Herzing-Madison WI Alterations Final Exam
A nurse is caring for a patient who has a pressure ulcer that is treated with debridement, irrigations, and moist dressings. How should the nurse anticipate healing to occur?
Secondary intention
The nurse recognizes that the goals of medication therapy for allergic rhinitis include (select all that apply) reduce nasal symptoms reduce inflammation treat infection
reduce nasal symptoms reduce inflammation
The nurse recognizes that ascites and anasarca develop in patients with nephrotic syndrome due to?
severe decreased serum albumin
Which of the following manifestations of cognitive impairment are characteristic of DELIRIUM versus DEMENTIA: Difficulty with word finding
Dementia
Which of the following manifestations of cognitive impairment are characteristic of DELIRIUM versus DEMENTIA: Insidious onset with prolonged course and duration
Dementia
Which of the following manifestations of cognitive impairment are characteristic of DELIRIUM versus DEMENTIA: Normal level of alertness
Dementia
The main contributor to systemic vascular resistance is?
Diameter of the blood vessels
Extra or Intra Cellular Fluid? Concentration of sodium is greatest
Extracellular Fluid
RA or OA? Lab results show normal ESR and normal C reactive protein
OA
RA or OA? Onset of disease typically occurs after age 40
OA
A patient with new onset left-sided hemiparesis arrives by ambulance to the emergency department. What of the following is the BEST first step to take to determine the patient's status?
Obtain a non-contrast CT scan.
What are three key aspects that we are trying to balance in treating pain? (select those that apply) Patient safety. Patient function. Patient and significant other satisfaction. Patient comfort.
Patient comfort. Patient function. Patient safety.
When a smiling and cooperative patient complains of severe discomfort, nurses caring for this patient often harbor misconceptions about the patient's pain. Which of the following is true? Patients are the best judge of their pain. Regular use of opioid analgesics leads to addiction. Chronic pain is psychological in nature. The amount of pain is reflective of actual tissue damage.
Patients are the best judge of their pain.
Hearing loss due to age-related degenerative changes in the inner ear
Presbycusis
IV potassium chloride (KCL) 40 mEq is prescribed for treatment of a patient with severe hypokalemia. Which action should the nurse take?
Infuse the KCL at a rate of 10 mEq/hour.
Extra or Intra Cellular Fluid? Concentration of potassium is greatest
Intracellular Fluid
Extra or Intra Cellular Fluid? Volume decreases with the administration of hypertonic IV fluids
Intracellular Fluid
Opportunistic infection that requires a warm, moist environment and produces a red, painful erythmatic rash
Cadidiasis
Lifelong viral infection transmitted via body fluids that causes painful vessicles and is often characterized by subclinical infections
Herpes Simplex
The primary clinical manifestation of hypertension is?
none, it is frequently asymptomatic.
What information will the nurse include when teaching a patient with newly diagnosed gastroesophageal reflux disease (GERD)?
"It will be helpful to keep the head of your bed elevated or sleep on many pillows.
Which of the following are characteristics of atypical or dysplastic nevi? SELECT ALL THAT APPLY: Raised, smooth bump Diameter is less than 5mm Irregular borders Variegated color
Irregular borders Variegated color
Your 48-yr-old male patient shares with you that he has a strong family history of Type II diabetes, and he wonders if he is at risk. Choose the following assessment findings that are characteristic of "prediabetes." SELECT ALL THAT APPLY: A blood glucose level between 100 and 125 mg/dL after 8 hours of fasting A1C between 5.7 - 6.4% Sedentary lifestyle and obesity Hypertension
A blood glucose level between 100 and 125 mg/dL after 8 hours of fasting A1C between 5.7 - 6.4% Sedentary lifestyle and obesity Hypertension
A 60 year old patient is being prepared for outpatient cataract surgery. When obtaining admission data from the patient, the nurse would expect that the patient has a history of?
A gradual loss of vision wtih abnormal color perception and glare
Fluids with the same osmolarity as the cell interior
Isotonic
An 81-year old female nursing home resident has just been discharged from the hospital after a fall, where she had an indwelling foley catheter placed during her stay. The nursing home charge nurse knows that 31% of all nosocomial infections are hospital-acquired UTIs. Which of the following symptoms would this patient be most likely to develop with a urinary tract infection? Abdominal discomfort and confusion C/o urethral burning and urinary frequency High Fever urinary retention
Abdominal discomfort and confusion
What is the primary intervention for hypertensive crisis?
Antihypertensive drugs administered intravenously (IV).
Which of the following is TRUE of head and neck cancers: Associated with significant deformity and debility Develop from squamous cells in the epidermis Tend to be less invasive than other cancers Arise from basal cells in the epidermis
Associated with significant deformity and debility
Which of the following scenarios describes the concept of physical dependence? Jane uses her husbands Percocet after she sprains her ankle. Bob ran out of his oxycodone and comes to the clinic complaining of anxiety, insomnia, nausea, pain, and sweating. John's physician increases his dose of morphine extended release for his chronic back pain. A patient in the Emergency Department asks for more pain medication because his broken leg still hurts.
Bob ran out of his oxycodone and comes to the clinic complaining of anxiety, insomnia, nausea, pain, and sweating.
The nurse is caring for a patient who had a stroke 3 days ago and is experiencing non-fluent aphasia. The patient is alert and can follow verbal commands appropriately, but is only able to utter a few words at a time, slowly and with great effort. Which area of the brain is mostly likely affected?
Broca's area of the frontal lobe
What are the three mechanisms responsible for regulating acid-base balance?
Buffers Renal system Respiratory system
A patient comes to your clinic with complaints of fatigue, weight loss and joint pain. She is concerned that she has contracted lyme disease after a weekend camping trip. You suspect she has systemic lupus erythematosus based on what finding?
