Sherpath lesson quizzes

Which nursing statement is accurate when providing education to a postmenopausal patient who is at risk for hypercalemia? -"It is important for us to monitor your serum parathyroid levels." -"It is important for you to increase your dietary intake of calcium." -"It is important for us to monitor your serum magnesium levels." -"It is important for you to increase your dietary intake of vitamin D."

"It is important for us to monitor your serum parathyroid levels." (Postmenopausal patient has increase risk for hyperparathyroidism, which is primary cause of hypercalcemia for this population.)

A patient is 2 days post-knee surgery. The pain management plan includes pharmacologic treatment, but the patient also requests nonpharmacologic methods, so the nurse brings the patient an ice pack. Which statement by the nurse indicates an understanding of the use of cold therapy to treat pain? -"Thermotherapy provides local analgesia." -"Ice packs should be applied for up to 1 hour." -"Rest periods from cold therapy should be provided to prevent tissue injury." -"Cryotherapy is effective for pain management because it speeds nerve conduction."

"Rest periods from cold therapy should be provided to prevent tissue injury."

A patient is admitted to the hospital with a broken hip, and the health care provider prescribes a patient-controlled analgesia (PCA) system to manage the pain. Which patient statement reflects understanding of education about the use of PCA provided by the nurse? -"This PCA machine dispenses a pill every time I push the button." -"I will be able to give myself pain medication any time I feel that I need it." -"This infusion pump is programmed to give me a set dose of medication at a set time interval." -"This infusion pump is controlled by a button, and if I can't hit the button my family can do it for me."

"This infusion pump is programmed to give me a set dose of medication at a set time interval."

The nurse assesses the patient's pain using the SOCRATES acronym. Which additional question would be relevant to the pain assessment? -"Where is the pain located?" -"Is the pain stabbing, burning, or aching?" -"Does anything make the pain worse or lessen it?" -"What are your past pain experiences?"

"What are your past pain experiences?" (Asking about past pain experiences provides a more thorough understanding of the patient's pain, as this question is not part of the SOCRATES assessment.)

Which questions would the nurse ask when conducting a health history assessment for a patient with a potassium imbalance? SATA -"Do you have lactose intolerance?" -"Do you take a diuretic, such as furosemide?" -"Are you experiencing swelling in your feet?" -"Do you use a salt substitute on your food?" -"Do you eat canned meats or vegetables often?"

-"Do you take a diuretic, such as furosemide?" -"Do you use a salt substitute on your food?" -(Furosemide is a potassium-wasting diuretic, which can cause hypokalemia.) -(Overuse of potassium-rich salt substitutes by people who have poor renal excretion may cause hyperkalemia.)

Which statement by the new nurse indicates understanding of the nurse's role in pain management? SATA -"I will be sure to educate the patient about pain treatment options." -"I will remember to assess for pain as a part of my initial assessment." -"I will perform a cardiac assessment to complete proper pain management procedures." -"I must advocate for adequate pain relief for my patient if current therapies seem ineffective." -"I must evaluate the patient's response to interventions to deliver focused patient care."

-"I will be sure to educate the patient about pain treatment options." -"I will remember to assess for pain as a part of my initial assessment." -"I must advocate for adequate pain relief for my patient if current therapies seem ineffective." -"I must evaluate the patient's response to interventions to deliver focused patient care."

Which specific questions would a nurse include in the assessment interview for a patient with hypermagnesemia? SATA -"What type of laxatives do you use?" -"Have you had diarrhea recently?" -"Do you use over-the-counter antacids?" -"Do you have lactose intolerance?" -"Do you take a prescribed diuretic?"

-"What type of laxatives do you use?" -"Do you use over-the-counter antacids?" -(Some laxatives are high in magnesium; therefore, this question is appropriate for the nurse to include when conducting a health history interview assessment for a patient with hypermagnesemia.) -(Some over-the-counter antacids are high in magnesium; therefore, this question is appropriate for the nurse to include when conducting a health history interview assessment for a patient with hypermagnesemia.)

