Med-Surg Exam #3

Venous Occlusive disease (VOD) aka Hepatic Sinusoidal Obstructive syndrome

phlebitis in the liver; cause blockage of blood to the liver blood vessels causing clotting and inflammation

Prophylactic

preventive removal of organ/tissue

Curative treatment

removal of entire tumor

Crohn's Disease

-RLQ pain -Age: 15-40 yr. -Distal ileum and ascending colon -Ulcerations on intestinal mucosa-separated by normal tissue- "cobblestone" appearance-patchy -Fistulas -Steatorrhea common; blood rare -Malnutrition

A patient with sickle cell anemia has a a) Low hematocrit b) Normal blood smear c) High hematocrit d) Normal hematocrit

-Low hematocrit Correct Explanation: The patient with sickle cell anemia has a low hematocrit and sickled cells on the smear. The patient with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain to his right shoulder. The intial appropriate action by the nurse is to a) Place the client in the high-Fowler's position. b) Assess the client's abdomen and vital signs. c) Notify the health care provider. d) Irrigate the client's NG tube.

- Assess the client's abdomen and vital signs Explanation: Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.

Phenothiazines (Post-anesthesia)

-Prochlorperazine (Compazine) -Promethazine (Phenergan) *Anti-emetics

Which of the following terms refers to a form of white blood cell involved in immune response? a) Granulocyte b) Lymphocyte c) Spherocyte d) Thrombocyte

-Lymphocyte Explanation: Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.

Anti-cholinergics (vestibular etiology)

-Meclizine (Antivert) *Anti-emetics

Diverticular Disease

-No Sx -LLQ pain -Fever, elevated WBC -Cipro antibiotics

Tegaserod (Zelnorm)

-Restricted use on pt. w/chronic constipation -Only for ER/hospitalization; withdrawn from market due to CV side effects -Hypovolemia and hypotension, and diarrhea common side effects

The nurse recognizes that the patient diagnosed with a duodenal ulcer will likely experience

-pain 2 to 3 hours after a meal. Explanation: The patient with a gastric ulcer often awakens between 1 to 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the patient with duodenal ulcer. Hemorrhage is less likely in the patient with duodenal ulcer than the patient with gastric ulcer. The patient with a duodenal ulcer may experience weight gain.

The nurse recognizes that the patient diagnosed with a duodenal ulcer will likely experience a) weight loss. b) hemorrhage. c) vomiting. d) pain 2 to 3 hours after a meal.

-pain 2 to 3 hours after a meal. Explanation: The patient with a gastric ulcer often awakens between 1 to 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the patient with duodenal ulcer. Hemorrhage is less likely in the patient with duodenal ulcer than the patient with gastric ulcer. The patient with a duodenal ulcer may experience weight gain.

A nurse is caring for a client who is undergoing a diagnostic workup for a suspected GI problem. The client reports gnawing epigastric pain following meals and heartburn. The nurse suspects the client has: a) appendicitis. b) diverticulitis. c) peptic ulcer disease. d) ulcerative colitis.

-peptic ulcer disease Explanation: Peptic ulcer disease is characterized by dull, gnawing pain in the midepigastrium or the back that worsens with eating. Ulcerative colitis is characterized by exacerbations and remissions of severe bloody diarrhea. Appendicitis is characterized by epigastric or umbilical pain along with nausea, vomiting, and low-grade fever. Pain caused by diverticulitis is in the left lower quadrant and has a moderate onset. It's accompanied by nausea, vomiting, fever, and chills.

Long tern NSAID users should also take a Proton Pump Inhibitors (PPIs) to prevent GI bleeding A) True B) False

A) True

Malignant tumor cells

Abnormal cells that serve no function; HARMFUL -Rapid and continuous growth -Disorderly and invasive; ability to spread (metastasize) -Abnormal chromosomes -smaller cell w/larger nucleus -infinite life span

Ano-Rectal Disorders

Anorectal abscess, anal fistula, anal fissure, hemorrhoids, anorectal STDs, pilonidal sinus or cyst

Peptic Ulcer Disease

Mucosal lesion of stomach or duodenum Types: -Gastric, Duodenal (most common), Stress

H2 Blockers (H2 Agonists)

Blocks HCL acid release by preventing release of gastrin -Treat: Duodenal ulcers, GERD, heartburn Drugs: Cimetidine, Ranitidine (Zantac), Famotidine

Which of the following are classified as a histamine-2 receptor antagonist?

Famotidine (Pepcid)

Hydroxyzine (Vistaril)

For OB patients (also is antihistamine) *Anti-emetics

Metoclopramide (Reglan)

For pt. receiving chemo; also used as anti-emetic

Peritonitis

Inflammation of peritoneum Manifestations: rebound tenderness, pain, muscle rigidity "board" like, absent bowel sounds, N & V, increased WBC, temp and pulse

Gastritis

Inflammation of the gastric mucosa and/or submucosa -Causes: Erosive and non-erosive (inflammation) ulcers -Chronic gastritis-associated w/pernicious anemia b/c intrinsic factor is not produced and B12 cannot be absorbed -H-pylori bacteria can be a cause of non-erosive gastritis

Prostaglandins

Inhibits gastric secretion, and increases secretion of mucous lining-acts as a buffer -Women can experience excess bleeding/spotting/cramping; miscarriage -Drugs: Misoprostol (Cytotect) *Has lots of side effects; need to do good assessment when med. given to pt.

INR (International Normalized Ratio)

Measures the time it takes for blood to clot and compares it to an average -Healthy person: 0.7-1.8 -Standard test for bleeding and coagulation test

The nurse is conducting a community health education program on obesity. The nurse includes which of the following diseases/disorders in the program? a) Chronic obstructive pulmonary disease b) Obstructive sleep apnea c) Rheumatoid arthritis d) Oral cancer

Obstructive sleep apnea Explanation: The nurse includes that obstructive sleep apnea is a disease/disorder associated with obesity as well as asthma; breast, endometrial, prostate, renal, colon, and gallbladder cancer; osteoarthritis, coronary artery disease, cholecystitis, cholelithiasis, chronic back pain, diabetes, hypertension, coronary artery disease, heart failure, and pulmonary embolism.

Which of the following represents the medication classification of a proton (gastric acid) pump inhibitor?

Omeprazole (Prilosec) Explanation: Omeprazole decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells. Sucralfate is a cytoprotective drug. Famotidine is a histamine-2 receptor antagonist. Metronidazole is an antibiotic, specifically an amebicide.

