Week 10 Canvas Quiz

A client's assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is performing the health interview, what assessment questions address likely etiologic factors? Select all that apply. "Have you ever been diagnosed with gallstones?" "Have you ever been tested for diabetes?" "Does anyone in your family have cystic fibrosis?" "How many alcoholic drinks do you typically consume in a week?" "Would you say that you eat a particularly high-fat diet?"

"Have you ever been diagnosed with gallstones?" "Have you ever been tested for diabetes?" "How many alcoholic drinks do you typically consume in a week?" "Would you say that you eat a particularly high-fat diet?" RATIONALE: Eighty percent of clients with acute pancreatitis have biliary tract disease such as gallstones or a history of long-term alcohol abuse. Diabetes and high-fat consumption are also associated with pancreatitis. Cystic fibrosis is not a noted etiologic factor for pancreatitis.

A nurse cares for an older adult client and teaches the client about age-related changes of the biliary tract. What statements will the nurse include when discussing age-related changes that occur in the pancreas of the older adult? Select all that apply. "The pancreas decreases secretion of enzymes with age." "The pancreas develops fibrous material with age." "The pancreas develops fatty deposits with age." "The pancreas enlarges and atrophies with age." "The pancreas decreases bicarbonate secretion with age."

"The pancreas decreases secretion of enzymes with age." "The pancreas develops fibrous material with age." "The pancreas develops fatty deposits with age." "The pancreas decreases bicarbonate secretion with age." RATIONALE: Age-related changes to the pancreas include: the development of fibrous material and fatty deposits, as well as decreased secretion of both pancreatic enzymes and bicarbonate. The pancreas remains the same size as the client ages and atrophy is not a normal age-related finding.

The patient asks the nurse if the placement of the autograft over his full-thickness burn will be the only surgical intervention needed to close his wound. The nurse's best response would be: "An autograft is a biological dressing that will eventually be replaced by your body generating new tissue." "Yes, an autograft will transfer your own skin from one area of your body to cover the burn wound." "Unfortunately, an autograft skin is a temporary graft and a second surgery will be needed to close the wound." "Unfortunately, autografts frequently do not adhere well to burn wounds and a xenograft will be necessary to close the wound."

"Yes, an autograft will transfer your own skin from one area of your body to cover the burn wound." RATIONALE: The autograft is the only permanent method of grafting, and it uses the patient's own tissue to cover the burn wound. Autografting is permanent and does not require a second surgery unless the graft fails. A biological or biosynthetic graft or dressing is a temporary wound covering. A xenograft is from an animal, usually pig skin, and is a temporary graft.

The nurse caring for a client with diverticulitis is preparing to administer the client's medications. The nurse anticipates administration of which category of medication because of the client's diverticulitis? Antianxiety Anti-inflammatory Antispasmodic Antiemetic

Antispasmodic RATIONALE: The nurse anticipates administration of antispasmodic medication to decrease intestinal spasm associated with diverticulitis. The client may also be ordered an opioid analgesic to relieve the associated pain. There is no indication that the client needs antianxiety, antiemetic, or anti-inflammatory medications at this time.

The patient is admitted with end-stage liver disease. The nurse evaluates the patient for which of the following? (Select all that apply.) Ascites Disseminated intravascular coagulation Hypoglycemia Hypercoagulation Malnutrition

Ascites Disseminated intravascular coagulation Malnutrition. RATIONALE: Altered carbohydrate metabolism may result in unstable blood glucose levels. The serum glucose level is usually increased to more than 200 mg/dL. This condition is termed cirrhotic diabetes. Altered carbohydrate metabolism may also result in malnutrition and a decreased stress response. Protein metabolism, albumin synthesis, and serum albumin levels are decreased. Low albumin levels are also thought to be associated with the development of ascites, a complication of hepatic failure. Fibrinogen is an essential protein that is necessary for normal clotting. A low plasma fibrinogen level, coupled with decreased synthesis of many blood-clotting factors, predisposes the patient to bleeding. Clinical signs and symptoms range from bruising and nasal and gingival bleeding to frank hemorrhage. Disseminated intravascular coagulation may also develop