Which questions would the nurse ask when conducting a pain assessment for a trauma patient? SATA -"Where is the pain located?" -"Where did the trauma occur?" -"What makes the pain worse or better?" -"Does the pain radiate anywhere?" -"On a scale from 1 to 50, how would you rate your pain?"

-"Where is the pain located?" -"What makes the pain worse or better?" -"Does the pain radiate anywhere?"

Which pain assessment tools utilize verbal reports from the patient? SATA -0-10 Pain Scale -Neonatal Infant Pain Scale -Universal Pain Tool -Wong-Baker Scale -Pain Assessment in Advanced Dementia Scale

-0-10 Pain Scale -Universal Pain Tool -Wong-Baker Scale

Which serum potassium concentrations would the nurse identify as hyperkalemia in the patients medical record? SATA -2.5 mEq/L -3.0 mEq/L -4.6 mEq/L -5.4 mEq/L -5.8 mEq/L

-5.4 mEq/L -5.8 mEq/L

Which serum calcium concentrations should the nurse identify as abnormal? SATA -7.9 mg/dL -8.4 mg/dL -9.0 mg/dL -10.0 mg/dL -10.6 mg/dL

-7.9 mg/dL -8.4 mg/dL -10.6 mg/dL

Which postoperative factors increase the risk for FVD? SATA -A draining wound -Pain medication -Dressing changes for severe burns -Intravenous (IV) fluids -Nausea and vomiting

-A draining wound -Dressing changes for severe burns -Nausea and vomiting -(Secretions, especially if the wound is connected to suction.) -(Burns cause a loss of fluid because of protective skin damage.) -(Patients with vomiting and/or diarrhea can lose a significant amount of fluid volume if it is not replaced.)

Which class of medications would the nurse identify as a cause of hyperkalemia? -Corticosteroids -Chemotherapeutics -Loop diuretics -Angiotensin-converting enzyme (ACE) inhibitors

-Angiotensin-converting enzyme (ACE) inhibitors (ACE inhibitors are a drug classification that can cause hyperkalemia by decreasing aldosterone. ACE inhibitors are widely used to control BP in diabetic patients.)

Which causes would the nurse include when providing patient education to a patient diagnosed with hypermagnesemia associated with an increased intake of magnesium? SATA -Adrenal insufficiency -Leukemia -Poor renal function -Antacid use -Magnesium-containing laxatives

-Antacid use -Magnesium-containing laxatives

Which actions support the nurse's role in pain management? SATA -Assessing the patient's pain level -Educating the patient about pain relief options -Evaluating patient response to pain interventions -Using medication as the primary treatment for pain management -Advocating with the health care provider for pain relief for the patient

-Assessing the patient's pain level -Educating the patient about pain relief options -Evaluating patient response to pain interventions -Advocating with the health care provider for pain relief for the patient

Which cues would the nurse anticipate when assessing a patient with a serum sodium level of 152 mEq/L? SATA -Hyperactive deep tendon reflexes -Confusion -Thirst -Lethargy -Seizures

-Confusion -Thirst -Lethargy -Seizures

Which patient cues are indicative of chronic pain? SATA -Dilated pupils -Constricted pupils -Increased heart rate -Decreased heart rate -Increased systolic blood pressure -Decreased systolic blood pressure

-Constricted pupils -Decreased heart rate -Decreased systolic blood pressure

Which factors would the nurse recognize as causes of water depletion hypernatremia? SATA -Diuretics -Dehydration -Hyperthermia -Emesis -Diarrhea

-Dehydration -Hyperthermia -Emesis -Diarrhea

Which cues are relevant to the adult patient's acute pain experience? SATA -Dilated pupils -Heart rate of 120 -Respiratory rate of 12 -Blood pressure of 118/62 -Pain rated 7 on 0-10 pain scale

-Dilated pupils -Heart rate of 120 -Pain rated 7 on 0-10 pain scale

Which factor would the nurse identify as increasing a patients risk for hypovolemic hyponatremia? SATA -Diuretics -Emesis -Diarrhea -Dehydration -Fever

-Diuretics -Emesis -Diarrhea

Which conditions are associated with FVE? SATA -Fecal retention -Excessive fluid loss -Excessive fluid intake -Excessive fluid retention -Decreased antidiuretic secretion

-Excessive fluid intake -Excessive fluid retention -(Excessive fluid intake can increase the circulating fluid volume. Fluid intake includes the fluids a person drinks, intravenous fluids, and enteral feedings.) -(When excessive fluids are retained in the circulating volume beyond the needs of the body, circulating volume increases can potentially result in FVE.)

