HESI Age-Related Risks

How many mL of fluid should the client drink per day? (102.7kg) 30ml/kg of fluid each day

3081 Older adults have a higher baseline osmolality and, thus, a higher osmotic operating point for thirst sensation. As the thirst mechanism decreases, the elderly individuals are more likely to take in fewer fluids. Urine output rises from osmotic diuresis.

The nurse sets the insulin drip to delivery how many mL/hr? (BG 312mg/dL)

4 R: Blood glucose level is 312 mg/dL which means that the insulin should be infused at 4 units/hour. If the concentration of the drip is 100 units/100mL, then for 1 unit of insulin per mL, Mr. Rogers's drip should be set at 4 mL/hr.

Which of the following objective signs indicate dehydration? SELECT ALL THAT APPLY

- High creatinine levels Creatinine levels may decrease after rehydration, which improves renal blood flow. This can be attributed to low renal blood flow due to dehydration and/or diabetic nephropathy. - Postural hypotension Hypovolemia, which can result from dehydration, can cause a drop in systolic BP of 10 to 15 mmHg when a client changes from a lying to a standing position. - Heart rate greater than 100 bpm Tachycardia, or an increase in heart rate, may occur with a drop in blood volume related to dehydration to help the body maintain adequate cardiac output. NOT - Hematuria. Hematuria is intact red cells in the urine. It can be caused by renal disease or infection but not by dehydration. - Increased urine output. Urine output varies according to the body's need to conserve or excrete water to maintain normal osmolality. Dehydration would cause the body to conserve fluid; therefore, urine output would decrease.

The nurse understand that which symptoms are associated with diabetic peripheral nephropathy? select all that apply.

- Reduced ability to feel pain or temperature in the extremities. R:Peripheral neuropathy is the most common form of diabetic neuropathy affecting the ends of the nerves in the feet and legs first, followed by neuropathy affecting the hands and arms in a stocking- like pattern. -Extreme sensitivity to touch. R:Peripheral neuropathy is the most common form of diabetic neuropathy affecting the ends of the nerves in the feet and legs first, followed by neuropathy affecting the hands and arms. -Problems with erectile dysfunction. R:This is a type of diabetic autonomic neuropathy, a condition in which the nerves of nearly all body systems (autonomic system) are impaired. NOT -Frequent UTIs or incontinence. R: This is a type of diabetic autonomic neuropathy that can affect nearly all body systems; it is a condition in which the nerves of the autonomic system are impaired. -Muscle weakness and difficulty walking. R:These symptoms are associated with motor neuropathy, a type of peripheral neuropathy, which can cause damage to the nerves that control muscles and movement in the body, such as moving your hands and arms or talking.

Which of the following statements made by Mr. Rogers indicates the need for further teaching?

- This medication may cause a rise in my blood pressure R: Doxazosin (Cardura) can result in a drop in blood pressure.

Which results of the dipstick urinalysis does the RN recognize as abnormal?

-+1 ketones R: Ketones are not normally found in the urine. Positive ketones can be associated with uncontrolled diabetes, malnutrition, or pregnancy. -Scant sediment R: Cloudiness or turbidity of the urine is an abnormal finding, which may be associated with an infection or with contamination of the specimen. -Trace leukocytes R: The presence of leucocytes in the urine is an abnormal finding, which may be associated with specimen contamination or with infection. NOT -pH 5.0. R: A pH between 4.5 and 8 is the normal range for urine. Lower pH (acidic urine) may be caused by diet, whereas higher pH (alkaline urine) may be caused by infection. -Absence of glucose. R: The absence of glucose is a normal finding in the urine. When glucose is present, it may indicate uncontrolled diabetes.

Which recommendation by the RN may help improve mild symptoms of BPH during the "watchful waiting" period?

-Avoid sources of caffeine R: Caffeine may stimulate an overactive bladder and irritate an already enlarged prostate. NOT -Take a mild decongestant at night to reduce nocturia. R: Decongestants and anticholinergics may prevent the muscles in the bladder and prostate from relaxing, increasing symptoms. -Increase fluids before bedtime to dilute acidic urine. R: Fluids should be reduced at night. Reducing evening fluid intake may decrease nocturia and improve symptoms. -Introduce acidic foods into the diet. R: Acidic foods can cause irritation to the urinary tract, worsening symptoms.

The RN understands that which symptoms are commonly associated with BPH?

