Adult Health Exam 2

How are T3 and T4 thyroid hormones regulated?

-Hypothalamus produces TSH Releasing Hormone (TRH) -TRH signals pituitary to tell thyroid gland to produce more or less T3 or T4 by increasing TSH or decreasing the release of TSH (Thyroid stimulating hormone)

Myxedema coma: Nursing care

-Maintain patent airway -Monitor respiratory function and LOC -Cardiac monitoring -Warming interventions: monitor body temp -Admin large dose of IV levothyroxine -Treat hypoglycemia

Coronary Artery Disease (CAD): Prevention

Active lifestyle Heart healthy diet Manage BP No smoking

What is a myocardial infarction?

Acute onset of myocardial ischemia that results in myocardial death, if definitive interventions do not occur. Similar symptoms and treatment to angina.

Signs and symptoms of Pulmonary Embolism (PE)

Dyspnea, anxiety, chest pain, tachycardia, hypotension, hemoptysis (PINK FROTHY SPUTUM), pain on breathing, apprehension (feeling of impending doom)

Myocardial Infarction: Diagnosed?

ECG Cardiac enzymes: Myoglobin, CK-MB, troponin I or T Stress test Thallium scan Cardiac catheterization

A client diagnosed with hypertension begins drug therapy using an antihypertensive agent. The nurse instructs the client's spouse to remove any objects in the home that can lead to falls. Which client statement confirms that the teaching has been successful? "Antihypertensive drugs can lead to falls." "Antihypertensives can lead to memory loss." "Constant thirst is a common side effect of antihypertensive therapy." "Insomnia is a common side effect of antihypertensive medications."

"Antihypertensive drugs can lead to falls." Rationale: One of the side effects of all antihypertensive drugs is hypotension, which can lead to falls.

When referred to a podiatrist, a client newly diagnosed with diabetes mellitus asks, "Why do you need to check my feet when I'm having a problem with my blood sugar?" The nurse's most helpful response to this statement is: "The physician wants to be sure your shoes fit properly so you won't develop pressure sores." "It's easier to get foot infections if you have diabetes." "Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." "The circulation in your feet can help us determine how severe your diabetes is."

"Diabetes can affect sensation in your feet and you can hurt yourself without realizing it." Rationale: The nurse should make the client aware that diabetes affects sensation in the feet and that he might hurt his foot but not feel the wound. Although it's important that the client's shoes fit properly, this isn't the only reason the client's feet need to be checked. Telling the client that diabetes mellitus increases the risk of infection or stating that the circulation in the client's feet indicates the severity of his diabetes doesn't provide the client with complete information.

A controlled type 2 diabetic client states, "The doctor said if my blood sugars remain stable, I may not need to take any medication." Which response by the nurse is most appropriate? "Some doctors do not treat blood sugar elevation until symptoms appear." "Diet, exercise, and weight loss can eliminate the need for medication." "You misunderstood the doctor. Let's ask for clarification." "You will be placed on a strict low-sugar diet for better control."

"Diet, exercise, and weight loss can eliminate the need for medication." Rationale: Dieting, exercise, and weight loss can control and/or delay the need for medication to treat type 2 diabetes mellitus in some clients. Because the client is controlling blood sugars, changing the diet is not indicated. Controlling blood glucose levels will prevent multisystem complications and should be the mainstay of treatment for diabetes mellitus. Although clarification is appropriate, stating the client misunderstood can close the line of communication between client and nurse.

A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." What is the best response by the nurse? "Hypertension often causes no pain." "Hypertension often causes no symptoms." "Hypertension is difficult to diagnose." "Hypertension often kills early in the disease process."

"Hypertension often causes no symptoms." Rationale: Hypertension is sometimes called the "silent killer" because people with it are often symptom free. Physical examination may reveal no abnormalities other than elevated blood pressure. People with hypertension may remain asymptomatic for many years. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision. Pain is not usually an issue, but that is not why hypertension is called the "silent killer." Hypertension is easily diagnosed by taking a series of blood pressure readings.

The nurse is caring for a client newly diagnosed with hypertension. Which statement by the client indicates the need for further teaching? "When getting up from bed, I will sit for a short period before standing up." "I will consult a dietician to help get my weight under control." "I think I'm going to sign up for a yoga class twice a week to help reduce my stress." "If I take my blood pressure and it is normal, I don't have to take my blood pressure pills."

"If I take my blood pressure and it is normal, I don't have to take my blood pressure pills." Rationale: The client needs to understand the disease process and how lifestyle changes and medications can control hypertension. The client must take all medications as directed. A normal blood pressure indicates the medication is producing the desired effect. The other responses do not indicate the need for further teaching.

Incentive Spirometer

-Device used to force the client to concentrate on inspiration and promote full inflation of the lungs, while providing immediate feedback; used particularly after surgery and in lung disorders. -Diaphragmatic breathing -Put patient in upright or semi-fowlers position. -Cough during and after each session. -Splint incision site when coughing postop.

An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as being suggestive of diabetes? "When I went to the washroom the last few days, my urine smelled odd." "No matter how much sleep I get, it seems to take me hours to wake up." "Lately, I drink and drink and can't seem to quench my thirst." "I've always been a fan of sweet foods, but lately I'm turned off by them."

"Lately, I drink and drink and can't seem to quench my thirst." Rationale: Classic clinical manifestations of diabetes include the "three Ps": polyuria, polydipsia, and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.

The public health nurse is presenting a workshop on hypertension for the Parent Teacher Organization of the local elementary school. A parent asks the nurse who is at risk for hypertension. What would be the nurse's best answer? "People at highest risk for hypertension include clients younger than 18 years." "People at highest risk for hypertension include those with diabetes." "People at highest risk for hypertension include Asians." "People at highest risk for hypertension include the immune-compromised."

"People at highest risk for hypertension include clients younger than 18 years." Rationale: Screening of BP is an important method for identifying people at risk for heart failure, renal failure, and stroke. Those at highest risk are older adults, African Americans, and clients with diabetes mellitus. Therefore options A, C, and D are incorrect.

Thyroid Storm: Signs and Symptoms

-Hyperthermia -HTN -Delirium -Abdominal pain and vomiting -Chest pain -SOB -Palpitations -Tachydysrhythmias

COPD: Nursing implications

-Administer O2 as prescribed: no more than 3L for goal or patient norm SpO2 of 88-92% -Nutrition: Small, frequent, high calorie foods to preserve energy. -Adequate fluid intake -Pursed-lip breathing: help with CO2 elimination

What is tuberculosis?

-Bacterial infection of the lungs. -Transmitted via airborne route. -Negative pressure room needed Clinical Manifestations -Persistent cough >3weeks -Hemoptysis (cough blood) -Fatigue, lethargy, weight loss, anorexia, night sweats, low grade fever -Altered mental status or inappropriate behavior

Thyroid Storm: 5 B's for Treatment

-Block synthesis by anti-thyroid drug -Block release by iodine -Block T4 into T3 conversion by propylthiouracil (PTU_ -Beta blocker -Block enterohepatic circulation (cholestyramine)

Breathing Retraining: Diaphragmatic and Pursed-lip breathing

-COPD and dyspnea patients -Control ventilation -Decrease work of breathing

Complication of uncontrolled diabetes

-Cardiovascular disease -Nerve damage (neuropathy) -Kidney damage (nephropathy) -Eye damage (retinopathy)

What is angina pectoris?

-Chest pain caused by inadequate flow of blood and oxygen to the heart. 3 Types Stable -occurs with exercise or emotional stress Unstable -occurs with exercise or at rest -increased frequency and severity not relieved by rest and nitroglycerin Variant -coronary artery spasm

What is atelectasis?

-Closure or collapse of alveoli Three types: -Adhesive-seen in premature infants. Surface tension in alveoli is altered. -Compressive-external pressure on lungs drive air out. -Obstructive-most common. foreign object blocking bronchial passage causing air trapping in alveoli. Clinical Manifestations -gradual, increase dyspnea, cough with sputum production, difficulty breathing in supine position, anxiety

Hypothyroidism: Lab Findings

-Decreased T3 and T4 levels -Increased TSH -Increased serum cholesterol -EKG: sinus bradycardia and dysrhythmias -Radioisotope scan and uptake - low response or iodine prep=hypothyroidism

Hyperthyroidism: Lab Findings

-Decreased TSH -Increased T3 and T4 -EKG - evaluates effect of excessive thyroid hormone on heart - arrhythmias -Radioactive iodine uptake - looks at size and function of thyroid gland. Given 24 hours before exam. Contra-pregnancy, shellfish and iodine allergy

Hyperthyroidism: Nursing care

-Minimize energy expenditure - alternate rest and activity -Promote calm, cool environment -Monitor weight, I&O's and nutrition - needs more calories and proteins -Monitor Vitals - report temp increase for signs of thyroid crisis -Educate emotional/behavior changes as norm -Med compliance -Prepare for surgery - total or partial thyroidectomy if unresponsive to meds

Hyperthyroidism: Considerations when administering Methimazole or PTU

-Monitor for signs of hypothyroidism (cold tolerance, edema, bradycardia, weight gain, depression) -Monitor leukopenia (low WBC), thrombocytopenia (low platelets), and elevated liver enzymes. -Take meds with meals in divided doses, same times, each day -Report fever, sore throat, bruising, jaundice, pregnancy -Limit dietary intake of iodine, fish, seafood, dairy, beans, lentils, spinach, potatoes

Coronary Artery Disease (CAD): Clinical Manifestations

-Myocardial ischemia -Related to location and degree of vessel obstruction -Angina pectoris -Epigastric distress -Pain that radiates to jaw or left arm -SOB

What is obstructive sleep apnea?

