nclex saunders q&a pt.3

The community health nurse is conducting a research study and is identifying clients in the community who are at risk for latex allergy. Which client population is at risk for developing this type of allergy?

Hairdressers Individuals at risk for developing a latex allergy include health care workers; individuals who work in the rubber industry; individuals having multiple surgeries; individuals with spina bifida; individuals who wear gloves frequently such as food handlers, hairdressers, and auto mechanics; and individuals allergic to kiwis, bananas, pineapples, tropical fruits, grapes, avocados, potatoes, hazelnuts, and water chestnuts.

A nursing instructor asks a nursing student about the risk factors associated with osteoporosis. The instructor determines that the student needs further teaching if the student states that which is an associated risk factor?

High-calcium diet consumption Risk factors associated with osteoporosis include a diet that is deficient in calcium. Postmenopausal age, family history, and long-term use of corticosteroids are risk factors associated with osteoporosis. Additional risk factors include being sedentary, cigarette smoking, excessive alcohol consumption, chronic illness, and long-term use of anticonvulsants and furosemide (Lasix).

Penicillin G procaine, 1,000,000 units given intramuscularly, is prescribed for an adolescent with an infection. The medication label reads as follows: "1,200,000 units/2 mL." The nurse has determined that the prescribed dose is safe. How many milliliters per dose should the nurse administer to the adolescent?

- 1.66 mL 1,000,000 / 1,200,000 = 0.83333 0.83333 x 2 m = 1.66 mL

The home care nurse is collecting data from a client who has been diagnosed with an allergy to latex. In determining the client's risk factors associated with the allergy, the nurse questions the client about an allergy to which food items? Select all that apply

-Kiwi -Bananas Individuals who are allergic to kiwis, bananas, pineapples, tropical fruits, grapes, avocados, potatoes, hazelnuts, and water chestnuts are at risk for developing a latex allergy. This is thought to be due to a possible cross-reaction between the food and the latex allergen. The incorrect options are unrelated to latex allergy.

The nursing student is asked to describe the correct steps for performing adult cardiopulmonary resuscitation (CPR). Arrange the steps of adult CPR in the order of priority. Drag and drop the options into the correct order.

1. Determine unconsciousness by shaking the client and asking, "Are you OK?" 2. Open the client's airway. 3. Initiate breathing. 4. Perform chest compressions. The sequence for basic CPR for health care providers follows the CAB—compressions, airway, breathing—procedure. After determining unconsciousness, compressions are started.

The health care provider's prescription reads "levothyroxine (Synthroid), 150 mcg orally daily." The medication label reads "levothyroxine, 0.1 mg/tablet." The nurse prepares to administer how many tablet(s) to the client? Fill in the blank. Record your answer using one decimal place.

1.5 tablet Convert 150 mcg to milligrams. In the metric system, to convert smaller to larger, divide by 1000, or move the decimal three places to the left. Therefore, 150 mcg = 0.15 mg. 0.15 mg x 1 tablet / 0.1 mg = 1.5 tablets

A health care provider prescribes potassium chloride (KCl) elixir, 20 mEq orally daily. The medication label states potassium chloride (KCl), 30 mEq/15 mL. How many milliliters should the nurse prepare to administer the dose? Fill in the blank.

10 mL 20 mEq / 30 mEq x 15 = 10 mL

The health care provider's prescription reads "phenytoin (Dilantin) 0.2 g orally, twice daily." The medication label states 100-mg capsules. How many capsule(s) should the nurse plan to administer over a 24 hour period? Fill in the blank.

4 capsules Convert 0.2 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000, or move the decimal three places to the right. Therefore, 0.2 g = 200 mg. 200 mg / 100 mg = 2 capsules The question asks for the number of capsule(s) for a 24 hour period. Since the medication is administered twice daily then the total daily number of capsule(s) is 4.

The nurse is caring for a group of clients. Which client is most likely to have a serum phosphorus level of 2.0 mg/dL?

A client with a history of alcoholism The normal serum phosphorus level is 2.7 to 4.5 mg/dL, so a value of 2.0 mg/dL is indicative of hypophosphatemia. Causative factors include decreased nutritional intake and malnutrition. A poor nutritional state is associated with alcoholism. Hypoparathyroidism, chemotherapy, and vitamin D intoxication are causative factors of hyperphosphatemia.

The nurse is caring for a client with pheochromocytoma. The client asks for a snack and something warm to drink. Which is the appropriate choice for this client to meet nutritional needs?

Graham crackers and warm milk The client with pheochromocytoma needs to be provided with a diet that is high in vitamins, minerals, and calories. Of particular importance is that food or beverages that contain caffeine (e.g., chocolate, coffee, tea, and cola) are prohibited.

Which nursing action would be appropriate to implement when a client has a diagnosis of pheochromocytoma?

Monitor the client's blood pressure. Hypertension is the major symptom that is associated with pheochromocytoma. The blood pressure status is monitored by taking the client's blood pressure. Glycosuria, weight loss, and diaphoresis are also signs/symptoms of pheochromocytoma, but hypertension is the major symptom.

The nurse reviews the activity schedule for the day and determines that the best supervised activity that the manic client could participate in is which?

Ping-Pong A person who is experiencing mania is overactive, full of energy, lacks concentration, and has poor impulse control. The client needs an activity that will allow him or her to use excess energy but not endanger others during the process. Painting, reading, and progressive relaxation are relatively sedate activities that require concentration, a quality that is lacking in the manic state. Such activities may lead to increased frustration and anxiety for the client. Ping-Pong is an activity that will help expend the increased energy this client is experiencing and is a safe activity.

The nurse is reinforcing instructions to a client with osteoporosis regarding appropriate food items to include in the diet. The nurse tells the client that which food item would provide the least amount of calcium?

Pork Foods high in calcium include plain yogurt, dairy products, seafood, sardines, green vegetables, calcium-fortified orange juice, and cereal. Of the items listed in the options, pork would contain the least amount of calcium.

After a tonsillectomy, a child is brought to the pediatric unit. The nurse places the child in which appropriate position?

