Test 2

Etiology, pathogenesis of systemic lupus

-Chronic inflammatory disease -*Autoantibody mediated* against nucleic acids (ANA), erythrocytes, coagulation proteins, phospholipids, lymphocytes, platelets and other self components

Etiology, pathogenesis of Cushing's disease

Excessive cortisol! Stress hormone

Function of T cells, and how are they activated?

(cell-mediated) Pathogens inside of cells "kicked in" with Antigen Presenting Cells (APCs) -Destroys intracellular invaders Once activated, T cells differentiate -Cytotoxic T cells with CD8+ markers: virus/cancer -Helper T cells with CD4+ markers: activate lymph -Regulatory T cells with CD4+CD25+ markers: control system when pathogen has been destroyed

Function of B cells, and how are they activated?

(humoral) Pathogens outside of cells Looks for antigens-membrane-bound antibodies(immunoglobulins). Receptors bind with one particular type of antigens. Once bound, B cells differentiate-plasma cells, memory cells. Plasma cells-antibody production (proteins) Memory-knows which antibody needs to be produced

Etiology, pathogenesis of multiple sclerosis

*T Cell mediated* Chronic inflammatory disease involving degeneration of the CNS myelin, scarring and plaque formation, and loss of axons -Autoreactive T cells to a myelin protein -Results in CD8+ T cell activation -Characterized by the presence of demyelination and T-cell predominant inflammation in the brain white matter -Glial cells destroyed from inflammation -Autonomic responses will be destroyed

Medical management of Urinary Incontinence

-Behavioral: keagal, timed voiding, urethral occlusion, catheterization -Pharmacological -Functional electrical stimulation -Surgery

How do T cells work against a viral attack?

-Cytotoxic T cells with CD8+ markers

Management of IBS

-Counseling to educate about link between stress and exacerbation -Rest and heat -Antispasmodics, such as diphenoxylate with atropine (Lomotil) may be prescripted

Etiology, pathogenesis of Irritable bowel syndrome

-Genetics -Mast cell activation -Interstitial cells of Cajal -Serotonin pathway -Stress -Hormone fluctuaton

Clinical manifestations of Crohn's Disease

-Granulomas -Abscesses -Fistulas -Liquid stools -intestinal obstructions -bile salts/vit b12 (anemia)

Management of chronic constipation

-Initial management includes patient education, dietary changes and bulk forming laxatives -Dietary fiber and bulk-forming laxatives such as psyllium and methylcellulose are the most effective -If fiber not tolerated, or does not lead to response, other laxatives may need to be used -Osmotic agents -Stimulant Laxatives -Suppositories -Disimpaction followed by bowel cleansing with lubricant enema

Etiology, pathogenesis of Parkinson's Disease

-Loss of dopamine? in substantia nigra= increased Acetylcholine. Balance and coordination issues. (MAO and COMT enzymes further break down dopamine) -Lewy body formation: encapsulated misfolded proteins. Fibrils made of proteins are deposited on neuronal body, causing neuronal degeneration and death. Prevent formation of dopamine!

Levels of CD4+ cells that influence treatment of HIV/AIDS

Below 200, between 200-350 is controversial

Clinical manifestations of IBS

-Chronic abdominal pain or discomfort associated with chaotic bowel motility -Heightened visceral sensitivity -Constipation dominant IBS, diarrhea dominant IBS or mixed -Patients typically experience functional irritability of the bowel: peristalsis dysfunctional -Spasmodic contractions trap gas and stool, leading to bloating, gas pain and constipation -Cholinergic stimulation can trigger rapid movement of contents, leading to diarrhea

Management of Ulcerative Colitis

-Corticosteroids reduce inflammation -Aminosalicylates such as sulfasalazine (Azulfidine) reduce inflammation -Iron supplements to correct anemia -TPN may be needed for those with severe disease or those awaiting surgery -If toxic megacolon develops, surgery may be needed to remove colon

Management of Crohn's Disease

-Corticosteroids reduce pain and bleeding by decreasing inflammation -Aminosalicylates such as sulfasalazine (Azulfidine) reduce inflammation -Immunosuppressant drugs such as azathrioprine (Imuran) and methotrexate (Rheumatrex) suppress response to antigens -Metronidazole (Flagyl) treats perineal complications -Opioids treat pain and diarrhea -Stress reduction and reduced physical activity rest the bowel -Diet of reduced high-fiber foods decreases bowel activity

Autonomic dysreflexia

-Results from the loss of coordinated autonomic responses to demands on heart rate and vascular tone -Noxious stimuli below the level of the injury leads to uninhibited or exaggerated sympathetic responses -Compensatory parasympathetic response produces bradycardia and vasodilation above the level of the lesion, but this is not sufficient to reduce elevated blood pressure. -SCI lesions lower than T6 do not produce this complication, because intact splanchnic innervation allows for compensatory dilatation of the splanchnic vascular bed. Complications: -Typical stimuli include bladder distention, bowel impaction, pressure sores or skin irritation, bone fracture, or visceral disturbances -Sexual activity can be a trigger. Manifestations: -Headache, diaphoresis, and increased blood pressure -Flushing, blurred vision, anxiety, and nausea may also occur -Bradycardia is common; some patients have tachycardia instead. Management: -Measuring and monitoring blood pressure. -Immediately sitting the patient upright to orthostatically lower blood pressure. -Removal of tight-fitting garments. -Search for and correct noxious inciting stimuli.

Mechanisms of autoimmune dysfunction

-Self/non-self recognition does not occur -Over-zealous antigen-antibody responses can damage normal cells. -Cells can be modified by drugs, environmental factors, etc.

Clinical manifestations of chronic constipation

-Stools may be too hard or too small, difficult to pass, or infrequent (less than three times per week). -There may be a frequent need to strain and a sense that the bowels are not empty.

Manifestations of HIV/AIDS

-The development of cryptosporidiosis, pulmonary and lymph node tuberculosis, wasting, persistent fever (longer than one month), persistent candidasis, recurrent bacterial pneumonia, and other opportunistic infections is common. -These patients may be wasting, or losing weight. -Kaposi's sarcoma: cancer of blood vessels

Manifestations of Addison's disease

-Weakness and fatigue, anorexia, weight loss, nausea, diarrhea, orthostatic hypotension -Hypoglycemia because of absence of cortisol -Hyperpigmentation and vitiligo -Loss of secondary sex characteristics in females

Manifestations of Cushing's disease

-Weight gain: trunk obesity, Na/H2O retention -Glucose intolerance: polyuria -Protein wasting: muscle weakness -Decreased serum Ca levels: osteoporosis, kidney stones -Suppression of immune system -Alterations in mental status -Females: increased androgen levels

Parkinson's Disease Manifestations

1. Resting *tremor* 2. Muscle *rigidity* 3. *Bradykinesia* 4. Postural *instability* -Autonomic nervous system dysfunction: GI motility, bladder dysfunction, sweating, orthostatic hypotension -Depression -Cognitive impairment

Etiology, pathogenesis of chronic constipation

A change in bowel habits, but it has varied meanings. -Slow colonic transit AND/OR Obstructed defecation(cannot relax external sphincter)

Which of the following are early symptoms of Alzheimer's disease? Select all that apply: A. Poor or decreased judgment B. Occasionally forgetting meetings C. Difficulty finding words D. Frequently misplacing keys E. Difficulty remembering names of unfamiliar objects F. Increased attention span

A, B, C, and D are early symptoms of Alzheimer's disease. Other symptoms include difficulty remembering names of familiar objects and decreased attention span.