A nurse is aware that both the sympathetic and parasympathetic portions of the autonomic nervous system affect GI motility. What are the actions of the sympathetic nervous system? Select all that apply. Causes blood vessel constriction Relaxes the sphincters Increases secretary activities Creates an inhibitory effect on the GI tract Decreases gastric motility

Causes blood vessel constriction Creates an inhibitory effect on the GI tract Decreases gastric motility RATIONALE: Generally, the sympathetic nervous system inhibits the gastrointestinal tract and the parasympathetic nerve stimulates the tract, increasing peristalsis and secretary activities.

The nurse is caring for patient who has been struck by lightning. Because of the nature of the injury, the nurse assesses the patient for which of the following? Stress ulcers Infection Central nervous system deficits Contractures

Central nervous system deficits RATIONALE: Lightning injury frequently causes cardiopulmonary arrest. However, of those patients who survive, 70% will have transient central nervous system deficits. Contractures, infection, and stress ulcer risks are no greater than with other causes of burn injury.

A 36-year-old driver was pulled from a car after it collided with a tree and the gas tank exploded. What assessment data suggest the patient suffered tissue damage consistent with a blast injury? Crackles (rales) on auscultation of bilateral lung fields Responsive only to painful stimuli Blood pressure 82/60 mm Hg, heart rate 122 beats/min, respiratory rate 28 breaths/min Irregular heart rate and rhythm

Crackles (rales) on auscultation of bilateral lung fields RATIONALE: Explosive blast energy generates shock waves that create changes in air pressure, causing tissue damage. Initially after an explosion, there is a rapid increase in positive pressure for a short period, followed by a longer period of negative pressure. The increase in positive pressure injures gas-containing organs. The tympanic membrane ruptures, and the lungs may show evidence of contusion, acute edema, or rupture. A low blood pressure and corresponding tachycardia are more suggestive of hypovolemia. Lack of response to stimuli suggests a neurological injury. An irregular heart rate and rhythm may be associated with blunt trauma to the heart (e.g., cardiac contusion).

The nurse is caring for a patient receiving intravenous ibuprofen for pain management. The nurse recognizes which laboratory assessment to be a possible side effect of the ibuprofen? Platelet count 350,000 billion/L White blood count 13, 550 mm3 ALT 25 U/L Creatinine: 3.1 mg/d

Creatinine: 3.1 mg/d RATIONALE: Ibuprofen can result in renal insufficiency, which may be noted in an elevated serum creatinine level. Thrombocytopenia (low platelet count) is another possible side effect. This platelet count is elevated. An elevated white blood count indicates infection. Although ibuprofen is cleared primarily by the kidneys, it is also important to assess liver function, which would show elevated liver enzymes, not low values such as shown here.

A client with peptic ulcer disease wants to know nonpharmacologic ways to prevent recurrence. Which of the following measures would the nurse recommend? Select all that apply. Following a regular schedule for rest, relaxation, and meals Smoking cessation Avoidance of alcohol Substituting decaffeinated products for all forms of coffee Eating whenever hungry

Following a regular schedule for rest, relaxation, and meals Smoking cessation Avoidance of alcohol Substituting decaffeinated products for all forms of coffee RATIONALE: The likelihood of recurrence is reduced if the client avoids smoking, coffee (including decaffeinated coffee) and other caffeinated beverages, and alcohol. It is important to counsel the client to eat meals at regular times and in a relaxed setting and to avoid overeating.

The nurse educator is reviewing the blood supply of the GI tract with a group of medical nurses. The nurse is explaining the fact that the veins that return blood from the digestive organs and the spleen form the portal venous system. What large veins will the nurse list when describing this system? Select all that apply. Inferior mesenteric vein Gastric vein Saphenous vein Inferior vena cava Splenic vein

Inferior mesenteric vein Gastric vein Splenic vein RATIONALE: This portal venous system is composed of five large veins: the superior mesenteric, inferior mesenteric, gastric, splenic, and cystic veins, which eventually form the vena portae that enters the liver. The inferior vena cava is not part of the portal system. The saphenous vein is located in the leg.

