N406 E2

A female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse? a) "If my fiancé was of Middle Eastern descent, I wouldn't be worried about having children." b) "I need to learn how to give myself vitamin B12 injections." c) "Thalassemia is treated with iron supplements." d) "I'll see a genetic counselor before starting a family."

"I'll see a genetic counselor before starting a family." Explanation: Two people with the beta-thalassemia trait have a 25% chance of having a child with thalassemia major, a potentially life-threatening disease. Iron supplements aren't used to treat thalassemia; in fact, they could contribute to iron overload. Vitamin B12 injections are used to treat pernicious anemia, not thalassemia. Thalassemia occurs primarily in people of Italian, Greek, African, Asian, Middle Eastern, East Indian, and Caribbean descent.

List normal changes to heart of an older client

- widening of heart valves - increased BP - decreased CO - decreased compliance of heart muscles

The nurse is caring for a client diagnosed with bladder cancer and requiring a cystectomy. The nurse overhears the physician instructing the client on the presence of a stoma with temporary pouch. In gathering information for the client, which urinary diversion would the nurse select? -Ileal conduit -Kock Pouch -Ureterosigmoidostomy -Indiana Pouch

-Ileal conduit When the physician is discussing a stoma, the nurse recognizes that the client will have an ileal conduit which is a cetaceous urinary diversion. Both the Kock Pouch and Indiana Pouch are continent urinary diversions. The ureterosigmoidostomy connects with the rectum for urinary drainage.

Which factor contributes to UTI in older adults? -Low incidence of chronic illness -Immunocompromise -Sporadic use of antimicrobial agents -Active lifestyle

-Immunocompromise Factors that contribute to urinary tract infection in older adults include immunocompromise, high incidence of chronic illness, immobility, frequent use of antimicrobial agents, incomplete emptying of the bladder, and obstructed urine flow.

A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. Which postoperative procedure should the nurse perform? -Determine the client's ability to manage stoma care -Show photographs and drawings of the placement of the stoma -Maintain skin and stoma integrity -Suggest a visit to a local ostomy group

-Maintain skin and stoma integrity The most important postoperative nursing management is to maintain skin and stoma integrity to avoid further complications, such as skin infections and urinary odor. Determining the client's ability to manage stoma care, showing photographs, and suggesting a visit to a local ostomy group would be a part of the preoperative procedure.

Which term refers to inflammation of the renal pelvis? -Pyelonephritis -Cystitis -Urethritis -Interstitial nephritis

-Pyelonephritis Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic. Cystitis is inflammation of the urinary bladder. Urethritis is inflammation of the urethra. Interstitial nephritis is inflammation of the kidney.

Which is the most common report by clients with pancreatitis? -Tarry, black stools and dark urine -Increased and painful urination -Increased appetite and weight gain -Severe, radiating abdominal pain

-Severe, radiating abdominal pain Clients with pancreatitis most commonly report severe mid- to upper-abdominal pain, radiating to both sides and straight to the back. The client may describe the stools as being frothy and foul smelling, not black or tarry. The client's urine may be dark. The client will not experience increased or painful urination, increased appetite, or weight gain.

A nursing instructor is explaining the pathophysiology and clinical manifestations of pancreatitis to a group of nursing students. The instructor evaluates the teaching as effective when a student correctly identifies which symptom as that most commonly reported by clients with pancreatitis? -Tarry, black stools and dark urine -Increased and painful urination -Increased appetite and weight gain -Severe, radiating abdominal pain

-Severe, radiating abdominal pain Severe abdominal pain is the major symptom of pancreatitis that causes the client to seek medical care. The pain occurs in the midepigastrium. Abdominal pain and tenderness and back pain result from irritation and edema of the inflamed pancreas. Pain is frequently acute in onset, occurring 24 to 48 hours after a very heavy meal or alcohol ingestion; it may be diffuse and difficult to localize.

How to assess pt with postural hypotension

1. Have pt lie supine for 5 min and assess BP and pulse 2. Have pt sit up with legs in dependent position for 5 min and assess BP and pulse 3. Have pt stand and assess BP and pulse A decrease of 20 mm Hg or more supports a finding of postural hypotension

Nitroglycerin mechanism of action

1. Relaxes smooth muscles causing venous dilation 2. Reduces preload and afterload to the heart 3. Dilates the coronary arteries resulting in increased perfusion of the myocardium

Name the three narrowed areas of each ureter

1. Ureteropelvic junction 2. Ureterovesical junction 3. Ureteral segment near the sacroiliac junction

Labs are screwed up when only what percent of the kidney is left?

10%!!!!!!

A client with idiopathic thrombocytopenic purpura (ITP), an autoimmune disorder, is admitted to an acute care facility. Concerned about hemorrhage, the nurse monitors the client's platelet count and observes closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the platelet count falls below: a)75,000/?l. b)10,000/?l. c)20,000/?l. d)135,000/?l.

10,000/?l.

A nurse educator is providing information to a small group of clients about hypertension. A participant asks what her target blood pressure should be. The nurse is aware of the target goals of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). Which of the following reflects the goal for blood pressure readings for people without co-morbidities?

140/90 or lower Explanation: The goal of hypertension treatment is to prevent complications and death by achieving and maintaining the arterial blood pressure at 140/90 or lower. The JNC7 specifies a lower goal pressure of 130/80 for people with diabetes mellitus or chronic kidney disease.

Hepatitis A incubation period

15-50 days with average 28 days

How much mL of blood can the liver store which can be shifted back into the general circulation?

500-1,000 mL of blood

Normal ejection fraction

55-65%

What medications will be commonly prescribed to treat pericarditis?

Analgesic meds and NSAIDS such as aspirin or ibuprofen (Motrin) for pain relief during acute phase Colchicine may be used instead of NSAIDs during acute phase Colchicine (Colcrys) or corticosteroids (e.g., prednisone) may be prescribed if the pericarditis is severe or if the patient does not respond to NSAIDs

The patient receiving epoetin alfa (Procrit) asks the nurse why it has to be administered IV because he read that it could be self-administered subcutaneously. What is the nurse's best response? a. giving the drug IV reduces the risk of a potentially serious response to the drug b. giving the drug by the IV route makes it begin working sooner c. only patients with renal disease can receive the drug subcutaneously d. it is all determined by physician preference and this doctor prefers the IV route

Ans: A It is now recommended that patients receive Procrit and other drugs in this classification intravenously rather than subcutaneously because this reduces the risk of antibody production that can result from severe anemia. This decision is not based on speed of onset, diagnosis, or physician preference.

CH. 54 The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? A) Hematuria B) Precipitous decrease in serum creatinine levels C) Hypotension unresolved by fluid administration D) Glucosuria

Ans: A Feedback: The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Some degree of edema and hypertension is noted in most patients.

A patient's physician has ordered a "liver panel" in response to the patient's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply. A) Alanine aminotransferase (ALT) B) C-reactive protein (CRP) C) Gamma-glutamyl transferase (GGT) D) Aspartate aminotransferase (AST) E) B-type natriuretic peptide (BNP)

Ans: A, C, D Feedback: Liver function testing includes GGT, ALT, and AST. CRP addresses the presence of generalized inflammation and BNP is relevant to heart failure; neither is included in a liver panel.

CH. 53 A patient is being seen in the clinic for possible kidney disease. What major sensitive indicator of kidney disease does the nurse anticipate the patient will be tested for? A. Creatinine clearance level B. Serum potassium level C. Blood urea nitrogen level D. Uric acid level

Ans: A. Creatinine is an endogenous waste product of skeletal muscle that is filtered at the glomerulus, passed through the tubules with minimal change, and excreted in the urine. Hence, creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

CH. 53 A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? A. Creatinine clearance B. GI absorption rate C. Liver function studies D. Therapeutic index

Ans: A. The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

CH. 53 A patient with elevated BUN and creatinine values has been referred by her primary physician for further evaluation. The nurse should anticipate the use of what initial diagnostic test? A)Ultrasound B)X-ray C)Computed tomography (CT) D)Nuclear scan

Ans: A. Feedback: Ultrasonography is a noninvasive procedure that passes sound waves into the body through a transducer to detect abnormalities of internal tissues and organs. Structures of the urinary system create characteristic ultrasonographic images. Because of its sensitivity, ultrasonography has replaced many other diagnostic tests as the initial diagnostic procedure.

The nurse is instructing the client with sickle cell disease about the use of an inhaled vasodilator that may reduce sickling. What medication is the nurse instructing the client about? A) Nitrous oxide B) Nitric oxide C) Betamethasone D) Terbutaline (Brethine)

Ans: B Feedback: Inhaled nitric oxide—not nitrous oxide (laughing gas), a vasodilating agent—is believed to reduce sickling by promoting the binding of oxygen to hemoglobin. It is being used in the form of handheld inhalers to abort or relieve pain experienced during sickle cell crises. Betamethasone is a corticosteroid, and terbutaline is not used as an inhaler.

