Adult Health 2 Exam 1

A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client?

Octreotide

What would you focus on in your patient assessment for a patient with portal hypertension?

-ASSESS ASCITES THROUGH ABDOMINAL GIRTH -DAILY WEIGHTS FIRST THING IN THE MORNING -assess esophageal varices -other signs of liver failure

Who is AT RISK for hypothyroidism?

- older population (patient's between the age of 40-70) - pt with grave's disease - pt with hashimoto's

What are the causes of hyperparathyroidism?

- parathyroid tumor - hormone secreting lung, GI, or kidney tumor - hyperplasia - neck trauma or radiation - Vit D deficiency - CKD/kidney stone formation

A patient with hyperthyroidism (thyroid storm) needs evaluating. What precaution would you put this patient on?

- NPO wait for gag reflex to return before allowing the patient to swallow

For patients with liver damage - What are 2 reasons to be cautious about medications for?

- bioavaliability won't be high - in children, liver is not as mature

Indications, causes, and interventions of Cullen's sign?

- blue discoloration around UMBILLICUS - indicates severe acute pancreatitis -START AN IV - due to hemorrhage

Indications, causes, and interventions of Gray-Turner's Sign?

- bruising on FLANKS - indicates severe acute pancreatitis - START AN IV - due to hemorrhage

A patient has undergone radiation therapy for cancer of the thyroid. What are some precautions the patient and nurse need to take?

- do not go around pregnant women/kids - nurse wear PPE because of patient's urine and blood

What are some nursing interventions for a patient with hepatitis?

- drug therapies - diet/ETOH cessation - patient education - careful w/ sexual partners (notify before having sex for hep B & C)

Why would a patient need to take Hydrocortisone (Corsef) When would the nurse instruct the patient to take it?

- for adrenal insufficiency - take in the morning between 6-8 AM

Indications, causes, and interventions of Trousseau's Sign?

- indicates hypoparathyroidism - spasm of hand & wrist when blood pressure cuff inflates - calcium levels

Indications, causes, and interventions of Chvostek's Sign?

- indicates hypoparathyroidism - twitching of facial muscles when cheek stimulated - calcium levels

A nurse is assessing a patient for signs/symptoms of acute pancreatitis, what could she find?

-SEVERE RUQ/LUQ PAIN (bring pt to hospital) -NAUSEA & VOMITING -ABDOMINAL GUARDING -pain even light touch -significant abdominal pain w/ even water or vomiting like crazy -hypotension --> hypovolemia & shock d/t fluid into the peritoneal cavity

What are treatments for variceal bleeding? (medications, surgeries)

-banding (decrease rebleeding & reoccurences) -sandostatin -vasopressin (not for cardiac issues) - PPIs for GERD

What are some post-operative interventions/concerns for a patient who received a liver biopsy?

-bleeding precautions -ABCs -listen to lung sounds -check VS

What are signs and symptoms of Addison's disease?

A added pigmentation & potassium (tan skin) D decreased weight (slender & very weak) D decreased BP (hypotension) S sodium loss S salt craving

The client is diagnosed with end-stage liver failure. The client asks the nurse, "Why is my doctor decreasing the doses of my medications?" Which statement is the nurse's best response? A) "You are worried because your doctor has decreased the dosage." B) "You really should ask your doctor. I am sure there is a good reason." C) "You may have an overdose of the medications because your liver is damaged." D) "The half-life of the medications is altered because the liver is damaged."

A) "You are worried because your doctor has decreased the dosage."

A patient has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The patients medication regimen includes lactulose (cephulac) four times daily. What desired outcome should the nurse relate to this pharmacologic intervention? A) 2 to 3 soft bowel movements daily B) Significant increase in appetite and food intake C) Absence of nausea and vomiting D) Absence of blood or mucus in stool

A) 2 to 3 soft bowel movements daily

A nurse works in the walk-in clinic. The nurse recognizes that certain patients are at higher risk for different disorders than other patients. What patient is at greater risk for the development of hypothyroidism? A) A 75-year-old female patient with osteoporosis B) A 50-year-old male patient who is obese C) A 45-year-old female patient who used oral contraceptives D) A 25-year-old male patient who uses recreational drugs

A) A 75-year-old female patient with osteoporosis

You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would have the highest priority in this care plan? A) Risk for injury related to weakness B) Ineffective breathing pattern related to muscle weakness C) Risk for loneliness related to disturbed body image D) Autonomic dysreflexia related to neurologic changes