Butterfly shaped rash extending over her nose and cheeks
Three broad ways that the renal system contributes to blood pressure regulation
By controlling sodium excretion and extracellular volume. The renal medulla secretes prostagladins. The juxtaglomerular apparatus in the kidneys secretes renin.
Nonproliferative retinopathy is defined by the following characteristics?
Capillary microaneurysms, retinal swelling and blurry vision
Blood pressure is a function of what two things?
Cardiac output and systemic vascular resistance
Inflammation of the subcutaneous tissue associated with a bacterial infection that causes redness, swelling, warmness and tenderness to the affected area
Cellulitis
A young male patient who is paraplegic has a stage II sacral pressure ulcer and is being cared for at home by his mother. To prevent further tissue damage, what instructions are most important for the nurse to teach the mother?
Change the patient's position at least every 2 hours.
The nurse is evaluating the effectiveness of albumin infusions for a patient that has low serum protein level. What assessment finding indicates that the patient's condition has improved?
Decreased peripheral edema and ascites.
The nurse assesses a patient who has been hospitalized for 2 days. The patient has been receiving normal saline at 100 mL/hour, has a nasogastric tube to suction, and is NPO. What assessment finding would be a priority for the nurse to report to the physician provider?
Decreasing level of consciousness (LOC) with confusion.
The nurse is assessing thier patient for risk of pressure ulcer development using the Braden Scale, the nurse understands that which of the following categories are assessed in this tool? (select all that apply). Friction and Shear Sensory Perception Signs of infection Moisture WBC level Mobility
Friction and Shear Sensory Perception Moisture Mobility
Interpret the following arterial blood gas results: pH = 7.35 PaCO2 = 50 PaO2 = 92 SaO2 = 94% HCO3 = 30
Fully compensated respiratory acidosis
Characterized by a deep infection around the hair follicle that is tender with purulent drainage
Furuncle
Which of the following statements is NOT true of osteoarthritis? Red, swollen, tender joints especially of the hands, hips and knees Joint malalignment often without significant loss of function Joint changes caused by activation of complement and deposition of immune complexes in joint surfaces Late disease characterized by crepitous joints and pain with activity
Joint changes caused by activation of complement and deposition of immune complexes in joint surfaces
A patient screened for diabetes at a clinic has a hemoglobin A1C fo 6.2%. The nurse will plan to teach the patient about
Lifestyle changes, like exercise and an improved diet, to lower blood glucose
The dominant extracellular cation is _____ while the dominant intracellular cation is ______ .
Sodium, Potassium
What stage is a pressure ulcer with the following characteristics? • Full tissue thickness loss • Visible subcutaneous fat • Slough and wound bed visible • No invasion of bone or muscle
Stage III
Your patient was admitted to a long-term rehab hospital from a skilled nursing facility with a Stage IV pressure ulcer on her coccyx. After several weeks, the pressure ucler is healing, and the wound bed now has granulation tissue and no subcutaneous tissue is visible. You need to document the current stage of this pressure ulcer. What do you document in the electronic health record?
Stage IV
What are the main ways of preventing and decreasing the risk of developing osteoporosis?
Supplements with calcium and vitamin D, and weight-bearing exercise.
After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that teaching has been effective? The patient restricts intake of chicken and fish. The patient has a glass of low-fat milk with each meal. The patient continues to drink three regular sugared-sodas a day. The patient avoids eating nuts and seeds.
The patient has a glass of low-fat milk with each meal.
A patient 1 day postoperative after adominal surgery has incisional pain, 99.5 degrees F temperature, slight erythema at the incision margins, and 30 mL serosanguineous drainage from the Jackson-Pratt drain. Based on this assessment, what conclusion would the nurse make?
The patient is having a normal inflammatory response.
A patient with a history of several transient ischemic attacks (TIA's) in the recent past arrives in the emergency department with left-sided hemiparesis and dysarthria that started 2 hours previously. The nurse should anticipate the need to prepare the patient for:
Tissue plasminogen activator (tPA) infusion
T or F 3% saline is a hypertonic fluid that is used to treat patients with traumatic brain injuries because it creates an osmotic gradient that pulls fluid from cerebral space into the blood vessels in order to decrease cerebral edema.
True
T or F If treated early, lyme disease is typically treated successfully with oral antibiotics.
True
T or F Influenza is a respiratory infection that is spread by droplets and is associated with significant complications like ARDS and death.
True
T or F Pink eye is an infection of the conjunctiva that is highly contagious but typically self-limiting.
True
T or F Strabismus is an inability to focus both eyes simultaneously on the same oject that lead to difficulty with depth perception.
True
T or F Infants and older adults are at greater risk for alterations in fluid balance than other age groups.
True
One of the most devastating and serious complications associated with diabetes and caused by angiopahty AND neuropathy is
Wounds and impaired wound healing
Which of the following assessment findings lead you to suspect that your patient has developed a hordeolum? Your patient's right eye is very red and painful and acutely sensitivity to light Your patient has a swollen, reddened, circumscribed and acutely tender area on their upper lid margin Your patient complains of excessive tearing of their right eye with a sensation of "sand" in their eye that they cannot get out Your patient has a hard, swollen and reddened area on their upper lid that is sometimes painful
Your patient has a swollen, reddened, circumscribed and acutely tender area on their upper lid margin
You are working with a patient who was newly diagnosed with Meniere's Disease. You are providing education for your patient include all of the following information EXCEPT: Your physician may recommend placing temporary tympanic tubes to relieve the pressure in your inner ear Your symptoms are caused by accumulation of endolymph and rupture of the membranous labyrinth If your condition become severe or debilitating, your physician may discuss a vestibular nerve resection to manage symptoms You can expect that your symptoms will come and go without any predictable pattern
Your physician may recommend placing temporary tympanic tubes to relieve the pressure in your inner ear
Baroreceptors are located in the a)_______________ and b)______________, and detect c)____________________.
