Final Exam outline

71-What can you think about dietary recommendations for someone at risk for colon cancer?

Increasing fiber Fruits, veggies, whole grains

Two main treatments for DKA?

Insulin IV Fluids

What would the nursing diagnosis be on a patient with a peritoneal radical prostatectomy? Risk diagnosis. A pt had a radical prostatectomy. Risk for infection related to ?

Possible fecal contamination of the surgical wound because of peritoneal area

63 -A patient that has had a TURP & you're doing teaching with continuous bladder irrigation. What education would you provide for why we irrigate?

Prevents obstructions of the cath

66-A patient with acute pancreatitis has what type of pain description?

Right or left??? upper quadrant pain, pain in the epigastrium with radiation to the back Severe unrelenting pain

A patient arrives at the E.D. vomiting bright red blood. What should you assess first?

BP specifically

What kind of symptoms would require an immediate intervention for someone who had an adrenalectomy?

BP would drop Let provider know

A pt that has chronic diarrhea problem what kinds of things could you do to decrease skin breakdown?

Barrier cream/ointment Turning the patient every 2 hours Disposable wipes

A patient with hyperparathyroidism, what type of risk factors would you see? Risk factors:

Risk factors: Genetics Mid aged Being on Dialysis ESRD- end stage renal disease

Diabetes mellitus type II

- Modifiable decreased insulin secretion or cellular resistant to insulin vs not producing insulin, which is type I

The nurse is caring for the client diagnosed with cirrhosis. After completing discharge education, the nurse recognizes the need for further teaching when the client makes which statement? -"Furosemide will help to reduce the amount of abdominal fluid." -"Propranolol has been ordered to decrease my blood pressure." -"My cirrhosis was caused from too much alcohol; I plan to stop drinking." -"I need to rest more; I plan on going to work on a part-time basis."

-"Propranolol has been ordered to decrease my blood pressure."

While providing care for an incontinent patient who receives Lasix (furosemide) 20 mg IV push twice daily, the nurse would include which of the following in the plan of care? Select all that apply. Schedule the first dose at 11 a.m. and the second dose at 11 p.m. Change the patient's incontinence brief 30-60 min after medication administration. Institute high fall risk protocol interventions. Check patient's platelet count prior to medication administration. Provide the dose undiluted.

-Change the patient's incontinence brief 30-60 min after medication administration. -Institute high fall risk protocol interventions. -Provide the dose undiluted.

Lab values versus organ relationships -Liver -Pancrease

-Liver - Ammonia, Urobilinogen, ALT and AST -Pancrease- Lipase & Amylase

The client recovering from acute pancreatitis who has been NPO asks the nurse, "When can I start eating again?" Which response by the nurse is most accurate?" 1. "When you pain is controlled and your serum lipase level has decreased." 2. "When I hear that your bowel sounds are active and you are passing flatus." 3. "As soon as you start to feel hungry you can begin eating." 4. "You will be NPO for at least 2 more weeks; oral intake stimulates the pancreas."

1

The nurse will teach her client the following measures to prevent the spread of Hepatitis A: (Select All That Apply) 1. Proper hand-washing, especially after handling shellfish 2. Consistent use of a condom during sex. 3. Avoid contaminated food or water 4. After contracting Hepatitis A, you are at particular risk for Hepatitis D 5. Receive the HAV vaccine before traveling to countries such as Mexico or the Carribean Islands.

1, 3, 5

Someone who had a kidney stone and you are educating them on how to prevent further kidney stones.

2-3 L a day of water Limit high Ca and vitamin D (supplements)

A client has been admitted to the hospital with a diagnosis of acute pancreatitis and the nurse is assessing the client's pain. What type of pain is consistent with this diagnosis? 1. Burning and aching, located in the left lower quadrant and radiating to the hip 2. Severe and unrelenting, located in the epigastric area and radiating to the back 3. Burning and aching, located in the epigastric area and radiating to the umbilicus 4. Severe and unrelenting, located in the left lower quadrant and radiating to the groin

2. Severe and unrelenting, located in the epigastric area and radiating to the back

What is A1c show and the goal for diabetics?

3 month average of BG Goal for diabetes to keep under 7

The nurse is reviewing the health history of the client hospitalized with nonalcoholic fatty liver disease(NAFLD). Which finding should the nurse associate with the disease process? 1. Living in a colder climate. 2. 70 year old at diagnosis. 3. Body mass index of 35. 4. History of recent antibiotic use.

3.Body mass index of 35.

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? 1. "I am so relieved that I can continue eating my fried fish meals every week." 2. "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." 3. "My wife will be happy to know that I can keep enjoying her liver and onions recipe." 4. "I will no longer be able to have red wine with my dinner."

4. "I will no longer be able to have red wine with my dinner." Nutrition therapy depends on the type of stone formed. When stones consist of uric acid (urate), the client should decrease intake of purine sources such as organ meats, poultry, fish, gravies, red wines, and sardines. Reduction of urinary purine content may help prevent these stones from forming. Avoiding oxalate sources such as spinach, black tea, and rhubarb is appropriate when the stone consists of calcium oxalate.

A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations should the nurse monitor the client? (Select all that apply.) A. Deep and fast respirations B. Decreased urine output C. Tachycardia D. Dependent pulmonary crackles E. Orthostatic hypotension

A, C, E DKA leads to dehydration, which is manifested by tachycardia and orthostatic hypotension. Usually clients have Kussmaul respirations, which are fast and deep. Increased urinary output (polyuria) is severe. Because of diuresis and dehydration, peripheral edema and crackles do not occur.

Which physiologic actions result from normal insulin secretion? (Select all that apply.) a. Increased liver storage of glucose of glycogen b. Increased gluconeogenesis c. Increased cellular uptake of blood glucose d. Increased breakdown of lipids (fats) for fuel e. Increased production and release of epinephrine f. Decreased storage of free fatty acids in fat cells g. Decreased blood glucose levels h. Decreased blood cholesterol levels

A, C, G, H The main metabolic effects of insulin are to stimulate glucose uptake in skeletal muscle and heart muscle and to suppress liver production of glucose and very-low-density lipoprotein (VLDL). In the liver, insulin promotes the production and storage of glycogen (glycogenesis) at the same time that it inhibits glycogen breakdown into glucose (glycogenolysis). It increases protein and lipid (fat) synthesis and inhibits ketogenesis (conversion of fats to acids) and gluconeogenesis (conversion of proteins to glucose). In muscle, insulin promotes protein and glycogen synthesis. In fat cells, it promotes triglyceride storage. Overall, insulin keeps blood glucose levels from becoming too high and helps keep blood lipid levels in the normal range.

A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes? (Select all that apply.) A. 56-year-old African-American male B. Female with a 30-pound weight gain during pregnancy C. Male with a history of pancreatic trauma D. 48-year-old woman with a sedentary lifestyle E. Male with a body mass index greater than 25 kg/m2F. 28-year-old F. female who gave birth to a baby weighing 9.2 pounds

A, D, E, F Risk factors for type 2 diabetes include certain ethnic/racial groups (African Americans, American Indians, Hispanics), obesity and physical inactivity, and giving birth to large babies. Pancreatic trauma and a 30-pound gestational weight gain are not risk factors.

What parameter should be critically evaluated when providing care to a patient with Graves' disease? A. Irregular heart rate and rhythm B. Elevated blood pressure C. Elevated temperature D. Change in respiratory rate

Answer: C Rationale: Increases in temperature may indicate a rapid worsening of the patient's condition and the onset of "thyroid storm." Further evaluation of cardiovascular status is warranted.