CH. 54 The nurse is caring for a patient with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply. A) Percuss for pain in the right lower abdominal quadrant. B) Assess for the presence of peripheral edema. C) Auscultate the patients apical heart rate for dysrhythmias. D) Assess the patients BP. E) Assess the patients orientation and judgment.

Ans: B, D Feedback: Most patients with acute glomerular inflammation have some degree of edema and hypertension. Dysrhythmias, RLQ pain, and changes in mental status are not among the most common manifestations of acute glomerular inflammation.

CH. 53 The nephrons are the functional units of the kidney, responsible for the initial formation of urine. The nurse knows that damage to the area of the kidney where the nephrons are located will affect urine formation. Identify that area. A. Renal papilla B. Renal cortex C. Renal medulla D. Renal pelvis

Ans: B. The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex.

CH. 49 A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop a nutritional plan. The nurse should prioritize which of the following in the patient's plan? A) Increased potassium intake B) Fluid restriction to 2 L per day C) Reduction in sodium intake D) High-protein, low-fat diet

Ans: C Feedback: Patients with ascites require a sharp reduction in sodium intake. Potassium intake should not be correspondingly increased. There is no need for fluid restriction or increased protein intake.

CH. 49 A nurse is caring for a patient with severe hemolytic jaundice. Laboratory tests show free bilirubin to be 24 mg/dL. For what complication is this patient at risk? A) Chronic jaundice B) Pigment stones in portal circulation C) Central nervous system damage D) Hepatomegaly

Ans: C Feedback: Prolonged jaundice, even if mild, predisposes to the formation of pigment stones in the gallbladder, and extremely severe jaundice (levels of free bilirubin exceeding 20 to 25 mg/dL) poses a risk for CNS damage. There are not specific risks of hepatomegaly or chronic jaundice resulting from high bilirubin.

The nurse is caring for a patient who had a brush biopsy 12 hours ago. The presence of what assessment finding should prompt the nurse to notify the physician? A) Scant hematuria B) Renal colic C) Temperature 100.2°F orally D) Infiltration of the patient's intravenous catheter

Ans: C Hematuria and renal colic are common and expected findings after the performance of a renal brush biopsy. The physician should be notified of the patient's body temperature, which likely indicated the onset of an infectious process. IV infiltration does not warrant notification of the primary care physician.

CH. 53 The health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator? A. Uric acid level B. Blood urea nitrogen (BUN) C. Creatinine clearance level D. BUN to creatinine ratio

Ans: C. The creatinine clearance measures the volume of blood cleared of endogenous creatinine in 1 minute. This serves as a measure of the glomerular filtration rate. Therefore the creatinine clearance test is a sensitive indicator of renal disease progression.

CH. 53 Which value does the nurse recognize as the best clinical measure of renal function? A. Volume of urine output B. Circulating ADH concentration C. Urine-specific gravity D. Creatinine clearance

Ans: D Creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? Elevated hematocrit concentration Enlarged mean corpuscular volume (MCV) Low ferritin level concentration Elevated red blood cell (RBC) count

Ans: Low ferritin level The most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Hematocrit and RBC levels are also low in relation to the hemoglobin concentration.

A client in acute renal failure receives an IV infusion of 10% dextrose in water with 20 units of regular insulin. The nurse understands that the rationale for this therapy is to a. Correct the hyperglycemia that occurs with acute renal failure b. Facilitate the intracellular movement of potassium c. Provide calories to prevent tissue catabolism and azotemia d. Force potassium into the cells to prevent arrhythmias

Answer: b Rationale: Dextrose with insulin helps move potassium into cells and is immediate management therapy for hyperkalemia due to acute renal failure. An exchange resin may also be employed. This type of infusion is often administered before cardiac surgery to stabilize irritable cells and prevent arrhythmias; in this case KC1 is also added to the infusion.

Risk factors for development of cholelithiasis

Any condition that cannot metabolize fat or impacts fat metabolism

During dialysis, a hypokalemic pt is at risk for what

Arrhythmias secondary to digoxin toxicity

What clinical manifestations would you see and what would you assess for in a pt with acute glormerulonephritis?

Assess for hematuria, increased BUN and creatinine, BP for hypertension, edema, azotemia, proteinuria due to increased permeability of the glomerular membrane, with associated pitting edema, hypoalbuminemia, hyperlipidemia, and fatty casts in the urine

A client in end-stage renal disease is prescribed epoetin alfa (Epogen) and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, the nurse

Assesses the hemoglobin level Explanation: Erythropoietin with oral iron supplements can raise hematocrit levels in the client with end-stage renal disease. The nurse should check the hemoglobin prior to administration of erythropoietin, because too high a hemoglobin level can put the client at risk for heart failure, myocardial infarction, and cerebrovascular accident. Erythropoietin may be administered during dialysis treatments. The BUN will be elevated in the client with end-stage renal disease.

Which condition commonly results in CAD

Atherosclerosis (fatty plaques)

Cause of pain with acute panreatitis?

Autodigestion of the pancreas causes the pain + irritation and edema of inflamed pancreas

Important teachings to be given to a pt with idiopathic thrombocytopenia purpura (ITP)?

Avoid Valsalva maneuver

Education for pt with CABG procedure

Avoid Valsalva maneuver, hold pillow on chest so they don't strain when they cough and deep breathe

In a pt with mitral valve prolapse and dysrhythmias, what must teaching include?

Avoid caffeine, alcohol, and smoking

CH. 33 A patient is admitted to the hospital with pernicious anemia. The nurse should prepare to administer which of the following medications? A) Folic acid B) Vitamin B12 C) Lactulose D) Magnesium sulfate

B Feedback: Pernicious anemia is characterized by vitamin B12 deficiency. Magnesium sulfate, lactulose, and folic acid do not address the pathology of this type of anemia.

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the physician. What type of anemia is the nurse concerned the co-worker may have? Iron deficiency anemia Megaloblastic anemia Sickle cell anemia Aplastic anemia

Correct response: Iron deficiency anemia Explanation: People with iron deficiency anemia may crave ice, starch, or dirt; this craving is known as pica.

The most common cause of iron-deficiency anemia in premenopausal women includes which of the following? Menorrhagia Inadequate iron supplementation Iron malabsorption Lack of vitamin B12

Correct response: Menorrhagia Explanation: The most common cause of iron deficiency anemia in premenopausal women is menorrhagia. In pregnancy, it may be caused by inadequate intake of iron. Iron malabsorption may occur following a gastrectomy or with celiac disease. Lack of vitamin B12 is also a potential cause of anemia.

he nurse is caring for a client with hypovolemic shock. Which of these does the nurse recognize is the liver's contribution to compensate for shock states? a. Stored blood in the liver can shift to the circulation to restore blood volume. b. The liver synthesizes ADH to retain water during periods of deficiency. c. The liver makes substances which constrict blood vessels to raise blood pressure. d. Kupffer cells are responsible for regulating blood volume and blood vessel tone.

Correct response: a. Stored blood in the liver can shift to the circulation to restore blood volume. Explanation: The liver has the ability to store approximately 500 to 1000 mL of blood which can be shifted back into the general circulation during periods of hypovolemia and shock.

The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client? A) Fresh frozen plasma B) Vitamin B12 C) Folate D) Iron

D) Iron Explanation: With iron deficiency, the erythrocytes produced by the marrow are small and low in hemoglobin. Vitamin B12 and folate deficiencies are characterized by the production of abnormally large erythrocytes. Fresh frozen plasma are infused due to a low platelet level, not light-colored hemoglobin.

SE of thiazide diuretics

HYPER: hypercalcemia hyperuricemia hyperglycemia hyperlipidemia (↑ chol, LDL) HYPO: hypokalemia hyponatremia

What does dextrose with insulin do to potassium

Helps move potassium into cells and is the immediate management therapy for hyperkalemia due to acute renal failure

Primary presenting features of acute glomerulonephritis

Hematuria, edema, azotemia (abnormal concentration of nitrogenous wastes in the blood), proteinuria (excess protein in the urine)

Idiopathic thrombocytopenia purpura (ITP)

Hemorrhagic disorder (autoimmune) characterized by excessive destruction of normal platelets

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? Hepatitis B is transmitted primarily by the oral-fecal route. Hepatitis A is frequently spread by sexual contact. Hepatitis C increases a person's risk for liver cancer. Infection with hepatitis G is similar to hepatitis A.

Hepatitis C increases a person's risk for liver cancer. Explanation: Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C.

If your pt had fluid in the lungs what position in bed would be best for her? And why?

