Evolve questions for fundamentals exam 4 04/30

nephrotic syndrome

protein uria, dyslipidemia, peripheral edema, hypoalbuminia , hypovolemia (it is due to damage to the glomerulus)

s/s of cystitis

requency and urgency of urination, pain on micturition, and hematuria

________ manifest with the presence of burrows with erythematous papules with possible vesiculation and interdigital web crusting. It is treated with __ _______ topical lotion

scabies; 5% permethrin

Do not keep the bed above 30 degrees to prevent

sheering

How does alcohol affect sleep

speeds onset of sleep and reduces rem sleep, awakens person during night and diff falling back asleep

can cause the loss of urine control bc of bladder overactivity and impaired coordination between the contracting bladder and urine sphincter

spinal cord injury or intervertebral disk dx (s1)

When moving an immobile patient from a bed to another surface, use a designated slide board well lubricated with

talc or use a mechanical lift

cystoscopy may cause localized trauma of the urethra resulting in

transient (1-2 days) dysuria and hematuria

Percussion identifies underlying abdominal structures and detects lesions, fluid, or gas within the abdomen. Gas or flatulence creates a tympanic note. Masses, tumors, and fluid are _____ to percussion.

tympanic note; dull

The ileoanal pouch anastomosis is a surgical procedure for patients who need to have a colectomy for treatment of

ulcerative colitis or familial adenopolyposis (FAP)

Fluids containing caffeine and other bladder irritants can prompt

unsolicited bladder contractions, resulting in frequency, urgency, and incontinence.

is the inability to partially or completely empty the bladder.

urinary retention

Herb effective for insomnia & restless leg syndrome

valerian

A Person with a transverse colostomy

will have thick liquid stool to soft consistensy

Children with fecal soiling associated with neuropathic or structural abnormalities of the anal sphincter sometimes have an

antegrade continence enema (ACE) procedure.

can interfere with timely access to a toilet

arthritis, parkinsons, dementia and chronic pain syndrome

FVO Neuromuscular changes

-Altered level of conciousness -HA -Visual disturbances -Skeletal muscle weakness -Parasthesias

A client reports to the nurse sleeping until noon every day and taking frequent naps during the rest of the day. Which would the nurse do initially? -Encourage the client to exercise during the day -Arrange a referral for a thorough medical evaluation -Explain that this behavior is an attempt to avoid facing daily responsibilities -Identify that the client is describing clinical findings associated with narcolepsy

-Arrange a referral for a thorough medical evaluation (Rationale: This behavior is a sign of hypersomnia, and the client needs a medical assessment; it is commonly caused by central nervous system damage or certain kidney, liver, or metabolic disorders. Exercise is appropriate for a client experiencing insomnia, not hypersomnia.)

A toddler is admitted to the pediatric unit with diarrhea and severe dehydration. After several days of treatment, the child is evaluated. Which clinical findings indicate that the child is rehydrated? Select all that apply. -Decreased hematocrit -Increase in daily weight -Negative blood cultures -Increase in sedimentation rate -Decreased blood urea

-Decreased hematocrit -Increase in daily weight -Decreased blood urea (A decrease in the hematocrit level indicates that the blood has become less concentrated as hydration improves. The daily weight reading increases with rehydration as water is retained. One liter of fluid weighs 2.2 lb (1 kg). The BUN level will decrease as blood volume increases because the components of the blood are in a more dilute solution. A blood culture will not provide information about hydration. An increased sedimentation rate indicates an inflammatory process, not the state of hydration.)

Signs of dehydration in infants and young children include:

-Dry Mouth and tongue - No tears when crying -No wet diapers for 3 hours or more -Sunken eyes or cheeks or soft spot in the skull -High Fever -Listlessness or irritability

(bladder) older adults may

-decrease in bladder capacity -increase in bladder irritability -an increase in bladder frequency

The female urethra is approximately

3-4 cm long (1 - 1.5 inches)

When positioning a patient on his or her side, position at a

30 degree tilt

benzodiazepines and sleep

Alter REM sleep Increase sleep time Increase daytime sleepiness

anticonvulsants and sleep

Decrease REM sleep time Cause daytime drowsiness

Nicotine and sleep

Decreases total sleep time Decreases REM sleep time Causes awakening from sleep Causes difficulty staying asleep

