pass to classes med surg 1
An 80 year old patient is brought to the ER for a suspected hip fracture. In order for the nurse to get an accurate pain assessment which tool will the nurse use? CPOT scale FLACC scale wong baker faces scale numeric 1-10 scale
1-10
top 5 leading causes of death in older adults
1. heart disease 2. cancer 3. unintentional injuries 4. chronic lower pulmonary disease 5. stroke
a nurse assess a pt at a community health fair. which client is at greatest risk for the development of hepatitis B? a 63 y.o. bussinessman who travels frequently across the country 46 y.o. woman who takes acetaminophen daily for h/a 20 y.o. college student who has had several sexual partners 82 y.o. woman who recently ate raw shellfish for dinner
20 y.o. college student who has had several sexual partners
A nurse is working with a client who is diagnosed with HIV several months earlier. The client will be considered to be in the last stage of HIV and progressing to AIDS when the CD4+ T lymphocyte cell count drops below what threshold?
200 cells/mm3 of blood
The nurse comes to reassess a patient after administering oxycodone. The nurse is concerned that the patient's respiratory rate is abnormal. Which respiratory rate would a nurse be most concerned with? 20 13 8 15
8
how does a non-rebreathing mask work? A one-way valve located between the reservoir bag and the base of the mask allows gas from the reservoir bag to enter the mask on inhalation but prevents gas in the mask from flowing back into the reservoir bag during exhalation It has a reservoir bag that must remain inflated during both inspiration and expiration. The nurse adjust the oxygen flow to ensure that the bag does not collapse during inhalation. The mask is constructed in a way that allows a constant flow of room air blended with a fixed flow of oxygen. Excess gas leaves a mask through the two exhalation ports, carrying with it the exhale carbon dioxide
A one-way valve located between the reservoir bag and the base of the mask allows gas from the reservoir bag to enter the mask on inhalation but prevents gas in the mask from flowing back into the reservoir bag during exhalation
?A nurse is assessing the postop patient on the second postop day. What assessment finding does the nurse realize needs to be immediately reported to the health care provider? Absence of bowel sounds Rales heard in the base of the lungs Moderate amount of pain at incision site Serious drainage noted on the postop dressing
Absence of bowel sounds
A female patient with diabetes has a decreased level of consciousness and a fingerstick glucose level of 39. What is the priority of care? Administer one ampule a 50% dextrose solution. Place a Salem sump tube and provide tube feedings. Provide a high protein high calorie snack. Administer a 500 mL bolus of normal sailing solution.
Administer one ampule a 50% dextrose solution.
a Clinic nurse is providing education for a patient diagnosed with migraine headaches. During the teaching session the patient asked the nurse about alcohol consumption. What would the nurse be correct in telling the patient about the effects of alcohol? Alcohol diminishes endorphins in the brain. Alcohol causes vasodilation of the blood vessels. Alcohol causes hormone fluctuations. Alcohol has an excitatory effect on the CNS.
Alcohol causes vasodilation of the blood vessels.
Nurse is caring for a client who is scheduled to have a MRI. The patient asks the nurse what to expect during the procedure. Which of the following statements should the nurse make? The MRI contrast dye contains iodine and can cause your skin to itch. An MRI scan is not distorted by movement so you do not have to lie still. An MRI is very noisy and you will be allowed to wear earplugs while in the scanner. An MRI is a short procedure and should take no longer than 30 mins.
An MRI is very noisy and you will be allowed to wear earplugs while in the scanner.
A nurse is assessing a patient with Cushing's syndrome. Which observation should the nurse report to the physician immediately? Dry mucous membranes. An irregular apical pulse. Frequent urination. Pitting edema of the legs.
An irregular apical pulse.
a nurse is caring for a patient who experiences debilitating cluster headaches. The client should be taught to take appropriate medication's at what point in the course of the onset of a new headache? 20 to 30 minutes after the onset of symptoms. When the patient senses his or her symptoms peeking. As soon as the patient senses the onset of symptoms. As soon as the patient's pain becomes unbearable.
As soon as the patient senses the onset of symptoms.
Patient with HIV has had a sudden decline in status with a large increase in viral load. What action will the nurse take first? Assess the patient for adherence to the drug regimen. Ask the patient about travel to any foreign countries. Request information about new living quarters were pets. Determine if the patient has any new sexual partners.
Assess the patient for adherence to the drug regimen.
A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low residue diet. Salami and whole-grain bread and V-8 juice. A fruit salad with yogurt. Broiled chicken with a low fiber pasta. A peanut butter sandwich and fruit cup.
Broiled chicken with a low fiber pasta.
a nurse is learning about HIV infections. which statement about HIV infection is correct? people with HIV are not contagious to others. antibodies produced are complete and function well. opportunistic infections and cancer are not the leading cause of death. CD4+ cells begin to create new HIV virus proteins.
CD4+ cells begin to create new HIV virus proteins.
what underlying conditions put people at higher risk of developing pulmonary HTN avoiding alcohol and smoking CAD: congenital heart disease, exercising 30 mins 3 times / wk COPD, lymphedema COPD, congenital heart disease, PE
COPD, congenital heart disease, PE
the result of which diagnostic study is increased in the client diagnosed with rheumatoid arthritis? phsophorous CRP alk phos magnesium
CRP
Patient with chronic right shoulder pain has learned that the use of imagery and guided meditation has helped control his pain. Family member asks how these techniques can help with pain. The nurse replies that these therapies can: Slow the release of transmitter chemicals in the dorsal horn Increase the modulating effect of the efferent pathways Prevent transmission of nociceptive stimuli to the brain Change the cognitive and affective thoughts about the pain
Change the cognitive and affective thoughts about the pain
The nurse is administering TPN to a patient who underwent a partial gastrectomy for a tumor in the stomach. Which of the nurses assessment most directly addresses a major complication of TPN? Checking the clients capillary blood glucose levels regularly. Measuring the clients heart with them at least every six hours. Having the client frequently rate his or her hunger on a 10 point scale. Monitoring the clients level of consciousness each shift.
Checking the clients capillary blood glucose levels regularly.
The nurse is admitting a 68 year old man with severe dehydration and frequent watery diarrhea that was sent to test for C. death. He just completed a 10 day outpatient course of antibiotic therapy for bacterial pneumonia. It is most important for the nurse to take which action? Don gloves and gown before entering the patient's room. Wear a mask to prevent transmission of infection. Wipe equipment with ammonia-based disinfectant. Instruct visitors to use the alcohol-based hand sanitizer.
Don gloves and gown before entering the patient's room.