Prone The child should be placed in a prone or side-lying position after tonsillectomy to facilitate drainage. The remaining options identify positions that will not achieve this goal.

Megestrol acetate (Megace), an antineoplastic medication, is prescribed for the client with metastatic endometrial carcinoma. The nurse reviews the client's history and contacts the registered nurse if which diagnosis is documented in the client's history?

Thrombophlebitis Megestrol acetate (Megace) suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of thrombophlebitis. Gout, asthma, and myocardial infarction are not contraindications for this medication.

The nurse reinforces home care instructions to the mother of a child recovering from Reye's syndrome. Which statement by the mother indicates a need for further teaching?

"I need to give frequent, small, nutritious meals if my child starts to vomit." The vomiting that occurs in Reye's syndrome is caused by cerebral edema and is a symptom of increased intracranial pressure. Small, frequent meals will not affect the amount of vomiting, and the health care provider is notified if vomiting occurs. Options 1, 2, and 3 are all correct statements. Decreasing stimuli and providing rest decrease stress on the brain tissue. Checking for jaundice will assist in identifying the presence of liver complications, which are characteristic of Reye's syndrome.

The nurse reinforces instructions regarding the use of permethrin 1% (Nix) to the parents of a child who has been diagnosed with pediculosis capitis (head lice). Which statement by a parent indicates the need for further teaching?

"The medication is applied to the hair after shampooing and left on for 24 hours." Permethrin 1% is an over-the-counter, antilice product that kills lice and eggs with one application and that has residual activity for 10 days. It is applied to dried hair after shampooing and left for 5 to 10 minutes before it is rinsed (not shampooed) out. The hair should not be shampooed for 24 hours after the treatment.

The nurse reinforces discharge instructions regarding skin care to a client after the grafting of burn injuries of the left chest and left arm. Which statement by the client indicates the need for further teaching?

- "I should never wear warm clothing over the newly healed skin area." Newly healed skin is more sensitive to the cold, and the client should be instructed to wear warm clothing. The client should wash with a mild soap, rinse thoroughly, and pat the skin dry with a clean towel. Newly healed skin sunburns easily, and direct sunlight needs to be avoided. Products that contain perfume, alcohol, or lanolin should be avoided because they tend to irritate newly healed skin.

The nurse determines that which individual presenting to the clinic is at the greatest risk for development of an integumentary disorder?

- An outdoor construction worker Prolonged exposure to the sun, unusual cold, or other conditions can damage the skin. An older client may be at a higher risk than a younger individual because immobility and lack of nutrition may increase the older person's risk. An adolescent may be prone to the development of acne, but this does not occur in all adolescents. The physical education teacher is at low or no risk of developing an integumentary problem.

The nurse is inspecting the stoma of a client after creation of an ureterostomy. Which appearance should the nurse expect to note?

A red and moist stoma After ureterostomy, the stoma should be red and moist. A pale stoma may indicate an inadequate amount of vascular supply, and a dry stoma may indicate a body fluid deficit. Any sign of darkness or duskiness in the stoma may mean a loss of vascular supply and must be corrected immediately, or necrosis can occur.

A family of a spinal cord-injured client rushes to the nursing station, saying that the client needs immediate help. On entering the room, the nurse notes that the client is diaphoretic, with a flushed face and neck, and complains of a severe headache. The pulse is 40 beats per minute, and the blood pressure is 230/100 mm Hg. The nurse acts quickly, knowing that the client is experiencing which?

Autonomic dysreflexia The client with spinal cord injury above the level of T7 is at risk for autonomic dysreflexia. It is characterized by severe, throbbing headache; flushing of the face and neck; bradycardia; and sudden, severe hypertension. Other signs include nasal stuffiness, blurred vision, nausea, and sweating. It is a life-threatening syndrome triggered by a noxious stimulus below the level of the injury.

Treatment that involves pairing a stimulus attractive to the client with an unpleasant event is known as which type of therapy?

Aversion therapy Aversion therapy, also known as aversion conditioning or negative reinforcement, is a technique used to change behavior. In this therapy, a stimulus attractive to the client is paired with an unpleasant event in hopes of associating the stimulus with negative properties. Milieu therapy provides positive environmental manipulation, both physical and social, to effect a positive change in the client. Desensitization is the reduction of intense reactions to a stimulus by repeated exposure to the stimulus in a weaker and milder form. Self-control therapy combines cognitive and behavioral approaches and is useful to deal with stress.

what is aversion therapy?

Aversion therapy is a treatment method in which a person is conditioned to dislike a certain stimulus due to its repeated pairing with an unpleasant stimulus. For example, a person trying to quit smoking might pinch his or her skin every time he or she craves a cigarette.

The nurse is reviewing the health record of a client diagnosed with a cataract. The initial sign/symptom that the nurse should expect to note in the early stages of cataract formation is which?

Blurred vision A gradual, painless blurring of central vision is the chief sign/symptom of a cataract. Early symptoms include slightly blurred vision and a decrease in color perception.

The nurse collects data on a client with a diagnosis of bipolar affective disorder-mania. Which finding requires the nurse's immediate intervention?

Client's inadequate attention to activities of daily living (ADL) and poor nutritional intake Mania is a mood characterized by excitement, euphoria, hyperactivity, excessive energy, decreased need for sleep, and impaired ability to concentrate or complete a single train of thought. It is a period when the mood is predominantly elevated, expansive, or irritable. Inadequate attention to ADLs and poor nutritional intake identify a physiological need requiring immediate intervention.

The home care nurse is assigned to care for a client who returned home from the emergency department following treatment for a sprained ankle. The nurse notes that the client was sent home with crutches that have rubber axillary pads and needs to reinforce instructions regarding crutch walking. On data collection, the nurse discovers that the client has an allergy to latex. Before providing instructions regarding crutch walking, the nurse should do which?

