Final Exam 220

Deficient ADH (antidiuretic hormone)

(DI) "Dehydrated" "Die" ADH! Diabetes Insipidous 7 D's 1. Diurese "Drain" fluid (High urine output) 2. Diluted urine low specific gravity (1.005) 3. Dry Inside "High and dry" labs HYPER osmolarity (High) HYPERnatremia over 145 Na+ (HIGH) 4. DRINKING a lot "thirsty" 5. DEHYDRATED dry mucous and skin 6. DECREASED blood pressure 7. DESMOpressin "Vasopressin" (ADH) Decrease urine output Death by headache! (low Na+) 135 or less

Excessive ADH (antidiuretic hormone)

(SI)ADH "Soaked" "yes" Adds Da H20 syndrome of inappropriate antidiuretic hormone 7 Ss 1. Stops urination ( low urine output) 2. Sticky and thick "urine" HIGH Sp gravity 1.030+ 3. Soaked inside "low and liquidy" labs HYPO osmlarity (low) HYPOnatremia below 135 Na+ (low) 4. SODIUM low!! (headache early sign) 5. SEIZURES- key words: headache, confusion 6. SEVERE high blood pressure 7. STOP ALL FLUIDS + GIVE SALT + Diuretics (NO IV or drinking) + ( IV 3% saline + eat salt)

Thyroid gland

- Anterior pituitary gland secretes thyroid stimulating hormone (TSH) - imbalances in thyroid hormones affect all body systems - TSH- increase indicates hypOthyroidism/ decrease- graves - T3 -T4

Syndrome of Inappropriate antidiuretic hormone (SIADH)

- Excess ADH causes fluid retention - Retained fluid causes cellular edema, imbalance of electrolytes (diluted) - Signs and symptoms - headache - weakness - anorexia - muscle cramps (electrolyte imbalances) - personality changes (increased sodium) - tachycardia - Urine concentrated- bloodwork diluted

Cognitive findings of psychotic disorders (schizophrenia)

- disordered thinking - inability to make decisions - poor problem-solving ability - difficulty concentrating to perform tasks - short term memory deficits - impaired abstract thinking

Positive symptoms of psychotic disorders (schizophrenia):

- hallucinations - delusions - alterations in speech - bizarre behavior (walking backward constantly)

Affective findings of psychotic disorders (schizophrenia)

- hopelessness - suicidal ideation - unstable or rapidly changing mood

Negative symptoms of psychotic disorders (schizophrenia)

-Catatonia - affect: blunted (narrow range of expression) or flat (facial expression never changes) - alogia: poverty of thoughts or speech (mumble or respond vaguely) - anergia: lack of energy - anhedonia: lack of pleasure or joy - avolition: lack of motivation in activities and hygiene

Diabetes Insipidous

-Deficiency in ADH -Reduces the ability of the kidneys to collect and concentrate urine- results in excessive diluted urination - Signs and symptoms - increased thirst - Excessive fluid intake without retention - Electrolyte imbalance - Urine is diluted- blood is concentrated (increased levels of everything)

A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? Select all that apply. A. Auditory hallucinations B. Lack of motivation C. Use of clang association D. Delusion of persecution E. Constantly waving arms F. Flat effect

A- auditory hallucinations C- use of clang association D- delusion of persecution E- constantly waving arms

Which of the following characteristics describe the obsessional thoughts experienced by clients with OCD? Select all that apply. A. intrusive B. realistic C. recurrent D. uncontrollable E. unwanted F. voluntary

A- intrusive C- recurrent D- uncontrollable E- unwanted

Nurse is assessing client with GAD. Which following finding should the nurse expect? Select all that apply. A. excessive worry for 6 months B. impulsive decision making C. delayed reflexes D. restlessness E. sleep disturbance

A. Excessive worry for 6 months D. restlessness E. sleep disturbance

A nurse is providing teaching for a client who has stage three HIV disease. Which of the following statements by the client should indicate to the nurse an understanding of the teaching? Select all that apply A. I will wear clothes when changing the pet liter box B. I will rinse raw fruits with water before eating them C. I will wear a mask when around family members who are ill D. I will cook vegetables before eating them.

A. I will wear clothes when changing the pet liter box B. I will rinse raw fruits with water before eating them C. I will wear a mask when around family members who are ill D. I will cook vegetables before eating them.

Mr. Johnson was recently admitted to a psychiatric unit because of severe OCD behavior. Which initial response by the nurse would be most therapeutic? A. accepting the ritualistic behavior B. challenging the client's needs for rituals C. expressing concern about harmfulness of the client's rituals D. limiting the client's rituals that are excessive

A. accepting the ritualistic behavior

A client who is sexually active asks the nurse about using pre-exposure prophylaxis (PrEP) for HIV. The nurse should tell the client the drug, a combination of 300mg tenofovir disoproxil fumarate and 200mg emtricitabine (TDF/FTC) can be used for which group of people who are at risk for becoming infected with HIV? A. anyone who is in an ongoing sexual relationship with an HIV infected partner. B. people who do not use condoms with in a sexual relationship C. a person who has a sexually transmitted disease that is not being treated. D. someone who has a compromised immune system.