a) aortic arch b) carotid arteries c) changes in stretch of the vessel wall
A patient with newly diagnosed Type 2 Diabetes Mellitus asks the nurse what "Type 2" means in relation to diabetes. Which statement by the nurse about Type 2 Diabetes is correct? a. "A person with Type 2 Diabetes may have decreased insulin secretion, but they also have insulin resistance." b. "Type 2 Diabetes is usually diagnosed when patients are children or young adults, and is sometimes associated with the onset of a virus." c. "Type 2 Diabetes is an autoimmune disorder characterized by Beta cell destruction in the pancreas so that insulin is no longer produced." d. "Type 2 Diabetes complications are less serious than those of Type 1 Diabetes."
a. "A person with Type 2 Diabetes may have decreased insulin secretion, but they also have insulin resistance."
A 22-year-old male with newly diagnosed Type 1 Diabetes has received patient teaching regarding insulin, blood glucose monitoring, and dietary instruction. The nurse determines a need for additional teaching when the patient says: a. "If I am sick and not eating, I do not need to take my insulin." b. "I am always going to need to take insulin because my body can no longer make it." c. "If I have a sick day with nausea and vomiting, my blood glucose may increase a bit " d. "One of the best things I can do to prevent hypoglycemia is to eat meals regularly."
a. "If I am sick and not eating, I do not need to take my insulin."
Upon examination a patient's findings include tenderness over the frontal and maxillary sinuses, hyperemic and edematous nasal mucosa, discolored purulent nasal drainage, and enlarged turbinates. The nurse suspects?
acute sinusitis
325mg aspirin is ordered for a woman admitted to the ER with a headache. Which of the following assessment findings should cause the nurse to question the provider about this order? a. When the nurse assesses the patient, she notes a pronounced right-sided carotid bruit b. The patient has a stiff neck and complains to the nurse, "I have never had a headache like this in my whole life. It hit me out of nowhere." c. The patient has a long-standing history of atrial fibrillation d. The patient shares with the nurse that she has a recent history of short ep
b. The patient has a stiff neck and complains to the nurse, "I have never had a headache like this in my whole life. It hit me out of nowhere."
An important nursing responsibility related to pain is to
believe what the patient says about the pain.
A patient was admitted to the emergency department complaining of severe headache and diagnosed with a hemorrhagic stroke. Which of the following is MOST likely to have contributed to this patient's risk for a hemorrhagic stroke? a. The patient has a history or atrial fibrilation b. The patient has Type II diabetes c. The patient has taken 5 mg of coumadin daily for the last six years d. The patient had a transurethral resection of the prostate (TURP) 2 weeks ago
c. The patient has taken 5 mg of coumadin daily for the last six years
Unrelieved pain is
dangerous and can lead to many physical and psychological complications.
The nurse recognizes the following uses of a tracheostomy (select all that apply) to facilitate removal of secretions to treat obstructive sleep apnea to permit long-term mechanical ventilation to bypass an upper airway obstruction
to permit long-term mechanical ventilation to bypass an upper airway obstruction to facilitate removal of secretions
One of the main mechanisms by which the kidneys assist in regulating the acid-base balance is
to reabsorb and conserve bicarbonate or excrete bicarbonate.
T or F Basal cell carcinoma tends to metastasize more often than squamous cell carcinoma because the cell type easily invades the basement membrane of the epidermis
False
A patient is admitted with diabetic ketoacidosis (DKA) with a blood glucose level of 480 mg/dL and a potassium of 6.2 mEq/L. Which action prescribed by the health care provider should the nurse take FIRST?
Place the patient on a cardiac monitor
A patient in the unit has a 103.7 degree F temperature. What intervention would be the most effective in restoring normal body temperature?
Administer antipyretics on an around-the-clock schedule.
What nursing action is of highest priority for a 68-year-old patient with renal calculi who is being admitted to the hospital with gross hematuria and severe colicky left flank pain?
Administer prescribed analgesics.
The most significant complication associated with a deviated septum is?
Airway Obstruction
The mainstay for treating sinusitis that persists longer than seven days is?
Amoxicillin
Damage to large and small blood vessels that is thought to be caused by accumulation of by-products of glucose metabolism that accumulates in basement membranes
Angiopathy
What are the ABCDE's of assessing skin lesions?
Asymmetry Border Color Diameter Evolving
Which of the following describes healing by primary intention? All answers are correct Characterized by irregular wound margins and extensive tissue loss Characterized by approximation of two layers of granulation tissue after resolution of wound contamination Characterized by a granulation phase where scar tissue forms
Characterized by a granulation phase where scar tissue forms
Which of the following statments is TRUE regarding osteomyelitis? Only those patients with an open wound that exposes the bone are at risk for developing osteomyelitis Patients will always exhibit systemic clinical manifestations of fever and have positive blood cultures Easily treated with oral antibiotics Characterized by sequestra that form as a result of devascularization and necrosis of bone
Characterized by sequestra that form as a result of devascularization and necrosis of bone
An adult male patient with Type 2 Diabetes has been waking at 7:00 AM with a blood glucose of 255 mg/dL. The provider wonders if this could be the Somogyi effect. What action should the nurse anticipate taking FIRST?
Check the patient's blood glucose at 3:00 AM
Nasal polyps are associated with what?