-Recurrent episodes of upper airway obstruction -Reduction in ventilation -Cessation of breathing (apnea) during sleep -Risk Factors: obesity, males, post-menstrual status, advanced age, impairment of hypoxic drive, alcohol use -Higher risk of developing HTN, MI, and CVA -S&S: Loud snoring, breathing cessation of 10 seconds or longer, awaken abruptly with loud snort, excessive sleepiness.

What is the most frequently occurring upper respiratory infection?

-Rhinovirus -aka Common Cold -Acute inflammation of mucus membranes of nasal cavity -Infectious

Influenza: Signs and symptoms Nursing management

-S&S: Headache, muscle aches, chills, fever, fatigue, weakness -NM: Rest, avoid physical contact with others, vaccination, increase fluid intake, NSAIDs.

Clinical manifestations of pneumonia

-Sudden chills with fever, chest pain by breathing and coughing, tachypnea, SOB, dyspnea, crackles, wheezing, coughing, diaphoresis, sore throat, anxiety, fatigue, weakness, lethargy, confusion. RUSTY BLOOD TINGED OR YELLOW OR GREEN SPUTUM

How is diabetes diagnosed?

-Symptoms of diabetes: polyuria, polydipsia, and unexplained weight loss with plasma glucose concentration ≥ 200 mg/dL (11.1 mmol/L) at any time of day without regard to time since last meal. -Fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours. -Two-hour postload glucose ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test. The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water. -A1C ≥ 6.5% (48 mmol/mol).

Medical management of obstructive sleep apnea

-Weight loss, avoid alcohol, positioning, oral appliances, continuous positive airway pressure (CPAP), prevent airway collapse, low flow oxygen at night -Protriptyline: increase respiratory drive and improve upper airway muscle tone.

What is Rhinitis?

-inflammation of the nasal mucosa -Caused by: changes in temp or humidity, odors, allergens, infection, age -Signs and Symptoms: Excessive nasal drainage (rhinorrhea), nasal congestion, sneezing, sore/dry throat, itching of nasal area, headache, watery eyes. -Nursing management: Adequate fluid intake, rest, expectorants (guaifenesin), NSAIDs, humidifiers, zinc, vitamin C

2. A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect? 1) Dehydration 2) Polyphagia 3) Hyperglycemia 4) Bradycardia

1) Dehydration Rationale: 1. Diabetes insipidus causes excessive excretion of dilute urine, resulting in dehydration. 2. Polyphagia is a finding of diabetes mellitus, not insipidus. 3. Hyperglycemia is a finding of diabetes mellitus, not diabetes insipidus. 4. Tachycardia, not bradycardia, is a manifestation of diabetes insipidus.

6. A nurse is teaching a client who has a new prescription for regular insulin and NPH insulin. Which of the following instructions should the nurse include in the teaching? 1) Keep the open vial of insulin at room temperature. 2) Inject the insulin into a large muscle. 3) Aspirate the medication prior to administration. 4) Administer the insulin in two separate injections.

1) Keep the open vial of insulin at room temperature. Rationale: 1-The client should keep the vial in use at room temperature to minimize tissue injury and to reduce the risk for lipodystrophy. 2-The client should inject the medication into subcutaneous tissue. 3-It is not necessary for the nurse to aspirate the medication. 4-The client should mix compatible solutions, such as regular insulin and NPH insulin, to reduce the need for an additional injection and reduce the risk for lipodystrophy.

9. A nurse in a clinic is reviewing the laboratory values of a client who has primary hypothyroidism. The nurse should anticipate an elevation of which of the following laboratory values? 1) Thyroid stimulating hormone (TSH) 2) Free T4 3) Serum T4 4) Serum T3

1) Thyroid stimulating hormone (TSH) Rationale: 1-The nurse should anticipate that TSH will be elevated. 2-The nurse should anticipate that the client's level of free T4 will be decreased. 3-The nurse should anticipate that the client's serum T4 will be decreased. 4-The nurse should anticipate that the client's level serum T3 will be decreased.

A client seeks care for hoarseness that has lasted for 1 month. To elicit the most appropriate information about this problem, the nurse should ask which question? 1. "Do you smoke cigarettes, cigars, or a pipe?" 2. "Do you eat spicy foods?" 3. "Have you strained your voice recently?" 4. "Do you eat a lot of red meat?"

1. "Do you smoke cigarettes, cigars, or a pipe?"

7. A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client who has diabetes mellitus. When mixing the two types of insulin, which of the following actions should the nurse take first? 1) Inject 10 units of air into the regular insulin vial. 2) Inject 20 units of air into the NPH insulin vial. 3) Withdraw 10 units of insulin from the regular insulin vial. 4) Replace the needle for withdrawal with a safety needle.

2) Inject 20 units of air into the NPH insulin vial. Rationale: 1- The nurse should inject 10 units of air into the regular insulin vial after injecting air into the NPH insulin vial. However, there is another action the nurse should take first. 2- The first action the nurse should take is to inject 20 units of air into the NPH insulin vial because this insulin is the intermediate-acting insulin, which will be drawn up last in order to avoid contaminating the regular insulin with NPH insulin. 3-The nurse should withdraw 10 units of regular insulin before withdrawing the NPH insulin to decrease the risk of contaminating the NPH vial. However, there is another action that the nurse should take first. 4-The nurse should apply a new safety needle to the syringe used to withdraw insulin when possible, before injecting the client with the regular and NPH insulin. However, there is another action the nurse should take first. Mnemonic: "Nicole Richie, RN" air in Nph, air in Regular, draw up Regular, draw up Nph

A client is being assessed for acute laryngitis. The nurse knows that clinical manifestations of acute laryngitis include 1. a moist cough. 2. hoarseness. 3. a sore throat that feels worse in the evening. 4. a non-edematous uvula.

2. hoarseness.

The nurse auscultates lung sounds that are harsh and cracking, sounding like two pieces of leather being rubbed together. The nurse would be correct in documenting this finding as 1. sonorous wheezes. 2. pleural friction rub. 3. crackles. 4. sibilant wheezes.

2. pleural friction rub.

4. A nurse is teaching a client who has type 1 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching? 1) "I'll wear sandals in warm weather." 2) "I'll put lotion between my toes after drying my feet." 3) "I'll check my feet every day for sores and bruises." 4) "I'll soak my feet in cool water every night before I go to bed."

3) "I'll check my feet every day for sores and bruises." Rationale: 1-The nurse should instruct the client to avoid shoes such as sandals that have an open toe or straps that rest between the toes to decrease the risk of foot injuries. 2-The nurse should instruct the client that lotion is appropriate for dry areas of the feet but not to apply it between the toes, because it creates a moist environment that promotes bacterial growth. 3-The client should check his feet daily to monitor for any problems and observe any other changes before they become serious. He can use a hand mirror to examine areas that are difficult for him to see. 4-The nurse should instruct the client not soak his hands or feet for prolonged periods of time, as this can increase the risk of infection. When cleansing the feet, the client should use warm, soapy water.

5. A nurse is developing a teaching plan for a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following actions should the nurse plan to take first? 1) Establish short-term, realistic goals for the client. 2) Give the client access to a video about diabetes. 3) Determine what the client knows about managing diabetes. 4) Evaluate the effectiveness of the client's admission teaching plan.

3) Determine what the client knows about managing diabetes. Rationale: 1-It is important to establish realistic goals with the client; however, there is another action the nurse should take first. 2-It is important to provide educational materials for the client; however, there is another action the nurse should take first. 3-The first action the nurse should take using the nursing process is to assess or collect data from the client. The nurse should find out what the client knows before proceeding with the plan. 4-It is important to evaluate the effectiveness of the instructions the client has received so far; however, there is another action the nurse should take first.

