Exam 4 ppt questions
A nurse is obtaining a health history from a client with the diagnosis of peptic ulcer disease. Which client statement provides evidence to support the identification of a possible contributory factor? "My blood type is A positive." "I smoke one pack of cigarettes a day." "I have been overweight most of my life." "My blood pressure has been high lately."
"I smoke one pack of cigarettes a day." - Smoking cigarettes increases the acidity of gastrointestinal secretions, which damages the mucosal lining. While blood type O is more frequently associated with duodenal ulcer, type A has no significance. Being overweight is unrelated to peptic ulcer disease. High blood pressure is not directly related to peptic ulcer disease.
When teaching the patient with acute hepatitis C (HCV), which statement demonstrates understanding of the disease process? "I will use care when kissing my wife to prevent giving it to her." "I will need to take adefovir (Hepsera) to prevent chronic HCV." "Now that I have had HCV, I will have immunity and not get it again." "I will need to be monitored for chronic HCV and other liver problems.
"I will need to be monitored for chronic HCV and other liver problems." explain that the majority of HCV lead to chronic conditions, if treatment fails, live CA and cirrhosis can occur
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? "It would be beneficial for you to eliminate drinking alcohol." "You'll need to drink at least two to three glasses of milk daily." "Many people find that a minced or pureed diet eases their symptoms of PUD." "Taking medication will allow you to keep your present diet while minimizing symptoms."
"It would be beneficial for you to eliminate drinking alcohol."
Cancer survivors are at risk for treatment-related problems. Which of the patients listed here has the greatest risk for developing such problems? An 80-year-old woman undergoing surgery for removal of a basal cell carcinoma on the face A 71-year-old man getting high-dose chemotherapy/radiation for advanced-stage lymphoma A 26-year-old man receiving chemotherapy for testicular cancer that is localized to the testicle A 48-year-old woman receiving radiation for Hodgkin's disease that involves lymph nodes extending above and below the diaphragm
A 71-year-old man getting high-dose chemotherapy/radiation for advanced-stage lymphoma The risk for treatment-related problems is associated with the complexity of the cancer itself; the type, variety, and intensity of treatments used; and the age and underlying health status of the patient.
A patient admitted to the hospital from a long-term care facility appears to be in the late stage of shock with systemic inflammatory response syndrome (SIRS). Which order implemented by the nurse has the highest priority? Insert an indwelling urinary catheter. Insert two large-bore intravenous catheters. Administer 0.9% normal saline at 100 mL/hr. Administer 100% oxygen by non-rebreather mask.
Administer 100% oxygen by non-rebreather mask. A patient in the irreversible stage of shock (late stage) will demonstrate profound hypotension and hypoxemia. If the condition progresses to systemic inflammatory response syndrome, the patient may experience profound hypoxemia. Oxygenation is a priority and should be initiated first with a 100% oxygen delivery method such as a non-rebreather mask.
A client is admitted with a diagnosis of acute pancreatitis. The medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolytes, and decreasing anxiety. Which interventions should the nurse implement? Select all that apply Provide a low-fat diet Administer analgesics Teach relaxation exercises Encourage walking in the hall Monitor cardiac rate and rhythm Observe for signs of hypercalcemia
Administer analgesics - pancreatitis is often accompanied by severe pain - complete pain assessment and keep patient at pain goal Teach relaxation exercises -helping the patient relax can reduce the metabolic rate and decrease pancreatic enzyme production Monitor cardiac rate and rhythm - patients with pancreatic may develop hypokalemia and cardiac arrhythmias
An older male patient visits his primary care provider because of burning on urination and production of foul-smelling urine. What contributing factor should the health care provider consider? High-purine diet Sedentary lifestyle Benign prostatic hyperplasia (BPH) Recent use of broad-spectrum antibiotics
Benign prostatic hyperplasia (BPH) - leads to urinary stasis
The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse teach the patient to best explain how this medication works? A. Increases insulin production from the pancreas B. Slows the absorption of carbohydrate in the small intestine C. Reduces glucose production by the liver and enhances insulin sensitivity D. Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying
C. Reduces glucose production by the liver and enhances insulin sensitivity
Patients may reduce the risk of developing cancer using health promotion strategies. Identify strategies which can reduce the risk of developing cancer (select all that apply.). Control weight Genetic testing Immunizations Use sunscreen Stop smoking Limit alcohol intake
Changing a person's lifestyle can limit cancer promotors, which is key in cancer prevention. Immunizations such as human papilloma virus (HPV) can prevent cervical cancer. Use of sunscreen (SPF 15 or greater) can prevent cell damage and development of skin cancer. Cigarette smoke can initiate or promote cancer development. Alcohol intake combined with cigarette smoking can promote esophageal and bladder cancers. Management of weight can reduce the risk of cancer. Genetic testing (i.e., APC gene) identifies the predisposition of colorectal cancer.