Meds to prevent N & V

Ondansetron Metaclopramide Aprepitant

Tumor Lysis Syndrome

Rapidly induced electrolyte imbalance secondary to radiation or chemo induced cell death and can result in acute renal failure

Normochromic

Red RBC

Tumor staging

Size of tumor; presence of metastasis

Hiatal hernia

Stomach herniates above the diaphragm

Bone Marrow Aspiration

Suctions out cells/fluids from iliac crest/sternum

Proton Pump Inhibitors (PPIs)

Suppress secretion of HCL into the stomach by blocking the last step in the process -Treat: Prevent and heal ulcers and erosive esophagitis; part of H-Pylori tx -Drugs: Omeprazole (Prilosec), Lansoprazole (Prevacid); oral and IV preparations *Long term NSAID users should also take PPI, to prevent GI bleeding

Squamo-columnar Junction

The are where most cell abnormalities occur in cervical cancer

Sickle Cell Anemia

abnormally shaped RBC caused by decreased O2 in the tissues -Rigid cells clumped together -Pain is classic symptom

Virtual colonoscopy

aka CT colonography; provides a computer simulated endoluminal perspective of the air-filled distended colon using conventional CT scan -more pt. friendly

Endometrial Cancer

aka Uterine cancer; cancer of the uterine lining -most common GYN malignancy in the US -Associated with prolonged exposure to estrogen w/o the protective effects of progesterone Risks: Smoker, never pregnant-"nulliparous", obese (higher estrogen levels), more menstrual cycles (early menarche, late menopause), Tamoxifen use (long term chemo for breast cancer), Hormone therapy after menopause, aging S/S: vaginal bleeding-abnormal amounts or intervals between; or bleeding after menopause Tx: surgery (first line); Hysterectomy and BSO (removal of ovarian and fallopian tubes), radiation, chemo if advanced

ITP - Idiopathic Thrombocytopenic Purpura

autoimmune disorder; bleeding disorder body makes platelets, but body destroys them S/S: ecchymoses (bruises), petechiae, mucosal bleeding, possible anemia Interventions: immunosuppressants, protection from trauma, transfusion if <20,000 platelets, observe and protect if platelets 30-50,000, splenectomy may be needed

Hypochromic

pale RBC

Cytoreductive

partial removal of tumor-take out as much as possible

Pharmacogenomics

chemotherapy individualized approach based on genetic makeup

Hemophilia (Bleeder)

clotting defect missing Hem A: 80% of cases; deficiency factor VIII Hem B: 20% of cases; deficiency factor IX Genetic etiology females are carriers

"TNM"

extent of Tumor, lymph Node involvement, extent of Metastasis

Teletherapy

external tx- beams of radiation e.g. "Cyberknife" -small doses, daily basis amount depends on type of CA -hair loss only on affected area

Multiple Myeloma

formed by malignant plasma cells; when B cells respond to an infection, they mature and changed into plasma cells Out-of-control growth of the plasma cells causes tumors in the bone reduces counts of other types of cells, interferes w/normal osteoclast and osteoblast cells and ends up causing fragile bone susceptible to fracture "Swiss cheese" appearance of bones; fractures are a major complication

Palliative

goals are comfort, extend life, promote quality of remaining life

A client is prescribed a histamine (H2)-receptor antagonist. The nurse understands that the following are H2-receptor antagonists. Choose all that apply. a) Ranitidine (Zantac) b) Esomeprazole (Nexium) c) Famotidine (Pepcid) d) Nizatidithene (Axid) e) Lansoprazole (Prevacid) f) Cimetidine (Tagamet)

• Nizatidithene (Axid) • Ranitidine (Zantac) • Famotidine (Pepcid) • Cimetidine (Tagamet) Explanation: H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton-pump inhibitors.

A nurse is assessing a client who is interested in undergoing bariatric surgery. Which of the following are criteria for candidacy? Select all that apply. a) Understanding of the causes of obesity b) Body mass index (BMI) of 27 c) Ability to explain why other weight-loss attempts have failed d) Understanding of required lifestyle changes e) No history of psychiatric illness

• Understanding of required lifestyle changes • No history of psychiatric illness Explanation: A client who is interested in bariatric surgery must be evaluated by a mental health practitioner to ensure that he or she does not have serious psychiatric disorders and is motivated to comply with lifestyle changes related to eating patterns, dietary choices, and elimination. The client also must be morbidly obese. A client with a BMI of 27 is overweight, but not morbidly obese. While assessment of knowledge about causes of obesity and its associated risks as well as insight into the reasons why previous diets have been ineffective are included in the client's plan of care, these do not predict positive client outcomes following bariatric surgery.

Which of the following are assessment findings associated with thrombocytopenia? Select all that apply. a) Bleeding gums b) Bradypnea c) Hematemesis d) Hypertension e) Epistaxis

• Bleeding gums • Hematemesis • Epistaxis Correct Explanation: Pertinent findings of thrombocytopenia include: bleeding gums, epistaxis, hematemesis, hypotension, and tachypnea.

Which of the following vitamins enhance the absorption of iron? a) E b) D c) C d) A

- Vitamin C Explanation: Vitamin C facilitates the absorption of iron. Therefore, iron supplements should be taken with a glass of orange juice or a vitamin C tablet to maximize absorption.

5HT3 Receptor blockers (chemo, severe N & V)

-Ondansetron (Zofran) *Anti-emetics

Which of the following medications is the antidote to Warfarin? a) Vitamin K b) Protamine sulfate c) Clopidogrel (Plavix) d) Aspirin

-Vitamin K Explanation: The antidote for Coumadin is vitamin K. Protamine sulfate is the antidote for heparin. Aspirin and Plavix are both antiplatelet medications.

A patient with sickle cell anemia has a a) low hematocrit. b) normal hematocrit. c) normal blood smear. d) high hematocrit.

-low hematocrit. Explanation: The patient with sickle cell anemia has a low hematocrit and sickled cells on the smear. The patient with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.

Dronabinal (cannabis)

Chemo and HIV only drug *Anti-emetics

Polycythemia

Increased RBCs

Achalasia

Motor disorder; esophagus narrows just proximal to the stomach, and dilates above that; dysphagia (difficulty swallowing) Tx: Pneumatic dilation, surgery Botox is a new treatment

Tumor grading

Classification of tumor cells Grade I-IV: refers to how closely the cells resemble the normal tissue

The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which of the following diseases/conditions?

-Peptic ulcers Explanation: Chronic gastritis caused by Helicobacter pylori is implicated in the development of peptic ulcers. Chronic gastritis is sometimes associated with autoimmune disease, such as pernicious anemia, but not as a cause of the anemia. Chronic gastritis is not implicated in system infections and/or colostomies.

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? a) Six small meals daily with 120 mL fluid between meals b) Three meals and three snacks and 120 mL fluid daily c) Six small meals and 120 mL fluid daily d) Three meals and 120 ml fluid daily

- Six small meals daily with 120 mL fluid between meals Explanation: After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals.

A client is admitted to the hospital with an exacerbation of his chronic gastritis. When assessing his nutritional status, the nurse should expect a deficiency in: a) vitamin C. b) vitamin A. c) vitamin B6. d) vitamin B12.

- vitamin B12. Explanation: The nurse should expect vitamin B12 deficiency. Injury to the gastric mucosa causes gastric atrophy and impaired function of the parietal cells. These changes result in reduced production of intrinsic factor, which is necessary for the absorption of vitamin B12. Eventually, pernicious anemia will occur. Deficiencies in vitamins A, B6, and C aren't expected in a client with chronic gastritis.

A client is prescribed tetracycline to treat peptic ulcer disease. Which of the following instructions would the nurse give the client? a) "Expect a metallic taste when taking this medicine, which is normal." b) "Take the medication with milk." c) "Do not drive when taking this medication." d) "Be sure to wear sunscreen while taking this medicine."