Which of the following is the most common chronic disease of childhood? 1. Cerebral palsy 2. Obesity 3. Asthma 4. Autism

3. Asthma

A nurse caring for a client with deep vein thrombosis must be especially alert for complications such as pulmonary embolism. Which findings suggest pulmonary embolism? 1. Bradypnea and bradycardia 2. Nonproductive cough and abdominal pain 3. Chest pain and dyspnea 4. Hypertension and lack of fever

3. Chest pain and dyspnea

3. A nurse is teaching about disease management for a client who has type 1 diabetes mellitus. Which statement made by the client indicates an understanding of the teaching? 1) "I am to take my blood sugar reading after meals." 2) "Insulin allows me to eat ice cream at bedtime." 3) "A weight reduction program will make me hypoglycemic." 4) "I give the insulin injections in my abdominal area."

4) "I give the insulin injections in my abdominal area." Rationale: 1-The client should take a blood sugar reading before meals with type 1 diabetes to determine if additional insulin is needed before eating. 2-The client should eat a balance of carbohydrates and protein at bedtime. Ice cream is classified as a carbohydrate on the diabetes exchange list and is not recommended due to high fat content. 3-The client should monitor blood sugars closely to regulate insulin needs and prevent extreme fluctuation of blood sugars while on a weight reduction program. Hyperglycemia is a continual complication of type 1 diabetes mellitus even when on a weight loss program. 4-The client should give insulin injections in one anatomic area for consistent day-to-day absorption. The abdomen is the area for fastest absorption.

10. A nurse is assessing a client who has thyrotoxicosis after taking too high of a level of levothyroxine. Which of the following manifestations should the nurse expect? 1) Drowsiness 2) Bradycardia 3) Dry skin 4) Heat intolerance

4) Heat intolerance Rationale: 1- The client who has an acute overdose of levothyroxine will exhibit insomnia, not drowsiness. 2-The client who has an acute overdose of levothyroxine will exhibit tachycardia, not bradycardia. 3-The client who has an acute overdose of levothyroxine will exhibit sweating and hyperthermia, not dry skin. 4- The client who has an acute overdose of levothyroxine will exhibit heat intolerance, sweating, and hyperthermia. These manifestations are indications of excessive levels of thyroid hormone that could lead to death.

When interpreting the results of a Mantoux test, the nurse explains to the client that a reaction occurs when the intradermal injection site shows 1. tissue sloughing. 2. drainage. 3. bruising. 4. redness and induration.

4. redness and induration.

1. A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being admitted to the emergency department confused, flushed, and with an acetone odor on the breath. Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client? 1) NPH insulin 2) Insulin glargine 3) Insulin detemir 4) Regular insulin

4) Regular insulin Rationale: 1. Isophane NPH insulin is intermediate-acting. It has an onset of action of 1 to 3 hr and is not appropriate for emergency treatment of ketoacidosis. 2. Insulin glargine is a long-acting insulin, with an onset of 2 to 4 hr. It is not appropriate for emergency treatment of ketoacidosis. 3. Insulin detemir is an intermediate-acting insulin. It has an onset of action of 1 hr and is not appropriate for emergency treatment of ketoacidosis. 4. Regular insulin is classified as a short-acting insulin. It can be given intravenously with an onset of action of less than 30 min. This is the insulin that is most appropriate in emergency situations of severe hyperglycemia or diabetic ketoacidosis.

A sputum study has been ordered for a client who has developed coarse chest crackles and a fever. At what time should the nurse best collect the sample? 1. Immediately after a meal 2. At bedtime 3. After a period of exercise 4. First thing in the morning

4. First thing in the morning

When assessing a client's potential for pulmonary emboli, what finding by the nurse indicates possible deep vein thrombosis? 1. Pain in the feet 2. Inability to dorsiflex 3. Negative Homan's sign 4. Pain in the calf

4. Pain in the calf

A nurse is caring for a client after a lung biopsy. Which assessment finding requires immediate intervention? 1. Client stating pain level of 7 out of 10 that decreases with pain medication 2. Client dozing when left alone but awakening easily 3. Oxygen saturation level of 96% on 3 L of oxygen 4. Respiratory rate of 44 breaths/minute

4. Respiratory rate of 44 breaths/minute

While auscultating the lungs of a client with asthma, the nurse hears a continuous, high-pitched whistling sound on expiration. The nurse will document this sound as which of the following? 1. Crackles 2. Pleural friction rub 3. Rhonchi 4. Wheezes

4. Wheezes

What is a Deep Vein Thrombosis?

Blood clotting in veins in the body, typically the legs

HTN emergency

>180/120 must be lowered immediately to prevent damage to target organs. Reduce BP 25% in first hour Reduce to 160/100 in 6 hours IV meds: IV vasodilators - Sodium Nitroprusside, Nicardipine, Fenoldopam, Mesylate, Enalaprilat, Nitroglycerin

An older adult client visits the clinic for a blood pressure (BP) check. The client's hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about the blood pressure medicine? Take the medicine on an empty stomach. A severe drop in blood pressure is possible. A possible adverse effect of blood pressure medicine is dizziness when you stand. There are no adverse effects from blood pressure medicine.

A possible adverse effect of blood pressure medicine is dizziness when you stand. Rationale: A possible adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Teaching should include tips for managing syncope and dizziness. The nurse would not teach the client to take the medicine on an empty stomach.

2. Order 2,000 mL of D5W to infuse at 100 mL/hr. If the nurse starts the infusion at 1000, when should the nurse anticipate changing the IV bag if each bag contains 1L? Provide answer in military time. A. 2000 B. 0600 C. 1800 D. 0800

A. 2000

The nurse is teaching the client about home blood glucose monitoring. Which of the following blood glucose measurement indicates hypoglycemia? A. 59 mg/dL B. 75 mg/dL C. 108 mg/dL D. 119 mg/dL

A. 59 mg/dL Normal glucose level: 70-110 (according to ATI)

1. A nurse is admitting a client who has a suspected MI and a history of angina. Which of the following findings will help the nurse distinguish angina from an MI? A. Angina can be relieved with rest and NTG B. The pain of an MI resolves in less than 15 mins C. The type of activity that causes an MI can be identified D. Angina can occur for longer than 30 mins

A. Angina can be relieved with rest and NTG

A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis? A. Blurred or deteriorating vision B. Fatigue & irritability C. Sudden weight loss and anorexia D. Increased hunger & increased urination E. Wounds that heal slowly or respond poorly to treatment F. Impaired balance & gait

A. Blurred or deteriorating vision B. Fatigue & irritability D. Increased hunger & increased urination E. Wounds that heal slowly or respond poorly to treatment

A nurse is assessing a client who has hypothyroidism and recently began treatment with thyroid hormone replacement therapy. Which of the following findings should indicate to the nurse that the client might need a decrease in the dosage of medication? A. Hand tremors B. Bradycardia C. Pallor D. Slow speech

A. Hand tremors

Which of the following are risk factors for the development of diabetes? Select all that apply. A. Hypertension B. Family history C. Cancer D. Obesity E. History of gestational diabetes F. Hyperthyroidism

A. Hypertension B. Family history D. Obesity E. History of gestational diabetes

A nurse is collecting an admission history from a female client who has hypothyroidism. Which of the following findings should the nurse expect? Select all that apply. A. Menorrhagia B. Dry skin C. Increased libido D. Hoarseness E. Diarrhea

A. Menorrhagia B. Dry skin D. Hoarseness

The best indicator that the client has learned how to give an insulin self-injection correctly is when the client can: A. Perform the procedure safely & correctly B. Critique the nurse's performance of the procedure C. Explain all steps of the procedure correctly D. Correctly answer a post-test about the procedure

A. Perform the procedure safely & correctly

6. The nurse admits a patient diagnosed with a new onset of type 1 diabetes mellitus. Which symptoms should the nurse expect to find during his initial physical assessment? A. Polydipsia, polyuria, and weight loss B. Weight gain, tiredness, and bradycardia C. Irritability, diaphoresis, and tachycardia D. Diarrhea, abdominal pain, and weight loss

A. Polydipsia, polyuria, and weight loss

8. What is the nurse's primary treatment goal for a client diagnosed with angina? A. Reversal of ischemia B. Reversal of infarction C. Reduction of stress and anxiety D. Reduction of associated risk factors

A. Reversal of ischemia

A nurse is preparing to receive a client from the PACU who is postoperative following a thyroidectomy. The nurse should ensure that which of the following equipment is available? Select all that apply. A. Suction equipment B. Humidified oxygen C. Flashlight D. Tracheostomy tray E. Chest tube tray

A. Suction equipment B. Humidified oxygen D. Tracheostomy tray

Nitroglycerin: Nursing indication

Admin sublingual, do not chew or swallow until tablet completely dissolves. Carry med at all times as precaution. Store in dark capped glass bottle. Med is volatile, inactivated by heat, moisture, air, light, and time. Resupply every 6 months. Take before pain develops. Monitor time taken for med to relieve pain. 3 total doses in 5-minute interval. EMS called right after. Adverse: flushing, throbbing, headache, hypotension, and tachycardia Sit down when taking med to avoid hypotension and syncope

COPD: Risk Factors

Advanced age Alpha-antitrypsin deficiency : genetic Environment Cigarette smoke : #1 cause Occupational dust and irritants Indoor/Outdoor air pollution

Hypertension: Risk Factors

Advancing adult age Race Smoking Obesity Hyperlipidemia Stress Family history Gender Excessive sodium intake Sedentary lifestyle Secondary hypertension -Kidney disease -Cushing's disease -Pheochromocytoma -Primary aldosteronism -Brain tumors -Medications -Pregnancy

Which ethnic background would the nurse screen for hypertension at an early age? African-American population Japanese population Mexican population Asian population

African-American population Rationale: The population of African descent is at the highest risk for development of hypertension. The other ethnic backgrounds have a lower risk.