The husband caring for a client in early stage of Alzheimer's asks the nurse what sort of changes he can do at home to keep her wife safe. The nurse enumerates which of the following appropriate actions? Select all that apply: A. Remove excess furniture, throw rugs and clear pathways of clutter. B. Always keep valuables suck as keys, wallets and mobile phones in the same place at home. C. Make sure appointments are scheduled on different dates at different times as possible. D. Ask the doctor if the medications can be given at varying times. E. Reduce the number of mirrors at home F. Allow independence when possible.

A, B, E, and F are appropriate suggestions for a caregiver of a client with Alzheimer disease. It is very important to establish routine schedules by setting appointments on the same day at the same time and to request to doctors if they can simplify the client's medication regimen to once-daily dosing with the same schedule.

Which of the following are the risk factors in developing Alzheimer's disease? Select all that apply: A. Family history of Alzheimer's disease B. Male gender C. Previous head injury D. Untreated high blood pressure E. High levels of Folic Acid F. Hormone therapy

A, C, D, and F are all risk factors for the development of Alzheimer's disease. Females are more prone to developing Alzheimer's as well as having low levels of Folic acid.

Which is NOT true about the polyol pathway in the development of diabetes mellitus? A. Episodes of hypoglycemia result in glucose being converted to sorbitol B. Activation of this pathway results in the accumulation of sorbitol in cells C. Neurons and RBCs use this pathway for glucose metabolism D. Activation of this pathway results in increased osmotic pressure in the cells and cellular swelling

A. Episodes of hypoglycemia result in glucose being converted to sorbitol

Laboratory results have been obtained for a 50-year-old patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Increased high-density lipoproteins (HDL) C. Decreased low-density lipoproteins (LDL) D. Decreased very-low-density lipoproteins (VLDL)

A. Increased triglyceride levels Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

The nurse identifies which one of the following medication is specific for Alzheimer's disease? A. Memantine (Namenda) B. Pramipexole Dihydrochloride (Mirapex) C. Aripiprazole (Abilify) D. Topiramate (Topamax)

A. Namenda is an N-Methyl-D-Aspartate Receptor Antagonist used in moderate to severe types of Alzheimer's disease. Mirapex is used for Parkinson's disease; Aripiprazole is an antipsychotic medication that can be used in some cases of Alzheimer's disease; while Topamax is an anticonvulsant medication.

A client with diabetes has a serum creatinine of 1.9 mg/dL. The nurse correlates which urinalysis finding with this client? A. Protein in the urine during a random urinalysis B. Glucose in the urine during hyperglycemia C. Ketone bodies in the urine during acidosis D. White blood cells in the urine during a random urinalysis

A. Protein in the urine during a random urinalysis

Which of the following nursing diagnosis should be considered as a priority in caring for the client with Alzheimer's disease? A. Risk for injury related to impaired judgment, disorientation and confusion. B. Impaired verbal communication related to degenerative changes. C. Anticipatory grieving related to client's awareness of something "being wrong" with changes of memory. D. Disturbed sleep pattern related to psychologic stress evidences by interrupted sleep.

A. Safety is always a priority especially in clients who exhibit signs of confusion, hyperactivity and wandering.

Which of the following is known to be the most common cause of dementia in the elderly? A. Parkinson's Disease B. Huntington's Disease C. Alzheimer's Disease D. Vascular Dementia

C. Is the most common cause of dementia in the elderly which causes a person to lose the ability to perform vital mental and physical functions.

A client with chronic hypertension is seen in the clinic. Which assessment indicates that the client's hypertension is not under control? A. Heart rate of 55 beats/min B. Irregular heart sounds C. Serum creatinine level of 1.9 mg/dL D. Blood glucose level of 128 mg/dL

C. Serum creatinine level of 1.9 mg/dL

The client in stage 2 Alzheimer's disease is exhibiting symptoms of confusion. The home care nurse does the following appropriate interventions, except: A. Furnish the client's room with pictures of her family and familiar possessions, remove hazardous items B. Orient the client to the environment C. Place the client in a secluded area where she can be alone and would facilitate independence D. Call the client by name, identify self and wait for a response

C. The confused client should be placed in a less stressful environment and should be reassured and reoriented to her current situation; leaving her alone in a secluded environment could precipitate agitation.

Etiology, pathogenesis of Crohn's Disease

ANY SEGMENT Inflammatory disorder in the lymph nodes. Obstruction of lymph nodes -Thickening of gut wall -Lumen narrowing

Etiology, pathogenesis of Addison's disease

Adrenocortical insufficiency -Organ-specific autoimmune disease -Autoantibodies specific for the cells of the adrenal cortex -Suppression of cells due to genetic mutation -Destruction of the adrenocortical cells -Extensive lymphocytic infiltrate

Manifestations of Hep C

Antibodies in blood RNA tests

Etiology, pathogenesis of Grave's disease

Autoimmune disease Multisystem syndrome one or more of following: -Hyperthyroidism -diffuse thyroid enlargement -opthalmopathy -dermopathy Thyroid autoantibodies found in more than 95% Suppression of TSH and TRH, increase in TH(T3) Increased iodide uptake Goiter

Etiology, pathogenesis of Ulcerative Colitis

COLON ONLY Autoimmune response, stress can exacerbate Changes in mucosa and submucosa. Patches of ulcerations/abscesses -hemorrhage, edema, inflammation

Why does the formation of advanced glycosylation end-products (AGEs) in diabetes mellitus cause micro- and macrovascular disease? A. AGEs suppress macrophage activity B. AGEs cause endothelial injury C. AGEs inhibit metabolism of lipids D. AGEs disrupt clotting mechanisms

B. AGEs cause endothelial injury

Which of the following best describes Alzheimer's Disease? A. Tumors within the spine which includes intramedullary lesions, extramedullary-intradural lesions, and extramedullary-intradural lesions. B. It is a chronic, progressive and degenerative brain disorder accompanied by profound effects on memory, cognition and ability for self-care. C. It is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia. D. It is a slowly progressing neurologic movement disorder that eventually leads to disability.

B. Alzheimer's disease is a progressive disease that destroys memory and other important mental functions. Option A describes spinal cord tumors, Option C describes Huntington's disease while option D describes Parkinson's disease.

The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. What information is appropriate for the nurse to include? A. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. B. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. C. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. D. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients with diabetes.

B. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin.

A client has long-standing diabetes mellitus. Which finding alerts the nurse to decreased kidney function in this client? A. Urine specific gravity of 1.033 B. Sustained elevation in blood pressure C. Presence of glucose in the urine D. Presence of ketone bodies in the urine

B. Sustained elevation in blood pressure

Which of the following communication techniques of the nurse is inappropriate to use for a client with Alzheimer's? A. Using short, simple sentences B. Utilizing open-ended questions C. Avoid arguing or contradicting the client D. Talking in a calm and patient manner

B. Using open-ended questions should be avoided when talking to clients with Alzheimer's disease for it puts pressure on them causing them to be overwhelmed and stressed.