A. anyone who is an ongoing sexual relationship with and HIV infected partner.

The nurse is providing follow-up care to a client with tuberculosis who does not regularly take the prescribed medication. Which of the following nursing actions would be the most appropriate for this client? A. ask the client's spouse to supervise the daily administration of the medications B. visit the client weekly to verify compliance with taking medication C. Notify the healthcare provider of the clients noncompliance and request a different prescription D. remind the client that tuberculosis can be fatal if it is not treated promptly.

A. ask the client's spouse to supervise the daily administration of the medications Rationale: Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. Visiting the client, changing the prescription, or threatening the client will not ensure compliance if the client will not or cannot follow to prescribe treatment.

A nurse is planning care for a client with BDD (body dysmorphic disorder). Which should the nurse do first? A. asses risk for self harm B. instill hope C. group therapy D. assist in treatment decisions

A. assess for risk for self harm

The client is diagnosed with cancer of the head of the pancreas. When assessing a client, which signs and symptoms will the nurse expect to find? A. clay colored stools and dark urine B. night sweats and fever C. left lower abdominal cramps and tenesmus D. nausea and coffee ground emesis

A. clay colored stools and dark urine Rationale: The client will have jaundice, clay colored stools, and tea colored urine resulting from blockage of the bile drainage.

A client with OCD is admitted to the hospital due to ritualistic hand washing that occupies several hours each day. The skin on the client's hands is red and cracked, with evidence of minor bleeding. The goal for this client is... A. decreasing the time spent washing hands B. eliminating the hand washing rituals C. providing milder soap for hand washing D. providing good skin care

A. decreasing the time spent washing hands

The nurse finds a container the clients urine specimen sitting on the counter in the bathroom. The client states that the specimen has been sitting in the bathroom for at least two hours. What should the nurse do with the urine specimen? A. discard the urine and obtain a new specimen B. send the urine to the lab as quickly as possible C. add fresh urine to the collected specimen D. Refrigerate the urine specimen until it can be transported to the lab.

A. discard the urine and obtain a new specimen

Neoplasm can be classified as either benign or malignant. The following are characteristics of malignant tumor apart from A. encapsulated B. infiltrate surrounding tissues C. metastasis D. poorly differentiated cells

A. encapsulated

Nurse Dorothy is evaluating care of a client with schizophrenia; the nurse should keep which point in mind? A. frequent reassessment is needed and is based on the client's response to treatment. B. the family does not need to be included in the care because the client is an adult. C. the client is too ill to learn about his illness D. relapse is not an issue for a client with schizophrenia.

A. frequent reassessment is needed and is based on the client's response to treatment

The nurse is preparing teaching for a client newly diagnosed with tuberculosis. Which drug generally used in initial treatment should the nurse include in the session? Select all that apply. A. isoniazid B. amikacin C. pyrazinamide D. rifampin E. ethambutol

A. isoniazid C. pyrazinamide D. rifampin E. ethambutol

A nurse is caring for a client who undergo a neurolytic ablation. The client asked the nurse the reason for this procedure. Which of the following responses should the nurse make? A. it should provide permanent pain relief. B. it reduces the adverse effects of your pain management C. it increases you ability to fight infections D. it increases cells that stop bleeding.

A. it should provide permanent pain relief. Rationale: Inform the client that neurolytic ablation causes permanent destruction of the nerves that transmit pain from a specific area and as a last resort after other methods have been unsuccessful.

The nurse is teaching an adult recreational drug user about measures to avoid acquiring hepatitis A. What information should the nurse include in the instruction? Select all that apply. A. observing proper hand washing technique B. follow safe syringe disposal technique C. obtaining a vaccination D. wearing a mask when in crowds E. using caution when eating fresh fruits and vegetables.

A. observing proper hand washing technique B. follow safe syringe disposal technique C. obtaining a vaccine E. using caution when eating fresh fruits and vegetables.

The nurse is developing a teaching plan for a client with viral hepatitis. What information should the nurse include in the plan? A. obtain adequate rest B. increase fluid intake C. take antibiotic therapy D. drink 8 ounces of an electrolyte solution every day

A. obtain adequate rest Rationale: Treatment consists primarily of bed rest and bathroom privileges. Bedrest is maintained during acute phase to reduce metabolic demands on the liver, thus increasing blood supply and promoting liver cell regeneration. When activity is gradually resumed, the client should be taught to rest before becoming overly tired. Although adequate fluid intake is important, it is not necessary to force fluids to treat hepatitis. Antibiotics are not used to treat hepatitis. Electrolyte imbalances are not typical of hepatitis.

