Chronic Past Questions (Final Study)
A group of student nurses are practicing taking blood pressure. A 56-year-old male student has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" Which of the following responses by the nursing instructor would be best? - "You have no need to worry. Your pressure is probably elevated because you are being tested." - "A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made." - "Yes. Hypertension is prevalent among men; it is fortunate we caught this during class." - "We will need to reevaluate your blood pressure because your age places you at high risk for hypertension."
"A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made." - Hypertension is confirmed by two or more readings with systolic pressure of at least 140 mm Hg and diastolic pressure of at least 90 mm Hg. An age of 56 does not constitute a risk factor in and of itself. The nurse should not tell the student that there is no need to worry.
A client with prediabetes states, "The doctor said if my blood sugars remain stable, I may not need to take any medication." Which response by the nurse in most appropriate? - "You will be placed on a strict low-sugar diet for better control" - "Some doctors do not treat blood sugar elevation until symptoms appear" - "Diet, exercise, and weight loss may eliminate the need for medication." - "You misunderstood the doctor. Let's ask for clarification
"Diet, exercise, and weight loss may eliminate the need for medication." - Lifestyle changes may halt the progression of prediabetes to diabetes
The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following? - " I will eat something at mealtimes to prevent hypoglycemia, even if I am not hungry" - " I can choose any foods, as long as I use enough insulin to cover the calories" - " I will need a bedtime snack because I take an evening dose of NPH insulin" - I can have an occasional beverage with alcohol if I include it in my meal plan"
"I can choose any foods, as long as I use enough insulin to cover the calories"
A client is placed on a low-sodium (1000 mg/day) diet. Which client statement indicates that the nurse's nutrition teaching plan has not been effective? - "I chose broiled chicken with a baked potato for dinner." - "I'm glad I can still have spam and bacon sandwiches." - "I chose a tossed salad with a vinaigrette dressing for lunch." - "I can should not regularly eat a ham-and-cheese sandwich with potato chips for lunch."
"I'm glad I can still have spam and bacon sandwiches." - Spam is canned meat which is high in sodium and bacon is high in cholesterol and salt which is not part of ow sodium diet.
The nurse is caring for a patient newly diagnosed with hypertension. Which of the following statements if made by the patient indicates the need for further teaching? - "When getting up from bed, I will sit for a short period prior to standing up. - "If I take my blood pressure and it is normal, I don't have to take my BP pills." - "I think I'm going to sign up for a yoga class twice a week to help reduce my stress." - "I will consult a dietician to help get my weight under control."
"If I take my blood pressure and it is normal, I don't have to take my BP pills." - Antihypertensive medication must be taken routinely to be effective.
When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. The patient tells the nurse, "My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." The most appropriate response by the nurse is - "You have the right to refuse to take the methotrexate." - "Methotrexate is less expensive than some of the newer drugs." - "It is important to start methotrexate early to decrease the extent of joint damage." - "Methotrexate is effective and has fewer side effects than some of the other drugs."
"It is important to start methotrexate early to decrease the extent of joint damage."76
An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as suggestive of diabetes? - "No matter how much sleep I get, it seems to take me hours to wake up." - "When i went to the washroom the last few days, my urine smelled odd" - "Lately, I drink and drink and can't seem to quench my thirst" - I've always been a fan of sweet foods, but lately I'm turned off by them."
"Lately, I drink and drink and can't seem to quench my thirst" The cardinal symptom of diabetes and polydipsia, polyuria, and polyphagia. Fatigue and odd odor to urine are not signs of diabetes.
An unlicensed nursing assistant (NA) reports to the nurse that a postsurgical client rates her pain as 8 on a 0-to-10 point scale. The NA tells the nurse that he thinks the client is exaggerating and does not need pain medication. What is the nurse's best response? - "Pain often comes and goes with postsurgical clients. Just ignore her for now and she will stop." - "Pain is whatever the person experiencing pain says it is, existing whenever the person says it does.'" - "We need to provide pain medications because it is the law, and we must always follow the law." - "It's not unusual for clients to misreport pain after surgery."