1. The patient with chronic gastritis is being put on a combination of medications to eradicate H. pylori. Which drugs does the nurse know will probably be used for this patient? A. Antibiotic(s), antacid, and corticosteroids B. Antibiotic(s), aspirin, and an antiulcer/protectant C. Antibiotic(s) and a proton pump inhibitor D. Antibiotic(s) and nonsteroidal anti-inflammatory drugs (NSAIDs)

A. Antibiotic(s) and a proton pump inhibitor

A child has been admitted to the unit with nephrotic syndrome. In talking with the mother, she reports that a cousin had acute glomerulonephritis (AGN) last year. The mother asks how these two diseases compare, as they both affect the kidneys. The nurse's response would include the information that: A. Both diseases produce smoky colored urine B. Both diseases cause greatly reduced urine output C. Both diseases have a genetic basis D. Treatment for both involves antibiotic therapy

A. Both diseases cause greatly reduced urine output

The nurse is caring for the client who developed ARF. Which findings support the nurse's conclusion that the client is in the recovery phase of ARF? SELECT ALL THAT APPLY. A. Increased urine specific gravity B. Increased serum creatinine level C. Decreased serum potassium level D. Absence of nausea & vomiting E. Absence of muscle twitching

A. Increased urine specific gravity C. Decreased serum potassium level D. Absence of nausea & vomiting E. Absence of muscle twitching

1. Your client with hiatal hernia chronically experiences heartburn following meals. You would plan to teach them to avoid which actions? A. Lying recumbent following meals. B. Taking in small, frequent bland meals. C. Raising the head of the bed. D. Taking H2-receptor antagonist medication.

A. Lying recumbent following meals.

A 23-year-old patient with a history of type 1 diabetes is admitted to the ED with nausea and abdominal pain. His respiratory rate is 34/min with deep breaths and a fruity smell to his breath. He is responsive, but difficult to arouse.What is the nurse's first priority for managing this condition? A.Airway assessment B.Administration of insulin C.Fluid and electrolyte correction D.Administration of IV potassium

A.Airway assessment

What is the best way to evaluate blood sugars for diabetic patients?

A1c

A nurse cares for a client with a deficiency of aldosterone. Which assessment finding should the nurse correlate with this deficiency? a. Increased urine output b. Vasoconstriction c. Blood glucose of 98 mg/dL d. Serum sodium of 144 mEq/L

ANS: A Aldosterone, the major mineralocorticoid, maintains extracellular fluid volume. It promotes sodium and water reabsorption and potassium excretion in the kidney tubules. A client with an aldosterone deficiency will have increased urine output. Vasoconstriction is not related. These sodium and glucose levels are normal; in aldosterone deficiency, the client would have hyponatremia and hyperkalemia.

A nurse cares for a client with an increased blood urea nitrogen (BUN)/creatinine ratio. Which action should the nurse take first? a. Assess the clients dietary habits. b. Inquire about the use of nonsteroidal anti-inflammatory drugs (NSAIDs). c. Hold the clients metformin (Glucophage). d. Contact the health care provider immediately.

ANS: A An elevated BUN/creatinine ratio is often indicative of dehydration, urinary obstruction, catabolism, or a high- protein diet. The nurse should inquire about the clients dietary habits. Kidney damage related to NSAID use most likely would manifest with elevations in both BUN and creatinine, but no change in the ratio. The nurse should obtain more assessment data before holding any medications or contacting the provider.

A nurse assesses clients at a community health fair. Which client is at greatest risk for the development of hepatitis B? a. A 20-year-old college student who has had several sexual partners b. A 46-year-old woman who takes acetaminophen daily for headaches c. A 63-year-old businessman who travels frequently across the country d. An 82-year-old woman who recently ate raw shellfish for dinner

ANS: A Hepatitis B can be spread through sexual contact, needle sharing, needle sticks, blood transfusions, hemodialysis, acupuncture, and the maternal-fetal route. A person with multiple sexual partners has more opportunities to contract the infection. Hepatitis B is not transmitted through medications, casual contact with other travelers, or raw shellfish. Although an overdose of acetaminophen can cause liver cirrhosis, this is not associated with hepatitis B. Hepatitis E is found most frequently in international travelers. Hepatitis A is spread through ingestion of contaminated shellfish.

A nurse contacts the health care provider after reviewing a clients laboratory results and noting a blood urea nitrogen (BUN) of 35 mg/dL and a creatinine of 1.0 mg/dL. For which action should the nurse recommend a prescription? a. Intravenous fluids b. Hemodialysis c. Fluid restriction d. Urine culture and sensitivity

ANS: A Normal BUN is 10 to 20 mg/dL. Normal creatinine is 0.6 to 1.2 mg/dL (males) or 0.5 to 1.1 mg/dL (females). Creatinine is more specific for kidney function than BUN, because BUN can be affected by several factors (dehydration, high-protein diet, and catabolism). This clients creatinine is normal, which suggests a non-renal cause for the elevated BUN. A common cause of increased BUN is dehydration, so the nurse should anticipate giving the client more fluids, not placing the client on fluid restrictions. Hemodialysis is not an appropriate treatment for dehydration. The lab results do not indicate an infection; therefore, a urine culture and sensitivity is not appropriate.

A nurse assesses a client who potentially has hyperaldosteronism. Which serum laboratory values should the nurse associate with this disorder? (Select all that apply.) a. Sodium: 150 mEq/L b. Sodium: 130 mEq/L c. Potassium: 2.5 mEq/L d. Potassium: 5.0 mEq/L e. pH: 7.28f. pH: 7.50

ANS: A, C, E Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and acidosis are manifestations of adrenal insufficiency.Potassium retention also promotes reabsorption of hydrogen ions, which can lead to acidosis. Sodium retention increases blood volume, which raises blood pressure, increasing the risk for strokes, heart attacks, and kidney damage.

A nurse cares for a client who is prescribed lactulose (Heptalac). The client states, I do not want to take this medication because it causes diarrhea. How should the nurse respond? a. Diarrhea is expected; thats how your body gets rid of ammonia. b. You may take Kaopectate liquid daily for loose stools. c. Do not take any more of the medication until your stools firm up. d. We will need to send a stool specimen to the laboratory.

ANS: A The purpose of administering lactulose to this client is to help ammonia leave the circulatory system through the colon. Lactulose draws water into the bowel with its high osmotic gradient, thereby producing a laxative effect and subsequently evacuating ammonia from the bowel. The client must understand that this is an expected and therapeutic effect for him or her to remain compliant. The nurse should not suggest administering anything that would decrease the excretion of ammonia or holding the medication. There is no need to send a stool specimen to the laboratory because diarrhea is the therapeutic response to this medication.

A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newly diagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary team meeting? (Select all that apply.) a. Registered dietitian b. Clinical pharmacist c. Occupational therapist d. Health care provider e. Speech-language pathologist

ANS: A, B, D Would also include endocrinologist & Ophthalmologists When planning care for a client newly diagnosed with diabetes mellitus, the nurse should collaborate with a registered dietitian, clinical pharmacist, and health care provider. The focus of treatment for a newly diagnosed client would be nutrition, medication therapy, and education. The nurse could also consult with a diabetic educator. There is no need for occupational therapy or speech therapy at this time.

A nurse teaches a client with a history of calcium phosphate urinary stones. Which statements should the nurse include in this clients dietary teaching? (Select all that apply.) a. Limit your intake of food high in animal protein. b. Read food labels to help minimize your sodium intake. c. Avoid spinach, black tea, and rhubarb. d. Drink white wine or beer instead of red wine e. Reduce your intake of milk and other dairy products.

ANS: A, B, E Clients with calcium phosphate urinary stones should be taught to limit the intake of foods high in animal protein, sodium, and calcium. Clients with calcium oxalate stones should avoid spinach, black tea, and rhubarb. Clients with uric acid stones should avoid red wine.

A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this clients teaching? (Select all that apply.) A. Do not walk around barefoot. B. Soak your feet in a tub each evening. C. Trim toenails straight across with a nail clipper. D. Treat any blisters or sores with Epsom salts. E. Wash your feet every other day.

ANS: A, C Clients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy and poor arterial circulation. The client should be instructed to not walk around barefoot or wear sandals with open toes. These actions place the client at higher risk for skin breakdown of the feet. The client should be instructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm water and soap, but feet should not be soaked in the tub. The client should contact the provider immediately if blisters or sores appear and should not use home remedies to treat these wounds.