Which actions would be included in the plan of care for an adolescent mother on the postpartum unit who tells the nurse that she hopes her baby will "be good" and sleep through the night. -Explain the period of PURPLE -crying -Keep the baby awake for longer periods during the day -Ensure sleep by adding cereal to the baby bedtime bottle -Put a soft brightly colored toy next to the baby at bedtime

Explain the period of PURPLE crying (The period of PURPLE (an acronym standing for Peak of crying, Unexpected, Resists soothing, Pain-like face, Long lasting, Evening) crying is an example of a program used by many hospital nurses to educate parents on the patterns of infant crying and methods to quiet the baby.)

The kidneys also affect calcium and phosphate regulation so patients with kidney impairment are also at risk for

anemia, hypertension and electrolyte imbalances

about 30% of ____ ___________ sleep is time is in rem cycle.

an infant

patients with chronic kidney conditions are at high risk for

anemia bc they cannot produce or cannot produce enough erythripoietin

Obstruction of the urine flow through the ureters (such as kidney stones) can cause

back flow of urine (urinary reflex) causing distention (hydrometer/hydronephrosis) and in some cases permanent kidney damage

What is the BRAT diet?

bananas, rice, applesauce, toast

Which mechanism of action explains how aluminum hydroxide decreases serum phosphorus?

binding with phosphorus in the intestines

cerebral cortex, thalamus and hypothalamus and brainstem control

bladder control

Kidneys help maintain renal blood flow through vasodilation by producing

prostaglandin e2 and prostacyclin These mechanisms increase arterial blood pressure and renal blood flow

The viral hepatitis diet should be high in

carbohydrates, with moderate protein and fat content

beta adrenergic blockers and sleep

cause nightmares, insomnia and cause awakening from sleep

can alter bladder contractility and the ability to sense bladder filling. Patients experience either bladder overactivity or deficient bladder emptying.

diabetes mellitus, ms and stroke

Tx of ticks (Borrelia burgdorferi)

doxycyclinem tetracycline, iv antibiotics

Symptoms of prostate cancer:

dysuria, hesitancy, urinary urgency, and leaking or dribbling (and normal spa range is 0 - 4 ng/ml)

Normal bowel sounds should occur

ever 5 to 15 seconds and last a second to several seconds

How would the nurse expect the urine of a child with acute glomerulonephritis with hematuria to appear?

flacola colored

When the kidneys become infected or inflames they can become tender resulting in: You assess for tenderness by gently percussing the

flank pain; costovertebral angle (the angle formed by the spine and 12th rib)

With an ileostomy the fecal effluent leaves the body before it enters the colon, creating

frequent liquid stools

valsava maneuver increases demands on the

heart

Use a mild, ________ ______ ________ or gentle commercial cleanser for incontinence

heavily fatted soap

As a client excretes fluid the urine specific gravity

increases

If fluids, electrolytes, and solutes are balanced

increased fluid intake increases urine production.

observable peristalsis means

intestinal obstruction

When there is a fluid volume defect fluid moves from the

intracellular and interstitial compartments to the intravascular compartment in an attempt to maintain blood volume

What is an ileus

loss of peristalsis w/o structural obstruction

signs and symptoms of chronic glomerulonephritis

Generalized edema headache; associated with hypertension fatigue dyspnea (difficult breathing) weight loss loss of strength increasing irritability nocturia

narcotics and sleep

Suppress REM sleep Cause increased daytime drowsiness

alcohol decreases the release of

antidiuretic hormones thus increasing urine production

Which action to promote sleep would the nurse recommend to a client?

)getting out of bed if unable to fall asleep after 20 min (To prevent sleep disturbances, a client should get out of bed if he or she is not able to fall sleep after 20 minutes. To prevent sleep disturbances, a client should not perform strenuous exercise within 6 hours before bedtime. A client should avoid reading, writing, and eating in bed. The client should also lower the temperature of the bedroom and keep it dark and quiet.

