Unit 6 (sem 3)
A nurse provides instructions to a group of adolescents about ways to prevent obesity. Which statements made by an adolescent indicates a need for further learning? Select all that apply.
"I should consume a high-fat diet." "I should take highly refined starch food." "I should watch television for four hours only."
Which statement by a 62-year-old patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective?
"I will measure my urinary output each day to help calculate the amount I can drink"
A 74-year-old who is progressing to stage 5 chronic kidney disease asks the nurse, "Do you think I should go on dialysis? Which initial response by the nurse is best?
"Tell me more about what you are thinking regarding dialysis."
The nurse is administering lactulose to a client with a history of cirrhosis of the liver. The client asks the nurse why this medication is needed because the client is not constipated. How will the nurse respond?
"This medication helps you lower the high ammonia level caused by your liver disease."
A nurse is providing counseling to a client with the diagnosis of systemic lupus erythematosus (SLE). Which recommendations are essential for the nurse to include? Select all that apply.
"Wear a large-brimmed hat" "Take your temperature daily." "Balance periods of rest and activity."
What advice is appropriate for a growing child to prevent obesity? Select all that apply.
"You should eat small meals throughout the day." "You should drink fewer sweetened beverages everyday." "You should watch television for less than 2 hours every day."
Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis (select all that apply)?
- Avoid commercial salt substitutes. - Take phosphate-binders with each meal. - Choose high-protein foods for most meals.
The nurse is caring for a client with bulimia nervosa. Which outcome criteria are important to discuss with the client? Select all that apply.
Abstaining from binge-purge behaviors Describing a realistic perception of body shape Demonstrating three learned skills for managing skills
A client at the fertility clinic is being treated for hypertension and obesity with a regimen of diet and exercise. During the past month, she has lost 8 lb (3.6 kg) and her blood pressure has decreased to 154/98 mm Hg. The client states that she is using self-control strategies to reduce her blood pressure and weight. What is the nurse's most therapeutic response?
Acknowledging the client's achievement while encouraging continuation of her current program
What is a major recognizable difference between anorexia nervosa clients and bulimia nervosa clients?
Anorexia nervosa clients deny the problem, where as clients with bulimia generally recognize that their eating pattern is abnormal
Cirrhosis S/S
Ascites, spider angiomata (vascular lesions), increased risk of infection, jaundice, splenomegaly, nail changes, bruising/bleeding, itching. Tremors: asterisks (hand flapping) Edema Confusion & forgetfulness
A nurse is providing discharge instructions to a client diagnosed with cirrhosis and varices. Which information should the nurse include in the teaching session? Select all that apply.
Avoiding aspirin and aspirin-containing products Avoiding acetaminophen and products containing acetaminophen Avoiding coughing, sneezing, and straining to have a bowel movement
A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV?
Cardiac rhythm
During routine hemodialysis, the 68-year-old patient complains of nausea and dizziness. Which action should the nurse take first?
Check patient's blood pressure (BP).
A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first?
Check the medical record for most recent potassium level.
A client with the diagnosis of bulimia nervosa, purging type, is admitted to the mental health unit after an acute episode of bingeing. Which clinical manifestation is most important for the nurse to assess?
Dehydration
A client with acute kidney injury moves into the diuretic phase after 1 week of therapy. For which clinical indicators during this phase should the nurse assess the client? Select all that apply.
Dehydration Hypovolemia
After an assessment, a nurse suspects that an adolescent has anorexia nervosa. Which characteristics may have been observed in the adolescence? Select all that apply
Denying illness Dismissing food Maintaining rigid body control
A nurse, the family, and an adolescent client with anorexia nervosa are planning appropriate outcomes for the client. What is an appropriate short-term goal for the client?
Eat planned nutritious meals.
An adolescent has been admitted with symptoms of fatigue, intermittent fever, weight loss, and arthralgia, and the diagnosis is systemic lupus erythematosus. What is the best intervention at this time?
Education about diet, rest, and exercise
A nurse is caring for an underweight adolescent girl with a diagnosis of anorexia nervosa. Which common characteristics of girls with this disorder should the nurse to recognize when obtaining a health history and performing a physical assessment? Select all that apply.
Fatigue Secondary amenorrhea
A nurse is caring for an 8-year-old child with acute poststreptococcal glomerulonephritis (APSGN). What medications does the nurse expect the practitioner to prescribe? Select all that apply.
Furosemide Labetalol The child with APSGN is oliguric; diuretics are used to increase urine output. The child with APSGN is hypertensive; antihypertensives are used to reduce the blood pressure
A 55-year-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication?