A) Risk for injury related to weakness

A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the patients fluid volume excess? Select all that apply. A) administering diuretics B) administering calcium channel blockers C) implementing fluid restrictions D) implementing a 1500 kcal/day restriction E) enhancing patient positioning

A) administering diuretics C) implementing fluid restrictions E) enhancing patient positioning

A nurse is teaching dietary-modification strategies to a client who has been newly diagnosed with cirrhosis. Which of the following foods should the nurse recommend? A) grilled chicken B) potato soup C) fish sticks D) baked ham

A) grilled chicken

A medical nurse is caring for a patient with type 1 diabetes. The patients medication administration record includes the administration of regular insulin three times daily. Knowing that the patients lunch tray will arrive at 11:45, when should the nurse administer the patients insulin? A) 10:45 B) 11:15 C) 11:45 D) 11:50

B) 11:15

A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic did the physician prescribe for this patient? A) A sulfonylurea B) A biguanide C) A thiazolidinedione D) An alpha glucosidase inhibitor

B) A biguanide

A patient is brought to the ER by the paramedics. The patient is a type 2 diabetic and is experiencing HHS. The nurse should identify what components of HHS? Select all that apply. A) Leukocytosis B) Glycosuria C) Dehydration D) Hypernatremia E) Hyperglycemia

B) Glycosuria C) Dehydration D) Hypernatremia E) Hyperglycemia

A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this patients plan of care? A) measurement of abdominal girth and body weight B) assessment for variceal bleeding C) assessment for signs and symptoms of jaundice D) monitoring of results of liver function testing

B) assessment for variceal bleeding

A patient with a diagnosis of esophageal varices has undergone endoscopy to gauge the progression of this complication of liver disease. Following the completion of this diagnostic test, what nursing intervention should the nurse perform? A) keep patient NPO until the results of test are known B) keep patient NPO until the patients gag reflex returns C) administer analgesia until post-procedure tenderness is relieved D) give the patient a cold beverage to promote swallowing ability

B) keep patient NPO until the patients gag reflex returns

A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the patients treatment? A) decisional conflict B) deficient knowledge C) death anxiety D) disturbed thought process

C) death anxiety

A nurse is caring for a client with diabetes mellitus who is prescribed regular insulin via a sliding scale. After administering the correct dose at 0715, the nurse should ensure the client receives breakfast at which of the following times?​ A) 0720​ B) 0730​ C) 0745​ D) 0815​

C) 0745​

The nurse is assessing a patient diagnosed with Graves disease. What physical characteristics of Graves disease would the nurse expect to find? A) Hair loss B) Moon face C) Bulging eyes D) Fatigue

C) Bulging eyes

The nurse is caring for a patient with a diagnosis of Addisons disease. What sign or symptom is most closely associated with this health problem? A) Truncal obesity B) Hypertension C) Muscle Weakness D) Moon face

C) Muscle Weakness

The nurse is teaching a patient that the body needs iodine for the thyroid to function. What food would be the best source of iodine for the body? A) Eggs B) Shellfish C) Table salt D) Red meat

C) Table salt

A patient with portal hypertension has been admitted to the medical floor. The nurse should prioritize which of the following assessments related to the manifestations of this health problem? A) Assessment of blood pressure and assessment for headaches and visual changes B) Assessments for signs and symptoms of venous thromboembolism C) daily weights and abdominal girth measurement D) blood glucose monitoring q4h

C) daily weights and abdominal girth measurement

A patient is receiving care in the ICU for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis. Consequently, the nurse should asses for what signs and symptoms of this complication? A) sudden increase in random blood glucose readings B) increased abdominal girth accompanied by decreased level of consciousness C) fever, increased heart rate and decreased blood pressure D) abdominal pain unresponsive to analgesics

C) fever, increased heart rate and decreased blood pressure

A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop a nutritional plan. The nurse should prioritize which of the following in the patients plan? A) increased potassium intake B) fluid restriction to 2 L per day C) reduction in sodium intake D) high-protein, low-fat diet

C) reduction in sodium intake

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition?