A client at the medical clinic is being evaluated for hypothyroidism. For which of these symptoms consistent with hypothyroidism does the nurse assess?Select all that apply. A. Pulse rate below 60 beats per minute B. Agitation and inability to sleep C. Increasing thermostat settings in the home D. Increase in appetite over the last year E Bizarre or manic behavio

ANS: A, C The nurse assesses the client with hypothyroidism for bradycardia (heart rate below 60). Blood pressure and heart rate and rhythm must be monitored as well as any indications of shock (e.g., hypotension, decreased urine output, changes in mental status). Intolerance to cold is also noted and increasing thermostat settings in the home or additional clothing may be necessary for comfort. Hypothyroidism does not cause agitation and inability to sleep; those symptoms are consistent with hyperthyroidism. Hypothyroidism can cause lethargy, apathy, drowsiness, decreased attention span, and memory. The client often reports an increase in time spent sleeping, sometimes up to 14 to 16 hours daily. The appetite decreases rather than increases and constipation frequently ensue. Bizarre or manic behaviors do not occur with hypothyroidism. Mood swings may occur with hyperthyroidism along w

An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client? a. Check with the pharmacist before taking other medications. b. Increase intake of calcium and vitamin D. c. Report any worsening of symptoms to the provider. d. Take the medication as prescribed by the provider.

ANS: B All of this advice is appropriate for any client taking this medication. However, long-term use is associated with osteoporosis and osteoporosis-related fractures. This client is already at higher risk for this problem and should be instructed to increase calcium and vitamin D intake. The other options are appropriate for any client taking any medication and are not specific to the use of esomeprazole.

A nurse cares for a client newly diagnosed with Graves disease. The clients mother asks, I have diabetes mellitus. Am I responsible for my daughters disease? How should the nurse respond? a. The fact that you have diabetes did not cause your daughter to have Graves disease. No connection is known between Graves disease and diabetes. b. An association has been noted between Graves disease and diabetes, but the fact that you have diabetes did not cause your daughter to have Graves disease. c. Graves disease is associated with autoimmune diseases such as rheumatoid arthritis, but not with a disease such as diabetes mellitus. d. Unfortunately, Graves disease is associated with diabetes, and your diabetes could have led to your daughter having Graves disease.

ANS: B An association between autoimmune diseases such as rheumatoid arthritis and diabetes mellitus has been noted. The predisposition is probably polygenic, and the mothers diabetes did not cause her daughters Graves disease. The other statements are inaccurate.

The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What information is most important to report to the health care provider? a. Hemoglobin (Hgb) 10.8 g/dL b. Temperature 102.1°F (38.9°C) c. Absent bowel sounds in all quadrants d. Scant nasogastric (NG) tube drainage

ANS: B An elevation in temperature may indicate leakage at the anastomosis, which may require return to surgery or keeping the patient NPO. The other findings are expected in the immediate postoperative period for patients who have this surgery and do not require any urgent action.

A 23-year-old patient with a history of type 1 diabetes is admitted to the ED with nausea and abdominal pain. His respiratory rate is 34/min with deep breaths and a fruity smell to his breath. He is responsive, but difficult to arouse.The student nurse asks why the patient is breathing so rapidly and deeply. What is the nurse's best response? A."His serum pH is high, and this is a compensatory mechanism." B."His serum pH is low and this is a compensatory mechanism." C."His serum potassium is high and this is a compensatory mechanism." D."His serum potassium is low and this is a compensatory mechanism."

ANS: B As ketone levels rise, the buffering capacity of the body is exceeded and the pH of the body decreases, leading to metabolic acidosis. Kussmaul respirations (very deep and rapid) cause respiratory alkalosis in an attempt to correct the acidosis by exhaling carbon dioxide.

After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I cannot drink any alcohol at all anymore. b. I need to avoid protein in my diet. c. I should not take over-the-counter medications. d. I should eat small, frequent, balanced meals.

ANS: B Based on the degree of liver involvement and decreased function, protein intake may have to be decreased. However, some protein is necessary for the synthesis of albumin and normal healing. The other statements indicate accurate understanding of self-care measures for this client.

A nurse assesses clients for potential endocrine disorders. Which client is at greatest risk for hyperparathyroidism? a. A 29-year-old female with pregnancy-induced hypertension b. A 41-year-old male receiving dialysis for end-stage kidney disease c. A 66-year-old female with moderate heart failure d.A 72-year-old male who is prescribed home oxygen therapy

ANS: B Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from the GI tract. They are chronically hypocalcemic, and this triggers overstimulation of the parathyroid glands. Pregnancy-induced hypertension, moderate heart failure, and home oxygen therapy do not place a client at higher risk for hyperparathyroidism.

A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks the nurse about the purpose of receiving famotidine (Pepcid). The nurse will explain that the medication will a. decrease nausea and vomiting. b. inhibit development of stress ulcers. c. lower the risk for H. pylori infection. d. prevent aspiration of gastric contents.

ANS: B Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent Helicobacter pylori infection.

A nurse cares for a client who is prescribed a drug that blocks a hormones receptor site. Which therapeutic effect should the nurse expect? a. Greater hormone metabolism b. Decreased hormone activity c. Increased hormone activity d. Unchanged hormone response

ANS: B Hormones cause activity in the target tissues by binding with their specific cellular receptor sites, thereby changing the activity of the cell. When receptor sites are occupied by other substances that block hormone binding, the cells response is the same as when the level of the hormone is decreased.

A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, I feel like I am going crazy. How should the nurse respond? a. I will ask your doctor to order a psychiatric consult for you. b. You feel this way because of your hormone levels. c. Can I bring you information about support groups? d. I will close the door to your room and

ANS: B Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.

A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client? A. Urine specific gravity of 1.033 B. Presence of protein in the urine C. Elevated capillary blood glucose level D. Presence of ketone bodies in the urine

ANS: B Renal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Specific gravity is elevated with dehydration. Elevated capillary blood glucose levels and ketones in the urine are consistent with diabetes mellitus but are not specific to renal function.

A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: Fasting blood glucose: 75 mg/dL Postprandial blood glucose: 200 mg/dL Hemoglobin A1c level: 5.5% How should the nurse interpret these laboratory findings? A. Increased risk for developing ketoacidosis B. Good control of blood glucose C. Increased risk for developing hyperglycemia D. Signs of insulin resistance

ANS: B The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen. Because the clients glycemic control is good, he or she is not at higher risk for ketoacidosis or hyperglycemia and is not showing signs of insulin resistance.

After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching? a. Some medications have been known to cause hepatitis A. b. I may have been exposed when we ate shrimp last weekend. c. I was infected with hepatitis A through a recent blood transfusion. d. My infection with Epstein-Barr virus can co-infect me with hepatitis A.

ANS: B The route of acquisition of hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. Hepatitis A is not transmitted through medications, blood transfusions, or Epstein-Barr virus. Toxic and drug-induced hepatitis is caused from exposure to hepatotoxins, but this is not a form of hepatitis A. Hepatitis B can be spread through blood transfusions. Epstein-Barr virus causes a secondary infection that is not associated with hepatitis A.

A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication should the nurse anticipate being prescribed to the client? a. Atropine sulfate b. Levothyroxine sodium (Synthroid) c. Propranolol (Inderal) d. Epinephrine (Adrenalin)

ANS: B The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium. If the heart rate were so slow that it became an emergency, then atropine or epinephrine might be an option for short-term management. Propranolol is a beta blocker and would be contraindicated for a client with bradycardia.

A nurse is giving a preoperative client a dose of ranitidine (Zantac). The client asks why the nurse is giving this drug when the client has no history of ulcers. What response by the nurse is best? a. All preoperative clients get this medication. b. It helps prevent ulcers from the stress of the surgery. c. Since you dont have ulcers, I will have to ask. d. The physician prescribed this medication for you.

ANS: B Ulcer prophylaxis is common for clients undergoing long procedures or for whom high stress is likely. The nurse is not being truthful by saying all clients get this medication. If the nurse does not know the information, it is appropriate to find out, but this is a common medication for which the nurse should know the rationale prior to administering it. Simply stating that the physician prescribed the medication does not give the client any useful information.

A client has a nasogastric (NG) tube after a Nissen fundoplication. The nurse answers the call light and finds the client vomiting bright red blood with the NG tube lying on the floor. What action should the nurse take first? A. Notify the surgeon. B. Put on a pair of gloves. C. Reinsert the NG tube. D. Take a set of vital signs.

ANS: B To avoid exposure to blood and body fluids, the nurse first puts on a pair of gloves. Taking vital signs and notifying the surgeon are also appropriate, but the nurse must protect himself or herself first. The surgeon will reinsert the NG tube either at the bedside or in surgery if the client needs to go back to the operating room.