-"Be sure to wear sunscreen while taking this medicine." Explanation: Tetracycline may cause a photosensitivity reaction in clients. The nurse should caution the client to use sunscreen when taking this drug. Dairy products can reduce the effectiveness of tetracycline, so the nurse should not advise him or her to take the medication with milk. A metallic taste accompanies administration of metronidazole (Flagyl). Administration of tetracycline does not necessitate driving restrictions.

Which nursing instructions help parents of a child with hemophilia provide a safe home environment for their child? a) "Be a role model to your child by wearing a helmet when riding a bike so your child will, too." b) "Establish a written emergency plan including what to do in specific situations and the names and phone numbers of emergency contacts." c) "Talk with your child about home safety and have him problem-solve hypothetical situations about his health." d) "Pad the corners of coffee tables when your child is a toddler and provide kneepads for sports when the child is older."

-"Establish a written emergency plan including what to do in specific situations and the names and phone numbers of emergency contacts." Explanation: Establishing a written emergency plan that includes what to do in specific situations helps the family provide safety measures for their child with hemophilia. Padding corners of furniture and using kneepads don't help provide a safe home environment for children of all ages. Telling the parents to be a role model by wearing a bike helmet is only applicable to children who are old enough to emulate their parent's behaviors. Having the child problem-solve hypothetical health situations doesn't help provide a safe environment; it addresses problem solving.

The nurse is conducting a community health education program on obesity. The nurse includes which of the following diseases/disorders in the program? a) Oral cancer b) Obstructive sleep apnea c) Rheumatoid arthritis d) Chronic obstructive pulmonary disease

-Obstructive sleep apnea Explanation: The nurse includes that obstructive sleep apnea is a disease/disorder associated with obesity as well as asthma; breast, endometrial, prostate, renal, colon, and gallbladder cancer; osteoarthritis, coronary artery disease, cholecystitis, cholelithiasis, chronic back pain, diabetes, hypertension, coronary artery disease, heart failure, and pulmonary embolism.

The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client states: a) "I should continue my treatment regimen as long as I have pain." b) "I should stop all my medications if I develop any side effects." c) "I can buy whatever antacids are on sale because they all have the same effect." d) "I have learned some relaxation strategies that decrease my stress."

-"I have learned some relaxation strategies that decrease my stress." Explanation: The nurse assists the client to identify stressful or exhausting situations. A hectic lifestyle and an irregular schedule may aggravate symptoms and interfere with regular meals taken in relaxed settings along with the regular administration of medications. The client may benefit from regular rest periods during the day, at least during the acute phase of the disease. Biofeedback, hypnosis, behavior modification, massage, or acupuncture may be helpful.

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? a) "I will receive parenteral vitamin B12 therapy for the rest of my life." b) "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." c) "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." d) "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year."

-"I will receive parenteral vitamin B12 therapy for the rest of my life." Explanation: Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life.

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin (Coumadin). The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? a) "I'll report unexplained or severe bruising to my doctor right away." b) "I'll use an electric razor to shave." c) "I'll watch my gums for bleeding when I brush my teeth." d) "I'll eat four servings of fresh, dark green vegetables every day."

-"I'll eat four servings of fresh, dark green vegetables every day." Explanation: The client requires additional teaching if he states that he'll eat four servings of dark green vegetables every day. Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day. The client should report bleeding gums and severe or unexplained bruising, which may indicate an excessive dose of warfarin. The client should use an electric razor to prevent cutting himself while shaving.

A nurse is teaching a client who has experienced an episode of acute gastritis and knows further education is necessary when the client makes the following statement: a) "I should feel better in about 24 to 36 hours." b) "My appetite should come back tomorrow." c) "Once I can eat again, I should stick with bland foods." d) "I should limit alcohol intake, at least until symptoms subside."

-"My appetite should come back tomorrow." Explanation: The gastric mucosa is capable of repairing itself after an episode of gastritis. As a rule, the client recovers in about 1 day, although the appetite may be diminished for an additional 2 or 3 days. Acute gastritis is also managed by instructing the client to refrain from alcohol and food until symptoms subside. When the client can take nourishment by mouth, a nonirritating diet is recommended. (less)

A client is prescribed 325 mg/day of oral ferrous sulfate. The nurse includes in client teaching, "Take your iron pill a) 1 hour before breakfast" b) with dairy products" c) along with a decreased amount of dietary fiber" d) and decrease fruits and juices in your diet"

-1 hour before breakfast" Explanation: Instructions the nurse will provide for the client taking oral ferrous sulfate is to administer the medication on an empty stomach. Instructions also include that there is decreased absorption of iron with food, particularly dairy products. The client is to increase vitamin C intake (fruits, juices, tomatoes, broccoli), which will enhance iron absorption. The client is to also increase foods high in fiber to decrease risk of constipation.

A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? a) 15 to 20 days b) 4 to 6 days c) 7 to 9 days d) 10 to 14 days

-10 to 14 days Explanation: Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (eg, metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton pump inhibitor (eg, lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton pump inhibitor and bismuth salts (Pepto-Bismol).

A client weighs 215 lbs and is 5' 8" tall. The nurse would calculate this client's body mass index (BMI) as which of the following? a) 19.5 b) 24.8 c) 32.7 d) 44.9

-32.7 Explanation: Using the formula for BMI, the client's weight in pounds (215) is divided by the height in inches squared (68 inches squared) and then multiplied by 703. The result would be 32.7.

Vitamin B and folic acid deficiencies are characterised by production of abnormally large erythrocytes called a) megaloblasts. b) mast cells. c) monocytes. d) blast cells.

-Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Explanation: Low preoperative HCT and Hb levels indicate the client may require a blood transfusion before surgery. If the HCT and Hb levels decrease during surgery because of blood loss, the potential need for a transfusion increases. Possible renal failure is indicated by elevated BUN or creatinine levels. Urine constituents aren't found in the blood. Coagulation is determined by the presence of appropriate clotting factors, not electrolytes.

Which nursing diagnosis should a nurse expect to see in a care plan for a client in sickle cell crisis? a) Acute pain related to sickle cell crisis b) Impaired skin integrity related to pruritus c) Disturbed sleep pattern related to external stimuli d) Imbalanced nutrition: Less than body requirements related to poor intake

-Acute pain related to sickle cell crisis Explanation: In sickle cell crisis, sickle-shaped red blood cells clump together in a blood vessel, which causes occlusion, ischemia, and extreme pain. Therefore, Acute pain related to sickle cell crisis is the appropriate choice. Although nutrition is important, poor nutritional intake isn't necessarily related to sickle cell crisis. During sickle cell crisis, pain or another internal stimulus is more likely to disturb the client's sleep than external stimuli. Although clients with sickle cell anemia can develop chronic leg ulcers caused by small vessel blockage, they don't typically experience pruritus.

GI Protectant

Coats the injured mucosa to protect from stomach acid -Avoid in renal failure/dialysis; don't take w/aluminum sale antacids; used as protective agent in ICU pts. -Drugs: Sucralfate (Carafate)

A patient with sickle cell crisis is admitted to the hospital in severe pain. While caring for the patient during the crisis, which of the following is the priority nursing intervention? a) Encouraging the patient to ambulate as much as tolerated b) Teaching the patient about increasing dietary intake of high-protein, high-calorie foods c) Administering and evaluating the effectiveness of opioid analgesics d) Limiting the patient's intake of oral and IV fluids

-Administering and evaluating the effectiveness of opioid analgesics Explanation: The use of medication to relieve acute pain is important. When opioid analgesic agents are used, morphine is the medication of choice for acute pain. Patient-controlled analgesia (PCA) is frequently used in the acute care setting.

