Exam 3 no 2

A patient with renal insufficiency has been hospitalized on a medical unit. The patient knows that renal function depends upon the functional status of nephrons. The patient asks the nurse when she will need to start dialysis based upon loss of nephron function. How should the nurse respond?

"When about 80% of the nephrons are no longer functioning."

Which if the following are critical components to assess in a grieving person?

-Perception of loss -Support system -Coping behaviors

Which of the following persons are most likely experiencing complicated grieving? select all that apply

-The spouse of a person who died 7 years ago and visits the grave several times a day. -A driver whose spouse and children all died as a result of h is driving drunk. -An adult who insisted for many years that he or she hated his or her deceased parent. -The parent of a child who died after having left the child in a hot car on a hot day.

- A nurse is caring for a 73-year-old male patient with a urethral obstruction related to prostatic enlargement. The nurse is aware this may result in what?

A urinary tract infection (UTI)

An experienced medical nurse has provided care for patients who have immunodeficiencies that are primary, as well as for patients who have secondary immunodeficiencies. Which of the following individuals is most clearly exhibiting secondary immunodeficiency?

A woman whose diagnosis of sepsis is attributable to her recent chemotherapy

A client presents at the ambulatory clinic reporting recurrent sharp stomach pain that is relieved by eating. The nurse suspects that the client may have an ulcer. How should the nurse explain the formation and role of acid in the stomach to the client? A) "Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food." B) As the stomach digests food, it turns part of the digested food into acid. C) Our body makes hydrochloric acid for the digestion of the food we eat. D) Acid is secreted by cells in the first part of the small intestine, and when we eat, the acid flows into the stomach.

A) "Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food."

A client with a diagnosis of peptic ulcer disease has just been prescribed omeprazole. How should the nurse best describe this medication's therapeutic action?

A) "This medication will reduce the amount of acid secreted in your stomach."

A nurse is caring for a client who has an order to discontinue the administration of parenteral nutrition. What should the nurse do to prevent the occurrence of rebound hypoglycemia in the client? A) Administer an isotonic dextrose solution for 1 to 2 hours after discontinuing the PN. B) Administer a hypertonic dextrose solution for 1 to 2 hours after discontinuing the PN. C) Administer 3 ampules of dextrose 50% immediately prior to discontinuing the PN. D) Administer 3 ampules of dextrose 50% 1 hour after discontinuing the PN.

A) Administer an isotonic dextrose solution for 1 to 2 hours after discontinuing the PN.

The nurse is administering total parenteral nutrition (TPN) to a client who underwent surgery for gastric cancer. Which of the nurse's assessments MOST directly addresses a major complication of TPN? A) Checking the client's capillary blood glucose levels regularly B) Having the client frequently rate his or her hunger on a 10-point scale C) Measuring the client's heart rhythm at least every 6 hours D) Monitoring the client's level of consciousness each shift

A) Checking the client's capillary blood glucose levels regularly

A client's health decline necessitates the use of total parenteral nutrition. The client has questioned the need for insertion of a central venous catheter, expressing a preference for a "normal IV." The nurse should know that peripheral administration of high-concentration PN formulas is contraindicated because of the risk for what complication? A) Chemical phlebitis B) Hyperglycemia C) Dumping syndrome D) Line sepsis

A) Chemical phlebitis

A client has come to the outpatient radiology department for diagnostic testing that will allow the care team to evaluate and remove polyps. The nurse should prepare the client for what procedure?

A) Colonoscopy

A patient with GERD has a diagnosis of Barrett's esophagus has been admitted to your unit. You are writing a care plan for this patient. What information is essential to include?

A) He will need to undergo an upper endoscopy every 6 months to detect malignant changes

The nurse is administering total parenteral nutrition (TPN) to a client who underwent surgery for gastric cancer. What is a major complication of TPN? A) Hyperglycemia B) Extreme hunger C) Hypotension D) Hypoglycemia

A) Hyperglycemia

The nurse is caring for a patient who is scheduled for a colonoscopy. The nurse is preparing to instruct the patient on a colon preparation procedure that will include polyethylene glycol electrolyte lavage prior to the procedure. What is the nurse aware of about the use of lavage solutions and when they are contraindicated? A) In a patient with an inflammatory bowel disease B) In a patient with polyps C) In a patient with a colostomy D) In a patient with colon cancer.

A) In a patient with an inflammatory bowel disease

A nurse is assessing a client who has peptic ulcer disease. The client requests more information about the typical causes of Helicobacter pylori infection. What would it be appropriate for the nurse to instruct the client?

A) Infection typically occurs due to ingestion of contaminated food and water.