High fowlers for maximum lung expansion

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? a) Hypercalcemia b) Hypermagnesemia c) Hyperkalemia d) Hypernatremia

Hypercalcemia Explanation: Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.

Side effects of potassium sparing diuretics

Hyperkalemia, drowsiness, lethargy, diarrhea, other GI effects

CH. 53 A nurse knows that specific areas in the ureters have a propensity for obstruction. Prompt management of renal calculi is most important when the stone is located where? In the ureteropelvic junction In the ureteral segment near the sacroiliac junction In the ureterovesical junction In the urethra

In the ureteropelvic junction Feedback: The three narrowed areas of each ureter are the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovescial junction. These three areas of the ureters have a propensity for obstruction by renal calculi or stricture. Obstruction of the ureteropelvic junction is most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction. The urethra is not part of the ureter.

Diet for patient with hepatic encephalopathy

Low protein bc it's the largest source of ammonia

Priority for pt taking hydroxyurea

Managing GI side effects

MCV (mean corpuscular volume) measures what

Measures the size of RCBs

Creatinine clearance test

Measures the volume of blood cleared of endogenous creatinine in 1 minutes. Serves as a measure of the glomerular filtration rate.

Pain med contraindicated in pancreatitis

Meperidine (Demerol)

Which one is a vasodilator used as an inhalant to reduce sickling: nitric oxide or nitrous oxide?

NITRIC oxide

Orders for pt with acute pancreatitis?

NPO to inhibit stimulation of pancreas and its secretion of enzymes

If your pt has a new cardiac dysrhythmia, which laboratory values are the priority to look up

Na, K, Ca, Cl, Mag

Should t-tube drainage be bloody

No

Class of drugs that reduce portal venous pressure

Non-selective beta blockers, B1 receptors

How does an ultrasound work

Noninvasive procedure that uses sound waves passed into the body through a transducer to detect abnormalities of internal tissues and organs

What is the B/P the target goals of the Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure?

Normally below 150/90 but people with diabetes or chronic kidney disease should be below 140/90

In an OLDER ADULT, what might early symptoms of UTI present like?

Older clients don't have the typical symptoms like burning upon urination, they have confusion, incontinence, slight elevation of temp

You are caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? a) Osteopathic tumors destroy bone causing fractures. b) Osteoclasts break down bone cells so pathologic fractures occur. c) Osteosarcomas form producing pathologic fractures. d) Osteolytic activating factor weakens bones producing fractures.

Osteoclasts break down bone cells so pathologic fractures occur. Explanation: The abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This in turn causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures. The plasma cells also form single or multiple osteolytic (bone-destroying) tumors that produce a 'punched-out' or 'honeycombed' appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae. Weakened vertebrae lead to compression of the spine accompanied by significant pain. Options A, C, and D are distractors for this question.

Which nursing intervention is most appropriate for a client with multiple myeloma? a) Monitoring respiratory status b) Restricting fluid intake c) Balancing rest and activity d) Preventing bone injury

Preventing bone injury Explanation: When caring for a client with multiple myeloma, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and balancing rest and activity are appropriate interventions for any client. To prevent such complications as pyelonephritis and renal calculi, the nurse should keep the client well hydrated — not restrict his fluid intake.

Choledochostomy

Procedure for pt with acute cholecystitis who may be too ill to undergo surgical procedure. Involves making incision in common duct, usually to remove stones

CH. 27 The nurse is part of a triage team that is assessing a patient to determine if his chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction is that the pain of angina is:

Relieved by rest and nitroglycerin

Majority of nephrons located in?

Renal cortex

What kind of clients need Epogen?

Renal patients

Ejection fraction

SV/EDV % of end diastolic blood volume ejected from the ventricle with each heartbeat

A client with multiple myeloma presents to the emergency department complaining of excessive thirst and constipation. His family members report that he has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms? a) Serum calcium level 13.8 mg/dl b) Serum sodium level of 133 mEq/L c) Hemoglobin of 9.8 g/dl d) Platelet count 300,000/mm3

Serum calcium level 13.8 mg/d Explanation: Excessive thirst, constipation, dehydration, confusion, and altered mental state are possible signs of hypercalcemia. Hypercalcemia is common in multiple myeloma because of the increased bone destruction. A platelet count of 300,000/mm3 is normal and wouldn't cause the client's symptoms. A sodium level of 133 mEq/L is slightly decreased but wouldn't cause confusion and excessive thirst. A hemoglobin of 9.8 g/dl level is slightly low but isn't likely responsible for the client's symptoms.

What does urine testing include?

Specific gravity, pH, protein, glucose, ketones, bacteria, RBC, WBC, casts, crystals

Gynecomastia is a common side effect of which of the following diuretics? Spironolactone Furosemide Vasopressin Nitroglycerin (IV)

Spironolactone Explanation: Gynecomastia is a common side effect caused by spironolactone. Vasopressin is used for bleeding esophageal varices and is not a diuretic. Nitroglycerin (IV) may be used with vasopressin to counteract the effects of vasoconstriction from the vasopressin.

Potassium-sparing diuretics

Spironolactone (Aldactone), Eplerenone (Inspra), Amiloride (Midamor), Triamteren (Dyrenium)

Complications that may occur to a patient with low platelet count

Spontaneous hemorrhaging can occur, neutropenia (low WBC)

What is important to give to pt with ITP to avoid straining?

Stool softeners

Cholestasis

Stoppage of bile flow

What forms to sublingual nitroglycerin come in?

Tablet and spray form

What radioactive substance is injected in a nuclear stress test?

Thallium

Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from: a) The digestion of dietary and blood proteins. b) Excess potassium loss subsequent to prolonged use of diuretics. c) Excessive diuresis and dehydration. d) Severe infections and high fevers.

The digestion of dietary and blood proteins. Circumstances that increase serum ammonia levels tend to aggravate or precipitate hepatic encephalopathy. The largest source of ammonia is the enzymatic and bacterial digestion of dietary and blood proteins in the GI tract. Ammonia from these sources increases as a result of GI bleeding (ie, bleeding esophageal varices, chronic GI bleeding), a high-protein diet, bacterial infection, or uremia.

You are caring for a client with thalassemia who is being transfused. What your role during a transfusion? To closely monitor the rate of administration To administer vitamin B12 injections To instruct the client to rest immediately if chest pain develops To assess for enlargement and tenderness over the liver and spleen

To closely monitor the rate of administration Explanation: In a client with thalassemia, when transfusions are necessary, the nurse closely monitors the rate of administration. Assessing for enlargement and tenderness over the liver and spleen, advising rest, or administering vitamin B12 injections are not indicated for thalassemia.

A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for? Vasopressin (Pitressin) Balloon tamponade Transjugular intrahepatic portosystemic shunting (TIPS) Sclerotherapy

Transjugular intrahepatic portosystemic shunting (TIPS) Explanation: A TIPS procedure (see Fig. 49-8) is indicated for the treatment of an acute episode of uncontrolled variceal bleeding refractory to pharmacologic or endoscopic therapy. In 10% to 20% of patients for whom urgent band ligation or sclerotherapy and medications are not successful in eradicating bleeding, a TIPS procedure can effectively control acute variceal hemorrhage by rapidly lowering portal pressure.

T/F: Liver is a more common secondary site of metastasis than a primary cancer

True

T/F: thalassemias are hereditary

True

Initial diagnostic test for a pt with high BUN and creatinine?

Ultrasound

Pyelonephritis

Upper urinary tract inflammation, which may be acute or chronic

Ejection fraction of less than 40% indicates that

The pt has decreased left ventricular function and likely requires treatment of heart failure

Why would a pt receiving hemodialysis receive Epogen and other drugs in this classification intravenously rather than subcutaneously?

This reduces the risk of antibody production that can result from severe anemia

Potential adverse effect of nitroglycerin

Throbbing headache or dizziness

What is allowed to be given before dialysis?

You can give phosphate binders and insulin bc they don't get removed from the blood through dialysis.

How can liver contribute to compensate for shock states?

Liver can store 500 to 1,000 mL of blood which can be shifted back into the general circulation during periods of hypovolemia and shock

Cardiogenic shock

A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute MI, as well as other conditions.

Normal BNP level

< 100

A 50-year-old client is reporting that the client's oral B12 is not working. The nurse knows that the vitamin may have a decreased absorption rate when taken with other substances. The nurse would begin the history by asking which questions? (Select all that apply.)

"Do you use neomycin?" "Do you drink alcohol?" "Do you take colchicine?" Rationale: Alcohol, neomycin, and colchicine may decrease the absorption level of oral vitamin B12. Constipation would not affect the absorption level of oral vitamin B12.