Clinical manifestations of Ulcerative Colitis

Blood, mucous in stool -intestinal obstruction -dehydration -fluid/electrolyte imbalances -malabsorption -chronic anemia -toxic megacolon

Which of the following is included in the treatment option for the improvement of Alzheimer's symptoms? A. Radiation B. Chemotherapy C. Cholinesterase Inhibitors D. Craniectomy

C. Current Alzheimer's medications such as cholinesterase inhibitors can help for a time with memory symptoms and other cognitive changes. In some cases, certain types of antidepressants, antipsychotics or sedatives may be needed to help control symptoms.

The first stage in using triglycerides for energy is hydrolysis of the triglycerides to which of the following substance(s)? A. Phospholipids B. Acetyl coenzyme A C. Glycerol and fatty acids D. Cholesterol

C. Glycerol and fatty acids

COPD: etiology, patho, manifestations

Cigarette smoking, noxious exposure(air pollution, occupational, etc.), infection, genetics, AAT deficiency. Hyperinflation and air trapping! Fatigue, weight loss, anorexia, wheezing, decreased lung sounds, pulmonary HTN, lung infections, osteoporosis, sleep problems Chronic bronchitis: airway obstruction from hypersecretion of mucous, unable to clear(ciliary dysfunction). -Tachypnea,dyspnea on exertion or rest -Chronic cough-impaire cilia fx -Hypoxemia, hypercapnia (respiratory acidosis) -Clubbing -Polycythemia(too many RBC) Emphysema: loss of alveolar recoil. genetic lack of or inhibition of alpha-1. -Tachypnea,dyspnea on exertion or rest -Prolonged expiration - increased A-P diameter of chest

Delirium VS. Dementia

Delirium: a state of temporary but acute mental confusion -UTI -ETOH -DRUGS -POST-OP -Fever Dementia: a syndrome caused by brain disease, evidenced by chronic personality disintegration, confusion, memory impairment, and deterioration of intellectual capacity and function.

Cushings disease vs. Cushings syndrome

Disease: excessive secretion of ACTH from anterior pituitary Syndrome: excessive levels of cortisol regardless of cause

Manifestations of systemic lupus

Facial rash Discoid rash Photosensitivity Oral or nasopharyngeal ulcers Non-erosive arthritis of at least two peripheral joints Presence of antinuclear antibody (ANA) Hematologic disorders Neurologic disorders Serositis Renal disorder

Functional changes and symptoms of BPH

Generalized disease of prostate due to hormonal (Testosterone/estrogen) changes that lead to enlargement of gland -does not predispose to the development of prostate cancer -decrease in urinary system -straining -dribbling at end of urination -urinary frequency, urgency -bladder pain -nocturia -incontinence -etc.

Etiology, pathogenesis of Alzheimers Disease

Genetics! Early: chromosome 21, Late: APOE genotype? Many fewer functional nerve cells and synapses than a healthy brain Driven by 2 processes 1. Extracellular deposition of beta-amyloid: plaques 2. Intracellular accumulation of Tau proteins: tangles The more plaques and tangles=greater dysfuntion

Manifestations of Grave's disease

Grave's dermopathy: swelling of anterior portions of legs Ocular manifestations: upward gaze, enlargement of ocular muscles

Etiology, pathogenesis of Hep C

Inflammation of the liver. Spread through blood and blood contact. Binds to receptor on cell surface, translation, replication, and new viruses are released from cell. Details of life cycle are unknown.

Manifestations of TB

Latent TB is asymptomatic Active disease will progress to -Weight loss, fatigue, productive cough, fever and night sweats -Rales, and dull chest percussion -Elevation in WBC counts

What is the role of vaccines in triggering the memory function of the adaptive immune system?

Memory cells present with vaccinations

Medical management of BPH

Mild to severe symptoms -manage with watchful waiting Moderate to severe symptoms -management with waiting and medical management(pharm) and surgical treatment -TURP: transurethral resection of prostate

Etiology, pathogenesis of TB

Mycobacteria are a separate class of bacterial organisms, surrounded by a thick cell wall that is very difficult to penetrate with the usual anti-infectives. Immunity to M. tuberculosis is primarily through Helper T cells, which stimulate macrophages to kill the bacteria

General characteristics of ADHD(cognitive)

Neurobehavioral disorder: chemical alterations in prefrontal cortex, highly heritable 1. Hyperactive/impulsive behaviors(observed age 4, peaks age 7-8) 2. Inattention (8-9 yo, lifelong) -highly heritable -more prevalence in males -insufficient levels of dopamine/norepinephrine

A 17-year-old adolescent with a hx of severe asthma is admitted to the ICU. He is comatose, appears much younger than his listed age, and has short stature. The nurse notes that the asthma has been managed with prednisone for 15 days until 3 days ago. The patient's father is extremely anxious and says he was unable to refill his son's prescription for the medicine until he got his paycheck. What is the nurse's role in this situation?

Nurse must be empathetic to the father's situation. Once the patient's status begins to improve, the nurse should assess the father's understanding of asthma regimen. The father and patient should receive instruction about adverse effects of corticosteroid therapy (infection, hyperglycemia, GI bleeds, sleep disruption, aggression, adrenal insufficiency, thinning of skin). Abruptly discontinuing therapy after long-term use(at least 10 days) can produce cardiovascular collapse. Incremental decrease in drug must be instructed.

Osteoporosis and SCI

Osteoporosis affects bones below the level of the injury and increases the risk of lower extremity fractures Heterotopic ossification refers to the deposition of bone within the soft tissue around peripheral joints.

General characteristics of Autism(developmental)

Pervasive development disorder (PDD), abnormal gene turned on in early fetal development. Alterations in frontal, temporal lobe. 1. Nonverbal behaviors: eye contact, facial expression, gestures, body postures 2. Restricted and repetitive behaviors/interests: body movement, sameness of routine, restricted interests 3. Other: inconsistent cognitive skills, delayed language, large head. -Inability to relate to others -Failure to use language to convey meaning -Obsessive desire for the maintenance of sameness -Anxiety -Congenital onset -Co-morbidity -genetics

SCI and autonomic nervous system

Possible mechanisms include ischemia, hypoxia, inflammation, edema, disturbances of ion homeostasis, and apoptosis.

Functional changes due to menopause

Progresses with the decline in oocyte Decreased inhibin B (primary initiator) Vasomotor instability Increased FSH stimulation accelerates follicular loss Vaginal atrophy

What is the role of antibodies? How are they produced, and where?

Proteins, produced by plasma B cells. Enhances innate immune response to promote antigen destruction!-targets more specific antigens DO NOT DIRECTLY DESTROY FOREIGN ORGANISMS -Neutralization -Agglutination: chains, clumping -Mark foreign material as targets for complement system, phagocytes, NK cells

The patient is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement? a. Provide a low-residue diet b. Rest the patient's bowel c. Assess vital signs daily d. Administer antacids orally

b. Rest the patient's bowel

Manifestations of multiple sclerosis

Relapsing-Remitting Primary-Progressive Secondary-Progressive Progressive-Relapsing In Mixed (General) type: blurred or double vision and optic neuritis (rapidly developing) are common early signs In Spinal type (2nd most common): weakness and numbness in one or more limbs is presenting symptom

Etiology, pathogenesis of HIV/AIDS

Retrovirus: use their RNA and host DNA to make viral DNA -causes severe damage to the immune system and eventually destroys it by using the DNA of CD4+ cells to replicate itself. "attachment" "uncoats" "integrase" "bud out"