-Bladder distention R: Enlargement of the prostate can cause obstruction, preventing emptying of the bladder and resulting in bladder distention. -Frequent stopping and starting of urinary stream R: Enlargement of the prostate causes obstructive symptoms such as difficulty maintaining a steady stream of urine. -Straining while urinating R: Enlargement of the prostate causes obstruction, making it difficult to urinate without straining. -Dribbling at the end of urination R: Enlargement of the prostate may cause an obstruction, making it difficult to end the urinary stream, resulting in dribbling. NOT -Priapism. R: Priapism is a persistent and painful erection and is not a common symptom of BPH.

The RN considers which pharmacological age-related principle(s) when administering medications or monitoring the effects of medications in the elderly client? SELECT ALL THAT APPLY

-Decreased cardiac output increases the risk for adverse drug reactions Decreasing cardiac function is responsible for about 50% of blood flow to the kidneys, leading to reduced kidney efficiency. Drugs are not filtered as quickly from the bloodstream, which increases their half-life and leads to toxicity. -Drug administered intravenously have a faster absorption rate than oral drug Decreased gastric blood flow and motility in the elderly can slow oral drug absorption. - Dehydration can decrease the half-life of drugs Dehydration leads to a delay in the filtration process of drugs. The extended biological half-life of drugs in the older adult increases the risk of adverse reactions. NOT -Mucosal edema can increase the absorption of drugs. Mucosal edema impairs absorption of the drugs, leading to a decreased desired effect. -Gastric pH is often decreased in the elderly. Gastric pH is generally increased in the elderly, which can alter drug absorption.

Which data is most important to report to the HCP?

-Dyspnea R: Dyspnea can result from nutritional problems and may be indicative of anemia; therefore, it is the most important symptom to report. NOT -constipation, heartburn, pallor

Along with clinical manifestations, which common laboratory findings indicate dehydration? SELECT ALL THAT APPLY

-Elevated hemoglobin and hematocrit No single laboratory test result confirms or rules out dehydration. Instead it is determined by laboratory findings with clinical manifestations. Common findings are elevated hemoglobin and hematocrit levels from hemo concentration (an increase in the number of red blood cells/plasma). In the case of dehydration, BUN would be elevated. -Increased serum osmolarity During dehydration, increased levels of sodium, BUN or glucose in the blood can increase the serum osmolarity. -Increased serum glucose Increased amounts of solutes, such as glucose or protein, can also increase specific gravity of the urine. - Increased urine specific gravity Urine specific gravity is a measure of the concentration of dissolved substances or solutes (urea and sodium). The specific gravity of water is 1.000. An increase in urine specific gravity is caused by dehydration.

What conditions, other than hyperglycemia, might Mr. Rogers have? Select all that apply.

-Glycosuria R:When blood glucose levels exceed the renal threshold, the glucose spills into the urine, causing glycosuria. -Ketonuria R:The lack of glucose in cells results in fat breakdown by the liver, and ketonuria results from the excretion of ketones in the urine. -Osmotic diuresis R:Glucose is an osmotically active particle, and lack of glucose results in cellular dehydration. NOT: -Hypernatremia. R: Excessive water loss and thirst result in volume depletion. This leads to hyponatremia rather than hypernatremia. -Hypervolemia. R: Insulin deficiency result in excessive glucose in the blood causing polyuria. Excessive water loss and thirst results in volume depletion.

Which laboratory finding is of most concern to the RN?

-Hemoglobin 11.2 g/dL Normal hemoglobin for an adult male is 13.2 to 17.3 g/dL. Although lower levels are often found in older adults, 11.2 g/dL indicates anemia. NOT - Potassium 3.9 mEq/L Normal parameters for serum potassium are 3.5 to 5 mEq/L -Sodium 140 mEq/L Normal parameters for serum sodium are 135 to 145 mEq/L - Phosphate 4.1 mg/dL Normal parameters for serum phosphate are 2.4 to 4.4 mg/dL

Which other symptoms should the nurse expect to find in a client with a diagnosis of diabetic retinopathy? Select all that apply.

-Loss of vision R:Micro aneurysms and edema can lead to increased intraocular pressure, retinal detachment and glaucoma, which can all cause loss of vision. -Reports of floaters R:Small micro aneurysms protrude from the vessel walls, causing the client to see red and black spots or lines described as floaters. -Difficulty with color perception R: Macular edema associated with diabetic retinopathy can cause impaired hue discrimination resulting in impaired color perception. NOT: -Jaundice of the sclera. R: Jaundice of the sclera is associated with liver disease but is not a symptom of diabetic retinopathy. -Pupil fixation R: Pupil fixation is not a symptom associated with diabetic retinopathy.

Which of the following results can affect drug distribution and influence drug-to-drug interactions?