Which findings in the older client are associated with a urinary tract infection (UTI)? Select all that apply. Fever Urgency Confusion Incontinence Slight rise in temperature
Confusion - one of the leading causes of confusion in older adults is UTI Incontinence - many older adults experience incontinence with UTI Slight rise in temperature - normal temps or a slight rise in temperature may accompany UTI in older adults
Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury (AKI) (select all that apply.)? Dehydration Hypokalemia Hypernatremia BUN increases Urine output increases Serum creatinine increases
Dehydration - the hallmark of the diuretic phase is large amounts of urine production - this often leads to dehydration in the patient. Hypokalemia- the kidneys begin to excrete urine but cannot concentrate it - the patient loses ions urine output increases
The nurse is evaluating a patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient correlates with the diagnosis? Excessive thirst Gradual weight gain Overwhelming fatigue Recurrent blurred vision
Excessive thirst - The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger).
A client is admitted to the hospital with a diagnosis of peptic ulcer. Which most common complication should the nurse assess for in this client? Perforation Hemorrhage Pyloric obstruction Esophageal varices
Hemorrhage - because of erosion of blood vessel walls is the most common complication of peptic ulcer disease. The complication of gastric perforation usually occurs after, and is not as common as, hemorrhage. Pyloric obstruction is not a common complication of peptic ulcer disease. Esophageal varices occur with portal hypertension, not peptic ulcer disease.
A patient with hepatitis B surface antigen (HBsAg) present in the serum is being discharged with pain medication after knee surgery. Which medication order should the nurse question? Tramadol Hydromorphone (Dilaudid) Oxycodone with aspirin (Percodan) Hydrocodone with acetaminophen
Hydrocodone with acetaminophen acetaminophen is toxic to the liver
A client is diagnosed as having kidney failure. During the oliguric phase, what should the nurse assess for in this client? Hypothermia Hyperkalemia Hypocalcemia Hypernatremia
Hyperkalemia - kidneys retain potassium during oliguric phase - most common reason for dialysis
A patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. Which intervention should the nurse include in the patient's plan of care? A: Immediately start enteral feeding to prevent malnutrition. B: Insert an NG and maintain NPO status to allow pancreas to rest. C: Initiate early prophylactic antibiotic therapy to prevent infection. D: Administer acetaminophen (Tylenol) every 4 hours for pain relief.