Which is a true statement regarding the nursing considerations in administration of metronidazole? The drug should be given before meals. Metronidazole decreases the effect of warfarin. It may cause weight gain. It leaves a metallic taste in the mouth

It leaves a metallic taste in the mouth. RATIONALE: Metronidazole leaves a metallic taste in the mouth. It may cause anorexia and should be given with meals to decrease gastrointestinal upset. Metronidazole increases the blood-thinning effects of warfarin.

The nurse recognizes that which patient is likely to benefit most from patient-controlled analgesia (PCA)? Postoperative patient who had elective bariatric surgery Patient with a femur fracture and closed head injury Patient with a C4 fracture and quadriplegia

Postoperative patient who had elective bariatric surgery RATIONALE: The patient undergoing bariatric surgery (an elective procedure) is the best candidate for PCA as this patient should be awake, cognitively intact, and will have the acute pain related to the surgical procedure. The quadriplegic would be unable to operate the PCA pump. The cardiac surgery patient with mild dementia may not understand how to operate the pump. Likewise, the patient with the closed head injury may not be cognitively intact.

A nurse is caring for a client admitted with a suspected malabsorption disorder. The nurse knows that one of the accessory organs of the digestive system is the pancreas. What digestive enzymes does the pancreas secrete? Select all that apply. Trypsin Ptyalin Pepsin Amylase Lipase

Trypsin Amylase Lipase RATIONALE: Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein; amylase, which aids in digesting starch; and lipase, which aids in digesting fats. Pepsin is secreted by the stomach and ptyalin is secreted in the saliva.

The nurse is caring for a patient who has circumferential full-thickness burns of his forearm. A priority in the plan of care is to prepare for an escharotomy as a prophylactic measure. to splint the forearm. active or passive range-of-motion exercises every hour. to keep the extremity in a dependent position.

active or passive range-of-motion exercises every hour. RATIONALE: Special attention is given to circumferential (completely surrounding a body part) full-thickness burns of the extremities. Pressure from bands of eschar or from edema that develops as resuscitation proceeds may impair blood flow to underlying and distal tissue. Therefore, extremities are elevated to reduce edema. Active or passive range-of-motion (ROM) exercises are performed every hour for 5 minutes to increase venous return and to minimize edema. Peripheral pulses are assessed every hour, especially in circumferential burns of the extremities, to confirm adequate circulation. If signs and symptoms of compartment syndrome are present on serial examination, preparation is made for an escharotomy to relieve pressure and to restore circulation. Splinting is not as important as providing range of motion. If done, splinting must keep the affected extremity in a functional position.

The patient is admitted with acute pancreatitis and is demonstrating severe abdominal pain, vomiting, and ascites. Using the Ranson classification criteria, the nurse determines that this patient has a 15% chance of dying. has no chance of survival. has a 99% chance of survival. has a 40% chance of dying.

has a 15% chance of dying. RATIONALE: Patients with acute pancreatitis can develop mild or fulminant disease. As a consequence, research has addressed criteria for predicting the prognosis of patients with acute pancreatitis. The early classification criteria were developed by Ranson, who suggested that the number of signs present within the first 48 hours of admission directly relates to the patient's chance of significant morbidity and mortality. In Ranson's research, patients with fewer than three signs had a 1% mortality rate, those with three or four signs had a 15% mortality rate, those with five or six signs had a 40% mortality rate, and those with seven or more signs had a 100% mortality rate.

Tissue damage from burn injury activates an inflammatory response that increases the patient's risk for acute kidney injury. acute respiratory distress syndrome. infection. stress ulcers.

infection. RATIONALE: The loss of skin as the primary barrier against microorganisms and activation of the inflammatory response cascades results in immunosuppression, placing the patient at an increased risk of infection. A systemic inflammatory response syndrome (SIRS) also increases the risk of acute kidney injury in the presence of poor tissue perfusion. Acute respiratory distress syndrome is also a potential complication, but the risk of infection is greater because of the loss of the skin barrier. Catecholamine release and gastrointestinal ischemia are the causes of stress ulcers.

