Exam 5 Med Surg

An obese client with leg trauma

A nurse is caring for a group of clients on a medical-surgical unit. Which client has the highest risk for developing a pulmonary embolism?

St. John's wort

A primary healthcare provider prescribes venlafaxine for a client with the diagnosis of major depressive disorder who has been taking herbal medications. When discussing this medication with the client, the nurse will determine whether the client is taking which herbal supplement?

Pear/Gynoid body shape

excess fat on the buttocks and thighs, common in women, and non significant correlation w/ metabolic syndrome

Flaxseed

found to lower cholesterol especially with postmenopausal women and those patients with high initial cholesterol concentrations

Gingko biloba

inconclusive results to treat alzheimer's dementia, enhances circulation

Reminiscence

the process of randomly reflecting on memories of events in one's life

Omega-3

can improve cardiac health, rheumatoid arthritis, age-related macular degeneration

Apple/Andriod body shape

excess fat in abdomen, common in men, and significant correlation w/ metabolic syndrome

Probiotics

proven to reduce cdiff when with antibiotics

Life review

structured process of reflecting on ones life, which is often facilitated by an interviewer

anastomosis

surgical joining of two ducts, vessels, or bowel segments to allow flow from one to another

LSG procedure

the surgeon removes the portion of the stomach where ghrelin is secreted.

Palpitations

A client has circumgastric banding, a bariatric surgical procedure. The nurse provides discharge teaching about signs and symptoms of dumping syndrome and includes what physiologic response?

Hypoventilation syndrome

A client is being considered for bariatric surgery. Which client health problem does the nurse identify as consistent with morbid obesity?

It may be taken after consultation with the healthcare provider.

A client is informed that he has benign prostatic hyperplasia (BPH), and the healthcare provider prescribes finasteride. The client would like to take saw palmetto instead of the finasteride. What does the nurse inform the client about this herbal supplement?

Providing short-term relief to the family caregiver

A client with bone cancer is receiving hospice care at home. The hospice program also provides respite care. What is the purpose of respite care?

Encourage the family members to provide palliative care to the client.

A client with chronic renal failure stops responding to the treatment. On examination, the primary healthcare provider determines that the client is terminally ill. What is the best nursing intervention in this situation?

To ease the pain from illness

A client with colon cancer is receiving hospice care at home. What is the focus of hospice care?

The cause of the spouse's death was suicide

A nurse facilitating a support group of widows and widowers recalls that research indicates that the probability of a spouse having a pathological or morbid grief response will be greater in what case?

Resistance to change Inability to recognize familiar objects Inability to concentrate on new activities or interests Tendency to dwell on the past and ignore the present

A nurse is assessing an older adult with the diagnosis of dementia. Which manifestations are expected in this client? Select all that apply.

Offer a cup of prune juice

A nurse is caring for an elderly client who has constipation. Which independent nursing intervention helps to reestablish a normal bowel pattern?

Decreased bone density

A nurse teaches an elderly client safety tip to prevent falls. Which physiologic change may have occurred in the client?

Social worker

A terminally ill client has died in the hospital and it is time to inform the client's family members. The nurse is unsure how to console the family members. Which member of the interprofessional team is appropriate for the nurse to ask for support in informing and consoling the family?

Divide the daily caloric intake into six smaller meals

A client had a gastric bypass procedure to treat morbid obesity. After surgery the client reports weakness, sweating, palpitations, and dizziness after eating. What should the nurse encourage the client to do?

Orlistat

Gastrointestinal Lipase Inhibitor; stops absorption of fat

Change in mental status

The nurse assesses an elderly client with a diagnosis of dehydration and recognizes which finding as an early sign of dehydration?

Venous thromboembolism (VTE) prevention

The nurse is caring for an elderly client who has a right hip fracture. Which priority intervention should be included in the plan of care?

Safety

The nurse is caring for an elderly client with dementia. Which client need should the nurse prioritize while providing care?

Adiponectin

an anti-inflammatory and insulin sensitizing hormone

Overweight

BMI 25-29.9

Lorcaserin

Selective Serotonergic 5-HT2C Receptor Agonist; suppresses appetite, common symptom is tiredness

Delirium

characterized by the patient's inattentiveness, disorganized thinking, and altered level of consciousness (either hypoalert or hyperalert)

inflammatory cytokines

such as inflammatory interleukins and tumor necrosis factor-alpha

Palliative care

supportive medical and nursing care that keeps the patient comfortable but does not cure the disease; manages the symptoms

Ghrelin

the "hunger hormone" that is secreted in the stomach; increases in a fasting state and decreases after a meal

Bariatrics

the branch of medicine concerned with the prevention and control of obesity and associated diseases

Death

the cessation of integrated tissue and organ function, manifested by lack of heartbeat, absence of spontaneous respirations, or irreversible brain dysfunction

Pulmocare diet

lower carb, high calorie, high fat; helps with respiratory issues

LAGB (laparoscopic adjustable gastric banding)

the surgeon places an adjustable band to create a small proximal pouch through a laparoscope

anastomosic leaks

a leak of digestive juices and partially digested foods through an anastomosis

Garlic

may slow atherosclerosis, lower blood pressure, decrease platelet aggregation. May increase bleeding times, PT, INR, and affect blood glucose

Black cohosh

menopausal symptoms; research indicates this may not be helpful in menopausal hot flashes. May harm the liver

X-ray and pH test

most reliable way to determine if NG tube is properly placed

gout patient

must be on low purine diet

Apolipoprotein E (ApoE)

one of several regulators of lipoprotein metabolism

Hospice care

treatment of the terminally ill in their own homes, or in special hospital units or other facilities, with the goal of helping them to die comfortably, without pain

St. John's Wort

treats mild to moderate depression, interacts with several medications, not taken during hospital stays

Basal Metabolic Rate (BMR)

the rate at which heat is produced by an individual in a resting state

An overproduction of insulin that occurs in response to the rise in blood glucose

After a subtotal gastrectomy a client demonstrates signs of dumping syndrome. About 90 minutes after the initial attack, the client reports feeling shaky. What does the nurse determine is the cause of the latter effect?