Which cues are psychological expressions of pain? SATA -Fear -Crying -Agitation -Depression -Helplessness -Facial grimacing

-Fear -Depression -Helplessness (These are psychological NOT behavioral)

Which condition would a nurse suspect when caring for a patient with a serum potassium concentration of 4 mEq/L and a serum sodium concentration of 150 mEq/L? -Hypokalemia -Hyperkalemia -Hyponatremia -Hypernatremia

-Hypernatremia (hypernatremia= greater then 145.)

Which items found during a medical history would the nurse identify as risk factors for hypocalcemia? -Inadequate dietary intake -Overproduction of parathyroid hormone -Hypomagnesemia -Extended immobilization -Hypoparathyroidism

-Inadequate dietary intake -Hypomagnesemia -Hypoparathyroidism

A patient is prescribed a nonsteroidal antiinflammatory drug (NSAID) for arthritis. The nurse would educate the patient about which potential side effects? SATA -Inflammation -Hepatotoxicity -Increased bleeding -Decreased heart rate -Gastrointestinal upset -Cardiac complications

-Increased bleeding -Gastrointestinal upset -Cardiac complications

Which feature is common to both hypotonic and isotonic FVE? -Equal gain of water and sodium. -Increased intracellular water. -Decreased serum osmolality. -Increased circulating volume.

-Increased circulating volume.

Which features of FVE would a nurse expect when caring for a patient with severe oliguric kidney disease? SATA -Decrease serum osmolality. -Increased shortness of breath of pulmonary edema. -Equal gain of water and sodium. -Water gain in excess of sodium. -Increased serum osmolality.

-Increased shortness of breath of pulmonary edema. -Equal gain of water and sodium. -(Patient with severe oliguric kidney disease is at risk for developing heart failure due to shortness of breath because of pulmonary edema caused by FVE.) -(Patient with severe oliguric kidney disease is at risk for developing isotonic FVE, in which there is an equal gain of water and sodium.)

Which technology innovations can the nurse use to accurately assess or manage pain? SATA -Informatics -Pharmacogenomics -Neuroimaging biomarkers -Noncognitive assessment tools -Magnetic resonance imaging

-Informatics -Pharmacogenomics -Neuroimaging biomarkers -Magnetic resonance imaging

Which statements describe hypertonic fluid volume deficit? SATA -It results in shrinkage of cells. -Serum osmolality does not change. -There is greater water loss than solute loss. -Water and solute are lost at about the same rate. -Volume moves from extracellular fluid to intracellular fluid.

-It results in shrinkage of cells. -There is greater water loss than solute loss. -(Water is pulled out of the cells into the intravascular space, shrinking (dehydrating) the cells.) -(In hypertonic fluid deficit, sodium (a solute) is lost to a lesser degree than water.)

Which factors would a nurse recognize as causes of hypokalemia? SATA -Laxative abuse -Anorexia -Emesis -Chemotherapeutic agents -Aldosterone blockers

-Laxative abuse -Anorexia -Emesis -Chemotherapeutic agents

Which factors are potential causes of hypomagnesemia? SATA -Excessive intake of antacids containing magnesium -Loop and thiazide diuretics usage -Total parenteral nutrition (TPN) with added electrolytes -Crohn disease -GI suctioning

-Loop and thiazide diuretics usage -Crohn disease -GI suctioning -(Loop&Thiazide lead to excess excretion of magnesium and, consequently, hypomag.) -(Crohn disease interferes with absporption of electrolytes and can lead to hypomag.) -(Prolonged GI suctioning can lead to hypomag.)

