Adult1 Final Questions

aching about HTN, which of the following should the nurse include in the teaching? a. "Reaching your goal blood pressure will occur within 2 months." b. "Diuretics are the first type of medication to control hypertension." c. "Limit your alcohol consumption to three drinks a day." d. "Plan to lower saturated fats to 10 percent of your daily calorie intake."

"Diuretics are the first type of medication to control hypertension." The nurse should include in the teaching that diuretic medication is the first type of medication to control hypertension, by decreasing blood volume and lowering blood pressure. d- The nurse should include in the teaching to have the client lower saturated fats to 5% to 6% of daily calorie intake to help lower cholesterol levels.

teaching heathy eating to a group of clines w/ HTN. which of the following statements needs intervention? a. "I may eat 10 ounces of lean protein each day." b. "Fresh fruits make a good snack option." c. "I will replace table salt with dried herbs." d. "I may thicken gravies with cornstarch as I cook."

"I may eat 10 ounces of lean protein each day." Lean meats should be limited to 5 to 6 oz per day. This statement by a client requires additional teaching.

Hydrochlorothiazide. which of the following instructions should he nurse include? a. "Take this medication before bedtime." b. "Monitor for leg cramps." c. "Avoid grapefruit juice.' d. "Reduce intake of potassium-rich foods."

"Monitor for leg cramps." Hydrochlorothiazide can cause hypokalemia. The client should monitor for manifestations of hypokalemia, such as fatigue, tachycardia, leg cramps, and muscle weakness.

complications of bowel obstruction: if hypovolemic is severe, _______ or even ____ can occur. bacterial peritonitis w/ or w/o actual perforation can also result. bacteria in the intestinal conents lie stagnant in the obstructed intestine. this is not a prob unless the _____ to the intestine is compromised...

- acute kidney injury, death - blood flow

strangulated obstruction, major ____ into the intestine + the peritoneum can occur. _____ + _____ can result in an increases intra-abdominal pressure or ______________________ syndrome.

- blood loss - sepsis + bleeding - acute compartment syndrome

diagnose assessment of intestinal obstruction

- norm WBC (unless strangulated) - abc testing, Hct, BUN, creatinine tesine (increased lvls found in blood) - dehydration - abd ultrasound - abd CT is definitive!! (no definitive labs)... Xray of abd/pelvis can detect

... however, w/ closed loop obstruction (obstruction w/ compromised blood flow), the risk for ______ is greatly increased. bacteria w/p blood supply can form + release an endotoxin into the peritoneal or systemic circulation and cause ____

- peritonitis - septic shock

wt los of ________ or _______ indicated malnutrition

10% in 6 months 5% in 30 days

to limit sat fat intake, the client should limit the total fat intake to be what percentage of total calories per day?

35%

bronchoscopy prep: NPO for _____-______ before actual procedure

4-8 hrs

possible malnutrition if cholesterol lvl is ____

<160

what vitamins promote wound healing following major surgery?

A, B12, C, K NOT vit D

DM not adhering to therapy... ANSWER is everything (but gender)

DM not adhering to therapy... ANSWER is everything (but gender)

Fat Embolism Syndrome (FES). which of the following laboratory findings should the nurse expect? a. Decreased serum calcium level b. Decreased level of serum lipids c. Decreased erythrocyte sedimentation rate (ESR) d. Increased platelet count

Decreased serum calcium level A decreased serum calcium level is an expected finding for FES, although the reason for this finding is unknown. all for an unknown reason

What finding should a nurse expect when assessing a client who has chronic venous insufficiency? a. dependent rubor b. edema c. hair loss d. Thick, deformed toenails

Edema An increase in venous hydrostatic pressure, which develops when fluid accumulates in the veins, causes fluid to leak out into the tissues resulting in edema. all of the other options are s/s of PAD

multiple long bone fractures from MVC. client is having SOB + experiencing chest pain. the nurse should assess the client for which of the following potential complications? a. Hypovolemic shock b. Fat embolism syndrome c. Compartment syndrome d. Venous thromboembolism