Classic symptoms of menopause

Sleep disturbances Mood disturbances Vasomotor symptoms: hot flashes, sweats, chills (estrogen withdrawal), increased serotonin Increase in adiposity Primary osteoporosis: estrogen decrease Cardiovascular disorders? Vaginal atrophy

A client is taking methotrexate for severe rheumatoid arthritis. The nurse instructs the client that it will be necessary to monitor: a. serum glucose b. serum electrolytes c. CBC with differential and platelet count d. sedimentation rate

c. CBC with differential and platelet count

A 38-year-old female patient comes in with complaints of double vision, visual loss, weakness, numbness of hands, fatigue, tremors that have been worsening over the past several months. During admission, the nurse notes nystagmus, scanning speech, ataxia, muscular weakness, and incontinence. Considering these findings, the nurse suspects that the patient has a. Amyotrophic lateral sclerosis b. Multiple sclerosis c. Myasthenia Gravis d. Parkinson's Disease

b. Multiple sclerosis

The nurse has received change-of-shift report. The nurse should assess which client first? a. a 72-year-old admitted 2 days ago with a blood alcohol level of 0.08 b. a 36-year-old with a chest tube due to spontaneous pneumothorax with current respiratory rate 18 and O2 at 95% on 2L c. a 28-year-old who is 2 days post-appendectomy with discharge prescriptions written whose husband is waiting to take her home d. a 62-year-old admitted with recent GI bleeding with Hgb of 13.8

a. a 72-year-old admitted 2 days ago with a blood alcohol level of 0.08

A 65-year-old client is prescribed ipatropium (Atrovent) for the treatment of asthma. Which of the following conditions should be reported to the health care provider before giving this client the ipatropium? a. a reported allergy to peanuts b. a hx of intolerance to albuterol (Proventil, VoSpire) c. a hx of bronchospasms d. a reported allergy to chocolate

a. a reported allergy to peanuts

When caring for a patient with Alzheimer's disease, which of the following is the most important? a. assess the patient's abilities to regularity b. implement a bowel training program c. speak loudly and clearly when you give instructions d. use behavior modifications and techniques

a. assess the patient's abilities to regularity

A patient with COPD is hospitalized for heart failure. The patient is weak and cannot cough, so the nurse should watch closely for the development of a. atelectasis b. pleural effusion c. pneumonia d. pulmonary HTN

a. atelectasis

The nurse is assessing a patient with Addison's disease during a follow-up visit. The nurse knows the stay alert for a. hypocalcemia b. hypokalemia c. hyponatremia d. hypopigmentation

c. hyponatremia

The obesity classification that is most often associated with cardiovascular health problems is a. primary obesity b. secondary obesity c. gynoid fat distribution d. android fat distribution

d. android fat distribution

The nurse is assessing a patient with Cushing's syndrome for complications associated with hypercortisolism including (select all) a. bacterial or fungal infection b. cholecystitis c. diabetes d. HTN e. jaundice f. obesity

a. bacterial or fungal infection c. diabetes d. HTN f. obesity

Which type of WBC release during an anaphylactic reaction? a. basophils b. eosinophils c. lymphocytes d. neutrophils

a. basophils

A plan of care for the patient with COPD could include: (select all) a. exercise such as walking b. high flow rate of O2 administration c. low-dose chronic oral corticosteroid therapy d. use of peak flow meter to monitor the progression of COPD e. breathing exercises such as pursed-lip breathing that focus exhalation

a. exercise such as walking. e. breathing exercises such as pursed-lip breathing that focus exhalation

A 42-year-old mother of two children is assessed by her health care provider after complaining of extreme fatigue, weight gain, and feelings of cold regardless of room temperature. Based on laboratory studies, she is diagnosed with hypothyroidism and started on levothyroxine (Synthroid). What teachings will she need about this drug?

Take in the morning upon awakening, and close to the same time each morning. If she forgets to take a dose, she should take it ASAP. If she is unable to take drug for a day or more from illness, she needs to contact provider. Symptoms similar to what she experienced before do not need to be immediately reported to provider unless they are significantly worse than previously experienced. Symptoms that should be reported: -rapid HR -palpitations -HA -SOB -anxiety -intolerance to heat

A 74-year-old male patient informs the nurse that he is taking diphenhydramine (Benadryl) to reduce seasonal allergy symptoms. The patient has a hx of an enlarged prostate and mild glaucoma (controlled by medication). What is the nurse's response?

The patient needs to understand the potential side effects related to anticholinergic effects of this medication. Based on his age, he is at a higher risk for urine retention, glaucoma (or other visual changes), and constipation.

A patient comes to the clinic complaining of no bowel movement for 4 days (other than small amounts of liquid stool). The patient has been taking psyllium mucilloid (Metamucil) for his constipation and wants to know why this is not working. What is the nurse's response?

They take several days or longer for best effects. Liquid stool is a concern...may be a result from fecal impaction. Nurse should assess the abdomen for bowel sounds. If bowel sounds are hypoactive or absent, nurse should report findings immediately. If bowel sounds are present, nurse should educate patient on importance of fluids.

Asthma: etiology, patho, manifestations

Type 1 hypersensitivity response, allergy linked/caused -triggered by foreign substance(dust, pollen, animals) -antigen bind to IgE on mast cell -crosslinking: release of mast cell granules full of histamine Histamine: vasodilation, increased capillary permeability, extravascular smooth muscle contraction Effects of histamine on Airway: Bronchoconstriction, edema, mucous secretion, neutrophil/eosinophil caused cell injury and stimulate more inflammation s/sx: Wheezing, cough(hyperacute vs. chronic), tachypnea, use of intercostal muscles, airway obstruction: air trapping, decreased expiratory flow rates

Urinary Incontinence: different types

Urge: (and overactive bladder)involuntary destrusor contraction, involuntary leakage Stress: sudden increase in abd. pressure (sneeze, cough) Overflow: urethral blockage, bladder unable to empty properly(BPH)

In evaluating an asthmatic patient's knowledge of self-care, the nurse recognizes that additional instruction is needed when the patient states: a. "I used my corticosteroid inhaler when I feel short of breath." b. "I get a flu shot every year and see my health care provider if I have an upper respiratory tract infection" c. "I use my inhaler before I visit my aunt who has a cat, but I only visit for a few minutes because of my allergies" d. "I walk 30 min every day but sometimes I have to use my bronchodilater inhaler before walking to prevent me from getting short of breath."

a. "I used my corticosteroid inhaler when I feel short of breath."

You are working with a family whose 7-year-old has just been diagnosed with attention deficit hyperactivity disorder. Which statements by the mother indicate a need for further teaching? (select all that apply) a. "My child will respond best to verbal instructions, since that will help him learn to pay attention and listen intently." b. "A consistent schedule for homework and activities will help him be organized." c. "I need to bring him for routine checkups while he is taking his medications because the medication can affect his appetite and growth." d. "I am going to ask the principal if my son can change classrooms because his current teacher has too many rules and he seems to get in trouble." e. "We might consider counseling because this has been stressful for the whole family."

a. "My child will respond best to verbal instructions, since that will help him learn to pay attention and listen intently." d. "I am going to ask the principal if my son can change classrooms because his current teacher has too many rules and he seems to get in trouble."

The patient is diagnosed with Crohn's disease, also known as regional enteritis. Which statement by the patient supports this diagnosis? a. "My pain goes away when I have a bowel movement." b. "I have bright red blood in my stool all the time." c. "I have episodes of diarrhea and constipation." d. "My abdomen is hard and rigid and I have a fever."

a. "My pain goes away when I have a bowel movement."

