Day 3

When caring for a group of clients, the nurse recognizes which of these individuals has increased risk for balanitis?

Client with a sexually transmitted infection Explanation: Balanitis refers to local inflammation of the glans penis that may result from trauma, irritation, or infection caused by a wide array of organisms, most commonly Candida albicans.

What would be important for the nurse to teach the parents of a pediatric client about the use of topical corticosteroids?

"Apply the medication sparingly." Explanation: Topical use of corticosteroids should be limited in children, because their body surface area is comparatively large, so that the amount of the drug absorbed in relation to weight is greater than in an adult. Apply sparingly and do not use in the presence of open lesions. Do not occlude treated areas with dressings or diapers, which may increase the risk of systemic absorption.

The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful?

"The belief is that it is an autoimmune disorder with an unknown trigger." Explanation: Systemic lupus erythematosus is believed to be an autoimmune disorder but the triggering mechanism is not known. The disorder is more common in women than in men, most with the disorder in the 3rd or 4th decade of life. The disease is considered the "great imitator" because the clinical signs resemble many other conditions. SLE is a diffuse connective tissue disease that affects multiple body systems.

A nurse is giving discharge instructions to a client who came to the emergency department following an ankle sprain. The client asks "Why does this hurt so much?" Which response would be most appropriate from the nurse?

"The nerves are being stimulated by the pressure from the swelling at the sprain."

A child is admitted to the emergency department and diagnosed with a suspected ruptured appendix. The parents are anxious about the child's condition and ask the nurse what to expect for immediate treatment. What is the best response by the nurse?

"We will be preparing your child for emergency surgery."

A client presents with an oral temperature of 101.7°F (38.7°C) and painful, swollen cervical lymph nodes. Laboratory results indicate neutrophilia with a shift to the left. Which diagnosis is most likely?

A severe bacterial infection Explanation: Fever and painful, palpable lymph nodes are nonspecific inflammatory conditions; leukocytosis is also common but is a particular hallmark of bacterial infection. Neutrophilia also indicates a bacterial infection, whereas increased levels of other leukocytes would indicate other etiologies. The shift to the left—the presence of many immature neutrophils—indicates that the infection is severe, because the demand for neutrophils exceeds the supply of mature cells.

An adolescent male comes to the urgent care clinic. Upon assessment, the following is noted: history of circumcision, erythema of the glans, and prepuce with a malodorous discharge. Based on symptoms, the probable diagnosis would be:

Acute superficial balanoposthitis Explanation: The symptoms for this client are suggestive of acute superficial balanoposthitis. It occurs in males who have phimosis or a large redundant prepuce. Balanitis xerotica occurs in uncircumcised males.

A client has been hospitalized with pancreatitis for 3 days. The nurse assesses the client and documents the accompanying results. The nurse realizes these findings are a manifestation of what sign?

Cullen's sign Explanation: Cullen's sign is evidenced by discoloration at the periumbilical area. This sign may indicate an underlying subcutaneous intraperitoneal hemorrhage. Chvostek's sign is a facial nerve spasm and Trousseau's sign is a carpopedal spasm; both signs occur with hypocalcemia. Broca's area, not sign, is an area within the brain that controls the motor functions involved in speech.

A child is admitted with a temperature, 101.2°F (38.4°C); pulse rate 100 beats/min; respirations 24 breaths/min. On admission the pain is localized in right lower quadrant. Legs are drawn up against the abdomen. Bowel sounds are sluggish. Rebound tenderness is present. White blood cell count of 17,000/mm3. Ultrasound confirms appendicitis. Which instruction would the nurse give to the child and the parent?

Do not rub or put pressure on the abdomen. Explanation: The nurse would instruct the child/parent to not rub or put pressure on the abdomen as palpating an inflamed appendix may cause it to rupture. A child with appendicitis will be NPO for surgery and therefore not instructed to drink. Heat to the abdomen may also cause the inflamed appendix to rupture. Ice is not an effective intervention.

Pathologic changes in the structure of the capillary and venular endothelium can result in the accumulation of fluid in interstitial space. What term refers to this accumulation?

