists.

19. When viewing a urine specimen under a microscope, what would the nurse expect to see in a patient with a urinary tract infection? a. Bacteria b. Casts c. Crystals d. Protein

ANS: A Bacteria indicate a urinary tract infection. Crystals would be seen with renal stone formation. Casts indicate renal alterations. Protein is not visible under a microscope and indicates renal disease.

2. When reviewing laboratory results, the nurse should immediately notify the health care provider about which finding? a. Glomerular filtration rate of 20 mL/min b. Urine output of 80 mL/hr c. pH of 6.4 d. Protein level of 2 mg/100 mL

ANS: A Normal glomerular filtration rate should be around 125 mL/min

14. A patient asks about treatment for urge urinary incontinence. The nurse's best response is to advise the patient to a. Perform pelvic floor exercises. b. Drink cranberry juice. c. Avoid voiding frequently. d. Wear an adult diaper.

ANS: A Poor muscle tone leads to an inability to control urine flow. The nurse should recommend pelvic muscle strengthening exercises such as Kegel exercises; this solution best addresses the patient's problem. Drinking cranberry juice is a preventative measure for urinary tract infection. The nurse should not encourage the patient to reduce voiding; residual urine in the bladder increases the risk of infection. Wearing an adult diaper could be considered if attempts to correct the root of the problem fail.

38. Which observation by the nurse best indicates that bladder irrigation for urinary retention has been effective? a. Recording an output that is larger than the amount instilled b. Presence of blood clots or sediment in the drainage bag c. Reduction in discomfort from bladder distention d. Visualizing clear urinary catheter tubing

ANS: A Recording an output that is greater than what was irrigated into the bladder shows progress that the bladder is draining urine. The other observations do not objectively measure the increase in urine output.

21. What signs and symptoms would the nurse expect to observe in a patient with excessive white blood cells present in the urine? a. Fever and chills b. Difficulty holding in urine c. Increased blood pressure d. Abnormal blood sugar

ANS: A The presence of white blood cells in urine indicates a urinary tract infection. Difficulty with urinary elimination indicates blockage or renal damage. Increased blood pressure is associated with renal disease or damage and some medications. Abnormal blood sugars would be seen in someone with ketones in the urine, as this finding indicates diabetes.

10. Upon palpation, the nurse notices that the bladder is firm and distended; the patient expresses an urge to urinate. The nurse should follow up by asking a. "When was the last time you voided?" b. "Do you lose urine when you cough or sneeze?" c. "Have you noticed any change in your urination patterns?" d. "Do you have a fever or chills?"

ANS: A To obtain an accurate assessment, the nurse should first determine the source of the discomfort. Urinary retention causes the bladder to be firm and distended. Further assessment to determine the pathology of the condition can be performed later. Questions concerning fever and chills, changing urination patterns, and losing urine during coughing or sneezing focus on specific pathological conditions.

39. The nurse anticipates urinary diversion from the kidneys to a site other than the bladder for which patient? a. A 12-year-old female with severe abdominal trauma b. A 24-year-old male with severe genital warts around the urethra c. A 50-year-old male with recent prostatectomy d. A 75-year-old female with end-stage renal disease

ANS: A Urinary diversion would be needed in a patient with abdominal trauma who might have injury to the urinary system. Genital warts are not needed for urinary diversion. Patients with a prostatectomy may require intermittent catheterization after the procedure. End-stage renal disease would not be affected by rerouting the flow of urine.

26. A nurse anticipates urodynamic testing for a patient with which symptom? a. Involuntary urine leakage b. Severe flank pain c. Presence of blood in urine d. Dysuria

ANS: A Urodynamic testing evaluates the muscle function of the bladder and is used to look for the cause of urinary incontinence. Severe flank pain indicates renal calculi; CT scan or IVP would be a more efficient diagnostic test. Blood indicates trauma to the urethral or bladder mucosa. Pain on elimination may warrant cultures to check for infection.

37. To reduce patient discomfort during closed catheter irrigation, the nurse should a. Use room temperature irrigation solution. b. Administer the solution as quickly as possible. c. Allow the solution to sit in the bladder for at least 1 hour. d. Raise the bag of irrigation solution at least 12 inches above the bladder.

ANS: A Using cold solutions, instilling solutions too quickly, and prolonging filling of the bladder can cause discomfort and cramping. To reduce this, ensure that the solution is at room temperature, lower the solution bag so it instills slowly, and drain the bladder fully after an ordered amount of time.

2. The nurse properly obtains a 24-hour urine specimen collection by (Select all that apply.) a. Asking the patient to void and to discard the first sample. b. Keeping the urine collection container on ice. c. Withholding all patient medications for the day. d. Asking the patient to notify the staff before and after every void.

ANS: A, B When obtaining a 24-hour urine specimen, it is important to keep the urine in cool condition. The patient should be asked to void and to discard the urine before the procedure begins. Medications do not need to be held unless indicated by the provider. If properly educated about the collection procedure, the patient can maintain autonomy and perform the procedure alone, taking care to maintain the integrity of the solution.

3. Which of the following are indications for irrigating a urinary catheter? (Select all that apply.) a. Sediment occluding within the tubing b. Blood clots in the bladder following surgery c. Rupture of the catheter balloon d. Bladder infection e. Presence of renal calculi

ANS: A, B, D Catheter irrigation is used to flush and remove blockage that may be impeding the catheter from properly draining the bladder. Irrigation is used to remove blood clots in the bladder following surgery. For patients with bladder infection, an antibiotic irrigation is often ordered. A ruptured catheter balloon will involve extensive follow-up and possible surgery to remove the particles. Renal calculi obstruct the ureters and therefore the flow of urine before it reaches the bladder

9. When caring for a patient with urinary retention, the nurse would anticipate an order for a. Limited fluid intake. b. A urinary catheter. c. Diuretic medication. d. A renal angiogram.

ANS: B A urinary catheter would relieve urinary retention. Reducing fluids would reduce the amount of urine produced but would not alleviate the urine retention. Diuretic medication would increase urine production and may worsen the discomfort caused by urine retention. A renal angiogram is an inappropriate diagnostic test for urinary retention.

29. Many individuals have difficulty voiding in a bedpan or urinal while lying in bed because they a. Are embarrassed that they will urinate on the bedding. b. Would feel more comfortable assuming a normal voiding position. c. Feel they are losing their independence by asking the nursing staff to help. d. Are worried about acquiring a urinary tract infection.

ANS: B Assuming a normal voiding position helps patients relax and be able to void; lying in bed is not the typical position in which people void. Men usually are most comfortable when standing; women are more comfortable when sitting and squatting. Embarrassment at using the bedpan and worrying about a urinary tract infection are not related to the lying-in-bed position. Fear of loss of independence is not related to use of the bedpan or urinal.

6. The nurse knows that urinary tract infection (UTI) is the most common health care-associated infection because a. Catheterization procedures are performed more frequently than indicated. b. Escherichia coli pathogens are transmitted during surgical or catheterization procedures. c. Perineal care is often neglected by nursing staff. d. Bedpans and urinals are not stored properly and transmit infection.