A male, age 67, reports taking diphenhydramine (Benadryl) for "hay fever". Considering this client's age, the nurse assesses for which of following findings? a. A hx of prostate or urinary conditions b. Any recent weight gain c. A history of allergic reactions d. A hx of PUD

a. A hx of prostate or urinary conditions

A nurse caring for a 50-year-old newly diagnosed with Parkinson's disease would want to educate the patient and their family about which of the following symptoms? (select all) a. A mask-like expression b. A shuffling gait c. A wide-based gait d. Difficulty swallowing e. Fluctuating muscle weakness f. Muscle rigidity g. Optic neuritis

a. A mask-like expression b. A shuffling gait d. Difficulty swallowing f. Muscle rigidity

A patient with Crohn's disease is admitted to the hospital for a possible complication. The nurse knows that complications of Crohn's disease include which of the following? (select all) a. Abdominal abscess b.Bowel obstruction c. Ileovesical fistula d. Intussusception e. Low sperm count f. Sepsis

a. Abdominal abscess b.Bowel obstruction c. Ileovesical fistula

The nurse is planning the care of a patient diagnosed with Addison's disease. Which intervention should be included? a. Administer steroid medications b. Place the patient on fluid restrictions c. Provide frequent stimulation d. Consult physical therapy for gait training

a. Administer steroid medications

A patient is concerned that he may have asthma. Of the symptoms that he relates to the nurse, which ones suggest asthma or risk factors for asthma? (select all) a. Allergic rhinitis b. Prolonged inhalation c. Hx of skin allergies d. Cough, especially at night e. Gastric reflux or heartburn

a. Allergic rhinitis c. Hx of skin allergies d. Cough, especially at night e. Gastric reflux or heartburn

The nurse is assessing a patient with systemic lupus erythematosus (SLE). Which of the following would the nurse expect to find? (select all) a. Alopecia b. Butterfly rash on face c. Excessive hair growth d. Hyperthyroidism e. Muscle pain and weakness f. Recurrent DVT

a. Alopecia b. Butterfly rash on face e. Muscle pain and weakness

A patient is admitted to hospital with s/sx of SLE. Which test would support diagnosis? a. Antinuclear antibody b. CBC c. Erythrocyte sedimentation rate d. Hepatobiliary scan

a. Antinuclear antibody (ANA)

The patient has a small amount of dark, watery stool. Which intervention should the nurse implement first? a. Check for fecal impaction. b. Encourage the patient to drink fluid. c. Check the chart for sodium and potassium levels. d. Apply a protective barrier cream to the perineal area

a. Check for fecal impaction.

The patient diagnosed with IBD is prescribed total parenteral nutrition (TPN). Which intervention should the nurse implement? a. Check the patient's glucose level b. Administer an oral hypoglycemic c. Assess the peripheral intravenous site d. Monitor the patient's oral food intake

a. Check the patient's glucose level

The patient is diagnosed with hypothyroidism. Which signs/symptoms should the nurse expect the patient to exhibit? a. Complaints of extreme fatigue and hair loss. b. Exophthalmos and complaints of nervousness c. Complaints of profuse sweating and flushed skin d. Tetany and complaints of stiffness of the hands

a. Complaints of extreme fatigue and hair loss.

A patient is seen in the clinic for ulcerative colitis, a form of inflammatory bowel disease. The nurse should anticipate including which of the following in the patient's care plan? a. Corticosteroid medication b. High fiber diet c. Lactulose therapy d. Protein milkshakes

a. Corticosteroid medication

A nurse has tested negative for HIV after recent exposure to contaminated blood. Which of the following is correct? a. Repeat test in 6 months b. The nurse has immunity c. The nurse is not contagious d. The nurse is not infected with HIV

a. Repeat test in 6 months

A client is receiving treatment for asthma with albuterol (Proventil, VoSpire). The nurse teaches the client that while serious adverse effects are uncommon, the following may occur (select all) a. Tachycardia b. Sedation c. Temporary dyspnea d. Nervousness e. Headache

a. Tachycardia d. Nervousness e. Headache

Which sign/symptom should the nurse expect to find in a patient diagnosed with ulcerative colitis? a. Twenty bloody stools a day b. Oral temperature of 102°F c. Hard, rigid abdomen d. Urinary stress incontinence

a. Twenty bloody stools a day

A client is given a prescription of finasteride (Proscar) for treatment of BPH. Essential teaching for this client includes which of the following? (select all that apply) a. full therapeutic effects may take 3 to 6 months b. hair loss or male-pattern baldness may be an adverse effect c. The drug should not be handled by pregnant women, especially if it is crushed. d. blood donation should not occur while taking this drug e. report any weight gain of over 5 lbs in 1 weeks time.

a. full therapeutic effects may take 3 to 6 months c. The drug should not be handled by pregnant women, especially if it is crushed d. blood donation should not occur while taking this drug

The nurse is caring for a patient with an adenoma of the adrenal cortex. The nurse should be alert for symptoms related to the secretion of which substance? a. glucocorticoids and androgens b. glucocorticoids and catecholamines c. Mineralocortoicoids and catecholamines d. Norepinephrine and epinephrine

a. glucocorticoids and androgens

To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to a. increase calcium intake to 1500 mg/day b. perform glucose monitoring for hypoglycemia c. obtain immunizations due to high risk of infection d. avoid abrupt position changes because of orthostatic hypotension

a. increase calcium intake to 1500 mg/day

A major goal of treatment for patients with AD is to a. maintain safety b. maintain or increase body weight c. return to a higher level of self-care d. enhance functional ability over time

a. maintain safety

An older male patient is experiencing difficulty in initiating voiding and a feeling of incomplete bladder emptying. These symptoms of BPH are primarily caused by a. obstruction of the urethra b. untreated chronic prostatitis c. decreased bladder compliance d. excessive secretion of testosterone

a. obstruction of the urethra

The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are (select all) a. persistent abdominal pain b. marked abdomen distention c. diarrhea that is loose or liquid d. colicky, severe, intermittent pain e. profuse vomiting that relieves abdominal pain

a. persistent abdominal pain b. marked abdomen distention

In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes: a. teaching the patient to use kegel exercises b. clamping and releasing a catheter to increase bladder tone c. teaching the patient biofeedback mechanisms to suppress the urge to void d. counseling the patient concerning choice of incontinence containment device

a. teaching the patient to use kegel exercises

The nurse is caring for a patient who uses cathartics frequently. Which statement made by the patient indicates an understanding of the discharge teaching? a. "In the future, I will eat a banana every time I take the medication." b. "I don't have to have a bowel movement every day." c. "I should limit the fluids I drink with my meals." d. "If I feel sluggish, I will eat a lot of cheese and dairy products."

b. "I don't have to have a bowel movement every day."

The health care provider prescribes levothyroxine (Synthroid) for a patient with hypothyroidism. After teaching regarding this drug, the nurse determines that further instruction is needed when the patient states: a. "I can expect the medication dose may need to be adjusted." b. "I only need to take this drug until my symptoms are improved." c. "I can expect to return to a normal function with the use of this drug." d. "I will report any chest pain or difficulty breathing to the doctor right away."

b. "I only need to take this drug until my symptoms are improved."