Cover the crutch pads with cloth. The rubber pads used on crutches may contain latex. If the client requires the use of crutches, the nurse can cover the pads with a cloth to prevent cutaneous contact. Telling the client that the crutches must be immediately removed from the house is inappropriate and may alarm the client. The nurse cannot prescribe a cane for a client. In addition, this type of assistive device may not be appropriate, considering this client's injury. No reason exists to contact the HCP at this time.

The client with non-Hodgkin's lymphoma is receiving daunorubicin (DaunoXome). Which sign/symptom should indicate to the nurse that the client is experiencing a toxic effect related to the medication?

Crackles on auscultation of the lungs Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as heart failure is a toxic effect of daunorubicin. Bone marrow depression is also a toxic effect. Nausea and vomiting are frequent side effects associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Fever is a frequent side effect, and diarrhea can occur occasionally. The other options, however, are not toxic effects.

The nurse prepares to assist a health care provider examine the client's skin with a Wood's light. Which action should be included in the plan for this procedure?

Darken the room for the examination. The examination of the skin under a Wood's light is always carried out in a darkened room. This is a noninvasive examination; therefore, informed consent is not required. A hand-held, long-wavelength ultraviolet light or Wood's light is used. The skin does not need to be shaved, and a local anesthetic is not necessary. Areas of blue-green or red fluorescence are associated with certain skin infections. The procedure is painless.

The nurse is monitoring a client receiving desmopressin acetate (DDAVP) for adverse effects to the medication. Which sign/symptom indicates the presence of an adverse effect?

Drowsiness Water intoxication (overhydration) or hyponatremia is an adverse effect of desmopressin. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur in overhydration.

A daily dose of prednisone is prescribed for a client. The nurse reinforces instructions to the client regarding administration of the medication and instructs the client to take this medication at which time?

Early morning Corticosteroids (glucocorticoids) should be administered before 9:00 am. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. The other answer options are incorrect.

After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which signs/symptoms are indicative of this disorder?

Excessive thirst and urine output Excessive thirst (polydipsia) and excessive urine output (polyuria) are classic symptoms of diabetes insipidus. The urine is pale in color, and its specific gravity is low. Anorexia and weight loss occur. Diarrhea and blurred vision are not manifestations of the disorder. Weight gain and increased urine specific gravity are associated with syndrome of inappropriate antidiuretic hormone (SIADH).

The nurse has provided instructions to a client with a herniated lumbar disk about proper body mechanics and other items pertinent to low back care. The nurse determines that the client needs further teaching if the client verbalizes which should be done?

Get out of bed by sitting straight up and swinging the legs over the side of the bed. Clients are taught to get out of bed by sliding near the edge of the mattress. The client then rolls onto one side and pushes up from the bed, using one or both arms. The back is kept straight, and the legs are swung over the side. Increasing fluids and dietary fiber helps prevent straining at stool, thereby preventing increases in intraspinal pressure. Walking and swimming are excellent exercises for strengthening lower back muscles. Proper body mechanics includes bending at the knees, not the waist, to lift objects.

A depressed client verbalizes feelings of low self-esteem and self-worth typified by statements such as "I'm such a failure. I can't do anything right!" Which action should the nurse take

Identify recent behaviors or accomplishments that demonstrate skill or ability. Feelings of low self-esteem and worthlessness are common symptoms of the depressed client. An effective plan of care is to provide successful experiences for the client that are challenging but will not be met with failure to enhance the client's personal self-esteem. Reminders of the client's past accomplishments or personal successes are ways to interrupt the client's negative self-talk and distorted cognitive view of himself or herself. Options 1 and 4 offer false reassurances. Option 2 is not a therapeutic intervention with a depressed client.

The nurse is reviewing the laboratory results of a client who has been diagnosed with multiple myeloma. Which finding should the nurse expect to note with this diagnosis?

Increased calcium level Findings that are indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia as a result of the release of calcium from the deteriorating bone tissue, and an elevated BUN level. An increased white blood cell count may or may not be present, but this is not specifically related to multiple myeloma.

The nurse is assisting with conducting a health-promotion program at a local school. The nurse determines that there is a need for further teaching if a student identifies which as a risk factor associated with cancer?

Low-fat and high-fiber diets Viruses may be one of multiple agents that act to initiate carcinogenesis and that have been associated with several types of cancer. Increased stress has been associated with causing the growth and proliferation of cancer cells. Two forms of radiation, ultraviolet and ionizing, can lead to cancer. High-fiber diets may reduce the risk of colon cancer. A diet that is high in fat may increase the risk of the development of certain cancers

The nurse is reinforcing instructions to a client regarding how to decrease the intake of phosphorus in the diet. The nurse should tell the client that which food item contains the least amount of phosphorus?

Oranges An orange contains the least amount of phosphorus. Foods high in phosphorus include fish, pork, beef, chicken, organ meats, nuts, whole-grain breads, and cereals.

The nurse is reinforcing instructions to a client regarding intranasal desmopressin acetate (DDAVP). The nurse should tell the client that the medication has which side effect?

Runny nose Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Headache, vulval pain, and flushed skin are side effects if the medication is administered by the intravenous (IV) route.

The nurse is reinforcing home care instructions to the mother of a child with bacterial conjunctivitis. Which instruction should the nurse give the mother?

That the child's towels and washcloths should not be used by other members of the household Bacterial conjunctivitis is highly contagious, and infection control measures should be taught. These include good hand washing and not sharing towels and washcloths with others. The child should be kept home from school until 24 hours after antibiotics are started. Bottles of eye medication should never be shared with others. Crusted material may be wiped from the eye with a cotton ball soaked in warm water, starting at the inner aspect of the eye and moving toward the outer aspect.

During the termination phase of the nurse-client relationship, the clinic nurse observes that the client continuously demonstrates bursts of anger. Which interpretation should the nurse make of this behavior?

The client is displaying typical behaviors that can occur during termination. In the termination phase of a relationship, it is normal for a client to demonstrate a number of regressive behaviors. Typical behaviors include return of symptoms, anger, withdrawal, and minimizing the relationship. The anger that the client is experiencing is a normal behavior during the termination phase and does not necessarily indicate the need for hospitalization or treatment.

