Adult Health Final Exam (EXAMS 2-5)
After teaching a patient with bacterial cystitis who is prescribed phenazopyridine (Pyridium), the nurse assesses the patient's understanding. Which statement made by the patient indicates a correct understanding of the teaching?
"An orange color in my urine should not alarm me." Rationale: Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many patients think that they have blood in their urine when they see this. In addition, the urine can permanently stain clothing. Pyridium is not used for STDs. There are no dietary restrictions or needs while taking this medication.
A confused patient with pneumonia is admitted with an indwelling catheter in place. During interdisciplinary rounds the following day, which question would the nurse ask the primary healthcare provider?
"Can we discontinue the indwelling catheter?" Rationale: An indwelling catheter dramatically increases the risks of urinary tract infection and urosepsis. Nursing staff should ensure that catheters are left in place only as long as they are medically needed. The nurse would inquire about removing the catheter. All other questions might be appropriate, but because of patient safety, this question takes priority.
A nurse assesses a patient who presents with renal calculi. Which question would the nurse ask?
"Do any of your family members have this problem?" Rationale: There is a strong association between family history and stone formation and recurrence. Nephrolithiasis is associated with many genetic variations; therefore, the nurse should ask whether other family members have also had renal stones. The other questions do not refer to renal calculi but instead are questions that should be asked of a patient with a urinary tract infection.
A nurse obtains the health history of a patient with a suspected diagnosis of bladder cancer. Which question would the nurse ask when determining this patient's risk factors?
"Do you smoke cigarettes?" Rationale: Smoking is known to be a factor that greatly increases the risk of bladder cancer. Alcohol use, recreational drug use, and prescription drug use (except medications that contain phenacetin) are not known to increase the risk of developing bladder cancer.
A nurse teaches a patient who is at risk for colon cancer. Which dietary recommendation would the nurse teach this patient?
"Add vegetables such as broccoli and cauliflower to your new diet."
A patient is scheduled to have a fundoplication. What statement by the patient indicates a need to review preoperative teaching?
"After the operation I can eat anything I want."
it is important to drink 1-2 liters of water to prevent kidney stones in this disorder
gout
triggers for psoriasis
stress, illness, hormonal changes, medications
protecting the skin is important in this connective tissue disorder
systemic lupus erythematosus
most important information to obtain for a patient who is being evaluated for fibrinolytic therapy
time of symptoms onset (need to have been normal within 4 hours ago)
safety actions include turning the client's head to the side in this condition
tonic clonic seizure
stiffening of the muscles of the arms and legs followed by an immediate loss of consciousness and jerking of all extremities
tonic clonic seizure
teach patient to not cross their legs when sitting for this condition
total hip replacement
common manifestations of migraine without aura
unilateral and pulsating headache, pain worsens with physical activity and photophobia (will be a select all that apply)
community resources for new colostomies
united ostomy association of America (they send someone else who has a colostomy to go and talk to someone who has a new colostomy)
one of the best ways to prevent injury following a total hip replacement
using an abduction pillow to maintain joint alignment (do not cross legs)
the best practice for preventing infection following a joint replacement
using aseptic technique for dressing changes
this medication should not be used in older patients with stomatitis and dysphagia
viscous lidocaine
foods that should be avoided in diverticulitis
whole grains, uncooked fruits and veggies, high fiber foods, nuts, seeds, popcorn
A nurse plans care for a patient with overflow incontinence. Which intervention does the nurse include in this patient's plan of care to assist with elimination?
Use the Valsalva maneuver. Rationale: In patients with overflow incontinence, the voiding reflex arc is not intact. Mechanical pressure, such as that achieved through the Valsalva maneuver (holding the breath and bearing down as if to defecate), can initiate voiding. Stroking the medial aspect of the thigh or providing digital anal stimulation requires the reflex arc to be intact to initiate elimination. Due to the high risk for infection, intermittent catheterization should only be implemented when other interventions are not successful.
With a history of breast cancer in the family, a 48-year-old female patient is interested in learning about the modifiable risk factors for breast cancer. After the nurse explains this information, which statement made by the patient indicates that more teaching is needed?
"I am glad that we can still have wine with every evening meal." Rationale: Modifiable risk factors can help prevent breast cancer. The patient should lessen alcohol intake and not have wine 7 days a week. Breast-feeding, regular exercise, and avoiding hormone replacement are also strategies for breast cancer prevention.
After teaching a patient with a history of renal calculi, the nurse assesses the patient's understanding. Which statement made by the patient indicates a correct understanding of the teaching?
"I should drink at least 3 L of fluid every day." Rationale: Dehydration contributes to the precipitation of minerals to form a stone. Although increased intake of calcium causes hypercalcemia and leads to excessive calcium filtered into the urine, if the patient is well hydrated, the calcium will be excreted without issues. Dehydration increases the risk for supersaturation of calcium in the urine, which contributes to stone formation. The nurse would encourage the patient to drink more fluids, not decrease calcium intake. Ingestion of aspirin or aspirin-containing products does not cause a stone. Antibiotics neither prevent nor treat a stone.
After teaching a patient who has stress incontinence, the nurse assesses the patient's understanding. Which statement made by the patient indicates a need for additional teaching?
"I will limit my total intake of fluids." Rationale: Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence. Many people try to manage incontinence by limiting fluids. Alcoholic and caffeinated beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing incontinence.
A nurse cares for a postmenopausal patient who has had two episodes of bacterial urethritis in the last 6 months. The patient asks, "I never have urinary tract infections. Why is this happening now?" How will the nurse respond?
"Low estrogen levels can make the tissue more susceptible to infection." Rationale: Low estrogen levels decrease moisture and secretions in the perineal area and cause other tissue changes, predisposing it to the development of infection. Urethritis is most common in postmenopausal women for this reason. Although immune function does decrease with aging and sexually transmitted diseases are a known cause of urethritis, the most likely reason in this patient is low estrogen levels. Personal hygiene usually does not contribute to this disease process.
The nurse is teaching a patient with benign prostatic hyperplasia (BPH). What statement indicates a lack of understanding by the patient?