Gastroesophageal reflux disease, GERD, we can to lower esophageal sphincter predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions? Eat small frequent meals and remain in an upright position for at least 30 minutes after eating. Eat larger in frequent meals and walk or do light exercise after all meals. Decrease daily intake of vegetables and water and ambulate frequently. Drink coffee diluted with milk at each meal and remain in an upright position for 30 minutes.
Eat small frequent meals and remain in an upright position for at least 30 minutes after eating.
An older adult patient has an open reduction and internal fixation of the left femoral head after a fracture. Which action by the nurse is best? Encourage the client to cough and deep breath every two hours Instruct the client to exercise their arms Keep the patient turned to the non-operative side Offer the patient a clear liquid diet
Encourage the client to cough and deep breath every two hours
A Patient has received dietary instructions as part of the treatment plan for diabetes type one. Which statement by the patient would alert the nurse of needing additional instructions? I should eat meals are scheduled even if I'm not hungry to prevent hypoglycemia I can eat whatever I want as long as I cover the calories with sufficient insulin I can have an occasional low-calorie drink as long as I include it in my meal plan I'll likely need a bedtime snack because I take an evening dose of NPH insulin
I can eat whatever I want as long as I cover the calories with sufficient insulin
A nurse is caring for a patient who is receiving chemotherapy and has a platelet count of 30,000. Which statement by the patient indicates a need for additional teaching? I floss my teeth every morning. I use an electric razor to shave. I take a stool softener every morning. I removed all the throw rugs from the house.
I floss my teeth every morning.
The nurse is providing discharge instructions to a patient who is newly diagnosed with Crohn's disease about dietary changes to implement during exacerbations. Which statement made by the patient indicates a need for further education? I will need to avoid caffeinated beverages. I should increase the fiber in my diet. I am going to learn some stress reducing techniques. I can have exacerbation and remissions with Crohn's disease.
I should increase the fiber in my diet.
A nurse is teaching a patient with osteoporosis about dietary selections. What client statement indicates the teaching was effective? I will decrease my intake of red meat. I will eat more dairy products to increase my calcium intake. I will eat more fruit to increase my potassium intake. I will decrease my intake of popcorn nuts and seeds.
I will eat more dairy products to increase my calcium intake.
The physician has prescribed insulin lispro, Humalog, for sliding scale coverage for a patient diagnosed with diabetes mellitus. What statement indicates the patient understands the action of the drug? I can save my dessert from supper for a bedtime snack. I will need to carry candy or some form of sugar with me at all times. I will make sure I eat breakfast within five minutes of taking my Humalog. I will eat a snack around 3 o'clock each afternoon.
I will make sure I eat breakfast within five minutes of taking my Humalog.
A patient was recently diagnosed with myasthenia gravis. Which is indicative of a person diagnosed with myasthenia gravis? Excessive serotonin activity in the brain. Defects in the expression of acetylcholine receptors. Impairment of acetylcholine binding to muscle cells. Decrease dopamine activity in the brain.
Impairment of acetylcholine binding to muscle cells.
Which aspect should a nurse include in the teaching plan for a patient with osteomalacia? Include calcium phosphorus and vitamin D supplements. Avoid dairy products. Avoid green leafy vegetables. Avoid any activity or exercise.
Include calcium phosphorus and vitamin D supplements.
A patient is being brought down to radiology to have an echocardiogram performed. Which action should the nurse perform to prepare the patient for the procedure? Have the patient sign and informed consent for the invasive procedure. Inform the patient they will be given a medication that will make them lose consciousness. Educate the patient not to have anything to drink or eat two hours prior to the procedure. Inform the patient that the test will last 30 minutes and will not be painful.
Inform the patient that the test will last 30 minutes and will not be painful.
For a patient newly diagnosed with radiation induced thrombocytopenia the nurse should include which intervention in the care plan? Inspecting the skin for petechiae once every shift. Administering aspirin if the temperature exceeds 102. Providing frequent rest periods. placing the client in strict isolation.
Inspecting the skin for petechiae once every shift.
How does smoking cigarettes affect the anatomy of the lungs? It disrupts mucociliary and macrophage activity It increases the body's immune response to pathogens It increases the surface area available for gas exchange it causes increased permeability of the alveolar tissue
It disrupts mucociliary and macrophage activity
They're result of a patient's recent endoscopy indicate the presence of peptic ulcer disease. Which teaching point should the nurse provide to the patient based on this new diagnosis? It would likely be beneficial for you to eliminate drinking alcohol. You'll need to drink at least 2 to 3 glasses of milk daily. Many people find that a men's store puréed diet uses their symptoms of public also disease. Your medications should allow you to maintain your present diet while minimizing symptoms.
It would likely be beneficial for you to eliminate drinking alcohol.
a nurse is performing Health history and physical assessment of a client who has a diagnosis of rheumatoid arthritis. What assessment finding is most consistent with the clinical presentation of RA? Signs of systemic infection. Visible atrophy of the knee and shoulder joints. Cool joints with decreased range of motion. Joint stiffness lasting longer than one hour especially in the morning.
Joint stiffness lasting longer than one hour especially in the morning.
A patient after having an echocardiogram was just diagnosed with mitral stenosis. The narrowing of this valve will impede the circulation of blood moving through which structures of the heart? R ventricle to pulmonary artery. L atrium to L ventricle. L ventricle to aorta. R atrium to R ventricle.
L atrium to L ventricle
A patient is diagnosed with opioid tolerance, what does this mean for the patient? Larger doses of opioids are needed to control their pain that they needed a month ago. The patient has signs and symptoms of respiratory depression, hypertension and diaphoresis Smaller doses of opioids are needed than they needed 2 months ago
Larger doses of opioids are needed to control their pain that they needed a month ago.
A patient with a history of a seizure disorder experiences a generalized seizure. What nursing action is the most appropriate? Apply restraints to the patient to prevent injury. Position the patient in high Fowler. Open the patient's chart to insert an oral airway. Loosen the patient's restrictive clothing.
Loosen the patient's restrictive clothing.
It is important for the nurse to assist a post surgical patient to set up and turn the head to one side when vomiting in order to Minimize the risk of aspiration avoid dizziness Maximize comfort Help eliminate inhaled anesthetics
Minimize the risk of aspiration
A patient with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribe treatment for regimen? Minimizing damage eradicating pain promoting sleep eliminating deformities
Minimizing damage
A patient with an infected appendix is scheduled for an appendectomy however the patient cannot find the operative consent form because of sedation from opioid analgesics that has been administered. The nurse should take which most appropriate action in the care of this patient? Obtain a telephone consent from a family member following agency policy. obtain a court order for the surgery. have the charge nurse sign the informed consent immediately. send the client to surgery without the consent form being signed.