Hepatic encephalopathy

A patient is recovering from a sub-thyroidectomy procedure. What position would the nurse place this patient in?

semi-fowlers w/ neutral position

What is the severe form of hyperthyroidism?

thyrotoxicosis

The nurse is providing care for an older adult patient whose current medication regimen includes levothyroxine (synthroid). As a result, the nurse should be aware of the heightened risk of adverse effects when administering an IV dose of what medication? A) A fluoroquinalone antibiotic B) A loop diuretic C) A proton pump (PPI) D) A benzodiazepine

D) A benzodiazepine

The nurse is caring for patient with hyperparathyroidism. What level of activity would the nurse expect to promote? A) Complete bed rest B) Bed rest with bathroom privileges C) Out of bed (OOB) to the chair twice a day D) Ambulation and activity as tolerated

D) Ambulation and activity as tolerated

An older patient with type 2 diabetes is brought to the ER by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patients daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of HSS is made. What nursing action would be a priority? A) Administration of antihypertensive medications B) Administering sodium bicarbonate intravenously C) Reversing acidosis by administering insulin D) Fluid and electrolyte replacement

D) Fluid and electrolyte replacement

A nurse is participating in the emergency care of a patient who has just developed variceal bleeding. What intervention should the nurse anticipate? A) infusion of IV heparin B) IV administration of albumin C)STAT administration of vitamin K by IM D) IV administration of octreotide (sandostatin)

D) IV administration of octreotide (sandostatin)

A nurse is amending a patients plan of care in light of the fact that the patient has recently developed ascites. What should the nurse include in this patients care plan? A) mobilization with assistance at least 4 times daily B) administration of beta-adrenergic blockers as ordered C) vitamin B-12 injections as ordered D) administration of diuretics as ordered

D) administration of diuretics as ordered

What kind of diet would the nurse put a patient with hepatitis on? B) initiate IV therapy of LR at 200ml/L C) weight the patient daily D) low-fat, low-carbohydrate diet

D) low-fat, low-carbohydrate diet

A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin (glucophage). Following an ordered increase in the patients daily dose of metformin, the nurse should prioritize which of the following assessments? A) Monitoring the patients neutrophil levels B) Assessing the patient for signs of impaired liver function C) Monitoring the patients level of consciousness and behavior D) Reviewing the patients creatinine and BUN levels

D) reviewing the patients creatinine and BUN levels

A patient presents to the ER with DKA (diabetes type 1). What is the first step the nurse would take for initial treatment for this patient?

DO NOT GIVE D5 RIGHT AWAY! -REHYDRATE with normal saline (0.45%) followed by an insulin drip on top of it -then the nurse can switch to a D5 w/ normal saline to make sure blood sugar doesn't drop too much with the new insulin

If a patient has a blood sugar of 180 postprandrial (post meal), is this normal?

yes, it is normal

The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent?

Lactulose

A patient is experiencing constipation due to hypothyroidism. What medication should the physician order for this patient?

Lactulose (colace)

The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia?

Spironolactone (Aldactone)

What would you tell the end-stage liver patient about medication dosages?

you should take a reduced dose of other medications because your liver does not inactivate medications the way a healthy liver would

What is the level of activity of a patient with hyperparathyroidism?

ambulation activity when tolerated

When would you instruct the patient to take pancreatic enzymes?

before meals and snacks

What's happening in diabetes type 1 (DKA) that we create ketones?

breakdown of fat (pull off fat storage) (ketone urea) metabolic acidosis

What is the main way to prevent DM complications?

control/manage blood sugar - euglycemia

A patient with Addison's Disease is prescribed Decadron. She takes the Decadron dose at 8 pm, when does the nurse need to assess the patient's levels and labs?

draw labs before 8 AM and see if the patient's levels have changed between 6-8 AM the next morning. coritsol levels are high in the morning between 6-8 AM

A patient presents with end-stage liver disease. What is the concern with medication dosing in this patient? (think therapeutic communication)

drug will not be inactived by liver. smaller doses because they can't metabolize as well because of the first pass effect. less absorption through the liver and more free drug available for uptake, can put patient at chance for overdose

A patient notices her blood sugar dropped following a workout, what would you advise the patient to do?

eat a snack

What is a fasting blood sugar level for a patient with a diagnosis of diabetes?

greater than 125 (>125)

A patient taking metformin is getting a CT scan in 24 hours. What should the nurse do regarding this medication?

hold the metformin

What is portal hypertension?

increased pressure throughout the portal venous system resulting from obstruction of blood flow into the and through the damaged liver

When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. What intervention should the nurse consider?

measure abdominal girth according to a set routine

What is the severe form of hypothyroidism?

myxedema

Why would a patient with end-stage liver disease have light (clay) colored stools?

no bile

Why do we give lactulose, and what is the goal - what are we looking for?

-decrease ammonia levels -goal is 2-3 stools/day

When should a patient with DM come to the hospital?

-decreased LOC -decreased I/O -blood glucose >300 with type 1 (DKA) -blood glucose >600 with type 2

What is the purpose for testing thyroid levels?