"There should be no problem with a glass of wine with dinner each night." Rationale: This patient did not associate wine with the avoidance of alcohol, and requires additional teaching. The nurse must teach a patient with BPH to avoid alcohol, caffeine, and large quantities of fluid in a short amount of time to prevent overdistention of the bladder. Decongestants also need to be avoided to lower the chance for urinary retention.
The nurse is teaching a 45-year-old woman about her fibrocystic breast condition. Which statement by the patient indicates a lack of understanding?
"This condition will become malignant over time." Rationale: Fibrocystic breast condition does not increase a woman's chance of developing breast cancer. Hormone replacement therapy is not indicated since the additional estrogen may aggravate the condition. Limiting caffeine intake may give relief for tender breasts. The fibrocystic changes to the breasts make it more difficult to examine the breasts because of fibrotic changes and lumps.
A patient states that she rates her pain as a "5" on a 0-to-10 scale postmastectomy. The provider has ordered morphine 4 mg for moderate pain every 4 hours. The morphine is supplied in a solution of 8 mg/mL. How many milliliters will the nurse administer? ____ mL
0.5
A nurse teaches patients about the difference between urge incontinence and stress incontinence. Which statements would the nurse include in this education? (Select all that apply.)
1. "Stress incontinence occurs due to weak pelvic floor muscles." 2. "Urge incontinence occurs due to abnormal bladder contractions." Rationale: Patients who suffer from stress incontinence have weak pelvic floor muscles or urethral sphincter and cannot tighten their urethra sufficiently to overcome the increased detrusor pressure. Stress incontinence is common after childbirth, when the pelvic muscles are stretched and weakened from pregnancy and delivery. Urge incontinence occurs in people who cannot suppress the contraction signal from the detrusor muscle. Abnormal detrusor contractions may be a result of neurologic abnormalities including dementia, or may occur with no known abnormality. Postvoid residual is associated with reflex incontinence, not with urge incontinence or stress incontinence. Management of urge incontinence includes decreasing fluid intake, especially in the evening hours.
The nurse is taking a history of a 68-year-old woman. What assessment findings would indicate a high risk for the development of breast cancer? (Select all that apply.)
1. Age greater than 65 years 2. Genetic factors 3. Increased breast density Rationale: The high-risk factors for breast cancer are age greater than 65 with the risk increasing until age 80; an increase in breast density because of more glandular and connective tissue; and inherited mutations of BRCA1 and/or BRCA2 genes. Osteoporosis and multiparity are not risk factors for breast cancer. A high postmenopausal bone density and nulliparity are moderate and low increased risk factors, respectively.
The nurse is administering finasteride (Proscar) and doxazosin (Cardura) to a 67-year-old patient with benign prostatic hyperplasia. What precautions are related to the side effects of these medications? (Select all that apply.)
1. Asking the patient to report any weakness, light-headedness, or dizziness 2. Immediately reporting any change in the alanine aminotransferase laboratory test 3. Assessing for blood pressure changes when lying, sitting, and arising from the bed
A patient is interested in learning about the risk factors for prostate cancer. Which factors does the nurse include in the teaching? (Select all that apply.)
1. Family history of prostate cancer 2. Eating too much red meat 3. Race 4. Advanced age Rationale: Advanced family history of prostate cancer, age, a diet high in animal fat, and race are all risk factors for prostate cancer. Smoking and obesity are not known risk factors.
After a breast examination, the nurse is documenting assessment findings that indicate possible breast cancer. Which abnormal findings need to be included as part of the patient's electronic medical record? (Select all that apply.)
1. Non-mobile mass at two o'clock 2. Nipple retraction 3. Peau d'orange Rationale: In the documentation of a breast mass, skin changes such as dimpling (peau d'orange), nipple retraction, and whether the mass is fixed or movable are charted. The location of the mass should be stated by the "face of a clock." Dense breast tissue and nontender axillary nodes are not abnormal assessment findings that may indicate breast cancer.
The nurse is taking the history of a 24-year-old patient diagnosed with cervical cancer. What possible risk factors would the nurse assess? (Select all that apply.)
1. Poor diet 2. Smoking 3. Multiple sexual partners 4. Younger than 18 at first intercourse
A 28-year-old patient is diagnosed with uterine leiomyoma and is experiencing severe symptoms. Which actions by the nurse are the most appropriate at this time? (Select all that apply.)
1. Review complete blood count for possible iron-deficiency anemia 2. Relieve anxiety by relaxation techniques and education. Rationale: With uterine leiomyoma's or fibroids, heavy bleeding is the predominant symptom, with anxiety occurring because of fears of cancer or infertility. Interventions would be directed to the heavy bleeding and anxiety relief, such as relaxation techniques and education about the pathophysiology and possible treatment of the fibroids. The nurse could suggest resources to give more information about the diagnosis. Typically patients with uterine fibroids do not have pain. Discussion of the possibility of infertility and side effects of laparoscopic surgery is premature and may increase the anxiety.
A nurse cares for patients with urinary incontinence. Which types of incontinence are correctly paired with their clinical manifestation? (Select all that apply.)
1. Urge incontinence—loss of urine upon feeling the need to void 2. Overflow incontinence—constant dribbling of urine 3. Stress incontinence—urine loss with physical exertion
Menopause is defined as the absence of a period for ____ months.
12
A patient who had a hysterectomy has a 200-mg dose of ciprofloxacin (Cipro) ordered to infuse in 30 minutes. At what rate would the nurse infuse the medication if the pharmacy provides 200 mg in a 100-mL bag of normal saline? (Record your answer using a whole number.) ___ mL/hr
200
if a patient is to receive 70 mL of tube feeding per hour, how much can be added at a time to a tube feeding bag
280 mL (4 hours at a time, 4 hours x 70 = 280) (you can only add things four hours at a time)
normal serum potassium level
3.5 to 5.0
the head of the bed should be at this angle for patient with parkinson's disease to prevent aspiration
30 degrees or greater
What comfort measure can only be performed by a nurse, as opposed to an unlicensed assistive personnel (UAP), for a patient who returned from a left modified radical mastectomy 4 hours ago?