Which prescription would the nurse question for a patient experiencing hypokalemia? -Aldosterone prescription -Calcium supplements -Potassium supplements -Loop diuretic prescription

-Loop diuretic prescription (its known to cause hypokalemia)

Which cues are behavioral indications of pain? SATA -Fear -Moaning -Agitation -Depression -Clenching teeth

-Moaning -Agitation -Clenching teeth (all are behavioral NOT psychological)

Which factors increase the risk for the development of hypertonic fluid volume deficit (FVD)? SATA -Vomiting -High fever -Osmotic diuretics -Diabetic insipidus -Hypertonic intravenous fluids

-Osmotic diuretics -Diabetic insipidus -Hypertonic intravenous fluids -(Osmotic diuretics are drugs that draw water from cells; this can result in hypertonic FVD.) -(Diabetes insipidus, caused by an absence of antidiuretic hormone (ADH), causes massive loss of body water in excess of loss of solute.) -(Hypertonic intravenous fluids pull from the cells, resulting in dehydration (i.e., hypertonic FVD).)

Which actions are considered nonpharmacologic pain management interventions the nurse can perform without a prescription from a health care provider? SATA -Patient repositioning -Using distraction techniques -Educating about opioid dependence -Postoperative splinting -Using progressive relaxation techniques

-Patient repositioning -Using distraction techniques -Postoperative splinting -Using progressive relaxation techniques

Which cues would a nurse expect in a patient with a serum potassium concentration of 3.1 mEq/L? SATA -Confusion -Postural hypotension -Cardiac dysrhythmia -Decreased bowel sounds -Hyperactive deep tendon reflexes

-Postural hypotension -Cardiac dysrhythmia -Decreased bowel sounds

Which factor would the nurse identify as a primary cause of hypocalcemia? -Protein depletion -Breast cancer -Immobilization -Angiotensin-converting enzyme (ACE) inhibitor use

-Protein depletion (Primary cause of hypocalemia)

Which statements reflect The Joint Commission's (TJC's) pain assessment standards? SATA -Document the comprehensive pain assessment. -Provide nonpharmacologic pain treatment modalities. -Address pain assessment and management with new staff. -Develop an evidence-based and standardized pain treatment plan. -Monitor patients at high risk for adverse outcomes related to opioid treatment.

-Provide nonpharmacologic pain treatment modalities. -Address pain assessment and management with new staff. -Monitor patients at high risk for adverse outcomes related to opioid treatment.

A patient who is in labor reports intense, painful contractions and feels very nauseous. The patient wants to proceed without the use of medication. Which nonpharmacologic interventions can the nurse implement for this patient? SATA -Repositioning the patient -Massaging the patient's back -Assisting with deep breathing exercises -Consulting with the patient's birthing doula -Keeping the patient hydrated with clear liquids

-Repositioning the patient. -Massaging the patient's back. -Assisting with deep breathing exercises.

Which relevant cues would the nurse expect to observe when assessing a patient with hypomagnesemia? SATA -Diaphoresis -Seizures -Cardiac dysrhythmia -Nystagmus -Tremors

-Seizures -Cardiac dysrhythmia -Nystagmus -Tremors

Which info regarding hypotonic FVE would the nurse include when developing an educational program for nursing staff? SATA -Serum osmolality decreases. -Serum osmolality does not change. -Retention of water and sodium are equal. -There is an increased circulating volume. -Retention of water is greater than sodium.

-Serum osmolality decreases. -There is an increased circulating volume. -Retention of water is greater than sodium. -(Serum osmolality decreases as a result of hemodilution because more water is retained than sodium.) -(Circulating volume is increased with both isotonic and hypotonic FVE.) -(In hypertonic FVE, water is ingested at a greater rate than sodium.)

Which disease process would the nurse identify as the cause of a patients serum potassium concentration of 5.3 mEq/L? -Osteoporosis -Alcoholism -Hyperaldosteronism -Sever infection

-Severe infection (This patient has a serum potassium level above 5.0 mEq/L, which is considered hyperkalemia. Severe infections, causing the release of intracellular potassium, are a cause of hyperkalemia.)