A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client? Dyslipidemia Inactivity Obesity Age

Age Rationale: Age and family history for cardiovascular disease are risk factors that cannot be changed. Obesity, inactivity, and dyslipidemia are risk factors that can be improved by the client through dietary changes, exercise, and other healthy lifestyle choices.

Which would be included in the teaching plan for a client diagnosed with diabetes mellitus? Sugar is found only in dessert foods. Once insulin injections are started in the treatment of type 2 diabetes, they can never be discontinued. The only diet change needed in the treatment of diabetes is to stop eating sugar. An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision.

An elevated blood glucose concentration contributes to complications of diabetes, such as diminished vision. Rationale: Diabetic retinopathy is the leading cause of blindness among people between 20 and 74 years of age in the United States; it occurs in both type 1 and type 2 diabetes. When blood glucose is well controlled, the potential for complications of diabetes is reduced. Several types of foods contain sugar, including cereals, sauces, salad dressings, fruits, and fruit juices. It is not feasible, nor advisable, to remove all sources of sugar from the diet. If the diabetes had been well controlled without insulin before the period of acute stress causing the need for insulin, the client may be able to resume previous methods for control of diabetes when the stress is resolved.

COPD: Medication

Antibiotics -therapy for management of bronchiectasis Bronchodilators -control bronchoconstriction in acute exacerbations. Corticosteroids -Instruct how to use Metered dose inhaler -Side effects: cough, dysphonia, oral thrush, headache, adrenal suppression, osteoporosis, skin thinning, easy bruising. Rinse mouth after inhaler use

Deep Vein Thrombosis: Medication

Anticoagulants -Avoid alcohol -Normal diet -Do not take: vitamins, cold meds, antibiotics, aspirin, mineral oil, anti-inflammatory, herbal, nutrition supplements.

A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The medical reports indicate a history of type 1 diabetes. The nurse suspects the client's symptoms to be those of diabetic ketoacidosis (DKA). Which action will help the nurse confirm the diagnosis? Assess the client's breath odor Assess the client's ability to take a deep breath Assess the client's ability to move all extremities Assess for excessive sweating

Assess the client's breath odor Rationale: DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue, with eventual stupor and coma if not treated. The breath has a characteristic fruity odor due to the presence of ketoacids. Checking the client's breath will help the nurse confirm the diagnosis.

Define: type 1 diabetes

Autoimmune, pancreatic islet beta cell destruction and total deficit of circulating insulin. Patients make little to no insulin, must be managed with injected insulin. Most often occurs in childhood and adolescence. May still occur at any age. Genetic predisposition. More common in men. Hyperglycemia and ketosis

3. Doctor's Order: Heparin 3,500 units SQ twice a day. Available: Heparin 5,000 units per ml. How many milliliters (mL) will the patient receive in 24 hours? A. 0.7 B. 1.4 C. 2.5 D. 0.5

B. 1.4

1. The order is to give 900 mg of a drug in liquid form. The medication label reads 0.3 g per 5 ml. How many ml(s) will you give? A. 54 B. 15 C. 26 D. 0.5

B. 15

Your patient calls you into the room complaining of dizziness, sweating, and tremors. This patient received 15 units of insulin lispro this morning and then never ate any of his breakfast. The patient is not NPO and he is able to swallow. You check his blood glucose level and it is 62 mg/dL. What is the best initial treatment for this patient to help get his blood glucose level up? A. ½ amp IV push dextrose B. 4 oz orange juice C. 4 saltine crackers D. Dextrose 5% in 0.9% NS IV to infuse at 100ml/hr

B. 4 oz orange juice

A nurse is preparing to administer a morning dose of insulin aspart to a client who has type 1 diabetes mellitus. Which of the following actions should the nurse implement? A. Check blood glucose immediately after breakfast B. Administer the insulin when breakfast tray arrives C. Hold breakfast for 1 hour after insulin administration D. Clarify the prescription because insulin should not be administered at this time

B. Administer the insulin when breakfast tray arrives

7. A client has been diagnosed with active tuberculosis (TB). The nurse should assess the client for: A. Chest and lower back pain B. Chills, fever, night sweats, and hemoptysis C. Fever > 104.7 F and nausea D. Headache and photophobia

B. Chills, fever, night sweats, and hemoptysis

A nurse is reviewing lab results of a client who is being evaluated for secondary hypothyroidism. Which of the following lab findings is expected for a client who has this condition? A. Elevated serum T4 B. Decreased serum T3 C. Elevated serum TSH D. Decreased serum cholesterol

B. Decreased serum T3

A nurse is reviewing the health record of a client who is being evaluated for Graves disease. The nurse should identify that which of the following lab values is an expected finding? A. Decreased thyrotropin receptor antibodies B. Decreased thyroid-stimulating hormone (TSH) C. Decreased free thyroxine index D. Decreased triiodothyronine

B. Decreased thyroid-stimulating hormone (TSH)

A nurse is reviewing the manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include? Select all that apply. A. Anorexia B. Heat intolerance C. Constipation D. Palpitations E. Weight loss F. Bradycardia

B. Heat intolerance D. Palpitations E. Weight loss

2. Which of the following nursing interventions is of the highest priority in helping a patient expectorate thick secretions related to pneumonia? • A. Humidify the oxygen as able B. Increase fluid intake to 3L/day if tolerated C. Administer cough suppressant q4hr D. Teach patient to splint the affected area

B. Increase fluid intake to 3L/day if tolerated

A nurse is reinforcing teaching with a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following information should the nurse include in the teaching? Select all that apply. A. Weight gain is expected while taking this medication B. Medication should not be discontinued without the advice of the provider C. Follow-up serum TSH levels should be obtained D. Take the medication on an empty stomach E. Use fiber laxatives for constipation

B. Medication should not be discontinued without the advice of the provider C. Follow-up serum TSH levels should be obtained D. Take the medication on an empty stomach

5. A nurse is caring for a client who is admitted to the ED with a BP of 266/147 mm Hg. The client reports a headache and double vision. The client states that she ran out of her diltiazem 3 days ago, and is unable to purchase more. Which of the following actions should the nurse take first? • A. Administer acetaminophen for a headache B. Obtain IV access and prepare to administer an IV antihypertensive C. Provide teaching regarding the importance of not abruptly stopping an antihypertensive D. Call social services for a referral for financial assistance in obtaining prescribed medications

B. Obtain IV access and prepare to administer an IV antihypertensive

During a community health fair, a nurse is teaching a group of seniors about promoting health and preventing infection. Which intervention would best promote infection prevention for senior citizens who are at risk of pneumococcal and influenza infections? A. Drink six glasses of water daily B. Receive vaccinations C. Exercise daily D. Take all prescribed medications

B. Receive vaccinations

5. A nurse is preparing discharge instructions for a patient after a thyroidectomy. Which discharge instructions should the nurse include? A. Report signs and symptoms of hypoglycemia B. Take thyroid replacement medication as ordered C. Avoid taking acetaminophen D. Carry injectable dexamethasone at all times

B. Take thyroid replacement medication as ordered

HTN urgency

BP is high but no evidence of immediate or progressive target organ damage. Close monitoring of BP and cardio status Assess for potential evidence of target organ damage. Assess for potential evidence of target organ damage Fast acting oral meds: beta blockers, labetalol (ACE inhib), captopril or angio II agonist clonidine.

The nurse is administering metoprolol to a client. What type of medication should the nurse educate the client about? Diuretic Beta blocker Vasodilator Angiotensin-converting enzyme (ACE) inhibitor

Beta blocker Rationale: Metoprolol is classified as a beta blocker. Beta blockers block beta adrenergic receptors of the sympathetic nervous system, causing vasodilation and decreased cardiac output and heart rate. Metoprolol is not classified as a diuretic, ACE inhibitor, or vasodilator.