A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching? "How did this happen? I've been faithful my entire marriage." "I'll be very careful when preparing food for my family." "I'll wash my hands often." "I'll take all my medications as ordered."

"How did this happen? I've been faithful my entire marriage." Explanation: The client requires further teaching if he suggests that he acquired the virus through sexual contact. Hepatitis A is transmitted by the oral-fecal route or through ingested food or liquid that's contaminated with the virus. Hepatitis A is rarely transmitted through sexual contact. Clients with hepatitis A need to take every effort to avoid spreading the virus to other members of their family with precautions such as preparing food carefully, washing hands often, and taking medications as ordered.

A nurse is teaching a client with a vitamin B12 deficiency about appropriate food choices to increase the amount of B12 ingested with each meal. The nurse knows the teaching is effective based on which statement by the client?

"I will eat a meat source such as chicken or pork with each meal." Explanation: Vitamin B12 is found only in foods of animal origin.

Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply. -Urinary retention -Deficient knowledge: management of urinary diversion -Disturbed body image -Risk for impaired skin integrity -Chronic pain

-Deficient knowledge: management of urinary diversion -Disturbed body image -Risk for impaired skin integrity Deficient knowledge, disturbed body image, and risk for impaired skin integrity are expected problems for the client with a new ileal conduit. Urinary retention and chronic pain are not expected client problems.

Normal albumin level

3.5-5 g/dL

Normal potassium level

3.5-5.0 mEq/L

The nurse is caring for a client who is scheduled for the creation of an ileal conduit. Which statement by the client provides evidence that client teaching was effective? -"I will not need to worry about being incontinent of urine." -"My urine will be eliminated through a stoma." -"My urine will be eliminated with my feces." -"A catheter will drain urine directly from my kidney."

-"My urine will be eliminated through a stoma." An ileal conduit is a non-continent urinary diversion whereby the ureters drain into an isolated section of ileum. A stoma is created at one end of the ileum, exiting through the abdominal wall.

An ileal conduit is created for a client after a radical cystectomy. Which of the following would the nurse expect to include in the client's plan of care? -Application of an ostomy pouch -Intermittent catheterizations -Exercises to promote sphincter control -Irrigating the urinary diversion

-Application of an ostomy pouch An ileal conduit involves care of a urinary stoma, much like that of a fecal stoma, including the application of an ostomy pouch, skin protection, and stoma care. Intermittent catheterizations and irrigations are appropriate for a continent urinary diverse such as a Kock or Indiana pouch. Exercises to promote sphincter control are appropriate for an ureterosigmoidoscopy.

Normal portal venous pressure

5-10 mm Hg

Call MD when t-tube drainage is more than?

500 cc in 24 hr

Which instruction would be included in a teaching plan for a client diagnosed with a UTI? -Take tub baths as opposed to showers. -Drink coffee or tea to increase diuresis. -Drink liberal amount of fluids. -Void every 4 to 6 hours.

-Drink liberal amount of fluids. Clients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The client should shower instead of bathing in a tub because bacteria in the bath water may enter the urethra.

A patient has been diagnosed with a lymphoid stem cell defect. This patient has the potential for a problem involving which of the following? A) Plasma cells B) Neutrophils C) Red blood cells D) Platelets

A (Feedback: A defect in a myeloid stem cell can cause problems with erythrocyte, leukocyte, and platelet production. In contrast, a defect in the lymphoid stem cell can cause problems with T or B lymphocytes, plasma cells (a more differentiated form of B lymphocyte), or natural killer (NK) cells.)

The nurse is reviewing the results of renal function studies of a patient. The nurse understands that which of the following is a normal BUN-to-creatinine ratio? a) 10:1 b) 8:1 c) 4:1 d) 6:1

A A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect.

Cardiogenic shock can be described as

A decrease of cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume

Ms. Quinn is admitted to the surgical intensive care unit after open heart surgery. The health care provider prescribes IV nitroglycerin, according to a hospital protocol for titration of the drug. Which factor would be most important when determining increases or decreases in the dose? A) Current blood pressure B) Susceptibility of the client to intracranial pressure C) Susceptibility of the client to renal insufficiency D) Current respiratory rate

A) Current blood pressure For a client receiving IV nitroglycerin, the nurse must monitor the blood pressure and presence of continued chest pain while the IV therapy continues. If chest pain continues, the IV dose can be increased; however, due to the vasodilation effects of the drug, if the blood pressure drops below a certain point, the dose cannot be further increased. It is important to assess for alcohol intoxication if giving high doses for a prolonged period. A client's susceptibility to renal insufficiency and intracranial pressure is not likely to be affected by the IV therapy and therefore need not be monitored closely. The GI tract is also not likely to be affected by the IV therapy.

You are caring for a client who is suspected of having coronary artery disease. The client is scheduled to have a nuclear stress test using thallium. When would the thallium be injected to determine narrowing of the coronary arteries? A) During and a few hours after exercise electrocardiography. B) Before and during exercise electrocardiography. C) Before and a few hours after exercise electrocardiography. D) Before, during, and a few hours after exercise electrocardiography.

A) During and a few hours after exercise electrocardiography.

CH. 53 The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? A. "I will feel a warm sensation as the dye is injected." B. "I will need to drink all of the dye as quickly as possible." C. "I should remove all jewelry before the test." D. "I should let the staff know if I feel claustrophobic."

A. A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected.

CH. 27 The nurse is providing education about angina pectoris to a hospitalized client who is about to be discharged. The nurse includes which of the following information about managing this condition? Choose all that apply. A. Balance rest with activity. B. Carry nitroglycerin at all times. C. Stop smoking. D. Follow a diet high in saturated fats. E. Avoid all physical activity.

A. Balance rest with activity. B. Carry nitroglycerin at all times. C. Stop smoking.

If you think your pt might have digitalis toxicity what would you look for?

Look at potassium level and digoxin level. Pt on diuretics may have hypokalemia and that increases digoxin effect

Meds given for systolic heart failure

ACE inhibitors, ARBs, beta blockers, diuretics, digitalis (Digoxin)

Lab of concern for pt with cholestasis

ALP

What is included in a Liver Function Test (LFT)?

ALT, AST, GGT

Hypochromia

Abnormal decrease in the hemoglobin content of erythrocytes

Megaloblasts

Abnormally large, immature, and dysfunctional RBCs

What has happened to pancreatic cells by the time symptoms occur in chronic pancreatitis?

About 90% of normal acinar cell function as been lost

Disease process of upper UTIs

Acute or chronic pyelonephritis, interstitial nephritis, kidney abscesses

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? a) Administering morphine I.V. as ordered b) Providing mouth care c) Placing the client in a semi-Fowler's position d) Maintaining nothing-by-mouth (NPO) status

Administering morphine I.V. as ordered Explanation: The nurse should address the client's pain issues first by administering morphine I.V. as ordered. Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues.

For a client diagnosed with idiopathic thrombocytopenia purpura (ITP), which nursing intervention is appropriate? a)Giving aspirin, as ordered, to control body temperature b)Teaching coughing and deep-breathing techniques to help prevent infection c)Administering platelets, as ordered, to maintain an adequate platelet count d)Administering stool softeners, as ordered, to prevent straining during defecation

Administering stool softeners, as ordered, to prevent straining during defecation

A client reporting shortness of breath is admitted with a diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor? Bilirubin Temperature Albumin Hemoglobin

Albumin With the movement of albumin from the serum to the peritoneal cavity, the osmotic pressure of the serum decreases. This, combined with increased portal pressure, results in movement of fluid into the peritoneal cavity. The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of ascites and edema.

Tx for patient with ascites to help correct decreases in effective arterial blood volume

Albumin infusion

How does albumin affect ascites

Albumin maintains oncotic pressure in the vascular system. A decrease in oncotic pressure due to low albumin level allows fluid to leak out from the interstitial spaces into the peritoneal cavity, producing ascites

CH. 54 A client requires hemodialysis. Which type of drug should be withheld before this procedure? A. Phosphate binders B. Insulin C. Antibiotics D. Cardiac glycosides

Ans: D Cardiac glycosides such as digoxin (Lanoxin) should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digoxin toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.

CH. 53 The nurse is assessing a client at the diagnostic imaging center. For which diagnostic test would the client assess for an allergy to shellfish? a) Bladder ultrasonography b) Computed tomography with contrast c) Cystoscopy d) Radiography

B The nurse is correct to assess for an allergy to shellfish most times when a contrast medium is ordered. The other options do not necessarily have a contrast medium.

CH. 53 The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? A. Glomerulonephritis B. Decreased fluid intake C. Increased fluid intake D. Diabetes insipidus

B. When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases. Disorders or conditions that cause decreased urine-specific gravity include diabetes insipidus, glomerulonephritis, and severe renal damage. Disorders that can cause increased specific gravity include diabetes, nephritis, and fluid deficit.