"Pain is whatever the person experiencing pain says it is, existing whenever the person says it does.'" - A broad definition of pain is "whatever the person says it is, existing whenever the experiencing person says it does." Action should be taken unless there are demonstrable extenuating circumstances. Rechecking without offering an intervention would be insufficient and the law is not the sole reason for providing care.
A newly diagnosed client with hypertension is prescribed a thiazide diuretic. What client education should the nurse provide to this client? - "This medication increases sodium levels in your blood, so cut down on your salt." - "Eat a banana every day because this medication causes moderate hyperkalemia." - "This medication can cause low blood pressure and dizziness, especially when you get up suddenly." - "Take over-the-counter potassium pills because this medication causes your kidneys to lose potassium."
"This medication can cause low blood pressure and dizziness, especially when you get up suddenly." - Thiazide diuretics can cause orthostatic hypotension, which may be potentiated by alcohol, barbiturates, opioids, or hot weather. Thiazide diuretics do not cause either moderate hyperkalemia or severe hypokalemia and it does not result in hypernatremia.
The quality improvement team at a large, urban hospital has recognized the need to better integrate the principles of transcultural nursing into client care. When explaining the concept of transcultural nursing to uninitiated nurses, how should the team members describe it? - Transcultural nursing refers to a systematic and evidence-based effort to improve health outcomes in clients who are immigrants. - Transcultural nursing is the comparative analysis of the health benefits and risks of recognizable ethnic groups. - Transcultural nursing refers a specialty that focuses on the comparative study and analysis of cultures and subcultures. - Transcultural nursing is a term used to describe interventions that seek to address language barriers in nursing practice.
- Transcultural nursing refers a specialty that focuses on the comparative study and analysis of cultures and subcultures. - Transcultural nursing, a term sometimes used interchangeably with cross-cultural, intercultural, or multicultural nursing, refers to research-focused practice that focuses on client-centered, culturally competent nursing. It is not limited to language barriers and foreign-born clients. It does not focus solely on health risks and benefits in ethnic groups.
A 26-yr-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to: - limit intake of calories until the glucose is less than 120 mg/dL - use only the lispro insulin until the symptoms are resolved - monitor blood glucose every 4 hours and notify the clinic if it continues to rise - decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%
- monitor blood glucose every 4 hours and notify the clinic if it continues to rise
The nurse is caring for a 65-year-old client who has previously been diagnosed with hypertension. What blood pressure reading represents the threshold between high-normal blood pressure and hypertension? - 150/100 mm Hg - 145/95 mm Hg - 140/90 mm Hg - 160/100 mm Hg
140/90 mm Hg - Hypertension is the diagnosis given when the blood pressure is greater than 140/90 mm Hg. This makes the other options incorrect.
The nurse is preparing discharge teaching for an adult client diagnosed with urinary retention secondary to multiple sclerosis. The nurse will teach the client to self-catheterize at home upon discharge. What teaching method is most likely to be effective for this client? - A list of clear instructions written at a sixth-grade level - An audio-recorded version of discharge instructions that can be accessed at home - A short video providing useful information and demonstrations - A discussion and demonstration between the nurse and the client
A discussion and demonstration between the nurse and the client - Demonstration and practice are essential ingredients of a teaching program, especially when teaching skills. It is best to demonstrate the skill and then give the learner ample opportunity for practice. When special equipment is involved, such as urinary catheters, it is important to teach with the same equipment that will be used in the home setting. A list of instructions, a video, and an audio recording are effective methods of reinforcing teaching after the discussion and demonstration have taken place.
The emergency department (ED) nurse is caring for an adult client who was in a motor vehicle accident. Radiography reveals an ulnar fracture. What type of pain is the nurse addressing with this client? - Neuropathic - Chronic - Acute - Nociceptive
Acute - Acute pain is usually of recent onset and commonly associated with a specific injury. Acute pain indicates that damage or injury has occurred. Chronic pain is constant or intermittent pain that persists beyond the expected healing time and that can seldom be attributed to a specific cause or injury. Nociceptive pain is caused by damage to somatic or visceral tissue. Neuropathic pain is caused by damage to peripheral nerves or structures in the CNS.