The patient diagnosed with ulcerative colitis has an ileostomy. Which statement indicates the patient needs more teaching concerning the ileostomy? a. "My stoma should be pink and moist." b. "I will irrigate my ileostomy every morning." c. "If I get a red, bumpy, itchy rash I will call my provider." d. "I will change my pouch if it starts leaking."

b. "I will irrigate my ileostomy every morning."

The client asks what can be expected from the levodopa/carbidopa (Sinemet) he is taking for treatment of parkinsonism. What is the best response by the nurse? a. "A cure can be expected within 6 months" b. "Symptoms can be reduced and the ability to perform ADLs can be improved." c. "Disease progression will be stopped." d. "EPS will be prevented."

b. "Symptoms can be reduced and the ability to perform ADLs can be improved."

The patient diagnosed with inflammatory bowel disease has a serum potassium level of 3.4 mEq/L. Which action should the nurse implement first? a. Notify the healthcare provider b. Assess the patient for muscle weakness c. Request telemetry for the patient d. Prepare to administer potassium IV

b. Assess the patient for muscle weakness

A nurse is discharging a patient with multiple sclerosis. The nurse should instruct the patient on which of the following? (select all) a. Avoiding consumption of shellfish b. Avoiding extremes of temperature c. Exercising vigorously every day d. Including red meat in the patient's diet e. Managing bowel/bladder symptoms f. Practicing strategies to manage fatigue

b. Avoiding extremes of temperature e. Managing bowel/bladder symptoms f. Practicing strategies to manage fatigue

A nurse is assigned to care for a client admitted to the hospital with a diagnosis of exacerbation of systemic lupus erythematosus (SLE). The nurse reviews the physician's orders expecting to find that which of the following medication classes is prescribed? (select all that apply) a. Antibiotic b. Corticosteroid c. Narcotic analgesic d. Antidiarrheal e. Anticoagulant

b. Corticosteroid e. Anticoagulant

Which of the following would the nurse include when providing teaching to a woman with HIV who wants to get pregnant? (select all) a. A C-section would be required b. If you don't use a barrier birth control, your partner is at higher risk c. The baby could be exposed to HIV during birth process d. The baby may not be born HIV positive

b. If you don't use a barrier birth control, your partner is at higher risk c. The baby could be exposed to HIV during birth process d. The baby may no be born HIV positive

The patient is admitted to rule out Cushing's syndrome. Which laboratory tests should the nurse anticipate being ordered? a. Plasma drug levels of quinidine, digoxin, and hydralazine b. Plasma levels of ACTH and cortisol c. A 24-hour urine for metanephrine and catecholamine d. Spot urine for creatinine and white blood cells

b. Plasma levels of ACTH and cortisol

The charge nurse has just received the shift report. Which patient should the nurse see first? a. The patient diagnosed with Crohn's disease who had two semiformed stools on the previous shift. b. The elderly patient just admitted from another facility who is complaining of constipation. c. The patient diagnosed with AIDS who had a 200 mL diarrhea stool and has elastic skin turgor. d. The patient diagnosed with hemorrhoids who had some spotting of bright red blood on the toilet tissue.

b. The elderly patient just admitted from another facility who is complaining of constipation.

Which statement(s) accurately describes mild cognitive impairment? (select all) a. always progresses to AD b. caused by variety of factors and may progress to AD c. should be aggressively treated with acetylcholinesterase drugs d. caused by vascular infarcts that, if treated, will delay progression to AD e. patient is usually not aware that there is a problem with his or her memory

b. caused by variety of factors and may progress to AD

Goals of rehabilitation for the patient with an injury at the C6 level include (select all that apply): a. stand erect with leg brace b. feed self with hand devices c. assist with transfer activities d. drive adapted van from wheelchair e. push a wheelchair on a flat surface

b. feed self with hand devices c. assist with transfer activities d. drive adapted van from wheelchair e. push a wheelchair on a flat surface

A female client is prescribed dantrolene sodium (Dantrium) for painful muscle spasms associated with multiple sclerosis. The nurse is writing the discharge plan for the client and will include which of the following teaching points? (select all) a. if muscles spasms are severe, supplement the medication with hot baths or showers 3x per day. b. inform the health care provider if she is taking estrogen products c. Return periodically for required laboratory work d. Sip water, ice, hard candy, to relieve dry mouth e. Obtain at least 20 minutes of sun exposure per day to boost vitamin D levels

b. inform the health care provider if she is taking estrogen products c. Return periodically for required laboratory work d. Sip water, ice, hard candy, to relieve dry mouth

The early stage of AD is characterized by a. no noticeable change in behavior b. memory problems and mild confusion c. increased time spent sleeping or in bed d. incontinence, agitation, and wandering behavior

b. memory problems and mild confusion

A patient with rheumatoid arthritis is experiencing articular involvement of the joints. The nurse recognizes that these characteristic changes include (select all) a. bamboo-shaped fingers b. metatarsal head dislocation in feet c. noninflammatory pain in large joints d. asymmetric involvement of small joints e. morning stiffness lasting 60 minutes or more.

b. metatarsal head dislocation in feet e. morning stiffness lasting 60 minutes or more.

Important nursing interventions when caring for a patient with Cushing's syndrome include (select all) a. restricting protein intake b. monitoring blood glucose levels c. observing for signs of hypotension d. administering medication in equal doses e. protecting patient from exposure to infection

b. monitoring blood glucose levels e. protecting patient from exposure to infection

A 24-year-old client has been taking sulfasalazine (Azulfidine) for IBS and complains to the nurse that he wants to stop taking the drug because of nausea, headaches, and abdominal pain it causes. What would the nurse's best recommendation be for this client? a. the drug is absolutely necessary, even with the adverse effects b. talk to the health care provider about dividing the doses throughout the day c. stop taking the drug and see if the symptoms of the IBS have resolved d. take an antidiarrheal drug such as loperamide (Imodium) along with the sulfasalazine

b. talk to the health care provider about dividing the doses throughout the da

A client is taking large doses of aspirin daily to treat rheumatoid arthritis. The nurse should instruct the client to tell the HCP when having: a. abdominal cramps b. tinnitus c. rash d. low blood pressure

b. tinnitus

Which of the following client statements indicates that the levodopa/carbidopa (Sinement) is effective? a. "I'm sleeping a lot more, especially during the day." b. "My appetite has improved." c. "I'm able to shower by myself." d. "My skin doesn't itch anymore."

c. "I'm able to shower by myself."

The nurse is caring for a patient scheduled for a radioactive iodine uptake test. Which of the following statements should be included in the patient instructions? a. "a small dose of IV radioactive iodine will be administered after the test." b. "minimize contact with others to avoid radioactive contamination" c. "take special precautions when urinating, such as flushing the toilet at least twice." d. "the procedure tests the rate of iodine excretion."

c. "take special precautions when urinating, such as flushing the toilet at least twice."

The nurse, a licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP) are caring for patients on a medical floor. Which nursing task would be most appropriate to assign to the LPN? a. Assist the UAP to learn to perform blood glucose checks. b. Monitor the potassium levels of a patient with diarrhea. c. Administer a bulk laxative to a patient diagnosed with constipation. d. Assess the abdomen of a patient who has had complaints of pain.

c. Administer a bulk laxative to a patient diagnosed with constipation.

A patient being admitted from the emergency department is diagnosed with fecal impaction. Which nursing intervention should be implemented? a. Administer an antidiarrheal medication every day and PRN. b. Perform bowel training every two weeks. c. Administer an oil retention enema. d. Prepare for an upper gastrointestinal series x-ray

c. Administer an oil retention enema.