Which cues would a nurse assess a patient for based on a serum phosphate concentration of 3.1 mEq/L? SATA -Tetany -Hyperreflexia -Decreased deep tendon reflexes -Muscle cramps -Shallow respirations

-Tetany -Hyperreflexia -Muscle cramps

A patient has a broken femur and is in excruciating pain. The health care provider prescribes an intravenous opioid and acetaminophen combination for pain relief. Which statement explains why the two medications are prescribed for pain? SATA -The mixture of medications produces fewer side effects. -Multimodal analgesia requires lower doses for effective pain relief. -The health care provider wants to avoid an unhappy patient call later complaining of unrelieved pain. -The combination of medications is more effective than just the opioid alone. -The choices of medications allow the nurse to select the best option based on patient preference.

-The mixture of medications produces fewer side effects. -Multimodal analgesia requires lower doses for effective pain relief. -The combination of medications is more effective than just the opioid alone.

Which aspects would the nurse consider when conducting a pain assessment for a patient in a non-life-threatening situation? -Health literacy does not influence the assessment. -The nurse should complete the assessment as quickly as possible. -The patient's values and beliefs about pain affect the assessment. -The nurse's values and beliefs about pain may influence the assessment. -A calm and supportive manner promotes effective communication.

-The patient's values and beliefs about pain affect the assessment. -The nurse's values and beliefs about pain may influence the assessment. -A calm and supportive manner promotes effective communication.

Which features are unique to isotonic FVE? SATA -Water shifts into the cells. -Serum osmolality decreases. -It increases circulating volume. -There is no change in serum osmolality. -Retention of water and sodium are equal.

-There is no change in serum osmolality. -Retention of water and sodium are equal.

Which aspects reflect key considerations for the nurse to effectively recognize cues related to pain? SATA -Culture -Urgency -Relevance -Physiology -Importance

-Urgency -Relevance -Importance

Which statements made by the nursing student regarding an isotonic fluid deficit demonstrate an understanding of the condition? SATA -Water and sodium are lost together equally. -Fluid shifts into the cells. -Serum osmolality does not change. -Water loss is greater than sodium loss. -Blood becomes more concentrated.

-Water and sodium are lost together equally. -Serum osmolality does not change. -(In an isotonic fluid deficit, sodium and water are lost at the same rate.) -(Because of the rate at which sodium and water are lost, the serum osmolality does not change in an isotonic fluid deficit.)

Which unique features of FVE would a nurse expect when caring for a patient with severe FVE caused by syndrome of inappropriate antidiuretic hormone (SIADH)? SATA -Water gain in excess of sodium. -Decreased serum osmolality. -Signs of cerebral edema. -Equal gain of water and sodium. -No change in serum osmolality.

-Water gain in excess of sodium. -Decreased serum osmolality. -Signs of cerebral edema.

A patient who presents to the emergency department with mild leg strain requests nonpharmacologic pain treatment. Which alternative therapies would the nurse suggest? SATA -Yoga -Aspirin -Exercise -Meditation -Biofeedback

-Yoga -Meditation -Biofeedback

Hypomagnesemia occurs when the serum magnesium concentration is below

1.3 mEq/L

A serum calcium concentration greater than _____ mg/dL is known as hypercalcemia.

10.5 mg/dL

Which serum sodium concentration would the nurse identify as hyponatremia? -130 mEq/L -135 mEq/L -140 mEq/L -145 mEq/L

130 mEq/L (hyponatremia is less than 135)

Hyponatremia is a condition with a serum sodium concentrated BELOW the normal range of less than

135 mEq/L

Hypernatremia is a conditon with a serum sodium concentrated ABOVE the normal range of

145 mEq/L

Hypermagnesemia occurs when the serum magnesium concentration is greater than

2.1 mEq/L

A serum potassium concentration of less than ________ is considered to be hypokalemia.

3.5 mEq/L

A serum potassium concentration above ______ is considered to be hyperkalemia.

5.0 mEq/L

A serum calcium concentration less than ______ mg/dL is referred to as hypocalcemia.

8.5 mg/dL

Which traditional Chinese therapy is often associated with nonpharmacologic pain relief? -Massage -Hypnosis -Acupuncture -Nerve stimulation

Acupuncture

Which scenario describes when a nurse would perform a focused pain assessment on a patient? -Anytime a patient is at high risk for pain -Before taking vital signs and the patient reports the pain is mild -After taking vital signs and the patient reports the pain is mild -After taking vital signs and the patient reports the pain is severe

After taking vital signs and the patient reports the pain is severe.