Fat embolism syndrome A client who has multiple long bone fractures is at high risk for developing a fat embolism syndrome. The nurse should assess the client for additional manifestations—such as an altered mental status, tachypnea, and tachycardia—and report the findings to the provider. a- The nurse should expect a client who has hypovolemic shock to display increased heart and respiratory rates and report increased thirst. c- The nurse should expect a client who has compartment syndrome to display increased edema and report severe, unrelenting pain at the fracture site. d- The nurse should expect a client who has a venous thromboembolism to display a sudden onset of unilateral swelling of the leg and report pain or tenderness in the calf or groin areas.

what finding is a complication of TPN? a. hyperglycemia b. aspiration c. diarrhea d. Stomatitis

Hyperglycemia TPN is prescribed when extensive nutritional support for prolonged periods of time is required. It is delivered through a central venous access device, usually via the internal jugular or subclavian vein. TPN contains a high concentration of dextrose, which can result in hyperglycemia. Frequent glucose monitoring should be implemented in clients receiving TPN. b- Aspiration is a complication of enteral feedings. This can occur if the tube is not placed correctly (e.g., in the lungs instead of the stomach) and feedings are infused. Because TPN is not administered via the gastrointestinal tract, aspiration is not a complication. c- Diarrhea is a complication of enteral feedings. Diarrhea can occur if the feedings are delivered too rapidly or the formula is too cold. Because TPN is not administered via the gastrointestinal tract, diarrhea is not a complication. d- Although mouth care is important for clients who are receiving supplemental nutrition, stomatitis is not expected. Stomatitis is an inflammation of the lining of the mouth that can include the inside of the cheeks, gums, and tongue. It is not caused by TPN.

left lower arm fracture. which of the following indicates impaired venous return in the client's affected arm? a. A bounding distal pulse b. Acute pain c. Ecchymosis of the surrounding skin d. Increasing edema

Increasing edema Increasing edema is a sign of impaired circulation. It is important for client who has a limb fracture to keep the limb elevated to reduce edema. a. bounding distal pulse enacted adequate ___

post CABG + is receiving opioid Th. besides managing pain, what other desired effects does the nurse identify as most important for the client's recovery? a. It decreases the client's level of anxiety. b. It facilitates the client's deep breathing. c. It enhances the client's ability to sleep. d. It reduces the client's blood pressure.

It facilitates the client's deep breathing. When using the airway, breathing, circulation approach to client care, the nurse should identify facilitation of deep breathing as the most important desired effect of opioids aside from pain relief. Following thoracic type surgeries, the client's has increased pain with moving, deep breathing and coughing. Opioid medications help minimize the discomfort experienced with deep breathing and coughing which prevents the development of postoperative pneumonia. The nurse should also encourage the client to splint his incision to help minimize pain.

what electrolyte is imp to monitor in bowel obstruction?

K+

a nurse is developing a plan of care for a client who has a fracture to achieve the outcome of functional healing. to assist in meeting this goal, which of the following nursing interventions is the highest priority? a. Maintain immobilization and alignment. b. Provide optimal nutrition and hydration. c. Promote independence in activities of daily living. d. Provide relief from pain and discomfort.

Maintain immobilization and alignment. Maintaining the prescribed immobilization and body alignment will keep the fracture fragments in close anatomical proximity, thereby promoting functional fracture healing. According to the safety and risk reduction priority setting framework, this goal should receive the highest priority.

pt has hypercholesterolemia + is taking somatostatin. Which of the following findings should the nurse recognize as a potential adverse effect? a. Urinary retention b. Muscle weakness c. Orthostatic hypotension d. Blurred vision

Muscle weakness Myopathy is an adverse effect of this medication. Signs of myopathy include muscle aches, tenderness, and muscle weakness.

which of the following is a r/f for developing HTN? a. High-density lipoprotein (HDL) level of 70 mg/dL b. A diet high in potassium c. Obstructive sleep apnea (OSA) d. Taking benazepril

Obstructive sleep apnea (OSA) The nurse should include OSA as a risk factor in the development of hypertension. OSA is a condition in which the client's airway becomes blocked by the relaxation of the tongue and muscles of the oropharynx, effectively obstructing the airway. The obstructed airway results in surges in the both the systolic and diastolic pressure during sleep and, in some clients, through the waking hours even when breathing is normal. b- The nurse should include diet as a factor in the development or prevention of hypertension. Low dietary potassium intake has been associated with an elevation in blood pressure and an increased risk of stroke, while a diet high in potassium has been found to decrease blood pressure. Other electrolytes impacting blood pressure include calcium and magnesium, both of which can result in hypertension if dietary consumption is low.

what is abetter indicator for nutrition deficiency?