Insert an NG and maintain NPO status to allow pancreas to rest. - decreases pancreatic enzyme stimulation
nurse is caring for a 55-yr-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect? A: Hematochezia B: Left upper abdominal pain C: Ascites and peripheral edema D: Temperature over 102 F (38.9 C)
Left upper abdominal pain - predominant manifestation of pancreatitis
The nurse is caring for a patient who complains of abdominal pain and hematemesis. Which new assessment finding(s) would indicate the patient is experiencing a decline in condition? Pallor and diaphoresis Ecchymotic peripheral IV site Guaiac-positive diarrhea stools Heart rate 90, respiratory rate 20, BP 110/60
Pallor and diaphoresis - clinical sign of active bleeding - immediately reassess and anticipate orders for blood work and possible blood administration
Which drug prescribed to a client with a urinary tract infection (UTI) turns urine reddish-orange in color? Amoxicillin Ciprofloxacin Nitrofurantoin Phenazopyridine
Phenazopyridine is a topical anesthetic that is used to treat pain or burning sensation associated with urination. It also imparts
A patient was admitted with epigastric pain because of a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? Back pain 3 or 4 hours after eating a meal Chest pain relieved with eating or drinking water Burning epigastric pain 90 minutes after breakfast Rigid abdomen and vomiting following indigestion
Rigid abdomen and vomiting following indigestion - The clinical manifestations of perforation are sudden and dramatic in onset. During the initial phase (0 to 2 hours after perforation), the patient has sudden, severe upper abdominal pain that quickly spreads throughout the abdomen. The pain radiates to the back and shoulders. Food or antacids do not relieve the pain. The abdomen appears rigid and boardlike as the abdominal muscles attempt to protect from further injury. The patient's respirations become shallow and rapid. The heart rate is elevated (tachycardia), and the pulse is weak. Bowel sounds are usually absent. Nausea and vomiting may occur
A nurse is caring for a client with acute pancreatitis. Which elevated laboratory test result is most indicative of acute pancreatitis? A: Blood glucose B: Serum lipase C: Serum bilirubin level D: White blood cell count
Serum lipase
A 70-yr-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? Weight gain of 6 lb Nausea and vomiting Urine specific gravity of 1.004 Serum sodium level of 118 mEq/L
Serum sodium level of 118 mEq/L Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death.
A 33-yr-old patient has recently been diagnosed with stage II cervical cancer. Which statement by the nurse best explains the diagnosis? "The cancer is found at the point of origin only." "Tumor cells have been identified in the cervical region." "The cancer has been identified in the cervix and the liver." "Your cancer was identified in the cervix and has limited local spread."
Stage 2 "Your cancer was identified in the cervix and has limited local spread."
Which patient is most at risk for a postrenal acute kidney injury? The patient admitted in hypovolemic shock The patient who has been taking excessive antibiotics The patient recently diagnosis with prostate cancer The patient admitted after accidental overdose of beta blockers
The patient recently diagnosis with prostate cancer - enlarged prostates block the outflow of urine and cause damage to the kindey - postrenal
The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? Ask the patient if the site hurts. Turn off the chemotherapy infusion. Call the ordering health care provider. Administer sterile saline to the reddened area.
Turn off the chemotherapy infusion.
Survivorship care plans should include information to provide future caregivers with important information about the treatment a patient with cancer has received. The most important entries in a well-written survivorship care plan include: (Select all that apply.) Type of tumor and dates of diagnosis. Screening tests that are appropriate for future use. Type of chemotherapy or radiation treatment used and length of dose. Typical side effects the patient experienced immediately after a dose of chemotherapy was given. Lifestyle recommendations for diet and exercise.
Type of tumor and dates of diagnosis. Screening tests that are appropriate for future use. Type of chemotherapy or radiation treatment used and length of dose. Lifestyle recommendations for diet and exercise.
A client with a history of pancreatitis is scheduled for surgery to excise a pseudocyst of the pancreas. The client asks, "What is a pseudocyst?" Which information should the nurse include in a response to this question? Malignant growth Pocket of undigested food particles Sac filled with pus from necrotic pancreatic tissue Walled-off space of pancreatic enzymes and exudate
Walled-off space of pancreatic enzymes and exudate
A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? "With type 2 diabetes, the body of the pancreas becomes inflamed." "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."
With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased.
A patient with a history of alcoholism is admitted to the ICU with hemorrhage from esophageal varices. Admission VS are BP 84/58 mm Hg, HR 105, and RR 32 breaths/min. The nurse recognizes the onset of systemic inflammatory response syndrome (SIRS) upon finding pulmonary edema. cardiac dysrhythmias. absent bowel sounds. decreasing blood pressure.
pulmonary edema. The respiratory system is often the first system to show signs of dysfunction in systemic inflammatory response syndrome. Increases in capillary permeability facilitate movement of fluid from the pulmonary vasculature into pulmonary interstitial spaces. The fluid then moves to the alveoli, causing alveolar edema and pulmonary edema.