A nurse cares for a client who is prescribed vasopressin (DDAVP) for diabetes insipidus. Which assessment findings indicate a therapeutic response to this therapy? (Select all that apply.) a. Urine output is increased. b. Urine output is decreased. c. Specific gravity is increased. d. Specific gravity is decreased. e. Urine osmolality is increased. f. Urine osmolality is decreased.

ANS: B, C, E Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolality, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.

Which patient statement indicates that the nurse's postoperative teaching after a gastroduodenostomy has been effective? a. "I will drink more liquids with my meals." b. "I should choose high carbohydrate foods." c. "Vitamin supplements may prevent anemia." d. "Persistent heartburn is common after surgery."

ANS: C Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. Although peptic ulcer disease may recur, persistent heartburn is not expected after surgery, and the patient should call the health care provider if this occurs. Ingestion of liquids with meals is avoided to prevent dumping syndrome. Foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrom

A nurse plans care for a client with hypothyroidism. Which priority problem should the nurse plan to address first for this client? a. Heat intolerance b. Body image problems c. Depression and withdrawal d. Obesity and water retention

ANS: C Hypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason for seeking medical attention. Memory and attention span may be impaired. The clients family may have great difficulty accepting and dealing with these changes. The client is often unmotivated to participate in self-care. Lapses in memory and attention require the nurse to ensure that the clients environment is safe. Heat intolerance is seen in hyperthyroidism. Body image problems and weight issues do not take priority over mental status and safety.

A client has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client? A. Famotidine (Pepcid) B. Magnesium hydroxide (Maalox) C. Omeprazole (Prilosec) D. Ranitidine (Zantac)

ANS: C Omeprazole is a proton pump inhibitor used in the treatment of GERD. Famotidine and ranitidine are histamine blockers. Maalox is an antacid.

After teaching a client with bacterial cystitis who is prescribed phenazopyridine (Pyridium), the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. I will not take this drug with food or milk. b. If I think I am pregnant, I will stop the drug. c. An orange color in my urine should not alarm me. d. I will drink two glasses of cranberry juice daily.

ANS: C Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many clients think they have blood in their urine when they see this. In addition, the urine can permanently stain clothing. Phenazopyridine is safe to take if the client is pregnant. There are no dietary restrictions or needs while taking this medication.

After teaching a client who has plans to travel to a non-industrialized country, the nurse assesses the clients understanding regarding the prevention of viral hepatitis. Which statement made by the client indicates a need for additional teaching? a. I should drink bottled water during my travels. b. I will not eat off anothers plate or share utensils. c. I should eat plenty of fresh fruits and vegetables. d. I will wash my hands frequently and thoroughly.

ANS: C The client should be advised to avoid fresh, raw fruits and vegetables because they can be contaminated by tap water. Drinking bottled water, and not sharing plates, glasses, or eating utensils are good ways to prevent illness, as is careful handwashing.

A nurse cares for a teenage girl with a new ileostomy. The client states, I cannot go to prom with an ostomy. How should the nurse respond? a. Sure you can. Purchase a prom dress one size larger to hide the ostomy appliance. b. The pouch wont be as noticeable if you avoid broccoli and carbonated drinks prior to the prom. c. Lets talk to the enterostomal therapist about options for ostomy supplies and dress styles. d. You can remove the pouch from your ostomy appliance when you are at the prom so that it is less noticeable.

ANS: C The ostomy nurse is a valuable resource for clients, providing suggestions for supplies and methods to manage the ostomy. A larger dress size will not necessarily help hide the ostomy appliance. Avoiding broccoli and carbonated drinks does not offer reassurance for the client. Ileostomies have an almost constant liquid effluent, so pouch removal during the prom is not feasible.

At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. The nurse will teach the patient to a. increase the amount of fluid with meals. b. eat foods that are higher in carbohydrates. c. lie down for about 30 minutes after eating.d. drink sugared fluids or eat candy after meals.

ANS: C The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.

A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the clients breath has a fruity odor. Which action should the nurse take? A. Encourage the client to use an incentive spirometer. B. Increase the clients intravenous fluid flow rate. C. Consult the provider to test for ketoacidosis. D. Perform meticulous pulmonary hygiene care.

ANS: C The stress of surgery increases the action of counterregulatory hormones and suppresses the action of insulin, predisposing the client to ketoacidosis and metabolic acidosis. One manifestation of ketoacidosis is a fruity odor to the breath. Documentation should occur after all assessments have been completed. Using an incentive spirometer, increasing IV fluids, and performing pulmonary hygiene will not address this clients problem.

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? a. At my age, I should continue seeing the ophthalmologist as I usually do. b. I will see the eye doctor when I have a vision problem and yearly after age 40 c. My vision will change quickly. I should see the ophthalmologist twice a year. d. Diabetes can cause blindness, so I should see the ophthalmologist yearly.

ANS: D Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter.

The laboratory values of a client who has diabetes mellitus include a fasting blood glucose level of 82 mg/dL (mmol/L) and a hemoglobin A1c (A1C) of 5.9%. What is the nurse's interpretation of these findings? a. The client's glucose control for the past 24 hours has been good but the overall control is poor. b. The client's glucose control for the past 24 hours has been poor but the overall control is good. c. The values indicate that the client has poorly managed his or her disease. d. The values indicate that the client has managed his or her disease well.

ANS: D Fasting blood glucose levels provide an indication of the client's adherence to drug and nutrition therapy for DM has been for the previous 24 hours. This client's FBG is well within the normal range.A1C provides an indication of general blood glucose control for the past several months because when glucose attaches to hemoglobin, the attachment is permanent for as long as those hemoglobin molecules are present within red blood cells. Normal red blood cell life span is about 120 days. This client's A1C level is within the desirable range, indicating good long-term glucose control as well as short-term control.

The laboratory values of a client who has diabetes mellitus include a fasting blood glucose level of 82 mg/dL (mmol/L) and a hemoglobin A1c (A1C) of 5.9%. What is the nurse's interpretation of these findings? a. The client's glucose control for the past 24 hours has been good but the overall control is poor. b. The client's glucose control for the past 24 hours has been poor but the overall control is good. c. The values indicate that the client has poorly managed his or her disease. d. The values indicate that the client has managed his or her disease well.

ANS: D Fasting blood glucose levels provide an indication of the client's adherence to drug and nutrition therapy for DM has been for the previous 24 hours. This client's FBG is well within the normal range.A1C provides an indication of general blood glucose control for the past several months because when glucose attaches to hemoglobin, the attachment is permanent for as long as those hemoglobin molecules are present within red blood cells. Normal red blood cell life span is about 120 days. This client's A1C level is within the desirable range, indicating good long-term glucose control as well as short-term control. Diabetic: -Fasting glucose: 80-130 -Postprandial for diabetic: 180 -A1c: Under 7 Non-diabetic -Fasting glucose: 70-100 -Post prandial: 140 A1c: 5.7-6.4 Pre-diabetic -Fasting glucose: 100 to 125 -Post prandial: ?? -A1c: 5.7-6.5

A nurse assesses a client who is prescribed levothyroxine (Synthroid) for hypothyroidism. Which assessment finding should alert the nurse that the medication therapy is effective? a. Thirst is recognized and fluid intake is appropriate. b. Weight has been the same for 3 weeks. c. Total white blood cell count is 6000 cells/mm3. d. Heart rate is 70 beats/min and regular.

ANS: D Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a clients heart rate is bradycardic while on thyroid hormone replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone. Thirst, fluid intake, weight, and white blood cell count do not represent a therapeutic response to this medication.

A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately? A. Serum chloride level of 98 mmol/L B. Serum calcium level of 8.8 mg/dL C. Serum sodium level of 132 mmol/L D. Serum potassium level of 2.5 mmol/L

ANS: D Insulin activates the sodium-potassium ATPase pump, increasing the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. In hyperglycemia, hypokalemia can also result from excessive urine loss of potassium. The chloride level is normal. The calcium and sodium levels are slightly low, but this would not be related to hyperglycemia and insulin administration.