Edema

A patient prescribed a medication for hypertension started taking it 3 days ago and arrives in the emergency department with an edematous face and tongue and having a difficult time speaking. What medication is the nurse aware of that may produce this type of side effect?

Enalapril (Vasotec)

A patient comes to the clinic with complaints of a sore throat and is diagnosed with acute pharyngitis. What does the nurse understand is the cause of acute pharyngitis?

Group A, beta-hemolytic streptococci Explanation: Viral infection causes most cases of acute pharyngitis. Responsible viruses include the adenovirus, influenza virus, Epstein-Barr virus, and herpes simplex virus. Bacterial infection accounts for the remainder of cases. Ten percent of adults with pharyngitis have group A beta-hemolytic streptococcus (GABHS), which is commonly referred to as group A streptococcus (GAS) or streptococcal pharyngitis.

Prior to administering a nonsteroidal anti-inflammatory drug (NSAID) to a client, what should the nurse obtain from the client? (Select all that apply.)

History of allergies Pain assessment Current medical conditions Past medical conditions Vital signs

The nurse provides a cool glass of water to a client with inflamed throat tissue. What condition should the nurse caution the client to avoid when drinking very hot liquids while having an inflamed throat?

Hyperalgesia Swallowing very hot fluid would produce hyperalgesia pain in inflamed pharyngeal tissue.

A 78-year-old male client begins an immunosuppressant therapy for his rheumatoid arthritis. The nurse is concerned because this client is at greater risk for what complication, compared with younger adults using the same treatment modality?

Infections

Which signs and symptoms should prompt a young woman's primary care provider to assess for systemic lupus erythematosus (SLE)?

Joint pain and proteinuria Explanation: Renal involvement occurs in approximately one half to two-thirds of persons with SLE, and arthralgia is a common early symptom of the disease. Nephrotic syndrome causes proteinuria with resultant edema in the legs and abdomen, and around the eyes. Although the manifestations of SLE are diffuse, these do not typically include alterations in hemostasis, gastrointestinal symptoms, dysmenorrhea, or miscarriage.

The cardinal signs of inflammation include swelling, pain, redness, and heat. What is the fifth cardinal sign of inflammation?

Loss of function

To avoid the side effects of corticosteroids, which medication classification is used as an alternative in treating inflammatory conditions of the eyes?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

The nurse is admitting a patient with COPD. The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia?

PaO2

Which term is used to describe edema of the optic nerve?

Papilledema Explanation: Papilledema is edema of the optic nerve. Scotoma is a defect in vision in a specific area in one or both eyes. Lymphedema is the chronic swelling of an extremity due to interrupted lymphatic circulation, typically from an axillary dissection. Angioneurotic edema is a condition characterized by urticaria and diffuse swelling of the deeper layers of the skin.

A client is admitted with an abrupt onset of referred pain to the epigastric area, with an episode of nausea. On the nurse's initial assessment, the client is lying still and taking shallow breaths, with a rigid abdomen. Which problem is the client experiencing?

Peritonitis Explanation: The onset of peritonitis may be acute, as with a ruptured appendix, or it may have a more gradual onset, as occurs in pelvic inflammatory disease. The pain usually is more intense over the inflamed area. The person with peritonitis usually lies still because any movement aggravates the pain. Breathing often is shallow to prevent movement of the abdominal muscles. The abdomen usually is rigid and sometimes described as boardlike because of reflex muscle guarding.

Magnetic resonance imaging of a client's knee has revealed the presence of bursitis. The nurse should anticipate performing which intervention for bursitis?

Placing an ice pack on the knee to decrease swelling Explanation: Bursae contain synovial fluid, and they exist to prevent friction on a tendon. They are necessary in areas where pressure is exerted because of close approximation of joint structures. Bursae may become injured or inflamed, causing discomfort, swelling, and limitation in movement of the involved area. Buck's traction, diphenhydramine, and surgery are not the standard treatment for bursitis.

What disease has primary lesions that have a silvery scale over thick red plaques?

Psoriasis vulgaris

The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching?