-Low serum albumin levels R: Serum albumin levels can affect the binding of drugs. Low levels of albumin can result in toxic effects, especially in the elderly. NOT: -Elevated BUN. Glomerular filtration rate (GFR), blood urea nitrogen (BUN), and creatinine (Cr) values affect the excretion of drugs from the kidneys. -Reduced glomerular filtration rate.Glomerular filtration rate (GFR), blood urea nitrogen (BUN), creatinine (Cr) values affect the excretion of drugs from the kidneys. -Elevated creatinine levels. Glomerular filtration rate (GFR), blood urea nitrogen (BUN), creatinine (Cr) values affect the excretion of drugs from the kidneys.

Which of the following teaching points should be included in this plan of care? SELECT ALL THAT APPLY

-Notify the HCP if there is headache or irritability Headache and irritability are symptoms of hypoglycemia, so these should be reported. Hypoglycemia can be dangerous when blood glucose levels are below 50 mg/dL in adults because it can cause irreversible damage to the cerebral cortex. The brain cannot burn anything other than glucose. A prn prescription for parenteral glucose or a carbohydrate meal is usually given. -Report excessive hunger and/or weakness Excessive hunger and weakness are a sign of hypoglycemia, which can be a result of not eating or an indication of a side effect of insulin or oral hypoglycemic agents. These symptoms should be reported. A prn prescription for parenteral glucose or a carbohydrate meal is usually given. -Report cold and clammy skin Hypoglycemia causes autonomic nervous system symptoms such as nervousness, sweating, irregular heart rhythm, tremor, and hunger, and these symptoms should be reported. NOT -Notify the HCP of hot, dry skin. This is a sign of hyperglycemia. Severe dehydration and electrolyte imbalances can occur because large amounts of glucose have a high osmotic pressure, which attracts water so that urine output rises (osmotic diuresis). -Report a blood glucose reading of 70 mg/dL. Hypoglycemia is a blood glucose level that is less than 60 mg/dL. A reading of 70 mg/dL does not need to be reported.

In addition to the insulin, which of the following immediate measures would be indicated in the treatment of Mr. Rogers? Select all that apply.

-Potassium supplements R:Ketones accumulate, which produces a drop in blood pH and increases the number of hydrogen ions in the blood, resulting in acidosis. The body attempts to buffer the acidic hydrogen ions by exchanging them with intracellular potassium ions. Potassium supplements are given to restore normal potassium levels. -Sodium bicarbonate R: The sodium bicarbonate is administered to correct the metabolic acidosis. -0.9% normal saline R:Fluids are used to correct profound dehydration and hyper osmolarity. NOT: -Prednisone or Epinephrine R: prednisone + epinephrine can increase the serum blood sugar.

With the understanding that Mr. Rogers' eating habits lack consistency, which physiological facts about he client's nutrition are most concerning to the nurse? Select all the apply.

-The stage II non-healing ulcer on the client's right heel could require amputation. R: Extra protein is needed for healing wounds and restoring losses. Extensive tissue destruction, such as that which occurs with burns, pressure sores, and diabetic ulcers requires a large protein increase for the healing and grafting processes. Older adults with diabetes mellitus II (DM) also demonstrate poor wound healing. -Dehydration exacerbated by lack of nutrition. R: Approximately 19% of total water intake comes from food. Uncontrolled diabetes mellitus causes an excess loss of water through urine as a result of high blood glucose levels. In such cases, the replacement of lost water and electrolytes is vital to prevent dehydration -Lack of appetite and not wanting to eat alone could lead to malnutrition. R: Many of the health problems of older adults result from general aging and states of malnutrition caused by poor food habits, such as a lack of appetite, or loneliness and not wanting to eat alone. -The development of hypoglycemia could be life-threatening. R: This is a concern to the nurse. NOT -Lack of exercise and activity require less nutritional nutrients R: The client's lack of exercise is not concerning to the nurse. A sedentary person requires less of all nutrients than an active person.

The RN understands that which physiological age-related change is often responsible for dehydration in the elderly

-Thirst decreases, contributing to less fluid intake R: Older adults have a higher baseline osmolality and, thus, a higher osmotic operating point for thirst sensation. As the thirst mechanism decreases, the elderly individuals are more likely to take in fewer fluids. Urine output rises from osmotic diuresis.

Which actions will help maintain skin integrity? Select all that apply.

-Use heel protectors -Use special mattress or foot cradles -Apply skin moisturizers to prevent cracking -Instruct the client to wear clean white socks Not: -Apply drying agents, such as alcohol, to skin. R: Do not use drying agents on the skin because they will worsen skin integrity.

Which antimicrobial medications are safe alternatives for clients with penicillin allergies?