The nurse is teaching a client about sleeping positions to follow to prevent pressure ulcers. Which statement made by the client indicates effective learning? Select all that apply. One, some, or all responses may be correct. - I should use pressure relieving pads -I should place a rubber ring under the sacral area - I should place pillows between two bony surfaces -I should keep the head of the bed elevated above 30 degrees - I should keep my heels off the bed surface using a bed pillow under the ankles

- I should use pressure relieving pads - I should place pillows between two bony surfaces - I should keep my heels off the bed surface using a bed pillow under the ankles

s/s of pyelonephritis

- N/V - Fever and chills - Flank pain - Costovertebral tenderness

The nurse recognizes which statements are true regarding the pharmacokinetic changes observed in infants? Select all that apply. One, some, or all responses may be correct. -an infants fat content is higher - an infants gastric pH is less acidic -An infants gastric emptying is slow -An infants first-pass metabolism is slow -An infants transdermal absorption is rapid

- an infants gastric pH is less acidic -An infants gastric emptying is slow -An infants first-pass metabolism is slow

• Hypnotics interfere with

- reaching deeper sleep stages -Provide only temporary (1 week) increase in quantity of sleep -Eventually cause "hangover" during day; excess drowsiness, confusion, decreased energy Sometimes worsen sleep apnea in older adults

FVO Resp changes/GI changes

-Increased response rate -shallow resp -SOB -Moist crackles present on auscultation GI Increased motility Enlarged liver

FVO cardiovascular changes

-increased pulse rate -Bounding pulse quality -Elevated blood pressure -Decreased pulse pressure -Elevated central venous pressure -Distended neck and hand veins -Engorged varicose veins -Wt gain

FVO Skin and mucous membrane changes

-pitting edem in dependant areas -Skin pale and cool to touch

Clinical manifestations of lice (Borrelia burgdorferi)

-ringlike rash 3-4 wks after bite -Rash commonly in groin, buttocks, axillae, trunk, and upper arms and legs -flu-like symptoms -Cardiac, arthritic and neurologic manifestations

A client with a history of severe diarrhea for the past 3 days is admitted for dehydration. The nurse anticipates administering which intravenous (IV) solution? -0.3% sodium chloride -0.9% sodium chloride -5% dextrose and 0.9% sodium chloride -5% dextrose and lactated ringers solution

0.9% sodium chloride An IV solution of 0.9% sodium chloride is the most appropriate initial IV fluid for this client because it is an isotonic solution that will act as a volume expander to quickly replace volume losses and promote physiological stabilization

Which is the maximum length for an enema tube in an adolescent?

10 cm

The average preschooler sleeps about

12 hours a night

Normal sleep requirements toddlers Preschoolers? School age? Adolescents? Young adults? Middle adults?

12 hours total with nap 12 hours/night varies; 9-12 hours 8-10 hours recomended 6-8.5 7-9

infant normal sleeping pattern

15 hours with naps

Normal sleep requirements neonates

16 hours

The male urethra is about

18 to 20 cm (7 to 8 in) long

The nurse manager is implementing a change in evening care for clients to include back rubs to promote sleep. The nurse manager convinces the managers of various nursing units and supports nursing staff who are willing to implement the change. Which component of Kotter's 8-step model is involved in this scenario? -Creating short-term wins -Creating a vision for change -Forming a powerful coalition -Anchoring the changes in the culture

Forming a powerful coalition

_____ ______ bites manifest as minute, red, noninflammatory points flush with the skin that progress to papular wheal-like lesions with secondary excoriation in intrascapular region. These bites are treated with gamma benzene hexachloride or pyrethrins.

Head lice

The nurse reviews the serum laboratory values of a client. The nurse suspects hypofunctioning of the adrenal gland based on which results? Select all that apply. One, some, or all responses may be correct.

Increased calcium, decreased cortisol, decreased sodium

A client develops an intestinal obstruction. A nasogastric tube is inserted and connected to low, continuous suction. The nurse monitors the client for fluid volume deficit. Which clinical finding would the nurse expect if the client becomes dehydrated? -Restlessness -Constipation -Inelastic skin turgor -Increased blood pressure

Inelastic skin turgor When there is a fluid volume deficit, fluid moves from the intracellular and interstitial compartments to the intravascular compartment in an attempt to maintain blood volume. Cellular dehydration is manifested by poor (inelastic) tissue turgor, which is assessed by the rapidity with which skin returns to its original position after being pinched.

A client who has had right upper quadrant pain for several months now experiences clay-colored stools. Laboratory results reveal elevated liver enzymes, and a needle biopsy of the liver is scheduled. What would the nurse include in the client's teaching about the procedure?