What is the most common type of thyroid cancer? A. papillary carcinoma B. anaplastic carcinoma C. medullary carcinoma D. follicular carcinoma

A. papillary carcinoma

A nurse is caring for a client who has cervical cancer and is scheduled for brachytherapy. Which of the following actions should the nurse take? Select all that apply. A. permit visitors to stay with the client 30 minutes at a time. B. warn pregnant individuals to visit the room only once daily. C. wear a dosimeter when in the clients room. D. place soiled dressings in a biohazard bag for discarding in the regular trash. E. dispose soiled linens in the hamper outside the client's room

A. permit visitors to stay with the client 30 minutes at a time. C. wear a dosimeter when in the clients room

A nurse is caring for a client newly admitted with suspected leukemia. The nurse anticipates which tests will be ordered to confirm the diagnosis? Select all that apply A. platelet count B. sedimentation rate C. red blood cell count D. white blood cell count E. bone marrow aspiration

A. platelet count C. red blood cell count D. white blood cell count E. bone marrow aspiration

When planning care for a client with hepatitis A, the nurse should review lab reports for which lab value? A. prolonged prothrombin time B. decreased blood glucose level C. elevated serum potassium level D. decreased serum calcium level

A. prolonged prothrombin time. Rationale: Prothrombin time may be prolonged because of decreased absorption of vitamin K and decreased production of prothrombin by the liver. The client should be assessed carefully for bleeding tendencies.

The nurse is talking to a group of teens about transmission of HIV, what bodily fluids does nurse inform them will transmit the virus? Select all that apply. A. semen B. urine C. breast milk D. blood E. vaginal secretions

A. semen C. breast milk D. blood E. vaginal secretions

When a blood transfusion is terminated following a reaction, what actions must the nurse take? Select all that apply A. send freshly collected urine samples to the lab. B. return the remainder of the blood component unit to the blood bank. C. return the IV administration set to the blood bank. D. Alert risk management about the incident E. report the incident to the infection control manager.

A. send freshly collected urine samples to the lab. B. return the remainder of the blood component unit to the blood bank C. return the IV administration set to the blood bank

Which patient has a 20 pack per year history? Select all that apply A. smoked one pack per day for 20 years. B. smoked half a pack for 15 years C. smoked two packs for 10 years D. just started smoking two packs a day three months ago.

A. smoked one pack per day for 20 years B. smoked a half a pack for 15 years C. smoked two packs for 10 years.

A nurse is caring for a client who has GAD and is experiencing severe anxiety. Which of the following statements should the nurse make? A. tell me about how you are feeling right now. B. you should focus on the positive things. C. why are you feeling like this? D. lets talk about your meds

A. tell me about how you are feeling right now.

Which factor is a priority to evaluate when completing discharge planning for a client who has had a lobectomy for treatment of lunch cancer? A. the support available to assist the client at home B. distance the client lives from the hospital C. the client's ability to do home blood pressure monitoring D. the client's knowledge of the causes of lung cancer.

A. the support available to assist the client at home.

Graves disease and HypERthyroidism

Autoimmune disease- antibodies cause hypERsecretion of thyroid hormones (T3 and T4) Signs and symptoms - anxiety, nervousness, irritability - weakness - HEAT intolerance - WEIGH LOSS - menstrual irregularity in women - insomnia - exophtahalmos- bulging eyes - photophobia - tachycardia - DECREASED TSH - INCREASED T4 Treatments: - Thionamides- inhibit production of thyroid hormone - Beta- adrenergic blockers- (propranolol, metoprolol) - Iodine solutions- inhibits release of thyroid hormone - radioactive iodine- destroys hormone producing cells - Thyroidectomy- removal of thyroid

A client diagnosed with cancer of the pancreas is being discharged to start chemotherapy in the HCP's office. Which statement made by the client indicates the client understands the discharge instructions? A. "I will have to see the HCP everyday for 6 weeks for my treatments." B. "I should write down all my questions so I can ask them when I see my HCP." C. "I am sure that this is not going to be a serious problem for me to deal with." D. "The nurse will give me an injection in my leg and I will get to go home."

B. "I should write down all of my questions so i can ask them when I see my HCP."

A nurse is teaching a client who has been diagnosed with tuberculosis how to avoid spreading the disease to family members. Which statements indicate that the client has understood the nurses instruction? Select all that apply. A. I will need to dispose of my old clothing when I return home B. I should always cover my mouth and nose when sneezing C. It is important that I isolate myself from family when possible. D. I should use paper tissues to cough in and dispose of them promptly E. I will avoid crowds.