Administering morphine for pain at a "4" on a 0-to-10 scale Rationale: Only the nurse is authorized to administer medications, but the UAP could inform the nurse about the rating of pain by the patient. The UAP could position the bed to 30 degrees and elevate the patient's arm on a pillow to facilitate lymphatic fluid drainage return. The patient's arm should be supported while walking at first but then allowed to hang straight by the side. The UAP could support the arm while walking the patient.
The nurse is administering sulfamethoxazole-trimethoprim (Bactrim) to a patient diagnosed with bacterial prostatitis. Which finding causes the nurse to question this medication for this patient?
Allergy to sulfa medications Rationale: Before administering sulfamethoxazole-trimethoprim, the nurse must assess if the patient is allergic to sulfa drugs. Urinary tract infection, hematuria, and elevated serum white blood cells are common problems associated with bacterial prostatitis that require long-term antibiotic therapy.
A nurse cares for a patient who has kidney stones from secondary hyperoxaluria. Which medication does the nurse anticipate administering?
Allopurinol (Zyloprim) Rationale: Stones caused by secondary hyperoxaluria respond to allopurinol (Zyloprim). Phenazopyridine is given to patients with urinary tract infections. Propantheline is an anticholinergic. Tolterodine is an anticholinergic with smooth muscle-relaxant properties.
A nurse assesses patients on the medical-surgical unit. Which patient is at greatest risk for bladder cancer?
An 86-year-old male with a 50-pack-year cigarette smoking history Rationale: The greatest risk factor for bladder cancer is a long history of tobacco use. The other factors would not necessarily contribute to the development of this specific type of cancer.
interventions for eczematous dermatitis
cool moist compresses and tepid baths with additives like cornstarch or oatmeal, and pharmacologic interventions such as corticosteroids
these medications can cause bone necrosis in patients with SLE (lupus)
corticosteroids
The nurse is assessing the reproductive history of a 68-year-old postmenopausal woman. Which finding is cause for immediate action by the nurse?
Bleeding from the vagina Rationale: Vaginal bleeding is not normal for the postmenopausal woman. Vaginal dryness and leakage of urine are common findings in adults of this age range. Pap tests may not be needed for women over 65 who have had regular cervical cancer testing with normal results.
Bladder scanning indicated a post void residual (PVR) of 90 mL in a 70 year old patient. The nurse should:
Record findings as this is normal
The nurse is conducting a history on a male patient to determine the severity of symptoms associated with prostate enlargement. Which finding is cause for prompt action by the nurse?
Cloudy urine Rationale: Cloudy urine could indicate infection due to possible urine retention and would cause the nurse to act promptly. Common symptoms of benign prostatic hyperplasia are urinary hesitancy, post-void dribbling, and a weak urinary stream due to the enlarged prostate causing bladder outlet obstruction.
A creatinine clearance test has been ordered to determine glomerular filtration rate (GFR). The nurse should:
Collect all urine over a 24 hour period
The patient is emotionally upset about the recent diagnosis of stage IV endometrial cancer. Which action by the nurse is best?
Create an atmosphere of acceptance and discussion. Rationale: Discussion of a patient's concerns about the presence of cancer and the potential for recurrence will provide emotional support and allay fears. Coping behaviors are encouraged with the support of friends and relatives. An emotional response should be accepted.
how long radiation sites should not be exposed to direct. sunlight
during treatment and up to one year after treatment is completed
A woman diagnosed with breast cancer had these laboratory tests performed at an office visit: Alkaline phosphatase --> 125 U/L (2.2 mckat/L) Total calcium --> 12 mg/dL (3 mmol/L) Hematocrit --> 39% (0.39) Hemoglobin --> 14 g/dL (140 mmol/L) Which test results indicate to the nurse that some further diagnostics are needed?
Elevated alkaline phosphatase and calcium suggests bone involvement. Rationale: The alkaline phosphatase (normal value 30 to 120 U/L [0.5 to 2.0 mckat/L)) and total calcium (normal value 9 to 10.5 mg/dL [2.25 to 2.63 mmol/L) levels are both elevated, suggesting bone metastasis. Both the hematocrit and hemoglobin are within normal limits for females.
A patient has just returned from a total abdominal hysterectomy and needs postoperative nursing care. What action can the nurse delegate to the unlicensed assistive personnel (UAP)?
Empty the urine from the urinary catheter bag. Rationale: The UAP is able to empty the urinary output from the catheter. The nurse would assess the heart, lung, and bowel sounds; check the hemoglobin and hematocrit levels; and evaluate the drainage on the dressing.
A 25-year-old patient has recently been diagnosed with testicular cancer and is scheduled for radiation therapy. Which intervention by the nurse is best?
Explore with the patient the possibility of sperm collection. Rationale: Sperm collection is a viable option for a patient diagnosed with testicular cancer and would be completed before radiation therapy, chemotherapy, or radical lymph node dissection. The other options would promote psychosocial support but are not the priority intervention.
what does the mnemonic FAST stand for
F= face A= arms S= speech T= time
risk factors for cholelithiasis
Female, fat, forty, fertile, and other medical conditions including diabetes mellitus
patients with this condition should east a high fiber diet (30-40 grams per day) and drink 8-10 cups of liquids daily
IBS (irritable bowel syndrome)
A nurse contacts the healthcare provider after reviewing a patient's laboratory results and noting a blood urea nitrogen (BUN) of 35 mg/dL (12.5 mmol/L) and a creatinine of 1.0 mg/dL (88.4 mcmol/L). What collaborative care measure does the nurse consult the provider about?
Intravenous Fluids Rationale: Normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Normal creatinine is 0.6 to 1.2 mg/dL (53.0 to 106.1 mcmol/L) (males) or 0.5 to 1.1 mg/dL (44.2 to 97.2 mcmol/L) (females). Creatinine is more specific for kidney function than BUN, because BUN can be affected by several factors (dehydration, high-protein diet, and catabolism). This patient's creatinine is normal, which suggests a nonrenal cause for the elevated BUN. A common cause of increased BUN is dehydration, so the nurse should anticipate giving the patient more fluids, not placing the patient on fluid restrictions. Hemodialysis is not an appropriate treatment for dehydration. The lab results do not indicate an infection; therefore, a urine culture and sensitivity are not appropriate.