Lying on the right side after the procedure is required because it will decrease the risk of hemorrhage. (Because of the vascularity of the liver, compression of the needle insertion site limits the risk of hemorrhage; also, it decreases the risk of bile leakage.)

The nurse is reviewing a plan of care for a client who was admitted with dehydration as a result of prolonged watery diarrhea. Which new prescription will the nurse question? -Oral psyllium -Oral potassium supplement -IV normal saline -Magnesium citrate

Magnesium citrate (Oral psyllium will absorb watery diarrhea -oral potassium is appropriate bc diarrhea causes pot loss - IV normal saline is the intervention of choice to manage dehydration due to diarrhea -Magnesium citrate would worsen dehydration bc it has a laxative effect)

The nurse suspects that the client has shift-work sleep disorder (SWSD). Which medication is indicated to treat this disorder? -Caffeine -Modafinil -Atomoxetine -Methylphenidate

Modafinil

The nurse is assessing a client who reports excessive daytime sleepiness, sudden muscle weakness during intense emotions, and an inability to walk just after waking or before going to sleep. Which disorder would the nurse suspect that the client is experiencing? -Nocturia -Narcolepy -sleep apnea -sleep deprivation

Narcolepsy

A decrease in aldosterone as is the case of Addisons dx (adrenal insuffeciency) causes retention of what electrolyte?

Potassium

s/s of nephrotic syndrome

Proteinuria, hypoalbuminemia, edema (anasarca), hyperlipidemia

With renal failure how is vitamin d and c affected?

Since the kidneys cannot activate vitamin d, then the body cannot absorb calcium therefore a supplement would be needed.

How do antidepressants and stimulants effect sleep

Suppress REM sleep Decrease total sleep time

An older adult is hospitalized for weight loss and dehydration due to nutritional deficit. Which factor would the nurse consider when planning care for this client?

The nutritional needs of an older adult are basically unchanged except for a decreased need for calories.

. An 80-year-old client is admitted to the hospital with severe dehydration. The client's daughter asks the nurse how her mother could have become dehydrated. Which response by the nurse is correct?

The thirst reflex is diminished with age

Which rational explains the purpose of administering diphenoxylate hydrochloride to clients with acquired immunodeficiency syndrome (AIDS) -To manage pain -To manage diarrhea -To manage candidal esophagititis -To manage behavioral problems

To manage diarrhea

Three percent sodium chloride is a high-concentration (hypertonic) electrolyte solution; it would only be used in a client with

hyponatremia and must be monitored closely during infusion

A client reports severe itching with redness and wheals on the uncovered parts of the legs after sleeping in an old bed. The primary health care provider prescribes antihistamines and topical corticosteroids. Which assessment finding made by the nurse supports the intervention? -Spreading, ringlike rash with erythema border after 3-4 weeks -Presence of burrows with erythematous papule with possible vesiculation -Uticaria grouped in threes surrounded by vivid flare, transforming into a persistent lesion -progression of minute red points to Paula wheal-like lesions with secondary excoriation

Urticaria grouped in threes surrounded by vivid flare, transforming into a persistent lesion

The nurse is caring for a client who has been admitted with partial- and full-thickness burns over 25% of the total body surface area. Lactated Ringer solution and 5% dextrose have been prescribed. Which would the nurse identify as the purpose of these fluids?

maintaining blood volume

Occurs when the brain gives the bladder permission to empty

micrutrition

A person with a sigmoid colostomy will have a

more formed stool

Diuretics affects on sleep

night time awakening caused by nocturia

High-Pitched and hyperactive bowel sounds

occur with small intestine obstruction and inflammatory disorders

two micrutrition centers in the spinal cord

one controls inhibition of bladder contraction and the other coordinates bladder contractility

Common causes of constipation chronic illnesses:

parkinsons, MS, rheumatoid arthritis, chronic bwel dx, depression

opioids decrease

peristalsis

can cause obstruction of the bladder outlet, causing URINARY RETENTION

prostatic enlargement or BPH

Bedbug bites manifest as _________ grouped in threes surrounded by vivid flare, transforming into persistent lesion. Severe itching due to bedbug bites is treated:

urticaria; treated with antihistamines, topical corticosteroids