The nurse discovers an unconscious patient and suspects a SCI. After calling for help and delivering chest compressions, a second nurse arrives who immediately: a. Administers 3 breaths by doing chin-tilt maneuver b. Administers 2 breaths by doing chin-tilt maneuver c. Administers 2 breaths by doing a jaw thrust maneuver d. Determines absence of breathing and gives 15 more chest compressions

c. Administers 2 breaths by doing a jaw thrust maneuver

Which of the following drugs is most immediately helpful in treating a severe acute asthma attack? a. Beclomethasone (Qvar) b. Zileuton (Proventil, Ventolin) c. Albuterol (Proventil, Ventolin) d. Salmeterol (Serevent)

c. Albuterol (Proventil, Ventolin)

The clinic nurse is talking on the phone to a patient who has diarrhea. Which intervention should the nurse discuss with the patient? a. Tell the patient to measure the amount of stool b. Recommend the patient come to the clinic immediately. c. Explain the patient should follow the BRAT diet. d. Discuss taking an over-the-counter histamine-2-blocker.

c. Explain the patient should follow the BRAT diet.

A patient returns to the surgical unit after undergoing a transurethral resection of the prostate (TURP). The nurse prepares for continuous bladder irrigation using a. Dakin's solution b. Half normal saline with 5% Dextrose c. Normal saline d. Sterile water

c. Normal saline

Which statement best describes the etiology of obesity? a. Obesity primarily results from a genetic disposition b. Psychosocial factors can override the effects of genetics in the etiology of obesity c. Obesity is the result of complex interactions between genetics and environmental factors d. Genetic factors are more important than environmental factors in the etiology of obesity

c. Obesity is the result of complex interactions between genetics and environmental factors

When caring for a patient suffering from a Addisonian crisis, the nurse should question which of the following orders? a. Dextrose b. Hydrocortisone c. Potassium chloride d. Vasopressors

c. Potassium chloride

The nurse is examining a patient with SLE. Which of the following symptoms would the nurse expect? a. Butterfly rash, edema, hypothermia b. Butterly rash, fatigue, diarrhea c. Proteinuria, fatigue, butterfly rash d. Weight gain, fatigue, butterfly rash

c. Proteinuria, fatigue, butterfly rash

A client is being treated with propylthiouracil (PTU) for hyperthyroidism, pending thyroidectomy. While the client is taking this drug, what symptoms will the nurse teach the client to report to the health care provider? a. Tinnitus, altered taste, thickened saliva b. Insomnia, nightmares, night sweats c. Sore throat, chills, low-grade fever d. dry eyes, decreased blinking, reddened conjunctiva

c. Sore throat, chills, low-grade fever

An early sign(s) of levodopa poisoning is (are) which of the following? a. Orthostatic hypotension b. Drooling c. Spasmodic eye winking and muscle twitching d. Nausea, vomiting, and diarrhea

c. Spasmodic eye winking and muscle twitching

The nurse is instructing an American patient with AIDS on how to prevent foodborne illnesses. Due to the patient's immune-compromised state, nurse should instruct the patient to avoid a. Pasteurized milk b. Peeled fruit c. Sushi d. Tap water

c. Sushi

Levodopa (Larodopa) is prescribed for a client with Parkinson's disease. At discharge, which of the following teaching points should the nurse include? a. Monitor blood pressure every 2 hours for the first 2 weeks. b. Report the development of diarrhea c. Take the pill on an empty stomach d. If tremors seem to worsen, take a double dose for two doses and call the provider

c. Take the pill on an empty stomach (protein can impair absorption)

The nurse is preparing to administer the following medications. Which medication should the nurse question administering? a. The thyroid hormone to the patient who does not have a T3/T4 level. b. The regular insulin to the patient with a blood glucose of 210 mg/dL. c. The loop diuretic to the patient with a potassium level of 3.3 mEq/L. d. The cardiac glycoside to the patient who has a digoxin level of 1.4 mg/dL.

c. The loop diuretic to the patient with a potassium level of 3.3 mEq/L.

The charge nurse of an intensive care unit is making assignments for the night shift. Which patient should be assigned to the most experienced ICU nurse. a. The patient diagnosed with respiratory failure who is on a ventilator and requires frequent sedation. b.The patient diagnosed with lung cancer and iatrogenic Cushing's disease with ABG's of pH 7.35, PaO2 88, PaCO2 44, and HCO3 22. c. The patient diagnosed with Addison's disease who is lethargic and has a BP of 80/45, P 124, and RR 28 d. The patient diagnosed with hyperthyroidism who has undergone a thyroidectomy two days ago and has a negative Trousseau's sign

c. The patient diagnosed with Addison's disease who is lethargic and has a BP of 80/45, P 124, and RR 28

The patient diagnosed with hypothyroidism is prescribed the thyroid hormone levothyroxine (Synthroid). Which assessment data indicate the medication has been effective? a. The patient has a three pound weight gain b. The patient has a decreased pulse rate c. The patient's temperature is within normal limits d. The patient denies diaphoresis

c. The patient's temperature is within normal limits

The parents of a young client receiving methylphenidate (Ritalin) express concerns that the health care provider has suggested the client have a "holiday" from the drug. What is the purpose of a drug-free period? a. To reduce or eliminate the risk of drug toxicity b. To allow the child's "normal" behavior to return c. To decrease drug dependence and assess the client's status d. To prevent the occurrence of a hypertensive crisis

c. To decrease drug dependence and assess the client's status

A client with asthma has a prescription for two inhalers, albuterol (Proventil, VoSpire) and beclomethasone (Qvar). How should the nurse instruct this client on the proper use of the inhalers? a. Use the albuterol, and use the beclomethasone only if symptoms are not relieved. b. Use the beclomethasone inhaler, and use the albuterol only if symptoms are not relieved. c. Use the albuterol inhaler, wait 5-10 min, then use the beclomethasone inhaler d. Use the beclamethasone inhaler, wait 5-10 min, then use the albuterol inhaler

c. Use the albuterol inhaler, wait 5-10 min, then use the beclomethasone inhale

Which of the following assessment findings would cause the nurse to withhold the client's regularly scheduled dose of levothyroxine (Synthroid)? a. a 1-kg (2lb) weight gain b. A BP reading 90/62 c. a HR of 110 bpm d. A temp of 37.9 C (100.2 F)

c. a HR of 110 bpm

An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to a. monitor blood glucose b. restrict fluid and sodium intake c. administer potassium sparing diuretic d. advise patient to make postural changes slowly

c. administer potassium sparing diuretic

A client with severe diarrhea has an order for diphenoxylate with atropine (Lomotil). When assessing for therapeutic effect which of the following will the nurse expect to find? a. increased bowel sounds b. decreasing belching and flatus c. decrease in loose, watery stools d. decreased abdominal cramping

c. decrease in loose, watery stools

A patient admitted to the ICU with a C7 spinal cord injury and diagnosed with Brown-Squard syndrome. On physical examination, the nurse would most likely find a. upper extremity weakness only. b. complete motor and sensory loss below C7 c. ipsilateral motor loss and contralateral sensory loss below C7 d. Loss of position sense and vibration in both lower extremities

c. ipsilateral motor loss and contralateral sensory loss below C7

A patient is admitted to the hospital with a C4 spinal cord injury after a motorcycle collision. The patients' BP is 82/48 mm Hg, his pulse is 42 beats/minute, and he remains orally intubated. The nurse determines that this pathophysiologic response is caused by: a. increased vasomotor tone after injury b. a temporary loss of sensation and flaccid paralysis below level of injury c. loss of sympathetic nervous system innervation resulting in peripheral vasodilation d. loss of parasympathetic nervous system innervation resulting in vasoconstriction

c. loss of sympathetic nervous system innervation resulting in peripheral vasodilation