A patient is starting hormonal therapy with tamoxifen (Nolvadex) to lower the risk for breast cancer. What information needs to be explained by the nurse regarding the action of this drug?
It selectively blocks estrogen in the breast. Rationale: Tamoxifen (Nolvadex) reduces the estrogen available to breast tumors to stop or prevent growth. This drug does not block the release of luteinizing hormone to prevent the ovaries from producing estrogen; leuprolide (Lupron) does this. Chemotherapy agents such as ixabepilone (Ixempra) interfere with cancer cell division, and doxorubicin (Adriamycin) inhibits DNA synthesis in susceptible cells.
Which finding in a female patient by the nurse would receive the highest priority of further diagnostics?
Nontender immobile mass in the upper outer quadrant of the breast Rationale: Malignant lesions are hard, nontender, and usually located in the upper outer quadrant of the breast and would be the priority for further diagnostic study. The other lesions are benign breast disorders. The tender moveable masses throughout the breast tissue could be a fibrocystic breast condition. A firm, defined mobile mass in the lower quadrant of the breast is a fibroadenoma, and a painful mass under warm reddened skin could be a local abscess or ductal ectasia.
The nurse is taking the history of a patient who is scheduled for breast augmentation surgery. The patient reveals that she took two aspirin this morning for a headache. Which action by nurse is best?
Notify the surgeon about the aspirin ingestion by the patient. Rationale: The surgeon must be notified immediately since the aspirin could cause increased bleeding during the procedure. Vital signs would be recorded and postoperative teaching would be completed in the preoperative time frame, but these are not the priority since the procedure may be rescheduled. The warning about the patient's health insurance is not appropriate at this time.
A nurse cares for a patient admitted from a nursing home after several recent falls. What prescription would the nurse complete first?
Obtain urine sample for culture and sensitivity. Rationale: Although all interventions are or might be important, obtaining a urine sample for urinalysis takes priority. Often urinary tract infection (UTI) symptoms in older adults are atypical, and a UTI may present with new onset of confusion or falling. The urine sample should be obtained before starting antibiotics. Dietary requirements and gait training should be implemented after obtaining the urine sample.
Of the four types of incontinence, the one the nurse knows is most likely to have an elevated post voiding residual is:
Overflow incontinenece
this class of medications is given for stress ulcer prophylaxis
PPI (proton pump inhibitor)
increase the dietary intake of calcium and vitamin D when taking this commonly prescribed class of medications
PPI (proton pump inhibitors)
this category of drugs end in -azole
PPI (proton pump inhibitors)
A 67-year-old male patient had some serum tests performed during his annual examination. The nurse reviews his results, as follows: testosterone: 680 ng/dL (23.6 nmol/L); prostate-specific antigen: 10 ng/mL (10 mcg/L); prolactin: 5 ng/mL (217.4 pmol). What action by the nurse is best?
Prepare the patient for further diagnostic testing. Rationale: The prostate-specific antigen is increased from the normal of 0 to 2.5, which could indicate benign prostatic hyperplasia or prostate cancer. Further testing would have to be done. The values of testosterone and prolactin are within normal range. If the prolactin were increased, there would be a possibility of galactorrhea. An increase in testosterone could indicate a possible testicular tumor.
A 55-year-old African-American patient is having a visit with his healthcare provider. What test would the nurse discuss with the patient as an option to screen for prostate cancer, even though screening is not routinely recommended?
Prostate-specific antigen Rationale: The prostate-specific antigen test would be discussed as an option for prostate cancer screening. A complete blood count and culture and sensitivity laboratory test will be ordered if infection is suspected. A cystoscopy would be performed to assess the effect of a bladder neck obstruction.
ask the person to speak, is their speech slurred?
S in FAST
A nurse reviews the allergy list of a patient who is scheduled for a contrast-enhanced CT. Which patient allergy should alert the nurse to urgently contact the healthcare provider?
Seafood Rationale: Patients with seafood allergies often have severe allergic reactions to the standard dyes used during intravenous urography. The other allergies have no impact on the patient's safety during an intravenous urography.
call 911 right away for a stroke
T in FAST
A patient has just returned from a right radical mastectomy. Which action by the unlicensed assistive personnel (UAP) would the nurse consider unsafe?
Taking the blood pressure on the right arm Rationale: Healthcare professionals need to avoid the arm on the side of the surgery for blood pressure measurement, injections, or blood draws. Since lymph nodes are removed, lymph drainage would be compromised. The pressure from the blood pressure cuff could promote swelling. Infection could occur with injections and blood draws. Checking urine output, elevation of the affected arm on a pillow, and encouraging beginning exercises are all safe postoperative interventions.
A nurse assesses a patient with bladder cancer who is recovering from a complete cystectomy with ileal conduit. Which assessment finding would alert the nurse to urgently contact the healthcare provider?
The ileostomy stoma is pale and cyanotic in appearance. Rationale: A pale or cyanotic stoma indicates impaired circulation to the stoma and must be treated to prevent necrosis. Blood-tinged urine and serous sanguineous drainage are expected after this type of surgery. Oxygen saturation of 92% on room air is at the low limit of normal.
interventions for difficulty chewing and swallowing in Parkinson's disease
elevate head of bed, offer bite sized portions and small frequent meals
a medication used for rheumatoid arthritis that puts the patient at risk for infection
abatacept (orencia)
the most commonly used medication to treat osteoarthritis
acetaminophen (tylenol)
colchicine and indomethacin are medications used for what
acute gout
teaching measures to prevent scalp injury is important for this side effect of chemotherapy
alopecia
the nurse should assist the patient to pre-plan for this side effect of chemotherapy
alopecia
what condition do you see severe steady right lower quadrant pain
appendicitis (pain at mcburney's point)
priority action for a patient reporting numbness and tingling in the lower leg following a crush injury
assess pedal pulses
patient and nurse safety for herpes zoster (shingles)
assess the staff for history of or vaccination of chicken pox, check admission prescriptions for analgesia, ensure that gloves are available in the room
Ask a person to smile, is one side of the face drooping?