What is autonomic dysreflexia?

is a syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above).

A woman whose husband died 2 months ago says to the visiting nurse, "My daughter came over yesterday to help me move my husband's things out of our bedroom, and I was so angry with her for moving his slippers from where he always kept them under his side of our bed. She doesn't know how much I'm hurting." Which statement by the nurse should be therapeutic?

"It's okay to grieve and be angry with your daughter and anyone else for a time." The therapeutic statement is the one that gives the client permission to grieve and acknowledges that anger is part of loss and that it may be aimed at the people who are trying most to help and are closest. The remaining statements are nontherapeutic because they do not encourage the client to express feelings.

The nurse is told in a report that the client has hypocalcemia and a positive Chvostek's sign. Which signs should the nurse expect to note during the data collection? Select all that apply.

- Tetany - Diarrhea - A positive Trousseau's sign A positive Chvostek's sign is indicative of hypocalcemia. Other signs and symptoms include tachycardia, hypotension, paresthesias, twitching, cramps, tetany, a positive Trousseau's sign, diarrhea, seizures, hyperactive bowel sounds, and a prolonged QT interval.

The nurse is monitoring the laboratory results of a client receiving an antineoplastic medication by the intravenous (IV) route. The nurse plans to initiate bleeding precautions if which laboratory result is noted?

A platelet count of 40,000/mm3 Bleeding precautions need to be initiated when the platelet count decreases. The normal platelet count is 150,000 to 450,000/mm3. When the platelets are lower than 50,000/mm3, any small trauma can lead to episodes of prolonged bleeding. The normal white blood cell count is 5000 to 10,000/mm3. When the white blood cell count drops, neutropenic precautions need to be implemented. The normal clotting time is 8 to 15 minutes. The normal ammonia value is 10 to 80 mcg/dL.

A client is complaining of pain underneath a cast in the area of a bony prominence. Which should the nurse anticipate?

A window will be cut in the cast. A window may be cut in a dried cast to relieve pressure, monitor pulses, relieve discomfort, or remove drains. Bivalving the cast involves splitting the cast along both sides to allow space for swelling, to facilitate taking x-rays, or to make a half-cast for use as an intermittent splint. Padding is not placed on top of a cast. The use of an air splint is not indicated.

A client has been placed in Buck's extension traction. Which technique provided by the nurse will provide countertraction?

Slightly elevating the foot of the bed The part of the bed under an area in traction is usually elevated to aid in countertraction. For the client in Buck's extension traction (which is applied to a leg), the foot of the bed is elevated.

The nurse is preparing a 2-year-old child with suspected nephrotic syndrome for a renal biopsy to confirm the diagnosis. The mother asks the nurse, "Will my child ever look thin again?" The nurse should respond by giving which statement?

"In most cases, medication and diet will control fluid retention." It is important to give the mother information that addresses the issue that is the parent's concern. Most children experience remission with treatment.

A client is admitted to the nursing unit after a left below-knee amputation following a crush injury to the foot and lower leg. The client tells the nurse, "I think I'm going crazy. I can feel my left foot itching." How does the nurse correctly interpret the client's statement?

"It is a normal response and indicates the presence of phantom limb sensation." Phantom limb sensations are felt in the area of the amputated limb. These can include itching, warmth, and cold. The sensations are caused by intact peripheral nerves in the area amputated. Whenever possible, clients should be prepared for these sensations. The client may also feel painful sensations in the amputated limb, called "phantom limb pain." The origin of the pain is less well understood, but the client should also be prepared for this whenever possible.

A client is being admitted to the hospital for the treatment of acute cellulitis of the lower left leg. The client asks the nurse to explain what cellulitis means. Which response should the nurse give to the client's question?

"It is a skin infection that involves the deeper skin layers and subcutaneous fat." Cellulitis is a skin infection into the deeper dermis and the subcutaneous fat, usually caused by Streptococcus pyogenes; it results in deep red erythema without sharp borders, and it spreads widely through tissue spaces. The skin is erythematous, edematous, tender, and sometimes nodular. Erysipelas is an acute, superficial, rapidly spreading inflammation of the dermis and the lymphatics.

The nurse assists with providing an instructional session to parents regarding impetigo. Which statement by a parent indicates the need for further teaching?

"Lesions are most often located on the arms and chest." Impetigo is most common during the hot and humid summer months. It begins in an area of broken skin, such as an insect bite. It may be caused by Staphylococcus aureus, group A β-hemolytic streptococci, or a combination of these bacteria. It is extremely contagious. Lesions are most often located around the mouth and nose, but they may be present on the extremities.

A client calls the emergency department and tells the nurse that he has been cleaning a wooded area and that he came into direct contact with poison ivy shrubs. The client tells the nurse that he cannot see anything on the skin and asks the nurse what to do. The nurse makes which statement to the client?

"Take a shower immediately, and lather and rinse several times." When an individual comes in contact with a poison ivy plant, the sap from the plant forms an invisible film on the skin. The client should be instructed to shower immediately, to lather the skin several times, and to rinse each time in running water. Calamine lotion is a treatment that is used when dermatitis develops. It is not necessary for the client to be seen in the emergency department at this time.

The nurse is initiating seizure precautions for a child being admitted to the nursing unit. Which items are essential for the nurse to place at the bedside?

A suction apparatus and oxygen Seizures cause a tightening of all body muscles that is followed by tremors. An obstructed airway and increased oral secretions are the major complications during and after the seizure. Suctioning and oxygen are helpful to prevent choking and cyanosis. A tongue depressor is not needed because nothing should be placed into the client's mouth during a seizure because of the risk for injury. Inserting a tracheostomy is not done because this is a surgical procedure. An emergency cart should not be left at the bedside; however, it should be available in the treatment room or on the nursing unit.

A client is taking lansoprazole (Prevacid) for the chronic management of Zollinger-Ellison syndrome. If prescribed, which medication would be appropriate for the client if needed for a headache?

Acetaminophen (Tylenol) Zollinger-Ellison syndrome is a hypersecretory condition of the stomach. The client should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as naprosen and ibuprofen. Acetaminophen would likely be prescribed for headache for this client because it would not be irritating to the stomach.