Obtain a telephone consent from a family member following agency policy.
Hey 63 year old client with type two diabetes mellitus is admitted for treatment of an ulcer on the heel of the left foot that has not healed with wound care. The nurse observes that the entire left foot is darker in color than the right foot. Which additional symptoms should the nurse expect to find? The client will state that the left foot is usually warm. Flexion and extension of the left foot will be limited. Capillary refill of the clients left toes will be brisk. Pedal pulses will be weak or absent in the left foot.
Pedal pulses will be weak or absent in the left foot.
A patient is admitted to the hospital with a diagnosis of severe acute diverticulitis. Which nursing intervention has the highest priority? Assess the clients temperature. Administer IV fluids. Place the client on NPO status. Obtain a stool specimen.
Place the client on NPO status.
An older patient with a history of hyper parathyroidism and severe osteoporosis is hospitalized. The nurse caring for the client plans first to address which problem? Need for teaching about the disorder. Possibility of injury. Urinary retention. Constipation.
Possibility of injury.
Patient asks about the purpose of withholding food and fluid before surgery. Which response by the nurse is most appropriate? Prevent aspiration and respiratory complications Decreases risk of elevated blood sugar and slow wound healing Decreases urine output so that a catheter will not be needed Prevents over hydration and hypertension
Prevent aspiration and respiratory complications
During a nurses assessment of a patients abdominal pain the nurse asks where the pain is located. Which part of the PQRST assessment is the nurse asking about?
R
a pt sprains an ankle while playing tennis and is brought to the emergency department. What is the priority action by the nurse? Exercise ice compression elevation rest ice compression elevation heat compression analgesics exercise rest heat compression exercise
RICE
the nurse is assessing a client who is experiencing an acute episode of cholecystitis. Where should the nurse anticipate the location of the client's pain? RLQ radiating to umbilicus. RUQ radiating to the right scapula and shoulder. RLQ radiating to the back. RUQ radiating to the left scapula and shoulder.
RUQ radiating to the right scapula and shoulder.
a pt has been having trouble talking and says that every time they walk they get short of breath. The provider orders and exercise stress test for the patient. Which instruction should the nurse provide to the patient prior to the procedure? Remember to wear a mask fitting shirt with buttons. Not to smoke a cigarette 30 minutes before the procedure. Make sure to have breakfast prior to the procedure. Remember to wear firm boots to the procedure.
Remember to wear a loosefitting shirt with buttons
The nurse is caring for a patient who has a normal glucose levels at bedtime, hypoglycemia at 2 AM, and hyperglycemia in the morning. What is this patient likely experiencing? Somogyi effect insulin spike dawn phenomenon excessive corticosteroids
Somogyi effect
A nurse is teaching a patient about their newly diagnosed type one diabetes mellitus. What statement indicated the patient understands their new diagnosis? With type one diabetes sometimes your pancreas makes too much insulin. Special B cells in the pancreas that make insulin are being destroyed by my own bodies T cells. Type one diabetes has caused my pancreas to no longer make glucose. Type one diabetes is temporary and I will only need to use insulin for a short time.
Special B cells in the pancreas that make insulin are being destroyed by my own bodies T cells.
the nurse Is educating a client scheduled for elective surgery. The patient takes aspirin daily. What education should the nurse provide regarding this medication? Stop taking the aspirin seven days before the surgery, unless otherwise directed by your physician Aspirin should be increased until three days before the surgery and it should be discontinued until three days after surgery take half doses of the aspirin until 1 week after surgery continue taking aspirin as ordered
Stop taking the aspirin seven days before the surgery, unless otherwise directed by your physician
The admitting nurse in a short stay surgical unit is responsible for numerous aspects of care. What must the nurse verify before the client is taken to the preop holding area? That preop teaching was performed That the family is aware of the length of the surgery that follow up home care is not necessary that the family understand the pt will be discharged immediately after surgery
That preop teaching was performed
The nurse prepares the patient for a total hip replacement. What information will likely postpone the surgery? The patient's hemoglobin is 15. The patient reports periodic heartburn. The patient's platelet count is 250,000. The patient reports burning with urination.
The patient reports burning with urination.
The nurse provides care for a patient immediately following a right BKA. The nurse is most concerned if which observation is made? The patient reports a throbbing headache. The patient voices concerned about being able to use a prosthesis. The patient periodically naps. The patient reports persistent pain at the operative site.
The patient reports persistent pain at the operative site.
A nurse is caring for a patient who is withdrawing from heavy alcohol use. The nurse and other members of the care team are at the bedside when the patient has a seizure. In preparation for documenting this clinical event the nurse should know which of the following? The patient's activities immediately prior to the seizure. The patient's ability to follow instructions during the seizure. The patient's ability to describe the seizure in the Postictal period. the success or failure of the care team to physically restrain the patient during the seizure.
The patient's activities immediately prior to the seizure.
Clinic nurse is caring for an adult oncology patient who reports extreme fatigue and weakness after the first week of radiation therapy. Which response by the nurse would best reassure this patient? The symptoms usually result from radiation therapy, however we will continue to monitor your lab studies and test results. The symptoms are part of your disease and are an unfortunately inevitable part of living with cancer. try not to be concerned about the symptoms. Every client feels this way after having radiation therapy. Even though it is uncomfortable this is a good sign. It means that only the cancer cells are dying.
The symptoms usually result from radiation therapy, however we will continue to monitor your lab studies and test results.
The nurse is preparing to insert an NG tube into a 68 year old female patient who is nauseated and vomiting. She has an abdominal mass and suspected small intestine obstruction. The patient asked the nurse why this procedure is necessary. What response by the nurse is most appropriate? The tube will let us measure your stomach contents so that we can plan what type of IV fluid replacement would be best. The two will push past the area that is blocked and thus help to stop the vomiting. The tube will help to drain the stomach contents and prevent further vomiting. The tube is just a standard procedure before many types of surgery to the abdomen.
The tube will help to drain the stomach contents and prevent further vomiting.
What is the role of alveolar macrophages and what happens if they do not function properly? They are a type of phagocyte. If not functioning properly the patient is at increased risk for pulmonary infection. They are a type of eusinophil. if not Functioning properly and the patient is at increased risk for an allergic reaction They are a type of monocyte. If not functioning properly the patient is at increased risk for tissue necrosis. They are a type of monocyte. If not functioning properly the patient is at increased risk for pulmonary infection.
They are a type of phagocyte. If not functioning properly the patient is at increased risk for pulmonary infection.