A client with type 1 diabetes presents to the ED with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate? - Observing the client for 1 hour, then rechecking the fingerstick glucose level - Administering a 500-ml bolus of normal saline solution - Administering 1 ampule of 50% dextrose solution, per physician's order - Inserting a feeding tube and providing tube feedings
Administering 1 ampule of 50% dextrose solution, per physician's order - Emergent treatment of hypoglycemia is 50% Dextrose IV push. None of the other actions will increase the client's blood glucose
A community health nurse is planning an educational campaign addressing hypertension. The nurse should anticipate that the incidence and prevalence of hypertension are likely to be highest among members of what ethnic group? - Asian-Americans - African-Americans - Hispanic-Americans - Pacific islanders
African-Americans - The prevalence of hypertension varies by ethnicity and gender, and is estimated at approximately 32.9% among Caucasian men, 30.1% among Caucasian women, 44.9% among African-American men, 46.1% among African-American women, 29.6% among Hispanic men, and 29.9% among Hispanic women. The prevalence of hypertension among African Americans is among the highest in the world.
A nurse educator is providing information about hypertension to a small group of clients. A participant asks what she can do to decrease her blood pressure and thus her risk for heart problems. The nurse describes modifiable and nonmodifiable risk factors. Which of the following risk factors are not modifiable? - Tobacco Use - Sedentary Lifestyle - Alcohol Intake - Age
Age - Age, Ethnicity and Gender are nonmodifiable risk factors. Alcohol Intake, Tobacco Use and Sedentary lifestyle are modifiable.
A nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? - Perform exercise prior to eating whenever possible - Always carry a form of fast-acting sugar - Eat a meal or snack every 8 hours - Check blood sugar at least every 24 hours
Always carry a form of fast-acting sugar - Patients with diabetes should always have a fast-acting sugar source on hand. Blood sugar should be checked before each meal, before bed, and before and after exercise. Patients should have a snack before exercise and should eat more frequently that every 8 hours to maintain a stable blood sugar.
A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review? - Anti-Smith antibody (Anti-Sm) - Antinuclear antibody (ANA) - Lupus erythematosus (LE) cell prep - Rheumatoid factor (RF)
Anti-Smith antibody (Anti-Sm)
A female patient of the Islamic faith requests that only females care for her in the hospital. Which actions should the nurse manager take in response to this request? - Explain to the client that this request cannot be fulfilled as male staff are also assigned to this unit - Assure the patient that only female nurses and nursing assistants will be assigned to care for this client - Post a sign stating only female staff may enter the room - Explain that the request will be forwarded to the client advocate representative
Assure the patient that only female nurses and nursing assistants will be assigned to care for this client - Limiting caregivers to female staff is reasonable and respects the client's faith beliefs, which takes priority over staffing patterns. Nursing management controls the staffing and it would be inappropriate to forward the request to the client advocate. Posting a sign outside the room would be a breach of confidentiality.
The nurse is administering the morning mediations to a patient on the cardiac telemetry unit. Metoprolol has been prescribed for this patient. Prior to administration, the nurse would tell the patient that the medication is which type of antihypertensive? - Angiotensin-converting enzyme (ACE) inhibitor - Diuretic - Vasodilator - Beta blocker
Beta Blocker - Metropolol is a beta blocker
A nurse is providing an educational class to a group of older adults at a community senior center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended intake of what nutrients? (Select all that apply) - Calcium - Calcitonin - Sodium - Vitamin D - Vitamin B-12
Calcium Vitamin D
A patient with osteoarthritis (OA) will need education about which of the following medications? - Adalimumab (Humira) - Capsaicin cream (Zostrix) - Sulfasalazine (Azulfidine) - Prednisone
Capsaicin cream (Zostrix)
Which of the following statements about hemodynamics and blood pressure is TRUE? Select all that apply - An increase in Systemic Vascular Resistance will cause a decrease in blood pressure - Cardiac Output = Heart Rate X Stroke Volume - BP= CO x SVR - A decrease blood pressure is the response to increased levels of Angiotensin II - Stroke volume is influenced by preload, afterload, and cardiac contractility
Cardiac Output = Heart Rate X Stroke Volume BP= CO x SVR Stroke volume is influenced by preload, afterload, and cardiac contractility Cardiac output = HR X SV Preload, afterload, and contractility all influence stroke volume Blood Pressure= CO X SVR Angiotensin II is a potent vasoconstrictor and will increase blood pressure