Hemoglobin level 13 g/dL
A nurse is caring for a client receiving hemodialysis for chronic kidney disease. The nurse should monitor the client for which complication?
Hep B
A nurse anticipates that dialysis will be necessary for a 12-year-old child with chronic kidney disease when the child begins to exhibit which symptom?
Hypervolemia
A 48-year-old patient with stage 2 chronic kidney disease (CKD) is scheduled for an intravenous pyelogram (IVP). Which order for the patient will the nurse question?
Ibuprofen (Advil) 400 mg PO PRN for pain
A client with cirrhosis of the liver and ascites is scheduled to have a paracentesis. What should the nurse do to prepare the client for the procedure?
Instruct the client to void
A client with acute kidney injury is to receive peritoneal dialysis and asks why the procedure is necessary. Which is the nurse's best response?
It helps perform some of the work usually done by the kidneys."
Cirrhosis labs
Labs: • AST/ALT - high • Albumin - low
anorexia nervosa
Low food absorption ——> Low BMI < 18.5
A client is admitted to the hospital with a diagnosis of cirrhosis of the liver. For which assessment signs of hepatic encephalopathy should the nurse assess this client? Select all that apply.
Mental confusion, flapping hand tremors, musty/sweet breath odor
A 64-year-old male patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching?
More protein is allowed because urea and creatinine are removed by dialysis.
A client with anorexia nervosa is admitted to the critical care unit following a period of prolonged starvation. What signs or symptoms indicate to the nurse that the client may have hypokalemia? Select all that apply.
Muscle weakness Cardiac dysrhythmias
A client is admitted to the hospital with a diagnosis of severe chronic kidney disease. Which assessment findings should the nurse expect the client to exhibit? Select all that apply.
Paresthesias Hypertension
The nurse is taking care of a client with cirrhosis of the liver and ascites. Which lunch is the best choice for a client with this disorder?
Penne pasta, spinach, banana, and decaffeinated iced tea A client with cirrhosis and ascites will require moderate to low fat and low sodium (penne pasta, spinach, banana, and decaffeinated iced tea). Caffeine can stimulate and cause distention.
A client is at high risk for developing ascites because of cirrhosis of the liver. How should the nurse assess for the presence of ascites?
Percuss the client's abdomen and listen for dull sounds
Which manifestations may indicate a client has systemic lupus erythematosus (SLE)? Select all that apply.
Pericarditis Discoid lesions Pleural effusion
A nurse is assessing the condition of a school-aged child with acute glomerulonephritis. What clinical finding does the nurse anticipate?
Perorbital edema
Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?
Phosphate level
A 42-year-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed actions should the nurse take first?
Place the patient on a cardiac monitor.
Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's teaching has been successful?
Poached eggs, whole-wheat toast, and apple juice
Cirrhosis complications
Portal hypertension- elevated blood pressure throughout entire portal venous system Esophageal varices- dilated tortuous veins usually found in the submucosa of the lower esophagus, hemorrhage from rupture leading cause of death in clients with cirrhosis, ascites, bleeding disorders Hepatic encephalopathy —> liver unable to detoxify —> ammonia & other toxins collect in the brain —> changes in mental status Enlarged spleen "splenomegaly" —> low platelet & WBC count Fluid volume overload —> ascites (accumulation of fluid) in the legs + abdomen = risk for infection from gut bacteria —> jaundice, renal failure
Before administration of captopril (Capoten) to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patient's
Potassium
A client with chronic kidney disease is receiving medication to manage anemia. Which primary goal should the nurse include in the care plan from this information?
Prevention of chronic fatigue
An adolescent with the diagnosis of anorexia nervosa is admitted to the psychiatric unit of a local hospital. What should the nurse include in the plan of care?
Provision of supervision during and after mealtimes
binge eating disorder treatment
Psychotherapy Strict diet/exercise Stimulants and orlistat
A nurse is caring for an adolescent with the diagnosis of anorexia nervosa. The plan of care should include helping the client do what?
Recognize how the need to control influences behavior
Which intervention will be included in the plan of care for a male patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein?
Restrict physical activity to bed rest.
Bulimia Nervosa Treatment
SSRIs (fluoxetine) and psychotherapy
A 6-year-old child treated for acute glomerulonephritis has improved and is soon to be discharged. What should the nurse plan to offer the parents in preparation for the discharge?
Samples of no-salt-added diets for the child to continue at home
A 25-year-old male patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider?
Serum potassium level 6.5 mEq/L
A 16-year-old girl has been admitted to the pediatric eating disorders unit with a diagnosis of anorexia and is undergoing behavioral therapy. Unit privileges are based on weight gain and have been explained to the client. What is the most appropriate intervention for the nurse to use when taking the lunch tray to the client's room?