Which of the following is the most common haematologic condition affecting elderly patients a) Anaemia b) Leukopenia c) Thrombocytopenia d) Bandaemia

-Anaemia Explanation: Anaemia is the most common haematologic condition affecting elderly patients: with each successive decade of life, the incidence of anaemia increases. Thrombocytopenia is a low platelet count. Leukopenia is a low leukocyte count. Bandaemia is an increased number of band cells.

Which type of sickle crisis occurs as a result of infection with the human parvovirus? a) Sequestration crisis b) Acute chest syndrome c) Sickle crisis d) Aplastic crisis

-Aplastic crisis Explanation: Aplastic crisis results from infection with the human parvovirus. Sequestration crisis results when other organs pool the sickled cells. Sickle crisis which results from tissue hypoxia and necrosis due to inadequate blood flow to a specific region of tissue or organ. Acute chest syndrome is manifested by a rapidly decreasing hemoglobin level, tachycardia, fever, and bilateral infiltrates seen on the chest x-ray.

Which of the following nursing interventions should be incorporated into the plan of care to manage the delayed clotting process in a patient with leukaemia? a) Monitor temperature at least once per shift b) Apply prolonged pressure to needle sites or other sources of external bleeding c) Implement neutropenic precautions d) Eliminate direct contact with others who are infectious

-Apply prolonged pressure to needle sites or other sources of external bleeding Explanation: For a patient with leukaemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for haemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain to his right shoulder. The intial appropriate action by the nurse is to a) Irrigate the client's NG tube. b) Notify the health care provider. c) Place the client in the high-Fowler's position. d) Assess the client's abdomen and vital signs.

-Assess the client's abdomen and vital signs. Explanation: Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated. (less)

When teaching a patient with iron deficiency anaemia about appropriate food choices, the nurse will encourage the patient to increase the dietary intake of which of the following foods? a) Dairy products b) Fruits high in vitamin C, such as organs and grapefruits c) Berries and orange vegetables d) Beans, dried fruits, and leafy green vegetables

-Beans, dried fruits, and leafy green vegetables Explanation: Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.

Which of the following is a symptom of Haemochromatosis? a) Inflammation of the mouth b) Weight gain c) Inflammation of the tongue d) Bronzing of the skin

-Bronzing of the skin Explanation: Patients with Haemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory. The skin may appear hyperpigmented from melanin deposits or appear bronze in colour.

Which of the following is a symptom of Cooley's anemia? a) Inflammation of the mouth b) Inflammation of the tongue c) Bronzing of the skin d) Dyspnea

-Bronzing of the skin Explanation: Patients with Cooley's anemia exhibit symptoms of severe anemia and a bronzing of the skin, which is caused by hemolysis of erythrocytes. Dyspnea, stomatitis (inflammation of the mouth), and glossitis (inflammation of the tongue) are symptoms of pernicious anemia.

A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. The most important action of the nurse is to a) Continue with the present infusion rate of heparin. b) Consult with the physician about discontinuing heparin. c) Begin treatment with the prescribed warfarin (Coumadin). d) Increase the heparin infusion by 100 units per hour.

-Consult with the physician about discontinuing heparin. Explanation: Platelet counts may decrease with heparin therapy, and this client's platelet count has decreased. The client may have heparin-induced thrombocytopenia (HIT). Treatment of HIT includes discontinuing the heparin. The question asks about the most important action of the nurse and that is to consult with the physician about discontinuing heparin therapy. The nurse may continue with the current rate and should not increase the heparin dose until consulting with the physician. Warfarin is not administered until the platelet count has returned to normal levels.

A client experienced extensive burns and 72 hours later has developed an ulcer. Which of the following types of ulcer is most likely in this client? a) Hashimoto's ulcer b) Stress ulcer c) Cushing's ulcer d) Curling's ulcer

-Curling's ulcer Explanation: Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or duodenum.

Which of the following ulcers is associated with extensive burn injury? a) Cushing's ulcer b) Curling's ulcer c) Peptic ulcer d) Duodenal ulcer

-Curling's ulcer Explanation: Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.

A patient's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which of the following statements made by the nurse correctly explains the cause of DIC? a) DIC occurs when the immune system attacks platelets and causes massive bleeding. b) DIC is caused when haemolytic processes destroy erythrocytes. c) DIC is a complication of an autoimmune disease that attacks the body's own cells. d) DIC is caused by an abnormal activation of clotting pathway causing excessive amounts of tiny clots to form inside organs.

-DIC is caused by an abnormal activation of clotting pathway causing excessive amounts of tiny clots to form inside organs. Explanation: The inflammatory response initiates the process of inflammation and coagulation. The natural anticoagulant pathways within the body are simultaneously impaired, and the fibrinolytic system is suppressed so that a massive amount of tiny clots forms in the microcirculation. As the platelets and clotting factors form microthrombi, coagulation fails. Thus, the paradoxical result of excessive clotting is bleeding. Decline in organ function is usually a result of excessive clot formation (with resultant ischemia to all or part of the organ).

Cancer Treatment: Surgery

-Diagnostic biopsies -Curative treatment -Cytoreductive -Prophylactic -Palliative -Reconstructive

Symptoms associated with pyloric obstruction include all of the following except: a) Nausea and vomiting b) Anorexia c) Diarrhea d) Epigastric fullness

-Diarrhea Explanation: Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down. The client may have nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.

Symptoms associated with pyloric obstruction include all of the following except: a) Nausea and vomiting b) Epigastric fullness c) Diarrhea d) Anorexia

-Diarrhea Explanation: Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down. The client may have nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss. (less)

Which of the following appears to be a significant factor in the development of gastric cancer? a) Age b) Diet c) Ethnicity d) Gender

-Diet Explanation: Diet seems to be a significant factor: a diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk of gastric cancer. The typical patient with gastric cancer is between 50 and 70 years of age. Men have a higher incidence than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as Caucasian Americans to develop gastric cancer.

Duodenal Ulcer

-Distal to pyloric sphincter -Hypersecretion of HCL -Pain occurs 2-3 hrs after meals, and often at night, to right of midline -*Relieved by food -*Melena -Well nourished

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? a) Nausea, vomiting, and anorexia b) Itching, rash, and jaundice c) Dyspnea, tachycardia, and pallor d) Nights sweats, weight loss, and diarrhea

-Dyspnea, tachycardia, and pallor Explanation: Signs of iron deficiency anemia include dyspnea, tachycardia, and pallor, as well as fatigue, listlessness, irritability, and headache. Night sweats, weight loss, and diarrhea may signal acquired immunodeficiency syndrome. Nausea, vomiting, and anorexia may be signs of hepatitis B. Itching, rash, and jaundice may result from an allergic or hemolytic reaction.

GERD (Gastroesophageal reflux disease)

-Excess back-flow of gastric or duodenal contents into the esophagus Causes: Incompetent lower esophageal sphincter (LES), pyloric stenosis, hiatal hernia. Caffeine, ETOH, nicotine also relax the LES.