4. A nurse is caring for a client who asks why her provider prescribed a daily aspirin. Which of the following is an appropriate response by the nurse? A. "Aspirin relieves the pain due to myocardial ischemia." B. "Aspirin dissolves clots that are forming in your coronary arteries." C. "Aspirin reduces the formation of blood clots that could cause a heart attack." D. "Aspirin relieves headaches that are caused by other medications."

C. "Aspirin reduces the formation of blood clots that could cause a heart attack."

6. A nurse is teaching a client who has angina about a new prescription for metoprolol. Which of the following statements by the client indicates understanding of the teaching? A. "I should have my clotting time checked weekly." B. "I will report any ringing in my ears." C. "I will call my doctor if my pulse rate is < 60 bpm." D. "I should place the tablet under my tongue."

C. "I will call my doctor if my pulse rate is < 60 bpm."

4. Calculate the IV flow rate in gtt/min for 200 mL of 0.9% NaCl IV over 2 hours. Infusion set has drop factor of 20 gtts/mL. Round to the nearest whole number. A. 2,000 B. 83 C. 33 D. 150

C. 33

6. A client with pneumonia has developed dyspnea, RR 32 breaths/min, and is having difficulty expelling secretions. The nurse auscultates the lung fields and hears bronchial sounds in the left lower lobe. Which action should the nurse take first. A. Administer antibiotics B. Encourage bed rest C. Apply oxygen D. Assess nutritional intake

C. Apply oxygen

A nurse is preparing to administer morning doses of insulin glargine and regular insulin to a client who has a blood glucose level of 278 mg/dL. Which of the following actions should the nurse take? A. Draw up the regular insulin and then the glargine insulin in the same syringe B. Draw up the glargine insulin and then the regular insulin in the same syringe C. Draw up and administer regular and glargine insulin in separate syringes D. Administer the regular insulin, wait 1 hour, then administer the glargine insuli

C. Draw up and administer regular and glargine insulin in separate syringes

A client is to receive insulin glargine (Lantus) in addition to a sliding scale dose of insulin aspart (Novolog). When the nurse checks the blood glucose level at the bedside, it is 268 mg/dL. How should the nurse administer the insulins? A. Inject air into the insulin glargine vial first, then inject air into the insulin aspart vial, and draw up the correct dose of aspart first B. Draw up the insulin glargine dose into the syringe first, followed by the correct dose of insulin aspart C. Draw up the correct dosages of the insulin aspart and insulin glargine in two separate insulin syringes D. Only administer the dose of the insulin aspart, because due to the patient's blood glucose level, the insulin glargine dose needs to be held

C. Draw up the correct dosages of the insulin aspart and insulin glargine in two separate insulin syringes

A nurse is assessing a client who is 12 hours postop following a thyroidectomy. The nurse should identify which of the following findings as indicative of thyroid storm/crisis? Select all that apply. A. Bradycardia B. Hypothermia C. Dyspnea D. Abdominal pain E. Mental confusion

C. Dyspnea D. Abdominal pain E. Mental confusion

8. The nurse is performing an assessment on a client with a suspected diagnosis of asthma. Which assessment finding supports this diagnosis? A. Circumoral cyanosis B. Increased forced expiratory volume C. Inspiratory and expiratory wheezing D. Normal breath sounds

C. Inspiratory and expiratory wheezing

8. An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and non-pitting edema of the face and periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: A. Thyroid storm B. Cretinism C. Myxedema coma D. Hashimoto's thyroiditis

C. Myxedema coma

1. The patient diagnosed with a community-acquired pneumonia is being admitted to the medical unit. Which nursing intervention has the highest priority? A. Administer the ordered oral antibiotic immediately B. Order the meal tray to be delivered as soon as possible C. Obtain a sputum specimen for culture and sensitivity D. Have the unlicensed assistive personnel weigh the patient

C. Obtain a sputum specimen for culture and sensitivity

A nurse is teaching foot care to a client who has diabetes mellitus. Which of the following information should the nurse include in the teaching? Select all the apply. A. Remove calluses using OTC remedies B. Apply lotion between the toes C. Perform nail care after bathing D. Trim toenails straight across E. Wear closed-toe shoes

C. Perform nail care after bathing D. Trim toenails straight across E. Wear closed-toe shoes

A nurse is caring for a client who has a blood glucose level of 52 mg/dL. The client is lethargic but arousable. Which of the following actions should the nurse perform first? A. Recheck the blood glucose in 15 mins B. Provide a carb and protein food C. Provide 4 oz of grape juice D. Report findings to the provider

C. Provide 4 oz of grape juice

5. The nurse is assisting a patient to learn self-administration of metered dose inhalers (MDI's) for his Asthma. The nurse explains that the best way to prevent oral infection while taking this medication is to do which of the following as part of the self-administration techniques? • A. Chew a hard candy before the first puff of medication B. Ask for a breath mint following the second puff of medication C. Rinse the mouth with water following the second puff of medication D. Rinse the mouth with water before each puff of medication

C. Rinse the mouth with water following the second puff of medication

Hypertension: Complications

CKD, Heart disease, PAD, retinopathy TIA. HTN is a silent killer. It can go unnoticed until it is measured by a medical professional.

Asthma: Medications

Corticosteroids -Instruct how to use Metered dose inhaler -Side effects: cough, dysphonia, oral thrush, headache, adrenal suppression, osteoporosis, skin thinning, easy bruising. Bronchodilators -Beta 2 agonists i. Side effects: Tachycardia, muscle tremor, hypokalemia, ECG changes with overdose. ii. Reinforce to patient that medications should not be used to treat acute asthma symptoms or exacerbations. Teach patient how to correctly use pMDI or aerolizer inhaler. Immunomodulators -Indicated by anaphylaxis

Asthma: symptoms

Cough Dyspnea Chest tightness Anxiety WHEEZING Mucus production

COPD: Clinical manifestations

Chronic cough Sputum production Dyspnea upon exertion - interferes with eating - weight loss -May occur at rest -Worse with exercise/mobility

What is asthma?

Chronic inflammatory disease of airways. Reversible inflammation, airway hyperresponsiveness, mucosal edema, and mucus production. Asthma attack caused by allergy to environment, foods, pet dander

Define: Type 2 diabetes

Condition of fasting hypoglycemia that occurs despite available insulin in the body. May occur at any age, usually seen in middle age. Genetic predisposition. Obesity, older adults, African Americans, Hispanic Americans and Native Americans. Insulin production varies. Managed with diet, oral and/or injected insulin

What is Raynaud's disease?

Constriction of the small vessels in the fingers and toes. Limit blood flow to affected areas. Body feels cool and numb in response to stress or cold temperatures. Causes vasospasms.

A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus? Failure to monitor blood glucose levels Recent weight gain of 20 lb (9.1 kg) Crying whenever diabetes is mentioned Skipping insulin doses during illness

Crying whenever diabetes is mentioned Rationale: A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus.

A newly admitted client with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the client the etiology of type 1 diabetes, what process should the nurse describe? A. "The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase." B. "Damage to your pancreas causes in increase in the amount of glucose that it releases, and there is not enough insulin to control it." C. "The amount of glucose your body makes overwhelms your pancreas and decreases your production of insulin." D. "Destruction of beta cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down."

D. "Destruction of beta cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down."

3. A nurse is caring for a client who has a DVT and has been taking heparin therapy for 1 week. Two days ago, the provider also prescribed warfarin. The client asks the nurse about receiving both heparin and warfarin at the same time. Which of the following statements should the nurse give? • A. "I will remind your provider that you are already receiving heparin." B. "Your laboratory findings indicated that two anticoagulants were needed." C. "Only one of these medications is being given to treat your DVT." D. "It takes 3-4 days before the therapeutic effects of warfarin are achieved, and then the heparin can be discontinued."

D. "It takes 3-4 days before the therapeutic effects of warfarin are achieved, and then the heparin can be discontinued."

During a home visit, a diabetic client begins to cry and says, "I just cannot stand the thought of having to give myself a shot every day." Which of the following would be the best response by the nurse? A. "If you do not give yourself your insulin shots, you will die." B. "We can teach your daughter to give the shots so that you will not have to do it." C. "I can arrange to have a home care nurse give you the shots every day." D. "What is it about giving yourself the insulin shots that bothers you?"