Look for adverse effects of prescribed medication.

Assess

The nurse provides literature to a patient about side effects and activities to avoid while taking a prescribed medication. Which nursing action is demonstrated when the nurse asks the patient to repeat back the information? -Analyzing -Assessing -Evaluating -Understanding

Assessing

Match the nonpharmacologic therapies with the appropriate description. Trains the body for voluntary control to relieve pain

Biofeedback

Which clinical manifestation would a nurse monitor for when providing care to a patient whose serum potassium level is 5.4 mEq/L? -Bradycardia -Hyperactive deep tendon reflexes -Lethargy -Emesis

Bradycardia

Match the body system to the associated physiologic alteration caused by pain. Increases oxygen demand

Cardiovascular

Which statement describes how pain experienced by postoperative patients increases the risk for development of pneumonia? -Inhibits the inflammatory response -Causes a reluctance to breathe deeply -Increases mucus as a result of emotional reaction and crying -Releases insulin, causing diabetes and decreased oxygenation

Causes a reluctance to breathe deeply

Spasm of the facial muscles when facial nerve is tapped?

Chvostek sign

Which neurologic assessment, performed by tapping the side of the face, would the nurse perform for a patient with risk factors for hypocalcemia? -Level of consciousness exam -Trousseau sign -Electrocardiogram -Chvostek sign

Chvostek sign

For which condition would the nurse monitor a patient with FVE? -Addison disease -Postsurgical hip repair -Severe burns with dressing changes -Cirrhosis of the liver with low albumin

Cirrhosis of the liver with low albumin. (Patients with severe liver disorders and low albumin are at risk for FVE)

Provide clear documentation in the patient's record.

Communicate

Which action would a nurse take when assessing for Trousseau sign? -Tap the skin over the facial nerve. -Have the patient exhale with a closed mouth and a pinched nose. -Cut the blood supply off with a blood pressure (BP) cuff. -Measure the BP of a patient standing and lying down.

Cut the blood supply off with a blood pressure (BP) cuff.

Which cue reflects that the patient is experiencing pain? -Hypoglycemia -Decreased urine output -Reduced respiratory rate -Loose bowel movements

Decreased urine output

Which statement reflects how the gastrointestinal system responds to pain? -Releases extra gas -Speeds metabolism -Increases gastric emptying -Decreases intestinal motility

Decreases intestinal motility

Foot kicks wildly when patellar tendon is tapped?

Deep tendon reflex

Share information about potential adverse effects and usages.

Educate

The nurse tells a patient that oxycodone can cause itchiness and sleepiness and that it must be taken only as prescribed. The nurse also recommends taking a stool softener with this medication as it may cause constipation. Which action is the nurse demonstrating? -Education -Evaluation -Assessment -Intervention

Education

Which test would the nurse anticipate for a patient with hyperkalemia? -Urine specific gravity -Serum calcium -Electrocardiogram (ECG) -Urine osmolality

Electrocardiogram (ECG) (An ECG would be anticipated for a patient with hyperkalemia to diagnose and monitor cardiac dysrhythmias.)

Match the body system to the associated physiologic alteration caused by pain. Releases hormones such as cortisol, glucagon, and insulin

Endocrine

Consider the effectiveness of pain management interventions.

Evaluate

Match the body system to the associated physiologic alteration caused by pain. Decreases motility and emptying

Gastrointestinal

Which patient condition would a nurse recognize as increasing the risk for fluid volume deficit (FVD)? -Hemorrhage -Heart failure -Foot infection -Acute kidney injury

Hemorrhage. (Hemorrhage with significant loss of blood volume from bleeding would increase the risk for isotonic FVD, leading to FVD.)