The healthcare provider suspects the Somogyi effect in a 50-yr-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take? - Check the blood glucose during the night - Administer a larger dose of Long-acting- insulin - Increase the rapid-acting insulin dose - Avoid snacking at bedtime
Check the blood glucose during the night
A parent informs the nurse that immunizations are contrary to her religious beliefs, and she does not want her child to receive them. The nurse proceeds to inform the parent that the child will be in grave danger of illness all her life and will not be allowed to start school unless she is immunized. The nurse also informs the parent that she had all of her own children vaccinated with no adverse effects. The nurse's behavior is an example of what? - Acculturation - Cultural imposition - Stereotyping - Ethnocentrism
Cultural imposition - The nurse's behavior is an example of cultural imposition, defined as the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture. Acculturation is the process by which members of a cultural group adapt to or learn how to take on the behaviors of another group. Cultural blindness is the inability of people to recognize their own values, beliefs, and practices and those of others because of strong ethnocentric tendencies. Cultural taboos are activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group.
The nurse is caring for a client whose medical history includes chronic fatigue and poorly controlled back pain. These medical diagnoses should alert the nurse to the possibility of what consequent health problem? - Depression - Skin breakdown - Anxiety - Hallucinations
Depression -Depression is associated with chronic pain and can be exacerbated by the effects of chronic fatigue. Anxiety is also plausible, but depression is a paramount risk. Skin breakdown and hallucinations are much less likely.
A nurse is planning the care of a client who has been diagnosed with kidney disease, which the nurse recognizes as being a chronic condition. Which of the following descriptors apply to chronic conditions? Select all that apply. Select all that apply - Diseases that resolve slowly - Diseases that have a prolonged course - Diseases that do not resolve spontaneously - Diseases that have a short, unpredictable course - Diseases where complete cures are rare
Diseases that have a prolonged course Diseases that do not resolve spontaneously Diseases where complete cures are rare - Chronic conditions can also be defined as illnesses or diseases that have a prolonged course, that do not resolve spontaneously, and for which complete cures are unlikely or rare.
The nurse caring for an older adult client with osteoarthritis is reviewing the client's chart. This client is on a variety of medications prescribed by different care providers in the community. In light of the QSEN competency of safety, what is the nurse most concerned about with this client? - Depression - Inadequate pain control - Drug interactions - Chronic illness
Drug Interactions - Drug interactions are more likely to occur in older adults because of the higher incidence of chronic illness and the increased use of prescription and OTC medications. The other options are all good answers for this client because of the client's age and disease process. However, they are not what the nurse would be most concerned about in terms of ensuring safety.
Which result for a patient with chronic systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider? a. Decreased C-reactive protein (CRP) b. Elevated blood urea nitrogen (BUN) c. Positive antinuclear antibodies (ANA) d. Positive lupus erythematosus cell prep
Elevated blood urea nitrogen (BUN)
A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which of the following statements would the nurse include in the education session? - Engage in aerobic activity at least 30 minutes/day most days of the week - Lower both LDL and HDL cholesterol levels - Reduce sodium intake to no more than 4 grams per day - Limit alcohol consumption to no more than 3 drinks per day
Engage in aerobic activity at least 30 minutes/day most days of the week -LDL cholesterol should be lowered, but increased levels of HDL cholesterol are preferred. Alcohol should be limited to 2 drinks per day for men and one drink per day for women Sodium intake should be lowered to 2300 mg per day or less Aerobic activity is the only correct answer.
The nurse has just taken report on a newly admitted client who is a 15-year-old girl who is a recent immigrant. When planning interventions for this client, the nurse knows the interventions must be which of the following? Select all that apply. - Applicable to others with the same diagnosis - Ethical - Appropriate to the nurse's preferences - Appropriate to the client's culture - Appropriate to the client's age
Ethical Appropriate to the client's culture Appropriate to the client's age - Planned interventions should be ethical and appropriate to the client's culture, age, and gender. Planned interventions do not have to be in alignment with the nurse's preferences nor do they have to be shared by everyone with the same diagnosis.