D. "What is it about giving yourself the insulin shots that bothers you?"

3. A nurse caring for a client with deep vein thrombosis (DVT) must be especially alert for complications such as pulmonary embolism (PE). Which findings suggest pulmonary embolism? • A. Nonproductive cough and abdominal pain B. Hypertension and lack of fever C. Bradypnea and bradycardia D. Chest pain and dyspnea

D. Chest pain and dyspnea

7. The nurse has just admitted a client to the ED for evaluation of a possible MI. Which diagnostic intervention by the nurse would be the priority? A. Cardiac catheterization B. Cardiac enzymes C. Echocardiogram D. Electrocardiogram (ECG)

D. Electrocardiogram (ECG)

4. A patient is admitted to the hospital for treatment of chronic obstructive pulmonary disease (COPD). Which nursing diagnosis is most important for this patient? • A. Activity intolerance related to fatigue B. Anxiety related to actual threat to health status C. Risk for infection related to retained secretions D. Impaired gas exchange related to airflow obstruction

D. Impaired gas exchange related to airflow obstruction

2. A nurse is assessing a client who has chronic peripheral arterial disease (PAD). Which of the following findings should the nurse expect? • A. Ulceration around the ankles and feet B. Scaling eczema of the lower legs with stasis dermatitis C. Edema around the ankles and feet D. Pallor on elevation of the limbs, and rubor when limbs are dependent

D. Pallor on elevation of the limbs, and rubor when limbs are dependent

7. A patient with hypothyroidism may present with which of the following symptoms? A. Polyuria, tachycardia, and hypotension B. Heat intolerance, nervousness, weight loss and hair loss C. Coarsening of facial features and extremity enlargement D. Tiredness, cold intolerance, weight gain, constipation

D. Tiredness, cold intolerance, weight gain, constipation

Angina: Treatment

Decrease myocardial oxygen demand and increase oxygen supply Medication: Nitroglycerin, aspirin, heparin, beta-blocker, clopidogrel Oxygen Reduce risk factors Reperfusion therapy: Thrombolytic and fibrinolytic drugs and surgery.

The nurse is employed in a physician's office and is caring for a client present for an annual exam. A blood pressure of 124/84 mm Hg is documented. Following revised guidelines for identifying hypertension, which educational pamphlet is help? Stress reduction to lower prehypertensive state Increasing fluids for low blood pressure Diagnostic testing for determining cardiac functioning Use of beta-blockers for treatment of hypertension

Diagnostic testing for determining cardiac functioning Rationale: A blood pressure of 124/84 mm Hg is now considered to be in the lower range of prehypertension. Knowledge of stress reduction may be helpful in lowering the blood pressure without medication therapy. A blood pressure of 124/84 mm Hg is not considered a low blood pressure or in need of medication therapy due to hypertension. Diagnostic testing for cardiac functioning is not typical for a client with prehypertension.

A client with newly diagnosed hypertension asks how to decrease the risk for related cardiovascular problems. What risk factor is modifiable by the client? Dyslipidemia Age Impaired renal function Family history

Dyslipidemia Rationale: Age, family history, and impaired renal function are risk factors for cardiovascular disease related to hypertension that the client cannot change. Obesity, inactivity, and dyslipidemia are risk factors that the client can improve through diet, exercise, and other healthy lifestyle changes.

A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which statement would the nurse include in the education session? Maintain a body mass index between 30 and 35. Maintain a waist circumference of 45 inches (114 cm) (men) and 40 inches (102 cm) (women) or less. Engage in aerobic activity at least 30 minutes/day most days of the week. Limit alcohol consumption to no more that 3 drinks per day.

Engage in aerobic activity at least 30 minutes/day most days of the week. Rationale: Recommended lifestyle modifications to prevent and manage hypertension include maintaining a normal body mass index (about 24; greater than 25 is considered overweight), maintaining a waist circumference of less than 40 inches for men and 35 inches for women, limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day, and engaging in aerobic activity at least 30 minutes per day most days of the week.

What is guaifenesin?

Expectorant; thins and loosens secretions

A client with type 1 diabetes mellitus is receiving short-acting insulin to maintain control of blood glucose levels. In providing glucometer instructions, the nurse would instruct the client to use which site for most accurate findings? Upper arm Thigh Forearm Finger

Finger Rationale: Even though the fingertips have a higher number of nerve endings, this site provides the most accurate blood sugar reading. Alternate sites, such as upper arm, forearm, and thighs are regarded as lagging test sites and are not an option for people who require tight glucose control.

When teaching a client about hypertension and lifestyle changes what does the nurse emphasizes should be included in the diet? Whole milk and cheeses Fresh fruits and vegetables Chloride-containing foods A glass of red wine

Fresh fruits and vegetables Rationale: The dietary approach to stop hypertension states that a diet high in fruits and vegetables and low in fat and sodium will prevent or control hypertension. There is no need to consume chloride-containing foods. Whole mile milk and cheeses are high in saturated fats and should be avoided. While alcohol is considered acceptable in low quantities, it is not something that must be included in the diet.

A nurse is preparing to discharge a client with coronary artery disease and hypertension who is at risk for type 2 diabetes. Which information is important to include in the discharge teaching? How to self-inject insulin How to recognize signs of diabetic ketoacidosis How to monitor ketones daily How to control blood glucose through lifestyle modification with diet and exercise

How to control blood glucose through lifestyle modification with diet and exercise Rationale: Persons at high risk for type 2 diabetes receive standard lifestyle recommendations plus metformin, standard lifestyle recommendations plus placebo, or an intensive program of lifestyle modifications. The 16-lesson curriculum of the intensive program of lifestyle modifications focuses on reducing weight by more than 7% of initial body weight and moderate-intensity physical activity. It also includes behavior modification strategies designed to help clients achieve the goals of weight reduction and participation in exercise. These findings demonstrate that type 2 diabetes can be prevented or delayed in persons at high risk for the disease.

Hyperthyroidism (Overactive thyroid): Signs and Symptoms

Hypermetabolic state: -weight loss -increased appetite -Irritability, mood swings -Heat intolerance and sweating -Tremors -Hair loss, brittle hair -Missed or light menstrual period, decreased infertility -Tachycardia, palpitations, arrhythmia -Insomnia -Skin thinning -EXOPHTHALMOS (bulging eyes) - present in Graves' disease -Blurry vision -Goiter

What is Radioactive Iodine Therapy?

Hyperthyroidism treatment -Absorbed by thyroid and destroy hormone producing cells: may need 1-3 doses -May require lifelong therapy -Monitor for signs and symptoms of hypothyroidism -Contraindicated by pregnancy -Effects of therapy may need 6-8 weeks to be seen. -Stay away from pregnant women, infants and children, for 1 week following treatment -avoid radiation exposure to others.

How to prevent atelectasis?

ICOUGH -Incentive spirometry -Coughing and deep breathing -Oral care -Understanding -Getting out of bed at least 3 times a day -Head of bed elevation

What is emphysema?

Impaired O2 and CO2 exchange result in destruction of walls of alveoli

Hyperglycemia: Signs and symptoms

Increased thirst, hunger, blurred vision, polyuria, headache, Fruity-smelling breath, nausea, vomiting, SOB, dry mouth, weakness, confusion, coma, abdominal pain.

What is bronchitis?

Inflammation of bronchi and bronchioles due to exposures to irritants

What is pneumonia?

Inflammation of lung parenchyma (alveoli and bronchioles) results in edema and exudate that fill alveoli. Caused by -infectious microorganisms, aspiration of fluid or foreign object. Treat with -Full course antibiotic therapy, nutrition, other typical respiratory shit. Most common cause of death from infectious disease Diagnosed -Chest x-ray, sputum culture, CBC, ABG, blood culture.

A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene? Instruct the client to sit for several minutes before standing. Insert an indwelling urinary catheter as ordered. Administer an isosorbide as ordered. Administer I.V. fluids as ordered.

Instruct the client to sit for several minutes before standing. Rationale: To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly, such as by sitting for several minutes before standing. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because doing so would counteract the effects of furosemide and could cause fluid imbalance. Administering a vasodilator, isosorbide, would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would make it easier to monitor urine output, but wouldn't minimize the effects of orthostatic hypotension.

NPH (Neutral Protamine Hagedorn) Onset-Peak-Duration

Intermediate-acting Onset: 2 hrs Peak: 6-8 hrs Duration: 12-16 hrs Usually taken after food

Peripheral Artery Disease (PAD): Clinical Manifestations

Intermittent claudication: Pain, cramp, numbness during exertion as a result of ischemia Leg numbness or weakness Coldness in lower leg or foot when compared to other side. Sores on toes, feet or legs that wont heal Change in color of legs (cyanosis)

Which is a by-product of fat breakdown in the absence of insulin and accumulates in the blood and urine? Cholesterol Ketones Hemoglobin Creatinine

Ketones Rationale: Ketones are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Creatinine, hemoglobin, and cholesterol are not by-products of fat breakdown.