A nurse cares for a patient who has hypothyroidism as a result of Hashimoto's thyroiditis. The patient asks how long will I need to take this thyroid medication? How should the nurse respond? You will need to take the thyroid medication until the goiter is completely gone. Thyroiditis is cured with antibiotics. Then you won't need thyroid medication. When blood tests indicate normal thyroid function you can stop the medication. You'll need thyroid pills for life because your thyroid won't start working again.
You'll need thyroid pills for life because your thyroid won't start working again.
Which of the following is not an expected physiologic change in the integumentary system in the older adult? a. Increased secretion of natural oils and respiration. b. Decreased subcutaneous fat and muscle tone. c. Capillary fragile lady. d. Decrease sensory receptors.
a. Increased secretion of natural oils and respiration.
Which of the following signs and symptoms should a nurse consider when taking care of an older adult with suspected pneumonia? a. The baseline body temperature in the older adult is about one degree Fahrenheit lower than younger adults. b. The white blood cell count on average is lower and older adults compared to younger adults. c. The older adult is more likely to have a productive cough compared to a younger at all. d. The old noodle is more likely to experience dizziness compared to a young adult.
a. The baseline body temperature in the older adult is about one degree Fahrenheit lower than younger adults.
Which patient is more likely to experience polypharmacy? a. The older adult with diabetes, arthritis, and Alzheimer's disease. b. The older adult with dementia and hyperlipidemia. c. The older adult with no chronic conditions and recent hip replacement. d. The older adult with no chronic conditions and substance use disorder.
a. The older adult with diabetes, arthritis, and Alzheimer's disease.
which of the following is an expected finding of an older adult with physiologic vision changes? a. decreased ability to distinguish colors b. reports of watery eyes c. holds objects close to face d. finds it easier to drive at night rather than daytime
a. decreased ability to distinguish colors
A nurse is gathering a health history from an older adult patient with physiologic hearing changes. Which communication technique should the nurse use during their conversation? a. reduce background noise b. speak with a high-pitched voice c. sit side by side with the patient d. make sure a family member is preset during the discussion
a. reduce background noise
all of the following are potential consequences of poor sleep in older adults except: a. restless leg syndrome b. cognitive decline c. increased risk for falls d. reduced quality of life
a. restless leg syndrome
A patient presents to the emergency department with a chief complaint of increasing shortness of breath. After taking the history and physical the nurse notes the patient has a history of left sided heart failure. The patient is now becoming increasingly agitated and coughing up pink tinged foamy sputum. The nurse recognizes the sides and symptoms and notify the provider of suspected? cariogenic shock acute pulmonary edema right sided heart failure pneumonia
acute pulmonary edema
which of the following is inappropriate management for a pt with hypercalcemia? administer calcitonin administer thiazide diuretics administer phosphorous administer biophosphonate therapy
administer thiazide diuretics Thiazide diuretics can increase renal tubular reabsorption of calcium, resulting in hypercalcemia calcitonin inhibits the activity of osteoclasts, which are the cells responsible for breaking down bone. When bone is broken down, the calcium contained in the bone is released into the bloodstream. Therefore, the inhibition of the osteoclasts by calcitonin directly reduces the amount of calcium released into the blood.
A nurse walks into a room and the patient is experiencing problems with completing daily activities because of an underlying cardiovascular disease. When the nurse takes the patient's vital signs, the patient has exertion fatigue and an increased blood pressure. Which observation by the nurse best indicates patient progress? chooses a healthy diet that limits sodium intake. sleeps with only awaking once during the night. ambulates 15 feet further every day. verbalizes the benefits of physical activity.
ambulates 15 feet further every day
A patient's health history is suggestive of inflammatory bowel disease. Which of the following would suggest chrome disease, rather than ulcerative colitis, is the cause of the client signs and symptoms? severe diarrhea involvement of the rectal mucosa. a pattern of distinct exacerbation and remissions. an absence of blood in stool
an absence of blood in stool
a nurse educator is teaching a group of recent nursing grads about their occupational risk for contracting hep B. what preventative measure should the nurse promote? annual immunizations consumption of vitamin rich diet annual vit K injections annual b12 injections
annual immunizations
a pt presents to the ER stating they have severe ripping pain. the nurse suspects this pt is suffering from aortic dissection aortic aneurysm aortoilliac disease cardiogenic shock
aortic dissection
a pt was recently dxed with right sided heart failure. the nurse explains to the pt s/s the pt needs to look out for. these can include: select all that apply: crackles in the lungs ascites hepatomegaly JVD
ascites hepatomegaly JVD
A patient has undergone esphagogastroduodenoscopy ,EGD. The nurse should place highest priority on which item as part of the patient's care plan? assessing for the return of the gag reflex. monitoring temperature. monitoring complaints of heartburn giving warm gargles for sore throat
assessing for the return of the gag reflex.
which nursing intervention is most appropriate for a client diagnosed with rheumatoid arthritis and reporting generalized pain? assist the pt with heat application and range of motion exercises. perform ADLs for the pt throughout the day. administer morphine IM for treatment of acute pain. massage the inflamed joints alternatively with essential oils and isopropyl alcohol.
assist the pt with heat application and range of motion exercises.
The perioperative nurse is caring for a patient who is recovering on the post surgical unit following a cholecystectomy. The patient has not started ambulating and states he needs to rest in bed. For what complication is the client most at risk? Atelectasis shock anemia dehydration
atelectasis
the nurse is discharging a patient home after surgery for trigeminal neuralgia. What advice should the nurse provide to this patient in order to reduce the risk of injury? avoid rubbing the eye on the affected side of the face. use over the counter antibiotic eye drops for at least 14 days. avoid watching tv or using a computer for more than 1 hr at a time. rinse the eye on the affected side with normal saline daily for 1 week.
avoid rubbing the eye on the affected side of the face.
sign of hypoxemia? blue colored lips cap refill < 3 secs pink mucous membranes RR 15
blue colored lips
A healthcare provider and nurses are discussing treatment options with a client diagnosed with severe ulcerative colitis. When providing client teaching during early treatment, the symptoms of which diagnosis would be discussed? Bowel herniation gastritis bowel perforation bowel outpouching
bowel perforation
A patient with metastatic osteosarcoma states that he all of a sudden has severe pain. The nurse notes that the patient has a fentanyl patch that was placed a couple of hours ago what type of pain is this patient experiencing? referred pain. breakthrough pain. neuropathic pain. chronic pain.
breakthrough pain.
why are antihistamines usually not prescribed to patients who have a respiratory infection? can make it easier for secretions to be cleared. can cause excessive fluid build up and make secretions difficult to clear. can cause excessive fluid build up.
can cause excessive fluid build up and make secretions difficult to clear.