A client admitted with right leg thrombophlebitis is to be discharged from an acute care facility. Following treatment with a heparin infusion, the nurse notes that the client's leg is pain free, without redness or edema. Which step of the nursing process does this reflect? - Analysis - Evaluation - Implementation - Diagnosis
Evaluation - The nursing actions described constitute evaluation of the expected outcomes. The findings show that the expected outcomes have been achieved. Analysis consists of considering assessment information to derive the appropriate nursing diagnosis. Implementation is the phase of the nursing process where the nurse puts the care plan into action. This nurse's actions do not constitute diagnosis.
Which information will the nurse include when teaching a patient who has type 2 diabetes about glyburide? - Glyburide should not be used for 48 hours after receiving IV contrast media - Glyburide should be taken even if the morning blood glucose level is low - Glyburide decreases glucagon secretion from the pancreas - Glyburide stimulates insulin production and release form the pancreas
Glyburide stimulates insulin production and release form the pancreas
The nurse is providing care for a client with a new diagnosis of hypertension. How can the nurse best promote the client's adherence to the prescribed therapeutic regimen? - Screen the client for visual disturbances regularly - Encourage the client to lose weight and exercise regularly - Emphasize the dire health outcomes associated with inadequate BP control - Have the client participate in self-monitoring BP at home
Have the client participate in self-monitoring BP at home - Adherence to the therapeutic regimen increases when clients actively participate in self-care, including self-monitoring of BP and diet. Dire warnings may motivate some clients, but for many clients this is not an appropriate or effective strategy. Screening for vision changes and promoting healthy lifestyle are appropriate nursing actions, but do not necessarily promote adherence to a therapeutic regimen.
A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient? - Hemoglobin A1C (glycosylated hemoglobin) - Urine dipstick for glucose and ketones - Oral glucose tolerance test - Fasting blood glucose
Hemoglobin A1C (glycosylated hemoglobin)
A patient is being discharged after 1 week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information will be included in the discharge teaching? - How to monitor and care for a long-term IV catheter - The need for daily aerobic exercise to help maintain muscle strength - The reason for taking oral antibiotics for 7-10 days after discharge - How to apply warm packs to the leg to reduce pain
How to monitor and care for long-term IV catheter
A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a patient with hypertension, the nurse learns that the patient has a family history of hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one pack of cigarettes daily and drinks "about a pack of beer" every day. The nurse notes what modifiable risk factor for hypertension. - A Family History of Hypertension - Hyperlipidemia - Female gender - Genetic Predisposition
Hyperlipidemia - Unlike family history, genetic predisposition and gender which are nonmodifiable risk factors; modifiable risk factors are cholesterol levels, alcohol intake, and tobacco use.
The nurse is writing a care plan for an 85-year-old client who has community-acquired pneumonia. The nurse assesses decreased breath sounds to bilateral lung bases on auscultation. What is the most appropriate nursing diagnosis for this client? - Ineffective airway clearance related to tracheobronchial secretions - Poor ventilation related to acute lung infection - Pneumonia related to progression of disease process - Immobility related to fatigue
Ineffective airway clearance related to tracheobronchial secretions - Nursing diagnoses are not medical diagnoses or treatments. The most appropriate nursing diagnosis for this client is "ineffective airway clearance related to copious tracheobronchial secretions." "Pneumonia" and "poor ventilation" are not nursing diagnoses. Immobility is likely, but is less directly related to the client's admitting medical diagnosis and the nurse's assessment finding.
A client experiences orthostatic hypotension while receiving furosemide (Lasix) to treat hypertension. How should the nurse intervene? - Administer a vasodilator as ordered. - Instruct the client to sit for several minutes before standing - Administer I.V. fluids as ordered - Insert an indwelling urinary catheter as ordered
Instruct the client to sit for several minutes before standing - Clients who experience orthostatic hypotension should be taught to rise slowly from a lying or sitting position and use a cane or walker if necessary for safety. It is not necessary to administer IV fluids. A vasodilator would only increase hypotension. There is no indication for a urinary catheter.