assessing face in F.A.S.T
patient teaching for methotrexate
avoid acetaminophen, it may take several weeks to become effective on pain, stay away from large crowds and ill people, folic acid may reduce side effects, do not take if pregnant or breast-feeding
diet modification for cholelithiasis
avoid high fat/high cholesterol foods like whole milk, butter, whole milk products (cheese and yogurt), and fried foods
patient teaching for those taking Humera (immune modulator)
avoid large crowds, avoid people who are sick, wash hands frequently
most important nursing action for a patient scheduled to have a mechanical embolectomy
ensure that informed consent is on the chart
how often should peripheral IV sites be assessed for patient receiving IV chemotherapy
every hour
side effects of 5-fluorouracil (5-FU)
fatigue, leukopenia, low WBC, diarrhea, mucositis, mouth ulcers, peripheral neuropathy
this symptom is a classic sign of SLE flare and should be reported immediately to their physician
fever
common medication class indicated for a bone density score of -2.8
bisphosphonates
a patient with a spinal cord injury who cannot sit up should not be given this class of medications to treats osteoporosis
bisphosphonates (they need to remain upright for 30 minutes following administration because it can cause erosions in the esophagus)
key manifestations of parkinson's disease
flexed trunk, slow movements, and uncontrolled drooling
this medication is in the class of mucosal barrier fortifiers
carafate or sucralfate
nurses should wear PPE when handling these kinds of oral medication
chemotherapy
foods that should be avoided when you have GERD
chocolate, citrus, mint, tomato, caffeinated teas, coffee, and soft drinks
febuxostat, probenecid, and allopurinol are medications used to treat what
chronic gout
use of this substance puts on at high risk of stroke
cocaine
teaching for patients taking phenytoin for status epilepticus
continue taking medication even once the seizures stop
how to clear an obstructed small bore feeding tube
flush with 30 mL of warm water and gentle pressure. To prevent obstruction in the first place, flush tube before and after administering medications and determine if any of the medications come in liquid form
characteristics of stool from a sigmoid colon colostomy
formed, soft to hard
dietary changes to prevent colon cancer
decrease animal fat, decrease refined carbs, increase fiber, and increase brassica vegetables such as broccoli and cauliflower
diet modifications following cholecystectomy
decrease high fat foods
risk factors for GERD
delayed gastric emptying, eating large meals, hiatal hernia, obesity, tobacco use, and H. Pylori infections
this medication is used to treat psoriatic arthritis and can cause serious infections
golumumab
safety precautions for patient with epilepsy in the hospital
have suction equipment at the beside, keep bed rails up at all times and padded, and ensure that the client has IV access to give them medication quickly such as Ativan
the location of the formation of emboli which causes embolic stroke
heart
nodules that develop in the distal finger joints in individuals with arthritis
heberden's nodules (osteoarthritis)
modifiable risk factors for stroke
high fat diet, alcohol intake, obesity, smoking
clinical manifestations of chron's disease
high pitched rushing bowel sounds
ask the person to raise their arms. Is one arm weak? (What part of the FAST pneumonic is this)
how to assess arms in the FAST pneumonic
dietary factors that contribute to the development of osteoporosis
increased calcium, alcohol, caffeine, increased vitamin D, and carbonated beverages
what is diet therapy for IBS
increased fluids and fiber, also avoid alcohol, caffeine, and other irritants
patients should wash their hands after touching pets and should not scoop litter boxes to prevent this complication of chemotherapy
infection
complimentary therapy for migraine headaches
lie down in a darkened room when experiencing a headache
characteristics of stool from an ascending colon colostomy
liquid and watery
characteristics of stool from a transverse colon colostomy
loose and pasty
lifestyle modifications for GERD
losing weight if needed, avoid chocolate, caffeine, and carbonated beverages, eat frequent small meals or snacks, remain upright after meals, and avoid use of tobacco
apply a heating pad for 20 minutes at least four times a day in this condition
low back pain
how do you assess for a main complication of dysphagia
make sure lung sounds are clear after snacks and meals
nursing assessment that indicates a priority goal for a patient with impaired swallowing following stroke is met
make sure the lungs sound clear
what might a blue mole with white speck on the lower leg indicate
melanoma
early signs of this type of headache include visual disturbances
migraine with aura
the length of time that radiation fatigue can last in cancer patients
months to years
the assessment that is most important when one leg is visibly shorter than the other following a total hip replacement
neurovascular status
what patient teaching should be given for lifestyle changes following fundlodiplication
nutritional lifestyle changes should continue after surgery (avoid the ones that caused the fundlodiplication)
this condition puts patients at an increased risk for low back pain
osteoarthritis
this condition may impede healing of fractures
osteoporosis (low bone density causing porous bones)
interventions to prevent the formation of pressure ulcers
place a small pillow between bony prominences, use a lift sheet to assist with repositioning, keep patient's heels off the surface of the bed
group in which primary osteoporosis most often occurs
post-menopausal women
how medications including rituximab work to treat cancer
prevent the start of cancer cell division
allowing the client to be as independent as possible with activities
priority goal of parkinson's disease
action that is most important when discharging a patient to rehab center following a joint replacement
providing verbal hand-off report to facility
teaching strategies for prevention of back injury
push objects rather than pull, don't twist more than 45 degrees, use assistance when lifting over 10 lbs, avoid standing or using a foot stool, and sit in chairs with good support
this action should be taken first when a patient starts to vomit blood
put on gloves
priority actions for an excessively loose cast
replace the cast
an autoimmune process in which antibodies lead to inflammation
rheumatoid arthritis
paraffin wax dips are used to decrease pain and increase mobility in this condition
rheumatoid arthritis
this condition is an absolute contraindication for a total joint replacement
severe osteoporosis
reduced immunity and blood producing functions, altered GI structure and functions, decreased respiratory functions, and motor and sensory deficits
side effects of general consequences of cancer (chemotherapy)
risk factors for colon cancer
smoking, older age, family history, high fat diets, low fiber diets
lifestyle changes for the prevention of osteoporosis
strength exercises, take calcium and vitamin d, walk for 30 minutes at least 3x a week
A nurse assesses a patient with tachycardia. Which clinical manifestation requires immediate intervention by the nurse?
Midsternal chest pain
The nurse caring for patients with gastrointestinal disorders would understand that which category best describes the mechanism of action of sucralfate (Carafate)?