Should nurses expect to assess with the patient who is not getting enough oxygen? cap refill deep tendon reflexes mucous membranes hepatosplenomegaly
cap refill
the nurse is caring for a woman recently dxed with viral hep A. which individual should the nurse refer for an immunoglobulin injection? caregiver who lives in the same house with the pt relative with a hx of hep A who visits pt daily child living in the home who received hep A vaccine 3 months ago friend who delivers meals to the pt and family each week
caregiver who lives in the same house with the pt
THE NURSE IS ASSESSING A CLIENTS CRANIAL NERVES AS PART OF A NEUROLOGICAL EXAMINATION. WHICH OF THE FOLLOWING ACTIONS SHOULD THE NURSE TAKE TO ASSESS CRANIAL NERVE THREE? test visual acuity elicit the gag reflex observe for facial symmetry check the pupillary response to light
check the pupillary response to light
the nurse is teaching the pt about their new dx of coronary artery disease. which modifiable risk factor should the nurse discuss about decreasing the formation of atherosclerosis? cholesterol age gender family hx
cholesterol
the term blue bloater refers to which condition
chronic obstructive bronchitis
an HCP recently dxed a pt with Raynaud's disease, the pt asks asks what might trigger the vasospasm from occuring? cold weather hot weather rain wind
cold weather
an older adult female has a bone density test that reveals severe osteoporosis. What does the nurse understand can be a problem for this client due to the decrease in bone mass and density? Compression fractures hypertension cardiac disease diabetes
compression fractures
what hormone deficiency is responsible for Addison's disease? thyroxine growth hormone insulin cortisol
cortisol
what is not a symptom of status asthmaticus crackles wheezing SOB anxiety
crackles
what assessment finding of a patient with acute pancreatitis would indicate a bluish discoloration around the umbilicus? rovsing's sign homan's sign grey-turner's sign cullen's sign
cullen's sign
which disease is more likely to cause weight gain and central obesity addison's disease type 1 diabetes hyperthyroidism cushing's disease
cushing's disease
a pt has recently been diagnosed with SIADH. Which clinical finding would the nurse expect to find? increased urine output decreased urine output increased serum sodium increased serum osmolality
decreased urine output
A client with an abdominal surgical wound sneezes and then states something doesn't feel right with my wound. The nurse assesses the upper half of the wound edges, noticing that they are no longer approximated and the lower half remains well approximated. The nurse would document that following a sneeze the wound _____. dehisced eviscerated pustulated hemorrhaged
dehisced
a nurse cares for a pt who is prescribed lactulose. the client states, i do not want to take this medication because it causes diarrhea. how should the nurse respond? we will need to send a stool specimen to the lab. diarrhea is expected, that's how your body gets rid of ammonia do not take any more of the medication until your stools firm up you make take kaopectate liquid daily for loose stools
diarrhea is expected, that's how your body gets rid of ammonia
the son of a pt with COPD asks the nurse how co2 and o2 are exchanged across the pulmonary capillaries and the alveoli. the nurse responds it is a process of osmosis active transport diffusion filtration
diffusion
what lung sounds do you expect to hear in someone who has atelectasis?
diminished with crackles
a group of nurses have attended an in-service on the prevention of occupationally acquired diseases that affect health care providers. what action has the greatest potential to reduce a nurses risk of acquiring hep C in the workplace. performing meticulous hand hygiene at the appropriate moments in care disposing of sharps appropriately and not recapping needles wearing an N95 mask when providing care for clients on airborne precautions adhering to the recommended schedule of immunizations
disposing of sharps appropriately and not recapping needles
an HIV negative pt who has HIV+ partner asks the nurse about receiving Truvada. What information is most important to teach the pt about this drug? reduces the number of HIV tests you will need. does not reduce the need for safe sex practices. has been taken off the market due to increases in cancer. is only used for postexposure prophylaxis.
does not reduce the need for safe sex practices.
a nurse is assessing a pt who has a suspected stroke. the nurse should place priority on which of the following findings? dysphagia aphasia ataxia hemianopsia
dysphagia
What are the 3 nursing interventions for someone who has atelectasis? educating how to use incentive spirometer. early mobilization. staying in bed. educating about deep breathing exercises.
educating how to use an incentive spirometer. early mobilization. educating about deep breathing exercises.
a Healthcare provider diagnoses primary osteoporosis in a patient who has lost power in mass. For which client is primary osteoporosis most common? young menstruating woman. elderly postmenopausal woman. elderly man. young child.
elderly postmenopausal woman.
a nurse is assessing a client which chronic airflow limitation and notes that the client has a barrel chest. the nurse interprets that this client has which of the following forms of chronic airflow limitation? emphysema bronchial asthma chronic obstructive bronchitis bronchial asthma and bronchitis
emphysema
The nurse is caring for a postop client with a Hemovac. The Hemovac is expanded and contains approximately 25 cc of serosanguinous drainage. the best nursing action would be to: empty and measure the drainage and compress the Hemovac Remove the Hemovac because it is expanded Notify the surgeon that the Hemovac is not functioning Assess the clients wound and apply a pressure dressing
empty and measure the drainage and compress the Hemovac
The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine, Pepcid, when which symptom is relieved? epigastric pain vomitting belching difficulty swallowing
epigastric pain
True or false. As a result of the physiologic changes that happen with aging, the older adult has an increased metabolic rate and requires an average 200 cal more than a middle-aged adult
false
An ileostomy was just created in a patient with ulcerative colitis. The nurse assesses the patient in the immediate postop period for which most frequent complication of this type of surgery? fluid and electrolyte imbalance. folate deficiency. malabsorption of fat. intestinal obstruction.
fluid and electrolyte imbalance
a pt has residual dysphagia after suffering from a recent cerebrovascular accident. When a diet order is initiated, the nurse avoids doing which of the following? giving the pt thin liquids. thickening liquids to the consistency of oatmeal. allowing plenty of time for chewing and swallowing. placing food on the unaffected side of the mouth.
giving the pt thin liquids.