B. I should always cover my mouth and nose when sneezing D. I should use paper tissues to cough in and dispose of them promptly

A client newly diagnosed with tuberculosis is being admitted with the prescription for "isolation precautions for tuberculosis." The nurse should assign the client which type of room? A. a room at the end of the hall for privacy B. a private room to implement airborne precautions A room near the nurses station to ensure confidentiality A room with windows to allow sunlight

B. a private room to implement airborne precautions

A client who is pacing and wringing his hands states, "I just need to walk" when questioned by the nurse about what he is feeling. Which response is most therapeutic? A. you need to sit down and relax B. are you feeling anxious? C. is something bothering you? D. you must be experiencing a problem now

B. are you feeling anxious? Rationale: Asking, "are you feeling anxious?" helps the client to specifically label the feeling as anxiety so he can begin to understand and manage it. Some clients need assistance with identifying what they are feeling so they can recognize what is happening to them. Stating, "You need to sit down and relax" is not appropriate because the client needs to continue his pacing to feel better. Asking if something is bothering the client or saying that he must be experiencing a problem is vague and doesn't help him to identify the feeling as anxiety.

A nurse is speaking with a client who has schizophrenia when the client suddenly seems to stop focusing on the nurse's questions and begins looking at the ceiling and talking to themselves. Which of the following actions should the nurse take? A. stop the interview at this point, and resume later when the client is better able to concentrate. B. ask the client "are you seeing something on the ceiling?" C. tell the client, "You seem to be looking at something on the ceiling. I see something there, too." D. continue with the interview without comment on the client's behavior.

B. ask the client "are you seeing something on the ceiling?" Rationale: Ask the client directly about the hallucination to identify client needs and assess for a potential risk for injury.

A diagnosis of Hodgkin's disease was made to a 58-year-old man who is admitted for the initial cycle of chemotherapy. During the hospitalization, the nurse should watch out for all of the following complications except? A. fertility problems B. benign prostatic hyperplasia C. Secondary cancer D. infection

B. benign prostatic hyperplasia Rationale: Hodgkin's disease is a type of cancer that affects the lymphatic system (bone marrow, spleen, liver, and lymph node tissue.

A 34-year-old female is diagnosed with hypothyroidism. What information should the nurse obtain from conducting a focused assessment? A. rapid pulse B. decreased energy and fatigue C. weight gain of 10lb (4.5kg) D. fine, thin hair with hair loss E. constipation F. menorrhagia (heavy or long period)

B. decreased energy and fatigue C. weight gain of 10lb (4.5kg) E. constipation F. menorrhagia (heavy or long period)

A nurse caring for a patient on an acute mental health unit. The client reports hearing voices that are stating, "kill your doctor." Which of the following actions should the nurse take first? A. encourage the client to participate in group therapy on the unit B. initiate one-on-one observations of the client. C. focus the client on reality D. notify the provider of the client's statement

B. initiate one-on-one observations of the client. Rationale: A client who is experiencing command hallucinations is at risk for injury to self or others. Safety is the first action of the nurse.

What is an instruction the nurse can give to help people prevent lung cancer? A. encourage cigarette smokers to have yearly chest radiographs B. instruct people about techniques for smoking cessation C. recommend that people had their houses and apartments checked for asbestos leakage D. encourage people to install central air filters in their homes.

B. instruct people about techniques for smoking cessation.

A nurse suspects that a client is at risk for tuberculosis. Which risk factor should the nurse assess in this client? Select all that apply. A. sharing clothes with an infected individual B. living in a poorly ventilated environment C. using injection drugs D. being an immigrant to the United States E. having a compromised immune system

B. living in a poorly ventilated environment C. using injection drugs D. being an immigrant to the United states E. have a compromised immune system

The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further education is needed if a nursing staff member states which of the following characteristic of the disease? A. prognosis depends on the stage of the disease B. occurs most often in older clients C. presence of reed Sternberg cells D. involvement of lymph nodes, spleen, and liver.

B. occurs most often in older clients Rationale: Hodgkin's disease is a disorder of young people up to age 40 and among adults. It is more common in adolescence between the ages of 15 and 19.

A nurse is caring for a client who has a new diagnosis of hepatitis C. Which of the following lab findings should the nurse expect? A. presence of immunoglobulin G antibodies (IgG) B. positive EIA test C. aspartate aminotransferase (AST) 35units/L D. Alanine aminotransferase (ALT) 15IU/L

B. positive EIA test

A nurse is planning a presentation at a community center about risk factors for cancer. Which of the following types of cancer should the nurse include when discussing familial clustering of specific types of cancer? A. skin B. prostate C. bone D. bladder

B. prostate Rationale: Types of cancer that typically demonstrate a familial tendency include breast, colorectal, ovarian, and prostate.