Glargine (Lantus) Onset-Peak-Duration

Long-Acting Onset: 1 hour-Not defined Peak: Continuous, no peak Duration: 24 hrs Used for basal dose Do not mix with other insulins

Beta Blockers: MOA - Nursing Implication

MOA: Block Beta-1 (heart) and/or Beta-2 receptors (bronchial and vascular) → ↓ heart rate and vasodilation Nursing implications: monitor vitals, monitor I & O, monitor wt, assess s/s HF, educate patient about rebound hypertension and not stopping drug suddenly

Diuretics: MOA - Nursing Implication

MOA: Lessen Na reabsorption in the kidneys or block vasopressin directly causing Na and H2O loss → decrease in blood volume and venous pressure → decrease in cardiac output and arterial pressure. Nursing implications: Monitor for fluid electrolyte imbalance, monitor I&O, monitor daily weight, monitor vitals especially bp, monitor skin turgor

ACE Inhibitors: MOA - Nursing Implication

MOA: angiotensin converting enzyme inhibitors slow the activity of ACE enzymes→ affect RAAS by ↓ production angiotensin II → vasodilation → ↓ bp Nursing implications: Monitor fluid and electrolyte values, monitor I & O, assess kidney function, educate patient on changing positions slowly and that ace inhibitors can cause a dry cough

Angiotensin 2 Receptor Blockers (ARBs): MOA - Nursing Implication

MOA: block angiotensin II receptors on muscles surround blood vessels → vasodilation → ↓ bp Nursing implications: Monitor fluid and electrolyte values, monitor I & O, monitor vitals, assess kidney function, educate patient on changing positions slowly

Methods of oxygen administration:

Nasal Cannula: Low flow. 2-6 L. Nasal membranes may dry and cause front sinus pain. Can be used while patient is eating. Simple Mask: 6-10 L. Holes on sides to let exhaled air through. Non-rebreather mask: High flow. 10-15 L. Bag attached to mask, fill with O2. Venturi Mask: "Air-entrainment" delivers fixed concentration of O2

Ca Channel Blockers: MOA - Nursing Implication

MOA: lower bp by preventing Ca from entering cells of your heart and arteries causing them to relax→ vasodilation and ↓ strength in heart contraction Nursing Implications: Monitor vitals especially bp and pulse, assess routinely for s/s of HF (peripheral edema, wt gain, dyspnea, crackles, etc) and monitor EKG, educate patient on changing positions slowly, teach patient avoid grapefruit juice and diet high in fiber

Myocardial Infarction: Drugs

Main treatment: Nitroglycerin, Aspirin, Morphine Along with Oxygen Therapy Others: Antiplatelet (Clopidogrel), Beta-blockers, ACE inhibs, and ARBs.

A client hospitalized for treatment of hypertension is being prepared for discharge. Which teaching topic should the nurse be sure to cover? Skipping a medication dose if dizziness occurs Maintaining a low-potassium diet Maintaining a low-sodium diet Receiving I.V. antihypertensive medications

Maintaining a low-potassium diet Rationale: The nurse must teach the hypertensive client how to modify his diet to restrict sodium and saturated fats. In addition to teaching about adverse effects of ordered antihypertensives, she must discuss the actions and dosages of these drugs. A client receiving antihypertensives may also take a diuretic as part of the drug regimen and thus may require dietary potassium supplements and high-potassium foods to avoid electrolyte disturbances. Instead of skipping medication if dizziness occurs, the client should notify the physician of this symptom. The client receiving antihypertensives at home takes them by mouth, not I.V.

Medical management of TB

Medications -Isoniazid (INH) Antibiotic Prophylaxis for neuritis. Monitor AST and ALT (enzymes) -Rifampin (Rifadin) Bactericidal Causes orange urine and other body secretions. Discolored contact lenses. -Pyrazinamide (PZA) Antimycobacterial Monitor uric acid, AST, and ALT -Ethambutol (Myambutol) Bacteriostatic Caution for renal disease patients. Monitor visual acuity, color, and discrimination.

Type 2 Diabetes: Modifiable and Non-Modifiable risk factors

Modifiable: Obesity (i.e., ≥20% over desired body weight or body mass index ≥30 kg/m2) Hypertension (≥140/90 mm Hg) High-density lipoprotein (HDL) cholesterol level ≤35 mg/dL (0.90 mmol/L) and/or triglyceride level ≥250 mg/dL (2.8 mmol/L) Non-modifiable: Previously identified impaired fasting glucose or impaired glucose tolerance?? Family history of diabetes Age equal to or greater than 45 years Race/ethnicity History of gestational diabetes or delivery of a baby over 9 lb

Coronary Artery Disease (CAD): Risk Factors

Modifiable: Smoking, obesity, high cholesterol, sedentary lifestyle, environment Non-modifiable: Diabetes, family history, age, gender, race

A nurse is caring for a client with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin? Review the client's first hemoglobin A1C result after discharge. Observe the client drawing up and administering the insulin. Provide a health education session reviewing the main points of insulin delivery. Ask the client to describe the process in detail.

Observe the client drawing up and administering the insulin. Rationale: Nurses should assess the client's ability to perform diabetes-related self-care as soon as possible during the hospitalization or office visit to determine whether the client requires further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the client performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the client about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning.

Aspart (Novolog) Onset-Peak-Duration

Onset: 5-15 mins Peak: 40-50 mins Duration: 2-4 hours

Peripheral Artery Disease (PAD): Meds

Pentoxifylline: Anti-inflammatory, Vasodilator Cilostazol: Vasodilator Aspirin: NSAIDs Clopidogrel: Blood thinner Statin drugs: Lipid-lowering meds

An older adult patient that has type 2 diabetes comes to the emergency department with second-degree burns to the bottom of both feet and states, "I didn't feel too hot but my feet must have been too close to the heater." What does the nurse understand is most likely the reason for the decrease in temperature sensation? A faulty heater Peripheral neuropathy Sudomotor neuropathy Autonomic neuropathy

Peripheral neuropathy Rationale: As the neuropathy progresses, the feet become numb. In addition, a decrease in proprioception (awareness of posture and movement of the body and of position and weight of objects in relation to the body) and a decreased sensation of light touch may lead to an unsteady gait. Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections.

Type 1 Diabetes: Signs and Symptoms

Polyuria, Polydipsia, Polyphagia Weight loss, malaise (discomfort with now known cause), fatigue, slow healing sores, "fruity breath" (accumulation of ketones).

What is percutaneous transluminal coronary angioplasty?

Procedure for MI, balloon-tipped catheter used to open block coronary vessels and resolve ischemia via skin puncture instead of incision.

What is Peripheral Artery Disease?

Progressive narrowing and degeneration of the arteries of the upper and lower extremities. In most cases a result of atherosclerosis.

Lispro (Humalog) Onset-Peak-Duration

Rapid-Acting Onset: 10-15 mins Peak: 1 hr Duration: 2-4 hrs Rapid reduction of glucose, to treat post meal hyperglycemia, prevent nocturnal hypoglycemia

When caring for a client with essential hypertension what instruction should the nurse provide to the client to normalize blood pressure? Reduce sodium intake. Increase iodine intake. Avoid intake of low-fat diet. Increase intake of fluids.

Reduce sodium intake. Rationale: The nurse advises the client with essential hypertension to reduce sodium intake. The nurse also advises the client to reduce oral fluid to decrease circulating blood volume and systemic vascular resistance and adhere to a low-fat diet.

What are the functions of the thyroid gland?

Regulate vital body functions -Breathing -HR -Central and peripheral nervous system -body weight -muscle strength -menstrual cycles -body temp -cholesterol level

The nurse is caring for a client newly diagnosed with secondary hypertension. Which condition contributes to the development of secondary hypertension? Calcium deficit Renal disease Hepatic function Acid-based imbalance

Renal disease Rationale: Secondary hypertension occurs when a cause for the high blood pressure can be identified. These causes include renal parenchymal disease, narrowing of the renal arteries, hyperaldosteronism (mineralocorticoid hypertension), pheochromocytoma, certain medications (e.g., prednisone, epoetin alfa), and coarctation of the aorta. High blood pressure can also occur with pregnancy; women who experience high blood pressure during pregnancy are at increased risk of ischemic heart disease, heart attack, stroke, kidney disease, diabetes, and death from heart attack. Calcium deficiency or acid-based imbalance does not contribute to hypertension.

What is myxedema coma?

Result of severe hypothyroidism -Decreased mental status -Hypothermia -Hypotension -Hypoglycemia -Bradycardia -Respiration failure: bradypnea -Coma

A client with primary hypertension reports dizziness with ambulation when taking the prescribed alpha-adrenergic blocker. When teaching this client, what should the nurse emphasize? Stopping medication if dizziness persists Rising slowly from a lying or sitting position Taking medication first thing in the morning Increasing fluids to maintain BP

Rising slowly from a lying or sitting position Rationale: Clients who experience postural hypotension should be taught to rise slowly from a lying or sitting position and use a cane or walker if necessary for safety. It is not necessary to teach these clients about increasing fluids or taking medication in the morning (this would increase the effects of dizziness). Clients should not be taught to stop the medication if dizziness persists because this is unsafe and beyond the nurse's scope of practice.