Diagnostic biopsies

-Excisional= takes out all of the tissue -Incisional= wedge of tissue -Needle=aspirated tissue using hollow needle

A patient was admitted to the hospital with the following lab values: hemoglobin 5 g/dL, abnormally shaped erythrocytes, leukocyte count 2000/mm3 with hypersegmented neutrophils and a platelet count of 48,000/mm3. The platelets appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that patient most likely has which of the following diagnoses? a) Hemolytic anemia b) Sickle cell anemia c) Folic acid deficiency d) Thalassemia

-Folic acid deficiency Explanation: Anemia caused by a deficiency of folic acid cause bone marrow and peripheral blood changes. The erythrocytes that are produced are abnormally large and are called megaloblastic red cells. Other cells derived from the myeloid stem cell are also abnormal. A bone marrow analysis reveals hyperplasia (abnormal increase in the number of cells). Pancytopenia (a decrease in all myeloid stem cell-derived cells) can develop. In advanced stages of disease, the hemoglobin value may be as low as 4 to 5 g/dL, the leukocyte count 2,000 to 3,000/mm3, and the platelet count less than 50,000/mm3. Cells that are released into the circulation are often abnormally shaped. The neutrophils are hypersegmented. The platelets may be abnormally large. The erythrocytes are abnormally shaped.

Which of the following surgical procedures for obesity utilizes a prosthetic device to restrict oral intake? a) Gastric banding b) Vertical-banded gastroplasty c) Biliopancreatic diversion with duodenal switch d) Roux-en-Y gastric bypass

-Gastric banding Explanation: In gastric banding, a prosthetic device is used to restrict oral intake by creating a small pouch of 10 to 15 milliliters that empties through the narrow outlet into the remainder of the stomach. Roux-en-Y gastric bypass uses a horizontal row of staples across the fundus of the stomach to create a pouch with a capacity of 20 to 30 mL. Vertical-banded gastroplasty involves placement of a vertical row of staples along the lesser curvature of the stomach, creating a new, small gastric pouch. Biliopancreatic diversion with duodenal switch combines gastric restriction with intestinal malabsorption.

Which of the following terms refers to an abnormal decrease in white blood cells, red blood cells, and platelets? a) Anemia b) Pancytopenia c) Leukopenia d) Thrombocytopenia

-Pancytopenia Correct Explanation: Pancytopenia is defined as an abnormal decrease in WBCs, RBCs, and platelets. It may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.

Which of the following surgical procedures for obesity utilizes a prosthetic device to restrict oral intake? a) Vertical-banded gastroplasty b) Gastric banding c) Biliopancreatic diversion with duodenal switch d) Roux-en-Y gastric bypass

-Gastric banding Explanation: In gastric banding, a prosthetic device is used to restrict oral intake by creating a small pouch of 10 to 15 milliliters that empties through the narrow outlet into the remainder of the stomach. Roux-en-Y gastric bypass uses a horizontal row of staples across the fundus of the stomach to create a pouch with a capacity of 20 to 30 mL. Vertical-banded gastroplasty involves placement of a vertical row of staples along the lesser curvature of the stomach, creating a new, small gastric pouch. Biliopancreatic diversion with duodenal switch combines gastric restriction with intestinal malabsorption.

A patient has been diagnosed with thrombocytopenia. What are the primary nursing interventions while instituting corticosteroid therapy in this patient? a) Gradually taper the dose and frequency of medication. b) Palpate the lymph nodes and tonsils every shift. c) Examine the extremities for redness. d) Eliminate aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

-Gradually taper the dose and frequency of medication. Explanation: For a patient with thrombocytopenia, he or she gradually tapers the dose and frequency of steroid medication before discontinuing it to avoid adrenal insufficiency or crisis. Eliminating aspirin and NSAIDS will help manage bleeding tendencies. Assessment of the extremities, tonsils, or the lymph nodes is part of a physical examination of a patient and not applicable to corticosteroid therapy.

A male client has a hemoglobin count of 10.2 gm/dl, a hematocrit value of 36%, and a low ferritin level. What question should the nurse ask first? a) How much alcohol do you drink? b) Can you explain your typical diet? c) Have you experienced abdominal pain? d) Are you taking iron supplements?

-Have you experienced abdominal pain? Explanation: The laboratory data support that the client has iron-deficiency anemia. The most common cause of iron-deficiency anemia in men is bleeding from ulcers, gastritis, inflammatory bowel disease, or gastrointestinal tumors. People who experience these problems may report abdominal pain. The nurse will make further assessments and may ask the other questions.

When assessing a female patient with anaemia, which of the following assessments is essential? a) Lifestyle assessments, such as exercise routines b) Family history c) Health history, including menstrual history d) Age and gender

-Health history, including menstrual history Explanation: When assessing a patient with anemia, it is essential to assess the patient's health history. Women should be questioned about their menstrual periods (e.g., excessive menstrual flow, other vaginal bleeding) and the use of iron supplements during pregnancy.

When assessing a female patient with a disorder of the hematopoietic or the lymphatic system, which of the following assessments is most essential? a) Health history, such as bleeding, fatigue, or fainting b) Menstrual history c) Lifestyle assessments, such as exercise routines d) Age and gender

-Health history, such as bleeding, fatigue, or fainting Explanation: When assessing a patient with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the patient's health history. An assessment of drug history is essential because some antibiotics and cancer drugs contribute to hematopoietic dysfunction. Aspirin and anticoagulants may contribute to bleeding and interfere with clot formation. Because industrial materials, environmental toxins, and household products may affect blood-forming organs, the nurse needs to explore exposure to these agents. Age, gender, menstrual history, or lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system.

The nurse is assessing a patient with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which of the following as a sign/symptom of possible hemorrhage? a) Polyuria b) Hypertension c) Hematemesis d) Bradycardia

-Hematemesis Explanation: The nurse interprets hematemesis as a sign/symptom of possible hemorrhage from the ulcer. Other signs that can indicate hemorrhage include tachycardia, hypotension, and oliguria/anuria.

The nurse in the ED is admitting a patient with bloody stools. The nurse documents this finding as being which of the following? a) Steatorrhea b) Tarry stools c) Hematochezia d) Melena

-Hematochezia Explanation: The nurse should document the finding of bloody stools as hematochezia. Melena is the term used for tarry black stools with occult blood. Steatorrhea is the term utilized for fatty stools that have an oily appearance and float in water.

A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, and labored breathing; the client also appears to be confused. Which of the following complications has the client most likely developed? a) Pyloric obstruction b) Penetration c) Hemorrhage d) Perforation

-Hemorrhage Explanation: Signs of hemorrhage following surgery include cool skin, confusion, increased heart rate, labored breathing, and blood in the stool. Signs of penetration and perforation are severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature, and increased heart rate. Indicators of pyloric obstruction are nausea, vomiting, distended abdomen, and abdominal pain.

A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, and labored breathing; the client also appears to be confused. Which of the following complications has the client most likely developed? a) Pyloric obstruction b) Penetration c) Hemorrhage d) Perforation

-Hemorrhage Explanation: Signs of hemorrhage following surgery include cool skin, confusion, increased heart rate, labored breathing, and blood in the stool. Signs of penetration and perforation are severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature, and increased heart rate. Indicators of pyloric obstruction are nausea, vomiting, distended abdomen, and abdominal pain.