A nurse teaches a client with type 1 diabetes mellitus. Which statement should the nurse include in this clients teaching to decrease the clients insulin needs? A. Limit your fluid intake to 2 liters a day. B. Animal organ meat is high in insulin. C. Limit your carbohydrate intake to 80 grams a day. D. Walk at a moderate pace for 1 mile daily.

ANS: D Moderate exercise such as walking helps regulate blood glucose levels on a daily basis and results in lowered insulin requirements for clients with type 1 diabetes mellitus. Restricting fluids and eating organ meats will not reduce insulin needs. People with diabetes need at least 130 grams of carbohydrates each day

A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the clients polyuria? A. Serum sodium: 163 mEq/L B. Serum creatinine: 1.6 mg/dL C. Presence of urine ketone bodies D. Serum osmolarity: 375 mOsm/kg

ANS: D Remember normal Serum osmolarity: 275-300. We may also see high A1c. Hyperglycemia causes hyperosmolarity of extracellular fluid. This leads to polyuria from an osmotic diuresis. The clients serum osmolarity is high. The clients sodium would be expected to be high owing to dehydration. Serum creatinine and urine ketone bodies are not related to the polyuria.

A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. Which action should the nurse take? A. Administration of oxygen via face mask B. Intravenous administration of 10% glucose C. Implementation of seizure precautions D. Administration of intravenous insulin

ANS: D The rapid, deep respiratory efforts of Kussmaul respirations are the bodys attempt to reduce the acids produced by using fat rather than glucose for fuel. Only the administration of insulin will reduce this type of respiration by assisting glucose to move into cells and to be used for fuel instead of fat. The client who is in ketoacidosis may not experience any respiratory impairment and therefore does not need additional oxygen. Giving the client glucose would be contraindicated. The client does not require seizure precautions.

A nurse cares for a client who has type 1 diabetes mellitus. The client asks, Is it okay for me to have an occasional glass of wine? How should the nurse respond? A. Drinking any wine or alcohol will increase your insulin requirements. B. Because of poor kidney function, people with diabetes should avoid alcohol. C. You should not drink alcohol because it will make you hungry and overeat. D. One glass of wine is okay with a meal and is counted as two fat exchanges.

ANS: D Under normal circumstances, blood glucose levels will not be affected by moderate use of alcohol when diabetes is well controlled. Because alcohol can induce hypoglycemia, it should be ingested with or shortly after a meal. One alcoholic beverage is substituted for two fat exchanges when caloric intake is calculated. Kidney function is not impacted by alcohol intake. Alcohol is not associated with increased hunger or overeating

If someone is in DKA and you draw up ABG what would the pH show? (non compensated)

Acidosis HCO3 would be low (Bicarbonate) High PaCo2 45 or up (this causes the kussmall resp, in class she said low...) PAO2 is usually normal HCO3 -22-26 -if HCO3 is under 22, it is more acidic, if above 26 it is more basic PaCO2 -the pressure of the carbon dioxide in the blood. -Generally just called Co2 in clinical setting -Normal range 35-45 -35 is more basic, less acid less Co2 (acid still there, just less) -45, more acidic, more acid, more Co2 PaO2 -80-100 mmHg. -related to the oxygen saturation -Depending on if it's an arterial or venous draw your O2 will look different, you should expect that in the arterial draw, your O2 is going to be more oxygenated compared to the venous draw.

What are some of the risk factors for prostate CA

Age Ethnicity Low fiber diet

You have a patient who has cirrhosis and they have dependent edema. What lab would be low?

Albumin

What labs are associated with cirrhosis?

Ammonia

Patient taking lactulose, which labs to monitor:

Ammonia Potassium

If a child is dx with cystitis what abnormalities may you find?

Anatomical or structural abnormalities

A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of bacterial cystitis? a. A 36-year-old female who has never been pregnant b. A 42-year-old male who is prescribed cyclophosphamide c. A 58-year-old female who is not taking estrogen replacement d. A 77-year-old male with mild congestive heart failure

Answer C Females at any age are more susceptible to cystitis than men because of the shorter urethra in women. Postmenopausal women who are not on hormone replacement therapy are at increased risk for bacterial cystitis because of changes in the cells of the urethra and vagina. The middle-aged woman who has never been pregnant would not have a risk potential as high as the older woman who is not using hormone replacement therapy.

A client has been admitted to the medical intensive care unit with a diagnosis of diabetes insipidus (DI) secondary to lithium overdose. The client has a prescription for Desmopressin (DDAVP). Which outcome indicates a positive response to treatment? a. Urine output of 60-80 mL/hour b. Blood glucose level of 110 mg/dL (6.1 mmol/L) c. Ability to sit quietly and read a magazine d. Potassium level within expected range

Answer: a Lithium may cause drug-related diabetes insipidus causing the kidneys to be unable to respond to ADHl, causing profound diuresis. Desmopressin acetate (DDAVP), a synthetic form of vasopressin (ADH), is the drug of choice to stop fluid loss.A blood glucose result of 110 mg/dL (6.1 mmol/L) is within the range of normal blood glucose levels. The ability to sit quietly and read a magazine is not an expected outcome after the administration of desmopressin; this is potentially and outcome for clients receiving lithium therapy for bipolar disorder. Hypokalemia may result from the ongoing diuresis of DI, but this does not evaluate the outcome of treatment.

51 -A patient with liver failure what would be your priority assessment?

Assess for signs of bleeding (clotting factors affected)

What foods do you want to avoid eating with colon cancer

Avoid fast food Avoid Pepperonis, hot dogs Red meats Lunch eats?? Alcohol & tobacco

Kidney stones- What do we want to teach them about dietary restrictions with a renal calculi

Avoid organ meats (liver, spleen) Avoid sardines Purine diet Avoid aged cheeses Alcohol Avoid meats high in nitrates

12 -A patient with alcohol induced cirrhosis needs more teaching after stating that he needs

Avoid protein in my diet

61- Teaching post op transsphenoidal hypophysectomy???

Avoid things that will increase intracranial pressure Don't bare down No bending over Vigorously blowing nose

Which symptoms are most often seen in hypothyroidism? (Select all that apply.) a. Increased appetite b. Cold intolerance c. Constipation d. Hypotension e. Exophthalmia f. Palpitations g. Tremors h. Weight gain

B, C, D, H Hypothyroidism slows metabolism way below normal. Appetite is decreased, not increased.The client may not generate sufficient heat to maintain core body temperature.The GI system is slowed, resulting in constipation.Cardiac output decreases leading to hypotension.Exophthalmia is a complication of the Grave's form of hyperthyroidism.Palpitations and tremors occur when the central nervous system and the cardiovascular system are overstimulated by hypermetabolism. They are not associated with hypometabolism.Because metabolism is slowed, caloric use for energy decreases and weight is gained even when intake is not excessive.

The nurse is teaching the client with diabetes about proper foot care. Which statement by the client indicates that teaching was effective? A. "I should go barefoot in my house so that my feet are exposed to air." B. "I must inspect my shoes for foreign objects before putting them on." C. "I will soak my feet in warm water to soften calluses before trying to remove them." D. "I must wear canvas shoes as much as possible to decrease pressure on my feet."

B. "I must inspect my shoes for foreign objects before putting them on." To avoid injury or trauma to the feet, shoes should be inspected for foreign objects before they are put on.

After teaching a patient with a history of renal calculi, the nurse assesses the patient's understanding. Which statement made by the patient indicates a correct understanding of the teaching? A. "Aspirin and aspirin-containing products can lead to stones." B. "I should drink at least 3 L of fluid every day." C. "I will eliminate all dairy or sources of calcium from my diet." D. "The doctor can give me antibiotics at the first sign of a stone."

B. "I should drink at least 3 L of fluid every day."

Phenazopyridine (Pyridium) is prescribed for a client for symptomatic relief of pain associated with a lower urinary tract infection (UTI). The nurse should provide the client with which information regarding this medication? A. Take the medication at bedtime B. A reddish-orange discoloration of the urine may occur C. Take the medication before meals D. Discontinue the medication if a headache occurs

B. A reddish-orange discoloration of the urine may occur

The nurse is caring for a client who received a renal transplant 24 hours previously. Which of the following trends in lab studies indicates to the nurse that the new kidney is functioning? A. Hemoglobin 12%, increased from 11.8% B. Serum creatinine 1.6 mg/dL, decreased from 1.9 mg/dL C. Serum sodium 140 mEq/L, increased from 136 mEq/L D. Serum phosphate 4.4 mg/dL, decreased from 4.8 mg/dL

B. Serum creatinine 1.6 mg/dL, decreased from 1.9 mg/dL

Gastrectomy 12 hours ago- what is important to tell the provider and watch for?