High in protein and vitamin C

An obese adult develops an abscess after abdominal surgery. The wound is healing by secondary intention and requires repacking and redressing every 4 hours. Which diet should the nurse expect the healthcare provider to prescribe to best meet this client's immediate nutritional needs?

Report the suspicion of neglect by the adult child to adult protective services.

An older, confused client is being cared for at home by an adult child who works full-time. The client has lost weight and is wearing soiled and inappropriate clothing. The home care nurse suspects elder neglect. What should the nurse do?

Obesity

BMI of 30 or higher

Morbid obesity

BMI of 40 or greater

Liraglutide

GLP-1 Receptor Agonists, SQ injection; delays gastric emptying; can cause tachycardia

Adequacy of wife's support system

Shortly after the death of her husband after a long illness, a woman visits the mental health clinic complaining of malaise, lethargy, and insomnia. The nurse, knowing that it is most important to help the wife cope with her husband's death, should attempt to determine which information?

Hepatic diet

low ammonia, low protein.; the drug lactulose removes ammonia

Gluceron diet

low carbs, high protein; helps with diabetics and insulin resistance

Renal diet

low protein. low calcium, low phosphorus

Ginseng

lower blood glucose and boost immune system

Dumping syndrome

Rapid emptying of gastric contents into small intestines. Client experience ab pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia.

Denial

A client who recently was told by her primary healthcare provider that she has extensive terminal metastatic carcinoma of the breast tells the nurse that she believes an error has been made. She states that she does not have breast cancer, and she is not going to die. The nurse determines that the client is experiencing which stage of death and dying?

"Palliative care is the same as hospice care."

A student nurse is describing palliative care to a client's family. Which statement made by the student nurse indicates a need for correction by the registered nurse?

Encouraging the client to do weight-bearing exercises

The nurse is providing home care to an older adult client with decreased bone density. Which nursing intervention will be most beneficial for the client?

Client A: Serum Sodium 167

The nurse is reviewing the laboratory reports of a group of elderly clients. Which client has an age-related impairment in thirst mechanism?

When the expected death of the client is within 6 months When the client seeks no aggressive disease management When the client has been issued a "do not resuscitate" order

The nurse reviews the medical record of a client who is eligible to receive end-of-life care. What are the criteria for a client to receive this type of care? Select all that apply.

Helping the client to find meaning and purpose in life by listening to his or her concerns Encouraging the client to pray if he or she wishes by facilitating privacy and a proper environment Allowing time for religious readings, spiritual visitations, or attendance at religious services

Which nursing interventions can help a terminally ill client cope with feelings related to death? Select all that apply.

Presence of unexplained bruises on the wrist(s) Presence of burns from cigarettes Presence of bed sores.

While assessing an older adult during a regular health checkup, a nurse finds signs of elder abuse. Which physical findings would further confirm the nurse's suspicion? Select all that apply.

Dementia

a broad term used for a syndrome that involves a slowly progressive cognitive decline, sometimes referred to as chronic confusion

Advance directive

a document stating a person's wishes about health care when that person cannot make his or her own decisions

Resistin

a hormone produced by fat cells that creates resistance to insulin activity

Leptin

a hormone released by fat cells and possibly by gastric cells; it also acts on the hypothalamus to control appetite

Cholecystokinin

a hormone that stimulates digestive juices and may work with leptin to increase or decrease appetite

Glucosamine

a substance produced naturally in the body; often used as a supplement to maintain cartilage in the joints

Roux-en-Y gastric bypass (RGB)

bariatric surgery that involves stapling the stomach to decrease its size and then shortening the jejunum and connecting it to the small stomach pouch, causing the base of the duodenum leading from the nonfunctioning portion of the stomach to form a Y configuration, which decreases the pathway of food through the intestine, thus reducing absorption of calories and fats

Depression

broadly defined as a mood disorder that can have cognitive, affective, and physical manifestations

Decreased vasoconstrictive response Decreased circulation of blood Decreased number of sweat glands

Which anatomic changes result in thermodysregulation in elderly people? Select all that apply.

Dementia

Which condition is contraindicated for St. John's wort herbal therapy?

Include yogurt in your diet

Which dietary suggestion should the nurse provide while teaching a group of geriatric female clients who have reduced amounts of circulating estrogen?

Black cohosh root

Which herbal medication would the nurse suggest to a client to reduce premenstrual discomfort?

The new graduate provides food according to the clients' preferences.

The registered nurse observes a new graduate nurse caring for clients on a geriatric unit and concludes that the new graduate is providing patient-centered care. Which action by the new graduate led to the registered nurse's conclusion?

Receive cyanocobalamin injections routinely. Consume a diet high in protein. Eat foods rich in calcium.

To help prevent long-term complications associated with gastric bypass surgery, the nurse needs to educate the client. Identify the factors that should be included in the nurse's teaching plan for this client. Select all that apply.

Creating a calm and safe environment

What is the priority nursing care for a client with delirium?

Integrity

When having a conversation with a nurse, an older client states, "I've lived a good life. I don't want to die, but I accept it as a part of life." What developmental stage, according to Erikson, has the client completed?

Ask the client what herbs have been taken

When obtaining an admission history of a preoperative client, the nurse learns that the client is taking several herbal supplements. Which is the priority nursing action?