A client presents to the clinic reporting vomiting and burning in her mid-epigastria. The nurse knows that in the process of confirming peptic ulcer disease, the health care provider is likely to order a diagnostic test to detect the presence of what? A) Infection with Helicobacter pylori

A) Infection with Helicobacter pylori

A client with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the client may be prescribed what drug?

A) Metoclopramide

A patient is scheduled to have a fecal occult blood test. Before the test, the nurse should instruct the patient to avoid: A) Nonsteroidal anti-inflammatory drugs B) Acetaminophen C) Fish D) Carrots

A) Nonsteroidal anti-inflammatory drugs

A nurse is promoting increased protein intake to enhance a client's wound healing. What is the enzyme that will initiate the digestion of the protein that the client consumes?

A) Pepsin

A nurse is caring for a client with a subclavian central line who is receiving parenteral nutrition (PN). In preparing a care plan for this client, what nursing diagnosis should the nurse prioritize?

A) Risk for Infection Related to the Presence of a Subclavian Catheter

A nurse is completing a health history on a client whose diagnosis is chronic gastritis. Which of the data should the nurse consider MOST significantly related to the etiology of the client's health problem?

A) Smokes one pack of cigarettes daily

A nurse is caring for an 83-year-old client who is being assessed for recurrent and intractable nausea. What age-related change to the GI system may be a contributor to the client's health complaint?

A) Stomach emptying takes place more slowly.

A client has sought care because of recent dark-colored stools. As a result, a fecal occult blood test has been ordered. The nurse should give what instructions to the client?

A) Take no NSAIDs within 48 hours of the test

11. To prevent osteoporosis in an elderly adult the nurse should recommend which of the following vitamins? A. Calcium and Vitamin D B. Vitamin B12 C. Vitamin K D. Calcitonin

A. Calcium and Vitamin D

7. health care professional is caring for a patient who is taking alendronate (Fosamax) to treat postmenopausal osteoporosis. The healthcare professional should explain to the patient that alendronate increases bone mass by which of the following actions? A. Decreases activity of osteoclasts B. Increases calcium excretion C. Promotes intestinal absorption of calcium and phosphorus D. Reduces action of osteoblasts

A. Decreases activity of osteoclasts

The nurse is instructing a 65-year-old female client diagnosed with osteoporosis. The most important instruction regarding exercise would be too? A. Exercise doing weight-bearing activities B. Exercise to reduce weight C. Avoid exercise activities that increase the risk of fracture D. Exercise to strengthen muscles and thereby protect bones

A. Exercise doing weight-bearing activities

An anterior pelvic tilt is naturally accompanied by? A. Increased lordosis of the lumbar spine B. Decreased lordosis of the lumbar spine C. Strong activation of the abdominals D. Near maximal elongation of the hip flexors

A. Increased lordosis of the lumbar spine

Which of the following is a therapeutic action of raloxifene (Evista)? A. Mimics the effects of estrogen on bone tissue B. Blocks the effects of estrogen on endometrial tissue C. Stimulates secretion of parathyroid hormone D. Stimulates menstruation

A. Mimics the effects of estrogen on bone tissue

A nurse who works in the specialty of palliative care frequently encounters issues and situations that constitute ethical dilemmas. What issue has most often presented challenging ethical issues, especially in the context of palliative care?

Ability of technology to prolong life beyond meaningful quality of life

Kubler- Ross developed a model of five stages to explain what people experience as they grieve and mourn. Which is stage V of Kubler-Ross's stages of grieving?

Acceptance

The nurse is caring for a patient who has been NPO for 2 days pending a diagnostic procedure that has been repeatedly cancelled. When evaluating this patient's urinalysis, what would the nurse anticipate?

An increased urine specific gravity

The most effective way for the nurse to provide culturally competent care to individuals who are grieving is which of the following?

Ask the client what rituals are personally meaningful

A nurse is caring for a client who just has been diagnosed with a peptic ulcer. When teaching the client about his new diagnosis, how should the nurse best describe a peptic ulcer? Inflammation of the lining of the stomach B) Erosion of the lining of the stomach or intestine C) Bleeding from the mucosa in the stomach D) Viral invasion of the stomach wall.