ANS: B E. coli is the leading pathogen causing UTIs; this pathogen enters during procedures. Sterile technique is imperative to prevent the spread of infection. Frequent catheterizations can place a patient at high risk for UTI; however, infection is caused by bacteria, not by the procedure itself. Perineal care is important, and buildup of bacteria can lead to infection, but this is not the greatest cause. Bedpans and urinals may become bacteria ridden and should be cleaned frequently. Bedpans and urinals are not inserted into the urinary tract, so they are unlikely to be the primary cause of UTI.

34. When caring for a hospitalized patient with a urinary catheter, which nursing action best prevents the patient from acquiring an infection? a. Inserting the catheter using strict clean technique b. Performing hand hygiene before and after providing perineal care c. Fully inflating the catheter's balloon according to the manufacturer's recommendation d. Disconnecting and replacing the catheter drainage bag once per shift

ANS: B Hand hygiene helps prevent infection in patients with a urinary catheter. A catheter should be inserted in the hospital setting using sterile technique. Inflating the balloon fully prevents dislodgement and trauma, not infection. Disconnecting the drainage bag from the catheter creates a break in the system and an open portal of entry and increases risk of infection.

13. Which nursing diagnosis related to alternations in urinary function in an older adult should be a nurse's first priority? a. Self-care deficit related to decreased mobility b. Risk of infection c. Anxiety related to urinary frequency d. Impaired self-esteem related to lack of independence

ANS: B Older adults often experience poor muscle tone, which leads to an inability of the bladder to fully empty. Residual urine greatly increases the risk of infection. Following Maslow's hierarchy of needs, physical health risks should be addressed before emotional/cognitive risks such as anxiety and self-esteem. Decreased mobility can lead to self-care deficit; the nurse's priority concern for this diagnosis would be infection, because the elderly person must rely on others for basic hygiene.

11. Which of the following is the primary function of the kidney? a. Metabolizing and excreting medications b. Maintaining fluid and electrolyte balance c. Storing and excreting urine d. Filtering blood cells and proteins

ANS: B The main purpose of the kidney is to maintain fluid and electrolyte balance by filtering waste products and regulating pressures. The kidneys filter the byproducts of medication metabolism. The bladder stores and excretes urine. The kidneys help to maintain red blood cell volume by producing erythropoietin.

27. A patient is having difficulty voiding in a bedpan but states that she feels her bladder is full. To stimulation micturition, which nursing intervention should the nurse try first? a. Exiting the room and informing the patient that the nurse will return in 30 minutes to check on the patient's progress b. Utilizing the power of suggestion by turning on the faucet and letting the water run c. Obtaining an order for a Foley catheter d. Administering diuretic medication

ANS: B To stimulate micturition, the nurse should attempt noninvasive procedures first. Running warm water or stroking the inner aspect of the upper thigh promotes sensory perception that leads to urination. A patient should not be left alone on a bedpan for 30 minutes because this could cause skin breakdown. Catheterization places the patient at increased risk of infection and should not be the first intervention attempted. Diuretics are useful if the patient is not producing urine, but they do not stimulate micturition.

1. If obstructed, which component of the urination system would cause peristaltic waves? a. Kidney b. Ureters c. Bladder d. Urethra

ANS: B Ureters drain urine from the kidneys into the bladder; if they become obstructed, peristaltic waves attempt to push the obstruction into the bladder. The kidney, bladder, and urethra do not produce peristaltic waves. Obstruction of both bladder and urethra typically does not occur.

33. The nurse would question an order to insert a urinary catheter on which patient? a. A 26-year-old patient with a recent spinal cord injury at T2 b. A 30-year-old patient requiring drug screening for employment c. A 40-year-old patient undergoing bladder repair surgery d. An 86-year-old patient requiring monitoring of urinary output for renal failure

ANS: B Urinary catheterization places the patient at increased risk for infection and should be performed only when necessary. Urine can be obtained via clean-catch technique for a drug screening or urinalysis. Spinal cord injury, surgery, and renal failure with critical intake and output monitoring are all appropriate reasons for catheterization.

12. While receiving a shift report on a patient, the nurse is informed that the patient has urinary incontinence. Upon assessment, the nurse would expect to find a. An indwelling Foley catheter. b. Reddened irritated skin on the buttocks. c. Tiny blood clots in the patient's urine. d. Foul-smelling discharge indicative of a UTI.

ANS: B Urinary incontinence is uncontrolled urinary elimination; if the urine has prolonged contact with the skin, skin breakdown can occur. An indwelling Foley catheter is a solution for urine retention. Blood clots and foul-smelling discharge are often signs of infection.

5. The nurse understands that peritoneal dialysis and hemodialysis use which processes to clean the patient's blood? (Select all that apply.) a. Gravity b. Osmosis c. Diffusion d. Filtration

ANS: B, C Osmosis and diffusion are the two processes used to clean the patient's blood in both types of dialysis. In peritoneal dialysis, osmosis and dialysis occur across the semi-permeable peritoneal membrane. In hemodialysis, osmosis and dialysis occur through the filter membrane on the artificial kidney. In peritoneal dialysis, the dialysate flows by gravity out of the abdomen. Gravity has no effect on cleansing of the blood. Filtration is the process that occurs in the glomerulus as blood flows through the kidney.

4. Which of the following symptoms are most closely associated with uremic syndrome? (Select all that apply.) a. Fever b. Nausea and vomiting c. Headache d. Altered mental status e. Dysuria

ANS: B, C, D Uremic syndrome is associated with end-stage renal disease. Signs and symptoms include headache, altered mental status, coma, seizures, nausea, vomiting, and pericarditis.

1. Which nursing actions are acceptable when collecting a urine specimen? (Select all that apply.) a. Growing urine cultures for up to 12 hours b. Labeling all specimens with date, time, and initials c. Wearing gown, gloves, and mask for all specimen handling d. Allowing the patient adequate time and privacy to void e. Squeezing urine from diapers into a urine specimen cup f. Transporting specimens to the laboratory in a timely fashion g. Placing a plastic bag over the child's urethra to catch urine

ANS: B, D, F, G All specimens should be labeled appropriately and processed in a timely fashion. Allow patients time and privacy to void. Children may have difficulty voiding; attaching a plastic bag gives the child more time and freedom to void. Urine cultures can take up to 48 hours to develop. Gown, gloves, and mask are not necessary for specimen handling unless otherwise indicated. Urine should not be squeezed from diapers.

30. The nurse would anticipate inserting a Coudé catheter for which patient? a. An 8-year-old male undergoing anesthesia for a tonsillectomy b. A 24-year-old female who is going into labor c. A 56-year-old male admitted for bladder irrigation d. An 86-year-old female admitted for a urinary tract infection.

ANS: C A Coudé catheter has a curved tip that is used for patients with enlarged prostates. This would be indicated for a middle-aged male who needs bladder irrigation. Coudé catheters are not indicated for children or women.

15. The nurse suspects that a urinary tract infection has progressed to cystitis when the patient complains of which symptom? a. Dysuria b. Flank pain c. Frequency d. Fever and chills

ANS: C Cystitis is inflammation of the bladder; associated symptoms include hematuria and urgency/frequency. Dysuria is a common symptom of a lower urinary tract infection. Flank pain, fever, and chills are all signs of pyelonephritis.