Zollinger-Ellison Syndrome (ZES)

-Hypersecretory; excess HCL -Diarrhea and steatorrhea; mid-epigastric pain -Poor response to traditional PUD therapy -Presence of ulcers and "gastrinomas" - tumors in the duodenum and pancreas. -*Negative for H. pylori

Which of the following are classified as a histamine-2 receptor antagonist? a) Flagyl b) Pepcid c) Prevacid d) Nexium

-Pepcid Explanation: Famotidine (Pepcid) is a histamine-2 receptor antagonist. Prevacid and Nexium are PPIs. Flagyl is an antibiotic.

A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important? a) Slow the transfusion and monitor the client closely. b) Immediately stop the transfusion, infuse dextrose 5% in water (D5W), and call the physician. c) Immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank. d) Stop the transfusion, notify the blood bank, and administer antihistamines.

-Immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank. Explanation: When a transfusion reaction occurs, the transfusion should be immediately stopped, normal saline solution should be infused to maintain venous access, and the physician and blood bank should be notified immediately. Other nursing actions include saving the blood bag and tubing, rechecking the blood type and identification numbers on the blood tags, monitoring vital signs, obtaining necessary laboratory blood and urine samples, providing proper documentation, and monitoring and treating for shock. Because they can cause red blood cell hemolysis, dextrose solutions shouldn't be infused with blood products. Antihistamines are administered for a mild allergic reaction, not a hemolytic reaction.

A patient who had bariatric surgery complains of diarrhea. The nurse recommends which of the following dietary changes? a) Increased fiber b) Increased protein c) Decreased fat d) Decreased carbohydrates

-Increased fiber Explanation: The nurse recommends that the patient increase fiber in the diet because a high-fiber diet can decrease both diarrhea and constipation after bariatric surgery.

A patient with severe anemia is complaining of the following symptoms: tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Lab results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which of the following nursing diagnoses is most appropriate for this patient? a) Fatigue related to decreased hemoglobin and hematocrit b) Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients c) Risk for falls related to complaints of dizziness d) Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

-Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit Explanation: The symptoms indicate impaired tissue perfusion due to a decrease in the oxygen-carrying capacity of the blood. Cardiac status should be carefully assessed. When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased cardiac workload can result in such symptoms as tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly) and by peripheral edema. (less)

Ulcerative Colitis

-LLQ pain -Age: 15-25 yr and 55-65 yr. -Rectum and spreads proximally -Contiguous/continuous lesions/ulcerations -Frequent and bloody stools

Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat? a) Lamb and peaches b) Shrimp and tomatoes c) Cheese and bananas d) Lobster and squash

-Lamb and peaches Explanation: Iron-rich foods include lamb and peaches. Shrimp, tomatoes, lobster, squash, cheese, and bananas aren't high in iron content.

Gastric Ulcer

-Lesser curvature -Normal or hypo section of HCL -Pain associated w/meals, rarely at night, to left of midline -*Worsen by food -*Hematemesis -Wt. loss/malnourished

Barrett's Esophagus

-Lining of esophageal mucosa is altered -Cellular changes in the lining of the lower esophagus-no longer squamous cells; now columnar epithelium -Precancerous cells-dysplastic in nature -Biopsies, barium swallow

Vitamin B and folic acid deficiencies are characterised by production of abnormally large erythrocytes called a) Mast cells b) Blast cells c) Megaloblasts d) Monocytes

-Megaloblasts Explanation: Megaloblasts are abnormally large erythrocytes. Blast cells are primitive WBCs. Mast cells are cells found in connective tissue involved in defense of the body and coagulation. Monocytes are large WBCs that become macrophages when they leave the circulation and move into body tissues.

For a patient with Hodgkin's disease who has developed neutropenia, what is the most appropriate nursing intervention to include in the care plan? a) Positioning the patient to increase the lung expansion b) Omiting fresh fruits and vegetables from the diet c) Monitoring the temperature every 4 hours d) Avoiding intramuscular (IM) injections

-Monitoring the temperature every 4 hours Explanation: For a patient with neutropenia, monitoring the temperature every 4 hours is essential. If the patient develops a fever, the patient is considered to have an infection and is usually admitted to the hospital. Cultures of blood, urine, and sputum, as well as a chest x-ray, are obtained.

Appendicitis

-Most common cause of RLQ pain -Vague mid-epigastric or peri-umbilical pain that progresses to RLQ within few hours, not days -Fever, nausea after the pain starts -Tender RLQ-McBurney's point -Rebound tenderness

Which cell of haematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a) Myeloid stem cell b) Monocyte c) Lymphoid stem cell d) Neutrophil

-Myeloid stem cell Correct Explanation: The myeloid stem cell is responsible not only for all non lymphoid white blood cells, but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues. A neutrophil is a fully mature WBC capable of phagocytosis.

A nursing student notes that a client has a new physician order for a proton-pump inhibitor. The student knows that a frequently prescribed proton-pump inhibitor of gastric acid is a) Tagamet b) Pepcid c) Zantac d) Nexium

-Nexium Explanation: Nexium decreases gastric acid secretion by slowing the hydrogen-potassium adenosine triphosphatase (H+, K+-ATPase) pump on the surface of the parietal cells of the stomach. It is used mainly for treatment of duodenal ulcer disease and H. pylori infection. It comes in a delayed-release capsule that is to be swallowed whole and taken before meals. The others are examples of H2 receptor antagonists

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? a) Thrombin time, calcium levels, and potassium levels b) Platelet count, prothrombin time, and partial thromboplastin time c) Platelet count, blood glucose levels, and white blood cell (WBC) count d) Fibrinogen level, WBC, and platelet count

-Platelet count, prothrombin time, and partial thromboplastin time Explanation: The diagnosis of DIC is based on the results of laboratory studies of prothrombin time, platelet count, thrombin time, partial thromboplastin time, and fibrinogen level as well as client history and other assessment factors. Blood glucose levels, WBC count, calcium levels, and potassium levels aren't used to confirm a diagnosis of DIC.

In adults, bone marrow is usually aspirated from which area? a) Sternum b) Ankle c) Femur d) Posterior iliac crest

-Posterior iliac crest Explanation: In adults, bone marrow is usually aspirated from the posterior iliac crest and rarely from the sternum. Bone marrow is not aspirated from the femur or ankle.

Which of the following is the most successful treatment for gastric cancer? a) Radiation b) Palliation c) Removal of the tumor d) Chemotherapy

-Removal of the tumor Explanation: There is no successful treatment for gastric carcinoma except removal of the tumor. If the tumor can be removed while it is still localized to the stomach, the patient may be cured. If the tumor has spread beyond the area that can be excised, cure is less likely.

A client has hereditary haemochromatosis. Laboratory test results indicate an elevated serum iron level, high transferrin saturation, and normal complete blood count (CBC). It is most important for the nurse to a) Inform the client to limit ingestion of alcohol. b) Instruct the client to limit iron intake in the diet. c) Remove the prescribed one unit of blood. d) Educate about precautions to follow after a liver biopsy.

