NADN 260 Exam 4

A client with a new medication prescription for allopurinol asks the nurse, "I know this is for gout, but how does it work?" The nurse's reply is based on which medication action? 1. Allopurinol decreases uric acid production. 2. Allopurinol reduces the production of fibrinogen. 3. Allopurinol decreases the risk of sulfa crystal formation in the urine. 4. Allopurinol prevents influx of calcium ions during cell depolarization.

1. Allopurinol decreases uric acid production. Allopurinol is classified as an antigout medication. It decreases uric acid production by inhibiting the xanthine oxidase enzyme, and it reduces uric acid concentrations in both serum and urine. The other options are incorrect.

Allopurinol is prescribed for a client and the nurse provides medication instructions to the client. Which instruction would the nurse provide? 1. Drink 3000 mL of fluid a day. 2. Take the medication on an empty stomach. 3. The effect of the medication will occur immediately. 4. Any swelling of the lips is a normal expected response.

1. Drink 3000 mL of fluid a day. Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day, unless otherwise contraindicated. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with, or immediately after, meals or milk. A client who develops a rash, irritation of the eyes, or swelling of the lips or mouth would contact the primary health care provider because this may indicate hypersensitivity.

The nurse is performing an assessment on a client with a diagnosis of myxedema (hypothyroidism). Which assessment finding would the nurse expect to note in this client? 1. Dry skin 2. Thin, silky hair 3. Bulging eyeballs 4. Fine muscle tremors

1. Dry skin Myxedema is a deficiency of thyroid hormone. The client will present with a puffy, edematous face, especially around the eyes (periorbital edema), along with coarse facial features; dry skin; and dry, coarse hair and eyebrows. The remaining options are noted in the client with hyperthyroidism.

The nurse is reviewing the medical record of a client with chronic pancreatitis. Which manifestations would the nurse expect to note documented in the record? Select all that apply. 1. Weight loss 2. Steatorrhea 3. Constipation 4. Mild jaundice 5. Hypoglycemia 6. Gnawing, burning, cramping epigastric pain

1. Weight loss 2. Steatorrhea 3. Constipation 4. Mild jaundice 6. Gnawing, burning, cramping epigastric pain As with acute pancreatitis, a major clinical manifestation of chronic pancreatitis is abdominal pain, usually described as a gnawing, burning, or cramping pain. Other manifestations include weight loss, steatorrhea, mild jaundice with dark urine, constipation, and diabetes mellitus. The client would be at risk for hyperglycemia due to injury of the pancreatic cells and autodigestion of the pancreas.

A client is receiving a new prescription for colchicine. Which information about this medication would the nurse include in an educational session? 1. "The medication is an analgesic that relieves pain." 2. "This is an anti-inflammatory agent specific for gout." 3. "Colchicine is a nonsteroidal anti-inflammatory drug." 4. "This medication is an osmotic diuretic that facilitates the removal of uric acid."

2. "This is an anti-inflammatory agent specific for gout." Colchicine is an anti-inflammatory agent whose effects are specific for gout. Colchicine is not an analgesic and does not relieve pain. It is not a nonsteroidal anti-inflammatory drug, nor is it an osmotic diuretic.

The nurse is reviewing the health care record of a client with a new diagnosis of rheumatoid arthritis (RA). The nurse understands that which is an early clinical manifestation of RA? 1. Anemia 2. Anorexia 3. Amenorrhea 4. Night sweats

2. Anorexia Rheumatoid arthritis is a chronic, progressive, systemic inflammatory autoimmune disease process that affects primarily the synovial joints. Early clinical manifestations of RA include complaints of fatigue, generalized weakness, anorexia, and weight loss. Anemia, amenorrhea, and night sweats are not early manifestations of RA.

The nurse is performing discharge teaching for a client with chronic pancreatitis. Which information would the nurse include? 1. Alcohol needs to be consumed in moderation. 2. Avoid caffeine because it may aggravate symptoms. 3. Diet needs to be high in carbohydrates, fats, and proteins. 4. Frothy, fatty stools indicate that enzyme replacement is working.

2. Avoid caffeine because it may aggravate symptoms. Knowing that caffeinated beverages, such as coffee, tea, and soda, will worsen symptoms, such as pain, will direct you to select the correct option. Alcohol can precipitate an attack of pancreatitis and needs to be avoided. The recommended diet is moderate carbohydrates, low fat, and moderate protein. Frothy, fatty stools indicate that the replacement enzyme dose needs to be increased.

Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's record, knowing that this medication would be used with caution in which disorder? 1. Myxedema 2. Kidney disease 3. Hypothyroidism 4. Diabetes mellitus

2. Kidney disease Colchicine is used with caution in older clients, debilitated clients, and clients with cardiac, kidney, or gastrointestinal disease.