Sensitive indicator of renal function

Creatinine clearance level

Changes to antibiotic dosages should be based on

Creatinine clearance test

What lab value is increased on exacerbation of HF

BNP

What medications should be held before hemodialysis?

BP meds, cardiac glycosides such as digoxin, antibiotics (some antibiotics are removed by dialysis so it's best to be administered after the procedure to ensure their therapeutic effects)

Disease processes of lower UTIs

Bacterial cystitis, prostatitis, urethritis

Target B/P for pts with diabetes or CKD

Below 140/90

Where should the t-tube bag be?

Below the site/lower than the site

Best time to take nitroglycerin

Best taken before the pain develops because it increases tolerance for exercise and stress when taken prophylactically

Complications of t-tube post op

Bile leak due to t-tube removal, CBD obstruction, t-tube site cellulitis

One most common cause of iron-deficiency anemia

Bleeding

Common causes of iron-deficiency anemia

Bleeding ulcers in men, gastritis, IBD, GI tumors

Symptom of vitamin K deficiency

Bleeding/hemorrhaging

Splanchnic circulation

Blood flow to the stomach, spleen, pancreas, intestines, and liver

Changes to antibiotic dosages should be based on?

Creatinine clearance test

What gauges the kidney's glomerular filtration rate?

Creatinine clearance test

What gauges the kidneys's glomerular filtration rate?

Creatinine clearance test does this

CH. 27 A client is receiving nitroglycerin ointment (Nitro-Dur) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin?

Blood pressure 84/52 mm Hg Hypotension and headache are the most common adverse effects of nitroglycerin. Therefore, blood pressure is the vital sign most likely to reflect an adverse effect of this drug. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment and report the finding to the physician immediately

Definitive method of diagnosis for iron deficiency anemia

Bone marrow aspiration and serum ferritin level

SE of beta blockers

Bradycardia, SEXUAL DYSFUNCTION, decrease in HDL

Goal in treatment of Hodgkin lymphoma

Cure

Appropriate diet for patient with end stage liver failure

Low protein, low sodium

A nurse is admitting a patient with immune thrombocytopenic purpura to the unit. In completing the admission assessment, the nurse must be alert for what medications that potentially alter platelet function? Select all that apply. A) Antihypertensives B) Penicillins C) Sulfa-containing medications D) Aspirin-based drugs E) NSAIDs

C, D, E Feedback: The nurse must be alert for sulfa-containing medications and others that alter platelet function (e.g., aspirin-based or other NSAIDs). Antihypertensive drugs and the penicillins do not alter platelet function.

Most common form of heart disease

CAD

Primary cause of heart failure

CAD, atherosclerosis (fat plaques)

What happens to calcium in multiple myeloma

Calcium is lost from the bone and reabsorbed in the serum

What can the liver do to help during hypovolemic shock?

Can give back 500-1,000 mL of blood back into the general circulation

What can nitroglycerin relieve pain from and what can it NOT relieve pain from?

Can relieve pain from angina but not from MI

What happens in a cardiac arrest in regards to the heart rhythm

Cardiac arrest may be caused by irregular heart rhythms called arrhythmias. A common arrhythmia associated w cardiac arrest is vfib. It can also be caused by progressive bradycardia or asystole

Which objective symptom of a UTI is most common in older adults, especially those with dementia?

Change in cognitive functioning The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these clients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.

A client comes to the clinic and informs the nurse that he is there to see the physician for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with? Hepatitis Cholelithiasis Cholecystitis Biliary colic

Cholelithiasis Explanation: Initially, with cholelithiasis clients experience belching, nausea, and right upper quadrant discomfort, with pain or cramps after high-fat meal. Symptoms become acute when a stone blocks bile flow from the gallbladder. With acute cholecystitis, clients usually are very sick with fever, vomiting, tenderness over the liver, and severe pain called biliary colic. The symptoms do not correlate with hepatitis.

Why would someone with chronic pancreatitis be diagnosed later in the disease process?

Chronic pancreatitis often goes undetected

Risk factors for developing liver cancer

Cirrhosis, cigarette smoking, metastases from another site

Name conditions that are risk factors for cholelithiasis

Cirrhosis, diabetes, obesity, rapid and frequent changes in weight, ileal resection or disease

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? a) Elevated urobilinogen in the urine b) Straw-colored urine c) Reduced hematocrit d) Clay-colored stools

Clay-colored stools CorrectExplanation: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

A client's angina pectoris is being successfully treated on an outclient basis with sublingual nitroglycerin. What teaching point should the nurse convey to the client when reporting concern about the headache that follows the use of the medication? A) "This is actually a result of your angina, not the nitroglycerin." B) "I'll contact you care provider. This may mean that nitroglycerin is not the right drug for you." C) "If you can take your nitroglycerin on a full stomach, it might reduce the frequency and severity of your headaches." D) "This is a common adverse effect of nitroglycerin; try taking acetaminophen to treat your headache."

D) "This is a common adverse effect of nitroglycerin; try taking acetaminophen to treat your headache." The most common adverse effect of nitroglycerin is a severe headache, which is typically treated with acetaminophen. Taking the drug on a full stomach is ineffective, and headaches do not contraindicate the use of the drug.

CH. 53 A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse? A. Distract the patient's attention from the pain. B. Enable the patient to sit up and ambulate. C. Provide analgesics to the patient. D. Assess the patient's back and shoulder areas for signs of internal bleeding.

D. After a renal biopsy, the patient is on bed rest. It is important to assess the dressing frequently for signs of bleeding and evaluate the type and severity of pain. Severe pain in the back, shoulder, or abdomen may indicate bleeding. In such a case, the nurse should notify the physician about these signs and symptoms. Distracting the patient's attention, helping the patient to sit up or ambulate, and providing analgesics may only aggravate the patient's pain and, therefore, should not be performed by the nurse.

CH. 53 A patient is scheduled for a test with contrast to determine kidney function. What statement made by the patient should the nurse inform the physician about prior to testing? "I don't like needles." "I take medication to help me sleep at night." "I have had a test similar to this one in the past." "I am allergic to shrimp."

D. The nurse should obtain the patient's allergy history with emphasis on allergy to iodine, shellfish, and other seafood, because many contrast agents contain iodine.

What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention? A. Therapeutic paracentesis B. Platelet infusions C. Diuretic therapy D. Albumin infusion

D. Albumin infusion Albumin infusions help to correct decreases in effective arterial blood volume that lead to sodium retention. The use of this colloid reduces the incidence of postparacentesis circulatory dysfunction with renal dysfunction, hyponatremia, and rapid reaccumulation of ascites associated with decreased effective arterial volume.

Diagnostic tests that can determine client ejection fractions

Echocardiogram, cardiac catheterization, nuclear stress test

Pt during PRBCs transfusion complains of chills, low back pain, and nausea, what do you do?

D/C infusion STAT and maintain IV line w normal saline solution using new IV tubing

What infusion is often administered before cardiac surgery and why?

D10W with insulin is the infusion often administered before cardiac surgery to stabilize irritable cells and prevent arrhythmias

Adverse effects of hydroxyurea

Death of cells (esp cells that are rapidly turning over, GI cells)

In iron-deficiency anemia, MCV is increased or decreased?

Decreased

Relationship between potassium and digoxin effect

Decreased serum potassium level = increased digoxin effect (digitalis toxicity)

Primary cause of ESRD?

Diabetes

A nurse has admitted a client suspected of having acute pancreatitis. The nurse knows that mild acute pancreatitis is characterized by: a) Sepsis b) Disseminated intravascular coagulopathy c) Edema and inflammation d) Pleural effusion

Edema and inflammation Correct Explanation: Severe abdominal pain is the major symptom of pancreatitis that causes the client to seek medical care. Abdominal pain and tenderness and back pain result from irritation and edema of the inflamed pancreas

ALP level in pt with cholestasis: elevated or decreased?

Elevated

Largest source of ammonia

Enzymatic and bacterial digestion of dietary and blood proteins in the GI tract

T/F: thrombocytopenia is associated with thalassemia

FALSE

Obstruction of bile flow interferes with absorption of what?

Fat soluble vitamins A, D, E, K

What supplementation of vitamins are needed for a patient with cholelithiasis?

Fat soluble vitamins: A, D, E, K

Hepatitis A transmission

Fecal-oral

Explain the changes of ferritin, MCV, RBC, and hematocrit levels in a pt with iron-deficiency anemia

Ferritin level: decreased MCV: decreased RBC: decreased Hematocrit: decreased

When should you monitor vital signs and signs of complications after a brush biopsy?

First 24 hrs

What kind of abnormalities may an ultrasound detect?