Which nursing action is essential before preforming a chest x-ray? A. make sure the client does not eat food B. remove the clients metal necklace. C. have a client swallow contrast dye D. administer a dose of pain medication

B. remove the clients metal necklace

A client who is in a sexual relationship with a partner who has HIV has a prescription for PreExposure prophylaxis (PrEP) using TDF/FTC. What should the nurse teach the client about taking this drug? A. renew your prescription every year B. take the medication daily C. it is not necessary to use condoms D. the drug is 100% effective

B. take this medication daily

The client with tuberculosis is to be discharged home with nursing follow up. Which aspect of nursing care will have the highest priority? A. offering the client emotional support B. teaching the client about the disease and its treatment C. coordinating various agency services D. assessing the clients environmental for sanitation

B. teaching the client about the disease and its treatment Rationale: Ensuring the client is well educated about TB is the highest priority. Education to client and family is essential to help the client understand the need for completing the prescribed drug therapy to cure the disease. The other interventions are less important than education about the disease process and its treatment.

A client who is neatly dressed and clutching a leather briefcase tightly in his arms scans the adult inpatient unit on his arrival at the hospital and backs away from the window. The client asks that the nurse to move away from the window. The nurse recognizes that doing as the client requested is contraindicated for which reason. A. The action will make the client feel that the nurse is humoring him B. The action indicates nonverbal agreement with the clients false ideas. C. The client will then think that he will have his way when he wishes. D. The nurse will be demonstrating a lack of composure over the situation

B. the action indicates nonverbal agreement with the clients false ideas. Rationale: The nurse's nonverbal behavior, moving away from the window as the client requests, indicates agreement with the clients false ideas. The clients behavior is likely to be reinforced if the nurse takes steps to agree with the false ideas the client holds.

The nurse is reviewing the chart of a client who is newly diagnosed with chronic lymphocytic leukemia. Which of the following lab values is expected to be seen? A. elevated aspartate aminotransferase and alanine aminotransferase levels B. thrombocytopenia and elevated lymphocytes. C. elevated sedimentation rate D. uncontrolled proliferation of granulocytes

B. thrombocytopenia and elevated lymphocytes Rationale: Chronic lymphocytic leukemia shows a proliferation of small abnormal mature B lymphocytes and decreased antibody response. Thrombocytopenia also is often present.

The infection control nurse is teaching the staff at a long-term care facility after a recent outbreak of tuberculosis. Which element of infection control should the nurse include in the teaching? Select all that apply. A. implementation of universal screening B. use of airborne precautions C. treatment of clients with suspected or confirmed disease D. administration of the bacilli Calmette-Guerin (BCG) vaccine to residents E. identification of infected individuals

B. use of airborne precautions C. treatment of clients with suspected or confirmed disease E. identification of infected individuals

An adult client with acute leukemia in the healthcare team establish goals of improved tidal volume and activity tolerance. Which activities would be the most helpful to getting these goals? Select all that apply. A. increasing fluids to 3,000 L/ 24 hours B. walking to increase the number of steps each day. C. taking deep breaths while sitting or lying in bed D. using a stationary bicycle to increase elevation and time

B. walking to increase the number of steps each day. C. taking deep breaths while sitting or lying in bed D. using a stationary bicycle to increase elevation and time.

What signs and symptoms in your patient with HIV indicates the disease is worsening and the immune system in severely compromised. A. open, oozing lesions around the mouth B. white hair like spot on the side of the tongue C. cheesy white film on the tonsils and inside cheeks D. vision changes.

B. white hair like spot on the side of the tongue. Rationale: Is known as oral hairy leukopenia. It occurs when the immune system is extremely compromised like with HIV and the Epstein-Barr virus. It is a signal that HIV is getting worse.

Clients with OCD often have exposure/response prevention therapy. Which statement by the client would indicate positive outcomes for this therapy? A. "I am able to avoid obsessive thinking." B. "I can tolerate the anxiety caused by obsessive thinking." C. "I no longer have any anxiety when I have obsessive thoughts." D. "I no longer feel a compulsion to perform rituals."

C. "I no longer have any anxiety when I have obsessive thoughts.

A nurse is caring for a client who has bulimia nervosa and has stopped purging behavior. The client tells the nurse about fears of gaining weight. Which of the following responses should the nurse make? A. "Many clients are concerned about their weight. However, the dietitian will ensure that you don't get too many calories in your diet." B. "Instead of worrying about your weight, try to focus on other problems at this time." C. "I understand you have concerns about your weight, but first, lets talk about your recent accomplishments." D. "You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you."