Patient is exhibiting an altered level of consciousness due to blood force trauma to the head. A nurse is assessing the patient in the ED. The nurse should first gauge the patient's LOC on the results of what assessment tool? glasgow coma sclae monro-kellie hypothesis cranial nerve functions mental status examination
glasgow coma scale
a patient with heart failure just had an ICD place. The patient during recovery is experiencing anxiety. What action should the nurse and not do to promote physical comfort and provide psychological support. Talk about the side effects of acute decompensation Have the patient lay down in the bed have the pt sit in a recliner provide supplemental o2
have the pt sit in a recliner
hyperthyroidism is caused by increased levels of thyroxine in blood plasma. the nurse understands that a client with this endocrine dysfunction experiences: -heat intolerance and systolic hypertension -anorexia and hypoexcitability - lethargy and weakness - cold intolerance and constipation
heat intolerance and systolic HTN
which of the following is NOT an appropriate recommendation for an exercise program for the pt with heart failure? after exercising for 30 mins, have a rest period with a cool down activity. remember to wait 2 hours after a meal before performing exercise activity. begin with low impact activities such as walking. high intensity training will provide the most benefit.
high intensity training will provide the most benefit.
a triage nurse in the ED is assessing a client who presented with reports of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this client's presentation? to the best of your knowledge, are your immunizations up to date? has anyone in your family ever experienced symptoms similar to yours? have your ever worked in an occupation where you might have been exposed to toxins? how many alcoholic drinks do you typically consume in a week?
how many alcoholic drinks do you typically consume in a week?
teaching for a pt with COPD should include which of the following topics? how to recognize the signs of an impending respiratory infection how to treat respiratory infections without going to the physician how to increase o2 therapy how to have his wife learn to listen to his lungs with a stethoscope
how to recognize the signs of an impending respiratory infection
A client with a history of Addison's disease and flu like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he woke up that morning. The clients blood pressure is 90-58, pulse is 116, temperature is 101?,. A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by IV infusion ? potassium insulin hydrocortisone morphine
hydrocortisone
the nurse is planning care for a pt with a fluid imbalance. the nurse knows that water and electrolytes flow from the arterial capillary bed into the interstitial fluid. what is the reason this occurs? venous pressure hydrostatic pressure active transport oncotic pressure
hydrostatic pressure
which electrolyte imbalance poses the greatest risk for cardiac arrest? hypernatremia hyperkalemia hypermagnesemia hypercalcemia
hyperkalemia
which of the following symptoms is more commonly seen with pt's with Addison's disease compared to Cushing's syndrome? hyperpigmentation weight gain moon face HTN
hyperpigmentation
which electrolytes imbalance is a pt with SIADH at risk for? hypernatremia hypokalemia hyperkalemia hyponatremia
hyponatremia
a burn pt is admitted to the floor that you are assigned. upon your initial assessment, the pt has s/s of third spacing. based on this change in state, what imbalance does the pt exhibit? hypernatremia hypovolemia hyperkalemia hypervolemia
hypovolemia
a nurse assesses a client on the med surg unit. which statement made by the client should alert the nurse to the possibility of hypothyroidism? i am always tired, even with 12 hours of sleep. i seem to feel the heat more than other people. food just doesn't taste good without a lot of salt. my sister has thyroid problems.
i am always tired, even with 12 hours of sleep.
the nurse obtains a hx from a pt with a diagnosis of cirrhosis. which statement from the pt is most directly related to the development of the diagnosis? i have been drinking about a fifth of vodka a day for the last few years. since my spouse left me 5 months ago i have been eating terribly for the past several weeks i have not slept for more than 5 hours a night my spouse was a heavy smoker and i am concerned about second hand smoke
i have been drinking about a fifth of vodka a day for the last few years.
a patient was recently dxed with left sided heart failure. when the nurse explains what this means to the pt which is correct? inability of the left ventricle to fill or eject sufficient blood into the systemic circulation. inability of right ventricle to fill or eject sufficient blood into the pulmonary circulation.
inability of the left ventricle to fill or eject sufficient blood into the systemic circulation.
a nurse is caring for a client who has had a stroke involving the right hemisphere. Which is the following alterations in function should the nurse expect? inability to recognize his family members. difficulty reading. right hemiparesis. aphasia.
inability to recognize his family members
an older adult is admitted for end stage liver disease. because the pt is an older pt, what s/s is part of the normal aging process? spongy skin over hydration skin turgor is not able to be assessed inelastic skin turgor
inelastic skin turgor
a nurse is preparing to hang the initial bag of the total parenteral nutrition, TPN, solution via the central line of a malnourished patient for a continuous dose. The nurse ensures the availability of which medical equipment before hanging the solution? nebulizer glucometer dressing tray infusion pump
infusion pump
the patient with sudden pain in the upper left quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention should the nurse expect to include in the patient's plan of care? immediately start enteral feeding to prevent malnutrition. insert an NG and maintain NPO status to allows pancreas to rest. Administer acetaminophen q4 hrs for pain relief. initiate early prophylactic antibiotic therapy to prevent infection.
insert an NG and maintain NPO status to allows pancreas to rest.
mr miller was just diagnosed with arterial insufficiency and he states that when he walks he gets a muscular cramp like pain that is relieved when he sits down. He asks the nurse what this might be and she tells him that this is called: intermittent claudication thrombophlebitis orthopnea thromboangitis obliterans
intermittent claudication
The nurse is caring for a patient following a bill of wrath to operative procedure. Which postop prescription should the nurse question and verify? irrigating the nasogastric tube leg exercises early ambulation coughing and deep breathing exercises
irrigating the nasogastric tube
Nurse is assessing an unconscious patient and observes that the patient's pupils are fixed and dilated. What is the most plausible clinical significance of the nurses finding? it indicates an injury at the midbrain level. it suggests an onset of a metabolic abnormality. it indicates paralysis at cranial nerve X. it indicates paralysis on the right side of the body.
it indicates an injury at the midbrain level.
A cardiologists is speaking with a nurse about a patient's myocardial infarction location after the cardiac Catheterization was performed. The physician explains that there was a blockage in the large artery that supplies the anterior wall of the left ventricle. As the nurse which of the arteries is he referring to? posterior descending coronary artery (PDA). left anterior descending coronary artery (LAD). Right coronary artery (RCA). Circumflex coronary artery.
left anterior descending coronary artery
A family member of a patient with left sided congestive heart failure is trying to figure out how the oxygenated blood get from the heart to the periphery. To help the family understand, which chamber of the heart ejects oxygenated blood into the systemic circulation? right ventricle left ventricle right atrium left atrium
left ventricle
a nurse cares for a pt with hepatic portal-systemic encephalopathy (PSE). The pt is thin and cachectic in appearance, and the family expresses distress that the pt is receiving little dietary protein. How should the nurse respond? low dietary protein is needed to prevent fluid from leaking into the abdomen. a low protein diet will help the liver rest and will restore liver fx. increasing dietary protein will help the client gain weight and muscle mass. less protein in the diet will help prevent confusion associated with liver failure.
less protein in the diet will help prevent confusion associated with liver failure.