PAB (short 1/2 life)

what med is prescribed to prevent osteoporosis?

Raloxifene (for prevention + Tx in postmenopausal women)

which of the following actions should the nurse take when finding that the TPN solution is infusing too rapidly? a. Turn the client on his left side. b. Sit the client upright. c. Prepare to add insulin to the TPN infusion. d. Stop the TPN infusion.

Sit the client upright. Fluid overload can cause dyspnea. The nurse should slow the infusion rate and sit the client upright to help prevent or treat dyspnea. The nurse should also administer oxygen if necessary.

what sweetener adds to the carb count?

Sorbitol

caring for pt w/ PUD. indication of perforation? - hypoactive bowel sounds - sudden abd pain - HTN - bradycardia

Sudden abd pain sudden sharp abdominal pain with a rigid abdomen, declining peristalsis, and progression to septicemia and hypovolemic shock

client following a CVA has severe dysphagia. which of the following nutritional therapies will likely be prescribed? a. NPO until dysphagia subsides b. Supplements via nasogastric tube c. Initiation of total parenteral nutrition d. Soft residue diet

Supplements via nasogastric tube Supplements via nasogastric tube provide enteral nutrition for clients who are at risk for aspiration caused by a diminished gag reflex or difficulty swallowing. This nutritional therapy will likely be prescribed. c- Total parenteral nutrition is initiated when the GI tract cannot be used for the ingestion, digestion, and absorption of essential nutrients. This nutritional therapy will not likely be prescribed.

strangulate bowel is going to show an increase in ___

WBCs

ranitidine to treat PUD. which of these statements indicate client has an understanding? a. "I can take this medication with or without food." b. "I will take this medication in the morning." c. "I should expect my stools to turn black." d. "I will take this medication with an antacid." e. "I will take this medication when I need it for pain." f. "I will eat five small meals each day."

a. "I can take this medication with or without food." f. "I will eat five small meals each day." take in PM to reduce nocturnal acid production report black stools bc it's an indication of GI bleeding

HgA1C lvl that indicates client is appropriately controlling his glucose lvls. (for a pt w/ DM). a. 6.3% b. 7.8% c. 8.5% d. 10%

a. 6.3% The client who has diabetes mellitus needs to manage activity and diet while monitoring blood glucose levels. High levels of blood glucose cause damage to the macro and microcirculation, affecting such things as eyesight and kidney function. The goal for a client who has diabetes mellitus is to keep the HbA1c values at 6.5% or less.

which of the following foods is a great source of protein? a. soybeans b. grains c. legumes d. green vegetables

a. soybeans The nurse should instruct that soybeans and soybean products are high-quality, or complete, sources of proteins. Complete proteins contain all nine essential amino acids required for growth and maintenance of the body.

which lab test help diagnose MI? a. Troponin I b. Troponin T c. Plasma low-density lipoproteins (LDL) d. CPK e. Myoglobin

a. Troponin I b. Troponin T d. CPK e. Myoglobin

med for hypothyroidism a. levothyroxine b. Levofloxacin

a. levothyroxine Levothyroxine is a synthetic thyroid hormone that is chemically identical to thyroxine (T4). It is used in the treatment of hypothyroidism. The nurse should prepare to instruct the client on the use of this medication.

obstruction below duodenum but above large bowel

a/b balance usually not compromised (bc of loss of both a + b)

TEN: abdominal distention w/ ___. prevent by ___

abd distention w/ overfeeding. prevent by checking residuals

pts w/ bowel obstruction: - report...