A client newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a client with prolonged, uncontrolled hypertension is at risk for developing what health problem? - Glaucoma - Right ventricular hypertrophy - Kidney damage - Anemia
Kidney damage - When uncontrolled hypertension is prolonged, it can result in kidney injury, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and cardiac failure. Glaucoma and anemia are not directly associated with hypertension.
Which of the following medications are routinely used in the treatment of hypertension? Select all that apply. - Clopidogrel - Losartan - Lisinopril - Hydrochlorothiazide - Diltiazem
Losartan Lisinopril Hydrochlorothiazide Diltiazem - Diuretics, ACE-inhibitors, ARBs, and calcium channel blockers are all used to treat hypertension. Clopidogrel inhibits platelet aggregation and is used after treatment for acute coronary syndrome.
A client hospitalized for treatment of hypertension is being prepared for discharge. Which teaching topic should the nurse be sure to cover? - Skipping a medication dose if dizziness occurs - Maintaining a low-sodium diet - Drinking at least 3 liters of fluid daily - Maintaining a low-potassium diet
Maintaining a low-sodium diet -A low sodium diet is standard teaching for patients with HTN along with medication management, smoking cessation, exercise, and follow-up with a primary care provider. Patients may also have a fluid restriction.
When implementing a comprehensive plan to reduce the incidence of falls on a gerontologic unit, what risk factors should the nurse identify? Select all that apply. - Unlimited visiting hours - Medication effects - Poor lighting - Extension cords - Sensory impairment
Medication effects Poor lighting Extension cords Sensory impairment - Causes of falls are multifactorial. Both extrinsic factors, such as changes in the environment or poor lighting, and intrinsic factors, such as physical illness, neurologic changes, or sensory impairment, play a role. Mobility difficulties, medication effects, foot problems or unsafe footwear, postural hypotension, visual problems, and tripping hazards are common, treatable causes. Unlimited visiting hours are actually helpful as family and friends are with the older adult patients.
A client's intractable neuropathic pain is being treated using a multimodal approach to analgesia. After administering a recently increased dose of IV morphine to the client, the nurse has returned to assess the client and finds the client unresponsive to verbal and physical stimulation with a respiratory rate of five breaths per minute. The nurse has called a code blue and should anticipate the administration of what drug? - Celecoxib - Acetylsalicylic acid - Naloxone - Acetylcysteine
Naloxone - Severe opioid-induced sedation necessitates the administration of naloxone, an opioid antagonist. Celecoxib, acetylcysteine, and acetylsalicylic acid are ineffective.
A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this patient's care, what desired outcome should the nurse identify? - Patient's BP remains consistently below 140/90 mm Hg - Patient takes medication as prescribed and reports any adverse effects - Patient is able to describe modifiable risk factors for hypertension. - Patient denies signs and symptoms of hypertensive urgency
Patient takes medication as prescribed and reports any adverse effects - The most appropriate expected outcome for a client who is given the nursing diagnosis of risk for ineffective health maintenance is that he or she takes the medication as prescribed. The other listed goals are valid aspects of care, but none directly relates to the client's role in their treatment regimen.
Based on a client's vague explanations for recurring injuries, the nurse suspects that a community-dwelling older adult may be the victim of abuse. What is the nurse's primary responsibility? - Report the findings to adult protective services. - Work with the family to promote healthy conflict resolution. - Confront the suspected perpetrator. - Gather evidence to corroborate the abuse.
Report the findings to adult protective services. - If neglect or abuse of any kind—including physical, emotional, sexual, or financial abuse—is suspected, the local adult protective services agency must be notified. The responsibility of the nurse is to report the suspected abuse, not to prove it, confront the suspected perpetrator, or work with the family to promote resolution.
According to the classification of hypertension diagnosed in the older adult, hypertension that can be attributed to an underlying cause is termed - Essential hypertension - Primary hypertension - Pulmonary hypertension - Secondary hypertension
Secondary Hypertension - Secondary hypertension is elevated BP with a specific cause that can be identified and corrected. Primary hypertension is elevated BP without an identified cause. It is also called essential hypertension. Pulmonary hypertension is elevated pressure in the pulmonary vasculature, which contributes to right heart failure. It can be primary (idiopathic) or secondary.