Nurse is providing discharge instructions to a patient that just had a gastrectomy and states the patient should do which of the following to prevent dumping syndrome? limit fluids between meals. sit in a high-fowler's position during meals. eat high-carb foods. ambulate following meals.
limit fluids between meals.
which cancer is the leading cancer killer in the US
lung
During a routine mammogram a patient asks the nurse whether breast cancer causes the most deaths. which type of cancer is the leading cause of death in the United States?
lung cancer
The nurse is examining a patient foot and ankle after a patient reports pain in the foot after stepping on a nail in the road three days ago. The patient has a prominent red streak running up his foot and ankle. Which of the following does the nurse suspect is happening? lymphagitis local inflammation cellulitis elephantiasis
lymphagitis
which Opioid analgesic is the most appropriate to give for an opioid naïve patient in severe pain from a hip fracture? fentanyl oxycodone hydromorphone morphine sulfate
morphine sulfate
A patient with acute on chronic pain will be managed using what type of analgesic regimen? multimodal therapy opioid analgesic non-opioid analgesic monotherapy
multimodal therapy
a pt recently diagnosed with thyroid cancer underwent a partial thyroidectomy and a significant amount of the parathyroid was also removed during surgery. As the nurse, which response should the nurse prioritize when taking care of the post-op pt to avoid potential complications? I was feeling flushed after the surgery. my eye keeps twitching and I can't control it. after i felt dizzy, but now i am feeling better. i don't feel like my muscle and bones are aching as much.
my eye keeps twitching and I can't control it.
The nurse on a cardiac telemetry floor is reviewing the lab results for a patient who was recently transferred from the critical intensive care unit. After reviewing, the nurse notes that the cardiac troponins T level was performed during this time in the CCU. The nurse knows that this test was performed to assist in diagnosing which condition? raynauds disease stable angina myocardial infarction atrial fibrillation
myocardial infarction A hs Troponin T above 30 ng/l is more likely to be consistent with an MI. The higher the hs Troponin T level the more likely the patient has had an MI
A family member is caring for an older adult patient with osteomalacia in the home. When the home health nurse comes to evaluate patient, what should be a focus point of the visit? ensuring that the pt is eating enough. making sure the pt has adequate financial resources. observing for safety hazards that could be a fall risk. making sure the client is receiving a daily bath.
observing for safety hazards that could be a fall risk.
During the first 24 hours after a patient is diagnosed with addisonian crisis which of the nurse perform frequently? obtains VS weigh pt measure abdominal girth administer insulin
obtain VS
Nurse explains to the patient with gastroesophageal reflux disease that this disorder: often involves relaxation of the lower esophageal sphincter allowing stomach contents to back up into the esophagus. Results in acid erosion and ulceration of the esophagus caused by frequent vomiting. Will require surgical wrapping or repair of the pyloric sphincter to control the symptoms. Is the protrusion of a portion of the stomach into the esophagus through an opening in the diaphragm.
often involves relaxation of the lower esophageal sphincter allowing stomach contents to back up into the esophagus.
immediately following a liver biopsy, the nurse places a client in which position on the right side on the left side prone supine
on the right side applies pressure, prevents bleeding/hemorrhage
which of the following can cause hypophosphatemia oncogenic osteomalacia hypercalcemia hypoparathyroidism hypoglycemia
oncogenic osteomalacia
The nurse is doing an assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active the nurse should assess for which symptom that is most consistent with a duodenal ulcer? pain relieved by food intake weight gain pain radiating to the right shoulder nausea and vomiting
pain relieved by food intake
The nurse is caring for a patient who has just been told that stage four colon cancer has recurred and metastasized to the liver. The tumor is creating pressure in the abdomen that the patient reports is increasingly uncomfortable. The oncologist refers the patient the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer? palliative reconstructive curative salvage
palliative
the nurse is teaching a pt about a high protein diet. the nurse determines additional teaching is required when the patient chooses what from the menu? baked salmon, lima beans, and custard. turkey and cheese sandwich, low fat yoghurt. grilled chicken salad with avocado and skim milk peanut butter and jelly sandwich, chips, and fruit drink
peanut butter and jelly sandwich, chips, and fruit drink
The nurse provides care for a patient in buck traction. The client reports pain in the affected extremity, and the nurse administers the prescribed medication. One hour later the patient states I don't know why but the pain isn't getting better. Which action does the nurse take first? performs a neurovascular assessment assess the level of the pt's pain offers pt a back rub contacts the healthcare provider
performs a neurovascular assessment
in a hospital a patient has experienced a seizure. In the immediate recovery what action best protects the patients safety? pad the bed rails place pt is side lying position administer anti anxiety meds as prescribed reassure pt and family
place in side lying position
the nurse is caring for a pt that they suspect has digoxin toxicity. in addition to the physical assessment, which electrolyte should the nurse closely monitor? sodium phosphorous chloride potassium
potassium
the most abundant electrolyte in the extracellular fluid, sodium, is regulated by all of the following except potassium intake antidiuretic hormone renin-angiotensin-aldosterone system thirst
potassium intake
which factors predispose patients to hospital acquired pneumonia? SATA: prolonged hospitalization chronic illnesses deep breathing and coughing malnutrition risk for aspiration intubation
prolonged hospitalization chronic illnesses malnutrition risk for aspiration intubation
which nursing action is a primary cancer prevention strategy? teaching testicular self-exams encouraging yearly paps promoting and providing vaccines facilitating annual mammograms
promoting and providing vaccines
in which position in the hospital bed improves oxygenation in pts with ARDS: acute respiratory distress syndrome prone side lying on left side lying on right supine
prone
a woman with a family hx of breast cancer received a positive BRCA 1 test and is requesting a bilateral mastectomy. this is an example of which type of oncologic surgery? prophylactic surgery salvage surgery reconstructive surgery palliative surgery
prophylactic surgery
a nurse cares for a pt who has cirrhosis of the liver. which action should the nurse take to decrease the presence of ascites? increase oral fluid intake weigh the client daily provide a low sodium diet monitor intake and output
provide a low sodium diet
a nurse on a cardiovascular floor is teaching her nursing student about the importance of measuring an ankle brachial index (ABI) to measure the degree of stenosis. she explains a baseline should be done for pts with certain risk factors. which risk factor would not indicate an ABI needs to be performed? pt is 45 y.o. pt has 20 yr hx of smoking. pt dxed with DM. pt has decreased pedal pulses bilaterally.
pt is 45
after a nurse is done getting the h+p from a pt with complex medical issues, which assessment finding indicates the pt is at an increased risk for developing heart failure? pt takes furosemide 20 mg daily. pt is caucasian. pt is 72 years old. pt has a potassium level of 4.5
pt is 72 years old
what is not a non-pulmonary assessment finding of patients with CF? pulmonary hypertension depression pancreatic insufficiency anorexia
pulmonary HTN
The nurse receives a patient from the emergency room being admitted for anginal pain and dyspnea. In order to continually monitor the patient's respiratory status which item is best to monitor the patient's respiratory status? pulse oximetry oxygen flowmeter cardiac telemetry count respirations
pulse oximetry
The nurse is providing care for a patient with a recent trasverse colostomy. Which observation requires immediate notification to the provider? purple discoloration of the stoma. beeft, red, shiny stoma. semiformal stool found in the ostomy pouch. skin excoriation around stoma.