A client is admitted to the hospital with a diagnosis of acute pancreatitis. Which would the nurse expect the client to report about the pain? 1. Eating helps to decrease the pain. 2. The pain usually increases after vomiting. 3. The pain is mostly around the umbilicus and comes and goes. 4. The pain increases when the client sits up and bends forward.

2. The pain usually increases after vomiting. Pain with acute pancreatitis usually increases after vomiting because of an increase in intraductal pressure caused by retching, which leads to further obstruction of the outflow of pancreatic secretions. The pain is a steady and intense epigastric pain that radiates to the client's back and flank. The pain may lessen when the client sits up or bends forward. Eating exacerbates the pain by stimulating the secretion of enzymes.

Which outcome would the nurse expect to observe in the client who is recovering from viral hepatitis without complications? 1. Presence of asterixis 2. Increasing prothrombin time values 3. Decrease in aspartate aminotransferase (AST) 4. Decreased absorption of vitamin K in the intestine

3. Decrease in aspartate aminotransferase (AST) Complications from viral hepatitis include bleeding tendencies with increasing prothrombin time values and abnormalities of liver function. Clients also can develop encephalopathy. A characteristic sign of encephalopathy is asterixis. Serum transaminase levels such as AST decrease, and vitamin K becomes absorbed as liver cells heal and regenerate.

The clinic nurse is performing an assessment on a client with a diagnosis of rheumatoid arthritis (RA). The nurse checks for which assessment finding that is associated with RA? 1. Age of onset is generally 65 years of age or older 2. Complaint of pain that is more severe after activity 3. Systemic symptoms such as fatigue, anorexia, and weight loss 4. Joint pain is asymmetrical and associated with past injuries to the joint

3. Systemic symptoms such as fatigue, anorexia, and weight loss In clients diagnosed with RA, systemic symptoms such as fatigue, anorexia, weight loss, and nonspecific aching and stiffness may appear before joint manifestations. RA is characterized by chronic joint pain of variable intensity, which is more severe on rising in the morning. The age of onset for RA is most commonly between 30 and 50 years of age. A complaint of pain that is more severe after activity and asymmetrical joint pain associated with past injuries to the joint are more commonly seen in osteoarthritis.

The nurse is monitoring a client for signs of hypocalcemia after thyroidectomy. Which sign or symptom, if noted in the client, would most likely indicate the presence of hypocalcemia? 1. Bradycardia 2. Flaccid paralysis 3. Tingling around the mouth 4. Absence of Chvostek's sign

3. Tingling around the mouth After thyroidectomy the nurse assesses the client for signs of hypocalcemia and tetany. Early signs include tingling around the mouth and in the fingertips, muscle twitching or spasms, palpitations or arrhythmias, and Chvostek's and Trousseau's signs. Bradycardia, flaccid paralysis, and absence of Chvostek's sign are not signs of hypocalcemia.

The nurse is educating a client being discharged from the hospital following treatment for acute pancreatitis regarding dietary needs to prevent further acute attacks. What statement by the client indicates teaching was effective? 1. "I need to increase my caffeine intake." 2. "I need to limit my fluid intake to 1000 mL/day." 3. "It is okay to still have a glass of wine every night." 4. "I need to eat low-fat foods and fresh fruits and vegetables to help prevent further attacks."

4. "I need to eat low-fat foods and fresh fruits and vegetables to help prevent further attacks." The client with acute pancreatitis needs to consume small, frequent feedings that are low in fat and consume fresh fruits and vegetables because that dietary plan is the least stimulating to the pancreas. Caffeine can stimulate the pancreas. Fluid intake is important when tolerated to prevent dehydration. Alcohol can precipitate an attack of pancreatitis and needs to be avoided.

A client has been diagnosed with gout, and the nurse provides dietary instructions. The nurse determines that the client needs additional teaching if the client states that it is acceptable to eat which food? 1. Carrots 2. Tapioca 3. Chocolate 4. Chicken liver

4. Chicken liver Liver and other organ meats would be omitted from the diet of a client who has gout because of their high purine content. Purines are a form of protein. The food items identified in the other options contain negligible amounts of purines and may be consumed freely by the client with gout.

The primary health care provider (PHCP) writes a prescription for acetylsalicylic acid, or aspirin, for a client who was admitted to the hospital with joint pain from rheumatoid arthritis. The nurse contacts the PHCP to verify the prescription if which finding is noted in the assessment data? 1. Renal colic 2. Hypertension 3. Diabetes mellitus 4. Gastric ulceration

4. Gastric ulceration Acetylsalicylic acid is a nonsteroidal agent that is prescribed for its anti-inflammatory, antipyretic, and anticoagulant properties. Contraindications to the medication include gastrointestinal bleeding or ulceration, bleeding disorders, history of hypersensitivity to aspirin or other nonsteroidal anti-inflammatory medications, impaired hepatic function, and chicken pox or flu in children or teenagers. The items noted in options 1, 2, and 3 are not contraindications to this medication.