32. A nurse notifies the provider immediately if a patient with an indwelling catheter a. Complains of discomfort upon insertion of the catheter. b. Places the drainage bag higher than the waist while ambulating. c. Has not collected any urine in the drainage bag for 2 hours. d. Is incontinent of stool and contaminates the external portion of the catheter.

ANS: C If the patient has not produced urine in 2 hours, the physician needs to be notified immediately because this could indicate renal failure. Discomfort upon catheter insertion is unpleasant but unavoidable. The nurse is responsible for maintaining the integrity of the catheter by ensuring that the drainage bag is below the patient's bladder. Stool left on the catheter can cause infection and should be removed as soon as it is noticed. The nurse should ensure that frequent perineal care is being provided.

20. The nurse would expect the urine of a patient with uncontrolled diabetes mellitus to be a. Cloudy. b. Discolored. c. Sweet smelling. d. Painful.

ANS: C Incomplete fat metabolism and buildup of ketones give urine a sweet or fruity odor. Cloudy urine may indicate infection or renal failure. Discolored urine may result from various medications. Painful urination indicates an alteration in urinary elimination.

24. Which statement by the patient about an upcoming computed tomography (CT) scan indicates a need for further teaching? a. "I'm allergic to shrimp, so I should monitor myself for an allergic reaction." b. "I will complete my bowel prep program the night before the scan." c. "I will be anesthetized so that I lie perfectly still during the procedure." d. "I will ask the technician to play music to ease my anxiety."

ANS: C Patients are not put under anesthesia for a CT scan; instead the nurse should educate patients about the need to lie perfectly still and about possible methods of overcoming feelings of claustrophobia. The other options are correct. Patients need to be assessed for an allergy to shellfish if receiving contrast for the CT. Bowel cleansing is often performed before CT. Listening to music will help the patient relax and remain still during the examination.

31. The nurse knows that which indwelling catheter procedure places the patient at greatest risk for acquiring a urinary tract infection? a. Emptying the drainage bag every 8 hours or when half full b. Kinking the catheter tubing to obtain a urine specimen c. Placing the drainage bag on the side rail of the patient's bed d. Failing to secure the catheter tubing to the patient's thigh

ANS: C Placing the drainage bag on the side rail of the bed could allow the bag to be raised above the level of the bladder and urine to flow back into the bladder. The urine in the drainage bag is a medium for bacteria; allowing it to reenter the bladder can cause infection. The drainage bag should be emptied and output recorded every 8 hours or when needed. Urine specimens are obtained by temporarily kinking the tubing; a prolonged kink could lead to bladder distention. Failure to secure the catheter to the patient's thigh places the patient at risk for tissue injury from catheter dislodgment.

8. A patient has fallen several times in the past week when attempting to get to the bathroom. The patient informs the nurse that he gets up 3 or 4 times a night to urinate. Which recommendation by the nurse is most appropriate in correcting this urinary problem? a. Clear the path to the bathroom of all obstacles before bed. b. Leave the bathroom light on to illuminate a pathway. c. Limit fluid and caffeine intake before bed. d. Practice Kegel exercises to strengthen bladder muscles.

ANS: C Reducing fluids, especially caffeine and alcohol, before bedtime can reduce nocturia. Clearing a path to the restroom or illuminating the path, or shortening the distance to the restroom, may reduce falls but will not correct the urination problem. Kegel exercises are useful if a patient is experiencing incontinence.

36. A nurse is providing education to a patient being treated for a urinary tract infection. Which of the following statements by the patient indicates an understanding? a. "Since I'm taking medication, I do not need to worry about proper hygiene." b. "I should drink 15 to 20 glasses of fluid a day to help flush the bacteria out." c. "My medication may discolor my urine; this should resolve once the medication is stopped." d. "I should not have sexual intercourse until the infection has resolved."

ANS: C Some anti-infective medications turn urine colors; this is normal and will dissipate as the medication leaves the system. Even if the patient is on medication, hygiene is important to prevent spread or reinfection. Fluid intake should be increased to help flush out bacteria; however, 15 to 20 glasses is too much. Sexual intercourse is allowed with a urinary tract infection, as long as good hygiene and safe practices are used.

5. The nurse knows that indwelling catheters are placed before a cesarean because a. The patient may void uncontrollably during the procedure. b. A full bladder can cause the mother's heart rate to drop. c. Spinal anesthetics can temporarily disable urethral sphincters. d. The patient will not interrupt the procedure by asking to go to the bathroom.

ANS: C Spinal anesthetics may cause urinary retention due to the inability to sense or carry out the need to void. The patient is more likely to retain urine, rather than experience uncontrollable voiding. With spinal anesthesia, the patient will not be able to ambulate during the procedure. A full bladder has no impact on the pulse rate of the mother.

16. Which assessment question should the nurse ask if stress incontinence is suspected? a. "Does your bladder feel distended?" b. "Do you empty your bladder completely when you void?" c. "Do you experience urine leakage when you cough or sneeze?" d. "Do your symptoms increase with consumption of alcohol or caffeine?"

ANS: C Stress incontinence can be related to intra-abdominal pressure causing urine leakage, as would happen during coughing or sneezing. Asking the patient about the fullness of his bladder would rule out retention and overflow. An inability to void completely can refer to urge incontinence. Physiological causes and medications can effect elimination, but this is not related to stress incontinence.

3. A patient is experiencing oliguria. Which action should the nurse perform first? a. Increase the patient's intravenous fluid rate. b. Encourage the patient to drink caffeinated beverages. c. Assess for bladder distention. d. Request an order for diuretics.

ANS: C The nurse first should gather all assessment data to determine the potential cause of oliguria. It could be that the patient does not have adequate intake, or it could be that the bladder sphincter is not functioning and the patient is retaining water. Increasing fluids is effective if the patient does not have adequate intake, or if dehydration occurs. Caffeine can work as a diuretic but is not helpful if an underlying pathology is present. An order for diuretics can be obtained if the patient was retaining water, but this should not be the first action.

18. To obtain a clean-voided urine specimen for a female patient, the nurse should teach the patient to a. Cleanse the urethral meatus from the area of most contamination to least. b. Initiate the first part of the urine stream directly into the collection cup. c. Hold the labia apart while voiding into the specimen cup. d. Drink fluids 5 minutes before collecting the urine specimen.

ANS: C The patient should hold the labia apart to reduce bacterial levels in the specimen. The urethral meatus should be cleansed from the area of least contamination to greatest contamination (or front-to-back). The initial steam flushes out microorganisms in the urethra and prevents bacterial transmission in the specimen. Drink fluids 30 to 60 minutes before giving a specimen.

7. An 86-year-old patient tells the nurse that she is experiencing uncontrollable leakage of urine. Which nursing diagnosis should the nurse include in the patient's plan of care? a. Urinary retention b. Hesitancy c. Urgency d. Urinary incontinence

ANS: D Age-related changes such as loss of pelvic muscle tone can cause involuntary loss of urine known as Urinary incontinence. Urinary retention is the inability to empty the bladder. Hesitancy occurs as difficulty initiating urination. Urgency is the feeling of the need to void immediately.