Mucosal barrier fortifier
A nurse assesses a patient who is prescribed 5-fluorouracil (5-FU) chemotherapy intravenously for the treatment of colon cancer. Which assessment finding would alert the nurse to contact the health care provider?
Mucositis and oral ulcers
A patient is receiving continuous tube feeding at 70 mL/hr. When the bag is empty, how much formula does the nurse add? (Record your answer using a whole number.) _____ mL
280mL
A nurse assesses patients at a community health center. Which patient is at highest risk for the development of colorectal cancer?
A 72-year-old who eats fast food frequently
A nurse assesses a patient's electrocardiogram (ECG) and observes the reading shown below: How would the nurse document this patient's ECG strip?
Sinus rhythm with premature ventricular contractions (PVCs)
A nurse is interested in providing community education and screening on hypertension. In order to reach a priority population, to what target audience would the nurse provide this service?
African-American churches
A nurse assesses a patient after administering isosorbide mononitrate (Imdur). The patient reports a headache. What action would the nurse take?
Administer PRN acetaminophen.
A patient is receiving chemotherapy through a peripheral IV line. What action by the nurse is most important?
Assessing the IV site every hour
A patient has hypertension and high-risk factors for cardiovascular disease. The patient is overwhelmed with the recommended lifestyle changes. What action by the nurse is best?
Assist in finding one change the patient can control.
A nurse working with patients who experience alopecia knows that which is the best method of helping patients manage the psychosocial impact of this problem?
Assisting the patient to pre-plan for this event
The nurse is evaluating a 3-day diet history with a patient who has an elevated lipid panel. What meal selection indicates that the patient is managing this condition well with diet?
Baked chicken breast, broccoli, tomatoes
After teaching a patient with diverticulitis, a nurse assesses the patient's understanding. Which menu selection made by the patient indicates the patient correctly understood the teaching?
Baked fish with steamed carrots and a glass of apple juice
A nurse assesses a patient with cholelithiasis. Which assessment findings would the nurse identify as contributors to this patient's condition? (Select all that apply.)
Body mass index of 46 Glycosylated hemoglobin level of 15% Pregnant with twins for the third time
After teaching a patient with irritable bowel syndrome (IBS), a nurse assesses the patient's understanding. Which menu selection indicates that the patient correctly understands the dietary teaching?
Broiled chicken with brown rice, steamed broccoli, glass of apple juice
A nurse is caring for a patient who has a serum calcium level of 14 mg/dL (3.5 mmol/L). Which provider order does the nurse implement first?
Connect the patient to a cardiac monitor.
A nurse is caring for an older adult patient who is admitted with moderate dehydration. Which intervention will the nurse implement to prevent injury while in the hospital?
Dangle the patient on the bedside before ambulating.
A nurse is evaluating a patient who is being treated for dehydration. Which assessment result does the nurse correlate with a therapeutic response to the treatment plan?
Decreased orthostatic light-headedness and dizziness
A nurse is caring for a patient who has the following laboratory results: potassium 3.4 mEq/L (3.4 mmol/L), magnesium 1.8 mEq/L (0.74 mmol/L), calcium 8.5 mEq/L (2.13 mmol/L), and sodium 144 mEq/L (144 mmol/L). Which assessment does the nurse complete first?
Depth of respirations
A nurse performs a skin screening for a patient who has numerous skin lesions. Which lesion does the nurse evaluate first?
Irregular blue mole with white specks on the lower leg
A nurse is caring for four patients receiving enteral tube feedings. Which patient should the nurse see first?
Patient with a potassium level of 2.6 mEq/L (2.6 mmol/L)
The nurse is reviewing the lipid panel of a male patient who has atherosclerosis. Which finding is most concerning?
Triglycerides: 198 mg/dL
A patient's small-bore feeding tube has become occluded after the nurse administered medications. What actions by the nurse are best? (Select all that apply.)
Try to flush the tube with 30 mL of water and gentle pressure. Flush the tube before and after administering medications Determine if any of the medications come in liquid form.
A nurse is assessing patients on a medical-surgical unit. Which patient is at risk for hypokalemia?
Patient with pancreatitis who has continuous nasogastric suctioning
A nurse assesses a patient in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure?
"I must stop halfway up the stairs to catch my breath."
The nurse has taught a patient with cancer ways to prevent infection. What statement by the patient indicates that more teaching is needed?
"It's alright for me to keep my pets and change the litter box."
A nurse teaches a patient who experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. Which statement would the nurse include in this patient's teaching?
"Minimize or abstain from caffeine."
While assessing a patient on a cardiac unit, a nurse identifies the presence of an S3 gallop. What action would the nurse take next?
Assess for symptoms of left-sided heart failure.
A patient who has had systemic lupus erythematosus (SLE) for many years is in the clinic reporting hip pain with ambulation. Which action by the nurse is best?
Assess medication records for steroid use.
A nurse cares for a patient with right-sided heart failure. The patient asks, "Why do I need to weigh myself every day?" How would the nurse respond?
"Weight is the best indication that you are gaining or losing fluid."
A nurse is teaching patients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods would the nurse include in the teaching? (Select all that apply.)
Peppermint Chocolate Tomato sauce Citrus fruits
The nurse is preparing to change a patient's sternal dressing. What action by the nurse is most important?
Perform hand hygiene.
After teaching a patient who is prescribed a restricted sodium diet, a nurse assesses the patient's understanding. Which food choice for lunch indicates that the patient correctly understood the teaching?
Grilled chicken breast with glazed carrots
A nurse assesses a patient who is hospitalized with an exacerbation of Crohn's disease. Which clinical manifestation would the nurse expect to find?
High-pitched, rushing bowel sounds in the right lower quadrant
A nurse is caring for patients with electrolyte imbalances on a medical-surgical unit. Which common causes are correctly paired with the corresponding electrolyte imbalance? (Select all that apply.)
Hypernatremia—Hyperaldosteronism Hypocalcemia—Diarrhea Hyperkalemia—Salt substitutes
A nurse is teaching a patient with psoriatic arthritis about the medication golimumab (Simponi). What information is most important to include?