Define: Diabetes Insipidus

Salt and water metabolism disorder that causes an imbalance of fluids in the body. This imbalance makes you very thirsty and causes the body to produce large amounts of urine.

Hypoglycemia: Signs and symptoms

Shaky, tachycardia, diaphoresis, dizzy, anxious, hungry, blurry vision, fatigue, weakness, headache, nervous, upset, inability to concentrate.

Regular Insulin (Humulin R) Onset-Peak-Duration

Short-acting Onset: 30-60 mins Peak: 2-3 hrs Duration: 4-6 hrs Usually given 20-30 minutes before a meal; may be taken alone or in combination with longer-acting insulin

Hypothyroidism: Signs and Symptoms

Slow metabolic state by inadequate amount of T3 and T4. -Fatigue, lethargy, muscle or joint pain - activity intolerance -Irritability -Constipation -Weight gain, with no caloric intake -Thick, brittle fingernails -Depression -Periorbital edema -Bradycardia, Hypotension -Dry flakey skin -Edema -Thickening of skin -Difficulty concentrating -Heavy, irregular menstrual cycle

how to prevent pulmonary embolism

Smoking cessation Avoid long periods of immobilization Physical activity Compression Stockings for circulation avoid crossing legs Admin anticoagulants: monitor for bleeding, avoid aspirin, soft toothbrushes.

Peripheral Artery Disease (PAD): Nursing Indications

Smoking cessation Weak insulated socks Avoid direct heat Avoid cold exposure Avoid leg crossing Avoid restrictive clothes Elevate leg to reduce swelling but not above heart level.

What is the condition called when a patient has a rapid & severe onset of airway obstruction that is unresponsive to common asthma attack treatments?

Status Asthmaticus

During the physical assessment of a client with hypertension, what would the nurse expect to be the most obvious finding? Client is underweight. Client is anemic. Hypotension in either one or both systolic or diastolic measurements. Sustained increase of either one or both systolic or diastolic measurements.

Sustained increase of either one or both systolic or diastolic measurements. Rationale: The most obvious finding during a physical assessment is a sustained elevation of one or both blood pressure measurements. A client being overweight might depict having hypertension. An anemic client does not display any traits of having hypertension.

Blood Pressure Range Values: Prehypertension

Systolic 120-139 Diastolic 80-89

Blood Pressure Range Values: Stage 1 Hypertension

Systolic 140-159 Diastolic 90-99

Blood Pressure Range Values: Normal

Systolic <120 Diastolic <80

Blood Pressure Range Values: Stage 2 Hypertension

Systolic >160 Diastolic >100

Hypertension: 2 specific parameters

Systolic BP >140 Diastolic BP of >90 Average of two or more accurate blood pressure measurements taken 1-4 weeks apart.

What is atherosclerosis?

The build-up of fats, cholesterol, and other substances in and on the artery walls. Reduces blood flow to the myocardium Hardens the arteries due to the build up

The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way? It will be significantly different with each reading. The results will be falsely elevated. It will give an accurate reading. The results will be falsely decreased.

The results will be falsely elevated. Rationale: Select the size of the cuff based on the size of the patient. (The cuff size should have a bladder width of at least 40% of limb circumference and length at least 80% of limb circumference.) The average adult cuff is 12 to 14 cm wide and 30 cm long. Using a cuff that is too small will give a higher BP measurement, and using a cuff that is too large results in a lower BP measurement compared to one taken with a properly sized cuff.

What is levothyroxine?

Thyroid hormone replacement therapy -Increase warfarin effect -Can increase need for insulin and digoxin -Monitor cardiovascular compromise -Motor for sign of hyperthyroidism (chest pain, palpitations, tachycardia, SOB, tremors, heat intolerance, rapid weight loss) -Treatment begins slowly and increase dose 2-3 weeks until desired response (TSH levels monitored) -Take meds as prescribed -Check with MD before OTC meds -Treatment is lifelong

Angina: Clinical Manifestations

Tightness, choking, heavy sensation Retrosternal, may radiate to neck, jaw, shoulders, back or arm. Usually left side. Anxiety Dyspnea, dizziness, nausea, vomiting.

A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible? To stimulate her appetite To decrease the possibility of nausea and vomiting To decrease the amount of glycogen in her system To restore liver glycogen and prevent secondary hypoglycemia

To restore liver glycogen and prevent secondary hypoglycemia Rationale: A client with type 1 diabetes who requires glucagon should be given a complex carbohydrate snack as soon as possible to restore the liver glycogen and prevent secondary hypoglycemia. A complex carbohydrate snack doesn't decrease the possibility of nausea and vomiting or stimulate the appetite, and it increases the amount of glycogen in the system.

Define: Mantoux test

Tool to screen tuberculosis. Intradermal injection on inner forearm. Skin test reaction should be read between 48-72 hours after administration. Reaction measured in millimeters of induration (palpable, raised, hardened area of swelling) Test is positive if reaction of 5mm or greater.

What is thyroidectomy?

Treatment of hyperthyroidism Subtotal: -when medication therapy fails or radiated is contraindicated. -remove part of thyroid gland, whatever remains will supply enough thyroid hormone for normal function Total: -client will be required lifelong thyroid replacement therapy Postop care: -Avoid neck extension, patient sit semi-fowler's position for pain management -Tingling/numbness of toes or around mouth, muscle twitching, positive Chvostek's or Trousseau signs. Notify provider.

Hypertension: Prevention

Weight reduction Dash diet (grains, fruits, vegetables) Sodium reduction Physical activity Moderation of alcohol consumption

A client with newly diagnosed type 2 diabetes is admitted to the metabolic unit. The primary goal for this admission is education. Which goal should the nurse incorporate into her teaching plan? Smoking reduction but not complete cessation An eye examination every 2 years until age 50 Weight reduction through diet and exercise Maintenance of blood glucose levels between 180 and 200 mg/dl

Weight reduction through diet and exercise Rationale: Type 2 diabetes is commonly obesity-related; therefore, weight reduction may enhance the normalization of the blood glucose level. Weight reduction should be achieved by a healthy diet and exercise to increase carbohydrate metabolism. Blood glucose levels should be maintained within normal limits to prevent the development of diabetic complications. Clients with type 1 or 2 diabetes shouldn't smoke at all because of the increased risk of cardiovascular disease. A funduscopic examination should be done yearly to identify early signs of diabetic retinopathy.

A nurse is explaining the action of insulin to a client with diabetes mellitus. During client teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when she states that insulin is secreted from the: alpha cells of the pancreas. parafollicular cells of the thyroid. beta cells of the pancreas. adenohypophysis.

beta cells of the pancreas. Rationale: The beta cells of the pancreas secrete insulin. The adenohypophysis, or anterior pituitary gland, secretes many hormones, such as growth hormone, prolactin, thyroid-stimulating hormone, corticotropin, follicle-stimulating hormone, and luteinizing hormone, but not insulin. The alpha cells of the pancreas secrete glucagon, which raises the blood glucose level. The parafollicular cells of the thyroid secrete the hormone calcitonin, which plays a role in calcium metabolism.

The nurse is teaching a client about hypertension and the effects on the left ventricle. What diagnostic test will the nurse describe? computed tomographic (CT) scan echocardiography fluorescein angiography positron emission tomography (PET) scan

echocardiography Rationale: Echocardiography will reveal an enlarged left ventricle. Fluorescein angiography reveals leaking retinal blood vessels, and a PET scan is used to reveal abnormalities in blood pressure. A CT scan reveals structural abnormalities.

A nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should: use commercial preparations to remove corns. walk barefoot at least once each day. wash and inspect the feet daily. cut the toenails by rounding edges.

wash and inspect the feet daily. Rationale: A client with diabetes mellitus should wash and inspect his feet daily and should wear non-constrictive shoes. Corns should be treated by a podiatrist — not with commercial preparations. Nails should be filed straight across. Clients with diabetes mellitus should never walk barefoot.

Deep Vein Thrombosis: Prevention

● After surgery try to ambulate and use compression socks or IPC device ● Don't smoke ● Stay active ● Manage weight

Deep Vein Thrombosis: Clinical Manifestations

● Can occur without any noticeable symptoms ● throbbing or cramping pain in 1 leg (rarely both legs), usually in the calf or thigh. ● swelling in 1 leg (rarely both legs) ● warm skin around the painful area. ● red or darkened skin around the painful area. ● swollen veins that are hard or sore when you touch them

Deep Vein Thrombosis: Risk Factors

● Trauma ● Recent surgery ● Venous stasis: bed rest/ immobilization ● Obesity ● Smoking ● Contraceptives/ hormone replacement therapy ● Age (>65 years) ● CHF ● Central venous catheters ● Dialysis access catheters ● Varicose veins ● Altered coagulation due to things like cancer