The nurse is assisting in a group therapy session. During this session the members are identifying tasks and boundaries. The nurse understands that these activities are characteristic of which stage of group development?

Beginning stage In the beginning or initial stage, the members are identifying tasks and boundaries. Information is given and group norms are established. In the middle stage, members are confronting each other, groups develop cohesiveness, and a sense of trust is established. The termination stage is when members leave the group, the group decides that its work is done, and the group members feel that they have met their goals. There is no stage of group development called the "self-awareness stage."

Which finding would indicate that a child had a tonic-clonic seizure during the night?

Blood on the pillow The complications associated with seizures include airway compromise, extremity and teeth injuries, and tongue lacerations. Night seizures can cause the child to bite down on the tongue. Seizures do not cause a high-pitched cry unless a tumor or intracranial pressure is the cause of the seizure diagnosis. Cyanosis can occur during the tonic-clonic part of the seizure activity, but blanching does not occur. Migraine headaches are not common in children with seizures.

The nurse is planning to administer amlodipine (Norvasc) to a client. The nurse should plan to check which before giving the medication?

Blood pressure and heart rate Amlodipine is a calcium channel blocker. This medication decreases the rate and force of cardiac contraction. Before administering a calcium channel blocking agent, the nurse should check the blood pressure and heart rate, which could both decrease in response to the action of this medication. This action will help to prevent or identify early problems related to decreased cardiac contractility, heart rate, and conduction.

The nurse is caring for a client after a thyroidectomy and monitoring for signs of thyroid storm. The nurse determines that which sign/symptom is indicative that a thyroid storm may be occurring?

Blood pressure of 80/60 mmHg Signs/symptoms associated with thyroid storm include a fever as high as 106° F (41.1° C), severe tachycardia, profuse diarrhea, extreme vasodilation, hypotension, atrial fibrillation, hyperreflexia, abdominal pain, diarrhea, and dehydration. With this disorder, the client's condition can rapidly progress to coma and cardiovascular collapse.

The nurse is caring for a client with an intracranial aneurysm who was previously alert. Which finding should be an early indication that the level of consciousness (LOC) is deteriorating?

Drowsiness Early changes in LOC relate to orientation, alertness, and verbal responsiveness. Less frequent speech, slight slurring of speech, and mild drowsiness are early signs of decreasing LOC. Ptosis of the eyelid is due to pressure on and dysfunction of cranial nerve III and does not relate to LOC.

The nurse is caring for a client after a mastectomy. Which nursing intervention should assist with preventing lymphedema of the affected arm?

Elevating the affected arm on a pillow above heart level After mastectomy, the health care provider's prescriptions regarding positioning are followed. The arm on the surgical side is usually elevated above the level of the heart, and simple arm exercises should be encouraged. No blood pressure readings, injections, IV line insertions, or blood draws should be performed on the affected arm. Cool compresses are not a recommended measure to prevent lymphedema from occurring

The nurse is reinforcing instructions to a client on how to decrease the intake of potassium in the diet. The nurse should tell the client that which food contains the least amount of potassium?

Lettuce Lettuce contains less than 100 mg of potassium. Potatoes, apricots, and avocados are potassium-containing foods and should be avoided by the client on a potassium-restricted diet.

The nurse prepares to care for a client with acute cellulitis of the lower leg. Which treatment should the nurse anticipate being prescribed for the client?

Warm compresses to the affected area Warm compresses may be used to decrease discomfort, erythema, and edema. After tissue and blood cultures are obtained, antibiotics are initiated. Heat lamps can cause more disruption to tissue that is already inflamed. Continuous cold and hot compresses are not the best measures.

What is multiple myeloma?

cancer of plasma cells With this condition, a group of plasma cells becomes cancerous and multiplies. The disease can damage the bones, immune system, kidneys, and red blood cell count. Symptoms may not be present or may be non-specific, such as loss of appetite, bone pain, and fever. Treatments include medications, chemotherapy, corticosteroids, radiation, or a stem-cell transplant.

A postoperative client has a prescription to receive an intravenous (IV) infusion of 1000 mL normal saline solution over a period of 10 hours. The drop (gtt) factor for the IV infusion set is 15 gtts/mL. The nurse sets the flow rate at how many drops per minute? Fill in the blank.

total volume x gtt factor / time in minutes = gtt/min 1000 mL x 15 / 600 minutes = 25 gtt/min

Meperidine hydrochloride (Demerol) is prescribed for the client with pain. Which should the nurse monitor as a side effect of this medication?

Urinary retention Meperidine hydrochloride (Demerol) is an opioid analgesic. Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

The nurse is assigned to care for an adult client who had a stroke and is aphasic. Which interventions should the nurse use for communicating with the client? Select all that apply.

- Face the client when talking. - Speak slowly and maintain eye contact. - Use gestures when talking to enhance words. - Give the client directions using short phrases and simple terms. A client who is aphasic has difficulty expressing or understanding language. The nurse should face the client when talking, establish and maintain eye contact, and speak slowly and distinctly. The nurse should use gestures and pantomime when talking to enhance words and use body language to enhance the message. The nurse should give the client directions using short phrases and simple terms, and phrase questions so that they can be answered with a yes or no. If there is a need to repeat something, the nurse should use the same words a second time.

A client with Parkinson's disease is embarrassed about the symptoms of the disorder and is bored and lonely. The nurse should plan which approach as therapeutic in assisting the client to cope with the disease?

Encourage and praise perseverance in exercising and performing ADL. The client with Parkinson's disease tends to become withdrawn and depressed and therefore should become an active participant in his or her own care to prevent this. Activities should be planned throughout the day to inhibit daytime sleeping and boredom. The nurse gives the client encouragement and praises the client for perseverance. Activities such as exercise help prevent progression of the disease, and self-care improves self-esteem.

The nurse is reviewing the health record of a pregnant client at 16 weeks' gestation. The nurse should expect to note documentation that the fundus of the uterus is located at which area?