Chronic or repeated inflammation
Which of the following signs help assess for tetany and hyperreflexia? Chvostek's sign and Trousseau's sign Ballance's sign and Bancroft's sign Battle's sign and Cullen's sign Smith's sign and Johnson's sign
Chvostek's sign and Trousseau's sign
A thrombus that develops in a cerebral artery does not always cause a loss of neurological function because
Collateral circulation (i.e. through the Circle of Willis) provides adequate perfusion to the affected area of the brain
Fluids that contain solutes that are unable to cross the cell membrane and create oncotic pull
Colloids
Conditions of the outer or middle ear that impair sound conduction to the inner ear
Conductive Hearing Loss
A patient with long-standing Type 1 Diabetes calls the clinic with complaints of illness. The patient is experiencing nausea, vomiting, and diarrhea. It is MOST IMPORTANT that the nurse advise the patient to
Continue to check blood sugars and take exogenous insulin
Which of the following manifestations of cognitive impairment are characteristic of DELIRIUM versus DEMENTIA: Distorted thinking and perceptions
Delirium
Which of the following manifestations of cognitive impairment are characteristic of DELIRIUM versus DEMENTIA: Fluctuating course with periods of lucidity
Delirium
Which of the following manifestations of cognitive impairment are characteristic of DELIRIUM versus DEMENTIA: Sleep-wake cycles reversed
Delirium
Cardiac monitoring is initiated for a patient with Diabetic Ketoacidosis (DKA). The nurse recognizes that this measure is important to identify for the following reason
ECG changes and arrhythmias related to hypokalemia
What is the underlying cause of vision loss with glaucoma?
Elevated intraocular pressure leading to atrophy of the optic nerve
You are admitting a patient with an upper gastrointestinal (GI) bleed and presenting with "coffee ground" emesis. You anticipate preparing your patient for which procedure that could be both diagnostic and therapeutic?
Endoscopy
A 72-year-old patient who has a history of a transient ischemic attack (TIA) has an order for aspirin 160 mg daily. When the nurse is administering medications, the patient says, "I don't need the aspirin today. I don't have a fever." Which action should the nurse take?
Explain that the aspirin is ordered to decrease stroke risk.
Extra or Intra Cellular Fluid? Includes the fluids inside the blood vessels and lymph
Extracellular Fluid
T or F Ankylosing spondylitis is a non-inflammatory disorder that affects the small, non-weight bearing joints, typically of the hands and feet.
False
T or F Complications of chronic external otitis include permanent hearing loss due to inflammation and destruction of the ossicles.
False
T or F Osteoarthritis is a progressive autoimmune disease that results in destruction of cartilage in weight-bearing synovial joints
False
T or F The defining difference between primary open angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) is that POAG is characterized by sudden pain and changes in vision where PACG develops slowly and the change in visual field is largly unnoticed until a large portion of a person's peripheral vision is gone.
False
T or F A lipoma is a malignant tumor that has a high risk for metastasis so it they are often removed using Mohs surgery.
False
T or F An open comedone with a necrotic core is more severe than a closed comedone that has developed into a pustule.
False
Which of the following statement is TRUE regarding forces that regulate movement of fluids within our bodies? Facilitated diffusion describes the passive movement of molecules from an area of low concentration to an area of high concentration Fluid moves into the venous end of capillaries because the combined forces of interstitial hydrostatic pressure and intravascular oncotic pressure exceed the combined forces of intravascular hydrostatic pressure and interstitial oncotic pressure The transport of glucose into the cell via a carrier molecule is an example of movement via oncotic pressure Oncotic pressure describes the passive movement of water across a semipermiable membrane from an area of high solute concentration to an area of low solute concentration
Fluid moves into the venous end of capillaries because the combined forces of interstitial hydrostatic pressure and intravascular oncotic pressure exceed the combined forces of intravascular hydrostatic pressure and interstitial oncotic pressure
The nurse recognizes that clear, pink-tinged, or persistent drainage with a nasal fracture after bleeding has been controlled could suggest a CSF leak. The nurse sends a sample of the fluid to the lab to be tested for?
Glucose
Which condition is described as a type of recurring acute arthritis characterized by the accumulation of uric acid crystals in articular, periarticular, and subcutaneous tissues?
Gout
Characterized by vesicles and pustules that follow a dermatome with buring pain and risk for chronic neuralgias
Herpes Zoster
Which of the following statements is FALSE regarding use of IV fluids? D5W is a hypotonic solution that is physiologically isotonic and provides free water Lactated Ringers is a hypotonic fluid that is used for fluid resuscitation 1/2 Normal Saline provides free water, sodium, and chloride, and replaces natural fluid losses 3% saline is a hypertonic fluid that is used in severe hyponatremia
Lactated Ringers is a hypotonic fluid that is used for fluid resuscitation
Late signs and symptoms of untreated lyme disease include all of the following EXCEPT: Poor muscle coordination Arthrtis pain and swollen joints Low grade fever, chills, stiff neck, fatigue Bell's palsy
Low grade fever, chills, stiff neck, fatigue
Which of the following is indicative of a water deficit? Low sodium Low hemocrit Low plasma osmolality Low urine osmolarity
Low plasma osmolality
A type of angiopathy that commonly affects the large and medium blood vessels of the cerebrovascular, cardiovascular and peripheral vascular systems
Macrovascular
Dry macular degeneration is characterized by:
Macular cell atrophy, abnormal accumulation of drusen and progressive, painless loss of vision
A patient who has diabetes is admitted for an exploratory laparotomy for abdominal pain. When planning interventions to promote wound healing, what is the nurse's highest priority?
Maintaining the patient's blood glucose within a normal range.