abd pain/ distention, n/v...

avoid what drink for glimepiride? a. grapefruit juice b. milk c. alcohol d. coffee

alcohol!!

what should pts w/ bowel obstruction avoid?

analgesics bc they further slow GI tract

TLC (total lymphocyte count): assess _____. <___ is possible malnutrition.

assess immune fin. <160 is possible malnutrition decreases lvls mean malnutrition

glyburide to Tx DM2. which of the following is a contraindication to taking tis med? a. "I had strep throat about one year ago." b. "I plan to continue nursing my baby until he is at least a year old." c. "I got my flu shot at the pharmacy two weeks ago." d. "I am allergic to shellfish."

b. "I plan to continue nursing my baby until he is at least a year old." Glyburide is a sulfonylurea that is used to treat type 2 diabetes, but it is contraindicated during pregnancy and breastfeeding.

sucralfate pt ed a. "An antacid may be taken with the medication if indigestion occurs." b. "Take sucralfate 1 hr before meals." c. "Take the tablets whole." d. "Store sucralfate in the refrigerator."

b. "Take sucralfate 1 hr before meals." *Sucralfate is a mucosal protectant. The client should take it on an empty stomach, 1 hr before meals, for maximum effectiveness. a- The client should not take antacids within 30 min of taking sucralfate. c- Sucralfate tablets may be broken or dissolved in water for easier ingestion.

levothyroxine for primary hypothyroidism. pt ed... a. "Take this medication until your symptoms are gone and then discontinue." b. "Tremors, nervousness, and insomnia may indicate your dose is too high." c. "Symptoms improve immediately after starting the medication." d. "The medication decreases the overproduction of the thyroid hormone thyroxine."

b. "Tremors, nervousness, and insomnia may indicate your dose is too high." The nurse should teach that tremors, nervousness, and insomnia may indicate an overdose of the medication and to notify the provider.

pt w/ DM reports foot pain. which of the following indicated infection? a. Bradycardia b. An increase in neutrophils c. An increase in RBCs d. An increase in platelets e. Localized edema

b. An increase in neutrophils e. Localized edema

what to expect w/ hypoparathyroidism? a. Flaccid muscles b. Client report of numbness in his hands c. Negative Chvostek's sign d. Client report of anorexia

b. Client report of numbness in his hands Numbness and tingling in the client's hands and feet are manifestations of hypoparathyroidism due to hypocalcemia. a- Excessive muscle contractions are manifestations of hypoparathyroidism.

early manifestation of fat embolism syndrome a. Petechiae b. Hypoxemia c. Headache d. Precordial chest pain

b. Hypoxemia Evidenced-based practice indicates that the nurse should recognize hypoxemia as the first expected manifestation of fat embolism syndrome. Hypoxemia, increased respiratory rate, and shortness of breath are caused by a low arterial oxygen level. a- late manifestation c- later manifestation d- late manifestation

osteoprosis exercise to promote: a. High-impact aerobics b. walking briskly c. Riding a bicycle d. Stretching exercises

b. walking briskly Weight-bearing exercises are essential for maintaining bone mass. Walking is an appropriate activity for an older client to promote weight bearing and to maintain bone mass.

TEN: check osmolatiry (lvl)

btwn 270-300. anything outside osmolarity causes huge shift in f/e

new prescription for esomeprazole to manage GERD. what statement indicates an understanding of the teaching? a. "I won't pass gas as often now that I am taking this medication." b. "I will take this medication each morning with my breakfast." c. "I have an increased risk of getting pneumonia while taking this medication." d. "I will need to take a daily stool softener while taking this medication."

c. "I have an increased risk of getting pneumonia while taking this medication." The client taking esomeprazole is at a greater risk for developing pneumonia due to an elevation of gastric pH, especially during the first few days of treatment. The nurse should instruct the client about manifestations of a respiratory infection and to report these findings to the provider if they occur.

verapamil for angina. instruction to give a. "Limit your fluid intake to meal times." b. "Do not take this medication on an empty stomach." c. "Increase your daily intake of dietary fiber." d. "You can expect swelling of the ankles while taking this medication."