25. The nurse anticipates preparing a patient who is allergic to shellfish for an arteriogram by a. Obtaining baseline vital signs after the start of the procedure. b. Monitoring the extremity for neurocirculatory function. c. Keeping the patient on bed rest for the prescribed time. d. Administering an antihistamine medication to the patient.

ANS: D Before the procedure is begun, the nurse should assess the patient for food and other allergies and should administer an antihistamine, because a contrast iodine-based dye is used for the procedure. Baseline vitals should be obtained before the start of the procedure and frequently thereafter. The procedure site is monitored and the patient kept on bed rest after the procedure is complete

35. An 86-year-old patient asks the nurse what lifestyle changes will reduce the chance of a urinary tract infection. Which response is accurate? a. Urinary tract infections are unavoidable in the elderly because of a weakened immune system. b. Decreasing fluid intake will decrease the amount of urine with bacteria produced. c. Making sure to cleanse the perineal area from back to front after voiding will reduce the chance of infection. d. Increasing consumption of acidic foods such as cranberry juice will reduce the chance of infection.

ANS: D Cranberry juice and other acidic foods decrease adherence of bacteria to the bladder wall. Urinary tract infections are avoidable in the elderly population with proper knowledge and hygiene. Perineal skin should be cleansed from front to back to avoid spreading fecal matter to the urethra. Increasing fluids will help to flush bacteria, thus preventing them from residing in the bladder for prolonged periods of time.

22. The nurse would anticipate an order for which diagnostic test for a patient who has severe flank pain and calcium phosphate crystals revealed on urinalysis? a. Renal ultrasound b. Bladder scan c. KUB x-ray d. Intravenous pyelogram

ANS: D Flank pain and calcium phosphate crystals are associated with renal calculi. An intravenous pyelogram allows the provider to observe pathological problems such as obstruction of the ureter. A renal ultrasound is performed to identify gross structures. A bladder scan measures the amount of urine in the bladder. A KUB x-ray shows size, shape, symmetry, and location of the kidneys.

23. A nurse is caring for a patient who just underwent intravenous pyelography that revealed a renal calculus obstructing the left ureter. What is the nurse's first priority in caring for this patient? a. Turn the patient on the right side to alleviate pressure on the left kidney. b. Encourage the patient to increase fluid intake to flush the obstruction. c. Administer narcotic medications to alleviate pain. d. Monitor the patient for fever, rash, and difficulty breathing.

ANS: D Intravenous pyelography is performed by administering iodine-based dye to view functionality of the urinary system. Many individuals are allergic to shellfish; therefore, the first nursing priority is to assess the patient for an allergic reaction that could be life threatening. The nurse should then encourage the patient to drink fluids to flush dye resulting from the procedure. Narcotics can be administered but are not the first priority. Turning the patient on the side will not affect patient safety.

17. When establishing a diagnosis of altered urinary elimination, the nurse should first a. Establish normal voiding patterns for the patient. b. Encourage the patient to flush kidneys by drinking excessive fluids. c. Monitor patients' voiding attempts by assisting them with every attempt. d. Discuss causes and solutions to problems related to micturition.

ANS: D The nurse should assess first to determine cause, then should discuss and create goals with the patient, so nurse and patient can work in tandem to normalize voiding. The nurse should incorporate the patient's input into creating a plan of care for the patient. Drinking excessive fluid will not help and may worsen alterations in urinary elimination. The nurse does not need to monitor every void attempt by the patient; instead the nurse should provide patient education. The nurse asks the patient about normal voiding patterns, but establishing voiding patterns is a later intervention.

In inflammatory states...

Alterations lead to increased BMR, increased protein and skeletal muscle breakdown States like lipus, RA, burns, etc

Which obesity shape is at more risk for health problems?

Android Obesity

Indications for Enteral Nutrition

Anorexia Orofacial fractures Head/Neck Cancers Burns Nutrition deficiencies Neurological conditions Psychiatric conditions CHemotherapy Radiation therapy

Nursing Considerations r/t enteral nutrition

Daily weights Assess for bowel sounds before feedings Accurate I/O Initial glucose checks Label with date and time started Pump tubing changed Q24H

WHich meds used to treat GERD work to neutralize the HCL acid?

Antacids and Acid Neutralizers

Which meds used to treat GERD work to form a protective layer over the mucosa?

Antiulcers

A patient undergoes peritoneal dialysis exchanges several times each day. What should the nurse plan to increase in the patient's diet? a. Fat b. Protein c. Calories d. Carbohydrates

B. Dietary protein guidelines for peritoneal dialysis (PD) differ from those for hemodialysis because of protein loss in the dialysate. During PD, protein intake must be high enough to compensate for the losses, so that the nitrogen balance is maintained. Recommended protein intake is at least 1.2 g/kg of ideal body weight per day, and it increases according to the individual needs of the patient

D.B. is admitted to a long-term care facility. He has a nursing diagnosis of impaired memory related to effects of dementia. An appropriate nursing intervention for him is to a. let him know what behavior is socially appropriate. b. assist him with all self-care to maintain self-esteem. c. maintain familiar routines of sleep, meals, drug administration, and activities. d. promote orientation at every encounter with the patient by asking the day, time, and place.

C. The nurse should maintain familiar routines by identifying usual patterns of behavior for activities such as sleep, medication use, elimination, food intake, and self-care.

After discharge instructions for a patient who has had bariatric surgery for treatment of obesity, the nurse determines that additional teaching is needed when the patient says: a. "I shouldn't eat concentrated sweets." b. "I can eat small, frequent meals throughout the day." c. I should drink several glasses of fluids with my meals." d. "I will need to have a cobalamin injection once a month."

C. Discharge teaching for a patient after bariatric surgery may include six small meals/day, a diet high in protein and low in fat and carbohydrates, avoidance of ingestion of solids with fluids, avoidance of large amounts of fluids at one time, restriction of fluid intake to less than 1000 mL/day, and avoidance of sugary foods. The dietary restrictions will help to prevent dumping syndrome and will aid in weight loss. Cobalamin injections or intranasal spray will prevent cobalamin-deficiency anemia.

An important factor associated with both short-term and long-term weight-loss success is a. Higher initial body mass index. b. Simultaneous smoking cessation. c. A strong desire to improve appearance. d. Fewer dieting attempts in the past year.

C. Motivation to lose weight is essential for a favorable and successful outcome.

Nursing Assessment for Nutrition

Changes in Weight Wound assessment (wound healing is a good indicator of nutritional status) Diet history Drugs Lab Test Results (Serum Albumin, Prealbumin, CBC, Electrolyte levels) Physical Exam Anthropometric measurements

WHich meds used to treat GERD work to increase the pressure of the LES?

Cholinergics

List common indications for TPN

Chronic intractable (hard to control or deal with) D/V Complicated surgery or trauma GI Obstruction GI Tract anomalies and fistulas Malnutrition

A patient is admitted to a medical unit with a diagnosis of malnutrition. The student nurse asks the nurse assigned to this patient about the relationship between drugs and nutrition. What is the most appropriate response for the nurse to make? A - "Foods alter the absorption or bioavailability of all drugs." B - "Drugs should be taken with food to prevent GI irritation." C - "If the patient skips a meal, drugs may not be taken." D - "Some drugs increase the requirements for essential nutrients."