Which of the following symptoms leads the nurse to suspect that a patient suffers from otitis media and NOT external otitis? Muffled hearing Malaise and anorexia Discomfort or pain with chewing Ear pain
Malaise and anorexia
A patient who has been treated for acute diabetic ketoacidosis is admitted to the nursing unit. After rehydration with IV normal saline and administration of insulin, the patient's blood glucose has decreased from 480 to 220 mg/dL. Based on his understanding of diabetic ketoacidosis, the admitting nurse knows that it will be most critical to monitor which of the following electrolytes?
Potassium levels
The most important health promotion nursing intervention related to glaucoma is?
Promoting regular eye exams that include measurements of intraocular pressure for early detection of glaucoma
The kidney plays a key role in regulation of fluids and electrolytes. In which segment of the nephron does approximately reabsorption of 80% of water and electrolytes occur?
Proximal Tubule
The kidney plays a critical role in long term regulation of acid-base balance. In which segments of the nephron is bicarb reabsorbed from the filtrate back into the blood?
Proximal tubule and distal tubule
What are the two main physiologic goals in the treatment of osteoporosis?
Reduce bone resorption and increase bone formation.
Which of the following statements is FALSE regarding malignant melanoma? Survival is NOT correlated to depth of tumor invasion Metastasizes by invading the lymph and/or blood vessels Commonly metastasizes to the liver and lungs Has a poor prognosis unless treated early
Survival is NOT correlated to depth of tumor invasion
A patient with uncontrolled diabetes had a four-vessel coronary artery bypass surgery that was complicated by a sternal wound infection with dehiscence. This wound will now undergo which type of repair (healing process)?
Tertiary intention
Which of the follow is NOT a general principle of wound healing? The color of the wound does not influence how the wound is treated Protect wounds from trauma to prevent additional damage and delayed wound healing Dirt and debris should be removed from the wound bed to support healing Wound infections should be treated before wounds are closed
The color of the wound does not influence how the wound is treated
Which of the following statements describes the changes in the eye associated with hyperopia? Age-related change that reduces the ability to accommodate for near objects A concave lens can be used to restore visual acuity The eyeball is too short so light rays focus behind the retina Is caused from an abnormally long eye or excessvie refraction of light rays
The eyeball is too short so light rays focus behind the retina
A 16-year-old male with type I diabetes has a blood sugar of 275 mg/dL at 7:30 AM and is found to have dawn phenomenon. The nurse will anticipate the following action
The insulin dose at bedtime will be increased
The main system responsible for long term regulation of blood pressure is?
The renal system
T or F Systemic effects of rheumatoid arthritis can include deposition of rheumatoid nodules under the skin or in organs causing symptoms such as cataracts and vision loss, skin ulceration, and vocal cord dysfunction.
True
T or F The nurse knows that the treatment approach to glomerulonephritis is aimed at decreasing the inflammation at the level of the glomerulus, which may include the use of corticosteroids and/or immunosuppresives.
True
T or F Cardiac output is described as the stroke volume (amount of blood pumped out of the left ventricle per beat) multiplied by the heart rate for 1 minute.
True
T or F Squamous cell carcinoma is a malignant tumor affecting the epidermal layer of skin that is highly curable with early detection and treatment, but can metastasize if left untreated because it can invade the basement membrane of the epidermis.
True
T or F The body normally maintains a steady balance between the acids produced during normal metabolism and the bases that neutralize and promote excretion of the acids.
True
A patient was just admitted to your unit with suspected UTI. During your assessment, your patient states, "I don't seem to pee as strong as I used to and it sort of sprays when I go." Based on this statement you also suspect your patient may have?
Urethral stricture
A patient who is nauseated and vomiting up blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about?
Use of nonsteroidal anti-inflammatory drugs (NSAIDS)
The upper airway functions to protect the lower airway by?
Warming, filtering, and humidifying
The patient demonstrates understanding of her diagnosis of astigmatism when she states: [SELECT ONLY ONE ANSWER] a. My vision is blurry because my cornea has irregular curvature so light rays do not come to a single point of focus on my retina b. I will need to wear corrective lenses because the muscles in my eye are no longer able to bend the lens of my eye so I can see objects close to me c. The muscles in my eye are different lenghts so I do not have stereoscopic vision therefore I have poor depth perception d. Since the light rays entering my eye focus behind the retina, I will need to wear corrective lenses so that I can see things far away
a. My vision is blurry because my cornea has irregular curvature so light rays do not come to a single point of focus on my retina
The nurse receives the lab report on their patient with a peptic ulcer and it is positive for helicobacter pylori. The nurse calls the physician and anticipates an order for?
antibiotics, particularly clarithromycin (Biaxin).
The emergency department nurse recognizes that one component of treatment for MINOR epistaxis is?
apply direct pressure by pinching the entire soft lower portion of the nose against the nasal septum for 10 to 15 minutes
A female patient who has had a stroke 24 hours ago has expressive or non-fluent aphasia. The nurse identifies the nursing diagnosis of impaired verbal communication. An appropriate nursing intervention to help the patient communicate is to
ask questions that the patient can answer "yes" or "no".
The nurse knows that the patient does NOT need further education regarding the new diagnosis of basal cell carcinoma when the patient states: a. "Basal cell carcinoma is like an iceburg, what I can see on my skin is small compared to what is actually there." b. "I will need to check my skin for other lesions similar to this one that have irregular color, surface and borders because basal cell carcinoma has a poor prognosis." c. "Basal cell carcinoma is a malignant tumor that can easily spread to other areas of my body if left untreated." d. "Basal cell carcinoma may invade other tissues, but it is slow growing and metastasis is not common."
d. "Basal cell carcinoma may invade other tissues, but it is slow growing and metastasis is not common."