Fluid accumulation, masses, congenital malformations, changes in organ size, and obstructions

Source of vitamin B12

Found only in foods of animal origin

What does ultrasound require

Full bladder

How is sublingual nitroglycerin adminsitered

Generally placed under the tongue or in the cheek (buccal pouch)

What are thalassemias

Group of hereditary anemias characterized by hypochromia, extreme microcytosis, hemolysis, and variable degrees of anemia

What labs to look at when giving Epogen

H&H

Risk of cirrhosis occurs with which hepatitis

HBV

Which hepatitis increases risk for liver cancer

HCV

Risk factors of prolonged jaundice

Hepatitis, severe jaundice (bilirubin exceeding 20 to 25) which poses risk for CNS damage

Pt teaching for a pt taking hydroxyurea

Hydroxyurea is a cytotoxic drug

Taking Lasix can cause what SE

Increased urine output and decreased blood volume = hypotension, dizziness, electrolyte imbalance esp potassium, dehydration

What medication is contraindicated and be questioned for a pt being treated for pericarditis?

Indomethacin (Indocin) bc it may decreased coronary blood flow

Interstitial nephritis

Inflammation of kidney

Glomerulonephritis

Inflammation of the glomerular capillaries that can occur in acute and chronic forms

Pancreatitis etiology

Inflammation of the pancreas due to autodigestion

Cystitis

Inflammation of urinary bladder

T-tube purpose

Inserted in common bile duct (CBD) for external drainage of bile after surgery

What to assess for after a brush biopsy

Internal bleeding such as pallor, dizziness, and flank or back pain. Signs of infection such as fever.

Lack of what keeps vitamin B12 from being absorbed?

Intrinsic factor

What is needed for absorption of vitamin B12?

Intrinsic factor

Assessing for allergies before giving a contrast dye is important bc they contain what?

Iodine

A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage?

Iron chelation therapy Explanation: Iron overload is a complication unique to people who have had long-term PRBC transfusions. One unit of PRBCs contains 250 mg of iron. Patients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. Over time, the excess iron deposits in body tissues and can cause organ damage, particularly in the liver, heart, testes, and pancreas. Promptly initiating a program of iron chelation therapy can prevent end-organ damage from iron toxicity.

Nonhodgkins lymphoma

Is the more common type -- a malignancy in the lymphocytes and not so much of a good outcome

What is given to pt with high ammonia level

Lactulose

Where is ejection fraction measured

Left ventricle

A nurse is planning care for a patient with acute pancreatitis. Which of the following patient outcomes does the nurse assign as the highest priority? a) Adequate fluid and electrolyte balance b) Developing no acute complications from the pancreatitis c) Maintenance of normal respiratory function d) Maintaining satisfactory pain control

Maintenance of normal respiratory function Correct Explanation: Airway and breathing are always the priority assessment. Acute pancreatitis produces retroperitoneal edema, elevation of the diaphragm, pleural effusion, and inadequate lung ventilation. Intra-abdominal infection and labored breathing increase the body's metabolic demands, which further decreases pulmonary reserve and can lead to respiratory failure. Maintenance of adequate respiratory function is the priority goal. The other outcomes would also be appropriate for the patient.

Normal hemoglobin levels

Male: 13-18 g/100mL Female: 12-16 g/100mL

A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? a) Hemolytic anemia b) Leukemia c) Multiple myeloma d) Polycythemia vera

Multiple myeloma Explanation: The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.

Drugs that may decrease absorption of oral vitamin B12

Neomycin, alcohol, colchicine

Hodgkin's lymphoma is considered what

One of the most treatable cancers

Clients with multiple myeloma have abnormal plasma cells that proliferate in the bone marrow where they release osteoclast-activating factor, resulting in the formation of osteoclasts. Which of the following is the most common complication of the pathology resulting from this process? a) Osteoporosis b) Calcified bones c) Pathologic fractures d) All of the options are correct.

Pathologic fractures Explanation: Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.

What happens when you have increased blood calcium levels

Pathological bone fractures

What happens to a pt if they are not treated for vitamin B12 deficiency?

Pernicious anemia can result, which is a type of megaloblastic anemia

A patient with suspected multiple myeloma is complaining of pain in the back. What is the priority nursing action? a) Send the patient for x-ray study of the spine. b) Have the patient lie on a hard surface. c) Have the patient rest. d) Encourage ambulation.

Send the patient for x-ray study of the spine. Explanation: The patient with myeloma can have bone pain, especially in the back and ribs. The pain will decrease with rest and increase with activity. Lying on a hard surface will not relieve the pain. The priority action is to make certain the patient does not have a fracture of the spine, as the bone destruction in this disease is sufficiently severe to cause vertebral collapse.

What indicator would you look up for the primary cause of end-stage renal disease?

Serum and urine levels of glucose

Example of phosphate binder

Sevelamer hydrochloride (Renagel, Renvela)

Major symptom of pancreatitis that causes the patients to seek medical care?

Severe abdominal pain

After a renal biopsy, what might indicate bleeding?

Severe pain in the back, shoulder, or abdomen may indicate bleeding

Shower or bath tub when you have UTI?

Shower!

Extreme microcytosis

Smaller-than-normal erythrocytes

The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN). Which does the nurse attribute as the reason for NPO status? a) To aid opening up of pancreatic duct b) To prevent the occurrence of fibrosis c) To drain the pancreatic bed d) To avoid inflammation of the pancreas

To avoid inflammation of the pancreas Explanation: Pancreatic secretion is increased by food and fluid intake and may cause inflammation of the pancreas.

Why would a pt with acute renal failure receives an IV infusion of 10 percent dextrose in water with 18 units of regular insulin?

To facilitate the intracellular movement of potassium

What is the purpose of nitroglycerin?

To treat angina symptoms, such as chest pain or pressure

What can Valsalva maneuver cause

Too much pressure can cause intracranial bleeding

CH. 27 A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? a) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. b) Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. c) Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. d) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician.

a) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

The nurse is teaching an older adult client about different types of proteins that can be eaten. Which food will the nurse identify that contain dietary protein? (Select all that apply.) a. beans b. nuts c. poultry d. butter e. fish

a. beans b. nuts c. poultry e. fish Dietary proteins are obtained from animal and plant food sources, which include milk, meat, fish, poultry, eggs, soy, legumes (peas, beans, and peanuts), nuts, and components of grains. Butter is a fat and not a source of protein.

A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing? a) Decreased total iron-binding capacity b) Decreased level of erythropoietin c) Increased reticulocyte count d) Increased mean corpuscular volume

b) Decreased level of erythropoietin Explanation: Differentiation of the primitive myeloid stem cell into an erythroblast is stimulated by erythropoietin, a hormone produced primarily by the kidney. If the kidney detects low levels of oxygen, as occurs when fewer red cells are available to bind oxygen (i.e., anemia), or with people living at high altitudes with lower atmospheric oxygen concentrations, erythropoietin levels increase. The increased erythropoietin then stimulates the marrow to increase production of erythrocytes. The entire process of erythropoiesis typically takes 5 days (Cook, Ineck, & Lyons, 2011). For normal erythrocyte production, the bone marrow also requires iron, vitamin B12, folate, pyridoxine (vitamin B6), protein, and other factors. A deficiency of these factors during erythropoiesis can result in decreased red cell production and anemia.

A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem? a) Folic acid deficiency b) Vitamin B12 deficiency c) Vitamin A deficiency d) Vitamin C deficiency

b) Vitamin B12 deficiency Explanation: Because vitamin B12 is found only in foods of animal origin, strict vegetarians may ingest little vitamin B12. Vitamin B12 combines with intrinsic factor produced in the stomach. The vitamin B12-intrinsic factor complex is absorbed in the distal ileum. Clients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and therefore the absorption of vitamin B12 may be diminished. The effects of either decreased absorption or decreased intake of vitamin B12 are not apparent for 2-4 years. This results in megaloblastic anemia. Some symptoms are a smooth, beefy red, enlarged tongue and cranial nerve deficiencies.

How is HBV transmitted

blood and body fluids

How is HCV transmitted

blood and body fluids, recreational drug use

How is HDV transmitted

blood, sexual contact, only occurs in people who are infected with HBV

CH. 27 A client with an acute myocardial infarction is receiving nitroglycerin by continuous I.V. infusion. Which client statement indicates that this drug is producing its therapeutic effect? a) "I have a bad headache." b) "I feel a tingling sensation around my mouth." c) "My chest pain is decreasing." d) "My vision is blurred, so my blood pressure must be up."

c) "My chest pain is decreasing."