B) Erosion of the lining of the stomach or intestine

A nurse is initiating parenteral nutrition (PN) to a postoperative client who has developed complications. The nurse should initiate therapy by performing which of the following actions? A) Starting with a rapid infusion rate to meet the client's nutritional needs as quickly as possible. B) Initiating the infusion slowly and monitoring the client's fluid and glucose tolerance C) Changing the rate of administration every 2 hours based on serum electrolyte values D) Increasing the rate of infusion at mealtimes to mimic the circadian rhythm of the body

B) Initiating the infusion slowly and monitoring the client's fluid and glucose tolerance

The nursing instructor is teaching new nursing students how to perform an abdominal assessment. When performing an abdominal assessment, what examination sequence should the nurse follow? A) Inspection, auscultation, percussion, and palpation B) Inspection, auscultation, palpation, and percussion C) Inspection, percussion, palpation, and auscultation D) Inspection, palpation, percussion, and auscultation

B) Inspection, auscultation, palpation, and percussion

A client's physician has determined that for the next 3 to 4 weeks the client will require parenteral nutrition (PN). The nurse should anticipate the placement of what type of venous access device. A) Peripheral catheter B) Nontunneled central catheter C) Implantable port D) Tunneled central catheter

B) Nontunneled central catheter

A nurse is caring for a newly admitted client with a suspected GI bleed. The nurse assesses the client's stool after a bowel movement and notes it to be a tarry-black color. This finding is suggestive of bleeding from what location?

B) Upper GI tract

What equipment is used to prevent respiratory complications? A. Trapeze bar B. Incentive spirometer C. Continuous passive motion machine D. Abductor wedge

B. Incentive spirometer

A nurse is providing care for a client who had a vertebroplasty of the thoracic spine. Which of the following is an appropriate action by the nurse? A. Apply heat to puncture site B. Place the client in a supine position C. Turn the client every 1 hour D. Ambulate the client within the first hour post-procedure.

B. Place the client in a supine position

2. Which of the following is the most common spinal curvature deformity? A. Herniation B. Scoliosis C. Lordosis D. Kyphosis

B. Scoliosis

A nurse is caring for a client who injured her lower back during a fall and describes sharp pain in her back and down her left leg. In which of the following positions should the nurse plan to place the client to attempt to decrease her pain? A. Prone without the use of pillows B. Semi-fowlers with a pillow under the knees C. High-fowlers with the knees flat on the bed D. Supine with the head flat

B. Semi-fowlers with a pillow under the knees

The first-line medications recommended to treat and prevent osteoporosis are: A. Single dose Calcium and Vitamin D, without food. B. Split dose of Calcium and Vitamin D, with food or Vitamin C beverage. C. Single dose Calcium and Vitamin D, with food or Vitamin C beverage. D. Split dose of Calcium and Vitamin D, without food

B. Split dose of Calcium and Vitamin D, with food or Vitamin C beverage

13. A nurse is providing dietary teaching about calcium rich foods to a client who has osteoporosis. Which of the following foods should the nurse include in the instructions? A. White bread B. White beans C. White meat of chicken

B. White beans

A nurse is providing pre procedure education for a client who will undergo a lower GI tract study the following week. What should the nurse teach the client about bowel preparation?

C) "You'll need to have enemas the day before the test."

An adult patient is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the patient has completed the test? A) Stool will be yellow for the first 24 hours post procedure. B) The barium may cause diarrhea. C) Fluids must be increased to facilitate the evacuation of the stool. D) This series includes analysis of gastric secretions.

C) Fluids must be increased to facilitate the evacuation of the stool

The patient asks the nursing assistant for a bedpan. When the patient is finished, the nursing assistant notifies the nurse that the patient has bright red streaking of blood in the stool. What is this most likely a result of? A) Diet high in red meat B) Upper GI bleed C) Hemorrhoids D) Cancer of the large intestine

C) Hemorrhoids

5. Which patient would be at greatest risk for developing osteoporosis? A. A 73-year-old man who has 5 alcoholic drinks per week and limit sun exposure to prevent recurrence of skin cancer B. An 84-year-old man who has recently been diagnosed with hypothyroidism and is prescribed levothyroxine. C. A 69-year-old woman who had a renal transplant five years ago and has been taking prednisone to prevent organ rejection. D. A 55-year-old woman who recently had a hysterectomy with bilateral salpingo-oophorectomy and refuses estrogen therapy.

C. A 69-year-old woman who had a renal transplant five years ago and has been taking prednisone to prevent organ rejection.

The nurse has been closely monitoring the blood work of a patient who recently experienced nephrotoxic effects from an over- the- counter medication. In the course of providing care the nurse has been teaching the patient about the various roles that the kidney plays in the maintenance of homeostasis. Which of the following functions is performed by the kidneys?

Control of acid- base balance.

A 68-year-old woman has experienced multiple urinary tract infections over the past several months, and her care provider suspects a structural problem with her bladder or urethra. To directly visualize these structures, what diagnostic may be ordered?