In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease... a. frequently results in toxic megacolon b. causes fewer nutritional deficiencies that ulcerative colitis c. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy d. is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis

c. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy

The nurse teaches the patient that the best time to take corticosteroids for replacement purposes is a. once a day at bedtime b. every other day on awakening c. on arising and late in the afternoon d. at consistent intervals every 6-8 hours

c. on arising and late in the afternoon

To prevent or decrease age-related changes that occur after menopause in a patient who chooses not to take hormone therapy, the most important self-care measure to teach is a. maintaining usual sexual activity b. increasing the intake of dairy products c. performing regular aerobic, weight-bearing exercise d. taking vitamin E and b-complex vitamin supplements

c. performing regular aerobic, weight-bearing exercise

A 65-year-old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is a. searching the internet for educational videos b. evaluating the home for environmental safety c. promoting physical exercise and a well-balanced diet d. designing an exercise program to strengthen and stretch specific muscles.

c. promoting physical exercise and a well-balanced diet

The nurse is providing an in-service on thyroid disorders. One of the attendees asks the nurse, "Why don't the people in the Unites States get goiters as often?" Which statement by the nurse is the best response? a. "It is because of the screening techniques used in the U.S." b. "It is a genetic predisposition rare in North America." c. "The medications available in the U.S. decrease goiters." d. "Iodized salt helps prevent the development of goiters in the U.S.."

d. "Iodized salt helps prevent the development of goiters in the U.S.."

After 1 month of therapy, a client in spinal shock begins to experience muscle spasms in the legs and calls the nurse in excitement to report the leg movement. Which response by the nurse would be the most accurate? a. "These movements indicate that the damaged nerves are healing." b. "This is a good sign. Keep trying to move the affected muscles." c. "The return of movement means that eventually you may be able to walk again." d. "The movements occur from muscle reflexes that cannot be initiated or controlled by the brain."

d. "The movements occur from muscle reflexes that cannot be initiated or controlled by the brain."

The nurse is teaching a client about the use of dextromethorphan with guaifenesin (Robitussin-DM) syrup for a cough accompanied by thick mucous. Which instruction should be included in the client's teaching? a. "lie supine for 30 minutes after taking the liquid" b. "drink minimal fluids to avoid stimulating the cough reflex" c. "take the drug with food for best results." d. "avoid drinking fluids immediately after the syrup but increase overall fluid intake throughout the day"

d. "avoid drinking fluids immediately after the syrup but increase overall fluid intake throughout the day"

Following a spinal cord injury, a patient undergoing rehab is receiving instructions about urinary management. Which of the following is the most important for the nurse to tell the patient? a. "carbonated drinks must be avoided." b. "Fluid intake must be limited." c. "Half a glass of cranberry juice must be included with breakfast." d. "urinate on a timed schedule."

d. "urinate on a timed schedule."

The nurse is assisting a client with chronic adrenal insufficiency to plan for medication consistency while on a family vacation trip. He is taking hydrocortisone (Cortef) and fludrocortisones (Florinef) as replacement therapy. What essential detail does this client need to remember to do? a. Take his BP once or twice daily b. Avoid crowded indoor areas to avoid infections c. Have his vision checked before he leaves d. Carry an oral and injectable form of both drugs with him on his trip

d. Carry an oral and injectable form of both drugs with him on his trip

A client with constipation is prescribed psyllium (Metamucil) by his health care provider. What essential teaching will the nurse provide to the client? a. Take the drug with meals at bedtime b. Take the drug with minimal water so that it will not be diluted in the GI tract c. Avoid caffeine and chocolate while taking this drug d. Mix the product in a full glass of water and drink another glassful after taking the drug

d. Mix the product in a full glass of water and drink another glassful after taking the drug

A client with a history of BPH is complaining of feeling like he "cannot empty his bladder". He has been taking finasteride (Proscar) for the past 9 months. What should the nurse advise this client to do? a. Continue to take the drug to achieve full therapeutic effects. b. Discuss the use of a low-dose diuretic with the health care provider c. Decrease the intake of coffee, tea, alcohol d. Return to the health care provider for PSA laboratory studies and a prostate exam

d. Return to the health care provider for PSA laboratory studies and a prostate exam

A patient complains to the nurse that she leaks urine while exercising. All other assessment data is normal, so the nurse suspects that this problem is a. Due to anxiety b. Due to patient not being in shape. c. Reflex incontinence d. Stress incontinence

d. Stress incontinence

The nurse finds that an 87-year-old woman with Alzheimer's disease is continually rubbing, flexing, kicking, out her legs throughout the day. The night shift reports that this same behavior escalates at night, preventing her from obtaining her required sleep. The next step the nurse should take is to a. ask the physician for a daytime sedative for the pt. b. request soft restraints to prevent her from falling out of bed. c. ask the physician for a nighttime sleep medication for the patient d. assess the patient more closely, suspecting a disorder such as restless leg syndrome

d. assess the patient more closely, suspecting a disorder such as restless leg syndrome

After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops a. muscle weakness and weight loss b. hyperthermia and severe tachycardia c. hypertension and difficulty swallowing d. laryngospasms and tingling in the hands and feet

d. laryngospasms and tingling in the hands and feet

The clinical diagnosis of dementia is based on a. CT or MRS b. brain biopsy c. electroencephalogram d. patient history and cognitive assessment

d. patient history and cognitive assessment

Dementia is defined as a a. syndrome that results only in memory loss b. disease associated with abrupt changes in behavior c. disease that is always due to reduced blood flow to the brain d. syndrome characterized by cognitive dysfunction and loss of memory

d. syndrome characterized by cognitive dysfunction and loss of memory

In teaching a patient with SLE about the disorder, the nurse knows that the pathophysiology of SLE includes a. circulating immune complexes formed from IgG autoantibodies reacting with IgG b. an autoimmune T-cell reaction that results in destruction of the deep dermal skin layer c. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles d. the production of a variety of autoantibodies directed against components of the cell nucleus

d. the production of a variety of autoantibodies directed against components of the cell nucleus

A patient is being admitted to the hospital with complaints of heat intolerance, diarrhea, weight loss, and palpitations. The nurse knows that these are symptoms due to an elevated secretion of a. adrenocorticotropic hormone b. growth hormone c. somatotropin d. triiodothyronine and thyroxine

d. triiodothyronine(T3) and thyroxine (T4)

A 25-year-old patient was admitted with an injury resulting in a complete C7 transection of the spinal cord. Which action should the nurse anticipate the need for the immediate post-injury period? a. bladder and bowel training b. diaphragmatic pacing c. monitoring for autonomic dysreflexia d. ventilatory support

d. ventilatory support

A 65-year-old patient has bronchitis and has been coughing for several days. Of the two antitussive medications, dextromethorphan and codeine, which is of choice for this patient? Why?

dextromethorphan, as codeine can cause dependence and constipation.