"Avoid large crowds or people who are ill."
A nurse cares for a patient who has a heart rate averaging 56 beats/min with no adverse symptoms. Which activity modification would the nurse suggest to avoid further slowing of the heart rate?
"Avoid straining while having a bowel movement."
A nurse is assessing a patient with peripheral artery disease (PAD). The patient states that walking five blocks is possible without pain. What question asked next by the nurse will give the best information?
"Could you walk further than that a few months ago?"
A patient tells the oncology nurse about an upcoming vacation to the beach to celebrate completing radiation treatments for cancer. What response by the nurse is most appropriate?
"Do not expose the radiation area to direct sunlight."
A nurse teaches a patient who is prescribed digoxin (Lanoxin) therapy. Which statement would the nurse include in this patient's teaching?
"Do not take this medication within 1 hour of taking an antacid."
The nurse is teaching a patient with gout dietary strategies to prevent exacerbations of other problems. Which statement by the nurse is most appropriate?
"Drink 1 to 2 L of water each day."
A nurse assesses a patient with renal insufficiency and a low red blood cell count. The patient asks, "Is my anemia related to the renal insufficiency?" How should the nurse respond?
"Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow." Rationale: Erythropoietin is produced in the kidney and is released in response to decreased oxygen tension in the renal blood supply. Erythropoietin stimulates red blood cell production in the bone marrow. Anemia and renal insufficiency are not manifestations of vitamin D deficiency. The kidneys do not play a role in the transportation of red blood cells or any other cells in the blood.
A nurse teaches a patient with heart failure about energy conservation. Which statement would the nurse include in this patient's teaching?
"Gather everything you need for a chore before you begin."
A nurse assesses a patient who presents with an increase in psoriatic lesions. Which questions would the nurse ask to identify a possible trigger for worsening of this patient's psoriatic lesions? (Select all that apply.)
"Have you been under a lot of stress lately?" "Have you changed any medications recently?" "Have you recently had any other health problems?"
A patient recently diagnosed with systemic lupus erythematosus (SLE) is in the clinic for a follow-up visit. The nurse evaluates that the patient practices good self-care when the patient makes which statement?
"I always wear long sleeves, pants, and a hat when outdoors."
A patient has peripheral arterial disease (PAD). What statement by the patient indicates misunderstanding about self-management activities?
"I can use a heating pad on my legs if it's set on low."
The nurse has taught a patient about lifestyle modifications for gastroesophageal reflux disease (GERD). What statements by the patient indicate good understanding of the teaching? (Select all that apply.)
"I sure hate to give up my coffee, but I guess I have to." "I just joined a gym, so I hope that helps me lose weight." "I will eat three small meals and three small snacks a day." "Sitting upright and not lying down after meals will help."
After teaching a patient who is recovering from laparoscopic cholecystectomy surgery, the nurse assesses the patient's understanding. Which statement made by the patient indicates a correct understanding of the teaching?
"I will decrease the amount of fatty foods in my diet."
A nurse cares for a patient with colon cancer who has a new colostomy. The patient states, "I think it would be helpful to talk with someone who has had a similar experience." How would the nurse respond?
"I will make a referral to the United Ostomy Associations of America."
After teaching a patient who is being treated for dehydration, a nurse assesses the patient's understanding. Which statement indicates that the patient correctly understood the teaching?
"I will weigh myself each morning before I eat or drink."
After teaching a patient with congestive heart failure (CHF), the nurse assesses the patient's understanding. Which patient statements indicate a correct understanding of the teaching related to nutritional intake? (Select all that apply.)
"I'll read the nutritional labels on food items for salt content." "Substituting fresh vegetables for canned ones will lower my salt intake." "I will eat oatmeal for breakfast instead of ham and eggs."
A patient in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate?
"It is normal to be fatigued even for years afterward."
After hiatal hernia repair surgery, a patient is on IV pantoprazole (Protonix). The patient asks the nurse why this medication is given since there is no history of ulcers. What response by the nurse is best?
"It prevents stress-related ulcers."
A patient is receiving rituximab (Rituxan) and asks how it works. What response by the nurse is best?
"It prevents the start of cell division in the cancer cells."
A patient has been diagnosed with hypertension but does not take the antihypertensive medications because of a lack of symptoms. What response by the nurse is best?
"Most people with hypertension do not have symptoms."
A nurse assesses a patient admitted to the cardiac unit. Which statement by the patient alerts the nurse to the possibility of right-sided heart failure?
"My shoes fit really tight lately."
After teaching a patient who is prescribed adalimumab (Humira) for severe ulcerative colitis, the nurse assesses the patient's understanding. Which statement made by the patient indicates a need for additional teaching?
"Nausea and vomiting are common side effects of this drug."
A patient has newly diagnosed systemic lupus erythematosus (SLE). What instruction by the nurse is most important?
"Notify your provider at once if you get a fever."
The nurse asks a patient who has experienced ventricular dysrhythmias about substance abuse. The patient asks, "Why do you want to know if I use cocaine?" What is the nurse's best response?
"Patients who use cocaine are at risk for fatal dysrhythmias."
A patient with coronary artery disease (CAD) asks the nurse about taking fish oil supplements. What response by the nurse is best?
"The best source is fish, but pills have benefits too."
A patient received tissue plasminogen activator (t-PA) after a myocardial infarction and now is on an intravenous infusion of heparin. The patient's spouse asks why the patient needs this medication. What response by the nurse is best?
"The heparin keeps that artery from getting blocked again."
A nurse cares for a patient who had a colostomy placed in the ascending colon 2 weeks ago. The patient states, "The stool in my pouch is still liquid." How would the nurse respond?
"The stool will always be liquid with this type of colostomy."
A patient is in the hospital after suffering a myocardial infarction and has bathroom privileges. The nurse assists the patient to the bathroom and notes the patient's O2 saturation to be 95%, pulse 88 beats/min, and respiratory rate 16 breaths/min after returning to bed. What action by the nurse is best?
Allow continued bathroom privileges.
A nurse cares for a patient who is on a cardiac monitor. The monitor displayed the rhythm shown below: What action would the nurse take first?
Assess airway, breathing, and circulation.