A new RN reports back to the ER charge nurse that she believes her patient is sufffering from hypoglycemia. The charge nurse knows that all of the following are symptoms of hypoglycemia EXCEPT: a. Irritability and anxiety b. Diaphoresis c. Tremulousness (Shaking) d. Excessive urination
d. Excessive urination
Which of the following is NOT true of dementia? a. Gradual or abrupt onset of symptoms b. A syndrome characterized by alterations in memory and often accompanied by changes in personality c. Some forms of dementia are reversible d. Normal, age-related change in mental function
d. Normal, age-related change in mental function
The nurse is assessing a patient with gastroesophageal reflux disease (GERD) who is experiencing increasing discomfort. Which patient statement indicates that ADDITIONAL patient education about GERD is needed? "I should quite smoking and try chewing gum instead." "I will need to sleep with my head elevated on a few pillows." "I should try taking antacids between meals and at bedtime each night." "I need to change the kind of food I am eating, but I don't have to worry about how much I eat in one sitting or whether I eat right before I go to bed."
"I need to change the kind of food I am eating, but I don't have to worry about how much I eat in one sitting or whether I eat right before I go to bed."
The nurse is educating a patient about the risk factors for head and neck cancers. Which statement by the patient indicates that the teaching was effective? "I should watch the amount of salt I use on my food" "I should quit smoking because eighty-five percent of head and neck cancers are caused by tobacco use" "I should reduce the amount of fat and cholesterol in my diet" "I should exercise more
"I should quit smoking because eighty-five percent of head and neck cancers are caused by tobacco use"
You are providing teaching to a patient who was newly diagnosed with psoriasis. Which of the following statments indicates that the patient needs ADDITIONAL education about his condition? "Psoriasis is an autoimmune disease that causes my skin cells to reproduce faster than normal." "I might have times when my psoriasis is under control, and other times where it flares up." "The first treatment my doctor will try is aimed at reducing inflammation and slowing cell growth." "Once this cream clears up my rash, I won't have to worry about it happening again."
"Once this cream clears up my rash, I won't have to worry about it happening again."
The nurse teaches a student nurse about the action of ibuprofen. Which statement, if made by the student, indicates that teaching was effective? "The drug decreases sensitivity of the brain to painful stimuli." "The drug decreases the modulating effect of descending nerves." "The drug decreases pain impulses in the spinal cord." "The drug decreases production of pain-sensitizing chemicals."
"The drug decreases production of pain-sensitizing chemicals."
Which acid-base balance? Patient in the PACU who is recovering from general anesthesia
Respiratory acidosis
You are providing education to a patient who received a new diagnosis of glomerulonephritis. You know the patient needs ADDITIONAL teaching based on which of the following statements: Antibiotics will clear up my problems and I won't have to have my kidney function monitored in the future I will need to follow up with my doctor regularly to monitor my kidney function My kidneys don't filter as well now so I will expect to see increases in my BUN and creatinine I may have to take corticosteroids because this is an autoimmune disease
Antibiotics will clear up my problems and I won't have to have my kidney function monitored in the future
What are the general nursing care interventions related to wounds/pressure ulcers presented in lecture? (select all that apply). Appropriate padding. Activity/ambulation Food and fluids. Turning/repositioning. Prepare the patient for daily leech therapy for optimal healing.
Appropriate padding. Activity/ambulation Food and fluids. Turning/repositioning.
You know your patient understands how the aging process affects their kidney by which of the following statements? As I get older changes in my kidney function are only indicative of diseases and that is why my doctor will monitor my kidney function The number of nephrons in my kidney doesn't change even though my kidneys will get bigger, and that is why kidney function might get worse as I get older As I get older the vessels in my kidney that filter my blood (glomeruli) get weak and leaky and that is why I expect to see a decrease in kidney function as I get older As I get older the blood flow to my kidney decreases and my kidneys cannot filter as well as they did when I was younger
As I get older the blood flow to my kidney decreases and my kidneys cannot filter as well as they did when I was younger
A type of neuropathy believed to contribute to hypoglycemic unawareness
Autonomic Neuropathy
Which of the following statements about Rheumatoid Arthritis are CORRECT? Joint stiffness or pain following activity Chronic, systemic autoimmune disease Characterized by deformity and soft tissue swelling Primarily affects weight-bearing joints A and C B and C All of the above
B and C
The following characteristics and products describe are associated with which kind of wound? - Hydrogel covered with gauze - Topical debridement - Absorptive dressing for excess exudate - Clean and protect
Black
Which acid-base balance? Intubated patient with ventilator set at 16 breaths per minute
Respiratory alkalosis
T or F In relation to ABGs, the term "compensation" means that the body is correcting the condition causing the acid-base disorder.
False
T or F Somatic pain is a subtype of neuropathic pain often characterized as numbness and tingling, burning, or shooting.
False
T or F Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by immune complexes that form in response to production of autoantibodies against the myelin sheath surrounding nerve fibers.
False
You are caring for a patient in the hospital with a newly diagnosed UTI. You suspect the infection has ascended and the patient now has pyelonephritis based on new onset of: Frequency and urgency Buring with urination UW positive for WBCs Fever and flank pain
Fever and flank pain
The exact cause of primary hypertension is not known, however there are several contributing factors (select all that apply) decreased sodium intake. Greater than ideal body weight. No known relatives with hypertension. Excessive alcohol intake. Diabetes Mellitus
Greater than ideal body weight. Excessive alcohol intake. Diabetes Mellitus
A 68-yr old male patient with Type 2 Diabetes takes metformin. He is scheduled for an outpatient MRI with IV contrast in two weeks. What should the nurse clinic teach the patient before he leaves his appointment to go home?