D - "Some drugs increase the requirements for essential nutrients." Rationale: Some drugs may increase nutrient requirements (see eTable 40-4). Some medications can be taken with food; other drugs must be taken without food. Food may alter the absorption or bioavailability of some drugs, but not all drugs.

The nurse teaches a patient about safe and successful weight loss. Which statement, if made by the patient, would indicate an understanding of the instructions? a. "I will keep a diary of daily weights to chart my weight loss." b. "I plan to lose 4 pounds a week until I have lost my goal of 60 pounds." c. "I should not exercise more than what is required because increased activity increases the appetite." d. "I plan to join a behavior-modification group to make permanent changes necessary for weight control."

D. Behavior-modification programs deemphasize the diet and focus on how and when to eat; support groups offer support and information on dieting tips. Patients should set a weight loss goal of 1 to 2 lb/wk. Weight should be checked weekly; daily weights are not recommended because of the frequent fluctuations that result from retained water (including urine) and elimination of feces. No evidence indicates that increased activity promotes an increase in appetite or leads to dietary excess.

A patient with advanced cirrhosis who has ascites is short of breath and has an increased respiratory rate. The nurse should: a. Initiate oxygen therapy at 2 L/min to increase gas exchange. b. Notify the health care provider so that a paracentesis can be performed. c. Ask the patient to cough and breathe deeply to clear respiratory secretions. d. Place the patient in Fowler's position to relieve pressure on the diaphragm.

D. Dyspnea is a frequent problem for the patient with ascites, and a semi-Fowler's or Fowler's position allows for maximal respiratory efficiency. Oxygen administration is not indicated; SpO2 level less than 90% would be an indication for oxygen. The respiratory distress is caused by ascites (not by respiratory secretions); coughing and deep breathing will not alleviate the respiratory distress. A paracentesis may be performed to remove ascitic fluid; however, this procedure provides only temporary relief and is reserved for severe respiratory distress or abdominal pain.

The surgical treatment of choice for the patient with symptomatic gallbladder disease is a: a. cholecystotomy. b. choledocholithotomy. c. cholecystoduodenostomy. d. laparoscopic cholecystectomy.

D. Laparoscopic cholecystectomy is the surgical treatment of choice for patients with symptomatic cholelithiasis. The procedure is minimally invasive (puncture sites only), and the patient experiences minimal postoperative pain and is discharged on the day of surgery or on the day after. Most patients are able to resume normal activities and return to work within 1 week.

Malnutrition

Deficit, excess or imbalance in essential components of a balanced diet

Nursing 101 for GERD includes:

Elevate HOB 30 degrees Don't lie down for 2-3 hours after eating Don't eat late in the pm Evaluate the medication affects and observe for side effects Avoid factors that cause reflux (smoking, food/drink, stress) Monitor weight loss Promote small, frequent meals

What is the conservative therapy and/or nursing care r/t hiatal hernia?

Eliminate tight clothing Avoid lift/straining NO SMOKING NO ALCOHOL Antacids/secratory meds ELEVATE HOB Weight loss

What are the complications r/t GERD? Remember that complications occur because of the gastric acid on the mucosa...

Esophagitis BARRETT'S ESOPHAGUS (This involves precancerous lesions) Respiratory: Can induce an asthma attack Dental Erosion

Vegetarian

Exclusion of red meat from diet (may not eat any meat at all) Need well-planned diet to avoid VITAMIN and PROTEIN deficiencies

What are the complications that can arise related to hiatal hernia?

GERD Esophagitis Hemorrhage (r/t erosion) Stenosis (narrowing) Ulceration Strangulation of herniated portion of stomach Dyspnea Bronchoconstriction REgurgitation

What are the GI/Hepatic risks associated with obesity?

GERD Gallstones NASH - Nonalcoholic Steatohepatitis (liver inflammation and damage)

Heartburn (pyrosis) Indigestion (dyspepsia) Hypersalivation Non-Cardiac Chest Pain Hoarseness Lump in throat These are all clinical manifestations of?

GERD - Gastroesophageal Reflux Disease

What type of diet is prescribed for a patient who underwent bariatric surgery?

HIGH protein LOW carb, fat, roughage 6 small meals/feedings per day Don't ingest fluids with meals (<1000ml/day)

Heartburn Pain Dysphagia Are all clinical manifestations associated with...

Hiatal Hernia

Obesity Pregnancy Ascites Tumor Heavy Lifting Trauma These are all things that cause increased pressure and are considered risk factors for ...

Hiatal Hernia

What is it called when a portion of the stomach moves into the esophagus through the diaphragm?

Hiatal Hernia

Which meds used to treat GERD work to decrease the HCL secretions?

Histamine (H2) Receptor Blockers Proton Pump Inhibitors

Prealbumin

Lab study used in assessment of malnourishment... Has a half life of two days. This is a better indicator of immediate nutrition status (this is like the random glucose test in a DM patient)

Serum Albumin

Lab study used in assessment of malnourishment... Helps us to better understand how they have BEEN (think of this like the HgA1c of metabolsim)

Treatment plan for Obese Patients:

Meal planning - too many wrong carbs are bad! Exercise Behavior modification Support groups like weight watchers Drug Therapy: -Classified into two categories (Decrease food intake by reducing appetite or increasing satiety OR decrease nutrient absorption) -Drugs to increase energy expenditure not approved by FDA

Planning Goals for obese patients

Modify eating patterns Participation in regular exercise program Achieve weight loss to specified levels Maintain weight loss Minimize or prevent health problems Multipronged approach ought to be used with attention to multiple factors All opportunities for patient education should stress HEALTHY EATING, and EXERCISE

What surgical procedure is performed to repair hiatal hernia and what is the risk associated with this procedure?

Nissen Fundoplication Small risk of impacting the chest during the procedure

What is considered one of the most important known preventable causes of cancer?

OBESITY Women --> breast, endometrial, ovarian and cervical Men --> prostate Both genders --> Colon

Vegan Diet

Only eat plant foods Lack of Cobalamin (B12) -weakness -paresthesia -loss of position senses -atxia -impaired thought process Can develop Megaloblastic anemia (same as B12 but without neuro) and neurological signs of deficiency

Gerontological Risks associated with malnourishment

Oral cavity deteriorating Digestion/Motility slows down Endocrine system M/S System Vision and hearing change

What are the musculoskeletal risks associated with obesity>

Osteoarthritis Hyperuricemia (gout - r/t insulin resistance and hypertension also increase uric acid)

WHich meds used to treat GERD work to Increase the GI motility?

Prokinetics

Bulimia Nervosa

Psychological disorder with nutritional impact Induced vomiting Frequent binge eating and self-indced vomiting associated with loss of control related to eating and persistent concern with body image

Anorexia Nervosa

Psychological disorder with nutritional impact W/H food Self-imposed weight loss, endocrine dysfunction and distorted psychopathologic attitude to weight and eating

Define SECONDARY Obesity

REsults from various congenital anomalies, chromosomal anomalies, metabolic problems, or CNS lesions/disorders Basically.... There is something other than overeating causing the obesity

What are the Respiratory risks associated with obesity?