An older adult is on cardiac monitoring after a myocardial infarction. The patient shows frequent dysrhythmias. What action by the nurse is most appropriate?
Assess for any hemodynamic effects of the rhythm.
A nurse admits a patient who is experiencing an exacerbation of heart failure. What action would the nurse take first?
Assess the patient's respiratory status.
The nurse is caring for four hypertensive patients. Which drug-laboratory value combination would the nurse report immediately to the healthcare provider?
Furosemide (Lasix)/potassium: 2.1 mEq/L
A nurse cares for a patient who is prescribed patient-controlled analgesia (PCA) after a cholecystectomy. The patient states, "When I wake up I am in pain." What action would the nurse take?
Encourage the patient to use the PCA pump upon awakening.
A nurse prepares to defibrillate a patient who is in ventricular fibrillation. Which priority intervention would the nurse perform prior to defibrillating this patient?
Ensure that everyone is clear of contact with the patient and the bed.
A nurse prepares to admit a patient who has herpes zoster. Which actions would the nurse take? (Select all that apply.)
Ensure that gloves are available in the room Check the admission prescriptions for analgesia. Assess staff for a history of or vaccination for chickenpox
An older female patient has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this patient?
Increase intake of calcium and vitamin D.
A nurse assesses a patient who is admitted for treatment of fluid overload. Which manifestations does the nurse expect to find? (Select all that apply.)
Increased pulse rate Skeletal muscle weakness Distended neck veins.
The nurse is caring for a patient on the medical-surgical unit who suddenly becomes unresponsive and has no pulse. The cardiac monitor shows the rhythm below: After calling for assistance and a defibrillator, what action would the nurse take next?
Initiate cardiopulmonary resuscitation (CPR).
After administering newly prescribed captopril (Capoten) to a patient with heart failure, the nurse implements interventions to decrease complications. Which priority intervention would the nurse implement for this patient?
Instruct the patient to ask for assistance when rising from bed.
A telemetry nurse assesses a patient who has wide QRS complexes and a heart rate of 35 beats/min on the cardiac monitor. Which assessment would the nurse complete next?
Level of consciousness
A patient with an esophageal tumor has difficulty swallowing and has been working with a speech-language pathologist. What assessment finding by the nurse indicates that the priority goal for this problem is being met?
Lungs clear after meals and snacks
A patient in the cardiac stepdown unit reports severe, crushing chest pain accompanied by nausea and vomiting. What action by the nurse takes priority?
Maintain airway patency.
The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.)
Obesity Delayed gastric emptying Eating large meals Hiatal hernia
A patient has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication would the nurse anticipate teaching the patient?
Omeprazole (Prilosec)
A student nurse is assessing the peripheral vascular system of an older adult. What action by the student would cause the faculty member to intervene?
Palpating both carotid arteries at the same time
A nurse is caring for four patients. Which one would the nurse see first?
Patient who had a first dose of captopril (Capoten) and needs to use the bathroom
A nurse plans care for a patient who is immobile. Which interventions would the nurse include in this patient's plan of care to prevent pressure sores? (Select all that apply.)
Place a small pillow between bony surfaces Use a lift sheet to assist with re-positioning. Keep the patient's heels off the bed surfaces
A patient had an acute myocardial infarction. What assessment finding indicates to the nurse that a significant complication has occurred?
Poor peripheral pulses and cool skin
A nurse cares for a patient who has a serum potassium of 7.5 mEq/L (7.5 mmol/L) and is exhibiting cardiovascular changes. Which prescription will the nurse implement first?
Prepare to administer dextrose 20% and 10 units of regular insulin IV push.
A student nurse is providing care to an older patient with stomatitis and dysphagia. What action by the student nurse requires the registered nurse to intervene?
Preparing to administer a viscous lidocaine gargle
A nurse is assessing a patient with left-sided heart failure. For which clinical manifestations would the nurse assess? (Select all that apply.)
Pulmonary crackles Cough that worsens at night Confusion, restlessness
A patient has a nasogastric (NG) tube after a Nissen fundoplication. The nurse answers the call light and finds the patient vomiting bright red blood with the NG tube lying on the floor. What action would the nurse take first?
Put on a pair of gloves.
After teaching a patient who has a history of cholelithiasis, the nurse assesses the patient's understanding. Which menu selection made by the patient indicates that the patient clearly understands the dietary teaching?
Roasted chicken breast, baked potato with chives, and orange juice
After teaching a patient to increase dietary potassium intake, a nurse assesses the patient's understanding. Which dietary meal selection indicates that the patient correctly understands the teaching?
Sausage, one slice of whole-wheat toast, half cup of raisins (120 gm), and a glass of milk
A nurse cares for a patient with atrial fibrillation who reports fatigue when completing activities of daily living. What interventions would the nurse implement to address this patient's concerns?
Schedule periods of exercise and rest during the day.
A nurse assesses a patient who has appendicitis. Which clinical manifestation would the nurse expect to find?
Severe, steady right lower quadrant pain
A nurse administers prescribed adenosine (Adenocard) to a patient. Which response would the nurse assess for as the expected therapeutic response?
Short period of asystole
A nurse assesses a patient with atrial fibrillation. Which manifestation would alert the nurse to the possibility of a serious complication from this condition?
Speech alterations
A nurse works with patients who have alopecia from chemotherapy. What action by the nurse takes priority?
Teaching measures to prevent scalp injury
A nurse cares for a patient who reports pain related to eczematous dermatitis. Which nonpharmacologic comfort measures would the nurse implement? (Select all that apply.)
Tepid bath with cornstarch Cool, moist compresses
The student nurse caring for patients who have cancer understands that the general consequences of cancer include which patient problems? (Select all that apply.)
Various motor and sensory deficits Nutritional deficits such as early satiety and cachexia Potential for reduced gas exchange Increased risk of infection from white blood cell deficits
A nurse evaluates prescriptions for a patient with chronic atrial fibrillation. Which medication would the nurse expect to find on this patient's medication administration record to prevent a common complication of this condition?
Warfarin (Coumadin)
A patient with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the patient's oral chemotherapy medications. What action by the nurse is most appropriate?
Wear personal protective equipment when handling the medications.