C. "I understand you have concerns about your weight, but first, lets talk about your recent accomplishments."

A nurse is reviewing testicular self-examination with a client. Which of the following client statements indicates understanding? A. "It's better to examine the testicles before bathing." B. "It is not necessary to report small lumps, unless they are painful." C. " I will examine one testicle at a time." D. "I will use my palms tp feel for abnormalities

C. "I will examine one testicle at a time."

A nurse is preparing to administer a new prescription for isoniazid (INH) to a light-skinned client who has tuberculosis. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication? A. "You might notice yellowing of your skin." B. "You might experience pain in your joints." C. "You might notice tingling of your hands." D. "you might experience a loss of appetite."

C. "You might notice tingling of your hands."

An adult with a history of COPD and metastatic carcinoma of the lung has not responded to radiation therapy and is being admitted to the hospice program. The nurse should conduct a focused assessment of which symptom? A. ascites B. pleural friction rub. C. dyspnea D. peripheral edema

C. Dyspnea

A nurse is caring for a client who has a new diagnosis of tuberculosis and has been placed on a multi medication regimen. Which of the following instructions should the nurse give the client related to Ethambutol? A. your urine can change dark orange B. watch for a change in the sclera of your eyes C. watch for any changes in vision D. take vitamin B daily.

C. Watch for any changes in vision Rationale: The client who is receiving ethambutol will need to watch for visual changes due to optic neuritis, which can result from taking this medication.

Which would be an appropriate intervention for a client with OCD who has a ritual of excessive constant cleaning? A. interruption of rituals with distracting activities B. intense psychotherapy sessions daily C. a structured schedule of activities throughout the day. D. Negative consequences for ritual performance

C. a structured schedule of activities throughout the day

While a client is taking alprazolam which food should the nurse instruct the client to avoid? A. chocolate B. cheese. C. alcohol D. shellfish

C. alcohol Rationale: Using alcohol or any CNS depressant while taking a benzo such as alprazolam is contraindicated because of additive depressant effects. Ingestion of chocolate, cheese, or shellfish is not problematic.

The client with schizophrenia is preparing for discharge. To minimize relapse, what is the most important feature of planning the client's aftercare? A. identification of two new ways to bolster self-esteem B. ensuring that the client lists three potential sources of social support. C. an accurate description of the medication regimen with a specific plan for obtaining falls. D. identification of three new methods of spending leisure time.

C. an accurate description of the medication regimen with a specific pan for obtaining falls. Rationale: The nurse should recognize that the most common reason patients relapse or decompensate into their illness is because they have stopped taking their medication, so teaching should emphasize compliance with medication.

A nurse is caring for a client who has multiple types of skin lesions. Which of the following skin lesions are indicative of a malignant melanoma? Select all that apply. A. diffuse vesicles B. uniformly colored papule C. area with asymmetric borders D. rough, scaly patch E. irregular colored mole

C. area with asymmetric borders E. irregular colored mole

A nurse observes a client who has OCD repeatedly applying, removing, and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following underlying reasons? A. Narcissistic behavior B. fear of rejection from staff C. attempt to reduce anxiety D. effect of antidepressant medication

C. attempt to reduce anxiety

A nurse in a dermatology clinic is using the ABCDE method while screening several skin lesions for skin cancer on a client. Which of the following findings should the nurse report to the provider? A. symmetric shape B. border regularity C. color variation with a lesion D. diameter >4mm

C. color variation with a lesion

The nurse is planning a program for clients at a heath fair regarding the prevention and early detection of cancer of the pancreas. Which self care activity should the nurse teach that is an example of primary nursing care? A. monitor for elevated blood glucose at random intervals B. inspect the skin is clear and the eyes for a yellow tint C. limit meat in the diet and eat a diet that is low in fats D. instruct the client with hyperglycemia about insulin injections

C. limit meat in the diet and eat a diet that is low in fats.

Which thyroid cancer will present with a proliferation of parafollicular cells (c cells) that produce excess calcitonin? A. papillary carcinoma B. anaplastic carcinoma C. medullary carcinoma D. follicular carcinoma

C. medullary carcinoma

A child is seen in the pediatricians office for complaints of bone and joint pain. Which of the following other assessment findings may suggest leukemia? A. increased activity level B. increased appetite C. petechiae D. abdominal pain

C. petechiae Rationale: The most frequent signs and symptoms of leukemia are a result of an infiltration of the bone marrow. Which include fever, pallor, fatigue, anorexia, and petechiae, along with bone and joint pain. Petechiae is brought about by damaged or broken blood vessels underneath the skin.

A nurse administers an estrogen agonist to a client. Which nursing actions would be beneficial? Select all that apply. A. observing client for signs of hypercalcemia B. ensuring that the client has a dental examination before starting the drug. C. teaching signs and symptoms of VTE. D. observing the client for CNS adverse effects, such as drowsiness, anxiety, and agitation.

C. teaching signs and symptoms of VTE D. observing the client for CNS adverse effects, such as drowsiness, anxiety, and agitation.