c. "Increase your daily intake of dietary fiber."

which of the following ha 15g carbs? a. 2 slices bread b. 1 cup sugar-free yogurt c. 1 cup milk d. 1 cup regular ice cream

c. 1 cup milk

liothyronine for hypothyroidism... which of the following is a therapeutic response to this med? a. Decrease in appetite b. Increase in weight c. Increase in energy d. Decrease in body temperature

c. Increase in energy An increase in energy is a therapeutic response to liothyronine. Depression, lethargy, and fatigue are manifestations of hypothyroidism and effective treatment will improve these manifestations.

pt is newly diagnosed w/ DM2. which of the following medications can cause glucose intolerance? a. Ranitidine b. Guaifenesin c. Prednisone d. Atorvastatin

c. Prednisone Corticosteroids such as prednisone can cause glucose intolerance and hyperglycemia. The client might require increased dosage of a hypoglycemic medication.

levothyroixine for hypothyroidism. avoid which herbal supplement? a. Saw palmetto b. cranberry c. Soy d. garlic

c. Soy The nurse should instruct the client to avoid soy because soy can reduce the effectiveness of the levothyroxine.

what would you expect w/ uncontrolled DM1? a. Hypertension b. Hematuria c. Weight loss d. Bradycardia

c. Weight loss Weight loss is an expected finding for a client who has uncontrolled diabetes.

hypothyroidism. should eat which of the following? a. Ripe bananas b. Poached eggs c. Whole grains d. Baked chicken

c. Whole grains Constipation is a classic manifestation of hypothyroidism; therefore, this client should increase her fluid and fiber intake. Whole grains provide ample amounts of fiber. a- Ripe bananas are an appropriate choice for clients who have diverticulitis or ulcerative colitis but not for hypothyroidism. b- Poached eggs are an appropriate choice for clients who have diverticulitis or ulcerative colitis but not for hypothyroidism. d- Animal based protein sources do not help with constipation, which is a classic manifestation of hypothyroidism.

3 indications for TEN

can't maintain nutrition w/ PO intake alone, swallowing impairment, Cann't eat due to a specific cond

FEV1/FVC

compares results of the two tests above. can indicate obstruction to airflow. used to determine obstructive pulm dz

which client has a manifestation of hypoparathyroidism? a. A client who has a vitamin D of 25 ng/mL b. A client who has a magnesium of 1.8 mEq/L c. A client who has a calcium of 9.8 mg/dL d. A client who has a phosphate of 5.7 mg/dL

d. A client who has a phosphate of 5.7 mg/dL This level is above the expected reference range of 3.0 to 4.5 mg/dL. Phosphorus levels are increased in a client who has hypoparathyroidism.

pt having an acute MI. the nurse should plan to administer which of the following medications after the initial acute phase to manage the client's pain + anxiety? a. Nitroglycerin b. aspirin c. oxygen d. morphine

d. Morphine Morphine is the medication of choice for managing the pain and anxiety of an acute MI. By reducing preload and afterload, it decreases the work of the heart.

vit B12 (pernicious) anemia

diag: macrocytic-> test blood (B12/folate low, HC elevated) -> ELEVATED MMA lvls s/s: red, beefy smooth tongue (glossitis)!!! confused + usually old. paresthesias, forgetfulness, confusion, tongue burning. NI: eat leafy green veggies, animal protein, fish, eggs, dairy products, dried beans, + citrus fruit. ***injections monthly for rest of life (bc of malabsorption)