-Vancomycin (Vancocin) -Clindamycin (Cleocin) -Erythromycin (Erythrocin) NOT -Cephalexin (Keflex). R: Clients who are allergic to penicillins may also have a cross-sensitivity to cephalosporin antibiotics. -Ticarcillin (Timentin). R: This choice is incorrect because ticarcillin (Timentin) is a fourth generation penicillin that is used for serious pseudomonal infections.

When using an 8-ounce drinking glass, the client should drink how many glasses per day to ingest 3081 mL in 1 day?

13 30 mL = 1 ounce 8 ounces x 30 mL = 240 mL/glass 3081 mL per day ÷ 240 mL/glass = 12.8 glassesRound to 13 glasses

The pharmacist delivers Mr. Rogers' dose of ampicillin (omnipen) in a 100ml bag of 0.9% normal saline. In order to deliver the medication over 30 minutes, the nurse sets the pump at how many ml/hr?

200

Which lab value needs to be reported immediately?

Arterial PH 7.05 -R:An arterial pH below 7.35 indicates an abnormal blood gas and indicates a shift to an acidotic state. This is an emergency situation. NOT: -Serum creatinine 1.2 mg/dL. R: Serum creatinine 0.6 to 1.3 mg/dL is a normal lab value. -Negative ketones. R: Negative ketones is a normal lab value. -Serum osmolality 285 mOsom/kg. R: The normal range for serum osmolality is 275 to 295 mOsm/kg and is determined by Na+ and its anions Cl- and HCO3.

The nurse understands that which information is correct regarding the prescribed insulin?

Glargine (Lantus) does not have a peak interval R:Glargine (Lantus), long-acting insulin, has an onset of 1 to 2 hours, has no pronounced peak, and has a duration of 24+ hours.

Prior to changing the dressing on Mr. Rogers' right heel ulcer, the nurse should first take which actions?

Inspect the feet carefully for temperature, sensation, and drainage. R:An inspection must be done by the nurse to assess for drainage in case a culture/sensitivity needs to be done to rule out the possibility of infection. Peripheral neuropathy may begin with nerve irritation and pain that progresses to the loss of sensation to fine touch. Diabetic clients may often ignore or be unaware of irritation or injury to their feet.

The RN anticipates that the client will receive which treatment for pernicious anemia?

Intramuscular injection of vitamin B-12 Pernicious anemia is a deficiency of vitamin B-12 that is often caused by a lack of intrinsic factor

Which information about the client is of most concern to the nurse?

Reports a new onset of blurry vision. R: blurry vision can indicate cataracts, glaucoma, optic nerve damage or diabetic retinopathy.

Which pattern should the nurse report immediately to the HCP?

ST depression and "U" waves. R: After insulin therapy, hypokalemia is expected because potassium shifts back into the cell. Hypokalemia is serum potassium level less than 3.5 mEq/L and can be life threatening. Flat or inverted T waves or increased "U" waves can occur with hypokalemia. NOT: -Sinus tachycardia. R: This EKG pattern is not life threatening, but would still need to be addressed if it continues. -Sinus bradycardia. R: The EKG changes in hyperkalemia (not hypokalemia) are bradycardia. -Sinus arrhythmia. R: The EKG pattern is not life threatening, but can be addressed if it continues.

The RN understands that which concept is important when addressing the client's physiological and psychosocial needs?

The client's diabetes mellitus should not present a problem for community dining. The client should be able to order or select dishes on his diabetic meal plan from the community dining center. A special dietary need will not typically prevent a client from enjoying the social benefits of a community dining experience.

Which technique is correct?

Use a 1 to 1.5 inch needle. For a male client who weighs 130 to 260 lbs (59 to 118 kg), a 1 to 1½ inch needle is recommended.

Which instruction related to bath safety is best?

Use a bath thermometer to ensure that the temperature is below 102 degrees F R:Use of an unbreakable thermometer to ensure temperature is below 102° F (38.8° C) will help prevent burns for the client with peripheral neuropathy.

The RN should instruct the client to take which action when collecting a urine sample?

Wipe the genital area clean R:This step helps prevent contamination of the sample from the skin. NOT: -Collect 1 or 2 ounces of urine. -Dry any excess urine from the outer specimen cup. -Hold the cup a few inches from the urethra. R: it is not the first step.

Which response by the client is of most concern to the RN?

my urine had a foul smell this morning R: New onset of a foul smell in the urine could be a sign of UTI and should be investigated further. Bladder (cystitis) and kidney (pyelonephritis) infections are common problems in clients with diabetes.

It is most important for the client to report which potential adverse or side effect associated with gabapentin (neurontin)?

tarry stool R: tarry or black stool may be an indication of a GI bleed, a potentially life-threatening complication. NOT -Restlessness, dry mouth, flatulence R: potential s/e but not life-threatening