CH. 27 A patient presents to the ED complaining of anxiety and chest pain after shoveling heavy snow that morning. The patient says that he has not taken nitroglycerin for months but did take three nitroglycerin tablets and although the pain is less, "They did not work all that well. " The patient shows the nurse the nitroglycerin bottle and the prescription was filled 12 months ago. The nurse anticipates which of the following physician orders? a) Serum electrolytes b) Ativan 1 mg orally c) Nitroglycerin SL d) Chest x-ray

c) Nitroglycerin SL Nitroglycerin is volatile and is inactivated by heat, moisture, air, light, and time. Nitroglycerin should be renewed every 6 months to ensure full potency. The client's tablets were expired and the nurse should anticipate administering nitroglycerin to assess if the chest pain subsides. The other choices may be ordered at a later time, but the priority is to relieve the patient's chest pain.

CH. 27 A nurse is teaching a client how to take nitroglycerin to treat angina pectoris. The client verbalizes an understanding of the need to take up to three sublingual nitroglycerin (Nitrostat) tablets at 5-minute intervals, if necessary, and to notify the physician immediately if chest pain doesn't subside within 15 minutes. The nurse tells the client that, after taking the nitroglycerin, he may experience: a. nausea, vomiting, depression, fatigue, and impotence. b. sedation, nausea, vomiting, constipation, and respiratory depression. c. headache, hypotension, dizziness, and flushing. d. flushing, dizziness, headache, and pedal edema.

c. headache, hypotension, dizziness, and flushing.

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients:

cannot tolerate high-glucose concentration. Explanation: Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.

How often can you take nitroglycerin

every 5 minutes for 3 doses (three strikes and you're out)

How is HAV transmitted

fecal-oral

SE of direct vasodilators

hypotension, headache, dizziness, tachycardia

Pericarditis

inflammation of the sac surrounding the heart (pericardium)

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called A) megaloblasts. B) blast cells. C) mast cells. D) monocytes.

megaloblasts. Explanation: Megaloblasts are abnormally large erythrocytes. Blast cells are primitive WBCs. Mast cells are cells found in connective tissue involved in defense of the body and coagulation. Monocytes are large WBCs that become macrophages when they leave the circulation and move into body tissues.

A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: wash her hands after touching the client. place the client in a private room. wear a mask when handling the client's bedpan. wear a gown when providing personal care for the client.

wash her hands after touching the client. Explanation: To maintain enteric precautions, the nurse must wash her hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.

Urinary irritants

Coffee and tea

Medications given for severe pericarditis or if pt does not respond to NSAIDs

Colchicine (Colcrys) or corticosteroids

What may indicate an allergic reaction to the dye used during the arteriogram?

Pruritus (itchiness) would indicate an allergic reaction to the dye, as well as decreased alertness and dyspnea

What is happening in a nuclear stress test

Radioactive substance, THALLIUM, is used to see narrowing of coronary arteries

MOA of nonselective beta blockers

Reduce portal pressure by reducing portal venous inflow via 2 mechanisms: 1. A decrease in cardiac output through B1 adrenergic blockade 2. A decrease in splanchnic blood flow through B2 adrenergic blockade

How does nitric oxide reduce sickling

Reduces sickling by promoting the binding of oxygen to hemoglobin

How does brain try to counter HF?

Releases ANP and BNP to counter it which should cause vasodilation and diuresis

SE of adrenergic inhibitors

Sedation and fatigue

What not to do with nitroglycerin sublingual tablets

Do not chew, crush, or swallow nitroglycerin sublingual tablets

SE of ACE inhibitors

Dry cough, hyperkalemia

What causes megaloblastic anemia

Due to impairment of DNA synthesis caused by folic acid deficiency and vitamin B12 deficiency

Facts about hepatitis A

- Fecal-oral transmission - Can be through sexual contact - Typically there is spontaneous recovery - 70% chance that jaundice will occur - Incubation period is 15-50 days, 28 days average

Normal troponin I level

0 - 0.04 ng/mL

BUN/creatinine ratio

10:1

Fat soluble vitamins

A, D, E, K

Osteoclasts' action can result in

Hypercalcemia and pathological bone fractures

What lab values might support that the client has multiple myeloma

Hypercalcemia, increased serum creatinine, increased serum protein

Diagnostic test accurate for an MI

Troponin I

Main causes of pancreatitis

Alcohol and gallstones

CH. 53 When describing the functions of the kidney to a client, which of the following would the nurse include? A. Control of water balance B. Regulation of white blood cell production C. Synthesis of vitamin K D. Secretion of enzymes

Ans: A. Functions of the kidneys include control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins.

Name an important electrolyte shift that occurs with dialysis

Hypokalemia

The nursing instructor is teaching nursing students about myocardial contractility and ejection fractions. What diagnostic tests can determine client ejection fractions? Select all that apply. A) Echocardiogram B) Cardiac catheterization C) Magnetic resonance imaging D) Positron emission tomography scan E) Troponin levels

A) Echocardiogram B) Cardiac catheterization C) Magnetic resonance imaging

Pruritus in cholestasis may be related to

An elevation in plasma bile acids

A nurse is preparing a client for an exercise stress test the following morning. Which client statement indicates a need for additional teaching?

"I won't eat or drink anything after midnight tonight." Explanation: The client requires additional teaching if he states that he'll fast from midnight until the test. Clients need to abstain from eating and drinking for only 4 hours before the test. The client should refrain from smoking for several hours before the test. Although the physician may direct the client to avoid certain medications, it's more likely that the physician will direct the client to take all his normal medications. The client must sign a consent form before the test.

Defect in the lymphoid stem cells can cause problems with

- T or B lymphocytes - plasma cells (a more differentiated form of B lymphocyte) - or natural killer (NK) cells

Function of kidneys

- Urine formation - Excrete waste products - Regulate electrolytes, acid-base balance, RBC production - Control water balance, blood pressure - Renal clearance - Synthesis of vitamin D to active form - Secretion of prostaglandins

Defect in the myeloid stem cells can cause problems with

- erythrocyte - leukocyte - and platelet production

A patient with sickle cell anemia is to begin treatment for the disease with hydroxyurea. What does the nurse inform the patient will be the benefits of treatment with this medication? Select all that apply. A) Fewer painful episodes of sickle cell crisis B) Lower incidence of acute chest syndrome C) Decreased need for blood transfusions D) Decreased need for other analgesic medications E) Ability to reverse the damage done from sickling of cells

A) Fewer painful episodes of sickle cell crisis B) Lower incidence of acute chest syndrome D) Decreased need for blood transfusions Explanation: Hydroxyurea is a chemotherapy agent that is effective in increasing fetal hemoglobin (i.e., hemoglobin F) levels in patients with sickle cell anemia, thereby decreasing the formation of sickled cells. Patients who receive hydroxyurea appear to have fewer painful episodes of sickle cell crisis, a lower incidence of acute chest syndrome, and less need for transfusions. However, whether hydroxyurea can prevent or reverse actual organ damage remains unknown.

Through the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what do myeloid stem cells further differentiate? Select all that apply. A) Leukocytes B) Natural killer cells C) Cytokines D) Platelets E) Erythrocytes

A, D, E (Feedback: Myeloid stem cells differentiate into three broad cell types: erythrocytes, leukocytes, and platelets. Natural killer cells and cytokines do not originate as myeloid stem cells.)

CH. 53 The nurse is providing care to a client who has had a renal biopsy. The nurse would need to be alert for signs and symptoms of which of the following? A. Bleeding B. Dehydration C. Infection D. Allergic reaction

A. Renal biopsy carries the risk of post procedure bleeding because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater. Dehydration and allergic reaction are not associated with a renal biopsy.

Medications given for acute phase of pericarditits

Analgesics and NSAIDs such as aspirin or ibuprofen (Motrin) Colchicine (Colcrys) may be used instead of NSAIDs

S/S of liver failure

Anemia, spider angioma, thrombocytopenia (decreased platelets)

S/S of cardiomyopathy

Angina Syncope Fatigue Dyspnea

CH. 53 The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: a) Specific gravity 1.035 b) Creatinine 0.7 mg/dL c) Bright yellow urine d) Protein 15 mg/dL

A. Specific gravity is reflective of hydration status. A concentrated specific gravity, such as 1.035, is suggestive of dehydration. Bright yellow urine suggests ingestion of mulitiple vitamins. Proteinuria can be benign or be caused by conditions which alter kidney function. Creatinine measures the ability of the kidney to filter the blood. A level of 0.7 is within normal limits.

CH. 53 A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram? A. Pruritus B. Unusually smooth skin C. Hypoventilation D. Increased alertness

A. The nurse should be alert for pruritus and urticaria, which may indicate a mild anaphylactic reaction to the arteriogram dye. Decreased (not increased) alertness may occur as well as dyspnea (not hypoventilation). Unusually smooth skin isn't a sign of anaphylaxis.