He should not take his metformin for 2 days before his MRI and he must have his creatinine level drawn before restarting his medication again after the MRI
To evaluate the overall effectiveness of treatment for a patient with Type 2 diabetes who is returning to the clinic for a follow-up appointment, which test does the nurse anticipate will be ordered for this patient?
Hemoglobin A1C
A patient has been diagnosed with peptic ulcer disease and is following up with his doctor with complaints of fatigue, but no fever. Based on his diagnosis and complications associated with PUD, you expect the doctor to order which labs?
Hemoglobin and hematocrit
A 50-year-old patient is being discharged after a week of IV antibiotic therapy for acute osteomyelitis in the right leg. What information will be included in the discharge teaching?
How to monitor and care for the long-term IV catheter (Peripherally inserted central catheter - PICC).
Fluids that cause a net shift of fluids from the intracellular space to the extracellular space
HypERtonic
Hyperreflexia and tetany are clinical manifestations for?
Hypocalcemia
An example of this kind of IV fluid is 5% dextrose in water (D5W)
Hypotonic
A patient with gastric ulcers understands the importance of on-going monitoring and follow up with his physician based on which of the following statements? I should make sure I get tested for anemia I will need to take supplemental digestive enzymes for the rest of my life There are no long-term complications associated with gastric ulcers because they can be treated with antibiotics I need to make sure that I take Vitamin D supplements
I should make sure I get tested for anemia
You are admitting an 85-year-old with multiple episodes of nausea and vomiting. You initially anticipate which orders?
IV fluids and antiemetics.
A patient with Type 2 Diabetes is treated with with diet and metformin. The patient also has Rheumatoid Arthritis. During an acute exacerbation of the patient's arthritis, the physician prescribes corticosteroids to control inflammation. The nurse monitors the patient's condition closely, recognizing that this medication may cause:
Increased blood glucose levels
Which visual disorder is characterized by the following: - Photopsia (light flashes) - Floaters - Cobweb-like field of vision - Painless loss of peripheral vision
Retinal detachment
Which of the following is TRUE of the upper respiratory system? Is not susceptible to inflammatory disorders It begins at the nose and ends at the bronchioles The turbinates in the nose filter small particles out of the air It contains specialized structures that function to protect the lower airway
It contains specialized structures that function to protect the lower airway
An assessment finding that alerts the nurse to recommend screening for osteoporosis in a middle-aged male patient is?
Measurable loss of height
Which acid-base balance? Patient reporting 12-14 watery stools per day
Metabolic acidosis
Which acid-base balance? Patient with intractable nausea and vomiting
Metabolic alkalosis
A type of angiopathy that commonly affects capillaries and arterioles of the eyes, skin and kidneys
Microvascular
A patient arrives in the emergency department with a severe nose bleed. The nurse's priority action involves
Monitoring the airway
Nerve damage, most commonly to sensory nerves, that is believed to be caused by the accumulation of sorbitol and fructose in nerves from persistent hyperglycemia
Neuropathy
The nurse obtains the following information from a patient newly diagnosed with prehypertension. What finding is most important to address with the patient?
No regular aerobic exercise.
A patient with new onset right-sided weakness that started 90 minutes earlier is admitted to the emergency department. The following diagnostic tests are ordered. Which test should be done FIRST?
Noncontrast computed tomography (CT) scan
You are interpreting the results of the ABG drawn on your patient. The pH is 7.36 - based on this value you know that the blood gas could be which of the following: Normal -OR- fully compensated Fully compensated -OR- uncompensated Uncompensated -OR- partially compensated Partially compensated -OR- normal
Normal -OR- fully compensated
Interpret the following arterial blood gas (ABG) results: pH=7.4, PaCO2= 40, HCO3= 25
Normal acid-base
The nurse is treating a patient with a fungal (Candida) pharyngitis. The nurse knows that it is important to educate the patient on swishing and swallowing what treatment?
Nystatin suspension
Your patient admitted with peptic ulcer disease develops sudden and severe abdominal pain, tachycardia, and rigid "board-like" abdominal muscles. You suspect
Perforation
Hypertension is defined as
Persistent systolic OR diastolic blood pressure equal or greater to 140/90 OR concurrent use of anithypertensive medications
Which of the following is NOT a characteristic finding in a patient with fibromyalgia? Numbness and tingling in extremities Photosensitivity Generalized fatigue and muscle weakness Difficulty concentrating or learning new things
Photosensitivity
The nurse is reviewing a patient's morning lab results. Which of the following serum levels is of highest concern? Calcium (Ca2+) of 8.5 mEq/dL (normal is 8.6-10.2 mEq/dL) Sodium (Na+) of 146 mEq/L Potassium (K+) of 2.4 mEq/L Magnesium (Mg+) of 1.4 mEq/L (normal is 1.5-2.5 mEq/L)
Potassium (K+) of 2.4 mEq/L
RA or OA? Affects joints bilaterally
RA
RA or OA? Lab results show elevated ESR and elevated C reactive protein
RA
You are caring for a patient in the hospital with NO history of hypertension. You collect a set of vital signs and her blood pressure is 198/102. Based on her past medical history and your knowledge of renal disorders you suspect?
Renal artery stenosis
A patient with a stroke has progressive development of neurologic deficits that include increasing weakness and flaccidity, drooling, and decreased level of consciousness (LOC). What nursing diagnosis is the GREATEST concern for the nurse and a priority for assessment?
Risk for aspiration related to inability to protect airway
A patient has a stroke affecting the right frontal lobe of the brain. Based on knowledge of the effects of damage to this area of the brain, the nurse establishes a nursing diagnosis of?