Just above the symphysis pubis At 12 weeks' gestation, the uterus extends out of the maternal pelvis and can be palpated above the symphysis pubis. At 16 weeks, the fundus reaches midway between the symphysis pubis and the umbilicus. At 20 weeks, the fundus is located at the umbilicus. By 36 weeks, the fundus reaches its highest level at the xiphoid process.

A client has had skeletal traction applied to the right leg and has an overhead trapeze available for use. The nurse should monitor which as a high-risk area for pressure and breakdown?

Left heel Common areas that are under pressure and are at risk for breakdown include the elbows (if they are used for repositioning instead of a trapeze) and the heel of the good leg (which is used as a brace when pushing up in bed). Other pressure points caused by the traction include the ischial tuberosity, popliteal space, and Achilles tendon.

The nurse is planning to put aneurysm precautions in place for the client with a cerebral aneurysm. Which item should be included as part of the precautions?

Maintaining the head of the bed at 15 degrees Aneurysm precautions include placing the client on bed rest with the head of the bed elevated in a quiet setting. Lights are kept dim to minimize environmental stimulation. Any activity such as pushing, pulling, sneezing, coughing, or straining that increases blood pressure or impedes venous return from the brain is prohibited. The nurse provides all physical care to minimize increases in blood pressure. For the same reason, visitors, radio, television, and reading materials are prohibited or limited. Stimulants such as caffeine and nicotine are prohibited; decaffeinated coffee or tea may be given.

The nurse is assisting in developing a plan of care for the client scheduled for cataract surgery. The nurse makes suggestions regarding the plan, knowing that which problem is specifically associated with this type of surgery?

Sensory perceptual alteration The most specific associated problem for the client scheduled for cataract surgery is sensory perceptual alteration (visual) related to lens extraction and replacement. Self-care deficit and imbalanced nutrition should also be concerns but occur as a result of a sensory perceptual alteration. Anxiety can occur with any type of surgical procedure.

The nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). Which instruction should the nurse give the client?

Take the medication on an empty stomach. Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast. Therefore, the remaining options are incorrect times of administration.

The client has been on treatment for rheumatoid arthritis for 3 weeks. Which is most important for the nurse to check during the administration of etanercept (Enbrel)?

The white blood cell counts and platelet counts Infection and pancytopenia are adverse effects of etanercept (Enbrel). Laboratory studies are performed before and during treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potential life-threatening infection. Injection site itching is a common occurrence following administration of the medication. In early treatment, residual fatigue and joint pain may still be apparent. A metallic taste and loss of appetite are not common signs of side effects of this medication.

The nurse is explaining the concept of a time-out in the perioperative area. Which statement best describes the purpose of a time-out?

To allow the surgical team a chance to verbally verify its agreement about the client's name, the surgical procedure, and the site The time-out occurs in the perioperative area after the client has been prepped and draped. The entire team must verbally verify its agreement regarding the client's name, the procedure to be performed, and the surgical site. The remaining options are incorrect because they do not occur during the intraoperative period in the perioperative area.

The nurse reinforces medication instructions to a client who is taking levothyroxine (Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which sign/symptom occurs?

Tremors Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur. The remaining options are signs of hypothyroidism

The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value should the nurse note as a result of the massive cell destruction that occurred from the chemotherapy?

Increased uric acid level Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in a massive cell kill. Although anemia, decreased platelets, and decreased leukocytes also may be noted, an increased uric acid level is related specifically to cell destruction.

The nurse is assisting in identifying clients in the community at risk for latex allergy. Which client population is most at risk for developing this type of allergy?

Individuals with spina bifida Individuals at risk for developing a latex allergy include health care workers; individuals who work with manufacturing latex products; individuals with spina bifida; individuals who wear gloves frequently such as food handlers, hairdressers, and auto mechanics; and individuals allergic to kiwis, bananas, pineapples, passion fruit, avocados, and chestnuts.

The nurse is reinforcing instructions to a community group regarding the risks and causes of bladder cancer. The nurse determines that there is a need for further teaching if a member of the community group makes which statement regarding this type of cancer?

It most often occurs in women. The incidence of bladder cancer is three times greater among men than among women, and it affects the white population twice as often as the black population. The remaining options are associated with the incidence of bladder cancer.

The nurse is caring for a client with severe back pain, and codeine sulfate has been prescribed for the client. Which should the nurse include in the plan of care while the client is taking this medication?

Monitor bowel activity. While the client is taking codeine sulfate, an opioid analgesic, the nurse should monitor vital signs and monitor for hypotension. The nurse should also increase fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency (codeine can cause constipation). The nurse should monitor respiratory status and initiate breathing and coughing exercises. In addition, the nurse monitors the effectiveness of the pain medication.

The nurse is monitoring a 7-year-old child who sustained a head injury in a motor vehicle crash for signs of increased intracranial pressure (ICP). The nurse assesses the child frequently for which earlysign of increased ICP?

Nausea Nausea is an early sign of increased ICP. Late signs of increased ICP include a significant decrease in level of consciousness, Cushing's triad (increased systolic blood pressure and widened pulse pressure, bradycardia, and irregular respirations), and fixed and dilated pupils. Other late signs include decreased motor response to command, decreased sensory response to painful stimuli, posturing, Cheyne-Stokes respirations, and papilledema.

A newly pregnant client is asking how to prevent neural-tube birth defects. Which food choice should the nurse recommend?

Oranges Folic acid (folate) helps prevent neural-tube birth defects; it is found in green, leafy vegetables; liver, beef, and fish; legumes; and grapefruit and oranges. Peanuts are high in protein and niacin. Milk is high in carbohydrates and vitamin D. Egg yolks are high in vitamin A, iron, and cholesterol

A client who had abdominal surgery complains of feeling as though "something gave way" in the incisional site. The nurse removes the dressing and notes the presence of a loop of bowel protruding through the incision. Which nursing interventions should the nurse take? Select all that apply.