Sleep apnea Obesity hypoventilation syndrome Decreased chest wall compliance Increased WOB Decreased total lung capacity and functional residual capacity

What are two of the most common GI irritants?

Smoking and alcohol

Factors that contribute to malnutrition include

Socioeconomic factors (think food security) Physical Illness -Illness, surgery, injury, hospitalization -Malabsorption Syndrome in GI tract -Fever increases BMR -Incomplete diets/vitamin deficiencies (alcohol drug users, chronically ill, those with poor diet practice)

What are the specific things to remember about the actual TPN Bag?

Solutions are prepared by a pharmacist or trained tech under strict aseptic techniques Must be REFRIGERATED until 30 minutes BEFORE use Must be LABELED with all nutrient content, all additives, time mixed, and the date/time of expiration

Define PRIMARY Obesity

THis is excess caloric intake for the body's metabolic demands

Restrictive Surgery (bariatric)

THis procedures reduces the SIZE of the stomach which gives the feeling of being full with less food Normal digestion and absorption still occur Done laproscopically "Vertical Banded Gastroplasty" -partitions the stomach -limits capacity -band delays emptying (feel fuller longer) "Adjustable Gastric Banding (AGB)" -Stomach size is limited

TPN (Total parenteral Nutrition) is used when...

The GI tract can't be used for ingestion, digestion, and/or absorption of essential nutrients

While performing a health assessment, the nurse documents a child's weight as 25 kg and height as 1.1 meters. What is the body mass index (BMI) of the child? Record the answer rounded to one decimal place. _______ kg/m2

The child weighs 25 kg and measures 1.1 meters in height. Body mass index (BMI) is calculated using the formula: Body mass index = weight in kg/(height in meters)2 = 25/(1.1)2= 25/1.21 = 20.66 kg/m2. Rounded to the nearest one decimal place that is 20.7 kg.m2

Body Mass Index

The degree to which a patient is classified as underweight, healthy (normal) weight, overweight, or obese Common clinical index of obesity or altered body fat distribution Use weight to height ratios

Enteral Nutrition is used when....

The gut still functions! If we can utilize the bowel we will USE the bowel!

What are the endocrine risks associated with obesity?

Type 2 Diabetes Mellitus -Hyperinsulinemia (too much circulating insulin) -Insulin Resistance (ineffective transport of glucose)

COmplications with enteral nutrition

V/D Constipation Aspiration Dehydration - This seems like it wouldn't make sense, but the formula is calorically dense and there is LESS water in it Geronotological patients are more vulnerable to complications - They may be a better candidate for continuous feedings... In the elderly we may also see F/E Imbalances Glucose Intolerance Decreased ability to handle large volumes Increased risk of aspiration

Nursing 101 r/t TPN

Vital signs Q4-8H Daily weights (are they meeting their goals) Blood glucose (initially Q6H, we want a reading between 110 and 150) BUN Electrolytes Liver enzymes Dressing changes - This formula is full of sugar which we know bacteria LOVE! Refeeding syndrome (on another flashcard) Infusion pump must be used - periodically check volume Blood and catheter cultures if infections is suspected X-ray to check changes in pulmonary status

What are the cardiovascular risks associated with obesity?

WHR is best predictor of risk (watch out android/apples) Risks include: High LDLs High Triglycerides Low HDLs Heart failure Hypertension r/t -increased circulation blood volume -abnormal vasoconstriction -decreased vascular relaxation -increased cardiac output

Describe waist-to-hip ratio (WHR)

Waist measurement DIVIDED by Hip measurement = WHR

WHat is the preferred tool to use when determining obesity for people who are predominately muscular?

Waist-to-hip ration

Signs and symptoms of decreased levels of Cobalamin (B12)

Weakness Paresthesia Impaired though process Tissue Hypoxia Sore tongue Nausea Vomiting Anorexia

Which statements about fluid in the human body are true? (Select all that apply) a. The primary hypothalmic mechanism of water intake is thirst b. Third spacing refers to the abnormal movement of fluid into interstitial spaces c. A cell surrounded by hypoosmolar fluid will shrink and die as water moves out of the cell d. A cell surrounded by hyperosmolar fluid will shrink and die as water moves out of the cell e. Concentrations of Na and K in interstitial and intracellular fluids are maintained by sodium-potassium pump

a, d, e Third spacing is when fluid moves into spaces that normally have little or no fluid. A cell surrounded by hypoosmolar fluid would swell and burst as water moves into the cell.

To provide free water and intracellular fluid hydration for a patient with acute gastroenteritis who is NPO, the nurse would expect administration of which infusion? a. Dextrose 5% in water b. Dextrose 10% in water c. Lactated Ringer's solution d. Dextrose 5% in normal saline

a. Fluids such as 5% dextrose in water allow water to move from the ECG to the ICF. Although D5W is physiologically isotonic, the dextrose is rapidly metabolized, leaving free water to shift into cells.

Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. What information does a nurse provide to this client about taking her prescribed trimethoprim/sulfamethoxazole (Bactrim)? Select all that apply. a. "Be certain to wear sunscreen and protective clothing." b. "Drink at least 3 liters of fluids every day." c. "Take this drug with 8 ounces of water." d. "Try to urinate frequently to keep your bladder empty." e. "You will need to take all of this drug to get the benefits."

a. "Be certain to wear sunscreen and protective clothing." b. "Drink at least 3 liters of fluids every day." c. "Take this drug with 8 ounces of water." e. "You will need to take all of this drug to get the benefits." (a) Wearing sunscreen and protective clothing is important to do while on this drug. Increased sensitivity to the sun can lead to severe sunburn. (b, c) Sulfamethoxazole can form crystals that precipitate in the kidney tubules. Fluid intake prevents this complication. (e) Clients should be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon. INCORRECT: (d)Emptying the bladder is important-but not keeping it empty-as is stated here. The client should be advised to urinate every 3 to 4 hours or more often if he or she feels the urge.

A nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences of them. Which client statement shows correct understanding of what the nurse has taught? a. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." b. "It is a good idea for me to reduce germs by taking a tub bath daily." c. "Trying to get to the bathroom to urinate every 6 hours is important for me." d. "Urinating 1000 mL on a daily basis is a good amount for me."

a. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." To reduce the number of UTIs, clients should be drinking a minimum of 1.5 to 2.5 liters of fluid (mostly water) each day.

A nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? Select all that apply. a. Dysuria b. Enuresis c. Frequency d. Nocturia e. Urgency f. Polyuria

a. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." c. Frequency d. Nocturia e. Urgency (a) Dysuria-painful urination-is a symptom of a UTI. (c) Frequency-frequent urinating and in small amounts-is a sign of a UTI. (d) Nocturia-urinating at night-is (or can be) a symptom of a UTI. (e) Urgency-having the urge to urinate quickly-is a symptom of a UTI. INCORRECT: (b) Enuresis-bed-wetting-is not a sign of a UTI. (f) Polyuria-increased amounts of urine production-is not a sign of a UTI.

Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. She is started on antibiotics and sent home. She returns to the clinic 3 days later-with the same symptoms. When asked about the previous UTI and medication regimen, she states, "I only took the first dose because after that, I felt better." How does the nurse respond? a. "Not completing your medication can lead to return of your infection." b. "That means your treatment will be prolonged with this new infection." c. "This means you will now have to take two drugs instead of one." d. "What you did was okay; however, let's get you started on something else."

a. "Not completing your medication can lead to return of your infection." Not completing the drug regimen can lead to recurrence of an infection and to bacterial drug resistance.

Which client with a long-term urinary problem does the nurse refer to community resources and support groups? Select all that apply. a. 32-year-old with a cystectomy b. 44-year-old with a Kock pouch c. 48-year-old with urinary calculi d. 78-year-old with urinary incontinence e. 80-year-old with dementia

a. 32-year-old with a cystectomy b. 44-year-old with a Kock pouch d. 78-year-old with urinary incontinence (a) The client with a cystectomy would benefit from community resources and support groups. Others who have had their bladders removed are good sources for information and for help in establishing coping mechanisms. (b) The client with a Kock pouch would benefit from community resources and support groups. Others who have had their bladders removed and are using an alternate method for urinating are good sources for information and for help in establishing coping mechanisms. (d) The older adult client with urinary incontinence would benefit from community resources and support groups. Others who have had this problem can provide methods of living with the problem or methods of curing (or minimizing) it.

A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? a. Administers morphine sulfate 4 mg IV b. Begins an infusion of metoclopramide (Reglan) 10 mg IV c. Obtains a urine specimen for urinalysis d. Starts an infusion of 0.9% normal saline at 100 mL/hr

a. Administers morphine sulfate 4 mg IV Morphine administered IV will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension.

The nurse teaches a patient with chronic kidney disease about prevention of complications. What should the nurse include in the teaching plan?

a. Monitor for proteinuria daily with a urine dipstick. b. Perform self-catheterization every 4 hours to measure urine. c. Take calcium-based phosphate binders on an empty stomach. ***d. Check weight daily and report a gain of greater than 4 pounds.*** Patients with chronic kidney disease are taught to report weight gain greater than 4 pounds (2 kg). Proteinuria is an expected finding and is not monitored. Calcium-based phosphate binders should be taken with meals because most phosphate is absorbed within 1 hour after eating. Self-catheterization is not indicated and may lead to infection.

A patient is admitted to the emergency department with a severe exacerbation of asthma. Which finding is of most concern to the nurse? a. Unable to speak and sweating profusely b. PaO2 of 80 mm Hg and PaCO2 of 50 mm Hg c. Presence of inspiratory and expiratory wheezing d. Peak expiratory flow rate at 60% of personal best

a. Unable to speak and sweating profusely During a severe exacerbation of asthma the patient may not be able to speak (or may speak in words, not sentences) because of difficulty breathing; the patient may also be perspiring profusely. Other indicators of severe asthma include absence of wheezing because of limited airflow; arterial blood gas results with decreased PaO2 (< 80 mm Hg) and increased PaCO2 (> 48 mm Hg); and peak expiratory flow rate at or below 40% of personal best.

A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instructions does the nurse provide for postprocedure home care? a. "After 12 hours, your toilet should be cleaned with a 10% solution of bleach." b. "Do not share your toilet with family members for the next 24 hours." c. "Please be sure to stand when you are urinating." d. "Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded."

b. "Do not share your toilet with family members for the next 24 hours." The toilet should not be shared for 24 hours following the procedure because others using the toilet could be infected with the live virus that was instilled into the client. If the toilet must be shared, then specific cleaning precautions need to be taken each time the client uses the toilet. The best scenario is for the client not to share the toilet.

A nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification? a. "A small-lumen catheter will help prevent injury to my urethra." b. "I will use a new, sterile catheter each time I do the procedure." c. "My family members can be taught to help me if I need it." d. "Proper handwashing before I start the procedure is very important."

b. "I will use a new, sterile catheter each time I do the procedure." Catheters are cleaned and re-used. Proper handwashing and cleaning of the catheter have shown no increase in bacterial complications. Catheters are replaced when they show signs of deteriorating.

A nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? a. 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C) b. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours c. 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy d. 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed

b. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client may be oversedated and may not be aware of any discomfort caused by bladder distention.

While caring for an 84-year old patient, the nurse monitor's the fluid and electrolyte balance, recognizing what as a normal state of aging? a. Hyperkalemia b. Hyponatremia c. Decreased insensible fluid loss d. Increased plasma oncotic pressures

b. A decrease in renin and aldosterone and an increase in ADH and ANP lead to decreased sodium reabsorption and increased water retention by the kidney which lead to hyponatremia.

Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence and is started on propantheline (Pro-Banthine). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? Select all that apply. a. Administer the drug at bedtime. b. Encourage increased fluids. c. Increase fiber. d. Limit the intake of dairy products. e. Offer hard candy for "dry" mouth.

b. Encourage increased fluids. c. Increase fiber. e. Offer hard candy for "dry" mouth. (b) Anticholinergics cause constipation. Increasing fluids will help with this problem. (c) Anticholinergics cause constipation. An increase in daily fiber in the client's diet will help. (e) Anticholinergics cause extreme dry mouth. INCORRECT: (a) Taking the drug at night will not have an effect on the complications encountered-dry mouth and constipation. The drug is usually taken three to four times a day. (d) Limiting dairy products does not have an effect on the complications encountered-dry mouth and constipation.

Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence. The health care provider prescribes the drug, estrogen (Premarin). Which risks does the nurse tell the client to expect? Select all that apply. a. Dry mouth b. Endometrial cancer c. Increased intraocular pressure d. Thrombophlebitis e. Vaginitis

b. Endometrial cancer d. Thrombophlebitis (b) Estrogen use can increase the risk for endometrial cancer. (d) Estrogen use can increase the risk for thrombophlebitis. Women who smoke-especially-should not use this drug. INCORRECT: (a) Dry mouth is not a side effect of estrogen use. (c) Increased intraocular pressure is not a side effect of estrogen use. It is a problem with anticholinergic use. (e) Vaginitis is not a side effect of estrogen use. However, clients should report any unusual vaginal bleeding.

Which interventions are helpful in preventing bladder cancer? Select all that apply. a. Drinking 2½ liters of fluid a day b. Showering after working with or around chemicals c. Stopping the use of tobacco d. Using pelvic floor muscle exercises e. Wearing a lead apron when working with chemicals f. Wearing gloves and a mask when working around chemicals and fumes

b. Showering after working with or around chemicals c. Stopping the use of tobacco f. Wearing gloves and a mask when working around chemicals and fumes (b)Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Bathing after exposure to them is advisable. (c) Tobacco use is one of the highest if not the highest risk factor in the development of bladder cancer. (f) Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Protective gear is advised. INCORRECT: (a) Increasing fluid intake is helpful for some urinary problems such as urinary tract infection (UTI), but no correlation has been noted between fluid intake and bladder cancer risk. (d) Using pelvic floor muscle strengthening exercises (Kegel) is helpful with certain types of incontinence; but no data show that these exercises prevent bladder cancer. (e) Precautions should be taken when working with chemicals; however, lead aprons are used to protect from radiation.

Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her stress incontinence? a. "They can relieve your anxiety associated with incontinence." b. "They help your bladder to empty." c. "They may be used to improve urethral resistance." d. "They decrease your bladder's tone."

c. "They may be used to improve urethral resistance." Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance.

A nurse is educating a female about hygiene measures to reduce her risk for urinary tract infection. What does the nurse instruct the client to do? a. "Douche-but only once a month." b. "Use only white toilet paper." c. "Wipe from your front to your back." d. "Wipe with the softest toilet paper available."

c. "Wipe from your front to your back." Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection.

A cognitively impaired client has urge incontinence. Which method for achieving continence does a nurse include in the client's care plan? a. Bladder training b. Credé method c. Habit training d. Kegel exercises

c. Habit training Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis.

The certified wound, ostomy, continence nurse (CWOCN) or enterostomal therapist (ET) teaches a client who has had a cystectomy about which care principles for the client's post-discharge activities? a. Nutritional and dietary care b. Respiratory care c. Stoma and pouch care d. Wiping from front to back (asepsis)

c. Stoma and pouch care The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms.

Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? a. Functional b. Overflow c. Stress d. Urge

c. Stress Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence.

Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. Which drug does the nurse expect the health care provider to prescribe? a. Nitrofurantoin after intercourse b. Premarin c. Trimethoprim/sulfamethoxazole d. Trimethoprim with intercourse

c. Trimethoprim/sulfamethoxazole Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole or fosfomycin is effective in treating uncomplicated, community-acquired UTI in women.

Which patient is at risk for hypernatremia? a. Has deficiency of aldosterone b. Has prolonged vomiting and diarrhea c. Receives excessive IV 5% dextrose solution d. Has impaired consciousness and decreased thirst sensitivity

d. A major cause of hypernatremia is a water deficit, which can occur in those with a decreased sensitivity to thirst, the major protection against hyperosmolality. All other conditions lead to hyponatremia

In a patient with sodium imbalances, the primary clinical manifestations are related to alterations in what body system? a. Kidneys b. CVS c. Musculoskeletal system d. CNS

d. As water shifts into and out of the cells in response to osmolality of the blood, the cells that are most sensitive to shrinking or swelling are those of the brain, resulting in neurologic symptoms

A patient is taking diuretic drugs that cause sodium loss from the kidney. What fluid electrolyte imbalance is likely to occur with this patient? a. Hyperkalemia b. Hyponatremia c. Hypocalcemia d. Hypotonic fluid loss

d. Because of the osmotic pressure of sodium, water will be excreted with hte sodium lost with the diuretic. A change in the relative concentration of sodium will not be seen but an isotonic fluid loss will occur

A health care provider requests phenazopyridine (Pyridium) for a client with cystitis. What does the nurse tell the client about the drug? a. "It will act as an antibacterial drug." b. "This drug will treat your infection, not the symptoms of it." c. "You need to take the drug on an empty stomach." d. "Your urine will turn red or orange while on the drug."

d. "Your urine will turn red or orange while on the drug." Phenazopyridine (Pyridium) will turn the client's urine red or orange. Care should be taken because it will stain undergarments. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed.

Which client does the nurse manager on a medical unit assign to an experienced LPN/LVN? a. 42-year-old with painless hematuria who needs an admission assessment b. 46-year-old scheduled for cystectomy who needs help in selecting a stoma site c. 48-year-old receiving intravesical chemotherapy for bladder cancer d. 55-year-old with incontinence who has intermittent catheterization prescribed

d. 55-year-old with incontinence who has intermittent catheterization prescribed Insertion of catheters is within the education and legal scope of practice for LPNs/LVNs.

The daughter of a patient with early familial Alzheimer's disease (AD) asks how AD is different from forgetfulness. You describe early warning signs of AD, including: a. Forgetting a colleague's name at a party b. Repeatedly misplacing car keys or a wallet c. Leaving a pot on the stove that boils dry and burns d. Having no memory of preparing a meal and forgetting to serve or eat it

d. Having no memory of preparing a meal and forgetting to serve or eat it. Memory loss that affects job skills: Frequent forgetfulness or unexplainable confusion at home or in the workplace may signal that something is wrong. This type of memory loss goes beyond forgetting an assignment, a colleague's name, a deadline, or a phone number. Difficulty performing familiar tasks: It is not abnormal for most people to become distracted and to forget something (e.g., leave something on the stove too long). People with Alzheimer's disease (AD) may cook a meal but then forget not only to serve it but also that they made it. Misplacing things: For many individuals, temporarily misplacing keys, purses, or wallets is a normal albeit frustrating event. Persons with AD may put items in inappropriate places (e.g., eating utensils in clothing drawers) but have no memory of how they got there.

Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients? a. Encouraging them to drink fluids b. Irrigating all catheters daily with sterile saline c. Recommending catheters should be placed in all clients d. Re-evaluating periodically the need for indwelling catheters

d. Re-evaluating periodically the need for indwelling catheters Studies have shown that re-evaluating the need for indwelling catheters in clients is the most effective way to prevent UTI in the hospital setting.

A client who is 6 months pregnant comes to the Prenatal Clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this client? a. Discharges the client to her home for strict bedrest for the duration of the pregnancy b. Instructs the client to drink a minimum of 3 liters of fluids, especially water, every day to "flush out" bacteria c. Recommends that the client refrain from having sexual intercourse until after she has delivered her baby d. Refers the client to the Clinic Nurse Practitioner (CNP) for immediate follow-up

d. Refers the client to the Clinic Nurse Practitioner (CNP) for immediate follow-up Pregnant women with UTI require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor-with adverse effects for the fetus.

A nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by a health care provider, for a client with a urinary tract infection (UTI) does the nurse question? a. Bactrim b. Cipro c. Noroxin d. Tegretol

d. Tegretol Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs Tequin and Tegretol. The former is used for UTI, and the latter is prescribed as an oral anticonvulsant.

A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection (UTI). Which nursing action can the home health RN delegate to a home health aide (unlicensed assistive personnel [UAP])? a. Assisting the client in developing a schedule for when to take prescribed antibiotics b. Inserting a straight catheter as necessary if the client is unable to empty the bladder c. Teaching the client how to use the Credé maneuver to empty the bladder more fully d. Using a bladder scanner (with training) to check residual bladder volume after the client voids

d. Using a bladder scanner (with training) to check residual bladder volume after the client voids Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (UAP) who has been trained and evaluated in this skill.

A nurse is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body parts? a. Children's terms that are easily understood b. Slang words and terms that are heard "socially" c. Technical and medical terminology d. Words that the client uses

d. Words that the client uses The nurse should use the terms with which the client is most familiar, so there is no chance for the client to misunderstand information. Using the client's language ensures the comfort level for the client.

A nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates correct understanding of these procedures? a. "If I restrict my oral intake of fluids, the adjustment will be easier." b. "I must go to the restroom more often because my urine will be excreted through my anus." c. "I need to wear loose-fitting pants so the urine can flow into my ostomy bag." d."I will have to drain my pouch with a catheter."

d."I will have to drain my pouch with a catheter." For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter.

Overnutrition

ingestion of more food than required

Gynoid obesity resembles a/an

pear

Undernutrition

poor nourishment due to inadequate diet or disease