IDA (iron deficiency anemia)

diagnose: anemia-> microcytic->check Loe iron lvls s/s: koilonychia/spoon nails (chronic), pale handa/no lines Tx: eat iron rich sources (red meat, organ meat, leafy green veggies, raisins) food don't work? daily food journal. supplements (monitor lvls)... Fe can cause poop to look bloody, tarry

folic acid/folate deficiency anemia

diagnose: macrocytic-> test blood (B12/folate low, HC elevated)-> NORM MMA lvls - NOT come w/ neurologists s/s like confusion or dementia (like older ppl... this is for B12 A). *nervous system remains norm - NI: diet rich in folate + B12. folic acid replacement Th s/s: macrocytics are commonly asymptomatic (B12/pernicious + folic acid/folate) causes: poor nutrition, malabsorb, drugs, chrons, anticonvulsants, PO contraceptives

captopril pt instruction to provide

don't give w/ salt substitutes (ACE inhibitor can cause hyperkalemia)

caring for a client with liver cirrhosis w/ ascites, bleeding esophageal varicies, + portal HTN. which lab finding indicates the client's GI tract is digesting + absorbing food? - elevated BUN - elevated HbA1C - decreased chloride - decreased bilirubin

elevated BUN As the body digests blood, BUN rises. An elevated BUN is an indication of GI bleeding.

after EGD, what is priority? - gag reflex - LOC

gag reflex

atherosclerosis diet

high in fruits, veggies, whole grains. reduce Na intake (no more than 2400mg/day... 1500mg/day preferred). reduce trans fat sat fats 3-5% of daily caloric intake

FRC (functional residual capacity) indicates...

hyperinflation or air trapping its the amnt of air left in lung after expiration

what electrolyte imbalance predisposes pt to a nonmechanical bowel obstruction?

hypokalemia

if TEN is not avail, give ____ or ____ what do you check frequently? ____ every ____

if TEN not avail, give D10W or D20W glucose Q4hrs

TLC (total lung capacity)

indicates air trapping from obstructive palm dz. decreased TLC indicated restrictive dz its the amnt of air in lungs after max inspiration

PAD early stage

intermittent claudication

obstruction at end of SI and lower in the intestinal tract

metabolic acidosis (loss of alkaline fluids)

obstruction high in small intestine

metabolic alkalosis (loss of gastric hydrochloride)

acute MI s/s a. Orthopnea b. Headache c. Nausea d. Tachycardia e. Diaphoresis

nausea (+ vomiting) tachycardia (+ dysrhythmias) diaphoresis dyspnea hest pain and sometimes jaw, back, and shoulder pain

physical assessment of a strangulated bowel

obstipation (no passage of stool), borborygmi (high pitched sounds) later they are absent, hiccups, lbm... what it looks like... color of vomitus, pattern of pain, flatus, color of abdominal skin, board-like abdomen, abdominal distention (common), peristaltic waves

RV (residual volume) is increased with...

obstructive palm dz (like emphysema)

PAD late stage

pain at rest (pain is described as numb, toothache, usually in distal part of extremity [toes, arch, forefoot, heal]). this pain commonly wakes the pt at night

FEF (forced expiratory flow)

provides more of an index for detecting smaller airway obstruction

DLCO (diffusion capacity of the lung for carbon monoxide)

reflects surface area of the alveolarcapiallry membrane. reduced when the a. membrane is diminishes )seen in emphysema, pulm HTN, + pulm fibrosis). increased w/ exercise + in a cond such as polycythemia + CHF

wha insulin for DKA?

regular insulin

serum albumin is ____ if dehydrated + ____ if have fluid access

serum albumin high if dehydrates, low if have fluid access (SA indicates nutrition lvl few wks before testing)

what is a better indicator of protein status than albumin?

serum transferrin

TEN: refeeding syndrome s/s

shallow resp, weak confusion, seizures, bleeding life threatening metabolic complication when pt is started on feeds during starvation... huge electrolyte shift. mainly hypophostphatemia

glipizide awn (DM2)

stim pancreas to release insulin Glipizide is an oral antidiabetic medication in the pharmacological classification of sulfonylurea agents. These medications help to lower blood glucose levels in clients who have type 2 diabetes mellitus using several methods, including reducing glucose output by the liver, increasing peripheral sensitivity to insulin, and stimulating the release of insulin from the functioning beta cells of the pancreas.

intussusception

telescoping of the bowel

FEV1 (forces expiratory volume 1)

test max amnt of air that can be expelled in 1st second of expiration

FVC

tests max amount of air that can be exhales as quickly as possible after max inspiration. indicates respiratory muscle strength + ventilatory reserve

volvulus

twisting of the bowel