Bleeding Fever 101- 102 or higher (99 is expected after this type of surgery)

How is hep B & C transmitted?

Blood and body fluids

When dealing with insulin I.V.s what lab values should you monitor?

Blood glucose Potassium - monitor if it gets too low with the insulin

The diabetic client has a hemoglobin (Hb)A1c level of 9.4. What does the nurse say to the client regarding this finding? A. "Keep up the good work." B. "This is not good at all." C. "What are you doing differently?" D. "You need more insulin."

C. "What are you doing differently?" Assessing the client's regimen or changes he may have made is the basis for formulating interventions to gain control of blood glucose.

A patient who had a gastroduodenostomy (Billroth I operation) for stomach cancer reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating. What long-term complication does the nurse suspect is occurring? A. Malnutrition B. Bile reflux gastritis C. Dumping syndrome D. Postprandial hypoglycemia

C. Dumping syndrome After a Billroth I operation, dumping syndrome may occur 15 to 30 minutes after eating because of the hypertonic fluid going to the intestine and additional fluid being drawn into the bowel. Malnutrition may occur but does not cause these symptoms. Bile reflux gastritis cannot happen when the stomach has been removed. Postprandial hypoglycemia occurs with similar symptoms, but 2 hours after eating.Awarded 0.0 points out of 1.0 possible points.

1. Gastroesophageal reflux disease (GERD) weakens the lower esophageal sphincter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, you should assign the highest priority to which of the following interventions? A. Decrease daily intake of vegetables and water, and ambulate frequently. B. Drink coffee diluted with milk at each meal, and remain in an upright position for 30 minutes. C. Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating. D. Avoid over-the-counter drugs that have antacids in them.

C. Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating.

Which explanation best assists the client in differentiating type 1 diabetes from type 2 diabetes? A. Most clients with type 1 diabetes are born with it. B. People with type 1 diabetes are often obese. C. Those with type 2 diabetes make insulin, but in inadequate amounts. D. People with type 2 diabetes do not develop typical diabetic complications.

C. People with type 2 diabetes make some insulin but in inadequate amounts(or they have resistance to existing insulin.) The explanation by the students that indicate understanding of the type of diabetes is "Those with type 2 diabetes make insulin, but in inadequate amounts." People with type 2 diabetes may also have resistance to existing insulin.Most clients with type 1 diabetes are not born with it. Although type 1 diabetes may occur early in life, it is considered an autoimmune disorder in which beta cells are destroyed in a genetically susceptible person. Risk for type 1 DM is determined by inheritance of genes coding for the HLA-DR and HLA-DQA and DQB tissue types (McCance et al., 2014). However, inheritance of these genes only increases the risk, and most people with these genes do not develop type 1 DM. Obesity is typically associated with type 2 diabetes. People with type 2 diabetes are at risk for typical diabetic complications, especially cardiovascular diseases.

Appendicitis patient is scheduled for surgery in 2 hours. They call about increased pain and vomiting. Their abdomen is distended and bowel tones decreased. What do you do?

Call the provider because of possibility for rupture

What is important to teach a pt if they take pyridium?

Change of color in the urine

A diabetic patient all of a sudden has fruity breath. What do you do?

Check BS Check ketones (but not the best choice just an FYI) Call the provider

Patient taking lispro at 1 pm what action at 2 pm should you take

Check the blood sugar again for hypoglycemia Peak action of a fast acting insulin is 30-90 min

A patient with cushing's disease. The return status post adrenalectomy What is highest normal priority post op?

Checking BP and maintain via fluid I.V. & watch electrolyte status Reduced aldosterone secretion causes disturbances of FLUID AND ELECTROLYTE BALANCE. Potassium excretion is decreased, causing hyperkalemia. Sodium and water excretion are increased, causing hyponatremia and hypovolemia. Potassium retention also promotes reabsorption of hydrogen ions, which can lead to acidosis.

Laboratory analysis reveals that the client passes a calcium oxalate stone. To prevent the formation of future stones, the nurse should instruct the client to avoid consuming which food? Lettuce Beans Chocolate Cheese

Chocolate

Peptic Ulcer Disease (PUD). A patient with peptic ulcer disease has a sudden complaint of sharp abdominal pain, what would be your priority?

Contact the provider because of sudden changes

A client with newly diagnosed hypothyroidism tells the nurse, "I just want to feel better now. Why can't I just get a standard dose of medication instead of all this dosage adjustment?" The nurse explains that starting levothyroxine sodium (Synthroid) at a high dose may cause which of these problems? A. Bradycardia and decreased level of consciousness B. Decreased respiratory rate and hypoxemia C. Hypotension and shock D. Hypertension and heart failure

Correct Answer: d Hypertension and heart failure are possible if the levothyroxine sodium dose is started too high or raised too rapidly, because levothyroxine would essentially put the client into a hyperthyroid state. The client would be tachycardic, not bradycardic. The client may have an increased respiratory rate. Shock may develop, but only as a late effect and as the result of "pump failure."

The nurse reviews the vital signs of a client diagnosed with Graves' disease and sees that the client's temperature is up to 99.6° F. After notifying the health care provider, what does the nurse do next? a) Administers acetaminophen b) Alerts the Rapid Response Team c) Asks any visitors to leave d) Assesses the client's cardiac status completely

Correct Answer: d If the client's temperature has increased by even 1°, the nurse's first action is to notify the provider. Continuous cardiac monitoring should be the next step. Administering a nonsalicylate antipyretic such as acetaminophen is appropriate, but is not a priority action for this client. Alerting the Rapid Response Team is not needed at this time. Asking visitors to leave would not be the next action, and if visitors are providing comfort to the client, this would be contraindicated.

1. A client with peptic ulcer disease associated with the presence of Helicobacter pylori is treated with triple drug therapy. The nurse will plan to teach the client about A. Sucralfate, nystatin, and bismuth. B. Metoclopramide, bethanechol, and promethazine. C. Amoxicillin, clarithromycin, and omeprazole. D. Famotidine, magnesium hydroxide, and pantoprazole.

Correct answer: Amoxicillin, clarithromycin, and omeprazole.

1. The nurse is planning discharge teaching for the client with gastroesophageal reflux disease (GERD). What dietary modification should be included? A. Avoid intake of caffeine and alcoholic beverages. B. Drink 12 to 16 ounces of water with each meal. C. Lie down for 15 to 20 minutes after eating. D. Eat three meals and a bedtime snack.

Correct answer: Avoid intake of caffeine and alcoholic beverages.

What kind of blood labs are associated with renal disease?

Creatinine BUN

A patient with DM what findings would support a RN dx of ineffective coping?

Crying whenever DM is mentioned

A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus? A. Recent weight gain of 20 lb (9.1 kg) B. Failure to monitor blood glucose levels C. Crying whenever diabetes is mentioned D. Skipping insulin doses during illness

Crying whenever diabetes is mentioned Explanation:A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus.

Cipro unusual side effect?

False positive reaction for opioids in urinalysis

How is hep A transmitted?

Fecal-Oral

Which of these nursing actions can the home health nurse delegate to a home health aide who is making daily visits to a client with newly diagnosed type 2 diabetes? A. Assist the client's spouse in choosing appropriate dietary items. B. Evaluate the client's use of a home blood glucose monitor. C. Inspect the extremities for evidence of poor circulation. D. Assist the client with washing his feet and applying moisturizing lotion

D. Assist the client with washing his feet and applying moisturizing lotion.The nursing action that the home health nurse can delegate to a home health aide who is making daily visits to a newly diagnosed type 2 diabetic client is assisting with personal hygiene. This action is included in the role of home health aides.Assisting with appropriate dietary selections, evaluating the effectiveness of teaching, and performing assessments are complex actions that would be performed by licensed nurses.