Nursing priorities for the management of acute pancreatitis include: (Select all that apply.) managing respiratory dysfunction. utilizing supportive therapies aimed at decreasing gastrin release. withholding analgesics that could mask abdominal discomfort. assessing and maintaining electrolyte balance. stimulating gastric content motility into the duodenum.

managing respiratory dysfunction. utilizing supportive therapies aimed at decreasing gastrin release. assessing and maintaining electrolyte balance. RATIONALE: Nursing and medical priorities for the management of acute pancreatitis include several interventions. Managing respiratory dysfunction is a high priority. Fluids and electrolytes are replaced to maintain or replenish vascular volume and electrolyte balance. Analgesics are given for pain control, and supportive therapies are aimed at decreasing gastrin release from the stomach and preventing the gastric contents from entering the duodenum.

The nurse is caring for a patient who requires administration of a neuromuscular blocking agent to facilitate ventilation with nontraditional modes. The nurse understands that neuromuscular blocking agents provide: high levels of sedation. no sedation or analgesia. complete analgesia. antianxiety effects

no sedation or analgesia. RATIONALE: Neuromuscular blocking (NMB) agents do not possess any sedative or analgesic properties. Patients who receive NMBs must also receive sedatives and pain medication.

Acute kidney injury from postrenal etiology is caused by conditions that interfere with renal perfusion. hypovolemia or decreased cardiac output. conditions that act directly on functioning kidney tissue. obstruction of the flow of urine.

obstruction of the flow of urine. RATIONALE: Acute kidney injury resulting from obstruction of the flow of urine is classified as postrenal or obstructive renal injury. Conditions that result in AKI by interfering with renal perfusion are classified as prerenal and include hypovolemia and decreased cardiac output. Conditions that produce AKI by directly acting on functioning kidney tissue are classified as intrarenal.

The nurse is admitting a client whose medication regimen includes regular injections of vitamin B12. The nurse should question the client about a history of: bariatric surgery. gastroesophageal reflux disease (GERD). total gastrectomy. diverticulitis

total gastrectomy. RATIONALE: If a total gastrectomy is performed, injection of vitamin B12 will be required for life, because intrinsic factor, secreted by parietal cells in the stomach, binds to vitamin B12 so that it may be absorbed in the ileum. Bariatric surgery, diverticulitis and GERD do not necessitate total gastrectomy and subsequent vitamin B12 supplementation.

The nurse is caring for a patient with cirrhosis of the liver. The nurse notes fresh blood starting to ooze from the patient's rectum and intravenous site. The nurse contacts the provider expecting a prescription for vitamin K injections. a laboratory test to determine factor X level. blood work to evaluate protein C level. an infusion of protein S factor

vitamin K injections. RATIONALE: The coagulation factors are plasma proteins that circulate as inactive enzymes, and most are synthesized in the liver. Vitamin K is necessary for synthesis of factors II, VII, IX, X, and protein C and protein S (anticoagulation factors). Thus, liver disease and vitamin K deficiency are commonly associated with impaired hemostasis.

Which of the following patients is at the greatest risk of developing acute kidney injury? A patient who was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks. has a history of controlled hypertension with a blood pressure of 138/88 mm Hg. has a history of fluid overload as a result of heart failure. has been on aminoglycosides for the past 6 day.

was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks. RATIONALE: Acute kidney injury can be caused by aminoglycoside nephrotoxicity, especially prolonged use of the drug (more than 10 days). Symptoms of acute kidney injury are usually seen about 1 to 2 weeks after exposure. Because of this delay, the patient must be questioned about any recent medical therapy for which an aminoglycoside may have been prescribed. The blood pressure of 138/88 mm Hg controlled by medication would not cause acute kidney injury, nor would fluid overload from exacerbation of heart failure.