- Notify the registered nurse. - Document the client's complaint. - Instruct the client to remain quiet. - Prepare the client for wound closure. Wound dehiscence is the separation of the wound edges, and wound evisceration is the protrusion of the internal organs through an incision. If wound dehiscence or evisceration occurs, the registered nurse is notified, and he or she then contacts the surgeon immediately. The client is placed in a low-Fowler's position, kept quiet, and instructed not to cough. Protruding organs are covered with a sterile, saline dressing. Ice packs are not applied. The treatment for evisceration is immediate wound closure under local or general anesthesia.

A client with diabetes mellitus has a glycosylated hemoglobin A (HbA1c) level of 8%. Which instruction does the nurse plan to reinforce to the client based on this test result?

- Prevent hyperglycemia. Elevations of the HbA1c value indicate a need for teaching related to the prevention of hyperglycemic episodes. The HbA1c value measures the amount of glucose that has become permanently bound to the red blood cells. Elevations in blood glucose levels will cause elevations in the amount of glycosylation. Thus, this test is useful for detecting clients who have periods of hyperglycemia that are undetected in other ways. Values are expressed as a percentage of the total hemoglobin and based on the health care provider's preference, include the following: diabetic client with good control, 7.5% or less; diabetic client with fair control, 7.6% to 8.9%; and diabetic client with poor control, 9% or greater. Some health care providers prefer levels lower that these noted. Avoiding infection relates to a low white blood cell count rather than the HbA1c level. Taking in enough fluids relates to an increased hematocrit level rather than the HbA1c level. Increasing iron relates to a low red blood cell count and hemoglobin level rather than the HbA1c level. HbA1c relates to glucose.

Diphenhydramine hydrochloride (Benadryl), 25 mg orally every 6 hours, is prescribed for a child with an allergic reaction. The child weighs 25 kg. The safe pediatric dosage is 5 mg/kg/day. Which conclusion should the nurse infer?

- The dose is within the safe dosage range. Use the formula for calculating a safe dosage range.Safe dose parameter: 5 mg/kg/day × 25 kg = 125 mg/day Dosage frequency: 25 mg × 4 doses (every 6 hours) = 100 mg/day The dose is within the safe dosage range.

The nurse is assisting in preparing a plan of care for a 4-year-old child hospitalized with nephrotic syndrome. Which intervention is most appropriate for this child?

Encourage the child to eat in the playroom. Mealtimes should center on pleasurable socialization. The child should be encouraged to eat meals with other children on the unit. A diet that is normal in protein with a sodium restriction is normally prescribed for a child with nephrotic syndrome. Parents or other family members should be encouraged to be present at mealtimes with a hospitalized child.

The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease (COPD). Which should the nurse expect to note in this client? Select all that apply.

- Dyspnea on exertion - Presence of a productive cough - Difficulty breathing while talking Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea (difficult or labored breathing) on exertion and at rest, oxygen desaturation with exercise, use of accessory muscles of respiration, and a prolonged expiratory phase of respiration. The client may also exhibit difficulty breathing while talking, and may have to take breaths between every one or two words. Some clients with COPD, especially those with a history of smoking, often have a productive cough especially on arising in the morning. The chest x-ray will reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.

The nurse is caring for a client receiving morphine sulfate intravenously for pain. Because morphine sulfate has been prescribed for this client, which nursing action should be included in the plan of care?

Encourage the client to cough and deep breathe Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breathe to prevent pneumonia. The remaining options are not specifically associated with this medication.

The nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of which disorder?

Graves' disease PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease. Myxedema indicates hypothyroidism. Cushing's syndrome and Addison's disease are disorders related to adrenal function.

Which signs/symptoms should the nurse expect to note when collecting data on a client with Addison's disease?

Hypotension and vomiting Common manifestations of Addison's disease include postural hypotension from fluid loss, syncope, muscle weakness, anorexia, nausea, vomiting, abdominal cramps, weight loss, depression, and irritability. The manifestations in the remaining options are not associated with Addison's disease.

Which criterion does the nurse determine is a characteristic of scabies? Select all that apply.

- It appears as burrows or fine, grayish-red lines. - It is transmitted by close personal contact with an infected person. - It is endemic among schoolchildren and institutionalized populations - Household members and contacts of the infected child need to be treated at the same time that the child is being treated. Scabies usually appears as burrows or fine, grayish-red lines. It is not caused by a fungal infection, and it is treated with the application of a topical scabicide. It is transmitted by close personal contact with an infected person, and it is endemic among schoolchildren and institutionalized populations. Household members and contacts of the infected child need to be treated at the same time that the child is being treated.

In planning activities for the depressed client, especially during the early stages of hospitalization, which is best?

Encourage the client to participate in a structured daily program of activities. A depressed person suffers with depressed mood and is often withdrawn. Also, the person experiences difficulty concentrating, loss of interest or pleasure, low energy, fatigue, and feelings of worthlessness and poor self-esteem. The plan of care needs to provide successful experiences in a stimulating yet structured environment rather than a quiet and solitary one.

A client who has been diagnosed with multiple myeloma asks the nurse about the diagnosis. The nurse bases the response on which characteristic of the disorder?

Malignant proliferation of plasma cells and tumors within the bone Multiple myeloma is a neoplastic condition that is characterized by the abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Altered red blood cell production and altered production of lymph nodes are not characteristics of multiple myeloma. Exacerbation in the number of leukocytes describes the leukemic process.

A pediatric client with a ventricular septal defect repair is placed on a maintenance dose of digoxin (Lanoxin). The safe dose is 0.03 mg/kg/day, and the client's weight is 7.2 kg. The health care provider (HCP) prescribes the digoxin to be given twice daily. How much digoxin should the nurse administer to the client at each dose?

- 0.1 mg Calculate the dosage by weight first; therefore, 0.03 mg/day × 7.2 kg = 0.21 mg/day. Next, note that the HCP prescribes digoxin to be given twice daily; therefore, 2 doses in 24 hours will be administered, and 0.21 mg/day divided by 2 doses = 0.1 mg for each dose.

The nurse reinforces medication instructions to a client with peptic ulcer disease. Which statement by the client indicates the best understanding of the medication therapy?