Risk for infection

The nurse is caring for a client who is status post operative from a vein stripping. What would the nurse monitor for?

Swelling in the operative leg

A 62-year-old client has been prescribed an antihistamine to alleviate vasomotor rhinitis. The client reports gastric irritation after taking the tablet. Which instructions should the nurse provide to help alleviate the client's condition?

Take the tablet with food.

A client with GERD develops esophagitis. Which diagnostic test would the nurse expect the physician to order to confirm the diagnosis?

Upper endoscopy with biopsy

A client has just been admitted to the unit with a history of recent streptococcal infection, hematuria, and proteinuria. Based on these findings, the nurse suspects which condition?

acute glomerulonephritis Explanation: Recent streptococcal infection, hematuria, and proteinuria are indicative of acute glomerulonephritis. These symptoms do not suggest acute kidney injury, prune belly syndrome, or urinary tract infection.

Some leukotrienes have the ability to attract neutrophils and to stimulate them. This property is known as:

chemotaxis.

A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer?

colchicine Explanation: A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The health care provider orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide is a diuretic; it is not used to relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps; it is not used to treat gout.

A client on NSAIDs is experiencing congestive heart failure. The healthcare provider has ordered a diuretic to the treatment plan. The nurse evaluates the client for what reaction?

decreased effectiveness of the diuretic. When combined with NSAIDs, there is decreased effectiveness, not toxicity, of the diuretic. Diuretics do not affect the effectiveness of NSAIDs, nor do they affect NSAID toxicity.

Clients who have had PID are prone to which complication?

ectopic pregnancy

The nurse is assessing a hospitalized child diagnosed with nephrotic syndrome. What set of assessments is most important for the nurse to complete to help identify hypoalbuminemia in this child?

heart rate and blood pressure Explanation: In nephrotic syndrome, hypoalbuminemia occurs with a loss of protein and albumin in the bloodstream. This causes many fluid shifts from the bloodstream (intravascular) to the interstitial tissues. The result is edema, as the fluid in the interstitial spaces increases. This leaves the intravascular fluid decreased or depleted, causing hypovolemia. The best set of assessments for this condition is to assess the heart rate and blood pressure. These will indicate hypovolemia from the fluid shifts occurring. The respiratory rate and the work of breathing are assessed for fluid overload in the lungs. The heart sounds and the lung sounds are assessed for fluid overload, not decreased fluid. Assessing the oxygen saturation is only necessary if there are adventitious lung sounds or increased work of breathing.

The nurse assesses a client in the emergency department with reports of abdominal pain. Which assessment finding will the nurse interpret as supporting appendicitis?

increased pain when pressure to the lower right quandrant is released Explanation: Appendicitis usually has an abrupt onset, with pain referred to the epigastric or periumbilical area that becomes more localized to the right lower quadrant over 2 to 12 hours. The nurse will interpret rebound tenderness, which is pain that occurs when pressure is applied to the area and then released, as supporting appendicitis. Although nausea can accompany the pain, it should not be intermittent over several days as the symptoms progress quickly. Palpation of the abdomen usually reveals a deep tenderness in the lower right quadrant, which is confined to a small area. Urination should not alter the pain and appendicitis pain does not typically occur the upper quadrants.

An older adult client presents with a perforation of a peptic ulcer. The nurse will monitor for signs and symptoms of which priority complication?

peritonitis Explanation: Perforation occurs when an ulcer erodes through all the layers of the stomach or duodenum wall. With perforation, gastrointestinal contents enter the peritoneum and cause peritonitis. Although the client may experience vomiting or diarrhea, these are not the priority compared to peritonitis.

The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis?

reports of constant chest pain Explanation: The most characteristic symptom of pericarditis is chest pain. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning. Other signs may include a mild fever, increased WBC count, anemia, and an elevated ESR or C-reactive protein level. Dyspnea and other signs and symptoms of heart failure may occur.

A client seeks medical attention for skin reactions to mosquito bites. The client refuses to use prescription medication for the reactions. Which herbal supplement could the nurse suggest to treat the mosquito bites?

tea tree oil