A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL, and the glycosylated hemoglobin (HbA1c) is 8.2%. Which action will the nurse plan to take next? A. Instruct the client to continue with the current diet and Glucophage use. B. Discuss the need to check blood glucose several times every day. C. Talk about the possibility of adding rapid-acting insulin to the regimen. D. Ask the client about current dietary intake and medication use.

D. Ask the client about current dietary intake and medication use. The nurse's next action would be to assess the client's adherence to the currently prescribed diet and medications. The nurse would also check for any stressors or undocumented illnesses. Glycosylated hemoglobin (HbA1C) levels >8% indicate poor diabetes control and need for adherence to regimen or changes in therapy.Instructing the client to continue with current diet and metformin use is inappropriate without further assessment. Checking blood glucose more frequently and/or using rapid-acting insulin may be appropriate, but this will depend on the assessment data. The HbA1C indicates that the client's average glucose level is higher than the target range, but discussing the need to check blood glucose several times every day assumes that the client is not compliant with the therapy and glucose monitoring. The nurse would not assume that adding insulin, which must be prescribed by the primary health care provider, is the answer without assessing the underlying reason for the treatment failure

Type 1 DM for teaching what is really important that they need to do?

Feet monitoring and care Eye exams

What are risk factors for someone getting cystitis?

Female Older Incontinence

58 -Patient with SIADH (Syndrome of inappropriate antidiuretic hormone secretion). How do you tell if the medication is not working?

Daily weight gain

-Patient who is taking ranitidine and you need to teaching on how it works

Decreases secretion of gastric acid

-Priority problems with hypothyroidism:

Depression

Diabetic versus nondiabetic levels (fasting, postprandial, and A1c goals)

Diabetic: -Fasting glucose: 80-130 -Postprandial for diabetic: 180 -A1c: Under 7 Non-diabetic -Fasting glucose: 70-100 -Post prandial: 140 A1c: 5.7-6.4 Pre-diabetic -Fasting glucose: 100 to 125 -Post prandial: ?? -A1c: 5.7-6.5

A patient is taking cortisol replacement. What teaching instructions do you need to give?

Don't stop it immediately Needs to be tapered If vomiting an injection cortisol may be needed

Patient with a bladder infection what is the most important information that you would need to report to the provider?

Dysuria (Discomfort, pain, or burning when urinating)

What kind of teaching is important with GERD

Elevate head of bed

Which of the following laboratory values would you interpret as confirming a client's diagnosis of pancreatitis? Decreased serum glucose Decreased lipase Elevated serum calcium Elevated amylase

Elevated amylase

f you have a patient with hepatic encephalopathy, how do you assess for asterixis

Extend an arm, flex the wrist and extend fingers

92 -Patient presents with RUQ pain, what focused assessments should the nurse complete? What labs as well?

Gallbladder Liver problems: · Liver function tests- ALS, AST · Clotting factors · BG · Ammonia level

Types of Viral Hepatitis and how they are transmitted

Hepatitis A virus (RNA) -A for ASS -Fecal-oral (includes sexual acts, contaminated water) -Self-limited -Immunization Hepatitis B virus (DNA) -B -Blood/body fluids (blood, wounds, sex, saliva, breast milk) -Acute/Chronic -Immunization Hepatitis C virus (RNA) o Blood/body fluids (IV drug us) o Acute/Chronic, o No Immunization o Behavior Modification o Curable w/ ART Hepatitis D virus (RNA) o Needs Hep-B o Similar to Hep-B · Hepatitis E virus (RNA) o Fecal-oral o developing country o similar to Hep-A · Non A-E hepatitis o Viral hep that is not caused by any of these virusus

Diabetic patient comes in and they have polyuria and high blood sugars. What labs would correlate with polyuria and high blood sugars in a diabetic patient?

High A1c Serum Osmolarity

Foods to avoid for patients with cholelithiasis?

High fat foods

A pt with Crohn's disease. PT post op with small bowel resection with Crohn's Disease. More education is needed when they say?

I am so glad I never need surgery again for Crohn's

Someone having lithotripsy (a procedure with using sound waves). What cure is immediately needed for someone who has a lithotripsy?

Increase water intake Measure and strain urine Check their flanks for ecchymosis

Acute pancreatitis LUQ pain radiating to the back. What's the best way to decrease their pain?

Keeping them NPO Push I.V. fluids Used opioids for pain

DKA clinical manifestations?

Kussmaul's breathing Hypotension Tachycardia Fruity breath

Treatment for hypothyroidism effectivness is evaluated by:

Levothyroxine - effectiveness of the treatment is determined by the regular heart rhythm and heart rate of 70 Evaluate for levels of T3 and T4

What complications would you see with a pt with ulcerative colitis?

Lower GI bleeding Localized pockets of infection Non-mech bowel obstruction Extra intestinal manifestations such as arthritis, ankylosing spondylitis?? SP Non mechanical bowel obstruction

-Priority post opt with the patient transsphenoidal hypophysectomy

Making sure head of bed is up, not laying flat Reporting clear or light yellow color nasal drainage (leaking spinal fluid) Headaches

What can diabetics do to decrease their insulin needs?

Moderate exercise- causes them to lose weight

Hyperaldosteronism. A pt has an adrenal cortical adenoma that causes hyperaldosteronism. What kind of nursing care would you need to do?

Monitoring blood sugars every 4 hours

60 -Someone who's had a thyroidectomy. What is education that the pt should be taught?

Need thyroid medications Lifelong

Admission assessment for the patient with GERD, you have a patient that has GERD, and they make a statement you should question further, I wake up at night with a burning sensation in my chest- What else could be going on?

Need to do further assessment because it could be cardiac issues,

Risk factors for DM

Obesity Sedentary lifestyle Ethnicity (Black, Indian, Latino) Genetic history (Family)

What finding is to expect on the pt with non alcoholic fatty liver disease: (Risk factors)

Obesity- high BMI

A BPH patient has a distended bladder & is agitated & confused. What treatment would be provided?

Place catheter

Teachings after gallbladder removal

follow a low fat diet

A patient with nephrotic syndrome, what would you anticipate to be prescribed?

Steroids to decrease inflammation

How does glucagon work to treat hypoglycemia?

Stimulates release glycogen stores from the liver so it can be converted to glucose Glucagon can be taken PO and in injections

What is the best way to cut the nails of a diabetic?

Straight across with clippers (not scissors)

What is one way that we can determine the severity of someone's BPH?

Strength of their urinary stream

A pt is taking levothyroxine. What side effect should be addressed?

Tachycardia

Grave disease the symptom that requires rapid intervention

Tachycardia and a really high fever

We have a patient who is status post gastroduodenostomy. What is it? What do we need to teach the patient?

Take stomach out and attach it to the duodenum Dumping syndrome Eat small frequent meals Vitamin supplements for anemia

Someone one on desmopressin (DDAVP?) and they ask how does it work?

Tells the kidneys to hold onto water via ADH/Vasopressin It can treat diabetes insipidus. It can also treat bedwetting problems and certain bleeding disorders Desmopressin is a man-made form of vasopressin (ADH) and is used to replace a low level of vasopressin. This medication helps to control increased thirst and too much urination due to these conditions, and helps prevent dehydration.

A client who has advanced cirrhosis is receiving lactulose. Which finding by the nurse indicates that the medication is effective? The client has at least one stool daily The client denies nausea or anorexia The client's billirubin level decreases The client is alert and oriented

The client is alert and oriented

A client who was admitted with acute bleeding from esophageal varices asks the nurse the purpose for the ordered ranitidine. Which response by the nurse is most appropriate? A. The medication will reduce the risk for aspiration. B. The medication will prevent irritation to the esophageal varices. C. The medication will decrease nausea and anorexia D. The medication will inhibit the development of gastric ulcers.

The medication will prevent irritation to the esophageal varices.

Patient with Grave's disease. If a parent has DM and they ask you if there is a link between DM and Grave's disease what do you say?

There is an association between DM and Grave's disease but because you have DM does not mean that you will get/gave Grave's disease

The nursing student knows he is assessing asterixis in the patient with hepatic encephalopathy when he sees which of the following physical manifestations? Patient reports an unpleasant and urgent sensation to defecate Rebound tenderness upon palpation Tremor of extensions and flexions in the wrists Purpuric lesions or ecchymoses around the navel

Tremor of extensions and flexions in the wrists

With an aldosterone deficiency what correlating findings would you see?