-Remove the prescribed one unit of blood. Explanation: Treatment for haemochromatosis is phlebotomy or removal of whole blood from a vein to reduce iron. Limiting dietary intake of iron is not an effective treatment. The client needs to perform activities to protect the liver, such as limiting alcohol ingestion. The definitive test for haemochromatosis had been a liver biopsy, but now genetic testing is performed. A liver biopsy could be performed to determine liver damage. However, this does not address the most immediate problem of too high iron.

Alosetron (Lotronex)

-Restricted use on pt. w/diarrhea -Multiple safety concerns (ischemic colitis); only approved for females

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? a) Three meals and 120 ml fluid daily b) Six small meals and 120 mL fluid daily c) Six small meals daily with 120 mL fluid between meals d) Three meals and three snacks and 120 mL fluid daily

-Six small meals daily with 120 mL fluid between meals Explanation: After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals.

Esophagogastrostomy

-Surgical intervention for Barrett's esophagus and for esophageal cancers by resect esophagus, and graft in a portion of the jejunum or colon

Esophagectomy

-Surgical intervention for Barrett's esophagus and for esophageal cancers if there is high grade dysplasia (immature cells) -Reduce likelihood of invasive cancer in Barrett's -Done prophylactically or for treatment of active esophageal CA

Nissen fundoplication

-Surgical intervention for GERD and Hiatal Hernia -Wrapping a portion of the gastric fundus around the sphincter area of the esophagus -Can be done Laparoscopic or Open

Which type of lymphocyte is responsible for cell-mediated immunity? a) Basophil b) B lymphocyte c) Plasma cell d) T lymphocyte

-T lymphocyte Explanation: T lymphocytes are responsible for cell-mediated immunity. B lymphocytes are responsible for humoral immunity. A plasma cell secretes immunoglobulin. A basophil contains histamine and is an integral part of hypersensivity reactions.

A nurse is caring for a client who had gastric bypass surgery 2 days ago. Which assessment finding requires immediate intervention? a) The client complains of pain at the surgical site. b) The client states he is nauseated. c) The client's right lower leg is red and swollen. d) The client states he has been passing gas.

-The client's right lower leg is red and swollen. Explanation: A red, swollen extremity is a possible sign of a thromboembolism, a common complication after gastric surgery because of the fact that the clients are obese and tend to ambulate less than other surgical clients. The nurse should inform the physician of the finding. Pain at the surgical site should be investigated, but the red, swollen leg is a higher priority. It isn't unusual for a client to be nauseated after gastric bypass surgery. The nurse should follow up with the finding, but only after she has notified the physician about the possible thromboembolism. Passing gas is normal and a sign that the client's intestinal system is beginning to mobilize.

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count? a) Leukopenia b) Anemia c) Thrombocytopenia d) Neutropenia

-Thrombocytopenia Explanation: A normal platelet count is 140,000 to 400,000/mm3 in adults. Chemotherapeutic agents produce bone marrow depression, resulting in reduced red blood cell counts (anemia), reduced white blood cell counts (leukopenia), and reduced platelet counts (thrombocytopenia). Neutropenia is the presence of an abnormally reduced number of neutrophils in the blood and is caused by bone marrow depression induced by chemotherapeutic agents.

Why are antacids administered regularly, rather than as needed, in peptic ulcer disease? a) To keep gastric pH at 3.0 to 3.5 b) To maintain a regular bowel pattern c) To promote client compliance d) To increase pepsin activity

-To keep gastric pH at 3.0 to 3.5 Explanation: To maintain a gastric pH of 3.0 to 3.5 throughout each 24-hour period, regular (not as needed) doses of an antacid are needed to treat peptic ulcer disease. Frequent administration of an antacid tends to decrease client compliance rather than promote it. Antacids don't regulate bowel patterns, and they decrease pepsin activity.

A client with sepsis is experiencing disseminated intravascular coagulation (DIC). The client is bleeding from mucous membranes, venipuncture sites, and the rectum. Blood is present in the urine. The nurse establishes the nursing diagnosis of Risk for deficient fluid volume related to bleeding. The most appropriate and measurable outcome for this client is that the client exhibits a) Stable level of consciousness b) Systolic blood pressure greater than 70 mm Hg c) Decreased bleeding d) Urine output greater than or equal to 30 mL/hour

-Urine output greater than or equal to 30 mL/hour Explanation: All options could be expected outcomes for a nursing diagnosis of risk for deficient fluid volume. However, the key words are most appropriate and measurable. That would be the option relating to urine output, which is the most direct measurement listed of fluid volume.

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? a) Use the smallest needle possible for injections. b) Maintain accurate fluid intake and output records. c) Encourage the client to use a wheelchair. d) Limit visits by family members.

-Use the smallest needle possible for injections. Explanation: Because thrombocytopenia alters coagulation, it poses a high risk of bleeding. To help prevent capillary bleeding, the nurse should use the smallest needle possible when administering injections. The nurse doesn't need to limit visits by family members because they don't pose any danger to the client. The nurse should provide comfort measures and maintain the client on bed rest; activities such as using a wheelchair can cause bleeding. The nurse records fluid intake and output to monitor hydration; however, this action doesn't protect the client from a complication of thrombocytopenia.

For a patient diagnosed with pernicious anaemia, the nurse emphasises the importance of lifelong administration of which of the following? a) Vitamin C b) Folic acid c) Vitamin B12 d) Vitamin A

-Vitamin B12 Explanation: For a patient with pernicious anaemia, the nurse emphasises the importance of lifelong administration of vitamin B12. He or she teaches the patient or a family member of the proper method to administer vitamin B12 injections. Administration of vitamin A, folic acid, or vitamin C is not recommended for this condition.

During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin? a) Vitamin A b) Vitamin K c) Vitamin D d) Vitamin E

-Vitamin K Explanation: Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E.

Which of the following statements correctly identifies a difference between duodenal and gastric ulcers? a) Malignancy is associated with duodenal ulcer. b) Vomiting is uncommon in patients with duodenal ulcers. c) Weight gain may occur with a gastric ulcer. d) A gastric ulcer is caused by hypersecretion of stomach acid.

-Vomiting is uncommon in patients with duodenal ulcers. Explanation: Vomiting is uncommon in patients diagnosed with duodenal ulcer. Malignancy is associated with a gastric ulcer. Weight gain may occur with a duodenal ulcer. Duodenal ulcers cause hypersecretion of stomach acid.

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: a) alcohol abuse and a history of acute renal failure. b) a history of hemorrhoids and smoking. c) a sedentary lifestyle and smoking. d) alcohol abuse and smoking.

-alcohol abuse and smoking. Explanation: The nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client's stools to be: a) black and tarry. b) bright red. c) clay-colored. d) coffee-ground-like.

-black and tarry. Explanation: Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of digestive enzymes on the blood. Vomitus associated with upper GI tract bleeding commonly is described as coffee-ground-like. Clay-colored stools are associated with biliary obstruction. Bright red stools indicate lower GI tract bleeding.

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client's stools to be: a) coffee-ground-like. b) black and tarry. c) clay-colored. d) bright red.

-black and tarry. Explanation: Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of digestive enzymes on the blood. Vomitus associated with upper GI tract bleeding commonly is described as coffee-ground-like. Clay-colored stools are associated with biliary obstruction. Bright red stools indicate lower GI tract bleeding.