"The nizatidine (Axid) will cause me to produce less stomach acid." Nizatidine, a histamine H2-receptor blocker, is frequently used in the management of peptic ulcer disease. Histamine H2-receptor blockers decrease the secretion of gastric acid (HCL). Antacids are used as adjunct therapy and neutralize acid in the stomach. Omeprazole is a proton pump inhibitor. Sucralfate (Carafate) promotes healing by covering the ulcer, thus protecting it from erosion caused by gastric acids.

The nurse is preparing to administer an enema to an adult client. Which interventions should the nurse plan to perform for this procedure? Select all that apply.

- Apply disposable gloves. - Lubricate the enema tube and insert it approximately 4 inches. - Clamp the tubing if the client expresses discomfort during the procedure. - Ensure that the temperature of the solution is between 100° F (37.8° C) and 105° F (40.5° C). The administration of an enema is a clean procedure, and standard precautions must be used. The nurse applies disposable gloves when administering an enema to prevent the transfer of microorganisms. To administer an enema, the nurse places the client in the left Sims' position because the enema solution will flow downward by gravity along the natural curve of the sigmoid colon and rectum, improving retention of the enema solution. The tube is lubricated for easy insertion and is inserted approximately 3 to 4 inches in an adult. If the client complains of cramping or discomfort during the procedure, the nurse clamps the tubing until the discomfort subsides. The container containing the enema solution is hung about 12 to 18 inches above the client's anus. A flow of solution that is too forceful can damage the bowel. The temperature of the solution should be between 100° F (37.8° C) and 105° F (40.5° C). Solution that is too hot will burn the client, and solution that is too cool will cause cramping.

Which guidelines should the nurse follow when performing narrative documentation? Select all that apply.

- Date and time entries. - Sign and title each entry. - Avoid judgmental and evaluative statements. - Do not leave blank spaces on documentation forms. The nurse always dates and times entries and signs and titles each entry. The nurse provides objective, factual, and complete documentation and avoids subjective, judgmental, and evaluative statements. Quotes are used to relate what the client actually said. The nurse avoids leaving blank spaces on documentation forms because this allows for an area in which notes can be entered by others at a later time. The recording of information in the client's record must be sequential.

The nurse is preparing a list of home care instructions regarding stoma and laryngectomy care to a client. Which instructions should be included in the list? Select all that apply.

- Obtain a Medic-Alert bracelet. - Prevent debris from entering the stoma. - Avoid exposure to people with infections. - Avoid swimming and use care when showering. The nurse should teach the client how to care for the stoma, depending on the type of laryngectomy performed. Most interventions focus on protection of the stoma and the prevention of infection. Interventions include avoiding swimming and using caution when showering, avoiding exposure to people with infections, preventing debris from entering the stoma, and obtaining a Medic-Alert bracelet. Additional interventions include wearing a stoma guard or high-collar clothing to cover the stoma, increasing the humidity in the home, and increasing fluid intake to 3000 mL/day to keep the secretions thin.

The nurse assists with preparing a nursing care plan for a child who has Reye's syndrome. Which is the priority nursing intervention?

Providing a quiet atmosphere with dimmed lights The major elements of care for a child who has Reye's syndrome are to maintain effective cerebral perfusion and to control intracranial pressure. Decreasing stimuli in the environment should decrease the stress on the cerebral tissue and the neuron responses. Cerebral edema is a progressive part of this disease process. Checking pupillary responses and output are part of assessment but not the priority. Changing the body position every 2 hours is important but would not directly affect the cerebral edema and intracranial pressure. The child should be in a head-elevated position to decrease the progression of the cerebral edema and to promote the drainage of cerebrospinal fluid.

The nurse is reviewing the laboratory results of several clients receiving pharmacologic therapy. Which laboratory test results indicate a therapeutic value and that the nurse can safely administer the medication as prescribed? Select all that apply.

- Gentamicin 8 mcg/mL - Theophylline (Theo-24) 10 mcg/mL - Carbamazepine (Tegretol) 10 mcg/mL The gentamicin, theophylline, and carbamazepine levels are within the normal therapeutic range; all other results are abnormal (too high). Therapeutic medication levels include the following: gentamicin, 5 to 10 mcg/mL; tobramycin 5 to 10 mcg/mL; digoxin (Lanoxin), 0.5 to 2 ng/mL; phenytoin (Dilantin), 10 to 20 mcg/mL; theophylline, 10 to 20 mcg/mL; and carbamazepine (Tegretol), 5 to 12 mcg/mL

The nurse should expect to note which interventions in the plan of care for a client with hypothyroidism? Select all that apply.

- Instruct the client about thyroid replacement therapy. - Encourage the client to consume fluids and high-fiber foods in the diet. - Instruct the client to contact the health care provider if episodes of chest pain occur. The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormones and providing measures to support the signs and symptoms related to a decreased metabolism. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. The client often has cold intolerance and requires a warm environment. The client would notify the health care provider if chest pain occurs because it could be an indication of overreplacement of thyroid hormone. Iodine preparations are used to treat hyperthyroidism. These medications decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone.

A client has just had a cast removed and the underlying skin is yellow-brown and crusted. The nurse determines that further skin care instructions are required if the client makes which statement?

"I need to scrub the skin vigorously with soap and water." The skin under a casted area may be discolored and crusted with dead skin layers. The client should gently soak and wash the skin for the first few days. The skin should be patted dry, and a lubricating lotion should be applied. Clients often want to scrub the dead skin away, which irritates the skin. The client should avoid direct exposure of the skin to the sunlight.

A client is admitted to the hospital with acute viral hepatitis. Which sign/symptom should the nurse expect to note based on this diagnosis?

Fatigue Common signs of acute viral hepatitis include weight loss, dark urine, and fatigue. The client is anorexic and finds food distasteful. The urine darkens because of excess bilirubin being excreted by the kidneys. Fatigue occurs during all phases of hepatitis. Spider angiomas—small, dilated blood vessels—are commonly seen in cirrhosis of the liver.