A patient with diabetes and a recent diagnosis of hypertension has experienced hypoglycemia twice in the last week. Which of the following history and assessment data are important to report to the provider? - Drinks grapefruit juice daily with breakfast - Takes metoprolol daily after breakfast and dinner - Takes psyllium daily as a fiber laxative with breakfast - Drinks skim milk every night with dinner
Takes metoprolol daily after breakfast and dinner - Metoprolol can mask the effects of hypoglycemia in clients with diabetes. Skim milk and grapefruit juice will increase blood glucose and psyllium does not cause hypoglycemia.
The nurse is caring for a client with a newly diagnosed allergy to peanuts. What immediate goal should the nurse apply to a nursing diagnosis of "deficient knowledge related to appropriate use of an EpiPen"? - The client will return to the clinic within 2 weeks to demonstrate the injection. - The nurse will teach the client's family member to administer the injection. - The client will demonstrate correct injection technique with today's teaching session. - The client will closely observe the nurse demonstrating the injection.
The client will demonstrate correct injection technique with today's teaching session. - Immediate goals are those that can be reached in a short period of time. An appropriate immediate goal for this client is that the client will demonstrate correct administration of the medication today. The goal should specify that the client administer the EpiPen. A 2-week time frame is inconsistent with an immediate goal.
The nurse is discussing macrovascular complications of diabetes with a client. The nurse would address what topic during this dialogue? - The relationship between kidney function and blood glucose levels - The fact that clients with diabetes have an elevated risk of stroke - The need to monitor urine for the presence of albumin - The need for frequent eye examinations for clients with diabetes
The fact that clients with diabetes have an elevated risk of stroke - Stroke and myocardial infarctions are considered macrovascular complications of diabetes, while the effects on vision and kidney function are considered to be microvascular.
The three major body systems involved in the stress response to protect the body from harm are - The nervous system, endocrine system, and immune system - The endocrine system, the neuro-renal system, and the immune system - The circulatory system, the renal system, and the nervous system - The nervous system, the respiratory system,
The nervous system, endocrine system, and immune system - The three major body systems involved in the stress response and work together to protect the body from harm are the nervous system, the endocrine system, and the immune system. (Dossey, Ch. 10, p. 232)
The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way? - It will give an accurate reading. - It will be significantly different with each reading. - The results will be falsely elevated. - The results will be falsely decreased.
The results will be falsely elevated. - BP cuffs that are too small will give a falsely high reading. BP cuffs that are too large will give a falsely low reading. The midline of the bladder of the cuff should be in line with the brachial artery.
The home health nurse is making an initial home visit to an older adult client who is a widower. The client takes multiple medications for the treatment of varied chronic health problems. The client states that he has also begun taking some herbal remedies. What should the nurse be sure to include in the client's teaching? - There is a need to inform his primary care provider and pharmacist about the herbal remedies. - Herbal remedies are consistent with holistic health care. - It is safest to avoid the use of herbal remedies. - Herbal remedies are often cheaper than prescribed medication.
There is a need to inform his primary care provider and pharmacist about the herbal remedies. - Herbal remedies combined with prescribed medications can lead to interactions that may be toxic. Clients should notify the physician and pharmacist of any herbal remedies they are using. Even though herbal remedies are considered holistic, this is not something that is necessary to include in the client's teaching. Herbal remedies may be cheaper than prescribed medicine, but this is still not something that is necessary to include in the client's teaching. For most people, it is not necessary to wholly avoid herbal remedies.