Match the nonpharmacologic therapies with the appropriate description. Has pain-relieving properties

Herbs

Which factor would the nurse recognize as a common cause of hypercalcemia? -Hyperparathyroidism -Inadequate dietary intake of calcium -Inadequate dietary intake of vitamin D -Hyperphosphatemia

Hyperparathyroidism

Match the body system to the associated physiologic alteration caused by pain. Releases inflammatory mediators

Immune

The health care provider prescribes an oral analgesic every 4 hours as needed for pain. At hour 3, the patient still complains of severe pain rated 8 on a 0-10 scale and verbalizes feelings of frustration as a result of lack of pain relief. Which action is mosteffective for the nurse to take while awaiting a prescription for an increase in pain medication? -Telling the patient to try to relax and rest -Turning on the TV to provide a distraction for the patient -Implementing massage and positioning techniques -Conversing with the patient to draw attention away from the pain

Implementing massage and positioning techniques

A patient with diabetes presents at the emergency department with a broken arm and pain rated 8 on a 0-10 pain scale. Which effect on the patient's blood glucose would be anticipated? -Increased blood glucose level -Decreased blood glucose level -Fluctuating blood glucose level -No effect on blood glucose level

Increased blood glucose level

Which cue would the nurse anticipate when assessing a patient experiencing pain? -Diarrhea -Indigestion -Weight gain -Increased bowel sounds

Indigestion (Pain results in delayed gastric emptying, indicated by indigestion.)

Which cue in a patient with end-stage renal disease would a nurse recognize as an indication of hyperphosphatemia? -Decreased blood pressure -Anorexia -Irritated and itchy eyes -Confusion

Irritated and itchy eyes (In patients who have end-stage renal disease, hyperphosphatemia will cause calcium phosphate crystals to form in soft tissues, causing itching or irritated eyes.)

Which cue would a nurse expect in a patient with severe hypocalcemia? -Stupor -Personality changes -Laryngospasm -Constipation

Laryngospasm (Laryngospasm is a clinical manifestation of severe hypocalcemia.)

Which finding in the patients medical history requires the nurse to provide education about hypermagnesemia? -Crohn disease -Excessive salt intake -Leukemia -Diabetic ketoacidosis

Leukemia (one cause associated with development of hypermagnesemia.)

Which cause would a nurse include when teaching a patient diagnosed with hypomagnesemia? -Constipation -Loop diuretics -Excessive intake of vitamin D -Renal failure

Loop diuretics (Loop diuretics cause hypomagnesemia and would be included by the nurse in the teaching session for a patient with hypomagnesemia.)

Match the nonpharmacologic therapies with the appropriate description. Restores a calm state, promoting relaxation

Medication

Which category on the dehydration severity scale would a nurse use to describe a patient whose weight has decreased from 160 lb- 152 lb since admission? -Mild dehydration -Moderate dehydration -Severe dehydration -Life-threatening dehydration

Moderate dehydration (Mild=2%, Mod=5%, Severe=8%, Life-t=15%)

Match the body system to the associated physiologic alteration caused by pain. Develops spasms, tension, and fatigue

Muscular

The nurse gives a patient a dose of intravenous morphine for pain relief. A few minutes later, the patient's respiratory rate is 5 breaths/min. Which medication would the nurse administer to reverse the effects of the opioid? -Naloxone -Dezocine -Fentanyl -Hydromorphone

Naloxone (Naloxone is an opioid reversal agent used to reverse respiratory depression caused by opioids.)

Which pain management strategy is a neurologic therapy? -Distraction -Positioning -Nerve stimulation -Massage therapy

Nerve stimulation

A patient rates pain a 9 on a 0-10 scale and requests pain medication. The nurse reviews the medication administration record (MAR) and finds oxycodone, ibuprofen, acetaminophen, and ketorolac are prescribed. Which medication would the nurse administer? -Ketorolac -Ibuprofen -Oxycodone -Acetaminophen

Oxycodone

The nurse working in an urgent care office assesses a patient who presents with a possible broken ankle that is edematous. The patient rates the pain a 9 on a 0-10 scale. The nurse obtains vital signs and notices that the patient grimaces every time the affected foot moves. Which cue reflects subjective data? -Vital signs -Edematous ankle -Weak pulse in the foot -Pain rating of 9 on a 0-10 scale

Pain rating of 9 on a 0-10 scale

Which POSToperative factor places a patient at risk for FVD? -Patient has a NG tube that is draining. -Patient received an enema to prepare for surgery. -Patient lost a moderate amount of blood during surgery. -Patient received NPO while waiting for surgery.