-determine if thyroid is overactive or underactive -know whether symptoms are related to thyroid and to treat for it (hyper or hypothyroidism)

What are the manifestations for hep A?

-flu-like symptoms -nausea/vomiting -malaise/fatigue

What goals would the nurse have for a patient who presented to the ER with worsening signs of liver failure (hep A)?

-getting up, being more active -eating more

What are "sick day" recommendations for a patient with DM type 1?

- monitor glucose and ketones every 3-4 hours - urine dip test for ketones - continuation of insulin - hydration - small, frequent meals - avoid diet soda (no sugar)

What are signs and symptoms of a patient with HHNS (diabetes type 2)?

-NO KETONES IN URINE -BLOOD SUGAR 600+ -NO KUSSMAULS -MENTAL STATUS CHANGE (confused) -extreme dehydration -extreme thirst -hyperglycemia -pH>7.4 (alkalotic)

The nurse is assessing a patient with pancreatitis. Other than addressing "pain" interventions. What kind of medical management will this patient be on?

-NPO (stops production of enzymes) -pain meds (opioids-dilaudid/fentanyl) -IV fluids

A nurse is assessing a patient for signs/symptoms of chronic pancreatitis, what could she find?

-broader pain (d/t repeated damage to pancreas) -bruising -excessive thirst -changes in skin color -unintentional weight loss -malnutrition -oily stools (steatorrhea) -fibrosis of pancreas

A patient is recovering from hepatic encephalopathy, what are the nurses treatment goals for this patient?

-check oxygen levels -safe ambulation -safety concerns when we're not in the room -we don't want the patient to be constipated, so give the patient lactulose

Metformin is a concern for patients kidney functions. What labs would the nurse need to monitor because of this?

-creatinine -BUN question dose and administration of the metformin because it won't clear through the kidneys

Patient education concerns with Hep A include what? What is the nurse looking for, for worsening signs and symptoms?

-increased jaundice (severe) -clotting factors (nose bleeds, bleeding gums, bruising that doesn't go away) indicate clotting isn't working, liver disease is worsening

What are signs and symptoms of a patient with DKA (diabetes type 1)?

-ketones -kussmauls -weight loss

Why would the nurse assign a client problem of "excess fluid volume" (ascites) to a patient with end-stage liver disease? What interventions would the nurse do?

-measure abdominal girth -spironlactone -daily weights (gain no more than 1 kg/day - 2.2 lbs) -keep pt positioned upright

What are occupational risk factors for blood-borne transmission of hepatitis?

-needlestick injuries -universal precautions -vaccinations against hep A & B

The nurse is receiving report on patient history with portal hypertension. What 3 things should the nurse keep in mind for this patient?

-portal hypertension -esophageal varices -banding

What are manifestations of Cushing's Syndrome?

-purple striae -hirsutism in females -amenorrhea (absence of menstrual period) in females -alopecia -buffalo hump

What are sources of dietary iodine?

-table salt - that specifically contain iodine

A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a patient admitted with cirrhosis, the nurse will serve the following foods on the tray?

-thiamine (vitamin B) to help with clotting factors -pork, fish, beans, legumes, lentils, breakfast cereals

In grave's disease, which labs are elevated or decreased?

-thyroid (TSH) can be normal or decreased -serum calcium is elevated -TSI elevated -T3 and T4 elevated

What is a fasting blood sugar level for a patient with a diagnosis of pre-diabetes?

100-125

Following an addisonian crisis, a patient's adrenal function has been gradually regained. The nurse should ensure that the patient knows about the need for supplementary glucocorticoid therapy in which of the following circumstances? A) Episodes of high psychosocial stress B) Periods of dehydration C) Episodes of physical exertion D) Administration of a vaccine

A) Episodes of high psychosocial stress

The nurse providing care for a patient with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. How should the nurse best reduce this risk? A) Establish fall prevention measures B) Encourage bed rest whenever possible C) Encourage the use of assistive devices D) Provide constant supervision

A) Establish fall prevention measures

A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? A) Fasting plasma glucose greather than or equal to 126 mg/dL B) Random plasma glucose greater than 150 mg/dL C) Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions D) Random plasma glucose greater than 126 mg/dL

A) Fasting plasma glucose greather than or equal to 126 mg/dL

A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator is aware that the patient will require further teaching when the patient states what? A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours B) If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day C) I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea D) I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine

A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours

A nurse is caring for a client who has type 2 diabetes mellitus and will have excretory urography. Prior to the procedure, which of the following actions should the nurse take? (Select all that apply). A) Identify an allergy to seafood B) Withhold metformin for 24 hr. C) Administer an enema D) Obtain a coagulation profile E) Assess for asthma

A) Identify an allergy to seafood B) Withhold metformin for 24 hr. C) Administer an enema E) Assess for asthma

A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a documented history of adrenal insufficiency. Considering the patients history and current symptoms, the nurse should anticipate that the patient will be instructed to do which of the following? A) Increase his intake of sodium until the GI symptoms improve B) Increase his intake of potassium until the GI symptoms improve C) Increase his intake of glucose until the GI symptoms improve D) Increase his intake of calcium until the GI symptoms improve

A) Increase his intake of sodium until the GI symptoms improve

A female client eats a nutrient-rich, balanced diet and exercises each day. However, recently she reports the following: weight gain of 25 lbs (11.4 kg), facial hair, and "purple marks" on her abdomen and breast tissue. On presenting to the office, her BP os 130/90. The nurse knows that these symptoms are indicative of: A) cushing's syndrome B) addison's disease C) early cirrhosis D) HTN

A) cushing's syndrome

A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurses risk of acquiring hepatitis C in the workplace? A) disposing of sharps appropriately and not recapping needles B) performing meticulous hand hygiene at the appropriate moments in care C) adhering to the recommended schedule of immunizations D) wearing an n95 mask when providing care for patients on airborne precautions

A) disposing of sharps appropriately and not recapping needles

A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What guideline applies to periods of illness in a diabetic patient? A) do not eliminate insulin when nauseated and vomiting B) report elevated glucose levels greater than 150 mg/dL C) eat three substantial meals a day, if possible D) reduce food intake and insulin doses in times of illness

A) do not eliminate insulin when nauseated and vomiting

Nurse is assessing a client who has thyrotoxicosis after taking too high of a level of levothyroxine. Which of the following manifestations should the nurse expect? A) heat intolerance B) drowsiness C) bradycardia D) dry skin

A) heat intolerance

An adult patient has been admitted to the medical unit for the treatment of acute pancreatitis. What nursing action should be included in this patients plan of care? A) measure the patients abdominal girth daily B) limit the use of opioid analgesics C) monitor the patient for signs of dysphagia D) encourage activity as tolerated

A) measure the patients abdominal girth daily

A 37-year-old male patient presents at the ED complaining of nausea and vomiting and severe abdominal pain. The patient's abdomen is rigid, and there is bruising to the patients flank. The patients wife states that he was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the patient for what health problem? A) severe pancreatitis with possible peritonitis B) acute cholecystitis C) chronic cholecystitis D) acute appendicitis with possible perforation

A) severe pancreatitis with possible peritonitis

A patient has been diagnosed with acute pancreatitis. The nurse is addressing the diagnosis of cute pain related to pancreatitis. What pharmacological intervention is most likely to be ordered for this patient? A) oral oxycodone B) IV hydromorphone (dilaudid) C) IM mepridine (demerol) D) Oral naproxone (aleve)

B) IV hydromorphone (dilaudid)

A patient has been admitted to the critical care unit with a diagnosis of thyroid storm. What intervention should the nurse include in this patients immediate care? Select all that apply. A) Administering diuretics to prevent fluid overload B) Administering beta blockers to reduce heart rate C) Administering insulin to reduce blood glucose levels D) Applying interventions to reduce the patients temperature E) Administering corticosteroids

B) Administering beta blockers to reduce heart rate D) Applying interventions to reduce the patients temperature

The nurse is planning the care of a patient with hyperthyroidism. What should the nurse specify in the patients meal plan? A) A clear liquid diet, high in nutrients B) Small, frequent meals, high in protein and calories C) Three large, bland meals a day D) A diet high in fiber and plant-sourced fat

B) Small, frequent meals, high in protein and calories

The home care nurse is conducting patient teaching with a patient on corticosteroid therapy. To achieve consistency with the bodys natural secretion of cortisol, when would the home care nurse instruct the patient to take his or her corticosteroids? A) In the evening between 4 PM and 6 PM B) Prior to going to sleep at night C) At noon every day D) In the morning between 7 AM and 8 AM

D) In the morning between 7 AM and 8 AM

A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide?

reduce fluid accumulation and venous pressure

The nurse is assessing a patient with common signs and symptoms associated with peritonitis. What is the hallmark sign/symptom of peritonitis?

rigid/board like abdomen (hard as a rock)