Risk for injury related to spatial-perceptual deficits, impaired judgment and increased impulsivenes
Hearing loss due to impaired function of the vestibulochochlear nerve (C8)
Sensorineural Hearing Loss
A type of neruopathy characterized by complete or partial loss of sensation to touch and temperature, paresthesias, hyperesthesia and pain
Sensory Neuropathy
A 64-yr-old male patient is diagnosed with significant bilateral atherosclerotic narrowing of his internal carotid arteries. He is unimpressed with the provider's recommendation for lifestyle changes and consideration of carotid endarterectomies. When the physician leaves the room, the patient says to the nurse, "It's a little fat in my arteries. What's the big deal?" Which of the following statements by the nurse accurately describes why this IS a "big deal?" Blockage of your internal carotid arteries increases your risk for subarachnoid hemorrhage and intracerebral bleeds. Since the internal carotid arteries provide the majority of blood supply to the brain, you would suffer significant disability if these vessels became blocked. If your internal carotid arteries become blocked, there will be damage to your occiptial lobe which will leave you either partially or completely blind. Since the internal carotid arteries supply blood to the cerebellum, you would have significant problems with balance if these vessels became blocked
Since the internal carotid arteries provide the majority of blood supply to the brain, you would suffer significant disability if these vessels became blocked.
Which of the following are TRUE of Alzheimer's Disease? Choose ALL that apply: Treatment with NMDA receptor agonists and cholinesterase inhibitors halt progression of disease when started early Structural changes in the brain characterized by amyloid plaques and neurofibrillary tangles Definitive diagnosis obtatined though history and physical, mental status exam and radiologic studies of the brain Pathologic changes precede clincal manifestations
Structural changes in the brain characterized by amyloid plaques and neurofibrillary tangles Pathologic changes precede clincal manifestations
A patient was admitted to your unit for with incapacitating nausea and sporatic vomiting x2 days, photophobia, vertigo and headache. The physician initially believes the patient is suffering from a severe migraine headache, but you begin to suspect Meniere's Disease based upon which assessment finding? a. Bulging tympanic membrane with visible fluid accumulation (effusion) b. Ruptured typmanic membrane c. Patient reports progressive inability to hear high-frequency sounds (especially female voices) d. Patient reports fluctuating hearing loss and tinnitus
d. Patient reports fluctuating hearing loss and tinnitus
All of the following are assessment findings of hypervolemia EXCEPT: peripheral edema crackles in bases of lungs elevated BP decreased urine output.
decreased urine output.
One of the diagnostic criteria for fibromyalgia syndrome (FMS) is
elicitation of pain on palpation of 11 of 18 identified tender points.
Polydipsia and polyuria related to diabetes mellitus are primarily due to?
fluid shifts resulting from the osmotic effect of hyperglycemia.
The nurse admits a patient with an upper gastrointestinal (GI) bleed. The nurse anticipates which of the following interventions (select all that apply). frequent vital signs measurements Foley cath placement establishing IV access for fluids and/or blood products accurate I/O measurements
frequent vital signs measurements establishing IV access for fluids and/or blood products accurate I/O measurements
The nurse is admitting a patient with glomerulonephritis. In the interview, the nurse will want to be sure to ask about?
history of recent strep throat infections
Lethargy, weakness, depressed reflexes, and kidney stones are most often clinical manifestations of?
hypercalcemia
What accounts for many of the clinical manifestations of alkalosis?
hypocalcemia
Ms. F is a 20-year-old patient who presented to the ER after a near loss of consciousness while participating in a vigorous marching band practice in July. 1 liter of 0.45% saline was rapidly infused at the scene by emergency responders, and Ms. F was infused with another 2 liters before arriving to the nursing unit for observation. The nurse caring for Ms. F checks in on the patient and finds her to be confused and lethargic. What should the nurse suspect?
hyponatremia
The following age-related physical changes play a role in the pathophysiology of hypertension in the older adult (select all that apply): increased collagen content and stiffness of the myocardium. loss of subcutaneous tissue makes it easy to auscultate the blood pressure. loss of elasticity in large arteries from atherosclerosis. increased peripheral vascular resistance.
increased collagen content and stiffness of the myocardium. loss of elasticity in large arteries from atherosclerosis. increased peripheral vascular resistance.
The lungs act as an acid-base buffer by?
increasing the respiratory rate and depth when CO2 levels in the blood are high, reducing the acid load.
All of the following are assessment findings of hypovolemia EXCEPT: jugular venous distention thrist postural hypotension tachycardia
jugular venous distention
Interpret the following arterial blood gas results: pH= 7.48, PaCO2= 40, HCO3= 31
metabolic alkalosis
A patient with rheumatoid arthritis (RA) is experiencing articular involvement of the joints. The nurse recognizes this characteristic feature of RA. morning stiffness lasting 60 minutes or more. Presence of Heberden's and Bouchard's nodes in fingers. non-inflammatory pain in large joints. asymmetric involvement of the joints
morning stiffness lasting 60 minutes or more.
The PRIMARY function of skin is
protection
The nurse recognizes that what drug class is commonly prescribed for the treatment of gastroesophageal reflux disease and promotes esophageal healing in 80-90% of patients.
proton pump inhibitors
When referring to fluid balance in the body, we know that hydrostatic pressure _______ : pushes water out of the interstitial space into plasma. draws water out of the interstitial space into plasma. pushes water out of the vascular space and into the interstitial space. pulls water from pleural cavities into plasma.
pushes water out of the vascular space and into the interstitial space.
The nurse understands that one potential complication of a deviated septum relates to fluid not draining properly from the sinuses is?
sinusitis
Nursing can aid in the reduction of hospital associated urinary tract infections. One way nurses can accomplish this is?
to obtain an order (or by protocol) to remove indwelling catheters when there is no longer an indication for one.