Dietary proteins are obtained from

Animal and plant food sources, which include milk, meat, fish, poultry, eggs, soy, legumes (peas, beans, peanuts), nuts, and components of grains

GI effects of taking hydroxyurea

Anorexia, N/V/D/C

S/S of digitalis toxicity

Anorexia, nausea, visual disturbances, bradycardia, confusion

A nurse discusses risk factors of cholelithiasis with a client. Which risk factors will the nurse include in the teaching? Select all that apply. Changes in weight Cystic fibrosis Diabetes Obesity

All Risk factors for the development of gallstones (cholelithiasis) may include: changes in weight, obesity, cystic fibrosis, and diabetes. All of these conditions impact fat metabolism, increasing the risk of developing cholesterol gallstones. Sickle cell disease does not impact the development of gallstones.

Protein byproduct

Amino acids, leftover amino acids form ammonia

Lab of concern for pt with GI bleed due to alcoholism

Ammonia level

Based on her knowledge of the primary cause of ESRD, the nurse knows to assess the most important indicator. What is that indicator? a) pH and HCO3 b) Blood pressure c) Serum glucose d) Urine protein

Ans: c) Serum glucose The nurse would evaluate serum and urine levels of glucose because diabetes is the primary cause of renal failure.

CH. 53 A patient who complains of a dull, continuous pain in the suprapubic area that occurs with and at the end of voiding would most likely be diagnosed with which of the following? a) A kidney stone b) Interstitial cystitis c) Prostatic cancer d) Acute pyelonephritis

B Pain over the suprapubic area is most likely related to the bladder. Pain intensity would increase with fullness. Pain at the end of voiding is one of the symptoms associated with interstitial cystitis.

A 54-year-old client has been prescribed sublingual nitroglycerin. After the nurse has finished teaching the client about the medication, what statement could the client make to suggest that the client understands proper self-administration? A) "I should take three tablets as soon as I start to feel chest pain." B) "I can take up to three tablets at five-minute intervals." C) "I should take as many tablets as I need to make the pain go away." D) "I should only take the medication if the pain becomes severe."

B) "I can take up to three tablets at five-minute intervals." Clients may take up to three doses of sublingual nitroglycerin at five-minute intervals to relieve anginal chest pain. They should take as few doses as necessary to relieve pain. Administration should begin at the first sign of pain.

CH. 53 Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? a) 20% b) 40% c) 50% d) 30%

C Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal. Renal function can be assessed most accurately if several tests are performed and their results are analyzed together. Common tests of renal function include renal concentration tests, creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein metabolism) levels.

A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan? A) Instruct the client not to crush the tablet. B) Instruct the client to place nitroglycerin tablets in a plastic pill box. C) Instruct the client on side effects of flushing, throbbing headache, and tachycardia. D) Instruct the client to renew the nitroglycerin supply every 3 months.

C) Instruct the client on side effects of flushing, throbbing headache, and tachycardia. Explanation: The client should be instructed about side effects of the medication, which include flushing, throbbing headache, and tachycardia. The client should renew the nitroglycerin supply every 6 months. If the pain is severe, the client can crush the tablet between the teeth to hasten sublingual absorption. Tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerin is very unstable and should be carried in its original container.

Some medications that can decrease portal pressure

Propranolol and nadolol + vasopressin and octreotide (Sandostatin)

Most common presenting symptom of cholestasis

Pruritus (itchiness)

Vitamin B12 and folate deficiencies are characterized by what (with the erythrocytes)

Characterized by the production of abnormally large erythrocytes

Impaired liver → impaired ________ → ________

Clotting; bleeding

Megaloblastic anemia

Condition in which bone marrow produces unusually large, structurally abnormal, immature red blood cells (megaloblasts)

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient? A) It is part of the required assessment information. B) It is important for the nurse to determine what type of foods the patient will eat. C) It may indicate deficiencies in essential nutrients. D) It will determine what type of anemia the patient has.

Correct response: C) It may indicate deficiencies in essential nutrients. Explanation: A nutritional assessment is important, because it may indicate deficiencies in essential nutrients such as iron, vitamin B12, and folate.

Which nursing assessment is most important in a client diagnosed with ascites? Assessment of the oral cavity for foul-smelling breath Auscultation of abdomen Daily measurement of weight and abdominal girth Palpation of abdomen for a fluid shift

Daily measurement of weight and abdominal girth Explanation: Measuring and recording of abdominal girth and body weight daily are essential to assess the progression of ascites and its response to treatment.

Albumin, protein, calcium, and creatinine levels in a pt with multiple myeloma?

Decreased albumin, increased everything else

Intitial appropriate nursing diagnosis for pt with cardiomyopathy with symptoms of dyspnea on exertion, fatigue, fluid retention, and nausea

Decreased cardiac output

In patients w iron-deficiency anemia, is ferritin level increased or decreased

Decreased; low ferritin level

Pernicious anemia that has not been treated for more than 3 months can result in

Degenerative lesions of the spinal cord, can cause damage to nerves and can affect memory and thinking, can lead to pernicious anemia

Recipe for pt w hyperkalemia or acute renal failure

Dextrose 10% in water w insulin

Example of cardiac glycoside

Digoxin (Lanoxin)

Cardiomyopathy

Disease of heart muscle that is associated with cardiac dysfunction and makes it hard for heart to pump blood to the rest of the body

If pt is receiving antibiotics for an infection and their kidney function is decreased, what will MD consider when changing the dose of antibiotics?

Doing a creatinine clearance test to see what the dose should be changed to and look at kidney function tests

The nurse should check the hemoglobin prior to administration of erythropoietin, because too high a hemoglobin level can put the client at risk for

HF, MI, and CVA

Labs that would support that the client has iron-deficiency anemia

Hemoglobin and hematocrit, ferritin level

Name some medication that make the liver toxic?

Isoniazid (INH) usually given for tuberculosis and Phenytoin (Dilantin) given for seizures

What does hydroxyurea do for in pts with sickle cell anemia?

It is a chemotherapy agent that is effective in increasing fetal hemoglobin (i.e., hemoglobin F) levels in patients with sickle cell anemia, thereby decreasing the formation of sickled cells.

Ejection fraction is rarely measured where?

It is rarely measured in the right ventricle

Normal hematocrit levels

Male: 42-52% Female: 37-47%

What are the diagnostic signs of a hemorrhagic stroke?

Signs specific to hemorrhagic stroke are vomiting, sudden severe headaches, seizures

Pt with ascites should avoid/decrease what

Sodium

Decrease in effective arterial blood volume can lead to

Sodium retention

In a urinalysis, what lab value is reflective of hydration status?

Specific gravity

Most serious location of a kidney stone and why?

Ureteropelvic junction bc of its close proximity to the kidneys nd the risk of associated kidney dysfunction

What is cutaneous urinary diversion

Urine drains thru an opening created in the abd wall and skin

What findings are normal after a brush biopsy?

Urine may contain blood, usually clearing in 24-48 hrs from oozing at site. Renal colic (pain from stone) is also common and an expected finding after a renal brush biopsy.

When does cardiogenic shock occur

Usually brought on by a heart attack, but not everyone who has a heart attack has cardiogenic shock

Recovery time of hepatitis A

Usually spontaneous recovery

Nitric oxide classification

Vasodilator

Nitroglycerin classification

Vasodilator Antianginal Nitrate

Which of the following medications is used to decrease portal pressure, halting bleeding of esophageal varices? a) Vasopressin (Pitressin) b) Spironolactone (Aldactone) c) Cimetidine (Tagamet) d) Nitroglycerin

Vasopressin (Pitressin) Vasopressin may be the initial therapy for esophageal varices, because it constricts the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Aldactone and Tagamet do not decrease portal hypertension.

When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements? -Vitamin A -Vitamin D -Vitamin E -Vitamin K -Vitamin B

Vitamin A, D, E, KBiliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat soluble and thus would need to be supplemented in a patient with biliary obstruction. Vitamin B is water soluble and would not be recommended for a patient with biliary obstruction.

Pernicious anemia is a type of?

Vitamin B12 deficiency / megaloblastic anemia

What is given if PT level is low

Vitamin K

What is necessary for normal blood clotting

Vitamin K is necessary

When can spontaneous hemorrhaging occur

When platelet count is < 10,000

A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for: a) acute heart failure. b) hypoxemia. c) chronic liver failure. d) pathologic bone fractures.

pathologic bone fractures. Explanation: Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, clients are at risk for renal failure secondary to myeloma proteins by causing renal tubular obstruction. Liver failure and heart failure aren't usually sequelae of multiple myeloma. Hypoxemia isn't usually related to multiple myeloma.

If pt had brush biopsy 9 hrs ago, what findings should the MD be notified of?

signs and symptoms of bleeding or infection like fever and chills