A nurse is providing follow-up teaching at a clinic visit for a client recovering from gastric resection. The client reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after meals. The nurse suspects the client has: a) dehiscence of the surgical wound. b) dumping syndrome. c) a normal reaction to surgery. d) peritonitis.

-dumping syndrome Explanation: Early manifestations of dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down. Dehiscence of the surgical wound is characterized by pain and a pulling or popping feeling at the surgical site. Peritonitis presents with a rigid, boardlike abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.

A client is being admitted to the hospital with abdominal pain, anemia, and bloody stools. He complains of feeling weak and dizzy. He has rectal pressure and needs to urinate and move his bowels. The nurse should help him: a) onto the bedpan. b) to the bathroom. c) to the bedside commode. d) to a standing position so he can urinate.

-onto the bedpan. Explanation: A client who's dizzy and anemic is at risk for injury because of his weakened state. Assisting him with the bedpan would best meet his needs at this time without risking his safety. The client may fall if walking to the bathroom, left alone to urinate, or trying to stand up.

Anemias

Decreased hgb/hct and/or RBCs S/S: Pallor; jaundiced if hymolytic, cool to touch, tachycardia, orthostatic hypotension, Dyspnea on exertion (DOE), decreased O2 sats, fatigue, HA, weak/decreased energy

Metastasis

Dissemination or spread of malignant cells from the primary tumor to distant sites

SIADH - Syndrome of inappropriate antidiuretic hormone

Causes: -fluid retention -hyponatremia (low Na+) -Untreated=progresses to seizure, coma, death!! -Can be caused by the cancer itself, or side effect of tx

Aprepitant (Emend)

Chemo drug *Anti-emetics

Hemochromatosis

Gene mutation; hereditary -excess iron absorption -men>women; middle age; gradual onset -Liver function deterioration Treatment: Phlebotomy to maintain a more normal serum ferritin level -Diet: avoid iron rich foods, vit. C

Chemotherapy drugs

Goal: to cure the CA; extend life -Systemic; cytotoxic -"Vesicant" -absorbed thru skin and mucous membranes -causes: bone marrow suppression; renal and liver toxicity -adverse effects: "Extravasation" = invasion of IV fluids into surrounding tissue

Radiation therapy

Goal: to eradicate 95% of tumor while preserving normal tissue Causes: tissue disruption and death!! Tx includes TELETHERAPY & BRACHYTHERAPY -affects skin integrity (radiation dermatitis), oral mucosa (stomatitis), altered taste, GI sx if stomach/colon involved, hair loss at site -Systemic effects: fatigue malaise (weakness & discomfort), anorexia

Polycythemia Vera (PV)

Increased, massive production of RBCs hyperviscous blood (blood sludge/thick like) increase in Hgb and RBC count considered blood cancer excess leukocyte and platelet production *Slow blood flow-prone to vascular

Ovarian Cancer

Most deadly GYN Cancer; survival rates low because often dx in late stages Risks: associated w/estrogen exposure, family history of breast and/or ovarian cancers, no pregnancies/late first pregnancy, infertility, early menarche, late menopause S/S: mild, vague, abdominal and GI symptoms for several months Tx: BSO - Bilateral Salipingo-Oophorectory (excision of both ovaries and fallopian tubes); hysterectomy, chemo and radiation

Antacids

Neutralize acids; symptomatic relief of heartburn -Can contribute to acid-base and electrolyte imbalances -Can cause "acid rebound" when used regularly -Give does 1-3 hrs. after meals and 1-2 hrs. before/after other meds *Monitor pt. fluid & electrolytes

Trimethobenzamide (Tigan)

Non-sedating drug *Anti-emetics

Benign tumor cells

Normal cells grow in the wrong place or at the wrong time -continuous or inappropriate growth -orderly growth, beyond what is normal, and at an increased rate (hyperplasia-expansion) -normal chromosomes -does not invade (but location and size can interfere with vital functions)

Cervical cancer

Risks: HPV infection, smoker, early sex, multiple partners, young women Prevention: HpV vaccine, Monogamous S/S: Pre-invasive=asymptomatic Invasive=irregular vaginal bleeding and /or foul, dark, smelly discharge Tx: Laser, Cryotherapy (freeze w/liquid nitrogen), Leep "Loop electrosurgical excision prodcedure" Advance tx: hysterectomy, radiation (brachytherapy), and/or chemo

Bone Marrow Biopsy

Takes a core sample w/a large bore needle and includes a small incision from iliac crest/sternum

Nadir

period of greatest bone marrow suppression in hematopoietic stem cell transplant

Carcinoma in situ

Tumor confined to the organ where first developed

Hodgkin lymphoma

starts in single lymph node spread to surrounding lymph nodes in an orderly fashion "Reed-Sternber" cells present

TIBC (total iron binding capacity)

tells how well heme is pulling up iron low results of heme means there's iron overload

Reticulocyte

immature RBC -Normal to be elevated with anemia or hemorrhage because the body is trying to recover; otherwise elevations are a concern

Reconstructive

improve function and/or appearance

Induction Chemotherapy

initial phase of chemo therapy tx very intense goal is remission and normalizing blood counts

Direct Visual colonoscopy

inspection of the large intestine (anus, rectum, sigmoid, transcending, and ascending colon) -used as diagnostic aid and screening device -most frequently used for cancer screening and surveillance of pt. w/colon cancer or polyps

Consolidation chemotherapy

intent is to cure destroy stray cells and continues to kill stray cells not destroyed through induction

Brachytherapy

internal tx - radioisotopes are implanted - solid or within body fluids

Non-Hodgkin Lymphoma

less orderly NO "Reed-Sternber" cells can be slow-growing or aggressive

Malignant lymphomas

lymphoid tissue cancer only lymphocytes are affected solid tumors enlarged/painless lymph nodes Hodgkin lymphoma & non-Hodgkin lymphoma

Maintenance chemotherapy

maintain remission reduce recurrence "cancer free"

Which of the following are immunosuppressants that prevent the patient's lymphocytes from destroying the stem cells in a patient diagnosed with aplastic anemia? Select all that apply. a) Cyclosporine b) Corticosteroids c) ATG d) Filgrastim e) Cyclophosphamide

• Cyclosporine • Corticosteroids • ATG • Cyclophosphamide Explanation: Immunosuppressants, including cyclosporine, corticosteroids, ATG, and cyclophosphamide, prevent the patient's lymphocytes from destroying the stem cells. Filgrastim is a growth-colony stimulating factor that may be used to decease the duration and severity of neutropenia associated with aplastic anemia. ** First set of flash cards printed stops here.

The nurse is caring for a client who has just returned from the PACU after surgery for peptic ulcer disease. For what potential complications does the nurse know to monitor? Select all that apply. a) Penetration b) Perforation c) Pyloric obstruction d) Cachexia e) Inability to clear secretions f) Hemorrhage

• Hemorrhage • Perforation • Penetration • Pyloric obstruction Explanation: Potential complications may include hemorrhage, perforation, penetration, and pyloric obstruction. A client who has had surgery for peptic ulcer disease may have a decreased appetite in the immediate postoperative stage, but it is not something the nurse would monitor for and would not cause cachexia. Inability to clear secretions is generally not a complication of peptic ulcer surgery.