Cystoscopy

You have assumed care of a patient who has returned after a barium enema study. When you assess the patient's bowel patterns and stools, what findings based upon the assessment of the stool would you report to the physician? A) Large, wide stools B) Milky white stools C) Three stools during an 8-hour period of time. D)​Stool has streaks of blood throughout the fecal material

D) Stool has streaks of blood throughout the fecal material

12. A nurse is reviewing the health record of a client who is to undergo total joint arthroplasty. The nurse should recognize which of the following findings as a contraindication to this procedure. A. Age 78 years B. History of cancer C. Previous joint replacement D. Bronchitis 2 weeks ago

D. Bronchitis 2 weeks ago

A nurse is caring for a patient who has a health history of severe osteoporosis. On assessment she notes the patient has severe kyphosis of the upper back. Which nursing diagnosis takes priority for this patients care? A. RIsk for skin breakdown B. Knowledge deficit regarding disease process C. Limited mobility D. Risk for falls

D. Risk for falls

A nurse is teaching a client who is going to have a bone scan. Which of the following statements should the nurse include? A. You will receive an injection of a radioactive isotope when the scanning procedure begins. B. You will be inside a tube-like structure during the procedure. C. You will need to take radioactive precautions with your urine for 24 hours after the procedure. D. You will have to urinate just before the procedure.

D. You will have to urinate just before the procedure.

Your patient has a diagnosis of bladder cancer with metastasis. The patient asks you about hospice. Which principle underlies hospice care:

Death must be accepted

A geriatric nurse is performing an assessment of an 85-year-old patient. The nurse realizes that what particular change is an age-related effect on the renal or urinary system?

Decreased glomerular filtration rate

The nurse s caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, the nurse recalls that several substances are filtered from the blood by the glomerulus and these substances are then excreted in the urine. The nurse identifies the presence of which substances in the urine as abnormal findings?

Glucose and protein

A nurse educator is speaking with a group of new graduates about a patient who has acute glomerulonephritis. The educator should tell the nurses that the patient may exhibit which of the following clinical manifestations?

Hematuria

A college football player is brought to the emergency room by paramedics after a blunt trauma injury received during a game. There is a high suspicion that the patient has sustained an injury to his kidneys from being tackled from behind. The emergency room nurse caring for the patient reviews the initial orders written by the health care provider and notes that an order has been written to collect all voided urine and send it to the laboratory for analysis. The nurse understand that this nursing intervention is important because:

Hematuria is the most common manifestation of renal trauma, and blood losses may be microscopic, so laboratory analysis is essential.

The nurse is working with a client who lost her youngest child 2 months ago. When the nurse approaches, the client, the client yells, "I don't want to talk to you. You have no idea what it's like to lose a child!" The nurse bases her response to the client on the understanding of which of the following?

Hostility is a common behavio ral response to grief

A patient with a recent diagnosis of HIV is soon to begin highly active antiretroviral treatment (HAART). When performing health education related to the patient's new medication regimen, the nurse should prioritize interventions relevant to which of the following nursing diagnoses?

Ineffective adherence

A patient has been admitted to the hospital with signs and symptoms of acute renal failure. Knowing the vital role that the kidneys play in maintaining fluid and electrolyte balance, the care team is monitoring the patient's laboratory values closely. Which of the following laboratory values is suggestive of renal failure?

K+ 7.1 mmol/L

A 16-year-old patient comes to the free clinic and is diagnosed with primary syphilis. The patient states that he contracted this disease by kissing someone who has syphilis. What is the most appropriate nursing diagnosis for this patient?

Knowledge deficit related to modes of transmission

- The nurse has paged a hospital patient's primary care provider because the patient's urine output over the past 12 hours is approximately 140 ml. The nurse would recognize that this patient is experiencing what health problem?

Oliguria

A 30-year-old woman has presented for care, stating, "I'm pretty sure that I've got a UTI. So I think I'll need some antibiotics." In the presence of a UTI, the nurse would expect the woman to have which of the following signs and symptoms? Select all that apply.

Pain on urination, Urinary Frequency, Urgency

A client with terminal cancer has been told he has 3 to 4 months to love. Which of the following would indicate to the nurse that further interventions are needed?

The client says he is well and is making future plans.

The nurse is caring for an 84-year-old female who was brought to the emergency room by her daughter, who related that her mother has had very recent mental status changes and periods of incontinence. What condition should the nurse first suspect?

UTI

The nurse is caring for a male patient with gonorrhea. The patient asks how he can reduce is risk of contracting another sexually transmitted infection (STI). The nurse should instruct the patient to:

Wear a condom every time he has intercourse

The nurse approaches a client who looks very sad and is sitting alone crying. The best response by the nurse in this situation is:

You look very sad. What is happening?

A patient has been admitted to a medical unit with respiratory symptoms that are characteristic of tuberculosis. When transporting the patient to radiology for a chest x-ray, the nurse has applied a mask that covers the patient's nose and mouth. This action addresses which component of the chain of Mode of exit infection?

mode of exit