Patient has NG tube that is draining. (Drainage from the tubes or other drains after surgery can contribute to fluid volume loss, leading to a fluid deficit.)

Which statement describes a benefit of patient-controlled analgesia (PCA)? -Patients can self-administer and manage their pain medication. -Patients' families can administer medication whenever desired. -Patients can give themselves as much medication as they desire. -The nurse does not have to perform a check before administration.

Patients can self-administer and manage their pain medication.

Which statement reflects the purpose of the Rights of Medication Administration? -Facilitate the discharge process -Prevent medication errors -Increase patient satisfaction scores -Aid the health care provider in prescribing the correct medication

Prevent medication errors

Which datum would a nurse identify as placing a patent at risk for hypovolemic hyponatremia? -Profuse diaphoresis -Water intoxication -Hypotonic intravenous (IV) solution -Excess fluid intake

Profuse diaphoresis (sweating)

Which cause would a nurse include when conducting patient education about factors contributing to hypermagnesemia? -Renal failure -Laxative abuse -Loop diuretics usage -Gastric suctioning

Renal failure (Renal failure is a primary cause of hypermagnesemia.)

Match the body system to the associated physiologic alteration caused by pain. Decreases air exchange

Respiratory

Which characteristic of non-opioid analgesic medications describes why nurses administer them more often than opioid analgesics? -Easier to dispense -Safer for the patient -Cheaper to dispense -Prescription not required

Safer for the patient

Which laboratory test would the nurse anticipate for an alert patient who presents to the emergency department with severe bilateral lower extremity weakness, shallow respirations, and normal heart rate and rhythm? -Serum potassium -Urine specific gravity -Serum sodium -Serum calcium

Serum potassium (The nurse would anticipate a serum potassium concentration test for this patient. Hypokalemia causes bilateral quadriceps muscle weakness that may also weaken the respiratory muscles.)

The nurse asks a patient experiencing painful kidney stones to rate the pain on a scale from 0 to 10. The patient rates the pain as a 7. Which phrase describes the patient's level of pain indicated by the rating? -Mild pain -Severe pain -Average pain -Moderate pain

Severe pain (Severe pain correlates to a self-reported pain number from 7 to 10.)

Which action allows the nurse to begin collecting cues about a burn patient's pain experience? -Performing comfort measures -Taking the patient's vital signs -Recording the patient's meal order -Removing the dressings to assess the wound

Taking the patient's vital signs (The first step when assessing a patient's pain is assessment of the patient's vital signs.)

A nurse is conducting a pain assessment using the SOCRATES acronym. Which concept reflects the meaning of the letter "T" in SOCRATES? -Time course -Type of pain -Temperature -Time of onset

Time course

Spasm of the hand and wrist muscles after blood pressure cuff is inflated?

Trousseau sign

Which assessment finding would support the diagnosis of hypocalcemia? -Trousseau sign -Lethargy -Shallow respirations -Stupor

Trousseau sign (Trousseau sign is a neurologic symptom of spasm of the muscles in the hand and wrist that occurs when the blood supply to the hand is occluded with a blood pressure cuff. It indicates increased neuromuscular excitability and is associated with hypocalcemia or hypomagnesemia.)

Which statement describes multimodal analgesia? -Two or more medications are used to relieve pain. -More than one intervention is used to control pain. -Pain medication is used in anticipation of a painful event. -Pharmacologic and nonpharmacologic strategies are combined.

Two or more medications are used to relieve pain.

Match the body system to the associated physiologic alteration caused by pain. Increases blood pressure through release of hormones

Urinary

Which action is eliminated by the use of patient-controlled analgesia (PCA) pumps? -Assessing the patient's pain -Requesting other types of pain medication -Educating the patient regarding pain management -Waiting for the nurse to administer pain medication

Waiting for the nurse to administer pain medication

Match the nonpharmacologic therapies with the appropriate description. Helps build strength, and balance body and mind

Yoga