A client has begun medication therapy with propylthiouracil (PTU). The nurse would assess the client for which condition as an adverse effect of this medication? 1. Joint pain 2. Renal toxicity 3. Hyperglycemia 4. Hypothyroidism

4. Hypothyroidism Propylthiouracil is prescribed for the treatment of hyperthyroidism. Excessive dosing with this agent may convert a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required to treat the hypothyroid state. Propylthiouracil is not used for relief of joint pain. It does not cause renal toxicity or hyperglycemia.

The home health nurse is reviewing medications with a client receiving colchicine for the treatment of gout. The nurse evaluates that the medication is effective if the client reports a decrease in which measure? 1. Headaches 2. Blood glucose 3. Blood pressure 4. Joint inflammation

4. Joint inflammation Colchicine is classified as an antigout agent. It interferes with the ability of the white blood cells to initiate and maintain an inflammatory response to monosodium urate crystals. The client would report a decrease in pain and inflammation in the affected joints, as well as a decrease in the number of gout attacks. Headaches, blood glucose, and blood pressure are not associated with the use of this medication.

A test for the presence of rheumatoid factor is performed in a client with a diagnosis of rheumatoid arthritis (RA). What result would the nurse anticipate in the presence of this disease? 1. Neutropenia 2. Hyperglycemia 3. Antigens of immunoglobulin A (IgA) 4. Unusual antibodies of the IgG and IgM type

4. Unusual antibodies of the IgG and IgM type Rheumatoid arthritis is a chronic, progressive, systemic inflammatory autoimmune disease process that affects primarily the synovial joints. The test for rheumatoid factor detects the presence of unusual antibodies of the IgG and IgM type, which develop in a number of connective tissue diseases. The other options are incorrect.

What are manifestations of hyperthyroidism

goiter and exophthalmos- related to Graves' disease Other clinical manifestations include nervousness, fatigue, weight loss, muscle cramps, and heat intolerance. Additional signs found in this disorder include tachycardia; shortness of breath; excessive sweating; fine muscle tremors; thin, silky hair and thin skin; infrequent blinking; and a staring appearance.

The nurse is caring for a client with acute pancreatitis. Which finding would the nurse expect to note when reviewing the laboratory results? 1. Elevated serum lipase level 2. Elevated serum bilirubin level 3. Decreased serum trypsin level 4. Decreased serum amylase level

1. Elevated serum lipase level The serum lipase level is elevated in the presence of pancreatic cell injury. Serum trypsin and amylase levels are also elevated in pancreatic injury. Although bilirubin can be elevated in the client with pancreatitis, it is secondary to the hepatobiliary obstructive process.

The nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which signs or symptoms, if noted in the client, will alert the nurse to the presence of this crisis? 1. Fever and tachycardia 2. Pallor and tachycardia 3. Agitation and bradycardia 4. Restlessness and bradycardia

1. Fever and tachycardia Thyrotoxic crisis (thyroid storm) is an acute, potentially life-threatening state of extreme thyroid activity that represents a breakdown in the body's tolerance to a chronic excess of thyroid hormones. The clinical manifestations include fever with temperatures greater than 100° F (37.8° C), severe tachycardia, flushing and sweating, and marked agitation and restlessness. Delirium and coma can occur.

The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all that apply. 1. Maintain NPO (nothing by mouth) status. 2. Encourage coughing and deep breathing. 3. Give small, frequent high-calorie feedings. 4. Maintain the client in a supine and flat position. 5. Give hydromorphone intravenously as prescribed for pain. 6. Maintain intravenous fluids at 10 mL/hr to keep the vein open.

1. Maintain NPO (nothing by mouth) status. 2. Encourage coughing and deep breathing. 5. Give hydromorphone intravenously as prescribed for pain. The client with acute pancreatitis normally is placed on NPO status to rest the pancreas and suppress gastrointestinal secretions, so adequate intravenous hydration is necessary. Because abdominal pain is a prominent symptom of pancreatitis, pain medications such as hydromorphone are prescribed. Some clients experience lessened pain by assuming positions that flex the trunk, with the knees drawn up to the chest. A side-lying position with the head elevated 45 degrees decreases tension on the abdomen and may help ease the pain. The client is susceptible to respiratory infections because the retroperitoneal fluid raises the diaphragm, which causes the client to take shallow, guarded abdominal breaths. Therefore, measures such as turning, coughing, and deep breathing are instituted.