During assessment of the patient with fibromyalgia, the nurse would expect the patient to report which of the following (select all that apply)? - Widespread bilateral, burning musculoskeletal pain - Sleep disturbances - Cardiac palpitations and dizziness - Multijoint inflammation and swelling - Multiple tender points
Widespread bilateral, burning musculoskeletal pain Sleep disturbances Multiple tender points
A nurse is caring for a client who is being assessed following complaints of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing lower back pain? (select all that apply) - X-ray - Computed tomography (CT) - Angiography - Magnetic resonance imaging (MRI)
X-ray Computed tomography (CT) Magnetic resonance imaging (MRI)
An older adult female with osteoporosis has been hospitalized. Prior to discharge, when teaching the client, the nurse should include information about which major complication of osteoporosis? - negative calcium balance - rheumatoid arthritis - bone fracture - loss of estrogen
bone fracture =
Which laboratory result will the nurse monitor to determine if prednisone has been effective for a patient with an acute exacerbation of rheumatoid arthritis? - blood glucose - serum electrolytes - c-reactive protein - liver function tests
c-reactive protein
Which information will the nurse include in teaching a female who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs? - use heating pad to decrease pain - soak feet in warm water for an hour each day - use callus remover for corns or calluses - choose flat-soled leather shoes
choose flat-soled leather shoes
Client A is scheduled to receive Humalog (Lispro) during lunch time. Which of the following would be foremost in your mind? - she should have her meal tray within 30 minutes after the insulin is administered - ensure that she eats within 10 - 15 minutes after the insulin is administered It does not matter when she eats, as Lispro is a basal insulin - she should eat within one hour after the administration of the insulin
ensure that she eats within 10 - 15 minutes after the insulin is administered - Lispro is insulin begins to act in 15 minutes, so waiting longer than that to eat could result in hypoglycemia.
When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone. The nurse will anticipate that the patient may - need a diet higher in calories while receiving prednisone. - develop acute hypoglycemia while taking the prednisone. - have rashes caused by metformin-prednisone interactions. - have an increase in blood sugar and may require insulin while taking prednisone
have an increase in blood sugar and may require insulin while taking prednisone
An older adult women's current medication regimen includes alendronate (Fossamax). What outcome would indicate successful therapy? - absence of tumor spread - increased bone mass - relief of bone pain - resolution of infection
increased bone mass
A nurse is preparing to place a client's prescribed NG tube. Which anticipatory guidance should the nurse provide to the client? - topical anesthetics will be used to reduce discomfort during insertion - insertion is likely to cause some gagging - a narrow-gauge tube will be inserted before being replaced with a larger-gauge tube - insertion will cause some short-term pain
insertion is likely to cause some gagging
A nurse is caring for a client with type one diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin? - observe the client drawing up and administering the insulin - provide a health education session reviewing the main points of insulin delivery - review the clients first hemoglobin A1c result after discharge - ask the client to describe the process in detail
observe the client drawing up and administering the insulin
A client with diabetes is attending on the prevention of associated diseases. What action should the client perform to reduce the risk of osteomyelitis? - exercise 3 to 4 times weekly for at least 30 minutes - perform meticulous foot care - increase calcium and vitamin intake - take corticosteroids as prescribed
perform meticulous foot care
A client presents to the clinic reporting symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? - fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L) - random plasma glucose greater than 150 mg/dL (8.3 mmol/L) - fasting plasma glucose greater than 116 mg/dL (6.4 mmol/L) on two separate occasions - random plasma glucose greater than 125 mg/dL (7.0 mmol/L)
random plasma glucose greater than 150 mg/dL (8.3 mmol/L) - Criteria for the diagnosis of diabetes include symptoms of diabetes plus random glucose greater than or equal to 200 mg/dL (11.1 mmol/L), or a fasting plasma glucose greater than or equal to 126 mg/dL (7.0mmol/L)
A client presents with intense back pain, rating it an "11" on the 0-10 scale. He is hunched over and reports that the pain is running down his legs. What information will the nurse inquire about while obtaining the history of the present health concern? - the pain medication the client would like to have ordered - what the client ate and drank for lunch - if the client exercises at least 30 minutes every day - the client's activity just prior to the onset of pain
the client's activity just prior to the onset of pain
Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)? - the patient's creatinine has risen from 1.3 to 1.9 mg/dL - the patient has gained 2 lb (0.9 kg) in the past 24 hours - the patient is scheduled for a chest x-ray in an hour - the patient's blood glucose level is 174 mg/dL
the patient's creatinine has risen from 1.3 to 1.9 mg/dL