The nurse visits the home of a client with tuberculosis. Which action should the nurse teach family members to take during the first 2 weeks of treatment to prevent the spread of infection to other family members. A. be compliant with medication regimen B. ensure that housemates of the client are tested and receive prophylactic treatment if indicated. C. use disposable tissues to contain respiratory secretions D. emphasize the importance of maintaining good general health through diet and exercise.

C. use disposable tissues to contain respiratory secretions.

A client at risk for lung cancer asks about the reason for having a computed tomography (CT) scan as part of the initial exam. What is the nurse's BEST response? "A CT scan is: A. far superior to magnetic resonance imaging for evaluating lymph node metastasis." B. noninvasive and readily available." C. useful for distinguishing small differences in tissue density and detecting nodal involvement." D. used to distinguish a malignant from an non-malignant adenopathy

C. useful for distinguishing small differences in tissue density and detecting nodal involvement.

Which of the following client statements demonstrates the major symptoms of schizophrenia? A. "I had too much to drink last night, started feeling all-powerful, and stupidly drove my truck into a tree." B. "I've been depressed ever since our house was destroyed by fire." C. "A stitch in time saves nine' means that prevention is easier than fixing a real problem." D. "You can read my mind. This light of mine will shine, fine; blinding world will end at nine."

D Rationale: A symptom of schizophrenia is clanging; which is when a person uses similar words together even though they do not make sense.

Which of the following family members exposed to TB would be at highest risk for contracting the disease? A. 45-year-old mother B. 17-year-old daughter C. 8-year-old son D. 76-year-old grandmother

D. 76 year-old grandmother

A nurse is providing teaching for a client who has stage two HIV disease is having difficulty maintaining a normal weight. Which of the following statements by the client should indicate to the nurse an understanding of the teaching? A. I will choose a diet high in fat to help gain weight B. I will be sure to eat three large meals a day C. I will drink up to 1 L of liquid each day D. I will add high-protein foods to my diet.

D. I will add high-protein foods to my diet. Rationale: The client should be taught to add high protein high calorie foods to the diet daily as the best way to gain weight and maintain health.

The nurse is preparing a community education program about preventing Hepatitis B infection. Which information should be incorporated in the teaching plan? A. Hepatitis B is relatively uncommon among college students B. Frequent ingestion of alcohol can predispose an individual to develop Hepatitis B. C. Good personal hygiene habits are most effective at preventing the spread of hepatitis B. D. The use of a condom is advised for sexual intercourse.

D. The use of a condom advised for sexual intercourse. Rationale: Hepatitis B is spread through the exposure to blood or blood products and through high risk sexual activities. Hepatitis B is considered to a an STD.

A 56-year-old female client is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She has pain with swallowing and burning tightness in her chest. The nurse should further assess the client for indications of which health problem? A. hiatal hernia B. stomatitis C. radiation enteritis D. esophagitis

D. esophagitis

The nurse is caring for a client who was recently diagnosed with hepatitis C. In reviewing the clients history, what information will be most helpful as the nurse develops a teaching plan? A. has a history of exercise induced asthma B. is a scientist and is frequently exposed to multiple chemicals C. traveled to Central America recently and ate uncooked veggies D. Has a known history of sexually transmitted disease.

D. has a known history of sexually transmitted disease. Rationale: Although primarily blood-borne, unprotected sex with multiple partners and a history of STD's are risk factors for transmission of Hep C.

A nurse is caring for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following actions should the nurse include in the clients plan of care? A. allow the client to select preferred meal times B. establish consequences for purging behavior C. provide the client with a high-fat diet at the start of treatment D. implement one-to-one observation during meal times.

D. implement one-to-one observations during meal times. Rationale: closely monitor the client during and after meals to prevent purging.

A nurse is caring for a client who has bipolar disorder. Which of the following is a priority nursing action? A. set consistent limits for expected client behavior B. administer prescribed medications as scheduled. C. provide the client with step-by-step instructions during hygiene. D. monitoring the client for escalating behavior

D. monitoring the client for escalating behavior Rationale: monitoring for escalating behavior addresses the client's priority need for safety and is therefore the priority nursing action.

When teaching a client about human immunodeficiency virus (HIV), the nurse should take into account the fact that which strategy is the most effective way to control the spread of HIV infection? A. premarital serologic screening B. prophylactic treatment of exposed people C. lab screening of pregnant women D. ongoing sex education about preventative behaviors

D. ongoing sex education about preventative behaviors Rationale: Education to prevent behaviors that cause HIV transmission is the primary method of controlling HIV infection. Behaviors that puts people at risk for HIV infection include unprotected sexual intercourse and sharing of needles for IV drug injection. Educating clients about using condoms during sexual relations is a priority and controlling HIV transmission.