purple discoloration of the stoma.
the nurse understands which factor is most likely the source of a pt that was dxed with hep D? practicing poor hygiene receiving blood transfusion eating infected shellfish overly exerting oneself
receiving blood transfusion
what health promotion strategy can improve an older adults ability to taste and smell?
recommending smoking cessation
a pt was dxed with cellulitis. on physical assessment, which finding does the nurse expect to find? red, swollen skin with inflammation spreading to surrounding tissues. painful skin that is swollen and pale in color. cold, red skin small, localized blackened area of skin.
red, swollen skin with inflammation spreading to surrounding tissues.
a client with liver disease has developed ascites; the nurse is collaborating with the client to develop a nutritional plan. The nurse should prioritize which of the following in the client's plan? reduction in sodium intake. increased potassium diet. high protein, low fat diet. increased fiber intake.
reduction in sodium intake.
a nurse is planning discharge teaching for the family of an older adult pt who has hemianopsia and is at risk for falls. Which of the following instructions should the nurse include? remind the client to scan their complete range of vision during ambulation. keep the client's personal care items in the bathroom. keep the overhead lights on in the client's bedroom while the client is sleeping. secure the client's extension cords under carpeting.
remind the client to scan their complete range of vision during ambulation.
a pt with multiple sclerosis asks the nurse how they can reduce their level of fatigue. The nurse response should tell the pt: rest in an air conditioned room as needed. take a hot bath. avoid taking naps during the day. remember to increase the dose of the muscle relaxants.
rest in an air conditioned room as needed.
the nurse is caring for a female pt who begins to experience a seizure while laying in bed. Which of the following actions by the nurse would be contraindicated? restraining the client's limbs. loosening restrictive clothing. removing the pillow and raising padded side rails. positioning the pt to the side, if possible, with the head flexed forward.
restraining the client's limbs.
The clients decreased mobility has been attributed to an auto immune reaction originating in the synovial tissue, which caused the formation of pannus. this client has been dxed with which health problem?
rheumatoid arthritis
The nurse is monitoring a patient with a diagnosis of a peptic ulcer. Which assessment findings should the nurse immediately report to the provider to indicate a perforated ulcer? nausea rigid, board-like abdomen numbness in legs bradycardia
rigid, board-like abdomen
what diagnositc test is most appropriate to determine thyroid activity? thyroid scan US serum T3, T4 levels serum TSH level
serum T3, T4 levels
a pt comes to ED with severe abdominal pain, n/v. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which lab test? serum potassium serum amylase serum bilirubin serum calcium
serum amylase
A patient is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy induced complication? serum potassium level of 2.6 urine output of 400 ml in 8 hrs blood pressure 120/64 to 130/72 sodium 142
serum potassium of 2.6 normal range: 3.5 to 5.2 mEq/L for adults
the nurse finished performing a physical assessment on her morning patient and she notices the legs have edema and a pooling of blood in the veins of the lower extremities. The nurse suspects the diagnosis of chronic venous insufficiency. Which other assessment finding should the nurse expect to see? skin hyperpigmentation absent pedal pulses intermittent claudication circular ulcer
skin hyperpigmentation
The public health nurse is presenting a health promotion class to a group at a local community center. which intervention most directly addresses the leading cause of cancer deaths in north america? smoking cessation monthly self-breast exams annual colonoscopies monthly testicular exams
smoking cessation
a nurse is caring for a pt admitted with liver disease and ascites. Which diuretic medication would most often be used for a pt with ascites? spironolactone lactulose lasix ammonia
spironolactone
the majority of bone infections are caused by which organism? staphylococcus aureus pseudomonas proteus escherichia coli
staphylococus aureus
Pain management nurse speaks with the patient about how to avoid constipation after starting their prescribed opioid. The nurse knows the patient understands when he states which response? I will decrease my fluid intake. I will decrease my exercising. I will start on a stool softener. I will start using bulk enemas.
stool softener
our primary prevention strategy a pt can make to reduce chance of developing peripheral vascular disease: stop smoking wear sunscreen lessen exercises to two times a week pushing self during exercises
stop smoking
A patient has been taking ibuprofen for the last several days but states that every time they take it their stomach has gotten upset. What advice can a nurse give to help with the gastric irritation? take with coffee. make sure to have on empty stomach. take with grapefruit juice. take with milk.
take with milk
the nurse is teaching a male pt with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the pt that this can be prevented most effectively by: taking medications on time to maintain therapeutic blood levels. eating large well-balanced meals. doing muscle strengthening exercises. doing all chores early in the day while less fatigued.
taking medications on time to maintain therapeutic blood levels.
ageism can be defined as:
the prejudice or discrimination against older adults
the nurse is assigned to care for a male pt with complete right-sided hemiparesis. The nurse plans care knowing that this condition: the pt has weakness on the right side of the body, including the face and tongue. the pt has lost the ability to move the right arm but is able to walk independently. the pt has lost the ability to move the right arm but is able to walk independently. the pt has complete bilateral paralysis of the arms and legs.
the pt has weakness on the right side of the body, including the face and tongue.
the nurse identifies which s/s as an early indication of fluid volume deficit? weak pulse thirst weakness hypotension
thirst
which hormone is primarily responsible for regulating the body's metabolic rate? triiodothyronine, T3 calcitonin parathyroid hormone, PTH
triiodothyronine, T3
fluid overload and decreased tissue perfusion result when the heart cannot generate cardiac output (CO) sufficient to meet the body's demands for o2 and nutrients. true or false
true
the function of the fluid in the pleural space is to lubricate and allow pleura to move smoothly within the chest cavity true or false
true
the target o2 sat for a pt with COPD is different than that of a pt with community acquired pneumonia true or false
true
The home health nurse is performing a home health visit for an oncology patient discharged three days ago after completing chemotherapy treatment for non-Hodgkin's lymphoma. The nurses priority assessment should include examination for the signs and symptoms of which complication? tumor lysis syndrome (TLS) SIADH disseminated intravascular coagulation, DIC hypercalcemia
tumor lysis syndrome, TLS
a nurse and a certified nurse assistant are caring for a pt who has bacterial meningitis. the nurse should give the CNA which of the following instructions? wear a mask. wear a gown. keep the pt's room well-lit. maintain the head of the bed at 45 degrees elevation.
wear a mask