Urine output would increase Function of aldosterone is increasing the amount of salt (sodium) reabsorbed into the bloodstream and to increase the amount of potassium excreted in the urine. Aldosterone also causes water to be reabsorbed along with sodium; this increases blood volume and therefore blood pressure.

How is Hep D trasmitted?

Viral Only people infected with Hep B can get Hep D- common in China, Russia

Someone comes in with a GI bleed what kind of symptoms would you see?

Vomiting coffee grounds- upper GI bleed Dark black or tarry stools Melena/hematochezia - bloody stool - lower GI bleed,close to the rectum Drop in blood pressure/high pulse Dehydration- dizziness/lightheadedness Complaint for pain all over the abdominal areas

Diabetic foot care

Wash and dry feet daily Cutting nails straight across file the edges with a nail file Apply a moisturizing lotion but not between the toes Never go barefoot Dry your feet completely especially between the toes Check your feet for blisters, cuts, redness; if present, check with the provider Exam your shoes each time before putting them on

53 -A pt with decreased sensations. What should you do to decrease risk for injury?

Wear shoes No heated blankets No heated mattress pads Check the water before taking shower or bath

59 -Patient with TSH def, s/sx you would see

Weight gain Decreased lidibo Alopecia (condition that causes hair to fall out in small patches)

Hypothyroidism- What kinds of symptoms are the most common?

Wt gain Intolerance to cold Low BP Fatigue (important) Dry brittle skin/coarse brittle hair

Patient with adrenal hyperfunction and the patient becomes agitated how would the nurse respond?

You feel this way because of your hormone levels

When caring for a client with nephrotic syndrome, which intervention would be included in the plan of care? a. Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss b. Administering heparin to prevent deep vein thrombosis (DVT) c. Providing antibiotics to decrease infection d. Providing transfusion of clotting factors

a. Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss ACE inhibitors need to be included in a plan of care for a client with nephrotic syndrome. ACE inhibitors can decrease protein loss in the urine.Heparin is administered for DVT, but in nephrotic syndrome it may reduce vascular defects and improve kidney function. Glomerulonephritis may occur secondary to an infection, but it is an inflammatory process. Antibiotics are not indicated for nephrotic syndrome. Clotting factors are not indicated unless bleeding and coagulopathy are present.

A 23-year-old has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider? a. Asterixis and lethargy b. Jaundiced sclera and skin c. Elevated total bilirubin level d. Liver 3 cm below costal margin

a. Asterixis and lethargy

1. The client admitted to a surgical unit following a TURP, has a CBI running. The nurse assesses the client's urine and finds dark red urine containing several small clots. Which intervention should the nurse implement? a. Increase the flow of the bladder irrigation fluid. b. Immediately stop the bladder irrigation fluid. c. Irrigate the urinary catheter manually. d. Deflate the balloon on the urinary catheter.

a. Increase the flow of the bladder irrigation fluid.

The nurse is planning for the client who is to undergo extracorporeal shock wave lithotripsy (ESWL). Which actions should the nurse include in the plan of care immediately following the procedure? SELECT ALL THAT APPLY a. Instruct on the need to measure and strain all urine. b. Give no fluids or foods for 24 hours post ESWL. c. Check for flank ecchymosis on the affected side. d. Assess the incision for clean, dry, and intactness. e. Remove the stent that was placed during ESWL.

a. Instruct on the need to measure and strain all urine. c. Check for flank ecchymosis on the affected side.

1. The nurse is caring for a 73-year-old man who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern? a. The patient complains of right upper-quadrant pain with palpation. b. The patient's hands flap back and forth when the arms are extended. c. The patient has ascites and a 2-kg weight gain from the previous day. d. The patient's skin has multiple spider-shaped blood vessels on the abdomen.

a. The patient's hands flap back and forth when the arms are extended.

A nurse is caring for a client who was prescribed high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition. The clients symptoms have now resolved and the client asks, When can I stop taking these medications?How should the nurse respond? a. It is possible for the inflammation to recur if you stop the medication. b. Once you start corticosteroids, you have to be weaned off them. c. You must decrease the dose slowly so your hormones will work again. d. The drug suppresses your immune system, which must be built back up.

b. Once you start corticosteroids, you have to be weaned off them.One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone and adrenal production of cortisol. Decreasing hormone therapy slowly ensures self-production of hormone, not hormone effectiveness. Building the clients immune system and rebound inflammation are not concerns related to stopping high-dose corticosteroids.

The nurse anticipates that a client who develops hypotension and oliguria post nephrectomy may need the addition of which element to the regimen? a. Increase in analgesics b. Addition of a corticosteroid c. Administration of a diuretic d. Course of antibiotic therapy

b. Addition of a corticosteroid The nurse expects that the post nephrectomy client with hypotension and oliguria will need the addition of corticosteroids. Loss of water and sodium occurs in clients with adrenal insufficiency, which is followed by hypotension and oliguria. So corticosteroids may be needed.The nurse must use caution when administering analgesics to a hypotensive client. No indication suggests that pain is present in this client. A diuretic would further contribute to fluid loss and hypotension, potentially worsening kidney function. A few doses of antibiotics are used prophylactically preoperatively and postoperatively. Additional therapy is used when evidence of infection exists.

1. Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy? a. Request that the patient stand on one foot. b. Ask the patient to extend both arms forward. c. Request that the patient walk with eyes closed. d. Ask the patient to perform the Valsalva maneuver.

b. Ask the patient to extend both arms forward.

Which laboratory test is the best indicator of kidney function? a. Blood urea nitrogen (BUN) b. Creatinine c. Aspartate aminotransferase (AST) d. Alkaline phosphatase

b. Creatinine The laboratory test that is the best indicator of kidney function is creatinine excretion. Creatinine excretion, the end product of muscle metabolism, remains relatively steady and therefore is the best laboratory marker of renal function.BUN may be affected by protein, fluid intake, rapid cell destruction, cancer treatment, steroid therapy, and hepatic damage. AST and alkaline phosphatase are measures of hepatic function.

What type of med is... omeprazole maalox Famodadine Ranitidine?

omeprazole- PPI maalox- antacid Famodadine- H2 blockers or H2 antagonists Ranitidine?- H2 blockers or H2 antagonists

The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor? a. Hemoglobin and hematocrit (H&H) b. White blood cell (WBC) count c. Blood urea nitrogen (BUN) and creatinine d. Lipid levels

c. Blood urea nitrogen (BUN) and creatinine In the client with hydronephrosis, the nurse monitors the client's BUN and creatinine. BUN and creatinine are kidney function tests. With back-pressure on the kidney, glomerular filtration is reduced or absent, resulting in permanent kidney damage. Hydronephrosis results from the backup of urine secondary to obstruction.H&H monitors for anemia and blood loss, while WBC count indicates infection. Elevated lipid levels are associated with nephrotic syndrome, not with obstruction and hydronephrosis.

A client with renal calculi is advised to restrict calcium in his diet. The nurse determines that the client understands the restrictions when he states he will avoid which of the following? a. Chicken, beef, and salmon b. Green vegetables, fruit, and legumes c. Chocolate, smoked fish, and low-fat milk d. Eggs, meat, and poultry

c. Chocolate, smoked fish, and low-fat milk

A client with a urinary diversion device has the nursing diagnosis risk for impaired skin integrity. Which of the following instructions would the nurse give the client? a. Change urine collection device every other day. b. Teach self-catheterization technique. c. Empty the bag reservoir every 2 hours. d. Monitor for foul-smelling urine.

c. Empty the bag reservoir every 2 hours.

1. The nurse teaches a group of clients that Hepatitis A is infectious and usually spread by which of the following routes? a. Infected blood and body fluids b. Sexual contact c. The fecal-oral route d. Sharing of dirty needles

c. The fecal-oral route

1. To detect further possible complications in a patient with severe cirrhosis who has bleeding esophageal varices, it is most important for the nurse to monitor a. bilirubin levels. b. potassium levels. c. ammonia levels. d. prothrombin time.

c. ammonia levels.

1. Which data will the nurse monitor in relation to the 4+ pitting edema assessed in a patient with cirrhosis? a. Hemoglobin b. Temperature c. Activity level d. Albumin level

d. Albumin level