A nurse on a medical-surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care? A. initiate contact precautions B. weigh the client weekly. C. measure abdominal girth at the base of the ribcage. D. provide a high-calorie, high-carbohydrate diet.

D. provide a high-calorie, high-carbohydrate diet.

A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take? A. discuss new relaxation techniques B. show the client how to change their behavior C. distract the client with a television show D. stay with the client and remain quiet.

D. stay with the client and remain quiet

The nurse is administering packed red blood cells to a client. What should the nurse do first? A. discontinue the IV catheter if a blood transfusion reaction occurs B. Administer the PRBC's through a percutaneously inserted central catheter line with a 20 gauge needle C. flush PRBC's with 5%dextrose and 0.45% normal saline solution D. stay with client during the first 15 minutes of transfusion.

D. stay with the client during the first 15 minutes of infusion.

An adult client dx with anxiety disorder becomes anxious when she touches fruits and vegetables. What should the nurse do? A. instruct the woman to avoid touching these foods. B. ask the woman why she becomes anxious in these situations C. assist the woman to make a plan for her family to do the food shopping and preparation. D. teach the woman to use cognitive-behavioral approaches to manage her anxiety.

D. teach the woman to use cognitive-behavioral approaches to manage her anxiety. Rationale: Cognitive-behavioral therapy is effective for anxiety disorders. The nurse can assist the client in identifying the onset of the fears that cause the anxiety and develop strategies to modify the behavior associated with the fears. Avoid touching foods, asking about reasons for anxiety, and providing ways to work around touching the food do not deal with the anxiety and are not interventions that will help the client.

Hepatitis E

Fecal-oral route Wash hands properly resembles Hep A self-limiting (goes away on its own)

Hepatitis A

Fecal-oral route of transmission bedrest and nutritional support How: poor hand hygiene, restaurant contamination Symptoms: flu, fever, jaundice, dark urine, liver and spleen enlargement, indigestion, upset stomach Prevention: wash hands good, safe water, proper sewage disposal, vaccine, immunoglobulin antibodies when dx to avoid becoming severely sick. No cure.

What forms of hepatitis are there vaccinations for?

Hepatitis A and Hepatitis B

Liver Cancer

Hepatitis B and C Dull persistent pain, epigastrium, weight loss, anemia, anorexia, weakness, jaundice, bile duct occluded, ascites, obstructed portal veins Surgery: lobectomy, cryosurgery, liver transplant

Cushing's disease

HypERcortisolism HypERfunctioning Signs and symptoms - weakness, fatigue - moon face - thin, fragile skin - irritability, depression - hirtuism - osteoporosis - acne -red cheeks -hyperglycemia Treatments: - ketoconazole: antifungal that also inhibits cortisol synthesis - mitotane- selective destruction of adrenocrotisol cells - hydrocortisone- given with ketoconazole to balance cortisol - hypophysectomy- removal of pituitary gland - adrenalectomy- removal of adrenal glands (only one-sometimes both)

Addison's Disease

HypOcortisolism (adrenal insufficiency) HypOfunctioning Signs and symptoms - weight gain - salt cravings (due to hyponatremia) - dehydration - hyperkalemia - hypoglycemia -hypercalcemia -Suppressed immune system (sometimes) Treatments: Steroids ( hydrocortisone, prednisone, cortisone) for adrenocorticoid replacement "Kim (K increases) and Caleb (Ca increases) drive North but Nancy (Sodium decreases) and Gloria (glucose decreases) drive South!"

Hepatitis C

Most common blood borne 1/3 cause of liver cancer and transplant How: blood, sex, needle sticks and sharing needles Prevention: antiviral meds, avoid alcohol and meds that affect liver, education on not sharing needles, screen blood. Healthcare workers- avoid needle pricks

Hepatitis D

Pt's with Hep B at risk Most likely to develop SEVERE LIVER FAILURE How: blood and sex transmission, IV, injection drugs, hemodialysis, multiple blood transfusions Meds: Only interferon alpha licensed drug available.

Adrenal Cortex

Secretes cortisol from the adrenal glands

Pituitary gland

Secretes vasopressin - antidiuretic hormone (causes kidneys to reabsorb water)

Schizophrenia:

The client has psychotic thinking or behavior present for at least 6 month. Areas of functioning, including school or work, self-care, and interpersonal relationships, are significantly impaired.

Hepatitis B

major cause for cirrhosis and liver cancer bedrest and nutritional support standard precautions How: blood, semen, vaginal secretions (sex), to baby via vaginal delivery. Symptoms: loss of appetite, might NOT be jaundice, dyspepsia, abd pain, malaise, weakness Medications: alpha inferon, antiviral agents: entecavir and tenofavir Preventions: Vaccine, protected sex, not sharing needles, infection control, blood screening