Setting the tray down and saying nothing
Associated medical issues with anorexia nervosa
Starvation Osteoporosis —> fractures Amenorrhea Anemia Electrolyte disturbances Hypothyroidism w/ low T3/T4
A nurse is notified that the latest potassium level for a client in acute kidney injury is 6.2 mEq (6.2 mmol/L). Which action should the nurse take first?
Take vital signs and notify the primary healthcare provider
bulimia nervosa signs/symptoms
Teeth and enamel erosion Esophageal tears Parotitis Thickened knuckles
A nurse is obtaining the health history of a 5-year-old child who has been admitted to the child health unit with acute glomerulonephritis. What does the nurse expect the child's mother to report?
The child had a sore throat a few weeks ago Acute poststreptococcal glomerulonephritis (APSGN) is associated with a history of streptococcal infection of the throat.
The parents of an adolescent child are worried about their daughter's use of laxatives. Which other behavior in the child does the nurse associate with bulimia nervosa?
The child indulges in binge eating.
Evaluation of clients with anorexia nervosa requires reassessment of behaviors after admission. Which finding indicates that the therapy is beginning to be effective?
The client has gained 6 lb since admission 3 weeks ago. -Weight gain of 6 lb since admission 3 weeks ago is objective proof that the client's eating behaviors have improved
Which action by a 70-year-old patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?
The patient cleans the catheter while taking a bath each day.
Which information in a patient's history indicates to the nurse that the patient is not an appropriate candidate for kidney transplantation?
The patient has metastatic lung cancer
A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2 L inflows. Which information should the nurse report immediately to the health care provider?
The patient's peritoneal effluent appears cloudy.
A nurse is caring for a client with acute kidney injury who is receiving a protein-restricted diet. The client asks why this diet is necessary. Which information should the nurse include in a response to the client's questions?
This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys.
A client with cirrhosis of the liver and ascites has been taking chlorothiazide, a thiazide diuretic. Why did the provider add spironolactone to the client's medication regimen?
To help prevent potassium loss
A 62-year-old female patient has been hospitalized for 8 days with acute kidney injury (AKI) caused by dehydration. Which information will be most important for the nurse to report to the health care provider?
Urine output over an 8-hour period is 2500 mL.
A nurse is counseling a client with the diagnosis of bulimia nervosa. The client admits to at times feeling helpless in regard to the eating disorder. What is the most appropriate short-term outcome for this client?
Verbalizing the desire to increase control over stressful situations
The nurse is teaching a client with decreased ovarian production of estrogen due to menopause about self-management and prevention of complications. Which actions performed by the client would help to reduce the complications? Select all that apply.
Walking for 30 minutes per day Performing weight-bearing activities Urinating immediately after sexual intercourse
A client with biliary cirrhosis receives serum albumin therapy. What is the most effective method for the nurse to evaluate the client's response to therapy?
Weigh daily The increased osmotic effect of therapy increases the intravascular volume and urinary output; weight loss reflects fluid loss.
A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft?
a fistula is much less likely to clot
bulimia nervosa
an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise Normal weight or overweight > 18.5
When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula?
auscultate for a bruit at the fistula site
Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before administering the medication, the nurse should assess the
bowel sounds
A nurse is interviewing a client who was diagnosed with systemic lupus erythematosus (SLE). Which common responses to this disease can the nurse expect the client to exhibit? Select all that apply.
butterfly facial rash inflammation of joints
Cirrhosis
chronic degenerative disease of the liver Caused by viral infection (Hep C or B), ETOH consumption, obesity, diabetes, high cholesterol, autoimmune
Treatment of Anorexia Nervosa
emergency procedures to restore weight, antidepressants or other medications, family therapy, cognitive-behavioral therapy/psychotherapy
A 37-year-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function?
glomerular filtration rate (GFR)
A nurse is caring for several clients with the diagnosis of bulimia nervosa. What primary feeling does the nurse anticipate that these clients experience after an episode of bingeing?
guilt
The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required?
magnesium hydroxide
The nurse is planning care for a patient with severe heart failure who has developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary collaborative treatment goal in the plan will be
maintaining cardiac output.
When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of
rapid and deep respirations
Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney disease (CKD), the nurse should check laboratory results for
serum phosphate
binge eating disorder
significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise that marks bulimia nervosa At least 3 of the following: - eating quickly, eating alone out of embarrassment, eating until uncomfortably full, binge eating when not hungry, feelings of guilt/depression/disgust after eating Pt are usually overweight/obese
